HomeMy WebLinkAboutSAM-07-2023-200617.TIF �A CO Case ti SAM-07-2023-200617
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f.�II `. CATAWBA COUNTY HEALTH DEPARTMENT L+�.;ca,
I Environmental Health Section
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8 47, sM 1 ' C 0�2/2023
WATER SAMPLE FIELD REPORT
Applicant BENNIE MCMANUS,PO BOX 91,GROVETOWN GA 30813
C:7068369399
Site Address: 2631 SOUTHERN BREEZE,SHERRILLS FORD NC 28673
Parcel Number: 462802564644
Driving Directions NC 16,left onto Balls Creek Rd,right onto W Bandys Cross Rd,lefto onto Buffalo Shoals Rd,then
immediately bear right onto E Bandys Crossroad,right onto Sherrills Ford Rd,lefto onto Island Point Rd,left
onto Riviera Dr,lefto onto Southern Breeze,property ont he left Sample Collected by: '�SI"k h; `Lead Date/Time Sampled: C7r0
1'1/23 /0° S W.\
Sampling Point: Sptsot p"A T NNA.* (9-e kd c..
Is well head accessible? Yes No_ ✓ Reason for inaccessibility (4 t..,'Pk '$ I n CA to W C-I I I Qal
Well New or Existing? New Existing
Type of Well: Drilled Bored I land Dug Punch 1Ir+14
Does well meet adequate construction standards from what can be observed: Yes No in (414)
Items of non-compliance: Evidence of improper grouting or no grouting
Well does not meet a required setback(comment)
Improperly constructed sanitary well seal
Well head not term at>= 12"above finished grade
Well head missing vent
Well head does not have a threadless tap
Well missing identification plate or pump tag
Wire conduit opening not sealed
Other(comment)
Comment:
rsamfieldreport 07/20/2023 09:37 Page I oft
A Cl� Case# SAM-07-2023-200617
CATAWBA COUNTY HEALTH DEPARTMENT
Environmental Health Section
188422 sM 07/20/2023
WATER SAMPLE TEST RESULTS
Applicant BENNIE MCMANUS,PO BOX 91,GROVETOWN GA 30813
C:7068369399
Site Address: 2631 SOUTHERN BREEZE,SHERRILLS FORD NC 28673
Parcel Number: 462802564644
Lab Coliforrn Analysis Results: Total Coliforms: 000 t Fecal/E.Coli: & IJ4.4 IT
No Collection Date Over 30 hours old
Invalid Results: Excessive turbidit
Y Excessive Chlorine
Lab Accident
r
Lab"Lech Initials Date/Time Received Cr :I ' ` 01� Vi"" Date/Time Completed v1 '91119 O
riVcD
'R. 2 3 2023
Er.vironmental Health
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