Loading...
HomeMy WebLinkAboutSAM-10-2023-206017.tif Case# SAM-10-2023-206017 �� ' ' a CATAWBA COUNTY HEALTH DEPARTMENT v ' �� Environmental Health Section 1$4 2 5M 10/05/2023 WATER SAMPLE APPLICATION Applicant MARTHA CALDERON,8389 COO KSVILLE RD,VALE NC 28168 C:8282264416 HISPANICWOMENFARMERS@GMAIL.COM Site Address: 2869 9TH AVE SE, HICKORY NC 28602 SELECTED SAMPLES Bacterial Name of Subdivision: Parcel Number: 372214433090 Lot: Block: Specific Directions Description: Water sample for Migrant Housing. 3rd sample Reason for Sample: migrant housing inspection Type of Well Drilled Is the well on this same property? Yes Is outside spigot available to collect sample? Yes Is power on? Yes Has well been tested before? Yes Results total coliform present Does the plumbing come out the top of the well through a sanitary well seal? Yes Does the well ever become cloudy or has there ever been a problem with taste and/or odor? No Explain Does the well top extend twelve(12)inches above the ground or well slab? Yes The well is in: Left Side Does this well supply water to more than one home? Nt Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are taken during one visit. The processing laboratories have different protocols and timeframes for reporting results; therefore,you may receive several different reports concerning your water sample. For questions or more information, please contact Catawba County Environmental Health at(828)465-8270. Date Signature or Owner or Agent Dwight Mikeal rsamapplication 10/5/2023 Page 1 of 1 d ero Rt Nor--, • cat awba county public health. ittqo_ 063 /� Water Sample Application Sample Requested By �(� ` � �� t.,. V/Aft'01; Home Phone Property Address _ ecli ' Business Phone ,�., . 'r )` Mailing Address` 9{�1 r.:>1 1 f "}'�C j(A I f f �d �r{ �1 l Driving Directions tn1 i t-�,... ...I;OItY-\ CV) 1`\.Q::V€,v i~t11 IA 4.4411 70 A._U V Y l f\-1..- y Y\ 1,J 5 Sample Requested: Bacteriological Inorganic Chemical Other Sample reason: Type of Well: Drilled / Bored Dug Other Is the well on this same property? Yes b' No_� PLEASE NOTE: Sample will be taken at the well head. If well head is not accessible, sample will be taken from a spigot on outside of home, unless otherwise specified: Is outside spigot available to collect sample? Yes y No Is power on? Yes +' No Has well been tested before? Yes ` No Unknown Results Does the plumbing come out the top of the well through a sanitary well seal? Yes No Unknown ' Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes No Explain Does the well top extend 12 inches above the ground or well slab? Yes_ No Unknown The well is located in front rear left side t` right side of the house, Does well supply water to more than one home? Yes No F' , 7 1 Date .a... ,A .;._. ,f ;E..... �`7, ' Signature of Owner or Agent �.....1 t catawbacot.antync.gov l nviro intental Heaaltla i?i#`i'whtl f auwy kverf,'lincv i . 1,,wInnief0 Oftvr PO Rn 389 14B'fon 14( 28658 8 8.40 8270 'A A h:o 1 •