HomeMy WebLinkAboutHawksridge Farms 2 3 09.tif ? tvaluation North Carolina Department of Environment and Natural Resources
❑ Re- evaluation Division of Environmental Health
(number) PREOCCUPANCY EVALUATION REPORT �
OF DRINKING WATER SUPPLY AND ' t ' .
WASTEWATER FACILITIES FOR MIGRANT HOUSING
On jekkaey .3 0. as required in G.S. 95- 225(c) and (d), an evaluation was conducted of the drinking water supply and
ate)
wastewater system serving a migrant housing facility at ?,? L1 S. /VC /a 7 ,�i.0
(address or directionss use reverse/if needed)
y CKe r / .4 D� and operated by j. C-/' C /Dcr
(name of person[s] ompany)
of .. . ,. - erns 'P b &0 3 3 .. / — . r 8"6GL3
(mailing address)
The housing is composed of units, served by _ wells /springs and sewage systems.
(number) (number) (number)
This report describes well /spring A and sewage system / . (Use reverse for a drawing, if needed.)
(number) (number)
The findings of this evaluation are as follows:
WATER SUPPLY
"e Community or non- transient - non - community water system under routine surveillance of Public Water Supply
(yes /no) Section, Division of Environmental Health
/Vc Private Water or Non - Community System
(yes /no)
At the time of inspection, there WO.S /W visual evidence of non - compliance with the "Protection of Water Supplies"
(was /was not)
15A NCAC 18A .1700 (attach copy of bacteriological sample). List deficiencies which were identified:
(Use reverse if necessary)
WASTEWATER FACILITIES
System sc,.6e to approval under 15A NCAC 18A .1900, "Laws and Rules for Sewage Treatment and Disposal
(subje /not subject)
Systems." Explain, if not subject to approval
On -Site Septic Tank System ❑ Chemical Portable Toilets ❑ Others
❑ Privy(ies)
At the time of inspection, there WaS fZt� visual evidence of non - compliance with 15A NCAC 18A .1900 (including
(was /was not)
.1962) "Laws and Rules for Sewage Treatment and Disposal System." List deficiencies which were identified:
(Use reverse if necessary)
The AA -wat r s stem to the best of my knowledge and belief, is sized to serve people.
/1/•' tee/ . Sh ,' 'S (maximum number)
a/ w Urs
Environmental Health Specialist Ith Department
fo j 3.9
Date Address
Forward copies to: Migrant Housing Operator / /v ..2 O G � 6 ��
Department of Labor, ,^�
Bureau of Migrant Housing ET) ?2 7 v
DENR 3765 (Revised 3/98) Office Phone Number
On -Site Wastewater Section (Review 12/98)
•
Purpose: General Statute 95 -225 requires the Commission for Health Services to adopt rules establishing the
standards for sanitation and quality of water for migrant housing. It further requires that the collection,
treatment, and disposal of sewage is to be in accordance with Article 11 of Chapter 130A of the North
Carolina General Statutes and 15A NCAC 18A .1900, "Laws and Rules for Sewage Treatment and
Disposal Systems." This form is developed to be used in making evaluations of water supplies and
sewage disposal systems for migrant housing operators.
Preparation: Local environmental health specialists shall complete the form each time they conduct an evaluation.
Prepare an original and two copies for:
1. Original to be left with the responsible person.
2. Copy for the local health department.
3. Copy for the N.C. Department of Labor, Bureau of Migrant Housing.
Disposition: This form may be destroyed in accordance with Standard 7, Inspection Records, of the Records
Disposition Schedule published by the N.C. Division of Archives and History.
Additional forms may be ordered from:
On -Site Wastewater Section
Division of Environmental Health
P. O. Box 29594
Raleigh, NC 27626 -0594
(Courier 52- 01 -00)
DENR 3765 (Revised 3/98)
On -Site Wastewater Section (Review 12/98)
•
rJ Evaluation North Carolina Department of Environment and Natural Resources
❑ Re- evaluation Division of Environmental Health
(number) PREOCCUPANCY EVALUATION REPORT
OF DRINKING WATER SUPPLY AND
WASTEWATER FACILITIES FOR MIGRANT HOUSING
On 1p j /kart' -3, o as required in G.S. 95- 225(c) and (d), an evaluation was conducted of the drinking water supply and
.-('date) '/
wastewater system serving a migrant housing facility at ?,2 Lf 3 5 /VC /a 7 /1`r,J
(address or directions use reversecif needed)
//a o ✓ / �C - S d and operated by /'Dc.. , —
p "3-34/-? (name of person[s] ompany) /�
of � rJ ✓',G�92 Farms RD Box or /u
� C
(mailing address) �/
The housing is composed of units, served by wells /springs and sewage systems.
(number) (number) (number)
This report describes well /spring and sewage system .2. (Use reverse for a drawing, if needed.)
(number) (number)
The findings of this evaluation are as follows:
WATER SUPPLY
Community or non- transient - non - community water system under routine surveillance of Public Water Supply
(yes/no) Section, Division of Environmental Health
No Private Water or Non - Community System
(yes /no)
At the time of inspection, there 14/) S /Zo7 visual evidence of non - compliance with the "Protection of Water Supplies"
(was /was not)
15A NCAC 18A .1700 (attach copy of bacteriological sample). List deficiencies which were identified:
(Use reverse if necessary)
WASTEWATER FACILITIES
System ce I ee.. to approval under 15A NCAC 18A .1900, "Laws and Rules for Sewage Treatment and Disposal
(subject /not .subject)
Systems." Explain, if not subject to approval
,r On -Site Septic Tank System ❑ Chemical Portable Toilets ❑ Others
❑ Privy(ies)
At the time of inspection, there WAS iZd visual evidence of non - compliance with 15A NCAC 18A .1900 (including
(was /was not)
.1962) "Laws and Rules for Sewage Treatment and Disposal System." List deficiencies which were identified:
(Use reverse if necessary)
The wast water s stem to the best of my knowledge and belief, is sized to serve people.
/ e / s/i /2S, maximum number )
( r
; As. k J w ctrs /!1/, r'Dr! ‘/ W,.
Environmental Health Specialist U.Alth Department
f0 8.0A-
Date Address �
Forward copies to: Migrant Housing Operator /�ew4n , I .265-! y
Department of Labor,
Bureau of Migrant Housing l J i 0 \ C 6 �2 7 e
DENR 3765 (Revised 3/98) ( ` Office Phone Number
On -Site Wastewater Section (Review 12/98)