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2382 Cornatzer RdDavie County, NC Tax Parcel RepO1't 611 Tuesday, September 27, 2016 `210. ` fib, s✓O - r P131O 'PG344 ,f ,f L9T 1. X2382 ,1506 i bP f� i L N1 101 All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the Davie County, NC implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY - Parcerihfo`rmi3fi�n Parcel Number: G700000134 Township: Shady Grove NCPIN Number. 5870201506 Municipality: Account Number. 82531887 Census Tract: 37059-804 Listed Owner 1: HOWARD JERMEY A Voting Precinct: EAST SHADY GROVE Mailing Address 1: 2382 CORNATZER ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A,R-20 State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: 11.017 AC CORNATZER RD Fire Response District: ADVANCE Assessed Acreage: 10.54 Elementary School Zone: SHADY GROVE Deed Date: 4/2010 Middle School Zone: WILLIAM ELLIS Deed Book f Page: 008240237 Soil Types: MrC2,GnB2 Plat Book: 10 Flood Zone: X Plat Page: 344 Watershed Overlay: - Building Value: 349640.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 77110.00 Total Market Value: 426750.00 Total Assessed Value: 426750.00 101 All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the Davie County, NC implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ' (336)753-6780 / Fax # (336)753-1680 OPERATION PERMIT Account #: 990005117 Tax PIN/1=H #: 5870-20-1506 Billed To: Collins Home Builders, Inc. Subdivision Info: , Reference Name: Location/Address: Cornatzer Rd -27006 Proposed Facility: Residence.V Property Size: 25 Acres ATC Number: 5775 Z d onv0 iZerL- **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. r :+ System Type: S.T. Manufacture1' Tank Date Tank Size G eO Pump Tank Size / �_ � Dated-1WSystem Installed By: ee io � le%�H. Specialist: 20 . GPS Coordinate: DCHD 11/06 (Revised) �. ' �, _ .. �. M� �� p.. �, yi ' • DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville; NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005117 Tax PIN /EH #: 5870-20-1506 Billed To: Collins Home Builders, Inc. Subdivision Info: Reference dame: Location/Address: Cornatzer Rd -27006 Proposed Facility: Residence Properly Size: 25 Acres ATC Number: 5775 Site Type: ONew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS.AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. ;' Residential Specifications: # Bedrooms 3 # Bathrooms �' # People Basementl7CBasement plumbing] Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size�� Cr- Type of Water Supply: &County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) 50—Tank Size GAL. Pump Tank,V& GAL. Trench Width Max. Trench Depth3V— Rock Depth* Linear Ft.t n,�� 2/►s�F� Site Modifications/Conditions/Other: As: 'stated in 15A NrAr- ,c? n 1 nr-mm JY�LUMS may also be used Contact the Davie County Environmental Health Section for final inspection of this system between Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990005117 Billed To: Collins Home Builders, Inc. Address: 127 Bay Hill Dr City: Advance, Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5870-20-1506 Subdivision Info: Location/Address: Cornatzer Rd -27006 Property Size: 25 Acres **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: NNew ❑Repair ❑Expansion Permit Valid for: W5 Years ❑No Expiration Residential Specifications: # Bedrooms 3 # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People -# Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): .3(00 Site Modifications/Permit Conditions: Type of Water Supply: XCounty/City ❑Well ❑Community Well Systeiji Type LTAR Initial 25-'10 WAUCkbo Repair 2solo O N Environmental Health Specialist Lp.11-06 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC E C E I V E Davie County Environmental Health 2011 P.O. Box 848/210 Hospital Street APR 2 7 Mocksville, NC 27028 R(336)753-6780/ Fax (336)753-1680 8Y� Application For: Site Evalultion/Improvement Permit ❑ Authorization To Construct (ATC) D, 4th Type of Application: Aew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. A PPT TC A TETT INTIMP N4 A TT(1TKT Name ly li', n S I fieri Contact Person �I s Address t 2'i tNa. j H: it la- Home Phone ,S 3 t, - 3 `4 S' 3 q-17- City/State/ZIP �Q�t/�,K� [� 7,10010 Business Phone nLID - 7-yZB Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: Z'Site Plan -RPlat(to scale)' (Permit is valid for 60 months with site plan, no expiration with complete plat:) Owner's Name ft W4 -f -CA - Phone Number J �t/ v'" W Owner's Address City/State/Zip Property Address A- e'' i I City "vex, , c.e. Lot Size SS c� . Tax PIN# rs 01bj _ZD_ 15 (p Subdivision Name(if applicable) ./ Section/Lot# i Directions To Site: 64 -4-c, -nynff4 r.,r v- 1/2- rv�, IL nm 1eC-1- YA If the answer to any of the following questions is `•`Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? 'Yes Does the site contain jurisdictional wetlands? _Yes _/No -No Are there any easements or right-of-ways on the site? ,Yes No Is the site subject to approval by another public agency? .,,No Will wastewater other than domestic sewage be generated? _Yes _ Yes oNo IF RESIDENCE FILL OUT THE BOX BELOW # People _�l # Bedrooms . # Bathrooms �- _ Garden Tub/Whirlpool [?Yes ❑No Basement: C�'Yes ❑No Basement Plumbing: CYYes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: VConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: Vounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 40 If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health"Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locatilA and flaggin or staking house/facility location, proposed well location and the location of any other amenities, t Site Revisit Charge Property ownVs or owner's legal representative signature Date(s): Client Notification Date: ` Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # 07 Invoice # Ppmi-1 7'7! ir DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990005117 Billed To: Collins Home Builders, Inc. Reference Name: Proposed Facility: Residence Property Size: Water Supply: On -Site Well Community Evaluation By: Auger Boring ) Pit PROPERTY INFORMATION Tax PIN/EH #: 5870-20-1506 Subdivision Info: Location/Address: Cor natzer Rd -2700 25 Acres Date Evaluated: Public Cut x FACTORS 1 3 4 5 6 7 Landsca a position L Slope %HORIZON k2. I DEPTH _ j( 0-24 Texture group Consistence Structure Mineralogy HORIZON 11 DEPTH Texture group�b Consistence Structure Mineralogy; HORIZON III DEPTH Texture group .Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION V5j LONG-TERM ACCEPTANCE RATE - 3 CC � SITE CLASSIFICATION: �j EVALUATION BY: GL",)V3 LONG-TERM ACCEPTANCE RATE: _ ; : OTHER(S) PRESENT: 1Iyar�� LEGEND Landscape Posi ion R - Ridge S - Shoulder L Linear slope FS - Foot slope N - Nose slope CC - Concave slope. CV - Convex slope T - Terrace FP ,= Flood plain H - Head slope Texture . S - Sand LS - Loamy sand SL - Sandy loam ' L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay ►" t VFR - Very friable FR - Friable FI - Firm VFI- Very firm EFI - Extremely firm NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb. GR - Granular ABK - Angular blocky SBK Subangular blocky PL - Platy PR - Prismatic Mineralonv 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) TTAR - T.nna_tP.rm arrPntnnro rntr - anUdnw/ftl. Tr.rir% Acme m__.e__�� S ■ EI■ soon NONE ■ON■ SEEN ■ ■ ■ 24q, -11 r,+t. aq t3$2. W7 S A L Davie County Environmental Health �` 1 J P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 WELL PERMIT Account #: 990005117 Tax PIN/EH #: 5870 -20 -1506 -Well Billed To: Collins Home Builders, Inc. Subdivision Info: Reference game: Location/Address: Cornatzer Rd -27006 Proposed Facility: Residential Well Property,Sizo -,.!6125 Acres ATC plumber: 0076 Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there has been a material change in any fact/circumstances upon which this permit was issued. Permit Type. New Repair ❑ Abandonment ❑ Proposed Well Location Diagram Certificate of Completion Diagram i I ' r 1 i 11 C mments: I ��f� Driller: AA l I�`�\r6wa [t Certification #: Grout Inspected: ) Z�PI Well Head Inspected:11-712617— 2b1 Z GPS GPS Coordinates: EHS: Date: ? 2D> EHS Date: W.P. 7-08 -r---" DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005117 Tax PIN/EH #: 5870-20-1506 Billed To: Collins Home Builders, Inc. Subdivision Info: Reference Name: Location/Address: Cornatzer Rd -27006 Proposed Facility: Residence Property Size: 25 Acres ATC Number: 5775 Site Type: IaNew ❑Repair ❑Expansion E **NOTE** This Authorization to Construct (ATG) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and.Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat oC-the intended use change. Residential Specifications: #.Bedrooms # Bathrooms Lf # People Basement EXBasement plumbin&C Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Io - Lot Size � Type of Water Supply: County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)'��v Tank Size GAL. Pump Tank GAL. ILr a/ Trench Width 32L -Max. Trench Depth 3V__ Rock Depth Linear Ft. 2S F� Site Modifications/Conditions/Other: As' stated in 15E NlI q r . IR C=-'PteC=-'Pted SFSterns. may also bee ui' - - Contact the Davie County Environmental Health Section for final inspection of this system between PHONE NO. May. 16 2011 04: 23PM P2 Ivey it; 1 .[:4440 'ntorr-abon Services ECEIV&4675316803t680 P-2 E MAY 1 6 2011 APPLICATION FOR PRJYATE WELL PERN177 DDavie County Environmental Health F.O. Sox 84210 Hospital Street NlockrMe, NC 27028 (336)153-6780 / Fax (336)7534630 ***IJVFORTAIVP** TH15 APF2;CATION C�.�YIVOTBB FROCBSSED LNUSS ALL OF THE REQUIRED WFORmATION IS pROvTOED. L ,TION Name Addmss / City/Stat--mp RC1 Name on PerTnit if Dffemr than Mailing Addr= jCde" � EEE Phone PROPERTY MORMATIO *Date Housa/1: acility Coeurs Flagged '10, NOTE: A survey plat cc site plan must Cwter's Nams .— Owner's Address Property Address Let Size Subdivision Yame(if apphcable) Direotioas TA Site: AF�� this app . tion. Inak dod: ii7'3ite Plan OP1at (to s,o_a_k,), / M8rr�, ..Phone?l=ber' 744 - Pevnit Type: New Well Well Repair Well Abandowriont Other (specify) Facility `lWe. Residential Food Service , Chttroh Coaa�erdal Other Ate There Awy Septic Systems Currently On The Site, INO Do You huend To Install A Near Septic System On ?his Site? YES NO TMMS AND CONDI:•IONS: This applizat;on must be accompanied by a plat or site plan of the propartq that includes Cnc existing and proposed property lines with dimensions, the specific iocavoe of the facility and aagv costing or future appurtenaaecs, the location of any existing septic system, sewer linen water lines, any exiaie$ water supplies;and any surface wmat. The agplict>itt is respaasible for identf bi; and msriringrhe property lines and corners. The applicant is responsible krmaldngthe site accessible. ay sieaiug this z pplicatioa, the applicant sipifies that t.'tey ucdeutand the teens and conditions and that they give pemtission for Davie County Ecvironmental Fle214t Mpresertatives to perform aeotsse_7 'field evaluations and procedures deamcd ncxssaty to detweaine the best location fora well. 5iguat: Da Site Revisit Charge Client Notification Date: ERS: .7/30/05 AcwL.nt #t Invoice 7 ul N ll�� f=� ter. � ` •�� ;t -RESIDENTIAL WELL CONSTRUCTION RECORD �� CEIVED North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 303 M NOV O 8 2011 1. WELL CONTRACTOR: / `► ct f fit Z w -l), Z Well Contractor (Individual) Name YADKIN WELL COMPANY. INC. Well Contractor Company Name 1908 HAMPTONVILLE ROAD Street Address HAMPTONVILLE NC 27020 CilyorTown State Zip Code 336 468-4440 Area code Phone number 2. WELL INFORMATION: WELL CONSTRUCTION PERMIT# � 7O ��4��e4- OTHER ASSOCIATED PERMIT#(if applicable) SITE WELL ID #(ii applicable)_ 3. WELL USE (Check Applicable Box): Residential Water Supply DATE DRILLED TIME COMPLETED //, 't.) V AM j< PM ❑ 4. WELL LOCATION: CITY: 411 w m ee COUNTY' a,,& 6c, N A a P rte- 66 (Street Name, Numbers, Community, Subdivision, Lot No, Parcel, Zip Code) TOPOGRAPHIC / LAND SETTING: (check appropriate box) IOSlope []Valley ❑FlagyJ Sl-�❑Ridge ❑Other LATITUDE ° v '-2 "DMS OR DD LONGITUDErY� �' '7L G " DMS OR DO Latitudellongilude source: CD! PS ❑Topographic map (location of well must be shown on a USGS topo map andattached to this form if not using GPS) S. WELL OWNER Bottom JCre, MX �1Owar Owner Name Bottom 93 2 cc( I" �9 n IZLr /U Street Address Ad vit4 c e- /VG 2 700 6 City or Town State Zip Code Area code Phone number 6. WELL DETAILS: / (' a. TOTAL DEPTH: g. WATER ZONES (depth): Top 7 " Bottom 7.9 Top g li Bottom $� Top q 7 Bottom 9 g Top Bottom Top Bottom Top Bottom Thickness/ 7. CASING: Depth Diameter Weight Material Top /—Bottom 7-3 Ft. 6.12.x" Jad-.21 pvc Top Bottom Ft. Top Bottom Ft. 8. GROUT: Depth Material Method Top_ Bottom Ft. 132.ifo^!4-z. SPS �r�. v% Top 3 Bottom o2 % Fl. &47,onrr' e- —PvmrS- Top Top Bottom Ft. 9. SCREEN: Depth Diameter Slot Size Material Top Bottom z--Ft.-In Fl. in. in Topp BolloFl. in in. To Bollo in. 10. SAND/GRAVEL PACK: Depth Size Material Top Bottom Fl. Top Bottom Ft. TO Boltom2—k Ft. 11. DRILLING LOG Top Bottom 12: REMARKS: Formation Description SIZE OFF S q7a" BIT SERIAL NO: /1, q 1?6 q b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN C. WATER LEVEL Below Top of Casing: VD FT. ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION (Use "+° if Above Top of Casing) STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. d. TOP OF CASING IS 4 FT. Above Land Surface* `Topp of casing terminated aUor below land surface may require a variance in accoordance with 15A NCAC 2C .0118. SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE e. YIELD (gpm): 30 METHOD OF TEST I y 0 M.7, }//" w /a B/0 ".1 f. DISINFECTION: Type HTH Amount I z CUPS PRINTED NAME OF PERSON CONSTRUCTING THE WELL Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GWAa 1617 Mail Service Center, Raleigh, NC 27699-161, Phone :(919) 807-6300 Rev. 2/09 Date Site Visited 10 1 By: J/Jur' Permit: Yes No What Is Height of Well Casing? Make Sure 12" Above Ground Level!!!! BUILDERS~U: c ADDRESS: PHONE NUMBER: q ? !2- q,5 -b North Carolina State Laboratory of Public Health 06 N. W?m ngton St. Environmental Sciences Raleigh, N 27611-8047 http:/lslph.ncpublichealth.com Inorganic Chemistry Phone: 919-733-7834 Fax: 919-733-8695 Certificate of Analysis Report To: ANDREW DAYWALT Name of System: DAVIE CO ENVIRONMENTAL HEALTH JEREMY HOWARD P O BOX 848 JUL 0 9 pop 2382 CORNATZER RD MOCKSVILLE, NC 27028 Courier # 09-40-06 MOCKSVILLE, NC 270DC HEALTH EIN:566000295EH �m r StarLiMS ID: ES061412-0036001 Date' Collected: 06/13/12 Date Received: 06/14/12 Sample Type: Sampling Point,:' Outside spigot Sample Source: New Well Temp. at Receipt: 6.0 Sample Description: Comment: New Well I (Profile) Time Collected: 10:00 AM Collected By: A Daywalt Well Permit#: 76 GPS #: N35656.529/W80026.765 Analyte Result Allowable Limit unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 ;° mg/L Cadmium < 0.001 0.005 mg/L Calcium 12 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0,05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron 0.._. < 0.10 0.30 mg/L Lead ; , ,. < 0.005 k £. ✓0.015 ;.. f ._. _ mg/L Magnesium 5 11I mg/L Manganese < 0.03 ... 0.05. _ ` mg/L Mercury < 5 �z 0.002' mg/L it try Nitrate 00 10.00 mg/L Nitrite <`0.10 ' ' 1.00 mg/L pH 7.1 " _ N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 4.00 mg/L Sulfate 8.30 250 mg/L Total Alkalinity 51 mg/L Total Hardness 51 mg/L Zinc 0.05 5.00 mg/L Report Date: 07/03/2012 Page 1 of 1 Reported By: D&O& NAwed f. RECEIVED JUN 21 2012 .North Carolina State Laboratory PubliAeMPLTRx28047 306 N. Wilmington St. Environmental Sciences Raleigh, NC 27611-8047 Microbiology Certificate of Analysis yo- http.//blP". ncpuu,ichealth.com Phone: 919-733-7834 Fax: 919-733-8695 Report To: Name of System: DAVIE CO ENVIRONMENTAL HEALTH JEREMY HOWARD P O BOX 848 2382 CORNATZER RD. MOCKSVILLE, NC 27028 MOCKSVILLE, NC 27028 EIN:566000295EH COURIER M 09-40-06 StarLiMS Sample ID: ES061412-0153001 , Collected ,06/13/2012 1000 ,. Andrew Daywalt IIIIIIIIIIIIIIIIIIIIIIIIIII,IiIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIJIIIIIIIII Received ,06/14/2012 4 so9:o2 Darneice Lyons ES Microbiology ID: 37401 c Sample Source: New -Well, �- - Well Permit Number: � i GPS Number: 35056.529N ti Sampling Point: Outside spigot 76 80°26.765W _ _i Sample Description: Comment: Environmental Microbiology - Colilert Profile Method: SM 92238 Test Name: Colilert Analyte -.....Test Result,.„ Analyst Date Total Coliform, Colilert : Present` F" Darneice Lyons 06/15/2012 E. coli, Colilert �,,`'_� , ,_ Absent ~`' `Darrieice Lyons 06/15/2012 : w _ c Report Date: 06/18/2012 a t f Reported By: Joy Hayes F, Explanations of Coliform Analysis: If coliform bacteria are Absent, the water is considered safe for drinking purpose. If coliform bacteria are Present the water is considered unsafe for drinking purpose. Presence of E. coli (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply. 1:4- 4V �� -79:� 0, 14A) - Z�9 7 Barium I Cadmium Chromium Fluoride Iron Magnesium Manganese I Selemium Silver Sodium Zinc pH Arsenic Barium Cadmium Chromium Copper Fluoride Lead Iron Ma Manganese Mercury Nitrate/Nitrite Selenium Silver Sodium Re -sampling is recommended in. months. Re -sample for lead and /or copper.. Take a first draw, 5 minute, and 15 minute sample inside the house (preferably the kitchen) and if possible a first draw, 5 minute and a 15 minute sample at the well head to determine the source of the lead and/or copper. OTHER CONSIDERATIONS Routine well water sampling for the above substances isrecommended every two to three years. Sample your well water when there is a'known problem or contamination in your area, after repairs or replacement of your well, or after a flooding event. Contact your local health department for sampling instructions. Tor further information please contact your county health department or the Occupational and Environmental Epidemiology Branch at 919-707-5900. 4 .-�"L f 14 .._ .., ._'� =... �y.r. �: .. MijKs.`-::.r Y-2. _. .K .. :"+r' 'Lr ._'.-r ":`—. v.,. 5 ...- r. +-. .. :`-..�•,L y,.. _.. L.'`,.w ... +'k r... -.. .. ... .+4.3- esium ' Zine H Arsenic Barium Cadmium Chromium Copper Fluoride Lead Iron Ma Manganese Mercury Nitrate/Nitrite Selenium Silver Sodium Re -sampling is recommended in. months. Re -sample for lead and /or copper.. Take a first draw, 5 minute, and 15 minute sample inside the house (preferably the kitchen) and if possible a first draw, 5 minute and a 15 minute sample at the well head to determine the source of the lead and/or copper. OTHER CONSIDERATIONS Routine well water sampling for the above substances isrecommended every two to three years. Sample your well water when there is a'known problem or contamination in your area, after repairs or replacement of your well, or after a flooding event. Contact your local health department for sampling instructions. Tor further information please contact your county health department or the Occupational and Environmental Epidemiology Branch at 919-707-5900. 4 .-�"L f 14 .._ .., ._'� =... �y.r. �: .. MijKs.`-::.r Y-2. _. .K .. :"+r' 'Lr ._'.-r ":`—. v.,. 5 ...- r. +-. .. :`-..�•,L y,.. _.. L.'`,.w ... +'k r... -.. .. ... .+4.3-