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2. 
3. REQUEST WATER SAMPLES HERE

   Or use the portal to apply for samples at https://centralpermits.orangecountync.gov/EnerGov_Prod/SelfService#/applicationAssistant?sectionName=Trending&showTemplates=false

5. NEED MORE INFORMATION?

   If you need help selecting which water samples that you need, please review the test that are available here.  https://www.orangecountync.gov/2879/water-sample-info. 

7. Site Address *
9. Applicant Name*
11. Email Address of Applicant*
12. Daytime Phone*
14. Call before sampling.

    1. Yes, please call for an appointment.
15. Special Instructions (gate codes, electric fences, driveway dangers, pets present, etc. )
17. Rental?

    1. Yes
    2. No
18. Owner Occupied?

    1. Yes
    2. No
19. Any existing water treatment?

    1. Yes
    2. No
20. Is this a NEW well construction?

    1. Yes
    2. No
22. PAYMENT METHOD

    1. MAIL CHECK TO OCHD ENVIRONMENTAL HEALTH P O BOX 8181 HILLSBOROUGH, NC 27278
    2. WANT TO BE NOTIFIED BY EMAIL WHEN READY TO PAY ON THE PORTAL OR BY PHONE

    Payment is required prior to making any appointments. 

24. Do you need to know if you water is safe to drink?

    1. BACTERIA $75

    A Bacteria water analysis is a presence/absence test for E. Coli in the water. 

26. Do you want to know about the minerals in the water?

    1. INORGANIC PANEL $110

    The Inorganic Panel tests for numerous mineral substances including nitrate/ nitrite.  This is a good place to start if you have mysterious odors to your water or staining of your laundry or ring around the bowl.  This is also recommended for inside point of use to verify water treatment systems are operating efficiently.

28. Do you want to know about a single mineral or substance in the water?

    1. INORGANIC SINGLE-SUBSTANCE $75/EACH

    Inorganic for a single substance is a good test for follow up on a water treatment system, testing for lead at drinking water points of use, coal ash presence, or just nitrate.

29. Which substances?
31. Do you just want to know about your water in general?

    1. FULL PANEL $150

    The Full Panel offers the bacteria and inorganic panel described above, including nitrate/ nitrate. This is our best value.

33. Do you have tiny solids or grit in the water?

    1. TSS/TDS $75

    Total Suspended Solids and Total Dissolved Solids in water can indicate that a well repair, a plumbing repair, or a filtration system may be necessary.

34. Does your water have an odor?

    1. SULPHUR/SULPHATE REDUCING BACTERIA $75
    2. IRON BACTERIA $75

    Sulphur/ Sulphate Reducing bacteria can cause the water to smell like rotten eggs. 

    Iron bacteria can cause the water to have a  musty, stale odor and reddish-orange or oily appearance.

36. Are you concerned about chemical contamination?

    1. HEXAVALENT CHROMIUM $150
    2. VOC (LIKE SOLVENTS) $150
    3. VOC WITH PETROLEUM $150
    4. HERBICIDES (LIKE GLYPHOSATE AKA ROUNDUP) $150
    5. CHLORINATED PESTICIDES (LIKE CHLORDANE AND DDT) $150
    6. NITROGEN PHOSPHORUS PESTICIDES (LIKE PRESENT-DAY "THIONS") $150

    A variety of chemical analyses are available to check for the presence of volatile organic compounds, pesticides, and products from spills/ leaks and dumping.

38. ACKNOWLEDGMENT

    Water samples may be requested by the owner or occupant of the property. The well head and sampling spigots should be exposed and made accessible. Please do not chlorinate the well before sampling unless instructed to do so otherwise.

40. *NOTICE: This office is not responsible for reporting delays by the lab. The majority of water sampling is analyzed at the NC State Public Health Laboratory. Chemical analysis can take several weeks. *

    NOTE: If you have not done so, you should register and log in to the portal. https://centralpermits.orangecountync.gov/EnerGov_Prod/SelfService#

    Please double check the email address provided.  All correspondence, notification about sampling or when the results are posted will be use this email.  

    1. YES
42. YOUR FULL NAME
    By typing in my name, I authorize the Orange County Health Department to enter the property and to perform the service requested.
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field