HomeMy WebLinkAboutAgenda - 06-13-2006-7aORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 13, 2006
Action Agenda
Item No. 7 ~A
SUBJECT: Final Report Mill Creek Road Area Studies
DEPARTMENT: Health PUBLIC HEARING: (YIN) No
ATTACHMENT(S):
Final Report Cancer Prevalence INFORMATION CONTACT:
Assessment and Water Quality Rosemary Summers, 245-2411
Assessment far Mill Creek Road Area Tom Konsler, 245-2360
(under separate cover) Candice Watkins-Robinson, 245-2388
PURPOSE: To provide information to the Board on the results of the cancer prevalence
assessment and water quality assessment in the Mill Creek Road area
BACKGROUND: In the summer of 2005, environmental health staff was approached by two
residents of the Mill Creek Road area with concerns about their water and the water in their
neighborhood and the perception of a high incidence of cancer in their neighborhood. The
Board of Commissioners authorized the Health Department to undertake a special water study
and to gather data on frequency and type of cancer experienced in the neighborhood. The study
design included 133 households and consisted of two separate and distinct parts: 1) total suite
of water samples for each household that completed an application and; 2) a telephone survey
to discover the incidence and type of cancers. The final report was completed earlier this month
and presented to the community at their regular meeting on May 15.
The results of the water studies show that the majority of the wells in the community have safe
drinking water. There are some wells that have one or more problems with iron or coliform
bacteria, however for most of the parameters measured, this community experienced the same
or lower levels than Orange County as a whole experiences.
The results of the cancer survey and cancer cluster assessment by the NC Cancer Registry
indicates that the area is experiencing about the same incidence of cancer as the remainder of
the Orange County population.
There remain a few households that environmental health staff members are working with to
further diagnose their particular well problem and determine what remedy might be available to
the homeowner.
FINANCIAL IMPACT: The Commissioners authorized $21,500 for the completion of these
studies., Direct operational costs for the studies to date total $9,078. There may be some
additional follow-up testing of individual wells that may require a small amount of funds.
Approximately $12,000 will be returned to the social safety net/critical reserve find. The
Department also kept track of the cost of staff time that was devoted to conducting this study;
both for direct field work as well as time spent in planning the studies and analyzing the data
While staff time can be considered as an in-kind contribution, other projects were delayed in
order to engage in this study, Staff costs include time for collecting water samples and
conducting the telephone interviews ($14,354) and time for planning the studies and analyzing
the data ($14,820).
RECOMMENDATION(S): The Manager recommends that the Board receive the Report.
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Final Report
Cancer Prevalence Assessment
Water Quality Assessment
Mill Creek Road Area
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North Carolina Public Health
Prepared by:
Orange County Health Department
Orange County, North Carolina
May 2006
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Table of Corrtents
Final Report
Mill Creelc Road Area Studies
Background ....................................................................................................... 3
Geographical Description ................................................................................. 3
Study Design ..................................................................................................... 4
Staffing and Costs ............................................................................................. S
Cancer Prevalence Assessment ......................................................................... 5
Water Quality Assessment ................................................................................ 10
Appendices
Appendix 1: Telephone Interviewing Staffing Plan & Protocol ................... 19
Appendix 2: Telephone Survey Form ............................................................ 21
Appendix .3: Telephone Survey Script,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 27
Appendix 4: NC Cancer Registry Study Report,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 34
Appendix S: Water Study Invitation Letters .................................................. 41
Appendix 6: Well Water Study Application .................................................. 44
Appendix 7: Letter on Water Test Results ............................................••..•..• 4S
Appendix 8: List of Educational Materials ...............................•..........,•.••.•••, 47
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Final Report
Cancer Prevalence Assessment and Water Quality Survey
Mill Creep Road Area
Background
In the spring of 2005, Glenda and .Toe Holloway, who reside in the area, approached the
Environmental Health Division of the Orange County Health Department (OCHD) and expressed
concern over their well water quality and quantity. They also spoke of others in the area that were
experiencing similar problems. Generally, the water troubles they described related to discoloration,
taste and odor problems, and to some extent, wells drawing down to lower yields during extended
pumping sessions.
During the initial interviews, staff reviewed the Holloway's file and discussed alternatives and
treatment systems with them acid they were offered an application for having their well water
sampled and analyzed. In .Tune 2005, Mr. Holloway appeared before the Orange County Board of
County Commissioners (BOCC) and related the community's water concerns and also gave
anecdotal evidence of a high number of cur°rent and past cancer cases in their area. His perception
was that because the water was so poor° overall in the community, it could be contributing to the
cancer prevalence. He also invited the BOCC members to the next community meeting to meet in
person with others in the community that felt affected.
A meeting took place on June 29, 2005 at the Cedar Grove Volunteer Fire Department station on
Penecost Road in Cedar Grove. All five BOCC members were present along with Orange County
Plamiing staff and Health Deputment staff. The residents recounted their experiences to
Commissioners and staff present. Commissioners informally committed to acting on the matter in
the near firttue and asked Health Department staff to follow up with a study proposal for BOCC
consideration. The Holloway's provided a list of conununity members to the Health Department that
they believed had reported cancer in their households
A proposal was presented to the BOCC on August 16, 2005 and approved by Commissioners.. The
Commissioners allocated $21,500 from the social safety net critical reserve fund to cover the costs
to the Health Department for the studies.
Geographical Description
The Mill Creek Road area is located in the northwest portion of Orange County. The area is largely
residential with agrarian and open spaces intermingled. There is very little commercial development
and no industrial development along this road, The segment of Mill Creek Road included in this
study runs along the road from just south of Lonesome Road (SR 1350) to just south of I-Iigh Rock
Road (SR 1.3450) and is approximately two miles in length. Most of the properties included in the
study are along Mill Creek Road although a few are located on or,just off High Rock and Governor
Scott (SR 1351) Roads..
All developed properties in the area are served by private wells and septic tarilc systems, Orange
County Health Department staff are not aware of any outstanding environmental problems in the
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study azea either during or prior to the study.. There are biosolids application sites near some of the
properties but no recent complaints have been registered concerning their operation. The only other
significant ecological disturbance in recent years was the construction of the Hillsborough reservoir
,just east of the area.
The tenain in this area is generally gently sloping with broad ridges with intermediate drainage
ways, some with intermittent streams. Slopes are mostly 5% or less but some stream side and
drainage way slopes can reach 10%. Soils on the upland ueas are well drained and principally in the
Georgeville-Herndon association. Some minor inclusions of Chewacla (alluvial), Enon, Lignum,
and Tattrm, and Wedowee also occur. (Soil Survey of Orange County, North Carolina), The
underlying geology is a mix of metavolcanic and metaigneous rocks (vazious USGS maps). Wells
drilled in this area are considered to have low to moderate susceptibility to groundwater
contamination fi°om surface or shallow subsurface sources (Terziotti and Eimers, 1999,
Susceptibility of ground water to surface and shallow sources of contamination, Orange County, NC,
USGS Report). These soils, rock formations and contatination susceptibility are typical to most of
Orange County and also to many slate belt areas of North Carolina.
Study Design
The Orange County Health Department Epidemiology Response Team (Epi Team) took the lead in
designing and implementing the studies. Assistance and consultation in the design and in
interpreting data results was provided by the Environmental Epidemiologist with the Region IV
Public Health Surveillance Team, a Toxicologist with the NC Division of Health Services, and the
NC Cancer Registry Coordinator. The Epi Team met three times to define the scope of the project,
develop a plan for implementation and to review surveys and implementation as it progressed.
The Epi Teazn utilized the list provided by the Holloway's to define the study area. An attempt was
made to include each potentially reported cancer household in the study area.. In consultation with
the NC Cancer Registry and on review of the literature, it became apparent that it is difficult to
associate cancer in a community with an enviromnental exposure unless the cancer is very prevalent
in a community and of certain types. The Epi Team decided that the best approach would be to
separate the two issues of concern to the community and to conduct separate studies in each area. If
indicated, the results could be correlated at the conclusion of each study. Therefore, the final plan
was to conduct a telephone survey to determine the prevalence of various types of cancer and request
a cancer cluster evaluation from the NC Cancer Registry and to simultaneously conduct a water
quality study through offering a complete suite of available water tests. It was decided to conduct all
studies with the entire population in question rather than sampling a portion of the study area. More
information on the process followed for each portion of the study is included with the detailed results
for each study.
Project leaders volunteered for various portions of the studies. Candice Watkins-Robinson, Health
Educator, volunteered for the lead responsibility for the cancer assessment study, Tom Konsler,
Envirotunental Health Supervisor, volunteered for lead responsibility for the water quality study,
Ron Holdway, Environmental Health Director, coordinated the overall effort, maintained contact
with the community, and consulted with the state participants.
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Staffing and Costs
The studies involved a total of 26 health department staff, one volunteer from the Medical Reserve
Corps, and time from the consultants listed above. Costs for the studies are incomplete since there is
still some follow-up work to be done, however costs to date total $38,252. Of that amount, $8,000 is
for water and air testing supplies and duplicating (surveys, informational packets, water results,
applications); $1,078 for staff travel for collection of water samples; $14,354 for staff time for
collecting water samples and conducting telephone interviews; and $14,820 for staff time in
planning the studies or analyzing the data, This staff time estimate does not include the time "off
hours" that staff spent in telephone interviewing or in attending community meetings. Health
Department staff members have continued to meet with the community on a monthly basis
tluoughout the study time period. Mr. and Mrs.. Holloway devoted countless hours to providing
follow-up in the community to assure that residents received and completed water testing
applications and that phone numbers for residents were gathered and passed to the Health
Department for telephone interviews,
Cancer Prevalence Assessment
The Mill Creek Road Area Cancer Rate Assessment has two parallel but sepazate studies. The first
consisted of a telephone survey of residents living in the Mill Creek Road area by the Orange
County Health Department. The second study was conducted by the North Carolina Cancer Registry
at the request of the Health Department and consisted of an exanzination of cancer incidence
reported tluough the North Carolina Cancer Registry for two census tracts.
Telephone Survey
The telephone survey began on October .3, 2005 and ended December 17, 2005. During this period,
the Orange County Health Department (OCHD) conducted a telephone survey of residents living in
the Mill Creek Road area. There were 133 total households in the study area.. Surveys were
completed for 86 households (65%). Twenty-two households (16% of the total) were reached but
declined participation in the survey, leaving a total of 25 households (19% of the total) not reached.
Pazticipants were limited to persons living in the home and relatives of persons diagnosed who are
either deceased or wider 18 years of age. The total number of household members in the cancer rate
study was 198.
The NC Public Health Regional Surveillance Team IV Envirannental Epidemiologist assisted the
Epi Team in developing the survey and telephone interviewer script. The end result was a 47-
question survey, telephone interview script, and survey question guide. (Please see appendices 1-3
for these documents.)
Telephone interviewers were either staff of the Orange County Health Depaztment or members of
the Orange County Medical Reserve Corps Volunteers. Prior to conducting the survey, all
interviewers were trained by reviewing the interviewer script in a group training session. Each
"survey day" during the first two weeks consisted of twelve hours, broken down into three shifts:
morning (8:00 a. m. - 12:00 p.m.), afternoon (12:00 p.m. - 4:00 p.m.) and evening (4:00 p.m. - 8:00
p. m.) Each shift had at least two telephone interviewers. Any homes that were unreachable during
the morning and afternoon shifts were forwarded to the evening shift interviewers. Afrer the first two
weeks, staff members continued to follow up on households that had been umeachable.
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Surveys were pre-printed with the property owner's (or occupant's) name, address, and phone
number. The interviewer was instructed to call each household once during their shift and forward
incomplete surveys to the following shift for an additional attempt. Five phone calls on different
shifts and days were attempted to households before labeling a resident as unresponsive. Forty-seven
households were not included in the survey for a variety of reasons (e. g., declined, disconnected
phone, or multiple calls/messages without response)..
Results of the Telephone Survey
Twenty-nine cancer cases and fourteen different cancer types were identified in the survey,
Nnmher of Reported Caneer Cases by Cancer Tvne
- ---- -
Cancer Type
Reported Number
of Cases
% of Population
n=198
Bladder 2 I
Brain 1 .5
Breast 4 2
Colorectal 4 2
Esophageal 1 .5
Liver 2 I
Lung 3 1.5
Non-Hodgkin's
lym Noma 1 ,5
Hodgkin's disease 1 .5
Multi le myeloma 2 1
Ovarian I .5
Prostate 2 I
Skin melazioma 1 .5
Stomach 2 1
Unknown cancer type 2 1
Twenty-eight people (14% of the surveyed population) reported a cancer diagnosis. One person was
diagnosed with two different forms of cancer resulting in 29 reported cancer cases. Of the 28 people
diagnosed, 15 are deceased, I 1 have cancers in remission, and 2 currently have cancer. The
race/ethnicity breakdown of diagnosed residents showed that 18 were African American and 10 were
Caucasian. The gender breakdown shows 15 females arrd 13 males diagnosed with cancer,
Discussion of Reported Cancers in Alphabetical Order
Bladder Cancer -Urinary bladder cancer is higher among whites than African Americans. Rates
are even lower for Hispanics, Asians, Pacific Islanders, and Native Americans (National Cancer
Institute, 2006). This cancer is typically diagnosed among people aged 40 or older.
Two study participants reported bladder cancer diagnosis. One participant was Caucasian and the
other was African American. One of the two participants explained that their colorectal cancer
metastasized to their bladder. Both participants were over the age of 40 when diagnosed.
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Brain Cancer -There was one report of brain cancer., The respondent was not certain of the
relative's age at the time of diagnosis.
Breast Cancer -Breast cancer- is one of the leading cancers among women in the United States. It
is typically diagnosed in women aged 40 or older. In addition to gender and age, risk factors for
breast cancer include race, family history, and history of hormonal therapy (American Cancer
Society [ACS], 2006). According to the NC Central Cancer Registry (NCCCR), between 1998 and
2002, Orange County had 487 breast cancer cases (2005).
Pour women reported breast cancer diagnoses during the telephone survey. Three of these women
were over the age of 40 when diagnosed and the fourth respondent was unable to provide the age of
the relative diagnosed with breast cancer..
Colorectal Cancer -Colorectal cancer is the third most commonly diagnosed cancer among men
and women in the United States.. Persons aged 50 years or older have an increased risk of diagnosis.
Current research shows that African Americans aze diagnosed at an earlier age than persons of other
races. African Americans also have higher diagnosis rates and shorter survival rates (ACS, 2006).
Orange County had 168 colorectal cancer cases between 1998 and 2002 (NCCCR, 2005).
Four telephone survey respondents reported a diagnosis of colorectal cancer. All of the diagnoses
were among persons older than 50 years of age. Two were African American and two were
Caucasian.
Esophaeeal Cancer -The risk of esophageal cancer increases with age, as nearly half of all people
diagnosed are older than 70 years of age. Men have a higher rate of esophageal cancer than women
and African Americans are more likely to develop this cancer than Caucasians (ACS, 2006).
There was one report of esophageal cancer in this survey. The respondent was 77 years of age at
time of diagnosis and is African American.
Liver Cancer -Risk factors for liver cancer include gender and lifestyle factors such as tobacco and
alcohol use, obesity, and enviromnental/chemical exposure. Two respondents reported a diagnosis of
liver cancer.
Lung Cancer -Lung cancer is the most prevalent form of cancer in Orange County. The primary
risk factors for lung cancer are tobacco use (smoking) and exposure to environmental hazards such
as asbestos and radon. Orange County had 262 hmg cancer cases between 1998 and 2002 (NCCCR,
2005). Three survey respondents reported a diagnosis of hmg cancer.
Hodgkin's Disease -This is cancer of the lymph nodes, Risk factors for lymphoma may be related
to genetics, lifestyle, and the environment. One respondent reported a diagnosis of Hodgkin's
lymphoma.
Multiple Myeloma -Generally 5-6 new cases world be expected each year for the county. Two
respondents reported a diagnosis of Multiple Myeloma. Both were African American and over 50
years of age when diagnosed. This is a disease of the platelets in the blood.
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to
Non-Hodgkin's Lymnhoma -One respondent reported diagnosis of non-Hodgkin's Lymphoma,
(one of many different types of lymph cancer). This respondent was .37 years of age when diagnosed.
Ovarian -Women who have experienced menopause have an increased risk of ovarian cancer. Half
of all ovarian cancers are found in women over the age of 63. Risk factors may also include family
history, onset and frequency of menstrual cycles, obesity, use of fertility drugs, smoking and alcohol
use, and use of hormonal replacement therapy. One respondent reported a diagnosis of ovarian
cancer. This person was 35 years of age when diagnosed,
Prostate -Risk factors for prostate cancer include age, race, nationality, family history, and diet.
Two out of tluee males will be diagnosed with prostate cancer and diagnosis rates are higher among
African American males than any other race (ACS, 2006). Orange County had 294 prostate cancer
cases between 1998 and 2002 (NCCCR, 2005).
Two males in the survey reported prostate cancer. One respondent, an African American male, was
54 years of age when diagnosed, and the other, a Caucasian male, was 68 years when diagnosed.
Slcin Melanoma - Rislc factors for skin melanomas include exposure to ultraviolet radiation, age,
family history, skin type, and gender. It is most cormnoilly diagnosed among older males (ACS,
2006). One skin melanoma diagnosis was reported by a Caucasian resident who was 55 yeazs of age
when diagnosed.
Stomach Cancer -Most stomach cancers are diagnosed when people are in their SOs or 60s. More
men than women are diagnosed with stomach cazicer. Two Africazi American residents in the survey
reported stomach cancer diagnoses. One respondent was 50 years of age when diagnosed. The age
at the time of diagnosis for the other respondent was unknown..
Untcnown Cancer Tvnes -Two people reported cancer diagnoses for relatives who were deceased
and they could not remember the type of cancer diagnosed.
What is a Cancer Cluster?
According to the Centers for Disease Control and Prevention (CDC), a cancer cluster is defined as a
greater than expected number of cancers among a group of people, in a specific geographic area,
over a period of time. The following factors aze considered when trying to determine whether a
cancer cluster exists: (1) cancer is a common disease affecting I in 4 people in their lifetime; (2) the
term cancer refers not to a single disease, but to a group of related, but different diseases; (.3) a
cancer cluster may be due to chance alone; (4) an apparent cancer cluster is more likely to be
genuine if the cases consist of one type of cancer, a rare type of cancer, or a type of cancer that is not
usually found in an age group.
Assessment Boundaries
The Orange County Health Department recognizes the following boundaries with regard to this
assessment:
• Point in Time Survey-The survey was conducted at a single point in time (in this case a
number of months) and therefore was confined to this study period.. It did not take into account
former residents of the area.
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• Incomplete Surveys -Callers were unable to obtain responses from all residents living in the
Mill Creek Road area; 25 (19%) households could not be reached and 22 (16%) households
reached declined to respond to the survey. The survey yielded a 65% overall completion rate.
Rental Property -It is assumed that 22 of the properties in the study area are rentals, This was
the number of households where the mailing address for the tax bills did not match the
property address, The databases available to Orange County Environmental Health list the
property owner's name and contact information, which prevented interviewers from reaching
several residents. In some instances, property owners when contacted refused to provide rental
resident contact information.
• Self-Reporting of Cancer Status -The survey used aself-report of cancer status and there was
no verification with medical records or medical providers. The onset or diagnoses of cancer
could have been reported incorrectly.
• External Risk Factors -According to the CDC and the National Cancer Institute, family
history and lifestyle factors such as diet azid tobacco use often influence cazicer diagnosis.
This assessment did not attempt to liirl< reported cancer diagnoses to any risk factors.
North Carolina Central Cancer Registry Evaluation
At the Orange County Health Department's request, the North Carolina Central Cancer Registry
evaluated the incidence of cancer in the Mill Creek Road area using the data gathered through the
North Carolina Central Cancer Registry. Reporting of cancer cases to the Registry is required of all
health care providers who diagnose or treat cazicer. The evaluation that the Registry conducted
included a broader geographical area thazi the one studied by the OCHD, For comparison purposes,
maps delineating both study areas can be found in Appendix 4. The Cancer Registry's study
comprised two census block groups in northwest Orange County. The Health Department's study
area fell within the area evaluated by the Cancer Registry.
This evaluation compared North Carolina, Orange County, and the study azea for afive-year period
of time (1999-2003). None of the rates were found to be significantly higher than North Carolina
rates or expected rates in the Registry's study area. The conclusion of this report is that the data do
not suggest a clustering of cancer cases in the Mill Creek area. The full report has been included in
the appendix.
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Summary of the Cancer Assessment Studies
The Orange County Health Department concludes that results gathered through the Mill Creek
Cancer Assessment Survey do not indicate a cancer cluster. This is confirmed through the findings
of the North Carolina Central Cancer Registry. Of the 86 responsive households containing 198
persons, 29 cancer diagnoses (14.6%) were reported, Twelve different cancers were reported with
no single cazicer being reported more than four times, Single cases of most cancers were the norm in
the survey results. The most often reported cancers were breast, lung, colorectal, and prostate (45%
of those reported) that have high incidence rates within the county, state, and nation. In addition,
most of the reported cancers were diagnosed aniong people who were within the typical age gr°oup
for being diagnosed with their particular cancer..
The absence of a cancer cluster is further indicated when comparing the year of cancer diagnosis to
the year the person moved into their Mill Creek area home. Four of the 29 (13.7%) of the cancer
diagnoses were found before the person moved to the Mill Creek Road area.
The Health Department concurs with the North Carolina Central Cancer Registry in concluding that
the data do not suggest any further study is indicated.
Water Quality Assessment
This section of the report includes the water and air sample results from the Mill Creels study area,
with a compazison of water sample results countywide where there is an established database. The
countywide results are based on sampling tlu~oughout Orange County from July 2004 through
January 2006. The number of'sampling points are reflected on each chart.
Staff recognizes that the samples taken and analyzed are a point in time evaluation of the water
supplies,. There are many factors that cazi influence a water supply over time and these results
should not be taken as an assurance that the well water system will be the same over time. Periodic
water tests are the best way to ensure the water supply is continually safe for human consumption.
Methodology
All households in the defined Mill Creek Road community who completed and returned azi
application for water samples from September 12, 2005 through December 14, 2005 were included
in the assessment. Once the application was received in the Environmental Health office, it was
logged into an electronic database and put into the list for a field visit to collect the array of samples.
That array included:
• bacteriological,
inorganic chemical,
pesticides,
• frill petroleum,
• radon in air, and
radon in water
Wells were sampled regardless of the age, depth, condition, or construction of the well.
To assure integrity in the study, Enviromnental Health Specialists who are also Registered
Sanitariazis in North Carolina were the only staff involved in the collection of samples. They
generally worked in the community in teams of two and also delivered informational and educational
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literature to the residents as part of their encounters, Radon test kits for air sampling of radon within
homes were also placed and picked up by staff by arrangement with the household occupants.
Chains of custody for the samples was assured by direct delivery of all non-radon samples to the NC
State Laboratory of Public Health in Raleigh. Staff'sent both air and water radon samples to the
vendor's private lab for analyses using FedEx next day air delivery. Results were logged into the
database for comparison with the county results in general.
Discussion of Each Sampled Parameter
Bacteriologic Quality
coliform bacteria, while not pathogenic in and of itself; is used as an indicator bacteria for the
presence of harmful bacteria. The presence of coliform bacteria indicates that surface water
contamination is present in the well, either tinough a shallow, unprotected vein of water (generally
less than 60 feet from the ground surface), or from ui inadequate length of casing or other well
construction deficiency,. For drilled wells, the casing is the metal pipe that extends from the ground
surface and goes into solid rock (bedrock) to seal out the shallow groundwater, which is poor in
quality. Hand-dug wells and bored wells rely on shallow groundwater and are expected to contain
coliform bacteria.. Shallow wells are also more prone to going dry or getting muddy during extended
periods of drought. For these reasons, current Orange County well construction standards require at
least 63 feet of casing on all new drilled wells.
Bacteria -Mill Creek
Health effects -Because coliform is used as an indicator of contamination, a well with
persistent coliform bacteria or with fecal coliform present should be considered an unsafe
source of drinking water. The presence of coliform indicates that conditions are favorable
for the presence of other bacteria that catz cause health problems such as diarrhea, upset
stomach, cramps, and vomiting.
Remedial action -When coliform is present, the well should be chlorinated thoroughly and
retested, If total coliform bacteria return after this treatment, the owner can opt to either
attempt to repair the well by installing a liner, or to install a treatment system on the well,
typically a chlorinator or ultraviolet light disinfection unit. If the well exhibits persistent
fecal coliform, the well should either be replaced or repaired with a liner. Owners of a well
Page I 1 of 47
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with total coliform contamination were instructed on chlorination of the water supply and
offered follow-up water samples once the process was complete. Residents having a well
with any type of coliform contamination were notified and given instructions on how to
chlorinate the well.
Inorganic Water Quality
An inorganic analysis tests the chemical quality of the water, which often affects appearance, taste,
and odor.
The following parameters were tested and were either Found within the range of acceptable drinking
water standards, or no drinking water standard exists,
• Alkalinity,
• Calcium,
• Chloride,
• Copper,
• Fluoride,
• Hardness,
• Magnesium,
The following inorganic elements exceeded the recommended dririlcing water limits in some of the
samples.
Iron - Iron occurs natrually in groundwater and is the most common source of nuisance problems
with well water in Orange County. While not considered a health risk, levels of iron above 0.3 mg/1
can cause the water to have a red or brown muddy appearance and can stain white plumbing fixtures
and clothes.
The recommended drinking water limit for Iron is 0.30 milligrams per liter (mg/1)
• Remedial action -Remedies for those wells with high iron levels include installing a liner in
the well or installing an iron filter or other treatment unit. The liner repair may be an option
in limited cases, depending on the well structure and water bearing aquifers.
Arsenic -Arsenic is a naturally occurring element in the soil and rock formations that can leach
into the groundwater. It can also be associated with agricultural activities and industrial processes,
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The low levels identified in this study are considered to be naturally occurring as they are consistent
with other naturally occurring levels of arsenic in Orange County..
The recommended drinking water limit for Arsenic is 0.01 mg/1, however the NC Department of
Environment and Natural Resources recommends a limit of 0.001 mg/1.
Health effects -Several studies have shown that long-teen exposure to inorganic arsenic can
increase the risk of lung cancer, skin cancer, bladder cancer, liver cancer, kidney cancer, and
prostate cancer. Long-term exposure is defined as the consumption of a half gallon of water
each day over a period of 70 years, The current EPA contaminant limit is .O1 mg/I, but there
is interest in North Carolina for prescribing a level of <.001 mg/1.
• Remedial action -Wells that show levels of arsenic above .001 mg/1 can be remedied by
installing a treatment system for drinking water such as a reverse osmosis or ultra-filtration
unit.
Manganese -Manganese is an element that dissolves in water from the natural rock formations..
Manganese levels above 0.05 mg/1 can turn well water black or brown and stains plumbing fixtures
and clothes. The levels found can cause nuisance problems, but do not pose any health risk.
The recommended drinking water limit for Manganese is 0.05 mg/1,
• Remedial action - Rernedies for wells with high manganese levels include installing a liner
in the well or installing a iron filter tr°eatrnent unit, The liner repair may be an option in
limited cases, depending on the well structure and water bearing aquifers,
- pH is a measure of how basic or acidic water is. With a pH below 6.5, the water is considered
acidic and there could be concerns about corrosion of plumbing components resulting in lead
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leaching into the water from soldered joints. Water with a low pH can also react with copper pipes
to cause blue-green stains and a metallic taste..
The recommended drinking water limit for pH is a level of 6.5 units or more.
Health effects -There are no adverse health effects at the pH levels found although it can
contribute to increased levels of lead and copper in severe cases. However, in the 14 sites
where pH was below the recommended limits, there was no associated elevated level of lead
or copper in the water.
• Remedial action -Low pH carp be remedied by installing a neutralizing treatment system
that will adjust the pH to a neutral level of 7.
Lead -Lead in well water usually is a result of the water being in contact with plumbing
components such as lead soldered joints or valves, pumps and fixtures that contain lead in the alloys,
The reconunended drinking water limit for Lead is 0.015 mg/1.
Comparison data for Orange County is
not available
Health effects -Lead in drinking water can cause a variety of adverse health effects. In
babies and children, exposure to lead in drinking water above the action level can result in
delays in physical and mental development, along with slight deficits in attention span and
learning abilities. In adults, it can cause increases in blood pressure and kidney problems.
• Remedial action -With elevated lead levels in water, it is recommended that children under
the age of six not drink the water unless a treatment system is installed. Treatment systems
are available that reduce the corrosive properties of the water and remove lead,
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Zinc -Zinc in drinking water can occur when corrosive properties of the water leach zinc from
metal plumbing components. Zinc levels above .015 mg/1 can cause a metallic taste to the water.
The recommended drinking water limit for Zinc is 5.9 mg/1.
Comparison data for Orange County is not
available
• Health effects - Atthe levels detected, there are no health risks.
• Remedial action -Controlling zinc in water is achieved by addressing the corrosive
properties of the water by installing a pH neutralizer and /or a water conditioner,
Radon
Radon is a naturally occurring radioactive gas found in most of NC's groundwater, especially in the
Piedmont area where granite is common. Radon in soil under homes is the biggest source of radon
in indoor air, and presents a greater risk of lung cancer than r°adon in drinking water.
The recommended drinking water limit for Radon is:
.300 PicoCuries per Liter (pCi/L) for states that have no EPA approved radon in indoor air program,
4000 PicoCuries per Liter (pCi/L) for states that have a radon in indoor air program,
Radon (water)
• Health Rislcs -Radon in water is not currently considered a health risk on its own. It does
contribute directly to the radon in air levels. See below for the health effects of radon in air.
• Remedial action -Water treatment systems are available (activated carbon filters or
aerators) to treat radon in water, however in the absence of elevated air radon in these homes,
Page I S of 47
18
treahnent systems are not necessary. Simple precautions such as running an exhaust fan
when showering or when cooking can be implemented to prevent a buildup of radon in the
home.
Radon air
The following charts reflect the percent of homes where radon levels were above the recommended
limit.
Tha rPCnnvnended limit for Radon in air is 4 pCi/L
Health Rislcs -Some people who are exposed to radon may have increased risk of getting
cancer over the course of their lifetime, especially lung cancer. Radon exposure from
actually consuming the drinking water is usually not a serious tlueat to health. The health risk
appears through making the radon airborne tluough such means as a shower head or tluough
steam generated by cooking..
• Remedial actions -Since none of the homes in Mill Creels had elevated radon in the air, no
special recommendations are needed.
Organic Compounds
Samples were collected from all the wells to analyze for the presence of pesticides and for petroleum
products.
Pesticides -The water was analyzed for the presence of 15 various organic pesticides. None of the
sarnples indicated the presence of pesticides.
Petroleum products -Samples were taken to determine if volatile or other classes of organic
compounds were present. Two of the 100 satnples indicated low levels of petroleum based or
organic compounds (chloroform and tetrahydorfuran). Chloroform at the level detected is evidence
of past chlorination of the well system and is commonly found at low levels in chlorinated water
systems. Tetrahydrofiuan is commonly found and used in many industrial and construction
processes and also in chemical compounds. It is commonly used as a solvent but can be used for a
variety of other purposes. When found in well systems at the level detected in the well in the Mill
Creek area, it is presumably residual from glue solvent used in the process of welding plastic pipe
,joints.
Page 16 of 47
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Both of these results were reviewed by a NC Division of Public Health toxicologist and he
concluded that the water is safe for continued usage. These two sites are scheduled for follow up
sampling as a precaution and those samples should occur within the next I S days,
Follow-up Plans
Owners of the wells have been notified of the sampling results by an individual written
comprehensive report including appropriate recommendations. Staff have been available by phone
for any consultation requested by residents. Some follow-up sampling for bacteriologic, some
inorganic and radon parameters occur over the coming weeks,
Bacteriolo~ie -The owners of wells showing coliform bacteria were notified of the presence of
bacteria and were provided with instruction to chlorinate the well,. The owners were asked to contact
Envirotunental Health for follow-up saznpling after the chlorination procedure, Standard
recommendations and procedures based on second sample results will be followed in advising
owners ofthe remedies available to them.
Staff will offer owners with wells with persistent bacteriological contamination the service of the
down-hole camera to assist in repair diagnosis. In situations where the wells are serving rental units,
the owner will be notified of the requirement to repair or treat the well.
Inorganic -The wells showing elevated lead levels will be resaznpled in accordance with standard
procedures. The residents of homes with persistently high lead levels will be contacted for further
recommendations if children reside in the homes. Owners who choose to install treatment systems
for problem contaminants will be offered a free follow-up water sample to assure that the system is
effectively removing the problem. Staff will offer owners with wells with extraordinarily high
inorganic contanination (estimated at 6-8 households) the service of the down-hole camera to assist
in repair diagnosis.
Radon -Only I /3 of the homes in the study area were tested for radon in the air due to the
difficulties in scheduling two site visits (to set up the test kit and to take it down) when the occupants
az'e home. Staff will continue to offer the air test kits to homeowners at no charge, but will not
oversee the placement and collection of the kits. However, for those sites where elevated levels of
radon were found in the water and no air test kit was placed, flu'ther attempts to collect air samples
will be made.
Summary of the Water Quality Assessment Study
The Mill Creek area has predominazrtly older wells, many which pre-date the more stringent well
construction standards cun'ently in place in Orange County. It is not unexpected to find both water
quantity azid quality issues in older wells with substandazd construction. While there are very real
water quality issues in the Mill Creek area, the problems are largely aesthetic and there were no
significant long-term health risks identified. The most prevalent water quality issue is the number of
wells showing coliform bacteria, however the prevalence of contaminated wells in the study area is
lower than that of the county as a whole, Well owners are being advised on the recommended
chlorination procedures and re-sampling, however few have responded to date.
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In the remaining water quality aspects, the Mill Creek study area water compares favorably with the
remainder of the county and no anomaly is identified.. Although some wells are problematic as
mentioned above, the groundwater appears untainted by hwnan generated chemicals or other
atypical contaminants. The geology, soils and ten'ain makeup of the area is overall very typical of
much of Orange County that is served by water wells. Environmental Health will continue to work
with well owners to resolve any remaining issues as indicated.
The following Health Department Staff worked on writing this report: Tom I{onsler, Candice
Watkins-Robinson, Ron Holdway, and Rosemary Summers
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Appendix 1: Telephone Interviewing Staffing Plan and Protocol
Telephone huerview Staffing Plan and Protocol for the Mill Creek Road Area Study
August 2005 through December 2006
Telephone hrterview Staff
Orange County Health Department (OCHD)10 employees will be asked to conduct telephone interviews for
the Mill Creek Area Smdy
Select Public Health Reserve Corps (PHRC) members will also be asked to participate. The program's
Volunteer Coordinator will query the PHRC database to identify volunteers with an interest in community
and public health programs. Volunteers with an interest in environmental health services will also be
queried A request for volunteers will be sent to these individuals by e-maIl.
Staff Roles
The Planning and Operations sections have determined that the following positions are needed to conduct
the telephone interview portion of this sttidy:
A. Database Developer (1)
B Data Entry Technician (2)
C. Staff Preceptor (1)
D Telephone Interviewer (8)
E Training Facilitator (1)
Database Developer -All demographic information, medical history, residential information and work
history collected during telephone interviews should be stored in a secured database. The Database
Developer will create a Microsoft Access Database (Table and Form) containing fields that correspond with
the Mill Greek Road Area Study Questionnaire
Data Entry Technician - T'he Database Entry Technician will be responsible for entering information
obtained during the telephone interview into the Mill.4rea Study database. Data entry volunteer should have
working knowledge of Microsoft Access.
Staff Preceptor -The Staff Preceptor will monitor the Study's Telephone Interviewers and Data Entry
Technicians. This person will verify that interviewers are collecting and recording the appropriate data.
They will also make sure volunteers have the necessary materials for carrying out their duties..
Telephone Interviewer - The'Telephone Interviewer will administer the Mill Creek Road Area Study
Questionnaire.
Questionnaire/Database Training Facilitator -The Training Facilitator will conduct a training session to
orient study volunteers to the questionnaire and database,
Staffing Methodology
The Planning Section identified 120 Mill Creek Area homes for tlis study; revised to 133 homes in September.
Planners are not certain of how many people actually live in each household. The most recent U S Census
data Eot average number of people living in an Orange County household is from 1985 where the average at
this time was 2 63 Planners estimate three persons per household. for this study. Because of this, there is a
potential of 360 Mill Creek residents as the denominator for the project period.
The First Floor Conference Room in the Wlitted Building will be designated as the Mill Area Study Call
Center. All training, phone interviews and data entry will be conducted in this location. An alternate
location identified is the Health Check Coordinator's shared office space (room For Eour callers).
Page 19 of 47
as
The Operations Section will recruit eleven volunteers to collect data on the (120) homes, As previously
stated, study volunteers will be OCHD employees and PHR.C members. Eight volunteers will be recruited to
Fill the role of Telephone Interviewer Two volunteers will be recruited to fill the role of Data Entry
'Technician. One volunteer will be aslted to fill the role of Staff Preceptor and one volunteer will serve as the
Training Facilitator. The Operations Section Chief will serve as Database Developer.
Telephone Interviewers will attend none-hour orientation led by the Training Facilitator to learn about the
purpose the study and the importance of cornfidentialiry. Interviewers will also conduct mock telephone
interviews using the Question-by-Question form and telephone script, to become comfortable with
administering the questionnaire.
Data Entry Technicians will also attend aone-hour orientation session to become comfortable with the
project database. During this session, they will learn about the study's purpose and the importance of data
integrity. They will also practice entering data into the database.
This survey will be administered over a period of five days. Each "suney day" will run twelve hours and be
broken down into three shifts: Morning (8:00 a m. -12:00 p m ), Afternoon (12:00 p.m. -4:00 p m.) and
Evening (4:00 p m - 8:00 p m.) Each shift will have two'Telephone Interviewers. The Morning Shift will
contact twelve homes and the Afternoon Shift will contact twelve homes. Any homes that were unreachable
during the Morning and Afternoon shifts will be forwarded to the Evening Shift interviewers. With this
formula, we have the potential of surveying twenty-four homes per clay.
The Staff Preceptor will monitor Telephone Interviewers to ensure that the survey is conducted in
accordance with the Planning Section's objectives. At the start of each shift, the Staff Preceptor will provide
materials needed for administering the survey (blank questionnaires, pens, etc) At the end of each shift, the
Staff Preceptor will collect completed and any blank questionnaires and supplies. Blanlt questionnaires will
be forwarded to the Evening Slft Telephone Interviewers and completed questionnaires will be given to the
Data Entry Technician
The Data Entry Technician is expected m enter data collected from the twenty-four homes the morning after
that data was collected Data collected on the fifth day of the study (Friday) will be entered that following
Monday
Once all questionnaires are administered and data is entered, the Staff Preceptor will forward all Forms and
computer fffes to the Operations Chief. The Operations Chief will work with the Planning Section Chief to
analyze data
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Appendix 2: Telephone Survey Form
Mill Creek Road Area Survey Survey Status:
Completed-
Orange County Health Department, Hillsborough, NC Attempted, no contact, try again-
October 2005 Call back for (person) a[ (date/time)
Lltert~iew Lrfortnntion
1. DATE 2. PROP. TMBL
MM/DD/YYYY
2A. PROPERTY ADDRESS
LASTNAME, FIRSTNAME
AUTO-FILL
2B. TELEPHONE
AUTO-FILL
3. PROPERTY OWNER
4. INTERVIEWER
AUTO-FILL
OWNER 2
FIRST NAME LAST NAME
5. INTERVIEW TIME
FIRST ATTEMPT SECOND
ATTEMPT
Dnta Collectiotr
6. DO YOU LIVE AT THIS ADDRESS? ^ YES ^ NO
6a. IP' NO, PLEASE PROVIDE THE NAME AND Name:
TELEPHONE NUMBER OF THE PERSON WHO LIVES Telephone #:
AT THIS ADDRESS
7. WHAT IS YOUR FH25T NAME?
8. WHAT IS YOUR LAST NAME?
9. ADDRESS
HOUSE NUMBER AND STREET NAME
CITY STATE ZIP
Page 21 of 47
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10, HOW MANY FULL TIMT;/P1;RMANT;NT
RT;SH));NTS LIVl; IN THIS HOUSEHOLD?
i 1. WHAT YEAR WAS THT; HOUSlJ BUILT?
12. DO1;S THTJ HOMI; HAV1; ITS OWN W1rLL?
13. HOW LONG HAS YOUR FAMILY LIVID AT THIS
ADDRISS?
14. WHIRL DID YOU LIVI BIFORI THIS HOUSI?
^ YES
YYYY
^ NO
Previous Address
Address
Previous
Address
Previous Address
COMMENTS:
Cancer History
15. HAVI YOU OR ANYONI IN YOUR HOUSIHOLD
IVIR BIIN DIAGNOSID WITH CANCIR?
Number of Years
Number of Years
Number of Years
Number of Years
Number of Years
^ YES ^ NO
16. WHAT'S YOUR RILATIONSHIl' TO PIRSON WHO WAS DIAGNOSID WITH CANCER?
^ SILF ^ SIBLING
^ SPOUSI ^ OTHIR:
^ CHILD ^ NO RELATION
^ PARENT
17. IS YOUR «pIRSON» OVIR 18 YIARS OF AGI? ^ YES ^ NO
18. IS YOUR «PIRSON» AVAILABLI FOR AN ^ YES ^ NO
INTIRVIIW?
19. IS YOUR «PIRSON» DICIASID? ^ YES ^ NO
Page 22 of 47
20. WHAT WAS YOUR «PT;RSON'S» DATi/ OF
DT/ATH?
21. WHAT STAT>; DH) YOUR «PI;RSON»
LIVE IN AT TIMI; OF DT;ATH?
22. MAY WE INTI',RVIT/W YOU ABOUT YOUR
«P1;RSON'S» CANCTJR DIAGNOSIS?
23. WHAT IS /WAS YOUR
«P>;RSON'S» NAMT;
FIRST NAME
24. WHAT IS/WAS YOUR «P>;RSON'S» DOB?
25. WHAT IS/WAS YOUR «P>JRSON'S» GI+;ND1;R?
26. WHAT IS/WAS YOUR «PT/RSON'S» RACE?
27. WHAT YEAR WAS THIr CANCER DIAGNOSED?
a~
MM/DD/YYYY
^ YES ^ NO
LAST NAME
MM/DD/YYYY
^ MALE ^ FEMALE
YYYY
28. W HAT TYPE OF CANC>;R WAS DIAGNOSED?
^ BLADDER (URINARY) ^ SKIN -MELANOMA
^ BRAIN ^ SKIN -BASAL CELL
^ BREAST ^ SKIN - SQUAMOUS CELL
^ COLON OR RECTAL ^ OVARIAN
^ ESOPHAGEAL ^ PANCREATIC
^ KIDNEY (RENAL) ^ PROSTATE
^ LEUKEMIA ^ STOMACH
^ LIVER (Including Intrahepatic Bile Duct) ^ UTERINE (Including Cervix or Corpus)
^ LUNG (Including Bronchus) ^ OTHER:
^ LYMPHOMA (Including Non-Hodgltin)
29. IS TH>; CANC>;R ACTIV); OR IN R>MISSION? ^ ACTIVE ^ REMISSION
30. WHO IS /WAS YOUR
«PI;RSON'S»
PRIMARY PHYSICIAN?
FIRST NAME
31. WHO I5 /WAS
YOUR «pERSON'S»
ONCOLOGIST?
FIRST NAME
LAST NAME
LAST NAME
Page 23 of 47
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32, WHAT WAS TH>/ NAM); AND ADDRESS OF
THI/ M1;DICAL FACILITY THAT PROVID)iD
TRIiATM1JNT?
ADDRESS
BUILDING NUMBER AND STREET NAME
CITY
STATE
ZIP
3.3. Medical Release Information
It is possible that further investigation will be needed in this study. If needed, would you be willing to
provide copies or allow the Orange County Health Department to obtain copies of your medical files for
review? ^ YES ^ NO
In order to do this, you will have to sign a medical release statement giving the Orange County Health
Department permission to obtain and review your files. Would you be willing to sign a medical release
statement? ^ YES ^ NO
34. PL)JAST; CONFIRM YOUR HOM7; NUMBTJR
INCAS); I N>;)/D TO CALL BALI{
###-##1#-##t#f{
35. IS TH1;RT; ANOTHER PHON>; NUMBER?
##i#-###-###'#
36. WHAT'S THL B)J5T TIM1J TO CALL YOU?
Work History
37. WHAT IS YOUR
«P1;RSON'S»
CURRENT JOB OR
OCCUPATION?
38. );MPLOYF,R &
LOCATION:
39. TYP>/ OF
WORI{:
40. TIM>/ WORI{1;D
IN THIS JOB:
^ RETIRED ^UNEMPLOYED
START DATE
END DATE
Page 24 of 47
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41. WHAT IS YOUR «P1/RSON'S»
PREVIOUS JOB OR
OCCUPATION?
42. >;MPLOY>;R & LOCATION:
43. TYP>; OT WORK:
44. TIMi; WORK>;D IN THIS JOB:
START DATE
DATE
END
41a. WHAT IS YOUR
«ppRSON'S» PRi/VIOUS JOB OR
OCCUPATION?
42a.1;MPLOYl/R & LOCATION:
43a. TYP>; OT WORK:
44a. TIM7; WORKED IN THIS JOB:
START DATE
DATE
END
41b. WHAT IS YOUR
«p>/RSON'S» PRI/VIOUS JOB OR
OCCUPATION?
42b. >;MPLOY>/R & LOCATION:
43b. TYPi; OP WORK:
44b. TIM7; WORK>;D IN THIS JOB:
START DATE
DATE
Recreational Hazards
45. DO YOU PARTICIPATi; IN ANY R)JCR>;ATIONAL
ACTIVITI>;S OR HOBBITJS WITH CH>;MICAL
>;XPOSUR>;?
END
^ YES ^ NO
Page 25 of 47
a8
46, IF YES, DESCRIPTION OF
ACTIVITY:
47. ADDITIONAL COMMENTS OR NOTES:
END SURVEY
Page 26 of 47
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Appendix 3: Telephone Survey Script
MILL CREEI{ SURVEY INTRODUCTORY SCRIPT
"Hello, my name is and I am calling from the Orange County Health Department.
May I speak to the head of the household or adult of the home? A group of citizens from your
community reported concerns to the Orange County Commissioners about the number of cancer
diagnoses in your neighborhood,. We are conducting a survey to gather additional information about
cancer cases in the Mill Creek Road area."
"May we have a few moments of your time to ask you some questions about your medical history?
Answering the survey questions is completely voluntary, and your participation will be greatly
appreciated."
A) Special Instructions: If person says no, thank them for their time and hang up politely.
Document across top of survey - "Declined".
Special Instructions: If person prefers to be surveyed at a later time, log their preferred time and
date..
CZSpecial Instructions: If person says, yes, thank them for their willingness to participate and
explain that the survey will take about 20 minutes to complete and that all information will be kept
confidential.
Dl Special Instructions: If person answering the call does not live at this address (i.e. landlord),
request the name and phone number of the person who does live there, Thank them for their time
and hang up politely.
At Completion of Survey: "Thaiil< you for participating in this interview. The Health Department
will be providing summary information to the community when the analysis is complete. We
appreciate your time."
Page 27 of 47
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Mill Creels Road Area Survey -Question-by-Question Sheet
1. DATE
Record the date interview is conducted,
Data Entry Format: MM/DD/YYYY
2. PROPERTY TMBL
This section of the survey will be pre-filled. Do not write in this area.
2A. PROPERTY ADDRESS
This section of the survey will be pre-filled. Do not write in this area.
2B. TELEPHONE
This section of the survey will be pre-filled, Do not write in this area,
3. PROPERTY OWNER
This section of the survey will be pi°e-filled Do not write in this area.
4. INTERVIEWER
Record YOUR First Name and Last Name
5. TIME OF INTERVIEW ATTEMPTED
Record time interview is conducted
6. DO YOU LIVE AT THIS ADDRESS?
Select YES or NO based on the response.
If no, request the name and telephone number of the person who lives at this address,
(Terminate telephone call at this point -see D. Special Instnrctions)
Contact person who lives at this address and continue to use the same survey
7. WHAT IS YOUR FIRST NAME?
Ask and record interviewee's first name.
8. WHAT IS YOUR LAST NAME?
Aslc and record interv'iewee's last name
9. WHAT IS YOUR COMPLETE ADDRESS?
This information will be pre-filled. Ask interviewee to confirm their full address (house number,
street name, city, and zip code), Record any changes in the appropriate fields..
10. HOW MANY FULL TIME or PERMANENT RESIDENTS ARE THERE IN YOUR
HOUSEHOLD?
Record the number of people who live in the home year round. Ask interviewee to include those
who spend six or more months at this residence.
Question E~lanation: The Health Department is interested in this information to help determine
whether any diagnosed cancers may be related to environmental exposures over time
Data Entry Format: 001
Page 28 of 47
~i
11. IN WHAT YEAR WAS THIS HOUSE BUILT?
Record the year the house was built.
Data Entr~yFo~mat: YYYY
12. DOES THIS HOME HAVE A WELL?
Select YES or NO based on response.
13. HOW LONG HAS YOUR FAMILY LIVED AT THIS ADDRESS?
Record the number of years (or months) family has lived at address.
Special Instructions: If the family has lived at the address for less than S years, go to the next
question.. If the family has lived at the address for more than S years, skip to Question 1S,
14. WHERE DID YOU LIVE BEFORE MOVING INTO THIS HOUSE?
Aslc interviewee to provide complete addresses (house number, street name, city, and zip code)
of their last five residences and the number of years lived at each residence. Record this
information in the appropriate fields.
COMMENTS
Record any additional comments stated by the interviewee.
Cancer History
Speciat Instructions: Explain that you will now be asking questions related to cancer diagnosis
within the household.
15. HAVE YOU OR ANYONE IN YOUR HOUSEHOLD EVER BEEN DIAGNOSED
WITH CANCER?
Select YES or NO based on the response,
~ecial Instructions: If response is no, end the interview. Thank interviewee for their time
and for the information provided. Explain that the necessary information has been collected
and that the Orange County Health Department will collect similar data from other residents.
Explain that general findings will be shared with the community. If the interviewee says yes,
go to the next question. If more than one person in household has had cancer, use_a
separate survey. for each diagnosed person and clip all surveys together.
16. WHAT IS YOUR RELATIONSHIP TO THE PERSON WITH CANCER?
Select the appropriate response or prompt interviewee with the following choices: self; spouse,
child, parent, sibling, other, or no relation.
SPPcial Instructions: If interviewee says self, skip to Question 24. If interviewee says
child, aslc if the child is under 18 years of age. If the child is under 18 years, a parent or
guardian should be interviewed. If parent/guardian not available, determine call back
date/time. Stop interview here and document call back info at upper right of is` page.
Page 29 of 47
~~
17. IS YOUR «PERSON» OVER 18 YEARS OF AGE?
Select YES or NO based on the response.
Special Instructions: Use appropriate relationship when referring to person diagnosed with
cancer. If yes, go to the next question.. If no, skip to Question 22.
18. IS YOUR «PERSON» AVAILABLE FOR AN INTERVIEW?
Select YES or NO based on the response.
Special Instructions: If no, go to the next question. If yes, ask to speak with that person and
skip to Question 22. Inhoduce yourself to the new interviewee and tell them the purpose of the
survey.
19. IS YOUR «PERSON» DECEASED?
Select YES or NO based on the response.
Special Insri-uctions: Ask question politely.. Use appropriate relationship when referring to
person diagnosed with cancer. If yes, go to next question. If no, skip to Question 22,
20. WHAT WAS YOUR «PERSON'S» DATE OF DEATH?
Record the month, date, and year person died..
Special Instructions: Use appropriate relationship when refen7ng to person diagnosed with
cancer.
Data Entrv Format: MM/L)D/YYYY
21. WHERE DID YOUR «PERSON» LIVE AT THEIR TIME OF DEATH?
Record staCe or country lived in at time of death?
Special Inshuctions: Use appropriate relationship when referring to person diagnosed with
cancer.
22. MAY WE INTERVIEW YOU ABOUT YOUR «PERSON'S» CANCER
DIAGNOSIS?
Select YES or NO based on the response.
~ecial Instructions: If no thank them for their time and end interview
23. WHAT IS YOUR «PERSON'S» NAME?
Record first and last name of person interviewee is reporting on.
24. WHAT IS YOUR «PERSON'S» DOB?
Record date of birth of person diagnosed with cancer.
Data Entry Format: MNI/DD/YYYY
25. WHAT IS YOUR «PERSON'S» GENDER?
We may not need to ask this question
Record gender of the person diagnosed with cancer.
26. WHAT IS YOUR «PERSON'S» RACE?
Record race of person diagnosed with cancer,
Special Instructions: If asked why racial information is needed, explain that certain ethnicities
have a higher risk for cancer than others.
Page 30 of 47
33
27. IN WHAT YEAR WAS YOUR CANCER DIAGNOSED?
Record year person was diagnosed with cancer.
28. WHAT TYPE OF CANCER WAS DIAGNOSED?
Wait for interviewee to reply before prompting with types of cancer. If you need to prompt the
interviewee, use the following cancers and descriptions:
Bladder Cancer found in the tissues of the bladder, The bladder is located in the
lower art of the abdomen.
Brain Mali pant (cancerous) tumor found in the brain.
Breast Cancer found in or near the breasts. Can be dia nosed in women and men.
Colon and Rectal Cancer found in the colon (large intestine) or rectum (anus) or both,
(Colorectal)
Esophageal Cancer affecting the esophagus, which is the tube that carries food and
li uids from the throat to the stomach.
Kidney (Renal) Cancer affecting one or both of the kidneys. The kidney is a small organ in
the lower art of the abdomen
Leukemia Leukemia is cancer that be ins in blood cells.
Liver (Including Cancer found in the tissues of the liver.. The liver is behind the ribs on the
Intrahepatic Bile right side of the abdomen.
Duct)
Lung (Including Cancer found in the tissues of the lung.
Bronchial)
Lymphoma (Non- Cancer found in the lymphatic system or lymph node tissues.
Hod Icin)
Multi le Myeloma An incurable, but treatable cancer of the lasma cell.
Ovarian Cancer found in the female's ovaries. Ovaries are located in the reproductive
s stem.
Pancreatic Cancer cells are found in the tissues of the ancreas.
Prostate Cancer found in the tissues of the male's rostate land.
Skin -Basal Cell The most common skin cancer. Cancer lesions are often found on the face,
neck, hands, or other arts of the bod that have been ex osed to the sun
Slcin -Melanoma The most serious form of skin cancer. Cancer begins in the cells of the skin
called melanoc tes. The melanoc to roduces skin i mentation.
Slcin -Squamous Skin cancer that arises on the upper level of the skin. Usually in areas that are
Cell exposed to sun, Squamous cell carcinomas are most commonly found on the
ears, the face, and the mouth.
Stomach Stomach cancer (also called gastric cancer) can develop in any part of the
stomach and may spread throughout the stomach and to other organs. It may
row alon the stomach wall into Che eso ha us or small intestine.
Uterine (Including Cancer found in the tissues of the woman's uterus.
Cervix or Cor us)
Other As]< erson to s ecif
Don't Know Don't rom t with this o tion. Wait for caller to sa that the don't know.
Page .31 of 47
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29. IS YOUR «PERSON'S» CANCER ACTIVE OR IN REMISSION?
Iverson alive, select active or remission based on response.
30. WHAT IS THE NAME OF YOUR «PERSON'S» PRIMARY PHYSICIAN
Record first and last name of person's physician,.
31. WHAT IS THE NAME OF YOUR «PERSON'S» ONCOLOGIST?
Record first and lasC name of oncologist,
Special Instructions: If' you need to explain what an oncologist is, state that an oncologist is a
physician that treats cancer.
32. WHAT IS THE NAME OF THE MEDICAL PRACTICE, HOSPITAL OR FACILITY
THAT PROVIDED TREATMENT:
Record the name, address, city, state, and zip for each facility.
33. MEDICAL RELEASE INFORMATION
Select YES or'NO based on the response.
Special Instructions: If asked why this information is needed, explain that it's possible that a
further look into your «person's» cancer history may be needed for this study. Ask person
if they would be willing to allow the Orange County Health Department to review their
medical files and if they would be willing to provide copies of their medical files. Explain that
only medical files concerning cancer reported during this interview would be needed.. If
person says yes, explain that a medical release statement will be required and that all medical
information obtained will remain confidential and stored in accordance with confidentiality
laws..
34. MAY I CONFIRM YOUR HOME PHONE NiJMBER INCASE I NEED TO CALL
BACK?
Record telephone number with area code.
Data Entry Format: ###-###-####
35. IS THERE AN ANOTHER PHONE iVLJMBER THAT YOU COULD BE REACHED
AT?
Record telephone number with area code,
Data Entry Format: ###-###-####
3G. WHAT'S THE BEST TIME TO CONTACT YOU?
Record preferred time of day.
Work History (related to cancer victim)
37. WHAT IS YOUR «PERSON'S» CURRENT OR JOB OR OCCUPATION?
Record the stated,job or occupation,
Special Instructions: If interviewee says they're unemployed or retired, skip to Question 41.
Use past tense if person is deceased. If cun~ently employed, go to next question.
Page 32 of 47
35
38. WHERE IS THIS EMPLOYMENT POSITION LOCATED?
Record the name, city, and state of the company.
39. WHAT TYPE OF WORK DO YOU DO IN THIS POSITION?
Record the type of work performed in position.
40. WHEN DID YOU BEGIN AND END THIS JOB?
Record the year or work began and the year work ended,
~ecial Instructions: If the person can't remember how long they worked in the position, prompt
them with the following: less than one year, one to five years, six to ten years, ten or more years,
41. WHAT WAS YOUR PREVIOUS JOB?
Record the stated job or occupation.
42. WHERE WAS THIS EMPLOYMENT POSITION LOCATED?
Record the name, city, and state of the company.
43. WHAT TYPE OF WORK DID YOU DO IN THIS POSITION?
Record the type of work performed in position.
44. WHEN DID YOU BEGIN AND END THIS JOB?
Record the year or work began and the year work ended.
~ecial Insu uctions: If the person can't remember how long they worked in [he position, prompt
them with the following: less than one year, one to five years, six to ten years, ten or more years.
S~P~ial Instructions: Repeat Questions 41-44 to obtain worts history. The Health Department
needs this information for the last 3 jobs held by the person with a cancer diagnosis.
Recreational Hazards (related to cancer victinc)
45. DOES YOUR «PERSON» PARTICIPATE IN ANY RECREATIONAL ACTIVITIES
OR HOBBIES THAT EXPOSE THEM TO ANY CHEMICALS?
Select YES or NO based on the response.
Special Instructions: Prompt interviewee with the following examples: dark room for
photography, woodworking shop where you finish furniture, etc.
46. PLEASE LIST OR DESCRIBE ACTIVITY
If yes, record the name or description of the recreational activity in the area provided.
47. ADDITIONAL COMMENTS OR NOTES
Record any additional comments stated by the interviewee,
Page 33 of 47
Appendix 4: NC Cancer Registry Study Report
M nnn
'b' ' rz
~~~,.~
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North Carolina Department of Health and Human Services
Division of Puhlic Health • Office of the State Health Director
1931 Mail Service Center • Raleigh, Noxth Carolina 27699-19.31
Tel 919-707-5000 • Pas 919-870-4829
Mrchnel P Ensley, Govemox
1\-IPI-I
Carmen I-Ioolcer Odom, Secretary
April 21, 2006
Ron Holdway, Director
Enviromnental Health Services Division
Orange County Health Deparrinent
.306-C Revere Road
Hillsborough, NC 27278
Dear Mr. Holdway:
~~
Leah Devlin, DDS,
State Health Director
As we have discussed, I have enclosed our report describing cancer incidence in the Mill Creels area of
Orange County.. At the request of the NC Senate and House of Representatives, copies of neighborhood
cancer evaluations are also sent to those who represent the area of the state being evaluated.
If you have questions regu~ding any of this information, please do not hesitate to contact me at
(919) 715-4556 or Karen I{night@ncmail.net,
Sincerely,
[Signature on file]
Karen L. Knight, Director
NC Central Cancer Registry
State Center for Health Statistics
CC: Paul Buescher, Director, State Center for Health Statistics
Ricl< Langley, Occupational and Envirorunental Epidemiology
Bill Faison, State Representative, District 50
Ioe Haclaley, State Representative, District 54
Verla Inslco, State Representative, District 56
Eleanor I{innaird, State Senator, District 23
[ ncnlion 5(0.5 Sie Forks Rand. 1 n Floor • Raleigh. N C 2760)-381 /
Narlb Carolina Public ncaltl,
War4in9 (o, a Lmi6ier and s>fv Nanh Carolhu
Wery^u erc. Everyday. [vnybndy.
~it~
.O
.M~.
3-~
North Carolina Department of Health and Human Services
Division of Public Health • State Center for Health Statistics
1908 Mail Service Center • Raleigh, North Carolina 27699-1908
Tel 919-733-4728 • Fax 919-733-8485
Michael F Easley, Governor Carmen Hooker Odom,
>ecretary
Preliminary Evaluation of Cancer Cases
Mill Greek Area, Orange County, NC
Apri12006 ~
North Carolina Central Cancer Registry
The Orange County Health Department contacted the North Carolina Central Cancer Registry (CCR)
with a community concern about possible elevated cancer incidence in the Mill Creek Area of Orange
County. The cancers of interest included lung and bronchus, liver, bladder and melanoma (skin) as
these are sometimes associated with environmental exposures.
Reporting of cancer cases to the Central Cancer Registry is required of all health care providers who
diagnose or treat cancer. Most reports are received from hospitals, but physicians whose practices
include cancer patients who are diagnosed and treated in their outpatient clinics also report cases. In
addition, the CCR links its data with death certificate files to be sure that all cancers identified on death
certificates are in the CCR database,
Years under study
This evaluation was restricted to the data collected since 1990 through 2003. 1990 was the earliest
year for which over 90 percent of the State's cases were reported to the CCR. Most of the cases that
are missed are those that are easily diagnosed and treated as outpatient cases, such as cases of
melanoma (skin) and prostate cancer. The CCR data are not yet complete for the years 2004 and
2005, so cases from these years were not included in the analysis.
Cluster Analysis Methods
When investigating clusters of cancer cases, several things are clues to likely associations with
exposures in the community. These include:
1. Groups of cases of all the same type of cancer (such as brain cancer or leukemia), Because
different types of cancer are caused by different things, cases of many different types of cancer
do not constitute a cluster of cases.
2. Groups of cases among children, or ones with an unusual age distribution.
3 Cases diagnosed during a relatively short time interval, Cases diagnosed over a span of years
do not constitute a cluster of cases unless there is consistency in the type of cancer.
~ The North Caxoluia Central Cancer Registry is part of the State Centex for I-Iealth Statistics, Chronic Disease and Injury Section,
Division of Public Health Questions about this report mn}' be directed to the Central Ganccr Registry at 919-715-4555_
Page 35 of 47
~~
4 Clusters of rare cancers. Because lung, breast, colon, and prostate cancers are so common, it
is very difficult to find any association between them and exposures in a community.
These analyses are done on a tiered basis, starting with the county rates, to ensure stable rates and to
identify potential cancer sites or age groups of concern, The results of this analysis were used to focus
on the smaller study area, in particular, the Mill Creek Area of Orange County,
Geographic Analysis
Delineation of a study area was a central focus of this study.. A primary concern to some homeowners
is the incidence of naturally occurring arsenic in wells. Because not all privately maintained wells in
Orange County or in the Mill Creek area have been tested for arsenic, it was not possible to accurately
delineate a study area based on that criterion. Instead, the study area delineation focused on a set of
addresses submitted to the North Carolina Central Cancer Registry by the Orange County Health
Department, which were used in a subsequent survey of homeowners. The initial study area
comprised of two Census Block Groups used by the Census Bureau for the 2000 U S. census, which
encompassed these addresses. The Census Bureau identifier numbers for these Block Groups are
1350108012 and 1350111012 (see attached exhibit). To garner input on the study area, the CCR
submitted this study area at an early stage in the analysis to the Orange County Health Department for
their review and the study area was finalized to include the two aforementioned Census Block Groups.
All bladder, liver, melanoma and Tung cancer cases were identified for the time period 1990-2003 in the
CCR database for Orange County, for cases whose city of residence at time of diagnosis was Mebane,
and all records for which the ZIP code at time of diagnosis was 27302. These records were geocoded
using a combination of county-maintained digital parcel-derived addresses, and vendor-maintained
digital street centerlines, The geocoding success rate was 98%, for records that had a geocodeable
street address. A rigorous attempt was made to geocode every record based on street address, city
and ZIP code, A total of 57 records were geocoded to within the study area.
The CCR has no residential, occupational or medical histories about cases, The CCR uses the
residence at the time of diagnosis as provided by the diagnosing facility to analyze cases by residence.
It is recognized that this may not be the relevant address in terms of etiology for a disease with a long
latency period, especially given the mobility of many populations. However, since we do not know at
what point the disease process that was later diagnosed as a malignant tumor actually began, it is not
possible to know what the relevant address is The focus of the CCR is on cancer surveillance, and
hence, we use the address at diagnosis. This approach is consistent with procedures used by all other
cancer registries in the United States including the National Cancer Institute's Surveillance,
Epidemiology and End Results (SEER) program, the North American Association of Central Cancer
Registries, and the Centers for Disease Control and Prevention. Incidence rates for a chronic disease
with a long latency period are useful for disease surveillance, but they may not be good indicators for
investigating the etiology of a disease. The CCR also uses the date of diagnosis as provided by the
reporting facility to determine in which year to classify each case,
Page .36 of 47
3`'i
Results
Cancer incidence rates were calculated for Orange County and compared with the corresponding State
rates, Estimated populations from the State Demographer's office2 were used to calculate the rates..
Note that all rates that appear in this report were age-adjusted to the United States 2000 population, as
estimated by the United States Census, All rates are expressed as cases per 100,000 population.
(These data should not be compared with published National Cancer Institute SEER incidence data or
with incidence data from the North American Association of Central Cancer Registries without verifying
that the same standard population was used for age-adjusting the rates.)
Table 1 shows age-adjusted incidence rates for cancer sites under study for Orange County and North
Carolina. These cases were all diagnosed between 1990 and 2003. Incidence rates for melanoma in
Orange County are slightly elevated. Rates for the cancer sites under study are displayed in Figure 1
for comparison,
Table 1.Age-Adjusted Cancer Incidence Rates,
1990-2003
North Carolina Orange County
Site Number Rate Number Rate
Liver 3,250 3.2 40 3.6
Lung/Bronchus 72,207 69.6 686 61..9
Melanoma 12,843 12.4 196 14.6
Bladder 17,858 17.5 190 17.2
a http://demog state nc us/
Page 37 of 47
~-D
Figure 1 -Age-Adjusted Incidence Rates 1990-2003
Orange County and North Carolina
Five-year (1999-2003) incidence rates were also computed and the results were similar to those found
for the period 1990-2003. None of these rates were found to be significantly higher than North Carolina
rates3.Trends in cancer incidence rates were also examined for all cancers combined. Trends in age-
adjusted rates for all cancers combined are presented in Figure 2 below. There does not appear to be
a temporal pattern in the rates.
Figure 2 -Age-Adjusted Incidence Rates by Year
All Cancers Combined, Orange County and North Carolina
soo -
500
°0 400 - ---
0
0
`m 300 - - ----- ---
a
~ --
200 -
--+-Qrange
100 -ta-North Carolina
0
~9 ~~ ~9 ~9 ^9 ~9 ~9 ~9 ~~ ~9 ti~ ti~ ti~ ti~
Year
95"/" confidence interv:ils mere calculated For the age adjusted incidence rates, using the method described in Fa}' IVIP, Feuer EJ
Confidence intervals Eor directl}' standardized rates: r1 method based on the Gamma distribution Statistics in IVfedicine
1997;16:791-807
Page 38 of 47
~l
The distribution of types of cancer were examined as well as age patterns. The four major cancers (lung,
colon, female breast and prostate) account for more than 59% cancer cases in Orange County. Pediatric
cancers comprise 1 % of the cases. And 81 % of the cases are of patients 50 years and over. Thus, the
age pattern of these cases is quite consistent with what is normally seen with cancer cases, i.e. the
majority of cancers occur at older ages.
In examining the Mill Creek area of Orange county, the observed number of cases was compared to the
expected number of cases. The expected number of cases is calculated assuming that the population
had the same incidence rates as the State. The procedure used for calculating the expected number of
cases for each block group was to apply the age/gender-specific cancer incidence rates for the State to
the age/gender-specific populations of the census block groups in the study area. This gives an
expected number of cases for each age and gender group.. These were added to arrive at an expected
number for the entire census block group. The census block groups were summed to form an expected
number of cases in the study area, as indicated in Table 3,
*S
Table 3. Observed and Ex ected Cases in Stud Area, 1990-2003
95%
Confidence
Interval"
Site Observed Expected Observed/Expected (Lower,Upper)
Liver <5 <5 1.67 (-0.:22, 3.55)
Melanoma 12 7.7 1.56 (0,68, 2.44)
Bladder 10 93 L08 (0.41, 1,74)
Luna 32 39 0.82 0.54, 1.10
nnnressed to maintain confidentiality.
There were fewer lung cancer cases observed than were expected and approximately the same number
of bladder cancer cases as were expected. The observed cases for melanoma and liver cancer were
somewhat higher than expected, but the difference was not statistically significant.
Summary
There were 1.56 times as many observed melanoma cancer cases in the study area than were expected.
However, the 95% confidence interval for the ratio of observed to expected includes 1.0, indicating a lack
of statistical significance. This is one tool used in evaluating the relevance of an association, but
statistical significance does not imply causation, nor does the lack of statistical significance address the
issue of biological relevance. One explanation for the slightly higher rate is that melanoma reporting in
Orange County is better than statewide melanoma reporting,
At this time, the data do not suggest a clustering of cancer cases in the MiII Creek area and no further
studies are suggested..
a 95% Confidence Intervals were calculated fox the rate ratios using the method described by Breslow and L)ay in: Breslow NE and
Da}' NE Stalirliral tbtelGadr iu Caucer RerearcG, Vnhuue II, Lyon, Prance: Bxtcrnationnl Agency for Research on Cancex, IARG Scienti£c
Publications N0.32,1987,p 59
Page 39 of 47
Proposed Study Area for Mill Creek Investigation, September 2005
/ r i ~ ® - -_ Legend. _
o Survey Addresses Supplied by Mr Holdvray
.~~,
~ Area!of Interest r . ®Orange County Street Centerline - GDT
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,NWQrangeCounty,,N(: ~Propased5tudyArea_Based_on_Survey_Addresses
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Page 40 of 47
Appendix 5: Water Study Invitation Letters ~"
NOTICE
ORANGE COUNTY
HEALTH DEPARTMENT
Rosemary L. Summers,
MPH, DrPH
Health Director
Richard E- Whitted Human
Services Center
300 West Tryon Street
Post OfRce Box 6181
Hillsborough, NC 27278
Phone: (919)245-2411
Fax: (919) 644-3007
www m gcange nc us/health
Central Administratlve
Services
Dental Health Services
Environmental Health Services
Health Promotion and
Education Services
Personal Health Services
306-C Revere Road
P O Box 8181
Hillsborough, NC 27278
Phone: (919) 245-2361
FAX: (919)644-3006
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August 31, 2005
TO: Selected Property Owners or Current Residents on Mill Creels and High Rock
Roads in Cedar Grove
Staff of the Orange County Health Department will be conducting a study of well water
quality along specific stretches of Mill Creek and High Rock Roads in coming weeks,
begimring the second week of September. The study was approved at recent meetings
of the Or°ange County Boards of I-Iealth and County Commissioners in response to
concerns fiom conununity members in that area about well water quality and cancer
rates. A separate study of cancer rates in the community using phone interviews will
also occur in September.
Participation in the well water quality study is completely voluntary and you are under
no obligation to respond to this notice- If you choose to participate, please complete the
attached application and return it by September l4°i to the Orange County Health
Department. Alternately, you can fill it out and give it to Glenda or .Joe Holloway who
live at 4620 Mill Creek Road and they will deliver it to us for action. There will be no
chu e for any water sample conducted as part of this study..
Please understand that the water samples results are subject to open records laws but
will not contain any medical information. The application must be signed by the owner
or tenant before we can collect any samples so please be sure to sign that portion of the
form prior to returning it. The samples will include bacteriological, inorganic chemical,
petroleum, pesticide and radon tests.. The air portion of the radon takes three days to
complete, so we will arrange to pick the Icit up from your home after it is finished..
There will be no action required by the Health Department for water problems
discovered during the survey unless the home is rented.. Our office will provide advice
and reconunendations to owners who wish to fix problems in their own home. If the
property is rented, and the water is found unsafe to drink, we will work with the
landlord to correct the problem as required by the appropriate laws and rules.
Your participation in this study is very important to you and your cornmwrity, so please
give it carefiil consideration before declining. If you have questions, please give the
Environmental Health office a call at 919-245-2360 and we will gladly attempt to
address any concerns that you may have.
Dr. Rosemary Summers, Orange County Health Director
Ron Holdway, Orange County Environmental Health Services Director
Page 41 of 47
Appendix 5: Water Study Invitation Letters
NOTIC>;J .Q-a-
ORANGE COUNTY
HEALTH DEPARTMENT
Rosemary L Summers,
MPH, DrPH
Health Director
Richard E. Whiffed Human
Services Center
300 West Tryon Street
Post Office Box BS81
Hillsborough, NC 27278
Phone: (919)245-2411
Fax: (919) 694-3007
www ro orange nc us/health
Central Administrative
Services
Dental Health Services
Environmental Health Services
Health Promotion and
Education Services
Personal Health Services
306-C Revere Road
P O Box 8181
Hillsborough, NC 27278
Phone: (919) 245-2361
FAX: (9i9) 694-3006
November 8th, 2005
TO: Selected Property Owners or Current Residents on Mill Creek and High Rock
Roads in Cedar Grove
This is a second mailing of a letter that was sent in September to selected Mill Creek
Road area residents. We are repeating the mailing in hopes that you will respond by
requesting a water sample analyses and answering a telephone survey. Orange County
Health Department staff is conducting a study of well water quality along specific
stretches of Mill Creek and High Rock Roads. The study was approved at recent
meetings of the Orange County Boards of Health and County Commissioners in
response to concerns from community members in that area about well water quality
and cancer rates. A separate study of cancer rates in the community using phone
interviews will also occur tluough December.
Participation in the well water quality study is completely voluntary and you are under
no obligation to respond to this notice. If you choose to participate, please complete the
attached application and return it by November .30th to the Orange County Health
Department. Alternately, you catr fill it out and give it to Glenda or Joe Holloway who
live at 4620 Mill Creek Road and they will deliver it to us for action. There will be no
char e for any water sample conducted as part of this study.
Please understated that the water samples results are subject to open records laws but
will not contain any medical information. The application must be signed by the owner
or tenant before we can collect samples so please be sure to include your telephone
number and sign that portion of the form prior to returning it. The samples will include
bacteriological, inorganic chemical, petroleum, pesticide and radon tests. The air
portion of the radon takes two to four days to complete, so we will arrange to pick the
kit up from your home after it is finished.
There will be no action required by the Health Department for water problems
discovered during the survey unless the home is rented. Our office will provide advice
and recommendations to owners who wish to fix problems in their own home. If the
property is rented, and the water is found unsafe to drink, we will work with the
landlord to correct the problem as required by the appropriate laws and rules.
z
Your participation in this study is very important to you and your community, so please
give it careful consideration before declining. If you have questions, please give the
Environmental Health office a call at 919-245-2360 and we will gladly attempt to
address any concerns that you may have..
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Dr. Rosemary Sununers, Orange County Health Director
Ron Holdway, Orange County Enviromnental Health Services Director
Page 42 of 47
Appendix 5: Water Study Invitation Letters
FINAL MAILING 4'S
a~~,s
ORANGE COUNTY
HEALTH DEPARTMENT
Rosemary L.. Summers,
MPH, DrPH
Health Director
Richard E. Whiffed Human
Services Center
300 West Tryon Street
Post Office Box 8181
Hillsborough, NC 27278
Phone: (919) 245-2411
Fax: (919) 644-3007
www w o2noe nc us/health
Central Administrative
Services
Dental Health Services
Environmental Health Services
Health Promotion and
Education Services
Personal Health Services
306-C Revere Road
P 0 Box 8181
Hillsborough, NC 27278
Phone: (919) 245-2361
FAX: (919) 6443006
December 151, 2005
TO: Selected Property Owners or Current Residents on Mill Creek and High Rock
Roads in Cedar Grove
z
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This is a third and final mailing of a letter that was sent in September to selected Mill
Creek Road area residents. We are repeating the mailing in hopes that you will
respond by requesting a water sample analyses and answering a telephone survey,
Orange County Health Department staff is conducting a study of well water quality
along specif c stretches of Mill Creek and High Rock Roads. The study was
approved at recent meetings of the Orange County Boards of Health and County
Commissioners in response to concerns from community members in that area about
well water quality and cancer rates. A separate study of cancer rates in the
community using phone interviews will also occur through December.
Participation in the well water quality study is completely voluntary and you are
under no obligation to respond to this notice. If you choose to participate, please
complete the attached application and return it by November 30th to the Orange
County Health Department. Alternately, you can fill it out and give it to Glenda or
Joe Holloway who live at 4620 Mill Creels Road and they will deliver it to us for
action. TH>iR>; WILL BE NO CHARG); FOR ANY WATER SAMPL>;
CONDUCTED AS PART OF THIS STUDY.
Please understand that the water samples results are subject to open records laws but
will not contain any medical information. The application must be signed by the
owner or tenant before we can collect samples so please be sure to include your
telephone number and sign that portion of the form prior to rettuning it. The samples
will include bacteriological, inorganic chemical, petroleum, pesticide and radon tests.
The air portion of the radon takes two to four days to complete, so we will arrange to
pick the kit up firoln your home after it is finished.
There will be no action required by the Health Department for' water problems
discovered during the survey unless the home is rented. Our offce will provide
advice and recommendations to owners who wish to fix problems in their own home.
If the property is rented, and the water is found unsafe to dril~lc, we will work with the
landlord to correct the problem as required by the appropriate laws and rules.
Yotu participation in this study is very important to you and your community, so
please give it careful consideration before declining. If you have questions, please
give the Earvironmental Health office a call at 919-345-2.360 and we will gladly
attempt to address any concerns that you may have.
Dr. Rosemary Sununers, Orange County 1-Iealth Director
Ron Holdway, Orange County Environmental health Services Director
Page 43 of 47
Appendix 6: Well Water Study Application
Mill Creels Road Area
Well Water Study
Application
APD # WSOS-
OWNER:
ADDRESS
PHONENUMBBR
SUBDIV[SION / L
Orange County Health Department ~-~j
Environmental Health Division
P.O.Box 8181,306-C Revere Road
Hillsborough, NC 27278
www.co orange.nc.us
TMBL. #
_ PI-ZONE NUMBER
DIRECTIONS /LOCATION _
DATE DR11~L6D
HAS THIS WELL BEEN SAMPLED BY OCFID 13L=PORB? N^
WHEN WAS THE WELL LAST CI-ILORINAT6D?
DESCRtBL- ANY CUR.REN7 PROBLEMS WITH YOUR WATER
APPLICANT:
ADDRESS
Y^ GIVE DATL- AND RESULTS
IS 7HL•RE A TREATMEN~i SYSTEM'? N^ Y^
WI1AT TYPL•? O Filler O Softener O Neutralizer
O Chlorinator O Ultraviolet Light O Other
WATER SAMPLES MUST BE REQUESTED HY THE OWNER OR TENANT WITH A SIGNATURE AUTIIORIZING THE OCHD TO ENTER THE
PROPER'iY l"O COLLECT TFIG SAMPLES
TI18 WELT. iIEAD AND SAMPLING SPIGOTS MUST BE EXPOSED AND MADE ACCESSIBLE TO THE OCHD
THE WELL SHOULD NOT BE CFILORINATED PRIOR TO SAMPLING UNLESS INSTRUCTED BY THH OCIiD
IfE2Ff3}':1 UTHORI7_G THE OCHD TO ENTL• R THC• PROPC•RT)' AND P£RFORA~f THE SERI'/C[ RLOUC•STLD
OWNER/TENANT: DATE:
RETURN THIS rORD1 TO: ORANGE COUNTY I-IL-AL~T[-1 D6PARTML-NT,
ENVIRONMENTAL. HEAL~TI-1 SERVICES DIVISION:
.306-C RL• V ERL- RD ,
1-IILL.SBOROUGH,NC 27278
OR TO T11E FIOLL.OWAYS (GLGNDA OR. 106) AT-4620 MILL CREEK ROAD
~• ® C ~ ~ ~ •
Sample Collection Information:
Bacteriological: by , RS
Inorg Chemical: by , RS
Petroleum: by , RS
Pesticide: by ' RS
by , RS
Radon (water):
Radon (air): by , RS
Page 44 of 47
Appendix 7: Water Test Results Letter to Households
ORANGE COUNTY
HEALTH DEPARTMENT
Rosemary L Summers,
MPH, DrPH
Health Director
Richard E. Whiffed Human
Services Center
300 West Tryon Street
Post Ofnce Box 8181
Hillsborough, NC 27276
Phone: (919) 245-2411
Fax: (919) 644-3007
www co o~anoe nc us/health
Central Administrative
Services
Dental Health Services
Environmental Health
Services
Health Promotion and
Education Services
Personal Health Services
306-C Revere Road
P O Box 8181
Hillsborough, NC 27278
Phone:(9i9)246-236D
FAX: (919)644-3006
February 13, 2006
Homeowner or° tenant:
PROP]aRTY ADDRESS»
«PROP_ADDR);SS_2» «PROP_STAT>;»
«OWNIrIb>«OWNI;R2»
4~
aPROP_ZIP»
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Representatives from the Orange County Health Department sampled water from the
well serving the property located at «PROP)/RTY ADDR1/SS». (TMBL «TMBL»]
The water sample results from your well are shown in the tables below:
Bacteriologic results
Coliform bacteria is ffi1 indicator bacteria that the lab looks for to indicate whether a
well is protected from sources of contamination. The Coliform bacteria is not a
harmful bacteria, but its presence indicates that the water could become contaminated
with bacteria that could cause health problems such as diarrhea, upset stomach,
Cramps, and vomiting. Wells that show the presence of Coliform bacteria should not be
Considered safe sources of water and should be either re aired, disinfected, or re laced.
YOUr Water Acceptable Level Recommendations
Raw Sam le» Absent for Coliform bacteria «rec bact»
Petrolel.Iln results
Contamination from petroleum products can occur from leaking underground storage
tanks or ifpetroleum-Containing Chemicals are spilled or leak from containers near
your well. It is reconunended that the well house not be used to store any chemicals,
YOUr Water Acceptable Level Recommendations
«PetrDl» varies «rec~etro]»
Pesticide results
Contamination from pesticide compounds can occur when wells are not properly
protected and chemicals have entered the well from agricultural sources or from
te17111te treatlnellt On 11ec'll"by StrUCtUIeS.
yOltl- Water Acceptable Level Recommendations
«Pest» "None Detected" <(reC eSt»
Tnorgallic chemical results
Your water was tested for 13 inorganic characteristics. Please refer to the enclosed
report sheet if you would like to see the actual concentrations. These can be compared
with the recommended levels on the back of that sheet. With the exception of Lead
and Al-senic, most of the inorganic chemicals do not adversely affect your health, but
can cause significant nuisance issues. If your water has a low pH or a high iron
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/manganese content, you may want to contact a company that sells water treatment systems. If you " fZ~
are having other significant problems with water quality or quantity, you may want to consider well
repair or well replacement Please contact our office to discuss your options.
Your water was acceptable for all of the inorganic chemical properties except the following:
Parameter Ypllr Water Acceptable Level Comments
Iron «IRON» m /1 0.3 mg/1 or below Can cause red, black, or
Manganese «MANGANESE»
m /1 0.05 mg/I or below muddy water, stains
white fixtures and clothes
PH «pH» Above 6.4 Can cause metallic taste,
blue/green stains,
corrosion of metal i es
Arsenic uArsenic» m /1 .O1 mg/1 or below «rec arsenic»
Radon in water results
Radon is a naturally occurring radioactive element found in most of NC's groundwater, especially in
the Piedmont area where granite is conunon. Radon exposure fi`om drir-dcing water is not a serious
tlueat to health, however, when radon becomes airborne such as such as tluough a showerhead, it
can raise the levels of radon in the air. See the next chart for' the amount of radon detected in your
air
Your Water (pCi/1) Acceptable Level Recommendations
«Radon Water results 3
00» 300 or below urec_radon_water»
Radon in air results
Radon can build up in the air in a home under certain circumstances when adequate air exchange
with fresh air is not provided. Approximately one out of 10 homes in North Car°olina has an airborne
radon level above 4 pCi/L. Inhalation of radon over extended periods is linked to an increased risk
of lung cancer.
Your Air (pCi/1) Acceptable Level Recommendations
«Radon_Air_results_4» 4.0 or below ((r eC 1"adOri a1T»
Full lab analyses reports for all of your samples taken are available to you by contacting our office.
Should you have any questions regarding these results, or any of the recommendations, please do not
hesitate to contact the Environmental Health Section at 919-245-3360,
~«-G
Ron Holdway, R.S.
Envirorm~ental I-Iealth Director
Tom IConsler-, R.S.
Environmental Health Supervisor
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Appendix 8: List of Educational Materials Left with Homeowners /'
Educational Materials Contained in Homeowners Packet
• Clinical services guide for the Orange County Health DepaiCment Clinics
• Cover note with Health Deparhnent Mission Statement and contact numbers
• Dental care and services information with Smart Start insert
• Disaster preparedness checklist
• Flu vaccine clinic schedule along with other connnunicable disease prevention
information
• Lead poisoning in children prevention tips
• MAN for Health brochure
• Mosquito control and prevention sheet (English and Spanish versions)
• Nuts°ition and exercise tips
• OCHD logo pen and pencil
• Septic system operation acid maintenance guides
• Teenage tobacco use prevention brochure (TRU Campaign)
• Well operation and maintenance guide
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