WQ0001664_Monitoring - 07-2022_20220815 (2)

DWR - NonDischarge Monitoring Report Submittal
NORTH CAROLINA
EnvOranm@nlrtl Qua,ly
Monitoring Report Submittal
Permit Number#* WQ0001664
Name of Facility:* Belvedere Plantations WWTF
Month:* July Year:* 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR Belvedere July WWTP 2022 7.95MB
DMR Signed.pdf
PDF Only
GW-59 Belvedere MW July 2022 14.5MB
Signed.pdf
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Greg Spillman
Signature:
Date of submittal: 8/15/2022
This will be filled in automatically

Initial Review
..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Reviewer: Gerald,Wanda
Is the project number correct?* WQ0001664
Is the monitoring report accepted?* Yes No
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 8/16/2022

SUBMIT FORM ON YELLOW PAPER ONLY
•
Mail original •EPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy t0: DIVISION OF WATER RESOURCES-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER.RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date 1/31i2020
Facility Name. Belvedere Plantation Non-Discharge WQ0001664 UIC
Permit Name(if different) NPDES Other
Facility Address 130 Fairway Dr Hampstead N.0 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
_ County Pender ❑ Lagoon ❑Remediation Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person Greg Spillman Telephone# [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name #3 Green No of wells to be sampled: 9 ❑ Water Source Heat Pump ❑Other INFILTRATION BASIN
(from Permt) _
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW7 Date sample collected: 7/5/2022 _ FIELD ANALYSES: WAS
Well Depth 17 ft Well Diameter 2 in pH o0400 6 8 units Temp 000it `"` -'C DRY at
Depth to Water Level 82546 7 Screened Interval 5 ft to 15 ft Spec. Cond 00094 (tMhOS time of
None sampling.
Measuring Point is 3 ft above land surface Relative M P. Elevation ft Odor 00085 _�- check
Volume of water pumped/bailed before sampling' 5 gallons Appearance mostly clear here l
Samples for metals were collected unfiltered ❑YES ❑ NO and field acidified. ❑YES ❑ NO 1--_J
LABORATORY INFORMATION
Date sample analyzed _ 7/5/2022 Laboratory Name Environmental Chemists. Inc. Certification No 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L. Nitrite(NO2)as N o0615 0.03 mg/L Pb . Lead°lost ug/L
Coliform: MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.5 mg/L Zn-Zinc o109z �_.. mg/L
Coliform MF Total 31504 /100mL Phosphorus Total as P 00665 0 66 mg/L
(Note Use MPN method for hrgtrty turbid samples; Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
'Dissolved Solids Total 70300 119 mg/L Al-Aluminum otto5 mg/1._
pH (Lab)00403 6 8 units Ba-Barium 01007 ug/L
TOC 00680 rng/L Ca-Calcium costs mg/L
Chloride 00940 11 mg/L Cd-Cadmium 01027 ug/L
•Arsenic 01002 ug/L Chromium: Total ot034 ug/L .
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC. GC/MS. HPLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate oo945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 tiMhos K-Potassium 00937 mg/L VOC 7873 .method#
Total Ammonia 00610 <0.2 mg/L Mg-Magnesium 00927 mg/L , method#
m _
(Ammonia Nitrogen.
-.------------._.__.
ogen.NH,as N.Ammonia Nitrogen Total) Mn -Manganese 01055 ug/L . method#
TKN as N oos2s mg/L Ni -Nickel 01067 ug/L . method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs• rng!L Effluent Total VOCs mg/L VOC Removal%
I certify that,to the best of my knowledge arid belief the information submitted in this report is true.accurate.and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
MR-certified laboratory I am aware that there are significant penalties for submitting false information including the possibility of fines and imprisonment for knowing violations.
Dana Hill,Director of Operations Dana Hill
Permitted(or Authorized Agent)Name and hue-Please Orin+or hive -a;r;
GW-59 Rev.8/2013

':l.7)MIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and l Copy to DIVISION OF WATER RESOURCES-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH.NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date 1/31/2020
Facility Name Belvedere Plantation Non-Discharge WQ0001664 UIC _
Permit Name(if different) NPDES Other
Facility Address 130 Fairway Dr Hampstead N C 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
County Pender ❑ Lagoon ❑ Remediation Infiltration Gallery
Li Spray Field ❑ Remediation
Contact Person: Greg Spillman Telephone# [phone] L.i Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name #7 Green No of wells to be sampled 9 ❑ Water Source Heat Pump ❑ Other INFILTRATION BASINS
----- ..__ ;,Ton,Perrot: _
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW8 Date sample collected. 7/6/2022 FIELD ANALYSES: WAS
Well Depth 18 ft Well Diameter 2 in pH o0400 6 1 units Temp 000lc `1' 'C DRY at
Depth to Water Level 82546 9 6 Screened Interval 5 ft to 15 ft. Spec Cond 00094 ).iMhos time of
None sampling,
Measuring Point is 3 ft above land surface Relative M P Elevation- _ft Odor o0085 __ __..__ check
Volume of water pumped/bailed before sampling: 5 gallons Appearance Orange here:r--1
Samples for metals were collected unfiltered ❑YES. ❑ NO and field acidified ❑YES ❑ NO L--J
LABORATORY INFORMATION
Date sample analyzed 7/512022 Laboratory Name Environmental Chemists. Inc Certification No 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 0 02 mg/L Pb-Lead oios1 ugiL
Coliform MF Fecal 31616 <1 tt100mL Nitrate(NO3)as N 00620 0 04 mg/L Zn-Zinc 01092 rng/L
Coliform MF Total 31504 I100mL Phosphorus Total as P 00665 1 16 mg/L
(Note Use MPH method for highly turtid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
)issolved Solids:Total 70300 81 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 6.1 units Ba- Barium 01007 ugiL
TOC o06s0 mg/L Ca-Calcium 00916_� _ mg/L
Chloride 00940 8 mg/L Cd-Cadmium 01027 _ ug/L
. Arsenic 01002 _ugiL . Chromium:Total 01034 ugiL
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC GC/MS. HPLC)
Phenol 32730 ugiL Fe-Iron o1045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 _ ugiL Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 ((Mhos K- Potassium 0os37 mg/L VOC 'a_:_ . method#
Total Ammonia 00610 <0.2 mg/L Mg-Magnesium 00927 mg/L , method#
iArnrnon,a Nitrogen:NH,as N.Ammonia Nitrogen.Total; Mn-Manganese 01055 ug/L method#
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs mg/L Effluent Total VOCs. mg/i.. VOC Removal%
I certify that.to the best of my knowledge and belief the information submitted in this repon:s true,accurate.and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-certrtied laboratory. I am aware that there are significant penalties for submitting false information including the possibility of fines and imprisonment for knowing violations
uo..iN.wua by Da.N.n
Hill DN.on 1 am I.
01.d.urn E•tl.na ninec.roin.vrobr.ervsonc coin
Dana Hill,Director of Operations Reason S.min..uNC CNnntlo<,rm.nl
,baron your mo.p boron nor.
Permittee for Authorized Anent)Name and Title-Please print Cr Noe Signature oPanmittee Orf uthorized Aaenfi rovil PDr Ella rver,on,122 !Date;
GW-59 Rev.8/2013

1 ",i YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT a NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: DIVISION OF WATER RESOURCES•INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH.NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Pant Clearly or Type PERMIT Number: Expiration Date 1/31/2020
Facility Name. _ Belvedere Plantation _ ^� Non-Discharge W00001664 UIC
Permit Name(if different) —_._._.__._.____.__._. NPDES Other
Facility Address 130 Fairway Dr Hampstead N C 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
County Pender [ Lagoon ❑ Remediation Infiltration Gallery-
LI Spray Field ❑ Remediation:
Contact Person Greg Spillman Telephone# [phone] D Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name #3 Green near woods No of wells to be sampled: 9 ❑ Water Source Heat Pump L...] Other: INFILTRATION BASINS
,from Fermat'<
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW9 Date sample collected 7/5/2022 FIELD ANALYSES: WAS
Well Depth 23 ft. a Well Diameter 2 in. pH o040o 6 7 units Temp 000t: ' � ' 'C DRY at
Depth to Water Level 82546 19 Screened Interval. 5 ft. to 15 ft Spec Cond 00094 1iMhos time of
_— None sampling,
Measuring Point is 3 ft. above land surface Relative M.P Elevation ft Odor 00085 — check
Volume of water pumped/bailed before sampling 5 gallons Appearance _ light orange here:"—]
Samples for metals were collected unfiltered ❑YES L_.J NO and field acidified: t=..;YES L i NO
LABORATORY INFORMATION
Date sample analyzed_ _ 7/5/2022 Laboratory Name Environmental Chemists. Inc Certification No 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO )as N 00615 0.03 mg/L Pb -Lead 01051 ug/L
Coliform MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 0as20 0 37 mg/L Zn-Zinc o1092 —mg/L
Coliform MF Total 31504 /100mL Phosphorus:Total as P 00665 0 45 mg/L
!Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
5issolved Solids.Total 70300 175 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 6.7 units Ba- Barium 01007 ugiL _
TOC Dow mg/L Ca-Calcium owe _ mg/L
Chloride 00940 52 mg/L Cd-Cadmium 01027 ug/L
Arsenic 01oa2 a ugiL Chromium: Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC. GC/MS. HPLC)
Phenol 32730 ugiL Fe-Iron 01045 ugiL (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 - mg/L Hg-Mercury 71900 ugiL Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 11Mhos K-Potassium 00937 mg/L VOC 7873 _ : method#
Total Ammonia 00610 <0.2 mg/L Mg -Magnesium 00927 mg/L . method# _
!Ammonia Nitrogen,NH3 as N.Ammonia Nitrogen.Total) Mn- Manganese 01055 _ ug/L _ . method#
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L . method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs mg/L Effluent Total VOCs. mg/L VOC Removal%
—I certify that to the best of my knowledge and belief.the information submitted 1n ti-i s report is true,accurate and compete,and that the laboratory anaiyncai data was produced using approved methods of analysis by a
DWR-ce rlif ed laboratory t am aware that there are significant pena[tles for s:,bmittrIg raise`nfor aatc.: ,nduding the ncssrbitity of tines and imprisonment for knowing violations
Drgrtally signed by Dana Hel
Dana Hill, Director of OperationsU In I IDN Ce US.OeCWSNC CN=Dana Hill Eedana hill®carohnewatemenrcenc corn
Rea�' Locao m the e,Inuthor ofthisdoamenl
Loca[pp Yn��.ewe,rnrmn r+ww
Permtttee(or Authorized Aoenti Name and Title..Please Oral or Type Signature Of Darllet A.0 Date 2022 08 12 15 29 32-041)0' ;Gate, —'-'-'4
Fozd PDF Edaor Version 11 2 2
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail originalDEPARTMENTOFENVIRONMENT&NATURAL-RESOURCES
and 1 copy to. DIVISION OF WATER RESOURCES-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL.SERVICE CENTER,RALEIGH.NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Pont Clearly or Type PERMIT Number: Expiration Date. 1131 2020
Facility Name Belvedere Plantation Non-Discharge W00001664 UIC
Permit Name(if different) NPDES Other
Facility Address 130 Fairway Dr Hampstead N C 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
County Pender ❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person Greg Spillman - _Telephone# [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name #3 green near tee box No. of wells to be sampled 9 ❑ Water Source Heat Pump ❑ Other INFILTRATION BASINS
,ii,;,r Permti
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW10 Date sample collected 7/5/2022 FIELD ANALYSES: WAS
Well Depth 18 ft Well Diameter 2 in pH 00400 6.8 units Temp o001c 2 6 C DRY at
Depth to Water Level 82546: 7.3 ft below measuring point Screened Interval 5 ft to 15 ft Spec Cond o00oe tlMhos time of
None sampling.
Measuring Point is 3 ft above land surface Relative M P Elevation ft Odor o008s check
Volume of water pumped/bailed before sampling 5 gallons Appearance Orange here
Samples for metals were collected unfiltered ❑YES a NO and field acidified. ❑YES ❑ NO _._...____.___
LABORATORY INFORMATION
Date sample analyzed 7/5/2022 Laboratory Name Environmental Chemists: Inc Certification No 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 0.02 mg/L Pb-Lead oiosf uglL
Coliform:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0 48 mg/L Zn-Zinc 01092 mg/L
Coliform MF Total 31504 !100mL Phosphorus: Total as P 00665 0 38 mg/L
:Note Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
Dissolved Solids Total 70300 110 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 6.8 units Ba-Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium 00916 mg/L _
Chloride oo9ao 9 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002. uglL Chromium Total 01034 . ug/L
Grease and Oils 00552 mg/L. Cu-Copper o1042 mg/L ORGANICS: (by GC. GC/MS HPLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) Li No(0)
Specific Conductance 00095 iMhos K-Potassium 00937 mg/L VOC 7 a: . method#
Total Ammonia 00610 <0 2 mg/L Mg-Magnesium 00927 mg/L method#
(Ammonia Nitrogen.NH3 asN.Ammonia Nitrogen.Total)
Mn-Manganese()loss ug/L . method#
_ _
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs mg/L Effluent Total VOCs mg/L VOC Removal% _
I certify that,to the best of my knowledge and belief.the information submitted in this report is true,accurate.and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-Certified laboratory. I am aware that there are significant penalties for submitting false nfOrmation in duding the 0Jss1)itrty of fines and imprisonment for knowing violations
o CA.Moi.0.CWSNM.O.
Re Cam.dCVYSNC.of On do M.EM.1.M.OcaroYn.w..nuwnc ran
Dana Hill, Director of Operations .....i...».W..at.a Uxun«.
Permittee for Authorized Agent)Name and Title Please print or tape Signature of Pe.- i Date',
OW-59 Rev 8/2013

SUBMIT FORM ON YELLOW PAPER ONL..
Malt original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: DIVISION OF WATER RESOURCES-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1817 Phone:919,807.6306
"!E•ase Font Clearly of Type
FACILITY INFORMATION PERMIT Number: Expiration Date 1/31/2020
Facility Name. Belvedere Plantation Non-Discharge W00001664 UIC
Permit Name(if different) __. NPDES Other _____
Facility Address 130 Fairway Dr Hampstead N C 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
— — _ — County Pender ❑ Lagoon -❑ Remediation: Infiltration Gallery
Li Spray Field ❑ Remediation:
^Contact Person Greg Spillman Telephone# [phone] LiRotary Distributor ClLand Application of Sludge
Well Location/Site Name Basin A right corner No of wells to be sampled: 9 ❑ Water Source Heat Pump 0 Other INFLITRATION BASINS
(from Permits
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): _ MW 11 Date sample collected- 7/5/2022 FIELD ANALYSES: WAS
Well Depth 15 ft. — Well Diameter 2 in. pH 00490 4 9 units Temp 000l( ')C DRY at
Depth to Water Level 8254s: 12 13 Screened Interval. 5 ft to 15 ft Spec. Cond 00094 IiMhos . time of
Sulfursampling
Measuring Point is 3 ft above land surface Relative M P Elevation ft Odor 00085check
Volume of water pumped/bailed before sampling: 5 gallons Appearance Light Tan here 1
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑ NO �
— _LABORATORY INFORMATION
Date sample analyzed 7/5/2022 Laboratory Name Environmental Chemists Inc Certification No 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N oo81s <0.02 mg/L Pb -Lead 01051 ug!L
Coliform: MF Fecal 31616 <1 /100mL Nitrate(NO3)as N G0620 <0.02 mg/L Zn-Zinc 01092 mg/L
Coliform MF Total 31504 !100mL Phosphorus: Total as P 00665 0 05 mg/L
i Note Use MPN method for highly forbid samples' Orthophosphate 70507_ rng/L Other(Specify Compounds and Concentration Units)
)issolved Solids Total 70300 53 mg/L Al-Aluminum 01105_— mg/LpH(Lab)00493 __..__...-..__4.9 units Ba -Barium Nov ug/L
TOC 00680 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 18 mg/L Cd-Cadmium o1oz7 ug/L
Arsenic o10oz ug/L Chromium Total 01034 uglL
Grease and Oils 00552 mgiL Cu-Copper 01042 mg/L. ORGANICS: (by GC. GC/MS. HPLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
'
Specific Conductance 00095 uMhos K-Potassium 00937 mg/L VOC 787:,3 . method#
Total Ammonia o0si0 <0 2 mg/L Mg-Magnesium 00927 mg/L , method#
iAnanoma Nitrogen.NH,as N:Ammonia Nitrogen.'Total) Mn-Manganese moss uglL . method#
TKN as N 00625 mg/L Ni- Nickel 01067 ug/L — _ method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs. • mg/L Effluent Total VOCs mg/L VOC Removal%
I certify that to the best of my knowledge and belief the Information submitted in this report is true,accurate aria complete.and that tree laboratory analytical data was produced using approved methods of analysis by a
DWR-certif ed laboratory. I am aware that there are significant penalties for submitting false Irtfor=.station including the possibi€its of tines and imprisonment for knowing violations
i gitaly signed by Dana Hill
Dana Hill, Director of Operation I Re Cs US.O=CWSNC.CN=Dana Hill.E=aerie.hill@carolinawalerservicenc cam
1 Reason I am the author or this document
Permrttee for Authorized Aoenti Name and Title-Please print or type Signature o ( ed cie i - Location.your signing Idtaadn Here ,pate;
Dale:2022.08.12 1 E32.19-04'00'
GW-59 Rev.8/2013 Fort PDF Editor Version.11 2.2

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT 8 NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: DIVISION OF WATER RESOURCES-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER.RALEIGH,NC 27699-1617 Phone'919-807-6306
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number. Expiration Date 1/31/2020
Facility Name Belvedere Plantation Non-Discharge W00001664 UIC
Permit Name(if different) _ _ NPDES Other
Facility Address 130 Fairway Dr Hampstead N C 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
_ County Pender ❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation
Contact Person Greg Spillman Telephone# [phone] LI Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Back of Basin B _ No. of wells to be sampled. 9 ❑ Water Source Heat Pump ❑ Other INFILTRATION BASINS
from Permai
SAMPLING INFORMATION If WELL
WELL ID NUMBER (from Permit): MW12 Date sample collected. 7/5/2022 _ FIELD ANALYSES: WAS
Well Depth 15 ft • Well Diameter 2 in pH 00400 5 2 units Temp 000lc ?0 t' 3C DRY at
•
Depth to Water Level 82546 9.8 Screened Interval 5 ft to 15 ft Spec Cond 00094 IiMhos time of
Sulfur
sampling
u
Measuring Point is 3 ft. above land surface Relative M P Elevation ft Odor 00085 check
Volume of water pumped/bailed before sampling. 5 gallons Appearance Light Brown here.(--1
Samples for metals were collected unfiltered ❑YES Li NO and field acidified ❑YES ❑ NO I I
LABORATORY INFORMATION
Date sample analyzed _ 7/5/2022 Laboratory Name Environmental Chemists. Inc Certification No 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 0.02 mg/L Pb Lead 01051 ug/L
Coliform- MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 <0 02 mg/L Zn-Zinc 01092 mg/L
Coliform MF Total 31504 /100mL Phosphorus Total as P 00665 0.33 mg/L
(Note Use MPN method for highly turbid sarnpiesi Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
dissolved Solids Total 70300 218 mg/L Al-Aluminum 01105 mgiL
pH(Lab)00403 5.2 units Ba-Barium o1007 uglL
TOC 00680 mg/L Ca-Calcium 00916 mg/L M _
Chloride 0os4o 70 mg/L Cd-Cadmium 01027 ug/L
-- --___— _------ ..._......----._.---
Arsenic o1002 ug/L • Chromium Total 01034 ug/L .
Grease and Oils 00552 mg/L Cu-Copper o1042 mg/L ORGANICS: (by GC. GC/MS HPLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate()was mg/L Hg- Mercury 71s00 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 IiMhos K-Potassium oos37 _ mgiL VOC 787: method#
Total Ammonia o0810 1.1 mg/L Mg -Magnesium 00927 mg/L . method#
(Ammonia Nitrogen.Was N Ammonia hdrogen Total) Mn- Manganese 01055 ug/L . method#
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs_ mg/L Effluent Total VOCs. -T;grt. VOC Removal%,
I certify that,to the best of my knowledge and belief.the information submitted in this report is true.accurate and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-certified laboratory I am aware that there are significant penalties for submitting raise information.including the possibility of fines and imprisonment for knowing vroiatrons
Dana Hill, Director of Operations DDNigitally signed by Dana Hill
'�y�"/P��',�''�- • Re C=US.0=CWSNC,nutty CN-Dana Hnl,E-0ana h;ll�carolinawa!erservicenc coin
... _ _ .... _._- ■ ■�.I� _ Location
I am outs armwr anon hererr,m.nr
Permittee or Authorized AgenD Name and Title•Please punt or tvoe r,7. A rate 20 208/21534 ca-04'0D (Dater
Date 2022 08 12 15 3852 04'00'
GW-59 Rev 8/2013 Foxe PDF Editor Verson 11 22

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: DIVISION OF WATER RESOURCES-INFORMATION PROCESSING UNIT
_COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699.1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 1/31/2020
Facility Name. Belvedere Plantation Non-Discharge W00001664 UIC
Permit Name(if different) NPDES Other
Facility Address _ 130 Fairway Dr Hampstead N C. 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
County Pender ❑ Lagoon ❑ Remediation Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: _ Greg Spillman Telephone# [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name 1st Basin C near front right corner No of wells to be sampled: 9 C Water Source Heat Pump ❑ Other INFILTRATION BASINS
from Perrnn)
SAMPLING INFORMATION If WELL
WELL ID NUMBER (from Permit): MVV13 Date sample collected: 7/5/2022 FIELD ANALYSES: WAS
Well Depth 15 ft. Well Diameter 2 in pH(Too 5.2 units Temp 000u `'a "C DRY at
•
Depth to Water Level 82546: 13 Screened Interval: 5 ft to 15 ft Spec. Cond 00094 t:Mhos time of
Sulfur sampling.
Measuring Point Is 3 ft above land surface Relative M P Elevation ft Odor 00085 check
Volume of water pumped/bailed before sampling: 5 gallons Appearance Light Tan here.
Samples for metals were collected unfiltered ❑YES ❑ NO and field acidified ❑YES .❑ NO .
LABORATORY INFORMATION
Date sample analyzed 7/5/2022_ Laboratory Name Environmental Chemists. Inc. Certification No 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 0oeis <0 02 mg/L Pb- Lead o1051 ug/L
—
Coliform: MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 <0 02 mg/L Zn -Zinc 01092 mg/L
Coliform MF Total 31504 i 100mL Phosphorus Total as P ooee5 0 06 mg/L
iNote Use MPN method tot highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
bissolved Solids.Total 70300 52 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 5 2 units Ba-Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium o0916 mg/L
Chloride o0940 9 mg/L Cd-Cadmium 01027 _uglL
Arsenic 01002 • ug/L Chromium Total oio34 _ ug/L •
Grease and Oils 00552 mg/I_ Cu -Copper 01042 mg/L ORGANICS: (by GC. GC/MS HPLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg- Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 tiMhos K-Potassium 00937 mg/L VOC 7873 . method#
•
Total Ammonia o0610 <0.2 mg/L Mg-Magnesium 00927 mg/L _, method#
(Ammonia Nitrogen NH,as N.Ammonia Nitrogen Total) Mn -Manganese 01055 ug/L method#
TKN as N 00625 mg/L Ni -Nickel oio6- uglL . method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs _ _ - mg/L t:{fluent Total VOCs mg/L VOC Removal%.--
I certify that.to the best of my knowledge and belief the information submitted in thus report is true accurate.arid complete,and that the laboratory analytical data was produced using approved methods of analysis by a
MR-certified laboratory I am aware that the, are stgmficant penalties for subri it rig false information.including the possibility of fines and imprisonment for knowing violations
DN Cnally S,0=waned by Dane He
Dana Hill, Director of Operations �„�' u �" ON C=U5.0-CWSNC CNaDanaMYl E tlan.Mll�aol awele«<e corn
Reason I am the author of ties document
Permdtee or Authorized Aaenti Name and Title•Please print or type I 013 Dote 2022Eddo( er on 211 2 2 'Da!e'
Fovl PDF Etlnor Va�on I1 7 2
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
and { copy to: ,IViSION OF WATER RESOURCES•-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699.1611 Phone:[phone]
Please Print Clearly or T
FACILITY INFORMATION PERMIT Number: Expiration Date V31/2020
Facility Name: Belvedere Plantation Non-Discharge W00001664 UIC -_
Permit Name(if different) NPDES Other
Facility Address 130 Fairway Dr Hampstead N C 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
County Pender ❑ Lagoon ❑ Remediation Infiltration Gallery
❑ Spray Field ❑ Remediation.
Contact Person Greg Spillman Telephone# [phone] C.1] Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Basin left corner No of wells to be sampled 9 [1 Water Source Heat Pump ❑ Other: INFILTRATION BASINS
bran Pennn
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW14 Date sample collected 7/5/2022 FIELD ANALYSES: WAS
Well Depth 15 ft .Well Diameter 2 in. pH 00400 5.1 units Temp 000f '`'' ''C DRY at
Depth to Water Level 82546 12 ft below measuring point Screened Interval 5 ft to 15 ft Spec Cond o0094 pMhos time of
Sulfursampling.
Measuring Point is 3 ft above land surface Relative M P Elevation ft Odor 00085check
Volume of water pumped/bailed before sampling: 5 gallons Appearance Tan here.r
Samples for metals were collected unfiltered: El YES ❑ NO and field acidified. ❑YES LI NO
LABORATORY INFORMATION
Date sample analyzed 7/5(2022 Laboratory Name Environmental Chemists, Inc Certification No 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00815 0 02 mg/L Pb-Lead oiosi ug/L
Coliform MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 -0 02 mg/L Zn-Zinc 01092 mg/L
Coliform. MF Total 31504 1100mL Phosphorus Total as P 00665 0 16 mg/L
Mote. Use MPH method for highly turbid samples; Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
)issolved Solids:Total 70300 238 mg/L Al-Aluminum 01105 mg/L
pH (Lab)00403 5 1 units Ba- Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 70 mg/L Cd-Cadmium 01027 ug/L _
Arsenic 01002 ug/L Chromium Total oto3a . ug/L •
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC GC/MS. HPLC)
Phenol 32730 ug/L Fe- Iron 01045 ug/L (Specify test and method f#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) El No(0)
Specific Conductance 00095 iMhos K- Potassium 00937 mg/L VOC 7873 . method#
Total Ammonia oos10 0 7 mg/L Mg- Magnesium oos27 mg/L _ : method#
tAmmonia Nitrogen.NH,as N.Ammonia Nitrogen 7otaii Mn-Manganese°toss ug/L , method#
TKN as N 00625 mg&L Ni -Nickel o1os7 ug/L method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs mg/L Effluent Total VOCs mg/L VOC Removal%
I certify that.to the best of my knowledge and belief the information submitted in this report is true,accurate and complete.and that Inc laboratory analytical data was produced using approved methods of analysis by a
OWR-certified laboratory. I am aware that there are significant penalties for submitting false information including the possibility of fines and imprisonment to Knowing violations
Digitally signed by Dana Nil
Dana Hill, Director of Operations ____ DN C=US.O=CWSNC.CN=Dana Hill.E=dada hill@carolinawaterservicenc corn
Reason.I am the author or this document
Permittee(or Authorized Agent')Name and Title-Please print or tvoe Sit;re n, den Location your signing location here I tja>„,
Date 2022.08 12 15.3717-04'00'
GW-59 Rev 8/2013 Foxd PDF Editor Version:11 2 2

YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original • PARTMENT OF ENVIRONMENT&NATURAL RESOURCES
and copy to. •`VISION OF WATER RESOURCES-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Pnnt Clearly or Type PERMIT Number: Expiration Date 1/31/2020
Facility Name. Belvedere Plantation Non-Discharge WO0001664 UIC
Permit Name(if different) NPDES Other
Facility Address 130 Fairway Dr Hampstead N.0 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
County Pender a-Lagoon ❑ Remediation Infiltration Gallery
❑ Spray Field ❑ Remediation.
Contact Person: Greg Spillman Telephone# [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Between Basin B&C No of wells to be sampled 9 ❑ Water Source Heat Pump ❑Other INFILTRATION BASINS
,frxr,Perrr.t..
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW15 Date sample collected 7/5/2022 FIELD ANALYSES: WAS
Well Depth 18 ft Well Diameter 2 in pH ooaoo 4 9 units Temp oo01t '`0, °C DRY at
Depth to Water Level 82546 13 Screened Interval 5 ft to 15 ft Spec Cond 00094 uMhos time of
Sulfur sampling,
Measuring Point is 3 ft above land surface Relative M P Elevation. ft Odor 00085 check
Volume of water pumped/bailed before sampling 5 gallons Appearance Light Grey here.Li
Samples for metals were collected unfiltered El YES E.NO and field acidified. ❑YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed 7/5/2022 Laboratory Name Environmental Chemists Inc Certification No 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 0.02 mg/L Pb-Lead 01051 uglL
Coliform MF Fecal 31816 <1 /100mL Nitrate(NO3)as N 00620 <0 02 mg/L Zn-Zinc o1092 mg/L
Coliform MF Total 31504 /100mL Phosphorus Total as P 00665 0 59 mg/L
Note Use MEN method for Nighty turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
)issolved Solids Total 70300 58 mg/L Al-Aluminum 01105 mg/L _
pH(Lab)00403 4 9 units Ba-Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 18 mg/L Cd-Cadmium 01027 ug/L
• Arsenic o1002 ug/L Chromium Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC GC/MS. HPLC)
Phenol 32730 ug/L Fe-Iron o1045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 7190o ug/L Lab Report Attached? ❑ Yes(1) L; Nc(0)
Specific Conductance 000gs IiMhos K-Potassium 0093. mg/L VOC 7873 . method#
Total Ammonia 00610 <0 2 mg/L Mg -Magnesium 00927 mg/L : method#
tAmmonia Nitrogen.NH,as N.Ammonia Nitrogen,Totali Mn- Manganese 01055 ug/L . method#
TKN as N 00625 mg/L NI-Nickel 0106' ug/L method#
For Remediation Systems Only(Attach Lab Reports): Intluer:t Total VOCs mg/L Effluent Total VOCs mg/L VOC Removal%
I certify that to the best of my knowledge and belief.the information submitted in this report is true.accurate.and complete.and that the iaboratoryy analytical data was produced using approved methods of analysis by a
DWR-certified laboratory. I an'aware that there are significant penalties for submittt •false information.including the possibility of fines and imprisonment for knowing violations
Dana Hill,Director of Operations Digitally sgned W Dana Hill
DN.C=US.D=CWSNC.CN=Dana Hill.E=dana hill@carolinawaterservicenc com
Dna
Permittee for Authorized Aoent)Name and Title-Please print or Noe HIII Rea
�A ocatlon your signing loca0on here 3i(:',
Date 2022 08.12 1538.26-04'00'
GW-59 Rev 8/2013 Foot PDF Editor Version,11 2 2