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Home My WebLink AboutWQ0003067_Monitoring - 03-2020_20200413GROUNDWATER QUALITY MONITORING: COMPLIANCE REPORT FORM Type Name: Name (if i Address: SUSn,fT FORM ON YELLOW PAPER ONLY County( V'jTe2u ;., _.... n�j� of-��, act Persor /V Telephone#7(i4-2?5�D AZ Location/Site Name: No_ of wells to be sampled: LID NUMBER (frorggjt): I f L LA / J.. Depth: I G/ / $ /� ft.p h to Water Level'82546: IS ft. below measuring point curing Point is It. above land surface ne of water pumped/baiied before sampling: gallons .-Aes for metals were collected unfiltered: YES ❑ NO sample analyzed: _ METERS NOTE: ►oao dissolved ar COD oo335 mg/L Coliform: MF Fecal 31616 /100ni Colifonn: MF Total 31504 /100m (Note. use MPN medwd for in" bmW sarnpfQ�) � Dissob4ed Solids. -Total 703oo 77 mg/L pH (Lab) o=3 ifunits TOC oo68o ' mg/L Chloride oogao mg/L Arsenicwom ug/L Grease and Oils ooss2 mg/L Phenol 3z73o ug/L Sulfate oo945 mg/L Specific Conductance ow% pMhos Total Ammonia oo610 mg/L (Aff-06- NkogcC NFhas it Aft-oria K&ogen. Total) . TKN as N owz mg/L Date sample collected: Well Diameter Screened Interval: Relative M.P_ Elevation: PARTMENT OF ENVIRONMENT & NATURAL RESOURCES /ISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT 17 MAIL SERVICE CENTER, RALEIGH, NC Z7699-1617 Phone: 91 :RMfT Numbed) Expiration Date: >n-Discharge UIC 'DES Other 'PE OF PERMITTED OPERATION BEING MONITORED ❑/Lagoon ❑ Remedmon: Infiltration Gallery V Spray Field ❑ Remediation: IT Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑ Other_ � FIELD ANNYS pH ooaoo: r units Temp. oomo: `C fL to _ft Spec_ Cond. 00094: 1LMhos fL Odor 000as: Appearance D YES ONO _ Laboratory Name: r�IUyl CgDAjmQ _F- r. ./NG - :olloidal concentrations_ Nitrite (N%) as N oo615 mg/L Nitrate (NO3) as N 00620 Q • mg/L Phosphorus: Total as P 00665 mg/L Orthophosphate 70507 mg/L A] -Aluminum 01105 mg/L Ba - Barium moo? ug/L. Ca - Calcium 00916 mg/L Cd - Cadmium o1o27 ug/L Chromium: Total � r° y ug/L Cu - Copper �i .� "T mg/L Fe -iron m4s n 2. _ug/L Hg -Mercury 71900 - ug/L m K - Potassiuoo937 rMR b ECTIN Mg - Magnesiti:T�"+AT M Mn - Manganese 01o55 ug/L Ni - Nickel =67 ug/L Certification No. 1 0 Pb - Lead moss ug/L Zn - Zinc 01 92 mg/L Oth (Specify Compoun d Concentrtr ion O� Qr • If WELL WAS DRY at time of ORGANICS: (by GC, GC/MS, HPLC) (Specify test and method #. ATTACH LAB REPORT_) Lab Report Attached? ❑ Yes (1) 13 No (0) VOC 78M , method # method # method # method # GW-59 Rev.812013 • SUBMIT FORM ON YELLOW PAPER ONLY • DEPARTMENT OF ENVIRONMENT 8 NATURAL RESOURCES GROUNDWATER QUALITY MONITORING: IN, DIVISION OF WATER RESOURCES- INFORMATION PROCESSING UNIT COMPLIANCE REPORT FORM 1617 MAIL SERVICE C RALEIGH, NC 27 1617 Phwke: 919-80 FACILrfY INFORMATION Please Pnnr Cleary or Type . PERMIT Number_ ication Date: Facility Name: li �� %• .T SL _ Non -Discharge UIC NPDES Other Permit Name (if different): 1 Facility Address: PE OF PERMITTED OPERATION BEING MONITORED ❑ Lagoon ❑ Remediation: Infiltration Gallery County Spray Field ❑ Remediation: Contact Person: _l 'AV1 �rL �• /1� �.{t� Telephone#r2:W-_ 5!-�?-W'W ❑ Rotary Distributor ❑ Land Application of Sludge Well Location/Site Name. �(/ "'r No- of wells to be sampled: ❑ Water Source Heat Pump ❑ Other_ SAMPLING INFORMATION If WELL WAS DRY WELL ID NUMBER from Permit)- (/y Date sample collected: (�2 FIELD ANTES: at time ell Depth: ftWeft Diameter. in.pH ooaotr units Temp- oomo: `C Depth to Water Level szsans ft. below measuring point Screened Interval: ft to _ft Spec- Cond. 0009a: �Ahos check Measuring Point is /pS fL above land surface Relative M.P.Elevation: ft Odor 000as: ham: Volume of water pumped/bailed before sampling: -6p _ gallons Appearance Samples for metals were collected unfiltered: `CII YES ❑ NO and field acidified: ❑ YES 0 NO LABORATORY INFORMATION �ll n I �A, / Q,,,n � (� t `O Date sample analyzed: `71 % ! D �_ Laboratory Name: �- Y Y 13a � v' I V Certification No. PARAMETERS NOTE: Values s ou d fled dissolved and colloidal concentrations. COD oo33s mg/L Nitrite (NO2) as N o061s mg/L Pb - Lead most ug/L Coliform MF Fecal 31616 /loomt- Nitrate (NO3) as N o0620 • mg/L Zn - Zinc =92 mg/L Coliform: MF Total31soa /100ml- Phospluxus: Total as P oo66s i mg/L (Note Use MPN metl for tNq*>srbid sarnpies) / Orthophosphate 7oso7 mg/L er (Specify Ggmpoun ncentration Its). �� V DissoN-ed Solids:Total 7o3o0 / / mglL AI -Aluminum oleos mg/L j %%/1%p/V �-G �� V ✓ pH (Lab) ooaos units Ba Barium olou ug/L TMomao . mg/L Ca - Calcium 00916 mg/L Chloride oosao tA17 mg/L Cd - Cadmium oi027 ug/L Arsenic wom ug/L Chromium: Total<o1o3a ug/L Grease and Oils oos52 mg/L Cu - Copper o1o42 mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 3z73o ug/L Fe - Iron oloas ug/L (Specify test and method #. ATTACH LAB REPURT.) Sulfate oosas mg/L Hg - Mercury 719W - ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0) Specific Conductance 0009s µNlhbs K - Potassium oo937 "41- VOC76732 , method# Total Ammonia owo mg/L Mg - Magnesium o0927 mg/L , method # (A-.N&o9er K%— N: Amr- N&o9m Totaq Mn - Manganese moss ug/L , method # TKN as N oo625 mg1L Ni - Nickel 01067 ug/L method # sGW-59 Rev.82013 n SUBMIT FORM ON YELLOW PAPER ONLY T DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES " GROUNDWATER QUALITY MONITORING: , , DIVISION OF WATER RESOURCES -INFORMATION PROCESSING UNIT COMPLIANCE REPORT FORM 1617MAILSERVICE.CENTER,RALEIGtf,NC27699-1617 Phoi�csi . _ ,. FACILITY INFORMA "r -NMI: a Yae PERMrr Number, (ration Date: do Facility Name: 147 7-We _ Non Discharge `��1�'' U1C Permit Name (if different): NPDES Other. FacGtyAddress: G TYPE'OF PERMITTED OPERATION BEING MONITORED County Q ® Remediation: Infiltration Gallery nField SKSpray ❑ Remediation: _ / Contact Person: ! N Q Telephone#�� 0 ❑ Rotary Distributor ❑ Land Application of Sludge Well Location/Site Name: No. of wells to be sampled: ❑ Water Source Heat Pump 0 Other. SAMPLING INFORMATION �GI✓ If WELL WADRY WELL ID NUMBER (from rl , �1 Date sample collected: FIELD ANALYSES: at Well Depth: �iv�fL Well Diameter in. pH ooaoo: {� units Temp. oomo. °C sampling, Depth to Water Level a-,. " Z fL below measuring point Screened interval: ft. to R Spec- Cond- 0009a:Of check Measuring Point is fL above land surface Relative M.P. Elevation: IL Odor 000ss: AAM 6 here: Volume of water pumped/bailed before sampling: gallons Appearance & Samples for metals were collected unfiltered: YES ❑ NO and field acidified: ❑ YES ❑ NO LABORATORY INFORMATION / � W f �l Date sample analyzed: / Laboratory Name: . Certification No. �J PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD oo335 mg/L Nitrite (NO2) as N o0615 mg/L Pb - Lead moss ug/L Coliform: MF Fecal 31616 /100mL Nitrate (NO3) as N om2o 0. 0 mg/L rr5--g/L Zn - Zinc =92 mg/L Coliform: MF Total 315o4 /100mL Phosphorus- Total as P oosss 0. tNitit- Use MPN method for t:yny turgid samples) Orthophosphate 7=7 mg/L Other (Specify Compounds and Concentration Units): Dissolved Solids. -Total 7o3oo / mg/L Al -Aluminum o11os mg/L pH (Lab) ooao3 units Ba -Barium o1o07 ug/L n/� i TOC ooseo • mg/L Ca - Caka.um oo916 mg/L Chloride oo94o mg/L Cd - Cadmium o1027 ug/L Arsenic moot ug/L Chromium: Total o1o34 ug/L Grease and Oils ooz2 mg/L Cu - Copper moat mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 3273o ug/L Fe - Iron otoas ug/L (Specify test and method #. ATTACH LAB REPORT.) Sulfate oosas mg/L Hg - Mercury 71900 � ug/L Lab Report Attached? ❑ Yes (1) ® No (0) Specific Conductance 0009s µMhos K - Potassium o0937 mg/L VOC 78732 . method # Total Ammonia owio mg/L Mg - Magnesium 00927 mg/L method # (Mmonra Nftg= K%as it Ammoroa rrmogen. Total) Mn - Manganese o1os5 ug/L , method # TKN as N oo625 mg/L Ni - Nickel 01067 ug/L , method # For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs. mg/L Effluent Total VO(—'s: mg/L VOC Removal% W / fJ/ /I " Ll J / Authorized Agent) Name and Title - Please print or type GW-59 Rev.8M13