WQ0011360_Monitoring - 03-2020_20200429

GNV-59A t✓ 0-1VY-PLL4,N CE ?'0R T FORM Permit o 6-0
(SMbndt one each monitoring period with GPV-59 forms.)
1
Enter date monitoring results were due. Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due dat ?
2
Was any required information missing on the GW-59 report forms?
YES
NO
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
O
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
YE
NO
If the answer to question 4 is "NO° skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent( and concentration(s)
,
exceeding standards in the space provided below:cal\,�M
-FE
COULM-\
/
5
For the constituents identified in question 4 abo ve standards been exceeded previousjy for the
YES)
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
LZ_ard , concentration(s) reported, and sample collection date for each occurrence (for the last two years).
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C
3--
- r6-aT QNI- S I I - s— Is S - da
q-n-1ck o-G-18 s) a1
1'1-A\- S, 3-S-t% S,
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO" contact the Regional Office within 90 days; an evaluation may be
re uired to determine the impact the w ge disposal sl2tem is havina at the review and compliance
boundaries surrounding this facility Fare to do soAhv subiect the permittee to a Notice of Violation
fines, and/or penalties. n -n
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rn v ru
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The person completing this portion (G 59A) of thet&nitoring report should sign below and submit this
form with GW-59 forms for required weds to the address provided at the top of the current GW-59 form.
t 1 emby acknawkdge ism #w above Wbrotaftn was mod and the intonnatimsubmilted in thus
report and to the best of knowteKige.
r
Signature of e i (or"FAWcORM Agent) Date
261
GW-59A 12/8/2003

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JUDIVII I rUMM UN rtLLUW YArtFt UNLY
GROUNDWATER QUALITY MONITORING: k�MTal�p4s+OPrwATERREaOURCE8
COMPLIANCE REPORT FORM i 1�f��Mttti�AMi�r,Wt9x`rd90:g6�9„ dhansr'�fa.ed7:e3o9
Nugmber x iration Da
FACILITY INFORMATION Please POW IearlyorType
PERMIT 113�� p te: f Ur�
Facility Name: \L�r—�E?E' t(t'�p� Non -Discharge UIC
Permit Name (if different): NPDES Other
Facility Address: @ TYPE OF PERMITTED OPERATION BEING MONITORED
�C{ r Nefe, \ IS,—` Pi C Countygoon ❑Remediation: Infiltration Gallery
(City) (State) (zip)
y� "Spray Field ❑Remediation:
Contact Person: O` Telephone#G� : ((0'�c� —3`J ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: ' Qy No. of wells to be sampled: ❑ Water Source Heat Pump ❑ Other:
WELL ID NUMBER (from Permit): W Date sample collected:3 _rC--Q' O _QS 0 FIELD ANALYSES:
Well Depth: k1Lft. Well Diameter: in. pH 004005 I) / units Temp. 000lo: / ; O-C
Depth to Water Level e2546: ft. below measuring point Screened Interval: ft. to ft. Spec. Cond. 00094: µMhos
Measuring Point is , �— w
g S ft. above land surface Relative M.P. Elevation: ft. Odor 0ooa5: e S�.
Volume of water pumped/bailed before sampling: -S gallons Appearance N
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
If WELL
WAS
DRY at
time of
sampling,
check
here:❑
LABORATORY INFORMATION .0
Date sample analyzed:, — 3- ( 3'n 3` ' 3C) Laboratory Name: ►\y 1 c0
{
0he M
PARAMETERS NOTE: Values should reflect dissoly d
and Colloidal concentrations.
Certification No.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 (100mL
Nitrate (NO3) as N 00620 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 Q t
mg/L
(Note: Use MPN method for highly turbid samples)
issolved Solids:Totai 70300 �'f?
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
/ mg/L
Al -Aluminum 01105
mg/L
pH (Lab) 00403 units
Ba - Barlum 01007
ug/L
TOC oosao mg/L
Chloride oosao
Ca - Calcium 00915
mg/L
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 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 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)
pecific Conductance 00095 µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 00610 G. Q ,f �Q, mg/L
Mg - Magnesium 00927
m /L
g
method #
(Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total)
Mn -Manganese 01055
ug/L
,
,method #
TKN as N 00625 mg/L
NI - Nickel 01067
ug/L
method #
Permiltee lot
G W-5
9 Rev.05-02-2017
Feuer o , 3- s (Mw - 4 j- mw
VOC Removal%

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name:
Permit Name (if,
=acilitv Address:
act Person: \ ' 1
Location/Site Name:
or
'Ails �\-AN County , QCVAz-J'\
(zip)
Telephone#:' � V r03—.�3 i
Ck No. of wells to be sampled:
Ionei 919407*0306
PERMIT Number:( N®UI 1 c� �4(piratlon Date: /0--,,J/^ ,j(
Non -Discharge UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
goon ❑ Remediation: Infiltration Gallery
—pray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
SAMPLING INFORMATION
WELL ID NUMBER (from P met): ��� "� Date sample collected" k—Q% FIELD ANALYSES: �---
Well Depth: ft. Well Diameter: in. T'— pH 0040 units Temp. 00010 .J f °C
Depth to Water Level 8254e: S1 ft. below measuring point Screened Interval: ft. to ft. Spec. Cond. 00094: µMhos
MeasuringPoint is 4 ft. above land surface Relative M.P. Elevation: ft. Odor 000e5: 1'�( '
Volume of water pumped/bailed before sampling: gallons Appearance _ ! —
Samples for metals were collected unfiltered: ❑ YESAM ❑ NO and field acidified: ❑ YES LKO
If WELL
WAS
DRY at
time of
sampling,
check
here: ❑
LABORATORY INFORMATION 4 30
Date sample analyzed: - �� --
�r
-�' 3 t�lLaboratory
Name: �}�(ZJt;6 y_\
Certification No.
PARAMETERS NOTE: Value should reflect di solved atid colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00515 mg/L
Pb - Lead o1o5i ug/L
Coliform: MF Fecal 31616 <
<,,JS100mL
Nitrate (NO3) as N 00620 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
Dissolved Sollds:Total 70300
mg/L
Al -Aluminum oiios mg/L
pH (Lab) 00403
units
Ba - Barium 01007 ug/L
TOC 006e0
mg/L
Ca - Calcium oo916 mg/L
Chloride 00940 G'
mg/L
Cd - Cadmium 01027 ug/L
Arsenic 01002
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 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
µMhos
K - Potassium 00937 mg/L
VOC 7873 method #
Total Ammonia ooseo G �� 1 v� 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 #
,•••, t cNviLaj untuarn tonal vvus: mg/L Effluent Total VOCs: mg/L VOC Removal%
MCA
Permlttee (or Authorized Agent) Name and Tit e - Please print or type Signature of Permlttee (or Authorized Agent) (Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
� �
AIL SERVICE CENTER; RALEIGH, NC 27699.1617 Phone; 919.807-6306
FACILITY INFORMATION 11_- 'ease Print Cleadyorrype
�t
PERMIT Number: 0011 'rw8iration Date:/� "•,- � - J'
r�
Facility Name: 11� � ��
li"�`ClTit�f\
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: U , - e_ (�
(street)
TYPE OF PERMITTED OPERATION BEING MONITORED
Al �
County
L -lagoon ❑Remediation: Infiltration Gallery
(City) (State) (zip)
Contact fzc+t1
0 nC
"ray Field ❑Remediation:
❑
Person:
Telephone#: (`�
Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:_75T t t,v \-kgk
SNo. of wells to be sampled:
Water Source Heat Pump ❑ Other:
•.
(from Permit
SAMPLING INFORMATION
WELL ID NUMBER (from P1 r It): �
�1
Date " 'a CD
FIELD ANALYSES:
If WELL
WAS
sample collected:
Well Depth: V ft.
Well Diameter: ram- in.
pH 00400Z Aunits Temp. 000lo:ii/ ,g , °C
DRY at
Depth to Water Level e2546: ft. below measuring point
Screened Interval: ft. to
ft. Spec. Cond. 000sa: µMhos
time ofsampling,
Measuring Point Is —S ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: a
check
Volume of water pumped/bailed before sampling: 15
gallons
Appearance b T'cjW (1
here:
❑
Samples for metals were collected unfiltered: El YES ° El�f NO and field acidified: ❑ YES 0
LABORATORY INFORMATION C)
Date sample analyze 33 3" a 3"3h Laboratory Name:Vit (7C-�C,(VZ Certification No.
PARAMETERS NOTE: Values should reflect dissoly6d and
colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615 mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 <- CzJ r /100ml-
Nitrate (NO3) as N 00620 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 mg/L
(Note: Use MPN method for highly turbid samples)
Dissolved Solids:Total
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
70300 c mg/L
Al - Aluminum 01105 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 �— mg/L
Cd - Cadmium 01027 ug/L
Arsenic 01002 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 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 µMhos
K - Potassium 00937 mg/L
VOC 7873 method #
j f mg/L
Total Ammonia 00610 tj
Mg - Magnesium 00927 mg/L
method #
(Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total)
Mn - Manganese 01055 ug/L
method #
TKN as N 00625 mg/L
Ni - Nickel 01067 ug/L
method #
GW-59 Rev.05-02-2017
11

SUBMIT FORM ON YELLOW PAPER nNl Y
GROUNDWATER QUALITY MONITORING: wtcr tma�tt �+r R7�v11FVr1�IprylAl,Lft1A411T rUry,UP WA'TARRESC VRCrES
COMPLIANCE REPORT FORM t K, r NM�oa�uigtiioNpol�slNa°;UNir
�� tii d � i I ii+ I�H, Nal� 1110416 7 pho* 04mo7.8306
FACILITY INFORMATION Please Print Clearly or Type y
�--- ` �,..�_ �^ PERMIT Number OQl l �IgRpiration Date: U
Facility Name: ���('� `�r��!� &'ut �V \ Non -Discharge tl UIC
Permit Name (if different): NPDES Other
Facility Address: / 0 • e_�C 1 E Pam;� TYPE OF PERMITTED OPERATION BEING MONITORED
( q ' (street) &ICounty 9"goon ❑Remediation: Infiltration Gallery
(City) (State) (zip) ,,��,, �
I�"Spray Field ❑ Remediation:
Contact Person:C��\ Telephone#: Q' G �l�J El Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: r No. of wells to be sampled: ❑ Water Source Heat Pump ❑ Other:
. —.1 ­.� �­
WELL ID NUMBER (from Permit): 1 lW ` .�J Date sample collected: '-' (G "' aV
Well Depth: �ft. Well Diameter: r� in.
Depth to Water Level 82546: h i ft. below measuring point Screened interval: ft. to _ft.
Measuring Point is ft. above land surface Relative M.P. Elevation: ft.
Volume of water pumped/bailed before sampling: : gallons
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES A -all
FIELD ANALYSES: j
pH ooaoo.� units Temp. 000to:t 1 1 °C
Spec. Cond. 000sa: µMhos
Odor 00095: -"(tti"(�tc _,
Appearance
If WELL
WAS
DRY at
time of
sampling,
check
here:❑
LABORATORY INFORMATION - .-
Date sample analyzed -- • -r
`VJ •3'J�}aboratory Name: Z� V )1
Certification No.
PARAMETERS NOTE: Values shoulb reflec dissoly d and colloidal concentrations.
COD 00335 mg/L
Nitrite (NOZ) as N 00515 mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31515 �- t /100mL
Nitrate (No,) as N 00620 Q mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P ooss5 o t 3 i mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
Dissolved SolldS:TOtal 70300 mg/L
Al - Aluminum o1105 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 mg/L
Cd - Cadmium 01027 ug/L
Arsenic 01002 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 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 µMhos
Total Ammonia ooslo C t-7_mg/L
K - Potassium 00937 mg/L
Mg Magnesium
VOC 7873 method #
- 00927 mg/L
method #
(Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total)
Mn - Manganese o1o55 ug/L
,method #
TKN as N 00525 mg/L
I=— o..
Ni - Nickel 01067 ug/L
method #
- - -- - --,-•-••• —••v ^•���•• ��� .�or�.�l• 11111LIU t fUtbi vets: mg/L L"luent Total VOCs: mg/L VOC Removal%
srn
- \ i"t--l-) cl -- as -- �73
Iltee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
' '
" • 4PA T N �. N T QUI'UTY t7l47F'WAT0RkFIOUR0115
l�lfttlIWi�'�Nfr
COMPLIANCE REPORT FORM
, p
'I ^ G� IiF�isNf'���. Yjrfil �hOnit �19.dti793oe
FACILITY INFORMATION Plea
<
rintClearlyorType
1
`—�.�
PERMIT Number (�D,� 8iration Date:
Facility Name: C�("" �''C,
��
��,
Non -Discharge UIC
Permit Name (if different):
NPDES Other
FacIII it y Address: �
i�c�
�
TYPE OF PERMITTED OPERATION BEING MONITORED
� f � (etree
(City)
9-
County �'�
E� —lagoon ❑ Remediation: Infiltration Gallery
ry
State) (Zip)
`_
Contact Person: G' i� Telephone* j0-0713`"3"q
,,..��,, ��..
A --pray Field ❑ Remediation:
❑
Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:
No. of wells to be sampled: 57
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION /o
WELL NUMBER (from Pe mil): ��"" �j Date sample collected —../©— �
FIELD ANALYSES:
If WELL
Well Depth: ft.
p
Well Diameter: in.
pH 004001;"1 � units Temp. omio: � �°C
WAS
DRY at
Depth Water Level ez5ae:I_ft. below measuring
point Screened Interval: ft. to
r
ft. Spec. Cond. 0009a: µMhos
time
ri
Measuring Point Is c S' ft. above land surface Relative M.P. Elevation: ft.
Odor 00085: .�,� ` l;
sampling,
Volume of water pumped/bailed before sampling: �
gallons
Appearance 6f ct;�S<_'_
checkling,
here:
Samples for metals were collected unfiltered: ❑ YES
NO and field acidified: ❑ YES LLYNO
❑
LABORATORY INFORMATION /
Date sample analyzed:.--- 3- 3 3 ,�-
(� Z
s
3--&�Laboratory Name: E `„ t j ,t M Certification
PARAMETERS NOTE: Values should r flect dis olved a d colloidal concentrations.
No.
COD 00335 mg/L
Nitrite (NO2) as N 00515 mg/L
Pb - Lead o1o5i ug/L
Coliform: MF Fecal 31615 /100ml-
Nitrate (NO3) as N 00620 0 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00555 j mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L
Al - Aluminum 01105 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 006e0 mg/L
Ca - Calcium oosis mg/L
Chloride 00940 mg/L
Cd - Cadmium 01027 ug/L
Arsenic 01002 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 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 µMhos
Total Ammonia 00610 � mg/L
K -Potassium 00937 mg/L
Mg Magnesium
VOC 7e73 ,method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
- 00927 mg/L
method #
Mn -Manganese 0i055 ug/L
method #
TKN as N 00625 mg/L
Ni - Nickel 01067 ug/L
method #
For Remediatlon Systems Only (Attach Lab Reports):
Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
P
Permittee (or Authorized Agent) Name and Title - Please print or type
Signature of Permfttee (or Authorized Agent) (Date)
GW-59 Rev.05-02-2017