WQ0000948_Monitoring - 06-2020_20200731 (2)

A a.l lily
(Submit one each monitoring period with 014-59 forms.)
j
Enter date monitoring results were due.(, ori�r 3t - Will this monitoring report (GW-59 and GW-59A)
be submitted after the established due date?
YES
NO
'
2
Was any required information missing on the GW-59 report forms?
YES
NP
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
NO
identification plate, area overgrown, etc.)? lithe answer is "Yes ", contact the Regional Once forguidance.
4
Are any monitored constituents equal to or above the established standards?
YES
NO
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 /s "YES" list the affected wells individually with constituent(s) and concentrations)
exceeding standards in the space provided below.
5
For the constituents Identified in question 4 above, have standards been exceeded previously for the
YES
NO i
same constituent(s) in the same well(s) in the last two years?
(_
If the answer to question 5 is "NO", skip to section B.
If the answer to question 5 Is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
I'
i
6
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,
i
i
f
i
Is the permittee implementing previously approved actions required by the Division involving this
YES
O
groundwater quality problem?
A
if the answer to question 7 is "YES", describe those actions in the space provided below.
i
If the answer to question 7 is "NO" contact the Regional Office within 90 days; an evaluation may be
�
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may sublect the permittee to a Notice of Violation
fines, and/or penalties.
CAD
L
Vt G
o
A U G X 4 2020
g
The person completing this portion (GW--59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated a"nd:the fifo-nnatton s*ubm ttedn th�;,,,��'
report (Compliance ReportGW-59A) Is_ true and,cornplete xo the best of my kaowiedge,
Sign d of Perms a (or Aut riz gen Date
GW-59A 12/8/2003

SUBMI I I -OHM ON YLLL W PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if differentY.
Facility Address: 100 East Jefferson ST. P 0 Box 614
Jackson N C(Sveeq 27845 o ton
County
(city' Johnny G. Youi nre' (Z'o) 252-534-3811
Contact Person: S Telephone #: 6
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: (r.«r, Pe ,)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: d ft. Well Diameter: in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 10 , o _ ft. below measuring point.
Measuring Point (M.P.) is: '3 ° ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: $3 Date sample collected: (S(v- t D -ZO
Field analysis: pH 5 ` , Specific Conductance uMhos
Temp. —`C, Odor �� ^�� Appearance 0-L—NO-r
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone- (9191 733-39,
PERMIT #: WQ0000948 X
Non -Discharge
NPDES
EXPIRATION DATE: 11—il—
UIC
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Environment I, Inc
Certification No. 2g1
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal a /100ml Nitrate (NO3) as N < 0.04 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC-
mg/I
Chloride %
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/I
Orthophosphate
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/1
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mgA
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen O= C5 mg/I
Other (Sppecify Compounds and Concentration Units)
Total Dissolved Residue mg/1
G7
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # _ -
method #
method # _
ORC Certification #23129
me and Title - Please print or type
a

SUBMI I FOHM ON YLLLQW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different :
Facility Address: 100 East Jefferson ST. P 0 Box 614
Jackson N C27845 o ton
County
`ci'yl Johnny G . Young t tz,°t Tele hone #: 252-534-3811
Contact Person: p 6
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: (1'� o«a)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: / / ft. Well Diameter: 4 in. Check One: ❑ Influent (98)
Screened Interval: ` ft. to ft. ❑ Effluent (99)
Depth to Water Level: I ► ft. below measuring point.
Measuring Point (M.P.) is: t • 5 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: Z5 Date sample collected: p4-10-Z�
Field analysis: pH 5 -2 , Specific Conductance uMhos
Temp. _%' C. Odor bb,,3 el, Appearance 6#4 I sT
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone: r9191 733-32:
PERMIT #: WQ0000948 X EXPIRATION DATE: 1L—il—
Non-Discharge UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
T Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Enyironment 1, Inc
Certification No. 281
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal < 1 /100ml Nitrate (NO3) as N D, co mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mgfl
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC < i i,ao
mg/1
Chloride it
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/l
GW-59
Rev. 03/2000
Orthophosphate
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/l
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/1
rmittee
rmiltee (or
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
iay
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
me and Title . Please print or type
method # =
method # =
(Date)

SUBMI I FORM ON YLLLQVV PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different .
Facility Address: 100 East Jefferson ST. P 0 Box 614
Jackson N C(S"°°0 27845 Northampton
County
(coy) Johnny G . Youii°I°' `ZIP) 252-534-3811
Contact Person: 7 Telephone #:
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
p (na„ P°m,r
Well Identification Number (from Permit): 7
Well Depth: -_ ., ft. Well Diameter:
Screened Interval: ft. to ft.
Depth to Water Level: 5L Q —ft. below measuring point.
Measuring Point (M.P.) is: 3-a ft. above land surface.
Gallons of water pumped/bailed before sampling: �5 _
Field analysis: pH �,y Specific Conductance
Temp. 13 C, Odor �� A
For Groundwater Treatment Systems
in. Check One: El Influent (98)
❑ Effluent (99)
Relative M.P. Elevation in ft.:
Date sample collected: 04 - tv-z
uMhos
ppearance 2 Ly-_
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 X EXPIRATION DATE: - Q
Non -Discharge UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
T Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Environment 1, Inc
Certification No. 9RI
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal 1 /100ml Nitrate (NO3) as N 0,13 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/l
Hg - Mercury mg/1
K - Potassium mg/I
Mg - Magnesium mg/1
Mn - Manganese mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC / , 61
mg/1
Chloride 4-J
mg/I
Arsenic
mg/1
Grease and Oils
mg/l
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/1
TKN as N
mg/1
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen < b mg/l
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
131,
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
method # =
method # =

SUBMI I FORM ON YLLLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different
Facility Address: 100 ast Jefferson ST. P 0 Box 614
Jackson N C`$1ee1' 27845 ton
County
'city' Johnny G. YouIRT) `Z°` Te1e hone #: 252-534-3811
Contact Person: p 6
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled:
_. _--- (from Pemll
Well Identification Number (from Permit): Y For Groundwater Treatment Systems
Well Depth: 0?_3 Jt. Well Diameter:_ in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: _ S , _. ' --ft. below measuring point.
Measuring Point (M.P.) is: 3. b ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: t?t Date sample collected: _66-10'i
Field analysis: pH 5-0 Specific Con�ductaannce uMhos
Temp. I S C, Odor ��Appearance C� -
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH, NC 27699-1636 Phone: [phone],
PERMIT #: WQ0000948 X
Non -Discharge
NPDES
EXPIRATION DATE: 12-j1-
UIC
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Environment 1, Inc
Certification No. 2R1
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal < I /100ml Nitrate (NO3) as N mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC < I r 00
mg/I
Chloride i
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/I
GW-59
Rev. 03/2000
VrIrlopflubpIldLe
Al - Aluminum
tllyn
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
Permitteeh"uthorized Agent)
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen C Drh mg/I
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
/D
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method # = .
method # =
method # =
me and Title . Please print or type
&-7 -- Z (-w Zr-)

SUBMI I I -OHM ON YLLLOW PAPER ONLY
t • . DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: WATER QUALITY DIVISION, GROUNDWATER SECTION
t636 MAIL SERVICE CENTER
COMPLIANCE REPORT FORM RALEIGH NC27699-1636 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different :
Facility Address: 100 East Jefferson ST. P 0 Box 614
Jackson N C`$1ee" 27845 o ton
I.County
(`"Y' Johnny G . Youii ,1 `Z'D1 252-534-3811
Contact Person: Ps Telephone #:
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
(from Pe rdi)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: J6 ft. Well Diameter: _ in. Check One: ❑ Influent (98)
Screened Interval: ft. to 5 ("— ft. ❑ Effluent (99)
Depth to Water Level: 16.5 „ft. below measuring point.
Measuring Point (M.P.) is: 1, O ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 795 Date sample collected: LYo- to -
Field analysis: pH 151— , Specific Conductance uMhos
Temp. 116—'C, Odor . N a ad Appearance Q4—t—%AK
PERMIT #: WQ0000948 X
Non -Discharge
NPDES
EXPIRATION DATE: 1l—il—
UIC
TYPE OF PERMITTED OPERATION BEING MONITORED
T Lagoon Remedialion: Infiltration Gallery
R Spray Field Remedialion:
Rotary Distributor Land Application of Sludge
Other:
N T # Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Environment 1, Inc
Certification No. 2 R I
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal / /100ml Nitrate (NO3) as N (0 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC < V 00
mg/I
Chloride
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/I
urtnopnospnaie
rrlyil
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lean mg/I
Zn - Zinc mg/I
Ammonia Nitrogen 0,V 4-, mg/I
Other (Secify Compounds and Concentration Units)
Total Bissolved Residue mg/1
/ SG�
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
method # =
method # =

SUBMI I FORM ON YLLLOVV PAPER ONLY
t . DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: , WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
COMPLIANCE REPORT FORM RALEIGH NC27699-1636 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if differentY.
Facility Address: 100 East Jefferson ST. P 0 Box 614
Jackson N C`Soee!) 27845 o ton
County
(c°Y) Johnny G . Youh�1e) 252-534-3811
Contact Person: g Telephone #: 6
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: ilrom Perry,,!)
Well Identification Number (from Permit): _�Q For Groundwater Treatment Systems
Well Depth: J/ ft. Well Diameter in. Check One: ❑ Influent (98)
Screened Interval: f 1 ft. to S ( ft. ❑ Effluent (99)
Depth to Water Level:_ ft. below measuring point.
Measuring Point (M.P,) is: ' , D ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: —' S Date sample collected: 0(0-1D-Z0
Field analysis: pH S •5 , Specific Conductance uMhos
Temp. 16—°C, Odor tiQ �(r Appearance C(.tn49—
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal ! 1 /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
TOC /, 3
units
mg/I
Chloride
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/I
PERMIT #: WQ0000948 X
Non -Discharge
NPDES
EXPIRATION DATE: 1L-il-
UIC
TYPE OF PERMITTED OPERATION BEING MONITORED
T Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Environment I, Inc
Certification No. �u7
YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N 0.41 mg/I
sphorus: Total as P mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/1
Ca - Calcium mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen y mg/I
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
/ ,�Aj-
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
method # =
method # =
ng ORC Certification #23129
Agent) Name and Title - Please print or type