WQ0023310_Monitoring - 07-2020_20200908

W-59A COMPLIANCE REPORT FORM Permit ,,W
(Submdt one each inonitoring peHod with GW-5 9 far .)
1
Enter date monitoring results were due. Will this monitoring report (GW-59 and GW-59A)
YES
O
be submitted after the established due date .
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
NO
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?
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(s) and concentration(s)
exceedin standards in the space provided below: MW
I\j aoo a
5
For the constituen entified in question 4 above, have standards been exceeded previously 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
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
CR
- -ao �A (,�,.�.4S � �a�p �� 3-S--, �, q, G 1
- - �- t +\ t SAC, 4CL
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
O
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 maybe 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
required to determine the impact the waste disposal s stem is havina at the reidew and compliance
boundaries surrounding this facility. Failure to do §6may subject the permi to a Notice of Violation
fines, and/or penalties. cn ,O
o m 2
2
M M71 eacp
0
gi Q i
N_
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g
The person completing this portion (G 59A) of the nitoring report should sign below and submit this
form with GW-59 forms for required we#j to the address provided at the top of the current GW-59 form.
1 hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW 89A) is Inje a complete to the best of my knowledge.
Signature of Pe ittee (or Authorized Agent) Date
GW-59A 12/812003

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SUBMIT FORM ON YFI 1 OW PAPER nNl Y
GROUNDWATER QUALITY MONITORING;
F DEPARTMENT OF ENVIRONMENTAL QUALITY, DIV. OF WATER RESOURCES
COMPLIANCE REPORT FORM
� �
I
�. INFORMATION PROCESSING UNIT
PROCRALEESSING
1e9yMAILINFORSERVICE CENTER, NC 27e9e 1s17
FACILITY INFORMATION c PleasePrinfClearlyorTypa�� 1
PERMIT Number: 3Eipiration Date:
Facility Name: �( C i� L1. J Ci
Non -Discharge II UU UIC
Permit Name (if different):
NPDES Other
Facilit ddress: , y
TYPE OF PERMITTED OPERATION BEING MONITORED
(:ilr,ovtl �.
County OL �
goon ❑ Remediation: Infiltration Gallery
;(�;p)
9�pray Field ❑ Remediation:
Contact Person: C es '(��31-
Telephone#: ? �� IJ' 3q3 i
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: aC\AQ ` 5't
No. of wells to be sampled:_
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): \
Date sample collectel— 1 S ­ Qa
FIELD ANALYSES:
If WELL
Well Depth: j ft.
Well Diameter. in.
t�
pH 00400;3_ i units Temp. 000lo: i U °C
WAS
DRY at
Depth to Water Level 8254e:9 ft, below measuring point
Screened Interval: ft. to
ft. Spec. Cond. 000ga: µMhos
time of
Measuring Point is ft. above land surt�c
Relative M.P. Elevation: ft.
Odor 000a5: Pj
sampling,
check
Volume of water pumped/balled before sampling: Af
gallons
Appearance C 2c.
here:❑
Samples for metals were collected unfiltered: ® YES
NO and field acidified: ® YES ❑ NO
LABORATORY INFORMATION �- n
Date sample analyzed: - - - Il -`c�` ' -� Laboratory Name: >✓11V \ ! p C Y�C'-tom(\
Certification No. (A 4,
PARAMETERS NOTE: Val es sho d refle t dlssoly d and
�
colloidal concentrations.
COD 00335 _
Nitrite (NO2) as N oo615 mg/L
Pb - Lead o1o5i ug/L
_mg/L
Coliform: MF Fecal 31616 Ct) t /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 Sollds:Total
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
70300 mg/L
AI -Aluminum olim mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC omeo mg/L
Ca - Calcium oo916 mg/L
Chloride oosao 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 M ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900 ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos
—mg/L
K - Potassium 00937 mg/L
VOC 7e73 method #
Total Ammonia oceto �C� p
Mg - Magnesium 00e27 mg/L
method #
(Ammonia Nitrogen; NH3es N: Ammonia Nitrogen, Total)
Mn -Manganese o1o55 ug/L
,method #
TKN as N 00625 mg/L
NI - Nickel 01067 ug/L
method #
W. 1-110—LIU11 �yaLnnra Willy tAuaan t_a4 Kepor<sf: Influent Iota) vUGs: moll- Effluent Tntal VOOa• m„n tint,

SUBMIT FORM ON YELLOW PAPER ONLY
•
�, All IM QF �INVI011111111111INTAL QUALITY * DIV, OF WATIIR RB90URC88 '
GROUNDWATER QUALITY MONITORING:"
*t; rt s 1t�1►fIY'pltlK�efNG►Ur'11y
COMPLIANCE REPORT FORM
*IAloko0:27600,1e11
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number• 0O'� Date: Q
yy jj j��
Facility Name: (I�PCt(SQL>>.� ��ll1\�T�cTitOY1
1�G11 LP,� �N��CI(�
expiration
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Fa II Address: lr1
TYPE OF PERMITTED OPERATION BEING MONITORED
!X Cat i"""'
County
❑ Remedlation: Infiltration Galle
❑0� Lagoon Geller/
0 "'' "`°`°' �'
ag�goon
!'•!'Spray Field ❑ Remedlation:
Contact Person:
Telephone#: I d`' of 13" ���`f
❑ Rotary Distributor ❑ Land Application of Sludge
_6a
Well Locatlon/Site Name:
No. of wells to be sampled:
❑ Water Source Heat Pump ❑ Other:
_
rom Permit
SAMPLING INFORMATION
ID UMBER (from Permit): �� "" a�
Date sa�ple O
If WELL
WeILDepth:L
eli Dialmeter: �ISn.R�
pH oo0aoo5�units Temp, cool o. 1 °C
DRY at
Depth to Water Level 8254e: ft. below measuring point
Screened Interval: ft. to
_
ft. Spec. Cond, 000ga: µ Mhos
time of
sampling,
Measuring Point Is ft. above land surfac
Relative M.P. Elevation: ft.
Odor 000e5: SL_
check
Volume of water pumped/bailed before sampling: C�f
gallons
Appearance t\
here:❑
Samples for metals were collected unfiltered: ® YES
NO and field acidified: ® YES ❑ NO
LABORATORY INF05M4TIONr)-'a O
Date sample analyzed. - - - -a
Laboratory Name: V� Cbl��r�-(Y-�
Certification No.
PARAMETERS NOTE: Vai es shcfuld refl ct dissolved and�colloidal
concentrations.
COD 00335
Nitrite (NO2) as N ooe15
mg/L Pb - Lead o1o51 ug/L
_ _mg/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00e20��—mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P ooss5 C� Q
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum o11o5
mg/L
pH (Lab) 00403 units
Be - Barlum 01007
ug/L
TOC ooeeo mg/L
Ca - Calcium oogle
mg/L
Chloride 00940 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease and 011s 00552 mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 uglL
Fe - Iron 01045
ug/L
(Specify test and method A ATTACH LAB REPORT.)
Sulfate oog45 mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 000e5 µMhos
K - Potassium 00937
mg/L
VOC 7e73 method #
Total Ammonia ooelo Z—mg/L
Mg - Magnesium oo927
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 Remedlation Systems Only (Attach Lab Reports): Influent Total VOCs: ma/L Effluent Total VOCs: ma/L VOC Removal%

SUtiMI I t-UKM UN YELLOW PAPER ONLY
DDate sample
COD 00335
mg/L
Collform: MFFecal 31e16-—/100mL
Collform: MF Total 31504
/100mL
(Note: use MPN method for highly turbid samples)
solved Sollds:Total 70300
mg/L
pH (Lab) 00403
units
TOC 006e0
—mg/L
mg/L
Chloride ooeso
Arsenic 01002
ug/L
Grease and Oils 00652
mg/L
Phenol 32730
ug/L
Sulfate 00945
mg/L
3ciflc Conductance 00095
µMhos
Total Ammonia oosso —
mg/L
(Ammonia Nitrogen; NH3 as N; Ammonle Nlvogen, Totel)
TKN as N 00625
mg/L
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION /r mease PnnrLt weany or Type —��
Facility Name: �/�Q�SAW �4n\TaLLsty\ clU c
Permit Name (if different):
FacjIlty Address: /
G I ` �'u" Count
act Person: T\r
Location/Site Name:
WELL ID NUMBER (from Permit):
Well Depth: is_ ft.
Depth to Water Level e2548: q, �6 ft• below measuring point
Measuring Point is ft. above land surfac
Volume of water pumped/balled before sampling:
Samples for metals were collected unfiltered: ® YES 71 NO and field acidified: W YES 0 NO
J:�` Laboratory Name:
and co
>'loldal concentrations.
Telephone#:�tO-' ,1 3 l
._.No. of wells to be sampled:
OF WATER RESOURCES.
a7estale�r
PERMIT Number:(&�QIO'C)3� jl, piratlon Date: \ t-3D _ cif "INon-Discharge uU UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
,❑.�j,LLagoon ❑ Remediation: Infiltration Gallery
A-s-pray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
Date sample collected:
Well Diameter: � In.
Screened Interval: ft. to ft.
Relative M.P. Elevation: ft.
gallons
FIELD ANALYSES:
pH 004018munits Temp. 000lo: °C
Spec. Cond. 00094: µMhos
Odor 000m:
Appearance A.C4CA Cc 'Ckx_
Certification No.
Nitrite (NO2) as N ooe15 mg/L Pb - Lead o1o5i ug/L
Nitrate (NO3) as N 00e20 %mg/L Zn - Zinc 01092 mg/L
Phosphorus: Total as P ooess mg/L
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
Al -Aluminum oleos
mg/L
Be - Barium 01007
ug/L
Ca - Calcium oogle
mg/L
Cd - Cadmium 01027
ug/L
Chromium: Total 01034
ug/L
Cu -Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
K - Potassium 00937
mg/L
VOC 7873 method #
Mg - Magnesium 00927
mg/L
method #
Mn - Manganese 01055
ug/L
method #
NI - Nickel 01057
ug/L
method #
FVI nm1111Surauvn .7yaln1116 vnry tMuar:n LOU Kepvrt5); influent iotai VVL:s: mo/L Effluent Total VOCs' inn/1 VAR Rurnnvalo%
WAS
DRY at
time of
sampling,
check
here: