WQ0001664_Monitoring - 07-2020_20200918

SUBMIT FORM ON YELLOW PAPER ONLY
•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER RESOURCES -INFORMAT1ON PROCESSING UNIT
COMPLIANCE REPORT FORM
•
•
1617 MAIL SERVICE CENTER, RALEIGH, INC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date. 1/31/2020
Facility Name: Belvedere Plantation
Non -Discharge VV00001664 UIC
NPDES Other
Permit Name (if different): _
Facility Address: 130 Fairway Dr
Hampstead N.0 28443
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
County Pender
❑ 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 Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW7
Date sample collected: 7/1/2020
FIELD ANALYSES:
WAS
Well Depth 17 ft.
Well Diameter: 2 in.
pH 00400 6 units Temp. 000u 239 °C
DRY at
Depth to Water Level 82546: 4
Screened Interval: 5 ft. to
15 ft. Spec. Cond. 00094 µMhos
time of
Measuring Point is 3 ft above land surface
Relative M.P. Elevation ft.
Odor 00085 None
sampling,
check
Volume of water pumped/bailed before sampling: 5
gallons
Appearance Tan
here:
❑
Samples for metals were collected unfiltered El YES
El NO and field acidified: ❑ YES El NO
LABORATORY INFORMATION
Date sample analyzed 7/1/2020
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 o1o51 ug/L
Coliform: MF Fecal 31616 2 /100mL
Nitrate (NO3) as N 00620 <0 02
mg/L Zn - Zinc 01092 mg/L -
rt
Coliform MF Total 315oa /100mL
Phosphorus: Total as P 00665 0.57
mg/L ^ � �° - i It
(Nola: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units).
issolved Solids Total 70300 105 mg/L
Al - Aluminum 01105
mg/L SEp
pH (Lab) 00403 6 units
Ba - Barium 01007
ug/L t")�
TOC 00680 mg/L
Ca - Calcium oo916
mg/L _ �a
Chloride 00940 13 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 IiMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia ooslo <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 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs mg/L VOC Removal%
fr-25-z"
Permittee (or Authorized Agent) Name and Title - Please orint or type Siqnature of Permittee (or Authorized Aqent) (Date)
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
• •
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DtVI 4ON 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
NPDES Other _
Permit Name (if different):
Facility Address:
130 Fairway Dr
Hampstead N.C. 28443
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
County Fender
❑ Spray Field ❑ Remediation:
Contact Person: Greg
Spillman
Telephone#: [phone]
❑ 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
from Perini
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit):
MW8
Date sample collected: 7/1/2020
FIELD ANALYSES:
WAS
Well Depth 18 ft
Well Diameter 2 in.
pH 00400 6.2 units Temp. 000ic 25 eC
DRY at
Depth to Water Level 82546: 7.3
Screened Interval: 5 ft to
15 ft Spec. Cond. 00094 µMhos
time of
Measuring Point is 3 ft above land surface
Relative M P Elevation: ft.
Odor 000as None
sampling,
check
Volume of water pumped/bailed before sampling 5
gallons
Appearance Tan
here:�l
Samples for metals were collected unfiltered. ❑ YES
❑ NO and field acidified. ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 7l1/2020
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 0.2
mg/L Pb - Lead o1o51 ug/L
Coliform. MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.82
mg/L Zn - Zinc 01092 mg/L
Coliform MF Total 31504
/100mL
Phosphorus: Total as P 00665 2,53
mg/L
(Note. Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 213
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 6.2
units
Ba - Barium 01007
ug/L
TOC oo68o
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 5
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
liMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia oo6lo <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 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs mg/L Effluent Total VOCs mg/L VOC Removal%
Permittee (or Authorized Agent) Name and Title - Please print or twe
GW-59 Rev.8/2013
Siqnature of Permittee (or Authorized Aqent) (Date)

SUBMIT FORM ON YELLOW PAPER ONLY
•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIV15ION 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
NPDES Other
Permit Name (if different):
Facility Address: 130 Fairway Dr
Hampstead N.C. 28443
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
County Pender
❑ Spray Field ❑ Remediation:
Contact Person Greg Spillman
Telephone# [phone]
❑ 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 ❑ Other: INFILTRATION BASINS
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW9
Date sample collected: 7/1/2020
FIELD ANALYSES:
WAS
Well Depth 23 ft.
Well Diameter: 2 in.
pH 00400 5.5 units Temp. 000lc 207 0C
DRY at
Depth to Water Level 82546 17
Screened Interval: 5 ftto
15 ft. Spec. Cond. 00094 IiMhos
time of
sampling,
Measuring Point is 3 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085 None
check
Volume of water pumped/bailed before sampling: 5
gallons
Appearance Tan
here:
Samples for metals were collected unfiltered. ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
—J
LABORATORY INFORMATION
Date sample analyzed 7/1/2020
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 0.12
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 1.47
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 176 mg/L
Al - Aluminum of los
mg/L
pH (Lab) 00403 55 units
Ba - Barium 01007
ug/L
TOC 00680 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 36 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total o1o34
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 hMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia 00610 <0.2 mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nilrogem, NH, as N, Ammonia Nitrogen, Total)
Mn - Manganese o1055
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%
S 2')• 70 _
Permittee (or Authorized Aoent) Name and Title - Please print or tvoe Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
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
NPDES Other
Permit Name (if different):
Facility Address: 130 Fairway Dr
Hampstead N.C. 28443
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
County Pender
❑ 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
from Permi!
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW10
Date sample collected: 7/1/2020
FIELD ANALYSES:
WAS
Well Depth: 18 ft.
Well Diameter: 2 in.
pH 00400 6.2 units Temp. 000ic 24 1 °C
DRY at
Depth to Water Level 82548: 4.1 ft. below measuring point
Screened Interval: 5 ft. to
15 ft Spec Cond. 00094 µMhos
time of
sampling,
Measuring Point is 3 ft. above land surface
Relative M P. Elevation ft
Odor 000e5 None
check
Volume of water pumped/bailed before sampling: 5
gallons
Appearance Tan
here:
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
I�
LABORATORY INFORMATION
Date sample analyzed 7/1/2020
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 0.05
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 2.65
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 75 _ mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 6.2 units
Ba - Barium 01007
ug/L
TOC 00680 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 <5 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 oo6lo <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 o1067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs. mg/L Effluent Total VOCs: mg/L VOC Removal%
Permittee (or Authorized Agent) Name and Title - Please print or tvpe Signature of Permittee (or Authorized Agent) ( Date)
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
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 1131/2020
Facility Name: Belvedere
Plantation
Non -Discharge WQ0001664 UIC _
NPDES Other
Permit Name (if different):
Facility Address: 130 Fairway Dr
Hampstead N.C. 28443
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
County Pender
❑ Spray Field ❑ Remediation:
Contact Person Greg Spillman
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Basin A right corner
No. of wells to be sampled: 9
❑ Water Source Heat Pump ❑ Other: INFLITRATION BASINS
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW11
Date sample collected 7/1/2020
FIELD ANALYSES:
WAS
Well Depth. 15 ft.
Well Diameter: 2 in.
pH 00400 4.4 units Temp. 000ic "` °C
DRY at
Depth to Water Level 82546: 14 ft. below measuring point Screened Interval: 5 ft. to
15 ft, Spec. Cond. 00094: ItMhos
i
time of
sampling,
Measuring Point is 3 ft. above land surface
Relative M.P. Elevation: ft.
Odor o0065 None
check
Volume of water pumped/bailed before sampling: 5
gallons
Appearance Tan
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed 7/1/2020
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 (NO,,,) as N 00620 <0.02
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 0.27
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 49 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 4A units
Ba - Barium 01007
ug/L
TOC oo6m mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 17 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
ug1L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095 )tMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia o0610 <0.2 mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; Nfl,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%
Perrittee (or Authorized Agent) Name and Title - Please print or tvPe Signature of Permittee (or Authorized Aqent) (Date)
GW-59 Rev.812013

SUBMIT FORM ON YELLOW PAPER ONI Y
GROUNDWATER QUALITY MONITORING:
•
.
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
IMEUMM1fi17
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
NPDES Other
Permit Name (if different)
Facility Address 130 Fairway Dr
Hampstead N C. 28443
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation Infiltration Gallery
County Pender
❑ Spray Field ❑ Remediation:
Contact Person: Greg Spillman
Telephone#: [phone]
❑ 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
tfrom Permd
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW12
Date sample collected: 7/1/2020
FIELD ANALYSES:
WAS
Well Depth: 15 ft.
Well Diameter 2 in
pH 0040o 5.2 units Temp 000lc 235 °C
DRY at
Depth to Water Level 82546: 11
Screened Interval: 5 ft. to
15
ft. Spec. Cond. 00094: ItMhos
time of
Measuring Point is 3 ft. above land surface
Relative M.P Elevation ft.
Odor 00085 Slight
sampling,
Volume of water pumped/bailed before sampling 5
gallons
Appearance Light Brown
checkhere r�
Samples for metals were collected unfiltered: ElYES
ElNO and field acidified: ❑ YES ❑ NO
_J
LABORATORY INFORMATION
Date sample analyzed 7/1/2020
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 0.1
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 0.86
mg/L
(Note. Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units)
issolved Solids Total 70300 157 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 5.2 units
Ba - Barium 01007
ug/L
TOC oo68o mg/L
Ca - Calcium oo916
mg/L
M
Chloride 00940 44 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
ChromiumTotal 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 ItMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 00610 0.2 mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen, NH, as N, Arnrnonia Nitrogen. Total)
Mn - Manganese oloss
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%
Permittee (or Authorized Aqent) Name and Title - Please urrnt or type Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
or Type
Facility Name Belvedere Plantation
Permit Name (if different).
Facility Address: 130 Fairway Dr Hampstead N C 28443
County Pender
ontact Person Greg Spillman Telephone# [phone]
tell Location/Site Name 1st Basin C near front right corner No. of wells to be sampled:
I
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
PERMIT Number: Expiration Date. 1/31/2020
Non -Discharge VV00001664 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other INFILTRATION BASINS
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW13 Date sample collected. 7/1/2020
Well Depth 15 ft. Well Diameter 2 in.
Depth to Water Level 82546: 14 ft below measuring point Screened Interval 5 ft to 15 ft.
Measuring Point is 3 ft. above land surface Relative M.P Elevation: ft.
Volume of water pumped/bailed before sampling: 5 gallons
Samples for metals were collected unfiltered. ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
FIELD ANALYSES:
pH o0400 5 units
Spec. Cond. 00094
Odor 00085
Appearance
Date sample analyzed 7l1/2020 Laboratory Name: Environmental Chemists, Inc.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615 <0.02 mg/L Pb - Lead o1o51
Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N oo620 <0.02 mg/L Zn - Zinc 01092
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 1.04 mg/L
(Note Use MPN method for highly turbid samples)
If WELL
WAS
Temp. 000lc 24 2 °C DRY at
fiMhos time of
None sampling,
check
Tan here —1
Certification No
ug/L
mg/L
Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
)issolved Sohds Total 70300
34 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
5 units
Ba - Barium 01007
ug/L
TOC om8o
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940
<5 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
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug1L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095
IiMhos
K - Potassium 00937
mg/L
VOC 7872 method #
Total Ammonia oo610 <0.2
mg/L
Mg - Magnesium 00927
m /L
g
method #
(Ammonia Nitrogen, NH„as N. Ammonia Nitrogen. Total)
Mn Manganese oloss
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%
Perrnittee (or Authorized Aqent) Name and Title - Please print or Noe Siqnature of Permtlee (or Authorized Aqent) — —
GW-59 Rev.8/2013

SUBMIT FORM ON YELL W PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or
Facility Name Belvedere Plantation
Permit Name (if different)
Facility Address: 130 Fairwa Dr Hampstead N.C. 28443
County Pender
Contact Person Greg Spillman Telephone#: [phone]
Well Location/Site Name Basin left corner. No of wells to be sampled:
pEPARTMENT OF ENVIRONMENT 8, NATURAL RESOURCES
(VISION OF WATER RESOURCES � INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
PERMIT Number: Expiration Date 1/31/2020
Non -Discharge WQ0001664 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other: INFILTRATION BASINS
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW14 Date sample collected 7/1/2020
Well Depth 15 ft. Well Diameter 2 in
Depth to Water Level 82546: 12 ft below measuring point Screened Interval: 5 ft to 15 ft.
Measuring Point is 3 ft, above land surface Relative M.P. Elevation: ft.
Volume of water pumped/bailed before sampling: 5 gallons
Samples for metals were collected unfiltered ❑ YES ❑ NO and field acidified ❑ YES ❑ NO
0
FIELD ANALYSES:
pH 00400 5 4 units
Spec. Cond 00094
Odor 00085
Appearance
Date sample analyzed 7/1/2020 Laboratory Name: Environmental Chemists, Inc.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615 <0.02 mg/L Pb - Lead o1o5i
Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 <0.02 mg/L Zn - Zinc 01092
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 0.3 mg/L
(Note Use MPN method for highly turbid samples) 0rth
If WELL
WAS
Temp. 000lc 216 °C DRY at
ItMhos time of
Slight sampling,
Light Brown check
here:
Certification No. 94
ug/L
mg/L
ophosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 117 mg/L Al - Aluminum
o11os
mg/L
pH (Lab) 00403
54 units
Ba - Barium 01007
ug/L
TOC 00680
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940
27 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
m /L
C C
g
u - opper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug1L
(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
ItMhos
K - Potassium 00937
mg/L
VOC 7873
Total Ammonia 00610 0.4
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen, NN,as N, Ammonia Nitrogen. Total)
Mn -Manganese 01055
method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
ug/L
,method #
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs mg/L Effluent Total VOCs
mg/L VOC Removal%
Permittee (or Authorized Aqent) Name and Title - Please print or Noe Siqnature of Permittee (or Authorized Agent)
GW-59 Rev.8/2013 mate;

avorvn t rUnM UN YtLLUW t'AFLK ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM '
FACILITY INFORMATION Please Print Clearly or Type
Facility Name. Belvedere Plantation
Permit Name (if different):
Facility Address: 130 Fairway Dr Hampstead N.C. 28443
County Pender
Contact Person: (-,re Spillman Telephone#: [phone]
Well Location/Site Name Between Basin B & C No. of wells to be sampled:
I
DEPARTMENT OF ENVIRONMENT 8 NATURAL RESOURCES
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
PERMIT Number: Expiration Date 1/31/2020
Non -Discharge W00001664 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other INFILTRATION BASINS
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW15
Date sample collected: 7/1/2020
FIELD ANALYSES:
If WELL
WAS
Well Depth 18 ft.
Well Diameter 2 in.
pH 00400 4.6 units Temp. 000ic ?m 3 °C
DRY at
Depth to Water Level 82546 12
Screened Interval: 5 ft to 15 ft.
Spec. Cond. 00094 )mMhos
time of
Measuring Point is 3 ft above land surface
Relative M.P. Elevation: ft
Odor 00085: None
sampling,
Volume of water pumped/bailed before sampling: 5
gallons
Appearance Tan
check
Samples for metals were collected unfiltered:El YES
NO and field acidified: ❑ YES ❑ NO
here:❑
LABORATORY INFORMATION
D t I I
a e saint, e ana yzed 7/1/2020 Laboratory Name. Environmental Chemists, Inc
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
0.05 mg/L
Coliform: MF Fecal 31616
<1
/100ml-
Nitrate (NO3) as N o0620
<0.02 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus. Total as P 00665
1.07 mg/L
(Note. Use MPN method for highly turbid
samples)
Orthophosphate 70507
m9 /L
issolved Solids:Total 70300
46
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
4.6
units
Ba - Barium 01007
ug/L
TOC oo66o
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940
11
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total o1o34
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Ppecific Conductance 00095
I1Mhos
K - Potassium 00937
mg/L
Total Ammonia oo6lo
<0.2
mg/L
Mg - Magnesium 00927
mg/L
(Ammonia Nitrogen, NH, as N, Ammonia Nitrogenjotai)
Mn -Manganese 01055
ug/L
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
Certification No. 94
Pb - Lead o1o51 ug/L
Zn - Zinc 01092 mg/L
Other (Specify Compounds and Concentration Units)
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 7873 method #
method #
method #
method #
-------•• ---•-•••� �•••7 Nvm W). HIIIUCIIt I uldl vk-)I-b mg/L Ltfluent Iotal VOC& mg/L VOC Removal%
�- zS-za
e (or Authorized Aqent) Name and Title - Please print or tvoe Signature of Permrttee (or Authorized Agentl [ at l --
GW 59 Rev. 8/2013

envirochem 'A
ANALYTICAL & CONSULTING CHEMISTS
Environmental Chemists, Inc.
i'1'02 V indmill kl"x. 'A:'WnlKtun. NC 2?;40; • 410.392.0223 Lab • 910.342.4424 FaN.
-:i; 13in,.ert�n, n i{ua�i, �fantec�, \C _"9 ii 2;_1473.3M2' Lab. Fax
'_� �-:'i lt'ilttrngt�m N;>;Mtia,', laik�omille. `C 28;�i) 910.3-'7.�� 3 Lab Fa•.
6t!iru �ttcirnnmentalrhemist;.c��m
CWS - Hampstead Date of Report: Jul 15, 2020
130 Fairway Dr Customer PO #:
Hampstead NC 28443 Customer ID: 08100029
Attention: Greg Spillman Report #: 2020-10815
Project ID: Belvedere Monitoring Wells
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
20-27178 Site: MW-13 7/1/2020 2:28 PM Water Mike Miracle
Test
Method
Color
Color
Depth to water ft.
Deotn to water F:
Ammonia Nitrogen
EPA 350 ^
gallons bailed before sampling
Gallons Bailed before sampling
Odor
Qualitative
Total Dissolved Solids tTDS)
SM 2540 C
Temperature
SM 2550 B
Chloride
SM 4500 0 E
pH
SM 4500 H B
Total Phosphorus
SM 4500 P F
Fecal Coliform
SM 9222D MF
Nitrate Nitrogen (Cale)
Nitrite Nitrogen
EPA 353 2
Nitrate+Nitrite-Nitrogen
EPA. 353.2
Nitrate Nitrogen
Subtraction Metrod
Results Date Analvzed
Tan
07/01/2020
13.9 feet
07/01/2020
< 0.2 mg/L
07/02/2020
5.0gallons
07/01/2020
None
07/01/2020
34 mg/L
07/01/2020
24.2 C
07/01/2020
< 5 mg/L
07/08/2020
5.0units
07/01/2020
1.04 mg/L
07/08/2020
<1 Colonies/ i00mL
07/01/2020
< 0.02 mg/L
< 0 02 mg!L
<0.02 mg/L
07/02/2020
07!12/2020
07/15/2020
1

77
envirochem
ANALYTICAL & CONSULTING CHEMISTS
Environmental Chemists, Inc.
llirl,imili • 910.342.0223 Lab • 4i .3v2.-42-! f
iwtd, N1anfec�. NC 27954 252.473_5171" Lab, Fa\
'37 i1 i!mingtun Hi:;hwat. lail.,c,r� i ;e, NC 285+-10 i7.3ti43 Lo'n Fa
ir,f'O a em ircmil ]ell tit irhemi t';.e<,rn
CWS - Hampstead
Date of Report: Jul 15. 2020
130 Fairway Dr
Customer PO #:
Hampstead NC 28443
Customer ID: 08100029
Attention Greg Spillman
Report #: 2020-10815
Project ID: Belvedere Monitoring Wells
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
20-27179 Site: MW-14
7/1/2020
1:50 PM Water Mike Miracle
Test
Method
Results Date Analyzed
Color
Color
Lt. Brown
07/01/2020
Depth to water ft
Depth to water F,
12.2 feet
07/01/2020
Ammonia Nitrogen
EPA 350.1
0.4 m /L
9
07/02/2020
Gallons bailed before sampling
Ga6ors Bailed before samp�ing
5.0
Odor
gallons
07/01I2020
Duautative
Slight g
07/01/2020
Total Dissolved Solids (TDS )
SM 2540 C
117 mg/L
07/01/2020
Temperature
SM 2550 a
21 6 C
07/01/2020
Chloride
SM 4500 Ci E
27 m /L
9
07/08/2020
pH
SM 4500 H B
5 4 units
07/01/2020
Total Phosphorus
SM 4500 P F
Fecal Coliform
SM 9222D MF
0.30 m /L
9
07/08/2020
Nitrate Nitrogen (Calc)
<1 Colonies/100ml-
07/01/2020
Nitrite Nitrogen,
EPA 3532
Nitrate+Nitrite-Nitrogen
EPA 353 2
< 0.02 mg/L
07/02/2020
< 0.02 mg/L
07/12/2020
Nitrate Nitrogen
Subtraction Method
<Q.02 m /L
9
07/ 15/2020
Page F cf » �_�

Environmental Chemists, Inc.
' ! ! "01112 Windmill Wai. 10%iLningtun, NC 28405 • 910.392.0223 Lab • 1C.3o2.44-4 1 ...
1,,1 13owserttw, n Road, Ivlantco, \C 2 `9i} 2;-'1A73,;7('r2 LabFa\
',:-A V ;1nicn tun Hi h% av, Jacksonville, NC 28; #0 410.34.3ti4.': Lab Fay
ANALYTICAL & CONSULTING CHEMISTS
CWS - Hampstead
130 Fairway Dr
Hampstead NC
Attention Greg Spillman
Lab ID
20-27180
Sample ID:
Site: MW-15
infa a en. irutur,cntahhemi�t+. ;,;,,
Date of Report: Jul 15, 2020
Customer PO #:
28443 Customer ID: 08100029
Report #: 2020-10815
Project ID: Belvedere Monitoring Wells
Test Method
Collect Date/Time Matrix
7/1/2020 2:15 PM Water
Color
Color
Depth to water. ft.
Deoth to water Ft
Ammonia Nitrogen
EPA 350 i
Gallons bailed before sampling
Gallons Bailed before sampagg
Odor
Qualitative
Total Dissolved Solids (TDS)
SM 2540 C
Temperature
SM 2550 B
Chloride
SM 4500 Cl E
QH
SM 4500 H B
Total Phosphorus
SM 4500 P F
Fecal Coliform
SM 52220 MF
Nitrate Nitrogen (Cale)
Nitrite Nitrogen
EPA 353 2
Nitrate+Nitrite-Nitrogen
EPA 353.2
Nitrate Nitrogen
Subtraction Method
Comment.'
Reviewed by
Results
Sampled
.--_..�..,_�...
Mike Miracle
Date Analyzed
Tan
07/01/2020
12.3 feet
07/01/2020
< 0.2 mg/L
07/06/2020
5.0gallons
07/01/2020
None
07/01/2020
46 mg/L
07/01/2020
21 3 C
07/01/2020
11 mg/L
07/08/2020
4.6units
07/01/2020
1.07 mg/L
07/08/2020
<1 Colonies/100mL
07/01/2020
0.05 mg/L
< 0.02 mg/L
<0.02 mg/L
07/02/2020
07/12/2020
07/15/2020
page P

Ih—/
/ / J/ ertilk r17 9a
Date: C� �J Frcillty Naene;
vnalyst: %� PermitM: '
L i iCtr f7
pH
ncurw 4- nria -LV
r r instrument ID: I r It C--
t_ alibration Time
Cal Butler 4 0 s u Cal Butler 10 0 s
Check Buffer 7 0 s.0
Comments
() (V)
(Y)
Cie*r
0
t ;u buffer Lot#/' Ricca 2901'91 EN 12/20 - - - su buffer Loasr _Ricca 2808744 Exo 7JS0 0 su butler Lour Ricca 2905Ad4 Exe i tU20
Sample locanott
Sample Collection
I Sample Analysis I pH Result
►post-attatysis Buffer
Time•
Time• s.0
Check value s.u. CommentvData Qualifiers
( L
47wf
► Post analysis butler check
is required when iserfinmrn..n.lw.
,. _i.:.,i_
- _ :nc )sorer s sue value p values in PH o (iunte , s u.), Retied all data t0 the nearest 0 01 S.U. and report to the nesnea'rest ._ 0 ! s u
Total Residual Chlnrino, iTRCI
Kerarotice Method: SM 4500 CI-G201 I Hach 8167 HR: Please circle Gable Method nstrument Ill
Daily Check Post analysis I
`heck Std. I Time check Sample Sample
Standard Result Standard i Sample TRC Result
u or m Nhen analyzing Location Collection i AnNvsu i CommentivData iat!fim
i at multinle tire.i Analyzed Time r i ' i ug/L or mgrL i
r RC Daily Check Standard &w value "A arm /I
:.heck standards must recover within :10% of the check standard's true value �- r•tv� �� rrrty�
%nnuai Calibration Curve Verification Date -
Reagent Blank Value: t When applicable. Analyze and document a reagent blank when standards. ;ample dilutions or P f Samples are Prepared)
Dissolved Oxygea (DO)
Reference Method SM 4500 0 G.-201 I instrument 10
_. althrationi Calibration vanahle Meter reading •Post -analysis calibration
�,!ntication or efficiency •enfcation iwhen necessary)
[',me.�.� Comments
aQromewc after calibration
Temperature �_---_ I Theoretical t'alcutated
I se this row Nhen perfiirneinR s vrrirkrtktn inmr:ed of
Sample Location
Sampk Colloction
Time
'Sample Analysis
Time
DO reading
MSVL CommenWData Qualifiers
- ""' $­ r.rrrr=rig anmysm u mutnPie :ocauons• the meter must be localibrued az each sne before analysis or apost-analysts calibration verification must be
• .,rr�e s +r.�•a.urtd ,:ratd..o 'aC .ream anttior uns,te ,mr+ :u•tc �nai•. i.-d I'luld .k -ecnrded s:rh a :ntc rha! ^he% art !nr•asurtd n ;ttu or uuriCt!ratch perfnrltted
Temperature
sample i -Sample Temperature
rumple Location Collection analysis 1C
CommentsiData Qualifiers
LZL1 i/
CIS
7 f t
24
.:'r rrr
uni.v-. ,. -i
� -inual r enficatwn Date
...I�. ,'_•:
_ •• - ^r.: `,! '. P! rn4 :11 I iirC'. ! -. r%At=t,d .n . ttl .4 'ttmcd LIICI`
f iekf Penrinnel Note:
�Zet 0- -119 D(W.Q.-A.001

/ 0 1 erti8c o •S 94
ihtte: Faclllry.�amr.
%nalyst: //GP /Y//�lfL Q Permit 0:
pH
aiitsranon T'me j Cal Butler a s u
i
••
Cal Buthr 10 0 s
• cuiw o.a+1w n—o •LV
Check ButTer 7 0 s.u.
t t insttu rent
Comments
0)
I)
r iYl
I LO
• eH check butler must reap within ±o t off snits of
the iwrTer'a tnv v�i
4 su ouster LOW Ricca '901791 Exo 1120
1 su butTer Low . Ricca 2808744 Fxn 7l20 10 su buffer Loan Ricca .'WSA94 Exp I p00
Sample !oration Sample Coilection
1 Sample Analysis
pH Result I ►Post•analysis Buffer
r;me •
Time•
1
s u Check value s.u. CommentwData Qualifiers
► Post analvsis buffer check is required when g y performing anal ses at multiple sampling locatioro and roust be within t 0 1 units of the buffer's true value
;Ii pH velum n pH umb It. e s u. ). Record darn
, all to
the nearest 0 01 s u. and report to the nearest 0 1 s.u.
Total Residual Chlorine (TRC)
Reference 1�tattod: SM 4500 Ct-" l:
Hach g167 HR: Please circle fable Method
Daily Check PCseck Time check
Instrument (D
Chak Sid
Standard Result Sid
µg/L or mg(L t worn uulynng I And
Sample SampleSample
Lots on Colkctton Analysis TRC Result
at multiple sitd) 1 Yned
i ommentvDau
( Time Time sglL or myL Qualifiers
I
rRC Daily Check Standard Frue value
heck standards must rmovcr within =10°e of the ch�eciLt standard's true tance value
aluo range Ag/L or mg l_
Vnnual Calibration Curve V'enfication Date:
4eagent Blank Value: ; VV1ten applicable. Analyze and document a reagent blank when standards, sampledilutions or PT Samples are prepared)
Dissolved Oxygen (DO)
Reference �Mdsod SM 45000 G; 201 I tnstrumcnt ID
Calibranory Caltbru:on vanWe Vteter reading f •Post.aralysn atibrarion
V'ePtication _ or ° etTuenty verification iwhet necessary) i
i.me Temperature after calibration ThOorettal Calcuiatm C ommrnts
P asure f Value ms/L Value rr.W,
I ;; tale r,._ ..—
- . — ��w>t{nIn In11fAU {II
in
trample Location Sample Collection I Sample Analysts DO reading
r' me Time
m Comments/Data Qualifiers
• when Perfortnmg analyses at multiple !orations, the meter must be replifarazed at each site before aria) sts or a
s°tDle s n asurN 1i ttit } n -he .trcun .irxL'nr ens to fe :,rie inahwd 1%ould c rew Oslocorded e a ys's that st anclYMaW`brationventot ;eattioniamust be performed
rempentrrrt
_ Reference Method: SM 2550 B-2010 instrument 10 : ^�_ % c,
le f
ample L xaton Col!ecpion Sample r` I)CMure
Vnalvsis 1C
rime Ti CommentsData Qualifm
L.
er tica;on Date `o
Field Personnel Vote:
tllX'.Q %.001

/ erti8c o /-7 94
titce
�.����—../ racilltyName:
cnal)st /ej Le /r/%%Z Permit is- ;C'
pH `
Reference Method: SM4500 H}B -2011 instrument
C vibration T me Cal Butler a 1) S u Cal Buffer 10.0 s y, Check Buffer 7 s u Comments
I r (J) r
•pH check hutTer must read within 10 1 pH units of the buffer's t ue value.
) su butler Laca Lath/ Ric2901791 Exp 12/20 ;u buffer Low Ricca 1808744 Elio 7/20 i0 su butler Lout Ricca 2905A94 Exit I O_P.0
Sample location
Sample Collection
Time
Sample Analysis pH Result
Time• s.0
►Post•analysis Butler
Check ~slue s.u.
Comments7DataQualifien
A", �
!Cl?
r4 ' f
► Post analysis butler check
is required when oerformina
anmi Uiik`•t milifIrd.--
.0 pri values In pH units (i.e., s.u.). Record all data to the nearest 001 s.u. and — - — -- — �,�,••r _ �""' �u" uui icr s urw � aiue
report to the nearest 0 I s. u
Total Residual Chlorine (TRC)
Reference Method: SM 4500 CI-G201 t Hach 8167 HR: Please fleck Itpbk Method Instrument ID
Daily Check Post-analysisTimechrck
Standard Result chick Std Standard Sample Sample Sample
Colleuion Analysis TRC Resultµget or mgri "whet �� Analymd I Luauion Time 1 Time ug/L or mgrL CommrnwDau ijualtr;crs
at multiple sires! � 1
r tic, Daily Check Standard true value AWL or mg(L acceptance range_.
Check Standards must recover within =1 o% or the check standard's true value ug L or mgrL
annual Calibration Curve Verification Date _
Reagent Blank Value: ________iwhen applicable. Analyze and docUM"t a reagent blank when standards, ;ample dilutions or PT Samples are prepared)
Dissolved Oxygen (DO)
Rerermce Method SM 4500 O G,-2D1 l Instrument ID
Caltoratton/ Calibration variable Meter reading ; • Post -analysis calibration
Venfication or',e ttftcienev I`entieation (wizen necessaryt
f me
Temperature j Barometric ifter calibration ThWCtKW Caiculateo i ort mar to
Pressure Value Valuer g,L
i
Sample Location + Sample
,c this row then perr—ming a verincrtN,n
Comments Data Qual [ r iers
s w'hrn pertbrmmg analyses at multiple locations, thcrInctermust be realibrated az each site before analysis or a post-analysiscalibration ventication must be performed
ta,ured J!rmtl% n the ,tram .jmyr r orct:t ,mh ^e rah z,� .u,uiil l c r ti rnJed :wth a :iota !i: at , a;e ox asoccd Situ of ntunNiaiely
Tempersbre
-- Refererrce Method' SM 2550 8-2010 iruwmrnt tn��.4/�i
SampleLxacon I
Collation
Anal)sis •••1C
Time
I Ttme j
ti
ltnua! Vtrticatwn Dave
Field Pemonnel N,r r,
CommentSData Qualifiers
"icy v' 2019 1)0N..Q%.U411

Environmental Chemist, Inc., 'Nilmington, INC Lab #94
5602 Windmill Wav
:"lilmington, NC 28405
3'0 3 n
San" 1 R A. 92.U223
p e ecelpt Checklist
';
r
,Client: ; .;
Date?
Report Number:U
Receipt of sample:
ES ❑ NO
'
Delivered BP S ❑ FedEx p Other ❑
�OY ES ❑ N0
N/A
1. .Were custody seals present on the cooler?
Originai temperature upon
NfA
receipt
2. If Custody seals were present, were they intact/unbroken?
•C
How temperature taken: ❑ rem Corr ted temperature upon receipt
Blank
+R Gun ;D: 'homas Traceable 5/N 1925116 57ture
Against Bottles
❑ YES ❑ NO
'R Gun Correction Factor'C: 0.4
3. If temperature of cooler
YES ❑ NO
exceeded VC, was Pro ect M r. '
4. Were proper custody/C!A notified?
procedures
YES ❑ N0
(relinquished/received} followed?
S. 'Were sample ID's listed on the COC?
p
YE5 t❑ NO
YES ❑
6. were samples 1D's listed on sample containers?
YES ❑ NO
Were collection date and time listed on the COC?
B( YES ❑ NO
8. Were tests to be performed listed on the COC?
rE5 (� NO
9. Did samples arrive in proper containers for each test?
S0.
YES ❑ NO
Did samples arrive in good condition for each test?
yE5 Q 40
11. Was adequate sample volume available?'
( YE5 NO
12. Were samples received within proper holding time for requested tests;
13_ Were acid preserved .
YE5 C7 NO
13
samples received at a pH of <2? •
14. Were Cyanide samples received
❑ YES L7 NO
at a pH >12?
115. 'Nere sulfide samples received
YES ❑ NO
at a pH >9?
16. Were NH3/7KN/Phenol
YES ❑ NO
received at a chlorine residual of <0.5 m/L?
17. Were Sulfide/Cyanide
YES ❑ NO
received at a chlorine residual of <0,5 m �
18 `Nere orthophosphate /l.
samples filtered in thec teid w thin 15 minutes?
* ';-)CI`,iciat;Ies are pM checked at ti • me of al and recorded on the benchsheet.
3acteria samples are
cr•ecked for Chlor!ne at time of analysis and ra
I corded or. he benchsheet.
Sample Preservation;
;Must be Comoieted for
Samole(s)
rnp
any saie,sj incorrectly preserved or Ntth headspace►
.were received
by adding (circle one):
Incorrectf r
H-504 HNO Y o•eserved and were adusted
iTime of oreservat+on:
accordingly
`ICI NaOH
title va f more than one preservat�,,iseded, notate :n common
Y -:starer serv�ce .mr ed ate+v for ncor, erw resewed is below
L sar^
^cf y t^e ;rate ab f ; roc. o'es, Obtain mple or
ed ,c ar.alwed by the :ustomrr rVhd was ^ot fi ed. date
`JOiatileS
Sampie(si
and time
'iere received with headspace
co
OC. CA,; m
04

ENVIRONMENTAL CHEMISTS, INC 6602
OFFICE 9 0-392-0223FAXton,N06 2,4
Analytical 8 Consulting Chemists NCDENR: DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION 0 37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
CLIENT: CWS-Hampstead PROJECT NAME: Belvedere WWTF-Hi h Rate Wells REPORT NO:
ADDRESS: CONTACT NAME: GregSpillman
PO NO:
REPORT TO: PHONE/FAX:
COPY TO: email:
Sampled B t46 ' eA"nf
Sample Identification
Date
Well: #
Depth to water: �Z
H (Field): Z
Gallons Bailed: j
i
Odor. /sil 'P
Color: art
Total of 9 wails (7,8,9,10,11,12,13,14.16) Due M
FTransfer
1.
2.
Temperature when Received QC:
Delivered
Comments:
necetveo tsy: t Date; ------- --
_Time.
TURNAROUND: �` ___--

6802 Windmill Way Wilmington, NC 28405
ENVIRONMENTAL CHEMISTS INC
Analytical & Consulting Chemists
OFFICE: 910-392-0223 FAX [phone]
NCDENR: DWQ CERTIFICATION # 94 NCDHHS DLS CERTIFICATION # 37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
CLIENT: CWS-Hampstead — _
PROJECT NAME: Belvedere WWTF-High Rate Wells_ REPORT NO: _y
'111-
-�-
ADDRESS:
_ PO NO: _
CONTACT NAME: Greg Spillman -
REPORT TO: PHONE/FAX:
COPY TO: -
email:
ul Saled B : /
_
SAMPLE TYPE: I = Influent, E = Effluent, w =well, ST =Stream, SO =Soil, SL =Sludge, Other:
Collection
Sample Identification
2
` W
x o m
E m
PRESERVATION
Date
Time
Tem
a9
0 o a r E i
3 U 5 z 0
o ANALYSIS REQUESTED
Well
0
-Z
=� _
Q
G G
C P Chloride, TDS, NO2
LDethth to water: S 7 rl
G G y X
C P - __ NO3, NH3, Total P
pH (Field): i, _
G G ,.
_-. ----- - X Fecal
Gallons Bailed_--^
G G
Odor, del-
-
-
--
- -4Z -- ---- --
_
G G
_
C P ---- ----
Color -'
G G
C_P ------ _ ---... _
G G
C P--
__�
G G i
CP ----- —
Total of 9 wells (7,$,9,10,11,12,13,14,15) Due March, July, November
-� Transfer
Relinquished By:
—
Date/Time
--
Receiv d B :
1.
-
Dat¢Time
-
2.
-
_ _ --
- 1
Temperature when Received °C � Accepted:-_ �-•" Rejected: ---------
Delivered B'' - - - - - - p e Requested:
"
Comments:
Received B : ------
Y .......
__Time:
TURNAROUND:

ENVIRONMENTAL CHEMISTS, INC 602Wi d ill Way ngton, NC 2845
Analytical 8 Consulting Chemists
223 FAX 424
NCDENR: DWO CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729
infOFFIC
o�envl ro nme nta is hem lsts. com
COLLECTION AND CHAIN OF CUSTODY
CLIENT: CWS-Hampstead
PROJECT NAME: Belvedere WWTF_HHl h Rate Wells REPORT NO:
ADDRESS:
,
CONTACT NAME: Gt� Spillman PO NO:
REPORT TO: PHONE/FAX:
COPY TO:
Sampled By: /
email:
SAMPLE TYPE: 1- Influent, E = Effluent W = Well, ST = Stream, SO = Soil, SL Sludge, Other:
Collection
Sample IdjenIfficatlonjDateTl�n
g $ o a La W PRESERVATION
Temp~ 4
g
Q
W
ANALYSIS REQUESTED
* =
z
o
Well.
C P
X
Chloride, TDS, NO2
C P
De th to wat
G GXN03,
NH3, Total P
CPpH
N Field :
( ) _
G G
X Fecal
Gallons Bailed:�7
G G
Odor: /
C P
G G
—
Color:
G G
C P
- - -
G G
C P
G G
C p
G G
Total of 9 wells (7,8,9,10,11,12,13,14,ib) Due March, July, November
Transfer
Relinquished By: Date/Time
1.
_
Received , Datelrime
2.
f'
Temperature when Received "C. ,'
- Acce ted:
Rejc-ted:D@livered
By:_____._,
_ --
Received By:__ ` Resampie Requested: -.--
Comments
=-
—_Date: —Ti._m..._e.-.:
TURNAROUND:

6602
ill Way Wilmington, NC
ENVIRONMENTAL CHEMISTS, I N C OFFICE 91'0 392-0223 FAX [phone]
Analytical & Consulting Chemists NCDENR: DWO CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION 0 37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
CLIENT: CWS-Hampstead PROJECT NAME: Belvedere WWTF-H h Rate Wells REPORT NO: y
ADDRESS: CONTACT NAME: Gre S illman PO NO:
REPORT TO: PHONE/FAX:
COPY TO:
Sampled Bv: , r ,o email:
Sample Identification
Collection
Date
Time
Temp
Well: ��
7-/- Za
Z
Z �� d
De th to water:
H (Field): . Z
Gallons Bailed:
Odor:
Color_
Total of 9 wells (7,8,9,10,11,12,13,14,16) Due March, July, November
Transfer
Relinquished By:
1.
2.
i emperature wnen Kecelved "G: _ Acce
Delivered By:-______— --
Received By
Comments:
--- --_Date:, Time: j
TURNAROUND:

Analytical & Consulting Chemists
CLIENT: C1
ADDRESS:
Samoled Bv:
Sample Identification
Well. ;'
De th to water PLc 1 '
Gallons Balled:
Odor: *'
Color.
Total of 9 wells (7,8,9,10,11,12,13,14
Transfer
1,
2.
Temperature when Received
Delivered
Comments:
ENVIRONMENTAL CHEMISTS,, INC 6602
OFFICWindmiE 9 0llWay Wilming3FAXton, C.28405
NCDENR: DWO CERTIFICATION # 94 NCDHHS- DLS CER"TIFICATION # 37729 inf 2 4424
o(�environme ntalchem ists.com
COLLECTION AND CHAIN OF CUSTODY _
_ PROJECT NAME: Belvedere WWTF-High Rate Wells REPORT NO:
CONTACT NAME: Greg Spillman
PO NO:
REPORT TO: _ PHONE/FAX:
COPY TO:
email:
TURNAROUND:

- ENVIRONMENTAL CHEMISTS INC 6602 Windmill Way Wilmington, NC 28405
Analytical & Consulting Chemists
NCDENR: OWQ CERTiFIGA710N # 94 NCDHHS: DLS CERTIFICATION # 37729 OFFICE: 910-392-0223 FAX [phone]
infopenvi ronmenfalchem fists. com
COLLECTION AND CHAIN OF CUSTODY
CLIENT: CWS-Ham tead --------
PROJECT NAME: Belvedere WWTF-High Rate Wells REPORT NO *^ ___,__
ADDRESS: CONTACT NAME: G S iliman ��
PO NO:
REPORT TO:
PHONE/FAX:
COPY TO:
Sampled Bv: .Al.1 , �� v _ - email:
Sample Identification
Collection
Date
Time
Tem
Wet[ /
S
/J
De th to water:
N (Field): ,
Gallons Bailed:
Odor:
Color:
Total of 9 wells (7,8,9,10,11,12,13,14,16) Due March, July, Novemb
Transfer
Relinquished I
1.
2.
I emperature when Received "C:
Delivered BY*_____.n ____ L Received By:
Comments:
—__---Date:
TURNAROUND:

ENVIRONMENTAL CHEMISTS INC 6602 Windmill Way Wilmington, NC 28405
Analytical & Consulting Chemists
NCDENR: DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37723 OFFICE- 910-392-0223 FAX [phone]
info&nvironmentalchemist;;,cony
—_
COLLECTION AND CHAIN OF CUSTODY
CLIENT: CWS-Hampstead
PROJECT NAME: Belvedere WWTF-High Rate Wells REPORT NO:
ADDRESS: _
w K
CONTACT NAME: Gre Spillman PO NO:
--
REPORT TO: PHONE/FAX:
r
COPY TO:
email:
_
Sampled By: i ` c SAMPLE TYPE: I = Influent, E = Effluent, W = Well, ST =Stream,
Collection
a
.9
m _
SO = Soil, SL = Sludge, Other:
'a x PRESERVATION 9
Sample Identification
o
` "
m
Date
Time
Tem
+�
o
0 a
E S ; v 9 W
Z
ANALYSIS REQUESTED
Well: r i' _
41, ` `
_ o
`ti
. i ,. -
! �y '
G
G
C
P
...
a Chloride, TDS, NO2
Depth to water' r' J r
G
, r -- -- ..
C
P
X NO3, NH3. Total P
IpH Field).
G
C
G
P
— X Fecal
;, � �—.--.---_._�
'Gallons Bailed: �;,
G
G
_
C
P
_
Cid —
Color..
Y
`—
G
G
l
C
P
G
G
i
C
P
G
~C
G
P
Total of 9 wells (7,8,9,10,11,12,13,14,16) Due March, July, November
� — Transfer
Relinquished By,
Date/Time
Received By:
2.
- dy/
Temperature when Received °C r
�_.._
= _v ----
_Accepted:
Delivered B�-
Resam —
�f -�- _.— ple Requested: _ ` -
Received By:___
Comments_—
—___�.._.___Date:
—f _._- Time
TURNAROUND:

ENVIRONMENTAL CHEMISTS INC 6602 Windmill Way Wilmington, NC 28403
Analytical &Con ,ulting Chemists
NCDENR: DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 OFFICE: nfo@environmenta chem str com 24
COLLECTION AND CHAIN OF CUSTODY
CLIENT: CWS-Hampstead PROJECT NAME: Belvedere WWTF-High Rate Wells REPORT NO:
t.
ADDRESS: _ CONTACT NAME: Greg Spillman PO NO:
REPORT TO: — PHONE/FAX:
COPY TO: @mail:
Sampled By: fPfj SAMPLE TYPE: 1 = Influent, E = Effluent, W = Well, ST = Stream, SO = Soil, SL = Sludge, Other:
Collection o W PRESERVATION
Sample Identification $ o E
Date Tim@ T@m H ~ a in
i _ zz ANALYSIS REQUESTED
- 1 _ = Z o
Well: i°f Lr "'-/"IG �� r✓ �� G G ?'7f'�� X
Chloride, TDS, NO2
Depth to water: Cr" -_-_ G G f X NO3, NH3, Total P
C P -
pH (Field). 1 ;4 1
G G (.' X
Fecai
C P --- _
Gallons Bailed:
G G
C P
Odor `� ;"i ( G _G
C P
Color: t. [' �� �: G G --
C P
G G
C P
- -- --- --��� G G
G G
Total of 9 wells (7,8,9,10,11,12,13,14,15) Due March, July, November
Transfer -� Relinquished By: Date/Time Re ived 8
Date/Time
2. s.
Temperature when Received °C: s Accepted;_-___ — Re acted: ------------ ^_
- -- f
Delivered B �,�' ..�By:- - --—_—____Resample Requested:
Y:.....__._,�,.___. _.__�__-__ Received ¢' - --
Date. �`
_Time „
omments •
-__TURNAROUND:

ENVIRONMENTALCHEMISTS, INC 6602 Windmill Way Wilmington, NC 28406
OFFICE: 910-392-0223 FAX [phone]
Analytical & Consulting (' hp.misls NCDENR: DWO CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 iiyfo@environmentalchemists,cofn
rOl I FrT[f*)N Arin rWAJIKI nC f1l lawww
CLIENT: CWS-Hampstead
ADDRESS:
PROJECT NAME: Belvedere WWTF-High Rate Wells
CONTACT NAME: Greg Spillman
REPORT NO:
PO NO:
REPORT TO:
PHONE/FAX:
F-
COPY TO:
email:
Sampled Rv- .47, La7 r ':'
QAU01 C *rvnr- ! - ! - -- -
Sample Identification
Collection
Qai
E
E 0
0
0
z;
C
t -
0
0 CL
I —
C
I
-
z
PRESERVATION
OLFVdM,
au = b011, SL :-- Sludge, Other:
ANALYSIS REQUESTED
Date
Time
I Temp
S
2
0
Z'
0
0
5
0
f
Depth to water:
C
P
x
EXI
I
Chloride, TDS, NO2
NO3, NH3,
T:F:7 Total P
I
I
G
C
G
P
G
C
—G
P
pH �Field):
x
Fecal
G
G
Gallons Bailed:
C
P
G
G
C
P
G
G
Odor:
C,
P
-C
----F-
G
G
C
P
G
G
C
P
G
G
C P
G +G
Total of 9 wells (7,8,9,10,11,12,13,14,15) Due March, July, November
Transfer
1.
Relinquished By:
Dateffime--
Received By:
Dategime
— - — ----------
Rejected: Resample Requested:
Delivered
------Received By: Date:
-�� 4� —Time:.Ai
Comments:_ _TURNAROUND: