WQ0018992_Monitoring - 08-2020_20201006 (2)

t GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name:
Permit Name (if different):
FaAy Address:-
{) ISveeu a w 7`
Contact Person: �~
Well Location/ Site Name:
County , �_Cb C
Telephone #: 1=
No. of Wells to be Sampled:
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: ft. Well Diameter: _ in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 1-1 A-::� ft. below measuring point.
Measuring Point (M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: I -,D Date sample collected: iS l l Id:"
Field analysis: pH ':? � 'I— , Specific Conductance uMhos
Temp. °C, Odor Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #:
EXPIRATION DATE:
Non-Discharge`3�-l!� a-) f l
of !i 1 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon
Remediation: Infiltration Gallery
Spray Field
Remediation:
Rotary Distributor
Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: _ t' r\s
Certification No. t-
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 S �� mg/I
Coliform: MF Total /100ml Phosphorus: Total as P . mg/1
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total %4 0
mg/I
pH (when analyzed)_ 7 °f
units
TOC
mg/I
Chloride t
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
Orthophosphate
mg/I
Al - Aluminum
mg/l
Ba - Barium
mg/l
Ca - Calcium mg/I
Cd - Cadmium mg/I
Chromium: Total
mg/I
Oct
Cu - Copper
6 2020 mg/I
Fe - Iron
mg/I
Hg - Mercury
„SEC✓TION mg/I
K - Potassium
SSrIVG llfVlT mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
(or
tkt-
YES NO)
Ni - Nickel mg/I
Pb - Lean mg/I
Zn Zinc mg/I
Ammonia Nitrogen n . CLi mg/I
Other (Specify Compounds and -Concentration Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No;r2_ (0)
VOC : method # =
or type
method # =
method # =
marl
a"I 12O2.A�-

It7 8L'T.7P
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone: [phone]:
PERMIT #: EXPIRATION DATE:
Non -Discharge 'j"_'� W t R !j cj 1 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other. r• �� n
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: S r<< -r:v\ ,r ba,,. A 1 .71
Certification No. t�
YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N 7j;i t, 4 mg/I
sphorus: Total as P . mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium mg/1
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
M
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type TI
Facility Name: +, "A ten&
Permit Name (if different):
Well Location/ Site Name: No. of Wells to be Sampled: ~i
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: ft. Well Diameter: _),r in. Check one: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: ?S t— ft. below measuring point.
Measuring Point (M.P.) is:_1;2�_ ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: r, Lz Date sample collected: ij
Field analysis: pH ,1 ) , Specific Conductance
Temp._? 'C.Odor Appearance
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total mg/1
pH (when analyzed) i units
TOC mg/I
Chloride n 5 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 Mn - anganese mg/I : method # =
method #
YES NO)
(or
GW-59
Rev. 03/2000 ermiuee (or Authorized Agent)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn Zinc mg/I
Ammonia Nitrogen_L�� mg/I
Other (Specify Compounds and Concentration Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
ReportAttached? Yes (1) No __�L_ (0)
VOC : method # =
,a C,I
or type
(;P

[��doQo��c��� Flo D�c�oQpor�a�c�d
114 OAKMONT DRIVE
GREENVILLE, N.C. 27858
SOUTHWINDS (HYDROTECH)
DON O'MARA
HYDROTECH
P.O. BOX 4602
EMERALD ISLE ,NC 28594
Drinking Water ID: 37715
Wastewater ID: 10
PHONE [phone]
FAX [phone]
ID#: 562 A
DATE COLLECTED: 08/03/20
DATE REPORTED : 08/11/20
REVIEWED BY:
MW-1
MW-2
MW-3
Analysis
Method
PARAMETERS
Date Analyst
Code
PH (field measurement), Units
Missing
7.4
7.7
08/03/20
SEB
4500HB-11
Fecal Coliform (MF), /100 Mls
Missing
1
28
08/03/20
MAR
9222D-06
Ammonia Nitrogen as N, mg/1
Missing
<0.04
<0.04
08/04/20
DTL
350.1 R2-93
Nitrate Nitrogen as N, mg/1
Missing
3.58
3.16
08/04/20
DTI,
353.2 R2-93
Chloride, mg/1
Missing
94
105
08/10/20
KDS
4500CLB-11
Total Dissolved Residue, mg/I
Missing
440
409
08/04/20
TMR
254OC-11
Static Water Level, feet
Missing
14.23
11.82
08/03/20
SEB
Water Bailed, Gals.
Missing
1.0
3.6
08/03/20
SEB

Pk)-� 7085, 114 Oakmont Dr.
Greenville, NC 27858
environment] inc.com
Phone [phone] • Fax [phone]
CLIENT: 562 A Week: 36
SOUTHWINDS (HYDROTECH)
DON O'MARA
HYDROTECH
P.O. BOX 4602
EMERALD ISLE NC 28594
1 [phone]
SAMPLE LOCATION
MW-1
MW-2
MW-3
SHED BY (SIG.) (SAMPLER)
>HED BY (SIG.)
BY (SIG.)
COLLECTION
DATE TIME
q_11 1N OF UUSTODY RECORD
' DISINFECTION
__TT__
LlCHLORINE
UV
01
NONE
P
P
r
P
P
p
LjA
G
C
A
A
A
IMo
E _
ul
p
ZC)
Z
FU-
2U
Q
•
a
-O
g¢ UpO!-
po
;�
o
GtLC,
-o
�o
2�5 1 6
st 6
UAI W IMt RECEIVED
-3-tea 3� 2op
DATEMME RECEIVED
RECEIVED BY (SIG.)
Page I of i
CHLORINE NEUTRALIZED AT COLLECTION
pH CHECK (LAB)
CONTAINER TYPE, P/G
CHEMICAL PRESERVATION
Cn
A -NONE D-NAOH
to
w
B-HNO3 E-HCL
cc
w
C - H2SO4 F - ZINC ACETATE/NAOH
c
cc
G - NATHIOSULFATE
a
CLASSIFICATION:
UWASTEWATER (NPDES)
Ll DRINKING WATER
DWR/GW
LlSOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print) Seu, , L )3,, j 1 cr 40
SAMPLES RECEIVED IN LAB AT
COMMENTS: A)) Q,,,/ )B S rrX b
Mw-) -Co L r7© fomte Ave }ems C�•��r✓ciao
I;L✓1 cwn A AL��-��.
=oRM #s
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
Grab sample in the blocks above for each parameter requested.
N® 383146