WQ0000948_Monitoring - 09-2020_20201102 (2)

SUBMI I I -OHM ON YELLOW PAPER ONLY
. t
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different :
100 East Jefferson ST . P 0 Box 614
Facility Address:
Jackson N C`$1e8" 27845 County Northampton
Contact Person: Johnny G. Young' cta� Telephone #: [phone]
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
prom Permit)
Well Identification Number (from Permit): / For Groundwater Treatment Systems
Well Depth: I ft. Well Diameter: in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 4_ ft. below measuring point.
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948
EXPIRATION DATE:
Non -Discharge X
UIC
NPDES
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.
Measuring Point (M.P.) is:_--5— ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 3;:5 Date sample collected: q o-tzo Date sample analyzed:
Field analysis: pH $4 Specific Corlductance uMhos Laboratory Name: Enyironment i, Inc
Temp. —°C, Odor o�� Appearance C--ley-1�- Certification No. 2$1
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
pH (when analyzed)
TOC /' ro 1
Chloride 7
Arsenic
Grease and Oils
Phenol
c"ifatA -
Specific Conductance
Total Ammonia
TKN as N
_ mg/I
_units
_ mg/I
_ mg/1
_ mg/I
_ mg/I
mg/I
mg/I
uMhos
_ mg/I
mg/I
YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N �•� mg/I
sphorus: Total as P <0 • o mg/I
Orthophosphate mg/I
Al - Aluminum mg/1
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 - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen < C • c 4 mg/I
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
21
., I 1
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
method # =
method 4 =

SUBMI I FORM ON YLLLOW PAPER ONLY
1 • e DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: WATER DUALITY 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 different :
100 East Jefferson ST. P 0 Box 614
Facility Address:
Jackson N C's"ee" 27845 Northampton
County
iav) (sut.) 252-534-3811
Contact Person: Johnny G G. Young Telephone #:
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
(fro Permit)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: / ft. Well Diameter: 4 in. Check 0ne: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: LS ft. below measuring point.
PERMIT #: WQ0000948 X
Non -Discharge
EXPIRATION DATE: 12-31-21
UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon
X Spray Field
Rotary Distributor
Other:
Remediation: Infiltration Gallery
Remediation:
Land Application of Sludge
NOTE* Values should reflect dissolved and
colloidal concentrations.
Measuring Point (M.P.) is: Is ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: Z.— Date sample collected: D oq Date sample analyzed:
Field analysis: pH 5e d , Specific Conductance uMhos Laboratory Name: Elly ronment I, Inc
Temp. I em,_°C, Odor �' Appearance ??aer 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 < i /100ml Nitrate (NO3) as N 4,31 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P < o•-'4 mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
pH (when analyzed)
TOC < 1,vo
Chloride
ArsPnic
Grease and Oils
Phnnnl
Clllfatc� ___
Specific Conductance
Total Ammonia
TKN as N
Orthophosphate
mg/1
_ mg/I
Al - Aluminum
mg/I
_units
Ba - Barium
mg/I
_ mg/I
Ca - Calcium
mg/I
mg/I
Cd - Cadmium
mg/I
_ mg/1
Chromium: Total
mg/I
— mg/I
Cu - Copper
mg/I
_ mg/I
Fe - Iron
mg/I
mg/I
Hg - Mercury
mg/I
_uMhos
K - Potassium
mg/I
— mg/I
Mg - Magnesium
mg/I
mg/I
Mn - Manganese
mg/I
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
YC
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method # = .
method # =
method # =
A)

SUBM1 I FORM ON YELLW 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(Sveel) 27845 Northampton
�s County
(c"y) Johnny G . YouiiQ) `z o) Telephone #: [phone]
Contact Person: P
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
P (Iron Perml'
Well Identification Number (from Permit): 7
Well Depth: ? ft. Well Diameter: �
Screened Interval: ft. to ft.
Depth to Water Level: 10 ft. below measuring point.
Measuring Point (M.P.) is: 34V ft. above land surface.
Gallons of water pumped/bailed before sampling: 3 0_
Field analysis: pH 6, lb, Specific Conductance
Temp. %`d °C, Odor 21,426 '' _ A
For Groundwater Treatment Systems
In Check One: I-]Influent(98)
❑ Effluent (99)
Relative M.P. Elevation in ft.:
Date sample collected: 09 09 4
uMhos
ppearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 EXPIRATION DATE: —1
Non -Discharge X UIC
NPDES
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: Eny4ronment I, Inc
Certification No. 9PI
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, /�4 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P < Gfo' 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/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC 1 m y/
mg/I
Chlorides
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
YES NO)
Ni - Nickel mg/(
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen C ° mg/I
Other (Sppecify Compounds and Concentration Units)
Total Dissolved Residue mg/1
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
Please print or type
method # =
method # =
0162-0
(Date)

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 different
Facility Address: 100 kst Jefferson ST. P 0 Box 614
Jackson N CIS""" 27845 Northampton
(coy)
1subl tz,oi County
Contact Person: Johnny G. You%Q Telephone #: [phone]
Welt Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled:lr 6
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: d13 ft. Well Diameter: �_ in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: !t- 0 ft. below measuring point.
Measuring Point (M.P.) is: 5"D ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: _peg Date sample collected: a v4 UrA
Field analysis: pH S• i , Specific Conductance uMhos
Temp. —°C, Odor 40,4 Appearance C.Lte4A-
DEPARTMENT OF ENVIRONMENT d, NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 EXPIRATION DATE: 11-il-�f
Non -Discharge X UIC
NPDES
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: Epyironment 1, Inc
Certification No. 1221
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/1 Nitrite (NO2) as N mg/I
Coliform: MF Fecal < I /100ml Nitrate (NO3) as N /1 So mg/I
Coliform: MF Total /100ml Phosphorus: Total as P < 0,04 mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC < 1 - 0©
mg/1
Chloride 34-
mg/i
Arsenic
mg/1
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
urinopnospnate
Iny/I
AI - 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/l
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen 0.04- mg/I
Other (S ecify Compounds and Concentration Units)
Total Dissolved Residue mg/1
7%
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
E o l uiz oti�

SUBMI I I-OflM ON YELLOW 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"°"' 27845 o ton
(cay) sine) 0p) County
Contact Person: Johnny G . YouWg Telephone #: [phone]
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled:mil)
Well Identification Number (from Permit): q For Groundwater Treatment Systems
Well Depth: 36 ft. Well Diameter: 4_ in. Check One: ❑ Influent (98)
Screened Interval: (0 ft. to _3fo ft. ❑ Effluent (99)
Depth to Water Level: & • 5 ft. below measuring point.
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER DUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phenrr 19191 733-19:
PERMIT #: WQ0000948 X
Non -Discharge
EXPIRATION DATE: 12—:31—
UIC
NPDES
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.
Measuring Point (M.P.) is:Jt ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/baed before sampling: 55 Date sample collected: O Date sample analyzed:
Field analysis: pH , Specific Conductance uMhos Laboratory Name: Enyironment I, Inc
Temp. /4 OC, Odor Appearance Certification No. 921
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/1 Nitrite (NO2) as N mg/I
Coliform: MF Fecal < 1 /100ml Nitrate (NO3) as N 80 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P < 0- 04- mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC < 1, 60
mg/I
Chloride 40
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/1
TKN as N
mg/1
urtnopnospnate
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/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 < O, 0+ mg/I
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
method # =
method If =

SUEBMI l FORM 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 different):
Facility Address: 100 East Jefferson ST , P 0 Box 614
Jackson N C' "0" 27845 o tai
County
" "c Johnny G . Your"°' tt'D1 252-534-3811
Contact Person: � Telephone #:
Welt Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: - 6 O
Well Identification Number (from Permit): D For Groundwater Treatment Systems
Well Depth: .3I ft. Well Diameter: AL in. Check One: ❑ Influent (98)
Screened Interval: l/ ft. to .3 t ft. ❑ Effluent (99)
Depth to Water Level: - d ft. below measuring point.
Measuring Point (M.P.) is: 3.115 ft. above land surface. Relative M.P. Elevation in ft.-
Gallons of water pumpjVj fled before sampling: 35 Date sample collected:
Field analysis: pH .5, 2 , Specific Conductance uMhos
Temp. _ / (k_°C, Odor ocCa Appearance tf�
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phnnn• /9191 711-195
PERMIT #: WQ0000948 EXPIRATION DATE:
Non -Discharge X UIC
NPDES
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: Euyironment 1, Inc
Certification No. ag}
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'
3T mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
, o mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total
mg/I
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
TOC /• S.Z
mg/I
Ca - Calcium
mg/I
Chloride /
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia
mg/I
Mg - Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/I
GW-59
Rev. 03/2000
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen < m, 04 mg/1
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
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 ,

-- --_� �o�•� 1 ♦.11111L Tr
(Submit one each monitoring period with G«=59 forms.)
j
Enter date monitoring results were due. , / 3/ 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
NQ
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.)? lfthe answer is "Yes'•, contact the Regional OjTicefor guidance.
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 1s "YES" list the affected wells individually with constituents) and concentrations)
exceeding standards in the space provided below:
c fI
i
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
same constituent(s) in the same well(s) In the last two years?
YES
NO
i�
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 constituents) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
f I
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
I NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
i
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
I
I
i
�
i
7
is the permittee implementing previously approved actions required by the Division involving this
YES
O
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
i
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 subiect the permittee to a Notice of Violation
i
`
�
I
i
I
fines. and/or penaibes.
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 Informatioriwas evaluated and the Infomiatiori'submified, n thls' � .,[ Y 3 .2+ yam,-<',3•• "r�.> ...c is ,
report (Com liance Report GW-59A) Is_ true and,COmplete to tFte best of my knowledge, •� '
„_
Signature P ittee (o uthori zed An. Date
G%V-59A 12/8/2003