WQ0004418_Monitoring - 11-2020_20210108

GW-59A COMPLIANCE REPORT FORM Permit #l.14.71Dt/OS
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. (i,�%3(7d0 ) Will this monitoring report (GW-59 and GW-59A)
YES/NO
be submitted after the established due dat
2
Was any required information missing on the GW-59 report forms?
YES
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.
�JI'
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Office for guidance.
YE
J
NO
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 is "YES" list the affected wells individually with constituent s) and conce ration(s)
exceeding standards in the space provided below: /1(4-I# 5 dl f e-..-e d
t//at/i9 40 /iw At--P 7/4/ 02.5 (/
-s//Fs/sto < / 7/ aelao L i > "it- v
'tt c c10 4(Lc) JL
/
--r
NO-1
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
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES'; hst 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).
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.
7
Is the permittee implementing previously approved actions required by the Division involving this
groundwater quality problem?
YES
NO
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 system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
fines, and/or penalties.
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C:, V)
NJ
8
The person completing this portion (G W-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.
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Gam,- , k),L,,( /02/Z VP
Signature of Permittee, th • razed Agent) D e
GW-59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Facility Name: Granville Family Park
Please Print Clearly or Type
Mail original
and 1 copy to:
Permit Name (if different): Antinori, LLC
Facility Address: 4162 - 4188 Highway 15 South
Oxford
NC 27565
Contact Person: Ticia S. Antinori
Well Location/Site Name: MW1
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW1
Well Depth: 28 ft.
Depth to Water Level 82546: 16.4
ft. below measuring point
Measuring Point is 2.2 ft. above land surface
Volume of water pumped/bailed before sampling: 2.0
Samples for metals were collected unfiltered: 0 YES
County Granville
Telephone#: [phone]
No. of wells to be sampled: 3
(from Permit)
Date sample collected: 11/5/2020
Well Diameter: 2 in.
Screened Interval: 18
ft. to
Relative M.P. Elevation: ft.
gallons
PERMIT Number:
Non -Discharge W00004410
NPDES
Expiration Date: 1/31/2026
UIC
Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon
❑■ Spray Field
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
❑ Remediation: Infiltration Gallery
❑ Remediation:
FIELD ANALYSES:
pH 00400: 6.30 units Temp. 0001o: 15.20 °C
28 ft. Spec. Cond. 00094: 774.0 µMhos
❑ NO and field acidified: ❑ YES El NO
LABORATORY INFORMATION
Date sample analyzed: 11/5/2020 - 11/12/20 Laboratory Name: Meritech, Inc.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
Coliform: MF Fecal 31616 <1
Coliform: MF Total 31504
(Note: Use MPN method for highly turbid samples)
Dissolved Solids:Total 70300 411
pH (Lab) 00403
TOC 00680 4.18
Chloride o0940 61.0
Arsenic o1002
Grease and Oils 00552
Phenol 32730
Sulfate 00945
Specific Conductance o0095
Total Ammonia 00610 <0.1
(Ammonia Nitrogen; NN3as N; Ammonia Nitrogen, Total)
TKN as N o0625
mg/L
/100mL
/100mL
mg/L
units
mg/L
mg/L
ug/L
mg/L
ug/L
mg/L
µMhos
mg/L
mg/L
Nitrite (NO2) as N o0615
Odor 00085: None
Appearance Clear
Nitrate (NO3) as N 00620 2.53
Phosphorus: Total as P 00665 0.066
Orthophosphate 70507
Al - Aluminum 01105
Ba - Barium 01007
Ca - Calcium o0916
Cd - Cadmium 01027
Chromium: Total 01034
Cu - Copper 01042
Fe - Iron o1045
Hg - Mercury 71900
K - Potassium 00937
Mg - Magnesium 00927
Mn - Manganese 61055
Ni - Nickel 01067
mg/L
mg/L
mg/L
mg/L
mg/L
ug/L
mg/L
ug/L
ug/L
mg/L
ug/L
ug/L
mg/L
mg/L
ug/L
ug/L
Pb - Lead 01051
Zn - Zinc 01092
Certification No. 165
ug/L
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 78732:
, method #
, method #
, method #
, method #
If WELL
WAS
DRY at
time of
sampling,
check
here.
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs:
mg/L
Effluent Total VOCs:
mg/L VOC Removal%
1 certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate. and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Ticia S. Antinori, Owner / ORC /,66e—) 4
12/31/2020
Permittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee or Authorized Agent) (Date)
GW-59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Facility Name: Granviile Family Park
Please Print Clearly or Type
Mail original
and 1 copy to:
Permit Name (if different): Antinori, LLC
Facility Address: 4162 - 4188 Highway 15 South
Oxford
/ reef
NC
27565
Contact Person: Ticia S. Antinori
Well Location/Site Name: MW4
County Granville
Telephone#: [phone]
No. of wells to be sampled: 3
(from Permit)
PERMIT Number:
Non -Discharge W00004410
NPDES
Expiration Date: 1/31/2026
UIC
Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon
❑■ Spray Field
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
❑ Remediation: Infiltration Gallery
❑ Remediation:
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW4
Well Depth: 28 ft.
Depth to Water Level 82545: 18.60 ft. below measuring point
Measuring Point is 2.8 ft. above land surface
Volume of water pumped/bailed before sampling. 10.0
Samples for metals were collected unfiltered ❑✓ YES
Date sample collected:
Well Diameter:
Screened Interval:
Relative M.P. Elevation:
gallons
11/5/2020
2
in.
13.5 ft.
FIELD ANALYSES:
pH 00400: 6.30 units Temp. 00010: 14.30 °C
to 28 ft. Spec. Cond. 00094: 838.0 µMhos
ft. Odor 00085: None
Appearance Muddy, dingy
❑ NO and field acidified: ❑ YES In NO
If WELL
WAS
DRY at
time of
sampling,
check
here.
LABORATORY INFORMATION
Date sample analyzed: 1 1/5/2020 - 11,12/20 Laboratory Name: Meritech, Inc.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
Coliform: MF Fecal 31616 1
Coliforrn: MF Total 31504
(Note. Use MPN method for highly turbid samples)
Dissolved Solids:Total 70300 493
pH (Lab) 00403
TOC o0680 2.03
Chloride 00940 113
Arsenic 01002
Grease and Oils 00552
Phenol 32730
Sulfate 00945
Specific Conductance 00095
Total Ammonia 00610 <0.1
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
TKN as N 00625
mg/L
/100m1
/100mL
mg/L
units
mg/L
mg/L
ug/L
mg/L
ug/L
mg/L
µMhos
mg/L
mg/L
Nitrite (NO2) as N 00615
Nitrate (NO3) as N 00620 0.27
Phosphorus: Total as P 00665 0.187
Orthophosphate 70507
Al - Aluminum 01105
Ba - Barium 01007
Ca - Calcium 00916
Cd - Cadmium 01027
Chromium: Total 01034
Cu - Copper 01042
Fe - Iron 01045
Hg - Mercury 71900
K - Potassium 00937
Mg - Magnesium 00927
Mn - Manganese 01055
Ni - Nickel 01067
mg/L
mg/L
mg/L
mg/L
mg/L
ug/L
mg/L
ug/L
ug/L
Pb - Lead 01051
Zn - Zinc 01092
Certification No. 165
ug/L
mg/L
Other (Specify Compounds and Concentration Units):
mg/L ORGANICS: (by GC, GC/MS, HPLC)
ug/L (Specify test and method #. ATTACH LAB REPORT.)
ug/L
mg/L
mg/L
ug/L
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 78732: , method #
, method #
, method #
, method #
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs:
mg/L Effluent Total VOCs:
mg/L VOC Removal%
I certify thet,, to the best of my knowledge and belief, the information submitted in this report is true, accurateand complete, and that the laboratory analytical data was produced using approved methods of analysis by a
Dik?,Qertified laboratory. I am aware that there are significant penalties for submitting false information, Including the possibilityof fines and imprisonment for knowing violations.
Tir:ia S. Antinori Owner/ORC
12/31/2020
P rrtittee (or Authorized Agent) Name and Title - Please print or type Signature of Perin ttee (or h ed Agent) (Date)
!J 53 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Facility Name: Granville Family Park
Please Print Clearly or Type
Mail original
and 1 copy to:
Permit Name (if different): Antinori, LLC
Facility Address: 4162 - 4188 Highway 15 South
Oxford
;Strae'.
NC 27565
Contact Person: Ticia S. Antinori
Well Location/Site Name: MW5
County Granviile
Telephone#: [phone]
No. of wells to be sampled: 3
(from Permit)
PERMIT Number:
Non -Discharge W00004410
NPDES
Expiration Date: 1/31/2026
UIC
Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon
O Spray Field
❑ Rotary Distributor
❑ Water Source Heat Pump
❑ Remediation: Infiltration Gallery
❑ Remediation:
❑ Land Application of Sludge
❑ Other:
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW5
Well Depth: 24 ft.
Depth to Water Level 82546: 11.4
Measuring Point is
ft. below measuring point
2.8 ft. above land surface
Volume of water pumped/bailed before sampling: 10.0
Samples for metals were collected unfiltered: © YES
Date sample collected: 11/5/2020
Well Diameter: 2
Screened Interval: 8.5 ft. to 23.5
Relative M.P. Elevation: ft.
gallons
in.
❑ NO and field acidified: ❑ YES It NO
ft.
FIELD ANALYSES:
pH 00400: 6.60 units Temp. 00010: 18.1 °C
Spec. Cond. 00094: 230.0 µMhos
Odor 00085: None
Appearance
Muddy, d
ngy
If WELL
WAS
DRY at
time of
sampling,
check
here.
LABORATORY INFORMATION
Date sample analyzed: 111512020 - 11/12/20
Laboratory Name: Meritech, Inc.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615
Colitorm: MF Fecal 31616 90 /100m1- Nitrate (NO3) as N 00620 0.47
Colitorm: MF Total 31504 /100mL Phosphorus: Total as P 00665
,Note: Use MPN method for highly turbid samples)
issoived Solids:Total 70300 174
pH (Lab) 00403
TOC 00680
13.3
Chloride 00940 4.0
Arsenic 01002
Grease and Oils 00552
Phenol 32730
Sulfate 00945
pecific Conductance 00095
Total Ammonia 00610 <0.1
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
TKN as N 00625
ma/L
units
mg/L
mg/L
ug/L
mg/L
ug/L
mg/L
µMhos
mg/L
mg/L
Orthophosphate 70507
Al - Aluminum 01105
Ba - Barium 01007
Ca - Calcium 00916
Cd - Cadmium 01027
Chromium: Total 01034
Cu - Copper 01042
Fe - Iron 01045
Hg - Mercury 71900
K - Potassium 00937
Mg - Magnesium 00927
Mn - Manganese 01055
Ni - Nickel 01067
0.136
mg/L
mg/L
mg/L
mg/L
mg/L
ug/L
mg/L
ug/L
ug/L
mg!L
ug/L
ug/L
mg/L
mg/L
ug/L
ug/L
Pb - Lead 01051
Zn - Zinc 01092
Certification No. 165
ug/L
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 78732: , method #
, method #
, method #
, method #
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs:
mg/L Effluent Total VOCs:
mg/L VOC Removal%
I certify that, to the best of my -knowledge and belief, the information submitted in this report is true; accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties forsulxnitting false information, including the possibility o: fines and imprisonment for knowing violations.
Ticia S. Antinori Owner/ORC
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.2/2010
Signature of Permittee
.L/GC--f%Zi
uthorized Agent)
12/31/2020
(Date)