WQ0033677_Monitoring - 11-2020_20210113 (2)

%AurrL-i r r MUNI t UKINk9:
COMPLIANCE REPORT FORM
riease rnnf Gearly or
ity Name. f- q Pms �ct hf/
lit Name (if different):
ityAddress: ,SOfo 7 f� tMyn 7T Pie /�_
�� touceq NC
An
�Cdyr :Stale:
act Person: i V1 Ct C (1 i inn 's
Location/Site Name: r qs f m 5 17 4d1 j,, 11.
WELL ID NUMBER (from Permit): 3
Well Depth: is ft.
. Depth to Water Level: 67_7 ft. below measuring point
Measuring Point is __3_: ft. above land surface
Volume of water pumped/bailed:before sampling:. , 3
Date sample analyzed: Ie- o, ` I- b f%Qdr
PARAMETERS NOTE: Values should reflecbdissoived a `
COD mg/i
Coliform: MF Fecal /10om1
Coilform: MF Total 1;100mi
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total '�✓1�
pH (when analyzed) ! f units
TOC d tng/I
Chloride
Arsenir, ; 0 mg/l
Grease and Oils mg/I
Phenol mg11
Sulfate mg/I
Specific Conductance �j µMhns
Total Ammonia �� ©, i(� mg/I
(Ammonla NlVogan; NH, as N:Ammonia Mbogen; 7o1'at)
TKN as N..... mg/I
For
d��t'l'
April) Name and Title - lease prlhl or type
r mrint i rvumoer:wr7-- - - • Expiration Date: _f AW-3
Non -Discharge ; ✓ UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
County !j(r � ❑ Lagoon ❑ Remediation: Infiltration Gallery
�/ [ '_gpray Field ❑ Remediation:
Telephone#: 512 - Y35(- 4 96%0 ❑ Rotary Distributor ❑ Land Application of Sludge
No, of wells to be sampled: � 3 ❑ Water Source Heat Pump ❑ Other:
fr°�mjPemW I
Date sample collected: l " 3 - t� FIELD ANALYSES: If WEWASLL
Well Diameter: in. pH units Temp. °C DRY at
Screened Interval: 4j ft. to 'ys ft. Sper. Cond. ��g µMhos time of
Relative M.P. Elevation: _ a 49 ft, Odor sampling,
Acne chic'
Appearance G),� ("
7 NO and field acidified:
nd
❑ YES ❑ NO
4
here.
La6orato. Name:
ry.
? / _
,ffJJ�'
Certification No.
colloidal concentrations.
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Nitrate (NO3) as N C)j 3 3 mg/I
Zn - Zinc mg/I
Phosphorus: Total as P 0 , d� (o mg/I
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
At - Aluminum
mg/1
ea. -'Barium
mg/1
14 M , i— Z . � (,
Ca Calcium
mg/I
'� L
Cd - Cadmium
mg/l
1WV t'•
Chromium: Total
ntg/I
7-_ri
Cu -Copper
a mg/I
Iri/
ORGANI ,i(by GC, GC/MS, HPLC)
F@ -Iron
mg/I
(Specify testland.method #. ATTACH LAB REPORT.)
Hg -Mercury
mg/I
Report Attached? ❑ Yes(l) ❑ No(o) 'r
K - Potassium
rrlg/1
i
VOC method # .
Mg - Magnesium
mg(I
"a di method #
Mn - Manganese
frig%i
method #
Ni- Nickel
mg/IJAI�tt7�
_
method #
Influent To VOCs:»
r.
� 'mg/L. Effluent Totai,VQCs: mg/L .VOC. Removal%
.. 4
Dataa)
JAN 1 3 2021 _
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tFacllltyfAddress:d�,7;a'�
► mUry1IUKINU:
ANCE REPORT FORM
FACII PleasePrint
e: e / M3e (if t): % ieA, I
id n ofr!eli �G
or Type
County _ Yw r KG
n �l.
act Person:U
i ►'I'► IS Telephone#: /29 --/ _fir 4Do
Location/Site Name: f JI,rJ No, of wells to be sampled: 3
11W ID NUMBER (from y Permit): _ _
Date sample collected:
Well Depth: .2O
ft. Well Diameter: .0 in
.Depth to Water Level: 3�ft. below measuring point Screened Interval: ,?S ft. to "is ft.
Measuring Point is �_ft. above land surface Relative M.P. Elevation; ays ft.
Volume of water pumped/bailed'before sampling:. _� gallons
:KMI I Number;wvti•»• V ( Expiration Date:. [A -� I - I
rn-Discharge UIC
'DES Other
'PE OF PERMITTED OPERATION BEING MONITORED
❑_, LL Ion ❑ Remediation: Infiltration Gallery
L`�'Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source "Heat Pump ❑ Other:
If WELL
FIELD ANALYSES: WAS.
pH (p, units Temp. � eC DRY at
Spec. Cond. �) µMhos time of
t'1DY�e sampling,
Odor check
nes for metals were collected unfiltered• . Appearance : �, pq here: ❑
C'�S ❑ NO and field acidified: ❑ YES ❑ NO
?RATORY INFORM' C
sample analyzed: st{ 0! S Laborato Name-,I.TL 4 �!
PARAMETERS NOTE: Values should reflecYdiss ivied acid col(oidei concentrations. —''--' {C
�e Certification No.I-gb
COD mg/,
Coliform: MF Fecal /i0otnt
Nitrite (NOz) as N
mg/I
Pb - Lead mg/I
Coliform: MF Total
Nitrate (NO3) asN r iZ c{
mg(i
Zn - Zinc �,� mg/I
G1001n1
(Note: Use MPN method for highly turbid samples)
Phosphorus: Total as P C), / ,
m �I
9.
��'-r
Dissolved Solids: Total
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
mg/I
pH (when analyzed) ! ',.3
Al - Aluminum
m /I
_units
TOC--�r m
Ba.-Barium
mg/I
iu/►t•I ^i
- _ i nu
9 /I
Chloride mg/I
Ca Calcium
mg/i
5
Arsenic f� mg/I
Cd - Cadmium
Chromium: Total
mg/I
m9li
►'''I/ .
did
Grease and Oils mg/I
Phenol
Cu - Copper ')
mgn
- a L
ORGANIC (by GC, GC/M5, HPLC)
Sulfate mg/I
mg/I
Fe -Iron
mg/I
(Specify tesii tiand.method #. ATTACH LAB REPORT.)
_
Specific Conductance Lj µMhos
Hg -Mercury
mgh
Report Attached? ❑ Yes (1) ❑ No (0)
l
Total Ammonia ! Lt;, mgll
K:- Potassium _!'�_ mg/I
VOC method # .
(Ammonla Nitrogen; NH, as N; Ammonla Nitrogen, Tofel) �
Mg - Magnesium
mg(I
, 'method #
TKN as N o �t%_Tm9/I
Mn - Manganese
mg/I
method #
i
For Remedlation Systems Only (Attach lrab• Reports};
Ni - Nickel
mg/I
method #
—
Influent To(aI VOCs:
t _ mg/L .
Effluent Total VOCS: mglL .VOC. Removal%
—�.
1lttee (or
GW=59
l , .5- �i
}I:hnr'S Fri �r 4De�il)'sa/ -C MI) Name and Title - Please print or type Signature
Rev. 112007
i
-Zq�D

■•.. �-.. a4u1aL-1 I r MUNI I UKINU:
COMPLIANCE REPORT FORM
or Type
Name:
Name (if different): _
Address: �6 re
AA — .— i8-k;1I
(tact Person:
II Location/Site Name: QSr ,fie,
C
NC County County Qu r'
`� 77 Telephone#: Ax y3Y- Ggd o
No. of wells to be sampled: 3
PERMIT Number:U4,V9M77 Expiration Date: «-31 -Al
Non -Discharge t/ U►C
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
pray Field ❑ Remediation:
❑ Rotary Distribl)tor ❑ Land Application of Sludge
❑ Water Source;Heat Pump ❑ Other:
vYIMLL ID NUMBER (from Permit):
Date sample collected: -e
If WELL
Well Depth: �-T5 ft.
Well Diameter: .Z in.
FIELD ANALI�SES:
d
pH ! °C
WAS.
DRY
Depth to Water Level: qo( ,3 ft. below measurin oint
;9 p
Screened Interval: 3v ft, tom ft.
units Temp.. (
Spec. Cond.
at
time of
Measuring Point is �_ft• above land surface
Relative M.P. Elevation:
µMilos
sampling
Volume of water pumped/bailed:before sampling; 7
-eft,
gallons
Odor D►'1 a
A
check
ate sample analyzed;t2s t
ARAMETERS NOTE: Values
COD mg/I
Coliform: MF Fecal 1100mi
Coliform: MF Total %100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total l mg/I
PH (when analyzed) +.,Z units
TOC rrlg/I
Chloride %, mg/I
Arsenic mg/l
Grease and Oils m9/i
Phenol mcg/I
Sulfate mg/I
Specific Conductance ' µMhos
Total Ammonia Le mg/I
(Ammonia Nltrogon; NH,as N; Ammonia Nitrogen, Total)
TKN as N I_ ,t{ �' mg/I
For Remedlatlon.Systems Only (Attach l!ab Reoortat:
Mee (or
GW=59
)rued Agent) Name and Title - Please prlht or type
Rev. 112007
i
I
• i
i
NO and field acidified:
❑ YES ❑ NO
ppearance , C
here: ❑
Laboratory Name:
q`k� �e!citb
(/K: Certification No.
id colloidal concentrations.
�0
Nitrite (NOz) as N
mg/I
Pb -Lead mg/l
Nitrate (NO3) as N _
Q. ;� mg/I
Zn - Zinc _r mg/I
Phosphorus: Total as P �`,� mg/I
Orthophosphate
mg/I
Other (SpeciX Compounds and Concentration Units):
At - Aluminum
mg/I
ea. -:Barium
mgll1•.1kin
jLl
Ca - Calcium
l
Cd - Cadmium
mg/l
.
Chromium: Total
mg/I
I i��AM�n
Cu -Copper
mg/I
ORGANICSQ(by GC,' GClMS, HPLC)
Fe -Iron
mg/I
(Specify tese;and.method #. ATTACH LAB REPORT.)
Hg -Mercury
mg/l
Report Attached? ❑ Yes (1) ❑ No (0)
K - Potassium Img/I
VOC method # .
Mg - Magnesium
mg(I
method #
Mn - Manganese
mg/I
method #
Ni - Nickel
mg/I
1
method #
P�rarr ✓/I a
of
Total;VOCs: —
VOG Removal%

Permit#_W6 _03307
(Submit one each monitoring period with GN -59 forms. )
1
Enter date monitoring results were due. ( ) Will this monitoring report (GW-59 and GW-59A)
YES
NO
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 I 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?
YES
N
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)
exceeding standards in the space provided below:
5
For the constituents identified 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).
6
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 maybe 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 system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the Dermittee to a Notice of Violation
fines, and/or penalties.
g
The person completing this portion (G W-59A) of the monitoring report should sign below and submit this
form with G W-59 forms for required wells to the address provided at the top of the current G W-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Complia ce Report GW--5�9A) is true and complete to the best of my knowledge.
Signature of Plermittee (or Authorized Agent) Date
GW-59A 12/8/2003