WQ0001664_Monitoring - 07-2021_20210812

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0001664
Name of Facility:* Belvedere Plantations
Month:* July Year:* 2021
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR July 2021 Belvedere DMR.pdf 8.86MB
FDF Only
GW-59 July 2021 GW Report.pdf 13.31 MB
ITF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Greg Spillman
Signature:
Date of submittal: 8/12/2021
This will be filled in automatically
Initial Review

Reviewer:
Saunders, Erickson G
Is the project number correct?*
WQ0001664
Is the monitoring report
Yes r No
accepted?*
Regional Office*
Wilmington
Accepted Date: 8/19/2021

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: W00001664
Facility Name:
Belvedere Plantation WWTF
County:
Pender
Month:
July
Year: 2021
PPL 001
Flaw Measuring Point:
Influent EfA rrt _] No flow 9errerated
Parameter Monitoring
Point: tnfkK„t
t ffluen=• .
L,rcxuuiw�fer toweft
wa Su
Lj Surface water
PararneterCode ►
50060
00310
50060
006110
00620
00400
70300
00076
�.
1
m
Q E
U �`
1K
c
O
E M
U N
O
hrs
1
��.-
82,000
Q
Q
ca
m IL
C
O M
f' N
tK U
mg/L
0.12
006
O
q
mglL
' <:
t^IT
a+
Zcr
X
G
i0 0 'D
O y p
F N fn
v
a
7
F
24-hr
09:35
L
mg/L
-
su
7.95
mg/L
NTU
0.39
0.96
<10
<10
-
2
3
10:00
1�
4
$2.l3€30
5
82,000
<2
<2
_
104
0.09
012
<1,; <0.2
<2': <0.2
1
4.21
0.52
-
7.95
776
539
<10
0.7
_
6
10:05
08:55
1
1
7
8
06:56
1
OW
7.62
0.95
9
09:45
1
-�
0.03
Z68
0.49
-
1 °
0.52
0.49
_
16
Li
821
_ 794
7.89
7.88
<10
<10
0,51
0.56
0.28
0.52
-
11
116..367
11 ' <2
1 <2
7.2 TY
500,300
121
13
14
15
W 10
1030
1
1
0.25 <0.2
0.17 <0.2
0.06
017
09:30
0715
1
1 1
16
10:35
1 -
Ali
48.200
_ 024
8.14
874
--
_
17
103,333
1i13,333
" a- <2
0.37 <02
<10
<10
7920.31 049
-
18
19
08 55
20
09:00
ti
<2
0.18
Q 13
<0.2
r
5.19
-
7,98
778
7,72
7.99
0.38
0.32
0.38
0.78
<10
<10
_ .
---
-
21
08:15
22
05:30
23
10:30
1
0 22
-�
24,.
25
26
08:15
1
3;-
f
1,3 $ ."
< 2
�.
0.16
<0.2
0.21
1.2
8
0.93
2T
08:05
1
1
5 -
i,,500
<2
0.23
0.13
0.22
<02
;.
4.19
5A
7,97
0.39
'
28
08:40
56.100
81.800
8 0.45
29
12:50
1
7.91 2.61
30
08.10
1
65,100 z�
4
0,00
2.00
2.00
!?4.00
1,04 00
0.12
.,�. �•
8.07 .�
0.5
31
0,15 000
0.37 0,20
0,02 0,20
<10
1.96 539.00 0,71
5.19 8.21 539.00 10.00
0.21 7.62 539,00 0.28
. _ _._.I
AversW
Daily Maximum:
_
Daily Minimum:
Sampling Type:
TzVx,y
compowls
-r,ptsts
Crab
Composite
fi
Composite
Grab
Composite
..�
Recorder
__...m_
--- _..
Monthly Limit:
-- -
Daily limit:
Sample Frequency:
" .:,
_
300.00D ...,
-
,..:.
10".
2XilYbek
5 X Week
4
2 X Week
2 X Week
6-9
x Week
3 X Yeer
10
C,

FORM NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) ragee___ of
Sampling Person(s) Certified Laboratories
Name: Greg Spillman Name: Enviromental Chemists, Inc. DW # 94
Name: Name: Carolina Water Services Inc. - Eastern Region Certificate # 5162
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Compliant Na,c.ompltant
If the facility is non -compliant. please explain in the space below the reason(s) the facility was not in compliance Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Greg Spillman Permittee: CWSNC
Certification No.: 1004824 Signing Official: Dena Hill
Grade: 4 Phone Number: 252-241-0661 Signing Official's Title. Director of Operations
Has the ORC changed since the previous NDMR? Yes No Phone, Number: 252-269-2540 Pned ytoana ill ration 3131/2026
Digitally signetl y ana ill
DN C=US. O=CWSNC. CN=Dana HillDanaHill E=dana hyour signing
location he a com
Reason I am the author of this document
Location. your Signing location here
Date 2021.09.72 15,03Version
-04'00'
Foxit PDF Editor Version 1 L0.0
nPA
Signature Date Signature Date
By Ibis signature, I certify that this report is accurate and complete to the best of my knowledge. I certify, under penalty of law, that this document and all attachments were prepared udder my directbn or supervision in
accordance with a system designed to assure that all qualified personnel property gathered and evaluated the information
submitted Based on my inquiry of the person or parsons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is. to the best of my knowledge and belief, true. accurate. and complete. I am
aware that there aw signifk:ant penalties for submitting false. information: including the possibility of totes and imprisonment for
knowing vrolatbns
Mai) Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM. woMnm5-/n NON -DISCHARGE MONITORING REPORT (NQMR) Page ___m_-_

FORM NDMR 05-16 NON -DISCHARGE MONITORING REPORT {NDMR) Page of
Sampling Person(s) Certified laboratories
Name: Greg Spillman Name: Enviromental Chemists. Inc. DW # 94
Narne: Name: Carolina Water Services Inc. - Eastern Region Certificate # 5162
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 1 a Compliant Witt Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Greg Spillman
Permmttee: CWSNC
Certification No.: 1004824
Signing Official: Dana Hill
Grade: 4 Phone Number: 252-241-0661
Signing official's Title: Director of Operations
Has the ORC changed since the previous NDMR? yes, No
Phone Number: 252-269-2540 Permit Expiration: 3/31/2026
Digdally signed by Dana Hill
DN: C=US. O=CWSNC CN=Dana HillDana Hill E ratio hyour srgonawater ion h re com
Reason I am the author of this document
Location. your Signing location here
Date 2021.08. 121503, 55-04'00'
Foxit PDF Editor version 11.0.0
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify_ antler penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evakia ted the information
submitted. Based ati my inquiry of the person orpersons who manage the system, or those persons directly responsible for
gathering the information, the infonnation submitted is. to the best of my knowledge and belief, true. accurate. and compiele. I am
aware that there are signrfu:ant penalties for submitting false information: irirluding the possibility of fines and imprisonment for
knowing violations
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM. NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: WQ0001664
Facility Name:
Belvedere Plantation WWTF
County:
Pender
Month: July
Year: 2021
PPi: 003
Flow Measuring Point:
❑ tr>f N)t JEttk"It
No fkw generated
Parameter Monitoring Point: ❑ [Awt n Effkiert ✓I Groundwater LOwetox) Surface water
Parameter
1
2
3
4
Code
R
0
♦
0
v
0
hrs
1
1
1
744M,
44'r 959
445,959
00940
U
mg7L
00610
E
4
00400
G
0
006 ':
70300
H TJ
t-wrR
_
a
mglL
ti
O
r«
1.2
50060
O -uf C
r-m2
cr Q
1'
_
24-hr
10.19
09:36
1051
m su
7.84
mglt_
t
0 `, �•,l
51
6
7
1052
1
—
1
1
444,900
447.000
447.000
44%.000
44,000
�446,000
447.9gt?
54
_._.....
243
8
9
0647
0658
<0.2 9 7.71
,,
-
c(} (34� ' 1
10
11
1
1
12
13
10'46
11.00
; <1
0
�, �.. .•
�_
m..r_
14
08:18
1
496.0ii0
�yr
15
06 31
1
448,0M
16
0841
1
446,000
44 7 flflii
44' 000 _
i.a17,98:
v
0 8
—
0
181
19
201
09:31
09:44 1
1
1
1
1
_
<1
<0.2
T9
21
06 58
299.0i 1
22
12:15
_ 412,981
23
1136
1
327,806
_
_ 317.
-- 317, 7 i 0
<0.2
7.78
_
, <0 04
0
25
26
0846
1
27
08.51
1 _
332:553
317,002
386,44$
'
448,Oi
150.583
rii>scler
566,218
_
281
07:56
1
54.00 0.00
i
29
12 09
1
-�t
0 02 243.00
O.ti6 ,; 243.fx1
Grab'
D.00
D.00
_
301 07:27 1
311 1
Average:
Dairy Maximum:
Daily Minimum:
Sampling Type
Monthly Limit:
Daily Limit:
Sample Frequency:
54.00 0.20 7.On
54.00
Grab Grab Grab'
250 1.5
6.5.8.5
3 x Year Weekly Weekly
500
3 X Year

FORM NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page ____ of
Sampling Person(s) Certified Laboratories
Name: Greg Spillman Name: Enviromental Chemists, Inc. DW # 94
Name: Name: Carolina Water Services Inc - Eastern Region Certificate # 5162
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? compliant Non-Cornpfiant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance Provide in your explanation the dates) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Greg Spillman Permittee: CWSNC
Certification No.: 1004824 Signing Official: Dana Hill
Grade: 4 Phone Number: 252-241-0661 Signing Official's Title: Director of Operations
Has the ORC changed Since the previous NDMR? Yes No Phone Number 252-269-2540 Permit Expiration: 3/31/2026
Digitally signed by Dana Hill
ill
DN: C=US, O=CWSNC. CN-Dana Hill,
Dana H E ratio hyour Signing
location here corm
Reason I am the author of this document
Location your signing location here
Date 2021.08.12 15.04.29-04'00'
1� rM4.iee�r� Foxft PDF Editor Version. 11 0.0
Signature Date Signature Date
By this signature. I certify that this report is accurrate and complete to the best of my knowledge cur tity. under penalty of law that this document and all attachments were prepared udder my direction or supervision to
accordance with a system deWned to assure that all qualified personnel properly gathered and evaluated the information
submitted Frased on my inquiry of the person or persons who manage the system. or those persons Wrrx;fiy responsible for
gathering the lntonrlaiton. the information submitted is, to the hest of my knowledge and belief. true. accurate. and complete. ! an1
aware that there are significant penalties for submitting false information, inrauding the possibility of fines and imprisonment for
knowing violations
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-2 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Permit No: WO00D1664
Facility Name: Belvedere Plantation WWTF
County: Pend�-r
Did infiltration occur at
site Name:
B
see Name:
this facility?~—
0.27
Area (acres):'
��� Area (acres):
8.55
Rate (GPD/ft):
Si#e Inliltrat\ Site Infiltrated?
Weather
Freeboard
Yes
C
O
ate.
G
O W
a W
f Vi m '4
W
C
gV t7
21
O.
.VO
V Q
r%1
!0 G
O j.,. ! 0 O a �
,p
y C7
t8 m
E p
ro
m
m
as
Q m
S' Q
m
LL
°F
79
in
053,289
ft
ft
408
330
GPDtft'114402,9
54,725
44.032
,' .,� DNt gal min
1320 53 48004 1320
1
PC
2
R
80
0
39,810
15M 3938850
1500
3
C
58,440
1440 .9'7 55875
1440
4.7562.047
4
C
3'6"
14
58.440
58.440
1440 97 55,875
1440 97 55.875
1440
4.75
62,047
5
C
2.1
1440
475
62,047
1440 28
6
CL.
74
0
58.440
1440 _97 55.875
1440
4.75
62.047
1440[64
7
PC
75
0
50,814
1380 32 48,258
1380
4,10
0
54,972
13808
R
78
0
41,278
1260 :>137,515
1260
3.19
ti
43,879
1260CL
77
0.9
54,182
1500 61 49,882
1500
4.24
0
57,184
150010
C
44,792
1500 #11 48,049
1500
4.09
0
54.523
1500
11
PC
44,792
1500 81 48.049
1500
409
0
54,523
15004
12
PC 1
82
1 0
3'6"
14
44.792
1500 '81 48,049
1500
4.09
0
_.-0
54,523
55,155
1500
1440
13
C
79
04
_.
44.074
1440 ."115 50.058
1440
426
14
PC
78
0
34,475
1380 .9: 37.390
1380
3 1, .......
0
42,223
1380
15
CL
76
0
39.940
1,320 40 0 41.744
1.620 #39 42.667
1.320
3 55
0
46,973
1,320 99
1.101 ` 1
16
CL
87
0
43.365
1.620
3.63
49,525
17
PC
35,010
1,400 98 35,188
1.400
1,400
2.
2,9Ei
0:,;
39,579
1,400 37
18
PC
35:010
1,400 �.96 35A 8
0
39.579
1.400 ;37
19
R
77
0.7
3'6"
14
35,010
1400 935J88
1400
2,99
0
39,579
1400 37
20
R
76
1.4
51.320
1500 36 50730
4 3`
1500
13
— 0
57328
1500 °87
21
C
74
0
39965
1380 40 41602
1380
354
77005
1380
22
CL
76
0
56,928
1320 A 57,540
1320
1680
. __
4.01
1 0 1
053.657
66,116
1320
1t380 56
23
PC
81
0.6
46.203
1680 .93 °' 47.121
�.
24
CL
43,665
1400 1 43,577
_
1400
_ I_—
3 71
0
....
48,198
1400 10
25
R
43.665
1400 Y1 43.577
1400
3.7 i
_ 3.7 '
3,87
0
48.198
1400 10
26
R
77
0
3'6"
14
43.665
44,767
1400 71 �? 43,577
1400
1440
0
48.198
1400 10
27
PC
78
0
1440 $1 45.572
0
50.772
1440 32
28
C
77
0.2
42.875
1440 %45 I 43,273
1440
368
48.793
1440 ti
29
CL
83
0.6
N.... i
59.107 1680 .03 57,592 1680 4.90
34,816 1200JL 32,699 1200 2.78
65,986
1680 1
30 CL 79 0
38,769 1200 30
31 (
52310 15M AS a 51075 1500 4.34
57109 1500
Month( Loadin GPD/ft
3,91
Year to Date Loading GPD/ft2:
15,66
page __T_
of
Month: July
Yeas
2021
Site Name:
^---
O_27 Area (acres):
- ---
Rate (GPD/ft):
^�
Site Infiltrated?
YES
No
�y
m
3j- p�T
C
_d m
>
m
O
c
> Q
_..........
gal min
....
GPD/ft2
—
It
#DIV/01

FORM: NDAR-2 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page__ of
Did the application rates exceed the limits in Attachment B of your permit?
If not a basin, were the sites kept free of vegetation and raked?
If not a basin, were there any instances of effluent ponding in or runoff from the sites?
If a basin, were there any instances of breakout from the berms?
Was the onsite automatically activated standby power source tested and operational?
El Compliant
j Non Compont
❑✓ Compliant
..._1 non-Complant
[,-j Comdtant
Non -Compliant
(+] Compliant'
NtxnCandWnt
Q Comp[iant
i_�„1 Non Compliant
If the facility is non compliant. please explain in the space below the reason(s) the facility was not in compliance Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Greg Spillman
Permittee:
Carolina Water Service, Inc N.C.
Certification No.: 1004824
' Signing Official:
Grade: 4 Phone Number: 252-241-0661
Signing Official's Title:
Has the ORC changed since the previous NDAR-2? i Yes Nc
i Phone Number: 800-348-2383 Permit ExF-• 3/31 /26
Digitally signed y Dana Hill
DN:C-US, O=CWSNC, CN=Dana Hill,
Reason I the uthor f this document
ana Hill Reasondana I aQcar, uthoaterseis document
/'+ }{ 1
4LA...nnn
Loc Oo you,signing location here
Date. 2DF
nnn www
• LM.S...iT? - .J 1��.2_.J1_71/'1r1A.ly �.-���.,
Version 1-1 000'
Foxlt PDF Ed t r Vim. 11.0.0
Editor
-
Signature Date
Signature Date
By this signature, I cerlify that this nepon is accurrate and complete to the best of my knowledge
1 certify. under penalty of iaw, that this document and all attachments were prepared under my direction or supervision in
acme darnce with a system designed to assure that all qualified personnel property gathered and evaluated the infortnannt,
submitted eased on my Inquiry of the person or persons who manage the system. Of those persons directly responsible 1:
;fatnefing the information, tha infcamartort submitted is, to the best of try knowledge and belief, true, accurate, and Complete. I ail,.
aware that there are significant penalties for submitting false information. including the possibility of fines and Imprlsorment for
knowing violations
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

JVUN111 r'QM1W UN 7LLL VVV t'At-t7 K tJNLI
T . . • DEPARTMENT OF ENVIRONMENT $ NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: • DIVISIONOFWATERRESOURCES- INFORMATIONPROCESSINGUNIT
•
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Pbone:919-807-6306
FACILITY INFORMATION Pfease Pnnf Clearly or Tyne PERMIT Number: Expiration Date 1131,2020
Facility Name Belvedere Plantation Non Discharge WQ0001664 UIC
Permit Name (if different) _ ^—� NPDES _ Other --- —
Facility Address 130 Fairway Dr Hampstead N C 28443 TYPE OF PERMITTED OPERATION BEING MONITORED
County Pender �— i._J Lagoon L.l Remediation Infiltration Gallery
❑ Spray Field L] Remediation
Contact Person Greg Spillman Telephone# [phone] E-1 Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name # 3 Green No of wells to be sampled 9 L? Water Source Heat Pump C l Other INFILTRATION BASIN
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): _ MW7
Date sample collected
7/21,•12021 _
FIELD ANALYSES:
WAS
Well Depth 17 ft
p T
Well Diameter
2 in
pH o0400 6.1 units Temp 000i, ''' G
DRY at
Depth to Water Level 8<516 5
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 um ed/bailed before sampling 5
p p p 9
gallons
9
Appearance light orange
PP -----
here
Samples for metals were collected unfiltered ❑ YES
0 NO and field acidified C_a YES ❑ NO
L...__...�
LABORATORY INFORMATION
_
Date sarnple. analyzed 7121 2021
Laboratory Name
Environmental Chemists. Inc. Certification No 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations
COD oo335
mg/L
Nitrite (NO„) as N owl,,
0.03 m /9+L
Coliform MF Fecal 3io16
<1
/100mL
Nitrate (NO,) as N oos20
003 mg/L
Coliform MF Total 315o4
r100mL
Phosphorus Total as P o06,i5
053 mg,1L
Mote Jst: MM meth(rf in: hi(3hly huIDd sampie5:+
Orthophosphate 70507
rnglL
issoived Solids Total 70300
95
mg/L
Al - Aluminum 01105
mg/L_
pH (Lab) 00403
61
units
Ba - Barium 0!007
ug/L
TOC oomo
mg1L
Ca - Calcium oogi6
mg/L
Chloride 00940
13
mg/L
Cd - Cadmium 01027
ug/L
Arsenic olow
ug/L
Chromium Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg"I
Phenol 32730
ug/L
Fe - iron 01045
ug/L
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
pecific Conductance 0oo95
IiMhos
K - Potassium o0917
rnglt_
'Total Ammonia ooeio
<0 2
mg/L
Mg - Magnesium 00927
_ _ _ mg/L
(FuhmoniaNitrogen
Mn - Manganese 01055,
- ug/L
TKN as N 00625
_ _
mg/L
Ni - Nickel o1oc-
ug/L
Pb - Lead olot.i ug/L
Zn - Zinc oiml- mg/L
Other (Specify Compounds and Concentration Units)
ORGANICS: (by GC GC,MS HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? A Yes (1) i....11 No (0)
VOC 'a; method #
method #--
method #
method #
r -•.. •s
VOC Rerri
f certify that, to the best of my knowtedge 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
DWR-certified laboratory i am aware that there are significant penalties for submitting false information including the po"bility of fines and imprisonment for knowing violations
Dana Director of Operations
Da na Hill
Perindlee ior Authorized Aoent) Name -ir.(' T:tle 1`1�ease Drall of Noe Sonatufe of Pefin,ttee io; Authoi zzed Ace

vvomr, rvrcwi UiV YCLLUV1r MAFLH ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
or -Yoe
Facility Name _ Belvedere Plantation
Permit Name (if different):-�-
Facility Address. 130 Fairway Dr Hampstead N C 28443
County Pender
act Person Greg Spillman Telephone# [phone]
Location/Site Name # 7 Green No of wells to be sampled
19
DEPARTMENT OF ENVIRONMENT $ NATURAL RESOURCES
DIVISION OF WATER RESOURCES INFORMATION PROCESSINGUNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 276"-1617 Ptwtte: 919-807-6306
PERMIT Number:
Expiration Date 1/31/2020
Non -Discharge WO0001664
_ UIC
NPDES
Other-_- -
TYPE OF PERMITTED OPERATION
_
BEING MONITORED
CJ Lagoon
�_� Remediation infiltration Gallery
❑ Spray Field
C7 Remediation
❑ Rotary Distributor
❑ Land Application of Sludge
El Water Source Heat Pump
1-1 Other - INFILTRATION BASINS
WELL ID NUMBER (from Permit): MW8
Date sample collected 7/2112021
FIELD ANALYSES:
If WELL
WAS
Well Depth - 18 ItWell
Diameter 2 in
pH oo400 6.5 units Temp ooarr 'C
DRY at
Depth to Water Level 62546 7 8
Screened Interval 5 ft to 15 It
Spec Cond oor,94 (,Mhos
time of
Measuring Point is 3 It above land surface
Relative M P Elevation ff
Odor 000m None
sampling
Volume of water pumped/bailed before sampling 5
gallons
Appearance Tan
checkhere, -
Samples for metals were collected unfiltered ❑ YES
❑ NO and field acidified LJ YES ❑ NO
LABORATORY INFORMATION
----------.-.-
_-_�
o: amp e ana yze ; :21!2Q2 i _ _ Laboratory Narne Environmental Chemists. Inc
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite ;NO,) as N oo615
<0 02 mg/L
Conform MF Fecal 31r iG <1
/100mL
Nitrate (NO,,) as N 00620
007 m9 iL
Coidorm MF Total 31504
i100mL
Phosphorus Total as P oohs
5 55 mgiL
,Note Uae MPN snethoA for hiOMy turbid sampiesi
Orthophosphate 70507
mgiL
issolved Solids Total 70300 211
mg/L
At - Aluminum ot,os
mgiL
pH (Lab) 00403 65
units
Ba - Barium 01007
ug/L
TOC oo68o
mg/L
Ca - Calcium 00916
_
mg/L
Chloride 00940 _ <5
mg!L
Cd - Cadmium 01027
uglL
—�____
Arsenic 01002 _
ug/L
Chromium Total 0to34
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L.
Phenol ,27sc
ug/L
Fe - Iron 01045
ug/L
Sulfate 00945 _
mg/L
Hg - Mercury 71WO
ug/L
Specific Conductance 00095
I+Mhos
K - Potassium 00W7
mg/L
Total Ammonia oo610 <0.2
mgiL
Mg - Magnesium 00927
mg&
(Ammorna N4rogen Ni-i, as N. Ammn„ ,a N,Uogen. ro,ali
—"-
Mn - Manganese otoss
_ ug/L
TKN as N 00625
- mgiL
Ni - Nickel 01067
ug/L
Fnr Rramnrliatinn C—tame nni„ rA"9 t, i �i, o . ,.
r.-n,. 1-1— „- _.
Certification No 94
Pb - Lead olosi ug/L
Zn - Zinc 0109 - mg/L
Other (Specify Compounds and Concentration Units)
ORGANICS: (by GC GCiMS HPI.C)
(Specify test and method #. ATTACH LAB REPORT )
Lab Report Attached? [ Yes (1) 'F; No (0)
VOC 7er3 method #
method # -
method #
method # ----�-
niy-t_ rmuen iotai vuus
mg%L_ VOC Removal%
Dana Hill. Director of Operations Dana Hill
.a._
Pe*mittee ,or Authonzed Aqent) Name and Title Please urn' or tvoe &Qrrature of Permiitee for Authonzed Agents !Date;
GW-59 Rev 8/2013

SUBMIT FORM ON YELLOW PAPER ONt Y
GROUNDWATER QUALITY MONITORING:
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
VISION OF WATER RESOURCES -INFORMATION PROCESSING UNIT
COMPLIANCE —REPORT -FORM
1617 MAIL SERVICE CENTER, RALEIGH. NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Pant
Clearly or Type
PERMIT Number: Expiration Date 1131/2020
Facility Name.
Belvedere Plantation
Non -Discharge WQ0001664 ­­ UlC
- _ ---- - -------- ---
NPDES Other
Permit Name (if different):
Facility Address
130 Fairway Dr
Hampstead N.0 28443
TYPE OF PERMITTED OPERATION BEING MONITORED
EJ Lagoon El Remediation Infiltration Gallery
County — Pender
El Spray Field Remediation.
Contact Person Greg
Spillman
Telephone# [phone]
El Rotary Distributor Land Application of Sludge
Well Location/Site Name- # 3 Green new woods
No of wells to be sampled 9
['71 Water Source Heat Pump Other INFILTRATION BASINS
from Pe
SAMPLING INFORMATION
If WELL
WELL 10 NUMBER (from Permit):
MW9
Date sample collected 7/21/2021
FIELD ANALYSES:
WAS
Well Depth 23 ft
Well Diameter 2 in
pH 00400 5 7 units Terrip 000ic 20 Oc
DRY at
Depth to Water Level 82S46 17
Screened Interval 5 ft to
15 ft Spec Cond r=94 liMhos
time of
Measuring Point is 3 ft above land surface
Relative M P Elevation
Odor 00085 None
sampling,
Volume of water pumped/bailed before sampling 5
gallons
Appearance light orange
check
here
Samples for metals were collected unfiltered 0 YES
EJ NO and field acidified 'Ll YES I NO
LABORATORY INFORMATION
Date sample analyzed 7/2
1
Laboratory Name Environmental Chemists. Inc Certification No 94
PARAMETERS NOTE:Valuesshould
reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N oo615 <0 02
mg!L Pb - Lead o1o51 ug1L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 5-0 _9
In g / L Zn - Zinc 01092 mgiL
Coliform: MF Total 315o4
/100mL,
Phosphorus Total as P oo665 1 77
mg/L
Mole Use MIIN,Tleth(xlfwt)Kjt)ly!t,,t),d sampres,
Orthophosphate rmw
mg/L Other (Specify Compounds and Concentration Units)
)issolved Solids Total 70300 167
mg/L
At - Aluminum of 1o5
mg/L
pH (Lab) oo4o3 57
units
Ba - Barium 01007
ug/L
TOC oo6so
— mg/L
Ca - Calcium oo916
mg/L
Chloride oo94o 50
mg/L
Cd - Cadmium 01027
ug/L
Arsenic oiow
ug/L
Chromium Total 01034
ug/L
Grease and Otis oo552.
mg/L
Cu - Copper 01042
mgJL ORGANICS: (by GC GUMS HPLC)
Phenol 32730
ug/L
Fe - Iron 01045,
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
r'ng/L
Hg - Mercury 71900
uq1L Lab Report Attached? 0 Yes (1) D No (0)
Specific Conductance 00095
liMhos
K - Potassium 00937
inglL VOC 7873 method #
Total Ammonia oo6lo <0 2
mgiL
Mg - Magnesium 00927
mg/L method #
;fvnmonfa Nitrogen NH t as N_Anvnoz,!a Wrogen
rota!)
Mn - Manganese olo5s
uq1L method #
I KN as N OM25
mg/L
Ni - Nickel oioc-,
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs TT19i
1L. Effluent Total VOCs mg/L VOC Removal%
Dana Hill, Director of Operations
Perm;ttee (of Authorized Agent) Name and Title Please Drint of tvoe
GW-59 Rev 812013
Dana Hill
Signature of Petrititlee ior Authorized Aaeril')
1 Date)

avnmr i f-UKM UN YtLLUV4 NAF IER ONLY
I
Q
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION —— Please Print Clearly or
aciiity Name _ _ Belvedere Plantation
ermit Name (if different)
acility Address — ^— — 130 Fairway Dr Hampstead N C 28443
County Fender
ontact Person. Greg Spillman — Telephone# [phone]
tell Location/Site Name # 3 green near tee box 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 276"4617 Phone: [phone]
PERMIT Number:
Expiration Date 1/31/2020
Non -Discharge WQ0001664
UIC
---
NPDES
Other_
TYPE OF PERMITTED OPERATION
_
BEING MONITORED
C...7 t-agoon
❑ Remediatlon Infiltration Gallery
❑ Spray Field
❑ Remediation
Rotary Distributor
Land Application of Sludge
L.] Water Source Heat Pump
❑ Other INFILTRATION BASINS
L ID NUMBER (from Permit): MW 10 — Date sample collected 7/2112021
Depth 18 ft. Well Diameter 2 in
1 to Water Level 82546 4 1 ft below measuring point Screened Interval ^ 5 ft to 15 ft
:wring Point is 3 ft above land surface Relative M P Elevation ft
ne of water pumped/bailed before sampling 5 gallons
)des for metals were collected unfiltered CJ YES ❑ NO and field acidified ❑ YES El NO
FIELD ANALYSES:
pH oo400 6 units
Spec Cond 00094
Odor 00085 _
Appearance
Date sample analyzed_ _ 7/21/2021 _ Laboratory Name Environmental Chemists Inc
_
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD omm>
_.__.-..
mg/L
Nitrite (NOS) as N oo615
<0.02 mg/L
Coliform MF Fecal 31616
3 --
/100mL
Nitrate (N4,,) as N 00620
0 08 mg/L
Coliform MF Total 31504
— r 100mL
Phosphorus Total as P oo6c5
25 mg/L
!Note Use IAPN mrtt A for highly turbid samples,
Orthophosphate 70507
^— 9
m /L
)issolved Solids Total -0300
74
mg/L
Al - Aluminum o1los —
mgiL
pH (Lab) 00403
6
units
Ba - Barium 01007
u /L
TOC oo68o
_
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940
7
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
Phenol 32730
ug/L
Fe - Iron oic45
ug/L
Sulfate oo945
mg/L
Hg - Mercury �19oo
_ ug/L
Specific Conductance 0009s
pMhos
K - Potassium 00937
_mg/L
Total Ammonia ooelo
<0 2
mg/L
Mg - Magnesium 00927 _
mg/L
lA+nmorna Nitrogen: NH; as N Arnroonia
Nitr»gen Total)
Mn - Manganese oio55
— ug/L
TKN as N 00625_
mg/L
Ni - Nickel oims
ug/L
Temp 000i( C
iiMhos -
None
light orange
Certification No 94
Pb - Lead o1o51 ug/L
Zn - Zinc 01092 mg/L
Other (Specify Compounds and Concentration Units)
ORGANICS: (by GC GCiMS. HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) i No (0)
VOC 7873 method #
method #
. method # —
rnethod #
r-ot metneaiauon aysterns vnry (Attach Lab Reporis): influent Total VOC.s rng/L Effluent Total VOCs mgrL VOC Removal%
Dana Hill, Director of Operations
Permittee for Authorized Aoentl Name and Title Pease onnt or tyoe
GW-59 Rev 8/2013
Dana Hill
Slaflatu'P. of Pe?m,;tee for Authorized Aoent3 rDatei
If WELL
DRY at
time of
sampling
here 1

SUBMI I F ORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: '
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name Belvedere Plantation
Permit Narne (if different) ----
Facility Address. 130 Fairway Dr Hampstead N C 28443
__...... _............ ... ...__�County Pender
Contact Person Greg Spillman Telephone# [phone]
Well Location/Site Name Basin A right corner No of wells to be sampled'
T
ULFARTMENT F 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 _ WQ0001664 UIC
NPDES _ _ Other _
TYPE OF PERMITTED OPERATION BEING MONITORED
O Lagoon 9 L_J Remediation Infiltration Gallery
Spray Field ❑ Remediation
Rotary Distributor _� Land Application of Sludge
r Water Source Heat Pump ❑ Other. INFLITRATION BASINS
WELL ID NUMBER (from Permit): MVV11 Date sample collected 7/21/2021 _
Well Depth 15 ft Well Diameter 2 in
Depth to Water Level 82546 13 It 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 Q YES 01 NO
LABORATORY INFORMATION
Date sample analyzed 7/21/2021
FIELD ANALYSES:
pH 00400 5.6 units
Spec Cond 00094
Odor 00085
Appearance
PARAMETERS
t_aboratoiy Name— e Environmental Chemists Inc.
NOTE• — —
Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L.
Nitrite (NO) as N oo615 <0 02
mg/L
Co6form. MF Fecal 32616 <1
/100mt
Nitrate (NO,;) as N 00620 <0 02
mg/L
Co6form MF Total 31504
/100mL.
Phosphorus Total as P oo665 0.28
mg/L
;Note Use W N method foi i,,ah1y turbo sam; tes;
Orthophosphate 70507
iissolved Solids Total 70300 60
mg/L
Al - Aluminum oilo5 ^
mg/L
mg/L
pH (Lab) 00403 56
units
Ba - Barium 01007
ug/L
TOC oo68o
mg/L
_
Ca - Calcium 00916
mgiL
Chloride o0940 20
mg/L.
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium. Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 010422
mg/L
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
Sulfate 00945
mg/L
Hg - Mercury rigoo
ug/L
pecific Conductance 00095
liMhos
K - Potassium 00937
mg/L
Total Ammonia oo6lo <0 2
mg/L
Mg - Magnesium 00927
mg/L
+Ammoi+,a Ndro(jei. NH,ias N Fwnmonw Nitingen. Total)
Mn -Manganese o1o55
ug/L
TKN as N 00625
rng/I_
Ni - Nickel 01067
ug/L
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs
Temp 000lc C
t,Mhos
None
Tan
Certification No 04
Pb - Lead oio51 ug/L
Zn - Zinc o1092 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) [J No (0)
VOC 767a method #
method #
method #
method #
rng/L. Effluent Total VOCs
Dana Hill. Director of Operations Dana Hill
Permittee for Authorized Agent) Name and Title Please onnt or NDe
GW-59 Rev 812013 510nalure of Pe.ni„?ee (or Author=zed
mg/l VOC Removal%
DRY at
time of
sampling.
check.
here.
FJ

SUBMI'l FORM ON YELLOW PAPI-P ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Facility Name
Permit Name (if different)
ise Print Clearly or Type
Belvedere Plantation
Facility Address 130 Fairway Dr Hampstead N C 28443
County Pender
Contact Person Greg Spillman Telephone# [phone]
Well Location/Site Name Back of Basin B No of wells to be sampled
9
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 Ii31%2020
Non -Discharge W00001664
UIC
NPDES _
_ Other
TYPE OF PERMITTED OPERATION
BEING MONITORED
Ll Lagoon
[1 Remediation Infiltration Gallery
U Spray Field
❑ Remediation
❑ Rotary Distributor
_
C_7 Land Application of Sludge
C I Water Source Heat Pump
❑ Other INFILTRATION BASINS
I
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW12
Well Depth 15 ft
Depth to Water Level s2s46 11
Measuring Point is 3 It above land surface
Volume of water pumped/bailed before sampling _ 5
Samples for metals were collected unfiltered. ❑ YES
Date sample collected 7!21/2021 _
T Well Diameter 2 in
Screened Interval. 5 It to 15 ft.
Relative M P Elevation. ft
gallons
F] NO and field acidified [] YES 10 NO
FIELD ANALYSES:
pH 00400 6 1 units Temp ocou C
Spec Cond 00094 pMhos
Odor 00085 Slight
Appearance — Brown
It WELL
WAS
DRY at
time of
sampling.
check
here(
1
LABORATORY INFORMATION
Date sample; analyzed 7/21 r2.021
_ Laboratory Name _
Environmental
Chernists_. Inc Certification No 94
i
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations
COD CC335
--1100mL
mg/L
Nitrite (NOS,) as N oo6i5
<0 02
mg/L
Pb - Lead olo51 ugiL
Colit rm MF Fecal 31616 <1
Nitrate (NO-,) as N o0620
<0 02
mg/L
Zn - Zinc 01092 rngtl.
Coliform MF Total 31504
i100mL.
Phosphorus Total as P oom5 _
1 08
_ _ mg/L
tNote i:se !.9i'r: meth-vi tar h hey habuf sa+ripies;
Orthophosphate -0507
mg1L
—
'Other (Specify Compounds and Concentration Units)
5,
issolved Solids Total 70300 147
mg/L
At - Aluminum o11o5
mgJL
I`
pH (Lab) 00403 -� is, 1�
units
Ba - Barium oloo7
ug/L
--`--�—�
TOC oo68o
mg/L
Ca - Calcium oo916
mg1t_
M
Chloride (10940. 31
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ugiL
Chromium. Total 01034
ug/L
Grease and Otls 00552 �
mg/L
Cu - Copper 01042
mgiL.
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 - Mercury7igoo
_
ugiL
Lab Report Attached? ❑ Yes (1) L_.! No (0)
Specific Conductance 00095
11Mhos
K - Potassium 00931
mg/L
V 0 C s 3 — _ method #
Total Ammonia oo6lo <0 2
mgJL
Mg - Magnesium 00927
mg/L
method #
,Amrmnia W myen NH, as N. Pmnuxnia Nitrogen. ?otali
Mn - Manganese o1055
ugiL
— method #
TKN as N oo525
mg/L
Ni - Nickel 010s7
_
ug/L
_
_------_ . method #
For • Only • otal VOCs• •
certify that. to tie best of my knowledge and betief, the information submitted in this report is titre, accurate. and complete- and that the laboratory analytical data was produced using aPproaed method§ of anatysis ey a
EitiVR-certi€+ed tabarata+} I am aware that ttlere are s+�nifirant penai0es ter submitting false Fnfarmatiori rntyudin the oos§iE�tiity at fi"es and impriec�nn?ent for k7owrng ; ;8iia�ls-
Dana Hill, Director of Operations Dana Hill

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM "
FACILITY INFORMATION �~ Please Prim Clearly or Type -
Facility Name. Belvedere Plantation
Permit Name (if different) _
Facility Address 130 Fairway DrHampstead N C 28443
County Pender
act Person Greg Spillman _ _ Telephone#. [phone]
Location/Site Name, 1st Basin C near front right corner No of wells to be sampled: 9
VE-PARTMENT OF ENVIRONMENT $ NATURAL RESOURCES
DIVISION OF WATER RESOURCES _ INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 276"-1617 Phone: [phone]
PERMIT Number: Expiration Date /31/2020
Non -Discharge WQ0001664 UIC
NPDES Other _
TYPE OF PERMITTED OPERATION BEING MONITORED
i_..-1 Lagoon L...] Remediation Infiltration Gallery
L.l Spray Field L Remediation
L-] Rotary Distributor L_] Land Application of Sludge
El Water Source Heat Pump C_] Other INFILTRATION BASINS
WELL ID NUMBER (from Permit): MW 13 Date sample collected 7/21/2021
Well Depth 15 ft Well Diameter 2 in
Depth to Water Level 82546 13 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 0 YES-- ] NO and field acidified. ❑ YES ❑ NO
LABORATORY INFORMATION _--
Date 5` r 1 1 d
FIELD ANALYSES:
pH 00400 4 9 units
Spec Cond 00094
Odor 000m
Appearance
a rip e aria yze „21/2021 _ Laboratory Name Environmental Chemists Inc
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N omi5
<0.02 mg/L
Coliform. MF Fecal 31616
<1
/100mL
Nitrate (NO) as N 00620
<0.02 mg/L
Cohform MF Total 31504
/100mL
Phosphorus Total as P 00665
0.67 mg/L
{Note Use MPN mehod for highly turb!d
sa,plesj
Orthophosphate ?ago?
mg/L
)issolved Solids Total 70300
33
mg/L
Al - Aluminum o1 im
mg/L
pH (Lab) 0e403
49
units
Ba - Barium oloo7
ug/L
TOC 00680
mg/L
Ca - Calcium m916
_
^^ mg/L
Chloride oo94a
<5
mg/L
Cd - Cadmium oio2i
ug/L
Arsenic 01002
ug/L
ChromiumTotal oio34
ug/L
Grease and Oils 00552
mg/L
Cu - Copper oio42
mg/L
Phenol Phenol 32730
_
T ug/L
Fe - Iron oio45
ug/L
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
>pecific Conductance 00095
_ ){Mhos
K - Potassium 00937
-„ ---�
mg/L
Total Ammonia oo(,10
<0 2
mg/L
Mg - Magnesium 00927
mg/L
4,Annlx)no Nitrogen, NH, as N. Arnmoma
Nitrogen. Tolall
Mn -Manganese o1055
- - ug/L
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs
Dana Hill, Director of Operations
-_._-___..__._T
ermittee for Authorized Agetill Name and Title - Please prrirr 1'vpe o
GVJ-59 Rev 812013
Pb - Lead 01,051
Zn - Zinc 01092
If WELL
Temp 000v. _ C DRY at
I,Mhos T time of
None samplir
light brown
Certification No 94
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 76; method #
method #
method # a_ -
method #
rng/t. Effluent Total VOCs
Dana Hill ""�--
of Permalee for Authorized Agent)
rrlg/I. VOC Removal%
here:
E-

JUDMI I 1-k,)Mlvl UN TCLLUYv t�AVI:-N UNLY
ROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
lye Pant Clearly or Type
Facility Name. Belvedere Plantation
Permit Name (if different) —
Facility Address 130-Fairway Dr Hampstead N C 28443
County Fender
ict Person Greg Spillman Telephone# [phone]
Location/Site Name Basin left corner. No of wells to be sampled
M.
DEPARTMENT OF ENVIRONMENT 8+ NATURAL RESOURCES
DIVISION OF WATER RESOURCES • INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEI{'H. NC 27699-1617 Phone: [phone]D6
PERMIT Number:
Expiration Date. 1131/2020
Non -Discharge VVQ0001664
- UIC
NPDFS
Other
TYPE OF PERMITTED OPERATION
BEING MONITORED
[J Lagoon
L..J Remediation Infiltration Gallery
LJ Spray Field
❑ Remediation:
LJ Rotary Distributor
(. Land Application of Sludge
t. ' Water Source Heat Pump
❑ Other INFILTRATION BASINS
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW14
Date sample collected
7/21/2021 _
FIELD ANALYSES:
WAS
Well Depth 15_ ft
Well Diameter
2 in
pH 00400 6 2 units Temp owl, C
DRY at
Depth to Water Level 82546, 12 ft below measuring point
Screened Interval
5 ft to 15 ft
Spec. COnd 00094 }Mhos
time of
Measuring Point is 3 ft above land surface
Relative M P Elevation
ft
Odor doom Slight
sampling
Volume of water pumped/bailed before sampling 5 gallons
—
Appearance Brown
check
here (_......_.�
Samples for metals were collected unfiltered ❑ YES ❑ NO
and field acidified: ❑
YES El NO
_
[late sample analyzed _ _ 7/21/2021 laboratory Name Environmental Chemists. Inc.
PARAMETERS NOTE_: Values should reflect dissolved and colloidal concentrations.
COD 00335
^
mg/L
Nitrite (NO) as N oo6i,,
<0 02 mglL
Conform MF Fecal 31616
<1
/100mL
Nitrate {N0,) as N 00620
002 mg/L
Coliform MF Total 31504
/100mL
Phosphorus. Total as P o%6;,
047 rng/L
lNote, iJse MPN rnelhod for hiai,iy Curb+d
sample;+
Orthophosphate 7050i
mg/L
issolved Solids Total 70300
1 12 _
mg/L
Al - Aluminum o11o5
mg/L
pH (Lab) 00403
6 2
units
Ba - Barium oloo7
ugiL
TOC o%8o
mg/L
Ca Calcium oo916
mg/L
Chloride oo94o
15
mg/L
Cd - Cadmium 01027
ugiL
Arsenic 01002 —
ug/L
Chromium Total o1o34
ug/L
Grease and Oils 00552
rng/L.
Cu - Copper 01042
ing/L
Phenol 32730
ug/L
Fe - Iron oio45
ug/L
Sulfate 00945
mg/L
Hg - Mercury 71900
------ ug/L
Specific Conductance 00095
IiMhos
K - Potassium oo93r
mg/L
Total Ammonia oo6I0
<0.2
mg/L
Mg - Magnesium 00927
mg/L
!Ammonia Nitrogen NH, as N: Ammonia Nitrogen_ lout)
Mn - Manganese o1o55
ug/L
TKN as N 00625
T mg/L
Ni - Nickel oi%
ugiL
^ � _
Pb - Lead c1o51
Zn - Zinc o1092
Certification No 94
ug/L
mg/L
Other (Specify Compounds and Concentration Units)
ORGANICS: Irby GC. GC/MS HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) No (0)
VOC 78713 method #
method #
method # _
method # -
y Invto"i u.au mul.»lia/. IrnlUet+i luidl void. mg!I_ tttiuent total VOCs 11194 VOC Removal%
Dana Hill, Director of Operations Dana Hill Permittee for Authorized Agent) Name and Title Please onnt or tvoe Signature of Perm!nee for Auttlonzed Anent! (Date)
GW-59 Rev 812013

SUBMI I FORM ON YELLW PAPER ONLY
6
0,
Ise Pnn! Clearly or Type
Belvedere Plantation
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name
Permit Name (if different
Facility Address 130 Fairway Dr Hampstead N C 28443
County - Pender
act Person Greg Spillman Telephone# [phone]
Location/Site Name_ Between Basin 8 & C No of wells to be sampled 9
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW1.5
Well Depth g n
Depth to Water Level 6254E 12
Measuring Point is 3 ft above land surface
Volume of water pumped/bailed before sampling. _
Samples for metals were collected unfiltered ❑ YES
Date sample collected
Well Diameter
7/21 /2021
2 in
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES _.._.._
DIVISION OF WATER RESOURCES, INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER. RALEIGH, NC 27699-1617 Phone: 919,807-6306
PERMIT Number: Expiration Date 1/31/2020
Non -Discharge _ WO00_0_1664 UIC
NPDES _ Other_
TYPE OF PERMITTED OPERATION BEING MONITORED
U Lagoon C.� RemediationInfiltration Gallery
CJ Spray Field ❑ Remediation
f_7 Rotary Distributor i__J Land Application of Sludge
-) Water Source Heat Pump M Other INFIL.TRATiON BASINS
Screened Interval 5 ft to 15 ft
Relative M P Elevation ft
5 gallons
11 NO and field acidified ❑ YES ❑ NO
FIELD ANALYSES:
PH 00430 5 units
Spec Cond oo094
Odor 000m
Appearance
Date sample analyzed 7/21/2021 Laboratory Name
PAR __.__ Environmental Chemists. Inc
--
AMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
—/100rnL
Nitrite INO1,) as N oo615 <0 02
mg/L
Coliform MF Fecal 3161E <1
Nitrate (NO-j) as N 00620 003
mg/L
Coliform MF Total 31504
t100mL
Phosphorus Total as P o0665 1 08
mg/L
iNote Use MPN medhcxl for homy wrbrcl samr*les)
--�
Orthophosphate 70507
mg/L
hssolved Solids Total 70300 39 _
mg/L
Al - Aluminum of io5
mg/L
pH (Lab) 00403 5
units
_
Ba - Barium 01007 T
ug/L
TOC 00680
mg/L
Ca - Calcium 00916
—
mg/L
Chloride 00940 10
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ugJL
Chromium Total o1034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mgiL
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
Sulfate 00945
mg/L
Hg - Mercury 71900
ugJL
pecific Conductance 00095
i,Mhos
K - Potassium 00937 _
mg/L
Total Ammonia oo6/o <0 2
mg/L
_
Mg - Magnesium 00927
mg/L
�Arnmon-a Nd409en NH, as N. Amino,,ia Nitrogen. Nyd6
---`--'—'---
Mn - Manganese oto5s
ugJL
TKN as N 00625
mg/L
Nt - Nickel oio67 -
ug/L
If WELT
WAS
Temp. 000l( "C DRY at
liMhos time of
None
light brown
Certification No 94
Pb - Lead 01051 ug/L
Zn - Zinc 01092 mg/L
Other (Specify Compounds and Concentration Units).
ORGANICS: (by GC GC/MS. HPLCj
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? 0 Yes (1) _! No (0)
VOC 7a73 method #
-------______, method #
— method #
method #
For Remediation Systems Only (Attach Lab Reports): influent Total VOCs. ma/L. Effluent Total VOCs
rng"T VOC Removal%
Dana Hill, Director of Operations -•
Dana Hill
.mop..... ... __
ermittee (or Authorized Aaent) Name and Title Please or ni or tvae Signature of Pern,ittee /or Authorized Aoent)
GW 59 Rev 812013 [late'