WQ0015053_Monitoring - 08-2021_20211001

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0015053
Name of Facility:*
Month:* August
Report Information
Type *
GW-59
Moyock Commons WWTP
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
Moyock Commons Signed 546.14KB
GW59.pdf
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Rod Holley
Reviewer: Plummer, Lauren
10/1 /2021
This will be filled in automatically

Is the project number correct?* WQ0015053
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Washington
Accepted Date: 10/6/2021

GW-59A COMPLIANCE REPORT FORM Permit 9 -i2-Q! 50�3
(Submit one each monitoring period with W 59 forms.)
Enter date monitoring results were due. ( fs' -3 ) —7 1 1 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
D i
1F the answer to question ? 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
0i
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional ice for guidance.
4
Are any monitored constituents equal to or above the established standards?
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 concentration(s)
exceeding/standards in the space provided below_
JAJ
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same wells) 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 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
YES
NO
groundwater quality problem?
!f the answer to question 7 is 'YES" describe those actions in the space provided below.
If the answer to question 7 is `WO'; contact the Reafonal Office within 90 days; an evaluation may be
required to determine the impacIthe waste dis osal system is having at the review and compliance
boundaries surrounding this facility. Failure to do, so may sublect the aermW2 to a Notice of Vloladonr
fines, and/or penalties.
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 information was evaluated and the information submitted in this
report (Compliance Report GW 'ti59A) is true and complete to the best of my knowledge_
9"Z,, z/
Signature of permimm (or Aut rized Agent) Date
GW-59A 12/8/2003

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