WQ0000948_Monitoring - 02-2021_20210331 (2)

SUBMI 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`s`) 27845 ton
County
I`"'' Johnny G. You�tg) (zip) 252-534-3811
Contact Person: Telephone #:
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sarripled: (from
Well Identification Number (from Permit): V For Groundwater Treatment Systems
Well Depth: -73 ft. Well Diameter: 4L in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 6.5 ft. below measuring point.
Measuring Point (M.P.) is:_,_3 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 35 Date sample collected: c9Z-Ia-2-I
Field analysis: pH Go S Specific Conductance uMhos
Temp. (—°C, Odor b .i Appearance C-V'2T
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal _ < / /100ml Nitr
Coliform: MF Total __ /100m1 Pho
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC / • l'..
mg/I
Chloride 3 °Z.
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/1
Sulfate
mg/1
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/I
GW-59
Rev. 03/2000
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH, NC 27699-1636 Phone- f919) 733-39;
PERMIT #: WQ0000948 X
Non -Discharge
EXPIRATION DATE:
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: Environment 1, Inc
Certification No. 9Q1
YES NO and field acidified
to (NO2) as N mg/1
ate (NO3) as N __ • boy mg/I
sphorus: Total as P mg/1
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium Kb -a mg/I
Ca - Calcium mg/I
Cd - Cadmium
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium • 1 2Q� mg/I
Mn - Manganese�/��.1�y mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen O, q-, mg/I
Other (Secity Compounds and Concentration Units)
Total Bissolved Residue mg/1
39
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method If = .
method # =
- Please print or type
o2 /

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 East Jefferson ST. P 0 Box 614
Jackson N C`S""'' 27845 ton
(c.y) u,el (zql County
Contact Person: Johnny G . Young Telephone #: [phone]
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: If-i
Well Identification Number (from Permit): % For Groundwater Treatment Systems
Well Depth: ft. Well Diameter: 4 in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 6,5 ft. below measuring point.
DEPARTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone, MCI) 711-19:
PERMIT #: WQ0000948 X
Non -Discharge
NPDES
EXPIRATION DATE-�-�l
U
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:3 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 3_�j— Date sample collected: eZ,- Ib Date sample analyzed:
Field analysis: pH 5,43 . Specific Conductance uMhos Laboratory Name: Environment 1, Inc
Temp. I C, Odor niD.r/�` Appearance Certification No. 2g1
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N mgA
Coliform: MF Fecal f /100ml Nitrate (NO3) as N mgA
Coliform: MF Total /100ml Phosphorus: Total as P mg/l
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC 1. 5lo
mg/l
Chloride 'k,�L
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/l
GW-59
Rev. 03/2000
Orthophosphate
mg/I
Al - Aluminum
mgA
Ba - Barium
mg/l
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/1
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mgA
Pb - Lead mgA
Zn - Zinc mgA
Ammonia Nitrogen < O,D* mgA
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 # = .
Authorized Agent) Name and Title - Please print or type
(or
method # =
method # =

SUBMI I FORM 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(sue" 27845 CountyNorthaulpton
(ci'y) Johnny G . You�1�"W (z'°' 252-534-3811
Contact Person: g Telephone #:
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: (from PemJr)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: 1% ft. Well Diameter: in. Check One: ❑ Influent (98)
Screened Interval: ft. to n. ❑ Effluent (99)
Depth to Water Level: G ft. below measuring point.
DEPARTMENT OF ENVIRONMENT 6 NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone- 19191 733-39:
PERMIT #: WQ0000948 X
Non -Discharge
EXPIRATION DATE: 12-:i1-
UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
T 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: f < 5 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 30 Date sample collected: 2--t0-2J Date sample analyzed:
Field analysis: pH S r o Specific Conductance uMhos Laboratory Name: Enyi ronment nc
Temp. Lt °C, Odor A/o,✓t_ Appearance Certification No. ;�g1
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
mg/I
pH (when analyzed)
units
TOC / • o ;r
mg/I
Chloride a3
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
YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N mg/I
sphorus: Total as P mgA
Orthophosphate mgA
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
PefmiPO'bAor
YES NO)
Ni - Nickel mg/I
Pb - Lead mgA
Zn - Zinc mg/I
Ammonia Nitrogen 0. 7' mg/I
Other (Secify Compounds and Concentration Units)
Total Bissolved Residue mg/1
`l
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
method # =
method # =
G. Young ORC Certification #23129
Authorized Agent) Name and Title - Please print or type
GW-59 Signal I ermittee Nr Aulhori t) (Date)
Rev. 03/2000

SUBMI 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 Ctsr`°Q 27845 County ton
(c"y) Johnny G. Youh °' `2pj 252-534-3811
Contact Person: g Telephone #:
Well LocationJ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
(from Pcrngl)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: / 8 ft. Well Diameter: _� in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 720'r ft. below measuring point.
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phnno-• 1Q1Q1 711-11'
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: 3 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 31-17' Date sample collected: 6 2 - -Z/ Date sample analyzed:
Field analysis: pH t 5 Specific Conductance uMhos Laboratory Name: Enyi ronment 1, Inc
Temp. °C, Odor A/L-v`c,` Appearance c' cc� Certification No. 28-1
PARAMETERS (Samples for metals were collected unfiltered YES NO
and field acidified
COD
mg/I
Nitrite (NO2) as N
mgA
Coliform: MF Fecal < I
/100ml
Nitrate (NO3) as N
or mg/l
Coliform: MF Total
/100ml
Phosphorus: Total as P
mgA
(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
mg/I
Ca - Calcium
mg/I
Chloride
mg/1
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
YES NO)
Ni - Nickel mgA
Pb - Lead mgA
Zn - Zinc mgA
Ammonia Nitrogen < o. 06t mgA
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 # = .
me and Title - Please print or type
method # =
method # =
GW 59 Signa?Ae7b1kTm1ttee r Aut oriz en ([
Rev. 03/2000

SUBMI I I -OHM 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 ast Jefferson ST. P 0 Box 614
Jackson N C784 ton
(coy) sub) �zgj County
Contact Person: Johnny G. Young Telephone #: [phone]
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: o-om6eTrwq
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: _�% ft. Well Diameter:_ in. Check One: ❑ Influent (98)
Screened Interval: IL ft. to 3& ft. ❑ Effluent (99)
Depth to Water Level: 15, 0. ft. below measuring point.
DEPARTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 0► ^rim- 1010% ��e tee•
PERMIT #: WQ0000948 X
Non -Discharge
EXPIRATION DATE:
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:----'— ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: Y_ Date sample collected: 02 10- I Date sample analyzed:
Field analysis: pH S 15 , Specific Con^uctance uMhos Laboratory Name: EnvironmentInc
Temp. �_'C, Odor fir: Appearance Certification No. _ 9R.1
PARAMETERS (Samples for metals were collected unfiltered YES
NO and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal L 1
/100ml
Nitrate (NO3) as N
S• 417 mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total
mg/I
Al - Aluminum
mg/l
pH (when analyzed)
units
Ba - Barium
mg/I
's D9
TOCmg/I
Ca - Calcium
mg/I
Chloride 45
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
YES NO)
-2l
Ni - Nickel mg/I
Pb - Lean mgA
Zn - Zinc m
Ammonia Nitrogen < D. C� mg/I
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
D
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
method # =
method # =

SUBMI I f=ORM 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`st"' 27845 ton
County
(city)
tac Johnny G . Youtg` (zip) 2
Contact Person: 8 Telephone #: [phone]
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sarripled:6
(1'�pe-ft)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: 3/ ft. Well Diameter: _AL in. Check One: ❑ Influent (98)
Screened Interval: It ft. to 3 1 ft. ❑ Effluent (99)
Depth to Water Level: % - 5 . ft. below measuring point.
DEPARTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 ph—..Iola%791_!'1•
PERMIT #: WQ0000948 X
Non -Discharge
EXPIRATION DATE:
UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
N T O Values should reflect dissolved and
colloidal concentrations.
Measuring Point (M-P.) is: 3r 0 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 1/a Date sample collected: 0 Date sample analyzed:
Field analysis: pH52:5� Specific Con ctance uMhos Laboratory Name: Environment 1, Inc
Temp. l!v °C, Odor Appearance Certification No. 2g1
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 0.3 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC 1.53
mg/I
Chloride .46
mg/1
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
Orthophosphate
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/1
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 04- mg/I
Other (Specify Compounds and Concentration Units)
Total Dissolved Residue mg/1
/00
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method # = .
method # =
method # =

1Z llilt 7T
(Submit one each monitoring period with G;V-59 forms.)
j
Enter date monitoring results were due. i- ^Z NV)ll this monitoring report (Gi1lr-59 and GIN-59A)
YES
NO
be submitted after the established due date?
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
_&.;-�
7
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
I YES
NO
identification plate, area overgrown, etc.)? lithe answer is "Yes"', contact the Regional Once forguidance.
1
4
Are any monitored constituents equal to or above the established standards?
YES
If the answer to question 4 is "NO", skip to section 8.
i
If the answer to question 4 is "YES" list the affected wells individually with consiituent(s) and concentration(s)
l
i
exceeding standards in the space provided below:
f `
5
For the constituents identified In question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same weil(s) in the last two years?
i
I
If the answer to question 5 TWO", , 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).
j
l f
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
I NO
�I
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
j
OFFICE IMMEDIATELY FOR GUIDANCE. if the answer is "NO`, monitoring wells may be improperly
�7
located; contact the Regional Office.
i
i
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
/ /
j
If the answer to question 7 is "YES`, describe those actions in the space provided below.
i
If the answer to question T is "NO`; contact the Reglonal 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 I
fines, and/or penalties.
j
i
8
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 evalated-and ,the informat(on subm_j��ed n this'
report (Compliance Report GW-59A) Is trui. e and complete tottie: tiest of my knowledge M;-''g3
3. -2 2�2I
I
S n re of Pe( uth rized Agent) Date
Iftee
G11`-59A i 2/8/2003