WQ0014046_Monitoring - 03-2021_20210331

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Please Print Clearly or
Name:
Name (if different).
Address: ri I
NC
County MA(Nu; I _
act Person: 1 ( j5 Telephone#:q (Q - SCR I
Location/Site Name-x n s ib (l`1 UJ 7P No. of wells to be sampled: IL4_
L ID NUMBER (from Permit): Date sample collected: 3 IGI ZI
Depth: 33 ft. Well Diameter: in.
Ito Water Level: 7 ,9 ft. below measuring point Screened Interval: ft, to
uring Point is ft. above land surface Relative M.P. Elevation: ft.
Ie of water pumped/bailed before sampling: gallons
,lac-fnrmnMl�-r
IEPARTMENT OF ENVIRONMENT 6 NATURAL RESOURCES
NVISION OF,WATER QUALITY -INFORMATION PROCESSING UNIT
617 MAIL SERVICE. CENTER, RALEIGH, NC 97699-1617 Phone: [phone]
No T Nu►>lbe
Non- t,% Jell
Expiration Date:
UIC
Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
(� Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
If WELL
FIELD ANALYSES:
AS
pH 45:14 units Temp. (p, L1 °C
DRY at
Spec. Cond. µMhos
time of
_yLl
Odor N 5me-
sampling,
check
Appearance �� wit'
here:
e sample analyzed: Z .3 J Z.1 Laboratory Name: Me(A
h �t(1C
ZAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N mg/I Pb - Lead
Coliform: MF Fecal 1 W II, /100ml Nitrate (NO3) as N b' mg/I Zn - Zinc
Coliform MF Total
Certification No. 1`''—
mg/I
mg/I
(Nola: Use MPN rnedtod for troghly turbid samples)
/100ml
Phosphorus: Total as P
L� Q 5 mg/I
<<s
€,
Dissolved al�
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Solids: Total mg/I
pH (when analyzed) 5.
Al -Aluminum
mg/I
1 1J?�
TOC c'1 to
units
Ba - Barium
mg/I
,
mg/I
Ca - Calcium
mg/I
!A
Chloride
mg/I
Cd - Cadmium
mg/I
n �
�� u i cvl 1
Arsenic
mg/I
Chromium: Total
mg/I
DWR SECTION
Grease and Oils
mg/I
Cu - Copper
mg/I
ORGANI 0CfiW W
Phenol
Sulfate
mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
mg/I
µMhos
Hg -Mercury
mg/I
Report Attached? ❑ Yes (1) X No (0)
K - Potassium
mg/I
VOC method #
Total Ammonia
(Ammonia Nitrogen; NH3 as N; Ammonia Nifr mg/I Mg -Magnesium mg/I
ogen, Total) Mn - Manganese m /I
TKN as N g
mg/I Ni -Nickel mg/I
For Remediation Systems Only (Attach Lab Reports)
. — nyvnU rvdme ano 1 Ibe - NleaSe print or type
GW-59 Rev.1/2007
Influent Total VOCs:
mg/L Effluent Total VOCs:
method #
method #
method #
mg/L VOC Removal%
odiei

G11'- )(.)A (4-0/1PLIANCE' Ri1;PCrUT v0 JZ�1E
rcl-1110 AAJQOC)lyiCl,4�o
,SuGrnii Ogle ca.Ir nw umrirr, nrrmd mUh GIP-?9 jcr,,nc.j
]
Enter date monitoring results were Will this monitoring report (GW-59 and GW-59A)
1 ES
' O
be submitted after the established due date?
2 Was any required information missinK on the GW-59 report forms? —
YE
NO
IF the answer to question 1 or 2 is `YE", list in the spat ; l.rovideu below the vvell identifcafion number(s) and
explain the problems encountered in obtaining the req+rirod information.
3 Are any of the monitor wells in need of repair or maintenance (dawal ed casing, unlocked or missing cap, missing
identification plate, area overgrown, etc.)? iJ the aruwer is "Yeas", cowoci the Regional O+?ice fnr puidunce.T-
YES
4 Are any monitored constituents equal to or above the estabished standards?
tYES
O
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:
S
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
NO
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).
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 may be improperly
located, contact the Regional Office.
_71—
Is the permittee implementing previously approved actions
j
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 facUrt Failure to do so ma sub'ect the
permittee to a Notice of Violation
fines, and/or penalties
8
The person completing this portion (GW-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 GW-59 form.
I here acknowledge that the above information was evaluated and the information submitted in this
re rt ( mpliance Report GW-59A) is true and complete to the best of my knowledge.
M.V.zct 1
I Z
Signature of Permittee (or Authorized Agent) Date
CNV- i').a I2/8/211113

SUBMIT FORM ON YFLI OW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
.
DEPARTMENT OFENVIRONMENT & NATURAL RESOURCES
COMPLIANCE REPORT FORM
, , ,DIVISION
OF WATER QUALITY -INFORMATION PROCESSING UNIT
FACILITY INFORMATION Please Pnnt C)eady or Type
617 MAIL SQRVICE CENTER, RALEIGH, NC 27689-1617 Phone:'[phone]
Facility Name: T�tDt� p f �}�J�1
t( �V4l0 Expiration Date: b 3%�Q
('@
Permit Name (if different):
NE=RM 7gL
Facility Address: � k�5 ��
No
PDES Other
NC
TYPE OF PERMITTED OPERATION BEING MONITORED
Coun H +
❑ Lagoon ❑ Remediation: Infiltration Gallery
Contact Person: j`n �1.75
Well Location/Site
__
Telephone#:Qjq'(p-j_jt6(/IU
� Spray Field El Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
Name-j�j� j-��� Wkx)-r?
No. of wells to be sampled: _ 4
❑ Water Source Heat Pump ❑ Other:
SAMPLING IN
from Permit
WELL ID NUMBER from Permit :
( ) ��
Date sample collected: 3 a Z t
If WELL
FIELD ANALYSES:
Well Depth: �ft.
Well Diameter: -A in.
WAS
pH 5, units Temp. Qo"A °C DRY at
Depth to Water Level: __ 1_'7 ft. below measuring point
Screened Interval: ft. to
ft. Spec. Cond. t434g5 µMhos time of
Measuring Point is ft. above land surface
Relative M.P. Elevation: ft.
— sampling,
Odor NONe
Volume of water pumped/bailed before sampling: — IC —gallons
check
Appearance (��
_
Samplesformetats-wefe collectedd unfiltered -AYES - - -❑ NZ5 and feld acidifed: ❑YES NO^
LABORATORY
here:
- --- - - --- ----
Date sample analyzed: Zf, - 3 �$�Z) Laboratory Name: CYief �G% �.�
PARAMETERS NOTE: Values should reflect dissolved and
Certification No. �S
colloidal concentrations.
COD mg/I
Coliform: MF Fecal � /100m1
1g
coC�
Nitrite (NO2) as N mg/I
Nitrate (NO3)(NO) as N 0,43 mg/I
Pb - Lead /I
Zn
Coliform: MF Total /100ml
Phosphorus: Total as P mg/I
-Zinc mg/i
(Nola: Use MPN method for highly torpid samples)
-
Dissolved Solids: Total (10 mg/I
Orthophosphate mg/I
Other (Specify Compounds and Concentration Units):
pH (when analyzed) �j,'] units
Al -Aluminum mg/I
Ba
TOC a •4q mg/I
- Barium mg/I
Ca - Calcium mg/I
Chloride 10l S mg/I
Cd - Cadmium mg/I
Arsenic mg/I
Chromium: Total mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol
mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate
Specific Conductance
mg/I
µMhos
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) 50 No (0)
Total Ammonia L O• l
mg/I
K - Potassium
Mg
mg/I
VOC method #
(Ammonia Nitrogen, NH, as N: Ammonia Nitrogen, Total)
- Magnesium
mg /
method #
Mn -Manganese
mg/l
#
TKN as N
mg/I
Ni - Nickel
mg/I
,method
method #
For Remediation Systems Only (Attach Lab Reports):
Rev.1/2007 V
Influent Total VOCs:
mg/L Effluent Total VOCs:
Signature of Permittee for Authorized
mg/L VOC Removal%
G W-59

]
Enter date monitoring results were ue d. ( Will this monitoring report GW-59A)
_D (GW-59 and
be submitted after the established due date?
YES
N(►
Z Was any required information missing on the GW-59 report forms?
YES
Nn
IF the answer to question 1 or 2 is 'YES", iisf in the spac ? provided below the well identification number(s) and
explain the problems encountered in obtaining the regirirod information.
Are
3 any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
identification
YES
U
plate, area overgrown, etc.)? lfthe answer is "Yes", cerdnct the Regional U+?iccJnr paidunce.
4 Are any monitored constituents equal to or above the established standards?
YES
If 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 constituents and concentration(s)
t)
exceeding standards in V7e space provided below.-
I
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
same constituent(s) in
YES
NO
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).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
"YES",
YES
NO
If the answer is 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.
Is the pemtittee implementing previously approved actions required by the Division involving this
groundwater quality problem?
^_t
YES
NO
—
If the answer to question 7 is `YES", describe those actions in the space provided below.
If the "NO",
answer to question 7 is 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 facilit .Failure to do so ma sub'ect the permittee to a Notice of Violation
fines, and/or
penalties
8
The person completing this portion (GIN--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
re ( mpliance Report GW-59A) is true and complete to the best of my knowledge.
3`3 i
Signature of Permittee (or Authorized Agent) Date
(;W1 59.a 12/3/211113

SUBMIT FORM ON YELLOW PAPER ONLY
► , , , EPARTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM �'
617 MAIL SERVICE CENTER, RALEIGH, NC ,27699-1617 Phone: [phone]
FACILITY INFORMATION _ Please Print Clearly or Type
Facility Name: -"rin ClT 1 PERJNIT p�uegba`:� Expiration Date: 1
Non �Isc arge 1 UIC
Permit Name (if different): NPDES Other
Facility Address: �`J�J00,pq 1rj TYPE OF PERMITTED OPERATION BEING MONITORED
NC a County ❑ Lagoon ❑ Remediation: Infiltration Gallery
I Spray Field ❑ Remediation:
rell
ct Person: -NOLle 00��s �.Telephone#:"1�C1'�dC1 i 'i0 El Rotary Distributor ❑ Land Application of Sludge
Location/Site Na`n-a ,- Of �CQa-"- U.)k� ` ,pNo. of wells to be sampled: 4_ ❑ Water Source Heat Pump ❑ Other:
ELL ID NUMBER MW 3
s I Zi
If WELL
(from Date sample collected:
FIELD ANALYSES:
WAS
]PPeermit):
ell Depth: �ft. Well Diameter:
a in.
pH (0-CH units Temp. k5rg °C
DRY at
De Depth to Water Level: 5 ft. below measuring
P � g point Screened Interval:
ft. to
ft. Spec. Cond. 53 µMhos
time of
I',
_
sampling,
Measuring Point is ft. above land surface Relative M.P. Elevation:
ft.
Odor N
heck
olume of water pumped/bailed before sampling: �a _gallons
Appearance emr
ere:
--
Date sample analyzed: Q Z - 3 18 Z1
Laboratory Name: ME'�
—Ae&N T,r%G • Certification No.
1
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead
mg/I
Coliform: MF Fecal 1 CO ! /100ml
Nitrate (NO3) as N Q, 1r0 mg/l
Zn - Zinc
mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P Q ,()u{y mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total L4 (,o mg/I
Al -Aluminum
mg/I
pH (when analyzed) S ,(D units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride r S mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
_mg/I
Grease and Oils mg/I
Cu - Copper
mg/1
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/1
Report Attached? ❑ Yes (1)
❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/1
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen. NH3 as N, Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs. mg/L VOC Removal%
r�)r wo- r�,g Js f ��
�ittee (or Authorized Agent) Name and Title - Please print or type
Signature of

CNV-59A (_41-0,I1LIANCE RVj1OI4'I' F'1_W"1i i'crt�tit rr\0RM1LiflU(,p
�r barir cute err• h m;rrirnrur,, nrrrnri a ,lh Gt6-? j; ; up,j
Enter date monitoring results were due. ( j1 J Will this monitoring be submitted areport (GW-59 and GW-59A) 1 F:S
after the established due date?
t Was any required information missing on the GW-59 report forms? --
--_'YE__-
_ _ _ YES
IF the answer to question 1 or 2 is "`rE >", its. in the spac f.rovidPa below the well idertifica•'ion numbers) and
explain the problems encountFred in obtains, the r&-gMr^d intormetion.
i
3 kre any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing— —I YES I N
I`O
identification plate. area overgrown, etc.)? iJ the ann ser is "Yes", crr:locr tits Regional r)%?7cc�;�r , ridrrnce.
Are any monitored constituents equal to or above the estahiished st;mdards7
_ _ _ YES O
t It the answer to question 4 is 'NO' skip /e section 8. -- — ----- _�
If the answer to question 4 is "YES" list the affected wells inciv;dually 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—i 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, concentrations) 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 anrwer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
i OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
Is the permittee implementing previously approveci actions required by the Division involving this YES I NU
groundwater quality problem?
If the answer to question 7 is "YES", describe (hose actions in the space provided below. - If the answer to question 7 is "NO contact the Re Tonal Office w/thin 90 days an evaluation maybe
re aired to determine the im act the waste dls osa/ s stem is Navin at the review and com maybe
boundaries surroundln this facilit .Failure to do so ma sub'ect the iermittee to a Notice of Violation
fines, and/or nena/ties
8 The person completing this portion (GW--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
rep
oyt�mpllance Report GW-59A) is true and complete to the best of my knowledge.
l
ture
(or Authorized Agent)
2_q1z\
Date

ROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
acility Name: 7-6Lt_Dn1 ni siojam
ermit Name (if different):
acility Address:
�16
t�
Please Print Clearly or Type
SUBMIT FORM ON YELLOW PAPER ONLY
County +2ur'U 1N
ntact Person: bav-e_ CYl()C\t e-Z S Telephone#: CIA -(XIM- ) M(P
III Location/Site Name: ©- - � \\ tl�0No. of wells to be sampled: LA
ILL ID NUMBER (from Permit): y
II Depth: Q-7 ft.
Ith to Water Level: I V ft. below measuring point
isuring Point is ft. above land surface
ime of water pumped/bailed before sampling: 110 1
IDles for-nwtalls-were coltecr€ct- -M-1
tRTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
ION OF WATER QUALITY -INFORMATION PROCESSING UNIT
MAIL SERVICE CENTER, "LEIGH, NC.97699-1617 Phone: [phone].
Non- �45rC��(P
Expiration Date:
Non- IscUIC
NPDES Other
Date sample collected: 01v
Well Diameter: 6A in.
Screened Interval: ft. to —ft.
Relative M.P. Elevation: ft.
and Feld acidified: QYES M NO^
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
If WELL
FIELD ANALYSES: AS
PH LD•30i units Temp. N, Z °C DRY at
Spec. Cond. 51% µMhos time of
Odor sampling,
check
Appearance C Ilea(- here: F-1
e sample analyzed: 3�Q, 2-1- J I \ g J 2-\ Laboratory Name: �er'�� Ti-c
2AMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO,) as N mg/I Pb - Lead
Coliform: MF Fecal /100ml Nitrate (N%) as N d,15 mg/l Zn - Zinc
Coliform: MF Total /100ml Phosphorus: Total as P Q mg/1
(Note: use MPN method for highly turbid sanples)
Certification No.
mg/I
mg/I
Orthophosphate mg/I Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total 3S mg/1
Al -Aluminum
mg/I
PH (when analyzed) 5.10 units
Ba - Barium
mg/I
TOC /, I ' p mg/1
Ca - Calcium
mg/I
Chloride a S mg/1
Cd - Cadmium
mg/1
Arsenic mg/I
Chromium: Total
Grease and Oils mg/I
Cu - Copper
_mg/I
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) 9 No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC , method #
Total Ammonia �'mg/I Mg - Magnesium mg/1
(Ammonia Nitrogen; NH, as N. Ammonia Nitrogen, Total)
Mn - Manganese mg/I
TKN as N mg/1 Ni - Nickel mg/I
method #
method #
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
remouee Ivr rrumvnzeu Aaenu Name ana I Isle - Please print or type
Signature of Permittee (or Authorized Acient) ;Date)

6
i'rl'll)ii hr
Shtuirir nnr crrc/r rn;r:rilnrir•; nrrrnri !1,,Nr G16-;9 j,r;rnc.�
Enter date monitoring results were J Will this monitoring report (GW-59 and GW-59A) YES
be submitted after the established due date?
Was any required information missing on the GW-59 mpolt (arms?
IF the answer to question 1 or 2 is "YE ist in the space�.r;ovi,jeo below the well !der,tific.a•`bn number(s) and
explain the problems en.ceuntFred In obt,+inrrr the required intorm9tOn.
YES
ire any of the monitor wells in need of repau ur maintennncc (dale-ged casing, unlocked or missing cap, Inissin }}}I
identification plate. area rwergrown, etc.)? if the aiiswer is "Yes ", reldoct flit, Regkrnul !),'5g 11'1?ti N(.
c e Jor ; ,,tirtunce.
Are any monitored constituents equal to or above the estahlislted standards? -- --
If ES NO
Ir 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:
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).
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 may be improperly
located; contact the Regional Office.
Is the permittee implementing previously approved actions required by the Division involving thiYFS I NO
groundwater quality problem? s
—r!f the answer to question 7 is "YES", describe those actions in the space provided below. It the answer to question 7 is "NO", contact the Regional Office within 90 da s an evaluation ma be
re uired to determine the impact the waste dis osal s stem is havin at the review and com liance
boundaries surroundin this facilit . Failure to do so ma sub'ect the ermines - a Notice of Violation
fines, and/or Sena/ties
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-59A) is true and complete to the best of my knowledge.
1___1
Agent)
Date
(:W-i9.A 12/8/2003

Meritech, Inc.
q Environmental Laboratory
Laboratory Certification No. 165
Contact: Janet Parrott
Page 1
Client: Town of Stovall
Report Date:
3/19/2021
P.O. Box 100
Stovall, NC 27582
Date Sample Rcvd:
3/9/2021
Meritech Work Order # 030921129
Sample: Effluent Grab
3/9/21
Parameters
Result
Analysis Date
ReportingLimit
Method
BOD, 5 day
Total Suspended Solids
67 mg/L
3/10/21
3/10/21
2.0 mg/L
SM 5210 B
Total Dissolved Solids
Ammonia, Nitrogen
201 mg/L
21
2.5 mg/L
10. mg/L
SM 2540 D
SM 2540C
ChloEPA
3.6 mg/L
29.0 mg/L
3/18/21
3/15/21
1
350.1
TKNride
Nitrite/Nitrate, Nitrogen
11.1 mg/L
0.27 mg/L
3/16/21
3/10/21
0.1 mg/L
0.20 mg/L
SM 4500 Cl B
EPA 351.1
Nitrogen, total
11.4 mg/L
3/16/21
0.10 mg/L
0.20 m
EPA 353.2
EPA
Phosphorus, total
Fecal Coliform
2.38 m g/L
3/15/21
g/L
0.020 mg/L
353.2
EPA 200.7
pH
<2 col/100 ml
8.9 S.U.
3/9/21
2 col/100 ml
SM 9222 D
3/16/21
1.0 - 14.0 S.U.
SM 4500-HB
Meritech Work Order # 030921130 Sample: MW #1 Grab
3/9/21
Parameters
Result
AnalyMs Date
Reporting imit
Method
Total Dissolved Solids
Ammonia, Nitrogen
28 mg/L
<0.1 mg/L
3/15/21
3/18/21
10.0 mg/L
SM 2540C
Chloride
Nitrate, Nitrogen
3.0 mg/L
3/15/21
0.1 mg/L
0.50 mg/L
EPA 350.1
SM 4500 Cl B
Phosphorus, total
0.59 mg/L
0.034 mg/L
3/10/21
3/15/21
0.10 mg/L
0.020 mg/L
EPA 353.2
EPA
Fecal Coliform
TOC
<1 col/100 ml
3/9/21
1 col/100 ml
200.7
SM 9222 D
pH
2.26 mg/L
5.8 SU
3/18/21
3/16/21
1.0 mg/L
1-14 SU
SM 5310C
SM4500H+B
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax-[phone]

Meritech, Inc.
A-0 Environmental Laboratory
Laboratory Certification No.165
Contact: Janet Parrott
Date:
Page 2Report
3/19/2021
Client: Town of Stovall
P.O. Box 100
Stovall, NC 27582
Date Sample Rcvd:
3/9/2021
Meritech Work Order #
030921131 Sample: MW #2 Grab
3/9/21
Parameters
Result
Analysis Date
Reporting Limit
Method
Total Dissolved Solids
60 mg/L
3/15/21
10.0 mg/L
SM 2540C
Ammonia, Nitrogen
<0.1 mg/L
3/18/21
0.1 mg/L
EPA 350.1
Chloride
12.5 mg/L
3/15/21
0.50 mg/L
SM 4500 Cl B
Nitrate, Nitrogen
0.43 mg/L
3/10/21
0.10 mg/L
EPA 353.2
Phosphorus, total
0.060 mg/L
3/15/21
0.020 mg/L
EPA 200.7
Fecal Coliform
<1 col/100 ml
3/9/21
1 col/100 ml
SM 9222 D
TOC
<1.0 mg/L
3/18/21
1.0 mg/L
SM 5310C
PH
5.7 SU
3/16/21
1-14 SU
SM4500H+B
Meritech Work Order #
030921132 Sample: MW #3 Grab
3/9/21
Parameters
Result
Analysis Date
Reporting Limit
Method
Total Dissolved Solids
46 mg/L
3/15/21
10.0 mg/L
SM 2540C
Ammonia, Nitrogen
<0.1 mg/L
3/18/21
0.1 mg/L
EPA 350.1
Chloride
1.5 mg/L
3/15/21
0.50 mg/L
SM 4500 Cl B
Nitrate, Nitrogen
<0.10 mg/L
3/10/21
0.10 mg/L
EPA 353.2
Phosphorus, total
0.044 mg/L
3/15/21
0.020 mg/L
EPA 200.7
Fecal Coliform
<1 col/100 ml
3/9/21
1 col/100 ml
SM 9222 D
TOC
2.49 mg/L
3/18/21
1.0 mg/L
SM 5310C
PH
5.6 SU
3/16/21
1-14 SU
SM4500H+B
Meritech Work Order #
030921133 Sample: MW #4 Grab
3/9/21
Parameters
Result
Analysis Date
Reporting Limit
Method
Total Dissolved Solids
35 mg/L
3/15/21
10.0 mg/L
SM 2540C
Ammonia, Nitrogen
<0.1 mg/L
3/18/21
0.1 mg/L
EPA 350.1
Chloride
2.5 mg/L
3/15/21
0.50 mg/L
SM 4500 Cl B
Nitrate, Nitrogen
0.15 mg/L
3/10/21
0.10 mg/L
EPA 353.2
Phosphorus, total
0.067 mg/L
3/15/21
0.020 mg/L
EPA 200.7
Fecal Coliform
<1 col/100 ml
3/9/21
1 col/100 ml
SM 9222 D
TOC
<1.0 mg/L
3/18/21
1.0 mg/L
SM 5310C
PH
5.6 SU
3/16/21
1-14 SU
SM4500H+B
I hereby certify that I have reviewed and approve these data. ,y�{�(1J f 2
Laboratory ReprTen"
tative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]