WQ0023310_Monitoring - 03-2021_20210415

GW-59A COMPLIANCE REPORT FORM Permit 33 t 0
(Submit one each monitoring period with GW--59 forms.)
1 Enter date monitoring results were due.("P ct1 4 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
IF the answer to question 1 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 lib
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 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 exceediqg standards in the space provided rye{ CnW-3O
L, N ox3(
For the constituents►identified inquestion 4 above, have standards been exceeded previouslyfor the e NO
5
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,s,conce t tion(s)reporteedd, and sample'co{leptiorkfigto fgr earc/t gccurren e(for the last two years).
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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 may be improperly
located;contact the Regional Office.
7 Is the permittee implementing previously approved actions required by the Division involving this YES 0
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 ste disposal system is having at the review and compliance
boundaries surrounding this facility. ilure to do so may subject the permittee to a Notice of Violation,
fines, and/or penalties.
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8 The person completing this portion( 59A)oW t onitoring report should sign below and submit this
form with GW-59 forms for required w to the addr 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 GIN A)is e a complete to the best of my knowledge.
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Signature of Pe ittee(or Authorized Agent) Date
GW-59A 12/8/2003
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SUBMIT FORM ON YELLOW PAPER ONLY
Mail original 4, »$'AN 0 T•PENVIRO ENTAI.QUALITY•OlV,OP WATER RESOURCES
GROUNDWATER QUALITY MONITORING: • l5 'If - INF0RNIATI0N.PROCI1100INOUNII •
COMPLIANCE REPORT FORM and 1`copy to
: 1 PERMIT Nuimber(,�OQ QNNFiNIGH,NO R79>l0•1817
FACILITY INFORMATIO Please Print Clearly or Type_. ` , v p /1•••3 a0 OR.
r ation Date: -�
Facility Name: Tcc *)J SRy4 c4li 01-\ cck w C4S/IN Non-Discharge UIC
Permit Name(If different): NPDES Other
Fa i�lity Address: a�g,a Wes, �kk (%�^ TYPE OF PERMITTED OPERATION BEING MONITORED
!l/�V� gC50.1J.� "" ` /C a'% ck County up\;,. ❑ Lagoon ❑Remediation: Infiltration Gallery
ll 9� ??�[, FP -pray Field ❑Remediation:
Contact Person: \( ` '-Q c' ,2, Telephone#:�L 0 �.?' 3 [S 4`' ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name p CtQQNi ea %ar Sl� No. of wells to be sampled: 3 El Water Source Heat Pump ❑Other:
` ` (from Permit)
SAMPLING INFORMATION S? If WELL
WELL ID NUMBER(from Permit): W-t/R Date sample collected: 3- U--a FIELD ANALY ES: WAS
Well Depth: I sft. Well Diameter: a in. pH oo4o0:Ct'j units Temp.0o010:13a'7 °C DRY at
Depth to Water Level 82546: Gp t9 ft.below measuring point Screened Interval: ft. to ft. Spec. Cond. 00094: µMhos time of
/I sampling,
Measuring Point is ft.above land surface e Relative M.P. Elevation: ft. Odor 00085: S 4.(4'C4r' check
Volume of water pumped/balled before sampling: v gallons Appearance (IN-* inn here: 1
Samples for metals were collected unfiltered: EYES CINO and field acidified: 0 YES CINO
LABORATORY INFORMATION q Q
Date sample analyzed ( 3' 1 3—It ))- '(S)3-og'!l aboratory Name: v\ c0�Q.(V\ Certification No. q 4"
PARAMETERS NOTE:Valuis shouf�d reflect Eilssolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01051 Coliform: MF Fecal 31616ug/L
g
C ' Ct1� /100mL Nitrate(NO3)(N0 )as N 00620 1�—, 5' mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 .6,,0`-' mg/L
(Note' Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Sollds:Total 70300 \3 q mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 units Ba-Barium o1007 ug/L
TOC 00680 mg/L Ca-Calcium oo91s mg/L
Chloride 00940 /a mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 uglL
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L 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-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) El No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooseo C 0 A a mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NH3as N;Ammonia Nitrogen,Total)
Mn-Manganese 01055 ug/L ,method#
TKN as N 00625 mg/L NI-Nickel 01067 ug/L ,method#
For Remediatlon Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
1,' rtify that!.tplthe best:ofalny knowledge and belief,the information submitted in this report is true,accu ate,and complete,and that the labor aloi'y analytical data vias produced using;a novedimethods o i' :' '''
„ LI f analysi ,�yfa r r +;;,,
qWf�11l(ied(al?orato y I.ainkaw,afe;ti)at(here ale significant penalties forsubmitting false slot mation,.,mcluding the.possibility of futes and imprisonment fm knowing violations a ( 't'
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Permittee(or Au horize.Agent)Name and Title-Please on t or type Signature of.Per• t e4grth.orized Agent) (Date)
GW-59 'ev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original dltpARTMIMNT OF ENVIRONMENTAL QUALITY•DIV,OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: INFORMATION PR000$SING UNIT •
COMPLIANCE REPORT FORM 1011`MAII,"UORVICE CENTER,RALEIGH,NC 27690.1617
Please Print Clearly or Type — i
FACILITY INFORMATION �-` c `\- PERMIT Number: Q Oa33l�cpiration Date:
Facility Name: UJ�c o )) t�1�0.kt(K\--V'cats-` VV cAN Non Discharge UIC
Permit Name(if different): NPDES Other
Facility Address: a%a Aa E. TYPE OF PERMITTED OPERATION BEING MONITORED
�O�CSo..VJ qt County ❑ Lagoon ❑ Remediation: Infiltration Gallery
IL-8115y Field E Remediation:
Contact Person: W w \t_l �11'` �,,� Tele hone#: 0 `��14" ❑ RotaryDistributor ❑ Land Application of Sludge
Well Location/Site Name: �{� •, ,on '�'cJ\(� No. of wells to be sampled: � ❑ Water Source Heat Pump ❑Other:
C (from Permit)
SAMPLING INFORMATION ^ If WELL
WELL ID NUMBER(from Permit): �� Date sample collected: 3 8 — o.. FIELD ANALYSES: / WAS
Well Depth: 1 S ft. Well Diameter: in. pH 00400: It 9 units Temp. 000lo:ISi I °C DRY at
Depth to Water Level 8254e: time of
p Si ro ft. below measuring point Screened Interval: ft. to ft. Spec.Cond. 00094: µMhos sampling,
Measuring Point is ft. above land surface Relative M.P. Elevation: ft. Odor 00085: SUj-C r I check
Volume of water pumped/balled before sampling: S gallons Appearance ma S+ty Clear here:
Samples for metals were collected unfiltered: 0 YES ❑ NO and field acidified: El YES ❑NO �J
LABORATORY INFORMATION
Date sample analyzed:a-t-i-3-9)3rj i 3'IS)) 3-it-a n Laboratory Name: EAU tC()C41(\e,.cys,._ Certification No. et .f.
PARAMETERS NOTE:Values shoLld refI ct diss6ived and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01051 ug/L
1 Coliform:MF Fecal 31616 .4 ' CO I /100mL Nitrate(NO3)as N oos2o 0 I, i [" mg/L Zn-Zinc olosz mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P o0665 < ( 4 O T mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 c 0 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 _ units Ba-Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 a 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 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-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia o0610 0, ' mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH3as N;Ammonia Nitrogen,Total)
Mn-Manganese 01055 ug/L , method#
TKN as N 00625 mg/L NI-Nickel 01067 ug/L , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
certify that,to the best of my knowledge 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
9Wf-certified laboratory f,am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment to'unowing violations.
\C°\• MIMIllig vb IIIIIIII MEM
Bpi► 'A%
Permittee(or'uth.'zed Agent)Name and Title-•ease print or type Signature of.Per• t e i'uthorized Agent) (Date)
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original .Dill►ART'MINT CON IwINVIRONMINTAI QUALITY.DIV.OF WATER RESOURCES
and 1 copy to:and PRCCIIIING UNIT
COMPLIANCE REPORT FORM 1a1Y MAIL$SRVICI CINTIRr RALEIGH,NO 27699•1017
Please Print Clearly or Type n " A33 TCpiration Date: . 0 _ 4
Facility Name: IN 04"
FACILITY INFORMATION Tc IK, PERMIT Number Q �+3 a`SQW Sce(N1'}a i0� \ 0.:,e,� 1 Non-Discharge UIC
Permit Name(if different): NPDES Other
FacilitylAddress: aa U % a 2S- TYPE OF PERMITTED OPERATION BEING MONITORED
(Ai UC Sail Al C 639 R County C.13 I in ❑ Lagoon III Remediation: Infiltration Gallery
' ,\ 1 r„ LI'5pray Field El Remediation:
Contact Person: \{(CA! VV E f,r)JQ Q(,� Telephone#: 11 Q a9a r3 YS CI Rotary Distributor El Land Application of Sludge
Well Location/Site Name:`q �\��(R VIC,,D CNN '' d (clk
e , No. of wells to be sampled: CI Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION M''\ 2 22 Q� If WELL
WELL ID NUMBER(from `Permit): \'�W s 3 F. Date sample collected:3- 6--a FIELD ANALYSES: l', WAS
Well Depth: `S ft. Well Diameter: in. pH oo400.ki,c1 units Temp. 000io:� l + °C DRY at
Depth to Water Level 82546: Mhos time of
p �] ft. below measuring point Screened Interval: ft. to ft. Spec. Cond. 00094: µ sampling,
Measuring Point is ft. above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: gallons Appearance \ - a(\ here:
Samples for metals were collected unfiltered: ®YES El NO and field acidified: ❑� YES ❑NO
LABORATORY INFORMATION r
Date sample analyzed:a- -9 J)3-I // 3-)S 3-�8 oLlboratory Name: &v r co e,t(N((1(N. Certification No.
PARAMETERS NOTE:Valdes sho(ld reflect dlssoiverd and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead o1051 ug/L
Coliform: MF Fecal 31616 L , Co 1 /100mL Nitrate(NO3)as N 00620 p , mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 .4 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 aa 3 mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium owls mg/L
Chloride 00940 a3 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L 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-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooelo a, as., mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH3 as N;Ammonia Nitrogen,Total) Mn-Manganese 01055 ug/L , method#
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L ,method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that,to the best of my knowledge 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-certifiecl laboratory. I am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for snowing violations.
Permittee(or 40•rized Agent)Name and Title-Please print or type Signature of.Perrellt,a'authorized Agent) (Date) 1
GW-59 Rev.06-07-2018