WQ0024577_Monitoring - 03-2021_20210419

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
� • . .
DEPARTMENT OF ENVIRONMENT& NATURAL RESOURCES
COMPLIANCE REPORT FORM
. . s .
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
FACILITY INFORMATION Please Prinf Clearly or Type
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
L
Faculty Name: �-,�w�,,�d� /r_'�� �12f-i%r�lT
/
/ �,/�'
PERMIT Number��/ Ex Iration Date:
"Y-1 7% p "" , A10.41
v6
Permit Name (if different):
Non -Discharge UIC
Fa i Address: `t_ w ,y /�� j( C�
NPDES Other
s h -� -
r
County /%/.�la�L�/�
TYPEPF PERMITTED OPERATION BEING MONITORED
La oon ❑ Remediation; Infiltration
Gallery
19'
Contact Person: 41 1-eee
`d
Tele hone#; -
p
Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: 4 lei
No. of wells to be sampled:
❑ Water Source Heat Pump ❑ Other:
SAMPLING INFORMATION
from PemY
WELL ID NUMBER (from Permit): _ %
Well Depth: ft.
���{////
Date sample collected: r�
EL
FIELD ANALYSES: If WLWAg
Depth to Water Level 62546:_ft. below measuring
Well Diameter: in.
Screened
pH 00400: units Temp. 000lo: °C DRY at
point
Measuring Point Is ft. above land surface
Interval: ft. to
Relative M,P, Elevation: ft.
ft. Spec, Cond. 00094: µMhos time of
sampling,
_
Volume of water pumped/bailed before sampling:
gallons
Odor 000as:
---'�'w
Appearance check
Samples for metals were collected unfiltered: ❑YES ElNO
and field acidified; ❑YES ❑ NO
here:
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: 6AWi;eQ,6(eff,4
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
Certification No. 111AI
COD 00336_ mg/L
uoinorm: im- hecal 31616
Nitrite (NO,) as N omis mmil
Ph - 1 oarl n,ne,
/100mL
Nitrate (NO3) as N oos20_ mg/L
Zn - Zinc 01092 m /L
Coiform MFTotal 31604 /1QQMm Pf>0rphpfu.&;..T, I_as.P.oAs&s..�.. 1� _w.,,�. ..
Orthophosphate 70507 /L
rut,S
mg IssolvedSotids:Totel70300_ mg/L Al-Aluminumollos mg/L er ( peclfy Compounds and Concentration Units):
pH (Lab).00go3
_ units Ba ug - be' 01007 _ /L En
TOCooseo KjP 1B �t. ..
mg/L C"- alciurn_oo9.1s_—---mg/L 'Zra—T- --
— —
Chloride. aoeao .. mg/L Gd - Gadmlum o1027 ., ug/L A F--
.-Arsenic 01002 _.__ __. ug/L- _-Chromium: Total olosa-__
------ ug/L
Grease and Oils 00562 mg/L Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MdA )Tvl
Phenol 32730 � �r
UgIL F8 -Iron 01045 � � I
Sulfate oo945 ug/L (Specify test anaA4H'�to�h
.�- H...w,�. n, ter_ . ,.:.... _. !n . ---. ., ,.... H;,1_ ,....�ug61a,.. �ab•Rmpesrtttached� E�,.:r. if�...T.(,�j._A�,
pacific Conductance 000es µMhos K - Potassium 00937 mg/L VOC 7s732: method #
_.Total Ammonia oosso D m.lL M Ma nesium onsx7 l _. ._� 7 g - g mg/L method (Ammonla-Hilrogen; NH, asN; Airmwnla Nltiogen, TolaQ
Mn - Manganese oosss ug/L.___ method #
mg - c et 01o67 ug/L method #
-For Remediation Is MIS Opiy (Attach Lab-Reports):Influe0j.. Total VOCs: mg/L Effluent TotaLVOCs: rng/L VOG Removal°%
fA
fA

UNDWATER QUALITY MONITORING:
PLIANCE REPORT FORM
Name:
Name (If different):
act Person: 7
Location/Site
or
SUBMIT FORM ON
County
Telephone#: �7�r2iel
No. of wells to be sampled:
PAPER ONLY
L ID NUMBER (from Permlt):
Depth:ff Date sample collected: J
7 to Water Level 82646: Well Diameter: iJ ft, below measuring point In.
uring Point Is _ ff• above land surface Well
Interval:_ ft. to ft.
7e of water pumped/balled before sampling: Relative M.p. Elevation:
les for metals were collected unfiltered: �� ft
-._._..._._._„_gallons
RATORYIAICno�ew,. .. ❑YES f-I Ain ___.. ..
.ergKTMEN7 OF ENVIRONMENT 8 NATURAL RESOURCES
'MSION OF WATER QUALITY -INFORMATION PROCESSING UNIT
317 MAIL SERVICE CENTER, RALEIGH, NC 27999.11117 Phone; [phone]
ERMIT Numberl'GId? V ??Expiration Date: -, .or
on -Discharge 0 .0 �/
PDES UIC
Other
(PE OF PERMITTED OPERATION BEING MONITORED
�oon
pray Field ❑ Remediatlon: Infiltration Gallery
❑ Rotary Distributor 0 Remediation:
-W.f.1 c- .-_ . _ ❑Land Application of Skid..
FIELD ANALYSES: if WEL
PH 00400: t� units WAS
Temp. oaolo: / °C DRY at
Spec. Cond. o0o94: µMhos time of
Odor 000ss:��
sampGn
_ u YE5 Appearance check
Date sample analyzed:-- _ """' ❑ NO
here:❑
PARAMETERS NOTE: Values shoWd a ect dissolved and colloidal convent tlons. `
Laboratory Name:
COD 00335
COIIfOrm: MF Fecal 31616 ------- Certification No. Lz ,c
mg/L Nitrite (NO2) as N oosls �
�-1 /100ML Nitrate (NO,) as N anr�n mg/L Pb - Lead otost
.� - rFfJ n �yrL cn - zinc o1092111g/L
L
©; Uso-MPNmethndrartdBhlrttxbfdar� /100ML Phosphoru¢: Total asPoOses
sbl .
olids:Total 7030o Orthophosphate 70507� mg/L
pH (Lab) 00ao3 ._._ _,�l �i ._ . mg/L Al - Aluminum o1105 Otherp
mg/L
(Specify Compounds and Concentration Units):
_._.. units- --._
mg/L
TOC ooeao _ Ba=Barumoioozg/L_ �r e oold ¢qo — Ca - Calcium go91aug/Lmmg/LCd -Cadmium 01027Arsenicoloo2ug/L. e and Oils 00552 Chromium: Total 01034--u�/Lmg/L ug/LCu - Copper o1042henol 3z73o IT1 /LSulfate ooe4s ug/L Fe - Iron oloasgORGANICS: (bY GC, GC/MS, HPLC)
ductance 0ooss mg/L ug/L (Specify test and method #, ATTACHLAB REPORT,}
µMhos Hg -Mercury 71900mmonia oos1u____ K - Potassium 00937 ug/L Lab Report Attached?
Q _ mg/L VOC 78732:Yft (1) ❑ No (0)
ta NiN; Amnw�7 otell Mg"Magnesiunl 00927 ____ Mn -Manganese o1055KN as_W tws2mg
- -
_ _.. ,method #. :.:.
ce o1os7
netho>#
For Remediatlon Systems Onl (Attach ug/L y ( Lab Reports) Influent Total VOCs: method #
mg/L Effluent Total VOCs:
mg/L VOC Removal%
2

SUBMIT FORM ON YELLOW_ PAPER ONLY
GROUNDWATER QUALITY MONITORING:
�•
:
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
,
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: /V 7 xpiration Date: �f
Facility Name: �-5 & i z ���� f,�y
L C� 7�C/�
Non -Discharge UIC
Permit Narne (if different):
NPDES Other
Facility Address: / -
TYPE OF PERMITTED OPERATION BEING MONITORED
County
[1a•Cagoon El Remediation: Infiltration Gallery
Spray Field ❑ Remediation:
Contact Person: r V
Telephone#: l�j'-T3f�' ��
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:
No. of wells to be sampled: S
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
-
If WELL
WELL ID NUMBER (from Permit):
Date sample collected: ? - / / -
FIELD ANALYSES:
WAS
Well Depth: '11 ft.
Well Diameter: in.
pH 00400sc_ SG units Temp. 000lo: 16 oC
DRY at
__A_
Depth to Water Level 62sas:
p �, ft. below measuring point Screened Interval: ft. to
ft. Spec. Cond. 000sa: µ Mhos
time of
Measuring Point is _ft. above land surface
Relative M.P. Elevation: ft.
Odor ocom: /�,y ��
sampling,check
Volume of water pumped/bailed before sampling:
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered. ❑ YES
C NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: '�_�;l � _
LaboratoryName: ,�VLIX_�r`N
!
T Certification No, 1D
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo615
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 1100mL
Nitrate (No,) as N 00620 G v, d y
mg/L Zn -Zinc olosz mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 F 5
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 C> mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 , (� units
Ba - Barium 01007
ug/L
TOC 00680 mg/L
Ca - Calcium oosss
mg/L
Chloride 00940 // 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 Doom µMhos
K - Potassium 00937
mg/L VOC 78732: method #
TotalAmmonia oosto /o mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen, NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese o1055
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%
��oI -,-I-