WQ0022870_Monitoring - 11-2021_20220204

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original 'EPARTMENTOF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to '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 PERMIT Number: Expiration Date: 2-28-2025
Facility Name: Chapel Ridge Non-Discharge W00022870 UIC
Permit Name(if different): NPDES Other
Facility Address: TYPE OF PERMITTED OPERATION BEING MONITORED
Pittsbr ro NC County Chatham ❑ Lagoon ❑Remediation: Infiltration Gallery
© Spray Field ❑Remediation:
Ccil,ict?erson: Peter Rhod&'. Telephone#:[phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: No. of wells to be sampled: 3 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-1 Date sample collected: 11/29/2021 FIELD ANALYSES: WAS
Well Depth: 47.14 ft, Well Diameter: 2 in. pH 7.0 units Temp. 15 °C DRY at
tMhos time of
Depth to Water Level: 20.30 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond. i. sampling,
Measuring Point is 0 ft. above land surface Relative M.P. Elevation: ft. Odor check
Volume of water pumped/bailed before sampling: 4.3 gallons Appearance here:
Samples for metals were collected unfiltered: DYES ❑NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 11/29/2021 Laboratory Name: Environment 1 Certification No. 10
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 <1.0/100m1 Nitrate(NO3)as N 0.16 mg/I Zn-Zinc mg/I
Coliform: MF Total /100m1 Phosphorus:Total as P 0.04 mg/I
(Note: Use MPN method for highly turbid samples) Orthophosphate mg/I Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 410 mg/I Al-Aluminum mg/I
pH(when analyzed) 7.0 units Ba-Barium mg/I KH
TOC 4.08 mg/I Ca-Calcium mg/I
Chloride 13 mg/I Cd-Cadmium mg/I FEB 0 8 2022 r, `t ',,2'1
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 mg/I Hg-Mercury mg/I Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance µMhos K-Potassium mg/I VOC , method#
Total Ammonia 0.09 mg/I Mg-Magnesium mg/I , method#
(Ammonia Nitrogen;NH,as N,Anrnonia Nitrogen,Total) Mn-Manganese mg/1 , 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%
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
DWQ-certified laboratory. I am aware that there are significant.enalties for submitting false information.including the possibility of fines and imprisonment for knowing violations.
Peter Rhodes-Regional Supervisor ,. Ll,. ----` I -3( _.'d ,
Permittee(or Authorized Agent)Name and Title-Please print or type Sign- re of Per lee(or Authorized Agent) (Date)
GW-59 Rev. 1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original .EPARTMENTOF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: 'IVISION OF WATER QUALITY-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 817 MAIL SERVICE CENTER,RALEIGH,NC 27699.1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 2-28-2025
Facility Name: Chapel Ridge Non-Discharge WQ0022870 UIC
Permit Name(if different): _ NPDES Other
Facility Address: TYPE OF PERMITTED OPERATION BEING MONITORED
Pittsboro NC County Chatham ❑ Lagoon ❑Remediation: Infiltration Gallery
© Spray Field ❑Remediation:
Contact Person: Peter Rhodes Telephone#:[phone] ❑ Rotary Distributor ElLand Application of Sludge
Well Location/Site Name: No.of wells to be sampled: 3 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-2 Date sample collected: 11/29/2021 FIELD ANALYSES: WAS
Well Depth: 36.65 ft. Well Diameter 2 in. pH 7.7 units Temp. 14 °C DRY at
Depth to Water Level: 11.05 ft.below measuring point Screened Interval: ft. to _ft. Spec.Cond. µMhos time of
sampling,
Measuring Point is 0 ft.above land surface Relative M.P. Elevation: ft. Odor check
Vr,i ri`a of water pumped/bailed before sampling: 4.5 gallons Appearance here:
Samples'or metals were collected unfiltered: ❑YES ❑NO and field acidified: ❑YES ❑NO
LABORAIRY INFORMATION
Date sample analyzed: 11/29/2021 Laboratory Name: Environment 1 Certification No. 10
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 <1.0/100m1 Nitrate(NO3)as N 0.13 mg/I Zn-Zinc mg/I
Coliform: MF Total /100m1 Phosphorus:Total as P <0.04 mg/I
(Note. Use MPN method for highly turbid samples) Orthophosphate mg/I Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 180 mg/1 Al-Aluminum mg/I
pH(when analyzed) 7.7 units Ba-Barium mg/I
TOC <1.00 mg/I Ca-Calcium mg/I
Chloride 25 mg/I Cd-Cadmium _mg/I
Arsenic mg/I Chromium:Total mg/I
Grease and Oils mg/1 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 mg/I Hg-Mercury mg/I Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance µMhos K-Potassium mg/I VOC , method#
Total Ammonia <0.04 mg/I Mg-Magnesium mg/1 , method#
(Ammonia Nitrogen;NH,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%
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
DWO-certified laboratory. I am aware that there are si•nificant•enalties for submittin.false information includin.the possibilit of fi;'es and imprisonment for known.violations.
Peter Rhodes-Regional S,,pervisor / --t__
Permittee(or Authorized Agent)Name and Title-Please print or type Signature Y' •ermittee(o'Authorized Agent) (Date)
GW-59 Rev 1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy t0: DIVISION 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 PERMIT Number: Expiration Date: 2 28 2025
Facility Name: Chapel Ridge Non-Discharge WQ0022870 UIC
Permit Name(if different): NPDES Other
Facility Address: TYPE OF PERMITTED OPERATION BEING MONITORED
Pittsboro " ` NC County Chatham ❑ Lagoon ❑Remediation: Infiltration Gallery
© Spray Field El Remediation:
Contact Person: Peter Rhodes Telephone#:[phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: No.of wells to be sampled: 3 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-3 Date sample collected: 11/29/2021 FIELD ANALYSES: WAS
Well Depth: 36.46 ft. Well Diameter: 2 in. pH 7.3 units Temp. 15 °C DRY at
Depth to Water Level: 12.00 ft.below measuring point Screened Interval: ft. to _ft. Spec.Cond. µMhos time of
sampling,
Measuring Point is 0 ft. above land surface Relative M.P. Elevation: ft. Odor check
Volume of water pumped/bailed before sampling: 3.9 gallons Appearance here:
Samples for metals were collected unfiltered: OYES El NO and field acidified: ❑YES El NO
LABORATORY INFORMATION
Date sample analyzed: 11/29/2021 Laboratory Name: Environment I Certification No. 10
PARAMETERS NOTE:V,ZIcies should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite(NO2)as N mg/I Pb-Lead mg/I
Coliform: MF Fecal <1.0/100m1 Nitrate(NO3)as N 0.18 mg/I Zn-Zinc mg/I
Coliform: MF Total /100m1 Phosphorus:Total as P <0.04 mg/I
(Note: Use MPN method for highly turbid samples) Orthophosphate mg/I Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 230 mg/I Al-Aluminum mg/I
pH(when analyzed) 7.3 units Ba-Barium mg/I _
TOC 1.11 mg/I Ca-Calcium mg/I
Chloride 22 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 mg/I Hg-Mercury mg/I Report Attached? Cl Yes(1) ❑ No(0)
Specific Conductance µMhos K-Potassium mg/I VOC , method#
Total Ammonia <0.04 mg/I Mg-Magnesium mg/I , method#
(Ammonia Nitrogen;NH,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%
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
DWQ-certified laboratory. I am aware that there are significant.enalties for submittin.false information including the possibility of fines and imprisonment for known.violations.
Peter Rhodes-Regional Supervisor v,-e __ I- ?r - zo�-� _
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of Pe,ttee(or Aut zed Agent) (Date)
GW-59 Rev. 1/2007

I ICI I M❑ -r��r��1� I^`'�/I I��
-Pr0M1r�(��INI1��1 II1`n T70Tg 3 1, Drinking Water ID: 37715
-- Wastewater Ie• .
114 OAKMONT DRi\./L PHONE [phone]
GREENVILLE, N.C. 27858 FAX [phone]
ID#: 265 A
CHAPEL RIDGE (AQUA NC)
MR. R.B. TUPPS
AQUA NORTH CAROLINA DATE COLLECTED: 11/29/21
202 MACKENAN CT. DATE REPORTED : 12/10/21
CARY, NC 27511
REVIEWED BY: j.„-'7'`'
MW-1 MW-2 MW-3 Analysis Method
PARAMETERS Date Analyst Code
PH (field measurement), Units 7.0 7.7 7.3 11/29/21 NNK 4500HB-11
Fecal Coliform (MF), /100 MIs <1 <1 <1 11/29/21 CAW 9222D-15
Ammonia Nitrogen as N, mg/1 0.09 <0.04 <0.04 12/03/21 BMD 350.1 R2-93
Nitrate Nitrogen as N, mg/I 0.16 0.13 0.18 12/01/21 KES 353.2 R2-93
Total Phosphorus as P, mg/I 0.04 <0.04 <0.04 12/02/21 BMD 365.4-74
Total Organic Carbon, mg/1 4.08 <1.00 1.11 12/08/21 HMM 5310C-14
Chloride, mg/1 13 25 22 12/06/21 DIJ 4500CLB-11
Total Dissolved Residue, mg/I 410 180 230 11/30/21 JMS D5907-13
Temperature, °C 15 14 15 11/29/21 NNK 2550B-10
Time 09:59 AM 10:21 AM 10:38 AM 11/29/21 NNK
Static Water Level, feet 20.30 11.05 12.00 11/29/21 NNK
Well Depth, feet 47.14 36.65 36.46 11/29/21 NNK
Water Bailed, Gals. 4.3 4.5 3.9 11/29/21 NNK

Environment 1,Inc. CHAIN OF CUSTODY RECORD
P.O.Box 7085, 114 Oakmont Dr. Page 1 of 1
Greenville,NC 27858
envirEnment 1 inc.com DISINFECTION CHLORINE NEUTRALIZED AT COLLECTION
Phone[phone]•Fax[phone]
lj CHLORINE -
CLIENT: 265 A Week: 49 4 G(/ 4, pH CHECK(LAB)
❑ UV (� _
CHAPEL RIDGE(AQUA NC) U NONE PPPPPPPPP CONTAINER TYPE,P/G
MR.R.B.TUPPS
AQUA NORTH CAROLINA CHEMICAL PRESERVATION
202 MACKENAN CT. AGC ACC A A A
CARY NC 27511
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DRINKING WATER
DWR/GW
SOLID WASTE SECTION
CHAIN OF CUSTODY(SEAL)MAINTAINED
- DURING SHIPMENT/DELIVERY
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SAMPLES COLLECTED BY:
(Please Print) n/eiscr\ N . ,keI(v=n
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SAMPLES RECEIVED IN LAB AT 3 .3 °C
RELINQU SHED BY(SIG.)(SAMPLER) DATE/TIME RECEIVED BY(SIG.) ill DATE/TIME COMMENTS: A(I Siur e S fn LD
y G ^nw-I, Mw•3, g(-61eJ Jvt, Lo 1 ocu�lt,n.
RELINQUISHED BY(SIG.) DAT JT1ME REC ED BY(SIG.) DATE/TIME
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RELINQUISHED BY(SIG.) DATE/TIME RECEIVED BY(SIG.) DATE/TIME
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PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a"C"for composite sample or a"0'for N4 398385
FORM#5 Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1)Samples not falling within the required guidelines will need to be re-collected.The client will be contacted and informed of any deviation
and asked to collect another set of samples.The client may request the laboratory to proceed with the analyses of the current samples.Any
samples analyzed outside of the required guidelines will be "qualified': This means that a note will be included on the sample result and
"Chain of Custody"specifying the deviation.The laboratory is also required to send a letter to the State noting the deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is not
permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided.The samples will meet the requirements of the regulation if there is
a temperature drop from the time of collection until received in the lab.Regardless,all samples should be packed in wet ice using as much
ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle,or in the case of 40 ml. Volatiles Vials,provide a bottle of Acid with
detailed instructions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. Unless specific instructions are provided for a test or bottle (example: cyanide or
volatile organics),fill sample bottles to the bottom of the bottle threads.This will leave a small air space for shaking the sample to mix with
any preservative and again prior to analysis. The lab must verify proper chemical preservation upon arrival in the lab and will note this
information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent.Therefore,these samples must be de-chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle.Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non-chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection"row on the front of this form above the proper parameter.Samples such as Coliforms(which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that
you note the"Total Chlorine at Collection"on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5)A"C"for Composite Sample or a"G"for Grab Sample should be placed in the box for all requested parameters.Grab temperatures as
well as Composite start dates and times can be recorded in the"comments"section.
6)Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature,Date,and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed(example:dry upstream location)
Any other information felt to be pertinent should be included in the"Comments"section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis.Therefore,samples should be
collected as late in the day as possible to allow enough time for transportation,checking in at the lab and analysis.
BOD,Nitrate,Ortho Phosphorus,Settleable Matter,Turbidity,Color,and MBAS samples have a 48 hour holding time.The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals.Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements.Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek
medical attention.Material Safety Data Sheets(MSDS)are available upon request which specify proper handling and personal protection.