WQ0024003_Monitoring - 03-2022_20220428

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DWR - NonDischarge Monitoring Report Submittal
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NORTH CAROLINA
Enrlranmenlel QHaflly
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0024003
Name of Facility:* Harvey Point Defense Testing Facility WWTP
Month:* March Year:* 2022
Report Information
..................................................................................................................................................................................................................................................................................................
Type* Upload Document*
GW-59 Scan GW-59 March 2022.pdf 1.85MB
PDF Only
NDMR, NDAR-1, NDAR-2, NDMLR Scan NDMR March 2022.pdf 1.86MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2,NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Dustin B. Combs
Signature:
(e.
Date of submittal: 4/28/2022
This will be filled in automatically
Initial Review
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Reviewer: Gerald,Wanda
Is the project number correct?* WQ0024003
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Accepted Date: 5/10/2022

FORM:NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page 1 of
Permit No.: WQ0024003 Facility Name: Harvey Point Defense Facility County: Perquimans I Month: March Year: 2022
PPI: 001 Flow Measuring Point: ❑influent E Effluent ❑No flow generated I Parameter Monitoring Point: ❑Influent ['Efficient (Groundwater Lowering ❑Surface Watei-
Parameter Code -* 50050 00310 00940 31616 00610 00620 00400 00665 70295 00530 00600 00625 00630
c ,_
m 0 ra 2 'a ° 03
m � a E c m o` m ° 'a U) v Q) + ,
£ w 3 0 (0,1 ° 0 2 2 « L 0 7a m c 33 m co To rn 4; ro
O F LL O m _ E
0 m L LL ° E Z ~ p H N v7 F- 0 ~ z Z
0 U U a .c o z :� z z
O ix O ° f°-
24-hr hrs GPD mg1L mglL #I100 mL mglL mglL su mglL mg/L mg/L mglL mg/L mg/L
1 07:30 4 9,380 7.55
2 07:30 4 7,884 7.45
3 07:30 4 9,058 7.33
4 7,206 7.79
5 5,148
6 09:30 1 _ 3,542
7 07:30 4 10,842 7.04
8 07:30 4 5,244 7.36 _
9 07:30 4 5,692 7.36
10 07:30 4 11,678 7.32
11 07:30 4 12,506 7.3
12 07:30 1 13,156 -
13 3,892 -
14 8,532 7.55
15 07:30 4 9,770 7.37
16 07:30 4 10,926 7.47
17 07:30 4 17,122 7.35
18 07:30 4 10,076 <2 <1 <0.2 25.2 7.65 2.53 <2.5 25.2 <0.5 25.2
19 7,366
20 08:00 1 5,670
21 07:30 4 9,420 7.26
22 07:30 4 7,954 7.01
23 07:30 4 10,000 6.97
24 15,976 6.79 _
25 17,410 6.91
26 6,340
I
27 10:15 1 4,572
.-
28 07:30 4 8,794 7.19
29 07:30 4 6,360 7.33
30 07:30 4 8,520 7.34
31 07:30 4 7,208 7.35
Average: 8,943 0.00 1.00 0.00 25.20 2.53 0.00 25.20 0.00 25.20
Daily Maximum: 17,410 2.00 1.00 0.20 25.20 7.79 2.53 2.50 25.20 0.50 25.20
Daily Minimum: 3,542 2.00 1.00 0.20 25.20 6.79 2.53 2.50 25.20 0.50 25.20
Sampling Type: Recorder Grab Grab Grab Grab Grab Grab Grab Grab Grab
Monthly Avg.Limit: 24,300 30 200 15 _ 30
Daily Limit: 6-9 _
Sample Frequency: Continuous Monthly 3 x Year Monthly Monthly Monthly 5 x Week Monthly 3 x Year Monthly

FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of 21
Sampling Person(s) Certified Laboratories
Name: Dustin Combs Name: Environmental Chemists Inc.
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑e Compliant ❑Non-Compliant
If the facility is non-compliant,please explain in the space below the reason(s)the facility was not in compliance. Provide in your explanation the date(s)of the non-compliance and describe the corrective
action(s)taken.Attach additional sheets if necessary.
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Dustin B.Combs Permittee: Harvey Point Defense Testing Activity
Certification No.: 1003645 Signing Official: Stephan Oltjen
Grade: III Phone Number: 252-562-2684 Signing Official's Title: Enviromental Safety Officer
Has the ORC changed since the previous NDMR? ❑yes ❑✓No Phone Number: 252-426-4360 Permit Expiration: 3/31/2023
V2'7/2
•
Signature Date Signature Date
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible for
gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I am
aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

I (1kM Ni lAk 1 Ott 11 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page.i of ,y{
Permit No.: W00024003 Facility Name: Harvey Point Defense Testing Activity WWII' I County: Perquimans Month: March Y1,.11 !O7:'
Field Name: 1 Field Name: 2 + Field Name: 3 Field Narno: 4
Did irrigation occur -
Area(acres): 1.46 Area(acres): 1 14 Area(acres): 1.38 Area(acroK): I :'1
at this facility? Cover Crop: Cover Crop: Cover Crop: Cover Crop:
LJYts I INI1 Hourly Rate(in): 0.5 Hourly Rate(in): 0.5 Hourly Rate(in): 0.5 Hourly Rate(In): I''•
Annual Rate(in): 57.2 Annual Rate(in): 57.2 Annual Rate(in): 57.2 Annual Rale(in):
Weather Freeboard Field Irrigated? [IYES ONO Field Irrigated? I�Jri s I No Field Irrigated? RYES ❑ND Field Irrigated? I I1 i
F. 1 I
of 0 C
o 0 41 a, a� m � a c }, COm -0 o E > o 0 73 13 o E T rn m -0 v t o
Qrn .0 a a, a a� a, y, a n , c E m m : y, e v. c E a a' „ , I
o U m" . ou 's a E ., roEma E a _, Eo5a. Ern ro E a 5a E o, .i0 " r ' '
wa .� a fl o aPrn d a o o 6 a P -u O p azo o a F . o o R 8o a a , cox z
°F in ft ft gal min in in gal min in in gal min in in gal mill In In
1 C 40 0 . 4,625 60 0.12 0.12 4,625 60 0.15 0.15 4,625 60 0.12 0.12 4,625 60 11 14 u I 1
2 C 46 0 4,725 60 0.12 0.12 4,725 60 0.15 _ 0.15 4,725 60 _ 0.13 0.13 4,725 60 fl I.t n I
3 C 50 0 3.25 0 0 0.00 0.00 0 0 0.00 D.00 0 0 0.00 0.00 0 0 11 00 010
4 C 52 0 0 0 0.00 0.00 0 0 0.00 0.00 _ 0 0 _ 0.00 0.00 0 0 0 00 Imo
5 C 49 0 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0 on nun
un
6 C 64 0 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0 n[1 n nu
7 C 63 0 4,725 60 0.12 0.12 4,725 60 0.15 0.15 4,725 60 0.13 0.13 4,725 60 u 11 n 1 I
8 PC 56 1.2 2,250 30 0.06 0.06 2,250 30 0.07 0.07 2,250 30 0.06 0.06 2,250 30 n rn, n(PI.
9 R , 44 0.2 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 u 011 o 00
1
10 CL 42 0.1 4,675 60 0.12 0.12 4,675 60 0.15 0.15 4,675 60 0.12 0.12 4,675 G(1 n 1 1
11 C 46 0.75 3.25 4,650 60 0.12 0.12 4,650 60 0.15 0.15 4,650 60 0.12 0.12 I 4,650 GO I II I4
12 R 56 0.1 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 (1 1I On n nu
13 C 40 0 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0
lun Onn
14 C 42 0 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0 On n uu
15 C 40 0 6,825 90 0.17 0.11 6,825 90 0.22 0.15 6,825 90 0.18 0.12 6,825 90 n I'i III I
16 PC 4t3 1 6,425 90 0.16 0.11 6,425 90 0.21 0.14 6,425 90 0.17 0.11 6,425 90 n In a I.'
17 CI ',9 0 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 ii no MID
18 C 'r7 0 3.25 4,500 60 0.11 0.11 4,500 60 0.15 0.15 4,500 60 0.12 0.12 4,500 60 III 4 Ill4
19 ['' (i4 0 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 (inn nun
20 c ',(3 0 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 niiu (I 1111
21 t: 4(0 0 5,850 75 0.15 0.12 5,850 75 0.19 0.15 5,850 75 0.16 0.12 5,850 I!, 11 1, n 1 3
_
22 1 'ill 0 0 0 0.00 0.00 0 _ 0 0.00 0.00 0 0 0.00 0.00 0 0 11 111 i (11)11
23 Pi 0 1 ', 2,475 40 0.06 0.06 2,475 40 0.08 0.08 2,475 40 0.07 0.07 2,475 40 ii 0, n 0,
24 (:1 /n ll'i 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 n nn n nn
'2b (:I '.4 (I -4.'!. _ 0 0 0.00 _ 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 nun n nn
Ai (, ',.' 1) 7,850 80 0.20 0.15 7,850 80 0.25 0.19 7,850 80 0.21 0.16 7,850 80 i i .'.' Il 1
2l I, 4', 11 7,850 80 0.20 0.15 7,850 80 0.25 0.19 7,850 80 0.21 0.16 7,850 80 0.':' (1 1/
21 (, .11 11 6,250 80 0.16 0.12 6,250 80 0.20 0.15 6,250 80 0.17 , 0.13 6,250 80 018 (I 11
211 ( t0 Ir 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0 Oil 0 04I
a0 (. 4:' n 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0 00 O(H I
11 I I GI, a 3.5 0 0 0.00 0.00 0 0 0.00 0 00 0 0 0.00 0.00 0 0 0 00 a 00
Monthly Loading: 73,675 1.86 73,675 2.38 1 /3,675 1.97 73,675 7 10
I.' M,snrl,I loafing Total(in): 18.94 24.25 20.03 19 30

10kM NI)AR I 08-1t NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page oie? of .
Did the application rates exceed the limits in Attachment B of your permit? OCompliant ❑Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ECompiiant ❑Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑Compliant ❑Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ECompliant ['Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Mcompiont Egon-Compliant
If the facility is non-compliant,please explain in the space below the reason(s)the facility was not in compliance. Provide in your explanation the date(s)of the non-compliance and describe the corrective
action(s)taken.Attach additional sheets if necessary.
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Dustin B. Combs Permittee:
Harvey Point Defense Testing Activity
Certification No.: 1007989 Signing Official: Stephan Oltjen
Phone Number: 252-562-2684 Signing Official's Title: Enviromental Safety Officer
lily 010C changed since the previous NDAR-1? Eyes ENo Phone Number: 252-426-4250 Permit Exp.: 3/31/23
Signature Date Signature Date
I iy n ir.•,ugn;dui a,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted Based on my
inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the
information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I am aware that there are significant
penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

:;UIiMI1 I URM ON YELLOW PAPER ONLY
Mall Original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to DIVISION OF WATER QUALITY-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699.1617 Phono:[phone] '
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: WQ0024003 Expiration Date: 3/31/202 3
Facility Name: Harvey Point Defense Testing Activity Non-Discharge X UIC
Permit Name(if different): NPDES Other
Facility Address: 2835 Harvey Point Rd. TYPE OF PERMITTED OPERATION BEING MONITORED
Hertford (Street) N.C. 27944 CountyPer
q uimans
❑ Lagoon ❑Remediation:Infiltration Gallery
(City) (Stale) ha LI Spray Field ❑Remediation:
Contact Person: Dustin Combs Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:MW#1 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:3/18/22 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter: 2 in. pH 00400:7.72 units Temp.0oo1o: 14 °C DRY at
tiler.of
Depth to Water Level 82546:7 ft.below measuring point Screened Interval: 2 ft. to 20 ft. Spec.Cond.00094: µMhos sampling,
Measuring Point is 4 ft.above land surface Relative M.P.Elevation: ft. Odor moss. None check
Volume of water pumped/bailed before sampling: 5 gallons Appearance Tan _ here:n
Samples for metals were collected unfiltered: El YES El NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/18/22-3/30/22 Laboratory Name: Environmental Chemists Inc. Certification No. #94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 0.03 mg/L Pb-Lead 01051 ug1L
Coliform: MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.14 mg/L Zn-Zinc o1o92 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 0-84 mg/L
(Note: Utiu MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 178 mg/L Al-Aluminum 01105 mg/L
pH (Lab)00403 units Ba-Barium 01007 ug/L
1 OC moo 12.7 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 61 mg/L Cd-Cadmium 01027 ugiL
Arsenic o1002 ug/L Chromium:Total 01034 ug/L _
(,Ic;r;;t,and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug1L Fe-Iron 01045 uglL (Specify test and method#.ATTACH LAB REPORT.)
:;ulf;tlo 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑■ No(0)
:;111,1 dtr.t:nnrlucl:rnce 001)95 ['Mhos K-Potassium 00937 mg/L VOC 78732: ,method#
I nlnl Arnruulll❑ixs;io 0.7 mg/L Mg-Magnesium 00927 mg/L ,method#
(Nnuu el,.WBngpnn,NI I,as N;Ammonia Nitrogen,Total) Mn-Manganese 01055 ug/L ,method#
f IcN nt; N terry, mg/L Ni-Nickel 01067 ug/L , method#
I are Itnmre6.dlon Syctorns Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I i arllfy that,to the lam v1 my knowledge and bellef,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
13W0.asrtiflsd hborato , I OM aware that there are significant penalties for submitting false information,including the possibility of fines and imrrisvn:nent for knowing violations.
'.I. Him t+ dirt' I nvnuur'uni,ll Safely Officer '• '�/� Z
1 .„Ill,. II,,,,,,, I r,.,i,-uii wrim and Idle-Please print or type Signal e n o Sa m,o(r Authnri7ed Anent) (Rile)
f `

SUBMIT I OIiM ON YI I I OW 1'AI'I I(ONI Y
Mail original DEPARTMENT 01 LNVIRONMLNT&NAIUNAI NI NOFIRCI II
GROUNDWATER QUALITY MONITORING: and 1 copy to; DIVISION OF WATER QUALITY•INI ORMAIION PROCI 83IN0 UNIT
COMPLIANCE REPORT FORM 1817 MAIL SERVICE CENTER,RALEIGH,NC 27800.1817 Phone:[phone]M
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: W0002/1003 Ixpn aim I),ttr• :i/aI/:'U:':t
Facility Name: Harvey Point Defense Testing Activity Non-Discharge X ill(:
Permit Name(if different): NPDES Othoi_
Facility Address: 2835 Harvey Point Rd. TYPE OF PERMITTED OPERATION BEING MONITORE E)
Hertford (Soul) N.C. 27944 County Perquimans ❑ Lagoon ❑Rernedialion: Infilhrllum(t ill(vy
(City) (State) (Zip)
❑■ Spray Field ❑Remodiat(on:
Contact Person: Dustin Combs Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludtiv
Well Location/Site Name:MW#2 No.of wells to be sampled: 3 ❑ Water Source Heat Pump ❑Other: _
(from Permit)
SAMPLING INFORMATION II WI I I
WELL ID NUMBER(from Permit): MW#2 Date sample collected:3/18/22 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter: 2 in. pH 00400:6.72 units Temp.mow: 14 "C DRY.tl
(Mhos hen,HI
Depth to Water Level 82546:6 ft.below measuring point Screened Interval: 2 ft. to 20 ft. Spec.Cond.00094: I Irltl,Il.
Measuring Point is 4 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: None r llrn k
Volume of water pumped/bailed before sampling: 5 gallons Appearance Clear him, ! i
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/18122-3/30/22 Laboratory Name: Environmental Chemists Inc. Certification No. #94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N costs<0.02 mg/L Pb-Lead 01051 ug/L
Coliform:ME Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.05 mg/L Zn-Zinc o1o92 mg/I
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 00665 0.12 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concenlrath}II hill'.(
)issolved Solids:Total 70300 109 mg/L Al-Aluminum 01 to5 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 10.7 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 18 mg/L Cd-Cadmium 01027 ug/L
Arsenic 01002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 010a2 mg/L ORGANICS:(by GC,GC/MS, Hill(;)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB RI I't11t I )
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) NI NI/(II)
`IIfIcilic Conductance 00095 µMhos K-Potassium 00937 ntglL VOC 78732: ,method#
I ail Ammonia ooslo 0.3 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ai iiii mtn Nllrniten,NI I,as N:Ammonia Nitrogen,Total) Mn-Manganese 0toss ug/L ,method#
I KN as N 00625 mg/L Ni-Nickel 01067 uglL , method#
I ,n Ii.i...•(liation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: nto/I VOC Rornoval'%
I comfy that,to the bast 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 analysiv by a
DWO.cirtlflad laboratory. I am aware that there are significant penalties for submitting false information,including the possibility or fines and imprisonment for knowing violations.
.I..I,l1,ui I iltlr'n I nvirontental Safety Officer , , ,/ i_ '
I i 1,,it, I.,Al ivu mind Atrenl)Name and Title-Please print or type Sienatura of Perm-ile(or Authorized Agent) II:.ti, r
i.W '.'I Itr'v 717010 ! —

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: 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: WQ0024003 Expiration Date: 3/31/2023
I ;wilily Name: Harvey Point Defense Testing Activity _ Non-Discharge X UIC
['or wit Name(if different): NPDES Other
Facility Address: 2835 Harvey Point Rd. TYPE OF PERMITTED OPERATION BEING MONITORED
Hertford (SLICK N.C. 27944 CountyPerquimans ❑ Lagoon ❑Remediation: Infiltration Gallery
(c.(y) (State) (lip(
❑■ Spray Field ❑Remediation:
Contact Person: Dustin Combs Telephone#: [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:MW#3 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:3/18122 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter: 2 in. pH 00400:6.94 units Temp.000io: 15 °C DRY at
Depth to Water Level 82546:6 ft.below measuring point Screened interval: 2 ft. to 20 ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is 4 ft. above land surface Relative M.P. Elevation: ft. Odor 00085: None check
Volume of water pumped/bailed before sampling: 5 gallons Appearance Tan here:❑
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed:3118122-3/30122 Laboratory Name: Environmental Chemists Inc. Certification No. #94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg1L Nitrite(NO2)as N 00615 0.02 mg/L Pb-Lead 01051 uglL
Coliform: MF Fecal 31616 5 /100mL Nitrate(NO3)as N 00620 0.050.05 mg/L Zn-Zinc o1092 mg/L
Coliform: MF Total 31504 1100mL Phosphorus:Total as P aos65 0.70 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mgiL Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 258 mg/L Al-Aluminum of 1os mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 11.4 mg/L Ca-Calcium 00916 mg1L
Chloride 00940<5 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Crease and Oils o0552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 uglL Fe- Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mglL Hg-Mercury 71900 ug/L Lab Report Attached?. ❑ Yes(1) ❑■ No(0)
,I,I 1 lin Conductance 0009E µMhos K-Potassium 00937 mg/L VOC 78732: , method#
I1,I,d Ammonia°Kilo<0.7 mg/L Mg-Magnesium 00927 mg/L ,method#
IAmm�,rlo Nlluel el.NI I,flu N:Armuorrio Nilrotter:.fo41)
Mn-Manganese 01055 ug/L , method#
I KN tie N nom, mg/L Ni-Nickel 01067 ug/L ,method#
I ur I4unrwlintlun `;y.tr•In,.Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I I arliho that,to the brat of my knowledge and belief,the Infurnwllon auhmltlud In hits rupurt is two,accurate,and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
uwO•oartifled laborator , I am aware lhal her.are al•nlfloenl enaltlee for subrnllln•file.Information,Includin•the•ossih)lil of fines and Imprisonment for knowin.violations.
1, IIII, li 1 rt mot, I11.il '. tin I. , mil , r I c .r I% l
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GW-59A COMPLIANCE REPORT FORM Permit#jk}vc ;(ytC 3
(Submit one each monitoring period with GW-59 prim.)
1 Enter date monitoring results were due. (3-3)—_,2 ) Will this monitoring report(GW-59 and GW-59A) YES L_N_O
be submitted after the established due date?
2 Was any required information missing on the GW-59 report forms? YES L%
IF the answer to question I 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 NQ`
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 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:
5 For the constituents identified in question 4 above, have standards been exceeded previously for the YES NO .
same constituent(s) in the same wells) 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).
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 I NO
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 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,
fines, and/or penalties.
g 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.
Signature of Permittee(or Authorized Agent) Date
GW-59A 12/8/2003