WQ0007283_Monitoring - 03-2022_20220502

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL WATER RESOURCES
GROUNDWATER QUALITY MONITORING: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM and 1 copy to:
1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 3 4 (—0.. 7
Facility Name: Town of Pollocksville Non-Discharge WQ0007283 UIC
Permit Name(if different): NPDES Other
Facility Address: Pollocksville,NC 28573 TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573 County JONES 0 Lagoon ❑ Remediation: Infiltration Gallery
0 Spray Field ❑ Remediation:
Contact Person: JOHNNIE CHADWICK Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:#2 EAST SIDE REAR LAGOON No. of wells to be sampled:SIX ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-1 Date sample collected: 3/14/2022 FIELD ANALYSES: / / WAS
L
Well Depth: 20 ft. Well Diameter:2 IN. in. pH o0400.6.9 units Temp.00010: �D "C DRY at
Mhos time of
Depth to Water Level 82546:15.54 ft. below measuring point Screened Interval: ft. to ft. Spec. Cond.00094: ) sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 1.5 gallons Appearance here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/14/2022 Laboratory Name: ENVIRONMENT 1 Certification No. 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead o1051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 0.78 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 1.02 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 150 mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 1.01 mg/L Ca-Calcium o0916 mg/L )i�1t pp
Chloride 00940 6 mg/L Cd-Cadmium 01027 ug/L 7GU� U AVK
Arsenic o1o0z ug/L Chromium:Total 01034 ug/L (('���''{
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC, GC/MS, LC)
Phenol 32730 ug/L Fe-Iron o1045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate o0945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance o0o95 µMhos K-Potassium o0937 mg/L VOC 7873 , method#
Total Ammonia oos10 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 0.04 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-certified laboratory. I am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
JOHNNIE J.CHADWICK,ORC j I / ' /,/,{ � —Z6o - Z
Permittee(or Authorized Agent)Name and Title-Please print or type /Signature of Permitte- . Authorized Agent) (Date)
GW-59 Rev.3-1-2016

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVINFORMATION PROCESSING UN TWATER RESOURCES
COMPLIANCE REPORT FORM and 1 copy to: 1817 MAIL SERVICE CENTER,RALEIGH,NC 27699-1817 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: —,,„ —27
Facility Name: Town of Pollocksville Non-Discharge WQ0007283 UIC
Permit Name(if different): NPDES Other
Facility Address: Pollocksville,NC 28573 TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573 County JONES ❑t Lagoon 0 Remediation: Infiltration Gallery
It Spray Field 0 Remediation:
Contact Person: JOHNNIE CHADWICK Telephone#:[phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:# 2 EAST SIDE REAR LAGOON No.of wells to be sampled:SIX 0 Water Source Heat Pump 0 Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-2 Date sample collected: 3/14/2022 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter:2 IN. in. pH 00400:7.0 units Temp.mow: '? °C DRY at
Depth to Water Level 82546:10.70 ft.below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 2.5 gallons Appearance here:
Samples for metals were collected unfiltered: 0 YES 0 NO and field acidified: 0 YES 0 NO
LABORATORY INFORMATION
Date sample analyzed:3/14/2022 Laboratory Name: ENVIRONMENT 1 Certification No. 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead o1o51 uglL
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N ooszo 1.73 mg/L Zn-Zinc 01092 mg/L
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 Concentration Units):
Dissolved Solids:Total 70300 460 mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 4.79 mg/L Ca-Calcium o0916 mg/L
Chloride 0094o 38 mg/L Cd-Cadmium 01027 uglL ZZUZ £ 0 AVW
Arsenic 01002 ug/L Chromium:Total 01034 uglL �nn
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC,GC/MS{AZI_C)
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? 0 Yes(1) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia 00610 0.92 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NH3 as N;Ammonia Nitrogen,Total) Mn-Manganese 01055 uglL ,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%
1 rmtify ticll,to the bust of my kmnwlmigt.an,1 bulint tlut ettonnatinn submitted in this report's tiuc.te.i.ur.ilc.;:nd complt.tm and that the latumrtnry.inalytlral data was produced usinrf aplrcnvrai methods,if analysis by.1
DWR-certihad lahoraluiy. I am aware that thine mu siynilut;ant penaltitrs for submitting[also urfi,rmatiom,Hu tutting the possibility of fines met imprivnnm ent for 4nnwinu vinlnlions
JOHNNIE J.CHADWICK,ORC r • 'Pi A /! 1f026—a2—
Permittee(or Authorized Agent)Name and Title-Please print or type gnature of PermitteeOhorized Agent) (Date)
GW-59 Rev.3-1-2016

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL QUALITY•DIV.OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: 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: Expiration Date: — 3/- 2 7
Facility Name: Town of Pollocksville Non-Discharge W00007283 UIC
Permit Name(if different): NPDES Other
Facility Address: Pollocksville,NC 28573 TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573 County JONES 0 Lagoon 0 Remediation: Infiltration Gallery
® Spray Field 0 Remediation:
Contact Person: JOHNNIE CHADWICK Telephone#:[phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:# 3 EAST SIDE LAGOON No.of wells to be sampled:SIX 0 Water Source Heat Pump 0 Other:
(from Permit)
SAMPLING INFORMATION Ilf WELL
WELL ID NUMBER(from Permit): MW-3 Date sample collected:3/14/2022 FIELD ANALYSES: �7 WAS
Well Depth: 25 ft. Well Diameter:2 IN. in. pH 00400:6.0 units Temp.00010: / / °C DRY at
Depth to Water Level 82546:13.87 ft.below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 2.0 gallons Appearance here:?
Samples for metals were collected unfiltered: ❑YES 0 NO and field acidified: 0 YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/14/2022 Laboratory Name: ENVIRONMENT 1 Certification No, 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead o1051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 2.79 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 00665 0.10 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 57 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680<1.00 mg/L Ca-Calcium 00916 mg/L
Chloride o094o<1.0 mg/L Cd-Cadmium 01027 ug/L G6; E Q Adw
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)ra
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? 0 Yes(1) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooslo<0.04 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%
I rrubfv drat,Irr tilt bi-.1 of my knowlortge and beliaf fhb infurmatiim snbnrillerl in fhb report r,tin., .u:cural, ;rnd bonrpletn.and that flit labor+toy.ni.ilytical d.ita yid.,Imrducrl l u':nuf approved nrath(Ids r4:uratysis by n
I)WR rertilie it I.ibur.lury. I;inr:rwarr It Lit Ihoie❑m signillcanl penutties fin siihnrdlurg false infnnnation,including Ihra po„ibility nl fines and myrrisnnnierit for knuwi�nywiol.di�ons.
JOHNNIE J.CHADWICK,ORC r �� /'�'%J�I� —..26 2
Permittee(or Authorized Agent)Name and Title-Please print or type nature of Permittee thorized Agent) (Date)
GW-59 Rev.3-1-2016
r

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL WATER RESOURCES
GROUNDWATER QUALITY MONITORING: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM and 1 copy t0: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date3_3 f-4,2
Facility Name: Town of Pollocksville Non-Discharge WQ0007283 UIC
Permit Name(if different): NPDES Other
Facility Address: Pollocksville,NC 28573 TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573 County JONES N Lagoon ❑ Remediation: Infiltration Gallery
❑■ Spray Field ❑ Remediation:
Contact Person: JOHNNIE CHADWICK Telephone#:[phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:# 4 UPGRADIENT EAST SPRAY No. of wells to be sampled: SIX ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-4 Date sample collected: 3/14/2022 FIELD ANALYSES: Q WAS
Well Depth: 22 ft. Well Diameter: 2 IN. in. pH 00400:7.3 units Temp.mow: / V °C DRY at
Depth to Water Level 82546:17.51 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond. 00094: µMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 1.0 gallons Appearance here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/14/2022 Laboratory Name: ENVIRONMENT 1 Certification No. 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 0.86 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 0.19 mg/L
(Note'. Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 130 mg/L Al-Aluminum 01105 mg/L DJ
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC oosao<1.00 mg/L Ca-Calcium 00916 mg/L MAY 113 2022
Chloride 00940 6 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 tMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia 00610<0.04 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH,as N;Ammonia Nitrogen,Total) Mn-Manganese 01055 ug/L , method# 1
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-certified laboratory. I am aware that there are significant penalties for submitting false information,including the possihility of fines and imprisonment for knowing violations. /
JOHNNIE J.CHADWICK,ORC N,_,� ! y-26-)- 2_Win'
Permittee(or Authorized Agent)Name and Title-Please print or type i ature of Permittee(or orized Agent) (Date)
GW-59 Rev.3-1-2016 L/

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL WATER RESOURCES
GROUNDWATER QUALITY MONITORING: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM and 1 copy to: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date3-3 f- a 7
Facility Name: Town of Pollocksville Non-Discharge WQ0007283 UIC
Permit Name(if different): NPDES Other
Facility Address: Pollocksville,NC 28573 TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573 County JONES ❑■ Lagoon ❑ Remediation: Infiltration Gallery
$ Spray Field ❑ Remediation:
Contact Person: JOHNNIE CHADWICK Telephone#: [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:# 5 DOWN GRADIENT EAST SPRAY No. of wells to be sampled:SIX E Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-5 Date sample collected:3/14/2022 FIELD ANALYSES: WAS
Well Depth: 21 ft. Well Diameter:2 IN. in. pH 00400:7.1 units Temp.00010: / , °C DRY at
Mhos time of
Depth to Water Level 82546:10.30 ft.below measuring point Screened Interval: ft. to ft. Spec. Cond.00094: f sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 2.5 gallons Appearance here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/14/2022 Laboratory Name: ENVIRONMENT 1 Certification No. 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N ousts mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 0.21 mg/L Zn-Zinc o1092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 0.09 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 200 mg/L Al-Aluminum o11os mg/L
pH (Lab)00403 units Ba-Barium 01007 ug/L GGG 77 E (G' 0 AVW
TOC 00680 1.13 mg/L Ca-Calcium 00916 mg/L
Chloride oo9ao 6 mg/L Cd-Cadmium 01027 ug/L ^a
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 o1o45 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 0.04 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen:NF13as 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-certified laboratory. I am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
JOHNNIE J. CHADWICK,ORC if
� / , - c76-Q2 -
Permittee(or Authorized Agent)Name and Title-Please print or type nature of Permitt ( Authorized Agent) (Date)
GW-59 Rev.3-1-2016

i
SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL WATER RESOURCES
GROUNDWATER QUALITY MONITORING: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM and 1 copy to:
1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 33 I - 2_7
Facility Name: Town of Pollocksville Non-Discharge WQ0007283 UIC
Permit Name(if different): NPDES Other
Facility Address: Pollocksville,NC 28573 TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573 County JONES 0 Lagoon ❑ Remediation: Infiltration Gallery
0 Spray Field ❑ Remediation:
Contact Person: JOHNNIE CHADWICK Telephone#: [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:# 6 DOWN GRADIENT WEST SPRAY No. of wells to be sampled: SIX ❑ Water Source Heat Pump ❑Other:
11 (from Permit)
SAMPLING INFORMATION If WELL
' WELL ID NUMBER(from Permit): MW-6 Date sample collected: 3/14/2022 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter:2 IN. in. pH 00400:7.2 units Temp.00o10:1 7 °C DRY at
Depth to Water Level 82546:8.60 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: ).tMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 2.5 gallons Appearance here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/14/2022 Laboratory Name: ENVIRONMENT 1 Certification No. 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 0.67 mg/L Zn-Zinc 01092 mg/L
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 Concentration Units):
Dissolved Solids:Total 70300 240 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC o0680,1.00 mg/L Ca-Calcium 00916 mg/L
Chloride 0094o 17 mg/L Cd-Cadmium 01027 ug/L ZZ Z V
Arsenic 01002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC, GC/IvrffLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method 1l'# TACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 000s5 µMhos K-Potassium o0937 mg/L VOC 7873 , method#
Total Ammonia oosio 0.06 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%
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-certified laboratory. I ant aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
JOHNNIE J.CHADWICK,ORC A ' _ /A41- ',i,....J .k- 4/- ,,?(, - 2--
/
Permittee(or Authorized Agent)Name and Title-Please print or type .nature of Permittee uthorized Agent) (Date)
GW-59 Rev.3-1-2016

EiL V L.Ii{v_ri IL'i olJ 1if- 1 Lh-Itl.r?d ) a'..r ,,.) aT`"I Drinking Water ID: 37715
Wastewater ID: 10
11 ! { i
ID#: 420
TOWN OF POLLOCKSVILLE (WELLS)
ATTN: JAMES BENDER, JR.
P.O. BOX 97 DATE COLLECTED: 03/14/22
POLLOCKSVILLE, NC 28573 DATE REPORTED : 03/28/22
���. .
REVIEWED BY: 3
MW-1 MW-2 MW-3 MW-4 MW-5 Analysis Method
PARAMETERS Date Analyst Code
PH (field measurement), Units 6.9 7.0 6.0 7.3 7.1 03/14/22 NNK 4500HB-11
Fecal Coliform (MF), /100 Mls <1 <1 <1 <1 <1 03/14/22 HCE 9222D-15
Ammonia Nitrogen as N, mg/1 0.04 0.92 <0.04 <0.04 0.04 03/15/22 KES 350.1 R2-93
Nitrate Nitrogen as N, mg/1 0.78 1.73 2.79 0.86 0.21 03/16/22 KES 353.2 R2-93
Total Phosphorus as P, mg/I 1.02 0.12 0.10 0.19 0.09 03/22/22 TRJ 365.4-74
Total Organic Carbon, mg/1 1.01 4.79 <1.00 <1.00 1.13 03/15/22 HMM 5310C-14
Chloride, mg/I 6 38 <1.0 6 9 03/16/22 HCE 4500CLB-11
Total Dissolved Residue, mg/I 150 460 57 130 200 03/15/22 HCE D5907-13
Static Water Level, feet 15.54 10.70 13.87 17.51 10.30 03/14/22 NNK
Water Bailed, Gals. 1.5 2.5 2.0 1.0 2.5 03/14/22 NNK
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CHAIN OF CUSTODY RECORD
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Rit!i 2 1 of
lroPir!, E0 !i•,, , rrh; IASI I\EAC TION 7
r 7:-,o-()63 , I, I CHLORINE NEUTRALIZED AT COLLECTION
Il ORINE '
''
ET-11': 420 Week: 14 a , A .A
1
1 pH CHECK(LAB)
O
'OWN OF POLLOCKSVILLE(WELLS) NNE PPPPPP , PP J-1— I — CONTAINER TYPE,PIG
--
,TTN:JAMES BENDER,JR. ._1 I .' - -
.0.BOX 97 C
'OLLOCKSVILLE NC 28573 A A GC A C C A A CHEMICAL PRESERVATION
I (-2 A-NONE D-NAOH
1,4 2 I Y P a i.
4J
..... U)
Lu
252)224-9831 0 A 2 ... IT: B-HNO, E-HCL
r..,- _, r -i.i „ g 0 i
4 Li
Cl- --FLSO, F ZINC ACETATE/NAOH
ce
6 !=t 1 I .1_11
COLLECTION _,
o ,
0
G-NA THIOSULFATE
SAMPLE LOCATION DATE TIME iZ
a:
MW-1 3-141-tt I04A I f b 7 Et 111 li lig 1111 II I I: It
1 iI 1 CLASSIFICATION:
ietZ WE: on. m 1 Nit: tv. it Is
MW-2 1 (Ds'INA 1 1 (7 7 i;13i;:iti 0.7: Mi;iti Igi.-: iM; 0.* t;:,i'..:' ;:o.• ::;*:, J VVASTEWATER(NPDES)
MW-3 A
I 17 7 .0P
I__ LI DRINKING MIER
7 f.g. kr SO lig li 1 a M: .:61i ni:
MVV-4 IL 5i r I Iliiat i':EWi
MW-5 1131A 1(7 ::::ii ilL:::$*?i .im$ f.oN liiiii nii: li„:CE;: .1::.,... iw
7 M MR ila ii;N n; i•!'.1i: g::. a: .2w 3 EM/R1GW
MW-6 V 11;1 2.1 17 imt: i WI :•5M: ti?g. 'iiii:ii:" M. w• m:::
7 Kiii ilitt Mg OR a N Ni::::i ilS:. aii:1 j SOLID WASTE SECTION
EMI CHAIN OF CUSTODY(SEAL) MAINTAINED
— DURING SHIPMENT/ ELIVERY
OY N
SAMPLES COLLECTED BY:
i I (Please Print) 1
I I 1 (Jid.se.A ii• ktt Ivo\
i It' I
...I L, SAMPLES RECEIVED IN LAB AT 2,87 ce
RELIk ISHED BY(SIG.)(SAMPLER) DATE/TIME REC4VED BY(SIG. s i DATE/TIME COMMENTS I I co\ .
/t.. / 3--N-zz I v.y5f apie_ LiAcv,...ri..,
7141/7-1-1 i:i 1
REIJNQUISHED BY(SIG.) DATE/TIME RECEIVFD BY(SIG.) DATE/TIME
RELINQUISHED BY(SIG.) DATEMME RECEIVED BY(SIG.) DATETTIME
I I
PLEASE READ Instructions for compl3ting this form on the reverse side. Sampler must place a''C''for composite sample or a"G"for
FORM#5 Grab sample in the blocks above for each parameter requested. N 403775