WQ0002096_Monitoring - 06-2022_20220808

GW-59A COMPLIANCE REPORT FORM Permit # W000maP
(Submit one each monitoring period with GW-59 forms.)
---e i -n,
1
Enter date monitoring results were due. 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
Q O
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
NO
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 standards in the space provided below:
mw-5 rnF Feces ( 11ioomL,
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
O
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, 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 may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is `NO", monitoring wells maybe improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
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 maybe
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facilitV. Failure to do so maV subject the permittee to a Notice of Violation,
Imes, and/or Denalt76s.
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rnJri r�
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The person completing this portion (GW-59A) of the monitoring report should sigtrbd1dw and submit this
form with GW-59 forms for required wells to the address provided of 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.
ZZ
Signature of Permta (or Authorized A ent) Date
GW-59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
• •
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
Please Print Clearly or Type
FACILITY INFORMATIO
PERMIT Number: Expiration Date: (� O
p
Facility Name: hhmKre RZ I s-k-d L 1 i% i W W T F
©
Non-DischargeW&WD2.0 7 UIC
Permit Name (if different):
NPDES Other
Facility Address: Dfo SoO-h Lrarlv S16A
knad
TYPE OF PERMITTED OPERATION BEING MONITORED
Ahoskl"e (street) G -7gjo County f-r OVW
❑ Lagoon ❑ Remediation: Infiltration Gallery
(City) (State) (zip)
Spray Field El Remediation:
Contact Person: RandRaridv Parker
Telephone#: 2 52— � 13 — 85 q /
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: sr
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
WELL ID NUMBER Permit): �%
Date samplecollected:�Z�
FIELD ANALYSES:
If WELL
WAS
(from
�
Well Depth: 1 1
ter:
pH 0 Temp. 00010: °C
DRY at
Depth to Water Level 82546:_ft. below measuring point
Screened Interval: ft. to q
ft. Spec. Cond. 00094: µMhos
time ofsampling,
Measuring Point is �L. 5 ft. above land surface�J
Relative M.P. Elevation: ft.
Odor 00085:
check
Volume of water pumped/bailed before sampling: L—
gallons
Appearance C/()u \j
here:❑
Samples for metals were collected unfiltered: ❑ YES ❑
NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: (p �" (p 2 22
r _
Laboratory Name: L�l/� D/►m �1, Lj1C�� Certification No.
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 { j /100mL
Nitrate (NO3) as N 00620 p, C)L -
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100ml- Phosphorus:
Total as P 00665 D. �-3
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 3® mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC 00680 q mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 37 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
uglL Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia 00610 L po 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%

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV.OF WATER RESOURCES
COMPLIANCE REPORT FORM
• • • •
INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION iPlease Print Clearly orType
PERMIT Number: Expiration Date: '' .t
Facility Name: OSIC-I % ��cS1 S TL� I ✓1 ✓1 Q �i I�l� I /-
Non -Discharge W&66 j 20Cf 6i UIC
Permit Name (if different):
NPDES Other
Facility Address: 2_40 iSiniJh iFarkj �'�afiintj
K16ad
TYPE OF PERMITTED OPERATION BEING MONITORED
< ( Street)
J 07
County
El Lagoon ❑Remediation: Infiltration Gallery
(City) (State) (Zip)
//JJ Parke
Field ❑Remediation:
Contact Person: / andv 1" ar
Telephone#: �J��— Sr'3 � ff6- 9 �
❑ 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
'If
WELL ID NUMBER (from Permit): m VU '
2 1
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: 2 in.
pH 00400: units Temp. 00010: °C
DRY at
point
Depth to Water Level 82546: _ft. below measuring�-
Screened Interval: ft. to 2
ft. Spec. Cond. 000sa: µMhos
time
Measuring Point is �, ft. above land surface
Volume �8
Relative M.P. Elevation: ft.
Odor 00085:
li
sampling,
check
of water pumped/bailed before sampling:
gallons
Appearance C/ o (�
here: ❑
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATI N
Date sample analyzed: ^
Laboratory Name: Emi) irorl mCf U % , �{/� Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
—�
COD 00335 mg/L
Nitrite (NO2) as N 00615 mg/L
Pb - Lead o1o51 u9 /L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620 /0. 0Lj- mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum o11o5 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 T , 3 ! mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 mg/L
Cd - Cadmium 01027 11
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 00610 mg/L
Mg - Magnesium 00927 mg/L
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn -Manganese o1055 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%
04
ju 1,a O msfw - �dminisfm4or
Permittee (or Authorized Agent) Na and Title - Please print or type
GW-59 Rev.05-02-2017
Signature oiPermiftd (or Authorized Agent)

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
COMPLIANCE REPORT FORM
INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, INC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Date: � D /�
Facility Name: n, �(� Qi t I �1G
_G
w l�� I 1
��nExpiration
Non -Discharge (} wl�v-1 UIC
Permit Name (if different):
NPDES Other
Facility Address: k6A
KbOA
TYPE OF PERMITTED OPERATION BEING MONITORED
(Street) r ,
l/ I %1 q�
County
❑Lagoon ❑Remediation: Infiltration Gallery
(City) (State) (zip)
&q PA
EYSpray Field ❑ Remediation:
Contact Person: Q fica
Telephone#: �J"L �5� 3 —� 50]�
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Y t zAd
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION t
WELL ID NUMBER (from Permit): m vy' rl
Date � '2zm
If WELL
Well Depth:ft•
sample collected:
Well Diameter: /" in.
FIELD ANALYSES:
pH ooaoo: units Temp. 00010: oc
WAS
DRY at
Depth to Water Level 82546: ft. below measuring point
Screened Interval: ft. to Iq
ft. Spec. Cond. 000sa: µ Mhos
time of
Measuring Point is 9 , 5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
sampling,
check
Volume of water pumped/bailed before sampling: ��`gallons
Appearance �� L.LGI t/
here:❑
Samples for metals were collected unfiltered: El YES ❑
NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date � ^ (� �2rj hyL
/' 1
En J.,
7
sample analyzed: l
Laboratory Name: Vi►^DY1 m�V) I"
ZV1G. Certification No. I
PARAMETERS NOTE: Values should reflect dissolved and
colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615 mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620 <b 6 Lt mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 �, Q� mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 UD mg/L
Al - Aluminum 01105 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 0 mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 q 5 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 ELMhos
K - Potassium 00937 mg/L
VOC 7873 method #
Total Ammonia 00610 D' OI ( 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%
- ti v •�� t�rPt pr rw vypePemtee(orAuhoredAgent a neranTe ant o
GW-59 Rev.05-02-2017

Environment 1, Incorporated
P.O. BOX 7085, 114 OAKMONT DRIVE
GREENVILLE, N.C. 27835-7085
AHOSKIE ASSISTED LIVING
240 SOUTH EARLY STATION RD.
AHOSKIE, NC 27910
Drinking Watar ID: 37715
Wax tavatOr IDS 10
PHONE [phone]
FAX [phone]
ID#: 377
DATE COLLECTED: 06/20/22
DATE REPORTED : 06/30/22
L
REVIEWED iT4'
Effluent
Well #4
Well #5
Well #7
Analysis
Method
PARAMETERS
Date
Analyst
Code
BOD, mg/I
42
06/21/22
HCE
521OB-16
Fecal Coliform (MF), /100 Mls
> 6000
< 1
1
< 1
06/20/22
KJC
9222D-15
Total Suspended Residue, mg/l
108
06/21/22
HMV
254OD-15
Ammonia Nitrogen as N, mg/l
9.12
< 0.04
< 0.04
< 0.04
06/29/22
KES
350.1 112-93
Total Kjeldahl Nitrogen as N,mgA
19.77
06/28/22
TRJ
351.2 112-93
Nitrate + Nitrite as N, mg/1 (calc)
0.07
353.2 R2-93
Nitrate Nitrogen as N, mg/l
< 0.04
< 0.04
< 0.04
< 0.04
06/21/22
KES
353.2 R2-93
Nitrite Nitrogen as N, mg/1
0.07
06/21/22
KES
353.2 R2-93
Total Phosphorus as P, mg/l
3.51
0.23
0.10
< 0.04
06/28/22
BMD
365.4-74
Total Organic Carbon, mg/l
16.69
2.37
1.06
06/27/22
HMM
531OC-14
Chloride, mg/l
54
37
6
95
06/27/22
BLV
4500CLB-11
Total Dissolved Residue, mg/l
330
130
180
220
06/21/22
DIJ
D5907-13
Total Nitrogen, mg/1 (calc)
19.84