WQ0007283_Monitoring - 07-2022_20220907

GW-59A COMPLIANCE REPORT FORM
Permit # 1) WOb 7.2 v 3
(Submit one each monitoring period with GW-59 forms.)
j
Enter date monitoring results were due. ill this monitoring report (GIN-59 and GIN-59A)
YES
NO`
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
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.
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
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. ti,"�
If the answer to question 5 is "YES", list in the space provided Blow, each well with constituents) exceeding
standards, concentration(s) reported, and sample collection date
ft each occlrre'hce (for the last two years).
00
6
Are the monitoring wells listed in section 5 located at or beyond t °` iew boundary?
YES
NO
If the answer is "YES", a groundwater quality problem maybe occurringt 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 may be
required to determine the impact the wast,"hsGosal system is having at the review and comDliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation
fines, and/or penalties. --�:l
—,
g
The person completing this portion (GIN--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
repo (Compliance Report GIN-59A) is and complete to the best of my knowledge.
e�
-�q .2c�zy
ignature of Permi (or thorized Agent) Date
GW-59A 12/8/2003

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
Please Print Clearly or Type
PERMIT Number: Expiration Date:
Facility Name: Town of Pollocksville
Non -Discharge WQ0007283 UIC
Permit Name (if different):
NPDES Other
Facility Address: Poilocksville,NC 28573
TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573
County JONES
FBI Lagoon ❑ Remediation: infiltration Gallery
❑■ 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: 7/182022
FIELD ANALYSES:
WAS
Well Depth: 20 ft,
Well Diameter: 2 IN. in.
r�
H 00400: 7.3 2 °C
p units Temp. 00010:
DRY at
Depth to Water Level 82546:7.88 ft. below measuring point Screened Interval: ft.
to
ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 000es;
sampling,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:7/18/22
Laboratory Name: ENVIRONMENT 1
Certification No. 10
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N oo615
mg/L
Pb - Lead olos1 u9 /L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 1.19
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100ml-
Phosphorus: Total as P006650.31
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 160
mg/L
AI - Aluminum o11o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC omm 1.03
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 10
mg/L
Cd - Cadmium 01027
ug/L
Arsenic o1oo2
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 0.07
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug1L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Kemewation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
JOHNNIE J. CHADWICK, ORC
Permittee (or Authorized Agent) Name and Title - Please print or type
(or Authorized
-z�_
GW-59 Rev.3.1-2016

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
•
•
DEPARTMENT OF ENVIRONMENTAL OU41TY - DIV. OF WATER RESOURCES
COMPLIANCE REPORT FORM
• • • •
INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]D6
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: — d�
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:# 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-2
Date sample collected: 7/18/22
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 IN. in.
pH 00400: 6.9 units Temp. 000m: O� °C
DRY at
Depth to Water Level 82546:14.25 ft. below measuring point Screened Interval: ft. to
ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: ft.
Odor 000n
samplir;,
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: 7/18/22
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 6.37
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 0.15
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 550
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Be - Barium 01007
ug/L
TOC oo68o 6.32
mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 58
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total o1o34
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
Total Ammonia oo610 ,
µMhos
mg/L
K - Potassium 00937
Mg - Magnesium 00927
mg/L
mg/L
VOC 7873 method #
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% _
JOHNNIE J. CHADWICK, ORC
Permittee (or Authorized Agent) Name and Title - Please print or type
Agent)
GW-59 Rev.3-1-2016

cl IMAIT GnRnA r1N VPI I nW PAPFR ONLY
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
,
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 276994617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date:
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 street)
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:# 3 EAST SIDE LAGOON
No. of wells to be sampled: SIX
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW-3
Date sample collected: 7/18/22
FIELD ANALYSES:
If WELL
WAS
Well Depth: 25 ft.
Well Diameter: 2 IN. in.
pH o040o: 5.9 units Temp. 000lo: °C
DRY at
time ofsampling,
Depth to Water Level 82546:11.97 ft. below measuring point Screened Interval: ft. to
_ft.
Spec. Cond. 00094: µMhos
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: ft.
Odor 000m:
check
Volume of water pumped/bailed before sampling:
2•0
gallons
Appearance
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed:7/18/22
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 1.45
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100ml-
Phosphorus: Total as P 00665 0.05
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Totaf 70300 51
mg/L
AI - Aluminum o1105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00660 <1.00
mg/L
Ca - Calcium o0916
mg/L
Chloride 00940 3
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total o1o34
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 o0610 0.111)
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as 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):
JOHNNIE J. CHADWICK, ORC
Permittee (or Authorized Agent) Name and Title - Please print or type
Influent Total VUGs:
mgtt- tmuent I ULM vvk,b.
,y—.,...a,.o
GW-59 Rev.3-1-2016

SUBMIT FORM ON YFLL_OW PAPFR nMl v
• • 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]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: p
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 ❑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:
WELL ID NUMBER (from Permit): MW4 Date sample collected: 7/18/2022
Well Depth: 22 ft. Well Diameter: 2 IN. in.
Depth to Water Level 82546:5.81 ft. below measuring point Screened Interval: ft. to _ ft.
Measuring Point is 2 ft. above land surface Relative M.P. Elevation: ft.
Volume of water pumped/bailed before sampling: 1.0 gallons
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES:
pH 00400: 7.4 units
Spec. Cond. 00094:
Odor 00085:
Appearance
Temp. 000lo: 9_1 °C DRY at
µMhos time of
sampling,
Date sample analyzed:7/18/2022
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 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 1.09
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 315o4
/100mL
Phosphorus: Total as P 00665 0.33
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 130
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium o1oo7
ug/L
TOC 00680 <1.00
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 8
mg/L
Cd - Cadmium 01027
ug/L
Arsenic o1oo2
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 0.06
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; N1­13as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
... .a�...va..aaa.vl. vyaaavu0 v31 y traaaaa:n Lau RCFluflb): IfINuCN[ IOral VUI.S
JOHNNIE J. CHADWICK, ORC
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.3-1-2016
mg/L trtluent I otal vacs: mg/L VOC Removal%
3ermittqej6r Authorized A, ent) (Date)
here: El

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
Please Print Clearly orType
PERMIT Number: Expiration Date: - j>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
Lagoon ❑ Remediation: Infiltration Gallery
0 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
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-5
Date sample collected: 7/18/2022
FIELD ANALYSES:
WAS
Well Depth: 21 ft.
Well Diameter: 2 IN. in.
pH oo400: 7.4 units Temp. 000lo: �;L— eC
DRY at
Depth to Water Level 82546:13.18 ft. below measuring point Screened Interval: ft. to
ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
sampling,
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 o1o51 ug/L
Coliform: MF Fecal 31616 1
/100mL
Nitrate (NO3) as N 00620 <0.04
mg/L
Zn - Zinc 01092 m9 /L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 0.05
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 190
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680 1.66
mg/L
Ca - Calcium 0o916
mg/L
Chloride 00940 11
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total o1o34
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 0.14
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total)
Mn - Manganese olo55
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%
JOHNNIE J. CHADWICK, ORC
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.3-1-2016
de--g-2vzz
(Date)

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]
FACILITY INFORMATION
Please Print CleaAy or Type
PERMIT Number: Expiration Date: - 3 /--,2017
Facility Name: Town of Pollocksville
Non -Discharge WQ0007283 UIC
NPDES Other
Permit Name (if different):
Facility Address: Poll ocksville,NC 28573
TYPE OF PERMITTED OPERATION BEING MONITORED
Pollocksville,NC 28573 (y `"'
County JONES
0 Lagoon ❑ Remediation: Infiltration Gallery
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:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-6
Date sample collected: 7/18/2022
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 IN. in.
pH oo400: 6.8 units Temp. 000lo: , °C
DRY at
Depth to Water Level 82546:15.72 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:
3.0
gallons
Appearance
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed:7/1812022
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 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.37
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 315o4
/100mL
Phosphorus: Total as P 00665 0.11
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 93
mg/L
At - Aluminum o1105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680 ,1.09
mg/L
Ca - Calcium 00916
mg/L
Chloride oo940 18
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total o1o34
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 oo610 0.17
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3 as 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%
1 1_
JOHNNIE J. CHADWICK, ORC
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.3-1-2016

e In F1
al -,"I; F, Ff o-�J' rj�j TFR g [Iru r"" PP @ Fr al � �E"' Cqj
Drinking Water ID: 37715
Wastewater ID: 30
TOWN OF POLLOCKSVILLE (WELLS)
ATTN: JAMES BENDER, JR.
P.O. BOX 97
POLLOCKSVILLE, NC 28573
PARAMETERS
PH (field measurement), Units
Fecal Coliform (NIF), /100 MIS
Ammonia Nitrogen as N, mg/I
Nitrate Nitrogen as N, mg/1
Total Phosphorus as P, mg/l
Total Organic Carbon, mg/1
Chloride, mg/1
Total Dissolved Residue, mg/l
Static Water Level, feet
Water Bailed, Gals.
MW-1
ID#: 420
DATE COLLECTED: 07/18/22
DATE REPORTED : 07/29/22
REVIEWED BY:
MW-2 MW-3 MW4 MW-5 Analysis Method
7.3
6.9
5.9
<1
<1
<1
0.07
2.80
0.10
1.19
6.37
1.45
0.31
0.15
0.05
1.03
6.32
< 1.00
10
58
3
160
550
51
7.88
14.25
11.97
1.5
2.5
2.0
Date Analyst
Code
7.4
7.4
07/18/22
PJC
4500HB-11
<1
1
07/18/22
DNS
9222D-15
0.06
0.14
07/25/22
TRJ
350.1 R2-93
1.09
<0.04
07/20/22
KES
353.2 R2-93
0.33
0.05
07/28/22
BMD
365.4-74
< 1.00
1.66
07/25/22
HMM
531OC-14
8
11
07/22/22
DNS
4500CLB-11
130
190
07/19/22
JDJ
D5907-13
5.81
13.18
07/18/22
PJC
1.0
2.5
07/18/22
PJC
015

i
TOWN OF POLLOCKSVILLE (WELLS)
ATTN: JAMES BENDER, JR.
P.O. BOX 97
POLLOCKSVILLE, NC 28573
PARAMETERS
PH (field measurement), Units
Fecal Coliform (1ViF'), /100 Ws
Ammonia Nitrogen as N, mg/l
Nitrate Nitrogen as N, mg/l
Total Phosphorus as P, mg/1
Total Organic Carbon, mg/l
Chloride, mg/l
Total Dissolved Residue, mg/l
Static Water Level, feet
Water Bailed, Gals.
MW-6
Analysis
Method
Date Analyst
Code
6.8
07/18/22
PJC
4500HB-11
< 1
07/18/22
DNS
9222D-15
0.17
07/25/22
TRJ
350.1 R2-93
0.37
07/20/22
RES
353.2 112-93
0.11
07/28/22
BMD
365.4-74
1.09
07/25/22
HMM
531OC-14
18
07/22/22
DNS
4500CLB-11
93
07/19/22
JDJ
D5907-13
15.72
07/18/22
PJC
3.0
07/18/22
PJC
Drinking Water ID: 37715
Wastewater ID: 10
ID#: 420
DATE COLLECTED: 07/18/22
DATE REPORTED : 07/29/22
REVIEWED BY: ����

E'li €1onli24Bt{ i 'In . � OF CUSTODYC01
RO. Bo% 7085 1 1-1 OaLi—tont Dr. I'a�e 1 of,
Ci'ivk nviIIc. NTC 278711i I
cnti irc;ttntCrt;tIf
Pho i e U
t 252) 756-620,"" Fw, (252) 756-00'
CLIENT: 42o Week: 31
;
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2
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#
CHLORINE NEtITRAIIZFDAT COLLECTION
CHECK (LAB)
�'
PH
OWN OF POLLOCKSVILLE (WELLS)
I.,t�;i
p
p
p
p
p
p
p
p
I
CONTAINER TYPE, PIG
TTN: JAMES BENDER, JR.
{{{
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III
Ili
.O. BOX 97
f
CHEMICAL PRESERVATION
OLLOCKSVILLE NC 28573
{---
A
G
C
A
C
C
A
A
A - NONE D - NAOH
;52) 2249831
Ld __
LU U w
iK
c!
Z
o
B - HNOS E - HCL
a
1�_______
00 _..
o o
w
awC0LLECT1Qt
^o
ca
b
y
oq
p U
O
r
o
l
!M
v�
A
C- H,,SU, F- =1NC ACETATE/NAQH LU
C: , L�t7NiQSULFATE
I
.
S 1LOCATION�
I SAMPLE
DATE
TIME
�- r-
r-�c, 1- c ; :�
r�
Lr,
d Z
E. E.
.e
i U
E-4 w
MW2
'
I
$
41
Y %
'9 F >:f)
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_
> �`
CLASSIFICATION:
ftASTEWATER(NPDES)
jam: w�
Ell
x a d.
5f
k✓ 3::+
DRINKING WATER
��.
_
:V111
{J �'1�--..-�—
..
•
f•
ii:
'st.•'i}lv i j}:•V
rs<�
?'M'•'SC iti'�
>j�iv.S�
•Q%>RiP 4i
DtNR/GW
MW-6
%� 4j�
......_
J
7
g{{
,',•::.
>:. f }> ?
�..-1 ���
,o-
` ;r �;:> •
r,•'"srr'.'
n
SOLID WASTE SEC'AON
)
.4'
fi4� 'F.
>nf vtiAi{
iiK�/.
\�.••.;.
CHAIN OF CUSTODY (SEA!) (MAINTAINED
DURINGOMENT/DELIVERY
V N
SAMPLES COLLECTED BY:
(Please Print) - G L h- t-Q ylO'"
n
_
ath (4 - (G
SAMPLES RECEIVED IN LABAT I+$ �IC
RELINQUISHED BY (SIG.) (SAMPLER)
DATE/TIME
R1 f '-'Vm BY (SIG.)
ATE1111E
COti4MENTS:
-
R 1-NED UI (Sit,.}
DATEMME
DATE IMME
RELINQUISHED BY (SIG.)
DATERIME
IELINQUISHED BY (SIG.)
DAT1=fN
REC' '; E& BY ( IG.)
PLEASE READ Instructions for completing thi` form on the reverse side. Sampler must place a "C' for composite sample or a "G" for NQ 41(1727
'nrnne xe ('rnh camnln in thn hln4:• ,kn— fnv nn..h . ,. ,, ,t ...,..,....,+

IF
Jo P cad
TOWN OF POLLOCKSVILLE (EFFLUENT)
ATTN: DAMES BENDER, JR.
P.O. BOX 97
POLLOCKSVILLE, NC 28573
PARAMETERS
BOD, mg/l
Fecal Coliform (MF), /100 Mls
Total Suspended Residue, mg/l
Ammonia Nitrogen as N, mg/l
Total Kjeldahl Nitrogen as N,mg/l
Nitrate+Nitrite as N, mg/l (calc)
Nitrate Nitrogen as N, mg/l
Nitrite Nitrogen as N, mg/1
Total Phosphorus as P, mg/l
Chloride, mg/l
Total Dissolved Residue, mg/l
Calcium, ug/l
Magnesium, ug/l
Sodium, ug/1
Sodium Adsorption Ratio (calc)
Total Nitrogen, mg/l (calc)
Effluent Analysis Method
Date Analyst Code
39
07/14/22
DNS
521OB-16
10000
07/14/22
JDJ
9222D-15
9.7
07/15/22
JDJ
254OD-15
12.20
07/25/22
TRJ
350A 112-93
28.58
07/26/22
KES
351.2 112-93
0.05
353.2 R2-93
<0.04
07/14/22
KES
353.2 112-93
0.05
07/14/22
BMD
353.2 R2-93
3.78
07/26/22
TRJ
365.4-74
102
07/18/22
DNS
4500CLB-11
690
07/19/22
JDJ
D5907-13
85901
07/22/22
LFJ
EPA200.7
14231
07/22/22
LFJ
EPA200.7
88513
07/22/22
LFJ
EPA200.7
2.3
28.63
Drinking Water ID, 37715
Waaterater ID: 10
ID#: 319
DATE COLLECTED: 07/14/22
DATE REPORTED : 07/29/22
REVIEWED BY:

C"HAIN OF CUSTODY RECORD,
3;�?;`S3'1Dstii.!{'Litz. 3'.iC7.
I'.O. l3w. 7055• I I d Clakn� ant Ur.
:}aCrm-i►!r N • 't-25"
n � ia�Jnm� �u l uar.�'J>Jrt DISIN (:TI0N -
i'IJJ,JJr 7:764- li) i^,t% 52 _Y( !'' 3 ~
319 Week: 31
Lj'V LIT
TOWN OF POLLOCKSVILLE (EFFLUENT) ;COI-:;Ir �� ( i
ATTN: JAMES BENDER, JR. ` P P P j P P P P P P 11 P P Pt
P.O. BOX 97 ' j —
POLLOCKSVIL.LE NC 28573 r A G A �C C C A A C A A A A
Eo
;252) 224-9831 z J rt�"
� J �� ,.00 zCOLLECTION _j a`_ i
SAMPLE LOCATION DATE TIME o �° w F{ z i z( z r~ 1,11
F
Effluent rc. f.'• <'�: fit. r , .
8i�' ,.«a ' is > 3 x it
fr <; J
BY (SIG.)
:Y;iNOUiSHED B'Y (SIG.)
i
[ ATETltAE RECEIVED GY ( G.;
7 `� _
DATENIME RECEIVED BY
QATEII'IME RECEIVED BY (SIG.)
- J
RNl #5 PLEASE READ Instructions for completing this fdrm on the reverse side.
U/M1J G J IIVJC COMMENTS:
DATE/1MF
Page 1 or 1
CHLORINE NEUTRALIZED AT COLLECT10i%4
pH CHECK (LAB)
CONTAINER TYPE, P/G
CHEMICAL PRESERVATION
A -NONE D-NAOH
C
B-HNO; E-HCL
cc
LU
LU
C H2SOt F - ZINC ACETATE/NAOH
cc
G - NA TI-110SULFATE
CLA SIFICATION:
WASTEWATER (NPDES)
DRINKING WATER
DVVR/GW
SOLID VVASTE SEC-PON
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING CUfENT/DELIVERY
Y N
SAMPLES COLLECTED BY: �/
1. ;. , ,I 1 %
��
SAMPLES RECEIVED IN LAB AT V -'F C
Sampler must place a "C for composite sample or a "G" for
Grab sample in the blocks ahnvP fnr Aarh narmmnf— r, ...
ti4 Ai n7ra