WQ0002096_Monitoring - 06-2023_20230726

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0002096
Name of Facility:*
Month:* June
Report Information
Ahoskie Assisted Living
Year:* 2023
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR Waste Water NDMR June 2023.PDF 272.67KB
PDF Only
GW-59 Compliance Report Form June 2023.PDF 2.7MB
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: * Paula Armstrong
Signature:
Date of submittal: 7/26/2023
This will be filled in automatically
Initial Review

Reviewer: Wanda.Gerald
Is the project number correct?* WQ0002096
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer:
Review Date:

GW-59A COMPLIANCE REPORT FORM Permit #
(Submit one each monitoringperiod with GW-59 forms.)
-.1%
IA.
1
Enter date monitoring results were due. Will this monitoring report (GW-59 and GW-59A)
YES
60
be submitted after the established due date.
2
Was any required information missing on the GW-59 report forms?
YES
NO
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
O
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'i
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.
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).
-5 , 0c. i .31M V5 bG i To 1
1L
M mw-5 $, 4 *1 jI. Mw�-r
;-AW T6C, ft m - L C1 a mac- �lh /��
1�ij
jt_
-c U (AW--� i q . j� � m w -r 7&- iv
31 *1
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
O
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 maybe improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
UO
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.
8
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.
(AaL_ a a -7 ky /.7
Signature of Perm(or Authorized Agent) 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
1 07 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
Please Print Clearly or Type
FACILITY INFORMATION _
PERMIT Number: Expiration Date: � 6
' f
i,
Facility Name: Ahoskk e tl �� S k-,Cj L. d t ✓1q
VU wr i
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: v796api f- � kdn
Ao a
TYPE OF PERMITTED OPERATION BEING MONITORED
t (Street) %ii61 L7 C1 %© County H-er-4+'-,0rd
❑ Lagoon ❑ Remediation: Infiltration Gallery
(City) (State) (zip)
U-Spray Field ❑Remediation:
�N
Contact Person: and. till Kc1'
Telephone#:'Z�Q f
r
�7 `j J
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: fL i -�
No. of wells to be sampled: _
El Water Source Heat Pump El Other:
from Permit
SAMPLING INFORMATION �LL
WELL ID NUMBER (from Permit): m wl — "T
Date sample collected: 4, i q JeZ)
FIELD ANALYSES:
If WELL
WAS
Well Depth: 9 ft.
Well Diameter:
in.
Q
pH 00400: LL � units Temp. 000lo: °C
DRY at
time of
Depth to Water Level s25as: ft. below measuring point
Screened Interval:
ft. to
ft. Spec. Cond. 0009a: µMhos
sampling,
MeasuringPoint is 'L , ,Cj ft. above land surface,
Relative M.P. Elevation:
ft.
Odor o0085:
check
Volume of water pumped/bailed before sampling: Z
gallons
Appearance u
here:❑
Samples for metals were collected unfiltered: 0 YES El NO and field acidified: K YES
❑ NOIf
LABORATORY INFORMATICIN
i I - 7 L-6
t�A'
A
Date sample analyzed: 7
Laboratory Name: Y VQyPo'
/11— )9t'1U,1
C4 Certification No.
PARAMETERS NOTE: Values should reflect dissolved and
colloidal concentrations. if
I
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 L J /100mL
Nitrate (NO3) as N 00620 U `j) C3 mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 Sj
5 (,a 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 01105
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC 00680 'T q 3 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 4mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total olo34
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)
pecific Conductance 00095 µMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia 00610 (j: 1 mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; N1­43as 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
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
• • • •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-161
FACILITY INFORMATION Please Print'Clearly orType
PERMIT Number: Expiration Date: fj
Facility Name: I e ass Is 1-d L I
V ,✓1��%
^ � �ti' T�
Non -Discharge �t� ©UC�G�9l� UIC
Permit Name (if different):
r
NPDES Other
Facilit Address: G qb K (,t;kt)n
RwEl
TYPE OF PERMITTED OPERATION BEING MONITORED
((Street) 7 COUnty j
❑ Lagoon ❑ Remediation: Infiltration Gallery
(City) (s'2' IZipl
R d Parker
�j y� [�
� 9'5 C
Ell -,Spray Field ❑ Remediation:
Contact Person: a!'
Telephone#: `5e-' S1 3 I
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: %' ,
No. of wells to be sampled:
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION �A G
WELL ID NUMBER (from Permit): C� Date J
FIELD
If WELL
WAS
Vyl sample collected: 7 -3
Well Depth: —� ft. Well Diameter: in.
ANALYSES:
pH 00400:4i• units Temp. 000lo: °C
DRY at
time
Depth to Water Level 82546: ) k7 ft. below measuring point
Screened Interval: ft. to 2i
ft. Spec. Cond. 00osa: µMhos
Measuring Point is � ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
sampling,
check
Volume of water pumped/bailed before sampling: 3
gallons
Appearance GJG
here:❑
Samples for metals were collected unfiltered: N YES
❑ NO and field acidified: N YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 1? i 7 tr
'7I7I f
Laboratory Name: iy -1( 'P Certification No. J©
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations. It
COD 00335 mg/L
Nitrite (NO2) as N 00615 mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 i /100mL
1
Nitrate (NO3) as N 00620 { Q; p mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 (j Cl mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L
Al - Aluminum 01105 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 �� mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 �' 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 µMhos
K - Potassium 00937 mg/L VOC 7873 method #
Total Ammonia oo6lo i � rj 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%a

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• .
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
• • • •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORM ION Please Print Clearly or Type
PERMIT Number: / Expiration Date: 71707
Facility Name: it j�11�i
1iVl F
Non-DischargeVli&Oct) �U�C?4, UIC
Permit Name (if different):
NPDES Other
Fa ' ity Address: '4-L}e &>LLR-1 L--Cxlq S+&R
4
TYPE OF PERMITTED OPERATION BEING MONITORED
'� stieaq 7q 0 County + i ilbr
El Lagoon ❑Remediation: Infiltration Gallery
(City) (State) (zip)
RSpray Field ❑ Remediation:
Contact Person: Al r
✓� LLJZ p
Telephone#: L ,^51 3 '� �� !
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:
No. of wells to be sampled:
❑ Water Source Heat Pump ❑ Other:
_
from Permit
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): (m l "— q
Date sample collected: /1'q /e5
FIELD ANALYSES:
If WELL
WAS
Well Depth: ' ft.
Well Diameter: Z in.
pH 00400: Tr!. units Temp. 000lo: °C
DRY at
Depth to Water Level 825a6: i
p ft. below measuring point
Q
Screened Interval: �' ft. to � 7
ft. Spec. Cond. 000sa: µMhos
time of
Measuring Point is 2 + ft. above land surface
j
Relative M.P. Elevation: ft.
Odor 00085:
sampling,
check
Volume of water pumped/bailed before sampling:
gallons
Appearance C Oi' 4
here:
❑
Samples for metals were collected unfiltered: © YES ❑ NO and field acidified: 0 YES El NO
LABORATORY INFORM TION
I i
W61 -H fi» I
Date sample analyzed: j ^ 7/7/15
Laboratory Name: Yoe)i A
a C aj Certification No. / v
PARAMETERS NOTE: Values should reflect dissolved and
colloidal concentrations. It
COD 00335 mg/L
Nitrite (NO2) as N 00615 mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 4,1 /100mL
Nitrate (NO3) as N 00620 4( DI 64� mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 t7 , '2 mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L
Al - Aluminum ol1o5 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 2 q mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 (� r 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 µMhos
K - Potassium 00937 mg/L
VOC 7873 method #
Total Ammonia 00610 Q, 2 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%

• in
Waypoint
ANALYTICAL
114 OAKMONT DRIVE
GREENVILLE, NC 27858
AHOSKIE ASSISTED LIVING
240 SOUTH EARLY STATION RD.
AHOSKIE, NC 27910
Drinking water ID: 37715
wastewater ID: 10
PHONE [phone]
FAX [phone]
ID#: 377
DATE COLLECTED: 06/19/23
DATE REPORTED : 07/11/23
REVIEWED BY:
Effluent
Well #4
Well #5
Well #7
Analysis
Method
PARAMETERS
Date
Analvst
Code
BOD, mg/1
r 34
06/20/23
BNC
521OB-16
Fecal Coliform (MF), /100 Mls
5300
< 1
< 1
< 1
06/19/23
BLV
922213-15
Total Suspended Residue, mg/I
94
06/20/23
HMV
2540D-15
Ammonia Nitrogen as N, mg/l
6.38
0.15
0.15
0.28
06/22/23
TRJ
350.1 112-93
Total K,jeldahl Nitrogen as N,mg/l
19.35
06/22/23
TRJ
351.2 R2-93
Nitrate+Nitrite as N, mg/I (calc)
0.11
353.2 R2-93
Nitrate Nitrogen as N, mg/I
< 0.04
0.05
< 0.04
< 0.04
06/20/23
TRJ
353.2 R2-93
Nitrite Nitrogen as N, mg/I
0.11
06/20/23
TRJ
353.2 112-93
Total Phosphorus as P, mg/I
2.51
5.56
0.98
0.28
06/22/23
BMD
365.4-74
Total Organic Carbon, mg/l
7.98
2.09
06/27/23
HMV
531OC-14
Total Organic Carbon, mg/l
25.28
07/07/23
HMM
531OC-14
Chloride, mg/I
32
48
14
111
06/26/23
HMV
4500CLB-11
Total Dissolved Residue, mg/1
370
120
180
230
06/20/23
BLV
D5907-13
Total Nitrogen, mg/1 (calc)
19.46
All OC requirements were not met: r Replicate varied by more than 30%.