WQ0002096_Monitoring - 09-2023_20231023 (2)

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0002096
Name of Facility:*
Month: * September
Report Information
Ahoskie Assisted Living
Year:* 2023
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR NDMR Sept 2023.PDF 206.9KB
PDF Only
GW-59 Compliance Report Sept 2023.PDF 2.66MB
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 G Armstrong
Signature:
Date of submittal: 10/23/2023
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: _anonymous
Review Date: 10/23/2023

GW-59A COMPLIANCE REPORT FORM Permit #W& 006 2 dq
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. (Itt, ED 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
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
-CO
identification plate, area overgrown, etc.)? ff 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 constitue t(s) and concentration(s)
exceeding standards in the space provided below 1>tii - F Ck� 3I I
pt1 W . Lf -- Tt3G 1 ? > L71 rnSI L�
f1'1w -5 - ► 12,1103 mIt_
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, concentrations) reported, and sample collection date for each occurrence (for the last two years).
_r, 'N
ilowl IL '1v�S-ic.52t(19,0
11,rnw-,r-"toc-
n2
Mgl--CDC,
�ui�� 1w S r
nq Vj -6 Tt<,, 3 Ow'Ji L_ 591.1L-11z3
Fec�•Q 7l�
n+ I
�11w - y rcc,
6
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 may be 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
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 (G W-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.
(PJ2.UL Al X AJr.Aa a2323
Signature of Permitte7 Authorized Age t) Date
Wa
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:
Facility Name: 'j- � i LiViyl
rr�� �y
Non-Discharge4 W�_/ � UIC
Permit Name (if different):i
NPDES Other
Facilit Address: !Z1+6 56W-h Eariv —MaJi6n
R.Aa d
TYPE OF PERMITTED OPERATION BEING MONITORED
(street) AJIC JZ-7gioCounty
Y`
❑Lagoon ❑Remediation: Infiltration Gallery
(city) (State) zirl
[g Spray Field El Remediation:
Contact Person: Y
nn��))
TTelephone*'GTT7L"' rJ r� .S 7/
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name-__��JAf I
No. of wells to be sampled: L
❑ Water Source Heat Pump ❑ Other:
(from Permit
SAMPLING INFORMATION Mw —4ected:
11Z
If WELL
WELL ID UMBER (from PI
l
Date saWell
Suniits
Well Depth:q ft.
1 QII
Diaple
meter: �in jJ
pH 00400:4 (FIELD
Temp. 000lo: °C
DRY at
Depth to Water Level 825as: ft. below measuring point
19ft. Sec. Cond. 0009a: µMhos
Screened Interval: ft. to p
time of
sampling,
Measuring Point is S ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
check
Volume of water pumped/bailed before sampling: �2_
gallons
Appearance Q Il
here:❑
Samples for metals were collected unfiltered: El YES El
NO and field acidified: El YES ❑ NO
LABORATORY INFORMATION
"'
Q6l
Date sample analyzed: j( j'2
Laboratory Name: V
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 ug/L
Coliform: MF Fecal 31616 < /100mL
Nitrate (NO3) as N 00620 D+!' • mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 a + S mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
hl
issolved Solids:Total70300 I r1L 140 mg/L
AI -Aluminum oiim mg/L ML IQ"X tija*- trr%cmdrd me*od
pH (Lab) oo403 units
Ba - Barium 01007 ug/L i aj
TOC 00680 I'L mg/L
Ca - Calcium 00916 mg/L -"CtP Z
Chloride 00940 40 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)
pecific Conductance 00095 µMhos
K - Potassium 00937 mg/L VOC 7873 method #
Total Ammonia 00610 + 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
•
•
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 INFORMA I N
' W
4 b
PERMIT Number: �t/�% Expiration Date: � 5� V
' 06��
Facility Name: S � S C� Is
i Yl n WT 1
Non -Discharge w� UIC
Permit Name (if diffeerlennt/
NPDES Other
�s):: ' f,�
Facility Address: 2 I V 6 -i t 1 ar C
TYPE OF PERMITTED OPERATION BEING MONITORED
(Street) A)t' _
\.! I Z-7 q16 County "e dr'
El Remediation: Infiltration Gallery
(S(zip)
�J /nJ �i
��
,❑-,Lagoon
lidtate)
Spray Field El Remediation:
Contact Person: IDaY'k� r
Telephone#:�'G 5
El Rotary Distributor El Land Application of Sludge
Well Location/Site Name: �(�
No. of wells to be sampled: 1,11
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION y}� /
I j �
))
3
FIELD AN�*ALYSES:
If WELL
WAS
WELL ID NUMBER (from Permit): !
Date sample collected: %
Well Depth: �ft.
Well Diameter: in.
pH 00a00:5units Temp. 000lo: °C
DRY at
Depth to Water Level 8254
n/6: ft. below measuring point Screened Interval:ft.
to �/ ft. Spec. Cond. 00094: µMhos
time ofsampling,
Measuring Point is L, ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085:
check
Volume of water pumped/bailed before sampling: _gallons
Appearance e 1,6JI
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION GG JJ
"' k
iB�,,� /� ,,, ll L
AAAfi(O� %C
Date sample analyzed: l h 1
Laboratory Name: VU1l� lki
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 ug/L
Coliform: MF Fecal 31616 `?� /100mL
Nitrate (NO3) as N 00620 < tl 12_
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 o' �©
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units): l
issolved Solids:Total70300 mmg/L
AI -Aluminum ol1o5
mg/L ML laAy,, (e5(A)i' CXClt-elk
pH (Lab) 00403 units
Ba - Barium 01007
ug/L Col u -iaM— WIU r cr i ' ' C-A
TOC 00680 mg/L
Ca - Calcium 00916
mg/L Co+n -tA C�
Chloride 00940 mg/L
Cd - Cadmium 01027
ug/L j)G I I t t M t
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)
pecific Conductance 00095 µMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia 00610 0,19 mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH, 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%
Paul ck sh-rckr► 2
Siqnature of Permittee (or orized Agent) (Elate)
lqrrms#-6n,4
- li dm of
Permittee (or Authorized Aqent) Name an
GW-59 Rev.3-1-2016
tle - Please print or type

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]
T l Cl i P Please Print Clearly or Type FACILITY INFORMATION
PERMIT Number: Expiration Date: �
�''
Facility Name: S SLL/T LI ✓ ✓7
�% Vt/TF
Non-Discharget, O606Z09tl uIC
Permit Name (if different):
NPDES Other
Fa ity Address: L b q
k4ad
TYPE OF PERMITTED OPERATION BEING MONITORED
(Street)
AQ� 7cl Id
County_14,er
❑ Lagoon ❑ Remediation: Infiltration Gallery
(city: (state' (zip)
P�
��3"
❑-Spray Field El Remediation:
Contact Person:
Telephone#: L �.J 7
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: 1i1 r� cid
No. of wells to be sampled: ..
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION r'�
�/��/y ` , P
Permit): V�/ J /
�I 2
Date sample collected: /'[.
FIELD ANALYSES:
If WELL
WAS
WELL ID NUMBER (from I I
r�
/V1
Well Depth: jq ft.
Well Diameter: L. in.
pH 00a0o:-- units Temp. 000lo: 46- oC
DRY at
Depth to Water Level 825546: t ft. below measuring point
o
Screened Interval: j ft. to / 7 ft.
Spec. Cond. 000sa: µ Mhos
time of
sampling,
Measuring Point is , 5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
check
Volume of water pumped/bailed before sampling: 3
gallons
Appearance ' ou
here:❑
Samples for metals were collected unfiltered: ❑ YES ❑
NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION % n r
- l7P, `,)
q r I f
�j1%6i(.yQ6,
A)
Date sample analyzed: I 11 I /
Laboratory Name: il-' Mn 20,
CA 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 /100mL
Nitrate (NO3) as N 00620 < bto mg/L
Zn - Zinc 01092 mg/L
_
Coliform: MF Total 31504 /100ml- Phosphorus: Total as P 00665 <, I%t f mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentratio% Units):'( J
issolved Solids:Total 70300 I r'L- U mg/L
Al - Aluminum 01105 mg/L
W L, - Uo,�{,Q,{�,�f - eX ceedt'C% Int--A6?
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
C'46 k�'' cri ;w
TOC 0o66o t Q mg/L
Ca - Calcium 00916 mg/L
L-ab, Cc' G Gt k - %( 0
Chloride 00940 9 C mg/L
Cd - Cadmium 01027 ug/L
4r d (�tyIS Mn }- t h c4-n r a >
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)
pecific Conductance 00095 µMhos
K - Potassium 00937 mg/L
VOC 7873 method #
Total Ammonia 00610 �,b 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 #
�-or Remediation Systems Only ..VOCs-
I certify that, to the best of my knowledge and belief, the information submitted in this report is true. acc
DWR-certified laboratory. I am aware that there are significant penalties for submitting false informatioi
mg/L Effluent Total VOCs:
mg/L VOC Removal%
ittee (or Authorized Agent) Narrejand Title - Please print or type Signature of Permittee
GW-59 Rev.3-1-2016

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: 09/11/23
DATE REPORTED : 09/27/23
REVIEWED BY:
Effluent
Well #4
Well #5
Well #7
Analysis
Method
PARAMETERS
Date
Analyst
Code
BOD, mg/I
32
09/12/23
HMV
521OB-16
Fecal Coliform (MF), /100 Mls
6
< 1
23
< 1
09/11/23
MCY
9222D-15
Total Suspended Residue, mg/l
54
09/12/23
BMD
2540D-15
Ammonia Nitrogen as N, mg/I
8.50
09/14/23
AMC
350.1 R2-93
Ammonia Nitrogen as N, mg/l
0.26
0.19
0.05
09/13/23
AMC
350.1 112-93
Total 1(jeldahl Nitrogen as N,mg/l
17.60
09/14/23
TRJ
351.2 112-93
Nitrate+Nitrite as N, mg/I (calc)
0.14
353.2 112-93
Nitrate Nitrogen as N, mg/I
0.10
<0.04
<0.02
<0.02
09/11/23
HMM
353.2 R2-93
Nitrite Nitrogen as N, mg/I
0.04
09/12/23
HMM
353.2 112-93
Total Phosphorus as P, mg/l
2.34
2.86
0.20
<0.04
09/14/23
TRJ
365.4-74
Total Organic Carbon, mg/I
17.91
21.03
1.80
09/19/23
HMM
531OC-14
Chloride, Ong/I
46
40
5
90
09/18/23
BNC
4500CLB-11
Total Dissolved Residue, mg/I
ML 330
ML 140
ML 250
ML 230
09/12/23
ADR
D5907-13
Total Nitrogen, mg/I (cale)
17.74
All QC requirements were not met: L Laboratory Control Sample exceeded control limits.
N Blank result exceeded method constant weight criteria.