WQ0014046_Monitoring - 06-2023_20230705

SUBMIT FORM ON YELLOW PAPER ONLY
, , ,
EPARTMENT.OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
VISION OF, WATER QUALITY INFORMAnoN FROCESSiNG UNIT
COMPLIANCE REPORT FORM
15 AAAtL SERVICE • CENTER, RALEIGH, NC 27699-1617 Phone:'(919) t33-3221-
FACILITY INFOR
PleasePrint ear t Clearly
y or Type
��ari V�
PERMIT Numb�D y to Expiration Date: i0 t
�cft'argell
Facility Name:
n b
NI!i UIC
Permit Name (if different):
NPDES Other
Facility A dress: 7 is 1S �J
TYPE OF PERMITTED OPERATION BEING MONITORED
t� (� NC County nv •t Jet
❑ Lagoon ❑ Remediation: Infiltration Gallery
0 Spray Field ❑ Remediation:
Contact Person. �G� S Telephone#Q IQ'(&A 'CEO
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name-rpL►Pn o•F ` t?y"\� (�1,�-� No. of wells to be sampled: 4
❑ Water Source Heat Pump ❑ Other:
nrLinna irrrvronri i ivn
LL ID NUMBER (from Permit): fC`111J14k a Date sample collected:�'7
I Depth: 33 ft. Well Diameter: in.
dh to Water Level V.9 ft. below measuring point Screened Interval: ft. to _ft..
isuring Point is ft. above land surface Relative M.P. Elevation: ft.
ime of water pumped/bailed before sampling: gallons
If WELL
FIELD ANALYSES: WAS
PH 4.1.1 units Temp. •�-� °C DRY at
Spec. Cond. r7 Z µMhos time of
sampling,
Odor check
Appearance C)m r- (here:
t..r�ovrw vrt r ,nrvr�mH r,vn
Date sample analyzed: (,1-1z3 - Co 1 ►1 )Z3 Laboratory Name: C11�-��GCti1 �� Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N mg/I Pb - Lead
Coliform: MF Fecal C' F(,�� /loom[ Nitrate (NOS) as N - -4 mg/1 Zn - Zinc
Coliform: MF Total /loom[ Phosphorus: Total as P • 03� 1 mg/I
mg/I
mg/I K H
(Note: Use MPN method for Nghly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Unfts): j U �- 0 6 23
Dissolved Solids: Total Ok 5 mg/I
Al - Aluminum
mg/I
PH (when analyzed) LA .1-7 units
Ba - Barium
mg/I
TOC 4 k• Vo mg/I
Ca - Calcium
mg/I
B
Chloride LA •o mg/I
Cd - Cadmium
mg/I
�t�1
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/l
ORGANICS: (by GC, GC/MS, HPLC)",f
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. , EPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
S ecific Conductance µMhos
K- Potassium
m /I
VOC method#
Total..
Nitrogen; NH3as N: Ammonia Nitrogen, Total)
Manganese(Arnrnonia
Mn -
..
method
• �.1101
dirmarlinalriell.
_ s
•
r•..
ttie and be[ij t,.the information submitted
inihis report is true, accur complete;
: that the laboratory analytical dafa was
using a methods of analysis by artified
certify!hal, to bestOfmy knowledge
submitting false information. the
produced
rossibility of fines and imprisonment for knowing
violations.
laboratory.' I am aware that there are significant penalties for
(or Authorized Aqent) Name and Title - Please print or type
of
Agent)
;Date)

CNN'-5')A (4-INIITIAN6; F IZ?F'Ok'(' p' )EZ�i
.IV.�-ok L4o(4GSuGrrur oar cir•h rrrrritnrng G-; „
1 Enter date monitoring results were due.. ( J will this monitoring report (GW-59 and GW-59A) YES
be submitted after the established due date?
2 Was any required information missing on the Gw-5 Forms? --
IF the answQr to question 1 or 2 is `^rE 5", ;ist ir) thebelow the wel!der, tifica•'ion number(s) and YES
explain the problems enccunt6red in ohtainhtg the required in'ormation.
3 j .kre any of the monitor wells in nced of repair or maintenance (damaged casing, unlocked or missin c:� rni,s�n
identification plate, area overgrown, etc.),! i the answer is "Yes', renlacl thr Regional O;tCC'Ji)r }
), J e P, g 1'i•:S
_ _ __ '� uidunce.
4 , Are any monitored constituents equal to or above the established standards? --- ----- ---
It the answer to question 4 is `NO' ski c section 8. — jS
If the answer to question 4 is "YES" list the affected wells individually with constiterent(s) and cencentration;s)T -
exceeding standards in the space provided below-
5
6
8
For the constituents identified in question 4 above, have standards been exceeded previously for the
same constituent(s) in the same well(s) in the last two years? YES NO
If the answer to question 5 isIf , skip to section 8
sttandards, concentratio.
the answer to question 5 is "YES", list in the space provided below, each well with cons ) exceeding
ns) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
If the answer is "YES a groundwater ualit 1 ES NO
OFFICE IMMEDIATELY FOR GUIDANCE. If th answer is "NO", monitoring wel soccurring. C AmayT eimp operlyL
located, contact the Regional Office.
Is the permittee implementing previously approved actions required by the Division involving this
groundwater quality problem?
YES I NO
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 ma be
requiredar to determine the im act the waste dls osa/ s stem is havin at the review and com liance
boundaries surroundin this facilit . Failure to do so ma sub'ect the t he re a to a Notice of v;.,rat:,,.,
fines, and/or enaltles
The person completing this Portion (GW--59A) of the monitoring report should sign be/ow and submit this
Form with GW-59 forms for required wells to the address Provided at the top of the current GW-59 form
Ih -
ere
reoon
Signature
Dwledge that the above information was evaluated and the information submitted in this
lance
Report GW-59A) is true and complete to the best of my knowledge.
0�----------------
�'. ter humonzety Agent)
12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
ROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
AWLIIT INtVKMAII UN rteasePrint GlearlyorType
acility Name: 'T�,Jn
ermit Name (if different):
acility Address: rl ( S5 (S Q
NC County rnl�►�
act Person: Do w ry-vhex,-xs Telephone#Q 1ct-(.AI' t DSkD
Location/Site Name:-�-XDLA-),r n4 �+-CGJaNo. of wells to be sampled: 4
DEPARTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
DIVISION OF'WA1ER QUALITY -INFORMATION,PROCESSING.UNrT
1617 MAIL SERVICE CENTER, RALEIGH, NC.47699-1617 Phone: [phone]
PEMIT h umber: Expiration Date:l 3i
Voi�DtkL'fiaTge (o UIC
VPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Spray Field El Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
ILL ID NUMBER (from Permit) 1 � r : 1 'Z IL
Z Date sample collected: (D 1
I Depth: Q .1 ft. Well Diameter: in.
th to Water Level: 11.4 ft. below measuring point Screened Interval: ft. to ft.
suring Point is ft. above land surface Relative M.P. Elevation: ft.
me of water pumped/bailed before sampling: a gallons
If WELL
FIELD ANALYSES:
IWAS
pH 16•O5units Temp.
at
_°C
Spec. Cond. Q V µMhos
time of
Odor i-
JDRY
sampling,
check
Appearance C
here:
late sample analyzed: L 17IZ3 - (y 11 1' 4 Laboratory Name: 1 ' rc�'�G`h -To . � (DS
ARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. Certification No.
COD mg/I Nitrite (NO,) as N mg/I Pb - Lead mg/I
Coliform: MF Fecal /100ml Nitrate (NO3) as N m
Q• y� 9/I Zn -Zinc mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mg/I
(Note: Use MPN method for Mghly turbid samples)
I 4 nn Orthophosphate mg/I Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total `C1
mg/1
pH (when analyzed) 5 jos units
Al -Aluminum
mg/I
TOC E;C mg/I
Ba - Barium
Ca
mg/I
Chloride -o mg/1
- Calcium
mg/1
Cd- Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Sulfate
Fe -Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
mg/I
Specific Conductance µMhos
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
TtIA `
K- Potassium
mg/I
VOC method #
o a mmonta
(Ammonia Nitrogen, NH3as N; Ammonia Nitrogen, Total) mg/I Mg - Magnesium mgll
Mn -Manganese mg/I
TKN as N mg/l Ni - Nickel mg/I
For Remediation Systems Only (Attach Lab Reports):
Influent TntAI VnCc
Effluent Total VOCs:
method #
method #
method #
VOC Removal%
De.. IMAn
Signature of Permittee (or Authorized Aqent)

CW-59A (4-011PLIl NNE- [Zi,FQIt'i' E lEt.\i FrV�j 001 y to
i crl��ii
Srrbnri! fint,-- r .•. It tnn:rinuirr•, n,'rr ni a !h Gt6- 9 irr; nn,j --
Enter date monitoring results were due. D Vyil� this monitoring report (GW-59 and GW-59A) be submitted after the established due date? ys
r Was any required information missing on the GW-59 report forms? --
- YES
IF the answer to question t or 2 is "`DES", list in the spac'� 1.rovi-ieo below the vvell idertificafion number(s) and
explain the problems encountFred in obtaining the required in`brmation.
3 1 .\re any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missin }-
I identification plate, area overgrown, etc.)? ifche aiswer is "Yes", cr,'rrinct the Regional cke g_ _I 1`I'•S NU
I Tre f)r dance.
Are any monitored constituents equal to or above the estahiished standards?
li 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 constihrent(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).
8
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 maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
Is the permittee implementing previously approvecf actions required by the Division involving this YES I NU
groundwater quality problem?
If the answer to question 7 is `YES", describe rb roe tltl se actions in the space provided below.
If the answer to question 7 is "NO", contact the Re Tonal Office within 90 days; an evaluation may be
required'r., determine the im act the waste d/s osal s stem is Navin at the review and com liance
boundaries suenaltie n this facilit .Failure to do so ma subject the ermittee to a Notice of Violation
fines, and/or penalties
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with G W-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 pliance Report GW-59A) is true and complete to the best of my knowledge.
re of Permittee (or Authorized Agent)
Date
12/8/2003

GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
ci)ity Name: kok-z
rmit Name (if different):
cilityAddress: rll G
y Please Print
�S H
NC 'OL') S
or Type
SUBMIT FORM ON YFI I OW PAPER ONLY
County6mrj t 11e-
act Person. �CC�Q m( Pam'--�s I- l CGO
Telephone#:�IQ' lit'!!q� ►
Location/Site NameT04]-� 0; ---ftNV USOTP No. of wells to be sampled: 4
rELL ID NUMBER (from Permit):
ell Depth:�J ft.
pth to Water Level: - I -Ift. below measuring point
Measuring Point is ft. above land surface
Volume of water pumped/bailed before. sampling:
3EPARTMENT.01` ENVIRONMENT& NATURAL RESOURCES
31VISIQN OF WATER.QUALITY-INFORMATION PROGESSING,UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC;$7699-1617 Phone:'(819) 733-3ai
Expiration Date:
_ UIC
Other
El
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon ❑ Remediation: Infiltration Gallery
Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
Date sample collected4P
Well Diameter: C in.
Screened Interval: ft. to ft.
Relative M.P. Elevation: ft.
s
If WELL
FIELD ANALYSES: WAS
pH 5. Q nits Temp. 1 T 3 -C DRY at
Spec. Cond. cS(p µMhos time of
Odor *,J samplinr�
check
Appearance C here:
to sample analyzed: 1 23 - l (1'Z3 Laboratory Name: 0')ec-Aec.-b 717-<,� . Certification No. kos
RAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD_ mg/1 Nitrite (NO2) as N mg/I Pb - Lead m /I
Coliform: MF Fecal /100m1 Nitrate (NO3) as N 4 0.1 mg/; Zn -Zinc mg/I
Coliform: MF Total /100ml Phosphorus: Total as P D mg/I
(Note: Use MPN method for highly turbid samples) Orthophosphate
mg/I Dissolved Solids: Total Z Other (Specify Compounds and Concentration Units):
mg/I
pH (when analyzed) • GZ
Al -Aluminum
mg/I
units
TOC . [, mg/I
Ba - Barium
mg/I
-
Chloride U • D
Ca - Calcium
mg/I
mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/1
Sulfate
Fe -Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
mg/I
Specific Conductance µMhos
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
K - Potassium
mg/I
VOC meth od#
Total Ammonia mg/I
(Ammonia Nitrogen. NH3 as N, Ammonia Nitrogen, Total)
TKN as N
mg/1
For Remediation Systems Only (Attach Lab Reports):
Permittee (or Authorized Agent) Name and Title - Please
(:IA/-FO Deg. 4 /0nn-r
Mg - Magnesium mg/1 method #
Mn - Manganese mg/I method #
Ni - Nickel mg/I method #
Influent Total VC)(.c

G-W-59A C0i`v11'L,IANIC Ril-11olt't' p';llZ;q
( l'i Itlit rrG�QIt4ti�}
r �rrbnrir nnr r,,.•.•lr rnu:,innirr n-rrn,l u�th G16- �7 i�,; nr.)
1 be submitted after the established duu e date? Enter date monitoring results were e. 2J Will this monitoring report (GW-59 and GW-59A) YES
? Was any required information missing on the GW-59 report forms? --
- YES
IF the answer to question i or 2 is "YES", ;ist in the space f.r0v0Pu below the well idertifiion number(s) and
explain the problems enceuntFred in obtaining the required in`brmation.
3 1 any of the monitor
identification plate, area overgrown,g wells need of repair or maintenance (damaged casing, unlocked or missing cap, missing rVl S
icleruwn, etc.)? i/ the am
arrsu•vr is "yc!, ", rerdaci the Regional Ql;?rcc fr)r 74ricfunce.
I
jAre any monitored constituents equal to or above the estahiished standards?
-- ---
_ Ir the answer to question 4 is `NO', ski _ ---- -- -- — ----. -- I p to section 8.-------�
If the answer to question 4 is "YES" list the affected wells individually with constit_rentis) and concentration(s)
exceeding standards in the space provided he!ow.-
1
6
8
rur ate constituents identified in question 4 above, have standards been exceeded previously for the
same constituent(s) in the same well+YES
s) in the last two years? N O
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).
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 maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. if the answer is "NO", monitoring wells maybe improperly
located; contact the Regional Office.
Is the r quality problem? implementing previ
groundwater qously approved actlons required by the Division involving this YF.S I No
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 da s an evaluation ma be
re aired to defermine the im act the waste disposal system is hav ng at the review and tom fiance
boundaries surrounding this WHIM . Failure to do so ma subject the permittee to a Notice of Violation
fines, and/or penalties
The person completing this portion (GW-59A) of themonitoring 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 hereb knowledge that the above information was evaluated and the information submitted in this
rejp(C pliannc Report GW- A) is true and complete to the best of my knowledge.
Signature of Permittee (or Authorized Agent) 1 Zj,t23
Date
C:11 -n9A 1 2/8/211p;

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
AGILITY INFORMATION Please Print Clearly or Type
Icility Name: ,grN EJ
lrmit Name (if different):
cility Address: 7 � 5 S
�� - NC CountycGr.V,lle
ntact Person: s ( G1-� pS(o
Telephone#: Q �"
III Location/Site Namelioo" p-- .3'q ' (P O- i=. No. of wells to be sampled: 4
ELL ID NUMBER (from Permit): mW- 4 Date sample collected: I `I 23
ell Depth: Qr7 ft. Well Diameter: in.
Depth to Water Levef:' �. below measuring point Screened Interval: ft. to _ft.
Measuring Point.is ft. above land surface Relative M.P. Elevation: ft.
Volume of water pumped/bailed before sampling: t(� gallons
trARTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
IVISION OF WATER.OUALITY-INFORMATION PROCESSING UNIT
07 MAIL SERVICE,CENTER, RALEIGH, NC $7699-1617 Phone: [phone].
T>j�lj1llb Expiration Date O R(O
on-Dis arge UIC
PDES Other
(PE OF PERMITTED OPERATION BEING MONITORED
El Lagoon ❑ Remediation: Infiltration Gallery
Z Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
FIELD ANALYSES:
WAS
PH L4: 17 units Temp. (((0.45 °C
DRY at
Spec. Cond. ,51 µMhos
time of
Odor None
sampling,
check
Appearance (', '�
here:
late sample analyzed"nLQ IZj (p' 1'� Laboratory Name: 0—Te'(-A'eL,h Certification No. 1(OS
ARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N_ mg/I Pb - Lead mg/I
Coliform: MF Fecal 4 1—fv�—/100ml Nitrate (NO3) as N —m
• 9/l Zn -Zinc mg/I
Coliform: MF Total /100ml Phosphorus: Total as P mg/I
(Nola: Use MPN method for highly turbid sammies) Orthophosphate
mg/I Other (Specify Compounds and Concentration Units):
D' I d I' Z(D
Isso ve So Ids. Total mg/1
Al - Aluminum
mg/l
pH (when analyzed) Cv .� h units
tjmg/I
Ba - Barium
mg/I
TOC
Ca - Calcium
mg/I
Chloride L mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC , method #
Total Ammonia _ m /I
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total) g Mg - Magnesium mg/l
Mn -Manganese mg/I
TKN as N mg/I Ni - Nickel mg/I
For Remediation Systems Only (Attach Lab Reports)
Influent Tntal V[1r:c
method #
method #
method #
Ac„ � Mnn'r
o-. , , - - (o Z,,3
Signature of Permittee (or Authorized Agent) not.,

GNV-s°).a (c)ME>[,ErAti6'1 EZi;F't?Et t i )Et.i'E i'l'i"li)fE 11�{�+�+VO1 ya4li
Subnth one r,• .!r trru:,itnritr•; nrrtcv! v"th i, IP->9
j Enter date monitoring results were due._�
te aWill this monitoring report (GW-59 and GW-59A) YES
be submitted after the established duedate?
--- _
Was any required information missing on the GW-59 report forms? --
- YES
IF the answer to question 1 or 2 is "YE ist in the spat l.rovi jea below the well !dentificjtion number(s) and
explain the problems encounthred in ob,a10-09 the ret?turod in`ormation.
3 - -- ------ r- —---------
.\re any of the monitor wells in need of repair ur maintenance (daoiaged casing, unlocked or missing cap, missing II?
identification plate, area overgrown, etc.)? if•t.he atisuer is "yea", contact the Regional (:)i }S
,.cc fcrr aidcmce. \
Are any mua
monitored constituents eql to or above the estahlished stanttards7
-1 — _
!r the answer to question 4 is °NO" skip rto section 8. --- -- — ---- --- ------
If the answer to question 4 is "YES" list the � �--- affected wells indiv,;dually with constih_ient(s) and concentration(s)
exceeding standards in the space provided heiow:
j 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 ansTe
question 5 is "NO", skip to section 8. _
!f the anquestion 5 is"YES'; listin the space provided below, each well with constituents) exceeding
standardsntrations) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
1'ES 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 may be improperly
located; contact the Regional Office.
Is the permittee implementing previously approvecf actions required by the Division involving this tyfs—
nbeNU
groundwater quality problem?—�lf the answer to question7 is "YES de cs othth se actions in the —space wr eo d d below.
If the answer to question 7 is "NO", contact the Re ional Office within 90 d�san evaluation ma be
re aired to determine the im act the waste dis osaI s stem is havin 9 thw and com liance
boundaries surroundin this facilit . Failure to do so ma subject the ermittee to a Notice of Violation
Fnes, 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"Obm Hance Report GW-59A) is true and complete to the best of my knowledge.
A
of Permittee (or Authorized Agent)
-Z&
Date
l:�y'-59.a 12/3/2003

, 1" .0
J;F7
Contact: Janet Parrott
Client: Town of Stovall
P.O. Box 100
Stovall, NC 27582
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Meritech Work Order # 060723149
Parameters Result
Sample: Effluent Grab
Page 1
Report Date: 6/16/2023
Date Sample Rcvd: 6/7/2023
6/7/23
BOD, 5 day
19.6 mg/L
6/8/23
2.0 mg/L
SM 5210 B
Total Suspended Solids
33 mg/L
6/8/23
2.5 mg/L
SM 2540 D
Total Dissolved Solids
236 mg/L
6/8/23
10 mg/L
SM 2540C
Chloride
80.0 mg/L
6/13/23
0.5 mg/L
SM 4500 Cl B
Ammonia, Nitrogen
0.1 mg/L
6/8/23
0.1 mg/L
EPA 350.1
TKN
6.81 mg/L
6/13/23
0.20 mg/L
EPA 351.2
Nitrite/Nitrate, Nitrogen
<0.10 mg/L
6/9/23
0.10 mg/L
EPA 353.2
Nitrate, Nitrogen
<0.10 mg/L
6/9/23
0.10 mg/L
EPA 353.2
Nitrogen, total
6.81 mg/L
6/13/23
0.20 mg/L
EPA 353.2
Phosphorus, total
4.20 mg/L
6/12/23
0.020 mg/L
EPA 200.7
Fecal Coliform
<4 CFU/100 ml
6/7/23
4 CFU/100 m
SM 9222 D
pH
8.98 S.U.
6/7/23
1.0 - 14.0 S.U.
SM 4500-HB
Meritech Work Order #
060723150 Sample: MW #1 Grab
6/7/23
Parameters
Result
Analysis Date
Reporting Limit
Method
Total Dissolved Solids
25 mg/L
6/8/23
10 mg/L
SM 2540C
Chloride
4.0 mg/L
6/13/23
0.5 mg/L
SM 4500 Cl B
Ammonia, Nitrogen
<0.1 mg/L
6/8/23
0.1 mg/L
EPA 350.1
Nitrate, Nitrogen
0.72 mg/L
6/9/23
0.10 mg/L
EPA 353.2
Phosphorus, total
0.031 mg/L
6/12/23
0.020 mg/L
EPA 200.7
Fecal Coliform
<1 CFU/100 ml
6/7/23
1 CFU/100 m'
SM 9222 D
TOC
<1.00 mg/L
6/9/23
1.00 mg/L
SM 5310C
pH
4.77 S.U.
6/7/23
1.0 - 14.0 S.U.
SM 4500-HB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
r
7
Contact: Janet Parrott Page 2
Client: Town of Stovall Report Date: 6/16/2023
P.O. Box 100
Stovall, NC 27582
Date Sample Rcvd: 6/7/2023
Meritech Work Order # 060723151
Sample: MW #2 Grab
FAMMCWE 6/7/23
Result Analssis Da P Re_ nortln� imi
Total Dissolved Solids method
Chloride 49 mg/L 6/8/23
15.0 mg/L 10 mg/L SM 2540C
Ammonia, Nitrogen < 6/13/23 0.5 mg/L SM 4500 Cl B
Nitrate, Nitrogen 0.1 mg/L 6/8/23
0.45 mg/L 0.1 mg/L EPA 350.1
Phosphorus, total 6/9/23 0.10 mg/L EPA 353.2
Fecal Coliform 0.047 mg/L 6 12 23
TOC <1 CFU/100 ml 6/7/23 0.020 mg/L EPA 200.7
<1.00 mg/L 6 23 1 CFU/100 m SM 9222 D
9
pH 5.05 S,U. / / 1.00 mg/L SM 5310C
6/7/23 1.0 - 14.0 S.U. SM 4500-HB
Meritech Work Order # 060723152
Sample: MW #3 Grab
Parameter 6/7/23
�� Analy i Date geoo in�Limit
Total Dissolved Solids od Meth
Chloride 21 mg/L 6/8/23
4.0 mg/L 10 mg/L SM 2540C
Ammonia, Nitrogen < 6/13/23 0.5 mg/L SM 4500 Cl B
Nitrate, Nitrogen 0-1 mg/L 6/8/23
<0.10 mg/L 0.1 mg/L EPA 350.1
Phosphorus, total 6/9/23 0.10 mg/L EPA 353.2
Fecal Coliform 0.036 mg/L 6/12 23
Fecal
<1 CFU/100 ml 6/ 2/ 3 0.020 mg/L EPA 200.7
<1.00 mg/L 6 9 23 1 CFU/100 m SM 9222 D
pH 5.02 S.U. 1.00 6/7/23 1.0 - 14.0 S.U. SM 5310C
SM 4500-HB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.(336)342_1522

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Page 3
Contact: Janet Parrott
Report Date:
6/16/2023
Client: Town of Stovall
P.O. Box 100
Stovall, NC 27582
Date Sample Rcvd:
6/7/2023
Meritech Work Order # 060723153 Sample: MW #4 Grab
Parameters Result Analysis Date
Reporting Limit
6/7/23
Method
Total Dissolved Solids
26 mg/L
6/8/23
10 mg/L
SM 2540C
Chloride
3.0 mg/L
6/13/23
0.5 mg/L
SM 4500 Cl B
Ammonia, Nitrogen
<0.1 mg/L
6/8/23
0.1 mg/L
EPA 350.1
Nitrate, Nitrogen
0.28 mg/L
6/9/23
0.10 mg/L
EPA 353.2
Phosphorus, total
<0.020 mg/L
6/15/23
0.020 mg/L
EPA 200.7
Fecal Coliform
<1 CFU/100 ml
6/7/23
1 CFU/100 m.
SM 9222 D
TOC
<1.00 mg/L
6/9/23
1.00 mg/L
SM 5310C
pH
5.40 S.U.
6/7/23
1-14 SU
SM4500H+B
I hereby certify that 1 have reviewed and approve these data.[�nrtCi��lt-oe.��
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

ustody Record (COC)
MERITECH INC.
NPDES #:
rReidsville,
Environmental Laboratories
Client: Town OF Stovall Phone: [phone]
--
Division of Water Technology and Control, Inc.
Fax:
Address: PO BOX 1OOEmail:
ne 1-336-342-4748
107 Main ST Project:
Stoval,NC 27582
1-336-342-1522
Po#:
Email: wtclab(cDbellsouth.net
Turn Around Time"
Attention: Janet Parrott
Web Site: www.meritech-labs.com
Std (10 days) 3 - 5 Day 24 - 48 Hr
Sample
Sampling Dates & Times
Person Taking Sample (Signature): Lab Use Only
Location/ID #
START END
Comp?
Date Time Date Time
#of
Grab? Conts. Tests Required On pH OK?
Effluent
, ,�, 13Q�
Ice? c,soK?
_ 'A
G BOD/TSS,TDS,Chloride,NH3,Ntot, N� ;
f
Ptot,Fecal Coliform, pH::'
M W #1
G TDS,Chloride,T0C,NH3,NO3,Ptot
Fecal Coliform, pH=
MW#2
J(J34—
G
TDS,Chloride,TOC,NH3,NO3,Ptot M
Fecal Coliform, pH= O
MW#3
G TDS,Chloride,TOC,NH3,NO3,Ptot
Fecal Coliform, pH= -�), C
MW#4
TDS,Chloride,TOC,NH3,NO3,Ptot
Fecal Coliform, pH=
Comments:
Method of Shipment:
pH should be done on site
El UPS
Will these results be used for regulatory purposes?
Fed Ex
'fJ
Yes No
H rk usi be approved prior to submitting samples.
Relinquishe#b�
Delivery ` L 1
Recei by:Hand
%� Dat TimeR
/, 4'° ecRelinquisheOate:
shl:Time:
Recel ed by:®Other_ Date:Time:
Time: Referved at lab by: gate: Time:
Sill /
: