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HomeMy WebLinkAboutWQ0001048_2023 Residual Annual Report_20240215 (2)Initial Review Reviewer nathaniel.thorn burg Is this submittal an application? (Excluding additional information.) * Yes No If not an application what is the submittal type?* Annual Report Residual Annual Report Additional Information Other Annual Report Year* 2023 Permit Number (IR) * W00001048 Applicant/Permittee Contentnea Metropolitan Sewerage District Email Notifications Does this need review by the hydrogeologist? * Yes OO No Regional Office Washington CO Reviewer Admin Reviewer Wanda Gerald Submittal Form Project Contact Information Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence. Name* Chuck Smithwick Email Address* cmsdlOO@embarqmail.com Project Information ......................... Application/Document Type* New (Fee Required) Modification - Major (Fee Required) Renewal with Major Modification (Fee Required) Annual Report Additional Information Other Phone Number* 2524138898 Modification - Minor Renewal GW-59, NDMR, NDMLR, NDAR-1, N DAR-2 Residual Annual Report Change of Ownership We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form. https://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report Permit Type:* Wastewater Irrigation High -Rate Infiltration Other Wastewater Reclaimed Water Closed -Loop Recycle Residuals Single -Family Residence Wastewater Other Irrigation Permit Number:* WQ0001048 Has Current Existing permit number Applicant/Permittee Address* 900 Wiley Gaskins Road Facility Name* Contentnea MSD Class B Residuals Program Please provide comments/notes on your current submittal below. Annual Sludge Application Report At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg at nathaniel.thornburg@ncdenr.gov. Please attach all information required or requested for this submittal to be reviewed here. (Application Form, Engineering Plans, Specifications, Calculations, Etc.) 20240215111051198.pdf 8.06MB Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger than upload limit. * By checking this box, I acknowledge that I understand the application will not be accepted for pre -review until the fee (if required) has been received by the Non -Discharge Branch. Application fees must be submitted by check or money order and made payable to the North Carolina Department of Environmental Quality (NCDEQ). I also confirm that the uploaded document is a single PDF with all parts of the application in correct order (as specified by the application). Mail payment to: NCDEQ — Division of Water Resources Attn: Non -Discharge Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Signature Submission Date 2/15/2024 ANNUAL LAND APPLICATION CERTIFICATION FORM WQ Permit##: ix =JCfl2 County: . �+ Year: &)n Facility Name (as shown on permit): rnn4M4neq=rf&D Land Application Operator: d M- W1t.J! Phone: -62a `, C Land application of residuals as allowed by the permit occurred during the past calendar year? .4 Yes ❑ No - If No, skip Part A, and Part B and proceed to Part C. Also, If residuals were generated but not land applied, please attach an explanation on how the residuals were handled. ID ,,.F A A""1;Paf;nn Cnmmarv' Total number of application fields in thepermit: Total number of fields utilized for land application during the year: Total amount of dry tons applied during the year for all application sites: L) g Total number of acres utilizes for land application during the year: 649 HD Part B - Annual Com iance Statement: Facility was compliant during calendar year gn ^ with all conditions of the land application permit (including but not limited to items 1-13 below) issued by the Division of Water Resources. ❑ Yes Y1 No If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action taken. 1) only residuals approved for this permit were applied to the permitted sites. 2) Soil pH was adjusted as specified in the permit and lime was applied (if needed) to achieve a soil pH of at least 6.0 or the limit specified in the permit. 3) Annual soils analysis were performed on each site receiving residuals during the past calendar year and three (3) copies of laboratory results are attached. 4) Annual TCLP analysis (if required) was performed and three (3) copies of certified laboratory results are; attached. 5) All other monitoring was performed in accordance with the permit and reported during the year as required and three (3) copies of certified laboratory results are attached. 6) The facility did not exceed any of the Pollutant Concentration Limits in 15A NCAC 02T .1105(a) or the Pollutant Loading Rates in 15A NCAC 02T .1105(b) (applicable to 40 CFR Part 503 regulated facilities). 7) All general requirements in as specified in the Land Application Permit were complied with (applicable to 40 CFR Part 503 regulated facilities). 8) All monitoring and reporting requirements in 15A NCAC 02T .1111 were complied with (applicable to 40 CFR Part 503 regulated facilities). 9) All operations and maintenance requirements in the permit were complied with or, in the case of a deviation, prior authorization was received from the Division of Water Resources. 10) No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of violations are attached to include appropriate actions and remediations. 11) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as specified in the permit. 12) No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred, ed, 13) All buffer requirements as specified on the permit were maintained during each application of residuals. Part C - Certification: "I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." CT--adb-rf)-,6rnW-hk 41, Permittee Na ane and Title (type dr print) I Signature of Permittee Date Signature of Preparer* Date Signature of Land Applier Date (if different from Permittee) (if different from Permittee and Preparer) * Preparer is defined in 40 CFR Part 503.9 (r) and 15A NCAC 02T .1102 (26) DENR FORM ACF (1212006) EXPLANATIONS FOR DEVIATIONS FOR THE 2023 ANNUAL SLUDGE LAND APPLICATION REPORT 10-18-23 Monitoring Well #9 Ammonia Nitrogen 1.67 mg/L 10-18-23 Monitoring Well #15 Total Organic Carbon 13.79 mg/L Monitoring Well #15 Total Chromium 12 ug/L The TOC levels naturally run higher in this area. As cited in the report prepared by Groundwater Management Associates, Inc. in July, 2019 the higher Chromium concentrations are most likely associated with the higher turbidity in the samples. NCDWR-WRO is aware of these violations. The lime was applied in January, 2023 based on the soil samples that were collected in December, 2022. Please reference the enclosed map for lime application rates. The soil samples were not collected during 2023 as an oversight. The soil samples were collected in early 2024 and lime will be applied accordingly. Soil samples will be collected again late 2024 to meet the monitoring requirements for this year. a 0 b co ED m z 0 0 -n N N O O O W 0 � b o � ro CD 0 �� F W C CD ro n p ro 0 '0 p7 0 rn rS ',zs cpo m add CD p o p CD o � CV p R. � n o ^w w ,co, O � � G `Y O ID � p 0 o� �o b� a s� n pj rho �' z f p ro CO CDID A CD n ro L5 v rw�l lid a. (D a ro rr, r•i� O � � � � C d r It w a P- rn-r O o Co 6 ro " �" F1 n o cn CD � c o Q. CP RESIDUAL SAMPLING SUMMARY AND LAB REPORT'S e^•1 f�� M dam" Ef I a p Wk MIA C� Y II II I� 1� WayPA®ant, NALYTICAL 114 OAKMONT DRIVE GREENVILLE, NC 27858 CMSD (SLUDGE & WELLS ACCT) CONTEDITNEA METRO. SEWAGE DIST. MS. RENEE PRIDUSN P.O. BOX 477 GRI.FTON, NC 28530 PARAMETERS PH (not to be used for reporting) Aluminum, (dry wt. basis), mg/Itg Arsenic (dry wt. basis), mg/kg Calcium (dry wt, basis), mg/kg Cadmium (dry wt. basis), mg/kg Copper (dry wt, basis), mg/kg Chromium, T.(dry wt, basis),ing/kg Lead (dry weight basis), mg/kg Magnesium (dry wt. basis), mg/kg Mercury (dry wt, basis), mg/kg ]Nickel (dry wt, basis), mglkg Potassium (dry wt. basis), mg/kg Seleninm (dry wt. basis), mg/kg Sodium (dry wt. basis), nig/Ug Zinc (dry wt. basis), mg/kg Sodium Adsorption Ratio (Cale) Total Nitrogen, mg/kg (Cale) Total Solids, % TKN (dry wt.), mg/leg Ammonia Nitrogen (dry wt.),mglkg Nitrate Nitrogen(dry wt.), mg/kg Nitrite Nitrogen(dry wt.), niglkg Phosphorus, T. (dry wt.), mg/kg Molybdenum (dry wt. basis), mg/kg Sludge Analysis Method Sample Date Analyst Code 4.1 05/16/23 JDJ 4500HB-11 18620 05/23/23 MTM EPA200.7 C 2.5 05/24/23 DRC 3113B-04 18035 05/23/23 MTM EPA200.7 2.0 05/24/23 DRC 3113E-04 244 05/23/23 MTM EPA200.7 19 05/23/23 MTM EPA200.7 17 05/23/23 DRC 3113E-04 7650 05/23/23 MTM EPA200.7 0.29 05/26/23 DRC EPA7471B 21 05/23/23 MTM EPA200.7 11454 05/23/23 MTM EPA200.7 C 5.0 05/25/23 DRC 3113B-04 3635 05/23/23 MTM EPA200.7 932 05/23/23 MTM EPA200.7 5.7 74403 1.63 05/16/23 HMV 254OG-15 c 60960 05/23/23 BMD 351.2 112-93 C 4870 05/22/23 AMC 350.1 R2-93 c 13430 05/23/23 TRJ 353.2 R2-93 c t2.95 05/23/23 TRJ 353.2 R2-93 c $2010 05/23/23 AMC 365.4-74 9.0 05/23/23 MTM EPA200.7 Drinking Water IDr 37715 Wastewater ID! 10 PHONE (252) 756-6208 FAX (252) 756-0633 ID# : 41.6 DATE COLLECTED: 05/1.6/23 DATE REPORTED : 06/08/23 REVIEWED BY: c Uncertified data, ❑WR does not offer non -aqueous certification for this analytical procedure. In Orlando, FL The results set forth herein are provided. by SGS Nortli America I€tc. Technical Report for Waypoint Analytical Contentnea Metro Sewage District; Grifton, NC 416 SGS Job Number: FC6581 Sampling Date: 05/30/23 Report to: Environment 1, inc PO Box 7085 Greenville, NC 27835 abaynor@wpacorp.com TTN: Ann Brown Total number of pages in report: 15 Test results contained within this data package meet the requirements of the National Environmental Laboratory Accredltation Program and/or state specific certification programs as applicable unless noted in the narrative, comments or footnotes. e-Hardc opy 2. 0 ff utowated Report Norm Farmer Technical Director Client Service contact: Ariel Hartney 407-425-6700 Certifications: FL(EB3510), LA(03051), KS(E-10327), NC(573), N7(FL002), NY(12022), SC(96038001) DoD ELAP(ANAB L2229), AZ(AZ0806), CA(2937), TX(T104704404), PA(68-03573), VA(460177), AL, AK, AR, CT, IA, KY, MA, MI, MS, ND, NH, NV, OK, OR, IL, UT, VT, WA, WI, WV This report shall not be reproduced, except in its entirety, without die written approval of SGS. Test results relate only to samples analyzed. SGS North America Inc. + 4405 Vineland Road + Suite C-15 + Orlando, FL 32811 + tel: 407-425-6700 + SCiS is the snlc audutrity for ettidtot'iz.ing flits +� modifications to this docurnent, Pleuse shave your ideas about Unuutlrorized mcKlitication ofthis repuvt is strictly prohibited, how wlc ccut serve you flutter at: 1f.etiet� standcttrl terms:tt: 1tttPJ?aevttisgs.corn:en?leans-asid-conditin ns l.f{S.LS.(::u5lct�xeri aFc(zr;tts,cot}t 1 of 15 rceW Sections:T of tents 3 Section 1: Sample Summary ........ ............. 4 Section2: Summary of Hits.................................................................................................... Section 3: Sample Results .............p 6 3.1 FC65 S 1-1: SLUDGE SAMPLE ..... o....................1.....................................¢ ............... 1.2 Section 4: Misc. Forms .......................................................................... .................................. 4.1: Chain of Custody........................................................................................................... 13 2of15 �css�a SGS North America Inc. Sample Summary Way -point Analytical Contentnea Metro Sewage District, Grifton, NC Project No: 416 Job No: FC6581 Sample Collected Matrix Client Number Date Time By Received Code Type Sample ID This report contains results reported as ND Not detected. The following apples Organics ND = Not detected above the MDL FC6581-1 05/30/23 10:00 AE 06/02/23 SO Sludge SLUDGE SAMPLE Soil samples reported on a dry weight basis unless otherwise indicated on result page. - 3of45 — ..,. FUS81 Summary of Hits Page 1 of 1 Job Dumber: FC6581 Account: Waypoint Analytical Project: Contentnea Metro Sewage Dish�ict; Grifton, NC Collected: 05/30/23 Lab Sample ID Client Sample ID Result/ Analyte Qual RL MDL Units Method FC6581-1 SLUDGE SAMPLE Corrosivity as pH 4.0 su Ignitability (Flashpoint) a > 200 Deg. F (a) Not ignitable. SW846 CHAP? SW846 1020C MOD 4ot15 FC66S9 'la"ILS 12 7 70.�E-'! Orlando, FL Sample Results Report of Analysis I 5 of 46 FC6561 SGS North America Inc. Report Of Analysis Client Sample ID: SLUDGE SAMPLE Lab Sample ID: FC6581-1 Date Sampled: 05/30/23 Matrix: SO - Sludge Date Received: 06/02/23 Method: SW846 8260D IN HOUSE Percent Solids: 1.5 Project: Contentnea Metro Sewage District; Grifton, NC Page 1 of 1 File ID DF Analyzed By Prep Date Prep Batch Analytical Batch Run #1 5E40169.D 10 06/13/23 14:46 JL 06/12/23 12:00 OP97298 V5E1794 Run #2 Purge Volume Run #1 5.0 ml Run #2 VOA TCLP List CAS No. Compound 71-43-2 Benzene 78-93-3 2-Butanone (MEK) 56-23-5 Carbon Tetrachloride 108-90-7 Chlorobenzene 67-66-3 Chloroform 106-46-7 1,4-Dichlorobenzene 107-06-2 1,2-Dichloroethane 75-35-4 1,1-Dichloroethylene 127-18-4 Tetrachloroethylene 79-01-6 Trichloroethylene 75-01-4 Vinyl Chloride CAS No. Surrogate Recoveries 1868-53-7 Dibromofluoromethane 17060-07-0 1,2-Dichloroethane-D4 2037-26-5 Toluene-D8 460-00-4 4-Bromolluorobenzene Result HW# MCL RL ND D018 0.50 0.010 ND D035 200 0.050 ND D019 0.50 0.010 ND D021 100 0.010 ND D022 6.0 0.010 ND D027 7.5 0.010 ND D028 0.50 0.010 ND D029 0.70 0.010 ND D039 0.70 0.010 ND D040 0.50 0.010 ND D043 0.20 0.010 Run# 1 Run# 2 Limits 98% 83-118% 94% 79-125% 95% 85-112% 100% 83-118% TCLP Leachate method SW846 1311 MDL Units Q 0.0031 mg/l 0.020 mg/l 0.0036 mg/l 0.0020 mg/l 0,0030 mg/l 0.0026 mg/1 0.0031 mg/l 0,0032 mg/I 0.0022 mg/1 0.0035 mg/l 0.0041 mg/1 ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value MCL = Maximum Contamination Level (40 CFR 261 7/1/11) B = Indicates analyte found in associated method blank E = Indicates value exceeds calibration range N - Indicates presumptive evidence of a compound 6of15 __. ;_.. FC6501 SGS North America Inc. Report of Analysis Client Sample ID: SLUDGE SAMPLE Lab Sample ID: FC6581-1 Date Sampled: 05/30/23 Matrix: SO - Sludge Date Received: 06/02/23 Method: SW846 8270E SW846 3510C Percent Solids: 1.5 Project: Contentnea Metro Sewage District; Grifton, NC Page 1 of 1 P � Is File ID DF Analyzed By Prep Date Prep Batch Analytical Batch Run #1 X087374.1) 1 06/19/23 11:42 HA 06/17/23 07:00 OP97389 SX3465 Run #2 Initial Volume Final Volume Run #1 100 ml 1.0 ml Run #2 ABN TCLP List CAS No. Compound Result HW# MCL RL 95-48-7 2-Methylphenol ND D023 200 0.050 3&4-Methylphenol ND D024 200 0.050 87-86-5 Pentachlorophenol ND D037 100 0.25 95-95-4 2,4,5-TrichlorophenoI ND D041 400 0.050 88-06-2 2,4,6-Trichlorophenol ND D042 2.0 0.050 106-46-7 1,4-Dichlorobenzene ND D027 7.5 0.050 121-14-2 2,4-Dinitrotoluene ND D030 0.13 0.050 118-74-1 Hexachlorobenzene ND D032 0.13 0.050 87-68-3 Hexachlorobutadiene ND D033 0.50 0.050 67-72-1 Hexachloroethane ND D034 3.0 0.050 98-95-3 Nitrobenzene ND D036 2.0 0.050 110-86-1 Pyridine ND D038 5.0 0.10 CAS No. Surrogate Recoveries Run# 1 Run# 2 Limits 367-12-4 2-Fluorophenol 32% 14-67% 4165-62-2 Phenol-d5 24% 10-50% 118-79-6 2,4,6-Tribromophenol 63% 33-118% 4165-60-0 Nitrobenzene-6 54% 42-108% 321-60-8 2-Fluorobiphenyl 62% 40-106% 1718-51-0 Terphenyl-d14 70% 39-121% TCLP Leachate method SW8461311 MDL Units Q 0,0056 mg/l 0.0098 mg/1 0.050 mg/1 0.0074 mg/1 0.0075 mg/1 0.0050 mg/l 0.0081 mg/1 0.0069 mg/l 0.0050 mg/1 0.016 mg/i 0.0093 mgA 0.020 mg/1 ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value MCL = Maximum Contamination Level (40 CFR 2617/1/11) B = Indicates analyte found in associated method blank E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound _. 7of15 FC6531 SGS North America Inc. Report of Analysis Client Sample ID: SLUDGE SAMPLE Lab Sample ID: FC6581-1 Date Sampled: 05/30/23 Matrix: SO - Sludge Date Received: 06/02/23 Method: SW846 8151A SW846 3510C Percent Solids: 1.5 Project: Contentnea Metro Sewage District; Grifton, NC Page 1 of 1 File ID DF Analyzed By Prep Date Prep Batch Analytical Batch Run #1 CC090380.1) 1 06/21/23 16:36 AF 06/17/23 09:00 OP97390 GCC2371 Run #2 Initial Volume Final Volume [in #1 10.0 ml 5.0 Jul Lin #2 Herbicide TCLP List TCLP Leachate method SW846 1311 CAS No. Compound Result HW# MCL RL MDL Units Q 94-75-7 2,4-D ND D016 10 0.050 0.017 mg/l 93-72-1 2,4,5-TP (Silvex) ND D017 1.0 0.0050 0.0013 mg/l CAS No. Surrogate Recoveries Run# 1 Run# 2 Limits 19719-28-9 2,4-DCAA 79% 39-135% ND = Not detected MDL = Method Detection Limit 1 = Indicates an estimated value MCL = Maximum Contamination Level (40 CIiR 261 7/1/11) B = Indicates analyte found in associated method blank E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound 8of15 MOW SGS North America Inc. Report of Analysis Client Sample ID: SLUDGE SAMPLE Lab Sample ID: FC6581-1 Date Sampled: 05/30/23 Matrix: SO - Sludge Date Received: 06/02/23 Method: SW846 8091E SW846 3510C Percent Solids: 1.5 Project: Contentnea Metro Sewage District, Grifton, NC Page 1 of 1 5A File ID DP Analyzed By Prep Date Prep Batch Analytical Batch Run #1 ST167645.1) 1 06/20/23 22:23 EM 06/17/23 08:30 OP97392 GST4102 Run #2 Initial Volume Final Volume Run #1 100 ml 5.0 ml Run #2 Pesticide TCLP List CAS No. Compound 58-89-9 gamma-BHC (Lindane) 12789-03-6 Chlordane 72-20-8 Endrin 76-44-8 Heptachlor 1024-57-3 Heptachlor epoxide 72-43-5 Methoxychlor 8001-35-2 Toxaphene CAS No. Surrogate Recoveries 877-09-8 Tetrachloro-m-xylene 2051-24-3 Decachlorobiphenyl TCLP Leachate method SW846 1311 Result HW# MCL RL MDL Units Q ND D013 0.40 0.00010 0.000022 mg/l ND D020 0.030 0.0010 0,00038 mg/1 ND D012 0.020 0.00020 0.000021 m9/1 ND D031 0.0080 0.00010 0.000026 mg/1 ND D031 0.0080 0.00010 0.000020 mg/i ND D014 10 0.00020 0.000050 mg/1 ND D015 0.50 0.0050 0.0021 mg/I Run# 1 Run# 2 Limits 866/6 42-127% 85% 27-127% ND = Not detected MDL = Method Detection Limit d = Indicates an estimated value MCL = Maximum Contamination Level (40 CFR 261 7/1/11) B — Indicates analyte found in associated method blank E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound -- - 5of15 ' K6581 SGS North America Inc. Report of Analysis Client Sample 111): SLUDGE SAMPLE Lab Sample ID: FC6581-1 Date Sampled: 05/30/23 Matrix: SO -Sludge Date Received: 06/02/23 Percent Solids: 1.5 Project: Contentnea Metro Sewage District; Gri€ton, NC Page 1 of Metals Analysis, TCLP Leachate SW846 1311 Analyte Result HW# MCL RL Units DF Prep Analyzed By Method Prep Method Arsenic < 0.10 D004 5.0 0.10 mg/l 1 06/15/23 06/16/23 LM SW846 6010D 2 SW846 3010A 4 Barium < 2.0 I1005 100 2.0 mg/l 1 06/15/23 06/16/23 LM SW846 6010D 2 SW846 3010A 4 Cadmium < 0.050 D006 1.0 0.050 mg/1 1 06/15/23 06/16/23 LM SW846 6010D 2 SW846 3010A 4 Chromium < 0.10 D007 5.0 0.10 mg/I 1 06/15/23 06/16/23 LM SW846 6010D 2 SW846 3010A 4 Lead < 0.050 D008 5.0 0.050 mg/1 1 06/15/23 06/16/23 LM SW846 6010D 2 SW846 3010A 4 Mercury < 0.0050 D009 0.20 0.0050 mg/1 1 06/15/23 06/15/23 is SW846 7470A 1 SW846 7470A 3 Selenium < 0.10 D010 1.0 0.10 mg/I 1 06/15/23 06/16/23 LM SW846 6010D 2 SW846 3010A 4 Silver < 0.10 D011 5.0 0.10 mg/I 1 06/15/23 06/16/23 LM SW846 6010D 2 SW846 3010A 4 (1) Instrument QC Batch: MA19487 (2) Instrument QC Batch: MA19490 (3) Prep QC Batch: MP42389 (4) Prep QC Batch: MP42391 RL = Reporting Limit MCL = Maximum Contamination Level (40 CFR 261 7/1/11) - .GS . 10 of 16 FC6581 SGS North America Inc. Report of Analysis Client Sample ID: SLUDGE SAMPLE Lab Sample 10: FC6581-1 Date Sampled: 05/30/23 Matrix: SO - Sludge Date Received: 06/02/23 Percent Solids: 1.5 Project: Contentnea Metro Sewage District; Grifton, NC Page 1 of 1 General Chemistry Analyte Result RL Units DF Analyzed By Method Corrosivity as pH 4.0 su 1 06/07/23 14:47 CC SW846 CHAP7 Cyanide, Total < 8.0 8.0 mg/kg 1 06/13/23 11:53 GT SW846 9012B ignitabtlity (Flashpoint) a > 200 Deg. F 1 06/05/23 09:49 CC SW846 1020C MOD Solids, Percent 1.5 % 1 06/08/23 12:28 GT SM19 2540G Sulfide b < 13000 13000 mg/kg 1 06/14/23 11:50 ST SM4500S2- F-11 M (a) Not ignitable. (b) Elevated detection limit due to matrix interference. Manually elevated. RL = Reporting Limit 11 of 15 FG55F3 i Misc. Forms Custody Documents and Other Forms Includes the following where applicable: • Chain of Custody Section 4 1� _._... 12 of 15 FUS81 Waypofn t Wnypoint Analyticul - Greenville CHAIN OF CUSTODY RECORD FM 16r f i Page I of 1 114 Oakmont Dr. Greenville, NC 27858 OISINFBCTtON CHLORINE NELI'MUZEDAT COLLECTION www.W aypoin€Analydcol.com Phone (252) 756-6208 - Fax (252) 756-0633 ❑ CHLORINE CLIENT. 416 Week:16 uV pHCHECKW) CMSD (SLUDGE & WELLS ACC'O I f c G GMAINERTYPUM CONTENTNRA \iETRO. SEWAGE DIST, ❑ NONE CHEMICALPRESEIT1+ATi0N ,Nf5. RENEE PRIDGEN P.O. BOX 417 ❑ GRIFTON NC 28530 E A -NONE D-NAOH (zsx) 51 t Ss843 B-HNO, E-HCL aJ. P1 0-14,60r F-ANCACETATElNAON COLLECTION 4 ¢ $ G-NATHOSULFATE a SAMPLELOCATION ©ATE TIME Sludge SampleOR C{ASS)FICATION C❑ WASTEWATER{NPOES) ❑ COWNOWATER r ❑ DWR(GW SW WE ff ❑ SWDWASTESECTION tAl EL Y RIFI AYl N CHAIN OF CUSTODY (SEAL) MAINTAINED OuRIH MENTIOELIVERY Y N SAMPLES COLLECTEta BY: T�E (Pease P)NQ1 ] 4416.1L ds d€lfrr SAMPLES RECEIVED IN LABAT..- J�.°C li SFIEDBY S .I( ER) DATERiM�E� RECE EDIiY SK3. TEIOME COMMENTS: 44 T3ELWQVISHEDBY(SIG.) BY{slts.) Id n . PO r Iztn I c�fo02 2 EDBY(sq OATEIIIME N Y{SIG.) TE711ME 4 A / , Coma€or ue1 n!Re a "f.` far emm�nslla sample ar a "G" far PLEASE READ tnsfructians for camp eiing t ar E e rvers e, n FORM se -... Grab sample in the blacks above for ouch parameter requested. iv 421846 F C.6581: Chain of Custody y Page 1 of 3 13 of 15 FC6se1 SGS Sample Receipt Summary Job Number: FC6581 Client: WAYPOINT Project: CMSD (SLUDGE & WELLS ACCT) Elate f Time Received: 612/2023 10:00:00 AM Delivery Method: FX Alrbili #'s: 638072848109 Therm ID: IR 1; Therm CF: -0.1; # of Coolers: 1 Cooler Temps (Raw Measured) °C: Cooler 1: (4.0); Cooler Temps (Corrected) °C: Cooler 1! (3.9); Cooler Information Y or N Samole Information Y or €y NIA 1, Custody Seals Present R/I ❑ 1. Sample labels present on bottles W ❑ 2. Custody Seals Intact W) ❑ 2. Samples preserved properly W ❑ 3. Temp criteria achieved G ❑ 3. Sufficient volumelcontainers recvd for analysis: 1 ❑ 4. Cooler temp verification [R Gun 4. Condition of sample I to S. Cooler media Ice.Ba 5. Sample recvd within HT R ❑ 6. DatesrilmesllDs on CCC match Sample Label W Trio Blank Information Y or N NIA 7. VOCs have headspace ❑ ❑ 91 1. Trip Blank present f cooler ❑ ❑ E/1 8. Bottles received for unspecified tests ❑ ❑� 2. Trip Blank listed on COG ❑ ❑ A 9. Composiling instructions clear ❑ ❑ W S NIA 10. Voa Soil Ki€sldars received past 48hrs? El{❑ or 11. %Solids Jar received? ❑ ❑ 0 3, Type Of TB Received ❑ ❑ F/I 12. Residual Chlorine Present? ❑ ❑ ❑� Misc. Information Number of Encores: 25-Gram 5-Gram Number of 5035 Field Kfls: Numbef of Lab Filtered Metals: Test Strip Lot fts: pH 0-3 J 230320 pH 10-12 Other: (Specify) H 1�0 - 12.0 222221 Residual Chlorine Test Strip Lot M Comments Wool Technician: NATHANS Date: 612/2023 10:00:00 AM R.Y. Date OW24111 Reviewer: Date: FC6581: Chain of Custody Page 2 of 3 14 of 15 F06581 Job Change Order: Requested Dale: 6/8/2023 Received Date: Account Name: Waypoint Analytical Due Date: Project Description; Contentnea Metro Sewage District; Grifton, NC Deliverable: CSR: AH TAT (Days): Sample #: FC6581-1 Change: Dept: Analyze total CN and S for reactivity TAT: 7 SLUDGE SAMPLE. Above Changes Per: Client FC6581 602023 611612023 COMMA 7 Dateliime: 618/2023 9:25:04 PM To Client: This Change Order Is confirmation of the revisions, previously discussed with the Client Service Representative, Page t of 1 1<C6551: Chain of Custody Page 3 of 3 16 of 16 FC6581 ro n n. m70 n O rn O C'E 8 z z z rn .• Ret � td 7tl r t� co trJ n w 00Fn e �x1 °c �o�COrt �r� cn N 0 Z rs dp Ci:cii w �' o CIO. 97 o0 F Qn ow m rn am � � z Q m M m �10 TOTAL CHLORINE, mg/I C7 v� _ OR ug/I AT COLLECTION m o C Rs TEMPERATURE,°C T S� AT COLLECTION o z # OF CONTAINERS f m m m 4i; O K t•. `.. V ► mm 1 � N W 1 n PARAMETERS/TESTS o _ L L Li� z o z x u' � o m z r m A m ri m �� F z rn 0 n O O m m "' m C) � j �7 [rp" Z _ 0 m m 0 C co � x a -n- t' m `r m cni 1 M � zz Cn < z (f m O b as O h r u t 4 d di N � O Fa � U r a Z Z 2 R. N y —s GLatc� a try � } �� Q Q aell r� w� Q o C6 O co Q � � Cd % O U N o Q 14 o� s P�- P, P. 0 CD 0 N c� u„ LPL 0 z w n ANNUAL METALS FIELD LOADING SUMMARY FOR" Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: f Total Dry Tons Applied (Annual): 7, nZ Permit #: 6A=Ickjq Cation Exchange Capacity (non 503 only): rj Operator: tnw l n-6mi dC,�`jr. Owner: -U)4p��i7 Predominant Soil Series: 6ff)(� Acres Used: �_. S q Acres Permitted: _ -, qt f Site #: 3 Field #: j Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sainple or Com- posite Date 1 2 6I Z5 3 4 5 6 7 8 9 10 LJ 11 12 % Solids j - j j _ -;5t Arsenic CZ.1J Cadmiwn Z G Z Copper ZQ-q Chromiwn G 1 Ci Lead 1-1 Mercwy Molyb- denum �' d Nickel Zl -Zi Selenium . Q 65 D Zinc a 37— G3Z Total Phos- horus 57610 1 5Za+ o Annual Heavy Metal Field Loadings (Calculated in lbs/acre): 1 Event App- MEN NONE, ®• I �6�_______�� NOW 1 �11 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel property gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Sigi.ature of Land Applier Date DENR FORM MFLSF (12/2006) W cv 0 U U3 Ps N rn tj aG c©� wU U 7 Id V� 9 s. al Y- Cd 0 1 "d, � k 0 m , U Cd W U O O Caw ,L.i U Qi 4 d �i- q ` d ac 0 x- Z 0 a (V (V O Li z LU Q ANNUAL METALS FIELD LOADING SUMMARY FORME Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Total Dry Tons Applied (Annual): Permit #: Cation Exchange Capacity (non 503 only): Operator: Owner: ('C,n+epy.(ne#_ r laO Predominant Soil Series: ?Q(I�p�U Acres Used: Z-oz, Acres Permitted: Z_(az Site #: -b Field #: 2. Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Corn- posite Date 1 2 3 4 5 6 7 s 9 10 11 12 % Solids .b'I Arsenic e- <Z. Cadmium 2- D Z. Copper Lqa /-44 chrom! le7 Gl Lead 1�) 0 Mercury 0, Tq D. z Molyb- denrux ct • D 61, D Nickel Z! V Selenium 5, D <�5B zhic q &z a -&z Total Phos- lror•us 162016 1 5W10 Annual Heavy Metal Field Loadings (Calculated in lbslacre): r I � mom Total Phos- "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for luiowing violations". Signature of Land Applier Date DENR FORM MFLSF (1212006) �_ 0 6 U 41 hil N � YY�ll rn � P-I 2�Yi 1rc V.p y h (D N ry+� v OCOG O O h1j.,jVk (a-}- �1-ca e,. kl7J( Gs JN -v-ax�rtsx � 12 u o x 0 d O p o N (�..� H � U P, P, w 0 0 "a O LL w 0 ANNUAL METALS FIELD LOADING SUMMARY FORM' Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: (Y1>y7 Total Dry Tons Applied (Annual): rf (p,��} Permit #: Cation Exchange Capacity (non 503 only): L115 Operator: ate }�l�cc)iCly /" - Owner: CMVer4nea— I`(I67 Predominant Soil Series: Pbf&nM,q_0 Acres Used: 7_ •'?Z Acres Permitted: V? Z Site #: 3 Field #: 3 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Coin- posite Date 1 6-11:Z3 6-16-43 3 4 5 6 7 8 9 10 11 12 % Solids [. 6`)D Arsenic < Z < Z, 6 Cadinhun Z• Copper 7f (4 ZW4 Chroiniuin I q? ) ri Lead I-1 11 Mercury Q," '1 p, Z5l Molyb- denum q , Nickel Z I ZI Selenium < 5. t) < 5. 6 Zinc 3Z Q �jZ Total Phos- horas 16WI6 162DO Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Event MENEM _ d 00000 00 mom WIRMr • r w MIM "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for luiowing violations". Signature of Land Applier Date ©ENR FORM MFLSF (12/2006) �I SAS N 4< O ff a d) q U a N s� m v p P 51 -Ftii�7F?i3c 041 '7 Gs QIc,P oar U 4f1 4� r� ° r U � N U )2 1 o 0 U � O env r aL 0 . a� Q 9b a 0 N N_ LL L4 Q' 0 z LLJ ANNUAL METALS FIELD LOADING SUMMARY FOR1VV Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: e3_)�neal rn6-j) Total Dry Tons Applied (Annual): Lk (per Permit H. U_)Q0CoL C w+ Cation Exchange Capacity (non 503 only): �. Operator: CiYxcl ,�,5 , c�;T[. Owner: bn�0`4n6JL01`}6-_D Predominant Soil Series: -�u5 Acres Used: �,� tf Acres Permitted: 33- "Zlq Site #: _B Field #• 9 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Com- posite Date 1 2 3 4 5 6 7 B 9 10 11 72 % Solids l-�3`>a �• Arsenic CZ.5 <2,05 Cadmimn Copper I L44 Zak cm'omim-n G G' Lead j Mercwy p.Zcf D. Molyb- denum G G'. D Nickel { Zi Selenium <5. t) <6. D Zinc L -i q3z. Total Phos- hoius 15WI05-W i d Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total© Event• s © © © © f7 © Q7 Total phorus certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". oY Signature of land Applier Date DENR FORM MFLSF (12/2006) i� x N 0 cd ro 2p, U .� R i3 a � o U ��, p o O w Z O (1 OrVO.T � J a� �U ors �rh 0 0 — � O O 0 v7 uz o 04 ANNUAL METALS FIELD LOADING SUMMARY FOR" Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: _L4nPaf),O Total Dry Tons Applied (Annual): Permit ##: o Catr n Exchange Capacity (non 503 only): (_j,• 5 Operator: Owner; (()r)tef 4rxq3- ff6:0 Predominant Soil Acres Used: ;�,�[�. Acres Permitted; 3.7 t-i Site #: ij Field #: Residual Analysis Data (Heavy Metals and Total Phosphorus use mgflcg, % Solids use Raw Percent ft Sample or Com- posite Date 1 2 3 4 5 6 7 8 9 10 11 12 % Solids Arsenic < Cadmium Z- UU Z �% Copper 14 Clu•oznium I q Lead 11 f ~? Mercluy Molyb- denum b Q • b Nickel j Zi Selenium 1 ti5, D Zinc Z 03 z Total Phos- hor is 5-Z;61 0 Lb U Annual Heavy Metal Field Loadings (Calculated in lbs/acre): EventSWAi NONE N "-w ►' r __________ • is "t certity, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for Knowing violations". C -, ,Signature of Land Applier Date DENR FORM MFLSF (12/2006) clq k V N �y cd p y O H V U N � U Y Savo a --.Xi U5 E c] 0 C Al 1 lx c. 0 Q i � F�t 6161 rn ;, b p 49 Q m� r� rw� P4U � o � l Cd o 0 o q cd as Ao� ANNUAL METALS FIELD LOADING SUMMARY FORMV Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: e6n "(7 Total Dry Tons Applied (Annual): . 31Z Permit #: 1.Jnj m 1 g Cation Exchange Capacity (non 503 only): Operator: Ghade)lfl baAua, Owner: ��t� _,( " [7 _ Predominant Soil Series: Acres Used: Ace es Permitted: `7:3 ` Site #: _ (qc4- I[_ Field #: Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/leg, % Solids use Raw Percent #): Sample Or Com- posite ]date 1 ! 3 L3 5 S 7 8 9 10 11 12 % Solids J. f -L5�b Arsenic C v5 Cadmium 2.0 2. D Capper 7 qtp�(( a romirun j C/ 1 a Lead Mercury D.Z� 0• ZC! Molyb- dentun �• !� C(• b Nickel ,Selenium • C7 C . o Zinc Total Phos- honis 7Ofd 010 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): D1 p E vent MOM "I eertiiy, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". 6 /�44 Signature of Land Applier Date DENR FORM MFLSF (12/2006) ANN nj Uc� wbn o U N � w a �N a� boo <) 2h�i� co a� Np N 0 m +n CIO T N pk a Ct) o -0 N P O o 7F m � z �ap� a a LL Ll- CK 0 Z w 0 ANNUAL METALS FIELD LOADING SUMMARY FORA? Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Total Dry Tons Applied (Annual): 9.25Z Permit #: Cation Exchange Capacity (non 503 only): 14- S Operator: ChGE1�5i� �iYl!'1 111�1C�}` K Owner ���/-)e.0—D(j�Predominant Soil Series: AjctoiCL Acres Used: 6.1rj Acres Permitted: ,51 Site #: C-TCac� j Field #: Residual Analysis Data (heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Com- posite Date 1 54 3 2 3 4 5 6 7 8L-9j 110111 12 % Solids 1. � Arsenic < Cadlniuln Z• b Z- 0 2- D Copper 4 Z 4 Z Chromium p c( l ci C Ci Lead t') 1`1 l) Mercury Q, ) O,ZC Q Zr'1 Molyb- demmn q b C.4 Nickel ! DZ4 Selenium <5, d � . d Zinc G3Z G3Z q3z Total Phos- ho111s ZOO 'Szolo 0 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total 1 2 3 4 51 L-6j 8 9 10 11 42 DT/Ac./ App Event C3 Z p,j Cp 0 41OZ d Arsenic C).e >t Cadmium o. UU3 O.W l 0 .t)0 p.Li�Co Copper 0-3� (a p .l")LI 0- L5 Chroinsu 0,05 , 0•UlC4 ov(1 a•C> Lead p.b D.o1Z c)-a t, a+ �� Merew-Y 0-boo 0,0b0 10.UDO 6.wo Molyb- denurn 0,019 0.61) U 0-tbg 0� GZg Nickel 0,03 0,01r ©.OIG O. Selenium 0, Q 0�&b t-I 0•OO5 Zinc i. {6 p, u G +4s l o3•G� 1 Total Phos- lsorus 1 ...................... "I certify, udder penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for linowing violations". — ZZ14 W 4�� C, P� - Signature of Lased Applies 10r Date DENR FORM MFLSF (12/2006) a M clq 0 V U Q v N a � U m U rn o� lo I � p q � O r Wk 'il 1 11 c Q � d n co 9 p o O � U � O v fil N ANNUAL METALS FIELD LOADING SUMMARY FORM' Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Con lfl(2iD Total Dry Tons Applied (Annual): ;7, - {Iq Permit #: 404q Cation Exchange Capacity (non 503 only): q.15 Operator: CbOyle - i CLJ, .Owner: (�r-y�� ��� 1� Predominant Soil Series; +} Acres Used: 3. oo Acres Permitted: 63 00 Site #: _ �} Field #: 14 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Coln- posite Date 1 Z3 2 3 4 5 6 71 8 9 10 11 92 % Solids Arsenic Cadrniwn Z • 0 Copper -,q(f Chroinivan i C) Lead 0 Mercury &, Molyb- denum D Nickel j Seleniwn Zinc gj3-z Total Phos- phorus 5z6I6 Annual Heavy Metal Field Loadings (Calculated in s acre): Total DAe./ pp 1 p•�f0� 2 3 4 V 5 6 7 8 9 10 11 i 2 fl- Arsenic:Event ,005 D, Cadmiwn C),Wq I 0,6bl Copper Q t4tpz (3 - t Z Chromi , b3 0.634 Lead 6.&3 I a.03 f Mercury l Molyb- denw-n .Oi .Oi G Nickel Gp Selenium 6,60q Zinc Total Phos- homs "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier Date DENR FORM MFLSF (12/2006) per. T N d5 0 V vi b4, d v o V r a� 0 � � �► � V'J v�i�t�i a p O`n ow �� ro w a NNN U CT � w -.. co � R ` � r Se a •� o CIO _ PA O O a ID cJ U p-1 1-4 n^� I-s r'�.�, ANNUAL METALS FIELD LOADING SUMMARY FORM" Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: ('�n j}[ l 17 Total Dry Tons Applied (Annual): 7.-? (':�' Permit #: Cation Exchange Capacity (non 503 only): fL6 Operator: Owner: Psl�ne�-r,:�� _ Predominant Soil Series: Pp/� Acres Used: Acres Permitted: Z.3�2 Site #: D Field ##: Residual Analvsis Data (Heavv Metals and Total Phosphorus use mg/leg, % Solids use Raw Percent #): Sample or Com- posite Date 1 V �3 3 5 6 7 8 9 10 11 12 % Solids Arsenic Cadmium �• v Copper zuq Chromium l Lead 1 Mercury .2G Molyb- denum q- b Nickel I Selenium <<j. D Zinc a 3Z Total Phos- phorus, Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac.l App. Event 1 1-14Z 2 3 4 W 5 6 7 8 S 10 11 12 Q p .1 Z Arsenic j) LW(- a, Cadmium 0 pU Copper 0 <55"J Cluomit D_OL43 Lead 0,p3Q Mercury 0,001 Molyb- denum 0•Q I Nickel o L.4 Selenitun , 51 1 zhic l ZG Z i q Total Phos- horas 114?�t I ilk° "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. X am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier Date DENR FORM MFLSF (12/2006) U a a N O � U U N a�i a � o U pq34 U O 44 ,o N � � o Rz��raP94 a Et�ti i � x \ O Q c d r p m W110 O O 0 © Q OJ F-+ ANNUAL METALS FIELD LOADING SUMMARY FOR" Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: (,'@�f f i;) !7 Total Dry Tons Applied (Annual): L. �7� Permit #: uoCtac4q _ Cation Exchange Capacity (non 503 only): q_Ij Operator: C Ae�rn'6mI /. Owner: (�Cr)j 1,y� Predominant Soil Series:�� Acres Used: Z. q g Acres Permitted: Z-c-t 'O Site #: P Field #: Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/lcg, % Solids use Rave Percent ft Sample or Com- posite Date �� Z 2 3 4 5 6 7 8 9 10 11 12 % Soiids Arsenic <Z.5 <Z,,5 Cadmium Z Z-d CopperE04 Z44 Chromium 4 lQ Lead l7 n Mercu►y (}. �l 0•Z Molyb- denum C1II5 Cl Nickel i t Selenium Zinc G3Z �3Z Total Phos- hows 5W) D 5 Z610 Annual Heavy Metal Field Loadings Calculated in lbs/acre): Event r.• ►R�liiiiitii�Si7iiil��ii� � � _�__�__�__��� � NMI 1 � 1 "I certify, under penalty of law, that this document was prepared under my do ect►on or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of Imes and imprisonment for luiowing violations". Signature of Land Applier Date iDENR FORM MFLSF (12/2006) a N Q 0 N 2 w a 6 M W 6 o o�"3 y O � ko 616101 � V 9 y � Scy)zl-1 o p. o 0 �6 <711 O Qi U a 0 0 N N LL iL. O L3_ LU 0 ANNUAL METALS FIELD LOADING SUMMARY FORM Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Total Dry Tons Applied (Annual): Permit #: mxpl C" Cation Exchange Capacity (non 503 only): Operator: it )0-60,, Owner: Predominant Soil Series: Acres Used: j, 691 Acres Permitted: d3. (�Z Site #: 'D Field #: I-7 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample of Com- posite Date! 1 2 3 ` 6 7 8 9 10 91 92 % Solids Arsenic CZ5 Z Cadinium Z. v .v Capper ZJ4q- Z Chroinimn j ' Iq Lead 11 n MercLny p.Z�r GZ�I Molyb- denum Nickel Selenhult < . zinc 3Z G{ Z Total Phos- honis 16W JO I 67DIO Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total yj Total Phos- phortis MENNEN �► "I certify, under penalty of law, that this document was prepared under my darectaou or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". de-4 W.2111-1sly Signature of Land Applier Date DEER FORM MFLSF (12/2006) a °J [j 1-1 Q TA I ai �n Sv � C!a o O CU r 4 �'J nn 6161 CD (].i F-1 U d ^n 1 1{ U w a y o o o10 00 q cr p G �o ua PH a 0 0 N N U U- Lc�1. C O Z w ANNUAL METALS FIELD LOADING SUMMARY FORW Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Total Dry Tons Applied (Annual): 1. (Z j Permit #: 14)),QQD IC49 Cation Exchange Capacity (non 503 only): 4.5 Operator: bli Owner: �'C�} r} (� yi�[� Predominant Soil Series:—AK+�kj Acres Used: T Q_Z Acres Permitted: I-L(Z Site #: 'D Field #: 153 Residual Analvsis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Com- posite Date 1 V -� 2 3 4 5 6 7 8 9 10 11 12 % Solids Arsenic Cadmium Z-D Copper I Z44 Chromiwn 19 Lead (� Merewy Molyb- denum. Nickel Zj Selenium <S Zinc �p3 Total Phos- horus ,c, 5-W 1 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App,-l4s-Z3 Event 1 C Go LI 2 3 4 5 6 7 8 9 10 11 12 Arsenic p,005 3 Cadmimn 0 .tO3 a ` Copper 6_3629 O.Z� C}norni b . bZ(, Lead p )Z3 C9 Mercau-y D . 000 fs• C Molyb- denum �,bl� t5•D1Z Nickel Selenium. 7 C)o ,Zinc 1, 5 Ep t-Z5� Total Phos- honis f D.) 76, 09 "I certify, under penalty of law, that this document was prepared under my direction or supervision m accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for lmowing violations". Signature of Land Applier Date IIFNR FORM MFLSF (1212006) u p N Lf U Cc aA v a, A ��. ��r� KD O � 0 ap.+ � � U0 � o � O O � r � 0049 Q l� a Q+ � �] o ro � �w 'd .o •� a `� C7 a� as A b a 4-i Q 0 0 N LL EL Of z w O ANNUAL METALS FIELD LOADING SUMMARY FOR" Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: t {1`OI� Total Dry Tons Applied (Annual): Z Qf /-) Permit #: Cation Exchange Capacity (non 503 only): 5 Operator: �' {j n}-btns�l f Owner: Predominant Soil Series: �. Acres Used: t 17'� Acres Permitted: ) .�5 Site #: Field #:�_ Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample o1 Co111- posite Date 1 2 3 4 5 6 7 8 9 10 11 12 % Solids Arsenic < .5 Cadznirun - 0 Copper L44 Chrorniwn I� Lead Merculy Molyb- denum Nickel Sele,"hun Zinc cj Total Phos- lhorus 57DIC) Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event 1 2 3 L4J 5 6 7 & S 10 11 12 Arsenic] [ Cadrniurn fj-tb t Copper , )C) clu-omiuly 0.4 b4 Lead 0,7 07 Mercury p.pD 1 oa Molyb- deawn t% b•Ob� Nickel 0,6t)9 a.CUq Selerliwn 60'2- 1 6"5c;z Zinc �•3�6 D•3S� Total Phos- horus ZI-�3 Zf-63G "I certify, under penalty of lave, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel property gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". 4'' l 4k� + a+ Signature of Land Applier Ap Date DENR FORM MFLSF (1212006) ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (02T Rules) Facility Name: f mJ /i� WQ Permit Number: (fC yfq _ `(�� _ � I7 NPDES Number: WWTP Name: fi(�jO�ZL�7i Monitoring Period: From C(N I e Z02,3 TojKfj _y 1, zD73 Pathogen Reduction (15A NCAC 02T .1106) - Please indicate level achieved and alternative performed: Class A: Alt. A (timeltemp) ❑ I Alt B (Alk Treatment) ❑ Alt. C (Prior Testing)❑ Alt.D (No Prior Test) ❑ Process to Further Reduce Pathogengs ❑ If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens": Compost ❑ Heat Drying ❑ Heat Treatment ❑ Thennopbilic ❑ Beta Ray ❑ Gam na Ray Cl Pasteurization ❑ Class B: Alt. (1) Fecal Density Alt. (2) Process to Significantly Reduce Pathogens ❑ If applicable to alternative performed (Class B only) indicate "Process to Significantly Reduce Pathogens": Lime Stabilization ❑ Air Drying ❑ Composting ❑ jAcrobic Digestion Anaerobic Digestion ❑ If applicable to alternative performed Class A or Class B) complete the following monitoring data: t Densien .Number o na yhoa Allowable Level Pathogen Frequency Sample 13xcee- Tech - Parameter in Sludge Minimum Geo. Mean Maximum Units deuces of Analysis Type rri ue 2 x 10 to the MPN t Z Z rnW G Qh GZZ) L 14 6th power lids per grain of Fecal Coliform total solids CFU 1000 mpn per gran, of total solid (dry weight) Salmonella bacteria 3 MPN per 4 grams (in lieu of fecal total solid (dry coliform) weight) Vector Attraction Reduction (15A NCAC 02T .1107) - Please indicate alternative performed: Alt, I (VS reduction) ❑ Alt, 2 (40-day bench) ❑ Alt, 3 (30-day bench) ❑ jAlt. 4 (Spec. 02 uptake) 10 Alt. 5 (14-Day Aerobic) ❑ Alt, 6 (All, Stabilization ❑ Alt 7 (Drying - Stable) ❑ I Alt. 8 (Drying - Unstable) ❑ Alt, 9 (Injection) ❑ Alt, 10 (incorporation) ❑ No vector attraction reduction alternatives were performed ❑ CERTIFICATION STATEMENT (please check the appropriate statement) [ "I certify, under penalty of law, that the pathogen requirements in 15A NCAC 02T .1I06 and the vector attraction reduction requirement in 15A NCAC 02T .1107 have been met." ❑ "I certify, under penalty of law, that the pathogen; requirements in 15A NCAC 02T 1106 and the vector attraction reduction requirement in 15A NCAC 02T .1107 have not been met." (Please note if you check this statement attach an explanation why you have not met one or both of the requirements.) "This determination has been made under my direction and supervision in accordance with the system designed to ensure that qualified personnel properly gather and evaluate the information used to determine that the pathogen and vector attraction reduction requirements have been met. I am aware that there are significant penalties for false certification including fine and imprisonment." r�II i n cP-C. Prepare�me and `nit e (type or print) �� res* Signature of PrepaDate Land Applier Name and Title (if applicable)(type or print) s'W Signature of Land Applier V(if applicable) Date *Prepares is defined in 40 CFR Part 503,9(r) and 15A NCAC 2T ,1102 (26) DENR FORM PVRF 02T (12/2006) CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRIFTON, NC 28530 PARAMETERS Total Residue, mg/l Fecal Coliform (MPH /gram Solids Sample Analysis Method N1 Date Analyst Code 16780 05/17/23 HMV 2540B-15 77 05/15/23 BNC 9221E-14 Drinking Water ID; 37715 Wastewater ID; 10 PHONE (252) 756-6208 FAX (252) 756-0633 xD#: 416 A DATE COLLECTED: 05/1.5/23 DATE REPORTED ; 05/24/23 REVIEWED BY: CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRIFTON, NC 28530 PARAMETERS Total Residue, mg/l Fecal Coliforin (MPN), /gram Solids Sample Analysis Method #2 Date Analyst Code 16900 05/17/23 HNIV 2540B-15 12 05/16/23 BLV 9221E-14 Drinking Water IDs 37715 Wastewater ID: 10 PHONE (252) 756-6208 FAX (252) 756-0633 ID# : 41.6 A DATE COLLECTED: 05/16/23 DATE REPORTED : 05/24/23 REVIEWED BY: CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRIFTON, NC 28530 PARAMETERS Total Residue, mg/l Fecal Coliform WN), /gram Solids Sample Analysis Method #3 Date Analyst Code 15900 05/17/23 lam' 254OB-15 82 05/17/23 BGV 9221E-14 Drinking Water ID: 37715 Wastewater IDt 10 PHONE (252) 756-6208 FAX (252) 756-0633 ID#: 416 A DATE COLLECTED: 05/17/23 DATE REPORTED : 05/24/23 REVIEWED BY: ✓✓� • Wayp®I nt ,a ANALYTICAL 114 OAKMONT DRIVE GREENVILLE, NC 27858 CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRSDGEN P.O. BOX 477 GRIFTON, NC 28530 PARAMETERS Total Residue, mg/l Fecal Coliform (MPN), /gram Solids Sample Analysis Method #4 Date Analyst Code 15300 05/24/23 JDJ 2540E-15 44 05/18/23 JDJ 9221E-14 Drinking Water IDS 37715 PqWrOL5) �t&V208 FAX (252) 756-0633 ID#: 416 A DATE COLLECTED: 05/18/23 DATE REPORTED : 06/06/23 REVIEWED BY: CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O, BOX 477 GRIFTON, NC 28530 PARAMETERS Total Residue, mg/i Fecal Coliform (MPH /gram Solids Sample Analysis Method #5 Date Analyst Code 14760 05/24/23 JDJ 2540E-15 C 12 06/05/23 JDJ 9221E-14 Dr�i7n_►kyiin�gg Water IDg; 337771p5 E-F""1VEVE-M 756-0008 FAX (252) 756-0633 ID#: 41.6 A DATE COLLECTED: 05/22/23 DATE REPORTED : 06/06/23 REVIEWED BY: o WayPA®ant.,. 0 NALYTICAL 114 OAKMONT DRIVE GREENVILLE, NC 27858 CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. sox 477 GRIFTON, NC 28530 PARAMETERS Total Residue, mg/l Fecal Coliform (MPN), /gram Solids Sample Analysis Method #6 Date Analyst Code 15000 05/24/23 JDJ 254OB-15 C 12 05/23/23 ADR 9221E-14 Drinking Water ID: 37715 PFTNr(6) �W&V208 FAX (252) 756-0633 ID# : 41.6 A DATE COLLECTED: 05/23/23 DATE REPORTED : 06/06/23 REVIEWED BY: WaypA® nt.., NALYTICAL 0 114 OAKMONT DRIVE GREENVILLE, NC 27858 CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRIFTON, NC 28530 PARAMETERS Total Residue, mg/l Fecal Coliform (MPN), /gram Solids Sample Analysis Method #7 Date Analyst Code 14080 05/24/23 dD.1 2540B-15 32 05/24/23 HMV 9221E-14 Drinking Water ID: 37715 PFTNrag�) �62&08 FAX (252) 756-0633 ID#: 416 A DATE COLLECTED: 05/24/23 DATE REPORTED : 06/06/23 REVIEWED BY: / '� 0 Specific Oxygen Uptake Rate SOUR Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facility Name Biosolids Permit Number Date Digester Temperature Sampling Date/Time Sampled By Analysis Date/Time Analyzed By Total Solids Beginning Temperature End Temperature Dissolved Oxygen Level Slope: Intercept: Correlation Coefficient: Oxygen Uptake Rate: Ambient Specific Oxygen Uptake Rate: Average Temperature: Temperature Correction Factor: )ry Solids rees Celsius tees Celsius 0.05 8.1 0.97 2.79 mg Oxygen/hr 0.17 mg Oxygen/hr/g 20 degrees Celsius 1.00 Temperature Corrected Specific Oxygen Uptake Rate: 0.17 mg Oxygen/hr/g Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically. Updated 10/23/2013 R rel u d; N co co Co d co co ti ti ti (116w) uoBAxo panlossip i i z Specific Oxygen Uptake Rate SOUR Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facility Biosolids Permit N Digester Temperature: Sampling Date/Time: Sampled By: Analysis Date/Time: Analyzed By: Total Solids: Beginning Temperature: End Temperature: Dissolved Oxygen Level Slope: Intercept: Correlation Coefficient: Oxygen Uptake Rate: Ambient Specific Oxygen Uptake Rate: Average Temperature: Temperature Correction Factor: 048 raves uunn nn 65 %Dry Solids 19 degrees Celsius 20 degrees Celsius 0.08 8.3 1.00 5.03 mg Oxygenlhr 0.31 mg Oxygenlhrlg 20 degrees Celsius 1.00 w Temperature Corrected Specific Oxygen Uptake Rate: 0.31 mg Oxygenlhrlg Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically. Updated 10/23/2013 F U CL O Iq co LO F- co ti (116w) uoBAxp POAJOSsI❑ 3 Specific Oxygen Uptake Rate SOUR Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facility Blame: Biosolids Permit Number: Date: Digester Temperature: Sampling Date/Time: Sampled By: Analysis Date/Time, Analyzed By: Total Solids: Beginning Temperature: End Temperature: Dissolved Oxygen Level Slope: Intercept: Correlation Coefficient: Oxygen Uptake Rate: Ambient Specific Oxygen Uptake Rate: Average Temperature: Temperature Correction Factor: IVISD 100001048 5117 -17-231085C ravis Dunn -17-231115C ravis Dunn 1.62 % Dry Solids 20 degrees Celsius 20 degrees Celsius 0.09 8.1 0.98 5.37 mg Oxygenlhr 0.33 mg Oxygenlhrlg 20 degrees Celsius 1.00 Temperature Corrected Specific Oxygen Uptake Rate: 0.33 mg Oxygenlhrlg Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically. Updated 10/23/2013 rn N N 00 Oj Oj 00 0 O FOR r" Lo, C� 06 C¢ LO VT M (I/6W) UOBAXp panlossla y' Specific Oxygen Uptake Rate SOUR Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facility Name: Biosolids Permit Number: Date: Digester Temperature: Sampling Date/Time: Sampled By: Analysis Date/Time: Analyzed By: Total Solids: Beginning Temperature: End Temperature: Dissolved Oxygen Level Slope: Intercept: Correlation Coefficient: Oxygen Uptake Rate: Ambient Specific Oxygen Uptake Rate: Average Temperature: Temperature Correction Factor: % Dry Solids degrees Celsius degrees Celsius 0.08 8.5 0.98 4.78 mg Oxygenlhr 0,29 mg Oxygenlhrlg 19 degrees Celsius 1.07 Temperature Corrected Specific Oxygen Uptake Rate: 0,31 mg Oxygenlhrlg Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically, Updated 10/23/2013 irm U d d CL c Q a x A c0 (O 00 a0 (Q IT cV 00 (O c0 Oa 00 00 [-� I- r-: (O (O (11OW) UGBAXp POAJOssiCI 5 Specific Oxygen Uptake Rate SOUR Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facility Name: CMSD Biosolids Permit Number: WQ000104f Date: 512, Digester Temperature: Sampling Date/Time: 5-22-231142 Sampled By: Travis Dunn Analysis Date/Time: 5-22-231143 Analyzed By: Travis Dunn Total Solids: Beginning Temperature: End Temperature: Dissolved Oxygen Level Slope: Intercept: Correlation Coefficient: Oxygen Uptake Rate: Ambient Specific Oxygen Uptake Rate: Average Temperature: Temperature Correction Factor: 1 59 % Dry Solids 20 degrees Celsius 21 dearees Celsius 5.17 mg Oxygenlhr 0.32 mg Oxygenlhrlg 21 degrees Celsius 0.95 Temperature Corrected Specific Oxygen Uptake Rate: 0.31 mg Oxygenlhrlg Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically. Updated 10/23/2013 RIM co L c (I/Om) ua6Rxo peAlossi❑ Specific Oxygen Uptake Rate SOUR Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facility Name: CMSD Biosolids Permit Number: WQ00 Date: Digester Temperature: Sampling Date/Time: 5-22-2 Sampled By: Travis Analysis Date/Time: 5-23-2 Analyzed By: Travis Total Solids: Beginning Temperature: End Temperature: Dissolved Oxygen Level Slope: I ntercept: Correlation Coefficient: Oxygen Uptake Rate: Ambient Specific Oxygen Uptake Rate: Average Temperature: Temperature Correction Factor: 5/23/202 1 311125 Dunn 311129 Dunn % Dry Solids degrees Celsius dearees Celsius I. - 3.88 mg Oxygenlhr 0.24 mg Oxygenlhrlg 20 degrees Celsius 1.00 v� Temperature Corrected Specific Oxygen Uptake Rate: 0.24 mg Oxygenlhrlg Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically. Updated 10/23/2013 FQ r•1 op Iq lP N 00 00 CO 00 0o co co ti t-_: (I/F)W) UOBAXp panlossl© INN Specific Oxygen Uptake Rate SOUR Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facility dame: CMSD Biosolids Permit Number: WQ0001048 Date: 51241 Digester Temperature: Sampling Date/Time: 5-24-2311406 Sampled By: Travis Dunn Analysis Date/Time: 5-24-23/1409 Analyzed By: Travis Dunn Total Solids: Beginning Temperature: End Temperature: Dissolved Oxygen Level Slope: Intercept: Correlation Coefficient: Oxygen Uptake Rate: Ambient Specific Oxygen Uptake Rate: Average Temperature: Temperature Correction Factor: 59 % Dry Solids 19 degrees Celsius 20 degrees Celsius 0.08 8.5 0.98 4.60 mg Oxygenlhr 0.29 mg Oxygenlhrlg 20 degrees Celsius 1.00 Temperature Corrected Specific Oxygen Uptake Rate: 0.29 mg Oxygenlhrlg Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically. Updated 10/23/2013 ry c0 14: N oo co Qo N 00 00 00 h ti ti (I16M) UOBAXp panlossla i LAN J'a � Moff. WMA 1 *01 oil' G W-59A COMPLIANCE REPORT FORM permit fl JtQj-e (Yubinit one each monitoring period with. GW 59 forins ) Enter date monitoring results were due. (I! Z3 ) Will this monitoring report (GW-59 and OW-59A) YES NO be submitted after the established due date? 2 Was airy required information massing on the GW-59 report forms? YES �O 1F the answer to question I 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 rrrissing cap, missing YES NO identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Officefor guidance. q Are any monitored constituents equal to or above the established standards? S 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,' L3P1 Z3 I ch(c)m i udn I Z w� io 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", ship to section 8. If the answer to question 51s "YES") list in the space provided below, each welt with constituent(s) exceeding standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years). Lf -V IL io 71j Zi —TG c�ICWp'lit tyn 70 Qqj' 14, Y) Are the monitoring wells listed in section 5 located at or beyond the review boundary? YES N, Q x If the answer is "YES'; a groundwater quality problem maybe occurring. CONTACT THE REGIONAL OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is 'WO", monitoring wells maybe Improperly located; contact the Regional Office. 7 is the permittee implementing previously approved actions required by the Division involving this S 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 Rogional 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.7 eTG(—' IeLge I *,�)'''6AU(C-t t l'4ir) �)I lt��l�i�r�.'ft?l C_i� �C) ! r7 � -he i `� - e xc�t �i tCur $ `let' �2Jh��`! � j ! ► G l �7uly,Zdf��Nti�hl i)t'(Cl.,rornjUIi�r � �� ley 1 Chi P i li a-wa f v 4-hf i U - g 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 of the top of the current GW-59 form. �1 � '•0 111 '�' 3F ' � S aFasL4t it � '�� � � F'aY.�+� R.fi'�lF- ll��� � FSPS^S >7 5 "y1.� �•'i �1 � �ri `' _� d le�l b�� at�t �abo�te¢irt � airy u •ash ilyat �p t ate �1 u .,�, r e�it1)��5�!% ,�°tr '�xi$�s��i.4i�,L." / ti 4i` �� EA l� 4� Al ��` '1 FL f �� � -� �%J� /• Signature o Permittee (or Authorized Agent) Date GW-59A 1.21812003 v m ED s p b C o Z ro m a �D t `- O ca m aEi O❑❑ O ❑ r� CL E LU a a CL S]J O C � U E p c o LL p Z Uj ro R Z U R Imo^ Ul O C7a J ro0. 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U N in um) .0 C �L .0 O ~ Cl. `J c a o N U " o:3 C0 U m E U Li ° ro U Z o ro' E .o W U o Z ro ttf oc U U U Z C Im a u o a E E 1 J � E E : 7 0 N 7 0 E c� 0 ❑) E � o � m rn rn can o r~n a r, o o 0 0 N 7 C C N Y z j C: o N ro cro z rn 0 z , x rn c c j C > O J O J O N J ...1 J N J to O O U) E cm E 0) E ...I 5 M E 5 m E i 0) E 0) E E` a O O N Z m O co m i ar o mo V oo 0 OM n 0i. V oO in m Nc E ©b N❑❑ M E 0- b Om U bon O GI Yo U b vl 0 Om O $1 b o 0m o Z N c Oo 0 Z T z 0 N o ccf o ,fj 0 �' m O c o° LL. a ~ ~ L L /c��a� E 'z cU C 0 N j a. L C3 Q Gl. �+! l7 ' 7 c Z �[ ❑. m . o co m C:d%' O U E "'' LLu ) U CQD ❑ O D. " n I) 6 z E2 O F- Z O O LL �O W LU QU z © Q Z wO 0 0 f `� rn i o 1 uj 0 a O 4 � C O O IS o L) O C7 n c E E o O €WQ O CL C O❑❑ice❑ ���}}, E (Ly7 LU a O m w z u A N ❑ 0 N r u t m ro O R co p p ILL,L❑❑❑❑ z a z ia m N m a o W a) E Ew QI o ct� O z El } a) U E m N v a1 cai O -o LlJ a m c Q U E 4= m -p 0 O'', m z El a Ol U j LLJ 41 E � N ❑® m a m E U5 N 2 � o � IL o _ m a E 3 ill N 0. N m ' m D�o. Z o a o- O N a C o N U) 41 E ° E Q_� in a 0 Q C W z N O ° pp a E o c U Q Z �j o L o 0 o Q r i7 N 7- E E E C: p C7 a U o o a�i Cj E as E U p U a ro v Q d 0 U 0 o N� y (J) () o ro c (D N m Q u? � V I O O E E E E E E E a E E a Q 0 Q v _V V �7 a Vl h a ti o m h o V• 0 N 0© 4'i o a m m n n Ll h N n 0N m o 0 m E i41 n to o m U) o� 0 0 o o a o o m ti o a n o z c z z a °,.' N W E � E 7 E � E ro p m U. p i>-' U E E 7 U E m0 wm Z o—C,a°mU U L pp' 'o� ) mZ 0 a Co U7I • EO U Cn ❑. �G ;? w to U U m e o u Z O a [> Z w a fd n p. •n o o E E E p E E m E a E x 1� Q1 s U ' 'J m q !0 N U d� v, �n aY o o o in o o Co a N N l o Orr in o N us m c- 0) to om coNoto ooa600 oo0 z N Z p U O O m C {� U ro C 'o o 10 U L, Z c %r E z z U) LL ° Q U Q m D- 00 c Y 'o m W Ca W o 0N -o m F: o U H ro o E m � p z m C9 � a� roQ ( j U r°n api m E rn E O ro Fo- m C i Q CL .l] J .�rtrj i•+ Q y1 G O E c a V cu E 0 CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRIFTON, NC 28530 PARAMETERS Drinking Water ID; 37715 Wastewater TD: 10 PHONE (252) 756-6208 FAX (252) 756-0633 ID#: 416 DATE COLLECTED: 10/18/23 DATE REPORTED : 1.0/27/23 REVIEWED BY; Well #9 Well #10 Well #14 Well #15 Well #17 Analysis Method Date Analyst Code Fecal Coliform (MF), /100 Mls < 1 < 1 < 1 < 1 Ammonia Nitrogen as N, mgll 1.67 0.53 Ammonia Nitrogen as N, mg/i 0.13 0.35 Nitrate Nitrogen as N, mgll <0.04 0.75 0.18 <0.04 Total Organic Carbon, mg/I 3.83 3.25 2.48 13.79 Chloride, mg/l 3 2 4 3 Total Dissolved Residue, mg/I M 70 M 51 M 50 M 92 Total Chromium, ug/l <5.0 5.0 <5.0 12 Copper, 11g/1 <10 <10 <10 <10 Conductivity (at 25c), uMhos/cm 136 <50 78 65 Total Ortho-Phosphate as P, mg/l 0.04 0.07 0.05 0.06 < 1 10/18/23 HMV 9222D-15 10/23/23 BMD 350.1 112-93 0,13 10/24/23 BMD 350.1 112-93 0.04 10/19/23 ADR 353.2 112-93 3.38 10/24/23 BLV 531OC-14 3 10/23/23 ADR 4500CLB-11 M 75 10/19/23 HMV D5907-13 8 10/23/23 MTM EPA200.7 <10 10/23/23 MTM EPA200.7 59 10/19/23 BNC 251OB-11 0.13 10/19/23 BLV 450OPE-11 All 4C requirements were not met; M Blank result exceeded method constant weight criteria. Waypoel t. 0 ANALYTICAL 114 OAKMONT DRIVE GREENVILLE, NC 27858 C14SD (SLUDGE & WELLS ACCT) CONTENTN'EA METRO, SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRIFTON, NC 28530 Well #18 Analysis Method PARAMETERS Date Analyst Code Fecal Coliform (IFI), /100 Mls <1 10/18/23 HMV 9222D-15 Ammonia Nitrogen as N, mgll 0.19 10/23/23 BMD 350.1 112-93 Nitrate Nit rogeu as N, m9/1 <0.04 10/19/23 ADR 353.2 112-93 Total Organic Carbon, mg/I 8,92 10/24/23 BLV 531OC-14 Chloride, mg/l 3 10/23/23 ADR 4500CLB-11 Total Dissolved Residue, mg/1 M 110 10/19/23 HMV D5907-13 Total Chromium, ug/l <5.0 10/23/23 MTM EPA200.7 Copper, ug/l <10 10/23/23 MTM EPA200,7 Conductivity (at 25c), uMhoslcm 150 10/19/23 BNC 251OB-11 Total Ortho-Phosphate as P, mg/I 0,03 10/19/23 BLV 4500PE-11 Drinking Water In; 37715 Wastewater Ins 10 PHONE (252) 756-6208 FAX (252) 756-0633 ID#: 416 DATE COLLECTED: 10/18/23 DATE REPORTED : 10/27/23 REVIEWED BY: * r All QC requirements were not met; X Blank result exceeded method constant weight criteria. Waypoent.. ANALYTICAL 114 OAKMONT DRIVE GREENVILLE, NC 27858 CLIENT: CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRIFTON, NC 28530 REVIEWED BY: VOLATILE ORGANICS qmn. MRTHODS 8260D Drinking Water IDs 37715 Wastewater ID; 10 PHONE (252) 756-6208 FAX (252) 756-0633 CLIENT ID: 416 ANALYST; JAP DATE COLLECTED: 10/18/23 Page: 1 DATE REPORTED: 10/27/23 Date Analyzed: PARAMETERS, ug/l 10/24/23 Well #9 10/24/23 Well #10 10/24/23 Well #14 10/24/23 Well #15 10/25/23 Well #17 1. Benzene <0.50 <0.50 <0.50 <0.50 <0.50 2. Bromobenzene <0.50 <0.50 <0.50 <0,50 <0.50 3, Broinochloromethane <0.50 <0.50 <0.50 <0.50 <0.50 4. Bromodichloromethane <0.50 <0.50 <0.50 <0.50 <0.50 5. Bromoform <0.50 <0.50 <0.50 <0.50 <0.50 6, Bromomethane <0.50 <0.50 <0.50 <0.50 <0.50 7. N-Butylbenzene <0.50 <0.50 <0.50 <0.50 <0.50 8. Sec-Butylbenzene <0.50 <0.50 <0.50 <0.50 <0.50 9. Tert-Butylbenzene <0.50 <0,50 <0.50 <0,50 <0.50 10, Carbon Tetrachloride <0.50 <0.50 <0.50 <0.50 <0.50 11. Chlorobenzene <0.50 <0.50 <0.50 <0.50 <0.50 12. Chloroethane <0.50 <0.50 <0.50 <0.50 <0.50 13. Chloroform <0.50 <0.50 <0.50 <0.50 <0,50 14. ChIoromethane <0.50 <0.50 <0.50 <0.50 <0.50 1.5. 2-Chlorotoluene < 0.50 < 0.50 < 0.50 < 0.50 <0,50 16. 4-Chlorotoluene < 0.50 < 0.50 < 0.50 < 0.50 <0.50 17, Dibromochloromethane <0.50 <0.50 <0.50 <0.50 <0.50 18. 1,2-Dibromo-3-Chloropropane <0.50 <0.50 <0.50 <0.50 <0.50 19. 1,2-Dibromoethane <0.50 <0.50 <0.50 <0.50 <0.50 20, Dibromomethane <0.50 <0.50 <0.50 <0.50 <0.50 21, 1,2-Dichlorobenzene <0.50 <0.50 <0.50 <0.50 <0.50 22. 1,3-Dichlorobenzene <0.50 <0.50 <0.50 <0.50 <0.50 23. 1,4-Dichlorobenzene <0.50 <0.50 <0.50 <0.50 <0.50 24, Dichlorodifluoromethane <0.50 <0.50 <0.50 <0.50 <0.50 25. 1,1-Dichloroethane <0.50 <0.50 <0.50 <0.50 <0.50 26. 1,2-Dicliloroethane <0.50 <0.50 <0.50 <0.50 <0.50 27, 1,1-Dichloroethene <0.50 <0.50 <0.50 <0.50 <0.50 28, Cis-1,2-Dichloroethene <0.50 <0.50 <0.50 <0.50 <0.50 29, trans-1,2-Dichloroethene <0.50 <0.50 <0.50 <0.50 <0.50 30, 1,2-Dichloropropane <0.50 <0.50 <0.50 <0.50 <0.50 31, 1,3-Dichloropropane <0.50 <0.50 <0.50 <0.50 <0.50 32, 2,2-Dichloropropane <0.50 <0.50 <0.50 <0.50 <0.50 33, 1,1-Dichloropropene <0.50 <0.50 <0.50 <0.50 <0.50 34, Cis-1,3-Dichloropropene <0.50 <0,50 <0.50 <0.50 <0.50 35. trans-1,3-Dichloropropene <0.50 <0.50 <0.50 <0.50 <0.50 36, Ethylbenzene <0.50 <0.50 <0.50 <0.50 <0.50 37. Hexacblorobutadiene <0.50 <0.50 <0.50 <0150 <0.50 38. Isopropylbenzene <0.50 <0.50 <0.50 <0.50 <0.50 39, 4-Isopropyltoluene <0.50 <0.50 <0.50 <0150 <0.50 40. Metbylene Chloride <0.50 <0.50 <0.50 <0.50 <0.50 41, Naphthalene <0.50 <0.50 <0.50 <0.50 <0.50 42, Propylbenzene <0.50 <0.50 <0.50 <0.50 <0.50 43. Styrene <0.50 <0.50 <0.50 <0.50 <0.50 44. 1,1,1,2-Tetrachloroethane <0,50 <0.50 <0.50 <0.50 <0.50 45. 1,1,2,2-Tetrachloroethane <0.50 <0.50 <0.50 <0.50 <0.50 46. Tetrachloroethene <0.50 <0,50 <0.50 <0.50 <0.50 47. Toluene <0.50 <0.50 <0.50 <0.50 <0.50 'O l Waypoint ANALYTICAL 114 OAKMONT DRIVE GREENVILLE, NC 27858 CLIENT: CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. Box 477 GRIFTON, NC 28530 REVIEWED BY; / VOLATILE ORGANICS qmn _ TaSF1''1''HnnB 8260D Drinking Water M 37715 Wastewater ID; 10 PHONE (252) 756-6208 FAX (252) 756-0633 CLIENT ID: 416 ANALYST: JAP DATE COLLECTED: 10/18/23 Page: 2 DATE REPORTED: 10/27/23 Date Analyzed; PARAMETERS, ugll 10/24/23 Well #9 10/24/23 Well #10 10/24/23 Well #14 10/24/23 Well #15 10/25/23 Well #17 48, 1,2,3-Trichlorobenzene <0.50 <0.50 <0.50 <0.50 <0,50 49, 1,2,4-Trichlorobenzene <0.50 < 0.50 < 0.50 < 0.50 < 0.50 50. 1,1,1-Trichloroethane <0.50 <0.50 <0.50 <0.50 <0.50 51, 1,1,2-Trichloroethane <0.50 <0,50 <0.50 <0.50 <0.50 52. Trichloroethene <0.50 <0,50 <0.50 <0,50 <0.50 53, Trichlorofluoromethane <0.50 <0.50 <0.50 <0.50 <0.50 54. 1,2,3-Trichloropropane <0.50 <0.50 <0.50 <0,50 <0.50 55. 1,2,4-Trimethylbenzene <0.50 <0.50 <0.50 <0.50 <0.50 56. 1,3,5-Trimethylbenzene <0.50 <0.50 <0.50 <0.50 <0.50 57. Vinyl Chloride <0,50 <0,50 <0.50 <0.50 <0.50 58, Total Xylenes <1.00 <1.00 <1100 <1,00 <1.00 59. Methyl Tert Butyl Ether < 1.00 < 1.00 < 1.00 <1.00 < 1.00 Rim Waypoult ANALYTICAL 9 114 OAKMONT DRIVE GREENVILLE, NC 27858 CLIENT: CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO, SEWAGE DIST. MS. RENEE PRIDGEN P,O. BOX 477 GRIFTON, NC 28530 REVIEWED BY: Armr - VOLATILE ORGANICS STD. METHODS 8260D Drinking Water IDi 37715 Wastewater ID1 10 PHONE (252) 756-6208 FAX (252) 756-0633 CLIENT ID: 416 ANALYST: 3AP DATE COLLECTED; 10/18/23 DATE REPORTED: 1.0/27/23 Date Analyzed: PARAMETERS, ug/1 10/25/23 Well #18 1. Benzene < 0.50 2. Bromobenzene <0.50 3, Bromochloromethane <0.50 4. Bromodichloromethane <0.50 5, Bromoform <0150 6. Bromomethane <0.50 7, N-Bntylbenzene <0.50 S. Sec-Bntylbenzene <0.50 9. Tert-Bntylbenzene <0.50 10. Carbon Tetrachloride <0.50 11. Chlorobenzene <0.50 12. Chloroethane <0.50 13, Chloroform <0.50 14. Chloromethane <0.50 15, 2-Clilorotoluene <0.50 16. 4-Chlorotoluene < 0.50 17, Dibromochloromethane < 0.50 18. 1,2-Dibromo-3-Chloropropane < 0.50 19. 1,2-Dibromoethane < 0.50 20. Dibromomethane < 0.50 21. 1,2-Dichlorobenzene < 0.50 22. 1,3-Dichlorobenzene < 0.50 23. 1,4-Dichlorobenzene < 0.50 24, Dichlorodifluoromethane <0.50 25, 1,1-Dichloroethane <0.50 26, 1,2-Dichloroethane < 0.50 27, i,1-Dichloroethene < 0.50 28, Cis-1,2-Dichloroethene <0.50 29. trans-1,2-Dichloroethene < 0,50 30. 1,2-Dichloropropane < 0.50 31. 1,3-Dichloropropane <0.50 32, 2,2-Dichloropropane <0.50 33, I,1-Dichloropropene < 0.50 34. Cis-1,3-Dichloropropene <0.50 35. trans-1,3-Dichloropropene < 0150 36, Ethylbenzene < 0.50 37. Hexachlorobutadiene < 0.50 38. Isopropylbenzene <0.50 39. 4-Isopropyltoluene <0.50 40. Methylene Chloride <0.50 41, Naphthalene <0150 42. Propylbenzene < 0.50 43. Styrene <0,50 44, 1,1,1,2-Tetrachloroethaiie <0.50 45, 1,1,2,2-Tetrachloroethane <0.50 46, Tetrachloroethene <0,50 47, Toluene <0.50 Page: 3 114 OAKMONT DRIVE GREENVILLE, NC 27858 CLIENT: CMSD (SLUDGE & WELLS ACCT) CONTENTNEA METRO. SEWAGE DIST. MS. RENEE PRIDGEN P.O. BOX 477 GRiTON, NC 285 0 REVIEWED BY: VOLATILE ORGANICS STD. METHODS 8260D Drinking Water ID: 37715 Wastewater IDI 10 PHONE (252) 756-6208 FAX (252) 756-0633 CLIENT ID: 416 ANALYST: JAP DATE COLLECTED: 10/18/23 Page: 4 DATE REPORTED: 10/27/23 Date Analyzed: PARAMETERS, ug/1 10/25/23 Well 1/18 48. 1,2,3-Trichlorobenzene < 0.50 49. 1,2,4-Trichlorobenzene <0.50 50. 1,1,1-Ti•ichloroethane <0.50 51, 1,1,2-Trichloroethane <0.50 52, Trichloroethene <0.50 53. Trichlorofluoromethane <0.50 54. 1,2,3-Tricbloropropane <0.50 55, I,2,4-Trimethylbeuzene <0.50 56, 1,3,5-Trimethylbenzene <0,50 57. Vinyl Chloride <0.50 58, 'Total X,ylenes <1100 59. Methyl Tert Butyl Ether < 1.00 SOILS ANALYSIS LAB REPORT'S W CD O T N � � m � � N U 0 a Z E L.. 0. 0 - O N Z L L _ � o � 10 L1. ■O tl' V� M N N N O. r a N o �. t-- VV N 2 Cj 6 C] 6 6 0 0 uO = V �• It h M CO 00 M N 00 00 h 00 00 00 N NO C� -. r d N 0 (h 0� 00 (� W N r r2 r r oy N a; .�. r r N .N W C) N N N N N N N 0 0 0 0 0 6 Lf) 00 h N h 0�0 A (�) w a' 0 0 0 0 0 (D 0 .� LO N N 0) to N co -. N N N— N N N co c0 (O 6) h N O r CO a2 N N It M 'IT LL -': ti —o N_(D� N N.- <° r N M N Z_ Y M N LD N M N U) ty)) Cl) N (_ LO �W Q U) J m E Q: N r r N r N r © 3 �°a a Lri co to Lfl cd m ffl o IL y LO CO O CO h J' N a)V :. LO CO (D iD (fl (fl (O -- : tD rn rn r O rn h �1} LO 6) N h N dt N (0tio � o Lo co o 0 0 d 0 O_ O 0 N N N CO (O CO wD to (.0 m LO fo La 0 07 M Ch a0 Ch a0 A6 0 co Cn t0 coN(OO CA O a: LLI Lf) O N Gr, . 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N C N (V z Y M00 � r w V � n co co r u LO Z LU co 4 M w LO C1 N " Q U N i� i� Z LLIrLLff x W LQl„ ❑ N N C ` U �a 7 A3 "O �0 U ,p N Uo (6 O m O C L O U W C O a- 7 tW N E � E o o rr •C O Q N �U) U N U m *0 U) @ m m _-z, z � a o U c X l0-U O X C W F- Nk N N U)f r CO d L CL Nc`no of dm' a `o 61610 0 6 a, e N N :. (3) co O m m 00 V cD oo h �ti ao ao C3 a. Ol 0):-. N r N N N N W '. W N N r N N O O T O N 00 CO O C; O O O O O O N V M A dt a a N � d c CD o ci c a LL. N N M o p L N cr Z M N m N dam' to co w 0 .: r co N o N o CD n0 3 o c? Ln o � 0 0 r 3 a 1 10 LO CO o U.. d •� :' m to 00 m I 1-- @ cn 't I cn I �.. co h r co It g N It d M d M OO d 0 E 4. i[j N N 'V' . Lo h h r Lo o 0 0 0 0 0 0 O CA CQ <P (D W 0) I 0) 0) I � 0) 0)0) m O W m m m m W 00 OO Q z Z Cl) co Q U h W N 04 h N N WW X N m iJJ Ga a 0. Q m z 6 U v r q 42 o aas E N'N m O o l0 0. 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N Q iC °Is: a m r v a a LL c " Z : o N VJ Z Q 0 V 0 LLJ a ZD w m h m SavedRx: LIME22-23 Soil Fertility Grower: CMSD Farm: WILEY GASKINS RD Field(s): Multiple Fields Tenn Lime - Fertilizer Application (lbs/ac) - 17.5......... ............. ............. ..._.-................... ................... -_- ............. .,------ .- ---------- Crop Type: Pick Type Equation Variables Target pH: 6 Lab: Waters NC Switch Rate: 600 Ibs/ac Total Area: 75.85 ac Equation: Lab - Default Rate Multiplier: NIA Total Product: 27540.64 lbs Commodity: Bermuda Grass Rate Subtract: NIA Total Product Bulk: 13.77 ton Sample Date: 2022-11-28 Min Application Rate: 600.0 Ibs/ac Product Cost / Bulk: $0.0/ton Rec Multiplier: NIA Max Application Rate: 3626.52 lbslac Total Product Price: $0.0 Rec Subtract: NIA Avg Application Rate: 1537.29 Ibslac Application Cost / Area: $0.0/ac Max Rate: NIA Application Area: 17.92 ac Total Application Cost: $0.0 Min Rate: 600 lbslac Average Field Rate: 363.10 lbslac Total Cost: $0.0 Ayden Nitrogen 12/13/22 08:50 AM E F C� S Y S T E M S" 4728 Old NC 11 Ayden, NC 28513 252-746-2152 1 /2 Ayden Nitrogen 4728 Old NC 11 1 P.O. Box 7 Ayden NC 28513 252-746-2152 Fax:252-740-8472 Contentnea Metro sewage Dist Po Box 477 Grifton, NC 28530 Quantity Description 13.750 Tons Dolomitic lime • Sulk 13.750 Each App Pees Dry Fertz Terms; Unless otherwise agreed in writing by Harvey Fertilizer & Gas Co, interest will accrue at a periodic rats of 1.5% per month. To avoid additional finance charges, payments must be In office by last day of month. Invoice Invoice Date 0110312023 Due Date 02102/2023 Customer ID 010202 Shipping Loc. 01 1024331 Unit Price Total $ 72.50 /Tons 15.00 /Each Sub Total Amount Due Remit To: Harveys P.O. Box 189 Kinston NC 28502 Phone #: 252-523-9090 996,88 206.25 1,203.13 1,203.13 :antentnea Metro sewage Dist Invoice 1024331 File Copy 1