WQ0018078_GW Monitoring_20061221

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;Point: Effluent: ❑ Influent:
::::::.:.:::.:.:.:.: ::.......::::% :-: ....•
........ ... ...... .
Point: ' Effluent:,- Influent:
` ❑ Surtace Water (SW) ❑
SIN CodelNarne
i f.dtoring
luent Flow For This Month Generated At his Facility: Yes: No:' �
.. .. ................
z 50050 00400. 50060 00310
00610 00530 31616
, Daily Rate
t
Fecal I
sr
,��'ime- ,Operator ORC .(Flow) into
". 'Treatment '
Cotilonn i r
r_%2400 Time on on Residual BOD-S
(Geo melrlc 'f
y-E' Clock Site Site?; , System %pH' Chlorine 20.:C NH3-N 7SS' Mean•),• ;; +
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HAS
Y/N_
' GALLONS
UNITS
UG/L
MG/L
MG/L
-MG/L
1100ML
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241-7 0 0
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24
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25
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27
090o
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2,6400'
29
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31
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N
2.2000 "
.
Average
Z8 7
{:
Daily Maximum :
.49006
Daily Minimum
ZZOoo
Monthly Limit(s)
Ilj
Composite (C) / Grab (G)
Operatorin"Responsible Charge (ORC): kq h l�.
" 2Q So2r ( Grade: f:S Phone: g 10 73�' % I
Check Box if ORC Has Changed: ❑ .
ORC Certification,�Number:
Certified, Laboratories (1): V 0.hir\ 1-.a6o ra to i.IQ,S (2): 1! il: y
Person(s) Collecting Samples:`
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
(SIGNATU E OF OPERATOR IN RESPONSIBLE-4 r :
DENR
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE v '
Division of Water.Quality
.AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Center
RALEIGH, NC 27699-1617
I
DENR:FORM NDMR1 (5/2003)

N%3 ,
bUtWl1 t-UKM UN Tr-LLUYY t'Ht9:K UNLT
Please Print Clearly or Type
,Facility i4ame: Bay Tree Lakes
Permit Name (it different):
Facility Address: 33 W. Bay Ride Road
Harrells 28466County Bladen
Contact Person: Stephen Jones t 110) (zip) Telephone #[phone]
Well Location/ Site Name: Well # 1 4
No. of Wells to be Sampled:
tom Ptrm
Well Identification Number (from Permit): Well #1 For Groundwater Treatment Systems
Well Depth: ' .a,U ft. Well Diameter: 2 In. Check One:
Screened Interval: - ft. to ft• . ❑ Influent (98)
Depth to Water Level: ft. below measuring point. ❑ Effluent (99)
Measuring Point is ft. above land surface.
Gallons of water pumpedibailed before sampling: /110
Field analysis: pH 4110 , Specific Conductance uMhos
Temp. ��°C, Odor Appearance
PERMIT #: 'EXPIRATION DATE: 31-0,
Non:Discharge WQ0018708 UiC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon —_Rerhedialion Infiltration Gallery
Spray Field
Rotary 6Istributor — -Land Application of ' `, IVED
Other g '�`��� g h 7 +I 4, c 'fit in
NOTE: Values "666)d,i'eflect dissolved -and;!
colloidal concentrations.. =
Date sample collected: Dale sample analyzed:
Laboratory Name: �-0 - !s' fiord
laboratory
Certification No: 22, 75
pARAMETEg$ (samples for metals were collected unuttered YES NO and field acidified
COD mg/I Nitrite (NO2) as N. mg11
Coliform: MF Fecal e t /100ml Nitrate (NO3) as N < Oao- mg/I
Coliform: MF Total /100ml Phosphorus: Total as P <0,.6-2. mg/I
(Note: Use MAN method for highly turbid samples) Orthophosphate mg/I
Dissolved Solids: Total _ <',! mg/I At - Aluminum mg/l
pH (when analyzed) units Ba Barium mg/i
Tnr. . x mall Ca - Calcium leg/i
Arsenic
m9/I
Grease and.0ils
mg/I
Phenol
mg/I
Sulfate.
mg/I
Specific Conductance
uMhos
Total Ammonia
I h mg/l
TKN as N
mg/I
UU - udunnuirl
Chromium: Total
IIour K
mg/l
Cu - Copper
mg/l
Fe - Iron'
mg/I
Hg - Mercury
mg/l
K - Potassium
mg/l
Mg ! Magnesium
mgll.
Mn - Manganese
mg/i
P, ^ i ( C•p
-YES' NO)
Ni Nickel - mgl
Pb - Lead -;
Zn - Zinc mgl
Ammonia Nitrogen mgl
Other (specify Compounds and Concentration Unit
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached?' Yes (1) No
VOG : method #
method., -a
. metho�, # a
Permitlee (or Authorized Agent) Name and Title - Please print or type.
(ate)
GW--59 Rev: d/98 ftnature 91erm nee for Aulhotizrr grnl)
Q'

SUBMIT FORM ON YELLOW PAPER ONLY
Please Print Clearly or Type
Facility name: Bav Tree Lakes
Permit Name (11 different)_
t3arrel s 28466county Bladen
Contact Person: Stephen Jones ""I I (z4i Telephone #[phone]
Well Location/ Site Name: Well #5 No. of Wells lobe Sampled: 4
reri mi+irmrl
Well Identification. Number r as
Permit): - well Fa For Groundwater treatment Systems
�IJ
Well Depth: s /S ft. Well Diameter: 2 in• I Check One:
Screened Interval: ft. to ft. t1 lnfiuent 1981
PERMIT M 'EXPIRATION DATE: ?-1,1 To
Non -Discharge WQ0018708 UIC
NPDES
TYPE OF PE M,TTED OPERATION BEING MONITORED
Lagoon Rerhediatlon: Infiltration Gallery,
^ V Spray Field Remediallon:
Rotary Distributor Land Application of Sludge
Other:
NQJE: Values should reflect dissolved and
epm IO Water Leven --di. DBlvw mdasuruly punu. Dvllvludt ap[[rivnlla[rv.u�•
Effluent99
Measuring Point is ft. above land surface.
Gallons of water pumped/bailed before sampling: Date sample collected: �z7�d �' Date sample analyzed: i2-27. U
Field analysis: p . g• , Specific Conductance uMhos Laboratory Name: V� ' OsFnzd 1'�'0° b0°�
Temp. .1 °C, Odor Appearance Certification_ No. 22- 75
PARAMETERS (Samples for metals were collected unflitered• YES NO
and field acidified
COD
mg/1
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
< 1 /100m1
Nitrate (NO3) as N
mg/i
Collform: MF Total
/100m1
Phosphorus: Total as P
01 to mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/l
Dissolved Solids: Total /umgA
Al - Aluminum
mg/1
pH (when analyzed)
units
Ba - Barium
mg/i
TOO
8,152.-- mg/I
Ca - Calcium
mg/I
Chloride
17 Q mg/I
Cd - Cadmium
mg/1
Arsenic
mg/I
Chromium: Total
mg/i
Grease and.011s
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/i
Hg - Mercury
mg/I
Specific Conductance
i Nhos
K - Potassium
mgli
Total Ammonia
-1-73 mg/I
Mg � Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/I
'Pel/ T we'r
YES NO) .
Ni Nickel mg11
Pb - Lear Div. 0 t �mgii
Zn - Zinc mg/I
Ammonia Nitrogen:.., � _ i � �,� mg/I
Other (Specify Compou68 and'Concentration Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached?, Yes _(1) No (0)
VOC method # -_
methods
methgo #
POMIR013 for Auoionxgo Agonti Name and T iU9 - pease prett cr type
•r
GIAr-59 Frev.:4/98 ne u►n ^1 Patmillan fro Asithmirsirt Annnil ( ate

SUBMI F FORM ON
PAPER ONLY
Please Print Clearly or Type
Facility Name: Bay Tree Lakes
Permit Name (if dl(ferent)-
lawn Stephen Jones ""'°, 141 910-588-4432
Contact Person: Telephone #.
Well Location/ Site Name:. Well #3 - No. of Wells to be Sampled: 4
eeri m�irmil
Well Identification Number (from Permit): ' well tFs For Groundwater Treatment Systems
Well Depth: * 2fSS-ft. Well Diameter: 2 in. Check One:
Screened Interval: ft. to n• . ❑ Influent (98)
Depth to Water Level: 5314 ft. below measuring point. ❑ Effluent (99)
Measuring Point is ft. above land surface.
Gallons of water pumped/balled before sampling: it IaO
Field analysis: pH 3 , Specific Conductance uMhos
Temp. Z,+. °C, Odor Appearance
PERMIT #: EXPIRATION DATE: - tj _
Non.0scharge_ WQ0018708 UIC
NPES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Rerhedfatlon: Infiltration Gallery,
✓ Spray Field Remedlation:
Rotary Distributor Land Applicallon of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample collected: / 'ZZ-o Date sample analyzed:
Laboratory' Name: Ism �' �Drd Laboratory
Certification. No.' 22, 75
EARAMETU$$ (Samples for metals were collected unfiltered., --YES
No and field acidified
COD
mg/i
Nitrite (NO2) as N
mg/l
Coliform: MF Fecal
c 1 /100ml
Nitrate (NO3) as N
ewo mg/l
Collform: MF Total
/100ml
Phosphorus: Total as P ®. 7 mg/I
IN Use MPN method for highly turbld samples)
Orthophosphate
mgll
Dissolved Solids: Total
mg/I
Al - Aluminum
mg/l
pH (when analyzed)
units
Ba - Barium
mg/I
TOC .
Y. SS ma/I
Ca - Calcium
mg/l
Ghionae
k I mgn
Arsenic
mg/l
Grease and.011s
mg/I
Phenol
mg/I
Sulfate
tng/I
Specific Conductance
uMhos
Total Ammonia
°,1' mg/l
TKN as _
mg/l
G%AI-59 Rev.:4/98
v%a - W"W1411 . 1
Chromium: Total
...y..
mg/l
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg'- Magnesium
mg/I
Mn - Manganese
mg/I
YES NO) ..
Ni - Nickel mg/I
Pb - Lead mg/l
Zn - Zinc mg/l
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
KeGe-lVED
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached?, Yes (1) No (0
VOG : method # R
methodA
metho #
PerwJfte (or Aulharked Agonl) Name and Title - Pleese pr or type
.Igna ure o . erm t ee jor Authorlml Aqam) (ate

SUBMIT FORM ON Yi;;LLuw FAM:K UNLY
Please Print Clearly -or Type
Facility Name: Bav Tree Lakes
Permit Name (if dUlere t)Ba Ridge Road
Facility Address: 33
Harrells 28466County Bladen
"r Person: p Stephen Jones "'� rev
Con act Telephone #[phone] Well Location! Site Name: Well #2 No. of Wells to be Sampled: 4
tom um
Well Identification Number (froth Permit): Well #2 For Groundwater Treatment Systems
Well Depth: ' I M12-ft. Well Diameter: 2 In. Check One: -
Screened Interval: _ ft. to ft. . ❑ influent (98)
Depth to Water Level: 7, 3S ft, below measuring point, ❑ Effluent (99)
Measuririg Point Is—ft. above land surface.
Gallons of water pumped/balled before sampling: !__._ 5 1
Field analysis: pH 44 6 Specific Conductance _ uMhos
Temp. zN °C, Odor_ Appearance
PERMIT #: . 'EXPIRATION DATE: I=ILdlk
Nort0scharge NQ0018708 UIC
NPDES
IyPE OF PERMITTED OPERATION BEING MONITORED
Lagoon - Rerhediation: Infiltration Gallery'
Spray Field Remedlatlon:
Rotary Distributor Land Application of Sludge
Other.
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample collected: "Z7-0 Date sam le analyzed: km
Laboratory Name: �� ""`a"`i"`s' og6ard
Certification No: 22. 75
pABp�METEga (Samples for metals were collected unflltered� YES - NO
and field acidlfted
COD mg/l
Nitrite (NO2) as N
m9/1
Coliform: MF Fecal c 1 /100ml
Nitrate (NO3) as N
�'°,�a mg/I
Coliform: MF Total /100mi
Phosphorus: Total as P
e0.61 mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
m9/l
m9/l
Dissolved Solids: Total 7 Z mg/l
Al —Aluminum
pH (when analyzed) units
Ba - Barium
m9/i
'Mr% 4,,07 mall
Ca - Calcium
m9/I
Chloride
° m.911
Arsenic
mg/I
Grease and,Olis
mg/l
Phenol
m9/i
Sulfate
mg/1
Specific Conductance
uMhos
Total Ammonia
°'� mg/I
TKN as N
m9/I
GWI-59 Rev.:4/98
ud - uaamium
Chromium: Total
rlryrr
mg/I
Cu - Copper
mg/I
Fe - Iron,
mg/I
Hg - Mercury
m9/1
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn- Manganese
mg/i
YES , NO)
Ni - Nickel M91
Pb - Lead M91
Zn - Zinc mgi
Ammonia Nitrogen m9/
Other (Specify compounds and Concentration Unit
C cr- j%pig---
i'1air--^—
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached?, Yes (1) Na I
VOC method # a
method,
meth # _ —

k,W-:1VA t_U1V1rjU1jA1N%_n ItErtiml VUI!UVI - - rermt ?Fw q,go ir b v
(Sil himit one each monitoring period with GW-59form* &)"
Enter date monitoring results we
besubmitted after the establishe
e due. (/2 - 3 1-0 L) Will this monitoring report (13W-59 and GW-59A)
I due date?
YES
2
Was any required Information missh
g on the GW-59 report forms?
YES
07
IF the answer to question I or 2 is '
(ES" list in the space provided below the well identification number(s) and
explain the problems encountered it.
obtaining the required information.
3,
Are any of the monitor wells in need i
if repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
CIKO)
identification plate, area overgrown,
!tc.)?,Ythe answer is "Yes". contact the Regional Officeforguldiapice.
4
Are any monitored constituents a
jual to or above the established standards?
YES,
If the answer -to question 4 is "NO", :kip
to section &
If the answer to question 4 is "YE
5" list the affected wells individually with constiluent(s), and concentratiod(s)
exceeding standards in the. space pi
ovided below.
5
For -the constituents Identified in
same constituent(s) in the'sarne i
luestion 4 above, have standards been exceeded previously for the
911(s) In thelast two years?
YES
If the answer to question -5 is "NO" -
kip to section 8.
If the answer to question 5 Is 11.Y1
S", list in the space provided below, each well with constituent(s) exceeding.
standards, concentration(s) reporte
and sample, collection date for each occurrence (for the .last two years).
6
Are the monitoring Wells listed in
In
action 5 located at or beyond the review boundary?
YES
NO
If the answer is "YESground
", it
problem quality ptoblemay be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIA TEL Y FMOR G
NCE. If the.answer Is "NO". monitoring wells may be improperly
located; contact the Regional A
ie:_
7
Is the permittee implementing pro
groundwater quality problem?
dously, approved actions required by the Division Involving this
YES
NO
If the answer to question 7 is "YES",
desdribe those actions in the space provided below.
If the answer to question 7 is "NO
'I, contact the Regional Office within 90 days; an evaluation may be
reautred to determine the Impact
he waste disposal system is having at the review and compliance-.
boundaries surroundina this fac
ty. Failure to do so may sublect the -pennittee to a Notice of Violation,
fines, and/or penalties.
8
The'person completing thispo
form with GW-59 forms for req.....uir
(GW-49A) of the monitoring report should sign below and submit this
d wells to the address provided at the top of the current G,W-59 form.
41616__rge6yv�`56 WXW a 0'. n I
0
repot Compliance 0
Nil s
a or 5767TU ! i. V
M. AV
"WX
Signature of Perinitteb rAuthori
edenjl, Date

47vu
rdLaboratory
1316 S. Fifth Street.
Page 1 of 2
ilmington, NC 28401
Telephone: [phone]
W�
NCIWCert. #: 075
. Fax: [phone]
NC/DW Certy'. #: 37721
www.oxfordiaboratorycom ,
La
oratory
Report
— Prepared for —
Wayne Vann
Report Date:
12/8/2006
Vann Laboratories
Date Received:.
11/29/2006
.PO Box 668.
Wallace, NC 28466
Work Order#:
0611-59777
Project No.:
Cust. Code:
VANN79
Project ID: VL112706103-107 N
4 X,NO3,TPHOS
Cust. P.O.#:
No. Sample ID
Date Sampled
Time Sampled Matrix
Sample Type
Condition
001 VL112706103
11/27/2006 `
16:50 WW
Grab
4 +/- 2 deg
Analyzed
Test Performed
Method
Results
Date Time
Qualifier
Nitrate+Nitrite
i SM 450OF
3.32 mg/L
11/29/06 14:00
No. Sample ID
Date Sampled
Time Sampled Matrix
Sample Type
Condition
002 VL112706104
11/27/2006
15:35 . GW ''
Grab
4 +1- 2 deg
Analyzed
Test Performed
Method
Results
Date Time,
Qualifier
Nitrate
SM 4500BIF
<0.10 mg/L
11/29/06 10:00
Phosphorus, Total
SM 4500B/E
<0.02 mg/L
1217106 8:00
No. Sample ID
Date Sampled
Time Sampled Matrix
Sample Type Condition
003 VL112706105
11/27/2006
16:05 GW
Grab
4 +/- 2-deg
Analyzed
Test Performed
Method
Results
Date Time
Qualifier
Nitrate
SM 4500BIF
<0.10 mg/L
11/29/06 10:00
Phosphors, Total
SM 4500BIE
40.02 mg/L
1217/06 8:00
No. Sample ID
Date Sampled
.Time Sampled Matrix •
Sample Type
Condition ,
004 VL112706106
11/27/2006
16:35 GW
Grab
4 +1- 2 deg
Analyzed
Test Performed
Method
Results
Date Time
Qualifier
Nitrate
SM 4500BIF
50.10 mg/L
.11129106 10:00
-
Phosphorus, Total
8M 4500B/E
0.27. mg/L
1217106 8:00

= �
Oxford
taborcitory
1316 S. Fifth Street
Page 2 of 2
Telephone: [phone]
-Wilmington,, NC 28401
NCMn�V Cert. #: 075
Fax: [phone]
NC/DW Cep. M 37721
www.oxfordia6oratory.com
Laboratory
Report
Work
Order #: 0611-59777.
No. Sample ID
Date Sampled 'Time Sampled Matrix
Sample Type Condition
005 VL112706107
11/27/2006 17:05 GW
Grab 4 +/- 2 deg C
Analyzed
Test Performed
Method Results
Date Time Qualifier
Nitrate
SM 4500B/F <0.10 mg/L
11/29/06 10:00
Phosphorus, Total
'SM 4500131E 0.10 mg/L
1217/06 8:00
Review d by:
fnr flvfnrel 1 �hnr�4 ni

Vann Labovatod6s
P.O. Box 068 .
Wallace NC, 28466
Phone: (9,685-3966
Fax: [phone]
well.samples
Client pH Meter
Model: 50:
Date Sampled: 11�i7��Z Sedal #: C000
222:
Calibrated: D
91 4 Time: xxp
Sampled By: Buffer
.00uo
suffer
'0.00 /a. �
Buff r
.00
Analyst:
Loeatlon aQ.
�.
F -�
Well'l. D.
..�
Depth of Well (ft) .
- -
Depth -to Water level(ft)
Water Depth (ft)
21,6/�3S
Well Vol. * 3 (Gals) ..
,
1. ,0
Time Sampled
J
Temperature,. oC
,.
Color.
.Dat, / Lv G
Sampler's Slgnatuie:L4
�.

M
August 24, 2006
Lake Creek Corporation
33 W. Bay Ridge Road
Rarrells, NC 28444
ATTN: Information Processing Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Monitoring Well Reports
Dear Sir or Madam,
In compliance with our Non -Discharge Spray Irrigation Permit Number WQ0018708,
please find enclosed our required monitoring reports for the month of July 2006.
This. includes : Original and two copies of GW-59 and GW-59A forms.
If you need any other information or have any questions, you may contact me by
telephone at [phone].
Thank you for your consideration.
Sincerely,
Hugh B. Bledsoe
ORC

SUbMi I I—UKM UN
PAPER ONLY
0
Facillty Name:_J&
Permit Name (if dif Is
Contact Person:&
Well Location/ Site
Print Clearlybf Type
County Wla�—'
Telephone #: 00-5w -49
No. of Wells to be Sampled:
Well Identification Number (from Permit): EUVMI F ' For Groundwater Treatment Systems
Well Depth • AL 7 ft. Well Diameter: In. Check One:
Screened Interval': ft. to ft. ❑ Influent (98)
Depth to Water Level:eft. below measuring point. ❑ Effluent (99)
Measuring Point is ft. above land surface.
Gallons of water pumped/bailed before sampling:
Field analysis: pH_.___ . I , Specific Conductance uMhos
Temp. 113 °C, Odor Appearance
PERMIT#: EXPIRATION DATE: b1`4l
Non -Discharge G�/`f !10l �'h 8� UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
✓Spray Field-Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample coilecte Date s p a y ed: l
Laboratory Name:
Certification No; ,12; S�
PARAMETER$ (Samples for metals were collected unfiltered YES - NO
and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/1
Coliform: MF Fecal
<1 /100ml
Nitrate (NO3) as N
mg/1
Coliform: MF Total
/100ml
Phosphorus: Total as P
<0,e2, mg/I
(Note: Use MPN method for highly turbid
samples)
Orthophosphate
mg/1
Dissolved Solids: Total
Smg/l
Al - Aluminum
mg/I
pH (when analyzed)_
units
Ba - Barium
mg/I
TOC-
mg/I
Ca - Calcium
mgll
Chloride
mg/l
Cd - Cadmium
mg/1
Arsenic
mg/I
Chromium: Total
mg/1
Grease and:011s
mg/I
Cu - Copper
mg/1
Phenol
mg/i
Fe - Iron
mg/1
Suifate
mg/I
Hg - Mercury
mg/1
Specific Conductance
i iMhos
K - Potassium
mg/l
Total Ammonia
< ��%�'mg/I
Mg ' Magnesium
mg/l
TKN as N
mg/l
Mn- Manganese
mg/l
GVLI-59 Rev. 4/98
YES NO)
Ni - Nickel
mgi
Pb - Lead—,
mg
Zn - Zinc
mg
Ammonia Nitrogen _
mg,
Other (Specify Compounds .and C entmAn Uni
r~)
F
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach
lab report.)
Report Attached? Yes _ (1)
No
VOC method #
: method #
method #

but311411 f ullm UN
VAi'kK ONLY
Facility Name:_
Permit Name (if
Weil Location/ Site Name:
Please Print Clearly or Type
County
Telephone #:lU-S�$ jl
No. of Wells to be Sampled:
Well Identification Number (from Permit): &U� Z For Groundwater Treatment Systems ,
Well Depth: .1-A. 7a - ft. Well Diameter: 2' in• Check One:
Screened Interval: ft. to ft. ❑ Influent
Depth to Water Level: ei&y ft. below measuring point. El Effluent
Measuring Point is ft. above land surface.
Gallons of water pi mped/batied before sampling: lo,d3
Field analysis: pH 4y , Specific Conductance uMhos
Temp. W °C, Odor . Appearance
(98)
PERMIT M EXPIRATION DATE:
Non:Discharge K!Q,, �-Q lKal UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Rerhediation: Infiltration Gallery
r%Spray Field Remediation:
Rotary Distributor Land Application of Sludge
NQTE: Values should reflect dissolved and
colloidal concentrations.
Date sample collect p�l�v � �dZ� Date .10 �� le �ed: Z /1-4
Laboratory Name: ��//
Certification No: Z2)?S
11
PARAMETERS (Samples for metals were collected unfiltered YES NO
and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal 1
/100ml
Nitrate (NO3) as N
<6,10 mg/l
Collform: MF Total
/100ml
Phosphorus: Total as P
0•01 mg/l
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total mg/1'
Orthophosphate
Al - Aluminum
-mg/I
mg/I
pH (when analyzed)
units
Ba - Barium
mg/l
TOC
mg/l
Ca - Calcium
mg/I
Chloride &;5
mg/I
Cd - Cadmium
mg/1
Arsenic
mg/I
Chromium: Total
mg/i
Grease and.Oils
mg/i
Cu - Copper
mg/I
Phenol
mg/l
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I -
Total Ammonia 4.oix-
mg/l
Mg'- Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
m411
GWI-69 Rev: a/98
YES NO)
Ni - Nickel
mg/l
Pb - Lear1
mg/l
Zn - Zinc
mg/l
Ammonia Nitrogen
.c;
- mg/I
Other (Specify Compounds and Fnnceitli(lon
Units).
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach
lab report.).
Report Attached? Yes (1)
No
(0)
VOC : method #
: method # =
: method # Q

but$Mi I t'UKM UN Tt:LLUW YAPEH ONLY
.Facility (Varner_
Permit Name (if
Well Location/ Site Name:
Please Print Clearly or Type
County °
Telephone #: ���s •t°�3?�'
No. of Wells to be Sampled:
Well Identification Number (from Permit): &W— 3 For Groundwater Treatment Systems
Well Depth * 1,AJ5 ft. Well Diameter: In. Check One:
Screened Interval: ft. to - ft. ❑ Influent (98)
Depth to Water Level: 7, Vbft. below measuring point. Cl Effluent .(99)
Measuring Point Is I ft. above land surface.
Gallons of water pumped/bailed before sampling: LUZ
Field analysis: pF `�- Specific Conductance uMhos
Temp. ;S °C, Odor Appearance
PERMIT M EXPIRATION DATE: d
Non=Dlscharge M4076T UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Rerrlediation: Infiltration Gallery
_ - Spray Field Remediatlon:
Rotary Distributor Land Application of Sludge
Other:
NQTE:, Values should reflect dissolved and
colloidal concentrations.
Date sample collect .: 7-4 Z4& Date sa Ie n Iy ed: 17-
Laboratory' Name:
Certification No.
PARAMETERS (Samples for metals were collected unfiltered., --YES _ -NO
and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform:,MF Fecal
K / /100ml
Nitrate (NO3) as N
mg/l
Coliform: MF Total
/100ml
Phosphorus: Total as P
ray �� mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total_
<40 mg/I
AI - Aluminum
mg/l
pH (when analyzed)
units
Ba - Barium
mg/I
TOC
�+00mg/I
Ca - Calcium
mg/i
Chloride
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/l
Chromium: Total
mg/I
Grease and_Oils
mg/l
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron,
mg/I
Sulfate
mg/l
Hg - Mercury
mg/l
Specific Conductance
uMhos
K - Potassium
m'g/I
Total Ammonia
ea�to mg/I
Mg ;Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/i
GVh,59 ROAM
YES NO)
Ni - Nickel ' mg/i.
Pb - Lead mg/I
Zn - Zinc mg/l
Ammonia Nitrogen ' mg/i
Other (Specify Compounds arikonitnr't'ration Units)
ORGANICS: (GG,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No _ (0)
VOC method #
method #
method # _

ovolvil I rumor vim 1CL.LVyy rtwcm UNLr
Facility (Name:_
Permit Name (if
Well Location/ Site Name:
Please Print Clearly or
County
Telephone M
No. of Wells to be Sampled:
Well Identification Number (from Permit): , ` ,5 For Groundwater Treatment; Systems
Well Depth: z '`-ft. Well Diameter: Z in. Check One:
Screened interval: ft. to ft. ❑ Influent (98)
Depth to Water Level: ft. below measuring point. 0 Effluent (99)
Measuring Point is ft. above land surface. �
Gallons of water pumped/b iled before sampling: !
Field analysis: pH - L , Specific Conductance ❑Mhos
Temp. `.°C, Odor Appearance
PERMIT M EXPIRATION DATE:.._
Non:Discharge W__Q ODIMY UIC
NPDES k
TYPE QF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
._, Spray Field Flemediatfon:
Rotary Distfibutor Land Application of Sludge
Other: --- -
NOTE: Values should reflect dissolved and
colloidal concentrations.
Dale sample collecte�: �� Z-0 Date sarpple n�ly;� ' 7 U1
Laboratory Name: J/C� s,�f rC do-/�
Certification No:.,1 Z �'
PARAMETE$� (Samples for metals were collected untifiered YES
NO and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal < I /100ml
Nitrate (NO3) as N
5" mg/l
Coliform: MF Total
/100ml
Phosphorus: Total as
P. mg/I
(Note: Uae MPN method for highly turbid samples)
Dissolved Solids: Total `t� mg/i
Orthophosphate
Al - Aluminum
mg/I
mg/I
pH (when analyzed)
units
Ba - Barium
mg/i
TOC
7, mg/I
Ca - Calcium
mg/I
Chloride
�0S mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and.0ils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mgll
Specific Conductance
Total Ammonia
uMhos
Z� mg/I
K - Potassium
Mg'- Magnesium
mg/I
mg/I
TKN as N
mg/i
Mn - Manganese
mg/I
G1R1-59 Rev: 4/99
YES NO)
Ni - Nickel
mg/I
Pb - Lead
M mg/I
Zn - Zinc
-- mg/1
Ammonia Nitrogen
mg/I
Other. (Specify Compounds and cReent
opri Units)
- rv1-
cro
.v
ORGANICS: (GC,GC/MS,HPLC)
--�
(Specify test and method #. Attach
lab report.) .
Report Attached? Yes (1)
No (0)
VOC method #
method # =
method # -

(Submit one each monitoring period with GW-59 forms:)
1
2
3
4
Enter date monitoring results were due. ( — 0-vb i Will this monitoring report
be. submitted after the established due date?
Was any required information missing on the GW:59 report forms?
IF the answer to question 1 or 2 is "YES list in the space provided below the well idea
explain the problems encountered in obtaining the required information.
YES
Are any of the monitor wells in need. of repair or maintenance (damaged casing, unlocked or missing cap, missing YES
identification plate, area overgrown, etc.)? If the answer is "Yes' , contact the Regional Of ce for guidance.
Are any monitored constituents equal to or above the established standards?
If the answer to question 4 is `NO-, skip to section 8. -
If the answer to question 4 is "YES" list the affected wells individuafly with constituents) and concentrations)
exceeding standards in the space provided below.
5 For the constituents identified in question 4 above, have standards been exceeded previously for the I YES I NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO". skjp to section 8.
-if the answer to question 5 is "YES; list in the space provided below, each well with constituent(s) exceeding
standards, concentrations) reported, and sample collection date for each occurrence (for the last two years).
6 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 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.
i Is the permittee implementing previously approved actions required by the Division involving this YES NO
groundwater quality problem?
If the answer to question 7 is "YES, describe those actions in the space provided below.
If the answer to question 7Is "NO", contact the Regional Office wlthln 90 days: an evaluation maybe
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 germittee to a Notice of Wolatjon,
fines. and/or penalties
g The person completing this portion (GW--59A) of the. monitoring report should sign below and submit this
form with OW--59 forms for required wells to the address provided at the top of the current GW-59 form.
Date

3 -p p

GW-59A COMPLIANCE REPORT FORM,,., Permit #' ©U I ��
(Submit one each monitoring period with GW 59 forms.)
1
Enter date monitoring results were due: - -0 Will this monitoring report (GIN-59 and GW-59A) "`
YES
O
be.submitted afterthe-establisheddue date?
-2
Was any required -information -missing on the. GW-59 report forms?
YES
NO
7F the answer to question 1 or 2 is "YES" list in the space - provided below_ the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells -.in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
identification plate, area.overgrown; etc.)? if the answer is "Yes'; contact the Regional Office jorguidance.
J
4-
Are any monitored constituents equal to or above the established standards?
YES
O
If the answer to. question 41s "NO" skip to section 8.; -
If the answer to question 4 is "YES" list the affected wells individually with. constituent(s) and concentrations)
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 constituents) exceeding -
standards, concentrations) reported, and..sample collection date fon:each occurrence (for the last two years).
6 •
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
if the answer is "YES", a groundwater qualityproblem,may be occurring. CONTACT THE REGIONAL .
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO ; monitoring,wells may be improperly
.located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
'YES
NO
groundwater quality problem? _
If the answer. to question.7 is "YES", describe those actions in the space provided below...
If the answer to question 7 is "NO", contact the Regional Office within 90 days:. an evaluation may be
required to determine the impact the waste disposal. system is having at the,review and compliance
boundaries surrounding this facility: Failure to do so may subject the bermittee to a Notice of Violation,
fines, and/or penalties.
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 at the top of the current GW-59 form.
'y'_Y_X�' afY• Y'2'L°p •t AYA. is X9E,•FdY+FG^^l';gS '8�!^P'.#FG-Tiin""F"�bu.N' .^Rt:. _J!^-"'•f'1.. `"�. 'K.ne"y $fiw .'Cin$•`_`e'T`.Y' F
I�h�rebyacknow�edge that�the,,�alove�n �orm�atl�onnw�as�,evalitate�d nd tit,e�n�o,'„ctn�atfonsublrm�tted n
s
`�i�
;re ork_(Compli eJReYpo W�5 �);is��rueand4completeto,�„,,'the•b�e"Est_of,my_,4,cnowledg�e,,,_,;;.�;����:�
.
Signature of P6rtt6eT0r A thoriz d Agent) Date
GW-59A 12/8/2003

For:
Vann Laboratories Phone: [phone]
P. 0. Box 668
Wallace, NC 28466 Wastewater ID #: 22
WASTEWATER ANALYSIS REPORT
Bay Tree Lakes Date Samples Collected:
March 27,2006
PARAMETER
UNITS
DATE
ANALYZED
Wll 1
Well #2
Well #3
Well #5
PH -
BOD5
mg1L
COD
mg1L
Fecal Coliform
c01.1100 ml
3-27-06
< 1 ...
< 1
< 1
< 1
Total Kjeldahl Nitrogen
mg1L
Total Residue (Dissolved)
mg1L
3-27-06
<40
<40
<40
40.7
Total Suspended Residue
mg1L
Detergents MBAS
mg1L
Oil & Grease
m91L
Total Phosphorous
mg1L
3-29-06
0.02
0.05
0.48
0.44
Sulfides
mg1L
Phenols
ug/L
Total Chromium
ug/L
Total Copper
ug/L
Total Magnesium
mg1L
Total Zinc
ug/L
Ammonia Nitrogen
mg1L
3-27-06
<0.20
Nitrate
mg/L
3-29-06
<0.10
<0.10
<0.10
0.17
Chloride
mg/L
—30-06
4.7
4.7
5.0
15.5
TOC
mg/L
—31-06
2.83 A
5. IS
6.10
15.5
*Analysis performed by Oxford Laboratory
Signed:
Date:

: r.•x:: r.•r rr. •: r•+. •.v: � :. ;. r} r::.•r.}•{{r:
Laboratorlei
PA Box 668
Wallace NC, 28466
Phone: [phone]
` -Fat [phone]
Well. Sample
Client. P� pH Meter
Date Sampled: J-2..7 "J
Model: 50
Serial #: C0008222:
Calibrated:., Date: :3-1-7 _-.y Time:. -:via
,,Sampled By:
Buffer 4.00
Buffer 10.00 wj-,clb
'Buffler 7.0o
_ .
Analyst:
LocatFon>rz
s
Well 1. D.
.
Depth of Well (ffa
Depth to Water Level (ft)
.'
r
Water Depth (ft) ;
Well Vol. * 3 (Gals)
-
��(j`�7
���SV.r,
�%
U
�1
.CiP
/�
. Vt
,
Time Sampled:-
,
dub
S`
Temperature, °C
i
Color .-
Sampler's Signature: Date. .-0

r
Oxford: Laborato rY
1316 S. Fifth, Street
Page 1 of 2.
Wilmington,,WC . 28401
,. Telephone: 910=763-9793
NC/WW Cert. #: 075
Fax: [phone]
NC/DW Cert. #: 37721 .
voww. oxfordlaboratory.com
Lab-ora-tory
Raport
-- . Prepared for —
Wayne Vann
', Report Date:
3130/2006_-'
Vann Laboratories
Date Received:
312812006'
PO Box 668
Wallace, NC 28466
Work Order #:.
0603-51860 '
Project No.: Bay Tree Lakes
Gust. Code: . '-
VANN79
Project ID: VL032706107-111-
NOXIN03/PO4
Cust. P.O:#:'
No. Sample ID Effluent:
Date Sampled
Time Sampled Matrix
Sample Type
Condition
001 VL032706107
3/27/2006
13:10 WW
Grab
4 ±1- 2 deg C
Analyzed
Test Performed
Method
Results
Date , ' Time .
Qualifier
Nitrate+Nitrite
SM`450oF _
5.49 mg/L
3/29/06 14:00
No. Sample ID Well I=
Date Sampled
Time Sampled' Matrix '
Sample Type
Condition
002 VL032706108
3/27/2006
14:05 GW
Grab
4 +1- 2 deg C
Analyzed
Test Performed
Method
Results
Date. Time
` ' Qualifier
Nitrate
SM 450061E
<0.10 mg/L
3129106 7:00
Phosphorus, Total -
SM 450013/E
0.02'mg/L
3129106 10:00
No. Sample ID Well 12
Date Sampled
Time Sampled' Matrix
Sample Type
Condition
003. VL032706109
-3/27/2006
13:45 GW
Grab
4 +1- 2 deg C -
Analyzed'
Test Performed'
Method
Results
Date . Time.
Qualifier '
Nitrate_
SM 4500B/F
<0.10 mg/L
3129106 7t00
Phosphorus, Total
SM 450OB/E .
0.05,mg/L
3/29106 10:00
No. Sample ID Well 13
Date Sampled
Time Sampled Matrix
Sample Type
Condition
004 ' VL032706110;'
3/2712006'
13:25 _ GW
-
Grab
4 +1- 2Aeg C
Analyzed
Test Performed
Method
Results
Date Time
Qualifier
' Nitrate,
SM 45006/F
<0.10 mg/L
3129/06: 7:00
Phosphorus, Total
SM.4500B/E _
0.48 mg/L
3129106 10:00

Oxford. Labo'r'atory,
1316 S. Fifth Street Page 2 of 2
Telephone: [phone] Wilmington, NC -28401 NC1ww Cert. #: 075
Fax: [phone] NC/DW Cert. M 37721
www.oxfordiabor.at.ory.com
Laboratory Report
Bay Tree Lakes Work Order #: 0603-5186.0
No.', Sample ID Well #5 . Date Sampled Time*Sampled Matrix Sample Type Condition
005 VL032706111 3/27/2006 14:26 GW Grab 4 +1 2-deg C
Analyzed
Test Performed 'Method Results Date Time Qualifier
Nitrate SM 4500B/F 0.17 mg/L _ 3129/06 7:00
Phosphorus, Total SM 4500B/E 0.44 mg1L 3129106 10:00
Revie ed by:
for Oxford'Labor to

a
Lake Creek Corporation
33 W. Bay Ridge Road
Harrells, NC 28444
April 20, 2006
ATTN: Information Processing Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Monitoring Well Reports
Dear Sir or Madam,
In compliance with our Non -Discharge Spray Irrigation Permit Number WQ0018708,
please find enclosed our required monitoring reports for the month of March 2006. This
includes: Originals and two copies of GW-59 and GW59A forms. i.
If you need any other information or have any questions, you may contact me by
telephone at [phone].
Thank you for your consideration.
Sincerely,
Hugh B: Bledsoe, ORC
I

61JUM1.1-l-UHM1tiN-XkLLQWPAPER ONLY
.Facility Name:_
Permit Name (if.
• Well'Location/ Site Name:
Please Print Clearly or Type
County 0-`3
Telephone #: 2
No. of Wells to be Sampled:,,_a
-Well Identification Number from Perrnit): ' WAR- f l For Groundwater Treatment Systems
Well Depth: ,,60 ft. Well Diameter: _ in. Check One:
Screened Interval: ft. to ft.
Depth to Water Level: 2Z 'ft. below measuring point. influent (98)
O Measuring Point Is ft. above land surface. Effluent (99)
Gallons of water pumped/bailed before sampling: /673
Field analysis: pH '-, O , Specifio'Conductance uMhos
Temp. °C, Odor Appearance
PERMIT M 'EXPIRATION DATE:
Non -Discharge K4 6' .3Incy UIc
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Rernedtatlon: Infiltration Gallery'
�./ Spray Field Remedlation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should. reflect dissolved and
colloidal concentrations.
Date sample collecte Date s'am 1 aly ed: "
Laboratory Name:
Certificatlon No. 244 7�r
PARAMETERS (Samples for metals were collected unfiltered. YES. NO
and field acidified
. YES'', NO) .
COD
mg/i
Nitrite (NO2) as N
mg/I
NJ =Nickel
mg/I
Coliform: MF Fecal
1 - /100ml
Nitrate (NO3) as N
mg/1
Pb- Lead
mg/I
Coliform:. MF Total
/1 OOmI
Phosphorus: Total as P
mg/I
Zn = Zinc
mg/l
(Note: use MPN method for highly turbid samples)
`�
Orthophosphate
mg/I
Ammonia Nitrogen
mg/l:-
Dissolved Solids: Total
< ` -mg/l
Al -Aluminum
mg/l
Other (specify Compounds and Concentration Units,
.pH (when analyzed)'
units
Ba - Barium
mg/1
TOC
mg/I
Ca - Calcium
mg/I
Chloride
mg/l
Cd - Cadmium
mg/i
Arsenic,
mg/I.
Chromium: Total
mg/l
Grease and.011s
mg/i
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (Gc,GC/Ms,NPLc)
Sulfate
mg/I
Hg - Mercury
mg/I,
(Specify test and method #. Attach lab report.)
.
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (1) No
(0'
Total Ammonia
tag mg/l
' Mg :: MagnesJum-
mg/I
VOC : metbod #
TKN as id
mg/l
Mn - Manganese,
mg/i,
: method #
method # =
Permittes (or Authorized A Name a Title - Please p nt or type
GVlr-59 Rev: 4/98
• _ - nature ol�erm tWe {or Avlhotirrt • ganil (Dale]

vv W.m. . v. v•. - .• . •". ' 1% V11L.I
.Facility iVame:_
Permit Name (if.
Contact Person:
-
Well'L-ocation/. Site Name:
Please Prinj Cliarly or Type
}
County C
Telephone #:
No. of Wells to be Sampled:,. -
Well Identification Number (from Permit):' Wel/X�f-Z_ For Groundwater Treatment Systems
Well Depth: ' ZW ft. Well Diameter: 7_ in. Check One:
Screened Interval: ft. to ft. ❑. Influent (98)
Depth to Water Level: ! E-f.. below measuring point. .13 Measuring Point Is ft. above land surface. Effluent (99)
Gallons of water pumped/bailedbefore sampling:
Field analysis: pH ' 440 , Specific Conductance Umbos
. Temp. ' /1 3 °C, Odor. Appearance
PERMIT M. 'EXPIRATION DATE: ` ..� '. d_
Non -Discharge tn%Q Dom doo UIC
NPDES
TYPE OF PEFIM17 TED OPERATION BEING MONITORED
Lagoon Rerhediallon: Infiltration Gallery
✓ Spray Field Remedfallon:
Rotary Distributor Land Application of Sludge
Other:
.NOTE:. Values should reflect dissolved and
colloidal concentrations.
Date sample collect d: 3-1�* Date s" m le a aly ed:
LaboratoryName: Mmu r
Certification No: -2-12, 73
PARAMETE$$ (Samples for metals were collected unfiltered• YES NO.
and field acidified
COD
mg/1
Nitrite (NO2) as' N '
mg/l
Coliform: MF Fecal -
< I_ _/f00ml
Nitrate: (NO3)'as N
<0.10 mg/l
Coliform: MF Total
/100mI
Phosphorus: Total as P '
L mg/l
(Note: use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total
s mg/1,
Al - Aluminum
mg/I
pH (when analyzed)
units.
Ba-- Barium
mg/I
TOC .
s, if mg/I
Ca - Calcium
mg/I
Chloride
q,7 _ mg/l
Cd--Cadmiurn
mg/1
Arsenic •
mg/I
Chromium: Total
mg/I
Grease and•Oiis
mg/I
Cu -'Copper
mg/1
Phenol
fng/I -
Fe - Iron
mg/I
Sulfate
trig/I
Hg - Mercury"
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia
C6120 mg/I .
Mg'- Magnesium-
mg/l
TKN as fd — _
- mg/I
Mn - Manganese
mg/I
GW-59 Rev.:4198
YES ' NO)
Ni - Nickel r.
Pb - Lead r
Zn = Zinc r
Ammonia Nitrogen r
Other (Specify Compounds and Concentration I
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab repo:
Report Attached? Yes (1) No ._._.
VOC method #
method #
method #
tPeadttee for Author zed Agent)
and This -Please print nor type
slgnaltre o enn!tee (or Aulhorizrd
gang

VVWIYII I 1"VI\IYI MY
rnT-CM UNL Y
.Facility_ Name:_ .!
Permit Name (if.difb
Weil'Location/ Site
Please Print Clearly.or Type
County-
Telephone M fo"�
No. of Wells -to -•be Sampled:
Well Identification Number (from Permit) M0 # 3 For Groundwater Treatment Systems
Well Depth: LP,5bft. Well Diameter: 9 in. Check One:
Screened interval: ft. to ft. O. Influent (98)
Depth to Water Level: Teft. below measuring point.
0 Effluent (99)
Measuring Point Is ft. above land surface. .
Gallons of water pu.mped/bailed before sampling: /'UI kZ
Field -analysis: ,pH 41. / , Speciflc Conductance —uMhos
Temp.17 °C, Odor Appearance
PERMIT #: EXPIRATION DATE:
Non-Dlscharge tAiQ 60 ma _UIC
NPDES
JYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Rernediallon: Infiltration Gallery -
Spray Field Remedialion:
Rotary Distributor Land Application of Sludge
Other:
NOTE Values should reflect dissolved- and
colloidal concentrations.
Date sample collected 'Date
-sa le nal zed: 3�
LaboratoryName: j-- � y&-An►6s. cicl
Certificatlon No: _fir ZS .
PARAMETE,p$ (Samples for metals were collected unfiltered,. YES NO
and field acidified
COD
mg/l
Nitrite. (NO2) as N
mg/i
Coliform: MF Fecal
< I /1.00ml
Nitrate (NO3) as N,
<0+10 mg/l
Coliform: MF Total
/100ml
Phosphorus: Total as P
11,48 mg%I
(Note: Use PAPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total. <40 I mg/l
Al - Aluminum
mg/l
pH (when analyzed)
units
Ba - Barium
mg/i
TOC
(010 mg/l
Ca - Calcium,
mg/I
Chloride
S. y mg/I
Cd - Cadmium
mg/l
Arsenic.*
mg/l
Chromium: Total
mg/I
Grease and.011s
mg/I
Cu - Copper
mg/i
Phenol
mg/I
Fe' Iron
mg/I ;
Sulfate
mg/I
Hg - Mercury-
mg/l
Specific Conductance
uMhos
K = Potassium
mg/I
TotalAmmonia
aVmgll
. Mg Magnesium,.
mg/I
,.TKN as .N
mg/I
Mn- Manganese
mg/l
NO)
Ni -'Nickel r
Pb - Lean r
Zn = Zinc r
Ammonia Nitrogen r
Other (Specify Compounds and Concentration t
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method M Attach lab repo
Report Attached? YeaL—(1) No
VOC : method #
:.method #
method #
Permittee (or Authorize gonl) Name and 7111e - Please printor
q-.2
nature 0 erm Ilee (or Aulhorizrc •gent) VD,

oumm r rurnrvr ury
.Facility Name:_
Permit Name (if.
Well-Locallon/ Site Name:
Please Print Clearly or Type
County
Telephone #:
No. of Wells to -be Sampled:
Well identification'Number from Permit : fN�•*
( For Groundwater Treatment Systems
Well Depth: ;2 4/ ft.. Well Diameter: in. check One:
Screened Interval: ft..to ft. O. Influent 98
Depth to Water Level: 4'lft. below measuring point.,.. )
Measuring Point is It above land surfaceEffluent (99)
PERMIT #: 'EXPIRATION DATE: > U�
Non -Discharge . % aolk7ld uIC
NPDES
.TYPE OF PERMITTED OPERATION BEING'MONITOAED
Lagoon � Refiediation: Infiltration Gallery,
7 Spray Field Remedlatton: .
Rotary Distributor _Land Application of Sludge
-Other. - -
NOTE:.:Values should reflect dissolved and
colioldal concentrations.
Gallons of water pumped/bailed before samplirig: /U:' -Date sample collects :- 3,z - a - Date Rample aly ed..
Field analysis: pH Specific Conductance uMhos Laboratoy Name:
Temp. °C, Odor Appearance Certification No: 7S�
PARAMETE$$ (Samples for metals were collected unfiltered• YES,'
NO and field acidified
GOD'
m'g/1 '
Nitrite 002) as N
mg/i
Collform:-.MF Fecal
/ /100ml
Nitrate (NO3) as N
O,f7 mg/l
Coliform: MF Total
/100ml
Phosphorus: Total as
P 6"yLf mg/l .
(Note: use MPN method for highly turbid samples)
Dissolved Solids: Total qo:7 mg/l-
Orthophosphate
Al - Aluminum
mg/I.
mg/I
pH (when analyzed)
units
Ba -Barium
mg/l
TOC
ISS mg/1
Ca - Calcium
mg/l
Chloride
mg/I
Cd -.Cadmium
rng/l
Arsenic,
mg/I
Chromium: -Total -
mg/l
Grease and.0ils
mg/1-
Cu - Copper
Phenol'
mg/l
Fe = Iron - '7
mg/l
Sulfate
.mg/l
Hg - Mercury-
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia
x, �a mg/I
Mg - Magnesium-
mg/l
TKN as N
mg/1-
Mn- Manganese
mg/I
- YES ' _:--NO).
Ni - Bickel
Pb - Lead t
Zn -� Zinc t
Ammonia Nitrogen r
Other (Specify Compounds and Concentration I
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab repo
Report Attached? Yes (1) No
VOC inelbod #
'method # '
method #
ERgnatwd of Perm ttee {(or AuihorirrK �rnt) l r