WQ0002096_Monitoring - 06-2024_20240724 (2)

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0002096
Name of Facility:*
Month:* June
Report Information
Ahoskie Assisted Living
Year:* 2024
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR June 2024 NDMR.PDF 277.37KB
PDF Only
GW-59 June 2024 GW-59.PDF 2.63MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * [e-mail]
Name of Submitter: * Paula Armstrong
Signature:
Date of submittal: 7/24/2024
This will be filled in automatically
Initial Review

Reviewer: Wanda.Gerald
Is the project number correct?* WQ0002096
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 7/29/2024

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
miff
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type
LIyl
PERMIT Number: /� Expiration Date: �%
Facility Name: osU 11SSi� ✓)�i
W W r F
Non -Discharge WO C `� 0096,5O UIC
Permit Name (if different):
NPDES Other
F Ility AVddress: 4D Stu Qi^
O�
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Sf..I e, "`""` 11,7916 County r o"
Par
n p
53o"Spray Field ElRemediation:
Contact Person: �anaq ke(SIn[ar
Telephone#: S 3 —� S-1'
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: 1'1Q eI CA
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION f�/� � J�' 4
— -I
&hC'1'L4
If WELL
WELL ID NUMBER (from Permit): I (I VV
Date sample collected:
FIELD ANALYSES i �
WAS
Well Depth: i9 ft.
Well Diameter: 2 in.
pH 00400 nits Temp. 000lo: °C
DRY at
p � ft. below measuring point Screened Interval: ft. to
Depth to Water Level 925a6: g p
p (Mhos
ft. Sec. Cond. 000sa: F
time
2
li
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation: ft.
Odor 00095:
check
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:❑
Samples for metals were collected unfiltered: R YES
❑ NO and field acidified: ® YES ❑ NO
LABORATORY INFORM TION
I2)
I
boa QIV
Date sample analyzed: — �Lf
Laboratory Name: �eoIIq n
T )C C' J Certification No.
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations. it
COD 00335 mg/L
Nitrite (NOZ) as N 00615 (), ()3 mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO.) as N 00620 () , (]y mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 0. 1, mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 8 mg/L
Al - Aluminum o11o5 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 't 5 mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 mg/L
Cd - Cadmium 01027 ug/L
Arsenic 01002 ug/L
Chromium: Total 01034 ug/L
Grease and Oils 00552 mg/L
Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045 ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 ftMhos
K - Potassium 00937 mg/L VOC 7873 method #
Total Ammonia 00610 D r�- mg/L
Mg - Magnesium 00927 mg/L method #
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055 ug/L , method #
TKN as N 00625 mg/L
Ni - Nickel 01067 ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%

SHRMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
•
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617
FACILITY INFORMA ION /Q� ii
PERMIT Number, /_Expiration Date: 0
oowo 091P
1'PleasePrin/fClearlyorType
Facility Name QsN � I :Z S Tc d L I � � ✓ l
V� W% T 1
Non -Discharge V UIC
NPDES Other
Permit Name (if different):
Fayc-�if�ty Address: QL4d d Lk+h �r V
Q
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
I- hoso 4 Z ''r"'i /JCS 7 Lf 10 County neFFJ`O V-
Jr--„y; islatei czir-:
a'Spray Field ❑ Remediation:
Person: aril Par I-er
nn r1 C
Telephone#: L� 2 — �) � � �J � I
❑ Rotary Distributor ❑ Land Application of Sludge
Contact
No. of wells to be sampled:
El Water Source Heat Pump El Other:
Well Location/Site Name: I^ A i
from Permit
SAMPLING INFORMATION 1.'
WELL ID NUMBER (from Permit): 1 / 1 Vy —
/
Date sample collected: (D I �i� f T
FIELD ANALYSES:
If WELL
WAS
Well Depth: �ft.
Well Diameter: 2 in.
pH 00400:5—.� units Temp. 000lo: 0C
DRY at
time of
Depth to Water Level 82546:_ft. below measuring point
Screened Interval: ft. to _
ft. Spec. Cond. 0009a: µMhos
sampling,
Measuring Point is 12 S ft. above land surface
Relative M.P. Elevation: ft.
Odor 00065:
check
Volume of water pumped/bailed before sampling: _gallons
Appearance 6Q4 Q
here:❑
Samples for metals were collected unfiltered: X YES ❑ NO
and field acidified: ® YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: ) U ^ c% I i?
Laboratory Name: WLtVF'� t �+ i�l
Yi �'
`/ rI C�GII
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 �; ©��
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616
/100mL
Nitrate (NO3) as N 00620 p, 5
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100ml-
Phosphorus: Total as P 00665 U, J
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 1 1 d
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC oosso �}1
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095
ftMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia ooslo 0. 0 5_
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH,as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mglL tmuent I oral vvt.s: IliyrL VVV RCIIIVYGI /0
-- .I-VV-v,- Iv

SUBMIT FORM ON YELLOW PAPER ONLY
• •
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
• •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
Please Print Clearly or Type
FACILITY INFORMATION
PERMIT Number: Expiration Date: Q
I` / ,I,
Facility Name: o5K� P, f 4SS I s4ed Lt 'Yt C) VV WT
Non-DischargeUIC
Permit Name (if different):
NPDES Other
Facility Address: 24D vu y arS I1 a
1ojq oca _
TYPE OF PERMITTED OPERATION BEING MONITORED
1p'h ps ki -e-, st" t' /vc, 7910
County Her4 D/"
❑ Lagoon ❑ Remediation: Infiltration Gallery
cir ;(s aiz) (Zip)
O
Spray Field El Remediation:
1 Contact Person: and ar
/� C
Telephone#: LJ �L `S 13 %I
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: eld
No. of wells to be sampled:
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): f / /
Date sample collected: 4' 1 i� l'Z4
FIELD ANALYSES:
If WELL
WAS
Well Depth: / ft.
Well Diameter: Z in.
pH 00400: , 3 units Temp. 000lo: °C
DRY at
Depth to Water Level 82546: ftbelow measuring point
Screened Interval: _ft. to ft. Spec. Cond. 00094: FtMhos
time ofsampling,
Measuring Point is 2,5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
check
Volume of water pumped/bailed before sampling: _
gallons
Appearance f
here:❑
Samples for metals were collected unfiltered: N YES ❑
NO and field acidified: N YES ❑ NO
LABORATORY INFORMATION j
2l l2
1 �
P
�
Date sample analyzed: (P 10 ""-' 4-r y-
Laboratory Name: �l.Iago, nt P1
City cal Certification No. if
tl
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615 (} i D 3 mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 < /100mL
Nitrate (NO3) as N 00620 j , 05 mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 I5 mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum 01105 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 00680 ', 1.00 mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 K, cJ mg/L
Cd - Cadmium 01027 ug/L
Arsenic 01002 ug/L
Chromium: Total 01034 ug/L
Grease and Oils 00552 mg/L
Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045 ug/L (Specify test and method M ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 )tMhos
K - Potassium 00937 mg/L VOC 7873 method #
Total Ammonia 00610 < U, U mg/L
Mg - Magnesium 00927 mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055 ug/L , method #
TKN as N 00625 mg/L
Ni - Nickel 01067 ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
r[11 S-'roY1
ent) Name and Title -.
-- P ck 1 h ; S -iraf or
print or type
Agent)
GW-59 Rev.06-07-2018

GW-59A COMPLIANCE REPORT FORM Permit # A000goq�
(Submit one each monitoring period with GW-59 forms.)
— Il n.1
I
Enter date monitoring results were due. Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
NO
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional OJTice, for guidance.
4
Are any monitored constituents equal to or above the established standards?
YE
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:
mw-5 TDC. ►q,(ptidjI .
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO" skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
lj,
l�- ' 2ozY rJW-y 706 i3,31 �f3
w-5 �vL i'f',`t M�A-
�
rn w s r, 21,03 n+ gftr
M V-5 Tor— Aid t- b12b23
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.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
N
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 facilitV. Failure to do so may subject the permittee 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.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
61JPj P, " x-
Signature of Permitte or Authorized Agent) Date
GW-59A 12/8/2003

•
114 Oakmont
Drive, Greenville, NC 27858
waypo� ��
Main 252.756.6208 ° Fax [phone]
Y
www.waypoiManalytical.com
ANALYTICAL
00377
Ahoskie Assisted living
Manger
Project
240 South Early Station Rd
Information :
Ahoskie , NC 27910
Report Date : 07/11/2024
Report Number : 24-162-0500
REPORTOFANALYSI'S
Received : 06/10/2024
Lab No : 93889
Matrix: Aqueous
Sample ID : EFFLUENT
Sampled: 6/10/2024 7:48
Test
Results
Units
MQL
DF Date / Time By Analytical
Analyzed Method
Ammonia Nitrogen
<0.02
mg/L
0.02
1 06/20/24 12:34 DRC 350.1
Biochemical Oxygen Demand (5-day)
31
mg/L
20
1 06/11/24 10:40 BMD 5230E-2016
Fecal Coliform
39
cfu/100mL
1
1 06/10/24 15:11 9222D-2006
Chloride
36.0
mg/L
2.00
1 06/17/24 10:00 BNC 4500-CI-B
Nitrate (NO3-N)
0.05
mg/L
0.02
1 06/11/24 13:35 JRF 353.2
Nitrite (NO2-N)
0.03
mg/L
0.02
1 06/11/24 16:29 KID 353.2
Nitrate+Nitrite-N
0.08
mg/L
0.02
1 06/11/2413:35 KID 353.2
Total Dissolved Solids
280
mg/L
13
1 06/11/24 11:00 AMC 2540C-2015
Total Suspended Solids
61
mg/L
33
1 06/11/24 08:52 MSK 254OD-2015
Total Kjeldahl Nitrogen
9.86
mg/L
0.20
1 06/21/24 14:24 DRC EPA-351.2
Total Nitrogen
9.94
mg/L
0.5
1 06/21/24 14:24 ELK CALCULATION
Phosphorus
1.58
mg/L
0.02
1 06/21/24 14:24 DRC 365.4
Lab No : 93890
Matrix: Aqueous
Sample ID : WELL #4
Sampled: 6/10/2024 7:28
Test
Results
Units
MQL
DF Date / Time By Analytical
Analyzed Method
Ammonia Nitrogen
<0.02
mg/L
0.02
1 06/20/24 13:02 DRC 350.1
Fecal Coliform
<1
cfu/100mL
1
1 06/10/24 15:11 AMC 9222D-2006
Chloride
33.0
mg/L
2.00
1 06/17/24 10:00 BNC 4500-CI-B
Nitrate (NO3-N)
0.04
mg/L
0.02
1 06/11/24 13:40 JRF 353.2
Nitrite (NO2-N)
0.03
mg/L
0.02
1 06/11/24 16:38 KID 353.2
Total Dissolved Solids
98
mg/L
13
1 06/11/24 11:00 AMC 254OC-2015
Phosphorus
0.16
mg/L
0.02
1 06/21/2414:26 DRC 365.4
TOC
1.45
mg/L
1.00
1 06/11/24 09:16 BLv 531OC-2014
Qualifiers/ OF Dilution Factor
H Beyond holding time
Definitions L Limit Exceeded
MQL Method Quantitation Limit
Page 2 of 5

Q
Way1®
PA
114 Oakmont Drive, Greenville, INC 27858
Main 252.756.6208 0 Fax 252.756.D633
~
wwwr.waypoEntanalyNwl.com
LY3I CAL
00377
Ahoskle Assisted living
Manger
Project
240 South Early Station Rd Information
Ahoskie , NC 27910
Report Date :07111/2024
Report Number : 24-162-0500
REPORT OFANALYSIS
Received : 06/10/2024
Lab No : 93891
Matrix: Aqueous
Sample ID : WELL #5
Sampled: 6/10/2024 7:13
Test
Results
Units
MOIL
DF Date f Time By
Analytical
Analyzed
Method
Ammonia Nitrogen
0.08
mg/L
0.02
1 06/20/24 13:06 DRC
350.1
Fecal Coliform
<1
cfu/100mt
1
1 06/10/24 15:11 AMC
9222D-2006
Chloride
2.50
mg/L
1.00
1 06117/2410:00 BNC
4500-Cl-B
Ni"te (NO3-N)
0.95
mg/L
0.02
1 06111/24 13:42 JRF
353.2
Nitrite(NO2-N)
0.04
mg/L
0.02
1 06/11/24 16:40 KID
353.2
Total Dissolved Solids
190
mg/L
13
1 06/11/24 11:00 AMC
254OC-2015
Phosphorus
0.12
mg/L
0.02
1 06/21/24 14:28 DRC
365A
TOC
14.6
mg/L
1.00
1 06/11/24 09:16 BLV
531OC-2014
Lab No : 93892
Matrix: Aqueous
Sample IO : WELL #7
Sampled: 6/ 10/ 2024 6:54
Test
Results
Units
MQL
DF Date/Time By
Analytical
Analyzed
Method
Ammonia Nitrogen
<0.02
mg/L
0.02
1 06/20/24 12:34 DRC
350.1
Fecal Coliform
<1 H
cIu/100mL
1
1 06/10/24 15:11 AMC
9222D-2006
Chloride
92.5
mg/L
5.00
1 06117/2410:00 BNC
4500-CI-6
Nitrate (NO3-N)
1.05
mg/L
0.02
1 06/11/24 13:44 JRF
353.2
Nitrite(NO2-N)
0.03
mg/L
0.02
1 06/11/2416:50 K)D
353.2
Total Dissolved Solids
180
mg/L
13
1 06/11/24 11:00 AMC
254OC-2015
Phosphorus
0.15
mg/L
0.02
1 06/21/24 14:30 DRC
365.4
TOC
<1.OD
mg/L
1.00
1 06/11/24 09.16 BLV
531OC-2014
qualifiers/ DF
Dilution Factor
li Beyond holding time
Definitions L
LimitExceeded
MQL Method Quantitation Limit
Page 3 of 5