WQ0033677_Monitoring - 11-2022_20230104 (2)

Date sample analyzed %' JAP /C� % Tr-" __
PARAMETERS NOTE: Values should reflect dissolve
COD mg/I
Coliform: MF Fecal /,100m1
Coliform: MF Total ' I100m1.
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total ✓ mg/1
pH (when analyzed) _ - units
TOCAl ]� rng/l
I
Chloride .5� mg/I
Arsenic . N D mg/I
Grease and Oils mg/I
Phenol `. mg/I
Sulfate mg/l
Specific Conductance µMhos
Total Ammonia L mg/l
(Ammonia Nitrogen; NH,as N; Ammonia Nitrogen, Total)
TKN as N L-.' r mg/I
For Remediation.Systems
t. Li
idtee (or tho ed pent) Name and Title Please print or
GW 5 Rev. 1t2007
i
VOC Removal%
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Ple ase Print Cloady or Type
I
PERMIT Number: e:�0AC 3
'%7Expiration Date:
Facility Name: l�y Hai
1�11 1 , Cl�C hpL`�
(�
Non Discharge
UIC
Permit Name (if different):
NPDES
Other
Facility Address: 7i0 %�'
t' yY14n S�^e f
TYPE OF PERMITTED OPERATION BEING MONITORED
n ""°"
NC ,
County le
❑Lagoon
ElRemediation: Infiltration Gallery
ca<.
Q.Bpray Field
❑Remediation:
nf1 t 5
Tele hone#: Pil�" wag �oQ�V
P
❑Rotary Distributor
❑ Land Application of Sludge
Contact Person:
Well Location/Site Name:
ff _
hPN
No. of wells to be sampled: 3
❑ Water Source:Heat Pump ❑ Other.
.
- f
- ((romPemfdl
_-_ -
OPLINU INt-UKMAI IUN .
LL ID NUMBER (from Permit): _
II Depth: 55-_ft.
)th to Water Level: _ft. below measuring point
asuring Point is _ _ft. above land surface
ume of water pumped/bailed before sampling: l.i_
nples for metals were collected unfiltered`. LEES ❑ NO and field acidified: ❑ YES ❑ NO
... _.... Laboratory Name: ��Q�Pr���] ��y�jj1 _ Certification No. ,y
d colloidal concentrations.
Nitrite (NO2) as N mg/I Pb - Leah mg/I
Nitrate (NO3) as N 70 mg/I Zn - Zine Qo C j (`� mg/l
Phosphorus: Total as P L C, mgll
Date sample collected: — �D
Well Diameter:in.
Our Interval: ft. to ' ft.
Relative M.P. Elevation: � ft.
gallons
FIELD ANALYSES:
pH 6�units Temp. 19 `C
Spec. Cond. µMhos
Odor 110Yt 'C
Appearance e I eCt r
p
Orthophosphate mg/I
Other (Specific Compounds and Concentration Units):
Al - Aluminum mg/I
�`�'� i u►1► rirr /�_ �. %
Ba -:Barium mg/1
M. L L ,0
Ca - Calcium Mg
Cd - Cadmium mg/I
- L 27
Chromium: Total mg/l
Cu - Copper f o19C) ;i mg/l
ORG'ANICS:;(by GC, GCIMS, HPLC)
Fe - Iron 1� mgll
(Specify.testiand.method #. ATTACH LAB REPORT.)
Hg - Mercury _ mg/I
Report Attached? ❑ Yes ❑ No (0)
K- Potassium , (n mg/;I
VOC meth
Mg - Magnesium mg/I
method
Mn - Manganese Q� CCt� mg/I
rtiAAd
Ni - Nickel mgA
method #
'.se, -
Total VOCs:
7112
lee (or Authorized Agent)
at
of

(GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name: / 411 y� 121Y� /Jr�13 7
Permit Name (if different):
Facilily Address: 566 '% 7 Pe
v (` �� 1
Contact Person: 1
Well Location/Site Name: y�
Please Print Clearly or Type
NC _ County
�iei 1=ip'
SAMPLING INFORMATION
NELL ID NUMBER (from Permit): _
Nell Depth: _ft.
Depth to Water Level: -35 ft. below measuring point
Measuring Point is 3 ft. above land surfia 22
Volume of water pumped/bailed before sampling! ✓�
Samoles for metals were collected unfiltered: ES
Date sample analyzed:
PARAMETERS NOT : Values should reflect dissolve
COD mg/l
Coliform: MF Fecal /,1001n1'.
Coliform: MF Total 11001111..
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total Q ' mg/l
pH (when analyzed) ! units
TOC AJ p mg/i
Chloride ! , b Irng/l
Arsenic 14 mg/l
Grease and Oils mg/l
Phenol mg/I
Sulfate mg/I.
Specific Conductance µMhos
Total Ammonia —mg/1
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen,
Total)
TKN as N 41, ✓ romg/I
For Remediation. Systems Only (Attachl��aq Reports),
I"Idy` 1�
)tte (or Authorized Agent) Name and Title . Please print or t
GW-5 Rev.112007
i
I
Telephone#: 91r4'l%3�9 - 6 9O0
No, of wells to be sampled:
PERMIT Niumbe'riq6C jai%%Expiration Date: [i5 --;;I
Non -Discharge UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
19- pray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source:Heat Pump ❑ Other:
Date sample collected: —.72
Well Diameter: 07. in.
Screened Interval ft. to qf�ft.
Relative M.P. Elevation: ft.
field acidified:
it WILL
FIELD ANALYSES: WAS
pH 4,Lunits Temp. /q °C DRY at
Mhos time of
Spec. Cond. µ sampling,
Odor 1o0.nif— check
Appearance AT Vie1H do'A 4 here:❑
lab
Certification No.
Laboratory Name: e
a
and colloidal concentrations.
Nitrite (NO2) as N mg/1
Pb - Lead mg/I
Nitrate (NO3) as N �3Sf mgll
Zn - Zinc p, L')�g mg/l
Phosphorus: Total as P e 0, I% mg/I
Orthophosphate mg/l
Other (Specify Compounds and Concentration Units):
Al - Aluminum mg/I
S GCS 11,4 34 i IL. q , c✓
Ba-'Barium l�. b� mg/t
C
Ca - Calcium mg/1
•^
Cd - Cadmium mg/l
'
Chromium: Total mg/i
Cu - Copper D,Qp 210 mg/1
ORGANICS..;tby GC,,GCIMS, HPLC)
Fe - Iron �. `�' mgll
(Specify .testiand.method #. ATTACH LAB REPORT.)
Hg -Mercury _mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
K -Potassium , 9 mg/I
VOC method #
Mg - Magnesium mgll
method #
Mn - Manganese O, q7 mg/I
method #
Ni - Nickel mg/I
method #
Influent Total VOCs: img'L _ EffliJent TotaI;VOCs: - mg/L VOC Removal%
c IV. S C'-
gnature of P .M e. (or Authorized Agent)
4
(Date)

OUNDWATER QUALITY MONITORING:
MPLIANCE REPORT FORM
FACILITY INFORMATIQN, Please Print Clearly orType
PERMIT Number.W40C 11-77Expiration Date: ' -1
Facility Name: y ?. 3
LAC,
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: Ci
TYPE OF PERMITTED OPERATION BEING MONITORED
NC
County
❑Lagoon ❑ Remediation: Infiltration Gallery
4' :�'ZW i_ir:'
r-, t'
urapray Field ❑Remediation:
`
C 1),L� le % A A i 5
a
Telephone#: �o�g �3a " /
❑ Rotary Distributor ❑ Land Application of Sludge
Contact Person:
Well Location/Site Name: fit.e is 6
No. of wells to be sampled:
El Water Source :Heat Pump El Other:
F from Pemd
If WELL
SAMPLING INFORMATION
WELL ID NUMBER (from Permit):
Y�Q
Date sample collected: �� o�D -�
FIELD ANALYSES: WAS.
___
Well Depth: I'�ft.
Well Diameter: in.
pH units Temp. _°C DRY at
time of
Depth to Water Level: 37.y ft. below measuring paint
Screened Interval: ft. to T-�ft.
Mhos
Spec. Cond. µ sampling,
Measuring Point is _ ft. above land sudtace
Relative M.P. Elevation: ft.
Odor check
Volume of water pumped/bailed before sampling: '3 �__sgallons
. Appearance (' f�Q!— here: ❑
Sam les for metals were collected unfiltered`. P-fES
❑ NO and field acidified: I ❑ YES ❑ NO
Date sample analyzed: { hC S Laboratory Name: )�r/ {r�
4{IhL Certification No.
_
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/l
Coliform: MF Fecal /100ml
Nitrite (NOZ) as N mg/I
Nitrate (NO3) as N `] mg/I
Pb - Lead mg/l
Zn -Zinc Al mg/l
Coliform: MF Total /,100ml
Phosphorus: Total as P �-�+ t �P mg/I
(Note; Use MPN method to highly turbid samples)
Orthophosphate mg/l
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total �,� mg/I
Al - Aluminum mg/I
SM,14 rrh
pH (when analyzed) f , 3 units
Ba-:Barium �,DQa, mgli
TOC Al D !T g/I
Ca - Calcium mg/I
."Hrr kit L
Chloride ) ► mg/I
Cd - Cadmium mg/I
r '
Arsenic A] D mg/I
Chromium: Total mg/l
Grease and Oils ! mg/l
Cu - Copper /V D mg/I
ORGANICS.,(by GC, GC/MS, HPLC)
Phenol `. mg/I
Fe - Iron _mgll
(S pecify.tesCand. method #. ATTACH LAB REPORT.)
Sulfate mg/l
Hg - Mercury mg/1
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K, Potassium 2 S-i mgll
VOC method #
Total Ammonia 41 lio mg/I
Mg - Magnesium mg/l
method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total) ,
A
Mn - Manganese 0, mg/I
method #
TKN as N mg/l
Ni - Nickel mg/I
i
method #
For Remediation. Systems Only (Attachi lab Rgports)
; Infiue„nt Total VOCs: Tmg/L EfflrJent Total VOCs: mglL VOC Removal%
r
nitiee (or A orized Agent) Name anc
GW-59 Rev.1/2007
Please print orltype
lure or P Ittgq (or Authorized Agent) (Date)

GW-59A COMPLIANCE REPORT FORM Permit 9. Wa 03 (P 7
(Submit one each monitoring period with GW=59 forms.)
I
Enter date monitoring results were due. (11 3) 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
O
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
oo
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
YES
NO 00
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:
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) repotted, 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.
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
reuired to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility Failure to do so may subtect the permittee to a Notice of Vrolation.
fines and/or penaitles.
8
The person completing this portion (GIN-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 G W-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Comp . nce Report G -59A) is true and complete to the best of my knowledge.
Signat o Permittee (or Authorize Agent) Date