WQ0000948_Monitoring - 09-2016_20161101 (3)

SUBMI i 1=OHM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different}:
Facility Address: 100 East Jefferson ST. P 0 Box 614
Jackson N CT'ee'l 27845ton
(cay) Swm! RDI COLlnty
Contact Person: Johnny G. Youhg Telephone C. 252-534-3811
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6em,nt
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: I ft. Well Diameter: _ in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 5. s ft. below measuring point.
Measuring Point (M.P.) is: L0 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 3— Date sample collected: a9 -I4--t r
Field analysis: pH �� , Specific Conductance uMhos
Temp. —OC, Odor 14Q Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 EXPIRATION DATE: 12-31-16
Non -Discharge X UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED -
Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
' Other:
(DOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: - Enyironment 1, Inc
Certification No. 281
PARAMETERS (Samples for metals were collected unfiltered YES -
NO and field acidified
COD
mg/I
Nitrite (NOp) as N
mg/I
Coliform: MF Fecal eo
/loom[
Nitrate (NO3) as N
oai- g
Coliform: MF Total
/Iooml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbld samples)
Orthophosphate
mg/I
Dissolved Solids: Total
mg/I
Al - Aluminum
mg/I .
pH (when analyzed)
units
Ba - Barium
mg/I
TOC
mg/I
Ca - Calcium
mg/I
Chloride /
mg/I
Cd - Cadmium
i_ mg/I
Arsenic
mg/I
Chromium: Totdl
4_ ° -� mg/I
Grease and Oils
mg/I
Cu - Copper WOU
n 1 2016 mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury ON
SECTION mg/I
Specific Conductance
uMhos
K - PotassiuritdFORMATION
PROCESSING UNIT mg/I
Total Ammonia
mg/I
Mg - Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mgll
Pb - Lead' mgA
Zn - Zinc mgA-
Ammonia Nitrogen mg/I
Other (Secify Compounds and Concentration Units)
Total Dissolved Residue mg/1
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (l) No (0)
VOC method # = _
method # =
method # =

SUBMI I I:ORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different :
Facility Address: 100 ast Jefferson ST. P 0 Box 614
Jackson N C(si i) 27845 ton
(city) County
Contact Person: Johnny G G. You�ig) t2ro) Telephone #:. [phone]
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
(from Pemdt)
Well Identification Number (from Permit):- For Groundwater Treatment Systems
Well Depth: ft. Well Diameter:_ in. Check One: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 1-46
ft. below measuring point.
Measuring Point (M.P.) is: W1 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 3� Date sample collected: og-of-16
Field analysis: pH a , Specific Conductance uMhos
Temp. 16 °C, Odor �D^f�� Appearance 1;-u Sr—
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 X
Non -Discharge
EXPIRATION DATE: 1L-31-
UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Environment 1. 1nc
Certification No. 2$1
PARAMETERS (Samples for metals were collected unfiltered YES
NO and field acidified
COD
mg/l
Nitrite (NOp) as N
mg/I
Coliform: MF Fecal < !
/100ml
Nitrate (NO3) as N
C o. DA4- mg/l
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/l
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/l
Dissolved Solids: Total
mg/l
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/l
TOC < f -00
mg/l
Ca - Calcium
mg/I
Chloride A 4:1
mg/l
Cd - Cadmium
mg/l
Arsenic
mg/l
Chromium: Total
mg/l
Grease and Oils
mg/l
Cu - Copper
mg/l
Phenol
mg/l
Fe - Iron
mg/l
Sulfate
mg/l
Hg - Mercury
mg/1
Specific Conductance
uMhos
K - Potassium
mg/l
Total Ammonia
. mg/l
Mg - Magnesium
mg/1
YES NO)
Ni - Nickel mg/l
Pb - Lead mg/l
Zn - Zinc mg/l
Ammonia Nitrogen_ a -Sep mg/1
Other (Secify Compounds and Concentration Units)
Total Dissolved Residue mg/1
107
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
TKN as N mg/1 Mn - Manganese mg/l method # =
method # =
ORC Certification #23129
me and Tide . Please print or type

SUBMI f FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Please Print Clearly or Type
Facility Name Town of Jackson
Permit Name (if different
Jackson !d 1,'- --' L /tits5 County
icily) Johnny G . Youpffa (Z'°' 252-534=3811
Contact Person: - - Telephone #:
Well Location/ Site Name: Wastewater treatmentNo. of Wells to be Sampled: 6
(from: Fee,ut)
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth:ft. Well Diameter: _ 4 in. Check one: 0 Influent (98)
Screened Interval: ft. to ft. Q Effluent (99)
Depth to Water Level: ft. below measuring point.
Measuring Point (M.P.) is: � o ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: 3 15 Date sample collected:. 4 -1q-1�
Field analysis: pH. _ , Specific Conductance —uMhos
Temp. °C, Odor *IJL Appearance &Cz;W - -
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTIO_ N
1636 MAIL SERVICE CENTER
PERMIT C WQ0000948 X
Non -Discharge
EXPIRATION DATE: 12-31-16
UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor -Land Application of Sludge
Other.
NQS Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: EnUronmentInc
Certification No.i1
PARAMETERS (Samples for metals were collected unfiltered YES
NO and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal - < J
-/100ml
Nitrate (NO3) as N
mg/i
Coliform: MF Total
A00ml
Phosphorus: Total as P
mg/I
(Note: use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total
mg/l
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
TOC _ i dLi
mg/I
Ca - Calcium
mg/I
Chloride 3
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/1'
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mg/I
Specific _Conductance
uMhos
K - Potassiums
mg/I
Total Ammonia.
,
Mg - Magnesium
mg/I
TKN as N
.Ing/I
mg/l
Mn - Manganese
mg/I
-YES NO)
Ni - Nickel mg/I
Pb - Lead mgfl
Zn - Zinc mg/l.
Ammonia Nitrogen <0-0.°4 - mg/I
Other (St
S ecify Compounds and Concentration Units)
Total Dissolved Residue mg/1
ORGANICS: (GC',GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method # =
method # =
method # =

SUBMI I FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different :
Facility Address: 100 East Jefferson ST. P 0 Box 614
Jackson N Cts""t 27845 o ton
(Car) County
Contact Person: Johnny G . YoulnQ� lz,v1 Telephone #:. [phone]
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
tri
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: 43 ft. Well Diameter:._ in. Check One: ❑ influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: 7-0 ft. below measuring point.
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 EXPIRATION DATE: 1L-31—
Non-Discharge $ UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Measuring Point (M.P.) is: 5, 0 ft. above land surface. Relative M.P. Elevation in It.:
Gallons of water pumped/bailed before sampling: _ 5 Date sample collected: 04_j,(4& Date sample analyzed:
Field analysis: pH 5'-0 , Specific Conductance uMhos Laboratory Name: Enyironment T, Inc
Temp. 16 °C, Odor atgajef Appearance C_fLrga _ Certification No. 281
PARAMETERS (Samples for metals were collected unfiltered YES NO
and field acidified
COD
mg/I
Nitrite (NO2) as N .
mg/I
Coliform: MF Fecal _ < !
/100ml
Nitrate (NO3) as N
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total
mg/I
Al - Aluminum
mg4
pH (when analyzed)
units
Ba - Barium
mg/I
TOC < 1,00
Mg/I
Ca - Calcium
mg/I
Chloride 13 �k
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia
, mg/I
Mg - Magnesium
mg/I
YES NO)
Ni - Nickel mg/l
Pb - Lead mg/l
Zn - Zinc mg/l
Ammonia Nitrogen < O., U �L mg/I
Other (Secify Compounds and Concentration Units)
Total Dissolved Residue mg/1
Iq6
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # = .
TKN as N mg/I Mn - Manganese mg/I method # =
method # =
me and Title - Please print or type
p s
GW -59 Signalr of Permitice r Authoriz g (Date)
Rev. 03/2000

SUBMI f FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different:
Facility Address. 100 ast Jefferson ST. P 0 Box 614
Jackson N CI$1eG' 27845 County o ton
(Cay) Johnny G . YouWg"" (zip) 252-534-3811
Contact Person: g Telephone C. 6
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: loom Penwrl
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: 136 ft. Well Diameter: -,#-- in. Check One: ❑ Influent (98)
Screened Interval: G!, ft. to 3& ft. ❑ Effluent (99)
Depth to Water Level: 1 -3 ft. below measuring point.
Measuring Point (M.P.) is: 16 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: .35 Date sample collected: 611-1't-(1,
Field analysis: pH 2l . Specific Conductance uMhos
Temp. 14 °C, Odor N-oA)e Appearance -co:n9tL
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 EXPIRATION DATE: 11-31-16
Non -Discharge X UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
X Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
EnvironmentInc
Laboratory Name: -�,
Certification No. 2g1
PARAMETERS (Samples for metals were collected unfiltered - YES NO and field acidified
COD mg/1 Nitrite (NO2) as N mg/I
Coliform: MF Fecal < 1 /1ooml Nitrate (NO3) as N b o 3% mg/!
Coliform: MF Total /loom[ Phosphorus: Total as P mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC 1,57
mg/I
Chloride '30
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
Mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/I
unnopnospnaie
Iny,l
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/1
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mgA
Pb - Lead mg/l
Zn - Zinc mg/I
Ammonia Nitrogen �0- 07 1= mg/l
Other (secify Compounds and Concentration Units)
Total Dissolved Residue m /1
0*
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method # =
method # =
method # =
ORC Certification #23129
me and Title - Please print or type
GW -59
Rev. 0312000

SUBMI I FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Town of Jackson
Permit Name (if different):
Facility Address: 100 ast Jefferson ST._ P 0 Box 614
Jackson 127845 CountyNorthatoot
(city)(zip)Johnny G . YouWA"" (i,°( Telephone #: - 252-534-3811
Contact Person: p
Well Location/ Site Name: wastewater treatmentNo. of Wells to be Sampled: 6
(from Permit)
Well Identification Number (from Permit): 10 For Groundwater Treatment Systems
Well Depth: / ft. Well Diameter:_ in. Check One:- ❑ Influent (98)
Screened Interval: %t ft. to -91 ft. ❑ Effluent (99)
Depth to Water Level: ft. below measuring point.
Measuring Point (M.P.) is: 3= rJ ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: Yo Date sample collected: 0,i-eY--rt
Field analysis: pHA , Specific Conductance uMhos
Temp. t2 °C, Odor Alp) Appearance C�`794�
DEPARTMENT OF ENVIRONMENT 8 NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: WQ0000948 R EXPIRATION DATE: 1L -:i1-16
Non -Discharge UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
X Spray Feld Remediation:
Rotary Distributor Land Application of Sludge
' Other.
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: En. y1ronment T, Inc
Certification No. 2g1
PARAMETERS (Samples for metals were collected unfiltered YES NO
and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N
mg/I
Coliform: MF Total
1100ml
Phosphorus: Total as P
mg/l
(Note: Use MPN method for highly turbid samples)
Total Ammonia
Orthophosphate
mg/l
Dissolved Solids: Total
mg/I
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
TOC / e 'i
mg/I
Ca - Calcium
mg/I
Chloride Z __
_ mg/1
Cd - Cadmium
mg/I
Arsenic
mg/l
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
YES NO)
Ni - Nickel mg/l
Pb Lead— mg/I
Zn - Zinc mg/I
Ammonia Nitrogen t O- OCL mg/I
Other (Secify Compounds and Concentration Units)
'Total Dissolved Residue mg/1
//3 -
Phenol
mg/I
Fe - Kron
mg/I
ORGANICS: (GC,GC/MS,HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. Attach lab report.)
Specific Conductance
LiMhos
K - Potassium
mg/I
Report Attached? Yes (1) No (0)
Total Ammonia
mg/I
Mg - Magnesium
mg/I
VOC method # = .
TKN as N
mg/I
Mn - Manganese
mg/I
method #=
method # =

(Submit one each monitoring period with Gik=59 forms.) --- '
T2Wasate monitoring results were due. (, �7,` tk' Will thls monitoring report (GW -59 and GW -59A) YES N9
mitted after the established due date?
required Information missing on the GW -59 report forms?
YES-t-TYswer to question 7 or 2 is "YES" list in the space provided below the well identification numbers) and
explain the problems encountered in obtaining the required information.
I
I �
S
�• •��y 01 my monnor weirs in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional Once for guidance. YES �'0
I
Are any monitored constituents equal to or above the established standards? !
YES I i
If the answer to question 4 is NO'; skip to section 8. hO
If the answer to question 4 Is "YES" list the affected wells individually with constituent(s) and concentration(si
exceeding standards in the space provided below.'
For the constituents identified In question 4 above, have standards been exceeded previouslyfor the YES No
same constltuent(s) In the same well(s) In the last two years?
Il ea �nswrtoqiest'n
question 5 is "NO'; skip to section 8.
If the 5 !s "YES", listn the space provided beloeach well withconsttenl(s) exceedngandarcentratia (s) reported, and sample collection date for each occurrence (for the last two years).
i'
Are the monitoring wells listed in section 5 located at or beyond the review boundary?YES �'
« <��r -ICE
is '•rt_5", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
i OFFICE IMMEDIATELY FOR GUIDANCE, If the answer is "NO", monitoring wells may be Improperly
located; contact the Regional Office.
i
I i
7 Is the permittee implementing previously approved actions required by the Division involving this YES N0
Igroundwater quality problem?
,
if the answer to question 7 is "YES'; describe those actions in the space provided below.
If the answer to questlon 71s "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 surroundin this faclll Iv. Failure to do so mailsub ect the ermlttee to a Notice of Violation
fines, and/or penalties
g The person completing this portion (GW59AJ of the monitoring report should sign below and submit this i
' form with GW59 forms for required wells to the address provided at the top of the current GW -59 form.
� I hereby acknowledge thatati,a above Inforrria'E(on w�s�evaluated.and the'Irifomiatloii`subm tted, n thls',�-•�:'
...,,.y..y,-t_da.Ytis.f..,�1v�,.at,.�. t•,•y,;;.. .... _. ..; +:.. ,o ,. ,.
report (Compliance Report GW -59A) Is .true and corrtp(ete po jfteaest of my k.npwledge,
Signature o, a ittee r Aut or'Y ent
Date
a G%V-59A 12/8/2003