WQ0001048_Monitoring - 10-2016_20161207 (2)

GW -59A COMPLIANCE REPORT FORM Permit # 0OCO104
(Submit one each monitoring period with GW -59 forms.)
1
Enter date monitoring results were due. -I LP ) Will this monitoring report (GW -59 and GW -59A)
YES
NO
be submitted after the established due date?
Y
2
Was any required information missing on the GW -59 report forms?
YES
N
IF the answer to question 9 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.
(he 6arnpie5vete coil-eekd-W)e- cit4o�foodirg-
The to lt.5 lu eit nab- f-eC•eI VeCI '40m a -h e Comm•ei OQ ( I (fib ur)4� I
`rhi b ha 5 been d i bcu��Gi �J i, -h �4 CDC Q 1 -00 12,1 I b W
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
"Yes",
YES
NO
identification plate, area overgrown, etc.)? If the answer is contact the Regional Office for guidance.
Y
4
Are any monitored constituents equal to or above the established standards?
YPS
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:
loeIi -#kq -TD C, 10,5c7 too- ll # 6 Fecal Coli �-am ZZ
�21I � 10 TGC II.OIa
Fecal Col i FCf m z
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
in the same well(s) in the last two
YES
NO
same constituent(s) years?
X
If the answer to question 5 is "NO", skip to section B.
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).
k)ell *q TuC. io-Zgl-14 J-16-ilo IG 3��rgll,
2-Z5-►� Ia.2u rill. (,-ZG-1� 13.7Zmc1C.
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
HiQ
]�
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 Reqional 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. All off -'the mn-)iia I 1­`�3 tU0-5 i n 4-N:5 [ePO(fi were ury-ler lJaLW
ItX f-Pf rnvJ tlq) Chir iF �il^
ht �IOodg 04ent"J OCCurfed c,&� ( Numcan2
mQ+4-hW-Th'i 5 �r�rnpl� (Vent tJabd l6CCt6b,C-Cl L0'4n Riff
-t-o 6arnpk i)� Ctnd 44)�e ( i6u K5 . GJe wM con -P nue -b% putge l -he tue11--) G5
n�-l-ruC+� and t•P_�r�r�plQcl(�.ri f� a-h� n-2,�.t f ulia,(1�( BEd al�t��mp(ir�,
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 tome address provided at the top of the current GW -59 form.
0
�t hereby acknowledge that theabove rnfor ion was eva ted and the information submitted m this
[report (Compliance Report GW -59A) is true _ eco
!f _etethe best of my knowledge
_ t..
z
o
M a,
Signature of Permittee (or Authorized Agent)C3 C:) --I ry �® Date
Cn z o Intl
rn
z
us
C
GW -59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
-R QUALITY MONITORING:
REPORT FORM
Name: C
Name (if different):
F ENVIRONMENTAL QUALITY - DM. OF WATER RESOURCI
INFORMATION PROCESSING UNIT
CENTER, RALEIGH, NC 27669.1617 Phone: [phone]
IT Number: Expiration Date:
ischarge IJOGCO 104 UIC
S N CWZZOT) Other
OF PERMITTED OPERATION BEING MONITORED
t 4:'� NC.. Z1653U
County Pitt
AI - Aluminum oleos
El Lagoon
El Remediation: Infiltration Gallery
m�n; sem. -��El
Ca - Calcium 00916
mg/L
Spray Field
11 Remediation:
Contact Person: I'TefYL�Y'fli�il
Telephone#:
❑ Rotary Distributor
Land Application of Sludge
Well Location/Site Name: 01,3 ov, plq(�t 4bd-t'E•
No. of wells to be sampled:
❑ Water Source Heat Pump
❑ Other:
hom Permt
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit):
Date sample collected: I o- 31-I to
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH oo400: 9 units
Temp. 000lo: Z I eC
DRY at
Depth to Water Level a2646: 15 ft. below measuring point
Screened Interval: ft. to �ft.
-sl
Spec. Cond. aooae: I
I to phAh°s
time of
sampling,
Measuring Point is Z. 5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 000e5:
check
Volume of water pumped/bailed before sampling: 5
gallons
Appearance C��Cl1G1�
here:
Q�.�.ue. r...,. 6e 1. ,.,e.e �..ue�fe.1 ��..rnre,.e.H IFI vcQ n
Mn —A finlA ��:.ra�� to VCQ Fl run
sample analyzed: )0-31-1 L, Laboratory Name: EITi l i cn 'nent 1, hr -
\METERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD oo33s mg/L Nitrite (NO2) as N oosts mg/L Pb - Lead 01o51
Coliform: MF Fecal 31616
/100mL Nitrate (NO3) as N oo6zo <0-04 mg/L Zn -Zinc o1o92
Coliform: MF Total 31504 /100ml- Phosphorus: Total as P oo665 mg/L
(Note: Use MPN method for hghy Mrdd samples) Ortho hos hate 70507 d • O U mg/L
Solids:Total 70300 /o L{ mglL
pH(Lab)ooao3 L{.gg units
TOC oosso I O .150 mg/L
Chloride ooma
Arsenic 01002
Grease and Oils 00552
Phenol 32730
mg/L
ug/L
mg/L
ug/L
Sulfate oo945 mg/L
c Conductance 00095 ) I Le µMhos
Total Ammonia oo6lo 0-("I mg/L
(Ammonia Nitrogen NHsas N. Amn a Ntmgen. Tool)
TKN as N 00625
P P
AI - Aluminum oleos
mg/L
Be - Barium 01007
ug/L
Ca - Calcium 00916
mg/L
Cd - Cadmium o1o27 ug/L
Chromium: Total oto34 <5 O ug/L
Cu - Copper 01042 .1-16 mg/L
Certification No.
ug/L
mg/L
Other (Specify Compounds and Concentration Units):
ORGANICS: (by GC, GC/MS, HPLC)
t �f
i -
�1�
Fe - Iron o1o4s ug/L (Specify test and method #. ATTACH LAB REPORT.)
Hg - Mercury 71900 ug/L Lab Report Attached? ro Yes (1) ❑ No (0)
K - Potassium oo937 mg/L VOC 7873 , method # twoc (0)
Mg - Magnesium oo927 mg/L
Mn - Manganese oloss ug/L
mg/L Ni- Nickelo1o67
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
I�('ll'P.LMlyhl %,11Y.�4 l�i`it(9 �.
Perm ttee (or Authorized A ) Ne and T1 Pkme pnrd w type
GW -59 Rev. 3-1-2016
ug/L
Effluent Total VOCs'
method #
method #
method #
mg/L VOC Removal%

UNDWATER QUALITY MONITORING:
PLIANCE REPORT FORM
Or
SUBMIT FORM ON YELL W PAPER ONLY
DEPARTMENT OF
INFORMATION PROCESSING UNIT
SERVICE CENTER, RALEIGH, NC 27666.1617 Phone: [phone]
Number: Expiration Date:
Facility Name:UYI�en`nea-I-(1.j.Ir7
9
Non -Discharge filOLC Cgo UIC
Permit Name (if different):
Be - Barium 01007
NPDES hACLG321>77 Other
Facility Address: acs k) I I eV GabU nE
73-3� 4`»
TYPE OF PERMITTED OPERATION BEING MONITORED
1 -Ac' 5
o County Pitt
❑ Lagoon ❑ Remediation: Infiltration Gallery
` °' ''P'
mg/L
❑ Spray Field ❑ Remediation:
Contact Person:�1i eflP�. �f'tliy.rl
Telephone#: Z2- 4
❑ Rotary Distributor C`d Land Application of Sludge
Well Location/Site Name: 6 O� Ri PILI IV (A
No. of wells to be sampled:
Water Source Heat Pump ❑ Other:
mg/L
Irom Damm
ug/L
SAMPLING INFORMATION
ug/L
If WELL
WELL ID NUMBER (from Permit):
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: Q tL
Well Diameter: _in.
pH oo4004a units Temp. 00010. I °C
DRY at
Depth to Water Level 62546:Ll ft. below measuring point Screened Interval: 2 _ft. to
ft. Spec. Cond. 00094. (o g • Lo µMhos
time ofsampling.
Measuring Point is '3 ft. above land surface
Relative M.P. Elevation: ft
Odor 000ss: ninf'
check
Volume of water pumped/bailed before sampling: 5
gallons
Appearance ('��(-l�
here:
❑
Samoles for metals were collected unfiltered: M YES
❑ NO and field acidified: C9 YES El NO
Itesample analyzed: lb &_I10 Laboratory Name: F() -it ronfnlrlt 1) IrX.
tRAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N oosts mg/L Pb - Lead o1os1
Coliform: MF Fecal 31616 •Z /700mL Nitrate (NO3) as N 00620 0 . LI mg/L Zn - Zinc 01092.
Coliform: MF Total 31504 /100ml. Phosphorus: Total as P 00665 mg/L
(Nae uaa MPN a ftx h6hy a d 3rrpaa) Orth h h te (� C-7 m /L
Solids:Total 70300 4 �j mg/L
PH (Lab) 00403 L♦ i units
TOC oo6so I I. Du mg/L
Chloride oos4o mg/L
Arsenic 01002
uglL
Grease and Oils oa5s2 mg/L
Phenol 32730
ug/L
Sulfate oo945— mg/L
c Conductance 00095 fobs • �p µMhos
06
Total Ammonia o10 0 • ©Li mg/L
(Am s NI"W. Nlgae N: AmmMia Ni MW. Tope)
TKN as N 00625
mg/L
For Remediation Systems Only (Attach tab Reports):
op osp a 70607
9
AI - Aluminum oleos
mg/L
Be - Barium 01007
ug/L
Ca - Calcium ooels
mg/L
Cd - Cadmium 01027
ug/L
Chromium: Total 01034 (o
ug/L
Cu - Copper 01042 <(). D Iii
mg/L
Fe- Iron o1o45
ug/L
Hg - Mercury 71900
ug/L
K - Potassium 00937
mg/L
Mg - Magnesium 00927
mg/L
Mn - Manganese oloss
ug/L
Ni- Nickel o1067
ug/L
Influent Total VOCs
mg/L
Certification No. 10
ug/L
mg/L
Other (Specify Compounds and Concentration Units):
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? 4 Yes (1) ❑ No (0)
VOC 7873 , method # C l
Effluent Total VOCs.
method #
method #
method #
mg/L
VOC Removal
GW -59 Rev. 3-1-2016

ER QUALITY MONITORING:
REPORT FORM
Name: _L12A
Name (if different):
Address: Q Or
SUBMIT FORM ON YELLOW PAPER ONLY
County Pitt
,n, --­11� l 1-., 1
6rl
��j�Q,e
act Person: '�-i� Telephone#: ?-524-S iSU
Location/Site Name: ,6 O � No, of wells to be sampled: 5
(eon Pi,min
IDLING INFORMATION
L ID NUMBER (from Permit): 1 LI Date sample collected: ID -31-1 (o
Depth: 1�_ft. Well Diameter: Z in.
In to Water Level 82546: 0 ft. below measuring point Screened Interval:1—ft. to Jft.
wring Point is '`fL above land surface Relative M.P. Elevation: fl.
Te of water pumped/bailed before sampling: IS gallons
Dies for metals were collected unfiltered: CO YES ❑ NO and field acidified: DYES ❑ NO
DEPARTMENT OF ENVIRONMENTAL QUALITY - DN. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
7 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
RMIT Number: Expiration Date:
n -Discharge (0 UIC
'DES HC003w Other
PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑Spray Field C1 Remediation:
E] Rotary
Distributor Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
FIELD ANALYSES: WAS
pH 004o0:q_'iL units Temp. o0olo ZI eC DRY at
Spec. Cond. 000ea: (00 3 µMhos time ofsampling,
Odor 00095: nonce Check
Appearance Clol aC l here:❑
Itesample analyzed: Iry'JI-ISG Laboratory Name: (%/1,1i(O`lffl$lt If I(`C
iRAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N oo615 mg/L Pb - Lead most
Coliform: MF Fecal 31616 1100mL
Cofrform: MF Total 31504 /100ml.
(Note Use MPN method for highly tuMd samples)
solved Solids:Total 70300 51 mg/L
pH (Lab) 00403 LA .J67_ units
TOCooseo 1,14 mg/L
Chloride oo94o rit
Arsenic o1002 ug/L
Grease and Oils 00552
Phenol 32730
mg/L
ug/L
Sulfate oo945 rit
is Conductance 000gs bo.'S µMhos
Total Ammonia 00610 <O. OLA mg/L
(Amnortle Nitrogen; NH,m N: Pnynptl814100W. Tafel)
TKN as N 00625
mg/L
Nitrate (NO3) as N 00620 p- 3O mg/L
Phosphorus: Total as P 00665 mg/L
Orthophosphate 70507 <C) . C) I mg/L
AI -Aluminum o11o5 mg/L
Be - Barium 01007
Ca - Calcium 00916
ug/L
mg/L
Cd - Cadmium olo27 ug/L
Chromium: Total 01034 Ca ugf-
Cu - Copper 01042 <0. 0 1 Q mg/L
Fe - Iron o1o45
Hg - Mercury 71900
Ug/L
ugf-
K - Potassium 00937 mg/L
Mg - Magnesium 00927 mg/L
Mn - Manganese 01055
Nt - Nickel 01067
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs.
Piem9e(o:A�Y rli�lrl 1( trYi AS- a0014rntiOaty)pe 02�
GW -59 Rev. 3-1-2016
Zn -Zinc o1o92
Certification No. to
mg/L
Other (Specify Compounds and Concentration Units):
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? V Yes (1) ❑ No (0)
VOC 7673 , method # ZW C. q-7
and that the laboratory analytical data
nlity of fines and imprisonment for km
method #
method #
method #
mg/L VOC Removal

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Name: ('.
Name (if different):
Address: qW
iEPARTMENT OF EMflRONMENTAL QUALITY -DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
MAIL SERVICE CENTER, RALEIGH, NO 27699-1617 Phone: [phone]
IT Number: Expiration Date: I.11 -C
ischarge 640XjC)Qq UIC
S N0003W_T) Other
OF PERMITTED OPERATION BEING MONITORED
S"""'
County Pitt
❑Lagoon
❑ Remediation: Infiltration Gallery
'-"
❑Spray Fieldr❑Remediation:
Contact Person: �� (jll�tl
Telephone#: Z5Z-5ZY J`J� �i
ElRotary Distributor
I.p Land Application of Sludge
Well Location/Site Name: I f je__(`.j3HC11 OP- IQ Ito 4.51? IQ 11)
No. of wells to be sampled:
❑ Water Source Heat Pump
❑ Other:
Horn Pomm
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): 1 Cj
Date sample collected: 16-31- Ito
FIELD ANALYSES:
WAS
Well Depth: ft.
We11 Diameter: Z in.
pH 00400:4$q units
Temp. 00010: ZO eC
DRY at
Depth to Water Level 82546: LI ft. below measuring point
Screened Interval: D --ft. to ft.
Spec. Cond. 00094: Ixj
µMhos
time of
sampling,
Measuring Point is Z. 5 ft. above land surface
Relative M.P. Elevation: ft.
Odor °ooas: f10(c,
check
Volume of water pumped/bailed before sampling: 5_gallons
Appearance cyu(4
here:❑
SannDles for metals were collected unfiltered: DYES ❑ NO
and field acidified: ® YES ❑ NO
de sample analyzed: 10-&-110 Laboratory Name: LrWIrWrf)£(li ZIInC.
1RAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N oo615 mg/L Pb - Lead oto51
Coliform: MF Fecal 31s% ZZ /100ml- Nitrate (NO3) as N oo62o O.3 0 mg/L Zn - Zinc 01092.
Coliform: MF Total 31504 /100ml- Phosphorus: Total as P o0665 mg/L
(Nod'. Uee MPNmealddydr Nghlytvddsenples) Orthophosphate 70507 O.©Z mg/L
solved Solids:Total 703DO IL.I�j mg/L AI-Aluminumollos mg/L
pH(Lab)00403— `q units
TOC oo66o mglL
Chloride oog4o
Arsenic 01002
Grease and Oils 00552
Phenol 32730
mg/L
ug/L
mg/L
ug/L
Sulfate 00945 mg/L
c Conductance 0009s II IIMhos
Total Ammonia oo6lo <0•py mg/L
(Artmonla Ndrogan', NH,. N: Armenia Nlt Ogen. Tole)
TKN as N 00625
mg/L
For Remediation Systems Only (Attach Lab Reports):
Ba - Barium 01007 ug/L
Ca - Calcium 00916 mg/L
Cd - Cadmium 01027 ug/L
Chromium: Total oto34 ug/L
Cu - Copper 01042 ®•Old mg/L
Fe - Iron 01045 ug/L
Hg - Mercury 71900 ug/L
K - Potassium 00937 mg/L
Mg - Magnesium 00927
Mn - Manganese 01055
Ni - Nickel 01067
Influent Total VOCs.
Certification No. I ('�)_
mg/L
Other (Specify Compounds and Concentration Unitso\6
V
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? 00 Yes (1) ❑ No (0)
VOC 7873 , method # (QZLbC(G-I)
mg/L method #
ug/L method #
ug/L method #
mq/L Effluent Total VOCs.
mq/L VOC Removal
GW -59 Rev. 3.1-2016

GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
or
Name:
Names
SUBMIT FORM ON YELLOW PAPER ONLY
County Pitt
act Person: i� U+ r I I lli1,I Telephone#: -�J�(
Location/Site Name: W 0-� rimd $(3 No. of wells to be sampled:
INFORMATION PROCESSING UNIT
MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
PERMIT Number: Expiration Date:
Non -Discharge I/JQ CQQ) oQ( UIC
NPDES NC( ZO7 ) Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor rX Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
WELL ID NUMBER (from Permit): leg
Date sample collected: I
FIELD ANALYSES:
WAS
Well Depth: icLft.
Well Diameter: Z in.
pH 004004-ta- units Temp. 000lo:. 7—( °C
DRY at
Depth to Water Level e2546: 05 ft. below measuring point Screened Interval: =ft. to JD ft.
Spec. Cond. 00094: I t�Z pMhos
time ofsamplir
Measuring Point is 7 ft. above land surface
Relative M.P. Elevation: ft.
Odor 000e5: ncn-e,
check
Volume of water pumpedibailed before sampling: 5
gallons
Appearance ('10(10 j
here: r
Samples for metals were collected unfiltered: 3 YES
❑ NO and field acidified: NYES ❑ NO
Phenol 32730 ug/L
L
LABORATORY INFORMATION
Date sample analyzed: I b -:t )Hip
Laboratory Name: rN l (or)
Certification No.��
Lab Report Attached? tV Yes (1) ❑ No (0)
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
K - Potassium 00937 mg/L
VOC 7873 , method # LC4_
COD 00335 mg/L
Nitrite (NO2) as N oo6i5 mg/L
Pb - Lead o1051 ugfL
Coliform: MF Fecal 31616 /1 DOmL
Nitrate (NO3) as N 00620 ��, 04 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /1 DDmL
Phosphorus: Total as P 00666 mg/L
(Note: Use MPNmethodfor highly Nmldsamples)
Orthophosphate 70507 QOQ mg/L
Other (Specify Compounds and Concentration Units):
solved Solids:Total 70300 Ion mg/L
AI -Aluminum otto5 mg/L
�nft1%
PH (Lab) 00403 t -)l t{2, units
Ba - Barium 01007 ug/L
r f
TOCoo6eo r).C(3 mg/L
Ca- Calcium oo916 mg/L
s)<�
Chloride o094o mg/L
Cd - Cadmium o1027 ug/L
Arsenic 01002 ug/L
Chromium: Total 01034 cf 6-b 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 oos45 mg/L
Hg - Mercury 71900 ug/L
Lab Report Attached? tV Yes (1) ❑ No (0)
ecific Conductance o0095 ) (A µMhos
K - Potassium 00937 mg/L
VOC 7873 , method # LC4_
Total Ammonia o0610 O.00-) mg/L Mg - Magnesium 00927 mg/L
(Ammonia Nitrogen: NH3 as N: Amrvtla Ni ropen, Totals
Mn -Manganese 01065 —ug/L
TKN as N 00625 mg/L Ni - Nickel 01067 ug/L
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs:
Effluent Total VOCs:
method #
method #
method #
mq/L VOC Removal%
GW -59 Rev. 3-1-2016