WQ0004910_Monitoring - 10-2016_20161212 (4)

GW -59A COMPLIANCE A.NCE REPORT FORM Permit # r✓ �`�
( iebinit one each monitoring period with GW -59 forms.)
1
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
1F 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
O
identification plate, area overgrown, etc.)? If the answer is - Yes ", contact the Regional Office forguidaitce.
4
Are any monitored constituents equal to or above the established standards?
YES
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: IV
DEC 12 2016
N o
5
For the constituents identified in question 4 above, have standards,p'"j,"v� evc�,e'd' �g�,4�O�us`, for the
same constituent(s) in the 1
YES
N
same well(s) in the last two years? V17
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).
KLp
DEC 14 LU lij
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YE5
NO
If the answer is "YES" a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. if the answer is "NO". monitoring wells maybe 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 permittee to a Notice of Violation
fines, and/or penalties.
I
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 a,bovQ Information was evaluated and the InformatIdp submitted In�#his-
report (Compliance Report.•GW-59A) Is. true and complete to theFbost of m knowledge,.., 5!
A5
Signature of PLyrfnittee (or Authorized Agent) Date
rw cn , ,1ror,nn,

GROUNDWATER QUALITY MONITORING:
Facility Name:_
Permit Name (if
Facility Address
Well Location/ Site Name:
SLIBMIT FORM ON YELLOW PAPER ONLY
Please Print Clearly or Type
County -4"
Telephone ff:
No. of Wells to be Sampled:
Well Identification Number (from Permit):
Well Depth:_ zs For Groundwater Treatment Systems
ft. Well Diameter: Z in. Check One: ❑ influent (93)
Screened Interval: ft. to 2-- ft.
Depth to Water Level: _ ft. below measuring point. I 0 Effluent (99)
Measuring Point (M.P.) is:
--2- ft. above land surface. Relative M.P. Elevation in tt.:
Gallons of water pumpgd/ba d before sampling: 2 Date sample collected: I I/�
Field analysis: pit— Specific Conductance
uMhos
Temp. 1&2— 'C, Odor Appearance
• DEPARTMENT DF EMlIRONMENT 6 NATURAL RESOURCE_
WATER QUALITY DIVI90N, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH N�^_7F.99-16]6 Phone-/715'J]J-;C'•;
PERMIT B: EXPIRATION. DA-, E-
Non -Discharge waxime
NPDES
TYPE OF PERMITTED OPERATION BEING PAONI T ORED
Lagoon _Remediation: Infiltration Galle.r,
_ Spray Field _ Remediation: -
notary Distributor _ Land Application of Sludge
Other:
NOTE Values should reflect dissolved and
colloidal concentration,
Date sample analyzed:
Laboratory Name:Gny�__/1'7Y1M�_,�rT
Certification No. -Io --
PARA_--_METERS (Samples for metals were collected unfiltered
COD YES _NO and field acidified —YES
Coliform: MF Fecal
Coliform: MF Total
mg/i
/" 00ml
Nitrite (NO2) as N
Nitrate (NO3) as N L- D � --
mg/i
mg/I
(Note: Use MPN method for highly turbid metes)
/100mI
Phosphorus: Total as P
Orthophosphate
mg/1
Dissolved Solids: Total
pH (when analyzed)
mg/I
Al - Aluminum
mg/I
mg/I
TOC
units
Ba - Barium
mg/I
Chloride
mg/l
Ca - Calcium
mg/I
Arsenic �—
— mg11
Cd - Cadmium
mg/I
Grease and Oils
mg/I
Chromium: Total
mg/I
Phenol
mg/I
Cu -Copper
mg/I
Sulfate
mg/I
mg/I
Fe - Iron
lig - Mercury
mg/I
Specific Conductance
uMhos
K -Potassium
mg/I
Total Ammonia N
mg/I
Mg - Magnesium
mg/I
mg
m /I
mg/I
Mn - Manganese
mg/I
1 certify that, to the best of my knowledge and belief. the information suhmiRad in We
rao;
Ni- Nickel __
Pb - Lead
Zr. - Zinc
Ammonia Nitrogen
Other (specify Compounds and Concer.tra:iun lint:_)
ORGANICS: (GC,GC/MS,NPLC
(Specify test and method r.. A!tach ;ab report.
Report Attached? Yes_ e<,1 } No _, _
VOC _. method tt
method 1) -
GW -59
Rev. 03/2000 Sgnat re of ermi tee nr—Aln �r,,..�..'' ---

GROUNDWATER QUALITY MONITORING:
COMPLIANCE RFPnDr rr ,nhn
Facility Name:__ _122W
Permit Name (if different),
Contact Person:—KQ
Well Location/ Site Name:
SUBMIT FORM ON YELLOW PAPER ONLY
Please Print Clearly or Type
County,W
Telephone #:
No. of Wells to be Sampled:
Well Identification Number (from Permit): _ �__
Well Depth:. 7,2 ft. Well Diameter.. to Z Z inFor Groundwater TreatmentSystems
' Check One: ❑ influent (93)
Screened Interval; �O L_ it
Depth to Water Level:. J() ft. below measuring point. 6 I] Effluent (99)
Measuring Point (M.P.) is: 2- ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water Pumped/bailed before sampling: Z Date sample collected: j
Field analysis: pH Specific Conductance uMhos
Temp. °C, Odor __ Appearance
PARA!_—,AETERS (Samples for metals were collected unfiltered—YES _ND
COD
Coliform: MF Fecal —
m
/' o0ml
Coliform: MF Total
/1 OOmI
(Note: Use MPN method for highly turbid samples)
Dissolved Solids:
m/I
Total Q
mg/I
pH (when analyzed) t
units
TOC L-
mg/I
Chloride
mg/l
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
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCE.
WATER QUALITY DIVISIorI, GROUNDWATER SErTION
1636 MAIL SERVICE CENTER
PERMIT ff: rXPIRATIOI•! DATE
Non -Discharge gf�_UIC _
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon _Remediation: Infiltration Galler•,�--
-,� Spray Feld _ Remediation:
notary Distributor _ Land Application of Stuoge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name:
Certification No. No._ 10
and field acidified _YES
Nitrite (NO2) as N
Nitrate (NO3) as N � /
mg /l
Phosphorus: Total as P
mg/I
mgp
Orthophosphate
m/I
Al - Aluminum
mg/I
Ba - Barium_
mg/l
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/1
N0+
Ni - Nickel
Pb - Lead
Zn - Zinc _ _
Ammonia Nitrogen_ j4 -V7__— mC!
Other (Specify Compounds and Concentration;-
ORGANICS: (Gr-,,GC/M--,HPLC)
(Specify test and method S. Attach lab repon,
Report Attached? Yes 1,<11 rk.
VOC method ft =
method # =
method 11 =-----
- ,,.Se pant or ype
G W-59
Rev. 03/2000 statureof Permittee tot qu' i or`fzet a n�nn /

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
1 Please Print Clearly or Type
Facility Name:—I&M QE 14AQL7� )D -)k
Permit Name (if different):_
of County VDnr Bn
Contact Person: 0 _G _���(��' Telephone #: Z -
Well Location/ Site Name: y.119[TQ No. of Wells to be Sampled:
Well Identification Number (from Permit): t Pemim
Well Depth: - For Groundwater Treatment Systems
3�2fi. Well Diameter: Z in. Check One: ❑ Influent (98)
Screened Interval: 2 ft. to, it.
Depth to Water Level: _��.__tt. below measuring point. Effluent (99)
Measuring Point (M.P.) is: Z ft. above land surface. Relative M.P. Elevation in ft.. —Ir --
Gallons of water pumped/ ifed before sampling: Z. Date sample collected: /(��t /!/„
Field analysis: pH_ __ , Specific Conductance /QQJ r-
uMhos
Temp. ,ate°C, Odor__ Appearance _
DEPARTMENT Of ENVIRONMENT 3 NATURAL RESOURCE
WATER QUALITY DIVISION, GROUNDWATER SErTlpry
1636 MAIL SERVICE CENTER
RALEIGH, NC 27699-1636 yr,pp,.. (q --
PERMIT OKOA-,
Non -Discharge �_ �)(%
NPDES -
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon _ Remediation: Infiltration caller"
Spray Feld __Remediation:
Rotary Distributor _Land Application of SWdge
Other:
NOTE Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed: -lig hi kog
Laboratory Name: e4j. --
Certification No. 10 --
EARAP�1___ ETERS (Samples for metals were collected unfiltered YES
COD _ND and field acidified —YES
Coliform: MF FecalL
Coliform:
mg/I
/' OOmI
Nitrite (NO2) as N
Nitrate (NO3) as N
mg/I
i )
MF Total
(Note: Use MPN
/100ml
Phosphorus: Total
mg/I
as P m /i
mg/l
method for highly turbid sa les)
Solids. Total I.
Orthophosphate
mg/I
_
pH (when analyzed )
mg/I
At - Aluminum
mg/I
TOC G
units
Ba - Barium_
mg/I
Chloride
mg1I
Ca - Calcium
mig/I
Arsenic
mg/1
Cd - Cadmium
mg/I
Grease and 011s
mg/I
mg/I
Chromium: Total
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mgA
mg/I
Sulfate
Specific Conductance
mg/I
uMhos
Hg - Mercury
K - Potassium
m /I
g
Total Ammonia
TKN as N
mg/I
Mg - Magnesium
mg/l
mg/I
mg/I
Mn -Manganese
mgil
Certify that, to the best of my knowledge and belief, the informattan suhtn)ttari m twe.e.,r.A;....._
__ NO}
Ni - Nickel
Pb -Lead --- — - Zr, - Zinc
Ammonia Nitrogen —/-0,C4
Other (Specify Compounds and Coer.:ra;iur.
ORGANICS:. (GC,GC/MS,HPLC)
(Specify test and method 8. Attach lab repon.,
Report Attached? Yes --I--�-(1) No
VOC method N -_l0
method it =
. ^___-- r, case porn or type
Rev. 03/2000 gnature of Yermntee (or AUlhonzed Agentl ------

GROUNDWATER QUALITY MONITORING:
COMPLIANCE RFpr)p-r mmmftn
Facility Name:_
Permit Name (if
Contact Person:_i�
Well Location/ Site Name:
SUBMIT FORM ON YELLOW PAPER ONLY
Please Print Clearly or Type
County 1�
Telephone ti:2_7)1�
No. of Wells to be Sampled:
Well Identification Number (from Permit):
Well Depth: --- _% ft. Well Diameter: Z
Screened Interval: ._— it. to �2_ ft.
Depth to Water Level:_I?– it. below measuring point.
MeasuringPoint (M P '-_�
I For Groundwater Treatment Systems
in. Check One:❑ Influent (93)
I ❑ Effluent (99)
. -) is. ft. above land surface. Relative M.P. Elevation in R..
Gallons of water Pumped/bailed before sampling: _�_ Date sample collected: 1Q
Field analysis: pH Specific Conductance uMhos
Temp. °C, Odor __ Appearance
DEPARTMENT OF ENVIRONMENT 3 NATURAL RESOURCE.:
WATER QUALITY DIVISION, GROUNDWATER SI7rT10N
1636 MAIL SERVICE CENTER
PERMIT 4: EXPIRATIO^! DA--�-t
Non -DischargeJjj 0XQgIO _UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITOREC
Lagoon _Remediation: Infiltralio: t7allcr
_ Spray Feld —Remediation:
Rotary Distributor _Land Application of SW,7ge - Other:
NOTE
NOTE Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed_
Laboratory Name: M G ---
Certification No-
PARAMETERS
o.
PARAtDIETERS (Samples for metals were collected unfiltered YES
COD _NO and field acidified _YES
Coliform: MF Fecal {
mg/I
OOml
Nitrite (NO2) as N
Nitrate (NO3) as N
mg/I
0,407
Coliform: MF Total
(Note: Use MPN
/100MI
Phosphorus: Total as P
mgA
mg/I
method for highly turbid s�mples)
Dissolved Solids: Total f
Orthophosphate
mg/I
pH (when analyzed) ,
mg/I
Al - Aluminum
mg/I
TOC
units
8a -Barium_
mg/I
Chloride
mg/I
Ca - Calcium
mg/I
Arsenic --
mg/1
Cd - Cadmium
mg/I
Grease and Oils
mg/I
Chromium: Total
mg/I
Phenol
mg/I
Cu - Copper
mg/I
g
Sulfate
mg/I
Fe - Iron
— mg/I
Specific Conductance
mg/I
uMhos
Hg - Mercury
K -Potassium
mg/I
Total
TKNs N Ammonia
mg/1
Mg -Magnesium
mg/I
mg/I
mg/I
Mn - Manganese
mg/I
GW -59
Rev. 03/2000
-- NO)
Ni - Nickel----
ickel_Pb
Pb- Lead
e
Zn - Zinc
Ammonia Nitrogen_��___rrt,_t
Other (specify Compounds
and G�ncer.trntion
t!ri:;1
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method t. Attach lab report..
RBOC rt Attached? Yesy(1) Ho
method N
method ft= _
method r) _
jj

GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Please
Facility Name:-7Q►V
Permit Name (if different
SUBMIT FORM ON YELLOW PAPER ONLY
Clearly or Type
ICI,Y) County,fQC�►�r M
Contact Person "rl zlm
'� �" ��� � Telephone
Well Location/ Site Name: Iyh4 ->P No. of Wells to be Sampled:
Well Identification Number (from Permit):
Well Depth: ft. Well Diameter. _ in. For Groundwater Treatment Systems
Screened Interval: ft to Check One: ❑ Influent (98)
_�_ ft
Depth to Water Level:. (I? ft. below measuring point. El Effluent (99)
Measuring Point (M.P.) is: 7- ft. above land surface. Relative M.P. Elevation in ft:
Gallons of water pumped/ led .
before sampling: L Date sample collected: )
Field analysis: pH _ . Specific Conductance uMhos
Temp. 20# 'C, Odor __ Appearance
DEPARTMENT Or ENVIRONMENT R NATURAL RESOURCE -
WATER QUALITY DIVISION, GROUNDWATER SECTION
7636 MAIL SERVICE CENTER
PERMIT#: EXPIRATI
� Or: C,a.Tt:
Non-DischargeA"1)Y02 _UIC _
NPDES
IYEPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Intiltraliun Gaf!er­
— Spray Field Remediation:
Rotary Distributor _ Land Application of Sludge
NOTE- Values should reflect dissolved .and
colloidal concentration.
Date sample analyzed:Z6//,,L
Laboratory Name: eir-e2i a&mr-7�C—__--
Certification No. Zy
PARAMETERa (Samples for metals were collected unfiltered YES _ND
COD
and field acidified
ied
Coliform: MF Fecal
Coliform:
mg/I
-00ml
Nitrite (NO2) as N
Nitrate (NO3) as N D.O cigif
mg/I
/I
MF Total
Use
/100mi
Phosphorus: Total as P
mg/I
MPN method for highly turbi
Dissolved Solids: Total
pies)
Orthophosphate
mg/I
g
PH (when analyzed)
mg/I
Al - Aluminum
mg/I
L O
units
Ba - Barium _
mg/I
Chloride
mg/I
Ca - Calcium
mg/I
Arsenic (O
mg/I
Cd - Cadmium
mg/1
Grease and Oils
mg/I
Chromium: Total
mg/I
Phenol
mg/I
Cu - Copper
m g/ I
Sulfate
mg/I
Fe - Iron
m9/I
Specific Conductance
mg/I
uMhos
Hg - Mercury
K - Potassium
mg/I
Ammonia
mg/I
Mg - Magnesium
mg/I
mg/{
TKNTotaI s N
mg/I
Mn - Manganese
mg/I
_YES NO)
Ni- Nickel
Pb - Lead
Zn - Zinc
Ammonia Nitrogen
Other (Specify Compounds ;rnd Concentration
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab repot!.
Report Attached? Yes A/(1) Pic,
VOC method # _�—
method ll
i eerfify that, to the best of my knowledge and belief, the Information submitted in this report.is true, accurate, and complete, and that thdfabotatory analytical data was produced
using approved methods Of analysis by a North Carolina DWO (formerly DENT) certirred laboratory, I am aware that thea are significant penalties for submitting false information .
Including the possibility of fines and impdsonMentforknowing viola
9
0312Sig lure of Perinittee (of ed ev
000