WQ0024003_Monitoring - 11-2016_20161228

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page I of A_
Permit No.: WQ0024003
Facility Name:
HPDTA Wastewater System
County:
Perquimans
Month: November
Year: 2016
PPI: 001
Flow Measuring Point:
❑ influent EEffluent E]No Flow generated
Parameter Monitoring Point: El influent
E✓ Effluent ❑ Groundwater Lowering ❑ Surface water
Parameter Code - 0
50050
00310
00940
31616
00610
00620
00400
00665
70295
00530
p
C
To O
>m °'
U ~
O ac
O
m
2
E
°
U
m
E
Q
�;
`
o
0 CL
o
d
v
~ �
O
�W-
y
N
24 -hr hrs
GPD
mg/L
mg/L
#/100 mL
mg/L
mg/L
su
mg/L
mg/L
mg/L
1
07:10 5
7,514
7.1
2
07:10 5
10,452
7,16
3
07:10 3
7,640
7.12
4
07:10 5
6,627
7.03
5
6,627
6
6,627
7
07:10 5
7,724
7.15
8
07:10 5
7,258
7.12
9
07:10 5
9,978
7.14
10
07:10 5
6,931
7.06
11
6,931
12
6,931
Q F F 8 2016
13
6,931
14
07:10 5
11,594
7.11
DWR I ECTION
151
07:40 2B
10,846
7.15
INC
RMATION HROCESSING, UNIT
16
07:10 5
11,936
7.13
17
07:10 5
15,218
7.17
18
07:10 5
4,305
<2
228
5
<0.2
46.9
7.15
6.09
791
9.4
19
4,305
20
4,305
211
07:10 5
3,402
7.19
22
07:10 5
3,248
7.18
23
07:10 5
2,303
24
2,303
25
07:45 2B
2,435
7.2
26
2,435
271
2,435
28
07:10 5
4,918
7.21
29
07:10 5
4,716
7.18
30
07:10 5
8,284
7.16
31
Average:
6,572
0.00
228.00
5.00
0.00
46.90
6.09
791.00
9.40
Daily Maximum:
15,218
2.00
228.00
5.00
0.20
46.90
7.21
6.09
791.00
9.40
Daily Minimum:
2,303
2.00
228.00
5.00
0.20
46.90
7.03
6.09
791.00
9.40
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Monthly Avg. Limit:
24,300
30
200
15
30
Daily Limit:
g -g
Sample Frequency:
Continuous
Monthly
3 x Year
Monthly
Monthly
Monthly
5 x Week
Monthly 1
3 x Year I
Monthly

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: Jeffrey J. Swanson Name: Environmental Chemists LNC. #94
Name: Name:
Page _ Q of A_
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? I] Compliant ❑ Non -Compliant
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Jeffrey J. Swanson •
Permittee: Harvey Point Defense Testing Activity
Certification No.: 992725
Signing Official: Brian D. Lee
Grade: 2 Phone Number: [phone]
Signing Officials Title: Environmental Saftey Officer
Has the ORC changed since the previous NDMR? ❑ Yes p No
Phone Number: [phone] Permit Expiration: 3/31/2018
J
ah
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _L of _ a
Permit No.:
WQ 0024003
Facility Name:
HPDTA Wastewater System
County:
Perquimans
Month:
November
Year:
2016
Did
irrigation
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4
occur
Area (acres):
1.31
Area (acres):
1.31
Area (acres):
1.31
Area (acres):
1.31
at this facility?
Cover Crop:
Grass
Cover Crop:
Grass
Cover Crop:
Grass
Cover Crop:
Grass
❑�
YES
❑ No
Hourly Rate (in):
.5 hr
Hourly Rate (in):
.5 hr
Hourly Rate (in):
.5 hr
Hourly Rate (in):
.5 hr
Annual Rate (in):
57.2
Annual Rate (in):
57.2
Annual Rate (in):
57.2
Annual Rate (in):
57.2
Weather Freeboard
Field Irrigated?
❑✓ YES
❑ NO
Field Irrigated?
❑Z YES
❑ No
Field Irrigated?
❑� YES
❑ NO
Field Irrigated?
❑ YES
❑✓ No
pU
O
d
r
m
-
C.
Ecc 0)
F-
c
�"' tM d N .D
M.
o `�°
•v 0 T Q
d N N G
a LO
d 'O
a
0 6
> Q
d
E
F- 'C
_
C
ca
❑ O
J
7` C
E
lK9 2 0
J
O d
a
O C.
> Q
d d
E
H •C
C
�CL
❑ p
J
7 �` C
E v
•� _ p
J
O G1
a
O C.
> Q
O d
E rn
P 'C
T C
❑ O
J
7 T C
E'
•N = 0
2 J
d
'°
O C.
> Q
d d
E
H •...
_
T C
,�
❑ O
J
7 �` C
E' m
= O
� J
°F
in ft ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
PC
56
0
2,100
40
0.06
0.06
2,100
40
0.06
0.06
2,100
40
0.06
0.06
0
0
0.00
0.00
2
PC
56
0
3,567
60
0.10
0.10
3,567
60
0.10
0.10
3,567
60
0.10
0.10
0
0
0.00
0.00
3
PC
81
0
1,600
20
0.04
0.04
1,600
20
0.04
0.04
1,600
20
0.04
0.04
0
0
0.00
0.00
4
CL
53
1.5 4
2,344
40
0.07
0.07
2,344
40
0.07
0.07
2,344
40
0.07
0.07
0
0
0.00
0.00
5
2,344
40
0.07
0.07
2,344
40
0.07
0.07
2,344
40
0.07
0.07
0
0
0.00
0.00
6
2,344
40
0.07
0.07
2,344
40
0.07
0.07
2,344
40
0.07
0.07
0
0
0.00
0.00
7
C
45
0
2,000
40
0.06
0.06
2,000
40
0.06
0.06
2,000
40
0.06
0.06
0
0
0.00
0.00
8
C
47
0
4,800
75
0.13
0.11
4,800
75
0.13
0.11
4,800
75
0.13
0.11
0
0
0.00
0.00
9
PC
52
0
3,433
40
0.10
0.10
3,433
40
0.10
0.10
3,433
40
0.10
0.10
0
0
0.00
0.00
10
C
45
1 4.02
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
11
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
12
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
13
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
14
R
48
0.3
4,167
60
0.12
0.12
4,167
60
0.12
0.12
4,167
60
0.12
0.12
0
0
0.00
0.00
15
C
56
0
4,533
60
0.13
0.13
4,533
60
0.13
0.13
4,533
60
0.13
0.13
0
0
0.00
0.00
16
C
47
0
4,167
60
0.12
0.12
4,167
60
0.12
0.12
4,167
60
0.12
0.12
0
0
0.00
0.00
17
C
48
0
2,667
40
0.07
0.07
2,667
40
0.07
0.07
2,667
40
0.07
0.07
0
0
0.00
0.00
18
C
41
0 4
1,500
20
0.04
0.04
1,500
20
0.04
0.04
1,500
20
0.04
0.04
0
0
0.00
0.00
19
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
20
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
21
C
29
0
2,500
40
0.07
0.07
2,500
40
0.07
0.07
2,500
40
0.07
0.07
0
0
0.00
0.00
22
C
36
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
23
C
29
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
241
1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
25
C
60
0 4.02
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
26
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
27
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
28
PC
32
0
2,367
40
0.07
0.07
2,367
40
0.07
0.07
2,367
40
0.07
0.07
0
0
0.00
0.00
29
PC
55
0
1,700
40
0.05
0.05
1,700
40
0.05
0.05
1,700
40
0.05
0.05
0
0
0.00
0.00
30
CL
63
0.1
2,100
40
0.06
0.06
2,100
40
0.06
0.06
2,100
40
0.06
0.06
0
0
0.00
0.00
31
0
0
0.00
0.00
Monthly Loading:
12 Month Floating Total (in):
50,233
1.41
24.34
50,233
1.41
24.34
50,233
1.41
24.34
0
0.00
10.83

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) -Page _Cof-A-
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑✓ Compliant
❑ Non -Compliant
❑✓ Compliant
❑ Non -Compliant
❑r Compliant
❑ Non -Compliant
El Compliant
❑ Non -Compliant
El Compliant
❑ Non -Compliant
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Jeffrey J. Swanson
Permittee:
Harvey Point Defense Testing Activity
Certification No.: 992726
Signing Official: Brian D. Lee
Grade: SI Phone Number: [phone]
Signing Officials Title: Environmental Safety Officer
Has the ORC changed since the previous NDAR-1? ❑ Yes p No
Phone Number: (252).426-4360 Permit Exp.: 3/31/18
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

SUBMIT FORM ON YELLOW PAPER ONLY
UNDWATER QUALITY MONITORING:
PLIANCE REPORT FORM
Facility Name: Harvey Point Defense Testing Activity
Permit Name (if different):
Facility Address: 2835 Harvey Point Rd.
Hertford N.C. 27944 County Perquimans
act Person: Jeff Swanson Telephone#: [phone]
Location/Site Name: No. of wells to be sampled: 3
L ID NUMBER (from Permit): MW#1
Depth: 20 ft.
1 to Water Level 62546: a ft. below measuring point
wring Point is ft. above land surface
ne of water pumped/bailed before sampling: 5.0
Al for metals were collected unfiltered: ❑ YES ❑
Date sample collected: 11/16/2016
Well Diameter: 2 in.
Screened Interval: 2 ft.
Relative M.P. Elevation:
to 20 ft.
ft.
PARTMENT OF ENVIRONMENT 6 NATURAL RESOURCES
1SION OF WATER OUAUTY4NFORMATION PROCESSING UNIT
7 MAIL SERVICE CENTER, RALEIGH, NC 27622.1617 Phone: [phone]
.RMIT Number: W00024003 Expiration Date: 3/21/2018
n -Discharge UIC
IDES X Other
PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
IN Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
FIELD ANALYSES:
pH 00400: 6.54 units
Spec. Cond. 00094_
Odor 000ee: none
Appearance light tan
If WELI
WAS
Temp. 000lo: 17.1 °C DRY at
µMhos time of
Ite sample analyzed:
Laboratory Name: Environmental Chemists Inc.
Certification No. #94
IRAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrile (NO2) as N 00615 mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100ml-
Nitrate (NO$) as N 00620 <0.02 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100ml-
Phosphorus: Total as P 00665 0.56 mg/L
(Note. Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
solved Solids:Total 70300 171
ml
At -Aluminum oleos mg/L
z
^
IBJ
pH (Lab) 00403
units
Be - Barium 01007 M uglL
TOC oo680 18.4
ml
Ca - Calcium 00916 o M mg/L
: y Q !1 '' 7
Chloride oog4o 535
ml
Cd - Cadmium 01027--o5:E �uglL
Arsenic 01002
uglL
Chromium: Total olo34 v c2 to -n ug/L
Grease and Oils 00552
mg/L
r+1
Cu - Copper o1042 0 i ml
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron o1645 ugll-
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
GS T
Hg - Mercury 71900 Q' 11 ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
ecific Conductance 00095
µMhos
K - Potassium oo9s7 �� mg/L
VOC 78732: method #
Total Ammonia 00610 0.4
ml
Mg - Magnesium 00927 -+ mg/L
method #
(Ammonia Nitrogen; NH3as N: Ammonia Nitrogen, Total)
Mn - Manganese o1o55 ug/L
method #
TKN as N 00625
ml
Ni - Nickel 01067 ug/L
method If
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Brian D. Lee Environmental Safety Officer HPDTA
Perms tee (or Authorized Agent) Name and Title - Please print or type
GW -59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
TER QUALITY MONITORING:
E REPORT FORM
=acility Name: Harvey Point Defense Testing Activity
permit Name (if different):
=acility Address: 2835 Harvey Point Rd.
Hertford N.C. 27944 County Perquimans
act Person: Jeff Swanson
Location/Site Name:
Telephone#:[phone]
No. of wells to be sampled: 3
PARTMENT OF ENVIRONMENT a NATURAL RESOURCES
'ISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
17 MAIL SERVICE CENTER, RALEIGH, NC 276994617 Phone: J919)733422'
:RMIT Number: W00024003 Expiration Date: 3/21/2018
in -Discharge UIC
IDES x Other
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
0 Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
ELL ID NUMBER (from Permit): MW#2 Date sample collected: 11/18/2016
ell Depth: 20 fl. Well Diameter: 2 in.
pith to Water Level 82546: 5 ft. below measuring point Screened Interval: 2 ft. to 20 ft.
aasuring Point is ft. above land surface Relative M.P. Elevation: ft.
flume of water pumped/bailed before sampling: 5.0 gallons
implies for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES:
pH 00400: 6.49 units Temp. 000lo: 15.0 °C
Spec. Cond. 00094: µMhos
Odor coo8s: NONE
Appearance light than
WAS
DRY at
time of
sampling,
check
here:❑
tBORATORY INFORMATION
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
uglL
Fe - Iron 01045
uglL
(Specify test and method #. ATTACH LAB REPORT.)
its sample analyzed:
mg/L
Laboratory Name: Environmental Chemists Inc.
Certification No. #94
Lab Report Attached? ❑ Yes (1) ❑ No (0)
tRAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
K - Potassium 00937
mg/L
VOC 78732: , method #
Total Ammonia oa610 0.6
COD 00335
mg/L
Nitrite (NO2) as N oo615
mg/L
Pb - Lead 01051
uglL
Mn - Manganese 01055
Coliform: MF Fecal 31616 <1
/100ml-
Nitrate (1,103) as N 00620 <0.02
mg/L
Zn - Zinc o1o92
mg/L
method #
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P oo665 0.40
mg/L
(Nota: Use MPN method for highly Untild samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds
^^
3td�ncentration Units):
solved Solids:Total703oo 391
mg/L
AI - Aluminum oleos
mg/L
pH (Lab) 00400
units
Be -Barium 01007
ug/L
A
`J
TOC 0068o 21.5
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 182
mg/L
Cd - Cadmium 01027
uglL
Arsenic o1oo2
ug/L
Chromium: Total olo34
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
uglL
Fe - Iron 01045
uglL
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
ecific Conductance 00095
µMhos
K - Potassium 00937
mg/L
VOC 78732: , method #
Total Ammonia oa610 0.6
mg/L
Mg - Magnesium 00927
mg/L
, method #
(Ammonia Nltrogan, NH3as N, Ammonia Nitrogen, Total)
Mn - Manganese 01055
uglL
method #
TKN as N 00625
ni
Ni - Nickel 01067
uglL
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal
Brian D. Lee Environmental Safety Officer HPDTA
Permittee (or Authorized Agent) Name and Title - Please print or type
GW -59 Rev. 212010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER DUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27668.1617 Phom:l919)7J3.3221
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: W00024003
Expiration Date: 3/21/2018
Facility Name: Harvey Point Defense Testing Activity
ri
Non -Discharge
UIC
Permit Name (if different):
Nitrate (NO3) as N 00620 <0.02
NPDES X
Other
Facility Address: 2835 Harvey Point Rd.
/100mL
TYPE OF PERMITTED OPERATION BEING MONITORED
Hertford N.C. 27944 County Perquimans
❑ Lagoon
❑ Remediation: Infiltration Gallery
Orthophosphate 70507
mg/L
M Spray Field
❑ Remediation:
Contact Person: Jeff Swanson Telephone#: [phone]
Al - Aluminum 01105
❑ Rotary Distributor
❑ Land Application of Sludge
Well Location/Site Name: No. of wells to be sampled: 3
units
❑ Water Source Heat Pump
❑ Other:
L ID NUMBER (from Permit): MW#3 Date sample collected: 11/16/2016 FIELD ANALYSES:
Depth: 20 ft. Well Diameter: 2 in. pH 00400: 6.46 units Temp. 000lo: 20.5 °C
n to Water Level 82546: 7 ft. below measuring point Screened Interval: 2 ft. to 20 ft. Spec. Cond. 00094: µMhos
luring Point is ft. above land surface Relative M.P. Elevation: ft. Odor 00085: none
The of water pumped/bailed before sampling: 5 gallons Appearance Light tan
Aes for metals were collected unfiltered: FlYES ❑ NO and field acidified: ❑ YES ❑ NO
Ile sample analyzed:
Laboratory Name: Environmental Chemists Inc.
Certification No. #94
1RAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
ri
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 <0.02
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 0.51
mg/L
(Note: Use MPH method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Co ds and Concentration Units):
solved Solids:Total 703oo 233
ni
Al - Aluminum 01105
mg/L
X77
pH (Lab) 00403
units
Ba - Barium 01007
uglL
TOC oosso 9.7
ni
Ca - Calcium 00916
mg/L
Chloride oo94o 158
mg/L
Cd - Cadmium 01027
1
Arsenic 01002
ug/L
Chromium: Total o1034
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 oto45
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
1
Lab Report Attached? ❑ Yes (1) ❑ No (0)
ecific Conductance 00095
µMhos
K - Potassium 00937
mg/L
VOC 78732: , method #
Total Ammonia oxalo <0.2
mg/L
Mg - Magnesium 00927
mg/L
, method #
(Ammonia Nitrogen; Hnsas N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel o1oe7
ug/L
method #
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs:
mg/L
Effluent Total VOCs:
mg/L VOC Removal%
DRY at
time of
sampling,
check
here: ❑
GW -59 Rev. 212010

GW -59A COMPLIANCE REPORT FORM Permit # (N9OoXvo3
(Submil one each monitoring period with GW -59 forms.)
1
Enter date monitoring results were due. i Will this monitoring report (GW -59 and GW -59A)
YES
NO
be submitted after the established due date
Z
Was any required information missing on the GW -59 report forms?
YES
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 Office for guidance.
�/
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 elo
MW df eh%D2ipv /liSN I ivit/c. It"rn— CXU[c",—)
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.
H the answer to question 5 is "YES", list in the space provided below, each well with consfituent(s) exceeding
standards, concentration(s) reported, 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
N
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
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.
g
The person completing this portion (GW59A) 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.
a.� In Lk -4? I Z//gLzay�
Signature of Permittes (or Authorized Agent) Date
GW -59A 12/8/2003