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Home My WebLink AboutWQ0002520_Monitoring - 11-2016_20161222GW -59A COMPLIANCE REPORT FORM Permit (Submit one each monitoring period with GW 59 forms.) I Enter date monitoring results were due. 11-45) WIII this monitoring report (GW -59 and GW -59A) be submitted after the established due date? E NO 2 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 identification plate, area overgrown, etc.)? Ifthe answer is "Yes-. contact the Regional OTIcefor guidance. YES O 4 Are any monitored constituents equal to or above the established standards? YES O If the answer to question 4 Is "NO" skip to section B. If the answer to question 4 Is "Vii "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 same constituent(s) In the same well(s) In the last two years? YES O If the answer to question 5 is 'NO", skip to section 8. If the answer to question 5 I "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). 6 Are the monitoring wells listed In section 5located 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 groundwater quality problem? YES O If the answer to question 7 is "YES", describe those actions in the space provided below. If the answer to question 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 surroundingthis facility, Failure to do so may subject the permittee to a Notice of Violation fines and/ore ISSTX8dN011%Vb0,N1 NOWO;3 Mn 91 OZ g9. Cl 8 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. e7Z5aa dcknowleieethat torfon"hv I hereby w report (Compliance RepoR,G)N?59A),le,t�u6 erifSophate,to ilia beat ofmrlsl 4.W�edge�f� Signature PermittAuthorized Agent) Date DWATER QUALITY MONITORING: IANCE REPORT FORM Name: Name (d . unmi I NC 77d_ County act Person: #,P r,! 7 -r,,-49 - Telephone#: 95Z 9113 - Location/Site Name: Oh/i vM I % No. of wells to be sampled:,, I PERMIT Number: Expiration Date: Non -Discharge w�7i r% UIC NPDES Other TYPE OF PERMITTED OPERATION BEING MONITORED ZLLgoon ❑ Remediation: Infiltration Gallery Spray Field ❑ Remediation: ❑ Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑ Other: PI ING INFORMATION p L ID NUMBER (fromR I Date sample collected: �I' / `J Depth: Well Diameter. �in. h to Water Level: & below measuring point Screened Interval: _ft. to _ft. luring Point is J_ ft. above land surface Relative M.P. Elevation: _ft n - ne of water pumped/balled before sampling:—�_9allons ^ sample analyzed: AMETERS NOTE: Values should reflect dissolve COD mgA Coliform: MF Fecal—4 1100m1 Coliform: MF Total /100ml (Nob: Us° NPN aaawd r NgWy �d rrOe°) Dissolved Solids: Total Z} m9A pH (when analyzed)ry) units TOC �r I%C/ mgA Chloride mgA Arsenic mgA Grease and Oils mgA Phenol m9A Sulfate mg/I Specific Conductance µMhos Total Ammonia G a O mgA (Nmnronie Ni"P.: NHa. N: A w Niacydn, Tab?) TKN as N For Remediation Systems Only (Attacn Lao reports): itlee led APenl1 Narne antl TM1Ie -Please PNnt u tyPeAGenll Name antl TM1Ie -Please Pnnt u ivPa GW -59 Rev. 1/2007 - FIELD ANALYSES: pH _units Spec. Cond. _ Odor Appearance _ Temp. °C DRY at µMhos ime of mpling, check here:❑ Laboratory Name: Certification No. 373 colloidal concentrations. Nitrite (NO2) as N mgA Pb - Lead mgA Nitrate (NOa) as N p, pr mgA Zn - Zinc mg/I Phosphorus: Total as P mgA Orthophosphate mgA Other (Specify Compounds and Concentration Units). AI -Aluminum mgA Ba - Barium mgA Ca - Calcium mgA Cd - Cadmium mgA Chromium: Total mgA Cu - Copper mgA ORGANICS: (by GC, GC/MS, HPLC) Fe - Iron mgA (Specify test and method X. ATTACH LAB REPORT.) Hg - Mercury mgA Report Attached? ❑ Yes (1) ❑ No (0) K - Potassium mgA VOC , method # Mg - Magnesium mgA method # Mn - Manganese mgA , method # Ni - Nickel mgA , method # inuucui VLai °.....,. Of min VnC SUBMIT FORM ON YELLOW PAPER ONLY QUALITY MONITORING: PORT FORM Name:v .v /Own 01� Name (if differpint): Address: �� cf+-✓['-/ - -4-11 n; NC 1 9 County 130a v o/ 7L - act Person: AeIV - 2 Telephone#:.7�2- 115 Loc No. of wells to be sampled: YT OF Et WATFR RMIT Number: t Expiration Date n -Discharge CJ� fZ7J� 'R� UIC 'DES Other PE OF PERMITTED OPERATION BEING MONITORED (Lagoon ❑ Remediation: Infiltration Gallery G"Spray Field ❑ Remediation: ❑ Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑ Other. IPI ING INFORMATION Gy Date sample collected: H- / -�� FIELD ANALYSES: .L ID NUMBER (from Permit): Depth: /9 ft. Well Diameter:,�in. Fe - Iron pH _units Temp. 'C !h to Water Level: F, 6'ft. below measuring point Screened Interval: _ft. to _R Spec. Cond. µMhos suring Point is CR ft. above land surface Relative M.P. Elevation: fL Odor me of water pumpedfbailed before sampling: gallons Magnesium Appearance iles for metals were collected unfiltered: ❑YES ❑ NO and field acidified: El YES El NO ORATORY INFORMATIONCin -/� -4b Laboratory Name: Mn - Manganese I,—Certification No.--? 73 sample analyzed: / V, TKN as N mgA Ni - Nickel mgA :AMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD mgA Nitrite (NO2) as N mgA Pb - Lead mgA Coliform: MF Fecal —%—f100ml Nitrate (NO3) as N p,Co mgA Zn -Zinc m9A Coliform: MF Total —1 11 00m Phosphorus: Total as P mgA (Nam: use MPNn+Nodror NyNyN d-rro-) Orthophosphate mgA Other (Specify Compounds arwcentration Units): Solids: Total mgA AI -Aluminum mgA Dissolved pH (when analyzed) units Be - Barium mgA '`' iy n /,0,17 TOC mgA .- C mgA Chloride R mgA -Cadmium Cd - Cadmium mgA Arsenic mgA Chromium: Total mgA Grease and Oils mgA Cu - Copper mgA ORGANICS: (by GC, GC/MS, HPLC) mgA Fe - Iron mgA (Specify test and method #. ATTACH LAB REPORT.) Phenol mgA Hg - Mercury m9A Report Attached? ❑ Yes (1) ❑ No (0) Sulfate µMhos K - Potassium mgA VOC , method # Spec Conductance Magnesium mgA , method # Total Ammonia Dr /eZ mgA Mg - (Ammonia Nft,,n. NH,.. N; Aninwnu Niaopan, Ta ) Mn - Manganese mgA method # TKN as N mgA Ni - Nickel mgA method # For Remediation Systems Only (Attach Lab Reports): GW -59 Rev. 112007 Influent Total VOCs: Effluent Total VOCs: VOC at of TER QUALITY MONITORING: Name: Name (if i Address: SUBMIT FORM ON VFI IOW PAPER ONLY County act Person: h4t-✓V '1 //'r;E)2 Telephone#- (rtaV3 LocatioNSite Name oSh vM aRT No. of wells to be sampled: a RMIT Number: Expiration Date: n -Discharge i.4262�70.7 0 UIC IDES Other 'PE OF PERMITTED OPERATION BEING MONITORED Lagoon ❑ Remediation: Infiltration Gallery 02-79pray Field ❑ Remediation: ❑ Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑ Other. SAMPLINGINFORMATION Date sample collected: 91-M, FIELD ANALYSES: = 37� Certification No. AS WELL ID NUMBER (from Permit): Well Diameter. in. pH units Temp. °C PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. DRY at 'me Well Depth: R Depth to Water Level: �. R below measuring point Screened Interval: _ft. to _R Mh Spec. Cond. µos mgA of sampling, Measuring Point is �_ft. above land surface Relative M.P. Elevation: fL Odor Zn -Zinc mg/I deet: volume of water pumped/bailed before sampling_—�gallons _ _ Appearance (N.Y: U. MMe for NyNy.a�d a.mq.n cere' ❑ I AROV ATORY INFORMATION 1�)� Laboratory /Y�'J/r'L�I?T = 37� Certification No. Date sample analyzed: /� "?'/)%9Nam: _ [�1/� PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD mgA Nitrite (NOz) as N mgA Pb - Lead mg/I Coliform: MF Feral G /100m1 Nitrate (NO,) as N 0. C>.T mgA Zn -Zinc mg/I Coltfonn: MF Total I100ml Phosphorus: Total as P mgA (N.Y: U. MMe for NyNy.a�d a.mq.n Orthophosphate mgA Other (Specify Co�ulds and Concentration Units): Dissolved Solids: Total 36/ mgA AI -Aluminum mgA pH (when analyzed) �units Be - Barium mgA TOC L„ ! r tit/ mgA Ca - Calcium mgA Chloride mgA Cd - Cadmium mgA Arsenic mgA Chromium: Total mgA Grease and Oils mgA Cu - Copper mgA ORGANICS: (by GC, GC/MS, HPLC) mgA Fe - Iron mgA (Specify test and method #. ATTACH LAB REPORT.) Phenol Sulfate mgA Hg - Mercury mgA Report Attached? ❑ Yes (1) ❑ No (0) Specific Conductance µMhos K - Potassium mgA VOC , method # Total Ammonia 6),/JL mgA Mg - Magnesium mgA method # (Amm Nibopen', WsN: Ammonia Nitrdp«,, Ta.) Mn - Manganese mgA , method # TKN as N mgA Ni - Nickel mgA , method # For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: :tee (or uthwzed Anent) Name and GW -59 Rev. 1/2007 Effluent Total VOCs: VOC Removal,, 42 TER QUALITY MONITORING: E REPORT FORM Name: Name (if County act Person: /re/) ;r / r I Ie _ Telephone#: 4�5^ - //;. Location/Site Name:/i ✓M r % No. of wells to be sampled: PI MG INFORMATION LID NUMBER (from Permit): /V Date sample collected: Depth:ft. Well Diameter: rn. 1 to Water Level: t, %g R below measuring point Screened Interval: /F ft. to R/Tft. wring Point is _V7 ft. above land surface Relative M.P. Elevation: fL ne of water pumped/bailed before sampling: 1_gallons ^ sample analyzed: /A-/.1.7� tAMETERS NOTE: Values should reflect dissolve COD mg/I Coliform: MF Fecal < f /100ml Colifomr: MF Total 11 00m (Nob: Um MM nxtlwd b "Hy W d 8MMOSS) Dissolved Solids: Total mgA pH (when analyzed) units TOC mgA Chloride Arsenic mgA Grease and Oils mgA Phenol mgA Sulfate mgA Specific Conductance µMhos Total Ammonia�.YD, OY mgA (AndnoNa N&Opm, NH,u N: Ammonia N!"W. TOW) TKN as N mgA OF ENVIRONMENT S :RMIT Number: Expiration Date: ,n -Discharge �F.raq.ZS. o UIC IDES Other P�E9F PERMITTED OPERATION BEING MONITORED L7 Lagoon ❑ Remediation: Infiltration Gallery Q -Spray Field ❑ Remediation: ❑ Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑ Other. FIELD ANALYSES: pH _units Spec. Cond. Odor Appearance Temp. °C DRY at µMhos a of L r Certification No. 373 LaboratoryName: and colloidal concentrations. Nitrite (NOz) as N mgA Pb - Lead mgA Nitrate (NO3) as N D g28 mgA Zn - Zinc ----Wmg/I Phosphorus: Total as P mgA Orthophosphate mgA Other (Specify Compounds and Concentration Units): Al -Aluminum mgA Ba - Barium mgA Ca - Calcium mgA Cd - Cadmium mgA Chromium: Total mgA Cu - Copper mgA ORGANICS: (by GC, GC/MS, HPLC) Fe - Iron mgA (Specify test and method #. ATTACH LAB REPORT.) Hg - Mercury mgA Report Attached? ❑ Yes (1) ❑ No (0) K - Potassium mgA VOC , method # Mg - Magnesium mgA , method # Mn - Manganese mgA method # Ni - Nickel mgA , method # GW -59 Rev. 1/1007 SUBMIT FORM ON YFFI I OW PAPER ONLY For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mgrL cmueni l otai VOCs. „y,� •--- 61 -7 - GW -59 Rev. 112007 DEPARTMENT OF ENVIRONMENT A NATURAL RESOCH(C GROUNDWATER QUALITY MONITORING: wsioN OF WATER QUALITY-INFORMAT1OWRR.45 S5iN4uN tjUAISERVICE CENTER, RALEIGH, NCzr9atg4u COMPLIANCE REPORT FORM INFORMATION Please Print Genly or Type PERMIT Number: Expiration Date: FACILITY Facility Name: �Dv-�/1 0'}- Non -Discharge �r�YiZ 1ili% UIC NPDES Other Permit Name (if different): TYPE OF PERMITTED OPERATION BEING MONITORED Facili Address: s.C.n64 9 'Lagoon ❑ Remediation: Infiltration Gallery NIC' O County ¢cr: �`•,e, �'� E Spray Field ❑ Remediation: �1 c n r�fY z Telephone#: J-O9f� ❑Rotary Distributor Land Application of Sludge Contact Parson: /YC�i7 Well LocatioNSite Name DiyiJM No. of wells to be sampled: ❑ Water Source Heat Pump ❑Other. P° If WELL SAMPLING WELL ID NUMBER (from Permit): Date sample collected: /1"q -/I-FIELD ANALYSES: AS °C DRY at Well Depth: ft. Well Diameter: In. pH units Temp. time of Depth to Water Level: R babes measuring point Screened Interval: �ft. to µMhos R Spec. Cond. sampling, Measuring Point is ft. above land surface Relative M.P. Elevation: R Odor check here: Volume of water pumped/bailed before sampling: _gallons Appearance Sam les for metals were wlleded unfiltered: DYES ❑ NO and field acidified: ❑ YES ❑ NO r ARORATORY INFORMATION t. Laboratory Name: tlwar-? ✓ 'A L Certification No. X73 Date sample analyzed: _/ PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD mgA Nitrite (NO2) as N mgA Pb- Lead mgA Coliform: MF Fecal < / /100ml Nitrate (NOs) as N .� D, O rtgA Zn -Zine JA Coliform: MF Total It 00ml Phosphorus: Total as P m9A (N°Y' lla MPN means rorNpNy avelE �ymple�) Orthophosphate mgA Other (Specify COMPOWd Concentration Units): Dissolved Solids: Total S/ mg/I AI -Aluminum mgA pH (when analyzed) units Ba - Barium mgA TOC ,� Op mgA Ca - Calcium mgA Chloride ,3a mgA Cd - Cadmium mgA Arsenic mgA Chromium: Total mgA Grease and Oils hgA Cu - Copper mgA ORGANICS: (by GC, GC/MS, HPLC) Phenol mgA Fe - Iron mgA (Specify test and method C ATTACH LAB REPORT.) Sulfate mgA Hg - Mercury mgA Report Attached? ❑ Yes (1) ❑ No (0) Specific Conductance µMhos K - Potassium mgA VOC . method # Total Ammonia mgA Mg - Magnesium mgA , method # (MunpNe NNopen; NH.rs N: Amman Haopen, aW) Mn - Manganese mgA method # TKN as N mgA Ni - Nickel mgA , method # For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mgrL cmueni l otai VOCs. „y,� •--- 61 -7 - GW -59 Rev. 112007 ROUNDWATER QUALITY MONITORING: OMPLIANCE REPORT FORM Name: Name (if aunml l rvrtm civ � rr,r � �... or NC a7lfOi( County act Person: 1, > a eP _ Telephone#: ZSR- PZ ` Location/Site Name. / 1Z Aff No. of wells to be sampled: PERMIT Number: Expiration Date: Non -Discharge L,)C- UIC NPDES Other TYPE OF PERMITTED OPERATION BEING MONITORED ❑ Lagoon ❑ Remediation: Infiltration Gallery 9'Spray Field ❑ Remediation: ❑ Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑ Other: f WELL vI ING INFORMATION L7 L ID NUMBER (from Permit): Ig Date sample collected: Depth: 30ft. Well Diameter: in. 1 to Water Level: �Zft. below measuring point Screened Interval:R. to �ft. wring Point is ft, above land surface Relative M.P. Elevation: ft. ne of water pumped/bailed before sampling: ,_gallons ^ FIELD ANALYSES: pH _units Spec. Cond. Odor Appearance _ Temp. °C IDRY at me of FN] N-� /_'n,i/i�a')I">oires Certification No. 37/�� -Laboratory tn2�� Name: should reRect dissolved and colloidal concentrations. COD mgA Nitrite (NO2) as N mgA Pb - Lead m9/I Coldonn: MF Fecal G 11 00m Nitrate (NO3) as N 0, /,3 mgA Zn - Zinc mgA Coliform: MF Total /100ml Phosphorus: Total as P mgA (Nola: Um MPN meewd Por highly lured MWIes) Orthophosphate mg/I Other (Specify Compounds and i ntration Units): Dissolved Solids: Total 15!9mg/I At - Aluminum mg/I pH (when analyzed) units Ba - Barium mg/I TOC Ori mgn Ca - Calcium mgA Chloride „,7 7 mg/I Cd - Cadmium mg/I Arsenic mgA Chromium: Total mgA Grease and Oils mg/I Cu - Copper mgA ORGANICS: (by GC, HPLC) mgtl Fe - Iron mg/I hod #. ATTACH LAB REPORT.) (Specify test and method #. Phenol Sulfate mg/I Hg - Mercury mgA Report Attached? ❑ Yes (1) ❑ No (0) Spec Conductance µMhos K - Potassium mg/I VOC , method # Total Ammonia D. 04�- mg/I Mg - Magnesium mgA method # (Amnrorva Nlwgenl NH,ea N', Ammanie Nitrogen, Total) Mn - Manganese mgA method # TKN as N mg/I Ni - Nickel mgA method # For Remediation Systems Only (Attach Lab Reports): influent l utei vw /5 (Date) dt—" (g�rized Agent) Name and Title - Please GW -59 Rev. 1/2007