WQ0003090_Monitoring - 11-2022_20230404

Monitoring Report Submittal
..................................................
Permit Number#* wg0003090
Name of Facility:*
Month: * November
town of liberty wwtp
Report Information
Type *
Revised - NDMR, NDAR-1, NDAR-2, NDMLR
Revised - GW-59
Year:* 2022
Upload Document*
Spray Report - Nov 2022 (2).pdf 3.39MB
PDF Only
Spray Report - Nov 2022 MW GW 59.pdf 3.35MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * [e-mail]
Name of Submitter: * Elix Fike
Signature:
Ct�irra�:r� l�.f^
Date of submittal: 4/4/2023
This will be filled in automatically
Initial Review

Reviewer: Wanda.Gerald
Is the project number correct?* wg0003090
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 4/19/2023

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Page _1_ of _1_
PermitNo.: WQ0003090 T-Facility
Name: Town Of Liberty - Wastewater
county: Randolph -7
Month: November
Year: 2022
PPI:
002
Flow Measuring Point:
influent El Effluent
❑ No flow generated
Parameter
monitoring Point:
E] influent [Z Effluent
❑ Groundwater Lowering
El Surface Water
Parameter Code
00400
00610
31613
00625
... . . ... ... 50060
70300
00630
0
0
M1111
s
+
Z
E
01
E
Cn
;g
E
U_
0
.2
0
(n
z z
z
0
mg1L
0
su
Mg/ L
M100MLI
mg/L
mg/L
mg/L
24-hr
hrs
I
1 7:00
8
21 7:00
8
7.27
18.3
10000
24.6
0.1
254
<0.040
3 7:00
8
4 7:00
8
WIN' I
5
6
5
*111111
7 7:00
8
8
7:00
8
9
7:00
8
8
7.27
ggpig' 0.08
10
7:00
2
8t a,11N
11
10:00
2
01
A
12
11:00
2
13
11:00
2
2420
26
0.22
k R 232
<0.040
14
7:00
8
7.81
17.9
7:00
8
15
16
7:00
8
17
7:00
8
8
18
7:00
19
11:00
2
R
P,
20
12:00
2
INN'!
21
7:00
8
0
V
A 0.21
A'
22
7:00
8
8
7.6
23
7:00
2
24
8:00
A "M
25
4...............
3
26
27
8
4
28
7:0
g
29
7:00
8
30
7_0_0
8
31
0.00
A
Average:
18.10
4,919.35
#REF!
0.15
243.0
Daily
Maximum:
7.81
18.30
10,000.00
*REF!
0.22
254.00
0.04
Daily
Minimum:
7.27
17.90
..00
1pf-",� 242000
#REF!
0.08
232.00
Q, 0.04
Sampling
Type:
Grab
�t,,,ggg
Grab
WE$ Grab
V Gra b
Grab
Monthly Avg.
Limit:
Daily
Limit:
A
77,77777,77,77,
J
Sample Frequency:
. . . w�
v
2x month
2x month
weekly
3x year
p 2x month
......... ...........
. . . .

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) 11 Certified Laboratories
Name: GLENN PRICE Name: PACE ANALYTICAL
Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 2 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.
non compiliant on the day of 11/12 11/27 and 11/28
rainfall I&I
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Elix Tremaine Fike Permittee: Scott Kidd
Certification No.: 989290 Signing Official:
Grade: SI Phone Number: 336 622 2990 Signing Official's Title: Town Manager
Has the ORC changed since the previous NDMR? ❑ Yes
21 No Phone Number: 336 622 4276 Permit Expiration: 8/31 /2024
Signature
Date Signature Dat
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

1�2ceAnalyfical"
www.pacelabs.com
i
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92634542
Sample: Effluent
Method
SM 254OC-2015
SM 254OD-2015
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
SM 521OB-2016
SM 9222D-2015
TKN+NO3+NO2
Calculation
EPA 300.0 Rev 2.1 1993
EPA 350.1 Rev 2.0 1993
EPA 351.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
ANALYTE QUALIFIERS
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 11/17/2022
Date Received: 11/03/2022
Lab ID: 92634542001 Collected: 11/03/22 11:25 Matrix: Water
Parameters
Results
Units
Total Dissolved Solids
254
mg/L
Total Suspended Solids
34.9
mg/L
Nitrogen, NO2 plus NO3
ND
mg/L
Nitrogen, Nitrate
ND
mg/L
Nitrogen, Nitrite
ND
mg/L
BOD, 5 day
26.8
mg/L
Fecal Coliforms
10000
CFU/100 mL
Performed by
PACE
Collected By
Garrett
Dreyer
Collected Date
11/03/22
Collected Time
1125
pH
7.27
Std. Units
Chlorine, Total Residual
0.10
mg/L
Total Nitrogen
24.6
mg/L
Report Limit Analyzed Qualifiers
50.0
11 /07/22 16:35
9.1
11 /07/22 09:55
0.040
11 /03/22 17:59
0.040
11 /03/22 17:59
0.040
11 /03/22 17:59
2.0
11 /09/22 11:58
1.0
11 /04/22 14:30
11 /03/22 11:25
11 /03/22 11:25
11 /03/22 11:25
11 /03/22 11:25
11 /03/22 11:25
11 /03122 11:25
0.040 11 /17/22 16:18
Chloride
27.8 mg/L
1.0
11/07/22 20:35
Nitrogen, Ammonia
18.3 mg/L
0.50
11/11/22 15:01
Nitrogen, Kjeldahl, Total
24.6 mg/L
2.5
11/17/22 07:06 M1
Phosphorus
3.9 mg/L
0.050
11/09/22 21:50
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
South Carolina Laboratory ID: 99030
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
Page 1 of 3

CHAIN -OF -CUSTODY Analytical Request Document
Anakvucal
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Company: Town of Liberty Billing Information:
Address:
Report To:
Copy To:
Customer Project Name/Number:
Phone:
Email:
Email To:
Site Collection Info/Adc
LAS USE ONLY- Affix Workorder/togin Label !Mere or List Pace Workorder Number or
WO#:92634AS42
ALL SHADE
Container Preservative Type
92634542
— Preservative Types: (1) nitric acid, (2) sulfuric
6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (S) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpresented, (0) Other
State: County/City: Time Zone Collected:
I CT ET ]PT[ ]MT[
Site/Facility ib Compliance Monitoring?
[ /Yes [ ]No
Purchase Order DW PWS 10 #:
U)
Quote #: DW Location Code:
Turnaround Date Required: Immediately Packed on Ice:
]Yes ]No
M!E
9
0
ii
e —D, Rush: Field Filtered (if applicable):
11
0
-a
7
]Dispose as appropriate [ ]Retum f I Same Day I Next Day Yes No
Z
Archive: ]4Day f 15 Day
12Day [ 13Day Analysis:
70-
—0
Hold: (Expedite Charges Apply)
0
• 0
Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Z
Z
D-1—t foi rr,il/qr,firl fql I oil (ni) kAlinp fWPl_ Air (AR). Tissue (TS), Bioassav (B), Vapor (V), Other (OT)
1:6,
Lab Profile/Line;
Lab Sample Recei _xah Check!iEst.
pi Custody Sealu ?resent/Intact
custody Signatures 9Ie"Ln,_
y 11 Ii.11
Collector Signat%nce Pr..1111
1 .1,
sottlentact
P tLk
correct Bottles
Gut f4cent volv,=,
S amples 7eceived an rceTv
T, tk
ODA - H,Caidspac!e AcCepta!ale
Y 14 �A,,
Us ,A Regulated sails
Y°_tr
Samples inlqoldinp Time
�"Yn,tT W.
Residual Chlorine Pre.senz,
C1 Strips:
Sample piJ P,cceptable
fL Preson,
de -
Y q
Lead },_ Itate Stripz:
LAE USE ONLY:
_TC_.__P _/C.11ected (or mposite End
LI Customer Sample lD matrix Grab Composite Start) Co
Fes
Cl
Lab Sam le 4 1 Comments:
# of Z = i 7
Ctns 0
0 = 0
Date Time Date Time
Effluent pWW 9 111 ,z- IISS_
to Z Li
5 X X
Customer Remarks/ Special Conditions/ Possible Hazards: �Vpe of M, Used: Blue Dry None 'SHORT HOLDS PRESENT t<72 hours]i:
P. ck in at, , J.iI U I Lab Tracking4t:
Effluent Monitoring
amples received via-.
Radchem sample(s)
screened (<500 cpm). Y N NA
FEDEX UPS
Client Courier Vacecot
,!9 grature)
Date/Time:
igna ur
Rec ,�ed by/Companr(S' t e)
}Date/Time:
7iTJL LAa no K
Arctnurn:
dished by/Company: (Signature)
D Time:
Receive nature)
d by/C6mp�ry: (Sig
"Date/Time:
iTemplate:
CD
�Prelogin:
r- ished by/Company: (Signature)
Tu
Date/Time:
J' Received by/Company: (Signature)
i Date/Time:
�PM:
LdU Zdlitidle 1UJJ1PUid6 C 1111U,
Temp Blank Received' Y N NA
Therm tD#: 4_1P_ r C —
Cooler I Temp Upon Receipt. tzOC
Cooler I Therm Corr, Factor: 2 OC
Cooler I Corrected Temp: oC
Comments:
Trip Blank Received: Y N NA
HCL MLOH TSP Other
Non Conformance(s)Pager:
YES i NO of:

C
r
P
e I c e
C-
,tc-I bcx is tc list num�'zr or
�7
<
zz 7 7
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pH Adjustment Log for Preserved Samples
0
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H upun ro'C-!ipc
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TIITI? PrIaseria-,io(I
adjusted
Amc-int ui
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Page 3 of 3

1�-;acieAnalyticalN'
www.Pacalabs.cam
f
i
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92636031
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 11/11/2022
Date Received: 11/10/2022
Sample: Effluent Lab ID:
92636031001 Collected: 11/10/22 13:25 Matrix:
Water
Method Parameters
Results Units Report Limit
Analyzed Qualifiers
Performed by
PACE
11/10/22 13:25
Collected By
Garrett
11/10/22 13:25
Dreyer
Collected Date
11/10/22
11/10/22 13:25
Collected Time
1325
11/10/22 13:25
pH
7.27 Std. Units
11/10/22 13:25
Chlorine, Total Residual
0.08 mg/L
11/10/22 13:25
Reviewed by:���
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

'CHAIN -OF -CUSTODY Analytical RequestDocument
�aceAi?aJ[ica?
- Chain -of -Custody is a LEGAL DOCUMENT- Complete all relevent fields
Company: Town of Liberty Billing Information:
Report To: t Email To:
Co py To: i Site Collection Info/Address:
i
LAB USE ONLY -Affix Workorder/tor' __ , ._ n z, rk r �e Number or
WIL
ALL SHADED A]!
Container Preservative T e ". 92636031 1111111111111111111111
»" Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, p) zinc ace�4.
(6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
(C) ammonium hydroxide, (0) TSP, (U) Unpreserved, (0) Other
L b P nil (Line
Customer Project Name/Number:
State: County/City: Time Zone Collected:
J [ ]PT[ ]MT[ JCT I
iET
$
Phone:
?Site/Facility ID 9-
1Compliance Monitoring?
[ JNo
Email:
{[Yes
lid
C Vetted By (pri t):
Purchase Order +:
DW PWS ID #:
( Quote ::
DW l ocation Code:
ti
Coll na'
Turnaround Date Required:
immediately Packed on ice:
{�
l
[ ] Yes C JNo
°'
sposal:
Rush:
;Field Filtered (if applicable);LL
C-'[
[ ] Dispose as appropriate [ ] Return
[ J Same Day [ J Next Day
[ J Yes [ ] No
o
[ ]Archive:
[ J 2 Day [ ]3 Day [ ] 4 Day [ ] 5 Day
Analysis:
[ ] Hold:
(Expedite Charges Apply)
CJ
:Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
[t
o...,�,,,-« Iol c.,itic IiH ra k nil tni
l Winp (WP). Air (AR). Tissue ITS), Bioassay (B), Vapor (V), Other (OT)
l a
Analyses a r t e
Lab: Sarmil.e Receipt cbe k' z: t:
( ( r`us:.atlti Seals aae._tllr ,tcG Y :+F WA
Cui;tod"r Y H 14A
t S Collector F:7:gnature -, re aemt 1" N NpM
e FF{{ F4ttlr s riltact„ 1 N N1%
] 1 p correct Battles l H NA
[ Samples h- c+y.a`.'4ct on Ice X N NA
i vo'k - Peadeipace ?acceptable Y N Gat
' USDA.: Regaaated scii'liz. y 111' N&
jj
I 5aatpzeu 3r.. 'iol 5.ns{ Ti:ae Y V NA
3e idural Chlorine r ear t Y IT bm
Cl st p+a
Sample Pi Acceptacblc � t 7
6 pA Stripe:
Sulfide- Present f N MS.
] i F U'B USZ ONLY.;
u ) [Comp / ! Collected (or
€
Customer Sample ID Matrix ` } Grab Composite Start)
l Composite End
m 3 Lab sampla # 1 commouto:
Res C n
� iL
Cl ts
i CL if° ) `�
Date Time
Dated
Time
EfP[uent ww g l 6,- 1 L
0 [
n
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None�(Z>nvxi rtvu.+a rttcSr_iv 44,G ri�urat. "r
Parkin Material Used; Lab Tracking #: Temp Blank Received* Y N N 4
g Therm ID#:
* m — o �,
Cooler :i Temp upon Receipt; —cc
Effluent Monitoring
Samples received via: Cooler 1 Therm Corr. Faciar; ®oC
f Radchem sample(s) screened (<SQO cpm): Y N NA fEDE}C UPS Client Courier Pace Courier Caoler 1 Corrected Temp: aC
r M14TiL CAB USE OR1LY Comments.
Relli is e ' mph nature) Date/Time: / jNRecee
by/Comp ry: (Sia tare) Date, T me: �
i Table.l
�� d bampany: (Signature) at /Time: (y/C mpany: (Signature) Date/Time: Trip Blank Received- Y N NA
,Template: HCL McOH TSP Other
CD
i $Pretogin:
� Received by/Coin an (Signature) )Date/Tim PM: Non Ccnfcrmanc , IPa e:
Relbsquished by/Company: (Signature) Date/Time: P y: ( g O: g
rtv 1ps: YES / NO af;

laceAnalytical 0
i/7-
www,pacelabs.com
i
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92636382
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 11/30/2022
Date Received: 11/14/2022
Sample: Effluent Lab ID:
Method Parameters
92636382001 Collected: 11/14/22 10:52 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
SM 2540C-2015 Total Dissolved Solids
232
mg/L
50.0
11/16/22 11:26
SM 254OD-2015 Total Suspended Solids
20.2
mg/L
5.8
11/15/22 08:51
EPA 353.2 Rev 2.0 1993 Nitrogen, NO2 plus NO3
ND
mg/L
0.040
11/15/22 10:43
EPA 353.2 Rev 2.0 1993 Nitrogen, Nitrate
ND
mg/L
0,040
11/15/22 10:43
EPA 353.2 Rev 2.0 1993 Nitrogen, Nitrite
ND
mg/L
0.040
11/15/22 10:43
SM 521OB-2016 BOD, 5 day
19.4
mg/L
2.0
11/20/22 12:21
Colilert-18 Fecal Coliforms
2420
MPN/100mL
1.0
11/15/22 09:16 El
Performed by
PACE
11/14/22 10:52
Collected By
Glenn Price
11/14/22 10:52
Collected Date
11/14/22
11/14/22 10:52
Collected Time
1052
11/14/22 10:52
pH
7.81
Std. Units
11/14/22 10:52
Chlorine, Total Residual
0.22
mg/L
11/14/22 10:52
EPA 300.0 Rev 2.1 1993 Chloride
31.1
mg/L
1.0
11/16/22 21:56
EPA 350.1 Rev 2.0 1993 Nitrogen, Ammonia
17.9
mg/L
0.20
11/21/22 14:02
EPA 351.2 Rev 2.0 1993 Nitrogen, Kjeldahl, Total
26.0
mg/L
2.5
11/29/22 04:01
EPA 365.1 Rev 2.0 1993 Phosphorus
3.8
mg/L
0.050
11/23/22 18:21
ANALYTE QUALIFIERS
Reported value should be considered a minimum
estimate since it
is the maximum reportable number
for this method
El
based on the sample volume used. The true value is likely greater than the value reported.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
South Carolina Laboratory ID: 99030
Florida/NELAP Certification #: E87648
South Carolina Certification #: 99030001
North Carolina Drinking Water Certification #: 37712
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Wastewater Certification #: 633
North Carolina Drinking Water Certification #: 37738
Virginia/VELAP Certification #: 460025
Page 1 of 3

CHAIN -OF -CUSTODY Analytical Request Document
° �aceAnaVlical
company: Town of Liberty
Address:
Report To:
Copy To:
Customer Project Name/Number:
Phone:
Email:
Collected
Chain -of -Custody's a LEGAL DOCUMENT _Complete all relevent fields
; Billing Information
Email To:
Site Collection Info/Address:
LAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
MTJL Log -in Number Here
�� �►2�3�332
Container Preservativ
`. Preservative Types: (1) nitric acid, (2 62636382 f
(6) methanol, (7) sodium bisulfate, (6) s,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) vtne,
Analyses Lab Profile[Line:
;State: County/City: Time Zone Collected: ( ) } Lab SampleReceipt 11acklx°
31 J [ ]PT[ ]MT( ICT [ IET
c a ) custody Sear :'regent/Tntacc r,
Compliance Monitoring} E custody signatures present S NA
( I I collector signature Pres&-= N NA
[ /Yes j I No [ ; I Bottles intact NPI
Correct Sactles NA
�y rint):
Purchase Order#: DW PWS ID #:
aCn
I I
Sufficient valum
T to
r
Quote #: DW Location Code:
Turnaround Date Required: Immediate y Pac e on Ice:
a
E-
ai
� H� F
ld" 1 7S_ �-
} -
I : Samples Received on Ice.
f J6A Eta.ds.,p.ce sccCe-.rk..toi+^
isnA. Reguilat:ed Soils
Ott A,A
Y "`':,°.
Y n ;
By (sign ture):
/
[ ]Yes [ ]No
p .... i t...
�- samples in Falding Time
+ .NA
}�
Residua! Chlorine:.kre;2;+ nr
y< LD -
Sample Disposal: Rush: Field Filtered (i app Ica e . _ ¢ Q ,
Same Da ( ]Next Day [ ]Yes [ j No 0 �Z t � � ' c1 strips. � f
( } Dispose as appropriate ( } Return [ l Y c: Sample pH Acceptable Qv pi NT
[ 1 Archive: [) Z DaY [ l 3 DeY [ l 4 Ray [ l 5 Day Analysis: ) a I } ( pi Sul�� _ ps: t i v hF u a
( } Hold: (Expedite Charges Apply) ( [ Lead Acetate
presort
* Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW}, Wastewater (WW), Z Z li E
Lead Itcetata 6txipe;
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT) [ to 1 L usa ONLY:
a` Lab Sample # f Commento:
Comp / Collected (or Res # of I" Z _ �' 2 ( i
Composite End
Customer Sample ID Matrix ` Grab Composite Stag) Cl Ctns ` C T _ 0 i
Datep Time Date Time ca Z LL in. ;1-^ �m
Effluent wW 9 1 -�
j
I
-- — l None SHORT HOLDSPRESENTtc72hours}: N N/A Lab Sample Temperature Infa: �
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry
„�..m..�...�.�...-....._,.,..._.�,.�. Lab Tracking#: .Temp Blank Received Y N NA
y Packing Material Used: ). � Therm [Dit: E
_ Cooler I Temp Upon Receipt: C_, OC
"Effluent Monitoring Cooler lTherm Corr Factor. oC
Samples rece ved via: �
Radchem sample(s) screened (<500 cpm): Y N NA FEDEX UPS Client Courier (ease Courier,. l Cooler l Corrected Temp. oC
�_-...�... �-w-_. Comments:
lD to/Time• MTJL LAB USE ONLY
Relinquished by/Comp ny: (Signature)
' Date/ Tme: g
Received by/Company: (Signature
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Cam`._-s'
e
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Date/Time:
; Received by/Comony: (S nature)
(Date/Time:
(
iTemplate: I Trip Blank Received: Y N NA
HCL McOH iSF Other
CD
Prelogin:
N
Relliquished by/Company: (Signature)
Date/Time:
received by/Company: (Signature?
Date/Time:
PM: Non Conformance(s): Page:
w
PB: YES / NO of.

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Page 3&3

aceAnalytical
www.pacclabs.com
I
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92638083
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 11/28/2022
Date Received: 11/22/2022
Sample: Effluent
Method Parameters
Lab ID: 92638083001 Collected: 11/22/22 12:55 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
Performed by
PACE
11/23/22 09:53
Collected By
Garrett
11/23/22 09:53
Dreyer
Collected Date
11/22/2022
11/23/22 09:53
Collected Time
1255
11/23/22 09:53
pH
7.60 Std. Units
11/23/22 09:53
Chlorine, Total Residual
0.21 mg/L
11/23/22 09:53
Reviewed by:
Stephanie Knott
704-977-0981
stephanie.knott@pace]abs.com
Page 1 of 2

CHAIN -OF -CUSTODY Analytical Request Document
PaceAna(�4ical Chain-of-Cuzsto.dv;, a LEGAL DOrUrvIENT - Complete all rolevent fields
LAB USE ONLY -Affix Workorder/ Login Label Here or List Pace Workorder Number or
WO#:92638 N8 3
Container Pr
-T- F--j- 92S38083
Pl;
Types:in1m,Repair
(6j methanol, (7) -sodlu,, biNulfare, (S) (A) a4c-f— ac,d, (R) a,r w'm
(C) ammonium hydroxide. tDTSP. (U) Unp,eer,ee., (rl; L)mc.r
Coma,
Billing Information:
Address:
Tm
i
EmaT
Cap,; To:
Site Collection InfojAddress:
Analyses
1Lab Profilc,'Line:
Customer Project Name/Number.
State: County/City: T;nrie Zone Collected:
PT[ ]MTi JCT ET
<)
w
Q-*+
f - "'samplc Rece iPL 1: 11 st
Custorly Soa-� - s Pr�sent - i k
cu.'t—ly ures Fr,. y N r"
Col I c�c tor F, ignatuz re-q<:w- Y N NA
Bo'tles Intact y N NA.
CoLract sotticn y N, 111"t
Volume Y N NA
'�,C,t - HeadnEtCe ACceotatl.L.. Y 11 NA
USDA R�g'jlatee' Soils' Y N npy
::oldlina ":Ire y ii NA
Fesiduai Chlorine P:,-snt y N NA,
r"_1 StL-vns:
------ — — --------
Lead Acetate Strips:
USE o411,y:
Lab '3'=pie 1-1,
Phone:
Email:
Site/FacilityID 11:
Compliance Monitoring?
Yes No
C tpcTed 6y
Purchase Order 4:
Quote
DW PW5 ID 4:
DW Location Code:
Collect.
Turnaround Date Required:
Immediately Packed an Ice:
Yes I ] No
I:
Hold
Rush:
Same Day Next Day
2 Day J i 3 Day 4 Day l 5 Day
(Expedite Cha,ge5 Apoty)
Field Filtered applicable):
Yes M 0
Analysis:
M3-,riy. Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (IIJW),
Product (P), Soil/Solid (SQ, Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (a r)
Customer Sample ID
matrix
Comp
Grab
Collected (or
Composite Start)
Composite End
Res
Cl
4 of
Ctns
Date
Time
Dare
Time
....... ...... ... .
Customer Remarks Special Conditions Possible Hazards
Type of Ice Used: Wet Blue Dry None
SHORT HO LOS PRESENT (<72 hours): Y N N/A
Lob Sample Temperature Info:
Temp Blank Received: Y N NA
Therm 104.
Cooler I remp I-11pon Receipt: ___oC
Canter I Therm Carr, Factor: —nC
Cooler 1 Corrected Temp _._oC
comment';:
Packing Material Used:
Lab Tracking #:
2 0 PS
Radchern sample(s) screened (<500 cjpm); Y N NA.
sampic-5 received via:
FEDEX UPS clieni. Courier Pace Courier
Relt MgtLir
��I'
Date/Time:
- 1---7
6t 0
Received by/Company: (Signature)
( i
av 1 --2�/
r�' A
Datej'Time`
ZZ
fAT-11- LAB USE ONLY
i
Fable 4:
Acctnun':
by/Company: by/Comany: (`Signature)
ID
Received by/Company: (Sign
Dat&/Tirne:
T e mo I a t f-:
Prelogin:
BinnIt R,2eived Y N N 'A
HCL N1 e () H Sp Other
Relinq�ishecj Lyf'f-omoary: (Signatur,)
Dare/Time:
Received Lv,Compariy: (Signature} jDate/Iirne:
RMI:
IPB:
Nor; Crnfornwnc.oi,,):Pa
'(E5 ", NO
I i;f

November 2022
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
1
16 1/2
2
16 1/4
3
16 1/2
4
17
5
17
6
17 1/4
7
17 1/4
8
17 3/4
9
17 1/2
10
18 1/2
11
17 3/4
R
1.7
12
17 1/2
13
17 1/4
14
17
15
17
R
0.5
16
16 1/2
17
16 1/2
18
17 1/2
19
18
20
18
21
17 3/4
22
18 3/4
23
19
24
18 3/4
25
18 1 /2
R
1.0
26
17 1/4
27
17
R
1.0
28
16
29
15 1/2
30
16 3/4
R
1.0
TOTAL 5.2

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _1_ of -2-
Permit No.: W00003090
Facility Name: Town of Liberty - Wastewater
County: Randolph
Month: November
Year: 2022
A N,
IBM
Field Name:
2
41 0
AIR, Field Name:
0A
4
Did irrigation occur
M
"oil
Area (acres):
19.7
Area (acres):
17.02
at this facility?
Cover Crop:
FESCUE
Cover Crop:
FESCUE
Hourly Rate (in):
0.2
Hourly Rate (in):
0.21
2 YES El NO
Oda K=1
Annual Rate (in):
52
T
Annual Rate (in):
52
4
Weather
Freeboard
Field Irrigated?
YES El NO
Field Irrigated?❑YES
[21 NO
.0
QOf
E
0
21
cm
2-6
W .0
CL M
E 2D
(D
E
z
E .2
Q
CL
L
0
-
CL
cc
0
x 0 Cc
6 O.
L
X 0
cc Z:
E
>1 CL
>
>
t:
3:
ft
ft
gal
min
in
in
gal
min
in
in
&TOM
2
PC
65
1.25
3
4
K 01 0 NIB 11 N I M
5
C
68
1.25
325,000
180
0.61
0.20
6
281,000
180
0.61
0.20
7
C
80
1.25
8
9
PC
40
1.25
10
MIT M
11
R
1.7
121
'M N11
131
141
151
R
1 0.5
161
181
C
1.25
325,000
180
0.61
0.20
191
mpg
201
1
211
C
1 40
1.25
4
281,000
180
0.61
0.20
221
C
1 42
1.5
231
C
1 40
1.5
325,000
180
0.61
0.20
241
251
R
M
261
271
R
"WE
281
291
C
43
1.25
301
R
311
Monthly Loading
x
475,000
1.82
762,000
1.22
12 Month Floating Total
24.02
LOW, MME
32.62

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
0 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Q Compliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 0 Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s)
the
(s) taken. Attach in compliance.
sheets
Provide
in our explanation the date(s) of the non-compliance and describe the corrective
action
Permittee Certification
Operator in Responsible Charge (ORC) Certification
Permittee: Scott Kidd
ORC: Elix Tremaine Fike
Signing Official:
Certification No.: 989290
Grade: SI
Phone Number: 336 622 2990 Signing Official's Title: Town Manager
Phone Number: 3366224276 Permit Exp.: 8/31/24
Has the ORC changed since the previous NDAR-1? ❑ Yes � No
2
4z
e- �? ''�2 Date
Signature
Date Signature
By this signature, 1 certify that this report is accurrate and complete to the best of my knowledge. I certify, under penalty 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
and belief, true, accurate, and complete. I am aware that there are significant
information submitted is,or to the best of my knowledge
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _2_ of _2_
Permit No.: WQ0003090
Facility Name: Town of Liberty - Wastewater
County: Randolph Month: November
Year: 2022
i?3•... "iir1s
� A
Field Name:
6
h i k`.; t k A - `; 2 t
„� �t } � t' �
Field Name:
8
Did Irrigation OCCUr``
��� f
Area (acres):
15.1
�,� w (it�,at��
'
Area (acres):
21.68
at this facility?
"'� ��s�'^
Cover Crop:
FESCUE
""
('�� fi
�x kf
Cover Crop:
FESCUE
Hourly Rate (in):
0.21
4. £" v5 i y k 4 sz dl ,,
its'.}2 ��
HourlyRate m
( )•
0.21
❑� YES El No
sk
Annual Rate (in):
52r��
s�1� '�
Annual Rate (in):
52
Field Irrigated?
❑ YES 7 NO
„
'��
Field Irrigated?
❑ YES [21 NO
Weather
Freeboard
O
d
>`
+?�
O
0I
N Q
O. fC
d
d 0
>, C
-
7 C
;\'.
;
2
l6
R
E
•x R
d
•V
T C
O_
O O.
f— •�.
!6 (�6
D O
X O
M S O
=t u d
s s
O.
i Q
of
F i
J
O
= J
E
d
y
CL
o
-
i Q
_
J
r2 J
Its
R�
a
LO
gal
min
in
in
��
gal
min
in
in
°F
in
ft
ft
2
�.' z1
350,000
180
0.59
0.20
3
C
60
1.25
�
,� ,
4
i)
71
r` s
9
1 C
55
1.25
350,000
180
0.59
0.20
11
R
1.7
12
13
14
15
R
0.5
16
a
17
C
49
1.25
A i d'3a
IN
350,000
180
0.59
0.20
18
19��:
`l{{
20
' ,t f ,. J• 4ti°y,:,
i a r z
a 7sC�.r. ''{4t
�
x�yy,�99
e`4>¢t lafsR
{
211
C
50
1.25k��a1;
221
1
1
i�{ t is€klS
241
13."
251
R
I
1
g.
���
�M r sx s 2
A
,'
-
1 j y;; 1➢l�'o�,, { (7
i {
271
R
1
1
1101
281
j
s,R,t3tsS1} as4'.s' f st h' i,
r ��� `� � �t�� � �,��t n
kh 4+'isl ss'k
�t? �
29
C
51
1.25
4r d¢ 's
� � ,a', �� �,? � 1 �c ,
30
31
,1. #I, B 11i �j,,'`i¢ i �, a'�4§
� a , �,4° �� � ,� �
, �.0 �,
12
Month
Monthly
Floating
Loading:
Total
(in):
0
101=
0.00
27.24
„?�
1,050,000
1.78
29.33

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? ❑� Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? El Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 0 Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 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:
Elix Tremaine Fike
Permittee:
Scott Kidd
Certification
No.: 989290
Signing Official:
Grade:
SI Phone Number: 336 622 2990
Signing Official's Title: Town Manager
Has the
ORC changed since the previous NDAR-1? ❑ yes 2 No
Phone Number: 336 622 4276 Permit Exp.: 8/31 /24
.�_ l �2
✓ 2- Z
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617