WQ0003090_Monitoring - 07-2020_20200824

Monitoring Report Submittal
Permit Number #* wg0003090
Name of Facility:* town of liberty wastewater plant
Month:* July
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
G W-59
Year:* 2020
Upload Document*
july spray report.pdf
FDF Only
july 59 sign.pdf
PDF Only
Please upload only one combined pdf document. Upload GW-59 individually.
Confirmation Email Address:* [e-mail]
Name of Submitter:* tremaine fike
Signature:*
Date of submittal: 8/24/2020
This will be filled in autorratically
Initial Review
Reviewer: Williams, Kendall
1.27MB
1.07MB

Is the project number correct? * WQ0003090
Is the monitoring report r Yes r No
accepted?*
Regional Office * Winston-Salem
Accepted Date: 8/24/2020

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page_l_of_1_
Pa
is
c
6
7
a
9
10
11
12
13
14
16
16
17
18
19
20
21
22
23
24
ermit No.: W00003090
PPI: Flow Measuring
rameterCode 50050
e
O
� m 3
U.
O c
Facility Name: Town Of Liberty - Wastewater
Point: El influent ❑ Effluent ❑ No flow generated
00400 00310 00610 00530 31613 00620
10e a w €
� c �9r
a e rm° .c
dP
Parameter
00625
cc
2
Ysg
oz
County: Randolph
Monitoring Point: ❑ influent
00665 50060 0M0
c � m
� 0
Mgr
a o v z
Month: July
[Z Effluent ❑ Groundwater lowering
70300 00940 00630
2 s 'g
°qgo
s r
QN zz
Year: 2020
❑ Surface water
00010
24hr hrs GPD
eu
mg/L
mg/L
L
#1100 mLmgIL
m L
m
mgiL m /L
mgll.
mg/L
mg/L
°C
6:00 8 260,000
8.81
24.9
3.63
113
>12000
0.412
6.72
1.14
0.18 7.17
197
35
0.454
29.2
8:00 8 263,000
6:00 8 271,000
254,000
197,000
6:00 8 218,000
6:00 6 231,DD0
6:00 8 239,000
6:00 8 305,000
7.87
1.33
6:00 8 241,000
246,000
245,000
6:00 8 209,000
6:00 8 225,000
6:00 8 235,000
6:00 8 203,000
7.17
23.1
3.62
32
>2420
0.063
10
1.18
0.08 101
0.063
6:00 8 196,000
8:00 3 671,000
10:00 3 234,000
6:00 8 222,000
6:00 8 210,000
6:00 8 257,000
6:00 8 312,000
7.08
0.48
6:00 8 194,000
9:30 3 1 289,000
10:30 3 1 236,000
6:00 8 1 125,000
6:00 8 1 208,000
6:00 8 678,000
6:00 8 408,000
6.56
0.08
8:00 8 296,000
Average: 270,258
24.00
3.63
72.50
1.00
0.24
8.36
1.16
0.43 8.64
197.00
35.00
0.26
29.20
Daily Maximum: 678,000
8.81
24.90
3.63
113.00
0.00
0.41
10.00
1.18
1.33 10.10
197.00
35.00
0.45
29.20
Daily Minimum: 125,000
6.56
23.10
3.62
32.00
0.00
0.06
6.72
1.14
0.08 7.17
197.00
35.00
0.06
29.20
Sampling Type: Recorder
Aonthly Avg. Limit:
Daily Limit: 550,D00
Sample Frequency: Daily
weekly
2x month I
2x month
2xmonth
2x month
2x month
2x month
2x month
weekly 2x month
3x year
3x year
2x month

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories `
Name: GLENN PRICE Name: RESEARCH & ANALYSIS LABORATORIES, INC
Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 21 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 rwraccaru
non compliant on the date of 7129 cause of I&i
Operator In Responsible Charge (ORC) Certification
ORC: Elix Tremaine Fike
Certification No.: 989290
Grade: SI Phone Number: 336 622 2990
Has the ORC changed since the previous NDMR? ❑ Yes El No
r Signature / Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permlttee Certification
Permittee: William Doerfer
Signing Official:
Signing Official's Title: Town Manager
Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
ignature Date
I certify, under penalty of law, q _ni 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

RESEARCh & ANALYTICAL Report of Analysis
LAbo RATO RI E5, INC. 7/9/2020
For: Town of Liberty .�►' 0.0
C�;••••,.r!'+•y
P.O. Box 1006 �•
Liberty, NC 27298 Ni NC#34
O: to
w S NC#37701
Attn: Kevin Coble
go
Client Sample ID: Effluent
Lab Sample 1D:
84101-01
Site: Town of Liberty
Collection Date:
7/1/2020
12:55
`Parameter
Method
Result
Units
Rev Limit Analyst Analysis Date/Time
Ammonia Nitrogen
SM 4500 NH3 D-2011
3.63
mg/L
0.1
FK
7/2/2020
BOD-5
SM 5210 B-2011
24.9
mg/L
2
HW
7/2/2020
1400
Chloride
SM 4500 Cl B-2011
35.0
mg/L
1
EE
7/8/2020
Dissolved Solids
SM 2540 C-2011
197
mg/L
25
AW
7/1/2020
Fec Coli-MF
SM 9222 D-2006
>12000
col/100 ml i
BJ
7/1/2020
1545
Nitrate + Nitrite
SM 4500 NO3 E-2011
0.454
mg/L
0.05
DW
7/2/2020
1110
Nitrate Nitrogen
(SM 4500 NO3 E-2011)-(SM
0.412
mg/L
0.05
DW
7/2/2020
1110
4500 N 02 B-2011)
pH
SM 4500 H+13-2011
8.81
Std. Units
7/1/2020
1255
Temperature (Thermometric)
SM 2550 B-2010
29.2
°C
7/1/2020
1255
Total Kjedjahl Nitrogen
Hach 10242
6.72
mglL
1
FK
7/6/2020
Total Nitrogen
Calc
7.17
mg/L
1
Total Phosphorous
SM 4500 P E-2011
1.14
mg/L
0.05
LP
7/7/2020
Total Suspended Solids
SM 2450 D-2011
113
mg1L
5
AW
7/1/2020
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1

Company
Street Address
City, Stale, Zip
Contact
Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
Phone [phone]
of
Phone
IJob No.
Project Effluent (Ist and 3rd weeks)
Sampler Name ' (Please Print)
Sampler Signature' .
ti,nq,lc Tu,ul,e,'
Temp
Res.
Chlorine
Sample Q
(I,ab Use Unl3•)
Dale Time
Comp,
Grab
C
CI.
Removed
Matrix Sample Location / I.D. 0
Z
YorN
SorNV
611
7 5 iZs$'
---------------------------
X 2-
0 19
w Effluent 0
,u,du,sneuUry Pale/ 1 mte
'Relinquished Sy Dale/'time
CHAIN OF CUSTODY RECORD
Water / Wasteivater ' Misc.
� o
C —
!-• e r
�7
C
0
E-
_
V
fa.
J
�i
%
v
0.
•6.�. 4
a •L
Requested Anal►
BOD, TSS, NH3N, I
TKN, NO3-N, T. Nit
T. Phosphors.
�lr r'�r•;�e . T�
Effluent
H:
TRC: 22• / L
14y JRemarks: ** Mar•ch,.July, November: Add Ct-.Ind TDS to Eff sampling Ist W
fn lce f Sample'lcmper:rture at receipt ) (" -C

RESEAACh & ANAIyT1CAI.
LAboRAWRIES, INC.
For: Town of Liberty
P.O. Box 1006
Liberty, NC 27298
Attn: Tremaine Fike
Report of ,Analysis
7/1 b/2020
Kb A�ALYT'i
M NC #34 Z
1 NC #37701
�l'ii127166 W`E;a I
Client Sample ID: Effluent Lab Sample 1D: 84419-01
Site: Town of Liberty Collection Date: 7/9/2020 9:24
Parameter Method Result Units R2pLRmit Analyst Anal sis Date/Time
Chlorine Residual SM 4500 Cl G-2011 1.33 ug/L 7/9/2020
pH
SM 4500 H+B-2011
7.27 Std. Units
7/9/2020
NA = not analyzed
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1

Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
�'' "~'"`'" ' Phone [phone]
CHAIN OF CUSTODY RECORD
Water/ Wastewater l Misc.
any ! OW11 uJ Liberty
Job No.
Address
Project Effluent (2nd, 4th and 5th weeks)
�
c'
�
O
Mate, Zip
Sampler Name
I ase P i
.
:
ct Phone
Sampler Signature
•�
a
:�
x
o.
z
0
Number
Temp Res. Chlorine
Sample
c
M
s
a.
au
Ise On! Date Time Comp Grab
Y)
,C Cl. Removed
Matrix Sample Location / I.D.
0
a
n.
d
e.
4
b
YorN
SorW
er
N
ti
d
a
—
.a
.l
7 z
X I
I
I
I W Effluent
0
By 7�— �ate/Time e i Remarks:
By Date Time I Received 6
No sample - pH, TRC
Effluent
pH:
TRC: - G
On Ice I Sample Temperature at receipt °C

RESEARCh & ANA[yTICA1 Report of Analysis
LA b 0 RATO R I ESF INC. 813/2020
For: Town of Liberty +,C;,.•••••••.,• •,i�
P.O. Box 1006 ` ,�4,�t �"�,'•'
Liberty, NC 27298 jr
2� NC#34 ZZ
w = NC #37701
Attn: Kevin Coble "s •:
Q
Client Sample ID: Effluent
Lab Sample ID:
84845-01
Site: Town of Liberty
Collection Date:
7/16/2020 12:45
Parameter
Method
Result
Units
Rep Lirnit Analyst Analysis Date/Time l
—
Ammonia Nitrogen
SM 4500 NH3 D-2011
3.62
mg/L
0.1 �FK
7/22/2020
BOD-5
SM 5210 B-2011
23.1
mg/L
2
HW
7/17/2020
1440
Chlorine Residual
SM 4500 CI G-2011
0.08
mg/L
7/16/2020
1245
Fecal Coliform QT
Colilert 18
>2420
MPN/100ml 1
BJ
7/16/2020
1527
Nitrate + Nitrite
SM 4500 NO3 E-2011
0.063
mg/L
0.05
DW
7/16/2020
1630
Nitrate Nitrogen
(SM 4500 NO3 E-2011)-(SM
0.063
mg/L
0.05
DW
7/16/2020
1630
4500 NO2 B-2011)
pH
SM 4500 H+B-2011
7.17
Std. Units
7/16/2020
1245
Total Kjedjahl Nitrogen
Hach 10242
10.0
mg/L
1
FK
7/21/2020
Total Nitrogen
Cale
10.1
mg/L
1
Total Phosphorous
SM 4500 P E-2011
1.18
mg/L
0.05
BJ
7/30/2020
Total Suspended Solids
SM 2450 D-2011
32.0
mg/L
5
AW
7/1712020
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1

Kesearch & Analytical
Laboratories, Inc.
Analytical / I'rocess Consultations
i
Phone [phone]
CHAIN OF CUS TOD Y RECORD
111111er/l astetvOler
Iny Town of Lihertp
Job No.
AtJdress
Project Effluent (1st and 3rd weeks)
c
tatc Zip
Sampler Name (Please Print)
y
't Phone
�1,
Sampler Signattre- /
•�
-�
—
L
u
n
C
E
Vu+nncr
Temp Ices. Chlorine Sample
©
n
Date Time Com Crab
;e Only) I
"C (.I. Removed Alatrix Sample Location ! I.U.
L
E E
c>r
t
c.
U
n
U
0
J
Y
J
J
_
J
J
..
J
lvk/ \
1t.j \V Effluent
I)
t
i
IiritlUishctf'[3y Uatc/'1•imc
7 •' V
ling B)"A fly �lay i Date role
Remarks:
AMC.
lie< ics(cd Analysis
BOU, TSS, Ni-UN, F.Coli,
TKN, NO3-N, T. Nitrogen
T.Phosphorus
Effluent
pH: 7
T
T11c: (A c"7 �
** March, July, November: Add Cl-and TUS to Erf sampling 1st Wk **
On leeI Sample Temperature at receipt i -C
1 � 1

RESEARCIi & ANA1yTICAL
LAbORdTORIES, INC.
For: Town of Liberty
P.O. Box 1006
Liberty, NC 27298
Attn: Kevin Coble
Client Sample ID: Effluent
Site: Town of Liberty
Parameter Method
Chlorine Residual SM 4500 Cl G-2011
pH SM 4500 H+B-2011
" = Maximum Allowable Limit
mg/L = milligrams per Liter = parts per million (ppm)
< = Less than or Below Detection Limits
Report of Analysis
7/24/2020
w C •,
Cy'
NC #34 Z to
S NC#37701
r ...•• A5
/F%FD
Lab Sample ID: 85152-01
Collection Date: 7/23/2020 14:35
Drinking*
Water Analysis
Result Units Standard Anaivst Date Time
0.48 ug/L 7/23/2020 1435
7.08 Std. Units 7/23/2020 1435
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1

.
Laboratories, Inc.
CHAIN
OF CUSTODY
RECORD
•i
Analytical / Process Consultations
Phone [phone]
{Wafer / Wave water
Afisc•.
Company Town ofliberty Job No.
Street Address
Project Effluent (2nel, 411) and 5th weeks)
4
City, State, 'Lip
Sampler Dame (Please Print)
u
u —
11, J: —
Contact
Pholle Sampler Signalyre�.
•�+
=
J
_
� � �
e
GGw.
ci
tinnydc Number
'Temp Res. Chlorine I Sample
C7
r 4 V
ti
Date
(Lah I'se Only)
Time Comp Grab Removed Matrix Sample Location / I.U.
"C Cl.
O
�z=
1' or N IS or W)
�•,
Itc nested Anah'sis
L••) ��' Ifilucnt
0
No sample - pH, TRC Oi
TF
Effluent
pH: %
TRC:
-
w y
Ds►tcll'imc It c Remarks:
Z!Ilnquishcd 13y
'Datclfime a river iv
On lee I Santplc'Cemperalure at receipt ^C

RESEARCh & ANA1YTICAL
LAbORATORIESP INC*
For: Town of Liberty
P.O. Box 1006
Liberty, NC 27298
Attn: Kevin Coble
Client Sample ID: Effluent
Site: Town of Liberty
Parameter Method
Chlorine Residual SM 4500 Cl G-2011
pH
SM 4500 H+B-2011
Report of Analysis
7131 /2020
C ,
NC #34 Z� N
NC#37701 ?
Lab Sample ID: 85368-01
Collection Date: 7130/2020 9:56
Result Units Rep Limit Analyst Analysis Date/Time
0.08 ugiL 7/30/2020 0956
6.56 Std. Units
7/30/2020 0956
NA = not analyzed
O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Pape t

Kesearcn & Analytical
Laboratories, Inc.
Analytical /Process Consultations
Phone [phone]
any To wit of'LMir- & Job No.
Address
Yate, Zip - --
et Phone
Number
se Only) Date Time
Q 6 -r.l 7 Sal: AF tii
CHAIN OF CUSTODY RECORD
Water / Wastewater MisC.
Project Effluent (2nd, 41h and 511t weeks)
v
�
Sampler Na a (Please Print)
V
0
s
'
;�
�'
a
d
z
Sampler S
a
d>
c
V
4=
O
d
o
c
a
v
Temp Res. Chlorine Sample
o
j
Crab Removed Matrix Sample Location / I.D.
°C Cl.
c
c7
a
E o
U
a:
V
C�
n:
C�
d
ou
IT
Y or N S or W
z
X A-1 10 0 1 W i E uent
0
Py Date/Time
P6410 �W
BY Date/Time
By
Remarks:
Ana
No sample -
Effluent
pH: � .5-6
On Ice Sample Temperature at receipt °C
dv�cg

July 2020
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
DATE
1
0
2
0
3
0
4
1
5
2
6
3
7
4
8
5
R
1.0
9
4
10
3
11
4
12
5
13
5 1/2
14
7 3/4
15
7 1/2
16
8 112
17
9 1/2
R
1.5
18
5 1/4
19
4 3/4
20
5 1 /4
21
5 1 /4
22
51/4
23
51/2
24
5 1 /2
R
0.5
25
5 3/4
26
5 3/4
27
6
28
6
R
2.5
29
1 1 /2
30
0
31
0
R
0.5
TOTAL RAIN 6.0

FORM: NDAR-1 10-13
NON
-DISCHARGE APPLICATION REPORT (NDAR-1)
Page _1_
of -2-
Permit No.: WQ0003090
Facility Name:
Town of Liberty -
Wastewater
County: Randolph
Month: buly 3111111110
Year:
2020
Did irrigation occur
Field Name:
i
Field Name:
2
Field Name:
3
Field Name:
4
at this facility?
Area (acres):
19.56
Area (acres):
19,54
Area (acres):
18.98
Area (acres):
16.78
Cover Crop:
FESCUE
Cover Crop:
FESCUE
Cover Crop:
FESCUE
Cover Crop:
FESCUE
YES ❑ NO
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
Hourly Rate (In):
0.21
Hourly Rate (in):
0.21
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather Freeboard
Field Irrigated?
YES
NO
Field Irrigated?
M YES
0 No
Field Irrigated?
[} YES
Q No
Field Irrigated?
❑ YES
Q✓ No
T
l0
m 2 c _
o «^
7 y�y���
:� O
i°
9
m.�'._
EW
L
7�'C
£tea
���y
01 01
C
EZ C
�.�d- Cl rm+
!,C
7 C
ro d
p�
C
E �+ C
°
a
® 8 a. c
`�
�--
a p�
o a i= ,;,
'a
�a v
°
o
�_
o o E m
�"
_��
10
°
E�
0
�- _ co
a E ea
>a ~
w v
"_0
E_
3 9
a 5
~'
i''-
,�
°
t-
E 3 a
fix° o
o o
=
>°a
�_�
>°a
J
J
H
°P In ft ft
gal min
In
In
gal min
In
in
gal min
in
In
11 gal min I
in
in
1
2
3
C 80 0
327,000 180
0.62
0.21
281,OD0 180
0.62
0.21
4
C 86 0
1
321,000 180
0.61
0.20
5
6
C 78 0.25 1
327,000 180
0.62
D.21
281,000 180
0.62
0.21
7
C 79 0.25
321 0000 180
0.61
0.20
8
PC 88 0/1.0 0.25
325,000 180
0.63
0.21
9
10
C 82 0.25
327,000 180
0.62
0.21
11
C 74 0.25
321,000 180
0.61
0.20
281,000 180
0.62
0.21
12
13
C 77 0.25
327,OD0 180
0.62
0.21
325,000 180
0.63
0.21
14
15
C 85 0.5
321,000 180
0.61
0.20
16
PC 76 0.5
327,000 180
0.62
0.21 11
325,000 180
0.63
0.21
17
C 76 0/1.5 0.75
18
281,000 180
0.62
0.21
19
-
20
C 89 0.25
321,000 180
0.61
0.20
21
C 84 0.25
325,000 180
0.63
0.21
22
C 94 0.25
327,000 180 1
0.62
0.21
23
24
R 0.5
25
C 96 0.25
321,000 180
0.61
0.20
26
C 92 0.25
327,000 180
0.62
1 0.21
27
28
R 2.5
Z9
30
31
R 0.5
Monthly Loading: i 2,289.000
4.31
1,9216,000
3.63
1,300,000
2.52
1,1 i!"! JO
2.47
12 Month Floating Total an%
1111110
41.36
42.03
21.44 .
36.99

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
El Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? (D Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? O 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? ❑ Compliant i] 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
ORC: Elix Tremaine Fike
Certification No.: 989290
Grade: SI Phone Number: 336 622 2990
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
a
Petmittee Certification
Permittee:
William Doerter
Signing Official:
Signing Officials Title: Town Manager
Phone Number: 336 622 4276 Permit Exp.:
8/31 /24
Signature Date
I certify, under penalty of law, Z"th'i. document and all attachments were prepared under my direction or supervision In accordance
with a system designed to assure that all qualified personnel property 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 mere 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

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: July Year: 2020
Field Name: 5 Field Name: 6 Field Name: 7 Field Name: 8
Did irrigation occur
Area (acres): 18.3 Area (acres): 15.1 Area (acres): 22.12 Area (acres): 21.68
at this facility? Cover Crop: FESCUE Cover Crop: FESCUE Cover Crop: FESCUE Cover Crop: FESCUE
El YES ❑ No Hourly Rate (in): 0.21 Hourly Rate (in): 0.21 Hourly Rate (in): 0.21 Hourly Rate (in): 0.21
Annual Rate (in): 52 Annual Rate (in): 52 Annual Rate (in): 52 Annual Rate (In): 52
Weather Freeboard field Irrigated? 1�1 YES ONO Field Irrigated? [Z YES NO Field irrigated? [I YES NO Field Irrigated? ❑ YES (] NO
p Lm E ocmV
o -m�m ° tM CD � £
w :a va m 2_ ;tem c
a,EEo ow ov oa E��8 ;R Eoa�c
:5 E 03
3 i- a '� =
°F In ft ft gal min In in gal min in In gal min in In gal min In In
1
2 C 84 0 299,000 180 0.60 0.20
3
4
5 C 78 0 299,000 180 0.60 0.20 350,000 180 0.59 0.20
6
7
8 CL 70 0/1.0 0.25 299,000 180 0.60 0.20
9
10 C 94 0.25 11 350,000 180 0.59 0.20
12 C 74 0.25 1 299,000 180 0.60 0.20
13 C 84 0.25 350,000 180 0.59 0.20
14
15 C 90 0.5 16 350,000 180 0.59 0.20
17 C 86 0/1.5 0.75 370,000 180 0.62 0.21
18
19 C 88 0.25 1 252,000 180 0.61 0.20 11 350,000 180 0.59 0.20
20
21
22
23 C 97 0.25 350,000 1 180 0.59 0.20
24 R 0.5
25
26
27 C 93 1 0.5 350,000 180 0.59 0.20
28 R 2.5
29
30
31 R 0.5
Monthly Loading: 1,196,000 2.41 252,000 0.61 370,000 0.62 2,450,000 4.16
12 Month Floating Total (In): 36.97 41.69 42.58 31.20

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-Compfiant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 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? ❑ Compliant 0 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.
THE LAGOON FREEBOARD IS NON COMPLIANT CAUSE OF RAINFALL AND I&I. -
Operator In Responsible Charge (ORC) Certification
ORC: Etix Tremaine Fike
Certification No.: 989290
Grade: SI Phone Number: 336 622 2990
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittes Certification
Permlttee:
William DoerFer
Signing Official:
Signing Official's Title: Town Manager
Phone Number: 336 622 4276 Permit Exp.
n /1
8/31 /24
Signature Date
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