WQ0003090_Monitoring - 10-2020_20201124

Monitoring Report Submittal
Permit Number #* wg0003090
Name of Facility:* town of liberty wastewater plant
Month:* October Year:* 2020
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR oct spray report.pdf 1.26MB
FDF only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* tremaine fike
Signature:
9�aww
Date of submittal: 11/24/2020
This will be filled in autorratically
Initial Review
Reviewer: Williams, Kendall

Is the project number correct? * WQ0003090
Is the monitoring report r Yes r No
accepted?*
Regional Office * Winston-Salem
Accepted Date: 11/24/2020

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_of_1-
Permit No.: W00003090
Facility Name: Town Of Liberty - Wastewater
County: Randolph
Month: October Year: 2020
PPI:
Flow Measuring Point: Q Influent El Effluent [I No flow generated
Parameter Monitoring Point: Influent [] Effluent El Lowering ❑Surface Water
Parameter Code
--►
60050
LL
00400
G
00310
4
00610
E
¢
00530
31613
00620
00625
00665
50060
00600
70300
00940
00630
00010
t1f
F=
cto
C
1- N
o
p
O C G
~�
y tt
LLCM
=
L
Y D
oz
�
O g
HL
d
O 'jq O
~�0
p
�z
O M y
~aM
.2
Ci
z Z
m
l
24-hr
hrs
GPD
su
MOIL
mg/L
mg/L
#/100 mL
m91L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
°C
1
774,000
7.33
13.3
6.49
18.4
>2420
QA79
10.1
1.62
0.28
10.2
0.152
26.4
2
494,000
3
427,000
4
345,D00
5
299,000
6
313,000
7
307,000
8
7:00
8
285,000
7.3
0.36
9
7:00
8
284,000
10
12:00
2
391,000
11
11:00
2
889,000
12
7:00
8
1,614,000
13
7:00
8
1,032,000
14
7:00
S
1 606,000
15
7:00
8
548,000
7.65
16,2
6.69
32.7
>2420
<0.05
11.6
1.05
0.31
0.119
16
7:00
8
394,000
171
12:00
2
563,000
181
17:00
2
380,000
19
7:00
8
210,000
20
7:00
8
357,000
21
7:00
8
327,000
22
7:00
8
316,000
7.87
0.09
23
7:00
8
321,000
24
348,000
25
336,000
26
7:00
8
358,000
27
7:00
8
324,000
28
289,000
29
7:00
8
343,000
30
7:00
8
632,000
7.11
0.05
31
481,000
Average:
470,548
14.75
6.59
25.55
1.00
0.04
#REF!
0.89
0.22
10.20
1
0.14
26.40
Daily Maximum:
1,614,000
7.87
16.20
6.69
32.70 1
0.00
0.08
#REFI
1.62
0.36
10.20
0.15
26.40
Daily Minimum:
210,000
7.11
13.30
6.49
18.40
0.00
0.05
#REF!
1.05
0.05
10.20
0.12
26.40
Sampling Type:
Recorder
Monthly Avg. Limit:
Daily Limit:
550,000
Sample Frequency:
Daily
weekly
2x month
2x month
2xmonth
2x month
2x month
2x month
2x month
weekly
2x month
3x year
3x year I
2x month

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: GLENN PRICE Name: RESEARCH & ANALYSIS LABORATORIES, INC
I Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? [Z Compliant El 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 compliant on the date of 10/1 10/11 10/12 10/13 10/14 AND 10/30
cause of I&I
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Elix Tremaine Fike Permittee: William Doerfer
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 No Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
C� tom. � Gyr'L.r •�c�/ '" '. �l off. o��9C17%±
� r^•
Signature Date
By this signature, I certify that this report is aocurrate and complete to the best of my knowledge.
r
v - -
Signature Date
I certify, under penalty . -f 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

RESEARCh & ANAtyTICA[
LA ORATORIES, INC.
For; Town of Liberty
P.O. Box 1006
Liberty, NC 27296
Attn: Tremaine Fike
Client Sample ID: Effluent
Site: Town of Liberty
Ammonia Nitrogen
BOD-5
Fecal CoMbrin QT
Nitrate +Nitrite
Nitrate Nitrogen
pH
Temperature (Thermometric)
Total lgedjahl Nitrogen
Total Nitrogen
Total Phosphorous
Total Suspended Solids
SM 45001VH3 D-2011
SM 5210 B-2011
Colilert 18
SM 4500 NO3 E-2011
(SM 4500 NO3 E-2011)-(SM
4600 NO2 &2011)
SM 4500 H+B-2011
SM 2560 B-2010
Hach10242
Calc
SM 4500 P E-2011
SM 2450 D-2011
Report of Analysis
10/12/2020
S� NC #34
i NC #37701
Lab Sample ID: SMS-01
Collection Dale:
1011 /2020
10:44
Resu t
-- 6.49
m9&
0.1
FK
10/72020
13.3
mgA -
2
HW
1022=
16M
a2420
MPNM00ml
1
BJ
10/12020
1609
0.152
mg/L
0.05
LP
10MMm
1650
0.079
mg/L
0.05
LP
10112m
1650
7.33
SW. Units
10M2020
1044
28.4
°C
10//2020
1044
10.1
mg/L
1
FK
1 OA 2020
10.2
mg/L
1
1.62
mg/L
0.06
LP
10/42020
18.4
mg/L
5
AW
10/2&M
G z IR- NA = not analyzed
P.O. Banc 473 106 Short Sheet Kemersv BG. North Carolina 27264 Tel: 33ra-BW2841 Fax [phone] www.rsrAWnbs.00m Page 1

Research & Analytical
Laboratories, Inca
`'� •'" ^- Analytical / Process Consultations
i
1"hone(336)996-2841
)ally Town
t Address
State, Zip
let [I"hone
e Number
Date Time
IIxc Onlgln.
CHAIN OF CUSTODY RECORD
Water / Wastewater
,lob No.
o
Project Effluent (1st and 3r•d weeks)
u
Sampler Name (P1 Print)
G
S
s
Sampler Signature
�'
:�
w
'E
o
ci
V
,l'enlp
liLIRemoved
rine
Sample
4.
W
Grab
"C
CrN
Matrix Sample Location / I.D.
6
v
o
e
=
nL:
0
V
Sor�V
�1
`�
n
11' I�fllucnt
(!
3
l
1
teli yuisll d By �d D tePfimc �l
/ S b •V�
telinquished By Datef Film
Received By
Remarks:
Misc.
Reyaested Analysis
BOD, TSS, N1-13N, F.Coli,
TKN, NO3-N, T. Nitrogen
T. Phosphorus
Effluent
pH: 3 3
TRC: -
** March, July, November Add Cl- and TDS to Gff sampling Ist Wk **
Oil lee I Sample Temperature at receipt "�- , '-A "f

RESEARCh & ANA1YTICA1
LAbORATORIESF INC.
:or: Town of Liberty
P.O. Box 1006
Liberty, NC 27298
kttn: Tremaine Fike
lient Sample ID: Effluent
ite: Town of Liberty
Parameter Method
;hlorine Residual SM 4500 Cl G-2011
'H SM 4500 H+8-2011
Result Units
Report of Analysis
10/15/2020
Aft
s 4,`l kl4y °
0 NC#34 ZI
i NC#37701
Lab Sample ID: 88685-01
Collection Date: 10/8/2020 12:33
Ran Limit Analvst Analysis DatelTime
0.36 ug/L 10/8/2020 1233
7.30 Std. Units 10/8/2020 1233
NA = not onotyzed
O. Box 473 106 Short Street Kerrrersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1
f_coa_basic_ v 1 d

r'(V.N& ircrl 09 /111c11yLlUd1
Laboratories, inc.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
ny Town pf Libertp Job No.
Wdress Project Effluent (2nd, 4th and 501s weeks)
Water Wastewater
C.
a
r
•e
a
e
N---
t3
9�
b
6
9
a,
v
s
a
E
c7
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.as
ate, Zip
Sampler Name ease Prin
2
t 1phone I Sampler Signature
a
somber
e Only)
Date
Time
Com
Crab
Tem P
C
Res.
CI.
Chlorine
Removed
V or N
Sample
Matrix
S or W
Sample Location / I.D.
o
6
Z
Regested Anal
J0IC 2-o
7- Z0
X
W
ElBuent
0No
sls%p
sample - pH, TROnly
Effluent
pH: • ,3 C
TRQ
I' quished'By
to te/Time
Received By
Remarks:
On ice Sample Temperature at receipt °C
linquished By
Dateqlme
Received 0j

RESEARCH NAIyTICAL
LAbORATORIESi
For: Town of Liberty
P.O. Box 1006
Liberty, NC 27298
Attn: Tremaine Fike
Client Sample ID: Effluent
Site: Town of Liberty
Parameter
Ammonia Nitrogen SM 4500 NH3 D-2011
13013-5 SM 5210 B-2011
Chlorine Residual SM 4500 Cl G-2011
Fecal Coliform QT Colilert 18
Nitrate + Nitrite SM 4500 NO3 E-2011
Nitrate Nitrogen (SM 4500 NO3 E-2011)-(SM
4500 NO2 B-2011)
SM 4500 H+8-2011
Hach10242
Calc
SM 4500 P E-2011
SM 2450 D-2011
pH
Total Kjedjahl Nitrogen
Total Nitrogen
Total Phosphorous
Total Suspended Solids
Method
Result
6.69
16.2
0.31
>2420
0.119
<0.05
Units
Report of Analysis
10/26/2020
��``G�►b 1�NA .. 4ie
ro: 0
00 NC#34 Z; -
NC #37701
� -OZI QED W��.�```�,
Lab Sample ID: 89030-01
Collection Date: 10/15/2020 12:15
Rea Limit Analyst Analysis DatelTime
mg/L
0.1
mg/L
2
ug/L
MPN/100ml
1
mg/L
0.05
mg/L
0.05
FK
10/21/2020
HW
10/162020
1045
10/152020
1215
BJ
10/1512020
1613
LP
10/162020
1140
LP
10/162020
1140
7.65
Std. Units
10/152020 1215
11.6
mg/L
1
FK 10/222020
11.7
mg/L
1
1.05
mg/L
0.05
BJ 10/162020
32.7
mg/L
5
AW 10/162020
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
Wate . / l'Vastewater
Misc.
Requested Anah'sis
pally Town of Liberty
Job No.
ii
V
.y
'",
u
=
j
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T
^'
E
o
v
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E
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t
y
Cl
V
0
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U
n
u
a
'7.
j,
.7
fir`
-j
4
r
,t Address
Project Effluent (Ist and 3r'd weeks)
State, Z11)
Sampier Nal]1C ICiiSe PI'111t)
}+
act
Phone
Salllpler SI nature
4.y
Ile Number
tIse Daly)
Date
Time
C'om ,
1
Crab
Temp
0C
Iles.
C1.
Chlorine
Removed
1' or N
Sample
rllatriz
S or 11'
Sample Location / I.D.
C
z
;--',0 p
❑ LJ
�'L) r
X
a'31
w
Effluent
0
3
1
1
1301), TSS, NH3N, F.Coli,
TKN, NO3-N, T. Nitrogen
T.Phosphorus
fluent
Effluent
L <�—
ruC: �.
lt<
tlRhed 13y
•/'Haled 0%1
o Sly
Rece
ed By
Remarks: ** March, July, November: Add CI- and TDS to Eff sampling 1st Wk **
Relinquished fly
Daterrime
Received By
On Ice
Sample 'Temperature at receipt r Oc

RESEARCH &ANAty-ricAt
I.AboMTORiES, INC.
For. Town of Liberty
P.O. Box 1006
Liberty, NC 27298
Attn: Kevin Coble
Report of Analysis
10/30/2020
Lab Sample ID: 89333-01
Collection Date: 10=020 12:15
tesuAam
0.09 ugA. 10/22/020 1216
7.87 Std. Units 101=020 1215
NA = not analyzed
'-d BOX 473 108 Shod Fax: 3364)WO326
,al ma hack ii wwrandelabs.00m Page 1

Research & Analytical
., Laboratories, Inc.
' Analytical / Process Consultations
Phone [phone]
Company Town of Liberip
Street Address
City, State, Zip
Contact Phone
Simple Number
(IA) Use Only} DI(c Time
Relin �hcd t3y
Relinquished fly
CHAIN OF CUSTODY RECORD
Water / Wristeturrter
Misc.
Job No.
Project Effluent (2nri, 4th anti Sth we'ekS)
3
C
Sampler Name (Please Print)
C
y
o
Sampler Signature
ii
q
T
E
Temp Res. Chlorine Sample
Grab o� Cl Removed Matrix Sample Location / I.D.
0
a
o
o
A.
A.
A"
a
d
Ill or N S or W
N
N
inir.
2z• r IE) A I I wV I Effluent
0
1
No sar
Datelrimc
,/?d `:
Daleffimc
BY 1 I I Remarks:
- pH, TRI
Effluent
pH: -7.17
TRC: U o q'
Oil Ice Sample Temperature at receipt 0c

1 $ESEARCh.:.RtALyTICA[
_AbORATORIESP NC.
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
11 /2/2020
Lab Sample ID: 89572-01
Collection Date: 10/30/2020 12:45
Result Units Rep Limit Analyst Analysis Date/Time
0.05 ug/L 10/30/2020 1245
7.11 Std. Units
10/30/2020 1245
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1
rai_coa_t)asic_v 1 c1

Research & Analytical
Laboratories, Inc.
• � •' An:ll� lull / Process Consultations
Phone (336)99G-2Kd1
CHAIN OF CUSTODY RECORD
Water li'rrsteivrdcr
ally 1 �nt�a nf'l iGc�rf��
►i, N0.
7week-51)
Address
ProjectI ffluent (2nd, 41h and 511,
itatc, Zip
Sampler Name (Please Print)
f
et I'ItUIl I'
Sillllpler Signature I•;y
_ J
— y av'J
.l.
—
-
Temp Res. ('hlmine Sample
o
�_ " — = =
sc nnlct Ualc Time ('ump Grall
Removed Matrix Sample Location / I.U.
0.
or iS or NV)
L IV1�b 7 a ( 5 S
' f .
it. w Csf tent
(1
rlioqui"sl lity Ualc/1'imc (cc Remarks-
�lingaished By 1 Ualell•ime F�Ilze.ive'1
II.
mhw.
On Ice I Sit1ple •temperature at receipt .1c
Ret ues(ed Analysis
No sample- pl-I• TRC omy
l;Jfluent

October 2020
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
DATE
1
0
2
0
3
0
4
0
5
0
6
0
7
0
8
0
9
0
10
0
R
1.5
11
0
R
1.0
12
0
13
0
14
0
15
0
16
0
R
0.3
17
0
18
0
19
0
20
0
21
0
22
0
23
0
24
0
25
0
R
0.2
26
0
27
0
28
0
R
0.2
29
0
R
0.8
30
0
31
0
TOTAL 4.0

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _1_ of_2_
Permit No.: WQ0003090
Did irrigation occur
at this facility?
Facility Name: Town of Liberty - Wastewater
Field Name: 1 Field Name: 2
County: Randolph Month: October
Field Name: 3 Field Name:
Year: 2020
4
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
0 YES ❑ NO
Weather Freeboard
a a c m
c « 0 aai a
CL
o a c �._
= u afi
« E ala
aJ
H
OF In ft ft
Hourly Rate (in):
0.21
Hourly Rate (In):
0.21
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
Annual Rate (In):
Field Irrigated?
52
} yES No
Annual Rate (in):
Field Irrigated?
52
❑ YES ❑ NO
Annual Rate (In):
Field Irrigated?
� $i
�o
oa (-°�
Q
52
[ yES , No
ra E ai
5 ° 'S
it Ego
O 'wfx�
J J
Annual Rate (in):
Field Irrigated?
m� a
E d mS
�- EW
oa
Q
52
❑ yES ❑ NO
a� E am
g+e o c
V Eo'o
p Ora
pp
J x J
In in
�' g
_�=
a
Ca
:9
'ggam
�F
F-'
E
°'
a.o
is
pa
E m
�+e
o�
oa
J
m�
E._
�o
oa
.1 Q
v
Ee
F=�
as
�vp
�O
J
in
E T w
c
Ewe
�o
'fix
g J
In
gat
min
In
In
gal
min
gal
min
In
in
gal
min
1
2
C
68
0
327,000
180
0.62
0.21
321,ODO
180
0.61
0.20
3
4
5
C
62
0
327,000
180
0.62
0.21
321,000
180
0.61
0.20
6
7
C
54
0
327,000
180
0.62
0.21
321,000
180
0.61
0.20
8
9
327,000
180
0.62
0.21
10
R
1.5
111
R
1
12
13
14
C
70
0
327,000
180
0.62
0.21
321,000
180
0.61
0.20
15
C
654
0
325,000
180
0.63
0.21
16
R
0.3
17
C
73
1 1
0
327,000
180 1
0.62
0.21
18
C
71
0
321,000
180
0.61
0.20
19
C
73
0
1325,000
180
0.63
0.21
20
C
58
0
327,000
180
0.62
0.21
21
C
64
0
321,000
180
0.61
0.20
22
C
62
0
327,000
180
0.62
0.21
325,000
180
0.63
0.21
23
241
C
70
0
1
321,000
180
0.61
0.20
251
R
0.2
261
C
68
1
0
281,000
180
0.62
0.21
271
C
70
1
0
325,000
180
0.63
0.21
x13
R
0.2
29
R
0.8
30
3i
Monthly Loading:
12 Month Floating Total (In):
2,616.000
4.93
43.44
2,247.000
4.24
43.58
1,300,000
2.52
22.01
281,000
0.62
34.94

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
P1 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? ❑J Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Q Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant it 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 W.
of 4.0 inches
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 ❑ No
1112
Permittee Certification
Permittee:
William Doerfer
Signing Official:
Signing Officials Title: Town Manager
Phone Number: 336 622 4276 Permit Exp.
8/31 /24
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 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 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

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: October
Year: 2020
Did irrigation occur
at this facility?
Field Name:
5
Field Name:
6
Field Name:
7
Field Name:
8
Area (acres):
18.3
Area (acres):
15.1
Area (acres):
22.12
Area (acres):
21.68
Cover Crop:
FESCUE
Cover Crop:
FESCUE
Cover Crop:
FESCUE
Cover Crop:
FESCUE
0 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?
Fj yEs ❑ NO
Field irrigated?
[1 yEs No
Field Irrigated?
❑ YES Q NO
G
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OF
In
ft
ft
I gal
min
in
in
gal
min
in
In
gal
min
In
in
gal
min
in
In
1
C
62
0
252,000
180
0.61
0.20
370,000
180
0.62
0.21
2
3
C
72
370,000
180
0.62
0.21
4
C
68
0
252,000
180
0.61
0.20
5
6
C
62
0
252,000
180
0.61
0.20
370,0D0
180
0.62
0.21
7
8
C
58
0
370,000
180
0.62
0.21
9
C
70
0
252,000
180
0.61
0.20
10
R
1.5
Ill
R
1
12
13
14
15
C
72
0
1350,000
180
0.59
0.20
16
R
0.3
17
18
19
20
PC
75
0
350,000
180
0.59
0.20
21
22
23
C
78 1
1
0
350,000
180
0.59
0.20
24
251
R
0.2
28
271
CL
64
0
299,000
180
0.60
0.20
281
R
0.2
0.8
LR
74
0
350,000
180
0.59
65 0
Monthly Loading:
150,000
449,000
90
0.30
D.9D
34.87
0.20
1,008,000
2.45
42.85
1.480.000
2.46
43.72
1,400,000
2.38
29.38
12 Month Floating Total (in):

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? 3 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 17 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 21 Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 21 Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant ❑✓ Non-Compilant
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.
of 4.0 inches
FREEBOARD IS NON COMPLIANT CAUSE OF RAINFALL AND 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 NDAR-1? ❑ Yes El No
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
William Doerfer
Signing Official:
Signing Officials Title: Town Manager
Phone Number: 336 622 4276 Permit Exp.: 8/31 /24
I1 - Q
Signatur 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 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 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