WQ0003090_Monitoring - 02-2021_20210316

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month:* February
Report Information
wg0003090
town of liberty wastewater plant
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
SKM C36821031011380.pdf 1.33MB
Im only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
tfike@to\Anoflibertync.org
tremaine fike
Reviewer: Williams, Kendall
3/16/2021
This will be filled in automatically

Is the project number correct? * WQ0003090
Is the monitoring report r Yes r No
accepted?*
Regional Office * Winston-Salem
Accepted Date: 3/16/2021

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT
(NDMR)
Page _1_ of _
Permit No.: WQ0003090
Facility Name:
Town Of Liberty - Wastewater
County:
Randolph
Month:
February
Year: 2021
PPI: 002
Flow Measuring Point: 0 Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point:
❑ Influent
0 Effluent
❑ Groundwater Lowerin g
❑surface water
Parameter Code Ok
1 50050
00400
00310
00610
01064?
26
006o65
50060
00600
70300
40 006�30
00ri
00010
c
a
m
°
mU.
jS
a
Z
0
zC
�
O
oZ
24-hr hrs
DPD
su
rn !L
mg/L
mg/L
#/100 mL rngtL
mg1L
a
mg/L
mg/L
mg/L
mg/L
mg/L mglL
°C
1
7:00 8
1,527,0 00
2
7:00 6
977,000
3
7:00 8
779,000
4
7:00 8
5t4,000
20.3
613 0.34
11
1.4
0.15
11.2
0.26
5
7:00 8
566,000
W17.8
6
11:00 2
648,000
7
12:00 2
923,000
8
7:00 $
1,492,000
9
7:00 8
793,000
10
7:00 8
702,000
11
7:00 8
497, 000
9.47
0.45
12
7:00 8
1,434,000
13
596,000
14
2,677,000
15
7:00 8
1,964,000
16
7:00 8
2,105,000
g223.5[387
17
7:00 8
1,577,000
8.44
13.1
6.8
ND
9.8
1.3
0.22
10.1
0.26
18
7:00 8
937,000
19
7:00 8
2,555,000
_
20
i,673,000
21
865,000
22
7:00 8
835,000
23
7:00 8
1,212,000
24
7:00 4
864,000
25
729,000
8.89
0.49
26
7:00 8
656,000
27
3:00 6
1,193,000
28
73.00 2
1,841,000
29
30
31
Average•
1,183,250
15.45
7.30
21,90
487.06 0.17
0.33
10.65
0,28
Daily Maximum:
2,677,000
9.47
17.80
7.80
23.50
613.00 0.34
0.49
11.20
0.26
Dally Minlmum:
497,000
8.44
13.10
6.80
20.30
387.00 0.34
*REF!0.15
10.10
0.26
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab GrabGrab
W2...rthk
Grab
Grab
Monthly Avg, Limit:
Daily Limit:
550,000
Sample Frequency:
Daily
weekly
2x month
2x month
2xmonth
2x month 2x montheekly
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: PACE ANALYTICAL
Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant Q 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 dates) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
non compliant for the whole month of february except for two day (214 and 2/11)
'ause oft&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 (] No
Signature Date
By this signature, I certify that this report is acourrate and complete to the best of my knowledge.
Permlttee Certification
Permittee: Scott Kidd
Signing Official:
Signing Official's Title: Interm Town Manager
Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
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

�aceAnaljftal
/www.pacelabsxom
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-996-2841
Tremaine Pike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92520358
Sample: Effluent
Method
Parameters
HACH 10206
Nitrogen, Nitrate
SM 254OD-2011
Total Suspended Solids
SM 521 OB-2011
BOD, 5 day
Colilert-18
Fecal Coliforms
TKN+NO3+NO2
Calculation
EPA 350.1 Rev 2.0 1993
EPA 351.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Nitrogen, Ammonia
Nitrogen, Kjeldahl, Total
Nitrogen, NO2 plus NO3
Phosphorus
Laboratory Report
Page 1 of 1
Report Date: 02/15/2021
Date Received: 02/04/2021
Lab ID: 92520358001 Collected: 02/04/21 12:45 Matrix: Water
Results
0.34
20.3
17.8
613
PACE
Garrett
Dreyer
02/04/2021
12:45
9.31
0.15
11.2
7.8
11.0
0.26
1.4
mg/L
0.10
0211212109:45
mg/L
0.50
02/13/21 05:31
mg/L
0.040
02/09/2113:29
mg/L
0.050
02/11/2108:09
ANALYTE QUALIFIERS
L1 Analyte recovery in the laboratory control sample (LCS) was above QC limits. Results for this analyte in associated
samples may be biased high.
Reviewed by:
Stephanie Knott
336-996-2841
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
VirginiaNELAP Certification #: 460025
Units
Report Limit
An Qualifiers
mg/L
0.30
02/05/2113:00
mg/L
7.8
02/05/2112:33
mg/L
2.0
02/10/2119:19 L1
MPN/100mL
1.0
02/05/2113:12
02/04/21 12:45
02/Q4/21 12:45
02/04/21 12:45
02/04/21 12:45
Std. Units
02/04/21 12:45
mg/L
02/04/21 12:45
mglL
0.52
02/15/2115:17
Page 1 of 2

V-7 CHAIN -OF -CUSTODY Analytical Request Document
�...-PaceAnalytical
Chain -of -Custody is a LEGAL DOCUMENT- Complete all relevent fields
Company: Town of Llbefty - Billing Information:
Address: --- - �4 _ �Y N "
! Report To:
Copy To: f Site
(Customer Project Name/Number:
+State: County/City: Time Zone Collected:
[ ]PT( ]MT[ ]CT [ ]ET
Phone:
Site/Facility ID #:
Compliance Monitoring?
Email:
[ Yes ( ]NO
Collected By (pL,�[int): _
^f1iG(i�
Purchase Order #;
DW PWS ID #;
z,
Quote#:
DW Location Code:
Collected Bx {signature):
Turnaround Date Required:
Imme ate y Packed on Ice:
[ ] Yes [ ] No
Sample Disposal:
Rush:
Field Filtered (ifapplicable):
[ ] Dispose as appropriate I I Return
( ) Same Day [ ] Next Day
[ ] Yes [ ] NO
[ I Archive:
[ ) 2 Day [ ] 3 Day [ ) 4 Day [ ) 5 Day
[ I Hold:
[ (Expedite Charges Apply)
Analysis:
Matrix Codes (Insert in Matrix box below); Drinking Water (DW), Ground Water(GW), Wastewater (WW),
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B),
Vapor (V), Other (OT)
Customer Sample ID
Matrix
Comp /
Grab
Collected (or
Composite Start)
Composite End
Res
Cl
# of
Ctns
_
Date
I Time
Date
Time
Eff)uent
— r--
Ww
9
V Y 1,
[7_ v,
5
Customer Remarks / Special Conditions /Possible Hazards: Type of Ice Used: Wet - Blue Dry Norte
Packing Material Used:
" Effluent Monitoring
d -by/Comp (Signature)
Relinquished by/Company: (Signature)
Radchem sample(s) screened (<500 cpni): Y
Date/Time: Received by/Cpmpa7:(Si gnature))
1 f1
Dat Time: Received by/Co�--rW (Si azure)
I
N NA
(Signature) _-
LAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
N
WQ#:92520358
ALL SHAD! I Jr N
aContainer reservative Tylu z eTr92520358
Preservative Types: (1) nitric acid, (2) sulfurs
16) methanol, (7) sodium bisulfate, (e) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium suitareb[
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
Analyses `Lab Proflle/Line:
---� I,a1i Sample Her,uipL Custody
--
Custody Seale Present/Sntact Y N NA
Custody Signatures Prreent Y N NA
Cc Alector Signature Preuant Y N NA
Hnttlna Intact• Y N NA
Correct: Bottles Y N NA
lutf icient Volume Y N NA
d uamplea Received on Tee Y N NA
_ VOA Headopaoe AcceptaLle Y N NA
.� IMIX Requlat.ed Soils Y N NA
O Sampies in Holding 'rime Y N NA
~ Residual Chloe inr PYLPSC.nt Y N NA
Z .� C] Strilo: _ __
r ,� Sample pH Aaavotabtn- Y N NA
/f b pH Stripe:
I— ` a,y Srili:id(•t pxesnut Y N NA
Y11 Lt!ad Acelatp SLripu:
H 1 J,AB USE ONLY.
Z _ ) I Lab Sample # / Commrrntn;
� v U
� S U
0 Z u a l- _
K. _ R X
SHORT HOLDS PRESENT (,72 hours): Y N N/A _ Lab Sample Temperature Info:
Lab (racking q: Temp Blank Received: Y N NA
Therm ID#:
Cooler ] Temp Upon Receipt: ,_= oC
amples received via: Cooler 1 Therm Corr. Factor: _ r ,_ oe
FEDEX UPS Client Courier Pace Courier I Cooler 1 Corrected Temp: .? oC
Date/Tilme: MTJL LAB USE. ONLY Comments:
Table
Acctnum:
Date/Time:
(Template:
Date/Time: ^IPM:
,nR-
Trip Blank Received: Y N NA
HCt Mooli TSP Other
Non Conformance(s): iPage:
YES / NO of:

aceAnalytical
www.pacelabszom
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92521733
Sample: Effluent
Method
Parameters
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Reviewed by: 10�- �
Stephanie Knott
336-996-2841
[e-mail]
Laboratory Report
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-996-2841
Page 1 of 1
Report Date: 02/15/2021
Date Received: 02/11/2021
Lab ID: 92521733001 Collected: 02/11/21 13:35 Matrix: Water
Results Units
PACE
Garrett
Dreyer
02/11/2021
13:35
9.47 Std. Units
0.45 mg/L
Report Limit Analyzed Qualifiers
02/11/21 13:35
02/11/21 13:35
02/11/21 13:35
02/11/21 13:35
02/11/21 13:35
02/11/21 13:35

��`� CHAIN -OF -CUSTODY Analytical Request Document
PaceAnalXical
- Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Company: Town of Liberty Billing Information: -
I
Address:
Report To:
Email To:
Copy To: Site Collection Info/Address:
Customer Project Name/Number: I State: County/City: Time Zone Collected:
Phone:
Email:
Collected
ID #:
Purchase Order #:
Quote #:
LAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
MTJL Log -in Number Here
ALL SHADEI WO# : 92521733 M.
Container Preservative Type I
I I 1111111111111111111Preservative Types: (1) nitric acid, (2) sulfuric W. 1733
(6) methanol, (7) sodium bisulfate, (8) sodium tl.
(C) ammonium hydroxide, (D) TSP, (U) unpreserved, (0) Other
/ [ ]PT[ ]MT[ }CT [ )ET
Compliance Monitoring?
[ (Yes [ ] No )
DW PWS ID M
DW Location Code:
Collected By (signature): ,
Turnaround Date Required:
Imme 1ateiy Packed on Ice:
—
( ] Yes [ ] No
Sample Disposal:
Rush:
Field Filtered (if applicable):
[ ] Dispose as appropriate [ ] Return
[ ] Same Day [ ) Next Day
[ ] Yes [ ]No
[ ] archive:
[ ] 2 Day f ] 3 Day [ ] 4 Day [ ] 5 Day
[ ] Hold:
(Expedite Charges Apply)
Analysis:
* Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B),
Vapor (V), Other (OT)
Comp/
Collected (or
Res
Customer Sample ID
Matrix *
Grab
Composite Start}
Composite End
Cl
Date
Time
Date
Time
Effluent
9
all ki
t 53
ll
'B
N
m
•c
a
II 7
v
t7
# of m
Ctns LE
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None
Packing Material Used��
Effluent Monitoring
Radchem sample(s) screened (<500 cpm): Y N NA
Relinquished byr pany: (Signature) Date/Time: Received by/Company: T
ignat re){`
f -'Iil It�.�
Relinquished by/Company: (Signature) D to Time: Received by/Company: (Signature)
Relinquished by/Company: (Signature
Received by/Company: (Signature)
Is Profile/Line
Lab Samoln
Custody Seals Preacmt/rutaot Y N NA
Custody Signatures Present Y N NA
Collector Signature Prevent Y N NA
Bottles intact
Y N
NA
Correct Bottles
Y N
NA
sufficient Volume
Y N
NA
Samples 110cei.ved on Ice
Y N
NA
VOA • Headspace Acceptable
Y N
NA
USDA Regulated Soils
Y N
NA
Samples in Holding Time
Y N
NA
Residual Chlorine Present
Y N
NA
C.1 Strips: �^
Sample PH Acceptable
Y N
NA
pR Strips:
Sulfide Present
Y N
NA
Lead Acetate Strips; _
LAB USE ONLY:
Lab Sample H / Comments:
SHORT HOLDS PRESENT (<72 hours): Y N N/A
Lab Tracking #:
pies received via:
FEDEX UPS
Client Courier Pace Courier
Date/Tirl•le• ` MTJL LAB USE ONLY
Date/Time:
Acctnum:
Template:
PS:
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
ThermlD4:
Cooler 1 Temp Upon Receipt: -CC
Cooler 1 Therm Corr. Factor: oC
Cooler 1 Corrected Temp: oC
Comments:
Trip Blank Received: Y N NA
HCL McOH TSP Other
Non Conformance(s): Page:
YES / NO Iof: ��-

aceAnalXical
www.pacelaha.eaa
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92522609
Sample: Effluent
Method
HACH 10206
SM 254OD-2011
SM 521OB-2011
Colilert-18
TKN+NO3+NO2
Calculation
EPA 350.1 Rev 2.0 1993
EPA 351.2 Rev 2.0 1993
EPA 353.2 Rev 2.01993
EPA 365,1 Rev 2.0 1993
Laboratory Report
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-996-2841
Page 1 of 1
Report Date: 02/25/2021
Date Received: 02/17/2021
Lab ID: 92522609001 Collected: 02/17/21 11:45 Matrix: Water
Parameters
Results
Nitrogen, Nitrate
ND
Total Suspended Solids
23.5
BOD, 5 day
13.1
Fecal Coliforms
387
Performed by
PACE
Collected By
Garrett
Dreyer
Collected Date
02/17/21
Collected Time
11:45
pH
8.44
Chlorine, Total Residual
0.22
Total Nitrogen
10.1
Units
Report Limit
Analyzed Qualifiers
mg/L
0.30
02/17/2118:10
mg/L
7.4
02/17/2118:16
mg/L
2.0
02/22/2116:07
MPN/100ml-
1.0
02118/2111:34
02/17/21 11:45
02/17/21 11:45
02/17/21 11:45
02/17/21 11:45
Std. Units
02/17/21 11:45
mg/L
02/17/21 11:45
mg/L
0.52 02/25/2113:63
Nitrogen, Ammonia
6.8
mg/L
0.10
02/22/21 12:48
Nitrogen, Kjeldahl, Total
9.8
mg/L
0.50
02/23/21 03:26
Nitrogen, NO2 plus NO3
0.26
mg/L
0.040
02/23/21 12:19
Phosphorus
1.3
mg/L
0.050
02/23/2112:22
Reviewed by: ok�—- 9
Stephanie Knott
336-996-2841
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #. 37738
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
Virginia[VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025

CHAIN-OF-C�,-..-e.�.,-._...:,,:-:.r-..—...--:.-.-...�.�.-�..-,7..T--�x,-�:.,,.:..�--.-:.:,,-.-,-,.:.
USTODY Analytical Request Document
...�5ceAnaiytical
Chain -of -Custody is a LEGAL DOCUMENT - Complete all rel ent fields
Company: Town of Liberty --' Billing Information: _ '-
1 Address:
Report To: Email To:
I Copy To: Site Collection Info/Address:
Customer Project Name/Number: State: County/City: Time Zone Collected:
/ [ ]PT[ ]MT[ ]CT ( ]ET
Phone: Site/facility ID #: Compliance Monitoring?
Email: [ /Yes [ ] No
Collected B (print): Purchase Order #: DW PWS ID #:
Quote #: DW Location Code:
LAB USE ONLY- Affix Workordr ` ' u ,.e a TO Pace Workorder Number or
WO • 925i2609
ALL StiADEC 11111111 l�IIIII 111 I fs
Container Preservative Type _
u 2 1 8 r T9�22509�
** Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, {4j soai iii „y,,,
(6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
(C) ammonium hydroxide, ID) TSP, (U) Unpreserved, (0) Other
Anal es Lab Profile/Line:
LJab Sample Receipt Cher'k1.i et
Custody Deala Present/Int.acL Y N NA
Custody Signatures Present Y N NA
Cnll,ert.or. Signature Present Y N NA
Bottles Intact Y N NA
Correct Bottles Y N NA
Sutficient. Volume Y N NA
Collected B i natur
�ts g� ):
Turnaround Date Required:
Immediately Packed on ice:
Y
Il
Sampled Received on Ice
VOA lleadspace Acceptably
Y N NA
Y N NA
[ ]Yes [ ]No
W
UsDA RegulaLed Soils
Y N NA
Sample Disposal:
Rush:
Field Filtered (if applicable):
~
Samples in Holding
g Timm
Rvs i.dual ChIorine Pronent
Y tJ NA
Y N NA
[ ] Dispose as appropriate [ ] Return ,
[ ] Same Day [ ] Next Day
[ ] Yes [ ] No
Z
C1 Strips:
[ ] Archive:
[ 1 2 Day [ 13 Day [ ] 4 Day [ 1 S Day
[ ] Hold: I
(Expedite Charges Apply)
Analysis:
s'
' Matrix Codes (Insert in Matrix box
below): Drinking Water (DW), Ground Water (GW), Wastewater (WW)
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
Customer Sample ID
Matrix •
Comp/
Grab
Collected (or
Composite Start)
Composite End
Date
I Time
Date
Time
Effluent --
W _
g
Z
Sample pl-1 Acceptable Y N NA
pTl Strips: _
—�.�..
C) F—
k� y
Sulfide Present Y N NA
Z
Cv
JI
Lead Acetate Stripe: --.�--
Y
F—
p
I,AH ULIE ONLY:
Res #of I— Z
_
W
L:ah Sample # / Commr_nho:
Cl Ctns
m Z
U
Q
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLUS PRESENT (<72 hours): Y N N/A
Packing Material Used: ILab Tracking #: -
Effluent Monitoring
Relin u C (Signature)
z —
Relin (shed by/Company: (Signature) —
Relinquish
I Radchem sample(s) screened (<500 cprn): Y N NA
Date/Time: Received Compa y
Sig at e)2//'a Itws'
!Received by/Company:
Received by/Comoanv:
iples received via:
FEDEX _UPS Client Courier _Pace Courier
Date/Time: �dd MTJL LAB USE ONLY
.L Table Jt:
Acctnum:
Date/Time:
(Template:
Date/Time: �)PM:
`PB:
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm ID#,
Cooler I Temp Upon RP•.celpt:,_.,_ _,.(
Cooler I Therm Corr. Factor,
Cooler 1 Corrected Temp:
Comments,
Trip Blank Received: Y N NA
HCL McOH TSP Other
i Non Conformance(s): I Paged
YES / NO I of:

aceAnalytical
www.pacelabs.com
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92524205
Sample: Effluent
Laboratory Report
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Page 1 of 1
Report Date: 02/26/2021
Date Received: 02/25/2021
Lab ID: 92524205001 Collected: 02/25/21 13:15 Matrix: Water
Method Parameters
Results Units
Report Limit Analyzed Qualifiers
Performed by
PACE
02/25/21 13:15
Collected By
Garrett
02/25/21 13:15
Dreyer
Collected Date
02/25/21
02/25/21 13:15
Collected Time
13:15
02/25/21 13:15
pH
8.89 Std. Units
02/25/21 13:15
Chlorine, Total Residual
0.49 mg/L
02/25/21 13:15
Reviewed by:
Stephanie Knott
336-996-2841
[e-mail]

CHAIN -OF -CUSTODY Analytical Request Document
.AaceAnalytical '
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:
Collected By
G mly'e
ID #:
Purchase Order#:
{/ Quote M
Email To:
Site Collection Info/Address:
State: County/City: Time Zone Collected:
/ [ ]PT[ ]MT[ ]CT [ ]ET
LAB USE ONLY -Affix Work, WO# :
925242 V 5
All. SHAOI 1111111111111111111111
Container Preservative Tye.252A20
`�
— 0,&W
I I I I
** Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, (5) zinc acetate,
(6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (8) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
Analyses
Lab Proflle/Line:
Lab Sample Receipt Checklist;
Custody weals Prevent/Intact Y N NA
Compliance Monitoring?
[Yes [ ]No
DW PWS ID #:
.lam
Custody Signatures Prevent
Collector Signature Present
Bottles Intact
Correct Bottles
Y N
Y N
Y N
Y N
NA
NA
NA
NA
DW Location Code:
Sufficient volume
Y N
NA
1�
Samples Received on Toe
Y N
NA
- r �ws"a!Lwu'�.rj= '`J)Q
~
Turnaround Date Required:
Imme iate y Pack don Ice:
-0
VOA • Headspace Acceptable
USDA
Y N NA
[ ]Yes [ ]No
c
T
Regulated Soils
Y N NA
Sample Disposal:
Rush:
Field Filtered if a licable :
( pP )
Samples in Holding Time
Residual Chlorine Present
Y N NA
Y N NA
[ ] Dispose as appropriate [ ]Return
[ ]Same Day [ j Next Day
[ ] Yes [ ] No
�
N
Cl Str.ipo:
[ ]Archive;
[ J 2 Day [ ] 3 Day [ ] 4 Day [ ] 5 Day
,e
`o
_ __
Sample pH Acceptable
Y N NA
[ ]Hold:
(Expedite Charges Apply)
Analysis:
]
U
pH Strips:
* Matrix Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Sulfide Present
Load Acetate Str.ipu:
Y N NA
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
Il
v
Comp/
Collected (or
Res
#of of
w
LAB USE ONLY:
Lab Sample 0/ Commento:
Customer Sample ID
Matrix *
Grab
Composite Start)
Composite End
Cl
Ctns
ns
Effluent
E
Date Time I Date Time
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry
Packing Material Used: ..m �..
. Effluent Monitoring
Relinquished by&o„,ipany:_(Sigua*ure)
Relinquished by/Company: (Signature)
None
Radchem sample(s) screened (<500 cpm): Y N NA
Date/Time: Received by/company: Sig tore)
212� J , 1 C
Received by/Company: (Signature)
Relinquished by/Company: (Signature) Date/Time: .— Received by/Company:
SHORT HOLDS PRESENT (<72 hours): Y N N/A
Lab Tracking #:.�
tples received via:
FEDEX UPS Client Courier_ Pace Courier
Date/Time: MTJL LAB USE ONLY
Table M _
-- Acctnum:
Date/Time:
Template:
Prelogin:
Date/Time: PM:
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm ID#:
Cooler], Temp Upon Receipt c
Cooler 1 Therm Corr. Factor: r
Cooler I Corrected Temp: __^_____C
Comments:
Trip Blank Received: Y N NA
HCL McOH TSP Other
Non Conformance(s)- Page:
YES / NO 1 of:

DATE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
February 2021
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
R 0.6
R 1.0
R 0.5
R 0.8
R 1.0
R 0.5
R 0.8
R 1.0
R 0.3
R 0.5
R 1.0
TOTAL 8.0

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _1_ of _2_
!0
°
9
10
11
12
13
14
15
16
17
18
19
20
21
Permit No.: WQ0003090
Facility Name: Town of Liberty - Wastewater County: Randolph Month: February
Year: 2021
Did irrigation occur
Field Name: 1 Field Name: 2 Field Name: 3 Field Name:
4
at this facility?
Area (acres):
19.56
Area (acres):
19.54 Area (acres): 18.96
Area (acres):
16.78
Cover Crop:
FESCUE
Cover Crop:
FESCUE Cover Crop: FESCUE
Cover Crop:
FESCUE
ED 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?
lf7 YES No
Field Irrigated?
yEs Field Irrl ated? [i yEs
9 No
Field Irrigated?
0 YEs ❑ NO
Q
c
am
o
E
�,�aE�
o
E�
Q
m
E
bs
o
INO
EE�
E
ga � we
7s+
3
�dmeEep�
E'a
ac
F
G
o
o a
i= •-
E
°
x a
_E �a
a as
x o
E m
OF
In
I ft
It
I gal
min
in
In
gal
min
in
In gat
min in
in
gal
min
In
in
C
40
0
321,000
180
0.61
0.20
C
34
0
281,000
180
0.62
0.21
R
0.6
C
43
0
327,000
180
0.62
0.21
R
1
C
52
0
321,000
180
0.61
0.20
C
35
0
325,000
180 0.63
0.21
281,000
180
0.62
0.21
C
36
0/0.5
0
321,000
180
0.61
0.20
R
0.8
R
1
R
0.5
R
0.8
C
52
0
325,000
180 0.63
0.21
R
1
R
0.3
C
35
0
326,000
180 0.63
0.21
R
0.5
C
52
0
321,000
180
0.61
0.20
C
38
0
.327,000
180
0.62
0.21
326,000
180 0.63
0.21
281,000
180
0.62
0.21
R
1
654.000
1.23
Monthly
Loading:11
1,284,000
2.42
1,300.000
2.52
843,000
1.85
12
Month
Floating
Total
(in):
39,41
38.31
25.83
29.61

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: February
Year: 2021
Did irrigation occur
Field Name:
5
Field Name:
6
Field Name:
7
Field Name:
8
at this facility?
21 YES ❑ NO
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
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?
IJ YES NO
Field Irrigated?
Q YES ❑ No
Field Irrigated?
YES (] NO
Field Irrigated?
YES ❑ No
Q
(i
d
o
3
3
E
E
m
a
a1�0
a
G
m
3 n
> Q
m«
a
t=
aC
9
G
E as
7LLti`C
E o n
a `y
S J
m 9
Gi
E .a
-
o a
> Q
0
G1 ad+
E
I= °�
=
0)
C
'� a
G
�
E w
7 �C
E a R7
K o 'a
__j
m Zs
7 .�
o
> Q
'o
m
E
F- •-
0
�G
m D
m
C j
E 4M
7 �'C
E 3 9
u o a
` Z J
E d
7 .Q
> Q
v
Gf
_ 40
~
a
}. C_
� �
E a,
�'C
o
OF
in
ft
ft
gal
min
in
in
gal
min
In
in
gal
min
In
In
gal
min
I In
in
1
2
3
C
44
0
299,000
180
0.60
0.20
4
C
38
0
252,000
180
0.61
0.20
350,000
180
0.59
0.20
5
R
0.6
6
7
R
1
8
9
C
43
0
299,000
180
0.60
0.20
10
C
36
0
1
252,000
180
0.61
0.20
185,000
90
0.31
0.21
350,000
180
0.59
0.20
11
C
45
0/0.5
0
185,000
90
0.31
0.21
12
R
0.8
13
R
1
14
R
0.5
i6l
R
0.8
16
17
C
40
0
299,000
180
0,60
0.20
18
R
1
19
R
0.3
20
21
22
R
0.5
23
PC
52
0
1 299,000
180
0.80
0.20
370,000
180
0.62
0,21
24
C
40
0
252,000
180
0.61
0.20
350,000
180
0.59
0.20
25
26
C
45
0/1.0
0
1
370,000
180
0.62
0.21
27
28
29
30
31
Monthly Loading:
12 Month Floating Total (in):
1,196,000
2.41
�� 30.88
756.000
1.84
38.14
1,11O,R00
1.85
3837
1,050,000
1.78
27,47

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? I] Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? I] Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant 2 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
Raifall of 8.0
Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Elix Tremaine Fike Permi tee:
Scott Kidd
Certification No.: 989290 Signing Official:
Grade: St Phone Number: 336 622 2990 Signing Officials Title: Interlm Town Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes I] No 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 aff 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

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
I] 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? 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 ❑� 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. f
Raifall of 8.0
Operator In Responsible Charge (ORC) Certification
Permlttee Certification
ORC: Elix Tremaine Fike Permittee:
Scott Kidd
Certification No.: 989290 Signing Official:
Grade: St Phone Number: 336 622 2990 Signing Official's Title: Interlm Town Manager
Has the ORC changed since the previous NDAR-1? Yes 0 No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
�/�b 12-
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