WQ0003090_Monitoring - 03-2021_20210420

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Page _l_ of
Permit No.: W00003090
Facility Name:
Town Of Liberty - Wastewater
county:
Randolph
Month:
March
Year: 2021
PPI: 002
Flow Measuring Point: 21 Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point:
❑ Influent
Q Effluent
❑ Groundwater Lowerin g
❑ Surface water
Parameter Code -►
60050
00400
00310
00610
00530
31613 00620
00625
00665
50060
00600
70300
0 9940
0000
00010
a.
c
is p
E
o
x
o
o
$
T�gev
€
mm
m
o
�c
c
�cc
+m
G
V� ernU.
a
o
E
oao
m
�'�
oa
o94
po°
c
L
o
a
~ �`�
L`0 z
''
`' �t
t-&
n
r
r�
C
to
lRz
e
a
o v
z
p
o
zz
m
24-hr hrs
GPD
su
mg1L
mg1L
mg/L
9/100 mL m L
H
mg/L
mg/L
mg/L
mg1L
mg1L
m L
mg/L
�
°C
1
7:00 8
641,000
2
7:00 8
918,000
3
7:00 8
696,000
4
7:00 8
658,000
8.71
7
5.4
9.3
2 0.63
8.1
1.1
0.32
8.5
138
14.7
0.38
5
700 $
616,000
6
13:00 2
631,000
7
12:00 2
488,000
8
7:00 8
403,000
9
7:00 8
489,000
10
7:00 8
437,000
11
7:00 8
438,000
9.3
0.57
12
7:00 8
430,000
13
423,000
14
441,000
15
7:00 8
329,000
16
7:00 8
494,000
6.94
33.4
6.3
13.1
166 ND
9.1
1.3
0.14
9.2
130
16.5
0.18
17
7:00 8
564,000
18
7:00 8
397,000
19
7:00 8
929,000
20
1,044,000
21
600,000
22
433,000
23
497,000
24
7:00 8
465,000
26
7:00 8
455,000
26
7:00 8
1,536,000
8.15
0.09
27
10:00 2
1,345,000
28
12:00 2
983,000
29
7:00 8
1,105,000
30
7:00 8
907,000
31
7:00 8
662,000
Average:
659,806
20.20
5.85
11.20
18.22 0.32
#REFr
1.20
0.28
8.85
134.00
15.60
0.28
Daily Maximum:
1,536,000
9.30
33.40
6.30
13.10
166.00 0.63
#REF1
1.30
0.57
9.20
138.00
16.50
0.38
Daily Minimum:
329,000
6.94
7.00
5.40
9.30
2.00 0.63
#REF!
1.10
0.09
8.50
130.00
14.70
0.18
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab Grab
Grab
Grab
Grab
Grab
Grab
Monthly Avg. Limit:
Daily Limit:
560,000
Sample Frequency:
Daily
weekly
2x month
2x month
2xmonth
2x month 2x month
2x month
2x month
weekly
2x month
3x year
3x year
2x month

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s)
Certified Laboratories
Name: GLENN PRICE
I Name: PACE ANALYTICAL
1 Name: GARRETT DREYER
Name:
Does all monitoring data and sampling frequencies meet the requirements In Attachment A of your permit? ❑ Compliant O Non-comphant-
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 for the whole month of february except for two day (2/4 and 2/11) — --
cause of I&I
Operator In Responsible Charge (ORC) Certification
ORC: Elix Tremaine Fike PermIfte: Scott Kidd
Certification No.: 989290 Signing Official:
Permittee Certification
Grade: Si Phone Number: 336 622 2990 signing Official's Title: Interm Town Manager
Has the ORC changed since the previous NDMR? ❑ yes 0 No Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
Signature Date
By this signature, 1 certify that this report Is aocurrate and complete to the best of my knowledge.
�5;
Signature Date
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 beat 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

F
e Pace Analytical Services, LLC
FaceAnalyticai 1377 South Park Drive
www.pacalabs care Kernersville, NC 27284
[phone]
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of liberty
Pace Project No.: 92525777
Sample: Effluent
Method
HACH 10206
SM 254OC-2011
SM 254OD-2011
EPA 350.1 Rev 2.0 1993
SM 52108-2011
Colilert-18
TKN+NO3+NO2
Calculation
EPA 300.0 Rev 2A 1993
EPA 351.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Parameters
Nitrogen, Nitrate
Total Dissolved Solids
Total Suspended Solids
Nitrogen, Ammonia
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Laboratory Report
Lab ID: 92525777001
Page 1 of 1
Report Date: 03/17/2021
Date Received: 03/04/2021
Collected: 03/0412114:00 Matrix: Water
Results
0.63
138
9.3
5.4
7.0
2.0
PACE
Garrett
Dreyer
314121
14:00
8.71
0.32
8.5
Units
Report Limit
Analyzed Qualifiers
mg/L
0.30
03/05/2113:41
mg/L
25.0
03/09/2109.40
mg/L
4.7
03/05/2113:25
mg/L
0.10
03/08/2111:38
mg/L
2.0
03/1012111:04 R6
MPN/100mL
1.0
03/0512112:31 D6
03/04/21 14:00
03/04/21 14:00
03/04/21 14:00
03/04/21 14:00
Std. Units
03/04/21 14:00
mg/L
03/04/21 14:00
mg/L
0.52
03/16/2115:00
Chloride
18.1
03/13/21 33
Nitrogen, Kjeldahl, Total
m4.7 g/L
9
.50
0.50 03/13/2105:18
05:18
Nitrogen, NO2 plus NO3
0.38 mg/L
0.040 03/10/21 10:22
Phosphorus
1.1 mg/L
0.050 03111/2101:45
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
R6 The RPD between valid sample dilutions exceeded 30%.
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
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 -CUSTODY Analytical Request Document
aceAnalytical
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Company: Town of Liberty Billing Information:
Address: -
Report To: Email To:
Copy To: Site Collection Info/Address:
Customer Project Name/Number: State: Couryty/City: Time Zone Collected:
/ [ ]PT[ )MT[ )CT [ IET
Phone: Site/Facility to #: Compliance Monitoring?
Email: [ (Yes [ ]No
WO#:92525777
III III if IN92525777
lllllll�l
,3rder Number or
10
NLY ---
u I e 1 4.
• I Preservative Types: 11) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, (5) zinc acetate,
(6) methanol, (7) sodium bisulfate,18) sodium thiasulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
Collected By print)_:" Purchase Order #: DW PWS ID #:
Y'rre 17 .� / DW Location Code:
� � � Quote #: �
Collected Byisignaturej. _
Turnaround Date Required:
Immeciately Pace on ice:
D
Yes [ ) No
Sample Disposal:
Rush:
Field Filtered (if applicable):
[ I Dispose as appropriate [ ] Return
[ ) Same Day [ J Next Day
[ ] Yes No
[ )
U
[ ] Archive:
[ ] 2 Day [ ) 3 Da Y [ ] 4 Day [ ] 5 Day
Z
W
is
[ J Hold:
(Expedite Charges Apply)
Analysis:
t)
H
` Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (W W),
Z
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B),
Vapor (V), Other (OT)
Uj
H
Customer Sample ID
Matrix"
Comp /
Grab
Collected (or
Composite Start)
Composite End
Res
CI
# of Imo-
Ctns
Z
Date
Tlrne
Date
Time
m
Z
effluent
g
_'M LI
I Yr;U
5
-5;
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT (42 hours): Y N N/A
Packing Material Used: Lab Tracking #:
Effluent Monitoring
Relinquished by/Ccppany: [Signature)
Relinquished by/Company: (Signature)
by/Company: (Signature)
T I Radchem samples) screened (<500 cpm): Y N NA
Date/Time: Received by/C nipsr (Si oat r
Date/Time: TReceived by/Como v: ,r
- S.-P110 KVCCIPL. UneCKI xaC:
Custody Sualy Prevent/intact Y N NA
Custody Signatureu Present Y N NA
Cullectox Siqnature Preuent Y N NA
aattlea Intact t N NA
Correct Hnttlen Y N NA
Sufficient Volume Y N NA
Samples Recnived on Tee Y N NA
VOA - Headopano Acceptable Y N NA
USDA Regulated Sails Y N NA
Samples in Holding Time Y N NA
Residual, Chlorine Prevent Y N NA
Cl Strips:
Sample pH Acceptablo ._r_.. Y N NA
pR Srripr.: - _..-
Sulfide Present' Y N NA
Lead Agetate Stripu• _
T,AR USE ONLY:
Lab Sample # / Comments:
pies received via:
FEDEX UPS Client
Courier Pace Courier
Date/Time-�
MTJL LAB USE ONLY
n, t• i F,
L
�..
TableOh
iw
_
IAcctn um:
Date/Time:
( Date/Time: IPM:
PB-
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm IDN: _
Cooler 1 Temp Upon Receipt: _ _oi
Cooler 1 Therm Corr. Factor: o
Cooler 1 Corrected Temp: ._of
Comments:
Trip Blank Received: Y N NA
HCL McOH TSP Other
Non Conformance(s): Page:
YES / NO of:

aceAnalXical
W".pacelabs cem
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92527181
Sample: Effluent
Method
Parameters
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Reviewed by; c5r ` ` """-"
Stephanie Knott
336-996-2841
Stephanie. [e-mail]
Laboratory Report
Lab ID: 92527181001
Pace Analytical Services, LLC
106 Short St
Kemersville, NC 27284
336-996-2841
Page 1 of 1
Report Date: 03/11/2021
Date Received: 03/11/2021
Collected: 03/11/21 14:00 Matrix: Water
Results Units
Report Limit Analyzed Qualifiers
PACE
03/11/21 14:00
Garrett
03/11/21 14:00
Dreyer
03/11/21
03/11/21 14:00
14:00
03111/21 14:00
9.30 Std. Units
03/11/21 14:00
0.57 mg/L
03111/2114:00

�/I CHAIN -OF -CUSTODY Analytical Request Document
aceAnalytical
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 (print):
Email To:
Site Colle
State:
ID #:
Purchase Order#:
Quote #:
Turnaround Date Required:
LAS USE ONLY- Affix WorkMcdar/Login Lapel Here or List Pace Workarder Number or
MTJL Loa -in NumhPr Horn
WO#=92527181
Container Preservative Typt
" Preservative Types: (1) nitric acid, (2) sulfuri 92527181
(6) methanol, (7) sodium bisulfate, (8) sodium th....ad.o, Pr nexdne, tAl ascoroic ano, tai ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other _
County/City: Time Zone Collected:
[ ]PT[ )MT[ ]CT [ ]ET
Compliance Monitoring?
( j%Yes [ ] No
DW PWSID#:
DW Location Code:
v
Immediately Packed on Ice:
I I
o
[ ]Yes [ ] No
Sample Disposal:
Rush:
LL
Field Filtered (if applicable):
f ] Dispose as appropriate [ I Return
[ ] Same Day [ ] Next Day
[ J Yes [ ] No #"'
[ ]Archive:
[ ] 2 Day [ J 3 Day [ ) 4 Day [ ] 5 Day
N\ o`
[ ]Hold:
(Expedite Charges Apply)
Analysis: , a-
* Matrix Codes (Insert in Matrix box
below): Drinking Water low), Ground Water (GW),
U
Wastewater (WW),
Product (P), Soil/Solid (SL), Oil (OL),
Wipe (WP), Air (AR), Tissue (TS), Bioassay (B),
Vapor IV), Other (OT) I�
Customer Sample ID
Comp / Collected (or
Matrix * Grab Composite Start)
Res # of m d
Composite End Cl Ctns m
Effluent
Date Time
W 9 A/0I I ly-0
Date Time O.
0
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None
Packing Material Used: -
* Effluent Monitoring
Radchem sample(s) screened (<50o cpm): Y N NA
Relinquished .by/CopApavi�: (Signature) Date/T. e: Received
Rlinylisiied by/C mpany; (Signature) D4t; I Received
SHORT HOLDS PRESENT (<72 hours): Y N N/A
Lab Tracking #:
pies received via;
OamFl.. ncc:e 31,c uneex1jec:
Custody Seals Prevent/Intact Y N NA
Custody Signatures Present Y N NA
Collector Signature Present Y N NA
Bottles Intact
Y N NA
Correct Bottles
Y N NA
Sutticiont Volume
Y N NA
SnmHles REcoyVe;d on Ice
Y N NA
V0A • Hrddapace Acceptable
Y N NA
USDA Requiated Sells
Y N NA
Samplen in Holding Rime
Y N NA
Residual Chlorine Prevent
Y N NA
Cl Stripe:
:;ample pit Acceptable
Y N NA
pTi Strips:
Sulfidc Present
_
Y N NA
Lead AceLato Stripe:
LAB UP,E ONLY:
Lab Sample # / Comments:
FE'DEH UPS Client Courier Pace Courier
Date/Time: MTJL LAB USE ONLY
Table4t:
Acctnum:
Prelogin:
Date/Time: PM:
[ PB:
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm ID#; _
Cooler 1 Temp Upon Receipt: _-___po
Cooler 1 Therm Corr. Factor:
Cooler 1 Corrected Temp: o
Comments:
Trip Blank Received: Y N NA
HCL MCOH TSP Other
Non Conformance(s): f Page:
YES / NO I of:

aceAnalj6cal
wwe pacelabs.com
Laboratory Report
Tremaine Fike
Town of Liberty
FAO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92527780
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 03/29/2021
Date Received: 03/16/2021
Sample: Effluent
Lab ID: 92527780001 Collected: 33/16/21 10:26 Matrix: Water
Method
Parameter's
Results
Units
Report Limit
Analyzed
HACH 10206
Nitrogen, Nitrate
ND
mg/L
0.30
03/16/21 17:22
SM 254OC-2011
Total Dissolved Solids
130
mg/L
25.0
03/18/21 13:49
SM 264OD-2011
Total Suspended Solids
13.1
mg/L
4.3
03/17/21 10:58
SM 521OB-2011
BOD, 5 day
33.4
mg/L
2.0
03/22/21 15:19
Colilert-18
Fecal Coliforms
166
MPN/100mL
1.0
03/17/21 09:07
Performed by
PACE
03/16/21 10:26
Collected By
Glenn Price
03/16/21 10:26
Collected Date
03116121
03/16/21 10:26
Collected Time
10:26
03/16/21 10:26
pH
6.94
Std. Units
03/16/21 10:26
Chlorine, Total Residual
0.14
mg/L
03/16/21 10:26
TKN+NO3+NO2
Calculation
Total Nitrogen
9.2
mg/L
0.52
03/25/21 15:36
EPA 300.0 Rev 2.1 1993
Chloride
16.5
mg/L
1.0
03/20/21 13:50
EPA 350.1 Rev 2.0 1993
Nitrogen, Ammonia
6.3
mg/L
0.10
03/25/21 12:34
EPA 351.2 Rev 2.01993
Nitrogen, Kjeldahl, Total
9.1
mg/L
0.50
03/25/21 04;06
EPA 353.2 Rev 2.0 1993
Nitrogen, NO2 plus NO3
0.18
mg/L
0.040
03/23/21 11:37
EPA 365.1 Rev 2.01993
Phosphorus
1.3
mg/L
0.050
03/24/21 13:13
Reviewed by: C�
uE�
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
North Carolina Wastewater Certification #: 40
Florida/NELAP Certification #: E87648
South Carolina Certification #: 99030001
North Carolina Drinking Water Certification #: 37712
VirginiafVELAP Certification #: 460222
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
Qualifiers

� ace�4rfalyrical"
:ompany: Town of Liberty
address:
Report To:
CHAIN -OF -CUSTODY Analytical Request Document
Chatrrof Custody is a LEGAL DOCUMENT' Complete all relevertt fields
Billing Information:
�`
Email To:
fn Address•
—
Site Collection In /
Copy To:
—e - —
State: Courtly/CftY Time Z.;, Collected -
State: 1
Customer Project Name/Number:
/ [ J PT I J MT [ J CT I I ET I
Compliance Monitoring?
Phone:
Site/Facility ID #:
! Yes [ )No
Email:
Collected By i I:
— DW PWS ID M.
Purchase order M. Dw Location Code:
Quote M.
Im late a an ice:
Collect," Y sgnature]:
Turnaround Date Required: [ J Yes [ ]NO
Field Filtered (if applicable):
sample Disposal:
Rush:
Same Day [ J Next Day [) Yes [ ]NO
I 1 Dispose as aPProPriate I ]Return
; J 2 Day I J 3 Day [ 14 Day [ 15 �Y Analysis:
[ 1 Arch'we
(F a Charges APOV) —
! ) Hohi:
box below). Drinking Water [DVS, Ground Water (GW). Waster (W W),
* Matrix Codes (Insert in Matrix
Oil (OL), Wipe (WP), Air (AR), Tissue (TB), Bioassay (B), Vapor (V), Other (OT1
pmdu ;-Still/Solid ISL),
Res #
Comp / Collected (or Composite End
Customer Sample 10
a Ctns
MatrixGrab Composite Start)
/lain Time I Date I Tune
Customer Remarks / Special Conditions / Possible Hazards:
• Ef bent Mlon)torkV
WN• aglr,*s •e, :.,,,,Ra. ,
ry:i,. r,.�•:. :s: ' Wig
row
'c MIR
Container Preservative
,q co 92527780
�� n Z I orucmwr� sou• iAF xAn unl ��y.w uxwv. 1�1 sn.� e�elein.
•* PeeservathKTYPes (1) nitric acid. (2) autrunc soo,1*1 n1
(6) methanol, (7) sodium I9sulfat4• (8) sodtumdwosuffW. i4 i5 i ez3ne. IA.) astortkc acid, (ai anuswnW m sukau.
(C) ammonium hydrodde, ([f) TSP, (U) unPrrserved, fo) �� 1 .
DatuL
Receive by m � t• r `, � )
nqulshed by/Comps ignature) / U
�lrP ed paw (Signatur Datme:
innuished bV,(ComPanY: (Signature) Dat ime: �
(Signature) Oate/lime: ! Received

Xff
aceAnaljftal
www.pacelabs.com
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92529921
SamPle: Effluent
Method
Parameters
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Reviewed by: e�
Stephanie Knott
704-977-0981
[e-mail]
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kemersville, NC 27284
[phone]
Page 1 of 1
Report Date: 03/26/2021
Date Received: 03/26/2021
Lab ID: 92529921001 Collected: 03/26/21 12:55 Matrix: Water
Results Units
Report Limit Analyzed Qualifiers
PACE
03/26/21 12:55
Garrett
03/26/21 12:55
Dreyer
03/26/21
03/26/21 12:55
12:55
03/26/21 12:55
8.15 Std. Units
03/26/21 12:55
0.09 mg/L
03/26/21 12:55

eAnalytical CHAIN -OF -CUSTODY Analytical Request Document
;
Chain -of -Custody is a LEGAL DOCUMENT -Complete all relevent fields
Town of Liberty jBilling Information:— f� �
Address:
Report To: Email To:
Copy To: Site Collection Info/Address:
Customer Project Name/Number: State: County/City: Time Zone Collected:
/ I ]PT( ]MTI JCT I ]ET
Phone: Site/Facility ID #: Compliance Monitoring?
Email: [ 411yes [ ] No
Collected By rint): Purchase Order #: DW PWS ID #:
Quote #: DW Location Code:
Collected By signaMre): Turnaround Date Required: Immediately Pace on Ice:
[ ] Yes [ ] No
Sample Disposal: _ Rush: Field Filtered (if applicable):
( ] Dispose as appropriate [ ] Return [ ] Same Da [ 1 N xt D
LAB USE ONLY -Affix Wori a ■o$1± + 262§•--di
ALL sHau
ContainerPreserv-ativeT }
^
.i.__J' I I _
"" _ Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, (5) zinc acetate, e
(6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane,
(A) ascorbic acid, (a) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
_ Ana_lysesProfile/line:
Lab Sample paste pt ("liec]cllst:
Custody Seals Precent./Tntact Y WNA
L\
Custody Si.Dnrs.turwe Present
tY' N NA
V
Collee LOr 5ignarute liz-vo ent
.7 ,N uA
t�Correct
l lOhtl.eel Intact:
Bottles
Y N
N
v
Sufficient Volume
Y N 9�q1
11
Sampler Received on Too
Y N tY11i"
p
VOA Headspdce Acceptable
Y N Na!
N
NSDA Reuulated Soils
Y N ti31
li
So 1p.leu t.n Holding Time
Y N 6[A
Rextduol Chlorine Pronent
Y N NA,i
[ ] archive:
y e ay
[ j Z Day [ J 3 Day [ j 4 Day I 1 5 Day
I ]Yes [ ]No
e
o
Cl Str'J.pu:
Sample pH Acceptablo i Y;N NA
[ ]Hold:
(Expedite Charges Apply)
Analysts:
—
t
pH Stripe.
• Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (Gw), Wastewater (WW),
tyq
U
m
_..
` Sulfide: Prr:scnt Y N411Ai
Lead AccL•ato Stripta+
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor IV), Other (OT)
II
-ate
_
Comp/
Collected(or
Res
'C
#of 9
t AH U58 ONLY:
Lab Sample # / Commento.
Customer Sample ID
p
Matrix "
Grab
Composite Start)
Composite End
CI
Ctns v
m
Date
Time
Date
Time
o
_
F°
Effluent lurw
n
21" ,
t -
r, X
i I I—
- - ---
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet
Packing Material Used:
' Effluent Monitoring
i s ed by/Company: (Signature)
!shed by/Company:
Blue Dry None
Radchem sample(s) screened (<500 cpm): Y N NA
Date/Time: i Received to ny: (Sig`n to )
i %
Date/Time: IIIReceived b Com an iena_urF0 ~
SHORT HOLDS PRESENT (02 hours): Y N N/A
Lab Tracking #
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm ID#:
C 1 1T U I
Samples received via:
er emp pon Rece pt,
Cooler 1 Therm Corr. Factor: of
FEDEX UPS Client
Courier Pace Courier
Cooler 7, Corrected Temp:
e�
Date/Time:
MTJL LAB USE ONLY
�oC
Comments -
Table
11�
Date/Time: �
.Acctnum:
Trip Blank Received: Y N NA
(Template:
Prelogln:
HCL McOH TSP Other
�Date/Time: �
PM:
-
i
Non Conformance(s): ;Page:
i
PB:
YES / NO of:

March 2021
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
11
0
12
0
13
0
14
0
15
0
16
0
R
0.5
17
0
18
0
R
0.9
19
0
R
0.2
20
0
21
0
22
0
23
0
24
0
25
0
26
0
R
1.5
27
0
R
0.5
28
0
R
0.5
29
0
30
0
31
0
R
0.7
TOTAL 4.8

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: March Year: 2021
Field Name: 1 Field Name: 2 Field Name: 3 Field Name: 4
Did irrigation occur
Area (acres): 19.56 Area (acres): 19.54 Area (acres): 18.98 Area (acres): 16.78
at this facility? 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? ;J YES p NO Field Irrigated? Q YES ❑ NO Field Irrigated? YES 0140 Field Irrigated? ❑ YES ❑ No
ma° om �an �dmya eAE
oc $ E - a
E>E»8
t3Ea) a Ta►
OF in ft ft gal min In in gal min In In gal min in In gal min In In
1
2 C 45 0 321,000 180 0.61 0.20
3 C 62 0 327,000 180 0.62 0.21
4 C 39 0 281,000 180 0.62 1 0.21
5 C 42 0 321,000 180 0.61 0.20
8 C 50 0 325,000 180 0.63 0.21
7 C 49 0 281,000 180 0.62 0.21
8 C 33 0 327,000 180 0.62 0.21
9 C 35 0 321,000 180 0.61 0.20
10 C 40 0 325,000 180 0.63 0.21 281,000 180 0.62 0.21
11 C 45 0 327,000 180 0.62 1 0.21
12 C 55 0 321,000 180 0.61 0.20
13
14 C 1 65 0 1 325,000 180 0.63 0.21 281,000 180 0.62 0.21
15 C 40 0 327,000 180 0.62 0,21
16 R 0.5
17
18 R 0.9
19 R 0.2
20 C 46 0 321,000 180 0.61 0.20
21 C 46 0 325,000 180 0.63 0.21
22 C 64 0 327,000 180 0.62 0.21
23 CL 46 0 321,000 180 0.61 0.20
24
25 C 48 0 327,000 180 0.62 0.21 1 93,667 60 0.21 0.21
25 C 7 0/1.5 321,000 180 0.61 0.20 27 R 0.5 93,667 60 0.21 0.21
28 R 0.5
29
30 C 53 0 327,000 180 0.62 0.21 93,667 60 0.21 0.21
31 CL 0/0.7 321,000 180 0.61 0.20
Monthly Loading: 2.289,000 4.31 2,5fi8,000 4.84 1,300,000 2.52 1,405,001 3.08
12 Month Floating Total (In): 38.79 38.31 25.83 27.76

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
Q 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-Compllant
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 ❑✓ 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. — —
Raifall of 4.8
Operator in Responsible Charge (ORC) Certification
ORC: Elix Tremaine Fike
Certification No.: 989290
Grade: St Phone Number: 336 622 2990
Has the ORC changed since the previous NDAR-1? ❑ Yes [21 No
Permittee Certification
Permittee:
Scott Kidd
Signing Official:
Signing Official's Title: lnterlm Town Manager
Phone Number: 336 622 4276 Permit Exp.: 8/31/24
Z(
Signature Date F Signature Date
By this signature, I certify that this report Is accurrate and complete to the best of my knowledge. J 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

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: March
Year.
2021
Did irrigation occur
Field Name:
5
Field Name:
6
Field Name:
7
Field Name:
6
at this facility?
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
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?
Y
{] NO
Field Irrigated?
YES
[ NO
Field Irrigated?
21 YES
❑ NO
C
co�
a E
E
v
de
pi
m
3°S
=
-9
?•
zc
o
E
E a�
rm ao m
m
Z.
Eo oe►
�o
r «,
o'acE
x
IL
w3a
�
E
OF in It ft
gal min
in
In
gal min
In
in
j gal min
In
In
gal min
In
In
1
2
3
C 40 0
370,000 180
0.62
0.21
4
C 46 0
299,000 180
0.60
0.20
350,000 180
0.59
0.20
51
C 52 0
1 252,000 180 1
0.61
0.20
6
7
8
C 55 0
370,000 180
0.62
0.21
9
C 56 0
299,000 180
0.60
0.201
1 350,000 180
0.59
0.20
10
11
C 67 0
370,000 180
0.62
0.21
12
C 72 0
262,000 180
0.61
0.20
13
C 60 0
299,OOD 180
0.60
0.20
350,000 180
0.59
0.20
14
15
C 48 0
252,000 880
0.61
0.20
370,000 180
0.62
0.21
16
R 0.5
17
18
R 0.9
19
R 0.2
20
21
C 62 0
252,000 180
0.61
0.20
22EC
46 0
370,000 180
0.62
0.21
23
68 0
24
CL fig 0
252,000 180
O.fi1
0.20
350,000 180
0.59
0.20
25
C 48 0
100,000 60
0.20
0.20
26
C 70 0/1.5
100,000 60
0.20
0.20
27
R 0.5
28
R 0.5
JOC
L16 0
116,667 60
0.200.7
Monthly Loading: 1,097.000
2.21
1,260,000
3.07
1,850,000
3.0$
1,516,fi67
2.58
12 Month Floating Total (€n):
2 1.71
3B 29
3754
25.69

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?
❑✓ 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. — —
Raifall of 4.8
I
Operator In Responsible Charge (ORC) Certification
ORC: Elix Tremaine Fike
y Certification No.: 989290
i+ Grade: SI Phone Number:
Has the ORC changed since the previous NDAR-1?
336 622 2990
❑ Yes i] No
Signature If Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permlttee:
Scott Kidd
Signing Official:
Signing Official's Title: Interlm Town Manager
Phone Number: 336 622 4276 Permit Exp.: 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 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