WQ0003090_Monitoring - 04-2021_20210526

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month:* April
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 C36821052613110.pdf 1.54MB
pmonly
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
tfike@to\Anoflibertync.org
Elix Fike
c, 2!ve t'�Fewww
Reviewer: Williams, Kendall N
5/26/2021
This will be filled in autorraticaly

Is the project number correct? * WQ0003090
Is the monitoring report r Yes r No
accepted?*
Regional Office * Winston-Salem
Accepted Date: 5/26/2021

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: April
Year: 2021
PPI: 002
Flow Measuring Point: ❑r Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent ❑✓ Effluent ❑ Groundwatertower4ng ❑ Surface water
Parameter Code _
50050
00400
00310
00610
00530
31613
00620
00626
00666
60060
00600
70300
00940
00630
00010
to
m
E
O
O�
EA
a
O
c
u.
a
O
m
E
�
o
t•- $ y
rn
`�
LL �
z
t
S'0
c
r .
8
a
+L
v
K t
e: v
°'
z
�-
t- n
p
0
c
t
U
+ S
z
m
y
24-hr
hrs
GPD
su
mg/L
mg/L
mg/L
#/100 mL
mg/L
mg/L
mglL
mg/L
mg/L
I m 1L
mg/L
mg/L
°C
1
7:00
8
1,381,000
6.89
17
7.5
10.4
1 2420
ND
11.4
1.4
0.12
11.4
ND
2
10:00
2
909,000
3
11:00
2
672,000
4
11:30
2
573,000
51
7:00
8
1 380,000
6
7:00
8
433,000
71
7.00
8
503,000
8
7:00
8
410,000
8.53
0.26
9
7:00
8
430,000
10
454,000
11
567,000
7:00
8
454,000
112
1317:00
8
424,000
14
7:00
8
426,000
15
7:00
8
389,000
7.64
2.8
5.4
15.1
2420
8.5
1.3
0.13
8.6
NO
16
7:00
8
390,000
17
420,000
18
324,000
19
7:00
8
333,000
20
7:00
8
362,000
21
7:00
8
350,000
22
7:00
8
326,000
7.96
0.048
0.1
23
7:00
8
321,000
24
10:00
2
367,000
25
12:00
2
526,000
26
7:00
8
387,000
27
7:00
8
342,000
28
7:00
8
329,000
29
7:00
8
366,000
7.61
0.07
30
7:00 1
8
257,000
31
Average:
460,167
9.90
6.45
12.75
2,420.00
0.02
#REF1
1.35
0.14
10.00
0.00
Daily Maximum:
1,381,000
8.53
17.00
7.50
15.10
2,420.00
0.05
#REFI
1.40
0.26
11.40
0.00
Daily Minimum:
257,000
6.89
2.80
5.40
10.40
2,420.00
0,05
#REFI
1.30
0.07
8.00
0.00
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
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
2x month

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories - — -
Name: GLENN PRICE Name: PACE ANALYTICAL
I
Name: GARRETT DREYER Name: i
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 0 Compliant p 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
actlon(s) taken. Attach additional sheets if necessary.
non compliant for the days of 4/1 4/2 4/3 414 and 4/11 cause of
i&I
i
i
I
i
Operator In Responsible Charge (ORC) Certification Permittee 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
,>X
Date
By this signature, I certify that this report is sccurrate and complete to the best of my knowledge.
Permittee: Scott Kidd
Signing Official:
Signing Official's Title: Interm Town Manager
Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
Signature Date
1 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

.. aceAnalytrcal
www.pacelabs.com
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92530772
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 04/13/2021
Date Received: 04/01/2021
Sample: Effluent
Method
Parameters
Lab ID: 92530772001 Collected: 04/01/21 11:45 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
HACH 10206
Nitrogen, Nitrate
ND
mg/L
0.30
04/01/21 19:56 M1
SM 254OD-2011
Total Suspended Solids
10.4
mg/L
3.3
04/02/21 10:59
SM 521 OB-2011
BOD, 5 day
17.0
mg/L
2.0
04/07/21 16:26
Colilert-18
Fecal Coliforms
2420
MPN/100mL
1.0
04/02121 11:13 1g,El
Performed by
PACE
04/01/21 11:45
Collected By
Garrett
04/01/21 11:45
Dreyer
Collected Date
04/01/21
04/01/21 11:45
Collected Time
11:45
04/01/21 11:45
pH
6.89
Std. Units
04/01/21 11:45
Chlorine, Total Residual
0.12
mg/L
04/01/21 11:45
TKN+NO3+NO2
Total Nitrogen
11.4
mg/L
0.52
04/12/21 13:46
Calculation
EPA 350.1 Rev 2.0 1993
Nitrogen, Ammonia
7.5
mg/L
0.50
04/13/21 15:54
EPA 351.2 Rev 2.0 1993
Nitrogen, Neldahl, Total
11.4
mg/L
0.50
04/10/21 04:14
EPA 353.2 Rev 2.0 1993
Nitrogen, NO2 plus NO3
ND
mg/L
0.040
04/07/21 13:16
EPA 365.1 Rev 2.0 1993
Phosphorus
1.4
mg/L
0.050
04/06/21 22:44
ANALYTE QUALIFIERS
1 g >2419.6
El Reported value should be considered a minimum estimate since it is the maximum reportable number for this method
based on the sample volume used. The true value is likely greater than the value reported.
M1 Matrix spike recovery
exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
Reviewed by: -
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
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
-. eAnalytical "
Chain -of -Custody is a LEGAL DOCUMENT -Complete all relevent fields
Company: Town of Liberty f Billing Information:
Address:
Report To:
Copy To:
Customer Project
Phone
Email:
Email To:
Site Collection Info/Address:
LAD USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
W0#:92530772
Container ALL SHADE �r � i11111111 Jill I III
u 2 8 t-�_ 9J253077 2
"Preservative Types: (1) nitric acid, (2) sulfuric
(6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (8) ammonium sulfate,
(C) ammonium hydroxide, ID) TSP, (U) Unpreserved, (0) Other
State: County/City: Time Zone Collected: (- -
/ [ 1PT[ 1MT1 )CT [ ]ET
Site/Facility ID #: Compliance Monitoring?
( VVYes [ ] No
Purchase Order #: DW PWS ID #:
Ar
4uote#: DW Location Code:
•Collected BK(signature�:_
Turnaround Date Required: Imme lately Packed on ice:
ci�
Yes [ ) No
=�
Sample Disposal:
Rush: Field Filtered (if applicable):
[ ] Dispose as appropriate [ ] Return
i Same Day [ ] Next Day [ ] Yes [ ) No
Z
[ ] Archive:
[ ] 2 Day [ ) 3 Pay [ ] 4 Day ( ] 5 Da y
i —
[ ]Hold:
Analysis:
(Expedite Charges Apply)
10
• Matrix Codes (Insert in Matrix box
below): Drinking Water (DW), Ground Water (GW), Wastewater (W W),
O
Z
I Z
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
Customer Sample ID
p
Matrix *
Comp /
Grab
Collected (or
Composite Start)
Composite End
Res
Cl
# of I'-
Ctns d
Z
, —
m
t+� U
Z u.
Date
Time
ff[uent
9
=Dateime
5
Analyses
Lab Profile/Line:
Lcib Sample Rr_,ceipt Checklist;
Custady Soalu Present/Y'ntact
1' It_, -,WA
custgdy Signaturen Propnnk
r,�,N NA
C011eitbr- Sxqu,akur:e Present
jLff NA
Bottles Intact
,VN NA
Correct Battlers
%VN NA
Sufficient Volume
.XrN NA
Sampluu R-eeive°d on iuc
'yM NA
VOA , Rua,lupaee^ Acue,pLeble
Y N tw
IISDA Regu'tared Soitn
Y N N&1
Samples in Healdinq Time
Y>N NA
Residual Chlorine P.Sont.
Y 113jNA
C1 Stripn,
_
Sample pll Acceptable- _��
N NA
pH Strips: lT' r
- — --
^ulfide Present
Y N (NA
Lead Acretrit', Strips;
LAB USE ONLY;
Lab Sample # / C'ommenkn
i Customer Remarks /Special Conditions / Possible
Hazards: ; iype of Ire Used: Wet Blue Dry None
(SHORT HOLDS PRESENT (<72 hours): Y
N N/A
I Packing Material Used:
Lab Tracking #: d
Effluent Monitoring
Radchem sample(s) screened (<500
JSamples received via:
cpm): Y N NA
FEDEX UPS Client
Courier
Pace Courier
Relinquished by/Company: (Signature)
._...
Date/Time: Received y/C mp ny: (S, na a re
)Date/Time:
MTJL
LAB USE ONLY
Relinquished by/Company: (Signature)
i
i — ----
�elfime. Received by/Compan ignature)
Qate/Time:
Table It:
A[ctnum:
.
.
I
r
Template:
__._._..,
!
Prclogin:
pa�.
�y/Comny: (Signature)
Date/Time: Received by/Company: (Signature}
Date/Time:
PM:
(
i
PB:
Lab Sample Temperature Info:
I Temp Blank Received: Y N NA
Therm ID#: I `J`.A
Cooler 1 Temp Upon Receipt:
Cooler 1 Therm Corr. Factor: _L�_
Cooler 1 Corrected Temp:
Comments:
Trip Blank Received: Y +N� NA
HCL McOH TSP Other
Non Conformance(s): Page:�Y
YES / NO of:

AacAnalytical
www.pacelabs.com
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92532066
Sample: Effluent
Method Parameters
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Laboratory Report
Lab ID: 92532066001
Results
PACE
Garret
Dreyer
04/08/21
13:00
8.53
0.26
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 04/09/2021
Date Received. 04/08/2021
Collected: 04/0812113:00 Matrix: Water
Units Report Limit Analyzed Qualifiers
04/08/21 13:00
04/08/21 13:00
04/08/21 13:00
04/08/21 13:00
Std. Units 04/08/21 13:00
mg/L 04/08/21 13:00

CHAIN -OF -CUSTODY Analytical Request Document
ace Analytical
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Company: Town of Liberty Billing Information:
Address:
LAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
W0#:97532066
ALL SH,
Container Prreservaativ
Report To:
Email To:
+• Preservative
Types: (1) nitric acid, (2) -
(6) methanol,
(C) ammonium
(7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
hydroxide, (D) TSP, (U) Unpreserved, (0) Other
Copy To:
Site Collection Info/Address:
Analyses
Lab Profile/Une;
tra; s'amp�.p Rnceipl�citeckiiat: __
Customer Project Name/Number:
State: County/City: Time Zone Collected:
/ [ ]PT[ )MT] JCT [ JET
CuoLody ne.alo Present/Intact Y C.NR
Custody Sl.gnatureo Present Y N NA
16;
Phone:
Site/Facility I #:
Compliance Monitoring?
Email:[
4(Yes [ ] No
Cral lector• Signature Present NA
nottloc Intact Y N NA:,
Correct i)uttl.es Y N
Co cted By (prints:,
Purchase Order #:
DW PWS ID #:
Quote#:
DW Location Code:
II
Sufficient Vcilumr Y N tjJ
Sampler RAceived on ice Y N F4�
VOA - Headepnno Acceptable Y N NAj
Collected'9y (signature):
Turnaround Date Required:
Imme iateiy Packed on Ice:
[ ]YES [ ] NO
m
USDA Regulated Soi Ls Y N yN�A
IL
m
Sampleu in Holding Time y N NA}
Reoidual. Chlorine PrortenG Y;P NA
Sample Disposal: -
Rush:
Field Filtered (if applicable):
[ J Dispose as appropriate [ j Return
[ J Same Day [ ] Next Day
[ ] Yes [ ] No
c
C1 Stripu:
[ J Archive:
2 Da 3 Da 4 Da 5 Da
I l Y I 1 Y I 1 Y I 1 Y
p
Sample pH A<:ceptaW.e ) N NA
`
[ JHold:
(Expedite Charges Apply)
Analysis:
v
L
U
p)t Stripu:
Sulfide Prwavnt �f Y N NA j
Lead Acetate Stripu:
r 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), Bloassay (B), Vapor (V), Other (OT)
m
W
LAB USS ONLY:
nab Sample it / Coinnionto:
Comp /
Collected (or
Res
# of
„
Customer Sample ID Matrix Grab Composite Start) Composite End Cl Ctns 1 ip T ^`fT
Date Time Date Time CL ��
Effluent WW g '// .'Lt 0
I f
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT (<72 hours): Y N N/A Lab Sample Temperature Info:
Packing Material Used; Lab Tracking #: Temp Blank Received: Y N NA
Therm ID#:
Effluent Monitoring T_ -- _ _ _ —_ _ _ _ _ _ _ _ __�___ _ Cooler 1 Temp Upon Recelpt: __ c
Radchem sample(s) screened (<500 cpm): Y N NA Samples received via: Cooler 1 Therm Corr. Factor- __(
i FE.DEX UPS Client Courier Pace Courier Cooler 1 Corrected Temp: __ c
Relinquished-boy/Company: (_S,,gwature) Date/Time: Received b/Co�pany: ignt
): _ Date/Time, t - MTJL LAB USE ONLY Comments:
V k �� Table9:
- ,Acctnum: _
- -
Rel' quished by/Company: (Signature) to -ime: Received by/Company: (Signature) Date/Time: ;gTemplate: Trip Blank Received: Y N NA
I ! Prelogin: HCL McOFI TSP Other
Relinquished by/Company: (Signature) Date/Time: Received by/Company: (Signature) l Date/Time: PM: Non ConformRnce(s); i Page:
IE
pg; YES / NO ' of:

Pace Analytical Services, LLC
raceAnalytical ® 1377 South Park Drive
Kernersville, NC 27284
wanw.paeelaba tem [phone]
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92533452
Page 1 of 1
Report Date: 04/26/2021
Date Received: 04/15/2021
Sample: Effluent
Method
Parameters
Lab ID: 92633452001 Collected: 04/15/21 13:25 Matrix: Water
Results Units Report Limit Analyzed Qualifiers
SM 254OD-2011
Total Suspended Solids
15.1
mg/L
3.1
04/19/21 18:57
SM 52108-2011
BQD, 5 day
2.8
mg/L
2.0
04/21/21 10:41
Colilert-18
Fecal Coliforms
2420
MPN/100ml-
1.0
04116M 12:24 1g,El
Performed by
PACE
04/15/21 13:25
Collected By
Garrett
04/15/21 13:25
Dreyer
Collected Date
04/15/21
04/15/21 13:25
Collected Time
13:25
04/15/21 13:25
PH
7.64
Std, Units
04/15/21 13:25
Chlorine, Total Residual
0.13
mg/L
04/15/21 13:25
TKN+NO3+NO2
Total Nitrogen
8.6
mg/L
0.52
04/26/21 14:21
Calculation
EPA 350.1 Rev 2.0 1993
Nitrogen, Ammonia
5.4
mg/L
0.10
04/26/21 14:10
EPA 351.2 Rev 2.0 1993
Nitrogen, Kjeldahl, Total
8.5
mg/L
0.50
04/24/21 06:13
EPA 353.2 Rev 2.0 1993
Nitrogen, NO2 plus NO3
ND
mg/L
0.040
04/22/21 09:26
EPA365.1 Rev 2.0 1993
Phosphorus
1.3
mg/L
0.050
04/22/21 19:21
ANALYTE QUALIFIERS
1g >2419.6
El Reported value should be considered a minimum estimate since it is the maximum reportable number for this method
based on the sample volume used. The true value is likely greater than the value reported.
Reviewed by:
•T, , it .��'
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87W
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 #: 460026

.,Pla'ceAnalytical
company: Town of Liberty
Address:
Report To:
Copy To:
CHAIN -OF -CUSTODY Analytical Request Document
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Billing Information:
Email To:
Site Collection Info/Address:
LAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
MT.q Lnlr-In Number Here
WO#:92533452
— ALL SHA[
_Container Preservative T
'• Preservative Types: (1) nitric acid, (2) sui 92533452
(6) methanol, (7) sodium bisulfate, (B) sodium tmosurrare, tVI ncAdne, tAl dawrua duu, tpr —10-p
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
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 (print):
Purchase Order #:
OW PWS ID #:
Quote #:
DW Location Code:
Collected By (signature):
Turnaround Date Required:
Immediately Packed onIce:
a
�-
[ ]Yes [ ] No
+a
Sample Disposal:
Rush:
Field Filtered (if applicable):
F-
( ] Dispose as appropriate ( j Return
[ ) Same Day [ ] Next Day
[ ] Yes ( ) No
Z
[ ) Archive:
[ ) 2 Day [ ] 3 Day ( ] 4 Day [ ) 5 Day
Analysis:
Z
[ ) Hold:
(Expedite Charges Apply)
O
* Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Z
2
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
_
F-
Comp /
Collected (or
Composite End
Res
# of
F^
Z
Customer Sample ID
Matrix *
Grab
Composite Start)
Cl
Ctns
O
r5
M
Z
Date
Time
Date
Time
Effluent
WW
a
, ,.
5
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue - Dry None
Packing Material Used:
Effluent Monitoring
i
Radchem sample(s) screened (<500 cpm): Y N NA
Relinquished pr'arly: (Signature) Date/Time: Recei a by/ 'om anyPS ighatJ
Relin ed by/Company: (Signature) Date/Time: Received by/Company: ( gesture)
by/Company: (Signature) [Date/Time: j Received by/Company: (Signature)
Anal
ses
Lab Profile/Line:
Lab Sample Receipt Checklist:
Custody Sualo Present:/Intact YkiNA
Custody Signatures PresentINNA
Collevt•.or Signature Preoenk NA
Bottles Intaot NA
correct Bottles NA
Sufficient Volume NA
sampleo Received on Ice NA
VOA - Headspace Acceptable Y N
USDA Regulated Soi to
N.,
rY.'
Samplers in Holding 'rime d NA
Residual Ctilorine Preoent Y &A
Cl Stripc:
t
Ls
Sample ptl Acceptable n,t t V N NA
pH Strips:
Sulfide Present - Y N
"cad Acetate Strips: -_
u
L,AH USF: ONLY:
Lair Snmple # / CommenLo:
�
�
U
U
U.
a
SHORT HOLDS PRESENT (<72 hours): Y N N/A Lab Sample Temperature Info:
Lab Tracking #: a Temp Blank Received: Y N NA
Therm IDN:
Cooler i remp Upon Receipt: o
iamples received via: Cooler 1 Therm Corr. Factor: ^ c
FEDEX UPS Client Courier pace Courier Cooler 1 Corrected Temp: _ Z I fo
Date/Time:. MTJL LAB USE ONLY Y T Comments:
9 _..
Table - —
Acctnum:
Date/Time:
�Prelogin:
Date/Time: PM:
PS:
Trip Blank Received: Y - N NA
IF HCL MCOH TSP Other
Non Coniormance(s): Page:
YES / NO of:

aceAnalytical
www.Welaft com
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92534571
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 04/26/2021
Date Received: 04/22/2021
Sample: Effluent Lab ID: 92534571001 Collected: 04/22/21 10:20 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
EPA 353.2 Rev 2.0 1993 Nitrogen, Nitrate 0.048 mg/L 0.040 04/23/21 10:11
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288 North Carolina Wastewater Certification #: 633
North Carolina Drinking Water Certification #: 37738 VirginiaNELAP Certification #: 460025

f _• PaceAnalytical YM
Company: Town of Liberty
Address:
Report To:
Copy To:
Customer Project Name/Number:
Phone:
Email:
By
CHAIN -OF -CUSTODY Analytical Request Document
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Billing Information: _
Site/Facility ID #:
Purchase Order#:
Quote #:
Email To:
Site Collection
State: Cou
/
LAB USE 0P.. ,eh..:.'�' _. iber or
W0#:92534571
Container 1111111111111111111111
92534571
_ u _
** Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, (5) zinc acetate,
(6) methanol, (7) sodium bisulfate, (8) sodium thlosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
A-1-- �6 o.nia.�h inn• .
Ity. Time Zone Collected:
[ JPT[ JMT[ ]CT [ ]ET
Compliance Monitoring?
[,/Yes [ ] No lam,
DW PWS ID #:
DW Location Code:
Collected By (signature):
Turnaround Date Required:
Immebiately Packed on Ice:
a
] Yes [ ] No
A
U.
Sample Disposal:
Rush:
Field Filtered (if applicable):
[ ] Dispose as appropriate (] Return
[ ] Same Day [ ) Next Day
[ ) Yes [ ] No
[ ] Archive:
[ ] 2 Day [ ] 3 Day [ J 4 Day [ ] 5 Day
Analysis:
`o
t
[ ] Hold:
(Expedite Charges Apply)
" 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)
n`
32
m
ro
Comp /
Collected (or
Composite End
Res
# of
Customer Sample ID
p
Matrix "
Grab
Composite Start}
Cl
Ctns
v
R
a
Date
Time
Date
Time
Effluent
w
g
Ilr'L?�� I
Customer Remarks /Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None
packing Material Used:
Effluent Monitoring
Radchent sample(s) screened (<500 cpm): Y N NA
Relinqu d bQ/Company: SSgnature) N� Date/Time: Reeved by/Company: (Signature)
ature) Date/rime: Receved byom(Signature)Relinquished by/Company: (Signn
Relinquished by/Company:
Received by/Company: (Signature)
SHORT HOLDS PRESENT (<72 hours): Y N N/A
Lab Tracking it:
Lab Sample Receipt Checklist:
Custody Seals present/intact -IV. NA
Custody Signae Luros Prsent
N NA
Collector Signature Present
W N NA
Bottles Intact;
N NA
Correct Bottles
N NA
a"uffirient Volume
N NA
Samples Received on Ice
Y N NA
VOA Headspace Acceptable
Y�L1
USDA RegulaLed Soils
Samples in Holding Time
YYIWLi A
D,r1 N� NA
Residual Chlorineoent
a:NA
Cl Strips: _v._-�
Sample pH Arcepta e
Y N NA
pH Strips -
Sulfide
Sulfide Present
Y N�tdAl
Load Acetate Stripu: _
LAD USE ONLY:
Lib Sample 0 / CommenLe:
samples received via:
FEDEX UPS Client Courier Pace Courier
Date/Time: MT1L LAB USE ONLY
it=� -- I
rAc�mm�
le #: _T
:Date/Time:nlate:
M:
Lab Sample Temperature Info:
Temp BlankReceived: Y NA
Therm ID#: PIMP il I
Cooler l Temp Upon Receipt:.• I
Cooler 1 Therm Corr. Factor:
Cooler 1 Corrected Temp: �L
Comments:
Trip Blank Received: Y NA
HCL Me0H TSP fher
Non Conformance(s): Page:
YES / NO of:

Pace Analytical Services, LLC
®
FacEAnalytical 1377 South Park Drive
Kernersville, NC 27284
www.pacdabs.com [phone]
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92535860
Sample: Effluent
Method Parameters
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Laboratory Report
Page 1 of 1
Report Date: 04/30/2021
Date Received: 04/29/2021
Lab ID: 92535860001 Collected: 04/29/21 13:10 Matrix Water
Results Units
~
Report Limit Analyzed Qualifiers
PACE
_ — 04/29/21 13:10
Garrett
04/29/21 13:10
Dreyer
04129/21
04/29/21 13:10
1310
04/29/21 13:10
7.61 Std. Units
04/29/21 13:10
0.07 mg/L
04/29/21 13:10

CHAIN -OF -CUSTODY Analytical Request Document R LAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
i/�ACP 11 9alvtfnal MTJL Loa -in Min t -r Nord
;" �' _ Chain -of -Custody is a LEGAL DOCUMENT- Complete all relevent fields
WO# :
©2535860
Company: Town of Liberty B)Iling Information;
ALL
ALL SHADI
Address:
Container Preservative Tyr
Report To: Email To:
• Preservative Types: (Y) nitric acid, (1) sulfu
(6) methanol, (7) sodium bisulfate, (8) sodium tiu.,wna«, kv) immune, tA) ascormc acid, (8) ammonium sulfate,
Copy To: Site Collection info/Address:
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
Customer Project Name/Number: State: County/City: Time Zone Collected:
'" Analyses
—
Lab Profile/Line: _
-lab Sample Re,:�3ipt Chocisl iat :'�' -
/ [ JPT[ ]MT[ ]CT [ JET
Custody Sedls Present/Intact Y N NA
Phone: Site/Facility ID #: ICompliance Monitoring?
f
Custody Signuturas Present Y N NA
Email: [ Yes [ ] NO
Collector Signature Present Y N NA
Collected By (print): Purchase Order #: DW PWS ID #:
Bottles Intact Y N NA
Correct Bottles Y N NA
,1 re Quote#: DW Location Code:
Sufficient Volume Y N NA
Collected By (signature): Turnaround Date Required: Immediately Packed on Ice:
H
Sampled Received On Ice Y N NA
VOA - Headspdce Acceptable Y N NA
i I ]Yes [ ] No
N
USDA Re4ulated Soils Y N NA
I.L
Samp.leo in Holding Time Y N NA
Sample Disposal: Rush: Field Filtered (if applicable):
m
Residual Chlorine Present Y N NA
[ ] Dispose as appropriate [ ] Return ( J Same Day [ ) Next Day [ ] Yes [ ] No
^- a
Cl Strips:
[ ] Archive: [ ] 2 Day [ 13 Day [ J 4 Day [ J 5 Day
`p
Sample pH Acceptable Y N NA
[ J Hold: (Expedite Charges Apply) Analysis:
pH Stripa:
U
Sulfide Present Y N NA
Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
m
Lead Acetato stripe:
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
li
Ad N
LAB USE ONLY:
Comp / Collected (or Res # of
v
Lab sample N / Comments,
Customer Sample ID Matrix * Grab Composite Start) Composite End Cl CtnsLL
Date Time Date Time
p
Effluent WW .9 , ;[ i l �, p
I
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None
SHORT HOLDS PRESENT (<72 hours): Y N N/A
Lab Sample Temperature Info:
Packing Material Used:
Lab Tracking fi': -V } mpu �
Temp Blank Received: Y N NA
Therm ID#:
" Effluent Monitoring _ _ --
Cooler 1 Temp Upon Receipt:
Radchem sample(s) screened (<500 cpm): Y N NA
(Samples received via:
Cooler l Therm Corr. Factor.
FEDEX UPS Client Courier Pace Courier
Cooler i Corrected Temp: -
Relinquished by/Company: (Signature) Date/Time: Received by/ om ny: KIgnku [ Date/Time; , MTJL LAB USE ONLY
Comments:
r
4J Table -II.:
_ _
•. Acctnum:
Relinquished by/Company: (Signature)
Daxe/Time:
Received by/Company: (Signature)
Date/Time:
Template:
Trip Blank Received: Y' N N<
Prelogin:
PM:
HCL McOH TSP Other
Non Conformance(s): Page:
Relinquished by/Company: (Signature)
Date/Tlme:
Received by/Company: (Signature)
Date/Time:
PR:
YES / NO

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
29
30
April 2021
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
0
0
0
0
0
0
0
0
0
0 R 0.6
0
0
0
0
0
0
0
0
1/2
2
4
5
6
9 R 0.8
6
4
6
8
8 1/2
10
TOTAL 1.4

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: April
Year: 2021
Did irrigation occur
this facility?
Field Name;
1
Field Name:
2
Field Name:
3
Field Name:
4
Area (acres):
19.56
Area (acres):
19.54
Area (acres):
18.98
Area (acres):
16.78
at
0 YES ❑ NO
Cover Crop:
p:
FESCUE
Cover p:
FESCUE
Cover op:
FESCUE
Cover p:
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?
ill yEs O;NO
Field Irrigated?
[] yEg ❑ NO
Field Irrigated?
YES NO
Field Irrigated?
E] yEs ❑ No
9
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m
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m 9
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ma
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mn
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W
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m9
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w
Ro
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30
_
�
OF
In
ft
ft
gal
min
in
In
gal
min
gal
min
In
in
gal
min
In
In
1
I
2
3
C
55
0
321,000
180
0.61
0.20
4
C
65
0
327,000
180
0.62
0.21
s
C
52
0
281,000
180
0.62
0.21
6
C
58
0
321,000
180
0.61
0.20
71
C
61
1 0
327,000
180
0.62
0.21
325,000
180
0.63
0.21
81
C
49
1 0
1
281,000
180
0.62
0.21
91
C
54
1 0
321,000
180
0.61
0.20
10
PC
61
010.6
0
327,000
180
0.62
0.21
325,000
180
0.63
0.21
11
12
C
74
0
281,000
180
0.62
0.21
13
C
66
0
321,000
180
0.61
0.20
14
C
50
0
327,000
180
0.62
0.21
1
325,000
180
0.63
0.21
15
C
64
1
D
1
281,000
1 180
0.62
1 0.21
16
C
45
0
321,000
180
0.61
0.20
17
C
60
0
327,000
180
0.62
0.21
325,000
1 180
0.63
0.21
18
19
C
60
0
281,000
180
0.62
0.21
201
C
52
1 0
327,000
180
0.62
0.21
321,000
180
0.61
0.20
325,000
180
0.63
0.21
21
221
C
39
0.25
281,000
180
0.62
0.21
231
C
43
0.5
327,000
180
0.62
0.21
321,000
180
0.61
0.20
241
C
52
010.8
0.75
325,000
180
0.63
0.21
25
26
27
PC
62
0.5
321,000
180
0.61
0.20
326,000
180
0.03
0.21
28
C
64
0.5
327,000
180
0.62
0.21
281,000
180
0.62
0.21
29
301
C
51
0.75
321,000
180
0.61
0.20
325,000
180
0.63
0.21
31
Monthly Loading:
12 Month Floating Total (in):
2,6i$.000
4.93
40.03
2.889.000
5.45
40.13
11111112,80a,00Q
5.05
1,967,000
4.32
29.00
27.10

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? 7 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑e Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ED Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant ❑r 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.
FREEBOARD IS NON COMPLIANT
of 1.4
IOperator in Responsible Charge (ORC) Certification i Permittee Certification I
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
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee:
Scott Kidd
Signing Official:
Signing Officials Title: Interim Town Manager
Phone Number: 336 622 4276 Permit Exp.: 8131 /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

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 2_of_2_
permit No.: W00003090
Facility Name: Town of Liberty - Wastewater
County: Randolph
Month: April
Year: 2021
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 On):
0.21
Hourly Rate On):
0.21
Hourly Rate On):
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?
Q YES ❑ NO
Field Irrigated?
YES No
field Irrigated?
Q YES Q NO
W
c
Ci
m
L
$'
Ee
~
C
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n
m
$
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ym °'
0. 1�0
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33
9Q
Es
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G$ '°o
J J
°F
in
ft
ft
gal
min
in
in
gal
min
In
gal
min
in
In
gal
min
In
In
1
C
45
0
299,000
180
0.60
0.20
2
3
4
5
C
64
0
299,000
180
1 0,60
0.20
6
C
65
0
350,000
180
0.59
0.20
7
8
C
68
1 0
299,000
180
0.60
0.20
9
C
78
0
126,000
90
0.31
0.20
185,000
90
0,31
0.21
101
PC
0/0.6
11
12
C
50
0
299,000
1890
0.60
0.02
370,000
180
0.62
0.21
13
C
52
0
1
252,000
180
0.61
0.20
350,000
180
0.69
0.20
14
15
C
55
0
299,000
180
0.60
0.20
370,000
180
0.62
0.21
161
C
50
0
252,000
180
0.61
0.20
350,000
180
0.59
0.20
17
18
C
55
0
1
299,000
180
0.60
0.20
370,000
180
0.62
0.21
19
C
53
1
0
252,000
180
0.61
0.20 1
350,000
180
0.59
0.20
20
21
C
52
0
299,000
180
0.60
0.20
370,000
180
0.62
0.21
22
C
60
0.25
252,000
180
0.61
0.20
231
C
63
0.6
350,000
180
0.59
0.20
24
C
010.8
25
26
C
48
0.25
299,000
180
0.60
0.20
252,000
180
0.61
0.20
370,000
1 180
0.62
0.21
27
C
85
0.5
350,000
180
0.69
0.20
28
291
C
66
0.5
299,000
180
0.60
0,20
252,000
180
0.61
0.20
370,000
1 180 1
0.62
0.21
30
C
73
0.75
350.000
180
0.59
0.20
31
2.691.000
5.42
30.37
Monthly Loading:
12 Month Floating Total On):1
1,638,000
4.00
36.60
Z405,M.
4.00
37.84
2,450,000
4.16
27.08

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?
21 compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
❑� Compliant
❑ Non-compilant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑Compliant
O 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
actions) taken. Attach additional sheets if necessary.
Raifall of 1.4
fOperator In Responsible Charge (ORC) Certification Permittee Certification i
ORC: Elix Tremaine Fike Permittee: Scott Kidd
Certification No.: 989290 Signing Official:
Grade: SI Phone Number: 336 822 2990 Signing Official's Title: interim Town Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes 2 No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
- -
Signature C(ate 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 taw, 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 iMormafion, 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