WQ0003090_Monitoring - 09-2021_20211027 (2)

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DWR - NonDischarge Monitoring Report Submittal
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NORTH CAROLINA
E Mranmenlcl Quaffly
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0003090
Name of Facility:* Town of Liberty WWTP
Month:* September Year:* 2021
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR new sept spray report.pdf 4.14MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2,NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Elix Tremaine Fike
Signature:
Date of submittal: 10/27/2021
This will be filled in automatically
Initial Review
.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Reviewer: Mokashi, Poorva

Is the project number correct?* WQ0003090
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Accepted Date: 11/9/2021

FORM:NDMR 10-13 NON-DISCHARGE MONITORING REPORT(NDMR) Page_1_of_1_
Permit No.: WQ0003090 Facility Name: Town Of Liberty-Wastewater County: Randolph Month: September Year: 2021
PPI: 002 Flow Measuring Point: ❑Q Influent ❑Effluent ❑No flow generated Parameter Monitoring Point: ❑Influent 2 Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code -* 50050 00400 00310 00610 00530 31613 00620 00625 00665 50060 00600 70300 00940 00630 , 00010
cTo a
O ea m € as _ E tea, c m m +
a v 0" u.. m £ 1--0 0) a o x Y ` +a- 8 1- m s >E E°- H y = z
a w z ;� rr c� x n Z m
0 re
24-hr hrs GPD su mg/L mg/L mg/L #1100 mL mg&L mg/L mg/L mg/L mg/L mg/L mg/L mg/L °C
1 202,000
2 304,000 6.94 ND 7.9 34:7 2420 ND 11.5 22 0.07 11,6 ND
3 214,000
-
4 201,000 -
5 182,000 _ ,
6 177,000
7 7:00 8 204,000
8 7:00 8 234,000 ,
9 7:00 8 232,000 7 _ 0.17
10 7:00 8 2494000
11 10:00 2 236,000
12 12:00 2 181,000
13 7:00 8 180,000
14 7:00 8 205,000 _ _
15 7:00 8 199,000 ,
16 7:00 8 220,000 7.16 20.8 4.9 37.5 2420 ND 9.5 2.1 0.1 9.5 ND
17 7:00 8 220,000 ,
18 11:00 2 208,000 ,
19 12:00 2 240,000
20 7:00 8 130,000
21 7:00 8 233,000 ,
22 7:00 8 585,000
23 7:00 8 1,756,000 7.34 0.78
24 7:00 8 484,000
25 308,000 ,
26 206,000
27 7:00 8 202,000
28 7:00 8 218,000 ,
29 7:00 8 221,000 ,
30 7:00 8 215,000 7.19 0.44
31 ,
Average: 288,200 10.40 6.40 36.10 2,420.00 0.00 #REF! 2.15 0.31 10.55 0.00
Daily Maximum: 1,756,000 7.34 20.80 7.90 37.50 2,420.00 0.00 *REF! 2.20 0.78 11.60 _ 0.00
Daily Minimum: 130,000 6.94 2030 4.90 34.70 2,420.00 0.00 *REF! 2.10 0.07 9.50 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
Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? E 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.
non compliant on the day of 9/22 and 9/23
rainfall l&I
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Elix Tremaine Fike Permittee: Scott Kidd
Certification No.: 989290 Signing Official:
Grade: SI Phone Number: 336 622 2990 'Signing Official's Title: Town Manager
Has the ORC changed since the previous NDMR? E Yes El No Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
/ I
- z
C.- z
7 /
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 arid 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
arn 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

Pace Analytical Services,LLC
1377 South Park Drive
aceAnalytical
www.pacelabs.com Kernersville,NC 27284
[phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 09/16/2021
Town of Liberty Date Received: 09/02/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92559195
Sample: Effluent Lab ID: 92559195001 Collected: 09/02/21 13:40 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2011 Total Suspended Solids 34.7 mg/L 13.2 09/07/21 16:29
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 09/03/21 13:59
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrate ND mg/L 0.040 09/03/21 13:59
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrite 0.053 mg/L 0.040 09/03/21 13:59
SM 5210B-2011 BOD,5 day ND mg/L 2.0 09/08/21 11:13
Colilert-18 Fecal Coliforms 2420 MPN/100mL 1.0 09/03/21 12:29 El
Performed by Pace 09/02/21 15:57
Collected By Garrett 09/02/21 15:57
Dreyer
Collected Date 09/02/2021 09/02/21 15:57
Collected Time 1340 09/02/21 15:57
pH 6.94 Std.Units 09/02/21 15:57
Chlorine,Total Residual 0.07 mg/L 09/02/21 15:57
TKN+NO3+NO2 Total Nitrogen 11.6 mg/L 0.52 09/16/21 15:38
Calculation
EPA 350.1 Rev 2,0 1993 Nitrogen,Ammonia 7.9 mg/L 0.10 09/14/21 11:02
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 11.5 mg/L 0.50 09/15/21 06:32
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 0.072 mg/L 0.040 09/15/21 12:28
EPA 365.1 Rev 2.0 1993 Phosphorus 2.2 mg/L 0.050 09/16/21 09:07
ANALYTE QUALIFIERS
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.
""atirm Reviewed by: . -' L� '
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 VirginiaNELAP 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 VirginiaNELAP Certification#:460025
Page 1 of 2

,� CHAIN-OF-CUSTODY Analytical Request Document I LAB USE ONLY-Affix Workorder/Login Label Here or List Pace Worker,4— -
/ ...FaceArialytical Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields 1 ' ..- , i
Company: Town of Liberty ;Billing Information: ALL ��
MIAddress: ¢ Container Presery III
E( ( 1 I
Report To: [Email To: Preservative Types:(1)nitric acid ,,., nyaroxsde,(5)zinc scetate,
i 1 (6)methanol,(7)sodium bisulfate,(8(uumum tniosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
Copy To: 1Site Collection Info/Address: (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other '.
Analyses 1Lab Profile/Line:
Customer Project Name/Number: State: County/City: Time Zone Collected: I Lab Sample Receipt checklist
[ / [ (PT{ )MT[ )CT [ ]ET
I i j h I f I Custody Seals Present/Intact Y 0 NA
Phone: Site/Facility ID#: Compliance Monitoring? { € [ Custody Signatures Present t'N NA
t (Email: [/Yes [ ]No I I i ( Collector Signature Present .N NA
kk ( Bottles Intact N NA
) !Co ected B.(print: Purchase Order#: DW PWS ID#: ) { ( Correct Bottles 'N NA
Quote#: DW Location Code: 4 j t Sufficient Volume N NA
[ [ Samples Received on Ice '.N NA
?Colleded By ature• Turnaround Date Required: Immediately Packed on Ice: a VOA - xeadspace Acceptable I
[ ]Yes [ ]NoCP ) ( USDA Regulated Soils I N`,NA
o iii ( Samples in Holding Time ii�t+''NA
Sample Disposal: (Rush: Field Filtered(if applicable): ~ Residual Chlorine Pr ent Y I NA
[ ]Dispose as appropriate( I Return [ ]Same Day [ ]Next Day [ ]Yes [ )No Z Cl Strips: c 1.
[ ]Archive: [ ]2 Day [ ]3 Day [ 1 4 Day [ )S Day Sample pH Acceptable , S ; N NA
[ (Hold: (Expedite Charges Apply) Analysis: o pH Strips: tIg C
O ♦- t� Sulfide Present Y No
*Matrix Codes(Insert in Matrix box below):Drinking Water(OW),Ground Water(GW),Wastewater(WW), Z Z 01 Lead Acetate Strips: A./, r•-
{ ) { ) { ) Wipe{ ) { ) ( ) y{ ) Vapor( ) { ) Y 11
Product P,Soil/Solid SL,Oil OL, WP,Air AR,Tissue TS,Bioassay B, V,Other OT CO F, •io LAB USE ONLY:
) Comp/ 1 Collected(or Composite End Res #of F- Z _ v , ; Lab Sample tt / comments
Customer Sample ID Matrix* Grab I Composite Start) Cl Ctns 0 M U U
g Date Time Date Time ' m Z u Q. 1 -#
Effluent wwg 2c �36 5 4... liniamarAh.
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Customer Remarks/Special Conditions/Possible Hazards: !Type of Ice Used: Wet Blue Dry None 'SHORT HOLDS PRESENT(<72 hours): Y N N/A I Lab Sample Temperature Info:
;Packing Material Used: •Lab Tracking#: mm Temp Blank Rece'v d: Y I NA
i Therm ID#: . N._ r I
"EfBUes'i Monitoring 1 Cooler 1 Temp Upon Receipt: '-ia f oC
•Samples received via: Cooler 1 Therm Corr.Factor: oC
Radchem sample(s)screened(<500 cpm): Y N NA FEDEX UPS Client Courier Pace Courier Cooler 1 Corrected Temp: ', ( oC
Relinquished b • Signature) `Date/Time: 1 Rece'ved by/ pany:(Signature) )Date/Time:`! 1 1 MTJL LAB USE ONLY a Comments: i
0 t"� �-,� I Table#:
Acctnum: -,. _1
,Rgnquished by/Company:(Signature) Da /Ti e: Received by/Company:(Signature) i Date/Time:Co a 1'Template: Trip Blank Received: Y NA
( i I HCL McOH TSP Other
[Prelogin: I
Rginquished by/Company:(Signature) j (Signature)Date/Time: Received by/Company: )Date/me:
a N..) i /PM Non Conformance(s): I Page:
1
i i( PB: YES / NO of:
,

Pace Analytical Services,LLC
1377 South Park Drive
/JceAnaIyticaI® Kernersville,NC 27284
www.pacelabs.com
[phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date:09/10/2021
Town of Liberty Date Received:09/10/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92560644
Sample: Effluent Lab ID: 92560644001 Collected: 09/09/21 14:50 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 09/09/21 14:50
Collected By Garrett 09/09/21 14:50
Dreyer
Collected Date 09/09/21 09/09/21 14:50
Collected Time 1450 09/09/21 14:50
pH 7.00 Std.Units 09/09/21 14:50
Chlorine,Total Residual 0.17 mg/L 09/09/21 14:50
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-Atttx Wort<orcor,.og;n
,,,I_ c MTJL Log-in Number Here
a eAnal1/tica(
Chain-of-Custody is a LEGAL DOCUMENT-Cornplete all relevant fields
ICompany: Town of Liberty I Billing Information: ALL
d
(Address: { _ Container Preser
i 1111111111111111111111
__
Report To: I Email To: � 3 *-7,.'-Preservative Types:(1)nitric ao 92560644
S (6)methanol,(7)sodium bisulfate,
Copy To: !Site Collection info/Address: _ (C)ammonium hydroxide,(o)TSP,(Ut unpreservec,lul utner
1-- — Analyses FLab Profile/Line:
1Customer Project Name/Number: )State: County/City: Time Zone Collected: ; ( Lab Sample Receipt Checklist,
) / [ IPT[ ]MT[ ]CT [ ]ET j )
I ( [ ) ( Custody Seals Pr ent/Intact Y N NA
Phone: Site/Facility ID#: Compliance Monitoring? n0 N i ? Custody signatures Present Y N NA
Email:
[/Yes [ (No '✓ __, y ) € ( Collector Signature Present Y N NA
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� [ Bottles Intact Y N NA
I Co cted By 1 Purchase Order#: DW PWS ID#: { P Correct Bottles I N NA
C>� IQuote#: DW Location Code: j v j ; Sufficient Volume Y N NA
H ! Samples Received on Ice Y N NA
Coll . :,signature Turnaround Date Required: Immediately Packed on Ice: f�, a ) j gVOA - Headspace Acceptable I N NA
'" y USDA Regulated Soils I N NA
[ ]Yes [ ]No j"'
,t} j Samples in Holding Time I N NA
Sample Disposal: Rush: Field Filtered(if applicable): G Residual Chlorine Present I N NA
I[ j Dispose as appropriate [ 3 Return [ ]Same Day [ I Next Day [ ]Yes [ ]No e Cl Strips:
[ ]Archive: [ ]2 Da [ {{ Sample pH Acceptable Y N NA
[ ]Hold: Y [ ]3 Day [ ]4 Day [ ]5 Day Analysis: L pH Strips:
(Expedite Charges Apply) J Sulfide Present Y N NA
*Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), nTs Lead Acetate Strips:
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) a LAB USE ONLY:
Comp/ Collected(or Res °#of w m Lab Sample it / Comments:
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Customer Sample ID Matrix* Grab Composite Start) Composite End CI Ctns is
Date ! Time Date Time = I--
'Effluent ww g -y' Zt IL(.S� ° >C X
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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:
I i Temp Blank Received: Y N NA
l Packing Material Used: 1Lab Tracking#: !
I Therm ID#:
•Effluent Monitoring + _� Cooler 1 Temp Upon Receipt: oC
I-- ISamples received via: Cooler 1 Therm Corr.Factor: oC f
Radchem sample(s)screened(<500 cpmj: Y N NA FEDEX UPS Client Courier Pace Courier Cooler 1 Corrected Temp: oC
,I _a �w _ ___ ht Comments:
Relinquish . .Ar� `• .(Signature) ;Date/Time: y Receiv_ed by/Comp :(Signature) l D te/Time: ( MTJL LAB USE ONLY-- --
°� . .. ; /� i 4 i ;Table#� 1:1 f
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PB: YES / NO of:

Pace Analytical Services,LLC
A �] 1377 South Park Drive
J
ce `naktical Kemersville,NC 27284
! www.pacelabs com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 09/29/2021
Town of Liberty Date Received: 09/16/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92561753
Sample: Effluent Lab ID: 92561753001 Collected: 09/16/21 12:25 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
HACH 10206 Nitrogen,Nitrate ND mg/L 0.30 09/16/21 17:11
SM 2540D-2011 Total Suspended Solids 37.5 mg/L 15.6 09/20/21 15:11
SM 5210B-2011 BOD,5 day 20.8 mg/L 2.0 09/22/21 13:55
Colilert-18 Fecal Coliforms 2420 MPN/100mL 1.0 09/17/21 12:43 El
Performed by PACE 09/16/21 12:25
Collected By Garrett 09/16/21 12:25
Dreyer
Collected Date 09/16/21 09/16/21 12:25
Collected Time 1225 09/16/21 12:25
pH 7.16 Std.Units 09/16/21 12:26
Chlorine,Total Residual 0.10 mg/L 09/16/21 12:25
TKN+NO3+NO2 Total Nitrogen 9.5 mg/L 0.52 09/29/21 17:46
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 4.9 mg/L 0.10 09/28/21 15:00
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 9.5 mg/L 0.50 09/29/21 05:21
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 09/28/21 14:31
EPA 365.1 Rev 2.0 1993 Phosphorus 2.1 mg/L 0.050 09/28/21 18:28
ANALYTE QUALIFIERS
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.
tj
Reviewed by: C*kzenu� �luk
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 VirginiaNELAP 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 VirginiaNELAP Certification#:460025
Page 1 of 3

'- rr LAB USE ONLY-Affix Workorde ' ' ' • -- -- ,,•^•'r^,^rr"Ninmha,'nr
� ; -..r �Ai -0E-CUST°DY; rG�;�3c.aY Request Document f
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Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevant fields
Company: Town of Liberty Billing Information:
ALL SHADED �� I
,Address: i 1 Container Preservative Type` 92561753
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Report To: l Email To: 1, "Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(a)sodium hydroxide,(5)zinc acetate, i
._._,_....,.._....r.__._._._,__..__..,.._____._._.__.._...—__.____.._.__.._—.,_. _��._..___...__.._._,._._._....._._..._._.._ .��__._._. .,__.-._,_.— .; (6)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(6)ammonium sulfate,
Copy To: 'Site Collection Info/Address: j (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
Analyses Lab Profile/Line:
'Customer Project NameJPdurb.r. state: County/City: Time Zone Lollected. Lam Samoi e Ileac i pr .. ,.i,z :
/ [ )PT[ (MT[ (CT [ ]ET i
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Packing Material Used: Lab Tracking#t: Temp Blank Received Y f NA
Therm IN: rM-,.1.§(-N�_
[ "Effluent Monitoring I_ ______- ____ i Cooler 1 Temp Upon Receipt: oC
Samples received via: i Cooler 1 Therm Corr.Factor: oC
Radchem samples)screened(<500 rpm): Y N NA FEDEX UPS Client Courier Pace Courier i Cooler 1 Corrected Temp: oC
;Relinquished b any:(Si n e) Date/Time: ceived,byfcompany:(Signature) )Date/Time: — ^MIKL LAB USE ONLY Comments:
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Pace Analytical Services,LLC
® 1377 South Park Drive
. aU/+epAn4` 'j alyticaI Kernersville,NC 27284
www.pacelabs.com
[phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date:09/24/2021
Town of Liberty Date Received:09/23/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92562866
Sample: Effluent Lab ID: 92562866001 Collected: 09/23/21 08:47 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 09/23/21 08:47
Collected By Glenn Price 09/23/21 08:47
Collected Date 09/23/21 09/23/21 08:47
Collected Time 0847 09/23/21 08:47
pH 7.34 Std.Units 09/23/21 08:47
Chlorine,Total Residual 0.78 mg/L 09/23/21 08:47
ati
Reviewed by: c �Y ruvf
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN-OF-CUSTODY Analytical Request Document
LAB USE ONLY-Affix Workorder/Login Label u.----.• .-
-FaceAnalytical won : 92562866
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields INV
;Company: Town of Liberty Billing Information: ALL SI
Address: I Container Preservat
92562866
Report To: r Email To: i *"Preservative Types:(1)nitric acid,(1, .,,,_,,,"yurocnlcric acid,(4)sodium hydroxide,(5)zinc acetate,
_ __ _ „; (5)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(6)ammonium sulfate,
Copy To: �~ Site Collection Info/Address: j (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
I _ Analyses Lab Profile/Line:
Customer Project Name/Number: IState: County/City: Time Zone Collected: ----------4._ , t,:rf SampleReceipt Checklist:
/ [ ]PT[ ]MT[ ]CT [ JET: �m")
Custody Seals Pro nt/int ct Y N NA
Phone: Site/Facility ID#: Compliance Monitoring? (�- Custody Signatures Present Y N NA
Email: 1[ Yes [ ]No Collector Signature Present Y N NA
Bottles Intact Y N NA
Collected y( rint): I Purchase Order#: DW PWS ID#:[Quote#: �DW Location Code: IZZk rYrre Sot ties Y K NA
I Volume Volum Y N NA
�
II s Ap
Collected y(signature) Turnaround Date Required: Immediately Packed on Ice: Deceived e Acceptable on ptea Y N NA
-a � VOA - Heu d-r,paGc abL Y N NA
6 [ ]Yes [ ]No N " I i USDA Regulated spilt: Y N NA
—
ILL Samples in !oldies Iime Y N NA
]Sample Disposal: sh: Field Filtered(if applicable): j—'1.--- , Re !dual Chlorine Present N NA
) ]Dispose as appropriate ( ]Return pp [ ]Same Day [ 1 Next Day [ ]Yes [ ]No 1.c j CI strips:
{ Archive: Day [ ] y [ ]5 Day ;O ] I r j Sample pia Acceptable- -ptable i' N NP.
I [ ]2Day [ ]34Da
[ ]Hold: (Expedite Charges Apply) Analysis: p Strips: _
iV " I .,i ulftd Present Y N NA
'*Matrix Codes(Insert in Matrix box below):Drinking Water(OW),Ground Water(OW),Wastewater(WW), —co ( 1 Lead Acetate Strips:
Product(P),Soil/Solid(SO,Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) j V 1 a USE ONLY:
q ( a 55 ] LAB
11 )Cornp/ i Collected(or Res f#of a_) 2 Lab Sample a / comments:
Customer Sample ID Matrix" Grab Composite Start) Composite End Cl [Ctns i I±: B
Date Time Date Time I 1 CL F--
j
Effluent ww g f''k/ i O� F11
� —
Zl 11 1 X i 1
i
f
I I I
( _ .._
i
q
I
1
r
j f )I i
Customer Remarks/Special Conditions/Possible Hazards: !Type of Ice Used: Wet Blue Dry None !SHORT HOLDS PRESENT(<72 hours): Y N N/A i Lab Sample Temperature Info:
Packing Material Used: (Lab Tracking it: Temp Blank Received: Y N NA
Therm ID!!:
Effluent Monitoring Cooler 1 Temp Upon Receipt: DC
Samples received via: Cooler 1 Therm Corr.Factor:_ oC
Radchern sample(s)screened(<SOD cpm): Y N NA FEDEX UPS Client Courier Pace Courier i Cooler 1 Corrected Temp: oC
Relinquished by/Company:(Sign t\ure) I Date ime: 1 Rece d by j oo, pang.(Signature) Da�tye//Time: 0 c Mtn.LAB USE ONLY Comments:
!Relquishe by/Company:(Signa ure)� 1— ?Date/Time: i Received by/Company:(Signature) 1 Date/Time: Templatte Acctnu o: Trip Blank Received: Y N NA
i- I HCL McOH TSP Other
L. no Prelogin:
Relnquished by/Company:(Signature) i Date/Time: i Received by/Company:(Signature) Date/Time:
N PM: Non CoMormance(s): Page:
_.-- --- I PB: YES / NO of:

Pace Analytical Services,LLC
aceAnalytical 1377 South Park Drive
Kernersviile,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Pike Report Date: 10/07/2021
Town of Liberty Date Received: 10/06/2021
PO Box 1006
Liberty, NC 27298
Project: TOWN OF LIBERTY
Pace Project No.:92565194
Sample: EFFLUENT Lab ID: 92565194001 Collected: 09/30/21 08:55 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 09/30/21 08:55
Collected By Glenn Price 09/30/21 08:55
Collected Date 09130/21 09/30/21 08:55
Collected Time 0855 09/30/21 08:55
pH 7.19 Std.Units 09/30/21 08:55
Chlorine,Total Residual 0.44 mg/L 09/30/21 08:55
C�`�n�2=ems
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN-OF-CUSTODY!Analytical Request Doct
The Chain-of--Custody is a LEGAL DOCUMENT.All relevant fields must be 2 I 11111111
®,1,
Section A Section B Section C
Required Client Information: Required Project Information: Invoice Information: I Page: 1 Of
Company: Town of Liberty Report To: Attention:
Address: Copy To: Company Name:
Address: Regulatory Agency
Email To: Purchase Order#: Pace Quote:
Phone: I Fax 'Project Name: Pace Project Manager: s;:State I Location
Requested Due Date: Project Number. Pace Profile#:
Requested Analysis Filtered(YIN)
a
MATRIX CODE ° COLLECTED o Preservatives }
Drinking Water DW lit 0 I
Water err 4,, tD U
Waste Wete, vwv — C -' ,�„+. 2
Product P O O a >-
SAMPLE ID Solt/Solid SL24
U
So t? START END < F- c
One Character per box. Wipe WP w w a z v co
m E o
0 r1 v 0
# (A-Z,0-91,-} Diner t7T U r Z Z r7 y, c U
Sample Ids must be unique Tissue TS X '3 to O H e ON 2 'a' o r
W m a a 0 2 0 0 O to 2 m C U q
x
I- m DATE TIME DATE TIME _ 0 I I I Z Z 0 oct
-
1 Effluent W1,1 G 9-30-21 0855 0 x x "Field data only"
2
3
4
6
7
8
10,
11
12
ADDITIONAL COMMENTS I RELINQUISHED BY!AFFILIATION DATE TIME \w ACCEPTED BYIAFF3LWTION j DATE TIME SAMPLECONDITtONS
E "" ,
•'Field data only" �.tt,Evi.w i'r,G2. 10/06/21 ' ^' i 'I Ci r• R i>'
,
SAMPLER NAME AND SIGNATURE ii
PRINT Name of SAMPLER: 5 >.
Glenn Price a o I' m— a
SIGNATURE of SAMPLER: t Pri`,p, I DATE Signed: W m 2 Tro Z. m m Z.
-U
m
Cl
to
N
0
IV

September 2021
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
DATE
1 221/4 R 0.5
2 21
3 20 1/2
4 211/2
5 211/4
6 21
7 211/4
8 211/2 R 0.6
9 21 1/4 R 0.4
10 21
11 20 3/4
12 21
13 21 1/4
14 21
15 21 1/4
16 22
17 211/2
18 213/4
19 22
20 22 3/4
21 21 R 1.5
22 14 R 2.5
23 13
24 12
25 12 1/2
26 12 1/2
27 12 3/4
28 12 3/4
29 12 1/2
30 12 1/4
TOTAL 5.5

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page_1_of2_
Permit No.: WQ0003090 l Facility Name: Town of Liberty-Wastewater I County: Randolph Month: September Year: 2021
Field dame 1 Field Name: 2 Field Name* 3 Field Name: 4
Did irrigation occur
Area(acres) . 20,2 ... Area(acres): 19.7 Area(acres): 19.94 - Area(acres): 17.02
at this facility? y
Cover Cron: ,FESC(.QE Cover Crop: FESCUE Cover Crop::: . FESCUE. Cover Crop: FESCUE
s ❑NO Hourly Rate(In) ",:"' 0.21 Hourly Rate(In): 0.21 Hourly:R;etail* (f21„ 4 Hourly Rate(in): 0.21
Annual Rate(in): 52 Annual Rate(in): 52 Annual Rate(In): 52:. Annual Rate(in): 52
Weather Freeboard Field gated? -OM 0 No ' Field Irrigated? ❑YES Q No Reid Irrigate 9 ms Q No Field Irrigated? 0 YES 0 NO
. - T
oc it
4 vm 07 E P m rss "E ? ar m a m ma car E
Cr3 ce >Alt g > aC
M J ".?"-sx
'S u'
Tri
°F in ft ft gal miry In in::` gal min in in gal mire in : In " gal min in in
1 R 0.5
2
3
4
5
6
7
8 C 73 0.6 1.75 327,000, ; 180. " 0.60 0.20
9 R 0.4
10
11
12 _ ...
13
14
15 C 75 1.75 327,000 180.. 0.60 0.20 321,000 180 0.60 0.20
16
17
18
19
20
21 R 1.5 _
22 R 2.5
23 .
24 C 70 1 327,000 180 0.60. .: 0.20
25 C 72 1 321,D00 180 0.60 fl.20
26 C 70 1 281,000 180 0.61 0.20
27
28
•
29
30
31
Monthly Loading: 981,000 _ 1.79 642,000 v 1.20 0 : 0.00. 281,000 0.61 � K
12 Month Floating Total(in): r 34.02 31,66 : . . .. r .L. 32.55

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? 2 CompliantE Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 Compliant 0 Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 2 Compliant 0 Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 2 Compliant 0 Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 Compliant ID 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 18,1.
Raifall of 5.5
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Elix Tremaine Fike Permittee:
Scott Kidd
Certification No.: 989290 Signing Official:
Grade: SI Phone Number: 336 622 2990 Signing Official's Title: Town Manager
Has the ORC changed since the previous NDAR-1? 0 Yes 2 No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
- I /
7 , f
/a7/-77-z
Signature % Date Signature - 1Datl
By this signature.I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel property gathered and evaluated the information submitted.Based on my
inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the
information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I am aware that there are significant
penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh,North Carolina 27699-1617

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page_2_of_2_
Permit No.: WQ0003090 , Facility Name: Town of Liberty-Wastewater I County: Randolph Month: September Year: 2021
Field Name:, 5 Field Name: 6 Reid Name: "7 Field Name: 8
Did irrigation occur
Area(acres): 18.3 Area(acres): 15.1 Area(acres): 22.12 Area(acres): 21.68
at this facility? Cover „ ,FESCUE Cover Crop: FESCUE Cover Crop: `FESCUE " Cover Crop: FESCUE
Crop:
YES ❑NO Homey Rate(lay 0,21 Hourly Rate(in):. 0.21 Hearty ate-11* ` 0.21 Hourly Rate(in): 0.21
Annual Rate(in): 52 Annual Rate(in): 52 .Annual Rate(fo): 52 Annual Rate(in): 52
Weather Freeboard Field irrigated?"" . 0.lad Field Irrigated? YES No Field irrigated? , YES . :Q io Field Irrigated? Ej YES ❑NO
ea ° ° a E E""°'' e 3 tit.. . a. 5" " E m . 13 a 6 ,c E"m.""""" '. "ci".S ""r r" �,"S`"" /a,"c". E m e -E >, c g . e
0 i
0. 2 >, O a„ h am..; Gd 8 " " , O G h m p a K o �N 5 �'" "' ',,, 3 01 . o q` Tis a3 R K p 5
a , p" o, o ccx c O"o .., G a3R .4 o a H - • rax
3
°F in ft ft gal: mirc`" in "� In; gal min in in gal min "" ' in - in gal min in in
1 R 0.5
2
3 C 58 1.5 . 252,000 180 0.61 0.20 370 0;_ , 180.- " ;0.62 fl 2'f
4
5 _
6 C 80 1.75 252,000 180 0.61 0.20
7 C 82 1.75 000� 180 0.62 0.21 _
8 C 0.6 _
9 R 0.4
10 _
11 C 79 1.5 252,000 180 0.61 0.20 _ _
12 C 83 1.75 370,000 : 180'"s 0.62 0.21
13
14 C 82 1.75 252,000 180 0.61 0.20 _
15' C 85 1.75 ;370,000 . 180 0.62.. 0,21
16 '
17 PC 79 1.75 252,000 180 0.61 0.20
18 PC 87 1.75 370,004 lea 0.62 . 0.21
19 _20 PC 81 1.75 252,000 180 0.61 0.20
121 R 1.5
22 R 2.5 _
23
-24 C , 70 1 299,000 ..180 0.60 0,20
25
26 _
27
28 '
29
30
31
Monthly Loading: 299,000 060 1,512,000 3.69 1,350,000 3.08 0 0.00 }
i 12 Month Floating Total(in): 32,20 � : ;',.. 40.30 39.07 ,,_„ ,, ` 29.46 F', ;, ,"•

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? 0 Compliant 0 Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Compliant fl Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Compliant 0 Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? icompuant fl Non-compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 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 l&i.
Raifall of 5.5
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Elix Tremaine Fike J Permittee:
Scott Kidd
Certification No.: 989290 Signing Official:
Grade: SI Phone Number 336 622 2990 Signing Official's Title: Town Manager
Has the ORC changed since the previous NDAR-1? 0 Yes El No Phone Number 336 622 4276 Permit Exp.: 8/31/24
1'3/2
Signature ' Date Signature Dat•
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 at 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.lain 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