WQ0003090_Monitoring - 12-2021_20220421

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DWR - NonDischarge Monitoring Report Submittal
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NORTH CAROLINA
Enrlranmenlel QHaflly
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0003090
Name of Facility:* town of liberty wwtp
Month:* December Year:* 2021
Report Information
Type* Upload Document*
Revised-NDMR, NDAR-1, NDAR-2, dec spray report 2021.pdf 4.47MB
NDMLR
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: 4/21/2022
This will be filled in automatically
Initial Review
.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Reviewer: Gerald,Wanda

Is the project number correct?* WQ0003090
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Accepted Date: 4/26/2022

FORM:NDMR 10-13 NON-DISCHARGE MONITORING REPORT(NDMR) Page_1_of_1_
Permit No.: W03003090 Facility Name: Town Of Liberty-Wastewater County: Randolph Month: December Year: 2021
PPI: 002 Flow Measuring Point: El Influent ❑Effluent ❑No flow generated Parameter Monitoring Point: ❑influent E Effluent ❑Groundwater Lowering E Surface Water
Parameter Code -► 50050 00400 00310 00610 00530 31613 00620 00625 00665 50060 00600 70300 00940 00630 00010
0 na .-a E> w o = 2 i m m
m
0 U } h in ti 4 E
° m E 1- a u. Ti Z ., Y o 10 s t°- 0 s 10- 1-- H co .mob= Z G.
0 0 a _ U z a. � " z o ` Z 1-
24-hr hrs GPO su mg/L. mg/L mg/L. #/100 mL mgll: mg/L mg/L. mg/L mg/I. mg/L mg/I: , mg/L °C
1 7:00 8 207,000
2 7:00 8 197,000 ,
3 7:00 8 205,000 7.45 0.06
4 11:30 2 234,000
5 14:00 2 209,000
6 7:00 8 144,000
7 7:00 8 209,000 _
8 7:00 8 221,000 _ _
9 7:00 8 232,000 7.7 ND 17.9 29.4 205 ND 33.3 3.7 0.32 33.4 ND
10 7:00 8 209,000 _ _
11 10:00 2 226,000 ,
12 13:00 2 305,000 _ _ _
13 7:00 8 174,000
14 7:00 8 214,000
,15 7:00 8 206,000
16 7:00 8 217,000 7.54 38:6 17.2 21.2 225 ND 27 3,1 0.15 27 ND
17 7:00 8 220,000
18 282,000
19 311,000
20 7:00 8 337,000
21 7:00 8 218,000 7.53 0.5
22 7:00 8 231,000
23 7:00 8 208,000
24 220,000 _
25 185,000
26 149,000
27 252,000
28 7:00 8 146,000 -
29 7:00 8 201,000 7.3 0.49
30 7:00 8 240,000
31 210,000 . ,
Average: 219,968 19-30 17.55 25.30 214.77 0,00 #REF! 3.40 0.30 , 30.20 0.00
Daily Maximum: 337,000 7,70 38.60 17.90 29.40 _ 225.00 0.00 #REF! 3,70 0.50 33.40 0.00
Daily Minimum: 144,000 7.30 .38.60 17.20 21.20 _ 205.00 0.00 #REF! 3,10 0.06 27.00 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
Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of 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.
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? ❑Yes CI No Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
/� a7 21,1 22
• ignature Date Signature Date
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible for
gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I
am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment
for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh,North Carolina 27699-1617

Pace Analytical Services,LLC
1377 South Park Drive
aceAnalytical
Kernersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 12/03/2021
Town of Liberty Date Received: 12/03/2021
PO Box 1006
Liberty, NC 27298
Project: TOWN OF LIBERTY
Pace Project No.:92575578
Sample: EFFLUENT Lab ID: 92575578001 Collected: 12/03/21 11:15 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 12/03/21 11:15
Collected By Garrett 12/03/21 11:15
Dreyer
Collected Date 12/03/21 12/03/21 11:15
Collected Time 1115 12/03/21 11:15
pH 7.45 Std.Units 12/03/21 11:15
Chlorine,Total Residual 0.06 mg/L 12/03/21 11:15
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

( 0 / CHAIN-OF-CUSTODY Analytical Request Document iLAB USE ONLY-Affix Workorder/Login
KM Lof n
-P ceAl Analytical
- Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
Company: Town of Liberty ;Billing Information: ._. �.: €
ALL SHADED AREA
Container Preservative Type"*
9255 55
Address: P
il Report To: Email To: ( "`Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,{5}zinc acetate,
_ _ - (b)methanol,(7)sodium bisulfate,IC)sodium thiosulfate,(9)hexane,(A)ascorbic acid.(8)ammonium sulfate,
Copy To: (Site Collection Info/Address: (C)ammonium hydroxide,(0)TSP,(U)Unpreserved,(0)Other
( Analyses Lab Profile/.-n
(Customer Project Name/Number: !State: County/City: Time Zone Collected: -- IET
—
/ [ [PT[ ]MT[ ]CT [ ]E
'NN:EQ.2y SETT1N PreNen#/inuact - NA
)
Phone: Site/Facility ID#: Compliance Monitoring? : ;,-,N : i ; : ; ] iCustodv Siona#uroNr., NA
`Email: [ Yes [ ]No
( ollected By(print): (Purchase Order#: IOW PWS ID#: l NA
(Quote»: OW Location Code:
t� E tl ; S � ter II N
;Coil re): rfiaround Date Required: immediately Packed on Ice:
_ ' [ )Yes [ ]No °T
)Sample Disposal: 'Rush: Field Filtered(if applicable): art_-..__l v,_or n: -c t TN NA
[ j Dispose as appropriate [ ]Return€ [ )Same Day [ ]Next Day [ ]Yes [ ]No n_ jF
E. )Archive: [ ]2 Day [ )3 Day [ ] Day I )S Day ; o - s_ -__o
[ ]Hold: _ {Expedite Charges Apply} Analysis: t.. _..f_ __.s. ., .�.,_C3 P _
E°Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WiN), l
}. Product(P),Soli/Solid(SO,Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) a
r Comp/ Collected(or Res #of
Composite End 1 ti i
Customer Sample ID ( Matrix [ Grab Composite Start) Ci (Ctns 76 i 1 i 1 j
€ lDate ' ;I-[ Date
Effluent £ T Time LVW '9 'o f 4i t ' ,a
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i
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i Customer Remarks/Special Conditions/Possible Hazards: (Type of ice Used: Wet Blue Dry None l SHORT HOLDS PRESENT(<72 hours): Y N N/A l Lab Sample Temperature Info:
Packing Material Used: Lab Tracking Temp Blank Received: V N NA
#
Therm mr L:
Effluent Monitoring i Coolers Temp UponReceipt: oC
Samples received via: Cooler I Therm Corr.Factor: eC
Radchem sample(s)screened(<500 cpm): Y N NA FEDEX Ups Client Courier race Courier 1
Cope`t_Corrected Temp: PC i
`Relinquished', . any:{Stier re) Date/Time: I Received by/Company (Signature) Date/Tim_: ' ;'- MTDL LAB USE ONLY Co amentr:
''�— .L Table#:
'1� ( ' - � sue`^ a Accinum:
e, quished by/Company:(Signature) Daterrime: iAeceived by/Company: Signature) ,Date/Time: i
Template: Trip Blank Received: Y N NA
_N Preiogin:
HCL 'ioDH TSB Other
'Re. puished by/Company:(Signature) Date/Time: Received by/Company:(Signature) Date/Time:
N iFP;9: Nog.uo.tour. . Page:
PIt: YES I NO of:

Pace Analytical Services,LLC
Lice n na'yticaI° 1377 South Park 84
'ace Analytical r Kernersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 12/22/2021
Town of Liberty Date Received: 12/09/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92576955
Sample: Effluent Lab ID: 92576955001 Collected: 12/09/21 13:10 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 29.4 mg/L 8.1 12/10/21 14:20
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrate ND mg/L 0.040 12/10/21 08:39
SM 5210B-2016 BOD,5 day ND mg/L 2.0 12/15/21 11:09 B2
Colilert-18 Fecal Coliforms 205 MPN/100mL 1.0 12/10/21 12:39
Performed by PACE 12/09/21 13:10
Collected By Garrett 12/09/21 13:10
Dreyer
Collected Date 12/09/21 12/09/21 13:10
Collected Time 1310 12/09/21 13:10
pH 7.70 Std.Units 12/09/21 13:10
Chlorine,TOtal Residual 0.32 mg/L 12/09/21 13:10
TKN+NO3+NO2 Total Nitrogen 33.4 mg/L 0.52 12/22/21 15:59
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 17.9 mg/L 0.50 12/22/21 14:36
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 33.3 mg/L 2.5 12/21/21 05:17
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 12/22/21 09:38
EPA 365.1 Rev 2.0 1993 Phosphorus 3.7 mg/L 0.050 12/21/21 22:26
ANALYTE QUALIFIERS
B2 Oxygen usage is less than 2.0 for all dilutions set. The reported value is an estimated less than value and is calculated
for the dilution using the most amount of sample.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville,NC 28804 South Carolina Laboratory ID:99030
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
North Carolina Drinking Water Certification#:37712 VirginiaNELAP Certification#:460222
North Carolina Wastewater Certification#:40
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

CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-Affix Workorder'>,.ogi
IT.ALi
ceAnaivucal
- , Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevant fields
Company: Town of Liberty I Billing Information: II
ALL SHADED ARE 1111 1
oI ��
Address: Container Preservative Type R.
u 2 [ 8 . , 111111
Report To: Email To: p *"Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,
[ (6)methanol,(7)sodium bisulfate,(6)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(a)ammonium sulfate,
Copy To: Site Collection Info/Address: I (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(D)Other
)
Analyses !Lab Profile/Line:
;Customer Project Name/Number: !State: County/City: Time Zone Collected: i illillilliLab Sample Receipt Checklist:
/ [ (PT[ ]MT[ (CT [ )ET
_,. is _t_s - int,-c_ k NA
Phone: i Site/Facility ID#: )Compliance Monitoring? Custody Siqnatures r en ; .a
Email: - ( Yes [ (Na ! ! ! ! ! ! lilliCallector Signature Present t N NA
1 Bottle_ Intact 11 N NA 1
elected ByJ,pzent`` Purchase Order#: IOW PWS ID#: 0 Be '
v ST f Quote 6W Location Code: 1 c
gC Immediately Packed on Ice: fl % , ea ❑ c _9 y
[Collect
;(signatur ;Turnaround Date Required: x
( :Yes [ )No Q
Samplesn r
.ample Disposal: I Rush: ;Field Filtered(if applicable):
[ (Dispose as appropriate [ (Return! [ j Same Day [ '3 Next Day II 1 Yes [ (No iv
if Archive: [ 7?Day [ l Day [ (a Day [ l s Day bampie
n ;ye -- y y_
Analysis: ` + ^g i " ''
_{ ]Hold: (Expedite Charges Apply) §O !1-- 1 '
*Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), Zz Lead Acetate Stripe:
„ j
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) c J
(.„0
Comp/ r Collected(or CompositeRes #er z s t e s-.,- --------,_..-_.
End [
Customer Sample ID Matrix Grab Composite Start) i C,r Ctns;0 c') 0
` Date r
Date Time i Time ! C't_n z u_ i a 1- .
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Customer Remarks/Special Conditions J Po r ,e Ha_ards. P Dry
PackingMate,ialUsed: Lab Tracking#: T Blan Re 3v ''.-N, NA NA
Therm!D-i: t-.;!..4 -®..+'i d .
_Effluent Monitoring -__ _ - -..- Cooler Temp Upon Receipt: - DC
Samples received via: i Cooler _Therm m Co.,.Factor. eC
Radchem sample(s)screened(<500 rpm): Y N NA FEDEX UPS Client Courier PaceCoolerr
t 6Corrected . -_ _
Relinquis y/Ca, -� (Signature) Date/Time: Received by/Company:(Signature) [Date/Time: MTIL LAB USE ONLY Comments:1 0 �� _DC
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ned by/Company:(Signature) Dat§ Vie: !Received by/Company:(Signature) Date/Time: Trip -lank Received: NA NA
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i Reli wished by/Company:(Signature) Date/Time: Received by/Company:(Signature) i Date/Time: PM c, Page:
_._.
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PS:
NO :of:

£do fi e6ed Document Name: Document Revised:November 15,2021
Sample Condition Upon Receipt(SCUR) Page 2 of 2
PaceAnalytical Document No.: Issuing Authority:
,1 F-CAR-CS-033•Rev.03 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is Project 4
verified and within the acceptance range for preservation
samples.
Exceptions:VOA,Coliform,TOC,Oil and Grease,DRO/3015(water)DOC,llHg
**Bottom half of box is to list number of bottles
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot ti
adjusted added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will he sent to the North Carolina DEHNR Certification Office(i.e.
Out of hold,incorrect preservative,out of temp,incorrect containers.

Pace Analytical Services,LLC
7 -P4ceAnaIyticaI 1377 South Park Drive
Kernersville,NC 27284
www.pacelabszom [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 01/06/2022
Town of Liberty Date Received: 12/16/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92578580
Sample: Effluent Lab ID: 92578580001 Collected: 12/16/21 15:15 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 21.2 mg/L 6.0 12/17/21 13:08
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 17.2 mg/L 0.20 12/23/21 20:18
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 12/17/21 13:00 M1
EPA353.2 Rev 2.0 1993 Nitrogen,Nitrate ND mg/L 0.040 12/17/21 13:00
EPA353.2 Rev 2.0 1993 Nitrogen,Nitrite ND mg/L 0.040 12/17/21 13:00
SM 5210B-2016 BOD,5 day 38.6 mg/L 2.0 12/21/21 23:23 B1
Colilert-18 Fecal Coliforms 225 MPN/100mL 1.0 12/17/21 13:00
Performed by PACE 12/16/21 15:15
Collected By Garrett 12/16/21 15:15
Dreyer
Collected Date 12/16/21 12/16/21 15:15
Collected Time 1515 12/16/21 15:15
pH 7.54 Std.Units 12/16/21 15:15
Chlorine,Total Residual 0.15 mg/L 12/16/21 15:15
TKN+NO3+NO2 Total Nitrogen 27.0 mg/L 0.52 01/06/22 14:04
Calculation
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 27.0 mg/L 2.5 01/06/22 05:28
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 01/03/22 13:08
EPA 365.1 Rev 2.0 1993 Phosphorus 3.1 mg/L 0.050 12/29/21 22:11 M1
ANALYTE QUALIFIERS
B1 Less than 1.0 mg/L DO remained for all dilutions set. The reported value is an estimated greater than value and is
calculated for the dilution using the least amount of sample.
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 South Carolina Laboratory ID:99030
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
North Carolina Drinking Water Certification#:37712 VirginiaNELAP Certification#:460222
North Carolina Wastewater Certification#:40
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

CHAIN-OF-CUSTODY Analytical Request DocumentLAB USE ONLY- orkor ,er
/ ceAna/vri al �` $ Or' �
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
Company: h 'Billing Information: a 1111
ti Town oT Liberty gp.1 1LLSHADEDi I111 It
Container Preservative Type Address: Y"e of
u 2 8
Report To: I Email To: I `4 Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate, -
- i (6)methanol,(7)sodium bisulfate,(5)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(e)ammonium sulfate,
I Copy To: 'Site Collection Info/Address: I (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
- Analyses -Lab Profile/Line:
Customer Project Name/Number: 'State: County/City: Time Zone Collected: t ..sample E�_- - -' __,_, __.
i / [ ]PT[ )MT[ ]CT [ JEET
_ d y Senan Cs-PrsoentlintactYN
Phone: Site/Facility ID#: Compliance Monitoring? Signatures-
Email: - [[I Yes [ [No C_ Presentature I
Ilected ¢Purchase Order C: IOW PWS!D#: iiiiiIIII , ECEtrrect C a
J - Quote#: Dlt'Location Code: , i r f , LEEREEET NA
amain N L,
Collected By I e)% gTurnaround Date Required: i immediately Packed on Ice: _
/ ,. 1 - _
� w 1[ ]Yes [ [No � _ i CvD Regulated d �u
/r _.. - n m in H 'rim Thug „CcEN.HA
;Sample Disposal: l Rush:
Field Festered((if applicable):
' e c
( ]Dispose as appropriate [ ]Return( [ ]Same Day [ j Next Day [ [Yes [ J No Z °r \ 1
? I rchive: 2 Day3 DayDay5 Day] [ ] [ l [ Z :lam _, _„ _= pH. a z
:[ ]Hold: - (Expedite Charges Apply) AnaaysiS:
-4 Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), iz I la--I L) rip
Product(P),Soil/Solid[St),Oil(O ,Wipe ipe)WP; Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) crj _- c�t
Como/ ( Collected(or - Res `#of I- Z Si Lab �,_ r _ . , Comm_.
Customer Sample i D { Matrix Composite End - '_
Grab Composite Start) Cl Ctns:G Hip i o J
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Date Time Date Time ) DO Z I L '0. ; i-
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Customer Remarks/Special Conditions/Possible Hazards: `Type of ice Used: g Wet> Blue Dry None SHORT HOLDS PRESENT(<72 hours)t Y' N N/A 1 Lab Sample Temperature info
Temp Blank Received:
I Pocking Material Used: 'Lab Tracking#:
y l NA
:,err iDv:
l II Effluent Monitoring - i".. _ Cooler I Ten p Upon-R ce.op oC
Samples received via: ,— `-..- I Cooler 1 Therm m r,Factor: of
Radchem samples}screened(<SUO cpm): y N NA i 1FEDEX UPS C- Courier race Courier Cooler 1 Co r ec,ed em . _ cC ent
Ro Da e/T me: Received by/Company:{Signature} Date/Time: M i B USE ONLY Comments:
�� '/ i i` .ems`,',- able r
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cuished by/Company:(Signature) [Drife/ me: Received by/Company:(Signature) Date/Time:
l !Template: Trip Blank Received: y1 4A
;D € HCL MsOH TSP Other
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RelMquished by/Company:(Signature) I Date/Time: Received by/Company: Si nature Date/Time: -
g 7 (Signature)} �t 17ime:
w Ply:: on CDnfcr mr ce(s): Page:
IPB: YES , NO 'of:

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C)

Pace Analytical Services,LLC
p o 1377 South Park Drive
'' ace Analytical(An aIyticaI Kerneraville,NC 27284
www.pacalabs.com
[phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 12/21/2021
Town of Liberty Date Received: 12/21/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92579204
Sample: Effluent Lab ID: 92579204001 Collected: 12/21/21 11:45 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 12/21/21 11:45
Collected By Garrett 12/21/21 11:45
Dreyer
Collected Date 12/21/21 12/21/21 11:45
Collected Time 1145 12/21/21 11:45
pH 7.53 Std.Units 12/21/21 11:45
Chlorine,Total Residual 0.51 mg/L 12/21/21 11:45
Reviewed by: `i.
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN-OF-CUSTODY Analytical Request ocument LAB USE ONLY-Affix Workorder/Login Label Here or List Pace Workorder Number or
MThL 1„,,_in N,onher Horn
aceAna/jmca t
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
Company: Liberty Billing information:
v Town of ALL SHADED
Address: Container Preservative T e
"Report To: l Email To: - **Preservative Types:(1)nitric acid,(2)sulFuric acid,
l I
- (6)met'nanol,(7)sodium bisulfate,(8)sodium thiosulfate,19i nexane,(A) Se3lu11:3{Al S tinily. ,,,,,,t, ,
;Copy To: !Site Collection Info/Address: 1 (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
Analyses lLab PrariietLine.
Customer Project Name/Number: i State: County/City: Time Zone Collected: iii [ ? 1 ; 11,Elli SmmpleU. Receipt Chmfflisco
/ [ ]PT[ ]MT[ ]CT [ ]ET
Phone: !Site/Facility ID 4: ECompliance Monitoring? ,
Email: II Ives I ]No ,3
BoCtime � cF
Collected By(print): I Purchase Order H: 1 OW PWS ID 5: ! 1 r Rot flee T N NI
r . Y _ ..- �j €Quote«: ;OW Location Code: Hill il ll ISempieuReceived
o immediately Pacned on Ice: d r able UN NA
�Coliec ey nature): tTurnaround Dale Required:
--`— I ]Yes [ ]Na L
Sapled in Holding Time Y N NA
r,
Sample Disposal: Rush: `Field Filtered(if applicable): ReAidual chlorine Present YN NA
]Dispose as appropriate [ ]Return 1 I ]Same Day [ ]Next Day 1[ ]Yes [ ]No lli_
If ]Archive: = j ]2 Day [ ]3 Day I ]4 Day [ ]5 Day(
Hold: 1
,Analysis: a _;
[ j dExpediteChargesAPPIY) N {3 _ Prescript Y N N,_
x Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WWVW), -Srad. f,c m..:,tr - '
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) _ 'm ,
i _, USE ONLY,
Comp/ Collected(or Res 4 of _= Sample ii -i-
Customer Sample ID Matrix* Grab Composite Start) Composite End CI Ctns'i-1- cis
. i Date Time Date Time '
Effluent km g If/Wm Ift/Wm E ] ( i0
,
, ,
r K ;
i , : : Esislii
i
I i ,
i
i
i
Customer Remarks/Special Conditions/Possible Hazards: Type of ice Used: Wet Blue Dry None SHORT HOLDS PRESENT(<72 hours): v N N/A l Lab Sample Temperature Info:
Packing Material Used: Lab Tracki a_;t: ... Temp Blank Received: Y N NA
Therm ID4:
'Effluent Monitoring _ -.. - _ _ _ - _ - _— Coa Temp Upon Receipt, C
_..--. - -__ �_ _ - !Samples received via: i Cooler 1 ThermFactor:. oC
Radchern sam¢ie($)screened(----.-SOD rpm): Y N NA FEDEX UPS Client Courier Puce Courier 1 Cooler 1 Corrected Temp: ,,
Relinquish i by �ature) Date/Time: Recei ed by/Company: Si npiure) !Date/Time: MOt �m ",s J �L LAB USEL t`
g Jc _�,� .i J Tabler.
f _ t
Re I, fished ompany:(Signature) ,D e/T ne: fl et'e vi ed by ompany:(Signature) i Date/Time: Trip Blank R. r: N NA
TemHiat-
,.. HCL Me0H TSP Other
N -_... orelogin:
Resin fished by/Company:(Signature) Date/Time: I Received by/Company:(Signature) °Date/Time: PM: Page:
No Contormar , ,
PB: ES I No or:

Q Pace Analytical Services,LLC
aceAnaiyticai 1377 South Park Drive
� Kernersville,NC 27284
www.pacelahs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Pike Report Date: 01/05/2022
Town of Liberty Date Received: 01/05/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92580958
Sample: Effluent Lab ID: 92580958001 Collected: 12/29/21 09:30 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 12/29/21 09:30
Collected By Glenn Price 12/29/21 09:30
Collected Date 12/29/21 12/29/21 09:30
Collected Time 0930 12/29/21 09:30
pH 7.30 Std.Units 12/29/21 09:30
Chlorine,Total Residual 0.49 mg/L 12/29/21 09:30
dva
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

• i • e *
. •
CHAIN-OF-CUSTODY i Analytica
The Chain-of-Custody is a LEGAL DOCUMENT.All II I II I 1 1
---
ectlon A Section B Section C 92580958
:equired Client Information: Required Project Information: Invoica Information:
4mPanY:—7s.t ep i..4.,..ie_J-47, Report To: Attention.
.ddress. Copy To. Company Name:
_Addre.sx Revelatory Agency
mail To. Purchase Order It: Pace Quote:
hone: i Fax: Project Name !ace Project Manager. ,...,:",',:!'''i. "--;--,:'...:'Suitollibcation.:
:equested Due Date: Project Number Pace Profiled:
7; -,ReqUestatfAtialysfe Flitareiff-YiNF.,...'...t,77,, ':',:,*7',. ' -.;`' -.
I 2 Er.
2 n
8 o COLLECTED ,.
Z
Preservatives
0
MATRIX CODE ,, ,, ' -1?. ' I'
Onniang Water OW -8 C.)
Water WT P 0 LI) tr."•
Waste Water WA/ M <
Product P 7.> ,,CC 0 i k'A: f 1
SAMPLE ID Soll1Salle 0. la —0
011 0- g 0 START END
wo. vvo — t7c fc, 1-, . •tzlk
One Character par box. Alf AR U1 0 as
..
(A-2,0-9/,-) Omer or ,...9 ,°- 0.
asSample Ids must be unique Taste TS 5 0- i?-
E .
00 0 . z00 00 _ ,, l'j
DATE TIME DATE TIME 0 u = = c_- X z z 2 0 -,;
4—
III
,i,,,......,..,
'7
r--
i _ , .
-10'
11,
lAt _
1: ''',.t. '' '143..O.E0Pi.,,,,A1,-;CONthlE1470 I.. ', ' ':it `", , -1 'D0N,..,,',, ' 'DATE,'.-- ' TIME-- . , ".,,'AkocepTED!flt tAFEDIATON, , ,, ,, DATE - Time - SAMPLE DoNDITD:,LE
I i5 171,-.'
Orlifisi • ,
•
q SAMPLER NAME AND SIGNATUR.
PRINT Name of SAMPLER: / /..
43
- o — -
u SIG-4,.',..of SAMPLER: \-- r• -,, -,^,,,,d: - ...il.../z9ziPe i
-C) _ . ----•'\--S------
0)
ca
ct:
iv
o
iv

December 2021
Liberty .W.W.T. .
Freeboard Lagoon Inches
DATE
1 23 1/2
2 23 3/4
3 24
4 24 1/2
5 24 1/2
6 24
7 24 1/2
8 25 R TRACE
9 24 3/4
10 24 1/2
11 24 1/2 R 0.5
12 23 1/2
13 22 3/4
14 23 1/4
15 23 3/4
16 24
17 24 1/2
18 25 R 0.3
19 24 1/4 R 0.7
20 22 1/2
21 21 R 0.5
22 20 1/4
23 19 1/4
24 19 3/4
25 20
26 20 1/4
27 20 1/2
28 20 3/4
29 211/4 R 0.3
30 20 3/4
31 20 1/2
TOTAL 2.3

December 2021
Liberty .C.W.W.T. .
Freeboard Lagoon Inches
DATE
1 231/2
2 23 3/4
3 24
4 241/2
5 241/2
6 24
7 24 1/2
8 25 R TRACE
9 24 3/4
10 24 1/2
11 24 1/2 R 0.5
12 23 1/2
13 22 3/4
14 23 1/4
15 23 3/4
16 24
17 24 1/2
18 25 R 0.3
19 24 1/4 R 0.7
20 22 1/2
21 21 R 0.5
22 20 1/4
23 19 1/4
24 19 3/4
25 20
26 20 1/4
27 20 1/2
28 20 3/4
29 21 1/4 R 0.3
30 20 3/4
31 20 1/2
TOTAL 2.3

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page 1 of_2_
Permit No.: WQ0003090 I Facility Name: Town of Liberty-Wastewater l County: Randolph Month: December Year: 2021
Field Name: 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? Cover Crop: FESCUE Cover Crop: FESCUE Cover FESCUE Cover Crop: FESCUE
p=
CI 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? El YES ❑No Field Irrigated? CI YES ❑NO Field Irrigated? QYES CI No Field Irrigated? YES ❑NO
m ° m d °' e n 'cs o) E r31, m a) E a1 m'rs 'Q CA E "CD e T a a) E of
O p) a . m :m.ew "�� "� G." Em m .,+ �. C 7 L C m C3} .+. �.�
.. m o .2 � � E � '� c0 oo. Ea) Ro xoo a moo` SEC - 0 I0 E
't> >, O. q %3. "F^:"' p ns C o o. H •�, 0 p e = p .: O GL t-"'.:,. 1A p 'ny O.. o O. i= 'y O co = O
w E m N m o. >Q J a J.. > Q J 2 J > < J" J" > Q J J
a` o
°F in ft ft
gal '. :mitt in in gal min in in gal, min in In` gal min in in
1
2 PC 50 1.75 218,000 120 0.40 0.20 214,000 120 0.40 0.20
3 C 55 2 216,000' 120 0.40 0.20 188,000 120 0.41 0.20
4
5
6
7 C 48 2 218,000 120 0.40 0,20
8 R 0.1
9 CL 35 2 214,000 180 0.40 0.13 188,000 120 0.41 0.20
10
11 R 0.5
12
13
14 C 48 1.75 218,000 120 0,40 0.20
15 C 49 1.75 188,000 120 0.41 0.20
16 C 59 2 214,000 180 0.40 0.13 216,000 180 0,40 0.13
17
18 0.3
19 R 0.7
20
21 C 36 0/0.5 218,000 180 , 0.40 0.13
22
23 C 46 1.5 188,000 120 0.41 0.20
24
25 C 58 1
26 1.5 214,000 180 0.40 0.13
27
28 PC 62 1.75 218,000 180 0.40 0.13
29 C 72 0/0.3 1.75 281,000 180 0.61 0.20
30
31
Monthly Loading: 1,090,000 , 1.99 856,000 k F 1.60 -' 432,000 t 0.80 1,033,000 p; .„', 2-24
12 Month Floating Total(in): 30.62 31.36 �b i' 28.68 ..,7. ,.� J 36.83

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 0 Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 2 Compliant 0 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? El Compliant 2 Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? El Compliant 0 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.
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 El No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
//'Z/2 2_ _ 10112 2_
Signature Date Signature Date
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted.Based on my
inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the
information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I am aware that there are significant
penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh,North Carolina 27699-1617

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page_2 of_2_
Permit No.: WQ0003090 1 Facility Name: Town of Liberty-Wastewater 1 County: Randolph Month: December Year: 2021
Field Name: 5 Field Name: 6 Field 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 Crop: FESCUE Cover Crop: FESCUE Cover Crop: . FESCUE Cover Crop: FESCUE
0 YES El NO a 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? Q YES 0 No Field Irrigated? ❑YES 2 No I Field irrigated? ❑YES El No Field Irrigated? 0 YES Cl NO
a 2
E E L EFE m F. g E m E a Eg (13 E .5 R awl cf .F - ,c m >, E d m i a 13 c CO ad d >
0 t lr 25 co R C �'"Q F-", .. "g m.°°" > '<2. t- ' c' J 'a s ° ..q l-EGI m x" ° •J Q ~ E J ins J
°F in ft d,ft gal min In in gal min in in gal mIn In In gal min in in
1 C 40 1.75 168,000 120 0.41 0.20 - 234,000 120 0.40 0.20
2 .
-
3
4 C 68 2 200,000 120 0.40 0.20 -
5 '
6 C 54 2 168,000 120 0.41 0.20 -246,000 120 0.41. 0.20
7 PC 48 2 234,000 120 0.40 0.20
8 R 0.1
-
9
10 CL 41 2 200,000 120 0.40 0,20
11 R 0.5
_
12
13 C 47 1.75 168,000 120 0.41 0.20 246,000 120 0.41 020
14 C 62 1.75 234,000 120 0.40 0.20
15 C 54 1.75 200,000 120 0.40 0,20
16
17 C 63 2 168,000 120 0.41 0.20 246,000 120 0.41 0.20 -
18 0.3
19 R 0.7 -
20 _ _
-
21 R 0.5
22
23 CL 34 1.5 234,000 120 0.40 0.20
24 C 42 1.5 200,000 120 0.40 0,20` ,
_
25 - -
26 C 58 1.5 246,000 120 0.41 0.20
27 CL 62 1.5 168,000 120 0.41 0.20
28 C 72 1.5 , 234,000 120 0.40 0.20
29 R 0.3
30
31 C 65 1.5 200,000 120 0,40 0.20
Monthly Loading: 1,000,000 2.01 840,000 ,. :r 2.05 • 984.000 1,64 1,170 000 1: 1.99 p<
12 Month FloatingTotalfin): ' . i . , ` fin;
`36 72 `;�. `° � §`���x•�. 35.66 � � 83.88 '�`s �'2 ,� '`';^

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? E Compliant ❑Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑✓ 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? E Compliant ❑Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 Compliant E 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.
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? ❑Yes l No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
1/2V 2_
Signature Date Signature Date
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in accordance -
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted.Based on my
inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the
information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I am aware that there are significant
penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh,North Carolina 27699-1617