WQ0003090_Monitoring - 11-2021_20220527

ti
�� 4
DWR - NonDischarge Monitoring Report Submittal ti . . F
NORTH CAROLINA
ERYYranm@nlrtl Quafily
Monitoring Report Submittal
Permit Number#* WQ0003090
Name of Facility:* Town of Liberty WWTP
Month:* November Year:* 2021
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR new nov spray report 4.1MB
2021.pdf
PDF Only
GW-59 new nov gw 59 2021.pdf 3.3MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR,GW-59).
Confirmation Email Address:* tfike©townoflibertync.org
Name of Submitter:* Elix Fike
Signature:
Date of submittal: 5/27/2022
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: 6/20/2022

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: November Year: 2021
PPI: 002 Flow Measuring Point: Q Influent ❑Effluent ❑No flow generated Parameter Monitoring Point: ❑influent ❑✓ Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code -► 50050 00400 00310 00610 00530 31613 00620 00625 00665 50060 00600 70300 00940 00630 00010
c
= E so c ca � S ffk ac m` m E : G? g o mct 2-c l 3 6 2 � AR 3° a 0 t 0 - fl in o y _ _p U r- F-O co W E r- m o u- o - « F- 0I- ,0 t- t- Z
a z V cZ . cc U x OWt Z ®O
24-hr hrs GPD su mglt. mg/L mg/L #/100 mL mg/L mg/L mg/1.. mg/L mg/L mg/L mg/L' mg/L °G
1 7:00 8 202,000
2 7:00 8 208,000
3 7:00 8 209,000 _
4 7:00 8 205,000 7.03 ND 15.7 23,6 2420 ` ND 17.2 3.2 0.09 172 210 24.2 ND
5 7:00 8 254,000
6 10:00 2 204,000
7 10:00 2 242,000
8 7:00 8 174,000 ,
9 7:00 8 211,000
10 7:00 8 211,000 7.29 0.23
11 12:00 2 202,000
12 7:00 8 195,000
13 11:00 2 194,000
14 10:00 2 232,000
15 7:00 8 159,000 7.28 21,7 14.5 32.9 980 _ 0.044 17.7 2.9 _ 0.9 17.7 191 24,2 ND
16 7:00 8 238,000
17 7:00 8 156,000
18 7:00 8 199,000
19 207,000
20 271,000
21 212,000 _
22 7:00 8 183,000
23 7:00 8 279,000 7.37 0.07
24 7:00 8 207,000
25 235,000
26 180,000 ,
27 181,000 _
28 198,000
29 7:00 8 180,000
30 7:00 8 204,000 ,
31
Average: 207,733 1085 15.10 -' 28.25 1,540.00 0.02 ' #REF! 3,05 0.32 17.45 200.50 24.20 0.00
Daily Maximum: 279,000 7.37 21.70 15.70 32.90 2,420.00 0.04 #REF! 3.20 0.90 17,70 210.00 24.20 0.00
Daily Minimum: 156,000 7.03 21.70 14.50 23.60 980.00 0,04" #REF! 2,90 0.07 17.20 191.00 24.20;` 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: GARRE I I DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? E1 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? El Yes El No Phone Number. 336 622 4276 Permit Expiration: 8/31/2024
7‘-'///:"" /0/91 5/Z/
( 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.1
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
aceAnalytical 1377 South Park Drive
Kernersville,NC 27284
/ www.pacelabs.cam [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 11/19/2021
Town of Liberty Date Received: 11/04/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92570701
Sample: Effluent Lab ID: 92570701001 Collected: 11/04/21 12:35 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540C-2015 Total Dissolved Solids 210 mg/L 25.0 11/08/21 11:51
SM 2540D-2015 Total Suspended Solids 23.6 mg/L 10.0 11/09/21 12:08
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 15.7 mg/L 0,20 11/08/21 11:31
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 11/04/21 18:57
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrate ND mg/L 0.040 11/04/21 18:57
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrite ND mg/L 0.040 11/04/21 18:57
SM 5210B-2016 BOD,5 day ND mg/L 2.0 11/10/21 17:13 B2
Colilert-18 Fecal Coliforms 2420 MPN/100mL 1.0 11/05/21 13:12 El
Performed by PACE 11/04/21 12:35
Collected By Garrett 11/04/21 12:35
Dreyer
Collected Date 11/04/21 11/04/21 12:35
Collected Time 1235 11/04/21 12:35
pH 7.03 Std.Units 11/04/21 12:35
Chlorine,Total Residual 0.09 mg/L 11/04/21 12:35
TKN+NO3+NO2 Total Nitrogen 17.2 mg/L 0.52 11/19/21 15:45
Calculation
EPA 300.0 Rev 2.1 1993 Chloride 24.2 mg/L 1.0 11/09/21 21:41
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 17.2 mg/L 0.50 11/19/21 00:53 M1
EPA 365.1 Rev 2.0 1993 Phosphorus 3.2 mg/L 0.050 11/17/21 20:28
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.
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.
Cie(UC(X
Reviewed by: irin"e
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 it: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 Anaiytic Request LAB USE N1 -Affix wart'
E e I�cst Document
aceArialyiicai
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
Company: Town of Liberty
r Billing Information: _ - ALL SAE - 1 -I
Address: Container Preservative T, 2 ? ..
MA
u 2 ` 8
`Report To: €Email To: [ '•Preservative Types:(1(nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,
I (6)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulface,
Copy To: i Site Collection Info/Address: [ (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
Analyses iLab Profile/Line:
Customer Project Name/Number: 'State: County/City: Time Zone Collected:
I / [ ]PT[ )MT[ ]CT I (ET
Phone: €Site/Facility ID#: 0 Compliance Monitoring? "_-
'Email: ]["Yes [ ]No _� r _.",r_ _ _ . -..
Collected By rint): Purchase Order#: DW PWS ID#: , s . , , , , , torrect Bebenles tbb, N t A
i Quote#: I DW Location Code:
i li a`IP Received L ,„
ollected By I: rnaround Date Required: Immediately Packed on Ice: D a 1t.
P p �' [ (Yes [ ]Na a� us s t
�' y '- :f� Samples a ._
sample Disposal: f Rush: (Field Filtered(if applicable): 12, --- ' i i , i I ,,, is-di,i 1
[ ]Dispose as appropriate I ]Return] [ ]Same Day [ )Next Day ][ (Yes [ ]No t iZ I i =1 s
[ ]Archive: i I )2 Day [ ]3 Day [ ]4 Day [ ]5 Day i 1Z to i fl y - -Acceptable 3 i "'
f Hold: Analysis: ,,�
] (Expedite Charges Apply} f ,0 _ - _ 1 ,, _
Matrix Codes(Insert in Matrix box below):Drinking Water(OW),Ground Water(OW),Wastewater(WW), lz .2 1 -_a s Acetate Sa-=co. Ielb
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) i 2
ON
Comp/ ` Collected(or j { Res #of I— C.) , a . , Mpi �-o_... .l. .
' Composite End i - = :]i
Customer Sample ID Matrix , Grab ; Composite Start) (
ClCI Ctns p ni) Q
Date [ Time ( Date Time -S
CO Z�Tz �Q
Q J S-
i
i
Customer Remarks/Special Conditions/Possible Hazards: i Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT(<72 hours): Y N N/A Lab Sample Temperature into.
Packing Material Used: ,Lab Tracking#: -
T-mp Blank R coie : Y ',_tJ. NA
Therm ID .
"Effluent Monitoring comer 1 Ter Upon e '
—� Samples received via: Cooler 1 Therm Corr,Factor: oC
Radehem sample(s)screened{sSGD rpm): Y N NA FEDEX UPS Client Courier Pace Courier Cooler 1 Corrected Te-in. siC
Relinquished Date
MTJL LAB USE ONLY Comments:
q !Date/Time: Received by/Company:(Signature) DateJTime:
/ // %'
I s Table::
7 § Acctnum.
Rehr uished bvr 5mpany:(Signature) .Date/Time: Received by/Company:(Signature) Date/Time: Template: to Blank Received: Y A NA
m HCL McOH TSP Other
N 'relog_in:
Relirauished by/Company:(Signature) Date/Time: i Received by/Company:(Signature) Date/Time: PM: Non„on..,mance(s): Page:
w
P:a: ""ES I NI co of:

E Jo E abed . .. _ . ..
•sinueluo 1suJou1'dual Jo)no'enpeas ososd lniuooul'P104 Jo ln0
e•11 a71J10 UDAv!J11,e)dNN30 eupose)LIMN n41 0]luac?q IBM WMMJ sly)Jo Ado a's'Owe s ewelldwo eupo)e)yorm puao?ye/ouedanzlp a sl amyl)an®ue4M;11oN
•
PPP, Palen)pr
e s01 s+AllesJaseid)e lunowy uopweeotd®wa paten(ps uoileniosojd slap 1die,ej uodr,}Id 6Alle/Jervie Jc Eglisl al imams
' 63jdwUPS pti JPSaJd Jo;Sol luawlsn(pv Hd
•
ii .
ET
•
I 1S
\ OT
\ 6
i 111111011k. ' Ilik. \
\ B
iilllllullr!I!
, II
, )
Y
y N N n+ y Ip , P, tk, 11 V ,'pD 'U 'D T w 6'
A, N� R 3! S Vt y, p' n N z h+ 7
O U i T g _ N N j 4+ w N . G
b; UNi N N
n
I
r rA LA
9
N d. 2 = n '� N O� 7 ,i v z 2 vNi C
N n n H X n Q a v ,.r 2 �° O p �'
N vfr n z a Ss v b 3
Q > D g N N fr v n 2
1D C.
p I E \ D Z N N
vI
a(eloq„to Japwnu ls((of 51 xoq Jo j1Qq tuo;loe
BH11'300(Damn)) E0B/OB0'ase®)9 pia 110']ol'suanl(1er)'VOA:suo;ldt)xil
'se(dUJES
U0p.EtN058Jd Jo)OPUS) 891,JE2dao.;e DLO U(t(l1M put pRIJIJBA
K 39ojoJd s(uo(leu(Joitpap Jo/pue Hd;(Moq,to pet!del JfJeuJ)pPIO0
e?tNp>1IIen J sevJ CJra O I gp•Awli-EEU37-NY9•11
:/..wetnny SulnssJ rON 3vawsno0
tJo eked 1)inos)1dle)ea coon uoJ1IPUe nJdwrS ./°?�/rPl�'d7"
I.Etat'L/Jer.ige3;pnsvP!'luewnoo3 1 :awn g luawn>00

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: 11/10/2021
Town of Liberty Date Received: 11/10/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92571735
Sample: Effluent Lab ID: 92571735001 Collected: 11/10/21 13:35 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 11/10/21 13:35
Collected By Garrett 11/10/21 13:35
Dreyer
Collected Date 11/10/21 11/10/21 13:35
Collected lime 1335 11/10/21 13:35
pH 7.29 Std.Units 11/10/21 13:35
Chlorine,Total Residual 0.23 mg/L 11/10/21 13:35
Reviewed by: tenure. <ltxk�e
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

LAB USE ONLY-Affix Workorder/Login orderf Login Label Here or List Pace Workorder Number or
;� CHAIN-OF-CUSTODY Analytical Request Document Iry
,� , ce Analytical ...
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields 'rt. ` .
Company: Town of Liberty Billing Information:
ALL SHADED 1 , l
Address: Container Preservative Type
i
_ L__ 92571735
E Report To: l Email To: I "Preservative Types:(1)nitric acid,(2)sulfuric a,
(6)methanol,(7)sodium bisulfate,(8)sodium thiosuifate,(9j hexane,(A)ascorbic aad;{ui ammemvmsmtetc,
Copy To: Site Collection Info/Address: i (Cl ammonium hydroxide,(Q)TSP,(U)Unpreserved,(0)Other
Analyses !Lab Profile/Line:
Customer Project Name/Number: I State: County/City: Time Zone Collected:
/ [ ]PT[ ]MT[ ]CT [ ]ET
`Phone: Ste/Facility ID#: Compliance Monitorj`Js =
t:Email: _ ,[ Yes [ ]No L" CN EA
.e lector lz_ �:�t,_ �St __ _,e; ,; FA
Cal ected By(.rint): Purchase Order#: DW PWS ID#: a
Quote#: DW Location Code:
'i Collected e' : ): iTurnaround Date Required: ;Immediately Packed on
[[ [Yes [ ]No a}
.Rush: Field Filtereda applicable): �' p- Holding t A
Sample+isposal: (ifPp l- _ a
[ i Dispose as appropriate [ ]Return i [ I Same Day [ ]Next Day [[ ]Yes [ ]No ;
[ ]Archive; [ ]2 Day [ ]3 Day [ ] Day [ ]s Day o s:r s
Analysis: s '
[ J Hold: [. {Expedite Charges Apply) 1" Lead
0 ., a -p N NA
*Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(OW),Wastewater(WW), _ ! Acetate _ __a
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(8),Vapor(V),Other(OT) m
Comp J Collected(or j Res #of 'o -3 -u:r..-� i r cv _ -
Customer Sample ID t Matrix* i Grab Composite Start) Composite End Cl Ctns b :is
Date Time Date Time 2
,[Effluent RIMo
i—
I t
,
I j
i 1
,
i
(Customer Remarks/Special Conditions J Possible Hazards: i Type of ice Used: Wet Blue Dry None SHORT HOLDS PRESENT(<77 hours): Y N N/A l Lab Sample Temperature .to:
Packing Material Used: LabTracking it: Te-rip Blank Received Y N NA
Therm IDA:
`Effluent Monitoring - Cooler 1 Temp Upon ed ipt:
Samples received via: Cooler 1 Therm Corr.Factor: ,-
Radchem sample(s)screened(<500 cpm): Y N NA FEDEX UPS Client Courser Pace Courier i Cooler 1 CorrectedTemp:
-Reiinquin ' rr t.a ny:(Signatu ;Date me: Received by/Company:(Signature) [Date/Tiime: M T7 LAB USE ONLY Comments:
f 3� t ' i- i - }} Table k
[ fO t 5 1D '�'_-: tO Acctnum:
Rel��yuished by/Company:(Signature) Date lime: I Received by/Company:(Signature) Date/Time:
Template: i Trip 8lare,Received: .s NA
m HCL rileOF' TSP Other
N Prelogin:
ReliQquished by/Company:(Signature) 'Date/Time: I Received by/Company:(Signature) Date/Time: ,PM: ti
Io,Ccnforrr a eisi: Page:
N Pa: YES 1 NO of:

Pace Analytical Services,LLC
aceAnalytical 1377 South Park Drive
Kernersville,NC 27284
www.pacolabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 12/02/2021
Town of Liberty Date Received: 11/15/2021
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92572428
Sample: EFFLUENT Lab ID: 92572428001 Collected: 11/15/21 10:28 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540C-2015 Total Dissolved Solids 191 mg/L 25.0 11/16/21 12:04
SM 2540D-2015 Total Suspended Solids 32.9 mg/L 14.7 11/15/21 17:32
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 14.5 mg/L 0.20 11/18/21 15:32
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrite 0.044 mg/L 0.040 11/16/21 09:26
SM 5210B-2016 BOD,5 day 21.7 mg/L 2.0 11/21/21 16:09
Colilert-18 Fecal Coliforms 980 MPN/100mL 1.0 11/16/21 10:37
Performed by PACE 11/15/21 10:28
Collected By Glenn Price 11/15/21 10:28
Collected Date 11/15/21 11/15/21 10:28
Collected Time 1028 11/15/21 10:28
pH 7.28 Std.Units 11/15/21 10:28
Chlorine,Total Residual 0.90 mg/L 11/15/21 10:28
TKN+NO3+NO2 Total Nitrogen 17.7 mg/L 0.52 11/29/21 17:23
Calculation
EPA 300.0 Rev 2.1 1993 Chloride 24.2 mg/L 1.0 11/18/21 04:17
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 17.7 mg/L 0.50 11/24/21 06:51
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 11/29/21 15:35
EPA 365.1 Rev 2.0 1993 Phosphorus 2.9 mg/L 0.050 12/01/21 18:45
C
Reviewed by: 4t t ' 4°-
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-AffixM Workorder/Login Label Here or List Pace Workorder Number or
/dceA/)c 1,1t/ c?l T1L Log-in Number Here
/ Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fieldsott, • • �'
'Company: Town of Liberty [Billing Information: ALL SHADED Al
_ tit\ 1 111 1
1Address: t Container Preservative Type*u 2 .._$ '
_
Report To: � 1 Email To: .Preservative Types:(1)nitric acid,(2)sulfuric acid,(3 92572428 ,
(6)methanol,(7)sodium bisulfate,(8)sodium thiosulfat ._,,.,,ammonium sulfate,
Copy To: 1I Site Collection Info/Address: (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(D)�.,..,
Analyses 'Lab Profile/Line:
Customer Project Name/Number: i State: County/City: Time Zone Collected: Lab Sample Receipt Check i
( __ Custody Sea l �z-L itt Int �r:t N NA
;Phone: Site/Facility ID#: ,Compliance Monitoring? Custody Signatures Present 40 N NA
ii Email: I[ Yes [ ]No O - Collette.: Signature Present ,N NA
II _ ' I �., Bottles Intact N NA
Collected y print): Purchase Order#: DW PWS ID H: Correct Bottles ON NA
{Quote#: DWLocationCode: CO Nutftcv-nr fume pji'ta NA
44 d`I'L . I }).-• II i Samples Received Oil Ice eii IS NA
Colle ed By(signature Turnaround Date Required: Immediately Packed on Ice: d o VOA uaa l p,cz Acceptable 6N N
- - [ ]Yes [ ]NO .� 0 ` N USDA Regulated Soil[ N
` Samples in lit.ding Time
�N
Sample Disposal: Rush: Field Filtered(if applicable): I s Residual Chlorine Present Y N ar
I[ I Dispose as appropriate [ ]Return ' [ I Same Day [ ]Next Day [ ]Yes [ ]No 1 0 i z ; Cl Strips:
[ ]Archive: ' I— i ` Sample pit Acceptable Y N �1
[ ]2 Day [ ]3 Day [ )4 Day [ ]S Day Z Analysis: m o
[ ]Hold: i (Expedite Charges Apply) Ith 'p s I ' pH strxpr.
I 40 (I..- t h"(.) % j Sulfide Present '.i N
*Matrix Codes(Insert in Matrix box below):Drinking Water(OW),Ground Water(GW),Wastewater(WW), Z 'Z II"I r Lead d Acetate Strips
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) c .,- i o A USE ONLY:
f- r
' Comp/ Collected(or Res l 4 of II— m m Lab sample :I / Comments:
a Composite End I Z 1— '
Customer Sample ID MatrixGrab Composite Start) ( CI iCtns O Ici) IU ' cv
IZ i o
g S Z Time Date Time , �� m Z tL {Q H
In , `1 X _X_X_ X'
Effluent !ww 2'� ,� _
) i
i
`
pp
] I
IV i
I
k
r1
I I
u
Customer Remarks/Special Conditions/Possible Hazards: Type of Ice Used: BI e Dry None SHORT HOLDS PRESENT(<72 hours):-. N N/A Lab Sample Temperature Info:
Packing Material Used: i Lab Tracking It: Temp Blank Ray: Y Z NA
' Therm
D Cooler 1DTernp Upon Rece pt: aboC
Effluent Monitoring --. .
Samples received via: Cooler 1 Therm Corr.rack : ioC
Radchem sample(s)screened(<500 pm): Y N NA FEDEX UPS Client Cou r Pace Cour'- r Cooler 1 Corrected Temp: oC
(Relinquished by/Company: Signature} Dat /Tii : f t 1 Receiv y/Company:(Signature) Date/Time: )p MTKL LAB USE ONLY Comments:
1. I/ f� s [ 98•Lit5 Table It: r-
/g� 6 I
Rel' quished by/Company:(Signature Date/ ime: I Received by/Company:(Signature) i Date/Time: TripBlank Received: Y N NA
Template:
i. m i HCL McOH TSP Other
Rellquished by/Company:(Signature) Date/Time: (Received by/Company:(Signature) Date/Time: PM: Non Confonnance(s): Page:
G' PB: YES / NO of:

H r" l+ K? ra -.. II. In w N Y _
Itnr.tffi - a. w < o
. ^ Q a /// _._..___ _ . / 6P4U-125 mLPlasllc Unprescrved(NJh)(Q-) v
o r Z'
- U 51' w 41 a
= O nrnu-25a nu Plastic Vnpreiurved(N/A)
� < 3 J v
s � w n 0 K
S .4., HP2U.SbO mt.Piratic UnprcSeNcil(t4/A) 3" _
Q. fica
r? y u
c bY1U-1 liter Mastic linpte3e Nevi(NIA) 's 'n r
_ r7- j � ?
a. Q / / / / br4S 125 mL Ptusiit H2;Q4(pli<21(CO X ` L,
mr BP3t1-2:O mt ptustic lHO pll<2} (j rP-, ; cr
` �� CP4Z-]25 nil Pln tk 21J Atciat: &41a01i{y9} * .. 1^ 74;
jw -/// tlP iG125 mi.Plbsttt t3aDVi tpN i 12}(G-) 2 ��',
La
Ll
0 7 YJL9Fi}-LVlde-srtntrttindGlams)u llnprcanrvcd rp =a �.
�� v �, Ati2tS-1 t+cor,Lt+Gcr UnprexNeri(N/A)(fl-) a c_ d C.
- a ry v
�� p N Pilo,
—^ / / -- A.GIIi-1 lttcr ArnGar li Cl(pH<2} ru -9, '3' 9
tD A(-3t1-25D rnL Arrrtur UnprrseNed(r/A)iCJ-) t i ` w Y fi. r]
Ar315-1i)[.er Amber ti.SO4(pit c2
.. a V /, / 77 ` AG3S-251 mL fvnbcr ti25i1a(pit<2) wL `-' S
4 m < 1
n - ^la /" �`7/ Ar c>r;3A)-25O mLAmn�r r�esan tN/A)tO-) ,. o U R
ru Dasiq-NJ ml-Vt7A Hcl (t4/A) v -_,
5 3 ID VG9T-40 mL VOA s4a25201(N/A) r.
A
0
6^ii A if' vG9t,-r-o at_v0/.W ry',tNf/�l i
VOArt(6 vlela per Olt)-5035 kit(t3JA) _
o G.. K
.. ..
c J r9Y L-40 rn VOA ri3YOa(idfA)
L
..
fY a.'- - V/GK 13 vial:per hit)-VPH/Gas kit{nt/A) -
< ' .,, a
r-t �� SP5T-125 mLStertto Plasmic{4JA-6d$ /'-+� li y W Z:
n .+ ^^` Sr2T-2S0 mL SLerila Plastic{P1JA-tabs 9 =T ::
u •
Ss y / // ` / -I y
n < / //1 7 / / bF3A-250 mLPlastic(NI t2)2504(9.3-9.7) •
:, AG01.1-100 nil nor n preaar d ve ut.b,iti/A)
....
fvL tin_
Cl ly
Or VSGl3-2D mL5oncttlstton vials (NJA}
•
a az
13690-40 ml Amber Unprmervu.d vials(N/A) '
4l
to
(D
W
0
W

Pace Analytical Services,LLC
aceAnalytical 1377 South Park Drive
Kemersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Pike Report Date: 11/24/2021
Town of Liberty Date Received: 11/24/2021
PO Box 1006
Liberty, NC 27298
Project: TOWN OF LIBERTY
Pace Project No.:92574266
Sample: EFFLUENT Lab ID: 92574266001 Collected: 11/23/21 11:20 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by Pace 11/23/21 11:20
Collected By Garrett 11/23/21 11;20
Dryer
Collected Date 11/23/2021 11/23/21 11:20
Collected Time 1120 11/23/21 11:20
pH 7.37 Std.Units 11/23/21 11:20
Chlorine,Total Residual 0.07 mg/L 11/23/21 11:20
—eb
Reviewed by: 6 } '"
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN-OF-CUSTODY Analytical eq est D cent
LAB USE ONLY-Affix Workorder/Login Label Here or List Pare va,sa.R_
ocu
WA LoK
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields °
'Company: Town of Liberty `Billinglnformation:
ALL SHADED AREA 1 11 i. 1_ i
`
,
Address:
Container Preservative Type" I 11 1 1
92574266
-~report To: ?Email To: �. `°Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)spa. - ._..:.;,,.,6,i-e sodium hydroxide,{5}zinc acetate,
It)methanol,(7)sodium bisulfate,(S)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
i Copy TO: i Site Collection Info/Address: i (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
I Analyses ;Lab Profile/Line:
li Customer Project Name/Number: State: County/City: Time Zone Collected: Sample
Reserpr Cherklinr:
/ ( (PT) ]MT) ]CT [ ]ET "
e Phone: ,Site/Facility ID#: )Compliance Monitoring? i i N. Stqlbatures Preset:LYN t
Email: i("Yes [ ]No Signature -_ _t N .
Collected By(. ' t): t Purchase Order#: )DW PWS ID#: I.:RattlesE.
/ .Quote#: )DW Location Code: of NR
'Collected By s e: )Turnaround Date Required: lImmediately Packe on Ice: Meadspace AcceptableYS
USDA Regulated Soils Lail NA
; II[ ]Yes [ ]No Samples s. Y; NA
Rush: Field Filtered(if applicable): 4 nc
a ample Disposal: pp }:
[ ]Dispose as appropriate [ 1 Return; [ ]Same Day [ ]Next Day [ ]Yes [ ]No nl i
[ (Archive: i [ ]2 Day [ ]3 Day [ ]4 Day [ ]S Day I . '`o Sim p at_-
Atie yea. ,_ ^i t i r
( ]Hold: (Expedite Charges Apply) } ;C) s' l f iAta Present
*Matrix Codes{Insert in Matrix box below):Drinking Water(OW),Ground Water(GW),Wastewater(WW), l Il lead Acetate Strips:
} Product(P),Soil/Solid(SL),Oil{OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor{V),Other(OT) :a i i i i i i i i i t, u,- catfy
1 Comp/ Collected{or ' Res #of j Lab Sample 4 Comments:
Composite End
Customer Sample ID l Matrix' Grab I Composite Start) i Cl ,Ctns is
1 ,o
i 4 Date : Time i Date Time (o
Effluent Ww igt ( 0 ;
i
Customer Remarks/Special Conditions;Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT(<72 hours) V N N/A VLab Sample Temperature l�M
PackingMaterial Used: Lab Tracking 1: Temp Blank Received: Y N NA
Therm(DP:
Effluent Monitoring Cooler 1 Temp Lhoon Receipt: oC
Samples received via: I Cooler.Therm CornFactor: _ of
Radchem sample(s)screened(<KQQ rpm): Y N NA FEDEX UPS Client Courier Pace Courier Cooler 1 Corrected Temp: et
e r. MTJLLABUSECNLY Comments:
Relinquished by! moan:.,-' ature) )Date/Time: Receiyellby/Company {Signatue) `Date/Time1
r
3 - i - r ill,. _.. _-� r= `: s. -- ' -v Acctnurn_
)R nqu d by/Company:(Signature) D e ime: (Received by/Company:(Signature} l DeteCTirie: in Blank Received: NA
am Template:
orV HCL McDH TSP Other
!Pre-login:
R ry N.,,C .. rra
quished by/Company:(Signature) Date/Time: Received by/Company:(Signature) i Date/Time: ,,PM , et,;: Page:
Pg YES NC of:

November 2021
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
DATE
1 19 1/2
2 20
3 20
4 201/2 R 0.5
5 201/2
6 21
7 21 1/4
8 21
9 211/4
10 22
11 22 1/4
12 22 1/2
13 22 1/4
14 22 1/2
15 22 1/4
16 22 1/2
17 22 1/2
18 23 1/4
19 23
20 23 1/2
21 23 1/2
22 23 1/2 R 0.3
23 22 1/4
24 21 3/4
25 22
26 22
27 22
28 22
29 22
30 22 1/2
TOTAL 0.8

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 1 County: Randolph Month: November 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 Crop: FESCUE Cover Crop: FESCUE
EYES ElNO Hourly Rate(in):' 0.21 Hourly Rate(in): 0.21 --Hourly,Rate(in): 021 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?' DYES []NO Field Irrigated? ❑YES El No Field irrigated? ❑Yas C3 No Field Irrigated? 2 YES El NO
a
° .. _ ea E m m ° ea 13 'a at E cs m . a co > aa) a Z7 te a a a -a a coa E a a,
t i o p aR E-2 ®"a ?,c Eic E 9 D m aE s E m m 'c E c.a EE m a :a°c a 8E
❑ 0 E. ❑ v a-2. E t « '4 x � ss a Q. EaE 'a E = 13 .= F, Ea in ¢ i an. 1 Ea . iiiE a a
a) aiw >.C. � � �' C C O C2 �' ' ❑ O xZ43. f= t: Go yp oC. = � p XZ C
w Em e ut ❑ o > a - a ..a > a ` _. g � > a . a a .4 > a
m F- 0.
e"
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 C 56 1.5 281,000 180 0.61 0.20
2
3 C 55 1.5 325,000 180 0.60 ; 0.20
4 C 0/0.5 _
5 C 45 1.5 281,000 180 0.61 0.20
6 C 49 1.75 325,000 180 0.60 0,20
7 _
8 _
9 C 56 1.75 281,000 180 0.61 0.20
10 C 50 1.75 325,000 180 0.60 0.20
11
12
13
14 _
15 C 46 1.75 _ 281,000 180 0.61 0.20
16
17 C 48 1.75 325,000 180 - 0.60 0.20,
18 , _. -
_
19
20
21 PC 52 1.75 325,000 180 ...
j 0.60 ` 0.20
22 R 0.3
23
24 C 55 1.75 281,000 _ 180 0.61 0.20
-
25
26
27
28
29 C 39 1.75 162,500` 90 0.30 0;20 140,500 90 0.30 0.20
30
31
Monthly Loading: 0 0.00 0 0.00 1,787,500 3,30 1,545,500 ;:, ; 3.34 g,
12 Month Floating Total(in): 31.09 'q a ^' ' ' 32.18 , ' _ 31.03 „r + , 37.06 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? 2 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? i 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? ❑✓ 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 NDAR-1? ❑Yes 2 No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
/7/7/2/
12/x7z,
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 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 f Facility Name: Town of Liberty-Wastewater ' County: Randolph I Month: November 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
YES ❑NO Hourly:Rate(In): 0.21 Hourly Rate(in): 0.21 F 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? 0 1ES, ❑NO Field Irrigated? ❑YES 0 NO Field Irrigated? ❑YES 0 N0 Field Irrigated? 0 YES 0 NO
m °.' c al CA m a a CD E' ' 9m S >:cn s +c m 0 mn0 aa Ez. = E m . > c , },E E .
dw ac =• acU ° m cco a m ° 'a e :z z E E ° • E3i7 TiE e6 i _ E E i = a E a E. Fs E E a
G mQ. o r © L1, Ca T * ,f o 0 a F i003 K 0 c0 15 0. F7 G s x0 8. o a � •� p co x 0 2d a O >. a g . 13 , 0 ` 0 ,51 ° °X-1
I.- a J J
°F in ft ft gal min in in gal min in in gal- min .In in gal min in in
1 C 62 1.5 299,000 180 0.60 0.20
2 C 59 1.5 350,000 180 0.59 0.20
3 C 60 1.5 84,000 60 020 0.20
4 C 50 0/0.5 1.5 123,500 60 0,21 021
5 C 52 1.5 350,000 180 0.59 0.20
6
7
8 C 43 1.75 299,000 180 0.60 0.20
9 C 65 1.75 84,000 60 0.20 0.20 r 123,500 60 0,21 ; 0.21
10
11 C 57 1.75 350,000 180 0.59 0.20
12
13 C 45 1.75 299,000 180 0.60 0.20
14
15
16 C 70 1.75 84,000 60 0.20 0.20 123,500 l 60 0.21 0.21
17 C 53 1.75 299,000 180 0,60 0.20
18
19 C 45 1.75 168,000 120 0.41 0.20 247,000 120 0.41 0.21
20 C 40 1.75 350,000 180 0.59 0.20
21
22 R 0.3
23
24
,25 C 50 1.75 150,000 90 0.30 0.20
26 C 52 _ 1.75 185,000 90 0,31 021
27 C 42 1.75 126,000 90 0.31 0.20
28 C 55 1.75 350,000 180 0.59 0.20
29
30 C 40 1.75 150,000 90 . 0.30 0.20 247,000 90 0.41 0,27
131
Monthly Loading: 1,496,000 3.01 546,000 fi 1 049,500 1,750 000 ;=" ,; 2.97 ,.
38.18 ' 36.71 35.90' ',: ,x " .x 30.65 '.
12 Month Floating Total(in): .... �k � � � * ,., _.. � , , � �� ���9.,d r �' �

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? ❑✓ Compliant ❑Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 2 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? (]Compliant ❑Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑✓ Compliant ❑Non-Compliant
If the facility is non-compliant,please explain in the space below the reason(s)the facility was not in compliance. Provide in your explanation the date(s)of the non-compliance and describe the corrective
action(s)taken.Attach additional sheets if necessary.
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 2 No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
Signature Date Signature Date
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of law,that this document and 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