WQ0003090_Monitoring - 05-2022_20220628

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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:* May Year:* 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR TF monitoring.pdf 3.75MB
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 Fike
Signature:
Date of submittal: 6/28/2022
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
Reviewer: _anonymous
Review Date: 7/19/2022

FORM:NDMR 10-13 NON-DISCHARGE MONITORING REPORT(NDMR) Page_1_of_1_
a Permit No.: WQ0003090 Facility Name: Town Of Liberty-Wastewater County: Randolph Month: May Year: 2022
PPI: 002 Flow Measuring Point: Influent Effluent ❑No flow generated Parameter Monitoring Point: ❑influent C✓ Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code --it- 50050 ' 00400 00 .10 'm 00610 '; 00530 31613 00620 00625 ^ 00665 50060 06600; 70300 00940 00630 00010
To 0
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24-ter hrs GPD su mglL mglL , 010/L #/100 mL mglL mglL tingiL . mglL mg/L. mg/L malt. mg/L °C
1 1 265,000
2 7:00 8 239,000
3 7:00 8 260,000
4 7:00 8 251,000.„
5 7:00 8 258,000 7.27 13 13.5 30 2420 0.07 16.6 2,7" 0.09 18.7 0.07
6 7:00 8 265,000
7 11:00 2 359,000 -
8 11:30 2 415,000
9 7:00 8 ' 206,000
10 7:00 8 258,000
11 7:00 8 247,000 7.46 0.02
12 7:00 8 265,000
13 7:00 8 286,000
14 289,000 •
15 318,000 ,
16 7:00 8 231,000
17 7:00 8 326,000
18 7:00 8 248,000
19 7:00 8 247,000 7.52 31.3` 9.9 64,8 2420 <0,04 13.6 2.8'" 0.08 13.7 0.1
20 7:00 8 496,000
21 388,000
22 237,000
23 266,000
24 7:00 8 466,000
25 7:00 8 409,000
26 7:00 8 294,000 7.25 _ 0.03
27 7:00 8 281,000
28 10:00 2 .912,000
29 10:00 2 400,000
30 209,000
31 242,000
Average: 318,226 2215 11.70 47,40 2,420.00 0.04. ` #REF! _ 2,75 0.06 15.20 0.09
Daily Maximum:: 912,000 7.52 31.30 13.50 64.80 2,420.00 0:07 - #REF! 2,80 0.09 16.70 0.10
Daily Minimum: -206,000 7.25 13.00'> 9.90 30.00 , 2,420.00 0 04" #REF! 2.70, 0.02 13.70' 0.07
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? ❑Compliant Q Non-Compllant
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.
/1G 1 Ccr--\ ciA:Ir on fN-A At Z+S, 20 2 cc- c c>; 2-c3.;
Operator in Responsible Charge(ORC)Certification Permittee Certification
CRC: Elix Tremaine Fike Permittee: Scott Kidd
Certification No.: 989290 Signing Official:
Grade: SI Phone Number: 336 622 2990 Signing Official's Title: Interm Town Manager
Has the ORC changed since the previous NDMR? ❑yes 2 No Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
_6/ 2s'//a
&/i ?(ZZ
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

Pace Analytical Services,LLC
Analytical®
1377 South Park Drive
ace Analytical Kernersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 05/19/2022
Town of Liberty Date Received: 05/05/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92603039
Sample: Effluent Lab ID: 92603039001 Collected: 05/05/22 13:10 Matrix: Water
i Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 30.0 mg/L 7.6 05/09/22 11:15
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 0.070 mg/L 0.040 05/06/22 08:35
EPA 353.2 Rev 2,0 1993 Nitrogen,Nitrate 0.070 mg/L 0.040 05/06/22 08:35
SM 5210B-2016 BOD,5 day 13.0 mg/L 2.0 05/11/22 15:17
Colilert-18 Fecal Coliforms 2420 MPN/100mL 1.0 05/06/22 12:29 El
Performed by PACE 05/05/22 13:10
Collected By Garrett 05/05/22 13:10
Dreyer
Collected Date 05/05/22 05/05/22 13:10
Collected Time 1316 05/05/22 13:10
pH 7.27 Std.Units 05/05/22 13:10
Chlorine,Total Residual 0.09 mg/L 05/05/22 13:10
TKN+NO3+NO2 Total Nitrogen 16.7 mg/L 0.040 05/18/22 14:57
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 13.5 mg/L 0.20 05/12/22 14:27
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 16.6 mg/L 0.50 05/18/22 04:48
EPA 365.1 Rev 2.0 1993 Phosphorus 2.7 mg/L 0.050 05/11/22 18:03
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.
Reviewed by: (255e an us
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

CHAIN-OF-CUSTODY Analytical Request Document ( LAB USE ONLY-Affix Workorder/Login Label Here or List Pace Workorder Number or (
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Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
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d By p' Purchase Order#: DW PWS ID#: Correct Bottles -N NA
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( I 1 !! tf ) i Samples Received on Ice LY)N NA 1
1: T around Date Required: Immediately Packed on Ice: D ( C j I VOA - Headspace Acceptable Y N j
[ ]Yes [ ]No 1 10 ( !!! USDA Regulated soilsz� �T1
} Samples in Holding Time Y NA 1
Disposal: I Rush: Field Filtered(if applicable): '1_
(� Residual Chlorine Present Y NC',..:)
se as appropriate [ ]Return ( ]Same Day [ ]Next Day [ ]Yes [ ]No Z Cl,` 3 Scrips:
re: ' I ]2 Day [ ]3 Day [ ]4 Day [ 15 Day Z 1-1°
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Analysis: 4 ) pH Stripe: i
(Expedite Charges Apply) O 1— I Sulfide Present Y N ipl
Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), Z Z II Lead Acetate Strips:
t(P),Soil/Solid(Si),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other COT) o H I O 1 LAB USE ONLY:
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Pace Analytical services,LLI,
J y a f l/'tic+ I 1377 South Park Drive
CdceAna
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www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date; 05/11/2022
Town of Liberty Date Received: 05/11/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92603977
Sample: Effluent Lab ID: 92603977001 Collected: 05/11/22 11:35 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by Pace 05/11/22 11:35
Collected By Garrett 05/11/22 11:35
Dreyer
Collected Date 05/11/2022 05/11/22 11:35
Collected lime 1135 05/11/22 11:35
pH 7.46 Std.Units 05/11/22 11:35
Chlorine,Total Residual 0.02 mg/L 05/11/22 11:35
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]

CHAIN-OF-CUSTODY Analytical Request Document t LAB USE ONLY-Affix orkorderj - --
•
2eAnaIticaI'
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
ty: Town of Liberty IBilling Information: ALL SHADED.
o I H I Container Preservative Type** 92603977 ll111II11IIl1
ro: Email To: "Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,
(6)methanol,(7)sodium bisulfate,(S)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
•
I Site Collection Info/Address: ( (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
Analyses 'Lab Profile/Line:
er Project Name/Number: State: County/City: Time Zone Collected: I l i Lab Sample Receipt Checklist:
i / [ ]PT[ ]MT[ ]CT [ ]ET ( [
6 i Custody Seals Present/Intact Y N NA
Site/Facility ID#: Compliance Monitoring? N l % custody Signatures Present Y N N.
[/Yes [ ]No I d 1 I ) Collector Signature Present Y N NA
}� [ P ; I Bottles Intact Y N NA
d By(print: ,Purchase Order#: 1 DW PWS ID#: 4 ) s Correct Bottles Y N NA
t : Quote#: DW Location Code: 0 i Sufficient Volume Y N NA
�� `i H Samples Received on Ice Y N NA
• C�•.c % (Turnaround Date Required: ;Immediately Pac e•on Ice: " ! I i VOA - Headspace Acceptable Y N NA
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"r 0 USDA Regulated Soils Y N NA
[ ]Yes [ ]NO „ L I I Samples in Holding Time Y N NA
Disposal: ' Rush: Field Filtered(if applicable): m Residual Chlorine Present Y N NA
:se as appropriate [ ]Return [ ]Same Day [ ]Next Day [ I Yes [ ]No C Cl Strips:
ve: [ ]2 Day [ ]3 Day [ ]4 Day [ ]S Day Analysis: `�v, o Sample pH..Acceptable Y N NA
,_ pH Strips:
(Expedite Charges Apply) t< V Sulfide Present Y N NA
c Codes(Insert in Matrix box below):Drinking Water(OW),Ground Water(GW),Wastewater(WW), II M Lead Acetate Strips:
ct(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) — a Fr, I LAB USE ONLY:
Comp/ Collected(or Res #of 9 t 2 ' Lab Sample P / Comments:
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I i. -I Temp Blank Received: Y N NA
I Packing Material Used: 1 Lab Tracking#:
Therm ID#:
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j ;Samples received via: Cooler 1 Therm Corr.Factor: oC
Radchem sample(s)screened(<500 cpm): Y N NA , FEDEX UPS Client Courier Pace Courier 1 Cooler 1 Corrected Temp: oC
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1377 South Park Drive
aceAnalytical Kernersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 05/31/2022
Town of Liberty Date Received: 05/19/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92605439
Sample: Effluent Lab ID: 92605439001 Collected: 05/19/22 13:20 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 64.8 mg/L 17.2 05/20/22 09:47
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 0.10 mg/L 0,040 05/20/22 10:50
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrate ND mg/L 0.040 05/20/22 10:50
SM 5210B-2016 BOD,5 day 31.3 mg/L 2.0 05/25/22 14:07
Colilert-18 Fecal Coliforms 2420 MPN/100mL 1.0 05/20/22 12:51 El
Performed by PACE 05/19/22 13:20
Collected By Garrett 05/19/22 13:20
Dreyer
Collected Date 05/19/22 05/19/22 13:20
Collected Time 1320 05/19/22 13:20
pH 7.52 Std.Units 05/19/22 13:20
Chlorine,Total Residual 0.08 mg/L 05/19/22 13:20
TKN+NO3+NO2 Total Nitrogen 13.7 mg/L 0.040 05/31/22 13:15
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 9.9 mg/L 0.20 05/25/22 13:12
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 13.6 mg/L 0.50 05/27/22 03:57
EPA 365.1 Rev 2.0 1993 Phosphorus 2.8 mg/L 0.050 05/23/22 22:37
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.
aoVe
Reviewed by: 0e y
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

CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-Affix W - • ,• _,_ _s..,,.,e.�nriist Pace Workorder Number or
•
aceAnalytical, R'' . • l' •"
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
is Town of Liberty (Billing Information: ALL liIll
}
i
qu j 2 aontainerPreservativ) 92605439 51
o: !Email To: I ••Preservative Types:(1)EEnitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)5oemm uyuw.�.c,�..,-...___-._
(6)methanol,17)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
Site Collection Info/Address: (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other i
Analyses ;Lab Profile/Line:
r Project Name/Number: IState: County/City: Time Zone Collected:
( i i 1 ( I I IL Lab Sample Receipt Che:rklint:
/ [ )PT[ ]MT[ ]CI [ ]ET I
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Site/Facility ID#: Compliance Monitoring? S $ Custody Signatures Present Y N NA j
d[ Yes [ ]to 1 11 ( I I Collector Signature Present Y N NA
t i ( Bottles Intact Y N NA.
By(p• ipo
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i ' Cozract Bottles Y N NAI
Quote#: DW Location Code: ) 1 Sufficient Volume Y N NA
�, ! ( ! Samples Received on Ice Y N NA
j r. eta.: Turnaround Date Required: ;Immediately Packed on Ice: i CL 1 VOA - Headspace Acceptable Y N NA 1
[ ]Yes [ ]No i..�.. USDA Regulated Soils Y N NA
, Samples in Holding Time Y N NA"
Disposal: Rush: Field Filtered(if applicable): ~o Residual Chlorine Present Y N NA
se as appropriate [ ]Return' I ]Same Day [ ]Next Day [ ]Yes [ ]No Z ' Cl strips:
is: [ ]2 Day [ ]3 Day [ ]4 Day [ ]S Day Z m t!1 Sample pH Acceptable Y N NA
Analysis: pH Strips:
(Expedite Charges Apply) O 12 p�• Sulfide Present Y N NA I
Codes(Insert in Matrix box below):Drinking Water(OW),Ground Water(GW),Wastewater(WW), Z Z P �e Lead Acetate Strips:
( } ( ) Wipe(WP), { ) { ) Bioassay{ ) Vapor{ } { T) Y u
#(P),Soil/Solid SL,Oil OL, Air AR,Tissue TS, B, V,Other O E-01 e�i���] LAB USE ONLY:
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7SHORT HOLDS PRESENT(<72 hours): Y N N/A 1 Lab Sample Temperature Info:
Cr Remarks/Special Conditions/Possible Hazards: ]'Type of Ice Used: Wet Blue DryNone
Packing Material Used: j Lab Tracking#: Temp Blank Received: Y N NA
I
I Therm ID#:
fluent Monitoring 1 Cooler 1 Temp Upon Receipt: oC
Radchem sample(s)screened(<500 cpm): Y N NA Samples received via: Cooler 1 Therm Corr.Factor: oC
Ii FEDEX UPS Client Courier Pace Courier 4 Cooler 1 Corrected Temp: oC
r — -` � Comments:
she an • re) j Date/Time: )Received by/Company:(Signature) 1 Date/Ti MTlL LAB USE ONLY 1
/ -�'� , Ui/ I t( I) 1 �0 Table#:
L 1 A m cctnu :
s Y/Company:(Signature) ate/Time: =Received b Allir pany:(Signature)( =Date/Time: (Template: Trip Blank Received: Y N NA
Prelogin: 4 HCL McOH TSP Other
shed by/Company:(Signature) ]Date/Time: Received by/Company:(Signature) /Date/Time: ipM. { Page:
Non Conformances): 'Pa
' `PS: YES / NO of:

DC#_Title: ENV-FRM-HUN1-0084 v01®Tech Spec Sample Condition
ace° Upon Receipt
Effective Date:05/12/2022
Laboratory receiving samples:
Asheville Eden Greenwood Huntersville Raleigh Mechanicsville❑ Atlanta❑ Kernersville(t
rSarripte t1on1Clp Client Name: p q
Project ft:
CA./.)� O
Courier: ❑Fed Ex ❑UPS ❑USPS ❑Client
❑Commercial "411..ce ❑Other:
Carrier Tracking Number:
Custody Seal Present? ❑Yes o Seals Intact? ['Yes [ No Date/Initials Person Examining Contents:
Packing Material: EBubble Wrap OBubble Bags TAKone ❑ Other Biological Tissue Frozen?
� ❑Yes ❑No L/A
Thermometer: ❑ Y.,a,f W IR Gun ID: af' Type of Ice: Let ❑Blue ❑None
Cooler Temp(°C): Correction Factor:Add/Subtract (°C)
Temp should be above freezing to 6°C
❑Samples out of temp criteria.Samples on ice,cooling process
Corrected Cooler Temp(°C):
has begun
USDA Regulated Soil( N/A,water sample)
Did samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
❑Yes ❑No including Hawaii and Puerto Rico)?Dyes o
Comments/Discrepancy:
Chain of Custody Present? Dyes ❑No ) l/A 1,
Samples Arrived within Hold Time? [ 'es ❑No ON/A 2.
Short Hold Time Analysis(<72 hr.)? NYes ❑No ❑N/A 3.
Rush Turn Around Time Requested? fares ❑No /A 4.
Sufficient Volume? rr, es ❑No ❑N/A 5.
Correct Containers Used? WYes ❑No ❑N/A 6.
-Pace Containers Used? es ❑No ❑N/A
Containers Intact? P4, es ❑No ❑N/A 7.
Dissolved analysis:Samples Field Filtered? ❑Yes ❑No I /A 8.
Sample Labels Match COC? F 'es ❑No ❑N/A 9.
-Includes Date/Time/ID/Analysis Matrix:
Headspace in VOA Vials(>5-6mm)? Oyes ❑No i►1N/A 10.
Trip Blank Present? Oyes ❑No /A 11.
Trip Blank Custody Seals Present? Oyes ®No .(RN/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes k7.No
Lot ID of split containers:
Temp Log:Temp must be maintained CLIENT NOTIFICATION/RESOLUTION
at<6 C during login,record temp -
every 20 minutes.
Time opened: ktaS Temp:
Time: put in cooler
Time: Temp:
Person Contacted: Date/Time:
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date:
Qualtrax Document ID: 70677 Page 1 of 2

0 CO
o Itemli * * g 'S n
CD o ° 3 * co o m
q s BP4U-125 mt Plastic Unpreserved(N/A)(Cl-) 0" o - m -- n
LU o ,o n O ? < N T co
o m 1111111111 BP3U-250 mL Plastic Unpreserved(N/A) 3 p o Cu = SCb
y
n o 0 e1 D R
BP2U-500 mL Plastic Unpreserved{N/A) = o a nos 0 0
CD .o m 0 -a -e, o rt (7'B
o BP1U-1 liter Plastic Unpreserved(N/A) IT tr -a ? s cp 10 0
m Cu 'o N X 3 m tv 0
d , pppriprpr BP4S-125 mL Plastic H2SO4(pH<2)(CI-) Z O N -4 O g }—I
-mil < m tD n _
cm o A Ad Add0d1 BP3N-250 mL plastic HNO3(pH<2) 2 0.3 III O - C)
- oo ' o- m -x. 0. ..
BP4Z-125 ml Plastic ZN Acetate&NaOH(>9) m - ui Z
10 Z or BP4B-125 mL Plastic NaOH(pH>12)(Cl-) o
m s WGFU-Wide-mouthed Glass jar Unpreserved �- o p " °`'
t. PI PPOP Pli
r' __ o. S o ts- 08 °O Q.
3 ° D AG1U-1 liter Amber Unpreserved(N/A)(Cl-) O ro o c
a v �- tD =� O S a
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'-- m CO
AG3U-250 mLAmber Unpreserved(N/A}(CI-) o a -A.
n
& d/
N
NM 106100p AG1S-1 liter Amber H2SO4(pH<2) = O O
FTC
o MEM AG3S-250 mL Amber H2SO4(pH<2) 0
m -® ,, ,lii DG94-250 mL Amber NH4CI(N/A)(CI-)
o °-
? DG9H-40 mL VOA HCl(N/A) -ts CD
O 0
o ~
3 3 m VG9T-40 mL VOA Na2S2O3(N/A)
a 2
ila
Q9 � �
`. 3 Lt VG9U-40 mL VOA Unpreserved(N/A) "a_
" 2 rD
o v. °' ^o TS DG9V-40 mL VOA H3PO4(N/A) C)
rp 0
o
s DG9S-40 mL VOA H2SO4(N/A) CL
m .—�- t� -v
o D V/GK(3 vials per kit)-VPH/Gas kit(N/A) \ B
3
n c SPST-125 mL Sterile Plastic(N/A-lab) T
"00
c, o
Q 5 Cl SP2T-250mi.SterilePlastic(N/A-lab) -�
CD ONJ r-, rz- PPP/0 PP"P"P"P
Q -,
co
<s BP3R-250 mL Plastic(NH2)25O4(9.3-9.7)
AGOU-100 mL Amber Unpreserved(N/A)(Cl-)
0
c
O o VSGU-20 mL Scintillation vials(N/A)
n
m ez
DG9U-40 mL Amber Unpreserved vials(N/A)

Pace Analytical Services,LLC
1377 South Park Drive
ace Analytical Kernersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 05/26/2022
Town of Liberty Date Received: 05/26/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92606570
Sample: Effluent Lab ID: 92606570001 Collected: 05/26/22 11:55 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 05/26/22 11:55
Collected By Garrett 05/26/22 11:55
Dreyer
Collected Date 05/26/22 05/26/22 11:55
Collected Time 1155 05/26/22 11:55
pH 7.25 Std.Units 05/26/22 11:55
Chlorine,Total Residual 0.03 mg/L 05/26/22 11:55
VL
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]

CHAIN-OF-CUSTODY Analytical Request Document LAB USZ ONLi-Affix I,Vorkorderf t. I •
fj
"ace Analytical MT! . 1, •
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevant fields
ny: Town of Liberty )Billing Information: f SHADED A( I 11 111111
6260557e
a: 1 } Container Preservative Type"*
I I i I i
To: i 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 sulfate,
D: 'Site Collection Info/Address: (C)ammonium hydroxide,(o)TSP,(U)Unpreserved,(0)Other
Analyses Lab Profile/Line:
Ier Project Name/Number: State: County/City: Time Zone Collected: j I lab Sample Receipt ChecYlist: "�'�
/ [ (PT[ ]MT( ]CT [ ]ETj E
j Custody Seals P esent/Intact Y N NA
Site/Facility ID#: Compliance Monitoring? i I y I -r Custody Signatures Present i N NA
9 [ Yes [ ]No s ) f i `It Collector Signature Present Y N NA
i '' i ' Bottles Intact Y N NA
ad By(prin : }Purchase Order#: DW PWS ID#: w, I i S 3 ' Correct Bottles Y N NA
�,/,' j Quote#: DW Location Code: V i } ! Sufficient Volume Y N NA
II 1 1 ( ( Samples Received on Ice Y N NA
:na Turnaround Date Required: jImmediately Packed on Ice: 5 j VOA - Headspace Acceptable Y N NA
p� 1 USDA Regulated Soils Y N NA
[ ]Yes [ ]NOit i Samples in Holding Time Y N NA
'Disposal: [Rush: Field Filtered(if applicable): c ( j ResidualChlorine Present Y N HA
ose as appropriate [ ]Return [ (Same Day [ ]Next Day [ j Yes [ ]No i ) ! I Cl Strips:
ive: I [ ]2 Day [ ]3 Day [ ]4 Day [ ]5 Day ; t .g.;_ Sample pH Acceptable Y N NA
g (Expedite Charges Apply)
Analysis: L pH Strips:
N. L3 ( Sulfide Present Y N NA
x Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), } jl I_ 1 Lead Acetate Strips:
Ict(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 N m ? 1 Lab Sample # / Comments:
ier Sample ID Matrix" Grab Composite Start) Composite End Cl Ctns ttt
Date Time Date Time p, 1—
mt 1ww g ,,�I'20v UST 0 1
I I
1
(
1 E J
i t
i I I
er Remarks/Special Conditions/Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT(<72 hours): Y N N/A II Lab Sample Temperature Info:
Packing Material Used: {Lab Tracking#: Temp Blank Received: Y N NA
I Therm IDS:
'fluent Monitoring _
1 Cooler 1 Temp Upon Receipt: oC
}Samples received via: Cooler 1 Therm Corr.Factor: oC
Radchem sample(s)screened(<500 cpm): Y N NA 1L FEDEX UPS Client Courier Pace Courier Cooler 1 Corrected Temp: oC
she.J;,.^ 'pam —ur R Date/Time: I Received by/Company:(S[ ature) Date/Time: c MTJL LAB USE ONLY Comments:
6s � t f) / } G J Table#: �_. �_
1 V
shed by/Company:(Signature) } te/ ime: 4 Rec ed by/Company:(5, ne) I Date/Time: } Trip Blank Received: Y N NA
1I Template:
( HCL McOH TSP Other
3 I Prelogin:
shed by/Company:(Signature) Date/Time: :Received by/Company:(Signature) Date/Time: iPM.
I i Non Conformance(s): ,Page:
I
} PB: YES / NO ;of:

May 2022
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
DATE
1 0
2 0
3 0
4 0
5 0
6 0 R 0.8
7 0 R 0,5
8 0
9 0
10 0
11 0
12 0
13 0
14 0 R 0.5
15 0
16 0 R 0.5
17 0
18 0
19 0 R 1.0
20 0
21 0
22 0
23 0 R 1.3
24 0
25 0
26 0
27 0 R 1,5
28 0
29 0
30 0
31 0
TOTAL 6.1

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page 1 of 2
Permit No.: WQ0003090 1 Facility Name: Town of Liberty-Wastewater I County: Randolph Month: May Year: 2022
Field Name: 1 Field Name: 2 Field Name: 3 Field Name: 4
Did irrigation occur A...,.. cres.t:, 20.2 ,1
Area(acres): 19.7 Arrret(acres): 1 i.,914. Area(acres): 17.02
at this facility? ' ''7'1%P. 1 ,
Cover Crop. FESCUE Cover Crop: FESCUE Cover Crop:, FESCUE Cover Crop: FESCUE
.'
2 NO lioUrty Rate(in): 0.21 Hourly Rate(in): 0.21 Hourly Rate(In): 0.21 Hourly Rate(in): 0.21 YES O
Annual Rate(in): 52 Annual Rate(in): 52 Annual Rate(In): 52 Annual Rate(in): 52
Weather Freeboard Field Irrigated? DYES 0 No Field irrigated? 0 YES 0 NO Field Irrigated? 2 yEs D No Field Irrigated? []YES El NO
I*-
o
:-;^ EE 0, E m
0 'a 2 GI/ la ca g. .,.0. a' *C3 139 F 5 - P , ot, $
o. =,t.r. . •'g = _ .
›,
m c°, L.. % II i g.= ib. I A,-5 E 7i-1. g :44 (i.) ri ..r.!:'LE E 7E' :5 g`-.1,', , g ,„ ...4"..f, :B-
o r, a .:4- li 2 -0- a. , 1=2) gi -6 a. r..- .,T, 75 a- i
= E co, ,n 1- a• > < L"'
To' 4.1
"
°F in ft ft gal min in in gal min in in - gal mint in in gal min in in
1 „
2 C 62 0 325,000 180 0.60 0.20 281,000 180 0.61 0.20
- -
3
4 .
, --, -
5 PC 65 0 , 281,000 180 0.61 0.20
6 CL 0/0.8 : .
7 R 0.5
8 ,
10
11 C 55 0 325,000 180 0.60 0,20 281,000 180 0.61 0.20
12
13 _ 1
14 R 0.5
15
16 R 0.5 17 C 82 0 281,000 180 0.61 0.20
_
18 C 80 0 325,000 180 0.60 0,20
19 R 1
20 , ... .
21 C 92 0 . 281,000 180 0.61 0.20
- - , ..„
22
23 PC 0/1.25 ,
24
25 CL 58 0 ; 281,000 180 0.61 0.20
26
27 R 1.5
- .
28 _ _ . . - _
29
30
31
Monthly Loading: 0 ` 0.00 0 ' ; ,'` 0.00 ,,.1, , 975,000 1,80 1‘686,000. ..,.*:';,1:: 3.65
12 Month Floating Total(in): , in= '' `' ;„,- :: '`,,,` , 21.63 ,-,,: ,;,; , 25.10 ,,,,,..,;,, ;,,,, , ,.1-,;;;1,,,,,s;-,,., , 40.28

FORM:NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? El compliant 0 Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 2 Compliant 0 Non-Compliant
:as a suitable vegetative cover maintained on all sites as specified in your permit? 2 Compliant Non-Compliant
ere all setbacks listed in your permit maintained for every application to each permitted site? Compliant D Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? compliant 2 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.
WE WENT OUT OF COMPLIANT ON THE DATE OF 01/03/2022 CAUSE OF RAINFALL. THE RAINFALL TOTAL OF 4.0 INCHES OVER TWO DAYS PERIOD.
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? El Yes 2 No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
Signature Date Signature Date
By this signature,1 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 far 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 ! County: Randolph Month: May Year: 2022
1> Field Name: 5 Field Name: 6 , "field Name: f 7 Field Name: 8
Did irrigation occur
Area(acres): 1 ,3 Area(acres): 15.1 Area(acres): 22.12 Area(acres): 21.68
at this facility? c ver Crop:- ' FESCUE ,,, Cover Crop: FESCUE Cover Crop„::' Crop: FESCUE
I FESCUE Cover
E]YES ❑NO 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? ID YES. . "[NO Field Irrigated? E]YEs [I No Field Irrigated? C]YES [3No,:. Field Irrigated? ❑YES ❑No
d I'
o d d 07 m a cs as" S" d o as E a ar a art , E at d zs n a E as
>, U ea :s a a al 'E nr eta:. " >: "";t+S E m (0 .-, >. c a i E E- , as , .. E;t. E m v % = c a a c
a w a ,`. ca -. Ssz, o = E R '5 E a1 a'- S� 1 " .5.z a -6 ' E a a E 0a
p a). a .e. C m ._ i t,, ._ .ttl, 74 0, nT... -aa a i= p R X a s3 tta,as 9e # :6 o G I= 0, x p m
'p +-' >.Q Gs C#. _ '"E. Q"- C R S C ." "- �" .-- 5 Q, eti=' coC R S C
°r in ft ft gal rain In In gal min in in gal train - -In ~In` gal min in in
1 C 68 0 299,000; 180 0.60 0,20 _ _
2
3 C 75 0 252,000 - 180 0.61 _ 0.20 350,000 _ 180 0.59 0.20
4 C 69 0 299,000 180 .. ..0 0.20 370,000 f 062 0,21
.�� .` , a
5
6_ CL 50 0/0.8 0 252,000 180 0.61 0.20 350,000 180 0.59 0.20
7 R 0.5 _
8
9 C 60 0 ,299,000 180" 060 0.20 70,000- 180 0.62>" 0.21
10 C 70 0 252,000 180 0.61 0.20
11
12 C 60 0 299,000 `" 180 0,60 0,20 350,000 180 0.59 0.20
13
14 R 0.5
,
15 _
16 CL 75 0.5 _ 0 252,000 180 0.61 0.20 370,000 -180 0,62: 0,21 _
17
18+ CL 83 0 _ 350,000 180 0.59 0.20
19 C 73 1 0 299,000>: "180- i "0.60.:'_� 0.20-' 252,000 , 180 0.61 0.20 370,000 y 180. --> ,0,62 - 0,21.
20
21 _
22 CL 60 0 299,000 160 0,60 0.20 '�_ -
23 PC 65 0/1.25 0 252,000 180 0.61 0.20 370,000 180 " _ 0,62` 0.21
24
25
26 CL 60 0 299,000 180 0.60 . 0.20"" 350,000 180 0.59 0.20
27 R 1.5 - : -
28 _ _
29
30 C 80 0 370,000 180 0.62" `0.21
31 C 70 0 299,000 180 0.60 0,20 252,000 180 0.61 0.20
MonthlyLoading: 2,392,000' 4.81 1,764,000 4.30 ` .. 2,220,000 370 e' 1,750,000 2.97 •
r 12 Month Floating Total(in): ' :. 1, :r. 37.19 ",. ., 36.68 31.12 tifitttior

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? 0 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? E 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.
WE WENT OUT OF COMPLIANT ON THE DATE OF 01/03/2022 CAUSE OF RAINFALL. THE RAINFALL TOTAL OF 4.0 INCHES OVER TWO DAYS PERIOD.
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 LI No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
„C�vi� �i/off _ (Q Z Zi
Signature Date Signature Da Ye
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under penalty of taw,that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted.Based on my
inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the 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