WQ0003090_Monitoring - 06-2022_20220728

DWR - NonDischarge Monitoring Report Submittal . wF
NORTH CAROLINA
Ertb.Oronmenterl Quafily
Monitoring Report Submittal
Permit Number#* WQ0003090
Name of Facility:* town of liberty wwtp
Month:* June Year:* 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR tremainejune.pdf 3.5MB
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:* E Tremaine Fike
Signature:
C .; rare
Date of submittal: 7/28/2022
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: 8/15/2022

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: June Year: 2022
PPI: 002 Flow Measuring Point: Q Influent ❑Effluent ❑No flow generated Parameter Monitoring Point: ❑Influent Q Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code 2 7 k. 00400 a; 00610 31613 zx's.`,''» 00625 =,:'r '.. 41,`~ 50060 �' , 70300 ' 00630
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24-hr hrs " " su ,• mg/L Ls'MT #/100 mL ,4<`«:° m /L m /L ,' s m /L -> mg/L L —
x•: �,-`;� ;�_ 'fi� '����.�x� .�r,'; .� mTM>g'_ _� 9 tt"a�'.=",_'�: 9 ��-'�°.. 9 �'_,"�°"��°.-�:u1 ��,�.
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© 7:00 8 in-', a 6.94 ... 12.3 2420 t+'''„w 17.8 0.07 '° ,. � <0.040 —
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El 11:00 2 k, — rt,• —
In 11:00 2 FkkTi7WMI— '
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al 7:00 8
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El 7:00 8 iitq'Tili°4,77-77,
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30 7:00 8 r c g 6.98 k , r,:;: a t , ,p, 0.21 �,' — °s —
Average:k ' . r 4 a 12,00 2,420.00 : ',',_1" #REF! -, : 0.30 ? 4 s. 0.00
Daily Maximum:rlr33- a`'+s ' ' 8.11 ...7,3 12.30 : 2,420.00 3 '' ,>` #REF! '`; 0.99 M `6.AVT1 r,aaa 0.04 +
•, itz .„ ems ` ';.,.
Dail Minimum: '--• •''`'r i.,x. :c� " k;•,a "R.M., i ",r.,, .s�a, A t, . " 0.04
Y 6.94W 11.70 �s rw 2,420.00 i> 1 a� *REF. x:.'e 0.07eNur
Sampling Type: ;, „ . 9 `-. :,=.. Rw.•. ),, Grab ' ` Xa; ;'a� Grab §, .' i Grab
ir,.; Grab Grab Grab y"ainae;, -t•''c^
Monthly Avg.Limit, ' .,. " `";;:+:,` c•. . All 41
Wit. : ..,, g '
Daily Limit:. ,, a,'° t; s .,M' .'- ;- � .'.
Sample Frequency:`•.l• •`:; weekly l 2x month x 2x month �a 2x month weekly 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 ❑✓ Non-Compliant
If the facility is non-compliant,please explain in the space below the reason(s)the facility was not in compliance. Provide in your explanation the date(s)of the non-compliance and describe the corrective
action(s)taken.Attach additional sheets if necessary.
non compliant on the day of 6/14/2022
RAINFALL I&I
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Elix Tremaine Fike Permittee: Scott Kidd
Certification No.: 989290 Signing Official:
Grade: SI Phone Number: 336 622 2990 Signing Official's Title: Town Manager
Has the ORC changed since the previous NDMR? ❑Yes LI No Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
7/2/-2.2. y"--;
.--z/z6itz
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
® 1377 South Park Drive
'4 aceA!lrt aIytica' Kernersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 06/15/2022
Town of Liberty Date Received: 06/02/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92607576
Sample: Effluent Lab ID: 92607576001 Collected: 06/02/22 13:30 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 29.6 mg/L 9.3 06/03/22 14:07
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 06/03/22 10:38
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrate ND mg/L 0.040 06/03/22 10:38
SM 5210E-2016 BOO,5 day 9.6 mg/L 2.0 06/07/22 22:49 R6
Colilert-18 Fecal Coliforms 2420 MPN/100mL 1.0 06/03/22 13:33 El
Performed by Pace 06/02/22 15:50
Collected By Garrett 06/02/22 15:50
Dreyer
Collected Date 06/02/2022 06/02/22 15:50
Collected Time 1330 06/02/22 15:50
pH 6.94 Std.Units 06/02/22 15:50
Chlorine,Free 0.07 mg/L 06/02/22 15:50
TKN+NO3+NO2 Total Nitrogen 17.8 mg/L 0.040 06/14/22 12:21
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 12.3 mg/L 0.20 06/08/22 12:36
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 17.8 mg/L 0.50 06/09/22 04:06
EPA 365.1 Rev 2.0 1993 Phosphorus 3.1 mg/L 0.050 06/14/22 21:08
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.
R6 The RPD between valid sample dilutions exceeded 30%.
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 Virginia/VELAP Certification#:460025

CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-F,ff ,A, L
-FSceAnalytical I o
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
Y: Town of Liberty Billing Information: ALL
Container Preserr, 02607575
u j 2 1 8 j
'0: j Email To: rt'Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,_______._--
_ ; (5)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
.•
Site Collection Info/Address: I (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
Analyses 'Lab Profile/Line:
rr Project Name/Number: (State: County/City: Time Zone Collected: ; Lab Sample Receipt Checklist:
/ [ ]PT[ ]MT[ ]CT [ ]ET ( 1 ! ,
I_ i ( I 1 , ; / Custody Seals Present/Intact Y N a
'Site/Facility ID#: /Compliance Monitoring? 1 1 j ` Custody Signatures Present Y N
['Yes [ ]NO { ( ( Collector Signature Present 4°N NA
} 1 ! 1 i / 1 Bottles Intact C"5., N NA
d By I Purchase Order#: 1 DW PWS ID#: i j Correct Bottles a N NA
Quote#: 1DW Location Code: ( 1 Sufficient Volume t42 N NA
Samples Received on Ice li N NA
• atu Turnaround Date Required: Immediately Packed on Ice: n i I I VOA - Headspace Acceptable Y N
[ (Yes [ ]NO ) w I ( USDA Regulated Soils Y N
o I ( Samples in Holding Time Y N QNA
Disposal: Rush: Field Filtered(if applicable): F 1 d{ ( Residual Chlorine,f sent YQ; NA
j p I Cl Stripe: Qt I7) ) €I
se as appropriate ( }Return [ ]Same Day [ ]Next Day [ ]Yes [ ]No -a (\ Sample pH Acceptpb e (Y(N NA
e: [ ]2 Day [ ]3 Day [ ]4 Day I ]5 Day Analysis: Z I��` I pH Stripe: )7',5'l } 4
(Expedite Charges Apply) O O �F Sulfide Present Y Pr t
Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater{WW), Z Z u Lead Acetate Strips:
j
:t(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(0T) ti
LAB USE ONLY:
Comp/ Collected(or Res #of 1— Z 0 Lab Sample # / Comments:
Sr Sample ID Matrix* Composite End — v
P : Grab Composite Start) Cl Ctns C� ci V 0
1 Date Time l Date a Time = u.. Q I-
It 1N1AI gf Z 2 t 6. 5 1 _ _
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_________1
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r Remarks/Special Conditions/Possible Hazards: (Type of Ice Used: 'Wet Blue Dry None (SHORT HOLDS PRESENT(<72 hours): Y N `sjA Lab Sample Temperature Info:
- _..-� Temp Blank Repeived: Y N (INN
Packing Material Used: !Lab Tracking#: a
i ThermlD#: ,,Yl`t JC:
uent Monitoring • _ _ _ --( Cooler 1 Temp Upon Receipt: /. `oC
,Samples received via: ,,„_...----- 1 Cooler 1 Therm Corr.Factor:-C, \ oC
Radchem sample(s)screened(<500 cpm): Y N NA
i FEDEX UPS Client Courier ace Coun i Cooler 1 Corrected Temp: ".t C> oC
-- ture a 1 _. I _.._ Comments:
) i Date/Time: (Received by/Company:(Si nat. e) ;Date/Time: MTJL LAB NLY I
/L� / Table#:
IAcctnum: ...___ ____. -_______________—_z ___._I
hed by/Company:(Signature) a e/Time: (Received by/C pany:(Signature) late/Time:I : 'Template: Trip Blank Received: Y N A
I (
i Prelogin:
1 HCL McOH TSP Other
i______s._ _
hed by/Company:(Signature) /Date/Time: i Received by/Company:(Signature) :Date/Time: ;PM: ( Non Conformance(s): /Page: .)
PB: YES / NO of:

DCm_Title: ENV-FRIM HU,N1-0034 v01_Tech Spec Sample Condition
ce. Upon Receipt
i
l u,:.,u:L,=: Effective Date: 05;12.2022
*Check mark top half of box if pH and/or dechlorinat;on Project „.
is verified and within the acceptance range for \\\n 0--
preservation samples.
Except:ens:l;OA,Coliform,TCC,Cd and Grease,CP.0i 313(. s, rj CCC,LLI--Is [----‘ loeri-y
**Bottom half of box is to list number of bottles
***Check all unpreserved Nitrates for chlorine
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pH Adjustment Log for Preserved Samples
Sample IC Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot d
adjusted added
I
Note: 4',tia^ever there is a discrepanC/arfea:ing,North Carolina compliance samples,a copy of this form wIil tie sent to the North Carolina GEHNR Cer,;fca!cn Office(i.e.
cut of hold,incorrect preservative,out of temp,incorrect containers)
Duel,rax Document ID: 70677 Pang 9 of 9

Pace Analytical Services,LLC
© 1377 South Park Drive
aceAna/ytical Kernersville,NC 27284
www.pacelabs.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 06/10/2022
Town of Liberty Date Received: 06/09/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92608788
Sample: Effluent Lab ID: 92608788001 Collected: 06/09/22 10:50 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 06/09/22 10:50
Collected By Garrett 06/09/22 10:50
Dreyer
Collected Date 06/09/22 06/09/22 10:50
Collected Time 1050 06/09/22 10:50
pH 6.99 Std.Units 06/09/22 10:50
Chlorine,Total Residual 0.11 mg/L 06/09/22 10:50
Reviewed by: n2Y t
Stephanie Knott
704-977-0981
stephani e.knott©pacelabs.com

�_^__..._.___. __.__ ._ ___-___�.._ .o .s:_r p,ra w nrkorder Number or
CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-Affix Workorder/I---I-
u
aceAnalyticai M i 1 . � . �, :; , •
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
Town Of Liberty 'Billing Information:
ALL SHADED A I li IIIIU !i!II
i
I Container Preservative T e`* 92608788
1 i ' i i 1
Email To: K"Preservative Types:{1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,isl zinc acetate,
(,
i {6}methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
Site Collection Info/Address: 1 (C)ammonium hydroxide,(D)TSP,WI Unpreserved,(0)Other
Analyses Lab Profile/Line:
'rojectName/Number: (State: County/City: Time Zone Collected: � I ( ( Lab Sample Receipt Checklist
/ [ ]PT[ ]MT[ ]CT [ ]ETI
F I ( Custody Seals Present/Intact Y N NA
Site/Facility ID#: (Compliance Monitoring? I ] I ) [ Custody signatures Present Y N NA
[ IE/Yes [ ]No $ss— Collector Signature Present Y N NA
i Hottlee Intact Y N NA
y(p i• Purchase Order#: DW PWS ID#: ] ( ) 1 Correct Bottles Y N NA
i
I
1 a I Sufficient Volume Y N NA
Quote#: DW Location Code:
11 l Samplers Received on Ice Y N NA
iv- Turnaround Date Required: Immediately Packe.on Ice: g 1 VOA - xeadspace Acceptable Y N NA
,/ i [ ]Yes [ ]No ( N €LE
USDA Regulated Soils Y N NA
( Samples in Holding Time Y N NA
posal: I Rush: `Field Filtered(if applicable): N Residual Chlorine Present Y N NA
as appropriate [ ]Return ; [ ]Same Day [ ]Next Day [ ]Yes [ ]No c j Cl strips:
[ ]2 Day [ ]3 Day [ ]4 Day [ ]5 Day o I Sample pH Acceptable Y N NA
(Expedite Charges Apply) Analysis: •s ( pH Strips:
U 1 Sulfide Present Y N NA
ides(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), tI Lead Acetate Strips: _
P),Soil/Solid(SO,Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) 11 ;a
LAB USE ONLY:
Comp/ Collected(or Res #of 0 Lab Sample # / Comments:
;ample ID Matrix` Grab Composite Start) Composite End CI !Ctns
Date Time Date OEM a
AL
IIIIIIIIIIIIIIIMIIIIIWIIIUIIIIIMM
IIIIIIIIIIIIIIMIMIIIIIIIIIIIMIIIIMI 11111111.1111011111111111
WIN g
I
1 1111111111111/1111111 ; /NM ; ; --
temarks/Special Conditions/Possible Hazards: i Type of Ice Used: Wet Blue Dry None ISHORT HOLDS PRESENT(<72 hours): Y N N/A 1 Lab Sample Temperature Info:
( 1 I Temp Blank Received: Y N NA
Packing Material Used: flab Tracking#:
1 I Therm ID#:
:nt Monitoring I _ Cooler 1 Temp Upon Receipt: oC
€Samples received via: I Cooler 1 Therm Corr.Factor: oC
iRadchem sample(s)screened(<500 cpm): Y N NA i
FEDEX UPS Client Courier Pace Courier) ; Cooler 1 Corrected Temp: oC
gnature Date/Time: (Received by/Company:(Signature) �� MTJL LAB U NLY Comments:
Date/Time: (
o /
I
7/?i �.10(', � o tc �� 7 l 2 - C Table#. __
— j l Acctn um:
• by/Company:(Signature) Da e/T me: I Received by/Comp y:(Sig ure) I`Date/Time: I
J i I Template: 4 TripBlank Received: Y N NA
I
I • HCL McOH TSP Other
IPrelogin:
d by/Company:(Signature) 'Date/Time: °Received by/Company:(Signature) (Date/Time: PM: —mance(—
Non Conformances) Page:
,
`P6: YES / NO of:

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: 06/28/2022
Town of Liberty Date Received: 06/16/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92610222
Sample: Effluent Lab ID: 92610222001 Collected: 06/16/22 13:40 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 25.7 mg/L 9.4 06/21/22 09:27
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 06/17/22 12:48
EPA 353.2 Rev 2.0 1993 Nitrogen,Nitrate ND mg/L 0.040 06/17/22 12:48
SM 5210B-2016 BOD,5 day 27.6 mg/L 2.0 06/22/22 12:24
Colilert-18 Fecal Coliforms 2420 MPN/100mL 1.0 06/17/22 13:37 El
Performed by PACE 06/16/22 13:40
Collected By Garrett 06/16/22 13:40
Dreyer
Collected Date 06/16/22 06/16/22 13:40
Collected Time 1340 06/16/22 13:40
pH 7.06 Std.Units 06/16/22 13:40
Chlorine,Total Residual 0.11 mg/L 06/16/22 13:40
TKN+NO3+NO2 Total Nitrogen 17.1 mg/L 0.040 06/28/22 15:51
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 11.7 mg/L 0.20 06/24/22 14:56
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 17.1 mg/L 0.50 06/25/22 04:57
EPA 365.1 Rev 2.0 1993 Phosphorus 2.9 mg/L 0.050 06/28/22 00:09
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: c (RAulg-t<
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 Virginia/VELAP 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 Virginia/VELAP Certification#:460025
Page 1 of 3

"7 T LAB USE ONLY-Affix Workorder Lo n Laf ei flare or List Pace Y'L'arkorder Number air�' C�fAii�i-€3�-ais r C}�Y Araalytaca� F�eEjLEesc t�ocurraent ;. � µ.,„a®.�,nrtt
. ceAi7aiytica! � �Zfi 10222
Chain-of-Custody is a LEGAL DOCUMENT-Complete af!re(event Welds i
Company: Town Of Liberty 1BillingInformation:
I ALL SHADED IIIIII i 1111N11111111i
Container Preservative T e*'
Address: ( YP ,���..�111 r Li FaI f . 1 _ 1 92610222
S Report To: (Email To: *`Preservative Types'(1)nitric acid,(2)sulfuric at
(6)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A(ascorutc a.u,tui
li Copy To: (Site Collection Info/Address: (C)ammonium hydroxide,(D)7SP,(U)Unpreserved,(0)Other
( i 1 Analyses Lab'Proff)e/Line:
l Customer Project Name/Number: 4State: County/City: Time Zone Collected: 3 i i c 1•` 1 ,Lab sample Receipt Caeri list:
i f / [ ]PT( ]MT[ ]CT [ ]ET [ € [
t E ? ; Cuotody;Seals .-,resentliptact Y :wi.
Phone: Site/Facility ID#: Compliance Monitoring? l [ Custody Signatures Present 'NA
Collector Signature Preae:It N NA
(Email: [ryes [ ]No ) E j Bottles Intact �v.'Bt NA
C ed By p int: I Purchase Order e: DW PWS ID#: I ; correct Bottles < ,ft tut!!! t Sufficient Volume 2`Nr
�/ Quote#: [OW Location Code: s 4 F
i C Samples'Receeived on Toe Ida [
'Collect si iTurnaround Date Required: Immediately Packed on Ice: Cl- voA - Headspace-.Acceptab7,e Y n. {
i [ ]Yes [ ]No # USDA Regulated Soils tN
0 t Sampler in Holding Time N NA
-1Sa ple Disposal: (Rush: (Field Filtered(if applicable): Residual chlorine °r esnt Y
( I Dispose as appropriate ( (Return I [ I Same Day [ ]Next Day `I (Yes [ I No Z /� Cl Stripe 0 l 4
( I Archive: [ ]2 Day [ ]3 Day [ ]4 Day [ ]5 Day . m /0 0 Sample pH acceptable 'y,N NA
H ChargesApply) !Analysis: " Su Strips , ,r / 2,�$-v
( J old: {Expedite ( 0 F- '.,,,- 4 Sulfide Present Y Y ft
*Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(OW),Wastewater(WW), Z Z Lead Acetate Strips:
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) CI)Ct1 n 0
I Comp/ Collected(or 1 Res #of l- z m Lab sample 4) / ccxrtt nttxr
Customer Sample ID Matrix` Composite End
p Grab Composite C! Ctns Cf ri U
Date Time
Date Time (1co Z Lt..:,► Q�
Effluent g .li7LL7]El13Z �F,i�G►itlAlt'!lr� .�41.. all
I
'
k 1 1 t e�
` T e of Ice Used: Wet Blue None 'SHORT HOLDS PRESENT <72 hours:(Y}N N A (Lab Sample Temperature Info:
E Customer Remarks/Special Conditions/Possible Hazards: YP Dry ( ) / j
k r� ' "� 1 Temp_Blank Received: Y N. NA
FParkin `Material Used: Lab Tracking*: € _ ,
g L• g Therm iDfi: T 2,-
'Effluent Monitoring I ) = Cooler 1 Temp Upon Receipt: oC
'Samples received via: F Cooler I Therm'Corr.Factor: - -/ oC
j !Radchem sample(s)screened(rSDQ corn): Y N NA € f (
FEDEx UPS Client Courier `,,Pace Courier )€ Cooler 1 Corrected temp: ,I oC
Relinqu` h.�__ an re Date/Time: l Received by/Company: Si(Signature) Date/Tlme i MTJL1A BUc( Er"--' ( Comments:
i
uist ed by/Company.(Signature) i ate tme: Received by/Company'Si nature) Date/Time: Trip Blank Received: N NA
u� Te raolate:
CD JCL McOH TSP Other
N I- 'e,FY';.lrlgin.
'.Reif ui;ledby/Ccmrany, co ,Signature_) te,Time: 'Received'}y/Comoan•i�^z(Stgru re) 'Data:Time: __
FF. YES' / (\Ill' f. _

DC#_Title: ENV-FRN1-HUN1-0084 vOl Tech Spec Sample Condition
\Ge• Upon Receipt
I u41,0asr0m Effective Data:05/1212022
*Check mark top half of box if pH and/or dechlorination Project r
is verified and within the acceptance range for
preservation samples. 1.7) W 11 o
Exceptions:VOA,Colifcrrn,TOC,Cd and Grease,CR0/3015(water)CCC,LLH; 1
**Bottom half of box is to list number of bottles 1 J.) ✓ ,�
***Check all unpreserved Nitrates for chlorine
. I _
,;
o
m r z v r w nt '
` c c E' O O C O n ` - n - T C m aT., 1 W u a v n `_.
-1C C.- J -J J J . G 4 J < ...I ...I ~ > O 2.. t.t Vi G 4
E d C = E C -" t E ;53 E E J ;-2 J J `^ -< .J _I E to 4
< N C .-+ Ni fv ., — ", — r,, Ul C o C G o ? ,n `-, o 0 o O
_ r, rr v
Ql a. a c. 2 c- a, -, L., CO W 0 so t. l� Q1 0 m S r� a. a. m o C
m cc m ra s m m S Q <\— — 3 1\ \\ \ C d ¢ C C > ? C q > n. a 47 > U
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3 \ \\\N N \\ 1 _ \\-_
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. \\---<\[
\ \ \\\ F \\
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\�12 \ \\,\,\. \ \\_,\___,\\\ \\ _
\\_7_______
pH Adjustment Log for Preserved Samples
sample ID Type of Pre.sarvative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative lot If
adjusted added
__— / )
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNa Certification Office(i.e.
Cut of hold,incorrect preservative,out of temp,incorrect containers)
Qualtrax Document ID: 70677 Page 2 of 2
Page 3 of 3

Pace Analytical Services,LLC
0 1377 South Park Drive
'aceAnalytical Kernersville,NC 27284
www.pacelabe.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 06/23/2022
Town of Liberty Date Received: 06/23/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92611312
Sample: Effluent Lab ID: 92611312001 Collected: 06/23/22 07:40 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 06/23/22 07:40
Collected By Glenn Price 06/23/22 07:40
Collected Date 06/23/22 06/23/22 07:40
Collected Time 0740 06/23/22 07:40
pH 8.11 Std.Units 06/23/22 07:40
Chlorine,Total Residual 0.99 mg/L 06/23/22 07:40
Reviewed by: � c4
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

"' ` CHAIN-OF-CUSSTODYAnalytica€Request Document LAB USE ONLY-Affix WAtorkorder/LOF O : .72Vi i2�__
.-aceArar4.:�ca! 1
Chain-of-Custody is a LEGAL DOCUMENT-Complete all reievent fields
Company: Town of Liberty Billing Information: ALL SHADED ARE111111111111111 1111111
Address. t Container Preservative Type t 92611312
! [ i t # f
I Report To: i Email To: 1 **Preservative Types:(1)nitric add,(2)sulfuric acid,(3)hydrochloric add,(4)sodium hydroxide,(S)zinc acetate,
I , (9)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid.(a)ammonium sulfate,
j Copy To: !Site Collection info/Address: i (C)ammonium hydroxide,(0)TSP,(U)Unpreserved,(0)Other
_ t Analyses )Cab Profile/Line:
Customer Project Name/Number: State: County/City: Time Zone Collected: " ' i 1 ] L Sample Receipt Checklist:
t / [ (PT[ 1MT[ )CT [ JEi• I ] i i
I t 1 sf Custody Seals o esent/intact Y ft CA
s Phone: (Site/Facility ID#: !Compliance Monitoring? I i Custody Signatures Present Y N NA
( i '✓ Collector Signature Present 'l N NA
)Email: ['Yes 1 1 No [ 1 i
7. collies Intact,: Y..N NA
IColle By(prin Purchase Order#: OW PWS ID#: r { N I I Correct aoctles Y N NA
`+
[ C/' p�� .'� Quote#: JW Location Code:
"CJ ' Sufficient Volume Y N NA
11 II 1 Samples Received on Ice i Et NA
Collected By(s nature): !Turnaround Date Required: !Immediately Packed on Ice: a [ VaA - Ceadspace Acceptable Y N NA
Yes No iii USDA Regulated Soils Y N A
( [ 1 [ 1 y Sampler; in gelding Time v FI NA
!Sample Dispos t. !Rush: !FieldFiltered(if applicable): Residual Chlorine Present N NA
( ]Dispose as appropriate [ (Return I [ (Same Day [ (Next Day t(( ]Yes [ ]No :'Ill: i Cl Stripe:
[ (Archive: It [ 1 2 Day [ 13 Day [ ]4 Day [ ]5 Day [ o t Sample pH Acceptable Y St NA
tp[ iHotd: I (Expedite Charges Apply) (Analysis: .= P- Stripe:
t ! 0 sulfide, Present: Y N NA.
t*Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(OW),Wastewater(WW), it ? i Lead Acetate Strips:-
, Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) a t Aa OSE ONLY:
[[Comp/ Collected(or I Res #of Lab Sample # / Coitvtiente:
Customer Sample ID Matrix` Composite End
P I Grab Composite Start) ] Cl Ctns .-.. m
I Date j Time Date Time Q ;
Effluent ww
1
f
# _
I
i I r
i 1 f
( ;
Customer Remarks/Special Conditions/Possible Hazards: )Type of Ice Used: Wet Blue Dry None !SHORT HOLDS PRESENT(<72 hours): Y .N N/A !Lab Sample Temperature Info:
Packing Material Used: 'Lab Tracking#: Temp Blank Received: V N NA [
Therm lD#:
( 'Effluent Monitoring 1 _ L. !
� ,„_• Cooler1Temp Upon Re eipt:_oC
t `•Samples received via: Cooler I Therm Corr.Factor: oC
?Radchem sample(s)screened <S00 r_ m: Y N NA t
P ( p ) FEDEX UPS Client Courier Pace Courier Cooler l Conceded Temp: cC
;Relinquished by/Company:{Sign; re) iDat fim : (Received by/Company: nature) )Date/Time: _a" Mill iABUSE ONLY I Comments:
d�c r G $'2" �'" s C..Q. Gam'"`�- tl,n,31' 7 t (} Tab e x" _.
1Rebrq,.iched b 'Corn arty• Signature(ei i Da -'e: _ Received b C �' (Sio. u — L'_ Th pl m
y, F o y! om„.gym re) tDa'.e;Tim=_:
� � Te.^,.lac._. 'r-i)+Blank Received: Y N NA
ro pre�E NCI. Iyte'H TSP Other
.mqi:> -� wmp ..,.:S K:-.._u _ age/T,.._ RE_eided,, , _ �a y.• ignc"ur_j �1L ..e/Tir*e: ao
N - Pix.. �id_ ..v+'rfor.Ylotwef$: 1 Pao __._

Pace Analytical Services,LLC
'aceAnalytical0 1377 South Park Drive
Kernersville,NC 27284
www.pacolaba.com [phone]
Page 1 of 1
Laboratory Report
Tremaine Fike Report Date: 07/01/2022
Town of Liberty Date Received: 06/30/2022
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.:92612488
Sample: Effluent Lab ID: 92612488001 Collected: 06/30/22 10:55 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 06/30/22 10:55
Collected By Garrett 06/30/22 10:55
Dryer
Collected Date 06/30/22 06/30/22 10:55
Collected Time 1055 06/30/22 10:55
pH 6.98 Std.Units 06/30/22 10:55
Chlorine,Total Residual 0.21 mg/L 06/30/22 10:55
Reviewed by: C*""nc€ 6"_
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

— —i
.
LAB U-E ONLY-Aff-pc Workorde
CHAIN-OF-CUSTODY Analytical Request Document WO# . 92612488
' aceAnalytical' —
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields I1
J Company: Town Of Liberty 'Billing Information:
ALL SHADED 92612488 11111111 1111111111111
inddress, 1I Container Preservative Type** i
—T4
i
( I 111 [ 1 irl I 1. I
Report To: [Email To: s'Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,
(6)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(8)ammonium sulfate,
Copy To: (Site Collection Info/Address: (C)ammonium hydroxide,(DI TSP,(U)Unpreserved,(0)Other
1 1 Analyses Lab Profile/Line:
Customer Project Name/Number: /State: County/City: Time Zone Collected:
I I Lab Sample Receipt Checklist:
/ [ ]PT[ IMT1 )CT [ ]ET , . NA
1-... C:un tatty Seale Present,Intact Y tv N A
,
Phone: Site/Facility ID#: Compliance Monitoring? .
`Custody Signatures Present Y lx NA i
!Email: 1 [,14Yes [ (No I IN)
t Collector Signature Present 17 tr NM. j
l - mottles intact yi N NA
lected B (pri : /Purchase Order g: OW PWS ID g: )10 Correct Bottles Y N NA
/.'"- Quote g: DW Location Code: iI Sufi ficient Volume Y RI NA
/
/li Samples Received on Ice "i I/I NA 1
1Collected ' nat • Turnaround Date Required: Immediately Parke on Ice: i--, VOA - ileadspace Acceptable Y 2.7 NA
; [ )Yes [ I No
i (0
USDA Regulated Soils Y N RA
Samples in Bolding Time r N NA
/5 pie Disposal: Rush: Field Filtered(if applicable): Residual Chlot-ine Present Y N NA
/
it j Dispose as appropriate [ ]Return i [ ]Same Day [ I Next Day [ I Yes [ ]No r..,,e. `p.7. , Cl Stripe:
1[ I Archive: [ I 2 Day [ 13 Day [ 14 Day [ 15 Day __,,.,"' cjr- • Sample pli Acceptable le N NA
/[ (Hold: (Expedite Charges Apply) Analysis: CT"' a - pli stripG:
Sulfide Present I N NA '
"Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), N,„„) -(ri Lead Acetate Strips:
(c• Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT)
, -2.cli—` TAEI USE ONLY:
Comp/ Collected(or Res (#of al 2 : Lab SampleB / Coto..e-i‘te:
•`, II: •
Customer Sample ID Matrix* Grab Composite Start) Composite End Cl I Ctns --- To
Date Time Date I Time * = 0
Effluent WW Ig VI/P.-I it01-5.- 0 . _ . .. ... . .
_X X.
I
I I
, .
I .
1
1 1
i
. 4.
1 1
1 I i
. , .
i 1 1 1 ...
(Customer Remarks/Special Conditions/Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT(<72 hours): Y N N/A [Lab Sample Temperature info:
I 1 Packing Material Used: Lab Tracking B: f Temp Blank Received: Y N NA
1
i I , i Therm ID#:
1 "Effluent Monitoring I 1 ,L.__ Te p I Upon Receipt: oC
1 i Coolerm
i I (Samples received via: i Cooler 1 Therm Corr.Factor: oC
i i Radchem sample(s)screened(<508 cpm): Y N NA r
t FEDEX UPS Client Courier Pace Courier I Cooler I Corrected Temp: oC
— ,
:-- I
I Retinouis a :(Si Date/Tirne: IReceiv by/Company:(Signature) !Date/Time: I MTJL LAB USE ONLY I Comments:
"( .elitaquish /Company:!Signature) i ate ime: i Received by/Corn,..!--..51„/:;Si . tore)---1Date/Time: i
; Trip Blank Received: Y N NA
0 ,
' HCI. MeGid TSP Orner
, •
. :Prelowni
Cor-/-/par,,,, natire .',..Jarefiime: /Rect•-,yed tviComos:,;•:izigriafuref -D,a 17i.--,e-:----
. iv P.,1- , Ncil(2,ieformaricets': ( ag(---"::
. ' "•••r.s ,,' N 0 'DT'
,..-. ..........

June 2022
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
DATE
1 1 R 0.3
2 1
3 1 1/4
4 1
5 1 1/4
6 1 1/2
7 2 1/4
8 3 R 0.2
9 3 3/4
10 31/2
11 4 1/2
12 4 1/2
13 4 1/2
14 41/2
15 51/4
16 61/2 R 0.8
17 63/4
18 7
19 7 1/4
20 7 1/2
21 8 1/4
22 8 1/2
23 8 1/4
24 8 3/4
25 8 3/4
26 81/2
27 9 R 1.0
28 9 1/2
29 9 1/4 R 0.3
30 91/4
TOTAL 2.6

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _1_ of_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? 0 Compliant ❑Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Q 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 Ri 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
•- - Fike Permittee: Scott Kidd
Certification No.: 989290 Signing Official:
Grade: - Number: 6 622 2990 Signing Official's Title: Town Manager
Has the ORC changed since the previous .• - - p • Phone Number: 336 622 4276 Permit Exp.: 8/31/24
-77 -7/76/?e
Signature DateSignature 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 Facility Name: Town of Liberty-Wastewater county: Randolph Month: June Year: 2022
M `' s. Field Name: 6 1_.,;',e, . t. Field Name: 8
Did irrigation occur i _; . 9 W',.
�r�`�° � Area(acres): 15.1 � - - ° �0 Area(acres): 21.68
ram. ..s: �: °'w.,.
at this facility? ," . , ., .x ' 4
" 8$ ;.;'.";' Cover Crop: FESCUE '4-4 `,,,,,,ze Cover Crop: FESCUE
IVA
ji, xFa- t -,,4 " Hourly Rate(in): 0.21 .�!;� ,.... r , Hourly Rate(in): 0.21
❑YES ❑NO -, 5'" r, A,='e Annual Rate(in): 52
"t;.: s. ,, roy , Annual Rate(in): 52 ,', F, .. .,,,. 'd..
, ` 'a 'mkt t.; '' ,,r,� s 4 4.-vim'
Freeboard :- ,'e,-. 4 � Field Irrigated? 2 YES ❑No -4 °x x4: ■ .'� Field Irrigated? 2 YES ❑NO
N � ,�y ., a a co) E co ; M. m •a E al
�, f6 N L^;-,,,�„w. z.?,:t :, yr 'L r 1,',.J1. '" E d d .d.. >. C 3 �` C '3 E N d „�., �. C 3 �" C
a n � ? • 'L = T E co � -a x E. 5 --- = 'a E R •� a E = =a
O ft, a a: o c i- co 0 R O m ".,..a. -2'. Q• co ca X 0
is «,� �.
°F ®©© -Itl , s rs�. : wx- 4 gal min in in - ., gal min in in
©0 71 _ 0 MEe a `. __-- xs ag'� 74,74e44.1.4 g s -_--
130 80 _ 0 - =°' >,.T a eat .EZ ---_ -_--
©Q 80 - 0 4 ., .1 z . ,f41 252,000 180 0.61 0.20 -___
1101m 72 0/0.2 0.25 252,000 180 0.61 0.20 -6.61.' '
10 ME 80 = 0.25 = 's �:v?� 17'15' a s € x a _ a --__ -__-
m m 82 _ 0.25 - ! ; . ---_EMEEZIMETWEZERrial-_--
®Q 75 MII 0.25 Eli EUSIRMELMBIEDI252,000 180 0.61 0.20 -_-_
®___-- ? .. _--- -_-_
° . e a a®© 84 Mill 0.25 - EtilintlwitAiMitaltalail
!° : T 252,000 . . „ a � r a, -_--
9__ 0/0.8 --' � w ry -_-_ATRaitafilitiErelignia.-_-_
111 - - , a ���
El© 81 _ 0.5 - 1, -_-- p a a a 4 0 ' s
20 0 81 0.5 � ' _ '' �� N " �.n; 252,000 180 0.61 0.20
¢: az ax
.,*442114
9 PC 86 ilill 0.5 r? -___ 350,000 180 0.59 0.20
Epp 82 NM 0.5 m FRE-527-11.,212111fIlitialiafiii iMtri7k741,,TV.FIT'afrii147,M-TK17.14.z...r44
9m 78 0/1.0 0.75 " ?3 -MOM_- 350,000 180 0.59 0.20
30 PC 86 Mill 0.75 "rowg .®'_ `...A a;A•. • -__- 350,000 180 0.59 0.20
Monthly Loading: &w s�': 1,260,000. 3.07 ° 1.78 h.'
12 Month FloatingTotal(in): ..s:.y° . ;.: 35 34 32.90

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? ❑✓ Compliant ❑Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? El 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.
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 El No Phone Number: 336 622 4276 Permit Exp.: 8/31/24
/2/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