WQ0003090_Monitoring - 07-2022_20220829

Monitoring Report Submittal
Permit Number #* wg0003090
Name of Facility:* town of liberty wwtp
Month: * July Year: * 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR july spray 2022.pdf 3.26MB
PDF Only
GW-59 july gw59 2020.pdf 2.76MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-7, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter: * Elix Fike
Signature:
Date of submittal: 8/29/2022
This will be filled in automatically
Initial Review

Reviewer: Gerald, Wanda
Is the project number correct?* wg0003090
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 9/20/2022

FonM:moMn10-13 NON -DISCHARGE MONITORING REPORT (NnK8R) Pao _1_m-1_
Permit No.: WQ0003090
Facility Name: Town Of Liberty - Wastewater
--FParameter
County: Randolph _T
month. July
Year: 2022
PP7__ 002--7
Flow Measuring Point: influent E Effluent No flow generated
Monitoring Point: El Influent 21 Effluent 0 Groundwater Lowenng surface water
mg
'a
113101
ON
"Velb
IN
INS
0.39
16
17
IS
6111V
10
gj
Sampling Type:
Grab
Grab
Grab
Grab
Grab
Monthly Avg. Limit:
Daily Limit:
Sample Frequency:
..ekly
)nth
2x month
2x month IN
weekly
3x year
h

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 -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
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 previo NDMR? ❑ Yes Ej No
Phone Number: 336 622 4276 Permit Expiration: 8/31 /2024
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

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SIR SPEEDY PRINTING GED)TER • 612-378-7778
off ..., CHAIN -OF -CUSTODY Analytical Request Document
PceAnaVical"
Chain-of-Custody is a LEGAL DOCUMENT -Complete all retevent fields
LABLISEONLY-Affix Work, WV# , 926154,54,
III�) IN IIIIIIIIII
ALL SHADI 92615454
Container Preservative Typn
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Company:
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Billing Informations
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Report To:
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., Preservative
(6) methanol,
(C} ammonium
Types:
(7) sodium
hydroxide,
(1)
nitric
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(D) TSP,
acid, (2)
(8) sodium
(U) Unpresarved,
sulrur
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(3) hydrochloric
(9)
Other
hexane,
acid, (4) sodium :hydroxide, (5) zinc acetate,
(A) ascorbic acid, M) ammonium sulfate,
Lab Profile/ i.lne:
Copy To:
Site Collection Info/Address:
Analyses
Customer Project Name/Number:
State: County/City: Time ?one Collected:
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Turnaround Date Required:
Immediately Packed on ice:
[ j Yes [ ] No
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I Dispose as appropriate [ ] Return
i .1 Ar h vc.
i IHoia: .._,.__
Rush:
[ ] Same Day [ j Next Day
[ j 2 Day [ 13 Day [ ] 4 Day [ ) 5 Day
(Expedite Charges ARPiy1
Field Filtered (if applicable):
[ ] Yes [ ] No
Analysis:
Matrix Codes {Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue ITS), Bioassay (B), Vapor (V), Other (OT)
Customer Sample ID
Matrix'
Comp!
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Composite Start}
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Res
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Date
Time
Date
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✓/
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Type of Ice used: et Blue Dry None_
SHORT `HOLDS PRESENT (<72 hours) 5` N N/A
L ati Sample Temperature in 0:
Temp Bunk f -ce tf Y N A
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LAB USE ONLY -Affix Workorder/Login Labe( Here or List Pace Workorder Number or
CHAIN -OF -CUSTODY Analytical Request Document
-r`'c ceAnalyr° cal MT11 Lag -in Number Here
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields��} V Z� 172
��
Company: Town of Liberty (6illingInformation: ALL SHADE r
Address: Container Preservative
Report To: Email To: ( — Preservative Types: (1) nitric acid, (2) sulfur; 92617274 i1
1 (6) methanol, (7) sodium bisulfate. IS) sodium
Copy To: Site Collection Info/AddreSS: I (C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (o) Other
i
Customer Project Name/Number: State: County/City: Time Zone Collected:
( / [ )PT[ JMT[ ]CT [JET:
Phone:
[ Site/Facility ID #:
Compliance Monitoring?
Email[
Yes [ ] No
Co '.ected By (p '
] Purchase Order #:
DW PWS ID
Quote #:
DW Location Code:
f
!lected B t
Turnaround Date Required:
Immediately Pac e on Ice:
[ !Yes [ !No
a e Disposal:
Rush:
Field Filtered (if applicable):
([ J Dispose as appropriate [ J Return
i [ ] Same Day [ ] Next Day I
[ ] Yes [ ] No
[ ]Archive:
2 Da 3 Da 4 Da " � Da
[[ J y[ J y[ J y[ Jy
!
Analysts:
[ I hold:
p (Expedite Charges apply)
* Matrix Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SQ, Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT) ; a
.Luc samp_e i.ecelpt CiI h. ist:
Custody, Seats P nt/ matt Y N V7N
I i i C::stody Signatures Present Y N+ NA
i Lol.lector Signature Present Y N LrA
( € settles Tntact x Y riff
3 r Correct sot
tles NI N A
F ± Sufficien dclume % Y Ne.
p Samples Receaved or, Tc=_- 1 z NA
1 VOA - H adtspace Accr ptacT:le S N tart
fi USDA RegulaPed sods Y N Liz
[ SamplLc in holding :irxe S N NA
Residual Chlorine Present Y N NA
1 strip
Sample; PH Acceptably Y Fri_
PH Strips
-
Sulfide present Y 7
Lead Acetate, Strips:
t f !
Comp/ Collected (or
Customer
ustomer Sample (D ¢ Matrix Grab Co �pmposite Start)
Res #of Lab Sample « % Commences:
i °J
_ d
Composite End Cl e Ctns
Date Time
'Effluent ww 19 a yg� r7
Ti
Date me CL 40
0
e..�-.___...___._..:� .sue-...s._�-...•¢
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Customer Remarks / Special Conditions / Possible Hazards: ;Type of ice used: Wet Blue Dry None SHORT HOLDS PRESENT (<72 hours): Y N 'N/A
Packing Material Used: - FLab Tracking #:
f
Effluent Monitoring
Radchem sample(s) screened (<Soo cpm): Y N NA Sampleseceived via:
( FEDEX UPS Client Courier Pace Courier
Relinquished�,.I me: !iR edby/Comp y:(Sgnatre) tDate/Time: M_.T...aJ.L.,. LAB USE _ ONLY
f
_
Table #:
_
y/Company: (Signature} ~y� ? ate/ impo e: l Received by/C ny gnatureJ Da) Da e%Time:
aD ]Template:
m
Prelogin:
ReQiquished by/Company: (Signature) iDateJTime: Received by/Company: (Signature) Date/Time: Ph9:
N I
Lab Sample Temperature info:
Temp Blank Received: Y N NA
Therm Me:
Cooler 1 Temp Upon Receipt: _____oC
Cooler 1. Therm Corr. Factor: _ oC
Cooler 1 Corrected Temp: oC
Comments:
Trip Blank Received: Y N NA
HCL McOH TSP Other
Non Conformancefs) Page
YES ! NO of:

DATE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
July 2022
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
10
10 3/4
10 3/4
11
11 1 /4
R
0.8
10 1/2
11
11 1/2
12
R
0.3
12
R
1.2
10 3/4
10
11
R
0.6
10 3/4
11 1/2
11
R
1.2
10 3/4
11
12
R
0.5
13
14
R
0.8
15
15
15
15
15
14
R
2.5
10
R
0.5
9 1 /2
10
10
TOTAL 8.4

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?
2 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? EZ 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 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
NON COMLIANT ON JULY 28 2022 18d
NFALL 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 [21 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

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _2_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?
121 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? EZ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 2 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 ❑J 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
NON COMLIANT ON JULY 28 2022 1&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 Officials Title: Town Manager
Has the
ORC changed since the previous NDAR-1? ❑ Yes 0 No
Phone Number: 336 622 4276 Permit Exp.: 8/31/24
Z
;�;7
qil
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