WQ0003090_Monitoring - 09-2022_20221026

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * September
Report Information
wg0003090
town of libety wwtp
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2022
Upload Document*
Fike report.pdf 3.46MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
e tremaine Pike
spy
Reviewer: Gerald, Wanda
10/26/2022
This will be filled in automatically

Is the project number correct?* wg0003090
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 11/14/2022

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _l_of_l_
Permit No.: WQ0003090
I Facility Name: Town Of Liberty - Wastewater
-Parameter
I County: Randolph
I Month: September
Year: 2022
PPI: 002
[Flow Measuring Point: 0 influent [] Effluent El No flow generated
Monitoring Point: El influent ED Effluent D Groundwater Lowering ❑ surface water
Parameter Code 0
00400
a. 00610
31613
Q
0
Q
0
0 0
4) M
0
+
.2
E
C.) i=
E
E
LL 0
z =
0
F-U) -6
0 Cn
z
C1
z
14
0
0
EWE,
24-hr
hrs
S u
mg/L
#/100 mL
mg/L
mg/L
Li
mg/L
�ffi - ",'�j
mg/L
1
7:00
8
6.78
9.9
2420
15.4
0.18
<0.040
ONE
2
7:00
8
U110 1145
3
111111V1
—
4
U'
'0111
5
81
61
7:00
8
NO 0
sk
71
7:00
8
8
7:00
8
6.94
=11
0.33M
MINE
9
7:00
8
10
11
2
Its
12
7:00
8
13
7:00
8
6.95
9.8
2420
15.2
0.12
Rg
<0.040
14
7:00
8
15
7:00
8
11141
NEW
16
7:00
8b
k141
0
17
11:00
2
1 WN
181
11:00
2
191
7:00
8
1 ILI ft,
911
201
7:00
8
P1 IN
SIMON
IS
Fit
211
7:00
8
221
7:00
8
7.39
0.16
gg
231
7:00
8
241
11:00
2
251
11:00
,
1 2
R
'j
26
7:00
8
27
7:00
8
211
28
7:00
8
29
7:00
8
7.36
MINN.@
0.16
30
7:00
8
311
MIA
Average:
9.85
2,420.00
*REF!
0.19
N"g—"N
0.00
Daily Maximum:
7.39
9.90
§q W""@R,%'
g
2,420.00
#REF!
0.33
0.04
Llfl�
Minimum:
9.80
,
2420 0
#REF!
0.12
'2' }xFNV
0.04
Daily
6.78
.0
.. ..... . .
Sampling Type:
Grab
Grab
I
Grab
Grab
Grab
Grab
10
Monthly Avg. Limit:
•U,
%
krlfi
MI
g
Daily Limit:
I'M gma
IN
A
'Q
M.,
Sample Frequency:
weekly
2x month
a;,,,
nth
2x month
2x month
'A-N o; R
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? El 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 Officials Title: Town Manager
Has the ORC changed since the previous NDMR? ❑ Yes 2 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

aceAnalXical"'
www.pacelabs.com
r
i
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92623479
Sample: Effluent
Method
SM 254OD-2015
EPA 350.1 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
SM 521OB-2016
Colilert-18
TKN+NO3+NO2
Calculation
EPA 351.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Parameters
Total Suspended Solids
Nitrogen, Ammonia
Nitrogen, NO2 plus NO3
Nitrogen, Nitrate
Nitrogen, Nitrite
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Nitrogen, Kjeldahl, Total
Phosphorus
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 09/14/2022
Date Received: 09/01/2022
Lab ID: 92623479001 Collected: 09/01/22 12:30 Matrix: Water
Results
Units
36.7
mg/L
9.9
mg/L
ND
mg/L
ND
mg/L
ND
mg/L
18.4
mg/L
2420
MPN/100mL
PACE
Garrett
Dreyer
09/01 /22
1230
6.78
Std. Units
0.18
mg/L
15.4
mg/L
15.4 mg/L
2.9 mg/L
Report Limit Analyzed
9.1 09/06/22 12:55
0.10 09/01/2218:24
0.040 09/02/22 08:50
0.040 09/02/22 08:50
0.040 09/02/22 08:50
2.0 09/06/2218:05
1.0 09/02/2214:15 El
09/01 /22 12:30
09/01 /22 12:30
09/01 /22 12:30
09/01 /22 12:30
09/01 /22 12:30
09/01 /22 12:30
0.040 09/14/22 21:52
0.50 09/14/22 04:16
0.050 09/13/2217:12 M1
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.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
South Carolina Laboratory ID: 99030
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
Qualifiers
Page 1 of 3

. _. ......
CErJl13/ytical
Company: Town of Liberty
Report To:
Copy To:
Customer Project Name/Number:
Phone:
Email:
Collected By
CHAIN -OF -CUSTODY Analytical Request Document LAB USEONLY- AffixWorkorder/Login Label Here or List Pace Workorder Number or
MTJI '�� /�i
Chain -of -Custody is a LEGAL DOCUMENT- Complete all relevent fields W V . 92f 2347 �/
Billing Information:
ALLS�iADED
ner e
ContaiPreservative Type
u i 2!�
� a - __ 92623479
" Preservative Types: (1) nitric acid, (2) sulfuric acid, I.
(b) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
dress: ! (C)ammonium hydroxide, to) TSP,(U) Unoreserved,10) Other
Analyses (Lab Profile/Line:
y: Time Zone Collected:Lab :,ample Pece'xic ht r 3
( JPT[ ]MT[ ]CT ( ]ETg
k j ( L`ustcdy Seai.�, tr.�EEnr�i T 1 ck Y NA
Compliance Monitoring? to
1 ] i x [ [ t CLccir 5 g .atu iis Prep W w { +A
[ /Yes [ ] No i col lector 5+gn.trzra Present tvrS
i 7 v � i3Cttt:Ze I.Ti Y.ctCC l`i 'a`'is4
i i € co recr aottle9 Cif NA
DW PWS ID #:
} I S.s?f#'Cie t: Yalu�e N t .
DW Location Code:
3 - fi i ➢Gimpluo P..e-c&iced an ice Y N
mmediately Pace on Ice: CLi _ V0A _ Headspace Acceptable Y N A
USDA R—laced Soils; Ls x7A
_,
s a 1 1 Yes [] No l o I t i s r 1e £ c.1 ng Tile � a 2
la ple Disposal Rush: Field Filtered (if applicable): � ~ { I ' ; ( Cl itzal Chlo ese - r'Wrm
[ ] Dispose as appropriate ( ] Return [ } Same Day ( ] Next Day ( J Yes ( ] No Z l j
[ ]Archive. @ [ ] 2 Day { ] 3 Day 1 ] 4 Day ( ] 5 Day Z Cis i ) a S ample p%t xoceor 11 xka u A - t ts>
( JHold: (Expedite Charges Apply) Analysis: M # O M1 ]A [ [ iH SltzapstcEt°
0 }— °`�.l 9V j# ! SI.aida Present,
X a ar
eud Acette Strips:
Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW), Z Z ( it aps:
E
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (i3), Vapor (V), Other (OT)co F- 6 r ) LAB USE ONLY -
Comp/ Collected (or ( Res #of F- Z _ [ CDl ( q Lab saircle # ? Coamenta:
E Composite End u- I E
Customer Sample ID Matrix * Grab Composite Start) Cl Ctns 0 cn 0 C}of
, , Ii
Date Time Date m Z Li Q
Time CZ _
;Effluent }wW 9 4" t uL. 12,5C) 15
Email To:
Site Collection Info/Ad
State: County/Cit
/
Site/Facility ID #:
Purchase Order#:
Quote #:
Turnaround Date Required:
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice used: Wet Blue Dry None SHORT HOLDS PRESENT (<72 hours)Y N 4 N/A Lab Sample Temperature Info:
TempBlank Received: Y N NA
Packing Materia] Used: / ILab Tracking #: a
t Therm IDH:
Effluent Monitoring Cooler 1Temp Upon Receipt: C•koC
5ampi iai — Cooler 1 Therm Corr. Factor I oC
gRadch em sample(s) screened (<SQO cam):
Y N NA FEDEX UPS Client Courier ace Courier Cooler 1 Corrected Temp-
i _aC
i Comments
Reli y: (Signature)Date(Time:; Rec 'ved by/Company ignature) jDate/T me: MT1L LAB
D i / p
t ft fJ q1V � 1 d l L Table #:
e' uis e y Company: (Signature) }D t /Time: eived by/Co any: (i iature) Date/Time:
a Template: Trip Blank Received. Y N NA
NPrelogin; f HCL MCOH TSP Other
ReWquuished by/Company: (Signature) (Date/T me: Received by/Company: (Signature) )Date/Time: PM:
I n Non Conformance(s): Page: '
;PB: YES / NO of:

C
2 r
:x s
"u'E S f--r C.",Icr�;-,-=
-----------
):j
P ac -3 2 c "' 2
Lo,;;
Page 3 of 3

acmnalylical
j www.pacclabs.com
I
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92624567
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 09/09/2022
Date Received: 09/08/2022
Sample: Effluent
Lab ID: 92624567001 Collected: 09/08/22 13:00 Matrix:
Water
Method Parameters
Results Units Report Limit
Analyzed Qualifiers
Performed by
PACE
09/08/22 13:00
Collected By
Garrett
09/08/22 13:00
Dreyer
Collected Date
09/08/22
09/08/22 13:00
Collected Time
1300
09/08/22 13:00
pH
6.94 Std. Units
09/08/22 13:00
Chlorine, Total Residual
0.33 mg/L
09/08/22 13:00
Reviewed by: n5<mc�
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN -OF -CUSTODY Analytical Request Document
�ace�l�a��`icai
Chain -of -Custody is a LEGAL DOC_UMENT-Completeallreleventfields
'Company: _ Town ofLiberty Billing Information:
Address:
Report To:
Copy To:
Customer Project
Phone
Email:
By (print):
LAB USE ONLY- Af„n U•,%orf or c ,'�oLt aLal .,e.. r a ova n�� 's,._ , ___ _ __
MiTY
ALL SHADED AF
Container Preservative Type ►i�'
92624567
Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) „Yu,—wonc acid, (4) sodium hydroxide, (5) zinc acetate, A
(5) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (8) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
c
Analvses iLab Profile/Line:
iState- County/City: Time Zone Collected:
/ [ ]PT[ ]MT[ ]CT [ )ET 3 )
Site/Facility ID #: Compliance Monitoring?
[ yYes [ ] No a M
Purchase Order #,- dg DW PWS ID 4: k
Quote #: I DW Location Code: j
�
Turnaround Date Required: .immediately Packed on Ice:
[ [ ] Yes [ ] No p 1.2
Lt
Email To:
Site Collection Info/Address:
Sample Disposal 1 Rush: Field Filtered (if applicable):
( I Dispose as appropriate [ j Return [ ] Same Day [ ] Next Day [ ; Yes [ j No [
[ ] Archive: [ ] 2 Day [ ] 3 Day [ ] 4 Day ( ] 5 Day (o
( IHold: Analysis:
(ExpeditethargesApply)
" Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW), co i
Product (P), Soii/Solid (SI.), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT) I
i
i
I
f
i
ff
Lab Sample Receipt c hec;;.lmnt:
rusted, Seals rze en*tr act Y N i3A
cusrodf Signatures Present Y R NA.
CollectorColleccor sigratu e c^zs ,ant, g td NX
Bottles intact Y t7 NA
Correct Potties v ti NA
Sufficient "olume v v NA
Samples Received on Ice x 7 KA
vwk - Yeadspace Acceptable 1 NA
USDA Regulated Sc ls. X N NA
8 mcl.eu in Holding Time i U NA
Fesidual Chlorine Present `_ N NA
Cl S „ pm
Sample PH Acceptable Y ri ZSA
nv Strips
Sulfide Present Y N NA
Lead Acetate Sr_ipcz:
Customer Sample ID
p
Comp/ Collected (or
Matrir. ` Composite End
I � Grab r .Composite Start)
1 Date Time Date Time
Res
Cl
# of m [ ( I $ Last Sample 4 ; Commence::
u 1 `
(Gins
li 0
l ( CL k 1
Effluent
WWg y�� 2 z ` (3 [
i
0
Customer Remarks / Special Conditions / Possible Hazards: }Type of Ice Used; Wet Blue Dry Nonev
Packing Material Used;
` Effluent Monitoring
Radchem sample(s) screened [<SQO cpm): Y N NA
Relinquishp pany`(�Sjgnatu [DateMme. =Refeodby/Comppy:(Sigrt4ure)
iRT HOLDS PRESENT (<72: hours): Y N N/A I Lab Sample Temperature info:
Tracking #: Temp Blank Received: Y N NA
Therm IN.
_ Cooler 1 Temp Upon Receipt: _ ,_oC
pies received via; Cooler 1 Therm Carr. Factor: aC
FEDEX UPS Client Courier Pace Courier { Gooier 3 Corrected Tcmpa: aC
Date/Time: i- MTJL LAB USE ONLY 1 Comments:
@trdished,by-/Company: (Signature) eDgte/Time: IReceived-by/C�impany: (Signature) Date/Time: =
n } , 4 i 'Template: ( Trip Blank Received: Y N NA
( ? a HCL McOH TSP Other
tv
6�puished by/Company: (Signature) i. Date/Time: M? Received by/Company: (Signature) ! Date/Time.
v PIA: Non Conformance(tl 'Page:
PB: YES / NO of:

acmnalXical "'
www.pecolobs.com
f
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92625200
Sample: Effluent
Method
SM 254OD-2015
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
SM 521OB-2016
Colilert-18
TKN+NO3+NO2
Calculation
EPA 350.1 Rev 2.0 1993
EPA 351.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Parameters
Total Suspended Solids
Nitrogen, NO2 plus NO3
Nitrogen, Nitrate
Nitrogen, Nitrite
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Nitrogen, Ammonia
Nitrogen, Kjeldahl, Total
Phosphorus
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 09/26/2022
Date Received: 09/13/2022
Lab ID: 92625200001 Collected: 09/13/22 11:55 Matrix: Water
Results
26.5
ND
ND
ND
23.7
2420
PACE
Garrett
Dreyer
09113/22
1155
6.95
0.12
15.2
9.8
15.2
2.6
Units
rrg/L
mg/L
mg/L
mg/L
mg/L
MPN/100ml-
Std. Units
mg/L
mg/L
mg/L
mg/L
mg/L
Report Limit
9.6
0.040
0.040
0.040
2.0
1.0
Analyzed
09/16/22 12:17
09/14/22 11:03
09/14/22 11:03
09/14/22 11:03
09/19/22 16:17
09/14/22 14:32
09/13/22 11:55
09/13/22 11:55
09/13/22 11:55
09/13/22 11:55
09/13/22 11:55
09/13/22 11:55
0.040 09/26/22 08:58
0.20 09/23/2212:36
0.50 09/25/22 08:12
0.050 09/21/2218:59
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.
c
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
South Carolina Laboratory ID: 99030
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
El
Qualifiers
Page 1 of 3

-�dCEAtl� �fC2i
Company: Town of Liberty
Address:
Report To:
Copy To:
Customer Project Name/Number:
.�,E USE ONLY- Workorder/Lot
C%'..i N-OF-CUSTODY Analytical Request Document gin Label Here or List Pace Workarder Number or
Chain-cf-Custody is a LEGAL DOCUMENT- Complete all releventfields
Billing information: ALL SHAD
f r 8262°! Jill III
CantainerPresevative�
u 2 & 280
Email To: " Preservative Types: (1) nitric acid (2) sulfur ..,-
_�__,� (6) methanol, (7) sodium bisulfate, (8) sodium thiosuFate, (9) hexane, (A) ascorbic acid, t61
Site Collection info/Address: I (C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other #`
Analyses Lab Profile/Line:
State: County/City: Time Zone Collected:
/ [ ]PT[ ]MT[ ]CT [ JET
Phone:
4Site/Facility ID #:
Compliance Monitoring?
Email:
€[ Yes [ ] No
I Collected y ( rant):
Purchase Order #:
DW PWS ID #:
Quote #:
DW Location Code:
'Turnaround Date Required:
Immediately Packed on Ice:
[ ] Yes [ ]NO
wisp;�L
Rush:
Field Filtered {ifapplicab€e}:
appropriate[ ]Return
[ ] Same Day ( ] Next Day
[ )Yes [ ]No
[ ] 2 Day [ ] 3 Day [ ] 4 Day [ ] 5 Day
Analysis: y
[ j Hold:
(Expedite Charges Apply)
I
d
i I
( I
Z
Z Z 4
Q
` Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WWI, Z Z
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue ITS), Bioassay (B), Vapor (V), Other [OT) ( c ?5
Lab Samole Receipt Che Yl tc
y) Custody Seals Present/Intact y s
i 'ns ody Signatures Present
( icollector Signature Present ', NA
I aril lea Intact �" NA
( F c ect Bottles Y 4 SSA.
( sufficient Volume RA
Samples Received on _ vt 7 NA
VOA - Headspacr Acerptable - ti
USDA Regulated sa is . V'
,Samples in Holdina'l'zmie /T�*
Residual chlorine PV3nt
Cl Strips, i"3
r ample PH Acc4 le r n 7srA
( ( prf Stripe:
.m..L<.� �
(.. j Sulfide, present S ti
4 L,<,ad Acetate Strips:
1
S r.nzi ar.+F arr,v-.:
i Comp J f Collected or
� ` p (
'
Res # of F- ( I aLD [ ) ( + ( Lab Sample # I Commento
Composite End Z s C }L !
„ Composite Start}
CustomerSamplelD Matrix Grab
l
CI Ctns 1= } U 9
Date Time
Date Time ¢ Z LL. l CL ( 3
JEffiuent K 9 t Zz
�5 ) ( ( �
. . .... . ............ .
s+
(.
Customer Remarks / Special Conditions / Possible Hazards. jType of ice used: Wet Blue Dry None
Packing Material Us�
i
` Effluent Monitoring _..
Radchem sample(s) Screened (<500 cpm): Y N NA
Relinquish_ } (Cate/Time: jRecg�edby;Compan (Signature}
e� _ ! 1 p' .
,any: (Signature) ate/Time: , Re _ived by/C r pang:
wished by/Company: (Signature)
Cate/Time: Received
w
SHORT HOLDS PRESENT (<72 hours�Y,J N N/A
Lab Tracking #:
pies received via:
FEDEX UPS
Client Courier Pace
Da Time:
_ M".
'
1 -f , o : Table # _
r L
Acctnum:
Date/Time:
`Template.
?Prelogin:
Date/Time:
PM:
PI?
Lao�Iampie temperature inro:
Ternp Blank Received: Y L NA
ThermiD#: ��'-P- 0
Cooler 1 Temp Upon Receipt: Y—'�-.c
Cooler 1 Therm Corr. Factor: --- . I a -
Cooler l Corrected Temp: oC
Comments:
Trip Blank Received: Y N NA
HCL McOH TSP Other
Non Conformance(,,): `Page:
YES / NO of:

�AAr
aceAnafjdka(
Document Name:
Bottle Identification Form (BIF)
Document Issued: November 15, 2021
Page 1 of 1
Document No.:
F-CAR-CS-043-Rev.01
Issuing Authority:
Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is Project #
verified and within the acceptance range for preservation �-�
samples. l 1' �.�•'r'"�`i .�.-.,
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/3015 (water) DOC, LLHg
**Bottom half of box is to list number of bottles
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Arnount of Preservative Lot It
adjusted added
r
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a Copy of this form will be sent to the North Carolina DEHNR Certification Office (i.e.
Out of hold, incorrect preservative, out of temp, incorrect containers.
Page 3 of 3

aceAnalytical
www.pacolaboxont
I
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92627092
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 09/28/2022
Date Received: 09/22/2022
Sample: Effluent Lab ID: 92627092001 Collected: 09/22/22 09:53 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 09/22/22 09:53
Collected By Glenn Price 09/22/22 09:53
Collected Date 09/22/2022 09/22/22 09:53
Collected Time 0953 09/22/22 09:53
pH 7.39 Sid. Units 09/22/22 09:53
Chlorine, Total Residual 0.16 mg/L 09/22/22 09:53
Reviewed : bY <iXP7u� / uY
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

FEo`m­Wy: Town of Liberty
CHAIN -OF -CUSTODY Analytical Request Document
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
i Billing information;
i Address:
Report To: Email To:
Copy Site Collection Info/Address:
T__
LAB USE ONLY -Affix Workorder/Login Label Here or List Pare Workorder Number or
MTJL Log -in Number Here
fh92
ALL SHAE W0# : 926270
Container Preservative To — _.- . — a I to all
*1 Preservative Types: (1) nitric add, (2) sulfi 111 Its a 1111 1 tin a I is -11,
(6) methanol, (7 sodium bisulfate, (8) sodiur
92627092
(C) ammonium hydroxide, (D) TSP, (U) Unpre
Analyses
ILab Profile/Line.
Customer Project Name/Number: I State: County/City: Tme Zone Collected:
Lab Gazvrple Receipt Checklist:
JPTf JMT[ IC' )ET
i
Custody seals Present/lura= Y N to
Custody Signatures Preent y N Nz�
Phone: Site/Facility ID Compliance Monitoring?
Email: [ 'Yes ]No
collector signature Present Y, N rx
ottlao Zntlact y 9 NA B
Correct Bottles y K NA
Collected. B print) Purchase Order#. DW PWS ID #:
>y
Quote #.- DW Location Code:
v J I
li;ufficierm Volume T N MA
'on
Samples Received on Ice y y &A
vok - Beadispace Accoptable y N, xr
Collected By (signature): V Turnaround Date Required: immediately Pace Ice:
1Y_ ]No
USDA Regulated Soils y N NA
a)
Samples in Ho_ldinq Time y N NA
Residual Chlorine Present Y N NA
Cl
SampI6 Disposal: I Rush: Field Filtered (if applicable);
Dispose as appropriate r, Return Same Day Next Day ]Yes ]No
•9= i R
Strips:
Archive: 12Day [ 13Day f 14Day 5 Day
Analysis:
n
8 a q
Sample pli Acceptable ' N NA,
PH Strips:
I Hold: fExpedite Charges Apply) I
!;'+
0
75
sulfide Present y N NA,
Lead Acetate Strips;
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 (9), Vapor (V), Other (OT)
it
A
2
1,10 USE ONLY,
Lab Sample Comments:
I Collected (or
Res # of
F
Customer Sample ID Matrix
Composite Start
Grab ',
Composite End
ClI I Ctns
LL
—
-6
I Date T_lme -1
i
=
CL
-6
l__
Date
lEffluent
9
1
-------------- J
_J
Sp
Customer Remarks Special Conditions Possible Hazards: ITYpe 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: Y N NA
Therm ID#:
Effluent Monitoring
Cooler I Temp Upon Receipt: oC
'Samples received via:
Cooler I Therm Corr. Factor: cc
Fadchem sample(s) screened (<500 cpm): Y N NA
it FEDEX LIPS
Client Courier
Pace Courier
Cooler I Corrected Temp: oc
re) Relinquis t�any�
�lgn-
Dat Time: Rec ed by/Comry: (Signature)
Date/Ti me:
. ....
MTJL LAB USE ONLY
Comments:
,
�by/'Comp.
VR�!ja.,,hed Signature)
Date/Time: R eived by/ pa (Signature)
Date/Time:
�Template:
Trip Blank Received: Y N NA
a:)
CD
iPi
relogn:
t
i
HCL MeOH TSP Other
N)
Ranquished by/Company: (Signature)
!D2te/Time: 1 Received by/Company: {Signature}
i
Date/Time:
ipm:
f
Non Conformance(s): Page:
'PB:
YES / NO

acmnalytical u
www.pacelabs.com
i
I
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92628341
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 09/29/2022
Date Received: 09/29/2022
Sample: Effluent Lab ID: 92628341001 Collected: 09/29/22 11:45 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by Pace 09/29/22 15:43
Collected By Garrett 09/29/22 15:43
Dreyer
Collected Date 09/29/2022 09/29/22 15:43
Collected Time 1145 09/29/22 15:43
pH 7.36 Std. Units 09/29/22 15:43
Chlorine, Total Residual 0.16 mg/L 09/29/22 15:43
Reviewed by:
-�n1c��4tz
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

i
! CHAIN -OF -CUSTODY Analytical Request Document
(- Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Company; Billing Information:
Address:_
iReportTa: Email To:
Copy To: Site Collection Info/Address. I
[Customer Project Name/Number: State: County/City: Time Zone Collected:
1 ( 1PT f lMT f 1CT ( IET
`tAB USE ONLY- Affix Workorder/Login Label Here or List Pace Workorder Number or
MTJL Log -in Number Horn
34
I
ALL
ContalrerPresei
Preservative Types: (l) nitric acid, 926213341 ..,..,. �, t,i unc acetate,
(6) methanol, (7) sodium bisulfate, (8) svmum thiosuliate, (9) hexane, (A) ascorbic acid, {e) ammonium sulfate, l
(C) ammonium hydroxide, (D) TSP, (U) Unpreserveo (C) Other
Analyses �— LabF ort.P1e ery Y t lj
Phone: Site/Facility 0#: �— Compliance Monitoring? !
E r ,s Pr �. , Y [ N"
Email [ ) Yes [ T No E )
i Ir ac Fq ___ L r e S 11 t i ti
C ected6- tl: Purchase Order#: DWPWSID#: ; ;
is t Es it �
4 _ Y ti U.
Quote#: Location CCde
�DW
SCai!ecF� maround Date Required: lkmmediately Packed on Ice: k j
! ( Sac -pies - t
ICA 21 iT'k
_
e Disposal: Rush: Field Filtered (if applicable): ) ��p
,. „'! i i f
E
1 Tom-- 1 ., i: T.I c,. 7 -
i[ ] Dispose as appropriate ( j Return ( ] Same Day ( ] Next Day [ j Yes [ ) No ' j
Archive: [ 1 2 Day ( } 3 Day C l 4 Day ( 1 5 Day ( i !
( i Dual Ch t_ _: _ Pr _>e.i, i.
i� r,p !
�( J Hold: l!
Ex edlteChargesA I) !Anal sis:
---- _
a 01e o f cr tL b:.
IPr
t—
p
�+ Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater(WW), i #
i
Product (P), Sail/Sold (S_), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
I _
I� , 1d c[
C Cam / Collected or j� Res 4 i i S j
Sample Matrix" p I ( Composite End I
Sa j k
m
Customer p c Grab Composite e Star Cl Ctns (
f ;Lab -ample s:
Date Time Date Time I
i � f
t{ 1
i i I i l
,
. f r
i
F ,
j
1
—
Customer Remarks J Special Conditions J Possible Hazards: Type of Ice Used: Wet Blue Dry Norse 'SHORT- HOLDS PRESENT (c72 hours) : Y N N/A !LAB Sample Temperature Info:
Packing Material Used: Lab Tracking #: ! T
P 'Samples received via:
ERadchem sample(s) jcr2encd (<;JO rpm): Y N NA! Fx L :t
FEDEX UPS Client Courier Pace Courier
Re4isid �y: (5 �a.at cep D�a t%EjTtme: Received by/CompanW (,Signatur"e}. .� B D t /Tim } ! M II I AR i ICF nN1 V
-- '"
��y/Company: {Signature} �te/Jf ime: j e Ived byJCom ny: { i nature} Date/Time: Acctnum: Trip Blank Received: YWN Na
� Template: ) HCL McOH TSP Other
m Prelogin:
III __.._._.__ .._.�._._�.
n 1PfJ: Non Conformance 1
Re�tquished by/Company: (Signature} Date/Time: Received byJCompany: (Signature) ate/Time: (s): !Pag=:
Itfj PB: ......---_ 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
September 2022
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
22
23
24
24 1 /2
24 1 /2 R 0.5
24 1 /2
24 1 /4
23 R 0.5
23
22 3/4 R 0.5
22 3/4
22 1 /2
23
23
24
25
26
27
27 1 /2
28 1 /2
29 1 /4
30
30 1 /4
30
29 3/4
29 1 /2
29
29 1 /4
29
28 3/4 R 0.3
TOTAL 1.8

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? O 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? ❑O 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.: 8131124
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _2_ of _2_
Permit No.: W00003090
Facility Name: Town of Liberty - Wastewater
County: Randolph Month: September
Year: 2022
IN fa # ;
It
Field Name:
6
a'` rx?; x f t
Field Nam e•
8
Did irrigation occur�
���
� � `� •„ „
Area (acres):
15.1
4x3'; �k'afl� : tti R��r-.r xx, Y �x
� x �� �p ����� � r
Area (acres):
21.68
at this facility?
��'Y ''�
Itx
Cover Crop:
FESCUE
�
��..«? f
Cover Cro p
FESCUE
❑ YES ❑ NO
WNW
Hourly Rate (in):
0.21
..
Hourly Rate (in):
0.21
„
Annual Rate (in):
52�g
`„
�`�°
Annual Rate (in):
52
I�
Weather
Freeboard
Y
Field Irrigated?
2 YES
❑ NO
' � , z `
Field Irrigated?
Q YES ❑ NO
m
>v
o
aU�d„
E m
(DO
E
:°
n
ER
—
��
o
E
E wam
a
$
o
0
J
a
o .
cc
o
Cc =J
E
R
iQ
Q
i
J
°F
in
ft
ftx
gal
min
in
in
3' �x �'
gal
min
in
in
1
C
70
1.75
252,000
180
0.61
0.20'
3
C
76
2
.;, .
350,000
180
0.59
0.20
4
PC
70
2
252,000
180
0.61
5
PC
69
0/0.5
2
6
8
R
0.5
9
�.
12
13
14
C
68
2
15
C
60
2
_
252,000
180
0.61
0.20
�.`a �."'"oY�.,
350,000
180
0.59
0.20
16
C
62
217
xx
181
C
84
2.25
252,000
180
0.61
0.20
19
C
61
2.25�o,,
�'�, . �a �
350,000
180
0.59
0.20
20
C
66
2.25
21
C
89
2.25
.. , ..
zzt ,
252,000
180
0.61
0.20
22
C
80
2.5
et
23
241
25
26
27
C
75
2.25
h..' xµ m �.a 252,000
180
0.61
0.20�t
28
29
30
,� `"1,512,000
Monthly Loading.
3.69
n y..
1,050,000
1.78
12 Month Floating Total (in)-
28.57

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 ❑ 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? 0 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 El No
Phone Number: 336 622 4276 Permit Exp.: 8/31 /24
X"'al
'1�11
Signature Date
Signature D to
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