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Home My WebLink AboutWQ0003090_Monitoring - 04-2023_20230707Monitoring Report Submittal Permit Number#* WQ0003090 Name of Facility:* town of liberty WWTP Month: * April Year: * 2023 Report Information Type* Upload Document* NDMR, NDAR-1, NDAR-2, NDMLR tremaine april 2023 report.pdf 4.28MB PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). Confirmation Email Address: * tfike@townoflibertync.org Name of Submitter: * Elix Fike Signature: Date of submittal: 7/7/2023 This will be filled in automatically Initial Review Reviewer: Wanda.Gerald Is the project number correct?* WQ0003090 Is the monitoring report accepted?* Yes No Regional Office* Winston-Salem Reviewer: _anonymous Review Date: 7/7/2023 FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _l_ of _l_ Permit No.: W00003090 Facility Name: Town Of Liberty - Wastewater County: Randolph Month: April Year: 2023 PPI: 002 Flow Measuring Point: ❑Q influent ❑ Effluent ❑ No flow generated Parameter Monitoring Point: ❑ influent Q Effluent ❑ Groundwater Lowering ❑ Surface water Parameter Code —► 00400 00610 31613 00625 50060 70300 00630 td = 0 CD Ea3 o o L C mM d -aa= wa,2a d cc Q H y = G £ O Y N C O N .O w O Q U. U Z F U ~ Q y Z Z O O ►�- 24-hr hrs su mg/L #1100 mL mg/L mg/L mg/L mg/L 1 2 3 7:00 8 4 7:00 8 5 7:00 8 WRIM 61 7:00 8 JAJIMM 7.11 14.2 2420 18.9 0 <0.040 7 7:00 8 8 10:00 2 9 8:00 2 10 7:00 8 11 7:00 8 12 7:00 8 8.45 0.22 RIM 13 7:00 8 14 15 16 17 Komi 18 19 7:00 8 20 7:00 8 7.16 11.4 1410 14.2 0 0.046 21 7:00 8 22 23 24 7:00 8 25 7:00 8 26 7:00 8 7.59 0.09. 27 7:00 8 28 7:00 8 29 5:30 2 t 301 10:00 2 31 Average: 12.80 1,847.21 #REF! 0.08 0.02 Daily Maximum: 8.45 14.20 2,420.00 #REF! 0.22 0.05 Daily Minimum: 7.11 11.40 1,410.00 #REF! 0.00 0.04 Sampling Type: Grab Grab Grab Grab Grab Grab Monthly Avg. Limit: - Daily Limit: Sample Frequency: weekly 2x month 2x month 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? 2 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 compiliant on the day of 4/7 4/8 4/9 4/10 4/11 4/15 4/25 AND 4/29 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 [21 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 Pace Analytical Services, LLC 1377 South Park Drive Kernersville, NC 27284 (704)977-0981 11'7palceAnalyfical www.pacelabs.com Tremaine Fike Town of Liberty PO Box 1006 Liberty, NC 27298 Project: Town of Liberty Pace Project No.: 92660997 Sample: Effluent Method SM 2540D-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 353.2 Rev 2.0 1993 EPA 365.1 Rev 2.0 1993 ANALYTE QUALIFIERS 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 Laboratory Report Page 1 of 1 Report Date: 04/19/2023 Date Received: 04/06/2023 Lab ID: 92660997001 Collected: 04/06/23 12:05 Matrix: Water Results Units Report Limit Analyzed 20.0 mg/L 5.4 04/07/2311:45 ND mg/L 0.040 04/07/2311:37 ND mg/L 0.040 04/07/2311:37 ND mg/L 0.040 04/07/2311:37 20.2 mg/L 2.0 04/12/2315:35 2420 MPN/100ml- 1.0 04/07/2312:53 Pace 04/07/23 09:03 Garrett 04/07/23 09:03 Dreyer 04/06/2023 04/07/23 09:03 1205 04/07/23 09:03 7.11 Std. Units 04/07/23 09:03 0.00 mg/L 04/07/23 09:03 18.9 mg/L 0.040 04/19/23 07:57 Nitrogen, Ammonia 14.2 mg/L 0.40 04/15/23 11:22 Nitrogen, Kjeldahl, Total 18.9 mg/L 0.50 04/13/23 06:30 Nitrogen, NO2 plus NO3 ND mg/L 0.040 04/18/23 12:41 Phosphorus 2.6 mg/L 0.050 04/14/2314:51 D6 The precision between the sample and sample duplicate exceeded laboratory control limits. 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: Stephanie Knott 704-977-0981 stephanie.knott@pacelabs.com 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 D6,EI Page 1 of 4 CD CD A A I Section A Required Client information CompaWY: Town of Libe. Address: PO Sox 1006 Liberty, NC 27298 CHAIN -OF -CUSTODY / Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. All relev2~' Submitting a sample via this chain of custody constitutes acknowledgment and acceptance of the Pace Terms and Conditions found amaw# e Section 8 Section C s Required Project Information: Invoice Information: ty spot To : 7remaine Fdca ttentiany Name: 1 dress: 92660997 urchase Order* � Quote: x one. (338)bZ21276 FaX: roject Name: Town of Litre - Every 2 Weeks ace Project Manager, stepnan e.krort ace(abs.rom, State t Location equested Due Date: ro ed # aceProfite q: 13077 NC t=lftefed YIN a O COLLECTED Preservatives MATRIX CAE m y p C—" W.., cW Wa r Wr ui m U J W.* �N'gtet AW 2 4 S' P SAMPLE ID5L c? STRR7 END a v Y 09 OL One Cttaraciar per box. p° na It {A-Z, 0.9 t , -} Unar or o T$ -s d Um'Caa Sample Ids must be unique X Oz p Z m tOi 4C UNS z m C 0 E E0 2U UCs ( f DATE TIME DATE TIME = z 2 C Zm aO i Eftluent (fq P5 X X X X X X X X 3" $' 6 7' 8 _9 30 11 12 ADDMONALCO"ENI '..RELIWWMHEDBYtAFFIUAT*N DATE TIME 'ACCEPTED BYIAFFILIATION DATE TIME, SAMPLE CONDITIONS ^� LM NAME AND SIGNATURE 3 u ro m a E PRINT Name of SAMPLER. lN✓%�Y r/ LU u z m� z s z SIGNATURE of SAMP DATE Signed: lid I tx UU} n} DG# — Title: ENV-1FIRM-HUN11-00,54 VQ1_TeCh Spec Sample Gondition vace, Upon Receipt Effective Date; 05/124-022 ------- .boratory receiving samples: ;heville 0 Eden [] Greenwoocl[] Huntersville [] RaleighE] Mechanicsville[,--] Atlantao Kernersviller/1, Offimm Client Name: Project H: J---urier: Fed Lx PS El —USPS J Commercial Race -/J arrier Tracking Number: ustody Seat Present? Elye5 No Seats Intact? Dye' El No Date/Initials Person Examining Contents;_ HJ icking Material: E]Bubblp Wrap FJBubb e Bags ONone El oti'ler Biological Tissue Frozen? I IR Gunlo 1,64- IF 0 0 2— Type of lce� ywQt 0 Blue jler Temp ('C Correction Factor: Add/ Subtract VC! rrected Cooler Temp ('C):__ iDA Regulated Soil ( M N/A, water sarnple'l d samples originate in a quarantine zone within the United States; CA, NY, or SC (Check friapO? ]Yes ONo -X Elyes [JNo [JN/A EJ Nc,(-,e Temp should be above freezing to 6*c Of temp C"'ter'a- SafyiPlvs On ice, coo, ng pr-,) has begun Did sar,-ple5 originate frorn a f<,ifqigTj source tin ternitio,) J 1—C-h—am of- Custody' Present? [yes 5amples Arr ved within Hold Time? 6Y ON; A 2 Short Hold Time Analysis (02 hr.}? ---PTyeS ---ONO E)N1jA 3 Rush Turn Around Time Requested? ---,_QyeS Sufficier"t vome? Q�111 N; A JN�' 4 5 Correct Ccrtai(ers Used? -Pace Containers Used? Eyes L]Na ContalneFs intact? �0_O N;± 7, Dissolved analysi5: Sampies Field FiltereV_ [Iy�i EINa — J �LN/�� — 8 Sample La:,iet5 Match COO OYLs _ ( 4c, E)NA 9. udes Oat Wirne!l O/Analys i,� Matrix: Headspace in VOA Vials (>5-6mm)? Trip Bank Present? Trip Blank Custody Sears Present? VV Oy`�%--E)NQ Elyes DO LI,, 6N.'A ------ -0 No ffN'/A 411. jjL li� 10 Temp Log: Temp must be maintained at <6 C during login, record temp every ZO minutes. Time opene&jq U D Temp: Time: 0 put in cooler Time; p: Person Contacted: Project Manager SCURF Review: i nt in Of,;r)iit CLIENT NOTIFICATION/RESOLUTION Date/Time: � Date: Field Data Required? Dlo Project Manager SRF Review: Qualtrax Document ID: 70677 Page 1 of 2 Page 3 of 4 DC# — Title, ENV-FRM-HUN1-0084 v0I—TeC—hSpec SampleCo Upon Receipt -Effective Date: 05/12/2022 *Check mark top half of box if pH and/or dechlorination Project is verified and within the acceptance range for preservation samples. Exceptions VOA, Coliform, TOC, Oil and =irease, DRO/8015 (water) DOC, U Hl; "Bottom half of box is to list number of bottles ***Check all unpreserved Nitrates for chlorine Me pH Adj u sitment Lc)g for 1 S'Imple I of pftsrvafivc of! tpon rfneipt Date -lime pfe➢efVolwfl Amount of M!,scvafive Lot $1 ... adjusted ad&'A Nw,n Whk2n,vij tbetkEs xi d15fNi),WCY Afecting WWII Carofin'a (off q?f 1,11 lce smopl�'S' a S opy of thk N)rrn UMlf I�w 5,?.w to jhIMR that of hold, incorrect (),)t o�( tern!),'Cnof�cot�on offif.(.. (I e Qualtrax Docurnent 1111, 10(377 Floge, 2 of 2 Page 4 of 4 aceAnal 'l'cal'o www.pacelabs.com Tremaine Fike Town of Liberty PO Box 1006 Liberty, NC 27298 Project: Town of Liberty WWTP Pace Project No.: 92661851 Sample: Effluent Laboratory Report Pace Analytical Services, LLC 1377 South Park Drive Kernersville, NC 27284 (704)977-0981 Page 1 of 1 Report Date: 04/12/2023 Date Received: 04/12/2023 Lab ID: 92661851001 Collected: 04/12/23 11:40 Matrix: Water Method Parameters Results Units Report Limit Analyzed Qualifiers Performed by PACE 04/12/23 11:40 Collected By Garrett 04/12/23 11:40 Dreyer Collected Date 04/12/23 04/12/23 11:40 Collected Time 1140 04/12/23 11:40 pH 8.45 Std. Units 04/12/23 11:40 Chlorine, Total Residual 0.22 mg/L 04/12/23 11:40 Reviewed by: �C�lieZ Stephanie Knott 704-977-0981 stephanie.knott@pacelabs.com Page 1 of 2 laceAnaljdicalo Jwww.pacolabs.com Laboratory Report Tremaine Fike Town of Liberty PO Box 1006 Liberty, NC 27298 Project: Town of Liberty Pace Project No.: 92663415 Pace Analytical Services, LLC 1377 South Park Drive Kernersville, NC 27284 (704)977-0981 Page 1 of 1 Report Date: 05/04/2023 Date Received: 04/20/2023 Sample: Effluent Method Parameters Lab ID: 92663415001 Collected: 04/20/23 13:50 Matrix: Results Units Report Limit Water Analyzed Qualifiers HACH 10206 Nitrogen, Nitrate ND mg/L 0.30 04/21/23 10:45 SM 2540D-2015 Total Suspended Solids 19.6 mg/L 8.9 04/21/23 10:49 SM 521 OB-2016 BOD, 5 day 19.6 mg/L 2.0 04/26/23 14:36 Colilert-18 Fecal Coliforms 1410 MPN/100mL 1.0 04/21/23 12:33 Performed by PACE 04/20/23 13:50 Collected By Garrett 04/20/23 13:50 Dreyer Collected Date 04/20/23 04/20/23 13:50 Collected Time 1350 04/20/23 13:50 pH 7.16 Std. Units 04/20/23 13:50 Chlorine, Total Residual 0.00 mg/L 04/20/23 13:50 TKN+NO3+NO2 Total Nitrogen 14.2 mg/L 0.040 05/04/23 13:20 Calculation EPA 350.1 Rev 2.0 1993 Nitrogen, Ammonia 11.4 mg/L 0.30 04/29/23 13:50 EPA 351.2 Rev 2.0 1993 Nitrogen, Kjeldahl, Total 14.2 mg/L 0.50 05/04/23 06:05 EPA 353.2 Rev 2.0 1993 Nitrogen, NO2 plus NO3 0.046 mg/L 0.040 04/25/23 16:09 EPA 365.1 Rev 2.0 1993 Phosphorus 2.3 mg/L 0.050 04/27/23 10:00 Reviewed by: Stephanie Knott 704-977-0981 stephanie.knott@pacelabs.com 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 Page 1 of 4 A race" CHAIN -OF -CUSTODY / Analytical Regi The Chain -of -Custody is a LEGAL DOCUMENT. All rejevanf I Submitting a sampte via this chain of custody constitutes acknowledgment and acceptance of the Face Terms and Conditions found at ht Section A Section B Section C [[[ Required Client Infannxtion: Required Project rnfattnation: trnroica Information: � Company: Town of LiDeny 7O: Tremaine Fike or t= v92N3Q1.5 I Address: PO Box 1006 1 :w — .111— n To: E=ry Name: FJAadreiv. F :.. .:'. A.ovis:v ... �[ i malt xchasa Order #- pace Quote: 'hone' {336i622-d2?6 Fes''''E= Name. Town of Liberty • Every 2 Weeks sca PrOiect Manager ste hanM.knoi" bs_com• < ' Stale f Locat;on ue*tad Dve pate: x P ace Profiled: 130T7 Sc Is Fled ttn Z o 0 COLLECTED Preservatives Marrtx coOr' c txuwnc w.r.. ow WCbr wT W"W Wa W W o SAMPLE [D � all or. $ ci START ENp ' Ono Character Per bo:L W" om V w as m {A,Z Q 3I . •} C OT p sample tds must tra Unique °c yt X Uj ~ m u� e 2'i. q 0 0 O N .. i.. d = Q. o o E i— DATE TIME DXTE TIME - j N- a C 2 N S 2 2 L7 m 2- Z . Z O O eo r �- d i Effluent V47 X X X X X X X X 2 3 A fi 7 8 9 i0 12 '.. RCYASTtONAL COptafENT3. REIJNQUt3ti£A -` Tmbi DATE TIME ACCEPTED BY1AFFIL FTrON DATE TIME SAMPLE CONOCnWM �j NANIE AND SIGNATURE m a PRINT Name of SAMPLER:.:: c > Y w i m E i SIGNATURE of SAMPLE DATE Signed: � z 3 ✓ 2� 2� tt` ov� ) a C iIV ENV+RM-HU 1.OUd4 vt31_Tech Spec ample Condition CO Upon Receipt r, .: ,ffaat tiva D�tn U5112d2022 _,. .-_.. aborzators/ receiving samples, _ %sfaeville [] EdenGreenwood _w hluntersville D Rau h[] Mechanicsville[J AtlantaEj Kernersvillej Client P13t"fie; _. _. Project R: �ourier: [ Fed Ex []tJPS ❑USPS Cr�rnr er ial []Pace []tither: -arrier Tracking Plumber: Custody Seal present? Ores ir: Seals Intact? [ ]Yes C_ Pio hate/initials Pei son Examining Contents; ticking Material Q8ubb1 a l ] 3ubWe Begs f 'Mona C)the> piotggic.ai Tissut? Frozen? herinonleter: o Cl lR cr,r5 la� I `i Type or Ise: [.]Ye, [_...JNr, N/A VfWel [18I;,e [J ivnne aoier Temp (°C );_ Correction Factc r; Add J Spbirar.t ('C) _ ..i'ej�m'yp shouid be above fccersng tcs 6 C )# otrected Cooler Tent � " �,,,J$.S iTt j73e5 Gist of to"'Y'. ry fr to if .�r2 a�._ S 0^. r , ��(70 `.-°� p,r ISDA Regulated Sort V.1 N/A: water s,a,^ipie) i;as bog,;ea >d samf ep {3riglnate in a quarantine CA, 147 res Jri o Scjcl c.K m=tips}' I'll Sara c; cr <atti Ir;�n a : ,,r i t:n r it 6'ng Aiwa, and put. (' ruC j `fh Cornments/tiiSCrepanGY, Chain at Custody Present? f�ve' [ �„ jtdJs 1 1 I Sa r riles Arrived within HU'd Time? Short. Hold Time Analysts (02 hr )? , rRU to Tufn AiOUnd Tllfne ftelaUCStC'iS? _i ��t5 (% ! �ip %A jj t �seni V iurr c? if t:... S rrei.: Crn Dine r� Used 41ar l rns )Wf -.-3 g Cccitainefs Used? ---------- - - -- - -- ---_ ---- I Cor;talnF?rS Intact? Dissolved analysis: Samples Field filtered? (,]Yes (:j,d,7 Sample Labels Ptau:h CUC3 (:r�s . Olw, ONJ,1 -Includes Date/Time/ID/Analysis IYlatrit<: Headspace in VOA Vials (ya-bmrn)? 7ri Blank Present? p Elr , Yet Otio jP;ct rA raJA 10 11 Trip (Bank Custody Seals Present? rl CC3htirlENTS/SAMPLE [3iSCREPANC'l Field Dina Requited? C]Yes [grip of split containers Temp lag: Temp must be maintained CLIENT NOTIFICATION/RESOLUTION at <6 C during login, record temp every 2O minutes. Time opened: ) Temp; Time: I j q put m cooler Tdmet Tempt Person Contacted; Project Manager SCURF Revlewe Date: Project Manager SRF Review; Date: Quallrax Document ID: 70677 Page 1 of 2 Page 3 of 4 #_ Title: -f RIVI-H NI-0084 < 1 chSpec Sara le- oiic9ltion Mier,flute �a�te: 4Xs11;�1�Q�� *Cheek mark trap half of box if ptl and/or dechlorination Project I! is verified and within the acceptance range for preservation sai'nplen, 1 Exceptiom VON (o6form, FOC, {ail and <iteta5e, DRO/80IS "Bottom half of box is to list n£araataer of bottles *"Check all taratareserved Nitrates for chlorine j pH Adjustment Log for preserved Samples $anrpif� li) rpa�C S'r��ervs7tiuIPp�ipt aprsaava8in djstd tr�r(58rv3tion Fernaut�i, of RrCs4 ru3hve Gqt y1 ad)usted I addi?d _ I , flute. W£r ntvtr tltierF is j dic•crF.par.cy :tit ciSng,tfxih t.mresp,aa c, rr�}d3�r�r _ s�.r,.r,i ws, a upy Ut t .#t>raltia l t)v r�,nt to tl:r, Mott iIrNn 3 '}ia{N;t Out of hold, Sncom" S prewfvmlve, aul of (9mp, mcurfuO wnutitlefs) Qualtrax Dec:un lent ICE: 70677 2. of 2 Page 4 of 4 IaceAnal ical jwww,pacelabsxom I Tremaine Fike Town of Liberty PO Box 1006 Liberty, NC 27298 Project: Town of Liberty Pace Project No.: 92664168 Sample: Effluent Laboratory Report Pace Analytical Services, LLC 1377 South Park Drive Kernersville, NC 27284 (704)977-0981 Page 1 of 1 Report Date: 04/26/2023 Date Received: 04/26/2023 Lab ID: 92664168001 Collected: 04/26/23 11:15 Matrix: Water Method Parameters Results Units Report Limit Analyzed Qualifiers Performed by PACE 04/26/23 11:15 Collected By Garrett 04/26/23 11:15 Dreyer Collected Date 04/26/23 04/26/23 11:15 Collected Time 1115 04/26/23 11:15 pH 7.59 Std. Units 04/26/23 11:15 Chlorine, Total Residual 0.09 mg/L 04/26/23 11:15 Reviewed by: Stephanie Knott 704-977-0981 stephanie.knott@pacelabs.com Page 1 of 2 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 R 0 April 2023 Liberty N.C.W.W.T.F Freeboard Lagoon Inches 0.5 1.0 TOTAL 6.2 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? D Compliant ❑ Non -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? [Z 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 Ej 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. IS AT 0 INCHES CAUSE OF I&I RAINF. 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 E21 No Phone Number: 336 622 4276 Permit Exp.: 8/31 /24 s j a� �-�._ --3 Signature I ate 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? 2 Compliant ❑ Non -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑J 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? ❑J Compliant ❑ Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant [21 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 NDARA? ❑ Yes [21 No Phone Number: 336 622 4276 Permit Exp.: 8/31/24 AV 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