WQ0003090_Monitoring - 02-2023_20230707

Monitoring Report Submittal
Permit Number#* WQ0003090
Name of Facility:* town of liberty WWTP
Month: * February Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR feb 2023 spray report.pdf 3.37MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * [e-mail]
Name of Submitter: * Elix Fike
Signature:
Date of submittal: 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.: WQ0003090 I Facility Name: Town Of Liberty - Wastewater
I County: Randolph I Month: February
Year: 2023
PPI77 02
Measuring Point: Influent 0 Effluent ❑ No flow generated
Parameter Monitoring Point: El Influent El Effluent El Groundwater Lowering El Surface water
Parameter Code
00400
00610
31613
00625
'0,
R",
0
Z
A
V
0,11 U
Kit}ll',",
+
1 711-00630
01, 1
CL
E
LL 0
0
W rn
�qg@,,4111 11
z z
gi,
R 10
0
0
24-hr
hirs
mg/L
071;1 R,
— — — - - - - - - - - -
1
7:00
8
1
8.06
i 13.1
2420
25.3
0
0.089
2
7:00
8
I
3
7:00
8
4
9:00
2
110
5
12:30
1 1
N"
6
7:00
8
M
71
7:00
8
8
7:00
8
8.55flk
0.62
9
7:00
8
10
7:00
8
11
7:00
2
12
6:30
8`yln
ma
"M
131
7:00
8
14
7:00
8
15
7:00
8x.P,
WWWA",ffa
16
7:00
8
8.76
11.7
261
28.2
0.35
M 0.15
17
7:00
8
18
7:00
2
34
IN
3�
191
3
201
7:00
8
NOWN
12
21
7:00
8
13Yid} a
22
7:00
8
MEN
23
7:00
8
8.66
0.53
N
24
7:00
8
25
261
IN I E
271
7:00
8
28
7:00
8
now29
30
31
Average:
12.40
794.75
#REF!
0.38
N
0.12
Daily Maximum:
8.76
13.10
2,420.00
#REF!
0.62
a
Ott 0.15
I M
Daily Minimum:
8.06
11.70
261.00
#REF!
0.00
0.39
Sampling Type:
Grab
Grab
Grab
Grab
�qp 0' Grab
Grab
L
Monthly Avg. Limit
I's,
N'11'1�,31110,*A,
MiUmQ ",
4" �
............
MR
3
Daily Limit:
W,INN
F 77
777
E�45y 0-11"'U'll",
Sample Frequency
weekly
2x month [k
2x month 11100",
2x month
weekly
3-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.
nplliant on the day
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 El No
Phone Number: 336 622 4276 Permit Expiration: 8/31/2024
c' Z
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

/ /W /
aceAnalytical
/ www.pacelabs.com
I
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92650058
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
TI<N+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: 02/09/2023
Date Received: 02/02/2023
Lab ID: 92650058001 Collected: 02/02/23 11:20 Matrix: Water
Results
Units
33.0
mg/L
0.089
mg/L
0.041
mg/L
0.048
mg/L
11.2
mg/L
2420
MPN/100mL
PACE
Garrett
Dreyer
02/02/23
1120
8.06
Std. Units
0.00
mg/L
25.4
mg/L
13.1
mg/L
25.3
mg/L
2.5
mg/L
Report Limit
9.3
0.040
0.040
0.040
2.0
1.0
Analyzed
02/03/23 14:43
02/03/23 11:35
02/03/23 11:35
02/03/23 11:35
02/08/23 14:05
02/03/23 12:48
02/02/23 11:20
02/02/23 11:20
02/02/23 11:20
02/02/23 11:20
02/02/23 11:20
02/02/23 11:20
0.040 02/09/2315:51
0.30 02/09/2311:54
2.5 02/08/23 05:55
0.050 02/09/2310:38
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:
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
El
Qualifiers
Page 1 of 3

r,.. �,.. n..,.�..... «,..�. v..
�' ( LAB USE ONLY RfflxSNorkorderfLtxgin Label Here or test Pace Workorderidvmi�er or
Ci-OF-OF-CUSTODY Analytical Request Document
f '' f�'e7CE�c?I7Cc�l ~ i
Chain -of -Custody is a LEGAL DOCUMENT.- Complete all relevent fields
WO
!Company: Town of Liberty IBilling Information
iye
` Con ervative
€Address, -
tr 2 a tamer Pres 92650058
ReportTb: - - Email To: — PmservativaTypes: (1) nitric acid, (2) s
(6) methanol; (7) sodium bisulfate, (B) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
COPY To: [ Site Collection Info/Address. (C) ammonium hydroxide, (D) TSP, (U) Unpreserved; (0) Other
Analyses Lab 2rofilegt ine: _
Customer Project Name/Number: @State: County/City: Time Zone Collected: ir BaSample RecelpE Chc:kliut�:
j / [ ) PT [ ]MT[ j CT [ j ET P 3 _ .-.;.
Cuarody Seals Preseazt/Intact o i A
:Phone: Site/Facility ID #: Compliance Monitoring? � � Custody Signatures Prerestt t'"="r ti NA
Email: [ Yes [ ]No Collector Signature Preett w N NA.
1 Battles in act L3A
�N
Collected By int : Purchase Order #: DW PWS ID #: � Correct Bottles r' KA
Quote #:
DW Location Code Sufficient Volume, pia NA.
6amplea Received on. Ice "k`1kt t7A
E ollecte Turnaround Date Required: immediately Packed on Ice: Q I ( VCR _, Fle.adspace Acceptable
[ )Yes [ ] No ? ( USDA. Regulated oozlh X P� V
??? O Samples e s iu Yold_n9 Time W' &A
s osal: Rush: Field Filtered (if applicable): Residual Chlorine Fxe 'tt' z ;hiA
( )Dispose as appropriate [ )Return [ ] Same Day j j Next Day [ j Yes [ ] No Z I cl 'SY ips;
Archive: ( 2 Da 3 Da 4 Day [ ] S Day Z ns Samgle FN Accepaile� Y�`N FBI.
(]] v C l v [ ] Analysis: o Px.��:�_i is
[ j Hold: ) (Expedite Charges Apply) Sulfide-pxettent'. X AFy?
* Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW), Z Z Lead Acetate sts pa'
Product (P), Sail/Solid (SL), Oil (OL), Wipe (WP), Air (AP), Tissue (TS), Bioassay (B), Vapor (V), Other (OT) u7 l USE OULYx
Comp / Collected (or Res : of F- -[j _
} — Lab Semple e # t Commerto
Customer Sample ID Matrix ` Grab Composite Start) Composite End Cl Ctns ,Ca `A C:
0
Date Time Date Time M -` Z u- a E--
Effluent WW g 70 US'' S INIX
1
t
)
Customer Remarks J Special Conditions J Possible Hazards: Type pf !ce Used: 'Wet Blue Dry None SHORT HOLDS PRESENT(<72 hrlurs):� Y Lab Sample Temperature info:
Packing Material Used: Lab Tracking #: Temp Blank Received: Y TV NA
Effluent Monitoring Therm ID#:
Cooler ITempUpon Receipt�oC
Samples received via: Cooler ITherm Corr. Factor C
P.adchem sample(s) screened (.500 epm): Y N NA FEDE.'? UPS Client Courier t Pace Courier Cooler i Corrected Tempi OC
Aom ^ gnature} Date/Time:Recejedby/Company: Signature} Date/Time: MT1LLAB U NLY Comments:
Table
�Acctnuct:
by/COrnpany: (Signature) II to ime: Received by/Company: Sign tare) Date Time: laze: Trip Blank Received: Y N NA
Tem
p
ro p )Pmiogin: HCL MOH TSP -Other -__...-..._
i
R�nquished by/Company: (Signature) !Date/Time: �IReceived by/Company: (Signature) Date�me: Phi; Non Conforrnance(s): Page:
PB: YES / Nr , o`

£ �o £ 95ed
a l} aaly0 uo aeDIjIIj,-,D L%JA]o -sjauleiuoa iaajjooul 'ducal jo ino 'a)AIJUJasajd ::)a»oaul'plou jo yr( ITT_ eulinae� 4iaol l at{� ci ivas all HIM, w)oj sly) jo l,doj a'saldwes anuinifim -v re,...
j
PaPpe
an;ienaasaJd Jo iunowV
u
p
n
O
3
G
0
w
a
n(pe
2�d awt�
paisnfpe uolierJasa�d aieq
idla�a.( uodn Nd
anlieiJasald jo ad/1
cll a dwc
_ I S
pail
ualierJas
S@JdWes POAJ@Saad 101 201;uowlsnrPV Hd
7.. 7
IT
I
j T
_\
\
\
o
`^
>
C)
�"
}
--
Vt
.n.+
N
N
N
IJ
In
.•J
u•
—
A
tJ
o
}
—
'
tom'
a
1
=-
>i-'
-3E7
?
3
�.
•-
Fi
a
o
v
n
'•�
J
=
'J
'.
�•
n
w
A
,y
'o C1
`
to
7
!-1
—
Q
0
sa11,oq,o.iogwnu4sil oa s} xoq do,Ieq wo;;oo*
5TC8/G'o �seaj9 ;^uQ 00 -D0
Sol dwLs
UO!!cAj252ad ao, a"Cuea d?uead3D e Dq, u1qUe PG11JUGA
Yi aMa(oad s. uoi'eu'JONDET .'O/pue Hd,i xoq,o,IcH do, >ipeu! N)egD*
(l18j u»oj uoliealjlivapl ainca iAc"'�'??`v

I�VaceAnalyfical
wwwpaces.com
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92651111
Page 1 of 1
Report Date: 02/08/2023
Date Received: 02/08/2023
Sample: Effluent
Lab ID: 92651111001 Collected: 02/08/23 13:30 Matrix:
Water
Method Parameters
Results
Units Report Limit
Analyzed Qualifiers
Performed by
Pace
02/08/23 16:58
Collected By
Garrett
02/08/23 16:58
Dreyer
Collected Date
02/08/2023
02/08/23 16:58
Collected Time
1330
02/08/23 16:58
pH
8.55
Std. Units
02/08/23 16:58
Temperature
0=
deg C
02/08/23 16:58
Chlorine, Total Residual
0.62
mg/L
02/08/23 16:58
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN -OF -CUSTODY Analytical Request Document
ceAnavicat
Chain -of -Custody is a LEGAL DOCUMENT - Complete aft reievent fields
Company: Town of Liberty Billing information: ,
Address:
Report To: _._ EmaitTo:
Copy To: Site Collection tnfo/Address:
Customer Project Name/Number: State: County/City: Time Zone Collected:
1 I ]PT[ ]MT[ ]CT I ]ET
Phone: Site/Facility ID #: Compliance Monitoring?
Email:
j Yes I ] No
Collected By (print): Purchase Order #: DW PWS ID #:
f Quote #: DW Location Code:
Coll e ): Turnaround Date Required: Immediately Pace on ice:
I ] Yes I ] No
Disposal: Rush: Field Filtered (if applicable):
j J Dispose as appropriate ( I Return ( 1 Same Day [ ] Next Day [ ] Yes [ ] No
j J Archive: f ] 2 Day [ ] 3 Day I ] 4 Day [ ] S Day Analysis:
I J Hold: (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)
Comp ( Collected (or Res # of
Customer Sample to Matrix ` Grab Composite Start) Composite End Cl Ctns
Date Time Date I Time
Effluent WW Tt Io
LAB USE ONLY -Affix WorkordAr/Loetn Label here or List Pace Workorder Number or
Conia,aerPresenaatlueT 926$1311
,
xM Preservative Types: (3) nitric acid, (2)sn€f'uric aao, tsr,+Y.....—..._ .
(6) methanol, (7) sodium bisulfate, (H) sodium thiosuifate, (9) hexane, (A) ascorbic acid, (9) ammonium sutiatr,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
'a
Customer Remarks Special Conditions/ Possible Hazards: Type of Ice_C15ed
Wet Biue }Dry Naae
SHQRTi'GTLDS PRESENT (<72 hours): Y "N Nj_4'
Lab-Sarripfe Temperature ln#oc .
Packing Matertat Used:
Lab Tracking,'
Te p Hlank Received: Y N NA
TiSerCri IDIi:
'Cooler ITemp upon Receipv oC
Effluent Monitoring
Samples received via:
Cooler,l Therrp Corr. Factor: oC
Radchemsample(s)screened (s5QDcpm): Y N NA
FEDEX-,. UPS Client Courier- Pace Courier
Coolerl.correctedTemp; �aC
Relingistre - y Signature
Date/Time:
Received hyfCampany: (Signature)
Date/Time:
A8T7LLABUSE ONLY,
Comments:. .
D
Table.
Acctrium,
ed by/Company: (Signature)
da�fTime:
Received by�m a. ignature)
(Date Ti re:
Template:
Trip Blanklieceived: -.Y' N NA
(Df
N
i
ii
(
Prelogin
HCL AneOH TSP Other
Relibuished by/Company: (Signature)
1 Date)Time: Received by/Company: (Signature)
( Date/Time:
PM:
e:
Non Conformance(s): Page:
«PE;
YES / NO of:

E to 1, abed
9ZO09b :# uolieo111P00 dVl3A/elul6alA
EE9 :# u011e0111U33 JWmOlseM eullOJeO 41JON
ZZZ09V :# uo11eo1111J90 dVl3A/e1u16a1A
6000£066 :# uo1leoijpiao eullaeo 41noS
OE066 :01 Ajolejogel eullOJeo 41noS
8£LLE :# uolleollpoo jaleM bul�ula0 eulloaeo UPON
99ZLZ ON 'uaP3 'V apS peon{ Mopealnl ise3 9OZ
u8p3 saolAJOS leo IAIBW coed
Ob :# UO1)eo1111193 JaleMalseM eu1l0Je3 UIPON
ULLE :# u01leo1111J90 JaleM bu1Au1J0 eullaeO WON
8b9L83 :# UOQe3311JO0 dVl3N/epuold
b088Z ON '0IIIAa4sV 'anlJ0 apisaaAl�:] 9ZZZ
011lnaysV saolAJOS 1eDRAIeuV coed
woo- sgelaoed�o ilou� -alue4dals
6860-LL6-VOL
pou>{ aluegdalS
:Aq paMOIAO�j
'sllwll loaluoo fuoleAogel papaeoxe aleolldnp aldwes pue aldwes aqi ueemlaq uolsloaad aql 90
•aldwes to lunowe iseal aqi bulsn uolinllp eqi jol palelnolea
sl pue onleA ue41 JaleaJ6 palewliso ue sl anleA polaodai aql •las suolinllp Ile jol paulewei O0 l/bw 0.1, uegi ssal 19
S2)3131" m) 31AIVNV
LVEL £Z/LZ/ZO
090'0
l/6w
87
6Z:90 £Z/EZ/ZO
97
1/6w
Z'8Z
9Z: L f MEMO
OZ'O
l/bw
L' 66
8Z:9 L EZ/LZ/ZO
0170'0
l/bw
17'8Z
00:9L EZ/91,/ZO
l/bw
4£'0
00:91 £Z WZO
shall 'Pis
9L'8
00:91, £Z/9WZ0
OVU
00:91, EZ/9L/ZO
£ZOZ/9WZ0
JOAGJQ
00:% EZ/91,/ZO
l;aaaeE)
00:9L EZ/96/ZO
coed
90 VVZf £Z/LL/ZO
0'L
1w001/NdW
M
69 s£:06 EZ/ZZ/ZO
07
l/bw
L'Zb
ZL:sI• £Z/L6/ZO
0170'0
l/bw
990'0
ZL:9L £Z/Lb/ZO
Ob0'O
1/6w
1790'0
Z6:96 EZ/L6/ZO
Ot7O'0
1/6w
9Vo
s0:M EZ/L6/ZO
0'9Z
l/6w
0'8Z
saaygen0 pozAleuV
1lwllljoda�l
silun
silnsad
JOleM :xlJleW Ob:Z £Z/96/ZO :P81081100 6O0£09Z M :al qel
EZOZ/96/ZO :PaAfaoa�j ale(]
EZOZ/LZ/ZO :ale(] jloda�,j
poday Aao;eaoge7
1, 10 6 abed
L 860-LMWL)
48ZLZ ON 'apinsIawaA
anuo Ted ginoS LLEL
O'11 'saolAAag leoIjAle4V aoed
snio4dsogd
leloi 'IgePIDN 'uG50A!N
eluowwV 'uaballN
uaboallN IEWL
lenplsad lelol'euuolgo
Hd
awli poloalloo
Oleo 1001001100
A8 poloalloo
Aq pawaol @d
swjoploo leoad
AeP q '0O8
01PM 'ua60J11N
OleA!N 'uaboAlN
EON snld ZON 'u060llN
splloS papuadsnS leloi
saalaweJed
£66I, 0'Z AOZl L'99£ Vd3
£666 0'Z AOZl Z'69£ Vd3
£661 O'Z AO�I LOSE Vd3
uo1lelnoleo
ZON+EON+N>ll
MZ-906Z9 WS
£66I, O'Z AOZj Z'Es£ Vd3
666I, O'Z AOZj Z'E9E Vd3
£666 O'Z AGH Z'£9£ Vd3
960Z-001179Z WS
PoglaW
;uonlM3 :aldwes
£09Z99Z6 :'ON loafoad aoed
Alaagll to uMoi :loafojd
96ZLZ ON `Aljeq!-1
900 6 Xo8 Od
Aljaq!-1 jo umol
a�{!� au!ewaii
i
1
ww'squleaed,mmm J
olealpfjeuda%

CHAIN -OF -CUSTODY Request Document i LAB USE ONLY- AffixWorkorder/Lofm Label Here or Llstftce WoercirtlerNumberlor
/ u b ,, �,. r ., H
- ere
-RaC6 nalytioai
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields-603 'Company: down or Libe BiFhng t❑€otrnation:
Container Prese vatEve T pe "` I
Address: 2 -P""tvAt
? . .. F w 2652603
Report To, Email To: <• Preservative Types- (2) nitric acid, (2) soifurc a.
(6) methanol, (7)sodium bisulfate, (8) sodium thiosutfate, (93 hexane,
Copy To: Site Collection Info/Address: (C) ammonium hydroxide, (0) TSP, (U) Unpreserved, (0) Other
Analyses Lab Profile{iirte.
Customer Project Name/Number: State: County/City: Time Zone Collected: :,as sar.pLe,,Receipt chesicsst
I [ ]PT[ jMT[ )CT [ jET
Phone:
Site/Facility ID k:
Compliancemonrtoringr
`Present
( Yes [ )No
0>12ector Signature N 1-M
Email:
-Ccwzect Bottles N
Colf ed By t):
Purchase Order 9:
DW PWS ID #:
Quote x:
Di V Location Cede:
su fzciextt volume Y fi 11Fg
Samplep Received on Ice N
40 - leadspace Acceptable', w NS
Coile ]:
Turnaround Date Required:
Immediately Packed on ice:
( jYes ( ]No
m
L15dA R gixla6ed,soile vN
s` les in H*lding'Time
s dtiaa . G2riaziaeOPres t Y STNA
Rush:
Field Filtered (if applicable):
I i Dispose as appropriate [ )Return
I j Archive:
( 1 Same Day f j Next Day
[ j 2 Day [ ) 3 Day [ 14 Day [ 15 Day-.
[ j Yes [ ]No
Z
Y'Cl
si apsWN
sample p t A^cegtla'
[ ] Hold:
(Expedite es Apply)
! p B P
Analysis:
�,
' `
�
Z
�:(�
V —
t1
vA
p'd !`trips=
Stxliw51e1�'esa_z:r Y� 3ii i
trea d 7,cetate st � -� e:
{viatrx Codes (Insert in Matrix box below}: Drinking Water (DW}, Ground Water (G4�}, Wastewater (WWj,
Product (P), Soil/Solid (SE), Oil (OL), Wipe (W P), Air (AR), Tissue (TS), Bioassay (8), Vapor {V}, Other (OT)
'
T FtH USE, 01 Y:
F- _
m
,
Lab sample f 'i omeedtez
Comp /
Collected (or
Res
# of
Customer Sample ID
Matrix
Grab
Composite Start)
Composite End
Cl
Ctns
Q
to
f1
V
Date
Time
Date
Time
CD ,"Z
it._;i
C'
-
Effluent
WW
g
2 23
ILYJ
5
XX
�j
i
f
i
Customer Remarks! Special Conditions Possible Hazards:
Type of Ice, Used: Wet Blue Dry None SHORT HOLDS PIRESENT (<72hasurs}: Y N/A Lab Sample Temperture Info:
[
packing material Used_ Lab Tracking x Temp 3lank Received: fN NA
Therm EDP:
Cooler 1 limp Upon Receipt !L oC
Effluent Monitoring
_
ampfes received via: I Cooled Therm Corr. Factor oC
Radcheir.
sample(s) screened (<SDD cpm); Y N NA FEDEX UPS C#lent Courier ;. ce Courier- Cooled Corrected Temp. oC
_
Relin u' C y: (5 atw e)
Date/Time:
Rerived by/Campo : (Signature) Da;e/Time: FYFTILLA6 Comments:
Table::
Acctnum:
Received by/Co any: ig ature] Date/Time:
Template: 1_Trip Blank Received: Y N NA
ui<, a try/company: (Signature)
D to ime:
CD
N
[[
i Prelogin: t HCL. McOH TSP Other t
�4
Received by/Commpany: (Signature) ?Date/Time: ,pM: {+iQn Page:
C4nfArm'anCe{�}:. g -
Reliuished byiCompany: ("signature]
PB: YES / NO s of _

Document Name:
Document Issued: November 15, 2021
Analytical
Bottle Identification Form (BIF)
Page 1 of 1
Document No.:
Issuing Authority:
ace
F-CAR-CS-043-Rev.01
Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg
**Bottom half of box is to list number of bottles
Project #
K
r
A
E
u
\
Z
'O
d
d
c
A
E
in
IV
Q
0.
Co
\
Z
'O
WW��..'
v
c
m
E
o
fV
M
M
a.
Co
\
Z
v
c
c
E
o
T
>
N
a
to
Q
\
Z
W
a
N
w
ei
>
rl
a
m
V
x
p
m
E
N
�%}
v
a
Co
V
y.
M
Z
J
E
o
N
2
M
a
m
QZ
Z
Ob
G!
a
m
E
H
N
V
a
m
N
^
G
p
m
m
J
E
N
o�
V
a
m
N
6
^
m
l7
E
v
�
W
Vi
3
Z
'D
C/
d
a
-0
a
iv
=
rl
rl
l9
a
N
Vz
Sa
.o
m
=
rl
S
r/
l9
a
a
W
a
e
a
E
voi
N
M
O
a
V
ct
ut
L
a
Q
.M
t�i
l7
a
N
V
x
O
�„
01
E
J
E
o
N
J
m
l7
a
\
V
M
a
E
E
O
N
Q
0
a
M
O
a
:!E
V
S
p
>
-
op
i
z
M
O
o
2
M
NN
Z
a
Q
J
E
�
a
01
l7
>
.Z..
v
Q1
y
O
�'
J
o
Y
D
Ol
W
>
\
?
i
O
,
E
'v
0.
Cn
W
o
Z
a
Y
m
o
Ln
X
®
N
>
."'
x
a
O
>
"'
n
M
M
`�+
>
fti1,
]t
(ry
>
.Z..
v
Yn
C!
°1
1%'1
J
Ln
N
F.
M
a
.Z.-
u
4i
;
VI
J
o
N
a
N
0.
W
n
N
i
.+u-,
b
J
E
0
N
Q
M
a
m
z
N
Z
a
c
.O
E
J
E
0
.M.�
®
l7
a
Z
c
c
Vt
J
0
5
l7
ut
>
C
z
.D
N
Ol
�r
a
W
E
a
J
0
a
M
O
o
1
2
3
4
5
6
7
8
9
1
\N
10
11
12
PH Adjustment Log for Preserved Samples
Sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservation
adjusted
Amount of Preservative
added
Lot H
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

11,�ValceAnalyfical
f www.peculabs.com
i
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92653673
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 02/23/2023
Date Received: 02/23/2023
Sample: Effluent
Method Parameters
Lab ID: 92653673001 Collected: 02/23/23 10:50 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
Performed by
PACE
02/23/23 10:50
Collected By
Garrett
02/23/23 10:50
Dreyer
Collected Date
02/23/23
02/23/23 10:50
Collected Time
1050
02/23/23 10:50
pH
8.66 Std. Units
02/23/23 10:50
Chlorine, Total Residual
0.53 mg/L
02/23/23 10:50
Reviewed by:Y""
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

tcompany: Town of Liberty
,4t�dress:
Report To:
Copy To:
jCustomer Project Name/Number.
CHAIN -OF -CUSTODY Analytical Request aes� Document
ent USED LV rko r/ Label reorl_ P
Chain -of -Custody is a LEGAL DOCUMENT Complete a i relevent fields m
Billing dnformat}a� `
coritatre
92653673
Email Toe_. — pre�Types Itynmic zdcl, (2) suthm, tst mwrocnronc ate, [4) softm hydroxide, (5) zinc acetate, r
(6) methanoLM-sodlurn bisulfate, ($) sodium thiosutfate-(9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
Site Collectton info/Address: (L) ammonium hydroxide, (D)TSP, IV) Unpreserved. (0) Other ­
Ana; ses tabPro
State: CountyjCity: Time Zane Collected: X ztb_sataPI Seca ?: E'�cklzst
J I ] PT [ )MT[ ]CT [ ] ET Seal, Srersencf satact Y NA
tod s araseas� � >�
Phone SiYefFacil"ity ID #:
Email:
[)
Compliance Monitoring?
[ Yes [ ]NO
[
✓)
Q
- ri
m
Ft
pp
k =
K.
-=
�.�
. ']
}
-
. "
-
L`sta Y agaaturea
Ca77.�etox. &fgnatL�szxa Psaaeat Y is >
Bottjee S.xataot- .Y bT 2a1
coxr c BatLlas Y N nza
SUffjcieat `V0j=e Y 15-NA
&attW+CH RGceiv>:d Sszl Ice - Y N NA
4'nA Headspaca.Acceptable ;'Y-N itlti
IISDFi: i2Ggu) sled `5oiis Y. id'SIX
9 zrtp e 3 f h 9lstix}g Ti 17 "ac: Y ]iT NbS
dttal C�t7"o irre Presien Y N NA
CI 6tx3pe-�
Collected B rint}: Purchase Order #.;
Quote#:
DW PWS ID #:
DWLocation Code-
Co Turnaround Date Required:
Imm late. Pac oonIce:
[ ]Yes [ ] NO
e Desposa6 Rush:
Da ro riate [ J Return [ j Same Day [ ] Next Day
Field Filtered [if applicable):
( ] Yes [ ] No
rspase as PP P
! ] Archive: [ ] 2 Day [ j 3 Day [ 14 Day [ ) 5 Day
Analysis:
o
! ]Hold! (Expedite Charges Apply)
.4y.
" Matrix Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
�
Product (P), Sail/Solid (SL), Oil (OL), W'pe {WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
a
Comp /
"
Collected (or
Composite End
Res # of
is
i7
Customer Sample ID Matrix Grab
Composite Start}
Cl CYns
.. , Co
','
Date
Time
Date
Time
C l----
fuent g
-3 -3
16 `�
� -
Customer Remarks / Special Conditions / Possible Hazards- rTY OT tce t�seo: wet xstuae urY Nwic,
Packing Material Used: Lab T83atak Rexesd: Y fd NA
` riserm i£1#
• C661er I Temp upon Receipt,
Effluent Monitoring oC
ples`received via.,:
Cooler 2ThermCorr�Factor: CC
ish y ig store)
DateJTime:
Rem ed by/Company: (5 gnature)
Date/riime
s
MTJLLAA USE ONLY'
Table
lAcctnunl .
fished by/Company: [Sgnature)
j at . ime:
Received by/Cc ny: ('gn ure)
Date/Time:
Template:
Trip Blank Reeved: Y N NA
m
Prelogin:
Ha McOH T5P ' Other
44qushed by/Company: (Signature)
DateJTme:
Received by/Company: {Signature}
Date/Time:
GPM:
t Non Conformante[5). Page:
N
]P$: 1
YES / NOaf: _ __

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
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
February 2023
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
R 0.3
R 0.8
R 1.2
�llw
TOTAL 3.0

FORM: NDAR-1 10-13
El 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? Q Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Q Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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.
FREEBOARD IS AT 0 INCHES CAUSE OF I&I RAINFALL
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 12 No
Phone Number: 336 622 4276 Permit Exp.: 8/31 /24
Signature Date
Signature E ate
/ 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: February
Year: 2023
Field N ame:
6
Field Name:
8
Did irrigation occur
4,
Area (acres):
15.1
V
Area (acres):
21.68
Cover Crop:
FESCUE
W,
C over Crop:
FESCUE
at this facility?
156 r
I
ate (in):
Hourly R
0.21
e (in):
0.21
❑ YES ❑ NO
"k
Annual Rate �n :
52
Weather
Freeboard
Aln",
Field Irrigated?
❑ YES
❑ NO
Field Irrigated?
YES NO
0, 05
0
.2
_ �ag I §,,
aj tt'j,!"
E
= - Ces
.........
11 li, "'IF
WU
"
E
Z,
E rn
CL M
.2
, , - _.1% g
Pz ,q=_�,n
gg m7v AM, , , ,
E .2
.9 M
z,.E
'70 -
E -
0
N ; "
.2
ca
E
i< 0 co
(1)
CL
E
0
- g­ � Qp� 6��
u,
ge,
> <
x 0
R
> <
0
M 0
Q
rL
k2!
Q
1,_
CL
"K
F
in ft
ft
R
gal
min
n
in
in
1
R
.3
0
0.8
­,u
2
R
1§
3
a.
4
C
50
0
0Atx
252,000
180
0.61
0.20
5.
C
32
6
C
35
0
N
ti
11 00
350,000
180
0.59
0.20
7
C
35
0
252
180
0.61
0.20
8
C
70
0
'000
1 A
11K
9
M Al X
M
350,000
180
0.59
0.20
10
C
61
0
252,000
180
0.61
0
11
C
62
0a.
.20
121
R
1.2
E, V, WD
13
lss#
252,000
180
0.61
0.20
14
C
52
AW
15
C
51
0
V " ,,
16
11,11! .............. ..........
17,
R
0.5
NK,
181
pp
INNE"'11, MINN,0E,11",
350,000
180
0.59
0.20
20
CL
45
0
0
252,000
180
21
PC
52
0
22
PC
53
23,
PC
61
0
252,000
180
0.61
0.20
24
R
0.2
25
26
"g
252,000
180
0.61
0.20
27
C
59
0
p,
28
291
3 01
­,Q) 41
311
1
1
1 1
Monthly Loading:
1,764,000,7-
771
430 _77,77=7
A 77777
77,7777,
77-8
u, 49w
7,77
K"O
"C'M
12 Month Floating Total 0
28.87
_411-
V,
r
26.14
7,
R

FORM: NDAR-1 10-13
Did the application rates exceed the limits in Attachment B of your permit?
1z 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? El Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 2 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.
0 INCHES CAUSE OF I&I
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Elix Tremaine Fike
Permittee:
Scott Kidd
Certification No.: 989290
Signing Official:
Grade: Sl Phone Number: 336 622 2990
Signing Official's 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
Signature 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