WQ0003090_Monitoring - 06-2023_20230727 (2)

Monitoring Report Submittal
Permit Number#* wg0003090
Name of Facility:* town of liberty wwtp
Month: * June Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR june 2023.pdf 6.86MB
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: 7/27/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* wg0003090
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 8/22/2023

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_ of _1_
Permit No.: W00003090
Facility Name: Town Of Liberty - Wastewater
County: Randolph
Month, June
Year: 2023
PPI: 002
Flow Measuring Point: R] influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ influent ❑✓ Effluent ❑ Groundwater Lowering ❑ Surface water
Parameter Code - 0
50050
1 00400
00310
00610
OGWO
31613
00620
00625
00665
50060
00600
70300
OOS40
00630
00010
❑
�f-
0
❑F
v
0
3
"
a
O
o
oB=
E
Q
m
2
y
E
o16
i
a
�
F
S
R
~w
°
z
:
°; 0E
~m o
pN
v
+
°' im
.r
ZZ
o
o
l-
24-hr
hrs
GPD
su
mg/L
mg/L
mg/L
#1100 mL
mg1L
mg/L
mg%L
mg/L
mgfL
mg/L
mg/L
mg/L
°C
1
7:00
8
307,000
2
7:00
8
292,OGO
3
11:00
2
337,000
4
11:00
2
331,000
5
7:00
8
340,000
6
1 7:00
8
286,000
7
7:00
8
300,000
8
7:00
8
298,000
7.23
13.6
9.4
27.5
2420
<0.040
15.1
2.5
0.01
15.2
0.073
9
7:00
8
260,000
10
303,000
11
279,000
12
7:00
8
160,000
13
7:00
8
279,000
14
7:00
8
241,000
15
7:00
8
309.000
7.01
0
16
7:00
8
240,000
17
203,000
181
231,000
19
7:00
8
216,000
20
7:00
8
320,000
21
7:00
8
389,000
22
7:00
8
317,000
7.09
40
11.9
20.3
1550
<0.040
15.7
2.8
0.09
15.7
<0.040
23
7:00
8
1,160,000
241
11:00
2
1 416,000
25
11:00
2
324,OD0
26
7:00
8
219,000
27
7:00
8
262,000
28
7:00
8
265,000
29
7:00
8
223,000
6.39
0
30
7:00
8
220,000
31
Average:
310,900
26,80
10.65
23.90
1,936.75
0.00
*REF!
2.65
0.03
15.45
0.04
Daily Maximum:
1,160.000
7.23
j40.00
11.90
27.50
2,420.00
0.04
#REF!
2.80
0.09
15.70
0.07
Daily Minimum:
160,000
6.39
13.60
9.40
20.30
1,550.00
0,04
*REF!
2,50
0.00
15.20
0.04
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Monthly Avg. Limit:
Daily Limit:
550,000
Sample Frequency:
Daily
I weekly
2x month
2x month
2xmorrth
2x month
2x month
2. month
2x month
weekly
2x month
3x year
3x year
2x month

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: GLENN PRICE Name: PACE ANALYTICAL
Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑� Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
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
23
Signature Date
Signature Da
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

v
Z N m Z Z Z1 N d
v, m 3 N m
�mD ��o c" D
O M O_ O Z m
m
-rin "
w y � m
fl) a _ DJ N
m CD A
0 N x T m
CD
D m
N D) N N
N C Q0 it
N 7 N
n D 3 n m m
� m �-4
CO Z —
n m rn
nCD-O 1 m N
m c 00
o z 0 0
n A
*k N 4t
v
N
J W
w W
co N
<
<
0
0 0
7 S
M. S S
Z�
Zvv
m
m O O
7
� N
>
D) ID
CD N
m
m nri
; Q
= o
=
o' m
o
C)
CD
7
4t 0
A
m
A
O
(]
O CD
O w W
N O O
O
j
N O
m
W
W
m
O
CD
0
A
CD
CD
CD
n
cr
m -4 cn
m o m
'O A
S (O S
� v 3
m o CD
7c 00
_ O k
m
m
m
o-
0
O
3
m 0
3 N S
ID m
;a 0- a 0 a
o n n.
N
CD N N 0
m 3 N m
a
a<i m ca m
< n =3
Q o_
N c m S
CD
CD
-O 7 tv
0 N m 3
n m n a
CL m m
c m m
o n
:3 m v n
cn 3 m
m
x m 3:3
m <
CD m c m
C=3a
CL CD
w in cn �'
o 7 m
m m m
<m m
a:) N. n
(p 7 (D
°CDo.
-, (D
CL
N
3 N O
CD �,
CD v o
m x. 2
c 3 c�
CD c O
3 R
N
O N O
0,0 —
m 0 3.
n0
Q (A
CD
C
3
0-
CD
7'
O
n.
y mmmmc» c)Cnmmmcn cn -0v
Z D D D D c�-i Z D D D� 3 C
rn j D.1 Z mcn cn (wll A F � n r-0 O
cn w o o. 0 0 w w w 0 p 0- Q CD
N N W co co N N N CD
D Z � = v
m m m m m + a m m m o m m? `G o
c < < < < O < < < o c Z n X
r N N N N N O N N N� n_ (D r Z r- (D
T o 0 0 0 0 0 0 0 C7 C -n
m cCOo CC) CD m N CY O T
CD
cn W W co W
O
S Z Z Z Oa S= 0 O O CDCDCCDD co Z Z Z o CC)
N O O O N O m m m p N O Cl)CC 6 O
_0 co`�° >> Z m m m m a n CL c
O C. CL 0- m o n n
N Z D con o=jO W n p Z Z Z CD
O n 3 < ON a
p� o O N a
� c m c v
N O cnO C( 3
O
Z o c Z a m
O m c) cnW W
(A
r
m
v
v
0
N
w
o m
Q' m o
w
m O M �_ o
O� �~ N O m w A CDO N N ..a
N O j O N O N N N M 0 N W O Z V v
fn W A N W CA W "" m O T W 0 W cn C7
O
N
cn n
3 3 3 3 3 3 El ? 3 3 3 3 3 C a
(n n n (n cn cn c o o n cn cn ?_
r= p r r r r= r n O
rn
v 3 0
r �
N
W
�J N
-mo Lnn
O
0 0 O 0 0 0 _r
0 0 C> O O N O O O N 3 47 Q
0 0 0 0 O O O o 0 0
CD CD
0 0 0 0 O O O O O O O O O O O O O "O
CD m m m 0) O O W m W O D) m m W O m CD O
m
N N N "3 N 0 0 0 0 0 0 00 00 0 --� D (D n �
O O zt N W W W O N W m .A m O (D N O L
N N N N N N Ili N m NJ N N N N N N N N <'
W W w W W W W W W W W W W W W W W < CD
O (J1 OW W O W D) W m W W N A s s W d Q CD
A W O A Cn U1 Ut Ul Cn (n V Ut A A A O CD CD
CA CA
U
rn rn W N
El D N N
m N N
W Cl)
(U
N
0
N
7
m
� v _
N � m
< o I
CD - m
N a m � 2
CDCD
n
O m N r
r

r'l
O
A
CHAIN -OF -CUSTODY t Analytical
�e The Chain -of -Custody is a LEGAL DOCUMENT. All r
I Submitting a sample via tins Chain of custody constitutes acknowledgment and acceptance of the Pace Terms and Conditions tot
Section A
Required Client Informalion:
Section e
Required Project Information:
Section C
Invoice Information -
WO# : 92671398
1111111111111111111111
ompany Town of Libe,-Y
eport To.
Tremaine F.ke
entron:
d less: �O Box 1we
^xf To
Pant Name:
ddress:
R
ibertv. NC 27298
mail. ;ryk &ownotlibenY= org
urchase Order #
ace Quote:
Sues
f Location
hone- i336)622.6276 Fax.
rolec, mar*
Town of L,beny - Every 2 Weeks
an
ace Project Mager:
stephanie.k
acera-..s.com.
equested Due Date:
roger.
ace Profile Uh 13077
aieYtW Fate Flttarad !N
—
Z
E
COLLECTED
Preservatives
y
KIRrR`X
f.OD£
'�
U
zz
O
Dnr rg Watt/
Dw
U
W.w
W.I. wNer
Wr
WW
P
c
^
S r\
V
Y
SAMPLE ID
rh9aYCl
so�saK
sL
�
�.
�
START END �
�
H
`D-�
Ons Charaeeer per Dos.
a1
ar
a�
!R
s
tP
p
(A-7- 0.4 f . -)
On r
'wawa
Or
rs
g
r-,
0 �
y,
W
n
�¢ Z
*k Sample Ids must be unique
X
m
o m
�
vD�s m
L)
Q O cc��
O cNv L .c
Z
r
DATE TIME DATE TIR4E vZ
i 7 2 2 r
z Z O
m
x
x
x
x
x
x
x
x
2
3
5
6
7
8
9
10
1t
12
ADORIONAL COMHEWTs
REtJNOt11SNED
BY t AFFXAT*k
DATE
TOE
ACCEPTED BY t AFFUAnoN
DATE
TWE
SAMPLE CONOrttOW
o
�
NAME AND SIGNATURE
c
Name of SAMPLER;
rstGNWATU
✓ _/
aN� FiJ- j "� �/
�j
a
i
/
RE ofSAMPLER: DATE Signed: f �l A Z

I
c
C
i9
y
y Q
� 0
I Q
o
0
0
0
a
'a c
x •r
tL
L a0
r 2
C
ula
v
s
Gv�iL
✓
q �
{
Gl
CD
a
a
z
m
❑
�
O
>
Nr
�
a �C7
❑U
u
a
r
v
v
'L
f
N
z
�
A
o-LL
T
G
to
Iv
j C l
z
L
,fin
raj
� ;
�_
0
c �
rJ
r•
� V
C
u
;
0 Z
C.
v°
m m
's
>
v
y
n
c
d
F i
_0
u
3
.z
N
v �
i � o
t
C
E
E %
y
a
° .,
t�-
a°
n�al
a
v
cr s
c
c
a�a
CL
L
0

,c�ei; Ga>,:atayrJu(; ,a;wy lw 4r'-£lb�
Sim ua;wij0v*S flu r ;-nSSA
1 i7(Ni;in�n Ranf?s27du(? fagw, 'lw OGZ-nDDV 1
E I ; : (L 5•y �} {Ss'itHNi a':seld lu' GSZ-t�fd8
n
z
I
'
V
S
I .o
,mil
D i
it
E s,
z z
_ _ c
m a
u
r
O
O
>a
L
ur
C
w
_
a
c
c
x
;L^w—
u
o O
x j
c�
a
f
L
It
n s
tL0
> E
V
" O
0
O
>
JI
i
A
w j
i ;az'; - vtv} 31_sr.9d a1u<ic ta: -yi 15siS j � � i j-
1
5EoS-(At)j.aaa slain Ei )IVOA
..._._�-_ tvittii t,04di H 70A lw Oq-4590
�� I +i i R=h�asaeaufl Vfln uW
(vitq) EGZSZe?,j 10A l"w 0, IGDA I�r
1 iv/N) KDH VGA lu Dy-WS90
r )!ff; N} It3rHN Jaqury
/ f /
ii>Ndtvo>zHfaCuryiw;:.Z-SE"3'y
IZ � hit ei35ZH fataufv.af,t 13i'3t� I / 1 1
�•13) {'�iN) Panf�x7sQutt )aLjujv iw osz-nf9V
71 iZ > +dd)13H fagwy faa�F i1 f I� _ice
r r af:x52;dun ,afli;:i' mil; -ritoJ i
i�i3' i`i .I'r Pam•
want?sarau^� fel ssel� R2U:nOw->wlt+n�f11$AA i 1 �� � ! i
(•13) lZi < Haj y{�eM �1lsaid iw SZt•9Vd8�I ! I/��/
r ) Ha 1 �y ! 1 I
if<e;� p ;tesa�r; Ni?�zs£id'?w52T-Z7d9 t
Al
Ha! IIDSZH ,x rld aw 74 I -Won
t_ Rat asafslvn anseid faDf i-nld9
tq'Ip,) Pa:�asrfduh ��zseld ,u: DOSi1Zd8
_
afdu► i 1 I I
pa•va3�l Jl:=zld 3'�%DSZ-r1Ed9 i
(•1-,) (v; N paivasaidun msew lw SLi ii?d9
v
v
O
V
O
a

aceAnalytical "
www.pacelabs.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: Liberty WWTP
Pace Project No.: 92672745
Page 1 of 1
Report Date: 06/21/2023
Date Received: 06/15/2023
Sample: Effluent Lab ID: 92672745001 Collected: 06/15/23 11:40 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by Pace 06/15/23 15:53
Collected By Garrett 06/15/23 15:53
Dreyer
Collected Date 06/15/2023 06/15/23 15:53
Collected Time 1140 06/15/23 15:53
pH 7.01 Std. Units 06/15/23 15:53
Chlorine, Total Residual 0 mg/L 06/15/23 15:53
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

N
O
�~ CHAIWOF-CUSTODY analytical Request Document
Cna n-of-Custody s a LEGAL DOCUMENT- Complete all relevent fields
Company I Billing Information:
Address:
Report To: Email To:
Copy To: Site Cole
LAB USE ONLY- Affix Workorddeerr/Loein Labei Here or List Pace Worrkkorder Number cr
WO# ' Vaa26 fl2 # 45
Container Prey NSHEEE
ativeT
2 1 1 1 1 82672743 1
•" Preservative Types: (1) n'tric acd, (2) sulfuric acctl. Is) rivarocrtfCnc acid, jai SQorum nyorvalur, ter C.— ar.ecom,
(6) methanol, (7) sodium bisulfate, (BI sodium thiosulfate, i 9) hexane (A) ascorbic acid, (8) ammonium SOfate-
(Cl ammonium hydroxide, (D) TSP, IV) Unpreserved, (0) Other_ .
Customer Project Name/Number:
State: County/City: Time Zone Collected:
/ ( IPT[ IMT( IE1` ( ]ET
Phone-
Site/Facility ID #:
Compliance Monitoring?
Email-
(Yes [ I No
Ced By ( t):
Purchase Order 9:
OW PANS ID #:
a
Quote t:
DW Location Code:
Collect sr n
Turnaround Date Required:
immediately Packed on ice:
-.
( I Yes L ]NO
r oral
Rush.
Field Filtered (if applicable):
�..
[ ) Dispose as appropriate L I Return
( j Same Day [ ( Next Day
[ I Yes [ ]No
! I archive:.. _ _ _ .. -...
( 12 Day [ 13 Day ( 14 Day ( 15 Day
Analysis:
t
[ I 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 (5), Vapor (V), Other (OT)
�t
Res
# of
Comp (
Collected (or
ComposiEeEn�a
Customer Sample ID
Matrix'
Grab
Composite Start)
CI
Ctns
Date
I Time
Date
I Time
Customer Remarks / Special Conditions / Possible Hazards:
(Signature)
Relinquished by/Company: (Signature)
of Ice Used: Wet Blue Dry None
nR Material Used:
Radchem samples) screened (.cSOO cpm): Y N NA
me:
(Signature)
)FIT HOLDS PRESENT (<72 hours): Y N N/A
Tracking #-,
pies received via:
FEDEX UPS Client
LS/ 0 13 o S
Lab Sample Receipt Cbe~kclist-
Custo&z Seals Present/intact Y N la
custody Signatures Present
Y IT NA
collector Signat:ire Present
Y N Wt
Bottles intact
Y N NA
Correct Betties
Y N MN
su;i:icient Volume
Y N LIA
Samples Received on Ice
Y N NA
SrZ - Readspsce Acceptable
Y S7 NA
USDA Regulated Soils
YN NA
Samples in Holding Time
Y x RA
Residual Chlorine Present
Y N M
Cl Strips:
Sample PH Acceptable
Y S Nh
pH Strips:
Sulfide Present
Y S NA
Lead Acetate Stripe: _
LAS USE ONLY:
Lab Sample # /_ Comments:
Courier Pace Courier
MTJL LAB USE ONLY
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm ID# -
Cooler 1 Temp Upon Receipt: _oC
Cooler 1 Therm Car. Factor. oC
Cooler i Corrected Temp: oC
Comments:
Template: Trip BlankRecelved: Y N NA
Prelogin: HCL McOH TSP Other
PM: Nan Conformance(s): Page:

�Yace�"
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92673932
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 07/05/2023
Date Received: 06/22/2023
Sample: Effluent
Method
Parameters
Lab ID: 92673932001 Collected: 06/22/23 10:30 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
SM 2540D-2015
Total Suspended Solids
20.3
mg/L
8.6
06/23/23 09:37
EPA 353.2 Rev 2.0 1993
Nitrogen, NO2 plus NO3
ND
mg/L
0.040
06/23/23 10:29
EPA 353.2 Rev 2.0 1993
Nitrogen, Nitrate
ND
mg/L
0.040
06/23/23 10:29
EPA 353.2 Rev 2.0 1993
Nitrogen, Nitrite
ND
mg/L
0.040
06/23/23 10:29
SM 521OB-2016
BOD, 5 day
40.0
mg/L
2.0
06/28/23 10:48 B1
Colilert-18
Fecal Coliforms
1550
MPN/100mL
1.0
06/23/23 08:22
Performed by
PACE
06/22/23 10:30
Collected By
Glenn Price
06/22/23 10:30
Collected Date
06/22/23
06/22/23 10:30
Collected Time
1030
06/22/23 10:30
pH
7.09
Std. Units
06/22/23 10:30
Chlorine, Total Residual
0.09
mg/L
06/22/23 10:30
TKN+NO3+NO2
Total Nitrogen
15.7
mg/L
0.040
07/03/23 12:42
Calculation
EPA 350.1 Rev 2.0 1993
Nitrogen, Ammonia
11.9
mg/L
0.20
07/05/23 14:44
EPA 351.2 Rev 2.0 1993
Nitrogen, Kjeldahl, Total
15.7
mg/L
0.50
06/30/23 06:21
EPA 365.1 Rev 2.0 1993
Phosphorus
2.8
mg/L
0.050
06/29/23 14:42
ANALYTE QUALIFIERS
B1 Less than 1.0 mg/L DO remained for all dilutions set. The reported value is an estimated greater than value and is
calculated for the dilution using the least amount of sample.
Reviewed by: ni�nc�J
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
Page 1 of 3

e � USE ON Affix Workorder/Login Labe( Here or List Pare
CHAIN -OF -CUSTODY Analytical Request Document w
XA� 2,"4nAh1hr;;1
/ - ­ 1 _
Chain -of -Custody is a LEGAL DOCUMENT - Complete al relevent fields
I" - ft/ �" [
ALL SHADE[[
Company: sown of Liberty Billing Information:
Address: !
Container Preservative Type
l
u 1 2 1 8 ; g�-(3932
— Preservative Types: (1) nitric add, (2) sulfurica _, r watum hydroxide, (5) zinc acetate,
Report To: Email To:
i
(6) methanol, (7) sodium bisulfate, (8) sodium thiosurrate, (9) hexane, (A) ascorbic acid, (8) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
Copy To:
Site Collection nfo/Address:
Anal -ses
Lab Profile/Line:
Customer Project Name/Number:
State: County/City: Time Zone Collected:
% [ JPT[ ]MT[ ]CT [ JET
Lab Sample Receipt checklist:
7i,
Custody Seals Prsent/Intact Y
e
Custody Signatures Present Nun
Phone.
Site/Facility tD #:
Compliance Monitoring?
[ /Yes [ ] No
Collector Signature Present R NA
Email:
9
Bottles intact NA
Correct Bottles N NA
tote (print}:
Purchase Order #:
DW PWS ID #:
Quote#:
DW Location Code:
jE
1 a
`
�
s
t
[j
Sufficient Volume NA
Samples Received on Ice NA
VoA - Headspacs Acceptable Y N�
Collected By (signature):
Turnaround Date Required:
Imm ate Pa on =ce.
i
[ ] Yes [ ] No
2
�Ip
USDA Regulated Soils Y,jJ
1111
Samples in Holding Time �j'l� NA
Residual Chlorine Present Y &47NA
Rush:
'Field Filtered (if app:icable):
Sample Disposal:
-
C1 Strips: 2 a 4 b A z
( J Dispose as appropriate ( J Return
I ] Same Day ( ) Next Day
j ] Yes j ] No
Z
Sample pH Acceptable N NA
] ]Archive:
H
( J old: �.,_ _ _
[ ] 2 Day [ ] 3 Day [ ] 4 Day [ ].5 Day
(Expedite Charges Apply)
Analysis:
Z
A
Z
m
Fo—
Z
�
�
1 `
•
gE Strips: 2 1-3d j�'JVY
Sulfide Present Y 1>�
Lead Acetate Strips:
Matrix Codes (nsert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (�1l4N),
Product (P), Soil/Solid (SQ, Oil (OL), Wipe (WP), Air (AR), Tssue (TS), Bioassay (B), Vapor (V), Other (OT)
C
1—
F
y
�
m
J
LAB USE ONLY:
Lab Sample / Ckmm+eate :
Comp)
Collected (or
Res
k of
Customer Sample ID
p
Matrix `
Grab
Composite Start}
Composite End
CI
Cms
f3
M
_
o
U
jr
M
V
ca
Z
LL
a
a
to
-rime
Date
Time
Effluent
WW
g
1630
s
�
(
I
!
Customer Remarks / Special Conditions / Possible Hazards: Type of ice Used: ei Blue Dry None
SHORT HOLDS PRESENT (<72 hours): !%P N N/A
Lab Sample Temperature Info:
Packing Material Used:
�
i Lab Tracking k:
Temp
Tim DNlank Rece_ 7 o 0 A
Effluent Monitoring
�
I
t
Cooler i Temp Upon Receipt:3 - Z oC
Cooler I Therm Carr, factor: -•�oC
mples received via:
Radchem sample(s) screened (<SW epm): Y N NA
FEDEX UPS Client Courier ace Ca
Gaoler 1 Corrected Temp: 3, E oC
Relinquished by/Co) ny: (Signal a /Ti Re r d by/C�reny:(Signature)
Date/Time: MTJL LAB USE ONLY
blil(s7 1136 Table#:
Comments:
!
��Z
I
�-
Acctnum:
Trip Blank Received: Y N NA
Ti C Reli uished by/ompany: Signature) Date/me: by/ any; ignature)
CD
Date/Time:
Template:
CD
N
Prelogin:
HCL McOH TSP Other
Relinquished by/Company: (Signature) Date/Time: Received by/Company: (Signature)
Date/Time: PM;
Non Conformance(s): Page:
PB:
YES / NO of:

(V/N) Sle!A pawasaidun iagwV lw Ob-n69a
(V/N) Sle!A uORejj!lu!:)S Iw OZ-n9SA
(V/N) sleyt paAjasaidun jaqurV lw OOT-n04V
n
(4'6-£'6) tOSZ(ZHN) 3RSeid lw OSZ-Mg
>
r
(qei- V/N) D!3seld alualS lw OSZ-iZdS
`
(qel - V/N) >llseld alualS lw SZI-JSdS
a �
`a w
(V/N) 0 se}/HdAIM -ad SIVA £) X9/A
I
s
£ a
l.4 S£OS-(31)1 jad Sle!A £} )IVOA
(V/N) tOdEH VOA iw OV-d690
u7
IIJ
o
(V/N) pamasaidun VOAIw 0t-I169A
E
(V/N) EOZSZeN VOA lw Ot-ib9A
tC
N
y 3
�
a
C A
(V/N) OH VOA lw Ot-H69O
_£
f-IO)(V/N) QVHN JagwV I- OSZ-(V£90)VVOV
a
�
(Z > Hd) 170SZH jagwV lw OSZ-S£9V
CL
L
�
(Z > Hd) tOSZH jagwV iai!I TSI9V
w
as
�
C
o
(-I:)) (V/N) p—asaidun jagwV lw OSZ-n89V
(Z > Hd) OH jagwV aal!l T-HT9V
E
�
w
2
a
c
(-10)(b'/N) p---dun aagwV ja111 T-nT9V
panxasaidun jef sselg pa4lnow-ap!M-nd9M
Q
l
S
a
( I]) (ZT < Hd) HOeN >llseld lw SZT-6bd9
IxCL
�+
O
(6<) HOeWS aleiaW NZ 313seld lw SZI-ZtdB
z
n
(Z > Hd) EONH :)!lseld lw OSZ-NEds
a
2
(-I:)) (Z > Hd) VOSZN :!lseld lw SZT-S6d8zzzzzzz
C^�
(V/N) paruasajdun >lueld Jal!i I-nid8
m
a`
a
T
r
(V/N) pamasaidun 3!lseld lw 005-nZd9
(V/N) pavasaidun �135e1d lw OSZ-R£4d8
(-I:)) (V/N) p—asadun 3llseld iw SZT-ntd8
z
zzxx
C
m
n
#wall
.-1
N
1'1
d'
t!f
t0
1�
m
01
rr
er
ti
a
H
xuley!i
�
E
co

-PaceAnal ical
' www.pacolabs.com
I
Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Liberty WWTP
Pace Project No.: 92675084
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 06/29/2023
Date Received: 06/29/2023
Sample: Effluent Lab ID: 92675084001 Collected: 06/29/23 09:20 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 06/29/23 09:20
Collected By Garrett 06/29/23 09:20
Dreyer
Collected Date 06/29/23 06/29/23 09:20
Collected Time 0920 06/29/23 09:20
pH 6.39 Std. Units 06/29/23 09:20
Chlorine, Total Residual 0.00 mg/L 06/29/23 09:20
Reviewed by: C u�
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

0.1107 CHAIN -OF -CUSTODY Analytical Request Document LAB USE ONLY -Affix Workorder/Login Label here or list Pace Workorder Number or
..a.4ceAnalytical
f j.J�
Chain -of -Custody s a LEGAL DOCUMENT - Complete all retevent fields
W ///���
f 67,
ALL sHA f f
Company: Biding Information: — —
Address:
Container Preservative J 11 jj
II11111ff
2 ` 1 1 82678084 )�
"Preservative Types (1) nitric aud, (2) sue.
Report To:
Ema I To:
(6) methanol, (7) sodium bisulfate, (8) sodium thiosuffate, tz, •._
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other _
Copy To: I Site Collection Info/Address:
Analyses Lab Profile/Line:
[Customer Protect Name/Number: ; State: County/City: T me Zone Collected:
Lab sample Receipt checklist:
/ I JPTI JMT[ :CT I JET
t
;1
Custody Seals Present:'Intact Y N NA
Custody Signatures Present Y N NA
Phone:
Sate/Faci ity ID #f:
Compliance Monitor`ng?
Email:
[ Yes ( )No
Collector Signature Present Y N NA
f
(
Bottles Intact Y N NA
Ccrreet Bottles Y N NA
Col� By( r'
Purchase Order It:
OW PWS ID #:
Quote #:
DW Location Code:
I
sufficient volume Y N NA
Samples Received of Ice Y N NA
VoA. - Beadspace Acceptable Y N NA
Col'eci
urnaround Date Required:
Immediately Packed on Ice:
( ]Yes [ ]No
]
USDA Regulated Soils Y N NA
`j
Samples in Holding Time Y N NA
Residual Chlorine Present Y N HA
Sa
Rush:
Field Filtered (:f apprcable):
( J Dispose as appropriate ( ) Return
[ , Same Day [ J Next Day
[ ] Yes ( ] No
[1
V
cl strips:
[ ] Archive:
[ J 2 Day [ ]3 Day I J 4 Day ( ] S Day
+o nr'
Sample pH Acceptable Y N NA
Strips:
( }Hold:
;Expedite Charges Apply)
Analysis:Y„-_....._.:....___.
j
pH
sulfide Present Y N NA
Lead Acetate strips:
' Matrix Codes (tnsert in Matrix box be ow): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SQ, Oil f OL), Wipe (WP), Air (AR), Tssue (TS), Bioassay (B), Vapor (V), Other (OT)
"�
LAB USE ONLY -
Lab Sample # r Comments:
Comp /
Collected (or
Res
b of
Customer Sample ID
p
Matrix'
Grab
Composite Start}
Composite End
Cl
Ctns
Date
Time
Date
Time
I
i
i
1
1
t � t
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT (<72 hours): Y N N/A Lab Sample Temperature Info:
Packing Material Used: Lab Tracking#: Temp Blank Received: Y N NA
Therm ft:
Cooler 2 Temp upon Receipt: oC
[Samples received via: ' Cooler i Therm Corr. Factor: oC
Radchem sample(s) screened (<SDD cprrt): Y N NA I FEDEX UPS Client Courier Pace Courier Cooler i Corrected Temp: oc
ure) _ Date/Time: Receive/Company: (Sign, e) Date/Time: MT1L LAB USE ONLY Comments:
��/b/Z1iTable#:
=9z:
Accmum:
ure) atlTrme: 1 Recei /Comps igna re) y Date/Time: Trip Blank Received: Y N NA
CID Template:
N i ! PFetogin: HCL McOH TSP Other
r Re ir�vished by/Company: (Signature) Date/Time: Received by/Company: (Signature) J Date/Time: pm; Nort nformancge:
Cal es]: J Pa
PS: I

C^7
N
O
N
N
O
U
H
O
• J
U -0
ZL
(a
>, O
tf -0
a� a)
Q)
—iLL
O N
W
H
Q
O O— N N',I- LO LO (D f— 00 co O O O N c) - N N O OLf) CO N N
N M It to CD 1-- 00 M O c— N M ItU-) tD ti M M O � N MICT 0 W ti 00 M O
� c— � � � � � T— T— N N N. N N N N N N M
co

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _1_of_2_
Permit No.: WQ0003090
Facility Name: Town of Liberty - Wastewater
County: Randolph
Month: June
Year: 2023
Did irrigation
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4
occur
-
Area (acres):
20.2
Area (acres):
19.7
Area (acres):
19.94
Area (acres):
17.02
at this facility?
Cover Crop:
P�
FESCUE
Cover P�
FESCUE
Cover Crop:
FESCUE
Cover P�
FESCUE
El YES ❑ NO
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
Q yEs ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ yE5 ❑ NO
Field Irrigated?
❑ YES ❑ NO
o
`y
.L.+
m
O
E
°
ii
.0
`
m
O
In
m °
C f0
2
-
�, O.
tC O_
�ft
®a
>r ID
_� Q
O CL
�! Q
a
m .0..
E�
i--'
�, C
as
a o
J
yap
_ C
=a
X O
t5 2 a
J
ma
E N
a
0 0-
i Q
c
N w;
_E
H C
_
a�
a, E
O O
J
E a'
7 C
E ='a
x 0
2 0
J
ma
E �3
= c
O a,
7 Q
a
6f ,��',.
_E m
t-
_
a�
A i
a
U 0
J
E Tm
O C
E c
iG O
z S O
J
ma
E 2
Q
O Q_
Q
a
O a;
_E
h •�
_
a�
a 0
�
D O
J
E a
3 _
•a
x o
= O
J
°F
in
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
I min
in
in
1
2
C
70
0
535,000
300
1.00
0.20
3
4
5
C
69
0
545,000
300
0.99
0.20
6
C
68
0.25
535,000
300
1.00
0.20
7
C
72
0.25
468,000
300
1.01
0.20
8
C
68
0.25
545,000
300
0.99
0.20
9
C
55
0.5
535,000
300
1.00
0.20
10
C
75
0.5
541,000
300
1.00
0.20
11
C
80
0.5
468,000
300
1.01
0.20
12
131
C
78
0.75
535,000
1 300
1.00
0.20
14
15
C
76
0.75
545,000
300
0.99
0.20
16
C
80
0.75
541,000
300
1.00
020
17
C
75
1
468,000
300
1.01
0.20
18
19
R
1
201
R
0.5
21
R
TRACE
22
R
2.4
23
24
25
C
80
0
1
468,000
300
1.01
0.20
26
271
C 1
83
0 1
545,000
300
0.99
0.20
28
29
C
75
0
535.000
300
1.00
0.20
30
31
Monthly Loading:
2,180,000
3.97
2.675.000
5.00
1,082Q00
2.00
1.872,000
4.05
12 Month Floating Total (in):
30.21
31.47
25.60
35.57

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit? 0 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 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 ❑� 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.
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 Officials Title: Town Manager
Has the ORC changed since the previous NDARA? ❑ Yes 0 No
Phone Number: 336 622 4276 Permit Exp.: 8/31 /24
ar-
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 property gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _2_ of _2_
Permit No.: WQ0003090
Facility Name: Town of Liberty - Wastewater
county: Randolph
Month: June
Year: 2023
Did irrigation
Field Name:
5
Field Name:
6
Field Name-
7
Field Name:
8
occur
-
Area (acres):
--
18,3
Area (acres):
15.1
Area (acres):
•
22.12
Area (acres):
21.68
at this facility?
Cover Crop:
P�
FESCUE
Cover P�
FESCUE
Cover P�
FESCUE
Cover R
FESCUE
0 YES ❑ NO
Hourly Rate (m):
0.21
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
Q YE ❑ No
Field Irrigated?
❑ YES NO
Field irrigated?
❑ YES, El NO
Field Irrigated?
❑ YES ❑ NO
m
U
aRi
H
°°
v
d
m
n
_
om
C>p_
0 a
L
? Q
=
O
J
E
20
J
0 CL
E mCLcoa
F— L
O
E aE
�E
S 0
c CL
iE
E m
FCL
.Ec
O
J
E
cm
? cE
_—
m
J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
I min
in
in
gal
min
in
in
1
2
3
C
70
0
350.000
180
0.59
0.20
4
5
6
7
8
9
10
11
12
13
141
CL
80
0.75
350,000
180
0.59
0.20
15
16
17
498,000
300
1.00
0,20
18
19
R
1
201
R
0.5
21
R
TRACE
22
R
2.4
23
24
25
261
CL
70
0
498,000
300
1.00
0,20
27
28
29
30
CL
74
0
350,000
180
0.59
0.20
31
Monthly Loading:
996,000
2.00
1
0.00
0
0.00
1,050,000
1.78
12 Month Floating Total (in):
37.09
99.52
23.62
20.19

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
❑� Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 2 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑✓ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑� Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant ❑� 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 [21 No
Phone Number: 336 622 4276 Permit Exp.: 8/31/24
7 Z� a
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