The URL can be used to link to this page

Home My WebLink AboutWQ0003090_Monitoring - 07-2023_20230830Monitoring Report Submittal ..................................................... Permit Number#* WQ0003090 Name of Facility:* TOWN OF LIBERTY WWTP Month: * July Report Information Type * NDMR, NDAR-1, NDAR-2, NDMLR G W-59 Year:* 2023 Upload Document* JULY 2023.pdf 3.89MB PDF Only MW REPORT JULY 2023.pdf 3.01 MB 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: 8/30/2023 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: 9/13/2023 FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_of_1_ Permit No.: WQ0003090 Facility Name: Town Of Liberty - Wastewater County: Randolph Month: July Year: 2023 PPI: 002 Flow Measuring Point: ❑✓ Influent ❑ Effluent ❑ No flow generated Parameter Monitoring Point: ❑ influent ❑✓ Effluent ❑ Groundwater Lowering ❑ Surface water Parameter Code —► 00400 L 00610 31613 00625 �, 50060 70300 car i � 00630 ., t t a� Opt` t}E a , d f" fn a ,i x za E d_ o im a° o L� oI�U " U. O _ .,•, I— y t C.:5 `*,_y to � S .��Z Z P' 'rf� 31 24-hr hrs su m /L #/100 mL m /L m /L ra m /L 11561m /L 1 10:00 2 t 1 2 10:00 2 3 7:00 8 4 11:00 2 4 61 7:00 8 8 aS t 7 7:00 8 `" 7.34t'� 8 .... :a. 1tit ISBN, .6p 5' 10 7:00 8Ist 12 7:00 8�!" 13 7:00 8 6.99 10.9 2420 15.6 0.12 F �„ <0.040 .h 15 OEM 16 }All I� 17 7:00 8 2,1 18 7:00 8 7.66 9.7 2420 1 15.8 t; 0.14 x a„ i7 N ±r, <0.040 ',`k14t 19 7:00 8 20 7:00 8 21 7:00 8 22 10:00 2.. 23 10:00 2 24 7:00 8 25 7:00 8 26 7:00 8 j s 27 7:00 8 7.13 0.33gj 28 7:00 8 ` 29 10:00 2 30 10:00 2 31 7:00 8 Average:Wlw 10.30 2,420.00 #REF! 0.20 Daily Maximum: 7.66 10.90 2,420.00 #REF! s= 0.33 , t 0.04 Daily Minimum: $ '' 6.99 9.70 2,420.00 #REF! 0.12 Sampling Type: Grab Grab Grab Grab Grab Grab x Monthly Avg. Limit;" Daily Limit: Sample Frequency: x mo 2x month weekly f3x year �2x month � ,ram a� � 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? [Z 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 No Phone Number: 336 622 4276 Permit Expiration: 8/31 /2024 R, Sigi1at.re 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 Laboratory Report Tremaine Fike Town of Liberty PO Box 1006 Liberty, NC 27298 Project: Town of Liberty Pace Project No.: 92676088 Pace Analytical Services, LLC 1377 South Park Drive Kernersville, NC 27284 (704)977-0981 Page 1 of 1 Report Date: 07/07/2023 Date Received: 07/07/2023 Sample: Effluent Lab ID: 92676088001 Collected: 07/07/23 08:29 Matrix: Water Method Parameters Results Units Report Limit Analyzed Qualifiers Performed by PACE 07/07/23 08:29 Collected By Glenn Price 07/07/23 08:29 Collected Date 07/07/23 07/07/23 08:29 Collected Time 0829 07/07/23 08:29 pH 7.34 Std. Units 07/07/23 08:29 Chlorine, Total Residual 0.67 mg/L 07/07/23 08:29 Reviewed by: Stephanie Knott 704-977-0981 stephanie.knott@pacelabs.com Page 1 of 2 Z 26g zr ZY (D m FD a CL (I or U ift c'i CL — — — — — — — — — — 71 :Dr c o m 04 t�L It CL LI) ti q cr Ln 4 w all, )> > z 0 rL 0 a, to All 5 DO (D M� th 3 01 CL 10 a cr — — — — — — — — — — m — Oj @ to M C) m i; (a Sr M w -6 ID 10 2 0 fu ry CL — — — — — — — — — — — w CFO vq z — — — — — — — m — — — 5 — — — — — — — i, — — — — H (Field) v ---------- Total residual Chlorine (Field) x 3 ry — — — — — — — — — — — — — — — — — — — — SL — — — — — — — — --- - — — — — — — — — — Z-1 — — — — — — — — -- — I-D cr p 5 "D I.' 1p" 01 W .1 �Q' I, fb Dj V.0 0 to q (I N, fj (I M in t-i 0) fit 0 ee fT �4 t4 z V {' to 6 abed 9ZO09h :# uopeollllaaO d`dl3Nelul6JIA ££9 :# uolleoIPPOO JWMalseM eullaeO glaoN ZZZ09t7:# UOPO WOO dHl3NelulbalA 6000£066 :# uolleoillliao eullaeo glnoS 0£066 :(]I tioleJogel eullaeo glnoS 8£LL£ :# uolleolllaJaO aaleM bu!MUIJ(] eugaeO UPON 99ZZZ ON 'uaP3 'y apS peob MopealN lse3 90Z uep3 seolnaas Ieoi)Aleuy aped Ob :# uolle01PPaO aaleMalseM eullaeO WON Z6LL£ :# uopeolilliao jeleM bul�uija eullaeo t4PON 8b9L83 :# u0IMIJlia80 ddl3N/ep!Jo13 b088Z ON 'elllnagsy'anla(] aplsJanld{ SZZZ apinagsy saolMas IeollRleuy aced woo•sgelaoed@n llouN-aluegdals MO-LL6-V0L llou>{ aluegdalS :Aq paMalnad %0£ papaaoxa suollnllp aldwes pilen uaaMlaq OdH aql 9�A •paliodai anlen aql uegl jaleaA Lla�li sl anlen anti aqi ,pasn awnlon aldwes aql uo paseq poglaw slgi Jol Jagwnu algelloda wnwlxew agl sl 11 aouls alelullso wnwlulw e pajaplsuoo eq pinogs anleA palJoda�l 13 -sllwil ialuoo ijolejogel papaaoxa aleoydnp aldwes pue aldwes agl uaaMlaq uolsloGAd aql g(] su31313t/nt) 31AIVNV 00U £ZILZILO 090'0 W90 £ZILZILO 09'0 19:60 £ZILZ/LO OZ'O 9V96 £Z/LZ/LO Oh0'O 09:£6 Me [ILO 095E 6 £Z/£ ILO 09:£6 MUILO 09:£6 £Z/£6/L0 09:£6 £Z/£6/LO 09:£6 £Z/£b/LO 13'9(] £q:Z £Z/176/LO O'l M 06:b6 £Z/6HL0 07 LVM MKILO Ot7O'O LVOL £Z/bb/LO 0170'0 6Z:b6 MKILO 976 sJaipleno pozAleuy 1pillJoda�l l/6w l/bw l/bw l/bw l/bw silun 'Pis ]WOM/NdW l/bw l/bw l/bw l/bw silun 9'Z 9'9 6 6'0 L 9'S 6 ZVO 66'9 0SU EVE WO JOABJ(] llaaaeE) 33Vd OZ1VZ 5'S 6 (]N ON 5'9Z sllnsad JaleM :xlJleW OS:£6 £Z/£6/LO :P81081103 W06£ZLL9Z6 :al qe-1 CZOZ/U/LO :pan!aaa-�:j ale(] EZOZ/LZ/LO :ale(] }iodaH .jiodeH AJo;eaogeg 6 to l abed L860-LL6(VOL) V8ZLZ ON 'apinsJawa)q anu0 JJed g1noS LLEI o'1"I 'saaln.iag jeailJ(leuy aped snaogdsogd lelol 'lWPIGIA 'ua60JllN eluowwy 'ua6oJPN ua6allN lelol Ienplse�j Ielo1 'auuolgo Hd awll paloalloo Ole(] paloalloO A8 paloalloo Aq pawJolJad swiollloo leoad Aep 9 (]Og aleJM 'ua60JllN CON snid EON 'uaboJllN sploS papuadsnS Ielol sJalaweJed £666 O'Z A9H 4'S9£ Vd3 £66l O'Z naH Z' 69£ dd3 £66l O'Z nad 6'09£ dd3 uollelnoleo ZON+EON+N>Il K-IJaIIIoo 910Z-s01Z9 WS £66 6 0'Z nab Z'£q£ Hd3 £66 6 0'Z Aa2J Z'£S£ Vd3 S60Z-oovsz WS poglaw 4uanlI43 :aldwes 6£ZLL9Z6 :'oN loafad coed Llaagil to uMol :loafad 96ZLZ ON `Aljaq!l 900 6 X09 Od Ajaagq� jo umol Off! j ouleulai I m N 0 AI -OF-CUSTODY I Analytical The Chain -of -Custody is a LEGAL DOCUMENT_ All re t Submitting a sampe via this chain of custody constitutes acknowledgment and acceptance of the Pace Terms and Condit ionsfoul Section A Section B Section C 92677239 Required Client Information: Required Project Information: Invoice Information: ra e : 1 Of ampany: Town of Libe eport TO: Tremaine Pike ttention: ,om To omoany Name: "be . NC 27298 dress: R " mail: 11ik towrnof#ibe .c.0 Urchase Order #' ace Qu0te� hone {336W622-4276 Fax: roject Name: Town of Libe - Every 2 Weeks ace Project Manager,, stephame.knott labs, m, Sfaae i Loeation aquastPd Due Date: rOjeOf #: ace Profile #: 13077 Na toasted AA a Z' 0 o COLLECTED Z Preservatives A.th�RiX CCGE eO Gztiatsng ;r+ts,er Saw a L` ur VIM, fr',V.- PSL Sal L E IDmax, START END OL One Character per box. A. to-Z 0-9 ! -? 0o ' aT o a z „' r & a. o n is a `�s tv° TS �„� A # Sample Ida must be unique x j o °w O c Z V miz O r M N gs to LZ �' tl C N N DATE TIME DATE TIME a M= x S 2 2 6 m H 2 ¢ P ti o. � z tt 1.-... Effluent F/"�S X X X X X X X X 2, 3' 4 5- 7'' 9' 1D` 12` ADf ITI INA4 COMMENTS RELIN0Is1 KW SY t REFRIATdON : DATE -- TINE ; ACWTED BY f AFF=TM3N ®ATE i TW SAMPLECC#MMNS "+4 LEft NAME AND SIGNATURE $ ' PRINT Name of SAMPLER!' w 5 ? 3 � ? E ? �- SIGNATURE of SAMPLER: - _ DATE Signed:P 3 � r _ %IV$ —$a W I V I _VVU-V VV $—I W-i A opv%. 04111plu 1-u I iu I Lool I ace Upon Receipt Eff octive Date: 05/102022 Laboratory receiving samples- Asfiev lie Eden LJ Greenwood L_J Huntersville LJ Raleighn MechanicsvilteE] Atlantao Kernersv111eL-J,- Carrier Tracking Number: Custody Seal Present? []Yes [Sa<o Seals Intact? ]Yes No Packing Material: [Rubble Wrap ElHubble Bags UNone Other Thermometer: D� C) ?--, — EJ IR Gun I Type of lew Wet ] Blue .00ler Tenip J*C Correclion Factor. Add / Subtract ('C) Corrected Cooler Temp (*C )-- USDA Regulated Soil (E] N/A, water sample) Old samples Dor VInate in a quarantine zone within the United States: CA, NY, or SC (check maps)? yes , 00 Dat'llnitials Person Examining Contents-tv— Biological Tissue Frozen? [JYes [:]No JaWA El None Temp should be above freezing to 6*C [JSamples out of temp criteria. Samples on Ice, cooling prate hasbegun Did samples originate from 0 foreign source (intern pally, nally, r" '. -allu Comments/Discrepancy: Chain of Custody Present? Ly- 1, Samples Arrived within Hold Time? ........ 17- Yes EJNo ON/A 2, Short Hold Time Analysis (02 hr.)? Ely- E]No ®N/A 3. Rush Turn Around Time Requested? Elyes 1! tire E]N/A 4. Sufficient Volume? N/A S. Correct Containers Used? -Pace Containers Used? des ElYes [JNo FJN/A NaE](:]NIA 6. Containers Intact? ides EINO ON/A 7, Dissolved analysis: Samples Field Filtered? Elye5 o E (/A -1 a_ R. Sample Labels Match COC? -Includes Date/Tl!ne/10/Analysis Matrix: Headspace in VOA Vials (>5-6mm)? 9Y05 Yes E]No EJN/A N0 N/A 9. 10, Trip Blank Present? Trip Blank Custody Seals Present? —— [JYes ElYes _Q [JNo A No N/A -- ---- ill J Temp Loiil: Temp must be maintained at <6 C during login, record temp every 20 minutes, Time opened., Temp: Time: put In cooler Time: Temp: Person Contacted: Project Manager SCURF Review: Project Manager SRF Review: Oualtrax Document ID70677 WEMMEBEEMEL0=00 Lot ID of split containers: CLIENT NOTIFICATION/RESOLUTION Date/Time: Date, Date: Page 1 of 2 Page 3 of 4 2aceAnalyfick Document Name: Bottle Identification Form Document No,; F•CAR•CS•041-Rev.O1 *Check mark top half of box if pH and/or dechlorination is Project # verified and within the acceptance range for preservation samples. Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, ltHg **Bottom half of box is to list number of bottles Document issued: November 15, 2021 Pape 1 of 1 Issuing Authority; Pace Carolinas Quality Office R)Wr-1 0� tG .M 16 U � a 'o c� a u .N vi M Q C V a N 4 130 ¢ 'v C a VV �pCj to ca z M a c a` M q. In u ' V •a O N V E t% �, to N V Q M z x V Q N T co 0 Z °� ° N V d U E rNy N g to u n x Q i p ro U E sN.i n9 a ca v a ro •N c7 a .G E a {� a a a a c n r[ D v V x n x d v x z v w Z y L! C I d ..� p N ry `, x C. 0 N x n ,y t% ry V a V f }` s E M z V a x Z QI E d J a rMv m d Zj O ' E a (�7 NO M N G O E 0 Q Z v 4)Q v 4 C o �, E 49 Z 0 M 4 E to , �, o M n C ° ` 10 a } 4 �. d m E m d Z ro to E rq 9. ei v Q N i 2 E VN) a '> va+ p�p� N tlMl C a C d �Q � „" +n c o A c `J,' E Cj } 'n w N n c C E O A S - - 6 7 — Sample ID Type of Preservative pH upon receipt hate preservation adjusted Time preservation Amount of Preservative t.ot a adjusted �- - —added Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will tie sent to the North Carolina DEHNR Certification Office ji.e. Out of hold, incorrect preservative, out of temp, incorrect containers. Page 4 of 4 Tremaine Fike Town of Liberty PO Box 1006 Liberty, NC 27298 Project: Town of Liberty - Effluent Pace Project No.: 92677762 Sample: Effluent Method SM 2540C-2015 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 5210E-2016 Colilert-18 TKN+NO3+NO2 Calculation EPA 300.0 Rev 2.1 1993 EPA 350.1 Rev 2.0 1993 EPA 351.2 Rev 2.0 1993 EPA 365.1 Rev 2.0 1993 Laboratory Report Pace Analytical Services, LLC 1377 South Park Drive Kernersville, NC 27284 (704)977-0981 Page 1 of 1 Report Date: 07/31 /2023 Date Received: 07/18/2023 Parameters Lab ID: 92677762001 Collected: 07/18/23 09:13 Matrix: Results Units Report Limit Water Analyzed Total Dissolved Solids 198 mg/L 25.0 07/18/23 16:39 Total Suspended Solids 15.8 mg/L 6.6 07/19/23 08:56 Nitrogen, NO2 plus NO3 ND mg/L 0.040 07/18/23 16:55 Nitrogen, Nitrate ND mg/L 0.040 07/18/23 16:55 Nitrogen, Nitrite ND mg/L 0.040 07/18/23 16:55 BOD, 5 day 11.6 mg/L 2.0 07/24/23 10:19 Fecal Coliforms 2420 MPN/100ml- 1.0 07/19/23 09:22 Performed by PACE 07/18/23 09:13 Collected By Glenn Price 07/18/23 09:13 Collected Date 07/18/23 07/18/23 09:13 Collected Time 0913 07/18/23 09:13 pH 7.66 Std. Units 07/18/23 09:13 Chlorine, Total Residual 0.14 mg/L 07/18/23 09:13 Total Nitrogen 15.8 mg/L 0.040 07/28/23 12:46 Chloride 27.9 mg/L 1.0 07/20/2316:22 Nitrogen, Ammonia 9.7 mg/L 0.10 07/28/23 10:52 Nitrogen, Kjeldahl, Total 15.8 mg/L 0.50 07/26/23 04:09 Phosphorus 2.5 mg/L 0,050 07/31/2311:35 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 VirginiaNELAP Certification #: 460222 North Carolina Wastewater Certification #: 633 VirginiaNELAP Certification #: 460025 I Qualifiers Page 1 of 3 ro m ro n rn n �+ n n n m n n. o 3 a c D v n ° N. c IIII trt 3 (G 3 c x p. a, o m @ _— �° o ? w d fD as w O d G < tP v 3 4bb 6r d N K O tl O O � v�i m ti a P• a �a �+ e —q w �, s z 3 3 3 n in to n a t A B o �? R # cr I ^" � a a =c o ® p P K CL Q .0 N FD J w O QQ m m :m a t7 ® ro y a m V aio .. o r C m �, w a '-' K n a• 3 a 0-1 m CL ro$i-` ID d yro ^' a0 � o n � Cj Cqf �. 3 m =! '� ro a o o -o a IA Cy m" zv z r n zo m m � ro a QmS .. ^ a• ri •,� " r,,,l -_n mac@( m f14 n N 41. m ro Q a� n . m m � .. i� o e to m Cri n ar f* BOC, TS$ NO3-N, Chloride, TCS n ` NH3-N, TKN, Tatar N., Total P. 4 o v F.Coli 3 n m R 3 ro ('a 3 N. pH (Field) M Total residual Chlorine (Field) -{/ n p G ; cr 7 q n i ib .. f... m u w N - -K m \ m Y a �y+V RV 0 n woctf5nnf CCU �N+ n O'W MM W th t7 a. (!t pV, ff' h•t rt !-+ . f Y Y- m A , to to Ct $ O, z sy rn ro rq a ro rn` r Y O tf to M; m r• a r'�1 p w r+ rt yr w x�' onro 1 rn Wx,. rya rncrad �•re m ob Q Q to to as C7 M Qa �^ N r�ro��On �p N roti n roq� 3 4° ...t 40 m C A: � w c irj z 0 z V. Z Z Zk.% 2X; 6ceMaVical Document Name: Bottle Identification Form (BIF) Document Issued; November 15, 2021 Page I of I 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, Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg **Bottom half of box is to list number of bottles dl E tA00- C6 -0 tN E LA -U `ryIn tg E 0 rq CL "4 0 rq E, rq tA 2 2 J CL E 0 z M Z 4 z NZ-0 1J 0 M Al . 0 E U) 2 0 z C E U -0 E < Z) -0 E a.Z E E 0 Z E MEEEE M 0 > <1 0 > z 0 M 0 > M & ,aEE M 41 �n rJ In CL 0) 6 rq "I 04 0 M 'Z' E 0 M M r- W C: E C, E E 3 4 7 71 8 8 10 pH Adjustment Log for Pr rved Samples Type of Preservative adjusted Time preservation Amount ----Lot—M Sample ID I- I adjusted added F Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEI-INR Certification Office (i,e. Out of hold, incorrect preservative, out of temp, incorrect containers. Page 3 of 3 Laboratory Report Tremaine Fike Town of Liberty PO Box 1006 Liberty, NC 27298 Project: Liberty WWTP Pace Project No.: 92679537 Pace Analytical Services, LLC 1377 South Park Drive Kernersville, NC 27284 (704)977-0981 Page 1 of 1 Report Date: 07/27/2023 Date Received: 07/27/2023 Sample: Effluent Method Parameters Lab ID: 92679537001 Collected: 07/27/23 12:10 Matrix: Results Units Report Limit Water Analyzed Qualifiers Performed by PACE 07/27/23 12:10 Collected By Garrett 07/27/23 12:10 Dreyer Collected Date 07/27/23 07/27/23 12:10 Collected Time 1210 07/27/23 12:10 pH 7.13 Std. Units 07/27/23 12:10 Chlorine, Total Residual 0.33 mg/L 07/27/23 12:10 Ck�111-u Reviewed by: Stephanie Knott 704-977-0981 stephanie.knott@pacelabs.com Page 1 of 2 Z'PYI z VP :3 Ou r rn 43cV - 03 gg--, 3 ib cm, (Cry c fD r C) n In rn — — — n CL AN Ln ro cr XO CY ZI Q'i ro O fy a 10 a M (A CD It ' z z -Z Z ryg4 In 7-1 rr OEM WIN" fJ31L 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2023 Liberty N.C.W.W.T.F Freeboard Lagoon Inches 3 1 /2 R 0.7 3 1/2 3 3 3/4 4 1/4 5 5 3/4 6 1 /2 R 0.4 6 1 /4 R 0.5 5 4 1/4 5 5 1/2 6 6 1/2 7 7 1/4 7 7 1 /2 8 8 1/2 8 3/4 9 R 0.2 9 9 1/2 9 1/4 9 3/4 10 10 1/2 11 10 3/4 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? 2 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? ❑✓ 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 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. 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 El No Phone Number: 336 622 4276 Permit Exp.: 8/31/24 IZ Z3 Signature Da e 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? ❑✓ 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? El Compliant ❑ Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? 0 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 IN 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 Fl, 71,� 21 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