WQ0003090_Monitoring - 10-2023_20231128

Monitoring Report Submittal
Permit Number#* WQ0003090
Name of Facility:* TOWN OF LIBERTY WWTP
Month: * October Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR OCT SPRAY REPORT.pdf 3.92MB
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: 11/28/2023
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: 11/29/2023

FORM: NDNR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_ of_1_
Permit No.: W00003090 Facility Name: Town Of Liberty - Wastewater
County: Randolph
Month: October
Year: 2023
PPI: 002
1 Flow Measuring Point: El Influent ❑ Effluent ❑ No Flow generated
Parameter Monitoring Point: ❑ influent 0 Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code — 0
3
50060r
70300
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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 [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

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Pace- Location Requested (Cityfstatel:
IAnalytical Kernersville, NC CHAIN -OF -CUSTODY Anatytical Request Document
a —IF Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevjnt fields ce I377 South Park Dr., NC 2728A Pace
WO#092691476
r-A I
Company N3cle: Town of Liberty
Street Address; PO Box 1006, Liberty, NC 27299
:,Customer R,crject 0:
Project Name: Town of Liberty - Every 2 Week:
: ',.'Site colif"on Info/facility 10 {as applicable):
Cortact)Reocrn To: File, Tremiline
phone 9: [phone]
E-mail: [e-mail]
Cc E-Ma; 1:
92S91476
Invoice To:
Invoice E-Mail:
Pwch"w Order a (if
Q—te In
Specily Container Size
Size: III IL M SOEatOmL. (31250�L
Terra C­. M other
Identify CC,--Aa;ne, Preservative Type—
... P—e—t- Types,(11 None. (2) HNO3, f3)
K2504, (4) H0, (S)NAOM, (6) Zn AzetaTc, 171
NaH504, M See. Thi-1tva, *1 Ascorbic Ave, (10)
MeCH, 41) Other
7—
Analysis Requested
U_ Z
Z i7L
Z Q
CD
.2
U_
7Z
P-j- Mgr:
Stephanie Knott
2!
�Tlme Zone Collected: ]AK iPT MT JCT ET
county / State origin of ornofei* North Carolina
Data Deliverables:
Level IV
julner
Regulatory Program iDW, RC RA, etc.j as applicable:
jAcaNum I Client 10:
Rush (Pre-approv2I required):
I 12Day [ 13day 10thel
Date Results
Requezted:
DW PwSID 4 or WW permit 4 as applicable:
Table M;
Field Filtered {if applicable, Yes I 'No
AnalySiSZ
Profile I Template:
13077
i- mat . n . x Codes [insert in Matrix box belowl: Drinking Water (DW), Ground t4rzter (GW), waste Water (WWI, Product IN, Soil/Solid (55), Oil (OL), Wipe (WP), Tissue (75), 8ioass3v(9), Vao0r(V),
Other JOT), Surface Were, (SW).Sedirnert (SED). Sludge M), Caulk
Prelog / Bortfle Ord. ID
1147718
Customer Sample 10
Matrix'
Grab
Co we
(or cornposit
Copaslle End
Re,
CL2
TvT_ .1
—
le Comment
Date
Dale
P
Gil.
Effluent
wr
X
X
X X
X X
X
X
,ust.,,, Remark, l Special Concrttions I Possible Hazards: Collected
Printed
Signature:
BY:
Na—
Additional Instructions from Pace':
',Relinquished by/C_p3ry. t5onatur.1
I &NA1
M,e) oatef me:
Traryknlp Number;
RecLived
OrIt'e"dby: t 1 3 -,aQf;er
W—rr. (s4nol—)
Dme/Ti R—ed
by/Company: (Signature) Date/Tirne7
�e= UPS Other
1�
Reii.q.a.d bWC.rnP2rv:
Dare/Ti­
{Signature) Q=eM­
Page: I of
TL,brnig' ug a sampie via this chain ofcustody constitutes acknowledgment and acceptance of the PaceO Terms and Com5tions found at avl
4�-.

Do�ornent Name: 1 Document Revised: November J.S, 2021
Sample Condition Upon Receipt (SCUR) Page, 1, of 2
Aacehnoxal I- 11 1 - Docurnent No Issuing Authority:
F-C6tR-CS-033-Rev.08 Pace Ciroliflas Qul'ity Offict
i'aboratory receiving Samples,
Asheville 11 Eden E] GreenwoodE] Huntersville [J RaleighechanicsvilleL] Atlanta[] Kernerwille[A
N
Client me:
O 0-M NaProject W
E]
Courier: ]fed Ex UPS EWSPS
F1 Conlyne-al [Apace Elother:
Co%tody St�al Present? []Yes No Seats Intact? [JYes (_JNo Oate/Initials Person txaminini; Contents._
Packing Material: []Bubble Wrap ElBubble Baps ffNone E] Other Biological Tissue fromn?
Thermometer: 0 C> 7 E�wet 081t,e OH—e [-]Yes EJNo FIN/A
El Type of tee:
Correction Factor;
Ternp 5hould be above freezing to OT
Cooler Terrtp� Add/Subtract (*C)
EJ Sample s out of te rrip f iterio, Samples o­ r e7 f of),11% pruce
has beguri
USDA Regulated Soil (ffrl/A, water sample)
old samples or Vitiate in a quarantine 1000 Within the #'ioftpd State,-, CA. NY, or SC (check m;iD01 oiti sarrinlos onvinan, irmn a forpipr­.-irro
[]Yes JJNo . ......
ricluding Hawa i and Puerto Ri'o",? F_ No
J Y es EJ
Comments/Discrepancy:
Chain of Custody Present?
ffye: _jjN,i
N,A
1.
— - - -------------
Samples Arrived within Hold Twne?
[,JYe a
[JW
[]NiA
2.
short Hold Time Analysis (<72 br.)?
EJN
Rush Turn Around Time Requested?
--Elh')
DMIA
Sufficient Volume?
]Yes
[)No
[N/A
5,
Correct Containers Used?
ffYes
[]No
CJN/A
6
-Pace Conuillefs used?
[]P1o[_jN/A
Containers In(act?
Yes
ONo
DN/A
7
Oiisolved analysis: Samples Field
[-Jyt?5
]No
11 N/,)
—
8
Sample Labels Match COC?
Fly,"
[]Na
nNJA
9
-Includes 0ate/Timv/ID/Ar)aIysr5 Matrix:
Headspace in VCA Vials (>5-6mm)?
QNo
N/A
LJ
I(I
Trip Blank Present?
L]Nr)
JN/A
11 — - — — ------
frip Blank Custody Spals Present?
_.,_.___Yes
[]Nu
t_,4N/A
COMMENTS/SAWIPLE DISCREPANCY
CLIENT NOTIFICATION/RESOLUTION
Per%oll contacted:
Project Manager SCURF Review;
Project Manager SRF Review;
Dakfe/'i a-oi':
Lot ID of split containers�
Date:
Date:
Field Data Required? EJy,,", [] No
Page 3 of 4

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Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92693002
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 10/13/2023
Date Received: 10/12/2023
Sample: Effluent Lab ID: 92693002001 Collected: 10/12/23 14:10 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 10/12/23 14:10
Collected By Garrett 10/12/23 14:10
Dreyer
Collected Date 10/12/23 10/12/23 14:10
Collected Time 1410 10/12/23 14:10
pH 6.99 Std. Units 10/12/23 14:10
Chlorine, Total Residual 0.02 mg/L 10/12/23 14:10
Reviewed by:���
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CHAIN-OF-CUSTUUY Analytical Request uocumern
Chain -of -Custody,- a LEGAL DOCUMENT - Complete all relevent fields
npany- Billing Information:
cress:
)o rt To: Email To:
)y To: Site Collection Info/Address:
tomer Project Name/Number: me JPT( JMTJ ICT ]ET
me, Site/Faci ity ID Compliance Monitoring?
ail.-. I %JOOYes ]Nc,
fett!�'By (print) Purchase Order DW PWS ID
Quote DW Location Code.
iecred By (si na Turnaround Date Required-. Immediate y Pacl.4ced on Ice':
Yes No
-)pleSsp�o-sal: Rush: Field Filtered (if applicable):
Dispose as appropriate Return Same Day I I Next Day ( ]Yes ]No
Archive 2 Day [ ] 3 Day [ ]4 Day 5 Day Analysis:
Hold:— (Expedite Charges Apply)
latrix: Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
-oduct (P), Soil/Solid (SQ, Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
Comp J Collected (or Res # of
: Composite End
rtomer Sample ID i Matrix Grab Composite Start) C, Ctns
Date Time Date Time
MTJL Log -in Number Here
ALL H1
- s WO#.92693002
Container Preservativi
—Preservative Types: (1) nitric acid, (2)
(6) methanol, (7) sodium bisulfate, (8) so
JQ ammonium hydroxide, (D)TSP, M Ui
Analyses
Lab Profile/Line:
Lab Sample Receipt checklist:
Custody Seals Present/Intact Y N NA
Custody Signatures Present Y N NA
collector Signature Present Y X NA
Bottles Intact Y N XA.
Correct Bottles Y N NA
sufficient Volume Y N NA
Samples Received on Ice Y N NA
VOA - Readspace Acceptable Y N HA
USDA Regulated Soils
Samples in Holding Time Y N Na
Residual C~hlorine Present y N NA
cl Strips;
Sample pli-Acceptable Y N NA
RE Strips:
Sulfide Present Y K NA
Lead Acetate Strips:
LAB USE ONLY -
Lab Sample Com=ents;
1 7
tomer 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:.
Lab 11 Tracking I I I I 1 9. Temp Blank Received; Y N NA
Packing Material Used:
Therm ID# -
Cooler I Temp Upon Receipt; _oC,
Samples received via-. Cooler 1 Therm Corr. Factor ....... pC
Radchern sample(s) screened 'K500 cpm). Y N NA FEM UPS I Client Courier Pace Courier Cooler 1 Corrected Temp: oC
O
ni
nquished
DateTme: R by/Company: (Si nure) i rlDate/Time: MTJL LAB USE ONy
Comments.
Sable
a
V Aoctnum:
o/- -- ±k�—
(Signature) Received by/& -
any (Si&ture) Date/-1 ime: r Trip Blank Received: Y N NA
ITemplate I P Other
HCL MeOH TS
.;prelogin:
iSignature)
Date/Time: f Received by/Company: (Signature) Date/Time.-
PM:
Non Conformance(s): Page:

Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92694276
Sample: Effluent
Method
SM 2540D-2015
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 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 11 /03/2023
Date Received: 10/19/2023
Lab ID: 92694276001 Collected: 10/19/23 11:35 Matrix: Water
Parameters
Results
Total Suspended Solids
19.2
BOD, 5 day
17.6
Fecal Coliforms
2420
Performed by
PACE
Collected By
Garrett
Dreyer
Collected Date
10/19/23
Collected Time
1135
pH
6.87
Chlorine, Total Residual
0.01
Total Nitrogen
26.3
Units
Report Limit
Analyzed Qualifiers
mg/L
10.4
10/20/23 13:50
mg/L
2.0
10/25/23 09:59
MPN/100ml-
1.0
10/20/2312:20 El
10/19/23 11:35
10/19/23 11:35
10/19/23 11:35
10/19/23 11:35
Std. Units
10/19/23 11:35
mg/L
10/19/23 11:35
mg/L
0.040 11/02/2314:10
Nitrogen, Ammonia
21.6
mg/L
1.0
10/31/23 07:58
Nitrogen, Kjeldahl, Total
26.2
mg/L
2.5
11/02/23 05:59
Nitrogen, NO2 plus NO3
ND
mg/L
0.040
10/21/23 00:05
Nitrogen, Nitrate
ND
mg/L
0.040
10/21/23 00:05
Nitrogen, Nitrite
ND
mg/L
0.040
10/21/23 00:05
Nitrogen, NO2 plus NO3
ND
mg/L
0.040
10/31/23 14:37
Phosphorus
3.7
mg/L
0.050
11/01/2310:36
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: C 4 q—* ,"`, - �g � t-
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
VirginiaNELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
VirginiaNELAP Certification #: 460025
Page 1 of 4

t7 j
12
Cb
2
V
Al O
K f 6
0
0 3
IT
Y 0
M
AmmuniatTotal Phos
1
FXX
BOD 5-day
Fecal Cell
ro
X Nitrate
TKNf-rN
ry
TRC (Field) «0, C> I
poll= .O..Wm
TSS
Bloom
pH (Field)
a
M
19 Lot> Use Only
t4
N za cl
9
0
Preservation non conformance identified
for
simple,

OU—Title; ENV- FRM-RUN 1-0084 vOIJech Spec Sample Condition
111?8ce Upon Receipt
Effective Date:
Laboratory receiving samples:
Asheville 0 Eden 0 Greenwood [] Huntersville] RaleighE] MechanitsvilleLl ABanta[ Kernersvillezr
Client Name:
Courier-, QFed Ex Elu PS EluS P S Client
Commercial [Face Elother:,
(',arrier'fracking Number:
Custody Seal Present? D Y es No Seals Intact? Elyes EJNo Date/in I itials Person Examining Contents:
Parking Material: E]Bubble Wrap ElBubble Bags (ZfNone El other Biological Tissue Frpzen?
Thermometer: El IR G,- 1D , 11-Y— T' 0 & -Z Type of ice: Wet El alue E] None OYes E]N, ffIN/A
Canter 7crup (*C):__J-1 L— CorrectiovtFactor: Adti/Stjt)triict ('C) rTemp should be above freezing to 6°C
corrected Cooler Temp ('C)�(,]Samout of temp criteria, Samples no ice, cooling process
.
has begun
USDA Regulated Soil (ffN/A, water sample)
Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check inaps)? Did samples originate fioma foreign source (internationally,
E]Yes 'No including Hawaii and Puerto Rico)? F]Yes 17INo
Chain of C Lis tody Present?
EIN/A
1,
Samples Arrived within Hold Time?
Oyes
ONo
C)N/A
2.
Short Hold Time Analysis (02 br,)?
Ocs
[]No
E)N/A
3
Rush Turn Around Time Requested?
PS
J,
EIN/A—,
4
Sufficient Volume?
No
N/A
S.
Correct Containers Used?
-Pace Containers Used?
C;Yes
[72yes
®No
ONO
[:]NIA
®N/A
6.
rontaifler5 Intact? —11ES—QN.
ON/A
Dissolved Analysis: Samples Field Filtered?
[lye-,
[]NO
E)N/A
8
Sample Labels Match COC?
-Includes Date/Time/ID/Analysis Matrix:
(es
EINO
[E:]N/A
9
—Headspace in VQA Vials (>5-6mm)?
(3Yen
I PJo
ffN/A
I 10.
Trip
p Blank Present?
Trip Blank Custody Seals Present? --.-.[]Yes
IN.
[]No
11
LOMMENTS/SAMPLt, DISCREPANCY
Ternp Log: 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:
Qualtrax Document ID: 70677
Field Data Required"? UYes LJNo
Lot ID of split containers
CLIENI'NOTIFICATION/RESOLUTION
Date/Time: ......
Date:
Date:
Page 1 of 2
Page 3 of 4

Document Name: Document Issued: November 15, 2021
Bottle Identification Form (81 F) Page 1 of I
Document No,: Issuing Authority:
aceAnalytical F-CAR-CS -043-Rev.01 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, 0110/8015 (water) DOC, LLHg
"Bottom half of box Is to list number of bottles
X
M
41
Z)
.Y
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12-
pH Adjustment Log for Preserved Samples
Type of Preservative Date preservation �adjusted Time preservation Amount of Preservative Lot 0
adjusted I added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will he sent to the North Caroka DEHNR Certification Office (Le
Out of hold, incorrect pfe5e(vative, out of ternp, incorrect containers.
Page 4 of 4

Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92695262
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 10/26/2023
Date Received: 10/26/2023
Sample: Effluent Lab ID: 92695262001 Collected: 10/25/23 13:10 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by Pace 10/25/23 13:10
Collected By Garrett 10/25/23 13:10
Dreyer
Collected Date 10/25/23 10/25/23 13:10
Collected Time 13:10 10/25/23 13:10
pH 7.05 Std. Units 10/25/23 13:10
Chlorine, Total Residual 0.06 mg/L 10/25/23 13:10
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

1�;alce
rnpany-
dress.
wort To:
ay _T___
r1
;tomer Project Dame/Number:
Chairs -of -Custody is a LEGAL DOCUMENT -Com.
j Billing information:
1 Email To:
Site Collection info/Address:
State: County/City:
all relevent fields
LAr, Uzlt: UNLY- ATT= La*ez rlufu vi ��. raar
MTJL Log -in Number Here
ALLSW
— Preservative Types: (1) nitric acid, (2)s:
f6) methanol, (7) sodium bisulfate, (8) sod
(C) ammonium hydroxide, (D) TSP, (u) Un;
Ana lyses
Time Zone Collected:
[ JPTJ JMTJ ICT [ JET
one:
Site/Facility ID
[compliance Monitoring?
Oes ]No
1p d By (priril'=:
Purchase Order #:
DW PWS ID
Quote
DW Location Code:
lecte
Turnaround Date Requ:red:
lots y Pac d ice:
oon
I ) Yes [ ]N.
e Disposal-,
Rush:
Field Filtered (if applicab e):
Dispose as appropriate Return
[ ]Same Day 1 ]Next Day
[ ]Yes ]No
Archive
2 Day [ ] 3 Day 14 Day 5 Day
Analysis
Hold:
(Expedite Charges Apply)
latrix Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
roduct (P), Soil/Solid (SQ, Oil (OL), W`pe (W?), Air (AR), Tissue (TS), B oassay (8), Vapor (V), Other (OT)
Comp/ j Collected (or Composite End
stomer Sample ID Matrix Grab Composite Start)
Date Time Date Time
- -- ------ -
-------
acimerkemarks Special Cond clone j Possible Hazards-
Type of ice Used. wet Blue cry None (SHORT HOLDS PRESENT (<72 h
Packing Material Used:, 41abTracking #:
S;mpies received via,
Radchem saimplefs) screened (<500 cpm): Y N NA 6 FEDEx ups Client
inquish Date/Time: Repei4vc! by/Ccimj*n��_ (Signature) [DateMme: T Ti
(5griature)
inquishedby/Company:(Sgrature)
91
Rec_e VCSC�Yln _e Date/Time
-
d bvl
Date/7'm?
----- - _FR.ceaved bv,,Company: {Signature,
Wo#'92695262
SM5262
saznple Receipt checklist:Custod y Seals Present/intact Y N NA
custody Signatures Present 'Y N NA
collector Signature Present y K ua
Bottles Intac:t Y N NA
correct Bottles YR NA
Sufficient Volume y NNA
Samples Received on Ice Y N NA
V0A - Headlispace Acceptable y N NA
USDA Regulated soils y N NA
Samples in Holding Time .Y N NAResidual Chlorine Present y X NA
Cl Strips:
Sample pH Acceptable
PE 5trips:
Sulfide Present Y N NA
Lead Aci�-,tate Strips—
LkB USE �=Y.
Lab Sample f i Comments -
Y N N/A Lab Sample Temperature logo:
Temp BlankReceived: Y N NA
Therm ID#-.
Cooler I Temp Upon, Receipt- _L_PC
Cooler I Therm Corr. Factor. oC
Courier Pace Courier Cooler 1 Corrected Temp: oc
MTSL ZAi USE ONLY Ccimmerit:s-
:Mum.,
,mplate: Trip Blank Received: Y N NA
elogi I n: HCL MeOH TSP other
A, i
,Ion Conformarice(s): 'Page:

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
31
30
30
30 1 /4
30 1 /2
30 3/4
30 1 /4
30 1 /2
30 3/4
30 1 /2
30 1 /4
30
29 1 /2
29
28 3/4
28 1 /2
28
29
28 1 /2
28
28 1 /4
28
27 1 /2
27
26 1 /2
26
26 1 /2
26 1 /4
26 1 /2
26 3/4
27
26 3/4
• OM 1
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
R 0.2
TOTAL 0.2

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _1_ of _2_
PermitNo.: WQ0003090
Facility Name: Town of Liberty - Wastewater
County: Randolph
Month: October
Year: 2023
Field Id Name:
2
e:
4
Did irrigation occur
Area (acres):
19.7
at this facility?fi
»
Cover Crop:
FESCUE
Cover Crop:
FESCUE
21 El
bk
Hourly Rate (in):
0.21
9 et
Hourly Rate (in):
0.21
YES NO
A
Annual Rate (in):
52
4
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
2 YES ❑ NO
Field Irrigated?
[21 YES El NO
Q
M
Q
% 2
0) 10
'0
E
0
VLt6E
.2
E cc
E
E .2
CU
2,
E
0
Q
CL
CL
0
.2
—
2
0 CL
i=
CC
0
C 0 M
0
0 CL
.0
cc
0
cc
0
0
>1 CL
M CL
>
_j
_j
>
_j
cc
U)
F
in
ft
ft
gal
min
in
in
gal
min
in
in
2
C
60
2.5
281,000
180
0.61
0.20
3
4
5
6,
C
75
2.5
281,000
180
0.61
0.20
&
7
8
9
10
IN
12
I. IN
13
A. MITI "a
14
15
64
2.25
0.20
16
G
3/ 1,UUU
IOU
U.OU
11!
171
MAN
18
19
C
70
2.25
20
PC
66
010.2
2.25
321,000
180
0.60
0.20
21
t by a3
22
1
1
6
23
2
MIN
24
2
25
C
60
0"i AA
26
ON'
27
C
70
2
2
321,000
180
0.60
0.20
28
C
72rr
1
291
301
311
1,284,000
Samr
Monthly Loading.
2.40
37.33
)sg nnn
1.2212
Month Floating Total

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? E Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 21 Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? O Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑✓ Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Elix Tremaine Fike
Permittee:
Scott Kidd
Certification
No.: 989290
Signing Official:
Grade:
SI Phone Number: 336 622 2990
Signing Official's Title: Town Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes 2 No
Phone Number: 336 622 4276 Permit Exp.: 8/31 /24
Signature Date
ell Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _2_ of _2_
Permit No.: WQ0003090
Facility Name: Town of Liberty - Wastewater
County: Randolph
Month: October
Year: 2023
Field Name:
6
Field Name:
8
Did irrigation occur
Area (acres):
15.1
*1704, E
Area (acres):
21.68
at this facility?
Cover Crop:
FESCUE
Cover Crop:
FESCUE
El YES El No
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
MAnnual
E
Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
❑ YES El NO
Field Irrigated?
YES El NO
E m
0
E
E .2?
=1 a
E
0
.2
:11
0 CL
E
0
0 M
0
2
0 CL
E
0
E
0
C�
M CL
> <
> <
L6
1=92MM"Nom
oF
in
ft
ft
N 4 "1
gal
min
in
in
gal
min
in
in
I
C
72
2.5
252,000
180
0.61
NO
2
C
60
2.5
3
11 W'I
4
C
70
2.5
0009, =1111MAININNISM, "all,
$
6
7
C
70
2.5
R
X
8.
C
68
2.5
9
10
12
13
141
15
16
17
18
INS
19
20
PC
0/0.2
M 11N
21
s.rm
O
22
gtakal
23
ItN,
A
24
I W
251
mom
1
26
27
Ai
28
29
C
71
2
350000
180
059
0.20
30.
311
1
1
30
252,000
.59
Monthly Loading:
0.61
12 Month Floating Total (in):
29.89

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
❑J Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
E✓ 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?
121 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 necessarv.
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 0 No
Phone Number: 336 622 4276 Permit Exp.: 8/31/24
o2
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