WQ0003090_Monitoring - 11-2023_20231228 (2)

Monitoring Report Submittal
..................................................
Permit Number#* wg0003090
Name of Facility:* town of liberty wwtp
Month: * November
Report Information
Type *
G W-59
NDMR, NDAR-1, NDAR-2, NDMLR
Year:* 2023
Upload Document*
gw 59 nov 2023.pdf 3.76MB
PDF Only
nov 2023 spray report.pdf 5.45MB
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 T Fike
Signature:
Date of submittal:
Initial Review
12/28/2023
This will be filled in automatically

Reviewer: Wanda.Gerald
Is the project number correct?* wg0003090
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 1/22/2024

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_ of _l_
Permit No.: WQ0003090
Facility game: Town Of Liberty - Wastewater
county: Randolph
Month: November Year: 2023
PPI: 002
Flow Measuring Point: ❑✓ Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent ❑✓ Effluent ❑ Groundwater Lowering ❑ surface water
Parameter Cade —►
" t 00400
00610
gg
31613
00625
50060
€�
70300
$ 00630
e
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d
O
U O
p
Q
N
.}j
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24-hr
hrs
su
F s
mglL
t C be
#/100 mL
i,
mgIL
d ?� 'f
mglL
i -`I 1 4
mg/L�
i,''V mg/L
1
7:00
8
�t,,1:
J.
S �. 4 79
" '?F' '
����
Z
7:00
8
d Ep
7.26
Y"4: R 0., .'
22.3
z4`7Y 1, \+":*a
2420
v
26.2
0.04�f
.,4
<0.040
'a
3
7:00
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g #REF!I
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rr!
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b 0.04
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`„ _ #REF!
', 0.03
204.00
s 0.04
3Y
Sampling Type:
' Grab
AN
,
�;
�� j� Grab
t zr uv".
Grab"
Grab
Grab,
tg'*' a S�`��
;
l� 4M1
e t Grab"
1
Monthly Avg Limit:
��� ,
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�
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Daily Limit:
.'
�
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�"
b"
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Sample Frequency.;
r��
weekly
u��., "�
T} 2x month
,�a�;
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2x month
,�<���s..
2x months:
weekly.i"
3x year
,., y, 2x month
i.c#f ?3
a1NE
,

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: GLENN PRICE Name: PACE ANALYTICAL
Name: GARRETT DREYER 11 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 EZ 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

(Yace��
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92696434
Sample: Effluent
Method
SM 2540D-2015
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
SM 521OB-2016
Colilert-18
TKN+NO3+NO2
Calculation
EPA 350.1 Rev 2.0 1993
EPA 351.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Parameters
Total Suspended Solids
Nitrogen, NO2 plus NO3
Nitrogen, Nitrate
Nitrogen, Nitrite
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 11/15/2023
Date Received: 11 /02/2023
Lab ID: 92696434001 Collected: 11/02/23 11:50 Matrix: Water
Results
18.9
ND
ND
0.049
18.0
2420
Pace
Garrett
Dreyer
11 /2/2023
1150
7.26
0.04
26.2
Units
mg/L
mg/L
mg/L
mg/L
mg/L
MPN/100mL
Std. Units
mg/L
mg/L
Report Limit
14.3
0.040
0.040
0.040
2.0
1.0
0.040
Analyzed
11 /03/23 13:25
11/02/23 16:38
11/02/23 16:38
11/02/23 16:38
11 /08/23 10:13
11/03/23 11:25
11/02/23 15:21
11/02/23 15:21
11/02/23 15:21
11/02/23 15:21
11/02/23 15:21
11/02/23 15:21
11 /15/23 16:40
Nitrogen, Ammonia
22.3
mg/L
0.50
11/10/23 14:23
Nitrogen, Kjeldahl, Total
26.2
mg/L
2.5
11/15/23 04:54
Nitrogen, NO2 plus NO3
ND
mg/L
0.040
11/14/23 03:45
Phosphorus
3.8
mg/L
0.050
11/14/2312:40
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:
Cue
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
Virginia/VELAP Certification #: 460025
El
Qualifiers
Page 1 of 4

Pace- tocae;on Requested (CVstate):
Pace Analyticalrterrtersvflle,NC CHAIN -OF -CUSTODY Analytical Request Document
f ace 1'.Tr Saueh Part: Dr, Kerner,ville, NC 272Ed Chain -of -Custody, is a LEGAL DOCUMENT - C-Plete ail relevant fields
LAKE USE ONY- AMx Yde:garoodLogin Label Hem
WO#e �
e
92696434
Company Name: Town of Liberty
Street address: PO Sox 3006, liberty, NC 27299
Customer Project 0:
Project Name Taun of Liberty - Every 2 Weeks
Site collection Info/Facility ID tan apP6catr}e):
ort ne
Cotttact/ReoTo: Pike, Tremai
1p"ne IT: E336)622-4276
E-mail: [e-mail]16434,.
'Cc E-Half:
Invoice Te:
Invoice E-Mail:
Purchase Order it (if
aPPli[able}:
i QUCAC p:
I
•county/Statearigin
Specify Container Size "
Sitr (I} IL 121 5DDmL W 250-L (ai
5mL 151 iDOmL (5}—rCAre, (91 Othev
ic—i—
Identify Container Preservative Type'•,
••' Preservative Types:11) roone, (21 HNO3, (3}
rtZSt?m, (dS Nd, t5} NaOFa, (6} Zn Acetate. 17)
M1aMSiM, 1fi}Sad. TAiosulfate, 49J AscorDK dpid, IS(ri
theC)N, 11 Othef
Analysis Requested
to
c
m
o
E
<
CDtL
CJ
Z
�^�B
tt
!—
t—
I
q,
rl
S
CL
o
a
Peaj. Mgr:
Stephanie Knott
o
o
—
ti
v
c
E n
a
a
Time Zone Cviiected: ( J Aa I J PT ( J MT ( ) CT E ) Er
of Samole(s]: North Carolina
Data Deliverables:
E ) Level It ( J Level III ( I level IV
{ ( SOWS
I ! Other
Rega=,y Program IDW, RCRA, etc.) as applicable:
A=Num f Client ID:
Rush (Pre-approvat required}:
E ] 2 Day ( ':3 day E ::. S day [ :Other
Date Results Reauamd:13077
OW PWSIO 0 or VVw Permit g as applicable
Table w
Feld F;lttred (if aPPlicablel: E ;Yes I ; Na
Profi?e I7emplate:
' ryts�rix Codes (inner, its Matrix box Detow): O�-kjng Water OW ,Ground Water(GW]. Waste Water (WWI, Product ip), Soil/Saco SS)..Oil OL}. Wi e {WP , Issue ETSj, Sioassa B„ Vapor Y,
Other 107), surface water (SW),Sedinui (BEDS. Sludge (SLJ, Caulk
Prelog J Battle Ord. 16;
Customer sampleple 10
Comp
Maul} ` /
Grab
Collected
or Composite Start)
Composite End
Res.
C12
Number&Type aP
Container
Sample COtf ment
Date
Time
Dace
T}me
Plastic
Glass
Effluent
WT
f
ty
X
X
X
X
X
X
X
X
Customer Remarks/ Special Conditions/Possible Hazards: Collected
Printed
Signature:
By-.
Name: { „�
L✓
Additional instructions from Pace':
a Ciwlers: Th—wiener * Carsecaon Factor rQ: Obs. T—p. ('Q Corrected Temp. t {!
Date Received
ny: {Signaturz} K
aaufime:
�M
Trading Number:
1;;0by/Company: (Signature!
D n+e: Received
Company: {sign ure
Date/Tmr:
Oetivered b/: ( j In- Person [ )Courier
I I FedEx ( 1 vP5 E )other
Aeeinduished byiC—Pony: tsvaturej
0ate/Timr: Rccc^hmd
by/CamPanp: (Sigrfnture:
DatelYmr:
xeli :ishedby/Company-t5i�yra;ure]
__C16i______.
oatePtime: Received
by/CamPany:(sfgnature]
Dntrrr=me:
page-, 1 of 1
Submitting a sample via this chain of custody corISWUtesa&-iowledgmentinc! acceptance orthe Pacew IermsarctAnotuatsrauncac❑tcpr:Jr vyvP�u +y�-�rw�c>vµ�z�������r, ����=,r9��-=•�••�-u r��•-•••W•�. _..-..__ __._ __.
•A

IC ENV-FRM-HUNI -0084 v01 Tech Spec Sample Condition
Upo
Lup n Receipt
Effective Date-, 05/10-2022-
Laboratory receiving samples:
Asheville [] Eden [] Greenwood [] HuntersvilleE] RaleighE] MechanicsvilleD AflantaEl Kernersvillee
Client Name; Project M
re PV P
Courier: [Jr i EX E]UPS ELISPS Elclient e r
Commercial Pace Dother:
Carrier Tracking Number:
Custody Seal Present? Dyes No Seats intact? Ely"' ONO Date/initials Person Examining Contents:
Packing Material: OBIAbble Wrap ®Stubble Bags [g rne E] Other
Thermometer; 11 Ift Gun D: Type of Ice; D'w e t ElBlue
Cooler Temp ('C): Correction Factor: Add/ Subtract (*C)
Corrected Cooler Ternp (*C):_ 2� r
USDA Regulated $011 (EI/N/A, water sample)
Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)?
Dyes C]No
Biological Tissue Fpxen?
Dyes DNo ON/A
0 None
Temp should be above freezing to 6°C
®samples out of temp criter- samples on ice, cooling process
has begun
Did samples originate from a foreign source {internationally,
mHudino, Wn-ni, ind P­rtn fli,Al? [-]Yoe rlivn
Comments/Discrepancy:
Chain of Custody Present?
es No NSA
1,
Sam ±s Arrived within Hold Time?
12Yes
DNo
QN/A
2,
Short Hold Time Analysis (<72 hr.)?
13fes
EJNo
[JNJA
1
Rush Turn Around Time Requested?
Del S
CIN/A
Sufficient Volume?
_E(N.
Yes Na �[] Ili A
Correct Containers Used?
-Pace Containers Used?
ffyL I
rYes
ONo
[]NO
EINIA
0N,A
6.
—Containers intact?
De-S
NG
[IN/A
7,
Dissolved analysis: Sarnpies Field Filtered?
®Yes
EJNe
[JN'A
8.
Sample Labels Match COC?
— -Includes Date/Time/Ili/Analysis Matrix,
OYes
r
®No
[:IN/A
9,
Headspace in VOA Viols (>56mm)?
[]Yes
[JNo
LT �1/ A
10,
Trip Blank Present?
Trip Blank Custodyj2als Present?
[]Yes
W Yes
[]No
Na
[JN1A
__EJN1
11.
LLIJ,kyagilml RillihIMMIMIZEW1
Temp Log: Temp must be maintained
at <6 C during login, record temp
every 20 minutes.
Time 'oTen7d!7U3--"Temp: 7.
Time: 3Aput in Cooler
— � —
Time; Temp.
Person Contacted:
Project Manager SCURF Review:
Project Manager SRF Review:
Qualtrax Document ID: 70677
Lot ID of split contwners:
CLIENT NOTIFICATIONIRESOLUTION
Field Data Required? lJYes EJNo
Page 3 of 4

Ooc,ument Name,
Bottle (denfification Form
Document No.
F-CAR-0-043-Rev 01
'Check mark top half of box if pH and/or dechlorination is
verified and within the acceptance range for preservation
samples.
Egceptions! VOA, Coliform, TOC, oil and Grease, DRO/8015 (water) DOC, Wig
"Bottorn half of box is to list number of bottles
............ -.-- - --------
o
o,
tY
T,
<
E
V
0,
t,
a,
iI
6�
6
C",
q
4
rh>vernb(£r t", 2 "'i
81F)
I of I
P;
w�a? Quality
Office
Project 4
W
T3
Ll-
49
M
YT
ri
C1 F
9.3
dt
V4
n,
n�
V)
VI
CK
.... . . .....
for Preserved S�An e
, , i'a—M-p-4e ID' s't, ry a t P a 6,1pri
Aniount of NewryMjve Lot U
�Wdp-d I
- ----- ----- ---------
Nuo'.: Nh+,wnr lh,4 fk? i; a dllxrt,'p,aIxy a:Qroplionce a copi of thit form will hw wot to the PJortfl ("Irolov) OONR ('142r6hcation Offiwo
01A (if hold, jocoxw("I out Of Unfit,, MCOtIOG roMaw(�? ,.
Page 4 of 4

Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92697856
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 11/09/2023
Date Received: 11/09/2023
Sample: Effluent Lab ID: 92697856001 Collected: 11/09/23 13:15 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by Pace 11/09/23 16:05
Collected By Garrett 11/09/23 16:05
Dreyer
Collected Date 11/09/2023 11/09/23 16:05
Collected Time 1315 11/09/23 16:05
pH 7.22 Std. Units 11/09/23 16:05
Temperature 0.04 deg C 11/09/23 16:05
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

' LHAIN-Ut- LUb f U T Analiyucai Kequesi uucumem -- . - -- - -
- Chain af-CuStar Esa L�ALDOCUr+aTl:W phlp(et all releveni te)ds'
:m an : Billing lnr'armaticnr "
I
jiZe
Om
apart To: Email -To: Frese+vatjva TV 92697$56 9e, (5) zinc acetate,
(6) re ethanct, (7) soy....... .. �, .,e a. �, a .j a o ,v. tw, aMmoWum sulfate,
:py To: Site Collection Info/Address: (C) ammonium hydroxide, (D) TSP, M Unpresemed, (0) other
Analyses 'Pr3fai Une: '
,stonier Project blame/Number: State: County/City: Time Zone Collected: t � Fib Sale Receipt �heckll sL
I [ ]PTE IMT[ lam' E ]ET
tone:
Site/Facility ID M
Compliance Mon torng?
nail:
c . Yes E ] No
allected By (print):
Purchase Order;;:
� DW PWS ID #:
i� !r
i
Quote #:
DW Location Code:
>I
Turnaround Date Required:
immediate Pac ed on lte:
. 4 ...�.- _
[ ] Yes E l too
_ e Disposal:
Rush:
Field Filtered (if appiicab e)_
) Dispose as appropriate I Return
E l Same Day j ] Next Day
E ] Yes [ ] No
) Archive:
E ] 2 Day [ ] 3 Day j ] 4 Day [ ] 5 Day
'Analysis
) Hold,
{Expedite Charges Apply)
Matrix Codes (insert in Matrix box below): Drinking Water (DW), Ground water (Uw), wastewater lvvw),
product i'P), Sol/Solid (51.), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
Corn I Col' ected (or # Res # of
Composite End
.istomer Samp'.e ID ?`Matrix * Grab Composite Start) $ � Cl Ctns
Datl a �m Time Date Time
f'
-------------------
I
i
'I
lstomer Remarks / Special Conditions / Possible Hazards: iType of ice used: Wet swe Dry Norse
Packing Material Used:
h
+ Radchem Sam pies) screerted E<500 cprn). Y N NP
iinquis •/ Air DatelTime: Res:eiv tsy/Compan `gnature)
by/Company:
r
Gustody'Sign3tures'UPresent
Y iv AtA
Collector Signature' Present,Y
N NX
Bottles intact
Correct Bottles
Y N *7S
SufUcfent Volume
Y N NA
i
Samples Received an ice
Y K NA
0A - Headspace AOGeptable
Y N NA
I
Usm Regulated Soils
Y N KA
1
Samples in Holding Time
Y N Hil
Residual Chlorine Present
Y N NA
Cl Strips.
,}
Sample pli-Acceptable
Y N BLA
r
PE Straps:
II
sulf ,de' ?resent:
Y N N
Lead Acetate Strips:
g IAA UVE ONLY:
`a
t
SHORT HOLDS PRESENT (<71 hones): Y N N/A
Lab Sample Temperature Info
Lab Trackingt :
Temp Blank Received: Y N NA
4 ; Therm im#:
Cooler i Temp Upon Receipt: pC
Samples received via:.
Cooler 9 Therm Corr. Factor ---.-PC
FEDEX UPS, Crsent
Courier, Pace urfer
Cooler 1 Corrected Terrip: oC
Da Pi me:
MTXLAB USE ONLY
Comments:
Table #^
Acctnum:
Date/Time:
;Template:
Trip Blank Received: Y N NA
)Prelogin:
HCL McOH TSP Other
�
Date/Time:
IPM:
( Non Conformance(s): ;Page:

Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92699069
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 521OB-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
Parameters
Total Dissolved Solids
Total Suspended Solids
Nitrogen, NO2 plus NO3
Nitrogen, Nitrate
Nitrogen, Nitrite
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 12/01 /2023
Date Received: 11 /16/2023
Lab ID: 92699069001 Collected: 11/16/23 11:50 Matrix: Water
Results
Units
246
mg/L
19.3
mg/L
ND
mg/L
ND
mg/L
ND
mg/L
18.5
mg/L
2420
MPN/100ml-
Pace
Garrett
Dreyer
11 /16/2023
1150
7.27
Std. Units
0.03
mg/L
30.4
mg/L
Report Limit Analyzed
50.0
11 /17/23 13:24
9.3
11/17/23 13:21
0.040
11 /17/23 16:09
0.040
11 /17/23 16:09
0.040
11 /17/23 16:09
2.0
11/22/23 09:05
1.0
11/17/2312:42 El
11/16/23 16:15
11/16/23 16:15
11/16/23 16:15
11/16/23 16:15
11/16/23 16:15
11/16/23 16:15
0.040 12/01/23 09:09
Chloride
30.9
mg/L
1.0
11/21/2311:52
Nitrogen, Ammonia
23.8
mg/L
0.50
12/01/23 06:08
Nitrogen, Kjeldahl, Total
30.4
mg/L
2.5
11/30/23 07:17
Phosphorus
4.0
mg/L
0.050
12/01/23 01:03
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
[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
Qualifiers
Page 1 of 4

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Darr' LptaYeon R[QYMied {C+NISt8tP7:
C ParaAnaEyitatXrrnrrl Re,N'> CHAIN -OF -CUSTODY Analytical Request C�r�cazr ent(-�a
3377 South Dark D, , Krme,'r ile, NC 27234 Chain-of{uz tadyix a tEGAI DOCu>.sE;tT - LomD[rte aEl rate'+a0t 9clds
Company N.s—: Tr— of Liberty
Street Address. t"iO Box 1006, Liberty, NC 2729E
Cusiorv>er Prpjrct d:
Pra)ett Name: T..n of Libe; 4y- November
Site Loliest» InfojFx xliy 10 {s5 aPpiitablek
CDpta:ClRtpprt Ta•. Pike, Tremaine
pt%6" a: [phone]
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Aparo.. / aitDt ITS:
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Rush (Pf�a¢7pmval required):
(; 2 DaY J (3 day [ t',day ' :"Giher- -_
Oate Results
R UeSg{ :
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0 Table a;
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Pield ihartd tit ap0liubEr}: J l yes t J Nc
FflyY %
�°' DiDfile/TemCtcte:
13077
" Mat 1. Codts il—rt in Matrix bax belowi: Onnkiag Water;DM' Crowd Water GWi Wt.tr Wafer {W W;:, Praduct (p$' Sci3Js-ho (SSY, oil (OLL wipe tWP;:'�� r: rssue s',S1. ai"SPY W vapor {V¢,
Othtr {OT)• Udact Water (SW).Se'4-1 t3EA1, Sludge (SQ, Caulk
P.'NQg j 9oti16 Ord. ID:
1354314
am
CuaDmer sple rD
nnaala'
CoraD /
Grsta
GolkYt^.d
tcrtamPDalta SaArxS
C—ppaFte End
Ras.
cLz
Nurobae Tpaa e9
c sano<r.
samp€e Comment
Date
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Oafe
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WT
ti
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X
X
X
X
X
Xi
X
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By:
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Addit-.3: 1=,ucti— From Pace'-
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Delivered by: I 11n- Pe:soa I J CDuritr
[ J PMEk E )UPS t J odtrr
Rd:rqu:t*aCbgltemaavr: S%GnasurY)
Data%rlmt' ReDRivaD
DYlCompan'r: WanatDreJ
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Retixruflhetl etr'—rt :(s'7fnetwxl
On:efim.>� Aat,tiroe4lryfCampan{:�:,ignatUra)
Dstt(.-one:
Page: i of i
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N SuSmitxing a sample via ;his tltain of custody corsrtitutes ackfloevledgmenesnd accepunre a1 the Pace' Terms aDtf Conditions foursd at https:J,rwww.pacelabs �omlresource-libearyJresourcejpau-Yerms-ard-ecnditioas/
C ra V-r i'CI'P.i.VK4!-Vltly Vill uatlZZ-

Title: M-FRIVI-HUNII-0084 vOl_Tech Spec Sample Condition
ace Upon Receipt
Effective Date: 05/ITIb4 22
Laboratory receiving samples.
Asheville El Eden [J Greenwood Huntersville El RaleighMechanicsville[] AtlantaE) KernersvilleE4
Client Naive:
WE=mProject #:
JV e-)
Courier: ed Ex Elop S USPS oclient
[�J commercial pace' []Other,,--.-.
Carrier Tracking Number:
Custody Seal Present? E]yes 610 Seals Intact? OYcs [_}No Date/initials Person Examining Contents:
Parking Material: []Bubble Wrap Doubble Bags None E] Other Biological Tissue Frpzen?
Thpirmonneter El IR Gun 10 1'�` Y Type of Ice: Wet ClBlue EJ None ]Yes E]No VJNIA
Cooler Temp ('C);, Correction factor: Add / Subtract ('C Temp should be above freezing to WC
Corrected Cooler remp ('C): E)Sample, out Of temp Criteria, Samples oil ice, cooling process
Ej7 has begun
USDA Regulated Soil ( N/A, water sample)
Did samples originate in a quarantine zone within the United States CA, NY, or SC (check maps)) Did samples originate from a foreign source (internationally,
[]Yes [JNo including Hawaii and Puerto Rico)? [:]Yes ONo
Chain of Custody Present?
JI ]No Samples Arrived within Hold Time? �1� 2.
- ----- ----- - EINIA
Short Hold Time Analysis (<72 hr)? F,--)Yes [J.No I, )NIA 3.
RushTurrYArnaudTuneRecluested� (Yes Jrl�o F]N/A 4
---- - -­­- -- ..... ... ...
Sufficient volume? 5 []No ["INIA
Correct Containers Used? MYL� [JNo E] N/A 6
-Pace Containers Used?
JN/A
lorA liners, Intact?
— --------- 7
i Disolved arialy�,is� Samples Field Filtered? t, []Nci EJN/A 8
--------- - - ---- -
Sample Labei,, Matruh COC? AjYes []No ®N/A 9
Intl de Date/Time/ll)/Analys s Matrix:
-_ ----- ---- --------- ...... .. .. . . ...... ... .... ............ ........
Fleadspa,ve in VOA Vials i>S,brnrn)? E)Yell [JNo I
Trip Blank Present?
Elyes EI-No 11
Trip Blank Custody Seals, Prpsent? e EJ N o [61,
---------- --
-- -__ - ------ - — ---- - - -
COMMENT5/SAMPLE DISCREPANCY Field Data Required? OYes E]No
Lot ID of splJ conta ners
Temp Log: Temp must be maintained CLIENT NOTIFICATION/ RESOLUTION
at <6 C during login, record temp
every 20 minutes,
Time operred-1 "'I Temp;
Time!Q 0 0 put in cooler
Time; Temp:
Per,,ori (cintacted
Project Manager SCURF Review: Date:
Project Manager SRF Review:
Qualtrax Document ID. 70677 Page 1 of 2
Page 3 of 4

wod Novem b (2 r 15 2021
Botffiklowificatk)n Form f[W') Pace of I
-- ---------
Do,,,,un,ient No Authtmty�
F,CAR-CN1043-ReV,()1 P�,CO. Cxofinas OurAlty Offico
... ....... - ..... ... .. .. . ... ...... .. ... ..
*Check mark top half of box if pH and/or dechlorination is 11yaject t�
verified and within the acceptance range for preseryAion
samples.
Cxcepflons: VOA, Cohform, TOC, Oil and Grear,e, DRO/8015 (w,)U?r) DC)", W-Ie,
*�Bottorn half of box is to list number of bottles
pH Adjustment Log for Preserved Samples
Sample M Twe Q1 PH Upon (Lceipt Date preservation adjusted Time preservation Amount of Pw4 jvAiw, 1,i I (i
adjusted
,J COP'; t)f to Etta Nortr
Om W winp, rDM;'wwrs
Page 4 of 4

Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty - Effluent
Pace Project No.: 92699501
Sample: Effluent
Method
SM 2540C-2015
SM 2540D-2015
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
SM 521OB-2016
Colilert-18
TKN+NO3+NO2
Calculation
EPA 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
Parameters
Total Dissolved Solids
Total Suspended Solids
Nitrogen, NO2 plus NO3
Nitrogen, Nitrate
Nitrogen, Nitrite
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 12/06/2023
Date Received: 11 /20/2023
Lab ID: 92699501001 Collected: 11/20/23 09:09 Matrix: Water
Results
204
16.9
ND
ND
ND
15.3
2420
PACE
Garrett
Dreyer
11/20/23
0909
7.76
0.48
27.8
Units
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
MPN/100ml-
Std. Units
mg/L
mg/L
Report Limit
50.0
8.5
0.040
0.040
0.040
2.0
1.0
0.040
Analyzed
11/20/23 15:27
11/20/23 19:27
11/21/23 09:33
11/21/23 09:33
11/21/23 09:33
11 /26/23 08:16
11/21/23 10:25
11/20/23 09:09
11/20/23 09:09
11/20/23 09:09
11/20/23 09:09
11/20/23 09:09
11/20/23 09:09
12/05/23 13:33
Chloride
32.6
mg/L
1.0
11/22/23 06:05
Nitrogen, Ammonia
24.2
mg/L
0.50
12/06/23 11:31
Nitrogen, Kjeldahl, Total
27.8
mg/L
2.5
12/05/23 08:05
Phosphorus
3.6
mg/L
0,050
12/05/23 02:01
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:Cnu�f�lX�
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
El
Qualifiers
Page 1 of 3

Mi

�
VI
IA
|~-------------
��
---------
----'-------------���-------'------�--�----
pHAdjustment Log for Preserved Sample,
—
_
Page oof3

Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92701006
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 12/01 /2023
Date Received: 11/30/2023
Sample: Effluent
Method Parameters
Lab ID: 92701006001 Collected: 11/29/23 10:19 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
Performed by
PACE
11/29/23 10:19
Collected By
Glenn Price
11/29/23 10:19
Collected Date
11/29/23
11/29/23 10:19
Collected Time
1019
11/29/23 10:19
pH
7.67 Std. Units
11/29/23 10:19
Chlorine, Total Residual
0.48 mg/L
11/29/23 10:19
✓
Reviewed by:"�'
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

WO#
ij*6ca R
Chalet F CQT(ii-Vionleids
.92701006
Company: ToW6-of Uberty
4
M-2 �21_011271___
11 Pres'&ri6d* Types: nlz7k add, (2) suihrrk aefd.(3) hydrochloric add, (4) sodhin; hydroxide, (5) zinc acetate,
(61 methanol, (7) soaturn b1sulfate, (3) softm th losuflate, (9) Hexane, (A) ascorbic acid, (5) ammonium sulfate,
-- - -------------
address:
Report To:
Emall To 1
(c) ammonium hydroxide, (0) TSP.(U) Unpreserved, (0) Other
Copy To -
Site Collection trife/Address.
Ana as
Customer Project Name/Number:
State: County/City: Time Zone Collected:
I )PTI 1MT1 ICT I IET
curL4 .... .. "",ioi
pte ztt
e�
Bottles Intact y b
-eCt Bottles Y 'f
Co= nt� ume y
Suffiaie,
S=ples Received 00�100
Email�
ID
Compliance Monitoring?
[0es ]No
Colle t >10 a
BY wi'�W!
r&
Purchase Order
Quote
DW PWS ID
DW Location Code:
IL
0
iniZ
j
pe' VoA ;� geadspace 6itabiY'B
Xc
:Samples - in Holding Tiaie y
Residual, Chlorir* P—tiselit; y
Cl Strips --
Sample j?X Acceptable Y
prenimt;
L&B:USE ONLY:
Lab SaZ � comsaeatsz
C o,lected By fs gnatu
TurnarouWd at. Req. red;lrn
d� 1
iiiev- on.1ce.
f I yes 3itevic )No
Sample Disposa:
Dispose as appropriate f Return
Ar&,lve:
Hold'.
Rush:
Same Day Next Day
Z Day I 13D.V 14Day I 15Day
ilixpedite Charges Apply'
Field Frtered (if applicable)-
)Yes ]No
Analysis:
Matrix Codes (insert in Matrix box below,,: Dr'nking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Sail/Solid (SQ, Oil (OL), Wipe (WP), Air AR), Tissue (TS), Sloassay (8), Vapor I (V), Other (OT)
Customer Sample ID matrix •
Comp Collected (or
n
Grab Composite Start)
7 Time
Composite End
Res ft of
Cl CItni;
Date
1 rme
Customer Remarks / Special Conditions / Possible Hazards:
I Effluent Monitoring
.Relinquished by/Company t {Signature)
DK
I
R cer�ed by/Com Signature)
Parr-,
Daelm
J;IT, - - - KFJL LA5 U.�t UNLY
7i
$
Relinquished by/Company, (Sig azure)
Date/Time:
re)
Trip Blank Reci4ved'.' Y N NA
Date/Time: , Teirnpla
PretogIn
Fla Med,4 TSO Other
03
CD
Date/Time: PM-
Relinqu'shed by/company:_(Sig"iture)
Date/Time:
i Received by/Company: (Signature)
Non Conforriiance(s):
0
YES / NO I Of,
Z

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _1_ of -2-
Permit No.: W00003090
Facility Name: Town of Liberty - Wastewater
County: Randolph
Month: November
Year: 2023
Name:
2Field
Name:
Did irrigation occur
Area (acres):
19.7
VOW,
11110
Area (acres):
17.02
at this facility?
Cover Crop:
FESCUE
Cover Crop:
FESCUE
Hourly Rate (in):
0.21
Hourly Rate (in):
0.21
YES ❑ NO
Annual Rate (in):
52
p,
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
71 YES ❑ NO
Field Irrigated?
YES El NO
CD
0
"gm
E
0
;�
tM
E2
0
CL M
= .2
CL
E cc
i=
Cc
E
E
0 M
F
E .2
0 CL
z, C
16 "a
M
zm
a
E
X 0
Q
CL
E
.2-
-
>1 CL
0 CL
>
0
0
>
0
0
_j
cc
CL
oF
in
ft
ft
gal
min
in
in
"KI
gal
min
in
I in
PER
281,000
180
0.61
0.20
1
C
42
2.25
321,000
180
0.60
0.20
51 1
2
C
50
2.25
1 0?
3
C
60
2.25
4
C
60
11-8112 A,
;i&," "N.
5
6
C
64
2.5
281,000
180
0.61
0.20
321,000
180
0.60
7
C
54
2.5
8
,
duip"
91
C
73
1
1 2.5
10
1 C
60
1
1 2.5
281,000
180
061
020
an
121
CL
60
2.5
22 , 1 111
321,000
180
0.60
1 k 60
131
C
50
2.5
m
141
MINE
ISO I ... . I I I It N" N."M
151
C
50
2.75
11
16
1 C
65
2.75
281,000
180
0.61
0.20
321,000
180
0.60
0.20
%ffi
17
C
63
2.75
2 tlll
man 5111,11-
18
,
19
V gggk A �14
20
21
R
1.5
tv1,
221
231
241
C
48
2.75
i�
&
251
C
1 40
2.75
321,000
1 180
0.60
0.20
26
C
47
2.75
6 A 1,1 131"
281,000
180
0.61
0.20
27
11111'111'11'�
28
29
C
45
3
30
C
60
3
1,605,000
3.00
1,405,000
3.04
Monthly Loading:
12 Month Floating Total
38.51

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? 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.
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
`z
>� ' 1 3
-?� l L 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

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -2- of -2-
Permit No.: W00003090
Facility Name: Town of Liberty - Wastewater
County: Randolph
Month: November
Year: 2023
g�c
Field Name:
6
Nig
KM
Field Name:
8
Did irrigation occur
SOM '�V
Area (acres):
15.1
zg­ gj .....
Area (acres):
21.68
at this facility?
'i9
2111 Iti
AN I
Cover Crop:
FESCUE
Cover Crop:
FESCUE
A
Hourly Rate (in):
Hourly Rate (in):
0.21
❑ YES El NO
4 0, 0
000 1111
Annual Rate (in):
52
V,
Annual Rate in):
52
Weather
Freeboard
Field Irrigated?
[2] YES El NO
, ", ',
3AiNV 2131,1111 ON,
,
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252,000
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Monthly Loading
756,000
1 84
1,400,000
2.38
12 Month Floating Total (in)-
24.77

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? 2 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? ❑✓ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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.
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 NDAR-1? ❑ Yes El No
Phone Number: 336 622 4276 Permit Exp.: 8/31/24
Signature Dat
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