NCG140339_DMR SW_20220329

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2021
*Report ALL STORMWATER monitoring data on this form (include "No Flow"/"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14 0❑ 3❑ 3❑ 9❑
Facility Name: LoweryStreet
County: Forsyth
Phone Number: (704 ) 977-0981 Total no. of SDOs monitored 3
Certified Laboratory Pace Analytical Lab #
Lab #
Stormwater Discharge Outfall (SDO) No. 001 VMA Outfall? Yes ❑ No ❑✓
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑'
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑✓
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall No.
0�1
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m /I
pH,
SU
Non -polar O&G
(EPA Method
1664 ( ))
mSGT-HEM ,
gll (VMA)
It applicable
New Motor Oil
Usage (gal/ma.)
Pfapplicable
Stormwater
Benchmarks
Indicate NO FLOW B
applicable
Circle Benchmark
100150
6.0-9.0
15
55 g
>al/mo. average requires TSS and
Non-polarO&G monitoring
Date Sample
Collected,
mo/dd/yr
�.�
3/31/2021
NO FLOW
k 06
6/30/2021
NO FLOW
9/22/2021
NO FLOW
12/29/2021
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 Q 30 19❑
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency 8
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
T,3 ri
s to p®lar O&+G, �Ivu Motor OBI
� � � k� � Total w`' , a Fz� pet.✓`* ' � r
Rainfall l]sage (gal/m'o }
Outfall No�� (SGT
002 incholids TSS),° SlJ
esmgll (UMA) lraavlr S ( b/e
Circle Benchmadc
5tormwater �` j
ti Indicate NO FLOW ff p0150 r 6 0 9 Q ' 15 >65 gallmo average requires SS and
Benchmarks appluable Non potarOSG monrtonng, r
Collected
a a
�l2 oldd`lyr
' "
m,
3/31/2021 NO FLOW
9/22/2021 NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 :1 !1 19❑
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑
Is this outfall currently in Tier 2 forany parameter? Yes ❑ No ❑
Was this outfall ever in Tier 2. during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency
Other
Outfall No
ao
Total Rainfall
mchesk
�.<. .k
Suspended £,
a
Soltds (TSS)
m ll.a.... ��
pH, $�{
SU
�..<
4 Non olar O&G x
pY#r
( EPA Method
'1664 (SGT HEM))
mgll (VIVI
�m
r New MortorO�l
14- Usage (gat/mo }
tix
c,
d
Stormwater
Ben chmarks
Indicate NO FLOW if
applicable
Circle Benchmark
>55 gallmo: averdgeliequlrei Tss and:
Non polar0&G.:'momtonng>
'�,kq k°" "Y'
$' %�'
`} 2 �• �'lks ' ^f
y�y "i r` „ "a 6. , '-#
!<' '� ai—�"'�.. ',,,�' ^�` 2k
3/31/2021
NO FLOW
9/2220211
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 0❑ 30 30 9❑
CERTIFICATION
"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 qualified personnel properly gather and
evaluate 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."
[Required by 40 CFR §122.22] I I' �f
Signature
Date f�
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015