NCG140339_DMR WW_20220329

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
II SUBMIT TO CENTRAL OFFICE* II
General Permit No. NCG140000
Calendar Year 2021
"Report ALL WASTEWATER monitoring data on this form (include "No Flow'T'No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG 14 0❑ 3❑ 3❑ 9❑
Facility Name: Lowery St.
County: Forsyth
Phone Number: (704 ) 977-0981
Certified Laboratory Pace Analytical
Lab #
Lab #
Total no. of outfalls monitored 3
Wastewater (WW) Discharge Outfall No. 001
Does this outfall discharge WW to SA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to SI3 or PNA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No 2]
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ✓❑
Were there any limit violations in the calendar year? Yes ✓❑ No ❑
Outfall No.
001
Daily Flow Rate,
cfs
pH,
SU
TSS,
mg/I
SS,
ml/I
if applicable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mg/I
Effluent
Limitations
Daily Maximum
HQW or ORW
50% of 7Q10
Indicate NO FLOW i/
applicable
freshwater
6.0-9.0
saltwater
6.8-8.5
Standard
30
HQW
20
HQW / ORW and Tr, or
PNA
10
HQW, ORW, SA,
SB, PNA, or any
Trout
5
No Limit
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
Collected,
mo/ddlyr
3/31/2021
NO FLOW
,.
I� 1
,r
6/30/2021
NO FLOW
^,NAL FtLE8
9/22/2021
NO FLOW
FF
` -I 1UN
12/29/2021
001
9.3
71
2540D-2015
Permit Date 8/1/2017 - 6/30/2022
Last Revised 8-22-2017

v-
Certificate of Coverage No. NCG14 0� 30 3❑ 9❑
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No. 2
Does this outfall discharge WW to SA waters?
Yes ❑
No
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No ❑
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes ❑
No ❑
Were there any limit violations in the calendar year?
Yes ❑
No ❑✓
Outfall No
ooz'
Daily Flow Rate,
cfs r
pH,
°SU '
�v,
TSS; ��
mgll f
x. x �.
SS,
mlfl
d appleea6le
rx
f Non Polar'OG EPA'Method 1 S64
{
(5GT�HENI)), mgll
a�
Effluent
L1117/tatlOnS
Da11yMaximum
HQW orORW :
of 7Q10
indicate NO FLOW f
applicable
freshwater
6.0 9 0
saltwater,
6•8 8 5,.jr+
:Standard
30
HQW
' 20 `
HQW l OR Aa�Tr or
.' BN
"10
HQW ORW sA
IN,
SBA MA or any.
-Trout
5
No Limit
- -' Samples above Benchmark
subject W Tiered Responses
'15
amp77
le
ldlyr,
06
3/31/2021
NO FLOW
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 8-22-2017

i_
t
Certificate of Coverage No. NCG14 13❑ 3-] 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 §122f 2] ,
Signature
Date `j
Mail Annual Summary Wastewater 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 8-22-2017