NCG020096 DMR WW (2)

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ANNUAL SUMMARY DMR - WASTEWATER
` SEND TO CENTRAL OFFICE*
PROCESS MINE/DEWATERING WASTEWATER
GENERAL PERMIT NO. NCG020000
'ReportAll Wastewater discharge monitoring'' data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 of each year. If
you have limit violations, you must also have turned in a Limit -Violation DMR to your. local Regional Office within,30 days of receiving sample results from a lab.
UEKI'Ir1cAI'E OF COVERAGE NO.�NCGO20096 SAMPLE COLLECTION YEAR: 2015
FACILITY NAME: Salem Stone Quarry COUNTY: Forsyth
PERSON COLLECTING SAMPLES: Barry McConnell PHONE NO. 336-769-3803
CERTIFIED LABORATORY: PACE ANALYTICAL Lab 440 ADD TO LISTERVE? YES NO EMAIL:
LIMITS VIOLATIONS? YES R' NO INDUSTRIAL SAND'? DISCHARGE TO SA WATERS4?
Part A! Wastewater Mnnitnrina Rennire.mentc
Outfall No.
Date Sample
Collected' .
Total Flow
Total Suspended
Solids,i
Turbidity3
Settleable Solids
pH Fecal Coliforms
MG/CFS
m
2'31'Z TU
... .
.
col/m12,4mm/dd/
nar
1Q Pit Discharge
1/30/15
0.21
2.9
5.1
ND
7.0
2Q Pit Discharge
4/30/15
0.11
30.1
3.8
ND
7.0
3Q Pit Discharge
7/17/15
0.42
10.4
11.0
ND
7.0
r,
ru, nuncs iuusL uionrrvr w w uiscnarges ror r�3. umy mausmai Sana mme aiscnarges are subject to I JS tunts.
2 i an effluent limit is exceeded, the permittee is required to institute monthly monitoring for that parameter for the remaining permit term.
3The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed! 10 NTU for freshwater streams, lakes, and reservoirs
designated as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the
Stormwater Discharge Outfall. Alternatively, the permittee may choose to monitor turbidity in the receiveing water, directly upstream and downstream of the discharge.
4Only facilities discharging to SA waters are required to monitor for Fecal coliforms.
Permit Date; 1/1/2010-12/31/2014 Last Revised 01-21-11
Page 1 of 2

Part A: Continued: Wastewater Monitoring Requirements
Outfall No. Date Sample Total Flow
Collected)
- mm/dd/ MG
Total Suspended Turbidity3 Settleable Solids pH Fecal Coliforms
Solids'
m 1''2 NTU2,3, ml/I2 Standard' col/m11,4
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW" "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH 1 OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANYINFORMATION REPORTED:
" 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 sumbitted. 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
there are significant penalties for submitting false information, including the possibility_ of fines and imprisionment for knowing violations.'.'
Permittee)
Permit Date: 1/1/2010-12/31/2014
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( te)
Last Revised 01-21-11
Page 2 of 2

ANNUAL SUMMARY DISCHARGE MONITORING
RFPnRT /r)MR1 _ 1A/ACT9:1iVATGl2
General Permit No. NCG020000
Calendar Year 2015
`Report ALL WASTEWATER monitoring data on this form (include 'No Flow/No Discharge' and Limit Violations) from the previous calendar year to the
DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCGO20063
Facility Name: Salem Stone Quarry
County: Forsyth
Phone Number: 336-672-1501 Total No. of Outfalls Monitored 1
Certified Laboratory Pace Analytical Lab # 40
Lab # -
Wastewater (WW) Discharge Outfall No. 1
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes No X
Does this outfall discharge WW to SA waters? Yes No X
Does this outfall discharge WW to SB or PNA waters? Yes No x
Does this outfall discharge WW to HQW or ORW waters? Yes No X
If so, what is the 7Q10 flow rate?NA or Tidally influenced waters, 7Q10 not available
Does this outfall discharge WW to Trout (Tr) designated waters? Yes a No
Were there any limit violations in the calendar year? Yes NoPX
Outfall No. 1
Daily Flow
Rate,. cfs
pH, SU
TSS mgll
SS mill..
r; pew.'
Discharge
Tur6idity, NTU .
Upstream (U)
Tur6ldRy,.
NTU
Downstream D
O
Turbidity, NTU'
Fecal Coliform,
col/100. m1 .
(SA):
Effluent
Limitations mo.
Avg. /Darty Max.
HQW or ORW
50% of 7Q10
Judicate NO FLOW it
applicable
Freshwater 6-0
9.0 Saltwater
6.8-&5
Industrial Sand 25/45
HQW or ORW 20/30SA,
HQW orORW and Tr
or PNA 10/15
HQW, ORW,
SB, PNA or
aoy Trout
.0.1/0.2
No Limit
wwvsmman.�,opi..:
50/25/10
N/A ,,,,m p
s 'm°s�
N/A wx�oowrswaw
Pa.
N/A
'. Date Sample
Collected, mo/dd/yi
10/13/2015
0.16
7.00
3.20
ND
5.10
N/A
N/A
N/A
rermn uate iwvzui5 — visutzuzu
Last Revised 10-2-2015

Certificate of Coverage No. NCG020063
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."
(Requi-d by 40 CFR §122.221
Signatur fa.e-�.�•
Date
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 10/1/2015 — 9/30/2020
Last Revised 10-2-2015