NCG020515_MONITORING INFO_20190225

MIZO
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
OD5/0
DOC TYPE
El HISTORICAL FILE
C�MONITORING REPORTS
DOC DATE
❑ (1 �J U��
v
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT DMR — STORMWATER
SUBMIT TO CENTRAL OFFICE"`
General Permit No. NCG020000
Calendar Year FEB 2 5 2019
I,
*Report ALL STORMWATER monitorin data on this -form include"No Flow''/"No Discharge and en Lhm ! �
p 9 { .. g. Ir r I� yc(.
Exceedances).from the previous calendar year to the DEQ by MARCH. 1 of,each year.
Certificate of Coverage No. N0002 ®�❑S
Facility Name: '\ (�-�Lj r C Ul
County: W - C� ti
Phone Number: (7©L( ) _)? t- S_ ` Total no. of SDOs monitored _
Certified Laboratory S���Qs,,,.(i� �a ��:�'-tLab # qqO
Lab #
Stormwater Discharge Outfall (SDO) No. _ VMA Outfall? Yes ❑ No Z
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No Z]
Was this outfall ever in Tier 2 during the past year? Yes ❑ No 21"
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 ❑
No,.turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
Outfall No.,.
Total
Rainfall,
inches
- -
TSS,
mg/l
SSI
mill �'
Turbidity,
NTU
^
Upstream .
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU°
Non -polar
O&G, mg11
(VMA)
New
' Motor Oil
Usage
allmo.
Stormwater
Benchmarks
Indicate NO
FLOW el
a Ikable.'
circle
Benchmark
100150 '
- 01
.
Circe
Benchmark
-50/25/10
', N/A
Water Quality
Standard applies.
." NIA
Water Quality
- Standard applies
15
�55 gairmo.
average requires
TSS and Non polar
.0&G monitorin
Date Sample
Collected,
molddl r
12,
°�
�.�
9' r.ti
J
,6 (d
00
1
�7_
N
N (
N l
q
t'
L5 5,t7
la,
N t
Permit Date 1011/2015 — 9/3012020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑❑❑❑
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 samp)es below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
ONTIUI
utfall No.
I., Rainfall,
inches..
TSS
v.
NTU'
•: .
Motor Oil
..
MIEM
Circle
Date Sample
.Collected,
rn • ..
; v
aR�!'%�jJ S
.$-, ri'1
w�
na -�' ,f
C i < 'F y ^` t5;,
^)
�^i[$ w �'� fi _
}%tl s�!� Y-r �f• i .� .
r i.7�,,
i4g �.� sw � L
`irL,r i''r'.
�.. � �i
e� �,.1
i in `3'•'�! �.+`'�
r,>..
Permit Date 101112015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑� 0��
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]
r
Signature
Date a r'a a �a p
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct -- Central Files is housed in DWR (not DFMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 2769911617 w
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 1011/2015 — 9/30/2020
Last Revised 10-2-2015

Analytical Results STATESVILLE
ANALYTICAL
Hammill Construction Co., Inc. •`
5051 St- Stephens Church Rd
Gold Hill, NC 28071
Receive Date: 11/13/2019
Reported: 11 /18/2019
For: ZION
Comments:
Sample Number
Parameter
Sample ID
Result
Unit Method
Analyzed
Analyst
191113-39-01
Settleable Solids
Zion
<0.1
ml/L SM254OF-20u
11/1412019
MD
191113-39-01
TSS
Zion
<2.747
mg1L SM254OD-2011
11/15/2019
CJE
191113-39-01
Turbidity
Zion
6.7
NTU EPA'801
11/14/2019
MD
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

Condition of Receipt
Sample Number 191113-39-01 . Temp on Arrival:
Parameter Schedule: Settleable Solids
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Turbidity
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 3

Client: J ( -,{�
—.--�
STATESVILLE ANALYTICAL
122 Court Street • P.O. Box 228
Statesville, NC 28687
[phone]
Address: j ( ` t�
S cps) /T ` f I L� "� �" "� r L 1
f r� % 0 •7 I
(
lam;
Contact Person: v �!{v
Phone # -�04 11171
l
-T-3c-FAX# 7rt i-rZ?^(`pfcf
Chain of
Custody Record
PO # Requisitioned by: (Time Date)
Customer
SamSample 1Dtl
p
Lab -ID
Time Sampled
(Grab Only)
Date Sampled
(Grab Only)
n
0
a
Matrix
Parameters requested for analysis
skate
w
ww
4.0/
I too
C1I-F
Relinquished by: - 5
Received by:
Relinquished by:
Received by:
Composite Sampfinc� #�
Time begin am, pm Date —I-1—
Time end am, pm Date
Composite Sampling #2:
Time begin am, pm Date
Time end am, pm Date _I_I_
Time
Time i' `7
Time
Time
Lab Comments:
am, pm Date 1 ± /J31) Sampled by:
am, pm Date �/ / Transported by:
am, pm Date _I_I_ /
Holding times met:
am, pm Date _I I v
Compliance work:
Non-compliance work:
Samples Transported On Ice:
Initials:

Analytical Results STATESMILLE
ANALYTICAL-
Hammill 'Construction Co., Inc. _
5051 St. Stephens Church Rd
Gold Hill, NC 28071
Receive Date: 06/10/2019
Reported: 06117/2019
For:
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
190610-09-01
Settleable Solids
Zion
<0.1
ml/L
SM2540F.2011
06/1012019
WC
190610-09-01
TSS
Zion
23
mg/L
SM2540o.2011
06/14/2019
WC
190610-09-01
Turbidity
Zion
7.98
NTU
EPA 1801
06/11/2019
MD
190610-09-02
Settleable Solids
Kluttz #2
<0.1
ml/L
SM2WF-2011
06/10/2019
WC
190610-09-02
TSS
Kluttz #2
6.625
mg/L
SM25400-2011
06/14/2019
WC
190610-09-02
Turbidity
Kluttz #2
7.08
NTU
EPA 18C 1
06/11/2019
MD
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 4

l
Condition of Receipt
Sample Number 190610-09-01 Temp on Arrival:.2
Parameter Schedule: Settleable Solids
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Turbidity
Received on Ice
Sample Number 190610-09-02 Temp on Arrival:.2
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Settleable Solids
Received on Ice
Parameter Schedule: Turbidity
Received on Ice
PO Box 228 a Statesville, NC 28687 e 704/872/4697
Page 2 of 4

Client•
/+ �
C-b q.l plc
SrATFSVlLLEANALYTICAL
122 Court Street • P.O. Box 228
Statnvilk. NC 28ti87
t704t PZ-407
Chain of
Custody Record
Address. SQ [ \ Q C
C ] CA 11 r C.- � t� Q a
Cro N c— 8 Gi 1
nfect CoPerson: Phone �i 70(.7 l -� 34 � FAX 0 -a�-�`�- l �1 cl c�
4
t l 7 Trot
PO p %quisitianed by: {Thyle
Cuswm!DN
SW
Lstrtf�} r
Tkne tampw
(Grab We annVW
Arralrtr
Parameters repuq" for anarpsls
rvw
v C ; Ca ; ~4
Relinquished by
Received by:
Relinquished by:
Received by:
ComoosltefigMgj1[)g #1-.,
Time begin am, pm Date J/
Time end am. pm Date _J_J—
SMnasite Sampling #2:
Time begin am, pm Date
Time end am, pm Date
Time am, pm Date lt�lff j —/01 —/If
Time /0/0 am, pm Date /�/ I
Time am, pm Date __J--J—
Time am, pm Date —JJ
Lab Commems:
Sampled by: .
Transported by:
Holding times met:y
>r�
Compliance work:
Non-compliance work:
r•
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va
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ri O
r� o)
00
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N
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