NCG120066_DMR_20200611

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/G/ //Z/d �j �/� or Certificate of Coverage No.: N/C/G/ / l Z1.0101 1(c'I
Facility Name: - -
County: Phone No.
�
Inspector:
Date of Inspection: S 2
Time of Inspection:
Total Event Precipitation (inches): 94 JUN 11 2020
CEN7jr DWR t j
0-CTION
All permits require qualitative monitoring to be performed during a "measurable storm event."
i
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall7escription: -
Outfall No. Structure (pipe, ditch, etc.):
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _C�'/�cl/'uir� �j, ,
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 � 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 ,( �/ 4 5
6. Suspended Solids: Choose the number which best describes the am unt of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 2 () 4 5
7. Is there any foam in the stormwater discharge? O Yes �Q No.
8. Is there an oil sheen in the stormwater discharge? 0Yes A No.
9. Is there evidence of erosion or deposition at the outfall? o Yes 0 No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N_/C_l6 / /`l pzlD/ U/ D/
Facility Name:
County
Inspector:
Date of Inspection: -5-12
or Certificate of Coverage No.: N/C/G// /Z/
Zc�>
No. _3g6
Time of Inspection: _a/uc, C? DC) Q 4,1
Total Event Precipitation (inches): , '? 4
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
OutfalI No. Structure (pipe, ditch, etc.):
Stream: Receiving St
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/01/2018

2• Color: Describe the color of the discharge using basic colprs (red, b>jOwn, blue, etc.) and tint
(light, medium, dark) as descriptors: _ �; 7� i�i /,� a,..r,� I'
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): Y7
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with Boating solids:
1 2 Q—) 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
7.
8.
9.
I
L
3 4
Is there any foam in the stormwater discharge? O Yes
Is there an oil sheen in the stormwater discharge? oYes
5
o No.
0 No.
Is there evidence of erosion or deposition at the outfall? o Yes WNo.
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/012018

i�
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc,gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/G/ 11 Z! 4/ d/:��(7y
Facility Name:
County:
1Lr/11TA
Date of Inspection:
Time of Inspection: -;)n
Total Event Precipitation (inches):
or Certificate of Coverage No.: N/C/G/DI(�j�j6/,e�j
7 An ---
0
Phone No. — t9/0 %
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. -5 Structure (pipe, ditch, etc.):
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, wn, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e.,
chlorine odor, etc.):�mells strongly of oil, weak
y� o ,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
I (i2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
1 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes 6D N
8. Is there an oil sheen in the stormwater discharge? 0Yes 0 N
9. Is there evidence of erosion or deposition at the outfall? 0 Yes
to. Other Obvious Indicators of Stormwater Pollutinn-
L
---„ ---b-- ••.......�, Y4W V� auu presence of Ioam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG120000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG12 0 � � <P
FACILITY NAMENIA IAPS �QnalA l
COUNTY YYi1k�S
PERSON COLLECTING SAMPLES soi�e�
LABORATORY,5160i lle 8/IQ1V jil ab Cert. #
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 20 aC>
SAMPLE PERIOD ❑ Jan -June ❑ my -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
[]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period'
Outfall No.
Date Sample
Collected 1
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Chemical Oxygen
Demand
mg/L
Fecal Coliform
Colonies per 300 ml
Total Suspended
mg/L Solids
pH,
Standard Units
Benchmarks
_
-
120
1000
100 or 504
6.0-9.0
Parameter Code
-
46529
00340
31616
C0530
00400
4
-54
360
4F Z
2/ b
q4
F
2 700
t3z
1,ao
S10
z15
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Pagel of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period'
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches'
Non -Polar Oil & Grease
mg/L
Total Suspended Solids,
mg/L
New Motor or Hydraulic Oil Usage,
gal/mon
Benchmarks
_
-
15
100 or 504
—
Parameter Code
-
46S29
00552
C0530
NCOIL
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DW including_a// "No_ Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period in the
case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION 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 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."
Signature of Permittee o
Permit Date:11/1/2018-5/31/2021
,/ z 20
Date
SWU-248, last revised 11/1/2018
Page 2 of 2

Analytical Results STATESVILLE
ANALYTICAL
Wilkes County Landfill
PO Box 389
Roaring River, NC 28669
Receive Date: 05/21/2020
Reported: 05/27/2020
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
200521-14-01
Chemical Oxygen
#1
56
mg/L HACH8000
05/22/2020
MD
Demand
200521-14-01
Fecal Coliforms
#1
300
CFU100 ML SM9222D-2006
05/21/2020
MD
200521-14-01
TSS
#1
6
mg/L SM254OD-2011
05/22/2020
CJE
200521-14-02
Chemical Oxygen
#2
28
mg/L HACH8000
05/22/2020
MD
Demand
200521-14-02
Fecal Coliforms
#2
3700
CFU100 ML SM9222D-2006
05/21/2020
MD
200521-14-02
TSS
#2
201.3
mg/L SM254OD-2011
05/22/2020
CJE
200521-14-03
Chemical Oxygen
#3
81
mg/L HACH8000
05/22/2020
MD
Demand
200521-14-03
Fecal Coliforms
#3
590
CFU100 ML SM9222D-2006
05/21/2020
MD
200521-14-03
TSS
#3
215
mg/L SM254OD-2011
05/22/2020
CJE
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2

Client:
—
I
—
122 Cuun Sircet P.O. Box 22X
J� Stutes011c, NC 23U7
I7011 X724697
Chain of
Custody1 Custody Record
Q�
AactLvq
tac a n: t Ph _ �3 FAXN
PO N Rt3q id br,
(me
Customer
Sample IOA ,--_--_
/
ere Sampled
Sampledleb-10
IGrab OnN
Dete Sampled
(Grab Ordyl
�
Matnx
uw. w ww
14twratas reyrx Iw ter—IymI
_
ra
o2
: o
h3
0
: W A -IA
POD
Relinquished by: �a � Time &m Date sIZ 140 Sampled by:
Received by: a_ _ _ Time~ om Date/A(/t&' Transported by:
Relinquished by:----- _ _ Time am, pm Date _/_/ __. Holding times met:
Received by: Time am, pm Date /_ — Compliance work:
irQIDRQSlt1=�l�mplfna N1: Time begin am, pm Date `J� J, Non-compliance work:
Time end -.am, pm Date Lab Comments: Samples Transported on Ice:
C4algQslte SamuilLi�
Time begin am, pm Date
Time end am, pm Date
Indials:
I`
m
kD
N
N o
N
00
Of
a
r`
00
to
00
N
U
Z
Gl
d
0
N
00
N
fV
X
0
cc
a

DEMLR Monitoring Form Rev. ogog2oIq
INSPECTION AND MONITORING RECORDS FOR ACTIVITIES UNDER STORMWATER G Page I of 6
AND SELF -INSPECTION RECORDS FOR LAND DISTURBING ACTIVITIES PER I 1 MCG10000
Protect Name ) 1 Land Quality or Local
Approving Authorky / I Dab of Plan Program
NCts010000 Caruncabe of APProvnl ����.
Coverage Number
Dab of Issuance
Coverage ender the NCGO10000 permit must be renewed annually, if issued after April 1, 2019 until Notice of Termination is filed and approved.
T S
Rain Amt (inches)
Day I Dab Daily Rainfall Required, except for
Holklays or Weekends. If no rain,
z
Am tilers any sib or pro)ect eorMkbns ttuK Ilm
comPietlon of inepmuon?
If yes, explain conditions arM areas of site that were
Inaccessible.
Check ALL *Pk" box(ea) that apply to
_ comokftd 3 current pk—
x Pacurtahr aroaion and sedknanc cantrW �
___ -,,, —,e W"WM cover
-Y flag of slopes or N.
f °' 9950AX 0 8COWty r:orwtricfiwr a devalo
Cowr arlfieisnt b restrain Mwion has besrt
look S/z / f Za
X

DEMLR Monitoring Form Rev. ogog2o19
Erasion and Sedimentation
Inspected
Measure ID or Location and Description
Measures
24 HOURS OF A RAINFALL
EVENT EQUAL T4
Stormwater Discharl
le OutWIG Ins pq
Storrnwater
Any visibleAny
Maness
Any
DischaMe
edknentsflon
in Sbasm
visible
Oubar
in Streams,
Turbidity
Erosion
ID or
Watiands or
from
below
Location
Outside Sit@
Discharge?
Soo?
Property?
(YIN)
Page 4 of 6
Measures moat be inspected at least ONCE PER 7 CALENDAR DAYS AND WITHIN 24
1.0 INCH Pi=a'i V�"M
Inspection
Oats
SDOs must be
THAN 1.01W
Inspection
Any visible oil Date
show, floe" or
uspended solids or
iscoloration? (YIN)
S-
Describe Actions Needed Noted as
COGIGUY0 actions "ulld be p..e....corrected
at least ONCE PER 7 CALENDAR DAYS AND WITHIN
Noted as
Describe Actions Needed Comte
Corree/dw aetlona slw�le be oe." -- -� - - -- 'b
Report visible rrtentatlon Into streams or wetlands to the appropriate DEQ Regional Office via phone calf or
within 24 hours of dlwwemm v ti«.._.,a_ . __ __..,---•_ -

DEMLR Monitoring Form Rev. 08082019
construction activities have twn;M "y
or Permartantty ceased
4:1
areas with
be
Limit for stabl¢ation or —'
Ground me aw- p
wmwwmt
cov'r bon Stabiftatial
(see tads insta ied7 (T p)
4:1
Is Ground
Cover Original
Srllident yw4woloa
to Ra*am Date
Erosion?
Describe Actlorts Needed
days for Perimeter dikes, $orates, stes$ pand HVVQ zones
14 days for $topes 10 R or less in length and net
10 days few W.S. r .6_ --
.S. y Per than 2:1
7 days for perfrneter dines. Sales, slopes and HVV�Q zones
7 days for $lopes greater than 50 R in length
1nA..,.r...r_—._.__.... -
10
and FPAOQ zones
Page S of 6
Dame
NOW as
Corrected

/
S dl ha --yoo�/-
wl uolaw uR4w q w.w
P Jo uomnffim • w.— _..
--REJW voeUllp U. tll
ON J {bOli 10 &40Gd Aum p u0
""°a puw�e eupsoco p Pue
geM 3etp ous;o Sege pue suo(ppLgo ulA
MURI 3ma sUOPIPUoa Luon*odsul jo uopgdum
3� jo "s Aug we* wry
S 1
asslj�-•--- r-•-»�� 'ulg ou A 'sW+nlssM �o SAMION I
X a3 Aidde Zstp (ss3 pcoq p� ia13droxo wlnb*H N�Isi! Ansa °3s0 I Sea
s3ge�dds TIV 113sy0 (�ul) w v ulwm
9!o 12Ead
LY9-v£L L 'S'p OOOOLOJON 3I3d S3WAelOV ONMWUSM ONIn 3/Od WMO03a �03~xjj3S GNV
lmw 3d wa3N3J 3I3'vNw IOlS m30N11 S3uL,%" wo:l EM003H JNRIOiPKM ONv NOI103dSNl
610L8080 'Aa1I uuo3 BuuOVUOW ly Ma

DEMLR Monitoring Form Rev. ogog2019
Erosion and Sedimentation
Inspected
Measure ID or Location and Description
Page 4 of 6
CONTROL M •cI. a; Measures must be inspected at least ONCE PER 7 CALENDAR DAYS AND WITHIN 24
)R GREATER THAN 1.0 INCH PER 24 HOUR PERIOD.
Measures
Inspection Date
Date Describe Actions Needed Noted as
nc*a) Operating Correcthre 4001111 aho Id 110 RK N„@d " soon as 2ossi6ta Corrected
Property? and be%n the nm storm event
(YIN)
!4 HOURS OF A RAINFALL
must be
EVENT EQUAL TO OR GREATER HAN
Stormwater Discharl
oudalls InstUdm
1.0 INC
Stortmvatx
VPsibis
hhcrene
Any
Inspection
Dischargeknentatlen
Streems,
in Stream
Turbidity
Visible
Erosion
My visible oii
Date
outlal
ID or
rAny
etlands or
hpn
below
sheen, Oowthhy or
spended solids or
Location
11 tside Site
Discharge?
Soo?discoloration?
(Y/N)
ad at least ONCE PER 7 CALENDAR DAYS AND WITHIN
24 HOUR PFRInn
Dab
Noted as
Describe Actions Needed Corrected
convadve actions Shedd be oadRMNd as e.g- h
before the nerd storm sygnt
WIMBI
Oflics via phone caH or emu

DEMLR Monitoring Form Rev. 08082019
—qmm Ina iooacorr where
construction arylvl IM have tunPaar>7y
or Permanency ceased
to
areas
b recorded. at
Limit for _ or "Erosion?
Cow Pef1^ t Srrtlr3erN ll � Describe Actions Needed
Cover Sbalmidon to Rescain Co
(see tlhls instals. r Dab-.11l�tiirs actions.w - --
h_. . (Tip) IErasion? seen u ....��r-- -
14
14
7 days for Perimeter dikes, swales, and HWQ zones
slaPes 10 ft
14 days for or less in length d not
10 dava fnr FS" I s&,_ ......_—_-
anSbe@per than 2:1
-,o — Pmwnusar asras, swabs, slopes and HVYQ zones
7 days for slopes greater than 50 ft in length
tnw....s..r�. _.__... .
norm
Page 5 of 6
DPI
lYatsd as
Censcted