NCG140012_DMR WW_20220329

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2021
Report ALL WASTEWATER monitoring data on this form (include"No Flov/7"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❑ IM 2Q
Facility Name: Mt. Airy
County: Surry
Phone Number: (336 )983-2181 Total no. of outfalls monitored 1
Certified Laboratory Prism Lab Lab# 402
Lab#
Wastewater (WW) Discharge Outfall No. 001
Does this outfall discharge WW to SA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No 2)
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. Daily Flow Rate, pH, TSS, SS, Non-Polar C&G (EPA Method 1664
001 cis SU mgll mill (SGT-HEM)), mg/I
Uappllcable
Standard
Effluent OOWnr ORW freshwater 30 NOW,ORW,SA,
50% of 7010 6.0-9.0 Now SB,PNA,eraay No Limit
Limitations 20 Trout Indicate NOble saltwater Samples above Benchmark
applicable 6� 8-85 HqW IO PNAntl Tr,or S subject to T15 Responses
Daily Mazimem V O 15
10
Date
Sample
Collected, {
mo/ddlY r
3/8/2021 NO FLOW
r _
um
5/10/2021 NO FLOW
9/1/2021 NO FLOW CENTRAi r
DWR SECTION
12/1/2021 NO FLOW
Permit Date 8/1/2017—6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No. NCG 14 E]K][I]F2�
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 4 CCFR§1 .2
Signature
Date jj
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—6/3012022
Last Revised 8-22-2017