NCG020313 DMR SW

ANNUAL SUMMARY DMR - STORMWATER
SEND TO. `CEN7iRAL OFFICE
STO"WATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Repoit•ALL STokM WATER Monitoring Data on this form (Including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 ojeach year.
CERTIFICATE .OF COY.ER,AGt NO. NCG02 O -- • j,,.- *a
FACILITY NAME: u -'i 'i' Z +� c -
PERSON COLLECTING SAMPLES ---I)$tvie i eV
CERTIFIED LABORATORYS f a ).s v l N fil�Lab
Lab #
SAMPLE COLL C YEAR:
COUNTY �►'✓ k S
PHONE NO. (3AVt V71— 534D
ADD TO LISTERVE? YES Ll NO EMAIL:
TOTAL RAINFALL: i2-45 .INCHES
EVENT DURATION: MINUTES
'art A: Stormwater Monitoring Re
ulrements
In Tier 2
Monthly
Monitoring?
0/0
# of Mouths In
Tier 2
Sampling'
Total Flow:Turbid
,Total -Suspended
Inity.
10030
(NTU)
see Footnote •
�ettietib�e Solids
Odfi)
0.11.
Outfall No:Bonds'.'
Date Sample
Collected
(miMd/yr OR
NO FLOW)'
p
ZS 1
A/
(e- -1
2
d
` If "NO FLOW" or "NO DISCHARGE, Enter -NV i'l,V W - or " iV V vi?jL;n^i%%jw or —11 vuum. ,.vav ww "u .............6.,. .
2 Per NCO02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
s If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit,
TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
s The discharge shall not cause an instantaneous measurement of the turbidity of the rdociving'water to exceed: IQ NTU for fireshwater 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 SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-19-10
Page 1 of 2

SEND '0 YOUR LOCAL DWO
DWQ REGIONAL OFFICES:
Asheville Regional Office (ARO)
Roger Edward's, Surface Water Protection
Supervisor
2090 US Highway 70
S.wamanoa, NC 28778
COUIU13R 12.59,01
Phone: [phone]
Fax: [phone]
Fayetteville Regional Office (FRO)
Belinda Henson, Surface Water Protection
Supervisor
225 Oreen Street
Systel.Building Suite 714
Fayetteville, NC 28301-5043
COURIER•14-56725
Phone: [phone] '
Fax: [phone]
Mooresville Regional Office (MRO)
Rob Krebs, Surface Water Protection
Supervisor
610 East Center Avenue, Suite 301
Mooresville, NC 28115
COURIER 09-08.06
Phone: (704) 663,1699
Fax: [phone]
Raleigh Regional Office (11110)
Danny Smith, Surface Water Protection
Supervisor
3800 Barr6tt Drive
Raleigh, NC 27609
COURIER 52-01-00
Phone: (9 19.) 791.4200 '
Fax: (919)'571-47'18
Washington Reglonal'Offfce (WaRO
Al Hodege, Surface Water Protection
Supervisor
943 Washington Square Mall
Washington, NC 27889
COURIER 16.04.01 .
Phone: [phone]
Fax: [phone] or [phone]
Wilmington Regional Office (WRO)
Rick Shiver, Surface Water Protection
Supervisor
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
COURIER 04-16.33
Phone:, [phone]
Fax:'(910) 350.2.004
Winston-Salem Regional Office (WSRO)
Steve Tedder, Surface Water Protection
Supervisor
585 Waughtown Street
Winston-Salem, NC 27107
COURIER 13-15.01
Phone: [phone]
Fax: [phone]
YOUMUST SIGN THIS CER TIFICATION 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•manag6 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 posslBility of fines and Imprisonment for knowing violations."
6 G` SL
(Signature of Permittee)
Z/9 116---
(D�atej
- .
Permit Date: 1/1/2010.12/31/2014 Last Revised 01-05-10