NCG020721 DMR WW (6)

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT DMR -WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year .2 0 1 r
*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 ofa Y-OM4 4-
-
Certificate of Coverage No. NCG02 0,
Facility Name: L0 i L Ll S N c)(/yl I Al S iTE FEB 2 2016
County: C24 ✓C /1) CENTRAL FILES
DVVR SF=CTIaN
Phone Number: a --V Y Total no. of outfa7fs monitored
Certified Laboratory t1VVe2v1t/4 s VT I �iVC- Lab # 10
-Towfv of VANL�_/3 xZ10 Lab #
Wastewater (WW) Discharge Outfall No. 00
®wily Flow
Rate, cfs
=
= pH, =
SU
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No 2
Does this outfall discharge WW to SA waters?
Yes [:1/
No P
Does this outfall discharge WW to S13 or PNA waters?
Yes ❑
No [0'
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No [lam
If so, what is the 7010 flow rate? or Tidally influenced waters,
7010 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.
no_
®wily Flow
Rate, cfs
=
= pH, =
SU
TSS
mg/1
SS,
mill-
I,appficable
Discharge
Turbidity,'
NTU
Upstream
-(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU. -
Fecal_,-
Coliform,.
col/1,00 m_ l
(SA)
-
Effluent
Limitations
-Mo. Ave I Daily Max.
_-
HQWoorORW
60% of
-7Q10 -
-
Indicate NO FLOW
it'applicable
freshwater
6.0-9.0
saltwater
6.8-8.5-
-
Industrial Sand
25/45
HQW orORW
20/30
HQW or ORW
and Tr or PNA
10/15
HQW,ORW,
SA, SB, PNA,
or any Trout
0.110.2
_
No Limit
Circle Water -
Q
that app/ esard
50/25/10
NIA-_
_ Water Quality -
Standard applies
N/A
- -Water Quality
Standard applies
-
- NIA - -
Date Sample
Collected,
mo/dd/yr,
310-11-S
01
d-910
.5. 2f ty"
22,.7 (
?
3,0
4,01
,d
13
7-5-
-7.
0c
3-r
0 1 it
2. ?
, ?
. 01
1
111-3 ,�
2
IF 1
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®©205-1
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]
Signature l.«'it bYA5U
Date
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 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 MAR]
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No.
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No ❑
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 reported?
Yes ❑
No ❑
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2095