NCG020430_MONITORING INFO_20190226

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
[I HISTORICAL PILE
L�MONITORING REPORTS
DOC DATE
❑ Cb g W3 In
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
❑ HISTORICAL FILE
DOC DATE
❑
YYYYM M DD

f
r; ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
eneral Permit No. NCG020000
Calendar Year Zo I'd
`Report ALL STORMWATER monitoring data on this form (include "No Flow"I'No Discharge' and Benchmark
Exceedances) from tl'e previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG
Facility Name: M6R) Di AI,-J 6rue - 5AmP50N y?7114& J_,7-
County: 5RL st; r l ._�.— --
Phone Number: ( qo3) 79(, 1 uob Total no. of SDOs monitored
Certified Laboratory 2AcC AAALurir_ _ lab # UW -C& 7
Lab #
Stormwater Discharge Outfall (SDO) No. zVMA Outfall?
Yes ❑ No ER
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 ®
RECEIVE
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
FFB 26 20 r5
Yes, enough consecutive samples below benchmarks to decrease frequency
❑
Yes, received approval from ULMLR to reduce monitoring frequency
❑
CENTRAL FIL&
No, turbidity benchmark exceedances did not require monthly monitoring
010�
Other 1
❑
Outfa311 No.
Total
Rainfall,
inches
TSS,
mg1l
SS,
m111
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mg/!
(VMA)
New
Motor Oil
Usage
allmo.
Sformwater
Benchmarks
frrdrcala NO
BFL WyIe
Circle
Benchmark
100/50
0.9
benchmark
nchrn
50125/10
N/A
swanddard
NIA
Standaro vA
15
y agefaq i
average regr.irea
O6 MO�"Pwer
Date Sample
Collectedmolddl r
":N�3, :;
�. .
,�
�.
��r�
wil�
•.,
r:
{
i
I
i
I
I
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 EIRIE0
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. I 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) 1
Signature f • 1� r�2
Date zoig
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Nate the address is correct — Central Files is housed in DWR (not DEMLR)
I
N.C. ❑epartment 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 DEM I R Stormwater Permitting Staff in the Central Office at:
[phone]
I
Permit Date 10t112015 — 9/30/2020
Last Revised 10-2-2015

RECEIVED
ANNUAL ISUMMARY DISCHARGE MONITORING FEB 2 6 2019
t
REPORT DMR) — WASTEWATER C
SUBMIT TO CENTRAL OFFICE* CTlonr
General Permit No. NCG020000
( Calendar Year Z o 7q
"Report ALL WASTEWATER monitoring data on this form (include "No Flory" No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH i ofeach near.
Certificate of Coverage No. NCG
Facility Name:. 1"f`1H111}1ft1q Up-1Lfe - 5l4mP5,t
County: ��fYL�S
Phone Number. ( o 3 ). -7/&& ) 2 (o D
Certified Laboratory r)qGc. A/%-ALy474r-&1
Total no. of outfalls monitored
lab # GUI0--667
Lab #
Wastewater (WW) Discharge Outfall No. .3
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No Pa
Does this outfall discharge WW to{ SA waters?
Yes ❑
No EJ
Does this outfall discharge WW toISB or PNA waters?
Yes ❑
No Er
Does this outfall discharge WW tJ HOW or ORW waters?
Yes ❑
No
If so, what is the 7010 flow rate? f or Tidally influenced waters,
7010 not available ❑
Does this outfall discharge WW tolTrout (Tr) designated waters?
Yes ❑
No 0
Were there any limit violations in the calendar year?
Yes ❑
No
Outfail No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mgA
SS,
mlll
Aappkcable
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA
Effluent
Limitations
Ito, Ave 1 Mily Max.
HOW or ORW
50% of
7Q10
Indicata NOFLOW
rraAwkaara
treahvolar
6.0-9.0
Saltwater
6.8-i3.5
lntluatHaiSand
1 25145
HOW ofORIN
( 20130
I
HOWorORW
gQQ Tr or PHA
110115
HOW, ORw,
$A,S., Rw,
aranyTrout
0.1/0.2
No Limit
ClrelaWater
Qualtly Standard
thatappnew
50/25/10
NIA
Water Quality
Stallard apples
NIA
Water Quality
Standard applies
NIA
Date Sample
Collected,
molddl r
I
r ,
,
I
I
I
I
I
I
I
I
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 FEE QQ
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 penaltiesfor
submitting false information, including the possibility of fines and imprisonment for knowing violations."
[Required by 40 CFR §122.221
Signature _ . t7--
Date Z-/Lt ]Zo70i
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. De rtment of Environmental Quality DEQ
Pa, hr ( )
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Files Telephone [phone]
Questions? Contact DEMfI R Stormwater Permitting Staff in the Central Office at:
1 [phone]
Permit Date 10/112015 — 9/30/2020
Last Revised 10-2-2015

it, .
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
Genera! Permit No. NCG020000
Calendar Year x e i g
'Report ALL STORMWATER monitoring data on this form (include "No Flow"r"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 ❑o
Facility Name: ,-VOW AA,-
County: y
Phone Number: (_j Total no. of SDOs monitored
Certified Laboratory EAE1 r _ Lab # qv . .
Lab #
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 samples below benchmarks to decrease frequency ❑ RECRV E�:! i"?<
Yes, received approval from DEMLR to reduce monitoring frequency 0 FEE 2 5 2019
No, turbidity benchmark exceedances did not require monthly monitoring ❑
OCNT�
Other ❑ ,•.,.._ tsl1L f1i�C ,
Outfall No.
Total
Rainfall,
inches
TSS,
mgll
SS,
mlll
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mgll
(VMA)
New
Motor Oil
Usage
allmo.
Stormwater
Benchmarks
indicate NO
FpDcabo
a JcadJe
`�hn
Benchmark
1QQ15Q
Q•1
Circle
Benchmark
�JQ12511Q
NIA
Standardappiles
NIA
SUn—apJltyplies
1
urm
.'rage requires
'rage55 mQui
lar
rSS O&Gn�on�ng
Date Sample
P
Collected,
_;
1�,.
t ki
tea,
lklat
�
mars
k
'
;x.
�E
a
Permit Date 10/1/2015 -- 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. N0002 QO R4 [N0
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 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/I
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream 1
(D) Turbidity,
NTU i
Non -polar
O&G, mgll
(VMA)(gal/Mo.)
New
Motor Oil
Usage
Stormwater
Benchmarks
lndicare No
aF! ka;le
ClCIOCircle
Benchark
100I50
0.1
Benchmark
50/25/10
NIA
Standard apWater plies
NIA
Standard apply Water ies
5
�550 Umo.
average requires
TSS and OdG m Nion� far
Date Sample
Collected,;"
mo/ddl r
! t ! _a
�w
;x '3
4
r
(.
r
iij
Permit Date 10/1/2015 - 9/3012020
Last Revised 10-2-2015

r
Certificate of Coverage No. NCG02 O]0 3❑❑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] .
Signature
Date
)IT
Mail Annual Summary Stormwater 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 10/112015 - 9/30/2020
Last Revised 10-2-2015

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year gv17
"Report ALL STORMWATER monitoring data on this form (include "No Flow"rNo Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02
Facility Name: 5AA,'V
County:,�r.✓Tt,,.:r�
Phone Number: (!r)irif -R3ity q Total no. of SDOs monitored �^
Certified Laboratory -'&= Lab # ,Ljg
I Lab #
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑
Is this outfall currently in Ter 2 for any parameter? Yes ❑
Was this outfall ever in Tier 2 during the past year? Yes ❑
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
No ❑
No ❑
No ❑
REr `N'r-F'\
JAN 2 4 ci)'ib
r,ENTRAL FILETS
OWR SECTION
Outfall No.
Total
Rainfall,
inches
TSS,
mgll
SS,
mlll
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mg/1
(VMA)
New
Motor Oil
Usage
allmo.
Benchmarks
indicate NO
appfkab a Wit
CircStormwater nchr
Benchmark
1110150
circle
Bencrtm/ark
JQI2FJ! 1 Q
NIA
Standard aplity
plles
NIA
Waist Quality
Standard applies
1
'agerea55 e
average requires
TSS and o6G mo ���lar
Date' Sample
CollectedIR
moiddl r!p,
�.`4i1 , .a,. ,
„t �S'Y
�, • {i4
-
.
t
-
,
u?(r �.� Z^2
_
} �t
;��,
'',f•L
, w :
, i -•� *"'
Permit Date 10/112015 - 9/3012020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑❑❑❑
Additional Outfall Attachment (make copies as needed for additional ouffalls)
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 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 Na.
Total
Rainfall,
inches
TSS;
mgli
SS,
rnyl
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mgll i
(VMA)(gal/Mo.)
New
Motor Oil
Usage
Stormwater
Benchmarks
lndfcafe NO
a�L kab a
circle
Benchmark
100/50
0.1
circle
Benchmark
50/25/10
NIA
Water
iplies
Standard applies
NIA
ityC
Standard Apity Water plies
15
�55 gallmo.
average requires
orrina<
TOdG m SS andNon-polar
Date Sample
Collected
mo/ddl r.:
Aq r'�
1 3,'` iYa -r^r
:.
"J . -� r�
7cTW•
,,'e
r- i
f.�rl
_ ,.i..:�
; '
r �
.t
,
/-r r �
, `.i� �,�.t s;
.z'•�+
F a {s y. �T �!
-. si �at�
.5,.`
'
C �� •.
Permit Date 10/1/2015 — 9130/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®0©a
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
Date �►
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct - Central Files is housed in DWR (not Dr=MLR)
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 10/112015 — 9/30/2020
Last Revised 10-2-2015

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE"
General Permit No. NCG020000
Calendar Year go / 6
"Report ALL STORMWATER monitoring data on this form (include "No Flow"/"No Discharge" and Ben mark
Exceedancesl from the previous calendar vear to the DEQ by MARCH >�gkhivea f ''. 6
Certificate of Coverage No. NCG02 �❑Q 0� �� � a ��
Facility Name: as2.U&t/ 5*doa CENTRAL FILES
; ,�v,
County: �srr✓��s�+t �s.r
Phone Number: (_Iz-r } T Total no. of SDOs monitored
Certified Laboratory Lab #, !lD
Lab #
Stormwater Discharge Obtfall (SDO) No. VMA Outfall? Yes ❑ No ❑
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No
Was this outfall ever in Ter 2 during the past year? Yes ❑ No ❑
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 exc eedances did not require monthly monitoring ❑
Other ❑
OutfallqNo ;Rainfall`
. Total„
`
I�TSS„
mg11
.ASS, v
rnlli
;Turbidity,
IVTU
3
.: Upstream ,r.
jU)Mrbidity,
NTU,�
Downstreamf
'{D)�Turbidtty,�
, ' "` : ��
NTu
fit.
Non polar
ibtG� m II4
�1�. �_ g
a[VMA}CWLIGF
iNew
"Motbr.b
Usage
Stormwater
Benchmarks
,,,dre,�,,,,ax
FLOWN
r
100150
0.1
cwde
50/25/10
NIA
s; ,
NIA
sue, °&WI&,
15
average " „� ;�s
r0mut2Lk a
Date`SampI--
iY a molded
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015

.IV
Certificate of Covemge'No. NCG02 ❑❑❑❑
Additional 4utfall Attachment (make copies as needed for additional outfails)
Stormwater Discharge 0utfall (SDO) No. VMA Outfall? Yes ❑ ` No ❑
Is this outfall currently In Tier 2 for any parameter? Yes ❑ No ❑
Was this outfalf ever in Tier 2 during the past year? Yes ❑ No ❑
If this outfail 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 ❑
ka� ;
OutfalI No: r
F',FTotal -TSS,
x
Ra�nfalf,
' :� !
+
�m�gll>
r`SS,
mill
.,
Tirri�I[fltY,'
NTU
S�.�..�
Upstream' '
{Uj,'Turbtdit`y°
NTU
l
Downstream
{D)Turbicli
' `4 1°s
A
�; _
,_
Nan polar
08�G i.ig/1
,`
_ � New.
=Motor"Oil'
U sage
Stormwater
Benchmarks
8mUc r.,vo
F`O1NH _°
cacr.
Heochme�ic
100150
0.1
"`c"
Flanclunerk....
50/25/16
NIA
sue,u``i,,
N/A
s _
'I
-&"-W roqtdm
ro a onfMng
�Date�Sample
Collected, f `
.,
-
�
��Y
> ; z
z .
4
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

IF
Certificate of Coverage No. N0002 2©® v❑
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 '
Date
Mail Annual Summary Stormwater 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 10-212015
I

11 ANNUAL SUMMARY DMR — STORMWATER n
SEND TO CENTRAL OFFICE * 11
STORMWA TER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT No. NCG020000
*Report ALL STORMWA TER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I ofeach year.
CERTIFICATE OF COVERAGE No. NCG02 p-^j--2,:- •v
FACILITY NAME: J! 2Ert AAs _5► AIC7 _
PERSON COLLECTING SAMPLES G.t,i_ jl*LL
CERTIFIED LABORATORY_ eAr-jr Lab # Y a
�^ Lab #
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: Oft ,2sls
COUNTY �ildOi✓'T(,,,vt�-.[V
PHONE NO.(4zr) Lob - 51gL(
ADD TO LISTSERVE? YES ❑ NO ❑ EMAIL:
Outfall
No.
Date Sample
Collected
(molddlyr OR
NO FLOW}
In Tier 2
Monthly
Monitoring?
(yIn)
# of Months in
Tier 2
- SamplingZ
Total Flow
(MC)
Total Suspended
Solids
(mgll}
TurbiditySettleable
{NTL�
Solids (mll1)
Total
Rainfall
(in)
Event
Duration
(minutes)
-
-
-
-
-
1003.4
See Footnote;, $
0.1 1
:...
rL
VCLJ
FEB 2
IT
n
DW r~ -
tC 5
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
'- Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pl-I), you must implement the Tier I or Tier 2 responses in the General Permit.
a TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
'The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater 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: 1/1/20W-12/31/2014 Last Revised 02-02-11
Page I of 2

Part B: Vehicle Maintenance Activity Mo itoring Re uirements for facilities using > 55 gal of new motor oil/month on average
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling 2
New Motor
Oil Usage
al/month
Total Flow
(MG)
TPH using method
1664A SGT-HEM
m 1)
Total Suspended
Solids
(m 1
pH
(Standard
Units
Total
Rainfall
in
Event
Duration
minutes
-
-
153
1 oo3, a
6-93
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO a
HAVE YOU CONTACTED THE REGION? YES ❑ NO [�J"
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
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."
(Signolre of Permittee)
Penrfri Date: 1/1/2010-12/31/2014
(Da e)
Last Revised 02-02-11
Page 2 of 2

ANNUAL ► UMMARY DMR - STORMWATER I
SEND TO CENTRAL OFFICE * j RECEIVED
STORMWA TER DISCHARGE OUTFALLS (SDO) FEB 12 2015
GENERAL PERMIT NO. NCG020000 CENTRAL FILES
*Report ALL STORMIVATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year.
CERTIFICATE OF COVERAGE NO. NCG02_ _�L SAMPLE COLLECTION YEAR: _ Z el:
FACILITY NAME: COUNTY Ptr ,,rb V
PERSON COLLECTING SAMPLES PHONE NO. (QZf) x - 3 im
CERTIFIED LABORATORY M) L Lab # Ll 0 ADD TO LISTSERVE? YES NO El EMAIL:
�� Lab #
Part A: Stormwater Monitorine Reauirements
Outfall
No.
V'
Date Sample.-
Collected
(rnoldd/ r OR. '
Y t
NO FLOW) .i
°Monthly. -
- Monitoring.
(Yln)'.. .
_# of Month Ah -
Tier,2
:Samplingz'
:;
r
. ' .
Total Flow
(MG)
Total Suspended
Solids
(ml/l)• ..
i
Turbidity
(NTU}
Settleable
`=Solids (tnVl}'
Total "
Rainfall.
(in)
`Event
Duration-.
'nut
(trtt es}
-
-
-
-
-
1003,4See
Footnote
0.1
` If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
I Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
TSS benchmark values are 100 mg/I except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
5 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater 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 permince may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
1C~j
d
5�
Permit Date: 1 / l l2010-1213112014 Last Revised 01-21-1 1
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average
Outfall •
No; Ito:
,.
Date Sample. s
� ' f
Colleet,
` (mo/dd/yr OR :
i
"NO'FLOW)
In:Tier,2
Monthly
, Monit4Cing?'
_ ... _ - - .
- -(Y'/n)
# of Months
in'Tier 2. ,
Sampling 2
New Motor
^Oil Usage:
allmonth -
Total Flow
(MG)
TPH using method
1664A-SGT-HEM
m 1_ *
Total Suspended
Solids ,
__ to
; pH
(Standard
-
Units °n
'Total::,,'
`, Rainfallj
1
Event'
; Duration '
nunutes
--
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NON
HAVE YOU CONTACTED THE REGION? YES ❑ NON
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LM11T
VIOLATIONS) BY MARCH 1 OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANYINFORMATION 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."
(SignaturPermittee)
Permit Date: 1/l/2010-12/31/2014
S
(Date)
Last Revised 0 1 -2 1 -1l
Page 2 of 2