NCG020065_MONITORING INFO_20190305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V CCU U a u 0 pz)
DOC TYPE
❑HISTORICAL FILE
❑y1VIONITORING REPORTS
DOC DATE
p C) o I -/ 0 3
YYYYMMDD

• ' ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE"
General Permit No. NCG020000
Calendar Year Z 0 1
*Report ALL STORMWATER monitoring data on this form (include "No Flow"/"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 ®D❑©fl
Facility Name:
County: 5W a,"
Rhone Number: 8( 2 i) SS 7 — YLI ?-y Total no. of SDOs monitored
Certified Laboratory Lab # S0q 0
Lab #
Stormwater Discharge Outfall (SDO) No. I VMA Outfall? Yes ❑
Is this outfall currently in Tier 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 ❑
RECEIVED
MAR 0 5 2019
CENTRAL FILES
DWR SECTION
Outfall No.
Total
Rainfall,
inches
TSS,
mgll
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
08G, mg/1
{VMA)
New
Motor Oil
Usage
Stormwater
Benchmarks
Indicate NO
FLOWif
a ficable
circle
8onchmark
Qt]I50
0.1
circle
Benchmark
50I.Z511 i]
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
+�
_19allmo.
>ce .
averagea requires
TSS and Non -polar
OdG monitoring
Date Sample
Collected;
molddl r
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 00®M
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No 0
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No 0'
Was this outfall ever in Tier 2 during the past year? Yes ❑ No Z
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,
m 1l..
g
SS,
mlll
Turbidity,
.NTU
-
Upstream
(U) Turbidity,
NTU � ::
Downstream
(D) Turbidity,
,�, .NTU_: _.
Non -polar
P&G, m /1
� . (VMA)g
New
Motor Oil
, . Usage
allmo.
Stormwater
Benchmarks
Indicate NO
FLOW it
applicable
Circle
Benchmark
t 100150
0.1
Circle
Benchmark
50/25/10
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
15
�55 gaUmo.
average requires
TSS and Non -polar
OSG monitoring
Date Sample
Collected,
molddlyr
MENOMMMM
z
46
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®❑G 00
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. C1 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 Q�
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 DEM!_R to reduce monitoring frequency
❑
No, turbidity benchmark exceedances did not require monthly monitoring
❑
Other
❑
Outfall No.
r.,•�:f•• -. >.
—.
Total
Rainfall,
inches
TSS,
mgll
SS,
m1!!
Turbidity,
R.NTU
Upstream
'(U) Turbidity,
:, NTUs
Downstream
(D) Turbidity,
NTU h
Non -polar
O$�G, mg&
(VMA)
New
Motor Oil
Usage.
allmo.
Stormwater
Benchmarks
Indicate NO
F`OWf!
a licable
Circle
Benchmark
100154
0•1
circle
Benchmark
5012511Q
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard appfles
15
y65 gallmo.
average requires
TSS and Non -polar
O&G monitoring
Date Sample
Collected,
moldd! r
MMMMMMMM
A/C) f-Gcw
a FLo
Permit Date 1011/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®0❑i 5❑
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 10-2-2015

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) —WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year 2 01 '"
'Report ALL WASTEWATER monitoring data on this form (include "No Flow"1"No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year,
Certificate of Coverage No. N0002 002100
Facility Name: &, �a T 1 c 2- L c 51c,"e-_ --( a
County: ,Tt
Phone Number:( tr2 Sr } J�57 — V L1�_k _ Total no. of outfalls monitored j
Certified Laboratory T,c,_ Lab# S&Yd
Lab #
Wastewater (WW) Discharge Outfall No. .z
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 SI3 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 jr) designated waters?
Yes ©
No ❑
Were there any limit violations in the calendar year?
Yes ❑
No
Outfall No.
��^
Daily Flow
Rate, cfs
pH,
SU
TSS,
mgll
SS,
mill
inapplicable
Discharge
Turbidity,
NTU .-
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
SA)
Effluent
Limitations
Mo. Ave I Daily Max,
HOW or ORW
50% of
7Q10
Indicate NO FLOW
i1 applicable
freshwater
6.0-9.0
saltwater
6.6-8.6
Industrial Sand
25145
HQW orORW
20130
HOW or ORW
and Tr or PNA
10115
HQW, ORW,
SA, St3, PNA,
or any Trout
0.110.2
No Limit
Circle Water
Quality Standard
that applies:
50125I1 0
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
N/A
Date Sample
Collected,
molddl r
Q
/Uy o,
a rt 2—.,
F1,
✓
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑❑❑❑
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfail 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,
7010 not available ❑
Does this outfall discharge WW to Trout jr) designated waters?
Yes ❑
No ❑
Were there any limit violations in the calendar year reported?
Yes ❑
No ❑
Permit Date 10/1/2015 — 913012020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑❑❑❑
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, 71010 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 ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
,.SU .
' x
TSS,
mgll
SS,
mill
itapplicable
Discharge
Turbidity,
NTU '
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
coi1100 ml
SA
Effluent
Limitations
Mo. Ave i pally Max,
HQW or ORW
50% of
7Q1 a
indicate NO FLOW
if applicable
freshwater
6.0-9.0
saltwater
6.8-8.5
Industrial Sand
25145
HQWorORW
20130
HQW or ORW
and Tr or PNA
1 011 5
HQW, ORW,
SA, SB,PNA,
or any Trout
0.1 I0.2
No Limit
Circle Water
Q thief apGpiloae�
%QI2vI10
NIA
Water Quality
Standard applies
NIA
water Quality
Standard applies
NIA
Date Sample
Collected, -
molddl r
Permit Date 101112015 — 9/3012020
Last Revised 10-2-2015

Certificate of Coverage No. N0002 �❑� ®S❑
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 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]
- - . � r - .- v _ - . - r . . -. — I- n -
Permit Date 10/1/2015 - 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 2 01 7
*Report ALL STORMWATE=R monitoring data on this form (include "No Flow'T No 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: I Ir �o ��c wr't r uar�
County: S 4+�ar1
Phone Number: ($28') 5,i7 — Lf Lf 2- Total no. of SDCs monitored ,
Certified Laboratory ti Irr'rc;,4 en -era F u 1 T HC , Lab # Jr 40
Lab #
Stormwater Discharge Outfall (SDO) No. I VMA Outfall? Yes ❑ No V]
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 CZ
If this outfall was in Tier 2 Fast year, was monthly monitoring discontinued? j D
Yes, enough consecutive :samples below benchmarks to decrease frequency [IRECEIVE
Yes, received approval from DEMLR to reduce monitoring frequency ❑ MAR 0'6 Z01B
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑ CENTKAL FILES
OutfalJ No.
Total
Rainfall,
inches
TSS,
mg/l
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mgh
(VMA)
New
Motor Oil
Usage
ailmo.
Benchmarks
Indicate
fjLQW I!
applicable
CircleStormwater Benchmark
Benchmark
100/50
0.1
Benchmark
Benchmark
."]012F11 Q
NIA
Water QualityWalaraualll
Standard applies
NIACirclo
Standard nppllo2
�
E 15
a55 q "9.1
.,,
eand raqul.a.
TSS and Non -polar
O&0 monitorrnn
Date Sam le
py�,I'
Collected 1
molddlyr
1jjW ]f
'i€'
al 1
1y ri
I ; I..
I {
�
Ir �I I t
1' 62r
a,.
1 i,, I
a�
,
1t, , 3f I 1 - l r
t,
,� } : . ;
i 5 r 0" 4 T .
, �,
Zotr of IOL
, f-7014,-
Permit Date 10/112015 -- 9/30/2020
Last Revised 10-2-2015

t
Certificate of Coverage No. NCG02 ❑D ©©©
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No Z
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 2
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,
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
FLOW ,I
a 1lca61e
Circle
Benchmark
100150
.F
0• F
Circle
Benchmark
r r C /+1 r�
50 25 10
A
N/A
water Quality
Standard applies
N/A
water Quality
Standard applies
1
a55 galiMo.
average requires
TSS and Non -polar
O&G monitoring
Date Sample
Collected
molddlyr
1.
:r-'�-
�_
�• ;.
,, f i s. +,
T, �,,�,R T a
;w►:ar,�°'y,l :
„, sa f t,r�r
f
1�'«�r,.
Lg
2c; Q -6a
Al.. -{v v
2of7 a 3--Qf
.
Permit Date 10/112015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 [][I[]❑
CERTIFICATION
"I certify, under penalty of law, that this document and all attachments were prepared under rrty 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,1 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
E
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DEMLR) f
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files i
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 rate 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 @©0 SC1
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. — VMA Outfall? Yes ❑ No JZf
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,
mgll
SS,
mlll
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mgll
(VMA)
New
Motor Oil
Usage
allmEircieo.
Sfarmavater
Benchmarks
Indicate NO
FLOWIf
a !!cable
Benchmark
9enchmark
100/50
0.1
Benchmark
BencCirclohmark
50/25/10
NIA
Watersuallty
Standard applies
NIA
watoravalrty
Standard appllas
15
>$6 o requI
aversga requires
TSS andNon•polar
0$0 men.rIn
Sample
Collected,
molddlyr
%
� � F
_+6tF,� �4 �1 r.
A f
r
H �. +�
�. i. e
a
~ Slil,ii�.i
r t rn
�i4} ,r, r !$�. �.
�Iru I i f
�,�3'i•�d+
1rY �ah'�r.
lt
L'. Ir ••�I' !
h 1
:itor
,I �Date .
Fw'u
2 Jif7 4?-QL4
Ar, `fay
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015

ANNUAL SUMMARY DISCHARGE MONITORING
---1%
REPORT (DMR —WASTEWATER
SUBMIT TO CENTRAL OFFICE* j
General Permit No. NCG020000
Calendar Year 0 l 7
"Report ALL WASTEWATER monitoring data on this form (include "No Flow'T'No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year_ '
Certificate of Coverage No. NCG02 [MI®M i
� Facility Name:',, t!r h r to 7a I c I- L rn a ff-o=t e 6o, klei,,/rP-t Q Cf �trr�
County: S W 1 iV _
Phone Number: (- 2�L) S S �_� �f 2 i� , Total no. of outfalis monitored
Certified Laboratory 17n c, Lab # q d
I
Lab #
Wastewater (WW) Discharge Outfall No. a
Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes ❑
Does this outfall discharge WW` to SA waters? Yes ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑
Does this outfall discharge WW` to HQW or ORW waters? Yes ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters,
Does this outfall discharge WW to Trout (Tr) designated waters? Yes
Were there any limit violations in the calendar year? Yes ❑
No 0
No ❑
No ❑
No ❑
7Q10 not available ❑
No ❑
No
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mg/1
SS,
mill
if applicable
Discharge
Turbidity,
NTU
Upstream
-(U) Turbidity,
NTU
Downstream
(D)Turbidity,
NTU
Fecal
Coliform,
col/100 ml
SA
Effluent
Limitations
Mo. Ave l Daily Max,
HQW or ORW
50% of
7Q10
Indicate NO FLOW
II applicable
freshwater
6.0-9.0
saltwater
6.8-8.5
v
industrial) Sand
25145
HQWorORIN
ZV1J0
0
HQWorORW
and Tr or PNA
HQW, ORW,
SA, S.,PNA,
or any Trout
Il ft �1
0•110•2
No Limit
Circle Water
Quality Standard
Ihalapplies;
50/25110
NIA
WaterOuallty
Standard applies
NIA
water Quality
Standard applies
NIA
S+
Date ample
Collected
mOlddl rr1#rilllyrlj
y
,.',rli'r:i'��14
gJ9'',{�ti.NI'
i
iU aFi
'iitI�Pi61j�tlitns#�i�l
�'i�IIY,II'! H"•Yltl�l
-i i
-•-Yhl���'I'iLl
_l
1 !i� F'
Ir171i'n,;ro�51.{a�,t,l,�lnri{;I;7'�i
�,hiF
I,vzt}�
i �.
.4r�i1^i�'
f �i��4 ;y,'
If,111..}& ,�, u.l
}M�lt:•slK'k�"``.'tii!.,iwY.fl
tIt L�.PV
i" IAw ,{ ''11'Ja�'
; N!}�h
U. i .:i,.l
lit" 11�if .i'i-�,,at,Fil
'. V.1 i '�I !
�1 '
t., til :
j;'rSviS'k'�
��. has d!° i i� k
a�kl� fl. r !. - !„�
F C
0
03
F fare
DWR SE
:110N
Permit Date 101112015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑❑❑❑
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 §122.221
Signature
Date
Mail Annual Summary Wastewater DMR to the NCDEQ Central OffiIce:
Note the address is correct — Central Files is housed in D WR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
i
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 — 9/3012020
Last Revised 10-2-2015

ANNUAL SUMMARY DISCHARGE MONITORING REcEIVr D
REPORT (DMR) -- WASTEWATER MAR 01 2J7
SUBMITrJT6. -kN,-- L�OFFICE'� cEnirr q $'
LF
General Permit No. NCG020000
Calendar Year 2 0l b
"F 6p6rtALL;WASTEWATER.;monrtbr.1 datlon'this`fo'rin (include':'NolFlov�r"(°NoaDlscfiarge :andlLlmit Violations) froml`�
:. '.. the previous calendar .year tb the+DEQ'by,`MA'RCN.1,of•each,year:
Certificate of Coverage No. NCG02 701Q©❑S
Facility Name: __&An tzyAof la TgI c I LI'm{ si>,.1 c
County:
Phone Number: �f( z i ) SS7— '�'2 S Total no. of outfalls monitored r
Certified Laboratory C-nV„717 „ A-.rl L,j r Lab # 5090
Lab #
Wastewater (WW) Discharge Outfall No. s2
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No ❑
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced
waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes
No ❑
Were there any limit violations in the calendar year?
Yes ❑
No 12
utf� !I N
O is o:
�rl ? r l
yDa'11y Flaw
i -
�nRate, cfs 1
r FF.' nl a
�^,''.pH;"
yr. r
n;:SU'
Ian I wl'
l�`A, JFecal„',:
' TSS;
i,: -;
rl
°.' IS I a ' [ ,1 tINl1
SS, ' .
�•r �1'�Y s t,
t iHeCAlfcabfe4 i
Dlscharge'�
[ t ,'rYrti
Turbidrty; r(U}'�Turbiciity,
i i 1 I t .;' ,
i
Upstream
F "- !'
, I J''A'
NTU� ;
IDownsttea�m !
r.�-e,
i°Turbidityco111'00R'ml
NT,U,i t
Collform
Ti - .��. ���
--.',(SA).!
Effluent
Limitations:
Mo. Ave I Dally Max.
-
HQW orORW
50% of
7Q1O
Indicate NO FLOW
H appueawe
rreshwiter '
s 0 9 0
siltwater,
6A.8.5
.
lnduatrlel..:and
; » 25145."HQW,'ORW,
HQW orORW
2OI30
HQWor,ORW
7r or PNA-
8A, SS, PNA; .
orarri7rout
0.1/0.2
No Limit
- elrcleWater
Quallty Standard
.,thatappllia:'
550/25/10
NIA
WaterQuallty
Standard appllos
- NIA
Walar.Quallty'
Standard applies
NIA
C Date:,$ample�,
� +COIIeCted,
mo1ddl f'
4
'� • C1111
'b
�i da ,.„u; i�
iJiuC4 ki I a liia+�
f, ,+t ii
k�! i A14i .; GSA
t55EAt&[Fi� t s �i'IS
,,
JNIi lr Ilk
Q
�d
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑❑❑❑
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 CPR §122.22]
Signature
Date
Mall 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

= ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) -- STORMWATER
�`' SUBIVl1T TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year Z D1 b
*Report ALL STORMWATER monitoring data on this form (include "No Flow T'No-Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year,
Certificate of Coverage No. NCG02 ®[0]®0
Facility Name: , 4 ha Iq Ta tc g L 1 en e Scar e C 0,
County: 5W4, 0
Phone Number:( ' �) S.S 7- q Total no. of SDOs monitored
Certified Laboratory C'{VD0 t r? —w/ 10c,Lab # SIJgO
Lab #
Stormwater Discharge Outfall (SDO) No. f VMA Outfall? Yes ❑ No 0
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 Z]
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 ❑
Outfa No.
Total
Rainfall,
inches.
TSS,
mg/I
SS,
m1/1
Turbidity,;
NTU
-
Upstream
(U) Turbidity,
NTU
..
Downstream
'(D) Turbidity,
NTU
Non -polar
O&G, mgll.
(VMA),
New
Motor Oil
Usage
al/mo,
SfOrmwafer
Benchmarks
lndica(e No
iLON"'
a !cabin'
Circle
Benchmark
100150
0.
Circle
Benchmark
�t)12 �11
NIA
Watorquality
Standard applies'
NIA
Water Quality
Standard appile
'55 gal,mo.
average raquires
TSS and Non -polar
O&G monitorin
Sample
Collected
! r
i :l,t�l
I �II ` ri�ra: a"i•h:r'�
S
:, I:'�".�7�L�M' ,'',s �" I. l'�w!R'ilaoit:,�' I�:+ 'CI ii ,#�"�bI�va"'I ,Ii`a! ��ii,.�,;��f..�a,I ,
,aI 11h
�l;i�i `�'• V 9IIpDate
rt�I
'iInll I "u,PHd 1•Il°,l'� ,!l,r.iyjall;l "r, {i.
r»mflrU
1i
�iI17 , "•_�I,,y', yy4+.i�lIa�' j.,.'
1IIIiFFFll'yI�I
J� imh1Ltt1„
slu•ti�
Permit Date 1011/2015 - 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 [MEE
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 Z
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<'
Total
Rairifaii,
inches
TSS �.•
mgll'�
SS
m111
Turbidity,
NTU
Upstream
(U} Turbidity,
NTU
Downstream
{D} Turbidity,
NTU
Non -polar
O&G; mgil
(VMA)
New
Motor Oil
Usage
allmo.
Stormwater
Benchmarks
Indicate NO
FLOW!(
a !!cable
Olrore
Benchmark
100150
0.1
arcte
Benchmark
50/25/10
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
15
�55gallmo.
averago requires
7SS and Nan -polar
08G monitoring
Date Sam le
p
Collected,
molddlyr
rri ,� ;
l ! , t
;.� x ,I�r;., �'.
�i �{r({'}jI)yll;{`•
�� ! �i i,.,�t
r�H�W�
:: ,• +i,
r•, :t p p
lefl)�(µir rry"��''�
'i�1.11lN +rl
I r
rr.� 3YHria
S't�
}pr''11$Fygj�i�
�r�, i� l �: 11
�t� 1 :1
,ilf:;„*.''.l'
r I. +,
ii., n.•
!� y`y']J1 c1j3j 4
���;1:'.}rill�l
� i : �r � �r.
Ali:N lf'.I
a ,,d- • �+
I�,ir'p'
{{#' l�j} +
N �!}{.i1i��:
: ,a„�' a;ftt. u,�il.
+�
�:i�yk'It
�'Il
•.�l�rd
, I' C,' " f'
1 , k rt !
:u 3 ` i i
5}tl`�I;fSI}] '� ��� ye
1;7^II}ut�f�i f?1 }
it rr. P, i t+;+. � �k`�
I"3 �,l
` + �,r;�„r€1 r
ti4'iyMtJ
V.�+rl;l� �1�'�1��1�1�i�
�i l �:Li::t 4}�
j`j� I.+rRi'i1f;j'r1
II�i}•S
t.i: �17��.`>��` : �rl",i�:.
dr 6
Na no-v
Permit Date 101112015 — 9/30/2020
Last Revised 10-2-2015

.J1
Certificate of Coverage No. NCG02 0M©®
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No 0
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No 0
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/1
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
I(VMA)
Downstream
(D) Turbidity,
NTU
Non -polar
O&G,.mgll
New
Motor Oil
.:.-Usage
allmo.
$tormwater
Benchmarks
Indicate NO -'
aFLOWabla
circle
Benchmark
100I50,
0.1
Circle
Benchmark
50/25/10 .I�'Standard'appWater
NIA'
[oa
NIA'
Soalar applieQuality
15
>65 gallmo,
average requires
TSS and GaGmonitrinta`
Date Sam pl e
Collected
'
molddlyr
i� � .I� ;
aibi!nilu'�isd :Shfr4�i41'
I:l�tti�i�
, t�?Y
hil,
tl{t;
al
� d �r�
�f� .lie:
Tila�
1ru~ I
rye, ��. l
��34ii{'�
#r "tii�'Nl+�
i°" :?!'i.' i
t
xyw
'�
Ifi
P �� It
N�; iWl@lit,
�j�� I ��':"-�'"� h� �
4�.i i1IS'i
; �� �a���j{S:•��"1.
1t� iL��tl.
Permit Date 10/112015 — 9/3012020
Last Revised 10-2-2015

Certificate of Coverage No. N0002
CERTIFICATION
1 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 �/28-117
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 101112015 — 9/30/2020
Last Revised 10-2-2015
t

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT AMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE
General Permit No. NCG020000
Calendar Year 201 S
`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 of each year.
Certificate of Coverage No. NCG02
Facility Name: Alan td ke, 4 1 a C 2 L ►�►� S e ��, a
County: S W A 1 A,-
Phone Number: ( Solt) 5 S 7 r q y.2ts" Total no. of outfall- ionyiffia e-d r 1.
Certified Laboratory C in je t'"rr w en at/ 7,c . Lab # Sa V U1
Lab # FFB 0 5 2016
Wastewater (WW) Discharge Outfall No. 21
[�wR SAkL FILE
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 SI3 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?
Yes ❑
No X
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mgll
SS,
mill
itappllcable
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
co11100 ml
(SA)
Effluent
Limitations
Mo, Ave r oally Max.
HOW or ORw
50o1a of
7Q10
Indicato NO FLOW
if applicable
freshwater
6.0.9.0
saltwater
6.8.8.5
Industrial Sand
25145
HOW ofORW
20130
HOW or ORW
And Tf or PNA
1
1 011 r
J
HOW, ORW,
SA, SB, PNA,
or any Trout
0.110.2
No Limit
Circle Water
Ouallty Standard
that applies:
50125/10
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
NIA
Date Sample
Collected,�
molddl r
iv
�';£ rt
'• � t ��^
� ;���.���
,s r�
N : r
'�� �a^[
L
, w
F��
�.c�,� ..s,�:�
=s 7 �—C r
+fir �,y
,.�x_r v<
-
•1 a
^�'``" y�•="`
f �,
�1§tY t Y'
ly r s .T „'
1
Al ow
No FLOW
03—
4 FLOW
y
No FL vw
Permit Date 1011/2015 — 9/3012020
Last Revised 10-2-2015

5
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year 2 U ( 5
"Report ALL STORMWATER monitoring data on this form (include "No Flow" /"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 [61®161©
Facility Name: /V ,m i cr ha (a T 1 t I U VII e 510. e_ C p,
County: S W A I Al
Phone Number: ($Z� ) 697— t(4 Z Total no. of SDOs monitored
Certified Laboratort [ n y „x,n „n p#A-" 1 I vir , Lab + G oq o
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 ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
Of �ll No.
Total
Rainfall,
inches
TSS,
mgll
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mgll
(VMA)
New
Motor Oil
' Usage
allmo.
$tormwater
Benchmarks
Indicate NO
FLOwif
a licablc
circle
Benchmark
ooiso
LV V
0 1
circle
Benchmark
JU12tJ110
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
15
�55 gallmo,
average requires
TSS and Non -polar
OdG monitoring
Date Sample
Collected
'^i•yilrta4f14'��y
molddl r
_
s'
S, .rly}�, 'F �.1
a Y`�
�Ffs r r i',rYt,F
_
V�d
�� i.s.t
�r 1�`)f ::
ti �X7
NO ECG
Permit Date 101112015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®®®©
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(VMA)(gal/Mo.)
TSS,
mgll
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU'
Downstream
(D) Turbidity;
NTU.
Non -polar
O&G, mgll
New
Motor: Oil
:Usage
Stormwater
Benchmarks
fndicateNO
rtowir
a lica6fc
Circle
Benchmark
Benchmark
100150
0.1
Benchmark
Benchmark
5012511i}
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
15
>a5 o requires
averagorequires
TSS and Non,pnlar
O&G monitoring
Date Sam le
p
Col lected,
molddf r
t ti
�;.
:. 6,:.
t •
y,.t
��
a•- y
4 . t i. c a
,
��µ y.r ...y
3,•
ti ��
r ��. 7
- -�'.
1
/Va rtalv
Permit Date 10/112015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑D ©®©
Additional OutfaII Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. L4 VMA Outfall? Yes ❑ No ❑X
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,
mgll
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mgll
(VMA)
New
Motor Oil
Usage
allmo.
Benchmarks
indicate
FLOWif
a Hcable
CircleStormwater Benchmark
benchmark
100I50
0.1
circle
benchmark
50/25/10
NIA
Water Quality
Standard applies
NIA
Water Quality
Standard applies
1 $
averageroqufres
;aga requires
TSS and Non -polar
OSG monitorin
Date Sam le
P#
Collected,
moldd! r
t+
y j t�`.
'
a;t ,G
Y�'4.J
I '�
ti '`�
t
T, sM
.Y t .:`
v
b ` , f't
«{ ,: 7
U
1 .64Nr
. }^
i i F
:. „�s
D 61641
Permit Date 10/112015 — 9/30/2020
Last Revised 10-2-2015

1
Certificate of Coverage No. NCG02 Fo ©®[�l
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 I/lit
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct -- Central Files is housed in DWR (riot 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 DMR -WASTEWATER
SEND TO CENTRAL OFFICE`.
PROCESS MINE/DEWATERING WASTEWATER
GENERAL PERMIT NO. NCG020000
* Report All Wastewater discharge monitoring data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 of each year. If
you have limit violations, you must also have turned in a Limit Violation DMR to your local Regional Office within 30 mays of receiving sample results from a lab.
CERTIFICATE OF COVERAGE NO. NC[Y.02 0 0 6 5
FACILITY NAME: AVan ahit la Ta [e
PERSON COLLECTING SAMPLES:gs_o
CERTIFIED LABORATORY: ' Lab # _ 5 0W
Lab #
LIMITS VIOLATIONS? YES ❑ NO S]
Part A: Wastewater Monitoring Reuuirements
SAMPLE COLLECTION YEAR:
COUNTY: I4 t 4/
PHONE NO. ( 2 ) S .2
ADD TO LISTERVE? YES ❑ NOD EMAIL:
INDUSTRIAL SAND"? ❑ DISCHARGING TO SA WATERSt. ❑
Outfall No.
Date Sample
t
Collected
50050
Total Flow
00530
Total Suspended
t
Solids
00400
Turbidity
00545
Settleable Solids
00400
pH
31616
Fecal Coliforms
-
mnVdd/yr
MG
mol,2
NTU ,
ml/I
Standard
col/MI'
Z
201tf
01w,
nil
ng D
1' e
ti\ i—
tr5A
11r Z
�
r
R
0 5��
-
r
LCkV �
t
FILES
T
S
All mines must monitor W W discharges for TSS. Only industrial sand mine discharges are subject to TSS limits.
z If an effluent limit is exceeded, the permittee is required to institute monthly -monitoring for that parameter for the remaining permit term. �'� `•,
�, ' !
3 The discharge shall not cause an instantaneous measurement of the turbidity -of the receiving water to exceed: 10 NTU for freshwater streams, lakes..?na reservoirs
''a .
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
Stormwater Discharge Outfall. Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the discharge.
4 Only facilities discharging to SA waters are required to monitor for Fecal coliforms.
Permit Date: 1/l/2010-12/31/2014 Last Revised 01-05-10
Page I of 2

Part A Continued: Wastewater MonitorinE Requirements
Outfall°No.
. .. ...
.Date Sample
1
Collected
50050
Total'Flow•
00530
Total Suspended
I
Solids
00400, >M
Turbidity
00545
l
Settleable Solids '
00400
' pH
31616.. -
..
_ Fecal Coliforms -
mm/dd/yr
MG
mgll
NTU2,
MV1
Standard .
col/ml '
,
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
t-
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.
1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
(Date)
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-05-10
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