NCG140012_MONITORING INFO_20190226

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ Q 0 1 (1`l`�
YYYYMMDD

'`
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2019
'Report ALL WASTEWATER monitoring data on this form (include "No FloWl"No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14 ®0❑I
Facility Name: Mt. Airy
County: Surry
Phone Number: (336 983-2181
Certified Laboratory Prism Lab
Lab # 402
Lab #
Total no. of outfalls monitored 1
Wastewater (WW) Discharge Outfall No. 001
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 ❑✓
Outfall No.
001
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mill
It applicable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mg/I
Effluent
Limitations
Daily Maximum
HOW or ORIN
50% of 7Q10
Indicate NO FLOW i!
applicable
freshwater
6.0-9.0
wlM
6. p-�.0
V J
Standard
30
HOW
0mter 2
HOW ! ORIN and Tr, or
PNA
10
HOW, ORIN, SA,
SO, PNA, or any
Trod
$
No Limit
Samples atrovs Benchmark
subject to Tiered Responses
15
Date
Sample
Collected,
molddl r
b
4s
312912010
NO FLOW
RECEIVED
6/28/2019
NO FLOW
CENTRA 11 P -,
9/3/2019
NO FLOW
Dk1VR SEC Ti%-r,'
121212019
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

i
Certificate of Coverage No. NCG 14 J F21 -1 2❑
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_§122.41 -.,7
Signature /
Date a4 I (to
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 — 6/30/2022
Last Revised 8-22-2017