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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
❑HISTORICAL FILE
dj(MONITORING REPORTS
DOC DATE
❑ �u � "l� ��
YYYYMMDD
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
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General Permit No. NCG140000
Calendar Year 2019
"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 I of each year.
Certificate of Coverage No, NCG14
Facility Name: west
County: Mecklenburg
Phone Number:( 04 ) 529-6364
Certified Laboratory Prism Lab
Lab # 402
Lab #
Total no. of outfalls monitored 1
Wastewater (WW) Discharge Outfall No. oat
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 ❑�
Outfall No.
Daily Flow Rate,
pH,
TSS,
SS,
Non -Polar O&G (EPA Method 1664
001
cfs
SU
mgll
MIN
(SGT-HEM)), mg11
if applicable
Standard
Effluent
HOW or ORW
50% of 7Q10
freshwater
6.0-9.0
30
HOW, ORW, SA,
No Limit
Limitations
HOW
20 20
S8,PNA,orany
Trout
lrrtlicafe NO FLOW ifsattwatar
5
Samples above Benchmark
applicable
C
6.
HOW 1 ORW and Tr, or
subject to Tiered Responses
Daily maximum
V-p.
V a J
pNA
10
15
Date
Sample
Collected,
molddl r
1/17/2019
001
6.3
BRL
4/5/2019
NO FLOW
,RECEIVED
9/11/2019
001
6
BRL
1211712019
NO FLOW
Permit Date 811/2017 -- 6/30/2022
Last Revised 8-22-2017
Certificate of Coverage No. NCG14 0❑ 0❑ 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 informaton, including the possibility of fines and imprisonment for knowing violations."
[Required by 40 CFR §122.
Sig nature
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 (919) 807-6300
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
(919) 707-9220
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017