NCG020313_DMR_2019

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
I SUBMIT TO CENTR rf CE* I
General Permit No. NCG020000
Calendar Year 0 I 1
*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 3 1 3
Facility Name: K ( K + +. z_ t'�, 1 1/)`'—
County: Cci4 el. ✓ ►r =..t5
Phone Number: (704 ) 2 7 r3 - .5 3 C)9 Total no. of SDOs monitored 1
Certified Laboratory SI:Jc;r.1/z A n✓=s-l y1-,`Pr l Lab# L
Lab#
Stormwater Discharge Outfall (SDO) No. _0 Z. VMA Outfall? Yes ❑ No LY
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No E
Was this outfall ever in Tier 2 during the past year? Yes (1 No FR"---
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 ❑
Upstream Downstream New
Outfall No. Total TSS, SS, Turbidity, (U) Turbidity, (D) Turbidity, Non-polar Motor Oil
0 Rainfall, mg/I mill NTU NTU NTU O&G, mg/1 Usage
`` inches (VMA) (gal/mo.)
Circle Circle N/A N/A >55 gallmo.
Storm water
Indicate NO Benchmark Benchmark
Benchmarks FLOWit 100/50 0.1 50/25/10 Water Quality Water Quality 15 TSS and Non-polar
applicable Standard applies Standard applies 08G monitoring
Date Sample
Collected,
mo/dd/yr
tam//ojt6:r I.Oct _ b .`O, 1 7: 1 Al M , Ad/4 A/l/-t IJ%A
////Z/CIS/9 6 Lit) . 5: 3 4-01 1 3 . 87 A/I P. A/i4- ,v/G- A/IA-
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCGO2 6 3 I .
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;X 21 G 9
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

•
Analytical Results Ar -
lig sell 1
ANALYTICAL
Hammill Construction Co., Inc.
5051 St. Stephens Church Rd 1111,
Gold Hill, NC 28071
Receive Date: 06/10/2019
Reported: 02/13/2020
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
190610-09-01 Settleable Solids Zion <0.1 ml/L SM2540E-2011 06/10/2019 WC
190610-09-01 TSS Zion 23 mg/L SM2540D-2011 06/14/2019 WC
190610-09-01 Turbidity Zion 7.98 NTU EPA 1801 06/11/2019 MD
190610-09-02 Settleable Solids Kluttz#2 <0.1 ml/L SM2540E-2011 06/10/2019 WC
190610-09-02 TSS Kluttz#2 6.625 mg/L SM2540D-2011 06/14/2019 WC
190610-09-02 Turbidity Kluttz#2 7.08 NTU EPA 180.1 06/11/2019 MD
Respectfully submitted,
Dena Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 4

Condition of Receipt
Sample Number 190610-09-01 Temp on Arrival: .2
Parameter Schedule: Settleable Solids
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Turbidity
Received on Ice
Sample Number 190610-09-02 Temp on Arrival: .2
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Settleable Solids
Received on Ice
Parameter Schedule: Turbidity
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 4

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Address: IzCi // 122 Court Street • P.O.Box 228
S"f F A t1, �►lU;a. ( i.4 Statesville,NC 28687 •
Contact Person: FqX n�i
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PO# Requisitioned by: (Time DBte) 111fF>C!I![ Custody Record z
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Customer Time Sampled Date Sampled rwvut v
Sample IDti Lab-ID R 4 E Parameters requested for analysis —
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Relinquished by: �__, A . Time barn,pm Date ! Sampled by:
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Relinquished by: / Time am,pm Date / / Holding times met: V
Received by: Time am,pm Date f/ /
Compliance work:
Composite Sampling#1:
Time begin am,pm Date. / / Non-compliance work:
Time end am,pm Date_/ / Lab Comments:
Composite Sampling#2:
Time begin am,pm Date / /
Time end am,pm Date / /_.
I

Analytical Results ,, . STATESVILLE
ANALYTICAL
Hammill Construction Co., Inc.
5051 St. Stephens Church Rd
Gold Hill, NC 28071
Receive Date: 11/13/2019
Reported: 11/18/2019
For: KLUTTZ#2
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
191113-40-01 Settleable Solids Kluttz#2 <0.1 ml/L SM2540E-2011 11/14/2019 MD
191113-40-01 TSS Kluttz#2 5.294 mg/L SM2540D-2011 11/15/2019 CJE
191113-40-01 Turbidity Kluttz#2 3.66 NTU EPA 1801 11/14/2019 MD
Respectfully submitted,
1Ov -ThiVaGjYbmit,,
Dena Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2

Condition of Receipt
Sample Number 191113-40-01 Temp on Arrival:
Parameter Schedule: Settleable Solids
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Turbidity
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 3

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Address, �'
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t Statesville,NC 28687
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Contact Person: 0...0 �1 i (�'`` r Ph�neC�'.,,.f; �ci S___3 0 t F 1 O`f' 1?`� -r f Lf q Chain of
PC Requisitioned by: (Time Date) •\\kl ti1'ILLI Custody Record
1\.all 11(11
Customer Lab-ID N Time Sampled Date Sampled Matrix _�amelas request�for analysis
Sample
(Grab Only) (Grab Only) sway, W b W
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Relinquished by: Time am,pm Date_/_/_ Holding times met:
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