NCG020023_DMR_20210301

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No.AC1 1300
Calendar Year coIO
"Report ALL WASTEWATER monitoring data on this form (include "No FloWTNo Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 �JUoUJ
Facility Name: 1 ')/"P,, b; 1
County: Pl Do- re --
Phone Number: ( Clio Total no. of outfalls monitored 11
Certified Laboratory Te& Lab #
Lab #
Wastewater (WW) Discharge Outfall No. /rop Exi +--
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 NJ
Does this outfall discharge WW to Trout jr) designated waters?
Yes ❑
No
Were there any limit violations in the calendar year?
Yes ❑
No
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Permit Date 10/1/2015 — 9/3012020
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 SIB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HOW 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 reported? Yes LJ No
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Permit Date 10/1/2015-9/3012020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 0k51
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 SIB 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 reported?
Yes ❑
No ❑
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Permit Date 1011/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. N0002 025111
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 0 3- 0 t- Z I
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 10/1/2015 — 913012020
Last Revised 10-2-2015