NCG060390_DMR_20210104

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Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N_ICI I l l l l l l or
Facility Name: , kc
County:
Inspector:
Date of Inspection: d
Time of Inspection: TS �ty✓
Total Event Precipitation (inches):
ficate(of Coverage Np.: N/C/d /& /0/217 Ito
Phone No.
-7+ S 7 3-7
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signatures I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
1. Outfall Description:
Outfall No. t✓d
Receiving Stream:
Structure (pipe, ditch, etc.): tic 414i
Page 1 of 2
SWU-242, Last modified 06101/2019

2. Color: Describe the color of
(Iight, medium, dark) as descriptors: _
3. Odor: Describe
chlorine odor, etc.):
basic colors (red, brown, blue, etc.) and tint
distinpt odors that the discharge may have (i.e., smells strongly of oil, weak
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
jl 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 V' 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
G) 2 3 4 5
7.
8.
9.
Is there any foam in the stormwater discharge? O Yes W/No.
Is there an oil sheen in the stormwater discharge? 0Yes 4(No.
Is there evidence of erosion or deposition at the outfall? O Yes W No.
10. Other Obvious Indicators of Stormwater Pollution: I_
List and describe ;V,
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

CERTIFICATE OF
FACILITY NAME,
COUNTY P�
PERSON COLLEC
LABORATORY C
��
STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
`Z Cr r,
Gaf Cob
Part A: Stormwater Benchmarks and Monitorine Results
Date submitted V-1/ a6�I
SAMPLE COLLECTION YEAR RG, .L
SAMPLE PERIOD ❑ Jan -June [July -Dec
or ❑ Monthly$ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA❑✓ Other C c=:Jlylf✓1 S_LJ rAC
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall' ,_7 or n No discharae this period'
Outfall No.
Date Sample
Collected, mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform,
Colonies per 100 ml
Enterococci,
Colonies per 100 ml
Benchmark
-
100 or 501
Within 6.0 — 9.0
120
30
1000E
S001
Parameter Code
-
C0530
00400
00340
00556
31616
61211
" .�,n.
0f, q
Ll
1 Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes [�no (if yes, complete Part Bj
Permit Date: 11/1/2018-05/31/2021 SWU-249, Last Revised 11/5/2018
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Date Sample Collected
(mo/dd/yr)
24-hour rainfall amount,
Inches'
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/Total
Petroleum hydrocarbons
Total Suspended Solids
Benchmarks
-
-
-
15 mg/L
100 mg/L or 50 mg/L4
Parameter Code
-
46529
NCOIL
00552
C0530
Footnotes from Part A also apply to Part B
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copV of this DMR including all "No Discharge" reports, within 30 days of recei t of the lab results or at end of monitoring period in the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 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. I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations,"
Signature of Perm
1 �z(
Date
Permit Date: 11/1/2018-05/31/2021 5WU-249, Last Revised 11/5/2018
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) 1 SPPP Annual Update DATA REVIEW FORM
Calendar Year o?6a0
Individual NPDES Permit No. N
Certificate of Coverage (COC) No. NCG
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: 5 i1't^�= &_41 MeQ6 ca
County: r1
Phone Number: (q[� - 57 (51 Total no. of SDOs monitored �-
Outfall No. 17
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes [ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No d
Total
Rainfall,
inches
Parameter, (units)
15j
lM L_
p
!
'i1�lldo��
COO
/
h
G = i ir7G
N1
(� V i
� 1�1�r�n
(0� Ilr I OfAl
1 -
e�
Benchmark
N/A
160
(Z • Q -q , v
I;Z Tj
�j Q
1000
Date Sample
Collected,
mmlddlyy
{
ace
t
iI
-7
30
L
S 20
ti
IS,
(,,1
,rr
.d M
AVAC)
1
c
, t
(y111L
< L
1 2d
1, 2
Srn L
,`7
06W
Pr
i 3 d
7
I
6i=v,-<5
SWU-264 - Generic Annual DMR
Last revised 6/01/2018

" 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."
Signature
Date //4-121
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa. NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE
450 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone] _
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington. NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington. NC 28405-2845
[phone]
SWU-264 - Generic Annual DMR
Last revised 6/01/2018