NCG140478_DMR_20210712

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2021
'Report ALL WASTEWATER monitoring data on this form (include "No FlowT'No Discharge' and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14
Facility Name: LANE TEMPORARY BATCH PLANT-STATESVILLE
County: [RED IREDELL
Phone Number: 70( ° ) a36-6s30 Total no. of outfalls monitored
Certified Laboratory Statesville Analytical Lab # DW 37755
Lab #
Wastewater (WW) Discharge Outfall No. 1
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 jr) designated waters? Yes❑ No❑✓
Were there any limit violations in the calendar year? Yes ❑ No ❑✓
Outfall No.
Daily Flow Rate,
cfs
pH,
SU
TSS,
mg/I
SS,
ml/I
11'appncable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mg/I
Effluent
Limitations
Daily Maximum
HOW or ORW
50%of7Q10
Indlcap NOFLOWsallwaiar
applicable
freshwater
6.0-9.0
c 8-0 5
V O O
Standard
30
HOW
20
HOW l O PNand Tr, or
10
HOW. OR. SA
58,PNA,orany
Trout
5
No Limit
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
Collected,
mo/dd/ r
6/3012021
NO FLOW
RECEVr
L 26 ZUZI
Permit Date 81112017 — 6130/2022
Last Revised 8-22-2017

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Certificate of Coverage No. NCG 14 K]K]E]K]
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 KeyhJ. -
�—°�--�--�
Date 7/12/21
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 — 6130/2022
Last Revised 8-22-2017

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