NCG140288_DMR_20210224

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR)— WAS T EVWQk7EFz
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year ZnZY)
'Report ALL WASTEWATER monitoring data on this form (include No Flow"PNo 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:
County:
Phone Number. QL
Certified Laboratory
Total no. of outfalls monitored Ob
Lab#y
Lab #
Wastewater (WW) Discharge Outfall No. on 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, 7010 n available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No
Were there any limit violations in the calendar year? Yes ❑ No
Outfail No.
Daily Flow Rate,
cfs
pH,
SU
TSS,
mg/l
SS,
mill
v
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgfl
Effluent
Limitations
Davyxaavman
% `s
50of 7Q10
b,cysaav No PLOWS
applicable
ramr
6.0-9.0
a,Hwamr
6.8.8.6
sr rd
30
How
20
Howl OM 09Tr. or
10
HGW, oRw. SR,
se.PNaerwn
Trout
5
No Limit
Samples more Renchma,k
cobjeetb 5Responses
Date
Sample
Collected,
mo/ddl r
L
3
L,
CENE
L , Ito
DWR SE
Permit Date 8/1/2017 — 6130/2022
Last Revised 8-22-2017
VEID
2021
'ILES
FION

Certificate of Coverage No. NCG14 FQIMEE
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
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 — W30/2022
Last Revised 8-22-2017

v