NCG020204_DMR WW_20210216

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year CEO
-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. NCG02
Facility Name:
County: _ `1>avid5otn___Aj —
Phone Number. CS-1 D 380 -� �y 6 Total no. of outfalls monitored
Certified Laboratory Bmce nalyti Sd
ec ;cC, lab# 33 en
h " r —Lab # I a - Chcsja-Ne
Wastewater (WIN) Discharge Outfall No. P10 I
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No (K
Does this outfall discharge WW to SA waters?
Yes ❑
No19
Does this outfall discharge W W to SB or PNA waters?
Yes ❑
No 10
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No m
If so, what is the 7010 flow rate? or Tidally Influenced waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes ❑
No iA
Were there any Iimft violations In the calendar
Yes ❑ No
Outfall No.
001
Dail Flow
y
Rate, cis
pH,
SU
TSS,
mg/l
SS,
mul
Discha rge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
col/100 ml
SA
Effluent
Limitations
Ma Ave/WyMm
MOW or ORW
50% of
7Q10
^ UNN
freehveter
6.0-9.0
salt e r
6.8.8.E
w miftw
26/46
NOWOroRw
20/30
HoworoRw
MdrrorPNA
10/16
HOW, oRW,
"'"yTm"
0.1/0.2
No Limit
mk rft�
�e�
50/26J10
WA
W&
'�'•
NIA
10 �
s"n0ir =
WA
Date Sample
Collected,
mo/d r
0.3 :5
e
r`
t
ILEu
N o
i s
o-s
a co
SS
the c$¢
re r\
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 QO ®OQ©
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]
Sign,
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 10/112016 — 9/30/2020
Last Revised 10-2-2015