NCG140478_DMR_20210405

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 Flow'/"No Discharge' and Limit Violations) from
the orevious calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG 14 0® 7 1
Facility Name: -
County: IRED
Phone Number:
LANE TEMPORARY BATCH PLANT-STATESVILLE
IREDELL
704 � 838-6930
Certified Laboratory Statesville Analytical
Total no. of outfalls monitored t
Lab # DW 37755
Lab #
Wastewater (WW) Discharge Outfall No. t
Does this outfall discharge WW to SA waters? Yes ❑ No0
Does this outfall discharge WW to SIB or PNAwaters? Yes ❑ No0
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No Q
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[:] No0
Were there any limit violations in the calendar year? Yes ❑ No Q
Outfall No.
Daily Flow Rate,
cfs
pH,
SU
TSS,
mg/I
SS,
ml/I
ifapplicable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mg/l
Effluent
Limitations
Dolly Maximum
HOW or ORIN
50%of7Q10
Indicate NO FLOW if
applicable
freshwater
6.0-9.0
saltwater
c O-8.5
V O O J
Standard
30
HOW
20
HOW /O PNA ntl Tr, or
10
HOW, ORW, SA,
S8,PNA,orany
Trout
5
No Limit
Samples above Benchmark
subject to Ti15tl Responses
J
Date
Sample
Collected,
mo/dd/ r
3/31/2021
NO FLOW
o.
n 2. 4,
1 L
DENR-LAND Q ALITf
STORA4N = tll
Permit Date 8/112017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No. NCG14 1KI 7❑V
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 4/5/2021
Kevin J. Sifford
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 — 6/30/2022
Last Revised 8-22-2017