NCG020048_DMR_20220315

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year ci a
•Report ALL STORMWATER monitoring data on this form(include"No Flow"/"No Discharge and Benchmark
Exceedances)from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 ❑�©
Facility Name: IAry
County: 22W4"1 _
Phone Number: Q[ )(,jto 7� _ Total no. of SDOs monitored
Certified Laboratory Lab#
Lab#
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No❑
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No
Was this outfall ever in Tier 2 during the past year? Yes❑ No
If this outfall was in Tier 2 last year,was monthly monitoring discontinued? �e Rg,j�
Yes,enough consecutive samples below benchmarks to decrease frequency ❑ REc P
Yes, received approval from DEMLR to reduce monitoring frequency ❑ APR 0 A 2022
No,turbidity benchmark exceedances did not require monthly monitoring ❑
FILES
Other ElCEN'Tht nWR AL
Upstream Downstream New
Total TSS, SS, Turbidity, (U)Turbidity, (D) Turbidity, Non-polar Motor Oil
Outfall No. Rainfall, mg/1 ml/I NTU NTU NTU O$G, mg/1 Usage
inches (VMA) (9 al/mo.
Stormwater Circle circle N/A N/A >55ga°aro.
Indicate NO Benchmark Benchmark a ge requires
Benchmarks
FLOW11 Water Quality Water Quality TSS and Nanpolar
applicable 100/50 0.1 50/25/10 S 15 tantlartl applies Standard applies Osc monitoring
Date Sample
Collected,
moldd/yr
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

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Certificate of Coverage No. NCG02 I L' ©I�
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 4,0CF�R§122.221
Signature
Date / a
Mail Annual Summary Stormwater 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 2 7 699-1 61 7
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

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