NCG140012_DMR SW_20220329

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2021
Report ALL STORMWATER monitoring data on this form (include "No FloviVi Discharge'and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14 ] 00 1❑ 2❑
Facility Name: Mount airy
County: Surry
Phone Number: 3( 36 )9a3-21s1 Total no. of SDOs monitored 1
Certified Laboratory Prism Lab Lab# 402
Lab #
Stormwater Discharge Outfall (SDO) No. 001 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?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Non-polar OSG
Total (EPA Method New Motor Oil
Outfall No. Total Rainfall, Suspended pH, 1664 (SGT-HEM)), Usage (gal/mo.)
inches Solids (TSS), SU mg/I (VMA) Irapplicable
m /I Irapplicable
Circle Benchmark
Stormwater
Indcale NO FLOWd 100/50 6.0-9.0 15 >55 gallmo.average reg Wres T55 and
Benchmarks applicable Non-polar O&G monitoring
Date Sample
Collected,
mo/ddtyr
302021 NO FLOW
5/10/2021 NO FLOW ,A
9/1/2021 NO FLOW
12/1/2021 NO FLOW
Permit Date 8/1/2017-6/30/2022
Last Revised 8-22-2015

•, r
Certificate of Coverage No. NCG14 EIKIEIIF2�
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 informs ion, including the possibility of fines and imprisonment for knowing violations."
[Required by 40 CFR§122.2
Signature
Date n xVx'
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 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017—6/3012022
Last Revised 8-22-2015