NCG140050_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 Flow"/"No Discharge"and Benchmark
Exceedances)from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14 0❑ 0❑Ffl 0❑
Facility Name: Shelby
County: Cleveland
Phone Number: 70( 4 )529-6364 Total no. of SDOs monitored 1
Certified Laboratory WaypointAnalytical Lab# 402
Lab#
Stormwater Discharge Outfall (SDO) No. 001 VMA Outfali? Yes ❑ No ❑✓
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑s
Was this outfall ever in Tier 2 during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency 0
Yes, received approval from DEMLR to reduce monitoring frequency 0
Other ❑
Non-polar O&G
Total (EPA Method New Motor Oil
Total Rainfall Suspended pH, 1664 Usage allmo.
Outfall No. (SGT-HEM)), 9 19 )
inches Solids (TSS), SU mgll (VMA) If applicable
m /l nappbcabin
Stormwater Circle Benchmvk
lod@atc NO FLOWif 100/50 6.0-9.0 15 >55 g ainno.avcngc rrqulrcc TSG and
Benchmarks applicable Non-polar 06G lnon tonng
Date Sample
Collected,
mo/ddl r 72/17/2021 NO FLOW U
6/22/2021 NO FLOW
L FtL
E S"
9/10/2021 NO FLOW ION
1 2/1 412 0 21 NO FLOW
Permit Date 811/2017—6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 ] ] 510[]
CERTIFICATION
"1 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, i luding the possibility of fines and imprisonment for knowing violations."
[Required by 40 CFR§122.22
Signature
Date
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 811/2017—6/30/2022
Last Revised 8-22-2015