NCG140208_DMR SW_20220329

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR)— STORMWATER
II SUBMIT TO CENTRAL OFFICE* II
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
Facility Name: .
County: Iredell
Phone Number:
Statesville Plant
704 1529-6364
Total no. of SDOs monitored 1
Certified Laboratory Waypoint Analytical 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 I]
Yes, received approval from DEMLR to reduce monitoring frequency E3
Other ❑
Outfall No.
001
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m /I
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mg/1 (VMA)
If applicable
New Motor Oil
Usage (gal/mo.)
Irapplicable
stormwater
Benchmarks
Indicate NO FLOWrT
applicable
Circle Benchmark
100/50
6.0-9.0
15
>55 gallmo. average requires TSS and
Non -polar 0&G monitoring
Date Sample
Collected,
mo/dd/yr
2/9/2021
NO FLOW
REC
6/15/2021
NO FLOW
8/23/2021
NO FLOW
DWR
12/10/2021
NO FLOW
12/20/2021
NO FLOW
Permit Date 8M/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 ] 2❑ 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 §1
Signature
Date 14
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