NCG140032_DMR_20230106

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14 L G 3 :1SAMPLE COLLECTION YEAR:_ z
FACILITY NAME: pe,• _ SAMPLING PERIOD: [K July-December ❑January June
SAMPLE COLLECTOR: Kile I COUNTY St- Ati
CERTIFIED LABORATOR Lab# c- PHONE NO.(' )
Lab# ADD TO LISTSERVE?AYES [:]NO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: []SA ❑HQW ❑PNA QTrout Other
Part A:Stormwater Monitoring Requirements
Date Sample
Outfall No.
Collected pH TSS Total 4 In Tier 2 #of Months in Tier 2
(mm/dd/yr OR
(Standard Units) (mg/L) Rainfall Monthly Monitoring?
NO FLOW)'
(in) (y/n) Sampling'
6-91 10023 - -
I 9,40 4 NJ
7 ��
'If"NO FLOW"or"NO DISCHARGE, Enter"NO FLOW"or"NO DISCHARGE"for each outfall here.Please make sure to mark the sample period above.
z If a value is in excess of the benchmark,or outside the benchmark range(for pH),you must implement the Tier 1 or Tier 2 responses in the General Permit.Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
s TSS benchmark values are 100 mg/I,except when discharging to ORW,HQW,Trout,and PNA waters where they are 50 mg/I.
4Foreach sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge.
Permit Date:8/1/2017-6/30/2022 Last Revised 07/27/17
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Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using>55 gal of new motor oil/month—averaged over a calendar year.
Non-Polar Total In Tier 2
pH Oil&Grease using Suspended Total New Motor Oil Usage Monthly #of Months in Tier 2
Outfall Date Sample (Standard method 1664 Solids Rainfall'
No. Collected (gal/month) Monitoring? Sampling
Units) SGT-HEM (in)
(mo/dd/Yr)1 (mg/L) (mg/L} (V/n)
6-92 152 100z3 - - - -
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES [:]NO
HAVE YOU CONTACTED THE REGION? YES ❑NO❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR(including all"No Flow"&"No Discharge" reports)within 30 days of receipt of sample(or at end of monitoring period in
case of"No Flow")to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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 ignifi ant oer1*'e for submitting false information,including the possibility of fines and imprisonment for knowing violations."
(Signature of Pe ittee) (Date)
Permit Date:8/1/2017-6/30/2022 Last Revised 07/27/17
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PROCESS WASTEWATER —Semi-Annual Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG146 0 SAMPLE COLLECTION YEAR: oZCi,Z
FACILITY NAME: — SAMPLE PERIOD: [July-December []January-June
SAMPLE COLLECTOR: COUNTY: .5 K nj v
CERTIFIED LABORATORY: Lab# PHONE NO.:CAU �f is- 6-&IS
Lab# ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
LIMIT VIOLATIONS? YES ❑ NO F)(� DISCHARGING TO CLASS: []SA ❑HQW ❑PNA ❑Trout ®Other. C_
OPTIONAL INFO:
Part A:Wastewater Monitoring Requirements
Non-Polar
Date Sample Total Suspended Settleable Oil&Grease Discharge
Outfall No. Collected' Type , Wastewater nd Solids Solids using method Duration Total Flow
(mm/dd/yr) (VE,RM,MD)z (standard) (mg/L) (mVQ 16645GT--HEM6 (minutes) (gallons/day)'
(mg/0
6-93,4 303,5 53 (15)6
'If wastewater systems have not discharged in this quarter—report"No Flow"or"No Discharge'here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here:Vehicle and Equipment Cleaning(VE), Raw Material Stockpiles(RM), Mixing Drum
Cleanout(MD). Report more than one type if the waste-stream is commingled.
3If an effluent limit is exceeded twice in a row,the permittee is required to institute monthly monitoring for that parameter for six months,unless DEMLR RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U.for wastewater discharges to freshwaters,and 6.8-8.5 S.U.for discharges to saltwaters.
Permit Date:8/1/2017-06/30/2022 Last Revised 07/27/17
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5 TSS limits are 20 mg/L for wastewater discharges to HQW waters,10 mg/L for Trout and PNA waters,and 30 mg/L for all other water classifications.
6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas.TPH does not have a limit for wastewater,but
instead is subject to benchmarks and provisions of Part IV,Section A,including the Tiered Response Action.
7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall beset to 50%of the Summer 70,10 Flow as per 15A N CAC
02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR.If the permittee cannot obtain a
Summer 7Q10 flow for the receiving waters at the discharge location,the permittee shall notify DEMLR,and the DEMLR Regional Office may require an annual flow report on
a case-by-case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY(INCLUDING ALL"NO FLOW" "NO DISCHARGE")WITHIN 30 DAYS OF RECEIPT OF SAMPLE(OR AT END
OF MONITORING PERIOD IN CASE OF"NO FLOW")TO:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED.-
"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 submittin Ise information,including the possibility of fines and imprisonment for knowing violations."
I�
c, �Q
(signature of ermittee) (Date)
Permit Date:8/1/2017-06/30/2022 Last Revised 07/27/17
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