NCG140329_DMR_20230103 (3)

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DM R) — WASTEWAI tK
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year o2 0 )-;--
*Report ALL WASTEWATER monitoring data on this form (include "No Flow"i'No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG 14 Fc-]EMI
Facility Name:
County: l4a19
Phone Number: ()-5-1) 37 -3; -3
Certified Laboratory M l cr0\0 o. t- Lab # _
Lab #
11
Total no. of outfalls monitored
Wastewater (WW) Discharge Outfall No. I
Does this outfall discharge WW to SA waters? Yes ❑ No [�
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No [EI'
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No a
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No Er
Were there any limit violations in the calendar year? Yes a' No ❑
Daily Flow Rate,
pH,
TSS,
SS,
Non -Polar O&G (EPA Method 1664
Outfall No.
cfs
SU
mg/I
ml/I
(SGT-HEM)), mg/1
if applicable
Standard
Effluent
HOW or ORW
50% of 7Q10
freshwater
6.0-9.0
30
HOW
HOW, ORW, SA,
SB, PNA, or any
No Limit
Limitations
i
Indicate NO FLOW if
saltwater
20
HOW I ORW and Tr, or
Trout
5
Samples above Benchmark
subject to Tiered Responses
applicable
6.8-8.5
PNA
15
Daily Maximum
10
Date
Sample
Collected,
mo/ddl r
o� 0-1 )
3. S
3 .-I
< `+.8'3
3o 2
O Lo ►,�
n�
y
3- 7. ot
<o. I o
4.7 Li
:I
Permit Date 8/1/2017 - 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No. NCG14 FMP-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 40 CFR
Signature
Date 01 /D;
Mail Annual Summary Wastewater 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 — 6/30/2022
Last Revised 8-22-2017