NCG070232_2023 DMR_20231103 (2)

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG070000
Stone, Clay, Glass, &Concrete Products
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR) Upload form within
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCGO7 0232 Person Collecting Samples:J. Frei/SwSG
Facility Name:Powell's Septic Tank Laboratory Name:Pace Analytical, SwSG
Facility County: Halifax Laboratory Cert. No.:12, 633, 5054
Discharge during this period: ✓❑ Yes ❑No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?❑Yes ❑✓ No
If so,which Tier(I, II, or III)? n/a
A copy of this DMR has been uploaded electronically via https://edocs.deo.nc.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded: 11/03/2023
Analytical Monitoring Requirements for Vehicle&Equipment Areas—Benchmarks in(Red)
Parameter Parameter Outfall 001 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class C
N/A Date Sample Collected MM/DD/YYYY 10/20/2023
46529 24-Hour Rainfall in inches 0.17
C0530 TSS in mg/L(100 or 50*) <3.0
00552 Non-Polar Oil&Grease in mg/L <5.0
NCOIL Estimated New Motor/Hydraulic Oil <25
Usage in gal/month
Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HOW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of All other water classifications have a benchmark of 100 mg/L
Notes(optional):
"I certify by my signature below,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, • • urat d complete.I am aware that there are significant penalties for submitting
false information,including the possibility of fines d impri .n t for knowing violations."
•
James D.Frei
uo,U.a;�,,.45 CAS 11/03/2023
Signature of Permittee or Delegated Authori •. Individual Date
Email Address [e-mail] Phone Number 252-535-9717