NCG020869 DMR SW

I . ANNUAL SUMMARY DMR - STORMWATER 11
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
RECEIVE®
JUL 10 2015
CENTRAL FILES
DWR SECTION
*Report ALL STORMWATER Moritormg Data on thts form (tnclud.ing No Flow and No Discharge'and Perrtttt Ltmit Vlolafions) by MARCH 1 of eaclT veer.
CERTIFICATE OF COVERAGE NO. NCG02_ $ 46 SAMPLE CgLECTION YEAR:v�'�
FACILITY NAME: 0.v^ = M �i +�o�( COUNTY / "1 y
PERSON COLLECTING SAMPLES 0. v M PHONE NO. ��) DQ '
CERTIFIED LABORATORY Lab # ADD TO LISTSERVE? YES ❑ NO ❑ EMAIL:
Lab #
Part A: Stormwater Monitoring Reauirements
:�:,'.. r _..�..7';
.. �
f i)ate-Sam le
. �, P �
,y � � �,;a f' -s
, ; ..
Outfallr, ..Collected..tt,�
k t
No (mod yr ORS
:,_ .. . �. � s._, ,� ..,
.�..�
� , rI. ,s �„
- � �,�,�
fi
� ��vMonthl �. s •. ��;,
. Y , ..
,`. ._. ri+' .§�.... ,.:.;, .l�"."� .;,:,d <.:1.:
Y= <<
-Monrtorm - _
_._ :.;E--`A[x; :y>"��. ,_'Yi',-,.. ,w... .c .. t%,b-...�., u..,, �a.��i
M,r s:,:�" i ..: ;' <,S
,i r<..-.,.C'�.+a...g.� �,,.�a-
m,,,
�-� �,� `> , �r.,�-�,,
-'..rte �i .o
�
9M,._�.:� ,�:,-,�.� N
h-7gcra
To- al Flow: g , a
rE
.4'5 .:.:...5f,"�kr. d�� _ t. i�4'✓kt�,s"
„
9
`��
Turbtdtt Y �5�
"-
yg� 'Y q;-
Settleable ..
�.''b^x
.Event .
w4
i4 a"
N' �'*ra�T"" ��
O Q
Q
ll 1VV rLv W or 1VU L1Jl..riHKIJC, Enter --NU rLUw"' or "NU DISCHARGE" for each outfall here and the Date Range.
Z Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmarkaange
s 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.
a TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
s The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams,. lakes, and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/2014 Last Revised 0 1 -2 1 -1 1
Page 1 of 2

Part B: Vehicle Maintenance Activity Mo itoring Re uirements for facilities using > 55 gal of new motor oil/month on average
- - -
=Date Sam le f In:Tter.2z_.
Outfall a,' - :;:. _ ,:4.
::Collected � Monthl _x
..No ' Y
mo/dd% r.OR` .r Monttormg
k y
-. r-
.. NO�FLOW,) �'
044
3.,
;#:of'Months -„New_Motor.
-_z
m: Tter 2 '- :OilAUsa a .:'
�.. ..
Sampling (al/month)
� -
r b:.r "r
Total:Flow p ..TP:H usin” -method y
's
, , . 1VIG -1664A SGT FIEM .
,.,, �, a : � ., . `�`�`'
F r(m )
4 rte- -: +�'
..TotalRSus ended Naa -
s a
.Solids p Standard:; Rainfall r Duration ;
(m9 ) Untts) (iii) t (minutes)
i 3
'-9
� ,a>,.=a•�-M�..YY."'.�-„�%:•�I5
r..r, - 3 ,E'Y '` - 3 .'i•". �,` - -°,
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)?
HAVE YOU CONTACTED THE REGION?
WHO AT THE REGION HAVE YOU SPOKEN WITH?
YES ❑ NO
YES ❑ NO
MAIL ORIGINAL AND ONE COPY -OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ 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 submitting false information, including the possibility of fines and imprisonment for knowing
vinlationc_” ` '
(Signature of Permittee)
Permit Date: 1/1/2010-12/31/2014
_-?z7bs-
(Date).
Last Revised 0 1 -2 1 -11
Page 2 of 2