NCG020285 DMR SW (3)

. V ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
,SUBMIT TO CENTRAL OF _t r
General Permit No. NCG020000
Calendar Year
Certificate of Coverage No. N0002
Facility Name: �y �f r_L !r e w, t' A .iky.
County: ice=
Phone Number: (�'-� =f '� Total no. of SDOs monitored %
Certified Laboratory Lab #
Lab #
Stormwater Discharge Outfall (SDO) No. % VMA Outfall?
Yes ❑ No
Is this outfall currently in Tier 2 for any parameter?
Yes ❑ No L
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
❑
Yes, received approval from DEMLR to reduce monitoring frequency
❑
No, turbidity benchmark exceedances did not require monthly monitoring
❑
Other
❑
Outfall No.
Total TSS,
Rainfall, mgt .
inches
Upstream
SS, Turbidity, (U) Turbidity,
mill... NTU NTU
Downstream New
(D) Turbidity, Non -polar Motor Oil
NTU _. ;. 'i m9... Usage
(VMA)' , .' al/mos
$formWaLer
Benchmarks
Date Sample
Collected,
molddlyrEL
NIA : '. NIA : >ss PUM.
motwc. xo a w��r�,. eencmma_ �mee eau res
FLOW!/ Wafer Quality. VYater Ouardy:. 15: TSS and Nonyolar
u„e 1001,15+0 01 50/251.1 sca.waa �P standa d as ofa ora wnfom
f 13M4� r�As
f C yR H
,xit ,� r,q
p� „
Z7 V
Permit Date 101112016 — 9/3012020
Last Revised 10-2-2015
CI V E®
JAN 08 ZU16
SAL FILES
SECTION

. r Certificate of Coverage No. NCG0251MJZ
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 .22] /
Signature
Date
—TSL -
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 10/112015 - 913012020
Last Revised 10-2-2015