NCG020030 DMR WW

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year a 0 1 S
"Report ALL WASTEWATER monitoring data on this form (include "No FlovVT'No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02
Facility Name: K n; ahthle- Uorr i
County:
Phone Number: (III Total no. of outfall
Certified Laboratory Lab # AWQ-96 11
Lab #
Wastewater (WW) Discharge Outfall No. 01
pWR Sty t ,_
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No [0
Does this outfall discharge WW to SA waters?
Yes ❑
No F✓
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No 0
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No 52J
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 0
Were there any limit violations in the calendar year?
Yes ❑
No [Z
Fecal
Outfall No: Daily -Flow pH,. TSS; SS,: Discharge Upstream Downstream Coliform,
Rate, cfs SU mg/I mVI Turbidity, (U)`Turbidity, (D) Turbidity, col/100 ml
01, Ifapplicable NTU NTU NTU SA
Industrial Sand
HQW or ORW freshwater 25/45 How, ORw,
Effluent 50% of 6.0-9.0 HQW or ORW SA, se, PNA, No Limit N/A N/A
Limitations 7Q40 saltwater 20/30 or any Trout Circle Water Water Quality Water Quality N/A
6.8-8.5 HOW or ORIN 0.1 /0.2 Quality Standard Standard applies Standard applies
at applies:
Mo. Ave / Daily Max. Indicate NO FLOW and Tr or PNA 25/10
if applicable 10/15
Date Sample
Collected,'
mo/dd/yr
U3 09 0.179 7.1 1 g,. 40.1 1
0z S 0. S S co < .C; 1
D I 3S3 <
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®®©❑0
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 §122.22]
Signature t U I
Date a gTI C
I
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 10/1/2015 — 9/30/2020
Last Revised 10-2-2015