NCG020310 DMR SW

ANNUAL SUMMARY DMR - STORMWATER
SEND TO CENTRAL OFFICE
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
4 DR Is 2016
ON
WF0RMADAIR T10fq Ppn�ro
"Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 of each year. I
CERTIFICATE OF COVERAG NO. NCG02t9 a _L ® SAMPLE COLLECTION YEAR: 90)!5 y�G�
FACILITY NAME: COUNTY %O �4
PRONE 10.( � 7
PERSON COLLECTING SAMPLES � � ADD TO LISTSE VE? YES ❑ NO ❑ EMAIL:
CERTIFIED LABORATORXS U ice' Lab # D
Lab #,-32 2
Part A: Stormwater Monitorine Requirements jydACVWT
Date Sample
Outfall Collected
No, (mo/dd/yr OR
NO FLOW)1
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in
Tier 2
z
Sampling
Total Flow
(MG)
Total Suspended
Solids
(mg/1)
Turbidit a
y
(NTU)
Total Event
Settleable Rainfall Duration
Solids (ml/1) (in) (minutes)
- -
-
-
-
1003,4
See Footnote 3,5
C7
0.1
< I
Q �
— _
l y
'If "NO FLOW' or `NO DISCHARGE, Enter "NO FLOW' or "NO DISCHARGE" for each outfall here and the Date Range.
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 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.
4 TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/1.
5 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 01-21-11
Page 1 of 2

Part R: Vehicle Maintenance Activitv Monitoring Rennirements for facilities using > 55 gal of new motor oillmonth on average
Date Sample
Outfall Collected
No. (mo/d '
NO FLOW)'-
In Tier 2
Monthly # of.Months
in Tier 2 _
Monitoring? Sampling'
(y/n)
New Motor'
Oil Usage
al/month)
Total Flow '
(MG)
TPH using method
1664A SGT -HEM
(m
Total Suspended pH Total Event
Solids (Standard Rainfall Duration
(mg/1) Units (in) (minutes)
_
153
1003 6-93
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 �J
YES ❑ NO
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH l 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 awar that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
viol is . '
-J L-4,
(Sig re of Permittee) (Date)
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-21-11
Page 2 of 2