NCG020274 DMR WW (2)

I
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year zd) S
*Report ALL WASTEWATER monitoring data on this form (include "No Flow'T'No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year
Certificate of Coverage No. NCG020274
s')f)1ffj--WIsClog tv
Facility Name. 5 y 1, 11 rvS L(/i e I" r•1 -n) RECTI
County, er t, I MAR 21 ?016
Phone Number ( ) 91 Ly, Iq (�� i3 Total no. of outfalls mons ored
Certified Laboratory ,fr_ T� CENTRAL, FILES Lab # pWR 0ECTION
Lab #
Wastewater (WW) Discharge Outfall No. t1k/ A4 2 -
Daily Flow
Rate, cfs
pH,
SU
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑
Does this outfall discharge WW to S13 or PWk waters?
Yes ❑
No ❑
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No ❑
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 ❑
Were there any limit violations in the calendar year?
Yes ❑
No ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mg/I
SS,
ml/I
ifapplicable
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
col/100 ml
(SA)
Effluent
Limitations
Mo Ave 1 Daily Max
HQW or ORIN
50% of
7Q10
Indicate NO FLOW
if appbcable
freshwater
6.0-9.0
saltwater
6.8-8.5
Industrial Sand
25/45
HQW or ORIN
20/30
HQW or ORW
and Tr or PNA
10/15
HQW, ORIN,
SA, SB, PNA,
or any Trout
0.1/0.2
No Limit
Circle Water
Quality Standard
that applies
50/25/10
N/A
Water Quality
Standard applies
N/A
Water Quality
Standard applies
N/A
Date Sample
Collected,
mo/dd/ r
Zo-- 2-)
V, UJ7
7f7,4f
Permit Date 10/1/2015 - 9/30/2020
Revised 11-16-2015 for Additional Monitoring Specific to this COC

Certificate of Coverage No.
Outfall No.
`0117d up- '
Total Al,
mg/l
Total Cu,
mg/i
Total Pb,
mg/I
Total Ni,
mg/I
Total Zn,
mg/I
Total
Chloride,
mg/I
Total Total
Fluoride, Hardness,
mg/l mg/I
Effluent
Limitations
N/A
N/A
N/A
N/A
N/A
N/A
N/A N/A
Date Sample
Collected,
mo/dd/yr
a
.
Permit Date 10/1/2015 — 9/30/2020
Revised 11-16-2015 for Additional Monitoring Specific to this COC

Certificate of Coverage No. nICCZQ:2 Q�.�
Additional Outfall Attachment (make copies as needed for additional outfalls) iV Gt (J �zS�d
Wastewater (WW) Discharge Outfall No. SW DO
Daily Flow
Rate, cfs
pH,
SU
Is this an industrial sand mine (See 40 CFR §436 Subpart D)?
Yes ❑
No ❑
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No ❑
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout jr) designated waters?
Yes ❑
No ❑
Were there any limit violations in the calendar year reported?
Yes ❑
No ❑
Outfall No.
Daily Flow
Rate, cfs
pH,
SU
TSS,
mg/1
SS,
ml/I
if applicable
Discharge
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Fecal
Coliform,
col/100 ml
(SA)
Effluent
Limitations
Mo Ave / Daily Max
HQW or ORW
50% of
7Q10
/ndtcate NO FLOW
�f applicable
freshwater
6.0-9.0
saltwater
6.8-8.5
Industrial Sand
25/45
HQW or ORW
20/30
HQW or ORW
and Tr or PNA
10/15
HQW, ORW,
SA, SB, PNA,
or any Trout
0.1/0.2
No Limit
Circle Water
Quality Standard
that applies•
50/25/10
N/A
Water Quality
Standard applies
N/A
Water Quality
Standard applies
N/A
Date Sample
Collected,
mo/dd/ r�
Y
-LL'-12-
Q,,007
7,
Gut
Permit Date 10/1/2015 — 9/30/2020
Revised 11-16-2015 for Additional Monitonng Specific to this COC

Certificate of Coverage No
N6(40a02-rZ
Outfall No.
fik,�e
Total Al,
mg/l
Total Cu,
mg/l
Total Pb,
mg/l
Total Ni,
mg/l
Total Zn, Total
mg/I Chloride,
mg/I
Total
Fluoride,
mg/l
Total
Hardness,
mg/l
Effluent
Limitations
N/A
N/A
N/A
N/A
N/A N/A
N/A
N/A
Date Sample.
Collected,
mo/dd/yr
Permit Date 10/1/2015 — 9/30/2020
Revised 11-16-2015 for Additional Monitoring Specific to this COC

Certificate of Coverage No. Nr'��
CERTIFICATION' Z D 2-S6
"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 <�
Date 3
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files rs 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
Revised 11-16-2015 for Additional Monitoring Specific to this COC