NCG020007 DMR SW (3)

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ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year 2 01g-
*Report ALL STORMWATER monitoring data on this form (include"No Flow"/"No Discharge"and Benchmark
Exceedances)from the previous calendar year to the DEQ by.MARCH 1 of each year.
I P' - E-1-1\ibIi
Certificate of Coverage No. NC G02=.n®Qf
JAN 11 2016
Facility Name: (.A, ,nk_oh (/�cr p, - (LltaSsn _
DWR iIONo
County: � �
� �^� SECTION
� �.
Phone Number: (6110 ) S.2-4 I I (0 Total no. of SDOs monitored —
Certified Laboratory Lab#
Lab#
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No'Zi
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑
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 0
Yes, received approval from DEMLR to reduce monitoring frequency 0
No,turbidity benchmark exceedances did not require monthly monitoring 0
Other 0
- - - - -Upstream Downstream - - , New
Outfall No. . Total - ' TSS, SS, Turbidity, (U) Turbidity, ,(D) Turbidity, Non-polar Motor Oil
Rainfall, mg/f .. min_ NTU NTU NTU O&G, mg/I Usage
inches - WMA) (gal/mo.)
Circle Circle N/A N/A >55 gal/mo.
Stormwater
Indicate NO Benchmark Benchmark average requires
Benchmarks FLOW/f 100/50 0.1 50/25/10 Waater Quality Water Quality 15 TSS and Non-polar
applicable Standard applies Standard applies 08G monitonng
_Date.Sample ': ---,-, 11.,--,--„- -`,, -- _ ', - -;, �.. ,- ,- I- ---- -• _- --_ — , - r`:
Collected, - vh= - _ �, 1!_' 'IL _ - - , �-{. lI - `` ' ,
m o/d d/yr' r"� - - . .-- ' `,I- i�,. -�= -_fit . .1_� __ ., i- - !'-- i i __
44 t0 O ,..(1 S /J-fl- P r - .} ,..tom 2 c t<c .�,i,�ti 2o-c
/L1 a n (FA/ /c ,/�' O �` 3 � -¢-� .)r 6�•�.�tr",D i..;
4 1 r 3� /( 1&( L ( ( k 4\ .�
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

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Certificate of Coverage No. NCGO2
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑
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 0
No,turbidity benchmark exceedances did not require monthly monitoring 0
Other 0
Upstream ' 'Downstream New -
Outfall.No. Total -TSS, SS,- ' Turbidity, (U) Turbidity, (D) Turbidity, Non-polar Motor Oil
Rainfall, mo -ml/l NTU NTU NTU O&G,,mg/I Usage
inches (VMA) (gal/mo.)
Stormwater Circle Circle N/A N/A >55 gal/mo.
Indicate NO Benchmark Benchmark average requires
Benchmarks FLOWif 100/50 0.1 50/25/10 WaterQualty Water Quality
Standard applies 15 TSS and Non-polar
applicable Standard applies 08G monitonng
Date Sample ,�1: ... ,.. - I' i, r . •
Collected, !-6 _ ll: _ ��_ 3 ,, `� I
mo/dd/yr
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

•
Certificate of Coverage No. NCGO2 T©a
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No
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 0
No,turbidity benchmark exceedances did not require monthly monitoring 0
Other ❑
Upstream Downstream `. : New
Outfall;No.-
Total - TSS _ ' SS Turbidity; (U) Turbidity,, "(D)"Turbidity, Non-polar -Motor
,:Rainfall, mgll = ml/I =NTU _ NTU. `- _` NTU =0&G`, m"g/I' ,Usage
_.inchesw,_ _ - (VMA)." : (gal/mo:)
Circle Circle N/A N/A >55 gallmo.
Stormwater
Indicate NO Benchmark Benchmark average requires
Benchmarks FLOW,f 100/50 0.1 50/25/10 WaaterQuality Water Quality 15 TSS and Non-polar
applicable Standard applies Standard applies 0&G monitoring
,�f' '3r UP
s PS
�':" .a +� A; 5 l = 4. �` °_' r
��,_��. _ ..�_� , u.�.t�: ��.,, _,.amu__m_. . ,�r�.�..
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCGO2 ®®®a
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 f-Isv 'nformation includi • the possibility of fines and imprisonment for knowing violations."
(Required by 41 IF-§122.2_; 9'
Signatur- ""
Date ! , ! /
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 10/1/2015—9/30/2020
Last Revised 10-2-2015