NCG120042 DMR SW (6)

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES x❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES x❑ NO❑
REGIONAL OFFICE CONTACT NAME: Thom Edgerton
Mail an original and one copy of this DMR, including all "No Discharge"reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of"No Discharge"reports)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
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 aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
C jZ5-‘ Ill eAcp
(Signature of Permitt 11111 Dte
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised October 18,2012
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Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG120000
Date submitted Tµ(i 20
CERTIFICATE OF COVERAGE NO. NCG12 0 0 y SAMPLE COLLECTION YEAR P-0(
FACILITY NAME C, etk(( So c+-)asfe EQ.-1111i: SAMPLE PERIOD ❑Jan-June ❑July-Dec
COUNTY or jMonthly1 3 - - (month)
PERSON COLLECTING SAMPLES DISCHARGING TO CLASS ❑ORW [DHOW Trout ❑PNA
LABORATORY Lab Cert.# ❑Zero-flow ❑Water Supply OSA
Comments on sample collection or analysis: R.,Qther
PLEASE REMEMBER TO SIGN ON THE REVERSE -÷
Part A:Stormwater Benchmarks and Monitoring Results
r No discharge this period?'
Date Sample 24-hour rainfall
Outfall No. Collected) amount,
(mo/dd/yr) Inches3 Chemical Oxygen Demand Fecal Coliform Total Suspended Solids
Benchmarks===> - - 120 mg/L 1000 count per 100 mL 100 mg/L or 50 mg/L4
Soo —1-0-
Spo—
1 Monthly sampling(instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2
For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text,Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note:Results must be reported in numerical format. For example,do not report Below Detection Limit, BDL,<PQL, Non-detect, ND,or other similar non-
numerical format. When results are below the applicable limits,they must be reported in the format,"<XX mg/L",where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely,where fecal coliform results exceed the dilution upper limit, report the result as">XX".
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date:11/1/2012-10/31/2017 SWU-248,last revised 10/25/2012
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