NCG020155 DMR SW (3)

ANNUAL SUMMARY DMR - STORMWATER
SEND TO CENTRAL OFFICE * I
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL STORMWATER Monitoring Data on this form(including No Flow and No Discharge and Permit Limit Violations)by MARCH 1 of each year.
CERTIFICATE OF COVERAGE NO.'NTCGO2140' :Sri,S. SAMPLE COLLECTION YEAR: o?O t Co
FACILITY NAME: 5he1t 000.ey-./ COUNTY C-0.5we I(
PERSON COLLECTING SAMPLES 5p.wiwnky PHONE NO. (33G ) 3S-5613
CERTIFIED LABORATORYgSeo,ra,•lf y{ies 'Lab#1,t)C43471 ADD TO LISTERVE?YES LINO 0 EMAIL: roSQ (emtcpvD.L
Lab#A)C41t 37701 TOTAL RAINFALL: 3579' INCHES
EVENT DURATION: 76720 MINUTES
Part A: Stormwater Monitoring Requirements
Date Sample In Tier 2
it of Months in
Collected Monthly Total Suspended 4
Outfall No. Tier 2 Total Flow TurbiditySettleable Solids
(mo/dd/yr OR Monitoring? 2 Solids
NO FLOW)1 (y/n) Sampling (MG) (mg/1) (NTU) (mI/I)
- - - - - 1003'4 See Footnote3'5 0.13
00a /,2/6//c, in --- ,6/0 S. 8 ay 2 <o. r
Psi %
. gQED
JAN 17 2017
CF"ltiITP?L FILES
DWR SECION
IC7N
' 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 iange
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/l.
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,du ectly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-19-10
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Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using>55 gal of new motor oil/month on average
Date Sample In Tier 2 New Motor Oil Total Flow . TPH using Total Suspended pH,
Outfall Collected Monthly #of Months Usage (MG) method 1664A Solids, (Standard
No. in Tier 2
(mo/dd/yr OR Monitoring? Sam lin 2 (gal/month) SGT-HEM (mg/I) Units)
NO FLOW) (yin) p g (mg/I)
- - 153 1003 6-93
icy-oG/ 12/4,/1(, rt /oo ,23.2'7 <S .4.5-- 4.. 7 8
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEENDENCES
AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO Q'
HAVE YOU CONTACTED THE REGION? YES ❑ NO❑
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY(INCLUDING ALL "NO FLOW","NO DISCHARGE" &LIMIT
VIOLATIONS)BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh,North Carolina 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
violatio s."
011/(7
(Sign tore of Per ittee) (D te)
Permit Date. 1/1/2010-12/31/2014 Last Revised 01-19-10
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