Central Ave Apts_Receptor Form - 5-7-2015

Page 1 of 5
Rev. 06/05/02
General Instructions
1.)
2.)
3.)
Site:DPJ Residential, LLC
Address:1931 - 2027 Central Avenue
City:Charlotte
County:Mecklenburg
Section 1 - Property Characteristics
Former gas station, auto repair & maintenance
Multi-family Residential
10
10
30
10
0
0
40
BROWNFIELDS AREA RECONNAISSANCE AND RECEPTOR SURVEY GUIDANCE FORM
Provide Information for the following potential receptors Current Usage Proposed Usage
This form was created to facilitate the preparation of a receptor survey for a given brownfield property. This is a guidance
document only, and Prospective Developers may complete and submit their own receptor survey, if they desire. Any receptor
survey submitted must be completed by a qualified environmental professional.
Complete "Property Characteristics" Section and all portions of other sections where an "X" has been placed in the
far left column under “Applicable to Site,” as determined by the DENR Brownfields Project Manager on a site
specific basis.
CENTRAL AVENUE APARTMENTS, MECKLENBURG CO
% of property that is used for commercial or industrial usage
including paved areas
% of property that is scrub/shrub
The search-radius distances to potential receptors from the Property boundary will be determined by the DENR
Brownfields Project Manager on a site by site basis.
Search-radius distances are measured from the site Property Boundary unless otherwise indicated by the DENR
Brownfield’s Project Manager.
% of property that is wooded
Size of Property (acres)
% of property that is open land
1.96
% of property that is grass area
% of property that is agricultural crops
% of property that is barren
Page 2 of 5
Rev. 06/05/02
Section 2 - Surrounding Properties
X North
X South NS - Commercial/O-1 Office
X East B-1 - Commercial
X West MUDD-O (CD) - Commercial
Applicable to Site
(DENR Use Only)
Direction from Subject
Brownfield Property Current Zoning/Land Use
R-22 MF - Single Family
Residential
Proposed Zoning/Land Use
Page 3 of 5
Rev. 06/05/02
Section 3 - Potential Receptors - include burial depth, construction material and diameter, when available.
Distance Direction Depth
X
Is a basement or subsurface
foundation within 650 ft. of the
Property boundary?
N Y 6/9/2015 On-site only
X
Is a school or daycare center
within 1000 ft. of the Property
boundary?
Y Y 6/9/2015 515 ft.West
X
Is a storm sewer within 500 ft. of
the Property boundary?Y Y 6/9/2015
X
Is a sanitary sewer within 500 ft.
of the Property boundary?Y Y 6/9/2015
X
Is a septic system leach field
within 500 ft. of the Property
boundary?
N Y 6/9/2015
X
Is a water line main within 500 ft.
of Property boundary?Y Y 6/9/2015
X
Is a natural gas line main within
500 ft. of the Property boundary?Y Y 6/9/2015
X
Is a buried telephone/ cable main
within 500 ft. of the Property
boundary?
N Y 6/9/2015
X
Is a buried electrical cable main
within 500 ft. of Property
boundary?
N Y 6/9/2015
Section 4 - Local Water Supply
Public:
Potable Water Supplier Name:Same
Potable Water Supply Source:Catawba River
Distance:~10 miles Direction:West
Potable Water Source Intake:Multiple Locations on Catawba River
Distance:Direction:
Field
Verified
Date
Verified
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors
Charlotte Water (Formerly Charlotte Mecklenburg Utilities)
Complete and attach map as
appropriate
Y/N
Beneath Central Avenue - ~3 ft.
Beneath Central Avenue - ~3 ft.
Beneath Central Avenue - ~3 ft.
Beneath sidewalk along Central
Avenue - ~3 ft.
Page 4 of 5
Rev. 06/05/02
Section 5 - Water Supply Wells
Distance Direction Depth
X
Is a public water supply well
within 750 ft. of the Property
boundary?
N Y 6/9/2015
X
Is a private water supply well
within 750 ft. of the Property
boundary?
N Y 6/9/2015
X
Is a irrigation supply well within
750 ft. of the Property boundary?N Y 6/9/2015
X
Is a monitoring well within 750 ft.
of the Property boundary?Y Y 6/9/2015 50
South (Shell
Station)Unk.
Section 6 - Water Bodies On Property
X
Is water body naturally
developed or man made? What is
the name of the water body?
None
X
List the uses of the water body.
Will the water body be accessible
to residents?
None
X
What is the source of the water
for the water body?None
X
What is the nature of the bottom
of the water body (e.g., rocky or
concrete bottom, drainage ways
or impoundments)?
None
X
Are there any wetlands present
on the property?None
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors Comments
Applicable to Site
(DENR Use Only)
Field
Verified
Date
Verified
Provide Information for the
following potential receptors Y/N Complete and attach map as
appropriate
Page 5 of 5
Rev. 06/05/02
Section 7 - Off-Site Surface Water Body
Distance Direction Depth
X
Are there surface waters located
within 500 ft. of the Property's
boundaries?Y
Unnamed
Tributary
of Briar
Creek
Intermittent 340 ft.Northeast
Additional water bodies, if needed
Section 8 - Additional Requests/ Observations
X
What is the direction of
groundwater flow beneath the
site? (attach data and map)
X
What is the distance to a off-site,
upgradient contaminant source
area (if any)?
X
Identify on-site sources and
estimated extent of on-site soil
contamination?
X
What was the last date at which
contaminants could have been
released from the former on-site
source?
1989
X
Identify on-site sources and
direction and estimated extent of
groundwater contamination?
X
Estimate depths to groundwater
across the site?
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors Comments
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors Y/N Name Type Complete and attach map as
appropriate
25 ft. to 32 ft. - see H&H's July 23, 2015 Brownfields Assessment
Report
50 ft. South (Shell Station)
USTs - see H&H's July 23, 2015 Brownfields Assessment Report and
attached table and figure from H&H's March 6, 2006 Phase I Limited
Site Assessment (LSA) Report
USTs - see H&H's July 23, 2015 Brownfields Assessment Report and
attached table and figure from H&H's March 6, 2006 Phase I Limited
Site Assessment (LSA) Report
Northeast - see H&H's July 23, 2015 Brownfields Assessment Report
and attached table and figure from H&H's March 6, 2006 Phase I
Limited Site Assessment (LSA) Report