Bowman Gray_WSSU Receptor Survey - 15181

Page 1 of 5
General Instructions
1.)
2.)
3.)
Site: Bowman Gray Stadium and Civitan Park
Address: 1250 S. Martin Luther King Jr. Drive
City: Winston-Salem
County: Forsyth
Section 1 - Property Characteristics
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.
Size of Property (acres)
% of property that is wooded
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.
92
15
% of property that is grass area
% of property that is agricultural crops
% of property that is barren
% of property that is used for commercial or industrial usage
including paved areas
% of property that is scrub/shrub
% of property that is open land
0
92
15
0
85
35
0
WSSU plans to construct athletic fields with small adjacent structure(s) that will serve as locker/restrooms and concession
stands, which is why the proposed usage of open land/grass areas is slightly smaller than the current usage. The athletic fields
would still fall into the same "open land" or "grass area" categories.
0
0
0
84
34
0
0
Rev. 06/05/02
Page 2 of 5
Section 2 - Surrounding Properties
X North
X South
X East
X
West
Section 3 - Potential Receptors - include burial depth, construction material and diameter, when available.
Distance Direction Depth
X
Is a basement or subsurface
foundation within 1000 ft of the
Property boundary?
Y Y 6/10/2015 150' (1) West N/A
X
Is a school or daycare center
within 1000 ft of the Property
boundary?N (2) Y 3/2/2015
X Is a storm sewer within 1000 ft of
the Property boundary?Y Y 3/2/2015
X Is a sanitary sewer within 1000 ft
of the Property boundary?Y Y 3/2/2015
X Is a septic system leach field
within 1000 ft of the Property N Y 3/2/2015
X Is a water line main within 1000 ft
of Property boundary?Y Y 3/2/2015
X
Is a natural gas line main within
1000 ft of the Property boundary?Y Y 3/2/2015
X
Is a buried telephone/ cable main
within 1000 ft of the Property
boundary?N Y 3/2/2015
X Is a buried electrical cable main
within 1000 ft of Property N Y 3/2/2015
Hwy 52 (4 lanes, limited access)
low and intermediate
residential, undeveloped land
Gas lines run along the same utility
corridor as the City's water/sewer
lines in subdivision to west of site.
Institutional and industrial
Maps with current and proposed land use designations are attached in Appendix A. The BF property has a red
rectangle around it on both maps.
Searched for schools/daycares on
internet (see maps) and also did
drive by of streets within 1,000 feet
of property. Maps in Appendix B.
Institutional, industrial and mixed
use
Intermediate density residential,
industrial, mixed use
Institutional, low density
residential, industrial
Hwy 52, low, moderate and
intermediate residential, park
Fiber optic line runs down the
north side of Williams St.
Telephone is on overhead poles in
this area of W-S.
Electrical lines are also on overhead
poles
Sewer lines available in all areas
within 1,000 feet.
Field
Verified
Date
Verified
See attached stormwater map.
(Appendix C)
See attached sewer/water main
map. (Appendix C)
See attached sewer/water main
map. (Appendix C).
Applicable to Site
(DENR Use Only)
Direction from Subject
Brownfield Property Current Zoning/Land Use Proposed Zoning/Land Use
Complete and attach map as
appropriate
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors Y/N
Institutional, low density
residential, undeveloped
Intermediate density
residential, industrial, mixed
Rev. 06/05/02
Page 3 of 5
Section 4 - Local Water Supply
Public: City of Winston-Salem Private:
Potable Water Supplier Name:
Potable Water Supply Source:
Distance: 2-11 miles Direction: as noted above
Potable Water Source Intake:
Distance:
Three intakes as described above
and on attached maps (Appendix
E).Direction: NE, SW and NW of BF Property
Section 5 - Water Supply Wells
Distance Direction Depth
X
Is a public water supply well
within 1 mile of the Property
boundary?
N Y 3/2/2015
X
Is a private water supply well
within 1/2 mile of the Property
boundary?
N Y 3/2/2015
X
Is a irrigation supply well within
1/2 mile of the Property
boundary?
N Y 3/2/2015
X
Is a monitoring well within 1500
ft of the Property boundary?
Y * Y 3/2/2015
(1) During door-to-door reconnaissance to offer methane monitoring to residents adjacent to SW property
boundary, Smith +Gardner located several houses that had basements. At least one was monitored with no
methane detected, but the City of W-S has not been able to gain access to most of these residential properties. See
Photo 1, Appendix D.
Skyline Village and Bowman Gray Stadium -
water is purchased from City of W-S, but they
maintain their own sewer and water lines (pink
areas on water/sewer map attached in Appendix
C).
City of Winston-Salem
Field
Verified
Date
Verified
(2) Except the main campus of WSSU is directly north of the Property Boundary. No public schools or daycares
within 1,000'.
Provide Information for the
following potential receptors Y/N
Salem Lake (2 mi. to NE) and Yadkin River/Idol Dam to both about
11 miles to NW/SW of site. See pages from Source Water
Assessment Plan with annotated maps showing approximate
location of BF Property (Appendix E).
Complete and attach map as
appropriate
Applicable to Site
(DENR Use Only)
* Seven groundwater monitoring
wells are currently located on the
property. GW incidents reported in
Phase I Report > 1,000 from
property.
Rev. 06/05/02
Page 4 of 5
Section 6 - Water Bodies on Property
X
Is water body naturally
developed or man made?
X
List the uses of the water body
X
What is the source of the water
for the water body
X
What is the nature of the bottom
of the water body (e.g., rocky or
concrete bottom, drainage ways
or impoundments)
X
Are there any wetlands present
on the property?
Section 7 - Surface Water Body
Distance Direction Depth
X
Are there surface waters located
within 500/1000 ft of the Property
boundary?Y Salem
Creek Stream
Forms
north
property
boundary
North
Looks to
be at least
four feet
deep.
X
Additional water bodies, if needed
Unnamed Creek
A stream that is shown going north through the site west of the
stadium (see Figure 1 in Appendix F) has been engineered beneath
parking lots and roads but surfaces north of the newly constructed
but not-yet-opened Salem Creek connector east of Civitan Park.
Salem Creek forms northern boundary of the property and flows
west to east.
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors Y/N Name Type Complete and attach map as
appropriate
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors Comments
Yes, engineered wetlands along the northern side of Civitan Park
(Photo 6). You can also see it under the words "Section 2" on the
aerial basemap of Figure 2 (Appendix F).
Urban stream. Class "C" stream from W-S Water Supply Dam
(Salem Lake) to Muddy Creek SW of town. Fishing is possible in
Salem Creek, but based on its steep banks and depth it is likely not
used recreationally for swimming/wading.
Salem Creek is fed by smaller streams, surface water runoff and
groundwater. The unnamed creek would have similar sources,
although it is not known
Both the unnamed creek flowing north of the Salem Creek
Connector (Appendix D, Photo 2) and Salem Creek (Photos 3 and 4)
appear to have a combination of a sediment and rocky bottom. The
unnamed creek flowing north just east of the site appears to have a
sandy/muddy bottom (Photo 5)
Rev. 06/05/02
Page 5 of 5
Section 8 - Additional Requests/ Observations

Neighborhood adjacent to the
west of parking lot/closed
municipal solid waste landfill
(See Photo 1, Appendix D. and
Figure 2 in Appendix E)
Applicable to Site
(DENR Use Only)
Provide Information for the
following potential receptors Comments
The City of Winston-Salem requested permission to access private
property after landfill gas was found at concentrations exceeding the
lower explosive limit at the property boundary. They were able to
test along the City right-of-ways and found that methane rapidly
attenuated offsite. However, there were very few homeowners
adjacent to the landfill that allowed access to their property.
Consequently, we will test five on-site soil vapor wells constructed
at five feet depth on the western side of the parking lot during the
second phase of assessment work to determine if offsite residences
could have vapor intrusion problems from volatile organic
compounds as well as methane.
Rev. 06/05/02
Appendix A
JEFFERSO
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Y a d k i n R i v e r
SalemLake
Forsyth CountyExisting Land Use
Legend
Land Use
Agricultural
Large Lot Residential
Single-Family Residential
Duplex/Triplex/Quadraplex
Commercial Recreation
Park / Open Space
Utility
Vacant
Multifamily Residential
Office
Commercial
Mixed Use
Industrial
Institutional
Transitional
Office / High-Density Residential
Office/Commercial
Railroad
Municipality
®
Proposed Beltway
Manufactured Home Park
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Walkertown
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Legend
Office / Moderate-Density Residential
Conservation Subdivision
Office / Urban Residential
Office
Office / Low-Intensity Commercial
Commercial
Office / High-Density Residential
Land Use Classification
Commercial Recreation
Park / Open Space
Industrial
Institutional
Intermediate-Density Residential / Industrial
Moderate-Density Residential / Institutional
Mixed-Use Development
Commercial / Industrial
Railroad
Municipal Boundary
Proposed Beltway
Urban Residential
Intermediate-Density Residential
High-Density Residential
Manufactured Housing Park
Agriculture/Large-Lot Residential
Utilities
GMA 5 / Rural Area
Low-Density Residential
Moderate-Density Residential
Special Land Use Condition Area
Activity Center
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Schools near 1250 S. MLK Jr Drive, Winston-Salem 27107 A University of North Carolina School of the Arts
1533 South Main Street, Winston-Salem, NC [phone] · uncsa.edu 5.0 14 reviews · design and production · john mauceri · chamber music B Piedmont International University
420 South Broad Street, Winston-Salem, NC [phone] · piedmontu.edu 1 review · theological seminary · teacher education · marriage and family therapy · biblical studies · music education C Winston-Salem State University 601 South Martin Luther King Junior Drive, Winston-Salem, NC [phone] · wssu.edu 3.6 31 reviews · financial aid · 4 year · african american · vocational rehabilitation counseling · historically black colleges D Carter G Woodson School 437 Goldfloss Street, Winston-Salem, NC [phone] · cartergwoodsonschool.org 3.3 5 reviews · E Salem Academy and College 601 South Church Street, Winston-Salem, NC [phone] · salem.edu 4 reviews · north carolina north carolina · track and field · independent schools · student body · class sizes F Salem Baptist Christian School 429 South Broad Street, Winston-Salem, NC [phone] · salemvikings.org G Forest Park Elementary School 2019 Milford Street, Winston-Salem, NC [phone] · wsfcs.k12.nc.us H Salem Montessori School 529 South Church Street, Winston-Salem, NC [phone] · salem-montessori.org I The Enrichment Center 1006 S Marshall St, Winston-Salem, NC [phone] · enrichmentarc.org J Gray High School Winston-Salem, NC
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Daycares near 1250 S. MLK Jr Drive, Winston-Salem 27107 A Buchanan Street Head Start 2555 Buchanan Street, Winston-Salem, NC [phone] B TLC Daycare & Early Learning 2832 South Main Street, Winston-Salem, NC [phone] · oaksummitlearning.com C TODDLER TECH 725 Waughtown Street, Winston-Salem, NC [phone] D Dianne's Day Care 1560 Billy Drive, Winston-Salem, NC [phone]
E Maggies Home Day Care 1224 West Sedgefield Drive, Winston-Salem, NC 27107 [phone] F Salem Montessori School 529 South Church Street, Winston-Salem, NC [phone]
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Appendix D

PHOTOGRAPHIC LOG
Client Name:
Winston-Salem State University
Site Location:
Bowman Gray Stadium/Civitan Park Brownfields
Agreement, Winston-Salem, North Carolina
Project No.
201444
Photo #
1
Date:
3/3/2015
Direction of Photo:
West

Description:
Looking across parking
lot to southwest of
Bowman Gray Stadium
below which is pre-
regulatory solid waste
landfill with single-family
residences immediately
adjacent to the west.

Photo #
2
Date:
3/3/2015
Direction of Photo:
South
Description:
The unnamed creek that
flows north through the
central portion of the
property. The creek flows
through stormwater
piping from the southern
property boundary to just
north of the newly-
constructed Salem Creek
Parkway.

PHOTOGRAPHIC LOG
Client Name:
Winston-Salem State University
Site Location:
Bowman Gray Stadium/Civitan Park Brownfields
Agreement, Winston-Salem, North Carolina
Project No.
201444
Photo #
3 Date:
3/3/2015
Direction of Photo:
East
Description:
A view of Salem Creek,
which forms the northern
property boundary.

Photo #
4
Date:
3/3/2015
Direction of Photo:
North
Description:
Salem Creek is fairly deep
and appears to have a
combination of a rocky
and sediment bottom.

PHOTOGRAPHIC LOG
Client Name:
Winston-Salem State University
Site Location:
Bowman Gray Stadium/Civitan Park Brownfields
Agreement, Winston-Salem, North Carolina
Project No.
201444
Photo #
5
Date:
7/7/2015
Direction of Photo:
North
Description:
This unnamed creek that
flows north to Salem
Creek forms the eastern
property boundary. It has
a sediment bottom, and is
fairly shallow surface
water feature.

Photo #
6
Date:

Direction of Photo:
Southwest
Description:
The unnamed creek shown in
Photo 2 funnels into the
engineered wetlands on the
north end of Civitan Park.
Prior to constructing the
wetlands, the City of
Winston-Salem removed
approximately 25,000 cubic
yards of landfilled waste
from this area, mostly
construction & demolition
but with pockets of sanitary
waste.

Appendix E

Source Water Assessment Program Report
for
WINSTON-SALEM, CITY OF
Community Water System

Introduction: What is a Source Water Assessment?
The North Carolina Division of Water Resources, Public Water Supply (PWS) Section is
responsible for implementing the Source Water Assessment Program (SWAP) and completing
assessments for all public drinking water supplies in the state. The 1996 amendments to the Safe
Drinking Water Act provided federal support and required states to conduct assessments of all
public water systems. A source water assessment is a qualitative evaluation of the potential of a
drinking water source to become contaminated by the identified potential contaminant sources
(PCS) within the delineated area. In North Carolina there are more than 10,000 public water
supply sources that were assessed by the state. The PWS Section has gathered information for
each water supply and developed a process for completing the assessments. This process is
summarized in the next few pages and detailed in Section 6 of this report.
This report provides a summary of the results for the Source Water Assessment for your
drinking water source(s).

What is the Source of Your Drinking Water?
Everyone wants clean, safe drinking water and we assume this natural resource will always be
available to us. However, surface water sources can be threatened by many potential contaminant
sources, including permitted wastewater discharges, urban storm water runoff, or other types of
non-point source contamination such as runoff produced by agricultural activities and land
clearing for development. Your drinking water source(s) is listed in Table 1. Protecting your
drinking water from becoming contaminated is a wise investment in public health and your
community's future.
PWS ID: 02-34-010 2 July 1, 2014
Table 1. Public Water Supply System Information
System Name WINSTON-SALEM, CITY OF
City WINSTON SALEM
PWS ID 02-34-010
Source Name YADKIN RIVER (PWSWANN WTP
Source Name YADKIN RIVER (IDOLS DAM)
Source Name SALEM LAKE

In addition to the sources listed in Table 1 above, this water supply system (WINSTON-SALEM,
CITY OF) has interconnections to allow for the purchase of water from the following water
system(s) or "Seller" system(s):
 DAVIDSON WATER INC A
 DAVIDSON WATER INC B
 DAVIDSON WATER INC C
 DAVIDSON WATER INC D
Please refer to the Source Water Assessment Program Report for the "Seller" system(s) to review
the assessment results for the purchased water supply sources that provide drinking water for this
water system (WINSTON-SALEM, CITY OF).
Assessment Report Contents
This assessment report includes the following sections:
Section 1: Assessment Area Delineation
Section 2: Potential Contaminant Source Inventory and Map
Section 3: What is a Susceptibility Rating?
Section 4: Reviewing Your SWAP Results
Section 5: List of Maps, Tables, and Figures for Your Surface Water Source(s)
Section 6: North Carolina's SWAP Approach
Section 1: Assessment Area Delineation
The area delineated for your surface water source(s) for this assessment is the water supply
watershed. A watershed is a geographic area of land draining to either a stream or lake. Local
PWS ID: 02-34-010 3 July 1, 2014
ordinances dictate the type of development that can take place in some sections of the water
supply watershed. In general, the watershed of your surface water source(s) is the area through
which contaminants, if released to the environment, can be reasonably expected to move across
the land surface following the path of overland flow or shallow subsurface flow and into the
surface water body (stream or lake).
Section 2: Potential Contaminant Source Inventory and Map
The potential contaminant source inventory map shows the delineated area for your surface
water source(s). This is the area where potential contaminant sources, if released to the
environment, could reasonably be expected to be a risk or a potential for contamination of your
drinking water supply. A PCS in this assessment report is a facility or site regulated under a state
or federal regulatory program. These facilities are identified in electronic databases that contain
location information for each facility. Only databases that include statewide information were
used for this source water assessment. Included in this report are:
1) A table of any PCS identified within the delineated assessment area; and
2) A map of the delineated assessment area showing PCSs, roads, jurisdictional
boundaries and other pertinent information.
It is important to note that the PCSs identified in this report are only potential sources of
contamination to your drinking water source. Environmental contamination is not likely to occur
if harmful contaminants are managed properly.
Section 3: What is a Susceptibility Rating?
In North Carolina the susceptibility of any drinking water source is based on two components,
a contaminant rating and an inherent vulnerability rating. Your surface water source(s) was
assigned a qualitative susceptibility rating of higher, moderate or lower based on the results of
the contaminant rating and inherent vulnerability rating process as described in the following
paragraphs.
Susceptibility Rating
The final susceptibility rating for your surface water source(s) is determined by combining the
contaminant rating and the inherent vulnerability rating. More detailed information on the
susceptibility rating process can be found in Section 6 of this report.
Contaminant Rating
The contaminant rating for your surface water source(s) was determined based on the number
and location of PCSs within the delineated area. Each PCS identified within the delineated area
was assigned a risk rating of higher, moderate or lower. If a PCS is a facility regulated in an
existing environmental program, it will receive a risk rating of higher. The number of PCSs that
occur within the delineated area was determined and a contaminant rating of higher, moderate or
lower was assigned to your surface water source(s).
PWS ID: 02-34-010 4 July 1, 2014
Inherent Vulnerability Rating
The inherent vulnerability rating of your surface water source(s) refers to the geologic
characteristics or existing conditions of the surface water source(s) and the delineated assessment
area (watershed). These characteristics include water supply watershed classification, surface
water source location and the watershed characteristics rating. The watershed classification is
based on the size of the watershed, development activities, and allowable waste treatment and
disposal practices. The surface water sources are located in streams, large multi-purpose
impoundments or small water supply impoundments. The raw water quality rating assessed
turbidity and total coliform values over twelve months. The watershed characteristics rating is an
assessment of the likelihood that contaminants will follow the path of overland flow or shallow
subsurface flow to a surface water source. An inherent vulnerability rating of higher, moderate or
lower was assigned to your surface water source(s).
PWS ID: 02-34-010 5 July 1, 2014
Table 2. SWAP Results Summary
Source Name
Inherent
Vulnerability
Rating
Contaminant
Rating
Susceptibility
Rating
YADKIN RIVER
(PWSWANN WTP Higher Lower Moderate
YADKIN RIVER
(IDOLS DAM) Higher Moderate Higher
SALEM LAKE Moderate Higher Higher

It is important to understand that a susceptibility rating of higher does not
imply poor water quality. Susceptibility is an indication of a water supply's
potential to become contaminated by the identified PCSs within the
assessment area.

Table 3. Surface Water Source - Information
Source Name Watershed
Classification Source Location
YADKIN RIVER
(PWSWANN WTP WS-IV Direct Stream
YADKIN RIVER
(IDOLS DAM) WS-IV Direct Stream
SALEM LAKE WS-III Class 1

PWS ID: 02-34-010 6 July 1, 2014
Section 4: Reviewing Your SWAP Results
Please review the information on your surface water source(s) provided in this report. If you
believe any of this information is incorrect, please contact the Public Water Supply Section by e-
mail at the following address: [e-mail]. Or you may submit comments to us at:
SWAP
Public Water Supply Section
1634 Mail Service Center
Raleigh, NC 27699-1634
Or you may contact the Source Water Assessment staff by phone at 919-707-9098.
Section 5: Maps, Tables and Figures for Your Surface Water Source(s)
Maps, tables and figures specific to your surface water source(s) are included in this report in the
following pages and are listed below.
Map 1. Location Map
Map 2. Delineated Area and PCS Map

Table 4. Potential Contaminant Source Attributes
Table 5. Inherent Vulnerability Rating
Table 6. Watershed Characteristics Rating Calculation

Figure 1. Land Use / Land Cover Categories
Figure 2. Watershed Characteristics Rating
Figure 3. Average Annual Precipitation Rating
Figure 4. Land Surface Slope Rating
Figure 5. Land Use Rating
Figure 6. Land Cover Rating
Figure 7. Ground Water Contribution Rating

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PWS ID: 02-34-010 46 July 1, 2014
"
FORSYTHFORSYTH
GUILFORDGUILFORD
STOKESSTOKES
DAVIDSONDAVIDSONDAVIEDAVIE
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Greensboro
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3
1
1
SALEM LAKE
MAP 1. LOCATION MAP ©RoadsRivers and StreamsMajor HydrologyMunicipal BoundariesCounty Boundaries
Watershed ZonesCritical Area (NA for WS-I)
Protected Area Boundary (WS-IV, V only)
Stream ZoneWatershed Boundary
0 5 10 15 Miles
WINSTON-SALEM, CITY OF, PWS ID: 0234010, SALEM LAKE

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6/6/6 24/4/4 2015 Query/Selection Results
htttttp://///swap.ncwater.org/w/w/ebsite/e/e swap/p/p MapFrame.htm 1/1
Community
SOURCE TYPE PWS_ID SOURCE CODE SYSTEM NAME SOURCE NAME CITY STATE ZIP
S 0234010 002 WINSTON-SALEM, CITY OF YADKIN RIVER (NW WT. DAM) CLEMMONS NC 27107
Hydrology
LABEL FIPS
412 197
412 67
Counties
COUNTY NAME CO_ABBR ACRES
FORSYTH  263713.342
YADKIN  216138.611
1
6/6/6 24/4/4 2015 Query/Selection Results
htttttp://///swap.ncwater.org/w/w/ebsite/e/e swap/p/p MapFrame.htm 1/1
Community
SOURCE TYPE PWS_ID SOURCE CODE SYSTEM NAME SOURCE NAME CITY STATE ZIP
S 0230015 S03 DAVIE CO8NTY WATER SYSTEM YADKIN RIVER MOCKSVILLE NC 27028
Hydrology
LABEL FIPS
412 67
412 59
Counties
COUNTY NAME CO_ABBR ACRES
DAVIE  170588.318
FORSYTH  263713.342
2
6/6/6 24/4/4 2015 Query/Selection Results
htttttp://///swap.ncwater.org/w/w/ebsite/e/e swap/p/p MapFrame.htm 1/1
Community
SOURCE TYPE PWS_ID SOURCE CODE SYSTEM NAME SOURCE NAME CITY STATE ZIP
S 0234010 001 WINSTON-SALEM, CITY OF YADKIN RIVER (IDOLS DAM) CLEMMONS NC 27107
Hydrology
LABEL FIPS
412 67
412 59
412 57
Counties
COUNTY NAME CO_ABBR ACRES
DAVIDSON  363208.372
DAVIE  170588.318
FORSYTH  263713.342
3
Appendix F