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HomeMy WebLinkAbout22007 Brownfields Assessment Work Plan Rev 1_South Tryon Commercial_(BPN 22007-18-060)_20180509i S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc Brownfields Assessment Work Plan South Tryon Commercial Charlotte, North Carolina H&H Job No. RMR-003 Table of Contents 1.0 Introduction .............................................................................................................................1  1.1 Background ............................................................................................................................1  1.2 Previous Assessment Activities .............................................................................................2  2.0 Brownfields Assessment Activities ........................................................................................5  2.1 Receptor Survey ....................................................................................................................5  2.2 Soil Assessment Activities ....................................................................................................6  2.3 Soil Vapor Sampling Activities .............................................................................................7  2.4 Quality Assurance – Quality Control ....................................................................................8  2.5 Investigation Derived Waste .................................................................................................9  2.6 Reporting .............................................................................................................................10  List of Figures Figure 1 Site Location Map Figure 2 Site Map Figure 3 Proposed Sample Location Map List of Appendices Appendix A Template Brownfields Property Receptor Survey Form 1 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc Brownfields Assessment Work Plan South Tryon Commercial Charlotte, North Carolina H&H Job No. RMR-003 1.0 Introduction Hart & Hickman, PC (H&H) is providing this Work Plan to conduct Brownfields assessment activities at the South Tryon Commercial Brownfields property (Brownfields Project No. 22007- 18-060) located northeast of the South Tryon Street and West Tremont Avenue intersection in Charlotte, Mecklenburg County, North Carolina (Site). The subject Site consists of two contiguous parcels totaling approximately 2.4 acres of undeveloped vacant land located in a mixed commercial and residential area in South End Charlotte. Future redevelopment at the Site includes construction of three commercial buildings with associated parking areas and open spaces. The future intended uses of the new buildings include retail and office spaces. A Site location map is provided as Figure 1, and the Site and surrounding area are shown on Figure 2. 1.1 Background The Site was undeveloped land until approximately the late 1930s when the west-central portion of the Site along S. Tryon Street was first developed with a farm machinery service company that was later used as an electrical supply warehouse. An addition was constructed on the northern side of the electrical supply warehouse building in the late 1970s. The electrical supply warehouse operated until the 1990s when the building was occupied by Grinnell Fire Sprinkler Systems. The property was then vacant until 2005 when it was purchased by DCI properties and leased to a dog daycare center. A restaurant operated in the west-central portion of the Site south of the electrical supply warehouse building between 1948 and the mid-1960s. The restaurant building was demolished in the early 1980s. A warehouse building constructed in the southern portion of the Site near W. 2 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc Tremont Avenue was occupied by a motor freight company beginning in the 1940s and later a welding supply company in the 1960s. By 1980, the original 1940s warehouse building in the southern portion of the Site was demolished and B&B Contracting Co., Inc. constructed a new building which was used as a drywall contracting business until the late 2000s. The northern portion of the Site remained undeveloped until the late 1960s when it was developed with a Terminix facility. Terminix operations continued in the northern and northeastern portions of the Site until the late 2000s. The Site buildings were razed in 2011. Approximate locations of former Site buildings are depicted on Figure 2. 1.2 Previous Assessment Activities H&H recently completed a Phase I ESA which included the Site and the east adjacent West Tremont Brownfields property. Results of previous assessment activities conducted east of the former Terminix facility (Figure 2) identified pesticide compounds at concentrations exceeding the North Carolina Department of Environmental Quality (DEQ) screening criteria in soil and groundwater. A Brownfields Agreement (Brownfields Project No. 14009-10-60) between 330 West Tremont, LLC and DEQ was executed on October 15, 2010 and includes the approximately 2.18-acre parcel adjacent to the east of the Site. The West Tremont Brownfields property was subsequently developed with the Three 30 Five luxury apartments. The limits of the West Tremont Brownfields property are depicted on Figure 2. Results of the recent Phase I ESA identified the following potential environmental concerns associated with the Site which are not covered by the east adjacent West Tremont Brownfields Agreement:  The former Virginia Carolina Chemical Company facility is located adjacent to the south across W. Tremont Avenue and topographically cross-gradient to upgradient of the Site. The Virginia Chemical Company formerly operated as a phosphate fertilizer plant from at least the 1890s until the 1960s. Results of assessment activities conducted on the former Virginia Carolina Chemical Company property have identified the presence of lead, arsenic, tetrachloroethene (PCE), and trichloroethene (TCE) in groundwater at concentrations 3 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc exceeding the DEQ 2L Groundwater Standards. The former Parks Cramer facility (a.k.a. Atherton Mill Property) is located approximately 1,100 ft east-southeast and topographically upgradient of the Site. Parks Cramer manufactured textile-related equipment. Soil and groundwater impacts consisting of chlorinated solvent and petroleum-related compounds associated with former Parks Cramer operations are well documented. Groundwater impacts extend downgradient of the Parks Cramer property and have been identified within approximately 400 ft of the Site. Plume migration modeling prepared by the consultant for Parks Cramer indicated that the plume is expected to travel toward the Site. In July 2007, H&H conducted soil and groundwater sampling activities at the Site on behalf of a previous prospective purchaser. Results of groundwater assessment activities identified low levels of PCE and TCE at concentrations exceeding the DEQ 2L Groundwater Standards in monitoring wells installed in western and southwestern portions of the Site. The PCE and TCE detections in the 2007 groundwater samples and the potential for groundwater impacts from nearby off-Site sources (Virginia Carolina Chemical Company and the Parks Cramer properties) to migrate toward the Site represent a potential environmental concern for the Site. Previous groundwater sample locations and concentrations of compounds of concern are shown on Figure 3. The Site received eligibility into the DEQ Brownfields Program via a Letter of Eligibility dated February 18, 2018. Ram Realty Acquisitions V LLC (the Prospective Developer or PD) subsequently elected to participate in the Brownfields Program Redevelopment Now option. As part of this process, a kick-off/data gap meeting with PD, counsel for the PD, DEQ Brownfields personnel, and H&H was held on March 22, 2018 to conduct a Site walk, to discuss historical uses of the Site, available environmental information, proposed redevelopment plans, data gaps, and the proposed schedule for completing the Brownfields Agreement. H&H proposes to conduct soil and soil vapor assessment activities at the Site to evaluate the 4 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc potential for impacts associated with environmental concerns identified during previous Phase I ESA activities and the recent data gap meeting. In addition, H&H proposes to collect background soil samples at the Site to establish Site-specific ranges for naturally occurring metals. H&H will also complete receptor survey activities in the area surrounding the Site as part of the proposed assessment. Our proposed scope of work is outlined in the following sections. 5 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc 2.0 Brownfields Assessment Activities The proposed assessment activities will be performed in general accordance with the DEQ Inactive Hazardous Sites Branch (IHSB) Guidelines for Assessment and Cleanup (Guidelines) dated October 2015, the DEQ Division of Waste Management (DWM) Vapor Intrusion Guidance (VI Guidance) dated March 2018, and most recent versions of the U.S. Environmental Protection Agency (EPA) Region IV Science and Ecosystem Support (SESD) Field Branches Quality System and Technical Procedures guidance. Prior to conducting the field activities, H&H will contact North Carolina 811, the public utility locator, to mark subsurface utilities located on the Site. H&H will also contract with a private utility locator to screen proposed sample locations for subgrade utilities that may not be marked by the public locator. Additionally, soil boring locations will be hand cleared to approximately 5 feet (ft) below the ground surface (bgs) prior to use of mechanical drilling equipment to further screen the boring locations for the presence of subsurface utilities. 2.1 Receptor Survey H&H will perform a Brownfields receptor survey in accordance with DEQ Brownfields Section guidance. The receptor survey will include information about land use in the Site area including zoning. H&H will also conduct a field search for water supply wells, basements, utility manways and chases, storm sewers, other underground utilities, drains, and surface water within a 1,500 ft radius of the Brownfield property boundaries. In addition, H&H will review the online Mecklenburg County Well Information System about potential wells in the area and, if warranted, contact utility companies for information concerning underground utilities in the immediate area of the Site. A template copy of the Brownfields Property Receptor Survey form is provided in Appendix A. 6 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc 2.2 Soil Assessment Activities H&H will contract a qualified drilling contractor to advance six (6) soil borings to depths of approximately 10 ft bgs and collect soil samples for laboratory analysis from each boring to evaluate the potential for impact in areas where future grading is planned. Proposed soil sample locations (denoted by SB nomenclature) are depicted on Figure 3 and will be advanced in the following areas:  within the footprint of the former farm machinery service building and electrical supply warehouse (SB-1 through SB-3); and  within the footprint of the former motor freight station and welding warehouse building (SB-4 through SB-6) The soil borings will be advanced utilizing a track-mounted direct push technology (DPT) drill rig. Continuous soil samples will be collected from the borings using acetate lined macrocore sleeves. Soil samples will be logged for lithological description and field screened for indication of potential impacts by observation for staining, and the presence of organic vapors using a calibrated photoionization detector (PID). Based upon field screening results, one soil sample will be collected from each soil boring for laboratory analysis from the depth interval interpreted most likely to be impacted. If there are no obvious indications of potential impact based on field screening results, H&H will collect samples from depth intervals representative of cut depths in the area of the boring based on review of the most recent grading plan. Soil samples selected for analysis will be placed directly into dedicated laboratory-supplied sample containers, labeled with the sample identification, date, time and requested analysis, and submitted to a North Carolina certified laboratory under standard chain of custody protocols for analysis of volatile organic compounds (VOCs) by EPA Method 8260, semi-VOCs (SVOCs) by EPA Method 8270, and Resource Conservation and Recovery Act (RCRA) metals plus hexavalent chromium by EPA Methods 6020/7471/7196. Per DEQ Brownfields request, soil samples collected from borings advanced within the footprint of the former farm machinery service building and electrical supply warehouse (SB-1 through SB-3) will also be submitted for 7 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc laboratory analysis of polychlorinated biphenyls (PCBs) by EPA Method 8082. Additionally, H&H will collect soil samples for PCB Congeners by EPA Method 1668, and request that the laboratory hold the samples pending analytical results for samples analyzed for PCBs by EPA Method 8082. If PCB aroclor compounds are detected at concentrations exceeding the DEQ IHSB Commercial/Industrial PSRGs in a sample, that sample will be analyzed for PCB congeners. H&H will also collect two (2) background soil samples from areas at the Site that do not appear to have been affected by historical operations to establish Site-specific background concentrations for metals. The locations of the background soil samples will be determined based upon review of historical resources and observations made by H&H personnel while in the field. The samples will be collected from a range of depths consistent with the depths of the samples collected from the areas of concern, with at least one sample collected from shallow soil (i.e., 1-3 ft bgs). The background soil samples will be submitted for analysis of RCRA metals plus hexavalent chromium by EPA Methods 6020/7471/7196. Following sampling activities, the soil sample borings will be properly abandoned and the surfaces will be repaired similar to pre-drilling conditions. Additionally, the soil sample locations will be estimated using a global positioning system (GPS) unit. 2.3 Soil Vapor Sampling Activities Review of available environmental reports indicates that low levels of chlorinated solvent compounds have been detected in Site groundwater at concentrations above the DEQ DWM vapor intrusion screening levels. H&H proposes to collect seven (7) soil vapor samples within the approximate footprint of the proposed commercial buildings to evaluate the potential for vapor intrusion. Soil vapor monitoring point locations (denoted by VMP nomenclature) are shown in Figure 3. The soil vapor monitoring points will be installed utilizing the track-mounted DPT drill rig to advance soil borings to approximately 10 ft bgs within the footprint of the proposed buildings. 8 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc After advancing the boring to depth, a six-inch stainless-steel screen point fitted with ¼-inch diameter Teflon® tubing will be installed within each borehole. Filter sand will be placed from the base of the boring to 6-inches above the screened interval. The sampling points will be completed by placing hydrated bentonite from the top of the filter sand to the ground surface. Prior to sampling, a leak check will be conducted at each soil vapor monitoring point by constructing a shroud around the sampling point and flooding the air within the shroud with helium gas. Helium within the shroud will be monitored using a helium gas detector. Vapor from the monitoring point sample tubing will be purged and sampled outside of the shroud into a Tedlar® bag and analyzed using the helium gas detector to ensure that helium concentrations are less than 10% of the concentration measured within the shroud. Following a successful field leak check, the vapor samples will be collected into six-liter Summa canisters for laboratory analysis by connecting the Teflon® sample tubing to an airflow regulator using a brass nut and ferrule assembly to create an air tight seal. The airflow regulator will be calibrated by the laboratory to allow the Summa canisters to fill slowly over a period of approximately one hour per point. Upon completion of sample collection, the air flow regulator will be removed from the Summa canister and the samples will be packaged and shipped to the laboratory for analysis of VOCs by EPA Method TO-15. Following sampling activities, the vapor monitoring points will be properly abandoned and the surfaces will be repaired similar to pre-drilling conditions. Additionally, the soil vapor sample locations will be estimated using a GPS unit. 2.4 Quality Assurance – Quality Control Non-dedicated equipment and tools will be decontaminated prior to use at each boring or sampling location or following exposure to soil or groundwater. For quality assurance and quality control purposes (QA/QC), one trip blank will be submitted for analysis of VOCs by EPA Method 8260 for each soil sample shipment. To evaluate the reproducibility of the sample results, H&H will collect one duplicate soil sample that will be submitted for VOCs by EPA 9 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc Method 8260, SVOCs by EPA Method 8270, and RCRA metals plus hexavalent chromium by EPA Method 6010/7471/7196. In addition, H&H will collect a duplicate soil vapor sample that will be submitted for VOCs by EPA Method TO-15. Laboratory QA/QC procedures will be employed to ensure appropriate sample handling and analysis and to aid in the review and validation of the analytical data. QA/QC procedures will be conducted in accordance with the method protocols and will include regular equipment maintenance, equipment calibrations, and adherence to specific sample custody and data management procedures. Samples will be analyzed in conjunction with appropriate blanks, laboratory duplicates, continuing calibration standards, surrogate standards, and matrix spiking standards in accordance with approved methodologies to monitor both instrument and analyst performance. Laboratory reporting limits for each analyte will be at or below appropriate screening criteria, where possible. Additionally, H&H will request that the laboratory include estimated concentrations for compounds that are detected at levels above the laboratory method detection limit, but below the laboratory reporting limit (J flags). The laboratory analytical data report and QA package for each group of samples submitted to and analyzed by the subcontracted laboratory will be provided in an appendix to the final report. Laboratory QA data consistent with Level II documentation will be requested for this project. A copy of the completed chain-of-custody record and shipping receipt will be appended to the corresponding laboratory analytical report included with the final report. 2.5 Investigation Derived Waste Investigation derived waste (IDW) generated during the assessment activities will be thin spread on-Site. However, if significant impacts are suspected (i.e., elevated PID readings, free-product, etc.) the soil cuttings will be containerized in 55-gallon drums and staged on-Site pending analytical results of a composite IDW sample. Based on laboratory analytical results of IDW samples, the drums will be transported off-Site to a suitable facility for disposal. IDW generated during the proposed assessment activities will be managed in accordance with DEQ IHSB Guidelines. 10 S:\AAA-Master Projects\Ram Realty - RMR\RMR-006 Tryon & Tremont Brownfields Assistance\Brownfields Assessment Workplan\final to DEQ\Brownfields Assessment Work Plan_South Tryon Commercial_(BPN 22007-18-060)_20180503.doc 2.6 Reporting Following completion of the assessment activities and receipt of the analytical data, H&H will document our findings in a Brownfields assessment report. The report will include a description of the sampling activities, a figure depicting sample locations, soil boring logs and vapor monitoring point construction logs, a discussion of the data in comparison to regulatory screening levels, laboratory analytical data reports, and conclusions and recommendations concerning our activities. TITLE PROJECT SITE LOCATION MAP SOUTH TRYON COMMERCIAL CHARLOTTE, NORTH CAROLINA DATE: JOB NO: REVISION NO: FIGURE: 04-10-18 0 1RMR-003 SITE 0 2000 4000 APPROXIMATE SCALE IN FEET N U.S.G.S. QUADRANGLE MAP QUADRANGLE 7.5 MINUTE SERIES (TOPOGRAPHIC) CHARLOTTE EAST, NORTH CAROLINA, 1991 REVISION NO. 0 JOB NO. RMR-003 DATE: 4-12-18 FIGURE NO. 2 SOUTH TRYON COMMERCIAL CHARLOTTE, NORTH CAROLINA SITE & SURROUNDING AREA MAP LEGEND SITE PROPERTY BOUNDARY LIMITS OF WEST TREMONT BROWNFIELDS AGREEMENT FORMER BUILDING FOOTPRINT APPROXIMATE LOCATION OF FORMER GASOLINE UNDERGROUND STORAGE TANK 2923 South Tryon Street-Suite 100 Charlotte, North Carolina 28203 704-586-0007(p) 704-586-0373(f) License # C-1269 / #C-245 Geology MOTOR FRE I G H T S T A T I O N (1950-1950) S. TR Y O N S T R E E T FORMER B&B CONTRACTING COMPANY W.TREMONT A V E N U E DO GG E T T S TR E E T NOTES: 1. BASEMAP OBTAINED FROM MECKLENBURG COUNTY GIS (2017). 2. HISTORICAL BUILDING FOOTPRINTS & HISTORICAL USES OBTAINED FROM AVAILABLE RESOURCES INCLUDING SANBORN FIRE INSURANCE MAPS, AERIAL PHOTOGRAPHY, & CITY DIRECTORS.FORMER RESTAURANT (1949-1959) FORMER FARM MACHINERY SALES & SERVICE (1959-1963) FORMER B&B CONTRACTING COMPANY FORMER TERMINIX, INC. (1969-2014) EMCI LTD (2101 S. TRYON STREET) MULTI-TENANT COMMERCIAL (307-349 W. TREMONT AVENUE) GAS FIRED PRODUCTS (305 DOGGETT STREET) MULTI-TENANT COMMERCIAL (1926-2030 S. TRYON STREET) MULTI-TENANT COMMERCIAL (1927 S. TRYON STREET) FORMER AUTO REPAIR SHOP (1950-1963) APPROXIMATE LOCATION FORMER UST DISPENSER S:\AAA-Master Projects\Ram Realty - RMR\RMR-003 - Tryon & Tremont Site\Figures\Figures.dwg, FIG 2, 4/12/2018 3:53:32 PM, zbarlow DPT-19 DPT-18 DPT-17 DPT-05DPT-16 DPT-03 DPT-13 DPT-15 DPT-20 DPT-14DPT-04 DPT-12 DPT-01 MW-1 MW-3 MW-2 DPT-10 DPT-09 DPT-08 DPT-06 DPT-04 DPT-07 DPT-02 DPT-19 DPT-18 DPT-17 DPT-05DPT-16 DPT-03 DPT-13 DPT-15 DPT-20 DPT-14DPT-04 DPT-12 DPT-01 MW-1 MW-3 MW-2 DPT-10 DPT-09 DPT-08 DPT-06 DPT-04 DPT-07 DPT-02 SB-2 SB-1 SB-3 VMP-3 VMP-2 VMP-1 VMP-4 VMP-5 VMP-6 VMP-7 SB-4 SB-5 SB-6 REVISION NO. 0 JOB NO. RMR-003 DATE: 3-27-18 FIGURE NO. 3 SOUTH TRYON COMMERCIAL CHARLOTTE, NORTH CAROLINA PROPOSED SAMPLE LOCATION MAP LEGEND SITE PROPERTY BOUNDARY LIMITS OF BROWNFIELDS AGREEMENT FORMER BUILDING FOOTPRINT PROPOSED BUILDING FOOTPRINT PROPOSED PARKING/ PLAZA AREA APPROXIMATE LOCATION OF FORMER GASOLINE UNDERGROUND STORAGE TANK MONITORING WELL LOCATION TEMPORARY MONITORING WELL LOCATION TEMPORARY MONITORING WELL/ SOIL BORING LOCATION SOIL BORING LOCATION PROPOSED SOIL BORING LOCATION PROPOSED SOIL VAPOR SAMPLE LOCATION 2923 South Tryon Street-Suite 100 Charlotte, North Carolina 28203 704-586-0007(p) 704-586-0373(f) License # C-1269 / #C-245 Geology MOTOR FRE I G H T S T A T I O N (1950-1950) S. TR Y O N S T R E E T FORMER B&B CONTRACTING COMPANY W.TREMONT A V E N U E DO GG E T T S TR E E T NOTES: 1. BASEMAP OBTAINED FROM MECKLENBURG COUNTY GIS (2017). 2. HISTORICAL BUILDING FOOTPRINTS & HISTORICAL USES OBTAINED FROM AVAILABLE RESOURCES INCLUDING SANBORN FIRE INSURANCE MAPS, AERIAL PHOTOGRAPHY, & CITY DIRECTORS. 3. PCE = TETRACHLOROETHYLENE TCE = TRICHLOROETHYLENE μg/L = MICROGRAMS PER LITER NA = NOT ANALYZED FORMER RESTAURANT (1949-1959) FORMER FARM MACHINERY SALES & SERVICE (1959-1963) FORMER B&B CONTRACTING COMPANY FORMER TERMINIX, INC. (1969-2014) FORMER AUTO REPAIR SHOP (1950-1963) FORMER UST DISPENSER DPT-08 (7/23/07) PCE <1.0 μg/L TCE 2.5 μg/L DIELDRIN 0.75 μg/LDPT-09 (7/23/07) PCE <1.0 μg/L TCE 14 μg/L DIELDRIN 0.15 μg/L MW-3 (8/9/07) PCE 1.6 μg/L TCE 11 μg/L DIELDRIN <0.050 μg/L DPT-02 (7/20/07) PCE 5.7 μg/L TCE <1.0 μg/L DIELDRIN NA DPT-07 (7/20/07) PCE 1.0 μg/L TCE <2.0 μg/L DIELDRIN NA MW-2 (8/9/07) PCE <1.0 μg/L TCE 3.0 μg/L DIELDRIN 3.0 μg/L FORMER FARM MACHINERY SALES & SERVICE (1959-1963)S:\AAA-Master Projects\Ram Realty - RMR\RMR-003 - Tryon & Tremont Site\Figures\Figures.dwg, FIG 1, 3/27/2018 4:41:19 PM, zbarlow Appendix A Template Brownfields Property Receptor Survey Form North Carolina Department of Environmental Quality Division of Waste Management Brownfields Program Site: Address: City: County: Brownfields Project Number: Property and Building Characteristics a. Provide occupancy and use information. c. Describe the foundation construction. Include details on type, floor construction, and depth below grade. e. Are any subslab ventilation systems or moisture barriers in place? If so, please provide details. d. Describe the HVAC system in the building. Include available details on type, equipment location, source of air return, and design considerations (e.g. positive pressure?). % of property that is grassed areas (unpaved) % of property that is agricultural crops % of property that is paved Size of Property (acres) BROWNFIELDS PROPERTY RECEPTOR SURVEY This form was created to clarify and simplify preparing a receptor survey for a brownfield site. Please provide the information requested below. Distances are measured from the site property boundary unless otherwise indicated by the DEQ Brownfield’s Project Manager (PM). Current Usage Proposed UsageSurface Conditions % of property that is wooded/brush If an existing building is on-site, please respond to the following. Information can be provided on additional sheets as needed. If numerous buildings are on-site, consult with your PM as only information on specific buildings may be needed. b. Describe the construction of the builidng including materials (e.g. wood frame, block), type and size of openings (e.g. windows, bay doors), and height (number of stories). % of property that is covered by buildings Rev. 09/2015 Page 1 of 3 North Carolina Department of Environmental Quality Division of Waste Management Brownfields Program Surrounding Property Land Use North-Northwest South East-Northeast West-Southwest Utilities Is there a septic system on-site? (Y or N) Please provide the utility providers for the subject property a. Natural Gas b. Sewer c. Electricity d. Other For surrounding properties, please complete the following table with available information. Is there a residence within 1,000 ft of the Property? Specific Land Uses of Interest Y/N * Distance (ft) Is a sanitary sewer within 100 ft of the Property boundary? For the subject property, please provide a map of known buried utilites. If available, include depth to top, construction material, and diameter of the utilities. In addition, please provide the following information on utilty providers. If additional assessment is required, the public utility locators should be contacted. This information can then be added to a site map. Y/N * Please provide information on the following land uses in the vicinity of the subject site, including a map of the surrounding areas. If specific receptors are present, please provide addresses of the facilities. DirectionUtility/Potential Receptor Is a buried electrical cable main within 100 ft of Property boundary? Is a storm water pipe within 100 ft of the Property boundary? * If yes, please provide a map or detailed information (distance, direction, depth) of the utility in correlation with the subject property. Is there a basement within 1,000 ft of the Property Distance (ft)Address Zoning/Land Use Proposed Usage Current Use/Occupant Is a school or daycare center within 1,000 ft of the Property? Is a water line main within 100 ft of Property boundary? Is a natural gas line main within 100 ft of the Property boundary? Is a buried telephone/ cable main within 100 ft of the Property boundary? Is a septic system leach field within 500 ft of the Property boundary? Direction Rev. 09/2015 Page 2 of 3 North Carolina Department of Environmental Quality Division of Waste Management Brownfields Program Water Supply What is the potable water supply for the property? Public Private ______ Surface Water & Wetlands b. List the uses of the water body. c. What is the source of the water for the water body? d. What is the nature of the bottom of the water body (e.g., rocky or concrete bottom, drainage ways or impoundments) If no on-site surface water features, what is the nearest surface water body? Are there any wetlands present on the property? If no wetlands on-site, are wetlands suspected on adjoining properties? a. Is the water body naturally developed or man-made? Is a public water supply well within 1 mile of the Property boundary? Is a private water supply well within 1,500 ft of the Property boundary? Is an irrigation well within 1,500 ft of the Property boundary? Response/Comments The purpose of this section is to provide information on the presence of surface waters and/or wetlands on, or in the vicinity of the Property. Are there surface water features on the property? (If yes, please complete a. to d.) If Private, please provide details of the water supply source (i.e. well location, well construction, etc). If public, please include the water providers name. Distance (ft)Direction Provide Information regarding Surface Water and Wetlands Y/NWater Supply Wells Please provide the following information regarding water supply wells in the vicinity of the Property. At a minimum, a windshield survey within 1,500 ft of the property boundaries should be completed to determine if water supply or irrigation wells may be present. Information from applicable databases can and should be utilized; however, should not be utilized in lieu of the windshield survey. If multiple wells are present within the requested radius, please provide a map of the well locations. If needed, please attach a separate table to list all wells. Please note, the PM may opt for a more extensive water supply well survey if needed. The purpose of this section is to provide information on the water supply for the site and surrounding areas. Address Rev. 09/2015 Page 3 of 3