MO-9552_40984_G_C_20200127_Draft Notice of Residual Petroleum for UST Review

�vYa se EWED
FEB 0 4 2020
Geological Resources, Inc.
January 27, 2020
Ms. Trudy Beverly
North Carolina Department of
Environmental Quality
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Re: Notice of Residual Petroleum
5012 Churchill Drive Residence
5012 Churchill Drive
Charlotte, Mecklenburg County, North Carolina
Incident # Pending
GRI Project No. 5295
Dear Ms. Beverly,
Please find enclosed the Notice of Residual Petroleum (NRP) for the above referenced site. Please sign
the NRP, have it notarized, then return to:
Corey N. Buchanan
Geological Resources, Inc.
3502 Hayes Road
Monroe, NC 28110
Please do not hesitate to contact the undersigned at [phone] if you have any questions or require
additional information.
Sincerely,
Geological Resources, Inc.
Gk"/ o. %wr�*P'
Corey N. Buchanan, P.G.
Project Manager
enclosure
cc: file
3502 Hayes Road Monroe, North Carolina 28110
Phone [phone] [phone] • Fax [phone]

NOTICE OF RESIDUAL PETROLEUM
5012 Churchill Drive, Charlotte, Mecklenburg County, North Carolina
The property that is the subject of this Notice (hereinafter referred to as the "Site")
contains residual petroleum and is an Underground Storage Tank (UST) incident under North
Carolina's Statutes and Regulations, which consist of N.C.G.S. 143-215.94 and regulations adopted
thereunder. This Notice is part of a remedial action for the Site that has been approved by the
Secretary (or his/her delegate) of the North Carolina Department of Environment Quality (or its
successor in function), as authorized by N.C.G.S. Section 14313-279.9 and 14313-279.11. The North
Carolina Department of Environment Quality shall hereinafter be referred to as "DEQ".
NOTICE
Petroleum product was released and/or discharged at the Site. Petroleum constituents remain
on the site, but are not a danger to public health and the environment, provided that the
restrictions described herein, and any other measures required by DEQ pursuant to N.C.G.S.
Sections 14313-279.9 and 14313-279.11, are strictly complied with. This "Notice of Residual
Petroleum" is composed of a description of the property, the location of the residual petroleum, and the
land use restrictions on the Site. The Notice has been approved and notarized by DEQ pursuant to
N.C.G.S. Sections 143B-279.9 and 143B-279.11 and has/shall be recorded at the
Mecklenburg Register of Deeds' office Book , Page
(name of county)
Any map or plat required by DEQ has been/shall be recorded at the Mecklenburg Register of
(name of county)
Deeds' office Book , Page , and has been/shall be incorporated into the Notice by this reference.
Source Property
Michele J. Alexander & Alexander Family Irrevocable Trust of Charlotte, North Carolina is the
owner in fee simple of all or a portion of the Site, which is located in the County of Mecklenburg, State of
North Carolina, and is known and legally described as:
Revised February 7, 2019

BEING all of lot 2 in Block S of ALLEN HILLS as shown on map thereof recorded in Map Book 7, Page
333 in the Mecklenburg County Registry. Said property commonly known as 5012 Churchill Drive
Charlotte, NC 28269; PIN # 045-213-02.
For protection of public health and the environment, the following land use restrictions required
by N.C.G.S. Section 143B-279.9(b) shall apply to all of the above -described real property. These
restrictions shall continue in effect as long as residual petroleum remains on the site in excess of
unrestricted use standards and cannot be amended or cancelled unless and until the Mecklenburg County
Register of Deed receives and records the written concurrence of the Secretary (or his/her delegate) of
DEQ (or its successor in function).
PERPETUAL LAND USE RESTRICTIONS
Soil: Soil containing residual petroleum above applicable regulatory standard(s) remains
on the site in the area of the closed inplace heating oil tank identified in Figure 1,
Attachment A. No soil shall be excavated or disturbed within 3 feet of the closed
heating oil tank except to remediate the soil in accordance with all applicable state
and federal statutes, regulations and guidelines.
Groundwater: Groundwater from the site is prohibited from use as a water supply. Water supply
wells of any kind shall not be installed or operated on the site.
ENFORCEMENT
The above land use restriction(s) shall be enforced by any owner, operator, or other party
responsible for the Site. The above land use restriction(s) may also be enforced by DEQ through any of
the remedies provided by law or by means of a civil action, and may also be enforced by any unit of local
government having jurisdiction over any part of the Site. Any attempt to cancel this Notice without the
approval of DEQ (or its successor in function) shall be subject to enforcement by DEQ to the full extent
of the law. Failure by any party required or authorized to enforce any of the above restriction(s) shall in
no event be deemed a waiver of the right to do so thereafter as to the same violation or as to one occurring
prior or subsequent thereto.
Revised February 7, 2019
2

IN WITNESS WHEREOF, fi4I t .- AV # W s caused this Notice to be executed pursuant to
N.C.G.S. Sections 143B-279.9 and 143B-279.11, this 3 day of fie IvUar4 , 20;4.
By. � ,,n (na�n—�ofr pon 'bleparryifagent issigning)
(siiggnat�ure' oof responsible party, attorney or other agent if there is one)
itle of ent for responsible parry if there is one)
Signatory's naive typed or printed: j��� �e�QA1,4zi�%�,
NORTH CAROLINA
COUNTY
(Name of county in ti ich acknowledgment was taken)
I certify that the following person(s) personally
that he or she signed the foregoing document: _
Date: �o) . r, 10 V
(Official Seal)
expires: 5 •- I ZG-&
me this day, each acknowledging to me
-e, m ° r
r G%"
(si nature of Notary Public
� 111ZiI me' r Cyr 1rid u
printed or typed name of Notary Public)
Notary Public
My commission ,.....•r"`�
P.M �p
0 ,.._,,,
•741
Revised February 7, 2019

Ap oved for the purposes of N.C.G.S. 143B-279.11
(Si nature of Re iona/ Supervisor)
Ronald H. Taraban
Regional Supervisor
Mooresville Regional Office
UST Section Division of Waste Management
Department of Environment Quality
NORTH CAROLINA I
:at4� I l COUNTY
I certify that the following person personally appeared before me this day, each
Acknowledging to that he signed the foregoing document:
Ronald H . Taraban (full printed name of Regional Supervisor)
Da L� rvo)
(official Seal) Sherian R. Black
Notary Public
���p�uun"rrun„�
Notary Public Number 20041820022
PN R. 8''yy.
�pTAigy ' . My commission expires:
MY July 12, 2024
COMMISSION EXPIRES
4VB00
l COX.

LEGEND
SUBJECT PROPERTY BOUNDARY LINE
TREE LINE
- — — — — — — - UNDERGROUND STORAGE TANK
f SOIL SAMPLE LOCATION
QF FILL PORT
Note:
1. This Site Map is based on data from the Mecklenburg
County, NC GIS office.
2. This site w anot professionally surveyed; site features and
utilities are approxlm.te
CHRUCHILL DR.
I
1 I
1
I ( 550 -Gallon
I
UST
SB 2-7' `SB-7-7
I _
1
i
GRASS
I
Area of Soil Contamination
5012
I
1 i
t
I�
1
I '
V ` TMEES�-,
L
o 15 30 so SITE MAP
012 Churchill Drive 5012 Churchill Drive
Incident No. N/A Charlotte Mecklenburg County,
( IN FEET) GRI Project No. 5295 NC
Geologico/ Resources, /nc. 1 inch =30 ft Date: 01/13/2020 1 Drawn by DTH I Figure: 1