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Home My WebLink AboutRA-493_1943_CA_RPTS_20201229_Recept Survey2725 East Millbrook Road Suite 121 Raleigh, NC 27604 Tel: 919-871-0999 Fax: 919-871-0335 www.atcgroupservices.com N.C. Engineering License No. C-1598 December 29, 2020 Mr. Mark Petermann North Carolina Department of Environmental Quality Division of Waste Management Underground Storage Tank Section 1646 Mail Service Center Raleigh, North Carolina 27699-1646 Re: Receptor Survey Report Wise Convenient Mart 2027 US Highway 1 North Wise, Warren County, North Carolina NCDEQ Incident No. 1943 ATC Project No. SLC0194301 Dear Mr. Petermann: ATC Associates of North Carolina, P.C. (ATC) is pleased to submit the results of a receptor survey for the former Wise Convenient Mart site located at 2027 US Highway 1 in Wise, Warren County, North Carolina. Figure 1 depicts the site on a topographic map and a site map is included as Figure 2. The survey was performed based on a November 5, 2020, Task Authorization (TA-01) by the Trust Fund Branch of the Underground Storage Tank (UST) Section, Division of Waste Management, North Carolina Department of Environmental Quality (NCDEQ). The work is being performed as part of the State Lead Contract # N122019A between NCDEQ and ATC. 1.0 SITE HISTORY & RECONNAISSANCE The site is a single-story brick building, formerly the Wise Convenient Mart (also known as the Wise Convenience Store). The parcel on which the site resides is approximately two acres and contains one mobile home (addressed as 106 Paynter Farm Road) and three houses addressed as 2011, 2017, and 2021 US Highway 1 North. In addition, the rear of the former Wise Convenient Mart building is an apartment. The former Wise Convenient Mart site operated two 550-gallon gasoline USTs. The USTs were reportedly removed on 1988, prior to UST regulations. The approximate locations of the USTs, based on conversations with the previous property owner, are shown on Figure 2. Receptor Survey Report December 29, 2020 Wise Convenient Mart, Incident #1943 ATC Project No SLC0194301 2 In May 2006, ATC submitted a Phase II Limited Site Assessment (LSA) documenting a receptor survey, the installation of five Type II monitoring wells (MW-1 through MW-5) and soil and groundwater analytical data. The LSA report identified eleven water supply wells within 1,000 feet of the site. ATC also installed a subsequent downgradient monitoring well (MW-6) in 2007. On November 11, 2010, Terraquest completed a Comprehensive Site Assessment (CSA) at the site. During this investigation, one additional Type II shallow monitoring well (MW-7) and a Type III deep monitoring well (DW-1) were installed at the site. During the investigation, approximately 0.75 feet of light non-aqueous phase liquid (LNAPL) was measured in MW-1. Between April 12 and 16, 2010, Terraquest conducted a mobile multi-phase extraction (MMPE) event at the site. During the event, 8,559 gallons of contaminated groundwater were recovered. A total of 708.15 pounds (approximately 131.38 gallons) of petroleum as gasoline were calculated to have been discharged as vapor. On October 22, 2012, Crawford Environmental Services (CES) collected groundwater samples from the monitoring well network. The laboratory analytical results of the groundwater samples indicated that several VOCs were detected in concentrations exceeding their respective 2L Standards in the samples collected from MW-1, MW-2, and MW-5. Five water supply wells were sampled (WSW-1, WSW-4, WSW-5A, and WSW-6). Concentrations of VOCs were detected in concentrations below their respective 2L Standards in the samples collected from water supply wells WSW-1, WSW-4 (post POE), and WSW-5A. On March 13, 2014, S&ME collected groundwater samples from seven groundwater monitoring wells (MW-2, MW-3, MW-4, MW-5, MW-6, MW-7, and DW-1) and six water supply wells (WSW-1, WSW-5A, WSW-6, WSW-7, WSW-8, and WSW-11). Monitoring well MW-1 contained approximately 0.25 inches of LNAPL and was not sampled. The laboratory analytical results of the groundwater samples indicated that several VOCs were detected in concentrations exceeding their respective 2L Standards in MW-5. In addition, benzene was also detected above the 2L Standard in monitoring wells MW-2 and MW-6. On March 13, 2014, S&ME collected water samples from. The laboratory analytical results of the water supply well samples indicated that MTBE was detected below the 2L Standard in WSW-1 and WSW-7 and 1,2-dichloroethane and di-isopropyl ether were detected below their respective 2L Standards in the water sample collected from WSW-5A. On August 18, 2017, S&ME submitted a Soil Sampling Report documenting the advancement of fifteen soil borings at the site. There were two separate UST areas associated with the site; one located on the northern end of the former store (soil borings B-1 through B-8) and one on the southern end of the former store (soil borings B-9 through B-15). The laboratory analytical results indicated that there were no detections of TPH-GRO in the soil samples collected from the area around the former UST on the northern end of the former store. Impacts in boring B-11 Receptor Survey Report December 29, 2020 Wise Convenient Mart, Incident #1943 ATC Project No SLC0194301 3 indicated exceedences of the Soil-to-Groundwater Maximum Soil Contaminant Concentrations (MSCCs). No samples indicated exceedences of the Residential or Industrial/Commercial MSCCs. The report recommended contacting the property owner (Mr. White) to facilitate water supply well abandonment and municipal water connections with well owners. In 2018, Warren County Public Utilities installed seven municipal water taps to the following addresses:  106 Paynter Farm Road  2011 US Highway 1 North – Unit 101  2011 US Highway 1 North – Unit 102  2017 US Highway 1 North  2021 US Highway 1 North  2027 US Highway 1 North (Store)  2027 US Highway 1 North (Apartment at rear of store) The above listed properties are owned by Mr. White and supplied water by water supply well WSW-1. ATC performed an updated receptor survey to confirm which properties had municipal water connections and will require final connection with a local plumber. 2.0 RECEPTOR INFORMATION 2.1 Water Supply Wells ATC conducted a water supply well survey in the surrounding vicinity of the site. As part of the survey, ATC performed the following:  On December 3, 2020, ATC mailed water supply well information forms to owners of properties within 1,000 feet of the site. As a result, eight letters were mailed out to six property owners. The survey followed the formatting outlined in the NCDEQ UST Guidelines for Assessment and Corrective Action. An example letter issued during the mailing event is included in Appendix A. In response to the mailing, ATC received three phone calls from property owners. No water supply well information sheets were returned.  ATC conducted a visual reconnaissance on November 21, 2020 and spoke with Mr. White to discuss the municipal connections and efforts to date. The reconnaissance was performed by driving and/or walking throughout the surrounding area and visually assessing the individual parcels of land for evidence of water supply wells, well houses, and/or water meters within a radius of 1,500 feet from the source area. Receptor Survey Report December 29, 2020 Wise Convenient Mart, Incident #1943 ATC Project No SLC0194301 4  ATC contacted Warren County Public Utilities to determine which properties within 1,000 feet of the site were connected to the city water system and which properties have meters. Water supply well information is included as Table 1 and potential receptors are presented in Figure 3. Field notes for the survey are included in Appendix B. Photographs are included in Appendix C. Based on ATC’s findings, it appears seven water supply wells used for potable purposes are located within 1,000 feet of the site (WSW-1, WSW-4, WSW-5, WSW-5A, WSW-7, WSW-8, and WSW-11). In addition, there are four water supply wells which are not in use or possibly abandoned/destroyed (WSW-3, WSW-6, WSW-9 and WSW-10) were identified. 2.2 Public Water Supplies ATC contacted Warren County Public Utilities to identify public water sources in the area. According to Warren County, municipal water is available to the site and surrounding properties. The source of the city’s drinking water is Kerr Lake. Based on conversations and correspondence with Warren County Public Utilities, the following properties were identified as having a water account. Water meters were not identified on some of these properties, as noted. Bold denotes a discrepancy between the information provided Warren County Public Utilities and the site observations and conversations with Mr. White is bold.  1989 US Highway 1 North – No account, not connected, no water meter observed (WSW-8)  2002 US Highway 1 North – Connected, active account, water meter observed (WSW-10)  2004 US Highway 1 North – Connected, active account, no water meter observed (WSW-11)  2007 US Highway 1 North – No account, not connected, no water meter observed (WSW-7)  2011 US Highway 1 North – Connected with two meters (duplex) observed, but accounts are inactive; according to property owner, there is no line from meter to duplex (WSW-1)  2017 US Highway 1 North – Connected, but account is inactive, water meter observed; according to property owner, there is no line from meter to residence (WSW-1)  2021 US Highway 1 North – Connected, but account is inactive, water meter observed; according to property owner, there is no line from meter to residence (WSW-1)  2027 US Highway 1 North – Connected - two meters, one for store and one for apartment. Store account is inactive, apartment account is active (WSW-1)  2041 US Highway 1 North – No account, not connected, no water meter observed (WSW-3 and WSW-4)  2049 US Highway 1 North – No account, not connected, no water meter observed (WSW-5)  106 Paynter Farm Road – Connected, but account is inactive, water meter observed, building used as office by tenant at 2021 US Highway 1 North (WSW-1) Receptor Survey Report December 29, 2020 Wise Convenient Mart, Incident #1943 ATC Project No SLC0194301 5 2.3 Surface Water In order to determine locations of the nearest surface water bodies in the vicinity of the site, ATC performed the following:  ATC reviewed a United States Geological Survey (USGS) Quadrangle Topographic Map;  ATC conducted a visual reconnaissance on November 21, 2020;  ATC reviewed the NCDEQ Division of Water Quality surface water map; and  ATC reviewed Warren County’s online Geographic Information Systems (GIS). Based on this evaluation, the nearest surface water body is an unnamed pond located 685 feet southwest of the source area. The surface water body is shown on Figure 1. 2.4 Wellhead Protection Areas According to the NCDEQ Wellhead Protection Program, the site is not located in a wellhead protection area as of the date of this report. 2.5 Deep Aquifers in the Coastal Plain According to the Geologic Map of North Carolina (1985) the referenced site is not located within the Coastal Plain physiographic region. 2.6 Subsurface Structures During the November 21, 2020, site reconnaissance, ATC surveyed the site and surrounding properties for subsurface utility lines. Based on the survey, utilities at the site and adjacent properties include water. ATC also noted overhead power and communication lines at the site. ATC reviewed tax property cards available on the Warren County GIS to determine the presence of subsurface structures at the site or on adjacent properties. At the time of the site reconnaissance, one residence was located on the site, an apartment at the rear of the store building. Based on the survey, structures on site and adjacent properties do not appear to extend beneath the subsurface (i.e. basements). 2.7 Land Use The site building is currently utilized as storage in the front part of the store building and residential in the rear portion. The surface cover at the site consists of gravel and grass. The site is zoned Agricultural-Residential (A-R). A mobile home and three additional residences are on the parcel Receptor Survey Report December 29, 2020 Wise Convenient Mart, Incident #1943 ATC Project No SLC0194301 6 that includes the site. A zoning map is included as Figure 4. Site photographs are included in Appendix C. 2.8 Adjacent Property Owners and Occupants The properties to the north and south consist of residences. The properties to the east and west of the site are agricultural. US Highway 1 North borders the site to the east. All of the surrounding properties are zoned Agricultural-Residential with the exception of Mike’s Tire which is zoned Neighborhood Business. There are no public assembly locations within 1,500 feet of the source area. Adjacent property ownership information is summarized on Table 2. A zoning map is included as Figure 4. A map depicting adjacent properties is included as Figure 5. 3.0 SITE CHARACTERISTICS 3.1 Regional Geology According to the Geologic Map of North Carolina (1985) produced by Philip Brown, et al, the referenced site is located within the Piedmont Province. More specifically, the site is underlain by Permian to Pennsylvanina granitic rock which is megacrystic to equigranular with instrusives. 3.2 Site Geology According to the United States Department of Agriculture - Soil Conservation Service Web- Based Soil Survey, the property is underlain with Vance sandy loam, 2 to 6 percent slopes, which is characterized as well drained, has a moderately low to moderately high capacity to transmit water, and originates from residuum weathered from granite and gneiss. Based on soil sampling performed in July 2017, soil at the site consisted of tan -orange silty sand from land surface to approximately three feet below ground surface (bgs), tan-orange-pink silty sand with traces of mica from 3 to 12 feet bgs, and orange-tan-light gray silty sand to sand from 12 to 25 feet bgs. 3.3 Regional Hydrogeology The occurrence and movement of groundwater in the Piedmont is within two separate but interconnected water-bearing zones. A shallow water-bearing zone occurs within the surficial soils and a deeper zone occurs within the underlying bedrock. Groundwater in the shallow soil zone occurs in the interstitial pore spaces between the grains comprising the surficial soils. Groundwater in this zone is typically unconfined. Groundwater movement is generally lateral from recharge areas to small streams that serve as localized discharge points. The occurrence and movement of groundwater in the underlying water-bearing zone within the Receptor Survey Report December 29, 2020 Wise Convenient Mart, Incident #1943 ATC Project No SLC0194301 8 Attachments: Table 1 – Water Supply Well Information Table 2 – Adjacent Property Ownership Information Figure 1 – Site Topographic Map Figure 2 – Site Map Figure 3 – Potential Receptor Map Figure 4 – Zoning Map Figure 5 – Adjacent Properties Map Appendix A – Water Supply Well Information Example Letter Appendix B – Field Notes Appendix C – Current Site Photographs Appendix D – Limited Site Assessment Risk Classification and Land Use Form TABLES TABLE 1 WATER SUPPLY WELL INFORMATION WISE CONVENIENT MART 2027 US HIGHWAY 1 WISE, WARREN COUNTY, NORTH CAROLINA INCIDENT #1943 Well ID Property Address Property Identification Number Well Owner Well Use Connected to Municipal Water Municipal Tap Distance from Source Area (ft.) Up or Down Gradient 2011 US Highway 1 North Connected to municipal water, but account is inactive. Duplex with two water meters. No lines between duplex units and water meters. 300 feet south-southwest Upgradient 2017 US Highway 1 North Connected to municipal water, but account is inactive. No line between house and water meter. 300 feet south-southwest Upgradient 2021 US Highway 1 North Connected to municipal water, but account is inactive. No line between house and water meter. 300 feet south-southwest Upgradient 2027 US Highway 1 North Connected to municipal water. One account is active (apartment) and one is inactive (store). The store portion of the building is used as storage. 300 feet south-southwest Upgradient 106 Paynter Farm Road Connected to Municipal water, but account is inactive. Currently used as office by occupant of 2021 US Highway 1 N. 300 feet south-southwest Upgradient WSW-2 2027 US Highway 1 2040131169 Abandoned See above Not Applicable Site Site WSW-3 2041 US Highway 1 2040030515 Inactive Within plume Not Applicable WSW-4 2041 US Highway 1 2040030515 Potable 165 feet northwest Downgradient WSW-5 2049 US Highway 1 2030945267 Willie Felts, Jr. 2049 US Highway 1 Norlina, NC 27563 Phone Number Not Available Potable No No 350 feet north Downgradient WSW-5A 2061 US Highway 1 2040042185 Willie Felts, Jr. P.O. Box 255 Norlina, NC 27563 Phone Number Not Available Potable 900 feet northwest Downgradient WSW-6 2061 US Highway 1 2040038915 Willie Felts, Jr. P.O. Box 255 Norlina, NC 27563 Phone Number Not Available Did not see well at this location 600 feet north (based on map location from S&ME) Downgradient WSW-7 2007 US Highway 1 2040122925 Joe and Mary Ann Hunt P.O. Box 153 Wise, NC 27594 252-456-4256 Potable No No 450 feet south Upgradient WSW-8 1989 US Highway 1 2040123522 Willie Felts, Jr. P.O. Box 255 Norlina, NC 27563 Phone Number Not Available Potable No No 800 feet south Upgradient WSW-9 1971 US Highway 1 204012079 Ashley and Stuart White 807 Rooker Dairy Road Norlina, NC 27563 252-213-0336 Abandoned No No structures on property 1,150 feet south-southeast Upgradient WSW-10 2002 US Highway 1 2040125855 Ashley and Stuart White 807 Rooker Dairy Road Norlina, NC 27563 252-213-0336 Not in Use Yes Connected to municipal water, meter observed 600 feet southeast Upgradient WSW-11 2004 US Highway 1 2040135011 Judith H. Sammons 2004 US Highway 1 North Norlina, NC 27563 Phone Number Not Available Potable Unsure Connected to water according to municipality; however, no water meter observed. Mr. White indicated property not connected. 540 feet southeast Upgradient No Connected to water according to municipality; however, no water meter observed Ashley and Stuart White 807 Rooker Dairy Road Norlina, NC 27563 252-213-0336 Walter (Wayne) and Joanne Paynter 2041 US Highway 1 Norlina, NC 27563 252-213-1331 WSW-1 2027 US Highway 1 2040131169 Potable Yes No TABLE 2 ADJACENT PROPERTY OWNERSHIP INFORMATION WISE CONVENIENT MART 2027 US HIGHWAY 1 NORTH WISE, WARREN COUNTY, NORTH CAROLINA NCDEQ INCIDENT #1943 Map Identification Number Property Address Property Owner PIN Number Parcel Use Zoning Status Site 2027 US Highway 1 North Ashley and Stuart White 807 Rooker Dairy Road Norlina, NC 27563 252-213-0336 2040131168 Residential Warren County A-R (Agricultural- Residential) 1 2021 US Highway 1 North Ashley and Stuart White 807 Rooker Dairy Road Norlina, NC 27563 252-213-0336 2040131168 Residential Warren County A-R (Agricultural- Residential) 2 2041 US Highway 1 North Walter and Joanne Paynter 2041 US Highway 1 North Norlina, NC 27563 Phone Number Not Available 2040030515 Residential and Wooded Warren County A-R (Agricultural- Residential) 3 Unaddressed Parcel on Paynter Farm Road Malvin Dorsey Capps P.O. Box 281 Norlina, NC 27563 Phone Number Not Available 2030929769 Agricultural Warren County A-R (Agricultural- Residential) 4 2007 US Highway 1 North Joe and Mary Ann Hunt P.O. Box 153 Wise, NC 27594 Phone Number Not Available 2040122925 Residential Warren County A-R (Agricultural- Residential) 5 Unaddressed Parcel on US Highway 1 North Hal A. White, Jr. & Others 807 Rooker Dairy Road Norlina, NC 27563 252-213-0336 2040231925 Agricultural Warren County A-R (Agricultural- Residential) Notes: Map identification numbers correspond with Figure 4 . FIGURES 2725 E. Millbrook Road, Suite 121 Raleigh, NC 27604 (919) 871-0999 FIGURE 1 SITE TOPOGRAPHIC MAP PROJECT NO: SLC0194301 REVIEWED BY: GA SCALE: As shown DATE: 12/2020 WISE CONVENIENT MART –INCIDENT #1943 2027 US HIGHWAY 1 NORTH WISE, NORTH CAROLINA Source: Google Earth SITE 2725 E. Millbrook Road, Suite 121 Raleigh, NC 27604 (919) 871-0999 FIGURE 2 SITE MAP PROJECT NO: SLC0194301 REVIEWED BY: GA SCALE: As shown DATE: 12/2020 WISE CONVENIENT MART –INCIDENT #1943 2027 US HIGHWAY 1 NORTH WISE, NORTH CAROLINA Source: March 2, 2016 S&ME Groundwater Monitoring Report Site Parcel Former Wise Convenient Mart Former UST Former UST Water meters (3) for: 2027 US Hwy 1 N –Store 2027 US Hwy 1 N –Apartment 106 Paynter Farm Road –Office Water lines present from meters to structures Water meter (1) for: 2021 US Hwy 1 N –Residence No water lines present from meter to structure Water meters (3) for: 2017 US Hwy 1 N –Residence 2011 US Hwy 1 N –Duplex No water lines present from meters to structures 2725 E. Millbrook Road, Suite 121Raleigh, NC 27604(919) 871-0999FIGURE 3POTENTIAL RECEPTOR SURVEY MAPPROJECT NO: SLC0194301REVIEWED BY: AWSCALE:As ShownDATE: 12/2020WISE CONVENIENT MART–INCIDENT #19432027 US HIGHWAY 1 NORTHWISE, HWARRENCOUNTY, NORTH CAROLINASource: Warren County GIS 500 Foot Radius 1,000 Foot Radius 1,500 Foot Radius LEGEND: N Impacted Area Site WSW-1 WSW-2 WSW-3 WSW-4 WSW-11 WSW-10WSW-7 WSW-5 WSW-5A WSW-6 WSW-8 WSW-9 Active Potable Water Supply Well Abandoned Water Supply Well Inactive Water Supply Well 2725 E. Millbrook Road, Suite 121 Raleigh, NC 27604 (919) 871-0999 FIGURE 4 ZONING MAP PROJECT NO: SLC0194301 REVIEWED BY: GA SCALE: As shown DATE: 12/2020 WISE CONVENIENT MART –INCIDENT #1943 2027 US HIGHWAY 1 NORTH WISE, NORTH CAROLINA Source: Warren County, NC Geographic Information System Site Parcel Agricultural Residential (A-R) Neighborhood Business (N-B) Neighborhood Business (N-B) 2725 E. Millbrook Road, Suite 121 Raleigh, NC 27604 (919) 871-0999 FIGURE 5 ADJACENT PROPERTIES MAP PROJECT NO: SLC0194301 REVIEWED BY: GA SCALE: As shown DATE: 12/2020 WISE CONVENIENT MART –INCIDENT #1943 2027 US HIGHWAY 1 NORTH WISE, NORTH CAROLINA Source: Warren County, NC Geographic Information System Site Parcel 1 Former Wise Convenient Mart 2 3 4 5 APPENDIX A WATER SUPPLY WELL INFORMATION EXAMPLE LETTER 2725 East Millbrook Road Suite 121 Raleigh, NC 27604 Tel: 919-871-0999 Fax: 737-207-8261 www.atcgroupservices.com N.C. Engineering License No. C-1598 Water Supply Well Information Former Wise Convenient Mart 2027 US Highway 1 North Wise, Warren County, North Carolina NCDEQ Incident No: 1943 An investigation of groundwater quality is in progress at the Former Wise Convenient Mart site located at 2027 US Highway 1 North, Wise, Warren County. Your property located at: Address:2049 US Highway 1 North Parcel ID Number: December 3, 2020 Willie Felts, Jr. P.O. Box 255 Norlina, NC 27563 Re: To Whom It May Concern: 2030945267 is located within 1,000 feet of the above referenced site. Because of the groundwater investigation, the North Carolina Department of Environmental Quality (NCDEQ) is requesting information regarding possible water supply well(s) located on your property. Please complete and return the attached Water Supply Well Information Form using one of the methods specified on the attached form. Sincerely, ATC Associates of North Carolina, P.C. Elizabeth A. Allyn Project Manager Incident Name:Former Wise Convenient Mart Incident Number:1943 Name: Telephone # of person completing survey: Address of property receiving survey:2049 US Highway 1 North Parcel No.:2030945267 Wise, Warren County, North Carolina City County What is the source of your drinking water? (mark all that are applicable) Public Water Water Supply Well Stream Intake Other Explain other: Is there a water supply well on this property:Yes No If "NO" disregard remaining questions May ATC collect a sample from your water supply well? Yes No Name and Address of owner(s) of property with water supply well How many water supply wells are on your property? What is the well(s) used for? (check all that apply) Drinking ________Irrigation ________Swimming Pool _______Water Livestock __________ Other (Specify) _______Don't use well _______ How many residences are connected to the well (list addresses below)? How deep is the well(s)?Date well(s) Installed? What is the casing depth of the well(s)? What is the screen interval of the well(s)? Additional water supply Information: 5. E-mail to liz.allyn@atcgs.com Please Provide the following Information (to the best of your knowledge) Please return completed survey to ATC Associates of N.C., P.C. as soon as possible using one of the following methods: 1. Fax to 737-207-8261 2. Mail to Liz Allyn, ATC Associates, 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604 3. Telephone 919-573-1198 4. Text a picture of the form(s) to: 919-418-0279 APPENDIX B FIELD NOTES APPENDIX C CURRENT SITE PHOTOGRAPHS Current Site Photographs Wise Convenient Mart Incident #1943 2027 US Highway 1 North Wise, Warren, North Carolina Photo 1: View of site (facing northwest). Photo 2: Monitoring well MW-1 (facing northwest). Current Site Photographs Wise Convenient Mart Incident #1943 2027 US Highway 1 North Wise, Warren, North Carolina Photo 3: Water meters associated with 2027 US Highway 1 North (one for store and one for apartment) and mobile home behind store (106 Paynter Farm Road) facing west. Photo 4: Water meter associated with 2021 US Highway 1 North (facing west). Current Site Photographs Wise Convenient Mart Incident #1943 2027 US Highway 1 North Wise, Warren, North Carolina Photo 5: Water meters associated with 2011 US Highway 1 North (duplex) and 2017 US Highway 1 North (facing west). Photo 6: Water supply well WSW-7 located at 2007 US Highway 1 North (facing west). APPENDIX D LIMITED SITE ASSESSMENT RISK CLASSIFICATION AND LAND USE FORM Part I - Groundwater/Surface water/Vapor Impacts High Risk 1. purposes?YES/NO/UNKNOWN 2. YES/NO 3. YES/NO 4. YES/NO 5. YES/NO 6 YES/NO Intermediate Risk 7. Is a surface water body located within 500 feet of the source area of the discharge or release? YES/NO An unnamed pond located 685 feet southwest of the site 8. YES/NO 9. YES/NO 10. YES/NO GCLs have not been exceeded; however, light non-aqueous phase liquid was detected in March 2014. Risk Classification and Land Use Form Is a water supply well used for drinking water located within 1,000 feet of the source area the discharge or release? Has the discharge or release contaminated any water supply well including any used for non-drinking Is a water supply well used for any purpose (e.g., irrigation, washing cars, industrial cooling water, filling swimming pools) located within 250 feet of the source area of the release or discharge? Does groundwater within 500 feet of the source area of the discharge or release have the potential for future use in that there is no other source of water supply other than the groundwater? Do vapors from the discharge or release pose a threat of explosion because of accumulation of the vapors in a confined space or pose any other serious threat to public health, public safety or the environment? Is the discharge or release located in the Coastal Plain physiographic region as designated on a map entitled “Geology of North Carolina” published by the Department in 1985? Are there any other factors that would cause the discharge or release to pose an imminent danger to public health, public safety, or the environment? Do the levels of groundwater contamination for any contaminant exceed the gross contamination levels established by the Department. Is the sources area of the discharge or release located within a designated wellhead protection area as defined in 42 USC 300h-7(e)? Page 1 of 3 Part II - Land Use Property Containing Source Area of Discharge or Release The questions below pertain to the property containing the source area of the release. 1. Does the property contain one or more primary or secondary residences (permanent or temporary)? YES/NO Explain.One permanent single-family residence (apartment) is located on the property. 2. YES/NO Explain.The property is residential. 3. YES/NO Explain.The front of the store building is used for storage currently, but has historically been used for commercial purposes. 4. Do children visit the property? YES/NO Explain. It is possible children visit this property as it is a residence. 5. Is access to the property reliably restricted consistent with its use (e.g., by fences, security personnel or both)? YES/NO Explain. The site property is unrestricted. 6. Do pavement, buildings, or other structures cap the contaminated soil? YES/NO Explain. The estimated area of the former UST basin is overlain by grass and gravel. Not Applicable 7. What is the zoning status of the property? The site property is zoned for Agricultural-Residential (A-R). 8 Is the use of the property likely to change in the next 20 years? YES/NO Although the specified use of the property may change in the next 20 years, due to the current zoning, the site will likely continue to be used for residential/agricultural purposes. Does the property contain a school, daycare center, hospital, playground, park, recreation area, church, nursing home, or other place of public assembly? Does the property contain a commercial (e.g., retail, warehouse, office/business space, etc.) or industrial (e.g., manufacturing, utilities, industrial research and development, chemical/petroleum bulk storage, etc.) enterprise, an inactive commercial or industrial enterprise, or is the land undeveloped? If yes, what mechanisms are in place or can be put into place to ensure that the contaminated soil will remain capped in the foreseeable future? Page 2 of 3 Property Surrounding Source Area of Discharge or Release 1. The nearest residence is located west-adjacent to the source area. 2. There are no public assembly locations within 1,500 feet of the source area. 3.What is the zoning status of properties in the surrounding area? The surrounding properties are zoned Agricultural-Residential (A-R). 4.Briefly characterize the use and activities of the land in the surrounding area. The surrounding properties consist of residential properties, wooded land, and agricultural land. What is the distance from the source area of the release to the nearest school, daycare center, hospital, playground, park, recreation area, church, nursing home or other place of public assembly? What is the distance from the source area of the release to the nearest primary or secondary residence (permanent or temporary)? The questions below pertain to the area within 1500 feet of the source area of the discharge or release (excludes property containing source area of the release): Page 3 of 3