NC0086517_Application_20150326

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number NC0086517
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise,please print or type.
1. Contact Information:
RECEIVED/DENR/DWR
Owner Name Gateway Village, LLC MAR 2 6 7 015
Facility Name Gateway Village
Water Quality
Mailing Address 800 West Trade Street Permitting Section
City Charlotte
State / Zip Code NC 28202
Telephone Number [phone]
Fax Number [phone]
[e-mail]
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same as abovelD
Street Address or State Road
City
State / Zip Code
County
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name Cousins Properties, Inc.
Mailing Address 800 West Trade Street
City Charlotte
State / Zip Code NC 28202
Telephone Number (704 )350-6200
Fax Number (704 )350-6201
4. Ownership Status:
Page 1 of 3 C-GW 03/05

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
Federal 0 State 0 Private ® Public 0
5. Products recovered:
Gasoline® Diesel fuel 0 Solvents ® Other
6. Number of separate discharge points: I.
Outfall Identification number(s) 001
7. Frequency of discharge: Continuous 0 Intermittent El
If intermittent:
Days per week discharge occurs: 7 Duration: Varies
8. Treatment System Design flow 0.05 MOD
9. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitudes
Irwin Creek
10. Please list all additives to the treatment system, including chemicals or nutrients, that have
the potential to be discharged.
Granulated Carbon
11. Is this facility located on Indian country? (check one)
Yes ❑ No El
12. Additional Information
All applicants (including renewal$
• A USGS topographical map (or copy of the relevant portion) which shows all outfalls
• A summary of the most recent analytical results (effluent data, if available) containing the
maximum values for each chemical detected
NEW Applicants only:
• Engineering Alternative Analysis
• Description of remediation treatment system components, capacities, and removal efficiency
for detected compounds.
• If the treatment system will discharge to a storm sewer, written approval from the
municipality responsible for the sewer.
• A list of any chemicals found in detectable amounts at the site, with the maximum observed
concentration reported for each chemical (the most recent sample must be collected less
than one year prior to the date of this application)
• For petroleum-contaminated sites-Analyses for Volatile Organic Compounds (VOC) should
be performed. Analyses for any fuel additives likely to be present at the site and for phenol
and lead should also be performed.
• For sites contaminated with solvents or other contaminants - EPA Method 624/625
analysis should be performed.
Page 2 of 3 C-GW 03105

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
13. Applicant Certification
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and elief such information is true, complete, and accurate.
36At�t,to-k ,J41 . o-rt. �Zeh4-e�"U
aiz kitHunter M. Hicks, P.E -A a Senior Engineer
Printed name of Person Signing Title
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Signature of Applicant Date
North Carolina General Statute 143-215.6 (b)(2) provides that: Any person who knowingly makes any false
statement representation, or certification in any application, record, report, plan, or other document files or
required to be maintained under Article 21 or regulations of the Environmental Management Commission
implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or
monitoring device or method required to be operated or maintained under Article 21 or regulations of the
Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section
1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both,
for a similar offense.)
Page 3 of 3 C-GW 03/05

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USGS Quad: G 15NE Charlotte, East, NC
Outfall Facility
Latitude: 35' 14' 4.2" N 350 14' 4.4" N
Longitude: 80° 51' 6" W 800 5 P 5.7" W
Stream Class: C
Subbasin:03-08-34 HUC:03050103
Receiving Stream: Unnamed tributary to Irwin Creek
Na•th Facility Location
Gateway Village NC0086517
Mecklenburg County

RESEARCh & ANALyTICAL
LAbORATORIES, INC. .7:I NC#34 = =
O ® Analytical/Process Consultations ��C ',�0iRgCtOP 5
March 5,2015
AMEC
2801 Yorkmont Road
Charlotte,NC 28208
Attention: Hunter Hicks
Chemical Analysis for Selected Parameters and Sampling Location Identified as Gateway Village
Miscellaneous Effluent
Parameters Unit Results
TSS mg/L <5.0
RAL Sample Number: 1373-01
Date Collected: 02/27/15
Time Collected: 0955
mg/L = milligrams per Liter=parts per million < = Less than or Below Detection Limit

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R ESEARCII & ANALyTICALStp
LAbORATORIES, INC. =c NCO*
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Chemical Analysis for Selected Parameters and Water Sample Identified as Gateway Village
(A AMEC-Charlotte Project, collected 27 February 2015)
1. Volatile Organics Quantitation Effluent
EPA Method 601 Limit
Parameter (me/L) (mg/L)
Tetrachloroethene 0.001 BQL
Cis 1,2-Dichloroethene 0.001 BQL
Dilution Factor 1
Sample Number 1373-01
Sample Date 02/27/15
Sample Time(hrs) 0955
mg/L =milligrams per Liter=parts per million(ppm) BQL = Below Quantitation Limits

Research & Analytical
Laboratories, Inc. CHAIN OF CUSTODY RECORD
Analytical /Process Consultations
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Wafer/Wastewater Misr.
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