NC0090204_Fact Sheet_20231024

NCDEQ / DWR / NPDES
FACT SHEET - NPDES PERMIT DEVELOPMENT
NEW NPDES Permit NCO090204
Siying Chen, Expedited Permitting and Compliance Unit July 17, 2023
Facility Information
Applicant
The Charlotte -Mecklenburg Hospital Authority
c/o Kimley Horn and Associates
Facility Name
The Pearl - Culvert Construction Excavation GW-REM
Applicant/Facility Contact
Bennett Thompson, VP of Real Estate [Bennett. Thompson@atriumheal th. org]
Facility Mailing Address
P.O. Box 32861, Charlotte, NC 28232
Project Location
Baxter Street and South McDowell Street rights -of -way, Charlotte,
Mecklenburg Count
EAA Preparer
Geosyntec Consultants of NC, P.C.
Alessandra Braswell, PhD, PE [[e-mail]]
Treatment Operator
Jake Dyer [[e-mail]]
Permitted Flow (MGD)
0.144 MGD
Type of Waste
Treated Groundwater (excavation dewatering)
Facility Class
PC-1
County
Mecklenburg
Facility Status
NEW
Regional Office
MRO
Stream Characteristics
Receiving Stream
UT to Little Sugar
Creek
Stream Classification
C
Stream Segment
11-137-8
Drainage basin
Catawba River Basin
Summer 7Q10 (cfs)
34
Subbasin
03-08-34
Winter 7Q10 (cfs)
55
Use Supporting
No
30Q2 (cfs)
87
303(d) Listed?
Yes — Benthos, Fish
Community
Average Flow (cfs)
—
IWC = 100 %
Instream Waste
[discharge to storm-
USGS Topo Quad
Charlotte East
Concentration
sewer
(IWC) %
inlet = "zero -flow"
conditions]
Fact Sheet - NPDES Permit NCO090204
Page 1 of 10

1. Background
Kimley-Horn and Associates, Inc. (KHA), on behalf of The Charlotte -Mecklenburg Hospital Authority,
is redeveloping properties located at 801 South McDowell Street and 801, 900, 928, and 943 Baxter
Street in Charlotte, North Carolina. The proposed site is under the North Carolina Department of
Environmental Quality (NCDEQ) Brownfields Program (No. 25032-21-060).
Charlotte Water has applied for a similar NPDES permit (NC0089923) for their dewatering activities, as
their site is directly adjacent to this KHA site, groundwater characteristics are anticipated to be identical,
and installation of an equivalent treatment system is planned. According to materials provided in the
Charlotte Water application, the properties appear to have existed as an urban area, generally developed
with a mix of commercial, residential, and undeveloped parcels since 1929. Previous assessments
indicate that two contaminant plumes have impacted soils and groundwater beneath Baxter Street related
to historic dry-cleaning operations (chlorinated solvents) and underground storage tank releases.
Investigations as early as 1997 have consistently detected several constituents above the Title 15A North
Carolina Administrative Code (NCAC) Subchapter 02L.0202 groundwater standards (2L Standards):
carbon tetrachloride (CT), tetrachloroethene (PCE), and trichloroethene (TCE). Civil & Environmental
Consultants, Inc. (CEC) performed groundwater sampling in March 2019 and found that PCE and
toluene levels have been higher than the 2L Standards and the Title 15A NCAC 02B surface water
standards. Geosyntec conducted a groundwater investigation in August 2021 and June 2022 and found
only PCE, TCE, and carbon tetrachloride are above the 2L Standard at that time.
2. Project Description
The project will consist of the construction of a culverted surface water feature, micro -tunneling to provide
for the installation of underground utilities, and the decommissioning of the existing culvert. Accumulated
groundwater from trenches, access pits, and boreholes will be pumped out and treated via a HERIC
Solutions Dewatering System before discharging into storm sewers currently under the responsibility of the
City of Charlotte. The storm sewers are tributaries to an unnamed tributary of the Little Sugar Creek, part of
the Sugar Creek Watershed.
The HERIC Solutions Dewatering System is a 100 GPM Mobile Treatment System. This system utilizes a
weir tank separator for mass solids settling and removal along with multiple -stage particulate filtration.
Metals are removed via ion exchange and carbon adsorption. A low -profile air stripper and pH
adjustment are also included as part of the system.
Dewatering and treatment activities are estimated to last approximately twelve (12) months. The collection,
treatment, and discharge of treated groundwater will be terminated once construction activities performed
below the groundwater table are completed.
Fact Sheet - NPDES Permit NCO090204
Page 2 of 10

3. Receiving Stream Evaluation
Little Sugar Creek and its UTs by association are currently classified C waterbodies located within the
Catawba River Basin. Little Sugar Creek is listed by the Division as impaired [2022 North Carolina 303
(d) List] for Benthos and Fish Community.
Little Sugar Creek 11-137 S C 14.2 FW Miles
1411 From NC 51 to North Carolina -South Carolina State Line
PARAMETER IR CATEGORY CRITERIA STATUS REASON FOR RATING 303D YEAR
Benthos (Nar, AL, FM 0 I Exceedi nit Criteria I Farr, Poor or severe Bioelassification 199
Fish Community (Nar, AL, FW) 0 Exceedin Criteria Farr, Poor or Severe Bioclassification 29
In accord with statewide NPDES permitting guidance, any discharge to a storm -sewer inlet is deemed
zero flow and therefore may afford no dilution to the effluent [15A NCAC 0213.0206 (d)].
4. DWR Evaluation of Proposed Discharge
Contaminants of Concern (COCs). The Division considered a list of COCs as site -assessment data
provided by the Applicant as analytes "believed to be present" [see application package for table of
Summary of Detection and details provided by Pace Analytical Services, LLC]. DWR has added
monitoring Monthlv for these organic and inorganic analytes (see permit Section A. (1.)). Metals require
effluent monitoring for Total Hardness to established compliance with EPA guidelines for metals in
dissolved fraction [see 9. EPA Metals Evaluation — for Total Hardness below].
In addition to analytes "believed to be present," DWR has added Monthly monitoring for suites of
analytes as a comprehensive spot-check for organic compounds:
• Total Purgeable Organic Compounds, EPA 624.1
• Base -Neutral Acids (Semi -Volatile Organics), EPA Method 625.1
5. Establishing Compliance & Permit Limits
The Applicant proposes to discharge from an onsite Groundwater Treatment System to an established
storm -sewer inlet along Baxter Street, and then conveyed to a storm -sewer tributary to the Little Sugar
Creek. Because this outfall discharges to a storm -sewer inlet, the Division will assume zero flow receiving -
stream conditions offering no dilution, per NPDES permitting guidance statewide. Permit limits therefore
reflect Contaminants of Concern (COCs) based on analytes identified by the Applicant as "known to be
present" [See EPA Application form 2D].
CoCs that are believed resent:
Parameter
CAS #
ProposeLimits
Limit Reference
Carcinogen?
Barium
7440-39-3
21,000
In -stream Target - Aquatic Life
No
& Secondary Recreation
Fact Sheet - NPDES Permit NCO090204
Page 3 of 10

Arsenic
7440-38-2
10
02B - Fish Consumption
Yes
Cadmium*
7440-43-9
02B - Hardness dependent
N/A
Chromium*
7440-47-3
02B - Hardness dependent for Cr-
N/A
III and Cr VI
Copper*
7440-50-8
02B - Hardness dependent
N/A
Lead*
7439-92-1
02B - Hardness dependent
N/A
Mercury
7439-97-6
0.012
02B - Aquatic Life & Secondary
N/A
Recreation
Nickel*
7440-02-0
02B - Hardness dependent
No
Selenium
7782-49-2
5
02B - Aquatic Life & Secondary
N/A
Recreation
Zinc*
7440-66-6
02B - Hardness dependent
N/A
1,2-cis-
156-59-2
720
In -stream Target - Fish
No
Dichloroeth lene
Consumption
Tetrachloroethylene
127-18-4
3.3
02B - Fish Consumption
N/A
PERC,PCE
Benzene
71-43-2
51
02B - Fish Consumption
Yes
Ethylbenzene
100-41-4
97
In -stream Target - Aquatic Life
N/A
& Secondary Recreation
Naphthalene
91-20-3
12
In -stream Target - Aquatic Life
N/A
& Secondary Recreation
Styrene
100-42-5
Toluene
108-88-3
11
02B - Aquatic Life & Secondary
N/A
Recreation
1,2,3-Trichloropropane
96-18-4
0.001
In -stream Target - Fish
Yes
Consumption
Total xylene
1330-20-7
670
In -stream Target - Aquatic Life
No
& Secondary Recreation
m&p-xylene
108-38-3
420
In -stream Target - Aquatic Life
N/A
& Secondary Recreation
o-xylene
95-47-6
600
In -stream Target - Aquatic Life
N/A
& Secondary Recreation
Trichloroeth lene
79-01-6
30
02B - Fish Consumption
Yes
Trichlorofluoromethane
75-69-4
67,000
In -stream Target - Fish
No
Consumption
Acetone
67-64-1
2,000
In -stream Target - Aquatic Life
No
& Secondary Recreation
Carbon Tetrachloride
56-23-5
1.6
02B - Fish Consumption
Yes
Chloroform
67-66-3
2,000
EPA NRWQC - Fish
N/A
Consumption
1,2-dichloroethane
107-06-2
650
EPA NRWQC - Fish
Yes
Consumption
1,2-trans-
156-60-5
4 000
EPA NRWQC - Fish
N/A
dichloroeth lene
Consumption
Trichloroethylene
79-01-6
30
02B - Fish Consumption
Yes
TCE
Di-n-butyl phthalate
84-74-2
9.5
In -stream Target - Aquatic Life
N/A
DBP
& Second Recreation
*Hardness dependent
Fact Sheet - NPDES Permit NCO090204
Page 4 of 10

Reasonable Potential Analyses (RPAs) -- Current databases reflect site -assessment from monitoring
wells and soil borings only. Therefore, in the absence of treated discharge data, no RPA was conducted.
Whole Effluent Toxicity (WET) Testing -- Whole Effluent Toxicity (WET) testing is included as Acute,
Monthly, Monitoring and Report only [TAA6C]. WET testing is required for the duration of the permit.
6. Engineering Alternatives Analysis (EAA)
The application considered other technologically feasible alternatives as the following:
• Land application: not feasible due to land constraints as this site is in the urban area of Charlotte,
nearby properties are currently valued at $4-10 million per acre
• Connecting to an existing WWTP: Chapter 23 of the City of Charlotte Sewer Use Ordinance at
Section 23-79(b)(14) indicates that the POTW owned and operated by the City do not accept
groundwater discharges without specific authorization
• Waste disposal: a local waste disposal company DART quoted the amount of disposal and
treatment of groundwater would be approximately $21 million
Wastewater reuse: not feasible because the project will be under construction during the period
of discharge, and therefore have no applicable options to reuse the water onsite
The applicant prepared a Present Value of Cost Analysis and the estimates are as below:
• Connection to an existing WWTP - $20,128,521
• Land application - $70,403,609
• Surface water discharge - $2,070,118
Charlotte -Mecklenburg Storm Water Services approves the discharge of treated groundwater from this
remediation site.
7. Comment Received On Draft Permit
No comment received on draft permit.
8. Changes To Final Permit
No change to final permit.
9. EPA Metals Evaluation — for Total Hardness
NPDES Implementation of Instream Dissolved Metals Standards — Freshwater Standards
The NC 2007-2015 Water Quality Standard (WQS) Triennial Review was approved by the NC
Environmental Management Commission (EMC) on November 13, 2014. The US EPA subsequently
Fact Sheet - NPDES Permit NCO090204
Page 5 of 10

approved the WQS revisions on April 6, 2016, with some exceptions. Therefore, metal limits in draft
permits out to public notice after April 6, 2016 must be calculated to protect the new standards - as
approved.
Tablel. NC Dissolved Metals Water Quality Standards/Aquatic Life Protection
Parameter
Acute FW, µg/l
(Dissolved)
Chronic FW, µg/l
(Dissolved)
Acute SW, µg/l
(Dissolved)
Chronic SW, µg/l
(Dissolved)
Arsenic
340
150
69
36
Beryllium
65
6.5
---
---
Cadmium
Calculation
Calculation
40
8.8
Chromium III
Calculation
Calculation
---
---
Chromium VI
16
11
1100
50
Copper
Calculation
Calculation
4.8
3.1
Lead
Calculation
Calculation
210
8.1
Nickel
Calculation
Calculation
74
8.2
Silver
Calculation
0.06
1.9
0.1
Zinc
Calculation
Calculation
90
81
Table 2 Notes:
1. FW= Freshwater, SW= Saltwater
2. Calculation = Hardness dependent standard
3. Only the aquatic life standards listed above are expressed in dissolved form. Aquatic life
standards for Mercury and selenium are still expressed as Total Recoverable Metals due to
bioaccumulative concerns (as are all human health standards for all metals). It is still necessary
to evaluate total recoverable aquatic life and human health standards listed in 15A NCAC
2B.0200 (e.g., arsenic at 10 µg/l for human health protection; cyanide at 5 µg/L and fluoride at
1.8 mg/L for aquatic life protection).
Table 3. Dissolved Freshwater Standards for Hardness -Dependent Metals
The Water Effects Ratio (WER) is equal to one unless determined otherwise under 15A NCAC
02B .0211 Subparagraph (11)(d)
Metal
NC Dissolved Standard, /l
Cadmium, Acute
WER* { 1.136672-[ln hardness] (0.041838)} eA 10.9151 [In
hardness] -3.1485
Cadmium, Acute Trout
waters
WER*11.136672-[ln hardness] (0.041838)} eA10.9151[In
hardness] -3.6236
Cadmium, Chronic
WER*{1.101672-[In hardness] (0.041838)} eA10.7998[ln
hardness] -4.4451
Chromium III, Acute
WER*0.316 • e^ 0.8190[ln hardness] +3.725 61
Chromium III, Chronic
WER*0.860 e^ 0.8190 In hardness +0.6848
Copper, Acute
WER*0.960 e^ 0.9422 In hardness]- 1.700
Copper, Chronic
WER*0.960 e^ 0.8545[ln hardness]-1.702
Lead, Acute
WER*{1.46203-[ln hardness](0.145712)} • e^{1.273[ln hardness]-
1.460
Fact Sheet - NPDES Permit NC0090204
Page 6 of 10

Lead, Chronic
WER*{1.46203-[ln hardness](0.145712)} • eAl1.273[ln hardness]-
4.705
Nickel, Acute
WER*0.998 e^
0.8460[ln hardness] +2.25 51
Nickel, Chronic
WER*0.997 e^
0.8460 In hardness +0.0584
Silver, Acute
WER*0.85 • e Al
1.72[ln hardness]-6.59
Silver, Chronic
Not applicable
Zinc, Acute
WER*0.978 e^
0.8473[ln hardness] +0. 8 841
Zinc, Chronic
WER*0.986 e^
0.8473[ln hardness] +0. 8 841
General Information on the Reasonable Potential Analysis (RPA)
The RPA process itself did not change as the result of the new metals standards. However, application of
the dissolved and hardness -dependent standards requires additional consideration in order to establish
the numeric standard for each metal of concern of each individual discharge.
The hardness -based standards require some knowledge of the effluent and instream (upstream) hardness
and so must be calculated case -by -case for each discharge.
Metals limits must be expressed as `total recoverable' metals in accordance with 40 CFR 122.45(c). The
discharge -specific standards must be converted to the equivalent total values for use in the RPA
calculations. We will generally rely on default translator values developed for each metal (more on that
below), but it is also possible to consider case -specific translators developed in accordance with
established methodology.
RPA Permitting Guidance/WOBELs for Hardness -Dependent Metals - Freshwater
The RPA is designed to predict the maximum likely effluent concentrations for each metal of concern,
based on recent effluent data, and calculate the allowable effluent concentrations, based on applicable
standards and the critical low -flow values for the receiving stream.
If the maximum predicted value is greater than the maximum allowed value (chronic or acute), the
discharge has reasonable potential to exceed the standard, which warrants a permit limit in most cases. If
monitoring for a particular pollutant indicates that the pollutant is not present (i.e. consistently below
detection level), then the Division may remove the monitoring requirement in the reissued permit.
To perform a RPA on the Freshwater hardness -dependent metals the Permit Writer compiles the
following information:
• Critical low flow of the receiving stream, 7Q 10 (the spreadsheet automatically calculates
the 1 Q 10 using the formula 1 Q 10 = 0.843 (s7Q 10, cfs) 0.993
• Effluent hardness and upstream hardness, site -specific data is preferred
• Permitted flow
• Receiving stream classification
2. In order to establish the numeric standard for each hardness -dependent metal of concern and for
each individual discharge, the Permit Writer must first determine what effluent and instream
(upstream) hardness values to use in the equations.
Fact Sheet - NPDES Permit NC0090204
Page 7 of 10

The permit writer reviews DMR's, Effluent Pollutant Scans, and Toxicity Test results for any
hardness data and contacts the Permittee to see if any additional data is available for instream
hardness values, upstream of the discharge.
If no hardness data is available, the permit writer may choose to do an initial evaluation using a
default hardness of 25 mg/L (CaCO3 or (Ca + Mg)). Minimum and maximum limits on the
hardness value used for water quality calculations are 25 mg/L and 400 mg/L, respectively.
If the use of a default hardness value results in a hardness -dependent metal showing reasonable
potential, the permit writer contacts the Permittee and requests 5 site -specific effluent and
upstream hardness samples over a period of one week. The RPA is rerun using the new data.
The overall hardness value used in the water quality calculations is calculated as follows:
Combined Hardness (chronic) _
(Permitted Flow, cfs *Avg. Effluent Hardness, mg/L) x (s7Q 10, cfs *Avg. Upstream Hardness, mg/L)
(Permitted Flow, cfs + s7Q 10, cfs)
The Combined Hardness for acute is the same but the calculation uses the IQ 10 flow.
3. The permit writer converts the numeric standard for each metal of concern to a total recoverable
metal, using the EPA Default Partition Coefficients (DPCs) or site -specific translators, if any
have been developed using federally approved methodology.
EPA default partition coefficients or the "Fraction Dissolved" converts the value for
dissolved metal at laboratory conditions to total recoverable metal at in -stream
ambient conditions. This factor is calculated using the linear partition coefficients
found in The Metals Translator: Guidance for Calculating a Total Recoverable
Permit Limit from a Dissolved Criterion (EPA 823-B-96-007, June 1996) and the
equation:
Cdiss - 1
Ctotal 1 + { [Kpo] [SS(1+a)] [10-6]
Where:
ss = in -stream suspended solids concentration [mg/1], minimum of 10 mg/L used,
and Kpo and a = constants that express the equilibrium relationship between
dissolved and adsorbed forms of metals. A list of constants used for each hardness -
dependent metal can also be found in the RPA program under a sheet labeled DPCs.
4. The numeric standard for each metal of concern is divided by the default partition coefficient (or
site -specific translator) to obtain a Total Recoverable Metal at ambient conditions.
In some cases, where an EPA default partition coefficient translator does not exist (ie. silver), the
dissolved numeric standard for each metal of concern is divided by the EPA conversion factor to
obtain a Total Recoverable Metal at ambient conditions. This method presumes that the metal is
Fact Sheet - NPDES Permit NC0090204
Page 8 of 10

dissolved to the same extent as it was during EPA's criteria development for metals. For more
information on conversion factors see the June, 1996 EPA Translator Guidance Document.
5. The RPA spreadsheet uses a mass balance equation to determine the total allowable
concentration (permit limits) for each pollutant using the following equation:
Ca = (s7Q 10 + Qw) (Cwqs) - (s7Q 10) (Cb)
Qom'
Where: Ca = allowable effluent concentration (µg/L or mg/L)
Cwqs = NC Water Quality Standard or federal criteria (µg/L or mg/L)
Cb = background concentration: assume zero for all toxicants except NH3* (µg/L or
mg/L)
Qw = permitted effluent flow (cfs, match s7Q 10)
s7Q 10 = summer low flow used to protect aquatic life from chronic toxicity and human
health through the consumption of water, fish, and shellfish from noncarcinogens (cfs)
* Discussions are on -going with EPA on how best to address background concentrations
Flows other than s7Q 10 may be incorporated as applicable:
IQ 10 = used in the equation to protect aquatic life from acute toxicity
QA = used in the equation to protect human health through the consumption of water,
fish, and shellfish from carcinogens
30Q2 = used in the equation to protect aesthetic quality
6. The permit writer enters the most recent 2-3 years of effluent data for each pollutant of concern.
Data entered must have been taken within four and one-half years prior to the date of the permit
application (40 CFR 122.21). The RPA spreadsheet estimates the 95th percentile upper
concentration of each pollutant. The Predicted Max concentrations are compared to the Total
allowable concentrations to determine if a permit limit is necessary. If the predicted max exceeds
the acute or chronic Total allowable concentrations, the discharge is considered to show
reasonable potential to violate the water quality standard, and a permit limit (Total allowable
concentration) is included in the permit in accordance with the U.S. EPA Technical Support
Document for Water Quality -Based Toxics Control published in 1991.
7. When appropriate, permit writers develop facility specific compliance schedules in accordance
with the EPA Headquarters Memo dated May 10, 2007 from James Hanlon to Alexis Strauss on
40 CFR 122.47 Compliance Schedule Requirements.
8. The Total Chromium NC WQS was removed and replaced with trivalent chromium and
hexavalent chromium Water Quality Standards. As a cost savings measure, total chromium data
results may be used as a conservative surrogate in cases where there are no analytical results
based on chromium III or VI. In these cases, the projected maximum concentration (95th %) for
total chromium will be compared against water quality standards for chromium III and
chromium VI.
9. Effluent hardness sampling and instream hardness sampling, upstream of the discharge, are
inserted into all permits with facilities monitoring for hardness -dependent metals to ensure the
accuracy of the permit limits and to build a more robust hardness dataset.
Fact Sheet - NPDES Permit NCO090204
Page 9 of 10

10. Hardness and flow values used in the Reasonable Potential Analysis for this permit included:
Table 4
Parameter
Value j
Comments (Data Source)
Average Effluent Hardness (mg/L)
[Total as, CaCO3 or (Ca + Mg)]
TBD
Average Upstream Hardness (mg/L)
[Total as, CaCO3 or (Ca + Mg)]
?
TBD
7Q 10 summer (cfs)
0.0
Discharge to storm sewer
1 Q 10 (cfs)
0.0
Permitted Flow (MGD)
0.144
Outfall 001
Fact Sheet - NPDES Permit NC0090204
Page 10 of 10

AFFIDAVIT OF PUBLICATION
Account #
Order Number
Idef0cation
Order PO
Amount
Cols
Depth
28386
450044
Print Legal Ad-IPL01334790 - IPLO133479
$971.92
2
38 L
Attention: Wren Thedford
NCDENR/DWO/POINT SOURCE
1617 MAIL SERVICE CENTER
RALEIGH, NC 276991677
[e-mail]
-------------------------------------------------------------------------------
Public Notice
North Carolina Environmental Management Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a NPDES Wastewater Permit N00090115 Camden Ex-
change, and N00090204 The Peal Culvert Construction Excavation GW-REM
The North Carolina Environmental Management Commission proposes to issue
a NPDES wastewater discharge permit to the person(s) listed below. Written
comments regarding the proposed permitwill be accepted until 30 days after the
publish date of this notice. The Director of the NC Division of Water Resources
(DWR) may hold a public hearing should there be a significant degree of pub-
lic interest. Please mail comments and/or information requests to DWR at the
above address. Interested persons may visit the DWR at 512 N. Salisbury Street,
Raleigh, NC 27604 to review the information on file. Additional information on
NPDES permits and this notice may be found on our website: https:l/deq.nc.gov/
public-notices-hearings,or by calling [phone]. Catalyst Capital Partners
has applied for an NPDES Permit iN00090115] for Camden Exchange located at
1600 & 1614 Camden Road and 109 & 115 West Park Avenue, Charlotte 28203
to discharge treated dewatering wastewater to a Ur to Irwin Creek. Catawba
River Basin. Water -quality limited parameters include Total Barium, Total Mercu-
ry, 1.1-dichlorcethylene, 1,2-dichloroethane, Benzene, Diisopropyl ether, Naph-
thalene, Phenolic Compounds, and Toluene. This discharge may affect future
allocations in this segment of Irwin Creek. Comments will be accepted up to 30
days from the date this notice is published. The Charlotte -Mecklenburg Hospital
Authority has applied for an NPDES Permit INC0090204] for The Pearl - Culvert
Construction Excavation kxxted at Baxter Street and South McDowell Street,
Charlotte 28204 to discharge treated dewatering wastewater to a UT to Little
Sugar Creek, Catawba River Basin. Water -quality limited parameters include
Total Arsenic, Total Barium, Total Mercury, Total Selenium, 1,2-cis-dichloroeth-
ylene, 1,2-dichlorcethane, 1,2-trans-dichlorcethylene, 1,2,3-trichloropropane,
Trichlorofluoromethane, Acetone, Benzene, Carbon Tetrachloride, Chloroform,
Di-n-butyl phthalate, Ethylbenzene, Naphthalene. Tetrachloroethylene, Toluene,
Trichloroethylene, and Xylene. This discharge may affect future allocations in
this segment of Little Sugar Creek. Comments will be accepted up to 30 days
from the date this notice is published.
IPLO133479
Jul 30 2023
North Carolina } SS
Mecklenburg County }
Before the undersigned, a Notary Public of said
County and State, duly authorized to administer
oaths affirmations, etc., personally appeared,
being duly sworn or affirmed according to law,
cloth depose and say that he/she is a
representative of The Charlotte Observer
Publishing Company, a corporation organized and
doing business under the laws of the State of
Delaware, and publishing a newspaper known as
The Charlotte Observer in the city of Charlotte,
County of Mecklenburg, and State of North
Carolina and that as such he/she is familiar with
the books, records, files, and business of said
Corporation and by reference to the files of said
publication, the attached advertisement was
inserted. The following is correctly copied from
the books and files of the aforesaid Corporation
and Publication.
1 insertion(s) published on:
07/30/23
In Testimony Whereof I have hereunto set my hand
and affixed my seal on the 31st day of July,2023
Notary Public in and for the state of Texas, residing in
Dallas County
;_; •"ter; STEPHA:1E1RiAT:C1H1R
' ' • My Notarya> Aires „26
Extra charge for lost or duplicate affidavits.
Legal document please do not destroy!

From: Alessandra Braswell
To: Chen, Sivina; Ben nett.Thompson(c atriumhealth.org
Cc: Pitner, Andrew; Weaver, Charles; Moore, Cindv; Farmer, Richard L
Subject: [External] RE: NPDES Permit Issuance - The Pearl - Culvert Construction Excavation (NC0090204)
Date: Tuesday, October 24, 2023 9:19:56 AM
Attachments: image001.pnng
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the
Report Message button located on your Outlook menu bar on the Home tab.
Hello Ms. Chen,
Thank you! We have received and are able to download and save the document.
Regards,
Alessa
Alessandra Smolek Braswell, Ph.D., P.E. (NC)
Senior Engineer
--------------------------------------
Geosyntec Consultants, Inc.1
Geosyntec Consultants of NC, P.C.2
314 Walnut Street, Suite 200
Wilmington, NC 28401
Direct: 910.372.6403
Mobile: [phone]
www.geos)lntec.com
1—Services Outside of North Carolina
2—Services Inside North Carolina
From: Chen, Siying <[e-mail]>
Sent: Monday, October 23, 2023 4:35 PM
To: [e-mail]
Cc: Pitner, Andrew <[e-mail]>; Weaver, Charles <[e-mail]>;
Moore, Cindy <[e-mail]>; Alessandra Braswell <[e-mail]>;
Farmer, Richard L <[e-mail]>
Subject: NPDES Permit Issuance -The Pearl - Culvert Construction Excavation (NC0090204)
CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you
recognize the sender and know the content is safe. If you have any suspicion, please confirm with the sender
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Hi Mr. Thompson,
Attached is the final NPDES permit renewal for The Pearl - Culvert Construction Excavation

(NC0090204). The permit will be effective on December 1, 2023.
Please respond to this email confirming that you received the attached document, were able to
open and view the document and have saved/printed a copy for your records.
Thankyou!
Siying (Sylvia) Chen (she/her/hers)
Environmental Specialist II, Division of Water Resources
North Carolina Department of Environmental Quality
Office: [phone]
si)�[e-mail]
E Q
tal;
NORTH CAROLINA
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third
parties by an authorized state official.

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
In
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Legend N Site Map
Site Monitoring Wells • Outfall 001 Streams
Abandoned Site Monitoring Wells - - - Storm Sewer Tributary Former Domestic Laundry Brownfields Project
BF# 25032-21-060
Other Wells Q Site Parcels Charlotte, North Carolina
} Private Wells Q Proposed Treatment System
1. Property boundaries and existing stream from Mecklenburg County GIS. Geosyntec° Ccusyn[crCoi,sulLai sUfN!".RC Figure
2. Proposed Treatment System location is approximate and not to scale.
300 150 0 300 Feet iiisttltcrrits
3. Wells are shown from Mecklenburg County Well Information System.
1
Charlotte, NC December 2022
Z:\GIS\Projects\K\Kimley Horn\Lookout\MXD\CAR220216 NPDES Permit Rg1_SiteMap_20221202.mxd 12/7/2022 12:17:53 PM

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
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BF# 25032-21-060
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Private Wells
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Well Information System. Charlotte, NC December 2022
\\charlotte-01\data\GIS\Projects\K\Kimley Horn\Lookout\MXD\CAR220216 NPDES Permit\Fig1_Property Map_202211.mxd 11/14/2022 10:38:59 AM

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1F
Pace AnaSyticaI Services, LLC
• 9800 Kinsey Ave. Suite 100
aceAmlytical Huntersville, NC 28078
w#wPw&wb&0" [704)8754092
SUMMARY OF DETECTION
Project.
Pace Project No..
Baxter St Assessment
92421696
Lab Sample ID
Client Sample 10
Method
Parameters
Resul!
Units
Report Limit
Analyzed qualifiers
92421696001
MW-35
EPA 8260D
ds-1,2-Dichloroethene
2.7
uglL
1.0
03/20/19 07:22
EPA 8260D
Tetrachloroethene
28.8
ug1L
1.0
03/20/19 07:22
92421696002
MW-45
EPA 82600
Tetrachloroethene
1.2
ug/L
1.0
03/20/19 07:40
92421696003
MW55
EPA 8260D
Benzene
37.1
uglL
5.0
03/25/19 12:45
EPA 8260D
Ethylbenzene
789
ug/L
5.0
03/25/19 12.45
EPA 8260D
Naphthalene
401
ug/L
5.0
03/25/19 12:45 M1
EPA 8260D
Styrene
7.0
ug/L
5.0
03/25/19 12;45
EPA 8260D
Toluene
153
ug/L
5.0
03/25/19 12.45
EPA 8260D
1,2,3-Trichloropropane
8.5
ug/L
5.0
03/25/19 12:45
EPA 8260D
Xylene (Total)
1430
ug1L
5.0
03/25/19 12.45
EPA 8260D
m&p-Xylene
887
ug1L
10.0
03/25/19 12A5
EPA 8280D
o-Xylene
543
ug/L
5.0
03/25/19 12:45
92421696004
MW-6
EPA 8260D
cis- 1.2-DichIoroethene
19,0
uglL
1.0
031201190T.59
EPA8260D
Tetrachloroethene
28.5
ug1L
1,0
0312011907.59
EPA 8260D
Trichloroethene
8.6
ug/L
1.0
03/20119 07.59
92421696006
MW-8S
EPA 8260D
cis- 1.2-DichIoroethene
2.9
ug1L
1.0
03/20119 08:35
EPA 8260D
Tetrachloroethene
93A
uglL
1.0
03120/19 0815
EPA 8260D
Trichlorofluoromethane
1.4
ug/L
1.0
03/20119 08:35
92421696009
TMW-17
EPA 8260❑
Acetone
94A
ug)L
25.0
03/20/19 09:12
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in fui1.
without the written consent of Pace Analytical Services_ LLC.
Page 4 of 38

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1F
Table 2
Analaytical Data - Most Recent Groundwater Results
Former Domestic Laundry Brownfields Property
Charlotte, Mecklenburg County, North Carolina
Well ID
MW-02D MW-03D
MW-04D
MW-06 and DUP
MW-08D
MW-09
MW-10
MW-11
MW-12
MW-13
MW-15
MW-16
MW-17
Screened Interval (ft bgs)
Top
Bottom
45 45
50 50
40
45
10
25
40
45
15
30
15
30
21
36
10
25
15
21.5
9
19
6
16
12.5
22.5
Analvte
Units
Date Sampled
15A NCAC 02L
Groundwater
Standards(µg/L)
8/27/2021* 8/26/2021
<1.05
8/26/2021
<1.03
8/27/2021*
<0.991
8/27/2021
<1.08
8/26/2021
<1.02
8/25/2021*
<0.989
8/27/2021
<1.06
8/26/2021
<1.01
8/27/2021
<1.08
6/3/2022
6/3/2022
<2.93
6/3/2022
Semi -volatile Organic Compounds (SVOCs) by EPA Method 8270E
2-chlorophenol µg/L 0.4
Benz(a)anthracene
µg/L
0.05
-0.211
<0.205
<0.198
<0.217
<0.204
<0.198
<0.212
<0.202
<0.215
<0.586
Benzo(a) pyrene
µg/L
0.005
0.211
<0.205
<0.198
<0.217
<0.204
<0.198
<0.212
<0.202
<0.215
<0.586
Benzo(b)fluoranthene
µg/L
0.05
--0.211
<0.205
<0.198
<0.217
<0.204
<0.198
<0.212
<0.202
<0.215
<0.586
Bis(2-chloroisopropyl) ether
µg/L
NC
<1.05
<1.03
<0.991
<1.08
<1.02
<0.989
<1.06
<1.01
<1.08
<2.93
Bis(2-ethylhexyl) phthalate
µg/L
3
<5.27
<5.14
<4.96
<5.42
<5.11
<4.95
<5.3
<5.06
<5.38
-
<14.6
Caprolactam
µg/L
4,000
<I.OS
<1.03
<0.995 - 0.617.1
<1.08
<1.02
<0.989
<1.06
<1.01
<1.08
Q.93
Dibenz(a,h)anthracene
µg/L
0.005
--0.211
<0.205
<0.198
<0.217
<0.204
<0.198
<0.212
<0.202
<0.215
<0.586
Di-n-butyl phthalate
µg/L
700
1.01
<1.05
<1.03
<0.991
<1.08
<1.02
<0.989
<1.06
<1.01
<1.08
22.5
Hexachlorobenzene
µg/L
0.02
1.01
<1.05
<1.03
<0.991
<1.08
<1.02
<0.989
<1.06
<1.01
<1.08
<2.93
Hexachlorobutadiene
µg/L
0.4
1.01
<1.05
<1.03
<0.991
<1.08
<1.02
<0.989
<1.06
<1.01
<1.08
<2.93
Indeno(1,2,3-c,d)pyrene
µg/L
0.05
).202
<0.211
<0.205
<0.198
0.217
<0.204
<0.198
<0.212
<0.202
<0.215
<0.586
Pentachlorophenol
µg/L
0.3
5.06
<5.27
<5.14
<4.96
5.42
<5.11
<4.95
<5.3
<5.06
<5.38
<14.6
Phenol
µg/L
30
<1.01
<1.05
<1.03
<0.99'
1.08
<1.02
<0.989
<1.06
<1.01
<1.08
0.394J
Volatile Organic Compounds (VOCs) by EPA Method 8260D
1,1,2,2-tetrachloroethane
µg/L
0.2
1,2-dibromo-3-chloropropane
µg/L
0.04
1,2-dibromoethane
µg/L
0.02
1,2-dichloroethane
µg/L
0.4
1,2-dichloropropane
µg/L
0.6
<I
Acetone
mg/L
6
,,.01
<0.0 i
<0.01 - 0.00595J
0.00642J,B
<0.01
<u.a
0.00736J
8.09J
T61 J
Bromodichloromethane
µg/L
0.6
<I
<1
<I
<I
<1
<1
<I
<1
Carbon tetrachloride
µg/L
0.3
<1
14.7
<1
<1
<
<I
<1
<I
<1
<1
Chlorodibromomethane
µg/L
NC
<1
<1
<1
<1
<1
<1
<1
<I
<1
<1
<1
<1
Chloroform
µg/L
70
3.17
3.01
6.03B
<1
2.89
1.66B
0.849J
0.882J
1.00
I
0.35J
0.643J
0.9091
cis-1,2-dichloroethene
µg/L
70
<1
<1
1
3.63 - 4.31
1.16
<1
<1
21.0
<1
4.04
0.697J
<l
<1
cis-1,3-dichloropropene
µg/L
0.4
<1
<1
<1
<1
<1
<1
<1
<I
<1
<1
<1
<1
<1
Ethylbenzene
µg/L
600
<1
<I
<1
<1
<1
0.224J,B
<1
<1
<1
<1
<1
<1
<1
Styrene
µg/L
70
<1
<1
<1
<1
<1
0.46J,B
<1
<1
<1
<1
<1
<1
<1
Trichloroethene
µg/L
3
<1
<1
0.916J
1.78 - 2.4
0.437J
<1
<1
8.39
<1
0.857J
<1
<1
<1
Tetrachloroethene
µg/L
0.7
<0.5
5.49
392
7.29 - 8.33
40.6
1.29
<0.5
31.4
<0.5
2.14
2.27
<0.5
<0.5
trans-1,2-dichloroethene
µg/L
100
<1
<1
<1
<1
<1
0.777J
<1
<1
<1
<1
<1
trans-1,3-dichloropropene
µg/L
0.4
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
Trichlorofluoromethane
µg/L
2,000
4.96
3.57
1.51
<1
2.07
<1
<1
<1
<1
<1
<1
0.594J
0.751J
Vinyl chloride
µg/L
0.03
<1
'
1
<1
<1
<1
<1
<1
<1
Resource Conservation and Recovery Act (RCRA) Metals by EPA Methods 6020B and 7470A
Barium
I µg/l-
1 700
1 57.5
42.4 - 45.4
25.4
7 -
49.6
Selenium
I µg/l-
1 20
1 1.33J
7.52 - 7.87
1
1
1 <2.50
-
<2.50
1 -
Notes:
1. Groundwater 2L Standards refer to the Title 15A North Carolina Administrative Code (NCAC) Subchapter 2L .0202 Groundwater Quality Standards, effective June 2020.
2. Only constituents that were detected above the Method Detection Limit (MDL) in at least one monitoring well are shown, along with constituents where the Reporting Limit (RL) exceeded the 2L Standard.
3. Black text concentrations are detected above the laboratory MDL.
FGrey highlighted values indicate that the MDL is greater than the Groundwater 2L Standards'
5. Concentrations highlighted in yellow indicate exceedances of the Groundwater 2L Standards.
6. µg/L indicates micrograms per liter.
7. fit bgs indicates feet below ground surface.
8. NC indicates there is no corresponding 2L Standard.
9. J indicates estimated concentration above the laboratory MDL and below the Reporting Limit (RL).
10. B indicates compound was detected in the method blank.
11. < indicates analyte not detected above the RL indicated.
12. * indicates the metals sample was collected on a different date (6/3/2022 for AM-02D and 6/2/2022 for MW-06 and MW-10).
13. (DUP) indicates duplicate sample.
Geosyntec Consultants of NC, P.C. Page 1 of 1 November 2022

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1F
Ira�a�laa�
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did—
PumE�t ' 01gT
Pum, O g4
ubmersible Pump
Shallow Tray System
Blower
Pump i/Pump 2
Pump 31 Pump
Particle Filters
Pressure Switch
pH Sensor
Metal Exchange
Vessel
Carbon Vessel
Flowmeter/Totalizer
Godwin
M3-OutiPT0
3'Dutlet
11p, 1-PM1, 230V
GED4-Tray Model
Dwyer19501HIgblLowl Pressure SwiMM1
Continuous I —el IF Tree in Cie. PVC
SIgM1t Glass
Cincinnati Fan
Mode1HPE
].5Hn 3-PM1, T30V
Goulds Pump
Mode130SPH40
3Hp, -Pd, T30V
.4'Impelbr
Goulds Pump
Mode138F1H5BOH
35 pZ3-PM1, T30V
Impelbr
Rosedab
Duad CM1amber
Size xTStr.—
vented Covers
EPDM Seals
Dwyer
MoISI DXW-11-153-1
Brass FitMd
Flouroelactamer Wetted Palls
NEM A 4%, 114'NPT Fine
Signet lT]T4L0
In- floe Flatp—near
WA500-PGN Data -Logger
Celdii Remote Access
Fiberglass Unils
T ,000 Id capacity
6'Topl5ottom- ieigs
HS-T50Media ResF
Flberglass Unils
1,0001b capacity
6'ToplBottom openings
Wrgin Coconut Carbon
DlscM1arge MebriF311c:
Signet 3-T53]-5CP0
iNg-1-e-711:
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Dlgita133L Flowmebr
{
H
I-IEFtlC SOLUTIONS. LLC
PO Box548
Indian Trail, NC T8o79
98o-7T1-2841
Mobile Treatment Unit
P & ID
Design Maximum Flow Rate - 100 GPM
Updated 11/14/22 by ECD
'Mobile Treahrent UniC' as pictetl in thls "PSID" Is to be
U[ilizetl for The Pearl b b&y Heric Solu[iom, LLC.

DocuSign Envelope ID: DC16609F-3BE4-4DA3 B280 4788DEAE2E1F
CONTAMINATED ON SITE GROUNDWATER
DEWATERING & TREATMENT SERVICES
MASS
EXCAVATIONS
TUNNELS AND
LAUNCH SHAFTS
f f
_
rr
TURNKEY SERVICES OFFERRED:
Various system types for multiple
contamination sources
Design and project logistics support
NPDES Permit assistance
Fabrication & on -site setup
Full site operation support
Remote telemetry support & alarm response
System maintenance
System sample collection & analysis
SYSTEM EXAMPLES ON NEXT RAGES
CAISSONS &
UTILITY
ACCREDITATIONS:
Licensed Physical/Chemical Operator in Charge
Licensed North Carolina GC (Unclassified)
Licensed South Carolina GC
Licensed Virginia Class A GC
Fully Insured w/ Pollution Liability Coverage
28 years dewatering experience in over 12 States
CONTACT:
ERIC DONNELLY
[phone]
[e-mail]

Docuj Envelope ID: DC16609F-3BE4-4DA3-B280 4788DEAE2Elr
a
100 GPM MOBILE TREATMENT SYSTEM
i
SYSTEM FEATURES:
100 gpm capacity for 24/7
automated operation
Weir tank separator for mass solids
settlement & removal
Multiple stages of particle filtration
Low profile air stripper
pH balancing
Metal adsorption — ion exchange
Carbon adsorption
Full touch screen controls with
remote telemetry and datalogging
Fully contained with lighting,
ventilation and security
rREarmeNroVERwew
,a„,,,�„ RFJpTE DPER4TOR
. 1
TI '
v wr
■
CONTACT:
ERIC DONNELLY
[phone]
[e-mail]

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number Facility Name
Outfall Number
Form Approved 03/05/19
New Facility Sewer Excavation GW-REM
001
OMB No. 2040-0004
TABLE A. CONVENTIONAL AND
NON•
•
1
Effluent Data
Intake Water
Maximum Daily
Average Daily
Source of Information
Believed Present?
Pollutant
Waiver
Requested
Units
(if applicable)
Discharge
Discharge
(use codes in instructions)
(check only one response per
(required)
(if available)
parameter)
❑
Check here if you have applied to your NPDES authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1'
Biochemical oxygen
Concentration
4
El Yes
El No
demand (BOD5)
Mass
4
2
Chemical oxygen demand
❑
Concentration
4
❑ Yes
❑ No
(COD)
Mass
4
3
Total organic carbon
❑
Concentration
4
❑
❑
(TOC)
Yes
No
Mass
4
4
Total suspended solids
❑
Concentration
mg/L
26.4
<4.02
3
❑
❑
(TSS)
Yes
No
Mass
Ibs
31.7
<4.83
3
Concentration
4
5.
Ammonia (as N)
❑
❑ Yes
0 No
Mass
4
6.
Flow
❑
Rate
MGD
0.144
0.144
3
❑ Yes
0 No
Temperature (winter)
❑
°C
°C
4
7.
❑ Yes
0 No
Temperature (summer)
❑
°C
°C
4
pH (minimum)
❑
Standard units
S.U.
6.39
6.39
3
8.
❑ Yes
0 No
pH (maximum)
❑
Standard units
S.U.
8.93
8.93
3
SamDlina shall be conducted accordina to sufficiently sensitive test procedures (i.e.. methods) approved under 40 CFR 136
for the analvsis of oollutants or oollutant
parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-21D (Revised 3-19) Page 1

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
This page intentionally left blank.

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
Facility Name
Outfall Number
Form Approved 03/05/19
New Facility
Sewer Excavation GW-REM
001
OMB No. 2040-0004
TABLE B. CERTAIN CONVENTIONAL
AND NON•
• '• 1
Presence or Absence
Estimated Data for Pollutants Expected to be Present or Limited by an ELG
(check one)
(Provide both concentration and mass estimates for eachpollutant.)
Pollutant
Effluent
Intake Water
Maximum Daily
Average Daily
Source Information
Believed Present?
Believed
Believed
Present
Absent
Units
Discharge
Discharge
(use codeess in instructions)
(check only one
(required)
if available
response per item)
❑
Check (✓) here if you believe all pollutants listed to be absent from the discharge. You need not complete Table B for the noted outfall unless you have quantitative data available.
1'
Bromide
❑
❑
Concentration
4
❑Yes❑
Mass
(24959-67-9)
No
2
Chlorine, total
❑
❑
Concentration
4
❑
Mass
residual
Yes No
Concentration
4
3.
Color
❑
❑✓
❑ Yes ✓❑ No
Mass
Concentration
4
4.
Fecal coliform
❑
❑✓
❑ Yes No
Mass
5
Fluoride
❑
❑
Concentration
4
❑Yes❑
Mass
(16984-48-8)
No
Concentration
4
6.
Nitrate -nitrite
❑
❑✓
❑ Yes ✓❑ No
Mass
7
Nitrogen, total
❑
❑
Concentration
4
❑
Mass
organic (as N)
Yes No
8.
Oil and grease
❑✓
❑
Concentration
mg/L
<5.8
<5.5
3
❑ Yes ❑ No
Mass
Ibs
<7.0
<6.7
9
Phosphorus (as P),
❑
❑
Concentration
4
❑ 0
Mass
total (7723-14-0)
Yes No
10.
Sulfate (as SO4)
❑
❑
Concentration
4
El El
Mass
(14808-79-8)
Yes No
Concentration
4
11.
Sulfide (as S)
❑
❑✓
❑ Yes ✓❑ No
Mass
All concentration data reported at less that the detection limit was assumed to be at the detection limit for the purposes of
EPA Form 3510-2D (Revised 3-19) estimation. Estimates (3 - Data from similar plants) are based on discharge monitoring data from permit # NCO089923 and Page 3
are from October 2021 to September 2022.

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
Facility Name
Outfall Number
Form Approved 03/05/19
New Facility
Sewer Excavation GW-REM
001
OMB No. 2040-0004
TABLE B. CERTAIN CONVENTIONAL
AND NON•
• '• 1
Presence or Absence
Estimated Data for Pollutants Expected to be Present or Limited by an ELG
(check one)
(Provide both concentration and mass estimates for eachpollutant.)
Pollutant
Effluent
Intake Water
Maximum Daily
Average Daily
Source Information
Believed Present?
Believed
Believed
Present
Absent
Units
Discharge
Discharge
(use codeess in instructions)
(check only one
re uired
if available
response per item)
12.
Sulfite (as S03)
❑
Concentration
4
❑Yes❑
Mass
14265-45-3
( )
No
Concentration
4
13.
Surfactants
❑
✓❑
❑ Yes No
Mass
14.
Aluminum, total
❑
Concentration
4
El Yes 0 No
Mass
7429-90-5
( )
15.
Barium, total
❑
Concentration
ug/L
0.542
<0.080
3 and 5- detected in
El 0
Mass
Ibs
0.000651
<0.0000961
(7440-39-3)
groundwater
Yes No
16.
Boron, total
❑
❑
Concentration
4
❑ Yes ✓❑ No
Mass
(7440-42-8)
17.
Cobalt, total
❑
0
Concentration
4
❑Yes❑ No
Mass
7440-48-4
( )
18
Iron, total
❑
❑
Concentration
4
❑ Yes '❑ No
Mass
(7439-89-6)
19
Magnesium, total
❑
❑
Concentration
4
❑ Yes No
Mass
(7439-95-4)
20
Molybdenum, total
❑
❑
Concentration
4
❑
Mass
(7439-98-7)
Yes No
21
Manganese, total
❑
❑
Concentration
4
❑ Yes ❑s No
Mass
(7439-96-5)
22.
Tin total
❑
IZI
Concentration
4
El Yes 0 No
Mass
7440-31-5
( )
EPA Form 3510-21D (Revised 3-19) Page 4

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
Facility Name
Outfall Number
Form Approved 03/05/19
New Facility
Sewer Excavation GW-REM
001
OMB No. 2040-0004
TABLE B. CERTAIN CONVENTIONAL
AND NON•
• '• 1
Presence or Absence
Estimated Data for Pollutants Expected to be Present or Limited by an ELG
(check one)
(Provide both concentration and mass estimates for eachpollutant.)
Effluent
Intake Water
Pollutant
Believed
Believed
Maximum Daily
Average Daily
Source Information
Believed Present?
Present
Absent
Units
Discharge
Discharge
(use codeess in instructions)
(check only one
re uired
if available
response per item)
23.
Titanium, total
❑
Concentration
4
El 0
Mass
7440-32-6
( )
Yes No
24.
Radioactivity
Concentration
4
24.1
Alpha, total
❑
❑✓
❑ Yes No
Mass
24.2
Beta, total
❑
0
Concentration
4
❑ Yes Z No
Mass
24.3.
Radium, total
❑
0
Concentration
4
❑ Yes Z No
Mass
24.4
Radium 226, total
❑
Concentration
4
❑ Yes 0 No
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-21D (Revised 3-19) Page 5

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DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number Facility Name Outfall Number Form Approved 03/05/19
New Facility Sewer Excavation GW-REM 001 OMB No.2040-0004
TOXIC•TAL CYANIDE, AND TOTAL PHENOLS1
Presence or Absence Estimated Data for Pollutants Expected to be Present in Discharge
check one Provide both concentration and mass estimates for each pollutant.
Pollutant
(CAS Number, if available)
Believed
Present
Believed
Absent
Effluent
Intake Water
Units
Maximum
Daily
Discharge
(required)
Average
Daily
Discharge
if available
Source of Information
(Use codes in Instructions.)
Believed Present.
(Check only one
response per pollutant.)
Check (✓) here if you believe all pollutants listed to be absent from the discharge. You need not complete Table C for the noted outfall unless you have quantitative data
available.
1.
Antimony, Total
(7440-36-0)
Concentration
4
El Yes
❑ No
Mass
2.
Arsenic, Total
(7440-38-2)
Concentration
ug/L
0.0159
<0.005
3
El Yes
❑ No
Mass
Ibs
0.0000191
<0.000006
3.
Beryllium, Total
(7440-41-7)
Concentration
4
El Yes
❑ No
Mass
4.
Cadmium, Total
(7440-43-9)
Concentration
ug/L
<O.UU4
<U.UU2
3
El Yes
❑ No
Mass
Ibs
<0.000005
<0.00OOO2
5.
Chromium, Total
(7440-47-3)
Concentration
ug/L
<O.UU5
<O.00z
3
El Yes
0 No
Mass
Ibs
<U.0000Ub
<U.00uuu3
6.
Copper, Total
(7440-50-8)
Concentration
ug/L
O.U293
<0.006
3
El Yes
❑ No
Mass
Ibs
0.0000352
<0.000007
7.
Lead, Total
(7439-92-1)
Concentration
ug/L
<O.00b
<O.002
3
El Yes
❑' No
Mass
Ibs
<0.000007
<0.00OOO2
8.
Mercury, Total
(7439-97-6)
Concentration
ug/L
<U.O002
<U.00Oz
3
El Yes
❑� No
Mass
Ibs
<U.00OOOOz
<O.5000002
9.
Nickel, Total
(7440-02-0)
Concentration
ug/L
<O.UUS
<U.UUS
3
El Yes
❑ No
Mass
Ibs
<O.Uuuuub
<0.000006
10.
Selenium, Total
(7782-49-2)
❑
Concentration
5- Detected in
__
❑ Yes
❑' No
Mass
11.
Silver, Total
(7440-22-4)
Concentration
4
El Yes
❑ No
Mass
12.
Thallium, Total
(7440-28-0)
Concentration
4
El Yes
El No
Mass
13.
Zinc, Total
(7440-66-6)
Concentration
ug/L
U.O924
<U.02
3
El Yes
❑ No
Mass
Ibs
0.Oouiii
<O.00002
14.
Cyanide, Total
(57-12-5)
Concentration
4
❑Yes
❑ No
Mass
15.
Phenols, Total
❑
Concentration
5 - Detected in
❑ Yes
0 No
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See Instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2D (Revised 3-19) Page 7

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
This page intentionally left blank.

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
Discharge
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
❑
Check here if all pollutants listed in Table D are expected to be absent from your facility's discharge.
❑
Check here if the facility believes it is exempt from Table D reporting requirements because it is a qualified small business. See the instructions for exemption criteria and for a list
of materials you must attach to the application.
Note: If you check either of the above boxes, you do not need to complete Table D for the noted outfall unless you have quantitative data available.
1.Organic Toxic Pollutants (GC/MS Fraction —Volatile Compounds)
1.1
Acrolein
(107-02-8)
❑
Concentration
4
❑ Yes ❑s No
Mass
1.2
Acrylonitrile
(107-13-1)
❑❑
Concentration
4
❑ Yes ❑✓ No
Mass
1.3
Benzene
(71-43-2)
❑�
❑
Concentration
ug/L
<1
<0.5
3
❑ Yes ✓❑ No
Mass
Ibs
<0.001
<0.001
1.4
Bromoform
(75-25-2)
❑
05-ND
Concentration
in untreated
groundwater
El Yes M No
Mass
1.5
Carbon tetrachloride
(56-23-5)
❑
Concentration
5- Detected in
groundwater
El Yes 0 No
Mass
1.6
Chlorobenzene
(108-90-7)
❑
Concentration
5-ND in untreated
groundwater
❑ Yes❑ No
Mass
1.7
Chlorodibromomethane
(124-48-1)
❑
Concentration
5-ND in untreated
groundwater
❑ Yes ✓❑ No
Mass
1.8
Chloroethane
(75-00-3)
❑
❑
Concentration
5-ND in untreated
groundwater
❑ Yes ❑� No
Mass
1.9
2-chloroethylvinyl ether
(110-75-8)
❑
❑�
Concentration
4
❑ Yes ❑� No
Mass
1.10
Chloroform (67-66-3)
❑
❑
Concentration
5- Detected in
groundwater
❑ Yes ✓❑ No
Mass
1.11
Dichlorobromomethane
(75-27-4)
❑❑
Concentration
5-ND in untreated
groundwater
El Yes ❑� No
MASS
EPA Form 3510-2D (Revised 3-19) Page 9

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
1.12
1, 1 -dichloroethane
(75-34-3)
El
El
Concentration
untreated
groundwater
El Yes ❑� No
Mass
Mass
1.13
1,2-dichloroethane
(107-06-2)
❑✓
❑
Concentration
ug/L
<2
<1
3
❑ Yes ❑✓ No
Mass
Ibs
<0.002
<0.001
1.14
1,1-dichloroethylene
(75-35-4)
❑❑
Concentration
5-ND in untreated
groundwater
❑ Yes ❑' No
Mass
1.15
1,2-dichloropropane
(78 87 5)
❑❑
Concentration
5-ND in untreated
groundwater
❑Yes ❑' NO
Mass
1.16
1,3-dichloropropylene
(542-75-6)
❑
❑�
Concentration
4
❑ Yes ❑� No
Mass
1.17
Ethylbenzene
(100-41-4)❑
❑
Concentration
ug/L
<2
<1
3 and 5-detected in
groundwater
El Yes ❑� No
Mass
Ibs
<0.002
<0.001
1.18
Methyl bromide
(74-83-9)
❑
Concentration
4
❑ Yes ❑✓ No
Mass
1.19
Methyl chloride
(74-87-3)
❑
Concentration
4
❑ Yes ❑� No
Mass
1.20
Methylene chloride
(75-09-2)
❑
Concentration
4
❑ Yes Z No
Mass
1.21
1,1,2,2-tetrachloroethane
(79-34-5)
❑
❑✓
Concentration
untreated groundwater
groundwater
El Yes ❑� No
Mass
1.22
Tetrachloroethylene
(127-18-4)
❑
❑
Concentration
5- detected
groundwater
El Yes ❑� No
Mass
1.23
Toluene
(108-88-3)
❑
Concentration
ug/L
<2
<1
3
❑ Yes ❑s No
Mass
Ibs
<0.002
<0.001
1.24
1,2-trans-dichloroethylene
(156-60-5)
❑�
❑
Concentration
5- detected
groundwater
El Yes ❑� No
Mass
EPA Form 3510-21) (Revised 3-19) Page 10

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
1.25
1,1,1-trichloroethane
(71-55-6)
❑
✓❑
Concentration
5- ND in untreated
groundwater
❑Yes ❑' No
Mass
1.26
1,1,2-trichloroethane
(79-00-5)
❑
✓❑
Concentration
5-ND in untreated
groundwater
❑Yes ❑� No
Mass
1.27
Trichloroethylene
(79-01-6)
Concentration
5-Detected in
groundwater
El Yes 0 No
Mass
1.28
Vinyl chloride
(75-01-4)
❑❑
Concentration
5-ND in untreated
groundwater
❑ Yes 0 No
Mass
2.Organic Toxic Pollutants (GC/MS Fraction —Acid Compounds)
2.1
2-chlorophenol
(95-57-8)
El
0
Concentration
4
❑ Yes ❑' No
Mass
2.2
2,4-dichlorophenol
(120-83-2)
❑
❑�
Concentration
4
❑ Yes 0 No
Mass
2.3
2,4-dimethyl phenol
(105-67-9)
❑
Concentration
4
❑ Yes 0 No
Mass
2.4
4,6-dinitro-o-cresol
(534-52-1)
❑
Concentration
4
❑ Yes ❑' No
Mass
2.5
2,4-dinitrophenol
(51-28-5)
❑
❑�
Concentration
4
❑ Yes 0 No
Mass
2.6
2-nitrophenol
(88-75-5)
❑
Concentration
4
❑ Yes ❑s No
Mass
2.7
4-nitrophenol
(100-02-7)
❑
Concentration
4
❑ Yes ❑' No
Mass
2.8
p-chloro-m-cresol
(59-50-7)
❑
Concentration
4
❑ Yes E No
Mass
2.9
Pentachlorophenol
(87-86-5)
❑
Concentration
4
❑ Yes ❑J No
Mass
EPA Form 3510-21D (Revised 3-19) Page 11

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
2.10
Phenol
(108-95-2)
❑�
❑
Concentration
ug/L
<1.08
<0.974
5-Detected in
groundwater
El Yes 0 No
Mass
Ibs
<0.00130
<0.00117
2.11
2,4,6-trichlorophenol
(88-05-2)
❑
Concentration
4
❑ Yes ❑� No
Mass
3.Organic Toxic Pollutants (GC/MS Fraction —Base /Neutral Compounds)
3.1
Acenaphthene
(83-32-9)
❑
'❑
Concentration
4
❑ Yes No
Mass
3.2
Acenaphthylene
(208-96-8)
❑
Concentration
4
❑ Yes ❑� No
Mass
3.3
Anthracene
(120-12-7)
❑❑
Concentration
4
❑ Yes s❑ No
Mass
3.4
Benzidine
(92-87-5)
❑
❑
Concentration
4
❑ Yes ❑.r No
Mass
3.5
Benzo (a) anthracene
(56-55-3)
❑
Concentration
4
❑ Yes ❑,r No
Mass
3.6
Benzo (a) pyrene
(50-32-8)
❑
Concentration
4
❑ Yes ❑' No
Mass
3.7
3,4-benzofluoranthene
(205-99-2)
❑
❑�
Concentration
4
❑ Yes 0 No
Mass
3.8
Benzo (ghi) perylene
(191-24-2)
❑
Concentration
4
❑ Yes ❑s No
Mass
3.9
Benzo (k) fluoranthene
(207-08-9)
❑
Concentration
4
❑ Yes 0 No
Mass
3.10
Bis (2-chloroethoxy) methane
(111-91-1)
❑
0
Concentration
4
❑ Yes 0 No
Mass
3.11
Bis (2-chloroethyl) ether
(111-44-4)
❑
Concentration
4
❑ Yes ❑' No
Mass
EPA Form 3510-2D (Revised 3-19) Page 12

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
3.12
Bis (2-chloroisopropyl) ether
(102-80-1)
Concentration
4
❑ Yes ❑' No
Mass
3.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
Concentration
4
❑ Yes ❑' No
Mass
3.14
4-bromophenyl phenyl ether
(101-55-3)
�❑
Concentration
4
❑ Yes ❑s No
Mass
3.15
Butyl benzyl phthalate
(85-68-7)
Concentration
4
❑ Yes ❑' No
Mass
3.16
2-chloronaphthalene
(91-58-7)
Concentration
4
❑ Yes No
Mass
3.17
4-chlorophenyl phenyl ether
(7005-72-3)
Concentration
4
❑ Yes 0 No
Mass
3.18
Chrysene
(218-01-9)
❑�
Concentration
4
❑ Yes ❑' No
Mass
3.19
Dibenzo (a,h) anthracene
(53-70-3)
❑
❑s
Concentration
4
❑ Yes No
Mass
3.20
1,2-dichlorobenzene
(95-50-1)
Concentration
5-ND in untreated
groundwater
❑ Yes No
Mass
3.21
1,3-dichlorobenzene
(541-73-1)
Concentration
5-ND in untreated
groundwater
❑Yes❑ No
Mass
3.22
1,4-dichlorobenzene
(106-46-7)
Concentration
5-ND in untreated
groundwater
El Yes ❑� No
Mass
3.23
3,3-dichlorobenzidine
(91-94-1)
Concentration
4
❑ Yes No
Mass
3.24
Diethyl phthalate
(84-66-2)
Concentration
4
❑ Yes ❑s No
Mass
3.25
Dimethyl phthalate
(131-11-3)
Concentration
4
❑ Yes 0 No
Mass
EPA Form 3510-21D (Revised 3-19) Page 13

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
3.26
Di-n-butyl phthalate
(84-74-2)
Q
❑
Concentration
5-detected in
groundwater
El Yes ❑� No
Mass
3.27
2,4-dinitrotoluene
(121-14-2)
❑
Concentration
4
❑ Yes ❑� No
Mass
3.28
2,6-dinitrotoluene
(606-20-2)
❑❑
Concentration
4
❑ Yes ❑s No
Mass
3.29
Di-n-octyl phthalate
(117-84-0)
❑
Concentration
4
❑ Yes No
Mass
3.30
1,2-diphenylhydrazine
(as azobenzene) (122-66 7)
❑
Concentration
4
❑ Yes '❑ No
Mass
3.31
Fluoranthene
(206-44-0)
❑
Concentration
4
❑ Yes No
Mass
3.32
Fluorene
(86-73-7)
❑
Concentration
4
❑ Yes '❑ No
Mass
3.33
Hexachlorobenzene
(118-74-1)
❑
Concentration
4
❑ Yes '❑ No
Mass
3.34
Hexachlorobutadiene
(87-68-3)
❑
❑�
Concentration
untreated groundwater
groundwater
❑ Yes El No
Mass
3.35
Hexachlorocyclopentadiene
(77-47-4)
❑
Concentration
4
❑ Yes s❑ No
Mass
3.36
Hexachloroethane
(67-72-1)
❑
Concentration
4
❑ Yes No
Mass
3.37.
Indeno (1,2,3-cd) pyrene
(193-39-5)
❑❑
Concentration
4
❑ Yes 0 No
Mass
3.38
Isophorone
(78-59-1)
❑
❑
Concentration
4
❑ Yes '❑ No
Mass
3.39
Naphthalene
(91-20-3)
❑
❑
Concentration
ug/L
<10.6
<10
3
❑ Yes ❑./ No
Mass
Ibs
<0.0127
<0.012
EPA Form 3510-21D (Revised 3-19) Page 14

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
3.40
Nitrobenzene
(98-95-3)
❑
❑
Concentration
4
El Yes ❑� No
Mass
3.41
N-nitrosodimethylamine
(62-75-9)
❑
Concentration
4
❑ Yes ❑' No
Mass
3.42
N-nitrosodi-n-propylamine
(621-64-7)
❑
Concentration
4
❑ Yes No
Mass
3.43
N-nitrosodiphenylamine
(86-30-6)
❑
Concentration
4
❑ Yes 0 No
Mass
3.44
Phenanthrene
(85-01-8)
❑
Concentration
4
❑ Yes 0 No
Mass
3.45
Pyrene
(129-00-0)
❑
Concentration
4
❑ Yes ❑' No
Mass
3.46
1,2,4-trichlorobenzene
(120-82-1)
❑
✓❑
Concentration
in untreated grow
groundwater
❑ Yes El No
Mass
4. Organic Toxic Pollutants (GC/MS Fraction —Pesticides)
4.1.
Aldrin
(309-00-2)
❑
❑�
Concentration
4
❑ Yes ❑,r No
Mass
4.2
a-BHC
(319-84-6)
❑❑
Concentration
4
❑ Yes ❑,r No
Mass
4.3
R-BHC
(319-85-7)
❑
Concentration
4
❑ Yes 0 No
Mass
4.4
y-BHC
(58-89-9)
❑
❑
Concentration
4
❑ Yes 0 No
Mass
4.5
b-BHC
(319-86-8)
❑
0
Concentration
4
❑ Yes 0 No
Mass
4.6
Chlordane
(57-74-9)
❑
Concentration
4
❑ Yes ❑' No
Mass
EPA Form 3510-21D (Revised 3-19) Page 15

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
4.7
4,4'-DDT
(50-29-3)
❑
Concentration
4
❑ Yes ❑� No
Mass
4.8
4,4'-DDE
(72-55-9)
❑
Concentration
4
❑ Yes ❑' No
Mass
4.9
4,4'-DDD
(72-54-8)
❑
Concentration
4
❑ Yes ❑' No
Mass
4.10
Dieldrin
(60-57-1)
❑
Concentration
4
❑ Yes No
Mass
4.11
a-endosulfan
(115-29-7)
❑
❑✓
Concentration
4
❑ Yes ❑' No
Mass
4.12
R-endosulfan
(115-29-7)
❑
❑✓
Concentration
4
El Yes ❑s No
Mass
4.13
Endosulfan sulfate
(1031-07-8)
❑
❑✓
Concentration
4
El Yes 0No
Mass
4.14
Endrin
(72-20-8)
❑
❑✓
Concentration
4
❑ Yes ❑' No
Mass
4.15
Endrin aldehyde
(7421-93-4)
❑
❑✓
Concentration
4
❑ Yes ❑� No
Mass
EPA Form 3510-21D (Revised 3-19) Page 16

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
Facility Name Outfall Number
Sewer Excavation GW-REM 001
Form Approved 03/05/19
OMB No.2040-0004
TABLE D. ORGANIC TOXIC••LLUTANTS
Pollutant
(CAS Number, if available)
(Gas Chromatography/Mass
Presence or Absence
(check one)
S• • or • 1
Estimated Data for Pollutants Expected to Be Present in Discharge
(provide both concentration and mass estimates for each pollutant)
Believed
Present
Believed
Absent
Units
Effluent
Intake Water
Maximum
Daily
Discharge
Average
Daily
DISChar a
Source of
Information
(use codes in instructions)
Believed Present?
(check only one response per
pollutant)
4.16
Heptachlor
(76-44-8)
Concentration
4
❑ Yes 0 No
Mass
4.17
Heptachlor epoxide
(1024-57-3)
Concentration
4
❑ Yes 0 No
Mass
4.18
PCB-1242
(53469-21-9)
Concentration
3
❑ Yes ❑J No
Mass
4.19
PCB-1254
(11097-69-1)
Concentration
3
❑ Yes ❑✓ No
Mass
4.20
PCB-1221
(11104-28-2)
Concentration
3
❑ Yes 0 No
Mass
4.21
PCB-1232
(11141-16-5)
Concentration
3
❑ Yes ❑/ No
Mass
4.22
PCB-1248
(12672-29-6)
❑�
Concentration
3
❑ Yes 0 No
Mass
4.23
PCB-1260
(11096-82-5)
Concentration
3
❑ Yes 0 No
Mass
4.24
PCB-1016
(12674-11-2)
❑�
Concentration
3
❑ Yes 0 No
Mass
4.25
Toxaphene
(8001-35-2)
Concentration
4
❑ Yes 0 No
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-21D (Revised 3-19) Page 17

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
This page intentionally left blank.

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
TABLE E. CERTAIN -DO
Pollutant
Facility Name Outfall Number Form Approved 03/05/19
Sewer Excavation GW-REM 001 OMB No. 2040-0004
1
Presence or Absence
check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
❑
Check (✓) here if you believe all pollutants listed to be absent from the discharge. You need not complete Table E for the noted outfall unless you have quantitative data available.
1.
Asbestos
❑
❑✓
2.
Acetaldehyde
❑
✓❑
3.
Allyl alcohol
❑
✓❑
4.
Allyl chloride
❑
❑✓
5.
Amyl acetate
❑
❑✓
6.
Aniline
❑
❑✓
7.
Benzonitrile
❑
❑✓
8.
Benzyl chloride
❑
❑✓
9.
Butyl acetate
❑
❑✓
10.
Butylamine
❑
❑✓
11.
Captan
❑
❑✓
12.
Carbaryl
❑
✓❑
13.
Carbofuran
❑
❑✓
14.
Carbon disulfide
❑
M
15.
Chlorpyrifos
❑
❑✓
16.
Coumaphos
❑
❑✓
17.
Cresol
❑
❑✓
18.
Crotonaldehyde
❑
❑�
EPA Form 3510-21D (Revised 3-19) Page 19

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
TABLE E. CERTAIN -DO
Pollutant
Facility Name Outfall Number Form Approved 03/05/19
Sewer Excavation GW-REM 001 OMB No. 2040-0004
1
Presence or Absence
check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
19.
Cyclohexane
❑
✓❑
20.
2,4-D (2,4-dichlorophenoxyacetic acid)
❑
❑✓
21.
Diazinon
❑
❑✓
22.
Dicamba
❑
❑✓
23.
Dichlobenil
❑
❑✓
24.
Dichlone
❑
❑�
25.
2,2-dichloropropionic acid
❑
❑✓
26.
Dichlorvos
❑
❑✓
27.
Diethyl amine
❑
❑✓
28.
Dimethyl amine
❑
✓❑
29.
Dintrobenzene
❑
❑✓
30.
Diquat
❑
✓❑
31.
Disulfoton
❑
❑✓
32.
Diuron
❑
✓❑
33.
Epichlorohydrin
❑
✓❑
34.
Ethion
❑
❑✓
35.
Ethylene diamine
❑
✓❑
36.
Ethylene dibromide
❑
❑✓
37.
Formaldehyde
❑
✓❑
EPA Form 3510-21D (Revised 3-19) Page 20

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
TABLE E. CERTAIN -DO
Pollutant
Facility Name Outfall Number Form Approved 03/05/19
Sewer Excavation GW-REM 001 OMB No. 2040-0004
1
Presence or Absence
check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
38.
Furfural
❑
✓❑
39.
Guthion
❑
❑✓
40.
Isoprene
❑
❑✓
41.
Isopropanolamine
❑
✓❑
42.
Kelthane
❑
❑✓
43.
Kepone
❑
❑✓
44.
Malathion
❑
❑✓
45.
Mercaptodimethur
❑
❑✓
46.
Methoxychlor
❑
❑�
47.
Methyl mercaptan
❑
❑✓
48.
Methyl methacrylate
❑
❑✓
49.
Methyl parathion
50.
Mevinphos
❑
❑�
51.
Mexacarbate
❑
❑✓
52.
Monoethyl amine
❑
❑�
53.
Monomethyl amine
❑
❑✓
54.
Naled
❑
❑�
55.
Naphthenic acid
❑
✓❑
56.
Nitrotoluene
❑
✓❑
EPA Form 3510-21D (Revised 3-19) Page 21

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
New Facility
TABLE E. CERTAIN -DO
Pollutant
Facility Name Outfall Number Form Approved 03/05/19
Sewer Excavation GW-REM 001 OMB No. 2040-0004
1
Presence or Absence
check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
57.
Parathion
❑
✓❑
58.
Phenolsulfonate
❑
❑✓
59.
Phosgene
❑
❑✓
60.
Propargite
❑
❑✓
61.
Propylene oxide
❑
❑�
62.
Pyrethrins
❑
❑✓
63.
Quinoline
❑
❑✓
64.
Resorcinol
❑
❑✓
65.
Strontium
❑
❑✓
66.
Strychnine
❑
❑✓
67.
Styrene
❑✓
❑
Contaminated groundwater
7.0 ug/L daily max (2019)
68
2,4 5-T (2,4,5-trichlorophenoxyacetic
acid
❑
❑
69.
TDE (tetrachlorodiphenyl ethane)
❑
✓❑
70.
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
propanoic acid]
❑
❑
71.
Trichlorofon
❑
❑✓
72.
Triethanolamine
❑
✓❑
73.
Triethylamine
❑
❑✓
74.
Trimethylamine
❑
❑✓
75.
Uranium
❑
❑
EPA Form 3510-21D (Revised 3-19) Page 22

DocuSign Envelope ID: DC16609F-3BE4-4DA3-B280-4788DEAE2E1 F
EPA Identification Number
Facility Name
Outfall Number
Form Approved 03/05/19
New Facility
Sewer Excavation GW-REM
001
OMB No. 2040-0004
TABLE
E. CERTAIN -DO
1
Presence or Absence
Pollutant
check one
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
Believed Believed
(specify units)
Present Absent
76.
Vanadium
El
77.
Vinyl acetate
❑
✓❑
78.
Xylene
❑/
❑
Contaminated groundwater
<2.0 ug/L daily max
79.
Xylenol
❑
✓❑
80.
Zirconium
El
El
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-21D (Revised 3-19) Page 23