NC0085731_Permit Issuance_20100920

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
September 20, 2010
Ms. Jetta Gill, Assistant Property Manager
Hines Charlotte Carillon, LP
227 West Trade Street
Charlotte, North Carolina 28202
Subject: Issuance of NPDES Permit NCO085731
Carillion Building
Mecklenburg County
Dear Ms. Gill:
Division personnel have reviewed and approved your application for renewal of the subject permit. Accordingly,
we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to the requirements of
North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the
U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
This final permit includes no significant changes from the draft permit sent to you on August 4, 2010.
If any parts, measurement frequencies or sampling requirements contained in this permit are unacceptable to you,
you have the right to an adjudicatory hearing upon written request within thirty (30) days following receipt of this
letter. This request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings (6714 Mail Service Center, Raleigh, North
Carolina 27699-6714). Unless such demand is made, this decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may require
modification or revocation and reissuance of the permit. This permit does not affect the legal requirements to
obtain other permits which may be required by the Division of Water Quality or permits required by the Division
of Land Resources, the Coastal Area Management Act or any other Federal or Local governmental permit that
may be required.
If you have any questions concerning this permit, please contact Bob Sledge at telephone number (919) 807-
6398, or via e-mail at [e-mail].
Sincerely,
�Coleen H. Sullins
r
cc: Central Files
Mooresville Regional Office/Surface Water Protection Section
NPDES Unit
cc: Mecklenburg County Water Quality Program
Aquatic Toxicology Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 O11t
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 _ NOIChCdl �hila
Phornet: www.ncwaterquality.org
gFAX:919.807-6492 \Customer Service: 1•677-623-6748 � �"t'!1'l���lf
Internet: www.ncwateflirmiwe Action
14 t Di
An Equal Oppwlunlry 1 Aflirtnalive Action Employer

Permit NCO085731
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Hines Charlotte Carillon, LP
is hereby authorized to discharge wastewater from a facility located at the
The Carillon Building
227 West Trade Street
Charlotte
Mecklenburg County
to receiving waters designated as Irwin Creek in the Catawba River Basin
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective November 1, 2010.
This permit and authorization to discharge shall expire at midnight on June 30, 2015.
Signed this day September 20, 2010.
ole n H . Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO085731
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or
discharge are hereby revoked. As of this permit issuance, any previously issued
permit bearing this number is no longer effective. Therefore, the exclusive authority
to operate and discharge from this facility arises under the permit conditions,
requirements, terms, and provisions included herein.
Hines Charlotte Carillon, LP is hereby authorized to:
1. Continue to operate an existing 0.0316 MGD wastewater treatment system with
the following components:
♦ Surge tank
♦ Two carbon absorption units
The facility is located at the Carillon Building at 227 West Trade Street, Charlotte
in Mecklenburg County.
2. Discharge from said treatment works at the location specified on the attached
map into a storm sewer to Irwin Creek, classified C waters in the Catawba River
Basin.

Permit NCO085731
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Permit NCO085731
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of this permit and lasting until expiration,
the Permittee is authorized to discharge from outfall 001. Such discharges shall be limited
and monitored by the Permittee as specified below:
EFFLUENT
CHARACTERISTICS
LIMITS
MONITORING REQUIREMENTS
Monthly
Average
Weekly._-
Average.
- Daily
Maximum
Measurement
Frequency
Sample Type
Sample Location
Flow'
0.0316 MGD
Monthly
Instantaneous
Effluent
Tetrachloroethene
Quarterly
Grab
Effluent
Iron
Quarterly
Grab
Effluent
Manganese
Quarterly
Grab
Effluent
[Chronic Toxicity2
Quarterly
Composite
Effluent
Footnotes:
1. All volumes of wastewater leaving the facility shall be monitored. If continuous flow
monitoring is not feasible, then the discharger shall record the approximate time that
discharge began and ended, along with the instantaneous flow at the time of the
effluent sampling.
2. Refer to A. (2.)).
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Permit NCO085731
A (2). CHRONIC TOXICITY PERMIT LDUT (QRTRLY) .. _
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant
mortality to Ceriodaphnia dubia at an effluent concentration of 90 %.
The permit holder shall perform at a minimum, auarteriu monitoring using test procedures outlined
in the "North Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998,
or subsequent versions or "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure"
(Revised -February 1998) or subsequent versions. The tests will be performed during the months of
March, June, September and December. Effluent sampling for this testing shall be performed at
th6 NPDES permitted final effluent discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a failure or ChV
below the permit limit, then multiple -concentration testing shall be performed at a minimum,
in each of the two following months as described in "North Carolina Phase II Chronic Whole
Effluent Toxicity Test Procedure" (Revised -February 1998) or subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the
highest concentration having no detectable impairment of reproduction or survival and the lowest
concentration that does have a detectable impairment of reproduction or survival. The definition of
"detectable impairment," collection methods, exposure regimes, and further statistical methods are
specified in the "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -
February 1998) or subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent
Discharge Monitoring Form (MR-1) for the months in which tests were performed. If reporting
pass/fail results using the parameter code TGP3B, DWQ Form AT-1 (original) is sent to the below
address. If reporting Chronic Value results using the parameter code THP3B, DWQ Form AT-3
(original) is to be sent to the following address:
Attention: NG DENR / DWQ / Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no
later than 30 days after the end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and
all concentration/response data, and be certified by laboratory supervisor and ORC or approved
designate signature. Total residual chlorine of the effluent toxicity sample must be measured and
reported if chlorine is employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is
required, the permittee will complete the information located at the top of the aquatic toxicity (AT)
test form indicating the facility name, permit number, pipe number, county, and the month/year of
the report with the notation of "No Flow" in the comment area of the form. The report shall be
submitted to the Environmental Sciences Section at the address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required,
monitoring will be required during the following month.
Should any test data from this monitoring requirement or tests performed by the North Carolina
Division —of Water Quality indicate potential impacts to the receiving stream, this permit may be re-
opened and modified to include alternate monitoring requirements or limits.
If the Permittee monitbrs any pollutant more frequently then required by this permit, the results of
such monitoring shall be included in the calculation & reporting of the data submitted on the DMR &
all AT Forms submitted.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum
control organism survival, minimum control organism reproduction, and appropriate environmental
controls, shall constitute an invalid test and will require immediate follow-up testing to be completed
no later than the last day of the month following the month of the initial monitoring.

The Charlotte Observer Publishing Co.
Charlotte, NC
North Carolina > ss Affidavit of Publication
Mecklenburg County)
THE CHARLOTTE OBSERVER
---------------------------------------------------------------------------
DINA SPRINKLE
NCDENR/DWO/POINT SOURCE BRANCH
1617 MAIL SERVICE CENTER
RALEIGH NC 27699
REFERENCE: 30063432
6491773 - noes permits _
Before the undersigned, a Notary Public of said
County and State, duty authorized to administer
oaths affirmations, etc., personally appeared,
being duly sworn or affirmed according to law,
doth 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.
PUBLISHED ON: 08/07
AD SPACE: 100 LINE
FILED ON: 08/12/10
Pubic Notice
NorthGmline Errvironmental Management CommissloryNPoES
unn
1617 Mad Service Canter
Helegh, NC 22�9-1617
Notice of lnlenito Issue a NPCES Wastewater Permd
The City of High
N0007.0 for the
pertmtle0 discharge
Fork Catawba Diver
rf
u+rwgtna -
NAME: TITLE:
DATE:
In Testimony Whereof 1 have hereunto set my hand an a fixed my seal, the
day `anndd year aforesaid. My Commission Expires May 17, 2011
Notas;, u+�.ty Commission Expires: _/_/_

Permit Notes
Hines Charlotte Carillon, LP has requested renewal of the permit for the Carillon Building
(NC0085731) in Mecklenburg County. There were no changes to the permit. The RPA showed
there was no RP for Tetrachloroethene or Manganese, and Iron is an action level parameter, so
no limit will be given. The facility has passed all tox tests since December 2005.

REASONABLE POTENTIAL ANALYSIS
Carillon Building
Ouifall 001
NCO085731
Ow = 0.016 MGD
Time Period Jan 2003-Dec 2004
Ow (MGD) 0.016
WWTP Class
1
7010S (cfs) 0
lWC (%) @ 7010S
100
7010W (cfs) 0
@ 701OW
100
3002 (cfs) 0
@ 3002
100
Avg. Stream Flow, OA (cfs) 0
@ OA
100
Rec'ving Stream Irwin Creek Via Storm Sewer
Stream Class C
STANDARDS &
PARAMETER
TYPE
CRITERIA (2)
POL
Units
REASONABLE POTENTIAL RESULTS
RECOMMENDED ACTION
(1)
Ncw03/ hFAV/
n tDot UnPied Civ AgambbCw
l hm* A=&
Acute: WA
Tetrachloroethane
NC
8.85
ugtL
24 0
0.5
Retain Quarterly Monitoring
_ _ _
Chronic: --- 9--
---- --- - -------- _. -._ -.- -
Acute: WA
Iron
NC
1.0
mWL
24 1
2.3
Action level parameter. Retain Ouadedy Monitoring
_ _ _
----.—.---------.---------.—.—_—
Acute: WA
Manganese
NC
100
ugtL
24 15
91.2
_ _ _
Retain Ouarterty Monitoring
Chronic:
__—_—.—_—
Acute: WA
0 0
WA
__ _
Chronic: Error @ Type
----.—.—.— —___—.—.—.—.—.—.—
Acute:, WA
0 0
WA
____ _
Chronic: Error @ Type
----------------------
Acute: WA
0 0
WA
Chronic: aror @ Type
--------------- - - --- — -----
Acute: WA
t
0 0
N/A
ChfORIC: ERof @Type
-------------------------
Acute: WA
0 0
WA
____ _
Chronic: ERor @Type
_---.----- ----- — — — — - — —
Acute: WA
Chronic: Error @Type
---------------------
Acute. WA
0 0
WA
_
Chronic: ERor @Typo
----_—_----------------------- —
Acute: WA
0 0
WA
Chronic: Error @Type
—.--- --- — --- — — — — - -
— —
Acute: WA
0 0
WA
_
Chronic: error @Type
-----------------------
Acute: WA
0 0
WA
Chronic: Error @Type
------- —_---------_---- - —
Acute: WA
t
0 0
WA
_
Chronic: Error @Type
-
------------------------------ —
Acute: WA
0 0
WA
Chronic: Error @Type --------------------------_—.—.—
Legend: " Freshwater Discharge
C = Carcinogenic
NC = NOn•carcinogentc
A = Aesthetic
npdesrpa 0085731a,rpa
8/1/2010

REASONABLE POTENTIAL ANALYSIS
Tetrachloroethane
Iron
Date
Data
BDL=1/2DL
Results
Date
Data
BDL=MDL
Results
1
1/17/2005
<
1.0
0.5
Std Dev
0.0000
1
1/28/2005
<
0.05
0.0
Std Dev.
0.1965
2
3/28/2005
<
1.0
0.5
Mean
0.5000
2
3/21/2005
<
0.05
0.0
Mean
0.1260
3
4/21/2005
<
1.0
0.5
C.V.
0.0000
3
4/11/2005
0.092
0.1
C.V.
1.5596
4
5/11/2005
1.0
0.5
n
24
4
5/9/2005
<
0.05
0.0
n
24
5
6/9/2005
<
1.0
0.5
5
6/142005
<
1
0.5
6
9/14/2005
<
1.0
0.5
Mult Factor =
1.0000
6
9/19/2005
<
0.05
0.0
Mult Factor =
4.6900
7
12/192005
<
1.0
0.5
Max. Value
0.5 ug/L
7
12/16/2005
<
1
0.5
Max. Value
0.5 mg/
8
3/16/2006
-. <
1.0
0.5
Max. Fred Cw
0.5 ug/L
8
3/162006
<
0,05
0.0
Max. Pred Cw
2.3 mg/
9
6/16/2006
`.<
1.0
0.5
9
6/16/2006
<
0.05
0.0
10
9/16/2006
<
1.0
0.5
10
9/22/2006
<
0.05
0.0
11
12122/2006
<
1.0
0.5
11
12/5/2006
<
1
0.5
12
3/5/2007
<
1.0
0.5
12
3/9/2007
<
0,05
0.0
13
8/92007
'<
1.0
0.5
13
6/8/2007
<
1
0.5
14
9/8/2007
-
1.0
0.5
14
9/14/2007
<
0.05
0.0
15
12/142007
<
1.0
0.5
15
12/4/2007
<
0.05
0.0
16
3/4/2008
<
1.0
0.5
16
W712000
<
0.05
0.0
17
6/72008
<
1.0
0.5
17
6/13/2008
-<
1
0.5
18
9/1312008
1.0
0.5
18
91122008
-<
0,05
0.0
19
12I122008
<
1.0
0.5
19
12/112008
<
0.05
0.0
20
3/11/2009
<
1.0
0.5
20
T202009
. <
0.05
0.0
21
6M2009
<.
1.0
0.5
21
6/19/2009
<
0.05
0.0
22
9/19/2009
<
1.0
0.5
22
9/182009
<
0,014
0.0
23
12/182009
<
1.0
0.5
23
12/1/2009
. <
0.05
0.0
24
3/1/2010
-<
1.0
0.5
24
3/52010
•<
0.05
0.0
25
25
26
26
'-
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
64
54
55
55
56
56
57
57
58
58
59
59
60
60
199
199
200
200
npdes rpa 0085731 a, data
- i - 8/1/2010

REASONABLE POTENTIAL ANALYSIS
Manganese
Date Data
BDL=I2DL
Results
1
1/28/2005 <
5
2.5
Std Dev.
7.6898
2
3/21/2006
14
14.0
Mean
8.2354
3
4/11/2005
16
16.0
C.V.
0,9337
4
5/9/2005
19
19.0
n
24
5
6/14/2005
15
15.0
6
9/19/2005
23
23.0
Mult Factor =
3.0100
7
12/16/2005 <-
1
0.5
Max. Value
30.3 ug/L
8
3/16/2006 -:
8.6
8.6
Max. Fred Cw
91.2 ug/L
9
6/16/2006
8.8
8.80
10
9/22/2006
5
5.00
11
12/5/2006
5.5
5.50
12
3/9/2007
6
6.00
13
6/8/2007 a
8.4
8.40
14
9/14/2007
6
6.00
15
12/4/2007
5
250
16
W12008
8.3
8.30
17
6/13/2008
1
0.50
18
9/12/2008
5
2.50
19
12/11/2008
5
2.50
20
3/20/2009
5
2.60
21
6119/2009
8.2
4.10
22
9/18/2009
0
0.15
23
12/1/2009
6
6.00
24
3/5/2010
30
30.30
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
199
zoo
npdes rpa 0085731 a, data
- 2 - 8/1/2010

SOC PRIORITY PROJECT: Yes No X
To: Western NPDES Program Unit
Surface Water Protection Section
Attention: Dina Sprinkle
Date: February 3, 2010
NPDES STAFF REPORT AND RECOMMENDATION
County: Mecklenburg
Permit No. NCO085731
PART I - GENERAL INFORMATION
1. Facility and address: Carillon Building GW Facility
Hines Charlotte Carillon LP
227 W Trade Street
Charlotte, North Carolina 28202
2. Date of investigation: January 21-2010-
3. Report prepared by: Samar Bou-Ghazale, Env. Engineer II
4. Persons contacted and telephone number: Mr. Kyle Murray, Terminal Operator; (704) 399-
6331.
5. Directions to site: From the intersection of Tryon Street and Trade Street in the business
section of the City of Charlotte, Mecklenburg County, travel northwest on West Trade Street
approximately 500 feet. The Carillon Building is on the left (southwest) side of West Trade
Street. The facility is located at the lowest floor on the parking deck adjacent to the car
detailing facility.
6. Discharge point(s). List for all discharge points:
Latitude: 350 16' 39" Longitude: 800 50' 14"
Attach a U.S.G.S. map extract and indicate treatment facility site and discharge point on
map.
USGS Quad No.: G 15 NE USGS Quad Name: Charlotte East
Site size and expansion are consistent with application?
Yes X No_ If No, explain:
8. Topography (relationship to flood plain included): The facility is located below the ground
portion of a parking garage.

9. Location of nearest dwelling: No Dwellings. Facility is located in the business section of the
City of Charlotte.
10. Receiving stream or affected surface waters: Irwin Creek.
a. Classification: C
b. River Basin and Subbasin No.: Catawba River Basin; 03-08-34
C. Describe receiving stream features and pertinent downstream uses: The treated
groundwater is being discharged into a storm sewer located on West 40' Street near
the junction with South Church Street. The storm sewer is tributary to Irwin Creek.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
a. Volume of Wastewater: 0.0316 MGD (Design Capacity)
b. What is the current permitted capacity: 0.0316 MGD
C. Actual treatment capacity of the current facility (current design capacity): 0.0316
MGD
d. Date(s) and construction activities allowed by previous Authorizations to Construct
issued in the previous two years: N/A
e. Please provide a description of existing or substantially constructed wastewater
treatment facilities: The existing groundwater dewatering and treatment facility is
a carbon filtration system consisting of an 850-gallon holding tank, two transfer
pumps, two carbon filtration units, control panel and associated piping valves,
flow meters, float switches, gauges, and sample ports.
f. Please provide a description of proposed wastewater treatment facilities: N/A
g. Possible toxic impacts to surface waters: Toxicity is being monitored.
h. Pretreatment Program (POTWs only): N/A.
2. Residuals handling and utilization/disposal scheme: Carbon canister is handled by
Siemens Water Technology located in Pennsylvania, Contact name, Marry Ann Frank,
Tel# [phone] ext 509.
3. Treatment plant classification (attach completed rating sheet): Class I
4. SIC Code(s): 6512 Wastewater Code(s): 66
NPDES Permit Staff Report

Main Treatment Unit Code: 00200
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds or are any public monies
involved (municipals only)? NIA.
2. Special monitoring or limitations (including toxicity) requests: Toxicity is being
monitored.
3. Important SOC, JOC or Compliance Schedule dates: (please indicate) NIA.
4. Alternative Analysis Evaluation: Has the facility evaluated all of the non -discharge
options available. Please provide regional perspective for each option evaluated. NIA
S. Air Quality and/or Groundwater concerns or hazardous material utilized at this facility
that may impact water quality, air quality or groundwater? Contaminated groundwater
exists at the site. No Air Quality Permit needed for this site.
PART IV - EVALUATION AND RECOMMENDATIONS
The Permittee, Hines Charlotte Carillon LP is requesting NPDES Permit renewal for the
discharge of treated wastewater. The wastewater is generated from the Groundwater remediation
at the facility. The site is being managed by DSCA in Raleigh. S& ME is handling the site
monitoring. Facility is in compliance with the effluent limit and the monitoring requirements.
The facility was in good operation at the time of the investigation.
Pending review and approval by the Western NPDES Program Unit, It is recommended
that the NPDES permit be renewed.
Signature of Repo r er Date
©2 _v.3 —/ v
Water Quality naI isor Date
NPDES Permit Staff Report

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 INCO085731
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:
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Hines Charlotte Carillon LP
Carillon
227 W. Trade Street
Charlotte
NC 28202
[phone]
[phone]
RX
jetta-gill@hines,com
�--VED
2. Location of facility producing discharge:
Check here if same as above
Street Address or State Road .
city
State / Zip Code
County
0CT 3 0 2009
DENR • WATER OUAUlY
POINT SO NCH
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 ORQ
Name Hines Interests Limited Partnership
Mailing Address 227 W. Trade Street, Suite 330
City Charlotte
State / Zip Code NC 28202
Telephone Number [phone]
Fax Number [phone]
4. Ownership Status:
Federal ❑ State ❑ Private Z Public ❑
Pagel of 3 C-GW 03105

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
S. Products recovered:
Gasoline ❑ Diesel fuel ❑ Solvents ® Other
6. Number of separate discharge points: 1
Outfall Identification number(s) NA - Storm Sewer to Irwin Creek
7. Frequency of discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: 24 hour/day
S. Treatment System Design flow 0.0316 MGD
9. Name of receiving stream(s) (Provide a map showing the exact location of each outfal4 including
latitude and longitudes
Irwin Creek -- Lat is 35.2285 - Log is 80.84396
10. Please list all additives to the treatment system, including chemicals or nutrients, that have
the potential to be discharged.
none
11. Is this facility located on Indian country? (check one)
Yes ❑ No ED
12. Additional Information
All licants (including renewals):
ap7 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:
D 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 03/05

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 belief such information is true, complete, and accurate.
Jetta Gill Assistant Prouerty Manager
Printed name of Person Signing Title
of Applicant
Date
Nbfth 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 03105

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Scale: 1"=1,475' Site Location Pieurc No.
The Carillon Building
Checked by227 West Trade Street, Suite 330
Drawn by: C,1{g Charlotte, Mecklenburg County 1
Date: 9-27-04 ENGINEERING • TESTING JobNo.: 1354-02-382A
ENVIRONMENTAL SERVICES