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Home My WebLink AboutJOHN BLACK MECK COUNTY_MISC_20171231Control Nu ber County Number 3 GROUNDWATER POLLUTION SOURCE INVENTORY 0 7 a Source ame OWNERSHIP "Jvt rrivate Source dr ss 2 Municipal 3 County 4 State City 7 County Region 5 Federal 6 Military Owner/ perator } Quad Name u riple sources at Site County Source s YES NO POTENTIAL SOURCE OF GROUNDWATER POLLUTION LOCATION OPERATION TYPE TYPE OF WASTE D POSAL FACILITY OTHER SOURCE 1 Facility 1 Municipal 1 Gasoline/diesel L.J Lagoon, etc. 1 Agricultural Activity Highway 2 Industrial 2 Other oil 2 Landfill-contro. 2 Salt water intrusion 3 Railroad agricultural 3 Solvents 3 Landfill-uncont. 3 Chemical stock pile 4 Waterway 4 011 and gas 4 Corrosives 4 Land application 4 River infiltration 5 Pipeline 5 Mining 5 Other chemical 5 Abandoned site 5 Mine drainage 6 Dumpsite 6 Other Source Sewage/septage 6 Sewer system 6 Intentional dump 7 Other 7 Sludge 7 Septic tank 7 Spill 8 Leachate 8 Injection well 8 Leak --above ground 9 Other solids 9 Disposal well 9 Leak --underground OIn use 10 Gas WASTE: wa'4'- Q, STATUS OF SOURCE: 2 Inactive 11 Pest/herbicides 3 Other 12 Fertilizers POLLUTION STATUS AND CROSS-REFERENCES GROUNDWATER POLLUTION FACILITY PERMITTED: Yes No 1 Confirmed IO Rank 1 NPDES 6 Mining Potential 2 Tabulate Q No: 2 DEM Nondischarge No: 7 Hazardous Waste (RCRA) MONITORING WELLS No: No: 1 No monitoring 2 State has data 3 Well Construction 8 Solid Waste (Landfill) 3 Data at facility No: No: Status unknown 4 Capacity Use 9 Oil Terminal Registration DATABASE CROSS-REFERENCE No: No: 1 ERRIS (CERCLA) list 5 UIC 0 Air Quality ID: No: No: 2 Surface Impou�nddment (SIA) Comments ID: e�d 3 GW Pollution Source Inv. Date: 4 Other DEM investigation Date: Compiler: Date: FORM APPROVED' OMB NO. 158-S78Q04 DATE PREPARED U.S. ENVIRONMENTAL PROTECTION AGENCY IMPOUNDMENT ASSESSMENT (SIA) LOCATION AND COUNT OF IMPOUNDMENTS SECTION I SERIAL NUMBER . .......... MON Y H DAY YEAR.SURFACE Z X cK 75 76 77 78 79 80 FACILITY IDENTIFICATION How many impoundments arc STATE IDENTIFICATION NO. (Optional) STATE CNTY./CITY PLACE CATEGORY SIA SITE NUMBER located at this site? Pam CITY OR TOWN 1 2 3 5 10 it - 13 14 18 22 25 26 23 1 37 STANDARD INDUSTRIAL SITE LOCATION NPDES NUMBER CLASSIFICATION (SIC Code) g > A -E.-IEF MINV TES srcoNns DEGREES MMUTES SFCONDS L ATITUDE---op- ILONGITUDE-1-1 I <1- I(,) I tL It 4Z r dw] io [49M 1 51 52 3 5 � ffi 57 59 60 61 16i 93 5 55 56 i... - 4 OWN E R NAME OF OWNER OWNER'S MAILING ADDRESS (Street No. or P.O. Box) NAME OF OPERATOR I a-1 vul I I I I I I I I I I I I I I -- I I I I I I - I I I I --L I I -- I I I I I o, A, 22 59 OPERATOR'S MAILING ADDRESS (Streelt No. or P.O. Box) 6 IN` 22 59 CITY OR TOWN STATE ZIP CODE 7 I LL I I I I I I I I I I 22 $2153 54 1 55 59 gu: EPA Form 7500-44 (6-78) STATE COPY CITY OR TOWN NAME OF OPERATOR I a-1 vul I I I I I I I I I I I I I I -- I I I I I I - I I I I --L I I -- I I I I I o, A, 22 59 OPERATOR'S MAILING ADDRESS (Streelt No. or P.O. Box) 6 IN` 22 59 CITY OR TOWN STATE ZIP CODE 7 I LL I I I I I I I I I I 22 $2153 54 1 55 59 gu: EPA Form 7500-44 (6-78) STATE COPY N. C. Department of Natural Resources and Community Development Office of Water Resources Facility and Impoundment Questionnaire I. General Facility_ Information 1) 2) 3) 4) 5) 6) Facility Name�� Facility Location Facility Mailing Address Facility Manager Telephone No. Facility Contact Telephone No. Facility Purposen� , ; � Qw.�,�n� , ��- - r�� o p tgnaR _ „ (a) Standard Industrial Classification (SIC) Group Name (b) Four Digit Number Primary Secondary 1) Number of Impoundments at Facility C� u� II. Impoundment Information (please complete this section for each impoundment) 2) 3) 4) 5) 6) 7) 8) 9) 10) Pur e c e) Storage Disposal Treatment Other (Specify) Nat pe of Waste 11 Surface Area, acres Average Influent, gal/day Year of Record Average Effluent, gal/day Year of Record Type of Bottom Liner 1-4 Years of Service to Depth of Impoundment Soil Type in of Impoundment (circle) Sandy Clayey Sand and Clay Distance from Impoundment to: (a) Water Supply Wells (b) Nearest Stream III. Monitoring Information 1) Number of Monitor Wells 2) Depth of Wells 3) Depth to Water in Wells 4) Include Analysis if Available Other (Specify) C v I \r t ��; ` r y_ r _.-_, �, •� -r t_ . Vii_`..:., ,� � / _. �, �/ \ � � , • � • •rte• \ } � \\ I. "``L��, �� • \ `. ' `\ � •� .� ti I \ fes.., � '`I• • • .^ Ap .'` � � {� tel•- yam• :�r. IN ID �Jill Rios-= ��_.� �� .W_S �� /� t �__ ,,� �<<` •ice ` f / 11 ht �.� - .z'\ �� W ��,, � it - V'• STEP 3. RATING THE GRObND-WATER QUALITY A. Is ground water presently used as a drinking water source? YES NO B. Total dissolved solids content of ground water ��-D mg/l. C. Score for Step 3: STEP 4. RATING OF THE WASTE HAZARD POTENTIAL r A. Classification of Impoundment User by Standard Industrial Classification: 1 or , B. Waste Type (Give I. D. Number): v z C. Score for Step 4: STEP 5. RATING THE OVERALL GROUND -WATER POLLUTION " POTENTIAL Step 1 + Step 2 + Step 3 + Step 4 = Step 5 SURFACE IMPOUNDMENT ASSESSMENT EVALUA ITON SYSTEM WORKSHEE p S fE P 1. RATING OF = UNSATURATED ZONE A. Thickness of unsaturated zone i meters. B. Earth Material: Description of Material ��l )06" J s �o� Earth Material Cate gory:_._Dr_ D. Score for Step 1: 2 - Thickness (meters) STEP 2, RATING THE GROUND -WATER AVAILABILITY A. Thickness of saturated zone meters. B. Earth Material of the saturated zone: Material Thickness (meters) Earth Material Category:7P,_ C. Score for Step 2: G C i Gtr�J y, G R 0 U N D 1-1 A T E R POLLUTION SOURCE EVALUATION R A N K I N G C P, I T E P I A THREAT TO GROUNDWATER Probability of Groundwater Violations 3 Violations documented or highly probable Default 1 Violations unlikely . E nt of Groundwater Contamination 3 Mappable, migrating plume 2 Default 1 Insignificant contamination expected Seriousness of Groundwater Threat 3 One of most serious in DEM region j 2'} Default I Not considered a serious problem �/.? FEASIBILITY FOR TAKING ACTION Feasibility for Remedial Action 3! Remedial action both feasible and desirable 2 Default I No remedial action recommended Desirability of Remedial Action �3 One of top regional office priorities , `� 2 J DefauI t 1 Not a priority incident THREAT TO PEOPLE OR ECONOMY How Hazardous to Health/Economy 3 People or business advised of contamination 0 Default 1 No expected impacts on people or business Number of People at Risk 3 4 or more family units, or $10,000 loss Defaul t 1 No people or other interests at risk Seriousness of People Threat 3 Strong DEM concern over threat to people l_ % Default 1 No threat to people or economy FEASIBILITY OF RECLASSIFYING GROUNDWATER Need to Reclassify Groundwater �3 Groundwater should be relassified RS or GC [22 Default 1 No reclass. nor remedial action recommended Desirability of Reclassification One of top reclassification priorities 2 Default 1 Not a priority incident THREAT OF POLLUTANTS How Toxic are Pollutants (use Sax) /3 Nigh value (2 Mod value 1 Low or None value Quantity of Pollutants in Ground 3 Reportable quantity of hazardous material (CERCLA def.) or quantity of real concern [ 2 J Default 1 ' Not of concern to regional office Seriousness of Pollutant Threat �j3'^� One of most serious in DEM region U Default 1 Not a serious threat RANK SCORE: Source Name: Control Number: County: _ 17.�� 070 Ranker: Da to : ' FORM APPROVED -U. S. GOVERNMENT PRINTING OFFICE: 1978-724-845 OM13 NO. 158-578004 "mow y U.S. ENVIRONMENTAL PROTECTION AGENCY SERIAL NUMBER DATE PREPARED SURFACE IMPOUNDMENT ASSESSMENT (SIA) OPERATIONAL FEATURES OF THE IMPOUNDMENT AND GROUND -WATER CONTAMINATION POTENTIAL MONTH DAY YEAR _ SECTION 11 INSTRUCTIONS: This form is to be completed for one impoundment per site (facility) identified in Section 1, Location and Count of Impoundments Form or for one im oundment site selected via random sampling Complete multiple choice b entering the code number theappropriate answer, 0.3p Q S 0 9 7 75 76 77 78 79 80°4.' .`, per procedures. questions preceding P P p g Pr P P 4 Y g pr o .. ..n .... ....... ........ , --. �,..,., :>:> .: �.,, t -.--.w ... ..,. :::.•:. ,:. :::.... .�,..: �,',u..-,. ';Do-:. ,.., ,,,.: :,r.x. a:. „o -;o v.w:, ,.tn o.a. �s.. e:o-> .:�o-t,.:. ,o- w.�, I. FACILITY IDENTIFICATION II. PURPOSE OF IMPOUNDMENT (Enter no. in block 23 IMa PE ON UT NND - tCNTY/ TY ATEGS[A SITE NUMBER COY e '<'° 1. Waste Storage 2, Waste Dis Deal 3. Waste Treatment(Specify below) 4. Other (Specify below) e`�'�FoY6..o<oco, @, :�: - -� •x ' �.et°.' M O :oy� 4s. ;oE;� o.: :.'� zs � -,ra?; s3s =�>ty�xrt��"7,4''�& SPECIFY °'yrs co- i 2 3 `=",.' 30 ,zas 11 13 - 18e 19 21 22:a s;r'�o-n.#`.',v'+ 23,,�,'tax::. �,gAo-: - 5 6 - - - »,.,.,.to-aw. ''?$' 14 24 - 34,¢. , _. III. IMPOUNDMENT DESCRIPTION a.• Age of impound b. IS IMPOUNDMENT c. If answer to IIIb is d, if answer to IIIb is e. Surface area of impoundment. f. Surface area ofimpoundments men[ in years. PRESENTLY USED? -yes', give no. of 'no', give lest year at this site (in aacrres). g. Average influent into I&LL impoundment (gallons per day and year of record). - 1. Yes 2. NO years in operation. of operation. (in acres) 'k. ? s. rrl } O YEAR OF ,. :` o- " - f, .. - 1 {- GALS./OAY ,�s,r RE R co- e*s 9Cmacaexs:«. 39 43 44 22 3138 23 .323 35 III. IMPOUNDMENT DESCRIPTION (Continued) h, Average effluent for impoundment (gallons per day and year of record), 1. Average daily influent forall Impoundments at this facility (gallons per day and year j. Average daily effluent removed from aal1ll impoundments and discharged to streams, taken, of record), etc, (gallons per day and year of recon), . •• YEAR OF YHAR OF YEAR OF GALS./DAY GALS./DAY GALS./DAY RECORD RECORD RECORD o-o-s'rwa ° 6'Y°'x 58 - 61 62 - 70 '." 71 - 74 36 - 4A 45 - 48 a ;2*"o-�' ""'. a� 49 - 57 c,'o-,,,saa"Ys .. q _. A o' III. IMPOUNDMENT DESCRIPTION (Continued) k.TYPE OF BOTTOM LINER (Enter no. from the types listed into blocks 23 and 24,) 1. FOR AGRICULTURAL IMPOUNDMENT GIVE AVERAGE DAILY NUMBER . IF CLAY LINER NO. 2,3 OR 4 IS SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.) (in blocks 40 thru 45) AND TYPE {in blatk46) OF LIVESTOCK. ' 01. None 04. Chemically Modified Clay 07. Metal 10. Butyl Rubber Sheeting 13. Chlorinated Polyethylene 02. Clay 05. Concrete 08. Polyethylene It. Hypalan Sheeting 14. Other Membrane type (Specify in blks. 28 - 39.) 1. Cattle 2. Hogs 3. Sheep 4. Poultry S. Other 03:,Bentonite Modified 06. Asphalt 09. Plasticized PVC 12. Ethylene Propylene l5. Other (Specify in blocks 28 thru 39.) :`q"`.g`°'x°°'?x' .AB's ':e> `-a�«;; •------ s >� 145246,m 25*FY V 27 Cdo- Y� 23 24 22: 28 40 0: L, a IV. GROUND -WATER MONITORING V. GROUND -WATER DEGRADATION . Number of moni- b. FREQUENCY OF GROUND -WATER QUALITY SAMPLING FROM a. HAVE SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN b. HAS THE GROUND -WATER QUALITY OF DRINKING WATER WELLS IN THE o ring wells assn- MONITORING WELLS. OBSERVED IN ANALYSIS FROM MONITORING WELLS? (If 'yea', explain AREA BEEN ADVERSELY AFFECTED BY SEEPAGE FROM THIS fated with this and describe below how the site was corrected.) IMPOUNDMENT? (If `yea', explain below.), 'mpoundment (if '0' nter.end go to 1. None 4. Monthly 7. Yearly 1. Yes 2. No 3. Unknown 4. Not Applicable 1. Yes 2. No 3. Unknown 4. Not Applicable (Can only be used when there esfirin V.b.), -- - - - - - - - - - - --- - - - - - - - - - - - - - are nc wells within one mile of impoundment.) 2. Daily 5. Quarterly 8. Other (Specify in blocks 50 thru 61.) EXPLAIN: - - - - EXPLAIN. - - - - - - � - 3. Weekly 6. Semi -Annually e tmyoto- � P>af;i B 13,111169 62 63 47 48 49 50 - 6 S fi VI. RATING OF THE GROUND -WATER CONTAMINATION POTENTIAL (See instruction manual EPA 570/9-78-003) VII. WASTE IDENTIFICATION NO STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 MISCELLANEOUS Enter the waste identification number UNSAT. ZONE CONFIDENCE G.W. AVAIL. CONFIDENCE G.W. QUAL. CONFIDENCE WASTE CONFIDENCE G.W. CONTAM. EALTH HAZARD CONFIDENCE IDENTIFIERS for Part VI, Step 4. POTENTIAL er o -w" -. 11 ,:' , 119 e.,od.--- 'xo�x'•.: �36 ,._ -�ms�-o�.::,;,a::ot?.-so-;�.-:,;'� --d62o-�u'�s?: 2 5 a�26 27 .` 29o. so-- .- 3422 41 - 44 28 Aa33r 3�5 e EPA;Form 7500-44A (6-78)¢ C k to w6 u�� STATE COPY FORM APPROVED *U. S. GOVERNMENT PRINTING OFFICE: 1978-724-845 OMS NO. 158-578004\ EPA Form 7500-44A (6-78) we f, _ STATF.COPY U.S. ENVIRONMENTAL PROTECTION AGENCY SERIAL NUMBER ' DATE PREPARED SURFACE IMPOUNDMENT ASSESSMENT (SIA) OPERATIONAL FEATURES OF THE IMPOUNDMENT AND GROUND -WATER CONTAMINATION POTENTIAL -7w °& ,MONTH DAY YEAR 039568 SECTION If .: INSTRUCTIONS: This form is to he completed for one impoundment per site (facility) identified in Section I, Location and Count of Impoundments Form or for one impoundment per site selected via random sampling procedures. Complete multiple choice questions by entering the code number preceding the appropriate answer. 75 76 77 78 79 80o- .. ..... -, ....... ,.:::MITt;.x ..:,,.: ..... :."v.:; ¢ 'oax. r ..:.- ..;n .. .. ,,,:::-:. :,o- rte»: o. :r �.»n. ... --', , v a..:.x.- , .u..,=.::•w t-xr :::,� .:.a^nr., 1. FACILITY IDENTIFICATION II. PURPOSE OF IMPOUNDMENT (Enter no. in block 23) esn` es a #__: IMPOUND a n abr sic xr ew x c: STATE !; CNTY./CITY PLACE y, CATEGORY c': SIA SITE NUMBER o#'2 dao- w£ g jo . 1. Waste Storage 2. Waste Disposal 3. Waste Treatment (Specify below) 4. Other (Specify below) MENT NO 8sSa•. sr 3;:ro:< : Ry tia �atP'Ca,a §, °z"'` Fr ^25o+: fx',_'ax�.,.< �' a'r°tioo° 4 1 g¢ SPECIFY 1 2 " ",, 3 5 : .E 6 10 11 13 14 - 18 'r 19 21 '*`io' 2 ` o - - {{{ - - III. IMPOUNDMENT DESCRIPTION a. Age of impound b. IS IMPOUNDMENT PR ESE NTLY USED? c. If answer to III.b is .yes', d. If anawer to III -b is 'no', e. Surface area of impoundment. z� f. Surface area of i oundments ee=e ment in years. give no. of give last year at this site (in s}p g. Average influent into 9LLL impoundment (gallons per day and year of record). 1. Yes 2. NO years in operation, of operation. (in acres) I/ Q ! J r� £ 2 YEAR OF }, VIM 1 V -- / .1 `.,$,m°� GALS./bAY RE R °aa;ax*e a b :>a,` s e % sc '_' `- o¢ f:x,''i' s,°�,t,a ---'k v✓d,o it,a 35 36.:ax^' 37" .¢ c: 38 39 n:, 40 - 43 44 - 49 50 - 56 a 22 :o-a:,-M..a:> 23 - 31 y,t' „ .>.h.: -..- 32 AI. IMPOUNDMENT DESCRIPTION (Continued) h. Average effluent forLbLLimpoundment (gallons per day and year of record), i. Average daily influent forte impoundments at this facility (gallons per day and year j. Average daily effluent mmoved from gg]jjj impoundments and discharged to streams, lakes, • of record), etc, (gallons per day and year of recon). YEAR OF YEAR OF YEAR OF GALS./DAY GALS./DAY GALS./DAY RE ORD RECORD RECORD 36 - 44 fie."'.:.,,. a�'`-< 4S-t:o- ,, . Is.x W x.o.:: 49 - 57 zFn dao- _ 5B - 61Afi NO x e- _ 62 70 s aY;kro- - 71 74 III. IMPOUNDMENT DESCRIPTION (Continued) k. TYPE OF BOTTOM LINER (Enter no. from the types listed into blocks 23 and 24.) - 1_ FOR AGRICULTURAL IMPOUNDMENT GIVE AVERAGE DAILY NUMBER LTthrRA E T GIVE IF CLAY LINER NO. 2,3 OR 4 IS SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.) (in blocks 40 AND TYPE OF LIVESTOCK. 01. None 04. Chemically Modified Clay 07. Metal 10. Butyl Rubber Sheeting ' 13. Chlorinated Polyethylene 02.tClay 05• Concrete 08. Polyethylene II. Hypalon Sheeting 14. Other Membrane type (Specify in blks. 28 - 39.) 1. Cattle 2. Hogs 3. Sheep 4. Poultry S. Other 03.'Bentonite Modified 06. Asphalt 09. Plasticized PVC 12. Ethylene Propylene l5. Other (Specify in blocks 28 thru 39.) 22 23 24 27 28 39 40 �'�, ao--. -_25 � ;noo-�x,,�5;w„k}.o-aAa,x ai�.:ok .a,z„✓oo..,!n`S,.: - 45 46 v�.r�w �¢: � N. ; - ,;::.:.; :: ,.,.,>:,: <-- .,: - .>;. .•.:,�,<..:.:� .. -,,- .. ',yo-;,:. ,¢ s;�R„ IV. GROUND -WATER MONITORING V. GROUND -WATER DEGRADATION ..Number of moni- b. FREQUENCY OF GROUND -WATER QUALITY SAMPLING FROM a. HAVE SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN b. HAS THE GROUND -WATER QUALITY OF DRINKING WATER WELLS IN THE o ring wells assn- MONITORING WELLS. 013SERVED IN ANALYSIS FROM MONITORING WELLS? (If 'yea', explain AREA BEEN ADVERSELY AFFECTED BY SEEPAGE FROM THIS iated with this and describe below how the site was corrected.) IMPOUNDMENT? (If `yes', explain below,), 'mpoundment (if '0' rater and go to 1. None 4. Monthly 7. Yearly 1. Yes 2. No 3. Unknown 4, Not Applicable 1. Yes 2. No 3. Unknown 4. Not Applicable (Can only be used when there e®tion V.6..). ----- - -- - - - - - - - - -- -•- --- - - - - - - - - -- !I are no wes within one mile of impoundment.) • 2. Daily S. Quarterly 8. Other (Specify in blocks 50 thru 61.) EXPLAIN: - - - ,-- - - - T - - .T - - - - --- EXPLAIN. - - - 3. Weekly 6. Semi -Annually 62 63 47 48sxo- ns,° 49- 50 - 61 VI. RATING OF THE GROUND -WATER CONTAMINATION POTENTIAL (See instruction manual EPA 570/9-78-003) VII. WASTE IDENTIFICATION N 'M STEP 1 STEP 2STEP 3 STEP 4 STEP 5 STEP 6 MISCELLANEOUS Enter the waste identification number z '•3'a.:;" '` ^`'- UNSAT. ZONE ONFIDENCE G.W. AVAIL, CONFIDENCE G.W. QUAL_. ON FIDENCE WASTE ON FIDENCE G W. CONT M. HEALTH HAZARD CONFIDENCE P O T E N T I A IDENTIFIERS for Pert VI, Step 4. :.: w,•l, ..«: -`--- :...,`.`:-- ,>3.. . ��>' � r� �:�. .o-et',�,;:. �°" <ag>� -�•b-:",g::�;,:5 au ; z, -- 22 :..: �x.�, �r= �::� �.,..$..: ::.. � -a,::e� 23 2a 25, �� 2s 27 z �> 30 „� 31 '�,.: r;: 36 �.:�«: 8 �< .� a.'�,�:.°- ,�• :x. �, r. .:.�.. ..�� ;. ,.�� n.. z-.-�„.�w�„> <::.,�:�.::-->xa:z'._,.�,..-::�a�::°s 29 ,, __�...-.:.� - 32 ��.,33 34 �_->.<, $;�?...a 35 :.::.;�,'a 37 �:.;�: � _ :�>, k..e�..�.a:.. 3B 40 :;a,:�:.'�_;a?' x:»'�-z:fl(..::... 41 44 EPA Form 7500-44A (6-78) we f, _ STATF.COPY