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Former Mobil Station No. 11658, 19 Ames Street, Dedham, MA 02026

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Former Mobil Station No. 11658, 19 Ames Street, Dedham, MA 02026 Figures MC MD M:\Graphics\1600-Westford\ExxonMobil\Mobil (some files moved to Global)\01-081 Dedham\01-081 dedham SLM.dwg, Model, 2/21/2011 3:13:19 PM, WShea MC MD M:\Graphics\1600-Westford\ExxonMobil\Mobil (some files moved to Global)\01-081 Dedham\01-081 dedham SM.dwg, B-30, WShea 2 Attachment A NPDES Permit No. MAG910000 NPDES Permit No. NHG910000 B. Suggested Form for Notice of Intent (NOI) for the Remediation General Permit 1. General facility/site information. Please provide the following information about the site: a) Name of facility/site: Former Mobil Station Facility/site mailing address: Location of facility/site: Facility SIC Street: 19 Ames Street code(s): longitude:_______________71 10'43.56"W latitude:_______________42 15'28.62"N 5541 b) Name of facility/site owner: 33 McDonald St LLC Town: Dedham Email address of facility/site owner: State: Zip: County: na Massachusetts 02026 Norfolk Telephone no. of facility/site owner: 781-329-1538 Fax no. of facility/site owner: na Owner is (check one): 1. Federal____ 2. State/Tribal____ 3. Private____ 4. Other ____ if so, describe: Address of owner (if different from site): Street: Town: State: Zip: County: c) Legal name of operator: Operator telephone no: 800-221-6119 Groundwater & Environmental Services, Inc. (GES) Operator fax no.: 978-392-8583 Operator email: Operator contact name and title: Michael Decoteau, PE, Senior Project Engineer Address of operator (if different from Street: owner): 364 Littleton Road, Suite 4 Town: Westford State:MA Zip: 01886 County: Middlesex Remediation General Permit Page 10 of 22 Appendix V - NOI NPDES Permit No. MAG910000 NPDES Permit No. NHG910000 d) Check Y for Ayes@ or N for Ano@ for the following: 1. Has a prior NPDES permit exclusion been granted for the discharge? Y___ N___, if Y, number:_________________ 2. Has a prior NPDES application (Form 1 & 2C) ever been filed for the discharge? Y___ N___, if Y, date and tracking #:__________________________________________________________________ 3. Is the discharge a “new discharge” as defined by 40 CFR 122.2? Y___ N___ 4. For sites in Massachusetts, is the discharge covered under the Massachusetts Contingency Plan (MCP) and exempt from state permitting? Y___ N___ e) Is site/facility subject to any State permitting, license, f) Is the site/facility covered by any other EPA permit, including: or other action which is causing the generation of 1. Multi-Sector General Permit? Y___ N___, discharge? Y___ N___ if Y, number:_______________ If Y, please list: 2. Final Dewatering General Permit? Y___ N___, 1. site identification # assigned by the state of NH or if Y, number:________________ MA:_________________________________________MassDEP Site No. 3-2716 3. EPA Construction General Permit? Y___ N___, 2. permit or license # assigned:____________________ if Y, number: _______________ 3. state agency contact information: name, location, and 4. Individual NPDES permit? Y___ N___, telephone number: if Y, number:_____________ MassDEP Northeast Regional Office 5. any other water quality related individual or general permit? Y___ 205B Lowell Street, Wilmington, MA 01887, Ph# 978-694-3200 N___, if Y, number:______________ g) Is the site/facility located within or does it discharge to an Area of Critical Environmental Concern (ACEC)? Y____ N____ h) Based on the facility/site information and any historical sampling data, identify the sub-category into which the potential discharge falls. Activity Category Activity Sub-Category I - Petroleum Related Site Remediation A. Gasoline Only Sites ____ B. Fuel Oils and Other Oil Sites (including Residential Non-Business Remediation Discharges) ____ C. Petroleum Sites with Additional Contamination ____ II - Non Petroleum Site Remediation A. Volatile Organic Compound (VOC) Only Sites _____ B. VOC Sites with Additional Contamination ____ C. Primarily Heavy Metal Sites ____ III - Contaminated Construction Dewatering A. General Urban Fill Sites ____ B. Known Contaminated Sites ____ Remediation General Permit Page 11 of 22 Appendix V - NOI NPDES Permit No. MAG910000 NPDES Permit No. NHG910000 IV - Miscellaneous Related Discharges A. Aquifer Pump Testing to Evaluate Formerly Contaminated Sites ____ B. Well Development/Rehabilitation at Contaminated/Formerly Contaminated Sites ____ C. Hydrostatic Testing of Pipelines and Tanks ____ D. Long-Term Remediation of Contaminated Sumps and Dikes ____ E. Short-term Contaminated Dredging Drain Back Waters (if not covered by 401/404 permit) ____ 2. Discharge information. Please provide information about the discharge, (attaching additional sheets as necessary) including: a) Describe the discharge activities for which the owner/applicant is seeking coverage: Groundwater that will be extracted during the operation of a Total Phase (soil vapor and groundwater) Extraction System. Treated groundwater will be discharged to the storm water system. b) Provide the following information about each discharge: 1) Number of discharge 2) What is the maximum and average flow rate of discharge (in cubic feet per second, ft3/s)? points: Max. flow____________0.0223 Is maximum flow a design value? Y___ N____ 1 Average flow (include units) __________0.0223 cfs Is average flow a design value or estimate? design_________ 3) Latitude and longitude of each discharge within 100 feet: pt.1: lat._____________42 15'29.69"N long._____________;71 10'43.51" pt.2: lat._____________ long._____________; pt.3: lat._____________ long._____________; pt.4: lat._____________ long._____________; pt.5: lat._____________ long._____________; pt.6: lat._____________ long._____________; pt.7: lat._____________ long._____________; pt.8: lat._____________ long._____________; etc. 4) If hydrostatic testing, 5) Is the discharge intermittent ____ or seasonal____? total volume of the Is discharge ongoing? Y ____ N______ discharge (gals):_________ c) Expected dates of discharge (mm/dd/yy): start_____________September 1, 2013 end_________________September 1, 2016 d) Please attach a line drawing or flow schematic showing water flow through the facility including: 1. sources of intake water, 2. contributing flow from the operation, 3. treatment units, and 4. discharge points and receiving waters(s). Please see the attached figures. Remediation General Permit Page 12 of 22 Appendix V - NOI NPDES Permit No. MAG910000 NPDES Permit No. NHG910000 3. Contaminant information. a) Based on the sub-category selected (see Appendix III), indicate whether each listed chemical is believed present or believed absent in the potential discharge. Attach additional sheets as needed. Minimum Maximum daily value Average daily value Sample Analytical Level CAS Believed Believed # of Type Method Parameter * (ML) of Number Absent Present Samples (e.g., Used concentration mass concentration mass Test grab) (method #) (ug/l) (kg) (ug/l) (kg) Method 1. Total Suspended 2 grab 2540 5 48,000 2.615 48,000 2.615 Solids (TSS) 2. Total Residual 2 grab 4500 20 Chlorine (TRC) 3. Total Petroleum 2 grab 8015 1 74,000 4.03 74,000 4.03 Hydrocarbons (TPH) 4. Cyanide (CN) 57125 2 grab 335.4 14 0.001 14 0.001 5. Benzene (B) 71432 2 grab 8260B 20 710 0.039 710 0.039 6. Toluene (T) 108883 2 grab 8260B 20 8,830 0.481 8,830 0.481 7. Ethylbenzene (E) 100414 1 grab 8260B 20 1,840 0.1002 1,840 0.1002 8. (m,p,o) Xylenes (X) 108883; 106423; 95476; 2 grab 8260B 60 16,100 0.877 16,100 0.877 1330207 2 9. Total BTEX n/a 2 grab 8260B 120 27,480 1.497 27,480 1.497 10. Ethylene Dibromide 106934 (EDB) (1,2- 2 grab 8260B 0.0100 3 Dibromoethane) 11. Methyl-tert-Butyl 1634044 2 grab 8260B 20 12 0.0007 12 0.0007 Ether (MtBE) 12. tert-Butyl Alcohol 75650 2 grab 8260B 200 (TBA) (Tertiary-Butanol) * Numbering system is provided to allow cross-referencing to Effluent Limits and Monitoring Requirements by Sub-Category included in Appendix III, as well as the Test Methods and Minimum Levels associated with each parameter provided in Appendix VI. 2 BTEX = Sum of Benzene, Toluene, Ethylbenzene, total Xylenes. 3 EDB is a groundwater contaminant at fuel spill and pesticide application sites in New England. Remediation General Permit Page 13 of 22 Appendix V - NOI NPDES Permit No. MAG910000 NPDES Permit No. NHG910000 Minimum Maximum daily value Average daily value Sample Analytical Level CAS Believed Believed # of Type Method Parameter * (ML) of Number Absent Present Samples (e.g., Used concentration mass concentration mass Test grab) (method #) (ug/l) (kg) (ug/l) (kg) Method 13. tert-Amyl Methyl 9940508 2 grab 8260B 20 Ether (TAME) 14. Naphthalene 91203 2 grab 8260C8260B 20 621 0.034 621 0.034 15. Carbon Tetrachloride 56235 2 grab 8260B 20 16. 1,2 Dichlorobenzene 95501 2 grab 8260B 20 9.2 0.0005 9.2 0.0005 (o-DCB) 17. 1,3 Dichlorobenzene 541731 2 grab 8260B 20 (m-DCB) 18. 1,4 Dichlorobenzene 106467 2 grab 8260B 20 2.1 0.0001 2.1 0.0001 (p-DCB) 18a. Total 2 grab 8260B 60 11.3 0.0006 11.3 0.0006 dichlorobenzene 19. 1,1 Dichloroethane 75343 2 grab 8260B 20 (DCA) 20. 1,2 Dichloroethane 107062 2 grab 8260B 20 (DCA) 21. 1,1 Dichloroethene 75354 2 grab 8260B 20 (DCE) 22. cis-1,2 Dichloroethene 156592 2 grab 8260B 20 (DCE) 23. Methylene Chloride 75092 2 grab 8260B 40 24. Tetrachloroethene 127184 2 grab 8260B 20 (PCE) 25. 1,1,1 Trichloro-ethane 71556 2 grab 8260B 20 (TCA) 26. 1,1,2 Trichloro-ethane 79005 2 grab 8260B 20 (TCA) 27. Trichloroethene 79016 2 grab 8260B 20 (TCE) Remediation General Permit Page 14 of 22 Appendix V - NOI NPDES Permit No. MAG910000 NPDES Permit No. NHG910000 Minimum Maximum daily value Average daily value Sample Analytical Level CAS Believed Believed # of Type Method Parameter * (ML) of Number Absent Present Samples (e.g., Used concentration mass concentration mass Test grab) (method #) (ug/l) (kg) (ug/l) (kg) Method 28.
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