WI0400523_Staff Report_20191028

Permit No. WI0400523
Date: 10/28/2019 County: Randolph
To: Shristi Shresta Permittee/Applicant: Cintas Corporation.
Central Office Reviewer Facility Name: Former Salem Uniform Services Facility
L GENERAL INFORMATION
1. This application is (check all that apply): ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 10/23/2019
b. Person contacted and contact information: Matt Allen, AECOM, [phone]
c. Site visit conducted by: Jim Gonsiewski
d. Inspection Report Printed from BIMS attached: ® Yes ❑ No.
e. Physical Address of Site including zip code: 4015 North Cherry Street Winston-Salem, NC 27105
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 872746.00 (Northing) Longitude: 1626889.72 (Easting)
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.): Site Survey
IL DESCRIPTION OF INJECTION WELLS) AND FACILITY
1. Type of injection system:
❑ Geothermal Heating/Cooling Water Return
® In situ Groundwater Remediation
❑ Non -Discharge Groundwater Remediation
❑ Other (Specify:
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system only
Were samples collected from Influent/Effluent sampling ports? ❑ Yes ❑ No.
Provide well construction information from well tag:
b. Does existing or proposed system use same well for water source and injection? ❑ Yes ❑ No
If No please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ® Yes ❑ No
What is/are the pollution source(s)? Industrial Cleaning and Laundry Service that was in operation from 1967
to 1986 Operated as Salem Uniform Services from 1967 to 1983 and Cintas from 1983 to 1986.
What is the distance of the injection well(s) from the pollution source(s)_
4. What is the minimum distance of proposed injection wells from the property boundary?
5. Quality of drainage at site: ❑ Good ® Adequate ❑ Poor
6. Flooding potential of site: ❑ Low Z Moderate ❑ High

7. For Groundwater Injection Remediation Systems only, is the proposed and/or existing groundwater monitoring
program (number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ® Yes ❑ No.
If No, attach map of existing monitoring well network if applicable and recommend any changes to the
groundwater -monitoring program.
8. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ® Yes ❑ No. If No, or no map, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9. For Non -Discharge Groundwater Remediation systems only (i.e., permits with WQ prefix):
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ N/A.
If No, please explain:
b. Are the site conditions (soils, topography, depth tb water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ N/A. If no, please explain:
III. EVAL UATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If Yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by Regional Office
❑ Issue upon receipt of needed additional information
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Date: 10/28/2019

IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional/If Needed)
The buildings at the site were demolished 2 to 3 years ago. All utilities were removed from the site so there are
no underground utilities in the injection or surrounding area. The SVE unit is currently in operation but,
according to Matt Allen, Project Manager for AECOM, the unit is likely to be shut down in a year since the
effectiveness of the system has significantly decreased. The in situ injection will be conducted by Regenesis.

Compliance Inspection Report
Permit: W10400523 Effective: Expiration: Owner: Cintas Corporation
SOC: Effective: Expiration: Facility: Former Salem Uniform Site
County: Forsyth 4015 N Cherry St
Region: Winston-Salem
Winston Salem NC 27105
Contact Person: Bethany Donovan Title: - Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s): _
On -site representative Matt Allen 919461-1434
Related Permits:
Inspection Date: 10/2312019 Entry Time: 10:05AM Exit Time: 11:15AM
Primary Inspector: Jim J Gonsiewski Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Other Inspection Type: Reconnaissance
Permit Inspection Type: Injection In situ Groundwater Remediation Well
Facility Status: 0 Compliant ❑ Not Compliant
Question Areas:
Wells System Operations
(See attachment summary)
Page 1 of 3

Permit: W10400523 Owner- Facility: Cintas Corporation
Inspection Date: 10/23/2019 Inspection Type : Reconnaissance Reason for Visit: Other
Inspection Summary:
The inspection was conducted on October 23, 2019 by Jim Gonsiewski of the Winston-Salem Regional Office, accompanied
by Matt Allen, Project Manager for AECOM. Wells were being installed by Geologic Exploration, Inc. at the time of the site
visit. The buildings at the site were demolished 2 to 3 years ago. All utilities were removed from the site so there are no
underground utilities in the injection or surrounding area. The SVE unit is currently in operation but, according to Matt Allen,
the unit is likely to be shut down in a year since the effectiveness of the system has significantly decreased. The in situ
injection will be conducted by Regenesis.
Page 2 of 3

Permit:
W10400523
Owner- Facility: Cintas Corporation
Inspection Date:
10/23/2019
Inspection Type : Reconnaissance
Reason for Visit:
Other
Location Yes No NA NE
Distance from septic tank & drainfield (feet)
Distance from other waste disposal/collection (feet)
Comment
Distance from other pollution source
Comment
Is well location subject to flooding? ❑ ❑ ❑ ❑
Minimum distance to property boundary (ft)
Comment:
System Operation Yes No NA NE
Is same well used as source well and injection well? ❑ 0 ❑ ❑
Is injection well capable of assimilating injected fluid? ❑ ❑ ❑
Injection flow rate at time of inspection (gpm)
Has system owner/operator noticed any abnormalities (turbidity, air in system, poor heating/cooling, etc) in ❑ ❑ ❑
system operation?
Comment on system operation ❑ ❑ 0 ❑
Is system operation and construction consistent with that described in application? ❑ ❑ ❑
Describe inconsistencies between application and observed operation/construction
Comment: System has not been constructed Currently additional wells are being installed. Good safety
procedures observed.
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