WI0400468_Staff report for Cintas Injection_20190816

Permit No. WI0400468
Date: 08/14/2019 County: Fors
To: Shristi Shresta Permittee/Applicant: _Cintas Corporation
Central Office Reviewer Facility Name: _Former RUS Facility
L GENERAL INFORMATION
1. This application is (check an that apply)
a. Date of Inspection:
❑ New ❑ Renewal
® Minor Modification ❑ Major Modification
b. Person contacted and contact information:
c. Site visit conducted by:
d. Inspection Report Printed from BIMS attached: ❑ Yes ❑ No.
e. Physical Address of Site including zip code: 3775 Industrial Road Winston-Salem, NC 27105
£ Driving Directions if rural site and/or no physical address:
g. Latitude
360 8'58.96"
Longitude: -80' 14' 27.55"
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.): Goo le Earth
II. DESCRIPTION OF INJECTION WELL 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) onl
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)? _Former dry-cleaning facility acility (the former dry-cleaning room, the former
interior wash line trenches, the former exterior wastewater basins, and an exterior area on the southwest corner
of the facility_ parking lot).
What is the distance of the injection well(s) from the pollution source(s)_320 feet
4. What is the minimum distance of proposed injection wells from the property boundary? _230 feet
5. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ❑ Low ® 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 to 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. EVALUATIONAND 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:
Condition Reason
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
DocuSigned by:
® Issue 1?97B66F179D45F...
5. Signature of Report Preparer(s):
Signature of WQROS Regional Supervisor: L-'~ T S"jt,
145ME225C94EA...
Date: 8/16/2019

IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional/If Needed)