WI0400428_DEEMED FILES_20151026

Ro gers, Michael
From:
Sent:
Wayne Watterson <[e-mail]>
Monday, October 26, 2015 4:54 PM
To: Rogers, Michael; Jamie Honeycutt
Cc: Knight, Sherri; Basinger, Corey
Subject: RE: WI0400428 NOi injection Well Operation TF-30817 Opal Shephard, Burlington
(Alamance County),
Attachments: Opal Shepherd Injection Event Record 10232015.pdf
Michael,
Please see the attached Injection Event Record
Wayne H. Watterson, P.E.
Senior Engineer
~ME
ENGINEER ING INTEGRITY.
We have moved:
S&ME, Inc.
8646 West Market Street, Suite 105
Greensboro, NC 27409
Ph: 336-288-7180
Fax: [phone]
Mobile: [phone]
wwatterson @smeinc.com
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
From: Rogers, Michael [mailto:[e-mail]]
Sent: Wednesday, October 21, 2015 5:01 PM
To: Jamie Honeycutt <[e-mail]>
Cc: Wayne Watterson <[e-mail]>; Knight, Sherri <[e-mail]>; Basinger, Corey
<[e-mail]>
Subject: RE: WI0400428 NOi injection Well Operation TF-30817 Opal Shephard, Burlington (Alamance County),
We rec'd the NOi via mail 10/16/2015. Please submit the necessary reporting forms when applicable. This project has
been assigned permit number WI0400428.
Regards,
From: Jamie Honeycutt [mailto:JHone ycutt @smeinc.com]
Sent: Monday, October 12, 2015 12:07 PM .
To: Rogers, Michael <michael.rogers @ncdenr.gov>
Cc: Wayne Watterson <WWatterson @smeinc.com>
Subject: NOi Injection Well Operation TF-30817 Opal Shephard, Burlington (Alamance County),
Michael,
Attached is the electronic copy of the Notice of Intent (NOi) to Operate Injection Wells at a NCDENR, UST Section, State
Lead Site identified as TF 30817 Opal Shephard located at 4050 NC Hwy 49 South, Burlington (Alamance County). I will
1
also mail a hard copy of the NOi to you. We plan to install 0-SOXs at one exiting monitor well located at the site. Please
give me a call on my cell (910 977-7614) if you have any questions.
thanks
Jamie T. Honeycutt
Environmental Professional
~S&ME
ENGINEERING INTEGRITY.
S&ME, Inc.
409 Chicago Drive, Suite 107
Fayetteville NC 28306
Ph: 910-323-1091
Fax: [phone]
Mobile: [phone]
[e-mail]
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
2
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Permit Number W10400428
1, Permit Information
S&ME, Inc.
Pernittee
TF-308'17 Opal Shepherd
Facility Name
4050 NC Hwy 49 South Burlington, NC 27215
Facility Address
2. Injection Contractor Information
S&ME, Inc.
Injection Contractor / Company Name
Street Address 8644 West Market Street,] 05
Dreenchnm NC' 27409
City State Zip Code
(336 ) 2811-7130
Area code - Phone number
3. Well Information
Number of wells used for injection -1
Well names MW-I
Were any new wells installed during this injection
event?
❑ Yes ®No
if yes, please provide the following information:
Number of Monitoring Wells
Number of injection Wells
Type of Well Installed (Check applicable type):
❑ Bored 0 Drilled 0 Direct -Push
❑ Hand -Augured 0 Other (specify)
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes DI No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy glare GW--30 for each well
abandoned.
4. injectant Information
(]-SOX: Calcium Pemxid. Calcium. Hydroxide
Injectant Type (Solid)
Concentration 10-40 mg/ at infection point
If the injectant is diluted please indicate the source
dilution fluid. Nil
Total Volume Injected_ 3 socks in MW t
Volume Injected per well_ 3 socks in MW-I
5. Injection History
Injection date(s)
1 oraa_r2o15
injection number (e.g. 3 of 5) 1
Is this the last injection at this site?
❑ Yes ❑ No
(unknown)
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
5 LA O IN THE PERMIT.
A URE OF 1 )ECt'ION CONTRACTOR DA
Michael Cook (SRz.MF, Inc ..Apr nt for NCDENIR
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: U1C Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-1ER
Rev. 8/5/2013

Rogers, Michael.
From:
Sent:
To:
Cc:
Subject:
Rogers, Michael
Wednesday, October 21, 2015 5:01 PM
'Jamie Honeycutt'
Wayne Watterson; Knight, Sherri; Basinger, Corey
RE: WI0400428 NOi Injection Well Operation TF-30817 Opal Shephard, Burlington
(Alamance County),
We rec'd the NOi via mail 10/16/2015. Please submit the necessary reporting forms when applicable. This project has
been assigned permit number WI0400428.
Regards,
From: Jamie Honeycutt [mailto:[e-mail]]
Sent: Monday, October 12, 2015 12:07 PM
To: Rogers, Michael <[e-mail]>
Cc: Wayne Watterson <[e-mail]>
Subject: NOi injection Well Operation TF-30817 Opal Shephard, Burlington (Alamance County),
Michael,
Attached is the electronic copy of the Notice of Intent (NOi) to Operate Injection Wells at a NCDENR, UST Section, State
Lead Site identified as TF 30817 Opal Shephard located at 4050 NC Hwy 49 South, Burlington (Alamance County). I will
also mail a hard copy of the NOi to you. We plan to install O-SOXs at one exiting monitor well located at the site. Please
give me a call on my cell (910 977-7614) if you have any questions.
thanks
Jamie T. Honeycutt
Environmental Professional
·ts&ME
ENGINEERING INTEGRITY.
S&ME, Inc.
409 Chicago Drive, Suite 107
Fayetteville NC 28306
Ph: 910-323-1091
Fax: [phone]
Mobile: [phone]
[e-mail]
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If yo.u received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
1
Ro g ers, Michael
From:
Sent:
To:
Subject:
Attachments:
Please find attached a NOi.
Rogers, Michael
Wednesday, October 21, 2015 4:58 PM
Knight, Sherri; Basinger, Corey
FW: WI0400428 NOi Injection Well Operation TF-30817 Opal Shephard, Burlington
(Alamance County),
NOi TF 30817-02 Opal Shephard In Situ Remediation Notification-2015-10-12.pdf
From: Jamie Honeycutt [mailto:[e-mail]]
Sent: Monday, October 12, 2015 12:07 PM
To: Rogers, Michael <[e-mail]>
Cc: Wayne Watterson <[e-mail]>
Subject: NOi injection Well Operation TF-30817 Opal Shephard, Burlington (Alamance County),
Michael,
Attached is the electronic copy of the Notice of Intent (NOi) to Operate Injection Wells at a NCDENR, UST Section, State
Lead Site identified as TF 30817 Opal Shephard located at 4050 NC Hwy 49 South, Burlington (Alamance County). I will
also mail a hard copy of the NOi to you. We plan to install O-SOXs at one exiting monitor well located at the site. Please
give me a call on my cell (910 977-7614) if you have any questions.
thanks
Jamie T. Honeycutt
Environmental Professional
~S&ME /
ENGINEERING INTEGRITY.
S&ME, Inc.
409 Chicago Drive, Suite 107
Fayetteville NC 28306
Ph: 910-323-1091
Fax: [phone]
Mobile: [phone]
[e-mail]
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
1
Permit Number WI0400428
Program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Opal Shepard Property TF-30817
Location Address
4050 NC Hwy 49 S
Burlington NC
Owner
Owner Name
Hassan
Dates/Events
Orig Issue
10/21/2015
App Received
10/16/2015
Reg ulated Activities
Groundwater remediation
Outfall
Waterbody Name
27215
Osman
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
10/21/2015
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Winston-Salem
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Hassan Osman
1637 Mail Service Ceter
Raleigh
County
Alamance
NC
Issue
10/21/2015
Effective
10/21/2015
27699163
Expiration
Req uested /Received Events
Streamlndex Number Current Class Subbasin
S&ME
October 12, 2015
North Carolina Department of Environmental Quality
DWR-UIC Program
1636 Mail Service Center
Raleigh, NC 27699
Reference: Notification of Intent
To Whom It May Concern:
RECE1VECIDENRIDWR
OCT 16 2015
Water Quality Regional
Operations Section
Please find enclosed the Notice of Intent to Constrict or Operate Injection WeiIs for TF site No. 30817-02
Opal Shephard. An electronic copy of this package was sent to Mr. Michael Rogers, of the NCDEQ, on
October 12, 2015.
Kindest regards,
S&ME, Inc.
e„“1
Jennifer Powers Crank
Administrator, Environmental Department
5&ME, Inc.
seSittYiktricaWDORVecfragivz8gaq Aiitgow fr 01Y:tin -NW iff 93-14A7f0945§d rimosimtiafiECtriim

Ro gers, Michael
From:
Sent:
To:
Cc:
Subject:
Attachments:
Michael,
Jamie Honeycutt <[e-mail]>
Monday, October 12, 2015 12:07 PM
Rogers, Michael
Wayne Watterson
NOi Injection Well Operation TF-30817 Opal Shephard, Burlington (Alamance County),
NOi TF 30817-02 Opal Shephard In Situ Remediation Notification-2015-10-12.pdf
Attached is the electronic copy of the Notice of Intent (NOi) to Operate Injection Wells at a NCDENR, UST Section, State
Lead Site identified as TF 30817 Opal Shephard located at 4050 NC Hwy 49 South, Burlington (Alamance County). I will
also mail a hard copy of the NOi to you. We plan to install O-SOXs at one exiting monitor well located at the site. Please
give me a call on my cell (910 977-7614) if you have any questions.
thanks
Jamie T. Honeycutt
Environmental Professional
~S&ME
ENGINEERING INTEGRITY.
S&ME, Inc.
409 Chicago Drive, Suite 107
Fayetteville NC 28306
Ph: 910-323-1091
Fax: [phone]
Mobile: [phone]
[e-mail]
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
1
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This fo rm shall be submitted at least 2 weeks prior to in iection.
AQUIFER TEST WELLS (ISA NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225 ) or TRACER WELLS {1 5A NCAC 02C .0229}:
1) Passive Injection S y stems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods .
2) Small-Scale Injection O perations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. Rlegi,ble SubmittaRl06tV!l);f}E~tJWRPlete.
W ~DY (J) '-I ;)f -.
DATE: October 12 , 2015 PERMIT NO. OCT I (j 2015 (to be filled m by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERA TED Woatar Q~ality Realonal perations Section
(1) ____ Air Injection Well ...................................... Complete sections B-F, K, N
(2) ____ Aquifer Test Well ....................................... Complete sections B-F, K, N
(3) X __ Passive Injection System ............................... Complete sections B-F, H-N
(4) ___ Small-Scale Injection Operation ...................... Complete sections B-N
(5) ____ Pilot Test. ................................................ Complete sections B-N
(6) ___ Tracer Injection Well ................................... Complete sections B-N
B. STATUS OF WELL OWNER: State Government
C. WELL OWNER-State name of entity and name of person delegated authority to sign on behalf of the business
or agency:
Name: Hassan Osman. NCDENR. DWM. UST Section
Mailing Address: 1637 Mail Service Center
City: Raleiuh State: NC Zip Code: 27699 County:_W:..a...;;::ak=e..._ _____ _
Day Tele No.: 919-707-8167 Cell No.: _________ _
EMAIL Address: hassan.osman/@ ncdenu wv Fax No.: __________ _
UIC/Jn Situ Remed. Notification (Revised 3/2/2015) Page I
D. PROPERTY OWNER (if different than well owner)
Name: Flo yd and Elsie Smith
Mailing Address: 2124 Gardner Holt
City: Burlin gt on State: ~Zip Code:27215 County: Alamance
Day Tele No.: 336-228-1526 Cell No.: _________ _
EMAIL Address:______ Fax No.: __________ _
E. PROJECT CONTACT -Person who can answer technical questions about the proposed injection project.
Name: Jamie T. Honeycutt (S&ME , Inc.)
Mailing Address: 409 Chicago Drive . Suite 107
City: Fayetteville State: NQ__ Zip Code: 28306 County: Cumberland
Day Tele No.: 910-323-1091 Cell No.: 910-977-7614
EMAIL Address: jhoneycutt @smeinc.com Fax No.: ________ _
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: 4050 NC H wy 49 South
County: Alamance
City: Burlin gt on State: NC Zip Code:~2~7=2=1~5 _____ _
(2) Geographic Coordinates: Latitude**: ___ 0 ____ " or 36_0 .023214
Longitude**: 0 __ ,, or 79_0 .443923
Reference Datum: ________ .Accuracy: ________ _
Method of Collection:.---'G=-o=o:.;;g"""le=--=E=art=h~---------
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: _______ .square feet
Land surface area ofinj. well network: square feet (:S 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be .:S 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification. (Note: Not all of the following
requested information is available.)
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
UIC/Jn Situ Rerned. Notification (Revised 3/2/2015) Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time .
A release of gasoline from a former underground stora ge tank system located on the pro pe rty has im pacted
l!Toundwater above the 15A NCAC 2L .0202 groundwater quality standards. Three monitor wells (M W-1 , MW-
2 and MW-3 ) are located on the site. MW-3 is presumed destroyed. Multi ple private water supp lv wells are
located within 1.000 feet of the release. The use of O-SOX (Calcium peroxide or EHC-O chemical) usin g MW-
I is planned to enhance the de gr adation of petroleum contaminant levels in the groundwater to below the 2L
Standards.
J. INJECT ANTS -Provide a MSDS and the following for each injectant. Attach additional sheets if necessary.
NOTE: Approved injectants (tracers and remediation additives) can be found online at
http://portal.ncdenr.org/web/wq/apsl~w.,Pro. All other substances must be reviewed by the Division of Public
Health, Department of Health and Human Services. Contact the UIC Program for more info (919-807-6496).
lnjectant: Calcium Peroxide in solid form . b y sock of chemical in monitor well , for oxygen
Volume ofinjectant: Varies , by diffusion. 1.75 lb EHC-O or 0.2625 lb Oxygen per well
Concentration at point of injection: __ ....:1:...:0c...-4-=-0=--=m=-=g.,../L:;:._ ____________ _
Percent if in a mixture with other injectants: Calcium peroxide <75%. Calcium Hydroxide <25%
lnjectant: ---------------------------------
Volume ofinjectant: ____________________________ _
Concentration at point of injection: ______________________ _
Percent if in a mixture with other injectants: ___________________ _
lnjectant:
Volumeofinjectant: ____________________________ _
Concentration at point of injection: ______________________ _
Percent if in a mixture with other injectants : ___________________ _
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: _____ Proposed'--------"l ___ Existing (MW-1)
(2) Provide well construction details for each injection well in a diagram or table format. A single
diagram or line in a table can be used for multiple wells with the same construction details. Well
construction details shall include the following:
(a) well type as permanent, direct-push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
(c) well contractor name and certification number
UIC/ln Situ Remed. Notification (Revised 3/2/2015) Page3
Well
s.
Type
Grout
(ft hls'1
Screen
aft-bls}
Casing
(ft-blsl
Well Contractor
Cert#
MW-1
Permanent
0-11
i
15-35
0-15
_
Quantex, Inc.
_
3106
Well Construction Record is Attached.
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Monitoring• well MW-1 was installed its October 2007. Passive oxveen releasine O-SOXs will be placed into
the existing well followine receipt of the notification permit number from NCDENR.
M. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
The injection of oxi, een is not expected to result in violations of the 2L Standards. The monitor well will be
sampled on a recular basis and additional O-SOXs installed l as per NCDENR). This ma. be followed b. rpost-
remediation sampline without oxveen infusion to check for rebound of contaminant levels.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "1 hereby certj, under penalty of law, that I am familiar with the information submitted in this
document and all attachments thereto and that. based on my inquiry of those individuals immediately responsible
for obtaining said information, I believe that the information is axle accurate and complete, 1 am aware that
there are significant penalties, including the possibility of fines and imprisonment, for submitting false
information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtengrrces in rdance with the 15,4 NCAC 02C 0200 Rules."
'' r S&ME, Inc. -Agent for NCDEQ Jamie T. Honeycutt [ S&ME. Inc. )
Signature of Applicant Print or Type Full Name
PROPERTY OWNER (if the property is not owned by the permit applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A ,NCAC 02C .020W. "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
See attached access agreement with Mx.Fio d Smith dated Sept. 16, 2015
Signature* of Property Owner (if different from applicant) Print or Type Full Name
* An access agreement between the applicant and property owner may be submitted in Lieu of a signature on this form.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
13ICIIn Situ Reined. Notification (Revised 31212015) Page 4

or
0
ANCE RD
/NIGHf.At4D' f L
L��
i )(•'" a -
''' r 1
-,t J ). ''"-- T-- ('' --1 .'-'2\'1--...,117-1 ,...). : . if .L' . 7-7 - i
i • J
GRAPHIC SCAM
2.000
1C-
SCA1 F: 1' - 2.020'
SCALE: AS SHOWN
DATE:
JUNE 2015
DRAWN BY: ROM
[ROJECT Na
4305-15-043
Kqr
�:
(MOiI1tOE H0 7 C.) 000
Al *CF:CT
SOURCE: BURLINGTON, NC QUADRANGLE, 7.5-MINUTE SERIES
USGS TOPOGRAPHIC MAP (2013)
OBTAINED FROM http:llstore,usgs.gov
S&ME
WWW.SMEINC.COM
VICINITY MAP
OPAL. SHEPHARD PROPERTY TF-30817
4050 NC HIGHWAY 49 SOUTH
BURLINGTON, NORTH CAROLINA
FIGURE NO.
1

APPROXIMATE LOCATION
OF FORMER DISPENSER ISLAND
GRAPHIC SCALE
2C 10 0
SCALE: 1 . = 20'
20
•
FORMER CANOPY
APPROX. LOCATION OF FORMER
550-GALLON UST
w~
(PRESUMED DESTROYED)
111
LEGEND
MONITORING WELL LOCATION
SOURCE: 2014 AERIAL PHOTOGRAPH OBTAINED FROM
http:lldata.nconemap.corn. PARCEL DATA OBTAINED FROM
ALAMANCE COUNTY, NC GIS WEBSITE.
SCALE:
AS SHOWN
DATE:
JUNE 2015
DRAWN BY -
ROM
PROJECT NO -
Ikbe 4305-15-043
S&ME
WWW.SMEINC.COM
SITE MAP
OPAL SHEPHARD PROPERTY TF-30817
4050 NC HIGHWAY 49 SOUTH
BURLINGTON, NORTH CAROLINA
FIGURE NO.
2

MW-1 ugFL
1,2-Dichloroethane 61.4'
Toluene 4,540*
1,2-Dibromoethane (EDB) 76.1'
Methyl-tert-butyl ether (MTBE) 76.7*
Benzene 4,480*
1,2,4-Trimelhyibenzene 635'
Total Xylenes 3,700*
1,3.5-Trimethylbenzene 206
Ethylhenzene 530
MW-3
Assumed Destroyed
•
GRAPHIC SCALE
20 ifl 0
SCALE: 1' = 26"
20
r,
'4
7:11M14
APPROXIMATE LOCATION
OF FORMER DISPENSER ISLAND
FORMER CANOPY
APPROX. LOCATION OF FROMER
550-GALLON UST
MW-2
V
/W-3 .
PRESUMED DESTROYED)
MW-2
Be]ow Detection Limits
ti
LEGEND
• MONITORING WELL LOCATION
uglL MICROGRAMS PER LITER
* INDICATES EXCEEDANCE OF 2L GROUNDWATER STANDARDS
NOTE: SAMPLES COLLECTED ON APRIL 29, 2015
SOURCE: 2014 AERIAL PHOTOGRAPH OBTAINED FROM
http://data.nconernap.com. PARCEL DATA OBTAINED FROM
ALAMANCE COUNTY, NC GIS WEBSITE.
SCALE:
AS SHOWN
DATE:
JUNE 2015
DRAWN BY
ROM
PROJECT NO:
4305-15-043
$S&ME
VWWY.SMEINC.COM
GROUNDWATER CONSTITUENT MAP
OPAL SHEPHARD PROPERTY TF-30817
4050 NC HIGHWAY 49 SOUTH
BURLINGTON, NORTH CAROLINA
FIGURE NO.
4

er—
1 40
WSW-4
tit4028 - Ho• ins
Flores
WSW-2
Below Detection Limits
WSW-3
Not Sampled
WSW-4 ug/L
Methyl-tert-butyl ether (MTDE) 1.1
[Subject Site]
Dollar General -WSW
Not Sampled
Dakar
General - WSW
WSW-1
Not Sampled
WSW-1
4143 - Bell
NOTES: ALL WATER SUPPLY WELLS (WSWs) ARE SHOWN
SAMPLES COLLECTED ON APRIL 29, 2015
GRAPHIC SCALE
no
150 0
SCALE! f" = 3017
300
BELLWAONT MT HERIADN RD
LEGEND
MONITORING WELL LOCATION
ug/L MICROGRAMS PER LITER
INDICATES EXGEEDANCE OF 2L GROUNDWATER STANDARDS
SOURCE: PARCEL DATA OBTAINED FROM ALAMANCE COUNTY, NC
GIS WEBSTTE.
SCALE
AS SHOWN
DATE
JUNE 2015
DRAWN BY:
RDM
PROJECT NO:
4305-15-043
$S&ME
WWW.SMEINC.COM
WATER SUPPLY WELL CONSTITUENT MAP
OPAL SHEPHARD PROPERTY TF-30817
4050 NC HIGHWAY 49 SOUTH
BURLINGTON, NORTH CAROLINA
FIGURE NO
5

1 ADVENTUS
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Safety -Data
MATERIAL SAFETY DATA SHEET:
O..SOXrM Page: I al6
I. PRODUCT IDENTIFICATION: 0-SOXT"I
PRODUCT USE:
MANUFACTURER:
AJvelttus Americus Inc.
2871 W. Forest Rd.. Suite 2
Freeport, IL
61032
Soil and water treatment.
EMERGENCY PHONE:
Office Hours: 815-235-3503
After Hours: 815-235-351)6
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid. n.o.s. (Calcium Peroxide). Class 5.1, PG II. UN1479
WHMIS CLASSIFICATION:
Oxidizer
2. COMPOSITION/INFORMATION ON INGREDIENTS
Ingredients
r. ale. nun PCris\irlt.
C'trlcinisi Hy lrc+xiit,:
3. PHYSICAL DATA
Chemical Formula
CaO,
Ca(OU 12
FOR CHEMICAL EMERGENCV
Spell, lam. Fire Exposure or Accident
Calf INFOTRAC - 24-Hour Number:
1-800-535-5053
Outside of the United States Ct}II 24-hour Ntrrntecr:
00I.33Z- 23.35t1O
CAS Nu. Percentage
1305.70-0 -15%-7OCi-
Appearance White & brown granules
Physical state Solid
Odor threshold None
Bulk Density 500-650g I.
Solubility in Water Insoluble
PH —11
DecnntpoxitiunTemperature Self -accelerating decomposition with woven release starting From 275
degree.~ Celsius
4. HAZARDS IDENTIFICATION
Emergency overview
Oxidizing agent. crtntacl with other material may cruse fire. Under fire conditions this material may
decompose and release oxygen that intensifies fire. This product also contains cr'y%ialline silica. Long Irrn
exposere to hazardous levels of silica dusts can cause lung disease (silicosis). The World Health
Organization had indicated that there is limited evidence that crystalline silica is carcinogenic to humans.
but the NTP anti OSHA have not classified this ingredient as carcinogenic.
Potential Health Effects:
• General Irritating to mucous membrane and eyes.

ADVENTIIS
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Safety iData
MATERIAI. SAFETY DATA SHEET:
O-SOX1 M Page: 2 of tt
• Inhalation Irritating to respiratory tract. longterm inhalation of elevated levels
may cause lung disease (silicosis).
• Eye contact May cause irritation to the eycc; Risks of serioiv- or permanent cyc
lesions.
• Skin contact May cause skin irritation.
• Ingestion Irritation of the mouth and throat with nausea and vomiting.
S. FIRST AID MEASURES
• Inhalation Remove atTected person to fresh air. Seek medical attention if effects
persist.
• Eye contact plush eyes with running water for at least 15 minutes with eyelids
held open. Seek specialist advice.
• Skin contact Wash affected skin with soap and mild detcrkcni and large amounts r+t
water.
• Ineestirm 1f'the person is conscious and nor convulsing. give 2-4 cupfuls of
water to dilute the chemical and week medical attention immediately
Do not induce vomiting.
6. FIRL FIGHTING MEASURE
Flash Point
• Not applicable
Flammability
• Not applicable
Ignition Temperature
• Not applicable
Danger ► i' Explosion
• Non -explosive
Extinguishing Media
• Water
Fire Hazards
• Oxidizer. Stowage vcsxeis involved in a Fire may vent gas or rupture due Iu internal pressure..
Dania material may decompose exothermically and ignite combustibles. Oxygen release due to
exothermic decomposition may'uppan combustion. May ignite other i•.mtliustihle materials.
Avoid contact with ineninpalible materials such as heavy metals, reducing agents. acids. hatter.

1 ADVENTUS
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Safety ,Data
MATERIAL SAFETY DATA SHEET:
0-SOX I m Page: 3 or rt
cnnahu,tihte I wood, papers. cloths etc.) Thermal decomposition release:, oxygen and heat.
Prctititsre bursts limy occur due to gas evolution. Pressurization if conked when heated or
decomposing. Cmttainers mays burst violently.
Fire Fighthig Measures
• Evacuate all noon -essential personnel
• We.ir protective clothing and self-contained breathing apparatus.
• Remain upwind of lire to avoid hazardous vapors and decomposition products.
• Use ►►:tier spay to coot lire- exposed containers.
1. ACCIDENTA1. RELF.ASE MEASURES
Spill Clean-up Procedure
• Oxidiser. Eliminate all tinurces of ignition. Evacuate unprotected personnel from equipment
reconmtenda tion% found in Section 9. Never exceed ;any occupational expaisure IintiS.
• Shovel or.ti►►eep material into plastic bags or vented containers 1[ar dirptrscil. Do not return spilled
or contaminated material to inventory. Avoid making dust.
• Flush it ;mining area with water to remove trace residue and dispose of laroperly. Avoid direct
discharge to sewers and surface waters. Notify authorities ifeniry t :cur..
• Do not touch or walk through spilled material. Keep away from coinhustihles (woad.. papertat..
etc.l. 13n not return product to container because of risk of contamination.
S. HANDLING ANI) STORAGE
Storage
▪ Oxidiser. Sion: in a cool, well -ventilated area away front all source of ignition and out of direct
sunlight. Store in a dry location away from heat.
• Keep away from incompatible materials. Keep containers tightly closed. ihu not store in
ttnlahcied or 111islaheled containers.
• Protect from moisture. Do not shire near combustible materials. Keep containers well sealed.
Ensure pressure relief and adequate ventilation.
• Store separately from organics and reducing materials. Avoid cnntantination than may lead in
dcctmitivsiI inn.
Handling
• Avoid cunm i i ►kith eyes. skin. and clothing. Use with adequate ventilation.
• Do not swallow. Avoid breathing vapors. mists, or dust. Do not coat. drink. or smoke in work
area.
• Prevent contact with combustible or organic materials.
• Label containers and keep theist tightly closed when not in Lic.
• Wash thnruuglily after handling,
9. EXPOSURES CONTRIOLS/PERSONAL. PROTECTION

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1ADVENTUS
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Safety Data
MATERIAL SAFETY DATA SHEET:
0-S0X1Mr Page: 4 of [i
Engineering Controls
■ General room ventilation is required. Local exhaust ventilation, process enclosures or other
engineers commis may be needed to maintain airborne levels below recommended exposure limits.
Avoid creating dust or mist. Maintain adequate ventilation. Do nut use in rinsed or confined
spaces. Keep levels Below exposure limits. To determine exposure limits. snnnitorine should be
performed regularly.
Respiratory Protection
• For many condition, no respiratory protection may be needed; however. in dusty or unknown
atmospheres tir when exposures exceed limit values. wear a N1OSH approved respirator.
Eye/Face Protection
• Wear chemical safety goggles and a full face shield while handling this product.
Skin Protection
■ Prevent contact with this produce_ Wear gloves and protective clothing: depending on condition of
use. Protective gloves: Chemical -resistant (Recommended materials: PVC' neoprene or ruhhcrl
Other Protective Equipment
• Ej'e•wath Niation
• Safety shower
• Impervious clouting.
• Rusher boots
General Hygiene Considerations
■ Wash will] soap and water before meal times and at the end of each work shift. Gond
manufacturing practices require grass amounts of any chemical removed loom skin as soon as
practical. especially before eating or smoking.
1t1. STABILITY AND REACTIVITY
Stu Willy
• Stable under ntrrntal conditions
Condition to Avoid
• Water
• shirts
• fiase.4
• Salts of hcinw metals
• Reducing agents
• Organic materials
• Flammable substances
Hazardous Decomposition Products
• Uxygeo which supports combustion
1I. TOXICOLOGICAi_ IN! OIl.M 4TION

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Safety Data
MATERIAL SAFETY DATA SHEET:
O-SOXTM
Page: 5 of 1.
• LD50 Oral: Min.2(Iflt7 mg/kg, rat
• LDSO Dermal: Min. 2000ing/kg, rai
• LDS() Inhakiriitn; Min. 45801 mg/kg. rat
12. ECOLOGICAL INFORMATION
Fcotoxic o I ogical Information
• Hazard, for the environment is limited due to the product properties o1' nri hivaccumulatinn, kwath
solubility and precipitation in aquatic environment.
Chemical Fate Infornwtfon
• As indicated by chemical properties oxygen is released into the environmeni
13. DISPOSA I. CONSIDERATIONS
Waste Treatment
• Dispose of in an approved waste facility operated by an authorized cuntractnr in compliance with
lord I'eauktlions.
Package Treatment
• The empty and clean containers are to he recycled or disposed of in conformity with local
regulations.
14. TRANSPORT INFORN1A'1'ION
• Pinptr Shipping Name: I:NC-O
• Hazard aid Class: 5_ I
• Lahels: 5.1 (Oxidizer)
• Pocking Group' II
15. REGULATORY INFORMATION
• SARA Salk tit Yes
• SARA 13131 Chemii al% Nu
• EPA TSCA inventory Appears
• C:tioatlian WHMIS Clashilicatittin C. D2B
• Canadian ❑SI. Appenn
• EINECS Inventory _ Appear~
16. PREPARA'I'R)N FORl4IA'1'1ON
Kerry 13rilaitxrs-Shaw
AJventus Rentettiautm'rechnologte,
1.145 Fewsier Drive
Mississauga, Ontario
1..4W 2A5
Date Prep./Rev:
Print Date:
Phone:
Pax:
i f31t)7
I f3/07
905.273-5374
905-273—.1.3(17

AVA MCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
UNDERGROUNDSTORGAETANKSECTION
September 16, 2015
DELIVERY CONFIRMATION
0303 1290 0000 2593 4009
Mr. Floyd Smith
2124 Gardner Holt
Burlington, NC 27215
Re: Access Agreement for Site Investigation
Former Opal Shephard Property
4050 Highway 49 South
Burlington, Alamance County, North Carolina
Incident Number: 30817
Risk Classification: mgh
Dear Mr. Smith:
Donald R. van der Vaart
Secretary
The Department of Environment and Natural Resources (DENR), Division of Waste
Management (DWM), Underground Storage Tanlc (UST) Section is required to take action
necessary to try to eliminate the source( s) of discharge of petroleum contamination, to determine
the significance and extent of petroleum contamination, and to conduct remediation at the above-
referenced site. The UST Section desires to begin the process of defining the extent of
groundwater contamination at the site.
In order to begin the investigation to determine the extent of petroleum contamination at
the site, the UST Section and its contractor request permission to access the site for soil and
groundwater investigation. The investigation may include soil and groundwater sampling,
borehole drilling, and monitoring well installation. Please be aware that the monitoring wells
may be installed off-site or on-site including on your property as part of the assessment and/or
corrective action activities that will take place. Also, the UST and its contractor will need to
access the site the property from time to tinie to obtain groundwater samples from these wells.
The State Contractor is planning to conduct the site investigation as soon as possible.
Please read over the attached agreement, sign, and date it, and return it to me in enclosed pre-
addressed envelope within ten (10) days from the receipt of this letter.
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone: [phone] \ FAX: [phone] Internet: http ://portal.ncdenr.org/web/wrn
An Equal Opportunity I Affirmative Action Employer -Malle io part by recycled paper
You should be aware that a refusal to allow access may result in a determination
that you are controlling an activity which results in the discharge of waste pursuant to lSA
North Carolina Administrative Code 2L .0100, et.seq, and you then may held responsible
for the assessment and remediation of contamination since the UST Section would be
unable to complete the required work.
Also, the State has the option to obtain an administrative warrant from the court to
access the property and conduct the site assessment needed. However, the UST Section is
first seeking your voluntary cooperation, and such cooperation would be greatly
appreciated.
If you have any questions concerning this matter, please call Hassan Osman at (919) 707-
8167.
cc: Attorney General Office-AGO
STL-File
Sincerely,
H~$M'} 05,mlf/J?
Hassan Osman
Hydrogeologist!UST Section
UNDERGROUND STORAGE TANK SECTION
September 16, 2015
Mr. Hassan Osman
Hydrogeologist
DWM/UST Section
I637 Mail Service Center
Raleigh, NC 27699-1637
Dear Mr. Osman
RE: Former Opal Shepard Properly
4050 Highway 49 South
Burlington, Alamance County, North Carolina
Incident Number: 30817
fTECMVIE
T1 OCT 5 2015 J
DWM-UST SECTION
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and
hereby permit the Department of Environment and Natural Resources (Department) or its contractor to
enter upon said property for the purpose of conducting an assessment and/or remediation of the
groundwater and/or soils under the authority of G.S. 143-215.94G.
I am/We are granting permission to the lands we own or control with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the Department or
its contractor. The Department or its contractor shall protect and prevent damage to the surrounding
lands. Any damages will be restored by the Department or its contractor to as close to the pre -work
condition as practicably possible.
Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest
feasible route to the nearest public road. The Department or its contractor will notify the land owners
48 hours prior to entry and may enter upon the land at reasonable times and have full right of access
during the period of the investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by Article 31
of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and
Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon request and
is a public record, in accordance with G.S. 132-I .

6. The activities to be carried out by the Department or its contractor are for the primary benefit of the
Department and of the State of North Carolina. Any benefits accruing to the owner are incidental.
The Department or its contractor is not and shall not be construed to be an agent, employee, or
contractor of the landowner. No representations or warranties, either expressed or implied, have been
made to me/by the Department, the State of North Carolina, or its/their contractor(s) regarding the
results that may be obtained or the quality of work to be performed_
I/We agree not to interfere with, remove or any ways damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
ee
(/el frg-(. ; ;11.E
yp nt Name ofOwner or Agent
_go ag/irk
Phone Number
/AL71Vtlie HT
Address
44
.v4 426
Cif /State/Zip Code �] 2 / 5
Alt
RE: Foriner Opal Sheppard Property
4050 Highway 49 South
Burlington, Alarnance County, NC
Incident Number: 30817
?ECE.,V/E0
OCT 5 ZO 5
DWM-UST SECTION

Jamie Honeycutt
From:
Sent:
To:
Subject:
Osman, Hassan < [e-mail]>
Monday, October 12, 2015 11:16 AM
Jamie Honeycutt
RE: TF-30817 Opal Shepha rd O-SOX Installation-Need Agent Authorization
I am the project manager of the above mentioned site. I give S&ME permission to act as an agent for UST section, DWM
if you have any question(s), p lease contact me at (919 ) 707-8167 .
Th anks
Ha ssan
Hassan Osman
Hydrogeologi st
NCDEQ/DWM/UST Secti on
1646 Mail Service Center
Ralei gh, NC 2769 9-164 6
Pho ne(9 19}707-8167
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties unless the content is exempt by statute or other regulation.
From: Jamie Honeycutt [mailto:[e-mail]]
Sent: Monday, October 12, 2015 9:16 AM
To: Osman, Hassan <[e-mail]>
Subject: TF-30817 Opal Shephard O-SOX Installation-Need Agent Authorization
Hi Hassan,
I'm working on the Notification Form to install the O-SOXs in MW-1 at the Opal Shephard site, which has to be
submitted to NCDEQ, DWR. Michael Rogers with NCDEQ, DWR has requested that since S&ME is signing the form as an
agent for NCDEQ, he needs an email from the NCDEQ Incident Manager giving S&ME permission to act as an agent for
NCDEQ. You can respond to this email stating that you give S&ME permission to act as an agent for NCDEQ and I'll
attach the email to the Notification Form and submit it to Michael Rogers. Call if you have any questions.
Thanks
Jamie T. Honeycutt
Environmental Professional
S&ME
ENGINEERING INTEGRITY.
S&ME, Inc.
409 Chicago Drive, Suite 10
Fayetteville NC 28306
1
Ph : 910-323-1091
Fax : [phone]
Mobile : [phone]
[e-mail]
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments . Please consider the environment before printing this email.
2
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department ofEnvitonmenr lirld Natural Resource- Dn'ision of Water Quality
WELL CONTRACTOR CERTIFICATION # 3106
1. WELL CONTRACTOR -
dames D Barker
Wet' Contractor (Individual) Narna
❑uanlev.
Well Conlrrtr-Ior Cr moor) Name
STREET ADDRESS 3277 Golden Nugget Drive
Clayton North Carolina 275?D
City or Toion State
{ 919 }. 219-9604
Area code- Phone number
2. WELL INFORMATION:
SfTE WELL!DO(appilcabrel NotAapllsole
STATE WELL PERMIT# iI applicable) Not Applicable
Zip Code
DWQ or OTHER PERMIT tl(If applicabie) Not Applicable
W ELL LIS E (Check AppEicable Box) monitoring 111 Munfcipnf/Publlc
Industrial/Commercial ❑ Agricultural ❑ Recovery
lnigalfon1 Other 1d (fistwe)
DATE DRILLED ?-4"-°
TIME COMPLETED '2 :CO
3. WELL LOCAT10
CITY: fin COUNTY I-ro''+ v .-
2
/4050
(Street Name, N.rraberc, CorCirturdty. Slidiusion,Let NA., Parcel, Zp Cade)
TOPOGRAPHIC I LAND SETTING:
°Slope OVafey gnat 0Ridge E7 Other
(ehetlt appropriate Coal y
LATITUDE 3 f • 306 May b- in degrees.
'+6a mievres•SGterreLserr
LONGITUDE —79 e '. 42 0'6 in n derame.' Format
Latitudr.Itongitudo source: gGPS ID Topographic map
(boa/ion or wee MIS! be shown on a USGS tope map and
rm
attached to ih!s foIf nor usotg GPS)
4, FACILITY -is th. named ! e iwsirkeu wham 4 a waq i7 located.
FACILITY r❑ tilt apptirattel Noi Applicable
iJAME OF FACILITY tr v21A4C er . , (Ar'pl •3r
STREET ADDRESS 4050 f.1C i 4.6
° inIection
❑ {
PArf LJ PM ES
ThJ r i,..-cr t tkk'�. 2 7 r
City or Torun Ste Zip Code
CONTACT PERSON NC DENR Srfdtivn
MAILING ADORESS 1637 Mal Service Center
Raleigh NC 276l39-1837
City or Town State Zip Code
L 919 i- 733 - 1346
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 5
DUES WELL REPLACE EXISTING WELL? YES D NO fa
e. WATER LEVEL Below Tap of Casing- 74 FT.
(Use '+' if Above Top or Casing)
1Jf2f;.
d. TOP OF CASING tS {-0.201 FT. Above Land Surf ce'
'Top of casing lerminated afro blow land surface may require
a variance in accordance with 1SA WCAC 2C .0118-
e. YIELD 1ppml aarAnwtteora METHOD OF TEST Not APPii able
DisINFECTEON: Type Not Applicable Amount Nvt.SpPIk4lc
g. WATER ZONES (depth); r
Frurn . To C' From To
From To From To
From To From To
9. CASING: Thickness/
Depth 41Piameter W1gti
ftunl "off FL
From "o Ft.
From 'To Ft.
7. GROUT: Depth
From £' `o / Ft.
Material
Neal Cement
From _ u[ 3' Ft. gentanile
From Ft.
B. SCREEN:, Depth Diameter Sld. Size Material
From r." To FLZ in. 0.010 in. PVC
Front ❑ Ft. _ ln. In.
From 7o Ft. in. in.
I. SAND/GRAVEL PACK:
aapih ? Size Material
From To `�..] FL 112 silk* Sand
PVC
Method
Pour
Pau,! Hydrate
F tom Ta
rortt To
10. DRILLING LOC'•
From To
0'
7 ' _ 7.511
11. REMARKS!
Ft.
FL
Formation Des iption
Ces+n (I('T'-t"-' /`Gv-r rf I
l6.1ef
we t Urre reJ f c C.
Sir -C S �Gvv2
1170 HEREtn' C F7tFY TRAIT S WEl AS C UGTEO IN ACCORDANCE WITH
15A reCAf 2C. 'E! L CONS 1�. r Ib� AI:O'MAT A COP' OF TRIS
RECORD HAS EE1:N PROV TO E NER.
S}GNATIfIRE OF CERTIFIED WELL CONTRACTOR
r
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt:.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No, (419) 733.701 E. exi 565.
Form Gw-1 ti
Rcv. 7/05