WI0500930_DEEMED FILES_20160818

Program Category
Deemed Ground Water
Permit Type
WI0500930
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi .shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Tate Property lncident#21716
Location Address
7601 .Louisburg Rd
Raleigh
Owner
Owner Name
Ncdeq State -Lead Program
Dates/Events
NC
Orig Issue
8/18/2016
App Received
8/17/2016
Re gulated Activities
Groundwater remediation
Outfall
Waterbody Name
27616
Dr!lft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
8/18/2016
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Government -State
Owner Affiliation
Mark Petermann
1646 Mail Service Ctr
Raleigh
Region
Raleigh
County
Wake
NC
Issue
8/18/2016
Effective
8/18/2016
27699164
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasln
Shrestha, Shristi R
From: Shrestha, Shristi R
Sent: Thursday, August 18, 2016 10:40 AM
To: 'Ashley Winkelman'
Cc: Gabe Araos; Rogers, Michael; Smith, Danny; Boiich, Rick
Subject: WI0500930 NOI Tate Property RE: Permit number
Good morning,
Thank you for submitting the Notice of intent to Construct or Operate Infection Wells (NCI) for the above referenced
site. This notification has been given the deemed permit number WI0500934. Please use this number for future
records submission.
Thank you for your cooperation.
Sh rssti
Shristi R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha . ncdenr. ,ov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email corresporacrence fo and this address is subject to
north Carolina e Lew and may be disclosed third parties.

Shrestha, Shristi R
From: Shrestha, Shristi R
Sent: Thursday, August 18, 2016 10:42 AM
To: Smith, Danny; Boiich, Rick
Cc: Rogers, Michael
Subject: WI0500930 Tate Proterty NOI
Attachments: #21716 Tate Property 20160314 Notice of Intent.pdf
Please find the attached NOL,
Shristi
Shristi R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shresthaia:ncdenr. ov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to
Vorfh Carolina Public Records Law and maybe discicsed to third p 'tips.

ATC
ATC ASSOCIATES OF NORTH CAROLINA, P.0
Engineering Individual Solutions
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax:[phone]
www.atcassociates. com
N.C. Engineering License No. C-1598
March 14, 2016
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, [TIC Program
1636 Mail Service Center
Raleigh. North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
Tate Property
7601 Louisburg Road
Raleigh, Wake County, North Carolina
NCDENR Incident No. 2I716
Dear Ms. Shrestha:
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of the North Carolina Department of
Environmental Quality (NCDEQ) State -Lead Program. The permit application covers injection
of chemicals via a process designed by Innovative Environmental Technologies, Inc. for
rcmediation of petroleum impacted soil at the above referenced site.
If you have questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Lcek
J
Ashley M. Winkelman, P.G. Gabriel Araos, A.F.
Project Manager Senior Project Manager
Attachments: Notice of Intent Form, Tables I through 5, Figures 1 through 12, Appendices A
through C
cc: Mr. Mark Petermann — NCDEQ State -Lead Program

Notice of Intent to Construct or Operate Injection Wells
Tate Pronert. , Ralei_h. North Carolina
NOTICE OF INTENT FORM
VATC

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 form shall be submitted at least 2 weeks prior to construction.
AQUIFER TEST WELLS (15A NCAC 02c .0227)
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 (15A NCAC 02C .0229):
l) Passive Injection S 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 Iniection 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 indhidual 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. Illegible Submittals Will Be Returned As Incomplete.
DATE: March 14, 2016 PERMIT NO. hJ J. 0 5 0 Qq 3 0 (to be filled in by DWQ)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1)
(2)
(3)
(4)
(5)
(6)
___ .Air Injection Well ...................................... Complete sections B-F, K, N
___ .Aquifer Test Well. ...................................... Complete sections B-F, K, N
___ .Passive Injection System ............................... Complete sections B-F, H-N
X Small-Scale Injection Operation ...................... Complete sections B-N
___ Pilot Test. ................................................ Complete sections B-N
___ 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: NCDE O State-Lead Pro gram -Mark Petermann
Mailing Address: ___ 1_6_4_6_M_ai_l _S_e_rv_ic_e_C_en_t_er ____________________ _
City: Ralei C!h State: NC Zip Code: 27699-1646 County: ___ W~ak~e ___ _
Day Tele No.: (919 ) 707-8169 Cell No.: --~N~o~t ~A~v~a=ila=b~le~------
EMAIL Address: [e-mail] Fax No.: ___ N_o~t~A~va~i~la~b_le~------
DWQ/UIC/111 Situ Rcmcd. Notification (Revised 7/9/2012) Page 1
D. PROPERTY OWNER (if different than well owner)
Name: -------'L~e~e-'A-=-n=n~M.a..c~G~h=e~e _______________________ _
Mailing Address: --~3-=-6-=--3.a..3.a..8 ~T-'-r=ee=h~o'""'u=se~R=o=ad~---------------------
City: Albemarle State: =-N~C __ Zip Code: 28001 County:~S=ta=n=IY~---
Day Tele No.: (704 ) 984-0619 Cell No.: Not Available
EMAIL Address: LeeAnn.McGhee ru1Schulthomes.com Fax No.: Not Available
E. PROJECT CONT ACT -Person who can answer technical questions about the proposed injection project.
Name: ----'G=a=b=r=ie=l -=--A=r=ao=s=·-=-P-".E=-."""· .a..A""'T""'C"-""'A=s=so=c=ia=t=es"-"-of=-N"'-'-"o""'rt=h-'C=a=r=ol=in=a=·-=-P-'-.C="-. __________ _
Mailing Address: ----=2""'72=5"'-=E.,_. M=il=lb=r-"'o=ok=R=o=ad=."""S=u=it=e....,1=2-=-1 ________________ _
City: Ralei gh State:____N_C_ Zip Code :_2=-7,....,6'"""0.....,,4 ____ County:_W'-'--=ak""'e..__ __ _
DayTeleNo.: (919 )871-0999 Cell No.: (919 } 816-7915
EMAIL Address: 2:abe.araos l'al atcassociates.com Fax No.: __ _..L(9'----'l'-'-9.L...) =87'---'l--'-0=3--=--3=---5 __ _
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: ___ 7_60_1 _L_o_u_is_bu_r~i.!~R_o_a_d _____ County: ____ W_ak_e ___ _
City: Ralei gh State: NC Zip Code: _2_7_6_16 ______ _
(2) Geographic Coordinates: Latitude**: ---~3~5° ____jl' ~•• or 0
Longitude**: ---~7~8° ___]l' __ 2_1" or 0
Reference Datum: __ ""'W~G-=--=-S.a..84 ____ Accuracy: ___ 10~--m~e~te~r __ _
Method of Collection: 000 -Acme Ma pp er 2.1
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
See Figure 1 for topographic map, Figure 2 for site map, and Figure 3 for potential receptor map. Table 1 includes
water supply well information for properties within 1,000 feet of the site and Table 2 includes the well construction and
groundwater elevation data.
G. TREATMENT AREA
Land surface area of contaminant plume: 750 square feet
Land surface area ofinj. well network: __ 7-'----'5'----'0'------____ .square feet (S 10,000 ft 2 for small-scale injections)
Percent of contaminant plume area to be treated: I 00% (must be S 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(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
DWQ!UIC!fn Situ Rcmcd. Notification (Rc,·isccl 7/9/'.!012) Page 2
Figure 4 presents extent of impacted soil; Figure 5 presents the groundwater elevation contour map; and Figure 6
presents the groundwater analytical map.
(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 andgroundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
Figures 7 through 10 presents the geological cross-sections. Tables 3 through 5 presents the soil and groundwater
analytical results.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity.
ATC pro poses to remediate im pacted soil via chemical in jection. The products to be injected are zero
vaient iron (ZVD. h drogen p eroxide !H2O2 i. and sodium persulfate. Innovative Environmental
Technolo gies . Inc. will perform the injection activities . with supervision b v A TC. Injection will be
performed in the area as shown on Figure 11 usin!! direct-push technologv . Ei ght direct-push in jection
points will be advanced in a general 1rrid pattern within the in jection area with 4 in jection intervals ran2:ing:
from 12 to 28 feet below ground surface.
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.or¥(web/wq/aps/gwpro. 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).
injectant: --~Z=e=r~o_V~a=l=en=t-=lr=-o=n~(Z=-V~l~! _____________________ _
Volume of injectant: 640 eallons
Concentration at point of injection: -----~8~0-=g=a=ll""'o=n=-s =Z'-VI~/7'--'5'-4'-0=-a=l=lo=n=s~o=f'-w~at=e~r ____ _
Percent if in a mixture with other injectants: --~l~.4~0'-1/o'------------------
lnjectant: ___ S=o=-d=i=u=m"-"-P""'er=s=u=lfi=a=te'--------------------------
Volume of injectant: 1.625 g allons
Concentration at point of injection: --~2""0'""3'-"'-l!a=l=lo=n=s'""'S""o""d=i=um"""-'P=-e=r=s=u""'lfi=at=e'-/7"'"'5'-4'-=l!a=l=lo=n=s'--'o"-'f'-w'-'-=at=e"'"r __ _
Percent ifin a mixture with other injectants: ---=2=3"-'¾""'o ________________ _
Injectant: ___ H~v_d_ro_!!_e_n_P_e_r~o_x_id_e _______________________ _
Volume of injectant: 495 e allons
Concentration at point of injection: 62 !.!allons H vdro gen Peroxide/754 srn llons of water
Percent if in a mixture with other injectants: --~7~¾~o _________________ _
MSDS Forms and IET proposal are included as Appendix A.
K WELL CONSTRUCTION DATA
(1) Number of injection wells: __ _..,.8 ___ Proposed ___ O"--__ Existing
DWQ/UIC/ln Situ Rcmcd. Notific:ition (Rc\'iscd 7/9/2012) Page 3
(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
Well construction details are included as Figure 12.
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
Direct-push boring s and in jection activities are scheduled to bee.in March 29 . 2016 . and are exp ected to last for
two d::i s.
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.
A pproximate! 120 dav s followin £i: the in jection event. ATC will perform confirmato rv soil sam plin 1.t in the
in jection area. Soil sam ples will be anal vzed for volatile orn anic com pounds (VOCs) bv EPA Method 8260B
and for volatile petroleum h vdrocarbons (VPH ) b , the Massachusetts Department of Environmental Oualit
(MADEP) to monitor the effectiveness of the remediation efforts. Groundwater monitoring was performed prior
to the scheduled event on Februarv 25 . 2016. Be l!inning Se ptember 2016 . ATC will perform semi-annual
monitoring events for two vears followin l! the March 2016 in jection event to monitor the groundwater qualitv
and to determine if the remediation efforts were effective for l!.roundwater im pacts. Groundwater sam ples will
be collected from existing monitoring wells MW-I throu!!.h MW-6 . MW-7R. MW-8 , and DW-1. Sam ples will
be laborato n , anal yzed for VOCs b v EPA Method 6200B and sulfate b ,· ASTM D516. Measurements of de pth
to water. tem perature. dissolved ox g en . conductivi tv. oxidation/reduction potential, p H. and total iron will also
be collected in the field.
N. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 l(e) requires that all permit applications shall be signed as follows:
I. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official;
4. for all others: by the well owner;
5. for any other person authorized to act on behalf of the applicant: documentation shall be submitted with
the notification that clearly identifies the person, grants them signature authority, and is signed and dated
by the applicant.
"I hereby certify, under penalty of law, that I have personally examined and 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 true, accurate and
complete. I 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 appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
DWQ/UIC'/11 Situ Rcmcd. Notification (Rc\'is.:d 7/9/2012) Pag.: 4
Documentation authorizing ATC to sign as anent far the NCDEQ ate -Lead Proeram is included in Appendix B_
Signature of Applicant Print or Type Fail Name
Documentation of property owner consent is included in Appendix C.
Signature of Property Owfferent from applicant)
Signature of Authorized Agent, if any
Submit one copy of the completed notification package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone] I Fax: (919) R07-6496
DWQIUICIIn Situ Rcmed. Notification (Revisal-I/9/20UZ)
Print nr Type Full Name
(-,74.0(A RqC:IS
Print or Type FullName
401%7J��II"P+"R'►
•
ocessi
SEAL
D22569
Pages

Notice of Intent to Construct or Operate Injection Wells
Tate Property. Ra]ei h. North Carolina
TABLES
c Tc

PROPERTY WELLID WELL OWNER/USER ADDRESS
WSW-I
Lee Ann McGhee
919.772.7136 760 I Louisburg Road
WSW-2
WSW-3 Doris Poole Averett 7615 Louisburg Road 919.876.6769
WSW-4 Harold & Liffie Chamblee 7705 Louisburg Road 919.876.5589
WSW-5 New Breed Community Church 7715 Louisburg Road 919.878.8388
WSW-6 Ronnie Stell 7008 Perry Creek Road 919.876.5174
WSW-7* Elise Wright 7100 Perry Creek Road 919.872.5396
WSW-8 Walter Burnett 7114 Perry Creek Road 919.876.6282
WSW-9 Russell & Anna Weir 7110 Perry Creek Road 919.737.5905; 919.815.2802
Notes:
Address locations in Raleigh, North Carolina 27616 unless otherwise specified
TABLEl
WATER-SUPPLY WELL INFORMATION
Tate Property
7601 Louisburg Road
Raleigh, North Carolina
Incident #21716
MAILING ADDRESS WELL USE
Note in Use (Vacant house) -
36338 Treehouse Road Drilled
Albemarle NC 28001 Not in Use (Vacant house) -
Bored
Same as property address Potable -Drilled
Same as property address Potable -Drilled
Same as property address Potable -Drilled
Same as property address Potable -Drilled
Same as property address Potable -Drilled
Same as property address Potable -Bored
Same as property address Potable -Drilled
CONNECTED
TO MUNICIPAL
WATER
No
No
No
No
No
No
No
No
No
• = Well may also supply water to properties located at 7102, 71 04, and 7106 Perry Creek Road
WELL DISTANCE UPOR WELL DEPTH SCREEN FROM SOURCE DOWNGRADIENT INTERVAL AREA
Unknown Unknown 60 feetN Downgradient
33 feet Unknown 60 feetN Downgradient
lllO feet 80-100 feet 350 feet NE Downgradie~t
estimated 145 feet Unknown 650 feet NE Downgradient
Unknown Unknown 925 feet NE Downgradient
-3111 feet Unknown 600 feet SW Up gradient
108 feet Unknown 830 feet SW Upgradient
11,5 feet Unknown 975 feet S Upgradient
148 feet Unknown 830feetNW Upgradient
Date Well Casing Screened
Well ID Interval Installed Depth (feet) (feet)
DW-1 4/12/2004 0-67 67-72
MW-1 417/2004 0-20 20-40
MW-2 417/2004 0-20 20-40
MW-3 4/7/2004 0-20 20-40
MW-4 4/8/2004 0-10 10-30
MW-5 4/8/2004 0-20 20-40
MW-6 4/8/2004 0-20 20-40
MW-7 4/20/2014 0-12 12-22
MW-7R 11/6/2014 0-20 20-40
MW-8 7/21/2004 0-20 20-40
Notes:
I. TOC ~ Top of casing
TABLE2
WELL CONSTRUCTION ANO
GROUNDWATER ELEVATION DATA
Bottom
of Well
(feet)
72
40
40
40
30
40
40
22
40
40
Tate Property
760 I Louisburg Road
Raleigh, North Carolina
Incident #21716
Top of Casing Date
Elevation (feet) Measured
96,20 4/21/2004
617/2004
8/10/2004
101.59 7/1/2014
2/25/2016
96.80 4/21/2004
6/7/2UU4
8/l0/2004
102.20 7/1/2014
2/25/2016
96.87 4/21/2004
617/2004
8/10/2004
102.27 7/1/2014
2/25/2016
94.66 4/21/2004
617/2004
8/10/2004
100.00 7/1/2014
2/25/2016
88.36 4/21/2004
6/7/2004
811012004
93.81 7/1/2014
2/25/2016
96.27 4/21/2004
6/712004
8/10/2004
101.64 7/1/2014
2/25/2016
97.55 4/21/2004
6/7/2004
811onoo4
102.92 7/1/2014
2/25/2016
86.67 4/21/2004
6/712004
8/10/2004
95.73 7/1/2014
99.45 11/12/2014
2/25/2016
91.51 7/21/2004
8/10/2004
96.90 7/1/2014
2/25/2016
Depth to
Water
(feet)
26.36
26.96
27.33
29.52
28.58
26.73
27.JJ
27.70
29.99
29.09
27.40
28.03
28.45
30.61
29.55
25.42
2609
26.45
28.57
27.53
19.83
20.91
21.02
22.93
21.58
26.25
26.81
27.15
29.45
28.53
27.93
28.58
29.00
31.18
30.14
23.40
24.11
24.50
DRY
28.12
26.90
23.92
23.92
25.91
24.73
Depth to
Free Product
(feet)
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
28.50
--
--
--
--
--
--
--
--
--
--
--
--
--
--
2. TOC Elevations were re-surveyed on 07/01/14 by ATC for wells which existed at the time. Monitoring well MW-3 is the site benchmark at 100.00 feet.
3. MW-7R TOC elevation was surveyed on l 1/J2/14 by ATC. Monitoring well MW-8 is the site benchmark at l 00.00 feet.
4. For monitoring wells with free product: groundwater elevation is determined by the following formula:
Groundwater elevation= TOC Elevation -Depth to Water+ (0.76 * Free Product Thickness)
Free Product Groundwater
Thickness Elevation
(feet) (feet)
--69.84
--69.24
--68.87
--72.07
--73.01
--70.07
--t,<J.47
--69. 10
--72.21
--73.11
--69.47
--68.84
--68.42
--71.66
--72.72
--69.24
--68.57
--68.21
--71.43
--72.47
--68.53
--67.45
--67.34
--70.88
--72.23
--70.02
--69.46
--69.12
--72.19
0.03 73.13
--69.62
--68.97
--68.55
--71.74
--72.78
--63.27
--62.56
--62.17
--DRY
--71.33
--72.55
--67.59
--67.59
--70.99
72.i7
EPA Method:
Sampk Depth ((eel) DateS■mpled. PID(ppm)
CS-I 20 03/16/00 -
GP-I 24 08/07/01 -
B-201 17 04/12/04 -
11-201 24 04/12/04 -
B-202 17 04/12/04 ..
B-202 24 04/12/04 -
B-203 12 04/12/04 -
B-203 20 04/12/04 -
B-204 20 07/21/04 -·
B-205 10 07/21/04 -·
B-205 20 07/21/04 --
B-206 10 07/21/04 -·
B-206 20 07121/04 -·
B-207 10 07/21/04 -·
B-207 20 07121/04 -·
SB-I 20 11/06/14 1361
SIi-i 2S 11/06/14 1724
SB-2 10 11/06/14 15
SB-2 IS 11/06/14 14.9
SB-3 20 11/06/14 0.1
SB-3 2S 11/06/14 0.1
Sll-4 20 11/06/14 1738
Sll-4 2S 11106/14 12'I
SB-S 20 11/06/14 0.6
SB-S 2S ll/06/14 184
SB-6 20 11/06/14 385
SB-6 2S 11/06/14 4SS
SB-7 10-15 09122/15 0.2
SB-7 IS-20 09122/IS 0.2
SB-8 10-15 09/22/1S 0.2
SB-8 15-20 09122/IS 0.2
SB-9 10-15 09/22/IS 0.0
SB-9 20-25 09/22115 0.9
Sll-10 0-S 09122/15 2.l
SB-10 IS-20 09122115 0.0
Sall-t.-Grou•dwater MSCC
R,oldClldal MSCC
lad111trial/Comme:rlal MSCC
Notes:
1. Conctn1n11JOll t rq,ortcd in milligrams per kilogram (mgll'g).
2. ~<" • not dctcctt:d.111 or above the laboratory dclcaion limit
l . ■•Id indicate, 00t1U11tration1 •bovc NCDENR Action Lc:vt::I.
BeQPDI' Toluene
ND 9.l
ND 4S
ND ND
ND 0.017
ND 0.41
ND 11
ND S.7
ND 33
ND 7.6
ND ND
ND ND
ND ND
ND 0.29
ND ND
ND ND
,004 <0.032
<0.L36 0.191
<O 0014 <0.0016
O!}flr,9) <0.0011
<00111 <0.0012
<:0 .1J1Jll <0.0013
<0.041 0.4J
<0.04 0.87
<0.001 <0.0012
<0.t.Lo118I <0.00093
<0.007 <0.0056
,o.0IJ09S <0,0011
<0•)()0&2 <0.00094
.. rta0087 <0.001
•.0 110083 <0.00095
<0.0009 1 <0.001
,oonoss <0.0024
<0.ltl1lJ83 <0.00095
'"Ull>9S <0.0011
<0.IK\J82 <0.00094
0.006 4.3
18 1,200
1'4 3!.ooe
4. fiDl,i C9 ·Cli Alipb■tics valuc1 are equal to CSI-Cl2 Alipbati.cs as rcportl:d iu tho labon.tory report
S. Pin1tl C9-C22 Aromatic1 arc equal lo C9-C10 Aromatics H reported in lhc ll!lbon,tory llllllytitol report.
Etbylbcmene
20
54
2.6
0.048
0.91
17
14
47
13
ND
ND
ND
0.41
ND
ND
0.98
4.S
<0.0016
<0.0011
<0.0012
<0.0013
5.9
IS
<0.0012
<0.00093
0.121
<0.0011
<0.00094
<0.001
<0.00095
<0.001
<0.00097
<0.00095
<0.0011
<0.00094
4.9
1,s,o
40.000
6. J • D$cted bill below lhc reporting limit (lowc&t calibration stond■rd); !here~. rccult ig an e~tim11tcd cooccntrntion.
7. B ,.An11l)'to le found in thcltS&ociatcdblonkuwell BIi in the sample.
Total
Xyleaea MTBE
140 -
220 -
15 -
o.41 -
11 -
121 -
160 -
320 -
110 -
ND -
ND -
ND -
3.6 -
ND -
ND -
II <0.04
46 <0.036
<0.0034 <0.0018
<0.0023 <0.0012
0.002SJ <0.0013
<0.0027 <0.0014
M <0.041
142 <0 .04
0.006! <0.0013
0.0076J <0.001
1.2 <0.007
0.00161 <0.0012
<0.002 <0.0011
<0.0021 <0.0011
<0.0002 <0.0011
<0.0022 <0.0012
<0.0021 <0.0011
<0.002 <0.001
<0.0023 <0.0012
<0.002 <0.0011
4.0 0,0!'1
3.12'1 350
81 .7'0 J.100
TAllLIU
SOIL ANALYTICAL RESULTS
Talc Property
7601 Lcnll1buq Road
lblelgb, Nortb Carolin■
lnddent #ll7Ui
1116118
hopropyl-Naphthalene Acetone benzene
36 -4,7
48 -12
15 -1.2
1.11 -0.014
I.I -ND
1' -S.1
37 -4.7
34 -10
16 -4
ND .. ND
ND -ND
ND -ND
1.2 -ND
ND --ND
ND -ND
26 4.SJB 1.3
26 4.IJB 3.6
<0.0014 <0.047 <0.0014
<0.00093 <0.031 <OOO!N l
0.0092 <0.034 <0.001
0.007 <0.037 <0.0011
l3 4.8JB 4.1
40 4..Sm 8.8
0.013 <0.035 <0.001
0.027 0.0281 <00l)(lll l
1.2 O.BJra 0.09SJ
0.0079 0.0331 <O.l.10095
<O.OOOR2 0.037! <0.00082
<0.00087 <0.029 <0.oo,_,s1
<0.000113 <0.028 <O.(.ll1!JS3
<0.00091 <0.031 <O uOO'ii l
<0.00085 <0.028 <O O(l(Jg_5
<0.000,13 <0.028 <0.001"'183
<0.0009S <0.032 <0-"""95
<0.000lt2 0.031 <0.00082
0.16 24 1.7
313 14,000 1,564
8.17' 368,880 40.880
MADEPVPH
p-bopropyl-o,-8utyl-u.o-Butyl-tert-B11tyl-naPropyl-1,2,4-1,3,S-CS-OI C!I-CII C9-Cll
lolaeae bera•n■ benzene heDZ!!lle benzene Ttlmetbyl-Trlm•thyl-Allpbadea Allphatla AromatlH benzene benune
ND 12 ND -IS 100 4S l,100 1,600 880
ND !.> 6.1 -28 87 II 1,200 3800 1.3(10
4-5 3.l 1.3 -3 36 IS 51 360 IIO
0.026 O.OIS 0.012. -0.026 0.22 0.09 SI 160 sz
ND 0 15 ND -0.89 10 s.s 131 771 280
8.3 ~ ND -12 " 1, '" 1,211 390
14 10 4.3 -12 140 " 281 1,201 480
14 I? ND -15 170 73 1100 3.000 ,so
ND ~ll ND .. 8.6 65 30 350 1,100 468
ND N!> ND --ND ND ND ND ND ND
ND ND ND .. ND ND ND ND ND ND
ND ND ND -· ND ND ND ND ND ND
ND 0.69 ND -0,37 3.S 1,8 61 290 130
ND ND ND --ND ND ND ND ND ND
ND ND ND -· ND ND ND ND 1.5 L1
1.9 9,l 1.7 O.J11J 3.6 42 20 380 760 690
1.4 11 2.S 0,5,1 9.4 73 32 620 760 670
<0.0016 <0.0014 <0.002 <0.01 118 <0.0014 <0.0016 <0.0012 <18 <18 <18
<0.0011 -..000093 <ll ,00 13 <0.(}f :12 <0.00093 <0.0011 <0.0008 <16 <16 <16
<0.0012 <0 .001 <0.0015 <0.01 113 <0.001 0.0043 0.00141 <16 <16 <16
<0.0013 <0.0011 <0.0016 <0.01tl4 <0.0011 <0.0013 <0.00094 <17 <17 <17
l.S ll 2.1 Q.511 II 77 36 910 l40 130
4.4 1, 4.3 O.BS ll 14' 64 l,40I 1,2N 1,I0t
<0.0012 <fl,001 <0.0015 <0.0(113 <0.001 0.0044 0.00141 <17 <17 <17
<(Uiti093 0 tJ0)22J <0.0012 <0.0111 <0.00081 0.0 )3 0.0042 <16 2S <16
O.IJ 0..58 0.081! 0.02 ~J 0,21 2 1.1 <17 56 14
<0.0011 <0.00095 <0.0014 <0.01 •12 <0.00095 0.003 0.000931 <18 <18 <18
<0.00094 "1,00082 <0.0012 <0.0 11 11 <0.00082 <0.00094 <0.00071 NA NA NA
<0.001 <0.ltlf087 <0.0012 <0.01 1 11 <0.00087 <0.001 <0.0007S NA NA NA
<.O.~it:&S -<1 00083 <0.0012 <0,0()1] <0.00083 <0.00095 <0.00071 NA NA NA
<0.001 <0.00091 <0.0013 <0.0li ,12 <0.00091 <0.001 <0 .00078 NA NA NA
•:(r.0001)7 <0.00085 <0.0012 <0.01111 <0.00085 <0.00097 <0 .00073 NA NA NA
<O.Ou09S <0.hu083 <0.0012 <O.0l!ll <0.00083 0.00141 0.003 NA NA NA
<0.0011 <O.!Hl09S <0.0014 <0.0012 <0.00095 <0.0011 <0.00081 NA NA NA
<0.00094 <0.00082 <0.0012 <0.0011 <0.00082 <0.00094 <0 .00071 NA NA NA
0,12 4.3 3.3 3.4 1.7 8.S 8.3 '8 540 31
100 626 620 62fl w 782 782 939 1,500 469
4.180 16.1 50 16.J SO 16.3:-o 1•.JSO 20, .... 20.440 24,528 40.000 12.:164
.. :'l §! = .. .. = = l:! i .. .. WellID Sample Date N ..9 .. = i .. = '3 = ... = ~ ...
MW-I 2/25/2016 <0.12 <0.17 <0.13 <0.25
MW-2 2/25/2016 <4.8 690 1,500 8,200
MW-3 2/25/2016 <0.12 <0.17 <0.13 <0.25
MW-4 2/25/2016 <0.12 <0.17 <0.13 <0.25
TABLE4
GROUNDWATER ANALYTICAL RES UL TS
= ~
f:!1, .. = .. la.l i! = ... " = ~ El = ..
:S ~
't ...
<0.09 <0.12
<3.6 <4.8
<0.09 <0.12
<0.09 <0.12
Tate Property
7601 Louisburg Road
Raleigh, North Carolina
Incident #21716
~
~ ..
~ ... .. ;
la.l i >, C.
C. <I ... z C
C. .::
" = !:l = .. t
C. e
C. = .. ....
<0.18 <0.12 <0.12
<7.2 430 88
<0.18 <0.12 <0.12
<0.18 <0.12 <0.12
.. = ..
..9
! ;,..
C. = ...
C. = .;
C.
<0.15
18J
<0.15
<0.15
.. = = ~ <
<4.9
<190
<4.9
<4.9
MW-5 2/25/2016 Not Sampled/ 0.03' of Free Product
MW-6 2/25/2016 <0.12 <0.17 <0.13 <0.25 <0.09 <0.12 <0.18 <0.12 <0.12 <0.15 150
MW-7R 2/25/2016 2.2 9.7 140 S80 <0.36 <0.48 <0.72 8S 12 2 <19
MW-8 2/25/2016 <0.12 <0.17 <0.13 <0.25 <0.09 <0.12 <0.18 <0.12 <0.12 <0.15 <4.9
DW-1 2/25/2016 <0.12 <0.17 <0.13 <0.25 <0.09 <0.12 <0.18 <0.12 <0.12 <0.15 <4.9
2L Standard (ug/1) 1 600 600 S00 20 0.02 70 6 70 2S 6,000
GCL (ug/1) S,000 260,000 84,SOO 8S,S00 20,000 so 70,000 6,000 2S,000 11,700 6,000,000
Notes:
1. MTBE ~ Methyl Tertia,y Butyl Ether.
2. !PE~ Isopropyl Ether.
3. "<" or ND = Not detected at or above the laboratory dectection limit.
4. Concentrations are reported in micrograms per liter (ug/1) ~ parts per billion (ppb).
S. Concentrations in bold equal or exceed the corresponding NCDENR Groundwater Quality 2L Standard (2L Standard) updated April 2013.
6. GCL = Gross Contamination Limit.
7. J = Indicates constituent was detected above laboratory detection limit but below laboratory reporting limit
.. ..
ai ai .. .. .. N N .. = = = ai ai = .. .. .. .. N l:! l:! t t N = = .. .. .. .. E, :5! :5! ~ :5! .e, ;,.. .e, C. El El = = = i = ·;:: ·;:: ~ = ..
,!, ~ ~-";' al .!! = Ill
"l "'· ... ...
<0.15 <0.13 <0.11 <0.13 <0.18 <0.13
48 15J <4.4 140 1400 440
<0.15 <0.13 <0.11 <0.13 <0.18 <0.13
<0.15 <0.13 <0.11 <0.13 <0.18 <0.13
<0.15 <0.13 <0.11 <0.13 0.44J <0.13
3.8 l.3J 0.52J 10 150 51
<0.15 <0.13 <0.11 <0.13 <0.18 <0.13
<0.15 <0.13 <0.11 <0.13 <0.18 <0.13
70 70 70 70 400 400
6,900 8,S00 1S,000 30,000 28,SOO 2S,000
TABLES
HISTORICAL GROUNDWATER ANALYTICAL RESULTS
Analy I ir:al Method
WELL ID D•te
CoUected
:
j
4/21/2004 15
DW-1 8/10/2004 ND
7/1/2014 <0,079
2/25/2016 <0.12
4121/2004 ND
MW-I 8/10/2004 ND
7/1/2014 <0 079
2/25/2016 <OU
4/21/2004 3b0
MW-2 8/10/2004 420
7/1/2014 9.7
2/25/2016 <4 8
4/21/2004 ND
MW-3 8/10/2004 ND
7/112014 <(!079
2/25/2016 <0,12
4/21/2004 ND
MW-4 8110/2004 ND
711/2014 <0.079
212512016 <0.12
4/21/2004 6-f
MW-5 8/10/2004 ND
7/1/2014 <16
2125/2016
4/2112004 ND
MW-6 8/10/2004 ND
7/1/2014 <0.16
2125/2015 <0.12
4/21/2004 ND
MW-7 8/10/2004 ND
711/2014
MW-7R 11/1212014 0.95
212512015 2.2
8/10/2004 ND
MW-8 7/1/2014 <0,079
2125/2016 <0,12
2L Standanl [u,m 1
GCL lu on1 5000
Notes:
I , MTBE • Methyl Tcrtimy Butyl Elhor.
2. !PE= lsopropyl Ether.
8260 or6200B
a
ii a
i e
j ...
I IO0D 430D
~7 120
<Q 09 <0.092
<O 17 <0.13
ND ND
ND ND
<0,09 <0.092
<0.17 <0.13
10,000 1900
12,000 1,600
490 1,000
690 1,500
ND ND
0.55 ND
<0.09 <0.092
<0.17 <0.13
3,1 4.8
ND 2.1
<0.09 <0.092
<0.17 <0.13
51ll0D l.500D
8?0 3,600
3,700 1 700
ND ND
ND ND
<0.18 <0.18
<0.17 <0.13
ND ND
ND ND
1.6 18
9.7 140
ND ND
<0.09 <0.092
<0.17 <0.13
600 600
260 000 84 -"""
3, "<" or ND c Not detcctcd at or above the laboratory decuction limit.
!
i ,::
2,700D
790
<0.11
<0,25
ND
ND
<0,11
<0.25
11,000
14,00&
5.800
8 200
ND
ND
<0.11
<0.25
80
58
<0.11
<0.25
9.800D
31000
14 500
ND
ND
<0.22
<0.25
ND
ND
52.7
580
ND
<0.11
<0.25
500
85.500
4 , Con«ntrations arc reported in micrograms per liter (ug/1) • puts per billion(ppb).
504.lor
6200B
ii,
~
1
.E ; 3
-1.2
--
<0.09 <0,089
<0.09 <0,12
-ND
- -
<0,09 <0.089
<0.09 <0.12
-90
--
<0,9 9.6
<3,6 <4.8
-ND
--
<0.09 <0.089
<0.09 <0.12 -ND
- -
<0.09 <0.089
<0.09 <0.12
-140
--
<18 120
-ND --
<0.18 <0,18
<0,09 <0.12
-ND
- -
<0.&9 <0.089
<0.36 <0.48
--
<0.09 <0.089
<0,09 <0.12
20 0.02
20000 so
Tate Property
760 I Louisburg Road
Raleigh, North Carolina
Incident #21716
~ j !I ., . .l: t I I e-i .:
-330D 42D
-49 23
<0.18 0,14) <0.11
<0,18 <0,12 c:O. t?
0.55 ND
ND ND
<0.18 <0.12 <0.11
<0.18 <0.12 <0.12
-840 NJ)
-ND ND
<1.8 640 58
<7.2 430 88
-ND ND
-ND ND
<0.18 <0.12 <0.11
<0.18 <0.12 <0.12
-31 3.1
-13 3.7
<0.18 <0.12 <0.11
<0.18 <0.12 <0.12
-780D 78E
-970 -670
<36 1,400 130
8260 or 6200B
.
~
~-
! e-.: i..
23
ND
<() 12
<O 15
ND
ND
<0.12
<O 15
NI)
ND
II
l it/
lW
!'ill
<(1 12
<t,.,s
ND
ND
<0.12
<0.15
64E
ND
<25
Not 8 1l1Tmled / 0.03' of Free Product
-ND ND ND
-ND ND 1.3
<0.36 <0.24 <0.23 <0.25
<0.18 <0.12 <0.12 <0.15
ND ND ND
-ND ND ND
Well Not SomoleiVDJV
<0.18 9.5 3,1 0.53
<0.72 85 12 2
-ND ND ND
<0.18 <0.12 <0.11 <0.12
<0.18 <0.12 <0.12 <0.15
70 6 70 25
70.000 fi.000 25 000 11 700
5. Conc,ntrations in bold equol or exceed the conosponding NCDENR Groundwater Quality 2L Standard (2L Standard) upd31cd April 2013.
6. GCL • Gross Contamination Limit
7. J .. Indicates constituent was detected above laboratory detocbOfl limit but below laboratory reporting limit
8. D a denotes Diluted Coocentration
9. -= Not reported in historical tables
IO . NA = Not Analyred
11 . E = denotes Estimated Concentration
12. NE = Not established
~ !I
.l: ...
e-..
I,
114D
34
<0,094
<0.13
ND
ND
<0.094
<0,13
ND
ND
88
140
ND
ND
<0.094
<0.13
ND
N D
<0.094
<0,13
lOOE
1,600
210
ND
ND
<O 19
<() 13
ND
ND
1.4
10
ND
<0,094
<0.13
70
JD OOO
3030C MADEPVPH
a C
·i: a
j a i t
] .. ij C g .., ,. ,. I:) a i! ~ ~ e ii .. "2 i i!: ~ .3 1l ~ ~ i 1 1 j ,:: ;!! ~ u
640D 240D 3.5 2,800 8""" 2,600
390 180 - -
--
<0.18 0.36} NA NA NA NA
<0.18 <0,13 NA NA NA NA
ND ND ND ND ND ND
ND ND --- -
<0.18 <0.1 NA NA NA NA
<0.18 <0.13 NA NA NA NA
1-41111 480 IO.I 22000 28.000 6,100
980 ND -- -
-
1,100 360 NA NA NA NA
1,400 440 NA NA NA NA
ND ND ND ND ND ND
ND ND ---
<0.18 <0.1 NA NA NA NA
<0.18 <0.13 NA NA NA NA
6.1 II ND 64 210 78
2,6 13 ----
<0.18 <0.1 NA NA NA NA
<0.18 <0.13 NA NA NA NA
l 500D 530D 3.2 13000 29000 7100
13000 5,000 ---
2,200 740 NA NA NA NA
0.52 ND 50.S 66 ND ND
ND ND ---
<0.36 <0,20 NA NA NA NA
0.441 <0.13 NA NA NA NA
ND ND 19.9 .ND ND ND
ND ND - --
23 10 NA NA NA NA
150 51 NA NA NA NA
ND ND ---
<O,JS <0.1 NA NA NA NA
<0.18 <0.13 NA NA NA NA
400 400 15 400 700 200
28.500 25 000 15.000 NE NI! NE
Notice of Intent to Construct or Operate Injection Wells
Tate Propert+ . P,alei h_ North Carolina
FIGURES
,'TC

SOURCE: MyTopoMap.com
u T
✓•5&PCI AF'8i
2725 E. Millbrook Road, Ste 121
Raleigh, NC 27604
(9I9) 871-0999
PROJECT NO: SL217l 604
SCALE: 1"= 1,350'
DATE: 8/2014
REVIEWED BY: GA
FIGURE 1: SITE TOPOGRAPHIC MAP
Tate Property — Incident #2 1 7 1 6
7601 Louisburg Road
Raleigh, Wake County, North Carolina

11192 90'5 959a - - H 12] -
LEGEND
C OVERHEAD ELECTRIC UNE
PP ® POWER POLE
MONITORING WELL (TYPE ll)
MONITORING WEl. (PIPE XI)(OEEP)
e POTABLE WELL LOCATION
FORMER UST
LOCATIONS
MW-6 4
CONCRETE
SLAB
I I
L J thy_ I e
�414-5
"E;II
"II
fl
LOUISBURG ROAD III
MW-7
WSW-2
(BORED WELL)
PORCH
1-STORY
HOUSE
MW-7R
WSW-1
(DRILLED WELL)
PP
( U.S. HIGHWAY 401 )
EIW-3
DECK
f�
MW-4
1
1
1
1
1
1
1
%
0 20'
T� --
SCALE IN FEET
t1
0
a 1-
0
0
L7
0
0
0
0
ul
$^

Source: Wake County iMaps
trti:1* ....''
tiff 7` +Eft �''
`•
11/2
r, :te/4 v i m !► �a �i}� y�i Fie � �
ti r ���_ •� 1l ti1l -'
�C/1<t1r'r
'4• A
or 4
�a
1 .�Y
r
l �'
■
'�
p 4�F416
500 Foot Radius
0 Potable Water Supply Well
1,000 Foot Radius 0 inactive Water Supply Well
wsaacinr
2725 E. Millbrook Road, Ste 121
Raleigh, NC 27604
[phone]
PROJECT NO: SL2171604
SCALE: 1" = 350'
DA'1E: 8/2014
REVIEWED BY: GA
FIGURE 3: POTENTIAL RECEPTOR MAP
Tate Property — Incident #217I6
7601 Louisburg Road
Raleigh, Wake County, North Carolina

LEGENR
E - OVERHEAD ELECTRIC LINE
PP ¢]
c
0
POWER POLE
MONITORING WELL (TYPE 0)
LIONITOR1NO WELL [TY*F Jl)[DEEP)
POTABLE WELL LOCATION
SQL BORING LOCATION
H-201 nljozro. 17-H DE.IH
70141 MILHL3 m3/14
95
mor 4ca
0.12-.
-
2 4nlLLEHE_mq/4_•
_
St.<
r"ess.�l 7569, .m./>•'
sa`
.ewe .am
.-PIEInea®c .4014
1
.....scy
1,44-fl/144a0000 .aM
94
45..0}
t.04-lu8"0.3199 2 .b11k 15
001. mans
0,04.11ow11106 ,44/1. 110
32
11 CONCENTRATIONS BELOW SOIL-
so4EPm Peps.
:1/14/A 711' 25'
11
1E. 2/
/O01o.1LO1la55n1/47 .acn mseee
501111643
4714
mural
1./
0.1
r.lowse®a _E_.o 2.5.
..m- 10
.yr1__2°
Gj 44/1/145 444/44 'JOp
+2.4•lllnmlrtala>X
I^44wrto415lt
4-4 4124111414v/4
G-_MW.Mii.�po
740
40
S8-2 I1 w,.
3E
u
11
/A
•A
7110
170
3_
:010p0 *lI.40 Kim. 5014 -10-
B-204 07 21 14751
IIIQ/A 7.0
eTPll1H1®E "5/•J 13
1G0L TWIN ngt19, 1111
WVE1n01UIE .14.'1a 00
5[r036t H12 milk 4
,.Ldp-sma Nuo0a4 ..4M14 67
C1�G 44169611 64114
.e-51. APIs= 46/4 1100
5.-ceemisiwPs•dW 410UST
4
8-2Dr $ L 50/11•_ 4PIH
u./.x/o. 172 ]4'
loufoE Too. 11
•,•••• m,••••• Enoe .aoc. 11
:ONL 41W40 y 19 120
I46694W4 •5/47 es 1.
51241fl001®14 g4/44 In.. ham.
-
m-4110 4i1Ya[ .11/.1
4444
1L -11•41 w40Or
4.0. 14ar
10
mw 10�
51
2.1
10
71
32
1133.
area Mum = ate
G *WNW ..h.
770
740
1203
310
sea .1/33/ ,
comisi114TIa..mn.+.P .tu. SET-5 C.
1 L].:FPi]1 B=�i.O7�
ii =
Se-ay,zy.li�-
0 10'
SHALE IN FEET
07/2T/54
•s ltl#,Ime 0EL04 945-•m-O
8 205 4
20'
EXIThT OF SOIL IMPAGTEo ABOVE SOIL -TO -GROUNDWATER
MSCCs (DASHED WHERE INFERRED)
ciw11411u1.a: 4504 $01-10w/' I 0#4EA MRC,
0-1+-16'I4Iu.. >nI00 21:6-10-0021.11061101
1
ROUNOWATER MSCCo
S9-2
.MW
CONCRE
LA5
(4,,_1 B-203
Qs -1
E410411445 Hft.T c+ 74-.,.-++qNu RF *5 .
04
B-20/ 211O4 to
CON:0o1.41wn Y1.0. 144 i0-IJ4a11Wnd1160.
I 207
,n: you4
cplKr llluiq.e 4144 k .1¢-I0261E4 11m
SHED
Ski 1 ❑ 07/52,3/12 n a••
M.
r114414/15 6E1p0 $OL-T0-02001044TLIt 16951
SA- I 0 Nais 211.16
V-20.
[ 14n0,KNS 4E1O1 201-10a1a1y1g1r11 46004
1I
HED
WSW-2
MOREL) WELL)
WSW-1
(DRI'
CP-1 121.07TOIL. 111 14' 077T"
10111DE m4i'.
40
rnana orac •3.4,44
O<
TOOL 2MF1le5 .q/Ip
320
M40I11146DE nKA9
N
1501115161.1161115 .14g
12
.41.00-I .1./y
/1
.rarnlo®E .uly
0.1
.-Ib5/12900S .•
20
1fA-110®mM2 N47
H
120. 2041> [ .1/.4
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fat/
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MG
R j2211Ws wiry
1300
nErIH
Qp 22/18
I111¢4 11016 14'104 54 -tn-o 006.614 £I
5B-8 m/22 12 atm
aoM2x1141104 4t4p11124-111-1RW100011I 061/6
. 011
6-206 ai °1q" I
wrc4Rwwls 401,n4 3334-7a-4700.0tw'0. 4apa.1
CM...51,▪ 61
ENTRATIONS BEL011Y SOIL -TO -GROUNDWATER MSCCa
22//F3.20 2'
04L'14 7.2
65012121529NE n614 10
1012.1. ir1tDI7 TM
IMPITT51105 SS
•prnOvlLm.3HE m LAI 43
4-01m4eex WWI 12
+•1115469/66. .4/y 11
114- olti"IQI4 .40.L 100
1s-1.4411.5,p//4 F.2 41 40
w- w,w+ts 1wro
e4-4. ?)M71a ma111
5.-5.0001mrs .10y
SQL- 7EF1"
74/22/12
M4ala"11 15a11 2115- 10-903161661ER WE,
SB-7 g"`
00152"1RhllbNs LIDO as
•.P1H
58-5
sOL
11/06/14
0512009012I6 611011 191-19-4051I555E0
a-203 a4j12D4 DEPTH2 H
1. 1)E .. J/1p 6.7 15
EnfYL°£NGJIE ..01 14 47
/446014..v+E 49/81 i 31 34
p-0101.164.55401912 .414 F 14 11
.-4.1r.olmlc1443/4 1aAL_
.4-09711400114 43 411041E02Y
1Mrpr1u0ppR .,yam 12 15
I54•11/ffsm401p11 q/41 140 170 -
a.t4 M/•.vrs r4/13 2/9 1190
04•0.0~01.2/44 12W =0
4.414✓ .1/12. I ma 019
SE-4 11/06/14
nrtrbtlnn.
700E
1/1M11HA1112E
s.I
19
4.1
mans
15
142
40
05
••VM
:La
4.4
10-0R01gmWM10 /1C0 y
1;
.au111s�1[ mural
1/
- 021- w. w 7E../y r,e. ree14
4.3
. -/gron1000E ../41 10
1�4044p"o4o4! •10 4 77
R�4 n1.400 .01i4 2 0
a�..1�ri fs - a�
~c.-�.,1 2„
24
140
/4
141
1200_
1100
iN
gg
Q€€
1n
Vi
o.
N
n
O
n�n
02
4

LEGEND
OVERHEAD ELECTRIC LINE
PP 0
EPP
POWER POLE
NiONITDRWC W LL (TYPE II)
MONITORING WELL (TYPE III)(DEEP)
POTABLE WELL LOCATION
73.00 + ORDUNDWATER ELEVATION CONTO1R (1t.)
(72.72) GROUNDWATER ELEVATION (ft.)
INFERRED GRDl1NDWATER FLOW DIRECTKIN
PAW-8
(72.78)r
CONCRETE
SLAEI
FO▪ R
LOCATIONS
rf
• MW-1
▪ (73.11)
1 1 1
1 t-J
{DW-1} (7)
V
MW-2
MW-▪ 7R
(72.55)
WSW-1
(DRILLED WELL)
NW-7
(NM)
WSW-2
(BORED WELL)
IAW-5
(73.13)
DI
o l{I
LOUISBURG ROAD I'
w _4
( U.S_
HIGHWAY 401
PECK
E- —E
N
20-- 1
SALE IN FEET
0
0
0
O
IZ
a
co
C
7 r•
f-�
z
L] �
zo z
.z<EC
o
W } 2
H
in Cr I 7
LU Lr1 m 0
VJf-Q Z
cea07
Z OJ H
7 W - lwJ
F 0I-157cc a CO a
F CD I-
a
N
O
3"

LEGEND
[ OVERI-IMD ELECTRIC i.INE
PP ® POWER POLE
•r MONITORING NW_ (TYPE II)
MONITORING WELL (TYPE III)(DEEP)
POTA8LE WELL LDCARON
1
1
MW-2 411 w/iRSi16
-
T1011,Q':NE
_-
[IMREEPREM
1a0
TOVV VID ES
1HPN'4ASNE
1It
IrpPROPIIEENZOME
1$
n-PRORIISF REpE
10
1,21-TIPItSlSYEREMKRE
1400
1.&$-TR.MET101.11Elabe
410
IT-
O LYiIPOI1HO5 +wwe IIL aT.,lulrm _�
1
MW-1 +.& cvfulle
ILO 0011P01/473 ofFoo 21 SIANEI.An
1 FORMER UST
LOCATIONS
NW— f
MW-8
r4
I
I_ J L J
MW-5
CROUNOWATER IMPACTED
AEOYE 2L STANDARDS
OS
r
DVf—
LOUIS13 RG ROAD
0.0
••"' MW-7k
114W-4 •,.E OT/D7}E
..7 id/l1VC IL SWORD
wsw-1
(DRILLED WELL)
MW -2 0-
WSW-2
(BORED WELL)
PP
IJ /�
PORCH
MW-3
MW-4
link-7R wnh wow.
CE•f[EME `` 29 i+
I se
MPPITIWLME 65
DECK.
-8
MW-3 WA- 1/2/25/11\
MO COlgarillOR ARPRW RI S',WKI{RD t
f 1
t
N
E
{ U.S, HIGHWAY 401
j
N
L
D J 20.
49'
cf I F IN FEET

LEGEND
OVERHEAD ELECTRIC LINE
P? O POWER POLE
4> M0NIT0R1NG WELL QTPE IQ
- MONITORING WELL (TYPE it (DEER)
POTA6LE WELL LOCAri0N
FORMER LIST
LOCATIONS
A
MW-1
1
GROUNDWATER IMPACT®
AB 1 E 2L STANDARDS
CO REFS
LA8
B-205
Ira
2
4
Sq-1
..Pai.
)I C
-202
r
s8-8�_ r§1"-7
8-207
MIN-2
f
Ocd
Are
047' ,dsas s'
SD-6
Bj296
0-203
CS-1
r
pii
nt�
II
LOUISBURG ROAO 1
' UW-7
SHED
SHED
WSW-2 -
(BORED WELL)
WSW-1
(ORtLLEO WELL)
SE
PORCH
EXTENT OF IMPACTED SOIL ABOVE
SOIL -TO -GROUNDWATER MSCCs � MW-3
PP
E C E
f
( U.S. HIGHWAY 4O1 )
C'
▪ W-4
MW-B
1�
20'
—>r-r
SCALE IN FEET
ime-1
>e
11
g
�[ N
0
3a+
0
I
0
0
co
El
o
CV
z a
w z
U
�d rL7=
I• ' CC CC
Tsi sr LWL � 0
CC
Cr
0 eLaL7
Ea gw Lu
1-
W N- sir
Cs1-nCC
•
z

100.00'---
90.00. -
80.00' -
70.00' -
50.00' -
50.00' -
40.00. -
30.00' -
20.30' -
A
Mil- 1
(102,20'}
0-2 2 CS-1 B-203 OW-1
SB-2 9-71.1 (101.54') (10I-59') 13-206 58-5
A'
SB-2 "i'
SAMPLING DEPTH ft 1
I1, p/:1
0 :01.I111U/105 A607II S01-TO
19001N6214T10I 1107C4
SO-2
.17/•0 11/66/14
PAIRING DEP111 Ef41 IS'
NO 00MP07705 ABWE %OL-111
CBD9196ADE9 16Cik
MW-1 .14 10/ES/16
ND CA4PDI0DS 0E1TCTE0
ABOVE' 7. STANDARD
B-204 ^W.a 075um.
S4MPN6: DEPTM 111.)
20'
T01.UE11-
7.6
E04n-9EHYEME
13
1 %Y14166
110
11A9l1A34LENE
46
6931470P11.13912ENE
-PROM 8E'N2ENE
9.6
1,24-116111CDPIBCM7EME
65
1.3.3.11011EBE•'19EH2p'1E
30
CO. CC NOTDITICS
360
L9-216 416114:11C3
1100
39-C77 61104/11071
460
j CLAY
Silty Sand/
GScpro Sand/
1
■ ■ Y t
i
■
■ I.
1 ` ,
•
t
•
B-202 ^+N7 a �.
SAMPLING 0EP'N I7i.j
17'
TIAAL 6YW '
10
HAPI411NLEHE
ID
1,7,4-1RIME1172Ld112EH2
10
C3-CO 9JPI9.7ICS
230
00-C19 41..911143000
770
00-c7.2 AR06N1C$
aB
B-202 n•7hc 50E
a.417.DT
SA1111-R10 DEPTH fill
24'
TOL!]E4L
11
F.II M 8E67C4,E
17
TOTAL f.TLENES
190
NAPHTH41.EHE
15
ISOP000116EM2NE
5.1
'I- iOWE-11E
r.3
is.rmayE
5.s
-PRUPriBEHQENE
s9
1,2,4-TRNETFTOP012E1lE
76
1,3,5-1R41ETHf5BW2ENE
36
C5-CB ALIP1tT14;5
D00
4:9-Gi9 ALI1.4441C5
1200
C9-OY7 ARON i1CS
330
WATER TABLE
+Aw $ -V&tL InPN11FICArr0N
(101.641-______.
TOP OF CASINO
WELL CASING
WELL SCREEN
■
■
■
MW-5 .6)1. w.'nr1
NOT S7001.00/0A3 OF 46ff P6u7L0'1
DW-1 w/L 97%73/1
NO C0MP01M5 DETECTED
AREA[ 27. ET.7964110
•
■
8-206 •17/t 0r/21/76
37NPJN7 1 10'
00 COMPOLPOS MOVE 401L.-TO
0 001Ak1E74 MECCA
B-206 RWsoL
w
rn
07;64
30
SNNRI1N0 OEPTIi IfLI
y4W4NUDIE
1,Z
C9 C22 A9040.605
130
�1 EXTENT OF IMPACTED 501L A30VC
5DIL-10-GREHINOWAIER 1450E:s
S-1 ,n-,y BOIL
as/1000
071/33.97170,111 (11
RO'
1OW0.19
B,7
ET-04,9 H2FNE
20
.T0011 11.i[NES
140
WPMNALEHE
D6
190PROD1111E747
4.7
A-WT.63E17E6E
12
n-PA]wL9012EHE
15
'.,4-TRfYl7HTL7EN:ESIE
100
',3S-1NIME71ryLiE1,:ENE
45
CD-E8 ALIKLATCS
11CO
C9-CI8 u1P171TCS
1600
CS-C22 AROANTIC5
NOTE: PREVIOUS EXCAVATION ACTNRIES AND
SOIL ASSESSMENTS INDICATE 501L IMPACTS
ARE ENCOUNTERED APPR0XIMATELY ice' SELOW
GROUND SURFACE AND EXTEND TO WATER TARLE-
20-
70
5
0
58-5
nog 3 11/11/'•
54.447U'40 OEI+R1 ta.1
T.3
NO COMPOUNDS ABOVE S3L-10
GROL6DE6TER HSCC0
SB-5 '"/W '1/W1'
SWUNG DEPTH IA.. J 23'
NO ONIAPOIJN0.5 AGM 50L-TO
['AMC/WATER 1.137C.
ROUNOWATER 1MPACTED
2L STANDARDS
8-203 .3/h5
5111PLTY3 OEPIH (TT./
FT7c11ENE
E5111.DE141E11E
'OIM7 %1'LENE
HA7.nIWENE
so.
04:1J1(94
13'
5,7
100
i5OPROPI7■EQE
47
n-EN1'ri F3F.N7E
lac-BIPI'LBENZEHE
10
43
n-PROPrLBE1RW
15
1,2,4-TR►IET111T.ECNQEHE
40
1 „9.6--1I4i1ETHn 1611ZE17
G-CS A110I90105
CB-C10 I PHA
06
260
200
79. 092 A9074774 S
can
8-203 1w149 7' 67/i.•w
S4FWH6 DEPTH et]
20'
110716E
3]
[;I441.gE67[H[
47
TOTAL TYLENCS
320
NA'HIPV:EK
34
150PIQVILBENZOAE
15
p.-lS7I`RC4'.'L13LIlp40
n-OJT''LBENZEIlE
12
n • P7OP4BEM1ET/E
25
1,2,4- T6I31E1H+4BEI#i7E
170
1,3,5-I'IJHET*ALPEN2EIIE
73
C9-C6 4JP1-sATC4
1100
!a-r,16 A11P11A1CS
3E00
04-722 071E141 .1005
7117
SCALE IN FEET
1
20
e
z
07
u.
a
Q •
45 z
2 LL.
oa z
• E7
ir
ttl
tn 7Da
1I
r�=
[n �
LU
la Q
0- p rru
I-m.a
W ff(0Q

100.00' -
0.0ar ---
70.00' -
60.00' -
54.00' -
4D.00.
30.00 -
20.00'
a
a
e
1.B-205
.1r045 07/01/01
•
A*4LN0 I*PU, ,15., 1 1ff
x0 cGxwL1 A :-1'a
B-205 44545 07/21/05
G,YP1042 55.1"15 IR+ I 20'
NO CD4.1POJ415 ABCNI SOLL-50
0604 5OM517.0 +07c05
SB-3 .5,11 11/P4/14
54.412,4U711 OEPOI Ott I 2.0'
2aOUHOIW54T 5. Cs -1I1
5B 3 Pah4 1l/OV1
Wu/kW DEPTH 01.1 ] 2'
NO c011P04500 ABM 5471..-'0
4404M1744 Ea wcOC.
•■
•r/
■•
■
MW-5 • a Ashs
II wor swPemro.w' 9r nit( Prmnlcr
EB-3 , MW-5
B-205 B-201 EB-1 GP-1 (101,64']
,
B-201 4.5%Ss501.w
S430PU00 05P114 i II,.
17•
^,1a`5.,1.t
25
iuP/mw Dr
27
5-150PR0PYI70111EIE11E
4.5
n-PROP11.0ENTE15E j
3
1,$1-1I7.67TMt 64 4411 '5
36
1.3.6-TWO-. ils 54f5f
15
Ca-e22 A*+Cw*1:5
100
B-201 50
,
i
■
■
500245I11 OEM i[t! 24
4A.41"14LEXE , 4.10
09-C22 A405.MTPC5 52
NOTE: PREN0U5 EXCAVATION ACTIVITIES AND
SOIL ASSESSMENTS INDICATE SOIL EMPACTS
ARE ENCOUNTERED APPROXIMATELY 12' BELOW
GROUND SURFACE AND EKTEND TO WATER TABLE
4. CLAY
1 - L Silk Surd/
clayey
,'t' 1. $C IE70na/
■
•
■
1 1 ■ 4 /,
J t 1 ■ ,
11•'- 1`+IL
I1 tom, i
-•k'
'1 1
WATER TA4LE
-g WELL IOENIIFTGTION
{1Sy1.E4'�
TOP OF CAv7HC
WELL CASING
WELL SCREEN
t `
s
1
1 ■
t ,
1' ■
■
+
i
CS-1 SB-4
.47
SB-1 4,45/55
S450P11540 OEPM nl-1
10TAL mars
2
f-
17-B67I41EN201E
44-0004499E112E5E
4.2.4-10504 4 or.nnx
6.1
30
1,7.3-T01KETH1LIK ZTE
Psy-GA A13P.191Ti05
CD-C10 AU P0.47101
20
385
700
C0-C22 57M151102
SO-1 ^+/4l 11
SAA0LE'11 DEPTH 'IL.
12I# IY4XI4ES
141P4R4uEyE
ISOPROPNIDDI
4a
29
Si
f�TOLUEnE
4
-PROMIBEY2540
154
1,44-,BIMEM1t0EH2D1E
:3
1.345-TROJEas5EHIPit
ST
CS -CA N IPi4*15
C0-C13 015. 4T1C9
020
60
01-C22 A80YATIOS
70
■
+
t•
,
,
SB-6
t
CS--1 •.o/ /
gy
HMI HUNG PUDEPTH A20
24
t01.IID41
9.2
t ;;01-
20
I�TAL 1'i1LEIi$
140
kA61-11I14LENE
36
7230170PYL6E16h1E
4.7
"-3N116EIIZENE
12
-PAOP4LBE?2ENE
15
I ,2,4.4f154Rt1711007 HE
100
1,3,5-TAM i41 7L9ENz, NE
5a
05-C1 5L27561105
1100
el -am Agaves
550Tir
c9-c.V AnolfAflL•
6B0
GP-} "vAv
PK
„942Mel
25'
SAYPLIH? 2PR1 I14
TOLU:I*0
40
X511P-P42E4JE
54
TM& WASHES
220
1P•PHIwJENE
4B
021 2[LGCNTENE
12
4.-BU11'1BE56E14 .
21
•eo-45-.11HEH7,EAE
0.1
PBGWLBEIIli-NE
20
1,2.4-iI0 .1sTr*
117
'.3,5-T9151E1H1I.BEIRFT+:
51
CS-C6 52.2P-5.4C5
1200
C9-C I ALP HAM
JH00
Ee-ER2 ATWMkIICD
1210
EKTENT OF IMPACTED SOIL ABOVE
Sot -TO -GROUNDWATER 445CC5
20
SB-6 Mora '0S
M. Mai
SWUNG MTH ,TL.
054.P45154L fE
09-002 A101HTNS
1.2
84
SB-S "m'X' 1/04V14
SLYPIIVO 0EFn1 1H.+ 25'
Iq 004030571551 MOTE 505-TO
12530107037E0 1.13055
GROUNDWATER IMPACTED
ABOVE 2L STANDARDS
SB-4 na/9
SAPP: NC DEI% al:.
L1,4,et W'I704E
+ssvED
44764-11571.556
160PROPTLBEN7ENE
_ n
14
20' m
51J I F
m
23 Z co 12
La
so u Z '2
77 a
se In �I-)
Rau LO
010 0 I-
a,v Cr cc CC m O
[�J L30. FN.2
142 -2 E1.1 .--1 LU
es Lua0O
4.4 r, HnE'C
4.1
e-E10PRO?RTOWEWE
rk- DIFYDDEX44)HE
5-P11131• 26KIENE
i•py-711Il0YµttOENIENE
E}•5-17611ESIPUKHTENE
15-11 ALPHA=
C9-050 A104I4AT1rS
69-C22 1.000AT05
IS
SB-4 ."oho sat
3PPDHJMC DEPTH •IL
TOTAL N1'I_kj+
H1REHAU NE
o-160Pp00.11211ENE
n-5UntafH2FNE
sa-•-•au>m m.lPsur
n-PROP11.014ZE iE
1 F.4-1PYETNYLBEI4IESE
13.7-7 7mBEKEEK
00-46 .41.2414.43I54
09-CI11 *10745I/3
ea
4.3
444
04
1402
1254
00-C22 M01,542525
1100
SCALE IN FEET
3 0
F
a
0
3
0
04
0
V
u7
a
As
iot
iS �

100.00' ---
90.00'
80.130.
70.00' —
6O00'-
50:00'
40.00' —
30.00' »--
20.00' —
IOW-5 DW-1
(101,641001.59')
MW-2
(102.27'j
1 1 1 1.
\ y• y 11 1 1 ` 1 I. Y y h 1
`
1 1 1' +
1 1 1 1 + + 1
1 1 1 . 1
\ 1 1
,;1111111111C\;y
y I 1 1\ 1 1
r ± y `.
\ \
,10
\ y
1111 MW-5 wn mryV11
;111
MO'. SAMPLED/UM' OF FEtE PROOUCT
1+.
• DW-1 -0_
BO m/
No t'7uPDW05 ABOVE zl Ng11m
uW-2 ;r. n>/ P11., 1.
TOLUENE
two
ET111.1.8Pa +1E
t5i6
TOTAL Kr-fNEE
e.700
µWR111-ENE
410
150PRO ,LIIEHLEHL
1e
a -FRO 'LOENTENE
1ir1
1, 2.4-TRIMI-NAYS EIEIarNE
1 ib[I
* Sa-♦giy ETKri. .T!ftE
OM
CLAY
Silly Sandi
StlpoM ro nq�
WATER TABLE
S WELL IDENTIFICATION
(101-6i�
TqP or
CA5[HG
WELL CASING
WELL SCREEN
Mw- 7R
(99 45')
MW-4
(93,81')
tMW-7R • agps/
8CIIE1a 2.2
TOTAL kYLLHE5
IUPH111.14,ENF
GROUNDWATER IMPACTED
ABOVE 2L '.,TANOARDS
NOTE: PREVIOUS EXCAVATION ACTMTIE_5 AND
SAIL ASSESSMENTS INDICATE SOIL IMPS CIS
ARE ENCOUNTERED APPROXIMATELY 12 BELOW
GROUND SURFACE AND EX ND TO WATER TABLE,
MS
SCALE 11.1 FEET
z9
ifl
Ag
0
I I
0
0
O
LD
N
(I)*
L3 2
Z W z
00
F U O 0
W oQ
▪ u
CA
IS1r 1 CC I-
re w
W • d W Z
0'--/ D - J L7
▪ LJ..-,W
a H
I,ICECD <I
ED I-r.tr
Ia
i1
O
an
C]

LEGEND
— E — OVERHEAD ELECTRIC LINE
PP Q. POWER POLE
MONITORING WELL (TYPE 10
r MONITORING WELL (TYPE III)(DEEP)
a POTABLE WELL LOCATION
® SDII. BORING LOCATION
• PROPOSED INJECTION POINT
INJECTION RADIUS OF INFLUENCE
D Ta' a0'
SCAL£ IN FEET
ErENT OF SOIL IMPACTED MOVE SOIL -TO -GROUNDWATER
MSCCI (DASHED WHERE INFEut1E00
MW-1 AREA A' r ` -3
750 S.F. 1 r I
1 I
S; .■157
1 1
' F .] B-204 GP-10 B-2U1 I
FORMER UST / ." �W-5 111 0 12 •
LOCATIONS i \ - C51
\ 4—�' \'\
.1.,B INJECTION POINTS BASED 0t
THE INJECTION RADII OF B' • Iti
SB-2
9-206 5R-5
.4- -3/
S
SR-9
e�
B-2070 {
WSW-1
(DRILLED WELL)
112
Q
m
0
N

28 feet
z
12 feel
16 feet
2 inch diameter direct -push boring
Injection to be performed through direct -push
rods at depths ranging from 12 to 28 feet below
ground surface.
Injection Point Well Type Depth (feet) Screen Interval Well Contractor
(feet) Name and
Certification
Number
1 through 8 Direct -Push 13 13-15 Innovative
Environmental
17 17-19 Technologies,
Certification
21 21-23 #2725-A
25 25-27
2725 E. Millbrook Road, Suite 121
Raleigh. NC 27604
[phone]
i 5 C 1 :. i E S INC
FIGURE 12
Injection Well Construction
Diagram
Tate Property
7601 Louisburg Road
Raleigh, North Carolina

ATC
ENVIRONMENTAL • GEOTECHHICAL
BUILOIHC SCIENCES • MATERIALS TESTING
April 8, 2016
I /fo5QQ'7'30
725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcassociates.com
N.C. Engineering License No. C-1598
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section,
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Injection Event Record
Tate Property
7601 Louisburg Road
Raleigh, Wake County, North Carolina
NCDENR Incident No. 21716
Dear Ms. Shrestha:
UK Program
RECENEDIi DEO/DWR
APR 112016
Water Quality
RegfonalOpo►atiorti Section
ATC Associates of North Carolina, P.C. (ATC) is submitting an Injection Event Record for the above
referenced site under contract to the North Carolina State -Lead Program. During the event, eight
temporary direct -push injection points were installed on March 29 and 30, 2016. The event consisted of
injection of zero valent iron (ZVI), sodium persulfate (Klozur), and hydrogen peroxide. Attachment 1
contains the Injection Event Record form and Attachment 2 contains the Field Summary Report prepared
by Innovative Environmental Technologies, Inc. (1ET), our injection contractor for this project.
Attachments 3 and 4 contain the injection well construction and abandonment records for the eight
injection points.
If you have questions or require additional information, please do not hesitate to contact Gabriel Araos at
[phone].
S incerely,
ATC Associates of North Carolina, P.C.
Ashley M. Winkelman, P.G.
Project Manager
cc: Mr. Mark Petermann— NCDEQ State -Lead Program
Attachments:
Attachment 1
Attachment 2
Attachment 3
Attachment 4
— Injection Event Record
— Field Summary Report
— Well Construction Records
— Well Abandonment Records
Gabriel Araos, P.E.
Senior Project Manager

ATTACHMENT 1
INJECTION EVENT RECORD
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number
1. Permit Information
NCDEQ State -Lead Program
Mark Petermann
Permittee
Tate Property
Facility Name
7601 Louisburg Road
Raleigh, NC 27616
Facility Address
2. Injection Contractor Information
ATC Associates of NC, PC
Injection Contractor / Company Name
2725 East Millbrook Road
Street Address suite 121
Raleigh NC 27604
City
State Zip Code
( 919) 871-0999
Area code — Phone number
3. Well information
Number of wells used for injection 8
Well names IP-i through IP-8
Were any new wells installed during this injection
event?
®Yes No
If yes, please provide the following information:
Number of Monitoring Wells
NA
Number of Injection Wells 8
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑X Direct -Push
❑ Hand -Augured ❑ Other (speiE6Enn
wriE
Please include two copies of the G W- l b for each
well installed. APR 1 12016
Water Ouafity
lonsi
petoituer8 3k.a114141
Were any wells abandoned during this injection
event?
Fl Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells NA
Number of Injection Wells
8
Please include two copies of the GW-30 for each
well abandoned.
4_ Injectant Information
ZVI, Sodium Persulfate (Klozur) ,
Injectant Type
Concentration See attached IET Field Report
If the injectant is diluted please indicate the source
dilution fluid. Raleigh Municipal Water Supply
Mixture of 5,508 lbs of solids and
Total Volume Injected 2480.4 gallons of solution
IP-l: 161-3 gal, 701 1ba
12-2: 265.3 gal, 701 11213
Volume Injected per wel11F-3: 279.75 gal, 763.5 lba
IP-4: 191.2 gal. 436 lbs. 1P-52 351.3 gal, 701 that 1l-4. 351.3 gat, 701
IP-7. 391-3 gal, 70] lha, IP-83 339.75 gal, 903.5 lima5. Injection History
Injection number (e.g. 3 of 5) 1 of 1
Is this the last injection at this site?
EI Yes ❑ No
1 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
STANDARDS LAI IN THE PERM'.
44
SIGNATURE OF INJECTION qfd, R-. fWii
ys ' p'O
Gabriel Araos , :p . > _ SEAL #
PRINT NAME OP PERSON PERFtMM]I ? INJEOTI
ma/yy:q`� ,7-
gnke
4 f•
"41411 `
Submit the original of this form to the Division of Water Quality within 30 days of injection.
Attn: MC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-322]
Form UIC-IER
Rev. 1 1 rob

ATTACHMENT 2
FIELD SUMMARY REPORT
ET
Innovatne Environmental Technologies, Inc.
Technology Discussion and Field Report
To
ATC Associates Inc.
For
The Application Of
"Zero Valent Iron Catalyzed Hydroxyl & Sulfate Free Radical
Oxidation"
At
Tate Property
Raleigh, North Carolina
February 2016
Innovative Environmental Technologies, Inc.
6071 Easton Road
Pipersville, PA 18947
(888) 721-8Z83
www.iet-inc.net
Pipersville, PA • Columbus, OH 4 Forked River, NJ • Concord, NC • Columbus, GA

Contents
Executive Summary
Introduction 3
Remediation Implementation 3
Injection Procedures 3
Direct -Push -Driven Perforated Rod Placement 3
Subsurface Pathway Development 3
ZVI, Sodium Persulfate and Hydrogen Peroxide Injection 4
Liquid Rinse 4
Post Injection Line Purge 4
Site Map 4
Conclusion 5
Appendix A - Injection Logs 6
11Page
ATC Associates Inc, — Tate Property

GtET
Executive Summary
On behalf of ATC, innovative Environmental Technologies, Inc. CET) has prepared the following injection
report. This report has been prepared to document remediation activities conducted at the site.
The injection program was implemented from March 29th to March 30`h of 2016. The remedial approach
employed the integration of both Fenton's chemistry and persulfate chemistry, utilizing zero valent iron
as the catalyst for both reactions. The integration of these two chemistries shall allow for synergistic
catalyzed reactions and long lasting (via persulfate) oxidation.
The materials were introduced in the vicinity of monitoring well MW-5 and included 5,288 pounds of
Sodium Persulfate and 1,795 gallons of ^'5% hydrogen peroxide. 320 pounds of ZV! was also suspended
in 475 gallons of water and injected into the targeted subsurface intervals from 13-27' feet below
ground surface (bgs). Surfacing of remedial material was limited during the implementation of the
design and resulted in slight field modifications to the proposed design. Shallow refusal was also
encountered during the attempt of 1P-6 at approximately 3 feet. The point by point injection dosages
along with instances of surfacing are noted in the attached field logs.
21Page
ATC Associates Inc. — Tate Property

Introduction
The Tate Property located in Raleigh, North Carolina, was identified as having soils and groundwater
impacted by the historical release of petroleum fluids. The primary compounds of concern at the site
were petroleum hydrocarbons. An injection program was proposed by IET for the remediation of VOC
impacts surrounding monitoring well MW-5 utilizing advanced oxidation technologies.
Remediation Implementation
Injection Procedures
IET completed a total of 8 injection locations at the Tate Property site. Details regarding each
injection attempt are provided in the field logs in the Appendix.
Direct -Push -Driven Perforated Rod Placement
A AMS Powerprobe 9500 unit comparable to the one pictured in Figure 1, was utilized to drive the
injection screen (as seen in Figure 2) to depths ranging from 13 to 27 feet bgs. It is at these depths,
that the likelihood exists of being in close proximity to the targeted waters in the more permeable
layers that were identified during characterization of the site. These more permeable layers are
those believed to have historically provided the preferential pathways taken by the dissolved -phase
VOCs.
FIGURE 1: AMS POWER PROBE 9500 VTR
FIGURE 2: RETRACTABLE INJECTION SCREEN
Subsurface Pathway Development
Compressed air was used to propel all injectants into the subsurface. Compressed air was first
injected into the subsurface at approximately 150 pounds per square inch (psi) until a significant
pressure drop was observed at the injection pressure vessel. This process is referred to as pathway
development. The intent of this step is to open pathways in the subsurface for the injectants to
follow, These pathways are believed to be those more permeable pathways along which VOCs are
more likely to have migrated, both in the vadose and saturated zones. Liquid and liquid -entrained
3'Page
ATC Associates Inc. — Tate Property

QET
injectants are then delivered with pressurized gas to the pathways that were produced during the
development step.
ZVI, Sodium Persulfate and Hydrogen Peroxide Injection
A colloidal suspension of 1-3 micron zero valent iron (ZVI) was immediately injected into the
subsurface fractures and voids that were developed during the compressed air injection step.
Immediately following, under constant pressure a sodium persulfate/ hydrogen peroxide solution
was then introduced.
Liquid Rinse
A small amount of water was injected to clear the injection lines of the chemical oxidants and ZVI
and promotes mounding of groundwater into the vadose zone.
Post Injection Line Purge
Compressed air was injected to clear the lines of all material and to force the remedial components
further into the formation before moving to the next injection location.
Site Map
limpacted Soil
Plume
sE—a
FIGURE 3: GENERAL INJECTION IMPLEMENTATION — INJECTION LOCATIONS
4IPage
ATC Associates Inc. —Tate Property

ET
1.onc_1Gsictr
The injection program at the Tate Property was implemented based on the proposed design with slight
field modifications. All proposed injectants were introduced at the targeted depths. It is expected that
the injection event will yield positive results in the area around monitoring well TOW-5 and IET looks
forward the assessing the data following future sampling events.
5IPage
ATC Associates Inc_ —Tate Property

GET
Appendix A - Injection Logs
61Page
ATC Associates Inc. —Tate Property

ET
INNOVATIVE ENVIRONMENTAL TECCINOLOi1f.S, INC.
Job Name: ATC - Tate Property
2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Time of Injection:
Date of Injection: 3/29/2016 (3/30/16)
8:04 12:33 12:23 12:07
Grid Point: IP-1 8:11 12:39 12:28 12:17
Injection Zone
Actual
13-15'
Proposed
13-15'
Actual
17-19'
Proposed
17-19'
Actual
21-23'
Proposed
21-23'
Actual
25-27'
Proposed
25-27'
Summan
Actual
13-27'
Proposed
13-27'
Duration of Fracture (seconds):
3
3
3
3
3
3
3
3
Pressure of Pre -injection pathway development
Estimated Radius of Influence
150
6
150
6
150
6
150
6
150
6
150
6
150
6
150
6
Pounds of Klozur
125
125
165
165
165
165
206
206
661
661
Gallons of 50°/0 H202
4.9
4.9
6.6
6.6
6.6
6.6
8.2
8.2
26.3
26.3
Gallons of 5.0% H202
50
50
65
65
65
65
85
85
265
265
Lbs of ZVI
7.5
7.5
10
10
10
10
12.5
12.5
40
40
Gallons of ZVI Solution
10
10
15
15
15
15
Pressure of Post -injection pathwa► dev.
100
100
100
100
100
100
20
T 100
20
60
60
100
Field
Observations: Retractable Injection Screen. Drilling significantly tighter during last 3-4 feet of advancing tooting. Screen Suspected Clogged at 25-27'.
Redrilied and Completed Injection Point. Completed 13-15' the on 3/30/16. Liquid injection Pressure 50 psi.

litNOVATIVE ENVIRONMENTAL TECHNOLOGIES, INC.
.rob Name:
Date of Injection:
ATC - Tate Property 2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Time of Injection:
3l30/2016
10:15 10:04 9:56 9:36
Grid Point: IP-2 10:19 10:10 10:01 9:45
Summary
Injection Zone
Actual
Proposed
Actual
Proposed
Actual
Proposed Actual
Proposed Actual
13-15'
13-15'
17-I9'
17-19'
21-23'
21-23' 25-27'
25-27' 13-27'
Proposed
13-27'
Duration of Fracture (seconds):
3
3
3
3
3
3 3
3
Pressure of Pre -injection pathway development
Estimated Radius of Influence
150
6
150
6
150
6
150
6
150
6
150 150
6 6
150
6
Pounds of Klozur
125
125
165
165
165
165 206
206 661.
661
Gallons of 50% H202
4.9
4.9
6.6
6.6
6.6
6.6 8.2
8.2 26.3
26.3
Gallons of 5.0% H202
40
50
45
65
45
65 50
85 180
265
Lbs of ZV1
7.5
7.5
10
10
10
10 12.5
12.5 40
40
Gallons of ZYI Solution
10
10
15
15
15
15 20
20 60
60
Pressure of Post -injection pathway dev.
100
100
100
100
100
100 100
100
Field
Observations: Retractable Injection Screen. Slightly cutting back volume to limit surfacing of injectant. Liquid Injection Pressure 50 psi.

INNOVATIVE fNV1RGNDIENTAL TECHNOLOGIES, INC.
Job Name: ATC - Tate Property 2016 Injections
Date of Injection:
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Time of Injection:
3/30/2016
14:53 14:31 14:12 13:58
Grid Point: 1P-3 15:00 14:37 14:26 14:07
Injection Zone
Actual
13-15'
Proposed Actual
13-15'
17-19'
Proposed Actual Proposed
17-19' 21-23' 21-23'
Actual
25-27'
Proposed
25-27'
Summary
Actual
13-27'
_Proposed
13-27'
Duration of Fracture (seconds):
Pressure of Pre -injection pathway development
Estimated Radius of Influence
3
150
6
3
150
6
3
150
6
3 3 3
150 150 150
6 6 6
3
150
6
3
150
6
Pounds of Klozur
187.5
125
165
165 165 165
206
206
723.5
661
Gallons of 50% H5O2
7.35
4.9
6.6
6.6 6.6 6.6
S.2
8.2
28.75
26.3
Gallons of 5.0% 11202
50
50
45
65 45 65
50
85
190
265
Lbs of ZVI
7.5
7.5
10
10 10 10
12.5
12.5
40
40
Gallons of ZVI Solution
10
10
15
15 15 15
20
20
60
60
Pressure of Post -injection pathway dev.
100 100 100 100 100 100 100 100 400
Field
Observations: Retractable Injection Screen. Slight foaming from reaction around tooling during 25-27' injection. Liquid Injection Pressure 35 psi.
Returned to point and introduced ZVI at 13-15'. No oxidant introduced to avoid surfacing. Returned to point 14:53-15:00 and applied
oxidant at 13-15'.

INNOVATIVE ENVIRONMENTAL NTAL TECWJOLOWES, INC.
Job Name:
ATC - Tate Property 2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Date of injection: 3/29/2016
Time of Injection:
10:43 10:33 10:14
Grid Point: IP-4 10:37 10:25
Summary
Injection Zone
Actual
Proposed
Actual
Proposed
Actual
Proposed
Actual
Proposed
Actual
Proposed
13-15
13-15'
17-19'
21-23'
21-23'
25-27'
25-27'
21-27'
13-27'
Duration of Fracture (seconds):
3
3
3
3
3
3
3
Pressure of Pre -injection pathway development
150
150
150
150
150
150
150
Estimated Radius of Influence
6
6
6
6
6
6
6
Pounds of Klozu r
125
125
0
165
82.5
165
206
206
413.5
661
Gallons of 50% Hz02
4.9
4.9
0
6.6
3.3
6.6
8.2
8.2
16.4
26.3
Gallons of 5.0% H202
35
50
0
65
20
65
85
85
140
265
Lbs of ZYI
0
7.5
0
10
10
10
12.5
12.5
22.5
40
Gallons of ZVI Solution
0
10
0
15
15
15
20
20
35
60
Pressure of Post -injection pathwap dev.
100
100
100
100
100
100
100
Field
Observations: Retractable injection Screen. Immediate surfacing of oxidant around tooling at 25-27'. Redrilled point with welded ring tooling to seal
annular space around tooling, Surface escape noted —6 ft from injection point at 21-23' injection. Suspected old soil baring. Attempted
17-19' with same issue. Liquid Pressure 45 psi, Returned to 13-15' and was able to introduce material with minimal surfacin.

INNOVATIVE ENVIRONMENTAL TECHNOLO 1ES, INC.
Job Name: ATC - Tate Property
Date of Injection:
Grid Point:
2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Time of injection:
3/30/2016
13:08 12:55 12:49 12:32
IP-5 13:13 12:59 12:54 12:40
Injection Zone
Duration of Fracture (seconds):
Actual
13-15'
3
Proposed
13-15'
3
Actual
17-19'
3
Proposed
17-19'
3
Actual
21-23'
3
Proposed
21-23'
3
Actual
25-27'
3
Proposed
25-27'
3
Summary
Actual
13-27'
Proposed
13-27'
Pressure of Pre -injection pathway development
Estimated Radius of Influence
150
6
150
6
150
6
150
6
150
6
150
6
150
6
150
6
Pounds of Kloxur
125
125
165
165
165
165
206
206
661
661
Gallons of 50% H202
Gallons of 5.0% H202
4.9
50
4.9
50
6.6
65
6.6
65
6.6
65
6.6
65
8.2
85
8.2
85
26.3
265
26.3
265
Lbs of ZVI
7.5
7.5
10
10
10
10
12.5
12.5
40
40
Gallons of ZVI Solution
10
10
15
15
15
15
20
20
60
60
Pressure of Post -injection pathway dev.
100 100 100 100 100 100 100 100
Field
Observations: Retractable Injection Screen. Slight foaming around tooling during 13-15' injection, —1/2 gallon. Liquid Pressure 50 psi.

INNOVATIVE. ENVIRONMENTAL TICH_NOLOG1E.S, INC-
Job Name: ATC - Tate Property
Date of Injection
2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Time of Injection:
3/30/2016
11:11 10:59 10:44 10:31
Grid Point:
111-6 11:17 11:06 10:51 10:38
Summary
Injection Zone
Actual
Proposed
Actual
Proposed
Actual
Proposed
Actual
Proposed
Actual Proposed
13-15'
13-15'
17-19'
17-19'
21-23'
21-23'
25-27'
25-27'
13-27'
13-27'
Duration of Fracture (seconds):
3
3
3
3
3
3
3
3
Pressure of Pre -injection pathway development
150
150
150
150
150
150
150
150
Estimated Radius of Influence
6
6
6
6
6
6
6
6
Pounds of Klozur
125
125
165
165
165
165
206
206
661
661
Gallons of 50% H202
4.9
4.9
6.6
6.6
6.6
6.6
8.2
8.2
26.3
26.3
Gallons of 5.0% H2O/
50
50
65
65
65
65
85
85
265
265
Lbs of ZVI
7,5
7.5
10
10
10
10
12.5
12.5
40
40
Gallons of ZVI Solution
10
1.0
15
15
15
15
20
20
60
60
Pressure of Post -injection pathway dev.
100 100
100
100
100
100
100
100
Field
Observations: Retractable Injection Screen. Slight foaming around tooling during 25-27' injection. Minimal. Liquid Pressure 50 psi.

INNOVATIVE. ENVIRONMENTAL TECHNOLOGIES, iNO.
Job Name:
Date of Injection
ATC - Tate Property 2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Time of injection:
. 3l3012016
9:14 9:03 8:48 8:29
Grid Point: IP-7 9:19 9:09 8:56 8:35
Summary
Injection Zone
Actual
13-15'
Proposed
13-15'
Actual Proposed
17-19'
17-19'
Actual
21-23'
Proposed
21-23'
Actual
25-27'
Proposed
25-27'
Actual
13-27'
Proposed
13-27'
Duration of Fracture (seconds):
Pressure of Pre -injection irath wa► development
3
150
3
150
3
150
3
150
3
150
3
150
3
150
3
150
Estimated Radius of influence
6
6
6
6
6
6
6
6
Pounds of Kloaur
125
125
165
165
165
165
206
206_
661
661
Gallons of 50% R202
4.9
4.9
6.6
6.6
6.6
6.6
8.2
8.2
263
26.3
Gallons of 5.0% 11202
50
50
65
65
65
65
85
85
265
265
Lbs of ZVI
7.5
7.5
10
10
10
10
12.5
12.5
40
40
Gallons of ZVI Solution
10
10
15
15
15
15
20
20
60
60
Pressure of Post -injection pathway dev.
100
100
100
100
100
100
100
100
Field
Observations: Retractable Injection Screen. Slight air escape around tooling at 17-19'. Able to inject without issue. Liquid Pressure 30 psi.

it:1r
INNOVATIVE E/RONM.EI►ITAL TEC11NOLOOIE.S, iNC.
Job Name:
Date of .Injection:
Grid Point:
Injection Zone
ATC - Tate Property 2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate Free Radical Oxidation
Time of Injection:
3/30/2016
12:14 12:07 11:59 11:43
LP-8 12:18 12:12 12:05 11:49
Actual
13-15'
Proposed
13-15'
Actual
17-19'
Proposed
17-19'
Actual
21-23'
Proposed
21-23'
Actual
25-2T
Proposed
25-27'
Summary
Actual
13-27'
Proposed
13-27'
[Duration of Fracture (seconds):
Pressure of Pre -injection pathwa% development
Estimated Radius of Influence
3
150
6
3
150
6
3
150
6
3
150
6
3
150
6
3
150
6
3
150
6
3
150
6
Pounds of Mazur
250
125
225
165
165
165
206
206
846
661
Gallons of 50% H2O2
9.8
4.9
9.15
6.6
6.6
6.6
8.2
8.2
33.75
26.3
Gallons of 5.0% I1202
65
50
50
65
50
65
60
85
225
265
Lbs of ZVI
25
7.5
10
10
10
10
12.5
12.5
57.5
40
Gallons of ZVI Solution
30
10
15
15
15
15
20
20
80
60
Pressure of Post -injection pathway dev.
100 100 100 100 100 100 100 100
Field
Observations: Retractable Injection Screen. Liquid Pressure 50 psi. Limited volume slightly to decrease surfacing potential_
Added material to 13-15' an 17-19' to account for incomplete IP-4.

INNOVATIVE ENVIRONMENTAL TECHNOLOGIES,, CHNOL► GIESr INC.
Job Name:
ATC - Tate Property 2016 Injections
In -Situ Chemical Oxidation using Zero Valent Iron Catalyzed Hydroxyl and Sulfate
Free Radical Oxidation
Date of Injection: 3129/16-3/30/16
Summary
Injection Zone
Pounds of Kloxu r
Actual
13-27'
5288
Pro9osed
13-27'
5288
Gallons of 50% 11202
210.4
210.4
Gallons of 5.0% 11202
1795
2120
Lbs of ZVI
320 320
Gallons of ZVI Solution
475 480
Field
Observations: Foaming around tooling during 1P-3,5,and 6 indicative
of oxidant coming into contact with free product in
subsurface.

ATTACHMENT 3
WELL CONSTRUCTION RECORDS
WELL CONSTRUCTION RECORD
This form an be used for single or multiple wells
1. Well Contractor Information_
John Allen
Well CoeIractur Name
4196-B
NC Wall Coitee tat Ccsli0catioaNumber
Innovative Environmental Technologies, Inc.
Cony Name
2. Well Construction Permit it:
hist ail applicable wdfl permits ri.e. Colon Sloe; Va nsice, Injection, arc)
3. Well lisle (check well use):
Water Supply Welt:
17/Agricultural
r7Geothcrmel (Heating/Cooling Supply)
L1lfidustrie11Comincrcial
r]Irrigation
CilVietnicipalfPuhlic
E]Rt sidential Water Supply (single)
UResidential Water Supply (shared)
Nuo-Water Supply Well:
t7Manitoririg
ClRecovery
Injection WeII:
r]Aquifer Recharoo
fAquifcr Storage and Recovery
uAquitbr rest
LUExperimentat Technology
FIGeotheermal (Closed Loop)
n1cothcrmal (Heating/Cooling Return)
4. Date Wetl(s) Complet,o•d_ 3/30/16
Sa. Well Location:
Tate Property
GJGronndwater Reined iation
0SaJRity Barrier
i..IStoimwater Drainage
[Subsidence Cannot
UTTracer
{Other (explain under 421 Remarks)
Wel11D# IP 1-8
FedllityWClwuerNamc Facility 1R (if applicable)
7601 Louisburg Rd, Raleigh 27616
Physical Address, City, and 2iip
Wake
County Parcel Identification No. MN)
Sb. Latitude and Longitude in deg rees/minutrslsecoeds or decimal degrees:
(if well field, CAC latilong is su1fcte"tl
35.877149 N 78'539176
6. is (are) the well(s): fll'ermanent or 12Temparary
7.1s this ri repair to an existing well• C7Ycs or LINO
Tf this is a repent. fill awl known mall cwtstrurtlo" information and explain rho rudure of the
repair radar er21 reniarls eection or on the back clans feral,
& Ntunber of wells constructed: eight
For inuldpfe vrjeclion or, non -water supply wells 0:NLYwith the same convtredioa, }au can
suborn' one farar.
9. Total wen depth below land surface: 27
For aiuhiple wclLr list all depths rdiffer rnr ire maple- 3g240.' wtd 2(0100')
(R)
10. Static water icvcl below top (dealing: -12 (h.)
if wain Icv el is above eosin use "+
11-Borehole diameter: 2.25 (in.)
12. Well construction method: direct push
(i.e. auger. rotary, table, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3il. Disinfection type: - Amotud.
iFor Internal Use ONLY'
14. WAxesZONES
FROM
70
ft.
ft.
11.
f.
1S. wags
CASING ilnxmiriti-cased
ivei�ORLINER tiro
FROM
TO
DIAMETER
Tlin-RL' LSs MA FOAL
ft.
, ft.
in.
16. INNERCASING
011 Iltt1ING
tgeutbermal closed-loopl
FROM
TO
DIAMETER
Tn10E.1ME.SS
MATERIAL
0 fl•
1. 25 '
1.875 '
0.25" "
steel
ft.
ft.
in.
17. SCREEN
FROM
7O
DIAMETER
SLOT SIRE
TTOCIODISS
MATERIAL
2.25 in-
0.25
steel
25 ft.
27
ft.
i .
1t GROUT
FROM
TO
.MATERIAL
EMPLACEMENT METHOD & AMOUNT
fi.
none
N/A
ft.
11.
ft
14 SAND/GRAVEL
PACK (if npu cable)
MOM
TO MATERIAL
EMPI-il.at:l.dIT Mita=
nine
NSA
ft.
ft.
20. DRILLING LOG (ettaekaddit ions& sheets if nett:Sir")
_ PROM
TO
DEriCRIr1IO IQ*. Amines& seiVlvde hole ran MM. M=I
ft.
ft.
No sampling
ft.
m
11.
ft.
fr.
ft-
ft. -
f
ft
fr.
n
IL
21.E
Solution injected at 4 intervals 25-27". 2123.17-19', 13-15' bgs.
22. Certification:
l
Signature of Cerra.
ed Well Contractor
4/6/16
Date
By signing this foryn, I hereby cenrfy that eke wei!(s) was {were) constructed in accordance
with ISANCAC 02C.010O or 15A INCAC 02C.0200 We!! C'mastrur_rion Standards and that e
copy ofthis retorrlhus been provlaed so rho wet! owner
23. Site diagram or additional welt details:
You may use the hack of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following,;
Division of Water Resources, Information processing Unit,
1617 Marl Service Center, Raleigh, NC 27699-1617
24b_ For Injeetion Wells ONLY: In addition to sodding the form to the address in
24a above, also submit a copy of This form within 30 {lays of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program.
1636 Mail Service Center, Raleigh, NC 276994636
24c. For Water Suppy & Injection Wells:
Also submit one copy of /his form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Four C1 W-t
North Camlma Dcpartmnrt dt ivironmcnr urxi
Naniral Resources - Division of Water Resources Revised August 20 13

WELL CONSTRUCTION RECORDS
For lntenial use UNIX;
This foam can be used far single ormnitiple was
1. Well Contractor Information:
John Allen
Wail Contractor None
4196-B
NC Well Contractor Certification Number
Innovative Environmental Technologies, Inc.
Company Name
2. WeU Construction Permit #:
Lisi oft applicable well permits it c. Camay, MOM Vareaze. injection. etc,)
3. WeII Use (check well use):
Water Supply Well:
DAgricultural
CiOeothezma) (Heating/Cooling Supply)
LJIndustrial/Cornmerciat
r]Irrigation
fl Memicipal/Pu111 it
(]Residential Water Supply (single)
[]Residential Water Supply (shared)
Non -Water supply Well:
r]Manitorieg El Recovery
Injection Well:
DAquifer Recharge
[],Aquifer Storage and Recovery
[]Aquif r Test
[]Expcemental Technolow
ClGcothermal (Closed Loop)
r]Geathexrnal (Heating/Cooling Return)
lAGroundwater Aemediation
rlSalioity Barrier
US1ormwater Drainage
rlSobssdeni:c Control
r7Traccx
fOfher (explain under #21 Remarks)
4. Bate Weil(s) Completed: 3130/'l 6 Well ID# f P 1-8
Sa. Wei Location:
Tate Property
Farili[y,'Oaner Nam.
Facility 1D# (if applicable)
7601 Louisburg Rd, Raleigh 27616
Physical Address, City, and Bp
Wake
County Parcel identifie ce No. (PIN)
5b. Latitude and Longitude in degreeshuinuteslseconds or decimal degrees:
(ifwert Geld, cue latfiong is sufficient)
35.877149 lv 78.539176 w
6. Is (are) the wefl(S): rlPermanent or CdTemporary
7. Is this a repair to an existing well: ❑Yea or RIND
Olds is n repair. fe1( out known well ronslrudim itJl'n iatian cad explain the nature of the
repair under 1'27 rmrearra s4Ct407 or an the back ofthlsrprm.
3. Number of wells constructed: eight
Fornxirli(ple injeetien ornort-water supply wells ONLY with the scone construction, you con
suhiaie once form.
9. Total well depth below land surface: 27
For maniple wells liar all depths ifdf rent ('example- 34200' and 3I 100)
10. Static water level below top of raising: —1 2
If water level rS above rasing, use
11. Borehole diameter: 2.25 OD.)
12. Wen construction method: direct push
(f)
(.)
(i.e. auger. rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpei) 141ethod of test:
13bk Disinfection type: Amount:
H. WATER ZONES
FROM
i TO
1EacBT TIONY
ft.
ft.
it:
ft.
IS. OCITERCASING tiernul i-cased wells) OR TENTER iifappiisablel
FROM
TO
DIAhWTJR
1 illrliti1 $F
m a) kits !
ft.
rt.
in.
llc INNER CASING_ORT[fli!NG igeotbermalsioted-leepi
FROM
TO -.
GIAM6TER
Tt 1CKNe¢S
VAATERIAL
0 ft.
25 R
1.07.5 in"
0_25"
steel
fL
ff.
is
17. SCREEN
FROM
TO I DL,.ME a SLOTSIZE
25 ft
ft.
27 tt 2.25 jn'
rt. tie.
Ttt10ENESS MATERIAL
0.25
steel
IL GROUT
:FROM
TO I MATERIAL I EMPLACEMENT METHOD & AMOWi1
e- I none N/A
rt
19. SANDICRAYEL PACT. (if appIic biej
PROM 'TO
EMPLACETIEReT'METHOD
ft R' none
a. R.
20. fRfI.LINC LOG (Mack ad.di1nu,al t:heets if occesnry)
•TO 0Fst'!OPTION twont: fy v-21a }
f No sampling
vomit
It.
NIA
ft.
e.
rt.
fi
ft.
ft.
$.
it.
it.
a1L REMARKS
Solution injected at 4 intervals 25-27', 21-23', 17-19', 13-15' Cgs_
22. C��ertifipftion:
Signature of Ce:tied Well Contractor
416116
Date
Ry St/An Pa form, T hereby cerigo hunt the well(s) wws {were) constructed to accordance
with ISANC'.4C 01C.'.0100 or NCAC 02C .0210 Well Construction Standards and that a
copyoflhls record has been prevtded to the rrllonner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional Wet site details or well
construction details. You may also attach additional pages if necessary,
SUBM rTAL INST[ICI'loNs
24a. For Ali Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Wafer Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24h. For injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this fazes within 30 days of completion of well
construction to the following_
Division of Water ll aoorces, I.indcrgraund lateelion Control Program,
1636 Mail Service Center, Raleigh,111C: 27699-1636
24e. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of cotupletion of
well construction to the county health department of the county where
constructed,
Form G W-1
North Carolina Reparhnent of F.ovironmcnt and Natural Resources - Division of Water Resorcos Revised Atlgust2013

A TIACHMENT 4
· WELL ABANDONMENT RECORDS
WELL ABANDONMENT RECORD
This. form can be used for single or multiple wells
I. Well Contractor Information:
John Allen
Well Coritriictor Name ( or well own~ personally abandoning well on his/her property)
4196-.B
NC Well Contractor Cei.tification Nuniber
Innovative Environmental Technologies, Inc.
Company Name
2. ,ve11 Construction Permit#: _____________ _
Lisi all applicable well permits (i.e County, Stale, Yarim,ce, I11;ection, etc.) ifknnwii
3. Well use (check well use):
WaterSupply Well:
nAgricultural □Municipal/Public
UGl:othermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Suppiy (shared)
□Irrieation
Non~Water Supply Well:
[])vt(mitoring
Injection Well:
nAquiferRecharge
□Aquifer Storage and Recovery
□Aquifer Test
□Experimental Technoiogy
□Geothermal (Closed Loop)
□Geothermal {Heating/Cooling Return)
4. Date well(s) abandoned: 03/30/16
Sa. Well location:
Tate Prqperty
Faciiity/OwnerName
nRecovery
l!IGroundwater Remediation
nSalinity Barrier
□Sto~ater Drainage
□Subsidence Control
nTracer
□Other ( eXplain under 7g)
Facility ID# (if applicable)
7601 Louisburg Rd. Raleigh 27616
Phy:tlcal Acldress, City, and Zip
Wake
County Parcel Identifi6rtion No. (PIN)
Sb. Latitude and longitude in degreesimin11tes/secilnds or decimal degrees:
(if well field, one lat/long is sufficient)
35.877149 N 785391_76 ---------~-
CONSTRUCTION DETAILS 0.-.' \\'ELL(Sl BEING ABANDONED
w
Auach well mnstnu;tirm reci)rd(,r) ifavai/able. For inuliiple inJect,oit or Mn-water supp~v
wells ONLY with the same coristructum.'abandonmeni, wu can submit onejorm.
IP 1-8 6a. Well.ID#: _________ _
6b, Total well depth: _2_7 _____ (ft.)
6c. Borehole diameter: _2_.2_5_· .. ____ (iu.)
6d. Water level below ground surface: _~ __ 1_2 _____ (ft.)
6e. Outer casing length (if know~): _N_/_A ______ (ft.)
6f. Inner casing/tubing length (if known): _2_5 _____ (ft.}
6g. Screen length (if known): _2 __________ {ft.)
I Fm-Internal Use ONLY:
WELLABANDONMENTDETAILS
7a. Number of wells being abandoned: _e_. •_ig_h_t ____ _
For multiple injecti,m or noncwatlir ,mpp(v wells ONLY with the $ame
crmstn1ction·ah011donmen/,. yau can !lllhmit am, form.
7b. Approximate volume of water rcmainmg iu well(s}: N/A (gal.)
JiOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant Used: ______________ _
7d.Amo1int of disinfectant used: _____________ _
7e. Sealing inatcrials used (check all that apply):
U N¢at Cemerit Grout
i7 Sand CementC,rout
O Concrete Grout
U Specialty Grout
D Bentonite Slurry
~ Bentonite Chips or Pellets
n 0ryc1ay
□ Drill Cuttings
D Gravel
0 Other ( explain under 7g)
7f. For each material selected above, provide amount of materials used:
bentonite 240 lbs (total)
7g. Provide a ~rief deseription of .the abandonment procedure:
Bore holes filled with bentonite chips to prevent
"dayljghting" from other injection locations.
8. Certification:
-~-~---. ---Signature of Certified Well Contrac\or or Well Owner
4/6/16
Date
By signing this form I hereby certify that the well(s) was {were) abandoned in
accotdande with 15A NCAC 02C .0100 or 2C .0200 Well C'onstroctioh Standards
and that a copy of this recofd has been j,ravided to the well owner,
9, Site diagram or additional well details:
You may use the back pf this page to provide additional well site details or well
abandonment details. Yoti may also attach additional pages if necessary,
.SUBMITTAL IN~'TRUCTIONS
lOa. For All Wells: Submit this form within 30 days of completion of wen
abandomrtentto the fullowing:
Division of\Vater Resource~, ~nformation Prm;essing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
IOb. For lniection Wells: In addition to sending the foiln to the address in 10a
above, also submit OI\e copy of this form within 30 days of completion of well
abandonment to the following:
Division ofWaterResources, Underground InjeetiouControl Program,
1636 !\-tail service Center, Raleigh, NC 27699-1636
10c. For Water Supplv & Iniection Wells: In. addition to sending the form to
the address(es) above. also submit one copy of this form within 30 days of
completion of v.-ell abandonment to the county health depart:merit of the county
where abandoned.
FonnGW-30 North Carolina Department of Environment and Naiural Resources --Division of Water Resources Revised August 20 I3