WI0500958_DEEMED FILES_20170309

Ro gers, Michael
From: Rogers, Michael
Sent: Thursday, March 09 , 2017 10:19 AM
To:
Cc:
Subject:
'Jack Garrison'; '[e-mail]'
Robertson, Laura R. ([e-mail])
WI0500958 Jack's Best Buy -Surfactant Addition
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells {NOi) for the above referenced
site.
Please remember to submit the following regarding this injection activity:
1) Well Construction Records (GW-1) and Abandonment Records (GW-30) when completed. Please provide copies of
the GW-ls and GW-30s if not already submitted (originals go the address printed on the form). NOTE: Direct push
or Geoprobe wells are considered wells and require construction (GW-1) and abandonment forms (GW-30). If well
construction/abandonment information is the same for the wells, only one form needs to be completed-just
indicate total number of injection points in the Comments/Remarks section of form. These forms can be found on
our website at
http ://de q .nc.gov /about/divisions/water-resources /water-resources-p ermits /wastewater-branch /g round-water-
protection /ground-water-re p orting-forms
2) Injection Event Records (IER). All injections, including air and passive systems require an IER. The IER can be
modified for air sparge wells (e.g ., air flow 'continuous' for date or rate of injection, etc.).
You can scan and send these forms directly to Shristi.shrestha @ncdenr.gov or via regular mail to address below. When
submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the form (i.e., WI0XXXXXX}
that has been assigned to the injection activity at this site. This notification has been given the deemed permit number
WI0500958. This number is also referenced in the subject line of this email. You may if you wish, scan and send back as
attachments in re p l y to this email, as it will already have the assigned deemed permit number in the subject line.
Thank you for your cooperation.
From: Jack Garrison [mailto:[e-mail]]
Sent: Wednesday, March 08, 2017 3:09 PM
To: Rogers, Michael <[e-mail]>
Subject: FW: Surfactant Addition
Mike,
Since she is out until March 20, can you look at this for us?
Jack H. Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering , PC
jack @leafenviro .com
Office : [phone]
Fax: [phone]
Mobile: [phone]
Leaf Environmental & Engineering, P.C.
1
Notice of Confidentiality
The information contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. If you are not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
prohibited. If you receive it in error, please notify Leaf Environmental & Engineering PC., by return email or by telephone at (919)
484-8536.
From: Jack Garrison [mailto:[e-mail]]
Sent: Wednesday, March 08, 2017 2:47 PM
To: 'Rogers, Michael'
Cc: '[e-mail]'; 'Shrestha, Shristi R'; 'Steven Gerrald'
Subject: RE: Surfactant Addition
Hello Shristi,
Here is the NOi discussed below, I hope we did it correctly. Let me know if you have any questions, thanks,
Jack H. Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering, PC
[e-mail]
Office: [phone]
Fax: [phone]
Mobile: [phone]
Leaf Environmental & Engineering, P.C.
Notice of Confidentiality
The infonnation contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. lfyou a,re not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
prohibited. lf you receive it in error, please notify Leaf Environmental & Engineering PC., by return email or by telephone at (919)
484-8536.
From: Rogers, Michael [mailto:[e-mail]]
Sent: Thursday, March 02, 2017 9:30 AM
To: Jack Garrison
Cc: wes @leafenviro.com; Shrestha, Shristi R; 'Steven Gerrald'
Subject: RE: Surfactant Addition
The NOi is submitted at least 2 weeks prior to injection. She will send you an acknowledgement email if the NOi is
complete. A copy is forwarded to the regional office for their review. If you don't hear anything from DWR in a couple
of weeks you are good to go.
From: Jack Garrison fmailto:[e-mail] j
Sent: Wednesday, March 01, 2017 4:03 PM
To: Rogers, Michael <[e-mail]>
Cc: [e-mail]; Shrestha, Shristi R <[e-mail]>; 'Steven Gerrald' <[e-mail]>
Subject: RE: Surfactant Addition
Thanks Mike,
We will email the NOi to Construct to Shristi .
2
Did I understand that we can proceed without hearing back, or do we have to wait until we hear back from Shristi?
Jack H. Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering, PC
jack@ leafenviro.com
Office: [phone]
Fax: [phone]
Mobile: [phone]
Leaf Environmental & Engineering, P.C.
Notice of Confidentiality
The information contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. If you are not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
prohibited. If you receive it in error, please notify Leaf Environmental & Engineering PC., by return email or by telephone at (919)
484-8536 .
From: Rogers, Michael [mailto:michael.rogers @ncdenr.gov]
Sent: Wednesday, March 01, 2017 3:49 PM
To: Jack Garrison
Cc: [e-mail]; Shrestha, Shristi R
Subject: RE: Surfactant Addition
If it is a deemed site with a NOi email to Shristi. If it is an application for remediation permit, send or hand deliver 2 hard
color copies ..
From: Jack Garrison [mailto:jack @ leafenviro.com]
Sent: Wednesday, March 01, 2017 3:47 PM
To: Rogers, Michael <michael.rog ers @ ncdenr.gov>
Cc: wes @leafenviro.com
Subject: Surfactant Addition
Mike,
We are preparing an application to inject lveySol, one of the approved injectants, into the subsurface at a site in Butner.
Can we email the application or hand deliver it to someone rather than wait for it to go through the mail?
Jack H. Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering, PC
jack@ leafenviro .com
Office: [phone]
Fax: [phone]
Mobile: [phone]
Leaf Environmental & Engineering, P.C.
Notice of Confidentiality
The information contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. If you are not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
3
prohibited. If you receive it in error, please notify Leaf Environmental & Engineering PC., by return email or by telephone at (919)
484-8536.
4
Rogers, Michael
From: Rogers, Michael
Sent: Thursday, March 09, 2017 10:16 AM
To:
Cc:
Robertson, Laura R. ([e-mail])
Bolich, Rick
Subject:
Attachments:
FW: Surfactant Addition WI0500958 Jack's Best Buy
NOi for Jack'sBestBuy.pdf
Please find attached a NOi.
From: Jack Garrison [mailto:[e-mail]]
Sent: Wednesday, March 08, 2017 3:09 PM
To: Rogers, Michael <[e-mail]>
Subject: FW: Surfactant Addition
Mike,
Since she is out until March 20, can you look at this for us?
Jack H. Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering, PC
jack@ leafenviro.com
Office: [phone]
Fax: [phone]
Mobile: [phone]
Leaf Environmental & Engineering, P .C.
Notice of Confidentiality
The information contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. If you are not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
prohibited. If you receive it in error, please notify Leaf Environmental & Engineering PC., by return email or by telephone at (919)
484-8536.
From: Jack Garrison [mailto:[e-mail]]
Sent: Wednesday, March 08, 2017 2:47 PM
To: 'Rogers, Michael'
Cc: '[e-mail]'; 'Shrestha, Shristi R'; 'Steven Gerrald'
Subject: RE: Surfactant Addition
Hello Shristi,
Here is the NOi discussed below, I hope we did it correctly. Let me know if you have any questions, thanks,
Jack H . Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering, PC
jack@ leafenviro.com
Office: (919) 4.84-8536
Fax: [phone]
Mobile: [phone]
1
Leaf Environmental & Engineering, P .C.
Notice of Confidentiality
The information contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. If you are not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
prohibited. If you receive it in error, please notify Leaf Environmental & Engineering PC., by return email or by telephone at (919)
484-8536 .
From: Rogers, Michael [mailto:[e-mail]]
Sent: Thursday, March 02, 2017 9:30 AM
To: Jack Garrison
Cc: wes @leafenviro.com; Shrestha, Shristi R; 'Steven Gerrald'
Subject: RE: Surfactant Addition
The NOi is submitted at least 2 weeks prior to injection. She will send you an acknowledgement email if the NOi is
complete. A copy is forwarded to the regional office for their review. If you don't hear anything from DWR in a couple
of weeks you are good to go.
From: Jack Garrison [mailto:jack @leafenviro.com]
Sent: Wednesday, March 01, 2017 4:03 PM
To: Rogers, Michael <michael.ro gers @ncdenr.gov>
Cc: wes @leafenviro.com; Shrestha, Shristi R <shristi.shrestha @ncdenr.gov>; 'Steven Gerrald' <steven @leafenviro .com>
Subject: RE: Surfactant Addition
Thanks Mike,
We will email the NOi to Construct to Shristi.
Did I understand that we can proceed without hearing back, or do we have to wait until we hear back from Shristi?
Jack H. Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering, PC
jack @leafenviro.com
Office : [phone]
Fax: [phone]
Mobile: [phone]
Leaf Environmental & Engineering, P .C.
Notice of Confidentiality
The information contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. lfyou are not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
prohibited . If you receive it in error, please notify Leaf Environmental & Engineering PC ., by return email or by telephone at (919)
484-8536.
From: Rogers, Michael [mailto:michael.rogers @ncdenr.gov)
Sent: Wednesday, March 01, 2017 3:49 PM
To: Jack Garrison
2
Cc: wes @leafenviro.com; Shrestha, Shristi R
Subject: RE: Surfactant Addition
If it is a deemed site with a NOi email to Shristi. If it is an application for remediation permit, send or hand deliver 2 hard
color copies.
From: Jack Garrison (mailto:jack @leafenviro.com]
Sent: Wednesday, March 01, 2017 3:47 PM
To: Rogers, Michael <michael.rogers @ncdenr.gov>
Cc: wes @leafenviro.com
Subject: Surfactant Addition
Mike,
We are preparing an application to inject lveySol, one of the approved injectants, into the subsurface at a site in Butner.
Can we email the application or hand deliver it to someone rather than wait for it to go through the mail?
Jack H . Garrison, Jr.
Senior Environmental Consultant
Leaf Environmental & Engineering, PC
jack@ leafenviro.com
Office: [phone]
Fax: [phone]
Mobile: [phone]
Leaf Environmental & Engineering, P.C.
Notice of Confidentiality
The information contained in and transmitted with this electronic communication (including attachments) is subject to attorney and/or
client privileges or is otherwise confidential. It is intended solely for the addressee designated by the sender. If you are not the
intended addressee or receive this communication in error, any dissemination, distribution, copying, or other use or reliance on any
information contained or transmitted herein by or to anyone other than the addressee designated by the sender is unauthorized and
prohibited. If you receive it in error, please notify Leaf Environmental & Engineering PC., by return email or by telephone at (919)
484-8536.
3
North Carolina Department of Environmental Quality-Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
Tl1efollowi11g are ''permitted by rule" aml do not require tlll ill(/ividual permit wllen constructed i11 accordance
wit/1 t/1e mies of15A NCAC,_.02C .01,Q0. TIiis form s/,a/l be submitted ill least2 WEEKS prior to i11iectio11.
AQUIFER TEST WELLS ,(11& ~C&~ 02C .0;20)
These wells are used to inject uncontaminated fluid into an aquifer to determine aq\lifer hydraulic characteristics.
IN SITU REMEDIATION {1 5~_ NC~C02C' .0225} 01· TRACER WELLS <Jt;A N ·, CDlC ;1J229 ):
I) Passive Injection Systems -In-well delivery systems to diffuse injectants into the subsutface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small-Scale Injection Operations -Injection wells located within a land surface area not to exceed 10,000
square feet for the pl,lrpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test <,r treatment areas exceeding 10,000 square feet.
3) PHot 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 ittjection 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 pei·mit shall be requi,·ed to conduct
more than one pilot test 011 any separate groundwater contaminant plume.
4) Air Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Pri11t Clearly or Type l11for111atio11. ll/egible S11b111illals Will Be Ret11r11e1I As Incomplete.
DATE: Q-JS .2011_ PERMITNo. LJ:(Q.(°cJO q{'fl (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(l) Air Injection Well... ................................... Complete sections B through F, K, N
(2) Aquifer Test Well ....................................... Complete sections B throughf, K, N
(3) Passive Injection System ............................... Complete sectionsB through F, H-N
(4) _L_ Small0 Scale hljection Operation ...................... Complete sections B through N
(5) Pilot Test. ............. , .................................. Complete sections B through N
(6) Tracer Ittjection Well ................................... Complete sections B through N
B. STATUS OF WELL OWNER: Choose an item.
C. WELL OWNER(S) -State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalfofthe business or agency: ~Q,,;J;.Jc{< I 5, V4A1 ,J Q/;/t:W
Name(s): Leaf Environmental & Engineering. P.C. -Wesley Z. Brummer. P.E., Vice President
MailingAddtess: PO Box 14609
City: ---~R~TP~· ~------State: NC Zip Code:~2=7~7~09~.· ___ County: Durham
Day Tele No.: 919-484-8536
EMAIL Address: [e-mail]
Deemed Pennittcd GW Remediation NOi Rev. 3-1-2016
CeJl No.: __ 9'-'1~9-'-3"""8~9-4~2=50~--
Fax No.: --=-91=9_-4-'-"8'--'-4-_,8=54_,_,0,___ __
Page I
D. PROPERTY OWNER(S) (if different than well owner)
Naive and Title: Vann Rhew
Company Name _
Mailing Address: 3409 Hamlin Road
City: Durham State: NC Zip Code: 27704 County: Durham
Day Tele No.: _ 919--477-64 i 4 Cell No.: 919-810-4866
EMAIL Address: [e-mail] Fax No.: NA
E. PROJECT CONTACT (Typically T nvironmental Engineering Finn)
Name and Title: _ Jack H. Ganison. Jr., Senior Environmental Consultant
Company Name Leaf Environmental & Engineerin&P.C.
Mailing Address: PO Box 14609.
City: RTP State: NC Zip Code: 27709 County
Day Tele No.: 919- 484-8536
EMAIL Address: jac gleafenviro.com
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Jadk's$estBuy
315 Central Avenue
Ce1I No.: 919--412--7781a
Fax No.: 919-484-8540
City: Durham County: Granville Zip Code: 27509
(2) Geographic Coordinates: Latitude *: ° ' " or 36 °. 1..E+572
Longitude**: 0 " " or-78 °, 759282
Reference Datum: NAD23 Accuracy:
Method of Collection: (kg& Earth
"FOR MR INJECTION AND AQ J IFFR TEST WELLS ONLY: A FACILITY S]TE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
C. TREATMENT AREA
Land surface area of contaminant plume: 50,0:0 square feet
Land surface area of inj. well network: _ 3,603
square feet ( 10,000 & for small-scale injections)
Percent of contaminant plume area to be treated: 7•5 (must be < 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS - Attach the following to the notification,
Contaminant plume maps) 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
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 goundwater, changes in lithology, existing and
proposed monitoring wells, and existing and proposed injection wells.
Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus
existing and proposed wells.
DeCLued Permitted GW Remediation NOI Rev. 3.1.2016 Page 2

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
durations of injection over time.
Inject surfactant upgradient of source area and in LIST pit, and pump from downgradient
monitoring wells. The purpose is to accelerate petroleum release from vadose zone mil
twrnp out to downgradient wells. Physical means to evaporate petroleum constituency from
source area has not been effective enough to Lower groundwater levels below the gross
contatninant level. Our goal _is to lower petroleum residuals in the groundwater to below the
GCL and allow for a Notice of Residual Petroleum (NORP) and site closure.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant. Attach additional sheets if necessary.
NOTE. Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online al http:lldeg.nc.gnvtabr+iat!divistons1water-
sesourcesrwaiet resources-permitstwastewater-br cldRTr3und=seater-utotectionit nd-wafer-approved-injectants.
All other substances must be reviewed by the DUES prior to use. Contact the UIC Program for more info
(919-807-6496).
injectant: — Ivey—sol Surfactant
Volume of injectant: 5 gallons surfactant, 20 gallons 1 i'0 _
Concentration at point of injection: 20% _
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
In jectant:
Volume of injectant;
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: Proposed 3 Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW- is, provide welt 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 (indicate if construction is proposed or as -built):
(a)
(b)
(c)
Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
Depth below land surface of casing, each grout type and depth, screen, and sand pack
Well contractor name and certification nuinber
deemed Pcnuitted CiW Remediatioa NO! Rev. 3-t-2016 Page 3

L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
Wells already constructed. Pilot study to last over several days to a week.
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.
Sample MW-5 and MW-6 before, during and after test to determine changes in gLoundwater•
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, tinder penalty of law, that I am familiar with the information submitted in
this docwnent and all attachments thereto and that. based on my inquiry of those individuals immediately
responsible for obtaining said information, !believe Mat the information is tn:e, accurate and complete. I am
aware that there are significant penalties, including the possibility of fates and inprisonrnent, for submitting
false information. 1 agree to construct, operate, maintain, repair, and ffapplicable, abandon the injection well
and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules." L r
Sign attire of Applicant Print or 'Type Full Nnnie and Title
PROPERTY OWNER of tbejaperty is not owned by the permit apglicauty.
"As owner of the property on which the injection well() are to be constructed and operated, T hereby consent
to allow the applicant to construct each injection well as outlined in this application crnd agree that it shall be
the responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction
Standards (I5A NCAC 02C .020 J. "
"Owner" means any person who holds the fee or ether 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.
Signature* of Property Owner fir different from applicant) Print or Type Vitt Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature an this form.
Submit the completed notification package to:
DWR - UIC Program
1636 Mail Service Center
Raleigh NC 27699-1636
Telephone: [phone]
Deemed Pumilted GW Rcinc diaGpn idol Rev. 3- t-20 t fi Page 4

WELL CONSTRUCTION RECORD
mg, form aexbelard lmsiege PWapt.walfa '
I. Well Cdnnxc:or inlbr•suadom
Lewis Lefever
WeRContraciwNeme
2480A
NC Wen Contraetar Cwrifieseleo Nelegeer
Parratt-Wolf, Ins..
Company Name
2.Weil GbnalruelIon Permit Oh
l.fa+rnll rypplicnok+rrllpemdts (La Caarrrg Stare, Yarlemo, Adsatm3 erg)
3. Weil Use (check ivoli me):
Water Supply Welk
f3Agriculinra]
❑Gsolhernal (Heating/Cooling Supply)
Okduslrial/Cemtuuoial
Clad Ilion
Nnn'Watcr Supply Well:
mlsaonkering
Tojacifeu Well:
L'Aquila Recharge
L'Aquila Storage Dad Recovery
rlAquifPrTat
C91x poriknt:stal recttnolosy
SUGeotheaua3 (Closed Loop)
O ki:thermayIrrrtiipRiCtsolingltehno)
C1Mamicipnl/Pab k
I]ftrsicicnliel Water Supply (single)
OHeaidenlial Water Shy (ohered)
Well(s)
4. ]rode C iiplotedr 7Je��i A
5e. Well Laci1icn;
Jack's Best Buy
Ullacovery
r3 GroussdwaierRerrsed:•:dian
D5s linityBonier
r3Stormwtttcf Drainage
Daub:tames Centro]
Mincer
C lOIhci (explain under 1121 Rolled(
wanes
Papally/Omer Name Facility MI! ffnppliohle)
315 Central Averwe, Butner, NC 27509
7Jysiest Address. C ty, radzilt
Granville
Oxlip Pe cal Tameifievltnn No, (]'AN)
5b. Latitude nod Longitude in degreeshniueu:IAecan Is or decimal degrees:
(iFeeoli 1#ald. ma Wrong is st <f cla,[l
36.134466 N 78.759440
6. Is (ere) dte well(s): tdpermranttnt or [inn !wary
T fs [ids a tapir to Ru exi~di rgw 1I: LIYes or £Na
Tar ivarep *. fill owlloann v 1I rmWlrro tivi 4 Jbra1N►01Fgee &Wee the rarA+re Orr
repair o+rdsrell!Rat,rrlsswami of: GIP Ore bark Oft ft m
B. Natnlher of wells raastr+tctcd: 3
NarvAriplaneftaram6.- mo-noror noppiprde ONLY1r,V*theMitt aaru Udt.++,yourem
SANE Due jinn.
4. Total lrelidepth beiowland sorfacer 30'C
ihu u+rdrrrle +rr% eta+ n7 depths rdt,(lerant (tsrw,prr-1p2W ' reed 4410611
le. Slade wafts kvcl Wow top of easing:
yworar kW rs abase aardrff rmr "a .'
11.11oreLofo diameter: 8.0 (in)
12,WolE cuusirutttort Pee IJd: Auger
auger. rotary, radii; diarst pis* eta)
(it)
al)
FOINWATER SUPPLY WELLS ONLY:
13R. Yield (pm)
13b. A;slnfeetinn type:
edatI]od of In ft
Amount;
For tnrernar the ONLY:
f .
'_IVIV41.121kliPf.9:= , _.�my iw,,0.r r7..::„t - `iV.1.14 :v t:1,1:.
mold
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r bI9aiwetwI
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fr.
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ft.
F.-trfltlit ta�riait4Nidii
'iti : l hull; etill41$ 4i61Ag• -X3. mow'+:
ERMt
70
nwolriitue
Trt]txfl6s lum oa1.�
_
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f-�l til•ON
p��gq� AFL
AWOWP,4IAk
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, I 2 '1�i u H YZ. Y7. 0 • ��t .r' .i:� + i-.�._.
1Vl0M
7U
Swarm
7111LICY 59
MAI7fl1A[.
0 fl,
5,0 R'
2.0 Ir''
St:h 40
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it.
it
bt.
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"':'r e.
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i.KrG . :.mitt,: jJ.
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ma
NAMETIIR
own= mranik'S8 MATIMAL
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22. Certifiesdon:
*twoofWeiContactor bats
By rions this fares ! hr8By arrdf' Mai she irettr4 urn from) crxunwefad tr+ arco+darlse
u4th IS! NCAC 02C'.0100 ar IS.! NC4C 02C.4200 Wr11 Courrnrilou S'uvecurtr mod punt n
cap finch rrem+ilearbon Kw/Ma silJGetrellmmar.
23. Site diagram or ntldiNnunl we}} deisf{s:
You may IAA Fite book of this page to prat adtlifionat well site details or Deli
coraieu=(ion details. Yet may Faso aooc h additional pages if accessory.
S]1BN ITTALfNSSU1 PIONS
24a. liar A!d Wells: Submit this torn within 30 dugs of eomph:F on of well
conanuttian to lbc folhsvriug
Divimtou of Water Resources, i rfarmaiion Avecsaiug Uutt,
1617 MO Service Confer, ftaleigh, NC Z7499.3617
2411. Y4r• Inteotipq Wells ONLY: ]rt addition to sending Ilrn town the the address in
24a above, also submit a copy of this form within 30 days of taompfeliela of erg
emhsetuction 14 tht foliow9a13:
Division of Wafer Resources, Underground IA cello's Coning Program,
I636 Mail Service Crater, Raieigfy NC 27699-1636
24c. Yor WaterSupj4y & trilectinp Weak
Also submit tone copy of this fortis within 36 days of completion of
well non:noelion ire tier toady keen department of the wanly s hero
construe'rd.
Pwm1 GW-1
Naxh Care] ism D Omani orEnvirknrnent id Natural Rueatxes- DiMision e7Wbn•lresourms Rm•istd August 3a1

400
A'
Wells
11 Casing
Z Screen
Strahgraphy
• 5iWClay
• Unmated Rack
• Mudstonel8aprollle/WeatherOd Rack
Bedrock
h4TEE ISQCONENTRAT 1 < g/L>
GCL = 2L000 .tgiL
2L = 1 I►g/L
FIGURE 2t INJECTION ZONE CROSS
SECTION WITH MTBE ISC-
CRNCENTRATIONS
Jack's Best Buy
315 Central Avenue
Butner. Granville C url+sy. NC
LEAF ENVIRONMENTAL
& ENGINEERING, P.C.
PR❑JECT NO. 212712
DATE! March, 2017
DRAWN BY! SRC
APPROVED BY1 WZB
FILE! Harrlss - Butner
SCALE! Not to Scale

r4,
t J
E nom my
priti
INJECTION POINTS: VP-1, 2, &3 AND UST PIT
DIRECTION OF GROUNDWATER FLOW
ESTIMATED RATE OF GROUNDWATER FLOW
= 0,023 FT/DAY
•
n-a
It DAM
�rF?i°ir7� �y c
a
1
3
FIGURE 3: GROUNDWATER POTENTIOMETRIC
SURFACE MAP
Jack's Best Buy
315 Central Ave
Butner, Granville County, North Carolina
LEAF ENVIRONMENTAL
& ENGINEERING, P.C.
PROJECT NO.: 212712
DATE: March, 2017
DRAWN BY: SRG
APPROVED BY: JHG
FILE: Harriss — Butner
SCALE: AS SHOWN

Mee.) W-2
Mat
INJECTION POINTS: VP-1, 2, &3 AND UST PIT
MTBE ISOCONCENTRATIONS (pg/L)
GCL = 20,000 yfg/L
2L = 1 yag/l.
Ind
,.+,
IK�arr'
or lop
FIGURE 1: MTBE 1SOCONCENTRATION MAP
Jack's Best Buy
315 Central Ave
Butner, Granville County, North Carolina
LEAF ENVIRONMENTAL
& ENGINEERING, P.C.
PROJECT NO.: 212712
DATE: March, 2017
DRAWN BY: SRG
APPROVED BY: JHG
FILE: Harriss — Butner
SCALE: AS SHOWN