WI0400574_Permit (Issuance)_20210819

NC Department of Environmental Quality — Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOI) 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 (NOTE: This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells is 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.
5) In -Situ Thermal Wells (IST) — Used to `heat' contaminated groundwater to enhance remediation
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: August 4, , 2021 PERMIT NO. W 10400574
(to be filled in by DWR)
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
Permit No. WI
Issued Date:
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well Complete sections B through F, J, M
(2) Aquifer Test Well .Complete sections B through F, J, M
(3) Passive Injection System ..Complete sections B through F, H-M
(4) x Small -Scale Injection Operation Complete sections B through M
(5) Pilot Test Complete sections B through M
(6) In -Situ Thermal (IST) Well Complete all sections except K
B. STATUS OF WELL OWNER: Business/Organization
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 1

C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): Tyson Foods Inc., Kevin Ig1i, Senior Vice President and Chief Environmental Officer
Mailing Address: 2790 S Thompson, Suite 201
City: Springdale State: AR Zip Code: 72764 County:
Day Tele No.: 479-290-4055 Ce11 No.:
EMAIL Address: [e-mail] Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title:
LI Building LLC
449 Trollingwood Road
Haw River, North Carolina 27258
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Ce11 No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: JC Weaver
Company Name Terracon
Mailing Address: 2701 Westport Rd
City: Charlotte State: NC Zip Code: 28208 County: Mecklenburg
Day Tele No.: 7043452230 Cell No.:
EMAIL Address: [e-mail] Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: 449 Trollingwood Rd
City: Haw River County: Aamance Zip Code:27528
(2) Geographic Coordinates: Latitude**: 36 ° 05 ' 00.4 " or
Longitude**: 79 ° 20 ' 59.4 " or
Reference Datum: Accuracy:
°
°
Method of Collection: Google
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: N/A square feet
Land surface area of inj. well network: 500 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: N/A (must be < 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS — Attach the following to the notification.
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 2

(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
4.25-inch hollow stem augers to be advanced to an estimated depth of 50 feet, or 20 feet below the water
table. RemRxTM CRP Persulfate will be emplaced from a depth range of 30 to 50 feet below grade, or the
depth interval corresponding to 20 feet below the water table. Once the auger is advanced to depth, the
auger would be pulled up where RemRxTM CRP Persulfate can be fed within the augers, filling the borehole
within the treatment interval. Eight soil borings will be advanced within the treatment area.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: 8 Proposed 0 Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 50 feet
(3) For Proposed wells or Existing wells not having GW-ls, 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 (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
K. INJECTION SUMMARY
NOTE: Only injectants approved by the epidemiology section of the NC Division ofPublic Health, Department
of_ Health and Human Services can be injected. Approved injectants can be found online at
http://deq.nc. gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-injectants. All other substances must be reviewed by the DHHSprior to use.
Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it may take 3 months or longer.
Injectant: RemRx CRP
Total Amt. to be injected (gal)/event: 3,300 lb
Injectant: Iron EDTA Total Amt. to be injected (gal)/event: 165 lbs
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Amt. Water to be injected (gal/event): 0
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 3

Total Amt. to be injected (gal/event): 3,465 lbs
No. of separate injection events:1 Est. Total Amt. to be injected (gal): 3,465 lbs
Source of Water (if applicable): N/A
L. 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.
Terracon Consultants proposes to monitor groundwater quality parameters at site monitoring well MW-01R for
a period of 1 year post iniection. Monitoring will be conducted on a quarterly basis. Groundwater parameters to
be monitored include conductivity. pH. oxidation/reduction potential, and dissolved oxygen. In addition to
groundwater quality parameters. groundwater may be collected for analysis of persulfate. sulfate. and volatile
organic compounds.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: `1 hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. 1 agree to construct, operate, maintain, repair, and if applicable, abandon the
in'ection well and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
JC Weaver/Project Scientist
ture of Applicant Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant1
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(I SA NCAC 02C .0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
Please refer to attached agreement
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 4

Legend
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LEGEND _
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VERTICAL EXTENT Or 1,1—DCE IN GROUND WATER ABOVE 2L STANDARDS (A —A')
SARAMAR, LLC (FORMERLY LAWRENCE INDUSTRIES)
HAW RIVER, NORTH CAf#OLINA
Durk
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DOM:
DATE:
03/13/01 02/0IS/04
PREFACT1M,
E098-007
FOX E 14
9