WI0501083_Permit (Issuance)_20210825

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 11 , 20 21
PERMIT NO. W I0501083
(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:
A.
B.
Permit No. WI Issued Date:
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) Small -Scale Injection Operation Complete sections B through M
(5) X Pilot Test Complete sections B through M
(6) Tracer Injection Well Complete sections B through M
(7) In -Situ Thermal (IST) Well Complete sections B through M
STATUS OF WELL OWNER: Choose an item.
Deemed Permitted GW Remediation NOI Rev. 2-17-2020
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): Speedway LLC - John Helms Manager of Environmental Remediation
Mailing Address: 500 Speedway Drive
City: Enon state: OH Zip Code: 45323 County: Clark
Day Tele No.: 937-863-3000 Cell No.:
EMAIL Address: [e-mail] Fax No.: 419-420-1495
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Same as well owner
Company Name
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: Jim Young - Senior Project Manager
Company Name Mid -Atlantic Associates, Inc.
Mailing Address: 409 Rogers View Ct
City: Raleigh State: NC Zip Code: 27610 County: Wake
Day Tele No.: 919-250-9918 Ce11 No.: 919-809-4577
EMAIL Address:[e-mail] Fax No.: 919-250-9950
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Speedway 6989
10920 Creedmoor Rd
City: Raleigh county: Wake Zip Code: 27615
(2) Geographic Coordinates: Latitude**: 0 " or 35 0. 94209
Longitude**: 0 " or 78.68555
Reference Datum: Accuracy:
Method of Collection: Google Maps
**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: 30,000 square feet
Land surface area of inj. well network: 50 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 5% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 2

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
(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.
I. 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:
We propose to inject a 500-gallon liquid solution with a concentration between 1,000 - 5,000 mg/L magnesium sulfate (Epsom salt)
into well MW-12D, a deep well screened in a rock formation at 67-72 ft bls, which exhibited a concentration of 6,820 ug/L benzene
on December 10, 2020. Interpretation of sulfate -reducing bacteria analysis suggests that bacterial growth within well MW-12D,
along with the water quality data obtained from this well, will support enhanced natural attenuation. Therefore a pilot test
is proposed for a low-cost way of testing the chemistry of sodium sulfate with the existing bacterial colonies within this well.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed 1 Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 67-72 ft below ground surface
(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 of Public 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. If no injectants are to be used use N/A.
Injectant: Magnesium sulfate (epsom salt) Total Amt. to be injected (gal)/event: 500
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 3

Injectant: Total Amt. to be injected (gal)/event:
Total Amt to be injected (gal/event):
500
No. of separate injection events: 1 Total Amt to be injected (gal): 500
Source of Water (if applicable): City water system (Wake County)
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.
In 3 month intervals, spanning a total of 6 months after the single injection event, we plan on sampling well MW-12D
using the low -flow methodology, obtaining field parameters (DO, pH, conductivity, temperature, and ORP)
and collection of samples for monitored natural attenuation including alkalinity, sulfate, ferrous iron, nitrite, nitrate, and
total organic carbon. A sulfate -reducing bacteria test will also be conducted on a sample collected from MW-12D.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby certifii, 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 submit. 'n_ false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
in 4 I4.nd al re ateappurtenances in accordance with the I5A NCAC 02C 0200 Rules."
John M. Helms, Manager of Environmental Remediation
Sign ture of Applicant Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C .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.
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 OW Remediation NOI Rev. 2-17-2020 Page 4

LEGEND
S MW-10
• MW-10D
(ND)
(NS)
74.8
J
1,1000
goo
BP
GASOLINE
AND
CONVENIENCE
STORE
GRASS
CVS
PARMACY
• MW-4
MW-14D (ug/L)
B
0.104 J
T
0.508 J
E
ND
X
0.450 J
N
ND
MTBE
ND
MW-14D
• MW-11
MW-3 •
MW-8 e
GRASS
SHALLOW MONITORING WELL LOCATION
DEEP MONITORING WELL LOCATION
WATER SUPPLY WELL (INACTIVE)
NOT DETECTED AT OR ABOVE LABORATORY METHOD DETECTION LIMITS
NOT SAMPLED
VALUE ABOVE NORTH CAROLINA GROUNDWATER QUALITY STANDARDS (NCGQS)
ESTIMATED CONCENTRATION
PROPERTY BOUNDARY
GRASS
MW-5 •
• MW-2
KEROSENE 0
D/ESEz 0
PREMIUM 0
REGULAR O
REGULAR
MW-1
GAS
GAS
MW-9 e
MW-10D
•
MW 7.. MW-7D
/
/KEROSENE /
/ CANOPY/
STORE
WOODED
(UNDEVELOPED)
GRASS
GAS
DIESEL
DIESE
GAS
ECI
MW-12D
ATM
SLOPE
SLOPE
MW-6
GRASS
SLOPE.
DUMPSTERS
MW-10D (ug/L)
0
0
En
En
En
74.2
ND
ND
2.30 J
1.05 J
51.6
MW-7D (ug/L)
B
369
T
3.75 J
E
X
N
MTBE
85.2
620
74.8
8.92 J
MW-13D la
(NS)
WOODED
AREA
WOODED
AREA
FIRE
DEPARTMENT
STATION
i
PROPERTY
BOUNDARY
1
WOODED
(UNDEVELOPED)
DATA LEGEND
CONTAMINANT
MW-7D (ug/L)
� CONCENTRATION
B=BENZENE
ti B
369
T=TOLUENE
T
3.75 J
E=ETHYLBENZENE
E
85.2
X=TOTAL XYLENES
X
620
N=NAPHTHALENE
N
74.8
MTBE=METHYL TERT-BUYTL-ETHER
MTBE
8.92 J
0
50'
SCALE: 1 "= 50'
JANUARY 2021
w
0
000R2709.25
CAD # 01 -270903-25
c
O
Z
0
W
z
0m
0
w
0
z
a..
0co
0
w
0
0
Qm
O
N
Z
0 0
Q
Ct
I- w
w CO
O uJ
Z 0
w 0
0 0
<
Z
J
ix 0
c0 O
O
< 0
0 w O
LU Z
w O
o _
(n 0 0
CV
O
O <

GRASS
ROO
NORWoop
BP
GASOLINE
AND
CONVENIENCE
STORE
LEGEND
• MW-10 SHALLOW MONITORING WELL LOCATIO
• MW-10D DEEP MONITORING WELL LOCATION
WATER SUPPLY WELL (INACTIVE)
(77.10') WATER TABLE ELEVATION AT LOCATION (FEET)
77.0 ESTIMATED WATER TABLE CONTOUR (FEET)
GROUNDWATER FLOW DIRECTION
— — — — PROPERTY BOUNDARY
CVS
PARMACY
1 MW-4
MW-14D
(76.26')
e MW-11
MW-3 e
1 MW-8 e
GRASS
REGUAR 0
Gb
MW-1
GAS
0
GAS
MW-9 e
MW-5 e
MW-2
MW-7 wa® MW-7D
(77.10')
/ KEROSENF
/ CANOPY/
STORE
WOODED
(UNDEVELOPED)
GRASS
GAS
DIESEL
GRASS
\:
MW-10D
(58.12')
DIESE
GAS
•
•
e MW-10
0 0 \
00 \
0
�o Off• 0
N•
O \
MW-12D
(76.22')/ BMW-12
ATM
SLOPE
SLOPE
MW-6
GRASS
SLOPE
DUMPSTERS
MW-13D
(NM)
WOODED
AREA
WOODED
AREA
FIRE
DEPARTMENT
STATION
NOTE: DUE TO DIFFERING SCREEN INTERVALS, MW-13D AND MW-14D WERE
NOT USED IN GENERATION OF THE ESTIMATED WATER TABLE CONTOURS
PROPERTY
BOUNDARY
WOODED
(UNDEVELOPED)
0
50'
SCALE: 1 "= 50'
JANUARY 2021
W
0
000R2709.25
O
Z
O
CAD # 01-270902-25
z
0 CO
U
W
0
0
ft
ct
0 0
0
w
0
d>-
Qm
ESTIMATED GROUNDWATER
w
u_ Q
5 0
Q Z
O 0 O
< N O_ 0
ct
O
O N 0
I < 0
0_ 0i:t LLI O
Z
W O
Li] 0_ _
O(/)00
UJ N
O 0 0) _1 0 <
0'
0
O
REFERENCE: EARTH SYSTEMS DRAWING DATED 8/2015

TABLE 3.1
WELL CONSTRUCTION DETAILS
SPEEDWAY 6989
RALEIGH, NORTH CAROLINA
MID -ATLANTIC ASSOCIATES, INC. JOB NO: R2709.25
WELL ID
DATE OF
INSTALLATION
TOTAL WELL
DEPTH (ft)
SCREEN INTERVAL
(ft)
MW-1
2/20/2008
32
17
- 32
MW-2
2/20/2008
32
17
- 32
MW-3
11/24/2008
34
19
- 34
MW-4
11/24/2008
34
19
- 34
MW-5
11/24/2008
34
14
- 34
MW-6
11/24/2008
34
19
- 34
MW-7
3/30/2009
32
17
- 32
MW-7D
3/30/2009
70
65
- 70
MW-8
3/30/2009
32
17
- 32
MW-9
3/30/2009
32
17
- 32
MW-10
2/21/2011
30
10
- 30
MW-10D
2/22/2011
70
65
- 70
MW-11
2/21/2011
35
15
- 35
MW-12
5/21/2015
34
19
- 34
MW-12D
5/23/2015
72
67
- 72
MW-13D
10/12/2016
50
45
- 50
MW-14D
10/12/2016
81
76
- 81
Notes:
ft= feet
Screen intervals and well depths reported in feet below land surface (BLS)

Florida Department of Environmental Protection - Division of Waste Management - Bureau of Petroleum Storage Systems
WELL CONSTRUCTION AND DEVELOPMENT LOG
WELL CONSTRUCTION DATA
Well Number:
VN.".W —\26
Site
S
Name:
�y sA-6U9
er:
KJ
Well Install Date(s):
S-1.1-5-13-15
t.-- W
Well Location and Type (check appropriate boxes):
POn-Site r Right -of -Way
r Off -Site Private Property
r Above Grade (AG) r Flush -to -Grade
If AG, list feet of riser above land surface:
Well Purpose: r- Perched Monitoring
r Shallow (Water -Table) Monitoring
r TUermediate or Deep Monitoring
r Remediation or Other (describe)
Well Install Method:
/�
T`
Surface Casing"Install Method:
Try, VI,
Borehole Depth
(feet): —1'L
Well Depth
(feet): —1 Z
Borehole Diameter
(inches): t Z
Manhole Diameter
(inches): 1 Z
Well Pad Size:
Z feet by - feet
Riser Diameter and Material:
-Z "
SC,t}'[' i�
Riser/Screen
Connections:
[ lush
r Other
-Threaded
(describe)
Riser Length: (fly feet
let to L`1 feet
from i.D.
Screen Diameter and Material:
Z" S CW +b
Screen Slot Size:
0 , d % IA
Screen Length: '.�i feet
from t.Qi feet to 11. feet
l s` Surface Casing Material:
ialso check: r Permanent r Temporary
1st Surface Casing I.D. (inches):
4
1st Surface Casing Length:
from 0 feet
4 3 feet
to 4 3 feet
2nd Surface Casing Material:
also check: r Permanent r Temporary
2nd Surface Casing I.D. (inches):
2nd Surface Casing Length:
from 0 feet
feet
to feet
3rd Surface Casing Material:
also check: r Permanent r Temporary
3rd Surface Casing I.D. (inches):
31-d Surface Casing Length:
from 0 feet
feet
to feet
Filter Pack Material and Size:
47"0' 3 V 54vI fl
Prepacked Filter Around
r Yes
Screen (check one):
rti..44o
Filter Pack Length:
from (p S feet
—1 feet
to —12- feet
Filter Pack Seal Material and
Size: !! �.N V\ vre � a7
Filter Pack Seal Length:
from Lft 0 feet
feet
to (g C feet
Surface Seal Material:
C-,EW1,EVtT UT
Surface Seal Length:
from 0 feet
Liafl feet
to LD O feet
WELL DEVELOPMENT DATA
Well Development Date:
Well Development Method (check one): 7 Surge/Pump r Pump I— Compressed Air
r Other (describe)
Development Pump Type (check): r Centrifugal r Peristaltic
r Submersible r Other (describe)
Depth to Groundwater (before developing in feet):
Pumping Rate (gallons per minute):
Maximum Drawdown of Groundwater During
Development (feet):
Well Purged Dry (check one):
r Yes r No
Pumping Condition (check one):
r Continuous r Intermittent
Total Development Water
Removed (gallons):
Development Duration
(minutes):
Development Water Drummed
(check one): r Yes r No
Water Appearance (color and odor) At Start of Development:
Water Appearance (color and odor) At End of Development:
WELL CONSTRUCTION OR DEVELOPMENT REMARKS

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Speedway LLC
Auditor: vti �� pti r-
Project Leader: :ty s
Contractor:
> -Vve f./�..L tr0A c-41
Contract Supervisor:
AFE #:
Speedway LLC
Soil Boring / Well Installation Field Audit
Date: ,j a - I -S
Location: /oqa 1. Ct9�
Project Summary:
e.e5 w4,1, C39,
The following Soil Boring / Well Installation Field Audit is to be utilized to conduct announced or unannounced audits during daily checks and
project work reviews. Upon completion of the form, the auditor should use the checklist below to complete the entire audit process:
Auditor has reviewed Soil Boring / Well Installation Field Audit findings with contractor supervisor.
❑ Provide a copy of the audit to the contractor supervisor.
❑ Retain copy of audit for project file.
❑ Insert into the Safe Acts Database.
SAFE: CONTRACTOR IN COMPLIANCE
AT -RISK: CONTRACTOR NOT IN COMPLIANCE.
N/A: ACTIVITIES THAT DO NOT APPLY
DESCRIBE AT -RISK ITEMS IN COMMENTS SECTION
HIGH RISK TASKS
PERFORM THIS SECTION FOR EVERY AUDIT.
No.
H.01
H.02
H.03
H.04
H.05
H.06
Safe At -risk N/A
HEALTH AND SAFETY PLAN
UTILITY LOCATE (PUBLIC)
UTILITY LOCATE (PRIVATE)
OVERHEAD UTILITIES
HAND CLEAR 5 FT
BARRICADES / CAUTION TAPE
No.
H.07
H.08
H.09
H.10
H.11
H.12
Safe At -risk N/A
PPE
LEL METERS / VAPOR MONITORING
SLIP / TRIP / FALL
DRUM HANDLING
HEAVY EQUIPMENT OPERATION
DECONTAMINATION
GENERAL SITE SAFETY
PERFORM THIS SECTION FOR EVERY FIELD AUDIT.
CORE ITEMS - FOUND ON MOST
No.
C.01
C.02
C.03
C.04
C.05
C.06
C.07
C.08
C.09
C.10
C.11
PROJECTS
Safe At -risk N/A
No.
FIRE PREVENTION / PROTECTION C.12
SUPORT TRUCK ACCESS / LOCATION C.13
EYE WASH STATION C.14
HAZARD COMMUNICATION C.15
MATERIAL / TOOLS / EQUIPMENT STORAGE C.16
SITE HOUSEKEEPING C.17
RIG KILL SWITCH C.18
CABLES C.19
HYDRAULICS C. 20
CAT - HEAD ROPE C. 21
WINCH C. 22
Safe At -risk N/A
BACK-UP SIGNAL
LIGHTING
CRIBBING
MAST POSITION DURING MOB
HAND AND POWER TOOLS (GUARDS / SHIELDS)
PUMPS
HOSES
NON -HAZARDOUS WASTE
FLUID MANAGEMENT
MATERIALS MANAGEMENT
HEAT / COLD STRESS
's
,/
✓
J
✓
V
V
✓!
✓
✓
V.
✓
✓
✓
V.
i/
✓
'U
✓
✓
✓
✓
AUDIT ALL THAT APPLY
UNIQUE PROJECTS - PROJECTS
No.
U.01
U.02
U.03
U.04
U.05
WITH SPECIAL CONSIDERATIONS
Safe At -risk N/A
No.
CHEMICAL MXING (ORC, BOSS, ETC) U.06
CHEMICAL INJECTION U.07
U.08
U.09
U.10
Safe At -risk N/A
/
3�
✓
PROVIDE POSITIVE REINFORCEMENT FOR AREAS OF COMPLIANCE AND SAFE WORK PERFORMANCE