WI0501086_Permit (Issuance)_20211130 (2)

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: 10/11 , 20_21
PERMIT NO. (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) X Small -Scale Injection Operation Complete sections B through M
(5) 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: Business/Organization
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): James A Buffaloe
Mailing Address: 3901 Summer Brook Dr
City: Apex State: NC Zip Code: 27603 County: Wake
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title:
Company Name
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Ryan Kerins, Project Manager
Company Name Terraquest Environmental Consultants, P.C.
Mailing Address: 100 E Ruffin St
City: Mebane State: _NC Zip Code: 276302 County: Alamance
Day Tele No.: 919-563-9091 Cell No.:
EMAIL Address: [e-mail]
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: McCullers Community Store
Fax No.: 919-563-9095
(2) City: Raleigh State: NC Zip Code: 27603_County: Wake
(3) Geographic Coordinates: Latitude**: " or 35°. 6654
Longitude**: " or -78_°. 6695
Reference Datum: North American Datum of 1927 Accuracy: 1/2 of a
contour interval from actual elevation, and/or more than 1/40 of an inch (0.6 mm) horizontally from actual position
Method of Collection: USGS topo quad
**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: 1,050 square feet
Land surface area of inj. well network: 1,105 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 100 (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.
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:
Petroleum was released from an underground storage tank system and has impacted groundwater. The
site is regulated by the NCDWM-UST who sets the sampling schedule. Dissolved -phase contamination has
been reduced below the GCL's, but highly weathered free product remains. Steam will be applied to the smear
zone to liberate product that will be recovered by the SVE pump and treat systems already in place. Follow up
gauging will determine if product has been fully recovered.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: 5 Proposed Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 25-29
(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: Steam Total Amt. to be injected (gal)/event: 5,000
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:
Injectant: Total Amt. to be injected (gal)/event:
Total Amt. to be injected (gal/event):
No. of separate injection events:1-3 Total Amt. to be injected (gal): 5,000-15,000
Source of Water (if applicable): municipal water system
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.
The site is monitored as regulated by the NCDWM-UST.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby cert f, 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. 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."
Signature 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 GW Remediation NOI Rev. 2-17-2020
Page 4

}K
--
P�
e
�1�
,
,,yyf �
i5•
czD, d` :
j•��il
a0o
- — A
;
Ii -f�
1-
!
s
i\`'..`
^
.
ri
- ,�-•rr:�
; .•
t .:
+� �.
f��rF= -1
E1riJ
B �e.1
41, i
•'��
y
. '
/
/J
r , *'+ J
_ ....
`tip
J
.
:n`L
y
J
„......
/�
) `�
\
III
m
f
_ ;
yj
�
•
,,1
L
j4
d
�88-=-
it
l I
(lf%
4jury
�f.11
i
y _
( ..,„
' fi
aar•
1
ICI,
, a e
)
t 4'
Z
�V
, &
LJ
�
Fes ,
'tip
-
,
j
—4T
r`
v6
, ,i,
�
k
.
•
nr
, ,.
wit
„..
_
MAP SOURCE:
USGS
7.5
MINUTE TOPOGRAPHIC MAP OF LAKE WHEELER,
GRAPHIC SCALE
NC
0'
2,000' 4,000'
- i=)
C�_
ENVIRONMENTAL CONSULTANTS, P.C.
ue
SITE LOCATION MAP
MCCULLERS COMMUNITY STORE
7930 FAYETTEVILLE ROAD
RALEIGH, WAKE COUNTY, NC
JAMES A. BUFFALOE
RALEIGH, NC
a ma
al
PROJECT NO. 00609
DRAWN BY: JRG
DATE:
6/18/21
SCALE: 1" = 2000'
CHECKED BY: MJB
FIGURE N0.
1

LEGEND
ACTIVE, SOLE -SOURCE WATER SUPPLY WELL
ABANDONED WATER SUPPLY WELL
3790 - LAST 4 DIGITS OF WAKE CO. PIN #.
SEE TABLE 2 OF LSA REPORT FOR PROPERTY OWNERS.
GRAPHIC SCALE
0' 200' 400'
1" = 400'
800'
TERRAciP.C.uest
ENVIRON▪ M▪ E▪ NTAL CONSULTANTS,
SITE VICINITY MAP
MCCULLERS COMMUNITY STORE
7930 FAYETTEVILLE ROAD
RALEIGH, WAKE COUNTY, NORTH CAROLINA
JAMES A. BUFFALOE
RALEIGH. NC
PROJECT NO. 00609
DRAWN BY: JRG
DATE: 6/18/2
SCALE: 1" = 400'
CHECKED BY: MJB
FIGURE NO. 2

•MW25
RITE AID
DRUG STORE
W24
LEGE\
D
• TYPE II GROUNDWATER MONITORING WELL
TYPE III GROUNDWATER MONITORING WELL
OO DRINKING WATER SUPPLY WELL
A GROUNDWATER RECOVERY WELL
wells with vacuum noted in yellow
• SOIL VAPOR EXTRACTION WELL
UST LEGEND
Ti 4,000—GALLON GASOLINE
T2 8,000—GALLON GASOLINE
T3 8,000—GALLON GASOLINE
T4 4,000—GALLON DIESEL
GRAPHIC SCALE
0'
40'
80'
= 80'
160'
V)
FIGURE NO.
0
0
m
z
0
0
w
0
m

N V V
= Steam Injection Point (5)
hnc
51
Reg •ass
{1. 1
' - 10
!a-100
:00 - ZOO
00-399
• L VOST Lk.
Coordinate Sys
NAD83 Nara'
Carolina State
(CORS96) US!
IC(

FORMER A
DISPENSERS
100.00' MW12
MW7 ASPHA MW6 B21
90.00'
80.00'
60.00'
ESTIMATED EXTENT OF
STG MSCC VIOLATION
HISTORICAL EXTENT OF
FREE PRODUCT
TEN —TEN ROAD MW20
ASPHALT
�/ l // 1, / 111 //
50.00'/� i� � � � 'll1 � �� � �i ' ll/� /� i: /� / /� % / / // / /% / / / //iii��//////////���������������,,,,,,,,,,,
l I l / l I l/ l 1/ I I/ / l I
/ / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
I l / / l / l / / l / l / 1, / / l / l / 1/ / / I / 1 / 1 / l/ I / 1 / 1 / / l / 1 /
1/'ll / /•ll /i /• / l' / / / 1/l1/l 11 11/l // 11/ll/l /l 11/ll////l 11////l1/l // Il/11/
40.00 /, /l /l /l /l/ll/l /l 11/l /l /l,ll/ll/l,/l// /•,/1//1,l1/ll/l/ ,/ //l,,,/ //l/ ,/ // /,l/ // /1l
/ l l /l /l l l /l / l l 1 1 1 l l 1/ l 1 / l l l l l l l l l l
/ / / / / / / / / /1 / / / // / / / // // / / // / / / / / / / / / /
// // //// // // // / / // // / / // // / / / // / / / // / / / // / / / // / / / /
r / i 'l111/l1/1/1/llll1l11/1/lll11111/ll/llll111l/l1/1/111/1/llll111lllllll1111lllllllllllllllllllllllllll/1/
30.00//1/////�/��//////�//�//////////// /////// // // / / / /l / / / / / / / / / / / / / // / / /
l l l l l l l l l 11 11 l l 11 11 /1 / l 11 11 1/ll 11 '/ 11 / 11 /l l /l// /l /l
l /l / //l//l//1/i//%/_lll /////i//l//1/l /%//1//lll //l///1//lll /%///1/l//ll//////lll/l /1//l//l/ll/1 /l 11/l1/1 /l 11/1 /
l 1/ 1 /l 11 1 1 l 1 / F_1 / l l/ I / l 1 1 l I / 1 / / l / 1 / / / 1 / / / I / / 1 l l I , l 1 1 l, l 1. 1 1 1
Il /l / l l l / / l /l /l /1 ' l /1 ' l l /1 / l l /l / l 1 /1 I l 1 /1 /l / / l /l
l I l 1/ l I I / l I l/ l 1 1 1 l 1 1 1 l l l/ l I l / I 1�•. i�, i � i•. i•, i �� l I
20.00'111i1/i 1i1111i11i li // /// / /�/ll/l / / / /•//� / •// //i ./ l//�/•//l/ l,/�////// 11 /. ' 'lll
/ / / / / / / / / / / / /
//%//////%//i/i//%//// //////%//%//////,// /i//%// ///////%/////////l//,////l//l//l///////l//l'// //ll1/l//1�1'�1//1//l/
/ // // //// // // /// /// // // /////// // /1 /////// // ////////// // ////////// // /////// // // /////// // // 1 //
10.00i1I11/11//l�l/�l/l/ j111/l /1/,I,1l111 Illll/1/ll�l/�l� / jl//Illl/l1ll;/ /.j1/ll11,11/l//,// j1,1ll1111111;1/,l/ ll//11,111�1�111�111,11�11111;/
B
1 00.00'
60.00'
TEN —TEN
LIMITS OF
SOIL EXCAVATION SW5
MW2 1�.�'AW1 GRAVEL B7 B1
18 MW15
ESTIMATED EXTENT OF
HISTORICAL EXTENT OFSTG MSCC VIOLATION
1/l 11/l1/l/1/lj11j11/1lll 1j11• /11/llll/llllllll/'/,// 1/1 /1/lllll111/llll 11/1 //1 // /l // //
1 /l /I// 11 /1 /1/l1/l l /1//l/ll/l /l /lll,l/l /l/l�/l�/loll//ll/11,/1/l/ll1,/1/l1/1 /1/11/l l
11/l1/l /l 11/l1/1 /l 11/l1/1 /l 11/1llll 11 11/1/l 11/1/11/lll/llllll
l l /1 /1 / l /l /l / I /l /l l /l /1 /'.i•,I i• i i ,1 1/ /1 / 11 /1 / l /I 1, / l /l /
////////1,/1�////��/�/l�1/�1/l1 / / / 11/l//l11/1l l//l/l// 11
/ /� 1� /� l 11 1/// //// l� / / I / //// l� / /� 1 l� / //1 //1//, l� / /� 1 //1/ /I 11 /• / /1 / /1///l // /1 l/ /1 1 /1/� l/ / 11
11 /1 11 l l/1l lllll � llll l!ll l / l ,/ 1, l i /l / l 11 / ll/ 1l 1I• 1 / / 1l l �ll /I / l 1l / / l /Il � / / / Ill • l / �111/ 111 l it t 1 111,
GRAPHIC SCALE
0' 20' 40'
HORIZONTAL SCALE 1:40
VERTICAL SCALE 1:20
VERTICAL EXAGGERATION = 2X
NOTES
Elevations are referenced to an
arbitrary datum plane of 100.00'.
Detailed lithologies for each monitoring
well are included in Appendix B.
A detailed discussion of site geology is
included in Section 5.0 of the CSA
Report.
This drawing is a fence diagram. The
distances between wells/soil borings do
not correlate with a straight line
between the first and last wells/soil
borings of the cross section.
Note that width of the monitoring wells
is exaggerated to reflect the screened
interval.
LEGEND
WELL IDENTIFICATION
ESTIMATED EXTENT OF
STG MSCC VIOLATION
MW2 MW3
SOIL
BORING
LOCATION
SAMPLE
COLLECTION
INTERVAL
SURFACE
DESCRIPTORS
ASPHALT
TYPE II
ELL CASING
TYPE II
WELL SCREEN
LIMIT OF
EXCAVATION
SW4 SOIL SAMP
FREE PRODUCT
TYPE III
OUTER CASING
TYPE III
INNER CASING
TYPE III
WELL SCREEN
PHREAT1C AQUIFER
POTENTIOMETRIC
SURFACE
SOIL ANALYTICAL RESULTS BELOW S—T—G MSCCS
SOIL ANALYTICAL RESULTS ABOVE S—T—G MSCCS
MW12 +MW1
NOT TO SCALE
LITHOLOGY
//
Il/l1/1'
// � / /// //
LEAN CLAY (CL)
Medium stiff, yellowish —orange,
mostly lean clay with little
fine—grained sand.
SANDY LEAN CLAY (CL)/
CLAYEY SAND (SC)
Intermixed layers of sandy
clays and clayey sands of
various thicknesses;
Stiff/dense, yellowish orange,
some clay, some fine—grained
sand.
CLAYEY SAND (SC)
dense, yellowish orange,
mostly fine—grained sand, little
clay.
UST BASIN AND PRODUCT LINE
TRENCH FILL
UST basin fill mostly sand and pea
gravel. Product line trench fill is
sand and crush and run gravel.
SOIL CONTAMINATION
Estimated extent of soil to
groundwater maximum soil
contaminant concentration
violation.
CEDAR GROVE, NC
SECTIONS
(%)
U)
0
U
GEOLOGIC
FIGURE NO.
co
u7
w
0
D_
CHECKED BY:
0
D_
co
rn
O
co
O
0
PROJECT NO:
AS SHOWN
1

LIF-04
not
isltice
M(,C
Commontore
Raleigfj, NC
�gUest
Prared:
Coordi SrasLesn:
Q TYPE II GROUNDWATER MONITORING WELL
TYPE HI GROUNDWATER MONITORING WELL
A GROUNDWATER RECOVERY WELL
UST LEGEND
T1 4,000—GALLON GASOLINE
T2 8,000—GALLON GASOLINE
T3 8,000—GALLON GASOLINE
T4 4,000—GALLON DIESEL
GRAPHIC SCALE
0' 5' 10' 20'
1" = 10'
(!)
J
w
lr)
LLJ O Q z
0O>
cL
>-
zoo
JJ
�ww
or,
�w<
r�
0<
w
J O 0
Jr w
a-)J
<
0
0

W8:
W6 ,MW7
W19 ▪ -- W7
W3 R.4W6
--- 0 �M��� 12
2/2019 ��/ �0
ESTIMATED EXTENT.
OF FREE PRODUCT MW4
�':=�
2.. ,�
m J.
•MW25
RITE AID
DRUG STORE
W24
LEGE\
D
• TYPE II GROUNDWATER MONITORING WELL
TYPE III GROUNDWATER MONITORING WELL
OO DRINKING WATER SUPPLY WELL
A GROUNDWATER RECOVERY WELL
wells with vacuum noted in yellow
• SOIL VAPOR EXTRACTION WELL
UST LEGEND
Ti 4,000—GALLON GASOLINE
T2 8,000—GALLON GASOLINE
T3 8,000—GALLON GASOLINE
T4 4,000—GALLON DIESEL
GRAPHIC SCALE
0'
40'
80'
= 80'
160'
FIGURE NO.
20
0
m
z
co
0
O

lJ
LEGE\3
TYPE II GROUNDWATER MONITORING WELL
TYPE III GROUNDWATER MONITORING WELL
Groundwater elevations as measured on 4/25/19
are listed in feet.
The interpreted groundwater flow direction is
indicated by the arrows placed perpendicular
the contour lines.
Data from pumping wells was ignored in the
construction of this map.
W El I I D
M W1
MW3
MW4A
MWS
MWBB
MW9
NM10
MW12
NEW 13
MN14A
MWV15
M'W16
MW 17
MEW 18
MW 22
RW 1A
RW2
RW3_
RW4
RW6_
R'W4 s
RW8
RW9
RW 10
Grau ndwater
El eta ti on (ft )
394.51
394.33
394.35
394.39
3.94.53
394.73
394.48
394.83
393.27
393.96
394.34
394.12
394.61
394.98
394.7
394.08
385.22
393.99
392.91
394.38
394.6
394.04
394.45
394.24
394.25
GRAPHIC SCALE
0' 20' 40'
1" = 40'
80'
to
O)
LO
N
� w
00
o_ NO
c0
Z Jz
W
< 0 u J
w
UwJ
(./1u�
r
J ▪ ▪ 0
J �
0
POTENTIOMETRIC
0
z
0
w
J
JAMES A. BUFFALOE
cV
0 0
0
m
CHECKED BY:
rn
0
0
0
PROJECT NO
6
z
0
0
C
\
m
z
0
II
w
J
U
N

TYPICAL STEAM INJECTION POINT DETAIL
LAND SURFACE
GENERAL INFORMATION
Well Driller:
Terraquest Environmental Consultants, P.C. —
Jonathan R. Grubbs #3001
TEMPORARY BORING FOR INJECTION POINT
BOTTOM
TERRAcluest
ENVIRONMENTAL CONSULTANTS, P.C.