WI0400523_Staff Report_20220920

Permit No. WI0400523
Date: 09/20/2022
To: Michael Rogers
Central Office Reviewer: Michael Rogers
County: Forsyth
Permittee/Applicant: Cintas Coporation
Facility Name: Former Salem Uniform Site
L GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ❑ Renewal
❑ Minor Modification ® Major Modification
a. Date of Inspection: 9/12/2022
b. Person contacted and contact information: Beth Donovan, PG; Phone: [phone]
[e-mail]
c. Site visit conducted by: Jim Gonsiewski.
d. Inspection Report Printed from BIMS attached: ® Yes ❑ No.
e. Physical Address of Site including zip code: 4015 N. Cherry Street Winston-Salem NC 27015
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 36°8'27.21"N Longitude:80°15'48.49"W
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.): Google Earth
IL DESCRIPTION OF INJECTION WELL(S) AND FACILITY
1. Type of injection system:
n Geothermal Heating/Cooling Water Return
® In situ Groundwater Remediation
n Non -Discharge Groundwater Remediation
❑ Other (Specify:
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? n Yes ❑ No.
Provide well construction information from well tag:
b. Does existing or proposed system use same well for water source and injection? n Yes ❑ No
If No, please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ® Yes ❑ No
What is/are the pollution source(s)? _On -Site Operations
What is the distance of the injection well(s) from the pollution source(s) 250 to 600 feet
4. What is the minimum distance of proposed injection wells from the property boundary? 30 ft
5. Quality of drainage at site: n Good ® Adequate ❑ Poor
6. Flooding potential of site: n Low ® Moderate ❑ High

7. For Groundwater Injection Remediation Systems only, is the proposed and/or existing groundwater monitoring
program (number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ® Yes n No.
If No, attach map of existing monitoring well network if applicable and recommend any changes to the
groundwater -monitoring program.
8. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ® Yes n No. If No, or no map, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9. For Non -Discharge Groundwater Remediation systems only (i.e., permits with WQ prefix):
a. Are the treatment facilities adequate for the type of waste and disposal system? n Yes n No n N/A.
If No, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? n Yes n No n N/A. If no, please explain:
III. EVALUATION AND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If Yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
Reason
2(G) Lithostratigraphic and hydrostratigraphic
logs of any existing test and injection wells.
These logs were not provided.
3(C) Provide a description of the rationale for
selecting the injectants and concentrations
Provide more detail on how the proposed
volumes and concentrations were determined.
3(F) Evaluation of the potential byproducts of
the injection process
Provide more information of the potential
byproducts, projected concentrations of the
byproducts, and the areas of byproduct migration
as determined by modelling or other predictive
calculations.
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition
Reason
4. Recommendation

n Deny. If Deny, please state reasons:
n Hold pending receipt and review of additional information by Regional Office
Z Issue upon receipt of needed additional information
n Issue
(��D)ocuSigned by:
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5. Signature of Report Preparer(s): E197B66F179D45F...
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Signature of WQROS Regional Supervisor:
9/20/2022
Date:
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional /If Needed)

View looking south of the proposed injection area. The former contamination source is located near the
center of the photograph. The previously installed injection wells are visible at the tree line near the
center of the photograph.

View looking west of the former location of the SVE unit on the north side of the site.