WI0400593_Notification of Intent (NOI) – GW Remediation_20230411

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 individualpermit when constructed in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to infection)
AQUIFER TEST WELLS (15A NCAC 02C .02201
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .02251 or TRACER WELLS (15A NCAC 02C .02291:
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: April 11, 2023 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:
Permit No.
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)
Tracer Injection Well ...................................
Complete sections B through M
(7)
In -Situ Thermal (IST) Well ...........................
Complete sections B through M
B. STATUS OF
WELL OWNER: State Government
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 1

C.
D.
E.
F.
G.
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): NCDEQ Division of Waste Management, UST Section, State Lead Program
Mailing Address: 1636 Mail Service Center
City: Raleigh State: NC Zip Code:27699 County: Wake
Day Tele No.: 919-707-8166
Cell No.:
EMAIL Address: Scott.Ryals(a_)NCDENR.gov Fax No.:
PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title:
Company Name
Mailing Address: 4774 US Hwy 601 N
City: Mocksville State: NC Zip Code: 27628 County: Davidson
Day Tele No.:
EMAIL Address:
Cell No.: 336-341-6324
Fax No.:
PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Al Ouarles. Senior Proiect Manager
Company Name ATC Associates of North Carolina, PC
Mailing Address: 7606 Whitehall Executive Center Drive, Suite 800
City: Charlotte State: NC Zip Code: 28273 County: Mecklenburg
Day Tele No.: 704-529-3200 Cell No.: 803-984-6764
EMAIL Address:William.Quarles(a)oneatlas.com Fax No.:
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: TF#44919, Crossroads Center-C
134 Arnold Road, Lexington, NC 27295
City: Lexington County: Davidson Zip Code: 28625
(2) Geographic Coordinates: Latitude": " or 35.867290'
Longitude": " or-80.250857'
Reference Datum: UST Basin Accuracy:
Method of Collection: Google Earth
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Land surface area of contaminant plume:—19,800 (2L.); —1,500 (GCL-Benzene) square feet
Land surface area of inj. well network: —4,245 (overlapping VEW-1 and MW-1) square feet (< 10,000 ft for
small-scale injections)
Percent of contaminant plume area to be treated: - 20% (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:
Release of gasoline from UST system. Intermediate Risk. goal to reduce benzene to below the 5.000 u2/L Gross
Contamination Level (recently 6,590 g/L in monitoring well MW-10). Ozone -enhanced air sparging in well
VEW-1 into the groundwater and in well MW-1 above the groundwater surface with some migration into
groundwater. To be conducted during the 96-hour Mobile -Multiphase Extraction Event (MMPE,) using wells
MW-1 and MW-10 as total fluid extraction wells. The injection will be performed at approximately 3 cfm for
for VEW-1 and 10 scfm for MW-1. Radius of influence anticipated to be 30 feet with the two overlapping zone
of influence. The five-day injection event is scheduled to begin the week of May 22, 2023.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: 2 Proposed 0 Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 10-25 feet NW-1) and 40-45 feet (VEW-1)
(3) For Proposed wells or Existing wells not having GW-Is, 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: Onlv iniectants anvroved by the enidemioloev section ofthe NC Division ofPublic Health. Devartment
of Health and Human Services can be injected. Approved iniectants can be found online at
http://deg.nc. gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-inj ectants. All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Projzram for more info i1you wish to approval for a different additive. However, please
note it may take 3 months or lonzer. If no iniectants are to be used use N/A.
Injectant: Ozone 060-700 mg/L vapor) Total Amt. to be injected (gal)/event:—75,000 cubic feet vapor
Total Amt. to be injected (gal)/event:—75,000 cubic feet vapor
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 3

No. of separate injection events: 1 Total Amt. to be injected (gal):—75,000 cubic feet vapor
Source of Water (if applicable): N
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.
ATC will sample selected monitoring wells, approximately two to three weeks after the Air Sparse event. The
water samples will be analyzed by SM 6200B. Dissolved oxygen in the injection wells (and wells MW-3 and
MW-10) will be measured prior to and following injection.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: I 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. 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. "
/�" 90 Al Quarles, Senior Proiect Manager
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.
See signed access agreement Cory Albright
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

Waste Management
ENVIRONMENTAL QUALITY
_' W
APR - g 2023
USr
March 20, 2023
Mr. Scott Ryals
Environmental Engineer
DWM UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
RE: State -Lead Acceptance
Crossroads Center-C
134 Arnold Road
Lexington, NC 27295
Incident Number 44919
Dear Mr. Ryals
ROY COOPER
Governor
ELIZABETH BISER
Secretary
MICHAEL SCOTT
Director
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and
hereby permit the Department of Environmental Quality (Department) or its contractor to enter upon said
property for the purpose of conducting an assessment and/or remediation of the groundwater and/or soils
under the authority of G.S. 143-215.94G.
I am/We are granting permission with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the Department or
its contractor in accordance with the acceptance of the site into the State -Lead Program. The
Department or its contractor shall protect and prevent damage to the surrounding lands. Any damages
will be restored by the Department or its contractor to as close to the pre -work condition as practicably
possible.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest
feasible route to the nearest public road. The Department or its contractor will notify, the landowners
48 hours prior to entry and may enter upon the land at reasonable times and have full right of access
during the period of the investigation.
4. Any claims which may arise against the Department, or its contractor shall be governed by Article 31
of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and
Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon request and
is a public record, in accordance with G.S. 132-1.
-:5>^NothJIng Compairesf_ .
State of North Carolina I Environmental Quality I Waste Management
1646 Mail Service Center 1 217 West Jones Street I Raleigh, NC 27699-1646
919 707 8200 T

6. The activities to be carried out by the Department or its contractor are for the primary benefit of the
Department and of the State of North Carolina. Any benefits accruing to the owner are incidental.
The Department or its contractor is not and shall not be construed to be an agent, employee, or
contractor of the landowner. No representations or warranties, either expressed or implied, have been
made to me/by the Department, the State of North Carolina, or its/their contractor(s) regarding the
results that may be obtained or the quality of work to be performed
I/We agree not to interfere with, remove or any ways damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
a
Signature
C r L., A I k r.5U-
T pe/Print Narde of Owner or Agent
3G; 3Lt IL3N
Phone Number / E-mail Address
RE: State -Lead Acceptance
Crossroads Center-C
134 Arnold Road
Lexington, NC 27295
Incident Number 44919
-11il id1 ii,, t (_)l �tj
Addr s
City/State/Zip Code
Y I -�, I -�
'Date
Nothing Compares'-1-1A.-
State of North Carolina I Environmental Quality I Waste Management
1646 Mail Service Center 1 217 West Jones Street I Raleigh, NC 27699-1646
919 707 8200 T

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SITE VICINITY MAP
CROSSROADS CENTER-C
134 ARNOLD ROAD
LEXINGTON, DAVIDSON COUNTY, NORTH CAROLINA
Project Number:
SLC4491901
Drawing File:
SEE LOWER LEFT
Date: Scale:
11/17/2021 1"= 2,00[
ATC
Drn. By:
DH
Cod. By:
AQ
App'd By:
AQ
Figure:
1

LEGEND:
MW-1 MONITORING WELL
-- Well Identification /
MW-11 DESTROYED MONITORING WELL /
-- Well Identification
--- SITE PROPERTY LINE /
PARCEL LINE /
NOTE: ALL LOCATIONS ARE APPROXIMATE /
/
/
/
I
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-�MW-12
*MW-13
MW-3 MW-4�
ARNOLD ROAD
SITE
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Date:
02/15/2023
Scale:
20 0 5 10 15 20
AS SHOWN
SCALE: 1" = 20' Figure:i
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LEGEND:
MW-2 MONITORING WELL
86.80 Well Identification
Relative Groundwater Elevation (ft)
-- SITE PROPERTY LINE
PARCEL LINE
_ GROUNDWATER ELEVATION CONTOUR
�46.8 (DASHED WHERE INFERRED) (ft)
GROUNDWATER FLOW DIRECTION
NOTE: ALL LOCATIONS ARE APPROXIMATE
/
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Date:
11/18/2021
Scale:
AS SHOWN
Figure:

LEGEND:\�
MW-1 MONITORING WELL
-- Well Identification
/
\
MW-11 DESTROYED MONITORING WELL
Identification
\�
—Well
---- SITE PROPERTY LINE
PARCEL LINE
\ �
U-
J
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Z �
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1
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NOTE: ALL LOCATIONS ARE APPROXIMATE
1
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NS
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U N N lL
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' O 0 X O Z
1
0 ozm
w
� > F-
MW 10 01/13/23
j
I
° $ c
Benzene 6 590
Toluene 14,900
/
1
2; 0
2 E N E 2 of
1
�'o
Ethylbenzene 2,010
SITE
`3 - 2 ; rn 'i � d
Xylene (Total) 7,560
1
I
m d Y o d E > x
y 2 2 E > (—
Naphthalene 414
1
y 0 y .2 z
Isopropylbenzene (Cumene) 74.3
/
1
m m o c o° 16 z m
n-Propylbenzene 175 /
„
tow o o O
1,2,4-Trimethylbenzene 1,190
/
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1
/
MW-10
MW-11
1
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VEW-1
/
MW-1
I
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1
1
MW-12�
/
I
1
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1
Q J
/
/
MW-1
01/13/23
I
O
Benzene
763
Q
Toluene
1,400
/
J O
Q
�
Ethylbenzene
1,640
1
=
U
Xylene (Total)
4,860
'
M W-3 \
Naphthalene
354
Q
\ MW-4�
n-Propylbenzene
114
1
Z
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1,2,4-Trimethylbenzene
894
Q
tert-Amyl Alcohol
798J
Z
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O O O
Benzene 2,720
Naphthalene 139
4—
O U) Q Z
tert-Amyl Alcohol 2,810
� O
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MW-13
Date:
02/15/2023
20 0 5 10 15 20
Scale:
AS SHOWN
j
SCALE: 1" = 20'
Figure: 5
Constituent of Concern
2L
GCL
Benzene
1
5,000
Toluene
600
260,000
Ethylbenzene
600
80,000
Xylene (Total)
500
50,000
Naphthalene
6
6,000
Isopropylbenzene (Cumene)
70
30,500
n-Propylbenzene
70
26,100
1,2,4-Trimethylbenzene
400
28,500
tert-Amyl Alcohol
40
40,000
MW-12
01/13/23
Benzene
77
Naphthalene
125
tert-Amyl Alcohol
170
MW-13
Ot/13/23
Benzene
4.9
tert-Amyl Alcohol
312

LEGEND:
MW-1 MONITORING WELL
�— Well Identification
MW-11 DESTROYED MONITORING WELL
�— Well Identification
-- SITE PROPERTY LINE
PARCEL LINE
Constituent of Concern
2L
GCL
Benzene
1
5,000
Toluene
600
260,000
Ethylbenzene
600
80,000
Xylene (Total)
500
50,000
Naphthalene
6
6,000
Isopropylbenzene (Cumene)
70
1 30,500
n-Propylbenzene
70
26,100
1,2,4-Trimethylbenzene
400
28.500
tert-Amyl Alcohol
40
40.000
NOTE: ALL LOCATIONS ARE APPROXIMATE
MW-10
01/13/23
Benzene
6 590
Toluene
14,900
Ethylbenzene
2,010
Xylene (Total)
7,560
Naphthalene
414
Isopropylbenzene (Cumene)
74.3
n-Propylbenzene
175
1,2,4-Trimethylbenzene
1,190
MW-12
01/13/23
Benzene
77
Naphthalene
125
tert-Amyl Alcohol
170
/
/
M W-12 /
/
/
MW-13+/
A
ARNOtD ROAD
MW-13
01/13/23
Benzene
4.9
tert-Amyl Alcohol
312
/
/
/
/
/
/
/
/
MW-2
NS
goo
5z-
VF, w'
MMPE using MW-3
and MW-10
3 f+ R o r SITE
M w -1
a.w d
Inject in MW-1 and I
EW-1
M -1
01/13/23
Benzene
763
Toluene
1,400
Ethylbenzene
1,640
Xylene (Total)
4,860
Naphthalene
354
n-Propylbenzene
114
1,2,4Trimethylbenzene
894
tert-Amyl Alcohol
798J
MW-4�
MW-3
MW-3
01/13/23
Benzene
2,720
Naphthalene
139
tert-Amyl Alcohol
2,810
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Date:
02/15/2023
20 0 5 10 15 20
Scale:
AS SHOWN
SCALE: 1" = 20'
Figure: 5

TABLE 1
WELL CONSTRUCTION AND GROUNDWATER ELEVATION DATA
Crossroads Center-C
134 Arnold Road
Lexington, Davidson County, North Carolina 27295
NCDEQ Incident #44919
Well ID
Date
Installed
Well
Diameter
(Inches)
Well Depth
(feet below
TOC)
Screen
Interval
(feet below
TOC)
TOC
Elevation
(feet)
Date
Measured
Depth to
Groundwater
(feet below TOC)
Depth to
LNAPL
(feet below
TOC)
LNAPL
Thickness
(feet)
Groundwater
Elevation
(feet)
MW-1
7/15/2002
1
24.55
10 - 25
100.00
06/27/2019
6.17
93.83
10/08/2021
13.33
86.67
01/13/2023
9.88
90.12
MW-2
8/7/2002
1
24.74
10 - 25
100.62
06/27/2019
10/08/2021
13.82
86.80
01/13/2023
10.59
90.03
MW-3
8/6/2002
1
24.67
10 - 25
98.39
06/27/2019
5.13
93.26
10/08/2021
12.31
86.08
01/13/2023
8.95
89.44
MW-4
8/6/2002
1
25.12
10 - 25
99.10
06/27/2019
5.74
93.36
10/08/2021
12.78
86.32
01/13/2023
9.13
89.97
MW-10
1/31/2018
2
24.69
10 - 25
99.7
02/01 /2018
13.75
85.95
05/07/2018
9.22
90.48
04/10/2019
8.25
91.45
06/27/2019
5.89
93.81
10/08/2021
13.00
86.70
01/13/2023
10.38
89.32
MW-11
1/31/2018
Unknown
Unknown
10-25
06/27/2019
02/01/2018
14.90
01/13/2023
Well Destroyed
MW-12
1/9/2023
2
20.00
5 - 20
98.62
01/13/2023
9.01
89.61
MW-13
1/9/2023
2
20.00
5 - 20
96.39
01/13/2023
6.69
89.70
VEW-1
8/7/2002
1
44.23
40 - 45
99.84
06/27/2019
6.20
93.64
10/08/2021
13.29
86.55
Notes:
TOC = Top -of -casing
-- = Not Measured
NA = Not Available
LNAPL = light non -aqueous phase liquid
If LNAPL is present in a well, groundwater elevation should be calculated by: [Top of Casing Elevation - Depth to Water] + [Free Product Thickness x 0.8581]
Page 1 of 1

TABLE 4
HISTORICAL GROUNDWATER ANALYTICAL RESULTS
Crossroads Center-C
134 Arnold Road
Lexington, Davidson County, North Carolina 27295
NCDEQ Incident #44919
w
m
~
�2
Gf
m
C
c
c
G7
Vl
y
y
C
=
C
N
N
N
y
C
3
O
C
N
C
N
C
N
C
N
L V
N
V
fA
V
y
U
C
G7
L
C
lC
N
N
E
t
W
C
N
"'
N
O
(0
(C
L
Well ID
07
C
>,3
.0
w
C
S
m
sH�
s
R EL
QDate
p
�
o
w
`
O
o
d
a
oX
w
m
d
r
QCollected
2
m
t
Q
T
O
E
W
E 00
U
Nm
W
O
2
Z
O
U
A
H
O
(0)
d=
�
T
T
L�
w
UcaU�Oo
t
d
Analytical Method
Standard Method 6200E MADEP Method VPH/EPH
2L Standard (1)
1
600
600
500
20
6
10
70
70
70
70
40
70
25
100
70
70
400
400
4000
40 400
700
200
10,000
GCL (2)
5,000
260,000
80,000
50,000
20,000
6,000
100,000
5,900
8,800
70,000
70,000
40,000
30,500
11,700
100,000
26,100
70,000
28,500
24,100
4,000,000
40,000 NE
NE
NE
NE
06/27/19
1,310
2,570
2,220
4,700
ND
691
NA
NA
NA
NA
ND
NA
155
NA
NA
364
NA
2,030
622
NR
NR NA
NA
NA
NA
MW-1
10/08/21
1,440
3,710
2,020
6,370
<0.140
4,480
<0.280
8.85
7.73
<0.220
0.698
1.95
68.6
4.05
4.16
275
7
2,130
503
NR
NR NA
NA
NA
NA
01/13/23
763
1,400
1,640
4,860
<8.4
354
<33.2
14.9
<8.0
18.6
<6.2
NA
52.6
NA
NA
114
6.6J
894
216
<1440
798J NA
NA
NA
NA
07/04/19
ND
ND
ND
ND
ND
ND
NA
NA
NA
NA
ND
NA
ND
INH
NA
ND
NA
ND
ND
NR
NR NA
NA
NA
NA
MW-2
10/08/21
<0.180
<0.220
<0.170
<0.210
<0.140
<0.470
<0.280
<0.180
<0.200
<0.220
<0.500
<0.380
<0.180
<0.089
<0.078
<0.190
<0.220
<0.190
<0.180
NR
NR NA
NA
NA
NA
06/27/19
10,800
147
1,770
141
130
288
NA
NA
NA
NA
252
NA
86
NA
NA
198
NA
151
NR
NR NA
NA
NA
NA
MW-3
10/08/21
5,310
63.5
1,810
41.2
<0.140
4,660
<0.280
12.5
9.57
<0.220
43.5
<0.380
68.6
4.92
<0.078
95.1
2.14
13.4
37.1
NR
NR NA
NA
NA
NA
01/13/23
2,720
43.3
514
11.11
<10.6
139
<41.5
<12.2
<10.0
<10.8
46.9
NA
32.6
NA
NA
55.7
<7.3
<12.4
<8.3
<1800
2,810 NA
NA
NA
NA
06/27/19
104.0
ND
53.5
489
ND
318
NA
NA
NA
NA
NA
NA
110
NA
NA
246
NA
1,860
906
NR
NR NA
NA
NA
NA
MW-4
10/08/21
37
4.28
2.82
22.2
<0.140
36.4
<0.280
4.64
4.53
<0.220
<0.500
<0.380
18.3
1.13
<0.078
16
<0.220
152
57.8
NR
NR NA
NA
NA
NA
02/01/18
5,870
7,000
1,130
5,020
ND
418
NA
NA
NA
NA
ND
NA
ND
NA
NA
198
NA
1,280
340
NR
NR 4,040
4,540
1,290
NA
05/07/18
13,600
18,300
1,850
7,870
ND
293
NA
NA
NA
NA
165
NA
ND
NA
NA
170
NA
1,210
300
NR
NR NA
NA
NA
NA
04/10/19
17,000
21,600
2,370
9,220
ND
448
NA
NA
NA
NA
130
NA
ND
NA
NA
200
NA
1,470
314
NR
NR NA
NA
NA
NA
MW-10
06/27/19
20,000
26,200
2,330
8,240
ND
415
NA
NA
NA
NA
96
NA
ND
NA
NA
240
NA
1,280
339
NR
NR NA
NA
NA
NA
10/08/21
5,950
16,600
4,160
13,200
<14.0
8,030
33.1J
60.7
44.9J
<22.0
<50.0
<38.0
184
20J
48.6J
511
<22.0
3,380
814
NR
NR NA
NA
NA
NA
01/13/23
6,590
14,900
2,010
7,560
<52.8
414
<208
<61.2
<50.0
<53.8
40.6J
NA
74.3
NA
NA
175
<36.5
1,190
278
<9020
<4550 NA
NA
NA
NA
MW-11
02/01/18
`JD
21.2
121
628
ND
28.8
NA
NA
NA
NA
ND
NA
ND
NA
NA
ND
NA
ND
ND
NR
NR ND
4,610
2,421
125
MW-12
01/13/23
77
0.9
7
19
<0.42
125
<1.7
17.6
10.1
2.3
<0.31
NA
50
NA
NA
25
<0.29
106
9
<72.2
170 NA
NA
NA
NA
MW-13
01/13/23
4.9
0.46J
<0.30
<0.34
0.72
1.1J
<1.7
<0.49
1.4
<0.43
0.33J
NA
1
NA
NA
<0.34
<0.29
<0.50
<0.33
166J
312 NA
NA
NA
NA
06/27/19
ND
ND
ND
ND
ND
ND
NA
NA
NA
NA
ND
NA
ND
NA
NA
ND
NA
ND
ND
NR
NR NA
NA
NA
NA
VEW-1
10/08/21
38.1
<0.220
<0.170
0.285J
0.294J
<0.470
<0.280
<0.180
<0.200
1.65
1.18
<0.380
0.475J
<0.089
<0.078
<0.190
<0.220
<0.190
<0.180
NR
NR NA
NA
NA
NA
Notes:
1) 15A NCAC 02L 0202 Groundwater Quality Standard (21- Standard). VPH = volatile petroleum hydrocarbons NR = Not Reported
2) NCDEQ Division of Waste Management (DWM) Gross Contamination Level (GCL). MADEP = Massachusetts Department of Environmental Protection
Only constituents detected above the reporting limit are shown J = estimated concentration below the laboratory reporting limit
Concentrations are reported in micrograms per liter (Ng/L) NE = Not Established
Concentrations in bold exceed the 2L Standard ND = Not Detected
Concentrations in bold and underlined exceed the GCL NA = Not Analyzed
VOCs = volatile organic compounds Grayed values and "<" indicate the compound was below the laboratory reporting limit
Page 1 of 1

/%W I
11
11
11
11
n
u
11
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IIYDIYIDUAL) NAME (print)
Walter Davis CERTMCATIONw 3162
WELL CONTRACTOR COMPANY NAMDSUbSUrfaCe Environmental Invest .PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if avolicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring Ck Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Lexington County Davidson Midge WSlope ❑Valley ❑Flat
Citao Station 134 Arnold Rd (check appropratobox)
(Street Name, Nttnibes, Cut:uatutir;; Subdivision, Lot No., .'.:p Code)
LatitudmIlongitude of well location
3. OWNER: X R C INC
Address 134 Arnold Road
(Su=t or Route No.)
Lexington, NC 27292
City or Town State Zip e
U-
Aro cod&- Phone number 07/15/02
4. DATE DRILLED
S. TOTAL DEPTH: 2 5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IX
7. STATIC WATER LEVEL Below Top of Casing:_FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0.0 FT. Above Land Surface*
-Top of cuing terminated attar below land surface requires a
variance in accordance with 15A NCAC 1C .011&
9. YIELD (gpm): n / a METHOD OF TEST n / a
10. WATER ZONES (depth): n / a
Type n / a
Amount
11.
12.
DISINFECTION:
CASING:
Wall Thickness
Depth
Diameter
or Weigh0t. Material
From% 1 0' _
To 0
FL-1
sch4 0 ,wc
From
To
Ft
From
To
Ft
13
14
15
(dcg;zcs/minutu/seeoods)
Latitudcllongitude source:❑GPS❑Topographic map
(cheek boz)
DEPTH DRILLING . LOG
From To Formation Description
LOCATION
SKETCH
Show direction and distance in miles from at least
two state- Roads or County Roads. Includo the road
numbers and common road names.
Crossroads Center
134 Arnold Road
Lexington, NC
11
16. REMARKS: Bentonite 8' to 6 MW#
l DO HEREBY C TIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTI�CT} ST THAT A COPY OF TH1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i, I_ / � � 8-1 4-02
OF PERSON CONSTRUCTING THE WELL DATE
t Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
17699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07R001

' WELL CONSTRUCTION RECORD
artment of Eavironment and Natural Resources - Division of Water Quality - Groundwater Section
North Carolina - Dcp CERTIFICATION r-3i&2
WELL CONTRACTOR (INDIVIDUAL) NAME (Print) Walter D av i s
WELL CONTRACTOR COMPANYNAMDSUbSUrface Environmental Invest.PxoNE r ���-$76--001 �
ASSOCIATED WQ PERMIT*
STATE WELL CONSTRUCTION PERMITS (if applicable)
(if ronlicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring M Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Lexington County Davidson ❑Ridge i ISlope ❑Valley lOFlat
Nearest Town:_ (check appropriate boa)
C i t o S i on 13 4 A r no 1 d Rd Latitude/longitude of well location
(Street Namc, Numbers, Community, subd1yisioa, Lot No., Z:p Cod_j
'
X R C I(de�ea/mtDute:/:aood~) 3. OWNER: NC l.atitude/longitude source:❑GPS❑Topographic map
Address 134 Arnold Road (chock box)
(Sweet or Route No.) DEP I-H 1�RTT.T ING LOG .
Lexin ton NC 27292 From To Formation Description
' city or Town slats Zip Code
U-
Area coda- Phone Dumber 8— 0 7— 0 2
4. DATE DRILLED
' 5. TOTAL DEPTH: 45'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EX
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 0-0 FT. Above Land Surface*
'lop of casing terminated atlor below land surfau requires a
variance in accordance with 15A NCAC 2C .OIIL
9. YIELD (gpm): n / a METHOD OF TEST n / a
' 10. WATER ZONES (depth): n / a LOCATION ATION SKETCH
n / a Amount n / a Show direction and distance in miles from at least
11. DISINFECTION: Type Wall Iunt _css two State Roads or County Roads. Include the road
' 12. CASING: numbers and common road names.
Depth Diameter or Weight/Ft. Material
From To---0 FL --A— sch40 AVC
From 40' To_ 0 FL--1-- 3-ChU _ "c Crossroads Center
From_____To Ft 134 Arnold Road
13. GROUT: Depth Matcriaii°mod Lexington, NC
From
35' To 0 Ft. neat cement tremie
Fromm C_ To—D-- Ft -
14. SCREEN: Depth
01 0 in. pyC
�� Depth Diameter Slot Sizc Material
FrornA ._. To-- Ft. 1 in. .
From To Ft. in. in.
15. SAND/GRAVEL PACK
From
45' Toth 38 Ft. 10/30 silica sand
From _To Ft.
16. REMARKS:
Bentonite 38' to 36' MW#
1 HEREBY C TIFY THAT THIS WELL T A COPYOFTHISSRRECORD HAS BEEN PROVIDIN ACCORDANCE WITHED TO THE VIM- L OWNER
CON CT ST
8-14-02
SIGN&URE OF PERSON CONSTRUCTING THE WELL DATE
' Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center i �Vgb, NC
27699-1636 Phone No. [phone], within 30 days

/%W I
11
11
11
11
n
u
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IIYDIYIDUAL) NAME (print)
Walter Davis CERTMCATIONw 3162
WELL CONTRACTOR COMPANY NAMDSUbSUrfaCe Environmental Invest .PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if avolicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring Ck Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Lexington County Davidson Midge WSlope ❑Valley ❑Flat
Citao Station 134 Arnold Rd (check appropratobox)
(Street Name, Nttnibes, Cut:uatutir;; Subdivision, Lot No., .'.:p Code)
LatitudmIlongitude of well location
3. OWNER: X R C INC
Address 134 Arnold Road
(Su=t or Route No.)
Lexington, NC 27292
City or Town State Zip e
U-
Aro cod&- Phone number 07/15/02
4. DATE DRILLED
S. TOTAL DEPTH: 2 5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IX
7. STATIC WATER LEVEL Below Top of Casing:_FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0.0 FT. Above Land Surface*
-Top of cuing terminated attar below land surface requires a
variance in accordance with 15A NCAC 1C .011&
9. YIELD (gpm): n / a METHOD OF TEST n / a
10. WATER ZONES (depth): n / a
Type n / a
Amount
11.
12.
DISINFECTION:
CASING:
Wall Thickness
Depth
Diameter
or Weigh0t. Material
From% 1 0' _
To 0
FL-1
sch4 0 ,wc
From
To
Ft
From
To
Ft
13
14
15
(dcg;zcs/minutu/seeoods)
Latitudcllongitude source:❑GPS❑Topographic map
(cheek boz)
DEPTH DRILLING . LOG
From To Formation Description
LOCATION
SKETCH
Show direction and distance in miles from at least
two state- Roads or County Roads. Includo the road
numbers and common road names.
Crossroads Center
134 Arnold Road
Lexington, NC
16. REMARKS: Bentonite 8' to 6 MW#
l DO HEREBY C TIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTI�CT} ST THAT A COPY OF TH1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i, I_ / � � 8-1 4-02
OF PERSON CONSTRUCTING THE WELL DATE
t Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
17699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07R001

' WELL CONSTRUCTION RECORD
artment of Eavironment and Natural Resources - Division of Water Quality - Groundwater Section
North Carolina - Dcp CERTIFICATION r-3i&2
WELL CONTRACTOR (INDIVIDUAL) NAME (Print) Walter D av i s
WELL CONTRACTOR COMPANYNAMDSUbSUrface Environmental Invest.PxoNE r ���-$76--001 �
ASSOCIATED WQ PERMIT*
STATE WELL CONSTRUCTION PERMITS (if applicable)
(if ronlicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring M Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Lexington County Davidson ❑Ridge i ISlope ❑Valley lOFlat
Nearest Town:_ (check appropriate boa)
C i t o S i on 13 4 A r no 1 d Rd Latitude/longitude of well location
(Street Namc, Numbers, Community, subd1yisioa, Lot No., Z:p Cod_j
'
X R C I(de�ea/mtDute:/:aood~) 3. OWNER: NC l.atitude/longitude source:❑GPS❑Topographic map
Address 134 Arnold Road (chock box)
(Sweet or Route No.) DEP I-H 1�RTT.T ING LOG .
Lexin ton NC 27292 From To Formation Description
' city or Town slats Zip Code
U-
Area coda- Phone Dumber 8— 0 7— 0 2
4. DATE DRILLED
' 5. TOTAL DEPTH: 45'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EX
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 0-0 FT. Above Land Surface*
'lop of casing terminated atlor below land surfau requires a
variance in accordance with 15A NCAC 2C .OIIL
9. YIELD (gpm): n / a METHOD OF TEST n / a
' 10. WATER ZONES (depth): n / a LOCATION ATION SKETCH
n / a Amount n / a Show direction and distance in miles from at least
11. DISINFECTION: Type Wall Iunt _css two State Roads or County Roads. Include the road
' 12. CASING: numbers and common road names.
Depth Diameter or Weight/Ft. Material
From To---0 FL --A— sch40 AVC
From 40' To_ 0 FL--1-- 3-ChU _ "c Crossroads Center
From_____To Ft 134 Arnold Road
13. GROUT: Depth Matcriaii°mod Lexington, NC
From
35' To 0 Ft. neat cement tremie
Fromm C_ To—D-- Ft -
14. SCREEN: Depth
01 0 in. pyC
�� Depth Diameter Slot Sizc Material
FrornA ._. To-- Ft. 1 in. .
From To Ft. in. in.
15. SAND/GRAVEL PACK
From
45' Toth 38 Ft. 10/30 silica sand
From _To Ft.
16. REMARKS:
Bentonite 38' to 36' MW#
1 HEREBY C TIFY THAT THIS WELL T A COPYOFTHISSRRECORD HAS BEEN PROVIDIN ACCORDANCE WITHED TO THE VIM- L OWNER
CON CT ST
8-14-02
SIGN&URE OF PERSON CONSTRUCTING THE WELL DATE
' Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center i �Vgb, NC
27699-1636 Phone No. [phone], within 30 days