WI0400542_NOI 08-16-2023_20230816

;ETC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
August 16, 2023
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
Mr. Mike Rogers
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
Airport Exxon
3751 North Liberty Street
Winston-Salem, Forsyth County, North Carolina
NCDEQ Incident No. 10022
Dear Mr. Rogers:
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to Construct or
Operate Injection Wells on behalf of NCDEQ State Lead Program. The permit application covers the
installation of two air injection wells (SPG-3 and SPG-4), as well as the injection of air through SPG-3,
SPG-4, and SPG-2 (an existing well) at the Airport Exxon site located at 3751 North Liberty Steet in
Winston-Salem, North Carolina.
If you have questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
a,
Chris Hanley, P.G.
Project Geologist
Attachments
Gabriel Araos, P.E.
Senior Project Manager

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT 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. This form shall be submitted at least 2 weeks prior to injection.
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 .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.
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 are 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.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: August 16, 2023 PERMIT NO. W10400542 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) X Air Injection Well......................................Complete sections B-F, K, N
(2) Aquifer Test Well.......................................Complete sections B-F, K, N
(3) Passive Injection System...............................Complete sections B-F, H-N
(4) Small -Scale Injection Operation ......................Complete sections B-N
(5) Pilot Test.................................................Complete sections B-N
(6) Tracer Injection Well...................................Complete sections B-N
B. STATUS OF WELL OWNER: State Government
C. WELL OWNER — State name of entity and name of person delegated authority to sign on behalf of the business
or agency:
Name(s): NCDEQ — State Lead Program
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code
Day Tele No.: 910-796-7406
27699 County: Wake
Cell No.: Not Available
EMAIL Address: Thomas. chayman(adeg.nc.gov Fax No.:
MUM Situ Remed. Notification (Revised 3/2/2015) Page 1

1a
E.
F.
G.
H.
PROPERTY OWNER (if different than well owner)
Name: Airroort Commission of Forsvth Coun
Mailing Address: PO Box 4457
City: Winston Salem State: NC Zip Code:27551 County: Forsyth
Day Tele No.: [phone] Cell No.: Not Available
EMAIL Address: Not Available Fax No.: Not Available
PROJECT CONTACT - Person who can answer technical questions about the proposed injection project.
Name: Gabriel Araos — ATC Associates of North Carolina_ P.C.
Mailing Address: 2725 E. Millbrook Road, Suite 121
City: Raleigh State: NC_ Zip Code:27604 County: Wake
Day Tele No.: 919-871-0999 Cell No.: 919-816-7915
EMAIL Address: gabe.araos&oneatlas.com Fax No.: 919-871-0335
PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: 3751 North Liberty Street County: Forsyth
City: Winston-Salem State: NC Zip Code: 27105
(2) Geographic Coordinates: Latitude": 0
" or 360.136050 N
Longitude": _° " or 800.230058 W
Reference Datum: WGS84 Accuracy: Not Available
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: 18,525 square feet
Land surface area of inj. well network: 600 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 3.2% (must be < 5% of plume for pilot test injections)
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.
UIC/In Situ Remed. Notification (Revised 3/2/2015) Page 2

L DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
In order to reduce light non -aqueous phase liquid (LNAPL) and dissolved petroleum constituent concentrations
at the site. ATC will perform an AS/SVE pilot test on existing air sparge well SPG-2 and newly constructed air
sparge wells SPG-3 and SPG-4. Air will be injected into these air sparge wells at an average pressure of 15
pounds per square inch (psi) and at an average flow rate of 5 cubic feet per minute (cfm). The purpose of this
injection will be to determine the most efficient and cost-effective method of cleaning up the site.
J. INJECTANTS — Provide a MSDS and the following for each injectant. Attach additional sheets if necessary.
NOTE: Approved injectants (tracers and remediation additives) can be found online at
http://portal.ncdenr.org/web/wq/aps/gwpro. All other substances must be reviewed by the Division of Public
Health, Department of Health and Human Services. Contact the UIC Program for more info (919-807-6496).
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: 2 Proposed 2 Existing
(2) 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:
(a) well type as permanent, direct -push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
(c) well contractor name and certification number
MUM Situ Remed. Notification (Revised 3/2/2015) Page 3

L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
The injection wells are scheduled to be installed on 9/6/2023. The injection activities are tentatively scheduled
to be conducted between September and October 2023.
M. 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.
Groundwater samples are collected from select monitoring wells associated with the releases on a semi-annual
basis.
N. SIGNATURE OF APPLICANT AND PROPERTY 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 I5A NCAC 02C 0200 Rules. "
on behalf of NCDEO Gabe Araos, on behalf of NCDEO
Signature of Applicant Print or Type Full Name
PROPERTY OWNER (if the property is not owned by the permit applicant):
"As owner of the property on which the injection wells) 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 wells) conform to the Well Construction Standards
(I5A 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.
Signature* of Property Owner (if different from applicant) Print or Type Full Name
* An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
MUM Situ Remed. Notification (Revised 3/2/2015) Page 4

Sri ,
"` 19
UNDERGROUND STORAGE TANK SECTION
May 16, 2019
Mr. Thomas Chapman
Hydrogeologist
DWM/UST Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Dear Mr. Chapman
RE: Access Agreement
Airport Exxon
3751 North Liberty Street
Winston-Salem, Forsyth County, North Carolina
Incident Number: 10022
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 to the lands we own or control with the understanding that:
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. 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 land owners
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.
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,
Yi ,A VZk �hV • Y� S6�
Signature
Type/Print Name of Owner or Ag6nt
3736 `76 -7 -6 ?,C
Phone Number
Address IVL Z7/ a S
W,^p41-- 4 Gf(% -, / I\jc
City/State/Zip Code
Date
RE: Airport Exxon
3751 North Liberty Street
Winston-Salem, Forsyth County, North Carolina
Incident Number: 10022

L1
L4
L2
L3
PERMANENT AIR SPRAGE WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP / PROTECTIVE CASING AND CONCRETE PAD
CASING MATERIAL steel
CASING DIAMETER 8 inches
CASING LENGTH 12 inches
PAD DIMENSIONS 2 feet x 2 feet
HEIGHT ABOVE GROUND flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 25 feet
BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 19 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 4 feet
;11I09=1:42eT61:/
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
TOTAL FILTER PACK FOOTAGE 7 feet
WELL SCREEN
SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 5 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
WELL 30 feet
DEPTH TO BOTTOM OF
BOREHOLE 30 feet
L1 = 0 FT.
L2 = 25 FT. DIAMETER OF BOREHOLE 8.25 inches
L3 = 5 FT.
L4 = 30 FT. DRILLING SUBCONTRACTOR:
DRILLER ADDRESS:
DRILLER CERTIFICATION #:
TITLE Well Information
Airport Blvd
3751 North Liberty Street 2725 East Millbrook Road, Suite 121
Winston-Salem, North Carolina Raleigh, North Carolina 27604
FILE PREP. BY REV. BY DATE
CH I CH 8/16/2023

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