Air Injection UIC Deemed Permitted 2012-2013

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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 individual permit when constructed in accordance
with the rules of ISA NCAC 02C.0200. This form shall be submitted at least 2 weeks prior to construction.
AQUIFER TEST WELLS (15A NCAC 02C .0227)
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 - Contaminant plumes located entirely within a land surface area not to
exceed 10,000 square feet. For tracer tests in uncontaminated areas the area of influence of the injection well(s) shall
be entirely within a land surface area not to exceed 10,000 square feet. 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: September 12 , 20 12 PERMIT NO. (to be filled in by DWQ)
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: Business/Organization
C. WELL OWNER — State name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Name: Petroleum World, Inc.
Mailing Address: P.O. Box 341
City: Mooresboro State: NC Zip Code: 28114 County: Cleveland
Day Tele No.: 828-453-2247
EMAIL Address: dpotterna,cchpw.com
Cell No.:
Fax No.: 828-453-2204
DWQ/UIC/In Situ Reined. Notification (Revised 4/26/2012) Page 1