WI0400607_Notification of Intent (NOI) – GW Remediation_20231130

ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES - MATERIALS TESTING
November 10, 2023
Mr. Michael Hall
Raleigh Regional Office
North Carolina Department of Environmental Quality
Water Quality Regional Operations Section
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
Reference: Notice of Intent to Construct or Operate Injection Wells
Cedar Square Grocery-B
7081 Cedar Square Road
Archdale, Randolph County, North Carolina
NCDEQ Incident No. 20078
Dear Mr. Hall:
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 injection of air through two air injection wells to be installed at the Cedar
Square Grocery-B site located at 7081 Cedar Square Road in Archdale, North Carolina.
If you have questions or require additional information, please contact our office at (919) 871-
0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Brian Buchanan
Project Scientist
Direct Line: 919-573-1203
Email: Brian. Buchanan(a)oneatlas.com
Attachments
Gabriel Araos, P.E.
Program Manager
Direct Line: 919-573-1205
Email: Gabe. Araos(cDoneatlas.com

NC Department of Environmental Quality (DEQ) — 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 application to he submitted and an individual permit
he issued when constructed in accordance with the rules of'I5A NCAC 02C.0200 (NOTE: This form must be
received at least 14 DAYS prior to iniection)
GROUNDWATER (GW) REMEDIATION INJECTION PERMIT TYPES:
(1) IN -SITU GW REMEDIATION PERMIT TYPE (15A NCAC 02C .0225)
• In -Situ 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).
• In -Situ Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet (SF) for the purpose of soil or groundwater remediation or tracer tests. If area to be treated exceeds 10,000
SF do not use this NOI; an injection Permit application shall be submitted, and a Permit issued per 15A NCAC
02C .0225(f).
• In -Situ Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy 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. Also, if pilot test is going to be conducted on separate groundwater
contaminant plumes do not use this NOI; a Permit application shall be submitted, and a Permit issued as per
15A NCAC 02C .0225(f).
• In -Situ Thermal (IST) — IST wells 'heat' contaminated groundwater in -situ to enhance remediation.
(2) AIR INJECTION PERMIT TYPE (15A NCAC 02C .0225)
These permit types are used to inject ambient air to enhance treatment of soil or groundwater.
(3) TRACER WELL PERMIT TYPE (15A NCAC 02C .0229)
These permit types are used to inject substances for determining hydrogeologic properties of aquifers.
(4) AQUIFER TEST PERMIT TYPE (15A NCAC 02C .0220)
These permit types are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
DATE: November 10 2023 NOI TRACKING NO.
(To be filled in by DWR)
DIRECTIONS- Submit this NOI only for (1) New deemed `permitted by rule' injection project or (2) If there is going
to be a different permit type (listed above) used for a previously issued NOI.
NOTE- After this NOI is processed and acknowledged, any supplemental or additional injections still meeting the
criteria referenced in Section G below shall be reported using Injection Event Records (IERs) and using the NOI
tracking number provided by DWR.
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) X 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)
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
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 1

B. STATUS OF WELL OWNER: State Government
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): NCDEQ — State Lead Program
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699 County: Wake
Day Tele No.: 919-707-8167 Cell No.: N/A
EMAIL Address: hassan.osman(, deq.nc.gov Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Mr. Rehan Shezad
Company Name N/A
Mailing Address: 2411 Murray Drive
City: Archdale State: NC Zip Code: 27263 County: Randolph
Day Tele No.: 336-861-3353 Cell No.: N/A
EMAIL Address: N/A Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Mr. Brian Buchanan
Company Name 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.: 919-573-1203 Cell No.: 704-517-9236
EMAIL Address: brian.buchanan(a oneatlas.com Fax No.: 919-871-0335
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Cedar Square Grocery-B
7081 Cedar Square Road
City: Archdale County: Randolph Zip Code: 27263
(2) Geographic Coordinates: Latitude": " or 35.8858150 N
Longitude": " or 79.8685190 W
Reference Datum: WGS84 Accuracy: N/A
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.
G. TREATMENT AREA
Land surface area of contaminant plume: square feet
Land surface area of inj. well network: square feet (< 10,000 ft' for small-scale injections)
Percent of contaminant plume area to be treated: (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 2

H.
I.
K.
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:
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): 23 feet
(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
INJECTION SUMMARY
NOTE: Onlv iniectants annroved by the enidemiologv section of the NC Division ofPublic Health. Department
Of Health and Human Services can be injected. Approved injectants can be found online at
http://deg.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 DHHS prior to use.
Contact the UIC Program for more info ifyou wish to get approval for a different additive. However, please
note it may take 3 months or longer. If no iniectants are to be used use N/A.
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant;
Total Amt. to be injected (gal)/event:
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 3

Total Amt. to be injected (gal/event):
No. of separate injection events: Total Amt. to be injected (gal):
Source of Water (if applicable
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.
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 I5A NCAC 02C 0200 Rules. "
Mr. , on behalf of NCDEQ Mr. Brian Buchanan, on behalf of NCDEQ
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 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 attached access agreement Mr. Rehan Shezad
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. 3-1-2023 Page 4

PERMANENT AIR SPRAGE WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP PROTECTIVE CASING AND CONCRETE PAD
L1
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
18 feet
L2
BACKFILL AROUND CASING
MATERIAL
cement grout
THICKNESS
13 feet
SEAL
TYPE OF SEAL
bentonite
L4
THICKNESS
3 feet
FILTER PACK
TYPE OF FILTER
#2 silica sand
DISTANCE ABOVE SCREEN
2 feet
TOTAL FILTER PACK FOOTAGE
7 feet
WELL SCREEN
L3
SCREEN MATERIAL
sch 40 PVC
DIAMETER
2 inches
LENGTH
5 feet
SLOT SIZE
0.010 inches
DEPTH TO BOTTOM OF
WELL
23 feet
DEPTH TO BOTTOM OF
BOREHOLE
23 feet
L1 = 0 FT.
L2 = 18 FT.
DIAMETER OF BOREHOLE
6 inches
L3 = 5 FT.
L4= 23 FT.
DRILLING SUBCONTRACTOR: Geologic Exploration
DRILLER ADDRESS: 176 Commerce Blvd, Statesville, NC 28625
DRILLER CERTIFICATION #: 4475
TITLE Well Information
AS-1 and AS-2
Ar
Cedar Square Grocery-B
ff
7081 Cedar Square Road
2725 East Millbrook Road, Suite 121
Archdale, North Carolina
Raleigh, North Carolina
27604
FILE
PREP. BY
REV. BY
DATE
N K
GA
11 /10/2023

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Ashley Winkelman
From: Osman, Hassan <[e-mail]>
Sent: Monday, December 21, 2020 10:08 AM
To: Ashley Winkelman
Subject: [EXTERNAL] Langley Tire Service # 13623
lExternall Eniaill This email originated FI-0111 outside of the Atlas mail system. Please use caution when
opening attachments.
HI Ashley:
Thanks
Hassan
ATC Associates is granted/approved a permission to act as an agent for NCDEQ to sign a notification for UIC,
DEQ
Hassan C)SInal-i
4,dwgeologist, UST
North Carolina Department of EmAroiiiiiental Qualih,
919.707.8167 (Office)
Hassati.Osiiian@ncdcrir,go,%,

car • �., ..,.n
MAR 8 2010
t 1ST SECTioNi
Herb Berger
Hydrogeologist
DWM UST Section
1637 Mail Service Ctr
Raleigh, NC 27699-1637
RE: Access Agreement
Former Cedar Square Grocery
7081 Cedar Square Road
Archdale, Randolph County NC
Incident# 20078
Dear Mr. Berger:
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 Environment and Natural Resources (Department) or its contractor to enter upon said
property for the purpose of conducting an investigation of the groundwaters under the authority of G.S. 143-
215.3(a)2.
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. The Department or its contractor shall protect and prevent damage to the surrounding lands.
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 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,
UWe agree not to interfere with, remove, or in any way damage the Department°s well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
Signature
Type/Print Name of Owner or Agent
Phone Number
�zoOD1 R6
i
Address
City/State/Zip Code
Date