WI0100711_Notification of Intent (NOI) – GW Remediation_20240301

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 be submitted and an individual permit
be issued when constructed in accordance with the rules of 15A NCAC 02C.0200 (NOTE: This form must be
received at least 14 DAYS prior to injection)
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: February 28 , 20 24 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 !ype (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) 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
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-DWM, UST Section, Federal & State Lead Program; Attn: Sharon Ghiold
1a
E.
F.
G.
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699-1646 County: Wake
Day Tele No.: 919-707-8166 Cell No.: NA
EMAIL Address: Sharon.ghioldkdeq.nc.gov Fax No.: 919-707-8165
PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Mike & Brenda Grgy, PeM & Donna Gray
Company Name Stone Pro
Mailing Address: 520 Cloudland Drive, Roan Mountain, TN 37617
City: Roan Mountain State: _TN_ Zip Code: 37617 County:_
Day Tele No.: 423-772-4176 Office No.: 828-742-1395
EMAIL Address: NA Fax No.: NA
PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Flora D'Souza, Environmental Project Scientist II
Company Name WithersRavenel, Inc.
Mailing Address: 115 MacKenan Drive
City: Cary State: NC_ Zip Code: 27511 County: Wake
Day Tele No.: 919-469-3340 Cell No.: 704-517-3035
EMAIL Address: fdsouzakwithersravenel.com Fax No.: 919-467-6008
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Cranberry 76 — 6741 North US Highway 19E NCDEQ Incident #17059
City
Elk Park
(2) Geographic Coordinates: Latitude"
County: Avery Zip Code: 28622
36.1532880
Longitude":-81.965358'
Reference Datum: Google Earth Accuracy: +/- 5m
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: 11,250 square feet
Land surface area of inj. well network: 1,200 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 9.4% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 2

H.
I.
J.
1N
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:
Cause of Contamination: The Cranberry 76 site had a release of gasoline from underground storage tanks.
Purpose: The purpose of the injection is to reduce dissolved phase contaminants (BTEX) concentrations to values
below the 2L Standards to reduce risk at the site.
Scope: The scope of this injection event will be to inject approximately 3,750 pounds of BOS 200 into 50
injection points within intervals between 6 and 13 feet below ground surface.
Goals: The goal of the BOS 200 injection is to reduce the BTEX concentrations in groundwater across the site.
WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed 1 (MW-6) Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 6-13 feet
(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
INJECTION SUMMARY
NOTE: Onlv iniectants avvroved by the evidemiolo,2v section of the NC Division ofPublic Health. Department
of Health and Human Services can be iniected. Approved iniectants can be found online at
http:Hdeq. 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 iZyou wish to eft approval for a di,&ferent additive. However, please
note it may take 3 months or longer. If no injectants are to be used use N/A.
Injectant: BOS 200 Total Amt. to be injected (gal)/event: 3,750 lbs BOS 200 diluted in 3,750 gal water
Injectant: Total Amt. to be injected (gal)/event:
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 3

Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant:
Total Amt. to be injected (gal/event):
Total Amt. to be injected (gal)/event_
No. of separate injection events: Total Amt. to be injected (gal):
Source of Water (if applicable): Town of Elk Park
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.
Post -injection sampling of monitoring wells will occur semi-annually.
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 1 SA NCAC 02C 0200 Rules. "
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 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 attached access agreement
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

40
..Our People. Your Success.
FIGURES
Cranberry 76 - NCDEQ Incident #17059 WR Project # 23-0307-AY
Notice of Intent - UIC February 2024

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7
A /I
32000
SUBJECT SI
TE
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IL
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_:.
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f
01 e GRAPHIC SCALE
k' k 0 250 500 00
1 inch = 500 feet
CRANBERRY 76 (TF# 17059) DRAWN BY: SCALE: FIGURE NO.:
WithersRavenel 6741 NORTH US HWY 19E mm I"=500' 1
1 / Engineers I Planners I Surveyors ELK PARK, AVERY COUNTY, NC APPROVED BY DATE PROJECT NO.
115 MacKenan Drive I Cary, INC 275111 t: 919.469.3340 1 license #: F-1479 GENERAL LOCATION MAP I'D 10/19/23 23-0307-AY
www.withersravenel.com 11
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W-3 \
MW-2 � \
MW-4 W-s \
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LEGEND \
TYPE II MONITORING WELL LOCATION \
® TYPE III MONITORING WELL LOCATION M ® \
r /'\ \1/ MUNICIPAL WATERLINE
SURFACE WATER
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY CIS DEPARTMENT.
0 20
1 inch = 40
DRAWN BY: I SCALE: FIGURE NO.:
-40- WithersRavenel CRANBERRY 76 - TF#17095 MIA1"=40 2
I / Engineers Planners Surveyors 6741 NORTH US HWY 19 E SITE MAP
APPROVED BY: DATE: PROJECT NO.:
ELK PARK, AVERY COUNTY, INC
115 MacKenan Drive I Cary, NC 275111 t: 919.469.33401 license #: F-14791 FD 10/19/23 23-0307-AY
w.withersravenel—rn
,k\0\0307—AY—C.M— 7!\FmYo\CM\Bow Yas C.0— 7Ld — Od be 31. 2023 — WL DNM

-14
WSW-
S -15
WS
LEGEND
WATER SUPPLY WELL LOCATION
MUNICIPAL WATER LINE
N SURFACE WATER
LINES BETWEEN WSW-1 AND PROPERTIES IT
SERVES
LTES
OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.
SUBSTATION RD
WSW-10
WSV
(INA
1,000 FT
kmiI1 A likkI
500 FT -
I*Ei SITE
�
o
\
US HIGHWAY 19E
WZ
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V�
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\
2 W
\
WSW-4
Q
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-1 (INACTIV
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W
Vy-2
SW-5
WSW-13
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ro _ �v
v
WSW-9
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WSW-16
U) 5, 3
/
L v ��
JJ �
/
GRAPHIC SCALE
. jL
C.
w Y v
u
100
200 400
/
1" = 200'

MW-6
MW-2 95 94 93 92.5 W-3 (NM)
(95.35) 92.34)
MW-4
(92•87) Q' (DESTROYED)
MW-5R �
(92.65) Hydraulic Gradient =0.029 ft/ft
LEGEND
TYPE II MONITORING WELL LOCATION
® TYPE III MONITORING WELL LOCATION
GROUNDWATER ELEVATION CONTOUR (ft)
(94.57) GROUNDWATER ELEVATION (ft) ~
GROUNDWATER FLOW DIRECTION
® NOTES: GRAPHIC SCALE 1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT. 0 15 30 60
C2.) TYPE III ONTOURS. WELLS NOT USED TO CREATE GROUNDWATER ELEVATION M W-1
3.) NM = NOT MEASURED (92.58)
--7-< I
1 inch = 30 ft.
DRAWN BY: SCALE: FIGURE NO.:
WithersRavenel GROUNDWATER
1/ CRANBERRY 76 - TF# 17095 MIA 1"=30' 4
Engineers I Planners I Surveyors 6741 NORTH US HWY 19 E ELEVATION CONTOUR APPROVED BY: DATE: PROJECT NO.:
g Y 115 MacKenan Drive Cary, NC 27511 t: 919.469.3340 license p: F-1479 ELK PARK, AVERY COUNTY, INC MAP - AUGUST 2023 FD 10/19/23 23-0307-AY
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SUMMARY OF GROUNDWATER ANALYTICAL RESULTS
MW-2
LEGEND
TYPE II MONITORING WELL LOCATION
® TYPE III MONITORING WELL LOCATION
MUNICIPAL WATER LINE
SURFACE WATER
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.
r _I
Analytic.A Method
6200E - Volatile
Organic onipounds
a
r
v
am
Sample
Date
�. E
-
-
« T
m
-2
p
w
Na
Nv
T
X
ID
Collected
¢
8-a
Y
Y
c
2
a`
67-64-1
71-43-2
104-51-8
135-98-8
100-41-4
98-82-8
99-87-6
591-78-6
78-93-3
91-20-3
103-65-1
108-88-3
95-63-6
108-67-8
1330-20-7
MW-1
8/11/2023
<1,80
<0.180
<0.180
<0.200
<0.170
<0.180
<0.089
<0.380
<0.710
<0.470
<0.190
<0.220
<0.190
<0.180
0,210
MW-2
8/10/2023
<1.80
Z28
0.902
OA59J
18.8
1.53
<0.089
<0.380
7.11
7.0
525
0.99
7A8
1.52
22.8
MW-3
8/10/2023
<180
<18.0
612
46.6J
2,830
124
22.3J
<38.0
<71.0
1,150
376
152
3,930
1,040
9,950
MW-4
8/10/2023
<180
<18.0
50A
25.0J
573
61
-8.90
<38.0
<71.0
571
256
50.5
2,570
767
Z730
MW-5R
8/11/2023
<18.0
<1.80
7.61
4.88J
61.6
11.3
5.06
<3.80
-7.10
81.7
40.4
3.48J
260
83.8
1801
10/2/2023
<10.0
<0.500
3.98
2.15
5.91
4.83
<0500
138
<5.00
19.4
15.2
0MW-6
050
7.12
1.7
8.18
Field Blank
8/10/2023
2.50J
<0.180
<0.180
<0200
<0.170
<0.180
<0.089
<0.380
<0710
<0470
<0.190
0244
0.190
<0.180
<0.210
Standard
6,
1
70
0
600
70
25
40
4,000
6
70
600
400
400
500NsC2L
GNCfGroundwater
6,000,000
5000
5900
8,800
80,000
3N0
1N7
40,000
4,000,000
6,0002N100
260100028,50024,1050000
5nardxl
NE
N
NE
E
E
E
10
NE
NE
NLC26
Notes:
1) All results provided in ug/L (micrograms per liter) or parts per billion.
u 2) Compounds analyzed for by laboratory but not listed were not found above laboratory detection limits. See the laboratory report included in Appendbrfar a full list of constituents.
3) NC 2L Standard - North Carolina Groundwater Quality Standard as per NC Administrative Code 15A NCAC 02L
4) GCLs for Groundwater = NCDEQ Gross Contamination Levels (GCLs)for Groundwater.
51 NC 213 Standard = North Carolina Surfacewater Quality Standard as per INC Administrative Code 11B NCAC 02B.
RESULT = Result Exceeds Laboratory Detection Limits
RESULT = Result Exceeds 10 x NC 2B Standard
RESULT = Result Exceeds NC 2L Standard
RESULT = Result Exceeds GCLs
W-3MW-6
MW-'4-lo' iYV-s
DESTROY
MW-5R
' r
MW-1
GRAPHIC
1 in& = 40
DRAWN BY: SCALE: FIGURE NO.:
WithersRavenel GROUNDWATER
1/ CRANBERRY 76 - TF# 17095 MM 1��=ao� 5
Engineers I Planners I Surveyors 6741 NORTH US HWY 19 E ANALYTICAL RESULTS APPROVED BY: DATE: PROJECT NO.:
g Y 115 MacKenan Drive Cary, NC27511I e469.3340 IicenseR: F-1479 ELK PARK, AVERY COUNTY, NC MAP - AUGUST 2023 FD 11/10/23 23-0307-AY
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\
\G,L
ESTIMATED EXTENT OF NAPHTHALENE IN
GROUNDWATER AT CONCENTRATIONS \9�
EXCEEDING 2L STANDARD. �9T
F
\ A
MW-6 �
***& o) MW-3
����� \ (19.4)
lMW-2 4*14.
\ MW-4 (11so) /
\ (81.7) �' \
A�\MW-5R ♦ — — — .
----'y-
B -y� \
LEGEND N►
TYPE II MONITORING WELL LOCATION _ , Z
TYPE III MONITORING WELL LOCATION
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.
p GRAPHIC SCALE
21 41 81
1"=40'
(<0.470)
--
_
.." 1,000'—
t '•, I - f -
t
SUBJECT SITE.
500' ±0.32 ACRE r
,
r`
\ I,
��- ,
Crap erry m..
A A,
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — I
110 h �;) � b 110
100 SURFACE GRADE V, 100
SILT CONCRETE/BOULDERS ;,'
90 c — �— — - -- —7 cLov 90
CLAYEY - — —
� LT _
80 SILT ---- L ----- 80
0
0
W
O
Ln
0
ESTIMATED EXTENT OF NAPHTHALENE IN
GROUNDWATER AT CONCENTRATIONS
EXCEEDING 2L STANDARD.
0 15 30 60
B B'
I I
F— — — — — — — — — — — — — — — —
110
C' 100 SURFACE GRADE
CLAYEY SILT low
SAND --
CLAYEY
\\�T_--SILT
---- /
ESTIMATED EXTENT OF NAPHTHALENE IN
GROUNDWATER AT CONCENTRATIONS
EXCEEDING 2L STANDARD.
90
0 15 30 60
70
60
110
100
90
80
70
60
50
50
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vav N
0
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40
..Our People. Your Success.
BORING LOGS
Cranberry 76- NCDEQ Incident #17059 WR Project # 23-0307-AY
Notice of Intent - UIC February 2024

MW-2
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jonathan Allred
CERTIFIC,Av�TION # 3213
WELL CONTRACTOR COMPANY NAME Palmetto Drilling Services, LLC
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I . WELL USE (9heck Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural El
Monitoring ®' Recovery ❑ Heat Pump Water Injection ❑ Other
❑ If Other, List Use
2. WELL LOCATION:
Topographic/Land setting
Nearest Town: Roan Mountain County Avery
❑Ridge ❑Slope ❑Valley ❑Flat
6741 Highway 19 East, Elk Park, NC 28622
(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Latitude/longitude of well location
3. OWNER: Mike & Perry Grant
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
Address 8512 Highway 19 E
(check box)
(Street or Route No.)
37687
DEPTH DRILLING LOG
Roan Mountain TN
City or Town State Zip Code
From To Formation Description
0J_ 772-4450
0 10.0 Brown Clayey Sand
Area code- Phone number
10.0 11.0 Green Clayey Sand
4. DATE DRILLED 7/30/09
11.0 13.0 Brown Silt wl organics d-
5. TOTAL DEPTH: 13.0
rock fragments at
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
bottom spoon
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
11. DISINFECTION: Type Amount
two State Roads or County Roads. Include the road
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
numbers and common road names.
From 0 To 3 Ft. 2" sch 40 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Methodanry—�
N/u
From 0 To Ft. Portland
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 3.0 To 13.0 Ft. 2 in. 0.010 in. PVC
From To Ft. in. in.
15. SAND/GRAVEL PACK:
—
Depth Size Material
S v
From 1.0 To 13.0 Ft. #2 Sand
rI
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THEN.$ C Y . S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG14ATURP, OF PERSON CONSTRUCTING
THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

PROJECT: NCDEQ Cranberry 76 MONITORING WELL NOI MW-3
��
CLIENT: NCDEQ UST Section PROJECT NO. 49-1430C
LOCATION:
ELEVATION:NiA
6741 US-19E Elk Park NC
DRILLER:
DATE DRILLED:
LOGGED BY:
3D Environmental Investigations
10/9/18
Ashley Barham
DRILL RIG:
DEPTH TO WATER:
Geo robe
8.22'
Elevation/
E
n �
a
o
-
WELL
a 0
E E
E >
)
_
°
`n
SOIL DESCRIPTION
CONSTRUCTION
Depth (Ft)
in z'
in
U
U
0
brown silt
M L
*'
3
_ -
black/brown clayey silt
6
ML-CL
s
�
9
12
15
18
21
Figure
Page 1 of 1

PROJECT: NCDEQ Cranberry 76 MONITORING WELL NOI MW-4
��
CLIENT: NCDEQ UST Section PROJECT NO. 49-1430C
LOCATION:
ELEVATION:NiA
6741 US-19E Elk Park NC
DRILLER:
DATE DRILLED:
LOGGED BY:
3D Environmental Investigations
10/9/18
Ashley Barham
DRILL RIG:
DEPTH TO WATER:
Geo robe
7.88'
Elevation/
E
n �
a
o
-
WELL
Depth (Ft)
a 0
E E
in
E >
in )
_
°
`n
SOIL DESCRIPTION
CONSTRUCTION
z'
U
U
0
brown silt
M L
*'
3
gray clayey silt
= _
6
ML-CL
s
s
9
black/gray clayey silt
12
15
18
21
Figure
Page 1 of 1

%0 WithersRavenel
Our People. Your Success.
WELL CONSTRUCTION LOG
Well ID: MW-5R Job Name: Cranberry 76 Job #: 23-0307-AY
Date: August 10, 2023 Site Loc.: Elk Park, Avery County, NC TOC EL: NA
WR Rep: S. Powell Driller: AmeriProbe GW EL: NA
NC NAD83 Easting: NA NC NAD83 Northing: NA
Depth in
Feet
PID
m
Soil Description
(Field USCS Classification)
Well Construction
0
Ground Surface
1
14.3
Tan silty CLAY
0-2 ft Concrete Grout
®®L?
®®
0-5 ft 2" Dia. PVC
® Casing
5-15 ft 2" Dia.
0.010-Slot PVC
Well Screen
3
2-4 ft Bentonite
4
5
4-15 ft Clean -Washed Torpedo SAND
6
18.5
7
8
9
10
11
10.2
Tan silty CLAY
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Notes:
1) Boring Terminated at 15' BLS
2) BLS - Below Land Surface
3) TOC - Top of Casing
= Groundwater Level (Measured Beneath TOC)
115 MacKenan Drive Cary, North Carolina 27511 te1:919.469.3340 fax:[phone] www.withersravenel.com
Page 1 of 1

WELL CONSTRUCTION RECORD (GW-1)
For Internal Use Only:
1. Well Contractor Information:
NICHOLAS HAYES
Well Contractor Name
A-4121
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geotherral (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cool
❑Municipal/Public
El Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Wells > 100,000 GPD
❑Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
El Other (explain under #21 F
4. Date Well(s) Completed: 10/02/23 Well ID#
5a. Well Location:
CRANBERRY - 76
MW-6
Facility/Owner Name Facility ID# (if applicable)
6741 HIGHWAY 19E ELK PARK 28622
Physical Address, City, and Zip
AVERY
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
360 09' 12.64" N 810 57' 54.36" W
6. Is(are) the well(s): [EPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15.0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if a licable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING eother at closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 tt•
5.0 tt•
2.0 in.
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5.0 ft'
15.0 ft'
2.0 in.
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 It.
3.0 ft'
PORTLANDBENTONrrE
SLURRY
ft.
ft.
rL
rt.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.0 tt•
15.0 tt•
20-40
FINE SILICA SAND
rt.
rt.
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 It.
6.0 ft'
CONCRETE/ROCKS
6.0 tt•
15.0 tt.
CLAY/RIVER COBBLE
rt.
et.
rt.
et.
ft.
tt.
rt.
et.
21. REMARKS
BENTONITE SEAL - 3.0 - 4.0 FEET
22. Certification:
Signature of Certified Well Contractor
10/12/23
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance with
1 SA NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a copy
of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
10. Static water level below top of casing:
7.0 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing, use "+ "
11. Borehole diameter: 6.0
12. Well construction method: AIR
(i.e. auger, rotary, cable, direct push, etc.)
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Igiection Wells: Copy to DWR, Underground Injection Control (NC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
13a. Yield (gpm) Method of test: Permit Program, 1611 MSC, Raleigh, NC 27699-1611
13b. Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

%0 WithersRavenel
Our People. Your Success.
WELL CONSTRUCTION LOG
Well ID: MW-6 Job Name: Cranberry 76 Job #: 23-0307-AY
Date: October 2, 2023 Site Loc.: Elk Park, Avery County, NC TOC EL: NA
WR Rep: T. Clough Driller: Geologic Exploration GW EL: NA
NC NAD83 Easting: NA NC NAD83 Northing: NA
Depth in
Feet
PID
m
Soil Description
(Field USCS Classification)
Well Construction
0
Ground Surface
1
NM
Concrete/Boulders
0-2 ft Concrete Grout
®® �
®®
0-5 ft 2" Dia. PVC
® Casing
5-15 ft 2" Dia.
0.010-Slot PVC
Well Screen
3
2-4 ft Bentonite
4
5
4-15 ft Clean -Washed Torpedo SAND
6
NM
7
Brown CLAY, wet
8
9
10
11
31.3
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Notes:
1) Boring Terminated at 15' BLS
2) BLS - Below Land Surface
3) TOC - Top of Casing
= Groundwater Level (Measured Beneath TOC)
115 MacKenan Drive Cary, North Carolina 27511 te1:919.469.3340 fax:[phone] www.withersravenel.com
Page 1 of 1

40
..Our People. Your Success.
DIAGRAM OF TYPICAL INJECTION POINT
Cranberry 76- NCDEQ Incident #17059 WR Project # 23-0307-AY
Notice of Intent - UIC February 2024

Boring # TBD
Date TBD
WR Rep TBD
Ird:J[O7_1OR ,F1=10&R,11071ZIII"M
Job Name Cranberry 76
Site Loc. Elk Park, Avery County, NC
Driller AST Environmental and their Subcontractor
1O ithersavenel
1/ Engineers I Planners I Surveyors
Job # 23-0307-AY
Easting NA
Northing NA
Depth in Feet
(below land
Detail
surface)
Soil Description
From To
(Field USCS Classification)
0
13
0
a
0
U
N
H
d
Native Soils (TBD)
c
�a
O
U
O
m
O U
N
� �
C
CO
�
CO
DPT injection points extend to 13 feet below
land surface. Injection intervals for each point
are 6 to 13 feet below land surface. Following
completion of injections, each point will be
abandoned with bentonite and/or concrete to
match original surface grade.
Page 1 of 1
115 MocKenan Drive, Cary, North Carolina 27511 tel:[phone] fox:919.467.6008 www.withersrovenel.com

40
..Our People. Your Success.
BOS 200 SAFETY DATA SHEET
Cranberry 76- NCDEQ Incident #17059 WR Project # 23-0307-AY
Notice of Intent - UIC February 2024

CalgonCarbon,
TRAP & TREAT® BOS 200®
Safety Data Sheet
SECTION 1: Identification of the Substance/Mixture and of the Company/Undertaking
1.1. Product identifier
Product name Activated Carbon
Product form Mixture
Product code 3967
Other means of identification Activated Carbon
1.2. Relevant identified uses of the substance or mixture and uses advised against
Use of the substance/mixture : Adsorbent
1.3. Details of the supplier of the safety data sheet
Calgon Carbon Corporation
P.O. Box 717
Pittsburgh, PA 15230
412-787-6700
1.4. Emergency telephone number
Emergency number : CHEMTREC (24 HRS): 1-800-424-9300
SECTION 2: Hazards Identification
2.1. Classification of the substance or mixture
Issued: 06/05/2015
Supersedes: 12/30/2011
Version: 1.0
GHS-US classification
Combustible Dust H232
Not classified as a simple asphyxiant. Product does not displace oxygen in the ambient atmosphere, but slowly adsorbs oxygen from a confined
space when wet. Under conditions of anticipated and recommended use, product does not pose an asphyxiation hazard.
2.2. Label elements
GHS-US labeling
Signal word (GHS-US) : Warning
Hazard statements (GHS-US) H232 - May form combustible dust concentrations in air
2.3. Other hazards
Other hazards not contributing to the Wet activated carbon can deplete oxygen from air in enclosed spaces. If use in an enclosed
classification space is required, procedures for work in an oxygen deficient environment should be followed.
2.4. Unknown acute toxicity (GHS-US)
No data available
SECTION 3: Composition/Information on Ingredients
3.1. Substance
Not applicable
3.2. Mixture
Name
Product identifier
%
Activated Carbon
(CAS No) 7440-44-0
>_ 80
Gypsum (Hydrated calcium sulfate)
(CAS No) 13397-24-5
< 20
SECTION 4: First Aid Measures
4.1. Description of first aid measures
First -aid measures general If exposed or concerned, get medical attention/advice. Show this safety data sheet to the
doctor in attendance. Wash contaminated clothing before re -use. Never give anything to an
unconscious person.
First -aid measures after inhalation IF INHALED: Remove to fresh air and keep at rest in a position comfortable for breathing.
First -aid measures after skin contact IF ON SKIN (or clothing): Remove affected clothing and wash all exposed skin with water for at
least 15 minutes.
First -aid measures after eye contact IF IN EYES: Immediately flush with plenty of water for at least 15 minutes. Remove contact
lenses if present and easy to do so. Continue rinsing.
First -aid measures after ingestion IF SWALLOWED: Rinse mouth thoroughly. Do not induce vomiting without advice from poison
control center or medical professional. Get medical attention if you feel unwell.
06/05/2015 TRAP & TREAT® BOS 2009) For Internal Use Only: PR#85 Page 1 of 7
3967

Activated Carbon
Safety Data Sheet
4.2. Most important symptoms and effects, both acute and delayed
Symptoms/injuries Not expected to present a significant hazard under anticipated conditions of normal use.
However, dust may cause irritation and redness of the eyes, irritation of the skin and respiratory
system. The effects of long-term, low-level exposures to this product have not been
determined.
4.3. Indication of any immediate medical attention and special treatment needed
No additional information available
SECTION 5: Firefighting Measures
5.1. Extinguishing media
Suitable extinguishing media Water spray. Carbon dioxide. Dry chemical. Foam. Sand.
Unsuitable extinguishing media None known.
5.2. Special hazards arising from the substance or mixture
Fire hazard Dust may be combustible under specific conditions. May be ignited by heat, sparks or flames.
Explosion hazard Dust may form explosive mixture in air.
Reactivity No dangerous reactions known under normal conditions of use. Carbon oxides, ammonia, or
toxic halide fumes may be emitted upon combustion of the material.
5.3. Advice for firefighters
Firefighting instructions Wear NIOSH-approved self-contained breathing apparatus suitable for the surrounding fire.
Use water spray or fog for cooling exposed containers. Evacuate area.
SECTION 6: Accidental Release Measures
6.1. Personal precautions, protective equipment and emergency procedures
General measures Evacuate area. Keep upwind. Ventilate area. Spill should be handled by trained clean-up crews
properly equipped with respiratory equipment and full chemical protective gear (see Section 8).
6.1.1. For non -emergency personnel
No additional information available
6.1.2. For emergency responders
No additional information available
6.2. Environmental precautions
Prevent entry to sewers and public waters. Avoid release to the environment. Product is not soluble, but can cause particulate emission of
discharged into waterways. Dike all entrances to sewers and drains to avoid introducing material to waterways. Notify authorities if product enters
sewers or public waters.
6.3. Methods and material for containment and cleaning up
For containment Sweep or shovel spills into appropriate container for disposal. Minimize generation of dust.
Methods for cleaning up Sweep or shovel spills into appropriate container for disposal. Minimize generation of dust.
Dispose of material in compliance with local, state, and federal regulations.
6.4. Reference to other sections
No additional information available
SECTION 7: Handling and Storage
7.1. Precautions for safe handling
Precautions for safe handling Avoid dust formation. Avoid contact with skin, eyes and clothing. Do not handle until all safety
precautions have been read and understood. Wash hands and other exposed areas with mild
soap and water before eating, drinking or smoking and when leaving work. Keep away from
sources of ignition - No smoking.
7.2. Conditions for safe storage, including any incompatibilities
Storage conditions Keep container tightly closed in a cool, dry, and well -ventilated place. Keep away from ignition
sources.
SECTION 8: Exposure Controls/Personal Protection
8.1. Control parameters
Activated Carbon (7440-44-0)
OSHA PEL (TWA) (mg/m') <_ 5 (Respirable Fraction)
<_ 15 (Total Dust)
06/05/2015 TRAP & TREAT® BOS 2009) For Internal Use Only: PR#85 2/7
3967

Activated Carbon
Safety Data Sheet
Gypsum (Hydrated calcium sulfate) (13397-24-5)*
OSHA PEL (TWA) (mg/m') <_ 5 (Respirable Fraction)
<_ 15 (Total Dust)
*Exposure limits are for inert or nuisance dust. No specific exposure limits have been established for this activated carbon product by OSHA or ACGIH.
8.2. Exposure controls
Appropriate engineering controls Provide adequate general and local exhaust ventilation. Use process enclosures, local exhaust
ventilation, or other engineering controls to control airborne levels below recommended
exposure limits. Use explosion -proof equipment with flammable materials. Ensure adequate
ventilation, especially in confined areas. Wet activated carbon can deplete oxygen from air in
enclosed spaces. If use in an enclosed space is required, procedures for work in an oxygen
deficient environment should be followed.
Personal protective equipment Gloves. Safety glasses. Insufficient ventilation: wear respiratory protection.
O O
Hand protection Gloves should be classified under Standard EN 374 or ASTM F1296. Suggested glove
materials are: Neoprene, Nitrile/butadiene rubber, Polyethylene, Ethyl vinyl alcohol laminate,
PVC or vinyl. Suitable gloves for this specific application can be recommended by the glove
supplier.
Eye protection Use eye protection suitable to the environment. Avoid direct contact with eyes.
Skin and body protection Wear long sleeves, and chemically impervious PPE/coveralls to minimize bodily exposure.
Respiratory protection Use NIOSH-approved dust/particulate respirator. Where vapor, mist, or dust exceed PELs or
other applicable OELs, use NIOSH-approved respiratory protective equipment.
SECTION 9: Physical and Chemical Properties
9.1. Information on basic physical and
chemical properties
Physical state
Solid
Appearance
Granular, powder, or pelletized substance
Color
Black
Odor
Odorless
Odor threshold
No data available
pH
No data available
Relative evaporation rate (butyl acetate=1)
Not applicable
Melting point
Not applicable
Freezing point
Not applicable
Boiling point
Not applicable
Flash point
No data available
Auto -ignition temperature
> 220 °C
Decomposition temperature
No data available
Flammability (solid, gas)
> 220 °C
Vapor pressure
Not applicable
Relative vapor density at 20 °C
Not applicable
Apparent density
0.4 - 0.8 g/cc
Solubility
Carbon and gypsum are insoluble; fertilizer components are soluble
Log Pow
Not applicable
Log Kow
Not applicable
Viscosity, kinematic
Not applicable
Viscosity, dynamic
Not applicable
Explosive properties
No data available
Oxidizing properties
No data available
Explosive limits
No data available
9.2. Other information
No additional information available
06/05/2015 TRAP & TREAT® BOS 2009) For Internal Use Only: PR#85
3967
3/7

Activated Carbon
Safety Data Sheet
SECTION 10: Stability and Reactivity
10.1. Reactivity
No dangerous reactions known under normal conditions of use.
10.2. Chemical stability
Stable under use and storage conditions as recommended in section 7.
10.3. Possibility of hazardous reactions
None known.
10.4. Conditions to avoid
Avoid dust formation. Heat. Ignition sources. Exposure to high concentrations of organic compounds may cause bed temperature to rise.
10.5. Incompatible materials
Alkali metals. Strong oxidizing agents.
10.6. Hazardous decomposition products
Carbon monoxide (CO), carbon dioxide (COZ). Ammonia. Toxic halide fumes.
SECTION 11: Toxicological Information
11.1. Information on toxicological effects
Acute toxicity
Not classified
Activated Carbon (7440-44-0)
LD50 oral rat
> 2000 mg/kg
Skin corrosion/irritation
Not classified
Serious eye damage/irritation
Not classified
Respiratory or skin sensitisation
Not classified
Germ cell mutagenicity
Not classified
Carcinogenicity
Not classified
Silica: Crystalline, quartz (14808-60-7)
IARC group 1 1 - Carcinogenic to humans
The International Agency for Research on Cancer (IARC) has classified "silica dust, crystalline, in the form of quartz or cristobalite" as carcinogenic
to humans (group 1). However these warnings refer to crystalline silica dusts and do not apply to solid activated carbon containing crystalline silica
as a naturally occuring, bound impurity. As such, we have not classified this product as a carcinogen in accordance with the US OSHA Hazard
Communication Standard (29 CFR §1910.1200) but recommmend that users avoid inhalation of product in a dust form.
Reproductive toxicity
Not classified
Specific target organ toxicity (single exposure)
Not classified
Specific target organ toxicity (repeated
Not classified
exposure)
Aspiration hazard
Not classified
Symptoms/injuries after inhalation
Not classified
Symptoms/injuries
Not expected to present a significant hazard under anticipated conditions of normal use.
However, dust may cause irritation and redness of the eyes, irritation of the skin and respiratory
system. The effects of long-term, low-level exposures to this product have not been
determined.
SECTION 12: Ecological information
12.1. Toxicity
No additional information available
12.2. Persistence and degradability
No additional information available
12.3. Bioaccumulative potential
No additional information available
12.4. Mobility in soil
No additional information available
12.5. Other adverse effects
No additional information available
06/05/2015 TRAP & TREAT(R) BOS 2000 For Internal Use Only: PR#85 4/7
3967

Activated Carbon
Safety Data Sheet
SECTION 13: Disposal Considerations
13.1. Waste treatment methods
Waste treatment and disposal methods Vacuum or shovel material into a closed container. Dispose in a safe manner in accordance
with local/national regulations. Do not allow the product to be released into the environment.
Additional information Activated carbon is an adsorbent media; hazard classification is generally determined by the
adsorbate. Consult U.S. EPA guidelines listed in 40 CFR 261.3 for more information on
hazardous waste disposal.
SECTION 14: Transport Information
14.1. In accordance with DOT
Not classified as hazardous for domestic land transport
UN-No.(DOT) None on finished product
DOT NA no. None on finished product
Proper Shipping Name (DOT) Not regulated
Department of Transportation (DOT) Hazard None on finished product
Classes
Hazard labels (DOT) None on finished product
Packing group (DOT) None on finished product
DOT Quantity Limitations Passenger aircraft/rail None on finished product
(49 CFR 173.27)
14.2. Transport by sea
Not classified as hazardous for water transport
IMO / IMDG
UN/NA Identification Number : None on finished product
UN- Proper Shipping Name : Not regulated
Transport Hazard Class : None on finished product
14.3. Air transport
Not classified as hazardous for air transport
ICAO / IATA
UN/NA No
: None on finished product
UN- Proper Shipping Name
: Not regulated
Transport Hazard Class
: None on finished product
Packing Group
: None on finished product
Marine Pollutant
: None on finished product
14.4. Additional information
Other information Under the UN classification for activated carbon, all activated carbons have been identified as a
class 4.2 product. However, this product type or an equivalent has been tested according to
the United Nations Transport of Dangerous Goods test protocol for a "self -heating substance"
(United Nations Transportation of Dangerous Goods, Manual of Tests and Criteria, Part lll,
Section 33.3.1.6 - Test N.4 - Test Method for Self Heating Substances) and it has been
specifically determined that this product type or an equivalent does not meet the definition of a
DOT self -heating substance (class 4.2) or any other hazard class.
SECTION 15: Regulatory Information
15.1. US Federal regulations
Activated Carbon Profile 85
All chemical substances in this product are listed in the EPA (Environment Protection Agency) TSCA (Toxic Substances Control Act) Inventory
or are exempt.
SARA Section 311/312 Hazard Classes Immediate (acute) health hazard
Cobalt (7440-48-4)"
Listed on the United States TSCA (Toxic Substances Control Act) inventory
Listed on United States SARA Section 313
SARA Section 313 - Emission Reporting 0.1 %
*Present below de minimis level
15.2. International regulations
No additional information available
06/05/2015 TRAP & TREAT® BOS 2009) For Internal Use Only: PR#85
3967
5/7

Activated Carbon
Safety Data Sheet
15.3. US State regulations
California Proposition 65
WARNING: This product contains, or may contain, trace quantities of a substance(s) known to the state of California to cause cancer, birth defects,
or other reproductive harm.
Silica: Crystalline, quartz (14808-60-7)
U.S. - California -
U.S. - California -
U.S. - California -
U.S. - California -
No significance risk level
Proposition 65 -
Proposition 65 -
Proposition 65 -
Proposition 65 -
(NSRL)
Carcinogens List
Developmental Toxicity
Reproductive Toxicity -
Reproductive Toxicity -
Female
Male
Yes
No
No
No
NA
Cobalt (7440-48-4)
U.S. - California -
U.S. - California -
U.S. - California -
U.S. - California -
No significance risk level
Proposition 65 -
Proposition 65 -
Proposition 65 -
Proposition 65 -
(NSRL)
Carcinogens List
Developmental Toxicity
Reproductive Toxicity -
Reproductive Toxicity -
Female
Male
Yes
No
No
No
NA
Titanium dioxide (13463-67-7)
U.S. - California -
U.S. - California -
U.S. - California -
U.S. - California -
No significance risk level
Proposition 65 -
Proposition 65 -
Proposition 65 -
Proposition 65 -
(NSRL)
Carcinogens List
Developmental Toxicity
Reproductive Toxicity -
Reproductive Toxicity -
Female
Male
Yes
No
No
No
NA
Aluminum oxide (1344-28-1)
U.S. - New Jersey - Right to Know Hazardous Substance List
U.S. - Massachusetts - Right to Know List
U.S. - Pennsylvania - RTK (Right to Know) - Environmental Hazard List
Calcium sulfate (7778-18-9)
U.S. - Massachusetts - Right to Know List
U.S. - New Jersey - Right to Know Hazardous Substance List
U.S. - Pennsylvania - RTK (Right to Know) List
Silica: Crystalline, quartz (14808-60-7)
U.S. - New Jersey - Right to Know Hazardous Substance List
U.S. - Pennsylvania - RTK (Right to Know) List
U.S. - Massachusetts - Right to Know List
Gypsum (Hydrated calcium sulfate) (13397-24-5)
U.S. - New Jersey - Right to Know Hazardous Substance List
U.S. - Pennsylvania - RTK (Right to Know) List
Ammonium Nitrate (6484-52-2)
U.S. - New Jersey - Right to Know Hazardous Substance List
U.S. - Massachusetts - Right To Know List
U.S. - Pennsylvania - RTK (Right to Know) List
Limestone (1317-65-3)
U.S. - Massachusetts - Right To Know List
U.S. - New Jersey - Right to Know Hazardous Substance List
U.S. - Pennsylvania - RTK (Right to Know) List
SECTION 16: Other Information
Indication of changes Revision 1.0: New SDS Created.
Revision Date 06/05/2015
Other information Author: CJS.
For internal use only PR #85
Prepared according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations
06/05/2015 TRAP & TREAT® BOS 2000 For Internal Use Only: PR#85 6/7
3967

Activated Carbon
Safety Data Sheet
NFPA health hazard 0 - Exposure under fire conditions would offer no hazard
beyond that of ordinary combustible materials.
NFPA fire hazard 1 - Must be preheated before ignition can occur.
NFPA reactivity 0 - Normally stable, even under fire exposure conditions,
and are not reactive with water.
HMIS III Rating
Health
Flammability
Physical
Personal Protection
This information is based on our current knowledge and is intended to describe the product for the purposes of health, safety and environmental
requirements only. It should not therefore be construed as guaranteeing any specific property of the product. The information is this document
applies to this specific material as supplied. It may not be valid if product is used in combination with other materials. It is the user's responsibility to
determine the suitability and completeness of this information for their particular use. While the information and recommendations set forth herein
are believed to be accurate as of the date hereof, Calgon Carbon Corporation makes no warranty with respect to the same, and disclaims all liability
for reliance thereon.
06/05/2015 TRAP & TREAT® BOS 2000 For Internal Use Only: PR#85 7/7
3967

40
W4Pour People. Your Success.
AST ENVIRONMENTAL PROPOSAL
Cranberry 76- NCDEQ Incident #17059 WR Project # 23-0307-AY
Notice of Intent - UIC February 2024

Client Name JNCDEQ
Project Location I Elk Park, NC (Cranberry 76)
Site Information
Predominate Geology of Treatment Zone
Saprolite
Treatment Zone Area (ftA2)
1,200
Contamination Depth Start (ft bgs)
6.0
Contamination Depth End (ft bgs)
12.75
Treatment Volume (ydA3)
300.0
Triangular Grid Spacing (ft)
5.0
Number of Injection Points - Design - including MW-06
50
Injection Interval Distance (ft)
1.5
Number of Injection Intervals per Point - Design
5.0
Total Number of Injection Intervals
250
Effective Porosity
30%
Pore Volume (L)
68,818
Soil Density (lb/ftA3)
110
Speciated CDC Design Calculations
Contaminant of Concern
Xylene
Design Basis Soil (mg/kg) or Groundwater (mg/L)
Groundwater
Design Concentration
9.900
Design Endpoint
0.500
Contaminant of Concern Mass Loading (lb/ftA3)
1.85E-04
BOS 200 per Injection Interval - Design (lb)
15
BOS 200 Slurry Volume per Interval (gal)
15
Average BOS 200 per Injection Point (lb)
75
BOS 200 Total (lb)
3,750
TPH Design Calculations
TPH Groundwater Concentration (mg/L)
TPH Soil Concentration (mg/kg)
TPH Mass (Ib)
BOS 200 Total Demand (Ib)
Design Basis
Select Speciated or TPH
Speciated
Design BOS 200 Total per Area (lb)
3,750
Trap & Treat Bacteria Calculations
Bacteria Concentrate (gal)
8
Sulfate Demand Calculations
Supplemental Gypsum per Interval - Design (lb)
10
Total Supplemental Gypsum (lb)
2,500
Slurry and Water Volumes
Slurry Volume per Interval (gal)
15
Estimated Water Volume (gal)
3,750
Summary
BOS 200 Total (lb)
3,750
BOS 200 Unit Price ($, per RPI website)
$6.25
Bacteria Concentrate (gal)
10
Bacteria Concentrate Price ($, per RPI website)
$115.00
Supplemental Gypsum Total (Ib)
2,500
Gypsum Unit Price ($)
$0.50
Estimated Shipping and Tax ($/Ib)
$0.40
Total Material Price ($)
$27,338
Number of Field Days to Complete
3
Mobilization ($)
$2,500
Total Installation Price ($)
$25,000
Estimated RDC Price ($)
Total Estimated Price ($)
$52,338
12/19/2023

0
0 0 0 °XX
MW-2 � 00 0 0
0
0 0
M 0 °° 00
o,, 0 0 0
° 0
MW-5R 0
1
LEGEND
TYPE II MONITORING WELL LOCATION
® TYPE III MONITORING WELL LOCATION
NAPHTHALENE CONCENTRATION CONTOUR (ug/L)
(94.57) NAPHTHALENE CONCENTRATION (ug/L)
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIB DEPARTMENT.
2.) TYPE III WELLS NOT USED TO CREATE CONTOURS.
6 --
'O�MW-6
(19.4)
SCALE
1 inch = 30 ft.
• DRAWN BY: SCALE: FIGURE NO.:
Wi thersRavenel NAPHTHALENE
1/ CRANBERRY 76 - TF# 17095 MM 1"=30' 6
Engineers Planners Surveyors 6741 NORTH US HWY 19 E ISOCONCENTRATION
APPROVED BY: DATE: PROJECT NO.:
ELK PARK, AVERY COUNTY, NC MAP
115 MacKenan Drive I Cary, NC 275111 t: 919.469.33401 license #: F-1479 I FD 11/10/23 23-0307-AY
www.withersravenel.com
.h\2A0W7—AY-0vihr 7E\6Mo\GD\Ber Ym CmM r 7MA 14 r6w 10 SM.S — WLTM WT

40
..Our People. Your Success.
ACCESS AGREEMENT
Cranberry 76- NCDEQ Incident #17059 WR Project # 23-0307-AY
Notice of Intent - UIC February 2024

jjA
WNW
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Beverly Eaves Perdue Dexter R. Matthews
Governor Director
April 12, 2010
Mike and Perry Gray
520 Cloudland Drive
Roan Mountain, TN 37687
RE: Site Access Request
Cranberry 76
6741 N. US Hwy 19E
Elk Park, Avery County, NC (ARO)
FTF Incident Number 17059
Dear Mr. Gray:
Dee Freeman
Secretary
The Asheville Regional Office (ARO) referred the subject site to the State Underground Storage Tank
(USA') Trust Fund Branch, Federal -Lead Program for inclusion on the list of sites awaiting cleanup
pursuant to G.S. 143-215.94G(a) in 1998. The Responsible Party removed two 1,000-gallon gasoline
USTs from the site in February 1996. In 1998, the FTF conducted site assessment activities and confirmed
soil contamination from USTs at this site (a high of 1,420 mg/kg gasoline range Total Petroleum
Hydrocarbons were identified). Due to the possible presence of groundwater users within 1500 feet of the
site and based on the confirmation of contamination remaining at the site, the subject property was
accepted into the Federal -Lead Program. According to the information on file, you are not considered to
be an owner or operator of the USTs pursuant to G.S. 143-215.94A.
In order to determine the risk posed by the contamination at the subject property, the UST Section will
need to access your property in order to take all reasonable and necessary action(s) to conduct assessment
and remedial activities necessary to protect human health and the environment. Please sign the attached
site access agreement letter and return to the address indicated on the letter. Please understand that failure
to allow access to the property could potentially make you responsible for the cleanup under other State
and Federal regulations. You will be notified when assessment and/or remedial activities are conducted.
If you have any questions, please feel free to contact me at [phone] or via e-mail at
Sharon. C=hiold( ncdenr.gov. Per your request, a copy of the upcoming report will bdmailed to you.
Sincerely,
)J1aron Ghiold
Hydrogeologist
1637Mail Service Center, Raleigh, North Carolina 27699-1637 One
Phone: [phone] FAX: [phone] Internet: www.wastenotnc.org NofffiCarollina
An Equal Opportunity l Affirmative Action Employer X7AM74

Mrs. Sharon Ghiold
DWM UST Section
1637 Mail Service Ctr
Raleigh, NC 27699-1637
Dear Mrs. Ghiold:
RE: Site Access Agreement
Related to Cranberry 76, FTF #17059 P
6741 N. US Hwy 19E, Elk Park, Avery County, North Carolina - ARO
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 land owner.

F77- 1 DES` 5�
I/We agree not to interfere with, remove, or any way damage the existing monitor wells, the
Department's well(s) or its contractor's well(s) and equipment during the investigation.
Sincerely,
Signature
Type/Print Name of Owner or Ag nt
'Z 3, 77 Z- q17L
Phone Number
SZ ® 16_ctollli- P
Address
5
City/State/Zip Code
,,r- r 9, 00 /LO
Date