WI0400500_Notification of Intent (NOI) – GW Remediation_20180824

North Carolina Department of Environmental Quality — Division of Water Resources
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. This form shall be submitted at least 2 WEEKS prior to injection.
AQUIFER TEST WELLS (15A NCAC 02C:.0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
INSITU REMEDIATION (15A NCAC 02( .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection S\ stems - 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: AuT,ust 20 , 20 18_ PERMIT NO. (V I O't d 0 ,'�d 0 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1)
Air Injection Well......................................Complete
sections B through F, K, N
(2)
Aquifer Test Well.......................................Complete
sections B through F, K, N
(3)
Passive Injection System...............................Complete
sections B through F, H-N
(4)
Small -Scale Injection Operation ......................Complete sections B through N
(5) X
Pilot Test.................................................Complete
sections B through N
(6)
Tracer Injection Well...................................Complete
sections B through N
B. STATUS OF WELL OWNER: Choose
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 UST Section
Mailing Address: 1646 Mail Service Center
City: Ralei State: NC _Zip Code:27699 County: Wake
Day Tele No.: 919-707-8166 Cell No.:
EMAIL Address: Sharon.�Lhiold a ncdenr.cov Fax No.:
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 1

D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: _ Cisco Properties
Company Name Cisco Properties
Mailing Address: 5955 S. Western Avenue
City: Los Am eles State: CA Zip Code: 90047 County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
E.
F.
G.
H.
PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Ashle-, Barham
Company Name ECS Southeast. LLP
Mailing Address: 4811 Kocer Boulevard
City: Greensboro State: NC Zip Code:
Day Tele No.: 336-856-7150
EMAIL Address: [e-mail]
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Hi�1dand Yarn Mills
1014 Mill Avenue
Cell No.
Fax No.:
27407 County: Guilford
336-478-1633
City: High Point _County: _ Guilford Zip Code: 27406
(2) Geographic Coordinates: Latitude": 35.9373360
Longitude * * : 80.0091430
Reference Datum: Accuracy:
Method of Collection: Goode Earth
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH
PROPERTYBOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Land surface area of contaminant plume: 100 square feet
Land surface area of inj. well network: 100 square feet (< 10,000 ftz for small-scale injections)
Percent of contaminant plume area to be treated: <1 % (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.
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 2

I. 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.
ECS will inject approximateh 1 kilogram of Enviro-BAC mixed with five gallons of into
monitoring_, wells MW-1 and MW-5. The h� drated Enviro-BAC will be pursed into the
monitoring, wells. The aqueous Enviro-BAC will mix with groundwater within the wells.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant. Attach additional sheets if necessary.
NOTE: Only injectants approved by the NC Division of Public 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/p-round-water-protection/eround-water-approved-ini ectants.
All other substances must be reviewed by the DHHSprior to use. Contact the UIC Program for more info (919
807-6496).
Injectant: Enviro-BAC
Volume of injectant: 14, mixed with five gallons in each well
Concentration at point of injection: 100%
Percent if in a mixture with other injectants: N/A
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:
is WELL CONSTRUCTION DATA
(1) Number of injection wells: Proposed 2 Existing (provide GW-ls)
(2) 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
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3

L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Planned injection activities to occur in August or September 2018.
Subsequent sampling activities to occur approximatel\ 30 and 60 da\ s from injection.
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.
ECS will collect a uroundwater sample from the monitoring wells in September
and October 2018. The groundwater sample will be anal% zed for volatile organic coma ounds
usin�� Standard Method 6200B. The groundwater sample will also be anal -,zed for
bacterial counts before injection and following injection.
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
c/I I•elated atw m-tenances in accordance with the 1 SA NCAC 02C 0200 Rules. "
4_6� A�hleu�O.(Mm
of A plicant rint or Type Full Name and Title
PROPERTY OWNER Iif the propert\ is not owned b\ the permit 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
(1 SA 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.
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.
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 4

Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 5

Sharon Ghiold
DWM UST Section
1637-Mail Service Ctr
Raleigh, -NC 27699-1637
Dear Ms. Ghiold;
RE: Site Access Agreement
former Highland Yarn Mills -A,
1014 Mill Avenue
High Point,_Guilford• County,.NC (WSRQ)
STF # 30550, Risk: 1160D
I MVWe are the owner(s) of a parcel ofproper ty, 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.
T am/We are granting permission with the understanding that:
1. The investigation shall be conducted by the UST Section Oft 0 Department's Division of Waste
Management or its oontractor;
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 DepmIment or its contractor shall have access to the site b the
shortest feasible route to the nearest public road. The Department or its contractor may a ter
upon the land at reasonable times and have full light 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, Toil Claims Against State
Departments and Agencies, and as otherwise provided by law.
5. The information derived lxam the investigation shall be made available to the
request and is a public record, in accordance with G.Sowner upon
. 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 co
nstzved to be an
employee, or contractor of the land owner. Put,

N
1w
Gravel Road
TWB
NS
PLANT BUILDING
BOILER ROOM
I
MW-2
NS
SOURCE:
GUILFORD COUNTY GIS DEPARTMENT
SCALE (IN FEET)
66 33 0 66
/
<0.5
TWC
MW-5
590 1
1
1
1
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I
1
I
MW-6A
2.4 ® (�L
DW� 1
♦
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f 10,009/
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COOLING
,SOWER
CHILLER
r.
PLANT BUILDING
C
1\
LEGEND
® MONITORING WELL
50 CONCENTRATION (ppb)
— — • ISOCONCENTRATION LINE
NS = NOT SAMPLED
FIGURE 5
ISOCONCENTRATION MAP OF BENZENE
HIGHLAND YARN MILL
1014 MILL AVENUE
HIGH POINT, GUILFORD COUNTY,
NORTH CAROLINA
NCDEQ INCIDENT NO. 30550
ECS PROJECT NO. 49-5794

rNT
r
PLANT BUILDING
Gravel Road
BOILER ROOM
MW-5
75 ` 76.56 1
0
78
TWC
TW13® NM
NM 84 —
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MW -6
78.5" 1
MW-6A®
8
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NM
MW-2 ® ®®
-3
NM 83.®, 8
C �XNG
�O\N
0
Note: The water level in MW-6Awas
not used in determining the
groundwater flow direction
SOURCE:
GUILFORD COUNTY GIS DEPARTMENT
SCALE (IN FEET)
66 33 0 66
1
I
1
1
1
r
e
PLANT BUILDING
e
LEGEND
CHILLER ® MONITORING WELL
60 GROUNDWATER ELEVATION
GROUNDWATER FLOW
NM = NOT MEASURED
TM
FIGURE 4
GROUNDWATER ELEVATION MAP
HIGHLAND YARN MILL
1014 MILL AVENUE
HIGH POINT, GUILFORD COUNTY,
NORTH CAROLINA
NCDEQ INCIDENT NO. 30550
ECS PROJECT NO. 49-5794

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PERMANENT MONITORING WELL CONSTRUCTION DIAGRAM
Project Highland Yarn Mills
Locking
Well Cover
GROUND SURFACE
Well No. MW-1
Location High Point, North Carolina
6.25 inch diameter
drilled hole
Drilled By Aquaterra
Well casing,
Drilling Started February 8, 1993
2 inch diameter,
Drilling Completed February 8, 1993
Method of Drilling Auger
Grout to Surface
Type of Rig Geoprobe
11.0 ft. Top of bentonite
13.0 ft. Top of Sand Pack
15.0 ft Top of Screen
Well Screen,
1 inch diamter
0.01 slot
30.5 ft.
All Measurments are from the Ground
Surface Unless Otherwise Noted.
MONITORING WELL DATA
Well No.
MW-1
Hole Diameter
6.25 inches
Hole Depth
30 feet
Casing Diameter
2 inch
Casing Length
15 feet
Screen Diameter
2 inch
Screen Slot
0.01 inch
Screen Type
slot
Surface Elevation
No Data
Screen Top El.
No Data
Screen Bottom El.
No Data
Well Status
permanent
REMARKS
well constr log permanent

PERMANENT MONITORING WELL CONSTRUCTION DIAGRAM
Well Cover
GROUND SURFACE
6.25 inch diameter
drilled hole
Well casing,
2 inch diameter,
Grout to Surface
10.0 ft. Top of bentonite
12.0 ft. Top of Sand Pack
14.0 ft Top of Screen
Well Screen,
1 inch diamter
0.01 slot
29.5 ft.
All Measurments are from the Ground
Surface Unless Otherwise Noted.
Project Highland Yarn Mills
Well No.
MW-5
Location
High Point, North Carolina
Drilled By
Aquaterra
Drilling Started
February 8, 1993
Drilling Completed
February 8, 1993
Method of Drilling
Auger
Type of Rig
Geoprobe
MONITORING WELL DATA
Well No.
MW-1
Hole Diameter
6.25 inches
Hole Depth
29 feet
Casing Diameter
2 inch
Casing Length
15 feet
Screen Diameter
2 inch
Screen Slot
0.01 inch
Screen Type
slot
Surface Elevation
No Data
Screen Top El.
No Data
Screen Bottom El.
No Data
Well Status
permanent
REMARKS
well constr log permanent