WS-9716_44919_CA_WR_20230412_NOI Permit

Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 1
NC Department of Environmental Quality – Division of Water Resources (DWR)

Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.

DATE: April 11, 2023 PERMIT NO. (to be filled in by DWR)

NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:

Permit No. WI Issued Date:

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

B. STATUS OF WELL OWNER: State Government

NOTIFICATION OF INTENT (NOI) 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 15A NCAC 02C .0200 (NOTE: This form must be received at least 14 DAYS 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.

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 (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).

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 is 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.

5) In-Situ Thermal Wells (IST) – Used to ‘heat’ contaminated groundwater to enhance remediation.

Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 2

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 Division of Waste Management, UST Section, State Lead Program
Mailing Address: 1636 Mail Service Center
City: Raleigh State: _NC___ Zip Code:27699 County: Wake
Day Tele No.: 919-707-8166 Cell No.:
EMAIL Address: [e-mail] Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Cory Albright
Company Name
Mailing Address: 4774 US Hwy 601 N
City: Mocksville State: NC____ Zip Code: 27628 County: Davidson
Day Tele No.: Cell No.: 336-341-6324
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Al Quarles, Senior Project Manager
Company Name ATC Associates of North Carolina, PC
Mailing Address: 7606 Whitehall Executive Center Drive, Suite 800
City: Charlotte State: _NC___ Zip Code: 28273 County: Mecklenburg
Day Tele No.: 704-529-3200 Cell No.: 803-984-6764
EMAIL Address:[e-mail] Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: TF#44919, Crossroads Center-C
134 Arnold Road, Lexington, NC 27295
City: Lexington County: Davidson Zip Code: 28625
(2) Geographic Coordinates: Latitude**: o ′ ″ or 35.867290°
Longitude**: o ′ ″ or -80.250857°
Reference Datum: UST Basin Accuracy:
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: ~19,800 (2L); ~1,500 (GCL-Benzene) square feet
Land surface area of inj. well network: ~4,245 (overlapping VEW-1 and MW-1) square feet (< 10,000 ft2 for
small-scale injections)
Percent of contaminant plume area to be treated: ~20% (must be < 5% of plume for pilot test injections)

Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 3

H. 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.

I. 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:
Release of gasoline from UST system. Intermediate Risk, goal to reduce benzene to below the 5,000 µg/L Gross
Contamination Level (recently 6,590 µg/L in monitoring well MW-10). Ozone-enhanced air sparging in well
VEW-1 into the groundwater and in well MW-1 above the groundwater surface with some migration into
groundwater. To be conducted during the 96-hour Mobile-Multiphase Extraction Event (MMPE) using wells
MW-1 and MW-10 as total fluid extraction wells. The injection will be performed at approximately 3 cfm for
for VEW-1 and 10 scfm for MW-1. Radius of influence anticipated to be 30 feet with the two overlapping zone
of influence. The five-day injection event is scheduled to begin the week of May 22, 2023.

J. 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): 10-25 feet (MW-1) and 40-45 feet (VEW-1)
(3) For Proposed wells or Existing wells not having GW-1s, 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

K. INJECTION SUMMARY

NOTE: Only injectants approved by the epidemiology section of the NC Division of Public Health, Department
of Health and Human Services can be injected. Approved injectants can be found online at
http://deq.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 if you wish to get approval for a different additive. However, please
note it may take 3 months or longer. If no injectants are to be used use N/A.

Injectant: Ozone (160-700 mg/L vapor) Total Amt. to be injected (gal)/event: ~75,000 cubic feet vapor

Total Amt. to be injected (gal)/event: ~75,000 cubic feet vapor
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 4

No. of separate injection events: 1 Total Amt. to be injected (gal): ~75,000 cubic feet vapor

Source of Water (if applicable): Not 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.

ATC will sample selected monitoring wells, approximately two to three weeks after the Air Sparge event. The
water samples will be analyzed by SM 6200B. Dissolved oxygen in the injection wells (and wells MW-3 and
MW-10) will be measured prior to and following injection.

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 15A NCAC 02C 0200 Rules.”

Al Quarles, Senior Project Manager
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 signed access agreement Cory Albright
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]
SITE VICINITY MAP
1"= 2,000'
1
Project Number:
Date:Scale:
Drawing File:
Figure:
App'd By:
Drn. By:
Ckd. By:
N
H:\2021\OTHER OFFICES\NORTH CAROLINA\NCDEQ-STATE LEAD\CROSSROADS CENTER\SLC4491901-VIC.DWG, FIG111/17/2021
SEE LOWER LEFT
CROSSROADS CENTER-C
134 ARNOLD ROAD
LEXINGTON, DAVIDSON COUNTY, NORTH CAROLINA
SLC4491901 DH
AQ
AQ
ARNOLD ROAD SITEVEW-1MW-10MW-1MW-2MW-4MW-3SCALE: 1" = 20'2005101520NLEGEND:SITE PROPERTY LINENOTE: ALL LOCATIONS ARE APPROXIMATEPARCEL LINEMW-1MONITORING WELLWell IdentificationMW-12MW-13MW-11DESTROYED MONITORING WELLWell IdentificationFigure:Drawing File:
Project Number:
Ckd. By:
Drn. By:
App'd By:
Ckd. Date:Scale:Date:H:\2023\1 OTHER OFFICES\NORTH CAROLINA\NCDEQ-STATE LEAD\CROSSROADS CENTER\SLC4491902-SITE.DWG, FIG2
SITE MAP02/15/2023SEE LOWER LEFTCROSSROADS CENTER-C
134 ARNOLD ROAD
LEXINGTON, DAVIDSON COUNTY, NORTH CAROLINA
SLC4491901AS SHOWNMS
AQ2NOTES:
1.Features shown are not an authoritative location, nor are they presentedto a stated accuracy.
COORDINATE SYSTEM:
NAD 1983 NORTH CAROLINA STATE PLANE FIPS 3200, US SURVEY FEET
ARNOLD ROADSITEVEW-1MW-10MW-1MW-11MW-2MW-4MW-3SCALE: 1" = 20'2005101520NLEGEND:SITE PROPERTY LINENOTE: ALL LOCATIONS ARE APPROXIMATEPARCEL LINE86.8GROUNDWATER ELEVATION CONTOUR(DASHED WHERE INFERRED) (ft)GROUNDWATER FLOW DIRECTIONMW-286.80MONITORING WELLWell IdentificationRelative Groundwater Elevation (ft)86.80NM86.6786.3286.08NMNM86.186.286.386.486.586.686.786.8Figure:Drawing File:
Project Number:
Ckd. By:
Drn. By:
App'd By:
Ckd. Date:Scale:Date:H:\2021\OTHER OFFICES\NORTH CAROLINA\NCDEQ-STATE LEAD\CROSSROADS CENTER\SLC4491901-POT.DWG, FIG3
GROUNDWATER ELEVATION CONTOUR MAP11/18/2021SEE LOWER LEFTCROSSROADS CENTER-C
134 ARNOLD ROAD
LEXINGTON, DAVIDSON COUNTY, NORTH CAROLINA
SLC4491901AS SHOWNDH
AQ4NOTES:
1.Features shown are not an authoritative location, nor are they presented
to a stated accuracy.
2.Groundwater elevations measured October 8, 2021.
3.NM = Not Measured
COORDINATE SYSTEM:
NAD 1983 NORTH CAROLINA STATE PLANE FIPS 3200, US SURVEY FEET
ARNOLD ROAD SITEVEW-1MW-10MW-1MW-2NSMW-4MW-3SCALE: 1" = 20'2005101520NLEGEND:SITE PROPERTY LINENOTE: ALL LOCATIONS ARE APPROXIMATEPARCEL LINEMW-1MONITORING WELLWell IdentificationMW-12MW-13MW-11MW-11DESTROYED MONITORING WELLWell Identification
Figure:Drawing File:
Project Number:
Ckd. By:
Drn. By:
App'd By:
Ckd. Date:Scale:Date:H:\2023\1 OTHER OFFICES\NORTH CAROLINA\NCDEQ-STATE LEAD\CROSSROADS CENTER\SLC4491902-GW.DWG, FIG5
GROUNDWATER ANALYTICAL MAP02/15/2023SEE LOWER LEFTCROSSROADS CENTER-C
134 ARNOLD ROAD
LEXINGTON, DAVIDSON COUNTY, NORTH CAROLINA
SLC4491901AS SHOWNMS
AQ5NOTES:
1.Features shown are not an authoritative location, nor are they presentedto a stated accuracy.2.Groundwater samples collected on 01/13/23.3.Only constituents exceeding the NCDEQ 2L Standards are shown.4.Concentrations underlined values exceed the GCL.5.µg/L = micrograms per liter.
6.J = estimated value between the laboratory reporting and method
detection limits.
COORDINATE SYSTEM:
NAD 1983 NORTH CAROLINA STATE PLANE FIPS 3200, US SURVEY FEET
TABLE 1
WELL CONSTRUCTION AND GROUNDWATER ELEVATION DATA
Crossroads Center-C
134 Arnold Road
Lexington, Davidson County, North Carolina 27295
NCDEQ Incident #44919
06/27/2019 6.17 ----93.83
10/08/2021 13.33 ----86.67
01/13/2023 9.88 ----90.12
06/27/2019 --------
10/08/2021 13.82 ----86.80
01/13/2023 10.59 ----90.03
06/27/2019 5.13 ----93.26
10/08/2021 12.31 ----86.08
01/13/2023 8.95 ----89.44
06/27/2019 5.74 ----93.36
10/08/2021 12.78 ----86.32
01/13/2023 9.13 ----89.97
02/01/2018 13.75 ----85.95
05/07/2018 9.22 ----90.48
04/10/2019 8.25 ----91.45
06/27/2019 5.89 ----93.81
10/08/2021 13.00 ----86.70
01/13/2023 10.38 ----89.32
06/27/2019 --------
02/01/2018 14.90 ------
01/13/2023
MW-12 1/9/2023 2 20.00 5 - 20 98.62 01/13/2023 9.01 ----89.61
MW-13 1/9/2023 2 20.00 5 - 20 96.39 01/13/2023 6.69 ----89.70
06/27/2019 6.20 ----93.64
10/08/2021 13.29 ----86.55
Notes:
TOC = Top-of-casing
-- = Not Measured
NA = Not Available
LNAPL = light non-aqueous phase liquid
If LNAPL is present in a well, groundwater elevation should be calculated by: [Top of Casing Elevation - Depth to Water] + [Free Product Thickness x 0.8581]
Well Destroyed
10 - 25
10 - 25
10 - 25
10 - 25
10 - 25
100.00
100.62
98.39
99.10
99.7
1
2
24.55
24.74
24.67
25.12
24.69
10 - 25 --
MW-1
MW-2
MW-3
MW-4
MW-10
7/15/2002
8/7/2002
8/6/2002
Unknown Unknown
1/31/2018
Well
Diameter
(Inches)
1
1
Screen
Interval
(feet below
TOC)
Depth to
LNAPL
(feet below
TOC)
VEW-1 8/7/2002
8/6/2002
40 - 4544.231
MW-11 1/31/2018
99.84
Well ID Date
Installed
1
Groundwater
Elevation
(feet)
TOC
Elevation
(feet)
Depth to
Groundwater
(feet below TOC)
Date
Measured
Well Depth
(feet below
TOC)
LNAPL
Thickness
(feet)
Page 1 of 1
TABLE 4
HISTORICAL GROUNDWATER ANALYTICAL RESULTS
Crossroads Center-C
134 Arnold Road
Lexington, Davidson County, North Carolina 27295
NCDEQ Incident #44919
Well ID Date
Collected
BenzeneTolueneEthylbenzeneTotal XylenesMethyl tert-butyl ether (MTBE)NaphthaleneBromomethanen-Butylbenzenesec-Butyl benzeneChloroformIsopropyl Ether2-HexanoneIsopropylbenzene4-Isopropyl toluene4-Methyl-2-Pentanonen-PropylbenzeneStyrene1,2,4-Trimethylbenzene1,3,5-TrimethylbenzeneEthanolter-Amyl AlcoholC5-C8 AliphaticsC9-C18 AliphaticsC9-C22 AromaticsC19-C36 Aliphatics1 600 600 500 20 6 10 70 70 70 70 40 70 25 100 70 70 400 400 4000 40 400 700 200 10,000
5,000 260,000 80,000 50,000 20,000 6,000 100,000 5,900 8,800 70,000 70,000 40,000 30,500 11,700 100,000 26,100 70,000 28,500 24,100 4,000,000 40,000 NE NE NE NE
06/27/19 1,310 2,570 2,220 4,700 ND 691 NA NA NA NA ND NA 155 NA NA 364 NA 2,030 622 NR NR NA NA NA NA
10/08/21 1,440 3,710 2,020 6,370 <0.140 4,480 <0.280 8.85 7.73 <0.220 0.698 1.95 68.6 4.05 4.16 275 7 2,130 503 NR NR NA NA NA NA
01/13/23 763 1,400 1,640 4,860 <8.4 354 <33.2 14.9 <8.0 <8.6 <6.2 NA 52.6 NA NA 114 6.6J 894 216 <1440 798J NA NA NA NA
07/04/19 ND ND ND ND ND ND NA NA NA NA ND NA ND NA NA ND NA ND ND NR NR NA NA NA NA
10/08/21 <0.180 <0.220 <0.170 <0.210 <0.140 <0.470 <0.280 <0.180 <0.200 <0.220 <0.500 <0.380 <0.180 <0.089 <0.078 <0.190 <0.220 <0.190 <0.180 NR NR NA NA NA NA
06/27/19 10,800 147 1,770 141 130 288 NA NA NA NA 252 NA 86 NA NA 198 NA 151 ND NR NR NA NA NA NA
10/08/21 5,310 63.5 1,810 41.2 <0.140 4,660 <0.280 12.5 9.57 <0.220 43.5 <0.380 68.6 4.92 <0.078 95.1 2.14 13.4 37.1 NR NR NA NA NA NA
01/13/23 2,720 43.3 514 11.1J <10.6 139 <41.5 <12.2 <10.0 <10.8 46.9 NA 32.6 NA NA 55.7 <7.3 <12.4 <8.3 <1800 2,810 NA NA NA NA
06/27/19 104.0 ND 53.5 489 ND 318 NA NA NA NA NA NA 110 NA NA 246 NA 1,860 906 NR NR NA NA NA NA
10/08/21 37 4.28 2.82 22.2 <0.140 36.4 <0.280 4.64 4.53 <0.220 <0.500 <0.380 18.3 1.13 <0.078 16 <0.220 152 57.8 NR NR NA NA NA NA
02/01/18 5,870 7,000 1,130 5,020 ND 418 NA NA NA NA ND NA ND NA NA 198 NA 1,280 340 NR NR 4,040 4,540 1,290 NA
05/07/18 13,600 18,300 1,850 7,870 ND 293 NA NA NA NA 165 NA ND NA NA 170 NA 1,210 300 NR NR NA NA NA NA
04/10/19 17,000 21,600 2,370 9,220 ND 448 NA NA NA NA 130 NA ND NA NA 200 NA 1,470 314 NR NR NA NA NA NA
06/27/19 20,000 26,200 2,330 8,240 ND 415 NA NA NA NA 96 NA ND NA NA 240 NA 1,280 339 NR NR NA NA NA NA
10/08/21 5,950 16,600 4,160 13,200 <14.0 8,030 33.1J 60.7 44.9J <22.0 <50.0 <38.0 184 20J 48.6J 511 <22.0 3,380 814 NR NR NA NA NA NA
01/13/23 6,590 14,900 2,010 7,560 <52.8 414 <208 <61.2 <50.0 <53.8 40.6J NA 74.3 NA NA 175 <36.5 1,190 278 <9020 <4550 NA NA NA NA
MW-11 02/01/18 ND 21.2 121 628 ND 28.8 NA NA NA NA ND NA ND NA NA ND NA ND ND NR NR ND 4,610 2,421 125
MW-12 01/13/23 77 0.9 7 19 <0.42 125 <1.7 17.6 10.1 2.3 <0.31 NA 50 NA NA 25 <0.29 106 9 <72.2 170 NA NA NA NA
MW-13 01/13/23 4.9 0.46J <0.30 <0.34 0.72 1.1J <1.7 <0.49 1.4 <0.43 0.33J NA 1 NA NA <0.34 <0.29 <0.50 <0.33 166J 312 NA NA NA NA
06/27/19 ND ND ND ND ND ND NA NA NA NA ND NA ND NA NA ND NA ND ND NR NR NA NA NA NA
10/08/21 38.1 <0.220 <0.170 0.285J 0.294J <0.470 <0.280 <0.180 <0.200 1.65 1.18 <0.380 0.475J <0.089 <0.078 <0.190 <0.220 <0.190 <0.180 NR NR NA NA NA NA
Notes:
1) 15A NCAC 02L 0202 Groundwater Quality Standard (2L Standard).VPH = volatile petroleum hydrocarbons NR = Not Reported
2) NCDEQ Division of Waste Management (DWM) Gross Contamination Level (GCL).MADEP = Massachusetts Department of Environmental Protection
Only constituents detected above the reporting limit are shown J = estimated concentration below the laboratory reporting limit
Concentrations are reported in micrograms per liter (µg/L)NE = Not Established
Concentrations in bold exceed the 2L Standard ND = Not Detected
Concentrations in bold and underlined exceed the GCL NA = Not Analyzed
VOCs = volatile organic compounds Grayed values and "<" indicate the compound was below the laboratory reporting limit
2L Standard (1)
GCL (2)
Analytical Method MADEP Method VPH/EPH
MW-10
VEW-1
Standard Method 6200B
MW-1
MW-2
MW-3
MW-4
Page 1 of 1