WI0400345_Staff Report for UIC Permit_20190916

Permit No. WI0400345
Date: 09/16/2019 County: Randolph
To: Shristi Shresta Permittee/Applicant: _Energizer Manufacturing Inc.
Central Office Reviewer Facility Name: _Energizer Manufacturing Inc.
L GENERAL INFORMATION
1. This application is (check an that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection:
b. Person contacted and contact information:
c. Site visit conducted by:
d. Inspection Report Printed from BIMS attached: ❑ Yes ❑ No.
e. Physical Address of Site including zip code: 419 Art Bryan Drive Plant II Asheboro, NC 27203
f. Driving Directions if rural site and/or no physical address:
g. Latitude: _ Longitude:
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.):
II. DESCRIPTION OF INJECTION WELL AND FACILITY
1. Type of injection system:
❑ Geothermal Heating/Cooling Water Return
® In situ Groundwater Remediation
❑ Non -Discharge Groundwater Remediation
❑ Other (Specify:
2. For Geothermal Water Return Well(s) onl
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? ❑ Yes ❑ No.
Provide well construction information from well tag:
b. Does existing or proposed system use same well for water source and injection? ❑ Yes ❑ No
If No, please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ❑ Yes
What is/are the pollution source(s)?
❑ No
What is the distance of the injection well(s) from the pollution source(s)_
4. What is the minimum distance of proposed injection wells from the property boundary?
5. Quality of drainage at site: ❑ Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ❑ Low 0 Moderate ❑ High

7. For Groundwater Injection Remediation Systems only, is the proposed and/or existing groundwater monitoring
program (number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ® Yes ❑ No.
If No, attach map of existing monitoring well network if applicable and recommend any changes to the
groundwater -monitoring program.
8. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ® Yes ❑ No. If No, or no map, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9. For Non -Discharge Groundwater Remediation systems only (i.e., permits with WQ prefix):
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ N/A.
If No, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ N/A. If no, please explain:
III. EVALUATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If Yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by Regional Office
❑ Issue upon receipt of needed additional information
® Issue
DocuSigned by: F
5. Signature of Report Preparer(s): _Q7R66F17Q,,45F
DocuSigned by:
Signature of WQROS Regional Supervisor: Eti T 5"jt,
`145B49E225C94EA...
Date: 9/16/2019

IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional/If Needed)

Docu5�".
6 S E C U R E 6
Certificate Of Completion
Envelope Id: 150B01 F981 C444DB8A2E1797EBA8OD6C Status: Completed
Subject: Please DocuSign: 20190916 W10400345 UIC Staff Report .docx.pdf
Source Envelope:
Document Pages: 3 Signatures: 1 Envelope Originator:
Certificate Pages: 1 Initials: 0 Jim Gonsiewski
AutoNav: Disabled 217 W. Jones Street
Envelopeld Stamping: Disabled Raleigh, NC 27699
Time Zone: (UTC-08:00) Pacific Time (US & Canada) [e-mail]
I Address: 149.168.204.10
Record Tracking
Status: Original Holder: Jim Gonsiewski Location: DocuSign
9/16/2019 1:17:10 PM [e-mail]
Signer Events Signature Timestamp
cuSigned by:
Jim Gonsiewski Sent: 9/16/2019 1:17:27 PM
E�E19-7BMF179D45F...
ovlev�[e-mail] Viewed: 9/16/2019 1:17:33 PM
North Carolina Department of Environmental Quality Signed: 9/16/2019 1:18:17 PM
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Using IP Address: 149.168.204.10
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