WI0400106_Permit (Issuance)_20110407

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7. Chapter 87, Article 21. Chapter 143. and other
applicable Laws. Rules. and Regulations.
PERMISSION IS HEREBY GRANTED TO
CMI Industries
FOR THE CONSTRUCTION OF 150 INJECTION WELLS AND OPERATION OF 158 TYPE
51 INJECTION WELLS, defined in Title 15A North Carolina Administrative Code 2C
.0209(e)(3)(C), to inject HRC 3DMe and HRC Primer, for the stimulation of anaerobic
biorernediation of chlorinated solvents and petroleum compounds. These injection wells/points
will be located at the CMI Wastewater Treatment Plant. 344 East Main Street. Elkin, Surry
County, North Carolina, and will be operated in accordance with the application submitted
February 14. 201 L. and in conformity with the specifications and supporting data submitted
March 16, 2011. all of which are filed with the Department of Environment and Natural
Resources and are considered a part of this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the
Water Use Act or any other applicable Laws, Rules. or Regulations. Operation and use of an
injection well shall be in compliance with Title 15A North Carolina Administrative Code 2C
.d104 and .4240, and any other Laws. Rules, and Regulations pertaining to well construction and
use.
This permit shall be effective, unless revoked, from the date of its issuance until March 31, 2013,
and shall be subject to the specified conditions and limitations set forth in Parts I through X
hereof.
Permit issued this the 7th day of April. 2011.
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. W10400106 PAGE I OF
ver. April 2011 APIJIC-i'

PART I - WELL CONS'i xtJCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (15A NCAC ZC
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided for
in N,C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit. the approved plans and specifications, and other supporting data.
This permit is valid only for construction of the number of injection wells -described in the
application and other supporting data. Construction of additional injection wells must be
approved in advance by the Aquifer Protection Section.
4. Each injection well shall not hydraulically connect separate aquifers.
5. Each injection well shall be constructed in such a manner that water from land surface cannot
migrate into the gravel pack or well screen,
6. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
7. Each injection well 'shall be afforded reasonable protection against damage during
construction and use.
8. Each injection well shall have permanently affixed an identification plate.
9. Within 30 days of completion of well construction, a completed Well Construction Record
(Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh., NC 27699-1636
PART II - WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall notify
the Aquifer Protection Section -Underground Injection Control (UIC} Central Office staff,
telephone number 919-715-6162 and the Winston-Salem Regional Office Aquifer Protection
Section Staff, telephone number [phone].
Permit No. WI04001 Ott P AGE 2 ❑F 7
ver. April 2011 APiLIIC-F+

PART III - OPERATION AND USE GENERAL CONDITIONb
1. This permit is effective only with respect to the nature. volume of materials. rate of injection,
and number of injection wells as described in the application and other supporting data.
?. This permit is not transferable without prior notice to. and approval by. the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to change
ownership. or there is a name change of the Permittee, a formal permit amendment request
must be submitted to the Director, including any supporting materials as may be appropriate.
at least 30 days prior to the date of the change.
3. The issuance of this permit shall not .relieve the-Permittee of the responsibility of coinplying
with any and all statutes. rules, regulations, or ordinances which may be imposed by other
local. state, and federal agencies which have jurisdiction. Furthermore, the issuance of this
permit does not imply that all regulatory requirements have been met.
PART IV - PERFORMANCE STANDARDS
i, The injection facility shall be effectively maintained and operated at all times so that there is
no contamination of groundwater which will render it unsatisfactory for normal use. In the
event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those .actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
?. The Permittee shall be required to comply with the terms and conditions of this permit even
if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to
surface or groundwater resulting from the operation of this facility.
PART V - OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
?. The Permittee must notify the Division and receive prior written approval from the Director
of any planned alterations or additions in the permitted facility or activity not specifically
authorized by the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify, by telephone the Aquifer Protection Section-U1C. Central
Office staff, telephone number 919-715-6162, Notification is required so that Division staff
can inspect or otherwise review the injection facility and determine if it is in compliance with
permit conditions.
Permit No. WI0400106 PAGE 3 OF
per. April 2011 AP L'1C-[

PART VI - INSPECTIOna
1. Any duly authorized officer, employee. or representative of the Division of Water Quality
may. upon presentation of credentials. enter and inspect any property, premises. or place on
or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained under
the terms and conditions of this permit, and may obtain samples of groundwater_ surface
water, or injection fluids.
?. Department representatives shall have reasonable access for purposes of inspection.
observation, and sampling associated with injection and any related facilities as provided for
in N.C.G.S. 87-§0. -
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VII - MONITORING AND REPORTING REQUIREMENTS
1. The proposed monitoring plan included in the application, along with additional wells and
parameters cited herein, shall be followed. The additional wells shall be four shallow
monitor wells presented on Figure 1 situated between Area A and the Yadkin River; wells
EBMW-6 and EBMW-17 associated with Area B: and wells FPMW-4 and FPMW_;
associated with Area B.
?. Additional laboratory parameters that will be performed concurrent with all other laboratory
analyses will consist of the following:
ferrous iron chloride ethane
nitrite/nitrate nitrogen sulfate sulfide
Total Organic Carbon (TOC) alkalinity
Alkalinity shall be reported as Total Alkalinity and individual values shall be given for the
concentrations of Bicarbonate, Calcium, and Magnesium.
3. All sample results shall be submitted to the Aquifer Protection Section's Winston-Salem
Regional Office and the Raleigh Central Office. Any monitoring (including groundwater,
surface water, or soil sampling) deemed necessary by the Division of Water Quality to ensure
surface and ground water protection, will be established and an acceptable sampling
reporting schedule shall be followed.
4. Pre -injection metals analysis of monitoring wells EBMW-10 and EBMW-18 shall be
submitted as soon as the results are available.
5. The Permittee shall submit an Injection Event Record within 30 days of completing each
injection.
Permit No. WI0400106 PAGE 4 OF
ver. April 2011 AP/L]IC-h

6, The Permittee shall produce a final project evaluation within 9 months after completing all
injection -related activity associated with this permit or produce a project interim evaluation
before submitting a renewal application for this permit. This document shall assess the
injection projects findings in a written summary. The final project evaluation shall also
contain monitoring well sampling data. contaminant plume maps and potentiometric surface
maps.
". The monitoring results and the final project evaluation shall be submitted to.
Aquifer Protection Section-U1C Program
DENR-Division of Water Quality
163t1 Mail Service Center
Raleigh, NC 27699-1636
and to:
Aquifer Protection Section
DENR-DWQ Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem. NC 27107
8. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge
of the occurrence, to the Winston-Salem Regional Office, telephone number [phone].
any of the following:
[A] Any occurrence at the injection facility which results in any unusual operating
circumstances:
{B ) Any failure due to known or unknown reasons. that renders the facility incapable of
proper injection operations, such as mechanical or electrical failures.
9. Where the Permittee becomes aware of an omission of anv relevant facts in a permit
application. or of any incorrect information submitted in said application 'or in any report to
the Director. the relevant and correct facts or information shall be promptly submitted to the
Director by the Permittee.
10. In the event that the permitted faciIit), fails to perform satisfactorily, the Permittee shall take
such immediate action as may be required by the Director.
PART V111 - PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the
Permittee must submit an application to renew the permit 120 days prior to its expiration date.
PART IX - CHANGE OF WELL STATUS
1, The Permittee shall provide written notification within 15 days of any change of status of an
injection well. Such a change would include the discontinued use of a well for injection. if a
well is taken completely out of service temporarily, the Permittee must install a sanitary seal.
If a well is not to be used for any purpose that well must be permanently abandoned
according to 15A NCAC 2C .0214. Well Construction Standards.
Permit No, W10400106 PAGE 5 OF 7
ver. April 2011 APUC-n

2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following;
(A)AII casing and screen materials may be removed prior to initiation of abandonment
procedures if such removal will not cause or contribute to contamination of the
groundwaters.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom
from obstructions that may interfere with sealing operations, '
(C) The well shall be thoroughly disinfected. prior to sealing, if the Director determines
that failure to do so could lead to the contamination of an underground source of
drinking water.
(D) Drilled wells shall be completely filled with cement grout or bentonite grout, which
shall be introduced into the well through a pipe which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel -packed wells in which the casing and screens have not been
removed, neat -cement, or bentonite grout shall be injected into the well completely
filling it from the bottom of the casing to the top,
(F) In those cases when, as a result of the injection operations, a subsurface cavity has
been created, each well shall be abandoned in such a manner that will prevent the
movement of fluids into or between underground sources of drinking water and in
accordance with the terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213 (h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART X -- WORKER PRECAUTIONS DURING APPLICATION
1. Ingestion may result in burn of the lips, tongue and mouth. Exposure to the eyes can cause
distortion of cellular membrane& loss of corneal, conjunctival and lens epithelium, and loss
of endothelium of the cornea and blood vessels. Inhalation may produce upper airway edema.
respiratory failure, wheezing. pulmonary edema. and pneumonitis. Skin exposure may cause
pain, redness, irritation and severe bums.
Permit No. W I0400106 PAGE 6 OF 7
ver. April 2011 AP.UIC-6 '

?. If the product is releasea into the environment in a way that could result in a suspension of
fine solid or liquid particles (e.g.. grinding. blending. vigorous shaking or mixing). then
proper personal protective equipment should be used. The application process should be
reviewed by an industrial hygienist to ensure that the most appropriate personal protective
equipment is used.
a Persons working with these products should wear goggles or a face shield. gloves. and
protective clothing. Face and body protection should be used for anticipated splashes or
sprays.
4. Eating. drinking. smoking. handling contact lenses. and applying cosmetics should not be
permitted in the application_area during or immediateiv followine application.
5. Safety controls should be in place to ensure that the check valve and the pressure delivery
systems are working properly,
6, The Material Safety Data Sheets should be followed to prevent incompatible or adverse
reactions and injuries.
7. Access to the area of application should he limited to the workers applying the product.
8. Violent reactions or ignition could occur under the appropriate conditions with acids,
alcohols, p-bis( 1.3-dibromothyl) benzene, cyclopentadiene. germanium. hypnitrous acid.
maleic anhydride, nitroalkanes. ?-tetrafluoropropanol, and thorium dicarbide. Measures
should�be taken to prevent such reactions.
Measures should be taken to prevent contamination of existingor future wells and surface
waters that may he ldcated near the application area.
Permit No. V710400106 PAGE 7 r)F
ver. April 21', 1 AP'UIC-t,

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DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
March ?8, 2011
PERMIT ISSUANCE MEMO
TO- Debra Watts
THROUGH. Thomas Slusser
FROM: " David Goodrich
RE: Permit To Inject HRC 3DMe
CM Industries' Wastewater Treatment
Elkin. Surry County. NC
1 recommend that Permit Number W10400106 be issued to CMI Industries to inject HRC 3DMe to remediate
ground water contaminated with chlorinated solvents and benzene.
SITE DESCRIPTION The site is a large textile manufacturing facility in the floodplain of the Yadkin River.
Contamination is quite extensive at this facility, but the permit focuses only on an area located near the facility's
wastewater treatment plant. Injection well permit WI0400110 addresses contamination at another location at this
facility. The original injection permit, issued in July of 2010, allowed the applicant to install 10 bedrock
injection wells, but only 3 of these were actually installed due to a lack of favorable bedrock fractures.
HVDROGEOLOGIC DESCRIPTION Ground water flows towards the Yadkin River at an estimated rate of
33 feet per year. Based on this rate, ground water would take I to 2 years to flow to the Yadkin River from the.
east and west injection zones, respectively.
EXTENT OF CONTAMINATION Contamination is quite extensive as indicated in Figure 101Sheet 9 and
the cross sections of the February ?7, 2009 original application. Contaminant concentrations have been as high
as 391 mg/L.
PROPOSED INJECTION Injection will occur via 6 existing bedrock wells, 2 proposed shallow bedrock
wells, and 150 direct push shallow (overburden) injection points in Areas A. B and C that will be backfilled with
Portland cement grout. The well and injection point locations are shown in Figure 1. The target injection zone is
an area covering several acres. The target depths are the overburden, the shallow bedrock zone, and the
intennediate bedrock zone. A single injection event is planned. The total injection volume for the program will
be approximately 185,000 gallons, which is less than 20% of the estimated pore volume of the injection zone.
HOw IT WORKS HRC is used to stimulate anaerobic biodegradation of chlorinated solvents via a process
called reductive dechlorination. HRC consists of organic acid compounds that release hydrogen when
microbially fermented under anaerobic conditions. Other microbes derive energy by oxidizing the hydrogen and
reducing the chlorinated solvents, which results in the replacement of chlorine with hydrogen. When all chlorine
molecules have been replaced, then the contamination has been reduced to an innocuous end -product, typically
ethane.
MONITORING Groundwater monitoring for field parameters will occur before injection and at one
month. 3 months, 9 months and 18 months after injection takes place. Sampling for laboratory analyses will take
place at 3months, 9 months, and IS months for VOCs. ferrous iron. chloride, ethane, nitrite/nitrate nitrogen,
sulfate, sulfide. TOC and alkalinity. Monitoring wells are located upgradient, within, and downgradient of the
injection zone.

EPIDEMIOLOGY On January 17, 2007, Dr. Luanne Williams of the DHIHS' Epidemiology Branch
provided comments on HRC 3DMe (HRC Advanced) for groundwater remediation. Dr. Williams did not
present any information that would preclude the use of these products for injection, but did provide a health risk
analysis and worker safety precautions, which are in Part X of the attached permit.
REGIONAL OFFICE COMMENTS Shuying Wang and Sherri Knight of the Winston-Salem Regional Office
recommend issuance of this permit, with recommended permit modifications in the proposed sampling program
that have been addressed in the permit.
OTHER CONCERNS There is a fly ash pond upgradient of the proposed inniection area. Metals have been
detected in shallow monitoring wells located between the -ash pond and the proposed injection location. Pre -
injection groundwater sampling of the proposed injection zone will include metals analyses to determine their
presence in the proposed injection zone. If metals are present in a significant amount, then the UIC Program and
the consultant will discuss how hest to reduce contaminant concentrations while minimizing metals
mobilization, which could occur due to the changes in pH and redox conditions resulting from the proposed
injection operation.

Documents Associated with
the -July 10, 2009
CMI Industries
Injection Well Permit

DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
June 30, 2049
MEMORANDUM
TO; Debra Watts
FROM: Thomas Slusser 7:�T>
RE: Permit To Inject HRC 3DMe
CMI Industries' Wastewater Treatment Plant
Elkin, Surry County. NC.
I recommend that Permit Number WI0400106 be issued to CMI Industries to inject HRC 3DMe to remediate ground water
contaminated with chlorinated solvents and benzene.
SITE DESCRIPTION The site is a large textile manufacturing facility in the fioodplain of the Yadkin River. Contamination
is quite extensive at this facility, but the permit focuses only on an area located near the facility's wastewater treatment plant.
Injection well permit W10400110 addresses contamination at another location at this facility.
HYDROGEOLOGIC DESCRIPTION Groundwater flows toward the Yadkin River at an estimated rate of 33 feet per year.
Based on this rate, groundwater would take 1 to 2 years to flow to the Yadkin River from the east and west injection zones,
respectively.
EXTENT OF CONTAMINATION Contamination is quite extensive as indicated in Figure 1 O/Sheet 9 and the cross
sections. Contaminant concentrations are as high as 391 mg/L'
PROPOSED INJECTION Injection will occur via b existing wells and 10 new injection wells, comprising two different
injection areas; see Figure 4 for details. The target injections zone is the shallow fractured bedrock occurring between 25-85 feet
below ground, and corresponds to the highest contaminant concentrations at this location. Two injection events are planned to
occur six months apart. The injection volume of each event represents approximately 7.7% of the estimated pore volume of the
injection zone.
HOW IT WORKS HRC is used to stimulate anaerobic biodegradation of chlorinated solvents via a process called
reductive dechlorination. HRC consists of organic acid compounds that release hydrogen when microbially fermented under
anaerobic conditions. Other microbes derive energy by oxidizing the hydrogen and reducing the chlorinated solvents, which
results in the replacement of chlorine with hydrogen. When a]1 chlorine molecules have been replaced, then the contaminant has
been reduced to an innocuous end -product, typically ethane.
MONITORING Groundwater monitoring will occur before injection and quarterly for one year beginning one month
after injection. Monitoring wells are located upgradient, within, an of the injection zone.
rk]o
EPIDEMIOLOGY On January 17. 2007, Dr. Luanne Williams provided comments HRC 3DMe (HRC Advanced) for
groundwater remediation. Dr. Williams did not present any information that would preclude the use of these products for
injection but did provide a health risk analysis and worker safety precautions, which are in Part X of the attached permit.
REGIONAL OFFICE COMMENTS Sherri Kni=ht and Stephen Berry of the Winston-Salem Regional Office recommend
issuance of this permit.
OTHER CONCERNS There is a fly ash pond upgradient of the proposed injection site. Metals have been detected in shallow
monitoring wells located between the ash pond and the proposed injection location. Pre -injection groundwater sampling of the
proposed injection zone will include metals analyses to determine their presence in the proposed injection zone. If metals are
present in a significant amount, then the UIC Program and the consultant will discuss how best to reduce contaminant
concentrations while minimizing metals mobilization, which could occur due to the changes in pH and redox conditions
resulting from the proposed injection operation.

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87: Article 21. Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
CMI Industries
FOR THE CONSTRUCTION OF 10 AND OPERATION OF 16 TYPE 5I INJECTION WELLS, defined in
Title 15A North Carolina Administrative Code 2C .0209(e)(3)(C), to infect HRC 3DMe for the stimulation of
anaerobic bioremediation of chlorinated solvents and petroleum compounds. These injection wells/points will
be located at the CMI Wastewater Treatment Plant, 304 East Main Street. Elkin, Surry County, North
Carolina, and will be operated in accordance with the application submitted March 5, 2009, and in conformity
with the specifications and supporting data submitted on June 19. 2009, all of which are filed with the
Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the Water Use Act
or any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in
compliance with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any other Laws,
Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until May 31, 2011, and shall be
subject to the specified conditions and limitations set forth in Parts I through X hereof.
Permit issued this the %o day of .2009.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No, WI0400106+ PAGE 1 OF 7
► cr.8107 AP/UIC-6

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
The Permittee must comply with all conditions of this permit and with the standards and criteria
specified in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any
noncompliance with conditions of this permit constitutes a violation of the North Carolina Well
Construction Act and is grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions
of this permit, the approved plans and specifications, and other supporting data.
3. This permit is valid only for construction of the number of injection wells described in the application
and other supporting data. Construction of additional injection wells must be approved in advance by
the Aquifer Protection Section.
4. Each injection well shall not hydraulically connect separate aquifers.
5, Each injection well shall be constructed in such a manner that water from land surface cannot migrate
into the gravel pack or well screen.
6. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each
well shall be permanently labeled with a warning that it is for injection purposes and the entrance to
each well must be secured with a locking cap.
7. Each injection well shall be afforded reasonable protection against damage during construction and
use.
8. Each injection well shall have permanently affixed an identification plate.
9. Within 3Q days of completion of well construction, a completed Well Construction Record (Form
GW-1) must be submitted for each injection well to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART I1 - WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall notify the
Aquifer Protection Section -Underground Injection Control (UIC) Central Office staff, telephone number
919-715-6164 and the Winston-Salem Regional Office Aquifer Protection Section Staff, telephone
number 336-771-5000.
Permit No. WI0400106 PAGE 2 OF 7
ver.8107 APIUIC-6

PART III - OPERATION AND USE GENERAL CONDITIONS
This permit is effective only with respect to the nature, volume of materials, rate of injection. and
number of injection wells as described in the application and other supporting data.
This permit is not transferable without prior notice to. and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership. or there is
a name change of the Permittee. a formal permit amendment request must be submitted to the
Director, including any supporting materials as may be appropriate, at least 30 days prior to the date of
the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any
and all statutes, rules, regulations, or ordinances which may be imposed by other local, state, and
federal agencies which have jurisdiction. Furthermore, the issuance of this permit does not imply that
all regulatory requirements have been met.
PART IV - PERFORMANCE STANDARDS
The injection facility shall be effectively maintained and operated at all times s❑ that there is no
contamination of groundwater which will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the
repair, modification, or abandonment of the injection facility.
?. The Permittee shall be required to comply with the terms and conditions of this permit even if
compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface
or groundwater resulting from the operation of this facility.
PART V - OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
�. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized
by the permit.
3. At least forty-eight (49) hours prior to the initiation of the operation of the facility for injection, the
Permittee trust notify by telephone the Aquifer Protection Section-UIC, Central Office staff, telephone
number [phone]. Notification is required so that Division staff can inspect or otherwise review
the injection facility and determine if it is in compliance with permit conditions.
Permit ND. W10400106 PAGE 3 OF 7
ver.8107 AP/IJIC-G

PART VI - INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit,
may inspect or copy any records that must be maintained under the terms and conditions of this
permit. and may obtain samples of groundwater, surface water, or injection fluids.
�?. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII - MONITORING AND REPORTING REQUIREMENTS
1. The proposed monitoring plan included in the application shall be followed. Alkalinity shall be
reported as Total Alkalinity and separate data lines shall be given for concentrations of Bicarbonate.
Calcium, and Magnesium. All sample results shall be submitted to the Aquifer Protection Section's
Winston-Salem Regional Office and the Raleigh Central Office.
?. Pre -injection metals analysis of monitoring wells EBMW-10 and EBMW-18 shall be submitted as
soon as the results are available.
3. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
4. The Pei, ittee shall submit an injection Event Record within 30 days of completing each injection.
5. The Permittee shall produce a final project evaluation within 9 months after completing all injection -
related activity associated with this permit or produce a project interim evaluation before submitting a
renewal application for this permit. This document shall assess the injection projects findings in a
written summary. The final project evaluation shall also contain monitoring well sampling data,
contaminant plume maps and potentiometric surface maps.
6. The monitoring results and the final project evaluation shall be submitted to:
and to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Aquifer Protection Section
DENR-DWQ Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Permit No. WI0400106 PAGE 4 OF 7
ver.8107 APMC-6

The Permittee shall report by telephone, within 49 hours of the occurrence or first knowledge of the
occurrence, to the Winston-Salem Regional Office, telephone number 336-771-5000, any of the
following:
(A)Any occurrence at the injection facility which results in any unusual operating circumstances:
(B ) Any failure due to known or unknown reasons, that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures.
7. Where the Permittee becomes aware of an omission of any relevant facts in a permit application. or of
any incorrect information submitted in said application or in any report to the Director, the relevant
and correct facts or information shall be promptly submitted to the Director by the Permittee.
8. In the event that the permitted facility fails to perform satisfactorily. the Permittee shall take such
immediate action as may be required by the Director.
PART NAH - PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose. the Permittee
must submit an application to renew the permit 120 days prior to its expiration date.
PART IX - CHANGE OF WELL STATUS
The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. if a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be
used for any purpose that well must be permanently abandoned according to 15A NCAC ?C .0113.
Well Construction Standards.
?. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC
2C .0113(b), including but not limited to the following:
(A) All casing, and screen materials may be removed prior to initiation of abandonment procedures
if such removal will not cause or contribute to contamination of the groundwaters.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) The well shall be thoroughly disinfected, prior to sealing, if the Director determines that failure
to do so could lead to the contamination of an underground source of drinking, water.
(D) Drilled wells shall be completely filled with cement grout, or bentonite grout which shall be
introduced into the well through a pipe which extends to the bottom of the well and is raised as
the well is filled.
Permit No. WI0400106 PAGE 5 OF 7
ver.8107 APIMC-6

(E) In the case of gravel -packed wells in which the casing and screens have not been removed,
neat -cement, or bentonite grout shall be injected into the well completely filling it from the
bottom of the casing to the top.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the terms
and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-34) as specified in 15A
NCAC ?C .0213 (h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PAGE 6 OF 7

PART X - WORKER PRECAUTIONS DURING APPLICATION
I -Ingestion may result in burns of the lips, tongue, and mouth. Exposure to the eyes can cause
distortion of cellar membranes, loss of corneal, conjunctival and lens epithelium and loss of
endothelium of the cornea and blood vessels. Inhalation may produce upper airway edema,
respiratory failure, wheezing, pulmonary edema. and pneurnonitis. Skin exposure may cause pain.
redness, irritation and severe burns.
2.If the product is released into the environment in a way that could result in a suspension of fine solid
or liquid particles (e.g., grinding, blending, vigorous shaking, or mixing), then proper personal
protective equipment should be used. The application process should he reviewed by an industrial
hygienist to ensure that the most appropriate personal protective equipment is used.
3.Persons working with these products should wear goggles or a face shield, gloves. and protective
clothing. Face and body protection should be used for anticipated splashes or sprays.
4.Eating. drinking, smoking, handling contact lenses, and applying cosmetics should not be permitted
in the application area during or immediately following application.
5-Safety controls should be in place to ensure that the check valve and the pressure delivery systems
are working properly.
S.The Material Safety Data Sheets should be followed to prevent incompatible or adverse reactions
and injuries.
7.Access to the area of application should be limited to the workers applying the product.
8. Violent reactions or ignition could occur under the appropriate conditions with acids, alcohols, p-bis
(1, 3-dibrornoethyl) benzene, cyclopentadiene, germanium, hyponitrous acid, maleic anhydride,
nitroalkanes, 2-tetrafluoropropanol, and thorium dicarbide. Measures should be taken to prevent
such reactions.
9.Measures should be taken to prevent contamination of existing or future wells and surface waters
that may be located near the application area.
Permit No. WI0400106 PAGE 7 OF 7
ver.8107 APfUIC-6

Application Reviewer: __ r [ U �C� We9"c4f,'
Pre -Review: Conducted`' Yes ❑ No
O.K. to Process? Yes ❑ No
If No. What Action Is Needed? ❑ Pre -Review Return
❑ Hold, Pending Receipt of Addinfo.:
NameiAffiliation of Person Contacted:
Date(s) of Contact: ❑ By Phone ❑ By E-Mail ❑ By Letter
Owner: I Existing ❑ Unknown Owner Type 9 Non -Gov't (❑ Ind. or ® Org) ❑ Gov. -Municipal
Facilitvl0 eratian: ❑ Proposed ❑ Existing
Rezulated Activities:
Application/Permit:
Permit Type:
❑ Injection Water Only GSHP Well System (5QW)
❑ Injection Mixed Fluid GSHP Well System (5QM)
❑ Injection Tracer Well (5T)
❑ Injection Experimental Technology (5X25)
Project Type: ❑ New ® Major Ilod.
N otes
❑ Gov --County ❑ Gov. -State ❑ Goy', -Federal
❑ Facility ❑ Operation
® Injection In situ Groundwater Remediation Well (5I)
❑ Injection Heating/Cooling Water Return Well (5A7)
❑ Injection Other Wells (SZ)
❑ Injection Aquifer Recharge (5R71 }
❑ Minor Mod. ❑ Renewal ❑ Renewal wMad.
FORM: BIMS 10/04/2007