WI0300448_Permit (Issuance)_20210331

;ETC
AN ATLAS COMPANY-
7606 Whitehall Executive Center Drive, Suite 800
Charlotte, NC 28273
Tel: [phone]
Fax: [phone]
www.atcassociates.com
LETTER OF TRANSMITTAL
TO:
Ms. Shristi Shrestha, Hydrogeologist
NCDEQ Division of Water Resources
1636 Mail Service Center
Raleigh, North Carolina
Project Name:
ATC Project Number:
Address:
March 23, 2021
FROM:
Ms.Noelle France, P.G.
ATC Group Services, LLC
7606 Whitehall Exec Ctr Dr, Ste 800
Charlotte, NC 28732
PROJECT/SUBJECT INFORMATION:
TF#36384 Scarlett's 66
SLC3638402
1030 Seigle Avenue
Charlotte, North Carolina 28205
Submittal
Date
Description
NOI
3/23/21
NOI
for
TF#36384
Williams
Grocery
Comments:
Copy to: File
Signature: 4410 P4r

NC Department of Environmental Quality — 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 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, 1SOC 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 eontatnination. 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 WeIIs (IST) — Used to `heat' contaminated groundwater to enhance remediation.
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: March 23 , 2021
PERMIT NO. WI0300448 (to be filled in by DWR)
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NO1 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) X 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) Small -Seale 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
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 1

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:
Narne(s): NCDEQ, Division of Waste Management, UST Section, State Lead Program
Mailing Address: 1636 Mail Service Center
City: Raleigh State: NC Zip: 27699
Day Tele No.: 919-707-8166 Ce11 No.:
EMAIL Address:[e-mail] Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Astley Scarlett
Company Name Scarlett 66
Mailing Address: P.O. Box 404
City: Paw Creek State: _NC Zip Code:28130 County: Mecklenburg
Day Tele No.: 704-249-5153 or 704-393-3025 Cell No.: NA
EMAIL Address: Unknown Fax No.: NA
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Noelle France, 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.:
EMAIL Address:[e-mail] Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: TF-36384 1030 Seigle Avenue
City: Charlotte County: Mecklenburg Zip Code: 28205
(2) Geographic Coordinates: Latitude**: " or 35.228610
Longitude**: ° ' " or -80.822149
Reference Datum: Topographic map Accuracy:
Method of Collection:
**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: NA square feet
Land surface area of inj. well network:NA square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: NA (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Rcmediation NOI Rev. 2-17-2020 Page 2

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.
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:
Air Sparging (using air compressor) connected to AS-1 during 96-hour Mobile -Multiphase Extraction Event
(MMPE) wells MW-1, MW-2 and MW-4 will be used as extraction wells. The sparging will be performed at
approximately 5 cfm per well for 96 hours. The MMPE/Air Sparge event is scheduled for April 12- April 16,
2021
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: 1 (AS-1) Proposed Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 45
(3) 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
K. INJECTION SUMMARY
NOTE: Only injectants approved by the epidemiology section of the NC Division ofPublic 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: Compressed Air Total Amt. to be injected (gal)/event: Approx 5cfin x 96 hrs = 28,800 cubic feet
Total Amt. to be injected (gal/event):
No. of separate injection events:1
Source of Water (if applicable): NA
28,800 cubic feet
Total Amt. to be injected (gal): 28,800 cubic feet
Deemed Perinitted GW Remediation NOI Rev. 2-17-2020 Page 3

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 MW-1, MW-2, MW-4, and AS-1 two weeks after the Air Sparge event. The water samples
will be analyzed by SM 6200B, during the post MMPE/AS sampling event.
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."
Signatur f Applicant
Notll.c W .?r&vlcc.)) -cos` M.t
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
(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.
See attached signed agreement Astley Scarlett, Property Owner
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. 2-17-2020 Page 4

TYPICAL AIR SPARGE MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
NOT TO SCALE
LOCKABLE WELL CAP
Li
A
8-0
4
L4
L2
L3
L1 = 0.5 FT.
L2 = 40 FT.
L3 = 5 FT.
L4 = 45 FT.
•
ter •
•
'at
d'
•
•
•
•
•
•
•
•
TITLE Air Sparge Well Diagram
(Example of typical MW installation displayed above)
Scarlett's 66
1030 Seigle Avenue
Charlotte, NC
FILE
PREP. BY
NF
REV. BY
AQ
PROTECTIVE CASING AND CONCRETE PAD
CASING MATERIAL
CASING DIAMETER
CASING LENGTH
PAD DIMENSIONS
HEIGHT ABOVE GROUND
Steel
8 inches
12 inches
2 feet x 2 feet
flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER
JOINT TYPE
2 inches
flush threaded
LENGTH 40 feet
BACKFILL AROUND CASING
MATERIAL
THICKNESS
SEAL
TYPE OF SEAL
THICKNESS
FILTER PACK
TYPE OF FILTER
cement grout
36 feet
bentonite
2'
#2 silica sand
DISTANCE ABOVE SCREEN 2'
WELL SCREEN
SCREEN MATERIAL
DIAMETER
LENGTH
SLOT SIZE
sch 40 PVC
2 inches
5 feet
0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 45.0 feet
DEPTH TO BOTTOM OF
BOREHOLE 45.0 feet
DIAMETER OF BOREHOLE 8.25 inches
latit
7606 Whitehall Executive Center Drive
Charlotte, North Carolina 28273
DATE
3/22/2021
PROJECT NO.
SLC3836402

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01/26/2021
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2.
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CERTAINTY.
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GROUNDWATER
SCARLETTE'S
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66
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#36384
MAP
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CHARLOTTE,
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NORTH
CAROLINA
Charlotte,
North
ASSOCIATES
Carolina
28273
OF
NORTH
(704)
CAROLINA,
529-3200
FAX
P.C.
(704)
529-3272
CAD FILE
TYPE CODE
PREP.
LB
BY
REV.
NF
BY
SCALE
AS SHOWN
01/26/2021
DATE
SLC3638401
PROJECT
NO.

-he sr
Sample ID
Constituent of Concern
Benzene
Ethylbenzene
Xylene (Total)
Naphthalene
Isopropylbenzene
(Cumene)
1,2,4-Trimethylbenzene
1,3,5-Trimethylbenzene
Lao
01/15/2021
M W-3
01/15/2021
EPA Method 6200-VOCs (ug/L)
No Concenrations Detected
Sample ID
MW-2
Constituent of Concern
01/15/2021
Benzene
542
Toluene
63.5
Ethylbenzene
213
879
Xylene (Total)
Methyl-tert-butyl ether
147
Naphthalene
242
Isopropylbenzene
(Cumene)
45.0
1,2,4-Trimethylbenzene
494
0
15
FORMER GASO
DISPENSER IS
FORMER` GASOLINE
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FORMER
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FORMER KIOSENE
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30
APPROXIMATE SCALE IN FEET
60
E
AND
M W-5
01/15/2021
EPA Method 6200-VOCs (ug/L)
No Concenrations Detected
Sample
ID
MW-1
Constituent of Concern
01/15/2021
Benzene
8840
Toluene
43200
Ethylbenzene
3250
19100
Xylene (Total)
Naphthalene
685
Isopropylbenzene
(Cumene)
125
1,2,4-Trimethylbenzene
3220
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FORMER GASOLINE
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APPROXIMATE FORMER
FUEL OIL UST & WASTE OIL UST
Sample ID
2L Class GA
Standards
2L Class
GSA
Standards
2L Class
GCL
Standards
Constituent of Concern
Benzene
1
1
5000
Toluene
600
600
260000
Ethylbenzene
Xylene (Total)
Methyl-tert-butyl ether
Naphthalene
Isopropylbenzene
(Cumene)
1,2,4-Trimethylbenzene
1,3,5-Trimethylbenzene
600
500
20
6
70
400
400
600
500
20
6
70
400
400
84500
85500
20000
6000
25000
28500
25000
EXPLANATION
{b MONITORING WELL LOCATION
fag/L PARTS PER BILLION
GROUNDWATER MONITORINGWELLS SAMPLED
09/09/19
CONCENTRATIONS IN ITALICS EXCEED 10x 2L
CLASS GSA STANDARDS
TITLE F I G U P E /l
GPOUNDWATEP QLALI I Y MAP
SCARLET T E'S 66 \CDEO INCIDENT #36384
1030 SEIGLE AVENUE
CHARLOTTE, MECKLE\3URG COU\ T Y, NORTH CAROLINA
;ETC
ASSOCIATES OF NORTH CAROLINA, P.C.
Charlotte, North Carolina 28273 [phone] FAX [phone]
CAD FILE
l YPE CODE
PREP. BY
LB
REV. BY
NF
SCALE
AS SHOW\
DATE
01 /26/2021
PROJECT NO.
SLC3638401

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 shallnot be construed to be an agent, employee, or
contractor of the landowner.
•
I/We agree not to interfere with, remove or any ways damage the .Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
. ..3 ct3 3 o'2S
Phone Number
2;10.4.4901-409_ caw efe(56-7-k
. Address
N oi., - edit O i;l 22/30
City/State/Zip Code
-
11
•
•
-
Date
cR