WI0300356_DEEMED FILES_20170721

Permit Number WI0300356
Program Category
Deemed Ground Water
Permit Type
Injection Deemed Air Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Terrell Bait Shop
Location Address
7970 E NC 150 Hwy
Terrell
Owner
Owner Name
United Oil of the Carolinas Inc
Dates/Events
NC
Orig Issue
7/21/2017
App Received
7/17/2017
Re g ulated Activities
Groundwater remediation
Outfall
Waterbody Name
28682
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
7/21/2017
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Mooresville
County
Catawba
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Lewis Efird
PO Box 68
Gastonia
Issue
7/21/2017
Effective
7/21/2017
NC 28053
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
Shrestha, Shristi R
From:
Sent:
To:
Cc:
Subject:
Shrestha, Shristi R
Friday, July 21, 2017 11:08 AM
'Al Quarles'
Lewis Efird; [e-mail]; [e-mail]; Scott Young; David
Reames; Newton, Brad; Basinger, Corey; Pitner, Andrew; Watson, Edward M
WI0300356 RE: NOi Terrell Bait Shop, UST Incident 40318, Sherrills Ford Rd/Hwy
150, Terrell, NC
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (NOi) for the above referenced
site.
Please remember to submit the following regarding this injection activity:
1) Well Construction Records (GW-1) and Abandonment Records (GW-30) when completed. Please provide copies of
the GW-ls and GW-30s if not already submitted (ori g inals go the address printed on the form). NOTE: Direct push or
Geoprobewells are considered wells and require construction (GW-1) and abandonment forms (GW-30). If well
cc;mstruction/abandonment information is the same for the wells, only one form needs to be completed-just indicate
total number of injection points in the Comments/Remarks section of form. These forms can be found on our website
at
http :// de q . n c. gov/ ab out/divisions /water-res ou rces /wate r-reso u rces-pe rm its/wastewater-bran ch /ground-water-
protect i o n/grou nd-wate r-re p orti n g-fo rms
2) Injection Event Records (IER). All injections, including air and passive systems require an IER. The IER can be
modified for air sparge wells (e.g., air flow 'continuous' for date or rate of injection, etc.).
You can scan and send these forms directly to me at Shristi.shrestha @ncdenr.gov or via regular mail to address
below. When submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the form
(i.e., WI0XXXXXX) that has been assigned to the injection activity at this site. This notification has been given the
deemed permit number WI0300356. This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in re p ly to this email , as it will already have the assigned deemed permit
number in the subject line.
Shristi
Shristi R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha @ncdenr .gov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From~ Al Quarles [mailto:[e-mail]]
Sent: Friday, July 14, 2017 10:43 AM
To: Shrestha, Shristi R <[e-mail]>
Cc: Lewis Efird <[e-mail]>; [e-mail]; [e-mail]; Scott Young
<[e-mail]>; David Reames <[e-mail]>; Newton, Brad <[e-mail]>
Subject: NOi Terrell Bait Shop, UST Incident 40318, Sherrills Ford Rd/Hwy 150, Terrell, NC
Ms. Shrestha,
See attached Notice of Intent for the installation of three air sparge wells on Catawba County Parcel ID No .
461709263370, just northeast of the intersection of Sherrills Ford Road and Hwy 150, Terrell, NC.
If you have any questions concerning the attached for issuance of a well permit, please contact us at your
convenience.
Regards,
Al Quarles
Senior Geologist
S&ME
S&ME, Inc .
9751 Southern Pine Boulevard
Charlotte, NC 28273. ,.,.,,:
Ph: 704-523-4726
Fax: [phone]
Mobile : [phone]
[e-mail]
www.smeinc.com
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
Shrestha, Shristi R
From:
Sent:
To:
Subject:
Attachments:
Please find the attached NOi.
Shristi
Shristi R. Shrestha
Hydrogeologist .
Shrestha, Shristi R
Friday, July 21, 2017 11:10 AM
Basinger, Corey; Pitner, Andrew; Watson, Edward M
WI0300356 NOi Terrell Bait Shop
NOi Terrell Bait Shop_07-14-2017.pdf
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha@ ncdenr.gov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and frorri this address is subject to th0
f forth Carolina Public Records Law and may be rJisctosed to third parties.
Shrestha. Shristi R
From:
Sent:
To:
Subject:
Attachments:
Please find the attached NOi.
Shristi
Shristi R. Shrestha
Hydrogeologist
Shrestha, Shristi R
Friday, July 21, 2017 11:10 AM
Basinger, Corey; Pitner, Andrew; Watson, Edward M
WI0300356 NOi Terrell Bait Shop
NOi Terrell Bait Shop_07-14-2017.pdf
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha @ ncdenr.gov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
North Carolina Public Pecords !.aw and may be disclosed to third parties.
Shrestha, Shristi R
From: Al Quarles <[e-mail]>
Sent: Friday, July 14, 2017 10:43 AM
To: Shrestha, Shristi R
Cc: Lewis Efird; [e-mail]; [e-mail]; Scott Young; David
Reames; Newton, Brad
Subject: NOI Terrell Bait Shop, UST Incident 40318, Sherrills Ford Rd/Hwy 150, Terrell, NC
Attachments: NOI Terrell Bait Shop_07-14-2017.pdf
Ms. Shrestha,
See attached Notice of Intent for the installation of three air sparge wells on Catawba County Parcel FD No.
461709263370, just northeast of the intersection of Sherrills Ford Road and Hwy 150, Terrell, NC.
If you have any questions concerning the attached for issuance of a well permit, please contact us at your
convenience.
Rega rds,
Al Quarles
Senior Geologist
S&ME
S&ME, Inc.
9751 Southern Pine Boulevard
Charlotte. NC 28273
Ph: 704-523-4726
Fax: [phone]
Mobile: [phone]
atu a ri esr&smeinc.com
www.smeinc.com
uclaes SuoIJ dp 163uoi67ej
4I+;ento aelem
LtOI'L 1 1fT
ZiM[a(0300N/ 3AI3C36
This electronic message is subject to the terms of use set Forth at www.smeinc.comlemail. If you received this message in error please advise the
sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
RECEIVE D/NCI]EQIDWR
JUL 17:;2017
Water Quality
Region& °per:56011s Section

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 individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This form shall be submitted at least 2 WEEKS prior to iniection.
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 115A NCAC 02C .0229 1:
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 O perations -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 In jection 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: ______ Ju_ly~14_._2_01_7 __ _ PERMIT NO. /,v' .JO 3 0 0 b 5 (t;, (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1)
(2)
(3)
(4)
(5)
(6)
=X~_~Air Injection Well ...................................... Complete sections B through F, K, N
___ Aquifer Test Well ....................................... Complete sections B through F, K, N
___ Passive Injection System ............................... Complete sections B through F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B through N
___ Pilot Test. ................................................ Complete sections B through N
___ Tracer Injection Well ................................... Complete sections B through N
B. STATUS OF WELL OWNER: Business/Organization
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): United Oil of the Carolinas (Lewis Efird)
Mailing Address: _P_O_B_o_x_6_8 ___________________________ _
City: Gastonia State:~ Zip Code:28053-0068 County: _G_a_st_o_n ___ _
Day Tele No.: -'--70=--4'---8=2"--'4"""'-3'""5-"-6-=-1 ____________ _ Cell No.: ____ _
EMAIL Address: lewis (ri';unitedoilofthecarolinas.com 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: Charles Franklin Conner. III. Michael Eric Conner. Trac Matthew Conner. and Kimberl,,
Conner Little : ioint owners.
Mailing Address: ------=P-'-.0=-'-. =B-"'o=x~7""'0~0 ________________________ _
City: Claremont State: _ NC __ Zip Code: __ =2~86~1~0--0~7~0~0 __ County: Catawba
Day Tele No.: 828-455-3863 (Charles F. Conner ) Cell No.:
EMAIL Address:Eric@ count ywiderental.net (Michael Eric Conner). c3 l957@ !11l1ail.com (Charles F. Conner )
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Al Quarles. L.G .. Senior Geologist/Project Manager
Company Name ---=S=&=M~E~. =In=c~. ~CC=h=a=r=lo~tt=e~) _____________________ _
Mailing Address: ------'9""'7-"'5...,_1--"S"""o:..:::uc::..:th=e:.:..rn~P=in=e'----'B=o=u=l=ev-'--'a=r=d __________________ _
City: Charlotte State: ___l:K;__ Zip Code:28273-5560 County: Mecklenburn.
Day Tele No.: 704-523-4726 Cell No.: 803-984-6764
EMAIL Address: __ ~a=g+=u=a=rl=e~s .....=s=m=e=in=c=.c~o=m~---Fax No.: --~7~04~-~52~5~-3~9~5~3 ___ _
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Terrell Bait Shop (facilit v located at: 7970 ENC 150 HWY)
Wells to be located at: Sherrills Ford Road (Catawba County Parcel ID: 461709263370)
City: Terrell County: Catawba Zip Code: 28682
(2) Geographic Coordinates: Latitude**: ___ 0
____ " or 35.589433°
Longitude**: ___
0
--__ " or _ ___,-8~0~.9~7-'-7~7=62~0
____ _
Reference Datum: __ ~W~el=l~A=S~-~1-~Accuracy: _______ _
Method of Collection:_G~o~o"--'0.,__l~e=E=a~rt=h ____________ _
**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: _______ square feet
Land surface area of inj. well network: square feet(:::: 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be ,:S 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(I) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil arid 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.
J. APPROVED INJECT ANTS -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 htt p://de q.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/ground-water-a pp roved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919-
807-6496).
Injectant: ----------------------------------
Volume of injectant:
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants:
lnjectant: ----------------------------------
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: ____________________ _
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: --~3 ___ Proposed ______ Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-1 s, 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
Grout Screen Casing
Well ID Type Driller
(ft-bis) (ft-bis) (ft-bis)
AS-1, AS-2,
Permanent 2" Sch 40 PVC 3-64 67 -70 0-67 S&ME, Inc.
and AS-3
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
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 .
Deemed Pennitted GW Remediation NOi Rev. 3-1-2016 Page 4
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty of law, that 1 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 firzes and imprisonment, for submitting
false information. I agree to construct, operate. maintain, repair, and if applicable, abandon the infection well
and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules.._
D. Lewis C_ Efird. President
Signature of Applicant
Print or Type Full Name and Title
PROPERTY OWNER (if the property is not owned by 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 he
the responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction
Standards (154 ArAC 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)
Signature* of Property Owner (if different from applicant)
Signatur 'or Proper y ,hwner (if different from applicant)
urek of Property Owner (if different from applicant)
Charles F. Connor III -
Print or Type Full Name and Title
Michael Eric Connor - OwheY
Print or Type Full Name and Title
KirnberI Connor Little -
Print or Type Full Name and Title
Trac\ Matthew Connor - oiA"`"-•
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.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-I636
Telephone: [phone]
Deemed Permitted GW Remediation N01 Rev. 3-l-2014
Page 5

Parcel Owner Report -Catawba County NC
Parcel ID: 461709263370
SHERRILLS FORD RD TERRELL, 28682
CONNOR CHARLES FRANKLIN 111
CONNOR MICHAEL ERIC
CONNOR TRACY MATTHEW
LITTLE KIMBERLY CONNOR
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawt>a County has made substantial efforts to ensure the accuracy
of location and labeling information contained on this map or data on this report. Catawt>a County promotes and recommends the independent verification of any data
contained on this map/report product by the user. The County of Catawba, ~s employees, agents, and personnel, disclaim, and shall not be held liable for any and all
damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity.
© 2017, Catawba County Government, North Carolina. All rights reserved.
.7 1
Y
Z000`
4,000
Y (IN FEET)
REFERENCE: 1993 LAKE NORMAN NORTH INC] USGS 1:24,000 QUAO SHEET
THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED
ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY INFORMATION. UNLESS
STATED OTHERWISE.
. a.
•
L*
Project Location
SCALE
" = 2,000'
DATE
12-5-16
DRAWN SY:
DDH
SS&ME
USGS TOPOGRAPHIC MAP
TERRELL BAIT SHOP
CATAWBA COUNTY, NORTH CAROLINA
FIGURE NO,
I PROJECT NO.
4335-16-038

MW-1 3
(None)
MW-3
(None)
RAW-9
(None)
IIIW-14
(None)
MW-8
(None)
MW-7
(None)
MW-2
(None)
- -1
4\.
0 30 60
(IN FEET)
I W-15
(None)
MW-11
(None)
S
MW-17
9 (None/
MW-6ss
2 42)
•
i ►
i ■ • ' ■
r f r t o ■
DMW-1■
MW-1i
(None)\ 314'r r
. 1
• .•
MW-12
(None)
'MW-18
(None)
49
1
1
REFERENCE: 2014 AERIAL PHOTOGRAPH
THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS
DISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY
INFORMATION, UNLESS STATE D0THERWISE.
r
•
TERRELL
BAIT SHOP
TS-8
(None)
(3.96)
IApproximate Former UST Locations
SCALE.
1, = 30
DATE:
6-30-17
DRAWN BY.
DDH
.IE.: T
4335-16-038
*S&ME
SITE MAP
TERRELL BAIT SHOP
CATAWBA COUNTY, NORTH CAROLINA
MIN-5
(None)
49
4
•
(None)
•
01
0
a
Free Product Thickness June & November 2016 n
Located Monitoring Well
i
Monitoring Well Not Located
Estimated Extent of Free Product
FIGURE NO.
3 3
s
a

_ _ EMCO WHEATON VAULT SCHEDULE
LOCATION
SIZE
MODEL #
AS-1, AS-3
12"x12"x18.6" deep
A0717-712VWB
AS-2
18"x18"x24.6" deep
A0717-718VWA
Parcel # 461709263370
I
0
a
STUB OUT FOR
FUTURE EXPANSION
air f
•
PROPOSED
SYSTEM
COMPOUND
TERRELL
BAIT SHOP
•
r • �■ ' '►
• ■ 4 �►•4
■ , 1 •
• ■ ► ■
•
► , ■ •
■ • 4 .
* • 4 • ■&
11 ,, 10 ■
'$ 4/1
•► r L
4 .. 1.0.
•
r
60
(IN FEET)
REFERENCE: 2014 AERIAL PHOTOGRAPH
THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS
DISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY
INFORMATION. UNLESS STATED OTHERWISE.
Parcel # 461709251219
N
Air Sparge Well
CI Soil Vapor Extraction Well
2" Dedicated SCH 40 PVC Soil Vapor Extraction Pipe
- 3" SCH 40 PVC Air Sparge Chase Pipe
L _ j Estimated Extent of Free Product
Approximate Former UST Locations
SCALE.
1 " = 20'
DATE?
12-8-16
DRAWN BY:
DOH
PROJECT NO:
4335-16-038
4S&ME
PROPOSED REMEDIATION
SYSTEM LAYOUT
TERRELL BAIT SHOP
CATAWBA COUNTY, NORTH CAROLINA
FIGURE NO.
4
q:14335118103B Tend BaltShopAtl_ Proposed Remediabon Desigmnixd plowed by DHamens 12-08-2018