WI0300359_DEEMED FILES_20171101

Pennit Number
Program Category
Deemed Ground Water
Permit Type
WI0300359
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Johnny Pruitt/NCDOT Site#15
Location Address
7719 Pageland Hwy
Mooresville
Owner
Owner Name
NC 28117
Ncdeq Dwm Ust Section-Federal & Stsate Lead Program
Dates/Events
Orig Issue
11/1/2017
App Received
10/25/2017
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
Draft Initiated
Scheduled
Issuance Public Notice
Central Files : APS SWP
11/1/2017
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Scott Ryals
1646 Ma il Service Ctr
Raleigh
Owner Type
Government -State
Owner Affiliation
Mark Petenmann
1646 Mail Service Ctr
Raleigh
Region
Mooresville
County
Union
NC
NC
Issue
11/1/2017
Effective
11/1/2017
27699
27699164
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasln
Shrestha, Shristi R
From:
Sent:
To:
Subject:
Attachments:
Please find the attached NOL
Shristi
Shristi R. Shrestha
Hydrogeologist
Shrestha, Shristi R
Wednesday, November 01, 2017 2:35 PM
Basinger, Corey; Pitner, Andrew
WI0300359 NOi Johnny Pruitt
MO-4711_1582_CA_NOI_20171101 (002).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.g ov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to thE-
1 orth Carolina Public Records Law and may b e discfos9d tc third parties.
Shrestha, Shristi R
From:
Sent:
To:
Cc:
Subject:
Shrestha, Shristi R
Wednesday, November 01, 2017 2:32 PM
'Travis Lee O'Quinn'; Ryals, Scott
David Loftis; Michael Pfeifer; Basinger, Corey; Pitner, Andrew
WI0300359 NOi RE: [External] Johnny Pruitt Site NOi
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 ginals go the address printed on the
form). NOTE: Direct push or Geoprobe wells are considered wells and require construction (GW-1) and
abandonment forms (GW-30). If well construction/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
h ttp ://de g.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ ground-water-
protection/ground-water-rep orting-forms
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 [e-mail] 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., WI0:XXXXXX) that has been assigned to the injection activity at this site. This notification has been given the
deemed permit number WI0300359. This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in r ep ly to this email, as it will already have the assigned deemed permit
number in the subject line.
Please send me a hard co py of the NOI for our records.
Thank you,
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.g ov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
Norlh Carolina Public Records Law and may be disclosed to thJi·d parties.
From: Travis Lee O'Quinn [mailto:[e-mail]]
Sent: Wednesday, November 01, 2017 11:46 AM
To: Ryals, Scott <[e-mail]>; Shrestha, Shristi R <[e-mail]>
Cc: David Loftis <[e-mail]>; Michael Pfeifer <[e-mail]>
Subject: RE: [External] Johnny Pruitt Site NOI
CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to
[e-mail].
Scott/Shrista,
I forgot to include the attachments to the NOI. See the attached NOI with the attachment.
Scott,
We installed the socks in MW-1, MW-4R, and MW-5R.
Let me know if you have any additional questions.
Thanks ,
Travis L. O'Quinn
Environmental Project Professional
.....
I I
S&ME
97S1 Southern Pine Blvd.
Charlotte, NC 28273 map
0: 704.523.4726
M: 704.995.5481
www.smeinc.com
Linkedin I Twitter I Facebook
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sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
From: Ryals, Scott mailto:scott. als (a)ncdenr.uov]
Sent: Wednesday, November 01, 2017 11 :29 AM
To: Shrestha, Shristi R <[e-mail] v>; Travis Lee O'Quinn <[e-mail]>
Cc: David Loftis <DLoftis @smeinc.com>; Michael Pfeifer <[e-mail]>
Subject: RE: [External] Johnny Pruitt Site NOI
Which wells did you install the socks in Travis? I will send Shristi the site map and concentration map and which
sock it is from their list we used and GW should have the well logs since they make everyone submit them.
Shristi, if you have any questions please contact me.
Thank you,
Scott C. Ryals. PE. CEE
Engineer, Trust Fund Branch
Division of Waste Management, UST Section
North Carolina Department of Environmental Quality
919 707 8168 office
scott.rvalsc incdenr,gov
217 West Jones Street (physical)
1646 Mail Service Center (mailing)
Raleigh, NC 27699
Notr g Compares
Email correspondence ft, and from this address is subject to #ha
North Carolina Public Records Law and may be disclosed !ro third ,car ties.
From: Shrestha, Shristi R
Sent: Wednesday, November 01, 2017 11:08 AM
To: Travis Lee O'Quinn <to_quinn'o smeinc.corn>
Cc: David Loftis <DLoftis'rc!smeinc.com>; Ryals, Scott <[e-mail]>; Michael Pfeifer
<MPfeifer<< smeinc_com>
Subject: RE: [External] Johnny Pruitt Site NOI
Please submit the part H ( Injection zone maps) and fill out 1(approves injectants information). Also, please include
GW-1 ( well construction records for the existing wells)_
Than you,
Shristi
Shrlstl 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.00v
512N, Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
amall correspondence to and from this address is subject to the
ror►h Caroline Publl records .awr and m _ y be disclosed to third parties.
From: Travis Lee O'Quinn [mailto:taqui.nnia.smeinc.com}
Sent: Wednesday, October 25, 2017 4:11 PM
To: Shrestha, Shristi R <shristi.shresthau ncdenr.eov>
Cc: David Loftis <DLoftis: 7 smeinc.com>; Ryals, Scott <scott.ryals ap7 cdenr.gov>; Michael Pfeifer
<MPfeifer<<t smeinc.com>
Subject: [External] Johnny Pruitt Site NOI
CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you verify that
the attachment and content are safe. Send all suspicious email as an attachment to report.spam@':a nc_gov.

Attached is the NOi for the Johnny Pruitt Site (Incident #15782) that is currently one of the NCDEQ, DWM, UST
Section Trust Fund/orphan site located at 7719 Pageland Highway in Monroe, NC. NCDEQ contracted S&ME to
install oxygen release socks at the site. On August 12, 2017, S&ME installed the socks in three existing monitoring
wells at the site.
Sorry, I was unaware that we needed to complete a NOi prior to install oxygen release socks. I will make sure I
complete the NOi prior to installing socks in the future.
Contact me with any questions or concerns.
Thanks,
Travis L. O'Quinn
Environmental Project Professional
I I
S&ME
9751 Southern Pine Blvd.
Charlotte, NC 28273 map
0: 704.S23.4726
M: 704.995.5481
www.smeinc.com
Linkedin I Twitter I Facebook
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.
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 injection.
AQUIFER TEST WELLS 05A 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 1 or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection S ystems -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 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: October 25 . ,2017 PERMIT NO. (/'J:J.,.O 30 03 59 (to be filled in byDWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
(1)
(2)
(3)
(4)
(5)
(6)
--~Air Injection Well ...................................... Coµiplete sections B through F, K, N
___ Aquifer Test Well ....................................... Complete sections B through F, K, N
~X~_~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 ~IR>/NCDEC!DWR
STATUS OF WELL OWNER: State Government OCT 2 Ji 2017
C. WELL OWNER(S) -State name of Business/Agency, and Name and Title ofpers~eRJ.r~iW~i.!M-ity to
sign on behalf oft};le business or agency: perat,ons Section
Name(s): ___ S_c_o_tt_R_y~a_ls~, _N_C_D_E_Q~._D_WM_~• U_S_T_S_e_ct_io_n _________________ _
Mailing Address: --~1~6~4~6~M~a~i=l~S~erv~ic~e~C~en~t~er~--------------------
City: Raleigh State: NC Zip Code: 27699-1646 County: ___ -'W"""'ak=e-
Day Tele No.: 919-707-8166 Cell No.: __________ _
EMAIL Address: scott.n ·als{w ncdenr.gov Fax No.: ___________ _
Deemed Permitted OW Remediation NOI Rev. 6/1/2017 Page I
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: -----'J"""'o=h=n'----'D"---'----'. &=--=J---=e=nn=y.L..-:C'-'-. =R=o-'-'ri=e ____________________ _
Company Name ---------------------------------
Mailing Address: ------'7'--'7....:1"""9....:P...::a""u..::.el""a~n=d-"-H=i""g=hw-'-'-=a.,_y ____________________ _
City: Monroe State: NC Zip Code:_2=8,._l"-'1=2,..._ ___ County: ___ ...,aU--'n_io~n_
Day Tele No.: ---~7~04~-~76~4~-9~4~8~8 ___ _ Cell No.: __________ _
EMAIL Address: _____________ _ Fax No.: ___________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: ___ T=r~a~v=is~O~'O~u=inn/P=~r-=-o,..=je=ct~P~r~o=fe=s=s=io=n=al~-----------------
Company Name ---=S=&=M=E ___________________________ _
Mailing Address: ------'9"""7""'5""'1-"S""'o""u=th=e=rn~P=in=e~B~ou=l=e~va=r-=d~------------------
City: Charlotte State: NC Zip Code: . ....a2=8=2~7=3 ____ County: Mecklenburu
Day Tele No.: 704-523-4726 Cell No.: __________ _
EMAIL Address: toguinn/@ smeinc.com Fax No.: 704-525-3953
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Johnny Puritt/NCDOT Site #15. 7719 Pageland Highway
City: --~M=o=n=ro""'e'------_________ County: Union Zip Code: ---=2=8=1..a..17.,__
(2) Geographic Coordinates: Latitude**: ___ 0 ____ " or ~3,._4.,_0.,_,.8""'1'"""6'""1-'-7=8 _____ _
Longitude**: " "or -80 °.417138
Reference Datum : ________ 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: _______ .square feet
Land surface area ofinj. well network: square feet(::: 10,000 ft 2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be.:::. 5% of plume for pilot test injections)
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.
Deemed Permitted GW Remediation NOI Rev. 6/1/2017 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.
A release of l!asoline from an underground storaQe tank s ystem located on the pro pe 11y has impacted
gr oundwater above the 15A NCAC 2L .0202 groundwater qualitv standards. The use of oxyg en releasing socks
(Provectus ORS) using three wells (MW-I. MW-IR. and MW-4R) is planned to enhance the de 1n adation of
petroleum contaminant levels in the aroundwater to below the 2L Standards. Nine 3-ft long oxygen release
socks were installed in the wells as follows: MW-I (3). MW-IR (3 ). and MW-4R (3).
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://deq .nc.eov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/1?.round-water-protection/!!round-water-a pp roved-iniectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919-
807-6496).
Injectant:
Volume ofinjectant: _____________________________ _
Concentration at point of injection:
Percent if in a mixture with other injectants: ____________________ _
Injectant:
Volume ofinjectant: _____________________________ _
Concentration at point of injection:
Percent if in a mixture with other injectants: ____________________ _
Injectant:
Volume ofinjectant:
Concentration at point of injection:
Percent if in a mixture with other injectants: ____________________ _
K. WELL CONSTRUCTION DATA
(1)
(2)
Number of injection wells: ______ Proposed ___ 3 ___ Existing (provide GW-Is)
For Proposed wells or Existing wells not having GW-Is, 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
Deemed Permitted GW Remediation NOi Rev. 6/1/2017 Page3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Oxen release socks were installed Aueust 12. 2017. Socks to be removed and replaced in approximatell 6
months followine installation. The socks will then be removed from the wells in approximately 6 months after
the second application.
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.
After removal of the socks. the wells will be sampled for SM 6200B parameters.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty of law, that I am familiar with the information submitted in this
document and ail 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,"
Travis O'Quinn.Project Professional
Signature of Applicant Print or Type Full Name and Title
PROPERTY OWNER (if the propem is not owned by the permit applicant):
"As owner of the property on which the infection well() are to be constructed and operated, 1 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(") 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 Attached Access Agreement
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*.Ira 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 27699-1636
Telephone: [phone]
Deemed Per1'10ed(1W Itemediation NUI Rev. 6/1/20l7 Page 4

LETTER OF TRANSMITTAL
SBME, Inc.
9751 Southern Pine Blvd.
Charlotte, NC 28273
704.523.4726
704.525-3953 fax
To: NC Dept. of Environmental Quality
Water Quality Regional Operations Section
163E Mail Service Center
Raleigh, NC 27699-1636
We Are Sending You: ® Attached
following items:
❑ Shop drawings ❑ Contract ❑ Plans
7 Copy of letter ❑ Report
RECEIVEDINCDEQIDWR
NIJV062D7
Water Quality Regional
Operations Section
Date: November 1, 2017
Job No.
4305-17-153
Pruitt, Johnny/NCDOT Site
#15 TF-15782 UST #MO-4711
Attn: Ms. Shrista R. Shrestha
Under separate cover via the
❑ Samples ❑ Specifications
Copies I Date
No
1
11/1/17
Notification of Intent
Description
These Are Transmitted As Checked Below:
n For approval ® For your use
® As requested ❑ For Review
❑ For Bids Due: ^I 1 ❑ Prints Returned After Loan To Us
Remarks:
Signed:
If you have any questions. please contact Travis O'Quinn at 764.523.4726.
Thank you
Gloria A. Keiffer, Administrative Assi

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 JSA 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 (1 5A 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 remedia.tion 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 Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. lllegible Submittals Will Be Returned As Incomplete.
DATE: November 1. . 2017 PERMIT NO. ________ (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
(1)
(2)
(3)
(4)
(5)
(6)
---'Air Injection Well ...................................... Complete sections B through F, K, N
---'Aquifer Test Well ....................................... Complete sections B through F, K, N
-X __ Passive Injection System ............................... Complete sections B through F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B through N
__ Pilot Test.. ............................................... Complete sections B ~Qj¼E D/NCDEQ/OWR
___ Tracer Injection Well ................................... Complete sections B throug fJ V O 6 2017
STATUS OF WELL OWNER: State Government
Water Quality Regional
Operations Section
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): ---=S=co=tt"-'R=y.,a=ls ..... -=-N=C=D=E=O ..... ,-=D'""'WM"-==-· -=U-=S-=-T-=S=ec=u=·o=n'-----------------
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699-1646 County: __ ~W-ak=e~
Day Tele No.: 919-707-8166 Cell No.: _________ _
EMAIL Address: __ _,.s=co=tt=.ry;..,.=al=s@n-==c=de=nr=·=g=ov..,__ __ _ Fax No.: __________ _
Deemed Permitted GW Remediation NOi Rev. 6/1/2017 Pagel
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: ______ J __ ohn=-=D ..... =&'"""J"""enn=-y._C.........a. R .... o=n--·e _____________________ _
CompanyName ______________________________ _
Mailing Address: ___ 77_1_9_P--'a~g=el~an_d~H~ig~h~w~a~y ___________________ _
City: Monroe State: NC Zip Code:--'2=8--=1=1=2 ____ County: __ ---'U=n=i=on=--
Day Tele No.: ---"""'7""'"04-'--""""7 .... 64 .... -.... 94""""8=-=8 _____ _ Cell No.: __________ _
EMAIL Address:. _____________ _ FaxNo.: __________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: -----=T=ra=v=is=-o~•o_uinn/P=·=-=-=ro,.,_jec=t=-P=ro=fe=s=si=o=na=l---______________ _
Company Name -----=S=&=ME=----------------------------
Mailing Address: ___ 97-5-l~S=· o=u=th=e=m=-P=-m=· =e-B=o=u-le~var~d ___________________ _
City: Charlotte State: NC Zip Code:_2_8_27_3 ____ County: Mecklenburg
Day Tele No.: 704-523-4726 Cell No.: __________ _
EMAIL Address: [e-mail] Fax No.: 704-525-3953
F. PHYSICAL LOCATION OF WELL SITE
(l) Facility Name & Address: Johnny Puritt/NCDOT Site #15, 7719 Pageland Highway
City: Monroe County: Union Zip Code: __ 2_8_1_17_
(2) Geographic Coordinates: Latitude**: ___ 0 __ __" or _3=-4"-0=.8=1=6=-17'"""8'-------
Longitude**: 0 __ " or -80 °.417138
Reference Datum: ________ Accuracy: _______ _
Method of Collection: ________________ _
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILI'IY SITE MAP WITII PROPER'IY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPIIlC COORDINA1ES.
G. TREATMENT AREA
Land surface area of contaminant plume: ________ square feet
Land surface area ofinj. well network: square feet~ 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be ~ 5% of plume for pilot test injections)
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.
Deemed Permitted GW Remediation NOi Rev. 6/1/2017 Page2
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.
A release of gasoline from an underground storage tank system located on the property has impacted
groundwater above the 15A NCAC 2L .0202 groundwater quality standards. The use of oxygen releasing socks
(Provectus ORS) using three wells (MW-1. MW-4R, and MW-5R) is planned to enhance the degradation of
petroleum contaminant levels in the groundwater to below the 2L Standards. Nine 3-ft long oxygen release
socks were installed in the wells as follows: MW-I (3), MW-4R (3), andMW-5R (3),
J. APPROVED JNJECTANTS -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 htrp ://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/gr ound-water-orotection/ground-water-a pproved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the U/C Program for more info (919-
807-6496).
lnjectant: -----=-0_,.._s_o___._ ___________________ _
Volume ofinjectant: __________________________ _
Concentration at point of injection: _____________________ _
Percent if in a mixture with other injectants: __________________ _
Injectant: -------------------------------
Volume ofinjectant: __________________________ _
Concentration at point of injection: _____________________ _
Percent if in a mixture with other injectants: __________________ _
lnjectant: ______________________________ _
Volume ofinjectant: __________________________ _
Concentration at point of injection: _____________________ _
Percent if in a mixture with other injectants: __________________ _
K. WELL CONSTRUCTION DATA
(1)
(2)
Number of injection wells: ______ Proposed ___ 3 ___ Existing (provide GW-ls)
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
Deemed Permitted GW Remediation NOi Rev. 6/1/2017 Page 3
L. SCHEDULES —Briefly describe the schedule for well construction and injection activities.
Oxygen release socks were installed August 12, 2017. Socks to be removed and replaced in approximately 6
months following installation. The socks will then be removed from the wells in approximately 6 months after
the second application.
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,
After removal of the socks. the wells will be sampled for SM 6200B parameters.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certi, 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."
Travis O'Quinn, Project Professional
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 be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NC.AC 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 Access Agreement
Signature* of Property Owner Of different from applicant) Print or Type Full Name and Tide
*4n access agreement between the applicant and property owner may be submitted in lieu of a signature an this form.
Submit the completed notification package to:
DWR — [.TIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted OW Remediation NO1 Rev. 6/1/2017 Page 4

e
E
O
a
d
r
0
140
c44 zoo°
:k!.OR1H CAROL/NA
S0U111 VAR/WIN-AT
1 i
4,000
(FEET)
r
REFERENCE: USGS USA TOPO STREAMING DATASET
GIS BASE LAYERS WERE OBTAINED FROM USGS NATIONAL MAR. THIS MAP 1S FOR
INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED ARE APPROXIMATED.
THEY ARE NOT BASED ON CIVIL SURVEY INFORMATION, UNLESS STATED OTHERWISE.
_NA* �
ClIF .sr r181o_
lI fO _• ,-
* Project Location
USGS TOPOGRAPHIC MAP
PRUIT, JOHNNY/NCDOT SITE #15 TF-15782 UST# MO-4711
7719 PAGELAND HIGHWAY
MONROE, UNION COUNTY, NORTH CAROLINA
SCALE:
1 " = 2,000 '
DATE:
9-12-17
PROJECT NUMBER
4305-17-153
FIGURE NO.
1

ri nlnnvd ]w f]Mnmanc ❑9 17-7[I17
eansii74.1;1 inr,nn
0
50
STAEILRD
100
(FEET)
REFERENCE: 2015 AERIAL PHOTOGRAPH
GIS BASE LAYERS WERE OBTAINED FROM UNION COUNTY AND NC ONEMAP. THIS MAP I5 FOR
INFORMATIONAL PURPOSES ONLY ALL FEATURE LOCATIONS DISPLAYED ARE APPROXIMATED.
THEY ARE NOT BASED ON CIVIL SURVEY INFORMATION, UNLESS STATED OTHERWISE.
STATE4LfNRD
* Monitoring Well
Project Parcel
cII=
SITE MAP
PRUIT, JOHNNY/NCDOT SITE #15 TF-15782 UST# MO-4711
7719 PAGELAND HIGHWAY
MONROE, UNION COUNTY, NORTH CAROLINA
SCALE:
1"= 50'
DATE:
9-12-17
FIGURE NO.
2
PROJECT NUMBER
4305-17-153

N
3
c
a
2
40
MW=2R
. 74ti75}
so
• (FEET)
i
-SR
t7 -2'4)
1
1
1
1
1
1
1
REFERENCE: 2015 AERIAL PHOTOGRAPH
GIS BASE LAYERS WERE OBTAINED FROM UNION COUNTY AND NC ONEMAP. THIS
MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED
ARE APPR07QMATED, THEY ARE NOT BASED ON CIVIL SURVEY INFORMATION, UNLESS
STATED OTHERWISE.
RAWAgir
R
1
(75.65) Relative Groundwater Elevation (feet) on 8/12/2017
— Relative Groundwater Contours (feat)
40 Monitoring Well
11 Project Parcel
GROUNDWATER ELEVATION MAP
PRUIT, JOH NNYINCDOT SITE #15 TF-15782 UST# MO-4711
7719 PAGELAND HIGHWAY
MONROE, UNION COUNTY, NORTH CAROLINA
SCALE:
1"=40'
DATE:
9-12-17
PROJECT NUMBER
4305-17-153
FIGURE NO.
3

111.
TABLE 3
WELL CONSTRUCTION AND LIQUID LEVEL DATA
Fruit, johnnyfNCDOT Site #15 (Incident No.: 15782, UST it: MO-4711)
7719 Pagetand Highway, Monroe, Union County, North Carolina
S&ME Project 4 4305-17-153
Well
ID
Date
Installed
Date
Water Level
Measured
Well
Casing
Depth
(Ft BG5)
Well
Casing
Diameter
( }
Screen
interval
(ft-BGS)
Depth
of Well
(ft•BG5)
Tap of
Casing
Elevation'
(ft)
DWat ro
from Top
Casing
tit
Free
Product
Thickness
•of
.. (ft)
Groundwater
Elevation
(ft)
MW-1
09101/01
01/12/10
0 30
_
30-40
40.0
100.00
6.75
NA
93.25
07/09/10
18.62
NA _
8138
05/03/13
5.23
NA
94.77
07124114
19.55
NA
80.45
08/28/15
33.22
NA
66.78
11/16
23.48
NA
76.52
08112/17
24.35
NA
75.65
MlV-1R
10/16/07
01/12/10
0 - 30
2
30. 4040.0
-
102.35
10.06
NA
92.29
07/09/I0
17,60
NA
84.75
05/03/13
8.6.8
NA
93_67_
07/2404
2135
NA
79,00
08/28115
35.55
NA
66.80
10131/16
27.50
NA
74.8.5
08112/17
27.57
NA
74.78
MW-2R
10/16/07
01/12/I0
0 - 30
2
30 - 40
-
40.0
102.3E
10.08
NA
92.28
07/09/10
22.42
NA
79.94
05/03113
8.69
NA
93.67
07(24/14
23.36
NA
79.00_
08/28/15
35.60
NA
66.76
10(31/16
r 25.78
NA
76.58
08112/17
27.61
NA
74.75
MW-3R
10/16/07
01/12/10
,
0 - 30
30 - 40
10.0
101.40
..
S.94
NA
92.46
07/09/10
21.17
NA
80.23
05/03/13
7.46
NA
93.94
07BLO4
22.18
NA
79.22
08/28/15
34.40
NA
67.00
10/31/16
NL
NL
NL
08/12/17
26.55
NA
74.85
]v1SV 4]2
10.16/07
Q1/12/10
0 30
30 - 40
40.0
100.03
7.13
NA
92.90
07/09/10
19.40
NA
80.63
05/03/13
6,65
NA
93.38
07(29114
20.32
NA
79.71
08/28/15
32.6.5
NA
67.38
10/31/16
24.02
NA
76.01
08/12117
24.70
NA
75.33
1v1W-5R
10/16/07
01/12/10
0 - 30
_
30 - 40
_
40-i.i
99.51
6.68
NA
92.83
07/09110
18.82
N A
80.69
05/03/13
5.89
NA
93.62
07/24/14
19.76
NA
79.75
08(28/1;
34.40
NA
65.11
I[1/31)16
23.45
NA
76.06
0 /12117
24.27
N A
75.24
NOTES
• Reference Point for Elevation Wasmune:as:
Benchmark Datum:
MW-1
Benchmark Elevation:
100
Assumed or Measured: Assutned
• If Free Product is present in a well. groundwater elevation should be calculated by: [Top of Casing Elevation - Depth to Water] + [free product thickness x 0.85811
ft-BGS - feet below ground surface tiiluf = Not Measured NA - Not Applicable
ND - Nal Detected NG - Not Gauged

State of North Carolina
Department of Environment,
Health and Natural Resources
Mooresville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Dan Graham
Hydrogeological Technician
DEHNRIDWQ/Groundwater Section
919 North Main Street
Mooresville, North Carolina 28115
RE:
Dear Mr. Graham:
Arn
�EHNR
?i.C. anFT.
EiIVI' 7? tin..
1. NATE.r.4'_ _.
Agreement for the Use of a Site for a
Soil/Groundwater Investigation
John Pruitt Property
Hwy. 601 and S.R. 2115, Monroe
Union County, N.C.
d 1 5 1997
a n- `�'s rr•i: i SL OFECE
ir_u nG� �V r1
I/We am/are the owner(s) of a parcel of property, as described in Attachment 1, and
hereby permit the Department of Environment, Health, and Natural Resources (henceforth
referred to as the Department) to enter upon the groundwaters under the authority of G.S. 143-
215.3(a)2.
1/We amlare granting permission with the understanding that:
l . The investigation shall be conducted by the Groundwater Section of the
Department's Division of Water Quality.
2. The costs of construction and maintenance of the site and access shall be born by
the Department. The Department shall protect and prevent damage to the
surrounding lands.
3. Unless otherwise agreed, the Department shall have access to the site by the
shortest feasible route to the nearest public road. The Department may enter upon
the land at reasonable times and have full right of access during the period of the
investigation.
4. At the end of the investigation, unless otherwise provided for by prior written
agreement, the Department shall remove from the site all structures placed or
erected by it and shall permanently abandon all wells constructed by it.
5. Any claims which may arise against the Department shall be governed by Article
31 of Chapter 143 of the North Carolina General Statutes, Tort Claims Against
State Departments and Agencies, and as otherwise provided by law.
919 North Main Street,
Mooresviille, North Carolina 28115
Voice 704-663-1699
FAX [phone]
An Equal Opportunity/Affirmative Action Employer
50% recycled/1O% post-ccnsumer paper

Pr
John Pruitt Property Investigation
Page 2
6. The information derived from the investigation shall be made available to the
owner upon request and is a public record, in accordance with G.S. 132-1 et seq.
7. The activities to be carried out by the Department are for the primary benefit of
the Department and of the State of North Carolina and any benefits accruing to
the owner are incidental. The Department is not and shall not be construed to be
an agent, employee, or contractor of the owner of the land.
I/We agree not to interfere with, remove or in any way damage the Department's welI(s)
and equipment during the investigation.
eck.e_s6nz et. F-0
(Type or runt Name Owner or enq
(Date)
-!A-
(Address)

rovectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 1 of 5
1. PRODUCT IDENTIFICATION: PROVECT-ORS
PRODUCT USE: Soil and water treatment.
MANUFACTURER: EMERGENCY PHONE:
PROVECTUS ENVIRONMENTAL
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
USA: (1I5) 650-2230
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n.o.s. (Calcium Peroxide), Class 5.1, PG Il, UN 1479
WHMIS CLASSIFICATION:
Oxidizer
2. COMPOSITION/INFORMATION ON INGREDIENTS
Ingredients
Calcium Peroxide
Inorganic Nutrients
3. PHYSICAL DATA
Chemical Formula
CaO2
CAS No. Percentage
1305-79-9 75%-85%
15%-25%
Appearance White & brown granules
Physical state Solid
Odor threshold None
Bulk Density 500-650gIL
Solubility in Water Insoluble
pH -11
Decomposition Temperature,_.___.___ Self -accelerating decomposition with oxygen release starting from 275
degrees Celsius
4. HAZARDS IDENTIFICATION
Emergency overview
Oxidizing agent; contact with other material may cause fire. Under fire conditions this material may
decompose and release oxygen that intensifies fire. This product contains <1% non -respirable crystalline
silica. The NTP and OSHA have not classified non -respirable crystalline silica as carcinogenic. Long term
exposure to hazardous levels of respirable silica dusts can cause lung disease (silicosis). ORS does not
contain respirable crystalline. silica.
Potential Health Effects:
• General Irritating to mucous membrane and eyes.

i)rovectus
ENV1RONMENTAL PRODUCTS" 111)
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 2 of 5
• Inhalation Irritating to respiratory tract. Long term inhalation of elevated levels
may cause Iung disease (silicosis).
• Eye contact,______,,.__, May cause irritation to the eyes: Risks of serious or permanent eye
lesions.
• Skin contact.---_ .......... .. May cause skin irritation.
• Ingestion Irritation of the mouth and throat with nausea and vomiting.
5. FIRST AID MEASURES
• inhalation Remove affected person to fresh air. Seek medical attention if effects
persist.
• Eye contact Flush eyes with running water for at least 15 minutes with eyelids
held open. Seek specialist advice.
• Skin contact Wash affected skin with soap and mild detergent and large amounts of
water.
• Ingestion. If the person is conscious and not convulsing, give 2-4 cupfuls of
water to dilute the chemical and seek medical attention immediately.
Do not induce vomiting.
6. FIRE FIGHTING MEASURE
Flash Point
• Not applicable
Flammability
• Not applicable
Ignition Temperature
• Not applicable
Danger of Explosion
• Non -explosive
Extinguishing Media
• Water
Fire. Hazards
• Oxidizer. Storage vessels involved in a fire may vent gas or rupture due to internal pressure.
Damp material may decompose exothermically and ignite combustibles. Oxygen release due to
exothermic decomposition may support combustion. May ignite other combustible materials.
Avoid contact with incompatible materials such as heavy metals, reducing agents, acids, bases,

rovectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 3 of 5
combustible (wood, papers, cloths etc.) Thermal decomposition releases oxygen and heat.
Pressure bursts may occur due to gas evolution. Pressurization if confined when heated or
decomposing. Containers may burst violently.
Fire Fighting Measures
■ Evacuate all non -essential personnel
• Wear protective clothing and self-contained breathing apparatus.
• Remain upwind of fire to avoid hazardous vapors and decomposition products.
• Use water spray to cool fire- exposed containers.
7. ACCIDENTAL RELEASE MEASURES
Spill Cleanup Procedure
• Oxidizer. Eliminate all sources of ignition. Evacuate unprotected personnel from equipment
recommendations found in Section 9. Never exceed any occupational exposure limit.
• Shovel or sweep material into plastic bags or vented containers for disposal. Do not return spilled
or contaminated material to inventory. Avoid making dust.
• Flush remaining area with water to remove trace residue and dispose of properly. Avoid direct
discharge to sewers and surface waters. Notify authorities if entry occurs.
• Do not touch or walk through spilled material. Keep away from combustibles (wood, paper, oils,
etc.). Do not return product to container because of risk of contamination.
8. HANDLING AND STORAGE
Storage
• Oxidizer. Store in a cool, well -ventilated area away from all source of ignition and out of direct
sunlight Store in a dry location away from heat_
• Keep away from incompatible materials. Keep containers tightly closed. Do not store in
unlabeled or mislabeled containers.
• Protect from moisture. Do not store near combustible materials_ Keep containers well sealed.
Ensure pressure relief and adequate ventilation.
• Store separately from organics and reducing materials. Avoid contamination that may lead to
decomposition.
Handling
• Avoid contact with eyes, skin, and clothing. Use with adequate ventilation.
• Do not swallow. Avoid breathing vapors, mists, or dust. Do not eat, drink, or smoke in work
area.
+ Prevent contact with combustible or organic materials.
• Label containers and keep them tightly closed when not in use.
• Wash thoroughly after handling.

rovectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA SKEET;
PROVECT-ORS Page: 4 of 5
9. EXPOSURE CONTROLS/PERSONAL PROTECTION
Engineering Controls
• General room ventilation is required. Local exhaust ventilation, process enclosures or other
engineers controls may be needed to maintain airborne levels below recommended exposure limits.
Avoid creating dust or mist. Maintain adequate ventilation. Do not use in closed or confined
spaces. Keep levels below exposure limits. To determine exposure limits, monitoring should be
performed regularly,
Respiratory Protection
■ For many condition, no respiratory protection may be needed: however, in dusty or unknown
atmospheres or when exposures exceed limit values, wear a NIOSH approved respirator.
Eye/Face Protection
■ Wear chemical safety goggles and a full face shield while handling this product.
Skin Protection
■ Prevent contact with this product. Wear gloves and protective clothing depending on condition of
use. Protective gloves: Chemical -resistant (Recommended materials; PVC, neoprene or rubber)
Other Protective Equipment
• Eye -wash station
• Safety shower
• Impervious clothing
• Rubber boots
General Hygiene Considerations
• Wash with soap and water before meal times and at the end of each work shift. Good
manufacturing practices require gross amounts of any chemical removed from skin as soon as
practical, especially before eating or smoking.
10. STABILITY AND REACTIVITY
Stability
• Stable • under normal conditions
Condition to Avoid
• Water
• Acids
• Bases
• Salts of heavy metals
• Reducing agents
• Organic materials
• Flammable substances
Hazardous Decomposition Products
• Oxygen which supports combustion

1.)
ENVIRONMENTAL PRODUCTS'
rovectus
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 5 of 5
11. TOXICOLOGICAL INFORMATION
• LD50 Oral: Min.2000 rng1kg, rat
• LD50 Dermal: Min. 2000mglkg, rat
• LD50 Inhalation: Min. 4580 mg/kg, rat
12. ECOLOGICAL INFORMATION
Ecotoxicol og ieal Information
• Hazards for the environment is limited due to the product properties of no bioaccumulatnon, weak
solubility and precipitation in aquatic environment.
Chemical Fate Information
• As indicated by chemical properties oxygen is released into the environment.
13. DISPOSAL CONSIDERATIONS
Waste Treatment
• Dispose of in an approved waste facility operated by an authorized contractor in compliance with
lncai regulations,
Package Treatment
• The empty and clean containers are to be recycled or disposed of in conformity with local
regulations.
14. TRANSPORT INFORMATION
• Proper Shipping Narne: EHC-O
• Hazard Class: 5.1
• Labels: 5.1 (Oxidizer)
• Packing Group: II
15. REGULATORY INFORMATION
• SARA Section _Yes
• SARA (313) Chemicals No
• EPA TSCA Inventory Appears
• Canadian WHMIS Classification C, D2S
• Canadian DSL Appears
• EWECS Inventory Appears

III 77
TABLE 4
SUMMARY OF GROUNDWATER SAMPLING RESULTS
Pruit, JohnnyfNCDOT Site #15 (Incident No.: 15782, UST #: MO-4711)
7719 Pageland Highway, Monroe, Union County, North Carolina
S&ME Project # 4305-17-153
Analytical Method ->
Volatile Organic Compounds by Standard Method 6200E or equivalent
Contaminant of Concern -
Acetone
W
n-Butylbenzene
G
w
a,d
w
tert-Butylbenzene
c
o
m
Q
Caw
ry w
rti
1,2-Dichloraethane
Diisopropyl ether
(isopropyl ether)
Ethylbenzene
lsapropylbenzene
Methylene Chloride
Methyl tent -butyl
ether
Naphthalene
n-Propylbenzene
Toluene
cu
d
a�
d+ o
ri .0
ri F
co
y
"5:-.
K1 E
on .g
r-i E■
Total Xylenes
Wl enll
Date
Collected
2L Standard (ig/L)
6,000
1
70
70
70
70
0.02
0.4 ,
70
600
70
5
20
6
70
600
400
400
500
GCL (141..)
6,000,000
5,000
6,900
8,500
15,000
70,000
50
400
70,000 1
84,500
25,000
5,000
20,000
6,000
30,000
260,000
28,500
25,000
85,500
MW-1
01/12/10
--
1.7
---
1.4
_
_.-_
-
2.9
2.3
0.64
1.9
---
11.7
--
0.92
---
---
07/09/10
---
0.048 J
- --
-
-
---
--
16
12
0.25 J
---
---
10
---
--
-
---
05/03/13
---
---
--
---
---
--
-
4.6
2.1
-
---
---
6.9
--
__
-
--_
--
07/24/14
---
1.1
-
< 0.25
-
< 0.25
< 0.25
5.0
2.0
< 0.25
< 0.25
---
2.8
<1
< 0.25
< 0.25
< 0.25
< 0.25
< 0.75
08/28/15
---
<0.50
--
<0.50
-
<0.50
<0.50
6.7
4.5
<0.50
<0.50
<2.0
3.7
<2.0
<0.50
<0.50
<0.50
<0.50
<1.5
10/31/16
5.1 J
<0.50
<0.50
<0.50
-
_
<0.50
<0.50
2.9
0.82
0.19 j
<.50
<5.0
2.7
_
<0,50
0.14 J
<0.50
<0.50
<0.50
<1.50
08/12/17
<50
<0.50
<0.50
<0.50
<0.50
<0.50
<0.50
5.8
1.1
<0.50
<0.50
<5.0
1.9
<2.0
<0.50
<0.50
<0.50
<0.50
<1.50
MW-1 R
01/12/10
--
-
-
---
_-
--
-
---
---
---
_--
__
15.3
---
--
---
---
--
_..-
07/09/10
---
---
--
---
---
0.25 j
--
--
---
---
--- _
-
6.2
--
---
---
---
---
---
05/03/13
---
-
--
---
--
---
--
---
0.63
---
.--
--
26.3
•--
---
---
---
--
07/24/14
---
< 0.25
--
< 0.25
---
0.27 J
< 0.25
< 0.25
< 0.25
< 0.25
< 0.25
---
10.2
< 1
< 015
< 0.25
< 0.25
< 0.25
< 0.75
08/28/15
---
<0.50
-
<0.50
--
<0.50
<0.50
<0.50
<0.50
<0.50
<0.50
3
7.5
<2.0
<0.50
<0.50
<0.50
<0.50
<1.50
10/31/16
9.8 J
<0.50
<0.50
<0.50
--
<0.50
<0.50
<0.50
<0.50
<0.50
<0.50
<5.0
6.6
<0.50
<0.50
<0.50
<0.50
<0.50
<1.50
08/12/17
<50
<0.50
<0.50
<0.50
<0.50
0.22 J
<0.50
<2.0
<0.50
<0.50
<0.50
<5.0
5.6
<2.0
<0.50
<0.50
<0.50
<0.50
<1.50
MW-2R
01/12/10
---
---
-
---
- -
--
--
---
0.85
--
--
---
27.8
---
--
--
---
--
---
07/09/10
--
---
-----
--
--
---
ND
--
--- _
---
5.7
---
-
---
---
---
05/03/13
--
---
-
--
---
--
---
ND
--
--
---
21.5
--
--
---
--
--
--
07/24/14
--
< 0.25
-
< 0.25
---
< 0.25
< 0.25
< 0.25
< 0.25
< 0.25
< 0.25
--
8.6
<1
< 0.25
< 0.25
< 0.25
< 0.25
< 0.75
08/28/15
--
<0.50
-
<0.50
---
<0.50
<0.50
<0.50
<0.50
<0.50
<0.50
<2.0
5
4.0
<0,50
<0.50
<0.50
<0.50
<1.50
10/31/16
12 J
<0.50
<0.50
<0.50
---
<0.50
<0.50
<0.50
<0.50
<0.50
<0.50
<5.0
0.62
<0.50
<0,50
<7.50
<0.50
<0,50
<1.50
08/12/17
<50
<0.50
<0.50
<0.50
<0.50
<0.50
<0.50
<2.0
<0.50
<0.50
<0.50
<5.0
2.9
<2.0
<0.50
<0.50
<0.50
<0.50
<1.50
MW-.1R
01/12/10
---
1.7
--
---
--
--
--
---
0.58
---
---
-
1.6
---
--
-
---
-_
07/09/10
---
--
-
---
---
---
-
---
--
--
-
---
0.74
---
--
---
---
----
05/03/13
--
---
--
---
----
---
--.
0.62
1.2
--
-
---
5.5
--
--
-
---
-
---
07/24/14
---
0.52
-
< 0.25
---
< 0.25
< 0.25
0.31 J
0.34 J
< 0.25
< 0.25
--
2.1
<1
< 0.25
< 0.25
< 0.25
< 0.25
< 0.75
08/28/15
---
<0.50
-
<0.50
-
<0.50
<0.50
<0.50
<0.50
Yle-
<0.50
<0.50
<2.0
1.1
_ <2.0
<0.50
_ <0.50
<0.50
<0.50
<1.50
10/31/16
No Sam We11 Not Located
08/12/17
_ <50
1 <0.50
I <0.50 I <0.50 1 <0.50
' <0.50
<0.50
<2.0
I <0.50 I
<0.50
<0.50
1 <5.0
0.43]
1 <2.0 1 <0.50
<0.50 I
<0.50
1 <0.50 1
<1.50

TABLE 4
SUMMARY OF GROUNDWATER SAMPLING RESULTS
Fruit, JohnnyfNCDOT Site #15 (Incident No.: 15782, UST #: MO-4711)
7719 Pageland Highway, Monroe, Union County, North Carolina
S&ME Project # 4305-17-153
Analytical Method -:
Volatile Organic Compounds by Standard Method 6200B or equivalent
Contaminant of Concern ---•
Q
Benzene
a
v
J
a
0
a
3
1,2-Dibromoethane
(EDB)
d
v
c
Diisopropyl ether
(Isopropyl ether)
w
Isopropylbenzene
Methylene Chloride
Methyl tert-butyl
ether
n-Propylbenzene
H°
1,2,4-
Trimethylbenzene
a
1
^may'.
H
Total Xylenes
Well
Date
Collected
2L Standard (µg/L)
6,000
1
70
70
70
70
0.02
0.4
70
600
70
5
T 20
6
70
600
400
400
500
GCL (l.tg/L)
6,000,000
5,000
6,900
8,500
15,000
70,000
50
400
70.000
84,500
25,000
5.000
20,000
6,000
30,000
260,000
28,500
25,000
85,500
MW-4R
01/12/10
---
3.1
--
---
---
---
-
3.5
37.9
-
---
---
285
-
-
.....
._
__-
07/09/10
--_
--
-
---
---
--
-
---
78
-
---
--
500
---
-
-
-
-- _
05/03/13
---
---
-
-
-
-
-
1.8
28.3
--
---
--
244
---
---
-
-__
-.._
-..
07/24/14
---
< 0.25
ND
< 0.25
--
< 0.25
< 0.25
2.3
45
r 0.25
< 0.25
ND
305
<1
< 0.25
< 0.25
< 0.25
< 0.25
< 0.75
08/28/15
--
<0.50
ND
<0.50
-
<0.50
<0.50
1.2
13.5
<0.50
<0.50
<2.0
125
<2.0
<0.50
<0.50
<0.50
<0.50
<1.5
10/31/16
<100
<1.0
<1.0
<1.0
---
<1.0
2
2.4
<1.0
<1.0
<10
140
<1.0
<1.0
<1.0
<1.0
<1.0
<3
08/12/17
<50
<0.50
<0.50
<0.50
<0.50
<0.50
<0.50
1.5 i
14
<0.50
<0.50
<5.0
76
<2.0
<0.50
<0.50
<0.50
<0.50
<1.50
MW-5R
{
01/12/10
---
589
--
4.1
--
--
-
126
111
9.9
14.7
--
36.1
50.6
11.6
8.6
9.7
1.9
-
13.2
07/09/10
---
3,700
--
4.5 J
---
---
--
410
160
48
28
---
21
180
29
14
23
---
31
05(03/13
---
1,410
--
6.2
--
---
--
321
221
116
34.2
---
10.4
207
32.6
--
133
38.6
127.9
07/24/14
--
901
--
7.7
---
< 0.25
< 0.25
257
203
68.7
27.3
--
26.7
123
18.2
10
45.7
9.4
49.7
08/28/15
--
560
---
9.5
--
<2.5
<2.5
5
199
89.4
43.7
29.4
9.4
80.6
21.8
5.6
19
2.0 J
17.7
10/31/16
<250
94
0.75 J
4
---
<2.5
<2.5
36
160
23
21
<25
14
10
4.9
0.90 J
7.8
1.6 j
7.80 J
08/12/17
<200
260
2.1
5.9
0.84
<2.0
<2.0
45
220
38
19
<20
12
46
8.5
1.3
12
1
6.6
Field Blank
08/12/17
_ <50
<0.50
<0.50
<0.50
<0.5O
<0.50
<0.50
<2.0
<0.50
<0.50
<0.50
<5.0
<0.50
<2.0
- <0.50
<0.50
<0.50
_ <0.50
<1.50
Notes:
Analytes that are not shown for the method were not detected.
Concentrations are reported in micrograms per liter (µgfL).
2L Standard: North Carolina Groundwater Quality Standards: 15A NCAC 2L.0202
Concentrations exceeding the laboratory's reporting limits are shown in BOLD fields.
Concentrations exceeding the 2L Standards are shown in Shaded and BOLD fields.
Concentrations exceeding theGCLs are shown in Shaded, Underlined, and BOLD fields.