WI0300424_DEEMED FILES_20191121 (2)

Permit Number Wl0300424
Program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
R.S.Braswell
Location Address
531 S Cannon Blvd
Kannapolis
Owner
Owner Name
Ncdeq State -Lead Program
Dates/Events
NC
Orig Issue
11/20/2019
App Received
11/13/2019
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28083
Draft Initiated
Scheduled
-Issuance Public Notice
Central Files: APS SWP
11/21/2019
Permit Tracking Slip.
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Government -State
Owner Affiliation
Scott Ryals
1646 Mail Serivce Ctr
Raleigh
Region
Mooresville
County
Cabarrus
NC
Issue
11/20/2019
Effective
11/20/2019
27699164
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
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 (NOTE: This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS (15ANCAC 02c .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION O 5A NCAC 02C .022 5) or TRACER WELLS O 5A NCAC 02C .0229):
1) Passive Injection S v stems -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 p erations -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 Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegi,ble Submittals Will Be Returned As Incomplete.
DATE: November 4, 2019_ PERMIT NO. v" J,,o ~ 0 O '1 L f (to be filled NO¥' ll'l~019
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
WaterQ~lity
illfgrmlOperationsSectfon
(1) ___ Air Injection Well ...................................... Complete sections B through F, K, N
(2) ----'Aquifer Test Well ....................................... Complete sections B through F, K, N
(3) X __ Passive Injection System ............................... Complete sections B through F, H-N
(4) ___ Small-Scale Injection Operation ...................... Complete sections B through N
(5) ___ Pilot Test. ................................................ Complete sections B through N
(6) ___ 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): North Carolina Department of Environmental Quality/Scott R y als
Mailing Address: 1646 Mail Service Center
City: ---=R=a=le=i=gh"'----------State: NC Zip Code: 27699-1646 County: _____ _
Day Tele No.: 919-707-8168 Cell No.: _________ _
EMAIL Address: scott.ryals @ncdenr.gov Fax No.: __________ _
Deemed Pennitted GW Remediation NOi Rev. 3-21-2018 Page 1
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Cla\ Neal. Vice President
Company Name IRN. Inc.. a Tennessee Cor_poratian
Mailing Address: 209 W 7th St.
City: Columba State: TN Zip Code: 38401 County:
Day Tele No.: 931-490-4795 Ce11 No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Flora D'Souza / Senior Scientist
Company Name: Terracon
Mailing Address: 2701 Westport Road
City: Charlotte State: NC Zip Code: 28208 County: Mecklenburg
Day Tele No.: 704-509-1777 Cell No.: 704-517-3035
EMAIL Address: flora.dsouza a terracon.com Fax No.: 704-509-1888
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: R.S. Braswell
531 South Cannon Boulevard
City: Kannapolis County: Cabarrus Zip Code: 28083
(2) Geographic Coordinates: Latitude**: 35 ° 29 ' 13.848" or °.
Longitude**: 80 ° 36 ' 0.844 " or °.
Reference Datum: Accuracy: _
NOV jf 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 of inj_ well net -work: square feet (i10,000 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.
Contaminant plume maps) 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
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 Ethology, existing and proposed
monitoring wells, and existing and proposed injection wells.
Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Deemed Permitted GW Remediation NOI Rev. 3-2]-2018 Page 2

I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. Tiris should include the rate, volume, and duration
of injection over time.
Terracon pro poses to place a sleeve ofRemRx CRP into well MW-IR.
J. APPROVED INJECTANTS-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 h ttp ://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/gr ound-water-protection/eround-water-aporoved-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: =R=emRx=~-------------------
Volume ofinjectant: 10 pounds ofCRP Persulfate
Concentration at point of injection: 100% -One a pproximate 1.8 inch b y 7-foot sleeve
Percent if in a mixture with other injectants: NIA
Injectant: ______________________ _
Volume of inj ectant:
Concentration at point of injection: ___________________ _
Percent ifin a mixture with other injectants: ___________________ _
Injectant: ____________________________ _
Volume ofinjectant: ___________________________ _
Concentration at point of injection: ___________________ _
Percent ifin a mixture with other injectants: _____________ _
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: NIA Proposed ______ Existing (provide GW-ls)
(2) 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. 3-21-2018 Page 3
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
Terracon prop oses to insert the RemRx sleeve during the week of November 18 . 2019.
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 Subcha pter 02L result from the injection activity.
Groundwater samples will be collected from the on-site monitoring well approximately 6 months after injection
activities are complete.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/ A pplicant: "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
irifection well and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
.._,_j{(il \il ffi :~ ,:,.__ fl om J)'S::.u,:z.a{ S..,r,o c &,,,J;st
Signature of Applican~ Print or 'l!ype Full Name and Title
Property Owner (if the prop erty is not owned b y 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 irifection well(s) conform to the Well Construction Standards
(J 5A 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 A gr eement
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. 3-21-2018 Page4
NCDEQ State Lead Program Access Agreement
June 9, 2017
Mr. Scott Ryals
Environmental Engineer
DWM UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
RE: State-Lead Acceptance
Former RS Braswell
531 South Cannon Boulevard
Kannapolis, Cabarrus County, North Carolina
Incident Number 15855
Dear Mr. Ryals
I am/We are the owner(s) of a parcel of property, located at or near the incident in question,
and hereby permit the Department of Environment and Natural Resources (Department) or its
contractor to enter upon said property for the purpose of conducting monitoring and/or remediation
of the groundwater related to the monitoring well on the southeast comer of the site under the
authority of G.S. 143-215.940 (the "Work").
I am/We are granting permission with the understanding that:
1. The Work shall be conducted by the UST Section of the Department's Division of
Waste Management or its contractor.
2. The costs of the Work and any associated construction and maintenance of the site
and access shall be borne by the Department or its contractor in accordance with
the acceptance of the site into the State-Lead Program. The Department or its
contractor shall protect and prevent damage to the other portions of the site not
associated with the Work and surrounding lands. Any damages to the site caused
by the Work will be restored by the Department or its contractor to as close to the
pre-Work condition as practicably possible.
3. Unless otherwise agreed, the Department or its contractor shall have access to the
site by the shortest feasible route to the nearest public road. The conduct of the
Work shall be accomplished in such manner so as to minimize business disruption.
The Department or its contractor will notify the land owner or its designated
representative 48 hours prior to entry and may enter upon the land at such times as
agreed to by the land owners. Further the Department or its contractor will have
access during the period of the investigation as reasonably needed to conduct the
Work as long as such access does not create any business disruption. Such access
does not include the conduct of any activities not within the scope of the Work as
defined herein.
4. Any claims which may arise against the Department or its contractor 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.
5. This access is not construed as conveying any property rights and shall be construed
only as a license for access to the site to conduct the Work.
6. This access is granted for the Work for the period of one year from the date of this
letter and may be renewed by agreement of the land owner.
7. 1/W e 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.
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.
RE: State-Lead Acceptance
Former RS Braswell
531 South Cannon Boulevard
Sincerely,
JRN, Inc., a Tennessee corporation
209 W 7th St.
Columba, TN 38401
931-490-4795
Kannapolis, Cabarrus County, North Carolina
Incident Number 15855
2
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FAIRVIEW STREET
DIAGRAM IS FOR GENERAL LOCATION ONLY, AND IS
NOT INTENDED FOR CONSTRUCTION PURPOSES
I
groundwater monitoring
well
ProjectManager. ProjectNo. l rc SITE MAP I f;g1ure I 1-----=SA""'C"-! 1--.:....71:....:.1.:.:59=6=60""A"-I nrra can
Drawnby: AEK Scale: NTS I;;;;;; RS BRASWELL {INCIDENT #15855)
1-C-he-ck-ed-b-y:~CL-C-t FileName~raswell 2701 Westport Road 531 South Cannon Boulevard
1-D-ate-:--'==""' Charlotte, NC Kannapolis, Cabarrus County, NC Approvedby: CLC ..,__M_a_,c_h_20_1a_L __________ ___.L ___________________ _
Well ID: MW-lR
Project No. : 71159660A
Site Location: 531 South Cannon Boulevard lrerracan
Field Personnel:
Date:
Location:
Drilling Method:
Driller:
CLC
9/26/2016
Hollow Stem Auger
EDPS
2701 Westport Road
Charlotte, NC 28208
704-509-1777
Monitoring Well Construction Diagram
-Land Surface De pth Below Land Surface (feet )
Riser Pipe --------~
Diameter 2" -----
Length 20'
Material PVC
Bottom of Grout 20
1-1-------------
Bottom of Bentonite Seal 23
Sand Pack ------------➔ ___________ Top of Screen 25
Well Screen -----➔
Diameter 2"
Length 15' Bottom of Screen 40 ------------Slot Size 0.01 Bottom of Tail Pipe 40 ------------Material PVC Bottom of Borehole 40 ---------
i< I 4.25 Borehole Diameter (inches) >:
I I