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Home My WebLink AboutWI0400512_DEEMED FILES_20190125Permit Number Program Category Deemed Ground Water Permit Type WI0400512 Injection Deemed In-situ Groundwater Remediation Well Primary Reviewer shristi.shrestha Coastal SWRule Permitted Flow Facility Facility Name Farrar's Store Location Address 397 Farrar's Store Rd Stokesdale Owner Owner Name Ncdeq Ust Section Dates/Events NC Orig Issue 1/25/2019 App Received 1/16/2018 Regulated Activities Groundwater remediation Outfall Waterbody Name 27357 Draft Initiated Sched.uled Issuance Public Notice Central Files: APS SWP 1/25/2019 Permit Tracking Slip Status Active Version 1.00 Project Type New Project Permit Classification Individual Permit Contact Affiliation Major/Minor Minor Region Winston-Salem Facility Contact Affiliation Owner Type Government -State Owner Affiliation Linda Blalock 1646 Mail Service Ctr Raleigh County Rockingham NC Issue 1/25/2019 Effective 1/25/2019 27699 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 ruk" and do not require an individual permit when constructed in accordance with the rules of 15A NC4C 02C.0200. This form shall be submurted at least 2 WEEKS prior to injection. AQUIFER TEST WELLS r ISA ('( 02C .0220) These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics. IN SITU REMEDIATION 115A N CAC 02c .02251 or TRACER WELLS t15A NCAC 02C .02291: 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 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 treatmentareas 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. 7TC.Z•v_ Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete. DATE: Januar+ 10 , 20 19_ PERMIT NO. l; 0 r i i N ( fe filled in by DWR) A. WELL TYPE TO BE CONSTRUCTED OR OPERATED (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: State Government 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): NCDEQ UST Section —Linda Blalock Mailing Address: 1646 Mail Service Center City: Raleigh State: NC Zip Code: 27699 County: Wake Day Tele No.: 919-707-8165 Ce11 No.. EMAIL Address: lindabialockarncdenr.ov 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: Gre "o n Westmoreland Company Name __________________________ _ Mailing Address: --~2~43~1~O~ak=Ri=·d=g=e~R=o=a=d~------------------ City: Oak Rid ire State: NC Zip Code: 27310 County: __ _ Day Tele No.: (336 ) 904-8095 Cell No.: __________ _ EMAIL Address: Fax No.: ------------------------ E. PROJECT CONT ACT (Typically Environmental Engineering Firm) Name and Title: -----~A~sh=l=e __ -..=B~ar=h=am=------- Company Name --~E=C~S~S~o~ut=h=e=as~t.~L=L=P~------------------ Mailing Address: ______ 4_8_1_1_K_o_11.~e_r _B~o_u_le_v_ar_d __________________ _ City: Greensboro State: NC Zip Code: 27407 County: Guilford Day Tele No.: 336-856-7150 Cell No.: 336-687-7094 EMAIL Address: ___ a=b=ar=h=am= .... @-"'e=c=sl=im=it=ed=·=co=m= Fax No.: F. PHYSICAL LOCATION OF WELL SITE (1) Facility Name & Address: ---~F=arr=ar~'s~S~t~o~re~------------------ 397 Farrar Store Road City: ___ S_t_ok_e_s_d_al_e _____ County: Rockingh am Zip Code: __ 2_7_3_5_7 _ (2) Geographic Coordinates: Latitude**: 35 .455604 ° Longitude**: 83.051305° Reference Datum: ________ Accuracy: _______ _ Method of Collection: Goo d e Earth **FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTYBOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES. G. TREATMENT AREA Land surface area of contaminant plume:-------=l~0~0 _____ square feet Land surface area ofinj. well network:_~l~0~0 ____ square feet(.:'.:: 10,000 ft 2 for small-scale injections) Percent of contaminant plume area to be treated: <1 % (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. 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. Installing one ORC Sox in one on-site monitoring well to assist with the biode gradation of the hvdrocarbons in the groundwater 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 hrt:p ://de q.nc.gov/about/divisions/water- resources/water-resources-permits/wastewater-branch/ground-water-protection/ground-water-approved-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: ----~O~R=C~S=ox~ __________ ______,.IN,...~---------~o,.. Volume ofinjectant: 113in3 ~(P Concentration at point_o_f_in_~-e-ct-io-n~:~~-1-00_o/c_o----~-~-r,;..t'i-\~~ ~v \.'3 .... Percent ifin a mixture with other injectants: ______ N_/A~ .... ~er-----.. =,."_:::~' .. -_-_,,._· ______ _ ~ ..... :--~~ '!,.0' ,;,;·• ~'o e,~ Injectant: ~o~ ~ito Volume ofinjectant: ----------------~------------- 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: ____________________ _ K. WELL CONSTRUCTION DATA (1) Number of injection wells: --"""'l ___ Proposed __ ___,O __ _cExisting (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 L. SCHEDULES -Briefly describe the schedule for well construction and injection activities. Deemed Permitted GW Remediation NOi Rev. 3-1-2016 Page 3 Well alread , constructed. Will take 1 dav to install ORC sox 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. The monitoring wells are sam pled ever v six months and will be sam pled six months after installation of the ORC sox to determine effectiveness. 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 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 iryection well and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules. " Signature of Applicant Print or Type Full Name and Title PROPERTY OWNER (if the pro pertv is not owned b y the permit a pp licant): "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 iryection well as outlined in this application and agree that it shall be the responsibility of the applicant to ensure that the iryection well (s) conform to the Well Construction Standards (1 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. 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. Submit the completed notification package to: DWR -UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: (919) 807-6464 Deemed Pennitted GW Remediation NOI Rev. 3-1-2016 Page 4 ~ Cs ECS SOUTHEAST, LLP "Setting the StandaniforService" !::::::::::::::::=:,., Geotechnical • Construction Materials • Environmental • Facilities NC Regi~tered Enginee'.ing Fi:m F-1078 NC Registered Geologists Firm C-406 Ms. Linda Blalock NCDEQ, Division of Waste Management, UST Section 1646 Mail Service Center Raleigh, North Carolina 27699-1646 RE: Farrar Store 397 Farrar Store Road Stokesdale, Rockingham County, North Carolina Incident #TF-24177 Dear Ms. Ghiold: SC Registered Engineering Firm 3239 March 6, 2018 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 Environmental Quality or its contractor to enter upon said property for the purpose of conducting an investigation of the groundwater under the authority of G.S. 143- 215.3(a)2. I am/We are granting permission with the understanding that: 1. The investigation shall be conducted by the UST Section of the Department's Division of Waste Management or its contractor. 2. The costs of construction and maintenance of the site and access shall be borne by the Department or its contractor. The Department or its contractor shall protect and prevent damage to the surrounding lands. 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 Department or its contractor may enter upon the land at reasonable times and have full right of access during the period of the investigation. 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. The information derived from the investigation shall be made available to the owner upon request and is a public record, in accordance with North Carolina G.S. 132-1. 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 shall not be construed to be an agent, employee, or contractor of the land owner. ECS Capitol Services, PLLC • ECS Florida, LLC • ECS Mid-Atlantic, LLC • ECS Midwest, LLC • ECS Southeast, LLP • ECS Texas, LLP www.ecslimited.com IJWe agree not to interfere with, remove, or any way damage the Department's well(s) or its contractor's well(s) and equipment during the investigation. Sincerely, 'ram-- . Suture / f 67-c ZA-AP -7/-1-)F16 Type/ int Ndhe of Owner or Agent 9nY---F05- Phone Number Li--3 o t6olc_Rol, ,r4R, Address City/State/Zip Date de HIGHWAY 65 APPROXIMATE AREA OF EXCAVATION as Lines 1 U cr 0 o_ 0/Soo �°� O 7� zo�9 a 1 �� Qs FORMER FARRAR'S STORE (EXISTING BLDG.) SOURCE: ECS FIELD NOTES AND DRAWINGS SCALE: 1 INCH = 10 FEET FIGURE 3 MONITORING WELL LOCATION MAP FARRAR'S STORE 397 FARRAR STORE ROAD STOKESDALE, ROCKINGHAM COUNTY, NORTH CAROLINA NCDEQ INCIDENT NO.24177 ECS PROJECT NO. 49-6306 FROM :RANSIER ENWRILLING 1NC FAX N0. :9102350686 Dec. 01 2006 12:OIP11 PG 1 t Non Residential We Con cl Malan WIN Comb. Depererrnr dEnekonabialed Wurel Rasairoer.PI 11 n or Pow Ovally WELL CONTRACTOR CERTIFICATION i 210r1 ,1. WELL CORITRACTOFC MiChbeii Rarssitf Di'1 liNN. Itrc. Wel C rdro ► r (1•MvIrkce0 Herr* Ranier Environmental Wel Correraelor Conpouy Nano STREET ADDRESS 4 Slslit Court Pinehwat SIC 28374 r Orr or Tom Slab Zip Coda 910 690-6688 ION-1 ATM Mdb Pions Humber 2_ WB1. WI OWIA1IOM: Sib w.eRIstEappamrer l STATE WELL PERMIT 0{Pagarca illt DWI or OUER ProeST A WalO roes r.1_ %NEIL We ElbaA atml ) leaaeeM+O a kokedrieloCarrinsoniiat Aafaaerar ReetWIMr +npocn Oerer ALIN (Ise) MeriFebea riliCeN1 Dam Crla.a 11! 17/2005 AM PIN Y Radon$Mrn Tie. Cow Moil 'MO S WELL LOCATION; CITY Sti:kinds* cower 3S7 POWS Store R0O peel sink Ibabob, CAfeereear. kal lb. , Prrerd. TOPOGRAPHIC 1 WC SETTING Mein Vary FM r RrAfe Mar R0 LATTTU.IE 36d 15.049 haw bil.iWow rr. Napsr la 164ai tomato 79d 65 512 Lal*rroe+Lcmpaanse swam x CPS dame beMom lope Taro Tow inewera fbe.W west snisUSW Masao 1DOre Gm M nekob. GPM L FACAffY Inmaarwdfrbldimaaw..err.lRlmplmd FACR.tir 1D* iiraoofostOoj NAME OF mail", runner FaI7aI s doll Sore Rood STREET AMORESs [307 Forcers St0kesdale NC CsnorTIMM Sear ZSCelr CO TACT PBtSCN Brea lriggino WANG ADDRESS 700 H. Eugene St Groensbxo NC dorretain 91ye 336 336-3174 x4ece. J. *y 40 Aran esd+ l.n or S. WEIL DETAILS: TOTAL DEPTIt 00 `& y� R DOER Mu. fni�. e. WATER L. q+erTcoorcirs Suu. - . r rasa W. al marl el. TOP OFCOSI Me I! -0L2 FrAnewtrd*w .. 'Top at (Moo tirmrirod mar bib, Im l _Imo paw more In Inca • maim meaday oft 1FA ROC 2C &vim) trio) tornion OF TEST f. DIEME7ECTIOILTabi Arnaud } WAITER ZONES (alepth) Frog TO Frgm To Flom To From TB Rom To__ _ Rao To 11, CUING' Ibblumm ONO DlMnulrs Weight leer reil from .0 2 To 25 Ft r Seal sa p►+r Row To FL From To Ft i. mown Moon Ueeario iTetlrad From 0.5 To 22 Pt poraend b.rmre ROM To FL From to -— R I. SCREW& Dordti o lrr Skit IleiRlal _.._ FrOM 25 To 56 FL 2" 0.RI o From To FL From To R. 3. IAPLOORAVEL PACKL ONO SSD laeelerleI! Peons 23 To 55 Ft. medkon 9M1 F*om To Ft. From To PL fO t11t# LING WO From Yd Namibian DneaysMen 0 14 d�1 811 14 44 brown micaceous Ai 44 S6 rock ti. llaamoce: ire naav oonr r nwr 7re4r04 rmmanNIMPprsaa 01111 76 "ins! 44 1449C111.4a0Riligelnwa rr Asr/serrmira SIEMk1lTtE NF CEdITPIED wall cueTRACkaR �ilr Pallas! Ftareass PRIPIITE0lee/ OFCeoseTIOJOIRID TRIM SuMnE iievinkelXLB r. dVrrard.rH y is 30 slips AN' hltinwm%elest 1917 WC ba.+der C'raaar-1daa1drt. MG.;yrri1817 1N1oIa d'H7'rsHbr6ue are 120' 100' 80' 60' 40' 20' MW-1 Clayey Silt ft+144-1-f--FH 120' 100' 80' 60' 40' 20' SCALE Horizontal Scale: = 40' Vertical Scale: = 20' N CROSS SECTION Farrar's Store 397 Farrar Store Road Stokesdale, Rockingham County, NC ECS Project No. 49-6306A