The URL can be used to link to this page

Home My WebLink AboutWI0400516_DEEMED FILES_20190306Permit Number Program Category Deemed Ground Water Permit Type WI0400516 Injection Deemed In-situ Groundwater Remediation Well Primary Reviewer shristi.shrestha Coastal SWRule Permitted Flow Facility Facility Name R & D Texaco Location Address US Hwy 64 Shuler Rd Mocksville Qwner Owner Name Ncdeq Ust Section Dates/Events NC Orig Issue 3/5/2019 App Received 2/20/2019 Regulated Activities Groundwater remediation Outfall Waterbody Name 27028 Draft Initiated Scheduled Issuance Public Notice Central Files: APS SWP 3/6/2019 Permit Tracking Slip Status Active Version 1.00 Project Type New Project Permit Classification Individual Permit Contact Affiliation Major/Minor Minor Region Winston-Salem County Davie Facility Contact Affiliation Owner Type Government -State Owner Affiliation Sharon Ghiold 1637 Mail Service Ctr Raleigh Issue 3/5/2019 Effective 3/5/2019 NC 27699 Expiration Requested /Received Events Streamlndex Number Current Class Subbasln 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 (1 5A NCAC 02C .0220 ) These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics. IN SITU REMEDIATION (1 5A NCAC 02c .0225 ) or TRACER WELLS <...:.:I5~A:e........:.;=~02e.:aC::...:·!!.!o2=2~9 1: 1) Passive Injection S y 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 fu jection 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. DATE: Print Clearly or Type Information. Hlegible Submittals Wil~'df!JflrdJt:, Incomplete. ~!IB00 J61,l)M, Februarv 13 , 20_19_ PERMIT NO. vy J,o lf O O $1 ~ (to be filled in by DWR) A. !lOZ O g 81:l WELL TYPE TO BE CONSTRUCTED OR OPERATED (1) (2) (3) (4) (5) (6) l:IM0/03CION/03/\!J:J:~ ti ___ .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 through N ___ 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): ------=-N~C=D=E=O-"'---'U~S=T~S-=-ec=t=io=n~-~H=as=s=an~O~s=m=an~------------ Mailing Address: --~1~6~4~6~M=ai~l =S~erv~ic~e~C~en=t~er~-------------- City: Raleigh State: NC Zip Code: __ 2~76~9~9 __ County: __ W~ak~e __ _ Day Tele No.: 919-707-8167 Cell No.: _________ _ EMAIL Address: Hassan.osman r@ ncdenr.gov 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: Rai A garwal Company Name __________________________ _ Mailing Address: ---'-4~70~l~E~. 2=9'-th_S=tr=e~e=t ___________________ _ City: ---~T~u=c=so~n~---State: AZ Zip Code: Day Tele No.: ---~5_2~0-_2~03~-~4~88~2~ EMAIL Address: ------------ 85711 County: Cell No.: ___________ _ Fax No.: ___________ _ E. PROJECT CONT ACT (Typically Environmental Engineering Firm) Name and Title: -----~A~sh=l~e v--=B~a=rh=a=m~------ Company Name ___ E=C~S~S~o~u=th~e~as~t ~. L=L=P~------------------- Mailing Address: ______ 4_8_l _l _K_o~Q.~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. : ___ 3=3"-"6'--6=8'""'7_-7.....,0=9-=-4 ___ _ EMAIL Address: ___ a=b=ar=h=a=m='-.aa·a'--'e=c=sl=im=it=ed=·=co=m= Fax No.: ___________ _ F. PHYSICAL LOCATION OF WELL SITE (1) Facility Name & Address: ---~R=&=D~T~ex=a~c~o _______________ _ US H wv 64 & Shuler Rd City: --=M=o=c=k=-sva.::il=le=---____ County_: ___ D_a_v_ie_Zip Code: ___ 2_70_2_8_ (2) Geographic Coordinates: Latitude**: 35.907156 ° Longitude**: 80.613967 Reference Datum: ________ .Accuracy: _______ _ Method of Collection: Google 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: <l % (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 monitorinl! well (TMW-lR) to assist with the biodegradation of the h vdrocarbons 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 http ://deq .nc.gov/about/divisions/water- resources/water-resources-permits/wastewater-branch/!.!Tound-water-protection/e..round-water-app 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: _____ ....:O~R=C:....:S=:..:oe:.:.x"---------------------------- Volume of injectant: _____ 1_1_3_in_3 _________ _ Concentration at point of injection: --------"'--10""'0"--'o/c:....::o'---------------------- Percent if in a mixture with other injectants: ______ N~/A~-------------- Injectant: ---------------------------------- Volume of injectant: _____________________________ _ 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: --~l ___ Proposed __ ~O ___ 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 L. SCHEDULES -Briefly describe the schedule for well construction and injection activities. Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3 Well alreadt constructed. Will take I day 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 02I, result from the injection activity. The monitorint wells are sampled ever' six months and will be sampled six months after installation of the ORC sox to determine effectiveness. N. SIGNATURE OF APPLICANT AND PROPERTY OWNER APPLICANT: "I hereby cert, 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 far obtaining said information, I believe that the information is true, accurate and complete. I am aware that th re are significant penalties, including the possibility of fines and imprisonment, for submitting false r t rmation. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and 1!'related nano , in accordance with the 15ii M :iC 02C 0200 Ru ,s. " ignature 114b6eittien, Print ')r Type Full Name and Title 'kg'? PROPERTY OWNER Cif the prolern• is not owned bti the permit applichril� g "As owner of the property on which the injection wells) are to be nstructed and operated I hereby consent to allow the applicant to construct each injection well as outlined inLiearilon and agree that it shall be the responsibility of the applicant to ensure that the injection weIl(s) conform to the Well Construction Standards (I1.4 .tiCAC 02C: _0200f. " "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—etPrvpreed-O vner (if different from applicant) Print or Type Fell Name and Title (An access agreement ben - • I the applicant and property owner may be submitted in lieu of a signature on this form. Submit the completed notification package to: DWR — ITIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: (919) 807-6464 Deemed Permitted GW Remediation NOI Rev. 3-1-20 3 6 Page 4 Mr. Hassan Osman Hydro geologist DWM/UST Section UNDERGROUND STORAGE TANK SECTION May 2, 2016 1637 Mail Service Center Raleigh, NC 27699-1637 Dear Mr. Osman RE: R & D Texaco US highway 64 & Schuler Road (2237 Old US l} Mocksville, Davie County, North Carolina Incident Number: 20550 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 an assessment and/or remediation of the groundwater and/or soils.under the authority of G.S. 143-215.94G. I am/We are granting permission to the lands we own or control with the understanding that: I. 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 home by the Department or its contractor. The Department or its contractor shall protect and prevent damage to the surrounding lands. Any damages 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 Department or its contractor will notify the land owners 48 hours prior to entry and 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 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 landowner. No representations or warranties, either expressed or implied, have been made to me/by the Department, the State of North Carolina, or its/their contractor(s) regarding the results that may be obtained or the quality of work to be performed. 1/We agree not to interfere with, remove or any ways damage the Department's well(s) or its contractor's well(s) and equipment during the investigation. Sincerely, Type/Print Name f Owner or Agent ( 12.°) ,20,3 - Phone Number #70 £,2 7- Address 7L12 /O V tS7/( City/State/Zip Cod Date RE: R & D Texaco US Highway 64 & Schuler Road (2237 Old US1) Mocksville, Davie County, North Carolina Incident Number: 20550 TMW-4 71.09 DISPENSER ISLAND MULCH PILE LEGEND MONITORING WELL 72.82 GROUNDWATER ELEVATION GROUNDWATER FLOW DIRECTION 1SOELEVATION LINE SOURCE: DAVIE COUNTY GIS DEPARTMENT AERIAL PHOTOGRAPH, DATED 2014 SCALE (IN FEET) 20 10 0 • MW-1R NM `,.._--� TMW-2 : ).--,_ 70.17 0 FIGURE 4 GROUNDWATER FLOW DIRECTION MAP R&D TEXACO IJS HIGHWAY 64 AND SHULER ROAD MOCKSVILLE, DAVIE COUNTY, NC NCDEQ INCIDENT NO. 20550 ECS PROJECT NO. 49-2116C • BUILDING FOUNDATION TMW-4 ❑ISPENSER ISLAND MULCH PILE LEGEND MONITORING WELL <0.5 TMW-1 R (2.0) �r , TMW-3 9 • TMW-2 MULCH PILE -23 SOURCE: DAVIE COUNTY GIS ❑EPARTMENT AERIAL PHOTOGRAPH, ❑ATED 2014 SCALE (IN FEET) 20 10 0 20 FIGURE 5 BENZENE ISOCONCENTRATION MAP R&D TEXAC❑ US HIGHWAY 64 AND SHULER ROAD MOCKSVILLE, DAVIE COUNTY, NC NCDEQ INCIDENT NO. 20550 ECS PROJECT NO. 49-2116C iM NON ON S1D1 NTL4L• WELL CONSTRUCTION RECORD North Carolina Department of Environment and Natural Resources- bivlsiori of Water Quatity WELL CONTRACTOR CERTIFICATION #. 22B4 1. WELL CONTRACTOR: Steve Poloniewice We Contractor (Individual) Name SAEAACCO Inc Weil Contractor Company Name STREET ADDRESS 908B North Field DR Fort Kill SC 29707 City or Town Stale t I- I803) 540-2194 Zip Code Area code- Phan number 2. WELL INFORMATION: SITE WELL ID #(R appticablel STATE WELL PERMITlinrapplkabte)_ OWQ or OTHER PER MIT #(If applicable} WELL 183E (Check Applicable Box) MonStcring (g MureicipaiUEtahlic ❑ Industrial/Commercial [3 Agtic iiturs1 ❑ Race/a:y in injection ❑ lrrigaticuo Other o (Est rue) DATE DRILLED TIME COMPLETED 5:30 AM G PNi O 3. WELL LOCATION: CITY: Mockavilie COUNTY Davie IIS Highway 64 & shiner Road (Street Name, Numbers. Commer y, Sub:Dusin), Lot No., Parcel. Zip Code) TOPOGRAPHIC./ LAND SEIZING: L7 Slope 0 Valley 22 Flat u Ridge D Other (check appropriate bar) LATITUDE LONGITUDE Maybe in degrees minutes, seconds or is a tIccirrrral TM,iiat Let€tudeJlong1 ude source: GPS ETopographie map (]ocatn n of well roust be Mown on a LISGS talio mace and attached to this farm Zrrot using GPS) 4. FACILITY- Is Me name d tnebusiness arhere The went es loCased. FACILITY ID #{If apptlrabte) NAME OF FACILITY vacs !fir. STREET ADDRESS r3i.ghway S4 & Shuler road Mookaville NC City or Town State Zip Code CONTACT PERSON ,1im Roush • MA1�Nti AI]l1rCt7� AL!—`�' vlr uitrrii.ai' - FFi- srca0[ 5vii Cary 279i2 city ar Town State Zip Code ( 919 J- 859-9350 Area cede- Phone nttmbes 6. WELL DETAILS: a. TOTAL DEPTH: 44 b. DOES WELL REPLACE EXISTING WELL? YES Li ND x c. WATER LEVEL Below Top at Casing: FT. (tJse `+° If Above Top of Casing} d. TOP OF CASING IS o . o FT. Above Land Sulfate' 'Top of casing terminated attar below land surface may require a variance in accordance lrrith 15A NCAC 2C _0118_ a. YIELD Wpm): METHOD OF TEST f. GISINFEECTION: Type Amount g. WATER ZONES (depot): Ft= To From To Frern To From To From To From To 6. CASING: Depth Diameter From o . a To 29' Ft. 2 Fr= To Ft. From To Ft. 7. GROLJ[: Depth From 1 ' Toll' From _ To Ft. From To Ft. B. SCREEN: Depth Diameter Slot Size Material Fnam29' To44' Fl.2^ In. .O10_ B1. ovc Frain To FL In. in_ From To FL in. in. 9. SAND/GRAVEL PACK: Depth Size Frorn Z7' To 45' Ft. LA From TO FL From To Ft. Material a PORTLAND Thickness/ Weight Material ach 40 pvc Method trirmtrie 10. DRILLING LOG From To 420' 20' 30' 3p' 44' 30' Maria silica sand Formation Description red silt clati red silt,/ clay brown silty clay 11.REMARKS: Do HEREe ' CENTS' MOLT THS WELL WASCOvdSTRUCTEri 2NACCORDANCE WITH lEA.NCAC 2C, WEt.1. CONSTRUCTION STANDARDS, ANC THAT COPY Of71.8ra RECORDHAS OREN PROVIDED TO TEE WELL OWNER. ��. SIGNATURE Dh CERTIFIED WELL CONTRACTOR DATE 1af2o'2o10 PRINTED NAME OF PERSON CONSTRUCTING THE WELL Submit the original to the Division of Water Quality within 30 days. Atbr: information Mgt, 1617 Mail Service Center- Raleigh, NC 27699-1317 Phone No.1919) 733•7D1& ext 568. Farm CGW-lb Rev 7/05 120' 100' SO' 60' 40' 20' TMW-1 R Silty Clay 1 1 1 120' 100' 80' 60' 40' 20' SCALE Horizontal Scale: = 40' Vertical Scale: - 20' CROSS SECTION R&D Texaco US 64 & Shuler Rd Mocksville, Davie County, NC ECS Project No, 49-2116D