WI0500810_DEEMED FILES_20150219

Permit Number WI0500810
Program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
michael .rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Vance Elementary School
Location Address
8808 Old Stage Rd
Raleigh
Owner
Owner Name
NC
Wake County Public School System
Dates/Events
Orig Issue
2/16/2015
App Received
2/11/2015
Regulated Activities
Groundwater remediation
Outf~II
Waterbody Name
27609
Draft Initiated
Scheduled
Issuance Public Notice
Central Files : APS SWP
2/19/2015
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 -County
Owner Affiliation
Mike Wiltzius
1551 Rock Quarry Rd
Raleigh
Region
Raleigh
County
Wake
NC
Issue
2/16/2015
Effective
2/16/2015
27610
Expiration
Requested /Received Events
Additional information requested
Additional information received
Streamlndex Ntmlber Current Class
2/12/15
2/16/15
Subbasin
NORTH CAF QUNA DEPARTMENTOF ENVIRONMENT AND NATURA4RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OFETiATE INJECTION WILLS
Tlie following are `*rini&ed 6a; mile' and do not'require an MdWdiwal permit when ronslruclud in accnrdafree
Ij with Me miles of t5A N(A1' 02?C.0 3iJ11, This form sling he submiKed al least 2 fveeks prior to Miec-'inn.
AQUA ER TEST WELLS Q:5X-r rir'67t
These wells are used to inject uncgntaminated fluid into an aquifer to determine aquifer hydraulic characteristics,
PV SITU I#.EME©IATION (15A Nt �ac' 0ZC .0225) or TRACER WELLS (r5A
1) Passivd Infection St,sterns - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infasion 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 reined iation or uacer tests. An individual perm it shall be regaired
for tcst or treatment areas exceeding 30,0DOsquare feet.
3) Pilot Tests -- Pre] iminary studies conducted for the purpose of evaluating the technical feasibility of a
renrediation slralegy in order to develop a full scale remediation plan for future implementation, and when: the
surface area of the 'injection zone wells are located within an area that clots not exceed five percent of the Iarid
surface above the known extent of groundwater contamination. An individuaI permit shall be required to conduit
more than one pilot test on any separate groundwater cootaeninant plume.
4} Air Aention Weiss - Used to inject ambient air to enhance in situ treatment of soil or groundwater.
Print Clearly or 7,�jpe Infurmadon. Illegible Submittals iifill Be Returned As lnrurttpfete.
DATE: Fel3mM 9 2015 PERMIT NO, (to be filled in by, ❑ WR)
A. W ELL TYPE TO RE CONSTRUCTED OR OPERATED
i
(1) _ Air Injection Welt. ..........................Complete sections B-F, K, N '
(2) Aquifer Test Well... ..... ........,........... --•----_..Complete sections 134, K, N 1
(3) Passive Injection System .............. ,...... .......... Complete sections 6-F, H-N
i
(4) x Small -Scale Injection Operation ......................Complete sections B-N
I
(5) ' _ Pilot Test .. ............... .. Complete sections R-N
(6) Tracer Injection Wei l..._........... .................. Xo:nplete sections 13-N �
3, STATUS OF WELL OWNER. t; `t Ouse .m itorr:.
C. WELL. OWNER — State rtame of entity seed name of persoa delegated authoril.y io sign ofl behalf of the
business or.agerrcy:
MOM; Lek L`bust€jrF*i b� �vdl 5s iri fll±fich J s wiftLius
MailingAddttste.1 R k Quarry Rt>tiid _ -- -- -
M _- City: Raleigh- State: _ Z'rp Code:276I0 _ [:aunty: Wake
Day'%k No.� f919)-45G-"W 4bct[ l o. 9.I91 9-9C35
-: EMAIL Addl�Itiit�w�t>s�.net Faat� (9z9? 5BS-0$33

i
E
i
D. PROPERTY OWNER (if different than well owner)
Name_
E.
12
Mailing Address:
City: State: _ Zip Code: County:
Day Tele No.: Cell No.;
EMAIL Address: Fax No.:
PROJECT CONTACT - Person who can answer technical questions about the proposed injection project,
Name. Rai Shah, P.
Mailing Address: P.O.Box 5611
City: Cary State: NC Zip Code:2751 2 County: Wake
Day Tele No.: 919-858-5350 Cell No.: 919-622-1155
EMAIL Address:rbshah a raenviroumentaI.com Fax No.:919-858-5351
PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: Vance -Elementary, School
8808 O#d Stake Read County. Wake
City: Ratei h State; NC Zip Code: 2"7609
(2) Geographic Coordinates. Latitude": " or
Longitudc*"-. _ io w
Reference Datutn: Accuracy:
**FOR AIR INJECTION AND AQUIFERTEST WELLS ONLY: A FACUTY SITE MAP WrM
PROPERTY BOUNDARMS MAY BE SUBIWITED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plumet7 square feet
Land surface area of inj. well network:3,6€30 square feet (c 10,000 112 for small-scale injections)
Percent of contaminant plume area to be treated (must he < 5% ofplurne for pilot test injections)
H. INJECTION ZONE KAPS — Attar the following to the notification.
(l) Contaminant phone map(s) with isoconcentration lines that show the horizontal extent of the -
contaminant plume in soil and groundwater, existing arid proposed monitoring wells, and existing and
purposed injection wells; and
'Crass -sections) to the .knoyvn `nr pnajected depth of contamination that show the hvrizontaI.sad
irk extent of the conmminautt oun,� in soil and grouttdwa#er, -changes in lithclogy,:'=Istiing
proposed monitoring wells, and existing and proposed injection wells, .` .
"'- Uril s. Sitar ReeLlad iHoti wi- + (Revisal 1 t119=13) page 2'.

I, DESCRIPTION. OF PROPOSED INJECTION ACl'l\fl'I'IES -Provide a. brief mir.rative regarding the
purpose, scope, and goals of the proposed injection aclivity.
One (l) 4" (INJ~.l)PVC well wiltbe installed !ilightly upgradici1t ofMW-7. T11e ,veil ,viii b¢scre~ned across the
locnl waler table~ Subsequently. the following field parameters wm be measured (baseline) hl INJ-1, MW-,7, MW-
2s, MW,.J and MW-J: Djssolved Oxygen (DO), pB, Temperat11re, Oxidation/Redi1ction potentfal (ORP). anc.f
Conductivity (EC}. AdditfonaUy, upQn purging ea.clt well three dines jt's Yoluflle, groundwater sa111ples will be
collected for laboratory analyses. for petroleum hydrocarbons using EPA 6200B, 625 and MADEP VPH/EPH.
The laboratory program will also include san1pHng for C:ieochemical paran1eters including alkalinity, dissolved
llitrate, irQrt(tQlal), ferrous hvn, sµlfate (dissplved), jne(hane 1md totnl d!$$Q)ved solids(TDS).
One Waterloo EnliuerTM \ViH be then installed in INJ~ I: The eminer used wiU be 3.8 inches in diameter, with
diffu$iwtsilicone tubing to reJ~~se n.o incri;ased amounl.(lfoxygen. O.xyge11will be suppli¢d to the 4iffosiye
emitter using compressed oxygen cylinder stored inside..the existing garage on the property. A low density
polyetbylerie (LOPE) hQse Will bfruti fro111 the oxyge1i cylinder, along the top ofthe gro11i1d, to the INJ-1
n1nnway. The LDPEUne wm be securccfto both e11ds with the appropriate ihreadedJittings. The diffusion emitter
wiJJ be charged \\'ith loWprcssilJC oxygen (appro~irnately 20 PSl),and !hen left to IIRhtraUy diffuse into the water
CQl1nnn,A high visibility snfetyfeoce wiU be erected around tlteINJ~r tmd aboveground low pressure g,_s line,
The pilot t~st ,vill be performed for a period ofoneweek, A sile visit will be performed by the EEC.Inc. staff
within 24 hQurs oflhQ initial start up to check o.n the system for leaks and ov<!rall furic:tion • .EEC staff wiH also
coJlect.theJielddalaforDO, pH,Temperaturo, ORPand EC from MW-7,MW-2S, MW-.J aud MW,-3 on a daily
ba!:iisiAt lb.e.cQncl11$i011 of the pilot test, ngrot1,1dwate.r sturiple will be obtithJed from MW-6. MW-2S. MW-I and
. MW-3 and analyzed ill the laboratory. for EPA 6200B/625/MADEP VPFI/EPl't.
The findings of the pifot .. test.will •be used. to detennine die feasibility of employing cnhanced.bioremcdintion al
the site; Based 6Q the obtf!ined dat;l, additionnl wells 11nd e1nitters fnay QC necessary to influence the impacted
grot:mdwater contamination plmne.
J. INJECT ANT$-Provide a MSDS ancl the following for each injectant. Aimcb addilional sheets if necessary.
NOT§:: Approved f,ijucfw11~ (llw:ei"S <.md tem.i!cdiatio/1 a/fdi(i••el>') 6:m . be . /oJmd 011/ilje al
!}111, · , i •, wt,J/ 11 · ·, 1, · 111 filT · i!:.i:i • !I V •!! "''.''Hm o. 11/lotl,er s11bsta11ces must be rerf ewed by the DiPf.~·lon of Public
Het1IIIT; Deparlm,ml of Health aMHwuan Services. · Coitlac:I the UIC Progr,.mifur111<fl•e itf/o (919-807-6496);
lnjec1ant: •=ox,,.,,..,' •=eu.._ __________________________ _
Vohtmc 6f injecta.nt: ~.1 =8-=2=Ji~te=r~s ___________________ _
Concentr!llion at pQii'lfofinjeclit>n: ~-~9=5°=¼=+_•· ------------------"-----
Percent ifirp1111ix1t1fo with other i11j¢ctai1ts . .:..: _,_N_,,_/,._,A,__ ________________ _
lajectant: _____________________________ _
VoJuineofinjectant: _____________________________ _
Coneeritrn1fo1tat pointofinjection: _____________________ _
Percent ifih a mixture With other injc~lanls: , __________________ _
J1yectant: ·--'.·~-----------------------------
Volume ofinjeclanl: __________________________ _
C<>nceJllr.mkm nt point of injet:'licw _____________________ _
lflCH,tSitzilkmcd. NotUlcntion (Rc,·iscd I i/l9/20Jl) Pa:gc.l
Percent if in a mixture witholher injectants: ___________________ _
K. WELL CONSTRUCTION DATA
(I) Number ofinjection wells: ----~Proposed. __ ~--~Existing
(2) Provide wdl 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 wilh tl1e same construction details, \Vefl
constmccion details shall include the following:
(a) well type as permanent, direct-push, or subsurface distributio1i system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
(c) well conlrac!or narne and certification number
UJC/ll1cSit11 Rcmc(I. Notification (Rcvisecl 11119/2013). Page4
L. SCHEDULES -- Briefly de?scril,c the schedule for well construction mid injectionactivilies:
see section
M. MONITORING PLAN — Describe below or in sepatate attachment a lnonitnring plan to be used to determine
itviolalions ofgroundivalerquality standards specified 11 -1 mull from the injection activity.
see section I
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICAN f: "I hetvby cerl j; u ntler penally of lenv, ►ha►1 aia fan i itior 141111.Ire i► forrus►llarr stibmilled iu
Iltls doetiutent and all anewfunebts thch?I& and d►a1, based mi rii)+ irrgrthy of tlipse- individuate Immediately
fvsponavfblk tar obiafning sstld l► fat mallon, 1 believe dial the hVi nvallon fs true, ace"r'ale (mill Complete. I am
anWe Ural there aia Tiguicant petrctlllas, biehrdiiig Ilse passibility offlttes and In ip) -ix ernuuvi11. far snbuiillfng
filve iii)-br•urrrlion. ' 1 agree to conslrlrcl, Opel -ale, maitrlrri►2, repair, cruel ifopplicable, aboxion the injeed'an IPell
and all ►elated o np►rrlenances in necorda►rce frith lire I _i"t.' It ' t1V"11.70m Rates. "
5ignntureafrtppiie at
PRO _OF�RTY-QWN ille is not owns by the petinif applicant):
-1 'I'.f 1 Imo. P- f:
Print or Type Full Morale
As vivnew of the properiy (ni which lire► i►tjrclrani wgll(s) are tq ire.cvttslrrtdled and olffliwleet, 1 heneby cornre►rt
to 01foly the rrpplicaut to consn-rnl eazlt It yc cilan well as outllned In this appliccNiuu and up-ee ►liar it ,shall be
Me rerspwnsibillty of Me applicant io enstnr Thal the h#eeflon ►t'ell(s) r:onfonInn to ilie lirell Con+sirtXltoit
Sim itlea -dv (y u r f0 • - 0111, J_ "
"O► her" means any person ► ho holds the. fee or other property rights in the ►++e)l being constnicled. A
well is real property turd its constn(etion on land shaN_be ciceived to vest ownership in tale Eut3d owner, in
lite absence bf);antrnry agrecirient in writing.
z" ' _Michael James Wiltzius
8iganturv* vrProp erty 6%4er (if diirereM ream applicant) Print or T.ypc Fill riante
Ai Y access ❑gmemewt beh ren nhe crpplicaut apid prpperty env► el- ma), be s.nbmilted hr lien) of o signawre'od this fdrm,
till Mc copy of rite compleAed nafification pach ago fo.-
D%VR — UIC Program
f636 Mail Service Center
Raleigh, NC 27699-1636
Tckplmc: (919) $07-6464
1.11C7ig&f+ritewd. NoiricaIkno (ii; 0wd I iti91.2013) Pages

L. SCHEl)ULES-Briefly dqscribe the schedule .for welt construction and ii1jecticm activities.
see section I
.M. MONITORING PLAN -Describe peloW orin separate attachment a moriitoring pJan to be used to detern'iine
ifviolatioas ofgroundwater quality standa.rds ~pecitied in.$Uhclfil1~•r.rgJ reslilt from the injeotfo,lacUvity.
see section I
N. SIGNATURE OF APPLICANT AND PROPERTY OW!',1ER
APPLICAN1': "/ hereby cerfifj,, under ~nalty of lmv, tliqt I amfainiliar Witl1 the lnformalioii 'suhmiited in
tiiis docunw111 and allaftacl11ne11ts thereto and thrit, base!I 011 my inq11ily oflltose individual,; immediately
re.rpoiisiblefor ob1ai11111gsaid lnformatio11, I believe Iha/the ief.01-,,101@1 ii true, aqcurate at1d complete. Jam
aware th.at there are significantpenallies, i11cli1dii1g the possibility of Jil1e.r and i11iprfso1ime11t, for submiili11g
jlllse h,formation I agree 10 co11:ftruct, operate, 111ain(ai11, repair, tmd.lfapp/tcab/e, ah,wlou tlie·i11jeclionwell
a11d qi/related app11ne11a11ces .1i1 accordance wit/I. the J_jA SCA<''. JJ2C t~JfJ!J Rul~s, ,;
12 C,.V\\ ~~
Signliture of ApplldmI \
R. fr:-I $ H J-H-1, f · f? -
Print or Type Full Name
PROPERTY OWNER (iflhe pro pertr is not o,vned by the pennit a pp licant):
''As owner of(lte properly on which 1'1ei11jectio11 well(s) are 10 be co11sttucted ai1dopem(e(/, I lterebyconsenl
tocillow Ilic applicant 10 co11s1t·1,cr eqclr iitjection ivc/1 as outlined in this applic(1tl011 and agree .thai it .vhal/ be
the responsibility of the (lpplicanl ro ensure that the f1yecti0i1 well(s) cot,form to the Well Construction
Sta,,dcirds (l5rI i\'< :Ac IJ2( ·j~?f lfJJ. ·•
"Owi1er'' means any person who holds the fee or o1her property rights in the ,vell being constructed. A
well is real propetty ~ndits coi1st.ruction on land shall be deemed to vest o\vnership ii1 the . Janci owner, in
the absence of c(>ntr~ry agreen:iertt i.n writing,
-~~ .. i( 1;:~-~ ' . Micha.el James Wiltzius
Slgnnture" of Property()\\' er(lf differ.ent from applicant) Prhtt or Type Full N~rile
• An qccess agreiinttrnl b<?Metn lite applicttnl a.ndproperlyowuer. 111ay be submilled /11 lieu q(,rsig,mtim.? 011 th,:rfom,.
$ubnlit one copy oftlie completed notification packag~ to:
·oWR:·-lJJCPrograin
1636 Mail Service Center
Raleigh, NC 27l599--l 636
Telepiione; [phone]
UICI In Si/liRemed. Noti/ic.l)(ion (Rcvi~cdl 1/19/2013) Page5
FI G. 2: SITE VICINITY MAP
8808 OLD STAGE ROAD
RALEIGH, NORTH CAROLINA 27613
~ WATER SUPPLY WELL
\!!!.I (Sec Tablo 2/1 or Pho,o I LSA Report)
City or Raleigh wo\or moln localed In wost
right-of-way of Old Stage Rood
10-ft topographic contours In orange
DRAWN BY: SKP SCALE: 1"=400'
CHECKED SY: MS
DATE: 9/20/12
EEC, INC.
8514 SIX fORKS ROAD. SUITE 101
RALEIGH, NORTH CAROLINA 27615
PARKING
M-3
Nat
tea
# UW-aD
rq
GYMNASIUM
PARKING
-U `
uAI
SHE
UST
PARKING
LEGEND
40- Monitoring Well
0 Type III McHtcring Well
WALKINGTRACK
Injection Wei;
[2-81 Constituent Concentration; 2l] ¢O ��
unils - vq/L
[ND] Not Detected SCALE IN FEET
j— :2L Exceedance Boundary NOTES; SAMPLfiS COUECTED &WG14: EVE-1- SML VAPOR MRACTfON POINT
Benzene lsoconcentration Map
Vance Elementary School EEC, Inc.
8808 Old Stage Road
Raleigh, North Carolina U8514 Six Forks Rd, Raleigh, NC 27615
Figure No. Scale: Drawn By: Checked By: Date: Project No:
2 1'.=3a TLC RBS 2/13/2015

�V1F9�
l� r
ca,
GYMNASIUM
SHE..
,
b E �
SVEA 18
pq
Farmer UST —�
I
PARKING
..0
MIN-
iuiW 7 1
f
PARKING J ++
-_ IV-4
LEGEND y {�
MQnlswing Well {� _
Type Ili Monitoring Well r
WALKING TRACK
{ Injection Well
[$.$] C.onstil len[ corXenlre nn;
[Units = uql 0 • 20 40 $o
(ND) Not Defected _ SCALE IN FEET
1 — 21-Exceedance B2s=- ary rWDTFS. SAMPLES CgL.L+ CM 8 MI.4. SUP_l ='SAIL VAPOR EXTRACTION Pofwr
1-Methyinapthalene Isoconcentration Map EEC Inc.
Vanoe. Elementary School
8808 Old Stage Road
Raleigh, North Carolina E8514 Six Forks Rd, Raleigh, NC 27615
Figure No: scale: lPrawil.By- Checked By. Date: Projact No.
3 n = 3a' TLC -RBS 211312015

VMS
MW-Bo �y
wI i1VY '
n+m
GYMNASIUM
i
SHE
SHED
r14)
f� ALL `t�■ f � � , l' ��-s
•1
sVe l
,,� 1--Farmer LIST —
M - p [ {z r 1
S
PARKING
HMI-1
' MCI
�L}MW-3
i_ Ma
f�
�
r PAFtKIIIiG
�-
PARKING
t
Hrw�
I�1
LEGI=No
Monitoring Well
'�� iu _
Type If! Monitoring Well
Y 1�
Injedfon Well
WALKING TRACK
1221 conslituent Concentrallon.
Units = UJIL
J 0 2f] ¢� 60
[ND] Not Delecsted —_
SCALE 11+! FEET
2L Excxedance Boundary
NQ SAMPLES COLLECTEII 616=14, SVE-1 = SOIL VAPOR EXTRACTION POINT
-
Napthalene lsoconcentration Map
EEC Inc.
Vance Elementary School
=
8808 Old Stage Road
Raleigh, North Carolina
j8514 Six Forks Rd, Raleigh, NC 27696
Figure NO.- Scale:
Drawn By:
Checked By:
Qate:
PmjeoL Na:
4 1" = 30'
TLC
RB5
2113/2015

t�
F&W-
+uW1
W
GYMNASIUM
SHE
i SHE
�� auws
sye i _
{ 1 /4_ _Farmer LIST
).
PARKING rN°� t 2s
MWI
PARKING
PARKING
LE�ENi3 i�
M iwriha Well ;
Type III Manitoririg Well WALILING�RACIC
�- lhjection WEII -
[12] Cons iltueot conoevation; a 20 40 88
UnfKs = ugll
[HD] Not 0eleeted SCALE IN FEET
50G- 21- Exceedance Heundaiy HOTE.S: SAMPLES COLLECTED G W201k bVr=-S - SOIL VAPOR EXTRACTION VO NT
Xylenes (Total) lsocancentratioh Map EEC, E i1C.
Vance Elementary School
a868. Cold Stage Road
Raleigh, North Carolina i8514 Six Forks Rd, Raleigh, NC-27615
Hqur4 No: Sipate: Drawn By: Checked by: Date: Fmjeot No:
5 1" = 30' TLC RBS 2/13/2015 -

(NORTHWEST) (SOUTHEAST)
❑Istancs along baseline {R}
0 15 30 45 60 75 90 105 120 135 150 165
110-- --- I. 1 I 110
Rol ,
�+y'•n-nm�wn i
I P^I I
100 � FAW-9 MW80 MW.7 e:J 1 ►nu.m u,uL.)e 1100
as 90
z
0
tE
4
80
70
r 60_
1
50
40
0
w
ORAVVN: TLG
EEC, INC. SITE 10: D-032192
5514 SIX FORKS RR PROJECT: VANCE ELEMENTARY SCHOOL
RALEIGH, NORTH CAROLINA 27615 PROJECT No:
LOCATION; RALEIGH. NORTH CAROLINA
PATE: 211812016
I
Farmer
UST
Basin
Area I
I
2.00 upt
53. 1
z
0
F
a
80 Lu
70
60
so
40
FIGURE 6
SITE GEOLOGIC CROSS-SECTION
(SECTION A -A')

1 Y ojyRUJDEA ML WELL. CONSTItrTC:T ON RECORD
North Carohna Dcpammai of hnviznnmeut and Nara -al RewTmCes D i6non of Water Quality
WELL CONTRACTOR CERTMCATION N 4155
1. VVELL_ CONTRACTOR;
_❑?yid grown
Wet{ Contractor (Individual) Name
Environmental Drilling & Probing Services, LLC
Well Corftcl c Company Name
17538 Greenhill Road
Streei Address
Charlotte NC 28278
City or Tgwn 84ato Zip Cade
(704 607-7529
Area code PtTone dumber
2. "ELL INFORMATION:
WELL CONSTRUCTION PERMITO NA
OTHER ASSOCIATED PERMIT#M appmable) NA
SITE VVEtL ID Jf lfap kA,,ia) 1NJ-1
I WELL USE (Cheek One Box) Monitoring N( MunicipallPuhiw- t
1ndustriaVComrneTrtal Lj AgricL ka-dl Lj Recoaerylj Injection U
Inigalionfj other i..t [list use)
DATE DIRMLED 213/15
4. WELL LOCATION:
8808 Old Stage Road
(SY"t Name, Hampers, Community. Subdivision. Lot No.. PartW. rp Code)
CITY: _ Raleigh COUNTY
TOPOGRAPHIC 1 LAND SETTING: (rhecl, appcbptiaTe Lox)
i1S7ope nValley p{Fiat MRidge nClher
LATITUDE 36 ' Dims OR 3x.xxmooD= DD
LONG1it1DE 75 Dms OR 7xx ogpg2W DD
LafiWdeliongitude source: (BPS OT"raphlc map
(location of welimustha shaivn on a USGS tDpo map andattached io
fh)s forrn Ynot using GPM
5. FACILrfY (Name of the business Wr re the well is Soc;ated.)
Vance Elementary School
Facility Name Fsd33ty M (if applicable)
_880a Old staaa Road
Street Address
Raleiah Nc
City or Town State Zip Code
Contact Name
Mailing Address
CiEy or "Powys State 7Jp Code
Area code Shone number
6. VIIEL.L DETAILS:
a- TOTAL DEPTH: 25 &
1.
b. UMS WELL REPLACE (EXISTING WELL? YCs n No Iy�
d. TOP OF CASING IS FT. Above Land b-uiface'
"Top of casing temtinated allow- below land surface may require
a variance in aotwdance with 15A NCAC 2C .0116.
c. YIELD toPm): METHM OF TEST
C DISINFECTION -Type Amount
9. WATER ZONES (depot):
Top Booth
, Top
aonorr
Top Bottom Top
Bottom
Tap Bottom
Top
Bottom
Thlcknessl
7. CASING: depth
Oiametrr
Welyht mairtud
Top - 10 Bottom
Ft
sCh_0 �1_
= Tap Bottom
Ft
= Top Softorn
Ft
$_ GROUT: Depth
Material MBthod
-rap 8 - - Bntlpm—fj-- Fi. Hentonite
_ Tremie
Bottom-- _9 -
FL Grout Tmse
- Top Bottom
Ft.
8. SCREEN: Depth
Dinmatcr
Statsbee MaierliE
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- 1 Q4 HEREBY CERTIFY TH- T n4US Vv-LLWAS VAVTR XjG II+IACCORMNCE WITH
- 15A NCAC 2C, MELL C0N5TWL9-,T IaN SiAN WTLS, AND THAT ACOPY OF TM
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a_ WATER LEVEL Below Top of Casing: FF- _ DaVId BfO1rL1I1 _
(Use "+"if Above Top of Casing} : PRINTEL) NAME of PERSON CONSTRUCTING THE WELL
Submit vAthin 30 days of completion to: 01vislon of Water ❑uality - Information ProcosMnRev. g, Form
v. 710909
IW7 Mail Serving Cerdar. Rateiah, NO2XE SS-161. Phans : J919) J107-S300

Ro gers, Michael
From:
Sent:
To:
Subject:
Raj~
Rogers, Michael
Friday, February 20, 2015 9:42 AM
'Raj Shah'
RE: Vance Elementary School NOi WI0500810
The RO is OK w/the final version of the NOi and they are not going to do an inspection, which it is optional for permitted
by rule sites. You are free to start work.
From: Raj Shah [mailto:[e-mail]]
Sent: Monday, February 16, 2015 1 :41 PM
To: Rogers, Michael
Cc: Smith, Danny; Bolich, Rick
Subject: Re: Vance Elementary School NOi WIOS00810
Pages 1 and 2 w/ changes
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/16/2015 12:22 PM, Rogers, Michael wrote:
Raj-
If appears this project would also qualify for a small scale injection (less than 10,000 SF). Please send
corrected NO _I and CC the above RRO staff menibers as they have the.9ption to inspect the site. BE
ADVISED, the Raleigh area is due for a winter storm this afternoon and tomorrow and staff may not be
available to quickly respond.
Thant yovfor submitting the Notice of Intent to Construct or Operate Injection Wells (NOi) for the . .
Vance-Eles;nen~~-ry School facility located at 8808 Old Stage Road, Raleigh, NC 27609. We received
your-revised NO(on. February 13, 2015.
Ptease remember to submit the following regarding this injection activity:
.-..,,. ... ·-...
1) -Welt lons.tnfc~fon Rec~teW"~t ►tlrid' A~ltffnmei1t"'Records {GW~30)~ if applicable. Please
provide copies of tbe GW:: ls and GW-30s, if applicable. NOTE: Direct push or Geoprobe wells are
. -..
1 ....
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.
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.).
NOTE: 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 http://portal.ncdenr.org/web/wq/aps/gwpro/reporting-
forms. You can scan and send these forms directly to me at michael.ro gers @ncdenr.gov or send by fax
to my attention at 919-807-6406. These forms can be sent by regular mail as well, but email is
preferred.
When submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the
form (i.e., WIXXXXXXX) that has been assigned to the injection activity at this site. This notification has
been given the deemed permit number WI0500810. This number is also referenced in the subject line of
this email. You may if you wish, scan and send back as attachments in reply to this email, as it will
already have the assigned deemed permit number in the subject line.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
NCDENR-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
http://portal.ncdenr.org/web/wq/aps/gwpro/reporting-forms
NOTE: Per Executive Order Na. 150, all e-mails sent to and from this account are subject to the North
Carolina Public Records Law and may be d;sclosed to third parties.
2
Rom Michael
From: Bolich, Rick
Sant: Friday, February 20, 2015 9:38 AM
To: Rogers, Michael
Cc: Smith, Danny; Rice, Eric
Subject: RE: W10500810 NOI Final
Michael;
We do not anticipate or see the need to perform an optional inspection of this facility based
on the information contained in the NOI at this time.
rb
-----Original Message -----
From: Rogers, Michael
Seat: Thursday, February 19, 2015 3:38 PM
To: Smith, Danny; Bolich, Rick
Subject: FW: WI0500810 NOI Final
Attached is the final corrected NOI for the above project (Raj had to submit 4 versions
he had the form filled out correctly and necessary attachments). Let me know as soon as
possible if you are going to do an optional inspection or not- they want to get started
away. If not, I'll tell him he is free to start injecting as he wants permission.
Thanks
-----Original Message -----
From: Michael Rogers[maiIto:michael.rogers(a)ncdenr.gov]
Sent: Thursday, February 19, 2015 2:53 PM
To: Rogers, Michael
Subject:
This E-mail was sent from "RNPAC7DDO" (Aficio 2075).
Scan Date: 02.19.2015 14:53:03 (-0500)
Queries to: robin.markham(@ncdenr.gov
until
right
I

Rodgers, Michael
From: Rogers, Michael
Sent: Monday, February 16, 2015 1:47 PM
To: 'Raj Shah'
Cc: Smith, Danny; Boiich, Rick
Subject: RE: Vance Elementary School NOi W10500810
This finally looks OK. # will process and finalize.
Danny/Ric.k- Please let Raj know if you have any issues or plan on doing an inspection or not (optional for the regions for
deemed permitted sites).
Thanks
From: Raj Shah[maiIto:[e-mail]]
Sent: Monday, February 16, 2015 1:41 PM
To: Rogers, Michael
Cc: Smith, Danny; Bolich, Rick
Subject: Re: Vance Elementary School NOI W10500810
Pages 1 and 2 w/ changes
Raj B. Shah, P-E, LEEDIAP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/16/2015 12:22 PM, Rogers, Michael wrote:
Raj -
If appears this project would also qualify for a small scale injection (less than 10,000 SE). Please send
corrected NO and CC the above RRO staff members as they have the option to inspect the site. BE
ADVISED, the Raleigh area is due for a winter storm this afternoon and tomorrow and staff may not be
available to quickly respond.
Thank you for suhmitting the Notice of Intent to Construct or Operate Injection We1Ts (NOI) for the
Vance0ementary School facility located at 8808 Old Stage Road, Raleigh, NC 27609. We received
your revised- Wtin Fury 13, 201
'Pkase remember to submit the following regarding this injection activity:

1) Well Construction Records {GW-1) and Abandonment Records {GW-30), if applicable. Please
provide copies of the GW-ls and GW-30s, if applicable. 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.
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.).
NOTE: 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 http:ljportal.ncdenr.org/web/wg/aps/gwpro/reporting-
forms. You can scan and send these forms directly to me at [e-mail] or send by fax
to my attention at 919-807-6406. These forms can be sent by regular mail as well, but email is
preferred.
When submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the
form (i.e., WIXXXXXXX) that has been assigned to the injection activity at this site. This notification has
been given the deemed permit number WI0500810. This number is also referenced in the subject line of
this email. You may if you wish,.scan and send back as attachments in reply to this email, as it will
already have the assigned deemed permit number in the subject line.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
NCDENR-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
http://porta1.ncdenr.org/web/wg/aps/gwpro/reporting-forms
NOTE: Per Executive Order Na .. 150, all e-mails sent tfJ-or+d from this account are subject to the North
Carolina Public Records Law and may be~~(}Jp third parties. -.
2
Ro gers, Michael
From: Raj Shah [[e-mail]]
Monday, February 16, 2015 1:41 PM
Rogers, Michael
Sent:
To:
Cc: Smith, Danny; Bolich, Rick
Subject: Re: Vance Elementary School NOi WI050081 O
20150216184209527.pdf Attachments:
Pages 1 and 2 w/ changes
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/16/2015 12:22 PM, Rogers, Michael wrote:
Raj-
If appears this project would also qualify for a small scale injection {less than 10,000 SF). Please send
corrected NOi and CC the above RRO staff members as they have the option to inspect the site. BE
ADVISED, the Raleigh area is due for a winter storm this afternoon and tomorrow and staff may not be
available to quickly respond.
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells {NOi) for the
Vance Elementary School facility located at 8808 Old Stage Road, Raleigh, NC 27609. We received
your revised NOi on February 13, 2015.
Please remember to submit the following regarding this injection activity:
1) Well Constru~ion Records (GW-1) and Abandonment Records (GW-30), if applicable. Please
provide copies of the GW-ls and GW~30s, if applicable. NOTE: Direct push or Geo probe 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.
'' :1 2) Injection Event Records (lER). All injections, including air and passive-systems require an IER. The
IER can be mgdified 'for air sparge wells {e.g., air flow 'continuous' for date or rate of injection, etc.).
NOTE: If we.ff c.oristruction/abandonment information is the same for the welts, only one form needs to
... · be completed-just indicate total number of injection points in the Comments/Remarks section of form. ~·1:.(~'
These fur.ms can:~e found on our website at http://portal.ncdenr.org![e-mail]/aps(~'#Pro/reporting-
forms~ You can scan and send these-forms directly Jo me atmichaer.rogers @ncdenr.ga'ibr send by fax
1
to my attention at 919-807-6406. These forms can be sent by regular mail as well, but email is
preferred.
When submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the
form (i.e., WIXXXXXXX) that has been assigned to the injection activity at this site. This notification has
been given the deemed permit number WI0500810. This number is also referenced in the subject line of
this email. You may if you wish, scan and send back as attachments in reply to this email, as it will
already have the assigned deemed permit number in the subject line.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
NCDENR-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
http://portal.ncdenr.org/web/wg/aps/gwpro/reporting-forms
NOTE: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: RfJQelS, Mtfhael
Sent~ Monday; February 16, 2015 10:12 AM
To: 'Raj Shah'
SUbject: RE: Vance Elementary School NOI
What is % of the plume to be treated on Section G, I can't make it out completely. Please provide
calculations you used. It must be 5 % or less to be pilot test. The treatment zone/ROI shown in plan
view on Figure 2 would be helpful.
From: Raj Shah [mailto:rbshah@ag raenvironmental.com]
Sent: Friday, February 13, 2015 5:13 PM
To: Rogers, Michael
Subject: Re: Vance Elementary School NOI
Mike,
Attached is a revised Notification of Intent. Could you please let me know as soon as you hear back from
the RRO so we can proceed with the pilot test? Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/12/2015 5:31 PM, Rogers, Michael wrote:
RaJ-
The NOi is insufficient as submitted and cannot be processed for the following reasons:
Section F-Need zip code for address of site.
Section G-percentage of treatment area for pilot test has to 5% or less, you have 400%.
Section H-There were no plume map or geologic cross-sections included showing
horizontal and lateral extent of the plume. Where the plume is not clearly delineated,
the extent can be inferred. Please show ROI ofwell on plume map.
In regards to your question about injecting right away~ a complete NOi is forwarded to
the RRO for their review. After I send a corrected and complete NOi, I will ask them to
let me know if they are OK w/the NOi and if they need to conduct a sfte inspection or
3
not. Based upon what they say, I will then let you know whether you can proceed or not
in the less than 2 week window.
If you have any questions, let me know.
From: Raj Shah [mailto:rbshah @agraenvironmental.com]
Sent: Wednesday, February 11, 2015 6:39 PM
To: Rogers, Michael
Subject: Vance Elementary School
Mike,
As per our telephone conversation yesterday, attached is a completed Notification of
Intent for the referenced site. Please let me know if it looks okay and if we are allowed
to proceed with the pilot test next week or we really need to wait two weeks. Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
4
., €Rogers, Michael
From:
Sent:
To:
Cc:
Raj Shah [[e-mail]]
Monday, February 16, 2015 1:33 PM
Rogers , Michael
Smith, Danny; Bolich, Rick
Subject: Re: Vance Elementary School NOi WI0500810
20150216135945267.pdf Attachments:
Mike,
As per our telephone conversation earlier, attached is a revised application. Please let me know if you have any
questions. Thanks.
Raj
Raf 8. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/16/2015 12:22 PM, Rogers, Michael wrote:
Raj-
If appears this project would also qualify for a small scale injection (less than 10,000 SF) .. Please send
corrected NOi and CC the above RRO staff members as they have the option to inspect the site. BE
ADVISED, the Raleigh area is due for a winter storm this afternoon.and tomorrow and staff may not be
available to quickly respond.
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (NOi) for the
Vance Elementary School facility located at 8808 Old Stage Road, Raleigh, NC 27609. We received
your revised NOi on February 13, 2015.
Plea~ remember to suqmit the following regarding this injection activity:
1) Well ~ion Records {GW-1} and Abandonment Records {GW-30); if applicable. Please
provide copies of the· GW-1s and GW-30s, if applicable. NOTE: Direct push or Geoprobe wells are
comkferedw.elts a@ require construction (GW-1) and abandonment forms (GW-3O). If well
constJ:¥Ctkm/ab-a'hdonment information is the same for the wells, only one form needs to be
c9mplete,.f',jusblidicate total mmiber of.injection points in the Com~/Remarks section of form.
2) .ktjecS,ioJI Event-Records (IER). All injections, including air and passive systems req_1.~ire an IER. The
IER can be modifiect fw: ~ir sparge wells .(e.g:, air flow 'continuous' for date or rate of injection, etc.).
NOTE: 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 http:!/portal.ncdenr.org/web/wg/aps/gwpro/reporting-
forms. You can scan and send these forms directly to me at [e-mail] or send by fax
to my attention at 919-807-6406. These forms can be sent by regular mail as well, but email is
preferred.
When submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the
form (i.e ., WIXXXXXXX) that has been assigned to the injection activity at this site. This notification has
been given the deemed permit number WI0500810. This number is also referenced in the subject line of
this email. You may if you wish, scan and send back as attachments in reply to this email, as it will
already have the assigned deemed permit number in the subject line.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
NCDENR-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
http://portal.ncdenr.org/web/wq/aps/gwpro/reporting-forms
NOTE: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Rogers,. Michael
sent:Mo~, February 16, ]01S 10:12 AM-
2
.., To: 'Raj Shah'
Subject: RE: Vance Elementary School NOi
What is% of the plume to be treated on Section G, I can't make it out completely. Please provide
calculations you used. It must be 5 % or less to be pilot test. The treatment zone/ROI shown in plan
view on Figure 2 would be helpful.
From: Raj Shah (mailto:rbshah @ag raenvironmental.com]
Sent: Friday, February 13, 2015 5:13 PM
To: Rogers, Michael
Subject: Re: Vance Elementary School NOi
Mike,
Attached is a revised Notification of Intent. Could you please let me know as soon as you hear back from
the RRO so we can proceed with the pilot test? Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/12/2015 5:31 PM, Rogers, Michael wrote:
Raj-
The NOi is insufficient as submitted and cannot be processed for the following reasons:
Section F-Need zip code for address of site.
Section G-percentage of treatment area for pilot test has to 5% or less, you have 400%.
Section H'-There were no plume map-or geologic cross-sections included showing ·
horizontal and lateral extent of the plume. Where the plume is not clearly delineated,
the extent can be inferred. Please show ROI of well on plume map. -·-·
In regards to your question about injecting right away-a complete NOi is forwarded to
the RRO for their review. After I send a corrected and complete NOi, I will ask them to
let me know if they are OK w/the NOi and if they need to conduct a site i nspection or
not. Based upon what they say, I will then let you know whether you can proceed or not
in the less than 2 week window.
If you have any questions, let me know.
From: Raj Shah [ mailto: rbshah @agraenvironmental.com]
Sent: Wednesday, February 11, 2015 6:39 PM
To: Rogers, Michael
Subject: Vance Elementary School
Mike,
As per our telephone conversation yesterday, attached is a completed Notification of
Intent for the referenced site . Please let me know if it looks okay and if we are allowed
to proceed with the pilot test next week or we really need to wait two weeks. Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: {919) 858-5351
4
Rogers, Michael
From: Rogers, Michael
Sent: Monday, February 16, 2015 12:22 PM
To: 'Raj Shah'
Cc: Smith, Danny; 6olich, Rick
Subject: RE: Vance Elementary School N01 W10500810
Raj -
If appears this project would also qualify for a small scale injection (less than 10,000 SF). Please send corrected NO] and
CC the above RRO staff members as they have the option to inspect the site. BE ADVISED, the Raleigh area is due for a
winter storm this afternoon and tomorrow and staff may not be avai[able to quickly respond.
Thank you for submitting the Notice of Intent to Construct or Operate injection Wells (NOI) for the Vance Elementary
School facility located at 8808 Old Stage Road, Raleigh, NC 27609. We received your revised NO[ on February 13,
2015.
Please remember to submit the following regarding this injection activity:
1) Well Construction Records (GW-1) and Abandonment Records (GW-30), if applicable. Please provide copies of the
GW-1s and GW-30s, if applicable. 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.
2) Injection Event Records (I ER). All injections, including air and passive systems require an IER. The I E R can be
modified for air spa rge wells (e.g., air flow `continuous' for date a rate of injection, etc.).
NOTE: If well construction abandonment information is the same for the wells, only one form needs to be completed -
just indicate total number of injection paints in the Comments/Remarks section of form.
These forms can be found on our website at http.Z/Portal.ncdenr.org/web/wci/aps&wproZreporting-form - You can
scan and send these forms directly to me at michael.rogers ncdenr.gov or send by fax to my attention at 919-807-
6406- These forms can be sent by regular mail as well, but email is preferred.
When submitting the above forms, you will need to enter the nine -digit alpha -numeric number on the form (i.e.,
WIXXXXXXX) that has been assigned to the injection activity at this site. This notification has been given the deemed
permit number W10500810. This number is also referenced in the subject line of this email. You may if you wish, scan
and send back as attachments in reply to this email, as it will already have the assigned deemed permit number in the
subject line.
Thank you for your cooperation.
M"at4 Rogers, P.G. (NC & FI_)
Hytlrogeologist

NCDENR-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
http://portal.ncdenr.org/web/wg/aps/gwpro/reporting-forms
NOTE: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Rogers, Michael
Sent: Monday, February 16, 2015 10: 12 AM
To: 'Raj Shah'
Subject: RE: Vance Elementary School NOI
What is% of the plume to be treated on Section G, I can't make it out completely. Please provide calculations you used.
It must be 5 % or less to be pilot test. The treatment zone/ROI shown in plan view on Figure 2 would be helpful.
From: Raj Shah [mailto:rbshah @ag raenvironmental.com]
Sent: Friday, February 13; 2015 5:13 PM
To: Rogers, Michael
Subject: Re: Vance Elementary School NOI
Mike,
Attached is a revised Notification of lntenL Could you please let me know as soon as you hear back from the RRO so we
can proceed with the pilot test? Thanks.
Raj
'Raj B. Shah, P.E, LEED®AP
-Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/12/2015 5:31 PM, Rogers, Michael wrote:
Raj-
The NOi is insufficient as submitted and cannot be processed for the following reasons:
Section F-Need zip code for address of site.
Section G-percentage of treatment area for pilot test has to 5% or less, you have 400%.
Section H-There were no plume map or geologic cross-sections included showing horizontal and lateral
extent of the plume. Where the plume is not clearly delineated~ the extent can be inferred. Please
show ROI of well on plume map.
In regards to your question about injecting right away-a complete NOi is forwarded to the RRO for their
review. After I send a corrected and complete NOi, I will ask them to let me know if they are OK w/the
NOi and if they need to conduct a site inspection or not. Based upon what they say, I will then let you
know whether you can proceed or not in the less than 2 week window.
If you have any questions, let me know.
From: Raj Shah [mailto:rbshah @ag raenvironmental.com]
Sent: Wednesday, February 11, 2015 6:39 PM
To: Rogers, Michael
Subject: Vance Elementary School
Mike,
As per our telephone conversation yesterday, attach.ed is a completed Notificati_<?n of Intent for the
referenced site. Please let me know if it looks okay arid if we are allowed to proceed with the pilot test
next week or we really need to wait two weeks. Thanks.
Raj
Raj 8. Shah, P£, LEED®AP
TechnicalDfrector
Agra Erwironmentat, rnc.
3
[phone] Ext 101
Fax: [phone]
4
Ro gers, Michael
From: Rogers, Michael
Sent:
To:
Monday, February 16, 2015 12 :05 PM
Smith, Danny; Bolich, Rick
Subject:
Attachments:
FW: Vance Elementary School NOi WI0500810
20150213173641.681.pdf
Attached is a revised NOi i am forwarding. This first one submitted to me was insufficient. Thus the latest. Raj needs to
clarify which does this qualify for-either pilot study or small scale. I have told him to cc you on all further
correspondence as they need a rapid response to OK injection, and be of the weather I am leaving this afternoon and
may not be back till Wednesday. I have entered this into BIMS.
From: Raj Shah [mailto:rbshah @ag raenvironmental.com]
Sent: Friday, February 13, 2015 5:13 PM
To: Rogers, Michael
Subject: Re: Vance Elementary School NOi
Mike,
Attached is a revised Notification of Intent. Could you please let me know as soon as you hear back from the RRO so we
can proceed with the pilot test? Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
, On 2/12/2015 5:31 PM, Rogers, Michael wrote:
Raj-
The NOi is rnsufficient as submitted and cannot be processed for the following reasons:
Section F-Nee<t~ip code for address of site.
S~ctkffHi• percentage of treatment area for pilot test has to 5% or less, you have 400%.
·-,
..__
1-
Section H-There were no plume map or geologic cross-sections included showing horizontal and lateral
extent of the plume. Where the plume is not clearly delineated, the extent can be inferred. Please
show ROI of well on plume map.
In regards to your question about injecting right away-a complete NOi is forwarded to the RRO for their
review. After I send a corrected and complete NOi, I will ask them to let me know if they are OK w/the
NOi and if they need to conduct a site inspection or not. Based upon what they say, I will then let you
know whether you can proceed or not in the less than 2 week window.
If you have any questions, let me know .
From: Raj Shah [mailto:rbshah @ag raenvironmenta l.co m]
Sent: Wednesday, February 11, 2015 6:39 PM
To: Rogers, Michael
Subject: Vance Elementary School
Mike,
As per our telephone conversation yesterday, attached is a completed Notification of Intent for the
referenced site. Please let me know if it looks okay and if we are allowed to proceed with the pilot test
next week or we really need to wait two weeks. Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
2
· Ro g ers, Michael
From: Rogers, Michael
Sent:
To:
Monday, February 16, 2015 10:12 AM
'Raj Shah'
Subject: RE: Vance Elementary School NOi
What is% of the plume to be treated on Section G, I can't make it out completely. Please provide calculations you used.
It must be 5 % or less to be pilot test. The treatment zone/ROI shown in plan view on Figure 2 would tie helpful.
From: Raj Shah (mailto:rbshah @agraenvironmental.com]
Sent: Friday, February 13, 2015 5:13 PM
To: Rogers, Michael
Subject:· Re: Vance Elementary School NOi
Mike,
Attached is a revised Notification of Intent. Could you please let me know as soon as you hear back from the RRO so we
can proceed with the pilot test? Thanks.
Raj
Raj 8. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
{919) 858-5350 Ext 101
Fax: [phone]
On 2/12/2015 5:31 PM, Rogers, Michael wrote:
Raj-
.The Nbl is insufficient as submitted and cannot be processed for the following reasons:
Section F-Need zip code for address of site.
Section G-percentage of treatment area for pilot test has to 5% or less, you have 400%.
Section H..-There were no plume map or geologic cross-sections included showing horizontal and lateral
extent of the plume. Where the plume is not clearly delineated, the extent carT be inferred. Please
show ROl of well on plume map.
l
In regards to your question about injecting right away-a complete NOi is forwarded to the RRO for their
review. After I send a corrected and complete NOi, I will ask them to let me know if they are OK w/the
NOi and if they need to conduct a site inspection or not. Based upon what they say, I will then let you
know whether you can proceed or not in the less than 2 week window.
If you have any questions, let me know.
From: Raj Shah [mailto:rbshah @ag raenvironmental.com]
Sent: Wednesday, February 11, 2015 6:39 PM
To: Rogers, Michael
Subject: Vance Elementary School
Mike,
As per our telephone conversation yesterday, attached is a completed Notification of Intent for the
referenced site. Please let me know if it looks okay and if we are allowed to proceed with the pilot test
next week or we really need to wait two weeks. Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: (919} 858-5351
' ... ,
Ro gers, Michael
From:
Sent:
To:
Raj Shah [[e-mail]]
Friday, February 13, 2015 5: 13 PM
Rogers, Michael
Subject: Re: Vance Elementary School NOi
20150213173641681 .pdf Attachments:
Mike,
Attached is a revised Notification of Intent. Could you please let me know as soon as you hear back from the RRO so we
can proceed with the pilot test? Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
On 2/12/2015 5:31 PM, Rogers, Michael wrote:
Raj-
The NOi is insufficient as submitted and cannot be processed for the following reasons:
Section F-Need zip code for address of site.
Section G-percentage of treatment area for pilot test has to 5% or less, you have 400%.
Section H-There were no plume map or geologic cross-sections included showing horizontal and lateral
extent of the plume. Where the plume is not clearly delineated; the extent can be inferred. Please
show ROI of well.on plume map.
. .
In regards to your question about injecting right away-a complete NOi is forwarded to the RRO for their
.. review. After r s:~nd a corrected and complete NOi, I will ask them to let me . know if they are OK w/the
NOiand ifthey need to conduct a site inspection or not. Based upon what they say, I will then let you
know whether y&:t:r-caoprQci!@ctor not in the less than 2 week window . ...
lfyouh.ave~ny q~estions, let me know . . ... ,..,..,.
1
From: Raj Shah [mailto:rbshah @agraenvironmental.com]
Sent: Wednesday, February 11, 2015 6:39 PM
To: Rogers, Michael
Subject: Vance Elementary School
Mike,
As per our telephone conversation yesterday, attached is a completed Notification of Intent for the
referenced site. Please let me know if it looks okay and if we are allowed to proceed with the pilot test
next week or we really need to wait two weeks. Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
Rogers, Michael
From: Rogers, Michael
Sent:
To:
Thursday, February 12, 2015 5:31 PM
'Raj Shah'
Cc: '[e-mail]'
Subject: RE: Vance Elementary School NOi
Raj-
The NOi is insufficient as submitted and cannot be processed for the following reasons:
Section F-Need zip code for address of site.
Section G-percentage of treatment area for pilot test has to 5% or less, you have 400%.
Section H-There were no plume map or geologic cross-sections included showing horizontal and lateral extent of the
plume. Where the plume is not clearly delineated, the extent can be inferred. Please show ROI of well on plume map.
In regards to your question about injecting right away-a complete NOi is forwarded to the RRO for their review. After I
send a corrected and complete NOi, I will ask them to let me know if they are OK w/the NOi and if they need to conduct
a site inspection or not. Based upon what they say, I will then let you know whether you can proceed or not in the less
than 2 week window.
If you have any questions, let me know.
From: Raj Shah [mailto:rbshah @ag raenvironmental.com]
Sent: Wednesday, February 11, 2015 6:39 PM
To: Rogers, Michael
Subject: Vance Elementary School
Mike,
As per our telephone conversation yesterday, attached is a completed Notification of Intent for the referenced site.
Please let me know if it looks okay and if we are allowed to proceed with the pilot test next week or we really need to
wait two weeks. Thanks.
Raj
Ra]B. Shah~P.E, LEEO®AP
Technical Director
Agra ~hvironmental, Inc .
. (9 .19J-~5350 ,~1
Fax_: (919) 858~5351
1
Rogers, Michael
From:
Sent:
To:
Subject:
Attachments:
Mike,
Raj Shah [[e-mail]]
Wednesday, February 11, 2015 6:39 PM
Rogers, Michael
Vance Elementary School
20150211185855743.pdf
As per our telephone conversation yesterday, attached is a completed Notification of Intent for the referenced site.
Please let me know if it looks okay and if we are allowed to proceed with the pilot test next week or we really need to
wait two weeks. Thanks.
Raj
Raj B. Shah, P.E, LEED®AP
Technical Director
Agra Environmental, Inc.
[phone] Ext 101
Fax: [phone]
1
NORIV'CAROI: NA DI PIll7`I'MENTO-F I NYWOiVfibl%l�l'1'r1N -i�EA'fURAL itl~SOLIRCc
NOTI FWATION OF INTENT TO .CONSTRUCT OR. OPI,RATE i!NJECTI€3N WEJILS
Tlrefullnrving are "perrmiller! by rules" aml rdii rrnf require an indUffewlpermll when srirrslrrrrlerd h) Derxire
ta�illr dd►e rl►Irs.nf f a. I :', [: I l ' Jl�}['-rl.'llrl.Jr1► lnt►1l ahrrll be srrhrrrillc�rl.�rl li n�12 eic�ckx rrnr ra.lrr' �cliu.
AQUIrEIZ TEST WELLS4���', tit=.1r iZ?�es" tN)-
These wells arc. used to inject uncontaminated 11tiid hito a aquil'er'lo detennine ite of fer hydraulirr ttiraco
tll��'��"Il REi1'I.FI?IATI(3�1 �t:� ►;��: �+' »:yr�_,rt?^,t .r►rT `lam. GER litELL�.{i � � ;€-�r• a�r�•,�p;
1 ] msisjivg IJcctiiln s}fRimi - in -well delivery Systems to tiiffibse injectanis into the suiyxI err re. I xatntplcs 111,310e
01W __ Pcks; MOC sj4letns and ntlaer gas Pnliision ern 110dS,
r
_'] inaitj ,t#e �sirctiau• tlLrat_ [yrt — Injeclintt ��'clls lvra#e d tir i4ltin �i tanti strriiu�r: coca stet to exceed ! 0,00.0
sgUim feet- for ittc purpow rrj waur groundwater remedialion or Imcor tcsm Aft: Rdivldgal permit sliall be required
r6j, test or lreal-Mcul areas cacceding l 0,00%square feet. ,f
3.) 1'i.ltL] csis Preliminary ssucties cvneltacfcri fcar lha: lat+rpose arevalit.'tting the t *ehuieal le: ihiiity of a
e'+;Inc411',,�tlipilSliillC�� iii [1rEIGt� in i[C„�i[fp,7 fit)k,cale tt'necclial.i��r pkutt for luturc� implcraie:lt[alinit, attel wite:rt; llic
surlaCa circa. a!'thcYttj4clialt xrinc rielts atr laca(dd wilhia nn area tltaAraes rant cxcesd live perce:rit orthe land
surface a1u)V61he knnavn exicia qrj;rnopidlv,ttrr.coliMmiimlion. AI iii4vUrial perwil shilli be required torouduct
rlrore thha Due piiat (est inn ratty sgmraair =;rouodivriter con tsrr irr;nA lrturne.
r
4 1i�Lcction E4MIs-- (.l-scd In inject ambic.rit air to ertliac in -situ treatittenl or soil orgroundwa(er,
Mitt ClLw4, or Y:y r- lirformallim. t)11! Re Rrrur► ed r!s irreurmplef
DDTT R. i:alirttary.9 ^2111S befilled in by iaWlZ)
As, t;1+1:l:1_'1'YiE'R 7'iy 1R/wCU
. i.....srcli❑ns,i A , k..N
Aclitilf_......,.w.,.._.._..__......,..:......Ctaen]itcte si coons t3-1?. K.:V
('i.y PaS§4Syslcup..,......,..............'.\�.Complcty st:ctio;tsti-f. 14-N
(4)• X_Small-tiort ()per.►I.in#r.._.__.__,_.,_........: ['❑inpletcseclioras> N
.I,5j _ Pif 1csl...............__.................kd\wrplete;-se,ctions R-N
rii accr ection k1'eiI---------- ...r .......,...........Cou,pi�.tc sections H-N
0. $TATIUS0 SYI;LLO� MA.- c t
C. �VI~I.,r> VVNr,.R -- State nwim of cutily urid name of person de li jiwteri. airtdreuil} sign on 1 uh ilf or the
biisineq or a�cucj _
Min 1 .1. ake:�. u ty Public ScJj[�1_SYsker>}:i :ir�r�Jarases i�ilt�ius
M. I(iug Addrm— 1551 Ro6k Othery Rw.0
f~�fy:: 1t'ai =�rh. _ _ _ --- Stale: SIC ilf C e T - counly:
Da y T !c Na:: -(914) 85659.7 Gell No.. [phone]
64A I I: Address:ptts
�i!{�1Ae:4YAu it�ntrr�.:lYixiJt�eiliMu�lt�r�s� t�ii'1t2(It±] - H�

G.
D. PROPERTY OWNER (if different than well owner)
Name:
Mailing Address: w
City: State: Zip Code: _ County:
DayTele No._ _ Cell No.:
EMAIL Address: Fax No.-
E. PROJECT CONTACT - Person who can answer technical questions about the proposed injection project,
Name: Rai Shah. P.
Mailing Address: P.O.Box 5611
City: Cate State: NC Zip Code:2751 2 County: Wake
Day Tele No.: 919-958-5350 Cell No.: 919-622-1155
EMAIL Address:rbshaliirvaeraenvironittental.cotn Fax No.:919-858-5351
F. PIIY81CAL LOCATION OF 1YELL SITE
(1) physical Address: Vance Elementary School
8808 Old.Stw,,e [toad County- Wake
City: Raleigh _ -State: NC Zip Code: 2"7609
(2) Geographic Coordinates: Latitude**: " or
Longitude**: io"
Reference Datum: Accuracy: -
-- -------------- lethod-of-Colleatiors---
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITR
MOPERTY BOUNDARIES MAY BE SUBIVIMED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATNIENT AREA
Land surface area of contaminant plume: 3,699
Land surface area of inj. w0l network:
Percent ofcon0minant plume area to be treated
square feet
square feet (< 10,000 10 fors -mall -scale injections)
(num be ¢ 5% of plume for pilot test .injections)
H. INJECTION ZONE i11.APS — Atlach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration Iines that show the horizontal extent of tile
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-seclion(s) to the known or projected depth of contamination that show the horizontal and
vedieal. exten of the contaminant plume in soil and groundwater, changes in - lithology, existing and
proposed monitoring wells, and existing and proposed injection wells.
UKW*.SOu Reined. Notific A (Revised 11/1912013) Page 2

I. DESCRIPTION OF PllOJ>OSED INJECTION ACTIVITIES -Provide a brief narrative 1·egarding the
purpose, scope, and goals oftlle proposed injection activity.
One (l) 4" (INJ-1) PVC ,vcll will be installed slightly upgradic11I of MW-7. The well \Viti be screened across the
local \Valer table. Subsequently, the foflowing field parame.ters will be measured (bascJine) in INJ-1, MW-7, MW-
2S, MW-1 and MW-3: Dissolved Oxygen (DO), pH, Tempemlure, Oxidalion/Reductfon potential (ORP), a11d
Conductivity (EC); Additionally, upon purging eacJ1 well three times it's volume, ground\•lator saniples \Viii be
collected for laboratory analyses for petroleum hydrocarbo11s using EPA 6200B, 625 and MADEP VPH/EPH.
The laboratory program will also include sampling for Geochemical parameter,s including alkalinity, dissolved
nitrate, iron (total), ferrous iron,.sulfa(e (dissolved), ri1ethane and totnl dissolved solids(TDS).
One Waterloo EtnitterTM will belhen installed in fNJ-1: The emi"er used will be J.8 h1ches in diameter, with
diffusive si.lico11e tubing lo relei\se M increased amount of oxygen. Oxygcu will be supplied to the <liffusive
emitter using compressed oxygen cylinder stored inside the existing garage on the property. A low density
polyethylene (LOPE) hose wiil be nm from the oxygen eylinder, aloilg the top of the ground, to U1e INJ-1
lllMnvay. The LOPE line will be secured to both ends with the appropriate threaded fiUings. The diffusion emitter
will be cfotrgecl with low pressure oxygen (approximately 20 PSI), and lhen left to naturaUy diffuse into the water
column. A high visibility safely tence will be erected around the INJ~ I and aboveground low pressure gas line.
The pilot test will be perfonned for a period of one week. A site visit will be performed by the EEC,lnc. staff
within 24 hours oflhe i.nitfol stmtup to check 011 the system fo.-leaks and overall fimction. EEC staff will also
collect tho field data for DO, pH, Temperature, ORP and EC from MW-7, MW-2S, MW--I and MW-3 on a daily
basis. At !he conclusion of the pilot test, a groundwater sample will be obtaii.ted from MW--6, MW-2S, MW-I and
MW-3 and analyzed in the laboratory for EPA 6200B/625/MADEP VPH/EPH.
The findings of the pilot test will be used to determine the feasibility of employing enhanced biorcmcdiutio11 al
the site; Based on the obtained data, additional wells and emillers may be necessary to influence the impocted
groundwater co11t11rnination plume.
J. INJECT ANTS -Provide a MSDS ·and the following for each injectant. Auach additional sheets if necessary.
NOTE: Approved lnjacran/s (lra,-ert and remediation addiffres) cm, he found 011/i11e C/I
lilfn/j_td1!.!l11 :dr!IJ.:f!t••Ju;bj_1.1J-_i 1J.:•::.1':fL't<'• All o//rer su.bstancey mus! be rel'iewed by !he Di!'i.yia11 of l'ublic
Heolih, Deparh11e11I of Het1/th 011d H111iu111 Services. Contacl the UIC Program fur more info (9 l 9-807-6496).
lnjcc1a111: =o=x"~•g=•e=n~-------------------·---------
Volumc of injectant: .c.:18'°'.""2..,_li"'tc""r=-s ____________________ _
Conccntrntion al point of in_ieclion: --~9~5""'¾.,a.o+'---------------------
Percenl ifin a 1i1ixturc with other irtjeclanls"-:__,_N""'/~A,__ _________________ _
lnjectnnl: ~"--------------------------------'
V0tttt11e·tifi!'!et;.t11nt. ___________________________ _
Conce~~1i,ii/a·t point of iitjeciion: ______________________ _
Percen(1tfii rr mix lure wiih orhcriujcchrills: ___________________ _
-·.:'~"L
lnjectatif: --'--------------------------------
. . " ' Vol~Qflnjecttmt; ___________________________ _
Concei~,;~f~!' ~l point ofinjeciion: ______________________ _
lJ'IO,n S'di> }(cine</. Notm ('"Jlfoll' :(~cvi~c<l 11/ 19/i0 13} . ... ~ -.....
,:',
., · .. , .-;
Percent ifin a mixture with other injectan1s: ___________________ _
l<.. WELL CONSTRUCTION DATA
( I) Number ofirijectlon wells: _____ .Ptoposed, __ ....,_ __ ,Exrsting
(2) Provid~ well construction delaUs for each injection well in 'a diagram or table for~1at. A single
dil!gn1m Qf Jin~ in a table , can be used for multiple wells with 1J1e sarne construction details. Well
cons1.ruc1ion details s1iall include the follo\Ving;
(a) \\iell type as perinane11t, direct-push, or sut>surf11,ce distr~~u1io11 system (infiltration gallery)
(b) depth below land surface ofgrmil; s~ree11,, and casing intervals ·
(c) well contraclor name and certification number
1)Ja/i;.-..<ii111 R~c<I. Notific;i i~n (Revised I t/19/20 ll).
L. SCHEDULES — Briefly describe [lie schedule ror well constructimi and injection activilics.
see section I
M. MONITORING PLAN -- Describe below or in separate attachmem a monitoring plan to be used to determine
if violations ofgroundwater guall(y standards Specified in ;33►[sclf.titn r OF 11_ astral from tine injection actluity.
508 section I
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
AP L, HCA ND "1 hercbj, cerlif); immkr penally of lmt•, ilea! I am fan i111,ur ividt Ilse !Marv►rrilia) t mike►i11ed i►r
flits documerie and all gllctehmelrls Ihe►-ela and I/iu1, based on my i►►githy of ihme irulividuads i iumedicrlely
1-espo►rrible-for ob[aining saiellrifinr-llrallan, I believe tha! Me h®r-nifilian Is jowe, uccrn•ale fates corrlplete. / atle
ashore Mal there ❑►e slg► ijIvivit pe►►allies, hreludilrg the ppsrfhillty, of fines asses imp1•isar mem, fru� subinhlfng
feilve lrefal•rrlallnn. l ngrre in conslrucl, ope►rrle, mahrluh►, frpalr, and if rrpplivahle, ubeimlan Nte h fectlon Imil
and all r elateel apluerlenrim-es fit accoida►rce ►rilh the [ s,•! if'_ir ' t1:?t 111U11 Rules. "
Signnture orApplirhnt
Prins ur Type Full Name
PROPERTY OWNG-R f If the prouarli is Dal P-Wned by Lillie pennil a , plicial :
"As owner. of [he pt opCi7y, On n-hlch 1110 bdecliorr wells) arc to be emislre►cled and-opeeaief), 11►errhy cometif
to allow lire applls_a►►l to constr itel eneh h9ection well as oullhled in Mir upplkyllion a► l e kyi•ee thal fl sholl-lie
the m pwis•1blllly of the applicant to ensime ►Ira[ 11re injectio►r lrell(s) co►1&.101 to the lVe/1 Cansn-uViiurl
,Wa1►tim-irk 1 j; l 'f :-!f ' r►� l.' _ it }sari . "
" Owiler" means any person who holds the face or other- property rights in the well being con,41rttcted. A
well is real property and its rust miction on land sit -ill be deemed to vest omiership its lite laud awfier, in
(he nftxence ofcotzimp agrec[ncut in writing.
err
?..r, Michae_i datues Wiltziu_s
SiUna Iure or prop orty-49 rer tit differenl fmm applItan[) — � Print at Type Ft:11 Nntnc
* err► (recess agree►rreetl huts rc+t dre celil-ilicaerf evil proper[)+ stirrrsei-►ua}• Gc salimfrted ier liar off slgrrrrlerre a►l 1hIs forn►.
Suimtdt arse copy of [ire completed nofilecalfun paclutgo Im
DX%IR — UiC Program
1636 Mail Service Cemer
Ral*h.,,lw'C 27699-1636
Telcpluxw: [phone]
U[C7frrSram armed. A'at+ficalign Itte0scd l 111912013j Pngc 5

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL: RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
The folloit ing are `�Permiaed by rule" and do not require an tndlpidaal permit when cons&ueted in accordance
with nc�'rfrles of 1 s 4 �vc:aC' II?�'. ra� flp. This farm shall be Wbmrihted at least 2 w As Erior to Weellon. .
AQUIFER TEST YVELLS ( Ili CAC: 0IC.Q120)
These wells are aged lv inject uncontaminated fluid into an aquifer to determine aquifer hydraulic char�edstics.
INSITUREMEDIATR)V (tsa N( .+mac 9i .a2?s) or TRACER WELLS os,i arc .kc 02 &Z22)s/
I) Passive Injection Svstc►i s - In -well delivery systems to diffuse injectaots into the subsur/46. Examples include
ORC socks, iSOC systems, anil other gas infusion. methods.
2} Small -Scale Injection flocrations — Injection wells located within a Land surfaceAfr'eanot to exceed 10,000
squarefeet for the purpose of soil or'groundwatcr remediation or tracer Eests. An individual permit shall be required
for test or treatment areas exceeding'(t .: 0D squarefeet. '
3) Pilot Tests - Preliminary studies condualed. for the. purpose of evalu*Tig the technical feasibility of a
rerhediation. strategy in csrder to develop a fuli'scale remediation plan !;6r future. implementation, and where the
surface area a#'the injection lode welts are locato¢ within 'an area �tfat does not exceed five percent of the land
surface above the known extent of groundwater coniamination.:An individual permit shall he required to ca]ndurt
moire than one pilot test. on any.separate.grorrndwatt�r rantsr►tiaan( plume.
4) Air Injection Well -.Used to inject.ambient air to enhance in -situ treatment of soil or.groundwater_
Ni► t Clearly or Type Information. Illegible SubmiWis Will -Be Returned As fircomplefet
DATE: February-9 201S PERMIT N.O.
A-
IL
C.
WELL TYPE TO BE CONSTRUCTED OR OPEAATJ
Air Injection Well ............... :.............
be filled in by DWR)
7,. K, lV
Aquifer Test Well.......................................Cornpletewctions B-F, K, N
Passive Injecilon System ........... ...•,...... ...... :..Complete secrk�ns.13-17, H-N
(4) SmailSca)eInjection Operations ....... ...............Complete sect an4,13-N
0) X Pilot ....................................... ._Complete sections 13-'N
(6) Tracer Injection Well, .......:.....................,.Complete sections B-N
STATUS OF W f'Ll, OWNER: 4"fivose tin iten..
WELL O.WKER — State name of entity and naive of person delegated authority to sign on beiiylf of the
business -or, r��e,iey_ .
lgaine::. Wa3 a Cou_ nt Public
.School System [Midiael.]alnes W.illzius)
Malting Address: 1551 RockQuarry Road
oily: _ Raleii;ti__ . State- NC Zip Code:2761 % County: Wake _
Day Tele Nb.. - MD.) 85&'A 7 Ce11 No_: [phone]
EhVIL Address:mWiltzius(R3wcpss.net Fax No.: (919) 50.9-0831
UTC/rrrSitu Reamed:. Nnlilicadaa (F(c0led 1 iI14 A13) Page i

D. PROPERTY OWNER (if different than well owner)
Name:-----------------------------------
Mailing Address: _______________________________ _
City: ____________ State: __ Zip Code:. _______ County: _____ _
Day Tele No .: ___________ _ Cell No.: __________ _
EMAIL Address: ______________ _ Fax No.: __________ _
E. PROJECT CONT ACT~ Person who can answer technical questions about the proposed injection project.
Name: Ra j Shah , P.E
Mailing Address: P~.O~.B=ox~56=1~1 _________________________ _
City: C ary State: NC Zip Code:27512 ___ County:_W~ak=e ___ _
Day Tele No .: 919-858-5350 Cell No.: 919--622-1 155
EMAIL Address:rbshah @agraenvironmental.com Fax No .:919-858-5351 __ _
F. PHYSICAL LOCATION OF WELL SITE
(I)
(2)
Physical Address: Vance Elementary School
=8~80~8~O=ld-S~t=a=ge~R=o=ad~ _______________ County: ~W'-'ak=e ____ --,,-;;___.
City: Ralei gh State: NC Zip Code: 2.J6o9 (!fig?-
. La · d * 0 " or ·::,-u.,, 0 • /,, ,,,--, -Geographic Coordinates: tttu e* : ___ __ __ _;::i..::?--~v:~~IGJ ____ _
~ 'c.; Longitude**: ___ 0 ____ " or_ '7 o_0 •. __,__t _&_~1 ____ _
Reference Datum: ________ Accuracy: _______ _
Method of Collection: ( "3;J,.7,I ~ fib a lJ,
**FOR AIR INJECTION AND AQUlFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDlNATf~'i.
G. TREATMENT AREA
H.
Land surface area of contaminant plume:~6~.4~0=0 ____ square feet
Land surface area ofinj. well network: square feet (S 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 4% (must be~ 5% of plume for pilot test injections)
INJECTION ZONE MAPS -Attach the following to the notification.
(I) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plwne 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 well s.
UIC//11 Sim Remed. Notification (Revised 11/19/2013) Page2 -...
I. DESCRIPTION OF PRQP,OSED' IN~CTJON ACTJVlTIE$' -Provide· a hr.id narrative regarding the
purpose, si:ope, and. g()'a,ls of the propos,ed injectioll activity. ·· · ·
One{l) 4"(INJ..,l) PVC weltwiU be installed sHg!Jtlyupgradfoot ofMW..;7. the well will l,e $Creened acron the
16~1 Wl'lt¢rtahle.Subs'equently, thefoUowing field parameters wiUbe measured (baseline) itt.INJ-kMW-7.MW-.
2S, MW.:i and MW.,;3: Dissolve~ O,cygen (DO);: pH, J'empetat1,11'e., Qxidatfon/Red~crion pot.enfial (ORP),. and
Con4ut:tiyity (EC) .. Additiollally, upon purging each weH three, times it's volume> groundwater samples wiII . be
coflected for laboratorram1lyses fqr p;:trole.~m hydroqatbons µsing EPA <>2008; 62?, and MADEP VPJ:1/EPH.
The l&bt>niJory prtjgram. will also ini::lude sampling for Geochemical parameters including alkalinity, dissolved
nitrate~ iron (total).,, ferrous iron , sulfate(dissolved),. methane· and total dis@1ved ~lids(TDS). . . . .
One Waterloo E:mitterTMWilJ be then installed in fNJ-L The emitter used will be 3.8 inches i11 diameter, with
.diffus,vesilicone tubing to release an .increased amount ofoxygen. Oxygen will be suppliedto thediffusive
emi~er U$ing eQinptesseci o1'.ygencylinder 5-tOt® iusi<,1¢ the e~isting garage 01, the property. A. low density
pQlycthyJene ,(LDPE) h<:>se wifi be ru,n from the oxygen cyJindet~ ~lcmg th~ tgp o'.{th~ ground, t◊ th¢ IN)-I
manway.TheLDPE linewilJ be secured to both ends .with the c\J>Pt<>priate threaded .fittings . The diffusion ¢milter
will be ch1,uged with low pressure oxyg:en(approximateJy 20 PSlh and then left. to naturally diffuse foto the wa:t~r
coh1mn. A high visibility safety fence ' will b~ erecJed around the lNJ-1 and ubovegrourid low pressure gas line.
The pilottest will be,perfqrnied for a ~riod ofone 'WeeJ<., A site visft will be p¢efbnn~d by th¢ ~EC,Inc. s~ff
within 24 hours of the initial start up to check on the system for l~ks and overall functiOII; E~c: staff wi}lalSQ
cotlectthe field datafor DO, pH, Temperature, ORP and EC from Mw.:1, MW-'.2S, MW-l andMW.,.3 on a da:i .ly
b~sis , At.the coriclusiort of the pilot fest, 11 groundw~ter sample w.illbe obtain~.from MW-'-6~ Mw.:2s; MW• I and
M~q an4 m1alyzed ip the laboratpty for EPA 62008/62?/l\1ADEP VPJ-f/EPH , . .
The finqir~gs qfthe p1 lortest wilf be us~ to. detertri lne the feasibility Qf employing enhanced bioremediation a:t
· th¢ site,. Bas~ on th~ obtained data, actditiotml wells and emitters 1J1aY be nec•~~s~cy t<> intluei;ice the impacted
groundwatercontiUniitation plume. ·
J; INJEC'i'ANTS ~ Proyide a MSDS and the fcillowing for each injectatit' Atta¢h additional sMets ifileCessary;
.NOTE: Apptqved inj¢ctCU'i.(s (trac:ei's and temed.ia.t;on additMis} can l:ie f6u,;d on/ine <.Jt
·-htf/D'•d.Ol.11,·,l.-or._@·g wet .1• q-,,ps :;1.,T:!Y-All qthe1• .<;ub~tµnce~ ,nustbe reviewed by !he . Division of Public
JJealth, Deparhhent of 1f filJ/h an4 Hi<mah Services. Coi1tac:til;¢ UIC Program for more info (919;.8{)7-6496,r .
InjeC:tai1t: ·""ox,.,_·:·u:;-='e =tl ___________________________ _
Volume ofjnje¢tanf: _,_I 8,,,.,.""2~li'°'te""r "'"s ___________________ _
Cort<;eritrMion at point of injection: --~9=5°~¼~+_. ________________ _
Per.c~nt if ina mixture. with otb.er inJectants . .,_: _,_N=/:,.:A,_ ________________ _
lnjectarit: _____________________________ _
Volume ofinJectant: __________________________ _
CQn:C~nfration at poiritofilijeclion: ------'-----------------~
Percent ifin a mixture with other injectarits: __________________ _
Injectant: ------------------------------
Volumeofittjectant: __________________________ _
· .ConGentratfon atpoint·ofinjection: _____________________ _
Ult:'!ln Situ ~emcd. N<.1tifica1ii;in (Revised. 11M/iQJ3)
Percent if in a mixture with other injectants_
K. WELL CONSTRUCTION DATA
(1) Number of injection welts: Proposed I Existing
(2) Provide well construction detalls for each injection well in a diagram or table format. A single
diagram or line in a sable Gan be used for multiple wells with the some construction details. Well
construction details shall include the following;
(a) well type as permanent, direct -push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
(c) well contractor name and certification number
U101a liter Heawd No9Graiion (RovisW I Ill 912D13) page 4

L, SCHEDULES-Briefly de$cribe' the schedule for well construction and injection activities;
· see section I
M. MONITORING PLAN.,.. Describe below or ln·separate attachment a monitoring pf an .to he used .to determine
ifviolations ofgroundwater qualit,y standards specified in l:l_ubchapt-:r..A~J1 result from the injection activity.
see section I
N. SIGNATURE OF APPLIC.ANTA.NllPRQPERTY OWNER
APPLICANT': ''1 hereby ce,rt!fy. lin,derp~niilty of law, fbal Jar11/amili<2r l'l1iththejnjorrnqtion submitted i.n
this docz~menl 'and qll attachlllents thereto and that,. based i>n ,ny · inquiry of thosft individiials iin1nedidtely
PesfttJit..~iblefor t>btainbiglald in/ormalion, Ib¢./ieve tht1t1he iiiforrnation ts tr11~;qci:.urate and fomple1e. Iam
aware that there are !trgnifk:mtt penalties, fncludingthepossibility ofjine1{antlimprisonmetJ1; Jot submitting
false irifarmatlon. J agree to con.r;frt«:I; operqt,:; 1naintafn1 repair, a.nd)fapplical,fe, abqndorr the injection well
and all related appurtenance'.!; in acc()rdance with the · i ). J '\i : ICJ.(!t :_1,;;_!}fl 8,µlfts. ''
·r z,;;.~~L
Signature ofAppUc!nt \
R J)-r s 1-t 2~. r e-.
. Print o.r Type Full Name
PROPER.TY OWNER (if the pro perty is not owned bv the pennit a pp licant):
"As owner of the property cm which flie injection well(.9 are to be constructed and operaJed, · 1.hetepy consent
1o allow the applicant to construct eat:h ifl}ectionweUas outlinedinthis appl(c:ation an4atr:ee)hal it,"<;hall be
the responsibility of the applicant to r;flslll·e tl1at the jnjec.ticin wel/(s) confonn to the Well C:01istnic.#on
Standards (1 5 J !VCAC {)"(' .li'.;01~, ''
"Owner'' Jl1eans any person who holds the fee or other property dghts in the well being coilstructed. A
we! I is real property ai1d it$ . construction on land· sha I I be deemed· to vest ownership in the· land owner; in
the. abse~ce of contriry agreement in writing. ·
~ .. ·~. /'/~~;7/t(_, r J;::,, •t. l,. 'I t;f~--~, . . . . . Michael James Wiltzius
$igllllture" (.)f Pl'operty Owber {if differe11t fr(.)tn applic11nt) Print or Type Full Name
"' A11 ac<:ess qgreemen/ belw.een tl1e apjJ/icai1tarzdpr9perty ()Wner fl'iay be Sitbmllledih Neu ofa sii:natz,re 011 thl.Vor111.
SulJmit.one copy oftbe,cQntp1¢tfd notifi¢ation pitck?,geJo:
UJC'/n Si111 Rem ed. Notificatfon (Revised I f /~/2013)
DWR-UIC Prt:>gram
1636 Mall &ervice Center
Ritle~gl1, NC 27699-1 liJ6
Telephone: [phone]
FIG. SITE VICINITY MAP
8808 OLD STAGE ROAD
RALEIGH, NORTH CAROLINA 27613
..:"'JI. WA T£R SUPPLY W£tl
1:tP (See Ttlble 2A of Phcte I LSA Report)
Cfty of Rolelgh woler main loc<1led ln west
right'-Of-woy of Old Slogs Rood
1 Q-ft topogrpphlc. c·on\ours ln orang~
DRAWN BY: SKP SCALE: 1"=400'
CHECKED . BY: MS
DATE: 9/20/12
EEC, INC.
8514 SIX FORKS ROAD, Su'ITE 101
RALElGH, NORTH CAROLINA 27615
IANf•9.' s elaeerjl�a.�l►Away fFn
Sit)
r MW-
GYMNASIUM
_ .a bJjk-vr g
SHE
4ry�
9
Ct Faw-7
SHE
Former UST
PARKING
R _ f -t4
41 w •:.. •.� � .f+v
1-
f Ll i-CL]2hM a
r FARKING r� _
PARKING
- r
_ f
WALKING TRACK.
LEGEND --
tl Monitoring We -
� __ _ - 0 20 44 sa
Type lit Monitoring Well = -=
�4,21 2t. Erceedarxe SCALE IN FEET
Groundwater Sampling Results EEC, Inc.
Vance Elementary School
8808 Old Stage Road
Raleigh, North Carolina -�8514 Six Forks Fed, Raleigh, NC 27515
Figure go: scale: Drawn By. Checked By: Date: Project No--
5 1" 3Q' TLC RBS 07/10/2014

MWSR _ �S
r+l
i
GYMNASIUM
SHE
MWa 'NJ"
SHE
r W-s
' • IFnrmer UST
,T 4W-2D �
PARKING �� a i�`MW2s
;�,MW.3 4
� t �
- - -PARKING
LEGEND
G Monitoring Well
J' ,S Type III Monitoring Well
Injection Well
Site Layout Map
Vance Elementary School
8808 Old Stage Road
Raleigh, North Carolina
Figure No: Scale: Drawn By:
3 1" = 30' TLC
PARKING y
MW-4
WALKING TRACK
U 20 40 60
SCALE IN FEET
EEC, Inc.
8514 Six Forks Rd, Raleigh, NC 27615
Checked By: pate_ Project l�lv:
RBS 2/11/2015

s
1. WELL CONTRACTOR:
David Brown _
Well Conirader(hldividuat) Name
.Environmental Drilling & Probing SefWcas. LLC
Wen Conl►ador Company Name
17-538_Gripanhill Road
Strad Addrasa
Chadotte NC_ 28278
Cllyar Tnwn State Zip Code
(704 S 607:7629 �.
Area cafe Phone number
2. WELL INFORMATION:
WELL CONSTRuofloN PERAi n# NA
DT1tER AssomTeD PERMIT#& ), - NA
SITE WELL ID tl(r appumbis)_ 1 NJ-1
S. WELL USE {Check One box} Monitoring W MunicipatlPu&lie n
IndustflallConwien5sl U Agricultural Ll Rawvary L3 Injecfinn L1
Irrigation[? Other L1 (list use) - - _ -
DATE DRI(.LED J
41. MLL. LOCATION:
8808 Old Stave Road
(Slyest Name. Nambmr , Community: SvtdN%lDPj Lot fro., ParoeL Zj) Cade)
Gfm Raleigh GOUNTIV
TOPOGRAPHIC 1 LAND S>;T ING: '(check appropdsle box)
177619pa Malley F](Flat ("]Rldge [10ther
LATITUDE 36 ' DMS OR 3x xXXXWX7C)t DO
LONGITUDE 75 • DMS OR 7X.VQ2LXc DI)
LaliiudellongRudesalrce: ❑3128 Mpogrephlcmap
(Incaiyion of well must be slrar+m on a USGS top& map erxlariaehecl to
this farm Ifnot using GPS)
S. FACILITY (Name of iha business Where'the well is located-)
Vamp Eliementary School
Fadrty,Name Facility IDV (if applicable)
A 08 Did Zfaaa Boat_ _
Street Address
- BaTeiah - - - TIC_
CRY or Town Stale Zip Cade
Contact Name — - - -
Malting Addrhss
CkyorTom Stale Zfp Code
Area Code Phone number
6. WELL DETAILS:
it. TOTAL DEPTH
b_ VOES WELL, RIEPLACE EXISTING -WELL? YES FI NOW
N(1NRN IDEM L WELL CONSMU TION RECORD
'North Q�towm DepmUneuf of Fhvi =meat and Natural Rcsources­ Division of Water Quawy
- M CONTRACTOR CERTMCATiOM # 4155
it: TOP OF CASING IS FT, Above Land SW;toe
'Top of casing lermInaled attar below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
a. YIELD (epm): METHOD OF TEST__
f. DISINFECTIDN: Type Amount
iw. WATER ZONES (depth).
Tap
bottom Tap >3attam
Top
Bottom Tap Bottom
Top
Hottot Top Bottorrl_,
Thioknossl
7. CASING:
Depth tliamicter Weight hlaterw
:Tup _ 1❑
Bottmj_ 0 _ Ft 4- sch 4U PVC
Top
Batlorn Ft
Tap
Bottom FL
8_ GROUT:
Depth Material Method
Top___0__
BatiarrL__6__ Ft - BP.0190fte 'mimic
: Top. B _
Bottom 0 FI gLQUIt Tremic
Tap
130tiom Ft.
9_ SCREEN., Depth Dlamelar Slotslw Materlal
TOP-2-5—
BdtmJ 0- FF,,, 4 „fn: 0.01 1, PVC
Top
Bollork—FL In. In,
Tap
Boma R in. Irr, T
10. SAN=RAVEL PACK:
Depth Size Material
Top 2b -
Bedlam 8 FtA2 nia-¢, --Sand
Top
Bottom , Ft:
Top
Bottom _ Ft.
11. DRILLING LOG
Top Bottom Formation ae,e_6P ran
1
1
i
r
r
1
12. REMARKS:
DQUERE RY CERnfy 7144T TWS WRL WAACAHBTRUCTEn 10ACCORIMMC$ PATH
15AHr luCX_ 4YEtL COMTRUCTIaN sTANDMD9, AttoTHAT A � OF TMS
$ CoRo t4 MEN YRnymm TO THE V ELL Dvmr �lz
2/11/15
SIGNATURE OF CFRTiFIED Wtt.L CONTRAf,OR�� DATE
a. WATER LEVEL Below Top of Casing: 17T. ' '—David QrD{t n
{flee •+- Il Above Top of Cgs}ng) :PRINTED NAME OF PER" CONSTRUCTING THE WELL
ForSubmit within 20 days of completion to: Division of Water Quality - information Processing, Rey. ZJQ9
Rev. p9
1"7 Nfti l Service Center, Raleigh, NC 27699V161, Phona : [phone]

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are 'permitted by rule" and do not require an irrdil<ideal perprlt when constructed In accordance
ivith the rules of l 5.4 A'CAC 02C.02,00 ZYtls fore shall be submitted at least 2 weeks prior to Inlecllon.
AQUIFER TEST WELLS [15A NC (.: 0at..0120)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
INSITU REMEWATION i5t A Nc AC t) C.ex251 or TRACER WELLS t t 5A.t3ZZ9}:
1) !f Mine IJection SyMems - In -well delivery systems to diffuse injeclants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small -Scale injection Oncrations — Injection wells located within a land surface area not to exceed-10,000
square feet for the purpose of sail or groundwater remediation or tioter tests. An individual permit shall be required
for test or tree Imtin t areas execeding I0,000 sgnnre reef.
3) Pilot ests - Preliminary studies ru)nducted for the purpose of evaluating the technical feasibility of a
reined ialion strategy in order to develop p hill scale rem ediation plan for future implementation, and where the
surface area of the injection zone. weiis art. located ► within an area that does not exceed live percent of the land
surface above the known extent of groundwater containinalion. An individual perm I shall be required to conduct
more than one pilot lest on any separate grourid�s ater contaminant plume.
4) Air Infection We]It - Used to inject ambieni air to enhance in -situ treatment of soil or groundwater.
PrI t Clear6, or Type lisfarr+uillon. IllegWe SubmIllals frill Be Rdurned its Incomplete.
DATE: February 9 , 2015 PERMIT NO. (to be filled in by DWRt
A. WELL TYPE'1*0 BE CONSTRUCTED OR OPERATED
(1)
Air injection Well ...................................::,Complete
sections B-F, K, N
(2)
Agl:ifcr Test Well .................................(`vmpletc
sections B-F, K, N
(3)
Passive Injection System ...............................Complete sections H-F, H-N
(4)
Small -Scale Injection Operations ......................Complete
sections B-N
(5) X
Pilot Test-- ......................................... —Complet
&,:sections B=N
(6)
Tracer Injection Well... _......... .......................Complete
s&lions B-N
B. STATUS OF
WELL OWNER: [-Dunne an itr,rn.
C. WELL. OWNER — Stale name of enlity and name of person delegated a1ltltority to sign on behalf of the
business or agency:
Name: Wake_Counly Puhlic School 5�stem_LMichael lamas 1V' tzius
Mailing. Address: .1551,Rncli Quarn� Road _
City. i . .- ,— - -
Day Tcle No.:
EMAIL Address:iiiwiltzriis0,wcpss.rmf
Slate: NC Zip Code:27610 _ County: Wake
L;c41!+ie : {91%669-9635
Fax No.: �919J 508-0831
LT11 IMSelu RemuL Nalificition &%is 1 If? FNgc

PROPERTY OWNER (if different than well owner)
Name:
Mailing Address:
City: State: Zip Code: County:
-
Day Tele No.: - _ Cell No.:
EMA IL Address: Fax No.:
E. PROJECT CONTACT - Person who can answer technical questions about the proposed injection project.
Name: _FUj Shah RE
Mailing Address: P,O.Sox 5611--
City: Cary State: NC 'Lip Code:27512_ County; Wake
Day,Tele No.: 919-858-5350 Cell No.: 919-622-I 155
EMAIL Address.rbsilah r acraenvironrncntal.com Far No.:919-858-5351
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: Vance Elementarg School _ _
8808 Old Stas'e Road _ - County: Wake_
City: Raleigh State: NC Zip Code:
(2) Geographic Coordinales: Latitude": or " _
Longitude"- " or °
Reference Datum:- -_ _-_ Accuracy:
Method of Collection:
"FOR AIR 1N)rCTION AND AQUIFEtt TEST WELLS ONLY: A I -AC lIXI'Y S11'E MAl' WI-111 PROPERTY
BOUNDARIES MAY IIE SUI314t ITE❑ IN LIEU OF UEOGRAP111C COORDINATES.
G, TREATMENT AREA
Land surface area of contaminant plume; fi 400 square feet
Land surface area of inj, well network: square feet (< 10,000 f12 for small-scale injections)
Percent of cotttamiltant plume area to be treated:_ 400 - otust be < 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS - Attach the following to the notiIII cat ion.
(1) Contaminant plume inap(s) with isoconcentration lines chat show the horizontal extent of the
` contaminant plume in soil and groundwater, existing and proposed moniloring wells, and existing and
' proposed injection wells; and
(Z} Crass -sections) to the known or projected depth of contamination that show rite horizontal and
vertical extent of the contaminant plume in soil and groundwater, changes in Iitltalogy, existing; and
proposed monitoring ►yells, and existing and proposed inject ion dells.
UK'?fff.Vrw Rcau-d. Notiliration (Revised 1 111911b13) Page 2

I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide ~ brfof narrative regarding the
puq,ose, scope, and goals of the proposed inj!;!ction activity.
One (l) 4" (INJ-1) PVC ,veil will beji1staUed slightly upgradient ofM\W7. The well will be screened across the
lo.cai water cable. Subsequently~ the foUowit1gJield pararneters will be measured (baseline) in INJ-1, MW-7. MW-
2S, MW~l and MW-3: Dissolved O~ygen {D0), pH; Temperature, Oxi<lation/Reduction potential (ORP), and
Conductivity (EC); Additionally, upon pur~ing eaQh weli three . tim~s it's volume~ ground,vater samples will be
coJtected for laboratory analyses for J)(:trolemn hydrocarbons using EPA 6200B, 625 and MADEP VPH/EPH.
The lal>oratory progra,~ will also include sampling for Geochemical parameters including alkalinity, dissolved
nitrate, iron (total)J ferrous iron , sulfateNissolved), methane and total dissolved solids(fDS). ·
One Waterloo EmitteffMWill be then installed iri INJ-1. The:emitter ll~ed will he 3.8 inches in diame.ter, ,vitb
diffusive silicone tubing to release an increased amount of 9xygen. Oxygen wiU be supplied to the . diffusive
emitter u~h1g cc;unpressed oxygen cylinder stored inside the existing garage .Qnthe property. A low density
polyethylene (LOPE) hose \~ill be run fron1 the oxygen cylinder, along tiie top ofthe ground, to the INJ-1
manway . The LOPE line \viii be se<:ured to both ends with the appropriate threade~ fittings. The diffusioll emitter
,vi.JI be diarged whh )Qw pressure oxygen (appro-xirnntety20 PSI), and then left to naturally diffuse into the water
column. A high visibility safety fence will be erec.ted around the INJ i'.I and aboveground lo\V pressure gas Jir1e.
The pilot test will be performed for a ped9cl of one week A site visit will be perforrited by th~ EEC.Inc. ~taff
within 24 hoors ofthe init.ial start upto check on the systein for leaks and overalffunction. EEC staff will also
colkct the field clata for DO, pH, Temperature, ORP and EC from MW..,7, MW-2S, MW~I and MW-:J on a daily
basis. At the co11closion .of the pilot . test, a groundwater · san1ple will be obtained from MW-6, MW-:2$, MW~ l and
MW,.3 and analyzed in the labonitory for EPA62MB/625/MADEP VPH/EPH.
The findings of the ' pilot test will be used to detef't11ii1e thefensibility of employing enhan<;cd . biqrcmediatiorrat
the site. Based on the obtained data, additional wells and emitters may be riecessary to infh1e1.1ce the impacted
groundwater contamination plume .
. J. INJECT ANTS -Provide a MSDS and the following for each injectant Attach additio1ial sheets if necessary .
NOTE: Appro.ved injci:1airts ((racers and re111ediatio11 additH·rr.v ca.11 be found online al
!J.t'f':."JJ!'rl,l/.J.ttJ/."W","!.~',wd,;i1;qjgJJ~f..'!_':nro. All other substances must be reviewed by JheDivision of Public
Jfealth, Depariment offlec1/th and Human Services. Contact the UJC Program for 111ore bifq (919-807-64'96).
lrijectant: ~oxce.v:..c• ·>:<e=----------------------------
Volume ofhtjectant: ~18=·=2~li=tc=rs~· ___________________ _
Concentration at point of injectipn : 9....,5...,o/c~o+-'-------------------
Percent if in a mixture With other injeclants~: ~N~/A~· ___________________ _
ltljectant: _____________________________ _
Yoltuneofjnjectant: __________________________ _
Concentration at point of injection; _____________________ _
Percent if in a mixture with other h1jeclant$: __________________ _
lojectant: _____________________________ _
VoJurne ofinjec1an1: _________________________ _
Concentralfon .itpollif ofinjettiLm: _____________________ _
lJIC/1,i Situ R~.ri1c<l. Notification (Revised I 1/1912013) Pagc3
Percent if in a mixture with other injectants: ____________________ _
K. WELL CONSTRUCTION DATA
(I) Number of injection wells: _____ Proposed Existing
(2) Provide well construction details for each injection well in a diagram or table fom1at. 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:
(a) well type as permanent, direct-push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen , and casing intervals
(c) well contractor name and certification number
UIC//n Si /11 Rcmcd . Notific-ntion (Revised 11/1 9/2013) Pagc4