WI0800151_Application_20100514

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
RECEIVED / DENR / DWQ
AQUIFFR-PRnTFrTinni $:CT/ON
MAY 14 MO
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
• Do not use this form for remediation systems that extract contaminated groundwater, treat it, and reinject the treated groundwater.
• Submit TWO copies of the completed application and all attachments to the address on the last page of this fonn.
• Any changes made to this form will result in the application package being returned.
Application Number (to be completed by DWQ): liJJ 0 8 jf/i
I. GENERAL INFORMATION:
Southern Cleaners and Laundry, Inc.
1. Applicant's Name (generally the responsible party): (Petitioner for DSCA Site # 67-0002)
Bob Wyrick for AECOM on behalf of DSCA Petitioner for
2. Signing Official's Name: nSCA sioa n7Arn7 Title: Project Manager for AECOM
3. Mailing address of applicant: NC Dry -Cleaning Solvent Cleanup Act (DSCA) Program
1646 Mail Service Center
City: Raleigh
Telephone number: 919.508.8400
State: NC
Fax number:
Zip: 27699-1646
4. Property Owner's Name (if different from Applicant): Site Area 1 - Ronald Massey, Interim Jacksonville City Mgr.
5. Property Owner's mailing address: P.O. Box 128, Jacksonville, NC 28541-0128
Offsite Area 2 - Jeffrey Hudson, County Manager, Onslow County NC - 118 Old Bridge Street
City: Jacksonville
State: NC Zip: 28540
6. Name and address of contact person who can answer questions about the proposed injection project:
Name: Bob Wyrick, PG
Company: AECOM North Carolina, Inc.
Address: 8540 Colonnade Center Drive Suite 306
Title: Project Manager for AECOM
City: Raleigh
Telephone number: 919.872-6600
Email Address: [e-mail]
II. PERMIT INFORMATION:
State: NC Zip: 27615
Fax number: 919.872.7996
1. Project is: I_ New L Modification of existing permit L Renewal of existing permit without modification
Renewal of existing permit with modification
2. If this application is being submitted for renewal or modification to an existing permit, provide:
existing permit number WI0800151 and the issuance date May 29, 2009
For renewal without modifications, fill out sections I & II only, sign the certification on the last page of this
form, and obtain the property owner's signature to indicate consent (if the applicant is not the owner).
For all renewals, you must submit a status report including monitoring results of all injection activities to
date.
Revised 8/07
UIC-5I/5T Page 1 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 51 Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
III. INCIDENT & FACILITY DATA
A. FACILITY INFORMATION
1. Facility name: Southern Cleaners & Laundry, Inc. (Southern Uniform Facility), DSCA Site #67-0002
2. Complete physical address of the facility: 818 Court Street
City: Jacksonville County: Onslow
State: NC Zip: 28540
B. INCIDENT DESCRIPTION
1. Describe the source of the contamination:
A Comprehensive Site Assessment (CSA) identified three leaking underground storage tanks (USTs) that
contained gasoline, heating oil, and varsol as the main source of the petroleum hydrocarbon volatile organic
compound (VOC) contamination. An accidental surface spill of tetrachloroethene (PCE) that occurred during a
routine delivery of 55-gallon drum of PCE in the mid-1970s was identified as the source of the chlorinated VOC
contamination.
2. List all contaminants present in soils or groundwater at the site (contaminants may be listed in groups, e.g.,
gasoline, diesel, jet fuel, fuel oil, chlorinated ethenes, chlorinated ethanes, metals, pesticides/herbicides, etc):
chlorinated ethenes and petroleum compounds
3. Has LNAPL or DNAPL ever been observed at the site (even if outside the injection zone)?
L Yes If yes, list maximum measured separate phase thickness _ feet
X No If no, list maximum concentration of total VOCs observed at site: 16,168 ppb (MW-20, July 2007) ppb
4. Agency managing the contamination incident:
L UST Section X Superfund Section (including REC Program and DSCA sites)
L DWQ Aquifer Protection Section Solid Waste Section
L Hazardous Waste Section L Other:
5. Incident managers name Scott Stupak and phone number 919.508.8576
6. Incident number or other site number assigned by the agency managing the contamination incident:
DSCA Site # 67-0002
C. PERMITS
List all permits or construction approvals that have been issued for the facility or incident, including those not
directly related to the proposed injection operation:
1. Hazardous Waste Management program permits under RCRA:
2. DWQ Non -Discharge or NPDES permits:
3. County or DEH subsurface wastewater disposal permits:
4. Other environmental permits required by state or federal law: monitoring well permits
Revised 8/07 UIC-51/5T Page 2 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
IV. INJECTION DATA
A. INJECTION FLUID DATA
1. List all proposed injectants.
NOTE: Any substance to be injected as a tracer or to promote in situ remediation must be reviewed by the
Occupational and Environmental Epidemiology Section (OEES) of the Division of Public Health, Department of
Health and Human Services. Review the list of approved injectantsT or contact the UIC Program to determine if
the injectants you are proposing have been reviewed by OEES.
Injectant: Anaerobic Biochem plus (ABC plus) in solution with water
Concentration at point of injection: estimated 5% to 25% by weight
Inj ectant:
Concentration at point of injection:
Inj ectant:
Concentration at point of injection:
Inj ectant:
Concentration at point of injection:
Injectant:
Concentration at point of injection:
2. Source of fluids used to dilute or chase the injectants listed above:
None
L Municipal water supply
L Groundwater from private well or any well within '/a mile of injection site
Air
Other:
3. If any well within'/a mile of injection site, a private well, or surface water is to be used as the fluid source, supply
the following information:
a. Location/ID number of source: N/A
b. Depth of source: N/A
c. Formation: N/A
d. Rock/Sediment type: N/A
e. In Attachment C, provide a current, complete chemical analysis of the water from the source well, including
analyses for all contaminants suspected or historically recognized in soil or groundwater on the site.
NOTE. If contaminated groundwater is to be used as the dilution or chase fluid, this is not the proper permit
application form. You must apply for a closed -loop groundwater remediation permit using gi+plication lbrm
G[YRS.
Revised 8/07
UIC-5I/5T Page 3 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
B. PROPOSED OPERATING PARAMETERS
1. Duration of Injection:
Maximum number of separate injection events: 2
Expected duration of each injection event: 15 days each
Expected duration between events (if more than one event): 6 months
2. Injection rate per well: 10+ gallons per minute (gpm)
3. Total Injection volume: 3,750 gallons per day (gpd); 56,250 gallons per event (if separate events)
4. Injection pressure: 5 to 200 pounds/square inch (psi)
5. Temperature at point of injection: ambient °F
6. Briefly describe how the above parameters will be measured and controlled:
The injection pressure will be continually monitored using pressure gauges attached to the injection apparatus.
The flow rate will be monitored by observing the water level in the injection tank.
7 Estimated hydraulic capacity of the well: 1 to 2 gpm
C. INJECTION WELL CONSTRUCTION DATA
1. Injection will be via:
Existing well(s) proposed for use as an injection well. Provide the data in (2) through (6) below to the best of
your knowledge.
X' Proposed well(s) to be constructed for use as an injection well. Provide the data in (2) through (6) below as
proposed construction specifications.
2. Well Drilling Contractor's Name: Redox Tech, LLC
NC Well Contractor Certification number: #7 0-375 c
3. Date to be constructed: TBD Number of boring. • 150/even
Approximate depth of each boring (feet): 22 feet —
4. Screened interval/Injection interval of injection wells:
Depth: 7 to 22 feet below ground surface (if multiple intervals, indicate shallowest and deepest depth).
5. Well casing (N/A if injection is through direct push rods):
Type: L PVC L- Stainless steel __ Other: N/A
Casing depth: to ft.
.6. Grout (N/A if injection is through direct push rods):
Type: L Cement L Bentonite _ Other: N/A
Grout depth: to ft.
Revised 8/07
UIC-51/5T Page 4 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
V. ATTACHMENTS
Provide the following items as attachments with the given headings:
A. SITE HISTORY
Provide a brief description of the site history including:
(1) site usage historically and present,
(2) origin of the contamination,
(3) previous remedial action(s).
NOTE: G.S. 89E-18 requires that any geologic plans, reports, or documents in which the performance is related to the
public welfare or safeguarding of the environment be prepared by a licensed geologist or subordinate under his or her
direction. G.S. 89E-13 requires that all drawings, reports, or documents involving geologic work which shall have been
prepared or approved by a licensed geologist or a subordinate under his or her direction be signed and sealed by him or
her.
B. HYDROGEOLOGIC DESCRIPTION
Provide a hydrogeologic description, soils description, and cross section of the subsurface to a depth that includes the
known or projected depth of contamination. The hydrogeologic description shall include:
(1) the regional geologic setting;
(2) significant changes in lithology;
(3) the hydraulic conductivity, transmissivity, and specific yield of the aquifer to be used for injection, including a
description of the test(s) used to determine these parameters; and
(4) the depth to the mean seasonal high water table.
C. INJECTION FLUID COMPOSITION
Describe the chemical, physical, biological and radiological characteristics of each injectant. Attach the Material Safety
Data Sheet (MSDS) for each injectant. If a private well or a well within V mile of the injection site is used as the source
well, include chemical analysis of source fluid here.
D. INJECTION RATIONALE
Attach a brief description of the rationale for selecting the injectants and concentrations proposed for injection, including:
(1) goals of the injection project;
(2) a description of the reactions between the injectants and the contaminants present including specific breakdown
products or intermediate compounds that may be formed by the injection; and
(3) summary results of modeling or testing performed to investigate the injectant's potential or susceptibility to change
(biological, chemical or physical) in the subsurface.
E. INJECTION PROCEDURE AND EQUIPMENT
Provide a detailed description of all planned activities related to the proposed injection including but not limited to:
(1) construction plans and materials;
(2) operation procedures;
(3) a detailed diagram of the surface and subsurface portions of the system; and
(4) a planned injection schedule.
F. MONITORING PLAN
Provide a plan for monitoring the results of the injection, including:
(1) a list of existing and proposed monitoring wells to be used;
(2) a list of monitoring parameters and analytical methods to be used; and
(3) a schedule for sampling to monitor the proposed injection.
NOTE: The selected monitoring wells must be located so as to detect any movement of injection fluids, process by-
products, or formation fluids outside the injection area or zone. The monitoring parameters should include the target
contaminants as well as secondary or intermediate contaminants which may result from the injection and other
parameters which may serve to indicate the progress of the intended reactions, such as pH, ORP, dissolved oxygen, and
Revised 8/07
UIC-51/5T Page 5 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Sitar Groundwater Remediation / Type 5T Wells — Tracer Injection
other electron acceptors and donors. The monitoring schedule should be consistent with the pace of the anticipated
reactions and rate of transport of the injectants and contaminants.
G. WELL DATA
Provide a tabulation of data on all existing or abandoned wells within'/4 mile of the injection well(s) which penetrate the
proposed injection zone, including, but not limited to, monitoring wells and wells proposed for use as injection wells.
Such data shall include a description of each well's use (water supply, monitoring, etc), total depth, screened or open
borehole depth interval, and well construction or abandonment record, if available.
H. MAPS
Attach the following scaled, site -specific maps:
(1) Area map based on the most recent USGS 7.5' topographic map of the area, at a scale of 1:24,000 and
showing the location of the proposed injection site.
(2) Site map including:
a. all property boundaries;
b. all buildings within the property boundary;
c. existing and proposed injection wells or well field(s)
d. any existing sources of potential or known groundwater contamination, including waste storage,
treatment or disposal systems within' mile of the injection well or well system;
e. all surface water bodies within'/4 mile of the injection well or well system; and
f. all existing or abandoned wells within' mile of the injection well(s) which penetrate the proposed
injection zone, including, but not limited to, monitoring wells and wells proposed foruseas injection
wells.
(3) Potentiometric surface map(s) including:
a. direction of groundwater movement
b. existing and proposed monitoring wells
c. existing and proposed injection wells
(4) Contaminant plume map(s) including:
a. the horizontal extent of the contaminant plume, including isoconcentration lines
b. existing and proposed monitoring wells
c. existing and proposed injection wells
Cross-section(s) to the known or projected depth of contamination, including:
a. horizontal and vertical extent of the contaminant plume, including isoconcentration lines
b. major changes in lithology
(5)
Revised 8/07
UIC-5I/5T Page 6 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
VI. CERTIFICATION
I, 4- , hereby certify under penalty of law that
I have personally examin d and am familiar with the information submitted in this document and all attachments
thereto and that, based on my inquiry of those individuals immediately responsible for obtaining said information,
I believe that the information is true, accurate and complete. I am aware that there are significant penalties,
including the possibility of fines and imprisonment, for submitting false information. I agree to construct,
operate, maintain, repair, and if applicable, abandon the injection well(s) and all related appurtenances in
accordance wittte approved s ecifrcations and conditions of the Permit.
Signature:
Title: ;vr 2 --01-S-ecT 4.Ja,(.0
Date: / LL. 2 3, 'zO i cl.
If authorized agent is acting on behalf of the applicant, supply a letter signed by the applicant authorizing the
above agent.
VII. CONSENT OF PROPERTY OWNER (if the property is not owned by the applicant)
("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.)
Ong.40 at4vi r Cp7-41 Ven1 t4144/— , as owner of the property on which the
injection well(s) are to be constru d and operated, hereby consent to allow the applicant to construct each
injection well as outlined in this application and agree that it shall be the responsibility of the applicant to ensure
that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC 2C .0200)
Date: ,o3/ 20/6
Signature:
Title:
Revised 8/07
Ala Mot et
Submit TWO copies of the completed application package, including all attachments, to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVED I DENR I DWQ
AQUIFFR•PROTF_CTION SECTION
MAY 14 2010.
UIC-5I/5T Page 7 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
VI. CERTIFICATION
I, Lex 4 in_.<.= ji r. ia.r At(c)M , hereby certify under penalty of law that
I have personally examined anoam familiar with the information submitted in this document and all attachments
thereto and that, based on my inquiry of those individuals immediately responsible for obtaining said information,
I believe that the information is true, accurate and complete. I am aware that there are significant penalties,
including the possibility of fines and imprisonment, for submitting false information. I agree to construct,
operate, maintain, repair, and if applicable, abandon the injection well(s) and all related appurtenances in
accordance with the approved specifications and conditions of the Permit.
Tar Agca'ii O / Lc h i 4TS0
Signature: �c •� rve1 r l A- S. -fi t t �- C )O2 - Date: r ill 23, 20 /
Title: S lur -1)0jr L k MAdlk yRr
If authorized agent is acting on behalf of the applicant, supply a letter signed by the applicant authorizing the
above agent.
VII. CONSENT OF PROPERTY OWNER (if the property is not owned by the applicant)
("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.)
I, tc.av1Pri -b , as owner of the property on which the
injection well(s) are to be constructed And operated, hereby consent to allow the applicant to construct each
injection well as outlined in this application and agree that it shall be the responsibility of the applicant to ensure
that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC 2C .0200)
Signature: -
Title: TrirER-0,1 c.47.1MAN)
Date: 22 I ( O
Submit TWO copies of the completed application package, including all attachments, to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Revised 8/07 UIC-5I/5T Page 7 of 7

TABLE 1
ERD Pilot Test Monitoring Schedule
Southern Laundry and Cleaners
818 Court Street, Jacksonville, Onslow County, North Carolina
DSCA # 67-0002
Well ID
Well Diameter
(inches)
Screened
Interval
(feet)
Baseline Event
Post -Injection Monitoring Samples
(Completed
April 2009)
3k
c
8
1
(Completed 09109)
2
(Completed (11/09)
3
(Completed 12/09)
6
(Completed 01/10)
9
(Scheduled 04/10)
DHC3
IProposed June 2010 Injection #2
12
(Scheduled 07/10)
15
(Scheduled 10/10)
IProposed December 2010 Injection #3
18
(Scheduled 01/11)
24
(Scheduled 07/11)
30
(Scheduled 01/12)
36
(Scheduled 07/12)
VOC
TOC
MNAIDkC
VOC
MNA
DHC
VOC
TOC
MNA
DHC
VOC
TOC
MNA
DHC
VOC
TOC
MNA
DHC
VOC
TOC
MNA
VOC
TOC
MNA
DHC
VOC
TOC
DHC
1
TOC
MNA
DHC
VOC
IOC
MNA
DHC
VOC
TOC
MNA
DHC
VOC
TOC
MNA
DHC
TOC
MNA
VOC
PT-1
1
10-20
1
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
PT-1d
1
25-30
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
i 1
1
1
1
1
1
MW-11
2
5-20
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
i
1
1
1
1
1
1
1
1
1
1
1
1.
1
1
1
1
1
MW-20
2
5-15
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1,
1
1
1
1
1
1
MW-20d
2
. 45-50
1
-
1
1
1
AS-7
2
- 45-50
1
1
1
- 1
11
1
MW-21
2
3-13
1
1
1
1
1
1
1
1
1
1
MW-17
2
5-15
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MW-18
2
5-15
1
1
1
1 July 2009 Ink
1
1
1
1
1
1
1
1
1
1
1
1
1
MW-23
2
3-13
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1,
1
1
1
1
MW-24
2
3-13
1
1
1
1
1
1
1
1
MW-26
1
5-15
1
1
1
1
1
1
MW-2e
1
2-12
1
1
1
1
1
1
1
1
MW-30
2
20-30
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
•
1
1
1
1
1
1
MW-33t
1
11-21
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
W MA l
1
11-21
1
1
1
1
1
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
11
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MW-42
1
11-21
1
1
1
1
1
1
f 1
1
1
1
1
1
1
1
1
r 1
1
1
1
1
1
1
1
1
MW-7
2
5-20
1
1
1
1
1
1
1
1
1
1
1
MW-10r
1
9-19
! 1
1
1
1
1
1
1
1
1
1
1
1
MW-31
2
10-20
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
i
1
1
1
1
1
Groundwater Samples =
9
9
9
4
13
9
8
5, 10
8
8
6
15
10
10
6
17
12
12
16
8
8
5
, 18
8
7
3
18
8
7
3
18
8
7
3
1
18
8
7
3
18
8
7
3
18
8
7
3
Notes:
MW-20d is planned for abandonment due to possible well integrity problems. Well AS-7 will be sampled in its place.
VOC - Volatile Organic Compounds by EPA Method 8260.
TOC = Total Organic Carbon
MNA = Monitored Natural Attenuation Parameters. MNA includes nitrate, total Fe, total Mn, sulfate, dissolved Fe, dissolved Mn, nitrite/nitrate, nitrogen (TKN), carbon dioxide, chloride, ethene, ethane, methane (organic acids and alkalinity were eliminated from sampling program after Month 9).
DHC = Dehalococcooides bacteria and functional genes
.0.1e.„.xs •4s Se, ,eaca,p 010 %(oZ2t_