WI0300473_Permit (Issuance)_20220407

NC Department of Environmental Quality — Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS (I5A NCAC 02C .0220)
These wells arc used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C ..0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells is located within an area that does not exceed five percent of the land surface
above the known extent of groundwater contamination. An individual permit shall be required to conduct more
than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
5) In -Situ Thermal Wells (IST) — Used to `heat' contaminated groundwater to enhance remediation.
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: January 12 , 20_22 PERMIT NO. (to be filled in
by DWR)
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
Permit No. WI Issued Date:
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well Complete sections B through F, J, M
(2) Aquifer Test Well Complete sections B through F, J, M
(3) Passive Injection System Complete sections B through F, H-M
(4) X Small -Scale Injection Operation Complete sections B through M
(5) Pilot Test Complete sections B through M
(6) Tracer Injection Well Complete sections B through M
(7) In -Situ Thermal (IST) Well Complete sections B through M
B. STATUS OF WELL OWNER: Business/Organization
Deemed Permitted GW Remediation NOI Rev. 2-17-2020
rage,

C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): Burke Oil Company, Mr. Gerald Baker - President
Mailing Address: PO Box 128
City: Valdese
State: NC Zip Code: 28690 County: Burke
Day Tele No.: 828-397-3421 Cell No.:
EMAIL Address:JerryAburkeincnc.com Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Richard & Susan Armstrong - Owners
Company Name
Mailing Address: 2227 1st Ave SW
City: Hickory State: NC Zip Code: 28602 County: Catawba
Day Tele No.. 828-381-3121
Cell No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Sara Rose, Project Manager
Company Name Alpha Environmental
Mailing Address: PO Box 2155
City: Asheville
State: NC Zip Code: 28802 County: Buncombe
Day Tele No.: 282-398-2040 Cell No.: 828-773-0798
EMAIL Address: srose(c�alphaenviron.com Fax No.: 828-398-2041
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Incident name: Rick's 999 Service Station (Incident #13257), property is
currently leased to Cash & Go Cars, LLC Address:436 1st Ave SW
City: Hickory County: Catawba Zip Code: 28602.
(2) Geographic Coordinates: Latitude**:
Longitude**: -_
Reference Datum:
Method of Collection:
0
0
" or
" or
Accuracy:
0
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**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: 3,000
exists on subject site ONLY)
Land surface area of inj. well network: 1,200 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 50-70% (must be < 5% of plume for pilot test injections)
square feet (including square footage of plume that
Deemed Permitted GW Remediation NO1 Rev. 2-17-2020

H. INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
The source of the release was from 3 3,000 gallon gasoline USTs, removed in 1994. Redox Tech has been
contracted to perform the injection activities. Redox Tech proposes to inject Oxygen BioChem (OBC) through
direct push in seven locations at 5 separate depth intervals into the groundwater. At each location, approximately
500 lbs of OBC in 250 gallons of slurry injectate will be injected, for a total of 3,500 lbs in 1,750 gallons. The
goal is reduce groundwater contamination levels to below gross contamination levels in the areas of monitoring
wells MW-4R and MW-7R.
J. WELL CONSTRUCTION DATA
(1)
(2)
(3)
No. of injection wells: 7
Proposed Existing (provide NC Well
Construction Record (GW-1) for each well)
Appx. injection depths (BLS): 35'-33', 33'-31', 31'-29', 29'-27', 27'-25'
For Proposed wells or Existing wells not having GW-1s, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
K. 1NJECTION SUMMARY
NOTE: Only injectants approved by the epidemiology section of the NC Division of Public Health, Department
of Health and Human Services can be injected. Approved injectants can be found online at
http://deq. nc.goviabout/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-injectants. All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it may take 3 months or longer. If no injectants are to be used use N/A.
Injectant: Oxygen Biochem (OBC) Total Amt. to be injected (gal)/event: 3,500 lbs of OBC in 1,750
gallons slurry iniectate
Deemed Permitted GW Remediation NOI Rev. 2-17-2020
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Injectant: Total Amt. to be injected (gal)/event:
Total Amt. to be injected (gal/event):
No. of separate injection events: 1 Total Amt. to be injected (gal): 3,500 lbs of OBC in 1,750 gallons
slurry injectate
Source of Water (if applicable): water source located on subject property
L. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
Groundwater monitoring will be conducted quarterly for the year following the injection activities. There are 8
monitoring wells that will be sampled. These wells are located in the area of injection, upgradient of the area of
injection and downgradient of the area of injection. Groundwater in these wells is analyzed for VOA
alkalinity, ferrous iron, nitrogen and phosphorus.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility oj'fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
Signature of Applicant
Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to he constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(I 5A NCAC 02C .0200)."
"Owner" means any person who holds
is real propert and its constructio
absence o ontra ement i
/�
e fee or other property rights in the well being constructed. A well
on land shall be deemed to vest i a rship in the land owner, in the
riting.
Si • . ture of Property Owner (if differ t om applicant) ' / Print or Type Full Nam : n Title
*An ' ccess agreement between the appl ant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NO1 Rev. 2-17-2020
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