WI0501092_Application_20220516

2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598

May 16, 2022

Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636

Reference: Notice of Intent to Construct or Operate Injection Wells
Peggy’s Quick Mart
5403 Flower Hill Road
Kenly, Johnston County, North Carolina
NCDEQ Incident #24277

Dear Ms. Shrestha:

ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of NCDEQ State Lead Program. The permit
application covers injection of air through two proposed air injection wells at the Peggy’s Quick
Mart located 5403 Flower Hill Road in Kenly, North Carolina.

If you have questions or require additional information, please contact our office at [phone].

Sincerely,
ATC Associates of North Carolina, P.C.

Brian Buchanan Ashley M. Winkelman, P.G.
Project Scientist Senior Project Manager
Direct Line: 919-573-1203 Direct Line: 919-573-1206
Email: [e-mail] Email: [e-mail]

Attachments
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 1
NC Department of Environmental Quality – Division of Water Resources (DWR)

Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.

DATE: May 16, 2022 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) X 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) 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

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 (15A NCAC 02C .0220)
These wells are 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.

Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 2

C. WELL OWNER(S) – State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): NCDEQ – State Lead Program
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699 County: Wake
Day Tele No.: 919-707-8167 Cell No.: Not Available
EMAIL Address: [e-mail] Fax No.: Not Available
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Albert and Margie Crawford
Company Name
Mailing Address: 11185 NC Highway 42 East
City: Middlesex State: _NC_ Zip Code: 27557 County: Nash
Day Tele No.: 919-284-3443 Cell No.: Not available
EMAIL Address: Not available Fax No.: Not available
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Brian Buchanan, Project Scientist
Company Name ATC Associates of North Carolina, P.C.
Mailing Address: 2725 E. Millbrook Road, Suite 121
City: Raleigh State: _NC_ Zip Code: 27604 County: Wake
Day Tele No.: 919-573-1203 Cell No.: 704-517-9236
EMAIL Address: [e-mail] Fax No.: 737-207-8261
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Peggy’s Quick Mart
5403 Flower Hill Road
City: Kenly County: Johnston Zip Code: 27542
(2) Geographic Coordinates: Latitude**: o ′ ″ or o. 35°40'41.95"N
Longitude**: o ′ ″ or o. 78°10'10.26"W
Reference Datum: WGS84 Accuracy: Not Available
Method of Collection: Google Earth
**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: square feet
Land surface area of inj. well network: square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be < 5% of plume for pilot test injections)

Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 3

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.

I. 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:

J. WELL CONSTRUCTION DATA

(1) No. of injection wells: 3 Proposed 0 Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS):________30 feet____________________________________________
(3) 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. INJECTION 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.gov/about/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: Total Amt. to be injected (gal)/event:

Injectant: Total Amt. to be injected (gal)/event:

Injectant: Total Amt. to be injected (gal)/event:

Injectant: Total Amt. to be injected (gal)/event:

Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 4
Injectant: Total Amt. to be injected (gal)/event:

Total Amt. to be injected (gal/event):

No. of separate injection events: Total Amt. to be injected (gal):

Source of Water (if applicable):

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.

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 of 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.”

, on behalf of NCDEQ Brian Buchanan, on behalf of NCDEQ
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 be 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
(15A NCAC 02C .0200).”

“Owner” means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.

See Attached Agreement Margie Crawford
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.

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]
Ashley Winkelman
From. Osman, Hassan <[e-mail]>
Sent: Monday December 21, 2020 10:08 AM
To: Ashley Winkelman
Subject: [EXTERNAL] Langley Tire Service # 13623
(External Email] This email originated from outside of the Atlas mail system. Please use caution when
'.opening attachments.
Hi Ashley:
Thanks
Hassan
ATC Associates is granted/approved a permission to act as an agent for NCDEQ to sign a notification for UIC.
Hassan Osman
Hydrogeologist, UST
North Carolina Department of Environmental Quality
919.707,8167 (Office)
I assan.Osnzan(ncdenr,gov

DENR
DIVISION OF WASTE MANAGEMNT
UST SECTION
1637 MAIL SERVICE CENTER
RALEIGH, NC 27699-1637\
ATTN: Hassan Osman, Hydrogeologist
RE: Agreement for the Use of Property for A Groundwater Investigation at the
incident known Peggy's Quik Mart, 5403 Flower Hill Road, kenly, Johnston
County, North Carolina (Incident Number: 24277)
Dear Mr. Osman:
I am/We are the Owner(s)/Agent(s) of a parcel of property, located at or the incident in
question, and hereby permit the Department of Environment and Natural Resources
(Department) or its contractor(s) to enter upon said property for the purpose of
conducting an investigation of the groundwater under the authority of G. S. 143-
215.3(a)2.
I am/We are granting permission with the understanding that:
1. The investigation will be conducted by the UST Section of the Department's Division
of Waste Management or its contractor(s). The investigation may include soil and
groundwater sampling, borehole drilling, and monitoring well installation.
Monitoring well(s) will be installed on the release site.
2. The cost of site investigation, any construction and maintenance of the site shall
be borne by the Department or its contractor. The Department or its
contractor shall protect and prevent damage to the surrounding lands.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site
by the shortest feasible route to the nearest public road. The Department or its
contractor may enter upon the land at reasonable times and have full right of access
during the period of the assessment investigation.
4. Any claims which may arise against the Department or its contractor shall be governed
by Article 31 of Chapter 143 of the North Carolina General Statutes. Tort Claims
Against State Department and Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner
upon request and is a public record in accordance with G. S. 132-1.

Address
Site Access Agreement (FT# 24277 continued)
Page 2 of 2
6. The activities to be carried out by the Department or its contractor are for the primary
benefit of the Department and of the State of North Carolina. Any benefits accruing
to the owner are incidental. The Department or its contractor is not and shall not be
construed to be an agent, employee, or contractor of the land owner.
I/We agree not to interfere with, remove, or any way damage the Department's well(s)
or its contractor's well(s), or equipment during the on -going investigation.
Sincerely,
l-%
Signati d e / Date
Signature
Atl rs . .c I'G Lc}fn r1
Type/Print Nafge of Owner or Agent
Date Type/Print Name of Owner or Agent
1t1775 NC 4a. Casir MJ\[ 7557
City/State/Zip Code
Address City/State/Zip Code
91? - DWI - -3Ll43
Telephone No. (Home) Telephone No. (Work)

PERMANENT AIR SPRAGE WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP PROTECTIVE CASING AND CONCRETE PAD
L1 CASING MATERIAL steel
CASING DIAMETER 8 inches
CASING LENGTH 12 inches
PAD DIMENSIONS 2 feet x 2 feet
HEIGHT ABOVE GROUND flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 25 feet
L2 BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 20 feet
SEAL
TYPE OF SEAL bentonite
L4 THICKNESS 3 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
TOTAL FILTER PACK FOOTAGE 7 feet
WELL SCREEN
L3 SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 5 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
WELL 30 feet
DEPTH TO BOTTOM OF
BOREHOLE 30 feet
L1 =0 FT.
L2 =25 FT.DIAMETER OF BOREHOLE 6 inches
L3 =5 FT.
L4 =30 FT.DRILLING SUBCONTRACTOR: Geologic Exploration
DRILLER ADDRESS: 176 Commerce Blvd, Statesville, NC 28625
DRILLER CERTIFICATION #: 4475
TITLE Well Information
AS-1, AS-2, and AS-3
Peggy's Quick Mart
5403 Flower Hill Road 2725 East Millbrook Road, Suite 121
Kenly, North Carolina Raleigh, North Carolina 27604
FILE PREP. BY REV. BY DATE
BB AW 5/16/2022
= Proposed AS well locationCAD FILE
PREP. BYTYPE CODE REV. BY SCALE PROJECT NO.
TITLE
DATE
NOTES:
GEOTECHNICAL
ENVIRONMENTAL
MATERIALS TESTINGBUILDING SCIENCES
2725 E. Millbrook Road, Suite 121
[phone] FAX [phone]
Raleigh, North Carolina 27604AS-1AS-2AS-3
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
FIGURE 3
POTENTIAL RECEPTOR SURVEY MAP
PROJECT NO: SLC2427701
REVIEWED BY: AW SCALE: 1” = 330’DATE: 03/2021
PEGGY’S QUICK MART–INCIDENT #24277
5403 FLOWER HILL ROAD
KENLY, NORTH CAROLINA
Source: Johnston County NC GIS
500 Foot Radius
1,000 Foot Radius
Well IdentificationWSW-3
Notes:
1. Only water supply wells located within 1,000 feet of the site
are shown on the figure.
2. Although tenant at WSW-1 indicates well is used for non-potable purposes, ATC is
identifying the well as potable since it is not connected to a municipal water supply.
Potable Water Supply Well
Inactive Water Supply Well
Irrigation Water Supply Well
Water Supply Well with Unknown Use –Property Connected to Municipal Water
Water Supply Well with Unknown Use –Property Not Connected to Municipal Water
WSW -1
WSW -2A
WSW -2
WSW-1A
WSW-4
WSW-5
WSW-9
WSW-10
WSW -11
WSW-13
WSW-14
WSW-15
WSW-16
WSW-18
WSW -20
N
Site
WSW -19
WSW-7
WSW-3
WSW -6
WSW-8
WSW-3A
WSW-12
WSW-17
WSW-21
WSW-22
WSW -23
CAD FILE PREP. BYTYPE CODE REV. BY SCALE PROJECT NO.
TITLE
DATE
NOTES:
GEOTECHNICALENVIRONMENTAL
MATERIALS TESTINGBUILDING SCIENCES
2725 E. Millbrook Road, Suite 121
[phone] FAX [phone]
Raleigh, North Carolina 27604
CAD FILE
PREP. BYTYPE CODE REV. BY SCALE PROJECT NO.
TITLE
DATE
NOTES:
GEOTECHNICAL
ENVIRONMENTAL
MATERIALS TESTINGBUILDING SCIENCES
2725 E. Millbrook Road, Suite 121
[phone] FAX [phone]
Raleigh, North Carolina 27604 = Proposed AS well locationAS-1AS-2AS-3