Polk UIC Deemed Permitted 2012

Central Files: APS SWP
07/15/13
Permit Number W10100255 Permit Tracking Slip
Program Category Status Project Type
Deemed Ground Water Active New Project
Permit Type Version Permit Classification
Injection Deemed In-situ Groundwater Remediation Well 1.00 Individual
Primary Reviewer Permit Contact Affiliation
eric.g.smith Jason Soban
Coastal SW Rule 2923 S Tryon St
Charlotte NC 28203
Permitted Flow
Facility
Facility Name Major/Minor Region
Brock's Cleaners, Inc. Minor Asheville
Location Address County
46 Maple St Polk
Tryon NC 28782 Facility Contact Affiliation
Owner
Owner Name Owner Type
Petitioner for Dsca Site#75-0001 Non-Government
Owner Affiliation
Christie Zawtocki
Manager Project
2923 S Tryon St Ste 100
Dates/Events Charlotte NC 282036449
Scheduled i
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
07/15/13 07/11/13 07/15/13 07/15/13
Regulated Activities
Groundwater remediation.
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

hart hockman
SMARTER ENVIRONMENTAL SOLUTIONS
Via Federal Express
July 9,2013
North Carolina Department of Environment and Natural Resources
Underground Injection Control Program
Division of Water Quality-Aquifer Protection Section
1636 Mail Service Center
Raleigh,North Carolina 27699-1636
Attention: Mr.Thomas Slusser
Re: Notification of Intent to Construct or Operate Injection Wells
DSCA ID No. 75-0001,Brock's Cleaners
Tryon,North Carolina
H&H Job No.DSO-69C
Dear Thomas
On behalf of the North Carolina Department of Environment and Natural Resources Dry-
Cleaning Solvent Cleanups Act (DSCA) Program, please find enclosed one copy of the
Notification of Intent to Construct or Operate Injection Wells. The project involves emulsified
vegetable oil to remediate impacted groundwater at the DSCA Program Site 75-0001, Brock's
Cleaners, located at 46 Maple Street, Tryon, Polk County, North Carolina. The project has not
been scheduled at this time.
If you have any questions or need additional information,please contact us at(704)586-0007.
Sincerely,
Hart A Hickman,PC
Christie Zawtocki,PE Jason Soban,PG
Project Manager Project Geologist RECE1VEDIDEN
Enclosure �®�Q
JUL 112013
cc: Billy Meyer,NCDENR DSCA Program Aquifer Protection Seft
2923 South Tryon Street,Suite 100 3334 Hillsborough Street
Charlotte,NC 28203 Raleigh,NC 27607 www.harthicknian.com
704.586.0007 main 919.847.4241 main

s
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 individual permit when constructed in accordance
with the rules of 15A NCAC 02C.0200. This form shall be submitted at least 2 weeks prior to construction.
AQUIFER TEST WELLS(15A NCAC 02C.0227)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU RE,MEDIATION(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.
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 are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE:July 9,2013 PERMIT NO. to be filled in by DWQ)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well.......................................Complete sections B-F,K,N
(2) Aquifer Test Well.......................................Complete sections B-F,K,N
(3) Passive Injection System...............................Complete sections B-F,H-N
(4) X Small-Scale Injection Operation......................Complete sections B-N ®��
(5) Pilot Test.................................................Complete sections B-N RECEIVE®IDENRI
(6) Tracer Injection Well...................................Complete sections B-N JUL 11 2013
B. STATUS OF WELL OWNER: Choose an item. Agd9erProteeti0nSemil
C. WELL OWNER — State name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Name: Brock's Cleaners,Inc. (Petitioner for DSCA Site#75-0001)
Contact:Jason Soban,Agent for Petitioner
Mailing Address:DSCA Program,Mail Service Center 1646
City: Raleigh State: NC Zip Code:27699-1646 County:Wake
Day Tele No.: 704-586-0007 Cell No.: 704-816-0458
EMAIL Address: [e-mail] Fax No.: 704-586-0373
DWQ/UIC/1n SUu Reined.Notification(Revised 7/9/2012) Page 1

D. PROPERTY OWNER(if different than well owner)
Name: Town of Tryon
Mailing Address:301 North Trade Street
City: Tryon State:NC Zip Code:28782 County:Polk
Day Tele No.: 828-859-6655 Cell No.: Not Available
EMAIL Address:Not Available Fax No.: Not Available
E. PROJECT CONTACT-Person who can answer technical questions about the proposed injection project.
Name: Hart&Hickman.PC,Jason Soban
Mailing Address:2923 S.Tryon St. Suite 100
City: Charlotte State:NC Zip Code:28203 County: Mecklenburg
Day Tele No.: 704-586-0007 Cell No.:704-816-0458
EMAIL Address: [e-mail] Fax No.:704-586-0373
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: Palmer Street Right-of-Way just east of Maple Street
County: Polk
City:Tryon State:NC Zip Code:28782
(2) Geographic Coordinates: Latitude": "or N 36°12' 34.52"
Longitude": 0 Xor W 82° 14' 17.58"
Reference Datum:WGS 84 geodetic datum
Accuracy:Unknown
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: approx 160,000 square feet
Land surface area of inj.well network:approx 1,800 square feet`,10,000 ft2 for small-scale injections)
(The injection well network includes three injections wells that are spaced 20 ft apart.)
Percent of contaminant plume area to be treated:approx 0.02(must be<5%of plume for pilot test injections)
DWQ/UIC/bi Situ Remed.Notification(Revised 7/9/2012) Page 2

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
Attachments 1A through 1D
Attachment'1 A: Site Map
Attachment 113:Shallow Groundwater PCE Isoconcentration Map—October 2012
Attachment 1C:Deep Groundwater PCE Isoconcentration Map—October 2012
Attachment 1D:Injection and Monitoring Well Locations and Deep Groundwater PCE
Isoconcentration Map—October 2012
(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.
Attachments 2A through 2B
Attachment 2A: Site Map and Cross-Section Location Map
Attachment 2B:Cross-Section A-A'
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose,scope,and goals of the proposed injection activity.
The Qroposed project is for a small-scale injection of SRS®-FR large droplet emulsified vegetable oil (EVO)
substrate targeting_an area of chlorinated volatile organic compounds (CVOCs) in fractured bedrock
groundwater that currently has the highest COVC concentrations in the plume associated with the site. The
proiect will include injection of approximately 1,100 gallons of 9.7% by weight SRS®-FR solution. The
solution will be mixed on-site using approximately 110 gallons of SRS®-FR and 990 gallons of water from a
municipal source The ratio of SRS-FR to water may be modified in the field depending on iniection
Conditions. The solution will be injected through three permanent bedrock infection wells spaced
approximately 20 ft apart and targeting 30 to 40 ft below ground surface depth interval (refer to attached
mgRs) -.The SRS®-FR will be injected-into the bedrock-groundwater to generate reducing conditions and
provide the necessary carbon and hydrogen to support biodegradation of CVOCs. The intended result of the
injection is to promote reductive dechlorination of CVOCs, thereby resulting in a significant decrease of
CVOC concentrations in the area targeted by the injection.
MQ/UIC/In Situ Remed.Notification(Revised 7/912012) Page 3

J. INJECTANTS—Provide a MSDS and the following for each injectant.Attach additional sheets if necessary.
NOTE: Approved injectants (tracers and remediation additives) can be found online at
httn://portal.ncdenr.orF/web/wq/aps/Mpro. All other substances must be reviewed'by the Division of Public
Health, Department of Health and Human Services. Contact the UIC Program for more info(919-807-6496).
Injectant: SRS®-FR(MSDS included as Attachment 3)
Volume of injectant: Approx. 110 gallons of 60%by wt SRS®-FR
Concentration at point of injection: 9.7%=approximately 97 kyrams/liter
Percent if in a mixture with other injectants:
Inj ectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: 3 existing bedrock wells
(2) 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:
(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
**A Well Construction Table is included as Attachment 4**
L. SCIIEDULE,S—Briefly describe the schedule for well construction and injection activities.
The injection will be performed utilizing bedrock injection wells BR-IW-1, BR-IW-2, and BR-IW-3. It is
anticipated that the project will be performed by injecting into one well at a time using a pump and an injection
manifold. Approximately 366 gallons of 9.7%by weight SRS-FP,will be infected into each bedrock injection
well at a rate of approximately 1 to 10 gallons per minute. Based on this injection rate and the time required to
infect the total volume,it is anticipated that the injection activities will be completed in two days.
DWQMC/!n Situ Reined.Notification(Revised 7/9/2012) Page 4

M. MONITORING PLAN—Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L.result from the injection activity.
Groundwater monitoring_will include a baseline pre-injection event and one year of quarterly groundwater
sampling post-injection. During each event, groundwater samples will be collected from MW-4I, MW-10I,
and MW-151 for VOCs, methane, ethane, ethene, ferrous iron, chloride, total organic carbon, and metabolic
acids. Monitoring well MW-4I will also be analyzed for dehalorespiring bacteria (DHB and DHC with
functional genes). Field parameters of dissolved-oxygen, pH, oxygen-reduction potential, and conductivity
will also be collected from each well during sampling. It is anticipated that monitoring wells MW-4I,MW-10I
and MW-151 will continue to be monitored lou-term as part of routine monitoring conducted at the site.
N. CERTIFICATION(to be signed as required below or by that person's authorized agent)
15A NCAC 02C.0211(e)requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general.partner or the proprietor,respectively;
3. for a municipality or a state,federal,or other public agency: by either a principal executive officer or
ranking publicly elected official;
4. for all others: by the well owner;
5. for any other person authorized to act on behalf of the applicant: documentation shall be submitted
with the notification that clearly identifies the person, grants them signature authority, and is signed
and dated by the applicant.
"I hereby certify, under penalty of law, that 1 have personally examined 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, 1 believe that the information is true, accurate and
complete. 1 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."
Signature of Applicant Print or Type Full Name
**H&H DSCA Contract included in Attachment 5**
Property Access Agreement included as Attachment 5
Signature of Property Owner(if different from applicant) Print or Type Full Name
'Jason Soban(Agent for Petitioner for DSCA Site#754001)
Signature of Authorized Agent,if any Print or Type Full Name
Submit one copy of the completed notification package to:
DWQ-Aquifer Protection Section RECEIVEDIDENDWO
1636 Mail Service Center
Raleigh,NC 27699-1636 JUL 112013
Telephone: [phone] Fax:[phone]
Aquifer Protection Section
DWQ/UIC/In Situ Remed.Notification(Revised 7/9/2012) Page 5

Attachment IA through 1D
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

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Attachment 2A through 2B
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

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ASSESSMENT REPORT. S6URIEB BIVRONMDifALSOIIRI0N9 TJc #C-I269/NC-245GmImy
2. PCECONCENTRATION REPRESENT OCTOBER2012 DATE 6-14-13 REVISION NO. 0
p DATA
}2{$ JOB NO. DSO-069 ATTACHMENT N0. 11