WI0501118_Application_20230816

3�TC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
July 25, 2023
Mr. Tyler Clark
Raleigh Regional Office
North Carolina Department of Environmental Quality
Water Quality Regional Operations Section
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
Reference: Notice of Intent to Construct or Operate Injection Wells
Former K&L Grocery
2281 Beaverdam Road
Enfield, Halifax County, North Carolina
NCDEQ Incident No. 3880
Dear Mr. Clark:
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 one existing air injection well at the K&L Grocery site
located at 2281 Beaverdam Road in Enfield, North Carolina.
If you have questions or require additional information, please contact our office at (919) 871-
0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Nicholas Kramer
Project Scientist
Direct Line: 919-573-1198
Email: Nicholas. Kramer(a)oneatlas.com
Attachments
Gabriel Araos, P. E.
Program Manager
Direct Line: 919-573-1205
Email: Gabe.Araos(ab-oneatlas.com

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 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 .02251 or TRACER WELLS (15A NCAC 02C .02291:
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 25, 2023 PERMIT NO.
A.
B.
C.
WELL TYPE TO BE CONSTRUCTED OR OPERATED
(to be filled in by DWR)
(1)
X 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)
Small -Scale Injection Operation ......................Complete
sections B-N
(5)
Pilot Test.................................................Complete
sections B-N
(6)
Tracer Injection Well...................................Complete sections B-N
STATUS OF WELL OWNER: Business/Organization
WELL OWNER — State name of entity and name 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.: 919-522-7955 Cell No.: Not Available
EMAIL Address: linda.blalockAdeq.nc.gov Fax No.:
UIC/In Situ Remed. Notification (Revised 3/2/2015) Page 1

D. PROPERTY OWNER (if different than well owner)
Name: Holley Keeter White
Mailing Address: 110 Line Boat Lane
City: Swansboro State: NC Zip Code:28584 County: Halifax
Day Tele No.: —
EMAIL Address
910-545-3083
Not Available
Cell No.: Not Available
Fax No.: Not Available
E. PROJECT CONTACT - Person who can answer technical questions about the proposed injection project.
Name: Nicholas Kramer — 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.: 919-573-1198 Cell No.: 919-820-7051
EMAIL Address: nicholas.kramer(koneatlas.com Fax No.: 919-871-0335
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: 2281 Beaverdam Road County: Halifax
City: Enfield State: NC Zip Code: 27823
(2) Geographic Coordinates: Latitude": 0 ffor 36.23491 N
Longitude": 0' �" or 77.69996 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 ftz for small-scale injections)
Percent of contaminant plume area to be treated: (must be < 5% of plume for pilot test injections)
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.
UIC/In Situ Remed. Notification (Revised 3/2/2015) Page 2

I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
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
http://portal.ncdenr.or /wed/apL 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:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Injectant:
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: 1 Proposed Existing
(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
UIC/In Situ Remed. Notification (Revised 3/2/2015) Page 3

L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
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.
N. SIGNATURE OF APPLICANT AND PROPERTY 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 Nicholas Kramer, on behalf of NCDEQ
Signature of Applicant Print or Type Full Name
PROPERTY OWNER (if the property is not owned by the permit applicant):
"As owner of the property on which the injection wells) 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 wells) conform to the Well Construction Standards
(15A NCAC 02C C. 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 access agreement Holley Keeter White
Signature* of Property Owner (if different from applicant) Print or Type Full Name
* An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
UIC/In Situ Remed. Notification (Revised 3/2/2015) Page 4

No
atnent of Environment and Natural
NCDENR
���verly Eaves Perdue; Governor
Dee Freeman, Secretary
Ms. Candy E Elliott
DWM UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
Dear Ms. Elliott:
RE: Site Access Agreement
K&L Grocery, Incident # 3880
Enfield, Halifax County, North Carolina
Division of Waste Management
Dexter R. Matthews, Director
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and hereby
permit the Department of Environment and Natural Resources (Department) or its contractor to enter upon said
property for the purpose of conducting an investigation of the groundwaters under the authority of G.S. 143-
215.3(a)2.
I am/We are granting permission with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access 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 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 Departments 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.

K&L GROCERY #3880
7. 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
landowner.
I/We agree not to interfere with, remove, or any way damage the Department's well(s) or its contractor's
well(s) and equipment during the investigation.
Sincerely,
Signature
ype/Print Name of Owner or Agent
10 �-iY C Toe�,� L �c
Address
Address
City/State/Zip Code
e S g S- 3o(� 3
Phone Number
)I .) i
Date

13
LEGEND
= MONITORING WELL (TYPE II)
® - WATER SUPPLY WELL
MW-4
CONCRETE
GREENE RESIDENCE
GRASS
MW-5
TILLED FIELD
/ w I
WSW1
PROP�R�
Mw— 7 /
\
\
GRASS/EARTH
W \
FORMER
550 GALLON
GASOLINE USTs
-27 FC
K&L
MW2 \
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13
MW4
(NM)
CONCRETE
GREENE RESIDENCE
GRASS
MW-2
(NM)
LEGEND
= MONITORING WELL (TYPE II)
WATER SUPPLY WELL
(70.41) GROUNDWATER ELEVATION IN FEET
NM — NOT MEASURED
= GROUNDWATER ELEVATION CONTOUR LINE (DASHED WHERE APPROXIMATE)
DO- = GROUNDWATER FLOW DIRECTION
MW5
(NM)
TILLED FIELD
1
g0
�No WSW- 1
PgR/�
M V}/ 7
(NM)
/ BAR)
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GRASS/EARTH
\ Mw- 1
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(117.76
FORMER
5.50 (-,AIION
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FORM
K&L O Y
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/4 w
NM) O
\MW 8 �
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(NM) APPROXIMATE SCALE IN FE
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13
LEGEND
MW-4
(NS)
CONCRETE
GREENE RESIDENCE
GRASS
MW-5
(NS)
TILLED FIELD
WSW— I
MW— 7
(NS) FORMER
/ BARFIELD RESIDENCi
(DI LAPI DATED)
O _
GRASS/EA TI
Mw 1
o o i (9,130)1 1 1
� � III I
EORME4 0 /
� \ 550 GALLON
GASOLINE
1 /
(NS) O(911
= MONITORING WELL (TYPE II)
WATER SUPPLY WELL
pio) = DISSOLVED BENZENE CONCENTRATION IN ug/L
(NS) NOT SAMPLED
DISSOLVED BENZENE CONCENTRATION CONTOUR (DASHED WHERE APPROXIMATE)
MW 9
(NS)
(2,402)
1 MW-8
WOODED
MW5 ` 45 0 45
APPROXIMATE SCALE IN FEET
0
0
00
cc
0
U
J
0
U
0
w
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13
LEGEND
MW-4
(NS)
CONCRETE
GREENE RESIDENCE
= MONITORING WELL (TYPE II)
WATER SUPPLY WELL
Mio) = DISSOLVED 1,2DICHLOROETHANE CONCENTRATION IN ug/L
(NS) NOT SAMPLED
DISSOLVED 1,2—DICHLOROETHANE CONCENTRATION CONTOUR
GRASS
MW-5
(NS)
TILLED FIELD
�NOPM
WSW-1
ERM go /
MW- 7
I
(NS) nRESIDENCE
/
/ I
(\ I
GRASS/EARTH
/MW)I
o• / 1(1,64511
I I
FORMER
550 GALLON
\ GASOLINE USTf I / v
M — \ )W19
(NS) 0�/ M
I\ \ / (203)
1 MW -8 / ��
/ / WOODED
T
MW5 45 0 45
(NS) APPROXIMATE SCALE IN FEET
(DASHED WHERE APPROXIMATE)
WOODED
0
0
00
cc
0
U
J
v
LLJ
QD

MW-4
(NS)
CONCRETE
GREENE RESIDENCE
WELL ID
MW-6R
Date Collected
6/14/2021
Total Xylenes
1,686
1,2,4-Trimethylbenzene
441
GRASS
MW-5
(NS)
TILLED FIELD
WSW-1
MW— 7
(NS)
O
GRASS/EARTH
O \
O
FORMER
550 GALLON
GASOLINE USTs
O
Ec
K&L
MW2 O \
(NS)
o O MW 6R\\'
WELLED
MW-8
Date Collected
6/ 14/2021
No additional compounds exceeded 2L
romrAiMiffilrai
= MONITORING WELL (TYPE II)
WATER SUPPLY WELL
(NS) NOT SAMPLED
o L
MW-9
_a (N:
MW-8
MW.3
(NS)
W-1
1/2021
,600
420
,390
23
117
�10
1.51
0
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L1
■C!
L2
PERMANENT AIR SPRAGE WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP / PROTECTIVE CASING AND CONCRETE PAD
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
15 feet
BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 10 feet
SEAL
TYPE OF SEAL bentonite
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 20 feet
DEPTH TO BOTTOM OF
BOREHOLE 20 feet
L1 = 0 FT.
L2 = 15 FT. DIAMETER OF BOREHOLE 6 inches
L3 = 5 FT.
L4 = 20 FT. DRILLING SUBCONTRACTOR: Geologic Exploration
DRILLER ADDRESS: 176 Commerce Blvd, Statesville, NC 28625
DRILLER CERTIFICATION #: 4475
TITLE Well Information AAIT
AS-1 WAk C
Former K&L Grocery
2281 Beaverdam Road 2725 East Millbrook Road, Suite 121
Enfield, North Carolina Raleigh, North Carolina 27604
FILE PREP. BY REV. BY DATE
N K GA 7/25/2023