WI0300516_Notification of Intent (NOI) – GW Remediation_20240227

NC Department of Environmental Quality (DEQ) —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 application to be submitted and an individual permit
be issued 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)
GROUNDWATER(GW)REMEDIATION INJECTION PERMIT TYPES:
(1)IN-SITU GW REMEDIATION PERMIT TYPE (15A NCAC 02C.0225)
• In-Situ 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).
• In-Situ Small-Scale Injection Operations—Injection wells located within a land surface area not to exceed 10,000
square feet(SF)for the purpose of soil or groundwater remediation or tracer tests.If area to be treated exceeds 10,000
SF do not use this NOI; an injection Permit application shall be submitted,and a Permit issued per 15A NCAC
02C.0225(f).
• In-Situ Pilot Tests-Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy 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. Also,if pilot test is going to be conducted on separate groundwater
contaminant plumes do not use this NOI;a Permit application shall be submitted,and a Permit issued as per
15A NCAC 02C.0225(f).
• In-Situ Thermal(IST)—IST wells `heat'contaminated groundwater in-situ to enhance remediation.
(2)AIR INJECTION PERMIT TYPE(15A NCAC 02C.02251
These permit types are used to inject ambient air to enhance treatment of soil or groundwater.
(3)TRACER WELL PERMIT TYPE(15A NCAC 02C.0229)
These permit types are used to inject substances for determining hydrogeologic properties of aquifers.
(4)AQUIFER TEST PERMIT TYPE (15A NCAC 02C.0220)
These permit types are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
DATE: 02/27 ,20 24 NOI TRACKING NO. W 10300516 (To be filled in by DWR)
DIRECTIONS- Submit this NOI only for(1)New deemed `permitted by rule' injection project or(2)If there is going
to be a different permit type(listed above)used for a previously issued NOI.
NOTE-After this NOI is processed and acknowledged,any supplemental or additional injections still meeting the
criteria referenced in Section G below shall be reported using Injection Event Records(IERs)and using the NOI
tracking number provided by DWR.
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
Deemed Permitted GW Remediation NOI Rev.3-1-2023 Page I

B. STATUS OF WELL OWNER: State Government
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
Mailing Address: 217 W Jones Street
City: Raleigh State: NC Zip Code:27603 County:Wake
Day Tele No.: 919-707-8168 Cell No.:
EMAIL Address:[e-mail] Fax No.:
D. PROPERTY OWNER(S)(if different than well owner/applicant)
Name and Title: Mr. Charlie Pearson / Property Owner
Company Name Park Lane Properties
Mailing Address: PO Box 2552
city: Gastonia State: NC Zip Code:28053 County:Gaston
Day Tele No.: [phone] Cell No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT(Typically Environmental Consulting/Engineering Firm)
Name and Title: Mr. Matt Craig / Project Manager
Company Name ESP Associates
Mailing Address: 20484 Chartwell Drive
city: Cornelius State: NC Zip Code:28031 County:Mecklenburg
Day Tele No.: Cell No.: 919-744-1802
EMAIL Address: [e-mail] Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name&Address: Former Pantry #342
2001 New Hope Road
City: Gastonia county:Gaston Zip Code: 28054
(2) Geographic Coordinates: Latitude": "or 35 °.242772
Longitude": "or 81 °.130139
Reference Datum: Accuracy:
Method of Collection:
"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: 4,500 square feet
Land surface area of inj.well network: 700 square feet(< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 15.5 (must be<5%of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev.3-1-2023 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
(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:
Petroleum release at the site from historic UST system. Goal is to reduce VOC
concentrations (Benzene) below its GCL using BOS 200 injection. 14 injection points
governing 700 square feet will be installed using a DPT drill rig. Injectant will be
administered and pre and post injection sampling will determine effectiveness.
J. WELL CONSTRUCTION DATA
(1) No.of injection wells: 14 Proposed Existing(provide NC Well
Construction Record(GW-1)for each well)
(2) Appx. injection depths(BLS): 15-30
(3) For Proposed wells or Existing wells not having GW-Is,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 Proms for more info i1you 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: BOS 200 Total Amt. to be injected(gal)/event: 3,675
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.3-1-2023 Page 3

Total Amt.to be injected(gal/event): 3,675
No.of separate injection events: Total Amt.to be injected(gal): 3,675
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.
Pre and post inection groundwater sampling events will be conducted to determine if
BOS 200 injection was effective at reducing constituent concentration below GCL & 2L.
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 1 SA NCAC 02C 0200 Rules."
Matthew Craig - Project Manager
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
(1 SA 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.
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]
Deemed Permitted GW Remediation NOI Rev.3-1-2023 Page 4

!� w
r
r
_ - - - 80
MW-9
MW-5
STRIP MALL BUILDING
- � I
' NM
p MW-2
O
j
2 ' _
_ — 78
78.10 '
' MW-1
MW-8
• . .,
' NM,
' 77.95
• MW-4
' NM
M W-3
NM
VW-2 MW-6
' MW-7
V NM
W-3
77.51 NM
SOUTH NEW HOPE�RpAD
:NCIDEQ Incident No. 24219 Groundwater elevations are relative and based
Former Pantry #342 - off a benchmark of 100-ft given to MW-1.
2100 South New Hope Road
Gastonia, North Carolina NM - not measured
LEGEND: All locations are approximate. PROJECT NO. 23-00200-074 SHEET TITLE FIGURE 3 ESP Associates,Inc.
SITE BOUNDARY GROUNDWATER ELEVATION MAP
MONITORING WELL N SCALE As Shown NOVEMBER 7,2023 P.O.Box 7030
GROUNDWATER FLOW DIRECTION 0 10 20 W' s Charlotte,NC 28241
GROUNDWATER ELEVATION CONTOUR OFeet S. DRAWN BY WR PROJECT Phone[phone]
FORMER PANTRY#342 ESP
DATE 1113012023 CHECKED BY CW GASTONIA,NORTH CAROLINA www.esl2associates.com

46-A ! �
ND
MW_ ND
w MW-5 -
I NS
MW-2
F�
Z
ND rpW-,'N---00
Af ............ .a ug/L
NS .. i. MW-4
- MW-3 •••'• r '
. •.• rl� NS'
_ '--- •::
t �V W.:6AEMMIL
MW-7 - 1
VW-3
ND NS
SOUTH NEW HOPE —
ROAD
Benzene Comparison Criteria:
2L Standard - 1 ug/L
NCDEQ Incident No. 24219 GCL - 5,000 ug/L
Former Pantry #342
2100 South New Hope Road ND - not detected
Gastonia, North Carolina NS - not sampled
LEGEND: All locations are approximate. PROJECT NO. 23-00200-074 SHEET TITLE FIGURE 5 ESP Associates,Inc.
SITE BOUNDARY BENZENE ISOCONCENTRATION MAP
N SCALE As Shown NOVEMBER 7,2023 P.O.Box 7030
0 20 40 w
MONITORING WELL s Charlotte,NC 28241
Feet s FORMER PANTRY#342 DRAWN BY WR PROJECT #ESP Phone [phone]
ISOCONCENTRATION CONTOUR DATE 1113012023 CHECKED BY CW GASTONIA,NORTH CAROLINA www.esl2associates.com

7111
IL Standards `
n-
r
<2L Standards
A
-I► ND` s �
Benzene 7,770 ugL MW_9 NDC'�
Diisopropy1 ether(IPE) 123 ugL _ MW 5
EthyIbenzene 1,900 ug'L
Isopropylbenzene(cumene) 107 ugL
Methyl Tert-Buhl Ether 0ITBE) 240 ugL NS
Naphthalene 383 ug<L
n-Propylbenzene 221 ugL W 2
�. Toluene 8,380 ugL
1,2,4-TrimethyIbenzene 1,250 ugL
X:-lene (Total) 1 6,810 jug L I r
ND Benzene 1 1.1 Jug L
• MW-1 .,
MW-8 rea A
:.' :; :• DNS ..
MW-4
_L �taudards MW-3 :,�
- NS NS
i VW-2 MW-6
MW-7 VW-3
NS
SOUTH NEW
HOPE�ROAD
NBV,-7
1 = 'NIethyl Tert-Butyl Ether(JITBE) I 105 uQ'L
Only analytes above 2L Standards shown.
Yellow highlighted values are greater than
the GCL.
NCDEQ Incident No. 24219
Former Pantry #342 RL NS - not sampled
2100 South New Hope Road
Gastonia, North Carolina ND - not detected
LEGEND: All locations are approximate. PROJECT NO. 23-00200-074 SHEET TITLE FIGURE 4 ESP Associates,Inc.
SITE BOUNDARY ANALYTICAL RESULTS MAP
N SCALE As Shown NOVEMBER 7,2023 P.O.Box 7030
ie MONITORING WELL F0 201,111 0 W s Charlotte,NC 28241
Feet DRAWN BY ET PROJECT
s I FORMER PANTRY#342 ESP Phone [phone]
DATE 1113012023 CHECKED BY CW GASTONIA,NORTH CAROLINA w,,espassociates.coln

t
O
O O
O O
O O
0 O VVW 1
O O
O
O
NC CGIA, Maxar, Microsoft, Esri Community Maps Contributors,County of Gaston,State of North Carolina DOT,;c OpenStreetMap,Microsoft, Esri,TomTom,
Garmin,SafeGraph,GeoTechnologies,Inc, METI/NASA,USGS, EPA, NPS, US Census Bureau, USDA,USFWS
LEGEND: SHEET TITLE
All I a re pproximate. PROJECT NO. 23-002000-074
FIGURE 1 ESPAssociates,Inc.
Monitoring Well N INJECTION LOCATION MAP
Feet SCALE As Shown P.O.Box 7030
Former UST Basin wy.' / Charlotte,NC 28241
DRAWN BY WR PROJECT
0 Injection Area FORMER PANTRY#342 +ESP Phone [phone]
Site BOUllClary DATE 2/22/2024 CHECKED BY
CW wwwespassociates.coni
GASTONIA, NORTH CAROLINA

C
ROY COOPER
comwor
. IN
ELIZABETH BISER
WRSteftnaC,ge e.nt <Seeretary
ENVIRONMENTAL QUALITY MICHAEL SCOTT
Dlreelor
June 6,2023
Mr. Scott Ryais
Environmental Engineer
DWM UST Section
1637 Mail Service Center
Raleigh,NC 2 7699-163 7
RE: State-Lead Acceptance
Former Pantry#324 I
2100 South New Hope Rd'
Gastonia, Gaston County,NC
Incident Number 24219
Dear Mr. Ryals
I
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 Environmental Quality(Department) or its contractor to enter upon said j
property for the purpose of conducting an assessment and/or remediation of the groundwater and/or soils
under the authority of G.S. 143-215.94G:`
I am/We are granting permission with the understanding that: I
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 in accordance with the acceptance of the site into the 'State-Lead Program. The
Department or its contractor shall protect and prevent damage to the surrounding lands. Any damages
will be restored by the Department or its contractor to as close to the pre-work condition as practicably
possible. j
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 will notify the landowners
48 hours prior to entry and 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.
Nothing Compares%..&-
State of NorthCarolina jEnviromnental Quality I Waste Management
1546 Mail Service 2l 1 W est Jones Street Raleiglt,NC 2 1699-1 646
Center
919'101$200 T

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 landowner.No representations or warranties,either expressed or implied,have been
made to me/by the Department,the State of North Carolina, or its/their contractor(s)regarding-the
results that may be obtained or the quality of work to be performed
I/We agree not to interfere with,remove or any ways damage the Department's well(s)or its
contractor's well(s)and equipment during the investigation.
Sincerely,
f,
Signature
M&yft&1W,-69iceM c� P/ l�L,4ye /Oi20A�ATX 6
Type/Print Name of,Owner or Agent
-70c Y&o 9`cfcyL�-
Phone Number/E-mail Addre s
30 y -v9 ers -
Address
r
Sc 1Q(C-- 2.S03 6
City/State/Zip Code
23
Date
RE: State-Lead Acceptance
Former Pantry 4324
2100 South New Hope Rd
Gastonia,Gaston County,NC
Incident Number 24219
Nothing Compares_
State of North Carolina I Environmental Quality I Waste Management
1646 Mail Service Center 1 217 West Jones Street I Raleigh,NC 27699-1646
919 707 8200 T

DocuSign Envelope ID: E96BA893-2932-4F35-8A7F-B91ACA4E6F90
AGREEMENT expiration or termination date unless specifically provided otherwise
herein, or unless superseded by applicable Federal or State statutes of limitation.
41. AMENDMENTS: This AGREEMENT may be amended only by written amendment duly
executed by the State and the CONTRACTOR.
42. NO WAIVER: Notwithstanding any other language or provision in this AGREEMENT or
in any CONTRACTOR supplied material, nothing herein is intended nor shall be
interpreted as a waiver of any right or remedy otherwise available to the State under
applicable law. The waiver by the State of any right or remedy on any one occasion or
instance shall not constitute or be interpreted as a waiver of that or any other right or
remedy on any other occasion or instance.
43. SOVEREIGN IMMUNITY: Notwithstanding any other term or provision in the
AGREEMENT,nothing herein is intended nor shall be interpreted as waiving any claim or
defense based on the principle of sovereign immunity or other State or federal
constitutional provision or principle that otherwise would be available to the State under
applicable law.
44. This AGREEMENT shall be binding upon the Parties upon execution by the undersigned.
This AGREEMENT shall become effective on the last date of the signatures by the
DEPARTMENT.
The CONTRACTOR and the DEPARTMENT have executed this AGREEMENT on the day and
year last written below.
North Carolina Department of
ESP Associates, Inc. Environmental Quality
(Owner, Partner, or Corp. Pres., or Elizabeth S Biser, Secretary
Vice Pres. Only) (or authorized agent)
Digitally signed by Edward
ea.'®�/��,�_, � G.Horstkamp III DocuSigned by:
�-- Date:2023.01.2712:47:09 -hKAM
By: -05�00� By: I o
Edward G.Horstkamp III
Executive Vice President
2/2/2023
Date: 1/27/2023 Date:
15