WI0300529_Notification of Intent (NOI) – GW Remediation_20240812

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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 Indiv}dual permit
be Issued when constructed in accordance with the rides of 15A NCAC 02C.0200(NOTE: This form must be
received at least 14 DAYS prior to infection)
GROUNDWATER(GW)REMEDIATION INJECTION PERMIT TYPES:
(1)IN-SITU GW REMEDIATION PERMIT TYPE(ESA 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
Sr 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.0225)
These permit types are used to inject ambient air to enhance treatment of soil or groundwater.
(3)TRACER WELL PERMIT TYPE(I,5A 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: August 21 ,2024 NOI TRACKING NO. (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.06-20-2024 Page I

r
Rogers, Michael
From: D'Souza, Flora <fdsouza@withersravenel,com>
Sent: Wednesday,August 21, 2024 2:05 PM
To: Rogers, Michael
Cc: Butcher, Blake L
Subject: [External] FW: NOI request for injection at Downtown 66 site
Attachments: AS-1912_22636_P_UIC 20240821.pdf
CAUTION: External email.Do not click links or open attachments unless verified.Report susplcious emails with the Report Message
button located on your outlook menu bar on the Home tab.
Michael,
I received the out of office response from Blake. Please let me know if you have any questions or need anything
else for this NOI.
Thank you,
Flora
From: D'Souza, Flora
Sent: Wednesday,August 21, 20241:58 PM
To: Butcher, Blake L<blake,[e-mail]>
Subject: NOI request for injection at Downtown 66 site
Blake,
Attached is the NOI for injection of BOS 200 at the Downtown 66 site located in Shelby, NC.This work is scheduled
for August 29th. Please let me know if you have any questions or need any additional information.
Thank you,
110 Flora D'Souza, CHMM
ENVIRONMENTAL PRUJECI SCIENTIST II I
t:919,469,3340 d,704,517,3035 Charlotte,NC WITHERSRAVENEt.COM
1

B. STATUS OF WELL OWNER: Choose an item.
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): NCDE -DWM UST Section Federal&State Lead Program,Attn:Thomas Cha man
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699-1646 County:Wake
Day Tele No.: 910-796-7406 Cell No.: NA
EMAIL,Address: Thomas.chanman�ic�deq._nc, og..v Fax No.:
D. PROPERTY OWNER(S)(if different than well owner/applicant)
Name and Title: Chris Jones
Company Name Central United Methodist Church
Mailing Address: 200 East Marion Street
City: Shelby State: NC Zip Code: 28150 County:Cleveland
Day Tele No.: 980-289-9283 Cell No.: NA
EMAIL.Address: NA Fax No.: NA
E. PROJECT CONTACT(Typically Environmental Consulting/Engineering Firm)
Name and Title: Flora D'Souza Environmental Project Scientist II
Company Name WithersRavenel Inc
Mailing Address: 115 Mackenan Drive
City: Cary State: NC_Zip Code:27511 County: Wake
Day Tele No.: 919-469-3340 Cell No.: 704-517-3035
EMAIL Address: fdsouzaomwithersrayenel.com Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name&Address: Former Downtown 66,NCDEO Incident#22636,232 East Marion Street
City: _ Shelby County:Cleveland Zip Code: 28150
(2) Geographic Coordinates: Latitude**: it or 35 °. 291506
Longitude**: ° ' "or -81 0. 537559
Reference Datum:NCDEO Database Accuracy: +/-5m
Method of Collection: NCDEO Database
**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: 980 square feet
Land surface area of inj.well network: 800 square feet`10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 82% (must be<5%of plume for pilot test injections)
Deemed Permitted GW Remedistion NOI Rev.06-20-2024 Page 2

H. INJECTION ZONE MAPS—Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcenttation 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.
(3) Injection Zone(IZ)map(typically the Radius of Influence)and existing and proposed injection wells.
Please see I�i;nure 7 prepared by AST Environmental for locations of the injection points, the boxes
shown on the map represent the anticipated area of influence. This figure follows the Goss Section
Location and Cross-Section A-A' in the 17igures Section.
(4) Potentiometric surface map(s)indicating the rate and direction of groundwater movement,phis 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:
Cause of Contamination:The Downtown 66 site had a release of gasoline and diesel from under round stora e
tanks.
Purpose:The purpose of the injection is to reduce the dissolved vhase contaminants(Benzene)concentrations
to values below GCLs to reduce site risk
Scope: The scope of this iniection event will be to inject approximately 2,550 pounds of BOS200 into 14
iniection points within intervals between 15 and 21 feet below Around surface.
Goals:The goal of the BOS200 injection is to reduce benzene concentrations in groundwater across the site.
J. WELL CONSTRUCTION DATA
(1) No.of injection wells: 14 in'points,no wells Proposed Existing(provide NC Well
Construction Record(GW-1)for each well)
(2) Appx,injection depths(BLS): 15 to 21 feet BLS through temporaa iniection points
(3) For Proposed wells or Existing wells not having GW-ls,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 iniectants approved by the epidemiology section ofthe NC Division of Public Health.Department
of Health and Human Services can be iniected Approved iniectants can be found online at
Irttp://den nc gov/about/divisions/Nvatei--resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-iniectants All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Pro rant for more info if you wish to geta roval for a di Brent additive, However, lease
note it may take 3 months or longer. If no iniectants are to be used use N/A.
Injectant: BOS200 Total Amt.to be injected(gal)/event:2 550 Ibs BOS200 diluted in 1 575- al
water
Deemed Permitted GW Remediation NO]Rev.06-20-2024 Page 3

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:
Total Amt.to be injected(gal/event):
No. of separate injection events:I Total Amt.to be injected(gal): 2,550
Source of Water(if applicable): local municipal water source
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.
Post-injection sampling of monitoring wells will occur semi-annually.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "1 hereby certify, under penalty of law, that I an;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, activate and
complete. I am aware that there are significant penalties, including the possibility offrnes and imprisonment,
for submittingfalse information. 1 agree to construct,operate, maintain,repair,and if applicable, abandon the
irrjectio well and all related appurtenances in accordance with the 15A NC11C 02C 0200 Rules."
l
Flora D'Souza,Environmental Project Scientist 11
Signature of Applicant UPrint 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
al/ow 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 access agreement
Signature*of Property Owner(if different from applicant) Print or Type Fall Name and Title
*An access agreement behveen 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 NOT Rev.06-20-2024 Page 4

10 V1 itherslRavenel
Our People.Your S4ccess.
FIGURES
Downtown 66- NCDEQ Incident#22636 WR Project#23-0307-BG
Notice of Intent-UIC August 2024

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TYPE II MONITORING WELL LOCATION A 25 50 x00
NOTES:
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—� INFERRED GROUNDWATER FLOW
NDTEs G PHIC.SCALE
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