WI0300512_Notification of Intent (NOI) – GW Remediation_20240912

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: 09/12 ,20 24 NOI TRACKING NO. WI0300512 (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.: 919-707-8166 Cell No.:
EMAIL Address:[e-mail] Fax No.:
D. PROPERTY OWNER(S)(if different than well owner/applicant)
Name and Title: Mrs. Pam Hinson
Company Name
Mailing Address: PO Drawer 428
City: Monroe State: NC Zip Code:28111 County:Union
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: Best Stop #2
10014 Lancaster Highway
City: Waxhaw County.Union Zip Code: 28173
(2) Geographic Coordinates: Latitude": "or 34 83670
Longitude": "or 80 °.72822
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: 34,075 square feet
Land surface area of inj.well network: 3,325 square feet(< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 9.7 (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. 60 injection points
governing 3,325 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: Proposed 60 Existing(provide NC Well
Construction Record(GW-1)for each well)
(2) Appx. injection depths(BLS): 28.5 - 45.0
(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: 27,750 Ibs
Injectant: Gypsum Total Amt. to be injected(gal)/event: 14,850 Ibs
Injectant:Magnesium Sulfate Total Amt. to be injected(gal)/event: 14,850 Ibs
Injectant:Starch Total Amt. to be injected(gal)/event:7,450 Ibs
Injectant:Yeast Extract Total Amt. to be injected(gal)/event:275 Ibs
Deemed Permitted GW Remediation NOI Rev.3-1-2023 Page 3

Total Amt.to be injected(gal/event): 14,825
No.of separate injection events: 1 Total Amt.to be injected(gal): 14,825
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.
Post-injection 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."
9 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

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LEGEND
® Monitoring Well
(Type II)
� ® Gauged Monitoring
Well (Type II)
## Groundwater �
Elevation (Feet) F
Depth to Groundwater Q
[##] (Feet BTOC) Z
� Groundwater Flow
Direction
- Groundwater Contour
Approximate Location
of Former UST System
� I Approximate Location
of Inactive ASTs
Parcel Boundary
Source:Esri,Mgm Earthstar Geographies,and the GIS User Commn
NOTES:
1.Well and tank locations were obtained from previous reports
prepared by other consultants and are approximate. 40 20 0 40 80
2.*=Top of casing elevation unknown.
3.BTOC=Below Top of Casing Feet
4.The qroundwater elevation contour interval is 0.25 feet.
PROJECT TITLE FIGURE
BEST STOP 2 GROUNDWATER ELEVATION -
ATLIN 10014 LANCASTER HWY MAY 1, 2024
WAXHAW, NC 4A
Engineers and Scientists
INCIDENT N0. JOB N0. DATE SCALE DRAWN BY/CHECKED BY
27776 223076 JULY 2024 AS SHOWN KMC/SJO

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® Monitoring Well
(Type II)
® Sampled Monitoring
Well (Type II)
(##) Benzene
Concentration (pg/L)
Benzene Estimated
IsoconcentrationLU
=
Approximate Location
of Former UST System Q
Approximate Location Z
LJ
of Inactive ASTs
Parcel Boundary
Source:Esri,Maxar, EarGhstar Geographies,and the GIS User Communit,
NOTES:
1.Well and tank locations were obtained from previous reports
prepared by other consultants and are approximate. 40 20 0 40 80
2.2L GWQS for Benzene is 1 pg/L. Feet
3.GCL for Benzene is 5,000 /L.
PROJECT TITLE
BEST STOP 2 ESTIMATED HORIZONTAL
FIGURE
AILIN 10014 LANCASTER HWY EXTENT OF BENZENE —
CWAXHAW, NC JUNE 6 & 7, 2024
Engineers and Scientists
INCIDENT N0. I JOB N0. DATE SCALE I DRAWN BY/CHECKED BY
27776 223076 JULY 2024 AS SHOWN KMC/SJO

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Best Stop 2 AST Environmental
1 10014 Lancaster Highway Site Plan 1567 CF Pours Drive
Waxhaw,North Carolina Harrisonburg,Virginia
Figure NCDEQ Incident#27776 www.astenv.com ENVIRON�NTAL,INC.

Sharon Ghiold
DWM UST Section r
11 ;:
1646 Mail Service Center
Raleigh,NC 27699-1646
Dear Ms. Ghiold:
RE: Site Access Agreement
Former Best Stop#2 at Piedmont
10014 Lancaster Hwy
Waxhaw,Union County,North Carolina(MRO)
STF Incident#27776,MO-7050, Facility ID 00-0-08712
Risk/Rank: High H350D
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 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.
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.

Best Stop#2 at Piedmont
STF #27776
Page 2
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.
Signature
Type/Print Name of Owner or Agent
—71D a1 -a/l 0
Phone Number
Address
City/State/Zip Code
Date

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