WI0501034_Permit (Issuance)_20190924

Mia Atlantic
Engineering & Environmental Solutions
September 24, 2019
Ms. Shristi Shrestha
Hydrogeologist
North Carolina Department of Environmental Quality
Underground Injection Control Program
1636 Mail Service Center
Raleigh, NC 27699-1636
409 Rogers View Court
Raleigh. NC 27610
office 919.250.9918
facsimile 9I9.250.9950
MAAONLINE.COM
Subject: NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION
WELLS
WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
INCIDENT NO.4052
MID -ATLANTIC JOB NO. R2647.05
Dear Ms. Shrestha:
On behalf of the Wake County Public School System, Mid -Atlantic Associates, Inc. is
pleased to submit the attached Notification of Intent to Construct or Operate Injection
Wells for the Willow Springs Elementary School. If you have any questions or need
additional information, please feel free to contact me at [phone].
Sincerely,
MID -ATLANTIC ASSOCIATES, INC.
S
Raymond S. Marchant, III, P.G.
Principal Geologist
Enclosures: Notice of Intent to Construct or Operate Injection Wells
Attachment A — Injection Zone Maps (Section H)
Attachment B — Safety Data Sheet (Section J)
Attachment C — Well Construction Information (Section K)
R2647.05/RSM/bro
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

NOTICE OF INTENT TO CONSTRUCT OR
OPERATE INJECTION WELLS
Mid Atlantic
Engineering & Environmental Solutions

North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individualpermit when constructed in accordance
with the rules of I5A 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.
INSITUREMEDIATION (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: September 24, 2019 PERMIT NO. W10501034 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete sections B through F, K, N
(2) Aquifer Test Well.......................................Complete sections B through F, K, N
(3) Passive Injection System...............................Complete sections B through F, H-N
(4) X Small -Scale Injection Operation ......................Complete sections B through N
(5) Pilot Test.................................................Complete sections B through N
(6) Tracer Injection Well...................................Complete sections B through N
B. STATUS OF WELL OWNER: Business/Organization
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:
Company Name Wake County Public School System
Delegated Signatory Authority: Raymond S. Marchant, III, Mid -Atlantic Associates, Inc. (consultant)
Mailing Address: 1551 Rock Quarry Road, Bldg B
City: Raleigh State: NC Zip Code: 27610 County: W
Day Tele No.:
919-588-3633
Cell No.: 919-669-9635
EMAIL Address: tknellerCcbwcpss.net
Fax No.: 919-508-0831
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page I

D. PROPERTY OWNER(S) (if different than well owner)
E.
F.
G.
Company Name Same as Well Owner
Mailing Address:
City:
Day Tele No.: _
EMAIL Address:
State: Zip Code: County:
Cell No.:
Fax No.:
PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Raymond S. "Trey" Marchant, III, Principal Geologist
Company Name Mid -Atlantic Associates, Inc.
Mailing Address: 409 Rogers View Court
City: Raleigh State: NC Zip Code: 27610 County: Wake
Day Tele No.: [phone] Cell No.: [phone]
EMAIL Address: tmarchant(a)maaonline.com Fax No.: [phone]
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Willow Springs Elementary School
6800 Dwight Rowland Road
City: Willow Springs County: Wake Zip Code: 27592
(2) Geographic Coordinates: Latitude": 35 ° 35 ' _" or 36 0.67N
Longitude": -78 ° 43 ' if or 41 0.26.
Method of Collection: Goo2le Earth Pro Software
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Note: There has been a release of heating oil from a UST at this site. The site is currently regulated by the North
Carolina Department of Environmental Quality (NCDEQ), Division of Waste Management (DWM),
Underground Storage Tank (UST) Section. Removal of free product is necessary to move the site towards closure
and prevent potential spreading of the plume (water supply wells are located nearby). Heating oil free product
remains present on the water table at well MW-1 and MW-3. As such, the "area of the contaminant plume"
indicated below refers to the approximate area of the heating oil free product plume.
Land surface area of contaminant plume: 2,890 square feet
Land surface area of inj. well network: 2,890 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 100% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification. Provided in Attachment A. Please
note that DEQ has only required limited assessment at this site. Groundwater isoconcentration maps are not
available (other than the one provided) and soil assessment maps are not available. Contaminated soil likely
remains in the vicinity of the UST (which was closed in place due to the presence of underground utilities over
and around the tank). However, no soil contaminant maps currently exist.
(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 — 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.
Residual heating oil free product (approximate thickness of 0.5 ft) remains present on the water table at the site
at well MW-3 and is also present in well MW-1 in a thickness of approximately 0.2 ft). We propose to inject
surfactant prior to performing an Aggressive Fluid Vapor Recovery (AFVR) event. Mid -Atlantic proposes to
iniect EnviroClean (EC-165) at the site to enhance free product recovery during the AFVR. Iniection will be
performed at wells MW-1, MW-3, multiple 2-inch diameter geoprobe borings (vet to be installed) and up to two
additional 4-inch diameter recovery wells (vet to be installed). The geoprobe borings will be advanced in the
locations shown on the attached drawing (5-foot grid) and the recovery wells will be installed in areas of greatest
free product thickness (drawing shows estimated locations). Injection will then be performed on the wells and
also into any geoprobe boreholes that exhibit evidence of contamination/freeproduct). EnviroClean (EC-165) is
a common cleanup/mitigation agent that can be applied as both an emulsifying agent for free product recovery
and biosurfactant for dissolved -phase groundwater remediation. It is estimated that up to 500 gallons of 4%
solution of EnviroClean will be gravity iniected into the above -referenced wells and borings over an estimated
period of up to 8 hours on -site. An 8-hour AFVR event will then be conducted at the site approximately one to
two weeks following completion of the surfactant injection event, with post-AFVR free product gauging
activities conducted approximately two to four weeks following completion of the AFVR event.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant. Attach additional sheets if necessary.
Provided in Attachment B
NOTE: Only injectants approved by 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-Drotection/eround-water-aDDroved-ini ectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919-
807-6496).
Injectant: EnviroClean EC-165
Volume of injectant: 500 Gallons
Concentration at point of injection: 4%
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA GW-ls for existing wells MW-1 and MW-3 and a table summarizing
proposed injection points are provided in Attachment C.
(1) Number of injection wells: 2, plus up to 20 open holes Proposed 2 Existing
(provide GW-1s)
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3

(2) 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
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Proposed wells and borings are scheduled to be installed from Thursday 9/26 through Saturday 9/28/19. The
iniection event is currently scheduled for Saturday 9/28/19, and the AFVR is scheduled to be conducted on
Saturday, October 12, 2019. It is anticipated that the surfactant injection will take approximately 8 hours for
completion and the AFVR is expected to run for approximately 8 hours. Post-AFVR free product gauging will
be conducted approximately two to four weeks following completion of the AFVR event.
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.
The site is currently regulated by the NCDEO DWM UST Section. Sampling of site monitoring wells (not
containing free product) will be performed once free product has been removed from the water table, with results
reported to the UST Section (assuming sampling is pre -approved by the UST Section). Please note that
EnviroClean is a proprietary blend of water -based, biodegradable surfactants that was specifically engineered as
a cleanup/mitigation agent and vapor suppressant for use on a wide range of hydrocarbon products. EnviroClean
in and of itself, does not cause or catalyze specific chemical reactions, nor does it contain any bacteria cultures.
The basic principle of EnviroClean is to emulsify and encapsulate hydrocarbon particles. As such the injection
activity is not anticipated to result in violations of the NCGOS for additional compounds other than those already
noted from the previous fuel oil release.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER Please note that Mid -Atlantic is signing
the application on behalf of the Wake County Public School System. Permission for Mid -Atlantic to sign
is provided in Attachment D.
APPLICANT: `I hereby certify, underpenalty 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 ac ordance with the 1 SA NCAC 02C 0200 Rules. " QRINCIPkL "m6isr
�i MyMo(►D S, MAc% mro- ATt4ilc gswo.
of Applicant r kaear r-o o, woe5� Print or Type Full Name and Title
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 well(s) conform to the Well Construction Standards
(1 SA NCAC 02C.0200). "
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 4

"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.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 5

ATTACHMENT A
INJECTION ZONE MAPS
(SECTION H)
Mid Atlantic
Engineering & Environmental Solutions

REFERENCES:
1. ANGIER, NC DIGITAL RASTER GRAPHIC, USGS. SCANNED FROM
1:24,000-SCALE GREEN LEVEL, NC TOPOGRAPHIC MAP, PUBLISHED 2013, USGS.
2. INSET MAP DIGITAL DATA FROM 2002 NATIONAL TRANSPORTATION ATLAS,
BUREAU OF TRANSPORTATION STATISTICS, WASHINGTON, D.C.
3. PROPERTY BOUNDARY DATA FROM WAKE COUNTY GIS.
SCALE: 1:12,000
500 1,000
DRAWN
TOPOGRAPHIC SITE MABY:
P DRAFT
Mid Atlantic WILLOW SPRINGS ELEMENTARY SCHOOL CHECK:
Engineering & Environmental Solutions 6800 DWIGHT ROWLAND ROAD ENG.
WILLOW SPRINGS, NORTH CAROLINA CHECK:^
APPROVAL:
Feet
2,000
DATE:
APRIL 2016
JOB NO:
OOOR2647.0B
GIS NO:
04G-R2647.OB-1
DWG NO: 1

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Legend
MONITORING WELL LOCATION
ESTIMATED GROUNDWATER ELEVATION CONTOUR
ESTIMATED GROUNDWATER FLOW DIRECTION
TRIBUTARY TO TERRIBLE CREEK
SUBJECT PRO
PERTY BOUNDARY
A Fe(
A1.
NM=NOT MEASURED 0 40 80 120 160
ESTIMATED GROUNDWATER TABLE DRAWN BY: DATE: APRIL 2016
ELEVATION CONTOUR MAP (3-31-16) DRAFT CHECK JOB NO.: 000R2647.OB
BY:
mll� WILLOW SPRINGS ELEMENTARY SCHOOL ENGINEER CHECK
Mid Atlantic BY: C�� GIS NO.: 04G-R2647.OB-3
Engineering & Environmental Solutions 6800 DWIGHT ROWLAND ROAD APPROVED
WILLOW SPRINGS, NORTH CAROLINA BY: (� DRAWING NO.: 3
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

Legend
9 MONITORING WELL LOCATION
5,000-GALLON HEATING OIL UST
ESTIMATED FREE PRODUCT CONTOUR
0.68' = FREE PRODUCT THICKNESS (FEET)
ND = NOT DETECTED
T f fi
+ f agdsm ►vmmoN WELL
Cl*rsa t4 To ibp- wNf- ON wets Mw-1 Mw-3 Ae45o)
FREE PRODUCT THICKNESS MAP
M• PRE-AFVR - JULY 6, 2018
id Atlantic WILLOW SPRINGS ELEMENTARY SCHOOL
Engineering & Environmental Solutions 6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
Q
N
1 inch equals 20 feet
�■ Feet
0 20 40
DRAWN BY: RDC DATE: AUGUST 2018
DRAFT CHECK BY: .JOB NO.: 000R2647.02
ENGINEER CHECK BY: GIS NO.: 06G-R2647.02-4
APPROVED
BY: DRAWING NO.: 3.1
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES

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MONITORING WELL LOCATION e3 Yr. r
SUBJECT PROPERTY BOUNDARY
4V#*
,d
Feet e
0 40 80 120 160"
Mid Atlantic
Engineering & Environmental Solutions
MONITORING WELL LOCATION MAP
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
DRAWN BY: "'r DATE: APRIL 2016
DRAFT CHECK JOB NO.: 000132647.013
BY:
ENGINEER CHECK GIS NO.: 04G-R2647.0B-1
BY: q5
APPROVED BY: fKmDRAWING NO.: 2
11 REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

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ATTACHMENT B
SAFETY DATA SHEET
(SECTION J)
Mid Atlantic
Engineering & Environmental Solutions

ENVIRO�CU
SAFETY DATA SHEET
SECTION 1 MATERIAL IDENTIFICATION
PRODUCT NAME / DESCRIPTION: EnviroClean
DISTRIBUTED / MANUFACTURED BY:
ENVIRO CLEAN PRODUCTS & SERVICES DATE: 05/18/2015
PO BOX 721090 PHONE: [phone]
OKLAHOMA CITY, OK 73172 EMERGENCY PHONE: [phone]
FUNCTION: Industrial Cleaner and Remediation Agent
SECTION 2 HAZARD IDENTIFICATION
CLASSIFICATION:
Acute Toxicity- Oral
Category 4
Skin Corrosion/Irritation
Category 3
Eye Damage/Irritation
Category 2B
Target Organ Specific Toxicity: Single
I Category 3
Target Organ Specific Toxicity: Chronic
I Category 2
SIGNAL WORD:
WARNING!
HAZARD STATEMENTS:
Harmful if swallowed
Causes mild skin irritation
Causes eye irritation
May cause respiratory irritation
May cause damage to organs through prolonged or repeated exposure
> <s !Rr"04
PRECAUTIONARY STATEMENTS:
Obtain special instructions before use
Do not handle until all safety precautions have been read and understood
Use personal protective equipment as required
Avoid breathing dust/fume/gas/mist/vapors/spray
Use only outdoors or in a well ventilated area
Wash all exposed skin thoroughly after handling
Avoid release to the environment

ENVIRO�CU
Store in a well ventilated place
TOXICITY INFO:
See Section 11.
SECTION 3 HEALTH HAZARDS
CHEMICAL NAME
(Proprietary Formula)
%WIW CAS NUMBER
Proprietary Blend of Ethoxylated Octylphenolic Surfactants
Non-ionic water based liquid blend, concentrate
This product does not contain any hazardous ingredients as defined by CERCLA and California's Prop. 65.
SECTION 4
Potential acute health effects:
FIRST AID
Eyes: May cause irritation with redness and pain.
Skin: May cause irritation with redness and pain.
Inhalation: Inhalation may cause irritation.
Ingestion: Ingestion may cause severe irritation, corrosion/ulceration, nausea, and vomiting.
Medical Conditions Aggravated by Exposure:
None known.
Eye Contact: In case of contact, immediately flush eyes with cool running water. Lift and
separate eyelids while flushing with plenty of water for at least 15 minutes. Get
medical attention.
Skin Contact: Wash with soap and water. Get medical attention if irritation occurs. Wash
clothing before reuse. Destroy contaminated shoes.
Inhalation: Remove victim to fresh air and keep at rest in a position confortable for breathing.
If not breathing, give artificial respiration. If breathing is difficult, give oxygen.
Seek medical attention if symptoms develop.
Ingestion: Do NOT induce vomiting unless directed to do so by medical personnel. Never
give anything by mouth to an unconscious person. If large quantities of this
material are swallowed, call a physician immediately. Give plenty of water.
SECTION 5 FIRE FIGHTING MEASURES
Fire Hazard Classification (OSHA/NFPA): 0
Extinguishing Media: As required for fire being fought.
Special Fire Fighting Procedures: Use self-contained breathing apparatus.
Hazardous combustion products: No known.

ENVIRO�CU
SECTION 6 ACCIDENTAL RELEASE MEASURES
Personal Precautions, PPE, and Emergency Procedures:
Wear protective clothing as described in Section 8 of this safety data sheet.
Containment Procedures: Stop the flow of material, if this is without risk. Wear appropriate protective
equipment and clothing during clean-up. Do not allow the spilled product to enter
public drainage system or open water courses.
Clean -Up Procedures: Sweep up or gather material and place in appropriate container for disposal.
Wash spill area thoroughly. Wear appropriate protective equipment during
cleanup. Dispose of collected material according to regulations.
SECTION 7 HANDLING AND STORAGE
Handling: Avoid contact with eyes, skin and clothing. Do not take internally. For industrial
use only. Wash after handling. Don't breathe dust, vapor, or gas. Keep this and
all chemicals out of reach of children.
Storage: Keep away from heat, sparks, and open flames. Prevent spills. Keep container
tightly closed and in a cool, well -ventilated place away from incompatible
materials. Empty product containers may contain product residue, do not reuse.
SECTION 8
PERSONAL PROTECTION / EXPOSURE CONTROLS
Ventilation System:
Always keep exposure below permissible exposure limits. In general, dilution
ventilation is a satisfactory health hazard control for this substance. However, if
conditions of use create discomfort to the worker, a local exhaust system should
be considered.
Airborne Exposure Limits: None Established.
Personal Protection:
As prescribed in the OSHA Standard for Personal Protective Equipment (29 CFR
1920.132), employers must perform a Hazard Assessment of all workplaces to
determine the need for, and selection of, proper protective equipment for each
task performed.
Eyes:
Wear face shield, safety glasses, or chemical goggles.
Hands & Skin:
For prolonged or repeated handling, use impervious gloves. Gloves should be
tested to determine suitability for prolonged contact. Use of impervious apron
and boots are recommended.
Respiratory:
If ventilation is not sufficient appropriate NIOSH/MSHA respiratory protection
must be provided.
Work Practices:
Eye wash fountain and emergency showers are recommended.
SECTION 9 TYPICAL PHYSICAL AND CHEMICAL PROPERTIES
Physical Form: Liquid
Color: Red

ENVIRO�CU
Odor:
Wintergreen
Odor Threshold:
NE
pH:
8.5+/-0.5
Boiling Point:
NE
Melting Point:
N/A
Flash Point:
>200 deg F
Evaporation Rate (Butylacetate = 1)
NE
Flammability:
Non -Flammable
UEL:
NE
LEL:
NE
Vapor Pressure:
NE
Vapor Density:
NE
Specific Gravity (Water =1):
1.03 +/- .05
Solubility Water:
Complete
Partition Coefficient:
NE
Auto -ignition Temperature:
NE
Decomposition Temperature:
NE
Viscosity (CPS):
NE
SECTION 10 STABILITY AND REACTIVITY
Stability: This product is stable under normal temperatures and pressures.
Incompatibility: Strong Oxidizers and strong acids.
Decomposition Products: No Known hazardous products.
Conditions to Avoid: Sparks/flames/high heat.
SECTION 11 TOXICOLOGICAL PROPERTIES
Raw Material Test Result Route Species
N/A
See Section 4 for symptoms.
CARCINOGENICITY:
No known carcinogens, mutagens, or reproductively toxic ingredients
SECTION 12 ECOLOGICAL INFORMATION
Raw Material Test Result Time Species
N/A
PERSISTENCE & DEGRADABILITY:
NE

ENVIRO�CU
BIOACCUMULATION:
NE
MOBILITY
NE
SECTION 13 DISPOSAL CONSIDERATIONS
Whatever cannot be saved for recovery or recycling should be managed in an appropriate and approved
waste disposal facility. Processing, use, or contamination of this product may change the waste
management options. State and local disposal regulations may differ from federal disposal regulations.
Dispose container and unused contents in accordance with federal, state, and local requirements.
SECTION 14 TRANSPORT INFORMATION
Not Regulated by DOT or IATA.
SECTION 15 REGULATORY INFORMATION
US FEDERAL REGULATIONS
SARA (SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT):
SARA 302 EXTREMELY HAZARDOUS SUBSTANCES LIST: NA
SARA 312 HAZARD CATEGORY:
SARA 313 TOXIC CHEMICALS LIST:
M
NA
CERCLA (COMPREHENSIVE ENVIRONMENTAL RESPONSE. COMPENSATION AND
LIABILITY ACT): NA
RCRA (RESOURCE CONSERVATION AND RECOVERY ACT) LISTED HAZARDOUS WASTES:
NA
CWA (CLEAN WATER ACT) LISTED SUBSTANCES: NA
FDA (FOOD AND DRUG ADMINISTRATION): NA
TOXIC SUBSTANCES CONTROL ACT (TSCA): NA
IATA: NA

ENVIRO�CLEAN
NFPA HAZARD INFORMATION SIGN
101
4 - DEADLY
3 - EXTREME DANGER
2 - HAZARDOUS
1 - SLIGHTLY HAZARDOUS
0 - NORMAL MATERIAL
[0]
FLASH POINTS:
4
- BELOW 73 F
3
-BELOW 100 F
2
- BELOW 200 F
1
- ABOVE 200 F
0
- WILL NOT BURN
[01 REACTIVITY HAZARD (YELLOW DIAMOND)
4 - MAY DETONATE
3 - SHOCK AND HEAT MAY DETONATE
2 - VIOLENT CHEMICAL CHANGE
1 - UNSTABLE IF HEATED
0 - STABLE
[] SPECIFIC HAZARD (WHITE DIAMOND)
OXY
OXIDIZER
ACID
ACID
ALK
ALKALI
COR
CORROSIVE
W
USE NO WATER
SECTION 16 OTHER INFORMATION
THIS INFORMATION IS OFFERED IN GOOD FAITH AS TYPICAL VALUES AND NOT AS A
PRODUCT SPECIFICATION. NO WARRANTY, EXPRESSED OR IMPLIED, IS HEREBY MADE. THE
RECOMMENDED INDUSTRIAL HYGIENE AND SAFE HANDLING PROCEDURES ARE BELIEVED
TO BE GENERALLY APPLICABLE. HOWEVER, EACH USER SHOULD REVIEW THESE
RECOMMENDATIONS IN THE SPECIFIC CONTEXT OF THE INTENDED USE AND DETERMINE
WHETHER THEY ARE APPROPRIATE.

ATTACHMENT C
WELL CONSTRUCTION INFORMATION
(SECTION K)
Mid Atlantic
Engineering & Environmental Solutions

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, Inc.
Company Name
2. Well Construction Permit #: NR
List all applicable will construction permits (i.e. County State. Variance, etc.)
3. Well Use (check well use):
Water Supply Well-
❑Agricultural
❑MunicipallPublic
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
E Monitoring
❑Recovery
Injection Well:
El Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
[]Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
[]Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 4117/15 well ID# MW-1
5a. Well Location:
Willow Springs ES NA
Facility/Owner Name Facility ID# (if applicable )
6800 Dwight Rowland Rd., Willow Springs 27592
Physical Address, City, and Zip
Wake
County
NA
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one ladlong is sufficient)
35.593511 N 78.728022 W
6. Is (are) the well(&): 2Permanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or E]No
Ifthis is a repair, fill out known well construction information and explain the nature ofthe
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: One
For multiple injection or iron -water supply wells ONLY with the same construction, you can
submit oneform.
9. Total well depth below land surface: 201
Fur multiple wells list all depths ifdiffereat (example- 3(200' and 2Q100!
10. Static water level below top of casing: NA
If router level is above easing, use "+ "
Il. Borehole diameter: 6.5"
For Internal Use ONLY:
14. WATER ZONES
FROM
'l'o
DESCRIPTION
13 rt'
14 rl'
Sandy Silt
ft.
I ft.
15. OUTER CASING for multi rased wells OR LINER if a licshle
FROM
TO
DWMUTER
'rHICKNN55
1FIA'1'ERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
'to
DIAME"l'ER
THICKNESS
MATERIAL
0 ft-
10 ft.
2 1°
Sch 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
To
DIAMUITR
SLO"1 SIZE
"THICKNESS
MATERIAL
10 fL
20 ft'
2 in.
0.010
Sch 40
PVC
ft.
ft.
in.
19. GROUT
FROM
To
MATERIAL
EMPLACEMENT MUTHOD x AMOUNT
ft.
ft.
0 ft.
6 ft•
neat cement
145 lbs. - pour
6 ft.
g ft,
bentonite
30 lbs. - pour
19. SAND/GRAVEL PACK if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
8 ft'
20 ft'
#2 sand
Pour
ft.
ft.
20. DRILLING LOG attach additional sheets if necessary
FROM
'l'U
DESCRIPTION color, hardness, sold k t4 e, gnin siu etc.
0 ft.
0.5 ft•
ground cover - Reddish Tan Silt
0.5 It-
13 ft.
Reddish Brown Clayey Silt
13 ft-
20 "-
Brown Sandy Silt
ft.
ft.
ft.
ft.
ft.
f.
ft.
ft.
21. REMARKS
22. Certife 'on:
6, 614� 4/19/15
Signature of enified Well Contractor Date
By signing t is form, I hereby certify that the weli(s) was (were) constructed in accordance
with I5A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and that a
copy ofthis record has been provided to the well owner_
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
Auger above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: g construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & lnjection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
(in.)
Form GW-t North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Ian. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, Inc.
Company ?lame NR
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Parlance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
❑hrl anon
Non -Water Supply Well:
RMonitcring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
[]Subsidence Control
❑Geothermal (Closed loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under #21 Remarks)
3/25/16 MW-3
4. Date Wells) Completed: Well ID#
5a. Well Location:
Willow Springs ES NA
Facility/Owner Name Facility ID# (if applicable)
6800 Dwight Rowland Rd., Willow Springs 27592
Ph ica1 Address, City, and Zip
Make NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/secands or decimal degrees:
(if well field, one latllong is sufficient)
35, 593527 78.728177
N W
6. Is (are) the wen(s): ®Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ANo
Ifthis is a repair, fill out latown well construction information and explain the nature ofthe
repair under #21 remarks section or on the back of this form.
one
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit oneform. 14'
9. Total well depth below land surface: (ft.)
For multiple wells list all depths if dierent (example- 3@200' and 2@1001
NA
10. Static water level below top of casing:
Ifwnter level is above casing, use "I
811
11. Borehole diameter: 0-)
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push, etc.)
(1)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
5 fL
6 ft.
Light Brown Sandy SILT
ft.
ft.
15. OUTER CASING for multitased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
ft.
in.
16. INNER CASING OR TUBING hernial closed -too
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 It.
4 ft.
2
Sch 40
PVC
ft
ft.
is
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
4 it.
14 ft.
2 in.
0.010
Sch 40
PVC
ft.
%
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
It.
ft.
0 &
3 ft.
neat cement
145 lbs. - pour
3 fL
3.5 ft.
bentonite
30 lbs. - pour
19. SAND/GRAVEL PACK ifapplicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3.5 It.
16 It.
#2 sand
Pour
ft
ft.
20. DRILLING LOG attach additional sheets if necessary
FROM
TO
DESCRIPTION color, hardness soillrock bpe, gnin size etc.
0 ft
0.5 ft.
ground cover - Reddish Tan SILT
0.5 ft.
3 ft.
Reddish Brown Clayey SILT
3 It.
14 It.
Light Brown Sandy SILT
fL
ft.
ft
ft.
ft
f.
%
ill.
21. REMARKS
22. Certitii 'on.
3/28/16
Signature of ertified Well Contractor Date
By signing t is form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy ofthis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: _ Amount completion of well construction to the county health department of the county
where constructed.
Form GsW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Ian. 2013

SUMMARY OF PROPOSED INJECTION POINTS
WCPSS WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
MID -ATLANTIC JOB NO. R2647.05
PROPOSED
ANTICIPATED
ANTICIPATED
ANTICIPATED
PROPOSED
PROPOSED
SCREEN
BENTONITE
CEMENT GROUT
SAND PACK
INJECTION POINT ID
DEPTH
DIAMETER
(FEET BLS)
DEPTH
INTERVAL (FEET
INTERVAL (FEET
INTERVAL (FEET
(FEET BLS)
BLS)
BLS)
BLS)
RW-1 AND RW-2 WELLS
4
15
5-15
3-4
1-3
4-15
(PERMANENT)
UP TO 20 GEOPROBE
2
10
NA
NA
NA
NA
BOREHOLES (TEMPORARY)
Notes:
BLS - Below Land Surface
NA - Not Applicable
Wells and borings to be installed by Quantex, Inc. certification number 3106

ATTACHMENT D
SIGNATURE AUTHORITY EMAIL
(SECTION N)
Mid Atlantic
Engineering & Environmental Solutions

Trey Marchant
From: Todd Kneller -Staff - EnvironmentGrounds <[e-mail]>
Sent: Tuesday, September 24, 2019 9:09 AM
To: Trey Marchant
Cc: Stephen McLoughlin _ Staff - EnvironmentGrounds
Subject: Willow Springs ES DEQ application
Good morning Trey -
In regards to the DEQ application for the injection remediation project at Willow Springs Elementary, Mid
Atlantic may sign on our behalf as our contractual environmental consultant. Please let me know if you need
anything further,
Todd Kneller, Senior Administrator
WCPSS Environmental & Grounds
1551 Rock Quarry Road, Raleigh NC 27611
919.588.3633 ofc
Total Control Panel
To: tmarchantLdmaaonline.com
From: [e-mail]
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