WM0701225_Application_20200420

Geological Resources, Inc.
April 17, 2020
Mr. David May
NCDEQ, Division of Water Resources
Washington Regional Office
946 Washington Square Mall
Washington, North Carolina 27889
Re: Monitoring Well Permit Application
Ballance Oil Company— Hatteras Village
57194 C Deering Ridge Road
Hatteras, Dare County
Incident No: 93307
GRI Project No: 2398
Dear Mr. May:
Please find enclosed a monitoring well permit application for the installation of two Type II monitoring
wells at the Balance Oil Company — Hatteras Village facility located at 57194 C Deering Ridge Road in
Hatteras, Dare County. GRI plans on installing the monitoring wells in May 2020 upon receipt of the
approved well permit.
Your prompt attention to this matter will be greatly appreciated. If you have any questions or require
additional information please do not hesitate to contact me at [phone].
Sin
cerely,
William Regenthal, P. G.
Project Manager
enclosures
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] [phone] 9 Fax [phone]

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT 8, NATURAL RESOURCES
DIVISION OF WATER QUALITY —AQUIFER PROTECTION SECTION
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
in accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made fi
1. Date: April 17, 2020
2. County:
Dare
)r a permit to construct monitoring or recovery wells.
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Northeast Oil Co. Telephone: [phone]
Applicant's Mailing Address: PO Box 1836 Abask*P NC 27910
Applicant's Email Address (if available):
5. Contact Person (if different than Applicant):
Justin Radford
704-698-12i52
e ephone:
Contact Person's Mailing Address: 113 West Firetower Road, Suite G, Winterville, NC 28590
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Rallance Oil .o. . In Telephone: NA
Properly Owner's Mailing Address: Post Office BOX 490, Hatteras, NC 27943
Property Owner's Email Address (if available):
7. Property Physical Address (including zip code) and PIN Number57194 C Deering Ridge Rd., Hatteras, NC - 958408999915
8. Reason for Well(s): Assessment
(ex: non -discharge permit requirements,
9. Type of facility or site for which the well(s) is(are) needed: AST
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
assessment, groundwater contamination,
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
NA
11. Type of contaminants being monitored or recovered: Petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many?
Existing Monitoring or Recovery Well Construction Permit No(s).: NA
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): _
14. Are there any water supply wells located less than 500 feet from the proposed well(s)?
If yes, give distance(s): NA
NA
No
15. Well contractor: Justin Radford Certification No.: 3270
Well Contractor Address: 3502 Hayes Road, Monroe, NC 28110
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth I. Grout horizons
C. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

Apr.17.2020 03:40 AM BALLANCE OIL CO INC, BILL 2529862424 PAGE. 1/ 1
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2, Number of wells to be constructed In unconsolidated 6, How will the well(a) be secured?
material:
3. Number of wells to be constructed In bedrock: 8. Eallmated beginning construction date; May 2020
4, Total Number of wells to be constructed: 7. Estimated construction completion date; May 2020
(add answers from 2 and 3)
ADDITIONAL INFORMATION
1. As required by 16A NCAC 02C .0105(f)(6), attach a scaled map of the site showing the locations of the following;
a, All property boundaries, at least one of which Is referenced to a minimum of two landmarks Ruch Be Identified roads,
Intersections, streams, or lakes within 500 feet of the proposed well or well system,
b. All existing walla, Identified by type of use, wlthln,600 feet of the proposed well Orwell system.
C. The proposed well or well system,
d. Any teat borings Within 500 feet of proposed well or wall system,
e. All sources of known or potential groundwater contamination (such as septic tank systeme, pee8clde, chemical or fuel
storage areas, animal feedlots as defined In G.3.143.215.108(6). landfills, or otherwaste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agrees that the proposed Wallis) will be constructed In accordance with approved apecillcetlone and conditione or
this Well Construction Porml a regulated under the Wall Construction Standards (Title 15A of the North Caroline Administrative Code,
Sub hapter2C) and accepts full reoponalblllty for compliance with these rules
Project; Manager
S e re o Appllca o Agent Title of Applicant or 'Agent
William, Regenthal, P. G. • If signing as Agent, attach authorization agreement stating
Printed name of Applicant or 'Agent that you have the 01,116041y to act as the Agent.
If the property is owned by someone other then the applicant, the property owner hereby consents to allow the applicant to construct
wells as outlined In this Well Construction Permit application and that It shall be the responsibility of the applicant to ensure that the
`well(a) conform to the Well gonBtruction Standards (Vile 16A of the North Caroline Administrative Coda, Subrhepter 2C),
Signature of Property Owner (If different than Applicant) Printed name of Property Owner (if different then Applicant)
DIRECTIONS
Pleaae send the completed application to the appropriate Division of Water Qualitys Aquifer Protection Section Regional Office; ,
Asheville Regional Office
2090 U.S, Highway 70
Swennenoa, NO 20778
Phone; [phone]
Fax: [phone]
Fayetteville Regional Office
226 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: (910) 48"707
Mooresville Regional Office
610 East Canter Avenue
Mooresville, NO 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3600 Barred Drive
Raleigh, NO 27609
Phone: [phone]
Fax; [phone]
Washington Regional Office
943 Washington Square Mail
Washington, NO 27889
Phone: [phone]
Fax: [phone]
Wilmington Reolonal Office
127 Cardinal Drive Extenelon
Wilmington, NC 28406
Phone; [phone]
Fax; [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: (33e) 7714630
GW-22MR (Rev. 7111)

Geological Resources, Inc.
April 17, 2020
Bill Ballance
Post Office Box 490
Hatteras, North Carolina 27943
Re: Monitoring Well Construction Permit Application
Balance Oil Company — Hatteras Village
57194 C Deering Ridge Road
Hatteras, North Carolina
Dare County
GRI Project No. 2398
Dear Mr. Ballance:
Geological Resources, Inc. (GRI), on behalf of North East Oil Company, Inc., is conducting an
environmental assessment at the above referenced property located in Dare County, North Carolina. The
assessment activities are being conducted at the direction of the North Carolina Department of
Environmental Quality (NCDEQ). It is our understanding that you are the owner of the property
identified as parcel number 958408999915 in Dare County. In order to complete the assessment, GRI, in
conjunction with NCDEQ, has determined that it is necessary to install two monitoring wells and collect
groundwater samples from the water table beneath your property. The wells will be installed by a rotary
auger drill rig. Please note, at the request of NCDEQ, a well permit is needed in order to complete this
scope of work. A well permit application has been attached for your review and signature.
At your earliest possible convenience, please sign the well permit application and return it via email, fax
or US Mail. GRI will attempt to minimize any inconvenience that the activities may cause. A map
showing the area in which the monitoring wells will be installed has been attached. Additionally, a well
construction diagram has been included for your files.
The monitoring well installation activities will be conducted at NO COST TO YOU, as North East Oil
Company, Inc., is responsible for the installation of the wells.
Your cooperation in this matter is greatly appreciated. Please do not hesitate to contact the undersigned at
[phone] if you have any questions or require additional information.
Sincerely,
Z/44.A
William Regenthal, P. G.
Project Manager
Enclosures
3502 Hayes Road • Monroe, North Carolina 28110
Phone [phone] [phone] • Fax [phone]

Apr.17.2020 03:30 AM BALLANCE OIL CO INC, BILL 2529862424 PAGE. 1/ 1
RIGHT TO ENTER AGREEMENT
FOR
CONDUCTING SUBSURFACE INVESTIGATIONS
STATE OF NORTH CAROLINA
COUNTY OF DARE
We, the undersigned, being all of the fee simple owners of certain tmots or parcel designated as
958408999915 of the County of. DARE, recognizing the benefits to said properties by reason of
conducting subsurface investigations hereby grant to North East Oil Company, Inc, and the agents the
right to enter said property in accordance with the requirements of the State of North Carolina, North
East Oil Company, Inc.'s agents may include Geological Resources, Inc,
The undersigned hereby covenant and warrant that they are the sole owners of said property; that they
solely have the right to grant this right to enter for conducting subsurface investigations against the lawful
claims of all persons whomsoever,
It is agreed that North East Oil Company, Inc. shall be responsible for restoring any damage done to the
ground of said property by its employees or its agents during the subsurface investigation and monitoring
period, and that North Best Oil Company, Inc, shall abandon the monitoring well on said property in
accordance with NCDEQ requirements at the conclusion of the monitoring period.
It is agreed that North East Oil Company, Inc, shall hold harmless the owner of the aforementioned
property for any personal Injury that might be sustained during the course of conducting or proximately
resulting from the conduct of subsurface investigations.
Right to Enter denied.
Right to Enter granted,
Signature
phone ; ,2L 1. 0 � z' 21Y w
Date
3802 Noyes Road + Monroe, North Carolina 26110
Phone [phone] . [phone] + Pox (704) a48-4012

Type 11.-Monitoring Well
TYPIC 1 Construction befalls
concrete pad .
manholo cover
ground,urface—.
` looking wall cap
grout cement U ^ v
{ — 2 Inch diameter'
schedule 40 PVG eating
• � I
henlDnile seal 5 I
0,00 Inch slotted 21nch diameter
schedule 40 PVC semen
sand flllar ptiok
�+— — i 2�. end oxly

LEGEND
O TYPE // MONITORING WELL
TYPE N MONITORING WELL
— SUBJECT PROPERTY
BOUNDARY LINE
- - — ADJACENT PROPERTY
BOUNDARY LINE
_.._.._.._.._.._ DITCH
Y UNDERGROUND WA TER LINE
---------- UNDERGROUND STORAGE
TANK BASIN
FUEL DISPENSER
PRODUCT LINE
su
PRODUCT PIPING SUMP
®
EXTRACTION POINT
®
TEMPORARY MONITORING WELL
Note:
I. This Site Map is based on data from the
Dore County GIS of NC and a Site Plan
dated May 1996 prepared by the former
consultan t.
2. This site was not professionally surveyed;
locations of wells are approximate.
r
r
I
r
r
I
r
r Residenc
Storage
GTanks ,
M 0 j Asphal4� /♦ O +`MOW_ 12 `
MW-2 MW-1
MW-8 ♦/ MW 4 Q O
TMW--1
Residence
Fol
Balance Oil `
Company +` /
Con venience
Store
\ �.+ MW-9 .,
4
` O
rue/
+ ; Canopy �}
Concretes ♦ (`
r ♦ ('q
r 4 ♦ v �
Rocco S
r ry v
r /
A5phal4� ^�sc
\ o
i
Building
Gras4' ♦
♦
MW-5 ♦ `
O
MW-6 �� +
O Form er
r Abo veground
SITE MAP
0 15 30 60 Ballance Oi/ Company 57194 C Deering Ridge Road
Incident No. 93307 Hatteras, Dare County,
6R( IN FEET 1 GR/ Project No. 2398 NC
Geolog%cal Resources, Inc. 1 inch = 30 ft Date: 11117117 1 Drawn 6y. DTH I Figure. 2

The Slash
IJ
1,500-FT RADIUS
y �
1,000-FT RADIUS
500-FT RADIUS
250-FT RADIUS
0 150 300 600
Feet
SCALE: 1 INCH = 300 FEET
� ao
\ ! �"
"ja0000
i`" ..Vivo-
ISLINGTON CT= SR 1
Legend
Tap / Water Sample
�,.
Location
��■
Water Body Outline o
I
�
Subject Parcel
dr
Road Centerline
I
%r -
��� '"wry ■���r
Parcel Boundary
a
AAll %
,1 a�
,
U
a
Q
LU
CONDO \ i� I, -' �o ��• 10
SiTp 57,1 92C DRR
y � o9,
i o
IV ROCCO'S SITE TAP ,
i
SEASIDE INN
AS
HAT
ER/EALTY
O n vc c` IFS
FAG cqA
FIGURE 2
SITE VICINITY MAP
BALLANCE OIL COMPANY
57194 C DEERING RIDGE ROAD
HATTERAS, DARE COUNTY,
NORTH CAROLINA
INCIDENT NO. 93307
GRI PROJECT NO. 2398
PREPARED BY:
GEOLOGICAL RESOURCES, INC.
JANUARY 5, 2017
0
Geological Resources, Inc.
NOTE:
THIS MAP IS BASED ON DATA FROM
THE DARE COUNTY GIS OF NC.