WM0501413_Application_20201001

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
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 for a permit to construct monitoring or recovery wells.
1. Date: 10/1/2020 FOR OFFICE USE ONLY
2. County: Lee PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery), Monitoring
4. Applicant: _Contract Lumber. Inc — Mr. Jim Hollowav Telephone: [phone] _
Applicant's Mailing Address: 3245 Hazaelton-Etna Road Pataskela Ohio 43062
Applicant's Email Address (if available): ihollowavl&Contractiumber com
5. Contact Person (if different than Applicant): ECS Southeast LLP — Mr. Matthew Gillis Telephone: _ 910-215-6174
Contact Person's Mailing Address: 9001 Glenwood Avenue Raleigh North Carolina 27617
Contact Person's Email Address (if available): moilli-s &ecslimited.com
6. Property Owner (if different than Applicant): R&G Investments USA LLC Telephone:
Property Owner's Mailing Address: P.O. Box 514 Morrisville North Carolina 27560
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 3193 Industrial Drive PIN 9651 76-9273.00
City Sanford County_ Lee Zip Code 27332
8. Reason for Well(s): Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: Former Industrial/Commercial
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
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).
No
11. Type of contaminants being monitored or recovered: VOCs & SVOCs
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Unknown
Existing Monitoring or Recovery Well Construction Permit No(s).: Unknown
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): N/A
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s):
15. Well Contractor. Quantex. Inc. Certification No.: 3106-A
Well Contractor Address: P.O Box 1388 Wendell North Carolina 27591
PROPOSED WELL CONSTRUCTION INFORMATION
As required by I SA NCAC 02C .0105(0(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 f. Grout horizons
C. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 4 5. How will the well(s) be secured? Temporary
Point — Abandoned same day
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: TBD
4. Total Number of wells to be constructed: 4 7. Estimated construction completion date:
(add answers from 2 and 3)
ADDITIONAL INFORMATION
As required by 15A NCAC 02C .0105(f)(5), 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 such as identified roads,
Intersections, streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
r. The proposed well or well system.
J. Any test borings within 500 feet of proposed well or well system.
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel
storage areas, animal feedlots as defined in G.S. 143-215.1OB(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
I, -Subchapter 2C) and accepts full responsibility for compliance with these rules
0116)
Title of Applicant or *Agent
• If signing as Agent, attach authorization agreement stating
that you have the authority to act as the Agent.
If the property is owned by someone other than the app'icant, 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(s) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C),
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources'
Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
3800 Barrett Drive
Raleigh, NC 27609
Wilmington, NC 28405
Swannanoa, NC 28778
Phone: [phone]
Phone: [phone]
Fax: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone]
Winston-Salem Regional Office
Fayetteville Regional Office
Washington Regional Office
943 Washington Square Mall
450 W. Hanes Mill Road
Suite 300
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Washington, NC 27889
Phone: [phone]
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
Wilmington Regional Office
127 Cardinal Drive Extension
IR Rev. 3-1.2016
GW-22M (Rev. 5/11)

PROPERTY OWNER ACCESS AUTHORIZATION
ECS SOUTHEAST, LLP
Project Name: Contract Lumber
Location: 3193 Industrial Drive, Sanford, Lee County, North Carolina
ECS Southeast, LLP (ECS) has been requested to conduct subsurface soil and groundwater sampling at the
site. The groundwater sampling at the site requires that ECS procure a permit from the North Carolina
Department of Environmental Quality (NCDEQ).
ECS respectfully requests that the owner of the property grant permission to ECS to access the property
to conduct the groundwater sampling. By signing below, property owner authorizes ECS to conduct the
aforementioned groundwater sampling at the site and to obtain the above -referenced permit on behalf
of the owner.
Property Owner (please print)
Property Owner
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SANFORD QUADRANGLES 2013
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FIGURE 1
TOPOGRAPHIC LOCATION MAP
CONTRACT LUMBER
3193 INDUSTRIAL DRIVE
SANFORD, LEE COUNTY, NORTH CAROLINA
ECS PROJECT NO.49:12328-A