WM0401412_Monitoring Well Permit Application_20221128

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.
Date: 11/22/2022
2. County: Alamance
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: SBR Investors, LLC (Mr. Ken Chapman) Telephone: [phone]
Applicant's Mailing Address: 2400 South Boulevard, Suite 300, Charlotte NC 28203
Applicant's Email Address (if available): kchapman(a�mpvre.com
5. Contact Person (if different than Applicant): Ron Navarro Telephone: [phone]
Contact Person's Mailing Address: 5260 Greens Dairy Road, Raleigh, NC 27616
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Holly Center Investments, LLC (Mr. Scott Thomas) Telephone: [phone]
Property Owner's Mailing Address: PO Box 1959 Burlington, NC 27216
Property Owner's Email Address (if available): N/A
7. Property Physical Address (Including PIN Number) Huffman Mill Road (PIN 173295)
City Burlington County Alamance Zip Code 27215
8. Reason for Well(s): Assessment of suspected contamination from former operations surrounding the subject property
(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: 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 pennit and/or incident no(s).
No
11. Type of contaminants being monitored or recovered: VOCs (ex: organics, nutrients,
heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).: No
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): approximately 200 feet from suspected
contaminants
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 Certification No.: 3106
Well Contractor Address: jbarker3 at nc.rr.gov

1.
PROPOSED WELL CONSTRUCTION INFORMATION
As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a.
b.
c.
d.
Borehole and well diameter
Estimated well depth
Screen intervals
Sand/gravel pack intervals
e.
f,
g•
Type of casing material and thickness
Grout horizons
Well head completion details
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
5. How will the well(s) be secured? Capped and
material: 3 locked
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 3
(add answers from 2 and 3)
6. Estimated beginning construction date: December 2022
7. Estimated construction completion date: December
2022
(within 96 hours of installation)
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.
c. The proposed well or well system.
d. 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. 143-215.10B(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,
Subchapter 2C) and accepts full responsibility for compliance with these rules
fhe-..c-erf P r
Signs a of Applicant o Agent Title of Appli an or *Agent
l- C If signing as Agent, attach authorization agreement stating Printed name of
Applicant or *Agent that you have the authority to act as the Agent.
If the property is owned by someone other than 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(s) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
See Attached
See Attached
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
Swannanoa, NC 28778
Phone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
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I`Wlirngton
GW-22MR Rev. 3-1-2016

GROUND
SURFACE
0.5' —1' PORTLAND CEMENT
ESTIMATED
—35 feet bgs
3' — 4' BENTONITE
SAND 8'-10'
GROUNDWATER
(ESTIMATED 20
FEET BGS)
V
V
MONITORING WELL COVER
1.0-INCH SCH 40 PVC
RISER
4 --INCH BORE
HOLE
1.0-INCH SHC 40 PVC SLOTTED SCREEN
0.01-INCH SLOT WIDTHS
SET TO INTERSECT GROUNDWATER
ESTIMATED 10 FEET IN LENGTH
NOT TO SCALE
C
PROPOSED
MONITORING WELL CONSTRUCTION
Sunbelt 4500 Site
Huffman Mill Road
Burlington, Alamance County, NC
ECS Project No. 49:17259-B

Commercial
shopping
center
Wooded land and
abandoned ►asldenco
Parking lot
SOURCE:
ECS PHASE I (May 2022)
2020 IMAGERY
SCALE SHOWN ABOVE
It>fly Center
shopping center-
-oor Bu
te*
ute*
doatorshtp and
auto ropair facility
- REC
Vacant
Lege n •
• Previous Assessment Groundwater
Sampling Point (November 10, 2022)
• Proposed Permanent Monitoring Well
Location
Proposed Soil -Gas Sampling Point
Proposed Building Footprint Outline
Approximate Parcel Boundary
FIGURE 1
PROPOSED SAMPLE LOCATION MAP
Sunbelt 4500 Site
Huffman Mill Rd
Burlington, Alamance County, NC
ECS Proposal Number: 49:34952P

ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49:34952
Scope of Work: Proposal for Additional Environmental Assessment
Project: Sunbelt 4500
Location: Huffman Mill Road, Burlington, North Carolina (PIN 173295)
As part of the proposed real estate transaction, ECS Southeast, LLP (ECS) has been requested by the
purchaser to conduct due diligence tasks including groundwater and soil -gas sampling at the site. The
groundwater sampling 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 above referenced tasks. By signed below, the property owner authorizes ECS to conduct
the aforementioned sampling at the site.
Property Owner (please print): Ril y ve5 Wle.e 'S,
Property Owner Telephone (please print): 3 36 _ 7 a'6 " `1 C$c�+-f fh ("41 A S Ai It J q50.-)
Property Owner Signature: 544114-------2- P Prer,` Date: 11 / a3 /9 4.