WM0401454_Monitoring Well Permit Application_20230601

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: 5/23/23
2. County:
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): monitoring
4. Applicant: BEEJU LLC attn: Minaben Patel Telephone: [phone]
Applicant's Mailing Address: 1122 E Morehead St Burlington NC 27215
Applicant's Email Address (if available): minapatel1972(c gmail.com
5. Contact Person (if different than Applicant): Ryan Kerins Telephone: [phone]
6.
7.
8.
9.
10.
11.
12,
13.
14.
Contact Person's Mailing Address: 100 E Ruffin St Mebane NC 27302
Contact Person's Email Address (if available): rdkerins(a_terraguestpc.com
Property Owner (if different than Applicant): SWC REVOCABLE TRUST 101 Attn Elmo Cobb Telephone: [phone]
Property Owner's Mailing Address: 1155 MAPLE AVE Burlington NC 27215
Property Owner's Email Address (if available):
Property Physical Address (Including PIN Number) 1155 MAPLE AVE PIN: 132989
City Burlington County Alamance Zip Code27215
Reason for Well(s): assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed:
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
Type of contaminants being monitored or recovered:
(ex: organics, nutrients, heavy metals, etc.)
Are there any existing wells associated with the proposed well(s)? If yes, how many?
Existing Monitoring or Recovery Well Construction Permit No(s).:
Distance from proposed well(s) to nearest known waste or pollution source (in feet):
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: Terraquest Environmental Consultants, P.c. Certification No.: 300
Well Contractor Address: 100 E Ruffin St Mebane NC 27302
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. 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 5. How will the well(s) be secured? Locking cap and
material: 2 manhole
3. Number of wells to be constructed in bedrock: 0
6. Estimated beginning construction date: June 2023
4. Total Number of wells to be constructed: 2
(add answers from 2 and 3) 7. Estimated construction completion date: June 2023
ADDITIONAL INFORMATION
1. 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 assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Agent, see attached Project Manager
Signature of Applicant or *Agent Title of Applicant or *Agent
Ryan D. Kerins * 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
well(s) as outlined in this Well Construction Permit application and acknowledges that it shall be the responsibility of the Applicant to
ensure that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C.
See attached agreement SWC REVOCABLE TRUST 101 Attn Elmo Cobb
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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22M/R (Rev. 5-26-2022)

AGREEMENT FOR SERVICES
This Agreement is made and entered into this 9th day of November, 2021, by and between Terraquest Environmental Consultants, P.C.
(hereinafter called "Terraquest"), and Minaben Patel (hereinafter called "CLIENT"), to provide for Terraquest to perform the services described
herein, in accordance with the terms and conditions set forth below and in the attached Schedules A and B, which are incorporated and made a part
hereof by reference, and payment to Terraquest by CLIENT.
RECITALS
CLIENT hereby engages Terraquest to conduct environmental investigations ("Services") for "Rick's Food Mart" located at 1122 F. Morehead St.
Burlington, NC 27360 (the "Property"),
In consideration of the matters described above, and of the mutual benefits and obligations set forth in this Agreement, the CLIENT and Terraquest
agree as follows:
1. Property Conditions: Upon execution of this Agreement, and as required throughout the project, CLIENT shall provide Terraquest with all
site information and any other such data in the possession of CLIENT as applicable and necessary for Terraquest to provide Services for the Property.
Additionally, CLIENT represents that the Property is either owned or leased by CLIENT or CLIENT has a written permit or authorization of the Property
Owner to allow Terraquest to entry upon and about the Property to perform its Services for the benefit of Client.
2. Environmental Documents: CLIENT hereby authorizes Terraquest to sign environmental documents, including but not limited to any
regulatory or government documents, on CLIENT's behalf, as CLIENT's agent for the purposes of this project and Services.
3. Price and Payment:
A. The price for the Services defined in this Agreement have been determined by Terraquest and quoted to CLIENT in a "Basis of Charges"
attached Schedule A. Terraquest's "Standard Rate Sheet" is attached as Schedule B and incorporated and a part hereof by reference as the basis for
any additional adjustments to the initial Price of Services for the Project. The Parties acknowledge that the attached cost estimate for the Services
may fluctuate depending on the Property conditions and time constraints. In the event that additional charges will be milled to CLIENT, all such
charges shall be based on the units and rates contained in attached Schedules.
B. It is mutually agreed by CLIENT and Terraquest that CLIENT shall timely make all payments for Services performed by Terraquest at the Property
under this Agreement. Payment of all invoices rendered pursuant to this Agreement shall be due and payable upon invoice submission date from
Terraquest. Any unpaid invoice balances 30 days past the invoice date shall accrue interest at the rate of 1.5% per month (18% per annum) until paid
in full. Any payments received after the specified due date are subject to an additional late fee of $35 as an administrative fee which shall be due
and payable on the 3111 day after the specified original invoice due date. Terraquest reserves the right to withhold the disclosure or release of its
determined data or any summary report or opinion until full payment has been made by CLIENT. Terraquest does not accept payment from real
estate closings.
C. For CLIENTS seeking reimbursement with the NC Leaking Underground Storage Tank Trust Fund it is further understood and agreed to by both
parties that each party will make every reasonable effort to enable CLIENT to obtain funds from the NC Trust Fund, but that Terraquest makes no
guarantee that such funds will be available to CLIENT for any of the costs associated with this Agreement.
4. GENERALTERMS & CONDITIONS
A. Terraquest is an independent consultant and agrees to provide to CLIENT, for its sole benefit and exclusive use, the consulting services set forth
In this Agreement. This Agreement shall not be assigned by CLIENT withoutthe prior written consent of Terraquest. All reports, information, analysis,
and data submitted by Terraquest to CLIENT shall remain confidential and shall not be disclosed to third parties without the prior written consent of
Terraquest; notwithstanding anything contrary herein, Terraquest reserves the right to report or disclose to any governmental or regulatory
authorities its findings if required by applicable regulation, code, law or court order.
B. Either party may terminate this Agreement without cause upon three (3) days' written notice to the other party. In the event that CLIENT requests
termination prior to completion of Services by Terraquest, CLIENT agrees to timely pay Terraquest for all incurred costs and services that Terraquest
has rendered prior to such notice upon invoice delivery by Terraquest.
C. Terraquest will perform its Services using the degree of skill and care that is ordinarily exercised under similar conditions by comparably situated
environmental consulting professionals. NO OTHER WARRANTY, EXPRESS OR IMPLIED, 15 MADE OR INTENDED TO BE MARE BY THIS AGREEMENT,
EITHER BY ORAL OR WRITTEN STATEMENTS. CLIENT agrees that Terraquest's liability to CLIENT or to any third party due to any negligent professional
acts or omissions shall not exceed and be limited to the amount of Terraquest's professional fees for the Services contemplated under this Agreement.
D. The Parties agree to perform all acts as reasonable and necessary for Terraquest to provide the Services on the Property and for CLIENT to make
timely payment to Terraquest pursuant to this Agreement.
E. ARBITRATION; WAIVER OF JURY TRIAL. The Parties agree that any dispute or controversy regarding the subject matter of this Agreement which
cannot be amicably resolved between the Parties shall be submitted to binding arbitration, pursuant to the NCRUAA (G.S. § 1-569.1 et seq.), upon
the written notice of either party delivered to the other of such party's intention to arbitrate and shall otherwise conform to the requirements set
forth below,
The alternative dispute resolution procedures which shall apply under this Agreement are as follows: If the parties cannot informally settle the dispute
within ten (10) days after receipt of the written notice of a dispute, then said dispute shall be settled by binding arbitration, conducted on a
confidential basis, pursuant to the NCRUAA (G.S. § 1-569.1 et seq.). All arbitration proceedings shall be held in Alamance County, North Carolina.
Judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction, and the arbitrator may include provisional
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MERM_que 0

remedies in their award. The arbitrator shall determine all questions of fad and law relating to any controversy, claim ordispute hereunder, including
but not limited to whether or not any such controversy, claim or dispute is subject to the arbitration provisions contained herein.
Any party desiring arbitration shall serve notice of intent to arbitrate on the other party, in accordance with the NCRUAA (G.S. § 1-569.3). The
arbitrator shall be agreed upon by both parties; if the parties fail to agree on an arbitrator, then the arbitrator shall be appointed pursuant to G.S. §
1-569.11. The parties shall bear their own attorney fees, costs and expenses associated with the arbitration. The arbitrator's fees shall be split evenly
between the parties. The arbitrator shall make a determination within three (3) months after the dispute is submitted for arbitration.
Notwithstanding the existence of a tlispute and until the arbitrator render a decision, each party shall be obligated tofulfill its obligations and continue
its performance in accordance with the terms hereof.
Notwithstanding anything herein to the contrary, each party retains the right to pursue in Small Claims Court any dispute within that court's
jurisdiction. Further, this Arbitration provision shall apply only to disputes in which either party seeks to recover an amount of money (excluding
attorneys' fees and costs) that exceeds the jurisdictional limit of the Small Claims Court.
G. CLIENT shall indemnify Terraquest and hold it harmless from and against any loss, damage, claim or injury which Terraquest or its subcontractor
shall suffer or incur as a result of any breach of this Agreement by CLIENT or as a result of any Incomplete or Incorrect information or data CLIENT
provides to Terraquest including boundary surveys of the property provided by CLIENT. CLIENT shall be responsible for and shall pay to Terraquest,
its directors, officers, or employees for all actual, general, and special consequential damages, Including attorneys' fees, costs of suits, costs of
arbitration, costs of appeal, which may be awarded in any arbitration or litigation instituted by or against CLIENT to recover any of the foregoing
items indemnified or to obtain injunctive relief from CLIENT'S failure to perform as specked in this Agreement. In addition to the foregoing and not
in limitation thereof, CLIENT shall indemnify and hold harmless Terraquest from any and all claims, liabilities, losses, damages and expenses, incurred
or arising from the performance of or resulting from acts of Terraquest performed in the course and within the scope of its engagement herewith
provided such are done in good faith; this indemnification and release shall specifically include (but not be limited to) any acts of Terraquest that
result in damage to public or private utilities on the Property. This indemnification shall survive the termination of employment and engagement of
Terraquest.
I. Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified mail or
overnight delivery to the respective address of each Party as set forth below.
1. The invalidity of any portion of this Agreement shall not be deemed to affect the validity of any other provision.
K. Terraquest may from time to time on behalf of CLIENT arrange for the services of subcontractors and others. All costs to Terraquest for those
services of subcontractors associated with providing services of this Agreement and/or contemplated for the Project shall be paid by CLIENT upon
rendering of invoice.
L. This Agreement shall be governed in all respects by the laws of the State of North Carolina. All litigation, arbitration, or legal proceedings associated
with this Agreement shall be conducted in a forum within Alamance County, State of North Carolina, unless otherwise agreed in writing bythe Parties.
M. This Agreement and attached Schedules A and B (the "Attachments") constitutes the entire agreement between the Parties and cannot be
changed or modified except by a written instrument signed by both Parties.
N. Neutral Interpretation and Counterparts. The Parties shall be deemed to have cooperated in the drafting and preparation of this Agreement.
Hence, any construction to be made of this Agreement shall not be construed against any Party. This Agreement may be executed in counterparts
and each executed counterpart shall be effective as the original. All faxed, entailed, or electronic signatures affirming this Agreement constitute an
original signature.
IN WRNEM WHEREOF, the Parties have caused this Agreement with the Incorporated Attachments to be executed in duplicate originals
by their duly authorized representatives on the date first set forth above.
CLIENT:
NIRMALPATEL
By, .3
Minaben Patel
Address for Notices:
Page 2 of 2
TERRAOUEST ENVIRONMENTAL CONSULTANTS, P.C.
BY:/�VYARR�
Authorized Representative
Address for Notices:
Terraquest Environmental Consultants, P.C.
100 East Ruffin St
Mebane, NC 27302
Z/ ' •

ACCESS AGREEMENT FORM
Access is hereby granted to BEEJU, LLC, Terraquest Environmental Consultants, P.C., and their
agents and assigns for the purpose of installing, sampling, and maintaining groundwater
monitoring wells on the property located in Burlington, NC with the Alamance County Parcel
Identification Number 132989.
The proposed well locations are shown on the enclosed figure. Note that the monitoring well
locations may be adjusted at the time of drilling, should unanticipated utilities, trees, shrubs,
structures, or other obstructions be encountered at the location shown of the enclosed figure.
Typical groundwater monitoring well details are enclosed for reference. The wells will be
constructed in accordance with regulations under Title 15A NCAC 2C.
BEEJU, LLC will be responsible for all costs associated with the NCDWM-UST-directed installation,
maintenance, and subsequent abandonment of the wells, and assessment and remediation of
the contaminant plume associated with the petroleum release that has the NCDWM-UST Incident
No. 47816.
Once the NC Division of Waste Management's Underground Storage Tank Section has issued a
Notice of No Further Action, the well will be abandoned by filling with cement or bentonite in
accordance with the rules contained within Title 15A NCAC 2C.
o
SWC Revocabl Trust 101— Authorized Representative
TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C.
Ryan D. Kerins, Project Manager
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MAP SOURCE: USGS 7.5 MINUTE TOPOGRAPHIC MAP OF BURLINGTON, NC
GRAPHIC SCALE
0' 2,000' 4,000'
SITE LOCATION MAP
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1122 E. E. MOREHEAD ST.
BURLINGTON, ALAMANCE COUNTY, NO
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BEEJU LLC BURLINGTON NC
PROJECT NO. 04221
DRAWN BY: JRG
DATE: 2/15/23
ENVIRONMENTAL CONSULTANTS, P.C.
SCALE: 1" = 2,000'
CHECKED BY: MJB
FIGURE NO. 1

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FIGURE 4 - TYPICAL TYPE II MONITORING WELL DETAIL
8" MANHOLE COVER
rel
LOCKING CAP
GENERAL INFORMATION
/ CEMENT GROUT Groundwater monitoring wells are simple 2"
diameter wells used to monitor groundwater
quality. They are constructed using Schedule 40
PVC piping and screen as shown in the diagram
to the left. Upon completion, an 8" round
8'
/
manhole cover is installed over the well for
protection. In the event that the well is
9'
BENTONITE SEAL installed in an area where there exists the
possibility that it could be damaged such as an
10'
-
TOP OF SCREEN agricultural field, an aboveground or stickup
_
manhole will be used. After the manhole is set,
—
a small concrete pad is poured around the
—_
manhole. Both the manhole and pad are flush
—
with the ground surface, except as noted, and
—
will not interfere with driving, mowing, foot
—_
traffic, etc. Type II monitoring wells are used
—
for sampling groundwater from shallow,
—
unconfined aquifers. They are used to
determine the horizontal extent of contamination.
—
Well Driller:
—_
Terraquest Environmental Consultants, P.C. -
-
Jonathan R. Grubbs #3001
-
GRAVEL PACK
30'
-
BOTTOM OF SCREEN
BOTTOM OF BORING
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TEP4MIUest
ENVIRONMENTAL CONSULTANTS, P.C.