WM0401506_Monitoring well permit applicantion: WM0401506_Reddings_20240118

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.
FOR OFFICE USE ONLY
1. Date: 1/17/2024
2. County: Wilkes PERMIT NO. ISSUED DATE
3. What type of well are you applying for?(monitoring or recovery): Monitoring
4. Applicant: NCDEQ Telephone: [phone]
Applicant's Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699
Applicant's Email Address(if available): scott.rvals(cDncdenr.gov
5. Contact Person (if different than Applicant): Greg Hans Telephone: [phone]
Contact Person's Mailing Address: 3525 Whitehall Park Drive, Suite 150, Charlotte, NC 28273
Contact Person's Email Address(if available): ghans(crDces-group.net
6. Property Owner(if different than Applicant): Southernmost Holdings, LLC (attn.: Shaun Redding)
Telephone [phone]
Property Owner's Mailing Address: 6040 Wilkes Yadkin Road, Ronda, NC 28670
Property Owner's Email Address(if available): shawnredding(a-)gmail.com
7. Property Physical Address(Including PIN Number): 5606 Wilkes-Yadkin Road (Wilkes County PIN:4837-47-2443
City Ronda County Wilkes Zip Code 28670
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: USTs
(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 known water quality permits. NCDEQ UST Incident#45154
11. Type of contaminants being monitored or recovered: organics/metals
(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 Known
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): Installed within/around Source Area
(Approx. 0-50 ft.)
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No known
If yes, give distance(s):
15. Well Contractor: Carolina Soil Investigation Certification No.: Corey Speece#2904/Daniel
Summers#2579
Well Contractor Address: 132 Gurney Road, Olin, NC 28660
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 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? 2 x 2 pad,well cover,
material: 1 locking j-plug
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: Week of
1/29/2024(at the earliest)
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3) 7. Estimated construction completion date: Same Day
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.
A6
Environmental Division Manager
Signature of Applicant or*Agent Title of Applicant or*Agent
Greg Hans *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 Access Agreement with NCDEQ State Trust Fund)
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] Raleigh Regional Office
Fax: [phone] 3800 Barrett Drive
Raleigh, NC 27609
Fayetteville Regional Office Phone: [phone] Wilmington Regional Office
225 Green Street, Suite 714 Fax: [phone] 127 Cardinal Drive Extension
Fayetteville, NC 28301-5094 Wilmington, NC 28405
Phone: [phone] Washington Regional Office Phone: [phone]
Fax: [phone] 943 Washington Square Mall Fax: [phone]
Washington, NC 27889
Mooresville Regional Office Phone: (2 - 04n Regional Office
610 East Center Avenue Fax: (2 - sale ill Road
Mooresville, NC 28115 ✓L al gh
Phone: [phone] r 27105
Fax: [phone] 1 ' - 00
11s r le 6-979
F Ott "Ile Q .>
VVII•ngton

1/17/24, 1:54 PM 5606 Wilkes Yadkin Rd-Google Maps
a alle Maps 5606 Wilkes Yadkin Rd
Proposed Monitoring Well Location
427
421
0 421
421
Old 421
Proposed Monitoring
Well Location
.Detail
Fj
d
r •
Imagery @2024 CNES/Airbus,Maxar Technologies,U.S.Geological Survey,Map data @2024 100 ft
https://www.google.com/maps/place/5606+Wilkes+Yadkin+Rd,+Ronda,+N C+28670/@36.1462256,-80.9159849,352m/data=!3m 1!1 e3!4m6!3m5!1 sOx8851 7b975ac01 1 e5:Ox6421 565c5f8aec44!8m2!3d3... 1/1

Iw_` ENVIRONMENTAL PROTECTION
HAZARDOUS SITES RESPONSE PROGRAM
BE0001U
TYPICAL
FLUSH-MOUNT GROUNDWATER MONITORING WELL
CONSTRUCTION DIAGRAM
TOP OF MANHOLE
V-2"
2"-3-- TOPOFCA3 +. BOLTED MANHOLE COVER
` v+jam CONCRETE PAD
MANHOLE SLEEVE
LOCKING WELL CAP
(SPACING DEPENDS
ON WELL DEPTH) 2" SCHEDULE 40 PVC PIPE
BENTONITE GROUT
•'Y;
2 FEET
BENTONITE SEAL
' �'
TYPE
2 FEET
J/ SAND PACK
GRAIN SIZE
2" SLOTTED SCHEDULE
40 PVC SCREEN
10 FEET
6„ BOTTOM CAP
6° BOTTOM OF BORING
ANNULUS

t, %rA ROY COOPER
� o Governor
w._ 1 Z023
ELIZABETH BISER
eQL,>`dprl Secretary
Waste Management ` MICHAEL SCOTT
ENVIRONMENTAL QUALITY
Director
October 30,2023
Mr. Scott Ryals
DWM UST Section Environmental Engineer
1646 Mail Service Center
Raleigh,NC 27699-1646
RE: State-Lead Acceptance
Redding's BP Service
5606 Wilkes—Yadkin Rd
Ronda, Wilkes County, NC
Incident Number 45154
Dear Mr. Ryals
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and
hereby permit the Department of Environmental Quality (Department) or its contractor to enter upon said
property for the purpose of conducting an assessment and/or remediation of the groundwater and/or soils
under the authority of G.S. 143-215.94G.
I am/We are granting permission with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the Department or
its contractor in accordance with the acceptance of the site into the State-Lead Program. The
Department or its contractor shall protect and Isrevert darna-c to the surrounding lands. Any damage
will be restored by the Department or its contractor to as close to the pre-work condition as practicably possible. ,
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest
feasible route to the nearest public road. The Department or its contractor will notify the landowners
48 hours prior to entry and may enter upon the land at reasonable tithes and have full right of access
during the period of the investigation.
4. Any claims which may arise against the Department, or its contractor shall be governed by Article 31
of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and
Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon request and
is a public record, in accordance with G.S. l 32-1.
Nothin Com ares�:
State of North Carolina j Environmental Quality I Waste Manageulcrt
1646 Mail Service Center 1217 West Jones Street j Raleigh,NC 27699-1646
1119 707 8200 T'

_y
�l
6. The activities to be carried out by the Department or its contractor
are f r the
eprima r aren fit o incidental.
Department and of the State of North Carolina. Any g
The Department or its contractor is not and shall not be construed to be an agent, employee, or
contractor of the landowner.No representations of North Carolina, orhts/theiressed or contractor(s)1ed regarding the
,have been
made to me/by the Department, the State
results that may be obtained or the quality of work to be performed.
I/We agree not to interfere with,remove or any ways damage the Department's well(s)or its
contractor's well(s) and equipment during the investigation.
Sincerely,
47X
UA.'
Signature
sACtLAik- Pdd1tis
Type/Print Name of owner or Agent
Phone Nu er/E-mail Address
Address
ityiStateiZip Code
; 1 5 2 6d,3
Date
RE: State-Lead Acceptance
Redding's BP Service
5606 Wilkes—Yadkin Rd
Ronda,Wilkes County, NC
Incident Number 45154
�Nothing Compares-;
State of North Carolina I Environmental Quality!Waste Management
1646 Mail Service Center 1 217 West]ones Street I Raleigh,NC 27699-1646
919 707 8200 T