WM0401523_WM0401523 permit application_20240315

2725 East Millbrook Road
Iff Suite 121
Aff Raleigh, NC 27604
WF kTc Tel: [phone]
Fax:[phone]
ENVIRONMENTAL • GEOTECNNICAL www.atcgroupservices.com
BUILDING SCIENCES • MATERIALS TESTING N.C. Engineering License No.C-1598
March 18, 2024
Mr. Lon Snider
North Carolina Department of Environmental Quality
Winston-Salem Regional Office
450 W. Hanes Mill Road Suite 300
Winston-Salem,NC 27105
Re: Permit to Construct Monitoring Wells
J&J Dry Cleaner
81 Plaza Parkway
Lexington, Davidson County,North Carolina
DSCA Site ID: DC290005
Dear Mr. Snider:
Enclosed please find an application for a permit to construct one temporary groundwater
monitoring well and a nested pair of shallow and deep groundwater monitoring wells. The
groundwater monitoring wells will be located at 15 Plaza Parkway in Lexington, Davidson
County, North Carolina. The permit application, site map with the proposed locations of the
monitoring wells, well construction details and other relevant information are enclosed as
attachments. Please review this package and return the approved permit to this office or via email
to [e-mail].
If you have any questions or require additional information, please contact our office at (919)
871-0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Robert Broda, P.G.
Project Manager

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: 3/18/2024
2. County: Davidson PERMIT NO. ISSUED DATE
3. What type of well are you applying for?(monitoring or recovery): Monitoring Well
4. Applicant: Flagship Realty, LLC (Petitioner for DSCA Site ID DC290005) Telephone: [phone]
Applicant's Mailing Address: DWM DSCA Program,Attn: Scott Stupak, 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address(if available): Scott.Stu pak(a)deg.nc.gov
5. Contact Person (if different than Applicant): Robert Broda,ATC Associates of North Carolina, P.G. Telephone: [phone]
Contact Person's Mailing Address: Robert Broda, 2725 E. Millbrook Road, Ste 121, Raleigh, NC 27604
Contact Person's Email Address(if available): Robert.Broda(a)oneatlas.com
6. Property Owner(if different than Applicant): Lexington Parkway Plaza, LLC C/O New South Properties of the Carolinas, LLC
Telephone: [phone]
Property Owner's Mailing Address: 1518 East 3rd Street, Ste 200, Charlotte, NC 28204
Property Owner's Email Address(if available): [e-mail]
7. Property Physical Address(Including PIN Number) 15 Plaza Parkway(PIN: 6724-04-72-7672)
City Lexington County Davidson Zip Code 27292
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: NCDEQ DSCA Program Site
(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).
J &J Dry Cleaner, DSCA Site ID: DC290005
11. Type of contaminants being monitored or recovered: Dry-cleaning Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, seven existing monitoring wells
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0401262
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): 65 feet and 170 feet
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: Ameriprobe, LLC Certification No.: 4196-B
Well Contractor Address: P.O. Box 135, Huntersville, NC 28070
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? Locking well cap,
material: 3 8"flush mount manhole cover
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 5/1/2024
4. Total Number of wells to be constructed: 3 7. Estimated construction completion date: 5/2/2024
(add answers from 2 and 3)
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.
�On behalf of Petitioner for DSCA Site DC290005 Agent for Petitioner for DSCA Site DC290005
Signature of Applicant or*Agent Title of Applicant or*Agent
Robert Broda *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 consent See attached access consent
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 Raleigh Regional Office
Swannanoa, NC 28778 3800 Barrett Drive Wilmington Regional Office
Phone: [phone] Raleigh, NC 27609 127 Cardinal Drive Extension
Fax: [phone] Phone: [phone] Wilmington, NC 28405
Fax: [phone] Phone: [phone]
Fayetteville Regional Office Fax: [phone]
225 Green Street, Suite 714 Washington Regional Office
Fayetteville, NC 28301-5094 943 Washington Square Mall Winston-Salem Regional Office
Phone: [phone] Washington, NC 27889 450 W. Hanes Mill Road
Fax: [phone] Phone: [phone] Suite 300
Fax: [phone] Winston-Salem, NC 27105
Mooresville Regional Office 6-9800
610 East Center Avenue W'" I° 797
Mooresville, NC 28115 ✓L al gh
Phone: [phone] r � !}
Fax: [phone]
F ettville
1Nil ngton
GW-22M/R(Rev.5-26-2022)

LEGEND: /� / /� v ^ • ,�.A
MW-2 MONITORING WELL i ' 3^ o u < u
-/�\ i
�,0.00557�Well Identification
Y PCE Concentration(mg/L) �`� �� `. Y �. 0 0
TEMPORARY MONITORING WELL \
�J01� (TERRACON) r < �
Boring Identification ' o
MW-1 DESTROYED MONITORING WELL
x "— -Well Identification w
--- SOURCE PROPERTY LINE 15 Plaza Parkway *� M
� w 1
PARCEL LINE �. 0 11
PCE ISOCONCENTRATION CONTOUR w
—0.007— (DASHED WHERE INFERRED)(mg/L) a o
NOTE:ALL LOCATIONS ARE APPROXIMATE F
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Groundwater Monitoring Well o M
*Mw-5 advanced to 20' bgs (Screen
Proposed Nested Wells (Two 1" Diameter <0.00050o rom 5-20' below round surface Z
ells. One to be installed on the top of r W
N bedrock [estimated 50' below ground = 2 <
= i surface] with 5' screen and one to be o z
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0_ \ ,1- � ~ • Date:
02/02/2024
a 3,
-•-��.., 7 1 . Scale:
� 0 20 40 60 w AS SHOWN
Attachment:
ti R SCALE:1"=60' 7

MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP PROTECTIVE CASING AND CONCRETE PAD
L1 CASING MATERIAL N/A
CASING DIAMETER N/A
CASING LENGTH N/A
PAD DIMENSIONS N/A
HEIGHT ABOVE GROUND flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 1 inch
JOINT TYPE flush threaded
PK-
LENGTH 5 feet
L2 BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 1 feet
SEAL
TYPE OF SEAL bentonite
L4 THICKNESS 2 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
WELL SCREEN
L3 SCREEN MATERIAL sch 40 PVC
DIAMETER 1 inch
LENGTH 15 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 20 feet
DEPTH TO BOTTOM OF
BOREHOLE 20 feet
L1 = 0 FT.
L2= 5 FT. DIAMETER OF BOREHOLE 6 inches
L3= 15 FT.
L4= 20 FT.
TITLE Temporary Monitoring Well TMW-1
J & J Dry Cleaner TC 2725 East Millbrook Road
81 Plaza Parkway Suite 121
ENVIRONMENTAL•GEOTECHNICAL
Lexington, Davidson County BUILDING SCIENCES•MATERIALS TESTING Raleigh, North Carolina 27604
North Carolina
FILE PREP. BY REV. BY DATE DSCA ID:
BB RB 3/18/2024 DC290005

MW-8S / MW-8D Wells finished at surface with locking
well caps and 8"diameter flush-
mounted manhole cover with 2'by 2'
concrete pad.
Two Nested 1"Diameter Schedule 40 PVC
Casings Extending From Ground Surface to Top
of Screens
20 Feet Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
2-Foot Bentonite Seal
Groundwater Table
15 Feet of 1"Schedule 40 Well Screen(0.010"Slot)
2 Filter Sand Pack Extending From 1 Foot
Below Bottom of Screen to 2 Feet Above Screen
IF
Bentonite Seal Extending from 2 Feet Above
Bottom Screen to 1 Foot Below Top Screen
30 Feet
#2 Filter Sand Pack Extending From Bottom of
Hole to 2 Feet Above Screen
5 Feet of 1"Schedule 40 Well Screen(0.010"Slot)
Not to Scale
ATC
2725 E.Millbrook Road, Suite 121 WELL CONSTRUCTION DETAIL
Raleigh,NC 27604
ENVIRUNMENTAL•GEBTECNNICAL [phone]
BUILDING SCIENCES•MATERIALS TESTING J&J Dry Cleaner
81 Plaza Parkway
DSCA Site ID: DC2905SL05
Lexington,North Carolina
DSCA Site ID: DC290005
DATE: 3/18/24 REVIEWED BY: RB

ROY COOPER NORTH CAROLINA
Governor. Environmental Quallty
MICHAEL S.REGAN
Serrriary
MICHAEL SCOTT
Director
PROPERTY ACCESS CONSENT
This document may not be modified without the Prograin's approval. Her DSCA Use Only
IJ;vou have questions on host,to,fill out this for or a out the it tivities DSCA iD No.
at this site lease all the ry leanin olvent leanu t
ro ra s ontra tar for this ro e t ason hittle with DC290005
sso iates of orth arolina at ason whittle fa:atcgs.cont or
Ifyou still have questions after onta tin r hittle
with lease onta t the ro e t ana er tie ur 11v at
tiuc nutrphytuanederingov or
Plcase Print
Lexington Parkway Plaza, LLC C/O New South Properties of the Carolinas,LLC
(Name of Property Owner or Tenant in Residence)
15 Plaza Parkway (Parcel 1134700000048)
(Street Number and Street Name of Property)
Lexington Davidson 27292
(City or Town in Which Property Is Located) / (County in Which Property is Located) / (Zip Code)
I voluntarily consent to the Division of Waste Management (Division) and its independent
contractors (contractors) entering and having continued access to my property for the following
purposes:
(1) taking such soil,groundwater and/or air samples as may be necessary;
(2) taking other actions related to the investigation of surface or subsurface conditions;
(3) taking response actions necessary to mitigate any threat to human health or the environment.
Other conditions:
(1) The Division and its contractors shall attempt to perform any activities at the Property in a
manner that minimizes interference with use of the Property.
�DREE
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Access Request for 15 Plaza Parkway Page 2 of 2
J&J Dry Cleaner May 4,2020
DSCA Site#:DC290005
(2) On conclusion of all activities,the Division and its contractors shall,to the extent practicable,
restore the Property to the original condition it was in prior to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance
with applicable laws and regulations,unless other arrangements are agreed to by the Property
Owner.
(3)The Division or its contractors will make reasonable attempts to notify the Property Owner at
least 48 hours prior to entering the Property for any purpose. In situations that the Division
determines to be of an emergency nature,the Division or its contractors shall have immediate
access to the property.
(4) Property Owner shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without prior consent of the Division.
By signing this consent document,I acknowledge that 1 am the legal property owner or tenant
In residence that has the authority to allow this work on the property and have contacted all
tenants(if there are tenants)occupying the property and all tenants agree to the conditions
of this"Property Access Consent".
S ecial Condition Specific to this Consent:
Nonvithstanding anything in the contrary in the Agreement, Division aclarow dg�s tJtat Plaza
LLC has not and shall not contact all tenants occupying the propeii}r and that Plaza LLC makes
no representation regarding the consent(or lack thereq)}of any tenant to the Agreement.
i
(Signature of Property Ovkder or Tenant in Residence) (Date)
77( << ! �-�-� (-4- C 1'A7 C°y(e l OL'4"°` Gam.
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
C. LOyIe c-� t(dS()L,
Camay) �5-1
( mail Address for Property Owner or Tenant in Residence tf you prefer to be contacted via
email)
i
Please return form to:
Jason Whittle
ATC Associates of North Carolina,P.C.
7606 Whitehall Executive Center Drive,Suite 800
Charlotte,NC 28273
Or via email to:[e-mail]
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