WM0801138_Application_20190731

CESQNCa
June 28, 2019
Eric Rice
North Carolina Department of Environmental Quality
Division of Water Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
CES of NC, PLLC
301 McCullough Drive, Suite 400
Charlotte, North Carolina 28262
704.909.2911 [office]
540.343.6259 [facsimile]
RE: MONITORING WELL PERMIT APPLICATION
GPM 3035 (FORMER SCOTCHMAN #35)
7162 MARKET STREET
WILMINGTON, NEW HANOVER COUNTY, NORTH CAROLINA
NCDEQ UST INCIDENT NO.: 32152
Dear Mr. Rice:
On behalf of GPM Southeast, LLC, Crawford Environmental Services of North Carolina, PLLC is
submitting the enclosed "Application for Permit to Construct a Monitoring or Recovery Well System". If
you have any questions, please contact us at [phone] or [phone].
Sincerely,
Crawford Environmental Services of North Carolina, PLLC
i
Aaron Williamson Daniel J. Fisher, PMP
Project Manager Director of Mid -Atlantic Operations
enclosure

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: 6/18/19
2. County: New Hanover
3.
4.
5.
6.
7.
8.
9.
10
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: GPM Southeast, LLC Telephone:
[phone]
Applicant's Mailing Address: 8565 Magellan Parkway, Suite 400, Richmond, VA 23227
Applicant's Email Address (if available):
Contact Person (if different than Applicant): Crawford Environmental Services Telephone: [phone]
Contact Person's Mailing Address: 1701 Shenandoah Avenue NW, Roanoke, VA 24017
Contact Person's Email Address (if available):
Property Owner (if different than Applicant): NCDOT (Right -of -Way) Telephone: [phone]
Property Owner's Mailing Address: 5501 Barbados Boulevard, Castle Hayne, NC 28429
Property Owner's Email Address (if available): _
Property Physical Address (Including PIN Number
Citv Wilmington
Closest parcel: 7162 Market Street, PIN# R04405-001-003-000
_County New Hanover Zip Code 28405
Reason for Well(s): Groundwater 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: Former UST
(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).
NCDEQ UST Incident No. 32152
11. Type of contaminants being monitored or recovered: Petroleum hydrocarbons
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? No (Destroyed/Abandoned)
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): <25 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: Regional Probing Services Certification No.: NC 3322-A
Well Contractor Address: PO Box 1161, Wake Forest, NC 27588
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?
material: Two (2) Locking Expandable Plug
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 7/1/19
4. Total Number of wells to be constructed: 2 7, Estimated construction completion date: 8/1/19
(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 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 Nort 'Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these les
Signa ❑Applicant or *Agent Title of Applicant or *Agent
w * 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 encroachment agreement
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]
AR Rev. 3-1-2016

WELL ID:
INSTALL DATE:
PROJECT:
PROJECT NUMBER:
WELL CONSTRUCTION
MW-1R & MW-5R
TBD
GPM 3035
LOCKABLE EXPANDING PLUG
PROTECTIVE COVER
MATERIAL
DIAMETER
LENGTH
SETTING DIMENSIONS
HEIGHT ABOVE GROUND
WELL CASING / RISER
MATERIAL
DIAMETER
LENGTH
JOINT TYPE
ANNULAR FILL
MATERIAL
THICKNESS
ANNULAR SEAL
TYPE
THICKNESS
FILTER PACK
TYPE
DISTANCE ABOVE SCREEN
WELL SCREEN
MATERIAL
DIAMETER
LENGTH
SLOT SIZE
DEPTH TO BOTTOM OF WELL
DEPTH TO THE BOTTOM OF
FILTER SAND
BOREHOLE DIAMETER
L1 =
0.25
feet
L2 =
10
feet
L3 =
10
feet
L4 =
20.25
feet
CRAWFORD NVIRONMENTAL
SERVICES
steel
8 inches
1 feet
2.0x2.0x0.5d feet
0 feet
polyvinyl chloride (PVC)
2 inches
10 feet
locking thread
Grout cement
6 feet
Sodium-bentonite (granular)
2 feet
#2 filter sand
2 feet
PVC
2 inches
10 feet
0.01-inch horizontal slot
20 feet
20.25 feet
8 inches

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LEGEND CLIENT: GPM Investments, LLC
Mw-1 0 Monitoring Well (Shallow) 7162 Market Street Figure 2
MW-2 ® LOCATION: Monitoring Well (Deep) Wilmington, North Carolina
AS-1 ♦ Air Sparge Well
Former Scotchman #3035
SVE-10 Soil Vapor Extraction Well 0 15, 30' 60'
eO? Utility/Power Pole I Site Map
—OHE— Overhead Electric Line 1 inch equals 30 feet
EOP End of Pavement Groundwater Monitoring Report

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
ROY COOPER
GOVERNOR
June 13, 2019
Aaron Williamson
Project Manager
Crawford Environmental Services, Inc.
1701 Shenandoah Ave NW
Roanoke, VA 24017
JAMES H. TROGDON III
SECRETARY
Subject: Encroachment Agreement (E033-065-19-00169) to install 2 groundwater monitoring wells at the
intersection of Market Street and Middle Sound Loop Road
Dear Mr. Williamson,
Attached for your files is an executed copy of the Encroachment Contract Agreement which covers the
proposed installation of the above Subject.
Please do not begin any of the actual relocations of your facilities until a Utility Relocation
Scheduling Conference (URSC) has been held. Please coordinate with Mr. Daniel Waugh, Resident
Engineer -Wilmington or his designated representative at [phone] to arrange for a URSC meeting
within ten (10) working days of receipt of this correspondence and prior to beginning the actual utility
relocations. If your company is using a contractor/ sub -contractor, then the contracting company must
attend the URSC meeting. A schedule should be determined in this Conference that will be suitable for
all. After a schedule has been determined, you should diligently pursue installing your facilities and
adhering to the schedule.
Please ensure that all necessary right of way and environmental permits are secured to accommodate
your proposed work. This could delay your work start and end dates as reflected above. If your work is
delayed by these types of issues, the department, in coordination with your staff will develop new work
timelines.
Take note that the installation of any utility is subject to the environmental rules and regulations of the
State of North Carolina. Violation of the NC Sedimentation Pollution Control Act, Clean Water Act, NC
Coastal Management Act, or other environmental commitments outlined in the projects permits will not
be tolerated and may result in work stoppage, penalties, and/or construction delays.
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] BARBADOS BOULEVARD
DIVISION OF HIGHWAYS Customer Service: 1-877-368-4968 CASTLE HAYNE, NC 28429-5647
5501 BARBADOS BOULEVARD
CASTLE HAYNE, NC 28428

A copy of the fully executed encroachment agreement which includes Division 3's Encroachment
Agreement Standard Conditions, is required to be on site when work is performed.
Work is being conducted in a designated night work only area. If a traffic lane closure is needed
traffic lanes will only be closed during the hours of 9:00 pm and 5:00 am.
A Continuing performance and Indemnity Bond (106991688) posted with the North Carolina Department
of Transportation is hereby obligated to cover work under this encroachment agreement.
This approval is subject to this work being done in accordance with the attached plan sheets.
Be advised that this encroachment falls within the limits of NCDOT Transportation Improvement
Project (TIP) U-4751 currently under construction. Any encroachment work performed by your
company that conflict with the construction of this project shall be removed and/or relocated at
the owner's expense.
Once work has been completed, inspected, and approved by an authorized NCDOT inspector, an
electronic copy of "As Built" plans (noted with any changes) sealed, signed, and dated by a licensed
North Carolina Professional Engineer, should be submitted to the Division 3 Utilities Coordination
Office for their files. Failure to submit the "As Built" plans within two weeks after completion of
construction will result in automatic revocation of this encroachment.
Thank you for your cooperation in this matter.
Sincerely,
I/DocuSigned by:
f�.Orvnr2 �±�L
4494B7BC702E4D4...
Lonny Sleeper
Division Utility Engineer
cc: Daniel Waugh, PE, Resident Engineer -Wilmington

Encroachment# E033-065-19-00169
ROUTE US 17 and SR 1403 PROJECT
TIP U-4751 STATE OF NORTH CAROLINA
COUNTY OF New Hanover
DEPARTMENT OF TRANSPORTATION RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS ON
-AND- PRIMARY AND SECONDARY HIGHWAYS
Crawford Environmental Services, Inc.
1701 Shenandoah Ave NW, Roanoke, VA 24017
704-909-2911
THIS AGREEMENT, made and entered into this the 13th day of June , 20 19 , by and between the Department
of Transportation, party of the first part; and Crawford Environmental Services, Inc.
party of the second part,
WITNESSETH
THAT WHEREAS, the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) US17 and SR 1403 located Within 100 feet west of the intersection of Market
St and Middle Sound Loop Road
with the construction and/or erection of:
Two groundwater monitoring wells mounted flush with grade
WHEREAS, it is to the material advantage of the party of the second part to effect this encroachment, and the
party of the first part in the exercise of authority conferred upon it by statute, is willing to permit the encroachment
within the limits of the right of way as indicated, subject to the conditions of this agreement;
NOW, THEREFORE, IT IS AGREED that the party of the first part hereby grants to the party of the second
part the right and privilege to make this encroachment as shown on attached plan sheet(s), specifications and
special provisions which are made a part hereof upon the following conditions, to wit:
That the said party of the second part binds and obligates himself to install and maintain the encroaching facility in such safe
and proper condition that it will not interfere with or endanger travel upon said highway, nor obstruct nor interfere with the proper
maintenance thereof, to reimburse the party of the first part for the cost incurred for any repairs or maintenance to its roadways
and structures necessary due to the installation and existence of the facilities of the party of the second part, and if at any time the
party of the first part shall require the removal of or changes in the location of the said facilities, that the said party of the second
part binds himself, his successors and assigns, to promptly remove or alter the said facilities, in order to conform to the said
requirement, without any cost to the party of the first part.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs, signal
lights, Flagmen and other warning devices for the protection of traffic in conformance with the latest Manual on Uniform Traffic
Control Devices for Streets and Highways and Amendments or Supplements thereto. Information as to the above rules and
regulations may be obtained from the Division Engineer of the party of the first part.
That the party of the second part hereby agrees to indemnify and save harmless the party of the first part from all damages
and claims for damage that may arise by reason of the installation and maintenance of this encroachment.
It is clearly understood by the party of the second part that the party of the first part will assume no responsibility for any
damage that may be caused to such facilities, within the highway rights of way limits, in carrying out its construction and
maintenance operations.
That the party of the second part agrees to restore all areas disturbed during installation and maintenance to the satisfaction of
the Division Engineer of the party of the first part. The party of the second part agrees to exercise every reasonable precaution
during construction and maintenance to prevent eroding of soil; silting or pollution of rivers, streams, lakes, reservoirs, other water
impoundments, ground surfaces or other property; or pollution of the air. There shall be compliance with applicable rules and
regulations of the North Carolina Division of Environmental Management, North Carolina Sedimentation Control Commission, and
with ordinances and regulations of various counties, municipalities and other official agencies relating to pollution prevention and
control. When any installation or maintenance operation disturbs the ground surface and existing ground cover, the parry of the
second part agrees to remove and replace the sod or otherwise reestablish the grass cover to meet the satisfaction of the Division
Engineer of the party of the first part.
That the party of the second part agrees to assume the actual cost of any inspection of the work considered to be necessary
by the Division Engineer of the party of the first part.
That the party of the second part agrees to have available at the encroaching site, at all times during construction, a copy of
this agreement showing evidence of approval by the party of the first part. The party of the first part reserves the right to stop all
work unless evidence of approval can be shown.
Provided the work contained in this agreement is being performed on a completed highway open to traffic; the party of the
second part agrees to give written notice to the Division Engineer of the party of the first part when all work contained herein has
been completed. Unless specifically requested by the party of the first part, written notice of completion of work on highway
projects under construction will not be required.
That in the case of noncompliance with the terms of this agreement by the party of the second part, the party of the first part
reserves the right to stop all work until the facility has been brought into compliance or removed from the right of way at no cost to
the party of the first part.
That it is agreed by both parties that this agreement shall become void if actual construction of the work contemplated herein
is not begun within one (1) year from the date of authorization by the party of the first part unless written waiver is secured by the
party of the second part from the party of the first part.
FORM R/W 16.1A (January, 1981)

RA(V (161A) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
R/W (161A) incorporating all revisions to date.
IN WITNESS WHEREOF, each of the parties to this agreement has caused the same to be executed the day and
year first above written.
^^Ds DEPARTMENT OF TRANSPORTATION
BY:
D r'816N UTILITY ENGINEER
ATTEST OR WITNESS:
C.fO�ar� �115 ircnr��YU�S Lro✓�rd E'r►v,f dnnen �. ( Svd�c� Zrec.
�O�eSS� d't,�� P1aj ec J`ter„ti g-�r- 704-909-2911
704-909-2909 Second Party
INSTRUCTIONS
When the applicant is a corporation or a municipality, this agreement must have the corporate seal and
be attested by the corporation secretary or by the empowered city official, unless a waiver of corporate
seal and attestation by the secretary or by the empowered City official is on file in the Raleigh office of the
Manager of Right of Way. In the space provided in this agreement for execution, the name of the
corporation or municipality shall be typed above the name, and title of all persons signing the agreement
should be typed directly below their signature.
When the applicant is not a corporation, then his signature must be witnessed by one person. The
address should be included in this agreement and the names of all persons signing the agreement
should be typed directly below their signature.
This agreement must be accompanied, in the form of an attachment, by plans or drawings showing the
following applicable information:
1. All roadways and ramps.
2. Right of way lines and where applicable, the control of access lines.
3. Location of the proposed encroachment.
4. Length and type of encroachment.
5. Location by highway survey station number. If station number cannot be obtained, location
should be shown by distance from some identifiable point, such as a bridge, road,
intersection, etc. (To assist in preparation of the encroachment plan, the Department's
roadway plans may be seen at the various Highway Division Offices, or at the Raleigh
office.)
6. Drainage structures or bridges if affected by encroachment.
7. Typical section indicating the pavement design and width, and the slopes, widths and
details for either a curb and gutter or a shoulder and ditch section, whichever is applicable.
8. Horizontal alignment indicating general curve data, where applicable.
9. Vertical alignment indicated by percent grade, P.I. station and vertical curve length, where
applicable.
10. Amount of material to be removed and/or placed on NCDOT right of way, if applicable.
11. Cross -sections of all grading operations, indicating slope ratio and reference by station
where applicable.
12. All pertinent drainage structures proposed. Include all hydraulic data, pipe sizes, structure
details and other related information.
13. Erosion and sediment control.
14. Any special provisions or specifications as to the performance of the work or the method of
construction that may be required by the Department must be shown on a separate sheet
attached to encroachment agreement provided that such information cannot be shown on
plans or drawings.
15. The Department's Division Engineer should be given notice by the applicant prior to actual
starting of installation included in this agreement.
16. Method of handling traffic during construction where applicable.
17. Scale of plans, north arrow, etc.