MO-29269_48436_CA_RPTS_20221010_Municipal Water Connections and Water Supply Well Abandonments Letter Report

Geological Resources, Inc.
October 10, 2022
Ms. Trudy Beverly
NCDEQ-UST Section
Mooresville Regional Office
610 East Center Ave.
Mooresville, NC 28115
Re: Municipal Water Connections and
Water Supply Well Abandonments Letter Report
15901 Cramur Drive
Huntersville, Mecklenburg County
North Carolina 28078
Incident Number: 48436
GRI Project Number: 5728
Dear Ms. Beverly,
Please find enclosed the referenced report for the above mentioned site.
If you have any questions, please contact Sam McKay at 704-845-4010.
Sincerely,
Geological Resources, Inc.
Johanna Moats
AP/AR Coordinator
Enclosure
Cc: Mr. Jeremy Martin, Ultimate Athlete, file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

Geological Resources, Inc.
October 10, 2022
Mr. Jeremy Martin
Ultimate Athlete
11235 Sam Furr Road, Suite 101
Huntersville, North Carolina 28078
Re: Municipal Water Connections and Water Supply Well Abandonments
15901 Cramur Drive Project
Huntersville, North Carolina 28078
NCDEQ Incident #48436
GRI Project #5872
Dear Mr. Martin:
Geological Resources, Inc. (GRI) presents this report that addresses the recent municipal water
connections and water supply well abandonment activities associated with the above referenced site
(Figure 1). The purpose of these activities was to eliminate potential receptors identified during
underground storage tank (UST) closure activities conducted at the site in November 2021. The results of
the UST closure activities were outlined in GRI's Initial Abatement Action Report dated December 8, 2021.
To reduce the risk to potential receptors at the subject site and in the area of the subject site, municipal
water connections were completed at two residential properties and two water supply wells were
abandoned. A summary of those activities is outlined as follows:
MUNICIPAL WATER CONNECTIONS AND WATER SUPPLY WELL ABANDONMENT
GRI prepared municipal water connection agreements for the following property owners:
• Mr. Henry Lee Cook, II (PID #00102319) and Ms. Sana Nasrallah (PID #00102320). The water
supply well located on the Henry Lee Cook property serviced both the Henry Lee Cook residence
and the Sana Nasrallah residence. Signed Public Water Connection Agreements were received
from Mr. Cook and Ms. Nasrallah on July 28, 2022 and August 24, 2022, respectively. Copies of
the executed agreements are included as Appendix A. Municipal water connections to both
residences were reportedly completed on September 7, 2022.
• GRI mobilized a licensed North Carolina Well Driller to the site on September 23, 2022. Both the
Henry Lee Cook water supply well (Cook Well) and the on -site water supply well (15901 Cramur
Drive Well) were abandoned in accordance with North Carolina Department of Environmental
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

Municipal Water Connections & Water Supply Well Abandonment
15901 Cramur Drive Project
GRI Project No. 5872
Page 2 of 2
Quality's Division of Water Resources guidelines. The locations of the water supply wells are
shown on Figure 2. Copies of the water supply well abandonment forms are included as
Appendix B.
Based on this information, and the information provided in the December 8, 2021 IAAR provided by GRI,
GRI will request that a NORR be submitted to Ultimate Athlete by the NCDEQ directing that a Notice of
Residual Petroleum (NRP) be prepared and submitted along with Public Notification. Once the NORR is
received from the NCDEQ and the NRP and Public Notification process is complete, we will request that a
Notice of No Further Action on this incident be processed as soon as possible due to the pending property
transaction.
We appreciate the opportunity to provide these services to you. Should you have any questions, please
do not hesitate to contact me at [phone] or [phone].
Sincerely,
Geological Resources, Inc.
W. Scott Ball
Project Manager
cc: Ms. Trudy Beverly — NCDEQ Mooresville Regional Office — UST Section
file
attachments
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] [phone] 9 Fax [phone]

FIGURES

c. —k'. ` 1
•� � �'��0 '`t-0 �� f � + , � ` ge,
.
/ 1 Pumpng r` I' w V
,,; �,�- ' • „gym
� S
Figure 1
Site Location
"'" 15901 Cramur Drive Property
15901 Cramur Drive
Huntersville, North Carolina
Mecklenburg County
►� 500 M Incident No. N/A
c 2000 FT GRI Project No. 5872
7Dat7il/26/2021 Location: 35.428619° N-80.913304' W

LEGEND
x x x— FENCE
TREE LINE
------------------ UNDERGROUND STORAGE TANK
❑o WATER SUPPLY WELL
Note:
1. This Site Map is based on data from the
Mecklenburg County, NC CIS office.
2. This site was not professionally surveyed; locations
of utilities, tank components and other site features
are approximate.
41
SITE MAP
0 30 60 120
15901 Cramur Drive Property 15901 Cramur Drive
Incident No. N/A Huntersville, North Carolina
( IN FEET) GRI Project No. 5872 Mecklenburg County
Geological Resources, Inc. 1 inch —60 ft Date: 11/20/2021 Drawn by: DTH Figure: 2

APPENDICES

APPENDIX A
Municipal Water Connection Agreements

Geological Resources, Inc.
June 20, 2022
Mr. Henry Lee Cook II
15915 Cramur Drive
Huntersville, North Carolina 28078
Re: Public Water Connection Agreement
15901 Cramur Drive Incident
Huntersville, Mecklenburg County, North Carolina
Parcel No. 00102319
Incident #48436
GRI Project No. 5872
Dear Mr. Cook:
Geological Resources, Inc. (GRI) completed underground storage tank (UST) removal, soil remediation
and assessment activities at the 15901 Cramur Drive site in November 2021. Concentrations of
petroleum contaminants that exceeded the North Carolina Department of Environmental Quality
(NCDEQ) action levels were reported in soil samples collected during the UST removal activities. Based
on this information, GRI proposes to connect properties within 250 feet of the source area that contain
a potable water supply well to municipal water to lower the NCDEQ risk classification of the release.
It is GRI's understanding that you are the owner of the property (15915 Cramur Drive) identified as
Parcel No. 00102319 and that water supply well (WSW -Cook) is located on this property. On behalf of
the current owner (Ultimate Athlete) of the 15901 Cramur Drive site, GRI is requesting your permission
to connect your property to public water. Costs associated with providing a public water connection to
your property and abandonment of your water supply well will be covered by Ultimate Athlete.
Please indicate in the spaces provided below if you will or will not allow your property to be connected
to the public water supply. We would greatly appreciate a response, even if you elect not to connect
your property to public water at this time.
Your cooperation in this matter will be greatly appreciated. If you have any questions, please feel free
me at [phone].
Sincerely,
kip4g .j/
W. Scott Ball
Project Manager
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

Municipal Water Hookup
15901 Crarnur Drive
Page 2 of 2
Yes, I agree to allow my property to be connected to the public water supply.
No, I do not agree to allow my property to be connected to the public water supply.
b
� s
Signature Date
(For Mecklenburg County Parcel No. 00102319)
Henry Lee Cook II
-')o`f - G 1'�-I--41 '� a
Phone Number
WSW - Cook
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

DocuSign Envelope ID: F4ACB331-97D9-4186-8F39-197A13EDAC49
Geological Resources, Inc.
June 29, 2022
Ms. Sana Nasralla
1009A Westbrook Drive
Charlotte, North Carolina 28202
Re: Public Water Connection Agreement
15901 Cramur Drive Incident
Huntersville, Mecklenburg County, North Carolina
Parcel No. 00102318
Incident #48436
GRI Project No. 5872
Dear Ms. Nasralla:
Geological Resources, Inc. (GRI) completed underground storage tank (UST) removal, soil remediation
and assessment activities at the 15901 Cramur Drive site in November 2021. Concentrations of
petroleum contaminants that exceeded the North Carolina Department of Environmental Quality
(NCDEQ) action levels were reported in soil samples collected during the UST removal activities. Based
on this information, GRI proposes to connect properties within 250 feet of the source area that contain
a potable water supply well to municipal water to lower the NCDEQ risk classification of the release.
It is GRI's understanding that you are the owner of the property (15921 Cramur Drive) identified as
Parcel No. 00102320 and that this property is connected to water supply well (WSW -Cook), located on
the adjoining Henry Lee Cook property. On behalf of the current owner (Ultimate Athlete) of the 15901
Cramur Drive site, GRI is requesting your permission to connect your property to public water. Costs
associated with providing a public water connection to your property and abandonment of the Cook
water supply well will be covered by Ultimate Athlete. Please indicate in the spaces provided below if
you will or will not allow your property to be connected to the public water supply. We would greatly
appreciate a response, even if you elect not to connect your property to public water at this time.
Your cooperation in this matter will be greatly appreciated. If you have any questions, please feel free
me at [phone].
Sincerely,
hapoaj/
W. Scott Ball
Project Manager
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

DocuSign Envelope ID: F4ACB331-97D9-4186-8F39-197A13EDAC49
Municipal Water Hookup
15901 Cramur Drive Incident
Page 2 of 2
�x Yes, I agree to allow my property to be connected to the public water supply.
❑ No, I do not agree to allow my property to be connected to the public water supply.
FDOCUSignedby- DocuSigned by:
113
54�"
S Off
Signature
(For Mecklenburg County Parcel No. 00102320)
Ms. Sana Nasralla
704-7779-6194 or 704-779-9244
Phone Number
WSW - Cook
7/28/2022
Date
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] [phone] 9 Fax [phone]

DocuSign Envelope ID: F4ACB331-97D9-4186-8F39-197A13EDAC49
roiaris 3 ff map — Mecklenburg County, North Carolina
Nasralla property
Date Printed: 6/27/2022 7:16:35 AM

DocuSign Envelope ID: F4ACB331-97D9-4186-8F39-197A13EDAC49
MECKLENBURG COUNTY, North Carolina
POLARIS 3G PARCEL OWNERSHIP AND GIS SUMMARY
Stream Watershed Districts
Stream Watershed Name I LAKE NORMAN
Watershed Class
CA
FEMA and Community Floodplain
FEMA Panel#
3710462100J
Date Printed
Identity
Parcel ID GIS ID
00102320 100102320
Property Characteristics
Legal desc
L2 M10-261 &TRACT
Land Area
0.595 AC
Fire District
HUNTERSVILLE
Special District
FIRE SERVICE D
Account Type
INDIVIDUAL
Municipality
HUNTERSVILLE
Property Use
SINGLE FAMILY
RESIDENTIAL -
WATERFRONT
Zoning
Contact appropriate Planning Department or see Map.
Water Quality Buffer
Parcel Inside Water Quality Buffer I Yes Post Construction District
Jurisdiction Huntersville
District Huntersville
06/27/2022
Ownership
Owner Name
Mailing Address
SANA NASRALLA
1009A WESTBROOK DR
CHARLOTTE NC 28202
STEPHEN PAUL SCOTT
1009A WESTBROOK DR
CHARLOTTE NC 28202
Deed Reference(s) and Sale Price
Deed
Sale Date
Sale Price
34617-358
05/27/2020
$738,000.00
08179-899
06/16/1995
$210,000.00
08179-896
06/16/1995
$0.00
Situs Addresses Tied to Parcel
kiRAMUR DR HUNTERSVILLEBuilt-Upon Area Restriction
Limit on amount of Built -Upon Area Yes
Site Location
ETJ Area
Huntersville
Charlotte Historic District
No
Charlotte 6/30/2011 Annexation Area
No
Census Tract #
62.04
This map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps,
surveys, planimetric maps, and other public records and data. Users of this map or report are hereby notified that the aforementioned public primary
information sources should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal responsibility for the
information contained herein.
Page 1/1

APPENDIX B
Water Supply Well Abandonment Forms

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Sam Bowers
Well Contractor Name (or well owner personally abandoning well on his/her property)
3222—A
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #: NA
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial RResidential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Storrnwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned: 9/23/2022
5a. Well location:
Ultimate Athlete NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: 1
7b. Approximate volume of water remaining in well(s): 0.0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:Sodium Hypoehlorite
7d. Amount of disinfectant used: 1 Pound
7e. Sealing materials used (check all that apply):
S Neat Cement Grout N Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Bentonite 35 Pounds
Portland Neat Cement 25 Pounds
7g. Provide a brief description of the abandonment procedure:
Pump and wiring were removed.
Tremie Bentonite Chips and Portland
Cement from total depth to grade
Facility/Owner Name Facility ID# (if applicable) S. Certification:
15901 Cramur Drive, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
00102370
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.428031 N 80.913761 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: 15901 Well
6b. Total well depth: Approx 50 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: 25 (ft.)
6e. Outer casing length (if known): U n k ft.)
6f. Inner casing/tubing length (if known): NA (ft.)
6g. Screen length (if known): U n k (ft.)
Signature of Certified Well Contractor or Well Owner
9/28/2022
Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Sam Bowers
Well Contractor Name (or well owner personally abandoning well on his/her property)
3222-A
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial RResidential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Storrnwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned: 9/23/2022
5a. Well location:
Henry Lee Cook NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: 1
7b. Approximate volume of water remaining in well(s): 0.0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:Sodium Hypoehlorite
7d. Amount of disinfectant used: 1 Pound
7e. Sealing materials used (check all that apply):
S Neat Cement Grout N Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Bentonite 900 Pounds
Portland Neat Cement 650 Pounds
7g. Provide a brief description of the abandonment procedure:
Pump and wiring were removed.
Tremie Bentonite Chips and Portland
Cement from total depth to grade
Facility/Owner Name Facility ID# (if applicable) S. Certification:
15915 Cramur Drive, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
00102319
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.428608 N 80.913981 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: Cook Well
6b. Total well depth: Approx 1 50 (ft.)
6c. Borehole diameter: 6 (in.)
6d. Water level below ground surface: 22 (ft.)
6e. Outer casing length (if known): U n k ft.)
6f. Inner casing/tubing length (if known): NA (ft.)
6g. Screen length (if known): U n k (ft.)
Signature of Certified Well Contractor or Well Owner
9/28/2022
Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Beverly, Trudy
From: Beverly, Trudy
Sent: Tuesday, October 11, 2022 8:11 AM
To: Johanna Moats
Cc: Scott Ball; Tomie Benton; Leslie Maxtone-Graham
Subject: RE: [External] 15901 Cramur Drive Property / WSW Abandonment
Received.
Trudy
u�en irunsne o7 Uffff nmentil 0"wry
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
North Carolina Department of Environmental Quality
UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy. B everlykncderin gov
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Office Mailing Address:
610 East Center Avenue, Suite 301
Mooresville, NC 28115
UST Petroleum Releases Website Address: https://deg.nc.gov/about/divisions/waste-management/underground-storage-tanks-section/corrective-action-branch
Non -UST Petroleum Releases Website Address: https://deg.nc.goy/about/divisions/waste-management/ust/nonust-program
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
httt)s://deo.nc. eov/about/divisions/waste-management/waste-management-rules-data/waste-management-L,is-mans
File Review Procedures:
htti s://deq.nc.gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
httj2s://deg.nc.gov/about/divisions/waste-manaaement/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
https:Hfiles.nc. gov/ncdeg/Waste%2OManagement/D WM/UST/WhatsNew/Final-Electronic-Document-Submittal-Policy_.pdf
htips:Hfiles.nc. gov/ncdeq/Waste%2OManagement/DWM/UST/Corrective%2OAction/UST%2Ofile%20names%20for%2OLaserfiche.docx
From: Johanna Moats<jmoats @geoIogicaIresourcesinc.com>
Sent: Monday, October 10, 2022 5:12 PM
To: Beverly, Trudy <[e-mail]>
Cc: Scott Ball<[e-mail]>; Tomie Benton<[e-mail]>; Leslie Maxtone-
Graham<[e-mail]>
Subject: [External] 15901 Cramur Drive Property / WSW Abandonment
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hello Ms. Beverly,
Please find attached the Municipal Water Connections and WSW Abandonment letter report for above mentioned site.
Thank you.
Best Regards,
Johanna Moats

AP/AR Coordinator
Geological Resources, Inc.
2021 Winner of the Union County Chamber Excellence In Business Award
3502 Hayes Road
Monroe, NC 28110
Main [phone] Fax [phone]
[e-mail]
www.geologicalresourcesinc.com
NCPCM Vendor of the Year Recipient