wm0701217_Application_20191023

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ATC ASSOCIATES OF NORTH CAROUNA, P.C.
Engineering Individual Solutions
October 22, 2019
Mr. Robert Tankard
North Carolina Department of Environmental Quality
Washington Regional Office
943 Washington Square Mall,
Washington, NC 27889.
Re: Permit to Construct Temporary Monitoring Well
R.H. Hassell's Grocery
Evan Town Rd and NC 45 South
Colerain, Hertford County, North Carolina
ATC Project No. Hassell007
NCDENR Incident #18885
Dear Mr. Tankard:
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcassociates.com
N.C. Engineering License No. C-1598
Enclosed please find one application for a permit to construct four temporary monitoring wells.
The monitoring well will be located at in farmland, located at the intersection of Evan Town
Road and NC 45 S, in Colerain, North Carolina. The purpose of the temporary wells is to help
delineate the horizontal extent of the impacted groundwater plume. The permit application, site
map with the proposed location of the monitoring well, well construction details and other
relevant information are enclosed as attachments. Please review this package and return the
approved permit to this office.
If you have any questions or require additional information, please contact our office at (919)
948-3553.
Sincerely,
ATC Associates of North Carolina, P.C.
Chris Hanley, P.G.
Project Geologist
Attachments

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER QUALITY — AQUIFER PROTECTION SECTION
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:
2. County:
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant:
5.
31
7
:.3
Applicant's Mailing Address:
Applicant's Email Address (if available):
Contact Person (if different than Applicant):
Contact Person's Mailing Address:
Contact Person's Email Address (if available):
Property Owner (if different than Applicant): _
Property Owner's Mailing Address:
Property Owner's Email Address (if available):
Property Physical Address (including zip code) and PIN Number
Reason for Well(s):
Telephone:
Telephone:
Telephone:
(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:
(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).
11
12
13
14
15
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)?
If yes, give distance(s):
Well Contractor: Certification No.:
Well Contractor Address:
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? Temp Well
material: 1 Will be abandoned after use
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 11 / 18 / 19
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 11 / 18 / 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. 143-215.1013(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agr es that the proposed wells) will be constructed in accordance with approved specifications and conditions of
this wmpII Construction P rmit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
S chapter 2C) and accepts full responsibility for compliance with these rules
Project Geologist
ture of App k ant or Title of Applicant or *Agent
Chris Hanley, P.G. ' 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
See attached
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 Quality's Aquifer Protection Section Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone: [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]
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: [phone]
GW-22MR (Rev. 7/11)

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Raleigh, NC 27604
ASSOC SATES INC. [phone] R. H. HASSELL'S GROCERY
PROJECT NO: 45.36019.0016 EVANS TOWN ROAD AND NC 45 SOUTH
HARRELLSVILLE, HERTFORD COUNTY,
SCALE: SEE ABOVE DATE: 9/2010 REVIEWED BY: MM
NORTH CAROLINA

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Map
55
Proposed Temporary Well Location
2725 E. Millbrook Road, Ste 121
Raleigh, NC 27604
[phone]
PROJECT NO: NA
SCALE: SEE ABOVE I DATE: 4/2016 1 REVIEWED BY: GA
FIGURE 1:
PROPOSED TEMPORARY WELL LOCATIONS
R. H. HASSELL'S GROCERY
EVANS TOWN ROAD AND AND NC 45 SOUTH
HARRELLSVILLE, HERTFORD COUNTY,
NORTH CAROLINA

SITE and PW-1
EURE, CURTIS STALLINGS
PIN:6951-86-6351
PW-2
GRIFFIN, DEBORAH L
PIN:6951-75-2426
Proposed TW Location
ADAMS, ARABELLA
HAYES
PIN:6961-05-0828
PW-3
RASCOE,GREGORY
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PIN:6951-85-2291
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Potable Well Location
VkTC(919)
2725 E. Millbrook Road, Ste 121 FIGURE 3: SITE VICINITY MAP
Raleigh, NC 27604
w 5 S O C i n T E s N O 871-0999 R. H. HASSELL S GROCERY
PROJECT NO: 45.36019.0016 EVANS TOWN ROAD AND AND NC 45 SOUTH
HARRELLSVILLE, HERTFORD COUNTY,
SCALE: SEE ABOVE DATE: 9/2010 REVIEWED BY: VIM NORTH CAROLINA

L1
TEMPORARY MONITORING WELL CONSTRUCTION DETAILS
CROSS SECTIONAL VIEW
(NOT TO SCALE)
GROUND LEVEL
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 5 feet
L2
SEAL
TYPE OF SEAL bentonite
L4
THICKNESS 3 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
WELL SCREEN
L3
SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 10 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 15 feet
'
DEPTH TO BOTTOM OF
BOREHOLE 15 feet
L1 = 0 FT.
L2 = 5 FT.
DIAMETER OF BOREHOLE 6 inches
L3 = 10 FT.
L4 = 15 FT.
TITLE WELL CONSTRUCTION DIAGRAM
VAMASSOCIA
R.H. HASSELL GROCERY
INC.
EVANS TOWN RD & NC 45 SOUTH
2725 East Millbrook Road, Suite 121
COLERAIN, HERTFORD COUNTY
Raleigh, North Carolina 27604
NORTH CAROLINA
FILE 7PREP.BY
DATE
PROJECT NO.
CH
�REV.BY
10/22/2019
1 HASSELL007

kTNAC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
October 3, 2019
Ms. Arabella Adams
100 Hickory Street 102B
Greenville, North Carolina 27858
Re: Environmental Assessment
R.H. Hassell Store
Highway 45 North
Colerain, North Carolina
Hertford County
NCDEQ Incident No. 18885
Dear Ms. Adams:
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
ATC Associates of North Carolina, P.C. (ATC) is conducting an Environmental
Assessment at the former R.H. Hassell Store on behalf of the North Carolina Department
of Environmental Quality (NCDEQ) and Eastern Fuels, Inc. In order to conduct the
assessment, the installation of temporary groundwater monitoring wells on your property
(NC Highway 45 South/Parcel 6961-05-0828), are necessary.
As the property owner, you will not be held responsible or held liable for any damages or
expenses for injury to persons or property in conjunction with Eastern Fuel's
investigation. NCDEQ has requested the completion of this assessment before the end of
the year. If you have any questions regarding ATC authorization to conduct these
activities, please contact Mr. Gabriel Araos, ATC SenHertford County,ior Project
Manager, at 919-871-0999 and reference R.H. Hassell.
Please provide your authorization and approval by signing below and return the signature
page in the enclosed envelope by October 31, 2019. Acknowledgment of this form is
required by NCDEQ.
If you have any questions or would like to further discuss any aspect of this site access
request, please contact us at 919-871-0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Brian Buchanan
Staff Scientist
cc: Mr. Wood Beasley
Gabriel Araos, P.E.
Senior Project Manager

ENVIRDNMENTAL• GEDTECNNICAL
BUILDING SCIENCES • MATERIALS TESTING
Ms. Arabella Adams
October 3, 2019
Page 2 of 2
Enclosure
Access
approved
cess denied
Ac
Phone number
(If you wish to be notified prior to field activities)
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www,atcgroupservices.com
N.C. Engineering License No. C-1598