WM0501391_Application_20200210

N C
F kT
ENVIRONMENTAL • GEOTECNNICAL
BUILDING SCIENCES • MATERIALS TESTING
February 4, 2020
Mr. Rick Bolich
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
North Carolina Department of Environmental Quality
Raleigh Regional Office
Di6vision
o Service Water
Resources — Water Quality Regional Operations Section
8 Center a�o0
�
Raleigh, North Carolina 27699-1628 t �O
Re: Permit to Construct Monitoring Wells
7Ninth
Bernard's
34 Street
Wear — DSCA Site #DC320031
Durham, Durham County, North Carolina 27705
DSCA Site No. DC320031
Dear Mr. Bolich:
Enclosed please find three applications for permits to construct three monitoring wells (MW-2,
MW-3, and MW-4). The monitoring wells will be located at 714 Iredell Street (PIN#: 0822-18-
32-5007), 725 Iredell Street (PIN#: 0822-18-32-3316), and 2024 West Main Street (PIN#: 0822-
18-21-7804) in Durham, North Carolina. The permit applications, 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.
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.
o11Ki r ---
Robert Broda, P.G.
Project Geologist

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: 02/04/2020
2. County: Durham
FOR OFFICE USE ONLY
PERMIT NO. kJMeb2Pt3j/ ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Norma Jean LLC (Petitioner for DSCA site #DC320031) Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Services Center 1646, Raleigh NC 27699-1646
Applicant's Email Address (if available): al.chapman(a)ncdenr.gov
5. Contact Person (if different than Applicant): Robert Broda, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh NC 27604
Contact Person's Email Address (if available): Robert. broda(c�atcgs.com
6. Property Owner (if different than Applicant): Blacknall Memorial Presbyterian Church Telephone: [phone]
Property Owner's Mailing Address: 1902 Perry Street, Durham North Carolina 27705
Property Owner's Email Address (if available): LCENEZY(a-)BLACKNALL.ORG
7. Property Physical Address (Including PIN Number) 714 Iredell Street (PIN #0822-18-32-5007)
City Durham County Durham Zip Code 27705
8. Reason for Well(s): Groundwater contamination
(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: Former Dry-cleaner
(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).
Type of contaminants being monitored or recovered:
(ex: organics, nutrients, heavy metals, etc.)
Chlorinated Solvents
Are there any existing wells associated with the proposed well(s)? If yes, how many? No U
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A
Distance from proposed well(s) to nearest known waste or pollution source (in feet): 345
Are there any water supply wells located less than 500 feet from the proposed well(s)? Nod''? T wCID
If yes, give distance(s):
15. Well Contractor: Innovative Environmental Technologies Inc. Certification No.: 3287-B U
Well Contractor Address: 232 Highway 49 S, Concord, NC 28025
PROPOSED WELL CONSTRUCTION INFORMATION
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: 1 Flush -mount steel protective casing
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 02/25/2020
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 02/27/2020
(add answers from 2 and 3)
ADDITIONAL INFORMATION
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 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 North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
/ 71-
Signature of Applicant or *Agent
Robert Broda. P.G. (Agent for Petitioner for DSCA Site #320031)
Printed name of Applicant or *Agent
Agent for DSCA Site DC320031 (will include power of attorney
Title of Applicant or *Agent upon request)
* If signing as Agent, attach authorization agreement stating
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 access agreement See attached access 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

ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
PROPERTY ACCESS CONSENT
This document may not he mortified without the Program's approval. O
For DSCA Use nh
If you have questions on how to fill out this forin or about the activities DSCA [p
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Programn's contractor for this project, Robert Broda with. ATC DC320031
Associates of North Carolina, P.C. (ATC) at Robert.Broda vategs.com
or [phone]. If you still have questions after contacting Mr. Broda with
ATC, please contact the DSCA project manager, AI Chapman at
ALChaUman6'v.ncdenr.gov or 919-707-8368.
Please Print
Blacknall Memorial Presbyterian Church
(Name of Property Owner or Tenant in Residence)
714 Iredell Street
(Street Number and Street Name of Property)
Durham Durham County 27705
(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:
(I) 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.
North Catalina Depw I nwnt of tnsironmental Quality ; Division of Waste Manmgrment
217 West loiws Street 1 I6•16 Mail Service Ctnitr i Ratcigli, ivtuth Cardlna 21699•I6d6
919.707.8200

(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 I 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".
b- Z}l`1Y U V, -vet� f iU/,
(Signature of Property Owner or Tenant in Residence) (Date)
2.
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
(Email Address for Property Owner or Tenant in Residerwjef you prefer to be contacted via
email)
Please return form to:
Robert Broda, P.G.
ATC Associates of North Carolina, P.C.
2725 East Millbrook Road, Suite 121
Raleigh, NC 27504
Or via email to: Robert.BrodaPatcgs.com
.t.�T..�.� D_EQ
North CmDtina Department of Environmental Quality I M-Won of Waste Management
217 West fonts 5mrt i 1646 NW1 Service Center , RAtigh. N *nh Cm odtna 27699.1tA6
919.707.8200

20'
OA C
F kT
ENVIRONMENTAL • OEOTECHNICAL
Well finished at surface with locking
well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
2" Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-5 feet)
2-Foot Bentonite Seal
15 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
(5-20 feet)
Groundwater Table
#2 Filter Sand Pack Extending 2 feet Above Screen
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3231 SL02
WELL CONSTRUCTION DETAILS
Bernard's Formalwear
734 Ninth Street
Durham, Durham County, NC 27705
DSCA ID: DC320031
DATE: 02/04/2020
REVIEWED BY: RB

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: 02/04/2020
2. County: Durham
FOR OFFICE USE ONLY
PERMIT NO. 4,�Ao6DaS/ ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Norma Jean LLC (Petitioner for DSCA site #DC320031) Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Services Center 1646, Raleigh NC 27699-1646
Applicant's Email Address (if available): al.chapman(a)ncdenr.gov
5. Contact Person (if different than Applicant): Robert Broda, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh NC 27604
Contact Person's Email Address (if available): Robert. broda(o)atcgs.com
6. Property Owner (if different than Applicant): 725 Iredell LLC Telephone: [phone]
Property Owner's Mailing Address: Walter K. Cleary, 180 Keeneland Trail Corbin Kentucky, 40701
Property Owner's Email Address (if available): waltercleary(aVrontier.com
7. Property Physical Address (Including PIN Number)_ 725 Iredell Street (PIN# 0822-18-32-3316)
City Durham County Durham Zip Code 27705
8. Reason for Well(s): Groundwater contamination
(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: Former DrV-cleaner
(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. Type of contaminants being monitored or recovered: Chlorinated Solvents
(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).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 180
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: Innovative Environmental Technologies Inc. Certification No.: 3287-B
Well Contractor Address: 232 Highway 49 S, Concord NC 28025
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)
Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Locking well cap,
material: 1 Flush -mount steel protective casing
Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed:
(add answers from 2 and 3)
6. Estimated beginning construction date: 02/25/2020
Estimated construction completion date: 02/27/2020
ADDITIONAL INFORMATION
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 North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
Signature of Applicant or *Agent
Robert Broda, P.G. (Agent for Petitioner for DSCA Site #320031)
Printed name of Applicant or *Agent
Agent for DSCA Site DC320031 (will include power of attorney
Title of Applicant or *Agent upon request)
* If signing as Agent, attach authorization agreement stating
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 access agreement See attached access 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

ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
PROPERTY ACCESS CONSENT
This document tnay not be modified without the Program's approval. For DSCA Use Only
If you have questions on how to fill out this form or about the activities DSCA ID No.
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program's contractor for this project, Robert Broda with ATC DC320031
Associates of North Carolina, P. C. (ATC) at Robert.Broda(d),atc s.com
or [phone]. If you still have questions after contacting Mr. Broda with
ATC, please contact the DSCA project manager, Al Chapman at
AI.Chapman64ncdenr.gov or [phone].
Please Print
725 Iredell LLC
(Name of Property Owner or Tenant in Residence)
725 Iredell Street
(Street Number and Street Name of Property)
Durham Durham County 27705
(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.
North Carolina Department of Wronmental Quality 1 Mistonof Waste Management
217 Wcst Janes street 11646 Mari service Center I Ra*k North Ovotina 276" 1646
919.707,8200

(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 I 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".
(Signature of Property Owner or
(Telephone
l
for Property Owner or Tenant in Residence for scheduling work/notification)
I- Cle4d-.
(Email Address for Property
email)
Please return form to:
Robert Broda, P.G.
ATC Associates of North Carolina, P.C.
2725 East Millbrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
in Residence if you prefer to be contacted via
e:::�Q. <A -
Nora h Carolina Dcp3rt menl of Environmental Quality I Division of Wasle Ntanagement
217 West Jones Street 11646 Mali $mice Ctnte>• I Raklgh. North CaroUna 216991646
919.707,6200

20'
Well finished at surface with locking
well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
2" Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-5 feet)
2-Foot Bentonite Seal
15 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
(5-20 feet)
Groundwater Table
#2 Filter Sand Pack Extending 2 feet Above Screen
2725 E. Millbrook Road, Suite 121
AV Raleigh, NC 27604
ffir kTc [phone]
ENVIRONMENTAL - GEOTECHNICAL
.DING SCIENCES - MATERIALS TESTING
PROJECT NO: DC3231 SL02
WELL CONSTRUCTION DETAILS
Bernard's Formalwear
734 Ninth Street
Durham, Durham County, NC 27705
DSCA ID: DC320031
DATE: 02/04/2020
REVIEWED BY: RB

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: 02/04/2020
2. County: Durham
FOR OFFICE USE ONLY
PERMIT NO. _kLs6 J';( ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Norma Jean LLC (Petitioner for DSCA site #DC320031) Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Services Center 1646, Raleigh NC 27699-1646
Applicant's Email Address (if available): al.chapman(a),ncdenr.gov
5. Contact Person (if different than Applicant): Robert Broda, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh NC 27604
Contact Person's Email Address (if available): Robert. broda(o)..atcgs.com
6. Property Owner (if different than Applicant): CPGPI Erwin Mill, LLC Telephone: [phone]
Property Owner's Mailing Address: 1330 Saint Marys Street, Suite 100, Raleigh NC 27605-3334
Property Owner's Email Address (if available): lack.dunn(Dcpgre.com
7. Property Physical Address (Including PIN Number) 2024 West Main Street (PIN #0822-18-21-7804)
City Durham County Durham Zip Code 27705
8. Reason for Well(s): Groundwater contamination
(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: Former Dry-cleaner
(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
11. Type of contaminants being monitored or recovered: Chlorinated Solvents
(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).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 260
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: Innovative Environmental Technologies Inc. Certification No.: 3287-B
Well Contractor Address: 232 Highway 49 S, Concord, NC 28025
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
G. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Locking well cap,
material: 1 Flush -mount steel protective casing
Number of wells to be constructed in bedrock:
Total Number of wells to be constructed: 1
(add answers from 2 and 3)
6. Estimated beginning construction date: 02/25/2020
Estimated construction completion date: 02/27/2020
ADDITIONAL INFORMATION
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 North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
Signature of Applicant or *Agent
Robert Broda. P.G. (Agent for Petitioner for DSCA Site #320031)
Printed name of Applicant or *Agent
Agent for DSCA Site DC320031 (will include power of attorney
Title of Applicant or *Agent upon request)
* if signing as Agent, attach authorization agreement stating
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 access agreement See attached access 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

RIGHT OF ENTRY AGREEMENT
Effective Date:
Janurary 17, 2020
Owner:
CPGPI Erwin Mill LLC
Licensee:
ATC Associates of North Carolina, P.C. as approved contractor of the
North Carolina Department of Environmental Quality, Licensee of
Waste Management
Property:
2024 West Main Street, Durham, NC 27705
License Area:
The area shown for the Proposed Groundwater Monitoring Well on the
attached Exhibit A, which is shown as a Diamond and labeled "Well
Location", along with access to the Groundwater Monitoring Well
along existing drives within the Property, as such drives may be
relocated from time to time.
License Purpose:
Installation of a Groundwater Monitoring Well ("Well'I and periodic
testing of such well, including:
(1) taking such soil, groundwater and/or air samples within the License
Areas; and
(2) taking response actions necessary to mititgate any threat to human
health or the environment.
Term:
Beginning on the Effective Date and continuing until testing is no
longer required by the Licensee and the Licensee has closed the Well.
License Fee:
None.
THIS RIGHT OF ENTRY AGREEMENT ("Agreement") is made and entered into as of
the Effective Date by and between Owner and the Licensee, and provides as follows:
Recitals:
A. The Licensee has requested access to the property of Owner for the purpose of
installing a groundwater monitoring well and performing certain periodic testing in the location
shown on Exhibit A to this Agreement in connection with the Licensee's Subsurface
Contamination Investigation associated with the dry -clearing facility located at Bernard's
Forrmalwear, 734 Ninth Street, Durham, NC 27705, being performed under the Dry-CIeaning
Solvent Cleanup Act (DSCA) Program — DSCA Site ID DC320031.
B. Owner has agreed to grant Licensee the right to enter Owner's Property and
permission to use the License Area pursuant to the terms and conditions of this Agreement.

License Terms, Covenants and Conditions:
NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth
herein and for other good and valuable consideration, the receipt and sufficiency ofwhieh are hereby
acknowledged, Licensee and Owner agree as follows:
1. Grant of License. Owner hereby grants to Licensee the right of entry and license to
use the License Area during the License Term for the License Purpose ("License"), but for no
other use without the prior written consent of Owner.
2. Commencement and Termination. The License shall commence on the Effective
Date and continue throughout the Term until the Well has been closed by the Licensee in
accordance with applicable laws, rules and regulations.
3. Owner Access to License Area. Throughout the License Tenn, Owner shall have
access to the License Area to inspect the License Area and to use the area for parking.
4. Maintenance of License Area; Restoration. Licensee agrees to keep the License
Area neat, clean, and free of debris at all times. Immediately upon the expiration of the License
Term, Licensee shall remove all of its property from the License Area and restore and surrender
the License Area to Owner in the condition in which it existed prior to the time Licensee began
using the License Area, includng properly closing the Well in accordance with applicable laws,
rules and regulations.
5. No Otivner-Licensee Relationship. Owner and Licensee expressly agree and declare
that this Agreement shall not create between them the relationship of Owner and Tenant with respect
to the License Area or confer any rights upon Licensee as would amount in law to a leasehold
interest. This Agreement creates only the privilege on the part of Licensee, personal to Licensee, to
use the License Area in the manner described in this Agreement.
6. Condition of License Area. Owner shall have no obligation to make any
improvements to the License Area or to otherwise maintain the License Area. Licensee hereby
accepts the License Area on an "AS IS, WHERE IS, WITH ALL FAULTS" basis, without any
representation or warranty by Owner or Owner whatsoever. Licensee's use of the License Area
shall be at Licensee's sole risk, and Owner shall have no responsibility whatsoever for, and
Licensee does hereby expressly waive, release and hold Owner (and its owners, officers, managers,
employees, agents, and contractors) harmless from, any and all loss, injury or damage to persons
or to property suffered by Licensee or its agents, employees, invitees or guests in, on or about the
License Area or any other portion of the Property, except where such loss, injury or damage is due
to the negligence or willful miscoduct of Owner or its owners, officers, managers, employees,
agents, or contractors.
7. Insurance. Licensee shall keep or cause to be kept for the mutual benefit of
Licensee and its property manager (if applicable) Commercial General Liability Insurance (1986
ISO Form or its equivalent) with a combined single limit, each Occurrence and General Aggregate -
per location of at least THREE MILLION DOLLARS ($3,000,000.00), which policy shall insure
against liability of Licensee, arising out of and in connection with Licensee's use of the License
Area, and which shall insure the indemnity provisions contained in this Agreement. The insurance
Fa

policy shall be issued by allorth Carolina licensed company reasonably acceptable to Owner, shall name
Owner as an additional insured as its interest may appear, and shall not be cancellable without thirty (30)
days prior written notice to Owner. Licensee shall provide a certificate evidencing the insurance to Owner
prior to using the License Area,
8. Indemnity. Licensee shall indemnify and hold Owner (and its owners, officers,
managers, employees, agents, and contractors) harmless from and against any and all claims,
damages, losses, liabilities, lawsuits, costs and expenses (including reasonable attorneys' fees at all
tribunal levels) to the extent arising out of or related to (i) any activity, work, or other thing done,
permitted or suffered by Licensee in connection with the License Area, (ii) any breach or default by
Licensee in the performance of any of its obligations under this Agreement, or (iii) Licensee's use of
the License Area or other exercise of its rights or obligations under the Agreement. Licensee's indemity
obligations include, without limitation, any such claims asserted by Licensee's owners, employees,
contractors, agents, and invitees, except where such claims arising from the negligence or willful
misconduct of Owner or its owners, officers, managers, employees, agents, or contractors. This
indemnity obligation shall survive the expiration or earlier termination of this Agreement. In no event
shall either party be liable to the other for any consequential, incidental, punitive, or indirect damages
or losses regaredless of the cause of such damages; provided that, this limitation shall not apply to
third party claims asserted against Owner that may include such damages.
9. Brownfields Acknowledgment. Licensee acknowledges that it has been advised that
the Property is currently under a Brownfields Agreement with the State of North Carolina for
exisiting environmental issues. Licensee agrees to obtain all necessary permits and consents from
the approproriate authorties having jurisdiction over the Brownfields Agreement prior to doing
any work in the License Area. Licensee further agrees to provide Owner with a copy of the results
of all tests performed by Licensee in the License Area.
10. Environmental. Licensee agrees to comply with all environmental laws, rules and
regulations in connection with its activities in the License Area and the Property. Licensee agrees
to hold Licensor free, harmless, and indemnified from any penalty, fine, claim, demand, liability,
cost, or charge whatsoever which Licensor shall incur, or which Licensor would otherwise incur,
including any remediation costs, professional fees and attorneys fees, by reason of Licensee's
failure to comply with any environmental laws, rules and regulations in connectoin with its
activities in the License Area and the Property.
11. Notices. Notices required under this Agreement shall be valid if (i) delivered against
a written receipt of delivery, (ii) mailed by express, registered or certified mail of the United States
Postal Service, return receipt requested, postage prepaid, or (iii) delivered to a nationally
recognized overnight courier service for next business day delivery to the receiving parry's address
as set forth below. Each such notice, demand or request shall be deemed to have been received
upon the earlier of the actual receipt or refusal by the addressee.
Owner;
CPGPI Erwin Mill LLC
1330 St. Mary's Street, Suite 100
Raleigh, NC 27605
3

Attention: Jack Dunn
Licensee:
ATC Associates of North Carolina, P.C.
2725 East Millbrook Road, Suite 121
Raleigh, NC 27604
Attn: Robert J. Broda, P.G.
12. Miscellaneous.
a This Agreement shall be binding upon and inure to the benefit of the parties hereto
and their legal representatives, successors or assigns.
b. This Agreement sets forth the entire agreement between the parties with respect to
the License and the License Area. Any prior conversations or writing with respect to
such subject matter are merged herein and extinguished. No subsequent amendment
to this Agreement shall be binding upon Owner or Licensee unless in writing and
signed by Owner and Licensee.
C. This Agreement may be signed in separate counterparts with multiple originals. Faxed
or scanned copies shall have the same force and effect as originals.
[SIGNATURE PAGE FOLLOWS]
4

IN WITNESS WHEREOF, Owner and Licensee have caused this Agreement to be
executed as of the date first written above.
Licensee:
ATC Associates of North Carolina, P.C.
By: —._._.._
Name: v'vt Scv+� w�ers
Title:
Owner:
CPGPI Erwin Mill, LLC,
By: CPGCCM Erwin Mill, LLCits Manager
By: Westmoreland -Mason Holdings, LLC, its Manager
By: /
ack Dunn, anager

Exhibit A — License Area

20'
JffAkT
F C
ENVIRONMENTAL . GEOTECHNICAL
nimn SCIFNCiS . MATMAI4Z Ti41
Well finished at surface with locking
well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
2" Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-5 feet)
2-Foot Bentonite Seal
15 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
(5-20 feet)
Groundwater Table
#2 Filter Sand Pack Extending 2 feet Above Screen
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3231 SL02
WELL CONSTRUCTION DETAILS
Bernard's Formalwear
734 Ninth Street
Durham, Durham County, NC 27705
DSCA ID: DC320031
DATE: 02/04/2020
REVIEWED BY: RB

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