WM0801148_Application_20200306

Geological Resources, Inc.
March 5, 2020
Ms. Morella King
NCDEQ, Division of Water Resources
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
Re: Monitoring Well Permit Application
Jim Dandy Food Store 11
1712 Arendell Street
Morehead City, Carteret County
Incident No: Pending
GRI Project No: 4433
Dear Ms. King:
RECEIVED/NCDENR/DWR
MAR 0 9 2020
Water Quality Regional
ection
Wil nipgton� Regions onal Office
Please find enclosed a monitoring well permit application for the installation of one Type II monitoring
well at Jim Dandy Food Store 11 located at 1712 Arendell Street in Morehead City, Carteret County.
GRI plans on installing the monitoring well in March 2020.
Your prompt attention to this matter will be greatly appreciated. If you have any questions or require
additional information please do not hesitate to contact me at [phone].
Sincerely,
Z144 A
William Regenthal, P. G.
Project Manager
enclosures
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

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 fi
1. Date: March 4, 2020
2. County: r'arter t
rc a permit to construct monitonng or recovery wens.
FOR OFFICE USE ONLY
PERMITNO. WM08011M ISSUED DATE 016/d20
3. What type of well are you applying for? (monitoring or recovery): Monitor'na
4. Applicant Tideland Construction, LLC Telephone: [phone]
Applicant's Mailing Address: 3600 North Drive. Greenville NQ 27834
Applicant's Email Address (if available): NA
5. Contact Person (if different than Applicant): William Recienthal Telephone: [phone]
Contact Person's Mailing Address: 113 W. Firetower Road Suite G Winterville NC 28590
Contact Person's Email Address (if available): w1rnQ geologicalresourcesinC Com
6. Property Owner (If different than Applicant): Phil rgif. Inr Telephone: NA
Property owners Mailing Address: 3504 Primrose Avenue Greensboro NC 27408
Property Owners Email Address (if available):
7. Property Physical Address (including zip code) and PIN Number ity,
8. Reason for Well(s): Assessment Carteret County
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
g. Type of facility or site for which the well(s) Islam) needed: UST
(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: Petroleum -
(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 Nola).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 01
14. Are there any water supply wells located less than 500 feet from the proposed well($)? No
If yes, give dlstance(s): NA
15. Well Contractor. Justin Radford Certification No.: 3270
Well Contractor Address: 3502 Hayes Road Monroe NC 28110
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 I. 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 cap
material: 0
3. Number of wells to be constructed in bedrock: 6. Estimated beginning construction date: March 2020
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: March 2020
(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 feel 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.
r SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Pe it s regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
ubchapter 2C) and accepts full responsibility for ompliance with these rules
./ ��-'Frr ///
nature o Appll pt e ' gent A Title o Applicant or'Ag t
1yrl I c. r�-r // 4Z4 v Lel ' If signing as Agent, attach authorization agreement stating
Printed name of Applic t 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).
yt r
l,'i��.1 �� l� I'� Ei�t cA� co-fili� 1 SFIC (IYCY I R islsv( L-
Stgnature of Property O ner (if d— iHerent than Applicant) Printed name of Property. Owner (if different than Applicant)
O 0 t CE1c , 1�q (-- .
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. 7l11)

Type IF. Monitoring Well
Typlc t Construction Detalls
concrete pad = manhole cover
g'roundeurface
looking well cap
grout cement «
Y Inch diameter'
Ie eohedule 40 PVC oaaln0
u
bentonite seal
sand (liter pick
0.01g Inch sloded Alnoh diameter
schedule Ao pVC screen
��. endoap

31512020
1712 Arendall St - Goal,a Map
Caslem CLifulill'i
i iow;lry Au I h 01 ity
Bay View Cemetery
I—
F_3 ml
Morehead City
Recreation Center
Morehead
City Parks &
Recreation
canMarket
Department
5-297
Smoke Shop at
6
Morehead City
I A),
Q;S
Childcare Network
ry
CAMCO
DESIGNS BY
one Harbor church CQastajl Equiptimit YBI
Wilgreelis
DONNA ITOWER�;
I irst Apostolic of
Morehead Rentals
N Munden FLPILHal
Morehead Clly
19 H,
Crematory & Cremory
C"
Aret)(ILIt St
.v
1712 Arendell Street
Lificusle
Arenclef) St
Arendell St
S.:i— Crystal Coast Cond
"I'
colifee Roasters
CoastalI li'mce
J
St Andrews
Arendeli St
i ,
Arendefl St Weds Fargo Advisor
E fW;C0l)c1t Gh1jrGli
St EgbLrts
'Aw Ready Mix
concrele Company
Cjjrj0ljL SCrt)Ul
Shevans Park
Fin]
d1i.0,11i 1P
Playground
mth
ienn,5 S
lomn,
51l