WM0401212_Monitoring Well Permit_20200109

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
Mr. Jay King
NCDEQ — DSCA Program
1646 Mail Service Center
Raleigh, North Carolina 27699
NORTH CAROLINA
Environmental Quality
January 14, 2020
SUBJECT: MONITORING WELL CONSTRUCTION
PERMIT NO. WM0401212
COUNTY: Surry
FILE NAME: White Swan Rentals — DSCA Site DC860002
Dear Mr. King:
In accordance with your application received on January 10, 2020, we are forwarding herewith:
Monitoring Well Construction Permit No. WM0401212 for the construction of two (2)
monitoring wells, one (1) at 110 Gwynn Avenue and one (1) at 222 Main Street in Elkin
in Surry County.
Henceforth, correspondence and data relating to this well shall be designated as specified in the
subject heading above. This Permit will be effective from the date of issuance and shall be
subject to the conditions and limitations as specified therein. If you have any questions regarding
this permit, please contact me or Jim Gonsiewski at [phone].
Sincerely,
for 1Docu Sigeened by:
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Lon T. Snider
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ - WSRO
cc: Rick L. Woodruff - First Baptist Church of Elkin (Electronic Copy)
Cicely Coley McCulloch - McCulloch Enterprises, LLC (Electronic Copy)
Robert Broda — ATC (Electronic Copy)
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES — WATER QUALITY REGIONAL OPERATIONS
SECTION
PERMIT FOR THE CONSTRUCTION OF A MONITORING WELL
In accordance with the provisions of Article 7, Chapter 87, North Carolina General Statutes, and
other applicable Laws, Rules and Regulations.
PERMISSION IS HEREBY GRANTED TO
NCDEQ — DSCA Program
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of two (2)
monitoring wells owned by the NCDEQ DSCA Program. The wells will be located at 110 Gwyn
Avenue and 222 Main Street in Elkin, North Carolina, in Surry County. This Permit is issued in
accordance with the application received on January 10, 2020, in conformity with specifications
and supporting data, all of which are filed with the Department of Environmental Quality and are
considered integral parts of this Permit.
This Permit is for well construction only, and does not waive any provision or requirement of
any other applicable law or regulation. Construction of any well under this Permit shall be in
strict compliance with the North Carolina Well Construction Regulations and Standards (15A
NCAC 02C .0100), and other State and Local Laws and regulations pertaining to well
construction.
If any requirements or limitations specified in this Permit are unacceptable, you have a right to
an adjudicatory hearing upon written request within 30 days of receipt of this Permit. The
request must be in the form of a written petition conforming to Chapter 150B of the North
Carolina General Statutes and filed with the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, North Carolina 27699-6714. Unless such a demand is made, this Permit
is final and binding.
This Permit will be effective for one year from the date of its issuance and shall be subject to
other specified conditions, limitations, or exceptions as follows:

1. Issuance of this Permit does not obligate reimbursement from State trust funds, if these
wells are being installed as part of an investigation for contamination from an
underground storage tank or dry cleaner incident.
2. Issuance of this Permit does not supersede any other agreement, permit, or requirement
issued by another agency.
3. The well(s) shall be located and constructed as shown on the attachments submitted as
part of the Permit application.
4. Each well shall have a Well Contractor Identification Plate in accordance with 15A
NCAC 02C .0108(o).
5. Well construction records (GW-1) for each well shall be submitted to the Division of
Water Resources' Information Processing Unit within 30 days of the well completion.
6. When the well is discontinued or abandoned, it shall be abandoned in accordance with
15A NCAC 02C .0113 and a well abandonment record (GW-30) shall be submitted to the
Division of Water Resources' Information Processing Unit within 30 days of the well
abandonment.
7. The County Health Department may require a county monitoring well construction
permit. Please contact the health department for their requirements.
Permit issued the 14th day of January, 2020
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
1DoSigned bQQy:
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for Lon T. Snider, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ - WSRO
By Authority of the Environmental Management Commission
Permit No. # WM0401212