WM0701228_Application_20200618

2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598

June 17, 2020

Mr. David May, L.G.
North Carolina Department of Environmental Quality
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889

Re: Permit to Construct Monitoring Well
Kinston Shirt Factory
501 E Caswell St.
Kinston, Lenoir County, North Carolina
ID No. NONCD0003031
State Contract No. N091319

Dear Mr. May:

Enclosed please find one application for a permit to construct one temporary groundwater
monitoring well. The temporary groundwater monitoring well will be located at 201 South
McDaniel Street, Kinston, Lenoir County, North Carolina. 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 or via email to [e-mail].

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.

Robert Broda, P.G.
Project Geologist

FOR OFFICE USE ONLY

PERMIT NO. ISSUED DATE
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: 6/17/2020

2. County: Lenoir

3. What type of well are you applying for? (monitoring or recovery): Monitoring

4. Applicant: NC DEQ, DWM. Telephone: [phone]

Applicant’s Mailing Address: NCDEQ IHSB- Superfund Section, 217 West Jones Street, Raleigh, North Carolina 27699-1646

Applicant’s Email Address (if available): Send to contact person listed below

5. Contact Person (if different than Applicant): Robert Broda, ATC Associates of NC, PC Telephone: [phone]

Contact Person’s Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604

Contact Person’s Email Address (if available): [e-mail]

6. Property Owner (if different than Applicant): Nicholas E. Harvey II (Lenoir County Board Of Education )
Telephone: [phone]

Property Owner’s Mailing Address: 2017 West Vernon Avenue, Kinston, North Carolina, 28501

Property Owner’s Email Address (if available): Unknown

7. Property Physical Address (Including PIN Number) 201 South McDaniel Street (PIN # 452519613981)
City Kinston County Lenoir Zip Code___28501

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: Inactive Hazardous Site
(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).

Unknown

11. Type of contaminants being monitored or recovered: VOCs
(ex: organics, nutrients, heavy metals, etc.)

12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 5

Existing Monitoring or Recovery Well Construction Permit No(s).: Unknown

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 300

14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Unknown

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)

2. Number of wells to be constructed in unconsolidated
material: 1 Temporary

3. Number of wells to be constructed in bedrock. 0

4. Total Number of wells to be constructed: 1 Temporary
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap,

6. Estimated beginning construction date: 06/30/2020

7. Estimated construction completion date: 06/30/2020

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. 143-215.10B(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

Agent for NCDEQ DWM (will include power of attorney
Signature of Applicant or *Agent Title of Applicant or *Agent upon request)

Robert Broda, P.G. (Agent for NCDEQ DWM) * 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 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
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
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22MR Rev. 3-1-2016
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: IHSB026P01
TEMPORARY MONITORING WELL
CONSTRUCTION DETAIL
Kinston Shirt Factory
501 E Caswell St.
Kinston, Lenoir County, North Carolina
ID No. NONCD0003031REVIEWED BY: LGDATE: June 17, 2020
2” Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-30 feet)
28-Foot Bentonite Seal to surface (0-28 feet)
#2 Filter Sand Pack Extending 2 Feet Above Screen
(28-40 feet)
10 Feet of 2” Schedule 40 Well Screen (0.010” Slot)
(30-40 feet)
Well finished at surface with locking
well cap.
Groundwater Table
TW-1
Lenoir2
Printed June 17, 2020
See Below for Disclaimer
Welcome to Lenoir County’s NEW Mapping Service. PLEASE NOTE: The Parcel Record Number is NOT the PIN. Searching the Parcel Record Numbers for a 12 digit
number will result in an error!
Page 1 of 1ConnectGIS Feature Report
6/17/2020https://lenoir2.connectgis.com/DownloadFile.ashx?i=_ags_mapba593dff31e049509c13139...
ROY COOPER
NORTH CAROLINA
Ge.
Envtronmenml QwIny
MICHAEL S. REGAN
see my
MICHAEL SCOiT
D0eW
TEMPORARY PROPERTY ACCESS ACCEPTANCE
I am the owner of the property located at 201 S. McDaniel St., Kinston, NC. I grant the Division of Waste
Management and/or its contractors to access my property to collect samples as indicated below during the
period June 1 to September 1, 2020. I understand the Division will coordinate the scheduling of the work with
me.
❑ Potable Well. How many water supply wells are located on your property?
Are the well pumps operational in all? Yes/No (circle one)
Does any well on your property have a treatment system? Yes/No (circle one)
How is the water from the wells on your property used?
❑ Soil (Surface Grab Sample) ❑ Soil Gas Probes
® Groundwater (Installation of monitoring wells) ❑ Crawlspace Vapor Sampling
❑ Indoor Air Vapor Sampling ❑ Other
any dogs or other animals present in the area of sampling (please plan to secure)? Yes/No (circle one)
",t-5.2?- //09
(Telephone Number)
5- 9 aoaa
(Date)
Please return thi's signed form to:
Ann Shields
Inactive Hazardous Sites Branch, DWM
1646 Mail Service Center
Raleigh, North Carolina 27699
Alternatively, you may email me at ann.shieldsgncdem.eov to provide acceptance of Division access for
sampling.
Associated Site Name: Kinston Shirt Factory
Kinston, Lenoir County
Site ID No. NONCD0003031
Nonh Carolina Departmentofr n.e Quality IDMsJwof Waste Management
217 Wert finea S"n 11666 Mp1I 5e 'C M' I RelelghN Ih Carolina 22699164
919.702b2OO