WM0801154_Application_20200717

NO WithersRavenet
Orrftap&r YoWe S�rooetia.
115 MacKenan Drive
CARY, NORTH CAROLINA, 27511
TEL: [phone]
FAX: [phone]
TO: NCDEQ-DWR
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
WE ARE SENDING YOU
❑ Shop Drawings
❑ Copy of Letter
LMEQ OF UpIkHOMMAL
DATE July 17, 2020 JOB NO. 02171214.33
ATTENTION Morella Sanchez -King
PHONE #
RE: Monitoring Well Permit Application
Former Nobles Property (NCDEQ TF#32155)
Whiteville, Columbus County, NC
❑ Attached via courier the following items:
❑ Prints ❑ Plans ❑ Samples
❑ Change order ❑ Diskette ❑
❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
1
07/17/2020
GW-22MR Monitoring Well Permit Application
THESE ARE TRANSMITTED as checked below:
® For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
® For review and comment ❑ Other: For your review, signature and notary sign and seal
❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
Ms. Sanchez -King,
Attached is a GW-22MR monitoring well permit application for review/approval. Please contact me with any
questions or comments.
REMARKS: Thank
COPY TO: File
SIGNED: Kevin Buchanan, Project Manager
ifenclosures are not as noted, please notify us at once.

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: 07/17/2020
2. County: Columbus
3.
4.
5.
,31
7
A
Ia
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: NCDEQ-DWM, UST Section, For TF#32155 (Former Nobles Property) Telephone: [phone]
Applicant's Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address (if available): [e-mail]
Contact Person (if different than Applicant): Kevin Buchanan, Project Manager, withersRavenei Telephone: [phone]
Contact Person's Mailing Address: WithersRavenel, 115 MacKenean Drive, Cary, NC 27511
Contact Person's Email Address (if available): [e-mail]
Property Owner (if different than Applicant): Irvin & Betty Sasser
Property Owner's Mailing Address: 2102 Canal Cove Road, Lake Waccamaw, NC 28450
Property Owner's Email Address (if available):
Telephone: [phone]
Property Physical Address (Including PIN Number) "Near4713 New Britton Highway" (Address from Columbus County Tax Card) NC PIN 0198.00-71-1038.00
City Whiteville County Columbus Zip Code 28472
Reason for Well(s): Groundwater Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: UST (Closed upgradient of proposed well locations)
(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).
YES - NCDEQ Incident # 32155, Former Nobles Property (NCDEQ-DWM UST Section, State Lead Cleanup Program)
Type of contaminants being monitored or recovered: Petroleum Hydrocarbons
(ex: organics, nutrients, heavy metals, etc.)
Are there any existing wells associated with the proposed well(s)? If yes, how many? YES - one well
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A Existing well installed on source property
Distance from proposed well(s) to nearest known waste or pollution source (in feet): 60
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? YES - 3 Wells
If ves, give distance(s): WSW-1 - 112 ft North, WSW-2 - 361 ft Northwest, WSW-8 - 491 ft South (See attached Map)
15. Well Contractor: Quantex, Inc. Certification No.: 3106A
Well Contractor Address: PO Box 1388, Wendell, NC 27591
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?
material: 2 Locking Cap, Manhole set in concrete
3. Number of wells to be constructed in bedrock:
6. Estimated beginning construction date: 8/3/2020
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 8/3/2020
(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 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
Project Manager, WithersRavenel, Inc.
On behalf of NCDEQ-DWM, UST Section for TF#32155
Signature of Applicant or *Agent Title of Applicant or *Agent
Kevin B. Buchanan
Printed name of Applicant or *Agent
* 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
Signature of Property Owner (if different than Applicant)
Irvin & Betty Sasser
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]
OR Rev. 3-1-2016

Environmental
Quality
North Carolina Department of Environmental Quality
Division of Waste Management
Roy Cooper
Governor
Mr. Scott Ryals, Incident Manager
NCDEQ-DWM, UST Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Dear Mr. Ryals:
RE: NCDEQ Access Agreement
Columbus County Property # 7523
NC Pin # 0198.00-71-1038.000
Sasser Property
2102 Canal Cove Road
Lake Waccamaw, NC 28450
NCDEQ TF ID # 32155
Former Nobles Property
Michael S. Reagan
Secretary
I am/We are the owner(s) of the parcels of property listed above, located at or near the
incident in question, and hereby permit the NC Department of Environmental Quality (NCDEQ),
formerly the Department of Environment and Natural Resources (NCDENR) or its contractor to
enter upon said property for the purpose of conducting an investigation of the groundwaters under
the authority of G.S. 143-215.3(a)2.
I am/We are granting permission with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division of
Waste Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the
Department or its contractor. The Department or its contractor shall protect and prevent
damage to the surrounding lands.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by
the shortest feasible route to the nearest public road. The Department or its contractor may
enter upon the land at reasonable times and have full right of access during the period of the
investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by
Article 31 of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State
Departments and Agencies, and as otherwise provided by law.

North Carolina Department of Environmental Quality
Division of Waste Management
Roy Cooper
Governor
Site Access Agreement
NCDEQ Access Agreement
Columbus County Property # 7523
NC Pin # 0198.00-71-1038.000
Sasser Property
2102 Canal Cove Road
Lake Waccamaw, NC 28450
NCDEQ TF ID # 32155
Former Nobles Property
Michael S. Reagan
Secretary
Page Two of Two
5. The information derived from the investigation shall be made available to the owner upon
request and is a public record, in accordance with G.S. 132-1.
6. The activities to be carried out by the Department or its contractor are for the primary
benefit of the Department and of the State of North Carolina. Any benefits accruing to the
owner are incidental. The Department or its contractor is not and shall not be construed to
be an agent, employee, or contractor of the land owner.
I/We agree not to interfere with, remove, or any way damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Attest:
Irvin and Betty Sasser
Type/Print Name(s) of Owner/Agent
Phone Number
2102 Canal Cove Road
Owner(s) Mailing Address
Lake Waccamaw, NC 28450
City, State, Zip Code
Date

■■ WithersRavenet
■■
Our People. Your Success.
VIA CERTIFIED MAIL - RETURN RECIEPT REQUESTED
ARTICLE #70171450000026138456
April 20, 2020
Mr. & Mrs. Irvin and Betty Sasser
2102 Canal Cove Road
Lake Waccamaw, NC 28450
RE: NCDEQ Access Agreement
Columbus County Property # 7523
NC Pin # 0198.00-71-1038.000
Sasser Property
2102 Canal Cove Road
Lake Waccamaw, NC 28450
NCDEQ TF ID # 32155
Former Nobles Property
Dear Mr. & Mrs. Sasser,
WithersRavenel (WR) is under contract with the North Carolina Department of Environmental
Quality (NCDEQ), Underground Storage Tank (UST) Section, Federal Trust Fund (FTF) Branch for
the assessment of leaking underground storage tanks (LUSTS). NCDEQ has tasked WR with
completing assessment and monitoring activities at the Former Nobles Property, located at 4713
New Britton Highway East in Lak-
E_�cC57M—aw, Columbus County, NC. This property is located
near the intersection of Pleasant Plains Church Road and New Britton Highway East, immediately
adjacent to your property. 00 r l ('8
Completed assessment activities relating to the site have indicated the presence of targeted
petroleum compounds in two previously -installed temporary monitoring wells located on the
adjacent property. In an effort to monitor the presence of petroleum compounds on the property,
the NCDEQ incident manager (Mr. Scott Ryals) has instructed WR to petition you to allow for the
installation and sampling of a permanent groundwater monitoring well, to be followed by well
sampling on an on -going basis. As such, WR is respectfully requesting your authorization to allow
for the access to your property to complete the requested tasks. Prior to well installation and any
sampling of the well, a WR representative will contact you to advise you of the projected dates of
activity and for collection of samples.
NCDEQ has requested that we approach you for the purposes of obtaining an access agreement
which will allow us to complete the monitoring and assessment work on the property. Any and all
fees for this monitoring and assessment are the responsibility of NCDEQ, and you Irvin and Betty
Sasser will incur no charges of any kind for this work. I have included an access agreement for
your consideration, and request that you complete and return the agreement in the enclosed self-
addressed stamped envelope. I have also included a copy of the agreement for your records.
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 1 www.withersravenel.com I License No. C-0832
Asheville I Cary I Greensboro I Pittsboro I Raleigh I Wilmington

%� WithersRavenel
Our People. Your Success.
VIA CERTIFIED MAIL - RETURN RECIEPT
REQUESTED
ARTICLE # 70171450000026138456
April 20, 2020
Mr. & Mrs. Irvin and Betty Sasser
2102 Canal Cove Road
Lake Waccamaw, NC 28450
Mr. & Mrs. Sasser, we appreciate your consideration in this matter. Should you have questions,
comments, or require additional information, please feel free to contact me at your earliest
opportunity. I can be reached at 919-819-4312 (cell), or via email: smillerl withersravenel.corn.
Alternatively, the NCDEQ Incident Manager for the site (Mr. Scott Ryals) can be reached via phone
at 919-707-8168 or email: I;r.r)tt.Ryals(@ncdenr.gov .
Cordially,
WithersRavenel
"7 '} ° t✓�
Sandra Miller
Project Environmental Scientist
/ attachments
xc: Mr. Scott Ryals (NCDEQ-DWM, UST Section)
Project File
Former Nobles Property - TF # 32155
WR Project # 02171214.33
Access Agreement April 2020

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GRAPHIC SCALE
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Engineers I Planners I Surveyors NEW BRITTON HWY E MONITORING WELL APPROVEDHY: DATE: PRO)ECT NO.:
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GROUND SURFACE OF GROUND SURFACE
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DIAMETER OF BORING VARIES
IRVIN & BETTY SASSER PROPERTY
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NEW 9RMON HWY E
WHITEVILLE. CCLU M9l15 COUNTY. NC
[N C DE4 TFN 32 t S S-FORMER NOBLES PROPERTY]
PROPOSED TYPE It WELL DIAGRAM
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APPROVED BY:
DATE:
PROJECT NO.
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02171214.33
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