WM0501405_Application_20200831

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: August 31, 2020
2.County: Wake
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4.Applicant: Wake County Telephone: [phone]
Applicant’s Mailing Address: P.O. Box 550, Raleigh, NC 27602
Applicant’s Email Address (if available): [e-mail]
5.Contact Person (if different than Applicant): Trey Marchant Telephone: [phone]
Contact Person’s Mailing Address: 409 Rogers View Ct, Raleigh, NC 27610
Contact Person’s Email Address (if available): [e-mail]
6.Property Owner (if different than Applicant): Wake Tech Community College Telephone: [phone]
Property Owner’s Mailing Address:9101 Fayetteville Rd, Raleigh, NC
Property Owner’s Email Address (if available): [e-mail]
7.Property Physical Address (Including PIN Number) 4721 Advantage Way PIN 0689923154
City Raleigh, NC County Wake Zip Code 27603-5655
8.Reason for Well(s): Assessment for UST closure at site with high water table
(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: 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).
UST incident 16158 (1994 release from previous UST system owned by Wake Tech, but on the same property)
11.Type of contaminants being monitored or recovered: organics (gasoline and/or diesel fuel)
(ex: organics, nutrients, heavy metals, etc.)
12.Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 1
Existing Monitoring or Recovery Well Construction Permit No(s).: not applicable (existing well owned by Wake Tech)
13.Distance from proposed well(s) to nearest known waste or pollution source (in feet): 100
14.Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes (4)
If yes, give distance(s): see attached table and drawing
15.Well Contractor:Geologic Exploration, Inc. Certification No.: 1175 (NC)
Well Contractor Address: 176 Commerce Blvd, Statesville, NC 28625
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
WM0501405
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 1
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured? Temp well, to be
abandoned the same day it's installed
6. Estimated beginning construction date: 9/11/20
7. Estimated construction completion date: 9111/20
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 th t the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as egoted under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
S p r 2C) and accepts full responsibility for compliance with these rules
�j/`/ _Director, Wake County Facility & Field Services
Signature of App cant or *Agent Title of Applicant or *Agent
Rick Stoaner. P.E. _ * 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 Wake Technical Community,Collece
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

DEPTH FROM GROUND SURFACE
LOCKABLE CAP TO TOP OF CASING (TOC)
FLUSH MOUNT
WELL PROTECTOR LAND SURFACE
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GRANULAR BACKFILL
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TOTAL DEPTH
a
OF WELL
'TH TO TOP OF
LENGTH OF
ITONITE SEAL
SOLID SECTION
'TH TO TOP OF
,NULAR MATERIAL
THREADED COUPLING
RISER
STABILIZED WATER
LEVEL FEET
BELOW TOP OF
PRE —PACKED
SCREEN
LENGTH OF
SLOTTED SECTION
CASING
MEASURED ON
LENGTH OF TAIL
TE GROUT CAP
PIPE
=
Atlantic
NOT TO SCALEI
DRAWN] DATE:
TYPE II FLUSH MOUNT BY: v/
MONITORING WELL SCHEMATIC DRAFT JOB
CHECK: NO:
ENG CAD
CHECK: NO: TYPE II MW—FLUSH-201
APPROVAL: DWG
NO:
REFERENCE:

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TABLE 3.1 WATER-SUPPLY WELL INVENTORY RESULTS SOUTHERN WAKE REFUELING CENTER 8315 OLD McCULLERS ROAD RALEIGH, NORTH CAROLINA INVENTORY DATE: JUNE 23, 2005 MID-ATLANTIC ASSOCIATES JOB NO. 000R1625.06 WELL NUMBER (See Drawing 3.1) OWNER NAME & ADDRESS USER NAME & ADDRESS USES OF WELL WELL DEPTH WELL CASING DEPTH WELL SCREEN INTERVAL ESTIMATED DISTANCE AND DIRECTION FROM SOURCE AREA 1 Wake Technical Community College 9101 Fayetteville Road Raleigh, NC 27603 Same* Not in use – power has been disconnected 200 ft. (6” drilled well) unknown -- 270 ft S 2 Leonard Rhodes 8241 Old McCullers Road Raleigh, NC 27603 Same everything 158 ft (6” drilled well) unknown -- 340 ft NE 3 Leonard Rhodes 8241 Old McCullers Road Raleigh, NC 27603 Same Not in use; capped with concrete 30 ft., bored well 30 ft. -- 425 ft NE 4 Tom and Debra Merrill 6605 Whitted Road Fuquay-Varina, NC 27526 unknown tenant 8304 Old McCullers Road Raleigh, NC 27603 everything unknown unknown -- 460 ft N 5 Wake Technical Community College 9101 Fayetteville Road Raleigh, NC 27603 Southern Wake Refueling Center 8315 Old McCullers Road Raleigh, NC 27603 everything 306 ft (6” drilled well) 33 ft. -- 250 ft NE 6 Gene Barden 8244 Old McCullers Road Raleigh, NC 27603 Same everything 204 ft (6” drilled well) unknown -- 620 ft N 7 Lawrence and Simora Bass 8232 Old McCullers Road Raleigh, NC 27603 Same everything Greater than 100 ft (6” drilled well) unknown -- 950 ft N 8 Felton Gulley 8140 Old McCullers Road Raleigh, NC 27603 Same everything 120 ft (6” drilled well) unknown -- 1,260 ft N *Updated November 2009
Contract Number: EC00000000004327
(Please reference this number on your invoices for payment)

MUTUAL TERMINATION AGREEMENT
Department: 44 - General Services Administration
Vendor: VC0000001149 - WAKE TECHNICAL COMMUNITY COLLEGE
Description of Services: Wake Technical Community College – Termination of Fueling Station MOA & Right of Entry –
Fueling Station

BOC Date Approved: June 15, 2020
Contract Start Date: Contract End Date:
Max Amount Payable: $0.00
Funding Source(s):
Federal State County Grants Other None

BFY Acct Template Object Description Amount
9999 66476B 0.00

Competition:
RFP#: Next Competition: NOT APPL Year Last Competed: NOT APPL
Person Responsible for Monitoring the Contract Performance Requirements: Kelli A. Braunbach

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STATE OF NORTH CAROLINA
COUNTY OF WAKE

THIS MUTUAL TERMINATION AGREEMENT (this “Agreement”), made and entered into this 12th day of
August, 2020 (the “Effective Date”) by and between WAKE COUNTY, a public body politic and corporate of the
State of North Carolina, hereinafter referred to as "Wake County” and WAKE TECHNICAL COMMUNITY COLLEGE,
a community college established pursuant to N.C.G.S. Chapter 115D (hereinafter referred to as “Wake Tech”).
Wake County and Wake Tech are also referred to herein as “a Party” or the Parties”.

W I T N E S S E T H:

WHEREAS, the Parties entered a Memorandum of Agreement dated on or about the 1st of June 1994
(hereinafter referred to as the “MOA”) setting forth their agreement and understanding related to the location
and shared use of a satellite fueling facility on a portion of the Wake Tech Main Campus (as defined in the MOA)
more particularly described in Exhibit “A” attached to the MOA; and

WHEREAS, Wake Tech provided the land for the satellite fueling facility (hereinafter “Facility”) and Wake
County provided the installation and continued operation of the Facility, such division of responsibilities more
particularly set out in the MOA; and

WHEREAS, Wake Tech has a project planned that requires the displacement of the existing Facility and
the joint recommendation of Wake County and Wake Tech is to decommission the Facility; and

WHEREAS, the Parties have agreed to terminate the MOA subject to the terms and conditions set forth herein.

NOW, THEREFORE, for and in consideration of the mutual covenants and promises contained herein,
and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Parties agree
as follows:

1. The Recitals are incorporated herein by reference and made a part of this Agreement.

2. The MOA is hereby terminated effective as of the Effective Date of this Agreement.

3. Notwithstanding anything to the contrary in this Agreement or the MOA, Sections 6 (with the exception
of the first sentence), 12, and 14 of the MOA shall survive the termination of the MOA (collectively, the
“Surviving Obligations”). For the avoidance of doubt, as part of the Surviving Obligations, Wake County shall, at
its sole cost and expense, complete the removal and decommissioning of the Facility on or before October 31,
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2020 (the “Outside Completion Date”) in accordance with all applicable laws and the plans attached hereto as
Exhibit “A” (the “Decommissioning Plans”) and without any requirement for a deed restriction applicable to the
Facility. Prior to the Outside Completion Date, Wake County shall provide Wake Tech with written certification
from Mid-Atlantic Associates, Inc. that the Facility has been fully removed and decommissioned in accordance
with all applicable laws and the Decommissioning Plans, and there has been a “no further action” regulatory
determination by North Carolina Department of Environmental Quality without any deed restriction applicable
to the Facility. Except for Wake Tech’s obligations expressly set forth in Section 6 of the MOA, Wake County shall
be fully responsible for any and all remediation required in connection with the removal and decommissioning
of the Facility.

4. Wake Tech shall execute the Right of Entry permit attached hereto as Exhibit “B” for the purpose of
permitting Wake County to perform the decommissioning of the Facility.

5. To the fullest extent permitted by applicable law, Wake County agrees to be responsible for any and all
costs, claims or liability, including but not limited to personal injury, accidents, negligence or damage, relating to
the Surviving Obligations and its obligations under this Agreement, or any claim arising therefrom, caused by
Wake County or its agents, contractors or employees.

6. To the fullest extent permitted by applicable law, Wake Tech agrees to be responsible for any and all
costs, claims or liability, including: personal injury, accidents, negligence or damage, relating to the Surviving
Obligations, or any claim arising therefrom, caused by Wake Tech or its agents, contractors or employees.

[Signature Page Follows]

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IN TESTIMONY WHEREOF, WAKE COUNTY AND WAKE TECH through their authorized officers and by their own
hands has hereunto set forth their hands and seals of the day and year first above written.

WAKE TECHNICAL COMMUNITY COLLEGE
By: _____________________________________
Name: Dr. R. Scott Ralls
Title: President

Date: August 12, 2020

WAKE COUNTY

By: _____________________________________
Name: Kelli Braunbach
Title: Director, General Services Administration

Date: August 12, 2020

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EXHIBIT “A”
Decommissioning Plans
Project Manual titled “Wake Tech Fuel Station Decommissioning” dated June 17, 2020 prepared for Wake
County by Timmons Group, Project No. 43578
Civil Drawings titled “Wake Tech Fuel Station” (Sheets 1-5) dated June 10, 2020 prepared by Timmons Group,
Project No. 43578

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EXHIBIT “B”
Right of Entry Permit

DocuSign Envelope ID: AC364D43-6C4D-4707-ADD6-B74BEFE28129
RIGHT OF ENTRY PERMIT

THIS RIGHT OF ENTRY PERMIT (“Permit”) made this the 12th day of August, 2020,
by and between Wake Technical Community College (hereinafter called “Landowner”) and
Wake County (hereinafter called “Permit Holder”).

WHEREAS, Landlord and Permit Holder entered into that certain Memorandum of
Agreement dated on or about the 1st of June 1994 (hereinafter referred to as the “MOA”) setting
forth their agreement and understanding related to the location and shared use of a satellite
fueling facility (the “Facility”) on a portion of the Wake Tech Main Campus (as defined in the
MOA) located at 9101 Fayetteville Road, Raleigh, NC 27603;

WHEREAS, Landlord and Permit Holder have agreed to terminate the MOA subject to
the terms and conditions of that certain Mutual Termination Agreement dated as of the date
hereof (the “Termination Agreement”); and

WHEREAS, under the terms of the Termination Agreement, Landowner has agreed to
enter into this Permit for the sole purpose of permitting Wake County to access the Facility to
perform the removal and decommissioning of the Facility in accordance with the MOA and the
Termination Agreement.

NOW THEREFORE, Landowner hereby grants unto Permit Holder, its employees,
agents, consultants and cooperating parties, the non-exclusive, revocable right and privilege to
enter the part of Landowner’s property, with a physical address of 4721 Advantage Way, 8315
Old McCullers Road, Raleigh, NC 27603, Parcel ID# 0689923154, and accessing the Facility (the
“Property”) at any reasonable time for the sole purpose of removal and decommissioning of the
Facility in accordance with the MOA and the Termination Agreement.

This privilege to enter the Property is subject to the following provisions and conditions:

1. The term of this Permit shall be for 90 days from the date of execution. This term may be
extended subject to mutual agreement of Landowner and Permit Holder.
2. In conducting the above activities, Permit Holder, its contractors, agents or employees
agree to exercise reasonable care in order to minimize physical damage to the Property
and not interfere with or disrupt Landowner’s use of the Property. Permit Holder shall
repair any damage to the Property caused by Permit Holder, its contractors, agents or
employees.
3. This Permit is not assignable.
4. This Permit does not bind Landowner to financial responsibility for services rendered on
the Property by Permit Holder or any contractors, subcontractors, and other designees of
Permit Holder and shall not subject the Property to any claimed liens.

[Signature Page Follows]

DocuSign Envelope ID: AC364D43-6C4D-4707-ADD6-B74BEFE28129
IN WITNESS WHEREOF, the parties have executed this Permit as of the above stated
date.

LANDOWNER PERMIT HOLDER

Wake Technical Community College Wake County

By: _________________________________ By: __________________________
Name: Dr. R. Scott Ralls Name: Kelli Braunbach
Title: President Title: Director, General Services
Administration

Address: 9101 Fayetteville Rd, Raleigh, NC 27603 Address: P.O. Box 550, Raleigh, NC 27602
Telephone: [phone] Telephone: [phone]
Email: [e-mail] Email: [e-mail]

DocuSign Envelope ID: AC364D43-6C4D-4707-ADD6-B74BEFE28129