WM0701235_Application_20201020

hart � hickman
SMARTER ENVIRONMENTAL SOLUTIONS
Via Email
October 14, 2020
North Carolina Department of Environmental Quality
Division of Water Resources — Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
Attn: Mr. Robert Tankard
Re: Permit to Construct Monitoring Well
One Hour Martinizing (NC DCSA No. DC740007)
Greenville, North Carolina
Dear Mr. Tankard:
Hart & Hickman, PC (H&H) is providing the attached monitoring well permit application for
groundwater assessment activities related to the One Hour Martinizing site in Greenville, North
Carolina. H&H is proposing to install Eve temporary monitoring wells at 0 Reade Street. Enclosed
please End the permit application, well construction details, site map with the proposed locations,
and other relevant information. Please review the provided information and return the approved
permits to the H&H Raleigh office.
Should you have any questions or need any additional information, please feel free to contact me
at [phone].
Sincerely,
Hart & Hickman, PC
e�E�7 p,R¢E�4
Robert Harrell
Project Environmental Scientist
Attachments
2923 South Tryon Street, Suite 100 3921 Sunset Ridge Rd. Suite 301
Charlotte, NC 232G3 Raleigh, NC 27607 www, ha rt-hickman. om
704-586-0007 stain 919-847_4241 main

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
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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.
Date: 10/14/2020
County: Pitt
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Temporary Monitoring Wells
Applicant: Preston Cannon, Jr. (petitioner for DSCA Site #DC740007) Telephone: Jay King [phone]
Applicant's Mailing Address: DSCA Program, 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address (if available): jay.king(cDncdenr.gov
Contact Person (if different than Applicant): Robert Harrell, Hart & Hickman, PC Telephone: [phone]
Contact Person's Mailing Address: 3921 Sunset Ridge Rd, Ste 301, Raleigh, NC 27607
Contact Person's Email Address (if available): [e-mail]
Property Owner (if different than Applicant): State of North Carolina c/o Kevin Carrawav Telephone: [phone]
Property Owner's Mailing Address: 901 East 5th Street, Greenville, NC 27834
Property Owner's Email Address (if available): carrawavcCCDecu.edu
Property Physical Address (Including PIN Number) 0 Reade Street (PIN# 4688405442)
City Greenville County Pitt Zip Code 27834
Reason for Well(s): Environmental Assessment for DSCA Program
(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: Former Dry CI
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
DSCA Site ID #DC740007
Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 6
Existing Monitoring or Recovery Well Construction Permit No(s).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Approximately 250 to 500 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): N/A
15. Well Contractor: Regional Probing Services Certification No.: 3322
Well Contractor Address: PO Box 1161, Wake Forest, NC 27588
PROPOSED WELL CONSTRUCTION INFORMATION
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: 5
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured? Wells will be
abandoned after sampling
6. Estimated beginning construction date: November 2020
4. Total Number of wells to be constructed: 5 7. Estimated construction completion date: November
(add answers from 2 and 3) 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
*.it___r &Itsx"Agent for Petitioner for DSCA Site DC920048 Agent for Petitioner for DSCA Site DC920048
Signature of Applicant or *Agent Title of Applicant or *Agent
Robert Harrell * 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 property access agreement (Attachment 3) See attached property access agreement (Attachment 3)
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]
J R Rev. 3-1-2016

ATTACHMENT I
MONITORING WELL CONSTRUCTION DETAILS

TEMPORARY MONITORING WELL CONSTRUCTION DETAILS
CROSS SECTIONAL VIEW
GROUND SURFACE
L1
STEEL DPT ROD
L3 (2.5-INCH DIAMETER)
WELL SCREEN
3-FT STAINLESS STEEL
L2 EXPANDABLE WELL SCREEN
(1-INCH DIAMETER)
DRIVE TIP
L1 = 37 FT.
L2 = 3 FT.
L3 = 40 FT.
TITLE Temporary Monitoring Well Diagram
Hart & Hickman, PC
2923 South Tryon St., Suite 100
Charlotte, North Carolina 28203
FILE PREP. BY REV. BY DATE PROJECT NO.
RH CZ 10/7/2020 DSO-089 (DSCA ID# DC740007)

ATTACHMENT 2
PROPOSED MONITORING WELL LOCATION MAP

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THE TIRE
STORE
7N'S SEAFOOD
MARKET
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W. TENTy STREET � � �
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FORMER SCOTT'S CLEANERS
(DSCA ID: DC740010) ttp
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LEGEND
SOURCE PROPERTY BOUNDARY
PARCELBOUNDARY
FORMER DRY-CLEANING FACILITY
TYPE II MONITORING WELL
Q TYPE III MONITORING WELL
ABANDONED/DESTROYED MONITORING WELL
TEMPORARY MONITORING WELL
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MW5�I
-4MW-2
MAN�
HOUR MAR IZI
(DSCA ID: DC74
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MW-1
ONE HOUR MARTINIZING WELL
MW-1'
SCOTT'S CLEANERS WELL
MW-1*
STADIUM CLEANERS WELL
(4.0)
PCE CONCENTRATION (mg/L)
_0 7_
PCE ISOCONCENTRATION
CONTOUR (mg/L)
PROPOSED TEMPORARY WELL
GP-35 E E/GHTy STREET
N/IVTy
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0
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E TENTy STREET
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NOTES
2
-OMW-6*
1�FORMER STADIUM CLEANERS
(DSCA ID: DC740008
1. GROUNDWATER SAMPLES WERE COLLECTED ON
8/15/19.
2. HISTORICAL DATA WERE CONSIDERED IN
CONTOURING FOR WELLS THAT WERE NOT
SAMPLED.
3. PCE = TETRACHLOROETHYLENE.
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/�P-sa¢ TREET 1
EAST
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EAST CAROLINA UNNERS17'y
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N1
II
PROPOSED MONITORING WELL LOCATION MAP
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PROJECT ONE HOUR MARTINIZING
APPROXIMATE
0 160 320
DSCA ID: DC740007
111 E. 10TH STREET
GREENVILLE, PITT COUNTY
SCALE IN FEET
• 2923 South Tryon Street -Suite 100
hart h i c k m a n Charlotte, North Carolina 28203
704-586-0007(p) 704-586-0373(�
SMARTER ENVIRONMENTAL SOLUTIONS License # C-1269 / #C-245 Geology
DATE: 10-2-19
REVISION NO. 0
JOB NO. DSO-89
ATTACHMENT NO. 6

ATTACHMENT 3
PROPERTY ACCESS AGREEMENT

F --7--
ill
4
Waste Management
ENVIRONMENTAL QUALITY
PROPERTY ACCESS CONSENT
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Division Director
This document may not be modified without the Program's approval. For DSCA Use Only
Ifyou have questions on how to fill out this form or about the activities DSCA [D No.
at this site, please call the Dry-cleaning Solvent Cleanup Program 's
contractor for this project, Christie Zawtocki with Hart & Hickman, DC740007
P.C. at czawtockigharthickman.com or [phone]. Ifyou still
have questions after contacting Ms. Zawtocki with H&H, please contact the DSCA
Program Project Manager, Jay King at Jay. Kinp_(abncdenr.gov or 919-707-8367.
Please Print
State of North Carolina c/o Kevin Carraway
(Name of Property Owner or Tenant in Residence)
0 Reade Street (PIN: 37964)
(Street Number and Street Name of Property)
Greenville Pitt County 27858
(City or Town in Which Property Is Located) l (County in Which Property is Located) / (Zip Code)
I voluntarily consent to the Division of Waste Management (Division) and its
independent contractors (contractors) entering and having continued access to my
property for the following purposes:
(1) taking such soil, groundwater and/or air samples as may be necessary;
(2) taking other actions related to the investigation of surface or subsurface conditions;
(3) taking response actions necessary to mitigate any threat to human health or the
environment.
Other conditions:
(1) The Division and its contractors shall attempt to perform any activities at the Property
in a manner that minimizes interference with use of the Property.
(2) On conclusion of all activities, the Division and its contractors shall, to the extent
practicable, restore the Property to the original condition it was in prior to any
activities conducted by the Division or its contractors. All monitoring wells will be
State of North Carolina I Environmental Quality I Waste Management
1646 Mail Service Center 1 217 West Jones Street I Raleigh, NC 27699-1646
919 707 8200 Telephone

Page 2 of 2
DSCA Site ID No.
DC740007
properly abandoned in accordance with applicable laws and regulations, unless other
arrangements are agreed to by the Property Owner.
(3)The Division or its contractors will make reasonable attempts to notify the Property
Owner at least 48 hours prior to entering the Property for any purpose. In situations
that the Division determines to be of an emergency nature, the Division or its
contractors shall have immediate access to the property.
(4) Property Owner shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without prior consent of the Division.
By signing this consent document, I acknowledge that I am the legal property owner
or tenant in residence that has the authority to allow this work on the property and
have contacted all tenants (if there are tenants) occupying the property and all
tenants agree to the conditions of this "Property Access Consent".
(Signature of ProliertyUwner or Tenant in Residence) (Date)
In addition to calling 811 for a locate prior to drilling also call our Facilities Service Center (328-6776) to
request a locate
_.John_ ill_(262) Z3Z11Z9_oLKeAn_Garr;;w k252��&-B91 Q
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
_gilli @ecu.edu or carrawayc&ecu.edu
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via email)
Please return form to the DSCA Program's contractor for this site:
Christie Zawtocki
Hart & Hickman, P.C.
2923 S. Tryon Street
Charlotte, NC 28203
Or via email to: [e-mail]