WM0501415_Permit (Issuance)_20201020

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
October 20, 2020
Chaucer Investments, LLC (petitioner for DSCA 492-0048)
N.C. DWM, DSCA (Mike Cunningham)
1646 MSC
Raleigh, NC 27699-1646
Subject: Monitoring Well Construction
Permit # WM0501415
DSCA #92-0048 (Rollins Economy Cleaners)
407 West Peace Street
Raleigh, NC -Wake County
To Whom It May Concern:
In accordance with the application received on October 7, 2020, and the additional requested
information received on October 16, 2020, we are forwarding herewith Monitoring Well Construction
Permit No. WM0501415 dated October 20, 2020, issued for the construction of a monitor well system
(installation of one well) at the subject property (1027 N. West Street). Please be aware that some counties
This Permit will be effective from the date of its issuance and shall be subject to the conditions and
limitations as specified therein. Please note the addition of stipulation #3 to the permit enclosed. If you have
any questions about this permit, please contact Eric Rice at [phone].
Sincerely,
SDocuSigned by:
BCDA9D825D4A48D...
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
cc: RRO Files
Wake County Health Department
Email- [e-mail] Robert Harrell, Hart & Hickman, 3921 Sunset Ridge Road
Ste 301, Raleigh, NC 27607
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 13800 Barrett Drive I Raleigh. North Carolina 27609
919.791.4200

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
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
Chaucer Investments, LLC (petitioner for DSCA #92-0048)
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM (DSCA #92-0048 -Rollins Economy Cleaners)
consisting of one well owned by Chaucer Investments, LLC (petitioner for DSCA #92-0048) at mailing address 1646
MSC in Raleigh, NC. The well will be located on the property owned by the City of Raleigh located at 1027 N. West
Street in Raleigh, NC -Wake Co. This Permit is issued in accordance with the application received on October 7, 2020
and the additional requested information received on October 16, 2020 in conformity with specifications and
supporting data, all of which are filed with the Department of Environment and Natural Resources 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
Resource's 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
Resource's Information Processing Unit within 30 days of the well abandonment.
7. If the well penetrates any water -bearing zone that contains contaminated waters, the upper three feet
of the well shall be grouted within one day after the casing is set or the well abandoned.
Permit issued the 20'' of October 2020
FOR THE NORTH CAROLINA ,AY&9QXf NTAL MANAGEMENT COMMISSION
Scott inson, egional upervisor
Divisi BMP@t° %ources
By Authority of the Environmental Management Commission
Permit No. WM0501415

g,p C, e w�
tC)1�/�0
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: 10/6/2020
2. County: Wake
FOR OFFICE USE ONLY
PERMIT NO. (t�S����3� ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Permanent Type II Monitoring Well
4. Applicant: Chaucer Investments LLC (petitioner for DSCA Site #DC920048) Telephone: Mike Cunningham [phone]
Applicant's Mailing Address: DSCA Program 1646 Mail Service Center Raleigh NC 27699-1646
Applicant's Email Address (if available): mike.cunningham(aDncdenr gov
5. 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): rharrell aaharthickman.com
6. Property Owner (if different than Applicant): City of Raleigh Telephone: [phone] or [phone]
Property Owner's Mailing Address: _ PO Box 590, Raleigh NC 27602
Property Owner's Email Address (if available): william iackson(a)citvofraleighnc qov or kris nikfaraaraleighnc qov
7. Property Physical Address (Including PIN Number) 1027 N West Street (PIN# 1704528222)
City Raleigh County Wake Zip Code 27602
8. Reason for Well(s): Environmental Assessment for DSCA Program
(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: Former Dry Cleaner
(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).
NCDEQ DSCA Site ID #DC920048
11. Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Approximately 250 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: 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
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? Bolted flush -mount
well with lockable well cap
6. Estimated beginning construction date: October 2020
Estimated construction completion date: October 2020
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. 143-215.1013(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
•t6r`�7 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 prooerty 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]
1R Rev. 3-1-2016

ACCESS AND LICENSE AGREEMENT
bTHIS ACCES AND LICENSE AGREEMENT (the "Agreement") is made as of
�_�%��1 AM 2020 by and between Hart & Hickman, P.C., a North Carolina
professional corporation, ("Licensee") having an address of 2923 S. Tryon Street, Suite 100,
Charlotte, NC 28203 and the City of Raleigh, a North Carolina municipal corporation ("City").
WHEREAS, a former dry-cleaning facility is located at 407 West Peace Street, Raleigh,
North Carolina 27603 (the "Former Dry -Cleaning Facility") and owned by Chaucer Investments
LLC.; and
WHEREAS, the City owns property known as Parcel ID No. 1704528222 located at 1027
N. West Street, Raleigh, North Carolina, 27603 (the "Property") located within contiguous to
an area containing soil and groundwater contamination related to the Former Dry -Cleaning Facility
and has the authority to grant the access required hereunder; and
WHEREAS, Licensee desires to assess whether soil and groundwater contamination
related to the Former Dry -Cleaning Facility may be present on and in the vicinity of the Property;
and
WHEREAS, Licensee desires to install, inspect, and sample monitoring well(s) on the
Property pursuant to the terms of this Agreement.
NOW, THEREFORE, in consideration of the execution of this Agreement, and other
valuable and good consideration, the receipt and sufficiency of which is hereby acknowledged,
Licensee and City agree as follows:
L Work. The term "Work" shall be defined to include the installation, inspection, and
periodic sampling of a groundwater monitoring well as described in the attached Exhibit "A".
Licensee shall work with Billy Jackson ([e-mail], 919-996-2984) and Kris
Nikfar ([e-mail], 919-996-4786) to determine the precise location of the
monitoring well. The Work will be performed by a North Carolina licensed well contractor at the
direction of a Licensee. As between Licensee and City, Licensee agrees to be solely responsible
for all costs and expenses incurred in performing the Work contemplated hereunder, and City shall
have no obligation or responsibility for such costs or expenses.
2. Grant of License. City hereby grants Licensee, its authorized agents, employees,
contractors, and sub -contractors (the "Performing Entities"), for the benefit of the Property, a non-
exclusive license ("License") for access to the Property to enter the Property for the express and
limited purpose of performing the Work pursuant to the terms of this Agreement. The City shall
in all other respects as owner of the Property be able to make all Iawful uses of the Property not
inconsistent with the terms of this Agreement.
3. Terms of License. The Performing Entities shall exercise their rights under the License

IN WITNESS THEROF, the parties have executed this Agreement on the dates set forth
on the first page of this Agreement.
Licensee
By: �l
�1✓iS-hc. zQ'.'- G3 Ca. Yl1rfsu,'4—
Printed Name, Title
(Coiperalle?Sea?)=
'Cafy;af 1aXeb%'
By:
(Corporate Seal)
Attest:
B : (h-
Printed Name, Title
By: klL�'( Q. � a.—
-u or'A A -7-)Q6,wa. Aksfan-r
City Clerk

L3
TYPE II MONITORING WELL CONSTRUCTION DETAI
CROSS SECTIONAL VIEW
LOCKABLE WELL CAP
L1
L2
L1 = 5 FT.
L2 = 10 FT.
L3 = 15 FT.
CONCRETE PAD
FLUSH METAL WELL COVER
CONCRETE PAD
BACKFILL AROUND CASING
MATERIAL
cement grout
LENGTH
3 ft (0 to 3 ft)
SEAL
TYPE OF SEAL
bentonite/grout
THICKNESS
1 feet (3 ft to 4 ft)
— WELL CASING
MATERIAL
schedule 40 PVC
DIAMETER
2 inches
JOINT TYPE
flush threaded
LENGTH
5 feet
FILTER PACK
TYPE OF FILTER
No. 2 Sand
THICKNESS
11 feet (4 ft to 15 ft)
WELL SCREEN
SCREEN MATERIAL
schedule 40 PVC
DIAMETER
2 inches
LENGTH
10 feet
SLOT SIZE
0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL
15 feet
DIAMETER OF
BOREHOLE
4.25 in
Monitoring Well Diagram
Hart & Hickman, PC
3921 Sunset Ridge Rd. Ste. 301
Raleigh, NC 27607
FILE PREP. BY REV. BY DATE PROJECT NO.
RH GK 10/6/2020 DSO-79 (DSCA ID# DC920048)

DEVEROUXS TREET
U
2
0o
m
h
2
O
W
U
C
MCCLUREDRIVE W
5
h
3W
?
I
�sw-1 •
W. PEACE STREET
I
w
I
I
CJ
i I
•
o•
�L
/
W
I
�
w
�
Y
m
0
Q�
U
W. JOHNSON STREET
i
I
� S.
ti
W
�W
Zh
O
O
2
p
N
APPRO7(INATE
0 100 200
SCALE IN FEET
LEGEND
- - — SOURCE PROPERTY BOUNDARY
PROPOSED MONITORING WELL LOCATION MAP
PROPERTY PARCEL BOUNDARY
Proposed Perrnanmt MonRorinp Well Location
•
ROLLINS ECONOMY CLEANERS
DSCA ID: DC920048
--- FORMER BUILDING FOOTPRINTS
407 W. PEACE ST.
Hilill;"I 11 RAILROAD
RAL1EIILGHH._Wa�AKE COUNTY
- — _ SUBGRADE PIPING
hart hickman pl, "923 Somh Tryon Suee -Sft, IN
Qudonc, N-11-128203
— • —SURFACE WATER FEATURE
. -n 586A00-(p) 70i586.W7)(t)
YYGR 01Y�1�lIgLOM11E 1 llcmec#Gl'69
SURFACE WATER SAMPLE LOCATION
aC-.45GeoI
DATE 1-21-20 REVISION NO. 0
JOB NO. DSO-79 ATTACHMENT NO.2