WM0501419_Application_20201116

GR
Geological Resources, Inc.
November 16, 2020
Mr. Brion Byers
NCDEQ, Division of Water Quality
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699
Re: Monitoring Well Permit Application
Red Apple Market #9
100 W Jackson Street
Rich Square, Northampton County
Incident No: 11920
GRI Project No: 4497
Dear Mr. Byers:
Please find enclosed a monitoring well permit application for the installation of four Type II monitoring
wells at the former Red Apple Market #9 site located at 100 W Jackson Street in Rich Square,
Northampton County. GRI plans on installing the monitoring wells in December 2020.
Your prompt attention to this matter will be greatly appreciated. If you have any questions or require
additional information please do not hesitate to contact me at [phone].
Sincerely,
•
William Regenthal, P. G.
Project Manager
enclosures
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

Type ill:Monitoring Well
Typic : f Construction Details
concrete pad
ground surface
grout cement
55- c
bentonite real
sand fA(er peak
'4
(0 -
-17
t1
-• manhole cover
looking well cap
2 Inch diameter
sohadule 40 PVC easing
r••
0A10 Inch slatted 2tnoh diameter
schedule 40 PVC Korean
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f •
end eels

WM0501419
Printed name of Applicant or *Agent
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Locking cap
material: 4
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: Dec 2020
4. Total Number of wells to be constructed: 4 7. Estimated construction completion date: Dec 2020
(add answers from 2 and 3)
1.
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 a• _-s that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction i 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
L' !i i Project Manager
r *Agent Title of Applicant or *Agent
gnature of Ap
William Regenthal, P. G.* 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 Right -to -Enter 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 Quality's Aquifer Protection Section 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]
17L 7Wincton;Sokriv
LMtwrpsville/
tr1riite , --" G. L:=
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: [phone]
`tr. Vl ngton
GW-22MR (Rev. 7l11)

RIGHT TO ENTER AGREEMENT
FOR
CONDUCTING SUBSURFACE INVESTIGATIONS
STATE OF NORTH CAROLINA
COUNTY OF NORTHAMPTON
We, the undersigned, being all of the fee simple owners of certain tracts or parcel designated as 5902-53-
6084 of the County of NORTHAMPTON, recognizing the benefits to said properties by reason of
conducting subsurface investigations hereby grant to Red Apple Markets, Inc. and the agents the right to
enter said property in accordance with the requirements of the State of North Carolina. Red Apple
Markets, Inc; s agents may include Geological Resources, Inc.
The undersigned hereby covenant and warrant that they are the sole owners of said property; that they
solely have the right to grant this right to enter for conducting subsurface investigations against the lawful
claims of all persons whomsoever.
It is agreed that Red Apple Markets, Inc. shall be responsible for restoring any damage done to the ground
of said property by its employees or its agents during the subsurface investigation and monitoring period,
and that Red Apple Markets, Incorporated shall abandon monitoring wells on said property in accordance
with NCDEQ requirements at the conclusion of the monitoring period.
It is agreed that Red Apple Markets, Inc. shall hold harmless the owner of the aforementioned property
for any personal injury that might be sustained during the course of conducting or proximately resulting
from the conduct of subsurface investigations.
ht to Enter denied.
Right to Enter granted.
phone :
Date
_LIAZA1/ 4eLif_s_Adl
- 3' $ - 2° -5
(RTE RAM #9)

\250-FOOT RADIUS
1,000-FOOT RADIUS
-------1,500-FOOT RADIUS
Sources Esn, HERE, Garman, USGS. Intermap, INCREMENT P; NRCan, Esri Japan, METI, Esn
OpenStreetMap contributors, and the GIS User Community
LEGEND
Adjacent Properties
—— —ncrivers
nc_northampton_parcels_poly
/
150
300
Feet
1 inch = 300 feet----,7
FIGURE 3: SITE VICINITY MAP
RAM #9
100 W. JACKSON STREET
RICH SQUARE, NORTHAMPTON COUNTY
NORTH CAROLINA
INCIDENT NO. 11920
GRI PROJECT NO. 4497
PREPARED BY:
GEOLOGICAL RESOURCES,INC.
APRIL 28, 2017
GP
Geological Resources, Inc.

LEGEND
- — SUBJECT PROPERTY
BOUNDARY LINE
- — — ADJACENT PROPERTY
BOUNDARY LINE
TREES
TYPE l/ MONITORING WELL
TYPE Ill MONITORING WELL
Note:
1. This Site Map is based on data from
Google Earth.
2. This site was not professionally surveyed;
site features and utilities are approximate.
Former ion Boundary
N
Geological Resources, Inc.
0 20 40
80
(INFEET )
1 inch = 40 ft
SITE MAP
Red Apple Mart ,f9
Incident No. 11920
GR/ Project No. 4497
100 W Jackson Street
Rich Square, Northampton County,
North Carolina
Date:
01/27/2020
Drawn by:
DTH
Figure: 2