WM0801166_Application_20210129

DocuSign Envelope ID: 8B086ECA-10C6 4C40-9CE8-8EOA40AA27D2 IJMENTAL QUALITY - DIVISION OF WATER RESOURCES
YVR11 1"VNRV LIIYN UCrAR11Y1 CIYI Vr CIYVIRVI
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: 01 /27/21
2. County:
PERMIT NO.
FOR OFFICE USE ONLY
ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Cape Fear Commercial Telephone: [phone]
Applicant's Mailing Address: 1051 Military Cutoff Road, Suite 200, Wilmington, North Carolina 28405
Applicant's Email Address (if available): mike(a)capefearcommercial.com
5. Contact Person (if different than Applicant): Erin Warren Telephone: [phone]
Contact Person's Mailing Address: 6714 Netherlands Drive, Wilmington NC 28405
Contact Person's Email Address (if available): EWarren(a-)ecslimited.com
6. Property Owner (if different than Applicant): New Hanover County Telephone: [phone]
Property Owner's Mailing Address: 230 Government Center Drive, Suite 195, Wilmington NC 28403
Property Owner's Email Address (if available): tburgess(a)nhcgov.com
7. Property Physical Address (Including PIN Number) 230 Government Center Drive, Suite 195 (PIN) R04916-003-002-000
City Wilmington County New Hanover Zip Code 28403
8. Reason for Well(s): Assessment
(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: Governmental
(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).
NO
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).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Unknown
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? NO
If yes, give distance(s):
15. Well Contractor: Mid -Atlantic Drilling Certification No.: 2540-A
Well Contractor Address: 426 Landmark Dr, Wilmington, NC 28412
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

DocuSign Envelope ID: 8BO86ECA-10C6-4C40-9CE8-8EOA40AA27D2
rmur-uamu vvr=L-L- %,vrya i r-.UCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 4
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured?
N/A GW Borings
6. Estimated beginning construction date: 2/151/21
4. Total Number of wells to be constructed: 4 7. Estimated construction completion date: 2/15/21
(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,
oocuSigned by: Subchapter 2C) and accepts full responsibility for compliance with these rules
4173
Signature of Applican or gent Title of Applicant or *Agent
Mike Brown
* 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).
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
3800 Barrett Drive
Wilmington, NC 28405
2090 U.S. Highway 70
Raleigh, NC 27609
Phone: [phone]
Swannanoa, NC 28778
Phone: [phone]
Fax: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone]
Winston-Salem Regional Office
Washington Regional Office
450 W. Hanes Mill Road
Fayetteville Regional Office
943 Washington Square Mall
Suite 300
225 Green Street, Suite 714
Washington, NC 27889
Winston-Salem, NC 27105
Fayetteville, NC 28301-5094
Phone: [phone]
Phone: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
OR Rev. 3-1-2016
Raleigh Regional Office
Wilmington Regional Office
127 Cardinal Drive Extension
GW-22M (Rev. 5/11)

DocuSign Envelope ID: BBA0847E-DF90-4EA2-BOD8-663972DD4F29
ECS SOUTHEAST, LLP
ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49-20202P
Scope of Work: Limited Groundwater Assessment
Project Name: New Hanover County Government Center —Environmental Services
Location: 230 Government Center Drive, Wilmington, New Hanover County, North Carolina
As part of the proposed real estate transaction, ECS Southeast, LLP (ECS) has been requested by the
purchaser to conduct subsurface groundwater sampling at the site. The groundwater sampling at the site
requires that ECS procure a permit from the North Carolina Department of Environmental Quality
(NCDEQ).
ECS respectfully requests that the owner of the property grant permission to ECS to access the property
to conduct the groundwater sampling. By signing below, property owner authorizes ECS to conduct the
aforementioned groundwater sampling at the site and to obtain the above -referenced permit on behalf
of the nwnpr.
Property Owner (please
Property Owner Signatu
ECS Proposal No: 49-19231P
Page 16
'imothv C. Burgess
Deputy County Manager

?TaQ by Esai I UGS, Nabana4 Cieagra
N
FIGURE 1
E E TOPOGRAPHIC LOCATION MAP
S SOURCE:
USGS TOPOGRAPHIC MAPS New Hanover County Government Center
Northwest QUADRANGLES 2013 230 Government Center Drive
Wilmington, New Hanover County, North Carolina
SCALE — AS SHOWN
TM ECS Proposal Number 49-20202P

J ' f a •I' # .f� �14
ori Park
it
r : Borne Oepull
r Ten-P.r1 A•Ii�y _ r*5 •,1�.
x1<r is .' y
11131 Ti
F'r.t �II 4 * * 5•L� OF4
YL
C rs
� ' + J � z+�*� J••• �� C7�rn rt
:•Ixestal . t I'
-
- t i 4P 1
i
f 7 1..arr116S �
' C: FOX
i • � 'x� f�4a01�C U��t:q Jr E.-�I.- rJ'rr�s
Arikhn' ih
y�
x �• ytA + 1h
� S
fr f { i ;
• .5
jjp
f + a
� ■J s
A
30U R _iT.• 's•.keereh I. I o lla!GT a GeoEya, 1-rLaay, USEA LSGS. ,F7(, Gelmapp'rp, Ae!err,- IGH --Z) 3wImk-ADO, aw.] II?r .=1a I.r3}' '_c.lri
N FIGURE 2
SOURCE: PHASE I ESA PROPOSED SAMPLE LOCATIONS
�E
s SCALE: AS SHOWN New Hanover County Government Center
® Shallow Groundwater Sampling Location 230 Government Center Drive
Wilmington, New Hanover County, North Carolina
Deep Groundwater Sampling Location ECS Proposal Number 49-20202P
TM

GROUND
CI IRFArE
TOP OF DIRECT PUSH STEEL
RODS ABOVE THE LAND
�..... "
SURFACE
10 FEET
1.5-INCH STEEL DIRECT
NATURAL FORMATION
PUSH RISER
BACKFILL
2--INCH BORE
HOLE
GROUNDWATER
SLOTTED STEEL SCREEN
0.01-INCH SLOT WIDTHS
SET TO INTERSECT GROUNDWA7
17
ESTIMATED 4 FEET IN LENGTH
WELL CONTRUCTION DIAGRAM
REPRESENTATIVE OF DIRECT PUSH!
DnIKIT CAMDI FD
NOT TO SCALE
'ER
IS
SCREEN
FIGURE 3
PROPOSED TEMPORARY SCREEN POINT SAMPLER
New Hanover County Government Center
230 Government Center Drive
Wilmington, New Hanover County, North Carolina
na
' ECS Proposal Number 49-20202P