WM0501430_Application_20210309

2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
March 9, 2021
Mr. Brion N. Byers, P.G.
Hydrogeologist
North Carolina Department of Environmental Quality
Raleigh Regional Office
Division of Water Quality, Aquifer Protection Section
3800 Barrett Drive
Raleigh, North Carolina 27609
Re: Permit to Construct Monitoring Wells
Sunshine Cleaners
3300 Guess Road
Durham, Durham County, North Carolina
DSCA Site ID DC320034
Dear Mr. Byers:
Enclosed please find six applications for permits to construct six permanent Type II groundwater
monitoring wells. Two groundwater monitoring wells will be installed on each of the following
three properties; 2603 West Carver Street, 3312 Guess Road, and 2626 Lombard Avenue in
Durham, Durham County, North Carolina. The permit applications, site maps with the proposed
locations of the monitoring wells, well construction details, and other relevant information are
enclosed as attachments. Please review this package and return the approved permit to this office
or via email to [e-mail].
If you have any questions or require additional information, please contact our office at (919)
871-0999 or my cellular telephone at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Robert Broda, P.G.
Project Geologist
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:03/08/2021
2. County: Durham
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Morris Lynwood Cherry, Jr., LLC (Petitioner for DSCA Site ID DC320034) Telephone: [phone]
Applicant’s Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant’s Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant): Robert Broda, ATC Associates of NC, PC Telephone: [phone]
Contact Person’s Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person’s Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): George W. and Linda A. May Telephone: [phone]
Property Owner’s Mailing Address: PO Box 49, Rougemont, North Carolina 27572
Property Owner’s Email Address (if available): Unknown
7.Property Physical Address (Including PIN Number) 2603 West Carver Street (PIN #0823-13-12-5621)
City Durham County Durham Zip Code___27705
8. Reason for Well(s): Groundwater contamination
(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:Dry-cleaner (DSCA)
(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).
DSCA Site DC320034
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?Yes, 4
Existing Monitoring or Recovery Well Construction Permit No(s).: Not Applicable
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet):0
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): ~20 Feet & ~500 Feet
15. Well Contractor: Innovative Environmental Technologies, Inc.Certification No.: 3287-B
Well Contractor Address: 232 Highway 49 South, 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
WM0501430

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)

2. Number of wells to be constructed in unconsolidated
material: 0

3. Number of wells to be constructed in bedrock: 1

4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap,
Flush-mount steel protective casing

6. Estimated beginning construction date: 04/05/2021

7. Estimated construction completion date: 04/08/2021

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

Agent for DSCA Site DC320034 (will include power of attorney
Signature of Applicant or *Agent Title of Applicant or *Agent upon request)

Robert Broda, P.G. (Agent for NCDEQ DWM) * 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 See attached access 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 Resources’ 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]

Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]

Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
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SUNSHINE CLEANERS
3300 GUESS ROAD
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DC320034
LOWER LEFT

2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3234SL04
MONITORING WELL
CONSTRUCTION DETAIL
Sunshine Cleaners
3300 Guess Road
Durham, Durham County, North
Carolina
DSCA Site ID DC320034REVIEWED BY: MGDATE: 03/08/2021
2” Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-20 feet)
Grout Extending From Ground Surface
To Top of Bentonite (0-15 feet)
#2 Filter Sand Pack Extending 2 Foot Above Screen
(18-35 feet)
15 Feet of 2” Schedule 40 Well Screen (0.010” Slot)
(20-35 feet)
Well finished at surface with a locking
well cap and flush-mount steel
protective casing
Groundwater Table
Type II Groundwater Monitoring Well
Installed in Bedrock
3-Foot of Bentonite Seal (15-18)
ROY COOPER
Governor
MICHAEL S. REGAN
Secretory
MICHAEL SCOTT
Director
NORTH CAROLINA
Environmental Quality
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval
If you have questions on how to fill out this form or about the activities
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program's contractor for this project, Robert Broda with ATC
Associates of North Carolina, P.C. (ATC) at RoberLBroda�r�,atcgs.com
or [phone]. If you still have questions after contacting Mr. Broda with
ATC, please contact the DSCA project manager, Jay King at
Jay.King(a)ncdenr.gov or [phone].
For DSCA Use Only
DSCA Site ID
DC320034
Please Print
Geoige W. and Linda A. May
(Name of Property Owner of Tenant in Residence)
2603 West Carver Street
(Street Number and Street Name of Property)
Durham Durham 27705
(City or Town in Which Property Is Located) / (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.
North caroling 0
217 West Jones 5tre
nt of Erwlronrnental Quality I
4bMadservlreCenter 1 R: 169-h.
919,7018200
i Waste Manage
th Carektrta 276991 646

(2) On conclusion of all activities, the Division and its contractors shall, to the extent piacticable,
restore the Property to the original condition it was m prior to any activities conducted by the
Division or its contractors All monitoring wells will be 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 pnor 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 Property Own r or Tenant in Residence)
!J as )2o/2_
(Date)
Met 999 1ft9g ` tek HA 1E009-
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Robert Broda, P.G.
ATC Associates of North Carolina, P.C.
2725 East Millbrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
North Carolina Depart nt of orvnrntai Quality 1 Div cwa of Wastr 0.4 mrnt
217West Jones Street 1 it4&1.1all".*rider Crrltcr 1 Rakich, Pva thCSrr rta276991446
919,707.0200

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: 03/08/2021

2. County: Durham

3. What type of well are you applying for? (monitoring or recovery): Monitoring

4. Applicant: Morris Lynwood Cherry, Jr., LLC (Petitioner for DSCA Site ID DC320034) Telephone: [phone]

Applicant’s Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646

Applicant’s Email Address (if available): [e-mail]

5. Contact Person (if different than Applicant): Robert Broda, ATC Associates of NC, PC Telephone: [phone]

Contact Person’s Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604

Contact Person’s Email Address (if available): [e-mail]

6. Property Owner (if different than Applicant): Terry M. Bennett and Michelle H. Bennett Telephone: [phone]

Property Owner’s Mailing Address: PO Box 703, Rural Hall, North Carolina 27045

Property Owner’s Email Address (if available): [e-mail]

7. Property Physical Address (Including PIN Number) 3312 Guess Road (PIN #0823-13-03-9091)
City Durham County Durham Zip Code___27705

8. Reason for Well(s): Groundwater contamination
(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: Dry-cleaner (DSCA)
(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).

DSCA Site DC320034

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? Yes, 4

Existing Monitoring or Recovery Well Construction Permit No(s).: Not Applicable

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0

14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes

If yes, give distance(s): ~500 Feet

15. Well Contractor: Innovative Environmental Technologies, Inc. Certification No.: 3287-B

Well Contractor Address: 232 Highway 49 South, 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: 0

3. Number of wells to be constructed in bedrock: 1

4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap,
Flush-mount steel protective casing

6. Estimated beginning construction date: 04/05/2021

7. Estimated construction completion date: 04/08/2021

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

Agent for DSCA Site DC320034 (will include power of attorney
Signature of Applicant or *Agent Title of Applicant or *Agent upon request)

Robert Broda, P.G. (Agent for NCDEQ DWM) * 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 See attached access 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 Resources’ 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]

Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]

Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
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SUNSHINE CLEANERS
3300 GUESS ROAD
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DC320034
LOWER LEFT

2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3234SL04
MONITORING WELL
CONSTRUCTION DETAIL
Sunshine Cleaners
3300 Guess Road
Durham, Durham County, North
Carolina
DSCA Site ID DC320034REVIEWED BY: MGDATE: 03/08/2021
2” Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-20 feet)
Grout Extending From Ground Surface
To Top of Bentonite (0-15 feet)
#2 Filter Sand Pack Extending 2 Foot Above Screen
(18-35 feet)
15 Feet of 2” Schedule 40 Well Screen (0.010” Slot)
(20-35 feet)
Well finished at surface with a locking
well cap and flush-mount steel
protective casing
Groundwater Table
Type II Groundwater Monitoring Well
Installed in Bedrock
3-Foot of Bentonite Seal (15-18)

PROPERTY ACCESS CONSENT

This document may not be modified without the Program’s approval.
If you have questions on how to fill out this form or about the activities
at this site, please call the Dry-Cleaning Solvent Cleanup Act (DSCA)
Program’s contractor for this project, Robert Broda with ATC
Associates of North Carolina, P.C. (ATC) at [e-mail]
or [phone]. If you still have questions after contacting Mr. Broda with
ATC, please contact the DSCA project manager, Jay King at
[e-mail] or [phone].

Please Print

Terry M. Bennett and Michelle H. Bennett
(Name of Property Owner or Tenant in Residence)

3312 Guess Road
(Street Number and Street Name of Property)

Durham Durham 27705
(City or Town in Which Property Is Located) / (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.
For DSCA Use Only
DSCA Site ID

DC320034
(2) On conclusion of all activities, dm Division and its contractors shall, to the extent practicable.
tatore the Property to the onginal condition it was in poor to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance with
applicable laws and regulations, unless other unngemenu tic agreed to by the Property
Owner.
(3) The Division or its contractor will make reasonable attempts to notify the Properly Owner at
least 48 hours poor to entering the Poverty for any purpose. In situations that the Division
determines to be of an ,s.sg.s.y nature, the Division or its contncton shall have inmrtdute
access to the property.
(4) Property Owner shall not willingly destroy. damage. remove. pave over or cove any
mooitonng wells at the site without pod consent of the Division
By signing thls consent document, acknowledge that 1 am the legal property owner or tenant
in residence that has the authority, to allow this work on the property and have conlancd all
tenants Of there are tenants) occup)Ing the property and all tenants sure to the conditions
of I his Property .A rce t CononC.
(Signature ofi4opaty )Owner or Tenant inResidence) (Date)
33 — Lft(2 —LoEffie&
(Telephone Number for Property Owner or Tenor in Raidmm fat scheduling wnrk/aooficshoo)
)41i-HRLey . nr-%'
(Email Addrrss for Property Owner el Tenant in Residence if you prefer to be coamcted aria
anvil)
Please return form to:
Robert &oda, P.G.
ATC Associates of North Carolina, P.0
2725 East Millbrook Road, Suite 121
Raleigh, NC 27604
Or via email to: Robert.eroda@atW,com

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: 03/08/2021

2. County: Durham

3. What type of well are you applying for? (monitoring or recovery): Monitoring

4. Applicant: Morris Lynwood Cherry, Jr., LLC (Petitioner for DSCA Site ID DC320034) Telephone: [phone]

Applicant’s Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646

Applicant’s Email Address (if available): [e-mail]

5. Contact Person (if different than Applicant): Robert Broda, ATC Associates of NC, PC Telephone: [phone]

Contact Person’s Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604

Contact Person’s Email Address (if available): [e-mail]

6. Property Owner (if different than Applicant): C & C Investments LTD Telephone: [phone]

Property Owner’s Mailing Address: PO Box 3089, Durham, North Carolina 27715

Property Owner’s Email Address (if available): Unknown

7. Property Physical Address (Including PIN Number) 2626 Lombard Avenue (PIN #0823-17-12-2257)
City Durham County Durham Zip Code___27705

8. Reason for Well(s): Groundwater contamination
(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: Dry-cleaner (DSCA)
(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).

DSCA Site DC320034

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? Yes, 4

Existing Monitoring or Recovery Well Construction Permit No(s).: Not Applicable

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0

14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes

If yes, give distance(s): ~50 Feet & ~500 Feet

15. Well Contractor: Innovative Environmental Technologies, Inc. Certification No.: 3287-B

Well Contractor Address: 232 Highway 49 South, 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: 0

3. Number of wells to be constructed in bedrock: 1

4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap,
Flush-mount steel protective casing

6. Estimated beginning construction date: 04/05/2021

7. Estimated construction completion date: 04/08/2021

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

Agent for DSCA Site DC320034 (will include power of attorney
Signature of Applicant or *Agent Title of Applicant or *Agent upon request)

Robert Broda, P.G. (Agent for NCDEQ DWM) * 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 See attached access 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 Resources’ 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]

Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]

Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
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2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3234SL04
MONITORING WELL
CONSTRUCTION DETAIL
Sunshine Cleaners
3300 Guess Road
Durham, Durham County, North
Carolina
DSCA Site ID DC320034REVIEWED BY: MGDATE: 03/08/2021
2” Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-20 feet)
Grout Extending From Ground Surface
To Top of Bentonite (0-15 feet)
#2 Filter Sand Pack Extending 2 Foot Above Screen
(18-35 feet)
15 Feet of 2” Schedule 40 Well Screen (0.010” Slot)
(20-35 feet)
Well finished at surface with a locking
well cap and flush-mount steel
protective casing
Groundwater Table
Type II Groundwater Monitoring Well
Installed in Bedrock
3-Foot of Bentonite Seal (15-18)
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
NORTH CAROLINA
Environmental Quality
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval
If you have questions on how to fill out this form or about the activities
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program's contractor for this project, Robert Broda with ATC
Associates of North Carolina, P.C. (ATC) at Robert.Brodagatcgs.com
or [phone]. If you still have questions after contacting Mr. Broda with
ATC please contact the DSCA project manager, Jay King at
Jay.King(euncdenr.gov or [phone].
For DSCA Use Only
DSCA Site ID
DC320034
Please Print
C & C Investments LTD or Phil Clegg
(Name of Property Owner of Tenant in Residence)
2626 Lombard Avenue
(Street Number and Street Name of Property)
Durham
Durham 27705
(City or Town in Which Property Is Located) / (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.
Dirt rrt rtCmirc n rttal Quail y I Divii.hin of
akic ti. Narlh Curatg 7n

(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 prioi to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance with
applicable laws and regulations, unless other anangements 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"
(Sigryaof Propert er or enant in Residence
(Telepho Ter for Property Owner or Tenant in Residence for scheduling work/notification)
ail Address for Pr
email)
Please return form to:
erty you u prefer to be contacted via
Owner or T tin Residence if
Robert Broda, P.G.
ATC Associates of North Carolina, P.C.
2725 East Millbrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
crtl of rm1ronmtotal Quit rtt
6 11/41all Service Center l 9 1646
919.7018200