WM0701246_Application_20210406 (2)

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: March 23, 2020
2. County: Pitt
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant: Petitioner for DSCA SITE #DC740012 (Bowen Cleaners)
Temporary Monitoring Wells
Telephone: [phone]
Applicant's Mailing Address: NCDEQ DWM, DSCA Program, Scott Stupak, 1949 Mail Service Center, Raleigh, NC 27699
Applicant's Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant): Nick Shore (AECOM) Telephone: [phone]
Contact Person's Mailing Address: 1600 Perimeter Park Dr, Suite 400, Morrisville, NC 27560
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Greenville HO RE, LLC
Telephone: [phone]
Property Owner's Mailing Address: 6000 Monroe Road, Suite 100, Charlotte, NC 28212
Property Owner's Email Address (if available): [e-mail]
7. Property Physical Address (Including PIN Number) 729 SW Greenville Boulevard (PIN 4676465534)
City Greenville County Pitt Zip Code 27834
8. Reason for Well(s): environmental 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: drycleaning
(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 DC740012
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, 8
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0701201
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): -665 feet
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: Regional Probing Certification No.: NC3322-A
Well Contractor Address: PO Box 1161, Wake Forest, NC 27588
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

PROPOSE© WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 1
5. How will the well(s) be secured? bentonite and grout
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: April 8, 2021
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: April 8, 2021
(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 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
On behalf of Petitioner for DSCA Side DC740012
Signature of Applicant or *Agent /1
Ford Nicholas Shore
Printed name of Applicant or *Agent
Agent for Petitioner of DSCA Site DC740012
Title of Applicant or *Agent
* 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 access agreement
Signature of Property Owner (if different than Applicant)
see attached access agreement
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]
GW-22MR Rev. 3-1-2016

;1
.3 µg/I
rGW-6 (14-18') (08/20/2014)
PCE - 330 00
TCE -627
cis-1,2-LJJI 7 2 €,/1
GW-6 (24-28') (08/20/2014)
PPE - 00
CE - 170 µg
2-DCE - 9
PW-1 (03/29/2017)
GW-5 (14-18') (08/20/2014)
1Ft.t.-4i.vµgii 00
TCE - 21.6 µg/1
cis-1,2-DC - 7
GW-5 (24-28') (08/20/2014)
PCE-00
TCE -38.5µg/1$
cis-1,2-DCE - 27.2 µg/
trans-1,2-Dry' - 0.43 J µg/1
f-PW-3 (03/29/2017)
BT)1.
"GW-4 (24-28') (08/20/2014)
00
GW-3 (24-28') (08/20/2014)
BDL 00
MW-1 (5-15') (11/08/2019)
PCE - 40.8 µg/1 00
cis-1,2-DCE - 8,540 µg/1
trans-1,2-DCE - 86.8 µg/1
Vinyl Chloride - 201 14/1
4-28') (08 20/2014)
00
MW-3 (5 - 15') (11/08/2019)
PCE - 0.417 µg/1 00
Xylenes - 1.17 µg/1
r MW-6 (5-15') (11/08/2019)
BDL 00
\ J
FOR ' THE
WHOUSE
FORMER BO N
DRY CL ERS
"GW-8 (18-22') (08/20/2014)"
PCE - 0.65 J µg/1 00
GW-8 (24-28') (08/20/2014)
BDL 00
STORM�1 7-rFC-R�
RETENTION
Proposed DPT GW-10
PARKING
PARKING
PARKING
Proposed DPT GW-13
OUTPARCEL
GW-9 (14-18') (08/20/2014)
E 00
GW-9 (24-28') (08/20/2014)
r L 00
Proposed DPT GW-11
TPARCEL
1119,111,pm
GW-7 (14-18') (08/20/2014)
I 00
CE - 9.1 µ4/1
;s-1,2-DCE= 1 9-µg/1
GW-7 (20-24') (08/20/2014)
- 210 µg/1 00
E - 120 µw/1
::is=1,2-DCE,.- 24 µg/I '
trans-1,2-DCt - at.56 ITg/1
MW-5 (5-15') (11/08/2019)
PCE - 0.395 µg/1 00
MW-7 (5-15') (11/08/2019)
PCE - 0.397 µg/1 00
Toluene - 7.20 µg/1
Proposed DPT GW-12
OUTPARCEL
r�
i MW-4 (5-15') (11/08/2019)
PCE - 0.387 µg/1 00
LEGEND
0 150
APPROX. SCALE, ft.
in
1.4
et) All
r
Monitoring Well Location
• Abandoned Monitoring Well Location
• Temporary Groundwater Sampling Location
▪ Pore Water Sampling Location
Potentiometric Surface Contour (ft/ms1)
Inferred Groundwater Flow Direction
Drainage Ditch
Outline of Previously Existing Structure
Approximate Extent of Soil Impacts
Property Boundary (Pitt County GIS)
Area of Chlorinated COC 2L Groundwater
Contaminant Exceedance
PCE - Tetrachloroethene
TCE - Trichloroethene
DCE - Dichloroethene
BDL - Below detection limits
ug/1 - micrograms per liter
Detections in Red exceed 2L Standard.
00 Groundwater analytical results do not exceed calculated vapor
intrusion risk for residential or non-residential exposure —
DSCA Indoor Air Risk Calculator, Version 7, August 2019.
00 Groundwater analytical results do not exceed calculated vapor
intrusion risk for non-residential exposure but do exceed for
residential exposure — DSCA Indoor Air Risk Calculator,
Version 7, August 2019.
00 Groundwater analytical results exceed calculated vapor
intrusion risk for residential and non-residential exposure —
DSCA Indoor Air Risk Calculator, Version 7, August 2019.
0
m
N
2
0
SHEET:
0
0
0
0
zz
Figure 1

AECOM
Client: DSCA Petitioner DC740012
Project Number: 60653383
WELL ID: DPT Borings
Site Location:
3400 South Memorial Drive, Greenville, NC
Date Installed: April 8, 2021
Well Location:
Various Coords:
Inspector:
Method: Direct Push
Contractor: Regional Probing
DIRECT -PUSH TECHNOLOGY BORING AND ABANDONMENT DETAIL
Describe Measuring Point:
Depth from G.S. (feet)
Abandoned once grab sample collected - match surface cover (asphalt or concrete patch, grass)
Top of Riser Pipe
Depth (abandonment)
(feet)
N/A N/A
Ground Surface (G.S.) 0.0
Riser Pipe: DPT stainless steel rods
Length 10 to 26 ft
Diameter (ID)
Type of Material Stainless Steel
Thickness
Grout: N/A
Type
Thickness
Stabilized Water Level
Top of Bentonite N/A Ground Surface
Bentonite Seal Thickness N/A Thickness: up to 30 ft
Top of Sand N/A N/A
Top of Screen
Screen: DPT Grab sampler extension
Length 4 ft
Diameter (ID) est 1 inch
Slot Size 10 slot
Type of Material Steel
Thickness
Type/Size of Sand N/A
Sand Pack Thickness N/A
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Borehole Diameter
2 inch
N/A N/A
Up to 30 feet bgs
Up to 30 ft bgs
up to 30 feet bgs
up to 30 feet bgs
Signature Date

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, Nick Shore with AECOM
Technical Services of North Carolina, Inc. (AECOM) at
nick.shorety,aecom.com or [phone]. If you still have questions after
contacting Mr. Shore with AEOCM, please contact the DSCA project manager,
Scott Stupak at cott.stupavui,cdenr.iLov or 919-707-8359.
For DSCA Use Only
DSCA ID No.
DC740012
Please Print
Greenville HO RE, LLC
(Name of Property Owner or Tenant in Residence)
729 SW Greenville Boulevard (PIN 4676465534)
(Street Number and Street Name of Property)
Greenville, Pitt County, North Carolina 27834
(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.
GQEQ
North Carolina Department of Environmental Quality I Division of Waste Stana9ement
217 West Jones Street 1646 Mall Ser.9ce Center I Raleigh. North Carolina 27699 1b46
919.707,8200

(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 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".
03 ^11r21
�. �o�am.P ofv..,,w.n. Owner .. ignature Property Owner or Tenant in Residence) (Date)
SC04+ eV' rb14c3'- q'y31 _
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
& oil-. B r Henatil ck.a t1+ . Covh
(Email Addressor Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Nick Shore
AECOM Technical Services of North Carolina, Inc.
1600 Perimeter Park Drive, Suite 400
Morrisville, NC 27560
Or via email to: [e-mail]
Nor th Carolina Ihpar trtrcnt of emvronrnentai Quality 1 Division of Waste Management
217 West Jones Street 1646 Mall Servke Center 1 Raleigh. North Carolina 27699'I646
919 707.4200