WM0501438_Application_20210513

2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
www.atcgroupservices.com
May 13, 2021
Mr. Brion Byers
North Carolina Department of Environmental Quality
Raleigh Regional Office
Division of Water Quality – Aquifer Protection
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Re: Permit to Construct Monitoring Wells
Jean’s Starflite
5205 Hillsborough Street
Raleigh, Wake County, North Carolina
NCDEQ Incident No. 39679
ATC Project No. SLC3967901
Dear Mr. Byers:
Enclosed please find one application for a permit to construct two monitoring wells. The monitoring wells
will be located at 5200 and 5204 Hillsborough Street (Parcel IDs 0784439213 and 0784438203) in
Raleigh, Wake County, North Carolina. The permit application, site map with the proposed location 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.
If you have any questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Jeremy J. Robbins, 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:05/13/2021
2.County:Wake
3.What type of well are you applying for? (monitoring or recovery):Monitoring
4. Applicant: Mark Petermann - NCDEQ State Lead Telephone: [phone]
Applicant’s Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant’s Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant): Gabriel Araos, ATC 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): Gate 3 Enterprises, LLC Telephone: [phone]
Property Owner’s Mailing Address: 105 Birkhaven Drive, Cary, NC 27518-8942
Property Owner’s Email Address (if available): [e-mail]
7.Property Physical Address (Including PIN Number) 5200 and 5204 Hillsborough Street (PINs: 0784439213 and 0784438203)
City Raleigh County Wake Zip Code 27606
8. Reason for Well(s): Suspected 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: UST
(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 UST Incident # 39679
11. Type of contaminants being monitored or recovered:Petroleum
(ex: organics, nutrients, heavy metals, etc.)
12.Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 3
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):100 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): 400 feet
15. Well Contractor: Geologic Exploration, Inc. Certification No.: 2581
Well Contractor Address: 176 Commerce Boulevard, Statesville, NC 28625
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
WM0501438
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)

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

3. Number of wells to be constructed in bedrock: 0

4. Total Number of wells to be constructed: 2
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap, 8”
flush mount manhole cover.

6. Estimated beginning construction date: 06/14/21

7. Estimated construction completion date: 06/14/21

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 speci fications 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

_________________________________________
Signature of Applicant or *Agent Title of Applicant or *Agent
Gabriel Araos, P.E. (Agent for NCDEQ State Lead) * 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 co nstruct
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 See attached
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]
GW -22MR Rev. 3-1-2016
GW-22M (Rev. 5/11)
GW-22MR (6/11)
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
www.atcgroupservices.com
April 19, 2021
Gate 3 Enterprises, LLC
105 Birkhaven Drive
Cary, NC 27518-8942
Re: Access Agreement for Environmental Assessment
Jean's Starfflte
5205 Hillsborough Street
Raleigh, Wake County, North Carolina
NCDEQ Incident No. 39679
ATC Project No. SLC3967901
To Whom It May Concern:
ATC Associates or North Carolina, P.C. (ATC), on behalf of the North Carolina Department of
Environmental Quality (NCDEQ), is conducting an environmental assessment at the Jean's Starflite at
5205 Hillsborough Street in Raleigh, North Carolina. As part of assessment activities, ATC is requesting
permission to install two monitoring wells on your properties located at 5200 and 5204 Hillsborough Street
(Parcel 11)s 0784439213 and 0784438203) in Raleigh, North Carolina, which is located adjacent and north
of the above referenced site. A map showing the location of your property in reference to the site property
is included.
You, as the property owner, will not be held responsible or held liable for any damages or expenses for
injury to persons or property while ATC is on the premises.
Please provide your authorization and approval by signing below and return the signature page in the
enclosed envelope by May 10, 2021. Acknowledgment of this foam is required by NCDEQ. Denial of
site access will be forwarded to NCDEQ for their pursuit of site access
If you have any questions regarding these activities, please contact Mark Pete ma in with NCDEQ at 336-
71.0-8267.
Sincerely,
ATC Associates of North Caro
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SITE
LEGEND
= TYPE 11 MONITORING WELL
- GROUNDWATER ELEVATION CONTOUR LINE (DASHED WHERE APPROXIMATE)
(90.92) = GROUNDWATER ELEVATION IN FEET
- GROUNDWATER FLOW DIRECTION
0
20
40
APPROXIMATE SCALE IN FEET
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SLC3967901
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CONTOUR
FIGURE 4
1. GROUNDWATER ELEVATIONS MEASURED 02/12/2021

on
1
Benzene 3,870
Toluene 13,800
Ethylbenzene 1,660
Xylenes (Total) 10,200
Naphthalene 302
n-Propylbenzene 148
1,2,4-Trimethylbenzene 1,640
,3,5-Trimethylbenzene 446
•
1
•
No compounds detected above
laboratory reporting limits
•
LEGEND 0
= TYPE II MONITORING WELL
•
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20 40
APPROXIMATE SCALE IN FEET
MW-2
No compounds detected above
laboratory reporting limits
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0 20 40 60 80 100 120Feet Figure 6 - Proposed Monitoring Well MapJean's Starflite5205 Hillsborough StreetRaleigh, Wake County, North CarolinaDATE: PREP:Path: S:\GIS_GPS\Project_Folders\SLC_Jeans_Starflite\JeanStarflite - Receptor Map.mxdREV:PROJECT NO.SCALE:SLC3967901ATC Associates of North Carolina, P.C.Raleigh, North Carolina, 27604(919) 871-0999JR±NOTES:Features shown are not an authoritative location, nor arethey presented to a stated accuracy.DATA SOURCES:NC One MapCOORDINATE SYSTEM:NAD 1983 StatePlane North Carolina FIPS 3200 Feet1 ' = 30 "4/5/2021Jeremy.Robbins^_Proposed Monitoring Well
@A Monitoring Well
Parcels
MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP PROTECTIVE CASING AND CONCRETE PAD
L1 CASING MATERIAL sch 40 PVC
CASING DIAMETER 8 inches
CASING LENGTH 12 inches
PAD DIMENSIONS 2 feet x 2 feet
HEIGHT ABOVE GROUND flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 10 feet
L2 BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 5 feet
SEAL
TYPE OF SEAL bentonite
L4 THICKNESS 3 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
WELL SCREEN
L3 SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 20 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 20 feet
DEPTH TO BOTTOM OF
BOREHOLE 20 feet
L1 =0 FT.
L2 =10 FT.DIAMETER OF BOREHOLE 6 inches
L3 =10 FT.
L4 =20 FT.
TITLE Monitoring Well
Jean's Starflite 2725 East Millbrook Road
5205 Hillsborough Street Suite 121
Raleigh, Wake County Raleigh, North Carolina 27604
North Carolina
FILE PREP. BY REV. BY DATE PROJECT NO.
JR GA 5/12/2021 SLC3967902