WM0501439_Application_20210518

Via Email

May 18, 2021

North Carolina Department of Environmental Quality
Division of Water Resources – Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609

Attn: Mr. Scott Vinson and/or Mr. Brion Byers

Re: Permit to Construct Monitoring Well
Ideal Cleaners (NC DSCA Site No. DC920026)
Raleigh, North Carolina

Dear Mr. Vinson and/or Mr. Byers:

Hart & Hickman, PC (H&H) is providing the attached monitoring well permit application for
groundwater assessment activities related to the Ideal Cleaners site in Raleigh, North Carolina.
H&H is proposing to install one permanent bedrock monitoring well at 7100 Sandy Forks Road.
Enclosed please find the permit applications, well construction details, site maps with the proposed
location, and other relevant information for each property. Please review the provided information
and return the approved permits to the H&H Raleigh office.

Should you have any questions or need any additional information, please feel free to contact me
at [phone].

Sincerely,
Hart & Hickman, PC

Carlin Slusher
Project Environmental Scientist

Attachments

ATTACHMENT 1

PERMIT APPLICATION - BEDROCK WELL – 7100 SANDY FORKS ROAD

1. MONITORING WELL APPLICATION
2. MONITORING WELL CONSTRUCTION DETAILS
3. PROPOSED MONITORING WELL LOCATION MAPS
4. PROPERTY ACCESS AGREMENT
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:5/18/21
2.County: Wake
3.What type of well are you applying for? (monitoring or recovery):Monitoring Well
4.Applicant: Falls Village Cornerstone, LLC (petitioner for DSCA Site #DC920026) Telephone: Scott Stupak [phone]
Applicant’s Mailing Address: DSCA Program, 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant’s Email Address (if available): [e-mail]
5.Contact Person (if different than Applicant): Carlin Slusher, Hart & Hickman, PC Telephone: [phone]
Contact Person’s Mailing Address: 3921 Sunset Ridge Rd, Ste 301, Raleigh, NC 27607
Contact Person’s Email Address (if available): [e-mail]
6.Property Owner (if different than Applicant): Margaret Parrish Telephone: [phone]
Property Owner’s Mailing Address: 7100 Sandy Forks Road, Raleigh, NC 27615-6715
Property Owner’s Email Address (if available): [e-mail]
7.Property Physical Address (Including PIN Number)7100 Sandy Forks Road (PIN# 1717114928)
City Raleigh County Wake Zip Code 27615-6715 ________________
8.Reason for Well(s): Environmental Assessment for DSCA Program
(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:Former Dry Cleaner
(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 ID #DC920026
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).: N/A
13.Distance from proposed well(s) to nearest known waste or pollution source (in feet):Approximately 250 feet
14.Are there any water supply wells located less than 500 feet from the proposed well(s)?No
If yes, give distance(s): N/A
15.Well Contractor: SAEDACCO Certification No.: NC Driller TBD
Well Contractor Address: 9088 Northfield Drive, Fort Mill, SC 29707
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
WM0501439

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? Wells will be secured
with a locking cap and a bolted steel vault/lid
6. Estimated beginning construction date: 6/7/2021

7. Estimated construction completion date: 6/9/2021

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 Petitioner for DSCA Site DC920026 Agent for Petitioner for DSCA Site DC920026
Signature of Applicant or *Agent Title of Applicant or *Agent

Carlin Slusher * 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 property access agreement (Attachment 3) See attached property access agreement (Attachment 3)
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

TYPE III MONITORING WELL CONSTRUCTION DETAILS
CROSS SECTIONAL VIEW
LOCKABLE WELL VAULT CONCRETE PAD
FLUSH METAL WELL COVER
CONCRETE PAD
BACKFILL AROUND CASING
MATERIAL Portland cement grout
LENGTH 0 - 86 ft
SURFACE CASING
MATERIAL Schedule 40 PVC
DIAMETER 4 inches
JOINT TYPE flush threaded
LENGTH 90 ft
L1
WELL CASING
L3 MATERIAL Schedule 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 90 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 2 feet (86 ft to 88 ft)
FILTER PACK
TYPE OF FILTER No. 2 Sand
THICKNESS 22 ft (88 ft to 110 ft)
WELL SCREEN
SCREEN MATERIAL Schedule 40 PVC
L2 DIAMETER 2 inches
LENGTH 20 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
L1 =90 FT.MONITORING WELL 110 feet
L2 =20 FT.DIAMETER OF
L3 =110 FT.BOREHOLE
8.5 in
TITLE Monitoring Well Diagram (Bedrock Well)
Hart & Hickman, PC
2923 South Tryon St., Suite 100
Charlotte, North Carolina 28203
FILE PREP. BY REV. BY DATE PROJECT NO.
CES GKO DS0-1653/4/2021
Disc la im er
iMap s m akes ev ery effor t to pro duce an d pu blish
th e m ost curren t a nd ac curate inform atio n possib le.
However, th e m ap s are p roduc ed for information pu rposes,
and ar e NOT surv eys. No warran ties, ex pressed or im p lied
,are pr ovided for the data th er ein , its use,or its in ter pretation.
Mon itor ing W ell Location M ap
0 430 860215 ft
1 inch = 400 feet±
Disc la im er
iMap s m akes ev ery effor t to pro duce an d pu blish
th e m ost curren t a nd ac curate inform atio n possib le.
However, th e m ap s are p roduc ed for information pu rposes,
and ar e NOT surv eys. No warran ties, ex pressed or im p lied
,are pr ovided for the data th er ein , its use,or its in ter pretation.
Mon itor ing W ell Location M ap
0 850 1,700425 ft
1 inch = 800 feet±
444
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0 FALLS OF NEUSE ROAD
RESIDENTIAL
FORMER TIRE CENTER
(UST RELEASES)SANDY FORKS ROADSUBURBAN DR
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IDEAL CLEANERS
(CLOSED OUT)
GAS STATION/
SERVICE GARAGE
(UST RELEASES)
WELLS
FARGO
DOLLAR TREE
NORTH RIDGE
COUNTRY CLUB
RESIDENTIAL
RESIDENTIAL
RESIDENTIAL
FORMER
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FORMER HILKER'S
CLEANERS
(CLOSED OUT)
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448446450 424420416GAS STATION/
SERVICE GARAGE
(UST RELEASES)
RESTAURANT
ABC STORE
COOK OUT
FORMER
BANK
DRUM/WASTE
STORAGE AREAS
TACO BELL
SUTTON SQUARE
SHOPPING MALL
RESIDENTIAL WATER
SUPPLY WELL
SHOPS AT
FALLS VILLAGE
REVISION NO. 0
JOB NO. DSO-165A
DATE: 11-24-20
FIGURE NO. 2
IDEAL CLEANERS
DSCA SITE NO: DC920026
6685 FALLS OF NEUSE ROAD
RALEIGH, NORTH CAROLINA
SITE MAP
LEGEND
SITE PROPERTY BOUNDARY
TOPOGRAPHIC CONTOUR
WATER SUPPLY WELL
INFERRED GROUNDWATER
FLOW DIRECTION
3921 Sunset Ridge Road, Suite 301
Raleigh, North Carolina 27607
919-847-4241(p) 919-847-4261(f)
License # C-1269 / #C-245 Geology
442
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ROY COOPER.
Governor
DIONNE DELI)-GATTI
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, Carlin Slusher with Hart & Hickman, P.C., at
cslusher tt harthickman.com or [phone]. If you still have questions after contacting Ms.
Slusher with H&H, please contact the DSCA Program Project Manager, Mr. Scott Stupak at
scott.stupak i:.ncdenr.gov or [phone].
For DSCA Use Only
DSCA ID No.
DC920026
Please Print
Margaret Parrish
(Name of Property Owner or Tenant in Residence)
7100 Sandy Forks Road (PIN 1717114928)
(Street Number and Street Name of Property)
Raleigh
Wake 27615-6715
(City or Town in Which Property Is Located) / (County in Which Property is Located) I (Zip Code)
l 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)
(2)
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.
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.
4eimp.EQV;
North Carolina Department of Environmental Quality Division of Waste Management
217 West Jones Street l 1646 Mall Service Cente_ ! Raleigh. North Carolina 27699.1646
919.707.8200

(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".
(Signature of Property Owner or Tenant in Residence) Date
9 (q -
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
11^ pa rr 2. evvvl
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Carlin Slusher
Hart & Hickman, PC
3921 Sunset Ridge Road, Suite 301
Raleigh, NC 27607
Or via email to: [e-mail]
£D_EQ
North Carolina Department of Environmental Quality 1 Division of Waste Management
217 West Jones Street 11646 Mail Service Center 1 Raleigh. North Carolina 27699-1646
919.707.6200