WM0801169_Application_20210607

hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS
Via USPS and e-mail
June 7, 2020
North Carolina Department of Environmental Quality
Division of Water Resources — Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
Attn: Mr. Geoff Kegley,
Re: Permit to Construct Monitoring Wells
Former Heritage Cleaners (NC DCSA No. DC650018)
Wilmington, North Carolina
Dear Mr. Kegley:
Hart & Hickman, PC (H&H) is providing the attached monitoring well permit applications for
groundwater assessment activities related to the former Heritage Cleaners site in Wilmington,
North Carolina. H&H is proposing to install 15 temporary monitoring wells in the City of
Wilmington right of way for various roads. Two temporary wells are proposed on the east side of
South Front Street, six temporary wells are proposed on the south side of Castle Street, five
temporary wells are proposed on the east side of South Second Street, and two temporary wells
are proposed on the north side of Queen Street. Enclosed please find the permit applications, well
construction details, site map with the proposed locations, and other relevant information. 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
ALX-77- �ILILEJ-L
Robert Harrell
Project Environmental Scientist
Attachments
2923 South Tryan Street, Suite 100 3921 Sunset Ridge Rd. Suite 301
Charlatbe, NC 23203 Raleigh, NC 27607 www.hart.hickmar).corn
704.586-0007 main 919-947.4241 main

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: 6/7/2021 I FOR OFFICE USE ONLY
2. County: New Hanover IPERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): temporary monitoring wells
4. Applicant: Alberta Properties LLC (petitioner for DSCA site #DC650018 Telephone: Mike Cunningham
Applicant's Mailing Address: DSCA Program, 1646 Mail Service Center, Raleigh NC 27699-1646
Applicant's Email Address (if available): mike.cunninghamCcDncdenr.gov
5. Contact Person (if different than Applicant): Robert Harrell, Hart & Hickman, PC Telephone: [phone]
Contact Person's Mailing Address: 3921 Sunset Ridge Rd, Suite 301, Raleigh, NC 27607
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): City of Wilmington Right -of -Way (ROW) Telephone: [phone]
Property Owner's Mailing Address: PO Box 1810, Wilmington, NC 28402
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) South Front Street Right -of -Way (between Castle Street and Queen Street)
City Wilmington County New Hanover Zip Code 28401
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 D
(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 # DC650018
11. Type of contaminants being monitored or recovered: Chlorinated Solvent
(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 700-900 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): Approximately 550 feet- this water supply well is out of service, and previously only used for irrigation
15. Well Contractor: Geologic Exploration Certification No.: 4518, 3098, 4475, 3552, and 4459
Well Contractor Address: 176 Commerce Blvd., Statesville, NC 28677
PROPOSED WELL CONSTRUCTION INFORMATION
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: 2
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured? Abandoned in
accordance with NC well construction standards
6. Estimated beginning construction date: 7/12/2021
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 7/16/2021
(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,
Subchapter 2C) and accepts full responsibility for compliance with these rules
'SlT •.11E -Agent for Petitioner for DSCA Site DC650018
Signature of Applicant or *Agent
Robert Harrell
Printed name of Applicant or *Agent
Agent for Petitioner for DSCA Site Dc650018
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 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
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)

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: 6/7/2021 I FOR OFFICE USE ONLY
2. County: New Hanover IPERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): temporary monitoring wells
4. Applicant: Alberta Properties LLC (petitioner for DSCA site #DC650018 Telephone: Mike Cunningham
Applicant's Mailing Address: DSCA Program, 1646 Mail Service Center, Raleigh NC 27699-1646
Applicant's Email Address (if available): mike.cunninghamCcDncdenr.gov
5. Contact Person (if different than Applicant): Robert Harrell, Hart & Hickman, PC Telephone: [phone]
Contact Person's Mailing Address: 3921 Sunset Ridge Rd, Suite 301, Raleigh, NC 27607
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): City of Wilmington Right -of -Way (ROW) Telephone: [phone]
Property Owner's Mailing Address: PO Box 1810, Wilmington, NC 28402
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) Castle Street Right -of -Way (between S. Front Street and S. Fourth Street)
City Wilmington County New Hanover Zip Code 28401
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 D
(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 # DC650018
11. Type of contaminants being monitored or recovered: Chlorinated Solvent
(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 50-600 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): Approximately 150 feet- this water supply well is out of service, and previously only used for irrigation
15. Well Contractor: Geologic Exploration Certification No.: 4518, 3098, 4475, 3552, and 4459
Well Contractor Address: 176 Commerce Blvd., Statesville, NC 28677
PROPOSED WELL CONSTRUCTION INFORMATION
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: 6
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured? Abandoned in
accordance with NC well construction standards
6. Estimated beginning construction date: 7/12/2021
4. Total Number of wells to be constructed: 6 7. Estimated construction completion date: 7/16/2021
(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,
Subchapter 2C) and accepts full responsibility for compliance with these rules
•.aaE��Agent for Petitioner for DSCA Site DC650018 Agent for Petitioner for DSCA Site Dc650018
Signature of Applicant or *Agent Title of Applicant or *Agent
Robert Harrell * 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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
J R Rev. 3-1-2016

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: 6/7/2021 I FOR OFFICE USE ONLY
2. County: New Hanover IPERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): temporary monitoring wells
4. Applicant: Alberta Properties LLC (petitioner for DSCA site #DC650018 Telephone: Mike Cunningham
Applicant's Mailing Address: DSCA Program, 1646 Mail Service Center, Raleigh NC 27699-1646
Applicant's Email Address (if available): mike.cunninghamCcDncdenr.gov
5. Contact Person (if different than Applicant): Robert Harrell, Hart & Hickman, PC Telephone: [phone]
Contact Person's Mailing Address: 3921 Sunset Ridge Rd, Suite 301, Raleigh, NC 27607
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): City of Wilmington Right -of -Way (ROW) Telephone: [phone]
Property Owner's Mailing Address: PO Box 1810, Wilmington, NC 28402
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) South Second Street Right -of -Way (between Castle St. and Queen St.)
City Wilmington County New Hanover Zip Code 28401
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 D
(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 # DC650018
11. Type of contaminants being monitored or recovered: Chlorinated Solvent
(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 350-850 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): Approximately 150 feet- this water supply well is out of service, and previously only used for irrigation
15. Well Contractor: Geologic Exploration Certification No.: 4518, 3098, 4475, 3552, and 4459
Well Contractor Address: 176 Commerce Blvd., Statesville, NC 28677
PROPOSED WELL CONSTRUCTION INFORMATION
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: 5
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured? Abandoned in
accordance with NC well construction standards
6. Estimated beginning construction date: 7/12/2021
4. Total Number of wells to be constructed: 5 7. Estimated construction completion date: 7/16/2021
(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,
Subchapter 2C) and accepts full responsibility for compliance with these rules
._:4
Se�7 -_.,",Agent for Petitioner for DSCA Site DC650018
Signature of Applicant or *Agent
Robert Harrell
Printed name of Applicant or *Agent
Agent for Petitioner for DSCA Site DC650018
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 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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
J R Rev. 3-1-2016

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: 6/7/2021 I FOR OFFICE USE ONLY
2. County: New Hanover IPERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): temporary monitoring wells
4. Applicant: Alberta Properties LLC (petitioner for DSCA site #DC650018 Telephone: Mike Cunningham
Applicant's Mailing Address: DSCA Program, 1646 Mail Service Center, Raleigh NC 27699-1646
Applicant's Email Address (if available): mike.cunninghamCcDncdenr.gov
5. Contact Person (if different than Applicant): Robert Harrell, Hart & Hickman, PC Telephone: [phone]
Contact Person's Mailing Address: 3921 Sunset Ridge Rd, Suite 301, Raleigh, NC 27607
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): City of Wilmington Right -of -Way (ROW) Telephone: [phone]
Property Owner's Mailing Address: PO Box 1810, Wilmington, NC 28402
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) South Second Street Right -of -Way (between Castle St. and Hwy. Bus. 17.)
City Wilmington County New Hanover Zip Code 28401
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 D
(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 # DC650018
11. Type of contaminants being monitored or recovered: Chlorinated Solvent
(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 350-850 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): Approximately 150 feet- this water supply well is out of service, and previously only used for irrigation
15. Well Contractor: Geologic Exploration Certification No.: 4518, 3098, 4475, 3552, and 4459
Well Contractor Address: 176 Commerce Blvd., Statesville, NC 28677
PROPOSED WELL CONSTRUCTION INFORMATION
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: 5
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured? Abandoned in
accordance with NC well construction standards
6. Estimated beginning construction date: 7/12/2021
4. Total Number of wells to be constructed: 5 7. Estimated construction completion date: 7/16/2021
(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,
Subchapter 2C) and accepts full responsibility for compliance with these rules
._:4
Se�7 -_.,",Agent for Petitioner for DSCA Site DC650018
Signature of Applicant or *Agent
Robert Harrell
Printed name of Applicant or *Agent
Agent for Petitioner for DSCA Site DC650018
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 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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
J R Rev. 3-1-2016

ATTACHMENT 1
TEMPORARY MONITORING WELL DIAGRAM

TEMPORARY MONITORING WELL CONSTRUCTION DETAILS
CROSS SECTIONAL VIEW
GROUND SURFACE
L1
STEEL DPT ROD
L3 (2.5-INCH DIAMETER)
WELL SCREEN
3-FT STAINLESS STEEL
L2 EXPANDABLE WELL SCREEN
(1-INCH DIAMETER)
DRIVE TIP
L1 = 47 FT.
L2 = 3 FT.
L3 = 50 FT.
TITLE Temporary Monitoring Well Diagram
Hart & Hickman, PC
3921 Sunset Ridge Road, Suite 301
Raleigh, North Carolina 27607
FILE PREP. BY REV. BY DATE PROJECT NO.
RH CS 6/7/2021 DSO-155 (DSCA Site: DC650018)

ATTACHMENT 2
PROPOSED TEMPORARY WELL LOCATIONS

4 f
dv.•'
LEGEND
SOURCE PROPERTY BOUNDARY
GP-1 (4/3/18) — PARCEL BOUNDARY
5-15' ¢ GP-2 (4/3/18) NOVEMBER 2019 TEMPORARY
.. a PCE <0.0010 MONITORING WELL LOCATION
_ 5-15' GP-4 (11/16/18)
PCE <0.0010 5-15' � APRIL 2018 DIRECT -PUSH GROUNDWATER
1 PCE
SAMPLING LOCATION
0.00050
'3 ® IRRIGATION WELL LOCATION
GP-1
Ar � f � G ~ DIRECTION ASSUMED GROUNDWATER FLOW
w 'wr1 GP-2 GP-4
GP-3 (4/3/18)
5-15' I _j SAMPLE ID AND DATE
GP-6 GP-5 FORMER HERITAGE CLEANERS
_ PCE <0.0010 GP-7
WSW-5 (8/19/20)
_ 35' * SAMPLE DEPTH (FT BGS)
T GP-7 (11/16/18) p GP-5 (11/16/18) PCE 0.0030 CONCENTRATION (mg/L)
5-15' 5-15' CONSTITUENT
- PCE 0.0056 PCE 0.00097 � - �
p Proposed Direct -Push
GP-6 (11/16/18)
5-15' _ r Sample Location
Q) PCE
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WSW-5 (8/19/20) 2 NOTES:
70 35' * � � '
—1
PCE 0.0030 M 1. AERIAL IMAGERY OBTAINED FROM NC ONEMAP.
�j 2. PCE = TETRACHLOROETHYLENE
_ •1 m i FT BGS = FEET BELOW GROUND SURFACE
3. * =SCREEN INTERVAL FOR WATER SUPPLY WELL
WSW-5 IS UNKNOWN, TOTAL DEPTH IS 35 FT BGS.
1� r all
r
QUEEN STREET r ;
APPROXIMATE
0 120 240
t,
T SCALE IN FEET
TITLE
4,
PCE CONTAMINATION CONCENTRATION MAP
i
PROJECT HERITAGE CLEANERS
T DSCA ID: DC650018
k„ 522 S THIRD STREET
WILMINGTON, NEW HANOVER COUNTY
• hart � hickman 39cg,Nortunset Caroliaa2760e301
�� Ralei h, North Carolina 27607
919-847-4241(p) 919-847-4261(f)
SMARTER ENVIRONMENTAL SOLUTIONS T.i'msc # C-1269 / #C-245 Gcologp
POW DATE: 1-21-21 REVISION NO. 0
JOB NO. DSO-155 ATTACHMENT NO. 7

ATTACHMENT 3
PROPERTY ACCESS AGREEMENTS

CITY OF WILMINGTON
PERMIT
PERMISSION is hereby granted for the work
described hereon to:
OWNER
Name...: HART & HICKMAN NCDEQ DSCA
Address: 3921 SUNSET RIDGE ROAD #301
---------------------------
RALEIGHNC 27607
Phone..: [phone]
Permit No.: 20210466
Issued....: 5/13/2021
Expires...: 7/02/2021
Cost......: $10.00
Job No....: MUTED REQ
Start date: 5/24/2021
CONTRACTOR
HART & HICKMAN-CARLIN S
3921 SUNSET_ RIDGE_ ROAD #301
----------- ----- ----- ---
RALEIGHN_C_ 27607
919 609-6896
DESCRIPTION OF WORK
3X3"X50'DEEP SUE BORINGS*CASTLE ST BTW 2ND+3RD*GRASSY/PLAZA
------------------------------------------------------------
AREA*RESTORE ROW*COMPLY W/CITY ROW STNDRD PROVISIONS*PED XNG
------------------------------------------------------------
LOCATION OF WORK
200 BLK CASTLE_ STREETST_ _ S 2ND+3RD
-- — — ----------
GENERAL WORK IN OR ADJACENT TO STREET UNDERGROUND UTILITIES IN R/W
Construct — Repair/Alter — Move X_ Construct — Repair — Abandon
------------------------------------- --------------------------------
------------------------------------- --------------------------------
Sidewalk (4" conc) Water Service
Width (ft) Length (ft) Sewer Service
Driveway: Standard (City or NCDOT) Storm Sewer
Width (ft) PL Street Gas Service
Fence: Material Height (ft) Gas Main
Wall: Material Height (ft) Telephone Cable
_ Barricade _ Electric Cable
Building _ TV Cable
Other: PER MAP DETAIL X Other: SDEWALK CLOSURE
—--------------- —---------------
All work to be performed according to City standards and specifications.
The permittee hereby agrees to pay all costs involved in repairing and
restoring the sidewalk, driveway, pavement, curb, or any other item
damaged during his work in the public right-of-way.
Signature: ""✓✓""'
------------------------- -------------------------
Inspections Division Permittee

CITY OF WILMINGTON
PERMIT
PERMISSION is hereby granted for the work
described hereon to:
OWNER
Name...: HART & HICKMAN NCDEQ DSCA
Address: 3921 SUNSET RIDGE ROAD #301
---------------------------
RALEIGHNC 27607
Phone..: [phone]
Permit No.: 20210467
Issued....: 5/13/2021
Expires...: 7/02/2021
Cost......: $10.00
Job No....: MUTED REQ
Start date: 5/24/2021
CONTRACTOR
HART & HICKMAN-CARLIN S
3921 SUNSET_ RIDGE_ ROAD #301
----------- ----- ----- ---
RALEIGHN_C_ 27607
919 609-6896
DESCRIPTION OF WORK
3X3"X50'DEEP SUE BORINGS*CASTLE ST BTW FRNT+2ND*GRASSY/PLAZA
------------------------------------------------------------
AREA*RESTORE ROW*COMPLY W/CITY ROW STNDRD PROVISIONS* PED XNG
------------------------------------------------------------
LOCATION OF WORK
100 BLK CASTLE_ STREETST_ _ FRONT+2ND
-- — — ----------
GENERAL WORK IN OR ADJACENT TO STREET UNDERGROUND UTILITIES IN R/W
Construct — Repair/Alter — Move X_ Construct — Repair — Abandon
------------------------------------- --------------------------------
------------------------------------- --------------------------------
Sidewalk (4" conc) Water Service
Width (ft) Length (ft) Sewer Service
Driveway: Standard (City or NCDOT) Storm Sewer
Width (ft) PL Street Gas Service
Fence: Material Height (ft) Gas Main
Wall: Material Height (ft) Telephone Cable
_ Barricade _ Electric Cable
Building _ TV Cable
Other: PER MAP DETAIL X Other: SDEWALK CLOSURE
—--------------- —---------------
All work to be performed according to City standards and specifications.
The permittee hereby agrees to pay all costs involved in repairing and
restoring the sidewalk, driveway, pavement, curb, or any other item
damaged during his work ini�the
,gpublic right-of-way.
Signature: "' V✓ "
------------------------- -------------------------
Inspections Division Permittee

CITY OF WILMINGTON
PERMIT
PERMISSION is hereby granted for the work
described hereon to:
OWNER
Name...: HART & HICKMAN NCDEQ DSCA
Address: 3921 SUNSET RIDGE ROAD #301
---------------------------
RALEIGHNC 27607
Phone..: [phone]
Permit No.: 20210468
Issued....: 5/13/2021
Expires...: 7/02/2021
Cost......: $10.00
Job No....: MUTED REQ
Start date: 5/24/2021
CONTRACTOR
HART & HICKMAN-CARLIN S
3921 SUNSET_ RIDGE_ ROAD #301
----------- ----- ----- ---
RALEIGHN_C_ 27607
919 609-6896
DESCRIPTION OF WORK
3X3"X50'DEEP SUE BORINGS*FRNT BTWN CASTLE+QUEEN*GRASSY/PLAZA
ROW*EETREEKETT7 ROW ROW*COMPLY W/CITY ROW STNDRD PROVISIONS*PED XNG
------------------------------------------------------------
LOCATION OF WORK
600 BLK S—FRONT—STREET ST CSTL+QUEEN
----- --- ——------------------ ---- ------------
GENERAL WORK IN OR ADJACENT TO STREET UNDERGROUND UTILITIES IN R/W
Construct — Repair/Alter — Move X_ Construct — Repair — Abandon
------------------------------------- --------------------------------
------------------------------------- --------------------------------
Sidewalk (4" conc) Water Service
Width (ft) Length (ft) Sewer Service
Driveway: Standard (City or NCDOT) Storm Sewer
Width (ft) PL Street Gas Service
Fence: Material Height (ft) Gas Main
Wall: Material Height (ft) Telephone Cable
_ Barricade _ Electric Cable
Building _ TV Cable
Other: PER MAP DETAIL X Other: SDEWALK CLOSURE
—--------------- —---------------
All work to be performed according to City standards and specifications.
The permittee hereby agrees to pay all costs involved in repairing and
restoring the sidewalk, driveway, pavement, curb, or any other item
damaged during his work in!�the
g�public right-of-way.
Signature:
------------------------- -------------------------
Inspections Division Permittee

CITY OF WILMINGTON
PERMIT
PERMISSION is hereby granted for the work
described hereon to:
OWNER
Name...: HART & HICKMAN NCDEQ DSCA
Address: 3921 SUNSET RIDGE ROAD #301
---------------------------
RALEIGHNC 27607
Phone..: [phone]
Permit No.: 20210469
Issued....: 5/13/2021
Expires...: 7/02/2021
Cost......: $10.00
Job No....: MUTED REQ
Start date: 5/24/2021
CONTRACTOR
HART & HICKMAN-CARLIN S
3921 SUNSET_ RIDGE_ ROAD #301
----------- ----- ----- ---
RALEIGHN_C_ 27607
919 609-6896
DESCRIPTION OF WORK
3X3"X50'DEEP SUE BORINGS*2ND BTWN CASTLE+QUEEN*GRASSY/PLAZA
ROW*EETREEKETT7 ROW ROW*COMPLY W/CITY ROW STNDRD PROVISIONS*PED XNG
------------------------------------------------------------
LOCATION OF WORK
600 BLK S—2ND—STREET ST CSTL+QUEEN
----- --- ——------------------ ---- ------------
GENERAL WORK IN OR ADJACENT TO STREET UNDERGROUND UTILITIES IN R/W
Construct — Repair/Alter — Move X_ Construct — Repair — Abandon
------------------------------------- --------------------------------
------------------------------------- --------------------------------
Sidewalk (4" conc) Water Service
Width (ft) Length (ft) Sewer Service
Driveway: Standard (City or NCDOT) Storm Sewer
Width (ft) PL Street Gas Service
Fence: Material Height (ft) Gas Main
Wall: Material Height (ft) Telephone Cable
_ Barricade _ Electric Cable
Building _ TV Cable
Other: PER MAP DETAIL X Other: SDEWALK CLOSURE
—--------------- —---------------
All work to be performed according to City standards and specifications.
The permittee hereby agrees to pay all costs involved in repairing and
restoring the sidewalk, driveway, pavement, curb, or any other item
damaged during his work in the public right-of-way.
Signature: ""✓✓""'
------------------------- -------------------------
Inspections Division Permittee

CITY OF WILMINGTON
PERMIT
PERMISSION is hereby granted for the work
described hereon to:
OWNER
Name...: HART & HICKMAN NCDEQ DSCA
Address: 3921 SUNSET RIDGE ROAD #301
---------------------------
RALEIGHNC 27607
Phone..: [phone]
Permit No.: 20210470
Issued....: 5/13/2021
Expires...: 7/02/2021
Cost......: $10.00
Job No....: MUTED REQ
Start date: 5/24/2021
CONTRACTOR
HART & HICKMAN-CARLIN S
3921 SUNSET_ RIDGE_ ROAD #301
----------- ----- ----- ---
RALEIGHN_C_ 27607
919 609-6896
DESCRIPTION OF WORK
2X3"X50'DEEP SUE BORINGS*S 2ND ST S/0 QUEEN*GRASSY/PLAZA
ROW*EETREEKETT7 ROW ROW*COMPLY W/CITY ROW STNDRD PROVISIONS*PED XNG
------------------------------------------------------------
LOCATION OF WORK
700 BLK S 2ND STREET ST QUEEN ST
----- --- ---------------------- ---- ------------
GENERAL WORK IN OR ADJACENT TO STREET UNDERGROUND UTILITIES IN R/W
Construct _ Repair/Alter Move X_ Construct _ Repair _ Abandon
------------------------------------- --------------------------------
------------------------------------- --------------------------------
Sidewalk (4" conc) Water Service
Width (ft) Length (ft) Sewer Service
Driveway: Standard (City or NCDOT) Storm Sewer
Width (ft) PL Street Gas Service
Fence: Material Height (ft) Gas Main
Wall: Material Height (ft) Telephone Cable
_ Barricade _ Electric Cable
Building _ TV Cable
Other: PER MAP DETAIL X Other: SDEWALK CLOSURE
—--------------- —---------------
All work to be performed according to City standards and specifications.
The permittee hereby agrees to pay all costs involved in repairing and
restoring the sidewalk, driveway, pavement, curb, or any other item
damaged during his work in the public right-of-way.
Signature:
------------------------
Inspections Division
Permittee

CITY OF WILMINGTON
PERMIT
PERMISSION is hereby granted for the work
described hereon to:
OWNER
Name...: HART & HICKMAN NCDEQ DSCA
Address: 3921 SUNSET RIDGE ROAD #301
---------------------------
RALEIGHNC 27607
Phone..: [phone]
Permit No.: 20210471
Issued....: 5/13/2021
Expires...: 7/02/2021
Cost......: $10.00
Job No....: MUTED REQ
Start date: 5/24/2021
CONTRACTOR
HART & HICKMAN-CARLIN S
3921 SUNSET_ RIDGE_ ROAD #301
----------- ----- ----- ---
RALEIGHN_C_ 27607
919 609-6896
DESCRIPTION OF WORK
2X3"X50'DEEP SUE BORINGS*QUEEN ST BTWN 2ND+3RD*GRASSY/PLAZA
------------------------------------------------------------
AREA*RESTORE ROW*COMPLY W/CITY ROW STNDRD PROVISIONS*PED XNG
------------------------------------------------------------
LOCATION OF WORK
200 BLK --QUEEN—STREET. ST S 2ND+3RD
----- --- ------------------ ---- ------------
GENERAL WORK IN OR ADJACENT TO STREET UNDERGROUND UTILITIES IN R/W
Construct — Repair/Alter — Move X_ Construct — Repair — Abandon
------------------------------------- --------------------------------
------------------------------------- --------------------------------
Sidewalk (4" conc) Water Service
Width (ft) Length (ft) Sewer Service
Driveway: Standard (City or NCDOT) Storm Sewer
Width (ft) PL Street Gas Service
Fence: Material Height (ft) Gas Main
Wall: Material Height (ft) Telephone Cable
_ Barricade _ Electric Cable
Building _ TV Cable
Other: PER MAP DETAIL X Other: SDEWALK CLOSURE
—--------------- —---------------
All work to be performed according to City standards and specifications.
The permittee hereby agrees to pay all costs involved in repairing and
restoring the sidewalk, driveway, pavement, curb, or any other item
damaged during his work in the public right-of-way.
�eu
Signature: L �Az"
---------------- --- -------------------------
Inspections Division Permittee

ATTACHMENT 4
AGENT AUTHORIZATION AGREEMENT:
DSCA AGREEMENT FOR ASSESSMENT AND REMEDIATION

ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
October 19, 2018
JAMES GOODNIGHT
ALBERTA PROPERTIES LLC
2108 CLARK AVE
RALEIGH NC 27605
RE: Petitioner Eligibility
DSCA Site ID DC650018
522 S Third ST
Wilmington, New Hanover County
The Dry -Cleaning Solvent Cleanup Act (DSCA) Program (DSCA Program) has reviewed your petition to enter into
an agreement and considers Petitioner an eligible petitioner. Enclosed, please fmd the executed assessment and
remediation agreement. By entering into this agreement, you agree to cooperate with the DSCA Program to assist in
the assessment and remediation of the dry-cleaning solvent contamination at the Site. By entering into and complying
with the agreement, you obtain the liability protection afforded pursuant to N.C.G.S. § 143-215.104K.
The financial responsibility requirements for this site are detailed in appendix B of the petition.
The owner(s) of the property will be notified prior to the commencement of any site work to be conducted by the
DSCA Program's independent contractors.
If you have any questions, please contact me at delonda.alexanderLamcdeting_ov or [phone].
Sincerely,
Delonda Alexander, DSCA Remediation Unit Supervisor
Division of Waste Management, NCDEQ
Attachments: Notification of Certification into the Dry -Cleaning Solvent Cleanup Act Program
Executed Administrative Agreement for State -Directed Assessment and Remediation
Petition
� EQ-
-
NorthC*rolhu
Department of Envw0Mnentat Qt*y I pM$Wn of waste Moropment
217 West lwnes Street 11646 MA Scrvkc Center ! RakWg North Carolina 27699^1646
919.707.8200

ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
Letter of Certification into the Drycleaning Solvent Cleanup Act Program
On October 19, 2018, pursuant to N.C.G.S. § 143-215.104G, the Dry -Cleaning Solvent Cleanup
Act (DSCA) Program has certified the site located at 522 S Third ST, Wilmington in New
Hanover County into the DSCA Program. The site has been assigned the DSCA identification
number DC650418.
Evidence of dry-cleaning solvent contamination has been documented arising from dry-cleaning
operations originating from the site.
Based on information submitted to the Division at the time of certification, the site is an
Abandoned/No Active Drycleaner for the purposes of determining a site's financial
responsibilities as required by N.C.G.S § 143-215.104F(f)(2).
The site will remain certified in the DSCA Program as long as there is at least one eligible
petitioner who is complying with an agreement between the DSCA Program and that petitioner.
Pete Doom, Special Remediation Branch Supervisor
Division of Waste Management, NCDEQ
Narth+Ca OU" Department of BtMrlrtxm eMS Q"Wy 1 DlvWM of Waste Managtmc»t
217 Wit jones Street 1 1" Maki Scrvke Center I RAW* North Carolina 27699.1646
919.707.8200

be&500fe
North Carolina Dry -Cleaning Solvent Cleanup Program
-
Department of Environmental Quality
Division of Waste Management
Superfund Section
DSCA PETITION FOR CERTIFICATION
The North Carolina General Assembly enacted the Dry -Cleaning Solvent Cleanup Act
and Amendments (DSCA) to facilitate the assessment and remediation of Dry -Cleaning
Facilities, Wholesale Distribution Facilities and Abandoned Sites (Facilities)
contaminated with Dry -Cleaning Solvent. In order for the DSCA cleanup fund to be
used at a Facility, the Facility must be certified by the Division of Waste Management
(Division) of the North Carolina Department of Environmental Quality (NCDEQ) as
meeting the eligibility requirements set out in the DSCA. Rules adopted by the
Environmental Management Commission (EMC) require any person petitioning for
certification of a Facility (Petitioner) to use this DSCA Petition for Certification (Petition).
This Petition is designed to enable the Petitioner to provide the Division with the
information necessary to demonstrate that the Petitioner and the Facility meet the
requirements for certification in the DSCA. Each Petitioner must complete this form and
sign the Acknowledgement page. If the Petitioner is a corporation, limited liability
company, partnership or other business entity, the Petition must be signed by an
individual with authority to bind the business entity, and the individual signing the
Petition must certify that he/she is authorized to legally bind the business entity to the
Petition.
In addition to this Petition, an Assessment and Remediation Agreement (ARA) must be
signed and executed in order for the Petitioner to receive the liability protection afforded
pursuant to N.C.G.S. § 143-215.104K. The ARA also gives the DSCA Program the
authority to undertake state -directed assessment and remediation at the site. The
DSCA Program cannot begin any work at a site until the ARA is executed.
A $1,000 application fee must be paid before the petitioner is
considered eligible. Checks should be made to the Division of Waste
Management and included with the completed petition and signed agreement.
Pay Online
Go to our website at www.ncdsca.org and click on the DSCA-ePayments link in the
right blue side bar. Use Invoice # DC650018PAF1
Please review the information in the Site and Petitioner Information
Summary and make any corrections necessary.
DSCA Petition October 2007 Page 1

DSCA PETITIONER SUMMARY
Petitioner's relationship to the Facility Site
Property Owner
Petitioner
Alberta Properties LLC
2108 Clark Ave
Raleigh, NC 27605
Representative
James Goodnight
2108 Clark Ave
Raleigh, NC 27605
[e-mail]
Property Owner
[Petitioner is the Current Property Owner]
Contamination attributed to
Dry -Cleaning
Facility
Heritage Cleaners
522 S Third ST
Wilmington 28401-5161, New Hanover County
Size or Type
Abandoned/No Active Drycleaner
DSCA Petition October 2007 Page 2

OTHER INSTRUCTIONS
1. Documentation of a dry-cleaning related release must be submitted.
Therefore, please submit copies of any reports documenting environmental
assessment or remediation activities previously conducted at this site.
This includes any Phase I or Phase II reports conducted for property
transfers.
2. Please make sure that the Acknowledgement page is signed and notarized.
3. Please make sure that you have initialed the applicable Appendices on the
Acknowledgement page.
4. Please be aware that you are required to provide access to the Certified Facility
Site as part of the Petition if you ARE the property owner.
If you are NOT the property owner of the Certified Facility Site, you will be
required to obtain access for the Division and the Division's independent
contractors in the Assessment and Remediation Agreement (ARA) to
undertake all work to be performed at the Certified Facility Site.
5. Completed petitions should be mailed to:
Division of Waste Management
ATTN: Delonda Alexander - DSCA Program
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
DSCA Petition October 2007 Page 3

ACKNOWLEDGEMENT
The Petitioner has indicated their status as a property owner. Therefore, Appendices A,
B and C apply to this Petitioner. Please proceed to these Appendices and read them
carefully since you will be certifying that you agree with or comply with these
Appendices.
Please initial the spaces below to acknowledge that you have read and are in
compliance with each applicable Appendix.
4�2—Appendix A Appendix B ppendix C
Petitioner (or authorized representative) hereby swears and affirms that the information
provided in this Petition, inclusive of all appendices and attachments, is true and correct
to the best of Petitioner's knowledge.
Petitioner (or authorized representative) hereby affirms Petitioner's intent to make with
the Dry -Cleaning Solvent Cleanup Act Program such agreements as may be reasonably
required under the North Carolina Dry -Cleaning Solvent Cleanup Act for the
assessment and remediation of a Dry -Cleaning Business at the Facility Site.
If signing as an authorized representative, I also hereby affirm that I am authorized to
execute this Petition on behalf of the Petitioner and that I am authorized to legally bind,
and hereby do legally bind, the Petitioner to this Petition and to all certifications
contained in this Petition, inclusive of all appendices and attachments.
This-2— day of Oc_t-4 — , 20 "
Signature of Petitioner (or auth.rep.):.�z
Name of Petitioner (or auth. rep. - typed or printed): 5
Title of Petitioner (or auth. rep. - typed or printed): nu�E
STATE OF N L
COUNTY OF WA)K
1, VKAWq 11 M , a Notary Public of the county aforesaid, do
hereby certify that OWKEri [name of Petitioner]
personally appeared before me th s day nd, having been duly sworn, executed the
foregoing DSCA Petition for Certification in my presence.
DSCA Petition October 2007 Page 4

ESS my hand and official seal this 2. day of f 20 It
ry Public
My Commission expires:
[SEAL]
KELSEY D. MCPHERSON
NOTARY PUBLIC
WAKE COUNTY, N.C.
My Commission Expires 07-26-2022
DSCA Petition October 2007 Page 5

APPENDIX A
ACCESS AGREEMENT A
(Petitioner is the Property Owner)
Heritage Cleaners
522 S Third ST
Wilmington
New Hanover County
DSCA Site ID No. DC650018
Name of Petitioner: Alberta Properties LLC
WHEREAS, the Petitioner is petitioning to the North Carolina Department of
Environmental Quality, Division of Waste Management (Division) for certification of the
Property into the Dry -Cleaning Solvent Cleanup Act Program (Program) pursuant to the
Dry -Cleaning Solvent Cleanup Act of 1997 as amended, Part 6, Article 21A, Chapter
143, N.C.G.S. § 143-215.104A et seq. (DSCA); and
WHEREAS, the Petitioner intends to enter into an Agreement for Assessment and
Remediation (ARA) with the Division concerning the Dry -Cleaning Solvent
contamination on the Property; and
WHEREAS, the Petitioner understands that the implementation of the ARA will require
that the Division and its independent contractors (contractors) have free and
unencumbered access to the Property for the purposes of investigating, assessing and
remediating Dry -Cleaning Solvent contamination on and around the Property; and
WHEREAS, the parties to this Access Agreement are the Division and the Petitioner;
NOW THEREFORE, in consideration of the terms and conditions contained in this
Access Agreement, and for other good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
Grant of License and Permission. Petitioner hereby grants to (a) to the Division a
license to access the Property to monitor and enforce the ARA and (b) to the
Division's contractor(s) a license to access the Property to undertake all work to be
performed at the Property, including, but not limited to, the following purposes:
a) Inspecting, sketching and photographing the Property;
b) Taking such soil, water and air samples as may be necessary;
c) Taking other actions related to the investigation of surface or subsurface
conditions, such as installation of monitoring wells or excavation of
impacted soil;
DSCA Petition October 2007 Page 6

d) Transportation of equipment onto and around the Property as necessary
to accomplish the investigation;
e) Taking response actions necessary to mitigate any threat to human health
and the environment;
f) Remediating dry-cleaning solvent contamination at the Property as
needed; and
g) Undertaking such other activities as necessary to complete the work to be
performed as required or permitted under the ARA.
2. Conditions Precedent. The licenses created in Paragraph 1 shall take effect upon
the certification of the Property into the Program and shall remain in effect, unless
otherwise terminated pursuant to Paragraph 12 below, so long as the Property
remains certified under the Program.
3. Observation. Upon the Petitioner's reasonable notice and request, the Petitioner
and its consultants shall have the right to observe any activities performed by or on
behalf of the Division at the Property. Upon the Petitioner's reasonable notice and
request, the Division or its contractors shall allow the Petitioner to split samples of
any environmental samples obtained on behalf of the Division. All costs associated
with obtaining and analyzing the split samples shall be borne solely by the Petitioner.
4. Interference. The Division and its contractors shall endeavor to perform any
activities authorized hereunder at the Property in a manner that minimizes
interference with the use of the Property. The Division and its contractors will make
reasonable attempts to notify the Petitioner at least 48 hours prior to entering the
Property for the purposes stated in Paragraph 1.
5. Insurance. The Division's contractors have agreed to maintain the insurances as
defined in their agreement with the Division, provided however, that the Division
shall have no liability for its contractor's failure to maintain such insurance.
6. Site Repair. The Division or its contractors shall remove and shall have the right to
remove from the Property all equipment and other materials belonging to the
Division or its contractors within a reasonable period of time after the completion of
the activities at the Property authorized hereunder. To the extent practicable, the
Division's contractors shall restore the Property to the original condition it was in
prior to any activities authorized hereunder at the Property, and except as otherwise
agreed to by the parties, shall properly abandon any monitoring wells in accordance
with any applicable laws and regulations.
7. Protection of Wells and Equipment. The Petitioner shall not damage, remove, pave
over or cover any monitoring or remediation wells on the property. The Petitioner
DSCA Petition October 2007 Page 7

also shall not tamper with or affect the operation of assessment or remediation
equipment installed on the property by the Division's contractors.
8. Notice. Any notices, reports, or other communications required or permitted under
this Access Agreement shall be addressed to the representative for each party as
set forth below:
To Petitioner:
ALBERTA PROPERTIES LLC
c/o JAMES GOODNIGHT
2108 CLARK AVE
RALEIGH NC 27605
To the Division:
North Carolina Division of Waste Management -DSCA Program
Attn: Delonda Alexander
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
9. Limitations. All obligations of the Division pursuant to this Access Agreement shall
be contingent upon the availability of moneys in the North Carolina Dry -Cleaning
Solvent Act Fund.
10. Governing Law. This Access Agreement shall be governed by and construed in
accordance with the laws of the State of North Carolina, without reference to choice
of laws principles.
11.Integration Clause. This Access Agreement represents the entire understanding
and agreement between the parties hereto and supersedes any and all prior
agreements, whether written or oral, that may exist between the parties regarding
same. No amendment or modification to this Access Agreement or any waiver of any
provisions hereof shall be effective unless in writing and signed by both parties.
12.Termination. The licenses created in Paragraph 1 may be terminated upon delivery
of reasonable written notice to the Division, which termination shall be effective upon
receipt of such notice. However, such termination will also terminate the ARA and
cause the forfeiture of liability protection under the DSCA. If no such notice is
served and subject to provisions of Paragraph 2 above, the licenses created herein
shall remain in effect until such time as all work or activities under the Program have
been completed at the Property. The right and obligation set out in the first sentence
of Paragraph 6 shall survive the termination of this license.
13. Modification. This Access Agreement may not be amended except in writing by the
parties to this Access Agreement.
DSCA Petition October 2007 Page 8

The parties each represent and warrant that this Access Agreement is executed by their
duly authorized representatives as of the date accepted and agreed upon below.
Accepted and agreed, this Z day of _ a , 20_a.
of Petitiefier or Signatory for Petitioner)
(Signature for thd''Division)
DSCA Petition October 2007 Page 9

APPENDIX B
CERTIFICATION OF ABILITY TO PAY AND
ACCEPTANCE OF FINANCIAL RESPONSIBILITY
G.S. § 143-215.104F(b)(2) requires that any person petitioning for certification of a Dry -
Cleaning Facility or Wholesale Distribution Facility or Abandoned Site (collectively:
Facility Site) shall provide the North Carolina Department of Environmental Quality
(NCDEQ) with information necessary to demonstrate such person's ability to incur the
response costs specified in G.S. § 143-215.104F(f).
The Petitioner has indicated that this facility is Abandoned/No Active Drycleaner.
Pursuant to G.S. § 143-215.104F(f), the required amount of response costs are as
follows:
For abandoned dry-cleaning facility sites in activities related to dry-
cleaning operations during the calendar year preceding the date of the
Petition, one and one-half percent (1.5%) of the costs of assessment or
remediation not exceeding one million dollars ($1,000,000).
Moreover, G.S. § 143-215.104F(f) requires that each Potentially Responsible Party who
petitions NCDEQ to certify a Facility Site shall accept written responsibility in the
amounts specified in G.S. § 143-215.104F(f), and described above, for the assessment
or remediation of the Dry -Cleaning Solvent contamination identified in the Petition.
Note: if two or more Potentially Responsible Parties petition NCDEQ jointly, the
amounts specified in G.S. § 143-215.104F(f), and described above, shall be the
aggregate requirements for the financial responsibility of all Potentially Responsible
Parties who are party to the Petition. Unless an alternative arrangement is agreed to by
the co -petitioners, the financial responsibility requirements of G.S. § 143-215.104F shall
be apportioned equally among the co -petitioners.
The Petitioner shall demonstrate his ability to incur, and his written acceptance of
financial responsibility for, response costs in the amounts specified in G.S. § 143-
215.104F(f), and described above, for the assessment or remediation of the Dry -
Cleaning Solvent contamination identified in the Petition. The Petitioner shall make this
demonstration by signing the Acknowledgement in this Petition.
DSCA Petition October 2007 Page 10

APPENDIX C
COMPLIANCE WITH STATE AND FEDERAL
ENVIRONMENTAL LAWS, RULES AND REGULATIONS
G.S. § 143-215.104F(b)(4) requires that every Potentially Responsible Party petitioning
for certification of a Dry -Cleaning Facility, Wholesale Distribution Facility or Abandoned
Site (collectively Facility Site) shall provide the North Carolina Department of
Environmental Quality (NCDEQ) with information necessary to demonstrate that the
Petitioner and any parent, subsidiary or other affiliate of the Petitioner, has substantially
complied with:
1. The terms of any dry-cleaning solvent assessment agreement, dry-cleaning
solvent remediation agreement, brownfields agreement, or any other similar agreement
to which the Petitioner or any parent, subsidiary or other affiliate of the Petitioner has
been a party;
2. The requirements applicable to any remediation in which the Petitioner has
previously engaged; and
3. Federal and State laws, regulations, and rules for the protection of the
environment.
By signing the Acknowledgement in this Petition, the Petitioner swears and affirms, to
the best of their knowledge, that the conditions stated above have been met.
DSCA Petition October 2007 Page 11

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WASTE MANAGEMENT
SUPERFUND SECTION
Dry -Cleaning Solvent Cleanup Act of 1997, as amended (DSCA) Program
IN THE MATTER OF:
HERITAGE CLEANERS
UNDER THE AUTHORITY OF
THE DRY-CLEANING SOLVENT
CLEANUP ACT OF 1997, AS AMENDED,
N.C.G.S. § 143-215.104A, et seq.
ALBERTA PROPERTIES LLC
2108 CLARK AVE
RALEIGH, NC 27605
DSCA SITE I.D. DC650018
AGREEMENT
FOR ASSESSMENT AND REMEDIATION
PURSUANT TO THE DRY-CLEANING SOLVENT CLEANUP ACT OF 1997, AS
AMENDED, PART 6, ARTICLE 21A, CHAPTER 143, N.C.G.S. § 143-215.104A ET SEQ.
("DSCA")
I. INTRODUCTION AND STATEMENT OF PURPOSE
The North Carolina Department of Environmental Quality, Division of Waste Management
("Division") and Alberta Properties LLC ("Petitioner"), collectively ("Parties"), hereby enter into
this Agreement for Assessment and Remediation ("Agreement") pursuant to the Dry -Cleaning
Solvent Cleanup Act of 1997, as amended, Part 6, Article 21A, Chapter 143, N.C.G.S. § 143-
215.104A et seq. ("DSCA").
In executing this Agreement, Petitioner agrees to cooperate with the Division's Dry -Cleaning
Solvent Cleanup Act Program ("Program") and the Division's independent contractors
("contractors" or "independent contractors") to assist in the assessment and remediation of the
dry-cleaning solvent contamination at the Site, as defined in Section II. E., below. By entering
into and complying with this Agreement, Petitioner obtains the liability protection afforded
pursuant to N.C.G.S. § 143-215.104K. Unless otherwise expressly provided herein, terms used
in this Agreement that are defined in DSCA or at 15A NCAC 2S .0102, shall have the meaning
assigned to them in those provisions, including any amendments thereto.
II. STATEMENT OF FACTS
A. On October 15, 2018, Petitioner filed with the Division a Petition for Certification for
Heritage Cleaners pursuant to DSCA.
B. On October 19, 2018, the Division certified Heritage Cleaners (hereinafter "Certified Facility
Site") pursuant to DSCA and informed Petitioner of its certification decision.
C. The Certified Facility Site is located at 522 S Third St, Wilmington in New Hanover County,
North Carolina.
DSCA ARAv20140312

D. Petitioner is a potentially responsible party, within the meaning of N.C.G.S. § 143-
215.104B(b)(21), for assessment and remediation of dry-cleaning solvent contamination at
the Site, as defined in subsection E, below.
E. The "Site" consists of all areas at the Certified Facility Site where dry-cleaning solvent
contamination arising from dry-cleaning or wholesale distribution operations is found and all
areas where dry-cleaning solvent contamination originating at the Certified Facility Site has
come to be located.
F. The Division is authorized to enter into this Agreement pursuant to the authority vested in the
Environmental Management Commission pursuant to DSCA and duly delegated to the
Secretary of the North Carolina Department of Environmental Quality and further delegated
from the Secretary to the Division.
NOW, THEREFORE, for the purpose of assessing and remediating the dry-cleaning solvent
contamination at the Site, the Parties agree as follows:
III. WORK TO BE PERFORMED
It is Petitioner's desire that assessment and remediation at the Site as required or permitted under
DSCA, the rules adopted under DSCA and guidance documents provided by the DSCA Program
shall be performed by independent contractors selected by the Division. The Division's
contractors shall maintain a minimum level of insurance as defined in their contract with the
Division.
IV. DISPUTE RESOLUTION
If Petitioner objects to any Division notice of disapproval or decision made pursuant to this
Agreement, Petitioner shall notify the Division in writing of Petitioner's objections within
fourteen (14) calendar days of receipt of the notice of disapproval or decision. The Parties shall
then have an additional fourteen (14) calendar days from receipt by the Division of the notice of
disapproval or decision to reach an agreement. If an agreement cannot be reached within the
fourteen (14) calendar days, or within an additional period if mutually agreed upon by the
Parties, the Division shall provide a written statement of its decision to Petitioner. Any decision
or action by the Division that cannot be resolved through the dispute resolution procedure
established herein may be subject to review pursuant to Chapter 150B of the North Carolina
General Statutes, to the extent such review is provided by law.
V. FINANCIAL RESPONSIBILITY REQUIREMENTS
Upon demand by the Division, Petitioner shall pay to the Division, on behalf of the Dry -
Cleaning Solvent Cleanup Fund ("Fund"), any amounts for which Petitioner is responsible
pursuant to N.C.G.S. § 143-215.104F(f). Petitioner shall have thirty (30) days from the date of
notice of such demand to make payment to the Division. These payments will only be required
by the Division when task -specific work has been completed by the Division's contractor.
DSCA ARAv20140312 2

VI. ADDITIONAL PROVISIONS
A. To obtain a unique EPA ID number for the disposal of hazardous wastes generated during
the assessment and remediation of the Site, Petitioner agrees that Petitioner will be the
Operator on the RCRA Subtitle C Site Identification Form. For the purposes of disposing of
hazardous waste generated during the assessment and remediation of the Site, Petitioner
agrees that Petitioner will be the Generator on Hazardous Waste Manifests.
B. The Petitioner agrees to allow the Division and the Division's independent contractors to act
as its authorized representatives for the preparation, signing, filing and delivery of any
permit application, hazardous waste manifest, non -hazardous waste manifest, National
Pollution Discharge Elimination System ("NPDES") permit, for complying with reporting
requirements and for any administrative activities that may be necessary during the course
of assessment and remediation conducted pursuant to this Agreement on the Petitioner's
behalf. Contemporaneous with the execution of this Agreement, Petitioner has executed the
Limited Power of Attorney, Attachment 1, which is incorporated herein by reference,
granting this authority to the State and its independent contractors.
C. The Petitioner agrees to execute such amendments to this Agreement as may be required in
order to comply with the provisions of DSCA and rules adopted under DSCA. If Petitioner
is a property owner of the Certified Facility Site, Petitioner agrees to file such land use
restrictions as shall be required -by the Division.
D. If, at any time, Petitioner becomes aware of information that may affect the priority of the
Site, Petitioner shall within thirty (30) days provide such information to the Division.
Activities that may alter a Site's priority include, but are not limited to, installation of
nearby water supply wells, new construction/redevelopment over or within contaminated
soil or groundwater at the Site, new occupancy of vacant structures within or near the Site,
or new uses of structures at or near the Site for daycares or schools. The Division may
revise the Site's priority ranking score using the most current version of the DSCA
Prioritization Ranking System.
E. Except as provided by this Agreement, the Division retains all its authority under the
Inactive Hazardous Sites Response Act of 1987, as amended, regarding inactive hazardous
substance or waste disposal sites in relation to the Site. If active dry-cleaning operations or
wholesale distribution operations are occurring at the Site, any hazardous wastes generated
by those operations shall be managed in accordance with Article 9 of Chapter130A of the
North Carolina General Statutes and the rules adopted at 15A NCAC 13A.
F. The signatory for Petitioner to this Agreement certifies that he/she is authorized to execute
this Agreement on behalf of Petitioner.
G. The Petitioner has designated the following representative(s) as the point of contact and the
Division will direct all correspondence related to this Agreement to:
DSCA ARAQ0140312

JAMES GOODNIGHT
ALBERTA PROPERTIES LLC
2108 CLARK AVE
RALEIGH NC 27605
All documents submitted to the Division pursuant to this Agreement shall be mailed or
hand delivered to:
North Carolina Division of Waste Management
DSCA Program
Attn: Delonda Alexander
1646 Mail Service Center
Raleigh, NC 27699-1646
H. Petitioner shall not assign or transfer any interest in this Agreement without the prior
consent of the Division. If Petitioner is the owner or operator of the facility or abandoned
site, Petitioner shall not transfer the ownership or operation of the facility or abandoned site
to another person without the prior written consent of the Division. The consent form can
be downloaded from the Division's web site at www.ncdsca.org or by requesting a copy
from the Division.
I. If Petitioner is a property owner of the Certified Facility Site, Petitioner shall provide a copy
of this Agreement, a copy of the Required Minimum Management Practices Rules, codified
at 15A NCAC 2S .0200 and a copy of the Access Agreement executed by the property
owner to all owners and operators of any dry-cleaning business operating at the Certified
Facility Site before the execution of this Agreement and provide written documentation to
the Division demonstrating that Petitioner has complied with this subsection.
J. If Petitioner owns or operates a wholesale distribution facility or dry-cleaning business
engaged in dry-cleaning operations at the Certified Facility Site, Petitioner shall comply with
the Required Minimum Management Practices Rules, codified at 15A NCAC 2S .0200.
K. All actions taken pursuant to this Agreement shall be in accordance with applicable local,
state and federal laws and regulations.
L. Petitioner understands and agrees that pursuant to N.C.G.S. § 143-215.104T, the State, its
agencies, officers, employees, and agents shall be absolutely immune from any liability in
any proceeding for any injury or claim arising from negotiating, entering into, monitoring, or
enforcing a dry-cleaning solvent assessment agreement, a dry-cleaning solvent remediation
agreement, or a Notice of Dry -Cleaning Solvent Remediation under DSCA or any other
action implementing DSCA. Petitioner agrees to indemnify and save and hold harmless the
Division and its officials and employees from any and all claims or causes of action arising
from or on account of acts or omissions of Petitioner or its officers, employees, receivers,
trustees, agents, or assigns during the term of this Agreement relating to the Site. Neither the
Division nor any official or employee thereof shall be held to be a party to any contract other
DSCA ARAv20140312 4

than (i) this Agreement involving Petitioner relating to the Site or (ii) any other contract
expressly executed by the Division or the State of North Carolina. Petitioner further agrees
that the Division and its officers and employees will not become potentially responsible
parties pursuant to N.C.G.S. § 143-215.104B(21) by virtue of negotiating, entering into,
monitoring, enforcing, or undertaking any other act relating to this Agreement and may not
be held liable for any acts of Petitioner's contractors or representatives in implementing this
Agreement.
M. The, Division's authorization of assessment and/or remediation activities pursuant to this
Agreement shall be contingent upon the availability of monies in the Fund. The Division
shall have no obligation to authorize assessment and/or remediation activities at the Site for
which monies are not available in the Fund.
N. The Parties agree that Petitioner's entry into this Agreement and actions undertaken by
Petitioner in accordance with this Agreement do not constitute an admission of liability by
Petitioner. No approval hereunder or receipt of funds hereby shall be taken as a warranty as
to the sufficiency or efficacy of the assessment or remediation of the Site.
O. Except as provided under N.C.G.S. § 143-215.104K, nothing herein shall constitute a
satisfaction of, or release from, liability for any claim arising as a result of operation,
ownership or use of the Site by Petitioner, its agents, lessees, successors or assigns.
P. This Agreement may not be modified without the written consent of the Parties; provided,
however, Petitioner agrees to execute such amendments to this Agreement as required by
section VI.C.
Q. Petitioner agrees that, except as provided in Section VI.A., all products generated by, from or
as the result of assessment and remediation of the Site are and shall remain the property of
the Division. These products may include but are not limited to documents, remediation
equipment, pumps and monitoring wells. Provided, however, "products" shall not include
any dry-cleaning solvent as defined at N.C.G.S. § 143-215.104B(b)(9), any hazardous
substance as defined at N.C.G.S. § 130A-310(2), or any contaminant as defined at N.C.G.S.
§ 130A-310.31(b)(4).
R. The obligations under Section VI, Paragraphs, (J) (L) and (Q) above shall survive the
termination of this Agreement.
S. This Agreement shall continue in force until (1) it is terminated or dissolved by either or both
Parties pursuant to its terms, (2) the Parties execute a subsequent agreement governing the
assessment and/or remediation of the Site, (3) the Division issues a "no further action" letter
with respect to the Site or (4) the Division is unable to obtain the consent of any property
owner to file any restrictions on the current or future use of any portion of the Site that are
necessary to assure adequate protection of public health and the environment as provided in
rules adopted pursuant to G.S. 143-215.104D(b)(3).
DSCA ARAv20140312
5

T. Termination under Section VI.S. (1) shall be effective upon ten (10) business days prior
written notice to the other Party. Termination by the Petitioner shall affect forfeiture of the
liability protection afforded pursuant to N.C.G.S. § 143-215.104K. Termination by the
Division shall entitle the Petitioner to initiate a contested case pursuant to N.C.G.S. Section
143-215.104S and N.C.G.S. Section 15013-23.
U. In the event that this Agreement is terminated, the Division shall retain all applicable
enforcement rights against Petitioner, and Petitioner shall retain all applicable defenses.
V. If Petitioner is a property owner of the Certified Facility Site, Petitioner agrees to grant
access to the Division and the Division's independent contractors to undertake all work to be
performed at the Certified Facility Site. If Petitioner is not a property owner of the Certified
Facility Site, Petitioner shall obtain access for the Division and the Division's independent
contractors to undertake all work to be performed at the Certified Facility Site.
This Agreement shall be deemed executed on the date on which it is signed by the chief of the
Superfund Section of the Division or his designee.
By: l�
Jun teson, LG [Date]
Ch f, Superfund Section
Division of Waste Management
North Carolina Department of Environmental Quality
By: I2 2 i
ignature of/f etitioner] [Date]
01 t l
[Title of Sign tory]
DSCA ARAv20140312 6

AGREEMENT FOR ASSESSMENT AND REMEDIATION PURSUANT TO DSCA
ATTACHMENT 1
LIMITED POWER OF ATTORNEY
("Petitioner"), do hereby
grant a limited power of attorney to the Division and to the Division's independent contractors,
as follows.
The Division and the Division's independent contractors shall have the limited power of attorney
for the preparation, signing, filing and delivery of any permit application, hazardous waste
manifest, non -hazardous waste manifest, National Pollution Discharge Elimination System
(NPDES) permit, for complying with any reporting requirements and for any administrative
activities that may be necessary in the course of assessment and remediation conducted pursuant
to the Agreement into which this Attachment 1 is incorporated.
This limited power of attorney shall terminate upon termination of the Agreement.
Dated -Or,{- 2 , 2vt
(Seal)
Signature of Petitioner
STATE OF WC COUNTY OF VA t,
On this I day of OCt 201 , personally appeared before me, the said named
Q®l"(S c-1��4da to me known and known to me to be the person described
in and who executed the foregoing limited power of attorney and he (or she) acknowledged that
he (or she) executed the same and being duly sworn by me, made oath that the statements in the
foregoing limited power of attorney are true.
Myr `o�nmission Expires 11T]1
[ 'ygjS q t MqKfoOn
Notary Public (Official Seal)
(Signature of Notary Public)
KELSEY D. MCPHERSON
NOTARY PUBLIC
WAKE COUNTY, N.C.
My Commission Expires 07-26-2022
DSCA ARAv07O5 Attachment 1