wm0501442_Application_20210615

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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: 6/14/2021
2. County: Durham
FOR OFFICE USE ONLY
PERMIT NO. (,Uo.4as-0 111-2_ ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Temporary Monitoring Well
4. Applicant: 2800 Erwin Durham Holdings, LLC
Telephone: [phone]
Applicant's Mailing Address: 1550 17th Street, Suite 500, Denver, Colorado 80202
Applicant's Email Address (if available): Dean.Millert7a dgslaw.com
5. Contact Person (if different than Applicant): ECS Southeast LLP — Samantha M. Szakasits Telephone: [phone]
Contact Person's Mailing Address: 5260 Greens Dairy Road, Raleigh, North Carolina 27616
Contact Person's Email Address (if available): sszakasitsCa�ecslimited.com
6. Property Owner (if different than Applicant): Blue Devils Hospitality, LLP Telephone:
Property Owner's Mailing Address: 1005 Slater Road, Suite 107, Durham, Durham County, North Carolina 27703
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 2800 Erwin Road — PIN 223406
City Durham County Durham Zip Code 27705
8. Reason for Well(s): Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: Off -site UST Incident
(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).
Unknown
11. Type of contaminants being monitored or recovered: VOCs, SVOCs, & MADEP EPHNPH
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Unknown
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 66 feet Northeast
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Unknown
If yes, give distance(s):
15. Well Contractor: Quantex Drilling Certification No.:
3106-A
Well Contractor Address: PO Box 1388, Wendell, NC 27591
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
c. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 3
5. How will the well(s) be secured? Not Applicable —
temporary monitoring wells to be abandoned upon completion
3. Number of wells to be constructed in bedrock: Zero (0) 6. Estimated beginning construction date: TBD
4. Total Number of wells to be constructed: 3 7. Estimated construction completion date: TBD
(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
7 a)de Managing Director
Signature of Applicant or *Agent Title of Applicant or *Agent
Mike Wilbert
* 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
Signature of Property Owner (if different than Applicant)
Blue Devils Hospitality, LLP
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]
L
Win
N
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]
ngton
GW-22MR Rev. 3-1-2016

June 2, 2021
ECS SOUTHEAST, LLP
ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49:24761P
Scope of Work: Proposal for Environmental Assessment Services
Project: AC Hotel Duke University
Location: 2800 Erwin Road, Durham, Durham County, North Carolina
As part of the proposed real estate transaction, ECS Southeast, LLP (ECS) has been requested by the
purchaser to conduct subsurface soil and groundwater quality sampling at the site. The groundwater
sampling requires that ECS procure a permit from the North Carolina Department of Environmental
Quality (NCDEQ).
ECS respectfully requests that the owner of the property grant permission to ECS to access the property
to conduct the soil and groundwater sampling. By signing below, the property owner authorizes ECS to
conduct the aforementioned sampling at the site.
Property Owner (please print): Taru n Patel
Property Owner Telephone (please print): 91 9.605.0559
Property g Owner Signature: �� Date: 6/14/21
ECS Proposal No. 49:24761P
Page 1 7

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FIGURE 1
TOPOGRAPHIC LOCATION MAP
AC HOTEL DUKE UNIVERSITY
2800 ERWIN ROAD
DURHAM, NORTH CAROLINA
ECS PROJECT NO. 49-14252

June 1, 021
1:1,128
0 00075 0.015 003 mi
0 0015 C103 0.015 W„
LEGEND
SITE PARCEL BOUNDARY
APPROXIMATE GROUNDWATER BORING LOCATION
SOURCE:
DURHAM COUNTY GIS WEBSITE
ACCESSED JUNE 1, 2021
SCALE:
AS SHOWN
Ers
TM
FIGURE 2
PROPOSED SAMPLE LOCATIONS MAP
AC HOTEL DUKE UNIVERSITY
2800 ERWIN ROAD
DURHAM, NORTH CAROLINA
ECS PROJECT NO. 49-14252

•
UST Incidents
Brownfields Program Sites
Proposed Groundwater Boring Location
LEGEND
Parcels (Polygons) - Parcels
Site Parcel Boundary
E
SOURCE:
NCDEQ-DWM SITE LOCATION TOOL
ACCESSED JUNE 11, 2021
APPROXIMATE SCALE:
200 FT.
Le§
me
FIGURE 3
CONTAMINATION SOURCE LOCATION MAP
AC HOTEL DUKE UNIVERSITY
2800 ERWIN ROAD
DURHAM, NORTH CAROLINA
ECS PROJECT NO. 49-14252

GROUND SURFACE
TOP OF DIRECT PUSH STEEL RODS
ABOVE THE LAND SURFACE
V
30-40
A
FEET
NATURAL FORMATION
BACKFILL
GROUNDWATER
=
1.5-INCH STEEL DIRE(
PUSH RISER
2--INCH BORE
- - HOLE
SLOTTED STEEL SI
0.01-INCH SLOT VI
SET TO INTERSECT GRO
ESTIMATED 15 FEET 1
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WELL CONTRUCTION DI
REPRESENTATIVE OF DII
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IIDTHS
UNDWATER
N LENGTH
AGRAM IS
SECT PUSH
1PLER
NOT TO SCALE
TM
FIGURE 4
PROPOSED TEMPORARY SCREEN POINT SAMPLER
AC HOTEL DUKE UNIVERSITY
2800 ERWIN ROAD
DURHAM, NORTH CAROLINA
ECS PROJECT NO. 49-14252
•