WM0701251_Application_20210802

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: July 9 2021
County: Wayne
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
Applicant: Mount Olive Pickle Company
Applicants Mailing Address:
Monitoring Wells
Telephone: [phone]
1 Cucumber Boulevard, Mt. Olive, NC 28365
Applicant's Email Address (if available): Iwatler(rDmtolivepickles.com
Contact Person (if different than Applicant): Kevin Clay Telephone: [phone]
Contact Person's Mailing Address: Mid -Atlantic Associates, Inc.. 409 Rogers View Ct., Raleigh, NC 27610
Contact Person's Email Address (if available): kclavc maaonline.com
6. Property Owner (if different than Applicant): Town of Mount Olive Telephone: [phone] ex. 108
Property Owner's Mailing Address' P.O Box 939, Mount Olive, NC 28365
Property Owner's Email Address (if available): i rovall oetownofmountolivenc.com
7. Property Physical Address (Including PIN Number) Town Right of Way/Property — See List
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: Non -Discharge Facility
(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).
NPDES Permit NC0001074
11. Type of contaminants being monitored or recovered: Nutrients
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes how many? 24
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0701159, WM0701160, WM0701221 , WM0701236
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Approximately 1,500 Feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s):
15. Well Contractor: Geologic Exploration. Inc. Certification No.: 2580-A
Well Contractor Address: 176 Commerce Blvd, Charlotte NC 28625
PROPOSED WELL CONSTRUCTION INFORMATION
As required by 15A NCAC 02C .0105(0(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter
b. Estimated well depth
c. Screen intervals
d. Sand/gravel pack intervals
e. Type of casing material and thickness
f. Grout horizons
g. Well head completion details
Continued on Reverse
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 1
3, Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured?
Expandable cap with lock
6. Estimated beginning construction date: July 2021
7. Estimated construction completion date: July 2021
1.
ADDITIONAL INFORMATION
As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
c. The proposed well or well system.
d. Any test borings within 500 feet of proposed well or well system.
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel
storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
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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).
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' If signing as Agent, attach authorization agreement stating
that you have the authority to act as the Agent.
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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]
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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

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STEELE HINSONUS 117MARTINSTATION HOLLOMANNCCGIA, NC911 Board
0 600 1,200 1,800Feet
PR OPOSED WELL LO CATIO N MAPMT. OLIVE PICKLE COMPANYMOUNT OLIVE, NORTH CAROLINA
DRAWN BY: KRC
DRAFT CHECK BY: ENGINEER CHEC K BY:
APPROVED BY:
DATE: JULY 2021
JOB NO.: R2423.06
GIS NO.: 3G-R2423.06-Permit
DRAWIN G NO.: 1
REFER ENCE S: PR OPERT Y LINES, HYDR OLOGY F ROM WA YNE COU NTY. AERIAL IMAGE RY FROM NC CGIA, 20 17.
LEGEND
kj PR OPOSED WELL LOC ATIO N
A EXISTING MONITORING W ELL LO CATION S
CHLO RIDE ISO CO NCENTR ATIO N CON TO URS
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PROPOSED PERMANENT MONITORING WELL INSTALL FOR JULY 2021 PERMIT APPLICATIONOFF-SITE ASSESSMENT OF CHLORIDE IN GROUNDWATERMT. OLIVE PICKLE COMPANY, MT. OLIVE, NORTH CAROLINAPERMANENT MONITORING WELL IDDEQ PERMITREQUIRED MOPC, TOWN LAND OWNED PARCEL OR TOWN RIGHT-OF-WAYDIRECTION OF WELL FROM FACILITY, NEARBY STREET OR FEATURESPIN NO. OR PIN NO. CLOSEST TO LOCATION IN TOWN RIGHT OF WAYADDRESS OR CLOSEST ADDRESS TO LOCATION(For Permit and NC 811)COMMENTAnticipated Wellhead Type (subject to change)Deep monitoring well (est. 60 ft below land surface) adjacent to North Church StreetFlushmount VaultMW-24 YES TOWN RIGHT OF WAYNorth of intersection of East Station St and North Church St2582-08-3512 123 East Station Street
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GRANULAR MATERIAL
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LENGTH OF
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THREADED COUPLING
LENGTH OF
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LAND SURFACE
TOTAL DEPTH OF
WELL FROM TOC
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