WM0801178_Application_20210806

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.
Date: August 6, 2021
2. County: New Hanover County
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring (temporary)
4. Applicant: Cape Fear Four, LLC Telephone: [phone]
Applicant's Mailing Address: 1051 Military Cutoff Road, Suite 200, Wilmington, North Carolina 28405
Applicant's Email Address (if available): bill(@capefearcommercial.com
5. Contact Person (if different than Applicant): Erin Warren Telephone: [phone]
Contact Person's Mailing Address: ECS Southeast LLP 6714 Netherlands Drive, Wilmington NC 28405
Contact Person's Email Address (if available): ewarren(cDecslimited.com
6. Property Owner (if different than Applicant): 2 parcels owned by entities under Harris Teeter; one parcel owned by MCCL
Investments, LLC Telephone: Harris Teeter: 704-844-3100; MCCL Investments: 828-606-1230
Property Owner's Mailing Address: Harris Teeter: 701 Crestdale Road, Matthews, NC MCCL Investments: 2060 Azalea Ridge
Rd. Hendersonville, NC
Property Owner's Email Address (if available): unknown
7. Property Physical Address (Including PIN Number) 902, 1000, and 1010 N. Lake Park Boulevard; PINS: R08818-002-013-000,
R08814-003-015-000, and R08814-003-013-000
City Carolina Beach County New Hanover County Zip Code 28428
8. Reason for Well(s): Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility for which the well(s) is(are) needed: Vacant land
10. Are there any current water quality permits or incidents associated with this facility or site? Unknown
11. Type of contaminants being monitored or recovered: VOCs and SVOCs
12. Are there any existing wells associated with the proposed well(s)? Unknown
Existing Monitoring or Recovery Well Construction Permit No(s).: Unknown
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Adjoining gas station
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? unknown/unlikely
If yes, give distance(s):
15. Well Contractor: Mid -Atlantic Drilling, Inc. (MAD) Certification No.: 2540-A
Well Contractor Address: jstewart(a)midatlanticdrilling.com 426 Landmark Drive Wilmington, NC 28412
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 5. How will the well(s) be secured? Same day
material: 5 abandonment
3. Number of wells to be constructed in bedrock: 0
6. Estimated beginning construction date: August 2021
4. Total Number of wells to be constructed: 5
(add answers from 2 and 3) 7. Estimated construction completion date: August 2021
ADDITIONAL INFORMATION
1. As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
G. 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
I:/"`� �� Manager
Signature of Applicant or *Agent Title of Applicant or *Agent
William W Schoettelkotte
Printed name 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 see attached
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office 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]
R Rev. 3-1-2016

ECS SOUTHEAST, LLP
ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49:25122P
Scope of Work: Proposal for Environmental Assessment Services
Project: Vacant Lot
Location: 902, 1000, and 1010 North Lake Park Boulevard, Carolina Beach, New Hanover
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 sampling at the site. This 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 signed below, the property owner authorizes ECS to
conduct the aforementioned sampling at the site.
Property Owner (please print): Jacob Phares, Vice President
Property Owner Telephone (please print): 704-844-3100
Property Owner Signature: Jac b H'hares (Aug 3,202113:22 PDT)
ECS Proposal No. 49:23719P
Page 18
Date: 8/2/2021

Owner Access Authorization
Final Audit Report 2021-08-03
Created: 2021-08-02
By: Lisa Fort ([e-mail])
Status: Signed
Transaction ID: CBJCHBCAABAAiCavlza5II9O7HjMPPQMOnXWZ740Z1-b
"Owner Access Authorization" History
Document created by Lisa Fort ([e-mail])
2021-08-02 - 11:52:04 PM GMT- IP address: 205.167.188.33
Document emailed to Jacob Phares [e-mail]) for signature
2021-08-02 - 11:52:19 PM GMT
Email viewed by Jacob Phares [e-mail])
2021-08-03 - 8:22:30 PM GMT- IP address: 104.47.66.126
1 Document e-signed by Jacob Phares [e-mail])
Signature Date: 2021-08-03 - 8:22:48 PM GMT - Time Source: server- IP address: 172.58.21.144
Agreement completed.
2021-08-03 - 8:22:48 PM GMT
0 Adobe Sign

ECS SOUTHEAST, LLP
ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49:25122P
Scope of Work: Proposal for Environmental Assessment Services
Project: Vacant Lot
Location: 902, 1000, and 1010 North Lake Park Boulevard, Carolina Beach, New Hanover
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 sampling at the site. This 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 signed below, the property owner authorizes ECS to
conduct the aforementioned sampling at the site.
Property Owner (please print):
Property Owner Telephone (please print):
Christina Long for MCCL Investments, LLC owner of 902
828-606-1230
Property Owner Signature: Date: 7/13/2021
a
ECS Proposal No. 49:23719P i�
Page 18
E.

GROUND
U IRrArr
TOP OF DIRECT PUSH STEEL
RODS ABOVE THE LAND
FT
SURFACE
15 FEET
1.5-INCH STEEL DIRECT
NATURAL FORMATION
PUSH RISER
BACKFILL
2--INCH BORE
HOLE
GROUNDWATER
SLOTTED STEEL SCREEN
0.01-INCH SLOT WIDTHS
SET TO INTERSECT GROUNDWAI
17
ESTIMATED 10 FEET IN LENGTF
WELL CONTRUCTION DIAGRAM
REPRESENTATIVE OF DIRECT PUSH
Pr IKJT SAMPI FP
NOT TO SCALE
ER
IS
SCREEN
FIGURE 2
PROPOSED TEMPORARY SCREEN
POINT SAMPLER