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HomeMy WebLinkAboutWM0601166_monitoring well_20210119ROY COOPER Governor MICHAEL S. REGAN Secretary S. DANIEL SMITH Director Mr. David L. Cheek, Manager Big Cedar Creek Properties, LLC 605 George P Road Robbins, North Carolina 27325 NORTH CAROLINA Environmental Quality January 19, 2021 SUBJECT: Well Construction Permit No. WM0601166 Three (3) monitoring wells: In and Out site/Joseph White property 200 S. NC Hwy 705 (P.I.N. #: 862115526784) Robbins, Moore County Mr. Cheek; In accordance with the application prepared by Pilot Geological, PLLC dated 11 January 2021 and received in the Fayetteville Regional Office on 11 January 2021, we are forwarding herewith Well Construction Permit No. WM0601166 dated 19 January 2021 issued to Big Cedar Creek Properties LLC for the construction of three (3) monitoring wells located on property owned by Joseph White (P.I.N. #: 862115526784) in Robbins, North Carolina. This Permit will be effective from the date of its issuance for one year and shall be subject to the conditions and limitations as specified therein. Please note that according to North Carolina Administrative Code, Title 15A, Subchapter 2C, Section .0105 (g), "it is the responsibility of the well owner or his agent to see that a permit is secured prior to the commencement of construction of any well for which a permit is required." Issuance of this permit does not constitute approval of the subject wells for reimbursement from Trust Funds. If any parts, requirements, or limitations contained in this Permit are unacceptable to you, you have the right to an adjudicatory hearing before a hearing officer upon written demand to the Director within 30 days following receipt of this Permit, identifying the specific issues to be contended. Unless such demand is made, this Permit shall be final and binding. Sincerely, --DocuSigned by: `Try 45egional Supervisor Division of Water Resources — Water Quality Programs Enclosure cc: FRO Files Moore County Health Depaitinent Joseph White Pilot Geological, PLLC North Carolina Department of Environmental Quality I Division of Water Resources Fayetteville Regional Office 1225 Green Street, Suite 714 I Fayetteville, North Carolina 28301 910.433.3300 NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES — WATER QUALITY PROGRAMS PERMIT FOR THE CONSTRUCTION OF A MONITORING WELL In accordance with the provisions of Article 7, Chapter 87, North Carolina General Statutes, and other applicable Laws, Rules and Regulations. PERMISSION IS HEREBY GRANTED TO BIG CEDAR CREEK PROPERTIES LLC FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of three (3) monitoring wells owned by Big Cedar Creek Properties LLC located at 605 George P Road, Robbins, North Carolina. The monitoring wells will be located on property owned by Joseph White at 200 S. NC Hwy 705 (P.I.N. #: 862115526784) in Robbins, Moore County, North Carolina. This Permit is issued in accordance with the application received on 11 January 2021 in conformity with specifications and supporting data, all of which are filed with the Department of Environmental Quality and are considered integral parts of this Permit. This Permit is for well construction only, and does not waive any provision or requirement of any other applicable law or regulation. Construction of any well under this Permit shall be in strict compliance with the North Carolina Well Construction Regulations and Standards (15A NCAC 02C .0100), and other State and Local Laws and regulations pertaining to well construction. If any requirements or limitations specified in this Permit are unacceptable, you have a right to an adjudicatory hearing upon written request within 30 days of receipt of this Permit. The request must be in the form of a written petition conforming to Chapter 150B of the North Carolina General Statutes and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless such a demand is made, this Permit is final and binding. This Permit will be effective for one year from the date of its issuance and shall be subject to other specified conditions, limitations, or exceptions as follows: 1. Issuance of this Permit does not obligate reimbursement from State trust funds, if these wells are being installed as part of an investigation for contamination from an underground storage tank or dry cleaner incident. 2. Issuance of this Permit does not supersede any other agreement, permit, or requirement issued by another agency. 3. The well(s) shall be located and constructed as shown on the attachments submitted as part of the Permit application. 4. Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC 02C .0108(o). 5. Well construction records (GW- 1) for each well shall be submitted to the Division of Water Resources Information Processing Unit within 30 days of the well completion. 6. When the well is discontinued or abandoned, it shall be abandoned in accordance with 15A NCAC 02C .0113 and a well abandonment record (GW-30) shall be submitted to the Division of Water Resources Information Processing Unit within 30 days of the well abandonment. Permit issued the 19th day of January 2021 FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION DocuSigned uSSignneby: '�.C.\ k Trent i49Rcn h: S upervisor Division of Water Resources — Water Quality Programs By Authority of the Environmental Management Commission Permit No. # WM0601166 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: 1 /11 /2021 2. County: Moore FOR OFFICE USE ONLY PERMIT NO. 14 /70(.0 DII (O(o ISSUED DATE oi//9142.1 ✓ 3. What type of well are you applying for? (monitoring or recovery): Monitoring 4. Applicant: Pilot Geological, PLLC Telephone: 336-870-3095 Applicant's Mailing Address: PO Box 128, Kernersville, NC 27285 Applicant's Email Address (if available): jrickspilotenviro.com 5. Contact Person (if different than Applicant): Jason Ricks Telephone: 336-870-3095 Contact Person's Mailing Address: Contact Person's Email Address (if available): 6. Property Owner (if different than Applicant): Joseph White Telephone: 910-220-2080 Property Owner's Mailing Address: 131 Malabar Drive, Troy, NC 27371 Property Owner's Email Address (if available): 7. Property Physical Address (Including PIN Number) 200 S NC HWY 705 (862115526784) City Robbins County Moore Zip Code 27325 8. Reason for Well(s): UST related 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: UST (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). 42273 11. Type of contaminants being monitored or recovered: Petroleum -related (ex: organics, nutrients, heavy metals, etc.) 12. Are there any existing wells associated with the proposed well(s)? If yes, how many? 5 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): On -site 14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes, one inactive If yes, give distance(s): 410 ft. 15. Well Contractor: Environmental Drilling and Probing Services, LLC Well Contractor Address: 17538 Greenhill Road, NC 28278 Certification No.: 3307 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 3. Number of wells to be constructed in bedrock: 0 4. Total Number of wells to be constructed: 3 (add answers from 2 and 3) 5. How will the well(s) be secured? Lockable Metal Cover 6. Estimated beginning construction date: 2/8/21 7. Estimated construction completion date: 2/8/21 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. 143-215.106(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, hapter 2C) and accepts full responsibility for compliance with these rules Signaturf Applicant or *Agent Jason Ricks - Agent Agent Title of Applicant or *Agent * 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). Joseph White Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant) DIRECTIONS Please send the completed application to the appropriate Division of Water Resources' Regional Office: Asheville Regional Office 2090 U.S. Highway 70 Swannanoa, NC 28778 Phone: (828) 296-4500 Fax: (828) 299-7043 Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301-5094 Phone: (910) 433-3300 Fax: (910) 486-0707 Mooresville Regional Office 610 East Center Avenue Mooresville, NC 28115 Phone: (704) 663-1699 Fax: (704) 663-6040 Raleigh Regional Office 3800 Barrett Drive Raleigh, NC 27609 Phone: (919) 791-4200 Fax: (919) 571-4718 Washington Regional Office 943 Washington Square Mall Washington, NC 27889 Phone: (252) 946-6481 Fax: (252) 975-3716 Wilmington Regional Office 127 Cardinal Drive Extension Wilmington, NC 28405 Phone: (910) 796-7215 Fax: (910) 350-2004 Winston-Salem Regional Office 450 W. Hanes Mill Road Suite 300 Winston-Salem, NC 27105 Phone: (336) 776-9800 Fax: (336) 776-9797 GW-22MR Rev. 3-1-2016 TEMPORARY MONITORING WELL CONSTRUCTION DIAGRAM All M Casin GROUND SURFACE 4 inch diameter drilled hole Well casing, 2 inch diameter, 11 ft Top of bentonite Bentonite 13ft Top of sand 20 ft Well Screen, 1 inch diamter 0.01 slot .-- Sand Pack 35 ft. 35 ft. easuring Points are from the Top of g Unless Otherwise Noted. Project In and Out Robbins, NC Owner Well No. MW-5, MW-6 and MW-7 Location 200 S. NC HWY 705 MD Coordinators State Permit No. Pending Topography Setting Ground Elevation Drilled By EDPS Drilling Started 2/8/2021 Drilling Completed 2/8/2021 Method of Drilling Air -Rotary Type of Rig Air -Rotary MONITORING WELL DATA Well No. MW-5, MW-6 and MW-7 Hole Diameter 4 inches Hole Depth 35 ft. Casing Diameter 2 inch Casing Length 20 ft. Screen Diameter 2 inch Screen Slot 0.01 Screen Type slot Surface Elevation No Data Screen Top El. No Data Screen Bottom El. No Data Well Status Active REMARKS MW-1 log.xls PiLuli�_ PILOT G E O L O G I C A L, P L L C May 20, 2020 Mr. Joseph White 131 Malabar Drive Troy, North Carolina 27371 Reference: Right -of -Access Agreement In and Out 226 South Highway 705 Robbins, Moore County, North Carolina Pilot Project G-5624.1 NCDEQ Incident No. 42273 Dear Mr. White: Pilot Geological, PLLC (Pilot) requests your permission to install a monitoring well (MW-1) on your property (200 South Highway 705) in association with the former underground storage tank (UST) system associated with the adjoining property located at 226 South Highway 705 in Robbins, North Carolina. The North Carolina Department of Environmental Quality (NCDEQ), UST Section has required that the monitoring well be installed due to a release of gasoline from the former underground storage tank (UST) system. The UST system and the accessible impacted soil have been removed in accordance with the NCDEQ, UST Section Guidelines. The two-inch diameter monitoring well will be installed flush with the ground surface and covered with a secured steel cover set in an approximate 2' by 2' concrete pad. A drill rig and associated equipment will be utilized to install the monitoring well. Pilot and its subcontractor will repair damages as best as feasibly possible. Periodic access for sampling and other activities will be required. Please provide the requested information below to grant Pilot permission to install and sample the monitoring well. In the future Pilot will attempt to contact you via phone prior to accessing your property. We currently are planning on installing the monitoring well on May 26, 2020. ti,),61 Phone #: 7/0 2eZ0 2- 0 8 Signature: 6ZA62-Date: g' A- 2/2-0 z c9 PO Box 128, Kernersville, NC 27285 www,pilotenviro.com In and Out May 20, 2020 If you have questions regarding this agreement, please contact Pilot at (336) 870-3095. Sincerely, Pilot Geological, PLLC Jason T. Ricks Principal Geologist 3 Drawing 1 Google Earth Interactive Mapping Software Scale : 1"= 20' Nisa LEGEND 42Co 1" Iwy 7°5 j Rot33i�s C. ,273.2 Site Boundary Approximate Soil and Groundwater Sample Location Proposed Monitoring Well Location Groundwater Contour (CI = 5 ft.) 1 73.00 Groundwater Elevation 1 114,,Ti SR PILOT GEOLOGICAL PLLC Proposed Monitoring Well Location Map 226 South NC HWY 705 Robbins, Moore County, NC Pilot Project G-5624.3 Drawing 2 USGS Topographic Map Robbins, NC Quadrangle Scale: 1" = 2,000' PILOT G F O O G I C A L, P L L C LEGEND --- Site Boundary USGS Topographic Map 226 South NC HWY 705 Robbins, Moore County, NC Pilot Project G-5624.3 Drawing 3 Google Earth Interactive Mapping Software Scale : 1"= 60' PILOT G E O t, O G I C A L, P L L C LEGEND Site Boundary U. UST System A. AST System G. Gas Station Site Map 226 South NC HWY 705 Robbins, Moore County, NC Pilot Project G-5624.3 Drawing 4 Google Earth Interactive Mapping Software Scale : 1"= 300' I L O T GEOLOGICAL P L L C Site Boundary Approximate Water Supply Well Location Receptor Survey Map 226 South NC HWY 705 Robbins, Moore County, NC Pilot Project G-5624.3 WELL CONSTRUCTION RECORD (GW 11 1-Wel/ C IsolarIn nrnmtioa-: Waiter L Davis t~ cil Cet ar)or ki!!s: 3162-A 4.e13 CC=Wet ckssirmitlm Ntut;hty 30 Environmental Investigations LLC COY ti' Ala COnntraction Permit 4: dtsr apitGadifr tarsitArur a tfa. po'+rtio /%r tit': cowry, )see l 3.►4d1 the (check asp ow); 1Vnter 'Sopply Wtrr1J Lth>naf D�htnje>11�sbit;c 'v`Ihcrrazi t1 knttinapiCce. dt1lr,Suppiy) Di:e i&ntiel W&er Soppy Gist:} Itsdttshial,lCtaatmcrrial 01#ridenit i WatcrSupply (Ahnr0.1) 1rri_ntticrl Noes.lvnter Snpply Welk mark flfl InirAliont Wel]: uirrr Recht,tte u7rr Storage Recnrry ksruifcr Tee Ji pall/nental 'l'rchnOugy Gentistrutal (Cfv'd Lourp) cRecavery f «sntivoirT Reined; 4Untt E3Suaity %rscr rjactntrwaterl)tfin,)p.0 f Sub%il CA-lntrot Tra.er clerr(hrttstrll tIIcsliaraC mint Return) m[tr cr (�`1plain trxlct142I Remark's) 4.Dale V'iel)ic)C'no) 5-26-20 Well ID, hllw-9 a.. Wdl I.urta(kin 57 ixthry, �r.Y �frn.c Ducar 1t (irai+rSr.utr) 226 8 Highway 705 Robin NC PGrAal Address, Ca r, :m! Tp Pik Z. Baum• ha i I,koi'rmion *ictMN) RP. Latitude and lonolmds in degoccsitnattutit.e.ibworads or decimal drgre,z; it rad, cr.:- t)i utnx IS 1u9; ) 3.5 4' 2-5—# sr,tr N 7 3 (/1, 2$ Rr 4. tiOrc) !be v I(N) fx Feras+p t or Ord"cenpoe,rr'y 7. this a repair to am exiainng wu•H: 0, n: ar 71 Out JF T ts'Juir. JW e.ul Lam we,. c,,te xuct,rsr :,sf vary Ksq iv)a+ ci,r & in .{e ru m nI'L4r re uvd • 171 r 4Nrks se,aioe cv rm e4 issck of Yhts ems. 8, For i eopn)be pirr or Closed -Loop op Co:Ala-rued Was ha.'►ins' the SION., orn struck on, only I GWI is nrxs$S_ TOTAI. +:t:Miltit`ofaelltc eiritt� 9. Total wdl devai 6slow hod rcarffett1035 Frrm)inp,N.+Klxs r!i ear3r ,'lr erent (ait'Ir.:u%.'.tY7'a".I-ntlaf) IQ Static raster k+ei beim, top orraeit : 1 r • t 3 ift4 If MIXT rrrtl i, raw,, exs . are -- - 1i.i `bakdiaarrtcr; 6 (in.) 12.Wt:1Iconstructing rat c1: Auger ftt rncs,ntwyy,age. data pugs, ctc) FOR WATER SLIMY WELTS 41N1,y; 13%, Yield (, tn) )Meshed rri t es1: t3b. Dili auction tF-pr; ; ,want: For Inrcrnal Use Only: 114 WitTl:RYA}rMr `rianm TV tt. tt_ r -2trtu01 tL f iiUtrFICR CASING Isar atrr[i:•cs s..it .iEsj QR LINER Csfa�Alirablel ritomTr) IM:sarI 7}acxxms [ M4TVAtsw n In ti.1P13Y1'.it CASING ORTIIillriGctcwrt-10<cl �tnty Ix) ra.km:ETE1c t Titan): ozr.s I M. At. - , ID. SL4 90 1 , re. I ill. l.. .Ritit�r 1maxim 1r} R)t•tsttrrR 1 ctAyt tiltX T111rJ,11,At MA 1 tx. rt. )mom -77 - 7.1.4.-re tml. [/ IL [t. t3 h- I L'tin'r.Ac arr)L-.7 Martin, uoi.7.-r ft. It I fI r+' NtiGRAVIa, lACpc g, ;able+ mom t TYr 4 T113it.,t. rstrt. rxuRN-1" vu l*1 L1r4L; LOG (..n.v.tharaddanmi Owls If asrorrorrr natiti TC} nr -crsurr in aHtlwY t� tp n- ts. �311 (L iS Gi p rp 17 d. as_ rL A. , k lt. =1. ACMAsais tL 5-28-20 3 .,1,5sa.X iEK Jf' L1 Walt rr,lift- fhui the kru ar:Vb st7tlr asth J.4�1 " ,ll; UJ.- 45.4 WA!: sr, {' Cumu Part,-,07, wad : it 17 r�fih1�irevevdili3lCifYvni.dtpmeM.CirutmLr. 23. Min illogriqn or additional welt dcfiailtc Y(yr nosy ttsa; the back of iti Mc IL' FS[Yide a.dcrriicnj µell site 3Gail! orivtli wastr dion t1 .nJ Y,rum may also attach oilltrcuai p:tt:cs ifnectcsmr .Frl?i3.MITTA r. t Ns ct'IR UCj1 ONS 24.4.. For Wain tistbenir t§ix Cclrrr t.T L-irnplaiOn noS1 toctstrtirtinn so Or Iblitar:a Divisina of Wader litryaffrees, laforrnation Ynxting Unit, 1617 I►faa Sexriec 1 arxr► itakigh, NC=11U3-1617 7.3b. For Injection We,: la si5diCwet to sendiit� sir Fenn to ttc 2'1u above, Also su irut erne copy of )ttrs twin Atha 30 &iv ot'ti,'snyirtion of well ecristrtLctintt Tothe Kith:skim= Division of Ws.ner Known -Its. Underground Iripsrtiore Control ,tn'sm,, 1636 Mall Striae (rater, l t leigk. NC 27699.16,36 Vic. For i tter addiriin io Sethfi-wen to the saqfec. zdvu ststtmis one copy of this firm within 34 4ttti� ,f C tlaplclitm or wdl alralruction to the onntty krdtlth Ce tslmrat of the crsortty u{rere ccatmtOecl, 7411/1 t;til'-t ?irxth l$idsa[ Lea tmen OCi trrtfc.ru>L-rd7 •} - tm of at i7Ptltt Puaan c ksyred 2-7-4 fi WELL CONSTRUCTION RECORDIGW-1} 1. It'rtI Contractor Information: '•t'r I1 'nnh.,int Manx' 3307 u•,•1I r "e,rsr V.101 r'010i.:1174.r1 Numb, _LYN ifoo rvkell#al f.f1 h 1c) 4- F b in) Se vie 05� uc r rscn 11rn `.un.• ?. 1{ eel ('mist -ruction Permit d; nr n1 147141r1Th, w.rfl. nn•.r-urru,rr rk•rm u, r r "1r r ,a,.tr 'LNr :.trrafn:Y 1'f. 3. It ell t 'se fche-rk ►►dl use): Water Supph' Well: Agrici l oral U11:ntr rpsl T'trhltt' (ie�)1ht`rtr,:tl tlls-tflne.''«+I1111, titIppis kc�td�tslt:r: \_1 iltr tiut�;+i, l�rrs; lc: In dntitnal1(•ummc.rc t.rl Q Ito.- Lknt,:1: \V le Stirnth r'd area 1 Im atwlt N -Water tiuppl) N‘ el!: Mil t1torr ne injection Well: Ayuih r Recharge Aquifer Slo)raer and Aqut ics Test f xp nmental 1 eehrxoinsn (e thcrm;.i it II (io,Ihermal (Hcutn :( 4. Date W'i'elks) ('nmpleted: Elr;rosuntlu:ticr 1t1:1T)t1J1i 1.ut Otial i nt t l 13;trn er fjtitt)nna;ttis I honor t Dsubcodt114e (',i trt•1 1 r:ell•: 1tc11rm) [)(.rthcrit"trlii:nunder ==E Itcnlarksl $15lZ0 $)' ►ti-ell II)/ MvV ^y1-r Sa. �l"ril location: '14 e-' der$ CErAN etllenc+p 1.' i1rn't...ncr `area• 2Zte 5eufih ?M.tcal lid -'. t. u\ and lip 00 Ore. '.'urtt. Fa.11t11. tl1=.tl,ipplu•ahlrt in 1 ebb t1} n aro lim l':atel Id. ntiti.sile,p tit+ i ('r, iude And Longitude in degrrrstminsttestceettnds or decimal degree-v. :it „ell 5cld arx lat')oot a lutflocotl 3S. `-)3'�-o/3N 7�r, ,5 532- 6. is(m-e) the *'cl1(si / Prrrttaneat nr DTrntllor nr) Is this a repair to an existing ► •ell: fares or tall .u1 e,w,r , ..el?,..nr,.u, r„ r. ,nl.orru.rn,n ruu, 1•4,r,r::t.r rtr,- .Ir,r•, ., the ;ter„ untie. ' •r murt ,1.1'1::1 . rin fire' hat .t(th:s fro -Pry x. 1-nr c ;eoprobeiDP'l or t loscd-Loop (.enthermn1 ''Fell, 'laving the satin: eon ,:tructi i::,tails 1 net.Mded indicate T[)'1-Af. .I r?vfERFR trf wctks dr1:eel 2 9. Total well depth bdo»- land surface: J e 35 eft.) medltlt:✓ .',•!: .:re' :,re' ,1':ijhl rl d,frrrr•.rr •rrutnpi: r u : di4 ,r»,1 : %�� • 10. Static water level below top of casing: _ Z 9.4f, 22- Y3 .7. i.,s (ft.1 I7 Mrrrrr :err.:, :Jh!.se ,ri+:n,• r:.ce r � --._.. _. �.._ 11. llorrhoie diameter: l..Q (in_ t (� 11 %%ell construction method: n t1 A .iL11n roue Cable. claret bush. mi. FOR WATER SUPPI.1' WELLS ONI.1': 1.3a. Yield (gpm) tilrth.rd of nett: 13b. Disinfection type: amount: Ei:r fntiZt-nal T'ac i}n}:c- L Print Form E 14, WATER 7,4)NES 1. FROM Ct) DESCHIPTIu, ft. I ft. P 15. OUTER CASING for multi -used yrclIsOR LINER ff. bit) f ittltii 1 TOf n1AAr£TEu T111- a,rf•Ss h1ATiSl1AL ( ft ft. in. t 1 i 1 16. INNER CASING_ ORTURING (Aeothernrfti dosed -loop} ,1 - + i w-j , -1 O iPyc I" l .. S(7Ei✓4 r 1.1tU1 I[J ' I11,1.1ti:i i I.OI sv,kI T}ti('1V0_' _ NIATER1.t1. i 35 rt. 1 ]5 IL • i 2• in. • 0.01 1 5Lt-1.4c. C I. rt. 1. ft, is 1 15 it • n [t. , Z- it. (r. 1. L I& (:ROUE' i fleePell i Lo _ s1_*,1r'x1.1. Fmr:Arrhirs-r Ntrrno D &AMC1L9,__ 13 11. }} f:. i rttl'#crljlt% : POT- 1 1 a. 0 rt. i 6-(1) VI poufs t L 19. SANl!(:RAVEL PACK Of xppticabk) FROM Tr} ht.'.Tyltt.41. FMri ActMY.J1T 4ft"THOA 35 rl. 13 rt ! #i Z 0,14ep 1 ft. ft. 1 ., t L In. DRILLING Lt_X: (attach additional streets if r ecetaaary) 1_tR( 1T[t _ .: _LU}_ti('RiPT1ON terlsr. karma ri4rrck trim LrAial in.. eu.j f 21- RENC &RKS 1 22. C'erritiea Irl ark /1.'ri' :J:r, with lt.ltt'r'. 8)1o)?o O14� r1 constructed rn accarciemo,t u= fps a'elf r'artrrrutrrnot Srandardt 07.1 that •rr,•r,r,f :rot hr101, n,-dshj.ai 10 !h.' will na-nrr 23. Site diagr>drn or additional well derails: 1'.,u intr. net' the hack of this page to pr.rt•rde ntidltional well sae details or we1i :::,ertslnrs:tu,n delalls You real slat stlach additional pages ifnr a .s u st'BMrr•rAl INtiTRR1 (7I()NS 14a. }:r,r All Wells: 'Strhrnt! +hi-. form within t+S ,lays of t:.)rnpletinn of well itlat:Ita l.,i, t• the „llt n.7np Riviciou of t1'tlter iteu+urcrs. information Pre- rssing Unit. l[.l 1r,il ticrt ice ('center. Ratrigh, NC 27699-161' 2411x Far iojrctiou Wells: In addrtl.•rl to .-riding the limn tot the addle`S` tt1 7.4a al,. we. also submit •1nc ,11 this Munn w,thrn )(I days of completion of well cor titruCti r, K' the 10110wtne. f)ivisian of 1• oter Re•cources, 1 ndergrnund Injection (Control Program, 1636 Mali S•er ice ('enter, Rakigh, NC 27699-1636 24c. For ti%'>,ter tiuppll & Injection Wail: In addition to striding the loon 1,1 the 9dttist s(c 1 abOVe. alcn Suhnut ill' this form within 30 d*,s t.i c<mt111tti.7n 01. well consln.:lion to the c.',•tmn• health department of the orients' where :,,a�trartc.l wniuss i.•f f-tt.lr,n.n,.,1LYl t,,rl}its 14e-sited 7-22 '01h WELL CONSTRUCTION RECORD (GW-l) 1. \Fell Contractor Inforn ttinn: 1(-14 M9 $4,19 afa t�ri1 ('L n nt t.tir Name stir t1'r11 rrattrti:I.-Peelle, tlnn `umbct EYvie liMine 4- PrrbMM servile' ea Company Name 2. Well ('nnstruction Permit 4: / rr1 nit epri:i ahle wet/ { an inallu)1 fa'rmtt rr ,• 1.1t ', c 'ounrt•, M:+l.•, l :arfrrnrr. rk J 3-Well Use jcheek well use): Water Supply Well: �Agntuitttril Geothermal (11e ttingi('1><diiu Supply) industrial/Commercial Int atton N-Water Supph'R'eli: 11•ltxutoring Injection %s'e1t; Aquifer Recharge Aquifer Storage :lad Recovery Aquttcr'I'cst L:xrerimrntul-frehnolt,gy [ ict'thcrnal ((loser} I.tx,p) Ciroth(xlnal Itlmtitiglt'txtlinn Return) Muff ItttptiITill In: �[�o�tcSrtitsal Wifit:r Supple (single) DResidensial \\'rite Supply t:shared) JRta:orery {irttundt.t;iter lerncdialii‘ii �tialinily Harrrirr EIStormt',ater 1)rtrnag� Subsidence Control DTraner rothe:r (explain under 421 Remarks) i. »iife'41 ells) completed: 61170 ` $)& tell 11)4 ?w ~ } 5a. Wcl1 Location: 4t-duj- COnVelfl►encp 5119rg 1:1ctlit}-tithed Nam, Fncdtn' 11)e (LIapplaah)e) 2vp 56, 7o Rbbb;t6 ( Itncl I'Msicd .\duress. City. and lip Moore. Counts Panel Ickuttticat:rm!'tw Zb. Latitude and longitude in degreesiminutert/seconds or decimal clearers: (11. well held, QM 1at'iong is sufficient! 3 L13227 N 7 . CF 33.s 6. Ware) the well(s) Permanent or 3T enipnrars 7. Is this s repair to an existing well: fl\'e:c etc n .film is a upset fro? n.l Crn•x•I well r..' :Ittriu+t tnfm .ntrlr,m w44/ vy/dun rh1 47,ell: r .f41, re'prur under / renlnrkr terr:..r: to,r: the here of 401 corm W / . For Geoprobclf)P'I• or Closed -Loop Geothermal Welts having the same construction, only 1 Gilt-1 is needed- Indicate 1'OTAI. NUMBER of wells drilled: 0YN1~ 9. Total well depot below land surface: le 55- (ft,) For multiple hells irct a/i,Irpths fl drf?'rrrnl (rxnmf.lr. ; .d . Ql) mid ''cr-Iflfi i 111. Stati+; water level below top of casing: _1_4. V g (ft.) Ij ~slur /err/ rn slim rasl,u;. rflf ' 11. Borehole diameter: (in.) 12. Well construction method: (le .w er. rntarr:. cable. direct push. etc A iT Rafi,1 -FOR WATER ER SUPPLY WELLS ONLY: l,1a. N'ictd (gpm) Nlethcrd of lest: 13b. Disinfection type: Amount: Yt•:m ilt'-I For Internal Use Only: LPrint Form 14. WATER ZC)NIS FROM t o DE ct:Rnvrtn1 ft. n. ft, n. 15. Oi11'ER CASING (far audit -cased wells) Olt LINER (if a ble) 4'ROM TO oLUNEMIL T111C1CiESS MATFR1AL cfl ft. 0 11. to in. $04-.1413 f 4t, 16. INNER (ASINC, OR T Lr131NG (geothermal closed -loop) antra TO Di.0tf t'l:R T1Ii(lei $$ Mt.sTERLal. 5~a ft. D ft. in, Sclti.�lt� Pic. ^ ft. n. in. 17. SCREEN FROM • 10 1 DLtMl.-r?:R Si_01 tip: TU1 K.YIN, 11.tTi-R181. �5 ft ID n Z it" 0.01 JS+1 1r'iC 1 4 -- I ft. rt. in. `18. GROUT FRtilt 1'O 11 %1TI.1AI, 1 FAtPI-srEMFyr 1ii`f U)t) f A240171' dig f- y €r. 414 ft. n Et- r r'tlltfonf1p J ( u1 Pov1Z povit ft. 19. SANf/GRAV n. RI. PACK (tf applicabk) fl4QM TO MATERJAI. rstri_tcrmtl4.iAirman 55 ft. mg a.. Z fi.,.et ,la rt. n. le. ORfi,f.1' C 1dX: (allachadditioatl sheets if ncetasary) FR()M T() ' DF:SC; RIPTION (c.ior, M rdnr , mil.etk type, vain sin, etc.) f_ L_. ft.� r y. tt. 4S ft. _ S C _ S„y-. i:l.. 1.4 S It. rt. It s-D it. ft.- ri. - ---- - r1. ti. ft. fl. 21. RF3MA(LKS 22. Certifies }Dummy' of redo 1t'e tit ..vxning rhrt f:rnr N I111 Dose 8)1o) Zo (*term cunttruciell i+I aG :4rrlar:e r 01! wen r'nnrrrrrclran Chrndvrds and Hurt a r rtx :yet! has Area 1,1,ny .'.1 f.• rh. „ ell crx•n.•r rehi• crrirft 1h1c1 Ihr elit 23. Site dig►rnm or additional well details: You may u_cthe hack oil this ru€,c tc, provide addilit>nnl well site details er wi li constriction details- You may also attach additional pages if nccessan' SFI13,4111'TAI. LN 1TRI'CTION'S 24a. For A11 Welk: Sul•rnil tills fiirm within 30 days of completion. of well Curtatlltaroit t.. the following Division of Water Resources, Information Processing Unit, 1617 flail Service ('cuter. Raleigh, ;SC 27699-1617 24b. For Injection Wells; In addition its .'ctidinz the tine to the address in 24a above, also ,tibnlit one copy of this limn within 3(1 dal;; of completion of well construction to the following: Division of Water Resources, (Underground Injection C'orttrol Program, 1636 Mail Service Center, Raleigh, NC 27699-1636 2.1c. For %Voter Supply & lni+setion Wells: in addition In sending the lnnn to the address(cs) above. also submit o,ne copof this form wnhtn 30 days of completion of well construction I.1 the cctunly health department of the count:' vdtcrti uousiru k:4. t ttr.4Iuva th•r.anmr»tut t'11slrrnnwItt:tt V•I:.luti I)Ivti':ion.,1't'L'alcr Rr .•ores. Rr+l .d2->2.261r Barber, Jim From: Brown, James Sent: Monday, January 11, 2021 3:33 PM To: Jason Ricks Cc: Barber, Jim Subject: RE: [External] RE: In and Out TA Attachments: GW-22MR Application.pdf Jim, I received the attached for MW installation. James Browll ogeologist, L iv Lon l ge .aier 'Carolina gar nicnt nuncn> aI QuaI 91. ;. _4 3 , ? 46 (Direct i 9 0, I3, 30 ( Office ) For spills or other environmental emergencies after hours: NC DEQ DWM Duty Phone 919-817-0375 NC State Emergency Management 1-800-858-0368. National Response Center 1-800-424-8802 UST Web Page UST GIS Map PIB Records Search CAB Records Search From: Jason Ricks <JRicks@pilotenviro.com> Sent: Monday, January 11, 2021 2:52 PM To: Brown, James <james.brown@ncdenr.gov> Subject: [External] RE: In and Out TA CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. James, Attached is the GW-22MR for the monitoring wells. Please let me know when it is approved, thanks. Sincerely, Jason Ricks, L 336.870.3095 (c) 336.310.4527 (o) PO Box 128 Kernersville, NC 27285 www.pilotenviro.com 1 i SRT: 0.117 sec Help Mobile View Information Cnrrh Owner's Name: AANYA PROPERTIES, INC Owner's Name 2: 226 0 N a co r3 0 6 Display Labels'_ Excel 2000/2003 ©2009-2021 Dude Solutions. All Rights Reserved. I Software Notices ittps://gis.moorecountync.gov/ConnectGI S_v6/Map.aspx?p=Moore_mgd North Carolina Secretary of State Search Results Page 1 of 1 • File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print an Amended a Annual Report form Business Corporation Legal Name AANYA PROPERTIES, Inc Information Sosld: 1987292 Status: Current -Active 0 Date Formed: 5/26/2020 Citizenship: Domestic Fiscal Month: December Annual Report Due Date: April 15th Registered Agent: Patel, Umesh J Addresses Mailing Principal Office Reg Office Reg Mailing 226 NC 705 Hwy 226 NC 705 Hwy 226 NC 705 Hwy 226 NC 705 Hwy Robbins, NC 27325 Robbins, NC 27325 Robbins, NC 27325 Robbins, NC 27325 Officers Stock Class: Common Shares: 10000 No Par Value: Yes https://www.sosnc.gov/onlineservices/search/Business Registration Results 1/19/2021 SRT: 0.124 sec Help Mobile View cu a) >- , cu LI J Information Search ✓ N O co O co V o cc o 0 >, C 'at) Q O L CI_ Parcel ID Short: 862115526784 z a N co (Y1 N N m • o Deed Book: WHITE, JOSEPH N O E E v (CS(13 o L Z Z c6 O l O • -L -L � a) a) • C C oaJ z 00 D/B/A CITY AUTO PARTS MALABAR DR 27371-9794 LOT 4-4 CN a) N ©2009-2021 Dude Solutions. All Rights Reserved. I Software Notices https://gis.moorecountync.gov/ConnectGl S_v6/Map.aspx?p=Moore_mgd Moore County, NC Page 1 of 2 Summary Full Legal Sales Permits Land Dwellings Additions Sketch OBY Comm Bldg Summary Value/Asmt Attached PP Assets Puhtic Map Home Property Search County Website Contact Us Owner Address Parcel ID Advanced Search Map Search PARID: 00008812 TOWNSHIP: 063 WHITE, JOSEPH Parcel CITYNAME: TROY ParlD / PIN: 00008812 / 862115526784 Record Type: REAL Tax Year: 2021 Tax Jurisdiction: RB : RB Township: 10 : SHEFFIELD Owner Account Number: 91137400 Name: WHITE, JOSEPH D/B/A CITY AUTO PARTS Mailing Address: 131 MALABAR DR TROY NC 27371 9794 Legal Physical Address: 200 S NC 705 HWY Legal Description 1: LOT 1 NAPA Zoning: TBD Plat Cabinet: Slide: Permits 'Permit Date Permit 4 ilPurpose 24-MAR-16 13593 ELECT 22-JUN-15 11286 ELECT 22-JUN-15 11289 EXT REPR Recorded Transaction Date 17-NOV-97 30-JAN-95 01-JAN-82 Description Book 1322 1061 488 /Page 428 473 862 ;Sale Price 0 0 0 NBHD Code / Name: 1013 : Class: CI : COM IMPROVED Land Use: C73 : RETAIL -SINGLE OCC. Living Units: 0 Topography: 1 : LEVEL Location: 2 Parking: 1 : OFF STREET Traffic: Utilities: 1 Restrictions: Deeded Acres: 0 Calculated Acres: .388 VC Notice / VC Date: R : 20-MAR-19 Field Notes Note: ;Number : SO 97000982 1 Valuation Appraised Land: Appraised Building: Appraised Total: 27,040 82,750 109,790 200NC705HWYS NBHD: 1013 1 of 1 ROLL: REAL l Open/Closer) liValidity Code Actions Printable Summary Printable Version Reports Property Record Card Go http://icare.moorecountync.gov/careprd/Datalets/Datalet.aspx:'mode=&UseSearch=no&pin=00008812&ju... 1 /13/2021 t a STATE 0i ROY COOPER NORTH CAROLINA Governor Environmental Quality MICHAEL S. REGAN Secretary MICHAEL SCOTT Director June 29, 2020 Mr. David Lee Cheek Big Cedar Creek Properties, LLC 605 George P Road Robbins, NC 27325 RE: Commercial State Trust Fund Eligibility Application In and Out — Facility ID # 0-0028988 226 South NC Highway 705 Robbins, Moore County, North Carolina Incident # 42273 UST # - FA-8065 Dear Mr. Cheek: This letter is to acknowledge receipt of and respond to your request for eligibility determination for access to the North Carolina Leaking Petroleum Underground Storage Tank Cleanup Funds for the above - referenced property. Review of your application by the Underground Storage Tank (UST) Section of the Division of Waste Management was reviewed and is now complete. Information supplied to the State Trust Fund indicates the following USTs have been associated with the site property: • Three 8,000-gallon gasoline USTs (installed 5/1/1982 and removed 4/6/2020), and • One 3,000-gallon kerosene aboveground storage tank (installed -unknown but in use). A release was discovered as a result UST removal on April 7, 2020. The USTs had been in temporary closure since December 31, 2010. The release was reported to the Fayetteville Regional Office on April 8, 2020 by submittal of UST Form 61. The tanks had been upgraded to meet the required federal corrosion protection, leak detection, and spill/overfill prevention standards at the time of release discovery. A review of the tank operating fees database indicates that all fees were paid prior to the release discovery. The AST on the property is located alongside the building and is physically distant from the former UST area that is the source of the present petroleum release. At the present time, the AST is not a factor in the eligibility determination. If in the future, information becomes available indicating that there has been an NORTH CAROLINA. Department of Enrimnmental Quality North Carolina Department of Environmental Quality I Division of Waste Management 217 West Jones Street 11646 Mail Service Center j Raleigh. North Carolina 27699-1646 919.707.8200 AST release that has comingled with the UST release, the eligibility will be redetermined. Based on the aforementioned information, the release associated with the UST system is conditionally eligible for reimbursement from the Commercial Trust Fund for reasonable and necessary costs incurred for any environmental assessment and cleanup of this site. In order to remain eligible, you must proceed with corrective action, if required, by and in accordance with North Carolina Administrative Code (NCAC) 15A 2L .0115 or 15A NCAC 2L .0106, whichever is applicable. Failure to mitigate the spread of contamination may cause you to be determined ineligible to receive reimbursement from the Commercial Trust Fund. Note, if new information becomes available at a later date which warrants consideration, then the eligibility determination may be reconsidered. In accordance with North Carolina General Statute (N.C.G.S.) 143-215.94B(b)(3), any discharge or release reported on or after January 1, 1994, is subject to a $20,000 deductible if prior to the discharge or release, the commercial UST from which the discharge or release occurred met the performance standards applicable to tanks installed after December 22, 1988 or met the requirements that USTs must meet by December 22, 1998 (i.e., the UST systems were required to be protected from corrosion and have spill and overfill protection equipment installed prior to release discovery). Based on the information available at this time, it appears that the N.C.G.S. 143-215.94B(b)(3) provision for a $20,000 deductible was met. In accordance with N.C.G.S. 143-215.94E, reasonable and necessary costs incurred in the environmental cleanup of this incident may be eligible for reimbursement after incurring an initial deductible of $20,000 per occurrence of these costs. You may be reimbursed for cleanup costs exceeding $20,000 as follows: 100 percent reimbursed for reasonable and necessary costs between $20,000 and $1 million, and 80 percent reimbursed for reasonable and necessary costs between $1 million and $1.5 million The status of your underground storage tank release assessment or remediation efforts may be affected by the statutory requirements of N.C.G.S. 143-215.94E(e5), as revised by Session Law 2005-365. Subsections (e 5)(6) through (e 5)(9) of this statute prohibit the Department from pre -approving any work eligible for reimbursement from the Commercial Underground Storage Tank Trust Fund, unless the Department determines that sufficient funds will be available to pay the claim within 90 days of final claim approval. To meet the requirements of this law, the Department is requiring the following: 1) Per 15A NCAC 2P .0402(b)(9), State Trust Fund preapproval is required for all work for which reimbursement will be requested, with the exception of emergency response actions (applied as per 15A NCAC 2L .0404, Initial Abatement Actions, including mitigation of fire, explosion, and vapor hazards) and assessment activities (applied as per 15A NCAC 2L .0405, Limited Site Assessments). 2) Following the submittal of a Limited Site Assessment Report and associated risk classification (15A NCAC 2L .0406), the Department will use Notice of Regulatory Requirements to direct responsible parties of a release to assess and/or remediate contaminated soil and groundwater according to 15A NCAC 2L .0407 based on the site's risk prioritization classification under N.C.G.S. 143-215.94E(e4). 3) The above referenced requirements, 1 and 2, are for sites with NO previous release(s) or incident(s). Any site with a prior release(s) or incident(s) must obtain pre -approval for all work to be conducted. Per N.C.G.S. 143-215.94E(j) and (k), please note that you have one year from task completion or the date of this eligibility determination, whichever comes later, to submit a reimbursement claim. The claim can only include costs beginning May 4, 2019 (one calendar year prior to eligibility application date of receipt) bTEQ NCRTH C.'J'.OLINA Department of Environmental quay North Carolina Department of Environmental Quality Division of Waste Management 217 West lones Street 11646 Mail Service Center I Raleigh. North Carolina 27699-1646 919.707.8200 or later. If a claim is not submitted within one year of the eligibility determination date or the completion of the task, costs may be denied. The Commercial Leaking Petroleum Underground Storage Tank Cleanup Funds will reimburse costs based on fund availability. Please note that this does not relieve you of any regulatory responsibility. Therefore, you must continue with all required assessment and/or corrective action, unless the site has received a Notice of No Further Action. To obtain the latest information on implementation guidance or updated forms, please visit http //portal.ncclenr_or.g.\_\ebb\\In/tist � idance. Please be aware that this letter does not constitute a final agency decision. Any additional information or comments to rebut this letter may be submitted to my attention at NCDEQ, Division of Waste Management, UST Section, 1646 Mail Service Center, Raleigh, NC 27699-1646. Should you require any further assistance, please do not hesitate to call or fax me at (919) 707-8232 or Mark Petermann at (336) 776-9688. Sincerely, William F. Hunneke Trust Fund Branch Manager UST Section -Division of Waste Management NC Department of Environmental Quality MAP: 42273_In and Out — 226 South NC Highway 705, Robbins, Moore County, NC Cc: Jason Ricks, Pilot Geological, LLC, 743 Park Lawn Ct., Kernersville, NC 27284, email-jricks@pilotenviro.com Fayetteville Regional Office email — james.brown46ncdenr.gov STF DCAPOLINA _E Department of Fnvlronmmtal dual North Carolina Department of Environmental Quality I Division of Waste Management 217 West Jones Street 11646 Mail Service Center 1 Raleigh. North Carolina 27699-1646 919.707.8200 North Carolina Secretary of State Search Results Page 1 of 1 • File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print an Amended a Annual Report form Limited Liability Company Legal Name BIG CEDAR CREEK PROPERTIES, L.L.C. Information Sosld: 1230854 Status: Current -Active D Date Formed: 11/18/2011 Citizenship: Domestic Annual Report Due Date: April 15th Registered Agent: Cheek, David L. Addresses Mailing Principal Office Reg Office Reg Mailing 605 George P. Road 605 George P. Road 605 George P. Road 605 George P. Road Robbins, NC 27325 Robbins, NC 27325 Robbins, NC 27325 Robbins, NC 27325 Company Officials All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20. Manager David L. Cheek 605 George P. Road Robbins NC 27325 https://www.sosnc.gov/online_services/search/Business_ Registration_ Results 1/19/2021