WM0601165_Monitoring Wells_20201204

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
Mr. Eugene B. McLaurin, President
Quality Oil Company
203 W. Broad Avenue
Rockingham, North Carolina 28379-3529
NORTH CAROLINA
Environmental Quality
December 4, 2020
SUBJECT: Well Construction Permit No. WM0601165
Three (3) monitoring wells: Quality Oil Company/Z.V. Pate site
4660 Main Street (P.I.N. #: 040170 - 01001)
Gibson, Scotland County
Mr. McLaurin;
In accordance with the application prepared by Geological Resources Incorporated dated 3 December 2020 and
received in the Fayetteville Regional Office on 4 December 2020, we are forwarding herewith Well
Construction Permit No. WM0601165 dated 4 December 2020 issued to Quality Oil Company for the
construction of three (3) monitoring wells located on property owned by Z.V. Pate Incorporated (P.I.N. #:
040170 - 01001) in Gibson, 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.
S incerely,
—DocuSignedby:�,�
TEtA44egional Supervisor
Division of Water Resources — Water Quality Programs
Enclosure
cc: FRO Files Scotland County Health Department
Z.V. Pate Inc. Geological Resources, Incorporated
NORTH CARCI NA 1.
Department of Environmental Qvatity,4
North Carolina Department of Environmental Quality 1 Division of Water Resources
Fayetteville Regional Office 1 225 Green Street, Suite 7141 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
QUALITY OIL COMPANY
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of three (3) monitoring
wells owned by Quality Oil Company located at 203 W. Broad Avenue, Rockingham, North Carolina. The
monitoring wells will be located on property owned by Z.V. Pate Incorporated at 4660 Main Street (P.I.N.
#: 040170 - 01001) in Gibson, Scotland County, North Carolina. This Permit is issued in accordance with
the application received on 4 December 2020 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 4th day of December 2020
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
DocuSigned by:
•n mAk.
Trent Affefii,819tfeftBSupervisor
Division of Water Resources — Water Quality Programs
By Authority of the Environmental Management Commission
Permit No. # WM0601165

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER QUALITY - AQUIFER PROTECTION SECTION
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: December 3, 2020
2. County: Scotland
FOR OFFICE USE ONLY
PERMIT NO. 01 O On 6, ISSUED DATE /2- kibb
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Quality Oil & Gas
Telephone:
910-997-3101
Applicant's Mailing Address: Post Office Box 203 W Broad Ave, Rockingham, NC 28379-3529
Applicant's Email Address (if available): NA
5, Contact Person (if different than Applicant): William Regenthal
Telephone: [phone]
Contact Person's Mailing Address: 113 W. Firetower Road, Suite G, Winterville NC 28590
Contact Person's Email Address (if available): Wirgeologicalresourcesinc.com
6. Property Owner (if different than Applicant): 7V Pate, Inc. Telephone: [phone]
Property Owner's Mailing Address: Post Office Rnx l_C),1....s.i.r44,11rdl\IC 28351
Property Owner's Email Address (if available): NA PiLL,
IgeGO
7, Property Physical Address (including zip code) and PIN Number PIN# 04017001001; fir6517 Main St.. Gibson, Scotland County
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: 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).
UST Incident 47392
11. Type of contaminants being monitored or recovered: Petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? NA
Existing Monitoring or Recovery Well Construction Permit No(s),: NA
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0 '
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Unknown
If yes, give distance(s): NA
15. Well Contractor: Justin Radford Certification No.: 3270
Well Contractor Address: 3502 Hayes Road, Monroe NC 28110
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? Locking cap
material: 3
1
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: Dec- 2020
J
4. Total Number of wells to be constructed: 3 7. Estimated construction completion date:t.).an.2Q2.0
(add answers from 2 and 3)
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. Al! 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. 143-215.108(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
Signature of Applicant or *Agent
William Regenthal, P. G.
Printed name of Applicant or *Agent
Project Manager
Title of Applicant or *Agent
if signing as Agent, attach authorization agreement stating
that you have the authority to act as the Acient,
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
w 11(s) conform o the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
/4„2.,44 4._6",'•-: /...-2--
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 Quality's Aquifer Protection Section 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]
\Anniston
r--
Y
‘1, S OV(iie Koorasv 10.
t >t,
1
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: [phone]
y ttd rs
\ I—Whnen
Nt'
GW-22MR (Rev. 7/11)

4660 Main St
4660 Main St,
Gibs on,NP-?8 4
- Proposed Type 1I Monitoring Well
Map data ©2020, Map data ©2020 20 ft

GIS
Overview Map
Quick Search
leaf
Lat Lon
Address Search
4660 Main Street
Parcel Number
Owner Name (Parcels)
Subdivision Name
Full Address
Streets/Roads
Hydrant ID
County Cemetery Sites
Last Name Owner (Cemetery)
Last Name Deceased (Cemetery)
Advanced Search
Search Builder
Coordinate Search
Comparable Search
Excel 2000/2003
Address Score
1 .... 4660 MAIN 89
2 ,r 4660 S MAIN 80
1:464
Feet
** No Water Supply Wells were observed during the UST closure activities.
.r 2009 2020 Dude Solutions. All Rights Reserved. 15ottware Notices

Type IF Monitoring Well
TypIc : t Construction befalls _
concrete pad -.
ground surface
grout cement
-4'
bentonite seal
4' - 18'
• sand filter pack
f
PI
•
manhole cover
0' - 5'
• 1
'- 18'
18'
locking wall cep
2 Inch dlametcr"
schedule 40 PVC casing
O.010 Inch slotted 2lnoh diKme ter
schedule 40 PVC screen
end ox fs

Geological Resources, Inc.
December 4, 2020
Mr. Trent Allen
NCDEQ Division of Water Quality
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, North Carolina 28301
Re: Monitoring Well Permit Application
Mumford's Service Center
4660 Main Street
Gibson, Scotland County
Incident No: 47392
GRI Project No: 5486
Dear Mr. Allen:
Please find enclosed a monitoring well permit application for the installation of three Type II monitoring
wells at the Mumford's Service Center facility located at 4660 Main Street, in Gibson, Scotland County.
GRI plans on installing the monitoring wells immediately upon receipt of the approved well permit.
Your prompt attention to this matter will be greatly appreciated. If you have any questions or require
additional information please do not hesitate to contact me at [phone].
Sincerely,
William Regenthal, P. G.
Project Manager
enclosures
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

Barber, Jim
From: VViUiamRegenthal xw|rDgeo|ogica|resourcesinc.00m>
Sent: Friday, December 4,ZO2OZ:57PM
To: Barber, Jim; Tomie Benton
Subject: RE: [6terna|]Well Permit Question
Attachments: Mumford's Well Permit Application - Signed.pdf
CAUTION: External email. Do not click links oropen attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Mr. Barber,
Attached is the well permit application for Mumford's Service [enter. Please let me know if you have any questions.
VViUiann Rcgentha|, P. G.
Branch Operations Manager 'WintemiUe
Geological ^ U �� Inc.��8���o��8������o xv�����K�������» n
113 W. Firetowver Road, Suite G, VVintervU|c, NC 20590
Main (7O4)84S'4OlO Office (7O4)G98-I2SS Fax (7O4)84S'4Ol2
Yv|r@QgP|ogigal{esgurceskIc.coIm
vvmmv.gem|oWima|resourcesinc.corn
Fronn:Barber,]inn[mai|[e-mail]
Sent: Friday, December 4,2OZ011:ZOAM
To: William Regentha| <vv|r@geo|ogica{resourcesinc.com>;Tornie Benton<tmb@geo|ogica|resourcesinc.com>
Subject: RE: [Externa|]Well Permit Question
William;
If you can get me an application today, |'U work on getting a permit number and email you the number so you can move
forward with work. It will get signed early next week and | can email to Geological Resources and hard copies will be in
the mail.
Jim Barber
Environmental Engineer
N[DE[-DVVR'VV[lRO
Fayetteville Regional Office
910'433-3340voice
9I0-486'0707fax
i�r7.ba[berVancdenr.goy
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
�GoGreen! Print this email only when necessary. Thank you for helping N[OENRbeenvironmentally responsible
From: William Regentha| knaUto:w|rV�egk��k�|���ur��in czgIm]
Sent: Friday, December 4,ZOZOQ:l7AM
z

ThnnectGlS
Page 1 of 1
Overview Map
Quick Search
Advanced Search
Search Builder
Coordinate Search
Google Maps or Bing Maps
Lat/Lon
Lat 34.759186
Lon -79.608436
Local Coordinates
X 1,817,256.533
Y 367,835.903
Clear
US National Grid
17S PU 27357 47217
Comparable Search
Excel 2000/2003
Results
1 : 300
Display Labels _
U2009-2020 Dude Solutions. All Rights Reserved. I Software Notices
Welcome Guest
Help Mobile View
Feet
Layers
Information
Parcels
Property Record
Card
Deed
Parcel Number:
Users Online: 1165
SRT: 0.339 sec
040170 01001
No Tax Record Match:
Owner Name (Parcels):
PATE Z V INC (GIBSON)
Spouse / Mail Address 1:
Mail Address 2:
Legal Description:
WAREHSE #1350,51,27,33,25
LegalLandU: 11
GIS Data Acres: 10.058
Mail City: LAUREL HILL
Mail State: NC
Mail Zip: 283510000
Land Value: 0
Building Value: 557090
Deferred Value: 0
Elderly Exemption:
Deed Book:
Legend
Display 50 Results
lttps://laurinburg.connectgis.com/Map.aspx
12/4/2020

North Carolina Secretary of State Search Results Page 1 of 2
• 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
Quality Oil Company
Information
Sosld: 0119145
Status: Current -Active 0
Date Formed: 12/4/1945
Citizenship: Domestic
Fiscal Month: May
Annual Report Due Date: September 15th
CurrentAnnual Report Status:
Registered Agent: Fulton, S Hewitt, III
Addresses
Mailing Principal Office Reg Office
203 W Broad Ave 203 W Broad Ave 9120 Morgan Street
Rockingham, NC 28379-3529 Rockingham, NC 28379-3529 Laurel Hill, NC 28351
Reg Mailing
9120 Morgan Street
Laurel Hill, NC 28351
Officers
Secretary
Jimmy McDonald
203 West Broad Ave
Rockingham NC 28379
Stock
President
Eugene B McLaurin
203 W Broad Ave
Rockingham NC 28379
Treasurer
Bradley M. Williams
9120 Morgan Street
Laurel Hill NC 28351
Vice President
Marvin Womble
203 West Broad Ave
Rockingham NC 28379
https://www. sosnc . gov/online_services/search/Business_Registration_Results
12/4/2020

North Carolina Secretary of State Search Results Page 1 of 2
• 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
Z. V. Pate, Incorporated
Information
Sosld: 0111035
Status: Current -Active 0
Date Formed: 7/6/1935
Citizenship: Domestic
Fiscal Month: December
Annual Report Due Date: April 15th
Registered Agent: Fulton, S Hewitt, III
Addresses
Principal Office
9120 Morgan Street
Laurel Hill, NC 28351
Officers
President
S. Hewitt Fulton , III
P.O. Box 159
Laurel Hill NC 28351
Stock
Reg Office
9120 Morgan Street
Reg Mailing
P.O. Box 159
Laurel Hill, NC 28351 Laurel Hill, NC 28351
Vice President
H Allen McLaurin
PO Box 159
Laurel Hill NC 28351
Secretary
Nancy Peele Paul
PO Box 159
Laurel Hill NC 28351
Mailing
PO Box 159
Laurel Hill, NC 28351
Treasurer
Bradley Williams
PO Box 159
Laurel Hill NC 28351
https://www.sosnc.gov/onlineservices/search/Business_Registration_Results
12/3/2020