WM0801179_Application_20210827

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 27, 2021
2. County: Brunswick 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: Samet Corporation Telephone: [phone]
Applicant's Mailing Address: 309 Gallimore Dairy Road, Suite 102, Greensboro, NC 27409
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Applicant's Email Address (if available): idrve(c�sametcorp.com
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(cecslimited.com
Property Owner (if different than Applicant): Teresa Holzwarth and James Rogers Telephone: Uknown
Property Owner's Mailing Address: 301 Pierpoint Drive, Wilmington, NC 28405
Property Owner's Email Address (if available): Uknown
Property Physical Address (Including PIN Number) Not Addressed, located east of 1265 Cedar Hill Road — PIN 0240000307
City Navassa County Brunswick County Zip Code 28451
Reason for Well(s): Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility for which the well(s) is(are) needed: Raw land
Are there any current water quality permits or incidents associated with this facility or site? no
Type of contaminants being monitored or recovered: Metals,PCBs, Pesticides, Nitrogen, Phosphorus
Are there any existing wells associated with the proposed well(s)? no
Existing Monitoring or Recovery Well Construction Permit No(s)
NA
Distance from proposed well(s) to nearest known waste or pollution source (in feet): Approximately 200 feet
Are there any water supply wells located less than 500 feet from the proposed well(s)? None Observed
If yes, give distance(s):
Well Contractor: Mid -Atlantic Drilling, Inc. (MAD) Certification No.: 2540-A
Well Contractor Address: 0stewart(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
material: 3
5. How will the well(s) be secured? Same day
abandonment
3. Number of wells to be constructed in bedrock: 0
6. Estimated beginning construction date: September
2021
4. Total Number of wells to be constructed: 3
(add answers from 2 and 3) 7. Estimated construction completion date: September
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.
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
Signature of Applicant or *Agent
Printed name of Applicant or *Agent
Title 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
Phone: [phone]
Winston-Salem Regional Office
2090 U.S. Highway 70
Fax: [phone]
450 W. Hanes Mill Road
Swannanoa, NC 28778
Suite 300
Phone: [phone]
Washington Regional Office
Winston-Salem, NC 27105
Fax: [phone]
943 Washington Square Mall
Phone: [phone]
Washington, NC 27889
Fax: [phone]
Fayetteville Regional Office
Phone: [phone]
225 Green Street, Suite 714
Fax: [phone]
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
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
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"d GW-22MR Rev. 3-1-2016
GW-22M (Rev. 5/11)
GW-22MR (6/11)

August20,2021 ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
ECS SOUTHEAST, LLP
Project Name: Cedar Hill Industrial Development — Phase II ESA
Location: Cedar Hill Road, Navassa, Brunswick County, North Carolina
ECS Southeast, LLP (ECS) has been requested to conduct subsurface groundwater sampling at the site. The
groundwater sampling at the site 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 groundwater sampling. By signing below, property owner authorizes ECS to conduct the
aforementioned groundwater sampling at the site and to obtain the above -referenced permit on behalf
of the owner.
Property Owner (please print):
Property Owner Signatur
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ECS Proposal Nurnber49-261S1-P E F. Se
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- Proposed Groundwater Sample Locations
864 ft
FIGURE 1
PROPOSED GROUNDWATER SAMPLE LOCATIONS
Cedar Hill Road
Navassa, North Carolina
Scale: As Shown `� Brunswick County
ECS Project No. 49-14568-D
M

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