WM0501476_Permit (Issuance)_20220406

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
April 6, 2022
Fountain Investments Realty, LLC (Petitioner for DSCA DC920067)
NCDEQ, DWM, DSCA Program
1646 Main Service Center
Raleigh, N.C. 27699-1646
Subject: Monitoring Well Construction
Permit # WM0501476
Rainbow Dry Cleaners Former
5265 Six Forks Road
Raleigh, NC -Wake County
To Whom It May Concern;
In accordance with the application received on March 16, 2022, and the additional requested information receive
on March 30, 2022, we are forwarding herewith Monitoring Well Construction Permit No. WM0501476 dated April 6,
2022, issued for the construction of a monitor well system (installation of three wells) at the subject property (5241 East Six
Forks & 5307 Six Forks Road). Please be aware that some counties have well construction proerams, and you may be
required to obtain a well construction permit before installation.
This Permit will be effective from the date of its issuance and shall be subject to the conditions and limitations as
specified therein. Please note the addition of stipulation #3 to the permit enclosed.
Sincerely,
—DocuSigned by:
ae,Ekt tar\_4.04.\,
BCDA9D825D4A46D...
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
cc: RRO Files
Wake County Health Department
I. arry _georger� oneatlas.com ATC, 2725 E. Millbrook Road, Raleigh, NC 27604
D.E
North Carolina Department of Environmental Quality 1 Division of Water Resources
512 North Salisbury Street 1 1611 Mail Service Center 1 Raleigh. North Carolina 27699-1611
919.707 9000

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
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
Fountain Investments Realty, LLC (Petitioner for DSCA DC920067)
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM (Rainbow Dry Cleaners Former) consisting of three
wells owned by Fountain Investments Realty (Petitioner for DSCA DC920067) at mailing address at 1646 MSC in Raleigh,
NC. The wells will be located on the property owned by SFR Office, LLC and Wake County Board of Education located
on 5241 East Six Forks Road and 5307 Six Forks Road respectively in Raleigh, NC -Wake County. This Permit is issued in
accordance with the application received on March 16, 2022, and the additional requested information received on March
30, 2022, 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 Resource's
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 Resource's
Information Processing Unit within 30 days of the well abandonment.
7. If the well penetrates any water -bearing zone that contains contaminated waters, the upper three feet of the
well shall be grouted within one day after the casing is set or the well abandoned.
Permit issued the 6th of April 2022
FOR THE NORTH CAROLINA akkowNTAL MANAGEMENT COMMISSION
e�inrrC �t6�i.�a.�a V
Scott mson, Regional Supervisor
Div kilfgWitlWitesources
By Authority of the Environmental Management Commission
Permit No. WM0501476
North Carolina Department of Env,renmental Quality I Division of Water Resources
512 North Salisbury Street 1161 1 Mail Service Center I Raleigh, North Carolina 27699-1611
919.707.9000

Rec 3-/ -ZZ
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: 03/15/2022
2. County: Wake
3.
4.
PERMIT NO.
FOR OFFICE USE ONLY
ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Permanent Monitoring Well
Applicant: Fountain Investments Realtv. LLC (Petitioner for DSCA site # DC920067) Telephone: [phone]
Applicant's Mailing Address: DSCA Proaram, Mail Service Center 1646. Raleigh, NC 27699-1646
Applicant's Email Address (if available): Not Available
5. Contact Person (if different than Applicant): Larry George. ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121. Raleiah, NC 27604
Contact Person's Email Address (if available): larrv.georgeeoneatlas.com
6. Property Owner (if different than Applicant): Wake Countv Board of Education Telephone: [phone]
Property Owner's Mailing Address: CIO WCPSS Real Estate Services. 111 Corning Street. Ste. 100. Cary. NC 27518
Property Owner's Email Address (if available): Not Available
7. Property Physical Address (Including PIN Number) 5307 Six Forks Road (Parcel No. 1706564113)
City Raleigh County Wake Zip Code 27609
8. Reason for Well(s): Groundwater Contamination
(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: Drv-cleaner
(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).
DSCA # DC920067
11. Type of contaminants being monitored or recovered: Div -cleaning Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Five existina monitoring wells
Existing Monitoring or Recovery Well Construction Permit No(s).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 280 feet
14. Are there any water supply wells located Tess than 500 feet from the proposed well(s)? No
If yes, give distance(s): Not Applicable
15. Well Contractor: Innovative Environmental Technologies. Inc
Certification No.: 2725
Well Contractor Address: 232 Highway 49 South. Concord NC 28025 980-781-0008
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
matenal: 2
5. How will the well(s) be secured? Locking well cap,
flush -mount steel protective casing
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 04/11/2022
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 04/15/2022
(add answers from 2 and 3)
1.
ADDITIONAL INFORMATION
As required by 15A NCAC 02C .0105(0(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 bonngs 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,
Subchapter 2C) and accepts full responsibility for compliance with these rules
2hi
Signature of Applicant or *Agent
Larry George
Printed name of Applicant or "Agent
Agent for Petitioner for DSCA site DC920067 (Will include
Power of Attorney upon request)
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 access agreement
Signature of Property Owner (if different than Applicant)
See attached access agreement
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: [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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ROY COOPER NORTH ▪ C• A▪ ROLINA
Governor Envfrvnmenfal Qualify
MICHAEL S. REGAN
Semi°sy
MICHAEL SCOTT
Director
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval.
If you have questions on how to fill out this form or about the activities
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program 's contractor for this project, Larry George with ATC
Associates of North Carolina, P.C. (ATC) at Iarrv.georgetiatcgs.com
or [phone]. If you still have questions after contacting Mr. George with
ATC, please contact the DSCA project manager, Sue Murphy at
[e-mail] or 919-707-8354.
For DSCA Use Only
DSCA ID No.
DC926067
Please Print
The Wake County Board of Education
(Name of Property Owner or Tenant in Residence)
5307 Six Forks Road (Green Elementary School, Parcel No.1706564113)
(Street Number and Street Name of Property)
Raleigh / Wake County / 27609
(City or Town in Which Property is Located) / (County in Which Property is Located) / (Zip Code)
1 voluntarily consent to the Division of Waste Management (Division) and its independent
contractors (contractors) (collectively referred to herein as the "Parties") entering and having
continued access to my property for the following purposes:
(1) taking such soil, groundwater and/or air samples as may be necessary;
(2) taking other actions related to the investigation of surface or subsurface conditions;
(3) taking response actions necessary to mitigate any threat to human health or the environment.
Other conditions:
(1) The Division and its contractors shall attempt to perform any activities at the Property in a
manner that minimizes interference with use of the Property.
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(2) On conclusion of all activities, the Division and its contractors shall, to the extent practicable,
restore the Property to the original condition it was in prior to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance
with applicable laws and regulations, unless other arrangements are agreed to by the Property
Owner.
(3) The Division or its contractors will make reasonable attempts to notify the Property Owner at
least 48 hours prior to entering the Property for any purpose. In situations that the Division
determines to be of an emergency nature, the Division or its contractors shall have immediate
access to the property.
(4) Property Owner shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without prior consent of the Division.
Special Conditions Specific to this Consent: The following special conditions specific to this
Property Access Consent are incorporated into this Properly Access Consent due to the unique
nature ofthe Property:
1. Grant of License — Property Owner hereby grants to the Division, and its employees,
representatives and/or contractors an irrevocable, non-exclusive right to enter upon the
Property from time to time to install, monitor and maintain an observation well monitoring
station, conduct various environmental investigations and/or remediation activities, Including,
but not limited to, periodic monitoring sampling, maintenance of two (2) installed
groundwater wells, as shown on the site plan labeled as Exhibit "4," attached hereto and
incorporated herein, and eventual proper well abandonment in accordance with the federal,
state and/or municipal protocols and removal of the observation and well monitoring station .
For purposes of this access consent, "observation and well monitoring station" includes all
installed equipment and structures used in the operation and maintenance of the monitoring
site.
2. Property Access — Whenever possible, vehicle access shall be aver existing driveways to the
visitor parking area, and parking shall be in identified areas marked as visitor parking areas
as is necessary to accommodate the installation, monitoring and maintenance of the well
monitoring station, In the event that the activities for which this access consent is granted
necessitate vehicle access other than that which is described herein, the Division shall obtain
Property Owner's prior consent prior to deviating from this condition.
3. Equipment Installation — Whenever reasonably possible, the Division or its contractors will
install, monitor and maintain equipment aver normal school hours, otherwise noted as non -
school hours. Normal school hours are defined as daily student and teacher workdays from 7
a.m. - 6 p.m. Non -school hours are defined as time periods when the Board determines in its
sole discretion that students are not scheduled to attend classes or school activities, as well as
weekends, holidays, staff vacation days, and during school breaks when no students are
scheduled to attend classes.
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4. Term. This access consent shall commence on June 1, 2021 (Effective Date), and shall end on
May 31, 2024, unless the Parties agree in writing to extend the term. lithe Division is required
by a government agency to maintain a well or other equipment on the Property beyond the
term set forth herein, then the access consent may be extended until thirty (30) days after such
requirement ceases upon written agreement by the Parties.
5. Policies - The Division agrees that use of the Property shall be in accordance with the
following conditions and provisions:
(a) The Superintendent of the Wake County Public School System or designee shall
always have administrative control of all areas of Board Property.
(b) Division will comply with all City ordinances provided that a copy of all such City
ordinances are provided to the Division prior to the commencement of the Work
(c) Applicable Wake County Board of Education Policies. The Division acknowledges
that the Wake County Board of Education has adopted policies governing its
relationship with vendors and conduct on School System property and agrees to abide
by any and all relevant WCPSS policies during the term of the Property Access Consent
and while on School System properly. WCPSS's related polices can be viewed at
hlips://www.wcptss.nel/Page/45862 and are incorporated into this Property Access Consent by
reference.
6. Comnllance with Laws and Permits -The Division acknowledges that it shall be the
responsibility of the Division and the Division's contractors to conduct all operations which
are the subject of this access consent in compliance with all federal, state, and municipal
statutes and ordinances, and with all regulations, orders, and directives of appropriate
governmental agencies, as such statutes, ordinances, regulations, orders and directives now
exist or provide, as well as to obtain any and all governmental permits and approvals which
may be necessary for the work to be conducted under this access consent. Property Owner
shall not be responsible for any failure by the Division or the Division's contractors to comply
with this requirement.
7. Liens and Claims The Division will not permit any mechanics, materialmen's, or similar
liens or claims to stand against the Property for labor or material furnished in connection with
any work performed by the Division under this Property Access Consent . Upon reasonable
and timely notice of any such lien or claim delivered to the Division by Property Owner, the
Division may bond and contest the validity and the amount of such lien, but the Division will
immediately pay any judgment rendered, will pay all proper costs and charges, and will have
the lien or claim released at its sole expense.
8. Cooneration —The Division agrees to coordinate its activities with Property Owner to minimize
any impairment of access by customers or business invitees of Property Owner to the Property
and any inconvenience to or disruption of Property Owner's business on the Property.
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9. Lunsford Act - The Division also acknowledges that G.S. § 14-208.18 prohibits anyone
required to register as a sex offender under Article 27,4 of Chapter 14 of the General Statutes
from knowingly being on the premises of any school. The Division shall conduct or arrange
to have conducted, at its own expense, sexual offender registry checks on each of its owners,
employees, agents and subcontractors ("contractual personnel') who will engage in any
service on or delivery of goods to the Property Owner's property or at a Property Owner
sponsored event, except checks shall not be required for individuals who are solely delivering
or picking up equipment, materials, or supplies at; (1) the administrative office or loading
dock of a school; (2) non -school sites; (3) schools closed for renovation; or (4) school
construction sites The checks shall include, at a minimum, checks of the State Sex Offender
and Public Protection Registration Program, the State Sexually Violent Predator Registration
Program, and the National Sex Offender Registry ("the Registries'). For the Division 's
convenience only, all of the required registry checks may be completed at no cost by accessing
the United States Department of Justice Sex Offender Public Website
at http://www.nsopw.gov/. The Division shall provide certification on the Sexual Offender
Registry Check Certification Form (Attachment A) that the registry checks were conducted on
each of its contractual personnel providing services or delivering goods under this Property
Access Consent prior to the commencement ofsuch services or the delivery ofsuch goods. The
Division shall conduct a current initial check of the registries. The sex offender registry checks
shall be conducted within 30 days of the Division execution of the Property Access Consent
and prior to performing any services on the Property Owner's property. In addition, the
Division agrees to conduct the registry checks and provide a supplemental certification form
before any additional contractual personnel are used to deliver goods or provide services
pursuant to this Property Access Consent. The Division further agrees to conduct annual
registry checks of all contractual personnel and provide annual certifications at each
anniversary date of this Property Access Consent. The Division shall not assign any individual
to deliver goods or provide services pursuant to this Property Access Consent ifsaid individual
appears on any of the listed registries. The Division agrees that it will maintain all records
and documents necessary to demonstrate that it has conducted a thorough check of the
registries as to each contractual personnel and agrees to provide such records and documents
to the Property Owner upon request. The Division specifically acknowledges that the Property
Owner retains the right to audit these records to ensure compliance with this section at any
time in the Property Owner's sole discretion. Failure to comply with the terms of this provision
shall be deemed a material breach of the Property Access Consent.
10. Well Abandonment - Prior to the expiration of the access consent, the Division shall, at no
cost to Property Owner, ensure proper well abandonment in accordance with the state and/or
municipal protocols, and in addition thereto shall (a) cause any excavations to be returned to
the original gradient, (b) remove all equipment placed on the Property, (c) fill and level all
ditches, ruts and depressions, if any, caused by the closure of the Division's excavation
operations on the Property and (d) remove all debris resulting therefrom.
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Insurance — Division is an Executive Agency of the State of North Carolina subject to the North
Carolina Torts Claims Act ("Tort Claims Act "), N.C.G.S. Article 31, section 143-291 et seq. The
statutory liability limit under the Tort Claims Act Is $1,000,000. Workers' compensation
coverage is provided by the State under the North Carolina Workers' Compensation Act
("Workers' Compensation Act' ), N.C.G.S. Ch. 97, section 97-1 et seq. for all Stale employees
participating under this Agreement. The Torts Claims Act and Workers' Compensation Act are
administered by the North Carolina Industrial Commission. Both parties hereby acknowledge
that Program's contractor for this project, ATC Associates of North Carolina, P.C. (Provider')
has separately agreed to maintain $1,000,000 in general liability, $1,000,000 in automobile
liability, and other appropriate insurance, as well as Workers Compensation in the required
statutory amount, for all employees participating in the provision of services under this
Contract. The Property Owner, Per that Agreement, Wake County Board of Education, shall be
named by endorsement as additional insureds on the General Liability policy. Provider has
further agreed to provide a policy endorsement requiring the Property Owner to receive thirty
(30) days prior written notice of cancellation for any statutorily permitted reason other than
non-payment of premium. In addition, Provider has agreed to provide at least five (5) business
days written prior notice to the Property Owner's Representative at the address noted below gig
via email (" i»suller(Jwcpss.n 1 ") of the cancellation, non -renewal (without replacement), or the
material reduction of coverage or limits of any of the policies. Upon notice of such cancellation,
nonrenewal or reduction, the Provider has agreed to procure substitute insurance so as to
assure the Property Owner that the minimum limits of coverage are maintained continuously
throughout the period of this Agreement. Prior to commencement of work under this Agreement,
a certificate of insurance documenting that such insurance has been procured shall be furnished
to the Property Owner. The Division shall not be liable for the Contractors failure to maintain
such insurance, however, failure by the Contractors to maintain the insurance described herein
throughout the duration of activities onsite shall be grounds for immediate termination of this
access consent.
11. Notice Prior to Remediation/Wel Abandonment -The Division agrees to provide 30 days
written notice prior to commencement of invasive remediation and/or well abandonment
activities and to coordinate schedule of said activities for a date and time that is mutually
agreeable to the Parties and is not disruptive to school functions on the Property.
12. Conditionf for Access The Division agrees for itself, its successors, assigns and contractual
personnel to display personal identification badges to identify their employment/employer and
to sign in and out of the administrative office located at the Property during each visit to the
Property.
13. Severablllty - In case any one or more of the provisions contained in this access consent shall
be invalid, illegal or unenforceable in any respect, the validity, legality, and enforceability of
the remaining provisions contained herein shall not in any way be affected or impaired
thereby.
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14. Notlees - Any notice provided for herein or otherwise required to be given hereunder shall be
deemed received when personally served or three (3) days after mailing by certified or
registered United States mail, return receipt requested, postage prepaid, or by facsimile
machine, with transmission and receipt confirmed, or by nationally recognized overnight
delivery service, addressed as follows:
To Property Owner:
With Copies to:
To Division:
The Wake County Board of Education
5625 Dillard Drive, Cary, NC 27518
Attention: Real Estate Services Sr. Director
Telephone: [phone]
Howard, Stallings, From, Atkins, Angell & Davis, P.A.
Attention: Kenneth C. Haywood
5410 Trinity Road, Suite 210
Raleigh, NC 27607
NCDEQ/DIVJS!ON OF WASTE MANAGEMENT
DSCA PROGRAM
Attention: Billy Meyer
217 West Jones Street
1646 Mail Service Center
Raleigh, NC 27699-1646
Telephone: [phone]
The person and the place to which notices are to be mailed may be changed by either party by
providing written notice of same to the other.
15. i4, gn►nent - This access consent may not be assigned by any Party without the prior written
consent of the non -assigning Party, which consent shall not be unreasonably withheld. No
notice shall be required if Property Owner assigns this access consent to Wake County.
16. ChanRe In Ownership — Property Owner shall notify the Division of any change in Property
ownership within thirty (30) days of the close of Property's escrow or the recordation of a
deed indicating Property Owner has transferred the Property to another person(s) or
entity(ies) by providing the Division at a minimum, the new Property owner's name and
contact information, No notice shall be required if Property Owner conveys the property to
Wake County. Should Property Owner fail to notfy the Division of Property Owner's transfer
of the Property, Property Owner agrees to indemni,fr the Division for any cause of action
asserted against the Division for trespass to the Property.
17. OoverninR Law - This access consent shall be construed and interpreted and governed by and
in accordance with the local law of the State of North Carolina without reference to any choice
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of law, rules or policies which may refer the resolution of any dispute arising hereunder to the
laws of any other jurisdiction.
18. Execution of Property Access Consent - Each of the undersigned hereby represents and
warrants that they are authorized to execute this access consent on behalf of the respective
Parties to the access consent, and that this access consent, when executed by those Parties,
shall become a valid and binding obligation, enforceable in accordance with its terms. Upon
execution, this access consent shall be binding as to the Parties' respective parent companies,
subsidiaries, affiliates, successors, heirs and assigns.
19. Counterparts - This access consent may be executed in one or more counterparts, each of
which shall be deemed an original, and all of which, taken together, shall constitute one and
the same access consent.
By signing this consent document, I acknowledge that I am the legal property owner or tenant
in residence that has the authority to allow this work on the property and have contacted all
tenants (if there are tenants) occupying the property and all tenants agree to the conditions
of this "Property Access Consent".
Property Owner: The Wake County Board of Editcalion
By• •
�Attested By:
Keith A. Sutton, Chair Cathy Cj M re, Secretary
(Date)
(Email Address for Property Owner: or Tenant in Residence if you prefer to be contacted
via email)
P Special Remedlellon Branch Head
9/27121
(Signature ofNCDEQ/DIVISION OF WASTE MANAGEMENT)
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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: 03/15/2022
2. County: Wake
PERMIT NO.
FOR OFFICE USE ONLY
ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Permanent Monitoring Well
4. Applicant: Fountain Investments Realty. LLC (Petitioner for DSCA site # DC920067) Telephone: [phone]
Applicant's Mailing Address: DSCA Program. Mail Service Center 1646. Raleigh, NC 27699-1646
Applicant's Email Address (if available): Not Available
5. Contact Person (if different than Applicant): Larry George. ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road. Suite 121. Raleigh. NC 27604
Contact Person's Email Address (if available): Iam.aeorgeaoneatlas.com
6. Property Owner (if different than Applicant): SFR Office. LLC Telephone: [phone]
Property Owner's Mailing Address: PO Box 31763, Raleigh, NC 27612
Property Owner's Email Address (if available): andv6 novacap.net
7. Property Physical Address (Including PIN Number) 5241 East Six Forks Road (PIN: 1706556494)
City Raleigh County Wake Zip Code 27609
8. Reason for Well(s): Groundwater Contamination
(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: Dry-cleaner
(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).
DSCA # DC920067
11. Type of contaminants being monitored or recovered: Dry-cleaning Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Five existing monitorino wells
Existing Monitoring or Recovery Well Construction Permit No(s).: Not Applicable
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 200 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): Not Applicable
15. Well Contractor: innovative Environmental Technologies. Inc.
Certification No.: 2725
Well Contractor Address: 232 Highway 49 South, Concord NC 28025 980-781-0008
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .01050)(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- 1
5 How will the well(s) be secured? Locking well cap,
Stick-up with steel protective casino
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 04/11/2022
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 04/15/2022
(add answers from 2 and 3)
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 .s 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
r ( ✓..uw-L<
Signature of Applicant or *Agent
Lam George
Printed name of Applicant or *Agent
Agent for Petitioner for DSCA site DC920067 (Will include
Power of Attorney upon request)
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 access agreement
Signature of Property Owner (if different than Applicant)
See attached access agreement
Pnnted 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: [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]
GW-22MR Rev. 3-1-2016
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
"I Suite 300
Winston-Salem, NC 27105
hone: [phone]
x: [phone]

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
NORTH CAROLINA
Environmental Quality
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval.
If you have questions on how to fill out this form or about the activities
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program 's contractor for this project, Larry George with ATC
Associates of North Carolina, P.C. at Larry. Georeategs.ccm or
[phone]. If you still have questions after contacting Mr. George
with ATC, please contact the DSCA project manager, Sue Murphy at
53111urphrCu;ncdenr. or or [phone].
Please Print
SFR Office, LLC
(Name of Property Owner or Tenant in Residence)
For DSCA Use Only
DSCA Site ID
DC920067
5241 E Six Forks Road (PIN #1706556494)
(Street Number and Street Name of Property)
Raleigh
Wake 27609
(City or Town in Which Property Is Located) / (County in Which Property is Located) / (Zip Code)
I voluntarily consent to the Division of Waste Management (Division) and its independent
contractors (contractors) entering and having continued access to my property for the following
purposes:
(1) taking such soil, groundwater and/or air samples as may be necessary;
(2) taking other actions related to the investigation of surface or subsurface conditions;
(3) taking response actions necessary to mitigate any threat to human health or the environment.
Other conditions:
(1) The Division and its contractors shall attempt to perform any activities at the Property in a
manner that minimizes interference with use of the Property.
North Carolina Department of rnsironnxruaIQua4ty Dhislon of Waste Management
217 West tones Srm1 1646Smite Center. Raleigh. North Carolina 27604 1646
014.707E200

(2) On conclusion of all activities, the Division and its contractors shall, to the extent practicable,
restore the Property to the original condition it was in prior to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance
with applicable laws and regulations, unless other arrangements are agreed to by the Property
Owner.
(3) The Division or its contractors will make reasonable attempts to notify the Property Owner at
least 48 hours prior to entering the Property for any purpose. In situations that the Division
determines to be of an emergency nature, the Division or its contractors shall have immediate
access to the property.
(4) Property Owner shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without prior consent of the Division.
By signing this consent document, I acknowledge that I am the legal property owner or tenant
in residence that has the authority to allow this work on the property and have contacted all
tenants (if there are tenants) occupying the property and all tenants agree to the conditions
of this "Property Access Consent".
(Sign
•
April 30, 2021
rope;- Owner or Tenant in Residence) (Date)
919.819.0614
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
[e-mail]
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Larry George
ATC Associates of North Carolina, P.C.
2725 East Milibrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
3:1EQ
North Carolina Department of CnvIrorvnenta1 Quality ; Division of Waste Management
ZIT West Jones Street • 1646 Mail Service Center Raleigth North Carolina 27699 1646
919.7028200

TYPICAL TYPE II MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
NOT TO SCALE
LOCKABLE WELL CAPS
L1
L4
L2
L3
LI = 0.5 FT.
L2 = 26 FT.
L3 = 15 FT.
L4 = 40 FT.
4/4
7,4
O
TITLE Permanent Monitoring Well Diagram
(Example of typical MW Installation displayed above)
Rainbow Cleaners
5265/5275 East Six Forks Road
Raleigh, Wake County, North Carolina
PROTECTIVE CASING AND CONCRETE PAD
CASING MATERIAL
CASING DIAMETER
CASING LENGTH
PAD DIMENSIONS
HEIGHT ABOVE GROUND
WELL CASING
MATERIAL
DIAMETER
JOINT TYPE
LENGTH
BACKFILL AROUND CASING
MATERIAL
THICKNESS
SEAL
TYPE OF SEAL
THICKNESS
FILTER PACK
TYPE OF FILTER
DISTANCE ABOVE SCREEN
WELL SCREEN
SCREEN MATERIAL
DIAMETER
LENGTH
SLOT SIZE
DEPTH TO BOTTOM OF
MONITORING WELL
DEPTH TO BOTTOM OF
BOREHOLE
DIAMETER OF BOREHOLE
Steel
8 inches
2.5 feet
2 feet x 2 feet
3 feet
sch 40 PVC
2 inches
flush threaded
25 feet
cement -sand grout
21 feet
bentonite
2'
#2 silica sand
2'
sch 40 PVC
2 inches
15 feet
0.010 inches
40.0 feet
40.0 feet
8.75 inches
2725 East Millbrook Road, Suite 121
Raleigh, North Carolina 27604
FILE
PREP. BY REV. BY
SL LG
DATE
2/28/2022
PROJECT NO.
DC9267SL02

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1
500' RADIUS MAP
RAINBOW CLEANERS
5265 AND 5275 SIX FORKS ROAD
RALEIGH, NORTH CAROLINA
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