WM0701278_Application_20220705

GO
Geological Resources, Inc.
July 1, 2022
Mr. David May
NCDEQ, Division of Water Quality
Washington Regional Office
946 Washington Square Mail
Washington, North Carolina 27889
Re: Monitoring Well Permit Application
Sligo Citgo
2152 Caratoke Highway
Moyock, Currituck County
Incident No: 38085
GRI Project No: 2954
Dear Mr. May:
HECEIVED/NCDENR/DWP
JUL 0 5 2022
Water Quality
Regional Operations Section
Washington Regional Office
Please find enclosed a monitoring well permit application for the replacement and/or installation of four
Type II monitoring wells at the former Sligo Citgo facility located at 2152 Caratoke Highway in Moyock,
Currituck County. GRI plans on installing the monitoring wells in August/September 2022.
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,
llJ444:
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]

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: July 1, 2022
2.
3.
4.
County: Washington
FOR OFFICE USE ONLY
PERMIT NO. (,(NQ /OI LZ 7t ISSUED DATE
What type of well are y u applying for?,(monitoring or recovery): Monitoring
Applicant: Astro, Inc: 1).-) o f� ( ( Telephone: [phone]
Applicant's Mailing Address: Post Office Box 1386, Ahoskie, NC 27910
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): WIrtQ_geologicalresourcesinc.com
6. Property Owner (if different than Applicant): Randall Richards Telephone: NA
Property Owner's Mailing Address: 108 Richards I ane, Moyock NC 27958
Property Owner's Email Address (if available):
7. Property Physical Address (including zip code) and PIN Number PIN# 8959-96-5352; 2152 Caratoke Highway, Moyock, Curritu
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 38085
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? Yes
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0701244, and others
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)? Yes
If yes, give distance(s): F-310' NE
15. Well Contractor: Justin Radford
Certification No.: 3270
Well Contractor Address: 3502 Hayes Road, Monroe NC 28110
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.
b.
c.
d.
Borehole and well diameter
Estimated well depth
Screen intervals
Sand/gravel pack intervals
e.
f.
9.
Continued on Reverse
Type of casing material and thickness
Grout horizons
Well head completion details
C ji'i

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: 4
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: Aug -Sep 2022
4. Total Number of wells to be constructed: 4 7. Estimated construction completion date: Aucl-Sep 2022
(add answers from 2 and 3)
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
Project Manager
Signature of Applicant or `Agent Title of Applicant or *Agent
William Regenthal, P.G. * 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).
See attached RTE See attached RTE
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]
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]
GW-22MR (Rev. 7/11)

Geological Resources, Inc.
November 12, 2021
Randall L. Richards
106 Richards Lane
Moyock, North Carolina 27958
Re: Right to Enter Agreement
Sligo Citgo
2152 Caratoke Highway
Moyock, North Carolina
Currituck County
Dear Mr. Richards:
Geological Resources, Inc. (GRI), on behalf of Astro, Inc., is conducting an environmental assessment at
the above referenced property located in Currituck County, North Carolina. The assessment activities
are being conducted at the direction of the North Carolina Department of Environmental Quality
(NCDEQ). It is our understanding that you are the owner of the property identified as parcel number
8959-96-5352 in Currituck County. In order to complete the assessment, GRI, in conjunction with
NCDEQ, has determined that it is necessary to install seventeen temporary monitoring points and collect
soil and water samples at your property. Please note, at the request of NCDEQ, a Right to Enter
Agreement is needed in order to complete this scope of work.
A Right to Enter Agreement for Conducting Subsurface Investigations has been enclosed for your review.
At your earliest possible convenience, please sign the agreement and return it in the envelope that has
been provided. GRI will attempt to minimize any inconvenience that the activities may cause. A map
has been attached.
Please check either the right to enter denied or right to enter granted box on the attached agreement.
Your cooperation in this matter is greatly appreciated. Please do not hesitate to contact the
undersigned at [phone] if you have any questions or require additional information.
Sincerely,
William Regenthal, P. G.
Project Manager
Enclosures
3502 Hayes Road • Monroe, North Carolina 28110
Phone [phone] • [phone] • Fax [phone]

RIGHT TO ENTER AGREEMENT
FOR
CONDUCTING SUBSURFACE INVESTIGATIONS
STATE OF NORTH CAROLINA
COUNTY OF CURRITUCK
We, the undersigned, being all of the fee simple owners of certain tracts or parcel designated as 8959-
9E-5352 of the County of CURRITUCK, recognizing the benefits to said properties by reason of
conducting subsurface investigations hereby grant to Astro, Inc. and the agents the right to enter said
property in accordance with the requirements of the State of North Carolina. Astro, Inc.'s agents may
include Geological Resources, Inc.
The undersigned hereby covenant and warrant that they are the sole owners of said property; that they
solely have the right to grant this right to enter for conducting subsurface investigations against the
lawful claims of all persons whomsoever.
It is agreed that Astro, Inc. shall be responsible for restoring any damage done to the ground of said
property by its employees or its agents during the subsurface investigation and monitoring period, and
that Astro, Inc. shall abandon monitoring wells on said property in accordance with NCDEQ
requirements at the conclusion of the monitoring period.
It is agreed that Astro, Inc. shall hold harmless the owner of the aforementioned property for any
personal injury that might be sustained during the course of conducting or proximately resulting from
the conduct of subsurface investigations.
Right to Enter denied.
AI-fkRight to Enter granted.
iewet,letie L /21;04fArevieia,
Signature
phone : 2 s-a -- 3 i Z-% 3
`.- 3 2 2
Date
3502 Hayes Road • Monroe, North Carolina 28110
Phone [phone] • [phone] • Fax [phone]

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