WM0501500_Permit (Issuance)_20220822

ROY COOPER.
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS,JR.
Director
NORTH CAROLINA
Environmental Quality
August 22, 2022
NCDEQ, DWM, State Lead (Mark Peterman- [e-mail])
1646 MSC
Raleigh, NC 27699-1646
Subject: Monitoring Well Construction
Permit # WM0501500
Dave's Grocery
3314 Poole Road
Raleigh, NC -Wake County
To Whom It May Concern:
In accordance with the application received on July 20, 2022, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501500 dated August 4, 2022, issued for the construction
of a monitor well system at the subject property. Please be aware that some counties have well
construction programs, 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. If you have
any questions about this permit, please contact Eric Rice at [phone].
Sincerely,
(—DocuSigned by:
Sctff VRAMVt,
BCDA9D825D4A46D...
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
cc: RRO Files/Laserfiche
Wake County Health Department
Email emily,fuller(a oneatlas,com ATC, 2725 E. Millbrook Road, Raleigh, NC 27604
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1611 Mail Service Center I 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
NCDEQ, DWM, State Lead
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM (Dave's Grocery) consisting of two monitoring well
owned by NCDEQ, DWM, State Lead at 1646 MSC Raleigh, NC. The wells will be located on the property owned by
House Boney, LLC at 3308 Poole Road in Raleigh, NC- Wake County. This Permit is issued in accordance with the
application received on July 20, 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 Quality'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 Quality'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 4th of August 2022
FOR THE NORTH CAROLINA liellagifielAbEMANAGEMENT COMMISSION
Scott ins • n, " egional Supervisor
Divi ' i SttPf tF D...
By Authority of the Environmental Management Commission
Permit No. WM0501500
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11611 Mail Service Center I Raleigh, North Carolina 27699-1611
919.707 9000

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
Ilk
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: 7/20/2022
2. County: Wake
3.
4. Applicant:
FOR OFFICE USE ONLY
PERMIT NO. I DS'OlSck) ISSUED DATE
What type of well are you applying for? (monitoring or recovery):
Mark Petermann — NCDEQ State Lead
Monitoring Well
Telephone: [phone]
Applicant's Mailing Address: 1646 Mail Service Center, Raleigh. NC 27699
Applicant's Email Address (if available): mark.aetermannencdenr.aov
5. Contact Person (if different than Applicant): Emily Fuller
Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121. Raleigh, NC 27604
Contact Person's Email Address (if available): emilv.fullereoneatlas.com
6. Property Owner (if different than Applicant): House Bonev, LLC Telephone: [phone]
Property Owner's Mailing Address: 4441 Six Forks Road. Suite 106 PMB #300. Raleigh, NC 27609-5729
Property Owner's Email Address (if available): flightschoollavahoo.com
7. Property Physical Address (Including PIN Number) 3308 Poole Road (PIN: 1723450025)
City Raleigh County Wake Zip Code 27610
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: 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).
NCDEQ Incident #12311
11. Type of contaminants being monitored or recovered: Petroleum Hydrocarbons
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? if yes, how many? 8
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): 50 feet and 70 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): 435 feet (WSW-1)
15. Well Contractor: Geologic Exploration, Inc. Certification No.: 2581
Well Contractor Address: 176 Commerce Boulevard. Statesville, NC 28625
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: 2
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 2
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap, 8"
flush mount manhole cover
6. Estimated beginning construction date: 8/11/2022
7. Estimated construction completion date: 8/12/2022
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. 143-215.10B(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
Proiect Manager (Agent for NCDEQ State Lead)
Signature of Applicant or 'Agent Title of Applicant or *Agent
Emily Fuller * 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
Signature of Property Owner (if different than Applicant)
See attacheit
Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application 10 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]
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

ATC
ENVIRONMENTAL • GEGTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
www.atcgroupservices.com
March 2, 2022
House Boney, LLC
4441 Six Forks Road, Suite 106 PMB #300
Raleigh, NC 27609-5729
Re: Access Agreement for Environmental Assessment
Dave's Grocery
3314 Poole Road
Raleigh, Wake County, North Carolina
NCDEQ Incident No. 12311
Dear Mr. Boney:
ATC Associates of North Carolina, P.C. (ATC), on behalf of the North Carolina Department of
Environmental Quality (NCDEQ), is conducting an environmental assessment at the Dave's
Grocery site located at 3314 Poole Road in Raleigh, Wake County, North Carolina. As part of
assessment activities, ATC is requesting permission to install two monitoring wells on your
property located at 3308 Poole Road (Property Identification Number 1723450025) in Raleigh,
North Carolina, which is located adjacent and west of the above referenced site. A map
showing the location of your property in reference to the site property with proposed monitoring
well locations is included.
You, as the property owner, will not be held responsible or held liable for any damages or
expenses for injury to persons or property while ATC is on the premises.
Please provide your authorization and approval by signing the attached signature page in the
enclosed envelope by March 31, 2022. Acknowledgment of this form is required by NCDEQ.
Denial of site access will be forwarded to NCDEQ for their pursuit of site access.
If you have any questions regarding these activities, please feel free to contact Ms. Emily
Fuller with ATC at emily.fullerac oneatlas.com or 919-871-0999 or Mr. Mark Petermann with
NCDEQ at Mark.Petermannna.ncdenr.00v or 919-707-8169.
Sincerely,
ATC Associates of North Carolina, P.C.
Emily J. Fuller, P.G.
Project Manager

ATC
ENVIRONMENTAL • GEOTECHNICAL
• BUILDING SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
www.atcgroupservices.com
Response to access request for 3308 Poole Road in Raleigh, NC for Incident #12311:
)4'Access approved
Access denied
Name get/M l/ �d.-
Signature * M134
E-mail PLlloW7340414L-1 m Y/'• eok+
Phone number

L11
MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP
L4
L2
L3
L1 = 0 FT.
L2 = 10 FT.
L3 = 20 FT.
L4 = 30 FT.
PROTECTIVE CASING AND CONCRETE PAD
CASING MATERIAL
CASING DIAMETER
CASING LENGTH
PAD DIMENSIONS
HEIGHT ABOVE GROUND
sch 40 PVC
8 Inches
12 inches
2 feet x 2 feet
flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 Inches
JOINT TYPE flush threaded
LENGTH 10 feet
BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 5 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 3 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
TOTAL FILTER PACK LENGTH 12 feet
WELL SCREEN
SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 20 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL
DEPTH TO BOTTOM OF
BOREHOLE
30 feet
30 feet
DIAMETER OF BOREHOLE 6 inches
TITLE Monitoring Well
Dave's Grocery
3314Poole Road
Raleigh, Wake County
North Carolina
ENVIRONNEN1Al • RENTECNRICAL
RUIEOINS SCIENCES • MATERIALS 'ESTINR
2725 East Milibrook Road
Suite 121
Raleigh, North Carolina 27604
FILE
PREP. BY
EF
REV. BY
AW
DATE
7/20/2022
PROJECT NO.
SLC1231103

113M ON111011
WILLIAMS ROAD
NOS:
FIGURE 2
SATE MAP
DAVE'S GROCERY — INCIDENT 112311
3314 POOLE ROAD
RALEIGH, NORTH CAROUNA
SLC1231101
Int
eLS
Gmfir
Dow
0l/13/202r
AS SNOW
T
no..

1•-
WILLIAMS ROAD
4'49 oa
NOTES:
1. Yfx110lwo NUM SAMPLED 1}/M/2O20
FIGURE 5
DISSOLVED BENZENE 'SOCONCENTRAT!ON CONTOUR MAP
DAVE'S GROCERY - INCIDENT #12311
3314 P0011 ROAD
RALEIGH, NORTH CAROL!NA
SLC12,111Or
°' LB
Omsk, Or
isA
O1/13/2021
"AS SHOWN
A