WM0501504_Application_20220810

ATC
ENVIRONMENTAL • GE©TECIfNICAL
BUILDING SCIENCES • MATERIALS TESTING
August 3, 2022
Mr. Eric Rice
North Carolina Department of Environmental Quality
Raleigh Regional Office
Division of Water Resources
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Re: Permits to Construct Monitoring Wells
Model Cleaners & Laundry
1910 Chapel Hill Road
Durham, Durham County, North Carolina
DSCA Site ID DC320028
Dear Mr. Rice:
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcassociates.com
N.C. Engineering License No. C-1598
NC Dept of Environmental Quality
AUG 10 2022
Raleigh Regional Office
Enclosed please find four applications for permits to construct three single monitoring wells and
one nested monitoring well. The monitoring wells will be located at 1910 Chapel Hill Road,
1920 Chapel Hill Road, 2000 Chapel Hill Road, and 1801 Burke Street in Durham, North
Carolina. The permit applications, site map with the proposed locations of the monitoring wells,
well construction details and other relevant information are enclosed as attachments. Please
review this package and return the approved permits to this office.
If you have any questions or require additional information, please contact our office at (919)
871-0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Ashley M. Winkelman, P.G.
Senior Project Manager

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES -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:
2.
3.
4.
8/1122
County: Durham
FOR OFFICE,USE ONLY
PERMIT NO. Oy�,, CSO/S ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: Robert Smart (DSCA Petitioner for DSCA site # DC320028) Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant's Email Address (if available): ] ay . king@ncdenr . gov
5. Contact Person (if different than Applicant): Ashley Winkelman, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): weasy ITT, LLC Telephone: 919 - 2 86 - 74 21
Property Owner's Mailing Address: 904 Ninth St, Durham, NC 27705
Property Owner's Email Address (if available): Not Available
7. Property Physical Address (including zip code) and PIN Number 1910 Chapel Hill Rd, Durham, NC 27707 PIN 0821-14-98-1688
8. Reason forWell(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: Former 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 # DC320028
11. Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, four
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0501212
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 15 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes,give distance(s): N/A
15. Well Contractor: Innovative Environmental Technologies, Inc.
Certification No.: 4400E
Well Contractor Address: 30 Grant Park PI #7864, Piedmont, SC 29673 do,
0f,
PROPOSED WELL CONSTRUCTION INFORMATION a;.o,
1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing >followin :� � j
�1 1� Q
a. Borehole and well diameter e. Type of casing material and this Ca"
b. Estimated well depth f. Grout horizons off,!
c. Screen intervals g. Well head completion details 0��
d. Sand/gravel pack intervals U .
CQ
Continued on Reverse

it T

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
flush -mount steel protective casing
cap,
3. Number of wells to be constructed in bedrock: 0 6, Estimated beginning construction date: 9/12/22
4. Total Number of wells to be constructed:
(add answers from 2 and 3)
1.
1
7. Estimated construction completion date: 9/14/22
ADDITIONAL INFORMATION
As required by 15A NCAC 02C .01050)(5), attach a scaled map of the site showing the locations of the following:
a.
b.
c,
d.
e.
All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or fakes within 500 feet of the proposed well or well system.
All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
The proposed well or well system.
Any test borings within 500 feet of proposed well or well system.
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. 143-215.1 OB(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
Agent for ISCA site DC320028(will include Power
Signature of Applicant or *Agent
Ashley winkelman
Title of Applicant or *Agent of Attorney upon request)
' 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 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 c'.mpleted applicafon to the appropriate Division of Water Resources-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 Extens on
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 271W:'
Phone: [phone] d�
Fax: [phone] Afo�
v
Wit .* nylon
GW-22MR (Rev. 8113)

w

APPENDIX A
ACCESS AGREEMENT
(Petitioner is NOT the Property Owner)
Model Cleaners and Laundry
1910 Chapel Hill RD
Lakewood Shopping Center Shopping Center
Durham
Durham County
DSCA Site ID No. DC320028
Name of Property Owner typed or printed: Weasy III, LLC
WHEREAS, Weasy III, LLC_ (name of Property Owner, hereinafter:
Property Owner) is the owner of a parcel of property located at 1910 Chapel Hill RD,
Durham in Durham County, North Carolina (Property); and
WHEREAS, Botek, Inc. (name of Petitioner) is petitioning to the North Carolina
Department of Environmental Quality, Division of Waste Management (Division) for
certification of the Property into the Dry -Cleaning Solvent Cleanup Act Program
(Program) pursuant to the Dry -Cleaning Solvent Cleanup Act of 1997 as amended, Part
6, Article 21A, Chapter 143, N.C.G.S. § 143-215.104A et seq. (DSCA); and
WHEREAS, the Petitioner intends to enter into an Agreement for Assessment and
Remediation (ARA) with the Division concerning the Dry -Cleaning Solvent
contamination on the Property; and
WHEREAS, the implementation of the ARA will require that the Division and its
independent contractors (contractors) have free and unencumbered access to the
Property for the purposes of investigating, assessing and remediating Dry -Cleaning
Solvent contamination on and around the Property; and
WHEREAS, the parties to this Access Agreement are the Division and Property Owner;
NOW THEREFORE, in consideration of the terms and conditions contained in this
Access Agreement, and for other good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. Grant of License and Permission. Property Owner hereby grants (a) to the Division
a license to access the Property to monitor and enforce the ARA and (b) to the
Division's contractor(s) a license to access the Property to undertake all work to be
performed at the Property, including, but not limited to, the following purposes:
a. Inspecting, sketching and photographing the Property;
b. Taking such soil, water and air samples as may be necessary;
DSCA Petition October 2007 Page

c. Taking other actions related to the investigation of surface or subsurface
conditions, such as installation of monitoring wells or excavation of
impacted soil;
d. Transportation of equipment onto and around the Property as necessary
to accomplish the investigation;
e. Taking response actions necessary to mitigate any threat to human health
and the environment;
f. Remediating dry-cleaning solvent contamination at the Property as
needed; and
g. Undertaking such other activities as necessary to complete the work to be
performed as required or permitted under the ARA.
2. Conditions Precedent. The licenses created in Paragraph 1 shall take effect upon
the certification of the Property into the Program and shall remain in effect, unless
otherwise terminated pursuant to Paragraph 12 below so long as the Property
remains certified under the Program.
3. Observation. Upon the Property Owner's reasonable notice and request, the
Property Owner and its consultants shall have the right to observe any activities
performed by or on behalf of the Division at the Property. Upon the Property
Owner's reasonable notice and request, the Division or its contractors shall allow the
Property Owner to split samples of any environmental samples obtained on behalf of
the Division. All costs associated with obtaining and analyzing the split samples
shall be borne solely by the Property Owner.
4. Interference. The Division and its contractors shall endeavor to perform any
activities authorized hereunder at the Property in a manner that minimizes
interference with the use of the Property. The Division and its contractors will make
reasonable attempts to notify the Property Owner at least 48 hours prior to entering
the Property for the purposes stated in Paragraph 1.
5. Insurance. The Division's contractors have agreed to maintain the insurances as
defined in their agreement with the Division, provided however, that the Division
shall have no liability for its contractor's failure to maintain such insurance.
6. Site Repair. The Division or its contractors shall remove and shall have the right to
remove from the Property all equipment and other materials belonging to the
Division or its contractors within a reasonable period of time after the completion of
the activities at the Property authorized hereunder. To the extent practicable, the
Division's contractors shall restore the Property to the original condition it was in
prior to any activities authorized hereunder at the Property, and except as otherwise
DSCA Petition October 2007 Page 8

agreed to by the parties, shall properly abandon any monitoring wells in accordance
with any applicable laws and regulations.
7. Protection of Wells and Equipment. The Property Owner shall not damage, remove,
pave over or cover any monitoring or remediation wells on the property. The
Property Owner also shall not tamper with or affect the operation of assessment or
remediation equipment installed on the property by the Division's contractors.
8. Notice. Any notices, reports, or other communications required or permitted under
this Access Agreement shall be addressed to the representative for each party as
set forth below:
To Property Owner:
Weasy III, LLC
904 Ninth Street
Durham, NC 27705
To the Division:
North Carolina Division of Waste Management -DSCA Program
Attn: Jay King
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
9. Limitations. All obligations of the Division pursuant to this Access Agreement shall
be contingent upon the availability of moneys in the North Carolina Dry -Cleaning
Solvent Act Fund.
10. Governing Law. This Access Agreement shall be governed by and construed in
accordance with the laws of the State of North Carolina, without reference to choice
of law principles.
11.Integration Clause. This Access Agreement represents the entire understanding
and agreement between the parties hereto and supersedes any and all prior
agreements, whether written or oral, that may exist between the parties regarding
same. No amendment or modification to this Access Agreement or any waiver of any
provisions hereof shall be effective unless in writing and signed by both parties.
12. Termination. The licenses created in Paragraph 1 may be terminated upon delivery
of reasonable written notice to the Division, which termination shall be effective upon
receipt of such notice. However, such termination will also terminate the ARA and
cause the forfeiture of liability protection under the DSCA. If no such notice is
served and subject to provisions of Paragraph 2 above, the licenses created herein
shall remain in effect until such time as all work or activities under the Program have
DSCA Petition October 2007 Page 9

i

been completed at the Property. The right and obligation set out in the first sentence
of Paragraph 6 shall survive the termination of this license.
13. Modification. This Access Agreement may not be amended except in writing by the
parties to this Access Agreement.
The parties each represent and warrant that this Access Agreement is executed by their
duly authorized representatives as of the date accepted and agreed upon below.
tjj__ A
Accepted and agreed, this I tP — day of NO(tp ybe„-- , 20 f 6 .
re fo - e Divisio
DSCA Petition October 2007 Page 10

:4, ii lit of l:nvsnJR:'1 n:==1 Quality
Ra1cizh Rc;2.Jonal Office
NC Dept of Environmental Quality
AUG I0 2022
Well finished at surface with locking
well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
—Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
40 Feet of 2" Diameter Schedule 40 PVC Casing
Extending From Ground Surface to Top of Screen
f 2 Foot Bentonite Seal
Groundwater Table
Raleigh Regional Office 42 Filter Sand Pack Extending 2 Feet Above Screen
5 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
M
Nik
ENVIRONMENTAL• GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3228SL02
DATE: 8/3/2022 REVIEWED BY: AW
WELL CONSTRUCTION DETAIL
1910 CHAPEL HILL ROAD
Model Cleaners
1910 Chapel Hill Road
Durham, Durham County, NC 27707
DSCA ID: DC320028

tt

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES — AQUIFER PROTECTION SECTION
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
1.
2.
3.
4.
PLEASE TYPE OR PRINT CLEARLY
In accordance with the provis:ons of Art cle 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
appl cation is hereby made for a permit to construct monitoring or recovery wells.
Date: 8/3/22
County: Durham
What type of well are you applying for? (monitoring or recovery): Monitoring
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
Applicant. Robert Smart (DSCA Petitioner for DSCA site ID DC320028)
Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699 1646
Applicant's Email Address (if available): jay . king@ncdenr , gov
5. Contact Person (if different than Applicant); Ashley Winkelman, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): RAD Durham Owner I LLC Telephone: [phone]
Property Owner's Mailing Address: 2050 Chapel Hill Road, Durham, NC 27707
Property Owner's Email Address (if available): Director@scrapexchange . org
1801 Burke Street, Durham, NC 27707
7. Property Physical Address (including zip code) and PIN Number PIN 0821-15-61-1730
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: Former Dry-cleaner
(ex: non -discharge facility, waste d:sposal 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 Site ID DC320028
11. Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, four
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0501212
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 400 Feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes„give distance(s): N/A
15. Well Contractor: Innovative Environmental Technologies, Inc. Certification No.: 4400B
Well Contractor Address: 30 Grant Park PI #7864, Piedmont, SC 29673
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C 0105(f)(7), attach a well construction diagram of each well showing thPoll�ivl}cfr
F:nvironmcntal Quality
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
c. Screen intervals g. Welt head completion details
d. Sand/gravel pack intervals
_1G 10 2022
Continued on Reverse
Raleigh Regional Office

a

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsol dated
material:
5. How will the well(s) be secured? Locking well cap,
2 flush -mount steel protective casing
3. Number of wells to be constructed in bedrock:
6. Estimated beginning construction date: 9/12/22
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 9114127
(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 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
Ashley Winkelman
Agent for DSCA site DC320028(Wi11 include Power
Title of Applicant or *Agent of Attorney upon request}
* 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 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 competed application to the appropriate Division of Water Resources's Aquifer Protection Section Regional Office:
Asheville Regional Office
2090 U.S. H:ghway 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 41,97
Phone: [phone] I}C
Fax: [phone] Illol'z,
GW-22MR (Rev. 8/13)

p

a
ROY COOPER
Go.4rnL(
ELIZABETH S. BISER
.cce'rrton
MICHAEL SCOTT
Dim tot
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, Ashley Winkelman with ATC
Associates of North Carolina, P.C. (ATC) at
ashlev.winkelman a.atcgs.com or [phone]. If you still have questions after
contacting Ms. Winkelman with ATC, please contact the DSCA project manager,
Jay W. King at [e-mail] or [phone].
For DSCA Use Only
DSCA ID No.
DC320028
Please Print
?AD Du nano, 4u,r r 1, LLCM
(Name of Property Owner or Tenant in Residence)
1801 Burke Street
(Street Number and Street Name of Property)
Durham / Durham / 27707
(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.
(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
North Carolina Department of Environmental Quality i Division of Waste Management
217 West Jone. Street ' 16'16 Mall Scry ce Center I Raleigh, North Carolina 2%99 [446
919.707 8200

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".
Q.0 to > 'ft
(Signs re of Property er or Tenant in Residence)
}84aoaa.
(Date)
C61 t01) iri$a -- a-151
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
i rQ.c rr S Crap f,YCdn a n cyze . o r
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Ashley Winkelman
ATC Associates of North Carolina, P.C.
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
North Carolina Department of Environmental Quality Division of Waste Nianuyentent
217 Wesi Jones Street ! 1041, Mali Service Center Raleigh, North Carolina 276QQ 16.113
Q19.7078200

NC Dept of Environmental Quality
t
N
Proposed Groundwater
Monitoring Well
1801 Burke Street
SOURCE: DURHAM COUNTY GIS
Former Model Cleaners
1910 Chapel Hill Road
0 = Proposed Monitoring Well
2725 E. Millbrook Road, Suite 121
If Raleigh, NC 27604
ENYINONNENTAt • SEOTECNAICAI [phone]
BUItOINB SCIENCES • NAIEB1115 IESTINS
%At
SCALE: NTS DATE: 2/17/2022
FIGURE 1
Proposed Monitoring Well Location
MODEL CLEANERS
1910 CHAPEL HILL ROAD
DURHAM, NC
DSCA SITE ID DC320028

o

TYPE II MONITORING WELL CONSTRUCTION DETAILS - NESTED
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAPS
Deeper Well
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 1 inch
JOINT TYPE flush threaded
LENGTH 40 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 3 feet
DEPTH 35-38 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
FILTER PACK LENGTH 7 feet
WELL SCREEN
SCREEN MATERIAL sch 40 PVC
DIAMETER 1 Inch
LENGTH 5 feet
SLOT SIZE 0.010 Inches
DEPTH TO BOTTOM OF
MONITORING WELL 45 feet
* - Length is from top of deeper bentonite layer
to the bottom of the shallower bentonite layer
Shallow Well and General Well Specifics
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 CASINGS
MATERIAL
THICKNESS
Steel
8 inches
12 inches
2 feet x 2 feet
flush mounted
sch 40 PVC
1 Inch
flush threaded
10 feet
cement -sand grout
5 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 3 foot
DEPTH 5-8 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
FILTER PACK LENGTH 27 feet`
WELL SCREEN
SCRFEN MATERIAL sch 40 PVC
DIAMETER 1 inch
LENGTH 10 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 20 feet
DEPTH TO BOTTOM OF
BOREHOLE
45.0 feet
DIAMETER OF BOREHOLE 8 inches
TITLE Nested Monitoring Well
Model Cleaners - 1801 Burke Street
1910 Chapel Hill Road
Durham, Durham County, North Carolina
2725 East Millbrook Road, Suite 121
Raleigh, North Carolina 27604
FILE
PREP. BY
AW
DAT!.
811/2022
PROJECT NO.
DC320028
NC Dept of Environmental Qt!ality
AUG 10 2022
Raleigh Regional Office

s

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES — 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: 8/3/22
2. County: Durham
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Robert Smart (DSCA Petitioner for DSCA site ID DC320028)
Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant's Email Address (if available): ] ay . king@ncdenr . gov
5. Contact Person (if different than Applicant): Ashley Winkelman, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): 1920 Provision LLC Telephone: [phone]
Property Owner's Mailing Address: PO Box 52357, Durham, NC 27717
Property Owner's Email Address (if available): [e-mail]
1920 Chapel Hill Road, Durham, NC 27707
7. Property Physical Address (including zip code) and PIN Number PIN 0821-14-74-9695
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: Former 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 Site ID DC320028
11. Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, four
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0501212
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 375 Feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes„give distance(s): N/A
15. Well Contractor: Innovative Environmental Technologies, Inc.
Certification No.:
Well Contractor Address: 30 Ct-ant Park Pi #I1864.. Piedmont, SC 29673
4400E
1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following: r, pC
7 x ,,,l1
a. Borehole and well diameter e. Type of casing material and t kftness
b. Estimated well depth f. Grout horizons `4 i p�
c. d. Screen Intel pack intervals g• Well head completion details �o6'ioz?,,
Sand/g'40"co
Aich
9,1
PROPOSED WELL CONSTRUCTION INFORMATION Q421'nylro
072/v
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 well cap,
material:
1
3. Number of wells to be constructed in bedrock:
0
flush mount steel protective casing
6, Estimated beginning construction date: 9/12/22
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 9/14/22
(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 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
Ashley Winkelman
Printed name of Applicant or *Agent
Agent for DSCA site DC320028(will include Power
Title of Applicant or *Agent of Attorney upon request)
* 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'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]
i
ngton
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]
+ 4 "-�e{fir off
449
to1 9
Rza:o
Ott.
ileo
GW-22MR (Rev. 8113)

4

ROY COOPER
Governor
ELIZABETH S. RISER
Secretor)
MICHAEL SCOTT
DHettot'
NORTH CAROLINA
Environmental Quality
PROPERTY ACCESS CONSENT
This document may not be modified svithout the Program's approval.
If you have questions on how Will 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, Ashley Winkelman with ATC
Associates of North Carolina, P.0 (ATC) al ore still have questions rJler
ashlcy.winkcIman(�•ttcgs.cam or [phone]. If y!
contacting Ms. Winkelman with ATC, please contact the DSCA project manager,
Jay W. King al Jay.King(Qncdcnr.bnv or [phone].
NC Dept of Environmen al Qcllity
AUG 10 2022
Raleigh Regional Office
For DSCA Use only
DSCA ID Nu,
DC320028
Please Print'tR-
an
nacew l +"
(Niaa of Property Owner or Tenant in Residence)
1920 Chapel Hill Road
(Street Number and Street Name of Property)
Durham / Durham / 27707
(City or Town in Which Properly 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:
(t) 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.
(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
£D_Ey
Sl. it...wtwn -
Not th C3ro1ln3. Departmcat of Env irnnmrntal Quality 1 Dlvlslon of waste h1 aiw9cmcnt
217West Jones 51reri 11b•$I,Mall Service Center 1 Ralcljh.North Cnrnlhtal7G'1'1 tl,At,
919.7078200

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 Properly Owner al
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 oldie Division.
By signing this consent document, l acknowledge that 1 ant 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 arc tenants) occupying the property and all tenants agree to the conditions
of this "Property Access Consent".
2l1-311 aa,
(Signature of Property Owner or Tenant in Residence) (Date)
,c-7G1f---�6
(Telcpho Ni ber for Property Owner or Tenant in Residence for scheduling work/notification)
l411cit kn n P y suck.[ e co . co
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Ashley Winkelman
ATC Associates of North Carolina, P.C.
2725 E. Mlllbrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
D_E
Nor Ili Carolina llepar twill of EnvIronnif mai Quality F Division or %Vast. management
217%VesIJones Street 116,16 Mall Service Center I Raleigh, North Carolina 2709IA•1f.
919.707.8200

I

Well finished at surface with locking
— well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
— 10 Feet of 2" Diameter Schedule 40 PVC Casing
Extending From Ground Surface to Top of Screen
2-Foot Bentonite Seal
10 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
— Groundwater Table
02 Filter Sand Pack Extending 2 Feet Above Screen
ENVIRONMENTAL• GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 E, Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3228SL02
DATE; 8/3/2022
REVIEWED BY: AW
WELL CONSTRUCTION DETAIL-
1920 CHAPEL HILL ROAD
Model Cleaners
1910 Chapel Hill Road
Durham, Durham County, NC 27707
DSCA ID: DC320028

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES — 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: 8/3/22
2. County: Durham
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Robert Smart (DSCA Petitioner for DSCA site ID DC320028)
Telephone: 919- 3 83 - 8883
Applicant's Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant's Email Address (if available): jay .king®ncdenr . gov
5. Contact Person (if different than Applicant): Ashley W : n kelman, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant); Triple B #26, LLC Telephone: [phone]
Property Owner's Mailing Address: 530 SE Greenville Blvd., Ste 200, Greenville, NC 27858
Property Owner's Email Address (if available): jpsextonftbrodyco.com
2000 Chapel Hill Road, Durham, NC 27707
7. Property Physical Address (including zip code) and PIN Number PIN 0821-14-44-2126
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: Former 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 Site ID DC320028
11. Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, four
Existing Monitoring or Recovery Well Construction Perm't No(s).: WM0501212
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 300 Feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes,give distance(s). N/A. _
15. Well Contractor: Innovative Environmental Technologies, Inc. Certification No.: 4400E
Well Contractor Address: 30 Grant Park PI #7864. Piedmont, SC 29673
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
1
material:
3. Number of wells to be constructed in bedrock
4. Total Number of wells to be constructed
(add answers from 2 and 3)
1
5. How will the well(s) be secured? Locking well cap,
flush -mount steel protective casing
6. Estimated beginning construction date: 9/12/22
7. Estimated construction completion date: 9114/22
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 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
Agent for DSCA site DC320028(Wi11 include Power
•
Signature of Applicant or *Agent
Ashley Winkelman
Title of Applicant or `Agent of Attorney upon request;
* 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 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'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]
win=11111
Athildrelli ni 441142**'il\
141104111
Attirat
ng,on
GW-22MR (Rev. 8113)

STATE OF NORTH CAROLINA
COUNTY OF DURI-IAM
PROPERTY ACCESS
AGREEMENT
THIS PROPERTY ACCESS AGREEMENT ("Agreement") is made as of this the
.06 day of , 2022, by and between, TRIPLE 13 #26, LLC
("Grantor"), and ATC A SOCIATES OF NORTH CAROLINA, PC ("Grantee").
RECITALS
WHEREAS, Grantor owns certain real property located at 2000 Chnpcl Hill Road,
Durham, North Cnrolinn 27707 (the "Property"), in Durham County, North Carolina;
WHEREAS, an investigation of subsurface soil, air, Auld groundwater conditions
minted to the Model Cleaners fitcility located at 1910 Chapel Hill Road, Durham, North
Cnrolinn 27707 ("DSCA Site DC320028"), is being conducted under the direction of the North
Cnrolinn Department of Environmental Quality ("NCDF Q"), Division of Waste Management
Dry -Cleaning Solvent Cleanup Program ("DSCA Program") to determine the extent of dry
cleaning solvent and petroleum contaminants that may have entered the soil, air, and
groundwater beyond DSCA Site DC320028 and at the Properly;
WHEREAS, Grnntee, on behalf of the DSCA Program, has agreed to enter the
Property for the limited putpose of investigation through taking surface and subsurfnce soil, air,
and water samples on and around the Property as described in the DSCA Program's Property
Access Consent form attached as Exhibit A; and,
WHEREAS, this Agreement is entcrcd into by the Parties to provide Grantee
access to the Property to enable Grantee to investigate the environmental condition of the
Property as required by the DSCA Program under stale law.
NOW, THEREFORE, in consideration of the premises and the mutual promises
set forth below, none of which shall constitute an admission of liability or fault or an admission
against interest by either Party, and other good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, the Parties agree as follows:
1. Grant of Right of Access. Grantor, to the extent required by law, grants
to Grantee, its representatives, contractors, subcontractors, agents, and such other persons

t

lawfully performing on behalf of Grantee, a limited right of access to and entry on the Property to
investigate the soil, air, and groundwater conditions, and subsequent [monitoring sampling if needed, of the
Property in nccordnncc with the DSCA Program investigation of DSCA Site DC320028 as described in
Exhibit A.
2. Requirements.
a. In connection with its entry on the Property or any act or omission concerning
un investigation of the Property, Grantee, its representntives, contractors, subcontractors, agents and all
other persons performing the invcstigntion on the Property, proceed nt their own risk and expense, and shall
comply with such rules and procedures as may apply to installation and stimpling of monitoring wells, and
shall exercise reasonable care not to impair the integrity ot'nny structures on the Property.
b. Grantee shall indemnify and holcl I1tn•mless Grantor and any other
owner of the Property, their respective heirs, successors or assigns, from and against any and all, liabilities,
losses, costs and expenses (including reasonable attorneys' fees and costs or defense), but excluding
consequential losses including but Limited to loss of profits, or incurred by, an indemnified party to the
extent caused by or resulting from the negligence or willful misconduct of Grantee, its representatives,
contractors, agents or any other person performing the environmental investigation of the Property on
Grantee's behalf or under Grantee's oversight, except to the extent such losses result from negligence or
willful misconduct by the Grantor, any other owner of the Property, their respective heir, successors or
nssigns.
c. In perforating the environmental investigation of, including the installation
of any monitoring wells on, the Property, Grantee, its representatives, contractors, subcontractors, agents,
or any other person acting on its behalf, shall perform such activities during daylight hours and do all
things necessary so as not to unduly disturb the normal use of the Property.
d. To the extent allowable by NCDEQ Grantee agrees to provide to Grantor
a copy of any and all test data and results from the investigation and assessment of the Property upon
completion of report(s) required under the DSCA program.
c. Grantee agrees to cause any monitoring wells installed during the site
investigation to be located in a mutually agreeable location and returned to its original condition upon wells
being properly abandoned (i.e. closed) as required by NCDEQ under applicable rules and regulations once
the wells arc no longer needed.
3. Term. The term of this Agreement shall commence on the date of execution of this

Agreement and shall run for a period of twelve (12) months. If not then extended in writing by either Party at the
conclusion of the initial Term, this Agreement shall automatically terminate except upon thirty (30) days prior
written notice by Grantee to Grantor of an intention to extend the term of the Agreement for an additional term
of twelve (12) months.
4. No Liability Admitted. The Parties acknowledge and agree That by entering into this
Agreement, no Party has admitted any liability of any sort for the possible environmental contamination
referred to in this Agreement. No Party has waived any right of any kind in connection with asserting a
claim against the other in connection with the possible environmental contamination referred to in this
Agreement.
5. Notice. Any notice: required or permitted under this Agreement shall be deemed fully
given if sent in writing personally or by certified or registered mail with return receipt requested, addressed
as follows:
Grantor
l lym(m J. Brody
Triple B 126, LLC
530 SE Greenville l3oilcvnrd, Suite 200
Greenville, NC 27858
Amy P. Wang, Esq.
Ward and Smith, P.A.
Post Office Box 867
New Bern, North Carolina 28563-0867
Grantee
Gabriel Arnos
ATC Associates of North Carolina, P.C.
2725 I. Millbrook Road, Suite 121
Raleigh, NC 27604
A Party may, by like written notice, at any time designate a different address to which notices shall be
subsequently sent.
6. Miscellaneous Provisions. Any amendment to this Agreement, and any waiver of
any condition or provision contained herein, shall not be valid unless in writing and signed by the affected
Party. The invalidity of any portion of this Agreement shall have no effect on the balance hereof. This
Agreement, and the rights and obligations ofcacli Party shall be construed under the laws of the State of
North Carolina. This Agreement shall be binding upon and inure to the benefit of Parties and their
respective successors or assigns. This Agreement shall not be assigned by either Party in whole or in part
or rights otherwise transferred without the prior written consent of the other, and any such assignment
without prior written consent shall be null and void and of no legal effect. Consent to assignment shall not
be unreasonably withheld. This Agreement is entered into solely to benefit the Parties hereto and no other
third person or entity shall be entitled to the benefits hereof except as above provided. This Agreement

shell supersede any previously executed property access agreement for investigation of this Property by or
on behalf oldie Parties. Nothing in this Agreement shall be deemed to create between the Parties a joint
venture or agency. This Agreement may not be recorded, 'I'!tc headings arc used I'or convenience only.
The singular shall include the plural and the masculine, feminine or neuter, includes the other. This
Agreement shall be executed in one or more counterparts, each of which shall be deemed an original, but
all of which shall constitute one document.
The Parties hereto affirm that the individuals signing This Agreement have been granted the
authority to do so. The Parties further affirm they will comply with all the terms and conditions ofthis
Agreement.
Triple B #26, I.I_C A'I'C Associates of North Carolina, P.G.
I3y:
I3y:
Hyman.), Brody, Manger Gabriel Arias
Date:
1,4 J1)11 'Lo 1. L
Date: (2023—

f
4.

EXHIBIT A

o

ROY COOPER
Governor
ELIZABETH S. BISER
see rlarr
MICHAEL SCOTT NORTH CAROLINA
Drrertor Environment of Quolisy
PROPERTY ACCESS CONSENT
This document may not be modified without the Program',s approval.
1f'y ou hava questions on how to fill out this form or abort the activities
at this .the, please call the ay -Cleaning Solvent Cleanup Act (DSCA)
Program :s contractor /br this protect, Ashley Winkelman with ATC
Associates oJ'North Carolina, P.C. (ATC) at
ushl :Y.wiultchullghutcg n or [phone]. if you still have questions tffer
contacting A. Winkelman with A 9 CC, please contact the D.SC4 project manager.
Jay W. King at ,layJS Im(alncdoIlr gnv or [phone],
For DSCA Una Only
DSCA in Not
DC320028
Please Print
(Name of Proporiy Ownor or Tenant In Residence)
2000 Chapel Hill Rood
(Street Numbor and Street Name of Property)
Durlintn / Durham / 27707
(City or Town in Which Property is Located) / (County in Which Property is Located) / (Zip Coda)
i voluntarily consent to the Division of Wnste Management (Division) and its independent
contractors (contactors) encoring and having continued nccess to my properly for tho following
purposes:
(I) taking such soli, groundwater and/or air samples as may be neccssnry;
(2) taking other actions related to the investigation o&surface or subsurface conditions;
(3) taking response actions necessary to mitigate any threat to bunion health or the environment,
Other conditions:
(1) The Division and its contractors shall attempt to perform nny activities nt the Property in a
manner that minimizes interference with use of the Property,
(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
North Carolina Department of Envlmrnnental Quality 1 0lvklon or waste Management
217 West Jones Street I to4a Mall Service Center I Raktoh.NorlltCerntlna27b99•Ibdb
919.7071200

with npplicnblc laws and regulations, unless other arrangements are agreed to by the Property
Owner,
(3) The Division or its contractors will make rcnsonnble attempts to notify the Property Owner at
(cast 48 hours prior to entering the Property for nny purpose. In situntions that the Division
determines to be of nn emergency nature, the Division or its contractors shall have immedinte
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 not the legal property owner or tcnn nt
in residence thnt has the authority to allow this work on the property and hnvo contacted nil
(ennuis (if there are tenants) occupying the property and all tenants agree to the conditions
of this "Property Access Consent".
(Signature of Properly Owner or Tannnt in Residence) (Date)
(Telephone Number for Property Owner or Tennnt in Residence for scheduling work/notificntinn)
(Email Address for Property Owner or Tenant in Residence if you prefer to be coninctcd via
email)
Please return form to:
Ashley Winkelman
ATC Associates of North Carollna, P.C.
2725 E. Mllibrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
,w.w uorr,
North Carolina Department of Environmental Qualnv I Division or Mama Management
217 West Jones Street 11646Mall Service Center I Raleigh. North Carolina 2710111.1h.th
4n0.70z1$200

t
N
Former Model Cleaners
1910 Chapel Hill Road
Proposed Groundwater
Monitoring Well
SOURCE: DURHAM COUNTY GIS
Proposed Monitoring Well
ETC
ilalllllc IAI • il•IIIH1IF41
Illliui!WEIS • 114111MIS MIMI
2725 E. Mlllbrook Road, Sella 121
Raleigh. NC 27804
[phone]
SCALE: NTS DATE: 211712022
FIGURE 1
Proposed Monitoring Well Location
MODEL CLEANERS
1910 CHAPEL HILL ROAD
DURHAM, NC
DSCA SITE ID DC320028

# 4 i

Well finished at surface with locking
well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
10 Feet of 2" Diameter Schedule 40 PVC Casing
Extending From Ground Surface to Top of Screen
- - 2-Foot Bentonite Seal
10 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
Groundwater Table
#2 Filter Sand Pack Extending 2 Feet Above Screen
ATC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC3228SL02
DATE: 813?2022
REVIEWED BY: AW
WELL CONSTRUCTION DETAIL-
2000 CHAPEL HILL ROAD
Model Cleaners
1910 Chapel Hill Road
Durham, Durham County, NC 27707
DSCA ID: DC320028

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•

1801 Burke Street
- PIN
0821-15-61-1730
Already Existing Well
• Proposed Well
1910 Chapel Hill
Road - PIN
0821-14-98-1688
1920 Chapel Hill
Road - PIN
821-14-74-9695

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