WM0401391_Monitoring Well Permit Application_20220901

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: 8/30/2022
2. County: Guilford
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Duke Energy Carolinas, LLC
Telephone: [phone]
Applicant's Mailing Address: 526 S Church Street #EC13K, Charlotte, NC 28202-1802
Applicant's Email Address (if available):
5. Contact Person (if different than Applicant): Chris Gilbert
Telephone: [phone]
Contact Person's Mailing Address: 526 S Church Street #EC13K, Charlotte, NC 28202-1802
Contact Person's Email Address (if available):
6. Property Owner (if different than Applicant): Norfolk Southern Corp Telephone: NA
Property Owner's Mailing Address: Norfolk Southern: 3 Commercial PI Norfolk, VA 23510 &
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 100 N Centennial St (7800357844)
City High Point County Guilford Zip Code 27260
8. Reason for Well(s): Groundwater Assessment on Norfolk Southern Right of Way
(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 Manufactured Gas Plant
(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).
#NCD986188837
11. Type of contaminants being monitored or recovered: MGP Related Constituents (i.e., Naphthalene, Benzene)
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 27
Existing Monitoring or Recovery Well Construction Permit No(s).: Guilford County Permit 2021-07-1-MW-21-RWO
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)? No
If yes, give distance(s):
15. Well Contractor: Geologic Exploration, Steve Taylor
Certification No.: NC2401-A
Well Contractor Address: 176 Commerce Blvd, 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: 9 Temp wells (6 turned permanent)
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 9
(add answers from 2 and 3)
5. How will the well(s) be secured? "Dolphin Lock"
Padlock
6. Estimated beginning construction date: 09/19/2022
7. Estimated construction completion date: 09/30/2022
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
Signature of Applicantr *Agent
Helen Corley
Printed name of Applicant or *Agent
An agent of Duke Energy (Principal Hydrogeologist)
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 executed agreement with Norfolk Southern consenting to well installations.
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office
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]
1
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11111
GW-22MR Rev. 3-1-2016

DocuSign Envelope ID: 99066502-1B2B-4038-AB35-7A99B467D6E7
RIGHT OF ENTRY AGREEMENT
SIXTH AMENDMENT
This Amendment is entered into as of June 7, 2022, between DUKE ENERGY CAROLINAS, LLC
("Licensee"), a North Carolina Limited Liability Company, and NORFOLK SOUTHERN RAILWAY COMPANY
("Company"), a Virginia corporation.
WHEREAS Company and Licensee have entered into an Environmental Right of Entry Agreement,
idientified as Custodian No. 214563 (R0E00226) made as of June 10, 2011 and as amended by First
Extension dated June 10, 2012, Second Extension dated June 10, 2013, and Third Extension dated June
15, 2016, a Fourth Extension dated June 20, 2019, and a Fifth Extension dated April 16, 2021 (collectively,
the "Agreement"), covering the entry of Licensee onto Company's Property adjacent to a facility of
Licensee at 500-510 Leonard Avenue, High Point, North Carolina for the purposes of installing one (1)
groundwater monitoring well in the original Agreement, and seven (7) additional wells under the Fifth
Extension for a total of eight (8) montioring wells on the property (MW-10, 13, 13D, 13WT, 14D, 14-WT,
04, 04D).
WHEREAS, Licensee has assumed responsibility for and has agreed to undertake at its own
expense cleanup of certain contamination and environmental obligations related to the Property as set
forth in the Agreement.
WHEREAS, Licensee has undertaken certain cleanup activities as set forth in the Agreement and
such activities are currently ongoing.
WHEREAS, Licensee wishes to renew and extend the term of the Agreement, identified as
Custodina No. 214563 subject to the terms and conditions set forth in the Agreement and as set forth in
this amendment to the Agreement (the "Sixth Amendment").
WHEREAS, Licensee wishes to amend the scope of work covered by the Agreement to proposing to
install nine (9) additional wells (TMW3-1A, 3-1B, 3-1C, TMW3-2A, 3-2B, 3-2C, and TMW3-3A, 3-3B, 3-3C)
subject to the terms and conditions set forth in the Agreement and as set forth in this Sixth Amendment.
NOW, THEREFORE, the parties, acknowledging mutual consideration and intending to be legally
bound, agree as follows:
1. The Agreement is hereby renewed, effective as of April 16, 2022, including all Exhibits thereto,
and as amended herein.
2. The term of the Agreement is extended to and includes June 7, 2023.
3. The scope of work covered by the Agreement is amended to include install nine (9) additional
wells (TMW3-1A, 3-1B, 3-1C, TMW3-2A, 3-2B, 3-2C, and TMW3-3A, 3-3B, 3-3C) as shown on Page
2 of the Exhibit A
4. Paragraph 3 of the Agreement (Paragraph 2 of the Fifth Extension) is hereby modified to reflect
that the applicant must submit a Protection Services request through the online application portal
at https://ns.railprospermitting.com.
5. Paragraph 9 of the Agreement is deleted in its entirety and replaced with the following:

DocuSign Envelope ID: 99066502-1B2B-4038-AB35-7A99B467D6E7
9. No work of any character shall be started on the Property until:
a. Certificates of Insurance, specifying that the policies are applicable to the
particular work, have been furnished to and accepted by Company as evidence that Licensee
and/or its contractor and subcontractor maintain the insurance coverages described in Exhibit C,
attached hereto, and made a part hereof.
b. Authorized representatives of Licensee have met with Company's Division
Engineer or his representative and also with a representative of Company's Communications and
Signals Department to receive any instructions Company may have concerning Licensee's
activities on the Property. Licensee agrees to follow, at its expense, all such instructions, and in
such manner as is satisfactory to Company.
In the event of any inconsistency or ambiguity between the provisions of the Agreement
and those of this Sixth Amendment, the provisions of this Sixth Amendment shall prevail.
However, except as expressly modified by this Sixth Amendment, the terms and conditions of
Agreement shall continue in full force and effect.
Each of the parties therefore has caused this Sixth Amendment to be executed by its duly authorized
representative.
NORFOLK SOUTHERN RAILWAY COMPANY
By:
DocuSigned by:
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— 9CD295D89FCB43F...
Printed Name: Malcolm G. Roop
Title: Real Estate Manager
Date: June 21, 2022
Activity Number: 1302546
VAH: 6/7/2022
a—DS
DUKE ENERGY CAROLINAS, LLC
1— DocuSigned by:
By: de.n.L4 welts.
"-7DF299CA2C11412...
Printed Name:
Title:
Date:
VP EHS
James R wells
June 16, 2022 1 09:38 PDT

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2801 Yorkmont Road, Suite 100
Charlotte, NC 28208
[phone]
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Title:
SITE MAP
HIGH POINT MGP SITE
100 NORTH CENTENNIAL STREET
HIGH POINT, NORTH CAROLINA
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Date:
8/23/2022
Project No:
7812-22-0806
('DUKE
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Legend
Parcels
Site Boundary
Railroads
Approximate Railroad
Right -of -Way
9 Monitoring Well Location
Proposed Temporary
Monitoring Well Location
—I Historical Site Features
The map shown here has been created
with all due and reasonable care and is
strictly for use with Wood project
number 7812-22-0806. Wood assumes
no liability, direct or indirect,
whatsoever for any such third party or
unintended use.
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File:
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2021\13
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Figure:
1
NCDOT GIS Unit, NCDOT Rail Division, Esri, © OpenS reetMap contributors, HERE, Garmin, USGS, NGA, Esri, HERE, Garmin, FAO, NOAA, USGS, EPA
Drawn by: LMD - Checked by: DRH - Date:8/23/2022

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 6228-22-0806
WELL NUMBER
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF N
BENTONITE SEAL
DEPTH TO TOP OF
GRANULAR MATERIAL
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
NOT TO SCALE
TOTAL DEPTH
OF WELL
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Derick Haydin Date: 8/16/2022

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 6228-22-0806
WELL NUMBER
T-3 Intermediate (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF
BENTONITE SEAL
21
DEPTH TO TOP OF
GRANULAR MATERIAL
22
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
25
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
30
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Derick Haydin Date: 8/16/2022

PROPOSED MONITORING WELL CONSTRUCTION
JOB NAME High Point Former MGP JOB NUMBER 6228-22-0806
WELL NUMBER
T-3 Deep (3 total)
LOCATION (LAT, LONG)
INSTALLATION DATE TBD
TBD
TOP OF CASING ELEVATION (FT AMSL) TBD
GRANULAR BACKFILL MATERIAL #2 Sand SLOT SIZE 0.010 in
SCREEN MATERIAL PVC SCREEN DIAMETER 2 in
RISER MATERIAL PVC RISER DIAMETER 2 in
DRILLING TECHNIQUE Rotary Sonic DRILLING CONTRACTOR Geologic Exploration
BOREHOLE DIAMETER $vi WOOD FIELD
REPRESENTATIVE TBD
LOCK BRAND "Dolphin lock" padlock SIZE/MODEL 35 mm
KEY CODE/COMBINATION Key
GROUND
SURFACE
STEEL MANHOLE COVER
DEPTH TO TOP OF
BENTONITE SEAL
36
DEPTH TO TOP OF
GRANULAR MATERIAL
37
THREADED COUPLING
SCREEN
GRANULAR BACKFILL
CAP
A
LENGTH OF
SOLID SECTION
40
1
CEMENT
BENTONITE
RISER
LENGTH OF
SLOTTED SECTION
5
NOT TO SCALE
TOTAL DEPTH
OF WELL
45
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
FEET
BELOW TOP OF
INNER CASING
MEASURED ON
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina
Completed By: Derick Haydin Date: 8/12/2022