WM0401408_Monitoring Well Permit Application_20221102

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: 10/31/2022
2. County:
3.
4.
Alamance
FOR OFFICE USE ONLY
D 0 14 PS
PERMIT NO. �! ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: SBR Investors, LLC (Mr. Ken Chapman) Telephone: [phone]
Applicant's Mailing Address: 2400 South Boulevard, Suite 300, Charlotte NC 28203
Applicant's Email Address (if available): kchapman(c�mpvre.com
5. Contact Person (if different than Applicant): Ron Navarro Telephone: [phone]
Contact Person's Mailing Address: 5260 Greens Dairy Road, Raleigh, NC 27616
Contact Person's Email Address (if available): RNavarro(c�ecslimited.com
6. Property Owner (if different than Applicant): Holly Center Investments, LLC (Mr. Scott Thomas) Telephone: [phone]
Property Owner's Mailing Address: PO Box 1959, Burlington, NC 27216
Property Owner's Email Address (if available): N/A
7. Property Physical Address (Including PIN Number) Huffman Mill Road (PIN 173295)
City Burlington County Alamance Zip Code 27215
8. Reason for Well(s): Assessment of suspected contamination from former operations surrounding the subject property
(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: Commercial
(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).
No
11. Type of contaminants being monitored or recovered: VOCs, SVOCs (ex:
organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).: No
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): approximately 200 feet from suspected
contaminants
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: Ground Zero Environmental
Well Contractor Address: 11100 Astarita Ave, Partlow, VA 22534
Certification No.: NCWC 30127-A

2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Capped and
material: 3 locked
3. Number of wells to be constructed in bedrock: 0
6. Estimated beginning construction date: November 2022
Total Number of wells to be constructed: 3 7. Estimated construction completion date: November
(add answers from 2 and 3) 2022
(within 96 hours of installation)
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. 143-215.10t3(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 Applicant or *Agent' Title of Applicant or *Agent
AA PC
n AL- C-L cAf c_!` * if signing as Agent, attach authorization agreement stating
Printed name of Applica\t 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 Weil 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).
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)

ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49:32172
Scope of Work: Proposal for Environmental Services
Project: Sunbelt 4500 Site
Location: Huffman Mill Rd, Burlington, Alamance County, NC (PIN 173295)
As part of the proposed real estate transaction, ECS Southeast, LLP (ECS) has been requested by the
purchaser to conduct due diligence tasks including groundwater sampling at the site. The groundwater
sampling requires that ECS procure a permit from the North Carolina Department of Environmental
Quality (NCDEQ).
ECS respectfully requests that the owner of the property grant permission to ECS to access the property
to conduct the above referenced tasks. By signed below, the property owner authorizes ECS to conduct
the aforementioned sampling at the site.
Property Owner (please print): i"I u i l Y TNV e.sinel �••� 5, L L L SCE Tl1 pm4-si I Y ' A-v.4
Property Owner Telephone (please print): (536) a a�in
Property Owner Signature: MAN"Jcf- Date: 1 v /act I a °?

Commercial
shopping
center
Wooded Land and
abandoned residence
Parking lot
SOURCE:
ECS PHASE I (May 2022)
2020 IMAGERY
SCALE SHOWN ABOVE
Pc:l;d
Holly Center
shopping center -
Former Buick
doalorshtp and
auto ropair facility
REC
Legend
Proposed Groundwater Sampling
Point
EC's-
Parcel Boundary
!:1,: C`_IA M axar. h?;:cCs4�o
FIGURE 1
PROPOSED SAMPLE LOCATION MAP
Sunbelt 4500 Site
Huffman Mill Rd
Burlington, Alamance County, NC
TM
ECS Proposal Number: 49:32172

GEOPROBE'R SCREEN POINT 15 GROUNDWATER SAMPLER
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GEOPROBE4 SCREEN POINT 15 GROUNDWATER SAMPLER