WM0801214_Application_20221206 (2)

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: December 6, 2022
2. County: New Hanover
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant: Petitioner for DSCA Site ID DC650020 (Coastal Dry Cleaners)
Monitoring Wells
Telephone: [phone]
Applicant's Mailing Address: NCDEQ DWM, DSCA Program, Mike Cunningham 1949 Mail Service Center, Raleigh, NC 27699
Applicant's Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant): Nick Shore (AECOM) Telephone: [phone]
Contact Person's Mailing Address: 5438 Wade Park Boulevard, Suite 200, Raleigh, NC 27607
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Charles and Joan Davis Telephone: [phone]
Property Owner's Mailing Address: PO Box 1956, Carolina Beach, NC 28428
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 555 Castle Street (PIN 31279050920)
City Wilmington County New Hanover Zip Code 28401
8. Reason for Well(s): environmental assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: drycleaning
(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).
none
11. Type of contaminants being monitored or recovered: chlorinated solvents and metals
(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).: none
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0 feet
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 Certification No.: 2580A
Well Contractor Address: 176 Commerce Boulevard, Statesville, NC 28646
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: 1
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap
6. Estimated beginning construction date: Jan 3, 2023
7. Estimated construction completion date: Jan 4, 2023
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
Env. Project Manager
Signature of Applicant or `Agent Title of Applicant or *Agent
Nick Shore on behalf of DSCA Petitioner for DSCA Site ID DC650020
* 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) 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
164 Mooresville, NC 28115
.4
Phone: [phone]L w1° 111
411044 *TM
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

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MICHAEL SCOTT
Director
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
Program's contractor for this project, Nick Shore with AECOM
Technical Services of North Carolina (AECOM) at
nick.shore(a aecom.com or [phone]. If you still have questions after
contacting Mr. Shore with AECOM, please contact the DSCA Program Project
Manager, Mr. Mike Cunningham at [e-mail] or 919-707-
8361.
For DSCA Use Only
DSCA ID No.
DC650020
Please Print
Charles and Joan Davis
(Name of Property Owner or Tenant in Residence)
553/555 Castle Street (PIN - 31279050920)
(Street Number and Street Name of Property)
Wilmington, New Hanover County, NC 28401
(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 orthe 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 ofthe 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
LDE�Q
DwonwPi r [rhIrMenlrl
North Carolina Department of Environmental Quality 1 Division of Waste Management
217 West Jones Street 1 1646 Mail Service Center I Raleigh. North Carolina 27699-1646
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, 1 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".
c
(Signature of Property Owner or Tenant in Residence)
9/0 36,`7- 22t1QD
9� ) ,) 12 2
(Date)
(Telephone Number for Property Owner or Tenant in Residence for scheduling
work/notification)
f
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Nick Shore,
AECOM
5438 Wade Park Boulevard, Suite 200
Raleigh, NC 27607
[e-mail]
Phone [phone]
Or via email to: [e-mail]
DEQ
oew+m.M «i,vwanmw,m amm
North Carolina Department of Environmental Quality I Division of Waste Management
217 West Jones Street 1164b Mail Service Center I Raleigh. North Carolina 27699-1646
919.707.8200

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Map Location
Water Supply Well Map
Coastal Dry Cleaners
545 Castle Street
Wilmington, New Hanover County, North Carolina
Feet
August 2022
Figure 1
AECOM
5438 Wade Park Boulevard, Suite 200
Raleigh, NC 27607
Phone: [phone]

AECOM
Client: Coastal Dry Cleaners (DC650020)
Project Number: 60691549
WELL ID: Proposed Temp Wells
Site Location:
545 Castle Street, Wilmington, NC
Date Installed: 3-Jan-23
Well Location: Coords:
Inspector:
Method: 4.25" ID Hollow -Stem Auger
Contractor: Geologic Exploration Inc.
PROPOSED MONITORING WELL CONSTRUCTION DETAIL
Depth from G.S. (feet)
12-inch diameter flush -mount steel vault to be set in 2'x2'x0.5' concrete pad
Describe Measuring Point:
Top of Riser Pipe
Ground Surface (G.S.)
0.0
0.0
Riser Pipe:
Length 10
Diameter (ID) 2"
Type of Material PVC
Thickness Sch 40
Grout:
Type neat cement
Thickness 6
Top of Bentonite
6
Bentonite Seal Thickness 2
Top of Sand 8
Top of Screen 10
Screen:
Length 10
Diameter (ID) 1"
Slot Size 10 slot
Type of Material PVC
Thickness Sch 40
Type/Size of Sand #2
Sand Pack Thickness 12
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Borehole Diameter 4.25" ID DPT
6
6
6
Elevation (feet)
Datum
Signature Date
Note: Depths are approximate and will be adjusted based on field conditions. Not to scale.