WM0401415_Monitoring Well Permit Applicqation_20221202

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Mr. Leo VanBuuren
McDonald's US, LLC
110 North Carpenter Street
Chicago, Illinois 60607
NORTH CAROLINA
Environmental Quality
December 2, 2022
SUBJECT: MONITORING WELL CONSTRUCTION
PERMIT NO. WM0401415
COUNTY: Stokes
FILE NAME: 1071 and 1075 North Main Street
Dear Mr. VanBuuren:
In accordance with your application received on November 29, 2022, we are forwarding herewith:
1. Monitoring Well Construction Permit No. WM0401415 for the construction of three (3)
temporary monitoring wells at 1071 and 1075 North Main Street in Walnut Cove in Stokes
County.
Henceforth, correspondence and data relating to these wells shall be designated as specified in the
subject heading above. This Permit will be effective from the date of issuance and shall be subject
to the conditions and limitations as specified therein. If you have any questions regarding this
permit, please contact me or Jim Gonsiewski at [phone].
Sincerely,
DocuSigned by:
M l . JMItP
145B49E225C94EA...
Lon T. Snider
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ - WSRO
cc: Dimitrios Sialmas
Ron Navarro — ECS Southeast, LLP (Electronic Copy)
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NORTH C CUNA '
D. mmmr� .ore.nt o�.i
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 W. Hanes Mill Rd, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES — WATER QUALITY REGIONAL OPERATIONS
SECTION
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
McDonald's US, LLC
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of three (3)
temporary monitoring wells owned by McDonald's US, LLC. The wells will be located at 1071
and 1075 North Main Street in Walnut Cove, North Carolina, in Stokes County. This Permit is
issued in accordance with the application received on November 29, 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:
D_E
NORTH CAROLINA
gaparMeM of Environment,/quay
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 W. Hanes Mill Rd, Suite 300 I Raleigh, North Carolina 27105
336.776.9800

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
Resources' 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 Resources' Information Processing Unit within 30 days of the well
abandonment.
7. The County Health Department may require a county monitoring well construction permit.
Please contact the health department for their requirements.
Permit issued the 2nd day of December, 2022
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
D_E
NORTH CAROLINA
EDocuSigned by:
L-oti 1ig. 3Mau-
145B49E225C94EA...
Lon T. Snider, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ - WSRO
By Authority of the Environmental Management Commission
gaparMeM of Environment,/quay
Permit No. WM0401415
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 W. Hanes Mill Rd, Suite 300 I Raleigh, North Carolina 27105
336.776.9800