WQ0029894_Final Permit_20230119 (2)

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Stallings Oil Company
300 S. Weslyan Blvd, Suite 200
Rocky Mount, NC 27804
Subject:
Mr. Discoll:
NORTH CAROLINA
Environmental Quality
January 19, 2023
Monitoring Well Construction
Permit # WM0501532
Former Zip Mart #15
2510 Sunset Avenue
Rocky Mount, NC 27804 — Nash County
In accordance with the application received on January 17, 2023, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501532 effective January 19, 2022, issued for the
construction of a monitor well system (installation of five wells). Please be aware that some counties
have well construction programs, and you may be required to obtain a well construction permit
before installation.
This Permit will be effective from the date of its issuance and shall be subject to the conditions and
limitations as specified therein. Please note the addition of stipulation #3 to the permit enclosed. If you have
any questions about this permit, please contact Tyler Clark at [phone].
Enclosure
cc: RRO Files/Laserfiche
NORTH CAROLINA
Department M Environmental Quality
Sincerely,
cu Signed by:
&AAA-SSA,
f. A� ail ltit al f or�
916E6AB32144F.
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11611 Mail Service Center I Raleigh, North Carolina 27699-1611
919.707.9000

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
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
Stallings Oil Company
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of five monitoring wells owned
by Stallings Oil Company, 300 S. Weslyan Blvd, Suite 200, Rocky Mount, NC 27804. The wells will be
located 6394 River Walk Drive, Rocky Mount, NC, 27803 owned by Tripp Investments, LLC. This
Permit is issued in accordance with the application received on January 17, 2023, 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:
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 Quality's
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 Quality's
Information Processing Unit within 30 days of the well abandonment.
7. If the well penetrates any water -bearing zone that contains contaminated waters, the upper three feet of the
well shall be grouted within one day after the casing is set or the well abandoned.
Permit issued the 19th of January 2023
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Docu Signed by:
Flavu-ssa f. hatiutal For
B2916E6AB32144F...
Scott Vinson, Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
Permit No. WM0501532
£ D_E
NORTH CAROLINA
Department of Environmental Duel
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11611 Mail Service Center I Raleigh, North Carolina 27699-1611
919.707.9000

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
NUR I h UAKULINA 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: 1/16/2023
2. County: Nash
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Stallings Oil Company
Telephone: [phone]
Applicant's Mailing Address: 300 S. Weslyan Blvd, Suite 200, Rocky Mount, NC 27804
Applicant's Email Address (if available): btolman[d3bmtco.net
5. Contact Person (if different than Applicant): Scott Driscoll
Telephone: [phone] x2627
Contact Person's Mailing Address: Geological Resources, Inc., 113 W. Firetower Rd., Suite G, Winterville, NC 28590
Contact Person's Email Address (if available): sdriscoll ac geologicalresourcesinc.com
6. Property Owner (if different than Applicant): Tripps Investments LLC Telephone: [phone]
Property Owner's Mailing Address: 6394 River Walk Drive, Rocky Mount, North Carolina, NC 27803
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 2510 Sunset Avenue / PIN 017163
City Rocky Mount County Nash Zip Code 27804
8. Reason for Well(s): 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: Former UST
(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).
NCDEQ Incident No. 15091
11. Type of contaminants being monitored or recovered: Petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many?
Existing Monitoring or Recovery Well Construction Permit No(s).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet):
20
—60'
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: Justin Radford Certification No.: 3270
Well Contractor Address: 3502 Hayes Road, Monroe NC 28110
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

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
Printed name of Applicant or *Agent
2. Number of wells to be constructed in unconsolidated
material: 5
5. How will the well(s) be secured? Locking/Manhole
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: Jan 2023
4. Total Number of wells to be constructed: 5
(add answers from 2 and 3)
7. Estimated construction completion date: Jan 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 assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Pt kee-4 G�2L
Signature of Applicant or *AgentTitle of Applicant or *Agent(
f* 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
well(s) as outlined in this Well Construction Permit application and acknowledges that it shall be the responsibility of the Applicant to
ensure that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C.
RTE Attached
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]
,..1.\ �-ii WinAton+5oler
.
Moorpsvwile•
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-22M/R (Rev. 5-26-2022)

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
GR
Geological Resources, Inc.
October 18, 2022
Tripps Investments, LLC
6394 River Walk Drive
Rocky Mount, North Carolina 27803
Re: Right to Enter Agreement
Stallings Oil Company/Former Zip Mart #15
2412 Sunset Ave
Rocky Mount, North Carolina
Nash County
GRI Project No. 2965
Dear Property Owner:
Geological Resources, Inc. (GRI), on behalf of Stallings Oil Company of Rocky Mount, North Carolina, is
conducting an environmental assessment at the above referenced property. The assessment activities
are being conducted at the direction of the North Carolina Department of Environmental Quality (NCDEQ).
It is our understanding that you are the owner of the property identified as parcel number 017163 located
at 2510 Sunset Avenue in the city of Rocky Mount, Nash County. To complete the assessment, GRI,
requires permission to enter your property to conduct ground water sampling and further environmental
assessment, which may include additional sub -surface investigation. A site map with the proposed
monitoring well locations is included for your reference.
At your earliest possible convenience, please sign the right -to -enter agreement and return it via email, fax
or US Mail. GRI will attempt to minimize any inconvenience to you or tenants that the activities may
cause.
The ground water assessment activities will be conducted at NO COST TO YOU, as Stallings Oil Company
is being directed to complete further sampling and assessment at the direction of NCDEQ.
Your cooperation in this matter is greatly appreciated. Please do not hesitate to contact me at (919) 920-
3662 if you have any questions or require additional information concerning this request. I can also be
reached by email at [e-mail].
3502 Hayes Road • Monroe, North Carolina 28110
Phone [phone] • [phone] • Fax [phone]

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
Former Zip Mart #15
Rocky Mount, NC
Page 2 of 3
Sincerely,
Scott Driscoll
Project Manager
Enclosures
3502 Hayes Road • Monroe, North Carolina 28110
Phone [phone] • [phone] • Fax [phone]

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
RIGHT TO ENTER AGREEMENT
FOR
CONDUCTING SUBSURFACE INVESTIGATIONS
STATE OF NORTH CAROLINA
COUNTY OF NASH
RECEIVED NOV 07 2022
We, the undersigned, being all of the fee simple owners of certain tracts or parcel designated as 017163
of the County of Nash, recognizing the benefits to said properties by reason of conducting subsurface
investigations hereby grant to Stallings Oil Company and the agents the right to enter said property in
accordance with the requirements of the State of North Carolina. Stallings Oil Company's agents may
include Geological Resources, Inc.
The undersigned hereby covenant and warrant that they are the sole owners of said property; that they
solely have the right to grant this right to enter for conducting subsurface investigations against the lawful
claims of all persons whomsoever.
It is agreed that Stallings Oil Company shall be responsible for restoring any damage done to the ground
of said property by its employees or its agents during the subsurface investigation and monitoring period,
and that Stallings Oil Company shall abandon monitoring wells on said property in accordance with NCDEQ
requirements at the conclusion of the monitoring and investigation period.
It is agreed that Stallings Oil Company shall hold harmless the owner of the aforementioned property for
any personal injury that might be sustained during the course of conducting or proximately resulting from
the conduct of subsurface investigations.
Right to Enter denied.
Right to Enter granted.
Signature
phone 27 2'- ?.,9/I 9
Date
(RTE Former Zip Mart #15)

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
TYPE II CVO\ITORI\G WELL
TYPICAL CONSTRUCTION DETAILS
CONCRETE PA
GROUND SURFACE
0'
GROUT CEMENT
BENTONITE SEAL
SAND FILTER PACK
a
PROPOSED WELL DEPTH 15' BGS
MANHOLE COVER
Traffic bearing; flush mounted; domestic steel
�L OCK/NG WELL CAP
a ad
11
4 a
a
2 /NCH DIAMETER
SCHEDULE 40 PVC CAS/NG
(PROPOSED CAS/NG LENGTH
OF 2 FEET)
TOP OF BENTONITE 2' BGS
TOP OF SAND PACK 3' BGS
0.010 /NCH SLOTTED
2 /NCH DIAMETER
SCHEDULE 40 PVC SCREEN
(PROPOSED SCREEN LENGTH
OF 10 FEET)
END CAP
Note:
1. This diagram is not to scale.
Geological Resources, Inc.

DocuSign Envelope ID: ACC93421-C726-464A-90E0-8AF6D6636813
CONNECTG15 el Nash County
[S.05*i NC. N i fl CG olino
2521
2 517
251'
013376
016338
Proposed Well Locations _ o224=
up to 5 monitoring wells
Project Site
016026
NashCc
Printed October 17,
See Below for Disch
03368
ConnectGlS has been prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this system are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained in this system. Nash Cc
Withers & Ravenel, ConnectGlS and other mapping companies assume no legal responsibility for the information contained in this system. Grid data is based on the North Carolina state plane coordinate system, 1983 North American Datum (NC NAD83).