WM0801217_Application_20230203

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
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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.
Date: 2/3/2023
County: New Hanover
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: Capital Growth Buchalter — Mr. Jeffery Lewin Telephone: [phone]
Applicant's Mailing Address: 361 Summit Blvd, Suite 110, Birmingham, AL 35243
Applicant's Email Address (if available): Ilewin(a)cgpre.com
Contact Person (if different than Applicant): Travis O'Quinn Telephone: [phone]
Contact Person's Mailing Address: 1812 Center Park Drive, Suite D Charlotte, NC 28217
Contact Person's Email Address (if available): tloguinn(a-)ecslimited.com
Property Owner (if different than Applicant): Wilmington 17th Street WW, LLC (PIN 06015-003-002-001) — Ms. Daniellle E.
Yance Telephone: [phone]
Property Owner's Mailing Address: 361 Summit Blvd, Suite 110, Birmingham, AL 35243, Wilmington, New Hanover, North
Carolina
Property Owner's Email Address (if available): Not Available
Property Physical Address (Including PIN Number): 2402 South 17t" Street, Wilmington, New Hanover County, NC (PIN
06015-003-002-001)
8. Reason for Well(s): Environmental Assessment
9. Type of facility or site for which the well(s) is(are) needed: Gas Station/Convenience Store
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).
Not Applicable
11. Type of contaminants being monitored or recovered: VOCs, SVOCs, Metals, EPH/VPH, EDB and DBCP
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).: Not Applicable
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 280 ft to the northeast
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): Not Applicable
15. Well Contractor: Quantex, Inc. Certification No.: 3106
Well Contractor Address: ibarker3(a-)nc.rr.com
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
(ex:

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Lockable caps
material: 2 and bolted covers
3. Number of wells to be constructed in bedrock
6. Estimated beginning construction date: to be
determined
4. Total Number of wells to be constructed: 2
(add answers from 2 and 3) 7. Estimated construction completion date: TBD
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. 143-215.10B(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 Applicant or *Agent
Travis O'Quinn / ECS / Agent of Capital Growth Buchalter
Printed name of Applicant or *Agent
Environmental Project Manager
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 signed Access Agreement Wilmington 17th Street WW, LLC
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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
✓1R Rev. 3-1-2016

ECS SOUTHEAST, LLP
ECS SOLITHE,AS1, LLP
PRO PtRTY OWN E R ACCLS5 AUTHORIZAT ION
Pr4pOs,al ND.: 4M5414P
Rope of Wckrk. PI nposat for Environmental Assessment Servibas
Prolect: ProPond Wawa Vvilmington
L tion: 2402 South 17tl'Street (PN R06015-43-002-mi)
1NitmiVon, New Harlower, North Carolina
As part of the proposed real estate transaction, EC$ Southeast, LLP JECS) has been requr:sted by the
purrrhmsar to tunduct subsurface grvundwatt�r quality sampling at the site. The groundwater sampling
r-Oqudnes that ECS procure a permit from tNe North Carolina Department of Enylronment4l Quality
(NCDM).
ECS reVecliulfy requests that tlhe owner of the property grant permisslorr to EC-5 to access the tmPertY
to conduct the soil an-d groundwater sampling. By slgning belpw, the property owner authorizes ECS to
GDndurt the aforementioned sampling at the site -
Property Ownur (please print): Danielle E, Yanoe, Aurhnriged Agent
P-Pe ty Owner Telephone f;4ease print}. 205-253-4591
Property oymer Signature [)atx: February I, 2023
Page 12 GC�w

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SOURCE:
FIGURE 1
SITE TOPOGRAPHIC MAP
USGS TOPOGRAPHIC MAP
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Proposed Wawa Wilmington
7.5 — MINUTE SERIES
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2402 South 17th Street
WILMINGTON, NC
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New Hanover County, NC
DATED 2022
ECS Project No. 49:17626-A

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NO WATER SUPPLY WELLS OR POTENTIAL SOURCES OF CONTAMINATION ARE KNOWN TO EXIST OTHER THAN ILLUSTRATED ABOVE.
SOURCE: FIGURE 2
NEW HANVOER COUNTY GIS POTENTIAL SOURCES MAP
DATED 2021 & NCDEQ s Proposed Wawa Wilmington
DWM SITE LOCATOR TOOL
C2402 South 171" Street
APPROXIMATE SCALE:S Wilmington, New Hanover County, NC
As Shown
ECS Project No. 49:17626-A

GROUND MONITORING WELL COVER
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a- -A A- FIGURE 4
PROPOSED MONITORING WELLSC 1:
Proposed Wawa Wilmington
2402 South 171" Street
Wilmington, New Hanover County, NC
ECS Project No. 49:17626-A