WM0100542_Monitoring Well Construction Application_20230404

FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
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:4/4/2023
2.County: Caldwell
3.What type of well are you applying for? (monitoring or recovery):Monitoring
4.Applicant: First Citizens Bank & Trust Company Telephone: [phone]
Applicant’s Mailing Address: 4300 Six Forks Road, Raleigh, NC 27609
Applicant’s Email Address (if available): [e-mail]
5.Contact Person (if different than Applicant): Mackie McMahan Telephone: [phone]
Contact Person’s Mailing Address: 1900 Center Park Drive, Suite A, Charlotte, NC 28217
Contact Person’s Email Address (if available): [e-mail]
6.Property Owner (if different than Applicant): Cogdell Investors, LLC Telephone:[phone]
Property Owner’s Mailing Address: 6023 Tindall Park Dr., Suite 209, Charlotte, NC 28210
Property Owner’s Email Address (if available):
7.Property Physical Address (Including PIN Number)1031 Morganton Blvd. SW, Unit B – PIN 06-129-1-5-A
City Lenoir County Caldwell Zip Code 28645
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: Historic auto repair
(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).:
13.Distance from proposed well(s) to nearest known waste or pollution source (in feet):N/A
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: 3D Environmental Investigations Certification No.: 3162
Well Contractor Address: 2157 Mocksville Hwy, Statesville, NC 28625
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
WM0100542 4/10/2023

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)

2. Number of wells to be constructed in unconsolidated
material: 4

3. Number of wells to be constructed in bedrock: 0

4. Total Number of wells to be constructed: 4
(add answers from 2 and 3)
5. How will the well(s) be secured? Temporary

6. Estimated beginning construction date: 4/14/23

7. Estimated construction completion date: 4/14/23

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

as Agent ECS as Agent
Signature of Applicant or *Agent Title of Applicant or *Agent

Mackie McMahan * 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).

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]

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

March 30, 2023
ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49:34135P
Scope of Work: Phase II Environmental Assessment
Project: FCB Project # 22-017933-02-2 Morganton
Location: 1031 Morganton Blvd SW Unit B, Lenoir, Caldwell County, North Carolina
PIN: 06-129-1-5-A
As part of the proposed real estate financing transaction, ECS Southeast, LLP (ECS) has been requested by
the property owner to conduct subsurface soil and 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 groundwater sampling. By signing below, the property owner authorizes ECS to conduct
the aforementioned sampling at the site.
Property Owner (please print): Cogdell Investors (Lenoir), LLC
Property Owner Address (please print): 6023 Tindall Park Drive #209, Charlotte, North Carolina 28210

Property Owner Telephone (please print): [phone]
Property Owner sera Bee Disa Aaa Sipahing Date: April 2, 2023

ECS Project No. 49:34135P
Page | 1 S
SOURCE:
ECS PHASE I ESA
DATED SEPTEMBER 28, 2022
SCALE:
AS SHOWN
FIGURE
PROPOSED SAMPLE LOCATION MAP:
FCB PROJECT # 22-017933-02-2 MORGANTON
1031 MORGANTON BLVD SW UNIT B
LENOIR, CALDWELL COUNTY, NORTH CAROLINA
ECS PROPOSAL NO. 49:34135P
LEGEND:
Proposed Groundwater Sample Location
Approximate Site Boundary
WELL CONTRUCTION DIAGRAM IS
REPRESENTATIVE OF DIRECT PUSH SCREEN
POINT SAMPLER
TOP OF DIRECT PUSH STEEL
RODS ABOVE THE LAND
SURFACE
NOT TO SCALE
2--INCH BORE
HOLE
1.5-INCH STEEL DIRECT
PUSH RISER
GROUND
SURFACE
GROUNDWATER SLOTTED STEEL SCREEN
0.01-INCH SLOT WIDTHS
SET TO INTERSECT GROUNDWATER
ESTIMATED 4 FEET IN LENGTH
NATURAL FORMATION
BACKFILL
30 FEET
FIGURE 3
PROPOSED TEMPORARY SCREEN
POINT SAMPLER
PROPOSED MAVIS STORE 2066
2025 HOFFMAN RD.
GASTONIA, GASTON COUNTY, NORTH CAROLINA
ECS PROJECT NUMBER 49-16987-A