WM0701308_Application_20230915

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: 8/30/2023
2. County: Jones
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: American Battlefield Trust — Ms. Kathleen M. Robertson Telephone: [phone]
Applicant's Mailing Address: 1156 15th Street NW, Suite 900, Washington D.C. 20005
Applicant's Email Address (if available): kobertson(a-)battlefields.org
5. Contact Person (if different than Applicant): ECS Southeast, LLP — Samantha M. Szakasits Telephone: [phone]
Contact Person's Mailing Address: 6714 Netherlands Drive, Wilmington, North Carolina 28405
Contact Person's Email Address (if available): sszakasits(a)ecslimited.com
6. Property Owner (if different than Applicant): Carolyn D. Hinnant Telephone:
Property Owner's Mailing Address: 6276 US Highway 70, Goldsboro, North Carolina 27530
Property Owner's Email Address (if available): sand p72(a)gmail.com
7. Property Physical Address (Including PIN Number) 6276 US Highway 70 (PIN 454338267200)
City Dover County Jones Zip Code 28501
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: UST and off -site REC
(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 and 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).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): approximately 190 feet Southeast
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Unknown
If yes, give distance(s): N/A
15. Well Contractor: TBD Certification No.: TBD
Well Contractor Address: TBD
PROPOSED WELL CONSTRUCTION INFORMATION
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: 4
3. Number of wells to be constructed in bedrock: Zero 0
5. How will the well(s) be secured? Not Applicable —
temporary monitoring wells to be abandoned upon completion
6. Estimated beginning construction date: TBD
4. Total Number of wells to be constructed: 4 7. Estimated construction completion date: TBD
(add answers from 2 and 3)
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 assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Signature of Applicant or *Agent
American Battlefield Trust
Printed name of Applicant or *Agent
Director of Project Management
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
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.
SEE ATTACHED
Signature of Property Owner (if different than Applicant)
Carolyn D. Hinnant
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]
GW-22M/R (Rev. 5-26-2022)

American Battlefield Trust
49:39434P
PROPERTY OWNER ACCESS AUTHORIZATION FORM
ECS Southeast, LLP
Proposal No.: 49:39434P
Project Name: Daugherty/Hinnatt Tract
Location: 6276 Highway 70, Dover, Jones County, North Carolina 28501
PIN(s): 454338267200
As part of the proposed real estate transaction, ECS Southeast, LLP (EC5) has been requested by
the purchaser 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 soil and groundwater sampling. By signed below, the property
owner
authorizes ECS to conduct the aforementioned sampling at the site.
Property Owner (Please Print)
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USGS TOPOGRAPHIC MAP
7.5 — MINUTE SERIES s
RIVERMONT & DOVER, NC
DATED 2019
SCALE SHOWN ABOVE
CONTOUR INTERVAL = 10'
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FIGURE 1
SITE TOPOGRAPHIC MAP
Daugherty/Hinnatt Tract
6276 Highway 70
Dover, Jones County, North Carolina
ECS Project Number: 49:19698-A

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(estimal�s G sair samples
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Legend
Site Parcel Boundary
Proposed Temporary Monitoring Well Location
N
FIGURE 2
SOURCE: "Y` F PROPOSED SAMPLE LOCATION MAP
GOOGLE EARTH
2020 IMAGERY Daugherty/Hinnatt Tract
6276 Highway 70
SCALE SHOWN ABOVE Dover, Jones County, North Carolina
iT" ECS Project Number: 49:19698-A

APPROX.
500 FOOT
RADIUS
p
NO WATER SUPPLY WELLS OR POTENTIAL SOURCES
OF CONTAMINATION ARE KNOWN TO EXIST OTHER
THAN ILLUSTRATED ABOVE.
SOURCE: N
NCDEQ
DWM SITE LOCATOR TOOL s
APPROXIMATE SCALE: I Ecrvso
= 420 FEET
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SITE PARCEL
BOUNDARY
FIGURE 3
POTENTIAL SOURCES MAP
Daugherty/Hinnatt Tract
6276 Highway 70
Dover, Jones County, North Carolina
ECS Project Number: 49:19698-A

GROUND TOP OF DIRECT PUSH STEEL
r, IRrnrF RODS ABOVE THE LAND
SURFACE
ESTIMATED
—15' FEET
1.5-INCH STEEL DIRE
NATURAL FORMATION
PUSH RISER
BACKFILL
2--INCH BORE
HOLE
GROUNDWATER
SLOTTED STEEL S
0.01-INCH SLOT W
SET TO INTERSECT GROI
ESTIMATED 4 FEET IN
WELL CONSTRUCTION DI
REPRESENTATIVE OF DIRECT
DnIKIT 4ZARAD1 GI
CT
CREEN
IDTHS
JNDWATER
LENGTH
AGRAM IS
PUSH SCREEN
2
FIGURE 4
PROPOSED TEMP SCREEN POINT SAMPLER
Daugherty/Hinnatt Tract
NOT TO SCALE 6276 Highway 70
Dover, Jones County, North Carolina
ECS Project Number: 49:19698-A