WM0501568_Application_20230718

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: July 18, 2023
County: Wake
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring Wells
Applicant: Six Forks-FCA, LLC - Petitioner for DSCA Site ID DC920020 (Sherrill's Cleaners) Telephone: [phone]
Applicant's Mailing Address: NCDEQ DWM, DSCA Program, Jay King 1949 Mail Service Center, Raleigh, NC 27699
Applicant's Email Address (if available): a ay.kinq(cDncdenr.gov
Contact Person (if different than Applicant): Nick Shore (AECOM) Telephone: [phone]
Contact Person's Mailing Address: 5438 Wade Park Boulevard, Suite 200, Raleigh, NC 27607
Contact Person's Email Address (if available): nick.shore(@aecom.com
Property Owner (if different than Applicant): City of Raleigh (Lenny Wallace) Telephone: [phone]
Property Owner's Mailing Address: PO Box 590, Raleigh, NC 27602
Property Owner's Email Address (if available): linwood.wallace(a)raleighnc.gov
Property Physical Address (Including PIN Number) City Right of Way at 7512 and 7601 Stuart Drive
City Raleigh County Wake Zip Code 27615
Reason for Well(s): environmental assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed:
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
none
11. Type of contaminants being monitored or recovered: chlorinated solvents and metals
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 14
Existing Monitoring or Recovery Well Construction Permit No(s).: Unknown, MWs installed by previous consultant
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 2,040 and 2,625 feet
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: Geologic Exploration Certification No.: 2580A
Well Contractor Address: 176 Commerce Blvd., Statesville, NC 28626
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 5. How will the well(s) be secured? Locking well cap
material: 2
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 8-9-23
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 8-9-23
(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 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
Env. Project Manager
ig ature of Applicant or *Agent Title of Applicant or *Agent
Nick Shore on behalf of DSCA Petitioner for DSCA Site ID 920020
* 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).
See Attached Access Agreement
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 Gen
Mooresville, F
Phone: (704';
Fax: (704) 6(
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]
-ax: [phone]
GW-22MR Rev. 3-1-2016

1L-A LEGEND
1
MW-4 (2/24/2010) 00
® Monitoring Well Location
1 BDL - Bch Abandoned Monitoring Well Location
IHOP to Peachtree Market
Eye Care Shopping Center Restaurant
Center Pore/Surface Water Sample Location
MW-1 (11/30/2016) N�JEXPO�URE UNIT #1 Sher ' ' - BB T MW-3 (10/29/2014) 0G Exposure Unit Bound
3 Chloroform - 12.8 ug/1 Ba p Boundary
eaning PCE - 1.1 ug/1
:VIW-11 (2/22/2010) 00 � � � / lhp Chloroform - 0.84 J ug/1 - Potentiometric Surface Contour (ft/msl)
� Inferred Groundwater Flow Direction
BDL
I
i - I MW-7S (2/22/20101 �� Surficial Drainage Feature
MW-2 Naphthalene
/2 5 J /l Chloroform- 3.6 J ug/l Unnamed Tributary to Mine Creek
Naphthalene - 0.5 J ug/l
PCE - 470 ug/1 EXPOSURE UNIT #2 � lebration at._ � Naphthalene - 0.84 J ug/1 � Approximate Location of Stormwater Pipe
Six atiou MW-7D (2/22/2010) 00
TCE - 0.5 J ug/1 f Chloroform- 3.4 J ug/l ■ Approximate Location of Dry -Cleaning
Chloroform - 0.39 J ug/1 Sh ping C'cntcr Grand g Machine
Asia Buffet )�'
BDL Below Laboratory Detection Limits
MW-5S (10/29/2014) }{ 4 J Estimate Value
DRY / ' ( - _ _ MW-8S (2/24/2010)
NM-5D (10/29/2014) N BDL ug/1 micrograms per liter
PCE - 4.3 u 1 # McDonald's MW-8D (2/24/2010) N -1
Restaurant J
{/ i Chloroform- 0.66 J ug/1 l J Area of PCE 2L Standard Exceedance
MTBE - 1.1 ug/1
' Chloroform- 3.3 J ug/l _ Naphthalene - 0.77 J ug/1
_ Red highlighted text indicates samples exhibiting greatest
MW-10 (1/11/2018) 00 VI risk in each exposure unit.
BDL i 3�
�' _ � PCE - Tetrachloroethene
- I MTBE - Methyl tert-butyl ether
MW-6 (7/3/2013) 00 L 3� Groundwater analytical results do not exceed
f' PCE - 5.3 ug/l / 00 calculated vapor intrusion risk for residential
Chloroform- 1.2 J ug/l MW-9S (1/11/2018) 00 or non-residential exposure - DSCA Indoor
Naphthalene - 0.49 J ug/l PCE - 8.68 ug/l Air Risk Calculator, Version 8, March 2021.
r Y% II MW-9D (1/11/2018) 00 Groundwater analytical results exceed
r s,. PCE - 8.06 ug/l
N calculated vapor intrusion risk for residential
and non-residential exposure - DSCA Indoor
* MW-12 (1/11/2018) 00 / Air Risk Calculator, Version 8, March 2021.
BDL
Note: Two surface water samples are labeled
SW-106. Location SW-106* was sampled in 2021
MW-13 (10/29/2014) 00 -
MW-14 (11/30/2016) 00 1 PCE - 0.49 ug/1 f. {
PCE - 8.1 ug/1 f _ Chloroform - 0.81 J ug/l ; ;r
/ MTBE - 0.63 J ug/1
r
PW-101 (12/17/2018)
SW-106 (3/13/2019) BDL
r • x BDL ,
PW-106 (3/13/2019) N i SW-101 (12/17/2018)
"� BDL
BDL
1 PW-106 (8/24/2021)
BDL
SW-106* (8/24/2021)
MW-15S (11/30/2016) 00 BDL
PCE - 9.53 ug/1
MW-15D (10/29/2014, 00 '
PW'-102 (12/17/2018)
PCE - 12 ug/l Toluene - 4.07 ug/1
Acetone- 1,800ug/l
Chloroform- 0.92 J ug/1
PW-103 (12/17/2018)
4 PCE - 1.60 ug/l
PW-107 (8/24/20211 SW-103 (12/17/2018) ; C
Acetone - 15.1 J ug/l BDL
p-isopropyltoluene - 151 ug/l f
2-Butanone - 5.94 ug/l Y'
Toluene - 7.67 ug/1 _ PW-104 (3/13/2019) x
� SW-108 (8/24/2021) f PCE - 1.06 ug/1
BDI. SW-104 (3/14/2019)
BDL
SW-107 (8/24/2021)
BDL
{ PW-108 (8/24/20211 Pam'-105 (31 3/20191
Carbon Disulfide - 0.37E J ug/l r+� BDL
w � ASW-105 (3/14/2019) -
.r' �# PW-109 (8/24/20211 BDL
* BDL
PW-110 (8/24/2021) - t ! 0
Carbon Disulfide - 0.364 Jug/l
. p-isopropyltoluene - 7.0 ug/l -
SW-109 (8/24/2021) a
BDL _
i
f�
0 320
APPROX. SCALE, ft.
J �Ad4#
r
DRAWN BY Groundwater Quality Summary Map
�l y SDH - 03/22/2019 AECOM TECHNICAL SERVICES OF
D_EP"=COM
NORTH CAROLINA, INC. Sherrill's Dry Cleaners
CHECKED EY: 5925 CARNEGIE BLVD. SUITE 370
FNs - 03/22/2019 , CHARLOTTE, NC 28209 7463 Six Forks Road
TEL [phone] Raleigh- NC;

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Dataset, Geographic Names Information System, National Hydrography
1,000 500 0 1,000 Dataset, National Land Cover Database,NationalStructures Dataset, and
National Transportation Dataset; U.S. Census Bureau - TiGER/Line; HERE
Scale in Feet Road Data
Site Location Map
AECOM Q
AECOM5438 Wade Park Boulevard, Suite 200 Sherrill's Dry Cleaners
Raleigh, NC 27607 7463 Six Forks Road
Phone: [phone]
Fax: [phone] Raleigh, NC
www.aecom.com DSCA Site ID: DC920020 SHEET:
I I I Figure 2

Client: Sherrill's Cleaners (DC920020)
WELL ID: Proposed Type II Well
_ Project Number: 60695852
A:COM Site Location: 7512 and 7601 Stuart Drive, Raleigh, NC Date Installed: 9-Aug-23
Well Location: Coords: Inspector:
Method: 4.25"ID HSA Contractor: Geologic Exploration
PROPOSED MONITORING WELL CONSTRUCTION DETAIL
Depth from G.S. (feet) Elevation (feet)
Datum
8-inch diameter flush -mount steel vault to be set in 2'x2'x0.5' concrete pad
Top of Riser Pipe 0.0
Ground Surface (G.S.) 0.0
Benton
Describe Measuring Point:
Note: Depths are
Riser P
ipe:
Length
Diameter (ID)
Type of Material
Thickness
Grout:
Type
Thickness
Top of Bentonite
60
neat cement
55'
ite Seal Thickness
3'
Top of Sand
Top of Screen
Screen:
Len gth
10
Dia meter (ID)
2"
Slot Size
10 slot
Type of Material
PVC
Thickness
Sch 40
Type/Size of Sand
#2
Sand Pack Thickness
12
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Borehole Diameter 4.25" ID HSA
Signature
and will be adjusted based on field conditions. Not to scale.
55
58
60
70
70
70
Date