WM0501584_Final Permit_20231002

DocuSign Envelope ID: 2595A2C1-1309-4EF0-B6C8-EE519D030F66
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Ms. Linda Blalock
NCDEQ State Lead Program
1646 Mail Service Center
Raleigh, NC 27699-1646
Sent Via Email
NORTH CAROLINA
Environmental Quality
October 2, 2023
Subject: Monitoring Well Construction
Permit # WM0501584
Hobgood Service Center (RA-780-5499)
219 Commerce Street
Hobgood, NC 27843 — Halifax County
Ms. Blalock:
In accordance with the application received on September 28, 2023, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501584 dated October 2, 2023, issued for the construction
of a monitoring well system (installation of two wells). Please be aware that some counties have well
construction programs. and you may be reauired 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 Michael Hall at [phone] or via email at
[e-mail].
Sincerely,
ocuSigned by:
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& f.
2916E6AB32144F...
Vanessa E. Manuel, Assistant Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
-Permit
-Application Package
cc: Consultant/Agent
Laserfiche
D E Q ,fJ North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1611 Mail Service Center I Raleigh, North Carolina 27699-1611
NORTH CAROLINA (J1(�.'�O'�.(�OQO
Department of Emlmnmenfal Duali�

DocuSign Envelope ID: 2595A2C1-1309-4EF0-B6C8-EE519D030F66
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
NCDEQ State Lead Program
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of two monitoring wells owned by
the NCDEQ State Lead Program, 1646 Mail Service Center, Raleigh, NC 27699-1646. The wells will be
located on the property owned by Robert G. Anthony Jr. —Trustee on Pine Street (PIN 0801677), Hobgood,
NC 27843 . This Permit is issued in accordance with the application received on September 28, 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.
ocuSigned by:
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2916E6AB32144F...
Vanessa E. Manuel, Assistant Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number: WM0501584
Permit Issued: October 2, 2023
D E Q �J North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1611 Mail Service Center I Raleigh, North Carolina 27699-1611
NORrH CAROLINA �/ 919.707.9000
oepanmem or environmental auaii

ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
September 28, 2023
Mr. Michael Hall
Raleigh Regional Office
North Carolina Department of Environmental Quality
Water Quality Regional Operations Section
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Re: Permit to Construct Monitoring Well
Hobgood Service Center
219 Commerce Street
Hobgood, Halifax County, North Carolina
NCDEQ Incident #5499
Dear Mr. Hall:
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
Enclosed please find one application for a permit to construct two permanent
groundwater monitoring wells. The permanent groundwater monitoring wells will be
located at an unaddressed property (PIN #0801677) in Hobgood, Halifax County, North
Carolina. The permit application, site map with the proposed location of the monitoring
well, well construction details, and other relevant information are enclosed as
attachments. Please review this package and return the approved permit to this office or
via email to nicholas.krameO( oneatlas.com.
If you have any questions or require additional information, please contact our office at
[phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Nicholas Kramer
Project Scientist

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: 09/28/2023
2. County: Halifax
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Permanent Monitoring Well
4. Applicant: Linda Blalock — NCDEQ State Lead Telephone: [phone]
Applicant's Mailing Address: Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant's Email Address (if available): Linda. Blalock cDncdenr.gov
5. Contact Person (if different than Applicant): Nick Kramer, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): nicholas.kramer(aoneatlas.com
6. Property Owner (if different than Applicant): Robert G. Anthony, Jr. - Trustee Telephone: [phone]
Property Owner's Mailing Address: 207 Columbia Place West, Chapel Hill, NC 27516
Property Owner's Email Address (if available): rga.hhh(cDatt.net
7. Property Physical Address (Including PIN Number) Unaddressed property on Pine Street (PIN 0801677)
City Hobgood County Halifax Zip Code 27843
8. Reason for Well(s): Groundwater Contamination
(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: Underground storage tank
(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 #5499
11. Type of contaminants being monitored or recovered: Petroleum hydrocarbons
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 5 monitoring wells (MW-1 — MW-5)
and 1 recovery well (RW-1)
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0501163ANMO501531
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet):--140feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): —350 feet N of proposed wells
15. Well Contractor: Geologic Exploration, Inc. Certification No.: 4459-A
Well Contractor Address: 176 Commerce Boulevard, Statesville, NC 28625
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 flush -mount steel protective casing
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 10/18/2023
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 10/18/2023
(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
Signature of Applicant or *Agent
Nick Kramer
name of Applicant or *Agent
Agent for State Lead Site — Incident #5499 (Will include power
of Attorney upon request)
Title of Applicant or *Agent
* If signing as Agent, attach authorization agreement stating Printed
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 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
Raleigh, NC 27609
Fax: [phone]
2090 U.S. Highway 70
Phone: [phone]
Swannanoa, NC 28778
Fax: [phone]
Winston-Salem Regional Office
Phone: [phone]
450 W. Hanes Mill Road
Fax: [phone]
Washington Regional Office
Suite 300
943 Washington Square Mall
Winston-Salem, NC 27105
Fayetteville Regional Office
Washington, NC 27889
Phone: [phone]
225 Green Street, Suite 714
Phone: [phone]
Fax: [phone]
Fayetteville, NC 28301-5094
Fax: [phone]
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3800 Barrett Drive
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
GW-22M (Rev. 5/11)
GW-22MR Rev. 3-1-2016

;ETC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
April 25, 2022
Kay Mann Anthony
Robert G. Anthony, Jr.
207 Columbia Place West
Chapel Hill, NC 27516
Re: Access Agreement for Environmental Assessment
Hobgood Service Center
W. Commerce Street and S. Pine Street
Hobgood, Halifax County, North Carolina
NCDEQ Incident No: 5499
To Whom It May Concern:
2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
www.atcgroupservices.com
ATC Associates of North Carolina, P.C. (ATC), on behalf of the North Carolina Department of
Environmental Quality (NCDEQ), is conducting an environmental assessment at the former Hobgood
Service Center site located at the corner of West Commerce Street and South Pine Street in Hobgood,
Halifax County, North Carolina. As part of assessment activities, ATC is requesting permission to
install one monitoring well on your property located along South Pine Street (no numerical address
given - Parcel ID 0801677) in Hobgood, North Carolina, which is located southwest, across South Pine
Street, of the above referenced site. A map showing the location of your property in reference to the
site property is included.
You, as the property owner, will not be held responsible or held liable for any damages or expenses for
injury to persons or property while ATC is on the premises.
Please provide your authorization and approval by signing the attached signature page in the enclosed
envelope by May 25, 2022. Acknowledgment of this form is required by NCDEQ. Denial of site access
will be forwarded to NCDEQ for their pursuit of site access.
If you have any questions regarding these activities, please feel free to contact Ms. Ashley Winkelman
with ATC at ashley.winkelmangatc sg com or 919-871-0999 or Ms. Linda Blalock with NCDEQ at
Linda.Blalockgncdenr.gov or 919-707-8165.
Sincerely,
ATC Associates of North Carolina, P.C.
I'/' �-� V, /- � �
Ashley M. Winkelman, P.G.
Senior Project Manager

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ENVIROHMENTAL - GEOT'ECHIMAL
BUILUIIIG SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
www.atogroupservioes.com
Response to access request for property located along South Pine Street (no numerical address given -
Parcel ID 0801677) for Incident #5499:
Access approved
❑ Access denied
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E-mail:
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TYPICAL TYPE II MONITORING WELL CONSTRUCTION DETAILS
LOCKABLE WELL CAP
L1
I L4
L2
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
NOT TO SCALE
PROTECTIVE CASING AND CONCRETE PAD
CASING MATERIAL
Steel
CASING DIAMETER
8 inches
CASING LENGTH
12 inches
PAD DIMENSIONS
2 feet x 2 feet
HEIGHT ABOVE GROUND
flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 15 feet
BACKFILL AROUND CASING
MATERIAL cement -sand grout
THICKNESS 1 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 3 feet
FILTER PACK
TYPE OF FILTER
#2 silica sand
DISTANCE ABOVE SCREEN
1 feet
TOTAL FILTER PACK LENGTH
11 feet
WELL SCREEN
L3
SCREEN MATERIAL
sch 40 PVC
DIAMETER
2 inches
LENGTH
10 feet
SLOT SIZE
0.010 inches
L1 =
0
FT.
L2 =
5
FT.
L3 =
10
FT.
L4 =
15
FT.
DEPTH TO BOTTOM OF
MONITORING WELL 15 feet
DEPTH TO BOTTOM OF
BOREHOLE 15 feet
DIAMETER OF BOREHOLE 8.25 inches
TITLE Permanent Monitoring Well Diagram
(Example of typical MW installation displayed above) Amwcw
Hobgood Service Center 2725 East Millbrook Road, Suite 121
219 Commerce Street Raleigh, North Carolina 27604
Hobgood, NC
FILE PREP. BY REV. BY DATE PROJECT NO.
JR I NK 9/28/2023 STL0549901