WM0501596_Final Permit_20231114

DocuSign Envelope ID: CF1E44F2-5F4B-44C6-83BA-7AD4F16E1092
ROY COOPER Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR. NORTH CAROLINA
Director Environmental Quality
November 14, 2023
Mr. Jason Kam
North Carolina Department of Environmental Quality
Inactive Hazardous Sites Branch
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
Sent Via Email
Subject: Monitoring Well Construction
Permit # WM0501596
Cary Dump (NONCD0000602)
313 North Dixon Avenue
Cary, NC 27513 — Wake County
Mr. Kam:
In accordance with the application received on November 13, 2023, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501596 dated November 14, 2023, issued for the
construction of a monitoring well system (consisting 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:
E�D
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2916E6AB32144F...
Vanessa E. Manuel, Assistant Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
-Permit
-Application Package
Ec: Tim Grant, ATC
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: CF1E44F2-5F4B-44C6-83BA-7AD4F16E1092
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
The North Carolina Department of Environmental Quality, Inactive Hazardous Sites Branch
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of two monitoring wells owned by
The North Carolina Department of Environmental Quality, Inactive Hazardous Sites Branch, at mailing
address 1646 Mail Service Center, Raleigh, NC 27699-1646. The well will be located on the property owned
by Ronald and Constance Pappalardo at 935 Madison Avenue, Cary, NC 27513. This Permit is issued in
accordance with the application received on November 13, 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
ocuSigneaby: the well shall be grouted within one day after the casing is set or the well abandoned.
E�D
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2916E6AB32144F...
Vanessa E. Manuel, Assistant Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number: WM0501596
Permit Issued: November 14, 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

DocuSign Envelope ID: CF1E44F2-5F4B-44C6-83BA-7AD4F16E1092
IYVRI rl Vf1RVL11Y/1 L/CrMr%I IVIC-111 1 yr CI14VIF%W14MENTAL 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: 11/13/2023
2. County: Wake
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Jason Kam — NCDEQ Inactive Hazardous Sites Branch Telephone: [phone]
Applicant's Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address (if available): 0ason.kam(cDncdenr.gov
5. Contact Person (if different than Applicant): Tim Grant, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): tim.grant(c�oneatlas.com
6. Property Owner (if different than Applicant): Seifco, Inc. Telephone: [phone]
Property Owner's Mailing Address: PO Box 18465, Raleigh, NC 27619-8465
Property Owner's Email Address (if available): [e-mail]
7. Property Physical Address (Including PIN Number) 935 Madison Avenue (PIN#0764039682)
City Cary County Wake Zip Code 27513
8.
Reason for Well(s): Suspected 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: Landfill
(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).
PRLU ID #NONCD0000602
11.
Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
12.
Are there any existing wells associated with the proposed well(s)? If yes, how many?
21
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0501417
13.
Distance from proposed well(s) to nearest known waste or pollution source (in feet):
20 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: Innovative Environmental Technologies, Inc. (IET) Certification No.:
3287-B
Well Contractor Address: 232 Highway 49 South, Concord, NC 28025
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

DocuSign Envelope ID: CF1E44F2-5F4B-44C6-83BA-7AD4F16E1092
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 8" flush mount manhole cover
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 11/27/2023
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 11/30/2023
(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 assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
/ !mt 1Aq,
,YL U. 6T 4;7�_
Signature of Applicant or *Agent
Tim Grant
Printed name of Applicant or *Agent
Agent for PRLU NONCD0000602
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 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
2090 U.S. Highway 70
Raleigh Regional Office
Swannanoa, NC 28778
3800 Barrett Drive
Wilmington Regional Office
Phone: [phone]
Raleigh, NC 27609
127 Cardinal Drive Extension
Fax: [phone]
Phone: [phone]
Wilmington, NC 28405
Fax: [phone]
Phone: [phone]
Fayetteville Regional Office
Fax: [phone]
225 Green Street, Suite 714
Washington Regional Office
Fayetteville, NC 28301-5094
943 Washington Square Mall
Winston-Salem Regional Office
Phone: [phone]
Washington, NC 27889
450 W. Hanes Mill Road
Fax: [phone]
Phone: [phone]
Suite 300
Fax: [phone]
Winston-Salem, NC 27105
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
GW-22M/R (Rev. 5-26-2022)

DocuSign Envelope ID: CF1E44F2-5F4B-44C6-83BA-7AD4F16E1092
PAT MCCRORY
MICHAEL S. REGAN
MICHAEL SCOTT
Waste Management
ENVIRONMENTAL QUALITY
Cary Dump
ID# NONCD0000552
Robert W. Safrit
Seifco, Inc.
935 Madison Avenue
Cary, Wake County
I/We own the above referenced property.
I/We hereby grant permission to the State and the State's representatives access to my/our
property to conduct an environmental investigation to determine what public health and
environmental hazards, if any, may exist and conduct cleanup actions of an imminent hazard
resulting from past operations of a landfill that ceased operation prior to January 1, 1983
Signed
Name (Print)
Date I- � 1--
Return to: Jason Kam
1
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�1,-�ea t W SSA
Pre -Regulatory Landfill Unit
Inactive Hazardous Sites Branch, NC Superfund Section
1646 Mail Service Center
Raleigh, NC 27699-1646
%,©�Et,." SA F R% J@(f 0 t 1'Z0M
MAI
State of North Carolina I Environmental Quality I Waste Management
1646 Mail Service Center 1 217 West Jones Street I Raleigh, NC 27699-1646
919 707 8200 T

DocuSign Envelope ID: CF1E44F2-5F4B-44C6-83BA-7AD4F16E1092
0MW-16
0.373
0
MW-17
0.264
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MW-15
0.225 /
4,3 43
= Proposed Monitoring Well
MW-18
0.269
LEGEND:
MONITORING WELL/
MW-16 TEMPORARY MONITORING WELL
�0.373 Well Identification
TCE Concentration (Ng/L)
PROPERTY BOUNDARY
—ss—ss— SANITARY SEWER
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— - - - — WASTE DISPOSAL BOUNDARY (BASED ON
FEBRUARY/OCTOBER 2015, AUGUST
\
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TCE ISOCONCENTRATION CONTOUR
— 30 — (DASHED WHERE INFERRED)
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Date:
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Scale:
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Figure: 4

DocuSign Envelope ID: CF1E44F2-5F4B-44C6-83BA-7AD4F16E1092
■CI
MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP
PROTECTIVE CASING AND CONCRETE PAD
CASING MATERIAL sch 40 PVC
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 5 feet
L2
L3
L1 =
0
FT.
L2 =
5
FT.
L3 =
15
FT.
L4 =
20
FT.
BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 1 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 2 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
WELL SCREEN
SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 15 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 20 feet
DEPTH TO BOTTOM OF
BOREHOLE 20 feet
DIAMETER OF BOREHOLE 8 inches
TITLE Monitoring Well
Cary Dump ��� 2725 East Millbrook Road
313 North Dixon Avenue Suite 121
ENVIRONNERTAL . SEOTECNNICAL
Cary, Wake County BUIL01NG SCIENCES • MATERIAiSTESTIN6 Raleigh, North Carolina 27604
North Carolina
FILE PREP. BY REV. BY DATE PROJECT NO.
BB TG 11/2/2023 PRLU0602L