WM0501597_Final Permit_20231116

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Mr. Alan Cubberly
Circle K Stores, Incorporated
1100 Situs Court, Suite 100
Raleigh, North Carolina 27605
Sent Via Email
NORTH CAROLINA
Environmental Quality
November 16, 2023
Subject: Monitoring Well Construction
Permit # WM0501597
Former Pantry #3093 (UST Incident #24129)
3223 NC Highway 55 (PIN # 0739343786)
Durham, North Carolina 27709 — Durham County
Mr. Cubberly:
In accordance with the application received on November 14, 2023, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501597 dated November 16, 2023, issued for the
construction of a monitoring well system (installation of three wells). Please be aware that some counties
have well construction programs, and you may be required 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
& 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
Ec: Maureen Jackson, ATC Associates of North Carolina, P.C.
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: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
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
Circle K Stores, Incorporated
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of three monitoring wells owned
by Cirlce K Stores, Incorporated at mailing address 1100 Situs Court, Suite 100, Raleigh, North Carolina
27604. The wells will be located on the property owned by Stalling's Oil Company, at 3223 NC Highway
55, Durham, North Carolina 27709. This Permit is issued in accordance with the application received on
November 14, 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:
E�D
& f, �l.atn.ttit,(,2916E6AB32144F...
Vanessa E. Manuel, Assistant Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number: WM0501597
Permit Issued: November 16, 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: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
;ETC
ASSOCIATES OF NORTH CAROLINA, P.C.
November 14, 2023
Mr. Mike Hall
North Carolina Department of Environmental Quality
Raleigh Regional Office
Division of Water Quality, Aquifer Protection Section
1628 Mail Service Center
Raleigh, North Carolina 27699
2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Tel: [phone]
Fax: [phone]
www.oneatias.com
N.C. Engineering License No. C-1598
RE: Application for Permit to Construct a Monitoring Well System
Former Pantry #3093
3223 NC Highway 54 - (PIN #0739343786)
Durham, Durham County, North Carolina
NCDEQ Incident No. 24129
Dear Mr. Hall
On behalf of Circle K Stores, Inc., ATC Associates of North Carolina, P.C. (ATC) has been directed by
the NCDEQ-DWM-UST Section to replace three monitoring wells that were destroyed during site
reconstruction activities at the above property. Circle K previously leased the property from Stallings Oil
Company (a copy of a previously executed access agreement is attached). ATC was not aware that a
well permit was needed for onsite monitoring well; therefore, this application is being submitted after the
wells were installed. Monitoring wells MW-1R, MW-2R, and MW-4R were installed on October 4 and
5, 2023. I have attached the well construction permit application to this cover letter.
We greatly appreciate your assistance in this matter. If you have any questions or concerns, please feel
free to contact me at [phone] or via email at maureen.jacksongoneatlas.com.
Sincerely,
TC ASSOCIAT OF NORTH CAROLINA, P.C.
au n ac cson,
Senior Project Manager

DocuSign Envelope ID: 8F80DDDC-1FDE r-P%F% 9C1F-6I %FDB 11vin JMENTAL QUALITY - DIVISION OF WATER RESOURCES IwR I" uF1RVL114M uUrriR I m_IM � yr GIY V IRVI
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: November 14, 2023
2.
3.
4.
5
6
County: Durham
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: Circle K Stores, Inc. Telephone: [phone]
Applicant's Mailing Address: 1100 Situs Court, Suite 100 Raleigh, North Carolina 27605
Applicant's Email Address (if available): acubberleyka,circlek.com
Contact Person (if different than Applicant):
Maureen Jackson
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121
Telephone: [phone]
h. North Carolina 27604
Contact Person's Email Address (if available): maureen.-jacksongoneatlas.com
Property Owner (if different than Applicant): Stallings Oil Company Telephone: Unknown
Property Owner's Mailing Address: 300 S. Wesleyan Blvd, Suite 200 Rocky Mount, NC 27804
Property Owner's Email Address (if available): Unknown
7. Property Physical Address (Including PIN Number) 3223 NC Highway 55 (PIN #0739343786)
City Durham County Durham Zip Code 27709
8. Reason for Well(s): petroleum release assessment for Former Pantry #3093 (UST incident #24129)
(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
(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).
UST incident #24129
11. Type of contaminants being monitored or recovered: petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes - 9 (plus several that were destroyed)
Existing Monitoring or Recovery Well Construction Permit No(s).: Unknown
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Approx. 70 and 90 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): N/A
15. Well Contractor: Carolina Soil Investigations, LLC Certification No.: 2579
Well Contractor Address: 132 Gurney Road Olin, North Carolina 28660
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

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 3
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured?
Steel traffic bearing cover, sealing and locking cap
6. Estimated beginning construction date: Oct 4, 2023
4. Total Number of wells to be constructed: ' 7. Estimated construction completion date: Oct 5, 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
l �
Signature of Applicant or *Agent
Maureen Jackson ATC on behalf of Circle K Stores
Printed name of Applicant or *Agent
Sr. Project Manager for ATC
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
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).
Access Agreement attached Stallings Oil Company
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 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]
OR Rev. 3-1-2016

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
From: Cubberley, Alan
Sent: Wednesday, February 17, 2021 8:11 AM
To: Maureen Jackson
Subject: [EXTERNAL] RE: Permits
[External Email] This email originated from outside of the Atlas mail system.
Please use caution when opening attachments.
I give Maureen Jackson permission to sign permits on behalf of Circle K (NPDES, well
permits for off -site wells, UST (DEQ) forms).
Alan Cubberley
Senior Manager — Risk Control
Fuel and Environmental — North America
e:acubberley(a-)circlek.com
t: [phone]
m: [phone]
Circle K Stores Inc.
1100 Situs Court, Suite 100
Raleigh, NC 27606
http://corpo.couche-tard.com/en/business-units/
..................................
.......................................:.. J,
Part of Alimentation Couche-lard
CONFIDENTIALITY NOTE: This e-mail message, including any attachment(s), contains information
that may be confidential, protected by the attorney -client or other legal privileges, and/or proprietary
non-public information. If you are not an intended recipient of this message or an authorized assistant
to an intended recipient, please notify the sender by replying to this message so that we can correct
our records to avoid the mistake in the future and then delete it from your system. Use, dissemination,
distribution, or reproduction of this message and/or any of its attachments (if any) by unintended
recipients is not authorized and may be unlawful. Your cooperation with this request is appreciated.
From: Maureen Jackson <[e-mail]>
Sent: Wednesday, February 17, 2021 7:47 AM
To: Cubberley, Alan <[e-mail]>
Subject: [EXTERNAL] Permits
Importance: High

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
When recorded, return to. -
Circle K Stores Inc
305 Gregson Drive
Cary, NC 27511
ACCESS AGREEMENT
THIS AGREEMENT is entered into as of April 30, 20I7, by and between STALLINGS OIL
COMPANY ("Grantor"), and CIRCLE K STORES 1NC.,a Tcxas corporation ("Grantee").
RECITALS:
WHEREAS, Grantor is the fee simple owner of that certain real property (the "Property") which
is the subject of that certain Mutual Termination and Release Agreement (the "Agreement")
between Grantee, as Tenant, and Grantor, as Landlord, which Property is legally described on the
attached Exhibit A; and
WHEREAS, Grantce is seeking Grantor's consent to enter the Property for the purpose of
removing the USTs, testing, assessing and remcdiating Covered Contamination; and
WHEREAS, Grantor and Grantee desire to set forth their respective rights, responsibilities and
obligations regarding the Grantee's entry to, assessment, and remediation of the Property.
NOW, THEREFORE, for and in consideration of the premises and the mutual covenants and
agreements herein, Grantor and Grantee agree as follows:
1. The above Recitals are hereby incorporated by reference.
2. Capitalized terms shall have the meaning set forth either herein or in the Agreement.
3. Grantor hereby grants to Grantee the right to enter the Property (the "Right") from time
to time for the purpose of removing the USTs and performing necessary tests, assessment and
remediation of Covered Contamination (the "Work"), pursuant to the following conditions:
A. The Right granted herein shall be exercised by Grantee and/or Grantee's agents,
employees and representatives.

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
B. The Right granted herein may be exercised from time to time with at least seven (7)
days prior written notice to Grantor as provided below, and for so long as reasonably necessary
or required in Grantee's discretion, but subject to Iimitations in the Agreement, to accomplish the
Work herein described.
C. The Right granted herein shall be exercised by Grantee with due regard to the limita-
tions in the Agreement and Grantor's use of the Property and without any material interference
with such use. Grantee understands that Grantor intends to develop the Property as a self -storage
facility, and Grantee agrees to consult and coordinate with Grantor in advance with respect to
any required assessment or remediation in order to ensure that Grantee's Work will not
materially interfere with Grantor's use of the Property. Grantee shall obtain Grantor's consent,
which shall not be unreasonably denied or delayed, regarding the location of any monitoring
wells or remediation equipment to be placed on the Property in order to ensure that such
location(s) will be compatible with Grantor's existing or intended development of the Property
and, to the extent necessary, the Grantor and Grantee will consult with the NC Department of
Environmental Quality ("DEQ") in order to determine a location satisfactory to all parties.
Grantee agrees that if any monitoring well or remediation equipment installed at a location
previously authorized by Grantor subsequently interferes with Grantor's desired development or
use of the Property, Grantee and Grantor will work together, using their best and commercially
reasonable efforts, to obtain any required approval from the DEQ for Grantee to, at Grantor's
cost, relocate the monitoring wells or equipment in order to accommodate such development or
use of the Property.
4. Except as set forth in Section 3.C. above, liability for any and all costs, expenses, fees
and/or any other expenditures necessitated by the Work shall be borne solely by Grantee, who
shall indemnify, defend and hold Grantor harmless therefrom; provided, however, that the
obligations described in this Section 4 shall not apply to any New Contamination, as that term is
defined in the Agreement. Grantee shall at all times keep the Property free and clear of all liens
and encumbrances relating to the Work. Grantee shall provide, at its sole expense, any security
necessary for the protection of the Work.
5. The Work shall be performed at all times in compliance with all applicable laws,
regulations and orders of the Agency. Grantee shall dispose of soil and groundwater removed
during the performance of the Work in accordance with such laws, regulations and orders.
Grantee shall promptly provide the Grantor with copies, at no cost to Grantor, of all
correspondence to or from any Agency pertaining to the Covered Contamination, and all
laboratory results, other environmental data and reports generated as a result of the Work.
6. Grantee shall indemnify, defend and hold harmless Grantor, its agents, employees,
officers and directors from and against any and all Damages connected with: (a) Grantee's
exercise of the Right granted herein; (b) any personal injury or property damage occurring on or
about the Property during the performance of the Work; or (c) any negligent or intentional act or
omission of the Grantee, its agents, employees, or representatives in the performance of this
Agreement. This indemnity shall not apply to Damages arising from interference with Grantor's
operations at the Property, unless such interference results from Grantee's violation of this
Agreement, gross negligence or intentional misconduct.

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
7. Upon the expiration of this Agreement, Grantee shall remove its remediation equipment
located at the Property, permanently close any monitoring wells, and repair and replace with
equivalent materials, any portion of the Property affected thereby to its present condition, in
compliance with industry standards and Agency Standards.
8. Grantee (or its environmental consultant), at its sole expense, shall procure and maintain
throughout the term of this Agreement commercial general public liability insurance with
combined single limit coverage of $1,000,000. Upon request, Grantee shall furnish Grantor with
a certificate of such coverage prior to any entry upon Grantor's Site.
9. This Agreement shall remain in force until the earlier to occur of (a) the granting of a "no
further action" letter (or similar) by the Agency with respect to all Covered Contamination, or (b)
fifteen (15) years from the date of full execution hereof. After the termination of this Agreement
and upon written request from Grantor, Grantee shall deliver a Termination of Access
Agreement in recordable form to Grantor.
10. Ibis Agreement, and all of the terms, provisions and obligations hereof, shall be
covenants running with the Property and shall inure to the benefit of and be binding upon
Grantor and Grantee and their respective heirs, successors and assigns.
11. Any notice required or permitted to be given to any party shall be in writing and shall be
delivered by hand, mailed by first class mail, postage prepaid, telecopied or sent by overnight
courier to the addresses set forth below. Any such notice shall be deemed to be received: (a) if
delivered personally, on the date of such delivery; (b) if mailed, on the third business day
following mailing; (c) if telecopied, on the date of transmission; or (d) if sent by overnight
courier, on the first business day following delivery to courier.
To Grantor:
STALLINGS OIL COMPANY
300 S Wesleyan Blvd
Suite 200
Rocky Mount, NC 27804
To Grantee:
CIRCLE K STORES INC.
305 Gregson Drive
Cary, NC 27511
Attn: Real Estate Administration
The parties may change their respective notice address to any other location within the United
States by giving a notice of the change in accordance with this Section.
(Signatures are on the following page.)

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
IN WITNESS WHEREOF, the parties authorized representatives have executed this
Agreement.
Grantor:
STALLINGS OIL COMP
a North Caro ' co ti
By:
Its:
Date Executed: --R/ !S f j?
Grantee:
CIRCLE K STORES INC.,
a Texas corporation
Zoe
By:
Date Executed: �� 7
NOTARY ACKNOWLEDGMENTS ON FOLLOWING PAGE

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
State of North Carolina )
/ ) ss.
County of n" 4 )
On this 1 SA day of M& re-4 , 20 %? , before me, the undersigned, a Notary
Tblic in and for said State, duly commissioned and sworn, personaIly appeared
"61 l?? • /mu.F. , personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person whose name is subscribed to the within instrument, and
acknowledged to me that he executed the same in his authorized capacity, and that by his
signature on the instrument the person, or the entity upon behalf of which the person acted,
executed the instrument.
WITNESS my hand and official seal.
SUSAN G WEAVER
NOTARY PUBLIC
Nash County
North Carolina
My Commission Expires February 19.2022
State of North Carolina )
) ss.
County of W Ali 2 )
W IA4 /�
Notary Public
My Commission Expires
On this day of tilwa rr h , 20 17 , before me, the undersigned, a Notary
Public in and for said State, duly commissioned and sworn, personally appeared
Me.-e. t-4% U). IR L' e; Il , personally known to me to be the person whose name is
subscribed to the within instrument, and acknowledged to me that he executed the same in his
authorized capacity, and that by his signature on the instrument the person, or the entity upon
behalf of which the person acted, executed the instrument.
WITNESS my hand and official seal.
NOTAFR }. Laxo�
�otary Public
E'UBLXG 1 My Commission Expires
pout

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
° item
�y w
rt� MW7--20 ` C
® a TYPE 11 Al WELL
= DESTROYED MOMTORIA'G IYELL
v
MW-19 �
cq
'i Y-`� ; �'i r - •i ce Q Q C,
MW-1 1- }' PROPEF
W-13 jU 801Ill
r '
OW-1
.. M -18I
r I MIN-9 1 iMW 4 FORMER
_ MW-15, r—t�4eet ; _ , "'ROSENE PUMP , 1
' II C- ! FORMER; A W-2
1 1
:}•.�,� _ �' �ii j, j PANTRY r F.�RMER
EAST U Y 1 I } ® �U93l. f BASIN
CoR,� 1 r Y� }! 70 feet 1� ! �r k j� 1 MW 6 ' s k
*FORMER - �''Y
'' i 70' feetMW- ' CAR WASH `
_4 F _1 MW-5f0 Z
LO
�IOIW 2 MW-3 ul
Z�
X Z
MW-12 FORMER �� MW-TA 0~
DIESEL PUMP,
• - , � - �-OC�D 'fir � �` _� - „`� - N Q � Z
�i LLI Z
LLJ
rygJ{MI+V-17 'j`�I^(nA'IW-8_/� nl
• ' R t4 \ sue, �y .1 , nd LL_ v J `L
�NQ k
MW-11
WL
..? �. .��'+ i1F �. ��� 'd.r � �, I 1 li ljw � •r _.. f -�ti ..-`� e \ S� ` I r
1 J
0 60 120 vi
lw-APPROXIMATE SCALE IN FEET
z

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
P15P... Screening Report
Area of Interest (AOI) Information
Area : 1,041,049.7 ft2
Nov 14 2023 13:48:00 Eastern Standard Time
� Cor�y,eflis
f
i
1
�
Ril
_
0
a,
s
p,
12.257
_ 0 GO'I 603 006 mi
UST Incidents • UST Active Facilities r — - � County Boundary a aoa nas a
i high Risk Land Use Restriction ands Notices ZV s^^ o
i Low Risk 1? Notice end Restriction °s

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
UST Incidents
#
IncidentNumber
IncidentNam
Count
1
3198
TOWN AND COUNTRY #4
1
2
24129
THE PANTRY #3093
1
3
26427
ON THE RUN #20
1
4
26557
CIRCLE K STORE # 2706330
1
5
33226
The Pantry #3780
1
6
33239
CIRCLE K STORE # 2706330
1
7
39185
Circle K Store # 6330
1
8
47811
Circle K Store #2723780
1
9
48653
Circle K Store #2723780 Circle K Store
#27237801312
Circle K Store 2723780
1
1
10
48746
UST Active Facilities
#
I FACILID
FACILNAME
Count
1
00-0-0000001200
CIRCLE K 2723780
1
2
00-0-0000035841
CIRCLE K 2706330
1
Land Use Restriction and/or Notices
# Prj_Numb,
1 RA-4799
2 RA-505
3 RA-5694
ar
Prj_Name
Count
ON THE RUN #20
1
TOWN AND COUNTRY #4
1
The Pantry #3780
1

DocuSign Envelope ID: 8F80DDDC-1 FDE-4EDF-9C1 F-6116FDBBBOA6
MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
L4
L1
LOCKABLE WELL
L2
L3
CAP
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 10 feet
BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 3 feet
SEAL
TYPE OF SEAL bentonite
THICKNESS 1 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 1 feet
TOTAL FILTER PACK FOOTAGE 14 feet
WELL SCREEN
SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 15 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
WELL 18 feet
DEPTH TO BOTTOM OF
BOREHOLE 18 feet
DIAMETER OF BOREHOLE 6 inches
ON,
DRILLING
DRILLER
DRILLER
L1 = 0 FT.
L2 = 3 FT.
L3 = 15 FT.
L4 = 15 FT.
SUBCONTRACTOR: Carolina Soil Investigations
ADDRESS: 132 Gurney Road Olin, NC 28660
CERTIFICATION #: 2579
TITLE Well Information
Former Pantry #3093
3223 NC Highway 54
Durham, Durham County
North Carolina
/
/
/
2725 East Millbrook Road, Suite 121
Raleigh, North Carolina 27604
FILE
PREP. BY
MJ
REV. BY
MJ
DATE
4/26/2023