WM0401502_WM0401505_Permit(application)_20240110

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: January 4, 2024
County: Davie
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: New Era, LLC (Brett Edwards) (Petitioner for DSCA Site ID DC300003) Telephone: [phone]
Applicant's Mailing Address: DWM DSCA Program, Attn: Eric Rice, 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address (if available): eric.rice(a�deq.nc.gov
Contact Person (if different than Applicant): Natalie McCarthy - Hart & Hickman, PC Telephone: [phone]
Contact Person's Mailing Address: 2923 S. Tryon Street, Suite 100, Charlotte, NC 28203
Contact Person's Email Address (if available): nmccarthy(acr�.harthickman.com
Property Owner (if different than Applicant): WP Property Group, LLC Telephone: [phone]
Property Owner's Mailing Address: 331 High Street, Winston-Salem, NC 27101
Property Owner's Email Address (if available): steveawilliamsdevelopmentgroup.com
Property Physical Address (Including PIN Number) 5427 US Highway 158
City Advance County Davie
Zip Code.
27006
Reason for Well(s): Environmental assessment for DSCA Program (DSCA Site DC300003)
(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: Dry-cleaning facility
(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).
NCDEQ DSCA Site ID DC300003
Type of contaminants being monitored or recovered: chlorinated solvents
(ex: organics, nutrients, heavy metals, etc.)
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).:
Distance from proposed well(s) to nearest known waste or pollution source (in feet): — 125 ft
Are there any water supply wells located less than 500 feet from the proposed well(s)?
If yes, give distance(s):
Well Contractor: Ameriprobe, LLC. Certification No.: 4198-B
Well Contractor Address: P.O. Box 135, Huntersville, NC 28070
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

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? Bolted manhole and
locking expansion plug.
6. Estimated beginning construction date: 1/29/2024
4. Total Number of wells to be constructed: 3 7. Estimated construction completion date: 2/2/2024
(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 Applicarff or *Agent
Natalie McCarthy, Agent for the Petitioner
Printed name of Applicant or *Agent
Agent for Petitioner for DSCA Site DC300003
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).
See attached property owner access agreement See attached property owner 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 Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
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]
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
'105
GW-22MR Rev. 3-1-2016

I
►J
AGREEMENT FOR ASSESSMENT AND REMEDIATION PURSUANT TO DSCA
ATTACHMENT 1
LIMITED POWER OF ATTORNEY
("Petitioner"), do hereby
grant a limited power of attorney to the Division and to the Division's independent contractors,
as follows.
The Division and the Division's independent contractors shall have the limited power of attorney
for the preparation, signing, filing and delivery of any permit application, hazardous waste
manifest, non -hazardous waste manifest, National Pollution Discharge Elimination System
(NPDES) permit, for complying with any reporting requirements and for any administrative
activities that may be necessary in the course of assessment and remediation conducted pursuant
to the Agreement into which this Attachment 1 is incorporated.
This limited power of attorney sh ie Agreement.
FBRENDA S. MODANIEL
J� NOTARY PUBLIC
Dated/►'OVCv jet1, �D2-3.F=KJINGaHAM COUNTY
t?RTH CAROLINA
(Seal) mmdwe Exp
Signature of Petitioner
STATE OF /V Or--Ki ci COUNTY OF
On this % — day ofAovu"e,- , ,20;L3, personally appeared before me, the said named
Ed cuo_,_ _ to me known and known to me to be the person described
in and who executed the foregoing limited power of attorney and he (or she) acknowledged that
he (or she) executed the same and being duly sworn by me, made oath that the statements in the
foregoing limited power of attorney are true.
My Commission Expires O_6--G'7—
�t e.c ,�Qati S (Signature of Notary Public)
Notary Public (Official S BRENDA S. MCDANIEL
P40TARY PUBLIC
:JCKlNCaHAM COUNTY
14ORTH CAROLINA
T ft•;y Comaftel m Exphe+_Q_.V —4,2- 2-0 2((
yA
DSCA ARAv07O5 Attachment 1

5S'A7E ..
f
ROY COOPER
4
Governor
ys j
ELIZABETH S_ BISER
Src'r-Mtrrp
MICHAEL SCOT T
NORTH CAROLINA
Director
Environmental Quality
PROPERTY ACCESS CONSENT
For DSCA Use Only
This document may not be modified without the Program's approval DSCA ID No.
If you have questions on how to fill out this form or about the activities DC300003
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program's contractor for this project Natalie McCarthy with Hart & Hickman, P.C. at
nrn: czuti� ir:;>alzl�ickir�ar�.ccn_i or [phone]. Ifyou still have questions after contacting
M. McCarthy with H&H, please contact the DSCA Program Project Manager, Mr. Eric Rice at
crric.ricoa-dcq.m. ro; or [phone].
Please Print
WP Property Group, LLC
(Name of Property Owner or Tenant in Residence)
5427 US Highway 158
(Street Number and Street Name of Property)
Advance Davie 27006
(City or Town in Which Property Is Located) 1 (County in Which Property is Located) / (Zip Code)
I voluntarily consent to the Division of Waste Management (Division) and its independent
contractors (contractors) entering and having continued access to my property for the following
purposes:
(1) taking such soil, groundwater and/or air samples as may be necessary;
(2) taking other actions related to the investigation of surface or subsurface conditions;
(3) taking response actions necessary to mitigate any threat to human health or the environment.
Other conditions:
(1) The Division and its contractors shall attempt to perform any activities at the Property in a
manner that minimizes interference with use of the Property.
(2) On conclusion of all activities, the Division and its contractors shall, to the extent practicable,
restore the Property to the original condition it was in prior to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance
North Carolina Department of Environmental Quality i Division of Waste Management
217 West Jones Street ; 1646 Mail Service Center ' Raleigh. North Carolina 27699-1616
919.707.8200

with applicable laws and regulations, Owner. unless other arrangements are agreed to by the Property
(3) The Division or its contractors will make reasonable attempts to notify the Property Owner at
least 48 hours prior to entering the Property for any purpose. In situations that the Division
access to the property.
determines to be of an emergency nature, the Division or its contractors shall have immediate
(4) Property Owner shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without prior consent of the Division.
By signing this consent document, I acknowledge that I am the legal property owner or tenant
in residence that has the authority to allow this work on the property and have contacteall
tenants (if there are tenants) occupying the property and all tenants agree to the conditions
of this "Proper"ceess Consent".
)3
� ua 1�y �1LLL��lLG f
5:-97Z- �73�45 -"
(Date)
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
P �
(Email Address far Property Owner or Tenant in Residence)
Please return form to:
Natalie McCarthy
Hart & Hickman, PC
2923 S Tryon Street, Suite 100
Charlotte, NC 28203
Or via email to: [e-mail]
North Carolina Department of Environmental Quality 1 DivisiOn of Waste Management
217 West Jones St reel E 164b hail Service Center Raleigh, North Carolina 27b99- E5�;w
1b46
919.707.8200

TYPE II PERMANENT MONITORING WELL CONSTRUCTION DETAILS
CROSS SECTIONAL VIEW
LOCKABLE WELL CAP CONCRETE PAD
FLUSH METAL WELL COVER
CONCRETE PAD
BACKFILL AROUND CASING
MATERIAL
LENGTH bentonite/cement grout
15 ft (1 to 16 ft)
WELL CASING schedule 40 PVC
MATERIAL 2 inches
DIAMETER flush threaded
JOINT TYPE 20 ft
L1
LENGTH
L3
SEAL
TYPE OF SEAL THICKNESS
bentonite
2ft (16 ft to 18 ft)
FILTER PACK No. 2 Sand
17ft (18 ft to 35 ft)
TYPE OF FILTER THICKNESS
WELL SCREEN schedule 40 PVC
L2
SCREEN MATERIAL 2 inches
DIAMETER 15 feet
LENGTH 0.010 inches
20 FT.
SLOT SIZE
DEPTH TO BOTTOM OF 35 feet
L1 =
L2 =
15 FT.
DIAMETER
OF MONITORING WELL
L3 =
35 FT.
BOREHOLE
6.25 in
TITLE Monitoring Well Diagram
Hart & Hickman, PC
2923 South Tryon St., Suite 100
Charlotte, North Carolina 28203
FILE PREP. BY NSM REV. BY DATE 12/18/2023 PROJECT NO. DSO-172C