WM0501613_Final Permit_20240111

North Carolina Department of Environmental Quality Division of Water Resources
512 North Salisbury Street 1611 Mail Service Center Raleigh, North Carolina 27699-1611
919.707.9000

January 11, 2024 Mr. David Kwiatkowski Warehouse Home Furnishings Distributors, Inc. (DC420001) 1646 Mail Service Center Raleigh, NC 27699-1646 Sent Via Email Subject: Monitoring Well Construction Permit # WM0501613 Warehouse Home Furnishings Distributors, Inc. (DC420001) 1190 Julian R. Allsbrook Road Roanoke Rapids, NC 27870 – Halifax County Mr. Kwiatkowski: In accordance with the application received on January 8, 2024, we are forwarding herewith Monitoring Well Construction Permit No. WM0501512 dated January 11, 2024, issued for the construction of a monitoring well system (installation of four 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,
Vanessa E. Manuel, Assistant Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ Enclosure -Permit -Application Package Ec: Consultant/Agent Laserfiche

DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17
North Carolina Department of Environmental Quality Division of Water Resources
512 North Salisbury Street 1611 Mail Service Center Raleigh, North Carolina 27699-1611
919.707.9000
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 Warehouse Home Furnishings Distributors, Incorporated – Petitioner for DSCA Site 420001 FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of four monitoring wells owned by Warehouse Home Furnishings Distributors, Incorporated – Petitioner for DSCA Site 420001, 1646 Mail Service Center, Raleigh, NC 27699-1646. The wells will be located on the property owned by ECU Health North Hospital at 250 Smith Church Road and Medical Service Center Drive Properties (parcels 0910834, 0911822, and 0919860), Roanoke Rapids, NC 27870. This Permit is issued in accordance with the application received on January 8, 2024, 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.

____________________________________
Vanessa E. Manuel, Assistant Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission

Permit Number: WM0501613
Permit Issued: January 11, 2024
DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17
FOR OFFICE USE ONLY
PERMIT NO.ISSUED DATE
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:1/8/2024
2.County:Halifax
3.What type of well are you applying for? (monitoring or recovery):Monitoring
4.Applicant:Warehouse Home Furnishings Distributors, Inc – Petitioner for DSCA Site ID 420001 (Oakland Cleaners) Telephone:[phone]
Applicant’s Mailing Address: NCDEQ DWM, DSCA Program, David Kwiatkowski, 1646 Mail Service Center, Raleigh NC 27699
Applicant’s Email Address (if available):[e-mail]
5.Contact Person (if different than Applicant): Bethany Donovan (AECOM)Telephone:[phone]
Contact Person’s Mailing Address: 5438 Wade Park Boulevard, Suite 200, Raleigh, NC 27607
Contact Person’s Email Address (if available):[e-mail]
6.Property Owner (if different than Applicant): ECU Health North Hospital (Jason Harrell) Telephone:[phone]
Property Owner’s Mailing Address: 250 Smith Church Road, Roanoke Rapids, Halifax County, NC 27870
Property Owner’s Email Address (if available):[e-mail]
7.Property Physical Address (Including PIN Number)250 Smith Church Rd & Medical Center Drive Properties (Parcel #’s 0910834, 0911822, 0919860)
City Roanoke Rapids County Halifax Zip Code 27870
8.Reason for Well(s):Monitoring of 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:drycleaning
(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).
None
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? 14
Existing Monitoring or Recovery Well Construction Permit No(s).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet):Approximately 1,500 ft
14. Are there any water supply wells located less than 500 feet from the proposed well(s)?None Known
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
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
DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17
DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17
DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17
DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17
APPROX. SCALE, ft.
0 300
DRAWN BY:
CHECKED BY:
PROJECT NO.:
Groundwater Quality Map
Oakland Cleaners
1190 Julian R. Allsbrook Road
Roanoke Rapids, NC
DSCA Site ID DC420001
LEGEND
Monitoring Well Location
micrograms per literug/l
Estimated ValueJ
PCE - Tetrachloroethene
TCE - Trichloroethene
MTBE - Methyl tert-butyl ether
Inferred Area of PCE 2L Standard
Exceedance
Potentiometric Surface Contour (ft)
April 2021
Inferred Groundwater Flow Direction
Location of former
Oakland Cleaners
facility
Temporary Monitoring Well Location
Pushpoint Sample Location
Surface Water Sample Location
Proposed Monitoring Well Location
Approximate location of
building of unknown use as
seen on 1974 aerial image.
76.0
77.0
78.0
79.0
75.0
80.0
MW-1 (04/07/2021)
PCE - 250 ug/l
TCE - 0.76 J ug/l
MW-2 (04/7/2021)
PCE - 20 ug/l
MW-3 (04/07/2021)
PCE - 60 ug/l
MTBE - 0.80 J ug/l
MW-4 (04/07/2021)
PCE - 52 ug/l
MTBE - 1.2 ug/l
MW-5 (04/07/2021)
MTBE - 0.83 J ug/l
MW-6 (04/07/2021)
MTBE - 0.8 J ug/l
MW-7 (04/07/2021)
PCE - 30 ug/l
MW-8 (04/07/2021)
BDL
MW-9 (04/07/2021)
BDL
MW-10 (07/20/2021)
PCE - 12 ug/l
MW-11 (07/20/2021)
BDL
MW-12 (07/20/2021)
PCE - 5.5 ug/l
MW-13 (12/20/2021)
PCE - 22.9 ug/l
MTBE - 0.319 J
Chloroform - 0.141 J
MW-14 (12/20/2021)
PCE - 0.737 J ug/l
Chloroform - 0.661 ug/L
DPT-100 (02/03/2021)
Toluene - 0.49 J ug/l
DPT-101 (02/03/2021)
PCE - 5.0 ug/l
PW-1 (04/07/2021)
Acetone - 22 ug/l
SW-1 (04/07/2021)
BDL
PW-2 (04/07/2021)
BDL
PW-3 (04/07/2021)
BDL
PW-4 (04/07/2021)
Acetone - 27 ug/l
Toluene - 5.2 ug/l
SW-4 (04/07/2021)
BDL
GW-5 (2011)
PCE - 1.4 ug/L
Toluene - 0.69 J ug/L
MTBE - 0.37J ug/L
Acetone - 10.2 J ug/L
GW-3 (2011)
PCE - 2.9 ug/L
Toluene - 0.63 J ug/L
MTBE - 0.22J ug/L
Acetone - 8.4 J ug/L
GW-2 (2011)
PCE - 42.2 ug/L
Toluene - 0.52 J ug/L
Acetone - 10.2 J ug/L
GW-6 (2011)
Toluene - 0.34 J ug/L
Acetone - 12.7 J ug/L
GW-1-2 (2011)
PCE - 2.6 ug/L
Toluene - 0.43 J ug/L
Acetone - 4.1 J ug/L
GW-4 (2011)
Toluene - 0.65 J ug/L
Acetone - 6.7 J ug/L
Chockoyette Creek
Groundwater analytical results do not exceed
calculated vapor intrusion risk for residential or
non-residential exposure – DSCA Indoor Air Risk
Calculator, Version 9, April 2022.
Groundwater analytical results do not exceed
calculated vapor intrusion risk for non-residential
exposure but do exceed for residential exposure
– DSCA Indoor Air Risk Calculator, Version 9,
April 2022.
Groundwater analytical results exceed calculated
vapor intrusion risk for residential and
non-residential exposure – DSCA Indoor Air
Risk Calculator, Version 9, April 2022.
Premier Capital Fund
XXV, LLC
Farmer’s
Furniture
O’Reilly
Auto Parts
L&R Realty, LLC
Save-A-Lot
Former
`Nature’s
Manna
DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17
Client:
Project Number:
Site Location:Date Installed:
Well Location:Coords:Inspector:
Method:Contractor:
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
Ground Surface (G.S.)
Riser Pipe:
Length
Diameter (ID)
Type of Material
Thickness
Grout:
Type neat cement
Thickness
Top of Bentonite
Bentonite Seal Thickness 3'
Top of Sand
Top of Screen
Screen:
Length
Diameter (ID)
Slot Size
Type of Material
Type/Size of Sand
Sand Pack Thickness
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Borehole Diameter 4.25" ID HSA
Describe Measuring Point:
Signature Date
Note: Depths are approximate and will be adjusted based on field conditions. Not to scale.
#2
PVC
10 slot
2"
Thickness Sch 40
Oakland Cleaners (DC420001)
60704817
250 Smith Church Rd. 0910834, 0911822, & 0919860
4.25" ID HSA
25
13
15
PVC
12
11
10
11'
25
Sch 40
2"
Geologic Exploration
0.0
15
0.0
25
WELL ID:Proposed Type II Well
DocuSign Envelope ID: B074B4E4-9C34-4B0F-A3A7-2600894EFC17