WR0500150_Recovery Well Permit Application_20240118

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 18, 2024 Mr. Hassan Osman North Carolina Department of Environmental Quality Division of Waste Management, Underground Storage Tank Section 1646 Mail Service Center Raleigh, NC 27699-1646 Sent Via Email Subject: Recovery Well Construction Permit # WR0500150 Wicker Mart 10 (UST Incident #12607) 200 South Horner Boulevard Sanford, NC 27330 – Lee County Mr. Osman: In accordance with the application received on January 12, 2024, we are forwarding herewith Recovery Well Construction Permit No. WR0500150 dated January 18, 2024, issued for the construction of a recovery well system (installation of nine 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 cc: Chris Hanley, ATC Associates of North Carolina, P.C. Laserfiche

DocuSign Envelope ID: 3D92E36A-7C13-4030-9BE0-EA18C71F27DA
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 RECOVERY 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, State Lead Program FOR THE CONSTRUCTION OF A RECOVERY WELL owned by The North Carolina Department of Environmental Quality, State Lead Program, at mailing address 1646 Mail Service Center, Raleigh, NC 27699-1646. The wells will be located on the property owned by Patterson-Seminole Properties, LLC at 200 South Horner Boulevard (PIN 9642-69-5083-00), Sanford, NC 27330. This Permit is issued in accordance with the application received on January 14, 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.
8. Discharge from this well must be treated at a NC permitted wastewater treatment facility appropriate to
treat this waste.

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

Permit Number: WR0500150
Permit Issued: January 18, 2024
DocuSign Envelope ID: 3D92E36A-7C13-4030-9BE0-EA18C71F27DA
2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
www.atcgroupservices.com

January 12, 2024

North Carolina Department of Environmental Quality - Division of Water Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609

Re: Permit to Construct Monitoring Well
Former Wicker Mart N0. 10
200 South Horner Blvd
Sanford, Lee County, North Carolina
NCDEQ Incident No. 12607
ATC Project No. STL1260701

Dear Sir or Madam:

Enclosed please find an application for a permit to construct one Type II recovery well. The recovery well
will be installed on a property (Pin# 9642-69-5083-00) located at 200 South Horner Blvd, Lee County,
North Carolina. The permit application, site map with the proposed location of the monitoring well, well
construction details, and other relevant informati on are enclosed as attachments. Please review this
package and return the approved permit to this office. The associated recovery well is scheduled to be
installed on January 31, 2024.

If you have any questions or require additional information, please contact my office at [phone].

Sincerely,
ATC Associates of North Carolina, P.C.

Chris Hanley, P.G.
Project Geologist
919-649-7605
[e-mail]

DocuSign Envelope ID: 3D92E36A-7C13-4030-9BE0-EA18C71F27DA
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: 1/12/2024

2. County: Sanford

3. What type of well are you applying for? (monitoring or recovery): Recovery

4. Applicant: Hassan Osman (NCDEQ State Lead) Telephone: [phone]

Applicant’s Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699

Applicant’s Email Address (if available): [e-mail]

5. Contact Person (if different than Applicant): Chris Hanley (ATC Associates) Telephone: [phone]

Contact Person’s Mailing Address: 2725 E Millbrook Rd, Ste 121, Raleigh, NC 27604

Contact Person’s Email Address (if available): [e-mail]

6. Property Owner (if different than Applicant): Patterson-Seminole Properties LLC Telephone: [phone]

Property Owner’s Mailing Address: PO Box 1185, Broadway, NC 27505

Property Owner’s Email Address (if available):

7. Property Physical Address (Including PIN Number) 200 S. Horner Blvd (PIN# 9642-69-5083-00)
City Sanford County Lee Zip Code
8. Reason for Well(s): Groundwater contamination assessment and remediation
(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).

Yes, NCDEQ UST Incident # 12607

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, 11

Existing Monitoring or Recovery Well Construction Permit No(s).: None

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 15 feet

14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No

If yes, give distance(s): NA

15. Well Contractor: SAEDACCO, Inc Certification No.: 4439

Well Contractor Address: 9088 Northfield Dr, Fort Mill, SC 29707

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: 3D92E36A-7C13-4030-9BE0-EA18C71F27DA
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)

2. Number of wells to be constructed in unconsolidated
material: 1

3. Number of wells to be constructed in bedrock: 0

4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured?
Locked metal flush-grade cover.

6. Estimated beginning construction date: 1/31/2024

7. Estimated construction completion date: 1/31/2024

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.

Project Geologist
Signature of Applicant or *Agent Title of Applicant or *Agent

Chris Hanley (ATC Associates) * If signing as Agent, attach authorization agreement stating Printed name of
Applicant or *Agent 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 signed 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]
Fax: [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
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22M/R (Rev. 5-26-2022)
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DocuSign Envelope ID: 3D92E36A-7C13-4030-9BE0-EA18C71F27DA
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DocuSign Envelope ID: 3D92E36A-7C13-4030-9BE0-EA18C71F27DA
MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP PROTECTIVE CASING AND CONCRETE PAD
L1 CASING MATERIAL sch 40 PVC
CASING DIAMETER 8 inches
CASING LENGTH 12 inches
PAD DIMENSIONS 2 feet x 2 feet
HEIGHT ABOVE GROUND Flush Grade
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 4 inches
JOINT TYPE flush threaded
LENGTH 5 feet
L2 BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 3 feet
SEAL
TYPE OF SEAL bentonite
L4 THICKNESS 1 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 1 feet
WELL SCREEN
L3 SCREEN MATERIAL sch 40 PVC
DIAMETER 4 inches
LENGTH 15 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 20 feet
DEPTH TO BOTTOM OF
BOREHOLE 20 feet
L1 =0 FT.
L2 =5 FT.DIAMETER OF BOREHOLE 12 inches
L3 =15 FT.
L4 =20 FT.
TITLE Recovery Well
Wicker Mart No. 10
200 South Horner Blvd, 2725 East Millbrook Road, Suite 121
Sanford, Lee County Raleigh, North Carolina 27604
North Carolina
FILE PREP. BY REV. BY DATE PROJECT NO.
CH 1/12/2024 STL1260701
DocuSign Envelope ID: 3D92E36A-7C13-4030-9BE0-EA18C71F27DA