WM0701328_Application_20240806

2725 East Millbrook Road
Suite 121
AWA
F kT Raleigh, NC 27604
Aff Tel: [phone]
Fax: [phone]
ENVIRONMENTAL • GEOTECHNICAL www.atcgroupservices.com
BUILDING SCIENCES • MATERIALS TESTING N.C. Engineering License No. C-1598
August 6, 2024
Mr. David May
Washington Regional Office
North Carolina Department of Environmental Quality
Water Quality Regional Operations Section
943 Washington Square Mall
Washington, North Carolina 27889
Re: Permit to Construct Monitoring Well
Rochelle Cleaners
110 S. Water Street
Elizabeth City, Pasquotank County, North Carolina
DSCA Site ID DC700002
Dear Mr. May:
Enclosed please find one application for a permit to construct two permanent groundwater
monitoring wells. The permanent groundwater monitoring wells will be installed at a property
addressed 701-1 East Main Street and 701-3 East Main Street in Elizabeth City, Pasquotank
County, North Carolina (PINs 891308995390 and 891308995297). The permit application, site
map with the proposed locations of the monitoring wells, well construction details, and other
relevant information are enclosed as attachments. Please review this package and return the
approved permit to this office or via email to Jeremy.Robbins(a)_OneAtlas.com.
If you have any questions or require additional information, please contact our office at (919)
871-0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Jeremy J. Robbins, P.G.
Project Manager

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.
FOR OFFICE USE ONLY
1. Date: 08/06/2024
2. County: Pas uotank PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Permanent Monitoring Wells
4. Applicant: 100 Water, LLC (DSCA Petitioner for DSCA Site ID DC700002) Telephone: [phone]
Applicant's Mailing Address: DWM DSCA Program Attm Ariana Rivera, 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address(if available): Ariana.Rivera(cDdeg.nc.gov
5. Contact Person (if different than Applicant): Jeremy Robbins, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): Jeremy.Robb ins(o).oneatlas.com
6. Property Owner(if different than Applicant): JWJ III, LLC (Attn: J. Wilson Jones, III) Telephone: [phone]
Property Owner's Mailing Address: 400 S.Water Street,Apartment 302, Elizabeth City, North Carolina 27909
Property Owner's Email Address (if available): wilsonj3(a�mackeysferrysawmill.com
7. Property Physical Address(Including PIN Number)701-1 and 701-3 East Main Street(PINs 891308995390 and 891308995297)
City Elizabeth City County Pasquotank Zip Code 27909
8. Reason for Well(s): Assessment
(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: NCDEQ DSCA Program Site
(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).
DSCA Site ID DC700002
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? No
Existing Monitoring or Recovery Well Construction Permit No(s).: Not Applicable
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): —30 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): Not Applicable
15. Well Contractor: AmeriProbe, LLC Certification No.: 4196-B
Well Contractor Address: PO 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 5. How will the well(s)be secured? Locking well cap,
material: 2 flush-mount steel protective casing
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 09/16/2024
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 09/18/2024
(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
on behalf of DSCA Petitioner for DSCA Site DC700002 Agent for Petitioner for DSCA Site DC700002
Signature of Applicant or*Agent Title of Applicant or*Agent
Jeremy Robbins *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
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 access consent See attached access consent
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 Washington Regional Office Winston-Salem Regional Office
2090 U.S. Highway 70 943 Washington Square Mall 450 W. Hanes Mill Road
Swannanoa, NC 28778 Washington, NC 27889 Suite 300
Phone: [phone] Phone: [phone] Winston-Salem, NC 27105
Fax: [phone] Fax: [phone] Phone: [phone]
Fax: [phone]
Fayetteville Regional Office Wilmington Regional Office
225 Green Street, Suite 714 127 Cardinal Drive Extension
Fayetteville, NC 28301-5094 Wilmington, NC 28405
Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone]
Mooresville Regional Office ri
610 East Center Avenue s sale r,,
Mooresville, NC 28115 �L r all
Phone: [phone] r�
Fax: [phone] j ti
II° or Is
Raleigh Regional Office Z
3800 Barrett Drive
Raleigh, NC 27609 F ills
Phone: [phone] GW-22M(Rev.5/11)
Fax: [phone] W11 ogron
GW-22MR Rev.3-1-2016
GW-22MR(6/11)

ROY COOPER r..•: -� %- fl
Governor � +
ELIZABETH S.BISERseeretaly
��. �;• ^ .
MICHAEL SCOTT NORTH CAROLINA
Director Environmental Quality
PROPERTY ACCESS CONSENT
For DSCA Use Only
This document may not be modified 14thout the Program's approval. DSCA ID No.
If you have questions on how to fill out this form or about the activities DC700002
at this site,please call the Dry-Cleaning Solvent Cleanup Act(DSCA)
Pr•ograrrr's contractor for this project.7erenry Robbins with ATC Associates of North Carolina,
P.C. (ATC) at.fere))iv.RobhinsL(boneallas.cont or(804) 725-8454. Ifyou still have questions
after contacting Mr. Robbins lvith ATC,please contact the DSCA Prograrrr Project Manager,
Ms.Ariana Rivera at Ar•iana.River r rr�,de{L.na gov or(919)707-8352.
Please Print
S I , LPL J . (V 15`on . W5 r
(Name of Property Owner or Tenant in Residence)
701-1 E Main Street(PIN 891308995390), 701-2 E Main Street(PIN 891308995298),
and 701-3 E Main Street(PIN 891308995297)
(Street Number and Street Name of Property)
Elizabeth City n Pas uotank 27909
;
(City or Town in Which Property Ts Located) / (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:
i
i
(1) taking such soil,groundwater,surface water, 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
i
(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.
I
(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 j
I
31
North Carolina Department of Environmental Quality I Division of Waste Management 1
E Q 217 West Jones street 1 1646 Mail Service Center I Raleigh,North Carolina 27699-16,16 i
r,ora)��/atra .g D.
cepvwro�aunswnnt�aa�ni /'�
V 912707.8200 I�
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Division or its contractors. All monitoring wells will be properly abandoned in accordance
with applicable laws and regulations, unless other arrangements are agreed to by the Property
Owner.
(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
determines to be of an emergency nature,the Division or its contractors shall have immediate
access to the property.
(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 contacted all
tenants (if there are tenants) occupying the property and all tenants agree to the conditions
of this "Pro"Accessnsent".
J
r7- Z3- Z
(Signgturc of Property Owner or Tenatit in Residence) (Date)
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
(Email AddreX for Property Owner or Tenant in P esidence if you prefer to be contacted via
email)
Please return form to:
Jeremy Robbins
ATC Associates of North Carolina, P.C.
{ 2725 E. Millbrook Road,Suite 121
Raleigh, NC 27604
or via email to;[e-mail]
I
North Carollno Department of Environmental Quality I Division of Waste Management
217 West Jones Street 11646 Mail Service Center I Raleigh,North Carolina 27699-1646
Nnm��rN.Yx`A i
919,707.8200

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500 Foot Radius 0- U O N U E
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Da1e1 8/5/2024
0 40 80 120 160 200 sae 1" — 105'
Feet At-h...t 1 v

TYPICAL TYPE 11 MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
NOT TO SCALE
LOCKABLE WELL CAP
PROTECTIVE CASING AND CONCRETE PAD
Li 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 15 feet
L2 BACKFILL AROUND CASING
MATERIAL cement-sand 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
TOTAL FILTER PACK LENGTH 11 feet
WELL SCREEN
L3 SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 10 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
. . . . . . . . . MONITORING WELL 15 feet
\V DEPTH TO BOTTOM OF
BOREHOLE 15 feet
Ll = 0 FT.
L2= 5 FT. DIAMETER OF BOREHOLE 9 inches
L3= 10 FT.
L4= 15 FT.
TITLE Permanent Monitoring Well Diagram
(Example of typical MW installation displayed above)
Rochelle Cleaners 2725 East Millbrook Road, Suite 121
100 S. Water Street Raleigh, North Carolina 27604
Elizabeth City, North Carolina
FILE PREP. BY REV. BY DATE PROJECT NO.
I JR I AO 8/5/2024 DC7002SI-01