WM0401550_Application_20240909

A TC
ASSOCIATES OF NORTH CAROLINA. P.C.
September 5, 2024
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
Telephone [phone]
www.oneatlas.com
Ms. Shuying Wang
North Carolina Department of Environmental Quality - Winston-Salem Regional Office
Division of Water Resources
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, North Carolina 27105
Re: Permit to Construct Monitoring Well
Ruby's Mini Mart
9118 NC Highway 62 South
Yanceyville, Caswell County, North Carolina
NCDEQ Incident No. 19825
Dear Ms. Wang:
Enclosed please find one application for a permit to construct one monitoring well on an adjacent property
to the Ruby's Mini Mart site located at 9118 NC Highway 62 South in Yanceyville, North Carolina. The
monitoring well will be installed at a property addressed 9158 NC Highway 62 South (Tax Map Number
0074.00.00.0010.0000) in Yanceyville, North Carolina which is located adjacent and south of the referenced
site. The permit application, site map with the proposed location of the monitoring well, well construction
details, and other relevant information are enclosed as attachments. Please review this package and return
the approved permit to this office.
If you have any questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Nick Kramer
Project Manager
Direct Line: 919-820-7051
Email: Nicholas. Krameraaoneatlas.com

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: 09/05/2024
2. County: Caswell
FOR OFFICE USE ONLY
PERMIT NO. WM0401550 ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Devin Valenza Telephone: [phone]
Applicant's Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address (if available): Devi n.Valenza(a�deg.nc.gov
5. Contact Person (if different than Applicant): Nick Kramer Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): Nick.Kramer(a).oneatlas.com
6. Property Owner (if different than Applicant): Loftin Aldridge Telephone: [phone]
Property Owner's Mailing Address: 9102 NC Highway 62 South, Yanceyville, NC 27379
Property Owner's Email Address (if available): Scott.Alydige123(@icloud.com
7. Property Physical Address (Including PIN Number) 9158 NC Highway 62 South (Tax Map Number 0074.00.00.0010.0000)
City Yancevville County Caswell Zip Code 27379
8. Reason for Well(s): Suspected 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: 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).
NCDEQ UST Incident #19825
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, 1
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 30
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): There are 7 water supply wells located less than 500 feet from the proposed well location which are
identified as: WSW-6 (153 feet), P#017 (160 feet east), P#016 (180 feet), P#012 (245 feet), P#018 (300 feet southeast), P#082
(330 feet), and P#078 (370 feet).
15. Well Contractor: Geologic Exploration, Inc. Certification No.: 4459-A
Well Contractor Address: 176 Commerce Boulevard, Statesville, NC 28625
PROPOSED WELL CONSTRUCTION INFORMATION
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

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, 8"
material: 1 flush mount manhole cover.
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 09/27/2024
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 09/27/2024
(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 Applicant or *Agent
Nicholas Kramer — ATC Associates (Agent for NCDEQ State Lead)
Printed name of Applicant or *Agent
Project Manager / Agent for STL1982504
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
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 access agreement See attached 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
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
ial Office
I
05

NV A Tkc
ASSOCIATES OF NORTH CAROLINA, P.C.
August 27, 2024
Mr. Loftin S. Aldridge, Jr.
9102 NC Highway 62 South
Yanceyville, North Carolina 27379
Subject: Access Agreement for Environmental Assessment
Ruby's Mini Mart
9118 NC Highway 62 South
Yanceyville, Caswell County, North Carolina
NCDEQ Incident No. 19825
Dear Mr. Aldridge:
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
Telephone [phone]
www.oneatlas.corn
ATC Associates of North Carolina, P.C. (ATC), on behalf of the North Carolina Department of Environmental
Quality (NCDEQ), is conducting an environmental assessment at the former Ruby's Mini Mart site located at
9118 NC Highway 62 South in Yanceyville, North Carolina. As part of the assessment activities, ATC is
requesting permission to access your property located at 9158 NC Highway 62 South (Tax Map Number
0074.00.00.0010.0000) in Yanceyville, North Carolina which is located adjacent and south of the above
referenced site. As part of assessment activities. ATC is requesting permission to install one monitoring
well on your property. A map showing the location of your property in reference to the site property and the
location of the proposed monitoring well is included following this letter.
You, as the property owner, will not be held responsible or held liable for any damages or expenses for
injury to persons or property while ATC is on the premises.
Please provide your authorization and approval by signing the attached signature page in the enclosed
envelope by October 1, 2024. Acknowledgement of this form is required by NCDEQ. Denial of site access
will be forward to NCDEQ for their pursuit of site access.
If you have any questions regarding these activities, please do not hesitate to contact Nick Kramer with ATC
at nicholas kramerponeatlas.co I or [phone] or Ms. Liz Price with NCDEQ at Liz [e-mail]_gov.
Sincerely,
ATC Associates of North Carolina, P.C.
Nick Kramer
Project Manager
Enclosures:
1. Signature Page
2. Map of Proposed Monitoring Well Locations

Ruby's Mini Marl
Incident #19825
AV
A$$00ARS OF NORTH CAPOUNA, P.C. August 27 , 2024m
Response to access request for 9158 NC Highway 62 South in Yanceyville, North Carolina, for Incident
#19825:
®Access approved.
❑ Access denied.
Name l /yi L. t3v1 ) cc / /7�<�/ ;(A ��c-9
Signature fik, i
Email )C/ v P / v ✓yi
Telephone Number 33� g 7 J

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TW-1 TEMPORARY WELL
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PARCEL LINE
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Date:
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LEGEND:
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4WSW-6 INACTIVE WATER SUPPLY WELL
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--- SITE PROPERTY LINE
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NOTE: ALL LOCATIONS ARE APPROXIMATE
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Figure:
SCALE: 1" = 300' 3

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MW-1 MONITORING WELL
J 80.46 Well Identification
Relative Groundwater Elevation (ft)
TW-1 TEMPORARY WELL
�— Boring Identification
---- SITE PROPERTY LINE
PARCEL LINE
[ ] FORMER UST
L_; ABANDONED IN PLACE UST
—83.0— GROUNDWATER ELEVATION CONTOUR
(DASHED WHERE INFERRED)
GROUNDWATER FLOW DIRECTION
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Date:
3/24
Scale:
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Figure:
SCALE: 1" = 40' 4

■CI
MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP
PROTECTIVE CASING AND CONCRETE PAD
CASING MATERIAL
sch 40 PVC
CASING DIAMETER
8 inches
CASING LENGTH
12 inches
PAD DIMENSIONS
2 feet x 2 feet
HEIGHT ABOVE GROUND
flush mounted
L2
L3
L1 =
0
FT.
L2 =
10
FT.
L3 =
15
FT.
L4 =
25
FT.
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 5 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
WELL SCREEN
SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 15 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 25 feet
DEPTH TO BOTTOM OF
BOREHOLE 25 feet
DIAMETER OF BOREHOLE 8.25 inches
TITLE Monitoring Well
Ruby's Mini Mart AA 2725 East Millbrook Road
9118 NC Highway 62 South ,I Suite 121
WIRRIIMENTAL • BEOTECNBICAL
Yanceyville, Caswell County, NC IIIIILOINCSCIENCES- NAFERIALSTESTINS Raleigh, North Carolina 27604
FILE PREP. BY REV. BY DATE PROJECT NO.
N K GA 9/5/2024 STL1982504