WM0501665_Well Permit_20241016

October 16, 2024 Mr. Scott Stupak North Carolina Department of Environmental Quality On behalf of Clayton Village, LLC Petitioner for DSCA Site DC510003 1646 Mail Service Center Raleigh, NC 27699-1646 Sent Via Email Subject: Monitoring Well Construction Permit # WM0501665 Clayton Village Cleaners (DSCA Site DC510003) 10183 US Highway 70 West Clayton, NC 27520 – Johnston County Mr. Stupak: In accordance with the application received on October 4, 2024, we are forwarding herewith Monitoring Well Construction Permit No. WM0501665 dated October 16, 2024, issued for the construction of a monitoring well. 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,
Michael Hall, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ Enclosure -Permit -Application Package Ec: Jeremy Robbins, ATC Associates of North Carolina, P.C. Laserfiche

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 Clayton Village, LLC (Petitioner for DSCA Site DC510003) FOR THE CONSTRUCTION OF A MONITORING WELL owned by Clayton Village, LLC (Petitioner for DSCA Site DC510003) at mailing address 1646 Mail Service Center, Raleigh, NC 27699-1646. The wells will be located on the property owned by Taelor Fields, of the North Railroad Company at Milepost H-097 1,357 (+/-) Feet (PIN: 10), Clayton, NC 27520. This Permit is issued in accordance with the application received on October 4, 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.

____________________________________
Michael Hall, Regional Supervisor
Division of Water Resources, Raleigh Regional Office
By Authority of the Environmental Management Commission

Permit Number: WM0501665
Permit Issued: October 16, 2024
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598

October 2, 2024

Mr. Michael Hall
Raleigh Regional Office
North Carolina Department of Environmental Quality
Water Quality Regional Operations Section
1628 Mail Service Center
Raleigh, North Carolina 27699-1628

Re: Permit to Construct Monitoring Wells
Clayton Village Cleaners
10183 US Highway 70 West
Clayton, Johnston County, North Carolina
DSCA Site ID DC510003

Dear Mr. Hall:

Enclosed please find three applications for permits to construct four permanent groundwater
monitoring wells. The permanent groundwater monitoring wells will be installed across three
properties at an unaddressed parcel on East Front Street (PIN 166806-38-9809), an
unaddressed parcel on East Front Street (PIN 166806-38-9260), and milepost h-097 1,357 (+/-)
feet (PIN: 10) in Clayton, Johnston County, North Carolina. The permit applications, 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 [e-mail].

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

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: 10/02/24

2. County: Johnston

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

4. Applicant: Clayton Village, LLC (Petitioner for DSCA Site ID DC510003) Telephone: [phone]

Applicant’s Mailing Address: DWM DSCA Program Attn: Scott Stupak, 1646 Mail Service Center, Raleigh, NC 27699-1646

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

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): [e-mail]

6. Property Owner (if different than Applicant): Taelor Fields, North Carolina Railroad Company Telephone: [phone]

Property Owner’s Mailing Address: 2809 Highwoods Boulevard, Raleigh, North Carolina 27604-1000

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

7. Property Physical Address (Including PIN Number) Milepost h-097 1,357 (+/-) Feet (PIN: 10)
City Clayton County Johnston Zip Code 27520
8. Reason for Well(s): Assessment 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: 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 in cident no(s).

DSCA Site ID DC510003

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? Yes, 5 offsite and 6 onsite

Existing Monitoring or Recovery Well Construction Permit No(s).: WM0501271 and WM0501426

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): ~20 ft SE

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

If yes, give distance(s): N/A

15. Well Contractor: Geologic Exploration, Inc. Certification No.: 4459-A

Well Contractor Address: 176 Commerce Boulevard, Statesville, NC 28625

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: 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? Locking well cap,
flush-mount steel protective casing

6. Estimated beginning construction date: 11/11/24

7. Estimated construction completion date: 11/14/24

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.

on behalf of DSCA Petitioner for DSCA Site ID DC700002 Agent for Petitioner for DSCA Site ID 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
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 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
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)
GW-22MR (6/11)
GW-22M (Rev. 5/11)
TYPICAL TYPE II MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
NOT TO SCALE
LOCKABLE WELL CAP
PROTECTIVE CASING AND CONCRETE PAD
L1 CASING MATERIAL Steel
CASING DIAMETER 8 inches
CASING LENGTH 12 inches
PAD DIMENSIONS 2 feet x 2 feet
HEIGHT ABOVE GROUND 0 feet
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 30 feet
L2 BACKFILL AROUND CASING
MATERIAL cement-sand grout
THICKNESS 30
SEAL
TYPE OF SEAL bentonite
L4 THICKNESS 3'
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2'
WELL SCREEN
L3 SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 5 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 40.0 feet
DEPTH TO BOTTOM OF
BOREHOLE 40.0 feet
L1 =0 FT.
L2 =35 FT.DIAMETER OF BOREHOLE 8.75 inches
L3 =5 FT.
L4 =40 FT.
TITLE Permanent Monitoring Well Diagram
(Example of typical MW installation displayed above)
Clayton Village Cleaners
10183 US Highway 70 West 2725 E Millbrook Rd Suite 121
Clayton, NC 27520 Raleigh, NC 27604
DSCA ID #DC510003
FILE PREP. BY REV. BY DATE PROJECT NO.
JR AO 10/2/2024 DC5103SL11