WM0501336_Application_20190114

AECOM AECOM Technical Services of North Carolina, Inc. 919.461.1100 tel
1600 Perimeter Park Drive, Suite 400 919.461.1415 fax
Morrisville, NC 27560
January 14, 2019
Aquifer Protection Section
North Carolina DEQ-DWQ
Raleigh Regional Office
Attn: Rick Bolich
3800 Barrett Drive
Raleigh, NC 27609
Subject: Monitoring Well Permit Application
Petitioner for DSCA Site #DC320023
3912 University Drive, Durham, NC
011101 uMI—Tel l l
NC Dept of Environmental Quality
JAN 2 , 2019
Raleigh Regional Office
AECOM Technical Services of North Carolina, Inc. (AECOM), on behalf of NCDEQ — DSCA Program,
has prepared the attached permit application for the construction of one monitoring well in Durham,
Durham County, North Carolina. The application is being submitted in accordance with 15A NCAC 2C
.0105. Proposed activities include installation of a total of one monitoring well on the offsite property
located at 3211 Shannon Drive in Durham, NC. Upon approval, please forward (or fax) a copy of the
monitoring well construction permit to AECOM at the address above or via email to
[e-mail].
If you have any questions or require additional information, please do not hesitate to call Michelle
Friedman at 919-461-1422 or Rob MacWilliams at 704-499-4839.
Sincerely,
AECOM TECHNICAL SERVICES OF NORTH CAROLINA, INC.
Michelle Friedman, PG Robert H. MacWilliams, PG
Project Manager Program Manager
Enclosures

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES — AQUIFER PROTECTION SECTION
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: 1/14/2019
2. County: Durham
3.
4.
5.
7
8.
FOR OFFICE USE ONLY
PERMIT NO. W,446 0/336 ISSUED DATE
What type of well are you applying for? (monitoring or recovery):
Applicant: DSCA Petitioner DC320023
monitoring
Telephone: [phone]
Applicant's Mailing AddresS NCDEQ Division of Waste Management, DSCA Program, 1646 Mail Service Center, Raleigh, 27699
Applicant's Email Address (if available): [e-mail]
i ll h icee Friedman Contact Person (if different than Applicant): MTelephone: 919-461-1422
Contact Person's Mailing Address: 160o Perimeter Park Drive, Morrisville, NC 27560
Contact Person's Email Address (if available): [e-mail]
Property Owner (if different than Applicant): Southcourt operating, LLC Telephone: Not available
Property Owner's Mailing Address: Gemini -Rosemont Realty, LLC, 330 Garfield Street, Santa Fe, NM 87501
Property Owner's Email Address (if available): contact: Carrie Kartcher CKarcher@trinity-partners. com
Property Physical Address (including zip code) and PIN Number_3211 Shannon Drive (PIN 0810-10-36-4058)
Reason for Well(s): _environmental 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: commercial dry cleaner 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).
11
DSCA Site DC 320023
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, 6
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0501223 (3 offsite wells, 2 abandoned in 2018)
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): -700 feet
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
Well Contractor Address: 176 Commerce Blvd, Statesville
Certification No.: TBD
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

2.
3.
4.
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? flush mount
material: 1
Number of wells to be constructed in bedrock:
Total Number of wells to be constructed: 1
(add answers from 2 and 3)
protective cover with locking expansion plug
Estimated beginning construction date: 2/21/2019
Estimated construction completion date: 2/28/2019
ADDITIONAL INFORMATION
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 /2yp/ ) and accepts f,r�P/,j/$�ensi i i for compliance with these rules
Digitally signed , Mdedm
Mlan, l�i� /� %A
Friedman, WI. /Y
a I It DN:cmFriedmamMichelle, n.t ject Manager
-05,00,
Michelle Friedman
Printed name of Applicant or *Agent
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
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 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's Aquifer Protection Section 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
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: [phone]
GW-22MR (Rev. 8/13)

Client: DSCA Petitioner- DC320023, Re enct, Cleaners WELL ID: Type II Monitoring
��0MPr o ect Number: TBD
Site Location: Durhant, NC Date Installed: TBD
Well Location: Coords: Lts ector•:
Method: Hollow Stem Auger Contractor-: Geoloeic Exploration
Describe Measuring Point:
Proposed Monitoring Well Construction Log
Top of Riser Pipe
Ground Surface (G.S.)
Riser Pipe:
Length
< = 30'
Diameter (ID)
2"
Type of Material
PVC
Thickness
Sch 40
Grout:
Type
NA
Thickness
NA
. Stabilized Water Level
Top of Bentonite
Bentonite Seal Thickness 2.5'
Top of Sand
Top of Screen
Screen:
Length
10,
Diameter (ID)
2"
Slot Size
10 slot
Type of Material
PVC
Thickness
Sch 40
Type/Size of Sand
#2
Sand Pack Thickness
12'
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Borehole Diameter 8"
Signature
Depth from G.S. (feet) Elevation (feet)
Datum
0.0
0.0
Surface completion: flush mount manhole In concrete
With IocKing Well cap
TBD
TBD
TBD
TBD
<=40
—40
<=40
Date

ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval. For DSCA Use Only
Ifyou have questions on how to fill out this form or about the activities DSCA ID No.
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program's contractor for this project, Michelle Friedman with 320023
AECOM Technical Services of North Carolina, Inc. (AECOM at
Michelle.Fi-iednian@,gecom.com or [phone]. Ifyou still have questions
after contacting Ms. Friedman with AECOM, please contact the DSCA project
manager, Jay King at Jay} [e-mail] or 919-707-8367.
Please Print
Southcourt Operating LLC
(Name of Property Owner or Tenant in Residence)
3211 Shannon Road (PIN #0810-10-36-4058)
(Street Number and Street Name of Property)
Durham Durham 27707
(City or Town in Which Property Is 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:
(1) taking such soil, groundwater 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) 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.
jg��D
.FIE
North Caroline Department of Environmental Quality I Dhislon of Waste Management
217 West Jones Street 1 1646 Mall Service Ccnttr I Raleigh. North Carolina 276".1646
919.707.8200

(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
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 "Property Access Consent".
(Signature o Prope Owner or Tenant�n Resi�G���✓fi o e)
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
(Email Address for Property Owner or Tenant in Residence if you prefer to
email)
Please return form to:
Michelle Friedman
AECOM
1600 Perimeter Park Drive, Suite 400
Morrisville, NC 27560
Or via email to: [e-mail]
NorthCarohna Department of EnWronmentalQuAy I DlvWonof Waste Management
217 West )ones Street 11646 Matt Service Center I Rakgh. North CaroUna 27699.1646
919.707.5200
via
e -T cam`*-t

LEGEND
Monitoring Well Location
® Temporary Monitoring Well Locations as depicted in the ECS
Groundwater Assessment Report, dated Feb 24, 2017
Abandoned Monitoring Well Location and Identification
Inferred Groundwater Flow Direction
— — — — Potentiometric Surface Contour line in ft/msl (Monitoring
wells gauged for groundwater elevation on August 7, 2018) nt3a
� aa.
Area of Chlorinated COC 2L Groundwater
Contaminant Exceedance
❑ Regency Cleaners Location I Approximate Property Boundary
PCE - Tetrachloroethene BDL - Below detection limits
TCE - Trichloroethene ugfl - micrograms per liter
DCE - Dichloroethene Detections in Red exceed 2L Standard.
99 Groundwater analytical results do not exceed calculated vapor
intrusion risk for residential or non-residential exposure
(DSCA Calculator Version 6 - November 2017)
00 Groundwater analytical results do not exceed calculated vapor
intrusion risk for non-residential exposure but do exceed for residen.
tial exposure (DSCA Calculator Version 6 - November 2017)
Groundwater al ti al it dcalculated
IN W an tical results excee vapor f
intrusion risk for residential and non-residential exposure i
(DSCA Calculator Version 6 - November 2017)
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APPROX. SCALE, ft.
►Ij soB- lonsn_otx AECOMrrQINAAtsrmncrsor Groundwater Quality Summary Figure
�COM c August 8, 2018
D
MMP- lor_slaots ss:scARNEGIEBLw.suirE3ro Regency Cleaners
v, ciutaorrr aczams 3912Durham,
University Drive
flo1� No. TEL Durham, NC
�3 60541711 rAx:(reps32-W63 DSCA Site # DC320023

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