WM0801129_Application_20190306

2725 E. Millbrook Road, Suite 121
Raleigh, North Carolina 27604
Telephone [phone]
Fax [phone]
ENVIRONMENTAL GEOTECHNICAL www.atcgroupservices.com
BUILDING UIENCEs • MATERIALS TESTING
February 2.1, 2019
Mr. Geoffrey Kegley
North Carolina Department of Environmental Quality
Wilmington Regional Office
Division of Water Quality — Aquifer Protection
127 Cardinal Drive Ext.
Wilmington, North Carolina 28405
Re: Permit to Construct Monitoring Well
Dodson Exterminators U.S.ellular
2861 Richlands Highway
Jacksonville, Onslow County, North Carolina
ATC Project No.. USCELL 19
Dear Mr. Kegley:
Enclosed please find one application for a permit to construct two monitoring well. The monitoring wells
will be located at 2869 Richlands Highway in Jacksonville, Onslow County, North Carolina.. The permit
application, site map with the proposed location 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.
If you have any questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Carter. C. Paradis
Staff Scientist
RECEIVEDMWEN
MAR 01
Water Quality Regional
Operations Section
Wilmington Regional Office

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: 2/21 /2019
PERMIT NISSUED DATE
,
2. County: Onslow
3. What type of well are you applying for? (monitoring or recovery): Monitoring Well
4. Applicant: Rich Nowacki Telephone: [phone]
Applicant's Mailing Address: 8410 West Bryn Mawr Ave, Chicago, IL 60631
Applicant's .Email Address (if available):
5. Contact Person (if different than Applicant): Gabriel Araos Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 2704
Contact'Person's Email Address (if available): gabe.araos(@-atcgs.com
6. Property Owner (if different than Applicant): Craig Smith Telephone:
Property Owner's Mailing Address: O'Reilly Auto Parts, 233 S. Patterson, Springfield, MO 65802
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 2869 Richlands Highway (PIN: 049238)
City Jacksonville - County Onslow Zip Code 28540
8. Reason for Well(s): Remedial Investigation
(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: Inactive Hazardous Site Program
(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. Type of contaminants being monitored or recovered: pesticides and herbicides
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? 3
Existing Monitoring. or Recovery Well Construction Permit No(s).: NA
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 100
14. Are there. any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): 350
15. Well Contractor: Regional Probing Services Certification No.: NC3322-A
Well Contractor Address: P.O. Box 1161 Wake Forest, NC 27588
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

i
PROPOSED WELL CONSTRUCTION INFORMATION
(Continued)
1
2. Dumber of wells to be constructed in unconsolidated 5,
.How will the well(s) be secured? Locking well caa, 8,f
1 material: 2 flush mount manhole cover
i 3. Number of wells to be constructed in bedrock: 0 _ 8. Estimated' • beginning construction date-
. 3/1/2019
4. Total Number of wells to be constructed: 2
7. Estimated construction completion date: 31.1
(add answers from 2 and 3)
ADDITIONAL INFORMATION
I. As required by 15A NCAC 02C .i1105{fi}{5), attach a scaled ma of the site showi h .
P wing the locations of the following.
a. All property boundaries, at least.oneof which is referenced to a minimum of two tan '
intersections,, streams, or lakes within 500 feet of the dmarks such as identified roads,
proposed well or well system,
b. All existing wells, identified by type of use, within 500 feet of the proposed well or yrvell system.
c.
The proposed well or well system. Y
d, Any test borings within 500 feet of proposed well or well sys#ern.
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 dis Deal areas with'
of the proposed well or well system. p } �n 500 feet
I SIGNATURES
The Applicant hereby agrees that the proposed well(s)will be constructed in accordconditions
this well Construction Pe i ante with approved specifications and of
rm t as regulated under th Well Construction Standards {Title 15A of the North Carolina Administrative Code,
u chapter 2C) an � epts full responsibility for compliance with these rules
10?
St' nature of i *
9 ppl cantor Agent .. Title. of Applicant or *Agent
* !f signing ,
Printed name of Applicant or *Agent
g as Agent, attach authorization agreement stating
that you have the authorriy to act as the Agent:
if the property is owned by someone other than the applicant, the property owns p p p y r hereby consents to allow the applicant to construct
wells as outlined in this Well Construction Permit application and that it shall be the responsibili of the a licant t
well(s) conform to the Well, Construction Standards ills 15A of the North � pp o ensure that the
{T rth Carolina Administrative Code, Subchapter 2C).
See attached
:See attached
Signature of Property Owner {if different than Applicant} Printed name of Pra ert owner if different tha
n Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office Raleigh Regional Office -
Wilmington Regional office
2090 U.S. Highway 70 $800 Barrett Dive 127 Cardinal Dive Extension
Swannanoa, NC 28778 nsion
Raleigh, NC 27f 09 Wilmington,: NC z8�05
Phony: [phone] Phone: {919} 791-424q
Phone: [phone]
Fax: [phone]
{ ) 299-� Fax: 9'l 9
t ) 571-4718 Fax [phone]
Fayetteville Regional Office Washington Regional Office 9 Winston-Salem Regional Office
22 Green Street, quite 714 943 Washington Square Mall 450 W.
Fayetteville, NC 28301-5094 Hanes Noll Road
Washington, NC 27889 Suite 300
Phone: [phone] Phone: {252} 946-fi481 Winston-Salem,
anston-Salem, NC 27105
x: [phone]
Fax: 252 975
}�3718 Phone: [phone]
Mooresville Regional Office Fax; [phone]
610 Bast Center Avenue
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SOURCE: USGS JACKSONVILLE NORTH TOPOGRAPHIC MAP
2725 E. Millbrook Road, Suite 121 Figure 1.
Raleigh, NC 27604
SITE TOPOGRAPHIC MAP
[phone]
PROJECT NO: 45.75017.0001 I DODSON EXTERMINATORS-U.S. CELLULAR
2861 RICHLANDS HIGHWAY
REVIEWED BY: JAC SCALE: DATE: JAN. 2018 JACKSONVILLE) ONSLOW COUNTY
See above NORTH CAROLINA

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MONITORING WELL CONSTRUCTION DETAILS
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FLUSH GRADE MANHOLE
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CROSS SECTIONAL VIEW
(NOT TO SCALE)
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LOCKABLE WELL CAP
PROTECTIVE ;CASING AND CONCRETE PAD
Ll
CASING MATERIAL
sch 40 PVC
CASING DIAMETER
8 inches
CASING LENGTH
12 inches
PAD DIMENSIONS
2 feet x 2 feet
HEIGHT ABOVE GROUND
i
flush mounted
WELL CASING
MATERIAL
sch 40 PVC j
DIAMETER
2 inches
JOINT TYPE
flush threaded
LENGTH
5 feet
L2
BACKFILL AROUND CASING
MATERIAL
cement grout
THICKNESS
2 feet '
SEAL
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TYPE OF SEAL
bentonite
L4
THICKNESS
2 feet
FILTER PACK
TYPE OF FILTER
#2 silica sand �
DISTANCE ABOVE SCREEN
1 feet
WELL SC REEN
L3
SCREEN MATERIAL
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sch 40 PVC
DIAMETER
2 inches
LENGTH
10 feet i
SLOT SIZE
0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL
15 feet
DEPTH TO BOTTOM OF
BOREHOLE
15 feet
L 1 _ 0 FT.
L2 = 61 FT.
DIAMETER OF BOREHOLE
6 inches j
L3 = 15 FT.
L4 = 15 FT.
TITLE Monitoring Well
Dodson Exterminators - US Cellular
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2725 East
Millbrook Road
1 Richlands Highway
+/' Suite 121
Jacksonville, Onslow Count
ENVIRON-MEN.TAL •. NEdTEGNNICAl
BUILD ING�StIENCE&'• MAtihIALS'TESTING Raleigh, North Carolina 27604
North Carolina
FILE PREP. BY REV. BY DATE PROJECT NO.
CP
GA 2/21/2019
USCELL19 i
i

ACCESS AGREEMENT
This Access Agreement is, made as of the 20th day of February, 2019, by and
between ATC ("ATC") and CREILLY AUTOMOTIVE STORES, INC., CO'Reilly").
WHEREAS, O'Reilly owns property located at 2861 Richlands Highway, Jacksonville,
Onslow County, North Carolina ("O'Reilly Property"); and
WHEREAS, ATC has requested that O'Reilly allow it to access the property for the
purpose of performing certain soil and/or groundwater testing, including the installation,
periodic monitoring, and, maintenance of monitoring wells; and
WHEREAS, O'Reilly has agreed- to allow ATC to access the property for the purpose
of soil and/or groundwater testing and installing, periodically monitoring, and maintaining
said wells (the "Workl; and
WHEREAS, ATC desires to obtain and O'Reilly desires to grant temporary access to
the O'Reilly Property for the purpose of completing the Work.
NOW, THEREFORE, in consideration of the terms and conditions of this Agreement,
the parties agree as follows:
1. O'Reilly agrees that ATC may have temporary access on, across and over
the O'Reilly Property for the purpose of completing the Work.
2. ATC.will conduct all Work on the O'Reilly Property strictly in compliance with
all applicable statutes, ordinances, codes and regulations and will insure that its,employees
and .contractors comply with. those statutes, ordinances, codes and regulations,
3, ATC will insure that the O'Reilly Property is kept free from health and safety
hazards arising from the Work on the. Property.
4. ATC shall cause the work to be conducted in such a. manner as to
reasonably minimize any disruptions or interference with O'Reilly's use of the O'Reilly
Property. Further, ATC shall, to the. extent possible, restore the area +of the. work to
substantially the same condition as existed prior to initiating. the Work.
6. O'Reilly shall have no liability of any kind for any claim for damage to the
person. or property of any ATC personnel, volunteers or third party completing. the Mork;
such liability shall be strictly that of ATC, and ATC will hold harmless and indemnify UReilly
from any and all such liability. Additionally, at all times that ATC is utilizing the O'Reilly
Property, ATC agrees to maintain general liability insurance coverage with a minimum limit
of $1,000,000 per occurrence and $2,000,000 in the aggregate that is endorsed to name_
O'Reilly Automotive Stores, Inc. and its subsidiaries and assigns as an additional insured, as
evidenced by the insurance certificate attached hereto as Exhibit A.
CAM C Drive=eiliy Auto1000-Legal DocwncntsloA-ATC-AcccssAgreement- Jacksonville NC.doc �.

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pa. ATC will indemnify, hold harmless and defend O'ReillY, its agents,
representatives, officers, and employees from and against all claims, demands, damages,
losses, lawsuits, other proceedings, causes of action, liabilities, claims of lien, liens, civil or
criminal penalties and charges, including reasonable attvrney's fees or other costs and
expenses arising out of or incident to an ersonaI injuries including but not limited to
p 9 any J g
emotional or bodily injuries or death, or other claims for payment which result from or are
caused by the intentional, willful or negligent acts, omissions, or errors of ATC andlor its
employees or contractors completing the Work or while using the temporary ingress and
egress area on the O'Reilly Property.
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7. ATC expressly waives any right to make any claims against O'Reilly in
connection with its use. of the Building and/or Property, and agrees to indemnify and hold
O'Reilly harmless from and against any and all damages, demands, claims, losses,
liabilities, injuries to ATC and/or any third parties and/or property, deaths, penalties, fines,
liens, judgments, suits, actions, investigations, proceedings, costs and expenses
whatsoever, which arise in connection with ATC's or its respective agents, employees, and
invitees usage of the Building and/or Property and all casts and expenses that O'Reilly may
incur in connection with any such liabilities
8. ATC shall pay all costs for completing the Work on the Property.
g. This access agreement shall be construed as a nonexclusive license in effect
from about March 1, 2019, through March 1, 2022.
10. ATC shall conduct no other activities in, on, or about the Property other than
those permitted herein.
INTENTIONALLY BLANK i
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CAW C DriveUReilly Auto1000-Legal Documents\DA-ATC-AccessAg=ment- Jacksonville NC.doc 2
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