WM0100274_Complete - Historical File_20190326

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Request for Permisslan to Install Monitoring Well November 15,, 1999
an Ville street. j%ge .2
Newlarnd, North Carolina
i am/We are the owner(s) of a parcel of property at or near the incident in question,
and hereby-permit A.T. Williams Oil Corripany or its contractors to enter upon .said
property for the purpase.`of installing- a-groundwater monitor well -and collecting
periodic samples from this well in the future..
I am/We are granting permission with the understanding that:
All work will be conducted by A.T. Williams Oil Company or its contractor.
• The costs of construction and maintenance of the site and access will be barn by Al
A.T. Williams Oil;C6mpar7 and -its contractor. A.T. Williams Oil Company -or its
contractor will protect and prevent damage to the surrocrnding lands. I
1
• Unless otherwise- agreed, A:T. Wiliiams..0il Company or its contractor will .have
access .' the subject:property by the shortest feasible route from the :hezrest
public road. A.T. Williams 'Oil .Company oi@ its contractor may enter upon .the �1
subject property at reasonable times and have right of access during'th life e cif the
project.-
Me agree not to interfere with, tamper-with, remove or in any way damage A.T. �
Williams Oil Company's we I(s) or e� "ui meet during the life of the project. M f-k4�aj A.
. � p 9 P J . - ,
The monitoring well VYi111 be properly abandoned according to North Carolina I
reguiations upon completion of the groundwater monitoring pro ram.
rig L HT P � aF rh(/ Ada-,.rT _mj WAeI �rce� i>,7 /L. �+—ce N.Ckc7 Td AUIW/vu• .Cain:/
cF A� rCJfJ ,t�,rj ,}•7 kU t?-_ /LL'(.."t, ry cr+7�hjY/ ,/ `y i
I/We have read this' entire agreement and fully understand and agree to all of then
conditions and limitations outlined.
v
1
Signature of property owner or current resident:
Print name of property owner or current resident: M I«��� M �
• ` 1
Address of property owner or current resident: x 3r Y r1n i
City/State/Zip Code;
Home Phone Number; ( a-q } -73,1
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Work Phone Number; ( 8zd 1 -733 - tilJ'/
Date: /t 8- S
I
L99-1747
tnM:11 P M

1 ID-A ANTIC
A:S S.O :C-I A.T-'E:
Eriginecriig"& Enviro"nrnenra1 Solur"ions
409 Rogers VIeH-Court/Raleigh!North Carollnu/37610
800--l86.7S68/919-2S0.'9918/919-250=9950 Facsimile
nww.m au online..com
November 15, 1999
Mr, Michael Lacey and Mr. Bruce Lacey
Post Office Box 400
Newland, North Carolina 28657
Subject: REQUEST FOR:PERMISSION TO INSTALL
MONITORING;WELL
LINVILLE:STREET
N1=INLAND, NORTH CAROLINA
Dear Mr. Lacey and Mr. Lacey:
On behalf of the A.T. Williams Oil Company, Mid-Atlantic Associates, P.A. (Mid-
Atlantic) is requ'estirig access to your property_to install and sample-a groundwater
monitoring well. This .work is being performed to satisfy North Carolina• .regulatory
requirements for soil and'ground'Water assessment related.to petroleum-fuel products
identified in the subsurface at the Newland Exxon located at the southeast.corner.of
the intersection of Linville Street (Highway: 194) and Highway 181 in'.Ne'wland,, North
Carolina. Mid-Atlantic or its designated contractors will perform all necessary wgrk as
required. At- present, we would Aike to install one -monitoring well on your property
located just to the south of the Newland Exxon. The proposed -well location and.the
w
well construction specifications are shon 'on the enclosed Application'for Permit to
Construct a Monitoring Well System. Installation of.th.e well, will take aporoxi;mately
two .hours: The well will be finished flush-to-grade with an 8-inch -diameter, .bolt- -
down, steel manhole surrounded -hy a flush-to-grade concrete pad. Although we do
not know how long the well will have to remain in place, we are estimating a period
of one,to-five years. If you have questions concerning this matter, please contact
P^1 L Trey Marchant at 1-800-486-7568.
To indicate your granting permission to install this well, please complete page 2, sign
in the designated area and initial page 1 of this agreement (at the bottom of the
page). Also, please sign on Page 2 of the Application for Permit to Construct a
Monitoring Well -System. Once properly completed, you may make a copy for your
records, However, please mail the originals back to us-in the enclosed self-addressed,
stamped envelope.
Initials MM�

•Y
ATTACHMENT C
ACCESS AGREEMENT
MID-ATLANTIC
ASS_0CIATE_S. ( N.C.
Engineering & F.nrironmentat Solutions

DEPTH FROM GROUND SURFACE
LOCKABLE CAP TO TOP OF CASING (TOC)
0.25 FT.
FLUSH MOUNT
WELL PROTECTOR BLAND SURFACE
v
• d'
b
•
• TOTAL DEPTH
a OF WELL
DEPTH TO TOP OF 6 FT. LENGTH OF -20 FT.
BENTONITE SEAL SOLID SECTION
10 Fr.
DEPTH TO TOP OF B Fr.
GRANULAR MATERIAL
THREADED COUPLING
RISER ,:..
PRE-PACKED
SCREEN LENGTH OF
SLOTTED SECTION
10 Fr.
71
GROUT LENGTH OF TAIL
CAP :: PIPE _0_
®BENTONITE
EI GRANULAR BACKFILL
NOT TO SCALE
TYPE II FLUSH MOUNT DRAWN DATE: AUGUST 2011
MONITORING WELL SCHEMATIC BY:
MID-ATLANTIC PROPOSED DRAFT JOB 00OR0786.20
ASSOCIATES, INC. WELL CONSTRUCTION CHECK: N0:
Engineering & Environmental Solutions WILCO #285 ENG CHECK: CA 01-078601-20
NEWLAND, NORTH CAROLINA
APPROVAL DWG
NO:
REFERENCE:

.a
ATTACHMENT B
WELL CONSTRUCTION DETAILS
MID-ATLANTIC
ASSOCIATES, INC.
Engineering S EnairnnmenCnlSolutions

14 Avery Co. -- Printable Map Page 1 of 1
Avery County, NC
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information is believed to be accurate but accuracy is not guaranteed.
http://wNw.webais.net Anderson&Associates,Inc. http://www.andassoc.com
http://arcims.webgis.net/nc/avery/printable2.asp 8/15/2011

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411.11-9 FORMER MONITORING WELL LOCATION (ABANDONED) I l'® STORM DRAIN
UGHT POLE n n
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-°—,—°—°—,- PRODUCT LINES
—ss—s— APPROXIMATE LOCATION OF SEWER MAIN 0 40'
--._.E—E—E— ELECTRICAL LINE
—v--v—v— WATER LINE SCALE. 1"= 40'
AND
ID-ATLANTIC MONITORING SITE WELL LOCATION MAP DRAWN /BY: DATE: JANUARY 2D11
•"/
FT ASSOCIATES, INC. FORMER WILCO #285 SITE CHE K: jM JOB NO: 099R0786.19
Ezz viaeering NEWLAND, NORTH CAROLINA ENG �c
CHECK: CAD NO: 01-078501-1 9
REFERENCE: AQUATERRA DRAWING NO. 61046-1 DATED 5/13/96 APPROVALS DWG NO 1.2

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CONTOUR INTERVAL=40 FEET '1 I-'I -•'�� -� '` ^ L_r�-~r�=='�
REFERENCES:
( SCALE: 1:12,000
1.NEWLAND,NC DIGITAL RASTER GRAPHIC,USGS.SCANNED FROM
1 1:2400-SCALE USGS TOPOGRAPHIC MAP.NEWLAND,NC,1994. Feet
2.INSET MAP DIGITAL DATA FROM 2002 NATIONAL TRANSPORTATION ATLAS,
BUREAU OF TRANSPORTATION STATISTICS,WASHINGTON,D.C. 0 1,000 2,000
I
ti DRAWN / DATE:
1 1J'ATL NTIC BR JANUARY 2011
TOPOGRAPHIC SITE MAP DRAFT n� Jos No:
J� A 5 S O C I rl T E S, I wr c - FORMER WILCO #285 SITE CHECK: �`'� 099R0786.19
NEWLAND, NORTH CAROLING CHEENG ( GfS NO:
11, i,'iaerfn & �nvfranri2nta( Salu.iorr.s CHECK' } O1G-99R0786.19-1
i APPROVAL: DWG NO: 1.1
1
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1 ._

ATTACHMENT A
SITE AND PROPOSE® MONITORING WELL LOCATION MAP
MID-ATLANTIC
ASS0CIAT_ES.fNNC.
En,ineerin, & Enrironmencrrl Solutioiu

6. Thickness of casing: SCH 40 inches
7. How will the well(s) be secured? Steel locking protectors and locking plugs
8. Estimated beginning construction date: September 15, 2011
9. Estimated completion date: September 15, 2011
ADDITIONAL INFORMATION
1. ATTACH A SITE MAP SHOWING THE LOCATIONS OF THE FOLLOWING:
1 - PROPOSED MONITORING WELL(S)
2 - ALL EXISTING MONITORING AND RECOVERY WELLS OR TEST BORINGS WITH THE PROPERTY
BOUNDARY
3 - ALL WATER SUPPLY WELLS WITHIN 500 FEET OF THE WASTE SOURCES
4 - AT LEAST TWO REFERENCE POINTS (NUMBERED ROADS, INTERSECTIONS, STREAMS, ETC.)
2. PROVIDE A WELL CONSTRUCTION DIAGRAM OF EACH WELL SHOWING DIAMETER, ESTIMATED DEPTH
SCREEN INTERVALS, SAND/GRAVEL PACKS, TYPE OF CASING MATERIAL, CASING WALL THICKNESS, WELL
HEAD COMPLETION DETAILS, ETC.
The Applicant hereby agrees the proposed well(s) will be constructed in accordance with
approved specifications and conditions of the Well Construction Permit as regulated under the
Well Construction Standards (Title 15A North Carolina Administrative Code, Subchapter 2C)
and accepts full responsibility for compliance with these rules.
Signature of Applicant or Agent
Senior Geologist, Mid-Atlantic Associates (Agent)
Title (if applicable)
If the property is owned by someone other than the applicant, the property owner
hereby consents to allow the applicant to construct monitoring wells as outlined in this
application and that it shall be the responsibility of the applicant to ensure that these
monitoring wells conform to the Well Construction Standards (Title 15A North Carolina
Administrative Code, Subchapter 2C).
See attached access agreement
Signature of Property Owner (if different from applicant)

•7
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING WELL SYSTEM
(Please Type or Print Clearly)
Date: August 16 2011 County Avery
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 monitoring wells.
1. Name of Applicant: WILCOHESS, LLC (Telephone: [phone] )
Applicant's Mailing Address: 5446 University Parkway, Winston-Salem, NC 27105
2. Name of Property Owner (if different from Well Owner): Michael Lacey
Owner's Mailing Address: P.O. Box 400, Newland, NC 28657
3. Contact Person: Raymond S. Marchant, III (Telephone: [phone] )
4. Location of Property: Southeast corner of the intersection of Linville St. and Highway 181, Newland, NC
5. Reason for Monitoring Well(s): Environmental Assessment
(ex: nondischarge permit requirements, suspected contamination, environmental assessment, etc.))
6. Type of facility or site for which the monitoring well(s) is needed: Underground Storage Tank
(ex: nondischarge facility, waste disposal site, landfill, underground storage tank, etc.)
7. Type of contamination being monitored (if applicable): Petroleum
(ex: nutrients, organics, heavy metals, etc.)
8. Are any existing recovery wells associated with the monitoring well(s)? No if yes, how many?
Recovery Well Construction Permit No.
9. Distance to a known waste or pollution source: ---100 feet
10. Are any water supply wells located less than 500 feet from the proposed monitoring wells? No
If yes, give distance: feet
11. Well Driller: South Atlantic Environmental Drilling and Construction Company, Inc.
12. Registration #: 2593
13. Driller's Address: 9088 Northfield Drive, Fort Mill, South Carolina 29707
PROPOSED MONITORING WELL CONSTRUCTION INFORMATION
1. Total Number of Wells to be constructed: 2 ; (A) Number to be completed in bedrock? None
(B) number to be completed in unconsolidated material? 2
2. Estimated depth of well(s): 20 feet
3. Gravel or sand pack interval (if appropriate) FOR OFFICE USE ONLY
From 8 feet to 20 feet
PERMITTED ACTIVITY
4. Type of casing used: PVC UST LEAK DETECTION
(ex: PVC, stainless steel, galvanized steel, etc.) _ GROUNDWATER QUALITY STANDARDS
5. Diameter of casing: 2 inches VIOLATIONS SUSPECTED FROM UNPERMITTED
ACTIVITIES
NOTICE OF NON-COMPLIANCE AT
UNPERMITTED
PERMIT NO. ISSUED 20
INCIDENT #

1002
MID-ATLANTIC
ASSOC I ATE S, INC.
Engineering & Envirortnaental Solutions
409 Rogers View Court/RaleighlNorth Carolinal27610
800-486-75681919-250-99181919-250-9950 Facsimile "" _`
www.Aft4online.com ?;i'(+^'rf (EZ_
August 16, 2011
AUG 19 20i1
Ashq".ik- Regional Office
j�-- ?r�ifior Protection
Mr. Landon Davidson
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Asheville Regional Office, Aquifer Protection Section
2090 U.S. Highway 70
Swannanoa, North Carolina 28778
Subject: MONITORING WELL CONSTRUCTION PERMIT APPLICATION
LACEY PROPERTY
WILCO #285 SITE
NEWLAND, AVERY COUNTY, NORTH CAROLINA
INCIDENT NO.: 15939
MID-ATLANTIC JOB NO. R0786.20
Dear Mr. Davidson:
Enclosed please find a monitoring well permit application. A copy of the Access Agreement
signed by the property owner is included as an attachment. If you have any questions, please
call me at 250-9918.
Sincerely,
MID-ATLANTIC ASSOCIATES, INC.
Raymond S. Marchant, III, P.G.
Senior Geologist
Attachments: Site Map with Proposed Monitoring Well Locations
Well Construction Details
Access Agreement
8-16-1 1 Application to Construct MW System/RSM/bro
MID-ATIANTIC
AS_S0Cr&T_ES. IvC.
Engineering &Ert«bwmeatal Solutions

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY—AQUIFER PROTECTION SECTION
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 .
WilcoHess,LLC
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of ONE well owned by WilcoHess,LLC
located at 5446 University Parkway,in Winston-Salem,NC. The well will be located on the property owned by Michael and
Bruce Lacey located at the corner of Pineola and Linvillle St.,Newland,NC in Avery County(Tax Parcel# 183618428278).
This Permit is issued in accordance with the application received on August 19,2011 inconformity with specifications and
supporting data,all of which are filed with the Department of Environment and Natural Resources 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.
Permit issued the 24 h day of August,2011
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
d Landon DTvidson,Regional Supervisor
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. #WM0100275
Revised July 2011

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY—AQUIFER PROTECTION SECTION
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
WilcoHess,LLC
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of ONE well owned by WiicoHess,LLC
located at 5446 University Parkway,in Winston-Salem,NC. The well will be located on the property owned by Michael and
Bruce Lacey located at the corner of Pineola and Linvillle St.,Newland,NC in Avery County(Tax Parcel# 183618429474).
This Permit is issued in accordance with the application received on August 19,2011 in conformity with specifications and
supporting data,all of which are filed with the Department of Environment and Natural Resources 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.
Permit issued the 246'day of August,2011
FOR THE NORTH CAROLIN ONMENTAL MANAGEMENT COMMISSTON
Landon Davidson,Regional Supervisor
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No.#V M0100274
Revised July 2011

A,ma
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H.Sullins Dee Freeman
Governor Director
Secretary
August 24, 2011
Steve Williams
WILCOHESS, LLC
5446 University Parkway
Winston-Salem, North Carolina 27105
Subject: Well Construction Permit No. WM0100274 and WM0100275
Michael M. Lacey and Bruce R. Lacey
Corner of Pineola and Linville St., Newland, NC
Tax Parcel # 183618429474 and 183618428278
Avery.County, North Carolina
Dear Mr. Williams,
In accordance with the application submitted on your behalf by Mid-Atlantic Associates, Inc. and
received on August 19, 2011 and additional information received on August 23, 2011 we are
forwarding herewith Well Construction Permits numbered WM0100274 and WM0100275 dated
August 24, 2011 issued for the construction of two monitoring wells as described in the
application and attached permit. These monitoring wells will be drilled on properties owned by
Michael and Bruce Lacey (Tax Parcel # 183618429474 and 183618428278)
This permit will be effective from the date of issuance and shall be subject to the conditions and
limitations as specified therein. A well Construction Record (GW-1a) shall be completed and
signed by the certified.drilling contractor. This form shall be submitted to the Department upon
completion of the well. Please note the attached permit conditions.
Sincerely,
G. Landon Davidson, L.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
ec: Raymond S. Marchant III (Mid-Atlantic Associates, Inc.)
North Carolina Division of Water Quality—Asheville'Regional Office One
2090 U.S.Highway 70, Swannanoa,N.C. 28778 Phone[phone] FAX [phone] North'Carolina
Customer Service 1-877-623-6748 Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer