WS-3254_9547_CA_LTRRPT_20230317

Terracon Consultants, Inc. 7327-G West Friendly Avenue Greensboro, NC 27410
P 336-854-8135 F 336-365-7020 terracon.com
March 17, 2023

Mr. Scott Ryals, L.G.
North Carolina Department of Environmental Quality
Division of Waste Management, UST Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646

Re: Letter Report
Jerry’s Place
983 US Highway 21
State Road, Surry County, North Carolina
UST Incident No. 9547
Terracon Project No. 75207118

Dear Mr. Ryals:

Terracon Consultants, Inc. (Terracon) is pleased to submit this Letter Report for the above-
referenced property. This report has been prepared in general accordance with North Carolina
Department of Environmental Quality (NCDEQ), Underground Storage Tank (UST) Section
Guidelines for Assessment and Corrective Action for UST Releases, dated July 15, 2008, revised
December 2013 and Task Authorization No. TA-04, approved on January 6, 2023.

If you have any questions regarding this report or the assessment activities, please contact us at
336-854-8135.

Sincerely,
Terracon Consultants, Inc.

Laura R. Elliott, P.G. Edmund Woloszyn, Jr., R.E.M.
Senior Geologist Department Manager II
Environmental Services

Enclosures

Letter Report Jerry’s Place - Incident No. 9547 ■ State Road, NC March 17, 2023 ■ Terracon Project No. 75207118
Responsive ■ Resourceful ■ Reliable 1
SITE INFORMATION
Date of Report: March 17, 2023 NCDEQ Incident No: 9547
Facility ID: Unknown Site Name: Jerry’s Place Site Location: 983 US Highway 21
State Road, Surry County, North Carolina
Latitude: N: 36°18’52”
Longitude: W: 80°51’38”
UST Owner/Operator: Jerry’s Place

Current Property Owners: Matthew Kennedy and Michael Maher 983 US Highway 21
State Road, Surry County, North Carolina
Consultant: Terracon Consultants, Inc. (Contact: Laura Elliott) 7327-G West Friendly Avenue Greensboro, North Carolina 27410
[phone] Laboratory: Pace Analytical National (NCDEQ No. 375)
12065 Lebanon Road Mt. Juliet, Tennessee 37122 [phone]
Release Information: Release Discovery Date: 1992
Estimated Quantity: Unknown
Cause of Release: Underground Storage Tank (UST) System
Source of Release: four 4,000-gallon gasoline USTs

Letter Report Jerry’s Place - Incident No. 9547 ■ State Road, NC March 17, 2023 ■ Terracon Project No. 75207118
Responsive ■ Resourceful ■ Reliable 2
INTRODUCTION
Jerry’s Place is located at 983 US Highway 21 in State Road, Surry County, North Carolina (Exhibit
1). Terracon completed this report to summarize the well abandonment activities performed at the
site on February 6, 2023, to prepare the site for closure. This Letter Report was prepared for the
site in response to a request by Incident Manager Mr. Scott Ryals with the NCDEQ Division of
Waste Management.
SITE SETTING
The approximate 1.58-acre site (Surry County Parcel I.D. 495301186476) located in State Road,
Surry County, North Carolina (Exhibit 1) is presently developed commercial businesses inside of
strip mall type building. The site is bound to the north and west by residences, to the south by
wooded and cleared land and to the east a cemetery Exhibit 2.
RELEASE SUMMARY
According to prior reports, four 4,000-gallon gasoline USTs were removed from the site in 1992.
During closure activities, LNAPL was observed flowing into a test pit that was excavated to a depth
of approximately 19 feet below ground surface (bgs). Approximately 1,029 tons of petroleum
contaminated soil was subsequently excavated during the UST closure activities.
MONITORING WELL ABANDONMENTS
On February 6, 2023, Terracon and a North Carolina licensed well driller, Environmental Drilling and
Probing Services (EDPS) mobilized to the site to properly abandon the eight monitoring wells onsite
MW-2/RW-2, MW-3/RW-3, MW-4/RW-4, MW-5, RW-5, MW-6, MW-7, and MW-8. The wells were
grouted from the bottom to the ground surface and the surface pads and manhole covers were
disposed of offsite.

The monitoring well construction details and historical groundwater elevation data are summarized
in Table 1. The well abandonment records are presented as an Attachment.

EXHIBITS
TOPOGRAPHIC MAP
Jerry’s Place (Incident No. 9547)
983 US Highway 21
State Road, Surry County, NC
TOPOGRAPHIC MAP IMAGE COURTESY OF THE U.S. GEOLOGICAL SURVEY QUADRANGLES INCLUDE: THURMOND, NC (1/1/1971) and ELKIN NORTH, NC (1/1/2000).
7327 W Friendly Ave Ste G
Greensboro, NC 27410-6253
75207118 Project Manager:
Drawn by:
Checked by:
Approved by:
JWR
EW
EW
1”=2,000’
May 2021
Project No.
Scale:
File Name:
Date: 1
Exhibit MIM
APPROXIMATE
SITE BOUNDARY
Jerrys Place
@A
@A
@A @A
@A
@A
@A@A
ED
"ÑÎ
"ÑÎ
Source: Esri, Maxar, Earthstar Geographics, and the GIS User Community
0 30 60Feet
Legend
"ÑÎ Former Monitoring Well
ED Water Supply Well
@A Monitoring Well
Site Boundary
Parcel Boundary
File Path:
Date:
Project No.
Scale:
LRE
JWR
EW
EW
2
PM:
Drawn By:
Checked By:
Approved By:7327-G West Friendly Avenue Greensboro, NC 27410
Phone: [phone] Fax: [phone]
75207118 EXHIBITNO.SITE DIAGRAM
10/5/2022
Jerry's Place (Incident No. 9547)983 US Highway 21State Road, Surry County, NC
WSW-5
MW-7
MW-3/RW-3(PAVED OVER)RW-6
RW-5 U.S
.
H
IGHWAY
21
MW-2/RW-2
MW-6
MW-1(DESTROYED)
MW-8
MW-4/RW-4
MW-5
1 inch = 60 ft.

TABLE

TABLE 1Monitoring Well Construction Details and Groundwater Elevation Data Jerry's PlaceState Road, Surry County, North CarolinaTerracon Project No. 75207118NCDEQ Incident No. 9547Well IDScreened Interval (ft. TOC)Total Well Depth (ft. BTOC)Top of Casing ElevationDate Water Level MeasuredDepth to Water (ft. BTOC)Groundwater ElevationComments6/16/2022 19.20 82.258/25/2022 20.10 81.356/16/2022 18.35 79.648/25/2022 19.39 78.606/16/2022 20.44 75.508/25/2022 21.27 74.676/16/2022 5.47 75.108/25/2022 6.12 74.456/16/2022 20.04 77.958/25/2022 20.93 77.066/16/2022 20.35 79.288/25/2022 20.50 79.136/16/2022 24.40 72.808/25/2022 24.95 72.256/16/2022 24.50 74.018/25/2022 24.90 73.61Notes:ft = feet TOC = Top of CasingbTOC = below TOC2-inch diameter Type II well 2-inch diameter Type II well 2-inch diameter Type II well MW-8MW-7MW-6RW-5MW-54-inch diameter Type II well 4-inch diameter Type II well 4-inch diameter Type II well 2-inch diameter Type II well; Stick-up completion4-inch diameter Type II well 2525271515-2515-2515-25Unknown15-25101.453012-32MW-2/RW-298.5197.2099.6397.9980.5725MW-4/RW-4 2-12 30 95.9497.993010-30MW-3/RW-3

ATTACHMENT
WELL ABANDONMENT RECORDS