WM0401258_Monitoring Well Permit Application_20201023

;ETC
ENVIRONMENTAL• GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
October 23, 2020
Mr. Jim Gonsiewski
North Carolina Department of Environmental Quality
Winston-Salem Regional Office
450 W. Hanes Mill Road Suite 300
Winston-Salem, NC 27105
Re: Permits to Construct Monitoring Wells
Boston Cleaners
1902 West Webb Avenue
Burlington, Alamance County, North Carolina
DSCA Site No. DC010012
Dear Mr. Gonsiewski:
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax:[phone]
www.atcassociates.com
N.C. Engineering License No. C-1598
Enclosed please find one permit application to construct one permanent monitoring well. The
monitoring well will be located at 1915 West Webb Avenue (PIN 8865299006) in Burlington,
North Carolina. The permit application, site map with the proposed location of the permanent
monitoring well, well construction details and other relevant information are enclosed as
attachments. Please review this package and return the approved permits to this office.
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.
Emily J. Fuller
Project Scientist

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: 10/23/2020
2. County:
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Glen Raven Mills, Inc. (Petitioner for DSCA site #DC010012) Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant's Email Address (if available): Al. Chapman (a�ncdenr.gov
5. Contact Person (if different than Applicant): Emily Fuller, 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): See above Telephone: See above
Property Owner's Mailing Address: 1831 N. Park Avenue, Burlington, NC 27217-1137
Property Owner's Email Address (if available): DSteed(a)glenraven.com
7. Property Physical Address (Including PIN Number) 1915 West Webb Avenue (PIN: 8865299006)
City Burlington County Alamance Zip Code 27217
8.
9.
10.
Reason for Well(s): Groundwater Contamination
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: Dry-cleaner
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
DSCA # DC010012
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?
No- Any wells nearby are associated
with separate DSCA sites
Existing Monitoring or Recovery Well Construction Permit No(s): Not Applicable
13.
Distance from proposed well(s) to nearest known waste or pollution source (in feet):
45 feet
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: Innovative Environmental Technologies, Inc. Certification No.:
3287-B
Well Contractor Address: 232 Highway 49 S, Concord, NC 28025
PROPOSED WELL CONSTRUCTION INFORMATION
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 5. How will the well(s) be secured? Locking well cap,
material: 1 Flush -mount steel protective casing.
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 11/23/20
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 11/24/20
(add answers from 2 and 3)
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 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 2C) and accepts full responsibility for compliance with these rules
Signature of Applicant or *Agent
Emily Fuller (Agent for Petitioner for DSCA Site #010012)
Printed name of Applicant or *Agent
Agent for DSCA Site DC010012 (will include power of attorney
Title of Applicant or *Agent upon request)
* 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 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' Regional Office:
Asheville Regional Office Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
►RAGA ININ1S[y

ROY COOPER NORTH CAROLINA
G'dvernor Environmental Quality
MICHAEL S. R:EGAN
secretary
MICHAEL SCOTT
DkWar
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval. If For DSCA Use Only
you have questions on how to f ll out this form or about the activities at this DSCA ID No.
site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA) Program's
contractor for this project, Meghan Greiner with ATC Associates of North DC010012
Carolina, P.C. (ATC) at Meghan.Greiner(d;;atc sg com or [phone]. If
you still have questions after contacting Mrs. Greiner with ATC, please
contact the DSCA project manager, Al Chapman at Al. Chapman(a)ncdenr.gov or
[phone].
Please Print
Glen Raven, Inc.
(Name of Property Owner or Tenant in Residence)
1915 West Webb Avenue
(Street Number and Street Name of Property)
Burlington
Alamance 27217
(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;
V(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.
_ ► R' a
e !e

(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 of Property Owner or Tenant in Residence) (Date)
-636-:za7- 6 ;�// or 35C - SFC- /`377
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
rick Vy..c4jr— Q ols4 -p-S 6 5�y.rR✓w.. (Email Address Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
Please return form to:
Meghan E. Greiner, P.E.
ATC Associates of North Carolina, P.C.
2725 East Millbrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
RE
2E.?ti"tr t iwab?�� f tr'i�t �Tb*•1b�b
qA1*?AM

2" Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-10 feet)
AIT
Ak C 2725 E. Millbrook Road, Suite 121
jr Raleigh, NC 27604
ENVIRONMENTAL • BEOTECHNICAL [phone]
PROJECT NO: DC010012
DATE: 10/15/2020 1 REVIEWED BY: MG
Well finished at surface with locking
well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
Cement Grout Extending From Ground Surface
To Top of Bentonite Seal (0-8 feet)
1-Foot Bentonite Seal (8-9 feet)
`/ Groundwater Table
#2 Filter Sand Pack Extending 1 Feet Above Screen
(9-25 feet)
15 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
(10-25 feet)
MONITORING WELL
CONSTRUCTION DETAIL
Boston Cleaners
1902 West Webb Avenue
Burlington, Alamance County, NC 27217
DSCA ID: DC010012

LEGEND:
MW— MONITORING WELL
'*-- Well Identification
PARCEL LINE
—0.7— PCE ISOCONCENTRATION CONTOUR (mg/L)
(DASHED WHERE INFERED)
r
MW-38 (10-25)
12/28/17
PCE
TCE
cis-1,2-DCE
Screen Depth: 10-251bgs
1.8
0.075
0.022J
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12/28/17
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Screen Dep[h:45-50'bgs 2 0.56 0.34
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MW-2S (15-25)
12/28/17
PCE
TCE
Screen Dep[h: 15-25' bgs
0.0033
<0.0010
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12/28/17
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12/27/17
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Screen Depth: 15-25 bgs
1.10
1 0.0113
MW-1D(45-50)
12/27/17
PCE
TCE
Screen Dq,t h: 45-50 bgs
0.870
0.021
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SCALE: 1"= 300' z N o z w