WM0401407_Monitoring Well Permit Application_20221101

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: October 21 2022
2. County: Guilford
FOR OFFICE USE ONLY �
PERMIT NO.1vMv90 1'4 0 1.) ISSUED DATE t 0rf 3 1( a). -a
3. What type of well are you applying for'? (monitoring or recovery): Monitoring (temporary)
4. Applicant: Weyhill Companies (Mr. James Molinaro)
Applicant's Mailing Address: 2205-K Oak Ridge Road Suite 198, Oak Ridge NC 27310
Applicant's Email Address (if available): jimAweyhiilcompanies.com
5. Contact Person (if different than Applicant): Ron Navarro
Contact Person's Mailing Address: 5260 Greens Dairy Rd, Raleigh, NC 27616
Contact Person's Email Address (if available): [e-mail]
Telephone: [phone]
Telephone: [phone]
6. Property Owner (if different than Applicant): Iv Culp Telephone: [phone]
Property Owner's Mailing Address: 1823 Eastchester Drive, High Point, NC
Property Owner's Email Address (if available): Not available
7. Property Physical Address (Including PIN Number) 1150 Silver Court, High Point, NC PIN 178718
City High Point County Guilford Zip Code 27263
8. Reason for Well(s): Phase It Environmental Site 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: Industrial
(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).
no
11. Type of contaminants being monitored or recovered: Petroleum and solvents (ex: organics,
nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Adjoining property, Approx. 200 ft to the
west
14. Are there any water supply wells located Tess than 500 feet from the proposed well(s)? none observed
If yes, give distance(s):
15. Well Contractor: Ground Zero Environmental Certification No.: NCWC 30127-A
Well Contractor Address: 11100 Astarita Ave, Partlow, VA 22534
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
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Capped and locked
material: 3
3. Number of wells to be constructed in bedrock: 6. Estimated beginning construction date: November 2022
4. Total Number of wells to be constructed: 3 7. Estimated construction completion date: November
(add answers from 2 and 3) 2022
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. Ali 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 nstrµction 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
Title of Applitantt or `Agent
* If signing as Agent, attach authorization agreement stating Printed name of
Applicant or *Agent 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 Weil Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
Signaturg/of Applicant or *Agent(
y- VoNt 'VS 1f1v (�
See attached
lv Culp
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
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]
GW-22M (Rev. 5/11)
GW-22MR Rev. 3-1-2016

DocuSign Envelope ID: AF179A3F-520A-4F11-8C9B-69CBOB62CCA4
ECS SOUTHEAST, LLP
PROPERTY OWNER ACCESS AUTHORIZATION
Proposal No.: 49:34436P-REV1
Scope of Work: Proposal for Environmental Assessment Services
Project: Silver Court Site
Location: 1150 Silver Court, High Point, Guilford County, North Carolina 27263 (PIN
7709331126)
As part of the proposed real estate transaction, ECS Southeast, LLP (ECS) has been requested by the
purchaser to conduct due diligence tasks including groundwater sampling at the site. The groundwater
sampling requires that ECS procure a permit from the North Carolina Department of Environmental
Quality (NCDEQ).
ECS respectfully requests that the owner of the property grant permission to ECS to access the property
to conduct the above referenced tasks. By signed below, the property owner authorizes ECS to conduct
the aforementioned sampling at the site.
Property Owner (please print): iv Culp
3364560790Phone
Property Owner Telephone (please print):
OocuSigned by:
Property Owner Signature: µ
6C96207B69194BE...
10/27/2022 14:53 PM EDT
Date:

High Point Furniture
Industries (REC)
Culp storage
warehouse
Silver Ct
SOURCE:
ECS PHASE I (OCTOBER 2022)
2020 IMAGERY
SCALE SHOWN ABOVE
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Legend
Proposed Groundwater Sampling
Location
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FIGURE 1
PROPOSED SAMPLE LOCATION MAP
Silver Court Site
1150 Silver Court
High Point, Guilford County, NC
ECS Proposal Number: 49:34436-REV1

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