The URL can be used to link to this page

Home My WebLink AboutWM0401447_Monitoring Well Permit Application_20230508NORTH 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: 2. County: Guilford PERMIT NO. FOR OFFICE USE ONLY ISSUED DATE 3. What type of well are you applying for? (monitoring or recovery): Monitoring 4. Applicant: NCDEQ Telephone: 919-707-8168 Applicant's Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699 Applicant's Email Address (if available): scott.rvals(@ncdenr.gov 5. Contact Person (if different than Applicant): Greg Hans Telephone: 704-325-5408 / 617-828-9948 Contact Person's Mailing Address: 3525 Whitehall Park Drive, Suite 150, Charlotte, NC 28273 Contact Person's Email Address (if available): ghans(cces-group.net 6. Property Owner (if different than Applicant): Fred D. Curl Telephone: 336-379-9155 Property Owner's Mailing Address: 707 N. English Street, Greensboro, NC 27405 Property Owner's Email Address (if available): curlsrentals(ogmail.com 7. Property Physical Address (Including PIN Number) 2303 E Bessemer Avenue PIN 7875604992 City Greensboro County Guilford Zip Code 27405 8. Reason for Well(s): 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: USTs (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). NCDEQ Incident 7877 11. Type of contaminants being monitored or recovered: petroleum / organics / metals (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).: N/A 13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Presumed Source Area — 0 Feet 14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No known If yes, give distance(s): 15. Well Contractor: Carolina Soil Investigation Certification No.: Corey Speece #2904 / Daniel Summers #2579 Well Contractor Address: 132 Gurney Road, Olin, NC 28660 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 material: One 6. Estimated beginning construction date: 5/22/2023 or 3. Number of wells to be constructed in bedrock: 0 later 4. Total Number of wells to be constructed: One 7. Estimated construction completion date: Same day as (add answers from 2 and 3) install 5. How will the well(s) be secured? 2 x 2 pad, well covers, locking '-plug 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. G. 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 assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C. Signature of Applicant or *Agent Greg Hans Printed name of Applicant or *Agent Environmental Division Manager Title of Applicant or *Agent * 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 well(s) as outlined in this Well Construction Permit application and acknowledges that it shall be the responsibility of the Applicant to ensure that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C. (See attached Access Agreement with NCDEQ State Trust Fund) 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: (828) 296-4500 Fax: (828) 299-7043 Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301-5094 Phone: (910) 433-3300 Fax: (910) 486-0707 Mooresville Regional Office 610 East Center Avenue Mooresville, NC 28115 Phone: (704) 663-1699 Fax: (704) 663-6040 Raleigh Regional Office 3800 Barrett Drive Raleigh, NC 27609 Phone: (919) 791-4200 Fax: (919) 571-4718 Washington Regional Office 943 Washington Square Mall Wilmington Regional Office 127 Cardinal Drive Extension Wilmington, NC 28405 Phone: (910) 796-7215 ial Office 05 3/30/23, 10:40 AM GO gle Maps 2303 E Bessemer Ave =d T or y —1+rfir,� ■ I�ti T s, 2303 E Bessemer Ave - Google Maps Kentwood st e g I' 2804 • rR codRich SmorykeShop obaccoshop 11MCP V I nda Hispana lazila, �. 615 'Ol r Gr ce aiding •T- P' loco 611 a 1 • n 2209 " l � T i� A ri ma NewGeri ions 2 Full Gospel \n,ModeQ1�{ I 2aa >��- • Beata' 8uppl , k �i � Mi r In Incib H o s og's Bar B 4ue. a1 e5o6 e ,1 IF mess, https://www.goog le.com/maps/place/2303+E+Bessemer+Ave,+Greensboro,+NC+27405/@36.0854616,-79.7566282,180m/data=!3m 1 ! 1 e3!4m6!3m5! 1 sOx88531 f4c9b6f46df:Ox15d333553ae0ed9a!8m2! ENVIRONMENTAL PROTECTION � HAZARDOUS SITES RESPONSE PROGRAM 6EOi6U TYPICAL FLUSH -MOUNT GROUNDWATER MONITORING WELL CONSTRUCTION DIAGRAM BOLTED MANHOLE COVER CONCRETE PAD MANHOLE SLEEVE LOCKING WELL CAP 2" SCHEDULE 40 PVC PIPE BENTONITE GROUT BENTONITE SEAL TYPE SAND PACK GRAIN SIZE 2" SLOTTED SCHEDULE 40 PVC SCREEN BOTTOM CAP BOTTOM OF BORING ANNULUS Waste Management ENVIRONMENTAL QUALITY Mr. Scott Ryals Environmental Engineer DWM UST Section 1637 Mail Service Center Raleigh, NC 27699-1637 RE: State -Lead Acceptance Former Clapp Amoco 2303 E Bessemer Ave Greensboro, Guilford County, NC Incident Number 7877 Dear Mr. Ryals March 28, 2023 ROY COOPER Governor ELIZABETH BISER Secretary MICHAEL SCOTT Director I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and hereby permit the Department of Environmental Quality (Department) or its contractor to enter upon said property for the purpose of conducting an assessment and/or remediation of the groundwater and/or soils under the authority of G.S. 143-215.94G. I am/We are granting permission with the understanding that: The investigation shall be conducted by the UST Section of the Department's Division of Waste Management or its contractor. 2. The costs of construction and maintenance of the site and access shall be borne by the Department or its contractor in accordance with the acceptance of the site into the State -Lead Program. The Department or its contractor shall protect and prevent damage to the surrounding lands. Any damages will be restored by the Department or its contractor to as close to the pre -work condition as practicably possible. 3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest feasible route to the nearest public road. The Department or its contractor will notify the landowners 48 hours prior to entry and may enter upon the land at reasonable times and have full right of access during the period of the investigation. 4. Any claims which may arise against the Department, or its contractor shall be governed by Article 31 of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and Agencies, and as otherwise provided by law. 5. The information derived from the investigation shall be made available to the owner upon request and is a public record, in accordance with G.S. 132-1. /'Nothing Compares" State of North Carolina I Environmental Quality I Waste Management 1646 Mail Service Center 1 217 West Jones Street I Raleigh, NC 27699-1646 919 707 8200 T 6. The activities to be carried out by the Department or its contractor are for the primary benefit of the Department and of the State of North Carolina. Any benefits accruing to the owner are incidental. The Department or its contractor is not and shall not be construed to be an agent, employee, or contractor of the landowner. No representations or warranties, either expressed or implied, have been made to me/by the Department, the State of North Carolina, or its/their contractor(s) regarding the results that may be obtained or the quality of work to be performed I/We agree not to interfere with, remove or any ways damage the Department's well(s) or its contractor's well(s) and equipment during the investigation. Si re Signature Fred D. C-(xr'l Type/Print Name of Owner or Agent 33(o-37y-116-9 lr"-rIs reH+als@arn^d.l.co� Phone Number / E-mail Address U 7o 7 A . Goa I'A Sk - _2 740.S A ess 6reco-56oro . Al G 2 71+0S- City/State/Zip Code lAg/.:7-3 Date RE: State -Lead Acceptance Former Clapp Amoco 2303 E Bessemer Ave Greensboro, Guilford County, NC Incident Number 7877 Nothinc j Compares'" State of North Carolina I Environmental Quality I Waste Management 1646 Mail Service Center 1 217 West Jones Street I Raleigh, NC 27699-1646 919 707 8200 T 3/30/23, 11:08 AM GIS Data Viewer Guilford County, NC Parcel Number 20045 Total Out Building Value 13500 PIN 7875604992 CURL RENTALS INC Card Image Total Land Value Total Deferred Value Bldg Card 335900 Owner 0 Owner History 1 Mail Address 707 N ENGLISH ST Appraisal Model Code 1 Mail City GREENSBORO Deed Data 8/17/1990 Mail State NC Neighborhood 7875C08 Mail Zip 27405 Property Type COMM Property Address 2303 E BESSEMER AVE Structure Size Legal Description 73-77 Lot Size 1.29 Deed 003827-01974 Year Built 1954 Plat Bedrooms Condo Bathrooms Total Assessed 685900 Grade Fair Total Building Value 336500 Disclaimer While every effort is made to keep information provided over the internet accurate and Map Scale up-to-date, Guilford County does not certify the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data herein, or for their 1 inch = feet use or interpretation by the User 3/30/202023 https:Hgisdv.guilfordcountync.gov/guilford/ ill