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HomeMy WebLinkAboutWM0401469_Monitoring well construction permit application_20230802 AECOM AECOM Technical Services of North Carolina, Inc. (704)522-0330 tel 6000 Fairview Road,Suite 200 Charlotte,NC 28210 July 26, 2023 Mr. Jim Gonsiewski Winston-Salem Regional Office Division of Water Resources Water Quality Regional Operations Section Re: Monitoring Well Permit Application—MW-3,MW-4, and MW-5 NCDEQ—DSCA Program,DSCA Site DC410063 A Cleaner World#188 Dry Cleaner 2527 Eastchester Drive High Point, Guilford County,NC Dear Mr. Gonsiewski: On behalf of the NCDEQ Dry-Cleaning Solvent Cleanup Act Program, AECOM Technical Services of North Carolina,Inc.(AECOM)has prepared the attached permit application in accordance with 15A NCAC 2C .0105. Proposed activities include installation of three monitoring wells on the adjacent property to the subject property located at 2525 Eastchester Drive (MW-3, MW-4,and MW-5). Included herein are the Application for Permit to Construct a Monitoring or Recovery Well System packets for the aforementioned property. The packet includes the Application for Installation of Monitoring Well, a map of the proposed well location, a general well construction diagram, and a signed access agreement. Upon approval, please forward the monitoring well construction permit(s) to me at jeff.hvozdikkaecom.com. If you have any questions or require additional information, please do not hesitate to call me at 704-522-0330. Sincerely, AECOM TECHNICAL SERVICES OF NORTH CAROLINA,INC. , A 7—� � Jeffrey T. Hvozdik,PG Project Manager 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. FOR OFFICE USE ONLY 1. Date: July 26, 2023 2. County: Guilford PERMIT NO. ISSUED DATE 3. What type of well are you applying for? (monitoring or recovery): Monitoring 4. Applicant: Petitioner—ACW Management Corp. Telephone: Applicant's Mailing Address: 2019 Eastchester Dr, High Point, NC 27265 Applicant's Email Address(if available): chrisedw6a�aol.com 5. Contact Person (if different than Applicant): Jeff Hvozdik(AECOM) Telephone: 704-522-0330 Contact Person's Mailing Address: 6000 Fairview Road, Suite 200, Charlotte, NC 28210 Contact Person's Email Address(if available): ieff.hvozdikCa�aecom.com 6. Property Owner(if different than Applicant): Telephone: 336-906-0854 Property Owner's Mailing Address: 2525 Eastchester Drive, High Point, NC 27265 Property Owner's Email Address(if available): phunt(cDtriad.rr.com 7. Property Physical Address(Including PIN Number): 2525 Eastchester Dr(PARCEL ID 7813300895) City: High Point County: Guilford Zip Code:27265 8. Reason for Well(s): Environmental assessment, groundwater contamination (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: Dry-cleaning facility (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). DSCA Site ID DC410063 11. Type of contaminants being monitored or recovered: Volatile organic compounds (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): 250 14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No If yes, give distance(s): 15. Well Contractor: Geologic Exploration Certification No.: Well Contractor Address: 176 Commerce Boulevard Statesville, NC 28677 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? Locking cap material: 3 3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: August 2023 4. Total Number of wells to be constructed: 3 7. Estimated construction completion date: August 2023 (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 Project Manager/Geologist i nature of Applicant or*Agent Title of Applicant or*Agent Jeffrey T. Hvozdik of AECOM/Agent for DSCA Program and on behalf of the Petitioner for DSCA Site DC410063 *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 Well Construction Standards(Title 15A of the North Carolina Administrative Code, Subchapter 2C). See attached signed 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 3800 Barrett Drive Wilmington, NC 28405 2090 U.S. Highway 70 Raleigh, NC 27609 Phone: (910)796-7215 Swannanoa, NC 28778 Phone: (919)791-4200 Fax: (910)350-2004 Phone: (828)296-4500 Fax: (919)571-4718 Fax: (828)299-7043 Winston-Salem Regional Office Washington Regional Office 450 W. Hanes Mill Road Fayetteville Regional Office 943 Washington Square Mall Suite 300 225 Green Street, Suite 714 Washington, NC 27889 Winston-Salem, NC 27105 Fayetteville, NC 28301-5094 Phone: (252)946-6481 Phone: (336)776-9800 Phone: (910)433-3300 Fax: (252)975-3716 Fax: (336)776-9797 Fax: (910)486-0707 Mooresville Regional Office �\ 610 East Center Avenue win sale r \\l\ Mooresville, NC 28115 ✓L r `I gh i Phone: (704)663-1699 Fax: (704)663-6040 J ' lie r le F eft 'Ile Will'ngtcn GW-22MR Rev.3-1-2016 Wilmington Regional Office I GW-22M(Rev.5/11) Raleigh Regional Office 127 Cardinal Drive Extension � . LEGEND 2 w Q Petitioned Property Boundary A Cleaner World#188,DC410063 o j ! Approximate Location of Dry-Cleaning y • ` Machine&Waste Storage* p 0-100 0 Approximate Footprint of Former a Q U _ .';, • Dry-Cleaning Machine* i y Q Approximate Location of Boiler Room �_ •.t w Approximate Location of Dumpster o U t ��� � Parcel Lines o U"a ® N ` Proposed Monitoring Well Locations Q N � _ _ Q >; ..� • '�+ ' - Temporary Monitoring Well Location(PSI,2022) x r `�` � � •�, ug/1 micrograms per liter p \ Red highlighted text indicates concentrations above 2L : n • �+ a ` ' Standards. c !�' .. ��� \.. • �: �� BDL-Below Detection Limit oN _ "'J ► '. ,A - PCE-Tetrachloroethylene .WU. U TCE-Trichloroethylene cis-1,2-DCE-cis-1,2-Dichloroethylenern Of "O a • 00 Analytical results do not exceed calculated vapor � o N o N O a, intrusion risk for residential or non-residential exposure zz z o Z —DSCA Indoor Air Risk Calculator W v H rj t y ® N Analytical results do not exceed calculated vapor a O intrusion risk for non-residential exposure but do 0 z o :a exceed for residential exposure—DSCA Indoor Air p 8 1 Risk Calculator 00 Analytical results exceed calculated vapor intrusion risk for residential and non-residential exposure — MW-5 �' °`- , DSCA Indoor Air Risk Calculator a i *Locations are based on a site walk performed on March 29,2023 • ' �"' � AECOM base layers from ArcMap Version 10.8.1 World Imagery ' '► ")t Base Map layer. z+'%' AECOM obtained historical soil,groundwater,and vapor quality data 1 from the Phase II Environmental Site Assessment prepared by 6 t Professional Service Industries,Inc.(PSI)and dated October 11, 2022. 4� MW_q % w •,� �e '�� "`fit, '� �'* �''� •--- � /� MW-3 — It rq ` S1(09/23/22) 00 r1 PCE-294 ug/L - �. o o TCE-15.4 ug/L44 a j > ' cis-1,2-DCE-13.9 ug/L x` j ►s IQQ Toluene-1.17 ug/L / SHEET: .41 ,� ,� APPROX.SCALE,ft. Figure 5 MW-3, MW-4 and MW-5 Ground Surface 0 Legend Title Bentonite seal Cap 5 2" Diameter SCH 40 PVC Riser ❑ Concrete Filter pack 10 ® Outside grout Screen Solid riser 15 end cap 1z r) 20 c� 25 E x 0 a Q 30 35 2" Diameter SCH 40 PVC 40 0.010" Machine Slot Screen 45 AECOMMONITORING WELL CONSTRUCTION DIAGRAM A CLEANER WORLD#107 DC410063 QE�,� z�,��:J�•...03'��is ROYCOOPERs�' Gat-ernor ,, - �J ELIZABETH S.BISER Secretory MICHAEL SCOTT NORTH CAROLINA Director Environmental Quality PROPERTY ACCESS CONSENT For DSCA Use Only DSCA ID No. DC410063 This document may not be modified without the Program's approval.if you have questions on horn to fill out this form or about the activities at this site,please call the Dry-Cleaning Solvent Cleanup Act(DSCA)Program s contractor for this project Mr.Jeffrey Hvozdik with AECOM at jefj:l vo,,zdiknaeconacom or 704-522-0330. Ifyou still have questions after contacting Mt: 11vozdik with AECOM,please contact the DSCA Program Project Manager Mr.Eric Rice at eric.rice(a)ncdenr:gnv or(919) 707-8373. Please Print --1 — r 1Q.J C.q MrntA)t t4L4 1,. a P4 IS 1. C�1�k (Name of Property Owner or Tenant in Residence) r r t 5 C� C9 si-CA.-le�Ce-r U r (Street Number and Street Name of Property) c� ocn` rIVC� a7�(� 5 (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 leaving continued access to my property for the following purposes: (1) taking such soil,groundwater,surface water,and/or air samples as may be necessary; (2) taking other actions related to the investigation of surface or subsurface conditions; (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. (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 arc agreed to by the Property Owner. (3) The Division or its contractors will make reasonable attempts to notify the Properly 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) /-?Dj 3 (Telephone Number for Property Owner or Tenant in Residence for scheduling worldnotification) 3� 6 � 6 og 5 (Email Address for ProDerty Owner or.T ant in Residence if you prefer to be contacted via email) P k r I Please return form to: Jeffrey IIvozdik AECOM 60M Fairview Road,Suite 200 Charlotte,NC 28210 Or via email to jeff' .hvozdik®aceom.cotn