WM0401475_Application_20230811

FOR OFFICE USE ONLY

PERMIT NO. ISSUED DATE
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: 8/02/23

2. County: Guilford

3. What type of well are you applying for? (monitoring or recovery): Temporary/monitoring

4. Applicant: Dow Silicones Corp. Telephone: [phone]

Applicant’s Mailing Address: 633 Washington Ave., 1803 Building, Midland, MI 48674

Applicant’s Email Address (if available): [e-mail]

5. Contact Person (if different than Applicant): c/o Chuck Bertz Telephone: [phone]

Contact Person’s Mailing Address: 5420 Wade Park Blvd, Suite 350, Raleigh, NC 27607

Contact Person’s Email Address (if available): [e-mail]

6. Property Owner (if different than Applicant): DDP Specialty Electronic Materials US9, LLC Telephone: [phone]

Property Owner’s Mailing Address: 2200 West Salzburg Rd, Midland, MI 48696

Property Owner’s Email Address (if available):

7. Property Physical Address (Including PIN Number) 2914 Patterson Street
City Greensboro County Guilford Zip Code 27407
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: Remediation Site
(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).

EPA ID No. NCD 003221546

11. Type of contaminants being monitored or recovered: Chlorinated solvents and 1,4-dioxane
(ex: organics, nutrients, heavy metals, etc.)

12. Are there any existing wells associated with the proposed well(s)? If yes, how many? 77

Existing Monitoring or Recovery Well Construction Permit No(s).: 052-96-MW-22-RW-3 (Guilford Cnty), WM0401113 (NCDEQ),
WM0401114 (NCDEQ), WM0401115 (NCDEQ), WR040437 (NCDEQ)

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0 – 1000 feet

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: Cascade Environmental Certification No.: Well Contractor Cert # 2980-A

Well Contractor Address: 825 South Main Street, New Ellington, SC 29809

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
material: 39 (VAP-B1-01 through VAP-B1-16; VAP-
B2-01 through VAP-B2-08; & VAP-B3-01 thru VAP-B3-
15)

3. Number of wells to be constructed in bedrock: 0

4. Total Number of wells to be constructed: 39
(add answers from 2 and 3)
5. How will the well(s) be secured? Abandoned with
neat cement in accordance with 15A NCAC 02C .0113

6. Estimated beginning construction date: 6/29/2023 (In
progress)

7. Estimated construction completion date: 8/25/2023

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

Remediation Manager
Signature of Applicant or *Agent Title of Applicant or *Agent

Robert Stuetzle * 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).

Tyson E. Campbell
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]

Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22MR Rev. 3-1-2016

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LEGEND
SITE FEATURES MAP
FIGURE
1
Scale: 1" = 200'
Feet0100200
NOTES
· Aerial photo source: ESRI World Imagery (primary map)and Google Earth Pro, 4/8/2017 (inset maps).· Features labeled in blue were installed during Phase 1activities, while features labeled in pink were installedduring Phase 2 activities; all other features (labeled in white )existed prior to Phase 1 activities taking place.· BRW = bedrock monitoring well.· DMW = deep (bedrock) monitoring well.· DPE = dual-phase extraction.· IMW = intermediate (partially weathered rock) monitoring well.· SB = soil boring.· SG = stream gauge.· SGV = soil gas/vapor.· SMW = shallow (saprolite) monitoring well.· VAP = vertical aquifer profiling.
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BUILDING 3 AREA
BUILDING 2 AREA BUILDING 1 AREA
Building 3 area
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£
Scale: 1" = 60'£
Scale: 1" = 60'£
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Scale: 1" = 120'£Scale: 1" = 40'£
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FIGURE
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NOTES
\\Scottsdale-AZ\Project\Dow C
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\Greensboro, NC\GIS\M
XDs\
Source area PDI work plan 04-2022\Figure 7 - Building 1 proposed boring locations.mxd 5/5/2022
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· Aerial photo source: Google Earth Pro (4/8/2017).
· VAP = vertical aquifer profiling.
ꞏ Brown text indicates result is for soil (ug/kg).
ꞏ Blue text indicates result is for groundwater (ug/L).
ꞏ *Sample determined to have been collected below the
water table.
ꞏ DRY = Temporary well set and attempted to sample, but
interval was dry.
Groundwater monitoring w ell (interme diat e)
1,4-DIOXANE RESULTS, BUILDING 1 AREA
DOW SILICONES COR PO RATION FACILITY
GREENSBORO, N ORTH CAROLINA
P a t t e r s o n S t
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PROPOS ED VA P LOCATION S, BUILDING 2 ARE A
FIGURE8
Scale: 1" = 50'
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DOW SILICONES COR PO RATION FACILITY
GREENSBORO, N ORTH CAROLINA
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Source area PDI work plan 04-2022\Figure 8 - Building 2 proposed boring locations.mxd 4/29/2022
Site boundary
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NOTES
Groundwater monitoring w ell (shallow)!(
Groundwater monitoring w ell (deep)!(
· Aerial photo source: Goog le Earth Pro (4/8 /2017).
ꞏ Aerial photo source: Google Earth Pro (4/8/2017).
ꞏ VAP = vertical aquifer profiling.
ꞏ Blue text indicates result is for groundwater (ug/L).

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Source area PDI work plan 04-2022\Figure 9 - Building 3 proposed boring locations.mxd 5/5/2022
Site boundary
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NOTES
· Aerial photo source: Goog le Earth Pro (4/8 /2017).
· Features labeled in blue were insta lled during Ph ase 1
activities, while features labeled in pink were installed
during Phase 2 activities; all ot her features (lab eled in white )
existed prior to Phase 1 activities taking pla ce.
· DPE = dual-phase extraction.
· SB = soil boring.
blue
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PROPOS ED VA P LOCATION S, BUILDING 3 ARE A
DOW SILICONES COR PO RATION FACILITY
GREENSBORO, N ORTH CAROLINA
P a t t e r s o n S t
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DOW CORNING CORPORATION FACILITYGREENSBORO, NORTH CAROLINA
ESTIMATED BORING DIAGRAM
FIGURE
5
Bentonite or neat
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NOTES
· Diagram is not drawn to scale.
Complete borehole consistent
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Concrete Slab (Approx 4-6" thick)
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feet below ground surface)