WM0401484_Monitoring well construction permit application_20231020

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: 10/04/2023
2. County: Davidson
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Mannington Mills, Inc Telephone: [phone]
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Applicant's Mailing Address: 75 Mannington Mills Road, Salem, NJ 08079
Applicant's Email Address (if available): dave.kitts6d0annington.com
Contact Person (if different than Applicant): Tom Dunham Telephone: [phone]
Contact Person's Mailing Address: SynTerra Corp., 511-102 Keisler Dr. Cary, NC 27518
Contact Person's Email Address (if available): tdunham(a),synterracorp.com
Property Owner (if different than Applicant): Mrs. Lois Koonts Telephone: [phone]
Property Owner's Mailing Address: 5417 Linwood-Southmont Road, Linwood, NC, 27299
Property Owner's Email Address (if available):
Property Physical Address (Including PIN Number) 1011 Cotton Grove Road (ID#s 6724-02-57-5153 and 6724-02-57-5055)
City Lexington County Davidson Zip Code 27292
Reason for Well(s): Groundwater Assessment
(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: RCRA
(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)
Hazardous Waste Manaaement Permit. Permit No. NCD 986 181 451
Type of contaminants being monitored or recovered: Metals
(ex: organics, nutrients, heavy metals, etc.)
Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 19
Existing Monitoring or Recovery Well Construction Permit No(s).: unknown
Distance from proposed well(s) to nearest known waste or pollution source (in feet): 250 ft
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, Brian Thomas Certification No.: NCWC 2581-A
Well Contractor Address: 176 Commerce Blvd, Statesville, NC 28625
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: 1 (add answers from 2 and 3)
5. How will the well(s) be secured? Protective steel
3. Number of wells to be constructed in bedrock: Q� Ming with pad lock
4. Total Number of wells to be constructed: 1 6• Estimated beginning construction date:. 10-16-2023�
—� 7. Estimated construction completion date: 10-20-2023
ADDITIONAL INFORMATION
1. As required by 15A NCAC 02C .0105(0(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 idert#Mod 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. 143-215.1013(5), landfills. or other waste disposal areas) within 500 feet
of the proposed well or well sys+ern.
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. }
Si lure of Applicant or Agent Title of Applicant or *'Agent
l.� 1 • LIM if signing as Agent, attach authorization agro meat stating
Printed name of Applicant or *Agent that you have the authority to act as the Agar#.
If the property is owned by someone other then 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.
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Signature of PYoperty Owner (if different than Apprment) Printed name of Property Ofter (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]
Fox: [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: (252) W-6481
Fax- [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]

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— — — STREAM THROUGH REINFORCED CONCRETE PIPE
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Grave NOTES:
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�r 1. ALL BOUNDARIESANDLOCATIONS ARE APPROXIMATE.
�— 2_ INSET SCALE: 1IN = 30OFT
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+ - 3_ PROPERTY BOUNDARY DERIVED FROM PRELIMINARY PLAT FOR THE FORMER
PORCELANITE FACILITY CREATED BY C_E_ ROBERTSON & ASSOCIATES, PC. ON
- JANUARY 12, 2022_
4_ STREAM DATA WITHIN INSET OBTAINED FROM CITY OF LEXINGTON ARCGIS PORTAL,
UPDATED JAN UARY 23, 2020.
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- 5 �, �F- ^t"•'�� �,=f ;;� 5_ TOPOGRAPHIC MAP PROVIDED BY ESRI, LAST UPDATED AUGUST 2021 _
- 6_ AERIAL PHOTOGRAPHY OBTAINED FROM NORTH CAROLINA ONE MAP, COLLECTED
FEBRUARY 3, 2018.
7. DRAWING HAS BEEN SET WITH A PROJECTION OF NORTH CAROLINA STATE PLANE
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SITE TOPOGRAPHIC MAP
5 ! '- 1111111VW. CC. WYATT DATE ATT DATE: 1E/ 1111s FORMER PORCELANITE FACILITY
CHECKED Br. M.FUNCHOM DATE06/09/2023 LEXINGTON, NORTH CAROLINA
� � APPROVED BY: T. 011NHAM DATE" 06/09/2023
Term PROJECTMANAGER: T DLINHAM
www.synterracorp.com

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LEGEND
EXISTING MONITORING WELL
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_ PROPOSED SHALLOW MONITORING WELL
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POTENTIAL BACKGROUND/HORIZONTAL
DELINEATION MONITORING WELL
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SURFACE WATER FLOW DIRECTION
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NOTES:
F EXISTING MONITORING WELL
1- SUPERIMPOSED SURVEY OUTLINEAND DETAILS DERIVED FROM PRELIMINARY PLAT
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FOR THE FORMER PORCELANITE FACILITY CREATED BY C-E ROBERTSON 8; ASSOCIATES,
PC. CREATED JANUARY 12, 2022.
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2. ALL BOUNDARIES AND LOCATIONS ARE APPROXIMATE.
3. STREAM DATA OBTAINED FROM CITY OF LEXINGTON ARCGIS PORTAL, UPDATED
JANUARY 23, 2020.
°
4 AERIAL PHOTOGRAPHY OBTAINED FROM NORTH CAROLINA ONE MAP, COLLECTED
-
FEBRUARY 3, 2018
5. DRAWING HAS BEEN SET WITH A PROJECTION OF NORTH CAROLINA STATE PLANE
T -
COORDINATE SYSTEM LIPS 3200 (NAD83).
GRAPHIC SCALE
90 0 90 180
(IN FEET)
DRAWN BY: C. WYATT DATE07/2V2022
REVISED BY: L. FOREMAN DATE' 06/12/2023
CHECKED By MCROBERTS DATES 06/12/2023
APPROVED BK T. DUNHAM DATES 06/12/2023
PROJECT MANAGER. T_ DUNHAM
FIGURE 13
PROPOSED MONITORING WELL LOCATIONS
FORMER PORCELANITE FACILITY
LEXINGTON, NORTH CAROLINA

Locking Well Cap
Upright Protective
Cover with Lock
Land Surface
3' Radius or 4' by 4' Concrete Pad
6" Borehole Diameter
(Nominal Dimension)
Cement Grout
2" Schedule 40 PVC Casing
w/ Threaded Couplings
Approximate 2'
Bentonite Seal
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Well Sorted
Sand Pack
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♦� Water Table
10' Screened Interval
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0.010" Slotted Screen
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2" Schedule 40 PVC
fV
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Sump/Sediment Trap
Bottom Cap
Estimate Depth = 40'
148 RIVER STREET, SUITE 220
GREENVILLE, SOUTH CAROLINA 29601
PHONE [phone]
FIGURE 3
HTTP://W W W.SYNTERRACORP.COM
GENERALIZED MONITORING WELL SCHEMATIC
synTerra