WM0401508_WM0401508_Permit(application)_GaitherTransou_01312024_20240131

2725 East Millbrook Road
Iff Suite 121
Aff Raleigh, NC 27604
WF kTc Tel: [phone]
Fax: [phone]
ENVIRONMENTAL • GEOTECNNICAL www.atcgroupservices.com
BUILDING SCIENCES • MATERIALS TESTING N.C. Engineering License No.C-1598
January 29, 2024
Ms. Shuying Wang, Hydrogeologist
North Carolina Department of Environmental Quality
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem,NC 27105-7407
Re: Permit to Construct Groundwater Monitoring Wells
Gaither Transou Property
1202 Guilford College Road
Jamesville, Guilford County,North Carolina
ID No. NONCD0000024
State Contract No. N091319
Dear Ms. Wang:
Enclosed please find one application for a permit to construct two temporary groundwater
monitoring wells. The groundwater monitoring wells will be located at 1202 Guilford College
Road (PIN 7823768490), Jamesville, Guilford County, North Carolina. The permit application,
site map with the proposed locations of the monitoring wells, well construction details and other
relevant information are enclosed as attachments. The work is being performed for the Division
of Waste Management, Inactive Hazardous Sites Branch (IHSB). Please review this package and
return the approved permit to this office or via email to Larry.George(coneatlas.com. Drilling is
currently scheduled to commence on Thursday, February 15, 2024.
If you have any questions or require additional information, please contact our office at (919)
948-3549.
Sincerely,
ATC Associates of North Carolina, P.C.
Larry M. George, P.G.
Principal/Senior 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: January 29, 2024
2. County: Guilford PERMIT NO. ISSUED DATE
3. What type of well are you applying for?(monitoring or recovery): Monitoring
4. Applicant: NCDEQ, DWM Telephone: [phone]
Applicant's Mailing Address: NCDEQ IHSB—Superfund Section, 1646 Mail Service Center, Raleigh, NC 27699-1746
Applicant's Email Address(if available): Send to contact person listed below
5. Contact Person (if different than Applicant): Larry George,ATC Associates of NC, PC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address(if available): larry.george(aboneatlas.com
6. Property Owner(if different than Applicant): Equity Trust Co. FBO Jacqueline McClain IRA Telephone: [phone]
Property Owner's Mailing Address: 6920 Wooden Real Ln, Summerfield, NC 27358
Property Owner's Email Address(if available): Unknown
7. Property Physical Address(Including PIN Number) 1202 Guilford College Road (PIN 7823768490)
City Jamestown County Guilford Zip Code 27282-9327
8. Reason for Well(s): Assess for potential 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: Inactive Hazardous 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).
Yes, Gaither Transou Parcel, IHSB Site(ID NONCD0000024)
11. Type of contaminants being monitored or recovered: PFAS,VOCs, and SVOCs
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? none
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): Unknown
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Unknown
If yes, give distance(s):
15. Well Contractor: Geologic Exploration (GEX) Certification No.: NCWC 2581-A
Well Contractor Address: 716 Commerce Blvd, Statesville, NC 28625
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 well cap
material: 2
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 2/15
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 2/16
(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 assumes total responsibility for ensuring that the well(s)will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Agent for NCDEQ DWM(will include power of attorney upon request)
Signature of Applicant or*Agent Title of Applicant or*Agent
Lawrence M. George, P.G(Agent for NCDEQ DWM) *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
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 agreements See attached 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 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]
Fax: [phone] Fax: [phone] Fax: [phone]
Fayetteville Regional Office Washington Regional Office Winston-Salem Regional Office
225 Green Street, Suite 714 943 Washington Square Mall 450 W. Hanes Mill Road
Fayetteville, NC 28301-5094 Washington, NC 27889 Suite 300
Phone: [phone] Phone: [phone] Winston-Salem, NC 27105
Fax: [phone] Fax: [phone] Phone: [phone]
Fax: [phone]
Mooresville Regional Office `
Win to Sale
610 East Center Avenue
Mooresville, NC 28115 ✓L al gh
Phone: [phone] r
Fax: [phone] J '
s 'lls —� le
F etttville
Will-ngton
GW-22M/R(Rev.5-26-2022)

Well finished at surface with locking
well cap.
Groundwater Table
2"Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen(+3-20 feet)
#2 Filter Sand Pack Extending to the surface
(0-6 feet)
2-Foot Bentonite Seal(6-8 feet)
10 Feet(or 15 Feet)of 2"Schedule 40 Well
Screen(0.010"Slot)(10-20 feet)
#2 Filter Sand Pack Extending 2 Feet Above Screen
(8-20 feet)
TMW's
TEMPORARY MONITORING WELL
'F HAkT 2725 E.Millbrook Road, Suite 121 CONSTRUCTION DETAIL
N C Raleigh,NC 27604
ENVIRONMENTAL GEOTECHNICAL [phone] Gaither Transou Property
BUILDING SCIENCES MATERIALS TESTING
1202 Guilford College Road
PROJECT NO: IHSBO50POI
Jamestown,Guilford County,NC
DATE: January 29,2024 REVIEWED BY:LG ID No.NONCD0000024

p
e
a
Al
m m
44
a o
76
w
f 4 a
U
S � 1
ti
IK
c
� •r t �
i c
N lU
r , LU
Q
S s' _Z
U
:"�i • _
w ' _ Q 0
�_ 't- L air -;. 1• - � � �Y {V Z H
t 0 � QZ
0 = 'w
- .'- 0
4 � Q W U .
d W v
y J � W Q
I.
a J 0 N 9
0 0
i..,
W � LLOO E
f �• W H Z e
0- W � o
l J = (D (n
� N2O u
TEMPORARY MONITORING WELLS ' W Q oN Q z
Q GUILFORD COUNTY PARCELS i `{ *0 40 80 160 240 320 Da1e 1/15/2024
s - 1• Scale'. C
500 Foot Buffer Feet 1" = 150'
o
A«ahme 1
S
lL

ROY COOPER
Governor
ELIZABETH S.BISER >
Secretary
MICHAEL SCOTT NORTH CAROLINA
Director Environmental Quality
TEMPORARY PROPERTY ACCESS ACCEPTANCE
I am the owner of the property at 1202 Guilford College Road,Jamestown, NC. I grant the Division of
Waste Management and/or its contractors to access my property to collect samples as indicated below
during the period from August 22, 2023 to February 22, 2024. 1 understand the Division will coordinate
the scheduling of the work with me.
Potable Well. How many water supply wells are located on your property?
Are the well pumps operational in all? Yes/No (circle one)
Does any well on your property have a treatment system?Yes/No(circle one)
How is the water from the wells on your property used?
Soil (Surface Grab Sample) X Soil Gas Probes
Groundwater(Sampling monitoring wells) _ Crawlspace Vapor Sampling
Indoor Air Vapor Sampling _ Other
Are there any dogs or other animals present in the area of sampling(please plan to secure)?Yes4o
(circle one)
33G ad r �3g9
(Print Na e) (Telephone Number)
c
(Sig ure) (Date)
Please answer the above questions and return this signed form to:
Jordan Lerew
Guilford County Department of Health and Human Services
400 W. Market St,Suite 300
Greensboro, NC 27401
Alternatively,you may email me at [e-mail] to provide acceptance of Division
access for sampling.
Gaither Transou Property
IHSB# NONCD0000024
Jamestown, Guilford County
.� North Carolina Department of Environmental Quality l Division of Waste Management
_ 217 West Janes Street 1 1646 Mail Service Center 1 Raleigh,North Carolina 2 7699-16 46
919.707.8200