WM0401527_Monitoring well permit application, WM040157_20240423

2725 E. Millbrook Road, Suite 121
Iff Raleigh, North Carolina 27604
Ar
Telephone [phone]
NkTcFax 919-871-0335
ASSOCIATES OF NORTH CAROLINA, P.C. www.atcgroupservices.com
April 15, 2024
Ms. Shuying Wang
Winston-Salem Regional Office
North Carolina Department of Environmental Quality
Water Quality Regional Operations Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, North Carolina 27105
Re: Permit to Construct Monitoring Wells
Steven Ridenour Property
3577 NC 8 & 65 Highway (Intersection of NC 8 & 65 Highway and Salem Street)
Germanton, Stokes County, North Carolina
NCDEQ Incident No. 12694
Dear Ms. Wang:
Enclosed please find one application for a permit to construct two monitoring wells. The monitoring
wells will be installed at a property located at 0 Main Street (PIN 6931-66-7377) in Germanton,
Stokes County, North Carolina. The permit application, site map with the proposed location of the
monitoring wells, well construction details, and other relevant information are enclosed as
attachments. Please review this package and return the approved permit to this office.
If you have any questions or require additional information, please contact our office at (919) 871-
0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Aaron D. Springer
Project Scientist
Direct Line: 919-871-0999
Email: aaron.springer(@oneatlas.com

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: 4/15/2024 FOR OFFICE USE ONLY
2. County: Stokes PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: NCDEQ DWM UST Section State Lead Program Telephone: [phone]
Applicant's Mailing Address: Devin Valenza, 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant's Email Address(if available): [e-mail]
5. Contact Person (if different than Applicant): Aaron Springer Telephone: [phone]
Contact Person's Mailing Address: ATC Associates of NC, P.C. 2725 E Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): aaron.springer dne oneatlas.com
6. Property Owner(if different than Applicant): Constance F. Frye Telephone: [phone]
Property Owner's Mailing Address: 1105 Ebert Street, Winston-Salem, NC 27103
Property Owner's Email Address (if available): not available
7. Property Physical Address(Including PIN Number) 0 Main Street (PIN #6931-66-7377)
City Germanton County Stokes Zip Code
8. Reason for Well(s): Suspected contamination /groundwater 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: UST
(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 UST Incident# 12694
11. Type of contaminants being monitored or recovered: Petroleum associated 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).: n/a
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): 25 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes, two active and six inactive
If yes, give distance(s): Active: 315, 386 feet Inactive: 105,180,190, 250, 320, 455
15. Well Contractor: Bernis Allen (AmeriProbe LLC) Certification No.: 4196 B
Well Contractor Address: P.O. Box 135, Huntersville, NC 28070
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, 8"
material: 2 flush mount manhole in 2'x 2' concrete pad
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 5/20/2024
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 5/21/2024
(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.
Project Scientist
Signature of Applicant or*Agent Title of Applicant or*Agent
Aaron D. Springer(Agent for NCDEQ State Lead Program) *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 agreement 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 j�—
ton so
610 East Center Avenue 1�^`W'"
Mooresville, NC 28115 PLC r d
Phone: [phone]
Fax: [phone] j t
N r Is 1
Wei ngton
GW-22M/R(Rev.5-26-2022)

Ms. Linda Blalock
DWM UST Section
1637 Mail Service Ctr
Raleigh,NC 27699-1637
Dear Ms. Blalock:
RE: Site Access Agreement
Ridenhour Residence Incident
Former Chaffin General Store/Martin's Grocery (PIN #6931-11-66-7377)
Germanton/Stokes County
Incident#: 12694
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 Environment and Natural Resources (Department) or its
contractor to enter upon said property for the purpose of conducting an investigation of the
groundwaters under the authority of G.S. 143-215.3(a)2.
I am/We are granting permission with the understanding that:
1. 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. The Department or its contractor shall protect and prevent damage
to the surrounding lands.
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 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.
i . i L.

Ridenhour Residence Incident/Incident#12694
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.
I/We agree not to interfere with, remove, or any way damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
Signature
OOV%-ST411Ce !P
Type/Print Name of O\\filer or Agent
Address
Address
nSb n- S je^j M L 17"(S
City/State/Zip Code
(.Ss- a` q ) or 33(r
Phone Number
Date

MONITORING WELL CONSTRUCTION DETAILS
FLUSH GRADE MANHOLE
CROSS SECTIONAL VIEW
(NOT TO SCALE)
LOCKABLE WELL CAP PROTECTIVE CASING AND CONCRETE PAD
L1 CASING MATERIAL stainless steel
CASING DIAMETER 8 inches
CASING LENGTH 12 inches
......•• PAD DIMENSIONS 2 feet x 2 feet
HEIGHT ABOVE GROUND flush mounted
WELL CASING
MATERIAL sch 40 PVC
DIAMETER 2 inches
JOINT TYPE flush threaded
LENGTH 20 feet
L2 BACKFILL AROUND CASING
MATERIAL cement grout
THICKNESS 15 feet
SEAL
TYPE OF SEAL bentonite
L4 THICKNESS 3 feet
FILTER PACK
TYPE OF FILTER #2 silica sand
DISTANCE ABOVE SCREEN 2 feet
WELL SCREEN
L3 SCREEN MATERIAL sch 40 PVC
DIAMETER 2 inches
LENGTH 10 feet
SLOT SIZE 0.010 inches
DEPTH TO BOTTOM OF
MONITORING WELL 30 feet
DEPTH TO BOTTOM OF
BOREHOLE 30 feet
L1 = 0 FT.
L2= 20 FT. DIAMETER OF BOREHOLE 8 inches
L3= 10 FT.
L4= 30 FT.
TITLE Monitoring Well
Steven Ridenour Property ��� 2725 East Millbrook Road
3577 NC 8 & 65 Highway Suite 121
ENVIRONMENTAL•GEOTECHNICAL
Germanton, Stokes County BUILDING SCIENCES•MATERIALS TESTING Raleigh, North Carolina27604
North Carolina
FILE PREP. BY REV. BY DATE PROJECT NO.
AS GA 4/15/2024 1 STL1269404

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LEGEND:
POTABLE WATER SUPPLY WELL NOTES: FIGURE 2 Project Number: Drn. By:
STL1269401 LB
• NON-POTABLE/INACTIVE WATER SUPPLY WELL POTENTIAL RECEPTOR MAP Date:
• WATER SUPPLY WELL WITH MUNICIPAL WATER 05122120237cale:AS STCHOWN App d By.MJ
CONNECTION BUT INACTIVE ACCOUNT STEVEN RIDENOUR PROPERTY ' FIGURE
o APPROXIVATE3SCALE IN FEET 700 GERMANTON, NORTH AI RO INA AN 2