WM0401534_Monitoring well permit application_20240521

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: 5/10/2024
2. County: Guilford County
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Temporary Monitoring Wells
4. Applicant: Terracon Consultants Inc. on Behalf of WhataBrands Real Estate Telephone: [phone]
Applicant's Mailing Address: 7327-G West Friendly Ave. Greensboro NC 27409
Applicant's Email Address (if available): chris.driscoll(@terracon.com
5. Contact Person (if different than Applicant): Chris Driscoll Telephone: [phone]
Contact Person's Mailing Address: 7327-G West Friendly Ave Greensboro NC 27409
Contact Person's Email Address (if available): chris.driscoll(cDterracon.com
6. Property Owner (if different than Applicant): Koury Corporation Telephone: [phone]
Property Owner's Mailing Address: 2275 Vanstory St #200 Greensboro NC 27403
Property Owner's Email Address (if available): Not available
7. Property Physical Address (Including PIN Number): 1408 Four Season Station Drive. (PIN: 7853045887)
City Greensboro County Guilford Zip Code 27407
8. Reason for Well(s): Due diligence 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: Open construction 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).
11. Type of contaminants being monitored or recovered: Analyzing samples for 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? 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): Approx. 200-300 feet from off -site
documented drycleaning solvent plume
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No known wells
If yes, give distance(s): N/A
15. Well Contractor: EDPS Certification No.: 3307
Well Contractor Address: 17538 Green Hill Rd Charlotte NC 28278
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)
Number of wells to be constructed in unconsolidated
material: 3
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 3
(add answers from 2 and 3)
5. How will the well(s) be secured? Sand + bentonite after
installation. Will abandon after sampling
6. Estimated beginning construction date: 5/23/2024
Estimated construction completion date: 5/23/2024
ADDITIONAL INFORMATION
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. 143-215.1013(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 WhataBrands Real Estate
Signature of Applicant or *Agent Title of Applicant or *Agent
Chris Driscoll Terracon Consultants * 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.
_Q,��. Koury Corporation
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
Richard L. Vanore, Jr., President
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
GW-22M/R (Rev. 5-26-2022)

PROPOSED TEMPORARY MONITORING
WELL CONSTRUCTION DIAGRAM
Notes:
*All temporary wells will be installed
in accordance to this diagram.
*Wells are temporary and will be
abandoned by a licensed North Car-
olina well contractor following sam-
pling in accordance with 15A NCAC
02C.
Number 2 Filter Sand
from bottom of screen
to a minimum of two
feet above the screen
ElBentonite
El Sand Filter Media
■ ierracon
Locking Well Cap
within Stick -Up Cas-
ing
Ground Surface
2"Diameter PVC
Schedule 20 Well
Casing
Minimum 2 feet of
hydrated bentonite
2" Diameter PVC
Schedule 20 Screen
Bottom of Well proposed to be
15-25 feet below ground surface
depending on observed ground-
water depth
PROJECT NO.: 75247064
DATE: May 2024
DRAWN BY: FCD

Driscoll, Chris
From: Williams, Wesley <[e-mail]>
Sent: Thursday, May 9, 2024 3:08 PM
To: Driscoll, Chris
Cc: Wulff, Melynne N; Elliott, Laura
Subject: Gate City Blvd & Pinecroft Rd Whataburger Site - Greensboro, NC
Chris,
Per your requirement to be able to install monitoring wells at our site in Greensboro, I give Terracon Consultants
Inc the authority to act as an agent on Whataburger's behalf to access the properties listed in the Well Permit
Application to install temporary monitoring wells.
Thanks you
Wes Williams
New Unit Project Manager, Real Estate Development
210.425.9430 cell
300 Concord Plaza Dr. I San Antonio, TX 78216
i
We're Hiring! Apply Here.
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