WM0501446_Application_20210730

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: 7/30/2021
2. County: Durham
3.
4. Applicant:
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
John Snyder PE, PG
Telephone: [phone]
Applicant's Mailing Address: 1955 Evergreen Blvd Duluth, GA 30096
Applicant's Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant):
Contact Person's Mailing Address:
Contact Person's Email Address (if available):
6. Property Owner (if different than Applicant):
Telephone:
AP Brightleaf Square Telephone: [phone] (owner's consultant)
Property Owner's Mailing Address: 1616 Camden Rd Suite 210 Charlotte, NC 28203
Property Owner's Email Address (if available): [e-mail] (owners consultant)
7. Property Physical Address (Including PIN Number) 0821-07-69-8234 823 W Morgan St
City Durham
County Durham
Zip Code 27701
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: adjacent former dry cleaner
(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).
None on this property. Evaluating "Former Eakes Dry Cleaners"
11. Type of contaminants being monitored or recovered: chlorinated solvents
(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).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): < 100 ft
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: Parratt-Wolff Todd Muench Certification No.: 3371
Well Contractor Address: 501 Millstone Drive, Hillsborough, NC 27278
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? Temp wells only,
material: 2 abandoned immediately upon sampling
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 8/4/21
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 8/4/21
(add answers from 2 and 3)
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. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant her- by agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
tion ;'e as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
ubchapter 2C) and accepts full responsibility for compliance with these rules
this Wel . r .tr
Signre of Appli .ant or *Agent
John Snyder, PE, PG
Environmental Engineer
Title of Applicant or *Agent
* 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).
-Fo C a- Forrest Cherry
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
- r r . r .r 6 9800
040.0
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797
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41.11110
GW-22MR Rev. 3-1-2016

-SITE.DWG
H:\2020\OTHER OFFICES\NORTH CAROLINA\NCDEQ-DWM-D
LEGEND:
MW-1 MONITORING WELL
Well Identification
Relative Groundwater Elevation (ft)
TRW-2 RECOVERY WELL
Well Identification
PARCEL LINE
PARCEL OF INTEREST
NOTE: ALL LOCATIONS ARE APPROXIMATE
From Oct. 14, 2020 GW Monitoring
Report for Durham Dry Cleaners
ONE HOUR
KORETIZING
(DC320029)
EAKES
CLEANERS
(DC32©004)
(SITE) Prop
DURHAM SCHOOL
OF THE ARTS
SCOT ' NC
ROBERT
(DC320025)
ENTIAL
LAMOND AVENUE
HOVVERTON BRYAN
FUNERAL HOME
BROWNFIELDS SITE
20071-16-032
DURHAM DRY
CLEANERS
(DC320026)
MEMORIAL STREET
200 0 50 100 150 200
SCALE: 1" = 200'
0
w
Date:
08/17/2020
Scale:
AS SHOWN
Figure:

PRpaTe,v„p WQ.1)ls &123.Cl��vs
MONITORING WELL [ COMPLETION DIAGRAM
COMPLETION: n tC C9 GlS L` U �/k aikd GV( (AAPA --. f
SURFACE I-�
P ELEVATION TOC: _ FEET NGVD
W ELL LLD NO.
P
1-eitmw 1 09-
WATER -BEARING ZONE: TN)
)
FT BGS
DATES �)
DRILLING DATE(S): IJ
CASING INSTALLATION DATE(S):
WELL INSTALLATION DATE(S):
PAD COMPLETION DATE(S):
DRILLING INFORMATION f�
DRILLING COMPANY: PL-if"
Ufa(
DRILLERS LICENSE NO: �31
DRILLING METHOD: I✓ re anc
HAS ❑
FROM: TO: FEET BGS
TOTAL DEPTH OF WELL
( (_) FEET BGS
FEET NGVD
TOTAL DEPTH OF BOREHOLE
j (l FEET BGS \�
FEET NGVD
GROUND SURFACE
ELEVATION: FEET NGVD
1\ SURFACE CASING
Material: Sc'
FROM:
SAND/CEMENT
FROM:
Borehole diameter:
�v &AcJ(_
Diameter: ,Cir
TO: FEET BGS
D
(� F JI Q,%ll�
4 PORTLAND/BENTONITE GROUT
Date: /JJ'UF—
FROM: TO: FEET BGS
Borehole diameter:
BENTONITE PELLETS vl J /J T
FROM: TO: FEEfGS
WELL RISER CASING
Material: itJ v /(J
Diameter:
FROM:
TO:
4 SAND PACK Silica Sand:
FROM: / V TO: 0
FROM: TO:
BOREHOLE DIAMETER
FEET BGS
FEET BGS
FEET NGVD
WELL SCREEN
Material:
Diameter: Slot size: CJ , U ( (J
FROM: \ TO: FEET BGS
FROM: ( C) TO: 0 FT NGVD
SUMP LENGTH
FEET
BGS = BELOW GROUND SURFACE
IN = INCH
NGVD = NATIONAL GEODETIC VERTICAL DATUM
PVC = POLYVINYL CHLORIDE
TOC = TOP OF CASING