WM0401325_Application for a Monitoring Well Permit_20211102

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: October 29, 2021
2. County: Guilford
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant:
Sherwin-Williams Company (c/o Jennifer Deka)
Monitoring Wells
Applicant's Mailing Address: 101 Prospect Avenue, Cleveland, OH 44115
Applicant's Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant): Nick Shore (AECOM)
Telephone: [phone]
Telephone: [phone]
Contact Person's Mailing Address: 5438 Wade Park Boulevard, Suite 200, Raleigh, NC 27607
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): City of Greensboro Telephone: [phone]
Property Owner's Mailing Address: PO Box 3136, Greensboro, NC 27402
Property Owner's Email Address (if available): [e-mail]
7. Property Physical Address (Including PIN Number) Spring Garden Street Right -of -Way (PIN NA)
City Greensboro County Guilford Zip Code 27407
8. Reason for Well(s): environmental 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: industrial
(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
11. Type of contaminants being monitored or recovered: chlorinated solvents and metals
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 10
Existing Monitoring or Recovery Well Construction Permit No(s).: Unknown
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 385
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: Geologic Exploration Certification No.: 2580A
Well Contractor Address: 176 Commerce Blvd., Statesville,_NC 28626
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
material: 1
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap
6. Estimated beginning construction date: 11-29-21
7. Estimated construction completion date: 11-29-21
1.
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 hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
C,• L
Env. Project Manager
Signature of Applicant or *Agent Title of Applicant or *Agent
Jennifer Deka
* 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).
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
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]
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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
Phone: [phone]
Fax: [phone]
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AECOM
AECOM Environment
1600 Perimeter Park Drilve
Suite 400
Morrisville, North Carolina 27560
Phone: [phone]
Fax: [phone]
www.aecom.com
Legend
Site Location
C ] 1/2 Mile Buffer
Parcels
Suspected WSW
Receptor Survey Map
(0.5 Mile Radius)
3125 Spring Garden Street
Greensboro, NC
Feet
0 280 560 1,120
August 2019
Project #: 60603968
Figure Number
6

AECOM
Client: Sherwin-Williams Greensboro
Project Number: 60635569
WELL ID: Proposed Type H Well
Site Location:
3125 Spring Garden Street, Greensboro, NC
Date Installed: 29-Nov-21
Well Location: Coords:
Inspector:
Method: 4.25" ID HSA
Contractor: Geologic Exploration
PROPOSED MONITORING WELL CONSTRUCTION DETAIL
Depth from G.S. (feet)
12-inch diameter flush -mount steel vault to be set in 2'x2'x0.5' concrete pad
Describe Measuring Point:
Top of Riser Pipe
Ground Surface (G.S.)
Riser Pipe:
Length 20
Diameter (ID) 2"
Type of Material PVC
Thickness Sch 40
Grout:
Type neat cement
Thickness 16'
0.0
0.0
Top of Bentonite 16
Bentonite Seal Thickness 3'
Top of Sand 19
Top of Screen 20
Screen:
Length 10
Diameter (ID) 2"
Slot Size 10 slot
Type of Material PVC
Thickness Sch 40
Type/Size of Sand #2
Sand Pack Thickness 12
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Borehole Diameter 4.25" ID HSA
30
30
30
Elevation (feet)
Datum
Signature Date
Note: Depths are approximate and will be adjusted based on field conditions. Not to scale.

GREENSBORO
Noarn CAROLINA
November 3, 2020
AECOM
Attn: Nick Shore
1600 Perimeter Park Drive, Suite 400
Morrisville, NC 27560
RE: Contract ##2020-00916 — Encroachment Agreement with City of Greensboro
September 15, 2020 — September 14, 2045
Dear Mr. Shore:
Enclosed please find a copy of the fully executed contract listed above for your records.
If you have any questions or concerns regarding this contract, please feel free to contact Richard
Lovett at [phone] or by email at [e-mail]. Thank you.
Sincerely,
Dena Davis
Field Operations Department
Enclosures
cc: File
Richard Lovett
640
PO BOX 3136 • GREENSBORO NC 27402-3136 • WWW.GREENSBORO-NC.GOV • 336-373-CITY (2489)

aO-O L-
ao
RESOLUTION AUTHORIZING A GLOBAL ACCESS AGREEMENTS BETWEEN
SHERWIN WILLIAMS AND THE CITY TO CONDUCT RELATED TO ENVIRONMENTAL
INVESTI GATT ON S
WHEREAS, the Field Operations Department oversees environmental matters on many City
properties and is frequently requested to provide oversight of environmental investigations where
the contamination may have impacted City properties or City utilized right-of-ways;
WHEREAS, the City Council is authorized to execute global access agreements;
WHEREAS, Sherwin Williams is requested permission to conduct an environmental investigation
that may impact City property or City Right —of-Way areas as part of their ongoing investigation;
and
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
GREENSBORO:
That the resolution authorizes the Field Operations Department to sign the Global Access
Agreement between the City of Greensboro and Sherwin Williams to conduct the necessary
environmental investigations.
THE FOREGOING RESOLUTION WAS ADOPTED
BY THE CITY COUNCIL OF THE CITY OF
GREENSBORO ON THE I5'h DAY
OF SEPTEMBER, 2020
APPROVED AS TO FORM
Y ATTORNEY

i TM
NORTH CAROLINA
ENCROACHMENT AGREEMENT
GUILFORD COUNTY
THIS AGREEMENT, made and entered into this , 7th _ day of September 2020, by and
between the CITY OF GREENSBORO, (hereinafter the City); and The Sherwin-Williams
Company (hereinafter Sherwin-Williams) party of the second part.
WITNESSETH:
THAT WHEREAS, the City of Greensboro owns certain street rights of way located in
Greensboro, North Carolina, and Sherwin-Williams has requested permission to work with the
North Carolina Department of Environmental Quality, Division of Waste Management
(hereinafter the "Division) to encroach into the City street rights of way, in the sidewalk, or City
owned property to conduct environmental investigations (the "Work"). The said encroachments
and Work may include:
(I)
(2)
(3)
Taking such soil, water and air samples as may be necessary;
Taking other actions related to the investigation of surface or subsurface conditions
by installing below ground surface monitoring wells; and
Taking response actions necessary to mitigate any threat to human health or the
environment related to their property.
Other conditions:
(I) Sherwin-Williams shall attempt to perform any activities at the property in a
manner that minimizes interference with use of the property (as defined in
Attachment l) and that of adjoining private owners. Sherwin-Williams will
provide 72 hour's written notice to the City's Engineering and Inspections
Department, Utility Coordination, P.O. Box 3 I36, Greensboro, North Carolina
(Tel. [phone]) (Fax. [phone]) before entering the property.
(2) Sherwin-Williams agrees that this Encroachment Agreement is not permission
for any use apart from the Work.
(3) On conclusion of all activities, Sherwin-Williams, to the extent practicable, shall
restore the Property to the original condition it was in prior to any activities
conducted as part of the environmental investigation. All monitoring wells will
be properly abandoned in accordance with applicable laws and regulations, unless
other arrangements are agreed to by the Property Owner.
(4) Sherwin-Williams or its contractors shall provide the City of Greensboro and
adjoining private owners notice prior to entering the Property for any purpose. In
situations that the Sherwin-Williams determines to be of an emergency nature
the Sherwin-Williams or its contractors shall have immediate access to the

Property and shall inform the City and private owners within 72 hours of entering
the Property.
(5) The City shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without providing prior notice to Sherwin-Williams,
or its contractors.
(6) Sherwin-Williams guarantees that the encroachment will neither cause a public
nuisance nor unreasonably interfere with the use of the streets and sidewalks by
the public or public utilities.
(7) Sherwin-Williams agrees to maintain the encroached upon area in a safe
condition and restore the area to its original condition upon completion of
activities granted in this agreement.
(8) Sherwin-Williams is responsible for locating any and all utilities (Public and
Private) and structures in the encroachment area and to prevent damage to the
same.
(9) Sherwin-Williams shall be responsible for all necessary permits and fees to carry
out the work, both annual and job specific, and all permits shall be in the name of
Sherwin-Williams.
(10) Termination for Convenience: The City, in its sole discretion, may terminate this
Agreement in Whole or in part whenever the City determined that said
termination is in its best interest. Any such termination shall be effective by the
delivery to Sherwin-Williams of a written notice of termination thirty (30) days
before the effective date of the termination.
(11) indemnification: Sherwin-Williams hereby agrees to indemnify and save harmless
the City of Greensboro, its officers, agents, and employees against all claims,
actions, lawsuits and demands, including reasonable attorney fees, made by
anyone for the damages, loss, or injury of any kind, including environmental,
which may arise as a result of, the Work carried out pursuant to the Agreement.
(12) PAYMENT OF Taxes and Insurance: Sherwin-Williams assumes full
responsibility for the payment of all assessment, payroll taxes or contributions
whether State or Federal, as to all employees engaged in the performance of work
under this Agreement.
(13) Non -Discrimination Requirements: In hiring, contracting, and all other acts
Sherwin-Williams shall abide by all local, State and federal laws and regulations
relevant to Minority/Women's Business Enterprises and shall not discriminate on
the basis of sex, age, race, creed, color, religion, national origin, or disability.
(14) Sherwin-Williams shall obtain the following:
a. Workers Compensation: Coverage to apply for all employees for statutory
limits in compliance with the applicable state and federal laws. The policy
must include employer's liability with a limit of $100,000 for each accident,
$100,000 bodily injury by disease each employee and $500,000 bodily injury
by disease policy limit.

b. Comprehensive General Liability: Shall have minimum limits of $1,000,000
per occurrence combined single limit for bodily injury liability and property
damage liability. This shall include premises and/or operations, products
and/or completed operations, broad form property damage and explosion
collapse and underground damage coverage, sudden and accidental pollution
losses, and contractual liability.
c. Business Auto Policy: Shall have a minimum limits of $1,000,000 per
occurrence combined single limit for bodily injury liability and property
damage Iiability. This shall include: owned vehicles, hired and non -owned
vehicles and employee non -ownership.
d. Special Requirements: The City of Greensboro is to be named as an additional
insured on the Comprehensive General Liability policy.
e. Current, valid insurance policies meeting the above requirements shall be
maintained for the duration of the project. Certificates of Insurance and
additional insured endorsements shall be sent to the City of Greensboro ten
(10) days prior to any expiration date. There shall also be a 30 day notification
to the City on the event of cancellation or material modification of any
stipulated insurance coverage. Certificates of Insurance Accord 25 (8/84) or
similar form meeting the required insurance provisions shall be forwarded to
the City of Greensboro. Wording on the Policy of Insurance which states that
no liability shall be imposed upon the company for failure to provide such
notice is not acceptable. Certificates of insurance may be required by the City
at any time.
f. It shall be the responsibility of Sherwin-Williams to ensure that all Sherwin-
Williams subcontractors comply with the insurance requirements specified
above.
(15) Scope of Agreement: This Agreement is intended by the parties hereto to be final
expression of their Agreement and it constitutes the full and entire understanding
between the parties with respect to the subject hereto, notwithstanding and
representations, statements, or agreements to the contrary hereto made.
(16) Governing Law: This agreement shall be construed and interpreted in accordance
with the laws of the State of North Carolina, which parties agree shall be the sole
and exclusive jurisdiction for any suit or cause of action based upon or arising out
of this Agreement. The parties further agree that the venue for any suit or cause of
action based upon or arising out of this Agreement shall be Guilford County,
North Carolina.

(17) Severability: If, after the date hereof, any provision of this agreement is held by a
court of competent jurisdiction to be illegal, invalid, or unenforceable under
present or future law, the remaining provisions of this Agreement shall be fully
enforceable.
(18) E-Verify
Sherwin-Williams certifies that it currently complies with the requirements of
Article 2 of Chapter 64 of the North Carolina General Statutes, and that at all
times during the term of this Agreement, it will continue to comply with these
requirements. Sherwin-Williams also certifies that it will require that all of its
subcontractors that perform any work pursuant to this Agreement to comply with
the requirements of Article 2 of Chapter 64 of the North Carolina General
Statutes. Violation of this section shall be deemed a material breach of this
Agreement.
(19) Iran Divestment Certification
As of the date of this Agreement, Sherwin-Williams certifies that it is not listed
on the Final Divestment List created by the State Treasurer pursuant to N.C.G.S.
147- 86.55 et. seq, and that Sherwin-Williams will not utilize any subcontractor
found on the State Treasurer's Final Divestment List. All individuals signing this
Agreement on behalf of Sherwin-Williams certify that they are authorized by
Sherwin-Williams to make this certification.
(20) Divestment from Companies Boycotting Israel Certification
As of the date of this Agreement, Sherwin-Williams certifies that it is not listed
on the Final Divestment and Do -Not -Contract List — Restricted Companies
Boycotting Israel created by the State Treasurer pursuant to N.C.G.S. 147-86.81
and that Sherwin-Williams will not utilize any subcontractor found on the State
Treasurer's Final Divestment and Do -Not -Contract List. All individuals signing
this Contract on behalf of the Sherwin-Williams certify that they are authorized
by the Sherwin-Williams to make this certification.
(21) Sherwin-Williams shall also forward to the following named City Department
Head all abandonment records, preliminary and final environmental reports,
closure reports, and Notices and reports from NCDEQ.
Mail to:
Dale Wyrick
Director of Field Operations
City of Greensboro
P.O. Box 3136
Greensboro, NC 27402-3136
Contact Information:
Phone: [phone]
[e-mail]

IN WITNESS WHEREOF, each of the parties to this agreement has caused the same to
be executed in duplicate originals the day and year first above written.
(Corporate Seal)
Sherwin-Williams.
By: B
ATTESTED BY:
By:
City Clerk
Recommended:
Engineering Director
Approv-d as
City Attorney
1f4gk 1E - MA
SVP £ 5
CITY OF GREENSBORO
By:
gfts
City Manager

r
L
oREEMSgoRO
City of Greensboro
Contract Signature Authorization Sheet
Field Operations
Vendor:
Contract Number:
Change Order Number:
The Sherwin-Williams Company
Tracking number: 17992
Service, Item or Project Description:
Encroachment Agreement - Oversight of environmental investigations where t
contamination may impact City properties. Contract has not monetary value.
r-as.. Signatures
t el
El
Dto
eprinent Head Recommendation/Authorization
M/WBE Office: Authorized '
This instrument has been preauclited in the manner required'
the Local Government Budget and Fiscal Control Act.
ttorney: Approved as to form
Assistant City Manager: Authorized
Mayor: Executed
Jeip City Clerk: Attested
Date1q*''ao
Date:
Date:
Date: /0 - 2S--z
Date:
Date:
Date: /0 o2 f —o2P-6
Date Primed: 10/16/2020