WM0401357_Monitoring Well Permit Application_20220428

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: 3/18/22
2. County: Alamance
PERMIT NO. ,iINI (j ` /(;J � S-IISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant: USACE (Dena Thompson)
Monitoring
Telephone: [phone]
Applicant's Mailing Address: 101 W York St, Savannah, GA 31401
Applicant's Email Address (if available): Dena. B.Thompsona.usace.army.mil
5. Contact Person (if different than Applicant): Ethan Dinwiddie - Terracon Telephone: [phone]
Contact Person's Mailing Address: 2401 Brentwood Road, Suite 107, Raleigh, NC 27604
Contact Person's Email Address (if available): ethan.dinwiddie(a.terracon.com
6. Property Owner (if different than Applicant): Carreno Developers LLC Telephone:
Property Owner's Mailing Address: PO Box 2366, Chapel Hill, NC 27515
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number)
City Burlington
County Alamance
Zip Code 27217
8. Reason for Well(s): 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: Former Tarheel Army Missile Plant
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents assocated with this facility or site? If so, list permit and/or incident no(s).
Federal Remediation Branch # NC7210020544
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? 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): 700 feet
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: Larry Opper
Certification No.: 3322
Well Contractor Address: PO Box 1161 Wake Forest, NC 27588
PROPOSED WELL CONSTRUCTION INFORMATION
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? _ Temporary Well
material: 1 (temporary) abandoned same day
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 5/4/22
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
7. Estimated construction completion date: 5/4/22
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. 143-215.106(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
Staff Geologist
Signature of Applicant or *Agent Title of Applicant or *Agent
Ethan C. Dinwiddie * 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 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]
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]
ngton
GW-22MR Rev. 3-1-2016

Well ID: RI-GW-01 through RI-GW-06
Project No. : 7021P145
Site Name: Former Tarheel Army Missile Plant
Field Personnel: Ethan Dinwiddie/Dan Govert
Date: 3/18/2022
Alamance County PINs 139443, 139764,
Location: 139783, and 139787
Drilling Method: DPT
Driller: Larry Opper (NC Cert No. 3322)
lrerracon
2401 Brentwood Road Suite 107
Raleigh, NC 27604
919.873.2211
Temporary Grab Monitoring Well Construction Diagram
Riser Pipe
Land Surface
Diameter 1-inch
Length 15 ft
Material PVC
Well Screen
Diameter 1-inch
Length 5 ft
Slot Size 0.010
Material Steel or PVC
Depth Below Land Surface (feet)
Bottom of Screen 20 ft
Bottom of Borehole 20 ft
2 Borehole Diameter (inches)
Note: Grab groundwater samples collected through DPT drilling rods using GeoProbe° SP-16
or similar tooling.

IVar
n,
co
co
pi
139473
139472
139-i 71
139469
139468
h i
13940; k-, ;
r `~
? /'t 4-i
TAMP jMW,1_
NHD Unnamed Tributary
of Service.Creek
(Perennial Stream)
Legend
City of Burlington ROW (ROW agreement
dated 11/14/201B)
p Properties without ROEs (Needed)
Properties without ROEs (Would be helpful)
O Properties with ROEs
Proposed Soil Vapor Sample
Proposed Grab Groundwater Sample
• Proposed Surface Water Sample
()Proposed Deep Monitoring Well
Proposed Shallow Monitoring Well
IS: Existing Monitoring Well
TAMP Site Boundary
o Alamance County Parcel Boundary
139485
MW-112
MW102 _ ,1 4 .. .
MW-111 ' MW-115t — MW-103
MW-109
e M W'1081*
MW 11.7 _F sr='
• . MW-107
MW101 `� '
MWW06colivi:. MW 11:
Notes:
- Properties identified and labeled by Alamance
County parcel ID number. See corresponding ROE
table for addresses.
- City of Burlington Right -Of -Way agreement should
be updated based on potential offsets of proposed
locations.
MW;,113
139789
139790
•
Service Layer Credits. NC Statewide Orthoimagery, NC One Map
Server, 2018; Site Boundary approximated from Alamance County GIS
Project No.:
7021 P145
Date:
March 2022
Drawn By:
ECD
Reviewed By:
DRM
f 1 r
0 75 150
300 Feet
Declaimer The Inbrmation depicted
h this Ole Is is, idonnational porpoise
rd salable for Woe prepared n fong urp e
ee engineering for regulator.
This ess non intended Is not for ypu6b a
reeii andt is intended yo p for use only by a
Professional land Sty Yla poi r rct 1 y
irerracon
2401 Brentwood Road. Suite 107 Raleigh, NC 27604
Proposed and Existing Sampling Locations
Tarheel Army Missile Plant
N. Graham Hopedale Road
Burlington, Alamance County, North Carolina
EXHIBIT
NO.
1
Phone: (919i 873-2211 Fax: (919i 873.9655

DEPARTMENT OF THE ARMY
RIGHT OF ENTRY FOR
ENVIRONMENTAL ASSESSMENT AND RESPONSE
Former Tarheel Army Missile Plant
Burlington, North Carolina
(Project:, Installation or Activity)
Parcel 139787
1821 Hilton Rd. Burlington, NC
Tract No., Address or Property I.D.
DACA21-9-22- 4.9a 21
Right -of -Entry No.
Carreno Developers LLC
PO Box 2366
Chapel Hill, NC 27515
Name and Address of Owner
The undersigned, herein called the "Owner", in consideration for the mutual benefits of the
work described below, hereby grants to the UNITED STATES OF AMERICA, hereinafter called
the "Government", a right -of -entry upon the following terms and conditions:
1. The Owner hereby grants to the Government an irrevocable and assignable right to
enter in, on, over and across the land described in Schedule A, for a period not to exceed five (5)
years, beginning with the date of the signing of this instrument, and terminating with the earlier
completion of the remediation or the filing of a notice of termination in the local land records by
the representative of the United States in charge of the Former Tarheel Army Missile Plant,
for use by the United States, its representatives, agents, contractors and assigns, as a work area
for environmental investigation and response; including the right to store, move, and remove
equipment and supplies; erect and remove temporary structures on the land; investigate and
collect samples; excavate and remove pollutants, hazardous substances, contaminated soils,
containerized waste, and replace with uncontaminated soil; construct, operate, maintain, alter,
repair and remove groundwater monitoring wells, groundwater purification and injection
systems, appurtenances thereto and -other devices for the monitoring and treatment of
contamination in soil, air and water; and perform any other such work which may be necessary
and incident to the Government's use for the investigation and response on said lands; subject to
existing easements for public roads and highways, public utilities, railroads and pipelines;
reserving, however, to the landowner(s), their heirs, executors, administrators, successors and
assigns, all such right, title, interest and privilege as may be used and enjoyed without interfering
with or abridging the rights and right -of -entry hereby acquired.
2. The Owner also grants the right to enter and exit over and across any other lands of
the Owner as necessary to use the described lands for the purposes listed above.
3. All tools, equipment, and other property taken upon or placed upon the described land
by the Government shall remain the property of the Government and may be removed by the

Government at any time within a reasonable period after the expiration of this permit or right -of -
entry.
4. If any action of the Government's employees or agents in the exercise of this right -of -
entry results in damage to the real property, the Government will, in its sole discretion, either
repair such damage or make an appropriate settlement with the owner. In no event shall such
repair or settlement exceed the fair market value of the fee title to the real property at the time
immediately preceding such damage. The Government's liability under this clause is subject to
the availability of appropriations for such payment, and nothing contained in this agreement may
be considered as implying that Congress will at a later date appropriate funds sufficient to meet
any deficiencies. The provisions of this clause are without prejudice to any rights the Owner may
have to make a claim under applicable laws for any damages other than those provided for
herein.
S. The land subject to this permit or right -of -entry is located in Alamance County, State
of North Carolina and is particularly described as follows:
PIN: 139787 , 1821 Hilton Road, Burlington NC 27217 -Exhibit A
WITNESS MY HAND AND SEAL THIS \ 3 dayz.of ?riL , 2022.
�� 96�SZg4
Owner Contact Number
Carreno
velop rs LLC
UNITED STATES OF AMERICA
HINELY.JOHN• 5 Digy
HINIELYJOHN.5.1tally signed n29914290
Le BY: .1 j _04'00 022'04.26 11:35:55

CERTIFICATE OF CORPORATE AUTHORITY
THIS FORM IS TO BE COMPLETED BY SOMEONE OTHER THEN THE PERSON SIGNING THE RIGHT -OF -ENTRY
1, rA'rt7 v •Q'( �` j�1� , certify that I am the
AME)
of ftn.rikt.b VtAAp6AT L-C; and that
(NAME OF CORPOR 4rION) I (NAME OF PERSON SIGNING ROE)
who signed the foregoing Right -of Entry dated `'E ((, ( 2e Z%between said
LCS1b Q.V e 6- IA- C and the United States of America, on behalf
(NAME OF CORPORATIO4 1
of said Corporation was then the cU,�'l/114." of said
(TITLE OF PERS SIGNING ROE)
c
mit.to
(TI E)
Corporation; and that the Right -of -Entry was duly signed for and in behalf of said
Corporation by authority of its governing body and is within the scope of its corporate
powers.
DATE: 117-- P 22
Signature
ilk0/1,0 6")1AA
PRINT NAME
TITLE

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