WM0401370_Application for Monitoring Well Permit_20220525

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: 4.27.22
2. County: Guilford
PERMIT NO.
FOR OFFICE USE ONLY
ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Two (2) Monitoring wells MW-7 and MW-8-see attached figure
4. Applicant: Second Green Holdings, Inc. (Formerly Ramco Fabricators, Inc.) Telephone: [phone]
Applicant's Mailing Address: 9501 West Market Street- Colfax, NC 27235
Applicant's Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant): Richard Miller Telephone: [phone]
Contact Person's Mailing Address: 5710 W. Gate City Boulevard -Suite K-Greensboro, NC 27407
Contact Person's Email Address (if available): rmiller(a)douohertvequioment.com
6. Property Owner (if different than Applicant): Maxine S. Sellars
Telephone: [phone] (This is for Cheryl Kirkpatrick who is Ms. Sellars daughter since she is getting older)
Property Owner's Mailing Address: 8719 Sheffield Road- Colfax, NC 27235
Property Owner's Email Address (if available): ccmkirk1 mail.corn (Cheryl Kirkpatrick- see explanation above)
7. Property Physical Address (Including PIN Number) 8719 Sheffield Road- PIN #168715
City: Colfax County: Guilford Zip Code: 27235
8. Reason for Well(s): Possible 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 Waste Disposal 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).
AOC)- NCD 986 171 494
11. Type of contaminants being monitored or recovered: VOCs and Metals (ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Seven (7) on adjacent separately owned
parcel
Existing Monitoring or Recovery Well Construction Permit No(s) : N/A- All on a separately owned property
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 50
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: IET- Terry White Certification No.: 3287-A
Well Contractor Address: 232 Highway 49 South- Concord, NC 28025
PROPOSED WELL CONSTRUCTION INFORMATION
1 As required by 15A NCAC 02C .0105(0(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter
b. Estimated well depth
c Screen intervals
d Sand/gravel pack intervals
e. Type of casing material and thickness
f. Grout horizons
g. Well head completion details

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: two (2)
3. Number of wells to be constructed in bedrock: None
4. Total Number of wells to be constructed: Two (2)
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking Cap
6. Estimated beginning construction date: 10.26.21
(already installed)
7. Estimated construction completion date: 10.26.21
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
Signature of pplicant or *gent
Richard Miller
Printed name of Applicant or *Agent
Vice President
Title of Applicant or *Agent
* If signing as Agent, attach authorization agreement stating
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).
Signature ofoperty 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]
GW-22MR Rev. 3-1-2016

k
LEGEND
❑� Water Supply Well
O Monitoring Well
Property Boundary
Leased Property Boundary
to Ramco Acquisitions, LLC
o Old Well (4bandoned
AO©2 c
+gi
-- MW-50_______
;
M1 V-6n- �o O
MW-8 •
Monitoring
Wells MW-7
and MW-8 on
Sellars Parcel
LEGEND
AOC 1- Open Shed Area
AOC 2- Steel Containment Storage Area
AOC 3- Inside of Paint Shed
AOC 4- MEK Dispensing Area
AOC 5- Drum Burial Area
1
AOC 6- Trenches in Fill Area
WATERS EDGE ENVI RONM ENTAL, LLC
Job No.
R19-33
Image/Photo
Guilford Co GIS
Date
5.2.22
Title
MW-7 and MW-8 Location Map
File Name
Offsite Well Permit
Figure
Scale
1"=175' approx.
Project Second Green Holdings (NCD986171494)
Colfax, North Carolina

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White
Well Contractor Name
3287-A
NC Well Contractoi Certification Number
IET
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (t. e. UIC, County, State, Variance, etc,)
3. Well Use (check well use):
Water Supply Well:
!gr
Geothermal (Heating/Cooling Supply)
Ind ustrial/Commercial
.Aicu1tura1
Irrigation
on -Water Supply Well:
Monitoring
Injection Well:
▪ Aquifer Recharge
E Aquifer Storage and Recovery
[]Aquifer Test
▪ Experimental Technology
QKGeothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Municipal/Public
DResidential Water Supply (single)
DIResidential Water Supply (shared)
Recovery
Groundwater Remediation
Salinity Barrier
DStormwater Drainage
Subsidence Control
Tracer
©IOther (explain under #21 Remarks)
4. Date Well(s) Completed:10/26/2021 Well ID# MW-7
5a. Well Location:
Ramco
Facility/Owner Name Facility ID# (if applicable)
9501 W. Market St. Colfax 27235
Physical Address, City, and Zip
Guilford
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36 06 40.763 N 80 01 08.332
For Internal (Jse Only:
14. WATER ZONES
FROM TO
DESCRIPTION
14 ft.
30 ft.
ft.
ft.
15. OUTER CASING (for multi -cased welts) OR LINER (if applicable)
DIAMETER THICKNESS MATERIAL
FROM
ft.
TO
ft.
in.
16. INNER CASING OR TUBING (geothermal closed loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft• 20
ft. 2
r"• sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
20 ft•
30 ft•
2
in.
0.010
sch40
PVC
ft.
ft.
in,
18. GROUT
FROM
3
ft.
TO
16 ft.
MATERIAL
Bentonite
EMPLACEMENT ME'1'IIOD & AMOUNT
Poured/300LB
0
ft.
3
ft.
Neat Cement
Poured/50LB
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL
EMPLACEMENT METHOD
16 It.
30 ft.
#2 Sand
Poured
ft.
ft.
20. MI LUNG LOG (attach additional sheets if necessary)
FROM
ft.
TO
ft.
DESCRIPTION {color, hardness, soil/rock type,grain size. etc.)
See Consultant Log
ft.
ft.
ft.
ft.
ft.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certification:
W i uJ
6. Is(are) the well(s)x Permanent or E3Temporary
7. Is this a repair to an existing well: DYes or oiNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the salve
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: one
9. Total well depth below land surface: 30
For multiple wells list all depths if different (example- 3@ 200' and 2@i100')
(ft.)
10. Static water level below top of casing: 14 (ft.)
If water level is above casing, use " "
11. Borehole diameter: 8 (in.)
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
10/29/2021
Signature ofCor fed Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 5A NCAC 02C. 0100 or 1 5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details, You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed,
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White
Well Contractor Name
3287-A
NC Well Contractor Certification Number
IET
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
['Geothermal (Heating/Cooling Supply)
ID Industrial/Commercial
[ Irrigation
Non -Water Supply Well:
XnMmutoring
Injection Well:
ElIAquifer Recharge
Q lAquifer Storage and Recovery
❑ 'Aquifer Test
o Experimental Technology
DGeotltcrinal (Closed Loop)
®Geothermal (Ileating/CoolingRelurn)
Municipal/Public
DIResidential Water Supply (single)
['Residential Water Supply (shared)
In Recovery
0Groundwater Remediation
0Salinity Barrier
DStormwater Drainage
0ISubsidence Control
0ITracer
®Other (explain under 021 Remarks)
4. Date Well(s) Completed:10/26/2021 Well ID# MW-8
5a. Well Location:
Ramco
Facility/Owner Name Facility ID# (if applicable)
9501 W. Market St. Colfax 27235
Physical Address, City, and Zip
Guilford
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36 06 40.763 N 80 01 08.332
6. Is(are) the well(s)JPermanent or E3Temporary
7. Is this a repair to an existing well: DYes or X INo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: one
9. Total well depth below land surface: 30
For multiple wells list all depths if different (example- 3@,200' and 2@100)
(ft.)
10. Static water level below top of casing: 15 (ft.)
If water level is above casing, use "
I1. Borehole diameter: 8 (in.)
12. Well construction method: Auger
(i. e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
15 ft.
30 ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap ieable)
FROM
TO
DIAMETER
YllrCKNESS MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
20 ft.
2 in'
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
5LOrSIzE
THICKNESS
MATERIAL
20 ft,
30 ft.
2 1II•
0.010
sch40
NC
ft.
ft.
In.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD81 AMOUNT
3 ft.
16 ft•
Bentonite
Poured/300LB
0 ft.
3 ft.
Neat Cement
Poured/50LB
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENTMETIOD
16 ft.
30 ft.
#2 Sand
Poured
ft.
ft.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hnrdrless, soil/rock type, grain eat, Me,)
ft.
ft.
See Consultant Log
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certification:
Signaiutc of Car
Cd Wl;ll (rrlltral:[or
10/29/2021
Dale
By signing this farm, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary,
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016