WM0401377_Monitoring Well Permit Application_20220712

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: 7/8/22
2. County: Alamance
FOR OFFICE USE ONLY
PERMIT NO. ISSUED 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): [e-mail]
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): [e-mail]
6. Property Owner (if different than Applicant): Ronald Lee Norton Telephone:
Property Owner's Mailing Address: 2121 NC Highway 54 Graham, NC 27253
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 1708/1710 Hilton Rd (PIN 139768)
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 associated 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): 900 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: Gary Ellingworth Certification No.: 3367
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
material: 0
3. Number of wells to be constructed in bedrock: 1
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5. How will the well(s) be secured? Permanent
monitoring well, secured with flush -mount metal manway,
locked cap, and concrete pad
6. Estimated beginning construction date: 7/18/22
7. Estimated construction completion date: 7/29/22
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. 143-215.10B(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
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).
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]
GW-22MR Rev. 3-1-2016

Well ID:
Project No. :
Site Location:
Field Personnel:
Date:
Location:
Drilling Method:
Driller:
MW-139, MW-140, MW-141, MW-142
7021P145
Former Tarheel Army Missile Plant
Ethan Dinwiddie/Dan Govert
3/18/2022
Alamance County PINs 139443, 139475, 139478,
and 139768
HSA/Air Rotary
Gary Ellingworth (NC Cert No. 3367)
Land Surface
Riser Pipe
Diameter 2-inch
Material PVC
Length 30 ft
Well Casing
Diameter 4-inch
Material PVC
Length 25 ft
Sand Pack
Sand Size
Well Screen
No. 2
lrerracon
2401 Brentwood Road Suite 107
Raleigh, NC 27604
919.873.2211
Monitoring Well Construction Diagram
Diameter 2-inch
Length 10 ft
Slot Size 0.010-inch
Material PVC
k
Note: Not to scale
Concrete
Depth Below Land Surface (ft)
1 ft
Bottom of Grout 25 ft
Bottom of Grout 25 ft
Bottom of Bentonite Seal 28 ft
Top of Screen 30 ft
Bottom of Screen
Bottom of Tail Pipe
Bottom of Borehole
40 ft
40 ft
40 ft
4 Borehole Diameter (inches)
>I 8
Borehole Diameter (inches)

139473
139472
139471
139470
139469
139468
NHD: UnnamedjTributary 1
ofService Creek �"lt
(Perennial Stream)
139483
139482
139476
/1P MW-2
"• 0
Legend
City of Burlington ROW (ROW agreement
dated 11/14/2018)
=Properties without ROEs (Needed)
=Properties without ROEs (Would be helpful)
] Properties with ROEs
Proposed Soil Vapor Sample
• Proposed Grab Groundwater Sample
• Proposed Surface Water Sample
°Proposed Deep Monitoring Well
9-Proposed Shallow Monitoring Well
9 Existing Monitoring Well
TAMP Site Boundary
Alamance County Parcel Boundary
MW-104
MW-110
MW-111
MW101
MWi102
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-115r MW-103
MW-109 9
MW-108 9
MW-117
MW-107
MW-106 -._ :..MW11 •�
1L
minimum m ill'
139790
MW-114
I
MW-5
Service Layer Credits: NC Statewide Orthoimagery, NC One Map
Server, 2018; Site Boundary approximated from Alamance County GIS.
Project No.:
7021P145
Date:
March 2022
Drawn By:
ECD
Reviewed By:
DRM
I I
0 75 150 300 Feet
Disdaimer The information depicted
In this file Is for Informational purposes
only and was not prepared for and is
not suitable for legal or engineering purposes.
This Information presented is t f eg I t ry
rand Is Intended for use only by a
PHew IL dS yopd to gltry
■ ierracon
2401 Brentwood Road, Suite 107 Raleigh, NC 27604
Phone: [phone] Fax: [phone]
Proposed and Existing Sampling Locations
EXHIBIT
NO
Tarheel Army Missile Plant
N. Graham Hopedale Road
Burlington, Alamance County, North Carolina
1

City of Burlington
Installation within public rights -of -way Authorization
April 27, 2022
Mr. Joe Melton
US Army Corp of Engineers
100 W Oglethorpe Road
Savannah, GA 31401
Subject: Utility Excavations Permit # 1389 — Monitoring Wells at Camp Road, Patrick Ave., Cobb Ave..,
Hilton Road
Mr. Melton:
The City of Burlington does hereby grant access to the public right-of-way for the installation of the above
referenced utility as shown on the attached plan. The City makes no guarantee of adequate public right-of-way
to support the proposed installation as shown on the submitted plan. This is the responsibility of the applicant.
Note that this is not an authorization to construct. Any installation or disturbance within the public
street or within public right-of-way will require a preliminary field meeting with a representative of the
Engineering Department before authorization to construct will be given. Contact the City of
Burlington Engineering Department (John Hammond) at 336-222-5050 (o), 336-512-7646 (m) or by
email JHammond(a burlingtonnc.2ov, to set this meeting. Deviation from the attached plan noting
alignment or methods of installation must be approved through this office. All work within NCDOT rights -of -
way will require a separate approval through the District Engineer's office.
All work that requires an adjustment to normal traffic flow shall be performed in a manner that complies with
FHWA traffic control practices as noted in the MUTCD manual. Pedestrian and vehicular traffic must be
maintained at all times. Please note day and time restrictions (if any) noted on the attached ROW use
application.
It is the applying utility's responsibility to locate all other utilities prior to installation. All utilities shall be a
minimum of 30" below the nearest roadway surface —or- depth required by the governing utility code. The
new installation shall be a minimum of 48 inches measured perpendicularly from the center of any City
maintained utility and 24" clear separation when crossing any City maintained utility.
The utility owner shall agree to remedy any possible conflicts regarding the permitted utility, which the City
may encounter while performing maintenance of a City owned utility, with no cost borne by the City. The
utility shall agree to restore all infrastructure in accordance with applicable City of Burlington specifications.
Note that all restorations performed by the utility within public right-of-way shall be guaranteed by the utility
against any settlement or failure.
Sincerely,
W. Todd Lambert, P.E.
City Engineer
cc: file
Austyn Howell
Streets Superintendent
John Hammond
R/W Inspector

RIGHT-OF-WAY USE APPLICATION (required for all work in the City maintained ROW)
City of Burlington NC
Engineering Department
425 S. Lexington Ave.
Burlington, North Carolina 27215
P: [phone], F: [phone]
APPLICANT INFORMATION:
Name of Company: USACE Savannah District
Contact Name: Joe Melton
Address: 100 W Oglethorpe Rd, Savannah GA, 31401
Telephone Number: 864-650-4998
Email: [e-mail]
Contractor Information: (if contractor is applicant, note such and provide applicable contact info)
Contractor Name: Northwind Engineering, LLC Telephone Number: [phone]
Subcontractor Name: Terracon
24-HR Contact Name: Danielle Hughes
(Contact during construction)
Telephone Number: [phone]
Telephone Number: [phone]
FROM TO
Project Address/Location: North Cobb Avenue near Parcels 139467 and 139475
FROM TO
Project Address/Location: Hilton Road near Parcels 139478, 139768, 139787, and 139788
FROM TO
Project Address/Location: Patrick Avenue near Parcel 139783
The proposed locations of the borings are provided on the attached figures and will be placed within the
50 foot right-of-way that the city has along these roads. All utilities will be cleared prior to
commencement of work. There are eight total wells included in this permit application. Please see the
final page of this application for a table outlining well locations and quantities.
(provide location sketch)
(Complete as Applicable)
Reason for Need to locate in City public right-of-way: ( i.e. Utility service, Video Services, fiber optic
connectivity, local telephone service, natural gas service, electrical service, etc.)
The need to locate the borings in the right -of way arises from assessment of the contamination plume from
the Former TAMP Facility. USACE cannot properly address this issue without sampling off of the TAMP
facility. Wells installed during the assessment will be completed as temporary or flush mount monitoring
wells that will be completed at the existing grade so that no vertical obstruction will be left. The US
Government will abandon any permanent monitoring wells at the end of the assessment and any requisite
remediation.

Construction Activity general work description:
Excavation Area: Length 1 (FT) Width 1 (FT)
The wells be installed in holes with a diameter less than 12 inches.
Pavement Cut:
Length (FT) Width (FT)
(Includes benching perimeter)
Pavement will not be cut unless a suitable offset location cannot be identified that is also within the
right-of-way.
Anticipated begin date:
Anticipated begin date:
Mobilization 1 - 5/2/2022
Mobilization 2 - 5/23/22
Work duration: 7 (days)
Work duration: 14 (days)
Construction plan or sketch submitted? Y N Material shop drawings submitted? Y N (attach)
Mill and overlay street for pavement restoration? Y N
Traffic control plan submittal:
Traffic control measures may vary based on location. Basic traffic control measures would include closure of a
section of the road shoulder using cones with a taper towards oncoming traffic. Road work signs would also be
displayed on both sides of the road at distances determined by City of Burlington or NCDOT requirements.
Additional measures required by the City of Burlington will be added if requested.
Print Name: Joe Melton Title: Contract Officer Representative
Signature: Date:
yam - E.'� raft. �� 19 Apr 2022
Signed by Joe Melton
Digital version on file

CITY USE
Permit #: 1389
Issue Date: 4/26/22
Permit Fees: $ N/A
Utility Pavement Cut Fees: $ N/A (per Utility Pavement Cut Policy)
Public Works restoration fee: $ N/A (Does not apply if contractor restoring pavement)
TOTAL FEES DUE:
$ 0.00
Preconstruction Meeting Required
N
Traffic Control Approvals: Traffic control plan for any disruption in traffic must be submitted prior to commencement of
construction, this includes but not limited to loading / unloading material and equipment and
Traffic Control Plan: Y construction within 5' of the travel lane. All traffic control to be installed by NCDOT and
Detour Plan: Y © MUTCD Guidelines.
Street Closure: Y 0
Permit Approval:
Engineering Department Signature:
Work Acceptance
Engineering Department Signature:
Permit Closed
Engineering Department Signature:
Project Notes:
date:
date:
date:
4/26/22
See following sheets for Locations included in this permit.
This permit shall only apply to City Streets, all NCDOT required encroachments shall be procured by the applicant and is not considered part of this
permit. The City does not guarantee that adequate right-of-way exist to support the proposed installation, R/W verification is the responsibility of the
applicant. This permit does not guarantee private utility easements or their use there of.
No lane reductions, closures or work between to 4pm and 9am; no work may reduce travel lanes within a school zone during school zone times.
No handholes may be placed in a location that conflicts with proposed sidewalks or else relocated at AT&T at such time the conflict arises.
All sidewalk impacts shall be left passable at the end of each work day with compacted gravel fine stone, level with adjacent grades. Any sidewalk
impacts shall be replaced in full panels; partial panel replacement is not allowed.
No trees, shrubs, or landscaping may be trimmed, removed, damaged or disturbed without prior, specific approval from the City of Burlington
(Engineering Department).
Pavement Repairs shall follow the City's adopted Utility Pavement Cut Policy which include pavement restoration within 24 hours of completion of
work.
No handholes may be placed within driveways or roadside drainage ditches.
Failure to meet Project Permit conditions shall revoke work permit.

Owner Name: NORTON RONALD LEE
2121 NC HIGHWAY 54
GRAHAM, NC 27253
GPIN: 8875951561
PI D : 148 -5 98 -75
Address Points
0 Address
Tax Address
Preliminary Address
Heavy Industrial Development Applicants
APPLIED FOR PERMIT
April 27, 2022
1:312
0 0.0035 0.007 mi
I r I
DISCLAIMER:
The datasets and maps available are notsurvey grade ora legal
document They are a best approximation of what is on the
ground, but do contain errors. The data comes fan various
sources nalonally, tie state ofNalh Carolina, and here in
Alamance County. Alam once County will not be held responsible
for the misuse, misrepresentation, or misinterpretation of the data or
Alamance County GIS maps. These maps and data are a service provided for the benefit
Alamance County Tax Department forAlam an ce Countyct¢ens.rWecon stanty stdvetoimprove the
alityandempand the am ou nt of data and ma available.
Sources: Esri, HERE, Garmin, US�6 , Intermap, INCREMENT F., NRaean,
Esri Japan, ME11, Esri China (HA1+VIRtfr Offtllni'Klaa+l aSr[BrinoUtyglddlgd)py errors,
NGCC, (c) OpenStreetMap contribut'8i'§51Behh4hi@i47S�J iFL"l�rR R lid"prodded regardless of
how caused; or any decision made a action taken or not taken by
user in reliance upar any information or datafumished hereunder.
The user knowingly waives any and all chins for damages against
any and all of the entities comprising the Alamance County Gt5
System that may arise from the mapping data. Data: 4/27/2022