WM0401425_Monitoring Well Permit Application_20230118

ATC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
December 22, 2022
Mr. Jim Gonsiewski
North Carolina Department of Environmental Quality
Winston-Salem Regional Office
450 West Hanes Mall Road, Suite 300
Winston-Salem, NC 27105
Re: Permit to Construct Temporary Groundwater Monitoring Well
Carolina Biological York Rd - Residence
2700 York Road
Elon, Alamance, North Carolina
ID No. NONCD0001441
State Contract No. N091319
Dear Mr. Gonsiewski:
Enclosed please find one application for a permit to construct one temporary groundwater
monitoring well. The temporary groundwater monitoring wells will be located at 725 East
Haggard Avenue (PIN #115770), Elon, Alamance County, North Carolina. The permit
application, site map with the proposed location of the monitoring well, well construction details
and other relevant information are enclosed as attachments. The work is being performed for the
Division of Waste Management, Inactive Hazardous Sites Branch (IHSB). Please review this
package and return the approved permit to this office or via email to
[e-mail]. Drilling is currently anticipated to commence during the week of
January 16, 2023.
If you have any questions or require additional information, please contact our office at (919)
948-3549.
Sincerely,
ATC Associates of North Carolina, P.C.
q.i
Larry M. George, P.G.
Principal/Senior Project Manager

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: 12/22/2022
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: NC DEQ, DWM
Monitoring
Telephone: [phone]
Applicant's Mailing Address: NCDEQ IHSB- Superfund Section, 217 West Jones Street, Raleigh, North Carolina 27699-1646
Applicant's Email Address (if available): Send to contact person listed below
5. Contact Person (if different than Applicant): Larry George, ATC Associates of NC, PC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Freeman & Company of Greensboro
Telephone: [phone] (Bonnie Rimmer, Property Manager)
Property Owner's Mailing Address: 211 N. Elm Street, Greensboro, NC 27408
Property Owner's Email Address (if available): Unknown
7. Property Physical Address (Including PIN Number) 725 E. Haggard Avenue (PIN # 115770)
City Elon County Alamance Zip Code 27244
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: Inactive Hazardous 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).
Yes, Carolina Biological York Rd - Residence IHSB Site (ID NONCD0001441)
11. Type of contaminants being monitored or recovered: VOCs
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, about 20 on -site monitoring
wells and one water supply well. Those within 500' of proposed temporary well are shown on the attached map.
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): Unknown
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Unknown
If yes, give distance(s):
15. Well Contractor: South Atlantic Environmental Drilling and Construction Co. Inc.
Well Contractor Address: 9088 Northfield Drive, Fort Mill, SC 29707
Certification No.: 2625
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 Temporary
3. Number of wells to be constructed in bedrock. Unknown
4. Total Number of wells to be constructed: 1 Temporary
(add answers from 2 and 3)
5. How will the well(s) be secured? Locking well cap,
6. Estimated beginning construction date: 1/16/2022
7. Estimated construction completion date: 1/16/2022
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
Agent for NCDEQ DWM (will include power of attorney
Signature of Applicant or *Agent Title of Applicant or *Agent upon request)
Lawrence M. George, P.G. (Agent for NCDEQ DWM) * 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 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]
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

ROY COOPER
r<
DIONNE DELLI-CATTI
>tatrtory
MICHAEL SCOTT
Dire:tor
NOR711 CAROLINA
Environmental Quality
TEMPORARY PROPERTY ACCESS ACCEPTANCE
1 am the owner of the propery located at 725 and 735 E. Haggard Ave, EIon, NC. I grant the Division of
Waste Management and/or its contractors to access my property to collect samples as indicated below
during the period August 5, 2022 to December 1, 2022. I understand the Division will coordinate the
scheduling, of the work with me.
❑ Potable Well. How many water supply welts are located on your property? _ !•' C'< ._.--
Are the well pumps operational in all? Yes/No (circle one)
Does any well on your property have a treatment system? Yes/No (circle one)
How is the water from the wells on your property used'? _,-
Ci Soil (Surface Grab Sample)
El Groundwater (Installation of monitoring wells)
0 Indoor Air Vapor Sampling
M Soil Gas Probes
11 Crawlspace Vapor Sampling
0 Other .spec*
Are there any dogs or other animals present in the area of sampling (please plan to secure)? Yes,
(circle one) }
:,?) 3 ci 5-4
(Pr' t h'urae) J � f (Tenet /cone Number)
(jam
'�'J7 ,
��'tr"V (i t�i4._'• / ' _I ,^_Yt.-,Y-)i..X<' l `S I' 1 7 c%�
'R
(Signature/ c c 1 . L -Q t•.L.r� (Date)
(.ac'itf)
Please answer the above questions and return this signed form to:
Ann Shields
Inactive Hazardous Sites Branch, UWM
1646 Mail Service Center
Raleigh. North Carolina 27699
Alternatively, you may email me at ann.shields,ct ncdenr,gov to provide acceptance of Division access for
sampling.
Associated Site Name: Carolina Biological York Rd. -- Residence
Elon, Alarnance County
Site ID Nos NONCD000144I
CV)
urro� f �
Narth Carolina Department al Environmental Quality I Envision of Waste Management
21? West tore, Street I 1646 Mall Service Centel I Raleigh. North Gtrola ?fi'in I046
a19707.8200

+ Proposed Temporary Monitoring Well
9 Existing Monitoring Well
Existing Water Supply Well(s)
Q500 Foot Buffer From Proposed Well
Site Property
Alamance County Parcels
PE
89

Well finished at surface with locking
well cap.
Groundwater Table
1" Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (+3-15 feet)
#2 Filter Sand Pack Extending to the surface
(0-11 feet)
2-Foot Bentonite Seal (11-13 feet)
15 Feet (or 10 Feet) of 1" Schedule 40 Well
Screen (0.010" Slot) (15-25 feet)
#2 Filter Sand Pack Extending 2 Feet Above Screen
(13-25 feet)
TMW's
ENVIRONMENTAL• GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: IHSB046P01
DATE: December 22, 2022
REVIEWED BY: LG
TEMPORARY MONITORING WELL
CONSTRUCTION DETAIL
Carolina Biological York Rd - Residence
2700 York Road
Elon, Alamance County, NC
ID No. NONCD0001441

Gonsiewski, James J
From: bonnie equitycommercialproperties.com <[e-mail]>
Sent: Wednesday, January 11, 2023 12:38 PM
To: Larry George
Subject: [EXTERNAL] Testing
[External Email] This email originated from outside of the Atlas mail system. Please use caution when opening
attachments.
Hello Larry,
Thank you for your call today. This email shall serve as notice you are granted an extension to access the property at
725-735 E. Haggard in Elon, NC.
If the testing is delayed beyond February 2023, please let me know.
Thanks,
Bonnie Rimmer
Equity Properties
PO Box 10645
Greensboro, NC 27404 (mail)
925 W. Market St. Suite 202
Greensboro, NC 27401 (physical)
336-617-0542 (office)
336-420-7365 (cell)
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