WM0801241_Application_20231205

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: December 5, 2023
4
County: Brunswick
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant:
The Chemours Company FC LLC
Applicant's Mailing Address: 22828 NC Highway 87W, Fayetteville, NC 28306
5.
H
7
A
a
Applicant's Email Address (if available): [e-mail]
Telephone: [phone]
Contact Person (if different than Applicant): Savannah Volkoff Telephone: [phone]
Contact Person's Mailing Address: 2501 Blue Ridge Rd, Suite 430, Raleigh, NC, 27607
Contact Person's Email Address (if available):
[e-mail]
Property Owner (if different than Applicant): NCDOT ROW Enroachment
Property Owner's Mailing Address: See attached
Property Owner's Email Address (if available): NA
Telephone: [phone]
Property Physical Address (Including PIN Number) See attached figure & approved DOT permit
City See attached figures/DOT permit County See attached figures/DOT permit Zip Code See figs/permit
Reason for Well(s): Groundwater Monitoring Wells
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: NA
(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).
NA
11. Type of contaminants being monitored or recovered: PFAS
(ex: organics, nutrients, heavy metals, etc.)
12
13
Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).: NA
Distance from proposed well(s) to nearest known waste or pollution source (in feet): None
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Possible private residence wells
If ves, give distance(s): N/A
15. Well Contractor: SAEDACCO Certification No.: 4220
Well Contractor Address: 9088 Northfield Dr., Fort Mill, SC 29707
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:
a
How will the well(s) be secured? Flush -mount well vault
6. Estimated beginning construction date: November 1, 2023
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: November 1, 2024
(add answers from 2 and 3)
ADDITIONAL INFORMATION
1. 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 assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Sathya Yalvigi °ig°ailyaign G.,Sa M1ya Vaivigl
DN. c SatM1ya Va gi, -US, o= CM1emours Company, ou=Corporate
Remediatio1 Group, email-SatM1ya v [e-mail]
2.21:54-f15'Ofl'
Signature of Applicant or *AgentDa1e 2
Sathya Valvigi
Printed name of Applicant or *Agent
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
well(s) as outlined in this Well Construction Permit application and acknowledges that it shall be the responsibility of the Applicant to
ensure that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C.
Signature of Property Owner (if different than Applicant)
NCDOT (See Attached Encroachment Agreement for Signature)
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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22M/R (Rev. 5-26-2022)

From: Bass, Michael L
To: Savannah Volkoff
Cc: Cherilvn Mertes; Michael Schott; Hammers, Angela K
Subject: RE: [External] Temporary Well Installation Requests & NCDOT Encroachment Applications (Brunswick County)
Date: Tuesday, December 5, 2023 10:11:56 AM
Attachments: imaae002.Dna
image003.jgg
Geosyntec Rea uestforTemDoraryWelI BrunwickCounty 20231120.Ddf
Encroachment Agreement Standard Conditions Updated July 2023.pdf
CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize
the sender and know the content is safe. If you have any suspicion, please confirm with the sender verbally that this email is
authentic. If you suspect fraud, click Thish Alert Report."
Savannah,
This email serves as an approval for one (1) Temporary Monitoring Well to be placed within NCDOT Right of
Way in Brunswick County. One Temporary Well will be placed on SR 1340 (Camp Branch Road NW). This well
will be abandoned within 4-6 weeks after installation. Please follow all attached Standard Conditions that
apply. If working within 5 ft of the edge of pavement, follow all MUTCD standards and traffic control that
apply. Please contact me at your convenience to set up a preconstruction meeting. Note that the applicant is
responsible for field verifying the placement of these Temporary Monitoring Wells prior to holding a
preconstruction meeting.
Thank you,
Michael L. Bass, Jr.
Assistant District Engineer
Division of Highways I Division 3 1 District 3
North Carolina Department of Transportation
910 398 9100 office
mlbass(a ncdot.gov
5911 Oleander Drive, Suite 101
Wilmington, NC 28403
0
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Savannah Volkoff <[e-mail]>
Sent: Tuesday, December 5, 2023 9:12 AM
To: Bass, Michael L <[e-mail]>
Cc: Cherilyn Mertes <[e-mail]>; Michael Schott <[e-mail]>; Hammers,
Angela K <[e-mail]>
Subject: RE: [External] Temporary Well Installation Requests & NCDOT Encroachment Applications

Geosyntec
consultants
Geosyntec Consultants of NC, PC
Mr. Benjamin Hughes, PE
District Engineer
NCDOT
5911 Oleander Drive, Suite 101
Wilmington, NC 28403
Geosyntec Consultants of NC, PC
2501 Blue Ridge Road, Suite 430
Raleigh, North Carolina 27607
PH 919.870.0576
FAX [phone]
www.geosyntee.com
November 20, 2023
Subject: Request for Temporary Environmental Groundwater Monitoring Well
Installation in Brunswick County
Dear Mr. Hughes,
On behalf of our client, The Chemours Company FC, LLC, (Chemours), Geosyntec Consultants
of NC, P.C. (Geosyntec) has prepared this request for installing a temporary environmental
groundwater monitoring well in Brunswick County. Installation of the environmental groundwater
monitoring well along with soil and groundwater sampling is proposed, as directed by the North
Carolina Department of Environmental Quality (NCDEQ). Specifically, Chemours is requesting
to install a temporary monitoring well at the following approximate location listed below and
shown in Figure 1 of Attachment 1. The location shown on the figure may be moved up to 10 feet
in either direction of the proposed coordinates during drilling to accommodate conflicts with
access issues with the drill rig.
Brunswick County
• Figure 1 — 1 temporary well, Camp Branch Rd NW, Ash, NC 28420
The proposed temporary monitoring wells will be installed by a North Carolina -licensed well
contractor under the direction of Geosyntec. Wells will generally be constructed as shown in the
schematics and plans in Attachment 2 and in accordance with applicable well construction
regulations. The final well locations depend on the presence of existing utilities and other possible
obstacles to the safety of drilling activities and field crew members. Temporary monitoring wells
will be abandoned in accordance with well abandonment regulations, following sampling and
receipt of data. Wells are anticipated to be abandoned within 4-6 weeks of installation.
Your cooperation in this matter is appreciated. Please contact me at [phone] or
mschottggeosyntec.com if you need any additional information or have any questions.
Sincerely,
Michael Schott, PE, PMP
Attachments
Attachment 1 Proposed Well Installation Locations (Figure 1)
Attachment 2 Plans & Details

Attachment 1
Proposed Well
Installation Location
(Figure 1)

1.5 mi. to
Swamp Rd
-78.372161, 34.164359
-5 ft from edge of pavement
4,700 ft. to
Tram Rd
(SR 1326)
Legend
$ Proposed Well Location
= Tax Parcel Boundary
Notes:
1. Investigative locations are approximate and may be adjusted based on
accessibility and on decision authority of Geosyntec field personnel.
2. County Boundaries were downloaded from OneMap site
(https://www.nconemap.gov).
3. The well location may be adjusted slightly due to conflicts with
existing utilities and / or access issues with the drill rig.
4. Basemap provided by the ESRI community 2023.
5. Brunswick County.
100 50 0 100 Feet
Proposed B-05 Sampling Location
GeosyntecO Geosyntec Consultants ofNC, P.C. Figure
consultants NC License No.: C 3500 and C 295
Raleigh, North Carolina I November 2023

Attachment 2
Plans & Details

skENVM.e ENTA. PROTKTOH
ow
man
TYPICAL
FLUSH -MOUNT GROUNDWATER MONITORING WELL
CONSTRUCTION DIAGRAM
BOLTED MANHOLE COVER
CONCRETE PAA
MANHOLESLEEVE
LOCKING WELL CAP
2" SCH EDUL E 40 PVC PIPE
BENTONME GROUT
BENTONITE SEAL
TYPE
SAND PACK
GRAIN SIZE
T SLOTTED SCHEDULE
aU PVC SCREEN
BOTTOM GAP
BOTTOM OF BO RIN G
ANNULUS
Figure 1: Typical Well Construction

Figure 2: Typical Appearance of a Completed Well at Grade