WM0401497_Application_20231211

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.
FOR OFFICE USE ONLY
1. Date: December 7, 2023
2. County: Guilford PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Huffman Oil Company Telephone: [phone]
Applicant's Mailing Address: P.O. Box 730 Burlington, NC 27216-0730
Applicant's Email Address(if available): sbarnwell(o)huffmanoil.net
5. Contact Person (if different than Applicant): Wayne Watterson (S&ME) Telephone: [phone]
Contact Person's Mailing Address: 8646 West Market Street, Suite 105 Greensboro, NC 27409
Contact Person's Email Address (if available): wwatterson(@smeinc.com
6. Property Owner(if different than Applicant): NC Department of Transportation Telephone: [phone]
Property Owner's Mailing Address: P.O. Box 14996, Greensboro, NC 27415
Property Owner's Email Address (if available): ewilson(a)ncdot.gov
7. Property Physical Address(Including PIN Number) ROW; north side of SR 2519 (intersection of Benaja Rd/Old Reidsville Rd.
City Browns Summit County Guilford Zip Code 27214
8. Reason for Well(s): groundwater contamination/assessment
(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: UST
(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).
Incident No. 44936
11. Type of contaminants being monitored or recovered: petroleum (ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? 13 (on other parcels)
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0401255, WM0401256, WM0401270,WM0401494
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): Approximately 230 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): Approximately 150, 250,290,460 feet
15. Well Contractor: Innovative Environmental Technologies, Inc. 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(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? Locked
material: 1 expandable cap within bold-down cover
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: December
2023
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3) 7. Estimated construction completion date: January 2024
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 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,
apter 2C)and accepts full responsibility for compliance with these rules
_ 1;o CL Senior Engineer/Agent for Huffman Oil Co.
Sil Title of Applicant or*Agent
Wayne Watterson *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 AMENDMENT OF ENCROACHMENT AGREEMENT NC Department of Transportation
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 Phone: [phone] Winston-Salem Regional Office
2090 U.S. Highway 70 Fax: [phone] 450 W. Hanes Mill Road
Swannanoa, NC 28778 Suite 300
Phone: [phone] Washington Regional Office Winston-Salem, NC 27105
Fax: [phone] 943 Washington Square Mall Phone: [phone]
Washington, NC 27889 Fax: [phone]
Fayetteville Regional Office Phone: [phone]
225 Green Street, Suite 714 Fax: [phone]
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
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Mooresville, NC 28115 JL r al ®�
Phone: [phone]
Fax: [phone] '
J • I� _ r le
,F lls C ��~✓�r1 GW-22MR Rev. 3-1-2016
Wilmington Regional Office Will n9ton GW-22M(Rev.5/11)
127 Cardinal Drive Extension ,
Wilmington, NC 28405
Raleigh Regional Office Phone: [phone] GW-22MR(6/11)
3800 Barrett Drive Fax: [phone]
Raleigh, NC 27609

' STAiE,y
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER J.R."JOEY"HoPKINS
GOVERNOR SECRETARY
December 6, 2023
Guilford County
Subject: Amendment of Encroachment Agreement: Huffman Oil Company—Installation
of Two(2)Ground Monitoring Wells on the north side of SR 2510 for
environmental assessment at 8007 Benaja Road(Huffman Oil Company),
EA200416(E072-041-19-00406)—District Tracking#7338
Mr. James A. Bromwell,Jr.,President
Huffman Oil Company
P.O. Box 730
Burlington,NC 27216-0730
Dear Mr. Bromwell:
This office has received and approves the change for this encroachment to include two(2)new
Monitoring Wells(MW-6 and MW-13)with the original approved Wells(MW-9& MW-10)
subject to the following comments:
1. The Special Provisions from the original Encroachment Agreement shall still apply.
2. Notify Mr.James Marley with the Greensboro District Office(jimarleyna.ncdot.gov)of
the schedule to install the Monitoring Wells.
With this approval, this letter and attached plan shall be amended to the original agreement.
If you have any questions, please contact Mr. W. E. Wilson, Senior Assistant District Engineer
with this office(ewilson ,nedot.gov).
Sincerely,
W. R. Archer,III,P.E.
Division Engineer
WRA/wew
attachment
Cc: Bobby Norris, P.E., Division Engineer w/attachment
jt'IailingAddress: Telephone:[phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax:[phone] 1584 YANCEYVILLE STRF,FT
DNISION OF HIGHWAYS Customer Service: I-877-3684968 GREENSBORO,NC 27405
P.O.BOX 14996
GREENSBORO,NC 27415-4996
Website:www.ncdot.gov

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E SOURCE:2014 AERIAL PHOTOGRAPH AND 2016 PARCEL DATA OBTAINED FROM NC ONEMAR
LEGEND
6 - MONITORING WELL
° • - PROPOSED MONITORING WELL LOCATION
d - WATER SUPPLY WELL 0 1 I 200
- TEMPORARY MONITORING WELL
Co - HAND AUGER LOCATION GRAPHIC SCALE (IN FEET)
6
m
MONITORING WELL LOCATIONS SCALE: FIGURE NO
Incident No. 44936 AS SHOWN
® DATE:
I MONTICELLO OIL SITE SEPT. 2023 3
8007 BENAJA ROAD PROJECT NUMBER
BROWNS SUMMIT, NORTH CAROLINA 4358-17-031

WELL CONSTRUCTION
Well ID Project Name Pro J ect Number
MW-13 44936-Monticello Oil Company 4358-17-031
S&ME Staff Installation Date County City Well Permit Number
L. Butler - Guilford Browns Summit Application
Drilling Contractor License Number Drill Rig Well Type/Use
- Flush Monitor Well
Water Level at TOB (0.01 ft- BTOC) Date/Time Northing(0.1 ft) Land Surface Elev. (0.01 ft) Drilling Method
- - - Hollow Stem Auger
Depth to Water(0.01 ft- BTOC) Date/Time Easting (0.1 ft) Total Well Depth (0.1 ft-bgs) Borehole Diameter(1 in)
- - - 35.1 8.25-inch
Pad Type
2'x 2' Concrete
Protective Casing
Flush Vault(8"diam)
TOC Relative to Ground 0.0 ft Casing Material
Depth Below Ground Surface(ft-bgs 2-in Sch 40 PVC
Casing Interval (0.1 ft-bgs)
0.0 to 20.0
Screen Type
2-in Sch 40 PVC(0.010)
Screen Interval (0.1 ft-bgs)
20.0 1 to 1 35.0
Top of Seal- 3.0 0.1 ft-bgs /%%/% O%%%%%i Grout Type
Portland Cement T2
Top of Filter Pack- 18.0 0.1 ft-bgs Grout Interval (0.1 ft-bgs)
0.0 to 3.0
Top of Screen- 20.0 0.1 ft-bgs Seal Type
3/8 in. Holeplug®
Seal Interval (0.1 ft-bgs)
3.0 to 18.0
Screened Interval- 15.0 0.1 ft-bgs Filter Pack
#2 Silica Sand
Filter Pack Interval (0.1 ft-bgs)
18.0 toT 35.0
Bottom of Screen- 35.0 0.1 ft-bgs - Development
Bottom of Filter Pack- 35.0 0.1 ft-bgs
Cave In- 0.1 ft-bgs Development Volume (gal)
Total Boring Depth- 35.0 0.1 ft-bgs
Notes: BTOC-Below Top of Casing
TBD-To Be Determined
For lithologic information
see attached boring log
Form Revision Date: 9/1/17 2:10 PM

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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` SOURCE:2014 AERIAL PHOTOGRAPH AND 2016 PARCEL DATA OBTAINED FROM NC ONEMAP.
6 LEGEND
6 MONITORING WELL
o
Q PROPOSED MONITORING WELL LOCATION
v WATER SUPPLY WELL 0 100 200
v
TEMPORARY MONITORING WELL
Y O HAND AUGER LOCATION GRAPHIC SCALE (IN FEET)
a
MONITORING WELL LOCATIONS SCALE: FIGURE NO.
3
Incident No. 44936 AS SHOWN
III _� MONTICELLO OIL SITE SEPT. 2023
S 3
8007 BENAJA ROAD PROJECT NUMBER
BROWNS SUMMIT, NORTH CAROLINA 4358-17-031

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8017 Old RAjd3ville Rd
44
13
,8021 Benaja Rd / 8014 Old Reidsville R
8 1 (8900011458)
*8017 Benaja Rd \ "
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Monticello oil 8008 Old Reidsville Rd
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Benaja Rd �
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MW-13
8009 Benaja Rd
i7i (inactive)
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(8900001580) 7929 Old Reidsville Rd
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Former Monticello Oil Bulk Facility
M 7921 Old Reidsvill�R ^, y
(7924 Old Reidsville Rd)
19 Old Reidsville ' I'
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3 • Former McGee's Grocery 7I
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SOURCE:2014 AERIAL PHOTOGRAPH AND 2016 PARCEL DATA OBTAINED FROM NC ONEMAP.
o LEGEND
v ® - WATER SUPPLY WELL LOCATION WITH WELL IDENTIFICATION 0 300 600
A - SENSITIVE LAND USE FEATURES
L (8900005935)- CONTIGUOUS PROPERTY GRAPHIC SCALE (IN FEET)
a
3 WATER SUPPLY WELL LOCATIONS SCALE: FIGURE NO.
® Incident No. 44936 AS SDHOWN
E III �_ MONTICELLO OIL SITE SEPT. 2023 4
8007 BENAJA ROAD PROJECT NUMBER
BROWNS SUMMIT, NORTH CAROLINA 4358-17-031