WM0401516_Application_20240306

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: 2/16/2024
2. County: _Davidson PERMIT NO. ISSUED DATE
3. What type of well are you applying for?(monitoring or recovery): Monitoring
4. Applicant: Manninaton Mills, Inc. Telephone: [phone]
Applicant's Mailing Address: 75 Manninaton Mills Road.Salem NJ 08079
Applicant's Email Address(if available): dave.kittsftmannington com
5. Contact Person(if different than Applicant): Tom Dunham Telephone: [phone]
Contact Person's Mailing Address: SynTerra Coro 511-102 Keisler Dr.Cary,NC 27518
Contact Person's Email Address(if available): tdunhamP-synterrecorp.com
6. Property Owner(if different than Applicant): City of Lexington Telephone: [phone]
Contact Person: Johnnie Taylor, City Manaaer
Property Owner's Mailing Address: _ 28 West Center Street Lexington NC 27292
Property Owner's Email Address(if available): JFTsylorO-LexingtonNC gov and ZCMacKenzieC&LexingtonNC.gov
7. Property Physical Address(Including PIN Number):City night-of-way Zane Perkins Drive City right-of-way Domino Drive,
100 Bookington Drive(6724-01-48-0328) City Lexington County Davidson Zip Code 27292
8. Reason for Well(s): Groundwater 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; RCRA
(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).
Hazardous Waste Management Permit Permit No_NCD 986 181 451
11. Type of contaminants being monitored or recovered: Metals
(ex: organics, nutrients, heavy metals,etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes,how many? Yes_19
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): between 500 and 1,000 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: Geologic Exploration, Brian Thomas Certification No.: NCWC 2581-A
Well Contractor Address: 176 Commerce Blvd Statesville, NC 28625
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? ,Steel manhole
material: 3 with pad lock
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 3-18-2024
4. Total Number of wells to be constructed: 3 7. Estimated construction completion date: 3-22-2024
(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. 143-215.1013(5),landfills,or other waste disposal areas)within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant assumes total respo .sibility for ensuring that the well(s)will be located,constructed,maintained,and abandoned in
accordance with 15A NCAC 02C.
Ae—
Sig re of Applicant or*Ag Lfnf Title of Applicant or*Agent
' 1'J(0 ( 1 ` J *If signing as Agent attach authorization agreement stating
Prin name of Applicant or*Agent that you have the authority to act as the Agent.
If the properly 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.
City o e in n �^
B : i �z
ohnnie Taylor,City-, na_.er
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources'Regional Office:
Asheville Regional Office
2090 U.S. Highway 70 Raleigh Regional Office
Swannanoa,NC 28778 3800 Barrett Drive
Phone: [phone] Raleigh, NC 27609 Wilmington Regional Office
Fax: [phone] Phone: [phone] 127 Cardinal Drive Extension
Fax: [phone] Wilmington, NC 28405
Fayetteville Regional Office Phone: [phone]
225 Green Street,Suite 714 Washington Regional Office Fax: [phone]
Fayetteville, NC 28301-5094 943 Washington Square Mall
Phone: [phone] Washington, NC 27889 Winston-Salem Regional Office
Fax: [phone] Phone: [phone] 450 W.Hanes Mill Road
Fax: [phone] Suite 300
Mooresville Regional Office VlfinstOY�"'e—!th NC 27105
s ty;nttoo-soleth � 9800
610 East Center Avenue E _ I'he�
Mooresville,NC 28115 R K. �I atwsh Fax: 03%776-�Yy97
Phone: [phone]
Fax: [phone]
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OAr,r Q r, _ LEGEND
PROPERTY BOUNDARY
u SURFACE WATER FLOW DIRECTION
STREAM
STREAM THROUGH REINFORCED CONCRETE PIPE
Sandy
Grove NOTES:
1 ALL BOUNDARIES AND LOCATIONS ARE APPROXIMATE.
IIJSET SCALE:11N=30OFT
i PROPERTY BOUNDARY DERIVED FROM PRELIMINARY PLAT FOR THE FORMEk'
PORCELANITE FACILITY CREATED BY C.E.ROBERTSON&ASSOCIATES,P.C.ON
JANUARY 12,2022.
/ 4 STREAM DATA WITHIN INSET OBTAINED FROM CITY OF LEXINGTON ARCGIS PORTAL,
UPDATED JANUARY 23,2020.
5.TOPOGRAPHIC MAP PROVIDED BY ESRI,LAST UPDATED AUGUST 2021.
—` 6 AERIAL PHOTOGRAPHY OBTAINED FROM NORTH CAROLINA ONE MAP,COLLECTFI
FEBRUARY 3,2018.
_ 7.DRAWING HAS BEEN SET WITH A PROJECTION OF NORTH CAROLINA STATE PLAI ll
COORDINATE SYSTEM FIPS 3200(NAD83)
GRAPHIC SCALE
1,000 0 1,000 2,000
FIGURE 1
IIN FEET)
SITE TOPOGRAPHIC MAP
A. ` DRAWN BY C wvATT DATE oa/v/2022 FORMER PORCELANITE FACILITY
_ REVISED BY.C,WYATT DATE 06/09/2023
Terra CHECKED BYM FLINCHUM DATE 06/OW2023 LEXINGTON, NORTH CAROLINA
57yn
APPROVED T DUNHAM DOTE 06/09,r2023
PROJECT MANAGER
AGER T DUNHAM
www.synterracorp.com

i
IL
ane Perkins Drive
� R
Yz
LEGEND
5• Ibemarle Street ,
"� � PROPOSED MONITORING WELL
FORMER PORCELANITE FACILITY SITE BOUNDARY
NOTES:
r. *- 1.AERIAL PHOTOGRAPHY OBTAINED FROM NORTH CAROLINA ONE MAP,COLLECTED
• r MARCH 20,2022.
2.DRAWING HAS BEEN SET WITH A PROJECTION OF NORTH CAROLINA STATE PLANE
�. ✓ 1 �: COORDINATE SYSTEM RIPS 3200(NAD83).
200 0 200 400
il►
r^ GRAPHIC SCALE(IN FEET) PROPOSED MONITORING WELL
DRAWN BY:E.ORDEMANN DATE:01/08/2024 ZANE PERKINS DRIVE
REVISED BY:E.ORDEMANN DATE:01/08/2024 LEXINGTON, NORTH CAROLINA
synTerra CHECKED BY T.T.
MCROB RTS DATE:01/08/2024
APPROVED BY:T.MCROBERTS DATE:01/08/2024
PROJECT MANAGER:T.DUNHAM
www.synterracorp.com

al Domino Drive �4d
Ellington Avenue `
flo
16
do
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u MIt
I 4
71-
LEGEND
PROPOSED MONITORING WELL
FORMER PORCELANITE FACILITY SITE BOUNDARY
II
NOTES:
�- 1 AERIAL PHOTOGRAPHY OBTAINED FROM NORTH CAROLINA ONE MAP,COLLECTED
r• f �
1. MARCH 20,2022.
�! 2 DRAWING HAS BEEN SET WITH A PROJECTION OF NORTH CAROLINA STATE PLANE
r+� COORDINATE SYSTEM HIPS 3200(NAD83).
2DO 0 200 400
?T GRAPHIC SCALE IIN FEET) PROPOSED MONITORING WELL
DRAWN BY E.ORDEMANN DATE.O1/08/2024 DOMINO DRIVE
a,'.; �,,•' 'r'4, �, ^� REVISED BY*E.ORDEMANN DATE:01/08/2024 LEXINGTON, NORTH CAROLINA
' CHECKED BY:T.MCROBERTS DATE:01/8/2024
f 7 �
APPROVED BY:T.MCROBERTS DATE:01/08/2024
�TPY�,/`■ ■ �./1
PROJECT MANAGER:T.DUNHAM
A� , www.s nterracor .com

"1 y 1 • .•r 1�' ,1I _ fj� �t . Alm N
� Jessup Street �.� '".� � � �.. � °' _ w• '�s � �a ' �.;�..
� Brookington Drive ''� 'c��
t�`,• �- •'� Old Linwood Road � ��� � �• r � 1 ,• -_; .,'
r �
IL
die
y - ' LEGEND
PROPOSED MONITORING WELL
FORMER PORCELANITE FACILITY SITE BOUNDARY
NOTES:
r *- 1.AERIAL PHOTOGRAPHY OBTAINED FROM NORTH CAROLINA ONE MAP,COLLECTED
r MARCH 20,2022.
2.DRAWING HAS BEEN SET WITH A PROJECTION OF NORTH CAROLINA STATE PLANE
p ✓ ' �: COORDINATE SYSTEM RIPS 3200(NAD83).
200 0 200 400
il►
r^ GRAPHIC SCALE(IN FEET) PROPOSED MONITORING WELL
100 BROOKINGTON DRIVE
DRAWN BY:E.ORDEMANN DATE:01/08/2024
REVISED BY:E.ORDEMANN DATE:01/08/2024 LEXINGTON, NORTH CAROLINA
synTerra CHECKED BY T.T.
MCROB RTS DATE:01/08/2024
APPROVED BY:T.MCROBERTS DATE:01/08/2024
PROJECT MANAGER:T.DUNHAM
www.s nterracor .com

Locking Well Cap Protective Cover Flush
with Land Surface
Land Surface
3' Radius or 4' by 4' Concrete Pad
6" Borehole Diameter
(Nominal Dimension)
Cement Grout
2"Schedule 40 PVC Casing
w/Threaded Couplings
Approximate 2'
Bentonite Seal
v
c
0
fV
N
O
n3
> Well Sorted
Sand Pack
v v
♦� Water Table
10'Screened Interval v
0.010"Slotted Screen o
fV
2"Schedule 40 PVC
m
n3
Sump/Sediment Trap
Bottom Cap
Estimate Depth =40'
148 RIVER STREET,SUITE 220
GREENVILLE,SOUTH CAROLINA 29601
PHONE[phone] FIGURE 3
HTTP://W W W.SYNTERRACORP.COM
GENERALIZED MONITORING WELL SCHEMATIC
synTerra