WM0100591_Monitoring Well Construction Application_20241022

FOR OFFICE USE ONLY
PERMIT NO.ISSUED DATE
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: October 22, 2024
2. County: Caldwell
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Robert Barlowe (Petitioner for DSCA Site ID DC140002)Telephone: [phone]
Applicant’s Mailing Address: DWM DSCA Program (Attn: Ariana Rivera), 1646 Mail Service Center, Raleigh, NC 27699-1646
Applicant’s Email Address (if available): [e-mail]
5.Contact Person (if different than Applicant): Sam Moore/AECOM Telephone: [phone]
Contact Person’s Mailing Address: 6000 Fairview Rd, Ste 200, Charlotte, NC 28210
Contact Person’s Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Gerson Ramos Telephone: [phone]
Property Owner’s Mailing Address: 3198 Covington Way, Lenoir, NC 28645
Property Owner’s Email Address (if available):
7. Property Physical Address (Including PIN Number)313 Harper Ave (PIN 2759079435)
City Lenoir County Caldwell Zip Code 28645
8. Reason for Well(s): Environmental 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: Dry Cleaner
(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).
Unknown
11. Type of contaminants being monitored or recovered: Volatile Organic Compounds
(ex: organics, nutrients, heavy metals, etc.)
12. 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).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 60
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: Geologic Exploration Certification No.: A-3098
Well Contractor Address: 176 Commerce Blvd, Statesville, NC 28677
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
WM0100591 10/23/2024
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: 0
4.Total Number of wells to be constructed: 1
(add answers from 2 and 3)
5.How will the well(s) be secured? Locking Cap
6.Estimated beginning construction date: Dec 2024
7.Estimated construction completion date: Jan 2025
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.
On behalf of DSCA Petitioner for DSCA Site DC140002 Project Manager
Signature of Applicant or *Agent Title of Applicant or *Agent
Samuel T Moore on behalf of Petitioner of DSCA Site DC140002
* 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
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.
*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-22M/R (Rev.5-26-2022)
PROJECT NO:
DATE BEGAN:
DRILLER: Geologic Exploration, Inc.
GROUND SURFACE ELEVATION:
DRILLING METHOD:
CONTRACTOR:
BORING NO:
DATE FINISHED:
NORTH:
GWL DATE/TIME:
DRILL EQUIP:
PROJECT NAME:
FIELD ENGINEER:
EAST:
GWL DEPTH:
PR
O
F
I
L
E
US
C
S
DEPTH
(FT.)
REC
(FT.)DESCRIPTION WELL CONSTRUCTION
Co
l
o
r
-
T
e
c

(
p
p
m
)
AECOM LITHOLOGIC LOG / WELL CONSTRUCTION LOG
CHECKED BY:
DRILLING
METHOD
ELEV
(FT.)
SAMPLE
TYPE /
SAMPLE
NUMBER
FI
D

(
p
p
m
)
SHEET:
DR
A
W
N

B
Y
:
CH
E
C
K
E
D

B
Y
:
PR
O
J
E
C
T

N
O
:
0
-5
-10
-15
-20
0.0
-5.0
-10.0
-15.0
-20.0
60737981
TBD
4 1/4" ID HOLLOW STEM AUGER
Proposed MW
STM
RH
M

60
7
379
8
1
Proposed Monitoring Well Construction
Barlowe Laundry
325 Harper Ave
Lenoir, NC
DSCA Site ID#140002
Borehole will not be advanced
into consolidated rock.
Bolted
Manhole
Cover
Locking
Well Cap
Concrete
Well Pad
Steel Well
Vault
Cement
Bentonite
Slurry
Bentonite
Seal
Borehole
Diameter
8"
PVC Riser.
Well
Diameter
2"
#2 Filter
Sand
0.01"
Slotted
Well
Screen
#2 Filter
Sand
HA
HSA
Barlowe Laundry
S. Moore
AECOM
Ha
r
p
e
r

A
v
e
Palm
e
r

S
t

N
W
Pe
n
n
t
o
n

A
v
e

S
W
TMW-1 (08/01/22)
Acetone - 7.29 ug/L
Chloromethane - 0.407 J ug/L
MEK - 0.984 J ug/L
TMW-2 (08/01/22)
Acetone - 3.44 J ug/L
Chloromethane - 0.669 ug/L
TMW-3 (08/01/22)
PCE - 1.17 ug/L
cis-1,2-DCE - 0.326 J ug/L
Acetone - 9.87 ug/L
Chloromethane - 0.468 J ug/L
MEK - 1.28 J ug/L
TMW-4 (08/01/22)
Acetone - 9.87 ug/L
Carbon Disulfide - 0.246 J ug/L
Chloromethane - 0.468 J ug/L
4-Isopropyltoluene - 0.575 ug/L
TMW-5 (08/01/22)
PCE - 3.45 ug/L
TCE - 1.03 ug/L
cis-1,2-DCE - 1.79 ug/L
Vinyl Chloride - 0.214 J ug/L
Acetone - 24.2 ug/L
Chloromethane - 0.665 ug/L
4-Isopropyltoluene - 0.394 J ug/L
MEK - 4.22 J ug/L
MW-1
MW-2MW-3
MW-4
SW/PW-1
SW/PW-2
SW/PW-3
SW/PW-4
SW/PW-5
SW/PW-6
*Historical data gathered from Phase II ESA
performed by Geological Resources, Inc. (GRI),
dated August 15, 2022.
LEGEND
Estimate ValueJ
Temporary Monitoring Well Location
Proposed Monitoring Well Location
Red highlighted text indicates concentrations
above 2L Standards.
micrograms per literug/L
PCE - Tetrachloroethylene
TCE - Trichloroethylene
cis-1,2-DCE - cis-1,2-Dichloroethylene
MEK - Methyl Ethyl Ketone
DC140002 - Barlowe Laundry
Petitioned Property Boundary
Parcel Lines
Intermittent Stream
Surface Water Sample Location
Pore Water Sample Location
APPROX. SCALE, ft.
0
Figure 5SHEET:
DR
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:
60
ST
M

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7
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0
9
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2
0
2
4
RH
M

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60
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2
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2
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7
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3
3
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