GW1-2021-02416_Well Construction - GW1_20210615

` Form
WELL CONSTRUCTION RECO "').' (v,..,I For Internal Use Only: Print
1.Well Contractor Information:
BRIAN C BAUER 31JN 1 0 ZO21 14.WATER ZONES
Well Contractor Name Uf'VRO_
TO I DESCRIPTION
�rnCC&SICetJ.
4179-B �Fifvit�' t'Cn I so�t,OC1 10 ft 20 ft• BLACK SANDY CLAY
py'ut'�,�, ft &
NC Well Contractor Certification Number 15.OUTER CASING *r 7Iti-eased we'b OR LINER if a kame
MOUNTAIN ENVIRONMENTAL SERVICES, INC. FROM To DIAMETER THICIG�Ess MATERIAL
Company Name 0 ft- 10 fL 2 SCH40 PVC
16.INNER CASING OR TUBING therssul ebeM-bo
2.Well Construction Permit#:NA FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.) NA ft ft. in.
3.Well Use(check well use): ft & in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SITE THICKNESS MATERIAL.
Agricultural []Municipal/Public 10 fL 20 ft 2 in- 0.010 SCH40 PVC
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft ft ;n
Industrial/Commercial Residential Water Supply(shared) 13.GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft 2 ft. PORTLAND POUR
x Monitoring DRecovery & ft.
Injection Well:
fL fr.
Aquifer Recharge Groundwater Remediation
lf.SAND/GRAVEL PACK d '
Aquifer Storage and Recovery []Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test []Stormwater Drainage 5 It 20 ft- #2 SILICA SAND POUR
Experimental Technology []Subsidence Control It. ft
Geothermal(Closed Loop) []Tracer 20.DRELLING LOG sanchsd dweW sheets If
Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soillrach type,grain size,eta
0 ft 1 ft- GRAVELIFILL
4.Date Weu(s)Completed:5/10/2021 Wen IID# ASTMW-3 1 ft 20 ft. BLACK SANDY CLAY. STRONG
5a.Well Location: ft ft PETROLEUM ODOR.
NA ft f.
Facility/Owner Name Facility ID#(ifapplicable) ft ft.
EVERGREEN PACKAGING fL ft
Physical Address,City,and Zip fL ft
HAYWOOD 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL FROM 2-5'.WELL DEVELOPED BY PUMPING
APPROX.15 GALLONS.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Wong is sufficient) 22.Certification:
35.536839 N 82.84478 W
� aa64C4' 5/11/2021
6.Is(are)the well(s)E)Permanent or x[]Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: Yes or x[]No with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under#21 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 20 FEET ft
P ( ) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths+f different(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing: 10 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mad Service Center,Raleigh,NC 27699-1617
11.Borehole diameter:6 (in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a
above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: H construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c. For Water Supply&Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

Canton Office
evergreen.* 175 Main Street• Conlon, NC 28716
packaging
June 10, 2021
North Carolina Department of Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail service Center
Raleigh, NC 27699-1617
Subject: Evergreen Packaging, LLC
Monitoring Well Installation
Canton, Haywood County, North Carolina
To Whom It May Concern:
Evergreen Packaging, LLC is submitting three (3) monitoring well construction records. The wells were
installed on the property of Evergreen Packaging's mill at 175 Main Street, Canton, North Carolina 28716
to investigate the extent of light non-aqueous phase liquid (LNAPL) resulting from a formerly leaking
aboveground storage tank (AST) pipe. Each well was installed on May 10-11, 2021 by Mountain
Environmental Services, Inc. (NC Well Contractor Certification No. 4179-13). Monitoring well records,
along with locations,can be found attached.
If you have any questions or concerns, please reach out to me at [e-mail] or(828)
424-0101.
Sincerely,
Chuck Cranford
Environmental Manager—Waste and Water Programs
828.646.2028(Office)
828.424.0101(Mobile)
[e-mail]

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BASE MAP FROM USGS 7.5 MINUTE TOPOGRAPHIC QUADRANGLE SERIES. CANTON,NORTH CAROLINA 1980.
A 1 =2,000 o 2,000 4,000
jv 1:24,D00 FEET
PROJECT. EVERGREEN PACKAGING DRAWN BY: C.MCELROY
CANTON MILL CHECKED BY. R.SPRING
APPROVED BY: B.FEUERSTEIN
TRC 175 MAIN ST, CANTON, NORTH CAROLINA 28716
DATE: MAY 2021
TITLE: PROD.NO.: 434828
1429 Rock Qua"Road,Suite 116 SITE LOCATION MAP FILE: 434828-001.mxd
Raleigh,INC 27610
IRS.-(,V www.TRCcompanies.com FIGURE 2
\\employees\gis\GIS11-PROJECTS1Evergn±en_Packaging\CantonMOM34828.9990W34828-001.mzd-Saved By:CMCELROY on 512512021,15:36:00 PM

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