WM0100517_Monitoring Well Construction Application_20220627

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 there to,
application is hereby made for a permit to construct monitoring or recovery wells.

1. Date: 06/27/2022

2. County: Buncombe

3. What type of well are you applying for? (monitoring or recovery): monitoring - temporary

4. Applicant: Hawthorne Residential Partners, LLC (Philip M. Payonk) Telephone: [phone]

Applicant’s Mailing Address: 806 Green Valley Road, Suite 311, Greensboro, NC 27408

Applicant’s Email Address (if available): [e-mail]

5. Contact Person (if different than Applicant): Kelsey Cahill Telephone: [phone]

Contact Person’s Mailing Address: 130 Oval Road, Suite 200, Arden, NC 28704

Contact Person’s Email Address (if available): [e-mail]

6. Property Owner (if different than Applicant): Doug Thrash Telephone: [phone]

Property Owner’s Mailing Address: 94 Gaston Mountain Road, Asheville, NC 28806

Property Owner’s Email Address (if available):

7. Property Physical Address (Including PIN Number) Morris Road and Case Road, portion of PIN 962633214700000
City Asheville County Buncombe Zip Code 28806

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: agricultural field
(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).

No

11. Type of contaminants being monitored or recovered: VOCs, SVOCs
(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).: No

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 600 - 700 feet

14. Are there any water supply wells located less than 500 feet from the proposed well(s)? yes

If yes, give distance(s): 325 – 375 feet

15. Well Contractor: Environmental Drilling & Probing Services, LLC Certification No.:

Well Contractor Address: 17538 Greenhill Road, Charlotte, NC 28278 3307-A

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
DocuSign Envelope ID: B7141174-3CDB-4E1F-83E2-A98A11766022

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)

2. Number of wells to be constructed in unconsolidated
material: 3

3. Number of wells to be constructed in bedrock: 0

4. Total Number of wells to be constructed: 3
(add answers from 2 and 3)
5. How will the well(s) be secured? Locked
expansion plug

6. Estimated beginning construction date: 07/11/2022

7. Estimated construction completion date: 07/11/2022

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,
Subchapter 2C) and accepts full responsibility for compliance with these rules

Prospective Site Purchaser
Signature of Applicant or *Agent Title of Applicant or *Agent

Mr. Philip M. Payonk of Hawthorne Residential Partnters, LLC * 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 co nstruct
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).

Mr. Doug Thrash
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-22MR Rev. 3-1-2016
DocuSign Envelope ID: B7141174-3CDB-4E1F-83E2-A98A11766022
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TW-1
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TW-3
SGI-1
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FIGURE NO.
1Drawing Path: X:\GIS\Asheville Projects\Morris Road, Asheville\Sampling Map1.mxd plotted by kelsey.cahill 06-22-2022REFERENCE:2019 AERIAL IMAGE FROM NCONEMAP.GOVWATER SUPPLY WELL LOCATIONS ESTIMATED FROM ANCHOR QEA FIGURE XPROVIDED IN AN EMAIL TO NCDEQ DATED 08/15/2017
LIMITED SOIL GAS AND GROUNDWATER ASSESSMENTMORRIS ROAD, ASHEVILLEBUNCOMBE COUNTY, NORTH CAROLINA
PROPOSED SOIL GAS ANDGROUNDWATER SAMPLE POINTS
!
0 300 600
(IN FEET)
LEGEND
@ AMonitoring Well
@ ASoil Gas Implant
¨#Water Supply We ll
500-foot Buffer
Site
1 " = 300 'DATE:
SCALE:
PROJECT NO.:
REVIEWED BY: DRL
J22-17860-03
6-22-22
APPROVED BY: DRL
PREPARED BY: KLC
Morris Roa d
Case Road
Brevard Road(Hwy 19 1)
Forme r Tic ar Chemic al Co -Brownfields # 17041-13-011 Groundwater Plume Extends Southward and Southwestwa rd