WM0401373_Monitoring Well Permit Application_20220630

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: June 23, 2022
2. County: Watauga
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant: Pinnacle Storage of Boone, LLC
Applicant's Mailing Address: 324 Greenville Avenue, Wilmington
Applicant's Email Address (if available):
5. Contact Person (if different than Applicant): Dan Matz
Temporary Monitoring Well
Telephone: [phone]
Telephone: [phone]
Contact Person's Mailing Address: 6004 Ponders Court, Greenville, South Carolina 29615
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): Sky Country , LLC Telephone: NA
Property Owner's Mailing Address: 348 Bare Ridge Road, West Jefferson, NC
Property Owner's Email Address (if available): NA
7. Property Physical Address (Including PIN Number) Chestnut Drive and New Market BLVD, Boone, Watauga, NC
North Carolina - Watauga County Parcel 2910491025000, 2910481866000, and 2910492133000
City Boone County Watauga Zip Code 28607
8. Reason for Well(s): Groundwater Assessment, suspected contamination
(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: Surrounding drycleaners and automotive repair facilities
(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: Organics - Petroleum and solvents
(ex: organics, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? None known at this time
Existing Monitoring or Recovery Well Construction Permit No(s).: Not Applicable
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Adjoining
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: Landprobe Certification No.: John Gorman 3485-A
Well Contractor Address: 6004 Ponders Court, Greenville, SC 29615
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?
material: Three (3) Temporary Well
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 5-3-22
4. Total Number of wells to be constructed: Three (3) 7. Estimated construction completion date: 5-4-22
(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. 143-215.10B(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
Signature of Applicant or *Agent Title of Applicant or *Agent
* 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).
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)

T• Grout horizons
b. Estimated wefl cieptn
c. Screen intervals
d. Sand/gravel pack inte rvals
9-
Continued on Reverse
PROPOSED NELL CONSTRUCTION INFORMATION (Continued)
Number of wells to be constructed in unconsolidated
material: Three t3)
Number of wells to be constructed in bedrock: 0 6.
Total Number of wells to be constructed: ThreeJ3)
(add answers from 2 and 3)
Well head completion details
5. How will the weH(s) be secured?
Temporary Well
Estimated beginning construction date:
7. Estimated construction com ptetion date:
-y -
5-3-22
5-422
ADDITIONAL INFORMATION
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. AU existing wel!s, identified by type of use, within 500 feet of the propcsed weN 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. 14321 5. 1OB(5) landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
'he Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifations and conditions of
pis Well Construction Permit as regulated under the Well Constwction Standards (Title 15A of the North Carolina Administrative Gode,
ubchapter 2C) and accepts fuH responsibility for compliance with these rules
mmommo
Tinted name of Applicant or *Agent
ae 4(,)7
A
Qent
gent
Title of Applicanfor `g
If signing as Agent, attach authorization agreement stating
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 app!ication and that it steal! be the responsbitity 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).
.%
signature of Property Owner (if differen 1 an pplicant)
Of\
Printed name of Property Owner (if diffe e than Applicant)

1. As required by 15A NCAC 02C .010507), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter
b. Estimated well depth
c. Screen intervals
d_ Sand/gravel pack intervals
e
fr
9
Type of casmg material and thickness
Grout horizons
Well head completion details
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?
material: Three (3)
3, Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed' Three f3 j
..____
(add answers from 2 and 3)
Tern.ora Well
6. Estimated beginning construction date:
5-322
7. Estimated construction corWetion date: 5.4..fl
-r
ADDITIONAL INFORMATION
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. 143-215.1OB(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 ISA of the North Carolina Administrative Code,
ubchapter 2C) and accepts full responsibility for compliance with these rules
Signatu
cant or Agent
i•ede AV, A/.
Printed name of Applicant or *Agent
Title of AppUcanf[or 'Agent
* if signing as Agent. attach authorization agreement stating
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 aflow 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).
Signature of Property Owner (if differen
bzim‘i
an pplicant)
s.7:74r n eh Lm- E r
Printed name of Property Owrier (if diffe e than Applicant)
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DRAWN:
DRM
CHECKED:
DPO
APPROVED:
DPO
DATE:
1-7-22
Job No:
J22-15410-06
BUNNELL
LAMMONS
ENGINEERING
6004 Ponders Court, Greenville, SC 29615
Phone: [phone]
Proposed Groundwater Boring
Location Plan
Tract 1 and Tract 2
Chestnut Drive & New Market Blvd
Boone, North Carolina
FIGURE
3

1-INCH WELL DIAGRAM
NO CAP (TEMPORARY WELL)
GROUND SURFACE—\
NATIVE SOIL
1—INCH O.D. PVC RISER
1—INCH O.D. PVC SCREEN
2 TO 5 FEET LONG
(SLOT SIZE 0.010—INCH)
BOREHOLE DIAMETER 2 TO 3 INCHES
OPEN BOREHOLE
SAND TO APPROXIMATELY 2 FEET ABOVE SCREEN
NOTE:
HELL IS RETRACTED AFTER SAMPLING
AND BORING ABANDONED WITH
BENTONITE GROUT.
JOB NO.:
NA
DATE:
04-13-20
SCALE:
NOT TO SCALE
BUNNELL
� LAMMONS
ENGINEERING
6004 Ponders Court, Greenville, SC 29615
Phone: [phone] Fax: [phone]
TYPICAL 1—INCH WELL
DIAGRAM
FIGURE
1