WM0100463_Application_20191108

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: November 8, 2019
2. County: Buncombe
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Whitehall Development Group Telephone: [phone]
Applicant's Mailing Address: 156 Spanish Point Drive, Beaufort, South Carolina 29902
Applicant's Email Address (if available): Sam Levin sam.levin234(@gmail.com
5. Contact Person (if different than Applicant): David Loftis, P.E. Telephone: [phone]
Contact Person's Mailing Address: 44 Buck Shoals Rd, C-3, Arden, NC 28704
Contact Person's Email Address (if available): dloftis(osmeinc.com
6. Property Owner (if different than Applicant): Silco24, LLC (Ms. Theresa Horn) Telephone: [phone]
Property Owner's Mailing Address: 1711 Highway 17 S, Unit 801, Surfside Beach, SC 29575-4422
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 48 Swannanoa River Road (PIN: 964871421300000)
City Asheville County North Carolina Zip Code 28805
8. Reason for Well(s): Limited groundwater assessment as part of due diligence to determine if lead has impacted the groundwater
(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: Commercial site
(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).
SHWS (EPAID NONCD0002038). Former Brownfields Site with Proiect ID 12020-08-011
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? No
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Unknown
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Not aware. Area serviced by city water.
If yes, give distance(s):
15. Well Contractor: To Be Determined Certification No.:
Well Contractor Address:
PROPOSED WELL CONSTRUCTION INFORMATION
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

xVELL CONSTRUCTION INFORMATION (Continued?
_. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured?
material: 5 __. _ _ Locked expansion piuo
3. Number of wells to be constructed in bedrock: 0 6. Estimated 'beginning construction date: 11/14119
4. 1 otal Number of wells to be constructed: 5 7. F-stimated construction completion date: 2
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
V1 "I1;c 1I ij FGIGIGiI(iea to a it ainimum or rwo ianamarks sucn as wenrinea roaas.
intersections. streams, or lakes within 500 feet of the proposed well or well system.
All existina wells. identified by type of use, within 500 feet of the proposed well or well system.
c. The proposed well or well system.
a. Anv test bonnos within bOu feet or or000sea weir or weir systerr-
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide. chemical or fue,'
storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feel
of the proposed wets or well systerr,
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 uoc
Subchapter 2C) and accepts full responsibility for compliance with these rules
Signature of Applicant or "Agent
Printed name of Applicant or 'Agent
Title of Applicant or -Agent
'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 construe,
wells as outlined i i Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s) nfo the Well Construction Standards (Title 15A of the_Ilorth Carolina Administra 've Code, Subchapter 2C).
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 {.jrtiC.e
Asheville Regional Office
3800 Barrett Drive
Wilmington, NC 2840
2090 U.S. Highway 70
Raleigh, NC 27609
Phone: [phone]
Swannanoa, NC 28778
Phone: [phone]
Fax: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone]
Winston-Salem Regional Office
Washington Regional Office
450 W. Hanes Mill Road
Fayetteville Regional Office
943 Washington Square Mall
Suite 30€)
225 Green Street, Suite 714
Washington. NC 289
Winston-Salem, NC 27105
Fayetteville, NC 28301-5094
Phone: [phone]
Phone: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone]
Fax: [phone]
Mooresville Reaional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
AR Rev. 3-1-2016
Raleigh Regional Office
GW-22M (Rev, 5/11)

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SCALE:
FIGURE NO.
VICINITY MAP
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DATE:
1
I I
I
FORMER SILVERMAN PROPERTY
8-9-19
48 SWANNANOA RIVER ROAD
PROJECT NUMBER
ASHEVILLE, BUNCOMBE COUNTY, NORTH CAROLINA
4341-19-014
/

COMPLETION REPORT OF WELL No. MW Sheet 1 of 1
PROJECT: Former Silverman Property
PROJECT NO: 4341-19-014 WATER LEVEL:
PROJECT LOCATION: Asheville, Buncombe Co., North Carolina
LATITUDE:
DRILLING CONTRACTOR: LONGITUDE:
DRILLING METHOD: 4 1/4 " H.S.A. TOP OF CASING ELEVATION:
DATE DRILLED:
DATUM: MSL
LOGGED BY:
STRATA
WELL
DETAILS
1
T
w
o
J
W
WELL CONSTRUCTION DETAILS
m
>-
w
W
p
o
5
10
15
20
0.00
GS
PROTECTIVE CASING
Diameter:
Type:
Interval:
RISER CASING
Diameter: 2-inch
Type: PVC
Interval: 0.25-5
GROUT
Type: Neat cement
I nterval: 0.5-3
SEAL
Type: Bentonite
I nterval: 3-4
FILTERPACK
Type: #2 Filter Pack
I nterval: 4-15
SCREEN
Diameter: 2-inch
Type: 0.010-inch
I nterval: 5-15
LEGEND
FILTER PACK
■ BENTONITE TOC TOP OF CASING
CEMENT GROUT GS GROUND SURFACE
BS BENTONITE SEAL
CUTTINGS / BACKFILL FP FILTER PACK
TSC TOP OF SCREEN
1 STATIC WATER LEVEL BSC BOTTOM OF SCREEN
TD TOTAL DEPTH
CG CEMENT GROUT
0.25
0.50
3.00
4.00
15.00
TOC
CG
BS
FP
TSC
TD
COMPLETION REPORT OF
WELL No. MW
Sheet 1 of 1