WM0100470_Application_20200605

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: 6/4/2020 FOR OFFICE USE ONLY
2. County: Haywood PERMIT NO. ISSUED DATE
3- What type of well are you applying for? (monitoring or recovery): Recovery
4. Applicant: Thom Morgan Kt��
Telephone: [phone]
Applican� s Mailing Address: 416 Stone Haven Drive
Applicant's Email Address (if available): -Th rrnor bellsautlulet f 1}V t;Qi •� ` ,
5. Contact Person (if different than Applicant): Chris Singleton
Telephone: [phone]
Contact Person's Mailing Address: PO Box 2012
Contact Person's Email Address (if available):
christa'�singleton environmental com
6. Property Owner (if different than Applicant): Southeast Real Property. LLC
Telephone:
Property Owner's Mailing Address: 1714 A C Skinner Parkway,Ste 290 Jacksonville FL 32256
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 131 Park Street — 8657-60-2189
City Canton County Haywood
8. Reason for Well(s): groundwater contamination Zip Code28716
(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: Former Bulk Storage Facility
(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).
Incident #89210
11 _ Type of contaminants being monitored or recovered: Petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Two 1 inch Piezometers and two 2-inch
monitoring wells
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): about 30 feet
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: Chris Singleton
Certification No.: 3328-B
Well Contractor Address: PO Box 604 Fletcher
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
C. Screen intervals f. Grout horizons
d. Sand/gravel pack intervals 9. Well head completion details
Continued on Reverse
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)

2. Number of wells to be constructed in unconsolidated
material: 4 5• How will the wells) be secured? Manway and lock
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 6/9/2020
4. Total Number of wells to be constructed: 4
(add answers from 2 and 3) 7• Estimated construction completion date:
6/10/2020
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 50.0 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 o struction 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 prop rty is owned by someone other than the applicant, the property owner hereby consents to allow the applicant to construct
wells as tli ed in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
Aofro
o to e Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C)p�-ot�,
Signarty w r (if different than Applicant) r L g- sow- � _ v Ut �,
PP ) Printed na of 1-1 opaRy Owner (if different t n Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources Regional Office
Asheville Regional Office Phone: [phone]
2090 U.S- Highway 70 Winston-5alem Regional Office
Swannanoa, NC 28778 Fax: [phone] W. Hanes Mill Road
Phone: [phone] Suite 300
Washington Regional Office Winston-Salem, NC 27105
Fax: [phone] Washington Square Mall
Phone: [phone]
Fayetteville Regional Office Washington, NC 27889 Fax: [phone]
Phone(252)
225 Green Street, Suite 714 : -81
Fayetteville, NC 28301-5094 Fax: [phone]
3716
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
-;—
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]�sFusa
�zt
GW-22MR Rev- 3-1-2016
Wilmington Regional Office
127 Cardinal Drive Extension \' 1 Wipe n^gto^
GW-22M (Rev. 5111)
Raleigh Regional Office
Wilmington, NC 28405 _
3800 Barrett Drive
Phone: [phone]
Fax: [phone]
GW 22MR (6/11)
Raleigh, NC 27609

Source: USA Topo Maps was obtained from ESRI Basemap. Back Drop to Project Boundary
represents 7.5 Minute Quadrangle sheet for Canton, North Carolina.
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v nary o/sources and is sublet( to change without notice. accuracy, lder makes no �• �.+' .,' '• )
rep esematlons or Wamanfies express or implied, as to accuracy, complel-ass -
ffineliness, or rights to the use of such mformauon. This document is not intended
for use as a land survey product nor is it designed or intended as a constmGron
design document. The use o misuse ofthe information contains o !h graphro
`- representation s at the le risk of the party using o misusing the ! rmalion el„, RQ•` l �%,- . ' •'i fl�� ( •. t
PROJECT NO. 20170275.001A FIGURE
DRAWN: 6/1/2016 Project Location Map
y" \
KL E/NFEL DER DRAWN BY: JP
Bright People. Right Solutions. CHECKED BY: RCB
131 Park Street
y r FILE NAME: 16-0601--131 Canton, Haywood Coun N
www.kleinfelder.com ParkSt Phase2-Location.mxd ty, orth Carolina

PROJECT NUMBER BORING NUMBER
SEI-736 I MW-3 SHEET 1 OF 1
SOIL BORING LOG
PROJECT: MES-Canton Bulk Plant LOCATION: Canton, NC
ELEVATION: N/A DRILLING CONTRACTOR Singleton Environmental, Inc.
DRILLING METHOD AND EQUIPMENT USED: Hollow Stem Auger
WATER LEVEL: 13 DATF- I nrr_FR - rti.,� c;., i--
DEPTH BELOW
SURFACE (FT)
STANDARD
DESCRIPTION
COMMENTS
INTERVAL
(FT)
PENETRATION
RECOVERY IN
TEST
SOIL NAME, USCS GROUP SYMBOL, COLOR,
DEPTH OF CASING, DRILLING RATE,
RESULTS
MOISTURE CONTENT, RELATIVE DENSITY,
DRILLING FLUID LOSS,
6"-6"-6"-6"
rPE
OR CONSISTENCY, SOIL STRUCTURE,
TESTS, AND INSTRUMENTATION.
N
MINERALOGY.
_
0.0 to 1.0 feet: Concrete and gravel
Concrete 0-3 Casing 0-5 ft.
1.0 to 17.0 feet: Brown Sandy silt
_
I
Bent 3-4 ft. _
5 —
_
Sand 4-20 ft. _
_
Screen 5-20 ft
10
GW @ 13 feet
GW
15
17 to 20 feet: River Alluvium
20
_
Well set @ 20 feet
25
—
—
30
35
40
—
—
MW-3 Boring Log

PROJECT NUMBER BORING NUMBER
SEI-1068 I MW-4 SHEET 1 OF 1
SOIL BORING LOG
PROJECT: MES-Canton Bulk Plant LOCATION: Canton, NC
ELEVATION: N/A DRILLING CONTRACTOR Singleton Environmental, Inc.
DRILLING METHOD AND EQUIPMENT USED: Hollow Stem Auger
WATER LEVEL: 13 nATF nr_r_�o • rr " c; i .
DEPTH BELOW
SURFACE (FT)
STANDARD
DESCRIPTION
COMMENTS
INTERVAL
(FT)
PENETRATION
RECOVERY IN
TEST
SOIL NAME, USCS GROUP SYMBOL, COLOR,
DEPTH OF CASING, DRILLING RATE,
RESULTS
MOISTURE CONTENT, RELATIVE DENSITY,
DRILLING FLUID LOSS,
6"-6"-6"-6"
rYPE
OR CONSISTENCY, SOIL STRUCTURE,
TESTS, AND INSTRUMENTATION.
N
MINERALOGY.
_
0.0 to 1.0 feet: Concrete and gravel
Concrete 0-3 Casing 0-5 ft. _
1.0 to 17.0 feet: Brown Sandy silt _
_
I
—
_
Bent 3-4 ft.
5 —
_
_
Sand 4-20 ft. _
—
Screen 5-20 ft
10
GW @ 13 feet
GW
15
17 to 20 feet: River Alluvium
20
Well set @ 20 feet
25
30
35
40
MW-4 Boring Log

PROJECT NUMBER BORING NUMBER
SEI-1068 I MW-5 SHEET 1 OF 1
SOIL BORING LOG
PROJECT: MES-Canton Bulk Plant LOCATION: Canton NC
ELEVATION: N/A DRILLING CONTRACTOR Singleton Environmental, Inc. _
DRILLING METHOD AND EQUIPMENT USED: Hollow Stem Auger
WATER LEVEL: 13 DATF
DEPTH BELOW
SURFACE (FT)
STANDARD
DESCRIPTION
COMMENTS
INTERVAL
(FT)
PENETRATION
RECOVERY IN
TEST
SOIL NAME, USCS GROUP SYMBOL, COLOR,
DEPTH OF CASING, DRILLING RATE,
tNTYPE
RESULTS
MOISTURE CONTENT, RELATIVE DENSITY,
DRILLING FLUID LOSS,
6"-6"-6"-6"
OR CONSISTENCY, SOIL STRUCTURE,
TESTS, AND INSTRUMENTATION.
N
MINERALOGY.
_
0.0 to 1.0 feet: Concrete and gravel
Concrete 0-3 Casing 0-5 ft.
1.0 to 17.0 feet: Brown Sandy silt
_
I
—
_
Bent 3-4 ft.
5 —
_
_
Sand 4-20 ft. _
—
Screen 5-20 ft
10
GW @ 13 feet
GW
15
—
—
17 to 20 feet: River Alluvium
20
Well set @ 20 feet
_
25
30
35
40
MW-5 Boring Log

PROJECT NUMBER BORING NUMBER
SEI-1068 I MW-6 SHEET 1 OF 1
SOIL BORING LOG
PROJECT—:— MES-Canton Bulk Plant LOCATION: Canton, NC
ELEVATION : N/A DRILLING CONTRACTOR Singleton Environmental Inc.
DRILLING METHOD AND EQUIPMENT USED: Hollow Stem Auger
WATER LEVEL : 13 DATF, I nr_r_Fa - rh,i, 'Zm 1.1-
DEPTH BELOW
SURFACE (FT)
STANDARD
DESCRIPTION
COMMENTS
INTERVAL
(FT)
PENETRATION
RECOVERY IN
TEST
SOIL NAME, USCS GROUP SYMBOL, COLOR,
DEPTH OF CASING, DRILLING RATE,
tlrrYPE
RESULTS
MOISTURE CONTENT, RELATIVE DENSITY,
DRILLING FLUID LOSS,
6"-6"-6%6"
OR CONSISTENCY, SOIL STRUCTURE,
TESTS, AND INSTRUMENTATION.
N
MINERALOGY.
_
0.0 to 1.0 feet: Concrete and gravel
Concrete 0-3 Casing 0-5 ft. _
1.0 to 17.0 feet: Brown Sandy silt
_
I
Bent 3-4 ft. _
5 _
_
Sand 4-20 ft. _
_
Screen 5-20 ft
10
GW @ 13 feet
GW
15
17 to 20 feet: River Alluvium
20
Well set @ 20 feet
25
—
30
35
40
—
MW-6 Boring Log