wm0100473_Application_20200630

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.
Date: June 29, 2020
2. County:
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FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery):
Applicant: Peak Hydrogeologic, PLLC c/o Jonathan Gerst, MS, PG Telephone: [phone]
Applicant's Mailing Address: 470 Hogback Mountain Road, Tryon, NC 28782
Applicant's Email Address (if available): 6gerst(a-)peakhydrogeologic.com
Contact Person (if different than Applicant):
Contact Person's Mailing Address:
Contact Person's Email Address (if available):
Telephone:
Property Owner (if different than Applicant): JH Enterprises LLC c/o John Heinitsh Telephone: [phone]
Property Owner's Mailing Address: 205 S Rice St, Brevard, NC 28712
Property Owner's Email Address (if available):
Property Physical Address (Including PIN Number) PIN 8522-32-8057-000; 15885 Rosman Hwy
City Lake Toxaway County Transylvania Zip Code 28747
Reason for Well(s): real estate due diligence investigation of soils and groundwater for presence of petro contamination
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: UST facility ID 00-0-0000030058, Lake Toxaway General Store
(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: TPH-DRO/GRO in soils and VOCs in groundwater
(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).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 5 to 15 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes
If yes, give distance(s): Two (2) private wells (-250-ft northwest and —95 east),
15. Well Contractor: W Walker Environmental Services LLC Certification No.: NC 4237 B
Well Contractor Address: P. O. Box 8446 COLUMBIA, SC, 29202
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
G. 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? Geonrobe 2" soil
material: 6 macrocores and then set 1" PVC to collect aroundwater
sam des from water table --30 ft b s then abandon wells
3. Number of wells to be constructed in bedrock: same day
4. Total Number of wells to be constructed: 6 6. Estimated beginning construction date: 718120
(add answers from 2 and 3)
7, Estimated construction completion date: 718120
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. 143-215.1013(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
President Principal Hydrogeolggist
Signature of Applicant or *Agent Title of Applicant or *Agent
Jonathan D. Gerst, MS. PG * 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 Cons ction Permit application and that it shall be the responsibility of the applicant to ensure that the
e I(s) form to th Wei nstmction S s (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
John Heinitsh
SignakH of Property Owfier Iff fferent than Applicant) Printed name of Property Owner (if different than Applicant)
E
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

GROUND SURFACE
VARIES
GROUNDWATER
ELEV: -30 FT BGS
SCREENED I
INTERVAL: >_5 FT >_5 FT
BOTTOM OF BORING
ELEV.: -40 FT BGS
GEOPROBE 2-INCH SOIL
MACROCORE ROD & LINER
1-INCH PVC FOR TEMPORARY WELL
IN -SITU SOIL
30REHOLE DIA. 2-INCH
TYPE OF SCREEN: 1-INCH PVC
NOTES:
1- GEOPROBE WILL ADVANCE 2-INCH DIAM. SOIL MACROCORE TO PROPOSED DEPTH OR REFUSAL.
2- REMOVE MACROCORE ROD FROM BOREHOLE, AND THEN PLACE 1-INCH DIAM. PVC SCREEN TO BOTTOM
OF BORING FOR STATIC WATER LEVEL GAUGING AND WATER TABLE SAMPLE COLLECTION.
3- SCREEN SOIL MACROCORES IN 1-FT INTERVALS (VISUAL, OLFACTORY, & PHOTO -IONIZATION DETECTOR)
TO IDENTIFY PRESENCE AND DEPTH OF PETROLEUM CONTAMINATION.
4- BORING TO BE PROPERLY ABANDONED IMMEDIATELY AFTER GROUNDWATER SAMPLE IS OBTAINED.
A116-
HYDRDGEOLOGIC
WELL SCHEMATIC
Limited Phase II Environmental Site Assessment
Lake Toxaway General Store
—15885 Rosman Highway
PEAK HYDROGEOLOGIC, PLLC (Transylvania County PIN 8522-32-8057-000)
Lake Toxaway, NC 28747
ENVIRONMENTAL & WATER
RESOURCES CONSULTING PROJ. NO.: 249-20 DRAWN BY: JDG FIGURE: 2
NOT TO SCALE
DATE: 06/29/2020

LEGEND
= subject property boundary
= topographic contour
O = 6x proposed soil & groundwater sample locations
O = 2x existing private wells
= underground storage tank locations
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Disclaimer: The information contained on this page is NOT to be construed or used as a survey Approx. Scale 1:654
or legal description. Map information is believed to be accurate but accuracy is not guaranteed.
0 55 ft 110 ft
SOURCE: Transylvania County, NC GIS (June 2020) SAMPLE LOCATION MAP
Limited Phase II Environmental Site Assessment
Lake Toxaway General Store
—15885 Rosman Highway
PEAK HYDROGEOLOGIC, PLLC (Transylvania County PIN 8522-32-8057-000)
Lake Toxaway, NC 28747
ENVIRONMENTAL & WATER
Ak,
RESOURCES CONSULTING PROJ. NO.: 249-20 DRAWN BY: JDG FIGURE: 1
HYDRDGEDLDGI SCALE: 1-in — 50-ft DATE: 06/29/2020