WM0100293_Permit (Issuance)_20190802

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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.
FOR OFFICE USE ONLY
1. Date: 8/2/19
2. County: Ave Counly PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): monitoring well(nested hair)
4. Applicant: Newland Investments I. LLC Telephone. [phone]
Applicant's Mailing Address: _5320 Old Pineville Road, Charlotte, North Carolina 28217
Applicant's Email Address(if available): tommck*forsiteinc.com
5. Contact Person(if different than Applicant): Steve Hart Telephone: [phone]
Contact Person's Mailing Address: Hart&Hickman. PC.2923 S.Tryon Street, Suite 100, Charlotte, North Carolina 28203
Contact Person's Email Address(if available): [e-mail]
6. Property Owner(if different than Applicant): Marcye 011is Telephone:
Property Owner's Mailing Address: P.O. Box 296, Pineola. North Carolina 28662
Property Owner's Email Address(if available): [e-mail]
7. Property Physical Address(Including PIN Number) 1276 Newland Highway(PIN 183502890078)
City Newland County Avery County Zip Code 28657
8. Reason for Weil(s): environmental 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: residential property adjacent to the former Newland Pesticides 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).
Newland Pesticides IHSB NONCDO002802
11. Type of contaminants being monitored or recovered: pesticides
(ex: organics, nutrients, heavy metals,etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? 5 monitoring wells
Existing Monitoring or Recovery Well Construction Permit No(s).: unknown
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): approximately 150 ft
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? yes
If yes, give distance(s): approximately 250 It
15. Well Contractor: SAEDACCO Certification No.: 3576
Well Contractor Address: 9088 Northfield Drive, Fort Mill. SC 29707
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? Locking cap at
material: 0 TOC and secured man-hole set in concrete pad
3. Number of wells to be constructed in bedrock: 2 6. Estimated beginning construction date: 9/02/19
4. Total Number of wells to be constructed: 2 7. Estimated construction completion date: 9/5/19
(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,
S bcha ter 2C)and accepts full responsibility for compliance with these rules
S141'_ c P �c e,I L Ha,e: R- 14,-bra,,,j f r-
Signature of Applican or ge Title of Applicant or"Agent
S_-eVz4lt �. 04 t- u,t !f signing as Agent, attach authorization agreement stating
Printed name of Applicant or'Agent }^n��sa�rm�dY 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).
Sig6atLV,e of Pbroperly Owner(if different than Applicant) Printed naole 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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
Fayetteville Regional Office Washington Regional Office Winston-Salem Regional Office
225 Green Street,Suite 714 943 Washington Square Mall 450 W. Hanes Mill Road
Fayetteville, NC 28301-5094 Washington, NC 27889 Suite 300
Phone: [phone] Phone: [phone] Winston-Salem, NC 27105
Fax: [phone] Fax: [phone] Phone: [phone]
Fax: [phone]
Mooresville Regional Office —
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
� ife
�tO" GW-22MR Rev. 3-1-2016

SITE ACCESS AGREEMENT
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This SITE ACCESS AGREEMENT ("Agreement") is entered into by :• mo��r. .a,, twi>
f"Owner")and Hart& Hickman, P.C. ("Contractor").
WHEREAS, Owner owns the property described as follows, (the"Property").
Address: 1276 Newland Highway,Newland,Avery County. North Carolina
Avery County Parcel Identification No. 183502890078
WHEREAS, Contractor wishes to conduct certain environmental assessment activities relating to
the Property including installation of a groundwater monitoring well pair for collection of
groundwater samples and continued monitoring of water quality by collecting samples from the
water supply well located on the Property; and
WHEREAS, Contractor needs permission of Owner to enter onto the Property in order to
conduct certain assessment activities as briefly described below.
The Contractor requests access to enter onto the Property to install a groundwater monitoring
well pair in a grassy area in the eastern portion of the Property. The monitoring well installation
activities will include advancing two soil borings using a track-mounted drill rig. The
monitoring wells will be installed next to one another. One well will be installed to a depth of
approximately 50 ft below ground surface, and the other will be installed to a depth of
approximately 100 ft below ground surface. Each well will be completed in an approximately 2 ft
by 2 ft concrete pad flush to the ground surface which will allow a mower to cross over the wells.
During drilling, mats will be placed on the ground to minimize potential for damage to the
Property. After the drilling, the Property will be returned as close as possible to pre-drilling
conditions. Drill cuttings and water from the wells will be containerized and removed from the
Property upon completion of the drilling activities.
After installing the well pair, the Contractor requests access to enter the Property periodically to
conduct monitoring and sampling of the well pair. The Contractor also seeks continued
permission to access the Property to collect samples from your drinking water well. To sample
the well, the Contractor will need to obtain water samples from a location as close to the
wellhead as possible. It is anticipated that such access will be needed no more frequently than
semi-annually.
NOW, THEREFORE, Contractor and Owner agree as follows:
I. Owner hereby grants Contractor its employees, agents, contractors, and subcontractors
(collectively referred to hereinafter as "Contractor Parties") permission to enter upon
Owner's Property, as necessary, to perform the assessment activities.
I

2. Applicable public, private, and employee/agent safety considerations and other
governmental compliance measures related to performance of the assessment activities,
where applicable, will be the responsibility of the Contractor Parties. Owner shall notify
Contractor of any Property-specific safety conditions that it may be aware of
3. Contractor Parties will provide a minimum of a three (3) days advance notice to Owner
or its designee prior to entering the Property for the assessment activities, unless a lesser
time is allowed by the Owner.
4. Within a reasonable time after the assessment activities are completed, Contractor Parties
will restore the Property as close as possible to conditions that existed prior to the
performance of the assessment activities.
5. This Agreement shall become effective on the date of execution by the last executing
party.
6. Contractor warrants that it and its subcontractor have insurance including Commercial
General Liability, Worker's Compensation, and Automobile insurance. Insurance
certificates will be provided upon request by the Owner.
7. Owner warrants that its signatory hereto has full right and authority to execute this
Agreement on behalf of Owner and that this Agreement is a valid and binding obligation
of Owner, subject to its terms.
IN WITNESS WHEREOF, the parties have affixed their signatures as of the dates written below.
OWNER
A04US4 By: Joer XL�.
DATE
Print Name�.rtu eS 0111s_
Preferred Contact Information:
(921r.&a(A - VA0- (ph)
mc�rul � btfSoli.ne# (email)
HART & HI K AN, PC
H �^
�v l ` jy` By:
DATE
Print Name: 15+ey"
2

Via Email
August 19, 2019
North Carolina Department of Environmental Quality
Division of Water Resources
217 W.Jones Street
Raleigh,North Carolina 27603
Re: Monitoring ell Permit Application—Agent Authorization
Newland Pesticides
1339 Newland Highway
Newland,NC
IHSB No.NONCD0002802
To Whom it May Concern:
Newland Investments I, LLC is completing additional environmental assessment activities to evaluate the
extent of groundwater impacts associated with the above referenced site which is being addressed in the
DEQ Registered Environmental Consultant (REC) program. Additional assessment activities include
installation of two groundwater monitoring wells on off-site property located at 1276 Newland Highway
in Newland, NC which will warrant obtaining a monitor well construction permit. To that end, I hereby
authorize Steve Hart with Hart & Hickman, PC (H&H) to sign the Application for Permit to Construct a
Monitoring or Recovery Well System as an agent on behalf of Newland Investments I, LLC.
Sincer ,
To McK' tric
anager
Newland Investments I, LLC

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SITE PROPERTY BOUNDARY
— — KENTUCKY CREEK APPROXIMATE
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WATER SUPPLY WELL
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PROPOSED GROUNDWATER MONITORING WELL PAIR
WELL LOCATION MAP
PROJECT
NOTES: 1339 NEWLAND HIGHWAY
a AERIAL IMAGERY AND PARCEL INFORMATION NEWLAND, NORTH CAROLINA
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OBTAINED FROM AVERY COUNTY GIS.
• 2923 South Tryon Street-Suite 100
h a rt h i c k m a n Charlotte,North Carolina 28203
704-586-0007(p)704-586-0373(f
SMARTER ENVIRONMENTAL SOLUTIONS License#C-1269/#C-245 Geology
DATE:2-21-19 REVISION NO.0
JOB NO.FDP-059 FIGURE NO. 1

TYPE II MONITORING WELL CONSTRUCTION DETAILS
CROSS SECTIONAL VIEW
LOCKABLE WELL CAP CONCRETE PAD
FLUSH METAL WELL COVER
CONCRETE PAD
BACKFILL AROUND CASING
MATERIAL cement grout
LENGTH 6 ft(0 to 6 ft)
WELL CASING
MATERIAL schedule 40 PVC
DIAMETER 2 inches
L1 JOINT TYPE flush threaded
LENGTH 10 feet(0 to 10 ft)
L3
SEAL
TYPE OF SEAL bentonite seal
THICKNESS 2 feet(6 ft to 8 ft)
FILTER PACK
TYPE OF FILTER No.2 Sand
THICKNESS 18 ft(8 ft to 26 ft)
WELL SCREEN
SCREEN MATERIAL schedule 40 PVC
DIAMETER 2 inches
LENGTH 15 feet(15 ft to 25 ft)
SLOT SIZE 0.010 inches
L2
DEPTH TO BOTTOM OF
L1 = 10 FT. MONITORING WELL 25 feet
L2= 15 FT. DIAMETER OF
L3= 26 FT. BOREHOLE
425 in
TITLE MW-5S
Monitoring Well Diagram Hart & Hickman, PC
2923 South Tryon St., Suite 100
Charlotte, North Carolina 28203
FILE PREP. BY IREV. BY DATE PROJECT NO.
AEM RWM 8/5/2019 FDP-059

TYPE II MONITORING WELL CONSTRUCTION DETAILS
CROSS SECTIONAL VIEW
LOCKABLE WELL CAP CONCRETE PAD
FLUSH METAL WELL COVER
CONCRETE PAD
BACKFILL AROUND CASING
MATERIAL cement grout
LENGTH 66 ft(0 to 66 ft)
WELL CASING
MATERIAL schedule 40 PVC
DIAMETER 2 inches
L1 JOINT TYPE flush threaded
LENGTH 70 feet(0 to 70 ft)
L3
SEAL
TYPE OF SEAL bentonite seal
THICKNESS 2 feet(66 ft to 68 ft)
FILTER PACK
TYPE OF FILTER No.2 Sand
THICKNESS 13 ft(68 ft to 81 ft)
WELL SCREEN
SCREEN MATERIAL schedule 40 PVC
DIAMETER 2 inches
LENGTH 10 feet(70 ft to 80 ft)
SLOT SIZE 0.010 inches
L2
DEPTH TO BOTTOM OF
L1 = 10 FT. MONITORING WELL 80 feet
L2= 10 FT. DIAMETER OF
L3= 81 FT. BOREHOLE
4.25 in
TITLE MW-513
Monitoring Well Diagram Hart & Hickman, PC
2923 South Tryon St., Suite 100
Charlotte, North Carolina 28203
FILE PREP. BY �REV. BY DATE I PROJECT NO.
AEM RWM 8/5/2019 FDP-059