WM0100479_Monitoring Well Construction Application_20201007

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.
FOR OFFICE USE ONLY
1. Date: 10/6/20
2. County: Buncombe PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Delray Ventures, LLC c/o Mr. Daniel Jimenez Telephone: [phone]
Applicant's Mailing Address: 715 North Church Street, Suite 110, Charlotte, NC 28202
Applicant's Email Address (if available): diimenez(adelray-ventures.com
5. Contact Person: Peak Hvdrooeologic, PLLC c/o Mr. Jonathan Gerst, PG Telephone: [phone]
Contact Person's Mailing Address: 470 Hogback Mtn. Rd, Tryon, NC 28782
Contact Person's Email Address (if available): Igerst(5peakhydrogeologic.com
6. Property Owner: Mountain Housing Opportunities, LLC c/o Mr. Mike Vance Telephone: [phone] ext. 117
Property Owner's Mailing Address: 64 Clinqman Ave Ste 101, Asheville, NC 28801
Property Owner's Email Address (if available): mike a(�mtnhousino.orq
7. Property Physical Address (Including PIN Number): 9648-19-3115 (363 Hilliard Ave.), and 9648-19-4116 (off Hilliard Ave.; no
address).
City Asheville County Buncombe Zip Code 28801
8. Reason for WeII(s): Assessment of suspected contamination from off -site sources
(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: Brownfield 24018-20-011
(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).
Off -site incidents: Dry Cleaner ID DC110005; LUST IDs 41515, 11416, 7418, 47031,41590, 31991
11. Type of contaminants being monitored or recovered: VOCs by EPA 8260, SVOCs by EPA 8270, RCRA Metals by EPA 6020,
possibly Hexavalent Chromium by EPA 7199 (ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? MW-16 (associated with
DC110005) located at 343 Hilliard Ave.
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): Tetrachloroethvlene detected in
MW-16 in excess of NC2LGQS. Free phase petroleum detected in nearby off -site monitoring well associated with LUST 41515
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: W. Walker Environmental Services, LLC Certification No.: NC 4237 B
Well Contractor Address: P.O. Box 8446 Columbia, SC 29202
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
material: 1
5. How will the well(s) be secured? Locked well caps
in flush -mount monument
3. Number of wells to be constructed in bedrock: 6. Estimated beginning construction date: 10/20/20
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 10/21/20
(add answers from 2 and 3)
1.
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. 143-215.10B(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
�Sig`nature of Appl nt or *ATitle of Applicant or *Agent
Mr. Daniel Jimenez
Printed name of Applicant or *Agent
Principal
* 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 application and that it shall be the responsibility of the applicant to ensure that the
conforrrto the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
Mr. Mike Vance
Sign re 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 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
Phone: [phone]
Fax: [phone]
GW-22MR Rev. 3-1-2016
GW-22M (Rev. 5/11)

SOURCE: Buncombe County, NC GIS Online August 7, 2020 SITE VICINITY MAP & SAMPLING LOCATIONS
Brownfield Assessment Work Plan
NCDEQ Brownfield Project #24018-20-011
Clingman Avenue & Hilliard Avenue Properties
Asheville, NC 28801PEAK HYDROGEOLOGIC, PLLC
ENVIRONMENTAL & WATER
RESOURCES CONSULTING PROJ. NO.: 257-20 DRAWN BY: JDG FIGURE: 1
SCALE: As shown DATE: 08/07/2020
USGS Topo for Tax ID 96 55105041
S ou rce : Esri, Digit alGlobe, GeoEye, E arthst ar G eo grap hics, CNES/A irbus
DS, USDA, USGS , AeroG RI D, IGN, an d th e GIS Use r Community
May 2 5, 20 17
0 0.035 0.070.0 175 mi
0 0.06 0.120.03 km
1:2,25 7

LEGEND
NCDEQ Brownfield Site #24018-20-011
5-ft topographic contour
parcel property boundaries & PINs “####”
existing monitoring well / groundwater sample location (VOCs, SVOCs, Metals)
temporary monitoring well & groundwater sample location (VOCs, SVOCs,
Metals)
grab soil sampling location (VOCs, SVOCs, RCRA Metals)
composite surficial soil sampling location (VOCs)
N
MW-16
Composite Area 1SB-5Composite Area 2SB-6TW-1
TW-2
TW-3
TW-4
TW-5
SB-7 & SB-8 to SB-#; SB-DUP
SB-1
SB-2
SB-4
SB-3
TW-DUP
MONITORING WELL SCHEMATIC
NCDEQ Brownfields Project #24018-20-011
Clingman Avenue and Hilliard Avenue Properties
Asheville, NC 28801
PEAK HYDROGEOLOGIC, PLLC
ENVIRONMENTAL & WATER
RESOURCES CONSULTING PROJ. NO.: 257-20 DRAWN BY: JDG FIGURE: 2
NOT TO SCALE DATE: 10/01/2020
USGS Topo for Tax ID 96 55105041
S ou rce : Esri, Digit alGlobe, GeoEye, E arthst ar G eo grap hics, CNES/A irbus
DS, USDA, USGS , AeroG RI D, IGN, an d th e GIS Use r Community
May 2 5, 20 17
0 0.035 0.070.0 175 mi
0 0.06 0.120.03 km
1:2,25 7

6-INCH DIAM. BOREHOLE
FROM GEOPROBE SOLID
STEM AUGER
~IN-SITU SOIL~
2-INCH DIAM., SCH. 40 PVC CASING
2-INCH DIAM., SCH. 40 PVC, 0.010-SLOT
SCREEN
NOTES:
1- GEOPROBE WILL ADVANCE 6-INCH DIAM. SOLID STEM AUGER TO NO GREATER THAN 5-FT BELOW FIRST
ENCOUNTERED GROUNDWATER.
2- SCREEN SOIL CUTTINGS IN 1-FT INTERVALS (VISUAL, OLFACTORY, & PHOTO-IONIZATION DETECTOR) TO
IDENTIFY PRESENCE AND DEPTH OF VOC CONTAMINATION.
3- REMOVE DRILL ROD FROM BOREHOLE, AND THEN PLACE 10-FT (2-INCH DIAM.) PVC SCREEN AND RISER
PIPE (LENTH VARIES) TO BRACKET WATER TABLE.
4- DEVELOP WELL, GAUGE STATIC WATER LEVEL >24-HOURS AFTER INSTALL, PURGE, AND COLLECT
GROUNDWATER SAMPLES FOR VOC, SVOC, AND METALS VIA LOW-FLOW METHOD.
GROUND SURFACE
GROUNDWATER ELEV: ~18 to 33 FT BGS
SCREENED
INTERVAL: 10 FT
BOTTOM OF BORING
ELEV.: ~20 to 40 FT
BGS
VARIES
10 FT
BOTTOM CAP
LOCKING WELL CAP
WELL HEAD COVER (TRAFFIC BOX)
NOT TO SCALE
FILTER PACK SAND (2-FT ABOVE SCREEN)
2-FT SEAL (3/8-INCH CHIPPED BENTONITE)
CEMENT GROUT