WM0100454_Application_20190610

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 recoverywells.
F
1. Date: 06/10/2019 OR OFFICE USE ONLY
2, County: Buncombe I PERMIT NO. Wfiri) UUISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4, Applicant: NCDEQ DWM DSCA Program (Mike Cunningham) Telephone: [phone]
Applicant's Mailing Address: 1628 Mail Service Center Raleigh NC 27699
Applicant's Email Address (if available): mike.cunninohamcdacdem.al
5. Contact Person (if different than Applicant): Brett Lawrence (Hart & Hickman PC) Telephone: [phone]
Contact Person's Mailing Address: 2923 S. Tryon Street Ste 100 Charlotte NC 28203
Contact Person's Email Address (if available): blawrence(dharthickman.com
6. Property Owner (if different than Applicant): June Tison Coe Rev Trust Telephone'. Not Available
Property Owner's Mailing Address: 10817 Meadowhill Road, Silver Spring MD 20901
Property Owner's Email Address (if available)'.
7. Property Physical Address (including PIN Number) 713 Mammon Avenue (PIN #974040151800000)
City: Asheville CountyBuncombe Zip Code 28804
8. Reason for Wallis): Assessment for the NCDEQ DSCA Program
(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 dw-cleaning facility (Nome Cleaners)
(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).
NCDEQ — DSCA Site #DC110010 (Former Norge Cleaners)
11. Type of contaminants being monitored or recovered: Chlorinated solvents
(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 Nc(s).'.
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet)'. Approximately <100 ft
14. Are there any water supply wells located less than 500 feet from the proposed well($)? Unknown
If yes, give distance(s)'.
15. Well Contractor: Carolina Soil Investigations Certification No.: 2579-A
Well Contractor Address: 132 Gurney Road Olin NC 28860
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C 0105(0(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. Coot horizons
c. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
r
Number of wet is to be constructed in unconsolidated 5. How wi l l the well(s) be secured? Lockable
material: 1 temporary wells expansion Plugwell to be abandoned by INC-licensed driller
-------------- ------ ----- ---within-24- hours -ofinstallation----
3. Number of wells to be constructed in bedrock'. 0
4. Total Number of wells to be constructed: 1
(add answers from 2 and 3)
6. Estimated beginning construction date'. 06/13/2019
7. Estimated construction completion date: 06/13/2019
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 feel of the proposed well or well system.
e 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
C:::�
On behalf of the NCDEQ DSCA Program
Signature of Applicant or "Agent
Brett Lawrence on behalf of the NCDEQ DSCA Program
Printed name of Applicant or `Agent
Agent for NCDEQ DSCA Program
Title of Applicant or *Agent
-lfsigning as Agent, attach authorization agreement stating
thatyou 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).
See attached legal we ma nt** scheduled to be executed on 611312019) June Tisch Coe Rev Trust
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 Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone'. [phone]
Fax: [phone]
Fayetteville Regional Office
226 Green Street, Suite 714
Fayetteville, NC 283015094
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, INC 27889
Phone: [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
05
GW-22MR Rev. 3-1-2016

TEMPORARY TYPE II SHALLOW MONITORING WELL CONSTRUCTION DETAILS
CROSS
SECTIONAL VIEW
LOCKABLE WELL CAP--�
GROUND SURFACE
WELL CASING
MATERIAL scheeuie40PVC
DIAMETER 1-inch
JOINT TYPE flush threaded
LENGTH 25a
u
SEALBACKFILL AROUND CASING
L
MATERIAL eentonire
LENGTH 23h(onre23ft)
FILTER PACK
TYPE OF FILTER No Sand
THICKNESS t2e(23nto35n)
WELL SCREEN
SCREEN MATERIAL schedule 40 PVC
L2
DIAMETER t-Inch
LENGTH tort
SLOT SIZE 0,010 Inches
DEPTH TO BOTTOM OF
-1 25 FT.
MONITORING WELL 35n
L2= 10 FT, DIAMETER OF
L3= 35 FT. BOREHOLE
4.25 in
TITLE Monitoring Well Diagram
hart ► hlckman
FORMER NORGE CLEANERS
r'NR0'°"`"`""01'"ad
713 Merrimon Avenue
2923 South Tryon St., Suite 100
Asheville, NC 28804
Charlotte,North Carolina 28203
DSCA SITE ID'.
PREP. BY
REV. BY
DATE PROJECT NO.
DC110010
CBL
6/1012019 DS0-167

Moore, Andrew W
From: Brett Lawrence <[e-mail]>
Sent: Thursday, June 13, 2019 8:55 AM
To: Moore, Andrew W
Subject: Re: [External] Monitoring Well Permit - DSCA Site DC110010
Attachments: imagel.jpeg; image2.jpeg
Andrew,
Photo copies of the warrant are attached. Please confirm receipt.
Th0
�anks,
n-
Brett Lawrence
Hart & Hickman, PC
[phone]
On Jun 5, 2019, at 2:41 PM, Moore, Andrew W <[e-mail]> wrote:
OK. Go ahead and send the application when you have everything together, with the exception of the
warrant of course. I'll follow up next week if there are any issues.
Andrew W. Moore, P.G.
Environmental Specialist —Asheville Regional Office
Water Quality Regional Operations Section
NCDEQ — Division of Water Resources
828 296 4684 office
email: Andrew.W.MooreCa)ncdenr.00v
2090 U.S. Hwy. 70
Swannanoa, N.C. 28778
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Brett Lawrence <[e-mail]>
Sent: Wednesday, June 05, 2019 2:36 PM
To: Moore, Andrew W <andrew.w.moore@ncdencaov>
Subject: RE: [External] Monitoring Well Permit - DSCA Site DC110010

Andrew,
The warrant is set to be issued at Sam on 6/13. We could possibly wait to submit the application until
the warrant is attached, if the permit could be issued that same day. With the warrant, we'll only have
from 9am -Spm on that one day to conduct the assessment. The scope of work is multiple soil samples
and one temporary groundwater well, we could push the well installation into late morning if that would
help.
Thanks,
Brett
Brett Lawrence, PG, Project Geologist
Hart"
Hickman, PC
<image009.jpg> 2923 S Tryon Street, Suite 100 -Charlotte, INC 28203
Direct: [phone] Mobile: [phone]
w w.hadhickman.com I<image010.jpg><image011.jpg><image012.jpg>
From: Moore, Andrew W <andrew.w.moore(@ncdenr.eov>
Sent: Wednesday, June 5, 20191:18 PM
To: Brett Lawrence <BLawrencePharthickman.com>
Subject: RE: [External] Monitoring Well Permit - DSCA Site DC110010
Brett,
Probably so, but I'm not sure. I'll have to talk to my supervisor, who signs the permits and who is out
until next week. I can follow-up early next week with an answer.
Any idea when you'll have the actual warrant? Would it be possible to wait to submit the monitoring
well construction application until the warrant is in hand?
Andrew W. Moore, P.G.
Environmental Specialist — Asheville Regional Office
Water Quality Regional Operations Section
NCDEQ — Division of Water Resources
828 296 4684 office
email: Andrew.W.Moore(o)ncdenr.gov
2090 U.S. Hwy. 70
Swannanoa, N.C. 28778
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

From: Brett Lawrence <[e-mail]>
Sent: Wednesday, June 05, 2019 11:52 AM
To: Moore, Andrew W <[e-mail]>
Subject: [External] Monitoring Well Permit- DSCA Site DC110010
Andrew,
Good morning. I need to get a well permit for anew DSCA site (Norge Cleaners DC110010) located at
713 Merrimon Ave in Asheville. However, this is not a typical DSCA site in that we are doing the
assessment under a legal warrant directly for DSCA (there is no petitioner). Therefore, I cannot send an
access agreement along with the well permit application. Additionally, I will not have warrant
documentation until the day the warrant is issued. I do have correspondence with the DSCA PM
indicating a warrant has been applied for, will this suffice for the access agreement in the well permit
application (I've attached for your reference)?
Thanks,
Brett
Brett Lawrence, PG, Project Geologist
Hart &Hickman, PC
<image013.Jpg> 2923 S Tryon Street, Suite 100 - Charlotte, NC 28203
Direct: [phone] Mobile: [phone]
w .hadhickman.com I<image014Jpg><image015Jpg><image016.]pg>

JUN 11 2019

JUN 13 P019