WM0100490_Monitoring Well Construction Application_20210524

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: 5/24/21
2. County: Buncombe
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Temporary Monitoring Wells
4. Applicant: Roberts & Stevens, P.A. Telephone: [phone]
Applicant's Mailing Address: City Center Building, 301 College Street, Suite 400, Asheville, NC 28801
Applicant's Email Address (if available): [e-mail], Attorney for Garnetta Woodard
5. Contact Person (if different than Applicant): Bradley Keyse Telephone: II28-329-3367
Contact Person's Mailing Address: 44 Buck Shoals Road, C-3, Arden, NC 28704
Contact Person's Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): City of Asheville Telephone: [phone]
Property Owner's Mailing Address: 161 S Charlotte St, Asheville, NC 28801
Property Owners Email Address (if available): Alisa McLaughlin <[e-mail]>
7. Property Physical Address (Including PIN Number) Right-of-way north of and adjoining PIN: 963814920900000
City Asheville County Buncombe
Zip Code 28806
8. Reason for Well(s): Limited Soil and Groundwater 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: former dry-cleaning site, UST
(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: volatile and semi -volatile organics
(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).: N/A
13. Distance from proposed wells) to nearest known waste or pollution source (in feet): dry-cleaning (DSCA) site 50 feet NW
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? None known
If yes, give distance(s):
15. Well Contractor: Environmental Drilling and Probing Services, LLC Certification No.: 4301
Well Contractor Address: 17538 Green Hill Road, Charlotte, NC 28278
PROPOSED WELL CONSTRUCTION INFORMATION
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. Grout horizons
c. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
Si nature of App
61Ce✓" Printed name of Applicant or *Agent
2. Number of wells to be constructed in unconsolidated
material: 4
3. Number of wells to be constructed in bedrock: 0
4. Total Number of wells to be constructed: 2
(add answers from 2 and 3)
5. How will the well(s) be secured? Lock and key
6. Estimated beginning construction date: 6/8/21
7 Estimated construction completion date: 6/9/21
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 onstruction P rmit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
• Subchapter 2C) and accepts full responsibility for compliance with theser rules
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Title of Applicant or *Agent
* 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
well(s) confo to the Well Cons ruction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
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Signature of Property Ownbr (if different than Applicant)
o1) , (ion•no/> e I
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]
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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]
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GW-22MR Rev. 3-1-2016

SCALE:
DATE:
PROJECT NUMBER
FIGURE NO.Drawing Path: D:\CAD\214146 Roberts & Stevens, PA_12 Brevard Road_Asheville, NC\214146.dwgN
12 BREVARD ROAD
ASHEVILLE, BUNCOMBE COUNTY, NORTH CAROLINA
1
214146
4/23/2021
1" = 2,000'SITE VICINITY MAP
0 2000 4000
(IN FEET)GRAPHIC SCALE (IN FEET)GRAPHIC SCALE
LOCATION OF SUBJECT PROPERTY
REFERENCE: 2019 ASHEVILLE (NC) USGS 1:24,000 QUAD SHEET MAPS
THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS
DISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY INFORMATION,
UNLESS STATED OTHERWISE.
FIGURE NO.Drawing path: D:\CAD\214146 Roberts & Stevens, PA_12 Brevard Road_Asheville, NC\214146.dwg
PROJECT NUMBERDATE:SCALE:N03060 (IN FEET)GRAPHIC SCALE (IN FEET)GRAPHIC SCALE12 BREVARD ROAD
ASHEVILLE, BUNCOMBE COUNTY, NORTH CAROLINA25/21/2021PROPOSED SAMPLE LOCATION MAP
1" = 30'214146REFERENCE:2019 AERIAL IMAGERY WAS OBTAINED FROM NC ONEMAP. SITE FEATURES OBTAINED FROM ECS SOUTHEAST, LLP PHASE I ENVIRONMENTALSITE ASSESSMENT (ESA) REPORT DATED FEBRUARY 9, 2021. THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONSDISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY INFORMATION, UNLESS STATED OTHERWISE.FORMER JOHNSON'S ARCO STATIONNCDEQ BROWNFEILDS: 22050-18-011PROPOSED GROUNDWATER SAMPLE LOCATION (VOCs, SVOCs)PROPOSED SOIL SAMPLE LOCATIONS (TPH DRO/GRO)APPROXIMATE LOCATION OF SUSPECTED HEATING OIL USTSUBJECT RIGHT-OF-WAY PARCEL BOUNDARIESBUNCOMBE COUNTY PARCELSBREVARD RO
A
D
HAYWOOD ROAD12 BREVARD ROADPIN: 963814920900000
TSC
BSC
30.00
40.00
DRILLING CONTRACTOR:
DRILLING METHOD:
DATE COMPLETED:
EDPS
2¼" H.S.A.
6/7/21
COMPLETION REPORT OF WELL No. TMW
LATITUDE:
LONGITUDE:
TOP OF CASING ELEVATION:
DATUM:
LOGGED BY:
TBD
TBD
TBD
Not Applicable
S&ME
Type:
Interval:
RISER CASING
0.00
None
None
Type:
Interval:
GS
Diameter:
Type:
Interval:
#2 Sand
0 - 40
None
None
None
SEAL
Diameter:
Type:
Interval:
FILTERPACK
None
None
1"
PVC
-1 to 30
Type:
Interval:
SCREEN
GROUT
PROTECTIVE CASING
Diameter:
Type:
Interval:
0.010
PVC
30 - 40
STRATA
WELL CONSTRUCTION DETAILS
DEPTH(ft.)DESCRIPTION
SYMBOLDEPTH(ft.)LEGENDWELL
DETAILS
PID (ppm)ELEVATION(ft.)PROJECT:
PROJECT NO:
PROJECT LOCATION:
12 Brevard Road
214146
12 Brevard Road
Sheet 1 of 2
WATER LEVEL:
0
5
10
15
20
25
30
35
TOC
GS
BS
BOC
TSC
BSC
TD
CG
COMPLETION REPORT OF
WELL No. TMW
TOP OF CASING
GROUND SURFACE
BENTONITE SEAL
BASE OF OUTER CASING
TOP OF SCREEN
BOTTOM OF SCREEN
TOTAL DEPTH
CEMENT GROUT
LEGEND
FILTER PACK
BENTONITE
CEMENT GROUT
CUTTINGS / BACKFILL
STATIC WATER LEVEL
MONITORING WELL TEMP WELL - MW PERMIT.GPJ WITH CPT.GDT 5/21/21Sheet 1 of 1
44 Buck Shoals Road, C-3
Arden, NC
TBD