WM0100496_Monitoring Well Construction Application_20210901

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
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PLEASE TYPE OR PRINT CLEARLY
I n accordance with the provisions of Article 7, Chapt er 87, General Statutes o f North Carolina and regulations pur suant thereto ,
applicatio n i s hereby made for a permit to co nstruct monitoring or recove ry wells.
FOR OFFICE USE ONLY Date: -�8/�3�1 /=2=02�1�--------
County: Buncombe PERMIT NO. ISSUED DATE
What type of well are you applying for? (mo nitoring or recovery): ___ ..:.:M=o=n=ito:.:r..:.:.in,_,g'-----------------
Applicant: Bojangles' of Western North Carolina Telepho ne: _ ___,_N__,_,_A_,_ ___ _
Applicant's Mailing Address: ----'-13�1�G=le=n�n�B=ri=d..,_q e"-'-'R=o=ad=•�A=r=de=n""",�N=o�rt=h�C=a=ro=l=in=a....,, 2=8�7-=0_,_4 ________ _
Applicant's Email Address (if available): --�B�il�I =Ea=s�te=r=lin=g��b�e=a=st=e�rli=n..._q@=b=o=co=u=n=rty�.c=om�--------
Co ntact Pe rson (if different than Applicant): D on R. Marlor, P.G .. ECS Southeast, LLP Telephone: ----=8:.:2=8-_,_7-=-8=-5-4....:....:..1 8:.:3e...-_
Co ntact Perso n's Mailing Address: 1900 Henderso nville Road, Suite 1 0, Asheville, NC 2 8803
Contact Person's Email Address (if ava ilable): ----=d=m=a=rl=or=@=ec=s=lia.a.m=it=ed=·=co=m�--------------­
Property Owner (if different than Applicant): Leford Properties I I LLC and Natter-Shoemaker LLC. Telephone: --�N�A�-
Pro perty Owner's Mailing Address : 34 Summit Tower Cir Ashe ville NC 28 804
Property Owner's Email Address (if available): __________________________ _ �7¥ Property Physical Address (Including PIN Numb er)� Patton Avenue
City Ash eville County--=B=u=n=co=m'-"b=e=----------------'Zip Code ___ =28"'7'--'5=9-
8.Reaso n for Well(s):assessment o f former service center and filling station
(ex: non-discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9.Type o f facility or site for which the well(s) is(are) needed: ----=U=S..:..T-=s=ite=-----------------­
(ex: non-discharge fa cility, waste disposal site, landfill , U ST, etc .)
10.Are th ere any current water quality permits or incidents associated with this fa cility or site? If so, list p ermit and/or incident n o(s).
No
1 1 . Type o f contaminants being monitored or recovered: _P:....e:.:t::.;:ro=le=-=u=m'-'------------------­
(ex: organics, nutrients, heavy metals, e tc.)
1 2.Are there any existing wells associated with the proposed well(s)? If yes, h ow many? Not that ECS is aware of
Existing Monitoring or Recovery Well Constru ction Permit No(s).: __ _,N=o=-----------------
13 . Distance from proposed well(s) t o nearest known waste or pollution source (in feet): 0, potentially within former tank basin
1 4. Are there any water supply wells located less than 500 feet from the pr oposed well{s)? _ __,_N=o:..:..t ..::.th::.:a:.:..t=E-=-C-=-S_;_;is�a=w=a=r-=-e-=o"-f-
lf yes, giv e distance(s): -----------------------------------
1 5 . Well Contra ctor: Carolina S oil I nvestigations Certification No .: ___ :.2 8:..:5,,__,6'---'-A'--'-----
Well Contractor Address : _..:..1 ::32�G=u,__,_rn=eCLy..:..R-==o=-=a,:.d.,_, O=lin.,_,,,-=-N-=-=C=-2=8,,,,6=6=0 _______________ _
WM0100496 09/032021
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.
b.
c.
d.
Borehole and well diameter
Estimated well depth
Screen intervals
Sand/gravel pack intervals
e.
f.
9.
Type of casing material and thickness
Grout horizons
Well head completion details
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
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: 4
(add answers from 2 and 3)
5. How will the well(s) be secured? Expansion cap
temporary
6. Estimated beginning construction date: Unknown
7. Estimated construction completion date:
(within 96 hours of installation)
Unknown
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. 143-215.106(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
Lit<RX.
Signature of Applicant or *Agent
S'tC2 L.
Printed name of Applicant or *Agent
:Y eti. 1c 4t_ �Mt)
dr
Title of Applicant *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 oiler 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).
A (il c la `. n r h[ �I
Signature of Property Owner (if differer han Applicant) Printed n of Prope Owner (if diffetent than Appfjbant) �
P �

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

SOURCE:
USGS TOPOGRAPHIC MAP
ASHEVILLE, NORTH CAROLINA QUADRANGLE
DATED 2019
SCALE: 1:24,000
FIGURE 1
SITE LOCATION MAP
BOJANGLES' RESTAURANT
974 PATTON AVENUE, ASHEVILLE,
BUNCOMBE COUNTY, NORTH CAROLINA
ECS PROJECT NO. 49-14483-A

MR. TIRE
(FORMERLY
CAROLINA
TIRE)
li
BUILDINGS
APPROXIMATE LOCATIONS
OF FORMER ESSO/EXXON
APPROXIMATE LOCATION OF SMITH MILL CREEK
(WITHIN CULVERT BENEATH SUBJECT PROPERTY)
LEGEND
0 PROPOSED GROUNDWATER SAMPLE LOCATION
el PROPOSED SOIL SAMPLE LOCATION
APPROXIMATE SITE BOUNDARY
F
SOURCE:
GOOGLE EARTH, DATED 2019
SCALE:
= 100 FEET
FIGURE 2
PROPOSED SAMPLE
BOJANGLES' RESTAURANT
974 PATTON AVENUE, ASHEVILLE,
BUNCOMBE COUNTY, NORTH CAROLINA
ECS PROJECT NO. 49-14483-A

GROUND
SURFACE
35 FEET
BENTONITE PLUG
MINIMUM 2 FEET
SAND SCREEN
MINIMUM 1 FOOT ABOVE
THE SLOTTED PVC SCREEN
GROUNDWATER
NOT TO SCALE
2-INCH PVC CASING
SCHEDULE 40
6-INCH
BORE HOLE
SLOTTED PVC SCREEN
0.014NCH SLOT WIDTHS
SET TO INTERSECT GROUNDWATER
ESTIMATED 10 FEET IN LENGTH
WELL CONTRUCTION DIAGRAM IS
REPRESENTATIVE OF ALL PROPOSED
TEMPORARY MONITORING WELLS
FIGURE 3
PROPOSED TEMPORAREY
WELL CONSTRUCTION
BOJANGLES' RESTAURANT
974 PATTON AVENUE, ASHEVILLE,
BUNCOMBE COUNTY, NORTH CAROLINA
ECS PROJECT NO. 49-14483-A