WM0100508_Monitoring Well Construction Application_20220308

FOR OFFICE USE ONLY

PERMIT NO. ISSUED DATE
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.

1. Date: 3/8/2022

2. County: Transylvania

3. What type of well are you applying for? (monitoring or recovery): Monitoring

4. Applicant: Tom Mosey Properties Telephone: [phone]

Applicant’s Mailing Address: 20991 Pinar Trail, Boca Raton, FL 33433

Applicant’s Email Address (if available): Joy Tulloch [e-mail]

5. Contact Person (if different than Applicant): James C. Bevers, P.E., ECS Southeast, LLP Telephone: [phone]

Contact Person’s Mailing Address: 1900 Hendersonville Road, Suite 10, Asheville, NC 28803

Contact Person’s Email Address (if available): [e-mail]

6. Property Owner (if different than Applicant): Mountain Industrial Properties, LLC Telephone: Unknown

Property Owner’s Mailing Address: 120 Shiners Ridge Road, Rosman, NC 28772

Property Owner’s Email Address (if available): Duane Aiken [e-mail]

7. Property Physical Address (Including PIN Number) 1989 Old Rosman Highway PIN 8562-08-5718-000
City Brevard County Transylvania Zip Code 28712
8. Reason for Well(s): assessment of suspected contamination of the groundwater
(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: industrial use of the property
(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: petroleum products and 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 No(s).: No

13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0-75

14. Are there any water supply wells located less than 500 feet from the proposed well(s)? Yes

If yes, give distance(s): 100 feet

15. Well Contractor: TBD Certification No.: TBD

Well Contractor Address: TBD

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
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? Locking
expansion cap
6. Estimated beginning construction date: TBD
7. Estimated construction completion date: TBD, same
day
(within 96 hours of installation)
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,
ubchapter 2C) and accepts full responsibility for compliance with these rules
•
Signature of Applicant or *Agent
I igorno..s Mt)Se
Printed name of Applicant or lAgent
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 ),t form to the Weiiction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
G?,7&
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)

FIGURE 1
SITE TOPOGRAPHIC MAP
1989 OLD ROSMAN HIGHWAY
BREVARD, TRANSYLVANIA COUNTY,
NORTH CAROLINA
ECS PROJECT NO. 49-16348-A
SOURCE:
USGS TOPOGRAPHIC MAP
ROSMAN, NORTH CAROLINA
QUADRANGLE
DATED 1997
SITE
FIGURE 2
PROPOSED MONITORING WELL
LOCATION MAP
1989 OLD ROSMAN HIGHWAY
BREVARD, TRANSYLVANIA COUNTY,
NORTH CAROLINA
ECS PROJECT NO. 49-16348-A
SOURCE:
GOOGLE EARTH, DATED 2017
SCALE:
= 200 FEET
LEGEND
PROPOSED GROUNDWATER SAMPLE LOCATION
FIGURE 3
PROPOSED WELL CONSTRUCTION
DIAGRAM
1989 OLD ROSMAN HIGHWAY
BREVARD, TRANSYLVANIA COUNTY,
NORTH CAROLINA
ECS PROJECT NO. 49-16348-A
NOT TO SCALE
EXPANSION CAP
WITH LOCK
2-INCH BORE
HOLE
1-INCH PVC CASING
SCHEDULE 40
GROUND
SURFACE
GROUNDWATER SLOTTED PVC SCREEN
0.01-INCH SLOT WIDTHS
SET TO INTERSECT GROUNDWATER
ESTIMATED 10 FEET IN LENGTH
SAND SCREEN
MINIMUM 1 FOOT ABOVE THE
SLOTTED PVC SCREEN
BENTONITE PLUG
MINIMUM 2 FEET
25 FEET
WELLS ARE INTENDED TO BE INSTALLED USING DIRECT
PUSH DRILLING OR AIR ROTARY, GROUNDWATER
SAMPLED, & ABANDONED ON THE SAME DAY.