WM0100528_Monitoring Well Construction Application_20221025

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:
2. County:
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant:Telephone:
Applicant’s Mailing Address:
Applicant’s Email Address (if available):
5. Contact Person (if different than Applicant):Telephone:
Contact Person’s Mailing Address:
Contact Person’s Email Address (if available):
6. Property Owner (if different than Applicant):Telephone:
Property Owner’s Mailing Address:
Property Owner’s Email Address (if available):
7. Property Physical Address (Including PIN Number)
City County Zip Code
8. Reason for Well(s):
(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:
(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).
11. Type of contaminants being monitored or recovered:
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many?
Existing Monitoring or Recovery Well Construction Permit No(s).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet):
14. Are there any water supply wells located less than 500 feet from the proposed well(s)?
If yes, give distance(s):
15. Well Contractor:Certification No.:
Well Contractor Address:
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
10/25/2022
Buncombe
Permanent monitoring well
Quality Way, LLC 828-691-1472
1165 Clark St. STE 700, Chicago, IL 60610
[e-mail]
Scott Clark 828-691-1472
1165 Clark St. STE 700, Chicago, IL 60610
[e-mail]
Continental Teves, Inc.828-654-2240
1 Quality Way, Fletcher, NC 28732
1 Quality Way (PIN 9642361779)
Fletcher Henderson 28732
due diligence assessment
industiral
NDPES - NCG030572
No contaminants known - Groundwater analysis will be for VOCs, SVOCs, & metals
No
N/A
NCDEQ UST Incident 41462 - 3,200 ft NE
No
SAEDACCO 4379
988 Northfield Drive, Fort Mill, SC 29707
WM0100528 10/28/2022

FIGURE 1: SITE LOCATION MAP
Continental Teves, Inc.
1 Quality Way
Fletcher, Henderson County, North Carolina
S&ME Project No. 22690313

48 Brookfield Oaks Drive, Suite F
Greenville, South Carolina 29607

NORTH
Approximate
Location of Subject
Property
Reference: 1965 Photorevised 1991 Edition USGS 7.5-minute Topographic Quadrangle – Skyland, North Carolina.
SCALE:
NOT TO SCALE
DATE:
10/24/2022
PROJECT NUMBER:
22690313A
FIGURE NO.
2CONTINENTAL TEVES PHASE I ESA
HENDERSON COUNTY, NORTH CAROLINA
PROPOSED SAMPLE LOCATION MAP
REFERENCE:
2022 Aerial imagery obtained from Henderson County GIS website.
APPROXIMATE LOCATION OF PROPOSED
MONITORING WELL AND GROUNDWATER
SAMPLE LOCATION
APPROXIMATE SUBJECT PROPERTY BOUNDARY
Well ID
TBD
S&ME Staff
TBD
Drill Rig
TBD
Water Level at TOB (0.01 ft-BTOC) Land Surface Elev. (0.01 ft)
Depth to Water (0.01 ft- BTOC)
Stickup Height - ft
TOC Relative to Ground 0.0 ft
0.0 to TBD
TBD to TBD
Top of Seal - TBD 0.1 ft-bgs
Top of Filter Pack - TBD 0.1 ft-bgs
0.0 to TBD
Top of Screen - TBD 0.1 ft-bgs
TBD to TBD
Screened Interval - 10.0 0.1 ft-bgs
TBD to TBD
Bottom of Screen - TBD 0.1 ft-bgs
Bottom of Filter Pack - TBD 0.1 ft-bgs
Cave In - TBD 0.1 ft-bgs
Total Boring Depth - TBD 0.1 ft-bgs
Form Revision Date:
TBD
9/1/17 2:10 PM
TBD - To Be Determined
Cement will be placed
from the top of the
bentonite seal to the
ground surface
Notes:
Seal Interval (0.1 ft-bgs)
Filter Pack
Grout Interval (0.1 ft-bgs)
Development Volume (gal)
Development
Yes
For lithologic information
see attached boring log
BTOC - Below Top of Casing
HSA & Air Hammer (if needed)
2' x 2' Concrete
Flush Vault (8" diam)
Seal Type
2-in Sch 40 PVC (0.010)
TBD
2-in Sch 40 PVC
Casing Interval (0.1 ft-bgs)
Screen Type
Borehole Diameter (1 in)
8
Filter Pack Interval (0.1 ft-bgs)
The total depth will be
determined based on
depth of groundwater.
Estimated to be 30 to 60
feet deep.
Screen Interval (0.1 ft-bgs)
Grout Type
#2 Silica Sand
3/8 in. Bentonite Pellets
Pad Type
Protective Casing
Casing Material
Depth Below Ground Surface (ft-bgs)
Project Name
1 Quality Way
Project Number
22690322
WELL CONSTRUCTION DETAIL
TBD
TBD
Northing (0.1 ft)
TBD
Date/Time
TBD
Total Well Depth (0.1 ft-bgs)
TBD TBD TBD
SAEDACCO
Easting (0.1 ft)Date/Time
Installation Date
11-7 to 11-9
County
Drilling Contractor
Drilling Method
Well Type / Use
City
Flush Monitor Well
Hendreson Fletcher
License Number
4379
Well Permit Number
TBD