WM0100457_Application_20190822

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: 8/21/2019
2. County: Buncombe
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Pulliam Properties, Inc. Telephone: [phone]
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Applicant's Mailing Address: 2 Walden Ridge Drive, Suite 70, Asheville, NC
Applicant's Email Address (if available): Rusty Pulliam rpulliam(a)pulliamproperties.com
Contact Person (if different than Applicant): James C. Bevers, PE, 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): jbevers .ecslimited.com
Property Owner (if different than Applicant): Talmadge & Helen Penland Telephone:
Property Owner's Mailing Address: 37 Parkview Drive, Candler, NC 28715
Property Owner's Email Address (if available):
Property Physical Address (Including PIN Number) 675 Patton Ave PIN 9638-58-3667
City Asheville County Buncombe Zip Code 28806
Reason for Well(s): assessment of suspected contamination of the groundwater
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: former automotive repair
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
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
Type of contaminants being monitored or recovered: solvents, gasoline, metals
(ex: organics, nutrients, heavy metals, etc.)
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
Distance from proposed well(s) to nearest known waste or pollution source (in feet): 0
Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s):
15. Well Contractor: TBD — Potentially CSI
Well Contractor Address:
Certification No.: 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 5. How will the well(s) be secured? Terre
material: 3 expansion cap
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: TBD
4. Total Number of wells to be constructed: 3 7. Estimated construction completion date: TBD
(add answers from 2 and 3) (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,
Subchapter 2C) and accepts full responsibility for compliance with these rules
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Signature o Applicant or *Agent V Title of Applicant or *Agent
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Printed name of Applicant or *Agent
* ff 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) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
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S" ature of Pro y O ner (i i th plicant) Printed name of Property Ow (if a ent 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]
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

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FIGURE 1
SITE TOPOGRAPHIC MAP
SOURCE: 1 FORMER DENNY'S RESTAURANT
USGS TOPOGRAPHIC MAP C 675 PATTON AVENUE, ASHEVILLE,
BUNCOMBE COUNTY,
NORTH CAROLINA
TIM ECS PROJECT NO. 49-9720—A

30 FEET
GROUND
SURFACE
EXPANSION CAP
WITH LOCK
BENTONITE PLUG
MINIMUM 2 FEET
SAND SCREEN
MINIMUM 1 FOOT ABOVE THE
SLOTTED PVC SCREEN
GROUNDWATER
NOT TO SCALE
2-INCH PVC CASING
SCHEDULE40
4-INCH BORE
HOLE
SLOTTED PVC SCREEN
0.01-INCH SLOT WIDTHS
SET TO INTERSECT GROUNDWATER
ESTIMATED 10 FEET IN LENGTH
WELLS ARE INTENDED TO BE INSTALLED USING DIRECT
PUSH DRILLING OR AIR ROTARY, GROUNDWATER
SAMPLED, & ABANDONED ON THE SAME DAY.
FIGURE 3
PROPOSED WELL CONSTRUCTION
DIAGRAM
FORMER DENNY'S RESTAURANT
675 PATTON AVENUE, ASHEVILLE,
BUNCOMBE COUNTY,
NORTH CAROLINA
ECS PROJECT NO. 49-9720-A