20210524_CCPCUA

yPER-USE°PERftlVIN THE hhp.l1www.ncwater.org1CCPCUA North Carolina Environmental Management Commission
CENTRAL COASTAL PLAIN CAPACITY USE AREA Department of Environmental Quality, Division of Water Resources
1611 Mail Service Center, Raleigh, NC 27699-1611, phone: [phone]
Ogew Application ❑Application for Permit Renewal ❑Permit Amendment ❑Temporary Permit Permit #
I. Applicant Information:
(a) Applicant: T fM IhOI Wr) (-JC.fc1aCl
(Name of Person, Company, or Corporation)
(b) Mailing Address: Gp QN a 41N'e City: -T"30N V File State: IV6 Zip Code: V
(c) Facility
County: 27aa es
(d) Authorized Contact Person: _ 7t" J&CTo1U { .��5 4ey- '
(Name) (Title) (Phone Number)
"1 i mm e mde r�-t�I m kt�. coy) gt6 - 346- I,4S
(Email Address) (Fax Number)
II. Puroose(s) for which water is to be used (check all that aoDI
(a)Public Water Supply System (PWSID#
(b)Livestock Supply, describe briefly
(c)_Agricultural Irrigation, describe briefly
(d)Aquaculture, describe briefly
(e)_Mining, describe briefly
(f) Industrial, describe briefly
(g)Other, describe briefly
*If (a) above is checked and applicant is a unit of local government, then applicant must have an adopted Local Water Supply Plan (G.S. 143-355(t) and (m)}.
❑I. Source(s) of Ground Water (attach extra sheets if necessary): (a) Fill in table below. Depths: feet below land surface. Land surface elevation: feet above mean sea level.
Well/
Sump
ID
Latitude
(decimal
degrees
ex. 34.264567)
Longitude
(decimal
degrees
ex.77.263546)
Date
constructed
Diam-
eter
(inches)
Well
Depth
or
max pit
depth
feet
Depth to
top of
screen or
open hole
(feet)
Depth to
bottom of
screen or
open hole
(feet)
Depth to
pump
Intake
(feet)
Pump
capacity
(gallons
/minute)
Pump type
(submersible,
turbine,...)
Depth
to
top of
gravel
pack
feet
Land
surface
elevation
(feet,
MSL)
Existing
(E) or
Proposed
(Plot
Abandon
A
Maximum
number of
gallons to he
withdrawn
daily
# of
Hours
to be
pumped
daily
DWR CCPCUA-2 Revised September 30, 2015

(b) Totaled daily withdrawals from ground water = gallons.
If (b) above exceeds 100,000 gallons, a Central Coastal Plain Capacity Use Area permit satisfies the requirement for a water withdrawal registration {G.S. 143-215.22(H)}.
Items IV through XII will require more space for completion than provided, please attach additional sheets as necessary.
IV. Document additional mining_ permit application requirements as listed in ISA NCAC 02E .0502(d)(4) or reference materials submitted under G.S. 74-47.
Mining permit #
Maximum pit depth (ft): # of excavated acres:
V. Document additional Aquifer Storage and Recovery program (ASR) permit application requirements as listed in 15A NCAC 02E .0502(d)(6).
VI. Locate sources of withdrawal (attach the relevant portions] of a map indicating roads and road names and note the following information — you may access
maps online at http://www.ncwater.org/CCPCUA and follow the link to the Ground Water Data Mapserver):.
(a) county(ies) in which withdrawal sources are located
(b) labeled positions of all wells and sumps listed in section III. (a)
(c) locations of all existing water supply wells within 1500 feet of the wells listed in section III. (a)
(d) locations of all discharge points for water withdrawals covered under this application
VII. Document conservation measures by user tvne:
(a) public water systems (15A NCAC 02E .0502(d)(5)(A))
i. Do you have a water conservation — based rate structure (ex. Flat rates, increasing block rates, seasonal rates or quantity based surcharges)?
ii. Do you have a water loss reduction program (ex. annual water audits, in -field leak detection, leak repair)?
iii. Do you have a water conservation ordinance for irrigation?
iv. Do you offer a retrofit program (ex. Low flow shower heads, toilet flappers, faucet aerators)?
v. Do you have a public education program?
vi. Evaluation of feasibility of water reuse?
(b) other users besides agricultural irrigators (15A NCAC 02E .0502(d)(5)(B))
i. Do you audit your water use by type of activity? (for example process make-up water, non -contact cooling water)
ii. Implementation schedule for feasible measures identified in the above item for conservation or reuse of water at the facility.
(c) agricultural irrigators (15A NCAC 02E .0502(d)(5)(C))
Total acres to be irrigated: Irrigation Method: Crops:
VIII. Substantiation for the amount of withdrawal requested: Submit documentation that justifies the total withdrawal requested. Documentation could include
design plans, development plans, planning studies, operation reports, past pumping records, etc. If withdrawals are to be seasonal or vary significantly from
month -to -month throughout the year, describe the reasons for the variations and specify those variations. Fill in table below.
Average Daily Water Use from Previous Calendar Year (gallons per day)
January
February
March
April
May
June
July
August
September
October
November
December
Daily Use
# of days
IX. Disposal of water: Describe how the water will be disposed of after it has been used. NPDES permit #
DWR CCPCUA-2
Revised September 30, 2015
Z. ,, i._- 4

X. Document plans to retrofit wells as described in 15A NCAC 02E .0502(i): Describe the methods and proposed schedule to retrofit wells which currently have
pump intakes deeper than the top of the uppermost confined aquifer that yields water to the well.
Xl. Document intermittent user status as described in 15ANCAC 02E .0507(13):
(a) persons who withdraw ground water less than 60 days per calendar year; or
(b) persons who withdraw less than 15 million gallons of ground water in a calendar year; or
(c) aquacultural operations licensed under G.S. 106-761 using ground water for the initial filling of ponds or refilling of ponds no more frequently than
every five years.
XII. Document Cretaceous Aquifer Reduction requirements:
(a) Identify Cretaceous Aquifer Zone wells and associated percent reduction requirements using the CCPCUA Cretaceous Aquifer Zones map available
from the Division of Water Resources {include documentation for wells to be excluded from reduction requirements due to 15A NCAC 02E .0503(8)
or 15A NCAC 02E .0503(9)1.
(b) Document Aquifer Storage and Recovery program (ASR) total net withdrawals.
(c) Approved Base Rate Calculation for Cretaceous Aquifer Zone wells as described in 15A NCAC 02E .0507(1); choose the larger of i., ii. or iii.:
i. total calendar year 1997 water use in gallons by well;
ii. total August I, 1999 through July 31, 2000 water use in gallons by well; or
iii. an adjusted water use rate calculation based on the larger of i. or ii. and the following:
A. documentation of water use reductions made since January 1, 1992;
B. actual or estimated water use from wells approved by the Division of Environmental Health by August 1, 2002;
C. percent of plant nursery operation using low volume micro -irrigation; or
D. documentation of other relevant information
(d) Plans for Reduction (use attached worksheet):
i. calculate difference between estimated water demand and approved base rate minus Cretaceous Aquifer reductions at year 2008, 2013 and 2018
ii. identify new water sources and probable yields
XIII. Temporary Permit for Cretaceous Aquifer Reduction Wells:
(a) Document static water level trends to be level or upward trending after January 1, 2012 or over the previous year from present day (This may involve
construction and measurement of monitoring wells by permit holders); and
(b) Document pump intakes to be above the top of the shallowest Cretaceous aquifer screened by the well. Pump installation records are required. In
addition, geophysical logs may be submitted for validation of the top of the aquifer; and
(c) Document present day pumping water levels to be above the top of the shallowest Cretaceous aquifer screened by the well; and
(d) If applicable, document chloride concentrations obtained from monitoring wells or unused production wells screened and gravel packed in one
Cretaceous aquifer to be fresh (< 250 mg/1) for 3 previous years from present day and do not trend toward higher concentrations or other site specific
data which will allow determination of susceptibility to salt water encroachment.
XIV. Certification: I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe the submitted information is
true, accurate, and complete.
(Si re) (Name) (Official Title) (Date)
DWR CCPCUA-2 Revised September 30, 2015

Central Coastal Plain Capacity Use Area
Water Withdrawal
North Carolina Environmental Management Commission
Department of Environmental Quality
Division of Water Resources
1611 Mail Service Center
Raleigh, NC 27699-1611
Water users in the fifteen counties designated as the Central Coastal Plain Capacity Use Area who use more than
10,000 gallons of water per day, for purposes other than individual household use, are required by law to register their water
use and report annually to the Division of Water Resources.
Each person who withdraws more than 10,000 gallons of surface or ground water per day shall submit this form, by
January 3151, documenting the prior year's water use. Please provide accurate longitude and latitude coordinates of
withdrawal locations or on a map with a scale of at least 1:24,000, such as a USGS topographic map, locate and label
withdrawal locations. Topographic maps for this purpose may be printed from the Division of Water Resources website at
pups:%hcww.ncwater.org./ccpcua using the Ground Water Data Map Interface.
Is: Facility Name: .. Gpr�� ��_FAt'iY]._ 1 b: Registration#:
nabefllea in by DWR)
Ic: Facility Address: �y'� c�tAitr >"IAM UJVJ, NN)&OD fdG 26&e2—
Id:County -:�nrJ.4S r4rikJTti' le: Reporting Year:
If., Company or Person Making Withdrawal: -rznyr 2yjJ p/LIpIJ Tr t/ ck e vq LC C
Ig: Mailing Address: 1�?,i LAwk'-
City: _S4r-k.-s,3nluC(62 State: ryZipcode: eA'S S4L6
I h: Contact Person: Lytaeb4 Title: $A.E'-2T't' 0 �f!`
l is Telephone: (C![O) 949 - 10 2A I j: Fax: (Cf to a 4 c 1 P 5
Ik: Email: Pr .as-r 1, a AIANd W IA41nn�rrlu t;Ohry
2a: Type of Water Use: Public Water System (PWS ID# )
Industrial ( SIC Code # : /627 or NAICS Code # : )
Agricultural Irrigation Livestock
Golf Course Irrigation Aquaculture
Landscape Irrigation Mining, Permit I.D.
Temporary Dewatering (less than 12 months)
2b: Total Daily withdrawal capacity gallons SN LLTraT[bN
Note to Irrigation Water Users:
You may use the table below to report water use or you may use Table 2d: Irrigation Water Use to report water use in terms of
acres irrigated and amount of water applied.
Table 2c: DAILY WATER USE BY MONTH FOR T HE REPORTING YEAR Fill in the table below recording the
number of days each month water was withdrawn, the average amount that was withdrawn for the days used, and the
maximum day withdrawal for month. Report withdrawal amounts in gallons of water. Enter "0" for months with no
withdrawals.
Month
# of Days
Used
Average Daily
Withdrawal for Days
Used(gallons)
Maximum Day
Withdrawal for
month(gallons)
Month
# of Days
Used
Average Daily
Withdrawal for Days
Used(gallons)
Maximum Day
Withdrawal for
month allons
Jan
Jul
Feb
Aug
Mar
Sep
Apr
Oct
May
Nov
Jun
Dec
DWR CCPCUA-1 (Revised February 19, 2018)

Table 2d: IRRIGATION WATER USE FOR THE REPORTING YEAR (Irrigators may report water use in this table if it is more convenient)
Answer the question shown at the tot) of each column for each month.
Month
How many days did
you irrigate in each
month?
For days initiated, how
many acres per day did
you irrigate, on
avers e?
For days irrigated, how
many inches per day
were applied, on
avers O
What was the
maximum daily
amount applied to
this acres e?
Month
How many days did
you nation, in each
month?
For days irrigated,
how many acres per
day did you irrigate,
on avem c?
For days irrigated, how
many inches per day
were applied, on
avem e?
What was the
maximum daily
amount applied to
this acres e?
Jan
Jul
Feb
Au
Mar
Se
Apr
Oct
May
Nov
Jun
Dec
Table 2e: GROUND WATER WITHDRAWAL INFORMATION FOR THE REPORTING YEAR (complete a row in this table for each ground water
withdrawal) Report all depths as in feet below land surface and pump capacity in " alions per minute" m .
Well or Sump Identifier
Latitude
Longitude
Well or Max Pit
Depth
,
(feet)
Depth to top
of screen or
open hole
feet
Depth to
bottom of
screen
feet
Depth to
pump intake
(feet)
Well
Diameter (inches)
or Acres Mined
# of days
used
this year
Pumping
Capacity
(spin)
If latitude and longitude are unknown you may mark and label the locations of all wells on a map to be submitted with this Form. Use the same identifiers used to report data in Table 2e.
Table 2f: SURFACE WATER WITHDRAWAL INFORMATION FOR THE REPORTING YEAR (complete a row in this table for each surface water
withdrawal) Report pump capacity in "gallons per minute" (Rpm).
Withdrawal Identifier
Latitude
Longitude
Name of Stream supplying withdrawal site,
Is withdrawal from a
pond or lake?
( Y or N )
Is withdrawal
from a river or
stream?
Y or
# of days
used
this year
Pumping
capacity
(gpm)
If latitude and longitude are unknown you may mark and label the locations of withdrawals on a map to be submitted with this form. Use the same identifiers used in Table 2f.
Please sign and return the completed form to: CCPCUA Withdrawal Registrations, NC Division of Water Resources, 1611 Mail Service Center, R leigh, NC 27699-1611
For asti ranee call 919-707-9000
PR)N PE ame of Pers Regist rin Title tgnatu Date
,io �al� ��1��►c�&
DWR CCPCUA-1 (Revised February 19, 2018)