WM0801142_Permit (Issuance)_20191031

DocuSign Envelope ID: 2B3B7A41-310C-468B-A34E-3C8F5C606A1C
PERMIT NO. WM0801142
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION OF A WELL OR WELL SYSTEM
In accordance with the provisions of Article 7, Chapter 87, North Carolina General Statutes,
and other applicable Laws, Rules and Regulations
PERMISSION IS HEREBY GRANTED TO
Circle K Stores, Inc.
FOR THE CONSTRUCTION OF two (2) monitoring wells, which will be located on property owned by
Kenneth G. Lloyd located at 6502 Market Street, Wilmington, New Hanover County, in accordance with the
application received October 29, 2019 and in conformity with specifications and supporting data, all of which
are filed with the Department of Environmental Quality and are considered part of the Permit.
This Permit is for well construction only and does not waive any provisions or requirements of the Water Use
Act of 1967, or any other applicable laws and regulations. Well construction shall be in compliance with the
North Carolina Well Construction Regulations and Standards. However, this Permit pertains to the
jurisdictional authority of the Division of Water Resource and does not waive the requirements of other
jurisdictions.
This Permit will be effective from the date of its issuance until October 31, 2020, and shall be subject to other
specified conditions, limitations, or exceptions as follows:
1. The well(s) shall be located and constructed as shown on the attachments submitted as part of the permit
application.
2. Well construction record (GW-1) for each well must be supplied to the Division of Water Resources'
Information Processing Unit within 30 days of well completion. Provide the well construction permit
number on the GW-1 form.
3.Issuance of this Permit does not obligate reimbursement from State trust funds, if these wells are being
installed as part of an investigation for contamination from an underground storage tank or dry cleaner
incident.
4. Issuance of this Permit does not supersede any other agreement, permit, or requirement issued by another
agency.
5. The well(s) shall have a Well Contractor Identification Plate in accordance with 15A NCAC 02C.0I08(o).
6. When the well(s) are discontinued or abandoned, they shall be abandoned in accordance with 15A NCAC
02C.0113 and a well abandonment record (GW-30) shall be submitted to the Division of Water Resource's
Information Processing Unit within 30 days of well abandonment.
If any requirements or limitations of this Permit are unacceptable, you have the right to an adjudicatory hearing
upon written request within 30 days. The request must be in the form of a written petition conforming to Chapter
150B of the North Carolina General Statutes and filed with the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, North Carolina 27699-6714. Unless such demand is made, this Permit is final and
binding.
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DocuSign Envelope ID: 2B3B7A41-310C-468B-A34E-3C8F5C606A1C
PERMIT NO. WM0801142
Permit issued this 315t day of October 2019
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
DocuSigned by:
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Morella Sanchez King, PhD, PE, Regional Supervisor
Water Quality Regional Operations Section, Division of Water Resources
By Authority of the Environmental Management Commission
Cc: ATC Associates of North Carolina, P.C. (via email)
NC DWR - Laserfiche
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35550FD6.DOCX