WM0801147_Application_20200124

4300 Sapphire Court, Suite 100
GMA Greenville, North Carolina 27834
Telephone [phone]
---- ^� Fax [phone]
www.qma-nc.com
GROUNDWATER MANAGEMENT ASSOCIATES, INC.
January 24, 2020
Mr. Geoff Kegley
NCDEQ-DWR,
Water Quality Regional Operations
Groundwater Protection Branch
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Permit Application for West Carteret Water Corporation (WCWC) Test Well TW9 near
Newport, Carteret County, North Carolina, GMA Project #56914
Dear Mr. Kegley
Groundwater Management Associates, Inc. (GMA) has been contracted by the West Carteret Water
Corporation (WCWC) to act as an agent during the test well application permit process.
Please find enclosed an application permit for one test well (TW9) located north of Highway 24 and
Page Lane near Newport, North Carolina. The enclosed permit application includes the completed
GW-22MR application form, a diagram of the test well design, property ownership information, and
figures illustrating the location of proposed the test well. The well construction contractor will be
Magette Well & Pump Company of Ahoskie, North Carolina.
Please let me know if you need any supplemental data from these well sites to support the
permitting of these new production wells.
If you have any questions, please feel free to contact me. GMA thanks you for your assistance with
this matter.
Best regards,
Groundwater Management Associates, Inc.
A�Q.�
Kelley A. Smith, PG
Project Hydrogeologist
CC: Richard K. Spruill, Ph.D., P.G.- Principal Hydrogeologist (GMA)
John Wise, P.E.-Principal Engineer (GMA)
Lisa Smith -Perri - WCWC

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.
FOR OFFICE USE ONLY
1. Date: Jan. 24, 2020
2, County: Carteret PERMIT NO, ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Monitoringlrest Well
4. Applicant: Lisa Smith -Perri w/ West Carteret Water Corp.
Applicant's Mailing Address: 4102 Hwy 24 Newoort NC 28570
Applicant's Email Address (if available): Lisa Smith -Perri - Iisa.smithoerriCa�wcwc.biz
5. Contact Person (if different than Applicant):
Contact Person's Mailing Address:
Contact Person's Email Address (if available):
Telephone: [phone]
Telephone:
6. Property Owner (if different than Applicant): Bernice N Paae Family TrustNVilliam A PageTelephone: 252-240-9657
Property Owner's Mailing Address: 501 Blue Heron Dr New ort NC 28570
Property Owner's Email Address (if available):
7. Property
Physical Address
(Including
PIN Number)
630501487642000 -No physical
address/Acreage
off Page
Lane
City
Newport
County Carteret
Zip
Code
28570
8. Reason
for Well(s):
Test Well for Yield &Water
Quality Assessment
(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: Vacan
(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: NA
(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).: None Known
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): None Known
14. 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: Magette Well & Pump Co. Certification No.: 2299
Well Contractor Address: 2342 US 13 S. Ahoskie. NC 27910
PROPOSED WELL CONSTRUCTION INFORMATION
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

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material: 1
3. Number of wells to be constructed in bedrock: 0
5. How will the well(s) be secured? Locking above
ground well cover
6. Estimated beginning construction date: 2/1/20
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 3/31/20
(add answers from 2 and 3)
ADDITIONAL INFORMATION
1. As required by 15A NCAC 02C .0105(0(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 wells) 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,
Sub ter 2C) and accepts full responsibility for compliance with these rules
un C7tA/ M&k j tX, e, b0L
Signature W.AWcant or *Agent Title of Applicant or *Agent
L« sM IV, p6w I * If signing as Agent, attach authorization agreement stating
Printed name of Applicant or *Agent 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 W I Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
� .Tic- 1,pILLIA" 1)9N41E I4*E J/e
Signature of Woperty Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [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]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
dR Rev. 3-1-2016

TEST WELL 9
LAND SURFACE
16"0 BORE HOLE -I
I
NEAT CEMENT GROUTBLS (O'-70' )
I
I
10"0 PVC OUTER CASING —
NEAT CEMENT GROUT
(40'-180' BLS)
9 7/8"0 BORE HOLI
4"0 SDR21/SCH80 WELL CASING
BENTONITE SEAL
(180'-185' BLS)
4"0 50-SLOT SS
CON'T SLOT -WIRE
WRAPPED SCREEN
#3 GRAVEL PACK
(185'-255' BLS)
I
BENTONITE SEAL - -
(255'-265' BLS)
4"0 304 SS CASING
4"0 50-SLOT SS
CON'T SLOT -WIRE
WRAPPED SCREEN
4"0 SCH80 SDR17 -
TAILPIECE/CELLAR
(305'-
(305310' BLS)
#3 GRAVEL PACK
012" CASING
STICKUP 2.0'
180'
185'
200'
240'
255'
25 I280,
305' 1
1 310'
A
SCALE GM A
VERTICAL 1"=50'
0 25 50�
GROUNDWATER MANAGEMENT ASSOCIATES, INC.
File: J: \500'S\56914 WELL DIAGRAM FOR TEST WELL 9 Date: 01 /21 /20
(4" x 4" PVC CASING AND STAINLESS STEEL SCREEN)
Project No. 56914 WEST CARTERET WATER CORPORTION I Figure 1
is \500's\569\14\well diagram —test well 9_56914.dwq

Tax Parcel Information:
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a r t e r e t C o u n t y,
N. C.
Owner: BERNICE N PAGE FAMILY TRUST
Current PIN: 630501487642000
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Site Address:
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NEWPORT
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Mailing Address:
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5oi BLUE HERON DR
NEWPORT NC
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28570
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Legal Description:
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ACAREAGE HWY 24 OCEAN
Prior PIN: 1502000io6
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City Limits:
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Rescue District: BR/GALES CK RESCUE
Fire District: BROAD GALES CK FIRE
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Tax District: 1015
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Township: WHITE OAK
Use: VACANT
NBHD: 150003
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Land Value: $79,782
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Bldg Htd Sq Ft:
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Bldg Value: $o
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Other Value: $o
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Year Built:
Total Value: $79,782 Noise Level:
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Sale Price: $0 AICUZ Zone:
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Deeded Acres: 35.66 GIS Acres: 35.658
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Deed Ref: ioo 8 / 266 Deed Date: p
Bedrooms: Bathrooms:
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iction and is compiled from recorded deeds, plats, and other public records and data. User; of this information are hereby notified that the aforementioned public primary
The information displayed by this website is prepared forthe inventory of real property found within th is jurisd
information sources shou d be co nsu Red for ve rification of the information oc) ntained on this site. Carteret
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sources should be consulted forver'Ification of the information contained on this site. Carteret County assumes nolegal responsibili yfor the information contained onthis site. Carteret County does notguarantee thatthe dataand map serviceswil be availableto userswithout interruption
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sources should be consulted forverification of the information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Carteret County does not guarantee thatthe dataand map services will be availableto users without interruption
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sources should be consulted for verification of the information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Carteret County does not guarantee that the data and map services will be available to users without interruption
or error. Furthermore, Carteret County may modify or remove map services and access methods at will.