WS0801047_Application_20200226

I Site 2 I
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY — DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A WATER SUPPLY WELL OR WELL SYSTEM
(Wells or Well Systems with a Design Capacity of 100,000 Gallons Per Day or Greater)
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 water supply wells.
1. Date:
2. County: Duolin
FOR OFFICE USE ONLY
PERMIT NO. WSOU 10 Y7 ISSUED DATE:
3. Applicant: Dennis N. Beasley- Boyce Farm Telephone:
Applicant's Mailing Address: 259 Beasley Road Magnolia N.C. 28453
Applicant's Email Address (if available):
4. Contact Person (if different than Applicant): Lon Beasley Telephone: [phone]
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Contact Person's Mailing Address: 810 Nash Johnson Pond Road Magnolia, N.C. 28453 t
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Conlac Person's Email Address (if available): Ion. beasleyahousoefraeford com
5. Property Owner (if different than Applicant):
Telephone: DEC 0 9 2019
Owner's Mailing Address:
Se ;tin
Owner's Email Address (if available): ".aI t7ffi
6. Property Physical Address (including PIN Number): PIN # 236700244546
City: Wallace ( Rockfish Township) County: Duolin Zip Code: 28466
7. Intended use of Well or Well System: Agricultural irrigation
(examples: irrigation, consumption, etc.)
8. Will the proposed water supply well or well system replace or be added to an existing well or well system? No
(If yes, complete questions 7 and 8) (If no, complete question 7 and then skip to question 9)
9. Total design capacity of proposed well or well system in gallons per day (gpd): 1.008.000gpd
10. If adding a well to an existing system, list the existing water supply wells in the existing system and their respective yields:
11. Is this a public well or well system? No If yes, give Public Water ID Number:
If yes, give Project Engineer and contact information:
12. Well Contractor: Steve English Well Contractor Certification No.: 2824-A
Well Contractor Address: P.O. Box 2797 Surf City, INC 28445
PROPOSED WELL CONSTRUCTION INFORMATION a,",
1. As required by 15A NCAC 02C .0105(f)(7), attach a well
construction diagram of each well showing the following: 2. No. of wells to be constructed in unconsolidated
a. Borehole and well diameter material: 2
b. Estimated well depth 3. No. of wells to be constructed in bedrock: 0
C. Screen intervals 4. Total No. of wells to be constructed: 2
d. Sand/gravel pack intervals (add answers from 2 and 3) -
e. Type of casing material and thickness 5. Estimated beginning construction date:
I. Grout horizons 6. Estimated construction completion date: 12/30/2019
g. Well Head completion details
Continued on Reverse

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.
2. As required by 15A NCAC 02C .0105(g)(3), for wells screened in multiple zones or aquifers, provide representative data on the
static water level, pH, specific conductance, and concentrations of sodium, potassium, calcium, magnesium, sulfate, chloride,
and carbonates from each aquifer or zone from which water is proposed to be withdrawn.
3. Attach any water use permits (if required). [e.g. Central Coastal Plain Capacity Use Area Permit is required in 15 eastern NC
counties by NC Division of Water Resources, visit: http://www.ncwater.org]
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
the Water Supply 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
SignaturebfApplicant or* ent
Stephen English
Printed name of Applicant or *Agent
Owner. E&B Water Wells
Title of Applicant or *Agent
* if 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
water supply wells as outlined in this Water Supply Well Construction Permit application and that it shall be the responsibility of the
applicant to ensure that the water supply well(s) conform to the Well Construction Standards (Title 15A of the North Carolina
Administrative Code, Subchapter 2C).
Signature of Property Owne if different than Applicant)
oczaA"S 0. 6e.w3/1-11/
Printed name of Property Owner (if differe t 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]
Fax: [phone]

1.
b. No existing wells within a 500 feet.
To whom it may concern:
These wells will be used seasonally for agricultural
irrigation to grow crops such as corn, soybeans, and
wheat. We irrigate using NRCS best management practices
and use center pivots. We only irrigate to supplement
deficits in rainfall to meet crop water demand. This should
mainly be during crop reproduction stages.

DIAGIIAM OF PROPOSED
CONSTRUCTION SPECIFICATIONS
Straight -Screened
or
Gravel -Packed Well
(Constructed in unconsolidated formations)
(Open -End Well
(Constructed in consolid-
ated formations)
land surface
s
A) Casing: i
``j L 1) Inner: t `I type j I. D. lbs./ft.
,
ft. (depth) ft. (into rock)
i
2) Outer: type I. D. lbs./ft.
z. 7i
ft. (depth)
g) Cement:
1) Inner Casing; ft. to - S ft.
JIh i 2) Outer Casing: ft. to ft.
Rock
V^' C) Screen(a): %�� type I. D.
ft, to i S V ft.
/ \T. ft. to ft.
C .�- .
D) Gravel: � , a. to ftin.
(size)
(Fill in each blank that applies and use appropriate diagram
i to show proposed construction including, but not limited to,
`= casing (outer and inner), sealing material (cement, clay,
y` etc.), packers, screens, gravel, chemical feed lines, etc.)
Location Diagram: (Previously prepared maps may be submitted provided they con-
tain information required in item (g) of the application).
r
Rock

Parcel #: 10- 60- - - Property Address:490 OLD CAMP RD
Account M 0401926 Mailing Address:259 BEASLEYS RD MAGNOLIA NC 28453
Deed Ref: 1689/27 2011 Year Built:1954 Misc. Impry Value:$46
Year Built:1954 Last Sale Price: $615,000 Fire Code: 08
DeededAcres:283 AssessedValue:238900 Notes: CO NV_ NOTES
Last Sale Date: 2010/11/18 Property Class:2 Remarks:
Year Built:1954 Heat SQ Feet:1554 Land Value Only:$174200
DISCLAIMER. Deoerdl 2919
The information gathered from this site is
for informational purposes only and the
map(sl printed from this site should NOT be
used as or in place of an actual survey.
Tie map(s) should NOT be used in sales
orconveyances.
Generated by http://gis.duplinwuntync.mm

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