WS0601439_Water Supply Well_20201030

ROY COOPER
Governor
MICHAEL S. REGAN
Secretory
S. DANIEL SMITH
Director
Mr. Michael Nagowski, Member
Hoke Healthcare, LLC
1638 Owen Drive
Fayetteville, North Carolina 28304
SUBJECT:
Mr. Nagowski:
NORTH CAROLINA
Environmental Quality
October 30, 2020
Well Construction Permit No. WS06-01439
Hoke Healthcare, LLC campus (PIN #: 494660201462)
One (1) Water Supply Well
Raeford, Hoke County
In accordance with the permit application from Bill's Well Drilling Company dated 28 October 2020
and received in the Fayetteville Regional Office on 28 October 2020, we are forwarding herewith Well
Construction Permit No. W S06-01439 dated 30 October 2020 issued to Hoke Healthcare, LLC for the
construction of one (1) water supply well to be located on land owned by Hoke Healthcare, LLC
(P.I.N. #: 494660201462) on Medical Pavilion Drive as identified above and depicted on a site map
provided with the permit application.
This Permit will be effective from the date of its issuance and shall be subject to the conditions and
limitations as specified therein.
Please note that according to North Carolina Administrative Code, Title 15A, Subchapter 2C, Section
.0105 (g), "it is the responsibility of the well owner or his agent to see that a permit is secured prior to
the beginning of construction of any well for which a permit is required." Local permitting may be
required, so also check with the county Environmental Health program to determine the requirements
for Hoke County.
If any parts, requirements, or limitations contained in this Permit are unacceptable to you, you have the
right to an adjudicatory hearing before a hearing officer upon written demand to the Director within 30
days following receipt of this Permit, identifying the specific issues to be contended. Unless such
demand is made, this Permit shall be final and binding.
ES-infeeral by:
VAN
`ISMAlb tekgional Supervisor
Division of Water Resources — Water Quality Programs
cc: FRO Files Bill's Well Drilling Company
Hoke County Health Department Division of Water Resources — Gabrielle Chianese
NORTH too 04"AD
oroeru. ianmanwauin
North Carolina Department of Environmental Quality I Division of Water Resources
Fayetteville Regional Office 1225 Green Street, Suite 7141 Fayetteville, North Carolina 28301
910.433.3300

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALTIY
DIVISION OF WATER RESOURCES — WATER QUALITY PROGRAMS
PERMIT FOR THE CONSTRUCTION OF A WATER SUPPLY WELL OR
WELL SYSTEM
(Wells or Well Systems with a Design Capacity of 100,000 Gallons Per Day or Greater)
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
HOKE HEALTHCARE, LLC
FOR THE CONSTRUCTION OF AN WATER SUPPLY WELL SYSTEM consisting of one water
supply well on property owned by Hoke Healthcare, LLC on Medical Pavilion Drive, Raeford, North
Carolina in Hoke County (Pin No.: 494660201462). This Permit is issued in accordance with the
application received on 28 October 2020 in conformity with specifications and supporting data, all of
which are filed with the Department of Environmental Quality and are considered integral parts of
this Permit.
This Permit is for well construction only and does not waive any provision or requirement or any
other applicable law or regulation. Withdrawals of 1 MGD or more are required to be registered with
the Division of Water Resources in accordance with 143-215-.22H.
This Permit does not constitute approval of a site, for which the Public Water Supply Section may
require additional information or approval of the proposed volume of water to be withdrawn, within
an area defined as a Capacity Use Area (G.S. 143-215.15) and regulated by the Division of Water
Resources.
Construction of any well under this Permit shall be in strict compliance with the North Carolina Well
Construction Regulations and Standards (15A NCAC 02C .0100), and other State and Local Laws
and regulations pertaining to water supply well construction.
If any requirements or limitations specified in this Permit are unacceptable, you have a right to an
adjudicatory hearing upon written request within.30 days of receipt of this Permit. 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 a demand is made, this Permit is final and binding.
This Permit will be effective for one year from the date of its issuance and shall be subject to other
specified conditions, limitations, or exceptions as follows:

1. A well test for yield shall be conducted in accordance with 15A NCAC 02C .0110(b) and the
results of that test shall be submitted to the Division of Water Resources Regional Office
within 30 days of the test conclusion.
2. Each well shall have a Well Contractor Identification Plate and a Pump Installation
Information Plate in accordance with 15A NCAC 02C .0107(j) (2) and (3).
3. Well construction records (GW-1) for each well shall be submitted to the Division of Water
Quality's Information Processing Unit within 30 days of the well completion.
4. When the well is discontinued or abandoned, it 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 Resources Information Processing Unit within 30 days of the well abandonment.
5. In accordance with your application and the information provided in reference to the
subject proposed well, this permit is issued with construction standards that exceed the
minimum standards specified in 15A NCAC 2C .0107. Specifically, the well grout
requirement for this well will be as follows: the well casing shall be grouted to the first
competent confining unit greater than 20 feet below land surface or a minimum of fifty
feet if no competent confining unit is encountered during construction. All other
minimum construction standards shall be met.
6. Any well has the potential to create a pathway for contaminates to enter the subsurface
aquifers. The location of this well increases the likelihood of this occurring due to the
application of agricultural chemicals in proximity to this well. As part of this permit, you as
the well owner, are responsible for maintaining a minimum setback of 50 horizontal
feet from the well with all chemical applications (i.e. herbicides, pesticides, fertilizers,
etc.) associated with any agricultural land use or chemical mixing operations.
Permit issued the 30th day of October 2020
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT
COMMISSION
---Dacusigned by:
Trent A&Ien;8Rtsgt tta@ESupervisor
Division of Water Resources - Water Quality Programs
By Authority of the Environmental Management Commission
Permit No. # WS0601439

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:
County:
Applicant
Hoke
Applicant's Mailing Address:
FOR OFFICE USE ONLY
PERMIT NO. Li ISSUED DATE: /0/30 /2
Hoke Healthcare. LLC
Telephone:
[phone]
210 Medical Pavillion Drive Raeford, NC 28376
Applicant's Email Address (if available): bpearce(capefearvalley.com
4. Contact Person (If different. than Applicant): Robert Godwin Telephone: [phone]
Contact Person's Mailing Address: 1638 Owen Drive Fayetteville. NC 28304
Contac Person's Email Address (if available):.
Property Owner (if different than Applicant):
Owner's Mailing Address:
[e-mail]
Telephone:
Owner's Email Address (if available):
Property Physical Address (including: PIN Number): 210 Medical Pavillion Drive (PIN: 49466020146Z)
City: Raeford County: - Hoke Zip Code: 78376.
7. Intended use of Well or Well System:
(examples: Irrigation, consumption, etc.)
8. Will the proposed water supply well or well system replace or be added to an existingwell or well system?
(If yes, complete questions 7 and 8) (1f 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): 500,000
10. If adding a well to an existing system, list the existingwater supply wells in the existing system and their respective yields:
11. Is this a public well or well system? If yes, give Public. Water ID Number:
If yes, give Project Engineer and contact information:
12. Well Contractor: tlona%han fl ami on ka. Well Contractor Certification No.: 3y6 5- A
8;11'.s Jy/tN n 9 Ca goo /(% ,4t$ii /oli F f v' d A/C a 8-3
Well Contractor Address: G ar qe e ff@ , 2r t
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .0105(f)(7), attach a well
construction diagram of each well showingthe following:
a. Borehole and well diameter
b. Estimated well depth
c. Screen intervals
d. Sand/gravel pack intervals
e. Type of casing material and thickness
f. Grout horizons
g. Well Head completion details
2. No. of wells to be constructed in unconsolidated
material: 1
3. No. of wells to be constructed In bedrock: 0
4. Total No. of wells to be constructed:
(add answers from 2 and 3)
5. Estimated beginning constructiondate:
'� .30 eCT2o20
6. Estimated construction completion date: �Re. .20L I
Continued on Reverse

ADDITIONAL INFORMATION
As required by 15A NCAC 02C .01050)(5), attach a scaled map of the site showing the locations of the following:
a.
b.
c.
d.
e.
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.
All existing wells. identified by type of use, within 500 feet of the proposed well or well system.
The proposed well or well system.
Any test borings within 500 feet of proposed well or well system.
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. 143.215.10(3(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::Uwww,ncwater.org]
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed inaccordance with approved specifications and conditions of
the Water Supply Wellonstruction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina
Ad ist ive Code, Subchapter 2C) andaccepts full responsibility for compliance with these rules
XSignatuAgent Titleof Applicant or `Agent
Vice President - Engineering. Emergency Management
Brian Pearce • if signing as Agent, attach aulhofization 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
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 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
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-22W Rev. 3-1-2016

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Barber, Jim
From:
Sent:
To:
Cc:
Subject:
Attachments:
Bill's Well Drilling Co <[e-mail]>
Wednesday, October 28, 2020 3:19 PM
Barber, Jim
White, Kenneth B
[External] Permit Request
Bladen Permit Request.pdf; Hoke Permit Request.pdf
Jim,
Please call Jonathan to discuss
Christina Jester - Office Manger
Bill's Well Drilling Co
800 McArthur Rd, Fayetteville, NC 28311
910-488-3740 - Phone
officecr billswelldrilling.com
www.billswelldrilling.com
Confidentiality Notice:
This message, together with any attachments, is intended only for the authorized use of the individual or entity to which it is addressed. It contains information
that is confidential and prohibited from disclosure to persons other than the intended addressee. If you are not the intended recipient, you are hereby notified that
any distribution or copying of this message or any attachment Is strictly prohibited. If you have received this item in error, please notify the original sender and
destroy this item, along with any attachments. Thank you.
1

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494660201462
KE HEALTHCARE, LLC
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rttps://hoke2.connectgis.com/Map.aspx

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Limited Liability Company
Legal Name
Hoke Healthcare, LLC
Information
Sosld: 1101985
Status: Current -Active 0
Date Formed: 6/11/2009
Citizenship: Domestic
Annual Report Due Date: April 15th
Registered Agent: Nagowski, Michael
Addresses
Mailing Principal Office Reg Office
1638 Owen Drive 1638 Owen Drive 1638 Owen Drive
Fayetteville, NC 28304-3424 Fayetteville, NC 28304-3424 Fayetteville, NC 28304-3424
Reg Mailing
1638 Owen Drive
Fayetteville, NC 28304-3424
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Member
Michael Nagowski
1638 Owen Drive
Fayetteville NC 28304
https://www.sosnc.gov/online_services/search/Business_Registration_Results 10/30/2020

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