WS0601432_Water Supply Well_20200327

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
Mr. Thomas N. Evans
1158 Page Circle Road
Fairmont, North Carolina 28340
SUBJECT:
Mr. Evans:
NORTH CAROLINA
Environmental Quality
March 27, 2020
Well Construction Permit No. WS06-01432
Stateline Rd/Goodyear fatun (PIN #: 924384270400)
Deed BK: D2219/Pages: 821 — 824 (dated 11 March 2020)
One (1) Water Supply Well
Fairmont, Robeson County
In accordance with the permit application from Charles R. Underwood Incorporated dated 22 March
2020 and received in the Fayetteville Regional Office on 25 March 2020, we are forwarding herewith
Well Construction Permit No. WS06-01432 dated 27 March 2020 issued to Thomas N. Evans for the
construction of one (1) water supply well to be located on land owned by Thomas N. Evans (P.I.N. #:
924384270400) located on Stateline road 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 penult 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 Robeson 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.
Sincerely, Doc uSigned by:
Trent Al en, Keg naC 1 Supervisor
Division o aterees°ources - Water Quality Programs
cc: FRO Files Charles R. Underwood Incorporated
Robeson County Health Department Division of Water Resources — Gabrielle Chianese
NORTH CAROLINA
Department of Environmental Quality
North Carolina Department of Environmental Quality I Division of Water Resources
Fayetteville Regional Office 1225 Green Street, Suite 714 I 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
THOMAS N. EVANS
FOR THE CONSTRUCTION OF AN WATER SUPPLY WELL SYSTEM consisting of one water
supply well on property owned by Thomas N. Evans located on Stateline road, Fairmont, North
Carolina in Robeson County (Pin No.: 924384270400). This Permit is issued in accordance with the
application received on 25 March 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 27th day of March 2020
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT
COMMISSION
—Doc�uSSiggnedd by: -
.nA
Trent Al1Zi; Rtalcpervisor
Division of Water Resources - Water Quality Programs
By Authority of the Environmental Management Commission
Permit No. # WS0601432

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)
1
2
3
PLEASE TYPE OR PRINT CLEARLY
In accordance with the provisions of Article 7. Chapter 87 General Statutes of North Carolina and regutations pursuant thereto
application is hereby made for a permit to construct water supply wells
Date �.. ,3t22/2O20
County'
FOR OFFICE USE ONLY
PERMIT NO W 5Ofe O f 4P.- ISSUED DATE 3 /2 7 /20v'
�,r Cq+ro f ✓j qo O eat r �1 ,r
Applicant ,..�_.... D .� l ,fi'�..i�i � ....�.�, � �Teleptione �.�'1� ' �c.��.L',1
Applicants Mailing Address //J.. f& / . .1C,4,07•47Lele, 01✓0
Applicant's Email Address (tf available) &J,f4ic'f/4J ai2z1,1
4 Contact Person (if different than Applicant) CAft U 0 Telephone ,I 0 _ .2
� I'1
d S N C30
Contact Person's Mailing Address AtiGt l
Contac Person's Email Address (if available)
5 Property Owner (if different than Applicant) filar.( rh.ort Telephone 9/8 Z7 ' /ll)
Owner's Mailing Address
z.:._..stA4 i‘.-ifitxvi _zikt ozfoo
Owners Email Address (if available) !G� Q.l'IfJl�iCE'�,IG/:,� G�'l7/. CD!?` 4/a
V100(0
6 Property Physical Address (including PIN Number) �,�W( Dile /fQ !l �� Gt��3�,� /l/ � 0 3Cary, �iY/1teJ4� County Zip Code FJ
7 Intended use of Well or Well System b�.,/�� �� �f 3 ���d 7
00
(examples irrigation, consumption etc) 1
8 Will the proposed water supply well or well system replace or be added to an existing well or well system? 144
(If yes, complete questions 7 and 8) (1f no. complete question 7 and then skip to question 9)
9 Total design capacity of proposed welt or well system in gallons per day (god)
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? iv 0 If yes give Public Water ID Number
If yes give Project Engineer and contact information .a,,.,.r19}1ID_.._�T.t
12 Well Contractor T,i4., e-Z 1 e_{ Well Contractor Certification No iti3O - 6
2 , 41 4
Well Contractor Address C 0.�(ii--�R ►UYd %Rio00 d x.t'n „ 00 ��_„A....2.3 --'ul
PROPOSED WELL CONSTRUCTION INFORMATION
1 As required by 15A NCAC 02C 0105(fx7) attach a well
construction diagram of each well showing the following
a Borehole and well diameter
b Estimated well depth
c Screen intervals
d Sand/gravel pack intervals
e Type of casing matenal and thickness
f Grout horizons
g Well Head completion details
2 No of wells to be constructed in unconsolidated
material
3 No of wells to be constructed 'n bedrock
4 Total No of wells to be constructed 1 _
(add answers from 2 and 3)
5 Estimated beginning construction date PiZ / L Zo Z I'
6 Estimated constructon completion date t <Tk) L % O Z- L)
Continued on Reverse

ADDITIONAL INFORMATION
1 As required by 15A NCAC 02C 0105(f)(5) attach a scaled map of the site showing the locations of the following
a Alt 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), Landfillsor 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 eastem 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 emlit as regulated under the Well Construction Standards (Title 15A of the North Carolina
Administrative CodejSubchapter 2C) and accepts full responsibility for compliance with these rules
Signature of Applicant or 'Agent
7:4174( 6102.5
statingPnnted name of Applicant or Agent
Title of Applicant or 'Agent
If signing as Agent, attach authorization agreement
that you have the authority to act es 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 wens 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 13rOPerty Owner (if different than Appl cant
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resourms Regional Office
Asheville Regional Office
2090 U S Highway 70
Swannanoa NC 28778
Phone [phone]
Fax [phone](343
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 (704) t383-1899
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]Q
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone [phone]
Fax [phone]
Winston-Salem Regional Office
450 W Hanes Mil, Road
Suite 300
Winston Salem NC 27105
Phone [phone]
Fax [phone]
GW-22W Rev 3-1.2016

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Robeson County Government
TAX ADMINISTRATION RECORD SEARCH
Select Search:
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Click the Zink in the name column to display the Property Record Report and details for that property.
6 Records Found Matching your criteria 280202013 ''" New Search
Line
1
2
Parcel Num
Owner
28020201301 MILLER DONALD GEORGE
28020201304 DAVIS CLAY W & WF
3 28020201302 GOODYEAR GENERAL JAMES
V
4 280202013
5 28020201303
6 28020201305
GOODYEAR GENERAL JAMES
GOODYEAR GENERAL JAMES
& WF CA
GOODYEAR GENERAL JAMES
Location Address
1110 STATE LINE
1316 ST. LINE
1165 COWPEN
SWAMP
1165 COWPEN
SWAMP
1165 COWPEN
SWAMP
1165 COWPEN
SWAMP
Records 1 to 6 of 6
Account
No.
1090705
1124936
Descriotion
LT N S SR 2277
AC NIE SIDE SR
2277
AC N
38267010 TR 3 OF SR 2277
38267011 A E COWPEN
38267013
AC N OF SR 2277
TR 3A
38267014 NORTH OF SR
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Data Disclaimer. All data shown here is from other primary data sources and is public information. Users of this
data are hereby notified that the aforementioned public information sources should be consulted for verification
of the information contained on this website. While efforts have been made to use the most current and
accurate data, Robeson County, NC and Data Providers assume no legal responsibility for the use of the
information contained herein.
You can direct any questions or comments about the data displayed here on the Robeson County Tax Contact
Page
This application was developed for Robeson County by ,;
NexGen Digital Document Solutions ups data H
www.ustaxdate.com

This ovensmenet test PIN 2110242411, 2UR2424212
211024241302, 21zq-0T41303,21024241i,
21024Iaini
k d.s w.nr dolegos+l id vda.m Us lone
r1Sed ft d . Robeson CouttyTU Cobctot,
but does ral ae* , deed timbal**,
PNi ! t
Excise Tax $ 373.0 o
2020001 990
=BB ROBESON CO, NC FEE $2S DO
STATE OF NC REAL ESTATE EMX
$373.00
pREMDMIO 1 SECOROEt3
F=< 03-11-2020 0323:02 PM
Vf COO L iocKLEAR
ti
.,. BK: D 2219
`--` PG: 821-824
NORTH CAROLINA GENERAL WARRANTY DEED
Tax Block: Lot:
Parcel Nos.: 2802-02-011; 2802-02-012;
2802-02-01302; 2802-02-01303;
2802-02-013; 2802-02-01305 ,p
Prepared by. ERIC WEST, Attorney at Law, PLLC
HOLD FOR: ERIC WEST, Attorney at Law, PLLC
• • PROPERTY IS /, IS NOT THE PRIMARY RESIDENCE OF THE GRANTORS
Brief Description for the Index:
81.o5Acres, SR 24777 — Whitehouse Township
TI IIS DEED made this io'' day of March , to_ ao , by and between
GRANTOR
CAROLYN C. GOODYEAR, widow
1165 Cowpen Swamp Road
Fairmont, NC 2834o
GRANTEE
THOMAS NICHOLS EVANS, Trustee of
the T.N. Evans Revocable Living Trust
Dated October 21, 2019
1158 Page Circle
Fairmont, NC 2834o
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as
required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt
of which is hereby acknowledged, has and by these presents does grant, bargain, sell and
convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in
Whitehouse Township, Robeson County, North Carolina and more particularly described as
follows:
See Exhibit "A" attached hereto and incorporated herein by reference.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
appurtenances thereto belonging to the Grantee in fee simple.

And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee
simple, has the right to convey the same in fee simple, that title is marketable and free and
clear of all encumbrances, and that Grantor will warrant and defend the title against the
lawful claims of all persons whomsoever except for the exceptions hereinafter stated
Title to the property hereinabove described is SUBJECT' to the following exceptions:
Subject to ad valorem taxes, all applicable zoning and land use ordinances, statutes
and regulations; and to the provisions of all applicable restrictive covenants and utility
easements of record
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has
caused this instrument to be signed in its corporate name by its duly authorized officers, the
day and year first above written.
(Seal)
State of North Carolina
County of Robeson
i, Devon Bodges , Notary Public of said County and State do hereby certify
that Carolyn C. Goodyear, personally known to me and personally appeared before me and
acknowledged the voluntary execution of the foregoing instrument,
Witness my hand and official seal this the loth day of March , 2020.
Notary gubiic
My Commission Expires: p8/22/2020

EXHIEIT "A"
TRACT TWO - Parcel No. 2802-02-Q11:
BEGINNING at an iron stake in a ditch; then dividing carver between Lot No. 3-A and 4-A
and runs thence South 33 degrees East 3.95 chains to a stake in the dividing line of Lot No. 1;
thence as that lot, North 55 degrees 15 minutes East 7.75 chains to a ditch, the original line;
thence North 49 degrees 20 minutes West 3.77 chains to the intersection of first mentioned
ditch; thence as that ditch, South 56 degrees go minutes West 6.66 chains to the beginning,
containing 2.8 acres, more or less, and being Lot No. 4-A of the G.E. and Mittie Morgan
lands.
TRACT THREE - Parcel No. 28O2-02-0121
BEGINNING at a stake on a ditch, the beginning corner of Lot No. 3 and runs as the line of
Lot No. 3, North 16 degrees 3o minutes West 13.95 chains to a stake, the original line; thence
as the original line, North 77 degrees 5 minutes East 5.75 chains to a stake, water oak
pointers; thence North 49 degrees 25 minutes East 8.17 chains to a stake and pine stump
pointer in original corner; thence South 49 degrees 20 minutes East 15.72 chains to a stake an
forked black gum pointer, corner of Lot No. 3-A; thence as that line, South 57 degrees West
11.63 chains to a stake; thence South 3o degrees 5o minutes East 5 chains to a stake; thence
as the ditch, South 56 degrees 50 minutes East 5 chains to a stake; thence as the ditch, South
56 degrees West 3 chains; thence as the ditch, North 65 degrees West 7.21 chains; thence as
the ditch, South 75 degrees 3o minutes West 1.74 chains to the beginning, containing 27.85
acres, more or less, and being Lot No. 4 of the G.E. and Mittie Morgan lands.
TRACT` FOUR - Parcel No. 28O2 g2-O t_3o2;
Containing 21.75 acres, more or less, being bounded on the North by lands of C.K. Morgan
Estate; on the East by lands of Cleo Goodyear; on the South by lands of Dixie Morgan; on the
West by the run of Cowpen Swamp.
wRACT FIVE - Parcel No. 2802-02-0130
Containing 8.7 acres, more or less, bounded on the North by lands of Cleo Goodyear; on the
East by lands of J.R. Harrington; on the South and West by lands of Cleo Goodyear.
Said above Tracts Four and Five being known and designated as Tract Nos. 3 and 3A
respectively on plat of property of C.E. & Mittie Morgan Estate recorded in Robeson County
Registry in Book of Maps 4, at Page 134.
For reference see Will of Dixie Morgan Page filed in 85 E 422, Office of the Clerk of Superior
Court of Robeson County and File No. 85 E 95, Office of Probate Court of Dillon County,
South Carolina.
TRACI' SIX AND SEVEN (ParcelNoa. 2802-02-013 and 2802-02-0L305):
That certain tract or parcel of land located approximately ten miles southwest of the Town of
Fairmont and on the northern side of the public road leading from the Joe Morgan residence
to Oakdale Church, adjoining the run of Cowpen Swamp on the West and lands of Dixie
Morgan Page et als on the North and East, the lands hereby conveyed being described by
courses and distances as follows: BEGINNING at a stake in the center of said public road, a
corner of Tract No. 2 of the G.E. and Mittie Morgan lands, and runs thence as the center of
said road and beyond, North 78 1/4 degrees East 3.86 chains to a stake, a corner of Tract No. 1,
thence North 5/ degrees West 1.54 chains to a stake; thence North 3o degrees 50 minutes
West 2.82 chains to a stake in the line of Tract No. 4; thence South 56 degrees 50 minutes
West as the line of Tract No. 4,1.40 chains to a stake; thence continuing with the line of Tract
No. 4, South 56 degrees West 3 chains to a stake; thence continuing with said line, North 65
degrees West 7.2t chains to a stake; thence to and with the southern line of Tract No. 3, South
75 1/2 degrees West 9.17 chains to a stake; thence continuing with said southern line of Tract
No. 3, South 781 degrees West 12.80 chains to a stake in the run of Cowpen Swamp, ashe,
blackgtun, and water oak pointers; thence as the run of Cowpen Swamp, a southerly direction,

approximately 6.5o chains to the center of the public road aforesaid; thence as the center of
said public road, an easterly direction, approximately 28 chains to the beginning, containing
22 acres, more or Iess.
Being that portion of Lot No. 2 of the G.E. and Mittie Morgan Estate lands lying north of the
center line of the public road aforesaid, a map of said lands being duly recorded in Robeson
County Registry in Book of Maps No. 4, at Page 134, reference to said map and registration
being hereby made for a more particular description of said lands.
Being same lands described in Deed dated December 29, 1958 from John P. Morgan and wife,
Bruce G. Morgan to Willie F. Page and wife, Dixie M. Page and recorded in Book 12-X, at Page
75, Robeson County Registry.
LESS AND EXCEPT THE FOLLOWING TRACT:
i. Being all of that 2.00 acre tract conveyed by Deed dated July 14, t992 from General
James Goodyear and wife, Carolyn C. Goodyear to Joshua James Goodyear recorded in
Deed Book 74 at Page 754, Robeson County Registry, reference to said Deed is hereby
made for a more particular description of said tract. (Parcel No. 2802-o2-01304)

Barber, Jim
From:
Sent:
To:
Cc:
Subject:
Attachments:
Russell Underwood <[e-mail]>
Wednesday, March 25, 2020 3:35 PM
Barber, Jim
Drilling
[External] 2 Permit Applications for 2 Ag wells for Nick Evans
Nick Evans -Carolyn Goodyear farm.pdf; Nick Evans -Terry Grier farm.pdf
CAUTION:
inks or open attachments unless you verify. Send all suspicious email as an attachment toii
i
Mr. Barber, please find enclosed permit applications for 2 wells on 2 different properties recently purchased by Thomas
Nick Evans. I looked at the Robeson county GIS site and since it does not yet list Mr. Evans as the owner, I asked that he
send me the deeds for these properties which are also enclosed. He bought them from a trust. He will call the farms,
Carolyn Goodyear farm and the Terry Grier farm.
We would appreciate the attention to processing these applications for him. I hope you are doing well through all of this
unrest in the country and I hope that soon, this virus is gone and we can all go back to business as usual.
Take care and if there is anything else that you need in reference to these, please call or email me.
Please notice as well, they set up an email for me called [e-mail] but since it was so new and I needed
these to get to you, I am sending on Russell's machine. Hope to be using that email in the future.
Thank you. Carolyn Underwood 919-604-1198
Russell D. Underwood, P.E.
President
Charles R. Underwood, Inc.
2000 Boone Trail Road
Sanford, NC 27330
Phone: [phone]
Fax: [phone]
Website: www.crupumps.com
1

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