WS0500158_Application_20220303

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: January 19, 2022
2. County: Wake
3. Applicant Ten Oaks Realty LLC
PERMIT NO.
FOR OFFICE USE ONLY
ISSUED DATE:
Telephone: [phone]
Applicant's Mailing Address: P.O. Box 257, Fallston, Maryland 21047
Applicant's Email Address (if available): Fred [e-mail]
4. Contact Person (if different than Applicant): Paul S. Scott, Geo-Technology Associates, Inc. Telephone: [phone]
Contact Person's Mailing Address: 3445 Box Hill Corp. Center Drive, Suite A, Abingdon, MD 21009
Contact Person's Email Address (if available): [e-mail]
5. Property Owner (if different than Applicant): Patricia Lasater Duma & Debra L Flentje Telephone: [phone]
Owner's Mailing Address: 7835 Valleyfield Drive, Springfield, VA 22153
Owner's Email Address (if available):
6. Property Physical Address (including PIN Number): 8736 Bells Lake Road Pin: 0679603162
City: Middle Creek
County: Wake
7. Intended use of Well or Well System: Potable supply
(examples: irrigation, consumption, etc.)
Zip Code: 27539
8. Will the proposed water supply well or well system replace or be added to an existing well or well system? Yes
(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): Estimated 80 gpm
10. If adding a well to an existing system, list the existing water supply wells in the existing system and their respective yields:
Sawyers Mill Well #10 — 17 qpm (PWSS # 02-00225) , Well #4 — 65 qpm (PWSS # 00-00814), Well #8 — 31 gpm (PWSS # 01-01304)
11. Is this a public well or well system? Yes
If yes, give Public Water ID Number: 43-92-216
If yes, give Project Engineer and contact information: Lindsay Mize, Aqua North Carolina, Inc. 919-653-6967
12. Well Contractor: Triad Drillers, Inc. Well Contractor Certification No.: 2461
Well Contractor Address: 8828 Kerrs Chapel Road, Elon, NC 27244
PROPOSED WELL CONSTRUCTION INFORMATION
1. 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
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: 0
3. No. of wells to be constructed in bedrock: 5
4. Total No. of wells to be constructed: 5
(add answers from 2 and 3)
5. Estimated beginning construction date: 3/21/2022
6. Estimated construction completion date: 4/1/2022
Continued on Reverse

DocuSign Envelope ID: F9A30775-C100-4F10-B37F-F512789591 D1
ADDITIONAL INFORMATION
Signre of Applicant or *Agent
e (
Printed name of Applicant or *Agent
1
As required by 15A NCAC 02C .0105(f)(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. 143-215.106(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
Jjt144, c z /'C401 /Pi g4 s- (M„
Title of Applicant or *Ager
* 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).
DocuSigned by:
Feb 22, 2022 1 7:21 AM Para L. Flentje
Agperty 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 Mali
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]
Wrlif$441* 11
IEIF 1
noon
GW-22W Rev. 3-1-2016

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
March 2, 2022
Dear Ms. Patricia Duma and Ms. Debra Lasater Flentje
7835 Valleyfield Dr.
Springfield, VA 22153-4117
Re: Preliminary Well Site Approval
Sawyer's Mill S/D
Water System No.: NC4392216
Wake County
Dear Ms. Patricia Duma and Debra L. Flentje Lasater:
On January 26, 2022 Tripp Pearce and I met with Paul S. Scott, Wayne Barefoot and Joshua
Robertson and conducted a preliminary investigation of the proposed well sites listed
below. The proposed wells have been assigned Water System Facility (WSF) Identification
Numbers and Sampling Point Codes as indicated below.
WSF
ID No.
Sampling
Point
Code
Description of Well Site
Preliminary
Latitude and
Longitude
SW11
RW11
100' radius around the proposed well location is
West of RW12 and is located East of Sawyer's Mill
Drive, at preliminary coordinates.
35°38'44.3"N
78°44'32.0"W
SW12
RW12
100' radius around the proposed well location is
West of RW13 and is located West of Northern Falls
Road, at preliminary coordinates.
35°38'44.7"N
78°44'34.1"W
SW13
RW13
100' radius around the proposed well location
located in the southeast corner of the property
adjacent to Bells Lake Road, at preliminary
coordinates.
35°38'44.6"N
78°44'32.0"W
SW14
RW14
100' radius around the proposed well location is
southwest of RW15 and is located West of Northern
Falls Road, at preliminary coordinates.
35°38'50.8"N
78°44'35.1"W
SW15
RW15
100' radius around the proposed well location
located in the northeast corner of the property
adjacent to Bells Lake Road, at preliminary
coordinates.
35°38'55.1"N
78°44'29.8"W
NOR DE _
oepa,tme�ll41 Ernl,pnmenial9ualih
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 3800 Barrett Drive I Raleigh, North Carolina 27609
919,791.4200

Dear Ms. Patricia Duma and Ms. Debra Lasater Flentje
March 2, 2022
Page 2
This letter is provided by the Public Water Supply (PWS) Section, in accordance with
Rule .0305(b) of the Rules Governing Public Water Systems (15A NCAC 18C), to provide
permission to drill wells at the listed sites in order to establish the quality and quantity of
water and the suitability of the wells as sources for a public water system.
In addition, this "preliminary well site approval" is to acknowledge that according to the
information and documentation provided, we understand that the proposed wells are
located on lots so that the area within 100 feet of the wells is owned or controlled by the
person supplying the water and that the supplier of water will protect the well lots from
potential sources of pollution and construct landscape features for drainage and diversion
of pollution as required in 15A NCAC 18C .0203(a)(1).
We understand that while one or more of the proposed well sites do not currently
satisfy the minimum horizontal separation distances summarized in the table below,
they must meet those requirements as specified in 15A NCAC 18C .0203(a)(2) for the
wells to be utilized as a source for a public water system. Following the
determination of well suitability, compliance with 15A NCAC 18C .0203(a)(2) would
require, but is not limited to, the removal of any existing surface water such as the
existing onsite ponds or other potential sources of pollution (e.g., existing wells,
subsurface sanitary disposal systems, etc.) and appropriate remediation of the site.
Existing wells within 100 feet of a proposed well must be abandoned in accordance
with 15A NCAC 02C.
Distance
(in feet)
Potential Source of Pollution
100
•
•
•
•
•
From any sanitary sewage disposal system, sewer, or sewer pipe (unless sewer is
constructed of water main materials and joints, in which the sewer pipe shall be at
least 50 feet from the well.
From buildings, mobile homes, permanent structures, animal houses or lots, cultivated
areas to which chemicals are applied.
From surface water.
From a chemical or petroleum fuel underground storage tank with secondary
containment.
From any other potential source of pollution not listed in this table.
200
•
From a subsurface sanitary sewage treatment and disposal system designed for 3,000
or more gallons of wastewater a day, unless your well water source is a confined
aquifer.
300
•
From any cemetery or burial ground.
500
•
•
•
•
From a septage disposal site.
From a chemical or petroleum fuel underground storage tank without secondary
containment.
From the boundary of a ground water contamination area.
From a sanitary landfill or non -permitted non -hazardous solid waste disposal site.
1,000
•
From a hazardous waste disposal site or in any location which conflicts with the North
Carolina Hazardous Waste Management Rules cited in NCAC 13A.
GCSE
. ilrAHounn
OBpaNnenl el Environmental Quality
North Carolina Department of Environmental Quality 1 Division of Water Resources
Raleigh Regional Office 3800 Barrett Drive 1 Raleigh, North Carolina 27609
919.79t.4200

Dear Ms. Patricia Duma and Ms. Debra Lasater Flentje
March 2, 2022
Page 3
We also understand that the owner will ensure that the lots are graded or sloped so that
surface water is diverted away from the wellheads and that the wells shall not have greater
than a 1 percent chance of flooding in accordance with 15A NCAC 18C .0203(a)(4).
PWS Section "Authorization to Construct" and "Final Approval"
Subsequent to well drilling and evaluating water quality and quantity (e.g., collecting and
analyzing samples and performing a 24-hour well drawdown test) the owner must submit
an "Application for Approval of Engineering Plans and Specifications For Water Supply
Systems" to document proposed well completion (e.g., selected pump, wellhead and well
house details) and associated transmission lines, treatment and/or storage facilities and
other critical information about the public water system. In accordance with 15A NCAC
18C .0305(a) no construction shall be undertaken until the PWS Section issues an
"Authorization to Construct" letter. In addition, in accordance with 15A NCAC 18C .0309(a)
the new wells and all associated treatment, storage or transmission/distributions lines
shall not be placed into service until the PWS Section has issued a "Final Approval." These
steps are described in the Engineering Planning and Development Guidance Document
available at
https://files.nc.gov/ncdeq/Water%20Resources/files/pws/planreview/EPD Guidance Jul
y2019.pdf
Be aware that plans, specifications and reports for the new wells must be certified by a
Professional Engineer. Therefore, it is recommended that a Professional Engineer or
Licensed Geologist (or their designated representative) experienced in the construction of
water supply wells, conduct on -site monitoring of well construction. At a minimum, certain
critical phases of well construction such as installation and grouting of casing should be
monitored. In many situations it may be necessary to go beyond the minimum
requirements in order to protect the public health and ground water resources.
Other Agency Approvals Required
This PWS Section "preliminary well site approval" letter does not address other agency
applicable rules and requirements pertaining to well construction and registration.
Local county well construction rules and ordinances may include additional requirements.
Well construction must meet the standards specified in the Well Construction Standards
(15A NCAC 2C). Be aware that these rules require a permit to be obtained from the Water
Quality Regional Operations Section of the Division of Water Resources before the well is
constructed if it is anticipated that the new well will be part of a water system with a design
capacity of 100,000 gallons per day or greater. In addition, these rules require that wells
be constructed by a properly certified well driller. For more information, call 919-707-
3668 or go to:
GCSE
. ilrAHounn
OopaNnenl el Environmental Quality
North Carolina Department of Environmental Quality 1 Division of Water Resources
Raleigh Regional Office 3800 Barrett Drive 1 Raleigh, North Carolina 27609
919.79t.4200

Dear Ms. Patricia Duma and Ms. Debra Lasater Flentje
March 2, 2022
Page 4
https://deq.nc.gov/about/divisions/water-resources/water-resources-
permits /wastewater -branch ground-water-protection/well-program#largecapwell
Sincerely,
Catherine Hadidon
Assistant Regional Engineer
Public Water Supply Section
Raleigh Regional Office
Cc: Central Files - Public Water Supply Section
Regional Files - Public Water Supply Section
Paul S. Scott, P.G (email)
AQUA North Carolina (email)
Wake County Health Department
Fred Sheckells, Ten Oaks Communities, LLC
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e[ En.[mnmemn[ quao�
NORTN
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 13800 Barrett Drive j Raleigh, North Carolina 27609
919.791.4200

\\PSMC-DATA\gta\Shared\Project Files\2021\35211800x1 - Bells Lake Road\GWW\CAD\Plot\35211800x1 Potential WLP.dwg
SOURCE: PLAN ADAPTED FROM AERIAL PHOTOGRAPHY OF WAKE COUNTY, NORTH
CAROLINA, PRODUCED AND MAINTAINED BY GOGGLE
LEGEND
APPROXIMATE SUBJECT PROPERTY
APPROXIMATE PROPOSED TEST WELL LOCATION
APPROXIMATE LOCATION OF STRUCTURE ASSUMED TO BE
SERVICED BY ONSITE WASTEWATER DISPOSAL (SEE NOTE)
APPROXIMATE EXISTING RESIDENTIAL WELL LOCATION (SEE NOTE)
NOTE: LOCATIONS OF OFF -SITE RESIDENTIAL WELLS AND STRUCTURES SERVICED
BY SEPTIC SYSTEMS ARE APPROXIMATE, AND ARE BASED ON LOCATIONS
PROVIDED ON THE WAKE COUNTY AND RALEIGH GIS iMAPS ONLINE INTERACTIVE
MAPPING APPLICATION
0' 25' 50' 100' 200'
SCALE: 1"
100'
.--".••,--sm'
GEO-TECHNOLOGY ASSOCIATES, INC.
GEOTECHNICAL AND ENVIRONMENTAL CONSULTANTS
3445-A BOX HILL CORPORATE CENTER DRIVE
ABINGDON, MARYLAND 21009
410-515-9446
FAX: [phone]
WWW.GTAENG.COM
0 2019 GEO-TECHNOLOGY ASSOCIATES, INC.
PROPOSED TEST WELL LOCATION PLAN - AERIAL
BELLS LAKE ROAD
WAKE COUNTY, NORTH CAROLINA
DATE
REVISIONS
JOB NO:
35211800
SCALE:
1"=100'
DATE:
MARCH 2022
DRAWN BY:
GMM
DESIGN BY:
REVIEW BY:
PSS
SHEET:
OF

\\PSMC-DATA\gta\Shared\Project Files\2021\35211800x1 - Bells Lake Road\GWW\CAD\Plot\35211800x1 Potential WLP.dwg
SOURCE: PLAN ADAPTED FROM ENTITLED "WELL LAYOUT" PREPARED BY MORRIS & RITCHIE
ASSOCIATES AND DATED FEBRUARY 22, 2022
LEGEND
APPROXIMATE SUBJECT PROPERTY
APPROXIMATE PROPOSED TEST WELL LOCATION
APPROXIMATE LOCATION OF STRUCTURE ASSUMED TO BE
SERVICED BY ONSITE WASTEWATER DISPOSAL (SEE NOTE)
APPROXIMATE EXISTING RESIDENTIAL WELL LOCATION (SEE NOTE)
NOTE: LOCATIONS OF OFF -SITE RESIDENTIAL WELLS AND STRUCTURES SERVICED
BY SEPTIC SYSTEMS ARE APPROXIMATE, AND ARE BASED ON LOCATIONS
PROVIDED ON THE WAKE COUNTY AND RALEIGH GIS iMAPS ONLINE INTERACTIVE
MAPPING APPLICATION
0' 20' 40' 80' 160'
SCALE: 1"=80'
GEO-TECHNOLOGY ASSOCIATES, INC.
GEOTECHNICAL AND ENVIRONMENTAL CONSULTANTS
3445-A BOX HILL CORPORATE CENTER DRIVE
ABINGDON, MARYLAND 21009
410-515-9446
FAX: [phone]
WWW.GTAENG.COM
0 2019 GEO-TECHNOLOGY ASSOCIATES, INC.
PROPOSED TEST WELL LOCATION PLAN
BELLS LAKE ROAD
WAKE COUNTY, NORTH CAROLINA
DATE REVISIONS
JOB NO: 35211800
SCALE: 1 "=80'
DATE: MARCH 2022
DRAWN BY: GMM
DESIGN BY:
REVIEW BY: PSS
SHEET: OF