WS0500158_Permit (Issuance)_20220321

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR. NORTH CAROLINA
Director Environmental Quality
March 21, 2022
Fred Sheckells
Ten Oaks Realty LLC
P.O. Box 257
Fallston, Maryland 21047
Subject: Water Supply Well Construction Permit
Permit # WS0500 158
Sawyer's Mill S/D
8736 Bells Lake Road
Middle Creek, N.C.-Wake County
Dear Mr. Sheckells:
In accordance with the application received on March 3, 2022, and the additional requested
information received on March 16 & 18, 2022, we are forwarding herewith, Permit No. WS0500158 dated
March 21, 2022, issued for the construction of a water supply well network (five wells). This Permit will
be effective for one year from the date of its issuance and shall be subject to the conditions and limitations
as specified therein.
Please note this permit does not constitute approval of the volume of water proposed to be
withdrawn within an area defined as existing within a Capacity Use Area, or any permits issued by the local
health department. Additional permits and/or approvals may be necessary and we encourage you to contact
the appropriate agencies prior to constructing any supply wells. If you have any questions, please contact
me or Eric Rice at [phone] or by email at scott.vinsonr ,ncdenr.gov or eric.rice;tlncdenr,gov
Enclosure
Sincerely,
1—DocuSigned by:
BCDA9D825D4A46D...
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
cc: pscottrr ;gtaeng.com Paul Scott, Geo-Technologies Associates, Inc. 3445 Box Hill Corp. Center
Drive, Abingdon, MD 21009
DWR, RRO Files
Wake County Health Department
PWS, RRO
North Carolina Department of Environmental Quality I Division aAf Water Resources
Raleigh Regional Office I 3800 Barrett Dnve I Raleigh, North Carolina 27609
919 791 4200

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION OF A WELL
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
Ten Oaks Realty LLC
FOR THE CONSTRUCTION OF A SUPPLY WELL SYSTEM (Sawyer's Mill S..D) consisting of five water supply
wells owned by Ten Oaks Realty LLC. at mailing address P.O. Box 257 Fallston, Maryland. The wells will be located
on the property owned by Patricia Lasater Duma & Debra L. Flentje at 8736 Bells Lake Road in Middle Creek, North
Carolina -Wake County. This permit is issued in accordance with the application received on March 3, 2022, and the
additional requested information received on March 16, & 18, 2022, in conformity with specifications and supporting
data, all of which are filed with the Department of Environmental Quality, which are considered a part of this permit.
This Permit is for well construction only, and does not waive any provision or requirement of any other
applicable law or regulation. This permit does not constitute approval of the proposed volume of water to be withdrawn,
within an area defined as a Capacity Use Area, overseen by the Division.
Construction of any well under this Permit shall be in strict compliance with the North Carolina Well
Construction Regulations and Standards (15A NCAC 2C .0100), and other State and Local Laws and regulations
pertaining to water supply well construction. Please be advised that some Counties may also require a permit.
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:
I. Furnish copies of chemical analyses to the Division of Water Resources (DWR), Public Water Supply Section
(PWS), Raleigh Regional Office (RRO), 1628 Mail Service Center, Raleigh, N.C. 27699-1628.
2. Send the results of the aquifer test to the DWR, PWS, RRO 1628 Mail Service Center, Raleigh, NC 27699-
1628.
3. Please ensure the contractor responsible for constructing the well is a North Carolina certified water well
contractor.
4. It is necessary given the reported possibility of the presence of wetlands,etc. to take proper precautions during
well installationls to avoid any impact to surface water features that may result in a violation of the rules (15A
NCAC 02B)
5. Provide the Raleigh Regional Office, WQROS at least forth -eight (48) hours notice prior to the initiation of
well installation
Permit issued the 21 S' of March 2022
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
,-DocuSigned by:
Ct",pA �Ji� n AL
Scott Vinson, Regional Supervisor
DiisioNfirtlie5PitegBurces
By Authority of the Environmental Management Commission
Permit # WS0500158
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11611 Mail Service Center I Raleigh. North Carolina 27699-1611
919.707.9000

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
FOR OFFICE USE ONLY
j/,,��
PERMIT NO. 'I 5O5Oa 1l5®oISSUED DATE
Telephone:
Applicant's Mailing Address: P.O. Box 257, Fallston, Maryland 21047
Applicant's Email Address (if available): Fredetenoaksrealtv.com
410-459-8401
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): PScotagtaena.com
5. Property Owner (if different than Applicant): Patricia Lasater Duma & Debra L Flentie 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 Zip Code: 27539
7. Intended use of Well or Well System: Potable supply
(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? Yes
(If yes, complete questions 7 and 8) Of 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 apm
10. If adding a well to an existing system, list the existing water supply wells in the existing system and their respective yields:
_awvers Mill Well #10 -17 Qom (PWSS # 02-00225) . Well #4 - 65 Qom (PWSS # 00-00814). Well #8 - 31 QM (PWSS # 01-013041
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
Well Head completion details
9•
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-F512789591D1
ADDITIONAL INFORMATION
Sign re 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. 143-215.108(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 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 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
/di& r,. ALT e#1 ot4
Title of Applicant or *Ageri
Orb! ✓Il•.JCf �+ L
"It 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
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).
oocuagn.a er:
54, de. !
Feb 22, 2022 J 7:21 AM Recta L. Flentje
perty 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 27809
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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