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HomeMy WebLinkAboutWM0801200_Application_20220712DocuSign Envelope ID: 24559A33-60B0-4CD5-BF83-DOD9BBD3CC6B NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM 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 monitoring or recovery wells. Date: 6/16/2022 2. County: Onslow FOR OFFICE USE ONLY PERMIT NO. ISSUED DATE 3. What type of well are you applying for? (monitoring or recovery): 4. Applicant: Capital Growth Buchalter — Mr. Jeffery Lewin Monitoring Telephone: 602-908-1424 Applicant's Mailing Address: 361 Summit Boulevard, Suite 110, Birmingham, AL 35243 Applicant's Email Address (if available): jlewinacgpre.com 5. Contact Person (if different than Applicant): Travis O'Quinn Telephone: 704-330-3818 Contact Person's Mailing Address: 1812 Center Park Drive, Suite D Charlotte, NC 28217 Contact Person's Email Address (if available): tloguinnaecslimited.com 6. Property Owner (if different than Applicant): Nance Properties Inc (PIN 043816) and Rentals ZV LLC PIN (036103) Telephone: Not Available Property Owner's Mailing Address: PO Box 1625, Swansboro, NC, 28584 Property Owner's Email Address (if available): Not Available 7. Property Physical Address (Including PIN Number): 1073 and 1071 W. Corbett Avenue, Swansboro, Onslow County, NC 28584 (PIN 043816 and 036103) 8. Reason for Well(s): Environmental Assessment 9. Type of facility or site for which the well(s) is(are) needed: Commercial Buildings 10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s). Not Applicable 11. Type of contaminants being monitored or recovered: VOCs, SVOCs, and Metals (ex: organics, nutrients, heavy metals, etc.) 12. Are there any existing wells associated with the proposed well(s)? If yes, how many? No Existing Monitoring or Recovery Well Construction Permit No(s).: Not Applicable 13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): UST Incidents approximately 2,000' northwest 14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No If yes, give distance(s): Not Applicable 15. Well Contractor: Quantex, Inc. Certification No.: 3106 Well Contractor Address: ibarker3 annc.rr.com 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 e. Type of casing material and thickness b. Estimated well depth f. Grout horizons c. Screen intervals g. Well head completion details d. Sand/gravel pack intervals Continued on Reverse DocuSign Envelope ID: 24559A33-60B0-4CD5-BF83-DOD9BBD3CC6B PROPOSED WELL CONSTRUCTION INFORMATION (Continued) 2. Number of wells to be constructed in unconsolidated material: 4 3. Number of wells to be constructed in bedrock: 0 4. Total Number of wells to be constructed: 4 (add answers from 2 and 3) 5. How will the well(s) be secured? Lockable caps and bolted covers 6. Estimated beginning construction date: 7/1/2022 7. Estimated construction completion date: 7/2/2022 1. ADDITIONAL INFORMATION As required by 15A NCAC 02C .0105(f)(5), attach a scaled reap 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. SIGNATURES The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of this 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 Signature o plicant or *Agent Printed name of Applicant or *Agent S 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 wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the u^ocu5ig'�'�`ne^d^by^{^••^ +^ +1--'Nell Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C). JMitibS , kft-a.i B8BF8034314F41A... S 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: (828) 296-4500 Fax: (828) 299-7043 Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301-5094 Phone: (910) 433-3300 Fax: (910) 486-0707 Mooresville Regional Office 610 East Center Avenue Mooresville, NC 28115 Phone: (704) 663-1699 Fax: (704) 663-6040 Raleigh Regional Office 3800 Barrett Drive Raleigh, NC 27609 Phone: (919) 791-4200 Fax: (919) 571-4718 Washington Regional Office 943 Washington Square Mall Washington, NC 27889 Phone: (252) 946-6481 Fax: (252) 975-3716 Wilmington Regional Office 127 Cardinal Drive Extension Wilmington, NC 28405 Phone: (910) 796-7215 Fax: (910) 350-2004 Winston-Salem Regional Office 450 W. Hanes Mill Road Suite 300 Winston-Salem, NC 27105 Phone: (336) 776-9800 Fax: (336) 776-9797 GW-22MR Rev. 3-1-2016 0.5 0 SCALE 1:24 000 KILOMETERS 2 1000 503 0 1 0.5 METERS a 2000 100o 0 1060 MILE HOD 3070 4000 50i}0 6000 7076 A0E 90L0 1COCO FEET SOURCE: USGS TOPOGRAPHIC MAP 7.5 — MINUTE SERIES HUBERT, NC DATED 2019 FIGURE 1 L SITE TOPOGRAPHIC MAP posed Wawa — Store Number C-05017 1073 and 1071 W. Corbett Avenue Swansboro, Onslow County, NC ECS Project No. 49:15757-A APPROX. 500 FOOT RADIUS SITE PARCEL BOUNDARY OIL STAINING/STRESSED VEGETATION NO WATER SUPPLY WELLS OR POTENTIAL SOURCES OF CONTAMINATION ARE KNOWN TO EXIST OTHER THAN ILLUSTRATED ABOVE. SOURCE: GOOGLE EARTH IMAGERY DATED 2019 & NCDEQ DWM SITE LOCATOR TOOL APPROXIMATE SCALE: 6• 100 ft. N FIGURE 2 L POTENTIAL SOURCES MAP P oposed Wawa — Store Number C-05017 1073 and 1071 W. Corbett Avenue Swansboro, Onslow County, NC ECS Project No. 49:15757-A LEGEND OAPPROXIMATE MONITORING WELL LOCATION SOURCE: GOOGLE EARTH IMAGERY DATED 2019 Not to Scale FIGURE 3 SAMPLE LOCATION MAP Proposed Wawa — Store Number C-05017 1073 and 1071 W. Corbett Avenue Swansboro, Onslow County, NC ECS Project No. 49:15757-A ESTIMATED —20' FEET GROUND SURFACE 0.5' — 6' PORTLAND CEMENT 6' — 8' BENTONITE SAND 8'-10' GROUNDWATER • • • • • • • • • • MONITORING WELL COVER 2.0-INCH SCH 40 PVC RISER 8.25 --INCH BORE HOLE 2.0-INCH SHC 40 PVC SLOTTED SCREEN 0.01-INCH SLOT WIDTHS SET TO INTERSECT GROUNDWATER ESTIMATED 10 FEET IN LENGTH NOT TO SCALE I FIGURE 4 PROPOSED MONITORING WELLS Proposed Wawa — Store Number C-05017 1073 and 1071 W. Corbett Avenue Swansboro, Onslow County, NC ECS Project No. 49:15757-A