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).
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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