WM0501549_Final Permit_20230510

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHAW E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
May 9, 2023
Mr. Tony Southerland
1105 Southerland Road
Clayton, NC 27527
Subject: Monitoring Well Construction
Permit # WM0501549
J.D.'s Country Store
4549 Wilsons Mills Road
Smithfield, NC 27577 — Johnston County
Mr. Southerland:
In accordance with the application received on May 2, 2023, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501549 dated May 9, 2023, issued for the construction of
a monitor well system (installation of three wells). Please be aware that some counties have well
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 the addition of stipulation #3 to the permit enclosed. If you have
any questions about this permit, please contact Michael Hall at [phone].
Sincerely,
DocuSigned by:
VAIn I,SSA f. A , fo r
B2916E6AB32144F...
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
cc: RRO Files/Laserfiche
D E Q J/ 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
NORTH CAROLINA 919.7Q7. 9Q0Q
oepanmem or enmmnmentai auai�

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT FOR THE CONSTRUCTION OF A MONITORING 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
Tony Southerland
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of three monitoring wells
owned by Tony Southerland, mailing address 1105 Southerland Road, Clayton, NC 27527. The wells will
be located on the property owned by Mr. Southerland on 4549 Wilsons Mills Road, NC 27577. This
Permit is issued in accordance with the application received on May 2, 2023, 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 of any other applicable law or
regulation. 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 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. Issuance of this Permit does not obligate reimbursement from State trust funds, if these wells are being
installed as part of an investigation for contamination from an underground storage tank or dry cleaner
incident.
2. Issuance of this Permit does not supersede any other agreement, permit, or requirement issued by another
agency.
3. The well(s) shall be located and constructed as shown on the attachments submitted as part of the Permit
application.
4. Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC 02C .0108(o).
5. 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.
6. 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 Quality's
Information Processing Unit within 30 days of the well abandonment.
7. If the well penetrates any water -bearing zone that contains contaminated waters, the upper three feet of the
well shall be grouted within one day after the casing is set or the well abandoned.
Permit issued the 9th of May 2023
FOR THE NORTH CAROLINA tNVIRONMENTAL MANAGEMENT COMMISSION
ocuSigned by:
UAdt t SSa, f. , for
82916E6AB32144F...
Scott Vinson, Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
Permit No. WM0501549
D E Q North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1611 Mail Service Center I Raleigh, North Carolina 27699-1611
Depnme of Envl A 919.707.9000
Deparlmem of EnHmnmamal Dual