WM0501557_Final Permit_20230622

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Mr. Dustin Kornegay, Administrator
Town of Pine Level
306 East Brown Street
Pine Level, NC 27568
Sent Via Email
NORTH CAROLINA
Environmental Quality
June 22, 2023
Subject: Monitoring Well Construction
Permit # WM0501557
Town of Pine Level Water Supply Well NC0351040
Crystal Blvd. (PIN 262313-13-3715)
Pine Level, NC 27568 — Johnston County
Mr. Komegay:
In accordance with the application received on June 21, 2023, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501557 dated June 22, 2023, issued for the construction
of a monitoring well. Please be aware that some counties have well construction programs, and you
may be reauired to obtain a well construction permit before installation.
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] or via email at
[e-mail].
Sincerely,
ocuSigned by:
E�D
a, f.
2916E6AB32144F...
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
-Permit
-Application Package
cc: RRO Files/Laserfiche
D E Q ,fJ 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
NORTH CAROLINA (J1(�.'�O'�.(�OQO
Department of Emlmnmenfal Duali�

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
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
Town of Pine Level
FOR THE CONSTRUCTION OF A MONITORING WELL owned by the Town of Pine Level at mailing address
306 East Brown Street, Pine Level, NC 27568. The well will be located on the propertys owned by Mr.
Richard Braswell, 3241 US 70E, Suite 101, Smithfield, NC 26577. This Permit is issued in accordance with
the application received on June 21, 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.
ocuSigned by:
E�D
a, f,
2916E6AB32144F...
Scott Vinson, Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number: WM0501557
Permit Issued: June 22, 2023
D E Q �J 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
NORrH CAROLINA �/ 919.707.9000
oepanmem or environmental auaii

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
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 0512512023 1
FOR OFFICE USE ONLY
2 County
PERMIT NO. ISSUED DATE
3 What type of well are you applying for? (monitoring or recovery) Monitoring
4. Applicant: Town of Pine Level Telephone: [phone]
Appf cant's Mailing Address. 306 East Brown Street, Pine Level, NC 27558
Applicant's Email Address (if available) admilistratorfa)oinelevel oM
5 Contact Person (if different than Applicant): Ethan Gartin (TRC) r� Telephone [phone]
Contact Person's Mailing Address 114 Edinburgh S Dr, Ste 200, Cary. NC 27511
Contact Person's Email Address (if available): egartin(dtrccomiganies com
6 Property Owner (if different than Applicant), Richard D. &aswetl Telephone [phone]
Property Owner's Mailing Address 3241 US 70E Suite 101 Smiihfield NC 26577__..
Property Owner's Email Address (if available), rbrasweII@rdbraswelt cam
7. Property Physical Address (Including PIN Number) Crystal Blvd. PIN: 262313-13-3715
City Pine Level County Johnston Zip Cede 27558
8 Reason for Weli(s) Sampling for Municipal Production Well
(ex: non4scharge permit requirements, suspected contamination, assessment, groundwater contamination, remedialion, etc.)
9, Type of facility or site for which the well(s) is(are) needed: Munieioat Public Water System _
(ex: non -discharge fac)lity, waste disposal site, fendfiil, UST, etc.)
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)
No known water quality permits or inctdents at the proposed well site
11. Type of contaminants being monitored or recovered: Organics, Nutrients. Heavy Metals. PFAS
(ex: organics, nutrients, heavy metals, etc.)
12 Are there any existing wells associated with the proposed well(s)? If yes, how many? 1 samoie (this permit). 1 production later
Existing Monitoring or Recovery Well Construction Permit No(s) : NIA
13 Distance from proposed well(s) to nearest known waste or pollution source (in feet): Approx. 6,580 ft to radium contaminant
14. Are there any water supply welts located less than 500 Beet from the proposed well(s)? _
If yes, give distance(s).
15. Well Contractor: TBD Certification No
Well Contractor Address.
PROPOSED WELL CONSTRUCTION INFORMATION
As required by 15A NCAC 02C .0105(0(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: 871AA512-5D7B-451C-B1EF-987C35B62083
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2 Number of wells to be constructed in unconsolidated 5. How will the weil(s) be secured? We4 enclosure
material. shall be securely locked when not being serviced.
3, Number of wells to be constructed in bedrock: 1 6. Estimated beginning construction date: August 2023
4, Total Number of wells to be constructed 1 _ 7 Estimated construction completion date: Autlust 2023
(add answers from 2 and 3)
ADDITIONAL INFORMATION
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 weft system.
b Alf 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 m fuel
storage areas, animal feedlots as defined in G.S. 143-215.1013(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or welt system.
SIGNATURES
The Applicant assumes total responsibility for ensuring that the wOl(s} will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Town Administrator
Signs ire of Applicant or 'Agent Title of Applicant or `Agent
Dustin Korneoay _ ' ff signing as Agent, attach authorization agreement stating
Printed name of Applicant or'Agent that you have the authority to alit 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
I(s) as outlined in tnis Well Construction Permit application and acknowledges that it shall be the responsibility of the App4cant to
ea e t t the li(s) will be la ated, constructed, maintained, and abandoned in accordance with 15A NCAC 02C
Richard D. Braswell
Stgnaluire of Property Owner (d 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' Regiona€ Office:
Asheville Regional Office Raleigh Regional Office Wilmington Regional Office
2090 Lt 5 Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannarioa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone [phone]
Fax [phone] Fax: [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, NG 28115
Phone [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mail
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W Hanes gill Road
Suite 300
Winston-Salem NC 27105
Phone [phone]
Fax [phone]
GVJ-22M/R (Rev 5-26-2022)

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
DONEC REAL ESTATE 3
ONE LLC
31550 NOTRTHWESTERN
H WY STE 200
FARMINGTON HLS, MI
ERIN A DOWNEV 8
ANTHONY D TETTERTON
2620 LOUIS STEPHENS DR
CARY, NC 27519-7679
CONTRACTOR TO CLEAR AND GRUB AREA WITHIN CHAIN LINK FENCE (APPROX. 0.62 ACRES)
PROPOSED NEW WELL
PROPERTY (1.72 ACRES)
'w.
-"HARD D BRASWELL
REVOCABLE TRUST
45 SHORELINE DR
PRINCETON, NC
F
KIGHARD D BRASWELL REVOCABLE TRUST
45 SHORELINE DR
PRINCE70N, NC 27569-9227
6' GALVANIZED STEEL CHAIN LINK FENCE TO
SURROUND WELL AND PROPOSED BUILDING
AND TO INCLUDE LOCKABLE ROLLING
DOUBLE GATE AT ACCESS ROAD
X X
X
PROPOSED
X WELL
BUILDING
V1 r
o j I
X I
X
4" SANITARY
SEWER CLEANOUT
(TYP.)
X
PROPOSED PERMANENT GRAVEL ACCESS
ROAD (SEE SHEET D1 FOR DETAIL)
%III
ISTING GRAVITY
SEWER PIPE CONNECT SEWER SERVICE TO
EXISTING GRAVITY SEWER PIPE
SS
EXISTING 6" WATER LINE PIN:262313-13-2477
RICHARD D BRASWELL REVOCABLE TRUST
45 SHORELINE DR
PRINCETON, NC 27569-9227
PROPOSED NEW WELL
LOCATION WITH
CONCRETE SLAB AND
ENCLOSURE
X X X
\\\ SAMPLE WELL X
10,
�BACKFLOW PREVENTER VAULT
1 X
6" DIP RAW WATER LINE
4" DIP
X
I PROPOSED 10,000 GAL X
L HYDRO -PNEUMATIC TANK
AND CONCRETE SLAB
—X X X
4" PVC SEWER SERVICE LATERAL
`6" DIP WATER LINE
24"SEPARATION REQUIRED CRYSTAL BLVD
SS SS SS-
ASPHALT REPAIR
_ i
- PIN: 262313-13-4458 '
RICHARD D BRASWELL REVOCABLL
45 SHORELINE DR
CONNECT TO EXISTING 6" WATER RINCETON, NC 27569-9227
LINE WITH 6" x 6" TAPPING SLEEVE
AND VALVE WITH THRUST BLOCK Y
NEW WELL AND WTP IMPROVEMENTS SCALE: 1"=50'
PINE LEVEL, NC PROJECT: 496613
Draper Aden Associates
DESIGNED
EwG
�"�� Engineering . Surveying • Environmental Services
DRAWN
ABM
14 Edinburgh South Drive, Suite 200 Richmond, VA Hampton Roads, VA
Ma
CHECKED
SRG
Cary, NC 2751le, INC
919-873 060 Fax: [phone] Blacksburg, VA Northern (Virginia
DATE
MAY 2023
NC Firm License # F-1429 Charlottesville, VA Virginia Beach, VA

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
0.2 � 0. 44 cap
OOmm thick concrete
SL4 pad
Borehole (dia-"
0.5m thick cement grout
(Portland cement: water in a
ratio of 4 kg: 2.5 L
5O= thick Clay seal
:r:r ter: (Perme ab it it 10-7-10-9 cm/s
� .r:r •ter:
.r:r •ter:
.r:r •ter:
•r�r • ~ Well casing —PVC (dia-2"
:r:r •ter:
.ti.ti
.r.r .r.
•r�r ~' Filter pack (2-5mm
'-" .r1r .tirti
.r:r• '�'� Well screen (1.2mm slot size)
Su np

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Mr. Richard D. Braswell
Johnston County Commissioner
3241 US Highway 70 E, Suite 101
Smithfield, NC 27577
Dear Mr. Braswell:
NORTH CAROLINA
Environmental Quality
April 10, 2023
R:
Preliminary Well Site Approval
Town of Pine Level
Water System No.: NC0351040
Johnston County
On March 2, 2023, I met with Mr. Ethan Gartin and conducted a preliminary investigation of
the proposed well site listed below and shown on the attached drawing provided by Mr.
Ethan Gartin. The proposed well has been assigned a Water System Facility (WSF)
Identification Number and Sampling Point Code as indicated below.
WSF ID
Sampling
Description of Well Site
Preliminary
No.
Point Code
Latitude and
Longitude
W02
RW2
100' radius around the proposed well location
35029'21" N
(well #2) at the preliminary coordinates, located
78°15'40" W
approximately 400 feet northwest of the
intersection of Pine St. and Crystal Blvd.
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 a well at the listed site in order to establish the quality and quantity of
water and the suitability of the well as a source for a public water system.
The proposed well must be drilled within 24 months of the date of this letter. If not
drilled within this 24-month period, this Preliminary Well Site Approval letter is
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 1 3800 Barrett Drive I Raleigh, North Carolina 27609
NORTH CAPQLIW
oePanmene ofuwim6ni quan�y 919.791.4200

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
Mr. Braswell
April 10, 2023
Page 2
void and permission to drill the well is no longer valid. To regain permission to drill
the well, PWS Section staff must revisit the proposed site to conduct an investigation
and issue a new preliminary well site approval letter before the well may be drilled.
In addition, this "Preliminary Well Site Approval" is to acknowledge that according to the
information and documentation provided, we understand that the proposed well is located
on a lot so that the area within 100 feet of the well is owned or controlled by the person
supplying the water and that the supplier of water will protect the well lot from potential
sources of pollution and construct landscape features for drainage and diversion of
pollution as required in 15A NCAC 18C .0203(a)(1). Furthermore, we understand that
Mr. Ethan Gartin, per letter dated March 16, 2023, has determined that the proposed well
location satisfies the minimum horizontal separation distances specified in 15A NCAC
18C .0203(a)(2) and summarized in the following table:
Distance (ft)
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 as 15A NCAC 13A.
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 1 3800 Barrett Drive I Raleigh, North Carolina 27609
NCH�HCAH�LINA
o.padm t m E.i.n Mel aual� /`� 919.791.4200

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
Mr. Braswell
April 10, 2023
Page 3
The inspection of the well site showed an abandoned mobile home located within 30 ft
from proposed well location. The removal of this mobile home along with any other
construction materials is the necessary condition for this well site approval.
We also understand that the owner will ensure that the lot is graded or sloped so that
surface water is diverted away from the wellhead and that the well shall not have greater
than a 1 percent annual 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 (i.e., 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 (i.e., 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 well 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:-Z/files.nc.gov/ncdeq/Water%20Resources/files[pws/planreview/EPD Guidance Jul
y2019.pdf
Be aware that plans, specifications and reports for the new well 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.
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 1 3800 Barrett Drive I Raleigh, North Carolina 27609
NCH�HCAH�LINA
oapadm t m E.i.n Mel aual� /`� 919.791.4200

DocuSign Envelope ID: 871AA512-5D7B-451C-B1EF-987C35B62083
Mr. Braswell
April 10, 2023
Page 4
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:
https:-//deq..nc.gov/about/divisions/water-resources/water-resources-
permits/wastewater-branch /ground-water-prote ction/well- program #largecapwell
Sincerely,
Boris Chertock
Environmental Engineer
Public Water Supply Section
Raleigh Regional Office
Cc: Shawn Guyer, Regional Engineering Supervisor
Regional Files - Public Water Supply Section
Central Files - Public Water Supply Section
Johnston County Health Department
Mr. Ethan Gartin, PE - by email
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 1 3800 Barrett Drive I Raleigh, North Carolina 27609
NCH�HCAH�LINA
oapad—t m E.i.n Mel aua'� /`� 919.791.4200