WM0701310_Application_20231101

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.
FOR OFFICE USE ONLY
1. Date: 1 011 6/2 0 2 3
2. County: Camden and Currituck PERMIT NO. ISSUED DATE
3, What type of well are you applying for?(monitoring or recovery): Monitoring
4. Applicant: Constellis—Ms. Katherine Mckenzie-Veal Telephone: [phone]
Applicant's Mailing Address: _ 850 Puddin Ridge Road, Movock, NC 27958
Applicant's Email Address(if available): [e-mail]
5. Contact Person(if different than Applicant): Jonathan Garrick Telephone: [phone]
Contact Person's Mailing Address: __ 1812 Center Park Drive, Suite D Charlotte, NC 28217
Contact Person's Email Address(if available): 1.arrick(&ecslimited.com
6. Property Owner(if different than Applicant): Stonebriar Commercial Finance, LLC Telephone: Not available
Property Owner's Mailing Address: 13530 Dulles Technology Drive Herndon VA 20171
Property Owner's Email Address(if available): Not Available
7. Property Physical Address(Including PIN Number): . 850 Puddin Ridge Road, Movock, NC 27958(PIN 001200000010000,
001200000020000, 001700000020000, and 018929000629520000, 018929003425030000,and 0289290091057900001
8. Reason for Well(s): _ Environmental Assessment
9. Type of facility or site for which the well(s)is(are)needed: Firing_Range
I
10. Are there any current water quality permits or incidents associated with this facility of site? If so, list permit and/or incident no(s).
AST Incident#95995 I
11. Type of contaminants being monitored or recovered: 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): Onsite(0 It)(AST Incident 95995)
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: Fishburne Drilling Certification No.: 2370-A
Well Contractor Address: 3219 S. Military Hwy.Chesapeake, VA 23323
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

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s)be secured? Sample will be
material: 10 collected through geoprobe sampling probe
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 11/27/23
4. Total Number of wells to be constructed: 10 7. Estimated construction completion date: 11/27/23
(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 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. 143-215.1013(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),'a//nd accepts full responsibility for compliance with these rules
IF� VP,Legal-Corporate Counsel
Signature of Applicant or*Agent Title of Applicant or*Agent
Katherine F. McKenzie-Veal 'If 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
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
w s)confo i to the W onstrucL
ndards(Title 15A of the North Carolina Administrative Code, Subchapter 2C).
it P �4-
Signature of Property Owner(if Brent than Applicant) Printed name of Property Owner(if different than Applicant) V�� L 4
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
Fayetteville Regional Office Washington Regional Office Winston-Salem Regional Office
225 Green Street, Suite 714 943 Washington Square Mall 450 W. Hanes Mill Road
Fayetteville, NC 28301-5094 Washington, NC 27889 Suite 300
Phone: [phone] Phone: [phone] Winston-Salem, NC 27105
Fax: [phone] Fax: [phone] Phone: [phone]
Fax: [phone]
Mooresville Regional Office °
Win le 610 East Center Avenue
Mooresville, NC 28115 al g
Phone: [phone] '--
Fax: [phone]
or v le
r �
ills t ^„r✓s�
ngton
GW-22MR Rev.3-1-2016

_ _ —_ _ -�� �" - _ - '� _ e•lam
�t � � �♦s tb�'.J = d
00
Pisma(
Su•amp -
00 — — C6f Airport.
04
ter. - ' - o - _ - -__ - ♦
Po �Ls B c
0.0
� 1pyy
Y Or 7 0
O c _
o�JO, ro tp 100<55I
•10 0 C10�3c'
�r10 y 10
a o o QD'
C! 'm C 00• 'to
yp, 0 f
.�y O 40 a•10
0 40•0
r —y- ao moo 0
coo 0
SCALE 1:24 WO
1 0.5 0 KILOMETERS 1 2
1000 500 0 METERS 1000 2000
1 0 1
MILES
1000 30 40 00 5000 6000 7000 8000 1000G
00
FEET
FIGURE 1
SOURCE: SITE TOPOGRAPHIC MAP
USGS TOPOGRAPHIC MAP s ACADEMI
7.5— MINUTE SERIES 850 PUDDIN RIDGE ROAD
LAMBS CORNER, NC C s MOYOCK, NC
DATED 2022
ECS Project No. 49:21055-A

APPROX.
500 FOOT
SITE PARCEL RADIUS
BOUNDARY
AST
INCIDENT
#95955
POND
POND
1
1
r ,
AST
Jr INCIDENT
I #88199 -
0.4mi
NO WATER SUPPLY WELLS OR POTENTIAL SOURCES OF CONTAMINATION ARE KNOWN TO EXIST OTHER THAN ILLUSTRATED ABOVE.
SOURCE: IL FIGURE 2
CAMDEN COUNTY GIS IMAGERY w �5 E POTENTIAL SOURCES MAP
DATED 2022 & NCDEQ s ACADEMI
DWM SITE LOCATOR TOOL 8S0 PUDDIN RIDGE ROAD
APPROXIMATE SCALE: C s
MOYOCK, NC
As Shown ECS Project No. 49:21055-A

1'
�YYn fYt -—
I
I •
• Paul
n
i
i
LEGEND
O APPROXIMATE MONITORING WELL LOCATION APPROXIMATE SITE PARCEL BOUNDARY
I N FIGURE 3
SOURCE: SAMPLE LOCATION MAP
Mecklenburg County GIS ACADEMI
Dated: 2022 850 PUDDIN RIDGE ROAD
MOYOCK, INC
Scale:As Shown C S
ECS Project No. 49:21055-A

GROUND TOP OF PVC RISER ABOVE
SURFACE GROUND SURFACE
—1.0-INCH SCH 40 PVC
RISER
ESTIMATED NATURAL FORMATION
—20-25' BACKFILL
FEET
2--INCH BORE
HOLE
APPROXIMATE 2 ft OF
BENTONITE SEAL
FILTER SAND
GROUNDWATER SLOTTED PVC SCREEN
0.01-INCH SLOT WIDTHS
SET TO INTERSECT GROUNDWATER
17 ESTIMATED 10 FEET IN LENGTH
FIGURE 4
TYPICAL TEMPORARY MONITORING WELL
'to
ACADEMI
Er7850 PUDDIN RIDGE ROAD
NOT TO SCALE MOYOCK, NC
ECS Project No. 49:21055-A