WM0501594_Final Permit_20231113

DocuSign Envelope ID: E24C1A90-9CCF-44EC-9A21-121 101 D7A804
ROY COOPER Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR. NORTH CAROLINA
Director Environmental Quality
November 13, 2023
Mr. Ibrahim K. Hauter
Vicksboro Grocery and Grill
6215 Vicksboro Road
Henderson, North Carolina 27537
Sent Via Email
Subject: Monitoring Well Construction
Permit # WM0501594
Vicksboro Grocery and Grill
6215 Vicksboro Road
Henderson, NC 27537 — Warren County
Mr. Hauter:
In accordance with the application received on November 9, 2023, we are forwarding herewith
Monitoring Well Construction Permit No. WM0501594 dated November 13, 2023, issued for the
construction of a monitoring well system (installation of up to two wells). Please be aware that some
counties have well construction Droerams. and you may be reauired to obtain a well construction
ermit 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,
DocuSigned by:
Vale t,SSa f.
B2916E6AB32144F...
Vanessa E. Manuel, Assistant Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Enclosure
-Permit
-Application Package
Ec: David Wells, Cape Lookout Environmental Sciences
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: E24C1A90-9CCF-44EC-9A21-121 101 D7A804
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
Vicksboro Grocery and Grill
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of up to two monitoring wells
owned by Vicksboro Grocery and Grill, 6215 Vicksboro Road, Henderson, North Carolina 27537. The wells
will be located on the property owned by R.C. Sr. and Cathy A. Creech, at 6237 Vicksboro Road, Henderson,
North Carolina 27537. This Permit is issued in accordance with the application received on November 13,
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
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2916E6AB32144F...
Vanessa E. Manuel, Assistant Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number: WM0501594
Permit Issued: November 13, 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