WS0801077_Application_20240306

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES — AQUIFER PROTECTION SECTION
APPLICATION FOR PERMIT TO CONSTRUCT A WATER SUPPLY WELL OR WELL SYSTEM
(Wells or Well Systems with a Design Capacity of 100,000 Gallons Per Day or Greater)
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 water supply wells.
1. Date: J [ W 27L(
2. County: New Hanover
3
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE:
Applicant Bill Clark Homes of Wilmington, LLC Telephone: [phone]
Applicant's Mailing Address: 200 E. Arlington Blvd., Greenville, NC 27858
Applicant's Email Address (if available): [[e-mail]
4. Contact Person (if different than Applicant): Jeovany Gutierrez -Bautista Telephone: [phone]
Contact Person's Mailing Address: 354 Sawdust Road, Rocky Point, NC 28457
Contac Person's Email Address (if available): [e-mail]
a
Property Owner (if different than Applicant): LHH Holdings LLC Telephone: [phone]
Owner's Mailing Address: 200 E. Arlington Blvd., Greenville, NC 27858
Owner's Email Address (if available): [[e-mail]
6. Property Physical Address (including zip code) and PIN Number: 8650 Sidbury Road, Wilmington, NC 326102.55.1388.000
7. Intended use of Well or Well System: Well #1
(examples: irrigation, consumption, etc.)
8. Will the proposed water supply well or well system replace or be added to an existing well or well system? No
(If yes, complete questions 7 and 8) (if no, complete question 7 and then skip to question 9)
9. Total design capacity of proposed well or well system in gallons per day (gpd): 72,000
10. If adding a well to an existing system, list the existing water supply wells in the existing system and their respective yields:
N/A
11. Is this a public well or well system? Yes If yes, give Public Water ID Number: NC7065077
If yes, give Project Engineer and contact information: 1� i�a'J�.l [Clio) % (( "970rj�"J 6
psr�� v G—P/�i• Co�^-
12. Well Contractor: Jeovany Gutierrez -Bautista Well Contractor Certification No.: 4125 A
Well Contractor Address: 354 Sawdust Road, Rocky Point, NC 28457
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .0105(f)(7), attach a well
2.
Number of wells to be constructed in unconsolidated
construction diagram of each well showing the following:
1
material:
a.
b.
Borehole and well diameter
Estimated well depth
3.
Number of wells to be constructed in bedrock: 0
C.
Screen intervals
1
d.
Sand/gravel pack intervals
4.
Total number of wells to be constructed:
e.
Type of casing material and thickness
(add answers from 2 and 3)
f.
Grout horizons
g.
Well head completion details
5.
Estimated beginning construction date:
6.
Estimated construction completion date:
Continued
on Reverse

ADDITIONAL INFORMATION
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. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
2. As required by 15A NCAC 02C .0105(g)(3), for wells screened in multiple zones or aquifers, provide representative data on the
static water level, pH, specific conductance, and concentrations of sodium, potassium, calcium, magnesium, sulfate, chloride,
and carbonates from each aquifer or zone from which water is proposed to be withdrawn.
3. Attach any water use permits (if required). [e.g. Central Coastal Plain Capacity Use Area Permit is required in 15 eastern NC
counties by NC Division of Water Resources, visit: http://www.ncwater.org]
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
the Water Supply Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina
Administrative Code, Sub c apter 2C) and accepts full responsibility for compliance with these rules
Signature of Applicant o *Agent Title of Applicant or *Agent
- (1 �w �" Sr ���v «�•�•• * If signing Agent, attach authorization
g g a s ge n 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
water supply wells as outlined in this Water Supply Well Construction Permit application and that it shall be the responsibility of the
applicant to ensure that the water supply well(s) conform to the Well Construction Standards (Title 15A of the North Carolina
Administrative Code, Subchapter 2C).
Signature of Property Owner (if different than licant)
Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources's Aquifer Protection Section Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone: [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, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: [phone]
GW-22W (Rev. 8/13)

Sc ultes
of Carolina
Generations ofi Wat®r 8. Wastewater Solutions
1 1921 - 2021
Well Seal
8x3 in
100-ft
-in DIA
2.5-ft
CUSTOMER
Bill Clark Homes
Address: 8650 Sidbury Rd.
City:
Wilmington IST: I NC jZip:j 28411
Rep.
A.C. Schultes of Carolina, Inc.
Well #
Production Well #1 W01
PUMP MANUFACTURE:
Grundfos
Type:
Submersible
Model:
1 230S200-5
GPM:j
200
TDH: 230
Pump Stages:
5
Check Valve: internal
Depth Gauge:
Required:
Not Required:
x
Air Line:
Required:
I
INotRequired:lx
Impeller Material: 304 SS
Strainer: 1 304 SS
Shaft & Coupling Material:
304 SS
MOTOR MANUFACTURE:
HP: 20
RPM:
3450
Phase:
3
Hertz:
60
Voltage:
460
CABLE
Size:
#8/3
Length:
1 120-ft
Type:
JUNCTION BOX
Required:
I x
Not Required:
COLUMN
PIPE
Pipe Size:
3-in.
Material:
I PVC
Type:
I Certa-Lok
Section Length:
1 20-ft
OTHER SPECIFICATIONS
Check Valve:
Pump Internal
Spacing:
Size: 7 3-in.
jMaterial7
304 SS
Discharge Outlet: 3-in. I Type:

Rotary Table: + 2 FT
Ground: 0
Borehole Dia: 21 "
Outer I Pit Casing Diameter 16"
SCH 20
Outer Casing Material:
BLACK STEEL
Bottom Of Pit / Outer Casing
40 FT
Inner Casing Dia:
8"
Inner Casing Material:
PVC
Certa lok SDR 17
Cement Grout:
95 FT
Bentonite:
95 FT
Top of Gravel:
100 FT
Certa-lok Adapter
Top of Screen:
Screen Dia:
8"
Screen Material:
304 SS
Screen Slot.
.030
Gravel Size:
SOUTHERN # 2
Bottom of Screen:
126 FT
Top of Screen: 136 FT
Bottom of Screen:
Cellar Material: 304 SS SCH.40
Bottom of Cellar: 160 FT
DRILLING DATA
Owner:
BILL CLARK HOMES LLC
Job Name:
SIDBURY LANDING
Job No:
C-1413
Well Number:
Production WELL # 1
Location:
8650 SIDBURY ROAD
Datum:
2-FT
Static Level (Ft):
Test Pumped (Hrs):
Flow Rate (GPM):
Pumping Level (Ft):
Draw Down (Ft):
Spec. Capacity (GPF):
Screen Mfg.:
Alloy Machineworks
Grout Material:
BENTONITE & CEMENT
Grout Quantity (CYDS):
7
Drilling Rig:
EUBANKS
Driller:
Jeovany Bautista 4125A
Date Well Completed:
GEOLOGIC DATA
Depth From Ground
Well Log
0-10
10-20
20-30
30-40
40-50
50-60
60-70
70-80
80-90
90-100
100-110
110-120
120-130
130-140
140-150
150-160
160-165
Well design does not guarantee water quantity or quality.