WS0801037_Permit (Issuance)_20190618

DocuSign Envelope ID:83D9AA7E-17C7-4B41-8483-9F000AB80D65
PERMIT NO.WS0801037
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH,NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION OF A WELL OR WELL SYSTEM
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
Columbus Regional Healthcare System
FOR THE CONSTRUCTION OF one(1)large capacity water supply well in accordance with the application
received on May 31,2019 and additional information received on June 13,2019 in conformity with specifications
and supporting data, all of which are filed with the Department of Environmental Quality and are considered part
of the Permit. The well will be located at 500 Jefferson Street,Whiteville, Columbus County.
This Permit is for well construction only and does not waive any provisions or requirements of the Water Use Act
of 1967, or any other applicable laws and regulations. Well construction shall be in compliance with the North
Carolina Well Construction Regulations and Standards.
This Permit will be effective from the date of its issuance until June 18,2020,and shall be subject to other specified
conditions, limitations, or exceptions as follows:
1. The well(s) shall be constructed in accordance with 15A NCAC 02C .0100.
2. The well(s) shall be constructed and located as shown on the attachments submitted as part of the permit
application.
3. A well construction record and copies of well logs, if generated, shall be submitted to the Division.
4. A 24-hour yield test shall be conducted for each well in accordance with 15 NCAC 2C .0110(b) and
submitted within 30 days of completion.
5. Well construction records(form GW-1) for the well must be supplied to the Division of Water Resources'
Information Processing Unit within 30 days of well completion.
6. Issuance of this Permit does not obligate reimbursement from State trust funds,if the well is being installed
as part of an investigation for contamination from an underground storage tank or dry cleaner incident.
7. Issuance of this Permit does not supersede any other agreement,permit, or requirement issued by another
agency.
8. The well shall have a Well Contractor Identification Plate in accordance with 15A NCAC 02C.0108 (o).
9. Notification to the regional Public Water Supply Section (PWSS) must be made if/when this
emergency backup well is placed into use and connected to the drinking water supply distribution
system. The PWSS can provide information regarding any monitoring requirements at that time.
10. When a well is discontinued or abandoned,it shall be abandoned in accordance with 15A NCAC 02C.0113
and a well abandonment record (form GW-30) shall be submitted to the Division of Water Resources'
Information Processing Unit within 30 days of well abandonment.
If any requirements or limitations of this Permit are unacceptable, you have the right to an adjudicatory hearing
upon written request within 30 days. 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 demand is made,this Permit is final and binding.
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DocuSign Envelope ID:83D9AA7E-17C7-4B41-8483-9F000AB80D65
PERMIT NO.WS0801037
Permit issued this 18'day of June 2019
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
DocuSigned by:
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Morella Sanchez King,PhD,PE, Regional Supervisor
Division of Water Resources
By Authority of the Environmental Management Commission
cc: Cape Fear Drilling Services Inc.(via email)
Rodney Merritt(via email)
DWR-Public Water Supply Section(via email)
DWR files(Laserfiche upload)
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