HomeMy WebLinkAboutWS0801042_Application_20190725NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY — DIVISION OF WATER RESOURCES
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: July 15, 2019
2. County: New Hanover
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE:
3. Applicant New Hanover Regional Medical Center (NHRMC)
Telephone: 910.667.7000
Applicant's Mailing Address: PO Box 9000, Wilmington, NC 28402
Applicant's Email Address (if available): Bert. Singletary(o)NHRMC.org
4. Contact Person (if different than Applicant): Bert Singletary Telephone: 910.520.6157
Contact Person's Mailing Address: PO Box 9000, Wilmington NC 28402
Contact Person's Email Address (if available): Bert. Singletary()NHRMC.org
5. Property Owner (if different than Applicant):
Owner's Mailing Address:
Owner's Email Address (if available):
Telephone:
6. Property Physical Address (including PIN Number): R0611-004-001-000
City: Wilmington County: New Hanover Zip Code28402
7. Intended use of Well or Well System: Cooling tower supply
(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? Yes
(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): 360,000
10. If adding a well to an existing system, list the existing water supply wells in the existing system and their respective yields:
NHRMC Emergency back-up well. 200 qpm
11. Is this a public well or well system? No If yes, give Public Water ID Number:
If yes, give Project Engineer and contact information:
12. Well Contractor: Sanford Sweeting with ARM Well Contractor Certification No.: 2082-A
Well Contractor Address: PO Box 882, Hampstead, NC 28443
PROPOSED WELL CONSTRUCTION INFORMATION
As required by 15A NCAC 02C .0105(f)(7), attach a well
construction diagram of each well showing the following:
2.
No. of wells to be constructed in unconsolidated
a. Borehole and well diameter
material: 0
b. Estimated well depth
3.
No. of wells to be constructed in bedrock: 1
C. Screen intervals
4.
Total No. of wells to be constructed: 1
d. Sand/gravel pack intervals
(add answers from 2 and 3)
e. Type of casing material and thickness
5.
Estimated beginning construction date: 8/19/19
f. Grout horizons
6.
Estimated construction completion date: 12/31/19
g. Well Head completion details
Continued on Reverse
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. 143-215.10B(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
Admi istrative Code, Subchapter 2C) and accepts full responsibility for compliance with these rules
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Signature of Applicant or *Agent Title of Applichnt or *Agent
Bert Singletary, Mqr. of MS, PO, and ES
* 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
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 Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone: (828) 296-4500
Fax: (828) 299-7043
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: (910) 433-3300
Fax: (910) 486-0707
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: (704) 663-1699
Fax: (704) 663-6040
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: (919) 791-4200
Fax: (919) 571-4718
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: (252) 946-6481
Fax: (252) 975-3716
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: (910) 796-7215
Fax: (910) 350-2004
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
1" X 40' PVC Well Vent 2' X 8" Riser With
Measuring Conduit With Cap � Sanitary Well Seal
Ground Surface
60' Portland
Cement Grout
135' Portland
Cement Grout
3' BentoniteT
Grout
Applied Kec9ource
Management, P C.
Hampstead, NC 28443
42' #3
Gravel Pack
L
60' X 14"
Certa Lok SDR 17
PVC Riser/Outer Casing
Top Of Castle Hayne
Limestone Aquifer
140' X 8"
Certa Lok SDR 17
PVC Riser
8" X 16" Stainless Steel
Centralizers at 50', 100',
140' and 180'
40' X 8"
0.030' Slot Well Screen
TD = Approx 180'
TITLE: Proposed High Capacity
Well Construction Diagram
JOB: SCALE: uH i t: uKAvvn
19197 NTS 7/5/19 JLC
FIGURE:
3
trY
N
From GoogleEarth Image dated 10/2016
TITLE: FIGURE:
Applied Keoource Proposed Well Location
Management, F C. JOB: SCALE: DATE: DRAWN BY: 2
Hampstead, NC 28443 NTS 7/14/19 JLC
A #.
r
Diesel Fuel -
* - Emergency Generator USTs
a ti
And ASTs
Proposed Well
Location
x
Jet Fuel AST
Diesel Fuel
Emergency Generator
AST Emergency Back-up
Well Location
a
4 -
4 �
N
From GoogleEarth Image dated 10/2016
TITLE: FIGURE:
Applied Resource Site Vicinity Map
Management, F. C. JOB: SCALE: DATE: DRAWN BY: 1
Hampstead, NC 28443 As Shown 7/14/19 JLC