WM0801139_Application_20190909

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
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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.
1. Date: 8128119
2. County: Carteret
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3, What type of well arc you applying for? (monitoring or recovery): Monitoring
4. Applicant: Lampe Management Company Telephone: [phone]
Applicant's Mailing Address: PO Box 608 Smithfield NC 27577
Applicants Email Address (if available): Guy Lampe - Gu l-lam emana ement.com
5. Contact Person (if different than Applicant): Brooks Wall, ECS Southeast, LLP Telephone: [phone]
Contact Person's Mailing Address: __ 6714 Netherlands Drive, Wilmington. NC 28405
Contact Person's Email Address (if available): bwallua'�i ecslimited.com
6. Property Owner (if different than Applicant): _ Channel Bay Mobile Home Park Telephone:
Property Owners Mailing Address: 2112 Arendell Street, Morehgad City, NC 28557 _
Property Owner's Email Address (if available):
7. Property Physical Address (Including PIN Number) 5264 Hiahway 70 PINS 635607677813000 and 635607675745000
City Morehead City Gounty Carteret Zip Code 28557
8. Reason for Well(s): assessment of suspected contamination of the groundwater
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: former automotive repair
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
Not known
11. Type of contaminants being monitored or recovered: organics (ex: organics,
nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? no
EAsting Monitoring or Recovery Well Construction Permit No(s).:
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet):
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? not known
If yes, give distance(s):
15. Well Contractor: _ ECS (Brooks Wall) Certification No.: 3389
Well Contractor Address. 5714 Netherlands Drive, Wilmington, NC 28405

PROPOSED WELL CONSTRUCTION INFORMATION
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
b. Estimated well depth
c. Screen Intervals
d. Sand/gravel pack intervals
Type of casing material and thickness
Grout horizons
Well head completion details
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
Number of wells to be constructed in unconsolidated 5. How will the weil(s) be secured? Temp
material 6 expansion ca
3. Number of wells to be constructed in bedrock:
Total Number of wells to be constructed: 6
(add answers from 2 and 3)
Estimated beginning construction date- 9/2019
Estimated construction completion date. Same Day
(within 9E hours of installation)
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 F,00 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.
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) and accepts full responsibility for compliance with these rules
Signature of Applicant or *Agent
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Printed name of Applicant or *Agent
Fa�C�(
Title of Applicant or *Agent
* If signing as Agent, attach authorization agmement stating
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 thn responsibility of the applicant It ensure that the
well(a) conform to the Well Construction Standa (Title 15A of the North Carolina Administrative Code. Subchapter 2C).
?VAA [WLVC701-A�0.6 VAIIItIV
Signature llilp rty Owner (if different than Applicant Printed name o Property Ownei (if different than Applicant)

- ---------------
SOURCE: PORTION OF USGS TOPOGRAPHIC MAP
USGS MANSFIELD QUADRANGLE HIGHWAY 70 PROPERTY
NC - CARTERET COUNTY 5264 HIGHWAY 70
7.5-MINUTE SERIES MOREHEAD CITY, NORTH CAROLINA 28557
SCALE: Eg ECS PROJECT NUMBER 49:10053
1"=24,000' ,,,

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PROPERTY
BOUNDARY
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TWO POTENTIAL RECEPTORS OR SOURCES OF CONTAMINATION ARE
KNOWN TO EXIST WITHIN 500-FEET FROM THE SITE. eK
100 FT UST INCIDENTS AST INCIDENTS
SOURCE: POTENTIAL SOURCES WITHIN 500-FEET
DIVISION OF WASTE MANAGEMENT HIGHWAY 70 PROPERTY
SITE LOCATOR TOOL 5264 HIGHWAY 70
E(! MOREHEAD CITY, NORTH CAROLINA 28557
SCALE: ex
AS SHOWN ABOVE + I I ECS PROJECT NUMBER 49:10053

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BOUNDARY i
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SOURCE: PROPOSED PROJECT BORING LOCATIONS
GOOGLE EARTH HIGHWAY 70 PROPERTY
IMAGERY FROM 9/2019 5264 HIGHWAY 70
IF-7iMOREHEAD CITY, NORTH CAROLINA 28557
SCALE:
AS SHOWN ABOVE ECS PROJECT NUMBER 49:10053

GROUND TOP OF DIRECT PUSH STEEL
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SLOTTED STEEL SCREEN
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0.01-INCH SLOT WIDTHS
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PROPOSED TEMPORARY WELL `
CONSTRUCTION s
HIGHWAY 70 PROPERTY
5264 HIGHWAY 70
MOREHEAD CITY, NORTH CAROLINA 28557
ECS PROJECT NUMBER 49:9487-A

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NC Counties, NCCGIA, NC OneMap, US EPA, Sources: Esri, HERE,
Garmin, FAO, NOAA, USGS, © OpenStreetMap contributors, and the
GIS User Community, NCDOT
NC Division of Waste Management
Carteret County, State of North Carolina DOT, BuildingFootprintUSA, Esri, HERE, Garmin, INCREMENT P, METI/NASA, USGS, EPA, NPS, US Census Bureau, USDA I Copyright:© 2013 National Geographic Society, i-cubed I NC Counties, NCCGIA, NC OneMap, US EPA I NCDOT