WV0800354_Permit (Issuance)_20240628 (2)

Aqua Well Drilling
1706 Kennedy Road Wilmington, NC 38409
910-395-1987I AquaWellDrillin [e-mail]
E-mail
TO: Geoff Kegley FROM: Gary Jones
Q CD M M(R.NC-Ga✓
E-MAIL4 gkq� PAGES: rZ
p-
PHONE: DATE: UI� - C— cA L-
RE: Variance CC: [Name]
❑ Urgent ❑ For review ❑ Please M Please reply El Please
comment recycle
Comments: includes coverage sheet -Variance Applications
Thanks
Gary

NORTH CAROLNA DEPARTMENT OFPNNIRONMENT AND NATURAL RESOURCES
VARIANCEAPPLICATION MR 2C.0100 WELL CONSTRUCTION SIANDARDB:
PRIVATEDRE KYSC WATER WELLS FOSUFR I5A NCACO2C.U000
WATERSUPPLY WELLS UNDER 15A NCAC 02C.0109
dl(w1e.rvPF�Y-oe@rro�mnMevaL "Prtmrt UrcnMlw l"a+�Wr4r"mid ine4Nrig L+SRmIw. MleuldoL aMammeivlotw5s.
WELLS OTflERTHAN WATER SUPPLY UNDER IAA NCAC 92C D1O4
L�dWme^admnxg mn rrcav9''^�
RlntNmly wrypatnformae'an I/IgMksu�m4mis wUl herdnmtans incompl9e
DATE:. 6 1e . 20�y PERMIT NO.: __(bbosmplebi W Dw!)NPt�
A. WELL OWNER—Por smgO fm ily msldrncss Ila Ne pmpedy owmes). Fov all oNers, list oamo cf IEe buavee^,
organv5on, or gm�mmf agency and Dotson delagamd slgoewm aaNcntyw
Meiling Addrnss:
Cia one — k. _ Stale A)2 zip Code88445 Coanry;,�K r F _
Day Tole No.: _ __ Ccll No._
EMAIL Address: _ Fae No..
K. PHTSICALLOCATIONOFWELLffiTE
(1) Pamel ldenaEe mFhuu er(PIN)of WN1
Cowry: _
Pysical Adarcss (8diffuanf @m� maifiog addmea):
Gto: SON'K ZRCNd
C. WE.LLDRffA,ERINFORMATTONIffhIcw)
Well Dnlling Conlramor's Name: L'JWL I (l'J
NC WUII Drill'mg Covusobr Cun6ta No: .JIQQ
CompmyName �� l ion Coom1KeaLPorsom cbRc,�/1P5
wry: I Slam�e _ zm Coaasove l comnr:S�2 1-Fzilrn/ems. _
DN, Tela No 91O 15-19a9 CNI No.:
ENIAH,Addmrs: 61 Iarltm l77 '1 erm IN,Nn:
humiGWS2V F,w 3 R;vz P2013

U. REASON FOR VARIANCE REQUEST—IDdode L^pc of ed$e; to be waeoueted: mlo For wlnoh the vanxncc is
bring mgnonted. "ose iptlon of any the vJnate wnevncuon loi not mrtl'wger woman IwaM, and welfam and Mo
weai;iara, In Corot n onNm oRnamn mamrdanoc uparim condones ienoawrorw M faiibl+
and/oc Roviden equal or want porn^. Jan of No moundwalu.
/fie/eta r
H ATTA(r(MANTS—Prvvidathe Wanting laf ,vnonae ataclu sots to Far application
(I) Amap A opin6geori loca0ou oftTcptopon}'Vmludiagmad meter YC Smk Roue Num6ea, di+u.'oeos any
kev lnedicot emJ wiiWxa fa➢nding two rion ccaain
(2) DoWiiad si wale cleaving location of pnpoeed boll content scone rysurn(a), Naming
f .datim4 property here, water bodies poLLmtiel sonroes of condemnation, other welly e5.
(3) Sabot a eoq oftb, loculw-eliptranitappllomiou and ao, t'ahnum'cap (SapplvsTle),
(� ivey oMes infrrsoaoon ralaysat to the varlamc voquest swap an a well QN paw ton da for operating temporal
IVS1iou_o .'nypleat 000avuc6on matetitFifaroick
x �s,a ate twa,�ty o,.aerco _ an
i
N mType I ry \�an(sj
Yirn fP R k(or'Wr1LCouNa Ybrt
r 8, rs,A drill")
0
9rm T u[Pmrm sh a eau
... rcdtq aM1 ue0 drgltr) w
eeco"t, E"Mmm,mmi HealM Syccnl - 9i�rtme oe
Prime'*S,VIa NMIu TtlleafGwty&vY3romneo4l AevIG 6g�aOUY
aNSANGC 02C 02:8 Ure.@crewy after, nblsron ofarian-Rmavreev or tho Dioiaion apIr bllcHealth mArequire
gorsel aft rmntton deenrad to cen-are to may a dulatov on the varianre wayawporie eamphimnx nv part of the
JoyNa,o, and chair mriond m urlmig m the retineet ' inun 30 dalu frc""FV Jma vmimwe request d ,warns
oyplkwin whn le droara iod with ehe decnian rt lactic, mow eommenve o ormle ed uve by fWanS a petition a`
ut,rte armGS 730 -23 wMan d0dpas fterrecergr of pe,diceeir2
.nv.av vum„e I .urmxw.3 won, r1a,1

6�� 7�
�,
�-�.� t
' J6d➢ �
R
f
C�� � � �
__ � I oS
p�
A
)i
�
O
P
�
�
C
G
�
}
{
1i
C

NORTH CAROIINADEPARTMENT OF ETNTRONMENT AND NATURAL RESOURCES
VARIANCE APPLICATION FOR 2C.0100 WELL CONSTRUCTION STANDARDS:
PRIVATE DRINRINC WATER WELLS UNDER I5A NCACO2C.0i
WATER SUPPLY WELLS UNDER USA NCAC 92C.0109
RRwu�.+vpy( wlHndemstlned'TnlavOrv�Nnd IPvhv tveLLa"and rossag ur W", eMr�+nlvL vndmnmeroia[wI1'a
WELLS OTRERT'RAN WATER SUPPLY UNDER ISA NCAC 02C AUIW
i aence,,.o-,un.ms vMrcem'+rs wdH
RLtl rlemly mTy'(a wjmmutioa Jtls331esubmIImisw6(M1ermmul o-erumreyl�
DATE: 6;--;' G 20021 PERMIT
A. WELL OWNER —For single family a a,dmws list the property oamer(s) For all od m , list rare of 10 bosince4
organiNuain, or government EMO and person d Road signffirre taxorily'.
Mailing Addrore
City r j2a.G Ts(his start iv - Zip Code
`�dscaartx 13��,.,Sw r�Gc
Day Telelso.'. 33l— iiD r-1 870 ( Coll Na.1�_^"�
EMAILAddress: �m Lsi CR i Fax No
"m
PRVSLCAL LOCATION OF WELLSUTF
p) Parrot Identification Namber (PIN) of well
Coanry'
(2j Phooal Artless (if dlRarert 9r, healing
Cry
C. WELL DRILLER INFORMATION (if lmmm)
smte.yC zipCodm
WeP Dd11irg Cantilever s Nsno P�
NC Wall Dolling Contractor Cmdfi aeon No OQ
Company Name 1 Coarser Person: P'NO4 3OnP$p
City: yy_ stars tip Cod4 1CxurL:Ns`0 \\OKSdPY�
Day Tele No: _QIO—�QF'\9hd7 Collor.'.
EMAIL Address: 1\cif\L 17�Fax No'.
Poem GW.TLV Fagot R ordr,brvuy2

r3. REASON FOR VARIANCE REQUpS T - 11,our, II, It c ;, to lec Coleovatiod, ralc for rrhioh No nnanoe is
cem?, 'canceled daseraptio_ of h "al Lose101 a, nc, home[]pe had, aoclom old tl=n
antlrc I,e,ocieannioa papers opceared la accr.�doaw whit 3e awrdards'a achearned Id, fe¢dSac
ran 'a, radvidepogaa( or later pmleoGoo of the gronadwidem
rnm
P. AT7ACaMENTS
A'T1'ACaMENTB—Provide mr;rnrwlov lamnnnUrn ae plmrnmantammle opoGweor.
(1) A mapcMwingRenewal cal Arid p I-a-Rcpaad ,N' S too Rolle Nalearpricamans pap
I, alaths, sc) indicator for fiat the wall lomtiom
(t) Daaded vm reap wSh urue 8hrcoo g booties of proposed well mletmet d,, septic s em<s)_ biAlydng
ondzl project Im¢ wama bodies cooperate d; i nodded; of acildralnmion, aherwtll; des
0) Intend I eddy of tLo lICE weR pulladdr Pva4onI'd My otiaanal map Qfr•}rplirnis)
.
all tidy oCw f,Earravon ICaalano ro pee euuaw roauxr Inch ads, ell encoar dvat dip2nm led,nd P"i cod
sell Ureter aeracnl crosLrv,,,oJ//uw ureremels/meNods.
SIf.NAT1IYPM,(� ��
rytsv@J fW 1 penv gvnc,(sJ
�V`_�m as �ill..17L�hLNF..r_
- z.,to an•wmlm �aa,nc.[��
5� rw.R 4 her E,11tb W.d
-. have" ,cNe . `v ado, — em�eaymn..mmum.) e
Sdpnnr m a n ....mrvl Xea.A SyeunAn
Yfies ... TYpe WII Nnmemrtl Titleof Gudry EmimnmeMa YCJth 9pala(
f-
¢t tis NC'AC @CP] 12 'to alecre(oryr/1M Division oJWmaXecorvcexm Nu^ Diween of➢ubl o Aeof�hmoy repwre evbmsm: do'ra m "o ed odd olIole a,s a regue t chat( 30
on Um v ed receipt
mpy ewe roi indeed m' y pi seers
service loashoorameac Inch dr,'tothe request and iPdafamerneW' oRM1cw ravteeAwrfanca
do,, ( h 's drasotf i _h a ardsN , ofsheD" _ ntcaedo Y. l.b 0✓itbmt ov
Larder mery en
6carNGedfn 11S'. HPW2 wUM1m bodice' djl�rerelpt of dear
(ol V]In➢a6 LRolenLmm ho 36Tpl Pops 2

i,
�
z
x
o'
�
P
r
o
h
T
}
s-z i39
3 i2 a
TE �L
R F
i
� �J�?
1
2 T�'f
j m Z
cC
� dL
S w �� �