WV0100069_Well construction variance application_20201111

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES
VARIANCE APPLrCATl(JN FOR JN;JECT!ON WELi, CO:'<ISTRUCT!ON STANDARDS, GEOTHERMAL AQUEOUS CL()SED·LOOP WELLS (15A NCAC 02C ,0222\ rm GEOTHERMAL DIIU!CT EXPA:'<1$10)( CLO!lED•LOOP WELLS (15,\NCAC 02C ,0223\
lhii. iomt MUST accompimy t!io Cloficd--Lcmp (.fo-othG1ti1ti:I Not.H'frmtlon..Ponfl avalfabfc onHrrn: !i-f http:/ J deg.pc gov/about/di vjs!om!wpfoMe.ioµrce_�!water-::mwurccs�pcnnjts(wastc wnrer,-Juppch/1,1:rou11<l•WOte_r�
pra�ection/groufi9"..w'.1t2MWPlic_atiqns P;·liff Ciao.rlt m• 'l'yptr iJl}'rm11«ilo11, ll{iigfMi! 9uhmlllnls Wlll lla Het11nu1,f Ar lii'Cflfitpft1M, A, WELL OWN£R(S} = For single family Mitldtnccil, H�t n:H pl'Wi!Otra HMG<l. o.r:i the pro_r;uty deed, PM ali. atb6r�1 UJit murie of'tlte busln1J$11/gove;mm(lifif-a.gl¾'lcy and. pets1m filill t!tle with dt,,l6g;M�d i;t�fitur!t' !litfll'Orlty;
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MnilingAdd1,ss: ! 501 Gu r-o,M /,,t'kk
Cit.y: /','.v�N,\>'1 ile,., Siato: J;M_ ZipCodc,'1'1lS Cmmty,_--------
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D, PHYSICAL LOCATION OF WELL SITE (2) c.
Vorn•I ldentlfl,ntion Numt," (PIN) of w,11,it••~· -··-'q.,_J,.,,·.,,;;i:d.al l,.,_,1,,,,· ::l;,,. �·71""3"-')-'0"'· _O()(),c.. c..();..,... __
County, CJ<;,A t'()lu. Physioal Addre-Rir or d!fferG11t tlrnii fi'iatling iltfrlrn�!I,'. __ . ,.'1,:,0c'..· . ...:;.���t\t.,�·. ,;;rCa,,,,,. JCB>.;b'\=k.c----
WV0100069
REASON FOR VARIANCE REQUEST — &etude type of well(c) to be eonstnietad, ruts for wbkh the
vatlaneo is being requeetedt description of how the alternate oa» w takion nil not endanger human health and
welfare and the eavvheraunono and reason why eanstruction and/or operation to ascot -dance with the standard§ is
not tealnnisalty feasible rod/or provides equator ben profeodon tithe groundwater,
leer}_n _bit A& dp- _vety_ -
ne,e,) TTh;\ Mpg!: _ d*ter krG+�U'
SIGNATURES
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TTTyypa pail Mama
Stgaaldr4 al Well aIwner
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H i of n 'f Aso Fah Name
nntura nttVelt (Wow
Not or Type Viol Norma
Per 2M ArCAC 02C .0241 the Dii ec€prof the DiVialan Of WOOS RtSolace& mgvrequire arhnuaat olltOr oration
deemed steam/any to make a daelsha( an the vania ca, mat uupasa eandidata as part of the decision and shall
respond in wilting to the Penn n'hhfn 30 days of receipt afthe variance inquest d variance applicant wha
dlxsati,slied with the decision of the Director may commence a collagist?! cage by:Minga petition as described in
G.S 150E-23 within 60 days attar receipt (grthe decision,
Ctaeddae CIOUrertiinf 35fnnca [Fenn Rev,1-I4 f6 Rage