WV0800277_Application_20210426

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APN.JCATION FOR 2c CON.;rPCf:TON STANDARDS:
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D. . E SOl° 'FOR AR/ANN C: '. NE U EST - Include 4_ti a ' cl(,s? be cor{strt;tftd; rule .tcx which the varian o
being rcquc.si,c d; Bova the ?rS[*,k : to cchtsLtactiC}t'L w1i! trot endanger human health &td we:fare aitd �1 `
environroeni; and reason why coast—ectien flndlar cpc,iii�30i ^vcord sicc w.ith the staadai ds is i2:-f technically feasible
an.r.i/oz provide equal or better Xo r;r.iC=. (-4. the groundwater.
ATTACHMENTS iMENTS —Provide th;4 aisraciin-r nt~s to th_;, ptAfrition:
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(2.)
(3)
(4)
.. map .1-101,,Fing grei-tw-a location or the property :ate gonte' umber, disttknocs. _may
iEx y nd i i€k ss, lcient .f'or finding the vvoll
Detailed d! s: e _ nap with sr k showing location of proposed weBB .relevant ;o septic cyst (s). btdi g
!' i dati ns- pr'op rty l s. v '.ntcr bodies, pmerstial scA3rcc s oI` ;ontarnillatioik- otter web, e
Stibiaai=_ a copy oftiac !ccal wcU pc;ra;t application 3ni site. evaiutition map Crlapplie l-i) ;).
Any other infairmatiar, i...lcv trot to the variance x;cakiest Bach s a weld cos straction dingL tsr proposed
well /icier ;Y:' atypical xtfct!oa rrkate,rya]slr#1V0}0s.
SIGNATUIZE{S)
igns tore.() f W Wi liPe vpc:-1ty ; 3xcr(s)
hell s r Type W i Ile'-opc:-ty Owitec.
of Per Res p<smiibiic for A Cortstrie.tiou
kvrity
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?}re aru or Ty c e. of E'crssn;t .c:a sz lc See_ Consc- sic-i<Frk
(Typiically Use driiiez)
54+-azo1:rsrT orOrisaay via'o;srnsi t-a I3 Sptihaist
i TiRt o; Type kuli Naro e. And ' 'xtic o€ COIIISMy Envieomr entni Plenith Specialist
'e J,54 WCAC 0 s:2. 3 i fi$2 Serrstr rs' of2he t)ivisi.J qf Waxer Rene r .r ss C!' rdr l ivfs4o t o" ''ucae 't u t sacs: retjui. .,
,elan xitto1 qf in ormeeion deemed nece. .ery ma.a d.s.c7sion on ih.c variance, r ccry i po COWillieraras par•i of 621
dtreiSiOn. ar7a ,sf Dll r:".;Pr MI €n writing so the .requesA vsItfin.30 days of receipt of Ike }xaria€ace request- A variance
ap ii 'ant 11.4w r. 67s,€aJ1s110 wath the decision of the Direr ' mom+ Corrine .ce c: contested ec'se by filing r1 pef.ftio a a,5'
dawn -hod l.P; G.S. J508-23 within 60 days after r'eceipl of the decision.
GW-22V Varian u i2s qil s=errcn'Rev. 3-5- [?1 r rage

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