WV0800305_Application_20220322

North Carolina Department of Environmental Quality (DEQ) — Division of Water Resources (DWR)
Existing permit number (if applicable)
VARIANCE APPLICATION FOR WELL CONSTRUCTION STANDARDS:
WATER SUPPLY WELLS UNDER 15A NCAC 02C .0107
All water supply wells not considered "Private Drinking Water Wells" and including irrigation, industrial, and commercial wells.
WELLS OTHER THAN WATER SUPPLY UNDER 15A NCAC 02C .0108
Including monitoring and recovery wells.
PRIVATE DRINKING WATER WELLS UNDER 15A NCAC 02C .0300
Print clearly or type information. Illegible submittals will be returned as incomplete.
DATE* March 16 , 2022
Issued Date: Exp. Date:
Permit No. for new projects (to be completed by DWR/DPH)
A. WELL OWNER(S) — For single family residences, list all persons appearing on property deed. For all others, list name
of the business/government agency and person and title with delegated signature authority:
Town of Wallace / Laurence Bergman
Mailing Address: 316 E Murray St
City: Wallace State: NC Zip Code: 28466 County: Pender
Day Tele No.: 910 285 4136 Cell No.: 910-271-8955
EMAIL Address: lbergman(a wallacenc.gov Fax No.:
B. PHYSICAL LOCATION OF WELL SITE
Parcel Identification Number (PIN) of well site: 2395-83-7713-000L
County: Pender
Physical Address (if different than mailing address): 250 Henderson Field Rd.
City: Wallace County: Pender
Zip Code: 28466
C. WELL DRILLER INFORMATION (if known)
Well Drilling Contractor's Name: Matthew English
NC Well Drilling Contractor Certification No.:
Company Name: E&B Water Well and Pump Service Contact Person: Matthew English
City: Teachey State: NC Zip Code:28464 County: Duplin
Day Tele No.: 910-284-5489 Cell No.:
EMAIL Address: e.b.welldrilling.nc(lgmail.com Fax No.:
GW-22V Variance Request Form Rev. 7-13-2020 Page 1

D. REASON FOR VARIANCE REQUEST - Include type of well(s) to be constructed; rule for which the variance is
being requested; description of how the alternate construction will not endanger human health and welfare and the
environment; and reason why construction and/or operation in accordance with the standards is not technically feasible
and/or provides equal or better protection of the groundwate • (refences to attached documents are acceptable).
The type of well to be constructed is a 4in non -potable irrigation well. The intent of this well is to
allow crop spraying aircraft to fill with water at the airport as opposed to hauling in water The
variance requested is to allow the well to be 50ft from two 10 000-gallon ASTs. These tanks are
double wall tanks The condition and operation of these tanks are regulated and monitored by
NCDOT on behalf of the federal government and follow strict NFPA and FAA guidelines.
Historically, USTs have been on site but were removed several years ago. Upon removal,
monitoring wells were located in numerous locations and were recently closed and sealed. The
USTs and the monitoring wells are in proximity (500ft) from two drinking wells, one that supplies
water to the airport buildings and no issues have ever been reported to the Town regarding
contaminates in drinking water or monitoring wells. Additionally, the well will be located up hill
from the ASTs. Also, our staff is regulaily trained to use and maintain these systems which greatly
mitigate the risks of spills or contamination. Since the tanks were installed around 2006, no spills
or misfuelling incidents have been reported.
Attached is a map of the proposed well location and a letter from the Town Manager stating that they are aware
of the proposed application and approve the overall project.
E. ATTACHMENTS - Provide the following information as attachments to this application:
A map showing general location of the property (including road names, NC State Route Number, distances, any
key landmarks, etc.) sufficient for finding the well location.
Detailed site map with scale showing location of proposed well relevant to septic system(s), building
foundations, property lines, water bodies, potential sources of contamination, other wells, etc.
Submit a copy of the local well permit application and site evaluation map (if applicable).
Any other information relevant to the variance request such as a well construction diagram showing proposed
well liner or atypical construction materials/methods.
GW-22V Variance Request Form Rev. 7-13-2020 Page 2

(b) Wells Other than Water Supply under 15A NCAC 02C .0108. If these wells are to be constructed on property
not owned by the well owner or applicant, please also attach and submit a completed Application to Construct
a Monitoring or Recovery Well System (GW-22MR) found on our website at:
http://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-appl ications
Submit one copy of the completed
vai iance application to the Division
of Water Resources Regional Office
seiving the area in which the well
will be located:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Telephone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
Telephone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue,
Suite 301
Mooresville, NC 28115
Telephone: [phone]
Fax: [phone]
WINSTON-SALEM
RALEIGH
ASHEVILLE
• • •
RESVILL
Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
Telephone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Telephone: [phone]
Fax: [phone]
FAYETTEVILLE
•
WASHINGTON
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Telephone: [phone]
Fax: [phone]
Winston-Salem Regional
Office
450 W. Hanes Mill Rd.
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22V Variance Request Form Rev. 7-13-2020
Page 4

F. SIGNATURE(S)
Signature(s) of WeII/Property Owner(s)
leAntiret.) C . * +vs/vs) ''vwr- N�sN
Print or Type WeII/Property Own
P • on Respons e for We onstruction
Typically, well driller)
\\.edv` 5
mm-e--)
Print or ype Same of Persoesponsible for Well Construction
(Typically, the well driller)
Signature of County Environmental Health Specialist (for Private Water Wells)
Print or Type Full Name and Title of County Environmental Health Specialist (for Private Water Wells)
Per 15A NCAC 02C . 0118 the Secretary of the Division of Water Resources or the Division of Public Health may require
submittal of information deemed necessary to make a decision on the variance, may impose conditions as part of the
decision, and shall respond in writing to the request within 30 days of receipt of the variance request. A variance
applicant who is dissatisfied with the decision of the Director inlay coininence a contested case by, filing a petition as
described in G.S. 150B-23 within 60 days after receipt of the decision.
G. SUBMITTAL INSTRUCTIONS
(1)
For the following types of water supply wells only:
(a) Private Drinking Water Wells under 15A NCAC 02C .0300
(b) Irrigation Wells underl5A NCAC .02C .0107 with a designed capacity of less than 100,000 gallons per day
and located on the same property as an on -site wastewater system permitted by a local health department.
Prior to submittal of the variance for these types of wells, please contact your regional environmental health specialist
by visiting: http://ehs.ncpublichealth.com/contacts.htm
Submit one copy of the completed variance application to:
North Carolina Department of Health and Human Services
Division of Public Health — Environmental Health Section
On -Site Water Protection Branch
1632 Mail Service Center
Raleigh, North Carolina 27699-1632
(2) For the following types of wells only:
(a) All Water Supply Wells under 15A NCAC 02C .0107 other than the ones listed under (1) above
GW-22V Variance Request Form Rev. 7-13-2020 Page 3

T'own of WaCCace
316 EAST MURRAY STREET • WALLACE, NORTH CAROLINA 28466 • PHONE: [phone]
MAYOR
Charles C. Farrior, Jr.
TOWN MANAGER
Laurence C. Bergman
March 16, 2022
To Whom it May Concern,
TOWN COUNCIL
Warren Hepler, Mayor Pro -Tern
Wannetta Carlton
William Jeffrey Carter
Frank Brinkley
Jason Wells
TOWN CLERK
Jackie Nicholson
TAX ADMISTRATOR
Chris Martin
FINANCE DIRECTOR
Shameshia Fennell
TOWN ATTORNEY
Anna Heath
As the Town Manager of the Town of Wallace, I am aware of the well project at 250 Henderson Field Road at
the Airport and authorize Gage King, the Airport Manager to submit the variance application on the behalf of
the Town.
The Town of Wallace supports the project assuming all environmental and regulatory demands are met. The
completion of this project will allow our airport to better serve our community and local businesses.
Sincerely,
Laurence Bergman
Town Manager
Ma&ant... progrmiv¢... pro8pgrou8
FAX: [phone] • EMAIL: [e-mail] • WEB: http://www.wallacenc.gov
The Town of Wallace is an equal opportunity provider and employer.

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Proposed Well Location (,50ft nom ASTs)
Google Earth