WV0800315_Application_20220920

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
VARIANCE APPLICATION FOR 2C .0100 WELL CONSTRUCTION STANDARDS:
PRIVATE DRINKING WATER WELLS UNDER 15A NCAC 02C .0300
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.
Print clearly or type information. Illegible submittals will be returned as incomplete.
DATE: Sep 14
, 2022 PERMIT NO.: (to be completed by DWQ/DPH)
A. WELL OWNER — For single family residences list the property owner(s). For all others, list name of the business,
organization, or government agency and person delegated signature authority:
Marian & Robert Mears
Mailing Address: 105 South Lockhart Street
City: Morehead City State: NC Zip Code: 28557County: Carteret
Day Tele No.: 252-813-9200
EMAIL Address: [e-mail]
B. PHYSICAL LOCATION OF WELL SITE
Cell No.: same
Fax No.:
(1) Parcel Identification Number (PIN) of well site: 637617128078000
County: Carteret
(2) Physical Address (if different than mailing address):
105 South Lockhart St
City: Morehead City
State: NC Zip Code: 28557
C. WELL DRILLER INFORMATION (if known)
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.:
Company Name: Contact Person:
City: State: Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
Form GW-22V
Page 1 Revised February 2013

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 groundwater.
Irrigation Well- variance request for:
1) 15A NCAC 02C .0107 (a)(2)(H): proposed location is less than 100'
from the sewer main located 15' from front property line
2)15A NCAC 02C .0107 (a)(2)(P): proposed location will also encroach on 25' setback
to existing structure/dwelling.
E. ATTACHMENTS — Provide the following information as attachments to this application:
(1) 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.
(2) 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.
(3) Submit a copy of the local well permit application and site evaluation map (if applicable).
(4) Any other information relevant to the variance request such as a well construction diagram showing proposed
well liner or atypical construction materials/methods.
F. OTHER MINIMUM CONSTRUCTION REQUIREMENTS
For water supply wells, approval of a variance will require that additional construction requirements beyond those
specified in 15A NCAC 02C .0107 be met. Minimum additional construction requirements for Coastal Plain and
Piedmont and Mountain region wells are referenced on Attachments A and B on pages 4 and 5 of this application.
Approval of a variance will not be considered in cases where the specified minimum additional construction
requirements cannot be met.
G. SIGNATURES
Signature of Person Responsible for Well Construction (typically the well driller)
Print or Type Full Name of Person Responsible for Well Construction
(typically the well driller)
Signature of County Environmental Health Specialist
Blakley C Lyles
Print or Type Full Name of County Environmental Health Specialist
Per 15A NCAC 02C .0118 the Secretary of the Division of Water Quality 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 may commence a contested case by filing a petition as
described in G.S. 150E-23 within 60 days after receipt of the decision.
Form GW-22V
Page 2 Revised February 2013

H. SUBMITTAL INSTRUCTIONS
(1) For the following types of water supply wells only:
(a)
(b)
Private Drinking Water Wells under 15A NCAC 02C .0300
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)
(b)
All Water Supply Wells under 15A NCAC 02C .0107 other than the ones listed under (1) above
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://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications
Submit one copy of the completed
variance application to the Division
of Water Quality Regional Office
serving 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]
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]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Telephone: [phone]
Fax: [phone]
Winston-Salem Regional
Office
585 Waughtown Street
Winston-Salem, NC 27107-2241
Phone: [phone]
Fax: [phone]
Form GW-22V
Page 3 Revised February 2013

COASTAL PLAIN
Minimum Additional Construction Requirements for Wells Requiring a Variance or a Permit to the Separation distances In 16A NCAC 2C
.0107(aX2) and .01070j(3) - Applicable to areas that are Underlain by Unconsolidated Sediments and Sedimentary Rocks
POTENTIAL POLLUTION SOURCE
septic tank and elrainfield
other Subsurface ground absorption wa ste
disposal system
other sewage and liquid -waste collection or
transfer fac it ity
cesspools and privies
ahimal fE•eillcSts or maikire pile•S
Surface water(GW racharge]._.porrds, lake
other surface -...water bodIes___creeks. river
watertight sewage or liquid -waste
col Icction ortranstor facility
Ianimal barns
building foundations(cxcl uding well house)
fertilizer, pesticide, herbicide or ether
chemical storage areas
other non -hazardous solid waste landfill
non -hazardous waste storage, treatment or
disposal lagoons
industrial/municipal Sludge -spreading or
wastewater -irrigation €ite
aboveground or underground heating ail
storage tanks
all other potential sources of groundwater
contamination
sanitary landfills
chemical or petroleum fuel underground
storage tanks regulated 11Ilder 15A NCAC
2N with secondary containment
chemical or petroleum iucl underground
storage tanks regulated Under 15A NCAC
2N w/o secondary Containment
'Dd,hle cased PVC may he required
Attachment A (Form Gi1V-22%')
'MINIMUM SEPARATION DISTANCE (ft)
Standard[ Single Family I Variance
E
100
50
100
100
100
1000
100
50
100
100
50
50
SITE SPECIFIC
25
25
50
25
10❑
50
25
25
SITE SPECIFIC
MINIMUM ADDITIONAL REQUIREMENTS
PVC
>20 feet below land
tiurFace or as specified
by the Director
PVC.
To the first sig nificant
clay greater than 20 foot
below land surface or to
the souree .igolfer
100
160
SITEISOURCE
140
100
100
100
100
100
SPECIFIC
SITE/SOURCE SPECIFIC
50
50
50
50
500
500
56
86
1 d 0
100
DO NOT ISSUE
1,5A NCAC 2C:.0107(d)(4)(B), ,0107(e)(1)(A), and 2C" ,0116 provide for the abilit - to construct a well to a depth of less than 20 feet where the best
source of water exists between a depth of ten and twenty feet below the surface of the land. Because additional minimum construction requirements
necessitate that: 1) casing extend to a depth greater than 20 feet below land surface: and 2) grout extend to the fast significant clan layer greater than
20 feet below land surface or to the source aquifer, a variance to horizontal separation distances for shallow wells cased to less than 20 feet is not feasible.
Well construction information should be provided with the Application for Permit for 'Valiance detailing how minimum additional construction
requirements will be satisfied.
Form GW-22V
Page 4 Revised February 2013

PIEDMONT A ND MOUNTAINS
Mini mum Additional Construction Requirements for Wells Requiring a Variance or a Permit to the Separation Distances in 15A NCAC 2C
_0107(a)(2) and .0107(a)(3) -Applicable to areas that are Underlain by Crystalline Bedrock
POTENTIAL POLLUTION SOURCE
septic tank and draintiold
other subsurface ground absorption waste
disposal system
ocher sewage and IIq u id -waste collection or
transfer facil ity
cesspools and pnvies
anirn al feedlots or manure piles
Surfacewater(GW rechargel._.ponds, lake
other surface water bodies_._ creeks, river
seater light sewage or liquid -waste
collection or transfer facility
animal barns
building toundations{excluding well house]
fertilizer, pesticide, herbicide or other
chemical storage areas
other non -hazardous solid waste landfill
non -hazardous waste storage, treatment or
disposal lagoons
industrialfmunicipal sludge -spreading or
wastewater -irrigation site
aboveground or underground heating oil
storage tanks
all other potential sources of groundwater
contaimination
MINIMUM SEPARATION DISTANCE (ft)
Standard! Single Family I Variance
100
50
100
140
50
100
100
100
50
100
100
50
50
SITE SPECIFIC
25
25
MINIMUM ADDITIONAL REQUIREMENTS
Casing Type I Casing Depth
Grout Depth
GALVANIZED
STEEL
If Bedrock depth Is <50 feet= the
greater of 15 feet into bedrock or 40
feet below land surface
If bedrock depth le 50-100 feet: 10
feet into bedrock
If bedrock depth is >100 feet: 5 Set
into bed rack
full length
of casing'
50
5
PVC or
The or 40 I eet below land
full length
SITE SPECIFIC
GALVANIZED
STEEL
greater
surface or 5 feet into bedrock
of casing'
100
520
25
25
100
100
SITE/SOURCE
100
140
100
100
SITEISOURCE SPECIFIC
100
100
SPECIFIC
50
50
50
50
sanitary landfills
chemical or petroleum fuel underground
storage tanks regulated under 15A NICAC
2r4 with secondary containment
chemical or petroleum fuel underground
storage tanks regulated under 15A NCAC 100
2IJ wfo secondary containment
500
50
100
560
50
DO NOT ISSUE
A aril bik with a ammeter that is at least la greater than the diameter of the casing must be used to drill the cased ptrticn of the well Grout should be ir►stsIed under Pressure.
In stallat1cn using a tremme pipe Is acceptable Ir the space to be grouted Is free of ebstrucba
Attachment B (Form GW-22V)
Form GW-22V
Page 5 Revised February 2013