WV0800326_Application_20230308

Aqua Well Drilling
1706Kennedy Road Wilmington,NC28409
910-395-1987I [e-mail]
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TO: Geoff Kegley FROM: GaryJones;
E-MAIL [e-mail] PAGES:
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RE: Variance
❑ Urgent ❑ For review O Please Z Please reply ❑ Please
comment recycle
Comments: includes coverage sheet- Variance Applications
Thanks
Gary

NORTH CAROLNA DEPARIMENT OF ENVIRONMhLT ANDNATURAL RESOURCES
VARLANCE APPLICATION FOR 2C.0100 WELL CONSTRUCTION STANDARDS:
PRIVATE DRINKINC WATER WELLS UNDER ISA NCAC 02C A3H)
WATER SUPPLY WELLS UNDER ISA NCAC 02C.0109
AflwmevpPfY'^vP^ �uxsNmN PXwmJr'!rdq Nvdr fYdk arnlfndxdby In'Igr6oM1 vehrrvvL oed eanmorJn! wells.
W ELLS OTHER THAN WATERSDPPLY UNDER 15A NCAC 02C.01M
LwlWrvsmonnarms ced rvmwry ovl<v
Aint dc+rFY or ryye ufwmawre Zl(ep./Alex�bmmuls xNi terOume6na ucompLfe
DATESB_% PERMLINO.:. _ _ _ (mbotvmPlmelln?DWO/DPII)
A. WELLOWNER-FOT SNglc Coolly osideneen lirtdm Pmpoh owaor(s) For all otlieq Est wmo of Nc b:ssv�ess,
orgartiwtioq or govemmcnt nonq abdpemon delegated slgnatare authodry
Mallina Adarasv:�BOk S� ���..Z 51NU _
city. �� i,S(m�- stata�e zipcndai) c count' Z; Zc
Day Tole No3�3e, (i5 Z 6Diq Coll No
EMAII,ktl css: A07 gCole 16- Fax No:
B. PHYSICAL LOCATION OR WELL SITE
(q Pamel ldonwuazlon Nmoar TIN) dwell sim
County:
(2) PLraiovl Aaemaa nl�ed,an m®tins eadaaaz /SG /t9 (./ /.
Cry- rinE i C/g.ol sutv�!i: zip Codm
C. WEd.DR1LLERINF0RMATI0N(ff"own)
WeLDnillny ConVaorotsNamo_ 9 1 nIS
NC Well Dahng Con"Qtor CerJP atio"n No .'dIQQ
CCmpmryNmne Contact Paraom Gmw ilOIAPS
City: }p(,l"`� smmry�2- Zpcod w county iNcu "Ft mein.
Duo, Tole No QIO- 5-1987 Co11No._
EMAIL AdiLzee. 1, Lr,lL .rr•.n f'ax No.:_ _,___.
Iv:m(ovZol Np RcviMFrbrvery20V

R. REASON FOR VARIANCE REQOfiST- lnclade g-pe of wdl(s) to bo consimeNd, rate for wbirA Ne variance u
being fcgp"MI, deeevrynon of bow Ne ar=nate mrtvtracaon r01 o rndeaget human biretta and welfare and Ne
eandrrmm"ud1y conrWotion Inver operate, in oworda�ry War, am eaadwds. nm rec."W"ly fiaslule
and/or proridcs equal or bates prommlw ofPoe groundwamr.
E. ATTACRIWINTS- Provide hofollowmgunto maalia11 of a o<bmm¢ n ften appFmtion
(1) A map eboope geaml location of eta Propane(;4,cofS aadnamc; NC Salc Rwm Mrlber, distances, an},
key la'.dmahe. oL) ouhrreem for fmdal-me wGl loco9on
(2) Dvtalal e withscale showing location of pmpoead wol, 21mmm to sepLc aseuMs) bhpdiag
fmmdatio s. ptoPeny flax aaterbodos potential smcres ofcmtandoation oMotwells,ete
(i) Sammla"u ofinemow vll pemduPp6ealm and she nmls raw map(ffappliovmm.
(4) f tI nt h niiauce voqucMuCAaoa well nrr'nem meneg ➢eepomd
Ill YPCN qGVQn-als/ M
SPCNA URP(S)
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siuia(s) o(W rvLAvpeaK
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b\gnN/��f/�
TT�eem Tyre wevwo _. _._-
�1(}{l/1�1 ��p- pvry omuegrJ
Sure i>)p nea�W ICvvrt awv __..
Rnrt _ — ''3(1QS�,SI Convweenn
Tfnwlfepcercll doll¢)
Tppa rcol Cwvry Eanrovmevvl He+Itb Spe Le.
Finat wTep: Pall Name and Thar o[Gua{ ..nv[mnmee6l Ham® Fpairp'eY
YerILAoK ( 02Gein�lsoOIIR the Sevwury o(the U/viainn clWaN.-Ree'muaesm Me DiNafon ofPub:(a Hevlfh may re9edre
auLm(tlN ad shvm In
^.mew oe0 g to t l rcgNc i .,uan 3 on v; vatlanre of impure co:vrcIvee wA Iv aj(he ap"k a rmd xho/I revpon0 in i* the ec she refusal umfimr and d(he,o, 0 of Re ed cfpe reguesi n vonanw
a„pv<bca m o to Alssall liod wrm ma decralon oj,ae Unaelor wm wmweno„ d ronresree rmn erfimg o perro+aa
vesnhed(n GS i5011-23 w(tha dO ddya frer rer�lofUra daeuvmrt
u raaa Ym.mwe eeaue,u om, la.1 a6.wl7 lesrx

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