WV0800329_Application_20230322

Aqua Well Drilling
17061(ennedy Road Wdrnngton,NC28409
910-395-1987I A9uaWell Drillin 17@gmaiLcom
E-mall
TO: Geoff Kegley FROM: Gary Jones
E-MAIL [e-mail]
PAGE3�
PHONE:
i
DATE:
RE: Variance CC: [Name]
❑ Urgent ❑ For review ❑ Please ® Please reply El Please
comment recycle
Comments: includes coverage sheet- Variance Applications
Thanks
Gary

NORTH CAROLINA DEPARTMENT OF ENIRONMENT AND NATURAL RESOURCES
VARIANCE APPLICATION FOR 2C.a100 WELL CONSTRUCTION STANDARDS:
PRIVATE DRINRIND AVATER WELLS UNDER 15A NCAC lHO ARK)
WATER SUPPLY WELLS UNDER 15A NCAC WC A109
dHwmissp➢V'wv^rrwrvm�kkml "Ynwuv DXreAnB luomfYelLvW[ao:vG6i8e ka2`ry hduvaS��n+�al wtu
WELLS OTHERTHAN WATER SUPPLY FISHER 15A NCAC 02C.010
LednAnR mmbmvrR tMd /MLO�TPi Will
PrOu rlmry it, Sipeujmmmion. Imewe mdmisidrnit(be, Pdumada: inmmybe.
DATE: 3-/S _,m 2-3 eERmlr Na: __,__(w b'1l,1Oeled[�DWQ/DR1)
A. WELL OWNER - Lot single GmaY residences list the property omva{u} For all olhmrs list rvmee of elu business,
otgml>a4bq or govammun[ag®cy and p¢son doted signawre eulhority
A-GNES'
MVlmg Addmss. -Z—c>�;r_ 9D�--
Cfe, Gw stagy c zip wd��ir Coamy- /r,G.✓
DayTalAlx nsip t"/e Cell NO
EMNLAddass: GCC �5/yFar No:
c✓� R. PHYSICALLOCATIONOFIMELLS� A}Ai .
(1) Erred Identification Nmmber(VM)ofwell ssm'. l01/ xe 34"s
County. _40C , 5wc <
(2) Physical Addets(if dnFo-cvt them invling Ailmss):
Cig.
State PLC Zip Code
C. WELL 9OI HE'S INFORMATION (ff4ncwm)
Well Dnl6eg Contractor's Namur C�tttt Les _
NC WcII Drillivg GntracYor.1Ccmfi` N Comperrry Name��''}�U O VLLFI\ t\�(Ll\-ro Contest Derap>L C�n`q o'n,e'S
Clr-A �'"��—�—qp Sppta[c 1y' '� Zip Cod Comlry' NPID 1 re rnPQ
DNTsc Nn'. 9Ns .;TS—h�� Co1I NO
EMAILAddrcis H,,�Lra 1 Fax N,..
4«mQW 2EV Nil Rohwr PoLrvery doll

N. REASON FOR VARLANCE R&Qi1RST- Lalude type of vacItS to be conewon-tr rule for el=h an, varimmc s
being mgaostAl, dosolOdoa of M1ow Me mining, 6w o MaWi read weKere and fee
evil banner, why ameavaea Unclear opera c In rcordeme with hexfaldrbxiBamtrienn
ially
antl/m perverts equal or bertev Pmreedonnf de gmundwesr.
E. ATTACHMENTS - Provide the Rllawing intienen as azmchmow' N Mic aDpineeonr
(i) Ame;eliciting 8nn oeffiIon of Ne Irmpray'inliern3 fom4 nail Ce N:: 6mle Aova Number, d�slanwsrep
Ay brinearva.da)snff encfm Rvdivg iho web lxsean.
(]) DotuiW inc map with scale 5fiowing Imatiw of proposed earth nineteen ev saber spsnomp), building
SerrdavosvproPA"y lips, wffier maim PMptial soarers ofcooWminazroh oplattelLi, it,
(p) Su'mnilnarcyW oil loenWent pcna.INA14afion rmd elm Cwn"bel snap(r aepaobtr`.
(4) Anp oIDm fare!... ort n)1evam m IM rune a, requeN each m' 8 wall cm birl uoa preen m t showing bmposed
wdl(iv'- or eiYPaal wntb IrlonsnamrlaWmebwds.
SIGNATURFtS)
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tlrrw�/�nmit, re.a.,
1�a4 S w $M f) u
e w wn y art
64Wmvu otP` R e
..vbm,af W.a noir"em.
(T"c, h 11ud7"pA
4 Jones_
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spem.o areaaary uamoeevvmf waaun spoamid
Aiu:m Ty�N311NweuW Td1e of GunNPmManmenb: MefllMSl art
c? 5AACACO2C.pLA'the SecremrJ�ofNra pfvlyton o/YYalerHzr'ouxer or Me DfvMon ofPWpe XeaUkmwregwre
submnrN uf/ l ,n un daamNnereasmy m make a dee,swn carte variance, mW urzlWse aoudll5fms re➢arr er the
del .ioq died shal/lepo et e, mrtring so Me roquevr wfi3W 30 dit of receipt Of Me vodance requeel A lunatic,
uuriafad wah true denafon lMa U�tznar may m rre a cpnms2d cmo bYfl/in8 a PefiNar o.. e di,
..rt�}.-ru»�zm f �c I508-2� weeM ao days Star receipt ldre d5en�^rrm. m
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