WV0800219_Application_20190712

A.
ILM
C.
Not th Carolina Department of Environmental Quality (DEQ) — Division of Water Resources (DWR)
VARIANCE APPLICATION FOR 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: Jul:v 9, 2019 20_ PERMIT NO.: " 0$ 0OZ I t
(to be completed by
DWR/DPH)
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:
Regency Court L.L.C.
Mailing Address: 10516 Devonshire Drive
City: Huntersville State: —NC Zip Code:28078 County: Mecklenburg
Day Tele No.: 910-264-7798 Cell No.: 910-264-7708
EMAIL Address: [e-mail] Fax No.:
PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) of well site:
County: New Hanover
(2) Physical Address (if different than mailing address): 709 Bedminister Lane
City: Wilmington County: New Hanover Zip Code: 28405
WELL DRILLER INFORMATION (if known)
Well Drilling Contractor's Name: _ Tony Robinson
NC Well Drilling Contractor Certification No.: 2690
Company Name: Coastal Well Drilling and Pump Contact Person: Tony Robinson
City: Castle Havne State: NC Zip Code: 28429 County: New Hanover
Day Tele No.: 910-231-4249 Cell No.: 910-231-4249
EMAIL Address: [e-mail] Fax No.:
GW-22V Variance Request Form Rev. 3-6-2017
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 groundwater.
Well is to provide water to stabilize a retention pond in the Re encv (a subdivision in
Landfall) and to maintain vegetation Within the pond required by the state The well Will be
Place on an easement which will be turned over to the Regency Homeowners Association once
the pond is transferred to the Regency HOA Then only feasible place to place the well is within
the easement close to the pond. The well will be about 22 feet from the corner of each home to
the left and right of the well All wiring necessary Will be in the ground Water usage Wil be less
than 60,000 gallon per day on more than 3 days per week There are no septic systems in the
toill !je Z/sr ao►nd c,K
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. SIGNATURE(S)
Signature(s) of WelvProperty O er
John D. Mollozzi Agent for Regency Court L.L.C.
Print or Type Well/Property Owner(s)
Signature of P son espo Bible for Well Construction
(Typically the well driller)
Ton Robinson
Print or Type Name of Person Responsible for Well Construction
(Typically the well driller)
Signature of County Environmental Health Specialist
Print or Type Full Name and Title of County Environmental Health Specialist
GW-22V Variance Request Form Rev. 3.6-2017
Page 2

e.o19 aa• n. � \`�,,
Kis
81
\\\\\ 78 \\\\\ I I /// // �� \
jJ L-2=83,
'tea\ \\ yk�// �o��v� ���9,y.tt.
82
AL 9S 9d
83
Po
POND
/h \ �� q p.
7.592 e4• \ /Y/ \
(0.17 \� \
84
\
l \ \tag 4/0.163 owes
7,9ie .a
\ ce5i
374 p
Ili ICI ,323(17
�9ry�/ v y"�7eosw•"gq \\
/ �09 Ow
20
II' S
203,�;� �� �\ •���y