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C.APPLICATION(FOR WELL CONSTRUCTION PERMIT comment[vH25]:ADOPTED STATE LANGUAGE i <br /> 02C.0303 <br /> A property owner or the property owner's agent shall submit an application for a permit to <br /> construct, repair, or abandon a well to Orange County Health Department. The application <br /> shall include: <br /> 1.The name, the address, email, and the phone number of the proposed well property <br /> owner or agent; <br /> 2.The signature of owner or agent; <br /> 3.The address (if available)and the parcel identification number of the property where <br /> the proposed well is to be located; <br /> 4.A plat or site plan; <br /> 5.The intended use(s)of the property; <br /> 6. Other information deemed necessary by the Orange County Health Department to <br /> determine the location of the property and any site characteristics, such as existing or <br /> permitted sewage disposal systems, easements or rights of way, existing wells or <br /> springs, surface water or designated wetlands, chemical or petroleum storage tanks, <br /> landfills, waste storage, known source of release of contamination, and any other <br /> characteristics or activities on the property or adjacent properties that could impact <br /> groundwater quality or suitability of the site for well construction; <br /> 7.Any current or pending restrictions regarding groundwater use as specified in G.S. <br /> 87-88(a); and <br /> 8.Any variances regarding well construction or location issued under 15A NCAC 02C <br /> .0118 or Section I of these Rulesl. comment[VH26]:LOCAL VARIANCE <br /> 9. Pursuant to 15A NCAC 02C .0307, no well construction permit shall be issued by the <br /> OCHD prior to the assignment of a valid E-911 or UT address to the well location by comment[VH27]:ADDRESS IS REQUIRED BY <br /> the addressing agency of the jurisdiction. LMCPS USAGE TO ISSUE THE PERMIT <br /> 10. Other information deemed necessary by the OCHD to determine the location of the <br /> property and any site characteristics such as existing or permitted sewage disposal <br /> systems, easements or rights of way, existing wells or springs, surface water or <br /> designated wetlands, chemical or petroleum storage tanks, landfills, waste storage, <br /> known underground contamination and any other characteristics or activities on the <br /> property or adjacent properties that could impact groundwater quality or suitability of <br /> the site for well construction; <br /> 11.An application for a public water supply well as defined in G.S. 130A-313 (North <br /> Carolina Drinking Water Act)shall also contain a pre-drill investigation document <br /> from the state Public Water Supply Section that indicates approval of the proposed <br /> well location. <br /> 12. An application for a monitoring well(shall also contain: comment[VH28]:NEW STATE SECTION <br /> 02C.0303.THEY ALSO ADDED INJECTION WELL <br /> a A map of the general site area, showing the location of: STUFF,BUT WE WILL NOT BE ENFORCING LOCAL <br /> ) n g 9 RULES ON A SPECIALITY WELL THAT WE HAVE NO <br /> OTHER RULES BUT THE STATE <br /> 12 <br />