WI0700513_Application_20201130

NORTH CAROLINA, DEPARTMENT OF ENVIRONMENT AND NATURAL .RESOURCES
NOTIFICATION OF IIV'I'EN'.>i' TO CONSTRUCT OR OPERATE INJECTION VVEI. LS
These wall are "per°r fitted 1?y r'zdlc"and do not requir'e an in accor'clance with
the rules of'1 Sf1 WAC 02C.0200. This n f ce rnlrst,l e s�ul��ticg` �r r.'ar' .�.corrstructran.
Gli'40 C I>LRMAL AQUEOUS CLOSED -LOOP WL!,T L
As described. in 15_ A,t�,_ A_Q' ()2C�.0222 these wells circulate potable water only or a mixture of'potable water and
performance-onl77ncing additives as part of a.geotherinal heating and cooling systean.
OR
GEOTP ERIOIAL DIRECT PXPAI�SION CLOSED -LOOP WELLS
S
As described in. 15A NCAC 02C 0223 these wells circulate a refi-igerant.gas as part of a geothermal heating and
cooling system.
I'x'Ixat Clcxrtrly or I ype Iltfor�rrnt ore: Itlegible,Subildilnfs Will Ba RrIurned * Incomplete.
DATE, Noyemberr224 , 2020_- PERM NO. _ �(to be completed by DWR)
A. TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO BE CONSTRUCTED
(1) AclueOUS (as per 1 SA NCAC 02C .022222.): x Number of walls: 13
(2) Direct Expansion (as per !_ A NC&fi 02C .0223 _ Number of weiis:
B. STATUS US OF, WELL. OWNER (eboose one)
(1) Single F aniily Residence __,x— Subunit this form two (2) businm clays prior to construction.
(2) Business/Orgftniration _ Submittbis form 3..0 days prior to construction.
(3) CTOVOMmetit: S.[ttl'O _ ,.,_ Municipal County federal Subunit this form 30 bays
Prior to construction.
C. WELL OWISER — For single family residmicos lis# the property owner(s), For all other's, list name of the
business, organi7 Lion, or government agency G did persona delegated signature authority;
C:hirisio 7 ier rind Jeatiifet` Birodii __--
Mailing Address: 106 NIaiiokin Tur n
City: _Yorktown State. VA Zip Code:23639 County:—_jork _... .....
Day Tele No.: _ Cell No.: ,.'.l.-~ i " 'l�(
LMA1l,Ad.dress: h c� ire C'ouv�u . is rOv ,Ch Fax.No.'-- _
:1). PHYSICAL LOCATION OF WELL SITE
(1) Parcel Idontitication Number (PIN) of we[ i site: 127CrO0001790000 ___ ___._
County.:
Currituck
(2) Physical Address.(if different than mailingaddross);
281 White's Point
City: Cor'olLa (Pine 1slartcl) _ _— State: NC zip Code:..,.._ 27927
WC/Closed-Loop Coothertral NotiiicaLion (Reyked 8/5/2013) Page 1

E. MAPS, PLANS, AND Sli'1LCIFICATIONS
(1) Maps must be scales] or otlierwise accurately indicate distances and orientations of features located
within 250 feet of the injection well(s), LLkel all features ie,u_1 a.1211ncltlde a north W , arrow. Attach a
site-specil;io snap showing the locations of the following:
Proposed injection well locations a Septic systems and associated spray irrigation
B tlildings sites, drain Holds, or repair areas
Property boundaries
Surface water bodies 0 )existing or potential sources of groundwater
a Water supply wells contamination
(2) flans and specifications of the surface and subsurfiwe construction details of the well sysWin,
T, 'ICYI'FS AND CONCENTRATIONS OF ADDITIVE' S —List any additives that will be used and their
concentrations. Only additives that the Department of health and Hurnan Services' .Division of public health
determines do not adversely affect human health shall be used, A list of appi�oved additives can be found
onlitle at.1 7 //port�l,l.MMLe l:or eblw-. /a sl wp1_o, All other additives require approval prior to. use.
Geosafe arltif't_ceze QG115%
G. WE DRILLO; t It iNF(IRlVItiTION (If known)
Well Drilling Contractor's Name: — Aa ilior_,l. Tate ri-.--�- ---
NC Well Drilling Contractor Certification No,; 4200A w.-._..__.._..._.._ _
Company Name:._ Virginia Energy Services Contact Person; _ KIM Krinsky —
City. Mcchatlic s�+311c _ hate: VA_ Zip Code:2"1111County: Hanover
Day Tale'No.- _ —. Cell No:: 25245577710 _
L;MAIL Address: lii�rvsgeothezmal cot�t - -- lax No.:,...-__
>CI. HEAT PUMP CONTRACTOR ]INFORMATION
Coampany Name: Norris Meduailical
Contact Peinoll, Hersgy Norris ___....m.� EMAIL Address: ',n(p(
Address: [OU Froedoln .Ave.
City: PowelI's ft Zip Code: _2796 State: ANC _CoLulty. Curritucic
Office Tole No., 252-4,91-2673 Cell No,. Fax No.:
UIe1Clogoid-Loop 0eothermal Notificklon (Revised 5/5/2,013) 1 Page 2

> , lPli arECTION -Provide a brief description of how (1) water supply wells; (2) surface water bodies; and (3)
861),tic systems and 'associated spray irrigation sites, drain fields, or repair areas withal 250 feet of the proposed
injection wells will be protected during construction of the wells.
Protection will bN_Pnvidcd during the drilling process containin.g.ftlids in a fait or pan and 11ovi ing ilt
fence if run off is a danger,, Bore holes will. be rullrouted to protect from aquifer cross contaming ion,, _
.f; VARIANCE -- Pursuant to l 5A NCAC 02C0241 the Director of the Division of Water Resources may grant
a variance from applicable well construction or operation standards provided that:
(1) use ofthe well(s) will not endanger human health and welfare or the groundwater; and
(2) [bat construction or operation in occordance with'the standards is notfeclinically feasible or the
proposed construction provides equal or better protection of the groundwater.
Any variance request should accompany submittal ofthis notification to expedite evaluation of the request.
"1'he variance request form can be accessed online at hillx_11/�nrta ncdenr oralw b/wrllaps( wla olpMnit-
�ppl?c.:1.�ons
X SIGNATURES -- The fallowing section is to be completed as required below or by that person's authorized
agent. 15A N_!aAC.02CO21 l.fo) requiressignatures as follows:
(a) for a corporation: by a responsible corporate officer,
(b) for a partnership or sole proprietorship; by a general partner or the proprietor, respectively;
(c) for a municipality or a, state, 'federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
(d) for all others: by the well owner;
(e) for any other person authorized to act on behalf of tbe, applicant- docurnwita.tion shall be
submitted with the notification that clearly identifies the person, grants their signature
lath. Nty, and is sighed and dated by the applicant.
'Thereby certify, under penally oflctw, that T have personally examined and oin,fatraihar with the information
submitted in this document and all attachments thereto and Thal, Lased on my inquiry of those individuals
irnmedtately respirrrOble far obtaining said irlfortnation, I beliei�e That the information is lrate, accurate and
complete, I am aware that there are significant penalties, including the possibility gf;fanes and imprisonment,
for sttbinitting false information..t agree to canslr vet, Qper a e, maintaln, repair, and if applicable, abandon
the ir?jeelion well and all, related ap. rt n Y,s r acc.•arda ce with the 15A NCAC._U2C' 0200 Raffles.
7MT ��
Si�jtatrn•e of Property Owner/AppHeil tit
F-Akv,
-Ifk t-I 5,-(/, 70 111'Jift or type Dull NwWD
Signature of Authorized Agent, ifany
Print or Type Frail Nance
UIC/Closed-Loop Geothm-ini Notification (Rtwlsed 8/5/2013) rage 3

NCtWrl-I C;AROLINA DPPARTMI NT OFENVIRONMENT AND NATURAL RESOURCES
VARIANCE APPLICATION.FOR INJECTION WELL CONSTRUCTION STANDARDS:
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS (15A NCAC", 02G,.02_ �2J oR
GEOTHERMAL DIRECT EX PANSION CLOSED -LOOT' WELLS (1.5 A, NCAC, I}2C 0223}
This form MUST accompany the Closed -Loop Geothermal Notification Form availkle online at
l?At Liag-VAIJ..nccl n.r.pl /woblvv # s� oral cmvit'g lieations4 cotl�errnA s
Print Clearly or ;yj)e litfortrt4adent, Illegible SuGaduals Will Be Return ad As Incomplete.
]DATE: 11124 , 20 20 PERMIT NO. _.. __- ----
. (to be coriipleted by DWR)
A. WELL OWNER - Iaor single fancily residences list the property owner(s). For all others, list name of the
business, orl anizalioil, or government agency qn_d person delegated signature authority:
Christopher & Jennifer Brodie
Milling Address: 106 Manakin Turn ---
City: Yorktown State: VA Zip Cod:e:23119 Count Currituck
Day Tole No.: f Cell NO.:- I I
EMAIL Address:... aCtotc CCsccC ltax No,:__ ___,__
)Q. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) oI well site: 127CO0001790000
County: Currituok
(2) Physical Address (if different than mfliing address): 281 White's. Point
City: Corolla -- Si.ate: NC Zile Code; 27.927
C.
WELL 11➢RILLE, R JNIFORl!'llATION (if known)
Well .Drilling Contractor's Mum: Arthur J. Tatem
4200A
NC Well .Drilling Contractor Certification No,:
l y ^ Krinsky
Coil] rtn Name- Virginia Frlerc�y ServlCes Contact 1'�rs�it; Kimberly .:
City: Knotts Island State: NG.. Zip Code: 27950 County: Curdluc k
Ida
y ..I'e1e Np.; 252-455-7 710 CotI No".252-202-7710
ENTAIL Address: vaenergygeoftol.com
Fax No..
WC/Clwod-Loop Geothermal Valiance Iteclilest (ReviRect 815/2013) Page 1.

D. REASON FOR VARIANCE R QlUC,ST — Include type of well(s) to be constructed; rile i'or which the
variance is being requested; description of how the alternate construction will not endanger human. health and
wel%are and fine environinent; and mason wily constroction and/or operation in accordance with dne standards is
not technically Feasible and/or provides egclal or better protection of the groundwater.
See attached page. for variance request information.
1<lI SIGNATURES
Sigr1 r� �l' Well driller
r
Print or Type Fes11 Miift
r6._ _
Sign€itra s•C oMell owner
n s
P iot pr 'l',ype Cull 1 amo
Per J5A NGrIC 02C, 02.4] the Director, of the Division o/' Waler Pxsources may r^egxair e submittal of
ir?formation deemE d necessary to make a decision on the variance, may impose conditions as part of the
decision, card .shall respond in writing to the request within 30 days of receipt of the variance request. fl
variance applicant who is dissalisfed with the decision of the Director may commence a contested case by
filing a petition crs described in S: I50R- 3 within 60 days after receipt of the decision.
lJi lC#ased-i,00l3 Oeotherniai Varlumv Reques1(Revised $15/2013) male 2

PAGE 4 of 4 — Brodie Variance Request
The proposed geothermal aqueous closed loop system for the address listed on
page I is in need of a distance requirement variance. The location of the
residential structure is impeding the location of the geothermal closed loop field
to be located within the setback distances respectively. We are proposing to
locate the vertical bores in front and along the left side of the residence. The
vertical bores will be grouted from top to bottom with high quality, low
permeability grout using the tremie method to assure the bore hole will be a solid
plug of environmental protection. The bore holes we construct will be the safest
points of ground water intrusion on the property when compared to the native
geology. We will construct triangulated borehole construction maps for each hole
for permanent locating and install metal detection tape in all of the horizontal
connecting trenches to facilitate easy bore hole locating if ever needed for any
reason. Due to the fact a geothermal vertical closed loop is constructed in the
same manner as an abandoned well and does not move water, does not contain
well screens or casing and is not an actual water well, future service will not be
required.

CONCRETE DRIVE
TO LOT 178
NORTH OF P/L
2-
G
o�
0
SITE
CURRITUCK
SOUND
CURRITUCK CO
DARE COUNTY
ATLANTIC
OCEAN
_PHASE 6
PHASE 7 NPHASE S
r' PHASE 4A
VICINITY MAP (N.T.S.)
LEGEND:
CO
Ex. Rebar
Ex. Slick Rod
Ex. Hole In Concrete
L�
Basketball Goal
Water Meter
■
Phone Ped.
A
CATV
Q
Manhole
(1"78)
oz
�wL^
D.B. 628, PG. 275
U o
w a
mm�a
LJ
0)
Cn��
< U)
:D
o o r-
U D 0 O
N
N
N68'20'09"E
--
Z7.55
N m MW am
• —
19.7'
PORCH a
0
6' RAD
EXISTING
DWELLING
ON PILINGS
ENCLOSED
N
0
0
16.3'
HVAC -010
84.93' i
REBAR
14" DEEP
N
u7 I EX. 5/"
REBAR
4" DEEP
(TOTAL) 258.25'
NOTES:
WHITE S POINT oR��
:: Address 281 White's Point
(5 ® PRIVATE R/W) 1a
�o �.�,...........
2�:.. Lot Area = 29,711 Sq. Ft.
_N61-11'53fE — — — Existing
(TIE LINE ONLY}
a- — — i Lot Coverage= 8,378 Sq. Ft, (28.2%)
Flood Zones are subject to change
Setbacks shown are as per the Subd.
Plat and as per Zoning; they do not
reflect any Restrictive Covenants
that may exist,
Proposed
Closed loop
geothermal
system, 13
�z
° _
bores g 200'
U
w
OR 2600' of
Q o
vertical bore,
�DQI
'
FULLY
N H
GROUTED
2' (TOTAL)
174.97'
15_M8L
JBENCH SEATING
WALK & STEPS
15' MBL
J 173.32'
---- S68°20'09"W
i
�i
l
7� I
i
18 0�)
I
D.B. 1244, PG. 42
tf
W
COMMON
PROPERTIES
D.B. 395, PG. 487
1, M. DOUGLAS STYONS, JR., P.L.S., certify that this plat was drawn from an actual field land survey
that the error of closure as calculated by latitudes and departures is at least 1:10,000;
CARO Nk
Witness my hand and I thi y of October A.D. 2020
SQL
P. L. S. L— 3227,M;
'$gi+f tgci iktyl
This survey Was based on the existing
Zulwq4p.*��
property corners found in conjunction
OF 01
with the recorded reference given,
2700 N. Croatan Hwy. Kill Devil Hills, NC. 27948 C-1697
Phone: [phone] Fax: [phone]
Certifier hereon is not responsible
Any unauthorized use or alteration of this document is prohibited A red seal must be present for this to be an original document
for utilities and/or features that are
not visible at the time of the survey,
nor any additional setbacks that
are not shown,
LOT
179, PHASE 6, PINE ISLAND P.U.D.
SCALE:
SURVEYED FOR
GRAPHIC SCALE Drainage & UtILIty Easements:
1" = 20'
CHRISTOPHER T. BRODIE
20 0 10 20 40 so Front: 20'
FILE NO.:
and J EN N I FFER B. B RO D I E
Side 10,
20-279
Rearl 20'
DWG NO.:
POPLAR BRANCH TOWNSHIP
{ IN FEET)
20279P
CURRITUCK COUNTY NORTH CAROLINA
1 inch = 20 ft.
DATE: 10-1-2020 REC. REF. P.C.-E, SL. 283-284 SHEET:
FLOOD ZONE:
REV.DATE: D.B. 1508, PG. 172
13720
"X.
PIN NO.: F.I.R.M.: F.I.R.M. DATE: 1 OF 1
127C-000-0179-0000 9942 00 K 12-21-18