WV0700175_Variance Application for Injection well Construction_20240229

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
VARIANCE APPLICATION FOR INJECTION WELL CONSTRUCTION STANDARDS:
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS (15. NCAC 02C .0222) QB
GEOTHERMAL DIRECT EXPANSION CLOSED -LOOP WELLS (15A NCAC 02C .0223)
This form MUST accompany the Closed -Loop Geothermal Notification Form available online at
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Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: 29 FEBRUARY
F�
B.
C.
2024 PERMIT NO.: (to be completed by DWR)
WELL OWNER(S) — For single family residences, list all persons listed on the property deed. For all others,
list name of the businessigovernment agency and person and title with delegated signature authority:
Chowan County, NC: Kevin Howary County Manager
Mailing Address: PO BOX 1030 W
City: Edenton
Day Tele No.: 252-482-8431
Zip Code: 27032 County: Chowan
Cell No.: 252-232-8208
EMAIL Address: [e-mail] Fax No.: 252-482-4925
State: NC
PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) of well .rite: 780519714506
County: Chowan
(2) Physical Address (if different than mailing address):
600 Broad Street
City: Edenton
County Chowan
WELL DRILLER INFORMATION (if known)
Well Drilling Contractor's Name: Charles Norris Dozier, 11
NC Well Drilling Contractor Certification No.: 4088-A
Gip Code: 27932
Company Name: Toano W0 and Pump Service, Inc. Contact Person: Bo Dozier
City: Toano State: VA Zip Code: 23161 County: games City County, VA
Day Teie No.: 757-566-0377 Cell No.: 757-784-4941
EMAIL Address: loan owe lland pumpC7aol.eom
Fax No.:
Closed -Loop Geothermal Variance Rcqucst Rev. 3-1-2016 Pagc 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.
I would like to request a variance permit for the (130) Geothermal Aqueous
Closed -Loop Wells located at John A. Holmes High School in Edenton, NC.
The rule which the variance is being requested is 5 (C) Industrial or municipal sewage or liquid
waste collection or transmission sewer mains constructed to water main standards
as stated in the American Water Works Association Standards C600 and/or C900.
This is a Geothermal Aquesous Closed -Loop well system grouted the entire depth
with thermal enhanced bentonite. It is filled with potable water it will cause
no harm to human health or the environment. There are space limitations on
the project that hinder the ability to construct the wells elsewhere.
E. SIGNATURES
SiK rifler and Certification No.
CHARLES N. DOZIER, II
Prl t or Type Full Name
Signature of Well Owner
llcer-)iel /6w)
Print or Type Null Name
Signature of Well Owner
Print or Type Full Name
Per I.MNCAC 02 .' the Director of the Division offater Resources may require submittal o{information
deemed necessary to make a decision on the variance, may impose conditions as part of the decision, and shall
respond in writing to the request within 30 days of receipt of the variance request. A variance applicant who is
dissatisfied with the decision of the Director may commence a contested case by filing a petition as described in
[;.3. 150B-23 within 60 days after receipt of the decision.
Closed -Loop Geothermal Variance Request Rev. 3-1-2016 Page 2