WV0700177_Variance Application_20240320

NOMH UAKULINA MWAK 1 MCN I UI•
AND NA URAL KbJVUKt:l::f
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
lhese uvils are ' permitted by rule" and do not trgtdre an individual perrodt wfren conrnwcled In accordance with
ihr tw/rs of j t N `d ' �C_,,i1.:f)t}. 7Hls nariceltutsl Per enb�lrrd prlor to constructlots,,,,
MXIIERNIAL A UEO 7SC OSED- OOP EL
As described in Sj A NC{ty D2, &2 2 these wells circulate potable water only or n mixture of potable water and
performmnce-enhancing additives as part of a geothermal heating and cooling system.
Du
GEOTHERMAL I ECT EXPANSION C O `ED LOOP WELLS
As described in 0' V 23 these wells circulate a refrigerant Son as part of a geothermal heating and
cooling system,
Print Clearly or 7ppe Information. Illegible Submittals !rill Re Returned As incomplete.
DATE: 03t7_0 _, . 2024 PERMIT NO.._ (to be completed by DWR)
A. TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO HE CONSTRUCTED
(1) Aqueous (as per .�AjjC_ACO2C;;,07_,22J: x Numbero£welis: 6,_ ,
(2) Direct Expansion(as per 5ANCAC�02C. 22 Number ofwells: ___—
9
C.
1).
STATUS OF WELL OWNER (choose one)
(1) Single Family Residence x_ Submit this farm two (2) business days prior to construction.
(2) Business/Organization ____ Submit this form 30 days prior to construction.
(3) Govemnxnt: State_,,,,,,,_ Municipal .__ County-- Federal _ Submit this form 30 days
prior to construction.
WELL OWNER -- For single family residences list the property owner(s). For all others, list name of the
btsiness, orrAuization, or government agency Md person delegated signature authority:
­Q!!LSW2hor Cido
Malting Address: 391 Carver Drive
City: ;QpthleblM State: NC Zip Code: 1gn17 County:
Day Tole No.: „ _ Cell No.:
EMAIL Address: _ _ ilex No.:
PHYSICAL LOCATION OF WELL SITE
(1) Pawl ldentlficationNumber (PIN)ofwell site: 987511761038
County: Dart
(2) Physical Address (if different than nailing address): 128 Harbour Bay tulve
City. Kitty Hawk
UtOCIOSW-Larp Geodwraui Mwincadcxr (nevisod ar52e 13)
State: NC Zip Code: sue°
Paco I

E. MAPS, PLANS, AND SPECIFICATIONS
(t) Maps must be scaled or otherwise accurately indicate distances and orientations of features located
within 250 feet of the injection weli(s). Attach a
sho-specific map showing the locations of the following:
• Proposed injection well locations o Septic systems and associated spray irrigation
• Buildings sites, dMn fields, or repair areas
• Property boundaries
• Surface water bodies • Existing or potential sources of groundwater
• Water supply wells contamination
(2) Plans and specifications of the surface and subsurface construction dentits ofthe well system.
r
F. TYPES AND CONCENTRATIONS OF ADDITI"VF.S -- List any additives that will be used and their
concentrations. Only additives that the Department of Health and Human Services' Division of Public Health
determines do not adversely affect human health shall be used. A list of approved additives can be found
' onfilleathwitp:ffft"l.ucdcnr.org/.w_cb/M/4TVML. All other additives require approval prior to use.
r
4 ?�.tiltf=.e_gL15%
G. WELL DRILLER INFORMATION (if known)
Weil Drilling Contractor's Nate: Arthur J •ratan _
NC Well Drilling Contractor Certification No.: 4200A ,
Company Name: Virginia gueW Services � � Contact Person: A,B, In
City: Kong, jgnsi— _,_,__,-__ State: _NC Zip Codc:27950____ County: Currituck
Day Tote No.: 804 749.1962 Cell No.: 252-202-9490
EMAIL Address: Fax No,:
H. HEAT PVMP CONTRACTOR INFORMATION
Company Name:
Contact Person• lohnD t s• johndylong( rahoy,com
Address: 3908 N. Crouton Highway
—
City: 'd 'k �_.,... Zip Code: 27949 Slate: NCa.._..._,.... _,,,• County:
Office Tele No.; „ Cell No.: 252.469"astt7 rnffi NQ t _ _ w
WC/C1os•d-r.aop Goothamol No i0odw (Revised 015/2013) 1 rose 2

i. PI1,OTECTION -• Provide a brief description of how (1) water supply wells; (2) surface water bodies; and (3)
septic systems mid associated spray irrigation sites, drain fields, or repair areas within 250 feet of the proposed
injeetion welts will be protected during construction of the wells:
t lt�nSSI �Ki duri .,.c <11!lG.�4GcsS ontpi!iin.B.flth� �t1 Ply teStth. an ?Cw�!
�.itx1A.4k�.�5-0�danenr bore halS1'�1Y.�4tt vL9 t p��.n tll9�ti�1�.�4�arrt nati-..._..
I. \'ARiAPICE pursuant to II . A_KAC 02C ,0241 the Director of the Division of Water Resources may grant
a variance from applicable well construction or operation standards provided that:
(1) use of the well(s) will not endanger human hcalih and welfare or the groundwater; and
(2) that construction or operation in accordance with the standards is not technically feasible or the
proposed construction Provides equal or better protection of the groundwater.
Any variance request should accompany submittal of this notification to expedite evaluation of the request.
I2te variance request form can be accessed online at httu.Jlnortal ncdenr arnlweb/wai7ns/a <vnro/nermit-
appgalio
It:. SIGNATURES —"lire following section is to be completed as required below or by that person's authorized
agent. 1 SA hCAC O2C „off requires signatures 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) fbr 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;
(c) for any other person authorized to act on behalf of the applicant: documentation shall be
submitted with the notification that clearly identifies the person, grants them signature
authority, and is signed and dated by the applicant.
`] hereby roYify, under penalty of 14% that I have personally examined and am familiar with the information
submitred in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, i believe that the information is true, accurate and
complete. I am au -are that there are sign Orleant penalties, including the possibility offines and imprisonment,
for submitting false information, i agree to constnwr. operate, maintain, repair, and if applicable„ abandon
the infertian well and all related appurtenances ityapeordance with the 1.5A Nf AG i)2C020O Rules. "
C�Signatue+eoCP��rnp�eriyClwunr/Apptkxot�
Perm Wrypa Full Name
" fitgusturc arAnrbarlred Agtnt, i -any
Print ar rype Full Nanw
UIC&-i»sod-t,pGoodumalNolincanontRVA"da1512013) Page3

NORTH CAROLINA DEPARTMCiNT OF ENVIRONMENT AND NATURAL RESOURCES
VARIANCE APPLICATION FOR INJECTION WELL CONSTRUCTION STANDARDS:
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS (15A NCAC tlZCQ,2, 22)PA
GEOTHERMAL DIRECT EXPANSION CLOSED -LOOP WELLS (19A NV�AC 02C A223)
This form MUST accompany the Closed -Loop Geothermal Notification Corm available online at
h)tn,,f(pcc Litil.nedcu.oraJ�yS�lw ( y l / c ii( )p�lication�NgrolhcrcyrA��pg
Prins Clearly or I)pe Information. Illegible Submittals R711 Be Returned As Incomplete.
DATE: 03120 1 2024 PERMIT NO. ____(to be completed by DWR)
A. WALL OWNER — For single family residences list the property owner(s). For all others, list name of the
business, organization, or government agency od person delegated signatum authority:
Christopher Grillo
Mailing Address: 391 Carver 17rive
City. Bethlehem State: PA Zip Code: 980" County:,,
Day Tole No.:
EMAIL Address:
Cell No.:_
Fax No.c_.___
H. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) of well site: 987511761038
conmty: Dare
(2) Physical Address (if different than mailing address): 128 Harbor Bay Chive_
City: Kitty Hawk state: N_C Zip Code: 27949
C. WELL DRILLER INFORMATION Of known)
Well Drilling Contractor's Name: Arthur J. Tatem
NC Wcll Drilling Contractor Certification No.: 4200A W
Company Name: Virginia Energy Services _.______ Contact Person: Kimberly Krinsky___
City: Knotts Island State: NC_ Zip Code:= County. Currituck
Day'rele No» $04-749.1962 Cell No.: 252-202-9490
EMAIL Address: [e-mail] Fax No.:
V1CICioaed•Lnap Goof mW Variance Roput (Revised WOO)
Pogo r

D. REASON FOR VARIANCE REQUEST - Include type of well(s) to be constructed; rule for which the
variance is being requested; description of bow 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 techarlcally feasible and/or provides equal or better protection of the groundwater.
See attached page for variance request information
E. SIGNATURES
.c92f�us�z. %az`.'al�
Signatu f Well Drifter N
Arthur J. Tatern
....v�, ._m.. .. PMne or Type Fu11 WV —W . �—
�r eaat�ur—ecf Well Owner T '�
-riaR�or Type Full Name _. ..
Per lid —MCA 0)C_jg2A the Director of the Division of Water Resources may require submittal of
information deemed necessary to make a decision on the variance, may impose conditions as part of the
decision, and shadl respond in writing to the request within .IQ days of receipt of the variance request. A
variance applicant who is dissattsf}ed with the decision of the Director may commence a contested cave by
filing a petition as described in ,C,,, j„ (L -, j within 60 days after receipt of the decis}on.
inClcluied-tng) t7coawawf variance Rxilmst (ReviNd a19/2019) palre 2

PAGE 4 of4—Cirillo Variance Request
The proposed geothermal aqueous closed loop system for the address listed on
page 1 is in need of a distance requirement variance. The location of the proposed
residential and accessory structures and the onsite operational & reserve drain
fields are impeding the location of the geothermal closed loop field to be located
within the residential and septic system setback distances respectively. We are
proposing to locate the vertical bores along the front and left side (facing) of the
residence. In this manner we can obtain maximum safety distance from the septic
system and achieve a very high degree of human health and environmental
protection. 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.

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CON rROL CORNER 30 0 15 3C
N=S56415.9843
C=2977119\.7707
1 inch m 30 ti
Ce) Ex. Rebar 56.97'
o Reber Set
Fire Hydrant
0 - Water Meter
0 Power PVC Stub
A CATV
NAVD E88 levatipn
4D Ex. S.S:S. Noil & Washer
Address, 413 Da Vlncl Lane
Lot Area =16,673 Sq. Ft.
Praaos45LC�_ �.,Ip�a„Cj(I_t,S,Y�t.14rv1xL
C\+n (
➢ulicling & Porch= 1,607 Sq. Ft.
Sl
Concrete Drive- 1,677 Sq. Ft,-
2,
6'
Concrete Pool Patio= 688 Sq, Ft,
Pool= 312 Sq. Ft.
_
Decks & Steps 295 Sq. Ft.
"1
Kitty Hawk Total= 4,779 Sq. Ft. (28.7%)
`46/
Pf•vgssed Pe,Cggn Infll <.SS_tw wq)
D.B. 1733,
➢ulklIng & Porch- 1,807 Sq, Ft.
PG. 156
Concrete Drive= 1,677 Sq. Ft.
Concrete Poot Patio- 688 Sq. Ft.
State DVO Total 4,172 (25.0%)
Flood Zones are subject to change I`-
1-5.0
Setbacks shown are as per the Subd. �,g Plat and as p ` nApproved � } reflect any R b 3• �•+
that may exis��c,, t,ac{�shown
are as per i s cll. per' IF&�®J!
Footage• 1f7
Health Department
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;X IN C NAIL & YlASHLI2 \ , _ ,WALE 3
1N C/[. MPRB. L �
PIRST PLICNT 11L��U�N''� 6 IF
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C-1 R= 47,00' L 5"W 42.54' "113 VepCF OF ASPy"`I<T
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I, M. QOUGLAS 9TYON5, JR., P.Ll•
S„ certify that this plat. � k s fp
was drawn foam on actual field tand survey that the error.' 11
r1{•\ �!• �.%
closure as Calculated ey kutudes and departulss y^'d �•i�,� 'ry"" of/�
s at least 1,10,000, /
:vil n•.ns' ol, hana and eral, this J
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PG. 217
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PROPOSED
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/ �N '-AI{LA OLEANDER
% '.: $� i & POMP ny GAAS$h
LOT 45, BLOCK 31
FIRST FLIGHT RIDGE
SURVEYED FOR
WILLIAM A. PLACE and
__ _'!R' — I f M, I A I I o owe A e we.

1, WILLIAM S, JONES, JR., R.L.S., CERTIFY THAT UNDER MY DIRECTION AND SUPERVISION THIS PLAT WAS DRAWN FROM
AN ACTUAL FIELD LAND SURVEY MADE BY ME FROM INFORMATIO`NV REFERENCED HEREON, AND THAT THE RATIO OF
PRECISION IS 1:10.000+. WITNESS MY HAND AND SEAL THIS ,�,�,[� DAY OF �� I9D ,,,;
% p+q
lly MI IX
KITTY DUNES HEIGHTS SUBD.°
,°
by P.O. S, SLIDE'S 51-5E ° w :<�e �. � � � yNs B.
\ pp rV z
L e-xlsT pw .p ✓ HU q e
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)fLON PIN 'Ex8' Wig•: 'r. ,
5.57° 2'I,r �j
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pp3 O. ud 11 NLOT 22
j; n 3e7s.r i n VICINITY MAP
m
zroo d ke'D 2
Ul ii zoHt
1
NOW OR FORMERLY
JAME'S C. WARD
O.B. IBEPG. 476
lu
O KNG ......''i
Q ��SlOy„9
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LOT 23
QI l fl ^ ° SEAL
L-2632 os
CONC. MON, /!�'/'gSniiIQiON
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`JO _OQI -PM rvE- P-DZ 4F 'T'HL-9=3c?.791 -
�x)sr, Fx(sr,
(RON F'/N CONC. MON. ?5 IO COJCRPr���
HARBOUR BAY DRIVE. - 60° RIW
SURVEY FOR
.STEVEN G. RICKARD a WIFE LAUREN A. RICKARD
LOT 22. HARBOVR BAY
PLAT CAB. E 0 SLIDES 135 , 136

I
Dare County
N/F
LOT 16
RONALD K. SAWYER &
PATRICIA W. SAWYER
PIN 987511658873
N/F
MILDRED FOREMAN &
J.S. ROEBUCK
PIN 987511656978
,.Sr1Ql

if 3
I, WILLIAM S JONES JR.. P.L,S. CERTIFY THAT UNDER MY DIRECTION SUPERVISION THAT THIS PLAT WAS DRAWN FROM
AN ACTUAL FIELD SURVEY MADE BY ME FROM INFORMA AS REFFEFRENCED HEREON, AND THAT THE RATIO OF
PRECISION IS 1:10.0001. WITNESS MY HAND SEAL THIS DAY OF u,5r 2011
FIRST FLIGHT RIDGE
P.C. F. SLIDE 276
VICINITY MAP
N.T.S. SET IRON PIN IRON
PIN----- N 55°30'08 E-- *' 89.31'
LOT 13
15.007 S.F.
25MBL___._
Il
EX IRON
PIN
1 _ 81.92
\./ 1 � S 56°33'03" W 89.30' ""
TIE LINE Y "LIGHT POLE
S 21°35'5I" E
30.32' i HARBOUR BAY DRIVE - 60" R/W
PK NAIL
ELEVATION- 23,38'
7 HOUSE
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