WV0700180_Variance Request_20240722

NORTH CAROLINADEPARTMENT OFENVA2ONMENTANTINATrrRAT. RRcnTTP1 PQ
NOTIMCATION OF INTENT TO CONSTRUCT OR OP7ERATE INJECTION WELLS
These wells are "permitted by rule" and do not require an individualpermit when constructed in accordance with
the rules of 1 SANCAC 02C..0200, This notice mgv0be submitted rip or to construction_
As described in 1 SA NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water and
performance -enhancing additives as part of a geothermal heating and cooling system.
OR
As described in 15A NCAC 02C .0223 these wells circulate a refrigerant gas as part of a geothermal hearing and
cooling system,
Print Clearly or Type hl formation. Illegible Submittals Will Be Returned As Incomplete,
]BATE: 07/22 20?h� PERMIT NO. ---(to be completed by DWR)
A. TYPE O GEOTHERMAL CLOSED -LOOP WELL TO DE CONSTRUCTED
(1) Aqueous (as per :l SA NCAC 02C .0222): x Number of wells: / O
(2) Direct Expansion (as per 15A NCAC 02C .02231 Number of wells:
R. STAT➢JS OF WELL OWNER (choose one)
(1) Single Family Residence —x Submit this form two (2) business flays prior to construction.
(2) B'1siness/Orgatuzation_Submit this form 30 days prior to construction.
(3) Government: State_ Municipal __ County_ Federal _^ Submit this form 30 days
prior to construction.
C. WELL OWNER — For single family residences list the properly owner(s), For all others, list name of the
business, organization, or government agency and person delegated signature authority
ICovin & Rhonda McKeever
Mailing Address: P.O. Box 900T --
City: Andover State: MA Zip Code: 01R10 Con
DayTeleNo.: Coll
EMA➢L Addross: Fax
D. PHYSICAL LOCATION Or, WELL SITE
(1) Parcel Identification Number (PIN) of well site: 071914229647
County: Tare _
(2) Physical Address (if different than mailing address): 9115 s Old Oregon Inlet Road
City: Nags Flead
State: NC Zip Code: 27959
UIC/Closed-Loop Geothermal Notification (Revisod 81512013) pab.,e 1

E. MAPS, PLANS, AND SP) CII+ICATIONS
(1) Maps must be scaled or otherwise accurately indicate distances and orientations of features located
within 250 feet of the injection well(s). Label alt features clearly and include a no d arrow. Attach a
site -specific map showing the locations of the following:
9 Proposed injection well locations m Septic systems and associated spray irrigation
® Buildings sites, drain fields, or repair areas
6 Property boundaries
® Surface water bodies ® Existing or potential sources of groundwater
A Water supply wells contamination
(2) Plans and specifications of thesurface and subsurface construction details of the well system.
h. TYPES AND CONCENTRATIONS OF ADDITIVES — 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 he found
online at firm ro tal.nodenr.org/web/w /a s wnl'o. Ail other additives require approval prior to use.
Gcosafe antifrgeze_@ 15%
C. WELL DRILLER INFORMATION (if known)
Well Drilling Contractor's Name: Arthur .i Tatem
NC Well Drilling Contractor Certification No.: 4200A
Company Name: Virginia Energy Services Contact Person: Art Tatern
City: Knotts Island State; NC—,_ Zip Code:27950_ County; Cu1_rAmek ____
Day Tele N'o.: _ 804-749-196i2 Coll No.: 252-202-9490
EMAIL Address: __.. _ Fax No.:
IL IIEAT PUMP CONTRACTOR INFORMATION
Company Name:_ R A Iloy
Contact Persons Johnt7ylen Grim EMAIL Ac(ress: johndylang(7rahoy.com _
Address: P O Box 179
City: Kitty hlawk
Office Tole No.: 2624898567
Zip Code: 27949
Cell No.:
State: Nc County: Ure
IIIUClosed-Loop Geothoimal Notification (Ravised 86/2013) Page 2

y. PROTECTION -- Provide a brief description of bow (1) water supply wells; (2) surface water bodies; and (3)
septic systems and associated spray irrigation sites, drain fields, or repair areas within 250 feet of the proposed
injection wells will be protected during construction of the wells:
2fotee 'on Ill llg irovided during the drilling process by contain ng fluids in a it or an and nrovlcJhie silt
fe ce if nm off is ajanger. Bore holes iLbe fully troute cg protect from amiifer cross contamina 'or _,
J. VARIANCE Pursuant to 15A NCAC 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 health and welfare or the groundwater; and
(2) that construction or operation in accordance with the standards is not technically feasible or die
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.
The variance request form can be accessed online at lion:/ir>anal.ncd nr.or web/wq/tea/gwpro! ierrnit-
applications
K. SIGNATURE — The following section is to be completed as required below or by that person's authorized
agent. 15A NCAC 02C 0211(g) 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) 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 the applicant: documentation shall be
submitted with the notification that clearly identifies the person,grants them signature
authority, antis signed and dated by the applicant.
"I hereby certify, under penalty of law, that l have personally examined and am fandliar with the Information
submitted 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 aware that there are signffieant penalties, including the possibility offznes and imprisonment,
,for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon
the tn'ectdnn well and all related appurtenances in acco nce with the 15t1 MCA 02C 0200 Rules."
Signature of Property E'Rtrer/Applicant y,s•f
�✓Il �G. '��."-r �rJ..d ,�. �"�' i1�c. {1V l l L a.; P
''• �• �''f ` • m Print: or Type Full Nance
Signxtureof Authorized Agent, it any
Print or Type Frill Name
UIC/Closed-Loop Gcothermal Notification (Revised 815/2013) Page 3

NOR'ITI CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL, RESOURCES
VARIANCE APPLICATION TOIL IN,1WCTION WELL CONSTRUCTION STANDARDS:
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS (15A &CAC 02C P122) oat
GEOTHERMAL DIRECTEXPANSION CLOSED -LOOP WELLS (1.5A NCAC 02C .0223)
This form MUST accompany the Closed -Loop Geothermal Notification Form available online at
httR//uoxCa'.ncdel .ar web/wq/ens/gwnro/nermi[-aaltlicafions#I�ecotltermAons
print aearlp or Type Injimnation. Illegible SnfiruiUals Will Be Returned As Incomplete.
DATE: 07/22 _, 2024 PERMIT NO. _—_--(to be completed by DWR)
A. WELL OWNER - For single family residences list the Property owner(s). For all others, list manic, of the
business, organization, or government agency anti person delegated signature authority:
Kevin and Rhonda McKeever
Mailing Address: PLO. Box 900
City: Andover State: MA Zip Code:01810 County:
Day Tele N'o.: Cell No.: _
EMAIL Address: _ Fax No.:
B. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Ntunber (PIN) of well site: 071914229647
County: Dare
(2) Physical Address (if different than mailing address):
9115 S Old Oregon Inlet Road
City: Nags Head State: SIC Zip Code: 2.7950
C. WE LL DRILLER INFORMATION (if known)
Well Drilling Contractor's Nance: Arthur J. Tatem
NC Well Drilling Contractor Certification No.: 4200A
Company Name: Virginia Energy Services Contact Person: Kimberly Krinsky'
City: Knotts Island — State: NC Zip Code:27950 County: Currituck
Day Telo No.: 804-749-1962 Cell No.: 252-202-9490
RMAILAddress: [e-mail] Fax No.:
CIIC/Closed-Loop Geothermal. Variance Reyuost (Itevised 9/5/2013) Page 1

D. REASON FOR VARIANCE RE,EQUEST — 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 hmnan 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.
See attached page for variance request information.
F,. SIGNATURES
5igna r of'Well Driller
i'— %
Print or Type Rnll Nano
h 1--v r";r s Q ; Print or Type Full Mune
Per LSd NC9C 02C 0241 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 shall respond in writing to the request within 30 days of'receipt of the variance request. R
variance applicant who is dissatisfied with the decision of the Director may continence a contested case by
tiding a petition as described in G S_ ]3LQ. -23 within 60 days after receipt of the decision.
UIC/Closed-Loop Geothennal Variance Request (Revised 8/5/20B) Page 2

PAGE 4 of 4—Mci(eever 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 existing
residential and accessory structures and the onsite and neighboring operational &
drain fields are impeding the location of the geothermal closed loop field to be
located within their setback distances respectively. We are proposing to locate the
vertical bores along the front and right side of the property. 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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1, WILLIAM S. JONES, JR,. R.4.S.. CERTIFY THAT UNDER MY DIRECTION AND SUPERVISION THIS PLAT
AN ACTUAL FIELO LAND SURVEY MADE BY ME FROM INFORMATION,.11�FERENCE1,O� HEREON, AN(i,'
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SURVEY FOR
DAVENPORT- BUILDERS, INC.
LOT to, BLOCK 10 , SECTION TWO, HOLLYWOOD BEACH
PLAT BOOK I , PAGE 78
TOWN OF NAGS HEAD
4 REVISED: 3—S-95 DARE COUNTY , NOBTH CAROLINA
SURVEYED 2-22.-95
WILLIAM S. JONES, JR.
NO'"E, FL 00o zD NL-a` F1RE sua TECT 2600 CROATAN HIGHWAY
7 TO CIRNGF BY FEMA. P.O. BOX 2942
KILL DEVIL HILLS, N.C. 27948
P/N 'rr /407/9 /¢c'�D643 [phone]
�' DATES 9-5 SCALE I J' = 501 DWN BY: G.KS. FILE NO. 9546