WI0400178_GEO THERMAL_20111005

Slu·sser, Thomas
From:
Sent:
To:
Subject:
Attachments:
Thomas,
Mike Floyd [[e-mail]]
Wednesday, October 05, 2011 5:30 PM
Slusser, Thomas
Notice of Intent question
Commercial GeothermalPermit Application.pdf; NCDENR Approval letter.pdf
We had assisted in the filing of a Notice of Intent to construct a geothermal field for what is commonly called "Project
Green" over in Guilford County (actually it is a large data center for American Express}. Debra Watts had sent us and the
owners an acknowledgement letter for that system. We noticed that in the original Notice of Intent application that the
quantity was for 40 wells to 450' depth. However, due to some design changes and a building expansion during
construction, the final total was 52 wells of the same depth. Is there some process for updating this in your files? A
c_opy of the letter from Debra is attached as well as the original application document (does not include the maps and
attachments to application}.
Mike Floyd
McCall Brothers, Inc
704-399-1506 phone
800-546-1506 toll free
704-398-2605 fax
m ike@mcca II bro.com
www.mccallbro.com
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Permit Number
Program Category
Ground Water
Permit Type
Wl0400178 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
·Coastal· SW Rule
Permitted Flow
Facilitv
Facility Name
5301 McConnell Road
Location Address
5301 McConnell Rd
Whitsett
Owner
Owner Name
American Express
Dates/Events
NC 27377
Orig Issue
03/28/11
App Received Draft Initiated
03/09/11
Re a ulated Activities
Heat Pump Injection
Outfall ~H "·'
Scheduled
Issuance
Central Files: APS_·_ SWP_
03/28/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
J Michael Floyd
McCall Brothers Inc
Charlotte NC
Major/Minor
Minor
Region
Winston-Salem
County
Guilford
Facility Contact Affiliation
Owner Type.
Non-Government
Owner Affiliation
Samuel Brick
3151 W Behrend Dr
Phoenix AZ
Public Notice Issue
03/28/11
Effective
03/28/11
282668710
85027
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
t-•~~--·· .... ~·~ . NCDEHR
North Carolina Department of Environment and Natural Resources
Division of Water-Quality
Beverly Eaves Perdue
-Governor
American Ex.press
Attn: Samuel Brick
3l51 West_Behrerni Drive
Phoenix. AZ 85027
Coleen H. Sullins
Director
3/28/201]
Subject: Acknowledgement oflntent to Construct Type 5QW Injectio_n Well System
Permit No. WI0400178 ·
5301 McConneH Road, Whitc;et:, NC '27377
Dear Mr. Brick:
Dee Freeman
Secretary
On 3/9/2011, the Aquifer Protection Section (APS) ·received notification of your intent to construct a closed-loop water-onlv
geothermal injection well system for the operation of a ground-:source heat pump located at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection w~ll system as long as the
following conditions are met:
1. The injection well system contains only potable water,
2. The injection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative . Coqe Title 15A Section 2C Subchapter .0213, and
3. The required notification form and associated maps have· been complet~ly and accurat~ly submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Wel1 Construction Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .021 l(u)(2). Additionally, you should contact the Guilford 'County ·Health ·
Department as they may have additional requirements for this type of system. Noncompliance-with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at [phone] or M ichael.Roizers rcimcdenr. uov if you have any questions.
cc: Winston-Salem Regional Office -APS
APS Central Files -Permit No. WW400'l 78
Guilthrd County Health Dept.
l\:1cCaH Brothers (,I. Michael Floyd)
Batchelor & f-:.imbalL lnc. tGordon Dunn)
AQUIFER PROTECTION SECTION
1636 Ma:! Service Center, Raleigh, North c·arolina 27699-1636
Location: 2728 Cepital Boulevard, Raleigh. Nortll Carolina 27604
Sincereiy,
~~ fhr Debra Watts
Supervisor
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 Customer Service: 1-877-623-6748
Internet: www.ncw.ateraualitv.o m
An Equal Opportunity Affirmative Aciion Employei
One -. North.Carol.ma
1\1 f ,If / va.:urautt ;.I'
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAI. RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHFILVfAL
WATER -ONLY INJECTION WELL SYSTEINI
TYPE 5OW WELL(S)
to Accordance With the Provisions of NCAC Title I5A 02C,0200
Print or type the required information and mail to address on the back page.
DATE: . 20L \ JS- Q 4 00l
Weir' Type Confirmation: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed -Loop)?
Yes Continue completing this form.
No Ito Not complete this form. Complete other UIC application Forms for installing
either a 5A7 well (open -loop well iri ectin potable water into the aquifer) or a 5QM well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
A. PROPERTY OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative wlauthority for signature): American Express - Samuel Brick
(I) Mailing Address: 3151 West Behrend Drive
City: Phoenix State: AZ Zip Code: 85027 County.
Hotne/Office Tele No.: [phone] Cell No.:
Email Address:samuel.i.brlckgaxep.comWebsite:_
(2) Physical Address of Well Site (if different than above). 5301 McConnell Road
City: Whitsett State: NC Zip Code: 27377 County: Guilford
Home/Office Tele No.: [phone] Cell Na.
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own ihe subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City; State: Zip Code: County:
Office Teie No.: Cell No.:
Website Address of Company, if any: Aquifer Protection Secdon
MAR 09 20
G3'illUtC 5QW Notification of Went Farm (Ftcviscd WOOS)ale 1

•• I
C. WELL DRILLER INFORI\-IATION
Company Name: /vf c.CA4--8Jlo --r 1Jt£/?~ ~e,
Well Driller Contractor's Name: _:I;_,s_e'_p,,......_1-1_____.h----....R .... tJ.::..,ec ......... _r: ... ei....,,£..___ _________ _
NC Contractor Certification No.: NC..W CC. -:tt 3505 ____ ;;____..;;::.....;;;....;;;..a:::;__ ____________ _
ContactPerson: :r: fY7t-C..H/:\U Ful./0 EMAIL Address: Mike.. e' mc..co.[(.i rd. (:a"'1
Address:· Ao. Bo)< ,~,87/o
City: Cf/lM..t.d"f'r'6 Zip Code: 2~ County: /YleCt<'-6AJi3.uA6
Office Tele No.: 7o4-.. 399-/So G Cell No.: 7o4 -3CJ9-ocx;. 3
D-. HEAT POMP CONTRACTORINFORMATION (if different than driller)
Company-Name:. Batchelor & Kimball Inc
Contact Person.: Gordon Dunn EMAil.. Address: Gordon~bkimechanical.com
Address: .. 5~_~1 ~c~onnell Road
City~ Whitsett Zip Code: 27377 County: _G_u_ilfo_rd ________ _
Office Tele-No.: '336 ) 603-1442 CeU No.; ________ _
E. STA'.fUS OF.AJIPLICANT
Ptivate: __
State·:______ ·
Fed~ral: __
Municipal: __
Commercial: ✓
Native American Lands:._
F. lNJEC1'lON.PR.OCEDURE (briefly describe .bow the inject.ion well(s)wili be used)
C/d~ /40,<1-6~~( ;k,.'/.,Arj 1' ~/4"0 ~;;.,s:~ ~ .10 we.tis
/11oAh---t:,/~-·-Ir)_"-~ Ml ·SJS~--
G. WELL CONSTRUCTION DATA
(l).Propose4date to•be constructed-: Af,..:1 ZOii Number of borings: _'/0--=. '---
.ApPtQximate dep~ of ~ch boring (feet):___J.%....;c_;;;a;;;_'_-___ _
(2) Typeoftubingto-be-used(copper,PVC~etc): _Sl> __ ~---_tl_H ____ {)_P ___ G ____ · ______ _
(3).Well ~asirtg•. Is the well(s) cased? (che¢k.e.ith~r--(a.) Yes or (b.) ~below)
.(aJ Yes· _____ if yes, then provide casing infomiation below
Ty~: __galvanized s~el __ black steel __ plastic __ other (:specify)
Castiig depth:-From ~--t.o ....... ___ feet (reference to .land surface)
·C~ing extends to above-ground ____ inches·
(b) .No . ✓-_{idtN..9 ~,w 6~ re,wu,c1 d.
(4) Grout Info (material surrounding well casing and/or piping): 6e.c"l't.v-tkttl ', e,tf/'4,vcJ
(a) Grout type: Neat Cement__ Bentonite L Other {specify) . /;·ui~,k t ..Sll,vJ)
(b) Grout placement: Pumpin~ Pressure__ Other __
(c) Grout depth of tubing (reference to land surface): from -5 to ... 450 (feet)
If weU has casing, indicate grout depth: from tJ/t to 1J/A (feet)
GPU/UIC SQW Notification of Intent Form (Revjsed 8/2008) Page2
X INJECTION•PX- LATED EQUIPMENT
Attach a diagram showing the en jincerlog layout or proposed modifieatlott of the iajectlon equipment and oxtedar
pipinghubing assoclitW with the Injecilcm operation. The manufacturer's brochum may provide supplementary
Information,
1. LOCATION OF WELL(S)
Attach two coplea of maps showing die following Information:
(1 ) Include a Site Map (cart be drawn) showing: bulldings, property lines. surface Willer badlas, potential
sourm of gmadwater contaminAdoe and the orlentatIon of and distanou. between the propowd well(s) and
any existing well(a) or wute diVostsl Wilities such as septic tanks or drain tialds located within 200 foot of
the gaothertttnl ilea( pump well system. Label all faaturea clearly and lack( U e0rth atA.
(2) Tile Site Map must show the subject prorAny In relation w the surrouatding area by using at least two Axed
re[etcm points Such as rows. scurne, and/or highway iatersestioni.
J. CERTIFICATION
Note,, This Permit Application mma be sighed by Salk person apptartng on the
recorded legal praparty dead.
"I hereby certify, tinder penalty of law, Otto I have poraonally emwined and am &mlliar with the information
submitted In this document and all attatchtneats thereto and that. based on my inquiry of those Individuals
Immediately raaponslbie for obtainln$ zald lttfonaadan, I believe that tha information is true, aocurate and aoritplote.
I am zwam that thara are tignifioant panalgen. Including ilia pm[bility of fines and Impriaattmem, [br submitting
false Information. I ngrce to epnstruot, operate malatala, tzpair, and If applicable. abandon the lNectlan well and
0 rotated appurneraances in accordance with, the approved specirYadons and candlLians of tht Permit."
Slgffaturc of Property Owner/Applicant _
Print or Type Pull Name And tide
Sigxt►t = of ftperty Owned/Applicant
Print or Typa Fall Name and title
Signore of Autborized Agent, if any
Print or Type Dull Name and title
Pleawe return two copies of the completed Applirialon package to:
North Otro[lna DENR.DWO
Aqu[fer Protection Section-UIC Pngram
1630 MaR SQrv[cc Center RECEIVED � DENR 1 Dtl�
A4�1� Prtated�n Section
Raleigh, NC 21699-1636
Telephone (919) 733-=1 41AR 0
Oi'lWICJQW 14ott[ication of (slant Nan (Ro+tfrd 1008) Aye3

i-'\t:i,~.::,l :· :.1..: I :., •
Aquik..-.D~otectt Section
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LINE TABLE \ 1-85
\ I
LINE LENGTH BEARING L -
L-1 131.52' N 40·45•05" E M\[[STREAI-I ROAD
L-2 176.93' s 49'"14'55Jt E
L-3 92..44' N 44·oa'o3" E
L-4 192.10' N 67°30'55" E
L-5 143.96' N Br34'10" E FRANZ WARNER PKWY
L-6 171.13' N 42·4a's3" E <I.I' ~ L-7 52.08' 54·24•34" s E l ~ L-8 69.45, s sa·40•39., E _.{l;
L-9 199.49' s 5y3r2a .. E ' ~ --(??-;:,_ '
.... .,)✓~-¼ .,,(·~; ...... ,..)~..._
L-10 47.87' s 35·59' 48" E Cl ' . )_/;;;,/--;•·.,t,;.7;,,;<</,-Y,{.f'~®_ ·.
~ &"f;::-~~~f;~~:~;~?-Jf}f>~?/}}1;1 -L-11 47.67' s 5rs2'32" E w · .. · .;.fil//4~.,;:f,;.y·,f~>~?$:@ :5 ~~/_,·/'.>r :Y/~{.,;,._ .. ·.,_,•;.,,·X,;,_,1/,,·,,f1.(-,· ,1/.J
L-12
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L-14
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L-15 26.55' s ao·3a'30" E (~1?f'¼, .. £.tl~;;.~E\.l-RO j g ,~ tAcCON.N '
L-16 40.77' s 29·45'35" E ~p~ CA ~
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L-17 36.40' s 0712'25" E ~Qi . l L-18 74.99' s 5a·54•47" E er
@ -\ t >-L-19 31.061 s 3a•13•14" E I I L-20 35.39' s1 ·32•s1"
.~
s E ~ a w ~ L-21 346.87' s ao·01•42" w ~
L-22 60.70' s 79·43•31" w ~
L-23 323.06' s 79·41•51" w VICINITY MAP L-24 247 .. 20' s 79·4f34" w
L-25 221.24' s 79·41'34" w (1"=2000')
L-26 19.32' s 79·35'06" w
L-27 30.62' N 01i7'59" E . ..... .... ~ ---• --. -•- -... -
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(.,P) 5M-51M
ACREAGE .1 PJAUC f.REEWN, (FIVER OPEN SPAM
CLMMM ARE. 000 TOPO PHC AND Mle WANNER
mru I of ipry 2 SSINYEY f7i0VlpM W.
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SITE DATA
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McCONNELL ROAD (S.R. 3000) LEGEND
BQ' RNV (23 GRAVELS m.,_ Wpm �Fm
a�� FEAY1' OL" Ate.

PROPOSED
BUILDING
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Horsepower HP
Manufacturer MFR
Maximum - ----- MAX
NEW BUILDING u,Wmum MIN
Mounted qm
Not Apprcuble N/A
Not In controct •• NIC
Numw 1
On Center— OC
rypicot TYP
Normolly Open NO
Normally Closed •- NC
PAD MOUNT AHU'S
{TYPICAL} -
r_-- __ --------- -------- ____ UD ______ _____.,._., _y.�_ _-_ _ _ —_1 w�..�_ �_—_—� 1 _--__— _T ___ —_� —
i 1 ! I r 1 I s i I r
TURNS RU
ENCLOSUREN
XDS- SEE
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CIRCUIT IT PIPIPING 1 r I 1
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s �
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CEOTHSEE ERMAE BI.ORES. i C@�_ PUTURE/AL'ffRNATE BARE HALE
FLgURE IfPLITES I M05 �� C INS 1 �EOCAT7O ({F RE:ULliRED)
I '
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10'-0' x 4Q'-0' x 3'-0' DEEP GEOTHERMAL CIRCUIT HEADER
SMUNC BASIN FOR GEOTHERMAL SITE LATERAL PiPIHCi TRENCH.
DEWATERING- EXCESS SITE WAFER TO HAINTWN 4'-O' MINIMUM COVER.
BE DIRECTED TD BASIN_ PUMP OUT AS RUN MIN. 12' BELOW RJTURC
RECJ!RED, SEE SPECIFICATIONS. BASIN SIORM WATER PIPNG.
TO BE nLLED IN AND COMPACTED AT
COMPLETION OF GEDFIELD INSTALLALION

)UARE GEOTEXTILE FABRIC COVER
SEAL TOP OF BOREHOLE WITH WELL SEAL
GROUT, BENSEAL OR EQUAL, 12" LARGER
THAN BOREHOLE OUTSIDE DIAMETER.
L WELL CASING TO
OCK (APPROXIMATELY
T' DEEP) -ro 545 P-E-MOUEO
'4" POLYETHYL[NE LOOP
r-- 5" BORE HOLE
I
i I
�� BORE HOLE
TREMI-GROUTED WITH
BETONITE FULL DEPTH
4)
GEOTHERMAL BOREHOLE FETAL

r-i
I I ' GEOTHERMAL BORE WITH
1 -1 /4" 7j 1-1 /4" U--TUBE (TYPICAL}
1-1/4„
lI
2„ RETURN, SUPPLY /2
CIRCUIT HEADER TO -"" - PIPING FROM HEADER TRENCH
MANIFOLDS ❑FFSETS, TEES IN MIDDLE. EQUAL
2" 1-1 /2" � 1-1 /2" DISTANCE BETWEEN BORES
(TYPICAL SUPPLY AND RETURN)
�I
II
TYPICAL CIRCUIT PIPING
Numil

FINISH GRADE
Lu
�Lu
08
I U
POLYETHYLENE PIPIN
BACKFILL WITH SAND 6" BELOW
AND 6" ABOVE PIPING
II flumiQu
SEEDED LAWN / SURFACING PER PLAN
(BY SITEWORK CONTRACTOR)
UNDERGROUND PLASTIC PIPE TRACER TAPE
(24" ABOVE: ALL HORIZONTAL BURIED PIPE)
TRENCH EXCAVATION, BACKFILL (GENERAL
.O-Q..o4a FILL UNLESS DETAILED OTHERWISE) AND
COMPACTION BY SITEWORK CONTRACTOR.
NO SHARP ROCKS, FROZEN BACKFILL, OR
UNSUITABLE MATERIAL
12' MIN
SUPPLY RETURN
HEADERS HEADERS
REFER TO PLANS FOR HEADER
QUANTITIES. FOR SPACINGS SEE
SPECIFICATIONS. BY GT.
GEOTHERMAL CIRCUIT HEADER TRENCH DETAIL

--------------------
NORTH CAROLINA
DEPARTMENT 0FENVlR0NMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL
WATER-ONLY INJECTION WELLSYSTEM
TYPE.S OW WELL {S)
In Accordance With the Provisions ofNCAC Title l5A 02C.0200
Print ortype the required in,.formatio11 and mail to address-on the back page.
DATE:-~~----_____ j , __ , 20Ji_
Well Type C(lnjirlliatuJn: Does:the proposed system circulate potable water only (no additives) in
continuous piping. that completely isolates the fluid from the en vironrnent (i.e.
elosed-.Joo p)?
Yes . ✓-Continue completing.this form.
No __ P:o Not complete this fotm. Complete other UIC applfoation forms· for fostalljng
:either a .SA 7 well fom;n-loop well inj"ecting potable ·wate( into the aquifer) or ~ SQM wefl: ( closed-·
loop -well ·contairµng additives such as. R ~22, ethanol, or othe.r antifreeze or corrosion inhibitors).
A. PROPERTI' O\VNER($)1APPLICANT(S)
List each Prqperty O\\lller .listed on prope~y deed .(if owned by a business or government agency, state name of
entity a.nd:a:representative w/authority for signature): American Ex press -Saniuel Brick
(I) Mailing Address; 3151 West Behrend Drive
:City: _Pho~nbc _ . State: AZ Zlp Code: _____ 8_5_02_7 ___ :C.ounty: ____ _
HQme/0ffice T.ele No.: (602) 766-_60~8 Cell No.:
·Email Addres·s: samuel.j.brick@axe p.comWebsite:
(2) Physical Address of Well.Site (if different than above): _53_0_1 __ M_c...;.C_o_nn_e_ll_R_o_a_d ______ _
qty:. Whitsett State: NC Zip Code: 27377 Coun·ty: Guilford
Hoine/Offi:ce'tele No~: (602 ) 766-6028 Cell No.:
B. AUTBORJZED A.Gi!NT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter -from the property owner authorizing Agent to install and ~perate UIC well)
Company:Name: ___________________________ _
Contact J>erson ..... ·: _____________ E~MAIL __ ._A ___ dd'-'--'-fi ___ es'----s '--: _________ _
Address: _____________________________ _
City: _________ State:_._ZipCode: ______ County: ______ _
Office Tele No.: . Cell No.:
Website Address of Company, if any: ____________ ---JR ....... · ECE/VEO / DENR
uifer Protection SI D'!VQ ect,on
GPU/UIC SQW Notification of Intent Form (Revised 8/2008) MAR O 9 20ff Pagel
C. WELL DRILLER INFORMATION
Company Name: MGCA L�i2cY yes c - - -
Well Driller Contractor's Name:
NC Contractor Certification No.: NCi.J CG -1+ 3505
Contact Person: 7' M(ct4AC_C FLOY6 EMAIL Address: M eke C ►zteCa r'o .Cory
Address: A? 0. ,Sax GGS -710
City: C'144Aces-r'r-
Zip Code: 2SZr;
Office Tele No.: 70¢ - 395 - rso e Cell No.:
County: VA6
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Batchelor & Kimball Inc
Contact Person: Gordon Dunn EMAIL Address: Gordon(dtkim echan i cal. com
Address:. 5301 McConnell Road
City:
Whitsett
Office Tele No.: t336) 603-1442
Zip Code: 27377
Cell No.:
County: Guilford
E. STATUS OF APPLICANT
Private: Federal: Commercial: V/
State:. Municipal: Native American I ands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
C("s
G. WELL CONSTRUCTION DATA
(I) Proposed date to be constructed: APrti 1- Z011 Number of borings: 46
Approximate depth of each boring (feet): 450
(2) Type of tubing to be used (copper, PVC, etc): %R H RD P45
(3) WeIl casing. Is the well(s) cased? (check either (a.) Yes or (b.) No below)
(a) Yes if yes, then provide casing information below
Type: galvanized steel black steel —plastic --other (specify)
Casing. depth: From to feet (reference to Iand surface)
Casing extends to above ground inches
(4) Grout info (material surrounding well casing and/or piping): 6'-_0 4ve•el � e u4WAIC P
(a) Grout type: Neat Cement Bentonite Other (specify) ,Le-Aj rank- e -52?­0
(b) Grout placement: Pumping_ Pressure Other
(c) Grout depth of tubing (reference to land surface); from S to- 450 (feet)
If well has casing, indicate grout depth: from Al 1A to OVIA (feet)
GPINUIC 5QW Noti%cation of iraent Form (Revised 817.W8) Page 2

H. INXECTION-RELATED EQ[IIPNMNT
Attach a dlagrAm showing the engimeting layout or proposed modification of the l0actlon cqulpmaaht anti rxta:rior
piping/tubing associated with the Weatlen operation. The manufacturor'a brochum may provide supplementary
lorormation.
I. LOCATION OF WELL(S)
Attach two copies or maps ahowing the following Information:
(1) Include a Site Map (ran be drawn) showing; buildings, property lines. aui'faee water bodies, potential
sourm of groundwater contamination and the orientation of and distances between the proposed well[si and
any existing wt1l(a) or waste dispohal foal]ities such as senLic tanks or drain fiatids located within 200 root of
the geothermal !teat pump well system. Label all faatutes clearly and Include a n rah
(2) The Site Map must show the subject property In relatlon to the surrounding area by using At loust two rioted
reference points such as roads. streams, andtor highway Intersections.
J. CERTIFICATION
Note: This Parmit Application must he illned by gg�cl parson appoaring on the
raearded legal property dead.
"1 hereby cent y, under penalty of law, that I have parmnally examined and aan familiar with tho information
submitted In this document And all attachments thereto and W. based an my inquiry of those Indlvldaais
immediately responolbie Par obtaining said Information, I believe thAt tha information la true, accurate and complate,
I am aware that thm are arignifIcAnt panAltles, including the possibility of tined surf Irnprisenmem, for submitting
(raise information. I agme to cpnstruat, opm% maintain, mor, and if applicable, abnodon the iNection well and
all mlatctt appurtmnmim In amerdanaa: with the approved speclNailons and conditions of the Pariah. '
Bigd"ature of Properly OwnerlApplleant
Print or Type Full Name and We
Signawre of Property OwnwlApplicant
Print or' Ype full Name and thle
Signature of Authorized Agent, if any
Print orType bull [dame and tills
Pleamo realm two eaples of die completed Application package to:
North Carolina I)EMDWO
Aquifer Protection Sectlon•UIC Program
1636 Mail Service Center RECEIVED 1 DENR 1
Raleigh, NC 27699-1636 Aquifer pmtadion Sat"hon�
Telephone (920) 733.=1
MAR 4 9 2011
aI't v IC 5QW r<rvriCtc 10 ft of leant No (Ramsed 0003) Pip 3

RECEIVED/ DENR / DWQ
-~··-··· .. ··· ........... _ ........... ············---·-----------········-·------------------Aq··~'~·'"•A'A"'i.an ~-.Alinn_ ·····················-·············•··•-··-···-···-···· · ··-·-·····•··•· ···· ·· ···· ·····-·-·-~-·· ·······-······-· · ······· -·--······ · Utt:C1·:rt~t1u1 1-ot:t.~n ;,11 ············--············-·····-· ··
.... MAR O 9 2011
LI NE TABLE \ 1-85
\
LINE LENGTH BEARING L -
L-1 131.52' N 40•45•05" E M\IT.STREAtvl ROAD
L-2 176.93' s 4914'55" E
L-3 92.44'. N 44•os1 03" E
L-4 192.10' N er.30'55" E
L-5 143.96' N 8]434'10" E FRANZ WARNER PKWY
L-6 171.13' N 42•4a'53n E q_.j-~ L-7 52.08' 54•24•34" s E ~ L-8 69.45' s sa·40•39 .. E I ~{l;
L-9 199.49' s 53'37'28" E ' ~ A..,,.,/!7-')'Jh . .
.. /,_,✓ ./0-:{f/ i;.,"777--~
L-10 47.87' s 35·59'4a" E 0 ' . . (i~.,,.·~~~~-:.0~x?--}:~w· ..
tr t,,,,,.,.. _,,,,.,e,,.,,.i' .. ., .... ·// ·--/ ~,
L-11 47.67' 57·52'32" --,./~#J?;::~>--:~:r~,..~r,,;,_"·" -··""./.1 s E w .. . .i'>?J: ;,;; ·'~-"~'l.;-/❖1/, "/0 ... ;..,: ' ~-"··· •• , .. ,(-1', 1/.%i··✓, ... , •• ,'J"/ / 1/,. ~ '7..-_.,,-_,,,._.(/----✓ .-~'/,.,.,,_ .... -.... ·--❖-/-i~~-d~
L-12 39.40' s 39·27'42" E ii~,;@//, SITE ,,z: ¾&:· ...J ,;~~~* . rt-7:fi:>::.:1 L-13 36.32' ag·45•·1 a" > JUDG E ADA.M S RO s E il~ ... :1/~ 'i.... . ~ ...-: ..-;. f' •• .-', :· ~/~.-~..,,z,..•~1 ct" L-14 28.16' s 42"55'53" E m-✓~ • ./';10_...{.... w·,,.•"' . CJ ~ z,r z:·¼·· f.,, _, -.
¼'/ Y~di .. ¾~Etl--~o g L-15 26.55' ao·3a'30" N>, ~N s E •• <-. .;,' J
L-16 40.77' s 29"46'36" E . ~E~p~ I fE . rm -L-17 36.40' s 01·12'25" E (7 ~ ~ ~ l
L-18 74.99' s 58"54'47" E 0::
0 f--~ t
>-
L-19 31.061 s 38"13'14" E I i .~
L-20 35.39' s 61 "32'51" E -0 0: w ~ L-21 346.87' s ao·o1 '42" w m <
L-22 60. 70' s 79·43'31" w
J
~
L-23 323.06' s 79"41'51" w VICINITY MAP L-24 247.20' s 79·4f34" w
L-25 221.24' s 79•4f34n w (1"=2000')
L-26 19.32' s 79·35'06" w
L-27 30.62' N 01i7'59" E ........ ---_,. -. ---•--.. -
W3 & N,ete SMtcy YrNI�E"6 Fn nCnoi. • �IyY �3 7[,L
Irv:• PA. 90u 175] -1111- m-A
RN{E fORSi, IIL 115/ia l'.44Y.. irl, roai'i
91E ea.R Im.roe rG ,J- [9r9] Slits--llH .O..r�'
rvrk 1 ar wrs- f sinner armyra sr: epir �r
µ W MEI. SIRFFIS A a[,! n.s ,Wxti[ e,C 4 `
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ttrrx xUMCK. s f ra n,vs y , j�'� t
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1-wn:
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MOO
Rk f } VME,.? _ SITE DATA.
�' . '; {Zaak
,•ram. �'^.� ;:.:., Q srt .rsrier-
ri� r-;K.. _Y ~('-,T,• •S,"%': '�:, AI64 M>!Ar fLQIJR14N - x.31 K
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runty
.wsro I INTM - ftiaic
.w,.w PROPOSED BUILDING
; smERE bmm - v"�URM
�`- I KF-5f1EEE PMIOQ
! C w.rr x iasEorus 1 3 - , e Eu x :. &vu - .. wvtt�
F ..r„PM. lanes PMIkVrf11 nn.i v.WOM ,. WACOanfc =oowm 1w sfws
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LEGEND
89 R/W (23' GRAVEL)
_
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PROPOSED
BUILDING
SEE Ar[CHFt%TVR4L
GRAYAMM A 01-M IGCTAIL 2
r FOR WELVLL MAY l nF9FR
MAWRES FOR MAN ENTRY
SY YVAIX
C
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i OFFICE
MECH
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21 �O3
24" SQUARE GEQTEXTILE FABRIC COVER
SEAL TOP OF BOREHOLE WITH WELL SEAL
{ i GROUT, BENSEAL OR EQUAL, 12" LARGER
�5—THAN BOREHOLE OUTSIDE DIAMETER.
STEEL WELL CASING TO
BEDROCK (APPROXIMATELY
I 60'-0" DEEP) Z �Q,�rr1o1lgL]
i 1-1/4" POLYETHYLENE LOOP
6" BORE HOLE
I I
I �-- BORE HOLE
TREMI—GROUTED WITH
BETONITE FULL DEPTH
�7']-p�GgL MAN
}
GtOTHERMAL BOREHOLE DETAIL
05-

2" RETURN, SUPPLY
CIRCUIT HEADER TO
MANIFOLDS "
2
n
GEOTHERMAL BORE WITH
1-1 f 4" U—TUBE (TYPICAL)
PIPING FROM HEADER TRENCH
OFFSETS, TEES IN MIDDLE EQUAL
DISTANCE BETWEEN BORES
(TYPICAL SUPPLY AND RETURN)
TYPICAL CIRCUIT PIPING

FINISH GRADE
111111111111111i111
w00
'Ti=
I �
=f f 1
POLYETHYLENE PIPING-
BACKFILL WITH SAND 6" BELOW
AND 6" ABOVE PIPING
12" MEN
SUPPLY RETURN
HEADERS HEADERS
REFER TO PLANS FOR HEADER
QUANTITIES. FOR SPACINGS SEE
SPECIFICATIONS. BY GT.
SEEDED LAWN / SURFACING PER PLAN
(BY SITEWORK CONTRACTOR)
UNDERGROUND PLASTIC PIPE TRACER TAPE
(24" ABOVE ALL HORIZONTAL BURIED PIPE)
TRENCH EXCAVATION, BACKFILL (GENERAL
FILL UNLESS DETAILED OTHERWISE) AND
COMPACTION BY SITEWORK CONTRACTOR.
NO SHARP ROCKS, FROZEN BACKFILL, OR
UNSUITABLE MATERIAL
z GEOTHERMAL CIRCUIT HEADER TRENCH DETAIL
hh5-�
ti