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Home My WebLink AboutWI0300125_GEOTHERMAL_20080728Program Category Ground Water Permit Type WI0300125 Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Permitted Flow FaciHtv Facility Name Fisher Street Theater Location Adclress 131 E Fisher St Salisbury Ow ner Owner Name Piedmont Players Theatre NC 28144 Scheduled Orig Issue 07/28/08 App Received Draft Initiated Issuance 07/18/08 Remilated Activities Heat Pump Injection Outfall NULL Central Files: APS_ SWP_ 07/28/08 Permit Tracking Slip Status Active Version 1.00 Project Type New Project Permit Classification Individual Permit Contact Affiliation Major/Minor Minor Region Mooresville County Rowan Facility Contact Affiliation Owner Type Non-Government Owner Affiliation Reid Leonard 213 S Main St Salisbury NC 28144 Public Notice Issue 07/28/08 Effective 07/28/08 Expiration Waterbody Name Stream Index Number Current Class Subbasin NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL WATER —ONLY INJECTION WELL SYSTEM (GROUND COUPLED HEAT PUMP) Type SQW Wells In Accordance with the provisions ofNCAC Title ISA: OMC.0200 Complete application and mail to address on the back page. This is not the proper form to be used for injection wells in an open -loon geothermal system. Do not use this form for systems that circulate an substances other than water. TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY DATE: July 16, 2008 A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous piping that completely isolates the fluid from the environment? YES X If yes, then continue completing this form. NO If no, do not complete this form. Form GW-57 HP, Application For Permit To Construct And/Or Use A Well(s) For Injection With A Heat Pwnp System, should be completed. B. SYSTEM FLUID Will any additives be introduced to the system's circulating heat transfer fluid? This includes, but is not limited to corrosion inhibitors and/or antifreezes. C. D. YES If yes, do not complete this form. Form GW-57 HP, Application For Permit To Construct And/Or Use A Well(s) For Injection With A Heat Pump System, should be completed. NO X If no, then continue completing this form. ¢¢ iv, v ❑ E bi rS [ 1`�� Lii et)nr�st Name: �+(1�bur�l Address i 3 AiN,rl- P � x �7� City: �J�/A Iv r y State: JV C Zip Code: 2'$ /45 County: go AAl Telephone: 7 4. te5S, 5170 G�� s (IL"t 4 Z t 1 t S�4-4 ATV5 aF PROPERTY OWNER -- PROPERTY OWNER Private: State: GW-57 CL (Jan, 2000) Federal: Municipal: x Commercial: Native American Lands: Page l of 4 JUL 18 zoos E. JOB (SITE) DATA Name : { R 4 " R 1✓T 7-14 RT lrr. Address: 131 g . _F r 5t d. f- 114-4 City: Ja. t r i � State: N c Zip Code:��7 44 County: ?€tpleutz Telephone: 0 g.. j, t 431 Contact Person ; t d[ W 6-1 se n .. r F. HEAT PUMP CONTRACTOR DATA 1 Name: N/A Note: This is for a borehole and thermal conductivity test. Address: City: State: Zip Code: County: Telephone: _ _ Contact Person: G. CONSTRUCTION DATA (check one) EXISTING WELL(S) being proposed for use as a ground -coupled heat pump well(s). Provide the information in (1) through (4) below to the best of your knowledge. Attach a copy of Form GW-1 (Well Construction Record) if available. X PROPOSED WELL(S) to be constructed for use as a ground -coupled heat pump well(s) . Provide the information in (1) through (4) below as PROPOSED construction specifications. Submit Form GW-1 after construction. (1) (2) (3) Well Drilling Contractor's Name: Coastal Geothermal 910-353-0926 NC Contractor Certification number: NC — 2723 Bruce Brazil" Date to be constructed: Aug. 2008 Number of borings: 1 Approximate depth of each boring (feet):_300' Well casing: Is the well(s) cased? (a) YES If yes, then provide the casing information below. Type: Galvanized steel Black steel Plastic Other (specify) Casing depth: From to ft. (reference to land surface) Casing extends above ground inches (b) NO X Grout (grout the vertical length of the borehole to a minimum depth of 20 feet b.l.s.): (a) Grout type: Cement Bentonite X Other (specify) (b) Grouted surface and grout depth (reference to land surface): X around closed loop piping; from 0 to 200 (feet). around well casing; from to (feet). NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS. G W-57 CL (Jan, 2000) Page 2 of 4 J. K. JUL 18 2008 H.' INJECTION-RELATED EQUIPMENT Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary information. I. LOCATION OF WELL(S) Attach two maps. (1) Include a site map (can be drawn) showing: buildings, property lines surface water bodies, potential sources of groundwater contamination and the orientation of and distances between the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of the ground-coupled heat pump well system. Label all features clearly and include a north arrow. (2) location map referencing the site to two nearby permanent reference points (such as roads, streams and highway intersections). PERMIT LIST: Attach a list of all permits or construction flPl)rovals that are related to the site. * ~n<t.. o.+-lk17 k-6.: +'1:(%,. e~4'>1c.G-l-(? II"\. J.4,.~!<Jt\ oha.£,~, Examples include: {1.hJ 1:h,t ttL1,+ wczil If, ~ r (1) (2) (3) Hazardous Waste Management program permits under RCRA NC Division of Water Quality Non-Discharge permits Sewage Treatment and Disposal Permits d.ctA-~nv,,n4-fr..ac, b, lrl-y t> f {h.Jl. p la ~IA. '1..d CERTIFICATION Cf <t,.t:1 +h e.t"'tV\~I H V /rC '.>'f s +.e~. "I hereby certify, under penalty oflaw, that I have personally examined and am familiar 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 significant penalties, including the possibility of fines and imprisonment, for submitting false information. I agree to construct, operate, intain, repair, and if applicable, abandon the ground-source heat pump system and all related appurt ances in accordance with the approved specifications and conditions of the Permit." ~-e ;o( ff authorized agent is acting on behalf of the well owner, L .e. e '°I it~ please supply a letter signed by the owner authorizing the above agent. t()A t'\'3lf -t ~ ne *e ( 7" 'f b 1) ~ ~p 7 I ( 0 ) GW-57 CL (Jan, 2000) 1 _ A. c. _,-<9 1 '-1-IJ ( l,A,t le ~ ~t') 'ti 'l' ~ l Page 3 of4 1 .'IJ 18 zoos L. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the well being constructed. A well is real property and its construction on land rests ownership in the landowner in the absence of contrary agreement in writing.) If the property is owned by someone other than the applicant, the property owner hereby consents to allow the applicant to construct each injection well as outlined in this application and that it shall be the responsibility of the applicant to ensure that the ground -source heat pump system's well(s) conforms to the Well Construction Standards (Title 15A NCAC 2C .0200) (Signature Of Property Owner if Different From Applicant) vo,gAVA CA Please return two copies of the completed Application package to: UTC Program Groundwater Section North Carolina DENR-DWQ 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6165 GW-57 CL Ciao, 2000) Page 4 of 4 Vccarrty 9C4.5 (� %ci.LIS17,1111 } Ni C http:/fmaps.live.com/print,aspx?mkt=en-us&z=19&s-1i&cp=py9t0288tpyv&pt=pb 7/14/2008 Rowan Co, NC -- Printable Map Page 1 of 1 Rowan County GIS DISCLAIMER: This information was prepared from the Rowan County, NC Geographic Information System. Rowan County has made substantial efforts to ensure the accuracy of location and labeling information contained on this site. The information provided is a representation of various City and County data sources and does not serve as an official rnap. Rowan County promotes and recommends the independent verification of any information contained on this site by the user. Rowan County makes no warranty or other assertion as to the fitness of the maps for any particular purpose and neither Rowan County nor its agents or employees shall be liable for any claim alleged to have resulted from any use thereof. http;//www.webgis.net Anderson & Associates, Inc. http:lwww.andassoc,com http:J/arcims2.webgis.netlncfRowanlpri.ntable.asp?process=undefined&x2=undefined&y2=undefine... 7/16/2008 Michael F. Easley, Governor William G. Ross Jr.. Secretary North Carolina Department of Environment and Natural Resources Coley 1-i Sullins Director Division of Water Quality July 23, 2008 Piedmont Players Theatre Attn: Reid Leonard 213 South Main Street Salisbury, NC 28144 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0300125 131 E Fisher Street Salisbury, NC 28144 Dear Mr. Leonard: In accordance with the application submitted to the Underground Injection Control (IJIC) Program that was received on July 18, 2008, the Aquifer Protection Section (APS) acknowledges your intent to construct a closed -loop geothermal water-on14 injection well system for the operation of a ground -source heat pump located at 131 E. Fisher Street. Salisbury, Rowan County, NC 28144. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C, Section .0211(u)(2)), However, it is recommended that you contact the Rowan County Health Department, as they may have additional construction.or permitting requirements for this type of system. If you modify your system at any time, including the addition of antifreeze, corrosion inhibitors, or any other substances to the circulating fluid, you must contact the APS to verify compliance with applicable rules. Thank you for submitting this notification. If you have any questions please call meat (919) 715-6166. Sincerely, A .150isr AAA, Michael Rogers Environmental Specialist GPU-Aquifer Protection Section cc: Mooresville Regional Office - APS APS Central Files - Permit No. WI0300125 Rowan County Health Dept. Coastal Geothermal — Bruce Brazils (102 Middle Street Jacksonville NC 28546) Aquifer Protection Section 1636 Mail Service Center Internet: www.ncwateruualitv.orp Location: 2728 Capital Boulevard _ Soar hCaroiina IV atrirn!!i Raleigh, NC 27699-1636 Telephone: (919) 733-3221 Raleigh, NC 27604 Fax 1: (919) 715.0588 Fax 2 (919) 715.6048 Customer Service: (877) 623-6748 An Equal Opporttmity!A€6rmalive Action Employer— 5O% Recycled/10% Post Consumer Paper Rowan Co, NC -- Printable Map Page 1 of i Rowan County GIS 010 157 163 2531 5144 61 5076 0108593 5Ba ti + 53 T 21 ' 0 2862 010 199 � �7 015 \ ilf03gr 1820 0IC . 019 00 • 01CfC5$)5¢0. 1 29 31° 3 0 rbdO tilt? 308 2134 41 0134 2ste 3102815 - ''i: 451 7 3V 1 332 7 333402 . 4900 010 +421 r . . '0103 Parcels Parcel ID: 0106585000001 Owner: Property Address: Date Sold: o Sale Inst.: Legal Description: Sale Amt.: $0 Land FMV: $0 Acreage: NIA Assessed Land Value:$0 Deed Year: 0 Building Value: $0 Total Assessed Value:$0 DISCLAIMER: This information was prepared from the Rowan County, NC Geographic Information System. Rowan County has made substantial efforts to ensure the accuracy of location and labeling information contained on this site. The information provided is a representation of various City and County data sources and does not serve as an official map. Rowan County promotes and recommends the independent verification of any information contained on this site by the user. Rowan County makes no warranty or other assertion as to the fitness of the maps for any particular purpose and neither Rowan County nor it's agents or employees shall be Gable for any claim alleged to have resulted from any use thereof. http://www.webgi s.net Anderson & Associates, Inc. http://www.andassac.com http://arcims2.webgis.net/ne/Rowan/printable.asp?process—idl&x2=1563063 .625&y2=70... 7/28/2008