WI0500111_GEOTHERMAL_20000512

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
May 12, 2000
To: Jay Zimmerman, L.G.
Groundwater Section
Raleigh Regional Office
From: Mark Pritz! f).P, [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Receipt of Notification for a Closed-Loop Geothermal Water-Only Injection Well
System.
Notification to construct and operate a well for a closed-loop geothermal heat pump system bas
been filed by George Devlin of Raleigh, North Carolina and a copy of the Notification is
enclosed for your files. This injection well system is deemed permitted by rule (NCAC T15A:
2C.21 l(u)2) and no regulatory action is necessary. If you have any questions, please contact me
at [phone] or Amy Axon at [phone].
cc: CO-UIC Files
Enclosures
ATA
NCDENR
JAMES B. HUNT JR:
GOVERNOR
BILL HOLMAN
SECRETARY
KERR T. STEVENS
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
May 12, 2000
George Devlin
1052 Sunset Meadows Drive
Apex, NC 27502
Dear Mr. Devlin:
DIVISION OF WATER QUALITY
In accordance with the notification submitted on your behalf by Bowman's
Mechanical dated May 3, 2000; the Groundwater Section acknowledges your
intention to construct closed -loop geothermal water -only injection wells for the
operation of a ground -source heat pump. The system as described in your
notification will not require an injection well permit and is deemed permitted by rule
(North Carolina Administrative Code Title 15A: 2C.0211(u)2). The Underground
Injection Control Group has added your site to our inventory. If you modify your
system, please contact the Groundwater Section to verify compliance. Thank you
for submitting this notification.
If you have any questions regarding geothermal heat pump wells please feel free to
contact me at [phone] or Amy Axon at [phone].
Sincerely,
Mal/4
Mark Pritzt
Hydrogeological Technician II
Underground Injection Control Program
ee: CC-UIC Files
RRO-UIC Files
FIIZST
GRouNOWATER SECTION
1636 MAIL SERVICE CENTER, RALEIGH, NC 27699-1635 - 2726 CAPITAL, BLVD-, RALEIGH, NC 27E04
PHONE [phone] FAX 919-715-as8R
AN EQUAL OPPORTUNITY ! AFFIRMATIVE ACTION EMPLOYER - So% RECYCLED/10% PORT -CONSUMER PAPER

NORTH CAR❑LINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP
GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM
(GROUND COUPLED HEAT PUMP)
c
Type SQW Wells v. c,�
—4 7�
In Accordance with the provisions of NCAC Title 15A: 02C.0200 — �' t
CD:F n
Complete application and mail to address on the back page. ¢ al
This is not the proper form to be used for injection wells in an open -loop geothermal system:
Do not use this form for systems that circulate an substances other than water. cn
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
2.0
DATE: 5--3 . t9-00
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
YES
NO
�If yes, then continue completing this form.
If no, do not complete this form. Fomi GW-57 HP, Application For
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
S. 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.
YES If yes, do not complete this form. Form GW-57 I-IP, Application For
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
NO If no, then continue completing this form.
C. PROPERTY OWNER
l „
Name: ( oeo,z
Address: _ ras z
City: A ('GState: la' r- Zip Code: z 2 Sv
County: L.� -1�e Telephone: ■ 1- 3 8 7 del
Z
D. STATUS OF PROPERTY OWNER
Private: t- Federal: Commercial:
State: Municipal: Native American Lands:
GW-57 CL (May 1998) Page 1 of 4

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility:
Address:
City: State: Zip Code: County:
Telephone: ' Contact Person:
Standard Industrial Code(s), SIC, which describes commercial facility:
F. HEAT PUMP CONTRACTOR DATA
Name: FloLowns Y ec 111tCq f
Address: 121 R S4u r 'van br•i'v e
City: CA a `t State: 1J- 4.• Zip Code: a 7S1 1 County: 1,1 a Ke
Telephone: � i9- `11 Contact Person: S4-eve sow mg d
G. CONSTRUCTION DATA (check one)
(1)
EXISTING WELL(S) being proposed for use as a ground -coupled heat pump
.....���. .,....... 2, ...a.,iLAaLei...iis I L (1/ LI W. ;I IYJ U IUry LU LIIG UCbl Ui yUUI
knowledge. Attach a copy of Form GW-1 (Well Construction Record) if available.
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.
Weil Drilling Contractor's Name: i�3 i r iI 5 Lief bra t, r1 - , ; J v'c .
NC Driller Registration number: v04::)
Date to be constructed: =; -± -00 Number of borings:
Approximate depth of each boring (feet): 5001
(2) 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 1�
(3)
Grout (grout the vertical length of the borehole to a minimum depth of 20 feet b.1.s.):
(a) Grout type: Cement Bentonite 1rOther (specify)
(b) Grouted surface and grout depth (reference to land surface):
L—around closed loop piping; from 0 to SD (feet).
around well casing; from to (feet).
NOTE: 'DIE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION i5 UNAVAILABLE BY OTHER MEANS.
GW-57 CL (May 1998) Page 2 of 4

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).
J. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
K. CERTIFICATION
"I hereby certify, under penalty of law, 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, maintain,
repair, and if applicable, abandon the ground-source heat pump system and all related appurtenances in
accordance with the approved specifications and conditions of the Permit."
GW-57 CL (May 1998)
Well Owner or Authorized Agent)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
Page 3 of4
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 injec1;ion 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 ISA NCAC 2C .0200)
(Signa~£~rent From Applicant)
Please return two copies of the completed Application package to:
GW-57 CL (May 1998)
UIC Program
Groundwater Section
North Carolina DENR-DWQ
P.O. Box 29578
Raleigh, NC 27626-0578
Telephone [phone]
Page 4 of4
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