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Home My WebLink AboutWI0500395_GEO THERMAL_20110719Permit Number Program Category Ground Water Permit Type ,. WI0500395 Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facilitv Facility Name Greg Taylor SFR Location Address 2501 Wrightwood Ave Durham 0 n r Owner Name Greg Da e s /Events NC 27705 Taylor Scheduled Orig Issue 07/19/11 App Received Draft Initiated Issuance 07/11/11 Reaulated Activities Heat Pump Injection Outfall NIJL;_ Central Files: APS_ SWP_ 07/19/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Kevin Letchworth Driller Well PO Box 1958 Wendell NC Major/Minor Minor Region Raleigh County Durham Facility Contact Affiliation Owner Type Individual Owner Affiliation Greg Taylor 2501 Wrightwood Ave Durham NC Public Notice Issue 07/19/11 Effective 07/19/11 2759 1 27705 Expiration Waterbody Name Stream Index Number Current Class Subbasin Beverly Eaves Perdue Governor Greg Taylo r 2501 Wrightwood Av e. Durham, NC 27705 NA NCDE NR North Carolina Department of Environment and Natural Resources Division of Water Quality Coleen H. Sullins Director 7/19/2011 Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System Permit No. WI0500395 2501 Wrightwood Avenue. Durham, NC 27705 Dear Mr. Taylor: Dee Freeman Secretary On July 11, 2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onl y 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 well 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 Code Title 15A Section 2C Subchapter .0213, and 3. The required notification form and associated maps have been completely and accurately submitted. Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Construction Act and North Carolina Administrative Code Title 15A Section 2C Subchapter .021 l{u)(2). Additionally, you should contact the Durham 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 (919) 715-6166 or Michael.Ro2:ers@ncdenr.2:ov if you have any questions. cc: R al eigh Regional Office -APS APS Central Files -Permit No. W I05003 95 Durham County Health Dept. Letco Inc cl/b/a NW Poole W ell Co. Ev ang elist Service Company AQUIF ER PROTECTION SECTION ts•rely, ~ •~ fo r Deb~ V\..(_ Supervisor 1636 Mail Service Center, Raleigh, No rt h Carolina 27699-1636 Location: 2728 Capital Bou levard, Raleigh, North Caroli na 27604 Phone : 919-733-3221 \ FAX 1: 919-715~0588; FAX 2: 919-715-6048 \ Cu stomer Service : 1-877-623-6748 Internet: www .ncwateraualitv.o ro A~ Equal Opportunity I Affirmative Action Employer None . C .. orth ~aro1.1na ,?vatutall!I NORIB CAROLINA DEPARTMENT OF ENVIRONMENT AND NA TlIR{\L RESOURCES · NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM TYPE 50 W WELL{S) In Accordance With the Provisions ofNCAC Title 15A 02C.0200 Print or type the required information <md mail to address on the back page. DATE : 1-'1 20.!E_ uSCOSl?039 5 Well 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 fonn. No ___ Do Not complete this form. Complete other UIC application fonns for installing either a SA 7 welJ (open-Joop weJI iniecting potable water into the aquifer) or a SQM weJI (closed- loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors). A. PROPERTY OWNER(S)/APPLICANT(S) List each Property Owner listed on property deed (if owned by a business or government agency, state name of entity and a representative w/authority for signature): _________________ _ Gi r\.te G ]:A 'ft., I> ti- (1) Mailing Address: 2. ~() I W~IGJt1 WOOO ,J.v(, City: bua.t+~. State: tv C..Zip Code: ~")')O.) County: Pun JJ,/11 t"I Home/Office Tele No.: °' 15 . l/0 , _ v2s-2-Cell No.: Email Address: Website: (2) Physical Address of Well Site (if different than above): ______________ _ City: _________ State: __ Zip Code: ______ County: ____ _ Home/Office Tele No.: ___________ _,,C=e=ll -"-N=o=.:'------------ B. AUTHORIZED AGENT 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 operate UIC well) Company Name: ____________________________ _ ContactPerson~=-------------~E=MAil.,===A=d=dres==s~=----------- Address: _______________________________ _ City: _________ State: __ Zip Code: ______ County: _______ _ Office Tele No.: Cell No.: Website Address of Company, if any:. ______________ _ GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page 1 C. WELL DRILLER INFORMATION CompanyName: Lehu k db4 /Ju }/WR /tk/16>, Well Driller Contractor's Name: __ T ()./Jte~ A1 · _ ::rOfle.S ~~~---------- NC Contractor Certification No.: z1g3 4 Contact Person: /ltv,~ Ud.-~_____,-1'...,l~t.=----'---E-MAIL--A-d_dres_s_: --------- Address: 3S't:D {21,/e5<,,i/le gp City: WerJeU Zip Code: 2'759 / County: _..:.,../J.......=1«=....k ...... e ______ _ Office Tele No.": {c/l 'f ) 2LC,-q(23 Cell No.: ;, ---------- D. BEAT PUMP CONTRACTOR INFORMATION (if different than driller) CompanyName: £Vlj/lJ<oe,,sr g,L"•Ge C.0 ~~ ContactPerson: ~""" €111:u>fof!c.rs;-EMAIL Address: eu11i"3:t,/1y 0 ~/f~.,J..,.e1-- Address: t I I , € 4-1C f.\ f!lc...~ ~ "a.D City: t4::(>cr)C'i Zip Code: ~-,n ,3 County: _e_H_ff'T_ll~"~~-------- Office Tele No.: q,.o,_ 3bZ-?8tO Cell No.: 'hJi-21$-?VZZ. E. STATUS OF APPLICANT Private: -1!__ State: Federal: Municipal: __ Commercial: Native American Lands: F. INJECTION PROCEDURE {briefly describe how the injection well(s) will be used) G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: '1 } n../1 I Number of borings: ----=3=-----r ~_?A, Approximate depth of each boring (feet): __ ~u ~.;x.,., ____ _ (2) Type of tubing to be used (copper, PVC, etc): _ ___._y..,Lo=...,_P__:_£ _________ _ (3) Well casing. Is the well(s) cased? (check either (a.) Yes m: (b.) No below) (a) Yes ___ ifyes, thenprovidecasinginformationbelow Type: ....:......_galvanized steel __ black steel___plastic __ other (specify) Casing depth: From ___ to ___ feet (reference to land surface) Casing extends to above ground ___ inches (b) No X) (4) Grout Info (material surrounding well casing and/or piping): (a) Grout type: Neat Cement__ Bentonite ✓ Other (specify) _S.'--qtt__,._J ___ _ (b) Grout placement: Pumping )I Pressure__ Other __ ( c) Grout depth of tubing {reference to land surface): from 0 to 300 1 (feet) If well has casing, indicate grout depth: from ·-to ____ (feet) GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page2 S. INJECTION -RELATED EQUIPMENT Attach a diagram showing the engineering layout or proposed modification 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 copies of maps showing the following information: (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 geothermal heat pump well system. Label all features dearly and include north arrow_ (2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed reference points such as roads, streams, and/or highway intersections. J. CERTIFICATION Note: This Permit Application must be signed by each person appearing on the recorded legal property deed. `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 injection well and all related appurtenances in accordance with the approved specifications and conditions of the Permit_„ r-- Signature ot;L apL'l ty Owner/Applicant c� A•]air Print os'Cype Full Name and tall, Signature of Property Owner/Applicant Print or Type Full Name and title Signatum of Authorized Agent, if any Print or Type Full Name and title Please return two copies of the completed Application package to: North Carolina DENR-DWQ Aquifer Protection Section-UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 733-3221 GP'U/UIC SQW Notification of Intent Form (Revised 8/2008) Page 3 Evangelist Service Co. Apex, UC 6-22-2011 Greg Taylor 2501 Wrightwood Ave. Durham, NC 27705 Sewer Easement Back of House ❑ ❑ NOT TO SCALE A Three 400' boreholes of 1.25: HDPE pipe. Trenching is 2-3' deep. AC 26' AD 36.5' AE 26' BC 31' Biz 44.5' BE36' BF 12" Sewer Easement