WI0600058_GEO THERMAL_20100607

. '
Permit Number WI0600058
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Hamilton Street
Location Address
Adjacent To Bldg 1-1939
Fort Bragg
Owner
Owner Name
NC 28310
Fort Bragg Director of Public Works
Dates!Events
Orig Issue
06/07/10
App Received Draft Initiated
05/21/10
Re gulated Activities
Heat Pi.imp Injection
Outfall NUL L
Scheduled
Issuance
Central Files: APS_ SWP_
06/07/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Mike Hadley
Driller Well
102 Middle St
Jacksonville
Major/Minor
Minor
NC
Region
Fayetteville
County
Cumberland
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Craig Lantz
3175 Reily Road-Stop A
Fort Bragg NC
Public Notice Issue
06/07/10
Effective
06/07/10
28546
28310
Expiration
Waterbody Name Stream Index Number Current Class Subbasln
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
61712010
Gregory Bean. Dir. of Public Works
Dept of the Army, Fort Bragg
2175 Reilly Road, Stop A
Fort Bragg, NC 28310
Subject Acknowledgement of intent to Construct Type 5QW Injection Well System
Permit No. WI0600058
Adjacent to Shia 1-1939, Hamilton St. Fort Bragg. NC 28310
Dear Mr. Bean:
.T(v oq o 3
?F• ri • q-
On 5/2112010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -only
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 conk ins only potable water,
2. The injection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative Code Tide 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 .0211(u)(2). Additionally, you should contact the Cumberland 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 Michae].Rosers r( ncdenr.eov if you have any questions.
eeSS�incerely,
for Debra Watts
Supervisor
cc: Fayetteville Regional Office - APS
APS Central Files - Permit No. W10500058
Cumberland County Health Dept.
Mike Hadley (Coastal Geothermal — l02 Middle Street. Jacksonville, NC 28546)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh, North Carolina 27604
Phone: [phone] I FAX 1: 915.715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
Internet Www.noualargualitv_ont
An Equal Opporninity l Affirmative Aclbet Employer
NorthCarolina
Naturally

REPLY TO
ATTENTION O'
DEPARTMENT UF-TBE AR1VrY
US ARMY INSTALLATION MANAGEMENT COMMAND
HEADQUARTERS, UNITED STATES ARMY GARRISON, FT BRAGG
2175 REILLY ROAD, STOP A �6CiIVED IraR rOViCt
FORT BRAGG NORTH CAROLINA 28310-5000 AQUSF;P PROTFCrinN c, 71QN
MAY $1 2010
May 12, 2010
Directorate of Public Works
Mr. Thomas Slusser
North Carolina Department of Environment
and Natural Resources
Underground Injection Control Program
Aquifer Protection Section, NCDENR-DWQ
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Dear Mr. Slusser:
Attached are two copies of a Type 5-QW injection well permit
application form related to a proposed Geothermal Well System
installation on Fort Bragg's Polo Field, for administrative
buildings. This application is for a test well to gather
necessary information for design. The test well will eventually
be utilized as a part of the system. As instructed on the
application, two copies of the form are being submitted,
including two copies of all attachments and supporting
information.
If you have any questions concerning this matter, please
contact Mrs. Suzanne Rohrs at 910-432-8470.
Since
Gregory G. Bean
Director of Public Works
Enclosure

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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-QW WELL(S1
In Accordance with the provisions of NCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Tyne information).
DATE: 5/11/2010
Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the environment (Le.
closed -loop)?
Yes x_ Continue completing this form_
No Do Not complete this form. Complete other UTC application forms for installing
either a 5A7 well (open -loop well injecting 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)/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 wlauthority for signatures; Crreiiory G. Bean. Director of Public Works
(l)
Mailing Address: 2175 Reilly Road_ Stop A
City: Fort Brag State: NC Zip Code: 28310 County: Cumberland
Home/Office Tele No.: r 910) 432-8470 Cell No.:
Email Address: Suzanne.Rohrs±a us.armv.mil Website:
(2) Physical Address of Wen Site. (if different than above): Adjacent to BLDG 1-1939. Hamilton Street
City: Fort Bragg State: NC Zip Code: 28310 County: Cumberland
Home/Office Tele No,: Cell No.:
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 Narne:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company, if any:
GPLJ/UIC 5QW Notification of Intent Form (Revised 71200S) Page 1

C. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal
Well Driller Contractor's Name: Sanford Sweeting
NC Contractor Certification No.: NC 2082
Contact Persori: Mike Hadley EMAIL Address: mhadle v@ bizec.rr.com
Address: 102 Middle St.
City: Jacksonville Zip Code: 28546 County: Onslow
Office Tele No.: 910-353-0926 Cell No.: 910-376-1100
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company: _NIA _____________________ _
Contact Person~: ---------~E=MA~=IL~A~d_dr~e=s-s:'"-----------
Address: _________________ _
City: ----------'S=t=at=e--'--: __ Zip Code: _____ County: ______ _
Office Tele No.: Cell No.:
E. STATUS OF APPLICANT
Private:
State:
Federal: ...x__
Municipal: __
-------------
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed Loop Geothermal Heat Transfer Systems
Test Borehole and loop
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: __ J_u~ne_20~1~0 ________ Number of borings: _ _.cl ____ _
Approximate depth of each boring (feet): _ ___;=2=-55"-------
(2) Type of tubing to be used (copper, PVC, etc): Hi gh Density Pol vethvlene
(3) Well casing. Is the well(s) cased? (check either (a.) Yes Q!: (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 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 _,x-=---Other (specify) ______ _
(b) Grout placement: Pumping X Pressure Other
(c) Grout depth of tubing (reference to land surface): from O to 255 (feet)
If well has casing, indicate grout depth: from ____ to ____ (feet)
GPU/UIC 5QW Notification of Intent Form (Revised 7/2008) Page 2
R. 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.
L 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 wells) 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 clearly and include a 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 ani familiar with the information
submitted in this document and all attachmentsthereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe - the information is true, accurate and complete_
I am aware that there are significant penalties, including it os ' ility of fines and imprisonment, for submitting
false information. I agree to construct, operate, main ' , re r, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approved ificati ns and conditions of the Permit"
RECEIVEDI OENR / CV]
AOU1FRPRnTFfi rof :7101
MAY1 1'Iwo
Signature of Property Owner/Applicant
Greeory G. Bean.. Director of Public Works
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature 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 [phone]
GPUItJIC 5QW Notification of Intent Form (Revised 712008) Pug 3

iA7OO478PGeot
hermal Test Well rolo
Groundwater Monitoring Wells
Status
X
A
Unknown
Removed
Installed
SWMIJ Boundaries
Current Phase
CurcentlyLnlnvestigatien
In Long-term Monitoring
N
■ »mmi■r in Feet
0 45 90 180 270 360
PA70047-8 P
Prepared By: Suzanne Rohrs
Prepared Date: 12 May 2010

RECD./ 1s o u:} cfC'lG�!
R €'4Wanrril
NORTH CAROLINA vo
$ 1 ! N YU
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEO1'.611RMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-OW WELL(S)
In Accordance with the provisions of NCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Type information).
DATE: 5/11/2010
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-Ioop)?
Yes x Continue completing this form.
No Do Not complete this form_ Complete other UIC application forms for installing
either a 5A7 well (open -loop well injecting 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)/APPLICANT(S)
List each Property Owner Iisted on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signatures; Gre>'on G. Bean. Director of Public Works
(1)
Mailing Address: 2175 Reilh Road. Stop A
City: Fort Braga State: NC Zip Code: 28310 County: Cumberland
Home/Office Tele No.: 1910 1 432-8470 Ce11 No.:
Email Address: Suzanne.Rohrscd us.armv.mil Website:
(2) Physical Address of Well Site (if different than above): Adjacent to BLDG 1-1939. Hamilton Street
City: Fort Braa2 State: NC Zip Code; 28310 County: Cumberland
Home/Office Tele No.: Cell No.:
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:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County:
Office Tele No.: Ceti No.:
Website Address of Company, if any:
GPUIU1C 5QW Notification of Intent Form (Revised 7/2008) Page 1

C. WELL DRILLER INFORMATION
Company Name: Coastal Geothennal
Well Driller Contractor's Name: Sanford Sweeting
NC Contractor Certification No.: NC 2082
Contact Person: Mike Hadley EMAIL Address: mhadle @),bizec.rr.com
Address: 102 Middle St.
City: Jacksonville Zip Code: 28546 County: Onslow
Office Tele No.: 910-353-0926 Cell No.: 910-376-1100
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company: _NIA _______________________ _
Contact Person: EMAIL Address: "--'------------====-===-=-==-==c.._ _________ _
Address: _________________ _
City: ________ _.c...Sta_te_: __ Zip Code: _____ County: ______ _
Office Tele No.: Cell No.:
E. STATUS OF APPLICANT
Private:
State:
Federal: _x __
Municipal: __
-------------
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed Loo p Geothennal Heat Transfer S vstems
Test Borehole and loop
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _ ___;c.Ju=n=e~2=0'"""'l'""0 ________ Number of borings: --=1'-----
Approximate depth of each boring (feet): _ ____;cc2=5=-5 _____ _
(2) Type of tubing to be used (copper, PVC, etc): Hi e:h Density Polyethylene
(3) Well 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 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 x Other (specify) ______ _
(b) Grout placement: Pumping X Pressure Other
(c) Grout depth of tubing (reference to land surface): from 0 to ill_ (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
GPU/UIC SQW Notification of Intent Form (Revised 7/2008) Page 2
H. 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.
L 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 clearly and include a 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 en 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 • .. the information is true, accurate and complete.
I am aware that there are significant penalties, including t! os " ility of fines and imprisonment, for submitting
false information. I agree to construct, operate, main i , re.: , and if applicable, abandon the injection well and
all related appurtenances in accordance with the uved -cifcati s and conditions of the Permit."
RECEIVED ? OFNR r DwQ
AQUIFFrit r7nni gFCTIQN
MAY 31 2010
Signature of Property Owner/Applicant
Greyory G. Bean. Director of Public Works
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature 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 [phone]
GPU/i]IC SQW Notification of Intent Form (Revised 7/2008) Page 3

i,A70047-8P Geothermal Test Well Polo Field!
Groundwater Monitoring Wells
Status
Unknown
Removed
■ Instead
7) 7
SWMU Boundaries
Current Phase
currently in trwestgation
M Long -tens Monitoring
Feet
0 45 90 180 270 360
FA70047-8P
Prepared By: Suzanne Rohrs
Prepared Date: 12 May 2010

Boone, Olita
From:
Sent:
To:
Subject:
Barber, Jim
Monday, June 07, 2010 11 :20 AM
Boone, Olita
RE: Fort Bragg 5QW (WI0600058)
Olita;
Thank you for sending the acknowledgem ent letter and supporting documentation for this project. I will
forward a copy to the party that is temporarily overseeing this project until Suzy Rohrs returns from leave in
the event that Ft. Bragg has a contractor ready to install this test well, along with other test wells previously
approved.
Jim Barber
From: Boone, Olita
Sent: Monday, June 07, 2010 11:10 AM
To: Barber, Jim
Cc: Godwin, Tonya
Subject: Fort Bragg SQW (WI0600058)
Hi Jim,
Here is the 5wq acknowledgement lettei for Fort Bragg (Hamilton St). Please confirm
receipt.
Regards,
Olita A. Boone
NC Dept of Environment and Natural Resources
Aquifer Protection 5ectior
[phone] Direc"
(91 9) 715-0SBf. Fax
Olita.Boone @ncdenr.gov
E-mail correspondence tCJ ancl from this add ress may be subject to the North Carolina PublicRecords Law and may be
disclosed to thircj partie;;.
1