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Home My WebLink AboutWI0700246_GEO THERMAL_20111018Permit Number WI0700246 Program Category Ground Water Permit Type / Injection Water Only GSHP Well System (5QW) Primary Reviewer eric .g.smith Coastal SW Rule Permitted Flow Facilit Facility Name Eric Martin SFR Location Address 824 Lexington Dr Greenville Owner Owner Name Eric Dates/Events NC 27834 Martin Scheduled Central Files : APS_ SWP_ 10/18/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Afflllation Mike Smith Contractor Heat Pump 102 Middle St Jacksonville NC Major/Minor Minor Region Washington County Pitt Facility Contact Affiliation Owner Type Individual Owner Affiliation Eric Martin 1818 Bloomsbury Rd Greenville NC 28546 27858 Orig Issue 10/18/11 App Received Draft Initiated Issuance Publlc Notice Issue Effective 10/18/11 Expiration 10/03/11 10/18/11 Regulated Activities Heat Pump Injection Outfall r-Ui..'- Waterbody Name Stream Index Number Current Class Subbasin VkT.x.pA RCDENR North Carolina Department of Environment and Natural, Resources Division of Water Quality Beverly Eaves Perdue Cvleen H. Sullins Governor Director 1.0/ 1812011 Eric Martin 1818 Bloomsbury Road Greenville. NC 27958 Subject: Acknowledgement of Intent to Construct Type 5QW Injection. Well System Permit No. W10700246 824 Lexinc*ton Drive, Greenville, NC 27834 Dear Mr. Martin: Dee Freeman Secretary On October 3, 2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-on1% 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: The injection well system contains only potable water, 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 The required notification form and associated reaps 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 Pitt 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 M�hael.RoaersCa?ncdenr.eov if you have any questions. Sincerely, for ehra V4'a - " Supervisor cc: Washington Regional Office - APS APS Central Files - Permit No. W10700246 Pitt County Health Dept. Coastal Geadiennal (MEke Smith) AWIFER PROTECTIDN SECTiDN 1636 Mail Service Center. Raleigh, North Carolina 27699-1636 Location: 2728 CapimI 6culevard, Raleigh. North Carolina 77W4 Phone: 919-73M221 i FAX i 919-71E�059E: FAY, 2. 919-71, 5-6D48 [ Cus'omer Service: 5-877.623-G74E Internet: vrww.ncwaiernualiiy.nr_ An EirjO I P,firme the Acmn LrnvJzK.- N oAhCaralina yIvlztm Tdallff NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR) NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM: TYPE 5-0 W WELL(S) In Accordance with the provisions ofNCAC Title 15A: 02C.0200, please complete this notification and mail to address on the back page (please Print or~ information). DATE: Se ptember 9, 2011 u....a:o~00°'4LD 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 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 SQM 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 w/authority for signature): =E=ri=c ~M=art=i=n ___________ _ (I) Mailing Address: =18=1,_,8'-'B==lo=o=m=s-=-bu=r'-'-y""'R=o=a=d _________________ _ City: Greenville State: NC Zip Code: __ ~2~7~85~8~ ___ County:~P~itt~---- Home/Office Tele No.: -'2=5=2'--'-3=2::.ol-'-6=8=8'---'--4 ___ __,C=e=ll _,_N__,_,o=.=-: __________ _ Email Address: rwquarles @suddenlink.net Website: (2) Physical Address of Well Site (if different than above): =82=-4-'--=L=ex=i=n=gt=o=n-=D::....:r..:..iv:..::e'---------- City: Greenville State: NC Zip Code: 27834 County: ~P1=·tt~---- Home/Office Tele No.: ------------~C~e=ll~N~o~-~: __________ _ B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Pennit 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 . .,_: ---------------=E=MA~I=L~A'-=d=dr:..::e=ss=-=----------- 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) RECEIVED / DENR / OWQ Aquifer Proter,tinn Ser.tion OCT O 3 2011 Page 1 C. WELL DRILLER INFORMATION Company Name: ___ C==oas=tal=---cG=e=o=th=e=rm=al=------------------------- Well Driller Contractor's Name: --"'S=an=f4=o=rd=S~w~e~et=in=g"---------------------- NC Contractor Certification No.: NC 2082 ______________________ _ Contact Person~: _M_ik_· ~e~S_m_i_th ________ E_MA __ IL_A_d_d_re_s_s: ___ m_sm_ith_@.._,._b_iz_e_c_.rr_.c_o_m ___ _ Address: 102 Middle St. ___________________________ _ City: Jacksonville Zip Code: 28546 _____ County: --~O=n=s=lo~w~--- Office Tele No.: 910-353-9040 Cell No.: 910-376-1101 ------------------ D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: Climate Control Heating and Cooling Com pany Inc. Contact Person: Mike Smith EMAIL Address: msmith{@,bizec.rr.com Address: 102 Middle St ___________________________ _ City: Jacksonville Zip Code: 28546 County: --~O=n=sl=o~w~----- Office Tele No.: 910-353-9040 ______ Cell No.: 910-376-1101 ________ _ E. STATUS OF APPLICANT Private: X State: Federal: Municipal: __ Commercial: Native American Lands: F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used) Closed Loo p Geothermal G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: _September 2011 ______ Number of borings: 10 Approximate depth of each boring (feet): ____ 200 (2) Type of tubing to be used (copper, PVC, etc): High 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) GroJJt 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 __ 200_ (feet) If well has casing, indicate grout depth: from ___ to ____ (feet) GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page3 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, I. LOCATION OF WELLS) 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 snow 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 he signed by each person appearing on the recorded legal property deed. "I hereby certify, under penalty of taw, 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." Signafure of operr, QwnerlApplicant rrIe M. pia-tf" Print or Type Full Name and title Signature of Property Owner/Applicant Print or Type Full Naive and title T 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 R"- SAVED 1 DENR 1 DAL - Raleigh, NC 27699-1636 MAW VMt&dkn &mun'l Telephone (919) 715-6935 Oct a 4 2011 GPUIUIC 5QW Notification of Intent Fenn (Revised 8/2008) Pap* 824 Lexington Drive, Greenville, NC - Google Maps Address 824 Lexington Dr maps Greenville, NC 27834 v CIIII -,?Cl A5'CRa Zf East Carolina University Wes: Research Ca Tpus �6 HUMT GkC to Fkrt Ckh Rd Page 1 of 1 ( Get Google Maps on your phone Tmcttheward "-GMAPS"tv 466453 I rortwwd Goff �N J Country Club 43 The Omxwood SCOW of *201 f Google - http://maps.google.cor lmaps?f--q&souree=s_q&h1—en&geocode�-&q-824+Lexington+Dr... 9/29/2011 824 Lexington Drive, Greenville, NC - Google Maps Page 1 of 1 cy Address 824 Lexington Dr maps Greenville, NC 27834 Q e R4 Po -4 1 O� 4psits �Rd A East Carolina Unrrerstty Vve5t Researcn Carr -pus v Hurt Ck-h in Get Google Maps onyour phone 49 Text ftword 'GMAPS"to466453 ron►vood Gaff -¢x-f CbwOrV Gads c� 4 The Oakwacol schQa01 02011 Google - http:llmaps.google.comlmaps?i=q&source =s q&hl—cn&geocode=&q=824+Lexington+Dr... 9/29/2011 87,� t Lr:x,fV, ..-q 4 �[ d t� ibPb��-c Lam P 1 � f �A Se, TWA+-er N Pl?opdsecl hoop .'r e.�,� gAs -DoON A Pad °��-R+c, 04RV"N ON 8z�. 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