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Home My WebLink AboutWI0700247_GEO THERMAL_20111019Permit Number Program Category Ground Water Permit Type WI0700247 Injection Water Only GSHP Well System (5QW) Primary Reviewer eric.g.smith Coastal SW Rule Permitted Flow Facilit Facility Name Troy and Karen Hullander SFR Location Address 806 Plantation Dr New Bern Owner Owner Name Troy Dates/Events NC 28560 Hullander Scheduled Orig Issue 10/19/11 App Received Draft Initiated Issuance 10/03/11 Regulated Activities Heat Pump Injection Outfall NUL~ Central Files: APS_ SWP_ 10/19/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Mike Smith Contractor Heat Pump 102 Middle St Jacksonville Major/Minor Minor NC Region Washington County Craven Facility Contact Affiliation Owner Type Individual Owner Affiliation Troy Hullander 806 Plantation Dr New Bern Public Notice Issue 10/19/11 NC Effective 10/19/11 28546 28560 Expiration Waterbody Name Stream Index Number Current Class Subbasin FA CDE R North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Troy Hullander Karen Hullander 806 Plantation Drive New Bern, NC 28560 Coleen H. Suliins Director 10/19/20 11 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0700247 806 Plantation Drive, New Bern, NC 28560 Dear Mr. & Mrs. Hullander: Dee Freeman Secretary On October 3, 2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onl v 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 .02ll(u)(2). Additionally, you should contact the Craven 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.Rogers/Cv.ncdenr.eov if you have any questions. cc: Washington Regional Office -APS APS Central Files -Permit No. WI0700247 Craven County Health Dept. Sincerely, 0We(\\.~ for Debra Watts Supervisor Coastal Geothennal / C1imate Control Heating and Cooling (Mike Smith) AQUIFER PROTECTION SECT ION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Locaiion: 2728 Capital Boulevard, Raleigh. North Carolina 27604 Phone: 919-733-3221 \ FAX 1: 919-715-0588; FAX 2: 919 -715-6048 \ Customer Service: 1-877-623-6748 Internet: www.ncwateraualitv.o ro An Equal Opportuniiy I Affirmative Action Employer I ~One, ·c . \101in arohna Jvaturalf!I 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(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 6 • 2011 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 SA 7 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): Troy and Karen Hollander __________ _ (1) Mailing Address: 806 Plantation Drive _________________ _ City: New Bern State: NC Zip Code: 28560 County: Craven Home/Office Tele No.: 252-638-6541 ______ _ Email Address: tkhullander@yahoo.com 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: _______________________________ _ Contact Person"-: ---------------=E=MA-=-=IL=.,Ao...=dd=r=e=ss=: __________ _ Address: _________________________________ _ City: _________ State: __ Zip Code: ______ County: ________ _ Office Tele No.: Cell No.: 0 I DENR ID . ) A lU1 ter rot~i:tion Sectio- GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) 0 Cr o a 2011 Page 1 C. WELL DRILLER INFORMATION CompanyName: ___ C=oas=ta=l....;:G=e=o=th=e=rm=al'----------------------- Well Driller Contractor's Name: ..,,S,.,,anfi=o=rd=S=w=e=et=in,:.,:g:,..._ __________________ _ NC Contractor Certification No.: NC 2082. ______________________ _ Contact Persons:,_: -"'-M=i=k=e-=S=m=i=th,,__ ______ ---=E=MA=-'=IL=A=-=d=dr=e=s=s:~_~m=sm=1=·th=®=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 Company 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 Loop Geothermal G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed:_ Ol,-/vbe£ 11) L l Numberofborings 3 Approximate depth of each boring (feet): ____ 250 (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 2! (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 __ 250_ (feet) If well has casing, indicate grout depth: from ___ to ____ (feet) GPU/UIC SQW 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 egtiipment and exterior piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary information. I. LOCATION OF ►W ELL(S) Attach two copies of reaps 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 wells) 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. T. CERTIFICATION [Mote: 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 •.onditions of the Permit." Sirat upelok Property Owner/App] icant Print c ype Full Name and title Signature of Property Owner/Applicant Pr nt 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 campleted Application package to: LA(erPro*11r)rr �rxr'i North Carolina DENR-DWQ Aquifer Protection Section.-UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 CYi' IMIC 5QW Notification of Intent Form (Revised 812008) P*4 806 Plantation Drive, New Bern., NC - Googie Maps Page 1 of 1 Goo,& maps Eta ��a+�3l7 a' Fw a E Yd m Q `a. To see all the details that are visible on the screen, use the "Print" link next to the map. 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