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Home My WebLink AboutWI0300100_GEO THERMAL_19971017State of North Carolina Department of Environment, Health and Natural Resources Division of Water Quality James B. Hunt, Jr., Governor Wayne McDavitt, Secretary A. Preston Howard, Jr., P.E., Director October 17, 1997 Mr. Ramesh Desai PO Box2037 Cornelius, NC 2803 1 Dear Mr. Desai: In accordance with your notifications dated September 18, 1997, the Groundwater Section acknowledges your intention to construct closed-loo p geothermal water-only injection well systems for the operation of ground-source heat pumps in the Lake Norman Country Suites development. The systems as described in your notifications will not require injection well permits and are deemed permitted by rule (North Carolina Administrative Code Title 15A: 2C.021 l(u)(2). If you modify your systems, please contact the Groundwater Section to verify compliance. Thank you for submitting this notification. If you have any questions regarding your geothermal heat pump borehole(s) please feel free to contact me at (919) 715 -6166 or Amy Axon at (919) 715-6165. cc: UIC Files MROFiles Groundwater Section Sincerely, 6 · ~4:VU~ 4, ~i\: Marcus A. Geist Underground Injection Control Program C:\WPDOCS\SHELLS\PERMIT\TRANSQW.WPD Voice 919/733-3221 FAX 919/715-0588 P.O. Box 29578, Raleigh, North Carolina 27626-0578 2728 Capital Blvd., Raleigh, North Carolina 27604 An Equal Opportunity/Affirmative Acti on Employer 50% recycled/ 10% post-consumer paper NORIB CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION DEPARTMENT OF ENVIRONMENT, HEALTII, AND NATIJRAL RESOURCES NOTIFICATION OF 1NTE1'1"T TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL-WATER-ONLY INJECTION WELL SYSTEM ( GROUND-SOURCE BEAT PUMP) In accordance with the provisions of NCAC Title 15A: 02C.021 l complete notification and mail to address on the back page. This is 11:!21. the proper form for injection wells to be used in an open-loop · ground-source heat pump system. Do not use this form for systems -that re-circulate any substances other than water below.the ground surface. Type SQWWells 'ID. DIRECTOR. NORTH CAROLINA DMSION OF WATER QUALITY DATE: 5ex:r:: \'6 , 19...9..:l Please type or print clearly. A. SYSTEM CLASSIFICATION Does the proposed system re-circulate potable water in continuous piping which isolates the fluid from the environment? YES ID If yes, then continue completing this form GW-57 CL. If no, do not complete this form. A form GW-57 HP (Application For Permit To Construct And/Or Use A Well For Injection With A Heat Pump System) must be completed. B. SYSTEM FLUID Will any additives be introduced to the system's subsurface piping, including but not limited to conosion inhibitors or antifreezes? YES If yes, do not complete this form. A form GW-57 HP (Application For Permit To Construct And/Or Use A Well For Injection With A Heat Pump System) must be completed. ..S., If no, then continue completing this form GW-57 CL. C. PROPERTY OWNER Name: Cq'f"'.e-tJ~ Address: f), () fJ o-4-...2. CJ t .N .. City: ['o Y}·-~ \ ~""-1 fY L Zip code: _~ __ J_I ___ _ County: ~( t (., I ~ 0-,-. ~'-""} Telephone: ~'( i a 6 {, 6 GW-57 CL (March 1997) Page 1 of 4 D. STATUS OF PROPERTY OWNER Private: __ ·--.. Federal: __ State:_·_ Public: __ Commerci~ __ y_.__ Native American .Lands: ---- E. FACILITY (SITE) DATA (Fill out ONLY if the Status of Property Owner is ·Federal, State, Public or Commercial). F. Address: _.:..;I ,_6_1 _;_1 __ ..,_5--'-~--"'-°'-'-'-{..-... Psdl"l!AP..,,., --------- City: r --.r--1-c,,v, ;_,, \ \. t Telephone: ~ q & · D ( l u c.--f &-" 5 -J dp-h Zip code: __ rv_·_<-___ County: ,..,._C.ctL. ContactPerson:__.fl,...~-"--1:rB?---o----- Standard Industrial Code(s) which describes Commercial facility: ____ _ HEAT PUMP CONTRACTOR DATA Name: __ _..F:-\--''==~ ........... \'\~ ..... 5' ..... , ... \ .... L='=...,.l\)._..n ___ , ...... )c,=~...a:V_..'....,,u=:·u=~-----TN= .... C-=-·------ \ f Address: __ A__,,__-'\J""'· .... N.:....L,.s"Sl .... t:""',.,....., .... ~_ ... _\.-..>,. .... l a,_v ____________ _ \ City: ~9-es N '\l \',.\& C, C-Zip code: ?.-9fuo::Z County: ~\\i;C F':?'J\.\.1&--Telephone:. 8',4-lb~, \c:\,8b Contact Person: __,N\........__,_1' .... ~=~..a..-----=L ... ~ .... :s .... ~ .. -;..__tt=___.e-:=--=-- I • G. WELLUSE Will the system well(s) also be used as the supply well(s) for your personal consumption? YES ____ NO_ ....... ✓_ H. CONS1RUCTION DATA (CHECK ONE) EX!STING WELL(S) being proposed for u se as a ground-source heat pump well(s). Provide the information in (1) through (4) below to the best of your knowledge. Attach a copy of Form GW-1 (Well Construction Record) if available. __ \j_,,,._ PROPOSED WELL(S) to be constructed for use as a ground-source heat pump well(s). Provide the information in (1) through (4) below as PROPOSED construction specifications. Submit Fonn GW-1 after construction. GW-57 CL (March 1997) Page 2 of 4 (1) Well Drilling _Contractor's Name: NC Driller Registration number. (2) Date to be constructed: · Oe:: Y3 -· No'3 \ 1 \ C\ C\ 7 Approximate depth of each boring: 3 CC? 1 Number of borings: 3Gc- (3) Well casing: Is the well(s) cased? (a) YES If yes, then provide casing information below. Casing type: Galvanized steel_ Black steel_ Plastic_ Other (specify) ______ _ Casing depth: from. __ to __ ft. (reference to land surface) (b) N) .( 4) Grout (material surrounding well casing and/or piping): (a) 'Grout type: Cement_; Bentonite~ • • Other (specify) ~p..qv r L 3 co -')...o (b) Grouted swface and grout depth (reference to land sunace): ~ around closed-loop piping; from 'lot to O ft. _ around well casing; frqm __ to __ ft. NOTE: THE WELL DR.Il.JlNG CONTRACTOR CAN SUPPLY THE DATA FOR EmiER EXISTING OR PROPOSED WELLS IF 11iIS INFORMATION IS UNAVAILABLE BY OTHER MEANS. H. LOCATION OF WELL(S) Attach two maps. (1) a site map (can be drawn) showing 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-source beat pump well system. (2) a location map referencing the site to a labeled road intersection. ~~~~t) GW-57 a, (March 1997) Page 3 of 4 No, ~nu,~Lc::..,i NO ~ O\.\.~-C-~<> N Sov'it.Ge.,., t!>N s. \."'r'e: !. CERTIFICATION "1 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 inq_uiry 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 beat pump system well(s) and all related appurtenances in accordance with Title 15A NCAC Subchapter 2C Section .0200." (Signature of Owner or Authorized Agent) Please supply a letter signed l7y the owner aiahorizi,ng the above agent, if authorized agent is signer. J. 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 land owner in the absence of contrary agreement in writing.) · If the property is owned by someone· other than the operator, the property owner hereby consents to allow ·the operator to construct a ground-source heat pump system as outlined in this notification and that it sh.all be the responsibility of the operator to ensure that the ground-source heat pump system's well(s) conform to the Well Construction Standards (Title 15A NCAC Subchapter 2C .0200) GW-57 CL (March 1997) (Signature of Property Owner if Different From System Operator) Please return the completed Notification package to : UICProgram Groundwater Section North Carolina DEBNR-DWQ P.O. Box 29578 Raleigh, NC 27626-0578 (telephone: 919-715-6166) Page 4of 4 S,~e ,s \..,oc.~t'.'I rt-J "'iVr ,:_ .$0 ~ e-r.-\.i"C °\\.)~~ ~..,,. of:. '*~ E::X,T ~C" 1~ .., . ., -:r:::-~ t c._ -c ,. "' I....._V'-<.cClll'\~C'\.. \ f\~- ~p. C,..C I ,...._-,.. 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