WI0300133_GEO THERMAL_20120517

~·-==.·
NCDE . R.~~:~
\
North Carolina.: Department -ot Environment-and N atoral·· Resources-
Beverly Eaves Perdue-----
Governor
Elzworth and Barbara Wiesenmayer
104 Wellcraft Court
Mooresville, NC 28117
Divisio □-of-:Water-Quality ·.
Charles Wakild·;-P.;£.
Director
May 17, 2012
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0300133
Dear Mr. and Mrs. Wiesenmayer:
Dee Freeman-
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Weli Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will.be valid indefmitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.org/web/wq/aps.
IC you nave any qU'estions regarding your current-permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
Eric G. Smith, P .G.
Hydrogeologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] I FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity\ Affim,ative Action Employer
One North Carolina
/vatural!y
Permit Number WI0300133
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (50M)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilitv
Faclllty Name
Elzworth and Barbara Wiesenmayer SFR
Location Address
104 Wellcraft Ct
Mooresville
Owner
OWnerName
NC 28117
Elzworth C Wlesenmayer
Dates/Events
·Orig Issue
06/29/09
App Received Draft Initiated
06/01/09
Scheduled
Issuance
Central Flies : APS_ SWP_
07/06/09
Permit Tracking Slip
Status
Active
Version
1.00
Proje.ct Type
New Project
Permit Classification
Individual
Permit Contact Afflllatlon
Major/Minor
Minor
Region
Mo.oresville
County
Iredell
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Elzworth C. Wiesenmayer
Owner
104 Wellcraft Ct
Mooresville NC 28117
Public Notice Issue
06/29/09
Effective
06/29/09
Expiration
05/31/14
_R_e.,.g_u_la_te_d_A_c _tiv_i_tl_es _______________ Rea uested/Received Events
Heat Pump Injection RO staff report requested
RO staff report received
Outfall l ,I ULL.
Waterbody Name Stream Index Number Current Class
06/03/09
06/12/09
Subbasln
Permit Number WI0300133
Program Category
Ground Water
Pennit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
F :\cllitv
Facility Name
Elzworth and Barbara Wiesenmayer SFR
Location Address
104 Wellcraft Ct
Mooresville
Ow ner
Owner Name
Elzworth
Datesf~vent<::
NC 281 17
C Wiesen mayer
Scheduled
Orig Issue App Received Draft Initiated Issuance
06/01/09
Rea ulated Activities
Heat Pump Inj ection
Cenlral Fifes: APS_ SWP_
06/30/09
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Pennlt Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Mooresville
County
Iredell
Faclllty Contact Affiliation
Owner Type
Individual
Owner Affiliation
Elzworth C . Wiesenmayer
Owner -
104 Wellcraft Ct
Mooresville NC
Public Notice Issue Effective
Reou estedfi:tec-eived Eve nts
RO staff re port requested
RO staff report received
2811 7
Expiration
06/03/09
06/12/09
Waterbody Name Stream Index Number Current Class Subbasln
AWA
NCDENR
North Carolina Department of Environment and . Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Elzworth and Barbara Wiesenmayer
I 04 Well craft Court
Mooresville, NC 28117
Re: Issuance of Injection Well Permit
Permit No. WI0300133
Coleen H. Sulli ns
Director
June 29, 2009
Issued to Elzwortb and Barbara Wiesenmayer
Iredell County
Dear Mr. and Mr. Wiesenmayer:
Dee Freeman
Secretary
In accordance with your application received June 1, 2009, 1 am forwarding Permit No. W10300133 for the
operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system to be located at at
the above referenced address. This permit shall be effective from the date of issuance until May 31, 2014, and
shall be subject to the conditions and limitations stated therein.
Please pay ~pecial attention to Part II, paragraph 1 of the Permit. At least forty-eight (48) hours prior to
constructing system, the Permittee shall notify the Aquifer Protection Section ,s Underground Injection
Control (UIC) Program Central Office staff, telephone number [phone], and the Mooresville
Regional Office Aquifer Protection·Section Staff, telephone number [phone].
In addition, please submit copies of the -Well Construction Completion form (GW-1) and site map within 30
days after constructioli ·as required'fu Part I, paragraphs 7 and 8.
Finally, your UIC system is subject to inspection by the APS, and at the time of the inspection each geothermal
injection well system shall have permanently affixed an identificati~n plate on a nearby building or other
permanently fixed structure indicating the location and presence of underground UIC wells according to 2C
.0213(g). Please insure this is completed in accordance with permit condition Part 1, paragraph 6 of this permit
issued June 29, 2009.
AQUIFER PROTECTION SECTION
1636 MaU Service Center, Raleigh , North Carolina 27699-1636
location : 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588 ; FAX 2: 919-715-6048 \ Customer Service: 1-877.-623-6748
Internet www.ncwaterquality .org
hi Equal Opponunlty I Affirmafiije Ac1ion Employer
o. · aro a
~
One C lin
tifurally
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit three months prior to its expiration date. As indicated in t he permit, this permit is not
transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at (919) 715~6166 .
Best Regards,
~tJ.y~
Michael Rogers, Environmental Specialist
cc: Andrew Pitner -Mooresville Regional Office
Central Office File-WI0300133
Iredell County Environmental Health Dept.
Susan Chambers -A WD Services, Inc.
Attachment(s)
. .
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21 , Chapter 143 , and other applicab le
Laws , Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Elzworth end Barbara Wiesenmayer
FOR THE CONSTRUCTION AND OPERATION OF 4 TYPE SQM INJECTION WELLS, defined in Title
15A North Carolina Administrative Code 2C .0209( e)(3 )(F), for the purpose of operating a vertical closed-loop
geothermal-mixed-fluid heat pump system. This system is located at I 04 Wellcraft Court, Mooresville, Iredell
County, NC 2 811 7, and will be constructed and operated in accordance with the application dated June 1, 2009 ,
and in conformity with the specifications and supporting data submitted, all of which are filed with the
Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in compliance
with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and
·Regulations pertaining to well construction and use.
This perm.it shall be effective, unless revoked, from the date of its issuance until May 31 , 2014, and shall be
subject to the specified conditions and limitations set forth in Parts I through X hereof.
('10
Permit issued this the 'l day of.--==~::=;~--• 2009.
kr\coleen H. Sullins, Director
\) Division of Water .Quality
By Authority pf the Environmental Management Commission.
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions o f this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation o f the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility i s constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not h ydraulically connect separate aquifers.
4 . Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
6 . Each geothermal injection well system shall have permanently affixed an identification plate on a nearby
building or other permanently fixed structure indicating the location and presence of underground me
wells according-to 2C .0213(g).
7. A completed Well Construction Record (Form GW-1 ) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville. NC 28115
[phone]
GW-ls must be submitted within 30 days of compl etion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
8 . Well construction records must also be submitted for the existing water supply wells on-site as well as a
site map showing any water supply wells on adjacent properties as specified in NCAC .021 l(d)(l)(D).
PART II -WELL CONSTRUCTION SPECIAL C ONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
P rotection Section•s Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone] and the Mooresvi11e Regional Office Aquifer Protection Section Staff, telephone
number (704 ) 663-1699.
WI0300133 2
2 . Boreholes shall not connect separate aquifer~ ( e.g., ~hallow surficial aquifers, saprolite. fractured bedrock,
etc.) and shall be filled with bentonite grout from the lowermost water bearing zone to land surface, as
specified in 15A NCAC 2C .0213(d)(8).
PART ID -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This pennit is not transferable without prior ~otice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Pennittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Perm.ittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV -PERFORMANCE STANDARDS
1. The injection · facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will . render it unsatisfactory for normal use. In the event th.at the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid , the Permittee shall ~e immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. Toe Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V -OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight ( 48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
WI0300133 3
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface-water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1 . Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall r eport by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Mooresville Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Pennittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Pennittee shall take such
immediate action as may be required by the Director.
PART VIIl-PERMIT RENEW AL
The Pennittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Su.ch a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must b e permanently abandoned according to lSA NCAC 2C .0213(h)(1), Well
Construction Standards.
Wl0300133 4
2. When operations have ceased at the facility and ,a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 1 SA NCAC 2C
.0214, including but not limited to the following:
(A)
(B)
(C)
(D)
(E)
(F)
(G)
All casing. and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
The entire depth of each well shal l be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
In the case of gravel-packed wells iri which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shal1 be submitted to:
WI0300133
Aquifer Protection Section-VIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1 636
5
Rogers, Michael
From:
'Sent:
ro:
Cc:
Pitner, Andrew
Friday, June 12, 2 009 3:39 PM
Rogers, Michael
Schutte, Marla
RE: 5QM App Subject:
Attachments: APRSR040929-wi0300133 Wiesenmayer 5QM-ahpslgned.pdf
Hi Mike,
The staff report for the Wiesenmayer's should be attached. I really like the ability to do these UIC permits & staff
reports electronically & I've ·been playing around with the digital sig n ature feature of adobe, so you should be able to
see that I've given this my electronic John Hancock.
As for the Wiesenmayer's, we found out about their system via some concerns expressed by Irede ll County HD and
Maria visited the site back in April. As there wasn't much to see then (and there wasn't much to see when we went by
to look at the neighbor's system that d ischa rges to LKN), we didn't figure it was worth another trip out there for this
staff report. If you need any additional info or have any other questions, feel free to let Maria or I know.
Andrew
From : Rogers, Michael
Sent: Wednesday, Ju ne 03, 2009 4:26 PM
To: Pitner, Andrew
Subject: SQM App
Andrew-
Attached is a staff report request. Thls a SQM well that we have rec 'd an App for but was installed in 2003. Even though
this is a residential site, I think an inspection is needed.
Thanks
Michael Rogers
Environmental Specialist
NC D iv of Water Quality
Aquifer Protection Section (APS), 2728 Capital Blvd., Raleigh, NC 27604
Telephone [phone]; Fax [phone] (put to m y attention on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law a11d may be
disclosed to third parties
1
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: June 3 . 2009
To: 0 Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
~ Andrew Pitner, MRO-APS
0 Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: (919 ) 715-6166
E-Mail: [e-mail]
A. Permit Number: WI 0300133
B. Owner: Elzwortb and Barbara Wiesenmayer
' ' c.~----
□ Proposed ~ Existing
D. Application:
0 David May, WaRO-APS
0 Charlie Stehman, WiRO-APS
0 Sherri Knight, W-SRO-APS
Fax: [phone]
D Facility D Operation
J. Pf!l"mll ~ D Animal D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle D 1/E Lagoon D GW Remediation (ND)
[81 UIC -~ Geothermal well
For Residuals: □ Land App. . 0 D&M
0 503 0 503 Exempt
D Surface Disposal
0 Animal
2. P!~--r.,,p~ ~ New O Major Mod. 0 Minor Mod. 0 Renewal D Renewal w/ Mod.
E. Comments/Other Information: 0 I would like to accompany you on a site visit.
NOTE : This well will need to be inspected as it has already been installed to see if it is compliance.
According to App, the well was drilled in 2003. According to Susan w/AWD, the driller was Larry Wells
(#2603).
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within, please take the following actions:
~ Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
0 Issue an Attachment B Certification from the RO.*
• Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail,
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer~ ------------------
FORM: APSARR 07/06 Page I of 1
~~A
B_1_t_L_.I..,..
NCD EMR
North Carolina Departmen t of Environment and Natural Resources
Division of Water Qu ality
Beverly Eaves Perd ue
Governor
Coleen H. Sullins
Elzworth C. Wiesenmaye.r
Barbara J. Wiesen.mayer
104 W ellcraft Ct.
Mooresville, NC 2811 7
Subject: Acknowledgement of Ap plication No. WI0300133
W ellcraft Court
Injection Mixed Fluid GSHP We1l System (SQM)
Iredell
Dear Mr and Mrs, Wiesenmayer :
Director
June 2 , 2009
Dee Freema n
Secretary
Tb~ Aquifer Protection Section of the Division of Water QuaLity (Division) acknowledges receipt. of your pennit application and
supporting materials on June 1, 2009. This· application package has been assigned the number listed above and will be reviewed by
Michael Rogers .
The reviewer will perfonn a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, th e Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that t he Division's Regional Office, copied below, m ust provide recommendations prior to final action by .the
Division. Please also note at this time, processing pennit applications can take as long as 60 -90 days after receipt of a complete
application. ·
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message , and they will r espond promptly, Also note that the Division bas reorganized . To
review our new organizational chart, go to http://h2o.enr.state.n c.us/do cuments/d wg ornc hart.odf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS P R OJECT.
3 /~.~
forDebra~
Supervisor
cc: Mooresville Regional Office, Aquifer Protection Section
Singleton Heating & AJC Co, Inc. (Attn: Tate, P.O. Box 954, Paw Creek, NC 2 8130)
Permit Applicati on F il e WI030013 3
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh , North Carolina 27699-1636
Location: 2728 Capital Boulevard , Raleigh, North Carolina 27604
Phone; 919-733-3221 \ FAX 1: 919-715-0588: FAX 2: 919-715-6048 I Customer Service: 1.STT-623-6748
Internet www.ncwaterauality.org
An Equal Opporttmlty I Affirmari,e ActKln Employer
rfo~hCarolin a /vatu rallg
NORTII CAROLINA
RECEIVED I OENR / DWQ
Aquifer Protection Section
JUN O I 2009
DEPARTMENT OF ENVIRONMENT AND NATURAL :RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION W11HA GEOTHERMAL BEAT PUMP SYSTEM FOR:
TYPE SOM WELUS)
~-Permit Application OR -----"Renewal (check one)
DATE: ef/ V'Vitf . lO_d ( r I fl3}--~ ~
PERMIT NO. _______ (leave blank if NEW permit application)
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): {J,. Z (,./ 0 ~'7'11 C. o,-,/ B~~ /3 !!}/fl.fr
-:5,, Wl £F~ NJ'J1,,q ~ C(
(1) MailingAddress: /IJ t/ t.f {.Li,,C~farr ¢1
City: MW(h:5 v'lw..£ State:_IJ-'.ZipCode: .R,fj J 1 County: rRt:064/-::
Home/Office Tele No.: 7 oy -4-IT -C) JO I Cell No.:
EMAIL Address: "bg_. + W \ e sg >1 >n Ak 1 er (¥ YYlr C:~
(2) Physical Address of Site (if different than above): _____________ _
City: ________ State:_ Zip Code: _____ County: ____ _
Home/Office Tele No.: __________ C=e=ll=--=-N_,_,,o=·=---------
EMAILAddress:. _____________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Pennit Applicant does not own the subject property,
attach a letter ftmn the property owner authorizing Agent to install and operate UIC well)
C.
Company Name: _________________________ _
ContactPerson~=--------------"E=MAIL==-'-'A=ddre$==:,_ _______ _
Address: ___________________________ _
City: ________ State: _Zip Code: _____ County: ______ _
Office Tele No.: Cell No.:
Website Address of Company, if any:. ____________ _
STATUS OF APPLICANT
Private: L Federal:
State: Municipal:_
Commercial:
Native American Lands:
GPU/UIC SQM Well Permit Application (Revised 7/2008) Page I
D .
RECENED I 01:NF< 1 LI"~"'
AqtiifFJ' Pratoc1 ....... ~"'"""'"
WELLDRU,LERINFORMATION ~I JUNO 1 Wu9
CompanyName:.__./)_._..L½=-<..o</J'---....,,.~::w...::;.~=· ,;_-:::~:--· _,. __ (""'"fl11_!!J!Y~ _________ _
Well Drilling Contractor's Name: _l_-'--/..-fl. _____ .. ..._. ---'------''----"_"----'L ........ 1 ~<::.;-, ____________ _
NC Contractor Certification No.: ---~"--f,,....;:c)"--'\ __________________ _
Contact Person: ,.>(<.?e?-i ~---EMAIL Address: tvtJ/q, 7!05 f fq, ~ , ,rr.,Jf-,
A~: /1J f.hr/4/~
City: 1?/4~ Zip Code: 2$71/F V ~
County: ___________ _
OfficeTeleNo.: 821-6,S-$g;:t3 CeJINo.: _______ _
E. HEAT PUMP CON'I'RACTOR INFORMATION (if diffen;nt than driller)
CompanyName: 5 ·1"61-~·rorl H<0:T1wG t-Ale. r Q l ~f.. , '
F.
G.
Contact Person: re:re. 1 EMAIL Address: s{ n ~Jc. ion ai c @ bd I SCit~ • nrl
A~: P,o. W r-G ~j
City: PA<J C..tt.£~\~ : A)(, Zip Code: ;l.8\~i"> County:------------·
Office Tele No.: ( ,Oli) J 9'j ·· Y:t13 Cell No.: _______ _
INJECTION PROCEDURE (briefly descn'be how 1he injection well(s) will be used)
6 eo th &1,,,,.1</ <!./0ed ,£, etriff2 4dut-f '~°:if &&ro1/ -fovr:,;.,
WELL CONSTRUCTION D"-TA (Skip to Section H if this is a Permit RENEWAL)
(I) Propose,f-1X> be consttuotec1/."!f' -.<'/4q'J1n Y. Number of borinS>: ___.'.___ __
Approximate depth of each boring (fee~:_ ~ ;:l ~ irf.{ ' J ,_2 i7f .J'/5 1
(2) Chemical additives to be used in closed-loop system ( only those chemicals indicated have been approved):
---'R-22 propylene glycol __ ethanol ·£,I'll J!f <111.A Lother (other additives will
need prior approval by NCDENR before use)
(3) Typeoftubingtobeused(coppec,PVC, etc): ~~~ e~~
(4) WeJJ casing. Is the well(s) cased? (check either (a.) YES m: (b.) NO be]ow)
(a) YES ___ if yes. then provide casing infonnation such as~ (steel, PVC, plastic, etc.), diameter,
~ and extent of casing appearing above ground: ______________ _
(b) NO V:
(5) Grout (material sgrrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite ,/" Other (specify) _____ _
(b) Grout deptn of tubing (reference to land surf.ace): fro~c,j ~to f il./(f.eet.) /J,;,l;,.,i;>
If well has casing. indicate grout depth: from ___ to ____ (.feet)
IL INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering Jayout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
infonnation.
GPU/UIC 5QM Well Permit Application (Revised 7/2008)
L LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(I) Include a site map (can be drawn) showing: buildin~ 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 1000 feet of 1he
geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER WE~S)
Are there aoy potable wat.er well(s) on the subject property or adjacent properties? / YES __ NO
If Yes, than indicate location on attached map(s).
K. CERTIFICATION
Note: Th.is Permit Application must be signed by each penon appearing 011 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 aIJ attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said infonnation. I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the poss11>ility of fines and imprisonment, for submitting
false infOJIIl.ldion. I agree to construct, operate, maintain, repair, and if applicable. abandon the injection well and
all related appw1eoances in accordance with the approved specifications and conditiom of the Pemtit. ..
((_;{~ gnature ~~pertyOwner/Applicant v
t' L ·Z. w 04t}-ij <:: WrCK. w lf\fri re."
Print or Type Full Name
~ \Dz:.h-._"'"'f= Signature of Property Owner/Applicant (
8MMeA u.Jle~vrv\AYE'<-
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UICProgram
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC SQM Well Permit Application (Revised 7/2008) Page3
(
1
I
I
IY' • I
I
i
I
q,'
,._r
J
4
-
-~ e1,1 ll'....._,. ~.-_/ I
..... a~ ----; -~
~~~;r:,,~~
W012
LOCAnON MAP
l02iiSicALE
LOT 4
... ~ ./'1,
~.,. ./ ,,r 1-
-Jt ./
,:-( . /J' , . ..,
/;;_"r /)~ y /
CRAIG L. LONG P.L.S.
l29-81ll Y JQE R0AO
MOORESVILLE. N.C. 2803t
[phone]
fr siJ
~i!fj ---~
16)rl6
WOOD DECK
lri'.". ~ ..... '°
t6X28.
WOOD-DECK
M .. ,_...J....J=, aa......., fl7·
I tO.'/
. 5.5 \Q
~ru~--r---1---:-----i
44A
DETAll
t ... NO· ST1'ft.Y I
-t~ Bffli:K
~ .. ,_ I· ("') .. l ..... m
r
• If.).
co.
(/2
r
1. t
l .
tOl 6
TWO STORY
BR ICK
l3.S cu
4.' CON.C . WAlK
24
(X) co ru-
7qy'-'3Cf2. -<fe<, 2.-.
70 'I-·-~'f<f -j'j91
E Series
Geothermal/Watet Source Heat Pumps
• R-41 OA Refrigerant
• 2, 2.5, 3, 3.5, 4, 5, 6 Ton Single Speed
• 3, 4, 5, 6 Ton Dual Capacity
--~~~-
-----r'-1
•Ci '
I ,~
'ti L---==----
S11-461 O!lo'03
I Specifications,
Installation and
Maintenance Guide
Manufactured by WFI
Vertical Features
4
Top Air Dlschatge
Powder coaled, limy-gauge ------'-~
steel cabinet
OptioBal auxilmy
heaterwilb
ell'dronic cootrols
()lffli:redrifled
lnbtllmced fin
coaled air coil
lnsubreddivider
panel
'
Small cabinet
Bottom Air Discharge
Comp,mor
Bidbeaior,al
expansion vahe
\
lnternalJy -::;;--_:_:-:__ l'CDMmble blower
Variable speed, softSW1iug -~--"--,-
ECM2 fan motor
E SERIES SPECIRCATIONS. : \ID MAINTENANCE GUl[?E
---
l'adOJy moullled
~rackacceplS
...Jdard size filters
l"Jll
~
~~
'11ilbbd:-itcw
aodpomp
----lnlernallr trapped
coodeos31e line
BrmswiYelwater L--rj: _______ coonedions
OpCiooal &ctosy
im1alled'Wllel"
healingsysiem
wilh buih-in coil
~" and pomp
,"'-.Revming
~=moonNe .. j control box
Microprocessor
CODlro.l
lntemally
insulaled cabinet
6
E SEF}IES SP(;CIFICATIONS, INSTJ._
H orizonta l Features
Compressor Compartment
Filler br.u:ket accepts -
stmdard si2e filters ~-
&ch unit is quality ----....,---"""\
built aod run-tested , ~
lmulationfo~low ------lempera!Utt opeJ3lion .
Qimpressor ···-----Fauh 2Jld di2gDOQiclEDs ~ f
Microptl'Cf:S!C"
I
control • mnowhle
Blcwler Compartment
Sideorend --......
::..-~
AUJiliary oplioml
hearer coil ~ly
Variablespe.ed.
soft starting lll2
fan motor
lntem2By iosobled
abinet
Hangerkit ----------
included
..,. "ox
;o MAINTENANCE GUIDE
Re¥ersiDg wive
Opliordlfactory
-;;!aJledwater
~~system
I : • boiJt-in coiJ
-~p
--1osul:nfd access
panels
/ Tme Jdt or right ffl1lm
/ OYelslzeclrillfXI / / tobeAanctd &o coated
air coil
Oplional auxi1wy
/ heater with
/ electtooic cootrols
Drain pan overflow
protedion
Closed Loop
Ground Source
Systems
36
E SERIES SPECIFICATIONS, INSTA __ -: " ~ MAINTENANCE GUIDE
GROlt. rrJ SOURCE SYSTEMS
.\t)JE:-i, • d::d loop systems with antifreeze
proter.f:-~ fr2-2 to 1"6 MlOOP" position (See seleclion
table f'1gr :!"),
l"' ~« a l'Olllp)eled bdweeo the unit, flow center
211d the~ '] fsee figure below), lln:tl porgillg and
c~d111f "-; 5required.A0ushcart (ora I.S HP
pllli7 -.: ;~ 10 achieve :idequate flow¥eJocilyiD
ihe • :r: ml dirt particles from the loop ilSelf.
~ .Y.oll£i Jr is~ in IIIOSI ireas 10 prefflll &-eezing.
flush dR ~r ~ely IO remove a.~ much air as po~le
then~ tu b:~ to a stalic pressure ci 40-50 psi
(sim:% :t" ~ ""'i p,ii r11iJJJer).111isls11ormallyadequate for
good~~ ~----loop·sllllic pressure will lluCIUale with
!be ~u ~~ ril be higher in the winter months than
~ !Z r~~ ,am_ 11lis fludu211oo is normal and
!Jlox ~ c~~ • ns ini1ially charging the sysaem.
. a.ie-•,1: t1B'.I -~ '! be sure to remowe the plug in lhe end
¥-~!-Hif 3PJ>licable)to allow trapped air
101il:
Oood,
llowt~-
heatf!J~
13~:-
r.i.r--~
6J?U~
details.
s.,.:re that the motor housing has been
•)~flow center provides adequate
~ the prtss0n: drop across the
fllFiri it to the unit capadly data pages
~' -; 3 gpm of flow per ton of cooling
~ ;;.'.. t-earth loop applictti~ (See
r:-= ~ f<ir loop pwnp power wiring
MULnPLE u: .rrs ON ONE FLOW
CENTER
l:"il:~ .,, • irN 2re ronnec1ed 10 one loop pmnping
S}Slfl"', fCl(f ~.:: is a»tomalitally achJMd by connecling
the sf.ti~~_:_ .. •.-0 OOllllector P2 in both 1111i1s with 2-wire
the~" .. -:-c. n~ ~ a,re polarity dependant (see
p:,ge 3-. >e ~ pc...7:s) may be powered from ei1her unit,
wllicbt<,,~ ;s---e ~E::at. lf a1her unit calls, lbe loop
pmr· -..:;,.~ ·mrt. 1be use of l\\'O units on one
fiov,-tt1ltt ~ ~ -• .l tol:U of 20 gpm capacily .
ClJISd IMf1: t;rcallll So"'" AppHcalfon -Slff&le 111111 lritb 11or "
GeoLiPILft
f'dyett1Jlii• -~
liisulelllan
TO
LOOP -,-
• For complete
Row Center
inst.llallon
Information refer
to PIN 96P090A04,
96P661A01
Ground Loop Connec:1or
Vibndion Absorbing Pad
Kits wfth Annafle.e
(CK4L or CK4L-GL}
24
E060
Low Capacity
Heating
Capacity
Data
Cooling
Capacity
Data
E SERIES SPECIFICATIONS. 'J MAINTENANCE GUIDE
• C ~ HEATING CIN..Y -E.L-..,._. .rtTfl HOT WATl:R-~. .; -.. err CEIi "~· lCW·•. HE u-,-E LAT HW ~CO@
700 16.2 1.SO 11.0 91.4 86.9 3.8 327
2.5 900 16..9 1.52 11.7 Sj',t M.O 3,5 S.34
1100 17.S 1.54 12.3 ac-82.0 3.3 3..38
700 18-1 1.53 10.8 1165 3.9 3.19
30 ,u 900 16.8 1.54 11.5 13.7 3.7 3.26
1100 17.4 1.56 12.IJ 3.4 3.31
700 16.7 1.53 11.5 92.. 40 3.31
7.0 900 17..4 1.54 12.2 en1 s.7 3..39
1100 18.0 1.56 12.7 au 14 3..44
700 24.7 1.63 19.2 102: .le4 5.3 4.68
2.3 800 25.9 1.62 20..4 96..c. 92..2 4.6 4.84
1100 26.6 1Jl2 21.1 912:.4 5.0 3.9 4.88
700 25.1 1.66 19-4 1CJ.l.2 96.5 5.5 4.ffT
50 .t.6 900 26.3 1.85 20.6 w.c 92.3 4..8 4.83
1100 26.9 1.84 21.3 92.E 8.9.1 4.1 4.88
700 2&.9 1.87 20.2 104.2. W.4 5.7 4..79
1.1 900 27.1 1.6& 21.4 !11.!J . 93.1 4.9 4Jl6
1100 "ZT.7 1.65 22.1 m..s 22.1 89.8 4.1 5.00
700 3:3.6 1,82 27.4 114A 28.S 106.2 6.8 5.81
12 900 315.2 1 .78 29.2 106.3 29.5 loo.& 5.7 8.05
1100 36.8 1.75 29.8 ICXU 29.6 98.0 4..6 6..08
700 34.9 1.85 28.6 116.2 29.5 1117.4 7.1 5.97
70 &B 900 38.7 un 30.5 1'17.7 • "'3 30.B 101 .7 5.9 6.23
1100 37.1 1.77 31.1 101.2 ' :;"2 30.8 96.9 4.7 6.24
700 35.& 1.87 29.3 117.1 1.7! 30.1 108.1 7.3 6.02
• 900 37.4 1.83 31.2 108.$ ~ ,.--s 31.5 102.3 11.1 6.28
1100 :Ji'.8 1.79 31.7 101.8 174 81.4 117.4 4.8 6.29
700 41.0 1.97 34.3 124,.3, 6.~ U:12 3S2 113.8 8.3 6.67
2.t 900 43.1 1.90 36.6 114..3 Eli3 l.SO 36.8 1117.2 5.8 6.99
1100 43.2 1.115 36.9 106A 6.1115 178 31>.3 101.3 5.2 6.f17
700 43.8 2.00 37.0 128..0 UH 37..9 116.9 8.7 7.06
90 44 900 48-0 1.93 39.5 117.4 1 .81 39.6 109.8 7.1 7.41
1100 46.0 1..88 39.7 U>B.7 1.79 38.9 103.4 5.4 7$1
~ 44.1 2.04 37.2 128.4 U16 I 38.1 116.9 9,0 6.99 .. 9UO 46.3 1.98 39.7 117.7 6S:> ,.M I 39..e 109.9 7.2 7.34
' 00 46.2 1.89 39.3 108.9 7.r. lllT 181 39.0 103..4 5.5 7.30
11 ~ ..., COOUNOONLY ;.~·.:-,:. C00UNG WJTl:I H0J WATl:R
EW1' t;;:,11!,/ ?',5,. ,:-c J: &-<=!I TC SC KW . HR . ~ -SC ltW · -· HW mr;
I :-:x: 35-.3 20.8 1.(77 38.9 32.8 315.e 20.8 1.06 '.11.2 2.0 33.5
s..: 18 u 900 '.11.3 23..6 1.10 41.3 lM,2 31W 23.8 1.09 39.5 2.1 34..9
-.,-,x: 38.7 26.8 1.16 42.7 335 I 311• 27.0 1.14 40.8 2.2 34.2
I ,, ~1~ 35..3 20.8 1..0S 38.9 342 i 357 2' 0 1.02 37.3 1.8 34..9
50 e.<: u 37.7 2'3.8 1.06 41.3 35,6 38.0 24.0 1.05 39..7 1.9 36.4
1'1!00 38.6 27.0 1.11 42.6 34..9 392 ZT.3 1.10 ◄1.0 2.0 35.6 . ; I ul= 35..4 20.8 1.01 38.9 35J) 35..B r 21.0 1.00 37.8 us S/5..7
2..9 37.8 23-8 1.()4 41.3 38.5 38.1 24.0 1.03 38.9 1.7 37.2
·r.ic 38.9 27.0 1.0D 42.7 35.7 39..S ZT..3 1.08 41.2 1.8 36.4 -30.8 19.9 1.41 35.6 21.9 , 31.6 19.7 1.38 32.2 ... , 22.7
:..0 u u tlOO 32.3 22.3 1.43 37.2 22.Ei 33_, I 22., 1.41 33.6 4.3 23.4
11GD 33.3 25.0 1.49 38.4 22A 34.1 24.8 1.47 34.7 4..5 23.1
1IQIJ 31.0 20.1 1.38 35.6 22.7 31.6 20.2 1.35 32A 3..8 23.4
70 ao 2..0 4..6 900 32.5 22..5 1.39 37.2. 23,4 j 33..1 22.6 1.37 33.8 4.0 24.1
1,m 33.5 25.3 1.45 38..4 232 34.2 25.4 1.43 34.11 4.1 23.9
700 31-2 20.2 1.34 3/5.7 23.3 31.6 20.5 1.33 3UI 3.5 23.9
11':I 2..8 ,;..-900 32.7 2Z.8 1.36 37.3 24..0 33.2 23.0 1.35 34.1 3.7 2,4,(j
1100 33.7 25.4 1.42 38.5 23.7 34.2 2:5.8 1.41 35.2 3.8 24.3
I 700 2fU 19.0 1.74 32.1 15..1 'ZT.2 18.4 1.72 26.8 6.3 15.8
5.0 ll.9 2.1 900 27.0 20.8 1.76 33..0 15.3 28..1 20.2 1.74 :0.5 6.5 16.1
uao a.a 23.1 1.81 34.0 15.3 28.9 22.4 1.80 28.4 6..7 16.1
I 700 28.4 19.2 1.70 32.2 15.5 27.2 19.1 1.69 27.1 5.9 16.2
90 8.C 1.9 4A 900 27.3 21.0 1.72 SS.2 15.8 28.1 20.9 1.71 '0.9 6..1 16.5
ttOO 28.1 23.4 1.78 34.2 15.8 29.0 23.2 1.78 28.7 6.3 16.5
7'00 26.7 19.A 1.68 32..4 15.SI 27.2 19.8 1.86 27.4 5.5 18.,4
11.0 2.7 6.1 900 ZT.5 21.2 1.70 33.3 16.2 2B.1 21.7 1.68 28.2 5.6 16.7
1100 2&4 23.6 1.75 34.A 16.2 29.0 24.1 1.73 29.1 S.8 18.7
'JtlO 21.7 17.8 2.02 28..6 10.7 • 22..9 16.9 2.00 21.1 6.6 11.4
5.0 0.9 2..0 900 22.0 10.2 2.04 29.0 10.8 23.2 18.2 2.02 21.4 8.7 11.6
1100 22.7 21.1 2.08 29.8 10.9 23.9 20.0 2.06 22.0 9.0 11.6
700 22.0 18.0 2.00 28.8 11.0 22.9 17.8 1.98 21.6 8.0 11.S
110 8.0 1.8 4.2 900 22.3 19-4 2.02 29.2 11.1 23.2 19.1 2.00 21.9 8.1 11.6
1100 23.0 21.3 2.oe 30.0 11.2 23.9 21.0 2.04 22.5 8.A 11.7
700 22.3 18.3 1.97 29.0 11.3 22.8 18.8 UIS 22..0 7.5 11.7
11.0 2.e 5.9 900 22.e 19.7 1 .99 29.A 11.A 23.2 20.2 t.97 22.3 7.6 11.8
1100 23.3 21.8 2.03 30.3 11.5 Z3.S 22.2 2.01 23.0 7.8 11.9
tlpllcly~at bmlupoo~i"FEUhf.cxiag:and 7!ff EATb~ SttdilllnClllpl&t II for~T mrnabl lanMllllipleflolrbs (b m) at
lbllill lalk 1llf ~bnieanisUSfdb ~opmb,p"Wll wm~UIII allililllmD 'dF. 'Jhesmindbaie~ilrhtllialalull
pllmml mmlooptlowrmr. 111f 11Jirdb ia~ isq91111111 u~dmlloopmd•~ br fflleforbmitrllllfflpllicma.
--
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 06/09/09
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __ _
L GENERAL INFORMATION
County: Mecklenburg
P e mittee: Wiesenmaver SFR
Project Name!
Application No.: WI0300133
1. This application is (check all that apply): IZJ New O Renewal
D Minor Modification D Major Modification
D Surface Irrigation O Reuse O Recycle D High Rate Infiltration O Evaporation/Infiltration Lagoon
D Land Application of Residuals D Attachment B included D 503 regulated D 503 exempt
D Distribution of Residuals D Surface Disposal
D Closed-loop Groundwater Remediation [8J UIC Injection Wells (SQM) GeoThermal
Was a site visit conducted in order to prepare this report? [8J Yes or D No.
a. Date of site visit: Site was reported by Iredell County Environmental Health, the MRO investigated on
04/09/2009, conducted an inspection and presented Mr. Wiesenmayer with a SQM application form.
b. Person contacted and· contact information: Chet Wiesenmayer at 704-658-930 I
c. Site visit conducted by: Maria Schutte
d. Inspection Report Attached: 0 Yes or [8J No.
2. Is the following information entered into the BIMS record for this application correct'?
[8J Yes or O No. Ifno, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location: BIMS info on facility and recon inspection updated by MRO;
b. Driving Directions: __
c . USGS Quadrangle Map name and number: __
d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
ll. NEW AND MAJOR MODIFICATION APPUCATIONS {this section noJ needed for renewals or minor
modifications, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
0 Yes D No [8J NIA. Ifno, please explain: __
3. Aie the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No~ N/A. If no, please explain: __
fORM: APRSR040929-wi0300133 Wiesenmayer 5QMQM
AQUIFER PROTECTION REGIONAL STAFF REPORT
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? 181
Yes D No D N/A. Ifno, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0 Yes 0No 181
NIA. Ifno, please explain: __
6 . Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No ~ N/ A. If no, please explain: __
7 . Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No IZJ NIA. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part N: __
8 . Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or 181 No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No 181 NIA. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program:
10. For residuals, will seasonal or other restrictions be required? 0 Yes O No~ NIA. If yes attach list of sites
with restrictions (Certification B?)
m. RENEWAL AND MODIFICATION APPllCAIIONS (use previous section for new or mai or modification
wste,ns)
Description Of Waste(S) And Facilities
Not applicable for this facility.
FORM: APRSR040929-wi0300133 Wiesen.mayer 5QMQM 2
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. INJECTION WEU PERMIT APPUCATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells. in situ remediation injection wells. and heat
pump injection wells.)
Description Of Well(S) And Facilities -New. Renewal. And Modification
1. Type of injection system:
D Heating/cooling water return flow (SA7)
t8J Closed-loop heat pump system (SQM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5Lf'Non-Discharge")
D Other (Specify: __J
2. Does system use same well for water source and injection? D Yes t8J No
3. Aie there any potential pollution sources that may affect injection? 0 Yes ~ No
What is/are the pollution source(s)?
What is the distance of the injection well(s) from the pollution source(s)? ft.
4. What is the minimwn distance of proposed injection wells from the property boundary? ~30.ll.
5. Quality of drainage at site: D Good t8J Adequate D Poor
6. Flooding potential of site: D Low t8J Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: n/a
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? 181 Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow. Map generall v illustrates the site and home but does not
meet requirements of rule to illustrate¼ mile radius around site. That distance is probably not necessary as
Lake Norman is the c losest water body is down gradient and the most likely to be affected. There are
neighboring water supply wells within ¼ mi radius but it is unlikely the system would impact them.
Injection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes t8J No. lfyes. explain:
For closed-loop heat pomp systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes t8J No. If yes. explain:
FORM: APRSR040929-wi0300133 Wiesenmayer 5QMQM J
AQUIFER PROTECTION REGIONAL STAFF REPORT
2. For renewal or modification of groundwater remediation p ermits ( of any type ), w ill
continued/add.itionaVmod.ified iniections have an adverse imp act on migl-ation of the p lume or management of
the contamination incident? D Yes D No. If yes. e xplain:
3 Drilling contractor: Name: AWD Services Inc. (I;arrv Wells -Driller)
Address: PO Box 125, Leicester. NC 28748
Certitication number: 2603
4 . Complete and attach Well Construction Data Sheet.
FORM: APRSR040929-wi0300l33 Wiesenmayer 5QMQM 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application: System was installed in 2003 , AU
wells are underground there is not much to see.
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal oftlris permit? D Yes [8J No. If yes, p le~e explain
briefly. __ .
4 . List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the pennit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7. Recommendation: D Hold , pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information;
18} Issue; D Deny. If deny, please state reasons: __
8. Signature of report preparer(s): Maria Schutte
A d P
. ,a.-.,...,,.,.._,..,., n rew 1tner :..~~-·-Signature of APS regional supervisor: ----'An=-==dr=e..cw_,P=-=i=tn=e-=-r __________ -_-..._"_, .. _, .. _ ..... ___ _
Date: June 10. 2009
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: APRSR040929-wi0300133 Wiesenrnayer 5QMQM 5