WI0400214_GEO THERMAL_20110831

Permit Number
Program Category
Ground Water
Permit Type
WI0400214 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Michael & Sally Bramley SFR
Location Address
332 Leeward Dr
Stokesdale
Owner
Owner Name
Michael
Dates/Events
NC 27357
Bramley
Orig Issue
08/31/11
App Received Draft Initiated
08/24/11
Re a ulated Activities
Heat Pump Injection
Outfall f\!~ JL~
Scheduled
Issuance
Central Files: APS_ SWP_
08/31/11
·Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
David J. Brown
1908 Hamptonville
Hamptonville
Major/Minor
Minor
NC
Region
Winston-Salem
County
Rockingham
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Michael Bramley
1661 Round Hill Cir
Kernersville
Public Notice Issue
08/31/11
NC
Effective
08/31/11
27020
27284
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
tr
Jli'A
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Michael Bramley
Sa11y Bramley
1661 Round Hill Circle
Kernersville, NC 27284
Coleen H. Sullins
Director
8/31/2011
Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System
Permit. No. WI0400214
332 Leeward Dtive, Stokesdale, NC 27357
Dear Mr. & Mrs. Bramley:
Dee Freeman
Secretary
On August 24, 2011, 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 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 ISA Section 2C Subchapter .021 l(u)(2). Additionally, you should contact the Rockingham 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 Michael.RO!zersramcdenr.1:mv if you have any questions.
cc: Winston-Salem Regional Office -APS
APS Central Files -Permit No. WI04002l4
Rockingham County Health Dept.
Yadkin Well Co., Inc. (David Brown)
Energy Solutions (Danny Goff)
AQUIF!:R PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Sincerely,
O~f\-~
for Debra· Watts
Supervisor
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www .ncwaterguality.orq
An Equal Opportunit)' Affirmative Actbn Employer
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'8 23 Aug. 24. 2011 1 9:56AVPugh 336 463 586'N4, 0912 P. 2
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DEPAIMMITOP WMONMMAND NATURAL RESOURCES (NCAP94t)
,NpxnnCATION OF INTENT, TO CONSTRUCT A aQSgR4QQZ GEOTEE104AL
WATER-0M 1R+1.=10N WELL SYSTEM.
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n Ac orttgrtce wlth the prot islous of NCAC We 1 SA: 02CMM. pleam
ill Picte Ws ao iLivtaon ad rl d to dddm ou t4r Daa Poe fpttasa 'j �}jl or Z 1Rtiv�7�.
DAM � rrr zcsf► ZU L4 Cca I
lir!!f a C�:r�l►rrr fort: Does I� prepesedaysierrt cIrerslelc patabk 9Y8iCr OrllYonly [rto sdditiras} in
awinoom piping dut cossfpletely isolairj tine fluid I�nm Elie envkQmnet:; (l.c,
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Continue completing this farm.
Na Do Not coroplac this if rm- CompIste at3tar UIC appl MM 011 forme for Itisitilling .
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loop welt or oIhw aritiirceore 0r Cw03ia:: inhsh ("),
V` A. PROPERTY 0WNY,9(SjiA,PPMGArU(S)
List ILqh Property O►vlier listed ou proper * deed Cif owuod by n[[ t►rsllpsss or government agency, route to me of
airily ead Ti iAm =01kwe wraurttarify for signalum): ft'1r
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B. ACtzHOIUZ D AGIENT OF O'WIMI'4 [F At?Y4Lf lht ftz-at:Appiimnt owa ehc subjtctproperry,
alt vb p Iet4r From The prepexly *w=r autla=riz4 Ag,enl to install and aperale tw vied}
Company Nwnr:
Caratae+ Pwscm- F�'rjAli_ Address:
Address: ----
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Wftitt Address of Company. if any:
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Aug 23 Aug, 24, 2411 l 9:516AMpugh
336 463 585!N 0, 0912 P, 3
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Ott: otamAlo N.C. T Zip Coda 21020, Cminty: Yndkk, _
On*Tek Noo � 336468-4440 � Coll lam.: 33b-37+V36
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Avg 23 Avg. 24- 2011 ' 9: 56AVP"gh 336 483 585[No. 0912 P. 4
H. i UEMOW-R1t1.ATW ROurl MOM
Auch it diagrana shCaving the BngiuCarlag Igyaut in pMpwW rnodtt5n11on Cf ea 1j*c ott equLpmeni and at[larlox
pipiala/ 6iog asstaaatad with the ?rtjectlon opabllon. The mouActurpr's biuchurc shay pmvido snpplamentary
it><5at*Aooss. .
1, LCCATxMt7>P'CVM(S)
Atlecb iwa nap!= atmaps sbowiwg the followlrtg lafor=llom
{i) tnclude a Site Map [css bt dravm) shotAig: buildings, pro" llcit% nrfm watFr Nadirs; petenlial
sources of gr+csttndwater eooPmlRation and the orlentatio3 of and dkUsnow betroen tbih proposed wAS) "A
a4y oxisgog well(s) or wmigro diq=al [acll illei aucl: as aepitc i.ft or drain "di localed witWo 20D fed of
Ibe g"Ikra ei hear pump well rydem. Label all feWure9 clearly Rn& ligluda a angb-arrm►r,
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referancc points Stich as muds, strGRtvu uNor Wshi ay 1 nwswioas.
J. CERnTiCATION
Doter T.1k s Permit Apptteallon must be aligned by each person Aplirnring oe the
nc4rded (kern property dread.
04 4ereby certify, ander panatty of JR%V. state I have pmwnady examined sad aria l criij ar ►vllh Am intermaliva
submitted iu this doeumtsnt acid all s+saclummia tberdtq and t!'isst, bued on my sbge&y of Ulan ludiuWtvls
hmodiaWyl nmandble Par ob11 uL nJg said infe mollput t believe Del the ir&rmadca its truo. accu mts Ilad cawplata.
I wri aware [fiat *=c are sigrail-leant petmkies, includ ng Isis pa7xUlfty of flees and iimprlsasrmeal, tat st,btaluing
fmisc iar£vrmaliaa I arm to cor uoc;t, apora k malrialm, rapair, and jeappGrabk, mbsudon the 1"Ictuan eref: sod
ill related appwUnartCes in secordanca Wirh6e approved spoci�a< als d itic R3 vi' C i'ei7a U8
StMtea o!' NFIty OwmilAp cant f
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Film or7 ype Pull Narese sad title
d CL14 3N
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s tore of eery 0wsoedApp>34i1
Priat or Type IMI Name sad title
Signature of Audxv zed Ag ne, iFany
Prial or Type Full Name and t:Ile
?Icuc rawra two caplet of (heacmplcted Application package ►a:
North CalolWa J3Fn-DWQ
Ac uiftr rmiection Scction-uic rroconau
1636 Msil Service Center
Rkkigh, NC 27699.1636
Tatepitotre [phone]
"*.CFJYEI) (QENR T'N I
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Aug, 24, 2011 9.56AM
No.0912 F. 1
FACSIMILE TRANSM ON FORM
DATE: �.�` TIME: REE NO. LOG NO.
COMPANY NAME FAX NO. �
II r 1 DELI R
AifEl[TIpN� f,�
FROM: k i e G mac,
COMPANY NAME fAX NO. �SE
Dqu
Li Rm
NUMBER OF PAGES PLEASE OR GIXAn
INCLUDING THIS SHEET 51MMRE
MESSAGE:
r c
t
'FOR ALL YOUR WATER rta=EOV
YADKIN WELL CO., INC.
1996 HAMPTONVI"E. ROAD
HAMPTONVILLE. NC 27020
DAVI❑ J. BROWN, VICE PRES.
TOLL FRU (SM) IA"353
OFFICE (336) 4EB-4440
u FAx 4334) 46E-40"
RES 13355 4684659
•C.0= NEWS AMERIGA • P06 LOVM VOW
PUMl U+tiaORM US UMWATEW 1FN= C* NVr RWaVE FA06W&E IN FULL