WI0500100_GEO THERMAL_20111031

Smith, Eric
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Mr. Rabinowitz:
Smith, Eric
Monday, October 31, 2011 3:50 PM
'[e-mail]'
Slusser, Thomas; Zimmerman, Jay
Margolis Geothermal Permit Applicatoin
Margolis Geothermal Application.pdf
Attached .is the permit application that your former property owner submitted to the State in April of 2000. The permit
number WI0500100 was assigned-to the application. As per our phone conversation today, it appears that no
geothermal well system was constructed on your property. We will follow up with a letter shortly that says roughly the
same.
If you have any questions, please feel free to contact me.
Sincerely,
Eric G. Smith, P.G.
Eric G. Smith, P.G.
Hyd rogeo logist
NCDENR
Aquifer Protection Section
Groundwater Protection Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
919-715-6196
919-715-6048 Fax
http:ljportal.ncdenr.org/web/wg/aps
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
1
MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
May 22, 2000
To: Jay Zimmerman, L.G.
Groundwater Section
Raleigh Regional Office
From:. Mark Pritzl Ptf [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Receipt of Notification for a Closed-Loop Geothermal Water-Only Injection Well
System.
Notification to construct and operate a well for a closed-loop geothermal heat pump system has
been filed by Peter and Judy Margolis of Chapel Hill, North Carolina and a copy of the
Notification is enclosed for your files. This injection well system is deemed permitted by rule
(NCAC T15A: 2C.21 l(u)2) and no regulatory action is necessary. If you have any questions,
please contactme at [phone] or Amy Axon at [phone].
cc: CO-UIC Files
Enclosures
A' f�
NCDENR
JAMES B. HUNT JR.
GOVERNOR
BILL HOLMAN
SECRETARY
KERR T. STEVENS
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL. RESOURCES
May 22, 2000
Peter & Judy Margolis
1510 Homestead Road
Chapel Hill, NC 27516
Dear Mr. & Mrs. Margolis:
DIVISION OF WATER QUALITY
In accordance with the notification submitted on your behalf by Bowman's
Mechanical dated May 18, 2000; the Groundwater Section acknowledges your
intention to construct closed -loop geothermal water -only injection well for the
operation of a ground -source heat pump. The system as described in your
notification will not require an injection well permit and is deemed permitted by rule
(North Carolina Administrative Code Title 15A: 2C.0211(u)2). The Underground
Injection Control Group has added your site to our inventory. If you modify your
system, please contact the Groundwater Section to verify compliance. Thank you
for submitting this notification.
If you have any questions regarding geothermal heat pump wells please feel free to
contact me at [phone] or Amy Axon at [phone].
Sincerely,
mat
Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Program
cc: CO-UIC Files
RRO-UIC Files
FIIZ5T
/H ASCFf.A
MEINEMMMI
GROUNE WATER SECTION
1636 MAIL SERVICE CENTER, RALEIGH, NC 27699-1836 - 2728 CAPITAL, BLVD., RALEIGH, NC 27604
PHONE [phone] FAX 91 9.71 S-0588
AN EQUAL OP►ORTUNTTY I AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% POST -CONSUMER PAPER

R€EElVED1 Dl~SR NORTH CAROLINA
Vita GROUNDWATER SEC i !Qk
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFIMA 6I4114TENT TO CONSTRUCT A CLOSED -LOOP
GEOTHERMAL WATER —ONLY INJECTION WELL SYSTEM
(GROUND COUPLED HEAT PUMP)
Type 5QW Wells
In Accordance with the provisions of NCAC Title 15A: 02C_0200
Complete application and mail to address on the back page,
This is not the proper form to be used for injection wells in an open -loop geothermal system.
Do not use this form for systems that circulate any substances other than water.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: g I:9 440
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
YES V If yes, then continue completing this form.
NO If no, do not complete this form. Form GW-57 HP, Application For
Permit To Construct AndlOr Use A Well(s) For Injection With A Heat
Pump System, should be completed.
S. SYSTEM FLUID Will any additives be introduced to the system's circulating heat transfer
fluid? This includes, but is not limited to corrosion inhibitors and/or antifreezes.
YES If yes, do not complete this form. Form GW-57 HP, Application For
Permit To Construct AndiOr Use A Well(s) For Injection With A Hear
Pump System, should be completed.
NO If no, then continue completing this form.
C. PROPERTY OWNER
Name: -Psis �0.r°�p► S
e 5--ecci
City: Ci-.Ape l 1\ ill State: u .>r. Zip Code: a 7 SI6
County: OC Telephone:
Address: 1S \
D. STATUS OF PROPERTY OWNER
Private: Federal: Commercial:
State: Municipal: Native American Lands:
GW-57 CL (May 1998) Page 1 of4

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility: _____________________ _
Address: -----------------------------City: _________ State: __ Zip Code: _____ County: ____ _
'felephone: __________ Contact Person: ____________ _
Standard Industrial Code(s), SIC, which describes commercial facility: ________ _
F. HEAT PUMP CONTRACTOR DATA
Name: '6owman s {Ylech~f\,·cq J
Address: I~ I Cf Sfurd,Vao+ brive.
City: Ca ("\1 State: rJ. C.. Zip Code: ~ 7~/ I County: l,Ja_Ke.
Telephone: q1 'I-tf. i I-'¾St. & Contact Person: Sfeve BoW-PJQ.IN
G. CONSTRUCTION DATA (check one)
EXISTING WELL(S) being proposed for use as a ground-coupled heat pump
well(s). Provide the information in (I) through (4) below to the best of your
knowledge. Attach a copy of Form GW-1 (Well Construction Record) if available.
PROPOSED WELL(S) to be constructed for use as a ground-coupled heat pump
well(s) . Provide the information in (1) through (4) below as PROPOSED
construction specifications. Submit Form GW-1 after construction.
(!) Well Drilling Contractor's Name: B;nj's We.I I Dr; I I,·~ ,Inc. .
NC Driller Registration number: _~_o_G.?_~----------------
Date to be constructed: 4-f ..-'2ooc, Number of borings: __ J ______ _
Approximate depth of each boring (feet):_--=5=-0---'0~'-------------
(2) Well casing: Is the well(s) cased?
(3)
NOTE:
(a) YES If yes, then provide the casing information below.
Type: Galvanized steel ____ Black steel __ Plastic __ Other (specify) ____ _
Casing depth: From ___ to ___ ft. (reference to land surface)
Casing extends above ground ____ inches
(b) NO JL_
Grout (grout the vertical length of the borehole to a minimum depth of 20 feet b.l.s.):
(a) Grout type: Cement__ Bentonite V Other (specify) _______ _
(b) Grouted surface and grout depth (reference to land surface):
Varound closed loop piping; from O to 5 0 (feet).
__ around well casing; from __ to __ (feet).
THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
GW-57 CL (May 1998) Page 2 of 4
H. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
I. LOCATION OF WELL(S) Attach two maps.
(I) 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 ground-coupled heat pump well system. Label all
features clearly and include a north arrow.
(2) location map referencing the site to two nearby permanent reference points (such as roads,
streams and ·highway intersections).
J. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program pennits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
K. CERTIFICATION
"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 infonnation. I agree to construct, operate, maintain,
repair, and if applicable, abandon the ground-source heat pump system and all related appurtenances in
accordance with the approved specifications and conditions of the Permit."
GW-57 CL (May 1998)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
Page 3 of 4
L. 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 landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure that the ground -source heat pump system's well(s)
conforms to the Well Construction Standards (Title 15A NCAC 2C .0200)
(SiignatureLOf Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
P.Q. Box 29578
Raleigh, NC 27626-0578
Telephone [phone]
GW-57 GL (May 1998) Page 4 of 4

a
PROPOSED HOUSE SITE
FOR
PETER & JUDITH MARGOLIS
LOT 6R TALBRYN
CHAPEL HILL TWP. ORANGE CO. N.C.
DATE: JUNE 9, 1999 SCALE: 1" = 1 ❑O'
LOT 5 -t66.
99
N
ROCKS
0
LOT 6R
4