WI0500119_GEOTHERMAL_20040401

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
April 1, 2004
MEMORANDUM
To: File
From: Thomas Slusser
Hydrogeological Technician II
Underground Injection Control Program
Reference: UIC Permits# WI0500017 and WI0500018
Petra on the Greens Town Homes
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
This permit number for a Type 5QW injection well system was originally issued in March 1996 and
due to expire in March 2001. Effective February 1, 1997, this type of injection well is deemed
permitted by rule and no longer requires a permit.
On this date the record for these permits were removed from the UICfile database, which keeps track
of injection wells that need permits, and added to the 5QWlist database, which keeps track of
injection wells that do not require permits. Likewise, the paper files were moved to a drawer that
stores 5QW injection well files.
N. C. Division of Water Quality / Groundwater Section
1636 Mail Service Center Raleigh, N.C. 27699-1636
Phone : [phone] Fax: [phone] Internet: http://gw.ehnr.state .nc.us
Customer Service
1-877-623-6748
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DATE: 'Z, /2 ~ 116
TO: (} 7 0 r-·Le
FROM: /1o.r /f-. Mi I I (3 c:t v". /1/V'--
SUBJECT: ().) -::r:,.oro 00 11
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NCDEHNR
DEM-GROUNDWATER SECTION
MEMORANDUM
To: Jim Greer
Groundwater Section
Raleigh Regional Office
From: Mark Milligan
UIC Program
Groundwater Section
Raleigh Central Office
GROUNDWATER SECTION
March 5, 1996
Re: Permits No. WI0500017 and WI0500018 issued to Petra on the Greens Town Homes for
two injection well system.
Two new permits for construction and operation of closed-loop geothermal injection well
systems serving two homes at Petra on the Greens Town Homes, Crabtree Crossing Pkwy.,
Morrisville, NC have been approved by RCO-UIC. A copy of the applications, required
variances, and·permits is enclosed for your UIC files.
Please inspect the proposed injection facility sites to verify the locations and
construction plans specified in the applications and to verify compliance with NCAC 15A 02C
.0200 standards, using either the enclosed Preconstruction Injection Facility Inspection Report
(form A) or the enclosed Injection Facility Inspection Report (form B)as appropriate at the time
of your visit. ···
Return the appropriate completed inspection reports by March 19, 1996 (within 2
weeks). The boarings containing the closed-loops will be located beneath a cement slab (drive-
way) upon completion of the homes. Therefore, if inspection cannot be accomplished by this
date, please inform RCO-UIC promptly.
cc: UIC Files
RRO Files
Enclosures
rnrnK:officc\wpdocs\pcrmits\askrwnop.pgl
State of North Carolina
Department of Environment,
Health and Natural (Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes. Secretary
A. Preston Howard. Jr., P.E., Director
March I, 1996
Mr, Eli Zablud
Adams Property Inc
Petra on the Greens Town Homes
9825 Chapel Hill Rd.
Morrisville, NC 27560
Dear Mr. Zablud:
In accordance with your applications dated January 26 and February 20, 1996 we are
forwarding Permits No. W10500017 and WI0500018 for the construction and operation of two
injection well systems, for the purpose of operating vertical closed -loop heat pump systems, in Wake
County.
These permits shall be effective from the date of issuance until March 31, 2001, and shall be
subject to the conditions and limitations stated therein, including the requirement to notify this office
by telephone 48 hours prior to initiation of operation of the facilities.
In order to continue uninterrupted legal use of these wells for the stated purpose, you should
submit an application to renew the permit six months prior to its expiration date.
If -you have any questions regarding your permit please feel free to contact me at
[phone].
Sincerely,
fftlr-41---
Mark R. Milligan
Underground Injection Control Program
cc: LIIC Files
RRC Files
Enclosures
mrm-c:lofl'icelwpdocslpermitsltran-mnew.pg 1
Groundwater Section
P.O. Box 29578. Raietgh, North Carolina 27626-0578
2728 Capital B1vd., Raleigh, North Carolina 27604
rC
Voice 919-733-3221 FAX [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/ 10% post -consumer paper

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL SYSTEM FOR
INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other
applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Petra on the Greens Town Homes
FOR THE CONSTRUCTION AND OPERATION OF AN INJECTION WELL SYSTEM for the
purpose of operating a vertical closed-loop heat pump system. This well system, to be comprised of
5 wells, will be located at 919 Crabtree Crossing Pkwy., Morrisville, North Carolina, in Wake
County, and will be constructed and operated in accordance with the application dated February 20,
1996, and in conformity with the specifications and supporting data submitted, all of which are filed
with the Department of Environment, Health, 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 system shall be in compliance with Title ISA North Carolina Administrative Code 2C,
.0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until March 31,
2001,-and shall be subject to the specified conditions and limitations set forth in Parts I through X
hereof
Permit issued this the ~day ofMarch, 1996 .
~t,f;:::ZL
Ted L. Bush, Jr ., Assistant Chief
Groundwater Section
Division of Environmental Management
By Authority of the Environmental Management Commission.
PERMIT NO. WI0500018
PART I-WELL CONSTRUCTION GENERAL CONDIDONS
1. The Permittee must comply with all conditions of 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 of 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 is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a lockable cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well, to the Division of Environmental Management (Division), within 30 days of
completion of well construction.
PART II -WELL CONSTRUCTION SPECIAL CONDIDONS
At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall
notify the Groundwater Section -Underground Injection Control (UIC), Central Office
staff, telephone number [phone].
PART ID -OPERATION AND USE GENERAL CONDIDONS
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.
PAGE2 OF7
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Environmental Management (Director). In the event there is a desire for the
facility to change ownership, or there is a name change of the Permittee, 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 Permittee 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 groundwaters which will render them unsatisfactory for normal use. In
the event that 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 take immediate corrective actions including those actions that may be
required by the Division of Environmental Management such as the repair, modification, or
abandonment of the injection facility.
2. The 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 groundwaters resulting from the operation of this facility.
PART V -OPERATION 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 Groundwater Section -Underground
Injection Control (UIC), 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.
PAGE30F7
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Environmental
Management 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 r~presentatives 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 (see attached diagram).
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary
by the Division of Environmental Management to insure surface and ground water
protection, will be established and an acceptable sampling reporting schedule shall be
followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Raleigh Regional Office, telephone number (919) 571-
4700, any of the following:
(A) Any occurrence at the injection facility which 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 Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take
such immediate action as may be required by the Director.
PAGE40F7
PART VIII -PERMIT RENEWAL
The Permittee shall, at least six (6) months 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. Such 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 be permanently abandoned
according to 15 NCAC 2C . 0113, Well Construction Standards .
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 15 NCAC 2C .0214, including but not limited to the following :
(A) 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.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) 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.
(D) 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.
(E) In the case of gravel-packed wells in 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.
(F) 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.
PAGES OF7
(G) 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) shall be submitted to:
Groundwater Section -UIC Staff
DEHNR-Division of Environmental Management
P.O. Box 29578
Raleigh, NC 27626-0578
PART X -OPERATION AND USE SPECIAL CONDITIONS
1. The fluid to be recirculated in the vertical closed-loop heat pump system shall be
potable water.
2. The material used to make up the heat exchange loop must be composed ofhigh-
density polyethylene or polybutylene pipe .
3. The high-density polyethylene or polybutylene pipe must be thermally fused according
to the manufacturer's specifications and must not leak after assembly.
4 . Upon completion of drilling of each well, the closed-loop pipe must be installed and
grouted without delay due to the cave-in potential of the uncased hole .
5. A high-solids bentonite slurry composed of twenty to thirty percent (20-30%) by
weight solids must be used as grout and must be em placed from bottom to top of the
well in a continuous operation through a pipe lowered to the grouting point.
6 . The full length of the hole should be grouted.
7. The diameter of the hole must be of sufficient size to allow placement of the pipe and
of a pipe to emplace the grout. The grout must fill the hole and surround all pipes.
8. When the closed-loop heat exchanger is removed from service, the pipes must be
filled with a high-solids bentonite slurry .
PERMIT NO. WI0500018
PAGE60F7
ATTACHMENT 1
PERMIT NO. WI0500018
The injection facility design incorporates 5 wells serving one town home, each one a closed
loop within a borehole which will extend from a depth of 4 feet below ground level to a depth
of 200 feet (variance) and which will be grouted from bottom to top (full length) with a high -
solids bentonite grout. The 5 injection wells will be connected to each other and to a heat
pump via a common influent line and a common effluent line. A trench filled with soil, sand,
and/or bentonite will extend from the top of each borehole to the surface and will contain the
lateral lines.
Sampling port-
Einfluent cid
Housing wall
Land surface .
•
•
•
•
Header/pipe system -variable design
•
V1
{
•
Trench
Soil Fill
Sensingports
Sampling port -
effluent
•
VERTICAL "CLOSED LOOP"
INJECTION WELL, USING ,
UNCASED BOREHOLE
High -solids bentonite
V;
PAGE 7 OF 7

NESC Inc.
P.O_ B 234
Monroe, NC 28111
Attn: ]err Myles
Subjects: 1) Request for Variance - NORTH CAROLINA WELL CONSTRUCTION
STAND RDS-bole-15A NCAt2C :02T3 d}(1)(A) required extensionill casing
above land surface
2) Request for Variance - NORTH CAROLINA WELL CONSTRUCTION
STANDARDS Rule 15A NCAC 2C .0213(e)(1)(C)(I) - Required emplacement of grout
from land surface to a minimum depth of 20 feet
Petra on the Greens Town Homes, 919 Crabtree Crossing Pkwy., Morrisville, NC
Permit No. W10500018
DearigErinliki:
This is in response to the letter of February 20, 1996, from Mr. Jerry Myles, ofNESCO, Inc.,
requesting variances from the referenced Rules. Rule 2C .0213 (d)(1)(A) requires that a well casing be
installed which extends from at least 12 inches above land surface to the top of the injection zone. The
permit application and supporting data indicate that the previously described injection well
construction method would not be possible due to the engineering design of the system.
Rule 2C .0213 (e)(1)(C)(I) requires that grout be emplaced in an injection well from land
surface to a minimum depth of 20 feet. The permit application and supporting data indicate that the
previously described injection well construction method would not be possible due to the engineering
design of the system.
The annular space of each well will be grouted full length from bottom to top with a high -
solids bentonite slurry, as per the International Ground Source Heat Pump Association
standards. The grout will be emplaced in a continuous operation through a pipe lowered to
the grouting point. This construction method will provide an adequate seal and prevent the
vertical migration ofcontaminants by way of the borehole.

Environmental Construction Services, Inc.
P .O. Box 703
Matthews, NC 28106
Attn: George Flinton
Subjects: I) Request for Variance -NORTH CAROLINA WELL CONSTRUCTION
STANDARDS Rule ISA NCAC 2C .0213(d)(l)(A)-Required extension of well casing
above land surface
2) Request for Variance -NORTH CAROLINA WELL CONSTRUCTION
STANDARDS Rule 15A NCAC 2C .0213(e)(l)(C)(I) -Required emplacement of grout
from land surface to a minimum depth of 20 feet
Petra on the Greens Town Homes, 919 Crabtree Crossing Pkwy., Morrisville, NC
Permit No. WI0500018
Dear Mr. Flinton:
This is in response to the letter from Mr. George Flinton of Environmental Construction
Services, Inc. and Mr. Jerry Myles ofNESCO, Inc ., requesting variances from the referenced Rules.
Rule 2C .0213 (d)(l)(A) requires that a well casin g be installed which extends from at least 12 inches
above land surface to the to p of the in jection zone. The permit application and supporting data
indicate that the previously described injection well construction method would not be possible due to
the engineering design of the system.
Rule 2C .0213 (e)(l)(C)(I) requires that grout be emplaced in an in fection well from land
surface to a minimum depth of 20 feet. The permit application and supporting data indicate that the
previously described injection well construction method would not be possible due to the engineering
design of the system.
1. The annular space of each well will be grouted full length from bottom to top with a high-
solids bentonite slurry, as per the International Ground Source Heat Pump Association
standards. The grout will be emplaced in a continuous operation through a pipe lowered to
the grouting point. This construction method will provide an adequate seal and prevent the
vertical migration of contaminants by way of the borehole.
Mr. -Eli- ab}ud
Variance to 15A NCAC 2C 0213
Page 2
2. The fluid to be circulated in the vertical closed -loop heat pump system will be potable water.
Based on my review of the available information and recommendations by our staff, it is my
finding that the combination of factors specified above are sufficient to satisfy the conditions for approval
of variances from 15A NCAC 2C .0213 (d)(1)(A) and from 15A NCAC 2C .0213 (e)(1)(C}(1) as defined
in 15A NCAC 2C .0118. On that basis, and with the additional requirement that you notify the
Raleigh Regional Office at {919) 571-4718, at least 24 hours before any well construction activities
are begun, the requested variances from Rule 15A NCAC 2C .0213 (d)(1)(A) and from 15A NCAC 2C
.0213 (e)(1)(C)(I) are hereby granted.
The granting of these variances does not affect any of the other requirements of the WELL
CONSTRUCTION STANDARDS or of the requirements of any other applicable laws or rules.
DATE: -3//
Ted L. Bush Jr., Assistant Chief
Groundwater Section
Division of Environmental Management
cc: UIC files
RRO

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FROM
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Federal State Private
Public Commercial I _ Other
Native 'American Lands
I
C, 'P1t'vPERTY OWNER (if different from applicant)
Name:: o n +► C� r e�.N s Ta�, arse s
Address. -- 45 C 't Hill Eck
: iz " t \ocrlsv..4tt PIS C- Zip code: a,-754v 0
County,:
Teleph• ne: 9 19 °I i 00 50
D, FACILITY (S! TE) DAT'(Fill out ONLY if the Status of Cx:ter is Federal, State, Public or Commercial)
Name f Business or Facility: c ❑r1 '�' e lr er 5
dregs
bd
t3' I � p �7S 4-I3
Telephone: i I ' I oa O
Contact Person: 5' 1,, pub L►
E. HEATING CONTRA.CT[''R DATA
Name:' _
Address:
City: Zip code:
Count!:
TeIephpne:
Contact Person:
F. INJECTION PROCEDURE(Brieflydescribe how the ecdon-wells) will be used.)
ii e11s � ilk e- iASok CJis rt Cis$cik Lai' r-c�tc.v►c� c0
axe cp.,. r , ez ti n �.:.t r� kctc Pc5
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P= :tom .'tt k-' tE..:
G. WELL USE Will the injection well(s) also be used as the supply well(s) for either of the following:
() The L fiction operation? YES l'iO,�
(b) Your personal consumption? YES NN0 —'
NORTH CAROL NA
ENVIRONMENTAL MANAOBMENT COMMIS SION
DEPA TNIMNT OF ENVIRQNMF.Ni`, I ALT H, AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND)OR USE A WELL FOR INJECTION
WITH A HEAT PUMP SYSTEM
Class $ \Veils
TO: DIRECTOR, NORTH CARGI.INA DIVISION OF ENVIRONMENTAL MANAGEMENT
DATE: �'' 19 f L
In accordance with the provisions of Article 7, Chappter� $7; Article 21, Chapter 143, and regulations pursuant
thereto, APPLICATION is hereby made fora PER MYT lb CQnSiruCt and/or use a well or well system as described
below and in any acoompanyIng data submitted as part of this APPLICATION.
A. PER/4T APPLICANT
Name:
Address:
City;
County:
Telephone.
, STATUS OF APPLICANT
Please type or print clearly,
Ac�c& 5 i IC:
mot# ei-,n p•c t
(Am- Zip code: -. 7 C ( ra
41Li t 6 n
Ad .��h re; s t
city: t}1or its v�t4 tl:�c� i t:
GW-$? HP (October 199') Rage 1 of 4

FROM 01.01.2000 ~0:00
. I : I
H. CQNSTRUCTION DATA j (check one)
~XISTINO WELL being proposed tor use as an injection well. Provide the data
ii'.) (1) through (7) below to the best of your knowledge. Attach a copy of
1tnn ow .. 1 (Well C~ns~~tion Record) if available.
~OPOSED WELL to be constructed for use as an injection well. Provide the
$ta in (l) through (7) below as PROPOSED consuuction specifications. Submit
J'prm GW•l after cons1n1ction. .
(ij Well Dril~ng ContrJctor's Name: Erv \l'l\"O'Y\'\"'V~ Co-... S~c-\:.t~ Ser--v-;c..e. er::.
•. NC t>rlllar Registratlon number: -..1.l .... ':{=0 __ ! ___ . _____ _
(2) Date to be constn1ctk: Fe.l:> ~'-Approximate depth: __ ;;l;;;._0_o_' --~--
(3) Welicas{tlg: ~Pr '3/q'( ·ro¼e4l.;\~ Gw·~\·p.e
(a) TTI>.e: Oalvaniz.ed steel__Black stccl___Ylastlo....t:_other(specift) ______ _
(b) trisldf:1e diametet:~ _ _.nches~ w~ t.hickness _____ inches or schedule#
(c) Ca$ ng depth:_ I From '1/M)Q_ to ft. (re ference to land sorface)
(4) Cementarout: /'J -e~~\'h.. :C~ ~ ~~ ~ ·i-or,
Cas ng extendi ahove arounL N ft . inches (must be at least 12 inches)
(a) Ar®nd inner r ''.Primary" casing: From ___ to __ _,ft .
(b) Around oUter it) casing, if present: Prom ___ to ft
: I
(!; Scr~ns (if appiicab~e): · · ~ fsr -· . · ···
(a) Tme: 1 : Inner diamoter:,_~ ____ lnches
(b} Pcpth: From _!__to __ --'feet below land suHace
I
(6) Gravel (if applicablt From __ to · feet below land surface
(7) N;C. Sta~ Reguhtl~ns (TiUe 15A NCAC 2C Seci.!r,n ,0200) require the pormittee ~\~ make
provisiMs for moni*ring 'i-'ell head processes. A i:':!-ucer on :-bollHntluent (grounchvalf.l" entering heat
pump} anti effluenl :water being injected int6 the well) lines is i.:::;;~::-:-..1, Will there t-e a ftucet on:
(a) the'lnfluent lin ? yes..£::_no_ (t•:) the effluent lint:•? yes.1::::_il o __
NOTB: :'t ir WB4L D~'l';,,t.nJO COmR.ACTOR CAN $UPPLY THB ·: . .-A'T'A Pl )}t ErrHER ~-Xi5TINO OR
PRO~OSSD WEU..S ~ THIS 00:0RMATION ts UNAV A!LABLB in O'!'HBR. MBAt-.!~.
. ·i i
I. P~vi:.OSBt> O$RAm-;G n.,T.A
· (a) I~$ttion rat0: 1 Average (dai1_Y~ !5 gallon. i per rr.:.nuiate ( m) +
~
) I epqon volµme: · Averasc (d~lY1 gallpns per da y e..s·
) 1 eeuon press)lref Average (daily} 3 o pcunWsg_.iare inc sl)
) I ~tion temp~atur,:.: Annual Average k o deg.,..es r
:, .; ... ;
l. lN,lBC'flON FLlfLl D,-u t
(1) Pluid solifce. If undtrground, from what depth, formation and type of rook/sediment unit will the
fluid _ be, 4tawn (e,;., granite, limestone, &a.t\d, eic.).
Depth: .. Fonnati.on: · · Rock/sediment unit: _____ _
• I
(a) SOtJRCB WBl..L CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy pf Fonn ow .. 1 (Well Construction Record). If Form GW-1 is not available.
provide the daf in part H (1) through (7) of this application fonn to the best of your
knowledge . ;
(2) Chemical Analysis df Source Water . The following chemical characteristics MUST accompany this
application; l
~H . : TorJ1 hardness ___ ppm (parts per million or mg/1); Iron ---. ppm;
Chloride . ___ =-ppm: Nitrate ___ ppm; Coliform bacteria ____ counts/1O0ml.
NOTE: Assistance in determining these valuos may be obtained by cont.acting (a), your local or count:,·
health offieal, Cb) a commercial water-testing laboratory, (c) your well driU1ng contractor, or
(d)'ihe reglonal"Hydrogeologist, Nonh Carolina Dept. of Environment, Heallh, and Natural
GW•57 :HP
t<esources. ;
(Oct()ber 1 994)
' : i
I
Page 2 of 4
.. ---------------------------------------,------------------------~-------------------
P. 3
FRQM
0i.0I.2004 i0;00
P 4
K. IE CTI ON-f.ELATBD .EQUIPMENT
NT
Atisch i!t diagi-am showing the engineering layout of the (1) injection equipment, and
(2) exterior p:ppingjtubing associated with the injection operation. The manufacturer's brochure, if
detailed, should satisfy (11) above
L. TOPOGRAPHIC MAP
Attach .a scaled topographic map which extends one mile beyond the property boundaries of the
facility and indicates the location of the facility.
M. LOCATION OF I LL($)
Attach it detailed, $I caled ma of the site of the facility, showing the location of and distances
betwoen the proposed wells(s) (Source wells and injection wc11s) and any waste (including hazardous
waste) treatment, rage or disposal facilities; boil' dings; property boundaries; surface water bodies:
and any other ppole tiai source of groundwater contamination, Additionally, indicate on the map the
dlnectioh and distakice to existing wells (injection wells, water supply wells, dry wells, abandoned
wells) !bested within 1,500 feet of the proposed injection well(s). Include with the map a description
of each existing well, incorporating type, construction information, date drilled, rr,u depth. indicate
on the nap at least two nearby reference points such as roads, road intersections, streams, etc., and
identify them by VS, NC or SR (county secondary roads) numbers or name. Label all features
clearly, Include a north arrow on the map to indicate orientaticit.
N. erlSTIFICATION
"I hereby certify, tinder penalty of law, that I have personally exiumined and am familiar with the
information submitted in this document and all attachments there-o and that, based on my inquiry of
those individuejs tnimediat i:• responsible far obtaining said information, I believe that the :r:ftrrmatio,
is true, accurate aid complete. I am aware that there are signincint penalties, including the possibility
of fines dud imprisciement, for submittiel false information, I agree to construct, operate, maintain,
repair, and if applesbie, abandon the itiecticri well and all relate ep urten ences in accordance with the
appr' ved speediest cos and conditions of the Permit."
(Signature of Owner o[ Authorized Agent)
1 �cY la Lt.) 4
Please supply a letter signed by the owner
authorising the above agent, )authorised agent is signer.
O. CONSENT OF PROPERTY OWNER (Owner means any parson who holds the fee or other property tights
in the well being constructed. A well is real property and its construction on land rests ownership in the
land owner in the absencrt of contrary agreement in writing.)
If the property is oiwned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection weal a4 oulined in this application and that it shall be
the responsibility Of the applicant to ensure that each injection well conforms to the Well
Construction Standards (Title 15A NCAC 2C .0200)
Name of Property Owner (Print);
Mailing Address: -
Signature of property Owner ii`Different
From Applicant)
GW-5.7 I1P (October 199;) Page 3 of 4

Page 9
Oil
9
Gr
than that of the water connectioft on the unit.
Clieck cart. fully for water tc.iks.
SX SERIES
.ram---�---w-
2
EARTH COUPLED APPLICATION
1, LINE VOLTAGE DISCONNECT ELECTRIC HEATER
2. LINE VOLTAGE DISCONNECT
3. FLEX DUCT CONNECTION
4. LOW VOLTAGE CONTROL CONNECTION
5. LINE VOLTAGE CONNECTION WATER PUMP
6. PIT PUGS
7. VIHRATJON PAD
8. CONDENSATE DRAIN
6 9 GROUND LOOP CONNECTION KIT
10. GROUND LOOP PUMPING PACKAGE
11. POLYBUIYLENE OR POLYETFIELENE WITH INSULATION
(Figure #12)
Do not exceed recommended condenser water flow

Grout Pieoement Methods — 23
TRENCH
3dHEHOLE WALL
Z//J !J_/f.J/IiC�/l�r%F
FIGURE 4. { . Grout Pipe i .ethod with Purnp

- Section Four
3
Earth Coil Type:
Water Flow:
Pipe Sizes:
Bore Lengths:
Pipe Lengths:
4, 5
Vertical - Single U-Bend
Parallel
3/4- or 1-inch loops, 1 1/2-
❑r 2-inch headers
175 to 225 feet/ton
350 to 450 feet/ton
FIGURE 4.5: Parallel Vertical Ground beat Exchanaer

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1H A,.N UROAN(.1 Waif NORTH CARO! INA GENERAL. STATIITFS +1?• 30.
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PRESTON WOOD
COUNTRY. CLUB INC.
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DECLINATION AT CENTER OF SHEET
,Pt/
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2:11;::-!--2—::Jjr-fi 7-7:
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SCALE 1:24 000
0
1000 0 1000 2000 3000 4000 5000 6000 7000 FEET
I--+ r-1 F-•I - Y—�
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CONTOUR INTERVAL 10 FEET
NATIONAL GEODETIC VERTICAL DATUM OF 1929
Mile IIAAD Pro] ll Ir. 1011 ... i.. ..
1 KILOMETER
i MILE
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47'3O" 700
CARY, N. C.
S5I4 DURHAM SOUTH 15e QUADRANGLE
35078-G7-TF-024
PHOTOINSPECTED 1988
1973
PHOTOREVISE❑ 1987
DMA 5255 TV SE—SER1ES V842
N. C. •