WI0500120_GEOTHERMAL_20040401

• · ·,v ( Michael F. Easley, Governor
..;...:r: • -1 -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
Di v ision 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 : (9 I 9) 7 15-0588 Internet: http://gw .ehnr .state.nc.us
Customer Service
1-877-623-6748
ii/4/0WEItiENa-
DATE:
TO: 0 7 6,
FROM: Pt o. r1 / t 1/1 ir
SUBJECT:
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NC DEHNR
DEM-GROUNDWATER SECTION
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MEMORANDUM
To: Jim Greer
Groundwater Section
Raleigh Regional Office
From: Mark Milligan
UICProgram
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 Towri 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 I SA 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
mrm-c :officc\wpdocs\pcnnits\aslawnop.pgl
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James 8. Hunt, Jr., Governor
Jonathan 8. Howes, Secretary
A. Preston Howard, Jr., P.E ., Director
Mr. Eli Zablud
Adams Property Inc.
Petra on the Greens Town Homes
9825 Chapel Hill Rd.
Morrisville, NC 27560
Dear Mr. Zablud:
March 1, 1996
M'A
D E HNR
In accordance with your applications dated January 26 and February 20, 1996 we are
forwarding Permits No. WI0500017 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].
cc: UIC Files
RROFiles
Enclosures
mnn-c:\office\wpdocs\permits\tranmnew.pgl
Groundwater Section
Sincerely, In r !J.r/, )_ ntJ fl I ,0y~
Mark R. Milligan
Underground Injection Control Program
P.O. Box 29578 , Raleigh, North Carolina 27626-0578
2728 Capital Blvd., Raleigh, North Carolina 27604 N '"---\1"'1 Voice 919-733-3221 FAX [phone] ~1" '-.J An Equal Opportunity Affirmative Action Employer
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NORTH CAROLINA
ENVIRONM:ENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONM:ENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL SYSTEM FOR
INJECTION
fu 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
6 wells, will be located at 921 Crabtree Crossing Pkwy., Morrisville, North Carolina, in Wake
County, and will be constructed and operated in accordance with the application dated January 26,
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 15A 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 !!I...!!. day of March, 1996.
CJ/.IL~4"cl ~
TeJ:L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Environmental Management
By Authority of the Environmental Management Commission.
PERMIT NO. WI0500017
..
PART I -WELL CONSTRUCTION GENERAL CONDITTONS
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 ohhis 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 CONDITIONS
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 ill -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.
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 ofthis 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.
PAGE 3 OF7
...
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 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 (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 Pennittee 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.
PAGE 5 OF7
(G) The Pennittee 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 CONDIDONS
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 . WI0500017
PAGE60F7
ATTACHMENT 1
PERMIT NO. W10500017 Sensing ports
The injection facility design incorporates 6 wells serving one borne; eaeh� one, a cldsedr leopy
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 6 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.
Land surface
•
•
•
Header/pipe system -variable design
.
•
Trench
•
Soil Fill
Sampling port -
influent
Housing wall
.43
�1
-1
Sampling port -
effluent
!•
V
• .�
VERTICAL "CLOSED LOOP"
INJECTION WELL, USING
UNCASED BOREHOLE
High -solids bentonite
.;..:v.
PAGE 7 OF 7

Environmental Construction Services, Inc.
P.O. Box 703
Matthews, NC 28106
Attn: George Flinton
Subjects: 1) Request for Variance -NORTH CAROLINA WELL CONSTRUCTION
STANDARDS Rule 15A 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, 921 Crabtree Crossing Pkwy., Morrisville, NC
Permit No. WI0500017
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 em placed in an in jection well from land
surface to a minimum depth of20 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 Zabiud
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)(I)(C)(I) as defined
in 15A NCAC 2C .0118. On that basis, and with the additional requirement that you notify the
Raleigh Regional Office at [phone], 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 I5A 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.
Sincerely,
r 7
Ted L. Bush Jr., Assistant Chief
Groundwater Section
Division of Environmental Management
cc: UIC files
RRO
mrm-c:erlicelwpdoce permiulvariance.pg I
DATE:

NESCOinc.
P.O. Box234
Monroe, NC 28111
Attn: Jerry Myles
Subjects: 1) Request for Variance-NORTH CAROLINA WELL CONSTRUCTION
-----~s=T AND ARDS Rule I SA NCAC-2-C .0213-CclJ(l)(A)-..:]teqmred 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, 921 Crabtree Crossing Pkwy., Morrisville, NC
Permit No. WI0500017
Dear Mr. Myles:_
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)(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 em placed 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.
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.
63-139--56 16: €31 = C S INC
324 PEE
,. ,
N1,SCO INC. P.O, Box 2114 Monroe. INC.
(704)410- z:i1 Fax [phone]
NC11uI'&
2728 CAP1TOI. RI.VI)
RALI1 GH , We
27626
DEAN 511i
121 C r4VrtC Crass i H,j MI,.
1
Tit] S ).F7'TOR Is TO HEQUE iT A VARIFNCE, TO 1 5A NCM 20.0213 (1)) (1 ) (A )
WHICH ICQU1 lu S THAT A Wild, CASING BE INSTALLED WHICH MUDS FROM
AT LEAST 12 iNCHK.N A11OV I,ANI) SURFACE TO 'J HF TOP O1` THE INJECTION
ZONE, i
ALSO TO RRQlt)ST A YARIA CE '1'O 15 A NCAC 2C. OM (E)(1)(C)(i)
W'U3 C1I REQUIRES FMPLACEMNT OF (+R(1V'r FROM THE LAND SY)RIWACS TO A
MINIUM I)i PI'11 Ii1' 20 h14I'T,
T11I Sh: WFT.LS WILL 111', 111W'At1L 1) TO '1'IlF, STANDARDS 101 BY J OSII IAA STANDARDS.
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DATE: /-'ii
NUMBER OF PAGES:
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CONSTRUCTION
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NVIRONMENTAL DRILLING 1 RLMEDIATION 'SYSTEMS
PO Box 703 ' Matthews. NC 28106 • 704.849-Q888 • FAX 704-849-O8n3

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
WITH A HEAT PUMP SYSTEM
Class 5 Wells
TO: DIRECTOR, NORTH CAROLiNA DIVISION OF ENVIRONMENTAL MANAGEMENT
DATE: J aN% pc7 , 19 q_
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and regulations pursuant
thereto, APPLICATION is hereby made for a PERMIT to construct and/or use a well or well system as described
below and in any accompanying data submitted as part of this APPLICATION.
Please type or print clearly.
Name: A a m 5
A, PERMIT APPLICANT
Address: G 5— 4 i i L
City: _ _ r i s i_ s hI a ll�___Zip code:
County: Wok S
Telephone: 1 411 as()
B. STATUS OF APPLICANT
Federal State
Public Conunercial V Other
Native American Lands
C. PROPERTY OWNER (if different from appli;•anoi
Name: t 6.
Address: `? k a ; h' c
City: Yt1 or r 1 ; >i i i -e. IL Zip code:a 7 sG a
33..
Telephone: ► Y- ' I- C' ©S O
D. FACILITY (SITE) DATA (Fill out ONLY if the Stz?us o. Dwner is Federal, Stat( , Public or Cc lnr-:ciai)
Name of Business or Facility: ?Jr.— r. it,L �,e r0
�-
Address: Q C'ro�±t ar�_cr,�- es -lam)
City: f• rC l 4-4
, p code:_a 7 1fe0
County: nil[
Tel ephene: t 1 $j CO.5c,
Contact Person: �1 &" �o� u
E. HEATING CONTRACTOR DATA
Name:
Address:
a 7 543C3
Private
City: Zip code:
County:
Telephone:
Contact Person:
F. LNTECTION PROCEDURE (Briefly dAscribe how the injectio well(s) will be used.) [
vi42Aks w t cL (oo -_emu. Cat
f'Y �`et) r'� 41-.�ct. idrl h4u�.•� a 4� +�� @�e1�.{i Limes
W L ss � t: la"-, �} tii5` �i'r 1.n �r, 1 ��`G'm [li jrLIs.-^ 10 r�1t Lp, C lr'
W 0-4t-e 5./ + L��~ W►� }� -5 �.. 4i, 5 C•'S {I-7 L=� V 3 i7 4 r.(r ��
G. WELL USE Will the injection well(s) also be used as the supply well(s) for either of the following:
(a) The injection operation?
(b) Your personal consumption?
YES NO ►�
YES NO --`
GW-57 HP (October 1 994) Page 1 of 4

H. CONSTRUCTION DATA (check one)
(1)
(2)
(3)
(4)
EXISTING WELL being proposed for use as an injection well. Provide the data
in (1) through (7) below to the best of your knowledge. Attach a copy of
Form GW-1 (Well Construction Record) if available.
PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after construction.
Well Drilling Contractor's Name: E t'.)111 roN 1n ~-h J ~S{lu.c+ro..-.. Sev-4 c..e.s-.
NC Driller Registration number: l't o 5
Date to be constructed: t=:--e.-b l j Approximate depth: __ ------'-P._------'---Cf) __ ' _____ _
Well casing: N. 'Pr. 3/4
11 fo{t-t-t-k,.tf-e.-..-t, (;eo p7~
(a) Type: Galvanized steel __ Black steel __ Plastic_L_Other(specify) ______ _
(b) Inside diameter:_--=-_.inches; Wall thickness-=--__ inches or schedule# ___ _
( c) Casing depth: From ~o o • to 4 i ft. (reference to land surface)
Casing extends above ground \&'.fr inches (must be at least 12 inches)
~u~f\ 15~~ Gr-au..-t l::~ 86-{t&rn -l--e +"P
(a) Around inner or "primary" casing: From ___ to ___ ft.
(b) Around outer (pit) casing, if present: From ___ to ___ ft.
(:'.:) Screens (if applicable): /J A
(a) Type:--==------~ Inner diametcr:_,,..____,.-~--·inches
(b) Depth: From ___ to ___ feet below land surface
(6) Gravel (if applicable): From ___ to ___ feet below land surface AJ t\.
(7) N.C. State Regulations (Title 15A NCAC 2C Section .0200) require the permittee to make
provisions f0r monitoring well head processes. A faucet on both influent (groundwater e:itering heat
pm11f·) ~!"!d efr-:-!~nt (water being injected into the well) lines is ,-,qcired. Will ihc,~ tc. ~ fiw•·-~r on:
(~) the influent line'! ve<_l:_no__ (b) the effluent line? y~:;~:10 __ _
NOTE: THE WELL DRILLING CONTlACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING Gi;.
J.
PROPOSED WELLS IF THIS DlFORMATlON !S UNAVAILABLE BY OTHER MEANS.
PROPOSE.' OPERATING DATA
(a:. Injection rate: .\w;rage (daily) Ii iralfons p::o:· !Di:.1;1te (gpm~.a
(r) Injection volume: ,~Yerage (daily) {o'l/00 irallons per ili>v (~pd) ~ ,
lC) Injection pressure: 1-1Verage (daily) ?,O pounds/square incn (psi)
(d) Injection temperature: Annual Average k:a degrees F
INJECTION H,UID DATA
(1) Fluid source. If underground, from what depth, fonnation and type 0f rock/sediment unit will the
fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth: _____ ~Formation:. ______ Rock/sediment unit: _____ _
(a) SOURCE WELL CONSTRUCTION Il\TFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Fonn GW-1 is not available,
provide the data in part H ( 1) through (7) of this application form to the best of your
knowledge.
(2) Chemical Analysis of Source Water. The following chemical characteristics ~1UST accompany Lhis
application:
pH--,----; Total hardness ____ ppm (parts per million or mg/]); Iron ____ ppm;
Chloride ppm; Nitrate ppm; Coliform bacteria coums/l00ml.
NOTE: Assistance in determining these values may be obtained by contacting (a) your local or coumy
health offical, (b) a commercial water-testing laboratory, (c) your well drilling contractor, or
(d) the regional Hydrogeologist, North Carolina Dept. of Environmem, Health, and Natural
Resources.
GW-57 HP (October 1994) Page 2 of 4
K. INJECTION-RELATED EQUIP:MENT
Attach a diagram showing the engineering layout of the (1) injection equipment, and
(2) exterior piping/tubing associated with the injection operation. The manufacturer's brochure, if
detailed, should satisfy (1) above
L. TOPOGRAPIIlC 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 WELL(S)
Attach a detailed, scaled map of the site of the facility, showing the location of and distances
between the proposed wells(s) (source wells and injection wells) and any waste (including hazardous
waste) treannent, storage or disposal facilities; buildings; property boundaries; surface water bod i es ;
and any other potential source of groundwater contamination. Additionally, indicate on the map the
direction and distance to existing wells (injection wells, water supply wells, dry wells, abandoned
wells) located 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, and depth. Indicate
on the map at least two nearby reference points such as roads , road intersections, streams, etc., and
identify them by US, NC or SR (county secondary roads) numbers or name. Label all features
clearly. Include a north arrow on the map to indicate orientation.
N. CERT1.b1CATION
"I hereby cenify, 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 ari.d imprisonment, for submiIT:n; false information. I agree to construct, open:te, maintain,
rc:i;ci , :!!1'1 '~ ~p~licable, abandon the inj,xtion well and ali r.:: .. a~d ;a.pp11rtenances i;, ;:::~.:-~;.::..n~e with the
::!flproved spec1ficacio.:c; a_n_rl conditions of ti;~ Pe:-:nit."
~ // ,1 /
r"" ~--JI • .A _,{/ ✓~-<. f
(Sienature of Ow ner or .\uthorized Agent)
£l..t Z.c,...\o Lu.A
Please supp!y a ietter .~i gned by the owner
auchorizing the abo,;,, ug e:ni, if authorizeu uge11t is signer .
0. CONSENT OF PROPERTY OWNER (Owr.~r mean::. ar;y person ,•ho holds the fee or other property rights
in the well being constructed. A well is real property and its construction on land rests ownership in the
land owner in the absence of contrary agreement in writing.)
GW-57 HP
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 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 ISA NCAC 2C .0200)
Name of Property Owner (Print): _______________________ _
Mailing Address: ____________________________ _
(October 1994) Page 3 of 4
(Signature of Property O wner if Difierem
From Applicant)
Page 9
/
7
(Figure #'1:)
SX SERIES
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 PLUGS
7, VIBRATION PAD
8, CONDENSATE DRAIN
S. GROUND LOOP CONNECTION KIT
10. GROUND LOOP PUMPING PACKAGE
11. POLYRUTYLENE OR POLYETHELENE WITH INSULATION
than that of the water connection on the unit.
:heck rareFuily for water leaks.
I7o_not exceed recommended condenser water flow

Grout Placement Methods - 23
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LILI
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1
FIGURE 4.1: Grout Pipe Method with Pump

— Section Four
Earth Coil Type:
Water Flow:
Pipe Sizes:
Bore Lengths:
Pipe Lengths!
Vertical - Single U-Bend
Parallel
3/4- or 1-inch loops, 1 112-
or 2-inch readers
175 to 225 feet/ton
350 to 450 feet/ton
FIGURE 4.5: Parallel Vertical Ground Heat Exchanger

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NESCO, INC.
P.O. Box 234, Monroe, NC 28111
[phone] FAX [phone]
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