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Home My WebLink AboutWI0500253_GEOTHERMAL_20100506Permit Number WI0500253 Program Category Ground Water Permit Type Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facilit Facility Name Michael Nicholson Van Hoy SFR Location Address 118 Lake Ct Chapel Hill Owner Owner Name NC 27516 Michael Nichol Van Hoy son Dates/Events Orig Issue 05/06/10 App Received Draft Initiated 04/28/10 \ Re gulated Activities Heat Pump Injection Private residence, single family Outfall NULL Scheduled Issuance Central Files: APS_ SWP_ 05/06/10 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Michael Nicholson Van Hoy Owner 118 Lake Ct Chapel Hill NC Major/Minor Minor Region Raleigh County Orange Facility Contact Affiliation Owner Type Individual Owner Affiliation Michael Nicholson Van Hoy Owner 118 Lake Ct Chapel Hill Public Notice Issue 05/06/10 NC Effective 05/06/10 27516 27516 Expiration Waterbody Name Stream Index Number Current Class Subbasin 3 NA NCDEN R North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Michael Nicholson Van Hoy Robin Lynne Van Hoy 118 Lake Ct. Chapel Hill, NC 27516 Coleen H. Sullins Director 5/7/2010 Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System Permit No. WI0500253 118 Lake Ct. · Chapel Hill, NC 27516 Dear Mr. and Mrs. Van Hoy: Dee Freeman Secretary On April 28, 2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onl y 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 15A Section 2C Subchapter .021 l(u)(2). Additionally, you should contact the Orange 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 (919) 715-6166 or Michael.Rogers@ncdenr.e ov if you have any questions. ~ -&-~~ fo, Debra 1:1 Supervisor cc: Raleigh Regional Office -APS APS Central Files -Permit No. WI0500253 Orange County Health Dept. Kevin Letchworth (NW Poole Well Co., P.O. Box 1958, Wendell, NC 27591) Bill Evangelist (Evangelist Service Co., 1117 Batchelor Rd., Apex, NC 27523) 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: FAX2: 919-715-6048 \Customer Service: 1-877-623-6748 Internet: www.ncwaterquality.org An Equal Opportunity I Affirmative Action Employer None C . orth arolina Jvatural/11 i NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATCIRAL RESOURCES NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL WATER -ONLY INJECTION NMI, SYSTEM TYPE 50W WELL4S) In Accordance With -the Provisions of NCAC Tulle 15A OZC.0200 Print or type the required information and mail to address on the back page. DATE: r 2� 2t1 Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in continuous piping that completely isolates the fluid from the environment (i.e. closed -loop)? Yes / Continue completing this form. No Do Not complete this farm_ Complete other UIC application forms for installing either a 5A7 well (oven loop well infecting potable water into the aquifer) or a SQM well (closed - loop well containing additives such as R 22, ethanol, or other antifreeze or corrosion inhibitors). A. PROPERTY OWNERS)/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 wlauthority for signature): M NL C N V Cam-- \ -\ tor L ii t. ti"A- \ m (1) Mailing Address: 1 A L.G k t CA r Car C— H 11 State: (-Zip Code: 2~75-i 6 County. Oro-.' V— W/no/Office Tele No.: (lck�`V7-S5- tS 0 10 Cell No.: (cl �4� - "7 -i $1 email Address: 7-1 "v An1 Ut fl Website: (2) Physical Address of Well Site (if different than above): City: State: Zip Code: _ _ County: Home/Office Tele No.: Cell No.: B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property_ attach a letter from the property owner authorizing Agent to install and operate UIC well) Company Name: Contact Person: EMAIL Address: Address_ City: State: T.tp Code: County: Office Tele No.. Cell No.: Website Address of Company, if any: i ti~tivtu►DbNRIDvNQ Aquifer Prntectjon Section APR 38 2018. C. WELL DRILLER INFORMATION Company Name: A/ t''') Pop E cc Well Driller Contractor's Name: JR e 5 NC Contractor Certification No.: 2 8 33 A Contact Person: Kit ti Lam CN w00-1f EMAIL Address: fetch wio(¢ k 6) Nwetow Ave- ceo" Address: Q • 1.0l- 19 S$ City: l,L7ex+O L C Zip Code: 27 S ) County_ W 19.ke Office T e l e No.: Ili- 26 6- 9 2 23 Cell No.: D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: EV14 ecISs S 'iZ c4D Contact Person: $I e c cif g N G EMAIL Address: evil n gel ta be 1lsh„ 1 . aef gla Address: L 1 t"i g 4T CFI e'c. aw City: ./loth° Zip code: 27f23. County: Cltgf#4,., Office TeleNo.: 91g-362-78t° CellNo.: 919- Alit -2IS- 7Yz2 E, STATUS OF.APPLICANT Private: i Federal: Commercial: State: Municipal: Native American Lands: F. INJECTION PROCEDURE (briefly describe bo* the' injection well(s) will be used) Tr ew Fk -•-7 Ne G. WELL CONSTRUCTION DATA (I) Proposed date to be constructed: 5 (7— 2'°1 ° Number of borings: Approximate depth of each boring (feet): 3) G (2) Type of tubing to be used (copper, PVC, etc): e. 0 !o t y 11), t (3) Well casing. Is the well(s) cased? (check either (a.) Yes or (b.) No below) (a) Yes if yes, then provide Casing information below Type: galvanized steel black steel plastic other (specify) Casing depth: From to feet (reference to land surface) Casing extends to above ground inches (b) No (4) Grout Info (material surrounding well casing and/or piping): (a) Grout type: Neat Cement Bentonite Y (b) Grout placement: Pumping 1" Pressure (c) 3 Grout depth of tubing (reference to land zrface): from If well has casing, indicate grout depth: nom Other (specify) SA n+f7 Other V to (feet) to (feet) H. INJECTIONS -RELATED EQUIPMENT Attach a diagram showing the engineering Iayout or proposed modification 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 copies of maps showing the following information: (1) 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 wells) or waste disposal facilities such as septic tanks or dram fields located within 200 feet of the geothermal heat pump well system. Label all features clearly and include a north &row. (2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed reference points such as roads, streams, and/or highway intersections. J. CERTIFICATION Nate: This Permit Application must be signed by each person appearing on the recorded legal property deed. "I hereby certify, under penalty of law, that l have personalty 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 information. 1 agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and all related appurtenances in accordance with the)pproved specifications and conditions of the Perin Sig a_iuurc of Property Owner/Applicant Ml CAA 1 C o o'h U Cin.. 0 '--1 L0 �N �� Print or Type Full Name and lick: 1.F1 Signature of Property Oij' Print or TypA Full Name and title Signature of Authorized Agent, if tiny Print or Type Full Name and title Please return two copies of the completed Application package to• North Carolina DENR D W Q Aquifer Protection Section-UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 733-3221 Vv•••r•m. • • • •a.• -••••a•• •r• • ••• a•••r•• • ONCE WOW I -J.93:?3I IMPROVEMENTS PERMIT .tPINBOLR FRANK 5/L1 ESTES DR CHAPEL HILL NC a7514 ,,,ae 929-2179 con 05. 31. B8 PAI 976B-70--2033 wC A C PARTNERSHIP PD BOX 835 CRRRBORU NC 27510 mummmada 7. 116M.. 4R ouEur-�mnr+s � TO BUILD 4 DR SFD iocnnw r memo• *tan PHASE 2 LAKE WDUDB 027S58 corms aar nLeFOR *BEDRM9 ____ z.TANK lab_ REMARKS: DISPOSAL _id _ Sr. CHAMB OTHER TYPE.SYS d NITRIFI VAl. _ OPER. REG Hai Cat Cnr DATE.ISSUED � SANITARIAN _ _ Y SANITARIAN DATE.APPROVED //-30 S19 in.w nw 'x.u.. aaellr In.c wI. w... awl i rW66. +r rerrssCI!. el p.. 4Z.7..ld.tlU ,Artagi n•+ n,n y — S sat .wr• ... �... el....mg. .24.27444( '—?� --- -{hfvery CnQrr[AV--- Q► ms•A. Mf i GN^ref /�...e} ('rrE. y OE: FLO:HARI, VTFI ICY L if Ken VW FFill' MI6 Woo Ccwre puve1 I1i11, Aticoh CCa- U1H iftr T]r ELANeyan.'e JOH / C. ATINS P.DFEssaDNAL LAND SURVEYOR 3016 CRRICEMEOR ROAD U1I5 IA . ROM{ C R IJNA zr7 3a3-ssjs SMILE. I•, •. . eaTEI AT, Liu Iwo &pa, 77_ PFuIL-, TWQ, , SIwll, era ..Cart s�ners_cr.... . RAT WOE, 04T .. N9£:. Pr7 OPsnas Lawn mover CATE Ptli }{apn IMPROVEMENTS PERMIT sue PINGOLA FRANK Set ESTES DR CHAPEL HILL NC 27514 wmftmE 929-2179 TO BUILD a BR sFD Lounm/mmumm IBA PHASE a LAKE WOODS PM 54 02796B L[NUFrvAl2 W' n.tuvm. #BEDRMS _ q___ S2. TANK REMARKS: DATE_ RPPROVEO AI ' 98 65. 31. BB 576B-7B-2033 wrest C & C PARTNERSHIP PO BOX 835 CRRRBORO NC 27510 7. 115M.. 4f OTHER - TYPE.BYS th I NITRIFI' 1,E4Y4 OAER. REO r/.1=I Ws. '.. MM., enmity 11.44 WE .... • ........4•1.• tem ••1 .......F. as., Es& 4.-.1•[ 44 ,..e.,, ••.• p••••4•Fl4n e4zu•let in Fad* ...4.. j4•4_&l. el.• •41.1. a melsten •• colc.....1 ly_LIEWIEr1. 4. 4 v.. ac.........r.m. oft., F:4•1 14I•••• •••••••••F .-,, xpeemm. Al - el -.S ..* rms... Vi....••• , 44-2I bad - -,•:•_•-• 4,_ • .4' __ _. faM_. .--e __--.A2.11COtt— '2 f sc.ai. .gertfikeK ..7,LUE1113.— Acovir • 7:" • • -4:44at.,••• •••• i fe -, i ; • / , l i 1,,,,A. 1 .... . , 1 1 , .e. ' . "4 i 1 t V. i 4 ,9 / 417..f 4 i' I t 1 c p x 1 d : il . ) , . ,.. r I , Z / 1 i It I I 1 . - ------ -,... _.--------- ------- It r..4' FIVOCtli•Fg Ca ca.,-,...... JOHN C. MINS P.Ostssiowd. LIMO 5114VETIN? SOS OIANCDAOSO ROAD CAM1-1Am, NOrli CAROLINA 27112 411CFMEM.Pai WV 4 WU. R3OIN MI NUe .f...'' . 363-6937 I toperty Or: MI lake 0.1.re: F. OOP Lar ed0.,..,,Al,i . KM' ----• FM F•1..,••10. AA! R Fl.rt 1111.4131 Hu!, liarb Cl.n.• Lual 4114Sh WP „, R_Adx.reCO%-f?".4/ .. FM-. OW . • COPNII maim NORTH CAROLINA DEPARTMENT OEENVIRONMEN?? ANDNATURALJ~.ESOl)RCES NOTIJITCATION OF INTENT TO CONSTRlJCTA CLOSED-LOOP GEOTHERMAL WATER..:ONLY INJECTION WELL SYSTEM TYJ>E S OW WELL(S) In Accordance With the Provisions.ofNCAC Title 15A 02C.0200 Print or type the required information dild mail to address on the back page. DATE: {kriJi 21 • 20-1.D Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in continuous piping that completely isolates the tiuidfrom the environment (i.e. closed-loo p)? Yes ✓ ·Continue completing this form. No . DoN<J!: compl~ this·form. Complete other UIC applicatiot1 forms for installing either a 5A7 well (open-loop well injecting potable water into the aquifer) or a SQM well (closed- loop well containing additives such .. as R-22, ethanol, ornther antifr~ze or corrosion inhibitors). A. PROPERTYOWNER(S)/APPLICANT(S) List each Property Owner listed oil property deed (if owned by a business or government.agency; state name of entity and a representative w/authority for signature): · fv'\ \. c.,,\..,-.. ~ N . , LlA o \ "> U v-.. V Cvi-\\o~ R-o\1 \ N · ( 1,,1 l'-J r-J~ \}t0:3 \-\.,'":s (1) MailingAddress: __ 1_~~· ._:i~-~--~0\_· _·_, _______ _ City: Gi-v,--£-<A \-\ ~ \ \ State:~ tzip Code: '7-7 57 G County: C,ro-1J5t-- J4ome/Office Tele No:: (q \ ~") ~:,'15-"tSO \ 0 Cell No.: · · . . R61o·1'"1\I AN \-1.0'( J;:mailAddress: .. · .· Website: · , ~5Mc...U, cc""' ( s v•C) ~s,-\~,~ (2) Physical Address of Well Site (if different than above): _____________ _ City:--~------State: __ Zip Code: ______ County: ____ _ Home/Office TeleNo.: --------------,'Ce~ll_N~o~.: _________ _ B. AUTHORIZED AGENT OF OWNER. IF ANY (if the Permit Applicant does not own the subject propt.my, . .· attach a letter from the property owner authorizing Agent to install ~d operate UIC well) Company Name: ___________________________ _ ContactPerson~=------------~E=MAIL==·=A=d=dr=e=ss==---------- Address: _____________________________ _ City: ________ State: __ Zip Code: _____ County: ______ _ Office Tele No.: Cell No.: Website Address of Company, if any: _____________ _ C. WELL DRILLER INFORMATION Company Name: AI t.+J 491)0ce L,Jg cc Co - Well Driller Contractor's Nance: _ 34 $M e r P . ]' .ves' NC Contractor Certification No.: 2 8 33 F Contact Person: get, = ti L61-01 wet EMAIL Address: 'etch r+1, NW Qweg 4,e/%Cv k, Address: �-O of. 1 S'$ -- - City:gwriL'Lt Zip Code: n7C 31 County. W14Icig Office TeleNo.:1irj-2b4- 92z� CellNo.: D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: Ell iaw(o EciSi-0O2.1-11cL W Contact Person: 6► „- Ed rd G er/93" EMAIL Address: evil.' seI W el5e /J'o h . Address: 101 t"7 $t4T C K tc aw Po0,6 City: Re (2). Zip Code: 2?f23 County: Cli+71114r+ Office TeleNo.: 9/5-3b2-7Q►a CellNo.: €0-W`21S 7Y2z E. STATUS OF APPLICANT Private: )( Federal: Commercial: State: Municipal: Native American. Lands: F. INJECTION PROCEDURE (briefly describe how the injection well( s) will be used) yo G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: $ f ay's' Number of borings: 3 Approximate depth of each boring (feet): 33 0 (2) Type of tubing to be used (copper, PVC, etc): e (.74 ti ?a a Y 'g- M7 c �� (3) Well rasing. Is the well(s) eased? (check either (&) Yes or (b.) No below) (a) Yes if yes, then provide casing information below Type: __galvanized steel black steel _ plastic other (specify) Casing depth: From to feet (reference to land surface) Casing extends to above ground inches (b) No } (4) Grout Info (material surrounding well casing and/or piping): (a) Grout type: Neat Cement Bentonite f Other (specify) ..14~ (b) Grout placement: Pumping t7 Pressure Other 0 (c) Grout depth of tubing (reference to cant nrface): from 0? to (feet) If well has casing, indicate grout depth: from to (feet) H. INJECTION -RELATED EQUIPMENT Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior piping/tubing associated with the injection operation_ The manufacturer's brochure may provide supplementary information. L LOCATION OF WELL(S) Attach two copies of maps showing the following information: (1) Include a Site Map (can be drawn) showing: buildings, properly 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 suck as septic tanks or drain fields located within 200 feet of the geothermal heat pump well system. Label all features clearly and include a north arrow. (2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed reference points such as roads, streams, and/or highway intersections. J. CERTIFICATION Note: This Permit Application must be signed by each person appearing on 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 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 information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and all related appurtenances in accordance with the approved specifications and conditions of the Perm) }" SigEisture of Property OwuerfApplicant II ++ l' 1 CAA 6,r..A 1 Lk\ O S 01r1 o LAJti Print or Type Full Name and title Signature of Property erlApplieant Print or Type Full Name and title Signature of Authorized Agent, Wary Print or Type Full Name and title Please return two copies of the completed Application package to: North Carolina DENR DWQ Aquifer Protection Section-1JIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 733-3221 V9203I IMPROVEMENTS PERMIT • SPINGOLA FRANK 501 ESTES DR CHAPEL HILL NC R7514 929-2179 wn 05.31.83 ei MAP !VOA WE 9768-70-2033 7.116M..4A W M C & C PARTNERSHIP PO 80X 83w CARRBOR❑ NC 27510 aECACJIIowa TO BUILD 4 BR SF"b wunMi o *IBA PHASE 2 LAKE MODS iEE RECOPY: 541 CONCF6 13 ar MNNEk 027968 #BEDRMS _! Sz. TANK 1 _ REMARKS_' DISPOSAL__ SZ. CHAMB OTHER TYPE. SYS thn( iVITRIFIf.�� :' OPER. RE£} DATE. I SSUED DATE.APPROVED i/-36- 48 roP 9-9 SANITARIAN 1.5.u•� SANITARIAN Y.,1, &J .0 .pMh•. ..la. M e. .., ..a.... ksa.t. in two. Gina, AO mrT= Y4 W qi�M .M w+t =Q 'M.. Mfk aNF; .1YM. Y`/fpYd/A! s/ 7 .OfIL ' +• j ar fLE-e '°— -- 44 'r �iak4rrr µ--me { Y - f ,S/w.y£x JOHN C. ATKINS Pr6EE6583NIL IARO SW /E70R ' 3W; qi.FIRCE1420.1 ROAD ouwnar, CaRalllaS 2712. 363-8938 I-operta OF, intsp a. V7W rot G wL4 WEIR tom tux arALE. r. r . CAT[ .4.0 s-H^: Las Coat. LOT I.o.r_9A1:4 rPC.• propel All, North Camila; Elwk wog*, . -. . FUT ea, irn.. AWE. . .. ON . �� [WRIT REGISTRY a • 9203I IMPROVEMENTS PERMIT �k: esr� tPTNBCILR FRANK 501 ESTES DR CHAPEL HILL NC 27514 momme 929-2179 .mw t TO BUILD 4 RR SFD IK.RgNIPAWmom %18A PHASE 2 LAKE Worm 50 027968 ppvrIMED ay A.u0101 05. 31. /38 �frY.�1 p. 976R-70--2033 um Err C & C PARTNERSHIP PO BOX 835 OARRBORO NC 27510 MAP INFAREACk 7.116M_.4R #BEDRMS _44 _ DISPOSAL _A__ OTHER ` TYPE.SYS _P,b►� ` TiS _.. SI. TRNft 1 {�_ SZ. CRAMB �_w NITRIFI c_d' 16 ' OPER. RED _____- REMARKS:- r 0+Qa�'6 )4. W don 5 DATE.ISSUED _ � 3,-'Cad ❑ D TE. APPRDVED /1—. 6 1,4 SANITARIAN SANITARIAN ''..V ,..,I, C.to I Y f.r e! �_. 2. Q i L•F +- mx1w. �w�w,4YwaI �r rrJ.0 v.v Ws,.ua. —LEGENDAm fin Iwpe![y OE; MICkIE2. VAS 112T G wit* Mari YAI I.3? fi14 Weer mat 0 JONN C, ATXLNS >'�•1 EsarmAL LAI1 sum�cmn 3016 CIANCEMIM ROAD ULLWl. NCRRt rA,FtmINA �17 1l3- 35 al. P S w lr/rc. YdrPs drwur tounry NEMO r