WI0500265_GEOTHERMAL_20120518

Beverly Eaves Perdue
Governor
N~C~DENR
North Carolina Department of Environmentand Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 18, 2012
John and Anne Hodges-Copple
1104 Watts Street
Durham, NC 27701
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WIOS-00265
Dear Mr. and Mrs. Hodges-Copple:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title ISA Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.org/web/wq/aps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raieigh, North Carolina 27604
Phone: [phone] I FAX: [phone]
Internet: www.ncwaterguality.org
An Equal Opportunity\ Alhmative Action Employer
One . North Carolma
/vaturallv
Permit Number WI0500265
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM}
Primary.Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
John & Anne Hodges-Copple SFR
Location Address
1104 Watts St
Durham
Owner
Owner Name
NC 27701
John Hodges-Copple
Dates/Events
Orig Issue
06/21/10
App Received Draft Initiated
05/19/10
Scheduled
Issuance
Central Files: APS_ SWP_
06/21/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Afflllatlon
Ryan Brazill
72 Wester Way
Bunn
Major/Minor
Minor
Region
Raleigh
County
Durham
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
John Hodges-Copple
1104 Watts St
Durham
NC
NC
Public Notice Issue
06/21/10
Effective
06/21/10
27508
27701
Expiration
05/31/15
_R_e .... gc..:.u:..:..la=t:.c:.e..::cd-'-A--'-c"-'t:..:..iv'-'i_;_;ti...;;.e..;;..s ________________ ""R=e=g=u=e=s-=te=d=/~R=e=c=e~ivc..ce=d=--=E=v=e.c.=n=ts"--__________ _
Heat Pump Injection RO staff report requested
Outfall NULL
Waterbody Name
RO staff report received
Additional information requested
Additional information received
Stream Index Number Current Class
06/04/10
06/07/10
06/07/10
06/10/10
Subbasin
Permit Number WI0500265
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Coastal SW Rule
Pennitted Flow
Facilitv
Facility Name
John & Anne Hodges-Copple SFR
Location Address
1104 Watts St
Durham
ner
Owner Name
NC 27701
John Hodges-Copple
Date s/Events
Orig Issue App Received Draft Initiated
05/19/10
Regulated Activities
Heat Pump Injection
Outfall NULL
Scheduled
Issuance
Central Files: APS_ SWP_
06/14/10
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Ryan Brazill
72 Wester Way
Bunn NC
Major/Minor
Minor
Region
Raleigh
County
Durham
Facility Contact Afflllatlon
Owner Type
Individual
Owner Affiliation
John Hodges-Copple
1104 Watts St
Durham NC
Public Notice {() f atr1u Effective
Reauested/Received Events
RO staff report requested
RO staff report received
Additional information requested
Additional information received
27508
27701
Expiration
csf 01f JS
06/04/10
06/07/10
06/07/10
06/10/10
Waterbody Name Stream Index Number Current Class Subbasin
4"el'A -8-1!~~
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
June 21, 2010
John and Anne Hodges-Copple
1104 Watts St.
Durham, NC 27701
Dear Mr. and Mrs. Hodges-Copple:
Subject: Issuance of Injection Well Permit
Permit No. WI0500265
Issued to John and Anne Hodges-
Copple
Durham County
Dee Freeman
Secretary
In accordance with your application received May 19, 2010, and additional information received June 10,
2010, I am forwarding Permit No. WI0500265 for the construction and operation of a vertical closed-loop
geothermal mixed-fluid heat pump injection well system to be located at the above referenced address.
This permit shall be effective from the date of issuance until May 31, 2015, and shall be subject to the
conditions and limitations stated therein.
Please pay special attention to Part VII.2 of the permit and submit copies of the Well Construction
Completion form (GW-1) within '30 calendar days of completion of installation ofgeothennal well(s).
Additionally, your UIC system is subject to inspection by the APS. Per special condition Part 11.3, in the
event-that there will be multiple wells with separate clusters, one well identification tag per 'cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 15A NCAC 2C .0213(g).
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to , and approval by, the Director of the
Division of Water Quality. If you have any questions regarding your permit or the Underground Injection
Control Program please call me at [phone].
cc: Jay Zimmerman -Raleigh Regional Office
Central Office File -WI0500265
Durham County Environmental Health Dept.
Ryan Brazill -Brazill Drilling Company.
Attachment( s)
Sincerely,
~/2,. ---
Michael Rogers, P.G. (N:2L)
Environmental Specialist
"NORTH CAROLINA
ENVIRONMENT AL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL 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
John and Anne Hodges-Copple
FOR THE CONSTRUCTION AND OPERATION OF 3 TYPE SQM INJECTION WELL(S), defined in Title
ISA North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at 1104 Watts St., Durham, Durham County,
NC 27701, and will be constructed and operated in accordance with the application received May 19, 2010, and
in conformity with the specifications and supporting data submitted June 10, 2010, all of which are filed with
the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and • ;0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until May 31, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX thereof.
Permit issued this the 21 nd day of June 2010.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit WI0S00265 UIC/SQM
ver. 03/2010
Page 1 of S
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
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 not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART II-WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone], and the Raleigh Regional Office Aquifer Protection Section Staff, telephone
.number [phone].
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation comers) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or 'cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III-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.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (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.
Permit WI0S00265 UIC/SQM
ver. 03/2010
Page 2 of 5
, PART IV -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it 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 Water Quality 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
ground water 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
Pennittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program 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
conditi'ons .
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality 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 . Division 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.
Permit WI0500265 UIC/SQM
ver. 03/2010
Page 3 of 5
PART VII-MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section -UIC Program
DENR-Division ofWater Quality
1636 Mail Service Center and
Raleigh, NC 27699-1636
Ph# 919-715-3221
Aquifer Protection Section
Raleigh Regional Office
3800 Barrett Dr.
Raleigh, NC 27609
[phone]
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Raleigh Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Raleigh Regional Office within 30 days
of completion of well construction.
4. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed.
5. 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 [phone] any of the following:
(A) Any occurrence at the injection facility that 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 ele'ctrical failures;
(C) Any loss ofrefrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. 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.
7. 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.
PART VIII -PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit WI0500265 UIC/SQM
ver. 03/2010
Page 4 of 5
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, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
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 15A 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 that 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.
(G) The Permittee shall submit a copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.I of this permit.
Permit WI0500265 UIC/SQM
ver. 03/2010
Page 5 of 5
Ro gers, Michael
From:
Sent:
To:
John Hodges-Copple [e-mail]]
Thursday, June 10, 2010 8:04 AM
Rogers, Michael
Subject: Watts geothermal permit WI0500265
Hi Michael,
Wanted to make sure that Walker Harris of SBS has gotten you the information you requested . (I trust he passed on that
there are no septic tanks or fields on the property or in the area ; the neighborhood has been on city water and sewer for
100 years!). Let me know if there is anything else we need to provide to you.
Thanks,
John Hodges-Copple
919-558-9320 direct
johnhc@t jcog.org
---Original Message ----
From: Rogers . Michael
To: [e-mail]
Sent: Monday, June 07, 2010 4 :05 PM
Subject: Watts geothermal permit WI0500265
Hello-
I am processing your permit for a geothermal well(s). Everything appears OK, except for one item-the
site map attached does not show the location of the geothermal wells in relation to structures, property
lines, and septic tanks/field, if any.
Please add the location of the wells in relation to the structure with distances of the wells to the house.
You can, if you like, scan, and reply to this e-mail as an attachment to expedite.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
1
Ro gers, Michael
From:
Sent:
To:
Walker Harris [[e-mail]]
Thursday, June 10, 2010 10:18 AM
Rogers, Michael
Subject:
Attachments:
FW: Watts geothermal permit WI0500265
Hodges-Copple .jpg
Michael,
Attached is a new site map that covers the items we discussed yesterday . Please let me know if you have any questions.
Thanks,
Walker Harris
919-291-2715
From: John Hodges-Copple [mailto:[e-mail]]
Sent: Tuesday, June 08, 2010 7:28 AM
To: Walker Harris; Brant Wurster
Subject: Fw: Watts geothermal permit WI0500265
Hi Guys,
see email below. Can one of you get up with Michael today and get him a version of the site map with the location of the
wells. Also let him know that there are no septic tanks or fields (house is on city water and sewer and has been since the
early 1900s --we had the joy of replacing the sewer line to the street a couple of years ago). There are no septic tanks or
fields on adjoining lots either. Here is Michael's contact info and a version of the site map is attached. Please let me
know when you have satisfied his request.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
michael .ro gers @ncdenr.gov
Walker, when it is convenient, give me a call on my work land line (558-9320) so I can catch up on progress and next
steps on the spray foam, in the downstairs rooms, the final elements of the duct work (downstairs bath, kitchen and
remaining vent in family room), the two returns downstairs and whatever needs to run in the chase that stretches from the
basement to the attic. So we don't hold up Doug's progress on the storage that will include this chase , I'd like to get
whatever goes within the chase installed relatively soon. Would it make sense to meet out at the house soon (I can do
tomorrow [Wednesday] morning from as early as you'd like until 8:40 am (I have a meeting in downtown Durham that
starts at 9).
Please note that Anne and I will be out of town June 30 through July 18 and not reachable at all from June 30 through July 9 as we will
be out of the country.
Thanks ,
John Hodges-Copple
919-558-9320 direct
[e-mail]
-----Original Message -----
From : The Hodges-Copple's
1
To: [e-mail] ; [e-mail]
Sent: Monday, June 07, 2010 7:50 PM
Subject: Fw: Watts geothermal permit WI0500265
-----Original Message -----
From: Ro gers , Michael
To: [e-mail]
Sent: Monday, June 07, 2010 4:05 PM
Subject: Watts geothermal permit WI0500265
Hello-
I am processing your permit for a geothermal well(s). Everything appears OK, except for one item-the
site map attached does not show the location of the geothermal wells in relation to structures, property
lines, and septic tanks/field, if any.
Please add the location of the wells in relation to the structure with distances of the wells to the house.
You can, if you like, scan, and reply to this e-mail as an attachment to expedite.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
[e-mail]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
____ Information from ESET NOD32 Antivirus, version of virus signature database 5182 (20100608)
The message was checked by ESET NOD32 Antivirus.
ht tp ://www.eset.com
____ Information from ESET NOD32 Antivirus, version of virus signature database 5187 (20100610)
The message was checked by ESET NOD32 Antivirus.
http ://www.eset.com
2
e S Rr
arp '.
„.•r .1 a ..re r +
g:7 pF.
ro
w
▪ il•
▪ • s • 1
a
L
•
✓
/ ry
sAl
J.
ti
t
4
4
•
t
t
r
w
r.L r��A..• ._.
c

Ro gers, Michael
From:
Sent:
To:
Subject:
Zimmerman, Jay
Monday, June 07, 2010 9:21 AM
Rogers, Michael
RE: WI0500265 Copple
Go ahead and issue as we don't have time to inspect this one unless there is something unique about it.
Jay
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third patiies.
From: Rogers, Michael
Sent: Friday, June 04, 2010 4:21 PM
To: Zimmerman, Jay
Subject: WI0500265 Copple
Jay-
Attached is a SQM application. Let me know if you wish to conduct a pre-permitting inspection.
Thanks
Michael Rogers , P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] {put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
1
~~A a.;,,_·~-·~ -
CDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
June 2, 2010
John Copple
Anne E. Hodges-Copple
1104 Watts Street
Durham, NC 27701
Subject: Acknowledgement of Application No . WI0500265
John and Anne Copple SFR
Injection Mixed Fluid GSHP Well System (5QM)
Durham
Dear Mr. & Mrs. Copple:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on May 19, 2010. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information_ if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 -90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to http ://h2o.enr.state.nc.us/documents/dwg orn:chart.pdf.
·· PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
o~~
for Debra J. Watts
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Brazill Drilling (Ryan Brazill-72 Wester Way, Bunn, NC 27508)
Sustainable Building Solutions, 4608-L Industry Lane, Durham, NC 27713
Permit Application File WI0500265
AQUIFER PROTECTION SECTION
1636 Mail Seivice Center, Raleigh, North Carolina 27699-1636
Location : 2728 Capital Boulevard , Raleigh , North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet: www .ncwaterguality.org
M Equal Opportunity I Affirmative Aciion Employer
No~i..c ,. 01u1 arouna
-Jvaturall!f
NORTH CAROM
DEPARTMENT COT ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT ANDIOR.USE A (8) FOR
INJECTION 'PUMA GEOTWERMAL-i'EAT PUMP SYSTEM FOR:
TYPE 5QM WE I4S t
New Permit Application OR Renewal (chi one)
DATE: I I` . 111 rF )
mAMIT idO. 1ar c5 cQxp 5 (km blank if NEW permit application)
�. PROPERTY OWNER( !APPLUCANT(S)
ate e_c Property Deno listed on property deed (if ownedby a braines.s or government agency, state -name of
amity and a rep tafiVe �v/mit ority for signatttc "sv A) % k �;� A 11 L
r_
(1) Mailing A I I v 4i L ff �- t
Ovv 4 ,., z z 7O ( County: 10//e414411.,
Hamei4ffioeTeleNo- 9'17-Ls"?-7S70 C 11)o.t 71 �3
(2)
.».Ali. Address: COW L @ tjn E air .r Gt v ,CG rrr�
P1i.yyic l Address of Sire Of different than above): ,. .
C�aA�►: Etatec Zip Coax Crony:
HometOlfwe TeleNo.: t�ellNn,:
FMAIf, Address;
S. AUTHOR AGENT OF OWNER, ANY (Tribe Pernui-t Applicant does mot own thissubject property,
aitgch a letter from the property awn r authorizing Agent to install and operate WC welt)
Company Nettie:
C remote EMA L Address:
City: S1at= hip Code: County:
Office Tele No.: Ceif : q a,.
Websitc Addy ss of Company, if any:
SIAM OFAPPLICAAC'
Ptttate: Eedetal.:
State:
Municipal: Na American Lands
RECEIVED I OENR I Uvi
IOIIFFFt'PRmpr..mi ' 9 CTJON
MAY 191L ftJ

D. WELL DR iT mil INFORMATION
Company Name: t' 1�' D h ) r► f ) 17 n ci
Well Drilling Contractor's Nur= 1,1j$ . - Pf tZ L
NC Cor actrs Cerramstion lie,: `T •''
Contact i r ' a �Ii adds:
Adenem 7P.1„;,-c-tce
.- _9.76d Scow*: kt
4121ceTeleNo.: ° �' yg � Ccu�vcx: 1 '7•-' 7A LJU g.a
BRAT PUMP CONTRACTOR INFOILMATION i ntiban dsilte
Company Name: S L5fig4 T)it 1: r9 5.otoTlo
Contact Pets= a Nth
BMA.U. Address;
etty: O o f h im ZipCodez a 7 713 �u �'h•.-�-�
OEee Tele Na.: ci# -1 3;• 1 1' 1_8 5-ce No.:
$ nCTIDN PIWCRBORFt (briefly dcscriib how tte it ection yell(s) will he used)
A J
G. WELL CONSTRUCTIONBATA (skip to Seettre H thin is a Petty RENT-414
(l) Proposed dry to be canstruud: n Number of baring= S
Approdrazon depth afeacb bcriag (feet): 2 h
(2) (Metaled additives to be used in closed -loop s (only those chemicals ira icab d have been approved):
R-22 ____penplede glycol ethanol < ka?, other (other additives will
need prior annoval by NCOENit before
(3) Type °fishing to be used (copper, PVC, de): r }ye. f -
t4) W elt casing, is the mell(s) cased? (check either (a_) vrs or (b.) NO below)
(a) YES _ ifyes, then psavide casing infosnsarasm stzb as Das (ieei, PVC, plastic, etc.), disputer
Geis, and egg& of casing appearing above grid: _
(b) NO
(5) Grunt (wreak snr;aesetiing welt eat ae.dPer pipir }=
(a)
(b)
&oust type: Cr-MEW Re aeiie _ aim (specify).
Grunt depth afttbiixs (reference to imtd starter): from % to _ feet)
If well has ening, intricate groat etie &oat (
E TTJTCTEON-REL TEDEQUIPME T
dtta h a diagram showing the engineering *ant orproped modification of the injection equIpmect and Paz
piping/tubing erasuukticd with. the Unction operate. The manefactuser's broa uTe rney amide supple nentr y
information.

I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information..
(1)
Include a site imp (can be drawn) showing: bnEdings, property lines, surface water bodies, porerrttai sources
of groundwathr contamination and the orientation of and distances between the proposed wslI(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields Luvacted within 1000 feet of the
geothermal. heat pump well system. Label all features clearly and include a north mow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate a facility's Location and the map name.
3. POTABLE 'WATER WELL(5)
Are the any patable water well(s) on the subject property or adjacent properties? YES _NO
IfYes, than indicate location on attached map(s).
K. CEI.TIFICAT1Oi
Note: This Permit Application must be signed by each person appearing on the recorded legal progeny deed.
"I hereby certify, under penalty of taw, that I have personally examined and am familiar w th the information
submitted in this document and all attachments thereto and that, based an my ingrdry of 'those individuals
immediately responsible for obtaining said inforruation, I believe iliac the information is true, aeauate 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, nperaxe, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the eel sty =dons and conditions of the Permit?'
�,-°
S igierure of Prrc erty Owi Applicant
\ft, Utz t O i.
?mint or Type Full N r 1
•2 T
Signature oProp pwner/AtiejeltI
Print or Type Full NaIe
r;•
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two conies attic completed Application paclage to:
North Carolina DENR-DWQ
Aquifer Protection Section
UJC Program
1636 Mail Service Center
RaiTigh, NC 27659-1636
Telephone [phone]
RECEIVED 1 DENR 1 DW4
AQUIFgP PRnTr—rInkl SPCTIOH
MAY 19 1010

�ry
_ -- /
— �
},
-- —
.i�
•
▪ 1.6
I *
\ � !
L
ft

r,
itno;bilii$ Olovm en th% rOp are faasolpipani0/111
• •
-, • •
fletd:**it Wid Irit nO erk4qactiovienti'aiii 404itiftAikr-,
Islweenkoefent4,0QuiviSas trwirottetry kni00011 we* taken *Iiitc
6 - ./4 0 x • .:-. - ' 0
1147)Fort.......ay 01 . 0: . , . 7 , . , IF - 7 • N . a,
- ktgistOeii 45nd wikliar !,',YAVI.4.4' . i, ., -
tt ihi
pa fr/om i.c,r , 1
ost iN RIAU PUT
Z WI Nil ffilAROdUllegg.
5 8141)8e ••••• .. . s=ale V
.( - ON Pai • to
as. off'
1 I ; SEAL .1
ri'ss' .1 4, e3 tif ./„Rir
,Z41. °.1 .---'Cl---4)./.5` 11- s. 3z1 1'T-lin' I
c 0.7
44,,:;;•;;;,;x...4.N..az,4511? #r - •
1/4 4 t 511%cl, A- zz'
GA Ad•(Ptter, ariA) La r
. - • -
_T:
.._..tiv.:_...fr- x t
rap NC — 144111W44 , •41
It
FR.--4,#•$e
p 00Z t
ViS WiwiLutidAOPOY
DMial (01303t
frd 07' 4' IA(
or. 7-/.1 PA,
F49 z 7
, •
fa Per Aim tor
woop Ok.
10.7i
ARV/4k./ Y 0 • e •
RAN NopAPE ofetz
por.7.617.00fLtiT
=,Ai 4 7 - •
it? Lille:0,04 :014/...4/.0r paftwApif • 61t,
1••;,1 0 V. 4 1115 $.0u4";
Q Az A re*
2) I 7 .gtf CV/

1104 Watts St. Durham, NC - Google Maps
http://maps.google.com/
Googie maps Address
tV nVM`01.13-56 Mai
yy
To see all the details ihat are visible on the
screen,use the "Print" sink next to the map.
1 of 1
5/21/2010 1:07 PM

1104 Watts St. Durham, NC - Google Maps
http:I/maps.google.cand
Goc. ,te maps Address
kidd 1100
To see al the details that are uisHle on the
screen.use the "Par link next to the rnap.
PSIkagi unk
1 ofl
5/21/2010 1:07PM

1104 Watts St. Durham, NC - Goegle Maps
http://maps.google.com/
Gopgk maps
eps Address
To see all the details that are risible on the
screen,use the 'Print" link next to the mail
Senci Lint
2
Green s! ...- cxean s2-
_Wrist— ??.4?.._7
Graceiat,mar
c1v+t,
Green al`...-..� .�.....
calm Goode- mp dt. 02010 c oonte-
Brae r z
NOLt3.4. Nul.L;id1L12ld• edlRO+tf OMOIeiN3Ol0/11333e1
1 of 1
5/21/2010 1:09 PM

1104 Watts St. Durham, NC - Google Maps
http: //maps . googl e. corm
Go -.gle maps Address
To see MI the details that are vlsbie on the
saeen.use the 'Print" ink next to the map_
Pit S L
ff
{
111
• j
al
lir
15! {;
n J • i
Avp
-• ikur7iirn '-
Nto
-17
!os!
DNI iirlus 81 -- rlus Sl •
-
-� ._. .
W MarthamAre
iwo
Z
st
-
g
2
W M rtharnhw
t
t ifi
Of
x&
=di Q C-angle - Map deia O'rosv cbo00 -
01,0Z g J.'dtN
aMo +
1 of 1
5/21/2010 1:09 PM

1104 Watts St. Durham, NC - Google Maps
http://maps.google.com/
Google maps Address
RECEIVED I DENR I DWO
AQUIFRR PRCITFflTI(]N SFCTIOl4
MAY 21 2010
To see all the details that are visible on the
screen,use the "Prbr Ilrtc next to the map.
Print
Send
61.
1 of 1
5/21/2010 1:08 PM

1104 Watts St. Durham, NC - Google Maps
http://maps.google.com/
Goog k maps Address
MENU f DEW I DINO
AQUIFFR RRr Tr.T N S CT1ON
MAY 1 M
To see all the details that are visible en the
srreen,use the "Print" link rim/ to the map.
Ltd Lux{ Liois
1 of 1
5/21/2010 1:07 PM