WI0500282_GEO THERMAL_20100806

Permit Number WI0500282
Program Category
Ground Water
Permit Type
..
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
4420 Lunsford Drive
Location Address
4420 Lunsford Dr
Durham
Owner
Owner Name
Daniel
Dates/Events
NC 27705
Barker
Orig Issue
08/06/10
App Received Draft Initiated
08/05/10
Re g ulated Activities
Heat Pump Injection
Outfall NULL
Scheduled
Issuance
Central Files: APS_ SWP_
08/06/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Stephen M. Bowman
President
145 Technical Ct
Garner
Major/Minor
Minor
Region
Raleigh
County
Orange
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Daniel Barker
3233 Seven Springs Rd
Hillsborough
NC
NC
Public Notice Issue
08/06/10
Effective
08/06/10
27529
27278
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
Beverly Eaves Perdue
Governor
Daniel Barker
Jacqueline Barker
3233 Seven Springs Road
Hillsborough, NC 27278
NA
, · EMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
8/6/2010
Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System
Permit No. WI0500282
4420 Lunsford Drive, Durham, NC 27705
Dear Mr. & Mrs. Barker:
Dee Freeman
Secretary
On 8/5/2010, 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, cir
municipal rules and regulations may result in the as_sessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Rogers<alncdenr.1wv if you have any questions.
Sincerely,
0Ck½_6~
for Debra Watts
cc: Raleigh Regional Office -APS
APS Central Files -Pennit No. WI0500282
Orange County Health Dept.
Supervisor
Bowman Mechanical Services, Inc -145 Technical Court, Garner. NC 27529
N.W. Poole Well & Pump Co. -PO Box 1958, Wendell, NC 27591
AQUIFER PROTECTION SECTION
1636 Mail Service Genier, 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 \ Customer Service: 1-877-623-6748
Internet: www.ncwatergualitv.org
An Equal Opportunity \ Affirmative Action Employer
None, C 1. ortn aro.ma
/Vaturall!f
08/05/2826 16:48 9/97799294
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PAGE 012/05
NORTH CAROLINA
DEPARTMENT Ole ENVIRONMENT AND NATURAL RESOURCE
NCrlIFICATION OF INTENT TO CONSTRUCT A ' -O D-LDOP GEC
WAT}R-ONLY INJECTION WELL SY M
Xy'P . 50W W ELIAS
in Accordance With the Provision ofNCAC Title i 5A 02C.0200
Prml ..r type the required infrawiation curd ma to addreir 1 the backpage
HATE: ta a , 20 10
Weil rype Cnnflmactlax: roes the proposed system circulate amble water ottly (or
continuous piping that completely isolates the fluid from t
Closed-10 )7
Yes Continue complains this farm.
No Do Not complete this farm. Complete other [.TIC appl ir.Ation fi
either u 5A7 well (ojemt-loop well laistiao potable %oatei into the aquifer)
loop well containing faillito such as R 22, ethanol, or other antifreeze or
A. PROPERTY OWNS S)/APPLICAM (8)
List a Property Chimer listed cm property deed (if owned #y a business or govexnme
entity and a representative w/authmity for sigolotu4): j rf 1 ,et?,rrtr- r,
(1) Mailing Addicts: gaa"'13 Sg+ i P1
City: slip r L ape: Pe. Zip Code: dign
Home/Office Tale No,: q r'ttI -IC"? Ceil No.: g/9
Email Address: rilfh rC alip. Ctrs Website:
(2) Physical Address of Well Site (f diffemm than above): -Lit00 +l.ct►'l e+
City: boa YJ41 0'1 State: ,1dd Zip Code: "7
Home/Moo Tate
B. AUTHORS AGENT OF OWNER, IF ANY Of the Pan* Applicant gm= o
attach a letter from the property owl r authorizing Aft to install and °paste UIC w
Company Name: _
Contact Paton; EMAIL Address:
Address:
City: State: Zip Code: County:
Office Tele 14o.: Cell No,:
Website Aims of Company, if tint:
'AyAL
additives) in
environment (i.e.
Ms for installing
r a SQIV[ well (closed.
filial:atm).
agency, state nacre of
9 tit$ StlbJeCt ply.
rttt lVEU 1 GENii I iAVO
Arp Protection Section
AUG052010

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PAGE 03/05
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C, WELL DRILL[, INFORMATION
Company Name: NW. Poop Luer-z. I nod, Co
Wall Driller Cootranhar's Name: Zr/TM ► E 4adE3
NC Contractor Codification No.: 6104 3 3 ' ..�...�
Contain Person: HE J6, r EMAi3. Ate'
Address: PO. 5exx. 1 1 S
City: LL) J D 4L Zip Cody; "75 t•
Office Tele No.: - 2-6 - I2- Cell too.:
County: cv a-4
D. HEAT PUMP CONTRACTOR INFORMATION Of dil' ermet than driller)
Company Name: &1+t1i1 SitlVEC.03
Contact Peter; r wW*.i , .. �..._)ait .Adore 1,033
Address: t+5 Sr`not: t ['gx-t
My: &filar _ Zip Cede: fr Comity: /Ate,
Office Tele No.: 76e Cell No.:
E. STATUS OF APPLICANT
Private: 72L. Federal: — Commereiai: ^y.
State: Municipal! Native American Lends:,
F. 1N.WCl ioN PROCEDURE (briefly describe how the wei ) will be wad)
C.
'WELL CONSTRUCTION DATA
(1) Proposed date to be constructsd: 8 - - !v Ntttabe r of borings: 2-
Ap mE depth of each boning (fert): ?.1
(2) Type of tubing to be used (copper, PVC, etc): iticrw ry
{3) Well sing. Is the welks) cased? (check aver (t1.) Yee 2z (b,) NO blow)
(a) Yee If yea, then provide casing informmion below
Type: _salonoised steal Week stealw,__ pisstic other (specify)
Cat depth: From to feet (=Terence to land- stnikee)
Casing extends to above ground lochs
(h) No
(4) Grout tnfo (materiel surrounding well casing and/or piping):
Grout type: Neat Cement
(a)
(b)
(c)
Mambo
Orotrt placement: ?from ()fir .► n
Grog depth of tubing (rokavoze to lend surface): from 0 to (feet)
If well has casing, indicate grout depth: from to (feet)
(liy) 5A WP

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PAGE 04/05
Oar, I/00 i
11. INJECITONAELATED EQUIPMENT
Attach a diagram showing the engineering layout or propoend modification ofthe injec
piping/tubing associated with the injection *pennon. The manufacb3r r'a bit ehintti
fmzdan,
I. LOCATION OP WELL(S)
Attach true copies of mans showing the following information:
(I) include a Site Map (cart be drown) showing: buildings, properly Un surf
sources of groundwater contamination and the orientation of and distances betwe
any cadging well(a) of Wigs disposal facilities such as septic tanks or chill field
the geothermal hest pump well system. Label all feenues dolly and fnottad4 ale
the Sire Map must show the subject property in 'statical to the strnotaiding arca
reference points such as meads. streams, and/or highway litterleed015.
(2)
J. CERTIFICATION
Natty: This Permit Applieaation mast be signed by perms appearing on the
recorded legal property deed.
"l hereby Certify, under penalty of law, tlmt I have personally examined and in ect
subm t1ed In this document and all attachments thereto and that, based on niy in
immedIemaly bible for obtaining said information, i believe that the info/maim is
t am aware that theme sere significant penalties. including the pooalbility of floes and In
false information. 1 agree to construct, operate, maintain, rep** andWf applleahle, eba
all related appurtenances in accordance with the rova4i s>:pecifcetions and rAndisions
Owner/Applreeut
Are el r I •terms'
Prtrrt or Type Fu11 Name and title
14011
of Property tet.A.;1:---ptioent
rn equipment and exterior
tY provide supplementary
e water bodies. meanie!
t the pr' fig) and
Worsted within 200 feet of
y wing at least two fixed
Her with the igfOrmation
my of thane individuals
se, accurate end complete.
aiearanent, fbr aazbmitling
km the injection well and
the Permit."
J4fidttiAL 30M l/rt! r
Print or Typo Full Name and tide
Signature of Authorised Agent, if any
Print or Type Pull Name sad title
Plea return two copies of the completed Appliogeke package ie.
North Cerull ^ DENR.DWQ
Aquifer Protection Sermon -WC Program
1636 Mail SErriae Center
Raleigh, NC 27699-1636
Telephone (919) 733,3221
RECEIVED
PaAvPt ctio Section
AUG Q5 2010

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06/05/201e 16:40 9197799294 PAGE 01/05
11111 °WW1% ommall
#■It— Mechanice"!
Services, Inc
Ins
HEATING`&'AIR CONUITIDNING-CHNTRACTUR!a.
145 Technical Court • Garner, NC 27529 • [phone] s Fax ( 19) 779-9294
FAX COVER SHEET
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COMMOVIS , @Gt.1
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Aquifer Prnfedion Section
AUG 05 2010

TRANSMISSION VERIFICATION REPORT
TIME : 08/03/2010 01:39
NAME : NCDE&NR/WATER [JAL
FAX : [phone]
TEL : [phone]
DATE, TIME
FAX NO./NAME
DURATION
PAGE(S)
RESULT
MODE
08/03 01:39
97799294
00: 00: 26
01
OK
STANDARD
ECM
M ,r41--04
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