The URL can be used to link to this page

Home My WebLink AboutWI0500318_GEO THERMAL_20101201Permit Number Program Category Ground Water Permit Type WI0500318 / Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facilit Facility Name Edmund C Tiryakian SFR Location Address 2908 Ericka Dr Hillsborough Owner Owner Name Edmund Dates/Events NC C 272788848 Tiryakian Orig Issue 12/01/10 App Received Draft Initiated Scheduled Issuance 11/24/10 Reg ulated Activities Heat Pump Injection Private re si dence, singl e fam ily Outfall NULL Central Files: APS_ SWP_ 12/01/10 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Edmund C. Tiryakian Owner 2908 Ericka Dr Hillsborough Major/Minor Minor Region Raleigh County Orange Facility Contact Affiliation Owner Type Individual Owner Affiliation Edmund C. Tiryakian Owner 2908 Ericka Dr Hillsborough NC NC Public Notice Issue 12/01/10 Effective 12/01/10 272788848 272788848 Expiration Waterbody Name Stream Index Number Current Class Subbasin ATA NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor Director Secretary 12/01/2010 Edmund C. Tiryakian Jacqueline F. Tiryakian 2908 Ericka Dr. Hillsborough, NC 27278-8848 Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System Permit No. WI0500318 2908 Ericka Dr, Hillsborough, NC 27278-8848 Dear Mr, and Mrs. Tiryakian: On 11/24/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -only 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 welt 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 .0211(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 Michaei.Roeers,Er.ncdenr.t ov if you Naive any questions. Sincerely, for Debra Watts Supervisor cc: Raleigh Regional Office - APS APS Central Files - Perrnit No. Orange County Health Dept. Bill Evangelist (Evangelist Service Company, 1117 Batchelor Rd., Apex, NC 27523) Kevin Letchworth (N.W. Poole Drilling & Pump Company, P.O. Box 1958, Wendell, NC 27591) AQUIFER PROTECTION SECTION 163E, Mail Service Center, Raleigh, North Carolina 27699-163F. Loralion: 2725 Capital Boulevard, Raleigh, North Carolina 27664 Fr na' 91f-733.3221 l FAX 1: 919-715.3588; FAX 2: 919 715-60481 Customer Service:1-877-f'i23.6746 Internet www,ncwaterunalitv.ora rnEqual G en:rirly':Atrr.rmaf+eagrnnEmptrier one Noah Carolina Naturally F= R]M : ESC FAX NC. :9193625783 Nov. 24 2010 1113::j81411Pl ►t F 7'�1'IS Awe Mi 7b d rL $; .ro U d3 NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES ,` y r + ' A . 014* NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GE J ,;7 . WATER -ONLY INJECTION WELL SYSTEM , TYPE SOW WELL(S1 In Accordance 'With the Provisions of NCAC Title I5A 02C-0200 Print or type the required inform :lion and mail to address on the back page. DATE: r!- 2'4 . 2o/0 Well Type Confrrrmation: Does The proposed system circulate potable water only (no(no additivtA. in`a continuous piping that completely isolates the fluid from the enviroi me t closed-loop-f? Yes ) Continue completing this form. • f No Do Not complete this form. Complete other IJIC application funs four irrs ling° ; ., either a 5A7 well (open -loop well injecting potable water into the aquifer) Oar a 5QM well. lowed-... loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion mhS:. L PROPERTY OWNER(S)/APPLICA IT(S) List each Property Owner listed on property deed (if owned by a business or government bgerit. - fe' entity and a representative wlauthority for signature): a H UI J G . "Tx PC YAK,i0l TACmuLu (1) Haling Address: O? Eta t t t4 A I R l 6 City: Vils Vaa4-611. _ State: Al C. Zip Code: 2 n3 ggitSCounty:= 010 0 _ Home/Offtce Tele No.: 19 t 43 2.- 52 4'3 Cell No.: 14 e. t) k 5 3 7•.. 14.4) Email Address: SCOiu gnno:�•�e.nWehsite: (2) Physical Address of Well Site (if different than above): City: State: Zip Code: County! Honic/Office Tele No.: Cell No.: • • y t, f•_ B. AUTHORIZED AGENT OE OWNER, TIP ANY (if the Permit Applicant does not own the subject :. $fach a letter from the property owner authorizing Agent to install and operate UTC well) Company Name: Contact Person: EMAIL Addre-. Address: City: State: Zip Code: County: Office Tele No.: Website Address of Company, if any: Cell No.: FROM : ESE* Fax NC. :9193625783 Nov. 24 2010 03 i :P2 C. WELL DRILLER INFORMATION Company Name: 1V . c,u . o . i7 rt � c c � -� a W , . ri x7 . Well Driller Contractor's Name: Cut ti• e"i`G1g.w0RI NC Contractor Certification No.: 2? S )' 1 A Contact Person: lath nr 4 "-4-c 64 fids2 ► I-p j EMAIL. Address: A et - Address: Qom• ifmc fal City: , Zip Code: 2 `7..5' 1 County: (.c)1, see Office Tele No.: 114 4 - 266 - 9 2 2. 3 Cell No.: 404 Q_ D. HEAT PUNK CONTRACTOR INFORMATION (if different than driller) Company Name: EVANt3en /tktc > � Contact Person: ei. &Jwrv6C= J sr-- EMAIL Address: .euam,e s irErr Address: i) I) VIM 14) s.e City: Ae c s Zip Code: -0 S 2 3 County: 41207-1 OfficeTeleNo__ 11- 36-Taro Cell No.: 9t5-- 2,0 5= '7ff22 E. STATUS OF APPLICANT Private: !r FederaI: State: Municipal: Native American lands: Commercial: F. INACTION PROCEDURE (briefly describe how the ejection well(s) will be used) G. WE],r, CONSTRUCTION DATA (1) Proposed date to be constructed: 12 ' C - I Q Number of borings: Approximate depth of each boring (feet): e (2) Type of tubing to be used (copper, PVC, etc): Pe (3) Well casing. is the well(s) cased? (check either (a.) Yes or (b.) No below) (a) Yes if yes, then provide casing information below Type: galvanized steel hiack steel plastic other (specify) Casing depth: Frain to feet (reference to land surface) Casing extends to above ground inches (b) No _Xi_ (4) Grout info (material surrounding well casing and/or piping): (a) Grout type: Neat Cement Bentonite) Other (specify) (b) Grout placement Pumping_ Pressure Other (c) Grout depth of tubing (reference to ]and surface): from to if well has casing, indicate grout depth: from to '(fit) FROM :ESE FR}( NO. :91936257E13 hlfli►. 24..201$ 03:39PF 173. H. INJECTION -RELATED EQUIPMENT Attach a diagram showing the engineering layout or proposed modification of the injection equipirtent agit&ierior pipingltabing associated with the injection operation_ The maniifacurer's brochure may provider, supp a n#ai3r , 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, property lines, surface water .bodies', fititential sources of groundwater contamination and the orienrarion of and distances between -the proposed vve1i(s) and any existing wells) or waste disposes] facilities such as septic tanks or drain fields Located wit in 206 fleet of the geothermal hear 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 st. feast twd 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 wit.ibe nfomon submitted in this document and all attachments thereto and that, based on my inquiry Of_ tlx . uedividuals immediately responsible for obtaining said information, I believe that the information is true, accurater ' piete..- I am aware that there are significant penalties, including the possib" of fines and iinprisoitment,- orsubmitt ng false information. I agree to construct operate, maintain, repair, f applicable, abaridrrn the ixijection well and all related appurtenances in accordance with approved s rhs and conditions of the Permit.. Signature of Property rredApplicant EoM0N-G"' Cr. Tt C YAKA Ah1 !print of Type Ful i Name and title Sign ure of Prone wner1Applicant Print or Type Full Name and title Signarwe of Authorized Agent, if any Print or Type Full Name and title Please return two copies of the completed Application package to: North Carolina DENR DWQ Aquifer Protection Section -I IC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 733-3221 . <-J'· :_. __ _ ,. ·. :-,. ~~-~ . ..... .. ,. ., -- . .. ....-· .· . ' ."~ . Lot 20 ·. -;-._:-::_\.-t •• -~ : -•• "i ... _ ~i,1;;' ):;.-_.·:.:•~_:_:/_!' . .. .. . ·- :-•••=•.=;\::"'!I • ::-- i ...... _:\/{ '··-·:·-:~·/f~ -_ ... _._-._:: .-· . .: ·- __ -.·:-..• .: -_ _._-~- I\) .I). ~ ..... IS) IS) w w ·. ig .-w 3:. ' . . ·' State of North Carolina OF ANAf,,t;, DejDartment of Environment QG and Natural Resources I Ir'1 r Division of Water Quality Beverly Eaves Perdue, Governor Dee Freeman, Secretary Coleen Sullins, Director Division of Water Quality Aquifer Protection Section Location: 2728 Capital Blvd. Raleigh, NC 27604 Mailing Address: 1636 Mail Service Center Raleigh, N.C. 27699-1636 FAX: (919) 715-0588 (919) 715-6048 Date: FA : Aryl `c-rnS,,--� 0 FAX NUMBER: �T• - FROM: PHONE: NO. OF PAGES INCLUDING THIS SHEET: J� .Ac, c-cpukt_tiLm\ -cb C 50\ki F �LC Q3r? cSl (it_6*\giL If you receive this fax by mistake call: Aquifer Protection Section kg 919-733-3221 JJJ.~A. !1£~?--J. NCD : . North Carolina Depa1iment of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Edrriund C. Tiryakian Jacqueline F. Tiryakian 2908 Ericka Dr. Hillsborough, NC 27278-8848 Coleen H. Sullins Diiector 12/01/2010 Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System Permit No. WI05003 l 8 2908 Ericka Dr. Hillsborough, NC 27278-8848 Dear Mr. and Mrs. Tiryakian: Dee Freeman Secretary On 11/24/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onlv 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 Jong as the following conditions are met: 1. The injection well system contains only potable water, " 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.Ro 0 ers@ncdenr.eov if you f\e any questions. I ' Sin,c'erely, J,_J;( (-\ \ r--, ,·'. ,.._,_I~·· ,, . .l-v-)("\ '( , I -J ] __..• ,/ I }( ' . ><:::.:::J--.-'°· >. v-A_ "'-~' cc : Raleigh Regional Office -APS APS Central Files -Permit No. Wl0500318 Orange County Health Dept. '-=-j-.' .. ( ~--··-. for Debra Watts ... _ .. Supervisor Bill Evangelist (Evangelist Service Company, 1117 Batchelor Rd .. Apex, NC 27523) Kevin Letchworth (N.W. Poole Drilling & Pump Company, P.O. Box 1958, Wendell, NC 27591) AQUIFER PROTECTIOi·J S::CTION 1636 Mail Service Ceme:·. R.aleioti, North Carolina 27699-1636 Location: 2728 Capital Boulevard. F:aleigh. North Carolina 2760l Phone: 91£i-733-3221 \ FAX 1: 919-715-0588: FAX 2: 919-715-6048 \ Customer Service : 1-877-623-6748 Internet www.ncwaterguality.org t..n Equal (ipportunit _r ·1 Afiirmative .A.ction ~mploye; None., C li ortn aro na 1(;1 h t" .fl ~/ •,/t:hll.t 'au!f TRANSMISSION VERIFICATION REPOT • :. - 4 t TIME . 12/01/2010` Q3 .54 "'': •; {•.; NAME : NCDE&NR/WATE# +tfll,� FAX : 919-715-0588 TEL t . h DATE,TIME 12/01 03:54 FAX NO./NAME 919196443006 DURATION 00:00:41 PAGE(S) 02 RESULT OK MODE STANDARD ECM • +• •• t • . , Godwin, 'Tonya From: Sent: To: Cc: Subject: Attachments: Mr. Evangelist, Godwin, Tonya Wednesday, December 01, 2010 4:02 PM 'evangelw@bellsouth.net' Rogers, Michael SQW Acknowledgement Letter-Edmund C Tiryakian WI0500318 (Tiryakian).doc Per your request, attached is the SQW acknowledgement letter for Mr. Edmund C. Tiryakian. You will also receive a copy of the letter in the mail. I have faxed the letter over to the Orange County Health Department to the attention of Andy Adams. Thank you for your assistance. Have a nice evening. Tonya Godwin Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 919-715-5348 919-715-0588 (Fax) 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