WI0500340_GEO THERMAL_20110113

Permit Number
Program Category
Ground Water
Permit Type
WI0500340 /
Central Files: APS_ SWP_
01/13/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Injection Water Only GSHP Well System (5QW)
Version
1.00
Permit Classification
Individual
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Scott J. Treamer SFR
Location Address
825 Sandlewood Dr
Durham
Owner
Owner Name
Scott
Dates/Events
NC 27712
J Treamer
Orig Issue
01/13/11
App Received Draft Initiated
12/17/10
Re gulated Activities
Heat Pump Injection
Private resi dence , s ingle family
Outfall 1 1_11
Waterbody Name
Scheduled
Issi.Janee
Permit Contact Affiliation
Joshua Niles Robertson
8228 Kerr Chapel Rd
Elon
Major/Minor
Minor
Region
Raleigh
County
Durham
Facility Contact Affiliation
Owner Type
lr.idividual
Owner Affiliation
Scott J. Treamer
Owner
825 Sandlewood Dr
Durham
NC
NC
Public Notice Issue
01/13/11
Effective
01/13/11
27244
27712
Expiration
Stream Index Num~er Current Class Subbasin
VAI
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
01/13/2011
Scott J. Treamer
825 Sandlewood Dr,
Durham, NC 27712
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No, WI0500340
825 Sandlewood Dr.
Durham, NC 27712
Dear Mr. Treatner:
On 12/17/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-Ioop 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 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 ISA 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 Durham 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 [phone] or MichaelRot ers'c7,ncdenr,cov if yours ,ve any questions,
for Debra
Supervisor
cc: Raleigh Regional Office - APS
+lei. nt \.. • ~_ �J.
Durham County Health Dept.
Josh Robertson (Triad Drillers, 8228 Kerrs Chapel Rd., Elon, NC 27244)
Stratton Lobdell (All American Heating & Air, 8817 Westgate Park Dr., Raleigh, NC 27617)
AQUIFER PROTECTION SECTION
1635 Moll Service Center, Raleigh. North Camiina 27699-1635
Location 272E Capital Boulevard,ialeigh, North Carolina 27604
Phone: 919-73:1-3271 1 FAX 1: 913-715-0588: FAX [phone] Customer Service, 1-977-623-6746
Internet www.ncwatemuaiitv.ora
�^ Ec:1al C:nriarr»nitr I Affront:ve Anon Employer
_One
N ❑ th Carolina.
atlll"all /

Dec 1,7 iQ,08:04a Lothridge Plumbing
W
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25 Years of Quality Service
',1',335n,i3,
Dear Sir or Madam,
3363572951
Lothridge Plumbing,
To :
Company : _NCDENR
Sent By : _Tina Yates_
Date : _December 17, 2010
Time :
# of pages including cover : ___,5 pages
919 715 0588
Cover sheet only :
Following is a Type SCOW Well application for processing. Thank you for your
attention to this matter. -'�-
Sincerely,
Tina Yas
Comptroller
PO Box 249
Linwood, NC 27299
Phone: [phone]
Fax: [phone]
Email: lothridge [©' mindspring.com
•,% • _
1
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4

Dec 17 10 •08:04a
Lathridge Plumbing 3363572951 K.)--
NORD I CAROI.INA
DEPARTMENT ENV[RONM1 N'1 AND NATURAI. RISOIJIRCIS
NOTIFICATION OF INTENT TO CONiS'l'RUCT A CLOSED -LOOP GI•.OTHH1 .RMAL..
WATER -ONLY INJECTION WELL SYSTEM.
TYPE SOW WELL(S)
in Accordance With the Provisions of NCAC 'Title I5A 02C.O300
Prim Or type titer required infiirfhtarirut told toad F) tfddress an the hock page.
DATE: December 14. 2010
Well Type Confirnmtion: Does the proposed system circulate potable water only (no adcliiive'.) in.
continuous piping that completely isolates the liuid from the environn,et;t
Yes ___X_- Coittirttre conipletiiit this k rm.
No Do Noi complete this Iorm. Complete other [ ifC application parrs tin' iittit;tllin + `
either a 5A7 well (open -loop well injr:etin potable water into the acluiicr) or n 5QM wcl[ (cititiet1' r. r:
loop well containing additives such as R-22, ethanol. or other al-nil'rcerx or corrosion inhibitorsr
A. PROPERTY OWNCR(S)/APPLiCANT(S)
List each Property Oaztcr fisted on property deed (if oivned by a business or govtrtunon1 agency. su : ntune eat'
entity and a representative wlauthority Iar signature): Sc �Tf _-� 11'�o.,rr� s
Mailing Address: 2ti •Sa••rdle;,���a .. - �__ . .
City:-.A•+fl-,u, .-i -- -- State: NC Zip Cndc ...27..712.
I Iumc/Oflicc Tele No.: (T. 41 -ily63 Cell 4n.: ---- -
imail Address:__ de- rZnngd..r/ d` .1. jWcbsitc_
(2) Physical Address of Well Site (if d i I-ferent Man above):
City:
County:
State: Zip Code: __.... County:
1•l oinefOfficc Tell Net.: --- Cell No.,
13. AUTIIORIZEI) AGENT' OIL OWNE R,1F ANY tit' the Permit Applicant dues not own the sulzjo i
attach a letter from the properly owner authorizing Agent to install and operate tiff' well)
Company Name: , �_.. __...... .—
Contact Person: !:!vlll.]!. Address _-
Address:
City: _ State: — Zip Code: _ County:
Office Trio No.: Cell No,
Wehsite Address oI'C ompany, it'any:__ __.--
Ct�1 tle sptt''Vntiiicarinri of intent font) (Revised Rr?{#flit)
f.1;M•Isertw
: •
: -

Dec 17 10.08:04a Lothridge Plumbing
C. WELL DRILLER INFORMATION
Company Name: Triad Drillers
Well Driller Contractor's Name_ Josh Robertson
3353572951
NC Contractor Certification No.: 2461-A
Contact Person: Josh Robertson EMAIL Address: triaddrillessvahao.cau
Address: 8228 Kerrs Chapel Road
City: Eton NC Zip Code: 27244 County: Ca ell
Office Tele No.: 336 421 3513_ Cell No.: _336 453 4527_
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: All American Heating & Air
Contact Person: Stratton Lobdell EMAIL Address:
Address: 8817 Westgate Park Drive
City Raleigh. NC Zip Code: 27617 County:
Office Tele No.: _919-782-6242 Cell No.: 919-622-I 552
al Iamcnirananiaxr coin `
E. STATUS OF APPLICANT
Private: X Federal: Commercial:
State: Municipal: Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed loop water only for heat pump
G. WELL CONSTRUCTION DATA
(1) Proposed date to be cons/acted: Number of borings:
Approximate depth of each boring (feet): 400
(2) Type of tubing to be used (copper, PVC, etc): HDPE
(3) Well casing. Is the well(s) cased? (check either (a.) Yes s (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
(b) Na X
(4) Grout info (material surrounding well casing and/or piping):
(a)
(b) Grout placement: Pumping Pressure Other
(c)
inches
Grout type: Neat Cement Bentonite X Other (specify)
Grout depth of tubing (reference to land surface): from _400 to _0 (feet)
If well has casing, indicate grout depth: from to
(feet)

Dec 1.7 10 013:05a
Lothridge Plumbing 3363572951
11[. INJECTION-It ELATED EQUIPMENT
•
Attach a diagram stowing the engineering layout or proposed modification ❑t-the injection equipnicnf abd �atc"rigs;
piping/tubing associated with the injection operation. 'Tic manufacturer's brochure may provide .suppletticiilbr .
iniarmatioti.
I. LOCATION OF W FI.i4(5)
Attach two copies ul' neaps slowing the following information:
(l) Include a Site Map (can be drawn) showing: buildings. property lines. surface water 1S.Klies. parental
sources of groundwater cnntrmtivalion and the orientation °land distances bct►►een the proposed w ilts.)` iiiL1- '
any existing ►villas) or waste disposal facilities such as septic tanks or drain Ileitis located within 200 feet -tit
(2)
the geothermal heat pump well system. Label all icatures clearly and include a. iior't!t arrow.
The Site Mnp must show the subject property in relation to the surrounding arca by uainy.*.'a least t►vu Iix d
reference points such as roads. streams. and/or liighwav intersections.
.I. CERTIFICATION
Note: This Permit Application nrust be signed by twit person appearing on the
recorded Icg.rl property deed.
-I hereby' certify. under penalty uf' imv. that I have personally examined and am ftmiliar with•.the irttiirntatior,
submitted in this document and all attachments thereto and that. based on my inquiry :af' thase;indivititiftkr..
immediately responsible for obtaining said information. I believe that the: information is three. accurate ;siist'vttinplete, '
1 urn aware that there are significant penalties. including the possibility of fines and iIuprisonincnt. `1'oz'•sttiurtiitfng
false information. I agree: to construct_ operate, maintain. repair. and if applic:iblt., abandon the irij cnofl i►ell'uiti ``
all related appurtenances in accordance with the approved specifications and conditions of the. Perin.it: ' •�''
Sigitatui(clb I' Property Owner/Applicant
Print or Type lull Name uiid title
SigIstIurc al't'I•operw ❑►vnerfApplicant
Print or'I'vpc f=u11 Name and title
Signature ol'Authorized Agent. if utiy
Print or Type Full Name and title.
['lease Return two Copies of the completed Application package to:
North Carolina DE iM-OWQ
Aquifer Protection Section-1.1C Program
1636 Mail Service Center
Raleigh, NC 27699-11636
Telephone [phone]
f�irl]!lf[C 5QW Niwitleatirn ol•latent 1=nmr (Revised X/20 X)

Dec 17 10 08:05a
Lothridge Plumbing
3363572951
GoMAPS - Durham County NC Public Access
i.):kala Explo�`F4 er � Goaps
Durham, NCII USA
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Zoom To View:
http://gisweb.durhamnc.gov/GoMaps/mapandex.cfm
Quick Search: 1Enter PIN". ParCei ID be Addr@s -!
Inters five Tools
tr. Layers I Address/ Parc& - sa
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NCDGF\
North Carolina Department of Environment and Natural Resources
Division -of Water Quality
Beveriy Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
01/13/2011
Scott J. Trcamcr
S25 SandInwood Dr.
Durham, NC 27712
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Penult No. W10500340
825 Sandlewood Dr.
Durham, NC 27712
Dear. Mr, Treamer:
On 12/17'2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-0tti �.
geothermal injection well system for the operation of a ground -source heal purrtp located as 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,
�. The injection well systemm, 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 Tide 15A Section 2C Subchapter .0211(u)(2). Additionally, you should contact the Durham County &cslth
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.
Phase contact Mike Rogers at [phone] or Michael.Rogers(ncdenr_gov if youve any questions.
5i
for Debra
Supervisor
cc: Raleigh Regional Office - APS
APS Central Piles - Permit No. WIO$00340
Durham County Health Dept.
Josh Robertson (Thad Drillers, 8228 Kerrs Chapel Rd, Eton, :ETC 27244)
Stratton Lobdell (All American Heating & Air. $817 Westgate Park Dr., Raleigh, NC 27617)
AQ'JiFER PE3cfr CTIO 1 SEGT ON '
e3� Mai! Service Center, Raleigh, Not Can ima 27699.1E35
Location 2728 Capital Bei*Vard, Raleigt, No Carolina 27604
?more: 919-733-3221 ', FAX 1: 919-715.O &PAX 2 919-715.fiW i Customer $Attica 1-877. 23-6748
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in Ecw i Cpaertunhr I ACnratNF A:fan Ernpvysr
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NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of rnwiro meat and Nanual Resounte- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # &/1^4
1. WELL CONTRACTOR:
o.Shiic 1O, irY'4S011
well Co f'aIpIII-e: tO
Well Contractor / cony Name^` e
Street
es
n
City or Town
Area code Phone number
Ale .77
State
Zip
2. WELL INFORMATION:
WELL CONSTRUCTION PERMI2
OTHER ASSOCIATED PERMFT#(iTappfcabtej tarMIJas
SITE WELL 10 #(rf sppti>�hEe1
3. WELL USE (check One Box)Monktoting ❑ Muniaipal/PubliC 0
IndustdatUCommerciat ❑ Agricultural C) vial! ❑ InjotbDi 0 J
Irrltyationi❑ Other ji( (Nat use) C/ n /
GATE DRILLED /2
4. WELL LOCATION_
.� r4fyl i _ �Jri ve
merest Name, Numbers, Community, Surdi.r r Let No, Peres dip jpCode)
/
CITY: �rALt(f't COUNTY L/ rfieil9'i
TOPOGRAPHIC 1 LAND SETTING' (check prDW ate bole
lglope 0Valley pFlat ❑Ridge ❑Other
LATITUDE 36 '1,4/%.1 DMSOR 3X.)0000CCXX CD
LONGITUDE 9 IZ- •59• 2I • DMs DR TX.XXXx;0 o1oc Do
Latitudeilortgitude source: AGPS Dropographic map
(location of well must be shown on a USGB tops map endattadaeo o
this ten rf not using GPM
5, FACILITY (Name otthe business where the well is located.)
Facility Name
Faeflity ID# (if applicable)
Street Address
City or Town
60i rearkel•
Contact Name
tifyikrig Aggress
C1ty or Town
mete 2p Gvde
NGState 7fip Code
479-4 9
Area coda Phone number
6. WELL DETAILS: ,I
a. TOTAL DEPTH: VA)
b. DOES WELL REPLACE EXISTING WELL? YES D NO Ng
C. WATER LEVEL Below Top of Casing. FT.
{Use "+' if Above Top of Casino)
d. TOP OF CASING IS 0 FT. Above Land Surface'
'Tap afcasing terminated at/or below land surface may require
a variance In aC0Drelanee Wild 10A NCAC 2C .Q11S,
o. VELD (gpm): METHOD OF TEST I/ P
t. DISINFECTION Amount.
g. WATER ZONES (depth)'
Top � Bottom 251
Top Bottom
Top Bottom
Too
Top
Top
Bottom
Bottom
Bottom
Thiakneasl
7. CASING: Depth Diameter Weight Material
Top_ p Bottom Ft.
Top 8ottorn Ft.
Top Bottom Ft
8, GROUT: Depth Mainly �i • tatbod
y
Top d Bottom ' 4 Ft/krmaJI_�avlzti ►Y1�
Top Bottom Ft
Top Bottom FL
S. SCREEN_ Depth Diameter Slot: Size Material
Top Bottom Ft In. in.
Top Bottom Ft. Jr._In.
Tap Bottom Ft. �in. tn, _
10. SAND/GRAVEL PACK:
Depth 812e Material
Top 13uttom Ft
Top Bottom._ Ft
Top Bottom Ft
11. DRILLING LOG
Top Bottom Fortlon Description
/) i 1 .50rti L%)r i 1i,i9lare
'/ 1 ' Liunee,Ie
1
1
1
1
it REMARKS:
CO HEREBY CERt1FY THAT THi$ WELL WAS CONSTRUCTED IN ACCORDANCE WITH
NCAC 2C, WELL CONSTRUCTION STANDARDS, ANO THAT A COPY OF 'NZ
GIG NAi URN PROVIDED WELL QWNER.
RT1FIED
1NTED NAME OF PERSO
Z0-I,
GONTRACirgr BATE
CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mali Service Center, Raleigh, NC 27699-161, Phone : (91S) 807-6300
5arm GW-lb
Rev. 2109
T.T/E0 3Edd
S I3 i ma fI�iIcil
5895TZt?%E Sly:ST ITOZ/60/ G

02/09/2011 15:45 3354215085 TRIAD DRILLERS
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