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Home My WebLink AboutWI0500381_GEO THERMAL_20110509Permit Number Program Category Ground Water Permit Type WI0500381 / I, Injection Water Only GSHP Well System (5QW) Primary Reviewer michael. rogers Coastal SW Rule Permitted Flow Facilit Facility Name Jude & Christine Siminitz SFR Location Address 5344 Bent Leaf Dr Raleigh Owner Owner Name Jude Dates/Events NC 27606 Siminitz Orig Issue 05/09/11 App Received Draft Initiated 04/29/11 Reaulated Activities Heat Pump Injection Outfall 1'1!'.H ! Scheduled Issuance Central Files: APS_ SWP_ 05/09/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Glen A. Darch 13109 Bold Run Hill Rd Wake Forest Major/Minor Minor Region Raleigh County Wake Facility Contact Affiliation Owner Type Individual Owner Affiliation Jude Siminitz 221 Lochwood W Cary NC NC Public Notice Issue 05/09/11 Effective 05/09/11 27587 27518 Expiration Waterbody Name Stream Index Number Current Class Subbasin i..~A .. 1.,~~ MCD~EM~R North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Jude T. Siminitz Christine B. Siminitz 221 Lochwood West Cary, NC 27518 Coleen H. Sullins Director 5/9/2011 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0500381 5344 Bent Leaf Drive, Raleigh, NC 27606 Dear Mr. & Mrs. Siminitz: Dee Freeman Secretary On 4/29/2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onl v 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 constructio:n 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 .02ll(u)(2). Additionally, you should contact the Wake 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(a)ncdenr. gov if you have any questions. cc: Raleigh Regional Office -APS APS Central Files -Permit No. WI0500381 Wake County Health Dept. Oien A. Darch Well Drilling (Glen Darch) Bowman Mechanical Services, Inc. (Stephen Bowman) AQUIFER PROTECTION SECTl0rJ 1636 Mail Service Center, Raieigh, North Carolina 27699-1636 Locaiion: 2728 Capital Boulevard, Raleigh, North Caroiina 27604 Sincerely, fo,Q~fc\.~ Supervisor Phone: 919-733-3221 \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 i Cusmmer Service: 1-877-623-6748 internet: www.ncwaterauality.org J,1 Eoua'. G:)pori:rn:t; \ Affirmaiive J..c::on Err.oloyer 'f. _One, C 1. 1\l ortn aro ma lvatural~lf NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR) NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTt . RMAL WATER -ONLY INJECTION WELL SYSTEM: TYPE 5-QW WELL(5) En Accordance with the provisions ofNCAC Title 15A: 02C.0200, please complete this notification and mail to address on the back page (please Print or Type information). DATE: /z 20_ L 71 1 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 forth. Complete other UIC application forms for installing either a 5A7 well (open -loop well injecting potable water into the aquifer) or a 5QM well (closed - loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors). A. PROPERTY OWNER(S)/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): DE T S1 m I n 14 z 01144 Inf. S ; (1) Mailing Address: City: Hoine/Offit. ele No.: zr l�r Atu uel lix-e• d— State: Ilk Zip Code: -- 7 571. County: Email Address: Sirr+,r; a-4-_(r3 y /i'" 1 Vlebs te: Ce11 No.: — 613 D 6, (2) Physical Address of Well Site (if different than above): ST3 A City: c..1;) 1-, State: AA -Zip Code: -7 G Q re Coun Home/Office Tele No.: Cell No.: I i 30 G- 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: Zip Code: County: Office Tele No.: Cell No.: Website Address of Company, if any: GPL'/U1C 5QW Notification of Intent Form (Revised 8/2008) Page 1 C. WELL DRILLER INFORMATION Company Name: P. 1.)ax7cpe7 taeff D)11&711.zzc-, Well Driller Contractor's Name: 1 NC Contractor Certification No.: 5 q�_ A Contact Person: �.( 7) ell 1r Address: 10 T 0 / I I4 ii City: _ Zip Code: County: a..0& Office Tele No.: ci 1 q - 49 -ss95/ Cell No.: 9 Li L, R49 - 99- / D. HEAT PUMP CONTRACTOR 1iN1FORMATION (if different than driller) Company Name: Bowman Mechanical Services, Inc. Contact Person: Stephen Bowman Address: 145 Technical Ct. EMAIL Address: bowmanmechanicat -npel1south. net EMAIL Address: City: Garner Zip Code; 27529 County;Walce Office Tele No.: 919-772-2759 Cell No.: 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) G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: f doll 1 Number of borings: (� 5" Approximate depth of each boring r feet): (2) Type of tubing to be used (copper, PVC, etc): PE L i-orn 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 Other (specify) (b) Grout placement: Pumping Pressure Other (c) Grout depth of tubing (reference to land surface): from to to j 35 (feet) If well has casing, indicate grout depth: from to (feet) GPU/U1C 5QW Notification of Intent Form (Revised 8/2008) Char. 7 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. 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 well(s) or waste disposal facilities such 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 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 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, 1 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 Permit" Signature 6 Property t. caner/Applt - - JvDE. j . Sim 1•0 Print or Type FFull Name and title r Signature of Property OwHree.r/Appli, )t Print or Type Full Name and title Signature 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-UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 GPLI/UWC 5QW Notification of Intent Form (Revised 8/2008) Page 3 0 50 100 200 Feat FieL.t rVolls PIN 0780870986 Real Estate ID 0301229 Map Name 078002 Owner SIMINITZ, JUDE T &CHRISTINE B Mailing Address 1 221 LOCHWOOD WEST DR Melling Address 2 CARY NC 27518-9757 MallIng Address 3 Deed Book 13881 Deed Page 1059 Deed Date 02/25/2010 Deeded Acreage 2.86 Akq•P‘med BuBding $0.00 Value Assessed Land Value $316,575.00 Total Assessed Value $316,575.00 Billing Class INDIVIDUAL Property Description L05A HUNTERS COVE SUB BM2002-1639 Heated Area Site Address 5344 BENT LEAF DR Chy Township SWIFT CREEK Year Bun 0 Total Sale Price $0.00 Sale Date Type and Use Design Style Land Class VACANT Old Parcel Number 701-00000-0000 .111111. WAKE COUNTY NORTH CAAOI.1 N'A 0 400 800 1600 Feet Field Value PIN 0780870986 Real Estate ID 0301229 Map Name 078002 Owner SIMINITZ, JUDE T &CHRISTINE B Mailing Address 1 221 LOCHWOOD WEST DR Mailing Address 2 CARY NC 27518.9757 Melling Address 3 Deed Book 13881 Deed Page 1059 Deed Date 02125/2010 Deeded Acreage 2.06 a Assessed Building 50.00 Value Assessed Land Value $316,575.00 Total Assessed Value $316,575.00 BlIling Class INDIVIDUAL Property Description LO5A HUNTERS COVE SUB BM2002-1639 Heated Area Site Address 5344 BENT LEAF DR City Township SWIFT CREEK Year Built 0 Total Sale Price $0.00 Sale Date Type and Use Design Style Land Class VACANT Old Parcel Number 701-00000-0000 WAKE COUNTY NORTH CURORU NA 0 50 100 200 Feet PIN 0780670966 Real Estate ID 0301229 Map Name 078002 Owner SIMINtTZ, JUDE T &CHRISTINE 8 Mailing Address 1 221 LOCHWOOD WEST DR Mailing Address 2 CARY NC 27518-9757 Malting Address 3 Deed Bonk 13B61 Deed Page 1059 Deed Date 02/2512010 Deeded Acreage 2.86 Assessed Building $0.00 Value Assessed Land Value $316.575.00 Total Assessed Value S316.575.00 Billing Class INDIVIDUAL Property Description LOSA HUNTERS COVE SUB SM2002-1639 Heated Area Site Address 5344 BENT LEAF DR City Township SWIFT CREEK Year Built 0 Total Sale Price $0.00 Sale Date Type and Use Design Style Lend Class VACANT Old Parcel Number 701-00000-0000 WAKE CO INTY NMI] I CA Rai U. A 0 400 WYW :�i :e r-•r : r � Ars lam: �!' �r-.d_L—y • ra�pvar,y 800 1600 Feet PIN Real Estate ID Map Name Owner Mailing Address 1 Mailing Address 2 Mailing Address 3 Deed Book Deed Page Deed bate Deeded Acreage Assessed Building Value 07E0070906 0301229 07E002 SIMINITZ, JUDE T &CHRISTINE 6 221 LOCHWOOD WEST DR CARY NC 27518.9757 13881 1050 0212512010 2.86 $0.00 Assessed Land Value $316,575,00 Total Assessed Value $316,575.00 Billing Class INDIVIDUAL property Descrip00n LO5A HUNTERS COVE SUB 6M2002-1638 Heated Area Site Address 5344 ;SENT LEAF DR City Township SWIFT CREEK Year Built 0 Total Sale Price $0.00 Sale Date Type and Use Design Style Lend Class VACANT Old Parcel Number 701.00000-0000 V AKE COUNTY NC/11TM CARMAN?.