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Home My WebLink AboutWI0500402_GEO THERMAL_20110722Permit Number Program Category Ground Water Permit Type WI0500402 / Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facilit Facility Name Douglas & Maria Cairns SFR Location Address 3905 Springstop Ln Durham Owner Owner Name Douglas Dates/Events NC A 27705 Cairns Orig Issue 07/22/11 App Received Draft Initiated 07/21/11 Re g ulated Activities Heat Pump Inj ection Outfall NULL Scheduled Issuance Central Files : APS_ SWP_ 07/22/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Ryan Brazill 72 Wester Way Bunn Major/Minor Minor Region Raleigh County Durham Facility Contact Affiliation Owner Type Individual Owner Affiliation Douglas A. Cairns 3905 Springstop Ln Durham NC NC Public Notice Issue 07/22/11 Effective 07/22/11 27508 27705 Expiration Waterbody Name Stream Index Number Current Class Subbasin Beverly Eaves Perdue Governor Douglas Cairns Maria Cairns 3905 Springstop Lane Durham, NC 27705 A'f9A ~j;..1-1 HCD E. North Carolina Department of Environment and Natural Resources Division of Water Quality Coleen H. Sullins Director 7/22/2011 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0500402 3905 Sp1ingstop Land, Durham, NC 27705 Dear Mr. & Mrs. Cairnes: Dee Freeman Secretary On 7/21/2011, 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 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 ISA Section 2C Subchapter .021 l(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 (919) 715-6166 or Michael.Ro !'.'ers@ncdenr.!!OV if you have any questions. cc: Raleigh Regional Office -APS APS Central Files -Permit No. Wl0500402 Durham County Health Dept Brazill Drilling (Ryan Brazill) Bowman Mechanical (Steve Bowman) AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 2728 Capital Bouievard , Raleigh, North Carolina 27604 Sincerely, O~A.&xnt .for Debra Watts Supervisor Phone: 919-733-3221 \ FAX 1: 919-715-0588 : Fl>Y. 2: 919-715-6048 \ Customs: Service: 1-877-623-5748 Internet: www.ncwateroualltv .oro An Equal Cipportuni1y \ Affirnaiive Action Employs, ·~ ,OnehC 1· J'\l ort aro ma /Vaturall!f NORTH CAROLINA DEPARTMENT Of ENVIROl:\i~ENT AND NATURAL RESOURCES (NCDENR) NOTIFICATION OF INTKNT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM: TYPE 5-0 W WELL(S) In Accordance with the provisions of NC AC Title 15A: 02C.0200, please complete this notification and mail to address on the back page (please £rim or~ information). DATE: __.7_-J?"'-----------' 20 J.Q_ \J..il o 5 OOc...fo;)-- Well Type Confirmation: Does the proposed system circulate potable water onlv (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 form. Complete other l.HC application forms for installing either a SA 7 ,veil (open-loop well injecting potable water into the aquifer) or a 5QM well (closed- loop ,vell containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors). A . PROPERTY OWNER(S)/APPLICA:.~T(S) List each Property Owner listed on property deed (if owned by a business or government agency, state name of entity and a representative ,v/authority for signature): Duv5 l""-:S A--. C.a,rfls a,,.._d M-o..,; a. Gt. C :el l r/\5 (1 ) Mailing Address: 3 q O '5' f5 p r j. f\.:§ ~+op LC\,l'\,e__., City : Q v rhaM. State : NG Zip Code:._=ol_-:7_70~··_6_· __ County: ,Du,h_o..~ Home/Office Tele No.: 4, l '1 _., Lf.o I --d-O t lo Cell No.: Email Address: _________ _,\\'-'-1-"-'eb"-=s'-'-'it:e::.e,_: _____________ _ (2) Physical Address of Well Site (if different than above): _______________ _ City: __________ State: __ Zip Code: ______ County: _____ _ Home/Office Tele No.: -------------"'C=e..:.:.11...:.N.:.:ro=•a....= __________ _ B. AUTHORIZED AGENT OF O\VNER, IF ANY (if the Permit Applicant does not own the subject property, attach a Jetter from the property O\Voer authorizing Agent to install and operate UIC well) Company Name:-------------------------------- Contact Person!-: -------------------'=E=.!MA=I,..,L...,A......=dd=,r~e"""ss'-'-: __________ _ Address:---------------------------------- City: _________ State: __ ZipCode: ______ County : ________ _ Office Tele No.: Cell No.: Website Address of Company, if any: _______________ _ JUL 21 20'1 C. D. E. WELL DRILLER INFORlVL.\TlON Company Name: J) DA~ ~Co· Well Driller Contractor's Name:c ~~ NC Contractor Certification No.: _0_~~~-----=__._ ____________________ _ Contact Person: '<'i L{Q,n EM.AIL Address: Address: jf1_ U}e,oho ~ _ City: J)U D'.)Jr'\ Zip Code: o( I 60 $} County: ...... 1:'-'Ct'1a:J-AA~li .......... vo,._._-J-.--_____ _ Office Tele No.: °t \9 ':\.94,-o;3B Cell No.: _______ _ HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: e-c.. .ufnWT") a]Je/nm cfLXl} .&vvC.Lo ( c.ftrx . Contact Person: ';:){pUp ~~ EMAIL Address : Address: 145 ,JQcM)t.ca/ Cf . City: GQ/'l;'.Y\.e/\ Zip Code : -J y7,5;>') County: _,,( .... LJt'°""""k£_,._,,_ _______ _ OfficeTeleNo.: Q(9 1'7'oi-.:;n50, Cel!No.: _______ _ STATUS OF APPLICA.i.~T Private: i State : Federal: Municipal: --. Commercial: Native American Lands: F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used) G. WELL CONSTRUCTION DA TA ( l) Proposed date to be constructed: 3 · ? \ -~ 0\ 0 Number of borings: _3 ___ _ / Approximate depth of each boring (feet):___,__\ _,i ..... D _____ _ (2) Type of tubing to be used (copper, PVC. etc): _ ___.1/i='{)'-P_e,.:....· __________ _ (3) Well casing. ls the well(s) cased ? (check either (a.) Yes QI (b.) No belO\v) (a) Yes if yes, then provide casing infonnation be[o·w Type: __ galvanized steel __ black steel___plastic __ other (specify) Casing depth: From ___ to ___ feet (reference to land surface) Casing e:·nends to above ground ___ inches (b) No V (4) Grout Info (material surround ing well casing and /or piping): v (a) (b) Grout type: Neat Cement __ Grout placement: Pumping V Bentonite Pressure __ Other (specify) ______ _ Other +' fi ri,=c_ to /0 () ·f; ) (c) Grout depth of tubing (reference to land sur1ace): ram ::,· 0 ( eet . If ·well has casing, indicate grout depth: from ___ to ____ (feet) H. INJECTION -RELATED EQUIPMENT Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior pipingttubine associated with the injection operation. The manufacturer's brochure may provide supplementary information. 1. 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 Note: This Permit Application must be signed In- each person appearing on the recorded legal property deed. "l 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. r 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.- Signaturejof P opertm wner/Applicant Juc',, LQ S Print or Type Ful4 Name and title i°2 i 7.r4 i 01hLYL4--.1 Signature of Property Owner/Applicant Print or Type Full Name and title Signature of Authorized Agent" if anti Print or Type Full Name and title Please return two copies of the completed Application package to: North Carolina DENR-DWQ Aquifer Protection Section-LJIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 GoMAPS - Durham County NC Public Access 38.08 rP p6' 7f 0L s=221t co m 76.00 �1.43 176.51 25,97 74 91,51 a Ei Durham...A 11 " Streams and Ditches DITCH V/ RIVER STREAM UNKNOWN 1 Highways /f Lot_Numbers Lot Dimensions Address_Points_from_Parcels Parcels I1 Parcol_ID_Labels - Bullding_Footprints_1994 Surface_Water_Polygons Municipal _Boundaries Chapel Hill Durham 11 Mordiv Ile laRaleigh Wednesday, July 20 2011 GoMAPS - Durham County NC Public Access • • Durham_C l�� Streams and bitches DITCH RIVER STREAM UNKNOWN Highways Parcels Su rface_Wate r_Pvlygons Municipal Boundaries Chapel Hill Durham Morrisville Ralsigh Wednesday, July 20 2011 N