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Home My WebLink AboutWI0500409_GEO THERMAL_20110808Permit Nu mber Program Category Ground Water Permit Type Wl0500409 / Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facilit Facility Name Walter & Karen Wiebe SFR Location Address 2001 MountVemon Church Rd Raleigh NC Owner Owner Name Walter w Dates/Events 27614 Wiebe Orig Issue 08/08/11 App Received Draft Initiated 07/28/11 Re q ulated Activities Heat Pump Injection Outfall ~ L Scheduled Issuance Central Files: APS_ SWP_ 08/08/11 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 Walter W. Wiebe NC 2001 Mount Vernon Church Rd Raleigh NC Public Notice Issue 08/08/11 Effective 08/08/11 27587 27614 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 8/8:20l I Waiter W. W iebe Karen K. Wiebe 2001 Mt. Vernon Church Road Raieieh. NC 27614 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0500409 2001 Mt. Vernon Church Road. Raleigh. NC 27614 Dear Mr. & Mrs. Wiebe: On 7/28/2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-onli. 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 Cock 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 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 Michacl.Rocersencdenr.aov if you have any questions. RBoDN for Debra Watts Supervisor cc: Raleigh Regional Office - APS APS Central Files - Permit No. W10500409 Wake County Health Dept. Olcn A. Duch Well Drilling. LLC Bowman Mechanical Services, Inc. AQUIFER PROTECTION SECTION 1638 Mail Service Center, Raieiuh, Nartti Camino 27699-1836 Locoman: 2728 Capital Boulevard, Ralsigr,, Nona: Caro,.tu 27 Phone: 919-733-342i l FAst I: r;,,, 2:5i&-715-6048 l Custaane: &twice-. 'l-S� r-a"`2b 73748 internee wrrw.ncwata►¢uaiitv.orp =t.21 Vppon., ,.At;',mctiva'.e:o' cnirioy-+ on, Nort Carohina Naturally NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS In Accordance With the Provisions of 15A NCAC 02C .0200 CLOSED -LOOP WATER -ONLY GEOTHERMAL INJECTION WELLS These wells circulate potable water only as part of a geothermal heating and cooling system. 'These wells are "permitted by rule" and do not require an individual permit when they are constructed in accordance with the rules of 15A NCAC 02C .0200 and this Notice is submitted prior to construction. Print or Type Information and Mail to the Address on the Last Page. HATE:. r� 1Y , 20.1/ PERMIT NO. UZI O' oO4 ]"1 (to be filled in by DWQ) A. STATUS OF WELL OWNER (choose one) Non -Government: Individual Residence r Business/Organization County Federal Government: State Municipal B. WELL OWNER -For individual residences, list each owner on property deed. For all others, state name of entity and name of person delegated authority to sign on behalf of the business or agency: Lti t b r - Mailing Address: a Qd I I-4+- vtI 01A C h 041 red, City: I < 6-1 et .‘ Stater C. Zip Code: 1)-16 ('' County: WaLz Day Tele No.: f Col 6 - `FtEa`1 Cell No.: EMAIL Address: vwc Per '#- tie lb oug Vila- Fax No.: - - C. LOCATION OF WELL SITE - Where the injection wells are physically located: (1) Parcel Identification Number (PIN) of well site: $ ` �. 54x.3 County: ,1i1 a P (2) Physical Address (if different than mailing address): City: State: NC Zip Code: D. WELL DRILLER INFORMATION Well Drilling Contractor's Name: ice- 1'P_A 4 AZ,- e// D ;jJ +! C NC Well Drilling Contractor Certification No.: 1 SOU L Company Name: G l'e :, - r G'� G ��9 4Jr2 III C Contact Person: C I Ph -(X EMAIL Address: 7()16vt JJdr■ //.) 6,4u/ Address: )3/0 j &'JI ife City: Wra,k e fcrP5 /Zip Code: Z 7 CP 7 State: NC County: i� !4 Office Tele No.: ( SSA- �`j Cell No.(/`) Y zz —99 Fax No.: 9/3) s`5-1- -� GPi3MC 5QW Notification (Revised 3/18/201 I) RECEIVED i DENR I DV1v:,' Aquifef Pratenti,fl Srtion Page I JUL 28 2011 E. F. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: Bo Wm 0..,,,... f1 .e c 4.a.,.,~~ S'erv-,;e-J J;n c.. Contact Person: sf e Ill !1 Ow"";;.,. EMAIL Address: Address: / 'IS-Tt:.cA,vc g J c,f- City: GJir_,, f.> r Zip Code: L 7S-1J) State: /fC.. County: _IA/2----''Q.--=--h :......-t ____ _ OfficeTeleNo.: e f>l)77z._ .... '"2,7S'J cellNo.: _______ FaxNo.: 64} 779-92..~f WELL CONSTRUCTION DATA 2... 3Sl:J/ (1) Number of borings to be constructed*: _____ Depth of each boring (feet): _______ _ * If existing water supply wells will be used then provide the information in item (4) below. (2) Type of tubing to be used (steel, PVC, etc): _J/.-'---1[)._'/1_~_;::. __________ _ (3) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, etc.), diameter. depth, and extent of casing appearing above ground: _________________ _ (4) Grout (material surrounding well casing and/or piping): (a) Grout type: Cement__ Bentonite** J< Other {specify) ** By selcctingbentonite grout, a variance is hereby requested to I 5A NCAC 2C .0213(d)(l)(A)-, w---,h--,--ic_h_req_u...,.ir-es_a_cem_. -e-nt-ty-pe grout (b) Grout depth of tubing (reference to land surface): from S Fe to 3-l!fl) '(feet) If well has casing, indicate grout depth: from ___ to ____ (feet) G. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate distances and orientations of features located within 1000 feet of the injection well(s). Label all features clearl y and include a north arrow. (1) Attach a site-specific map showing the locations ofthe following: * Proposed injection wells * Buildings * Property boundaries * Surface water bodies * Water supply wells * Septic tanks and associated spray irrigation sites, drain fields, or repair areas * Existing or potential sources ofgroundwater contamination (2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the facility's location and the map name. NOTE: In most cases, an aerial pi,otograph of tire property parcel showing property lines and structures can be obtained and downloaded from t/Je applicable county GIS website. Typically, the property can be searched by owner name or address. Tlie location of the wells in relation to property boundaries, 1,ouses, septic tanks, other wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or elevation data. GPU/UJC SQW Notification (Revised 3/18/2011) Page2 H. CERTIFICATION (to be signed as required below or by that person's authorized agent) 15A NCAC 02C .0211(b) requires that all permit applications shall be signed as follows: I . for a corporation: by a responsible corporate officer; 2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively; 3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or ranking publicly elected official; 4. for all others: by the well owner (which means all persons listed on the Qropert\ deed). If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant that names and authorizes their agent to sign this application on their behalf. 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, I 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, oerate, maintain, repair, and if applicable, abandon the injection well and all related appurtenances in accorday(ce with the ,proved peci6cations and conditions of the Permit." Property Owner/Appl ican •Wl'e Type Full Name Signa tre of Property Owner/Applicant C•-._ . Print or Type Full Name Signature of Authorized Agent, if any Print or Type Full Name Submit the complete application package to: DWQ - Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 733-3221 dill it►pr {(7- •t'r)n Section JUL 2S coil GPII/UTC 5QW Notification (Revised 3/18/2O11) Page 3 0 50 100 200 Feet PIN 0890523658 Real Estate ID 0094045 Map Name 089004 Owner WIEBE, WALTER W & KAREN K MailInn Address 1 2001 MOUNT VERNON CHURCH RD Mailing Address 2 RALEIGH NC 27614-7153 Mailing Address 3 Deed Book 05796 Deed Page 0701 Deed Da'e 9/27/1993 Deeded Acreage 4.67 Assessed Building Value $261,434.00 Assessed Land Value $275,406.00 Total Assessed Value $536,840.00 Billing Class INDIVIDUAL Property Description FLETCHER SCOTT PROP Heated Area 3625 Site Address 2001 MT VERNON CHURCH RD City Township BARTONS CREEK Year Built 1976 total Sale Price $320,000.00 Sale Date 9/2711993 Type and Use Single Family Design Style Conventional Land Class RESIDENCE -a 10 ACRES -HOME SITE Old Parcel Number 225.00000.0020 WAKE COUNTY NUM CMOLINA 0 50 100 200 Feet PIN Real Estate ID Map Name Owner Mailing Address 1 Mailing Address 2 Mailing Address 3 Deed Book Deed Page Deed Date Deeded Acreage Assessed Building Value 0090523658 0094045 089004 WMEBE, WALTER W & KAREN K 2001 MOUNT VERNON CHURCH RD RALSIGH NC 27614-7153 05796 0701 9/27/1993 4.67 $261,434.00 Assessed Land Value $275,406.00 Total Assessed Value $536,840.00 Billing Class INDIVIDUAL Property Description FLETCHER SCOTT PROP Heated Area Site Address City 3625 2001 MT VERNON CHURCH RD Township Year Built Total Sate Price Sale Date Type and Use Design Style BARTONS CREEK 1976 $320.000.06 9/27/1993 Single Family Conventional Land Class RESIDENCE-‹ 10 ACRES -HOME SITE Old Parcel Number 225-00000-0030 WAKE COUNTY NOMA.' CANtli1NA 0 0 0$erid'Or �/le 6yy�� \,AcktC• n �] a r 3 7 \\\ / r 0 1 ;Ifk. si4 � Cr°65��t eCt ‘vaMa 4 r dip 410 ;%4Nift •�.7ea4 r[ tenth Pleasant Union Elementary a .Br.Dr !4, 0 400 800 1600 Feet PIN 0890523658 Real Estate ID Map Name Owner 0094045 089004 WIEBE, WALTER W & KAREN K Mailing Address 1 2001 MOUNT VERNON CHURCH RD Mailing Address 2 RALEIGH NC 27814.7163 Mailing Address 3 Deep Book 05796 Deed Page 0701 Deed Date 9/27/1993 Deeded Acreage 4.67 Assessee Building Value $261,434.00 Assessed Land Value $275,406.00 Total Assessed Value $536,840.00 Billing Glass INDIVIDUAL Property Description FLETCHER SCOTT PROP Heated Area 3625 Site Address 2001 MT VERNON CHURCH RD City Township BARTONS CREEK Year Built 1976 Total Sate Price $320,000.00 Sale Date 9/27/1993 Type and Use Single Family Design Style Conventional Land Class RESIDENCE-c 10 ACRES -HOME SITE Old Parcel Number 225-00000_0030 WAKE COUNTY VONIu LAM /LINA * 1,.KEIgiT-300113 IF NOT IN COMPLIANCE WITII t'l lzt lLA71ON5 a7s WAK-EIOUNTY HEAL PARCEL NO: 7 1-EgrtC TANK LAW • OWNER OR CONTRACTOR i Ax MAP, NO LOCATION f se +a ti 7ZO Id) 9 9' SUBDIVISION NAME GARBAGE DISPOSAL, UNtI YF� ;Cy ❑ MOBILE HOME aUSINeSS I❑ N4, BEDROOMS 3 ;LOT AREA 460eic.' SIZE OF TANK gal.' NITRIFICATION LINE (Z Q ❑ (2 f } q, ft- bEPTH OF STONE IN LINES: 12" ❑ 18" X WATER SUPPLY' INDIVIDUAL 1 PUBLIC ❑ PERMIT VOID 12 MONTHS FROM DATE OF ISSUANCE. HOUSE 0 LAYOUT BY /0— jr 7 DAlE TNaiALCI'L19Y r tom. APPROVED BY s 1 srel t" P 164.03 Site plan *pprirel as sbawn for St/nowt j3 E 773.44 Any clt gee tosilo-plan voids a regar ingnaypools, decks, araVor accessory straetares. Applicant is responsfble-- portions oft! ysepticar air area and Adher to allLocai and add. for pram 1s wells imm daarage State RiiIt%. Approved by Wake County Dep JtntesttofEsiwirnnnien 2trd Waste 'ater Section SITE PLAN: 1 "=100' From a survey by Philip Lovdai R.B. 21102 Po.] 65, Wake County 2011 Mount Vernon Church Road Raleigh, NC 27614 1 certtfy+thel 3 E ip n of pied or exsling sltuchne(s) are accurately shown- I urictersland (allure to locate structures in necnrdanoe witty 1 ' • plot .plan may require the relor• lion of struct s(s) r ardiess degree of corrrpt: son 1 hereby • sn a lesion to feluniclpa1fCaun• 11epresen the ri. l of entry to make ova .. , +ns or ins, ; . s upo+1 , ;(s property. IMPERVIOUS SURFACE CALCULATIONS: Driveway Parking pad at house Parking pad at garage 1-louse Including addition Outbuilding 1 (barn) Terrace Walk 134 4;t'113 4-43 TQrAL IMPERv1O� AR A .13333 sf 3959 sf 996 si 2913sf �rv°lrra 3 3G Torsi treated area. 3B�Crsf Existing decks (demolished) 720 sf New deck and landing 265 sty sso sf pin --O5g0 . a4- . E Z . 3(DSp, 513 sf 13337/2133664 =Er.1% impervious 1.10 o� '1114 5n. _ Exist€nn barn WIEBE 2001 Mt. Vernon Church Rd., Raleigh, ttC 2761a KARL GAS INS ARCHITECT 91921 7449 9192744796m 919217119Sf kadgeskinsgmindspringRom ,l-