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Home My WebLink AboutWI0500431_GEO THERMAL_20110913Permit Number Program Category Ground Water Permit Type l. •' WI0500431 / Injection Water Only GSHP Well System (5QW) Primary Reviewer michael. rogers Coastal SW Rule Permitted Flow Facilit Facility Name Margaret S Norton SFR Location Address 11212 Conley Cove Ct Raleigh Owner Owner Name Margaret Dates/Events NC 27613 s Norton Orig Issue 09/13/11 App Received Draft Initiated 09/09/11 Rea ulated Activities Heat Pump Injection Outfall NULL Scheduled Issuance Central Files : APS_ SWP_ 09/13/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Per mit Classification Individual Permit Contact Afflllatlon 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 Margaret S. Norton 2803 S Pennsylvania Ave NC Long Bch Twp NJ Public Notice Issue 09/13/11 Effective 09/13/11 ' 27587 08008 Expiration Waterbody Name Stream Index Number Current Class Subbasin NA NCDE R North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Margaret S. M01to11 2803 South Pennsylvania Avenue Long Beach To~nship, NJ 08008 Coleen H. Sullins Director 9/13/2011 Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System Permit No. WI0500431 11212 Conley Cove Court, Raleigh, NC 24613 Dear Ms. Morton: Dee Freeman Secretary On September 9, 2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-on]\' 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 15A Section 2C Subchapter .021 l(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.Ro 2ers/a)ncdem.gov if you have any questions. cc: Raleigh Regional Office -APS APS Central Files -Permit No. WI050043 l Wake County Health Dept. Glen A Darch Well Drilling, LLC (Glen A. Darch) Bowman Mechanical Services. Inc. (Steve Bowman) AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604 Sincerely, roQ~A~~ Supervisor Phone: 919-733-3221 I FAX 1: 919-715-0588: FAX 2: 919-715-6048 I Customer Service: 1-677-623-6748 Internet: www.ncwatergualitv.o rg An Equal Opoortuni•; \ Aiiinnative Action Emo:oyr- None, C 1. 1orth aroma lVaturall!f NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS In Accordance With the Provisions of I5A NCAC 02C .0200 CLOSED -LOOP WATER -ONLY GEOTHERMAL INJECTION WELLS These wells circulate potable water only as part of a geothermal beating 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 Addressonthe Last Page. DATE: I 7-3 . 241L PERMIT NO.V\1I ►7V 0431 (to be filled in by DWQ) A. STATUS OF WELL OWNER (choose one) Non -Government: Individual Residence X Business/Organization Government: State Municipal County Federal 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: are S' for /0„ Mailing Address: 7 0 3 S Pem Sy.1024 r / v� City: L0 l'x2C4 T r-.5'*:v State: NYZip Coder O 'OO8 County: Day Tele No.: Cell No.; EMAIL Address: /►'l Qe#ih0Z Fax No.: C. LOCATION OF WELL SITE — Where the injection wells are physically located: 7 (1) Parcel Identification Number (PIN) of well site: 0 7 S ? .7 ,'. 3 7 County: wake (2) Physical Address (if different than mailing address): I ? ! Z. ' 1 Co' %e,y Col►e CI City: q ter; I State: NC Zip Code: 27 6 /3 D. WELL DRILLER INFORMATION Well Drilling Contractor's Name: Glen A Darch Well Drilling LLC NC Well Drilling Contractor Certification No.: 3900-A Company Name: Glen A Darch Well Drilling LLC Contact Person: Glen A Darch Address: 13109 Bold Run Hill Rd. City: Wake Forest Zip Code: 27587 State: NC EMAIL Addre Aquifer protection Section ss: dwelldrillirtg;riaol.com RECE,V , DENR 1 DWQ Fax No.: (9191556-3839 SEP 09 Ulf County: Wake Office Tele No.: ( 9191556 3839 Cell No.: (919)422-9931 GPUIUIC 5QW Notification (Revised 3/ t 8/201 > ) Page 1 E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: Bowman Mechanical Services Inc. Contact Person: S f eve 8ow,..cvf EMAIL Address: bowmanmechanical(@ bellsouth.net Address: 145 Technical Court City: Gamer Zip Code: 27529 State: NC County: Wake Office Tele No.: (919) 772-2759 Cell No.: ________ Fax No.: (919 ) 779-9294 F. WELL CONSTRUCTION DATA (1) Number of borings to be constructed*: S-Depth of each boring (feet): __ 3_0_0 ____ _ * 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): HDPE (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** X Other (specify) _______ _ ** By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C .0213(d)(l)(A), which requires a cement type grout. (b) Grout depth of tubing (reference to land surface): from Sfc to 3 OO (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 of the 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 of groundwater 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 photograph of the property parcel showing property lines and structures can be obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by owner name or address. The location of the wells in relation to property boundaries, houses, 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/UIC SQW Notification (Revised 3/18/2011) Page 2 Aug 23 11 10:28a Marty Norton 6094921820 p,1 08/ 23/2811 i9: ah .I.,1- rl• .fl H- C tT1FICATION (to be signed as required below or by that person's authorized agent) 15A NCAC 02C .0211(b) requires that ail permit applications sball be signed as follows: 1. for a corporation: by a responsible corporate officer; 2. for a partnership or sole proprier[xahip: 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. fur all others: by the well owner (which means all persons listed on the property deedj. If an authorized agent is signing on behalf of the applicant, then supply a letter sued by the applicant that names and authorizes their agent to sign this application on their behalf. "l hereby cetiify, undor penalty of law, that l nave persnnally examined and am familiar with the information submitted in this document and all attachment thereto and that, based an my inquiry of those individuals immediately responsible for obtaining said information, l believe that the info:nation is true, accurate and complete. 1 art aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting false information. 1 agree to construct, operate, nneinrain, repair, and if applicable, abazao;tthe ;injection well, and all related appurtenances in accordance with the appre specifications and conditions of the Permit." Print or Typ ull Name Applicant Signature of Property Owner/Applicant Print or Typc Pull blame Signature of Autboiz d Agent, if any Print or Type Full Name Submit the complete application package to: DWQ - Aquifer Protection Section 1636 Mail Service Center Raki8h, NC 2769-I636 Telephone (919) 733-3221 1U'WrJ! SQW Notihcatinn (Rer ised 311 til20311 RECEIVED / DENR 1 DVNQ Aquifer Preftectron Section SEP 0 9 2011 hie 0 50 100 � mm v� � y t !Q7 200 Feet PIN 1718495181 Real Estate ID 0273552 Map Name 171801 Owner STEEN. WALTER A 8 NATALIE C Mailing Address 1 PO BOX 97247 Mailing Address 2 RALEIGH NC 27624-7247 Mailing Address 3 Deed Book 09950 Deed Page 1020 Dead Date 3/3/2003 Deeded Acreage 1.22 Assessed Building Value $1,012,318.00 Assessed Land Value $215.000.00 Total Assessed Value $1,227,318.00 Billing Class INDIVIDUAL Property Description L012 DEVON SUB PH1 BM1999-2251 Healed Area 5183 Site Address 5324 WYNNEFORD WAY City Township BARTONS CREEK Year Built 2002 Total Sale Price $0.00 Sale Date Type and Use Single Family Design Style Conventional Land Class RESIDENCE•c 10 ACRES -HOME SITE Old Parcel Number 282.00000-0000 W COUNTY %eei II LAWLINA 0 400 800 1600 Feel PIN 1718495181 Real Estate ID 0273552 Map Name 171801 Owner STEEN. WALTER B & NATALIE C Mailing Address 1 PO BOX 97247 Mailing Address 2 RALEIGH NC 27624-7247 Mailing Address 3 Deed Book 09950 Deed Page 1020 Deed Date 3/3/2003 Deeded Acreage 1.22 Assessed Building Value $1,012,318.00 Assessed Lanc Value $215,000.00 Total Assessed Value $1227,318.00 Billing Class INDIVIDUAL Property Description L012 DEVON SUB PH1 BM1999.2251 Heated Area 5183 Site Address 5324 WYNNEFORD WAY City Township BARTONS CREEK Year Built 2002 Total Sale Price $0.00 Sale Dale Type and Use Single Family Design Style Conventional Land Class RESIDENCE-< 10 ACRES -HOME SITE Old Parcel Number 282-00000-0000 01111".- WAKE COUNTY NITh1ll CR%ULINA 1 C-- A - ?1 tx5 Sc e7. - 5 Kivu v\A-f g5-a in -Rd" /71 P-SX ram" fir--. 1,5V0 tr-‘'2/1/1 CI644411'1 1MPE1M=FOOTAGE SWAM 'i[FFA AOTARE 'IorrLFOOWJ 1F_mg SF "BRAWN 4,311SF +ra7ue SF wawa VAX 12,00SF 'AMIABLE 760SF 6030 Inuccuiercnim eareimgamoftsreRn wont AroarECT EMMA MID 1 7 wr SCALE d + N 151 lr 931I'