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Home My WebLink AboutWI0500436_GEO THERMAL_20110916Permit Number Program Category Ground Water Permit Type Wl0500436 / lnjection ·water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facilitv Facility Name George Adams SFR Location Address 2124 Light Horse Tri Wake Forest Owner Owner Name George Dates/Ev e nts NC 27587 Adams Scheduled Orig Issue 09/16/11 App Received Draft Initiated Issuance 09/15/11 Requlated Activities He at Pump Injection Priv ate residence , single family Outfa ll NULL Central Files : APS_ SWP_ 09/16/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Michele Adams 1001 White Crane Way Raleigh Major/Minor Minor Region Raleigh County Wake Facility Contact Affiliation Owner Type Individual Owner Affiliation George Adams Owners 1001 White Crane Way NC Raleigh NC Public Notice Issue 09/16/11 Effective 09/16/11 27615 27615 Expiration Waterbody Name Stream Index Number Current Class Subbasin ~ .-.-.~"·---NCDENR North Carolina Department ef Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor George Adams Michele Adams 1001 White Crane Way Raleigh, NC 27615 Coleen H. Sullins Director 09/16/2011 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0500436 2124 Light Horse Trail Wake Forest, NC 27587 Dear Mr. Adams: Dee Freeman Secretary On 09/15/2011, 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 tbe construction and operation of this type of geothermal injection well system as long as the following conditions are met: l. 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 .021l(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 uers mmcdenr. 1wv if y~ve any questions. S.n I ':Jw'' 11:i;cere y, i .-1 • --~//~"J/J. --:l:!l----. ~ ~-::.:.J,./ !;\- cc: Raleigh Regional Office -APS APS Central File:,, -Pemm :Ko. 1YI0 5-0~ Wake County Health Dept. for Debfa Watts Supervib:J Glen A. Darch (Glen A. Darch Well Drilling, LLC, 13109 Bold Run Hill Rd., Wake Forest, NC 27587) Steve Bowman (Bowman Mechanical Services Inc., 145 Technical Ct., Gamer, NC 27529) AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 2728 Capiial Boulevard, Raleigh, North Carolina 27604 Phone: 919-733-3221 \ FAX 1: 919-715-0588; FAX 2: 9~9-715-5048 \ Customer Service: 1-877-623-6748 Internet: www.ncwaterouali1v ,o ro /-."[ Equa l Opportun;::· \ Affirmative Action Employer NOnel 0 • ort 1 L-arohna ;Vatural~lf 08-30-'11 29118 F1OM-Snyder-Hankins 9198709923 T-817 P0002/0003 F-760 Y\i-1-066d13(0 NORTh CAROLINA DEPARTMENT OP ENVIRONMENT AND NATURAL RESOURCES NOTIIICA'ITON OF INTENT TO CONSTRUCT OR OPERATE R J C?X0N WELTS in ACoordauc, With the Provisions of l SA NCAC 02C MOO CLOSED -I 0PP_ WATER-ONkar GEUx 4Dig. iNit rfiA T vVLi .4 These well; circulate potable water only us part of a geothermal heetiog erld cooling aystew. These wells are `permitted by rule" and do not require sit individual permit who thoy are constructed in accordance with the rates of I5A NCAC 02C .0200 and this Notice is submitted prior to co tntttion. Print or 7,ps ) korma ion and Maid to the Addr4 t oh die Last P ge DATE: I: ( /L 0 r/ , 20PERMIT NO. (ta be filled ita by DWQ) A. STATUS OF WELL OWNER (chow one) Non -Government lndividua} Residence Business/Organization Government: State Municipal County Federal WELL OWNER - For individual residences, list gadi owner on Props+ deed. r"or all hers, state name of entity 4 :limo of person delegated authority to sign on behalf of the business or agthcy: e4)" e iNt\ c--h e �a�S Maui Ad SS: 1 aP 1 lambs is eraAe- la City:-- 14 t k �.._.. Staff ik zip)zodo: 7.i.&.z County: 3'lc- 5'35 L Geli'A 6.: EMAIL. Address: — - ifat.No. VG-3 ca., piA 9lib/I� C. LOCATION OF WELL SUE - Where the injection wells are phydi ally located: . (1) Pareei IdentificationIt+lumber (PIN) of well site: 48 :36 U$? county; (2) Physical .,9,ddtess Of different Om=Mug address}' 2 ! q 1, t 3.1)4 - r re... I Day Tele No,: City; / ± rote. s+ Stale: Ec Zip code: _ a 7 5 F? 7 », WELL DRILLER iNEOR117ATZON �. P� 4 Pet d 4/ek . >r; J4 (L C Well lulu Gootxectar's 1�,�: NC Well Drilling Contractor Certificate No.: 3900 - Company Name! �r e.} JJ C C %/ � f/ L (2 Contact hem_ ry �1L DcC ' ALLAddte9 Ild r`fl"17 d 40/ C(,, Address: 13 / - eo 4 41 City: 1144 %f rrr «J 1Eip Code: .7 197Statot ! CCoonty: Office Tele No.: (ell)) 5' E -3Sfeell No.: $/9 4I ZZ- / Y4x NEL; CV,) IR CA GPUMICg1WNotifiaa'J (Revised 3/) IJJ10 RECEIVED I DENR 1 TWO paw Aquitet Rrotertion Section SEP 1 5 loll E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: Bowman Mechanical Services Inc. Contact Person,_: -------------=E""-MA=-"~IL:::....o...A:..::d:.::d""'re""s=s,_:"""b..,.o .... wm ....... anm==e=c=h=an=i=c=alei:@;,.,b=e""'l~ls"""oc.:u:th~.ne::e=t Address: 145 Technical Court City: Garner Zip Code: 27529 State: NC County: Wake Office Tele No.: (919) 772-2759 Cell No.: ________ Fax No.: (919 ) 779-9294 F. WELL CONSTRUCTION DATA s--z7c:.-,,,,. (1) Number of borings to be constructed*: _____ Depth of each boring (feet): ____ J ____ _ * 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 req~es a cement type grout. (b) Groutdepthoftubing(referencetolandsurface): from Sfc to -Z.75'" (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 clearly 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 5QW Notification (Revised 3/18/2011) Page2 08-30-'11 09:18 FROM-Snvder-Hankins 9198703923 T-817 F0003/0003 F-76@ Q. CERI ICATiII I (to be signed as required below or by that person's authorised agent) 15A NCAC O2C .02)1(b) requires that all permit applications shalt be signed as follows: 1. for a corporation: by a responsible co orate officer; 2, for a partnership or tole proprietorship: by a BOD141011 partner ur 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 otters: by the well owner ‘Csylapasguilipttaaat s died . It an authorised agent is signing on behalf of the apelentiti then eup 'letter signed by the applicant that names and authorizes their tigertrt.to appflcation on their hereby certlfj+, under penalty of taw that € have personally ftakitieid and am familiar with the ittiorrtation submitted in this document and a1E attachments thereto and that; d on.nsy inquiry of those Individuals immediately re possible for obtaining said informatiOn, t believe ti t the infermsdan lain* accurate and cotapfete. I am aware that there are significant petuiltie$0 IinoledidOileireiSitillity at' Ones and imPtisontotent. for submitting false information. I agree to construct, operate, riridataikSepoir,4if applicable) abandon the injection well and all related appurtenances In aecosdatzce with die"approved 40c1 r :dons and conditions of the Permit" fProperty D►+ or&Aplalicsett Orr e. l:aa-tri j AM Name Signature & Property OwnFApant c t�h l e (4,:6ale 1.5 pritlt QC Type Full Name Signautre ofAutheriz d Agent, if any Print or Type Full Naito Submit the complete application package to: DWQ - Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 21699-1636 Telephone (919) 7334221 fiat Ia IN" et,s1it *SPe:a...nn. rt/n.-.nr 4M10.0M14 REGEfVE DIDENR/GWt7 Aquifer Protection Section SEP 15 2011 Am A 25 50 100 Feet PIN 0883677089 Real Estate ID 0258648 Map Name 088302 Owner ADAMS, GEORGE & MICHELE Mailing Address 1 1001 WHITE CRANE WAY Mailing Address 2 RALEIGH NC 27615-1687 Mailing Address 3 Deed Book 14200 Deed Page 0188 Deed Date 1211 51201 ❑ Deeded Acreage 18.03 Assessed Building Value $0.00 Assessed Land Value $831,050.00 Total Assessed Value $631,050.0D Billing Class INDIVIDUAL Property Description LOSR NEUSE RIVER BRANCH BM2011-00389 Heated Area Site Address 2124 LIGHT HORSE TRL City Township NEW LIGHT Year Built 0 Total Sale Price $0.00 Sale Date Type and Use Design Style Land Class VACANT Old Parcel Number 153-- WAKE COUNTY NORMN L.ROI.INA "ERLY NORTH ?NET ua34OJ SCALE i " = i 00' 100 50 0 IOo S 89042'30" E 272.68' i1LA60' is Iij Od6'` J;_ k NEW PROPERTY, 1pj 191 ET0 _ ��• - UN G 19 NEW PROPERTY LINE LEGEND SYSTEM LINE REPAIR LINE PRIVATE WELL SEPTIC SYSTEM SETBACKS Saute I bare Ade i- ( 20I.7r 34� - 1.9911 AC 86734 SF i10 +f Y t--�i !_•� N 8805650" W L PROPERTY LINE HEREBY ABANDONED sT SEPTIC TANK PT PUMP TANK NOTES: Zis I) SITE DATA TO INCLUDE PROPERTY BOUNORIFS, STRUCTURE LOCATION, UT1UTIES, ROADS AND OTHER SITE FEATURES WERE PROVIDED 9Y SULLIVAN SURVEYING AND ARE SHOWN TO DISPLAY GENERAL SITE CONDITIONS, 2) ALL SEPTIC S1a1 EM COMPONENTS TO INCLUDE TANKS, PUMPS, MANIrows. AND SYSTEM AND REPAIR LINES HAVE BEEN GPS LOCATED BY SOIL SERVICES, LLC. ALL LOCA11CM. ELEVATIONS AND DIHENS:OHS ARE AP'PROXLMATE AND AS SUCH NO SPECIFIC ACCURRACY EITHER VERTICAL OR HORIZONTAL IS IMPLIEC. 3) PROPERTY AND EASEMENT SOUND RIES SHOWN ON THIS SITE SKETCH ARE APPROXIMATE AND ARE NOT INTENDED FOR LOCATING PROPERTY OR IDENTIFYING PROPERTY OP. EASEMENT CORNERS. TM18 IS NOT A SURVEY. SOIL SERVICES, PLLC 3220 PURNELL ROAD. WAKE FOREST, NC 27587 OFFICE: (919) 745-192B FAX (919) S54-1849 WYIWSOSLSE RVICES.ORG Shaer rra SEPTIC SYSTEM SITE PLAN P.o; rcc NEUSE RIVER RANCH - TRACT 4 WAKE CO., NC `SNYOER-HANKINS CUSTOM HOMES Prgea IN I904I Sheet NE 1 VICINITY M in4 'D By NOT TO SCA rove Ktvise 5ni thi 1-6,1k1Y)5 GA, 14014-a5r `c' ^ ,G- �ev l 6 sriC - 1 - rJe^ 21ztah ta +J e�r'�l 1 t YP«.;,- �►4os44 L e re',€Jt'1 ..2.7 5e7 r�ms.,,ar+�u.n 4 LEGEND: ❑Ak04646 0 1 • IRON FOUND i e WELL HEAD $nM L999 Pg 1301 Y s£PTIC FLAG HUV OR reRHEaLr UN I TED STATE OF AMER ICA DB 5104 Pg 301 N 00?02' 96" w f 164, 63' ,D, Date 4'2:7• I I aI rur k•— Use is 4. Q 4 {INTERIOR F[ELp Reject MBL Front 440 Rear 3 D Side Corner Con n?ents: PROPOSED IMPERVIOUS AREA SUMMARY: HOUSE S TERRACE DR I1vE_ (LDT 4R) MI, 2c.Fo 35753E 415 5f 120 41"55F 50' PRIVATE ACCESS EASEN 99 Pg '3Ol N OL?02' 46' W LC Ixx:. RI °' f co PROPOSED _ — .:xi TERRACE T. : li: -- .'-''r tl) ttki4tiar\ICILI"7- i rmi 5R ETZ ifl[-7 mmummaLl ttimmuzi examomitis nowimarii inisSSetrAl !_ rS[Iil LP tpima r. si� o cu omozuil,qg pE;gm,_r__$.7 O UO L44 NOT LOCATED) r 1f B°M 2011 Pg 3R 11ON 20L0 Pg ;052 LINE BEARING DISTANCE L l 1 5 03751' 09' E 93.82 501?03'10' Y[ t413.B2 LINE DISTANCE BOOK or MAPS EO l t PAGE DEED BI101t;0l 1 PAGE .0 L3 25. 59 2ECORDAT I ON ■ 0 400 800 1600 Feet PIN 0883677089 Real Estate ID Map Name Owner 0258648 088302 ADAMS, GEORGE & MICHELE Melling Address I 1001 WHITE CRANE WAY Mailing Address 2 RALEIGH NC 27615-1687 Mailing Address 3 Deed Book 14200 Deed Page 0188 Deed Date 12/152010 Deeded Acreage 18.03 Assessed Building Value $0.00 Assessed Land Value $631,050.00 Total Assessed Value $631,050.00 Billing Class INDIVIDUAL Property Description LOSR NEUSE RIVER BRANCH BM2011-00389 Heated Area Site Address 2124 LIGHT HORSE TRL City Township NEW LIGHT Year Built 0 Total Safe Price $0.00 Safe Date Type and Use Design Style Land Class VACANT Old Parcel Number 153-- 11111111. AKE COUNTY NUR! II LAI1V_INA 13131411"441 Mechanical Services, Inc HEATING & AIR CONDITIONING CONTRACTORS 145 Technical Court • Garner, NC 27529 • (919) 772-2759 • Fax (919) 779-9294 9-27-2011 Aquifer Protection Section \ NCDENR 1636 Mail Service Center Raleigh, NC 27699-1636 Subject: George & Michelle Adams 2124 Light Horse Trail Wake Forest, NC 27587 To Whom it may concern, Permit # W10500436 for a 5QW geothermal injection well has Glen A Darch Well Drilling listed as the drilling contractor to perform the requested work. Please change the records by removing Mr. Darch from the permit and adding; N.W. Poole Well & Pump Company 3500 Rolesville Road Wendell, NC 27591 919-266-9223 Wake County Contact Person- Harry Lechworth NC Well Drilling Contractor Certification #- 2833A or 2514A E-Mail- lechworth@Wnwpooleweli.com Please let me know if any further paperwork is required. Thank you for your assistance. Sincerely Robert Marshall Bowman Mechanical Services, Inc. RECEIVED 1 DENR 1 OWQ Aquifer Protection Section SEP 29 2011