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Home My WebLink AboutWI0500469_GEO THERMAL_20120131Permit Number Program Category Ground Water Permit Type WI0500469· Injection Water Only GSHP Well System (5QW) Primary Reviewer eric.g.smith Coastal SW Rule Permitted Flow Facilit Facility Name Elizabeth Tomita SFR Location Address 5313 Granada Hills Dr Raleigh Owner Owner Name Elizabeth Dates/Events NC 27613 Tomita Scheduled Orig ls"'ue 01/31/12 App Received Draft Initiated Issuance 12/06/11 Regulated Activities Heat Pump Injection Private residence, single family Outfall NULL Central Ffles: APS_ SWP_ 01/31/12 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Elizabeth Tomita Owner 5313 Granada Hills Dr Raleigh Major/Minor Minor Region Raleigh County Wake Facility Contact Affiliation Owner Type Individual Owner Affiliation Elizabeth Tomita Owner 5313 Granada Hills Dr Raleigh NC NC Public Notice Issue 01/31/12 Effective 01/31/12 27613 27613 Expiration Waterbody Name Stream Index Number Current Class ~ubbasin A.TA .NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Elizabeth Tomita 5313 Granada Hills Dr. Raleigh, NC 27613 Charles Wakild, P.E. Director 01/31/2012 Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System PermitNo. WI0500469 5313 Granada Hills Dr. Raleigh, NC 27613 Dear Ms. Tomita: Dee Freeman Secretary On 12/06/2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-only 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 ISA 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 .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-.ctMooo Rogers at (919) 807-6406 o, Mkhoel~-:s:~~;·l;QZ:~•stiom. for De ra atts Supern cc: Raleigh Regional Office -APS APS Central Files,..__Pennit-No; Wl0500469 Wake County Health Dept. Harry Lechworth (N.W. Poole Well & Pump Co., 3500 Rolesville Rd., Wendell, NC 27591) Steve Bowman (Bowman Mechanical Services Inc., 145 Technical Ct., Garner, NC 27529) AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 512 N. Salisbury St., Raleigh, North Carolina 27604 Phone: 919-807-6464 \ FAX: 919-807-6496 Internet: www.ncwatergu~lily.org An Equal Opportunity I Affirmative Action Employer . One ... North Carolina /ya(t1r.a.lt11 ~(99 ~ 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. DATE:_/_?,,-+-,/-~--~· 201.L PERMIT NO. ________ (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: £. //7:4 f>~f/.. ToNI l fq Mailing Address: ---=r;--:---=-3_13 __ G=---~-ti___:/l..:..:.a .=..t:l._:_a.:....___:_//,_:_,.:.._:/ l---'s=-----_,():..__:r'--.__ _________ _ City: ~~--•·7'"'~------State:/VC Zip Code: '2.. 76/3 County: _____ _ Day Tele No.: ---'<-+-'-/9L,'-_t./____:_'/_?_-_0_8 _fJ -=--9 ___ ___,C=e=ll -"-'N=o·c:...: __________ _ EMAIL Address: _____________ -----"'F"""ax=N_,_,o=.:'--------------- C. LOCATION OF WELL SITE -Where the injection wells are physically located: (1) Parcel Identification Number (PIN) of well site: 0 78 7 0 6 S7€t unty: Wak-e (2) Physical Address (if different than mailing address): O 7 9' 70 6 ?7 b I City: _______________ State: NC Zip Code: ________ _ D. WELL DRILLER INFORMATION Well Drilling Contractor's Name: N.W. Poole Well & Pum p Co NC Well Drilling Contractor Certification No.: 2833A or 2514A Company Name: N.W. Poole Well & Pump Co Contact Person: H atTY Lechworth EMAIL Address: Lechworth@ NWPoolewell.com Address: 3500 Rolesville Rd RECEIVED/ DENR / DWQ Aquifer Protection Section City: Wendell Zip Code: 27591 State: """N""C'---County: Walce Office Tele No.: (919) 266-9223 Cell No.: Fax No.: (919 ) 266-7507 DEC O 6 2011 GPU/UIC 5QW Notification (Revised 3/18/2011) Page I E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: Bowman Mechanical Services Inc. F. Contact Person.~: ------------~E=MA~=IL~A=d=d=r=es=s~: ~b~o~w=m=anm==e=c=h=an=1=· c=a-1@.,_.-=b=el=ls=o=u=th=·=ne=t 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 WELL CONSTRUCTION DATA '? u r-o / (1) Number of borings to be constructed*: __ '---____ Depth of each boring (feet):_~L~J_ 1 ____ _ * 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 'I 5-0 (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. Abm, a 'layer' can be selected showing topographic contours or elevation data. GPU/UIC 5QW Notification (Revised 3/18/2011) Page2 201%12-01 11:09 Lisa Tomita 19194863512» 9197799294 P 111 H. CERTIFICATION to be signed as required below or by that person's authorized agent) 15A NCAC 02C .0211(b) requires that al! permit applications shall be signed as follows: 1. for a corporation; by a responsible corporate officer, 2. fur 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 wall owner (which means all persons listed on the property deed). If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant that acmes and authorizes their agent to sign this application on their behalf. `'1 hereby certify, under penalty of law, that 1 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 fpr obtaining said information, i believe that the infonnatiun 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 infection well and ail related appurtenances in accordance with the approved specifications and conditions of the Permit" Signet re of Property Owner/Applicant Print or Type Full Name Signature of Properly Owner/Applicant Print or Type Full Name Signature of Authorized Agent, if a yy 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 RECEIVED / ❑ENR 1 DII1O Aquifer Proter on Section DEC 00 2011 Granada hills Dr creoi-k,J bor! ko 4-5 1 F 0 12.5 25 50 Feet Field value PIN 0787063761 Real Estate ID 0301005 Map Name 078709 Owner TOMITA, ELIZABETH A Mailing Address 1 5313 GRANADA HILLS DR Mailing Address 2 RALEIGH NC 27613-8580 Mailirg Address 3 Deed Book 10018 Deed Page 1618 Deed Date 3/32/2003 Deeded Acreage 0.19 Assessed Building $293,608.00 Value Assessed Lana Value $108,000.00 Total Assessed Value $401,608.00 Billing Class INDIVIDUAL Property Description LD1028 LONG LAKES SUB P1 TR1 BM2002-01104 Heated Area 3141 Site Address 5313 GRANADA HILLS DR City Raleigh Township LEESVILLE Year Buil; 2003 Total Sale Price $298,500.00 Sale Date 3I32/2003 Type and Use Single Family Design Style Conventional Lard Class RESIDENCE-c 10 ACRES -HOME SITE Old Parcel Number 321-00000-0000 WAKE COUNTY r. �Op, re w w 7 0 410 Oa oar alai gm ANN ma "MN gel 400 on— . 1P Stone VV,ry' ril Imp 40 n 111: 11, y�f �iy 0.06, 800 .41 CS- 4 76 4.� lei Shaker Noi4ht�: C retry Trl Fral lit awl fW dy Ba I I. ' iSt• ht 14. .4 G,anada'Hil'•rM. 1 rhino utir'•` 41. 1600 Feet ;111i11111i Whid:Moit taut Lf NuuIIt , _ Old PPP lid fD►raf.Rd *�f� - e` % } Air siiitfinoutAllec, A i� 7� 1111 L-nn c�Vtr As me is A4/11 4q mei Leesville Road S thooIs rJ ��7arrglewit-�� n«.Pork PIl 1 Field Value PIN 0787063761 Real Estate ID 0301005 Map Name 078709 Owner TOMITA, ELI7.ASETH A Mailing Address 1 5313 GRANADA HILLS DR Mailing Address 2 RALEIGH NC 27613-8580 Mailing Address 3 Deed Book 10018 Deed Page 1818 Deed Date 3/32/2003 Deeded Acreage 0.19 Assessed Building Value $293,608.00 Assessed Land Value $108,000.00 Total Assessed Value $401,608.00 Billing Class INDIVIDUAL Property Description L01028 LONG LAKES SUB P1 TR1 BM2002.01104 Heated Area 3141 Site Address 5313 GRANADA HILLS DR City Raleigh Township LEESVILLE Year Built 2003 Total Sale Price $298,500.00 Sale Date 3/32/2003 Type and Use Single Family Design Style Conventional Land Class RESIDENCE -a 10 ACRES -HOME SITE Old Parcel Number 321-00000-0000 BOW WAKE COUNTY NO0.TH CA ROUNA