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Home My WebLink AboutWI0500515_GEO THERMAL_20120424Permit Number WI0500515 Program Category Ground Water Permit Type Injection Water Only GSHP Well System (5QW) Primary Reviewer eric.g.smith Coastal SW Rule Permitted Flow Facili Facility Name . John & Virginia Sall SFR Location Address 201 Vineyard Ln Cary Owner Owner Name John Dates/Events NC 27513 Sall Scheduled Orig Issue 04/24/12 App Received Draft Initiated Issuance 04/23/12 Regulated Activities Heat Pump Injection Outfall NULL Central Files: APS_ SWP_ 04/24/12 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation John H. Boyette 1109 Nash St Nw Wilson Major/Minor Minor Region Raleigh County Wake Facility Contact Affiliation Owner Type Individual Owner Affiliation John Sall 201 Vineyard Ln Cary NC NC Public Notice Issue 04/24/12 Effective 04/24/12 27893 27513 Expiration Waterbody Name Stream Index Number Current Class Subbasin Beverly Eaves Perdue Governor John Sall Virginia Sall 201 Vineyard Lane Cary, NC 27513 AVA MCDENR North Carolina Department of Environment and Natural-Resourc~~ Division of Water Quality Charles Wakild, P.E. Director April 25, 2012 Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System Permit No. WI0500515 201 Vineyard Lane, Cary, NC 27513 Dear Mr. & Mrs. Sall: Dee Freeman Secretary On April 23, 2012, 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 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) 807-6406 or Michael.Rogers @ ncdenr.gov if you have any questions. cc: Raleigh Regional Office -APS APS Central Files -Permit No. WI05005 l5 Wake County Health Dept. John Boyette, Jr. -Boyette Well & Septic, Inc. Vic Nev,·comb -Newcomb and Company 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 I FAX: 919-807-6496 Internet: www:ncwaterguality.org · An Equal Opportunily I Affirmative Action Employer Sincerely, 0-, ,--1-t1 , ~ -!Joovtt forD~s Supervisor N%rthCarolina Naturattu 03/23/2007 18:49 FAX 2522930955 BOYETTE WELL [ant NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES NOTIFICATION OF INTENT TO CONSTRUCT A CWJ ;LOOP GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM TYPE 5QW WELL(S) In Accordance With the Provisions ofNCAC Title 15A 02C.0200 Print or type the required information and maid to address on the back page, DATE: J i ( • 20 12- 1S Do j I.5 Well Type Confirmation: Toes the proposed system circulate potable water only (no additives) in continuous piping that completely isolates the fluid from the environment (i.e. closed -loop)? Yes /Continue completing this form. Na Do Not cotnpiete this form. Complete other UIC application frinns for installing either a 5A7 well (opera -loop wen irLyroting potable water into the aquifer) or a 5QM well (closed - loop well containing additives such as R-22, ethanol, Of other antifreeze or corrosion inhibitors). A, PROPERTY OWNER(S)/APPLICANT(S) List e I Property Owner listed on property deed (if owned -by a business or government agency, state name of entity and a representative wlauthority for signature): J i/Nr t , A.j; .,J1 -7w (I) City: Mailing Address 4- ° 1 : r4 Stale: I+IG Zip Code: Z 't-I l3 county: ! .� Home/Office Tele No.: Ceti No.: Email Address: Website: (2) Physical Address of Well Site (if different than above): City: State: Zip Code: County: Hone/Office Tele No.: ctil A. AUTHORIZED AGENT OF OWNER, IF ANY (if the Peimi't Applicant does not own the subject property, attach a letter from the property own r authorizing Agent to install and operate UIC well) Company Name: Contact Person: E.MAIIJ_Address: Address: City: State: Zip Code; County: Office Tele No.: Cell No.: Website Address of Company, if any: RECEIVEDIDENRIDWQ APR 23Zt112 Aquifer P otecttar Section GPUIUIC 5QW Notification of Intuit FOmL (Itevi d 8/20UU8) PRP 1 03/25/2007 18:50 FAX 2522930955 BOYEFLE WELL e002 D. WELL DRILLER INFORMATION Company Name: ""o-fe - V'I-((C J. Wall Ihiiler Connector's Name: 1'0 (�.•, ►{ » i ri NC Contractor Cer i atian No.: 2- cm Contact Person; ao 66". UE . .2 / -r EMAIL Address: 7 $c•1F1TK.- t co Address: �j D 4 WT City: ,Lt?,N Zip Code: —7 tol 3 County: W �o n Office Tele No,: 0 52-)2.37—�3 s Cell No.: e �b)2 0 q'Z C. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Ntane:/Svireztebt 4el d Cei. .4N Contact Person: _ EMAILAddress:f r e= -V4 Yl� 40 •.Cep Address. ' mad ran - City: it. Zip Code: �i v' . Con-g Office Tele No.: , rl iv > 363 • Cell No.: 7(� 1f,EA ":7 D. STATUS CFy+#PPLICANT Private: State: Federal.: Commercial: Municipal: Native American Lands: E. INJECTION PROCEDURE (briefly describe how tho injection walks) will be used) G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: �JZ% Number of borings: 3 Approximate depth of each boring (feet): p o (2) Type of tubing to be used (copper, PVC, etc): (3) Well casing, Is the wells) cased? (chock either (a.) Yes er elow) (a) Yes if yes, then provide easing information below Type: _galvanized steel black steel plastic other (specify) Casing depth: From to feet (reference to Land surface) Casing extends to`above ground inches (b) No ✓ (4) Grout Info (material surrounding well casing and/or piping): l rr (a) Gout type: Neat CementBentonite Le' Other (speaiEy) j�s S1 tl � (b) Grout placement: Pusnpiag Pre sure Other (o) Grout depth of tubing (reference to land surface): from to — - (feet) If well has casing, indicate grout depth: from to (feet) U. INJECTION -RELATED EQUIPMENT Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary information. L LOCATION OF WELL(S) Attach two copies of mops showing the following information: (1) Include a Site Map (van 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 misting well(s) yr waste disposal facilities such as septic tanks or drain fields located within 200 feet of the geothermal beat pimp well system. Label all features clearly and j piude a north arrow. C,ptI/UIC SQW NottflCation of Intent Form (Revised ar20o8) Page 2 03/25/2007 18:50 FAX 2522930055 BOYETTE WELL. ij003 (2) The Site Map must show the subject property in relation to the surrounding area by using at !east two fixed reference points such as roads, streams, and/or highway intersections. I. CERTIFICATION Note; This Permit Application must be signed by each person appearing on the recorded legal property deed. "I 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, 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." Signet r€ of Property Owner/Applicant invvv .5a\1 Print or Type Full Name and title . 634.a. Signature of Proper& Owner/Applicant OZn n Print or Type Full Name and title Signature of Authorized Agent, if any Print or Type Full Name and title Please return two copies of the completed Application package to: North Carolina DI'NR DWQ Aquifer Protection Section -[]IC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 RECEIVED/DEA/ON APR 2 3 al? Aquifer Protection Sec orP COPUIITIC $QW Notification of Intent Form vied W008) Poe 3 R1004 03/25/2007 18:50 FAX 2522930955 BOYETTE WELL C 7,6 I 1/Rkeiled fA Citmi t N 13.6% 0-04,5 • (ir ea 14' r r rf 5-e PA 1oo,- • el- 03/25/2007 18:50 FAI 2522930955 B0YE°TTE WELL ti l j 005 GFNERAtOR �� Ls� "_..:..: . ..•.- '��,'• 31,31d2. IPI A 97121 779 449 34 75 /law Pon P4 "1: 3 5 ` go TRACREEDY CREEK 'O:- I-, CS- PRCFERTI,WS INC .2 p p 5r 89&,8?8 SQ.FT. r�r 13.88 ACRES /oe)0lr� 770,621 SHeLrtQ BRICK WALK • f 7 f• BRiCK WALK Lc &f ' Of /25/2007 18:49 FAX 2522930955 BOYETTE WELL lg]UUl NORTII CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES NOTIFICATION OF INTENT TO CONSTRUCT A CLOSE;Q:LQQf GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM TYPE SQW WELL(S.) In Accordance With the Provisions ofNCAC Title 15A 02C.0200 Print or type the required uformatlon and mail m address on the back page. DATE: frp,;.R J(., . 20.fl:.- A. Well Typt Co11flrmatlon; Does the propos~ &ysteni circulate potable water QDh (no additives) in continuous piping that completely isolates the fluid from the environment (i.e. olo§~g-lgQU)? Yes v'continue completing this form. No __ Do Not colnplete this form. Compleie other UIC application funns for installing either a SA 7 weU (open~loop well injecting potable water into the aquifer) or a SQM well (closed• loop woll containing additiyes such as R-22. ethanol, or other antifreeze or corrosion inhibitors). PROPERn' OWNER(S)/APPLICANT(S) List~ Property Owner listed on property deed (if owned· by a business or government agency. state name of entity and a representative w/authority for signature):_,_-,·"""~ !-'-'-tr,-'-/_, ..... 1.,--'·t'i __ ., __ .. ~_l+ ___ ., ------~~ (l) Mailing Address: __ 1 _\l_:._, ... ;_~; __ '1_t\_1'J...;.;.t _ ___,, ____ _,=--=---------~ City: :~,~ .. ,~·v.~ · State: .l'JI .. Zip Code: Z "t-5 l,3 County: ____ _ Home/Office Tele No.: _.._,_ ________ __,Ce..,...l)__,_N=o=·=---------- EmailAddress:. ________ ..,.W...,e=bs,..,.it'"'e: ___________ ~ (2) Physical Address of Well Site (if different than above): _____________ _ City:---.-------State:_ Zip Code: ______ County: ____ _ Home/Office Tele No.: Cell No,; AUTHORIZED AGENT OF OWNER, IF ANY (if the Pennlt Applicant does not own the subject property, attach a letter from the property owner J!Uthorizing Agent to install and operate UIC well) Company Name: lr "" Contact Person: ,.. EMAIL Askfres~: Addrc~s: _____________________________ _ City: ________ . State: __ Zip Code; _____ County: -~----- Office: Tele No.: Cell No.: Website Address of Company, if any: _________ ~---- RECEIVEO/DENR/OWQ APR 2 3 2012 Aquifer Protection Section OPU/UIC ,Qw Notlficl'ltion of Intent Form (Revised 8/2008) Page I 03/25/2007 18:60 FAX 2522930955 BOYET TE WELL Z 002 B, WELL DRILLER INFORMATION T Company Name: i� e-i, 1� - 2 ,tt . wall Driller Contractor's Nacre: i"D (4 [k NC Contractor Certil'ipation No.: 2-1-1) S` Contact Person. 1-o A-. E!.{AYL Address: "3'N-1 r 1- t &rr4-04,, Ca+4*• Address: >r D R w . N • City: Go vs. Zip Code: & fl7 3 _, County: 1.141'20 Office Te1e No.: Z. _ Cell No.: e C, BEAT PUMP CONTRACTOR INFORMATION 6f different than driller) Company Nerve: 4I rw car 47/ c7NI Contact Person: Ai_ ' (,l ENIA11. Adtiiresa: Address:. Y' e'77 City: ' • 44-7:: Zip Coda: Cou 0.44 Office Te1e Na.: . i , 33'/ Cell No.: /9 `' 57 D. STATUS OF '1LICANt Private; V State: Federal Municipal: Commercial: Native American Lands: E. INJECTION PROCEDURE (briefly describe how the injection wel(s) will be used) G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: 319 Nu nber of borings: 3 - Approximate depth of each boring (feet): o a (2) Type of tubing to be used (copper, PVC, etc): 17g(41 e (3) Well casing, Is the well(s) cased? (check either (a.) Yes or (b. elow) (a) Yes if yes, then provide easing information below Type: _galvanized steel bleak steel plastic other (specify) Casing depth: From to feet (reference to land surface) Casing extends toabove ground - _ inches (b) No V' (4) Grout Info (material surrounding well casing and/or piping):/ 1/ 5 ri (a) Grout type: Neat Cement Bentonite t/ Other (specify) "� (b) Grout placement: Pumping_ Pressure Other (c) Grout depth of tubing (reference to land surface): from to (feet) 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 piping/tubing associatd with the injection operation. The manufacturer's brochure may provide supplementary information. I, LOCATION OF WELL(S) Attach two copies of maps showing the following information: (1) Include a Site Map (can be drawn) showing: buildings, property linos, surface water bodies, potential Sources of groundwater contamination and the orientation of end 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 wall system. Label all features clearly and j elude a north arrow, GP[]/[JiC 5QW Notification of Invent Form (Revised 8/2008) Page 2 03/25/2007 18:50 Fla 2522030955 BOYE'ITE WELL (2) The Site Map mist show the subbact property in relation to the surrounding area by using at least two fixed reference points such as roads, streams, and/or highway intersections, 3, CERTIFICATION Note: Ibis Permit Application must be signed by eac.1J person appearing on the recorded legal property deed. "I hereby certify, under penalty of law, thet 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, operate, maintain, repair, and if applicable, abandon the injection well and ail related appurtenances in accordance with the approved specifications and conditions of the Permit." l Prf PL a-le--- Signatsisre of Property Owner/Applicant tn-v1 5 a Il Print or Type Full Name and title A.6 zA-/A Signature of Property Owner/Applicant Nit R G, r-q A '"$ .S P LLJ Print or Type Full Name and title Signature of Authorized Agent, if any Print or Type Full Name and title Please return two copies of the completed Application package to: North. Carolina DEN1 DWQ Aquifer Protection Section -MC Program 1636 Mail Service Center Raleigh, NC 27699.-1636 Telephone (919) 715-6935 RECEEVED!tENRIDWQ APR 23201Z AtlUlfei Plot C10n Section QPt3NIC 5QW Notifcedon of Intent Form ¢ieviscd 8/2008) Purge, Q 004 03/25/2007 18:50 FAX 2522930955 DOYETTE WELL (If a.5 r r Wad (AA CAN 03/25/2007 18:50 FAX 2522930055 3f ,3Ir2. 770.6 ' 2-p et:1 97121 1)Ia77VP Y47S Fr, U� Au -pc lI 5 ; 3SoiA.L10`740 TRACT 1 RAY atm Tix.3 L:Aes PROPERTIES TIES ;J'f C / 00 696,8 l6 SQi i . 13.68 ACM/ 00 �] 1s ' r \' /;I . c BOYETTE WELL $H LTEE QNEPAV SACK WALK "4 BRICK WALK I3A Ad 4ti -STORY FRAME GARAGE pie 0 1G t I1o05