WI0600039_GEO THERMAL_20120517

Beverly Eaves Perdue
Governor
i..~A~~ ~·-~~ =-=-,;,,i -. ----_-
NCDEN~-
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild,P;-E.
Director
May 17, 2012
Raven Rock State Park
3009 Raven Rock Road
Lillington, NC 27546
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0600039
To Whom it May Concern:
Dee Freeman--
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.org/web/wq/aps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
Eric G. Smith, P.G.
Hydro geologist
cc: UIC Pennit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
Internet: www.ncwaterguality.org
An Equal Opporlunily \ Affirmative Action Employer
Nirth Carolina
Jvnftttal/11
Permit Number WI0600039
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
michael.rogers
Permitted Flow
Facilit ·
Facility Name
Raven Rock State Park
Location Address
3009 Raven Rock Rd
Lillington
Owner
Owner Name
State of North Carolina
Dates/Events
NC 27546
Orig Issue
03/10/09
App Received Draft Initiated
01/09/09
Scheduled
Issuance
Central Files : APS_ SWP_
03/10/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Fayetteville
County
Harnett
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
3009 Raven Rock Rd
Lillington
Public Notice Issue
03/10/09
NC
Effective
03/10/09
27546
Expiration
02/28/14
_R_e~g~u_la_t_e_d_A_c_t_iv_it_ie_s _______________ Re quested/Received Events
Heat Pump Injection Additional information requested
Outfall NULL
Waterbody Name
Additional information received
RO staff report requested
RO staff report received
Stream Index Number Current Class
01/13/09
02/19/09
02/26/09
03/04/09
Subbasin
Permit Number WI0600039
Central Files: APS SWP
03/05/09
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (50M)
Primary Reviewer
michael.rogers
Permitted Flow
FaciIii'v
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Facility Name
Raven Rock State Park
Location Address
3009 Raven Rock Rd
Lillington NC 27546
Owner
Owner Name
State of North Carolina
Dates/Events
Major/Minor
Minor
Region
Fayetteville
County
Harnett
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
3009 Raven Rock Rd
Lillington NC 27546
Scheduled
Orly Issue App Received Draft initiated IssuanCO
01 /0 9/09
Regulated Activities
Public Notice Issue
3i►o f Oq
Effective Expiratn
J/ILJ
Re, ested/Re ived Events
Heat Pump Injection
Outfal! �I.ILL
Additional information requested
Additional information received
RO staff report requested
RO staff report received
01 / 13/09
02/19/09
02126/09
03/04/09
Waterbody Nance
Stream Index Number Current Class Subbasin

JP!A , -.1,,_'.1-_~
NCDEN R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Kristen Brigner
Park Superintendent
Raven Rock State Park
3009 Raven Rock Road
Lillington, NC 27546
Re: Issuance of Injection Well Permit
Permit No. WI0600039
Issued to Raven Rock State Park
Harnett County
Dear Ms. Bringer:
Coleen H. Sullins
Director
March l 0, 2009
Dee Freeman
Secretary
In accordance with your application received January 9, 2009, I am forwarding Permit No. WI0600039 for the
operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system to be located at
3009 Raven Rock Road, Lillington, Harnett County, NC 27546. This permit shall be effective from the date of
issuance until February 28, 2014, and shall be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. In addition, please submit copies of the
Well Construction Completion form (GW-1) and site map within 30 days after construction as required
in Part I paragraphs 8 and 9.
Please submit the data within 30 calendar days ofreceipt of this letter to the following address:
Aquifer Protection Section (APS)
Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
Additionally, your UIC system is subject to inspection by the APS and at the time of the inspection must display
a permanently affixed identification plate in accordance with requirements of 2C .0213(g). Please insure this is
completed in accordance with permit condition Part I, paragraph 7 of this permit issued March 10, 2009.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh. North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715--6048 \ Customer Service i--877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportun,ty I Affirmative Action Employer
r, Tone • C 1 · 1 '\lortn ·aro ma
)Vaturall!f
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit three months prior to its expiration date. As indicated in the permit, this permit is not
transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone].
Best Regards,
Michael Rogers, Environmental Specialist
cc: Art Barnhardt -Fayetteville Regional Office
Central Office File -WI0600039
Hamett County Environmental Health Dept.
Attachment(s)
2
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED ED TO
Raven Rock State Park
FOR THE CONSTRUCTION AND OPERATION OF 28 TYPE 5QM INJECTION WELLS, defined in Title
I5A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed -loop
geothermal -mixed -fluid heat pump system. This system is located at 3009 Raven Rock Road, Lillington,
Harnett County, NC 27546, and will be constructed and operated in accordance with the application dated
January 9, 2009, and in conformity with the specifications and supporting data submitted, all of which are filed
with the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in compliance
with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until February 28, 2014, and shall be
subject to the specified conditions and limitations set forth in Parts 1 through X hereof.
Permit issued this the (, day of siAr...„ , 2009.
i\_Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (ISA NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to
2C .0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Fayetteville Regional Office
225 Green Street
Systel Building Suite 714
Fayetteville, NC 2830]
GW-ls must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
9. Well construction records must also be submitted for the existing water supply wells on-site as well as a
site map showing any water supply wells on adjacent properties as specified in NCAC .021 l(d)(l)(D).
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the Aquifer Protection
Section's Underground Injection Control (UIC) Program Central Office staff, telephone number [phone]
and the Fayetteville Regional Office Aquifer Protection Section Staff, telephone number [phone].
4
PART III-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV -PERFORMANCE ST AND ARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V -OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
5
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Fayetteville Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to ISA NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in I SA NCAC 2C
.0214, including but not limited to the following:
6
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing,-if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to :
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART X-OPERATION AND USE SPECIAL CONDITIONS
None.
7
Re: Raven Rock WI 0600039
1 of2
Subject: Re: Raven Rock WI 0600039
From: Art Barnhardt <[e-mail]>
Date: Wed, 04 Mar 2009 12:42:34 -0500
To: Michael Rogers <[e-mail]>
Go ahead an issue.
ArtB. _
Michael Rogers wrote:
He said he was going to talk to you. He did mention he wanted
GPS locations of the wells, bu~ that could be obtained after
permit issuance.
Art Barnhardt wrote:
Did Bill get you his intent on a site visit?
ArtB.
Michael Rogers wrote:
Art-
Do you want to conduct a pre-permitting site
inspection on the above project. If not, let me know
and I will do the permit and forward to Debra for
issuance.
Thanks
Stephen A. Barnhardt, L.G.
Aquifer Protection Section Supervisor
3/4/2009 12:48 PM
State of North Carolina QF W H r�
Department of Environment off
and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
Division of Water Quality
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mailing Address: 1636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: [phone]
[phone]
Date: o / ? �o
FAX TO:
FAX NUMBER:
FROM:
PHONE: Ft - 12-0675 '
NO. OF PAGES INCLUDING THIS SHEET: //
Corl/ r-t. 1_4_4) r-v V14
J7 z of-nceMA-Q.
If you receive this fax by mistake call: Aquifer Protection Section @ 919-733-3221

To: Art
From: Michael Rogers
DWQ — APS
co
Date: 2.26/09
Subj: 5QM well
gi4-,i( (z,c/=
my'
Attached is permit application for a 5QM permit for your review. Per our 5QM permitting
process, we are allowing the RO to decide whether to conduct a pre -permitting inspection and
submit a Staff Report. Please decide within 5 working days of receipt to decide if you want to
conduct a pre -permitting approval field inspection (the inspection does not have to be done in 5
days - just the decision whether to schedule an inspection or not). If you elect not to conduct a
pre -permitting inspection, let us know and we will go ahead and issue permit.
Please review and notify us within 5 working days of receipt if you will or will not do an
inspection and submit a Staff Report. FYI — the contractor for this site is eager to begin work,
Thanks

A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: February 26 . 2009
To: D Landon Davidson, ARO-APS
~ Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
D Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: (919 ) 715-6166
E-Mail: [e-mail]
A. Permit Number: WI 0600039
B. Owner: Raven Rock State Park
C. Facility/Operation: _
~ Proposed D Existing
D. Application:
0 David May, WaRO-APS
0 Charlie Stehman, WiRO-APS
0 Sherri Knight, W-SRO-APS
Fax: [phone]
D Facility D Operation
1. Permit Type: D Animal D SFR-Surface Irrigation□ Reuse D H-R fufiltration
D Recycle D 1/E Lagoon D GW Remediation (ND)
~ UIC -SQM Geothermal well
For Residuals: □ Land App. 0 D&M
D 503 D 503 Exempt
D Surface Disposal
0 Animal
2. Project Type: ~ New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Information: ~ I would like to accompany you on a site visit.
NOTE: If m v schedule will allow , I would like to go out in the field with your staff if vou ins pect
this site. Late in the mornin g or early afternoon works better for me.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within, please take the following actions:
~ Return a Completed APSARR Form.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: Date: _____ _
FORM: APSARR 07/06 Page 1 of 1
Beverly Eaves Perdue
Governor
Kristen Brigner
State of North Carolina
3009 Raven Rock Road
Lillington, NC 27546
NA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
Fearuary 2-1 . :009
Subject: Acknowledgement of Application No. Wl0600039
Raven Rock State Park/NCDENR
Injection Mixed Fluid GSHP Well System (SQM)
Harnett
Dear Ms. Brigner:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on January 9, 2009. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 -90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to h ttp://b2o.em .state.nc.us/documents/dwg orechart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Jrely, ~-~
for~Watts
Supervisor
cc: Fayetteville Regional Office, Aquifer Protection Section
Watco Corporation (Jamie Williams, 1431 Mechanical Blvd., Garner, NC 27529)
Permit Application File WI0600039
AQUIFER PROTECTION SECTION
1636 Ma il Service Center, Raleigh , North Carolina 27699-1636
Locati on: 2728 Capital Boulevard, Raleigh , North Carolina 27604
Phone: [phone] I FAX 1: 919 -715-0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunity\ Affirmative Action Employer
OnehC 1· N ort aro 1na
;Natura/lg
Additional Raven Rock Plans
1 of 1
Subject: Additional Raven Rock Plans
From: "Jamie Williams" <[e-mail]>
Date: Thu, 19 Feb 2009 09:21 :45 -0500
To: <[e-mail]>
Michael,
Here are the drawings you requested. Please let me know if you rieed anything else.
Thanks,
Jamie Williams
Project Manager
Watco Corporation
jwilliams @watcomechanical.com
Office-919.277.3032
Mobile-919. 795.6966
From: Marissa Martin [mailto:[e-mail]]
Sent: Thursday, February 19, 2009 9:00 AM
To: Jamie Williams
Subject:
I C0 9 389 . f Content-Type: application/pdf1 -Drawings.pd I =-l Content-Encoding: bas~64
==
2/26/2009 10:50 AM
Raven Rock State Park Geothermal Loop Wells
1 of2
Subject: Raven Rock State Park Geothermal Loop Wells
From: "Jamie Williams" <[e-mail]>
Date: Wed, 18 Feb 2009 10:29:31 -0500
To: <[e-mail]>
Michael,
I have attached the site maps for the proposed well field at Raven Rock State
Park , as well as a letter from the architect stating there are no other wells or
septic fields in the area. I have marked the area of the proposed well field on
both maps but it is difficult to see on the topographic map without blowing it up
larger. Please let me know if you need hard copie_s of these drawings or if you
need any additional information. Thank you for your help.
Jamie Williams
Project Manager
W atco Corporation
jwilliams @watcomechanical.com
Office-919 .277 .3032
Mobile-919.795.6966
11 200902 ~8094324377 dt7 1 Content-Type: application/pdf l . .p I Content-Encoding: base64 =1J
Content-Type: application/pdf C09-389 Geological Survey.pd C . b
64
in/pdf /1
1,---~
._ _ _ _ ontent-Encod1ng: ase __JI
2/18/2009 1:37 PM
From: Chris Roberts [mailto:[e-mail]]
Sent: Wednesday, January 28, 2009 2:06 PM
To: Larry Wirth
Subject: FW: Raven Rock Permitting
Importance: High
Larry,
spoke with Glenn about this, and Glenn's response was that there are no tanks or wells within
1000' of the proposed geothermal well field. If there were any in the past, they are not aware of
them, and they are definitely not in service anyrnore. Please proceed with the drilling.
!f you need anything more formai than this to start your well drilling, please let me know_ Thanks.
Chris
Chris Roberts, AIA, LEER AP
Associate Principal
Director of Promise Studio
LS3P ASSOCIATES LTD.
Architecture Interior Architecture Planning
434 Fayetteville Street, Suite 1790
Raleigh, NC 27601
Tel: [phone]
Fax [phone]
This message may contain information that is privileged or confidential. If you are not the intended recipient. you are hereby
notmied that any disclosure, copying, distribution, or use of the information contained herein is STRICTLY PROHIBITED. If you
received this transmission in error, please immediately Contact the sender and destroy the material in its entirety, whether in
electronic or hard copy format.

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50 M WELL (S)
__ X __ New Permit Application OR _____ Renewal ( check one)
DATE: December 29 , 2008_
PERMIT NO. ________ (leave blank ifNEW permit application)
A. PROPERTY OWNER(S)/APPLICANT(S)
List each 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): State ofNorth Carolina
(1) Mailing Address: 3009 Raven Rock Road
City: Lillin gton State: _NC_ Zip Code:_2~7"-54~6 ___ County: Harnett
Home/Office Tele No.: (910 )893-4888 Cell No.:
EMAIL Address: [e-mail]
(2) Physical Address of Site (if different than above): ---~S_A_ME ____________ _
City: _________ State: __ Zip Code: ______ County: _____ _
Home/Office Tele No.: ---------------'C""'e=ll'""N"""'o""'"."--: __________ _
EMAIL Address: ________________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: NCDENR/Raven Rock State Park
Contact Person: Kristen Bri Em er EMAIL Address: Kristen.Bri gn [e-mail]
Address: 3009 Raven Rock Road -------------------------
City: Lillington ______ State: _NC_ Zip Code: _27_5_4_6 ____ County: Harnett ____ _
Office Tele No.: [phone] _________ C"""e=ll'--=N"'-o""'"."-: _________ _
Website Address of Company, if any:_~In=£=o=.r~av~e=nr=o'-"c=k.,_(m=,n=cm=ai=T.=n=et~------------
C. STATUS OF APPLICANT
Private: Federal:
State: x Municipal: __
GPU/UIC SQM Well Permit Application (Revised 7/2008)
Commercial:
Native American Lands:
RECEIVED I DENR / DWQ
AQUIFl=R-PRnTJ:r.Tf()N ~!;CTION
.IAN O 9 2009
Page 1
D. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal Brazill Drillin g
Well Drilling Contractor's Name: --~B=ru~c~e ~B=r=az=i=ll
NC Contractor Certification No.: ~27~2~3~----------
Contact Person: Michael Hadle y
Address: 102 Middle St.
EMAIL Address: rnhadle y@ bizec.rr.com
City: Jacksonville . NC Zip Code: 28546 _____ County: ""O=n=sl=o--'--'w ________ _
Office Tele No.: 910-353-0926 Cell No.: 910-376-1100
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Watco Co rp oration
Contact Person: Jamie Williams EMAIL Address: jwilliams @watcomechanical.com
Address: 1431 Mechanical Blvd. ------------------------------------
City: Garner NC Zip Code:
Office Tele No.: 919-277-3032 Cell No.: -----
27529 County: ~W~ak=e'----------
919-795-6966 ---------
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed Loop Geothermal Heat Pum p Systems
G. WELL CONSTRUCTION DATA (Skip to Section H if this is a Permit RENEWAL )
(1) Proposed.date to be constructed: _Jan/Feb 2009 ______ Number of borings: __ 28 __
Approximate depth of each boring (feet): ____ 300' ___ _
(2) Chemical additives to be used in closed-loop system (only those chemicals indicated have been approved):
___ R-22 __ x_propylene glycol ___ ethanol _________ other (other additives will
need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): _______ HOPE _______ _
(4) Well casing. Is the well(s) cased? (check either (a.) YES or (b.) NO below)
(a) YES if yes, then provide casing information such as~ (steel, PVC, plastic, etc.), diameter,
depth, and extent of casing appearing above ground: ------------------
(b) NO _x_
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite x Other (specify) --------
(b) Grout depth of tubing (reference to land surface): from __ O __ to _300_ (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 associated with the injection operation. The manufacturer's· brochure may provide supplementary
information.
GPU/UIC 5QM Well Permit Application (Revised 7/2008) Page2
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1)
(2)
Include a site map (can 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
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
geothermal heat pump well system. Label all features clearly and include a north arrow.
Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
3. POTABLE WATER WELL(S)
Are there any potable water well(s) on the subject property or adjacent properties? YES XNO
If Yes, than indicate location on attached map(s). +94 +
K. 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,"
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Atli zero. gent, if any
Kri '• rigner, Park Superintendent
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUJUIC 5QM Well Permit Application (Revised 712008) Page 3

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