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Home My WebLink AboutWI0600041_GEO THERMAL_20090504Permit Number Program Category Ground Water Permit Type WI0600041 / Central Files : APS_ SWP_ 05/04/09 Permit Tracking Slip Status Active Project Type New Project Injection Water Only GSHP Well System (5QW) Version 1.00 Permit Classification Individual Primary Reviewer michael. rogers Permitted Flow Facilit Facility Name William Oliver SFR Location Address 1109 Need more Rd Turkey Owner Owner Name William Dates/Events NC 28393 Oliver Orig Issue 05/04/09 App Received Draft Initiated 05/01/09 Re g ulated Activities Heat Pump Injection Outfall NULL Waterbody Name Scheduled Issuance Permit Contact Affiliation Major/Minor Minor Region Fayetteville County Sampson Facility Contact Affiliation Owner Type Individual Owner Affiliation William Oliver 1109 Need more Rd Turkey Public Notice Issue 05/04/09 NC Effective 05/04/09 28393 Expiration Stream Index Number Current Class Subbasin Permit Number WI0600041 Program Category Ground Water Permit Type Injection Water Only GSHP Well System (5QW) Primary Reviewer michael. rogers Permitted Flow Facilit Facility Name William Oliver SFR Location Address 1109 Needmore Rd Turkey Owner Owner Name William Dates/Events NC 28393 Oliver Orig Issue App Received Draft Initiated 05/01/09 Re g ulated Activities Outfall NULL Scheduled Issuance Central Files: APS_ SWP_ 05/04/09 Permit Tracking Slip Status In review Version Project Type New Project Permit Classification Individual Permit Contact Affiliation Major/Minor Minor Region Fayetteville County Sampson Facility Contact Affiliation Owner Type Individual Owner Affiliation William Oliver 1109 Need more Rd Turkey NC 28393 Public Notice Issue Effective Expiration Waterbody Name Stream Index Number Current Class Subbasln RA MCDEMR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor William Oliver 1109 Needrnore Road Turkey, NC 28393 Coleen H. Sullins Director 5/4/2009 Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System Permit No. WI060004l 1109 Needmore Road Turkey, NC 28393 Dear Mr. Oliver: Dee Freeman Secretary In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on 5/1/09, the Aquifer Protection Section (APS) acknowledges your intent to construct a closed-loop geothermal water-only injection well system for the operation of a ground-source heat pump located at 1109 Needmore Road, Turkey, Sampson County, NC 28393. This system is deemed permitted by rule (North Carolina Administrative Code Title ISA, Subchapter 2C, Section .021 l(u)(2)). However, it is recommended that you contact the Sampson County Health Department, as they may have additional construction or permitting requirements for this type of system. If you modify your system at any time, including the addition of antifreeze, corrosion inhibitors, or any other substances to the circulating fluid, you must contact the APS to verify compliance with applicable rules. Thank you for submitting this notification. If you have any questions please call me at (919) 715-6166. Sincerely, 1C~A-~ ~ichael Rogers cc: Fayetteville Regional Office -AES APS Central Files -Permit No. WI0600041 Sampson County Health Dept. Environmental Specialist GPU-Aquifer Protection Section Mark Scronce (Rich's Heating & A/C, Inc -210 Buck Rd, Wallace, NC 28466) AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604 Phone: 919-733-3221 I FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748 Internet: www .ncwaterguality.om /\n Equal Opportunity I Affirmative Action Employer Ni¥ili Carolina Jvatural/11 NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR) NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM: TYPE 5-QW WELL(S) In Accordance with the provisions of NCAC Title 15A: 02CA200, please complete this notification and mail to address on the back page (please Print or Tvpc information). DATE: April 22, 2009` A. Well Type Confirmation: Does the proposed system circulate potable water anl% (no additives) in continuous piping that completely isolates the fluid from the environment (i.e. closed -loop)? Yes x Continue completing this form. No Do Not complete this form. Complete other UIC application forms for installing either a 5A7 well (open -loop well injecting potable water into the aquifer) or a 5QM well (closed - loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors). 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 wlauthority for signature): William Oliver (1) Mailing Address 1109 Needmore Rd City: Turkel State: NC_ Zip Code: 28393 County: Sampson Home/Office Tele No.: 910-533-3042 Cell No.:twork) 910-533-3693 Email Address:wolfcub1954 afvahoo.com Website: (2) Physical Address of Well Site (if different than above): City: State: Zip Code: County. Home/Office Tele No.: Ce11 No.: 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: Contact Person: EMAIL Address: Address: City: State: Zip Code: County: - Office Tele No.: Cell No.: Website Address of Company, if any: __ C. WELL DRILLER INFORMATION Company Name: Coastal Geothermal Well Driller Contractor's Name: Sanford Sweeting NC Contractor Certification No.: NC 2082 Contact Person: Mike Hadley EMAIL Address : mhadlev@bizec.rr.com Address: 102 Middle St. City: Jacksonville Zip Code: 28546 County: Onslow Office Tele No.: 910-353-0926 Cell No.: 910-376-1100 D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company: _Rich's Heating & A/C, Inc. Contact Person: Marie Scronce EMAIL Address: Address: 210 BuckRd. City: Wallace, NC Zip Code: _28466_ County:-=D~u=plin=· ""--- Office Tele No.: __ 910-285-5522 __ Cell No.: ______ _ E. STATUS OF APPLICANT Private: _X_ Federal: Commercial: State: Municipal: __ Native American Lands: F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used) Closed Loop Geothermal Heat Transfer Sy stems G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: _May/June -2009 __ ~Number of borings: _ 4 __ _ Approximate depth of each boring (feet): __ 200 _____ _ (2) Type of tubing to be used (copper, PVC, etc): _High Density Polyethylene_X (3) Well casing. Is the well(s) cased? (check either (a.) Yes ,ru: (b.) No below) (a) Yes ___ if yes, then provide casing 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 _x __ (4) Grout Info (material surrounding well casing and/or piping): (a) Grout type: Neat Cement__ Bentonite _x_ Other (specify) ______ _ (b) Grout placement: Pumping_X_ Pressure__ Other __ (c) Grout depth of tubing (reference to land surface): from _o __ to _200_ (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. 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 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 200 feet of the geothermal heat pump well system. Label all features clearly and include a north arrow. (2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed reference points such as roads, streams, and/or highway intersections. J. 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." t Iv~ J . ()4J<,. Signature of Property Owner/ Applicant W: (/,•~""' f. {){,' i'lr Print or Type Full Name and title RECEIVED/ DENR / DWQ AQUIFJ::R-PRtm:r.110N ~~CTION Signature of Property Owner/Applicant MAY t 1 2009 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 DENR-DWQ Aquifer Protection Section-UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 Diiox 1 109 Neag Turkz,(, pc- `e39.3 Ph›•.e_ on D • 33. 30142 W+3RIt Thor.{. 1lL .5$3' 3693 �- a ( 52' 03 a u5° a:atop' 4 — rnore, 55' Ari-"re% - � c4z.I A. 4 -{La_ p 'rDs-a VArr-1'c1J ! 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