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HomeMy WebLinkAboutWI0600042_GEO THERMAL_20090602Permit Nurriber Program Category Ground Water Permit Type WI0600042 / Injection Water Only GSHP Well System (5QW) Primary Reviewer michael. rogers Coastal SW Rule Permitted Flow Facilitv Facility Name Cumberland County Board of Education Location Address 7465 Century Cir Fayetteville Owner Owner Name NC 28306 Cumberland County Board of Education Dates/Events Orig Issue 06/02/09 App Received Draft Initiated 05/26/09 Re q ulated Activities Heat Pump Injection Outfall Scheduled Issuance Central Files: APS_ SWP_ 06/02/09 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Scott Triplett 8275 Tournament Dr Memphis TN Major/Minor Minor Region Fayetteville County Cumberland Facility Contact Affiliation Owner Type Government -County Owner Afflllation Wilson Lacey 81 O Gillespie St Fayetteville Public Notice Issue 06/02/09 NC Effective 06/02/09 381250851 28306 Expiration Waterbody Name Stream Index Number Current Class Subbasin Jl?A -NCDEMR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Wison A. Lacey Cumberland County Board of Education 810 Gillespie Street Fayetteville, NC 28306 Coleen H. Sullins Director 6/2/2009 Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System Permit No. WI0600042 7465 Century Circle Fayetteville. NC 28306 Dear Mr. Lacey: Dee Freeman Secretary In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on 5/26/2009, 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 7465 Century Circle, Fayetteville, Cumberland County, NC 28306. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C, Section .021 l(u)(2)). However, it is recommended that you contact the Cumberland 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, O~l(1,~ cc: Fayetteville Regional Office -APS . C\~ Michael Roc:rers '-f""" Environmen~al Specialist GPU-Aquifer Protection Section APS Central Files -Permit No. Wl060004: Cumberland County Health Dept. MidSouth Geothennal LLC (Scott Tripiett -8275 Tournament Drive, Ste 185, Memphis, TN 28125) AQUIFER PROTECTION SECTION 1636 Mail Service Genier, Raieigh, North Carolina 27699 -1636 Location: 2728 Capiial Boulevard, Raleigh, North Carolina 27604 Phone: 919-733 -3221 \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Cusiomer Service: 1-877-623-6748 Internet: www.ncwaterauality.org An EquE 1 Oppor1un i:y I Affirmative Action Em;iloyer NOnel C 1· ort1 aroma Jvnturall!f G5/131/2009 11! 44 9617489e197 MID -SOUTH GEOTHERMAL. PAGE 02/ 1II No .Th1 CAKOLJNA DEPARTMIZIT OP ENVIRONMENT AND TURAL RESOURCES IN DENR) NMT CA 1ON OF MEM TO CONSTRUCT A CILtlinityLOOP GEOTRIMMAL WATER -LIMY INJECTrow WELL SYSTEM TYPE ,-OW W L L(S In Accordance with tea provisions orNCAC Tide I5A: O2C.o22OO. please complete dila not1Cca6011 674 mall to Er:Wren on the back page (please r!'i4f orb bgerpiRdon)• DATE: FLA. 7 a 20(3 -{ We!! 11747.5 C tfinuadefl; Dogs the proposed symem circulate potable wwa9r only (no additives) in continuous piping that completely isolates the fluid from the environment (io, closest loop)? Yes Y. Continue completing This form. No Do Not complete this form. Complete other UfC application forces for iisiaWng either a 5A7 wail Cop. -loop wet t iteetinx pot le wetter into the aquifer) or a 5QM well (closed - !clop well contsimiug additives such as R-22, ethanol, or other axltlfxeene crr corrosion Inhibitors). A pRonsery OWNER(S)/AFFLICANT(S) List es4 PitiPerrY Owner listed an properly deed (if owned by a business or government agency. stars name of entity nod a representative w/authority for siattsture):Q (APa_ d C,ot n4- ` I CSC�QC+-� B. (I) M8sftng Address: 1 • • �-C.O Ile, stale.: sue. zip Cam: at;'q). Cot .rs�? i��a PP rL r, O cify` Home/Office Tele No.: • ii' 1 �1- t�1g �'�'' `� _ Ce1t_Ne u Email Address: Wassite: (2) Physical Address ofW411 Site cif different than above)•1 U 1p }! +w `� Cit3'� ►]; f .� rule: zip Curie: .3.faL9 County: 'L, im-Se 4 Home/OfRoe Tele No.1 16- 443-n0_4 J Cell No,: AtTnEfoRIZED AGENT OF OWNER, IF ANY (if the Permit ADpftcant does not own the subject propes#.y, eusoli a letter from ire property ovinejcut prising Agent install and o TJXC wall) Cosa yNatne: ( mbe.r1O- uj Goiuth/ [caret $I omits() _ Contact Perso . l tiYi: , �. >ti� rt Ad _Luil50 n Leo des- kF2,../1C.0 Address: j O Th 1195p air p e i (e $late: tp C am " _ . _.0 n13r_ [ Ot71ra Tele No.: �e 7q Ccli ire! Website Addrross ofCompany, if ar:y:, QPt7lt 0 SOW Notlfcatlen printers Perm Oilevlse+i $RGO$j L LIDO 30iid 500 rise eraLOL.9018 9 :ax 60H/9Z/52 05/01/2009 11:44 9817499997 L_: MID-5COTH GEOTHERMAL PAGE 03/10 C. WELL. DREL LEER}y INFORMATION -r', CompanyNatte:I+lf_-� ji',LkVrb Ge€71'i`t- i .0 } [.-Lim. Wet! Daher contractor's Namt: r6 r 4l'�^ So at. a n NC Contractor Ceti ation cNo,: # it.)8E ['_, a 62-A fix. s . /30/0 Gnmtsra# t'cl5abr' Ii _ [e Address: .`�75�C7 [.k.rt a.jT1?.._e& , '.' . \$s Vll,� OffceTeleNo °l i 1 c.Q5 Cell No.: gok-' 1 -- ' 04 _ D. Iffr.A2T PUMP CONTRACTOR INFORMATION (if dilxerent than driller) Company Name:D. it i7 t._44 h tc_ tt-,6�fa Kt( C i it ..+Qat= Person. �0 ?Z�` ��, i.zi+:-�- ��u, 00-, Address: 4'z.---1'6 1 ora LnG 1 la v - e.. e . t.g5 City � C iN vu_LZie, i Ci.-a ZiI7 COdE: d$5 3 County: r fit LB ki Office TeleNo.: 41-10 ' jOQ5 Con No.: Q()t` -1.10$ E. STATUS OF APPLICANT Private: Federal: — CouunlaI: A _ State: Municipa3: Native American Lands: F. INJECTION PR6CEDURE (bric1y describe how the Injection well(s) will be used) G. WELL, CONSTRUCTION DATA (I) Proposed date to be eonr-h-ucted: 5 taTibei Number of borings: ;:,:)-4-. 2] Approxhnate depth of each Wiring (feel): , {7 CA- (2) Typo of tubing to be used (aappeL, PVC, etc): L E 1'3.0- 1 C3L6'i-t (3) Well casi.ug. Is r t well(,.) cased? [check either (a) Yes ox (b.) No below) (a) Yea if yes, then provide casing information below Type: 14_ rgnh'&ni2nd steel bla:k steal elastic other (,.peon) Casing de 3: Prom • W feet, (refeteu a to laud surface) Castro extends fa above ;;round inchee (h) No (4) Grout Info (mart:dal surrounding well casing andlor piping): (e) (b) (c) Grout type: Neat Cetnent I3eatonite Other ("Wry) Groot placement: Pttroping Pressure`. Other Grout depth of tubing (reference a to land surface): from to -1Sr) (feat) #',.yeti leas casing, indicate pa out depth: from to _ (feet) rimamt:30W NvCetwa aro:eat Fwnri irdavised sr,:nnal Pa*7 iL/E0 39Vd 91 iI14.w-id Sad EP@LeL9B16 sz:Zi Eza2Z/93jge 05/01/2009 11:44 90I7409097 MID-SOJTh GCtriiiEP1t4. PAGE a4/la A, MJEC'r1ON-RELATED EQ :PATEN Attach a (agranx Showing the engineering layout or proposed modification of the injection equipment end exterior piping/tubing assouieted with the I f eotion apexation. The rnonufiaMirer'S b roDh sre shay provfdv svpplerfientsury information.. If. LOCATION OE W]ELLCS) Attach two copies of maps showing the foi'awink itiferraadon: tt? Include a Site Map (aazi be draWil) showing: buildist ,, property 1i31trs. surface water bodies, potential sources of gnandwatercontamination and the ortentatiott of and distancAsa between the proposed: well(s) and any a fisting at li(s) or waste disj.vasal facilities sua6 as septi0 tanks ar drain fields located within 200 feet of the geotptxnsal heat pump wail system. Label all features clearly and include a north arrow. (2) The Bite Map roust show rise subject property in ralatinn to the 5urr4unding area by naittg at least two axed reference points such as roads, streams, and/or highway intersections. J. CERTariCATIori Note: MIA Parrott Application must be signed by a seh person appenrbog oir the recorded 116111 property deed. "[ hereby certify, under penalty of law, that i have persena'Ly examined turd axe fiimil:tar• with the Anformar1on suhrnittoci itin IN; document and all attaebr»ems thereto and that, baste •vit my inquiry of those individuals immediately responsible for obtaining said Information, I'bcUeve thru the [ufotmation is nue. i ccurare awl oomphre. 1 3W aware that there arc significant Pena ties, irlekuding the possibility or fines and imprisontriont, fbr submittii Wee ln!'rnmation. 1 agree to construct, opmicetrriria. repair, and if ap• abiu den thv iojeewe lt elt and all TClatcd appurtenances ist accordancoyviatte approved p5 ii[3tion# an eQnditt �yf the Penult." petty Owrfar/ ,� T : SUV] LOte Print or Type Full Name and t ie Signatttte of Property Owner/A,pptirant Print or Type Full Nlmo and title Signature of Authorized Agent, if any Print or Type F'u}I Neate and title Please raturu two copies of the oornpletied Application package to: North Carolina DENR-DWQ Agelter Protection Section-UTC 1'irogram 163E Nutt/ Servile Center Raleigh, NC 27699-106 Telephone (919) 715-6935 o1'!TR1rC SOW Notification of rr r.ni Sam, Marisod MOO TT/tag 3910d Para; 9Nltahft#"ld EDO CPOLB/96i6 9Z:ZI 566Z/93/60 ('T) 'II' IS) ~ co ~ lD IS) .... c,, lD N N ..-i (Tl (SJ IS) N ...._ lD N ...... 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PAGE 88/10 FLEX OONN. SUCTION 0*--FliZZR— ADJUSTABLE EUPPQRT TRIPLE DUTY VALVE F 4x. COlSN.(TYP.) SHAFT GUARD STEEL OR CAST IRON e5 wITH DRIP TRIXIGH. 2' DEEP 16 CA. OAL_V. - DRAIN FAN UNDER PUMP ASSIAMLY. PAC{AGE FRAME VIBRATION ISOLATION FLOOR 1/2" PAN DRAIN TO FLOOR DRAIN 1 /2" . TRVLI01 DRAIN TO FLOUR DRAIN 1/2" CRAIN TO FLOOR DRAIN 4, THICK CONCRETE F AD (bY mail COHT O NOTE: SEE PLANS FOR ROU ING OF PIPING. DETAIL IS MR VALVE AND ACCESSORY INDICATION ONLY. BASE MO ED P P(PIN D AIL NO TT/132 3,9Vd EINII- - 1d SOO EM LBL98T6 43:61 620Z/9;;/99 91S67B7643 135/ 26/ 200S Zig starer Tra--0 off 1 it Pa WIPO Ufa/ r L r'r ct�so7' Erprirow 1i daLsg &i L ilAw0.i4% tv1!4umaziui -4 Ott tala - 1 ' (1 tl:i' it* tiN GoB6/Te/9e Cb C9 (") v (S) r- lX) r- t€ .... O'l IJ) N N rl O'l (SI re ...... ID N ...... ~ LO cg .... ...... .p. (D U) ~ UI • ""( ...... C5l .-... .... ~ It .. .Spc ciult, v Gcollre rwal Well 1 kid .�crvice r FAX LEAD SHEET To: Crystal Pace c/o Craig Spivey Company: JS Clark company, Inc. Fax Nutnher: (910) 792-9558 Pages (inciu&t:. cowo: 10 Date: May 1, 2009 From: Janice Scott .RE: NC 5-QW Permit Application for Western Elementary School Dear Crystal, The application must be submitted in duplicate, so please make a copy and have Mr. Wilson l,acey sign both copies and mail to the NC DENR. Their address is listed at the bottom of page 3 ol'the permit application. Once the application has been approved and the permit issued, please forward us a complete copy for our Liles and records. Please do not hesitate to email or call ifyou have any questions. My number is listed below. Thank you for your time. Sincerely, Janice I Scott 82751ournanaent Drive Ste. I 85 + Memphis, 'I N 38125.0851 Office (90i) 748-9095 • Fax (990l) 748-9.097 ,_ .... .., .... ... \ L 1 \'T ,JI ,.J ~!' ,.. ~-- ",ti' .......... . . . --~ . J't ~-?~ ··:1J ,,· ~: 1r·, .,:·:ht'..., ·i•1 · -~ . .' ~w. ""U·l"'i .:.1.J. 7 :~t .. r 1 _ GEOlHERMAl. WEU.F,ELO F1.AN .. ..;!. .;-... -.• 11·:-·•7 . . ...... _1t ·· t .. , .... ~...--,.:•: ~ ~-l !"'..,. -• t'·f t' .. : I Fi-EX. CONN. SUCTION D1Ff USER ADJUSTABLE i SUPPORT r `-- TRIPLE DU Pi' VALVE Ft EX. CONN.(TYP-) { SHAD 1GUARD 1\ ' - STEEL OR CAST IRON BASE •1WITH DRIP TROUGH. }. PFC 'Th I ,} , » 1 - FLOOR — 1 /2" PAN DRAIN TO FLOOR DRAIN 1 /2" TROUGH DRAIN TO FLOOR DRAIN 1 /2" DRAIN TO FLOOR DRAIN 2" DEEP 16 GA. GALV. DRAIN PAN UNDER PUMP ASSEMBLY. _• PACKAGE FRAME VIBRATION ISOLATION 4" THICK CONCRETE PAD (BY MECH. CONTR.) NOTE: SEE PLANS FOR ROUTING OF PIPING. DETAIL IS FOR VALVE AND ACCESSARY INDICATION ONLY. 3 BASE MOUNTED PUMP PIP S;• G DETA1_L WO— SCnt E - - ekth:f ? :tA T�. - �• �s au , rr'ii n 141E fir P.M. V,PeR. :It rL9. RAT,,: G5. rarDwaWW! waft !I* Mut t rtW A*Pree s- k cOk' - 21.01 WNW, rRr r+r +•i& •u �[ r Sir A:., PZ Ik • IL Tr =' ari7 1'FW 14L4005r S'Ki4Y —An a 5111' gvaa► ,.n , f5c rPA[s'..14 P..rav ic P , f W 5'Siii ,,. 1S Sr-fll �• km AA_ ff-- ROM Di6M C �iESxNI11 Flr'k147h fur :0+41 .14 ee. f '7fti ;F$ BAIN Ar'ae S4 A:_qe MaiOnly. ;ik 1. Sik lf'k. WS '.a' mat "'iexEr 37i • k' .t,W r.5,6 11'i 3ox18 0-8 f1AJtE Lni)'+ER (RUs+at EL.F-375 dtn+ mat-, ¶ ' I, fl Efrf "X• 6E SELEc'F..7 An• �. PRt UE Flit Skiff v3*OR 7F'i CJ1FFet, IN r tOCFI[7 1474 FM P $- -- erne A. .(06V r'IItait i .3 MEM LOti1tt OCT Sr a13*HC' Of fE3 7* ^lsif'.._i R1 30 E711.A'1S1' 1p1FvER (FJSI(.1i 6.7-375 MTH 'SE: ` IalL Fvl$li Ta7 6r sac.:'TED 8Y MEN 'FCM+. PE" I; 8" DELP PIS -PLATED SHEE - r?Sf1i2 P-3 ^•'F p aa;;, TN -STEW E4P* :. 1ATIK i ti .4. '- s' &Air. c:5 # sra SEE 1/11-20.7 FOR C:I.Yrl{UA7N1fi tr— ''.' .s k i name _a SECS ;aRnE, hH\1)E FDrE 9tkt1£E AV: a1kvEt1 ID 5. ItCPt AT F_13Z $ 1 V $iei.L-f j1 t, 4. Q C ; 4 Q 9 4-9. 3nI- .2a fat 1 4 1 .# .1. -} .• I�f�IIllIti�I & I r r 6 I s 15 t; I o 1 I I I I it. 14. 1 14. I : r n Pitcc. 5LL •JL- rust CO!.raiA'7. 4IIIil1 _fiIP Gpg... Sti1£11 ME Vag/AMR } LI.E.' ?Aka env +•_, ' O°D PUMP ROOM PLAN :/=t'- fiL Specialty Geothermal Well Held Services FAX "EAT) SHEET To: Mr. Hill Todd Company: NC DENR Fax Number: (910) 486-0707 Pages (inciiwv. coved): 10 Date: May 20, 209 From: Janice Scott RE: Western Elementary School - NC Water Permit Mr. "fodd, As per Scott's request, i am forwarding you our copy of the 5-QW Well Permit for Western Elementary. Our copy is not signed, but 1 am checking to see what the status of the permit is at JS Clark. Please du not hesitate to call if you have any questions or require additional information. M.y number is (9O 1) 748-905. Sincerely, Janice E. Scott 827,5 tournament Drive Ste, 185 • Memphis, IN .i8125-0.8.51 Office (901) 748•9095 • Fax (901) 748-9097 Drnntte Fields Facility Planner Operations Center Rhone: (314) 678 2557 Fax; (910) 678-7043 email: donnallelda@ces.kl2.nc.us FAX COVER SHEET naxer Os.26-2009 Attention: Crafg Spivey FAX (910) 792-9558 Company: John B. Clark Regarding: NC 5-QW Permit (Western Elementary) Number of pages including this one: 11 ri Original will follow. Cerra eats: Mr. Rogers, I am faxing this copy of the permit application per Mr. Craig Spivey's request. As far as I understand, the original application was mailed by CCS as per instructions given, however, documents have not yet been received by your office. If you have any questions at all, please feel free to contact my office @ (910) 67825S9 Cc: Craig Spivey (John S. Clark) CiVdenbal and Pr'rr$eged: ThEt inforrnalm contained in ttds facsimile is prtvi{eged end arildenikat Infnrmatiati Inta,aea for the sole use aft e[idrers t. If the reader of this faasimio is not the Intended redpiern or the employee or agent rm.ponsitie fa dertw+rno it to iha intended ret:Vient, you are hereby rid that any disserrkin ors, dislakton, or CONn9 of This cnmaspandence is sty prihlltod. If you have calmed this FAX in error, please Inrnedskity nrrtfly the sen4er, and return the original message by mail toll.* sender at ire ads f etrad below. Mailing Address, 810 Gillespie Street, Fayetteville, North Carolina. 28306 I t / tf 39tid ONTRIrid So frtiOat.30IG 9Z:ZT 6613Z/9r;/513 Donna Fields Facility Planner Operations Center oo� n sYsr�4 S�% tti CU1v1BERLAND COUNTY SCHOOLS Phone: (910) 678-2557 Fax: (910) 678-7043 email: donnafields@ccs.k12.ne.us FAX COVER SHEET Date: 05-26-2009 Atm=ion: Michael Rogers FAX (919) 715-0588 Company: North Carolina Division of Water Quality Regarding: NC 5-QW Permit (Western Elementary) Number of pages including this one: 11 ❑ Original will follow. Comlueuts: Mr. Rogers, I am faxing this copy of the permit application per Mr. Craig Spivey's request. As far as I understand, the original application was mailed by CCS as per instructions given, however. documents have not yet been received by your office. If you have any questions at all, please feel free to contact my office @ (910) 678-2539 Cc: Craig Spivey (John S. Clark) Signed: Donna C. Fields confr&nfiel and Privi*�ed: The information centaired in this facsimile is pitulleged and confidential irrfomiat on intended for the sole use of the addressee. W the reader of this facsimile is not the intender) recipient or the employee or agent responsible for dellverring it to the intendep redpient, you are hereby notified that any dissemination; distribution, or copying of this correspondence is strictly prohibited. If you have received this FAX in error, please immediately notify the sender, and retum the original message by mail to the sender at the address listed below. Mailing Address: 810 Gillespie Street, Fayetteville, North Carolina 28306 TT/TO 3JVd SNINNtf1d SDD EtraGBL90t6 E9:at 600 15c150 057e112009 11:44 9017489297 MID -SOUTH GEUTMERMAL PAGE 02110 NORTH CAROLINA DEPARTMENT T OF ENVIRONMENT AND NATURAL. SOURCES (NCDENR) NOWICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM: TYPE $-OW WELL(SI in Accordance with the provisions of NCAC Title I5A: 02C.0200, please compi'pe ti:ix t,vticaten and mail to ad tress on the back page (please ''t or Type infomaation). 'PATE: 4 p(G[`t , 20C+C1 Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in continuous piping that completely isolates the fluid from the environment (i_e, closed -loop)? 'es , i� . Continue completing this form. No Do Not complete this farm. Complete other UM application forms for installing either.a 5A.7 well (open -loop well infecting potable water into the aquifer) or a 5QM well (closed - loop well containing additives such as R-22, ethanol, or other antifreeze or currosioa inhibitors). A. PROPERTY OWNER(SyAPPLJCA NT(S) List each Property Owner listed pit proper deed (if owned by a buslxtel;a or governmeitt agency, state name o£ entity and a representative wlauthorlty for slgpanare)_C (AKA C -tom n + C,Qw A Yt.4 d 3 (l) Mailing Addresa: _ { • ��(- ��� Cltcyl e,t); Ile, State: NC, Zip Code: a% couu y: eu►u r n D Home/Offlee Tele No.:. ei 1 - t5W Ceil No.: Email Address: Website: (2) Physical Address of Well Site of different than abavei=r.,_,e � t[-u.rLfJi f} I C+tv: ` ��►7i t te. slate AL. zip Code! ag, e, tQ County:Ot I f-r t.Ltk Horne/OfficeTele No.:010- 4q3-00'Ci cell No.- B. AUTHORIZED AGENT OF OWNER, IF ANY of the Permit Applicant does nut osvu the subject property, att=eh a letter from the property owne autlirrizing Agent install and £operat ] UIC well) Company Natne: �U( r'l'► be r] a hl ti ' &J t# EU teak n Contact Person: l 5Q 11 A.. e,i.4 B LI Address= i.�lt J In 1-i3) eLvc. (2.4 e..L S. Address, g ID 4' I/ €54 p ke City: ` "i g g ifC 4 4 (C State: I(tY, Zap Code: a9S sty: ] L frn be do. ricj Orrice Tele No.: (` i 0 ) Cell No.: Wcbsitc Address of Company, !tarty: LIAU19 • LAC • V- 1,2 -ne OPU/WC SQW Notificaticn of r'ntent Perm [wised e/1009) Nigel II/Z0 3910d 9NINNdld SXX Et0LBL90T6 EO:n 500E/9U/50 05/01/20P9 1/:44 9017463$397 MID -SOUTH GEOTHERMAL PAGE 03f10 C. WELL DRILLER irtOORMATION Company Name:. Aii f S ()talk G c 444 �l & 1. L LC, Weil Dtilier contractor's Name: J (A: 3-0 ft.1___ NO Contractor Certification No.: 1 L2t*gw t-K-r. 6e 3oi ,7 �' $ Contact Perscr : Tf ` rat f } -k s-r�D A re � � Lt �b Yv1r Address: u�r, i�.�3�.. 1 S'1-1 City: � zipcode: 32 Og5f County:-rA,ze J / Office Tele Na.: Gib 1-148 -ter OciS co No,: i-(, . D. HEAT PUMP CONTRACTOR ,,INFORM�AT INFORMATION (if different than driller) Company Name: )l\ ID SO G e6- i e LC K. Contact Person; tS{' OTV Address: R.,Xl �. ct r iG s 1"be • ric--€.. l�s Cit . IY\ 4t4 is Z} �1 C f L e �f y` �"�-� -p, Code: o � 5 t County:� � Office Tele No.:`'t(.51- L •:I 5 Ceti No.: 4 01- eX i E. STATUS OF APPLICANT ; r private: Federal: Commercial: ) State: Municipal: Native American Lands: F. INJECTION PR jCEDURE (isrfe.#ly describe how the Nevada wells) will be used) G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: 5 a5-(] Number of borings: Approximate depth of each boring (fetter): (2) Type of robing to be used (capper, rVC, etc): t b �. L F� t�6 �- - (3) well easing. is the well(s) cased? (check either (a.) Yet 0.E (b.) No below) (a) Ye& �r if yes, then provide easing information below Type; ^ jalvanizcd steel black suet, plastic other (specify) Casing depth: From to feet (reft:rence to land sw-fac-e) Casing extends t % above grot nd _ inches (b) I o C (4) Grout info (material Sutrounding well casing end/or piping): (a) (b) (o) Grout type: Near Cement Berttoriite der (specify) Grout placement: •Pumpin Pressure Other Grout depth of tubing (reference to land surface): (torn. 3 ' to ') (feet) If well has casing, indicate grout depth: from (feet) Gruen; 50W Notification otlntalt Fano (Itevised 81$008) Pew 2 UI/EO 3Jtd DNINNdld SOD £tOL8L9016 £O:ZI 600Z/9Z/S0 135/41f2ee9 11:44 2a1748905" mip -SDUTH GEDTHERm PASE 04/ 10 g. INJECTION -RELATED EQUIPMENT Attach a diagram showing the engine,ering lnyotrt OF proposed modifitativm oft the injection equipment and taftrior piping/tubing asso.:iated with the injection operation_ The manufacturer's brochure rimy provide supplementary information. ii- LOCATION OF WELL(S) Attach two copies of naps showing the foI`owing intbrrnation: (I) include a Sito Map Cyan be drawn) property lines, surface whiter bodies, potentuat sources of groundwater contamination and the oil eirtation of and distances between the proposed well(s) and any existing wants) or waste disponi facilities such as septic tanks or drain fields located within 200 feat of the geothermal heat pump well system. Label all features clearly and lnellt a north wow- (2) The Site Map rrxust show tho subject property in re}anon to the surrounding area by usixlg at least two fixed taference points such as roads, streams, and/or highway irilerseCtiorril, J. CER I W!CAT1ON Note: This Permit Application must be signed by rt,IA person appearing on the recorded '^gaI property deed. "I hereby certify, under penalty of inw, that E have personally examined and urn familiar with the information submitted in this document and ail atrachmettis 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. atn aware that there are sig:ail6caitt pena;ties, Including the possibility ef Hanes and itnpri -comsat, for subnuttltng false information. 1 agree to construct, opetste.,-mai: si repair, and if ap licabie, at,- on the iujeutiot well and ail related appurtenances in accordance yifitiiihe approved-ificatior rs candies a3 fthe Pernut." r'y party Dwr rl.' Itri L-aCeq Print or Type hull Name and tale Signature of Property Owner/Applicant Print or Type Full Mine and title Signature ofAuthoriied Agent, ifaay print or Type Full Name and title Please mum two e,opies of the completed Application package to: North Carolina DENR-DWQ Aqu fer Protection Section -WC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 GPUMc Sow NaniBcartarr of tntant Farm (Revised 812908E - roue 3 i't/'2 39t7d DNINNV1d 530 EV0L8L9016 E0:61 6130Z/56/5I3 .--I .--I ...... ID (SI ~ H z a 1[ U) u u (T) "" (SI r--- (D r--- lD (SI .--I (Tl (T) (SI N .--I (Tl (SI (SI N ....... lD N ...... ID (SI >fl hltp://mup.,,google.oomtmaps?ll=35.0 12292,-79, 039603&z= I5&:t91&hl=en · , _ 5/1/200.9 l 1 :59 AM .... .... 0,. .p.. lO IS) .... -.J 0,. (X) lO cg ~( \ CS) Ul ' ,... CS) 35/U1/21309 l I NAM jft ss 11:44 901748$097 MID -SOUTH GEOTHERMAL PAC 06/10 TUt4 Cala.' R.4,041 Fikqe-rrevit.J.Z, AC. Fx 4\\\1'/ \ i I 11 I • 1 tJr .'s Q• ' • ✓ �. AlitM rw+y rr WirilmWM.�.1riwerr�e fir. glissgpminnEevlisOF Ge0114UMAI_ ► at]. Fx. t.b 11/90 3D'dd 9NINNti1d .J Lt1iBL9016 Ee:zr GOOZ/9z/G0 051e1t2 a9 11;41 9817459e97 ratma MID-5WTH GFATHEf}NAL • • e PAGE B7/L ,wr,. ..n.e.-,.....r......,.. ZIILB 3EiUd ONINN01d co5EbeLBL99T6 Ee:n 6e0Z19Z150 85/01/20.09 11:4 9017490097 MID -SOUTH GEOTHERMAL PAGE B/ 1 B FtEX. CONN. Suo# RirRISER - ADatsTABLE SUPPORT TRIPLE DUTY VALVE Fl.ZX. C+Nt4.(D P.) SHAFT GUARD I I � y FLOOR 1 /2" PAN DRAIN To FLOQR DRAIN 1/2" TROUGH DRAIN TO IL.00R DRAIN 1 /2" DRAIN TO FLOOR DRAIN STEM Off CAST ION L9AS WITH OW TRQUGH, 2" DEEP 16 CA. CALV. DRAIN PAN UNDER PUMP As3E leL''. PACKAGE FRAM - WBRA'flON ISOLA ilON 4' THICK OONC ETE PAD (BY MECH. CONTR.) NOTE: SEE PLANS FOR ROUTING OfPtiPING. DETAIL IS FOR VALVE AND ACCESSORY INDICATION ONLY. BASE MOUNTEQ PUMP' PIPING DETAIL 1.t/82 3Jdd ONINLiVid s:a £78L8L9016 EG:ZI 680Z/9ZISO w a_ iAi el 11 Vel 1 1 . OP ] ail, FM at a lelanaSvirli pm We f r 1 ,t Mt e - If a' MIL __ ............41fro_ - - 0 t ...c.,p� ill a tie pli" CV MUM fIf i i air dir,lut I ME Am 10 ►art Om 0104 ...ate 04,114 r- .-�r I] d`•ROW w-0 426 p-C, T� .car...+... - _ .� _.�- -. �.y�y w' .�..'.-.�... _ I: ll .�._.3 y�y,�� {...-.�.�.�__ sU] 7:: Baal ITV iiiie i I� INM! wMt ..ik+iil3�rk tlfFi:i Lif .! y 9105707043 05/26/2009 .-1 .-1 ...... IS) .-1 l!J z H i it (f) u u CV) s;t IS) r--- 00 r--- LD IS) .-1 CJ1 CV) IS) N .-1 CJ1 IS) IS) N ...... LO N ...... ID IS) \!) ~ I-' -.J -1>- (0 t.O ts) U) \ . ..... ( .... CSI ' I-' al May.26, 2009 11:47AM John S. Clark Company No 6586 gi,L.,AltK ■S(SA John S. Clark Ca. P 1Unor 1721 Alen's Lane Suite 210 • Wilmington) North Carolina 28405 Telephone: (910) 792-9555 Fay: (910) 792-9558 E-Mail Address: davideogjsclark com • FAX TRANSMISSION COVER SHEET Date: May 26, 2009 To: Cumberland County Schools Attn: Donna Fax: (910) 678-7043 Re: NC 5-QW Permit (Wotan Elementary) Sender: David Converse, Asst. PM r YOU SHOULD RECEIVE INCLUDING THIS COVER SHEET IF YOU _11__PAQE(S), DO NOT RECEIVE ALL THE' PAGES, PLEASE CALL (910) 792-9555 Comments: Donna Ple • a tikrt f the mal vwe� r nta tease cmoleteitam i and_s�n. Also.D1eaap fax to Michael Roars in Raleigh, at 919-715- 0588, and also a oopx faxed to John $ CI. at 9'10-7 -95S t Thank you, David Qonverse AssistantPraject Managgr Oatiggsfigniclaric 910.792,9655 1T/T1 3Jdd SNINNdld SDO Eb9LBL9916 £6:ZL 680Z,H/G Ro gers, Michael l=rom: .ent: To: Craig Spivey [craigs@JSClark.com] Wednesday, May 27, 2009 9:26 AM Rogers, Michael Subject: Attachments: Thanks Michael, RE: Geothermal well permit image001.jpg My office number is 910 792 9555, mobile 910 279 0542 From: Rogers, Michael [mailto:michael.rogers@ncdenr.gov] Sent: Wednesday, May 27, 2009 9:13 AM To: Craig Spivey Subject: RE: Geothermal well permit Since this is a SQW water only well, the well is deemed permitted after receipt of the completed signed applicat ion, which was yesterday. I will ask the admin folks to expedite the Acknowledgment letter and fax you a copy. The letter will have a permit number assigned to this project. Also, would you please give me your direct phone number. Michael Rogers Environmental Specialist NC Div of Water Quality Aquifer Protection Section (APS), 2728 Capital Blvd., Raleigh, NC 27604 ·elephone (919) 715-6166; Fax 715-0588 (put to my attention on cover letter) E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties From: Craig Spivey [mailto:craigs@JSClark.com] Sent: Wednesday, May 27, 2009 8:45 AM To: Rogers, Michael Subject: RE: Geothermal well permit Thank you for the help, When would you anticipate us getting the permit? From: Rogers, Michael [mailto:michael.rogers@ncdenr.gov] Sent: Wednesday, May 27, 2009 8:43 AM To: Craig Spivey Cc: WilsonL@ccs.k12.nc.us; David Converse; striplett@midsouthgeothermal.com; John Fogelquist; Todd, Bill; Barnhardt, Art; Morgan, Andrew; Janice Scott Subject: RE: Geothermal well permit Thanks for the info. Please contact Bill Todd and Art Barnhardt at the FRO prior to drilling (910-433-3300) . . /hanks again. Michael Rogers 1 Environmental Specialist NC Div of Water Quality Aquifer Protection Section (APS), 2728 Capital Blvd., Raleigh, NC 27604 Telephone (919) 715-6166; Fax 715-0588 (put to my attention on cover letter) ..:-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties From: Craig Spivey [mailto:craigs@JSClark.com] Sent: Wednesday, May 27, 2009 8:13 AM To: Rogers, Michael Cc: WilsonL@ccs.k12.nc.us; David Converse; striplett@midsouthgeothermal.com; John Fogelquist; Todd, Bill; Barnhardt, Art; Morgan, Andrew; Janice Scott Subject: RE: Geothermal well permit Michael, Please see attached scanned application. I have also attached a scanned original without signatures. If this is not sufficient, let me know. I would anticipate that we would start drilling as soon as we get the permit or June 1st if we had the permit in hand. Thanks for the help From: Rogers, Michael [mailto:michael.rogers@ncdenr.gov] Sent: Wednesday, May 27, 2009 7:26 AM -o: Craig Spivey ..;c:: WilsonL@ccs.k12.nc.us; David Converse; striplett@midsouthgeothermal.com; John Fogelquist; Todd, Bill; Barnhardt, Art; Morgan, Andrew Subject: RE: Geothermal well permit Would you please scan in the Application w/attachments and email to me, Bill Todd, and Art Barnhardt. The attachments to the faxed copy were degraded. We will then process, issue a permit number, and send acknowledgment letter. When do you plan to start drilling? Thanks Michael Rogers Environmental Specialist NC Div of Water Quality Aquifer Protection Section (APS), _2728 Capital Blvd., Raleigh, NC 27604 Telephone (919) 715-6166; Fax 715-0588 (put to my attention on cover letter) E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties From: Craig Spivey [mailto:craigs@JSOark.com] Sent: Tuesday, May 26, 2009 4:46 PM To: Rogers, Michael Cc: WilsonL@ccs.k12.nc.us; David Converse; striplett@midsouthgeothermal.com; John Fogelquist :ubject: RE: Geothermal well permit Michael, 2 I spoke with Mid South Geothermal earlier. They confirmed that this is a water only system as the application states. Mid South confirmed this with Optima Engineering as well. If you have any questions please do not hesitate to contact me. 'lease note that my e-mail address was incorrect on the previous e-mail. I appreciate you informing me of the status. Craig From: David Converse Sent: Tuesday, May 26, 2009 3:39 PM To: Craig Spivey Subject: FW: Geothermal well permit FYI David M. Converse Assistant Project Manager John S. Clark Company, LLC 1721 Allen's Lane, Suite 210 Wilmington, NC 28403 910.792.9555 Ph. 910.792.9558 Fax davidco"sclark.com gect eps =ARK ram: Rogers, Michael[mailto:michael.rogers@ncdenr.govj Sent: Tuesday, May 26, 2009 3:28 PM To: David Converse Cc: craigsp@jsclark.com Subject: FW: Geothermal well permit fyi. Michael Rogers Environmental Specialist NC Div of Water Quality Aquifer Protection Section (APS), 2728 Capital Blvd.. Raleigh, NC 27604 Telephone (919) 715.6166; Fax 715-0588 (put to my attention on cover letter) E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties From; Rogers, Michael Sent: Tuesday, May 26, 2009 2:01 PM To: 'WilsonL@ccs.k12.nc.us' Subject: Geothermal well permit Mr Lacey - want to confirm that the geo wells you will be installing for the elementary school in Fayetteville will be water -only 5QW type welts. That is the application we received. f thought I heard they were going to be 5QM wells containing an additive such as ethanol. Please confirm that you submitted the correct forms for the correct well system. 3 Thank you for your cooperation. 'V1ichael Rogers .nvironmental Specialist NC Div of Water Quality Aquifer Protection Section {APS), 2728 Capital Blvd., Raleigh, NC 27604 Telephone {919) 715-6166; Fax 715-0588 (put to my attention on cover letter) E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties 4 "Ro gers , Michael From: Sent: To: Craig Spivey [craigs@JSClark.com) Tuesday, May 26, 2009 4:46 PM Rogers, Michael Cc: WilsonL@ccs.k12.nc.us; David Converse; striplett@midsouthgeothermal.com; John Fogelquist Subject: Attachments: Michael , RE: Geothermal well permit image001.jpg I spoke with Mid South Geothermal earlier. They confirmed that this is a water only system as the application states. Mid South confirmed this with Optima Engineering as well. If you have any questions please do not hesitate to contact me. Please note that my e-mail address was incorrect on the previous e-mail. I appreciate you informing me of the status. Craig From: David Converse Sent: Tuesday, May 26, 2009 3:39 PM To: Craig Spivey Subject: FW: Geothermal well permit FYI David M. Converse Assistant Project Manager John S. Clark Company, LLC 1721 Allen's Lane, Suite 210 Wilmington, NC 28403 910.792.9555 Ph. 910. 792.9558 Fax davidco @j sclark.com ,,.f-ARK ~N TFIACTOR From: Rogers, Michael [mailto:michael.rogers@ncdenr.gov] Sent: Tuesday, May 26, 2009 3:28 PM To: David Converse Cc: craigsp@jsclark.com Subject: FW: Geothermal well permit fyi. M ic hael Rogers Enviro nm ental Special is t NC Div of W ater Quali ty Aq u ife r Protect ion Section (APS ), 2728 Cap ital Blvd., Raleigh , NC 27604 Telep hone (9 19) 715-6166 ; Fax 7 15-0588 (pu t to my atte ntion on cover letter) 1 E-mail $Orrespondence to and from this address may be subject to the North Carolina Public Records Law and may be Uisclosed to third parties From: Rogers, Michael Sent: Tuesday, May 26, 2009 2:01 PM To: 'WilsonL@ccs.k12.nc.us' Subject: Geothermal well permit Mr. Lacey- I want to confirm that the geo wells you will be installing for the elementary school in Fayetteville will be water-only SQW type wells. That is the application we received. I thought I heard they were going to be SQM wells containing an additive such as ethanol. Please confirm that you submitted the correct forms for the correct well system. Thank you for your cooperation . Michael Rogers Environmental Specialist NC Div of Water Quality Aquifer Protection Section (APS), 2728 Capital Blvd., Raleigh, NC 27604 Telephone (919) 715-6166; Fax 715-0588 (put to my attention on cover letter) E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties 2 DATE,TIME FAX NO./NAME DURATION PAGE(S) RESULT MODE TRANSMISSION VERIFICATION REPORT 06/02 13:37 919107929558 00:00:27 01 OK STANDARD ECM TIME 06/02/2009 13:38 NAME NCDE&NR/WATER QUAL FAX 919-715-0588 TEL 919-733-3221