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Home My WebLink AboutWI0600044_GEO THERMAL_20090612Permit Number Program Category Ground Water Permit Type WI0600044 / Central Files: APS_ SWP_ 06/12/09 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 Coastal SW Rule Permitted Flow Facilit Facility Name Fort Bragg Behavioral Health Clinic-WAMC Location Address Warne Loop Rd Longstreet Rd Fort Bragg NC 28310 Owner Owner Name Gregory G Bean Dates/Events Orig Issue 06/12/09 App Received Draft Initiated 06/05/09 Re g ulated Activities Heat Pump injection Outfall f\.UU . Waterbody Name Scheduled Issuance Permit Contact Affiliation Mike Hadley Driller Well 102 Middle St Jacksonville NC Major/Minor Minor Region Fayetteville County Cumberland Facility Contact Affiliation Owner Type Individual Owner Affiliation Gregory G. Bean Director Public Works of 3-1631 Butner Rd Fort Bragg NC Public Notice Issue 06/12/09 Effective 06/12/09 28546 28310 Expiration Stream Index Number Current Class Subbasin Permit Number W10600044 Central Files; APS SWP 06/12/09 Permit Tracking Slip Program Category Ground Water Status Project Type In review New Project Permit Type Version Permit Classification Injection Water Only GSHP Well System (5QW) Individual Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facility Facility Name Fort Bragg Behavioral Health Clinic-WAMC Location Address Wamc Loop Rd Longstreet Rd Fort Bragg Groner Owner Name Gregory Dates/Events lDrig Issue Permit Contact Affiliation Mike Hadley Driller Well 102 Middle St Jacksonville NC 28546 Major/Minor Region Minor Fayetteville County Cumberland NC 28310 Facility Contact Affiliation Owner Type individual G Bean Owner Affiliation Gregory G. Bean Director Public Works of 3-1631 Butner Rd App Received 06/05/09 Regulated Activities Outfali NULL Draft Initiated Scheduled Issuance Fort Bragg NC 28310 Public Notice ssu Eff cti e o 5 Expiration Waterbody Name Stream Index Number Current Class Subbasin NA NC:DEMR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Gregory G. Bean Director of Public Works 3-1631 Butner Road Fort Bragg, NC 28310 Coleen H. Sullins Director 6/12/2009 Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System Permit No. WI0600044 Fort Bragg Behavioral Health Clinic-W AMC Loop Rd & Longstreet Rd Fort Bragg, NC 28310 Dear Mr. Bean: Dee Freeman Secretary In accordance with the application submitted to the Underground Injection Control (VIC) Program that was received on 06/05/2009, 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 W AMC Loop Rd. & Longstreet Rd., Fort Bragg, Cumberland County, NC 28310. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C, Section .0211(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. ~ly, A{.~~ for M~l Rogers Environmental Specialist GPU-Aquifer Protection Section cc: Fayetteville Regional Office -APS APS Central Files -Permit No. WI0600044 Cumberland County Health Dept. AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604 Phone: 919-733-3221 \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748 Internet: www.ncwaterguality.org An Equal Opportunity 1, Affinnative Action Employer 0 ~1-.c 1· N 01 u1 aro 1na lvaturall!f 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-"W W ELLLS ) In Accordance with the provisions of NCAC Title 15A: 02C.0200, please complete this notification and mail to address on the back page (please Print or Type information). DATE: 4 June . . 2009 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-ioop'1? 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). A. PROPERTY OWNER(S)IAPPLICANT(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): Director of Public Works (1) Mailing Address: 3-1631 Butner Road City: Fort Bragg State: NC Zip Code:28310 County:Cumberland Home/Office Tele No.: 910396.5564 Cell No.: N/A Email Address: N/A Website: N/A (2) Physical Address of Well Site (if different than above): WAMC Loop Rd & Longstreet Rd City: (same) State: Zip Code: _ County: Home/Office Tele No.: Cell No.: IL 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: OK/1 5QW Notification of Intent Form (Revised 712008) Page 1 C. WELL DRILLER INFORMATION Company Name: Coastal Geothermal Well Driller Contractor's Name: Sartfo.rd sweeting NC Contractor .Certification No.: NC 2082 Contact Person: Mike Hadlev EMAIL Address: mhad1ey@ 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 PUM,PCONTRACTOR INFORMATION (if different than driller) Company: _NIA _GeothennaJ Borehole for testing p.utpose _ Contact Person: EMAIL Address: Address: ___________ _ City: _________ Zip Code.: _____ County: ____ _ Office Tele No.: Cell No.: ______ _ E. STATUS OF APPLICANT Private: State: Federal: _X_ Mu11icipal: __ Cornm.ercial: Native American Lands: F. INJECTION PROCEDURE (briefly describe how the injection weU(s) will be used) Closed Loo p Geothermal Heat Transfer S vstems G. WELL CONSTRUCTION DATA ( I) Proposed date to be constructed: _ 2009 ___ Number ofborings: _l __ _ Approximate depth of each boring (feet): __ 250 _____ _ (2) Type of tubing to be used (copper. PVC, etc): _High Density Polyethylene_X (3) Well casing. ls the well(s) cased? {check either (a.) Yes m:: (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) Groui type: NeatCement__ Bentonite _x_. _ Other (specify) ______ _ (b) Grout placement: Pumping_X_ Pressi:rn)_. -. _ Other __ ( c) Grout depth of tubing(reference to land surface): from _0 __ to _250 _ (feet) If well has casing, indicate grout depth: from ___ to ____ (feet) GP U/UIC 5QW Notifi¢aJion oflntent Form .(Rcvised 7/2008) 'Page 2 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 WELLS) Attach two copies of maps showing the following information: (I ) 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 taw, that I have personalty examined and am familiar with the information submitted in this document and all attachments thereto and Arai based on my inquiry of those individuals immediately responsible for obtaining said information, t belie\ e lh• the information is true, accurate and complete. I air aware that there are significant penalties, including the pas ility of fines and imprisonment, for submitting false information. I agree to construct. operate, mairitiin. rep , and if applicable, abandon the injection well and all related appurtenances in accordance with tlte;rpprovedcificatio and conditions of the Permit " rtECEIVED r DENR r DV Aquifer Protection Secli011 JUN 0 2409 ignature of Property Owner/Applicant Gregory G. Bean, Director of Public Works Print or Type Full Name and title Signature of Property Owner/Applicant Print or Type Pull 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 D ENR-DW Q Aquifer Protection Section-11C Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 GPU..I/UIC 5QW Notification of intent Form (Revised 7/2008) Pap 3 Site Characterization & Geothermal investigation h Ft. Bragg — Behavioral Health Clinic — preliminary site plan Cromwell project: 2008-044 Loop Road around Womack Med Facility RECEIVED ! DENR 1 DWQ Aquifer Protection Section JUN 0 5 2009 Parking Lot Addition drill the other 3 shallow borings with one in each potential parking lot as noted by the arrows. Art-, Plan North 11 Existing parking 111111111111111111 reared II ti 11tt 1[ltlltli - `�1111I111�111II��, Proposed Behr for borings for (drill outside o .(III L59, �lsll: Fi+ CENT' T' J iiiiii !I.l1 III T,„:,, �-�-err.-rcr 1 1111111 11 II1 L r---1 T Site Characterization & Geothermal Investigation NTP Attachment 3 Ft. Bragg — Behavioral Health Clinic — proposed site location for geotechnical investigation Cromwell project: 2008-044 All American Freeway Loop Road around Womack Medical Facility Potential additional parking lot additions (3 borings) Plan North Womack Medical Facility 2/17/08 Proposed Behavioral Health Clinic site for borings for bldg and geothermal Parking lot addition (one boring) Dig eltot dbe Site Characterization & Geothermal Investigation NTP Attachment 2 Ft. Bragg — Behavioral Health Clinic — preliminary site plan Cromwell project: 2008-044 Loop Road around Womack Med Facility 1 Parking Lot Addition drill the other 3 shallow borings with one in each potential parking lot as noted by the arrows. L33-4 1 Plan North Ll1J[ -- 111111111111] 111111111111 111I111111I.�,111111111III i- Existing parking ' 1111II1IiIrillrrri�Tilriirrllil � _ lllrrilillliiiiiriilr[Illllrrlllrrll Womack Medical — - — _ Facility I I I111111I111111f 1 l f kf 1 = �� '1!I!!lf11l111111�� 11111111i1�1 '� �=, _�111111 I� 111fIII��fi�T,.� Hilt. mum,. l TRAkCE rrn I. 1 [ll1lllilill 1RIIIIIIII 111I111I1ni1IIIIII ' 11111-I111111I 1111111i111111 Illllilllllllll1Illllllirillll{I I. 2.!"-. ■ L3S 2/17/08 Proposed Behavioral Health Clinic site for borings for bldg and geothermal (drill outside of building footprint) ti E NE R'r 1 C£raTEF: 1i ll I1III!}j IEI11111 L J _ • 11IIlil�ili� llllllll�a�� , a Service Road Potential parking lot - provide 1 parking lot boring in this area I` C48 - f1MirSaA HOSPITAL i[[[[t[4[s+r [[[[[ f [- 7-maj Jr— L " g p I 111I11 I111111 1..11111 11[[i1I111 JL1,111111 111111111Iiiiii c.4.3 '1' _ # ' :111111111 I ICI Illllilll ' Illllil Illlll I i�lilll�� r',R _�5▪ � _ '1 [rr[ [ir[i + " [r[+[[[[[[ir [[t� rrri[[[i [t[r[Ci{[irlf[[`L' C.S7 1 ~� � IIIIII' IfII a F LE L •it T;w r� StTF eg r �`f rzi