WI0600054_GEO THERMAL_20210419

~·•~
. .-..,~-~
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Fort Bragg Directorate of 1,ublic Works
Attn: Suzanne Rohr~
21 75 Reilly Road
Srop A
Fort Bragg. NC 28310
Coleen H. Sullins
· Director
4719/2010
Subject: Acknowledgement oflntent to Construct Type 5QW I11jection Well System
Permit No. WI06 0 0054
Adjacent to Building 0-9016, Fort Bragg, NC 28310
Dear Ms. Rohrs:
Dee Freeman
Secretary
On April 12, 2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onl v
geothermal injection well sy stem 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:
l . 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 foi-m and associated maps have been completely and accuratel y submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Construction Act and North Carolina
Administrati~e Code Title 15A Section 2C Subchapter .02il(u)(2). Additionally, you should contact the C umberlan d 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) 7 15~6166 or Michael.Rogers@.n c denr.gov if you have any questions .
cc : Fayetteville Regional Office -AP $
APS Central Files -Permit N o. WI0600054
Cumhefland County Health Dept.
~ A.~
Olita A . Boone
Office Assistant
Coastal Geotherma l -Mike Hadley -102 Middle Street, Jacksonville. NC 2854(,
AQU IFER PROTECTION SECTION
rn36 Mail Service Center, Raleigh, North Carolina 27699-1636
location: 2728 Capital Bouievard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588 ; FAX [phone] \ Cu3tomer Service 1-877-523-6748
c Internet: www .ncwateraualitv.o rg
P "1 Equal Opportun\/ \ A.fflrmat1ve Ac~1on Employei
One . NortbCarolma
/Vatural/11
Permit Number WI0600054
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal .SW Rule
Permitted Flow
Facilitv
Facility Name
Building 0-9016
Location Address
Adjacent To Building 0-9016
Fort Bragg NC
Owner
Owner Name
28310
Fort Bragg Directorate of Public Works
Dates/Events
Orig Issue
04/19/10
App Received Draft Initiated
04/12/10
Re g ulated Activities
Heat Pump Inj e ction
Outfall l'·u; :...
Scheduled
Issuance
Central Files: APS_ SWP_
04/19/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Mike Hadley
Driller Well
102 Middle St
Jacksonville
Region
NC
Major/Minor
Minor Fayetteville
28546
County .~
Cumb ftand
Facility Contact Affiliation
Owner Type
Government -Federal
Owner Affiliation
Gregory G. Bean
Director Public Works
Fort Bragg Directorate Of Public Works
trB~we-C NC 28310
Public Notice Issue
04/19/10
Effective
04/19/10
Expiration
Waterbody Name Stream Index Number Current Class Subbas in
• �1 t ocn0005+
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: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Type information).
DATE: April 1 , 20_I0
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)?
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): Fort Bragg Directorate of Public Works
Mr. Gregory G. Bean. Director
(1)
Mailing Address: TMSE-BRG-PWE-C. ATTN: Suzanne Rohrs. 2175 Reilly Road. Stop A
City: Fort Bragg State: NC Zip Code: 28310 County: Cumberland
Home/Office Tele No.: (910 ) 432-8470 Cell No.: [phone]
Email Address: Suzanne.rohrsfd!us.army.nul Website:
(2) Physical Address of Well Site (if different than above): Adjacent to Buildin�0-9016
City: Fort Brae State: _NCZip Code: 28310 County: Hoke
Home/Office Tele No.: Cell 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:
GPUNIC 5QW Notification of Intent Form (Revised 8/2008)
RECEIVED ! DENR / DV1IQ
Aquifer Protection lion
APR i 2 20i0 Page 1

C. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal
I•
Well Driller Contractor's Name: ~S~an_fi~o~rd~S~w~ee~t_in_sr~-------------
NC Contractor Certification No.: 2082
Contact Person: Mike Hadle y
Address: 102 Middle St
--------------------
EMAIL Address: mhadie [e-mail]
Zip Code: =28=5~4~6 __ County: ONSLOW City: Jacksonville
Office Tele No.: 910-353-0926 ___ Cell No.: 910-376-1100 ____ _
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name:_~N=/A~----------------------
Contact Person_: _______________ E_MA __ IL_A_d~dr~e~ss~=-----------
Address: ----------------------------------
City: _________ Zip Code: ____ County : _____________ _
Office Tele No.: Cell No.:
E. STATUS OF APPLICANT
Private:
State:
Federal: X
Municipal: __
-----------
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Test loo p for closed loo p !!eothermal heat transfer system
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _April/l0 ______ Number of borings: _l ___ _
Approximate depth of each boring (feet): __ 250 _____ _
(2) Type of tubing to be used (copper, PVC, etc): polyethlene ____________ _
(3) Well casing. Is the well(s) cased? (check either (a.) Yes or (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__ Pressure 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)
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page2
...
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 believ . a the information is true, accurate and complete.
I am aware that there are significant penalties, including !!l pos · ility of fines and imprisonment, for submitting
false information. I agree to construct, operate, main.91£, rep · , and if applicable, abandon the injection well and
all related appurtenances in accordance with the ~roved sr, 1fications and conditions of the Permit."
~-~
Signature of Property Owner/Applicant
Gre eory G. Bean. Director of Public Works
Print or Type Full Name and title
Signature of Property Owner/Applicant
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-VIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone] RE~EIVED I DENR I DWQ
Aquifer Protection Section
APR 1.2 2010
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page 3
Test WeII' ATF •

4 Test Weir ATF '
Feet
0 475 950 1,900 2,850 3,800 4,750

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 ofNCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page {please Print or~ information).
DATE: -----=-A=p=ri=-1-=-1 __ __,, 20_10_
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-loo p)?
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 SQM well (closed-
loop well containing additives such as R-22, ethanol, or other_ antifreeze or corrosion inhibitors).
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): --=---F=ort'--"---"=Bc.e.ra,:,::2:,.t:g"-'D=ir""ec,,__,_to~r'""a""'te'----'oc'..efc...eP'"""u°"'b""Ii~c-'W-'---o~r""k"""s ___ _
Mr. Gre !Zo rv G. Bean. Director
(1) Mailing Address: IMSE-BRG-PWE-C . ATTN: Suzanne Rohrs. 2175 Reill y Road. Sto p A
City: Fort Brag2: State: NC Zip Code: · 28310 County: Cumberland
Home/Office Tele No.: [phone] Cell No.: (910 ) 224-4120
Email Address: Suzanne.rohrs @us.arm y .mil Website:
(2) Physical Address of Well Site (if different than above): --'A'--"-=d""ja=-c:::,enc!.:t..:.to::....::B=m=·1=d1=· n'-='12:'---"0'-----9"--'0"---'1'-"6'----------
City: Fort Bragg State: _ NC_ Zip Code: __ ....,,2=8"'---31"-'0'--------County: Hoke
Home/Office Tele No.: ____________ .....:C=e=ll=--=N'--'-o=."'-: __________ _
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 . .,_: -------------------==E=MA-""---"'IL'='---'A~dd,,,,r'""e"'=ss'--'--:-----------
Add:ress: ----------------------------------
City: _________ State: __ ZipCode: ______ County: _______ _
Office Tele No.: ---------------------"C=e=ll---=N--'-'o=·-=---= __________ _
Website Address of Company, if any: _____________ ----AR=E=CEIVEO / DENR / DWQ
Aq u,fer Protection Section
GPU/UIC SQW Notification of Intent Form (Revised 8/2008) APR 12 2010 Page I
C. WELL DRILLER INFORMATION
Company Name: Coastal Geothennal
Well Driller Contractor's Name: ~San=fi~or~d_S~w~e~e~t1=·n=g~-------------
NC Contractor Certification No.: _20_8_2 __________________ _
Contact Person"--: _,,_M=i=k=e -=-H=a=d=le'""y ____ -=E=MA"-="=IL=-=--A=d=d=--re=s=s:,....,m=ha=d=le-=-v'-"(@=b1=· z=ec=.rr=-=-=.c=o=m.c.__ __ _
Address: 102 Middle St
Zip Code: 28546 County: -=O-=-N=S=L=O--'W-'---------City: Jacksonville
Office Tele No.: 910-353-0926 ___ Cell No.: __ 910-376-1100 ____ _
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
CompanyName:_-=-N~/A~-----------------------
Contact Person_: _______________ E~MA~~IL_A~d=dr~e=ss~=-----------
Address: _________________________________ _
City: __________ Zip Code: _____ County: _____________ _
Office Tele No.: Cell No.: __________ _
E. . STATUS OF APPLICANT
Private:
State:
Federal: X
Municipal: __
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Test loo p for closed loo p geothermal heat transfer sv stem
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _April/l0 ______ Number of borings: _l ___ _
Approximate depth of each boring (feet): __ 250 _____ _
(2) Type of tubing to be used (copper, PVC, etc): polyethlene --------------
( 3) Well casing. Is the well(s) cased? (check either (a.) Yes QI (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__ Pressure 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)
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) P age2
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.
L 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 weIl(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.
3. 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_t the information is true, accurate and complete.
I am aware that there are significant penalties, including th�poss aility of fines and imprisonment for submitting
false information. I agree to construct, operate, maintain, rep ' , and if applicable, abandon the injection well and
ail related appurtenances in accordance with the approved sp rtications and conditions of the Permit."
Signature of Property Owner/Applicant
Gre,om G. Bean. Director of Public Works
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Authorized Agent, if any
Print or Type Full Name and tide
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 RECEIVED r DENR / TWO
Telephone [phone] Aquifer Prelor:Fion Section
APR 12 2010
GPUICTIC 5QW Notification of Intent Form (Revised 812OO) Page

Test Well ATF

Test Well ATF
Feet
0 475 950 1,900 2,850 3,800 4,750

DEPARTMENT OF THE ARMY
US ARMY INSTALLATION MANAGEMENT COMMAND
HEADQUARTERS, UNITED STATES ARMY GARRISON, FT BRAGG
2175 REILLY ROAD, STOP A
REPLYTO FORT BRAGG NORTH CAROLINA 28310-5000
ATTENTION OF
April 1, 2010
Directorate of Public Works
Mr . Thomas Slusser
North Carolina Department of Environment
and Natural Resources
UIC Program
Aquifer Protection Section, NCDENR-DWQ
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Dear Mr. Slusser:
Attached are two copies of a Type 5-QW injection well permit
application form related to a proposed Ground Source Heat Pump
installation at Fort Bragg's satellite training area, Aberdeen
Training Facility (ATF). As instructed on the application, two copies
of the form are being submitted, including two copies of all
attachments and supporting information.
If you have any questions concerning this matter, please contact
Mrs. Suzanne Rohrs at 910-432-8470.
Enclosure
Gregory G. Bean
Director of Public Works
RE~EIVEO / DENR I DWQ
Aquifer Protection Section
APR 12 2010
Page 1
' memory Road, Ashley Heights, North Carolina
Memory Ln, Aberdeen, NC 28315
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