WI0700076_GEO THERMAL_20000320

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
March 20, 2000
MEMORANDUM
To: Willie Hardison
Groundwater Section
Washington Regional Office
From: Mark Pritzl ,t!f. [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Receipt of Notification for a Closed-Loop Geothermal Water-Only Injection \Ven
System.
Notification to construct and operate injection wells for a geothermal heat pump system has been
filed by Kermit M. Bunn of Snow Hill, North Carolina and a copy of the Notification is enclosed
for your files . This injection well system is deemed permitted by rule (NCAC Tl5A:
2C.21 l(u)2) and no regulatory action is necessary. If you have any questions, please contact me
at [phone] or Amy Axon at [phone] .
cc : UlC Files
Enclo sures
Aria
NCDENR
JAMES a. HUNT JR,.
GOVERNOR
BILL HOLMAN
SECRETARY
KERR T STEVENS
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
March 20, 2000
Kermit M. Bunn
2234 Shine Road
Snow Hill, NC 28580
Dear Mr. Bunn:
DIVISION OF WATER QUALITY
In accordance with the notification submitted on your behalf by Climate Control
Heating & Cooling Company, dated February 25, 2000; the Groundwater Section
acknowledges your intention to construct a closed-Ioop geothermal water -only
injection well for the operation of a ground -source heat pump. The system as
described in your notification will not require an injection well permit and is deemed
permitted by rule (North Carolina Administrative Code Title 15A: 2C.0211(u)(2)).
The Underground Injection Control Group has added your site to our inventory. If
you modify your system, please contact the Groundwater Section to verify
compliance. Thank you for submitting this notification.
If you have any questions regarding geothermal heat pump wells please feel free to
contact me at [phone] or Amy Axon at [phone].
Sincerely,
PlaPAL
Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Program
cc: CO-UIC Files
WARO-UIC Files
FIZZ T
GROUNDWATER SECTION
1636 MAIL SERVICE CENTER, RALEIGH, NC 27609-163S - 2726 CAPITAL, BLVD., RALEIGH, NC 27604
PHONE S1 0-733.3221 FAX S19.715-OS88
AN EQUAL OPPORTUNITY / AFFIRHATIVe ACTION EMPLOYER - SOY RECYCLED/10Y POST -CONSUMER PAPER

FJ2-24-00 08:36PM FROM CLIMATE CONTROL
PQ1
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LQOP
GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM
(GROUND COUPLED MEAT PUMP) c
Fri
Type SQW Wells
lit Acccrdancc with the provisions of NJCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
This is not the proper form to he used fur injection welts in an oircn-luuir geothermal system
Do not use tills fortti fur systems that circulate poly substances other duo' water.
TO: DIRECTOR, NORTH CAROLINA DIVI5IION OF WATER QUALITY
DATE: /- e-b 2-
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
YES If yes, then continue completing this form.
NO It -no, do not complete this fatty'. Faim GW-57 HP, Application For
Pernrrlt 7"o Construct And/Or Use A Well(s) For Injection With A Near
Pump Syxtem, should be completed.
SYSTEM FLUID Will any additives be introduced to the systertl's circulating heat transfer
fluid? This includes, but is not limited to corrosions inhibitors end/or antifreezes.
YES i f yes, do not complete this form. Form OW-57 HP, Application For
Permit To Construct And/Or Use A Well(a) For Injection with A Heat
i'wiip System, should be completed.
NO 1 Iino. then continue completing this farm.
--.- C. PROPERTY OWNER
Name: 1114,7-�-- - l - � 4 z--,.--.
Address' ). 3 y f?.e
City: J ie_.c. Stec: t. Zip Code: J-YY_J` 2
County: �,Q_:_. Telephone; . Z.. iti) - I' 5/7
D.
STATUS OF PROPERTY OWNER
Private- r!
State:
Federal: Commercial:
Municipal; Native American Lands:
OW-57 CL (May 1998) Page 1 of 4

·02-24-00 08: 36PM FROM CLI,MUE CONTROL P02
E.. FACILITY (SITE) DATA
(Fill out ONLY if the Stal us of Owner is FeJeral, State, Municipal or Co111mc1-cial).
Name of Business or Facility: ______________________ _
Address:------------~'."'.'""""'~-=-------=-------City: _________ Stntc: _ Zip Code; _____ County~ ____ _
Telephone: __________ Contact Person: ____________ _
Standard Industrial Code(~), SIC, which describes conunercinl facility; ________ _
f. HEAT PUMP CONTRACTOR DAT A.
Name: Clin~Je C,p n trol Ue pting 1\ Co oling Co . 1 I nc.
Address; 102 Mjdd]e St,:;eet
City: Iacksoovi J le . Stoic:~ Zip Code: 28546 ;,,_Cot1111y: QosJcu,r ,
1"elcphone: ~J0.,JS3-9040 · Cournct Person: Midwel l·lad'le~
O. CONSTRUCTION DATA (check one)
(I)
(2)
EXISTING Wl.!LL(S) b.:ing proposed for use 11s n grouuJ-couplcJ hcut pump
wclt(s), Provide lhe informalio11 in (I) throush (4) below lo tl~e best of your
knowledgi,, Attach a copy of Fonn ow.1 (Well Construclioo Record) if available.
PROPOSED Wt;LL(S) to be c:onstructed for 1.1se ns a grom,d~eoupled heat pump
welt(s) . ProviJe the infomiolion in (1) through (4) below as PROPOSED
construction specific:alions. Submit Form GW-1 after construction.
Well Orillio~ Conlroc::tor's Nome: CJ jma,te .GAotcoJ HeatJog & Caalios Co.• ~
NC Driller Certification nunber,, 'J. 0 8 Z,. wt1\S
Da1c to be constrnctcJ: filj {ill-tt,,k., 00 Number o( bo1•jngs: M: q-, I qt
Approxiniate depth of eac:h boring (feet): V" ti ,r-~ J'f O ~
C-c.tl:{Cl! ,-11. rh ·l ~f)( ~;i, cb~
~-1'1 ... r,,o:P
Well cnsing: Is 1he well(s) cnsed? NO
(u) YES If yes, then provide tl1e casing info11m1lio11 below.
Type; Oalvanizeu steer_ D1ack sleet_ Plnslic_ Othet (specify) _____ _
Casing deplh: From ___ to ___ n. (reference to hmd surface)
Casing ex.tends above ground ____ inches
(b) NO _t_
(3) Orouc (grout the vertical length of the borehole to a minimum cleplh of20 feel b.l,s.):
NOTE.:
(a) Grout type: Ceinen\_ Bentonite. ~ Other (specify) _______ _
(b) Grouted surface and grout depth (reference to land surfoce):
~ around closed loop piping; f roin O to. ~ (feet).
_ around well casiog; from_ to_ (feet).
THE Wl;LL DR.ILLING comiv.cron. CAN SUPPLY Tl 16 DATA FOil rm·11St EX1S1'1t,10 OR
l'ltOPOSl!D WELLS II' 1·1 ns JNl'ORMATION Iii UN.I\ VAll.ADU.i UY 0111ER. MEANS.
OW-57 CL (May 1998) Paae 2 of4
'02-24—OOU 08.36PM FROM CLIMATE CONTROL
F)3
H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior pipingAubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
LOCATION OF WELL(S) Attach two 'naps.
A (1)
(2)
Include n site amp (can be drawn) slowing,: 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 ►vastc disposal facilities sui Ii as septic tanks
or drain fields located wvithin 200 feet of tho ground -coupled heat pump well system. Label all
features clearly and include a aunt' arrow,
location map referencing the site to two nearby permanent reference points (such as roads,
streams and highway intersections).
J. PERMIT LIST: Attach n list of ail permitsor construction approvals that aid related to the site.
Examples 'include
(I) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment arid Disposal Permits
K. CERTIFICATION
"I hereby certify, sunder penalty of law, that l 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 ant aware that there are significant penalties, including the possibility
or lines and itnprisaniut iif, rur submitting false information. 1 agrcc to construct, operate, maintain,
repair, and if applicable, abandon the ground -source heat pump system and all related appurtenances in
accordance with the approved specifkaiions and conditions of the Permit."
X1'J-1Z4 f �.) i As3
(Signature of Well Owner or Authorized Agent)
lfaurhorised agent is acting an behalf of the well owner,
please ,rurpply a letter signed by the owner
authorizing the above agent.
OW-57 CL (May 1998) Page 3 of 4

J/1
L. CONSENT OF PROPERTY OWNER (Owner means any person who holds lhe fee or other property
rights in the well being constructed. A well is real properly and its construction on land rcsls
ownership in the landowner in the absence of contrary agreement in writing.)
If the properly is owned by someone other than the applicant, the· property owner hereby consents to
allow the applicant lo construct each injection well as outlined in this application and lhal il shall be
the responsibility of the applica11l lo ensure that the ground-source heal pu111p syslem 's wcll(s)
conforms to the Well Construction Standards (Title I SA NCAC 2C .0200)
GW-57 CL (May 1998)
(Signature Of Properly Owner Ir Di ITerenl From Applicant)
Please return two copies of the completed Application package lo:
UIC Program
Groundwater Section
North Carolina DENR-D\VQ
P.O. Box 29578
Raleigh, NC 27626-0578
Telephone [phone]
Page 4 of 4
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