WI0700131_GEO THERMAL_20090217

Permit Number
Program Category
Ground Water
Permit Type
WI0700131 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Permitted Flow
Facili
Facility Name
Vince & Phyllis Castelli SFR
Location Address
1921 Sandfiddler Rd
Corolla
Own
Owner Name
Vince
Dates/Events
NC 27927
Castelli
Scheduled
Orig Issue
02/09/09
App Received Draft Initiated Issuance
02/04/09
Reg ulated Activities
Heat Pump injection
Outfall iJ U'_L
Central Files: APS_ SWP_
02/17/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Fred Marki in
PO Box 179
Kitty Hawk
Major/Minor
Minor
NC
Region
Washington
County
Currituck
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Vince Castelli
104 Marlin Dr
Duck
Public Notice Issue
02/09/09
NC
Effective
02/09/09
27949
27949
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Vince Castelli
Phyliss Castelli
1127 N. George Mason Drive
Arlington, VA 22205
Coleen H. Sullins
Director
2/9/2009
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0700131
104 Marlin Drive
Duck, NC 27949
Dear Mr. & Mrs. Castelli
Dee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on
2/4/2009, 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 104 Marlin Drive, Duck, Dare
County, NC 27949. 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 Dare 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 [phone].
cc: Washington Regional Office -APS
Sincerely,
O~l\.~
\ ~tll/\J Michael Rogers
\ -Environmental Specialist
GPU-Aquifer Protection Section
APS Central Files -Permit No. WI0700131
Dare County Health Dept.
Fred Marklin (RA Hoy Heating & A/C -PO Box 179, Kitty Hawk, NC 27949)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location : 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919 -715-6048 \ Customer Service: 1-877-623-6748
Internet: www .ncwaterquality.org
An Equ al Opportu nity\ Affirmative Action Em ployer
Ni¥th Carolina
)Vaturalllf
FRX NO. : 757-436-2665
FROM : Chesdpeal<e We �lr �t 1�.d'34erseei ut, UU IAr AI t rc
Feb. 04 2009 09:24RM P1
NOM CAAOLrNA
MAR' IMEN 7 OF VWRONMENT A74D 14-AT kL
i fttt.�rY�,►t 11tiW� 111WQ
4Gi I1RR � :''�1r� �m�Il{k1
FES 0 4 2009
NOTIFICATION OF INTENT TO CONSTRTJCT A C_L I`,qgi-it ewvp
GEOTMERMAL TERMI JECITON WELL SY M
(GROUND COUFLED HEAT PUMP}
Type Sow We11s
in Aco rdamc with the provisim of NC-4C'PlT1� 3 5A: 02C O200
Complete appficmiva and mail to addmesson the back pzgt.
1
Tfuls o ,tIIe proper form to be uecd for IuJectloxi wells in an apc+i-ie�ealhe 1 system.
th6 farts fur systems tlsat cleculs" Anv}t�tn�� 0rtiser tha__ ,knur.
TO DI iF-TOR, NORTH CARCX TNA DIVIMN DF WAT&K QUAL"
rwra If ?,or
A. SYSTW CLASSWICATION In cart'inrtous
piping that ovrx iewly imli es t;he'lluid from the ervim9srRCSGt7to rr
/ I
Yes i/ Zxyes, t'aen continua vamp?geir� this form.
NO I f nv, do not aornplute this Porn. Farm OW-S7 HP, A.Pplicalon For
Fermrr To Lom o-wt, ndt Or ilyaJ Mellfxj Fop bjecltonjAVIth A Heat
PM,F 5yllem, A00d be corttpi-fed.
S. SYMM FLUID Will arty additives be iraroduced to the tyssem': almulad S heat U%mf:r
fluid? This includzs, but is not iirntte'1' to "mosion kh1bitors and/or cm fmcm.
r
YES If yea, do not c-omplete tfft Farm- Form G,W-57 Hl-, ApPigabon For
ns Permit To Corrw=Andlpr Vie A Wetl{sJ For fnjwfon �fth 4 Heat
Pump Sy-rram, shouid be completed.
No If no, they; continue aampietiTts this f0rrt7. f
C- PROPERTY OWNER �
+r Address: 104 MAR-Iw E+R.
v City:yd T State: MC- Zip Cvcia: 87R Y
✓COurrty: 'fslepltvnc E5v-- "I - (0tZ-C
01 STATUS OF PROMTY OWNER
Ptivrse: f� Federal: Corrrmer4ial: _
Ste' MunlCipsl: Native American Lands:
Revised 7106
Gwrutl-57 Ci.
) of
I d Wd9'F-:01 MOE 61 '1—N 599Z -92P-154- : 'ON Xdj t I nM e je3dL5$ aH j

r INLJ.LI'VW I � 1 iiw►�
,5"?1 I}FFP'P VkX—(,TV4j �F 1
E. FACIL TY (S]TE) DATA �T- R 4 2009
(xiIl out ONLY if the Status of'Own" is Federal, Slate, Municipal or Commercial).
Name of Business of Facility:
Address:
City: State: Zip Code: County:
Telephone: Corset Person:
Standard Industrial Cade(s) SIC, which describes commercial facility:
F. y�HEAT PUNY C,nC� TPUCTOR DATA
VAddrem; 3 9 1 E �ATA U LJ IL a &T
vZity: A Stare: ►u C Zip Code: S." L .1 _ County:
�elephaae: Z -- �� 1� �4 � Coaract Person►:. �i�� rri t���� i � � Y
U CONSTRIJCTION DATA (check bite)
MSTiNO WELLS) being proposed for use 25 a ground coupled heat pUMp
well(s). Pmyide the information in (I) through (3) below to the best of your
knowledge. Attach a copy of Form OW-1 (Well Construction Record) if
available -
PROPOSED WELL(S) to be cowtruetud for use as a ground -coupled heat pump
welI(s). Provide the information in (1) through (3) below as PROPOSED
corLstmction specifications. Submit Form GW- I after construction.
(1) Well Drilling Cormaoror'sName: a(�SA CA KCt Wd� o4, � u.ti ���V%t .
NC Contraotor Certification, number: 2- i e Z _
—20(2v
Data to be constructed: Number of borings: _
Approximate depth of each boring (feet): Zoo P�-C;r _
(2}. Well casing: Is the well(s) eased?
(a) Y1;S If'yes, then provide the casi[Lg information below
Type: Galvanized steel Black steel— Plastic Otbcr (specifS,)- _ --
Casing depth: From toT ft (reference to land surface)
Casing extends above ground In6cs
(b) NO f
(3) Grout (grout thce vertical Iengd, of the borehole to a minimum depth of20 %e; b-]_s-)'
(a) (rmut type. Ccment Benton'ite vo"- other(specify)
(b) Grouted surface and gout depth (reference to IAnd surface):
around closed loop piping; from to. 9:!�o (feet).
_ground we' ding; from to_ (feet} NOTE; Ti Ir. W C L L ukli.t fNC CqN+T ACrnR CAN SU'Pt.Y rl IF DA i'A FOR L ITI FER $_X$$Tz r p OR
PROIN),Stt) ` Ttl[S ICI ORMATION 15 UNAVAILARLE BY MHER M):ANS.
Rev ised 7/06 (i W/t11(:-57 C. � :Le 2 of 4
fd 41cj;,7,:0i 200F_ GT 'nopl
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Olt Chcsdpcake Weil FRX NO. r3 �3r_265�
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H. !'NJFCTION-RELATED EQUIPMENT
Nov. 19 2eeP- 10; 2t;pN p1
RECi - -
FEB 042019
Attach a dimgrwn showing; the engineering layout of the injcction equipment and exterior pip ingnubin g
associated with the iniection operation. The rrianufacrurcr's broc;iurc niay provide suppleinciltary
information-
WCATION OF WELL(S) Attach two neaps,
(1) Include a site snap (can be drawn) show ing: buildings, property lines surface water bodies,
potential sources of groundwater contarnination and the orientation of and distances between
the proposed well(s) and any existing wolt(s) or waste disposal facilitij;s suchas septic tasks
or drain fields located within 200 feet of the ground -coupled hear pump well system- label all
features cicar,y and include a north arrow.
(2) location map reforencine, the site to two, nearby p maneat rtfe:renve points (such as road&
streams and h*way intersections).
PERWT LIST: Arch a list of all permits or construction approvals that are related to the site.
Examples include:
111) Hazardous 'Waste Martagement program permits under RCRA
(2) NC Division of Water Quality Non Discharge permits
b"'M Sewage Treatmant and DispoW Permits
lL CtkTMCATiON
"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 therew and that, based on my inquiry of
those individuals immediately responsible for obtaining said information, I believe that die information
i5 true, accurate and complew. I am $ware that there are significant penaitier:, irrcitiding the passibility
offinos and imprisonment, for subinitting false information- I agree to construct, Opel -are, maintaia,
xopsir, and if applicable, abandon the ground -source heat pump system and all related appurtenances in
accoTdance with the approved specifieatious and oonditinns of the P it."
Ravi%ed 7/06
(Si. of Well th�ner or Authorized Agem)
if authorized agent &,s acting on bvhal (of tha well owner,
please supply a letter signed by the owner
authorizing the above agent-
GwlUIC-57 CL
Pace 3 o f 4
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FAX NU. = 7.57-436-2C65 Nov. 19 2006 10:26PM P1
L. CONSENT OF PROP LK 1-Y 0WNER (Owner meane any persen who hc[ds the Fee or other property
rights in the well being constructed_ A well is mai property and its construction or: sand rests
ownership in the landowner in the absence of contrary agreement in writing.]
If the property is owned by someone ether than the applicant, dim property owner hereby constants to
allow the applicant to construct each injection well as outlined in tltis applicazlorl end that it shall be
the responsibility At the applicant to ensure that the ground -source heat pump system's wedl(s)
confonns to the Weil Construerion Standards (Title 15A NCAC 2C; .02.00)
Revised 7/06
(Siva ? Of Property Owner If Different Prom Applicapt)
Please return two copies of the completed Application packaize to:
U1C Progmm
Aquifer Protection Section
North Caroliha DE R-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
C,W,rt.JIC-57 CL
RECENEDIDENRr100
AQU1mQ'ppnTFrnnPo =rrTT DN
FEB 0 4 2ogg
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FROM : Chesapeake We11
FAX NO. 757--436-2665 Feb, 04 2W9 09:31RM P1
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ARLINGC'ON, VA. 22205
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sandfiddler road, corolla, nc - Google Maps
Page 1 of 1
CAddress Sandfiddler Rd
' 101 �gj C NC 27927
i7aps
Get Google Maps on your phone
Text the word "GAMPS" to 46645 3
http:llmaps. google, comlmaps?f=q&source=s_q&h1=en&geocode=&q=sandfiddler+road,+... 2/17/2009