WI0700146_GEO THERMAL_20090824

Permit Number WI0700146/
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (SQW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Wilber Ray Daniels
Location Address
1128 Bull Hill Rd
Windsor
Owner
Owner Name
Wilber
Dates/Events
NC 27983
Ray Daniels
Central Files: APS_ SWP_
08/24/09
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Jeff Stagg
636 Benefit Rd
Chesapeake VA
Major/Minor
Minor
Region
Washington
County
Bertie
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Wilber Ray Daniels
2702 Beechwood Dr
Tarboro NC
23322
27886
Orig Issue App Received Draft Initiated
Scheduled
Issuance Public Notice Issue Effective Expiration
08/18/09
Re g ulated Activities
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin
RA MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Wilber Ray Daniels
2702 Beechwood Drive
Tarboro, NC 27886
Coleen H. Sullins
Director
8/24/2009
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0700146
1128 Bull Hill Road
Windsor, NC 27983
Dear Mr. Daniels:
Dee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (VIC) Program that was received on
8/18/2009, 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 1128 Bull Hill Road, Windsor, Bertie
County, NC 27983. 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 Bertie 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].
Sincerely,
' Ol~A.&o-~
r () nA Michael Rogers
cc: W asbington Regional Office -APS
~-Environmental Specialist
GPU-Aquifer Protection Section
APS Central Files -Permit No. WI0700146
Bertie County Health Dept.
Jeff Stagg (J .A. Stage Energy -636 Benefil Rd, Chesapeake. VA 23322}
Gary Hughes (Gary's Electrical Svc -PO Box 312, Colerain. NC 27924)
AQUIFER PROTECTION SECTION
1636 Mai! Sel\lice Center, RaleiQh. North Carolina 27699-1636
Location: 2728 Capital Bouievard, Raleigh. North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588: FAX 2: 919-715-6048 \ Customer Sel\lice : 1-877,623-6748
Internet: www.ncwaterouality .org
An Equal Opportuniiy \ Affirmaiil'e Action Em ploye r
N°~1-.c 1· 0101 aroma
"7Vaturall!f
Aug IS 09 09' 18a Jeffrey A- Stagg
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NORTH CARO YNA AUG 1
DE.PAI•t7'P. E-NT OF ENV iRCH04E T kND � ATt7RAr RESOURCES (hiCFE1,rR)
NO'?< MCATMN 4F >Q►I'1 ENT TO CONSTRUCT A E'�,0 E, D- P GEOTHERMAL
�AE&QL--Ly INitCTfON -ATLL MTF-K:
TYPE 5-QW WELL(S)
In Accurdaucc wiffi theprovisians OWCAC Tine 15A, 02C.MD, please
cov4dm this nlotifcP6ton an4 mai i to address on toss back page (pisase kLhd or Tie irsfc+r�rian)_
DATE: f"3..14 2 -_
Wes' TyVe CanPrvWvn: ]Does the proposed system chculaze prole w er 2r v (no adds ives) in
txaa6zWous griping thM carrtplemly fsaiates the fluid from the eaviramwnt (i.e.
CCLS�-tt7l?�)�
Ye$ Cuntintre aoMpi.eting this form.
NO Do Not cozrnplate tbis farm. Gampleie otio- tJ.TC application fortes for ins(ailing
nit' era SA well (nnett soap well 1nTae�g potAle wafer into the aquifer) sir s 5Q.Nl w6li (closet?-
ILlD17 well COSfaFrlplo add) �5 SidG�Z a5^2CtF8S1Sal, or other i!1]tiC( Zf' or iArYo5l4II inllibikors).
Ai PROPERTY OWN-EWS)1APPLICA-NT(S)
List each Property Ow=r listed an proper), deed (I,"award �), a tr,�aincss a> vemna t y� e name of
--�j mtky and a mpmRerda► ve w1aulborrty for sigrafure): : y
city. T4c"- - - .ztate; Ma
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sty
HomOC3tT`me •i'ele No.' �Cr�e��, 2 74T Cs2I N,0 • �_
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'N' (7) Pbysica1 Address of Welt Site (if diffmznt than above): __NZA
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6LC Tap Codes .. _ cmmty: i
t Coma'Offke Tale Na_ Ce? Tea:
f & ..:--AUTi>fiiRMD AGENT OF €1WINER 1FANY (f the hermit Applicant do_ eg wt own the sabjmt property,
ry `'.-atach a letter from the property owater authadxing Agent To inMafi and operpte U[C well)
CDnrpany Name:
Contact Person: _ �._ w T E f I - - - —
Addrew. _ --- -- —
City: _ _ Coin
Office Tele N6- : - T . Ceti
Website Ad&C55 OfCumpmy, if may: — —
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3e"ie County Health Departs"e'rt Aquifer Pt , t� n ���
n�rj~me► tal Health Division AUG
i
! O . DOW 6" Madsor, MC 27"3 8 20a9
"Ironer 2a2-7104-5303 Face 2=67914-'3367
Eiffthorft Von for Wastewater sl suer" Construcwon
Owner:WILSER RAY DANlr=LS FERIi+r�T#�a0s-- 1 t ,
Owner Address:2702 BEECHWnoo DRIVE TARBORO, NC 27888-20M
Owner Pl3one #:8237794 MIA@►4lL PA HOME SEMAcic 7� paWr
Pre arty r4ddr"awl 130 BULL HILL ROAD
PIN:882-5-46--5273
Record 02MBI 102
Establishment Type:Kome
Type of Well; Pubtic. Well
Design Row (GPD),W0
Initled Site
Wastewater system_Canverrti
Long Term Ameptance Rate(
Trench Wdth-3 FT ,
Trerich 5pacfnT g {QC):9 F
Trench Bottom From NGL:-1 Ii+
sept€D Tank Volume:? 000 GA
• `I
o ql
o Cif
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-70.00 feet .
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07
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x 9
Li T.0
SUMC TANK
HOUSE �
e
a
v
C
____.._____�_
S5z,5,3-w
=100 feet BULL ]I ILL RDAD
UA-TRASHALLOW PLACEAJENT TB FJWCt1 MAJOANUM MEMO" DEPTH
REPAIN ARFA ULTR.4SHALLOW PLACEIaENT
MAINTAW SYSTEM 10 PE,ET OFF ALL PROPE'RlIr AAAW is
OQ, MOT INSTALL STSTEN IN WET SOIL COND!' ONS
AWAINrAIN MOME AT LEAST S FELT OFF ANY PART OF SYSTEM
fJX /NCH RJWAL SD/L COVM OVER IAIiTALLAW ST&7EMLAAFXWCAPE17i TO SHEV WAXER QUOCKLY
MAKE SORE PLUMSING GWAOLF FROM FOUNDA"ON MATONES ELEVA770M OF SY87-CM
DAWM AmMori d �SieAt� — DRii`s 1]� _- 41
Oa Nbtf Ca►rer Elntff Appraved Peronft VOW After 60 AlAonths

Aug 18 09 09:33a Jeffrey A. Stagg
757-421-2108 p.1
7s-+�raae
Sortie County Health 13epart,"ent
Environmental Health Division
P.O Sox 530 tNrrrdsvr, AM 27983
Phone: [phone] Fax: [phone]igi
Page 4
RECLIVEU / ❑ENk i OV�U
Aquifer pratectiar7 SLn
AUG 1 g 2009
AMMortzaUOR Ear -wastewater. System ConstrxrCtJon
Owner:VViLSER RAY DANIELS
OwnerAddre":2702 IBEECI-WOOO bR1VE
Owner -Phone *823=iTM4
Pro0er4y Addrea&l130 BULL HILL RQAL?
Pi N:6B25-46-5273
Record #20081102
Establishment Type:Flome
Type of Well: Public_ Well
Designs Flown {GPD):3B4
TARBORO, NC 27886.2005 PERMIT. "006��y
AIIMJ'WUJW )ioAOE SETHAc1G- TS FJrEr
250M feet
Initial Site
r
Wastewater Sysdam.Canrmnti rT311Pip� _�_---------------
Long Term AoDeptanw Raft(, fD/SQF7):.3
Trench-Width-3 FT
T4ench Spacing (OG):9 FT
Trench Bottom From NGL:-1 Ili+► � 1 � j � � w � iU u! i I
SeptfcTank Vokime:low Gi 4(' 22
.:1. OMi
{ < f �u
19.000mm0
yl
S&M
CtANK
-C;�.
r C2 C. p ;:' .i.L ilk,
_r
� L•U r/--7 �
S 57- SW a-w
25a_Ga feet
BULL HILL ROAD
_. j
ULTMASHALLOHw Pr.ACE"MUT �S JJiCH MA]Cl1YfJM TJ�E+{r+trrr oEPTH
REPAIR AREA ULMASMALLOW PLAME WEMT
hMJfJrAfM SYSTEM Td F'AEET OFF ALL PROPERTY Limies
vo NOT INSTALL. SYSTEM 11V INEr SOIL CWMI77ONS
MA#mTAf#V HOME A r L"Sr a FEET' OPP AMY PART OF SYSTEM
sJxJPMW FWMAL SO& COMM vINVTA2-LIM YSrMM rto SMEV IMAr»Jr QUICKLY
MAIrIF SUMS PLUMAJJVo OMADE FROM FOUMDA7V10M AWA TOMES EL.EVA'i MM OF SYSTEM
-----------
OFl1fR ANt�lloay7faeBd Arl@rJ# Daet@L � 4
LpDn Kg rr4h, R.S.
Do Not, Cover U pt11 Approved Permit Void After 60 Months