WI0700155_GEO THERMAL_20091118

Permit Number WI0700155
Program Category
Ground Water
Permit Type
Injection Water Only G~HP Well System (SOW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facili
Facility Name
David L Blain SFR
Location Address
4901 Trent Woods Dr
New Bern
Owner
Owner Name
David
Dates/Events
NC 28562
L Blain
Orig Issue
11/18/09
App Received Draft Initiated
10/28/09
Re g ulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Scheduled
Issuance
Central Files: APS_ SWP_
11/18/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
David L. Blain
Owner
4901 Trent Woods Dr
New Bern NC
Major/Minor
Minor
Region
Washington
County
Craven
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
David L Blain
Owner
4901 Trent Woods Dr
New Bern
Public Notice Issue
11/18/09
NC
Effective
11/18/09
28562
28562
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
£~A .8.•.J.~ NCD-EM-R
North Carolina Department of Environment and -Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
David L. Blain
Caroline W. Blain
4901 Trent Woods Dr.
New Bern, NC 28562
Coleen H. Sullins
Director
11/18/2009
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0700155
4901 Trent Woods Dr.
New Bern, NC 28562
Dear Mr. & Mrs. Blain:
Dee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on
10/28/2009, the Aquifer Protection Section (APS) acknowledges your intent to construct a closed-loop geothennal water-
only injection well system for the operation of a ground-source heat pump located at 4901 Trent Woods Dr., New Bern,
Craven County, NC 28562. 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 Craven County Health Department, as they may have additional
construction or pennitting 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].
Jai{ JL{ l::fdlxD
for Mic~ogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Washington Regional Office -APS
APS Central Files -Permit No. WI0700155
Craven County Health Dept.
Patrick McKee (Airtech Mechanical Services, Inc., P .O. Box 366, Morehead City, NC 28557)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard , Raleigh . North Caroiina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunity I Affirmative Action Employer
NOnithe C .. o . ·. arouna
lvatural~lf
�.Sd �C�l55
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
1NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTPERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-OW WELLtS'r
In Accordance with the provisions of NCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the hack page (please Print or T)Te Information).
DATE: j BTU br rah D 20 jol
Well Type C'onfrrrrrrrteo►r: 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_)( Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing
either a 5A7 well (eft -loop well injecting potable water into the aquifer) or a SQM wel; (closed -
loop well containing additives such as fit-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 wlauthority for signature): �I _ �d 0 /1 �o 1a1 a'
(1) Mailing Address: , 0/ 70.rl j wbr)rjs Dhuz(
City: , _�„
County: G _�.©A .
Horre/Office Te1e No.:—.-5jq—C2 4.3 Cell No.:
Email Address: Website:
(2) Physical Address of We]I Site (if different than above): _
City: Slate: Zip Code: County:
Home/Office Tele No.: Cell No.:
& AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the propet'ty owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: 5tatc: Zip Cade: County -
Office Tele No.. Cell No.:
Website Address of Company, if any: lit=NR I []Wt7
+�1s]t�r Prttlstti►x Sarlipn
GPUUiC 5Q W Notification of Intent Form (Revised 9/2008) Pena t

C. WELL DRILLER INFORMATION
Well Dnller Contractor's Name: +-,+..__ . ..:..rJJ.J___._. .... .c. .... b ......... a ..... e_u_ ... ~""'-...._..,,...'.L.,.._:;.. ___________ _
Company Name: App},id ,Re::~ ~;pnuzf, ,Pc .
NC Contractor Certification No.: _:;J,-=5_.3""'-'-)--'A--'-------------------,-.,----
Contact Person: :Jaou.s (oraefk. EMAIL Address: -:::l,m A-.R.mebell&:i)J/2 , 11€7
Address: '.80 . @oX: 8)?2..
City: ¼, mpsJeq d Zip Code: 2fJLl-l/ 3 County: ....,__y-f'___.,'..f]~d<-=e,r-a....a.-____ _
Office Tele No.: YO---;). 70--2Cfl9 Cell No.: 9/0 ---SI 2-tlc??o
D. HEAT PUMP CONTRACTOR JNFORMATIQN {if different than driller)
CompanyName:A,d-ed1 rhechu .01 ca/ Se£0CL5 I pJ('.
Contact Person: Pa±o cJl.. Cb c_.~ EMAIL Ad~ress:
Address: :P O· &)){_ ,31/) {p
City:rhocf hwd C,iy Zip Code: 2<l55 7 County: ..... C ..... ,i .... ( ..... -kr~f~±'--------
Office Tele No.: J.S;).-~-· 58'/'/ 0w Cell No.: ________ _
E. STATUS OF APPLICANT
F.
G.
Private: x__
State:
Federal:
Municipal: __
Commercial:
Native American Lands:
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
CJ~~95''!Jf:;:'J!/:f:J;;/::;t;: ov lv .
WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _______ Number of borings: _'-/~----
/
Approximate depth of each boring (feet):_J_CQ.___ ____ _
(2) Type of tubing to be used (copper, PVC, etc): -+-H~D..,,.,,_i? ___ f....,__ __________ _
(3) Well casing. Is the well(s) cased? (check either (a.) Yes .Qt (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 (refei:ence to land surface) ------
Casing extends ~bove ground ___ inches
(b) No --~✓--
(4) Grout Info (material surrounding well casing and/or piping):
(a)
(b)
(c)
Grout type: Neat Cement __ Bentonite Other (specify) 1bef me!£ .
Grout placement: Pumping__ Pressure_L Other
Grout depth of tubing (reference to land surface): from____,Q __ to 2fJO (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
GPU/UJC SQW Notification of Intent form (Revised 8/2008) P11ge2
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RECEIVED I DENR DVVQ
Aquifer PmlWian Sertion

C
725 n
L
2.3-1. �
Trent Woods Drive
150,49
Approximate Property Lines
-- -- - Approximate Building Perimeter
' Existing Well
Approximate Closed Loopl Locations
Notes,
1. Subject property and surrounding area are currently being transferred to public sewer
and already has public water services.
2. Geothermal well locations are approximate and will be a minimum of 20' ❑part.
Adapted from Google Earth and Craven County GIs Map, October 2009.
TITLE; �IS MAP FIGURE:
lied Ke5ource Mana aemcn s PC
PO. Box 882. Hampstead, rtc 28443 JOB: SCALE: I DATE: (DRAWN BY;
[410[ 276 2914 FAX [phone] Blain 1 " = 90' j 10/27/09 I DNH

;'>� t G�ivpiial rve
G4Q k �
Approximate Properly Lines
- - - Approximate Building Perimeter
Existing Well
Approximate Closed Loop Locations
Notes:
1 , Subject property and surrounding area are currently being transferred to public sewer
and already have public water services.
2. Geotherma] well locations are approximate and will be a minimum of 20' apart,
Adapted from Google Earth and Craven County GIS Map, October 2009.
TITLE. FIGURE:
AERIAL MAP
--lied Pe�ource Mana ernernt F'C '
P.O. Box88Z HQmpslead, 214C 2B443 JOB; SCALE: DATE: (DRAWN BY:2
[phone] FAX [phone] Blain 1 " — 90' 1 01271Q9 1 DNH

INF0Rlv1A TION
PARCEL ID: B-053 -013
Owner:
Mailing Address:
Address of Property:
Property Description:
BLAIN, DAVID L& CAROUNEW
4901 TRENT WOODS DR
NEW BERN NC 28562
4901 TRENT WOODS DR
5 TRENT A WILSON CR
Page 1 of 1
Assessed Acreage: 1.090 Calculated Acreage: 1.09
Deed Book Page: 2637 0780 Deed Recording Date (m d y): a 20 2007
Recorded Survey:
Estate File (WIii) Year-E-Fokler:
Total lmprovement(s) Value:
Number of Improvements:
City Name:
Drainage District:
Special District:
$126 ,780
6
Trent Woods
Life Estate Deed Book & Page:
LancfValue:
Total Value:
Tax Exempt (YES/NO):
Fire Tax. District:
Lot Description:
Lancf Use:
Craven County does NOT warrant the informalion shown on this page and
should be used ONLY for tax assessment purposes. October 27, 2009 10:28:43 AM
http://gismaps.cravencounty.com/maps/map_cama.asp?pid=8-053 -013
$316,320
$443,100
NO
RESIDENTIAL-ONE FAMILY
UNIT
10/27/2009
Ro gers, Michael
From:
Sent:
To:
Subject:
Attachments:
Diana Helias [[e-mail]]
Wednesday, October 28, 2009 12:48 PM
Rogers, Michael
Re: NOi Trent Woods Drive
Aerial Map fig2.pdf; GIS Map fig1 .pdf
We will measure more accurately in the field for the loop locations, but will maintain an approximate distance of 50' from
the existing septic field. I have attached revised drawings to state this.
Thank you,
Diana
-----Original Message -----
From: Rog ers , Michael
To: Diana Helias
Sent: Wednesday, October 28, 2009 12:07 PM
Subject: RE: NOi Trent Woods Drive
What will be the appx distance from the septic field to the proposed wells?
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: Diana Helias [mailto:[e-mail]]
Sent: Wednesday, October 28, 2009 11:11 AM
To: Rogers, Michael
Subject: NOI Trent Woods Drive
Michael,
Please find attached to this message, an NOi for the property located at 4901 Trent Woods Drive in New Bern . A hard
copy will follow in the mail.
Please let me know if there are any questions.
Thank you,
Diana Helias
Project Coordinator
Applied Resource Management, P.C.
www.ARM-PC .com
ARM's Waterworks
www.WaterWorksWells.com
1
RECEIVED/ DENR / DWQ
Aquifer Protection Section
OCT 2 8 2009
910 .270 .2919
910 .270 .2988 Fax
P .O . Box 882
Hampstead, North Carolina 28443
2
v I.
Approximate Property Lines
- - - Approximate Building Perimeter
Existing Well
;. Approximate Closed Loop Locations
Notes:
i . Subject property and surrounding area are currently being transferred to public sewer
and already have public water services.
2. Geothermal well locations are approximate and will be a minimum of 20' apart.
3. A distance of approximately 50' will be maintained from the current septic system,
Adapted from Google Earth and Craven County G!S Map, October 2009.
TITLE: FIGURE:
AERIAL MAP
7 :-Plied Ke5aurce Manamoment PC
P.O. BOX 882. Hampstead, NC 28443 1 JOB: SCALE; DATE; DRAWN By:
[phone] FAX [phone]
Blain 1' = 90' � i QJ27]09 ❑NH

125
r.
A
2:4
Trent Waods Drive -
t 5D.as
c
Z n
4 R
Approximate Property Lines
- �- Approximate Building Perimeter
Existing Well
Approximate Closed Loopi Locations
Notes:
1. Subject property and surrounding area are currently being transferred to public sewer
and already has public water services.
2. Geothermal well locations are approximate and will be a minimum of 20' apart.
3. A distance of approximately 50' will be maintained from the current septic system.
Adapted from Googie Earth and Craven County GIS Map, October 2009.
TITLE; i FIGURP
� GiS MAP
r 'lied l2e�ource Mana�ement r'C
PO. 8ox a82, Hompsl6❑d. NU 26443 i JOB: SCALE: DATE' DRAWN BY:
[9101210-2919 FAX [phone]a[n 111 = 90' 10/27/09 DNH
I
}