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HomeMy WebLinkAboutWI0700163_GEO THERMAL_20100304umoe Program Category Ground Water Permit Type WI07001 63 Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facilit Facility Name Dave Zielinski SFR Location Address 109 Commanders Cir New Bern Owner Owner Name Dave Dates/Events NC 28562 Zielinski Orig Issue 03/04/10 App Received Draft Initiated 02/04/10 Re Aulated Activities Heat Pump Injection Private residence, single family Outfall h!UL~ Scheduled Issuance Central Files: APS_ SWP_ 03/04/10 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Dave Zielinski Owner 109 Commanders Cir New Bern NC Major/Minor Minor Region Washington County Craven Facility Contact Affiliation Owner Type Individual Owner Affiliation Dave Zielinski Owner 109 Commanders Cir New Bern Public Notice Issue 03/04/10 NC Effective 03/04/10 28562 28562 Expiration Waterbody Name Stream Index Number Current Class Subbasin A~A ;;-;;-;,1,'-__ _ NC DENR Nort h Carolina Department of Environment and Natural Resour ces Division of Wa ter Quality Beverly Eaves Perdue Governor John D. Zielinski 109 Commanders Circle New Bern, NC 28562 Co leen H. Sullins Director 3/4/2010 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No . WI0700163 109 Commanders Circle New Bern, NC 28562 Dear Mr. Zielinski: Dee Freeman Se cre tary In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on 02/04/2010 , 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 109 Commanders Circle, New Bern, Craven County, NC 28562. This system is deemed permitted by rule (North Carolina A~nistrative Code Title 15A, Subchapter 2C, Section .0211 (u)(2)). However, it is recommended that you contact the Craven County Health Department, as they may have aqditional 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 (919) 715-6166. ~~D for Mic~ogers Environmental Specialist GPU-Aquifer Protection Section cc: Washington Regional Office -APS APS Central File:. -Permit No . WI07001 6.., Craven County Health Dept. Mike Hadley (Climate Control Heating & Cooling Co., Inc., 102 Middle St., Jacksonville , NC 28546) AQUIFER PROTECTIO N SECTION 1636 Mail Service Center. Raleigh, North Carolina 27699-163 6 Lacaiion: 2728 Capital Boulevard, Raleigh . North Carolina 276()1' Phone: 919-733-3221 \ FAX 1: 919-715..058 8; FAX 2: 919-715-6048 \ Customer Serv ice : 1-877-623-6748 Intern et: www.ncwateraual ity .org An Equal Opportun .l;· \ Afi irma;;ve Act:J n Employe r Ni~hCarolina J\Jatural/11 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-OW WELL(S) In Accordanoe with the provisions of NCAC Title 15A: 02C.0200, please complete this notification and mail to address on the back page (please Print or X}M information). DATE: Feb 01.2010 Well Type Confirmation: Does the proposed system circulate potable water on[(no additives) in continuous piping than completely isolates the fluid from the environment (i,e. closed-lg(W Yes x Continue completing this form. No Do Not complete this form. Complete other MC application forms for installing either a 5A7 well en -loop well inn 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)lAPPLICANT(S) List each Property Owner listed on property deed (if awned by a business or government agency, state name of entity and a representative w/authority for signatures; Dave Zelinski (1) Mailing Address: 109 Commanders Circle City: New Henn State: _NC_ Zip Code, 28562_County: Craven HomelOfEw Tole: No.: 252-638-6825 Cell No.: Email Address: Website: (2) Physical Address of Well Site (if different than above). City: State; Zip Code: County: HomelOfice Tele No, - Cell No.: IL 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: NIA Contact Person: _ EMAQ, Address: Address: City: State: Zip Code: County. Office Tele No.. Cell No.: Website Address of Company, if any: FECE 1 ❑ENR I D'Nq Aquifer Protedion SM*M FEB 0 4 2010 C. WELL DRILLER INFORMATION Company Name: Coastal Geotherma l Well Driller Contractor's Name: Sanford Sweeting NC Contractor Certification No.: NC 2082 Contact Person: Mike Hadley EMAIL Address: mhadley@bizec.rr.com Address: 102 Middle St. City: Jacksonville Zip Code: 28546 County: Onslow Office Tele No.: __ 910-353-0926 Cell No.: _910-376-1100 _____ _ D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company: _Climate Control Heating & Cooling Co., Inc _______ _ Contact Person: Mike Hadlev Address: 102 Middle St City: Jacksonville State: NC EMAIL Address: mhadley@bizec.rr.com Zip Code: _28546_ County:~O~ns~lo~w _____ _ Office Tele No.: _910-353-9040 ___ Cell No.:910-376-1100 __ _ E. STATUS OF APPLICANT Private: _X_ Federal: Commercial: State: Municipal: __ Native American Lands: F. INJECTION PROCEDURE (briefly describe how the iajection well(s) will be used) Closed Loo p Geothermal Heat Transfer Systems G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: _Feb/March 2010 __ Number of borings: _ 4 __ _ Approximate depth of each boring (feet):_250 __ _ (2) Type of tubing to be used (copper, PVC, etc): _High Density Polyethylene_X (3) Well casing. Is the well(s) cased? (check either (a.) Yes m: (b.) No below) (a) Yes ___ if yes, then provide casing information below Type: __galvanized steel __ black steel~lastic __ 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_X_ Pressure__ Other __ (c) Grout depth of tubing (reference to land surface): from _o __ to 250_ (feet) If well has casing, indicate grout depth: from ___ to ____ (feet) H. INJECTION -RELATED EQUIPMEN 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. 1. LOCATION OF WELLS) Attach two copies of maps showing the following information: (1) Include a Site Map (can be drawn) shaw�ng: 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 intrude 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 signet/ 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 that the information is true, accurate and complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting false information. I agree to construct, operate, m rain, prtr and if , abandon the injection well and all related appurtenances in accordance wig) tlxt a ve a on ' 'gns of the Permit." �i 7i'a ,] or voc FlufMaw 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-UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 Fit*' 54. ,z -/0/ A(P— 4 V, w*� .544jew- At 4 7 -Or SZIRY"� o q i f aw "AWWXIIW I �(WeAow"- A?, -W-IA 30 All I Print - Maps Page I of 1 Bing Maps 109 Gommander Cir, New Bern, NC 28562- 8917 My Notes FREE! Use ffing 411to find movies, businesses eg more: 900-DING-411 emw :77 Clark R. A. V Comer heftW -1 82010 Rwtgq ED 2010 Wiomsft Wes . qhingt-)n Forks, Rhow Bond Golf and Country Club Now 88r )61 Woods Rinr Bond %-n%:ApUq 82010 Umnaft http:lAvww.bing.comlmapslprint.aspx?mkt--en-us&z--16&s=r&cp=35.075888,-77.143026&... 213/2010 NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR) NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM: TYPE 5-0 W 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: Feb 01. 2010 Well Type Confirmation: Does the proposed system circulate potable water onl y (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 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 signatures; Dave Zelinski (1) Mailing Address: 109 Comm an ders Circle City: New Bern State: _NC_ Zip Code: 28562_County:_C=ra_v-=en ______ _ Home/Office Tele No.: 252-638-6825 Cell No.: -=~~-----==~------ Em ai I Address: _____ ___,W_,_e=b=s1=·te=: ____________ _ (2) Physical Address of Well Site (if different than above): ___________ _ City: _________ State: __ Zip Code: ___ County : _____ _ 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: _N/A _______________ _ ContactPerson'-'-: ___________ E=MAIL==-=A=ddr=es=s.,_: _________ _ Address: _________________ _ City: ________ State: __ Zip Code: _____ County: _______ _ Office Tele No.: Cell No.: Website Address of Company, if any: ______________ RE~EIVEO I DENRJ DWQ AQtiifer Protection Section FEB O 4 2010 C. WELL DRILLER INFORMATION Company Name: Coastal Geothermal Well Driller Contractor's Name: Sanford Sweeting NC Contractor Certification No.: NC 2082 Contact Person: Mike Hadley EMAIL Address: mhadlev(a).bizec.rr.com Address: 102 Middle St. City: Jacksonville Zip Code: 28546 County: Onslow Office Tele No.: __ 910-353-0926 Cell No.: _910-376-1100 _____ _ D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company: _Climate Control Heating & Cooling Co., Inc _______ _ Contact Person: Mike Hadley Address: 102 Middle St EMAil., Address: mhadlev@bizec.rr.com City: Jacksonville State : NC Zip Code: _28546_ County:-=On=s=lo"'"'"w'---- Office Tele No.: _910-353-9040 ___ Cell No.:910-376-1100 __ _ E. STATIJS OF APPLICANT Private: _x_ State: Federal: Municipal: __ Commercial: Native American Lands: F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used) Closed Loo p Geothermal Heat Transfer Systems G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: _Feb/March 2010 __ Number of borings: _ 4 __ _ Approximate depth of each boring (feet):_250 __ _ (2) Type of tubing to be used (copper, PVC, etc): _High Density Polyethylene_X (3) Well casing. Is the well(s) cased? (check either (a.) Yes m: (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_X_ Pressure__ Other __ (c) Grout depth of tubing (reference to land surface): from _O __ to 250_ (feet) If well has casing, indicate grout depth: from ___ to ____ (feet) A. INJECTION -RELATED EQUIPMEN 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 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 1 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 am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting false information. 1 agree to construct, operate, niamtam, repair, and if applicable, aandon the injection well and all related appurtenances in accordance with tl rfiV@fijl5�c 'cations an ottd of the Permit." 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-UIC Program 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 715-6935 ems-s,�Ar-�s,Fsrhxv 1 - prf4rti�LWfJ�P•A�i.?�1,1�is+F�idt �H+� yratdW 1�h95'ri �fikh . �rr,�ri � [err aa, c x rr,a�r (ac rr r-►xss�r+wr.� r fur ,�sr.�aaswc �ve,�ay.�ax`�r� • ,aalr^r,�-.rinpa o�.9s�a�.swtr,�s aru�� �«ts.,wra �s�sr�iss�*; ms W+00:95 *ram A*W -awls rr Z _/,,wr N� 4r: 0�� wkf4- 4 �e"-,re f "fi fr-&a �TJL+d �iCLiP , �G,�!lrtF su�fGl+r/Sreav �a T�FS�rv/P G54.$(LsdV "[.�'LdYTY fir-y :. sd aow-V --Wvw ye.,K 9 r �BPt�C -y �sue�I.r,.uGS �j�,ror�,CaK faPJW.F Print - Maps Page 1 of I Bing Maps 109 Commander Cir, New Bern, NC 28562- 8917 My Notes FREE! Use Bing 411 to find movies, KI businesses &more: 800-BING-411 % Ol %SL 70 - FtV- - ro-1-P TtkycQ---- j Eli ad, e WasPingb3n Foft 0 T WbW �nt nd 17 Oak Grove '17. IRMO 19201D WkIDSA fUver Bond Wand Cownlry Ou b RherSwA Qr e 2010 momoft http:llwww.bing.comlmapslprint.aspx?mkt--en-us&z--16&s--r&cp=35.075888,-77.143O26&... 2/3/2010