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Home My WebLink AboutWI0700147_GEO THERMAL_20090824 (2)Permit Number Program Category Ground Water Permit Type WI0700147 / Injection Water Only GSHP Well System (5QW) Primary Reviewer michael. rogers Coastal SW Rule Permitted Flow Facilit , Facility Name James Keyzer and Linda Keyzer Location Address 7547 Shore Dr Creswell Owner Owner Name James Dates/Events NC 27928 Keyzer Orig Issue App Received Draft Initiated 08/19/09 Re Qulated Activities Outfall r J! Scheduled Issuance Central Files: APS_ SWP_ 08/24/09 Permit Tracking Slip Status In review Project Type New Project Version Permit Classification Individual Permit Contact Affiliation Charles C. Menefee 2257 Santa Fe Arch Virginia Beach VA Major/Minor Minor Region Washington County Washington Facility Contact Affiliation Owner Type Individual Owner Affiliation James Keyzer 239 Highland Dr Wadesboro Public Notice Issue NC Effective 23456 28170 Expiration Waterbody Name Stream Index Number Current Class Subbasln NA MCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor James Keyzer Linda Keyzer 239 Highland Drive Wadesboro, NC 28170 Coleen H. Sullins Director 8/24/2009 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0700129 7547 Shore Drive Creswell, NC 27928 Dear Mr. & Mrs. Keyzer: Dee Freeman Secretary In accordance with the application submitted to the Underground Injection Control (UIC ) Program that was received on 8/19/2009, the Aquifer Protection Section (APS) acknowledges your intent to construct a closed-loop geothermal water- only injection well system for the,op~ration of a ground-source heat pump located at 7547 Shore Drive, Creswell, Washington County , NC 27928. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C , Section .02ll(u)(2)). However, it is recommended that you contact the Washington 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 (919) 715-6166. Sincerely, O~A -~ Michael Rogers cc: Washington Regional Office -APS APS Central Files -Permit No. \\'J0700129 Dare County H ealt h Dept. Environmental Sp ecialist GPU-Aquifer Protection Section Fred Marklin (RA Hoy Heating & A/C -PO Box 179, Kitty Hawk, NC 27949) Charles Menefee (C& G Well Drilling -2257 Santa Fe Arch, Virginia Beach, VA 23456) AQUIFER PROTECTION SECT;ON 1636 Mail Service Center , Raleigh, North Carolina 27699-163 6 Locatio n: 2i28 Capital Boulevard , Raleigh, North Caroiina 27604 Phone : 919-733-3221 \ FAX 1: 919-715-05B8; FAX 2: 919-715-6048 \ Customer Service : 1-877-523-6748 Internet: www.ncwaterauality.org i ,1 Equ,1 Oppori1:a.::: \ Affl r~1 a,:,e i\C'.'on Ern ploye : NOnel C 1· ort1 aro.1na v'\Jaturall!f Aug 19 09 04 :41a C & G Well Drilling RECEIVED I OENR Iowa AQU\FS::RPRO~CTION SECTION AUG f9 2009 NORTH CAROLINA 7574266008 DEPAR1MENT 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: flctru r-t /1 . 20.!!_y Well Type Confinnatlon: Does the proposed system ~irculate potable water only (no additives} in continuous piping that completely isolates the fluid from the environment (i.e. closed-loop)? Yes Vcontinue completing this fonn. No ___ Do Not complete this form. Complete other UJC application forms for installing p.2 either a 5A 7 well ~-loop well injecting potable water into the aquifer) or a SQM well {closed- Joop weH 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 propeny deed (if owned by a business or government agency, state name of entity and a ~presentative.w/authority for signature): ~ er /4a£.,,t, /4,,AA. k E Y .Z.fYf (1) MaUingAddress:_.2_1<..._t[___,Af.......,__,z~(,=/A..,___\:'."'.1C __ ~1.-/< ___ ,_u _~"'----------- city: Maer{oCO . State: .. &le, Zip Code: 2."t"(?o County: Ull&-~ry&:,,,,.v Home/Office Tele No.: ..Z.=S..="2~...;_7 _'7_]:;___-_'7'.:..__,.(c.:Gc..-;.f------"=C=ele.:..] N.:.=,.,O •c.:....= .z,s-;=-=-«------'-,2_('....;7----'---Z-=l:..:)~z __ Email Address: _____ AM='------W,=eb=s=it=c:'-------------- (2) Physical Address of Well Site (ifdifferentthan above): 7 S-C,,, Z r1, of'c.. J,,e,~ City: C4 @r weu:.. State:~ipCode: 2. 7? .z. &-County: fo>t-r{,~a,-..,._,,,, Home/Office Tele No.: 41-z e., Cell No.: ~ A/et../' C'et,vrt-f't., e,,"hq,,A/' B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Pennit Applicant does not own the subject property, attach a letter from the property owner authorizing Agent to install and operate UIC well) Company Name: ____________________________ _ ContactPerson""-: _____________ __,,E~MA=I~L:.LA~d~d~res:2s~: _________ _ Address: ______________________________ _ City: _________ Stat~: __ Zip Code: ______ County: _______ _ Office Tele No.: Cell No.: Website Address of Company, if any: ______________ _ Aug 19 09 04:42a C & G Well Drilling 7674266008 p.3 REClr IVM 1 DENR i DW4 A0UFFR'PQ0TP n0 N vq" AUG 18 2909 C. WELL DRILLER_ UVORMATION Company Name: CVF ce-& -G r r rJ" r zc_ Well ❑Tiller Contractor's Name: 04.4,r-Ies- Ak 1,11 e4 f_ - - NC Conbuotor Certification No.: J7 _ -- - Contact Person: EMAIL Address: G° few Iry p/fE AO Co '- Address:�-S 1 i City: , ��F--�� _ Zip Code: County: Office Tele No.: 7-r ? Y-Z G 7 e�. Z CeII No.: 7 r z 2 f 42 (D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Nwne: r %` , A/C ir,- - ' F,rdMS:-✓ _ I , G Contact Person:: '�> _ EMAIL Address: - Address: e_4 4— City: Zip Code: . County: Office Tele No.: 1 ! IL STATUS OF APPLICANT Private: at• Federal: Commercial: State: Municipal: Native American Lands - INJECTION PROCEDURE (briefly describe how the injection well(s) will be used) ►- 14S+ �,_V WELL CONSTRUCTION DATA (1) Proposed date to be constructed-,5 �=�Number of borings: Approximate depth of each boring (feet): 12ec (2) Type of tubing to be used (copper, PVC, etc): (3) Well casing, Is the well(s) cased? (check either (a-) Yes or (b.) No below) (a) Yea ifyes, then provide casing information below Type: ____ galvanized steel black stcei__plastic other (specify) Casing dew: From ---to feet (reference to land surface) Casing extends ground inches (b) No (4) Grout Info (material surrounding well casing and/or piping): (a) Groat t;+pe: Neat Cement Bentonite (b) Grow placement: Pumping Pressure (c) Grout depth of tubing (reference to land surface): from If well has casing, indicate grout depth: from — Other (specify) Other to Ac (feet) to (feet) Aug 19 09 04:42a C & G Well Drilling 7574266008 8/3-8azuu9 zZ:W riu ru4dagaaa4 RECEIVED /,OENR I OWO p.4 A 18 09 03,59p G S G Wiwi Drilling AQUFFR PPnTF(.'r ION 5FPTION 7574266008 p,2 AUG 19 2009 H. INJECTION-REILATED EQUU%M4T Attach a diWarn stwwitng the engineerft layour or prWoscd madificaf on of the ityection equipment and exteri pipinlylahft anociattd witch Hte injection operation. The mmufmct zerrs brochure may.prnvide supplementa inForn atiar- L LOCATION OF WEL L4S) Ananh two aapees of stops showing the following informtation- (1 ) irhetude a Site Map (can be drawn) showing: building&. property fines, surface x*zwr bodies, patch sourcce oV&rou dwartm-contsMi=6CM mW she oriesrwkm oPand distsomam bet vwn, the proposed VMI(# a any existing well(s) or wanes disposal (Wilities sass:h as septic twAa or drain fields locued, within 200 feet the geodwaarml how purrep werl Mtam- Label at] fLmures eitarly rand icWWe q Ty th arrow. (Z) The Site MW must show the subject prolmny in relation W the stm mmcling area by using at leak two Fla rafereace points such as roads, strearns, and/orhWsway irttcraectiwL J. CKUTIFWATION Naftz This P%ranit Apphenli os must 6e saWnn,d by r� 9e apprahrirsg ea t#e rwearrhd i alp 1 pnnmwty deed. 'I hereby carfify under penalty of taw. that I bave per, sraaily =uwnirm4 and air familiar with ji, isr£orntaii submitted in d)is document and oil machmants dumuto and that. -bawd are my iMuiry of otiose individu irmlmcd1mly res"nmble for obtaining said infbmw1oi% I believe am ibe infarmWim is true, aecumw attd a mnpte t am aware tint dmm are significant peaaltaes. endudigg the possib ity arr aes and imprls=ssheru, fof subtnini false infarmetim. I ngr+[e to fit. operate, mainmin, rWWr, and if appricabie. abwdan the injecritm wd1: al! rchftd appurumwmn s is accarda we with the ap d specxYiaatkv* condidana of the Permit - r i wupte ofPropeny OwfiedApp J-h*ie-s- 71c1z- Print or Type Full I+ MM and tidy Segrhar of Property Owaan► Z- I.Varf Z) Print or Type Full Niam and tide Sigrrat urr of Audwrized Amrhs;, if any Prim or Type Full Name and twin Please return two copies of Qta complcbad Application peckq p W Ne the Camlima DENR-UWQ Aquifer Protecdox Seutkm-UIC Progrm xu I6M Mai Service Castes Raie;gh, NC,276"-16345 Telephone (9I9) 7154935 Aug 19 09 04:43a C & G Well Drilling RECEIVED l DENRI DWQ �sf1+��euu� er:xu VAA sU%Gv%amU% AQUIFFR'PRnTI.r.Tl0N11;F(MON 7574266008 P.5 AUG 19 2009 PLANTS IT COUNTS COMMONNAME BOTANICAL NAME CALIPeR HEl SP>� ACIN COMMENTS -- m- 6 Aukxa 990WC0- $alrklb" pn E F Wx QramWra'A!1!lRf� Bdmwo Batide liargjdi- .7 Mk E& 8.10 r BB. 1W'jW.0em, WW f: s+ 1 a wir mu5aimr, W�I I $ Uve Ykomwm m O.C. B8 Shrubs CODE COUNT COMMOILNAIIE BOTANICAL WME MIPM HEIGHT SPREAD SPACING COMEIIENTS ACA 6 Iftlum ChmW Axa" EnW1� i��70 Au n Immwr — T62y w a.e. corm i7al. %*a Pink Yia}VBr¢ CAW 2 Csriw#a Gamep* parrca — ZrMit. 1 ra.r- armlet-sprq 27 Dowd Vmurnum w+lu(n esvfWi — !b fa a� Can 'roar; 0 + ' —IZ41f w ountO R Qviss Perwwobm" micswavokms 1518" W o,a !r JR _ police - - 2w mh ! F a.e er , 3 Raw Rao I& s a.0 MG $cv Liana f�1S diFMldgf iti9rlYrl�ifidarldlf A.0 Aaf. Fink "%vat _ 7a Rs� gl�hra SlbmradC --- 163A" 3' oz Con oinw. ffw& n e Graurdcovers I Perennials SUE COUNT! COMMOhL NAME BDTANICAL_NAME CAUPERHEIGHT SPREAD PACING CC]MMENTS — Full 1Caa At ("rOlAliN[ "bit ! �7%IEY FAX T Var>Qatad L+flDpe itrerfff 1Ole!!¢gph) y8 — 81a#sYed i>�i1Q1d1� _—;.. - pAY b8 10. iiaylilr I 14mim Ls Gov' — !6' o e Bub Ylq,�frlPtMl pj SSG 4N IML'O�P[.4TE'�7FW+ik:h A*b +1O i7E reear+�na riri tlalri CGxgVCI1;a, rcruti aawr�a�awr wua.' unwr'lrrwnr- Aug 19 09 04:43a C & G W9II Drilling 7574266008 P.6 Ua/Lb/;ZUUV CY:U t VAA ll1y0374 �1g q4 z, -- - EPTIC TAW ,— OWL dv0 ]R MEADO NQTES- i. Trim womre 8om ABS to PbrroFs tree farm. 2. LQ may new cbapmg w rarnmra karr Lrbhr. leae rney !7mw atw Arnm- 8. RV end 9B aeL'o"now wo km—;Oe Plants to Fraddw bemes on the twAMOG (D r*-of b0d' Plants AOIW-' biF*)- 4.AApm-ftdNOAmMwbKimpoed.andsmokeinv bwMh9 ft {tiara s rumse- &.. marri" mutt beds kx+teiillttr Plan13 a.'o epltnwn — — — SEPARATE LAWN AND MEJ1`nOYYy. I f7j j , 8SI8 .-2Ri1A� 1 —30-YL { I wy VVVE STEPS c E411t;:iim ON COOMAY I h MVL _ 2 C.1 KOAC►1; STEPPM SrCWZS {TO SEPARATE LAVW14 AND MEADOM ll/k � L�K� _m., -rf4 Vt 5 Lnvw MOR v • 1 _'Vvvw� fp Gam. 1 r.wucr. .1• tu yw/ .7r. a LL 2 rr. 4 LL awe +fir L u az= W a c aoc O � u Z W J ELF UYGMAne art I%E�F m HKU4.+1to6 OR YMDEsaawo. xc. xa' 79 e"9 m oM.w: Be �>E �rc2ra0 ase. w 7oGx7[x ar9ir*rnE PLA€+1TING PLAN aauE sum L-1 Aug 19 09 04:41a C & G Well Drilling P,1 7574266008 le.9, RECEIVED / DENR i DvVQ AQUIFFR'PR0TFCTi0N SECTION AUG 19 20p9 ,fJ