HomeMy WebLinkAboutWI0700163_GEO THERMAL_20100304 (2)umoe
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