WI0700228_GEO THERMAL_20120523

Beverly Eaves Perdue
Governor
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 23, 2012
Washington Housing Authority
Post Office Box 1046
Washington, NC 27889
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: \VI0700228
To Whom it May Concern:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May I, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http ://portal.ncdenr.or g/web/wg/aps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
C:7 p ,-,1-_r-
(/vlV' ~/lr
Eric G. Smith, P.G.
Hydro geologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
Internet: www.ncwaterauality.org
An Equal Opportunity\ Affinnative Action Employer
One] C 1. Nort1 aroma
Natural/11
Permit Number WI0700228
Program Category
Ground Water
Permit Type
\
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Faci l itv
Facility Name
Westbrook Housing Project
Location Address
105 Manuel Dr
Washington
Owner
Owner Name
NC 27889
Mid-East Regional Housing Authority
Dates/Events
Orig Issue
06/09/11
App Received Draft Initiated
05/19/11
Scheduled
issuance
Central Files: APS_ SWP_
06/10/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
John Taylor
Driller Well
2030 Taylor Rd
Chocowinity NC
Major/Minor
Minor
Region
Washington
County
Beaufort
Facility Contact Affiliation
Owner Type
Government -Municipal
Owner Affiliation
Dallas Holliday
809 Pennsylvania Ave
Washington NC
Public Notice Issue
06/09/11
Effective
06/09/11
27817
27889
Expiration
05/31/16
_R_e_..g..:...u;.;..;la;;;..;;t..:...ed.c.;_;;_A..:...cc..ct.:....civ..:...it:..:...ie"--'s'--______________ "--'R=e=o =u=es=t=e=d=/R'""'e=c=e=i-=-ve=d=---=Ec..=v-=e=n=ts.__ _________ _
Heat Pump Inj ection RO staff report requested
RO staff report rec·eived
Outfall NUL
Waterbody Name Stream Index Number Current Class
05/24/11
05/31/11
Subbasin
Permit Number WI0700228
Central Files: APS SWP
06/08/11
Permit Tracking Shp
Program Category
Ground Water
Status Project Type
In review New Project
Permit Type Version Permit Classification
Injection Mixed Fluid GSHP Well System (5QM) Individual
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted How
Facility
Facility Narne
Westbrook Housing Project
Location Address
105 Manuel Dr
Washington
vner
Permit Contact Affiliation
John Taylor
Driller Welf
2030 Taylor Rd
Chocowinity NC 27817
MajorlMinor region
Minor Washington
County
Beaufort
NC 27889 Facility Contact Affiliation
Owner Name Owner Type
Mid -East Regional Housing Authority Government - Municipal
ateslEuen-c
Orig Issue
App Received
05/19/11
Re -6 uiated Activities
Draft Initiated
Scheduled
issuance
Owner Affiliation
Dallas Holliday
809 Pennsylvania Ave
Washington NC 27869
Public Notice Issue
Effective Expiration
Heat Pump Injection
❑utfaIl NULL
RO staff report requested 05/24111
RO staff report received 05/31/11
Waterbody Name Stream Index Number Current Class Subbasin

A711
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coieen H. Sullins Dee Freeman
Governor Director Secretary
June 9, 2011
Dallas Holliday, Director of Modernization
Mid East Regional Housing Authority
809 Pennsylvania Ave.
Washington, NC 27889
Ref: Issuance of Injection Well Permits WI0700221 and WI0700228
Issued to Mid East Regional Housing Authority
Washington, Beaufort County, North Carolina
Dear Dallas:
In accordance with the application received on May 19, 2011, I am forwarding permit number WI0700221 for the
construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system to be
located at the Eastern Village Housing Project, 809 Pennsylvania Ave., Washington, NC 27889. and permit number
W10700228 for the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection
well system to be located at the Westbrook Housing Project, 105 Manuel Dr.; Washington, NC 27889. These
permits shall be effective from the date of issuance until May 31, 2016, and shall be subject to the conditions and
limitations stated therein, including the requirement to install well identification tags as specified in Part II3
and to submit well construction records as specified in Part VII.2. Be sure to read the entire permit to ensure
that you are aware of all compliance requirements of the permit.
You will need to notify this office at least 48 hours prior to beginning construction and operation of the injection
well system. In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must
submit an application to renew the permit 120 days prior to its expiration date. This permit is riot transferable to
any person without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at [phone] or michael.rooers�7anedenr.vov if you have any questions about your permit.
Best Regards,
Michael Rogers, P.G. {NC & FL)
cc: David May, Washington Regional Office
WI0700221 Permit File
Beaufort County Environmental Health Dept.
Haskell Taylor, Jr., Taylor Well Systems, 2030 Taylor Road, Chocowinity, NC 27817
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NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Mid-East Regional Housing Authority
FOR THE CONSTRUCTION AND OPERATION OF 50 TYPE SQM INJECTION WELL(S), defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at the Westbrook Housing Project, 105
Manuel Dr., Washington, Beaufort County, NC 27889, and will be constructed and operated in accordance with
the application received May 19, 2011, and in conformity with the specifications and supporting data submitted,
all of which are filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Construction and Operation of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until May 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 9th day of June, 2011.
1f\. Coleen H. Sullins, Director t Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #WI0700228 UIC/SQM
ver. 03/2010
Page 1 of 5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone] and the Washington Regional Office Aquifer Protection Section Staff, telephone
number [phone].
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation corners) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or 'cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
Permit #WI0700228 UIC/SQM
ver. 03/2010
Page 2 of 5
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #WI0700228 UIC/SQM
ver. 03/2010
Page3of5
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center and
Raleigh, NC 27699-1636
Ph# 919-715-3221
Aquifer Protection Section
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
[phone]
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Washington Regional Office within 30 days of
completion of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and
retained on site to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Washington Regional Office within 30
days of completion of well construction.
4. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed.
5. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Washington Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss ofrefrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
7. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit #WI0700228 UIC/SQM
ver. 03/2010
Page 4 of 5
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l).
Notification shall be submitted to the addresses given in Part VII.I of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in ISA NCAC 2C
.0214, including but not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if the
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that failure
to do so could lead to the contamination of an underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe that extends to the bottom of the well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been removed, the
casing shall be perforated opposite the gravel pack, at intervals not exceeding 10 feet, and grout
injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been created,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII. I of this permit.
Permit #WI0700228 UIC/SQM
ver. 03/2010
Page 5 of 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: Mav 25. 2011
To: Aquifer Protection Section Central Office
Central Office Reviewer: Michael Rollers
Regional Login No:
County: Beaufort
Pcrmittee: Mid -East Regional Housin . Authorit►
Project Name: Washinkton Housinj Project
Application No.: WI0700221
I GENERAL INFORMATION
1. This application is (check all that apply): ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals
❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals D Surface Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (5QM Closed Loop injection - Geothermal)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a.
h,
c.
d.
Date of site visit: Ma► 25, 2011
Person contacted and contact information; Mr. Haskell "John" Taylor, Well Contractor (252.943.5842)
Site visit conducted by: Allen Clark and Rand\ Sipe
Inspection Report Attached: ® Yes or ❑ No.
2. Is the following information entered into the BIMS record for this application correct?
❑ Yes or ® No. If no, please complete the following or indicate that it is con-ect an the current application.
Under Permit Type in BIMS, the facility is listed as a Type 5QW.
II. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
❑ Yes ❑ No ® N/A. Um), please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional i✓ngineer? ❑ Yes ❑ No ® N/A. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)?
Yes ® No ❑ NIA. If no, please explain:
5. Are there any buffer conflicts (new treatment facilities or new disposal sites)? [1 Yes or ® No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit:
m
m
J
FORM: Mid -East Regional Housing Authority - Washington Housing Project; UIC Staff Report W1070022I May 26, 2011

AQUIFER PROTECTION SECTiON REGIONAL STAFF REPORT
6. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No [8J N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
III. RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or major modification
s pstems): NIA
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use
injection wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation
injection wells, and heat pump injection wells.)
Description Of Well (S) And Facilities-New, Renewal. And Modification
I. Type of injection system:
D Heating/cooling water return flow (SA 7)
[8J Closed-loop heat pump system (SQM)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes 1Z! No
3. Are there any potential pollution sources that may affect injection? D Yes [8J No
4. What is the minimum distance of proposed injection wells from the property boundary? '100 ft.
5. Quality of drainage at site: [8J Good D Adequate D Poor
6. Flooding potential of site: [8J Low D Moderate D High
7. Does the map presented represent the actual site (property lines, wells, surface drainage)? [8J Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
V. EVALUATIONANDRECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application: See Below.
2 . Attach Well Construction Data Sheet -if needed information is available.
3. Do you foresee any problems with issuance/renewal of this permit? D Yes [8J No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item: None
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition: None
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
FORM: Mid-East Regional Housing Authority-Washington Housing Project; UIC Staff Report WI0700221 May 26, 2011
. .
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Condition Reason
One well identification tag per "cluster" of wells In compliance with 15A NCAC 2C .0213(g).
shall be permanently affixed to the heating and
cooling unit, in a clearly visible location.
7 . Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft pennit by regional office; D Issue upon receipt of needed additional information;
~ Issue ; D Deny. If deny, please sra?ons:Mn
8. Signature ofreport preparer(s): --➔/1f!l"'--=J.,_.._/II __ WijLLI-",:_' :/i~f/. ______________ _
Signature of APS regional supervisor: _ ...... L_.._=-=,..~f"""'vY{'-----"_7_~--------------
Date: _..('-------'3.._lr"""""io-'-tl,__
ADDITIONAL REGIONAL STAFF REVIEW ITEMS:
As part of the permitting process for this proposed UIC (Type SQM) system, a site visit was conducted to the two
(2) project sites on May 25 , 2011, by WaRO DWQ/APS staff Allen Clark and Randy Sipe. These two (2) locations
(housing communities) are within the city limits of Washington, NC, and are on public water and sewer.
There were no problems observed during the site visit that should prevent this pennit from being issued .
*The only item observed worth noting is the presence of a wastewater lift station that is located along Pontiac Drive
at the southern most end of that project site. The station is located approximately thirty (30) feet from the most
southerly located building, which is located on Pontiac Drive. However, WaRO staff does not believe this should
prevent permit issuance.
Allen Clark
DWQ/APS
WaRO
FORM: Mid-East Regional Housin g Authori ty -Washington Housing Project; UIC Staff Report WI070022 l May 26, 2011
Compliance Inspection Report
Permit: WI0700221
SOC:
County: Beaufort
Region: Washington
Effective: 04/26/11 Expiration:
Effective: Expiration:
Contact Person: Jennifer Savage
Directions to Facility:
Title:
System Classifications:
Primary ORC: Certification:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Owner: Washington Housing Authority
Facility: Washington Housing Authority
905 Pennsylvania Ave
Washington NC 27889
Phone: [phone]
Phone:
Inspection Date: 05/25/2011
Primary Inspector: Allen Clark
Secondary lnspector(s):
Entry Time: 02 :30 PM ExitTime: 03:15 PM
Phone:
Dwight R Sipe Phone:
Reason for Inspection: Routine Inspection Type: Reconnaissance
Permit Inspection Type: Injection Water Only GSHP Well System (5QW)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Other
(See attachment summary)
Page: 1
Permit: WI0700221
Inspection Date: 05/25/2011
Inspection Summary:
Owner -Facility: Washington Housing Authority
Inspection Type: Reconnaissance Reason for Visit: Routine
As part of the permitting process for this proposed UIC (Type 5QM) system, a site visit was conducted to the two (2)
project sites on May 25, 2011 , by WaRO DWQ/APS staff Allen Clark and Randy Sipe. These two (2) locations (housing
communities) are with in the city limits of Washington , NC, and are on public water and sewer.
There were no problems observed during the site visit that should prevent this permit from being issued .
*The only item observed worth noting is the presence of a wastewater lift station that is located along Pontiac Drive at the
southern most end of that project site . The station is located approximately thirty (30) feet from the most southerly located
building, which is located on Pontiac Drive. However, WaRO staff does not believe this should prevent permit issuance.
Allen Clark
DWQ/APS
WaRO
Other
Comment:
Yes No NA NE
Page : 2
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NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES F `) ri
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED -LOOP MIXED —FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids other than potable•water as part of a geothermal heating and cooling system.
(check one) New Application
Renewal* 0145 Modification
* For renewals completelif t stl ift-t c '
Print or Type Ir formation and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE; �� , 20 if
►,, o oat
PERMIT NO. (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence Business/Organization X'
Government: State Municipal County Federal
R PERMIT APPLICANT - For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
,A'i i t] — 7 IZL (t7A 4-L ,Or�Si G 14 c� %442i / 7 Y
Mailing Address: g `1 F ',�f• ; v LLJ 4 I11/ A /4 W:
72 City: Ai G/'JC 7i State:it/6 Zip Code: a7jc-c5"% County,, e67A itVt 1
i Day TeleNo.: 2 S:9- t7 `i C-004 i Ce11No_:
- - EMAIL Address: Fax No.:
C. LOCATION OF WELL SITE - Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: Sa- 7 6- y Y - r . o 16 Courrty: - E 4ur7lr i
{2} Physical Address (if different than mailing address}: fb1s4 s rrt t I r]•
L.J 1,- (1-Ink (R=}
City:Le/11fi+ri.)670.+r., State: Q Zip Code: 7? L7
D. WELL DRILLER INFORMATION MAY 1 8 20U
Well Drilling Contractor's Name: I SLL_ 7/9 VA - OE " ball
NC Well Drilling Contractor Certification No.: -2 I13S i3
Company Name: r/4" Y I( >• L-ate LC 5 y 5 ;� 4 torthi S
Contact Person: G EMAIL Address: r,r F u
Address: (-lip 3. V 1 Li
City: C' CUW i ',if 7 Y Zip Code: $>i 2 State: AK- County: 13G4 ti.r-74'Z
Office Teie No.: Cell No.: a 5-a- 3 a Fax No.:
GPUIUIC 5QM Permit Application (Revised 1124I2011) Page I

E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: It //< 7 6 c fl: /VC '-4 L'.M68 #,;;s-;s ~ 0
Contact Person: f,3 712 /CI C /"fl'-k E. £ EMAIL Address:
Address: /.S~3 7 Af(I L 1,~#7 J 7/!dtL
City: New 1$UJJ Zip Code: d>YS-&'1 State: /VGCounty: _.C""-'-&t/V,c=L...<-=--=-'~..c;..IV'.'.;;__ ___ _
Office Tele No.: d).()2 -b J" , S-8''-/ I Cell No.: _________ =--'Fa=x:....aN""'"'o=-=-.:'---------
F. WELL CONSTRUCTION DATA
I
(1) Number of borings to be constructed*: JaO Depth of each boring (feet):_.J~SO~-----
* If existing water supply wells will be used then provide the information in item (4) below.
(2) Chemical additives to be used: R-22 ___ Propylene glycol ;( Ethanol __ _
Other _________ ( other additives will need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): __ h~J_D~f~E _________ _
(4) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, plastic, etc.), diameter. depth,
and extent of casing appearing above ground: --'--At--",1H//J'--"---------------
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite** _x_ Other (specify)
** By selecting bentonite grout, a variwice is hereby requested to ISA NCAC 2C .0213(d)(l)(A)-. w----:h---:-ic--=-h-req-u"""ir-es_a_c_eme-nt_typ_e grout.
(b) Grout depth of tubing (reference to land surface): from O to ;;).S-() (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
G. WELL LOCATIONS-Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearl y and include a north arrow.
(1) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fielqs, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
fficility's location and the map name.
NO'f~: In most cases, an aerial photograph of (lie pr(Jperty parcel showing prQJJerfY, Ufles and structures can be
obtained and downloaded from the applicabff C(lflffJY GIS website. Typically, the _prgpej'ty can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanb.. other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours Qr
elevation data.
GPU/UIC SQM Permit Application (Revised 1/24/2011) Page2
Transmitted with Yenta Fax & Voice software - http://www.ventafax,com
5/1812011 8:43:10 AM From: Jennifer Savage Fax ID: Pagel/ 5
Attn.: To: JOHN TAYLOR
65f 17£2b11 15: 81 25294589E1 cIR:Q./KOWA-1ER
H. CERTIFICATION (to be signed as required be'sow or by that person's authorized, agent)
15A NCAC 02C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsii
2. fors partnership or sole prnp:tied
3. for a municipality or a state, f
af1'ieer or ranking publicly eleate
4. for ail others: by the well owner
If sin authnriaed agent is signing on
applicatrtthat names and authorizes f
"I hereby certify, under penalty of law, tits
submitted In this document and all attaai
immediately responsible for obtaining sai
complete. I ern aware that there are slgnii
for submitting fast: information. !agree ti
injection well gild all related impurtenance
the Permit."
PACE a1/81
Lie carp(:= Emmet-,
rrship: by a general partner or the proprilitor,
derai, or other public agency; by eith
d official;
iv./ ',: s e is "sued art the
respectively;
a principal era
cad).
behalf of the applicant, then supply
teir agent to sign this application oa tit
II T have personally examined and are farrti
metes thereto and that, based on my ink
d infonnatiDn. 1 believe that the informat
cat penakies, including the possibility tr
a construct. operate, maintain, repair, and i
a in accordance with the approved specify
letter signed '
"r bait.
(at with the lnfos
iry of those indl:
n is tree, accu
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applicable, aban
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Signature of Property tawny/Applicant
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Print or Type melt N9t:1C 6, -At
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Signature of Property Owner/Applicant
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Sigsiature of Authorized Agertn, .fang
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Print or Type. pull Name
Submit two copies of the completed application package to..
DWQ - Aquila Protective Section
1636 Mail Service Center
Raleigh, NC 2769 -1636
Telephone [phone]
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YvtLd-Ee1st ~0q0©-~1e1t -U@'LesL~q Au;b~(9,rL,t~
was lUivqt©-l'V 4 ©-~:;; lA\Jq A Letev©-r Lib~
Serving Beaufort. Bertie. Hyde, Manin. Pill. Tym~ll & Washington Co~1mies
April 14, 2011
WeberWell Drilling Inc.
32815 Dupont Blvd
Dagsboro, DE 19939
Attenti.on: Mr. Andrew Weber
Re: Washington Housing Project
Westbrooke and .East Village
Geo-Thermal Systems·1nstaUations
Washington, NC 2.7889
Subject: Geo-Thermal bore field w,ell drilling
Authori~tlon :to .contractor to .represent WH.MERHA for permits
Dear Mr. Weber:
This letterwill authorize Trison Cortstruc:tion; Inc., and Weber WelLDrilling, Inc as their suh-·contracfor,
to representthe owner in the application for permits for Well drilling and Geo-Thermal loop and
grouting installations, associated with the r.eferenced .project.
It is understoodthat this authorization is,extended for the purpose of applyingJor and obtaining the
constructicmpermits, and fmng any and al! documentatiqn to the proper authorizing authorities as
required for code ce>mpliam;~, inspecdons and code enforcement for all applicable local and state
regulations, and all required Health Department documentation.
Th;mkyou.
Sinc.erely, . . . /?/ J . /
£)fl~/~/
Dallas Holliday ~
Direct9rof Moderni2ation
~.
~
809 Pennsylvania Avenue • Washingtt.m, NC 27889
[phone] • Fax (252) 975-i 279
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Bevetty Eaves Perdue
Governor
Washington Housing Authority
Dallas Holliday
809' Pennsylvania Avenue
Washington. NC 27859
Subject:
Dear Dallas:
ATA
MCDENFt
North Carolina Department of Environment and Natural Resources
Division of Water Quality "r" -
Coleen H. Sullins cizZ Dee Freeman
Director • \r- cA al 13, Secretary
044
4.'2 7,'201 t
Acknowledgement of Intent to Construct Type 5¢W Injection Well System
Permit No. W10700771
905 Pennsylvania Ave, Washington, NC 27889
On 4f1812011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -only'
geothermal injection well system for the operation of a ground -source heat pump located at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection well system as long as the
following conditions are met:
I. The injection well system contains only potable water,
2. The infection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative Code Title l SA Section 2C Subchapter .0213, and
3. The required notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Weil Construction Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .0211(u)(2), Additionally, you should contact the Beaufort County Health
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at {q 19) 715-6166 or M hael.Ro2erc( ncdenr.OEov if you have any questions.
Sincerely,
�rrr Debrd w'zans
Supervi..ur
cc Washir.gun Regional Office — APS
APS Central Fitts - Permit No. WR 7O 22!
Bc iufart CounEy HMitth Dept.
Weller Well Drilling [,iennirtrr Savage)
Honeywell Enrrp, Services
AQ1J1FFER PROTECTION SEC T IQN
163& Mail Servxe Cease:. Raleigh. North Carolina 27699.1 o"3c
Location: 2728 Carta! Bouevard. Rai jt . Norte Carolina 2761114
Pnore_9t.733-32211FAX j:9-715.05655. FAX 2: 91S-715.6 48 I CnsromerSe nm: i.371% 34374&
iremat vem4rGNa&reuatnV-Ora
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NC PIN : 5676-44-6016
Scale : 1 Inch = 236 Feet.
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Date : 05/1712011
++++++++++ +++++ DISCLAIMER ++++-F +++++++-0++
THIS MAP IS PREPARED FOR THE INVENTORY OF REAL PROP-
ERTY IN ACCORDANCE WITH N.C- LANs RECORDS TECHNICAL
SPECIFICATIONS FOR BASE, CADASTRAL AND DIGITAL
MAPPING SYSTEMS_ GRAPHIC ILLUSTRATIONS HEREON ARE
COMPILED FROM RECORDED DEEDS, PLATS AND OTHER
PUBLIC RECORD RESOURCES. PERSONS ARE HEREBY
NOTIFIED TO CONSULT ALL APPLICABLE PUBLIC RECORDS
FOR VERIFICATION. BEAUFORT COUNTY AND ITS AGENTS
ASSUME NO LEGAL RESPONSIBILITY FOR THE ACCURACY OF
INFORMATION DEPICTED ON THIS MAP.
Online Maps: www.co.beaufort.nc.us