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Home My WebLink AboutWI0700244_GEO THERMAL_20110920Permit Number Program Category Ground Water Permit Type cl Wl0700244 / Injection Water Only GSHP Well System (SQW) Primary Reviewer michael. rogers Coastal SW Rule Permitted Flow Facilit Facility Name Joe & Leigh Healy SFR Location Address 3303 Virgina Ave New Bern Owner Owner Name Joe Dates/Events NC 28560 Healy Orig Issue 09/20/11 App Received Draft Initiated 09/20/11 Re g ulated Activities Heat Pump Injection Outfall r-.:;J u Scheduled Issuance Central Files: APS_ SWP_ 09/20/11 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Mike Smith Contractor Heat Pump 102 Middle St Jacksonville Major/Minor Minor NC Region Washington County Craven Facility Contact Affiliation Owner Type Individual Owner Affiliation Joe Healy 3303 Virgina Ave New Bern Public Notice Issue 09/20/11 NC Effective 09/20/11 28546 28560 Expiration Waterbody ·Name Stream Index Number Current Class Subbasin NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Pardue Coleen H. Sullins Governor Director 9/20/201.1 Joe & Leigh Healy 3303 Virginia Avenue New Bern, NC 28560 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0700244 3303 Virginia Avenue, New Bern, NC 28560 Dear Mr. & Mrs. Healy: Dee Freeman Secretary On September 20. 2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water- o_nlv 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 inflection well system contains only potable water, The injection well system is constructed in accordance with well construction standards specified in North Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and 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 Well Construction Act and North Carolina Administrative Code Title 15A Section 2C Subchapter .0211(u)(2). Additionally, you should contact the Craven 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 (919) 715-.6166 or 1ylichae1.R"ers.&ncdenr.eoy if you have any questions. Sincerely, P kWati. Groundwater Protection Unit Supervisor cc: Washington Regional Office - APS APS Central Files -Permit No. W1`0700244 Craven County Health Dept. Ccasyal Geothermal 1 Climate Control Heating and Cooling Conipanv, Inc.. {Mike 5mab i AQUIFER PROTECTION SECTION 1636 Mail Service Center, Rala.th, North Carolina 27699-1636 Locatlon- 2728 Capital Boulevard, R6fit, North Carolina 27604 Phone: 819-733-3221 LFAX is 919-715-0588-, FAX 2: 919-715-BN8 i Cusnmer Service. 1-87-7-623.6748 Intemeet: warw.nrwaterrmuality.ar An EmicA 4paanunoy f Afnm ative- Axlm Emotive, Cane North Carolina .,. RE~El~ED I DENR I DWQ Aqurfe, Protection SecUon DEPARTMENT OF ENVlRO~~~ A~~~~~ RESOURCES (NCDENR) $£p 2 0 2011 NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM: TYPE 5-QW 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: Se ptember 2 . 2011 \J'\[(.0'100d.~ Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in continuous piping that completely isolates the fluid from the environment (i.e. closed-loo p)? 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 signature): Joe and Leigh Healy ___________ _ (1) Mailing Address: 3303 Virginia Avenue ________________ _ City: New Bern State: NC Zip Code: 28560 County: Craven Home/Office Tele No.: ---~C~e=ll~N~o=.:=9-=10~-4~74~-~9~8 =15~------ Email Address: joesheal v@gm ail.com Website: (2) Physical Address of Well Site (if different than above): ______________ _ City: _________ State: __ Zip Code: ______ County: __ _ Home/Office Tele No.: ----------------=C=e=llc..=cN_,__,o=.,_: __________ _ 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: _____________________________ _ Contact Person.~: --------------=E=MA=IL~A-=d=d=re=s=s ,_: __________ _ Address: ________________________________ _ City: _________ State: __ ZipCode: ______ County : _______ _ Office Tele No.: Cell No.: GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) P age 1 C. WELL DRILLER INFORMATION Company Name: ___ C_oas_tal_G_e_o_th_e_rm_al _____________________ _ Well Driller Contractor's Name: -=S=an=fi=o=rd=-=S"""w""""e"""et=in=o,__ __________________ _ NC Contractor Certification No.: NC 2082 ______________________ _ Contact Person~: ~M~ik~e ~S_m_ith-'-________ E_MA __ IL_A~d~dr_e~ss~: ___ m_s~m_i~th~@_.,__.b_iz~e~c.~rr~.c~o~m~--- Address: 102 Middle St. ----------------------------- City: Jacksonville Zip Code: 28546 _____ County: -----'O=n=s=lo"""'_ w--'----- Office Tele No.: 910-353-9040 Cell No.: 910-376-1101 ------------------ D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Name: Climate Control Heating and Cooling Company Inc. Contact Person: Mike Smith EMAIL Address: msmith@ bizec.rr.com Address: 102 Middle St'----------------------------- City: Jacksonville Zip Code: 28546 County: -----'O~n=s=lo~w-'------ Office Tele No.: 910-353-9040 ______ Cell No.: 910-376-1101 _________ _ E. STATUS 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 Loop Geothermal G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: _September 2011 ______ Number of borings: 5 Approximate depth of each boring (feet): ____ 250 (2) Type of tubing to be used ( copper, PVC, etc): High Density Polyethylene _____ _ (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) GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page3 A. iN.IECTION-RELATED EQUIPMENT RECEIVE] ► GENR 1 DilM Awfer Pmltlinn Seclian SEP 2 0 20il 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 WEL"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 he signed by each person appearing on the reeorded 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 irnrnediately 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, maintaiin, repair, and if applicable, abandon the injection well and aft related appurtenances in accordance with the approved specifications and conditions of the Permit" Si6ature of Property C 7er/Applicant Print or Type Full Name and title C4�L � - ( _ Signa Property OwAer/Ajoicant Print Lvkype Full Name an 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 GPUMIC 5QW Notification of Intent Form (Revised 8/2008) Page 4 3303 Virginia Avenue, New Bern, RTC - Google Maps Page 1 of 1 To see all the details that are visible on the Go;le maps screen, use the "Print' link next to the map. h -"7� 6f �s �{ J7 w �]Y 6"M zfiOs Ffprn ��4�f/ya Ln fit' 4�� _ $� vsc gym a�Dr r• � 4 � ❑orser'� r �. � � N r x S+a Ohd jVV,onsiu[e Dr p m $1 Paifi Sew '°fig Caa 6 m $ R ti n a Trent a Woods 5lfalra� SdgrP sd 4� dd?A Lr1 .ndsorAve ILr !]:a"eel tiill,c�� r�arrn�s Rd ''��¢ � r r t'01:erbury Ra StW,,�P $ �, V, Fox Chase Rdp� x 164. 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