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Home My WebLink AboutWI0700275_GEO THERMAL_20120409Pe r mit Number W10700275 ' Injection Water Only GSHP Well System (5QW) Primary Reviewer eric.g.smith Coastal SW Rule Permitted Flow Facili Facility Name Artesian Aquafarms Location Address 218 Bunker Hill Rd South Mills Owner Owner Name Gary Dates/Events NC 27976 Sawyer Scheduled .Orig Issue 04/09/12 App Received Draft Initiated Issuance 03/15/12 Regulated Activities Heat Pump Injection Outfall NULL Central Files : APS_ SWP_ 04/09/12 Permit Tracking Slip 1.00 Individual Permit Contact Affiliation Jesse L. Royall Driller Well 2111 Magnolia St Richmond VA Major/Minor Minor Region Washington County Camden Facility Contact Affiliation Owner Type Individual Owner Affiliation Gary Sawyer 218 Bunker Hill Rd South Mills Public Notice Issue 04/09/12 NC Effective 04/09/12 23223 27976 Expiration Waterbody Name Stream Index Number Current Class Subbasin Govemor Mr. Gary Sawyer Artesian Aquafarms 218 Bunker Hill Rd. South Ivfills, NC 27976 _14 ^''r"^*..�.I.■ CK Director 04/09/2012 Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Pertnit No. W 10700275 218 Bunker Hill Rd. South Mills, NC 27976 Dear Mr, Sawyer - Secretary On 03/15/2012, 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: 1, The injection well system contains only potable water, 2. 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 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 Well Construction Act and North Carolina Administrative Code Title I SA Section 2C Subchapter .021 l(u)(2). Additionally, you should contact the Camden 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) 807-6406 or Michael.Rggers.Qncdenr.y if you have any questions- S' cerely, for D ra acts Sulae r cc: Washington Regional Office - APS APS Central Files - Pennit No,.W[0700275 Camden County Health Dept. sse 1'. iko,e 4ii ;:!3Yd Jr i JyLi U, III, _ I • E I.- . l:.fllifu, 1636 Mail SeFViQB Genter, Raleigh, With Carolina 2789P GA Location: 512 R Salisbury St., Raleigh, North Carolina V604 One 7 Phony 919.807-6464 l FAX, 91 M07-6496 IWOT[h �rlll 1711 ili;l Internetwww.ncwaterpuality.orp ��'iQl�� Ao Fqual ❑pPnrunity \AMrmoUve MOP E"loyer ` March 5, 2012 DWQ Aquifer Protection Section North Carolina DENR-DWQ 1636 Mail Service Center Raleigh, NC 27699-1636 Subject: Closed Loop Recirculation Well Dear Sir: RECEIVED/DENR/DWQ MAR I 5 2012 HYDRO ... INC. Please find attached our Closed Loop Notification of Intent to construct these wells. This application is being submitted at the request of Mr. Gary Sawyer of Artesian Aquafarm based on instructions received in conversations with Mr. Mike Roges, Environmental Specialist with DENR's DWQ, Aquifer Protection Section. If you have any questions please contact me at 804-363-0174. It is our intent to construct these wells the week of March 19th 2012. Sincerely, Copy: Gary Sawyer P.O. Box 27186, Richmond, VA 23261-7186 • 804-643-2725 • Fax: 804-788-9058 NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS In Accordance With the Provisions of 15A NCAC 02C .0200 CLOSED -LOOP WATER -ONLY GEOTHERMAL INJECTION WELLS These wells circulate potable water only as parr of a geothermal heating and cooling system. These wells are `Vermitted by rule" and do not require an individual permit when they are constructed in accordance with the rules of 15A NCAC 02C .0200 and this Notice is submitted prior to construction. Print or Type Information and Mail to the Address on the Last Page. DATE: N9 c 5 , 20 l z. PERMIT NO. A. STATUS OF WELL OWNER (choose one) B. C. Non -Government: Individual Residence Government: State Municipal (to be filled in by DWQ) Business/Organization Y, County Federal WELL OWNER - For individual residences, list each owner on property deed. For ail others, state name of entity and name of person delegated authority to sign on behalf of the Business or agency: Mailing Address: 216 City_ d L] V State: 1N CZip Code: 2-79-1ca County: �$+•1 Day Tele No.: EMAIL Address: 5fWAIM- o • c--vfaxNo.: Z 52. - 5c07. - 3a1�Qcl- LOCATION OF WELL SITE - Where the injection wells are physically located: (1) Parcel Identification Number (PIN) of well site: l9]- 1"►5at- 60-OL 147-% County: i1AVv% i�. ►� (2) Physical Address (if different than mailing address): S+PtiYti+'L. City: D. WELL DRILLER INFORMATION State: NC Zip Code: Well Drilling Contractor's Name: S �k+r-- .4\rc C-- L r,.a *", C° NC Well Drilling Contractor Certification No.: y 5 98 ZZ ac" _ 3:3- c N il� Company Name: S' �0 -,oca Contact Person:_EMAIL. Address. .3 S'iDr 60� .4VI Address: z-W\__MA-*,w4Pk S ee•-� _. _ City:-- av►s� Zip Code: �_ State: � Coun, N� ty' ►C�1�fY� Office Tele No.: $04-&41- Cell No.: {2�4 363 ~ 01-7 `-f Fax No.: fsoi 1o,44 - z�51r E. F. HEAT PUMP CONTRACT!R INFORMATION (if different than driller) Company Name: N t A- Contact Person: EMAIL Address: )> ..0 C: & .... s::: '"O l> .., :::c, Address: ---------------------------------~s,-ci> -c:n City: __________ Zip Code: _____ State: __ County: ---------- Office Tele No.: Cell No.: Fax No.: ----------~~~~----~-- o· r,,...:, :::I <:::) en -r-.> Cl> s s· :::, WELL CONSTRUCTION DATA ---(1) Number of borings to be constructed*: 1-Depth of each boring (feet): 12.. S ---------* If existing water supply wells will be used then provide the information in item (4) below. (2) Type of tubing to be used (steel, PVC, etc): __ N __ C..-___________ _ (3) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, etc.), diameter, depth, and extent of casing appearing above ground: f'v C:.. I 2.. ,, -,-0 l "'2..o ~+ ~ r~~~ (4) Grout (material surrounding well casing and/or piping): ::;:o m (") m < m C -CJ m :z: c2 CJ ~ (a) Grout type: Cement__ Bentonite** __ Other (specify) 11 • ."/<> 8e....sP'-'Yl 1°,b ~~-..-t' ** By selecting bentonite grout, a variance is hereby requested to ISA NCAC 2C .0213(d)(l)(A), which requires a cement type grout. (b) Grout depth of tubing (reference to land surface): :from __ O __ Cb __ o __ (feet) If well has casing, indicate grout depth: :from _6=--_ to _l_Z.----'-S-=------_ (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 clearly 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 fields, 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 facility's location and the map name. NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or elevation data. 30. it CERTIFICATION (to be signed as required below or by that person's authorized agent)Pn m l SA NCAC 02C .0211(b) requires that all permit applications shall be signed as follows: 3 N° 0 1. for a corporation by a responsible corporate officer; _° 2. for a partnership or sole proprietorship, by a general partner or the proprietor, respectively# v Z 3. for a municipality or a state, federal, or other public agency: by either a principal ex&Ovq�S officer or ranking publicly elected official; 4. for all others: by the well owner (which means all persons listed on the property deed). a - If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant that names and authorizes their agent to sign this application on their behalf. "l 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, maintain., repair, and if applicable, abandon the injection well and all related appurtenances in accordance with the approved specifications and conditions of the Permit." Signature of Property Owner/Applicant Print or Type Full Name Signature of Property Owner/Applicant Print or Type Full Flame Signature of Autho ' gcnt, if any � Lr Print or Type Full Name Submit the complete application package to: DWQ - Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (919) 733-3221 20' 120' 125' """"r" "'JECTIQN 'GENATED WAFER GROUND LEVEL BENTONITE/CEMENT GROUT �"O HOLE PVC PIPE PVC PIPE "ON1TE HOLE PLUG 12% BENTONITE/CEMENT TTED PIPE TOM CAP PROPERN OF _ SYQNOR HYDRO, INC. MNOR HYOR0, INC_ 2111 UACMX A Sr. RICHMDNO, VA 2MM PH 804/03-2725 FAX B04/788-9058 TIM ORWM IS Silebn= W"N THE ACREEYIENT THAT fT IS HOT TO 8E R Gm• OR LIED WELL ELEVATION PART OR YR4OLC 1R IS NOT 70 BE USED IN ►" Mmocm THAT YAY CONSITRTFE A OETRAIENT DEtMTLY OR INDIRECTLY TO SYDNOR. ACCEPTARCE JOB NAM CLOSED LflOP O]CYGE NATION SYSTEM OF DRAWING WILL DE CONSTRUED AS AN Aalm1EM 70 niE ASNVE awrmm ARTESIAN AQUAFARMS cp x1 p we w 2-1-12 XONE CL Ai2a4 av m n m C m n v m v G-) s is http://maps.google.com/ To an all lhedate" That are vwme an the arxeen, t»e 1ha "Prksl" lNik nexl !o the map. Im■ all 17 Cemmem..sv. d W. Pm wom". kia o.-b*-k • *? u.oeme7oQG.Poe- 'JOPOS uaPa10ld Ja#mby ZIQZ 91 M QMGM30I03AGOM 3I112012 218 hunker hill road south mills ne - Googie Maps rage iw1 �'t To see all the deta6s that are vlsible on the screen, use tha "Print" link next to the map. C C,,�6s'a' Luc ,PrTcr►� knj!j .O:pnaK.mep GevEleryUS r.""rN 5". UWA Farm Sarin agrncy. 4AaylEra CQ657 [jaq, - A http://maps.google.com/ 3/1/2012 GoMAPS - Camden County NC Public Access LEGEND CENTERLMES CORE -VILLAGES RAILROAD 1 � PARCELS � AERJAES_2010 0 COUNTY a" Wednesday, March 14 2012 N ***WARMING: THIS IS NOT A SURVEY!*** This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. ...105 YEARS