WI0800054_GEO THERMAL_20000606

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
June 6, 2000
To: Charles Stehman, Ph. D., L.G.
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl f'\.P, [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
---
Re: Rec.eipt of Notification for a Closed-Loop Geothermal Water-Only Injection Well
System.
Notification to construct and operate a well for a closed-loop geothermal heat pump system has
been filed by David B. Pryor of Southport, North Carolina and a copy of the Notification is
enclosed for your files. This injection well system is deemed permitted by rule (NCAC TISA:
2C.21 l(u)2) and no regulatory action is necessary. ffyou have any questions, please contact me
at [phone] or Amy Axon at [phone].
cc: CO-VIC Files
Enclosures
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DIRECTC
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NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RE5OURGEs
June 6, 2000
David B. Pryor
5900 Dutchman Creek Road
Southport, NC 28461
Dear Mr. Pryor:
DIVIMON OF WATER QUALMY
In accordance with the notification submitted on your behalf by Climate Control
Heating & Cooling dated May 15, 2000; the Groundwater Section acknowledges your
intention to construct closed -loop geothermal water -only injection well for the
operation of a ground -source heat pump. The system as described in your
notification will not require an injection well permit and is deemed permitted by rule
(North Carolina Administrative Code Title 15A: 2C.021 1 (u)2). The Underground
Injection Control Group has added your site to our inventory. If you modify your
system, please contact the Groundwater Section to verify compliance. Thank you
for submitting this notification.
If you have any questions regarding geothermal heat pump wells please feel free to
contact me at (9I 9) 715-6166 or Amy Axon at [phone].
Sincerely,
mawl� P-4
Mark Pritzl
Hydrogeological Technician II
Underground injection Control Program
cc: CO-UIC Files
WIRO-UIC Files
GgovryowAr€R 3tcT1ON
1636 MAIL SERVICE CEKTCA, RALEIGH. NC 27699-1636 . 272a CAPITAL., BLVD., RALEIGH, NC 27604
PHONE [phone] FAX 919-715.O5aa
AIN EgUAL OTPaRTUNITY I AFFIRMATIVE ACTIaN EMPLOYER - 50% RECYCLE0110% POST-c0N5UM1EA PAPER

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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP
GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM
(GROUND COUPLED HEAT PUMP)
Type 5QW Wells
d
In Accordance with the provisions ofNCAC'fiLie 15A: 02C.0200 CDa
Complcle application and mail to address on the back page. v �,
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= 15-::;r
This is not the In•opev form to be used for injection wells in an otmi- ue) geothermal systir. am
Do not use (Iris forin for systesrss that circulate any subsWieces other thasl water. -� r
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TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: /Qd X-
n
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in contintlous
piping that completely isolates the fluid from the environment?
YES __ If yes, then continue completing this form.
NO If no, do not complete this form. Form GW-57 HP, Application For
Permit Tu Constiwel AndlOr Use A Well(s) For 1, jection With Heat
Pump System, should be completed.
B. SYSTEM FLUID Will any additives be introduced to the system's circulating heat transfer
fluid? This inc [tides, but is not limited to corrosion inhibitors and/or antifreezes.
YES If yes, do not complete this form, Form GW-57 I-IP, Applicaticir Far
Permit To Conslowel AndlOr• Use A Well(s) For- h jection With A Heat
Prrtrrla SjWem, should be completed.
NO If no, /hen contisltie aompletittg this form,
C. PROPERTY OWNER
Name:
Address: 2L9 C-" G k-
City: State: Zip Code: .2-V 41c;
County: r*6g,v+i-ewtie In Telephone; �. S-Z+ r'4 e4 7.{
D. STATUS OF PROPERTY OWNER
Private: Federal:
State.: Municipal:.
G W-57 CL (May I998)
Commercial:
Native American C.ands:
Page I of 4

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is federal, Stale, Municipal or Commercial).
Name of Business or facility: _______________________ _
Address: ______________________________ _
City: __________ State: __ Zip Code: _____ County: ____ _
Telephone: __________ Contact Person: _____________ _
Standard Industrial Code(s), SIC, which describes commercial facility : ________ _
F . HEAT PUMP CONTRACTOR DATA.
Name: Climate.. Control Heating 8,. Cooling Co. 1 Inc.
Address: 102 Middle Street
City: Tacksomd 1 )e State:NC.,.._ Zip Code: 28546 County: Qns]aw
Telephone: 9l0-353-9040 Contact Person: Michael Had] ey
G. CONSTRUCTION DATA (check one)
XXX
EXISTING WELL(S) being proposed for use as a ground-coupled heat pump
well(s). Provide the information in (I) through (4) below to the best of your
knowledge. Attach a copy of Form GW-I (Well Construction Record) if available.
PROPOSED WELL(S) to be constructed for use as a ground-coupled heat pump
well(s) . Provide the information in (I) through (4) below as PROPOSED
construction specifications. Submit Form GW-1 after construction.
(I) Well Drilling Contractor's Name: Climate Contrnl Heating l!, Cooling Co., Inc.
NC Driller Certification number: A[C 2..0BZ... S,+Nfo~i)_ .S~e,L;,/-j' Mj
Date to be constructed: £ 0 t} Number of borings: ~
'} "'o ., Approximate depth of each boring (feet): ___ vV ______________ _
(2) Well casing: ls the wcll(s) cased? NO
(a) YES If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic __ Other (specify) _____ _
Casing depth: From ___ to ___ ft. (reference to land surface)
Casing extends above ground ____ inches
(b) NO X
(3) Grout (grout the vertical length of the borehole to a minimum depth of 20 feel b.l.s.):
NOTE:
(a) Grout type: Cement__ Bentonite. J{ Other (specify) _______ _
(b) Grouted surface and grout depth (reference to land surface):
X around closed loop piping; from O to -2Ocreet).
__ around well casing; from __ to __ (feet).
THE WELL DRILLING CONTRACTOR CAN SUPPLY Tl IE DATA FOR EITIIER EXISTING OR
PROPOSED WELLS II' TIIIS INFORMATION IS UNAVAILAIJLE IJY OTHER MEANS.
GW-57 CL (May 1998) Page 2 of4
.J
H. INJECTION-RELATED EQUIPMENT
Attach a diagram showing lhe engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
I. LOCATION OF WELL(S) Attach two maps.
(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 wcll(s) and any existing well(s) or waste disposal facilities such as septic tanks
or drain fields localed within 200 feel of the ground-coupled heal pump well system. Label all
features clearly and include a n1,1rth arrow.
(2) location map referencing the site to two nearby permanent reference points (such as roads,
streams and highway inlersections).
J. PERMIT LIST: Allach a list of all permits or construction approvals that are related to the site.
Examples include:
(I) Hazardous Waste Management program perm its under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Perm its
K. CERTIFICATION
"I hereby certify, under penally 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. l agree to construct, operate, maintain,
repair, and if applicable, abandon the ground-source heat pump system and all related appurtenances in
accordance with the approved specifications and conditions of the Permit."
GW-57 CL (May 1998)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
Page 3 of4
....
Ill
L. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure that the ground-source heat pump system's well(s)
conforms to the Well Construction Standards (Title ISA NCAC 2C .0200)
GW-57 CL (May I 998)
Please return two copies of the completed Appiication package to:
·u1c Program
Grnundwater Section
North Carnlina DENR-ffWQ
P.O. Box 29578
Raleigh, NC 27626-0578
Telephone [phone]
Page 4 of4
Directions to David Pryor Residents
Take Rt. 133 South to Rt. 211 towards Southport.
When you drive towards town, look for signs to Ferry and Southport Elementary school.
Take that right, go past elementary school into Indigo Plantation.
Take the first right, Dutchman Creek, follow to the end, lot is visible from the road.
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