WI0800057_GEO THERMAL_20040324

Bill Evangelist
P.O. Box 362
Apex, NC 27502
March 24, 2004
Ref.: Notice of Regulatory Requirement
North Carolina Administrative Code
Well Construction Standards
Applicable to Injection Wells
Dear Mr. Evangelist:
I Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
The Underground Injection Control (UIC) Program of the North Carolina Division of Water Quality
is responsible for the regulation of injection well construction and operation activities within the
state ofNorth Carolina. The purpose of this letter is to inform you of two recurring issues pertaining
to closed-loop water-only injection well systems associated with ground-source heat pumps.
First, closed-loop water-only injection wells (Type 5QW) are permitted by rule in the North Carolina
Administrative Code, Title 15A, Subchapter 2C, Section .021 l(u)(2). This provision requires that
the person responsible for the construction of the injection well system submit notification prior to
construction. We understand this to mean that we receive notification before construction begins.
This is important for reviewing the proposed well construction plan and observing construction if
necessary. Our records indicate that in recent months at least one system for which you were the
heat pump contractor was constructed prior to receipt · of the notification, thereby violating the
condition of the rule referenced above.
Second, the required pre-construction form "NOTIFICATION OF INTENT TO CONSTRUCT A UOSED-LOOP
GEOTHERMAL WA TER-ONL y INJECTION WELL SYSTEM" is frequently submitted without the required
engineering design plan of the piping and other equipment associated with the proposed injection
well system. This is a necessary piece of documentation that must accompany every Notification of
Intent to Construct.
N. C. Division of Water Quality I Groundwater Section
1636 Mail Service Center Raleigh, N.C. 27699-1636
Phone : [phone] Fax: [phone] Internet: http://gw.ehnr.state .nc .us
Customer Service
1-877-623-6748
L.._):IQ 8CO 057-
Mr. Evangelist
March 24, 2004
Page 2 of 2.
Immediate implementation of these important aspects of constructing closed-loop water-only
injection well systems will be greatly appreciated and is required for compliance with well
construction regulations. If you have any questions regarding injection wells or their rules and
regulations please contact Thomas Slusser at [phone] or me at [phone].
Evan 0. Kane, L.G.
Underground Injection Control Program Manager
Cc: Groundwater Section Wilmington Regional Office
DIVISION OF.WATER QUALITY
GROUNDWATER SECTION
January 8, 2004
MEMORANDUM
To:
From:
Re:
Charlie Stehman
Evan KanettJt-
Receipt of Notification for a Closed-Loop Geothermal Water-Only Injection Well
System. (Type 5QW.):
Notification of intent to construct and operate a closed-loop, water only injection well system for
a geothermal heat pump (Type 5QW injection well) has been filed by Doug Champion for his
home in Beaufort, Carteret County. A copy of the notification is included with this memo. This
injection well system is deemed permitted by rule (15A NCAC 2C.021 l(u)2) and no further
regulatory action should be necessary. If you have any questions about this notification, please
contact me at [phone].
cc: CO-UIC Files
Enclosures
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina ❑cpartment of Environment and Natural Resaumes
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen f i. Sullins, Deputy Director
Division of Water Quality
January 8, 2004
Mr. Doug Champion
885 Osprey Point Road
Beaufort, NC 28516
RE_ Notification of intent to construct Type 5QW injection wells
Dear Mr. Champion:
In accordance with the notification submitted on your behalf to the UIC Program on January 8,
2004, the Groundwater Section acknowledges your intent to construct four closed -loop
geothermal water -only injection wells for the operation of a ground source heat pump. The
system as described in your notification is deemed pernnitted by rule (North Carolina
Administrative Code Title 15A: 2C.021I(u)(2)} and does not require an injection well permit
from the state, but you should check with your county health department as well because they
may have additional construction or permitting requirements for this type of system. If you
modify your system at any time, please contact the Groundwater Section to verify compliance
with applicable rules.
Thank you for submitting this notification. If you have any questions regarding geothermal heat
pump wells or injection well rules please contact me at [phone].
Sincerely,
Evan Q. Dane, L.G.
Underground Injection Control Program Manager
Enclosure
cc: Groundwater Section - Wilmington Regional Office
CO-C.TIG files
N. C. Division of Water Quality 1 Groundwater Section
1636 Mail Service Center Raleigh. N.C. 27699-1636
Phone: [phone] Fax: (419)73"588 Internet: http:llgw.ehnr.state.ne.us
OA
Customer Service
l-877-G23�748

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
In Accordance with the provisions ofNCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
This is not the proper form to be used for injection welds in an oven -loon eeotherwal system.
Do of this form for systems that circulate any substances other than water.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: ��- 1, . 2a 03
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
fm
C_
YES __X If yes, then continue completing this form.
NO If no, do not complete this form. Form GW-57 HP, Application For
Perm ir To Construct AndlOr Use A Well(s) For Injection With A Heat
Pump System, should be completed.
SYSTEM FLUID Will any additives be introduced to the syatem's circulating heat transfer
fluid? This includes, but is not limited to corrosion inhibitors and/or antifreezes.
YES If yes, do not complete this form. Form GW-57 HP, Application FeS
Permit To Construct AndlOr Use A Well(s) For Injection With A Bat
Pump System, should be completed. a
NO _ _I If no, then continue completing this farm. co
PROPERTY OWNER
Name:
N
City: Ijflrtcti-41� ' 01 State: Ny Zip Code:
County: 0,1W7FTelephone;
D. STATUS OF PROPERTY OWNER
Private: -7x— Federal: Commercial:
State: Municipal: Native American Lands:
Ver.3/01 GWIUIC-57 CL Page I of 4
c
4

E. FACILp
( TE) DATA
(Fill ouOK
if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility:
Address:
City: __ State: V Zip Code: County-.
Telephone: — Contact Person:
Standard Industrial Code(s), SIC, which describes commercial facility:
F. HEAT PUMP CONTRACTOR DATA
Name: �i�' S�5ertl.c'-
Address: .
City: _ State: dip Code: _ jCJ L County:�—
Telephone: — Contact Person: B.11 FmWgkiff
G- CONSTRUCTION DN A (check one)
MSTING WELL(S) being proposed for use as a ground -coupled heat pump
well(s). Provide the information in (1) through (3) below to the best of your
knowledge. Attach a copy of Form GWA (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 (1) through (3) below as PROPOSED
construction specifications. Submit Form GW-1 after construction-
(1) Well Drilling Contractor's Name.-4I►l7``e,,-4
NC Contractor Certification number: �� f
Date to be constructed: lq- 0a Number of borings: 7
r
Approximate depth of each boring (feet): 6 C
(2) Well casing: fs the well(s) cased?
(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
(3) Grout (grout the vertical length of the borchole to a minimum depth of 20 feet b-I.s.):
(a) Grout type. Cement Bentonite X Other (specify)
(b) Grouted surface and grout depth (reference to land surface):
around closed loop piping; from -- 0 to ?A& (feet).
around well casing; from to (feet).
NOTE: THE WELL DRfU NG CONTRACTOR CAN SUPPLY TIM DATA FOR EITHER MSTING OR
PROPOS,] Wr-LLS IFTRIS IN-ORMATION IS UNAVAILABLE BY OTHER MPANS-
Ver.3/gi GWIWC-57 CL Page 2 nf4

H. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the 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($) 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 well( s) and any existing well( s) or waste disposal facilities such as septic tanks
or drain fields located within 200 feet of the ground-coupled heat pump well system. Label all
features clearly and include a north arrow.
(2} location map referencing the site to two nearby permanent reference points (such as roads,
streams and highway intersections).
J. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
K. CERTIFICATION
Ver.3/01
"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, o~te, 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."
(Signature of Well Owner or Authorized Agent)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
GW/UIC-57 CL Page 3 of4
L. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee Of 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 somcone 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 punp.system's well(s)
conforms to the Well Construction Standards (Title 15A NCAC 2C .0200)
(Sr�triuttue rapt rty ( a ' Tf Diff�rom Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Ver.3101 GW/U1C-57 CL Page 4 of 4

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WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Reso es -.Division of Water Quality -Groundwater Sectiion
f Pam - r �!
WELL CdNf'RACf dR (iNb[V1IIUAL) NAME [p�iat .V d►r' L4 C$1tTIFiCATiON 1R ' �70
WELL CONTRACTOR COMPANY NAME ,, tat) • PtioNE
STATE WELL CONSTRUICTiON PERM1" FATED WQ PEW1611TM
(if apptireblc) of applicablel
1. WELL USE (Check Applicable Box); Residential ❑ MunicipallPublic ❑ Industrial ❑ Aencult=10
Monitoring ❑ Recovery 0 Heat Pump Water Injection Q Other K If Other, List Usc-i o5z'- k "�'='a Tl-e ru�-s
2_ WELL LOCATION: .0
Nearest Town: r=GL � Coun J
(Street Namc, Numbers, Community, Subdivision, Lot Na., Zip Code)
3. OWNER:(�['�. (?.�
Address
[5treet�
,--City or Town? Zip Code
-_ 7�
Ara% code- Phone number
4. DATE DRILLED — r ' _ 3
5. TOTAL DEPTH: 2CF4=
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO PK
7. STATIC WATER LEVEL Below Top of Casing: �,
�{Use "+" if Above Top of mg)
S. TOP OF CASING IS Mk— Fr. Above Land Surface•
'Tap of wing termtasted odor below land sartexe requires a
variance In accord v with 1 SA NCAC 2C .011&
9. YIELD (gpm): _ Nf METHOD O TLST
10. WATER ZONES (depth);--
11. DISINFECTION: Type
Amount
12. CASING:
Wall Thickness
Depth
Diameter
or Weight/Ft. Material
Frain To
Ft.
From To
Ft
From To
Ft
13. GROUT: , Depth
M teriad
Method
FromTo- -
Ft.
JD'-6i,; f
From Tv
Ft.
14. SCREEN: Depth
Diameter
Slat Size Material
From To
Ft. in.
in.
Front _, _ �_ To
Ft. in,
in.
15. SANDIGRAVEL PACK:
Depth
Size
Material
From Tn
Ft.
From To
Ft.
16. RENL RK.S:
{{
, 1
Topographicland setting
ORidge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude!longitude of well location
(dcreeslminutrWscconds)
Latitudellongitude source: ❑GPSi7Topographie map
(c*k box)
DEPT DRRI:IM I.OG
From To ` rmtiran Ik�cription
t -i,�-
60
[0
LOCATION SKETCH
Show direction and distance in miles from at least ,
two State Roads or County Roads. Include the toad . -.
numbers and common road names.
Ll
r
rf
i` i,,'
�-' 7�vlj 110
I Des HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSST tUIST )N Sj1 D %RDS, ANDTIMT A COPY OF TMS RECORD HAS BEEN PROVEDED TO THE WM-L O NER
.1CL•`tII� �I1. �1•� I d --
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, INC
276994636 Phone No. (919) 733 32211, within. 30 days, GW-I REV. 07/2001