WI0800058_GEO THERMAL_20000705

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
July 5, 2000
MEMORANDUM
To: Charles Stehman
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl l'\f. [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Receipt of Notification for a Closed-Loop Geothermal Water-Only Injection Well
System.
Notification to construct and operate injection wells for a geothermal heat pump system has been
filed by Harry G. Gotte III of Beaufort, North Carolina and a copy of the Notification is enclosed
for your files. This injection well system is, deemed permitted by rule (NCAC T15A:
2C.21 l(u)2) and no regulatory action is necessary. If you have any questions, please contact me
at [phone] or Amy Axon at [phone].
cc: UIC Files
Enclosures
ARIA'W"
iTCDENR
JAMES H. HUNT JR,
GOVERNOR
BILL •HCL MAN
SECRETARY
KERB T. STEVENS
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
July 5, 2000
Harry G. Gotte III
P.O. Box 2127
Beaufort, NC 28516
Dear Mr. Gotte:
DIVISION OF WATER QUALITY
In accordance with the notification submitted on your behalf by Climate Control
Heating & Cooling Company, dated July 3, 2000; the Groundwater Section
acknowledges your intention to construct a closed -loon 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.021I(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 [phone] or Amy Axon at [phone].
Sincerely,
Mark Pritzl
Hydrogeological Technician Il
Underground Injection Control Program
cc: CO-UIC Files
wllao-Urc Files
m>.v
GROUNDWATER SECTION
1636 MAIL SERVICE CENTER, RALEI+3N, NC 2789?9-1636 - 2728 CAPITAL, BLV13., RALEIGH, NC 27604
PHONE 9 i 9-733-3221 FA% O I B-715-OSSO
AN EgUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER - 50`Ys REGYCLE0110k' POST -CONSUMER PAPEP

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 of NCAC 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 wells in an o gn-loo eothermal system.
Do not use this form for systems that circulate ans substances other than water.
TO: DIRECTOR NORTH CAROLINA DIVISION OF WATER QUALITY
DATE; Yi-NG a.3 . 24 6d
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in contimtous
piping that completely isolates the fluid from the environment? v
L
YES If yes, then continue completing this form.
w __ NO If no, do not complete this form. Form GW-57 HP, Application-&r
Permit To Construct And1Or Use A Wells) For Injection With AHeat
Pump System, should be completed.
w
B. SYSTEM FLUID Will any additives be introduced to the system'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 For
Permit To Construct AndlOr Use A Well(s) For Injection With A Neat
Pump System, should be completed.
NO If no, then continue completing this form.
C. PROPERTY OWNER
Name:
Address: a
City: State; ,L1- Zip Code: _ :n6
County: CI Telephone:
D. STATUS OF PROPERTY OWNER
Private: Federal: Commercial:
State: Municipal: Native American Lands:
GW-57 CL (Jan, 204[]} ,/0 Page 1 of4
r--a-s —,v-

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, 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:
R HEAT PUMP
l.
Name. � 1 W
Address:
City:
Telephone:
G.
DATA
CONSTRUCTION DATA (check one)
EXISTING WELL(S) being proposed for use as a ground -coupled heat pump
well(s). Provide the information in (1) 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 (1) through (4) below as PROPOSED
construction specifications. Submit Form GW-1 after construction.
(1) Well Drilling Contractor's Name: �J�► ►Cr'dC �I►►'ee.�i �I�,
NC Contractor Certification number: 20 07,_
Date to be constructed: Add Number of borings: -3
t
Approximate depth of each boring (feet): 206
(2) Well casing: Is the wells) cased?
(a) YES If yes, then provide the casing information below.
Type; Galvanized steel Black steel . PIastic 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 borehole to a minimum depth of 20 feet b.l.s.):
(a) Grout type: Cement Bentonite YOther (specify)
(o) Grouted surface and grout depth (reference to land surface):
around closed loop piping; from 1) to 2,0 (feet).
around well casing; from to (feet).
NOTE; THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION I5 LINAVALLA13LE BY OTHER MEANS.
GW-57 CL (Jan, 2000) Page 2 of 4

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(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 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
"I hereby certify, under penalty oflaw, 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 (?btaining 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 ground-source heat pump system and all related appurtenances in
accordance with the approved specifications and conditions of the Permit."
GW-57 CL (Jan, 2000)
(Signature of Well Owner or Authorized Agent)
If authorized agent is acting on behalf of the well O}l,,7ler,
please supply a letter signed by the owner
authorizing the above agent.
Page 3 of4
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 I SA NCAC 2C .0200)
GW-57 CL (Jan, 2000)
(Signature Of Property Owner If Different From 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]
Page 4 of4
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ti SITE PLAN r s r r j
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F�S�
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C �YL( AVILS
1 R A I
OWNER:
ADDR SS:
TAX PARCEL:
PROPERTY LOCA
�l32.CL _ PHONE. OL�— L 6 I11
3977 -1 1 11f _]- (. - 7-1
SUB SfON: _
LOTS _ BLOCK: SEC:
TYPE. STRUCTURE:
47a-
NO- BEDROOMS' NO. BATHS:
NO. PEOPLE DESIGN FLOW —�_L--1
GARBAGE GRINDER: YES i ] NO ("kpf
SEPTIC TANK� GAL. PUMP TANK: P�GAL.
1-4O.I.I1'4£S7 VIIka'-". �~
TOTAL LENGTH: 77= TOTAL - _ SQ. FF.
WATER SOURCE. _T t'-_ I&
HORIZONTAL DISTAN OM WELL: 't FT.
SITE MODIFIED: YES NO { J
c
D�,VE REQUI-MENTS: _ --_-
• STRUCTURF SHALL BE PLA _ _D SO THAT GRAVITY
FLOW IS ACHIEVED OR PUMP SYSTEM SHALL BE
REQUIRED-
• DO NOT PARK, PAVE, DRIVE. OR BUILD OVER ANY PART
OF SEPTIC SYSTEM OR REPAIR AREA.
• MAINTAIN A MINIMUM 5 FEET BETWEEN ANY
FOUNDATION AND ANY PART OF SEPTIC SYSTEM OR
REPAIR AREA.
or.
*SYSTEM SHALL NOT BE INSTALLED
UNDER WET CONDITIONS
*Trench bottom depth to be no deeper than
naturally occurring surface,
Easement Required: Yes Not
Drainage Maintenance Req. Surface t Osubsurfacc l
Maintain Minimum "' From Water Line
Cornments:lS AK &I� 5�s
Prior to any changes in System layout, approval must be obtained
from Health Department.
*NOTICE: Construction must comply with al] state and local
regulations. Do not install well until well site has been approved
on inspection.
"NOTICE: Beware much property in Carteret -County is subject
to Wetland Regulations and properties containing wetlands
should receive approval from U-S. Army Corp. of Engineers
prior to development_
FOR SYSTEMS REQUIRING; LESS THAN 18" TRENCH
BOTTOMS. A MINIMUM OF b" SOIL OVER
IS REQUIRED AND MAY REQUIRE ADDITIONAL
FILL OF AT LEAST GROUP II SANDY
LOAM TEXTURE-

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