WI0800088_GEO THERMAL_20000320

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
March 20, 2000
To: Charles Stehman, Ph.D., L.G.
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl 1\.-P. [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 Tom Bishop of Jacksonville, North Carolina and a copy of the Notification is enclosed
for your files. This injection well system is deemed permitted by rule (NCAC Tl SA:
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: UICFiles
Enclosures
W:LO ~CDO~
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
NCDENR
March 24, 2440
JAMS$ M. MUNT JR_
GOVERNOR
BILL. HOLMAN
SECRETARY Taal Bishop
2714 Northwoods Drive
Jacksonville, NC 28540
KERR T STEVENS .
PIRECTOR Dear Mr. Bishop:
DiviSION OF WATER QUALITY
In accordance with the notification submitted on your behalf by Climate Control
Heating & Cooling Company, dated March 13, 2000; the Groundwater Section
acknowledges your intention to construct a closed -loop geothermal water-onl%,
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 l (u)(2)j.
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,
M44
= Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Program
cc: CO-UIC Files
WiRO-LI1C Files
GROVNOWATSA SECTION
1636 MAIL SERVICE CIENTER, RALEIGH, NC 27699-1698 - 2720 CAPITAL, BLVb.. RALEIGH, NC 27604
7 PmoNc 9i 9-733.3221 FAX 91 P-71 5-OSBB
w AN EQUAL OPPORTUN47Y 1 AFFIRMATIVE ACTIPN EMPLOYER - 50% RECYCLEs1109a' POST -CONSUMER pAPJER
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A
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)
hype 5QW Wells
In Accordance with (lie provisions oFNCAC Title 15A: 02C.0200 C
Complete application and mail to address on the back page -
This is not the proper form to be ttsed Cur injci:tinn wells in an atren-looLgeother-inal system.
Do not use this form for systems that circulate Any substances other than_lvater.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: .3, 1 4 0?-?
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that compictcly isola(es the fluid from the environment?
YES _X_ If yes, then continue completing this form.
NO I F no, do not complete this form. Forni G W-57 HP, Application For•
Permit To Construct AndlOr Use A Well(s) For Injection With A Heal
Punip System►, should be completed.
B. SYSTEM FLUID Will any additives be introduced to the system's circulating heat transfer
€Iuid? This includes, but is not Iitit iled to corrosion inhibitors and/or antifreezes.
YES If yes, do not complete this form. Form GW-57 HP, Application FQr
Permit 7o Construct AndlOr Use A Well(s) For h jection With A Heat
Pump System, should be completed.
NO i ii'Zio, then coutill ue completing this form. M rF + �r'"r'J IN"
s
C. PROPERTY OWNER ""41µ I-tGf '�.ulM-SS D!.
Name: d lrrt
Address: 14.
City: dN J► State: Lip Code:
CountyId`LAJ 'Telephone: q1 ❑ rQ 3r— 3 t 3
D. STATUS OF PROPERTY OWNER
Private: Federal.
State: Municipal;
GW-57 CL (May 1998)
Commercial:
Native American Lands:
Page I of 4

E. FACILITY (SITE) DATA
(FiII out ONLY if tite Status ofOwner is Federal, State, Municipal or COMIII el'cial).
Name of Business or Facility:
Address: _
City: State: Zip Code: Cotiltl}'
Telephone: .— Contact Person:
Standard Itidustrial Code(s), SIC, which describes cwnlnercial facility-
F. HEAT PUMP CONTRACTOR DATA
Name: Climate1. Control l-leatin CoolingCo., Inc.
Address: t02 Middle Street
City: ark-gnrivi 1 je SLale:m, Zip Corte: gLSAfa CoUlity:
Teiephotie: 910-353,.9040 __ Laniact I'ei soft_ Michael 1 i'qcI1 �.
G. CONSTRUCTION DATA (clieck ogle)
EXISTING WELL(S) being proposed fol' use as a grottild-coupled !teat pump
eve;i(s). Provide the information hi (1) through (4) below to the best of your
knowledge. Attach a copy ofrorin GW-1 (Well Construction Record) if available.
xxx PROPOSED WELL(S) to be constructed for use as a ground -coupled heat pomp
well(s) . Provide the itiforniatiou iii (1) through (4) below as PROPOSED
construction specifications. Submit Form GW- I after eonstructioii.
(1) Well Drilling Contrac(or's Nardi: Climate Control 11e��. Cg �� Coolint; Go. , Inc.
NC Drilicr Certification number.:�w!�a��
Date to be coitstructcd: -3, 6 Nuinbcr of buriiigs:
Approxiiiiate depth ofeach boring (feet):
2,6v r
(2) Well casitig: Is (lie well(s) cased? Np
(a) YES if yes, theft provide [lie casing iittfarmation below.
Type: Galvanized steel Black steel Mastic Other (specify)
Casing depth. FI.0111 to ft. (reference to lattd surface)
Cashig extends above ground , inches
(b) NO X
(3) Grout (grout the vertical length of (lie borehole to a III iniinum dep III of 20 feet b.1.s.):
(a) Grout type: Cement Bentonite _ X Other (specify)
(b) Grouted surface and grout depth (reference to land surface):
arowid closed Tool] pipllig; from D to (feet).
around well casing; from to (feet).
NOTE: TI1L W 1:LL DRILLINU CONTI AC ORt CAN SUPPLY TI iE DATA FOR Errl [L•:it EXISTING Oft
PROPOSE!} WELLS 11' MIS INFOR-MA"rION IS UNAVAIt.A13LL UY 0T11Et(Mi;ANS.
GW-57 CL (May 1999) Page 2 of 4

J/1
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.
(!)
(2)
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 heat pump well system. Label all
features clearly and include a 111,11'lh arrow.
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 arc related to the site.
Examples include:
(I) 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 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 lo construct, operate, maintain,
repair, and if applicable, abandon the grotind-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
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 15A NCAC 2C .0200)
GW-57 CL (May 1998)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Progrnm
Grounc.Jwatcr Section
North Carolina DENR-DvVQ
P.O. Box 29578
Raleigh, NC 27626-0578
Telephone [phone]
Page 4 of 4