WI0800089_GEO THERMAL_20020208

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
February 8, 2002
To: Charles Stehman, Ph. D ., L.G., Regional Groundwater Supervisor
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl f1.e [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 (type SQW injection well.)
Notification to construct and operate a well for a closed-loop geothermal heat pump system has
been filed by Coastal Carolina Community College in Jacksonville, North Carolina and a copy of
the Notification is enclosed for your files. This injection well system is deemed permitted by
rule (NCAC Tl5A: 2C.21 l(u)2) and no regulatory action is necessary. If you have any
questions, please contact me at [phone].
cc: CO-UIC Files
Enclosures
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
February 8, 2002
David Heatherly
Coastal Carolina Community College
444 Western Blvd.
Jacksonville, NC 28546
Dear Mr. Heatherly:
Gregory J. Thorpe, Ph-D.
Acting Director
Division of Water Quality
In accordance with the notification submitted on February 1, 2002; the Groundwater Section
acknowledges your intention to construct a closed-loolr geothermal water -only injection well
system 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,0211(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 h= to contact me at
[phone] or Evan Kane at [phone],
Sincerely,
MORI,
Mark Pritzl
Hydrogeological Technician H
Underground Injection Control Program
cc: CO-UTC Files
WIRO-[TIC Files
Rn�
Customer Service Division of Water quality 1 Groundwater Section
1 800 623-7748 1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF UMNT TO CONSTRUCT A CLOSED -LOOP
GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM
(GROUND COUPLED HEAT PUMP)
Type 5QW WeUs
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 oven, -Iooy geothermal system.
Do not use this form for systems that circulate any substances other than water.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: JanuaU 30,
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the enymmment?
YES X If yes, then continue completing this form.
NO If no, do not complete this form. Form GW-57 HP, Appliccrtion For
Permit To Construct And1Gr Use A Wells) For Injection With A Heat
Primp System., should be completed.
B. SYSTEM FLUID Will any additives be introduced to the syste&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 Heat
Pump System, should be completed.
NO JC if no, then continue completing this farm.
C. PROPERTY OWNER
Name:.,_ Coastal C raliu CQnimunity College
Address_ - 414 Wesm Blvd
City:Jacksonville State: NC Zip Code: 28546
County: Onslow Telephone:. (910)_455-I221
D. STATUS OF PROPERTY OWNER
Private: Federal:
State: —X— Municipal:
GW-57 CL (Jan, 2000)
Commercial:
Native American Lands:
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Page l oF4

E: JOB (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility: Coastal Carolina Community College
Address: 444 Western Blvd
City: Jacksonville State: NC Zip Code: 2 8546 County: Onslow
Telephone: [phone] Contact Person: D a 'd Heatherl
Standard Industrial Code(s), SIC, which describes commercial facility: _______ _
F. HEATPUMPCONTRACTORDATA
Name: Qimate Control Heating & Cooling Co., Inc.
Address: 102 Middle Street
State: NC Zip Code: 28546 County: Onslow City: Jacks onville
Telephone: [phone] Contact Person:M ==i=ch=a=e'"-'l H=adl==--ey,___ _____ _
G. 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-1 (Well Construction Record) if available.
X 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: =Sanfi=o=r .... d=L=·-=S=w=e=enn=· =g,_ ______ _
NC Contractor Certification number: ~N~C~---=20=8=2 ___________ _
Date to be constructed: 02-01 -02 Number of borings: _l_
Approximate depth of each boring {feet): __ 2=00=----
(2) Well casing: Is 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 _x:....=........ __ _
(3) Grout (grout the vertical length of the borehole to a minimum depth of 20 feet b.1.s. ):
{a) Grout type: Cement __ Bentonite ..x_ Other (specify) ______ _
(b) Grouted surface and grout depth (reference to land surface):
__x_ around closed loop piping; from .JL to~ (feet).
__ around well casing; from __ to __ {feet).
NOTE: THE WELL DRil.LINGCONTRACTORCAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
GW-57 CL (Jan, 2000)
G. INJECTION-RELATED EQUIPMENT
Page2of4
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.
H. 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).
(3)
PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(l) 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 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 cppditions of the Permit."
(Signature of Well Owner or A orized Agent)
If authorized agent is acting on behalf of the well
❑wner,
please supply car letter signed by the owner
authorizing the above agent.
GW-57 CL (Jan, 2000) Page 3 of 4

.
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-57CL
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UICProgram
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
(Jan, 2000) Page 4 of 4
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