WI0800099_GEO THERMAL_19980722

GROUNDWATER SECTION
July 22, 1998
:MEMORANDUM
To: Charles Stehman
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl tLt f
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Receipt ofNotification for a Closed-Loop Geothermal Water-Only Injection Well System.
Notification to construct and operate an injection well system for a geothermal heat pump system
has been filed by Charles Kay of Jtr'i,ip; a copy of the Notification is enclosed for your files.
These injection well systems are deeme permitted by rule (NCAC TISA: 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].
I
cc: UIC Files
WIROFiles
Enclosures
A.
ICDENR
3AME8 B. HUNT JR.
GOVERNOR
WATKZ McDrvirr
SECRETARY
A. 12RE13TON HOWARD,
JR., P.E.
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
July 30, 1998
Charles Kay
311 W. Country Meadow Lane
Hubert, NC 28539
Dear Dr. Kay:
DfvISior4 OF WATER QUALITY
In accordance with the notification submitted on your behalf of Climate Control
Heating and Cooling Co., Inc. dated July 24, 1998; the Groundwater Section
acknowledges your intention to construct closed -loop geothermal water -only injection
wells 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 free to
contact me at (919) 715 - 6166 or Amy Axon at [phone].
Sincerely,
Ir
Mark Pritzl
Hydrogeological Technician 11
Underground Injection Control Program
cc: UIC Files
WIRO Files
GROUNDWATER SECTION
P.O BOX 29878. RA LEIG H, NC 27526-OS78 - 27Z8 CAPITAL BLVD., RALE1G K, NC, 27604
PHONE [phone] FAX [phone]B
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACT16N EMPLOYER - 50% RECYCLED/10% POST-CONSLFMER PAPER

NORTH CAROLINA DEPARTMENT OF
ENVIRQNMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
AV_
, June 25, 1998
NCQENR
Mr. Michael Hadley
Climate Control Heating and Cooling Company
GAMES B. H V N7 jR.
GOVERNOR 269 Center Street
Jacksonville, NC, 28546
Dear Mr. Hadley:
WAY1v1r. MCDEV1717
SECRETARY
On June 2, 1998 the Groundwater Section receiver] notifications of intent to construct
closed -loop water -only geothermal systems for Jeff Sprague, Charles Kay, Regina Lanier,
Larry McRacken, US Government at Camp Le]eune, Jim Bispo, and Sue Souhrada. These
A. PRESTON HOWARD, notices were submitted several months after the systems were installed. The Underground
JR_ P.E. Injection Control Group has added these sites to their inventory and is in the process of
DIRECTOR sending fetters to the property owners acknowledging receipt of the notifications.
Please note that NCAC Title 15A Subchapter 2C, Section .0211 requires that the person
responsible for the construction of the injection well system shall submit notification QEior
to construction. Therefore, in the future, please submit the enclosed GW-57 CL forms
(Notification of Intent to Construct a Closets -Loop Geothermal Water -Only Injection Well
System) before you begin construction of such systems.
Also, I have enclosed several GW-1 Forms (Well Construction Record). one form for each
well constructed should be submitted to the following address within 30 days of well
completion.
NC DENR
Division of Water Quality, Groundwater Section
P.C, Box 29578
Raleigh, NC 27626-0578
If you have any questions regarding these enclosures or injection wells, please feel free to
contact me at [phone].
Enclosures
Sincerely,
Zon,� �yAmy Program Manager
Underground Injection Control
GROUNDWA-MR SECTION
P,O BOX 29S78, RALEIGH. NC 27626-OS78 272.8 CmAPITAL BLVD„ RALCInW, NC, 27604
PHONE 9 S 9-733-3221 FAX R19-715-059a
AN EQUAL Opp Ol47UNITY 1 AVVIRMATIVE ACTION EMPLOYER 50% RECYCLE17/10% POST -CONSUMER PAPER

NURTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMNUSSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
NOT1FICATION OF INTENT TO CONSTRUCT A CL05ED-LOOP
GEOTHERMAL-WATER-iiNLY INJECTION WELL SYSTEM
(GROUND -SOURCE MEAT PUMP)
In accordance with the provisions of NCAC Title 15A: 02C.0211
complete notification and mail to address on the back page.
T1zis is not the Pj4 per _rrn for injection wells to be used in an opera-loo,J2
ground -source heat pump system. Do not use this form for systems that
re -circulate any substances other- than water below.the ground surface.
Type 5QW Wells
` Ot DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUAL=
DATE: , 19- L IS[-
Please type or print clearly.
A. SYSTEM CLASSIFICATION Does [lie proposed system re -circulate potable
water in continuous piping which isolates the fluid from the environment?
YES If yes, then continue completing this form GW-57 CL.
NO _ If no, do not complete. this fbnn. A forms GW-57 FIP
(Application[ For Permit To Construct An(l/Or Use A Well
For Injection With A Heat Pump System) must be completed.
B. SYSTEM FLU1D W41 any additives be bitroduced to the systein's subsurface
piping, including but not limited to corrosion inhibitors br antifreezes?
YES If yes, do not complete this form. A form GW-57 HP
(Application For Permit To Construct And/Or Use A Well For
Injection With A Meat Pump System) trust be completed.
ND 'e� If no, Bien continue completing this form GW-57 CL.
C PROPERTY OWNER
Narne. ekvIe.5
Address: ----�1 tv Wirt f 1► ,_ Id,
'I CCity: �� �'�� zip code: eU��9
County: VAIS fail) _ Telephone: LD• 3� / S
GW-57 CL (MarcIz 1997) Paire I of 4

D. STXI•US or• PROPERTY OWNER
Private: Federal:
State: Public:
Commercial: Native American Laauls:
E. FACILITY (srrE) DATA (Fill out ONLY if the Status of Property Owner is
Federal, State, Public or Commercial).
Name of Business or Facility -
Address:
City: Zip code: County:
Telephone: _ _ Contact Person:
Stand,ird Industrial Code(s) which describes Commercial facility:
F. HEAT PUMP CONTRACTOR DATA
Name:
Address: _ " q & A% t o 1 --
City: ^1_I�'�V+� e Zip code:
County- Telephone: d .
Contact (lersoll..
G. WELL Us],-- Will the system well(s) also be used as the supply well(s) for
your personal consumption?
YLS NO��
H. CONSTRUCTION DATA (CHECK ONE)
EXISTING W ELL(S) being proposed for use as a ground -source heat
pump welt(s). Provide [lie viformation in (1) through (4) below to
the Best of your knowledge. Attach a copy of.Form GW-1 (Well
Construction Record) if available.
PROPOSED WELL(S) to be constructed for use as a ground -source
heat pump welt(c). Provide the information in (1) t1wough (4) below
as PROPOSED construction specifications. Submit Form GW-1 after
construction.
GW-57 CL (March 1997) Page 2 of 4

NOTE:
(l) Well Drilling Contractor's Name:~t~·-'-/...:.tiJt.i.::...1.L.A✓i~~'.l---=----'~!:::/_!IL..:.-_::!!..!hl_:........i ____ ,
NC Driller Registration number: · 1"1 s3
(2) ·Date to be constructed: ·I I -q 7 : .
Approximate depth of each boring: / !J5 1
Number of borings:. __ ~!_lf:-#---
(3) Well casing: Is the well(s) cased?
(a) YES If yes, then provide casing information below.
Casing type: Galvanized steel _ I31ack steel_ Plastic_
Other (specify) ________ _
Casing depth: from. ___ to ___ ft. (reference to land surface)
(b) N) X
(4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement_; Bentonitels_;
Other (specify) ______ _
(b) Grouted surface and grout depth (reference to land surface):
-.l. around closed-loop piping; from ti) to (} ft.
_ around well casing; from ___ to ___ ft.
THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DAT A FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
H. LOCATION OF WELL(S) Attach two maps.
(1) a site map (can be drawn) showing 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-source heat pump well system.
(2) a location map referencing the site to a labeled road intersection.
GW-57 CL (March 1997) Page 3 of 4
1. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined
and am rainiliar with the inforration submitted in this document and all
attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtainiuig 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
well(s) and all related appurtenances in accordance with Title 15A NCAC
Subchapter 2C Section .0200." f'
Cs"'I 3�.C_ ) -
(Signature of Owner or tlioriaed Agent)
Please supply a laver signed by the owner
auliwrizing the above agent, ifauthorizerl agent is signer.
J. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or
other property rights in the well being constructed, n well is real property and its
construction on Iand rests ownership in the land owner in the absence of
contrary agreement in writing_}
If the pfoperty is owned by someone other than the operator, the property
owner hereby consents to allow the operator to construct a ground -source heat
pump system as outlined in this notification and that it shall be the responsibility
of the operator to ensure tliat the ground -source heat pump system's well(s)
conform to the Well Construction Standards (Title 15A NCAC Subchapter 2.0 .0200)
(Signature of Property Owner if Different From. System Operator)
Please retui-t► (fie completed Notificatim packiige to:
UIC Prograxn
Groundwater Section
North Carolina DEIINR-DWQ
P.Q. Box 29578
Raleigh, NC 27626-0578
(telephone: [phone])
OW-57 CL (Marelk 1`.�97) Rage 4 of 4

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