WI0800116_GEO THERMAL_20040722

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
July 22, 2004
To: Charles Stehman, Regional Aquifer Protection Supervisor
Aquifer Protection Section
Wilmington Regional Office
From: Thomas Slusser /,.JS
Central Office
Re: 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 Mr. William Scheick at North
Topsail Island, North Carolina. A copy of the notification is included with this memo. This injection
well system is deemed permitted by rule (15ANCAC 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 (919)
715-6166.
cc: CO-UIC Files
Enclosures
&~~A ---;~_. ---NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William Scheick
TBF Properties, LLC
1020 Dickinson Circle
Raleigh, NC 27614
July 22, 2004
RE: Notification of intent to construct Type 5QW injection wells
Dear Mr. Scheick:
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
In accordance with the notification you submitted to the UIC Program dated July 3, 2004 the
Aquifer Protection Section acknowledges your intent to construct [6] closed-loo p geothermal
water-onl y injection wells for the operation of a ground-source heat pump at Lot IO on Osprey
Drive, North Topsail Beach, in Pender County. The system as described in your notification is
deemed permitted by rule (North Carolina Administrative Code Title 15A: 2C.021 l(u)(2)) and
will not require an injection well permit from the state, but you should check with your county
health department prior to constructing the system because they may have additional
construction or permitting requirements for this type of system. If you modify your system at any
time, including the addition of antifreeze, corrosion inhibitors, or any other substances to the
circulating fluid, you must contact the Groundwater Section to verify compliance with applicable
rules.
Thank you for submitting this notification. Please contact me at [phone] or Evan Kane at
[phone] if you have any questions regarding geothermal heat pump wells or injection
well rules.
Cc: Charles Stehman, IN I/:?. o
Aquifer Protection Supervisor
CO-UIC Files
Aquifer Protection Section
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
2728 Capital Blvd., Raleigh, North Carolina 27604
Phone: [phone] / FAX: [phone] / lntemet: http://gw.ehnr.state.nc.us
Best regards,
~-
Thomas Slusser
Hydrogeological Technician II _
Underground Injection Control Program
OnehC 1· Nort aro 1na
An Equal Opportunity/Affinnative Action Employer-50% Recycled/10% Post Consumer Paper ✓-Nnturnllu
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 wells in an open-loop ~eothermal system.
TO:
A.
Do not use this form for systems that circulate an y sub stan ces other th an water.
DIRECTOR, NORTH CAROLINA DMSION OF WATER QUALITY
DATE: ;F//t.Y 3 . 20o/l/'
c._
C: r-
SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuol!,...
piping that completely isolates the fluid from the environment?
YES X If yes, then continue completing this fonn .
NO __ If no, do not complete this form. Fonn GW-57 HP, Application For
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
N ..
w
0
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.
C.
D.
Ver.3/01
YES __ If yes, do not complete this form. Fonn GW-57 HP. Application For
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
NO . • X If no, then continue completing this fonn.
PROPER'JY OWNER
\.rv'ill.·o.ftl Schtict
Name: 7/J r /k d/>~'f?E.-5 LL c
Address: /CJ t,o v 1cK/NSM.J c>.;ectt.t!:.
City: AJ~e,<Pc{ State: N c. Zip Code: _£_7_6._~ .. r' ______ _
County: /4/At<c. Telephone : m -£:'l'l -t'o,S,£
STATUS OF PROPER1Y OWNER
Federal: Commercial: Private:_K_
State: Municipal: __ Native American Lands:
GW/UIC-57CL Page 1 of4
r ,
.z.
E. JOB (SITE) DATA
Name of Business or Facility:
Address: 4�' t /0 05O r = VP.
City: a - State:_ALCe Zip Cade: - —County:
Telephone: Contact Person. — - -
Standard Industrial Code(s), SIC, which describes commercial. facility: — --
F HEAT PUMP CONTRACTOR DATA
Name: Climate Control Heating. & Cooling Co._ Inc_
Address: 102 Middle Street
City: Jacksonville State: NC Zip Code: 28546 County: Onslow
Telephone: [phone] Contact Person: Michael Hadley
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
constriction specifications. Submit Form GW-1 after construction.
(1) Well Drilling Contractor's Name: Sanford L. SweetiM,
NC Contractor Certification number. NC - 2082
Date to be constructed: Number of borings:
Approximate depth of each boring (feet):
(2) Well casing: Is the well(s) cased?
(a) YES If yes, then provide the casing infonnation 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.l.s_):
(a) Grout type: Cement Bentonite X Other (specify) _ - -
(b) Grouted surface and grout depth (reference to land surface):
X around closed loop from 0 to 200 (feet). i .
,5 6 �j�Ujr
around well casing; from to (feet).
NOTE: TIM W ELL DRILLING CONTRACTOR CAN'RIPPLY THE DATA FOR EITHER MSTING OR � _ -
PROPOSED WELLS IF TM IN`FORMA710N IS UNAVAILABLE BY OTHER MEANS.
Ver.3101 GWIUIC-57CL Page 2 of 4

G. 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.
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 fucilities 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)
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 pennits
(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, 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 Pennit."
u/~4~
(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-57CL Page 3 of 4
L. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
Ver.3/01
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)
.£/~ J/ d~ (r.1r ~1t1t-1 tlc)
(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]
GW/UIC-57CL Page4 of4
07/ 09/2004 I0: 42 9196756433 DAVID PFANNIIL.L.ER
97/07/2004 15:14 9103531060 CUYAT'E CONTWIL.
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