WI0800120_GEO THERMAL_19981229

GROUNDWATER SECTION
December 29, 1998
MEMORANDUM
To:-Charlie Stehman-
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl flf [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 an injection well system for a geothermal heat pump system
has been filed by Vickie and Tom Matheson of Wilmington, North Carolina and a copy of the
Notification is enclosed for your files. This injection well system is deemed 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].
cc: UIC Files
Enclosures
, 7f)
NCDENR..
JAMES B. HUNT.JR.
GOVERNOR
Vickie & Tom Matheson
WAYNEMCDEVITr. 1639 Allens Lane
SECRETARY Wilmington, NC 28403
Dear Mr. & Mrs. Matheson:
A PREST'ON HowAno,
NORTH CAROLINA► DEPARTMENT OF
ENVIRONMENT ANo NATURAL RESOURCES
DIvis[ON OF WATER QUALITY
December 18, 1998
P. In accordance with the notification submitted on your behalf by Energy Earth dated
bIREGTOR >. ;., T December 14, 1998; the Groundwater Section acknowledges your intention to
._ r •.
,. x,'k - _ � construct closed -loop geothermal water -only injection wells for the operation of a
x^
a•�
ground -source heat pump. The system as described in your notification will not
�",`y''•`�'•,'T;A require an injection well permit and is deemed permitted by rule {North Carolina
r"•f Administrative Code Title 15A; 2C.Q21I(u)(2). The Underground Injection Control
sxy - •I ,• ' �' :, a ..: b
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].
lS Sincerely,
Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Program -
cc: UIC Files
WIRO Files
GROUNDWATER SECTipN
P.0 BOX 29578, RALEI6H, NC 87626-O578 - 2728 CAPITAL "VD,. RALEIGH, Nc, 27604
PHONE Big-733-3221 FAX 919-71 5-OSSO
AN SgUAL OPPOSTUNITY I AVFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% FGST-CONSUMER PA6P'G"

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A _CX,O_ SEID-LU(&
GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM
(GROUND COUPLED I1EAT PUMP)
Type 5QW '
the proper forin to be used i'ar ingeetieii ;vcll- ti, ►.;t t,,�rt 1�� Beet:,. •�,
than -
-r0: �,1>t.�.e�'OR., NOx•r1� cA1�0>w�`� T)1��Stt3�:, t.rx� ,� .�,
DATE: _jz 7
A. � 3t� ]EiouS
that completely
YES
NO i L-:'ij (AV-5 ' 'For
Heat
-rt :ivss .:r.'s -_irL:uladng heat transfer
fluid? . „i., v0or antifreezes.
yr.S g-p• .4pplic(ilton For
For lrjrcr.'cr+ .' ' 1 Heat
NO If no,1! en coatinu L:�,ryrsl ri,�
t'tSUr hK1t Y UWNEK
aik�. - —
kddress
Git}: W AotiAAJ'aj� Sta!e �C•. zip t'c�• e _ rJ - --
CoLiih n►aWR_— Telep uaze `?ice d
Privete: C oo;
,ta:e� ._ _ands'
G W57 CL (May 1998) Page i of 4

E. FACILITY (SITE) DA TA
(Fi!! 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 describe~ commerci.e.1 facility :
HEAT PUMP CONTRACTOR DATA
Name: £N t.. R. Yr £A ~--_
Address: CJO to Sc(~ VB I\~\/_&~--.
City: w ,\rn I N':!)\O,.J State: _01.r..., Zip Code: ~.£.Cou!1~ ru,e.w HANCl~et\....
Telephone: __ '7 f c) ? 9 ~ CJ a '.a~ Contact Person: -~ c.. K CJMR.. t e.tv
G. COJ\STRUCTION DATA (check one)
E-XIST1NG WELL(S) being propc,~d tt-r use as a ground-coupled heat pump
well(s). Provide the information in (l) through ( 4) belo ·w to the best of your
knowledge. Attach a copy of Form GW-1 (Wdl ConstTUction Record) if available.
X PROPOSED \VELL(S) to be constructed fer use as a ground-coupled heat pump
well(s) . Provide the informaTii:in in (1) through (4) below as PROPOSED
constn.iction specifications. Submit Fom: GW-1 r.fter construction .
(1) Well Drilling Contractor's Name: G/;MA,7?.c Cotffia} H~ ..,--C/1, ld ,
NC Driller Registration Illtmber: ill 3 __
Date to be constructed: _/-Z:,48' __ Number of borings: _ }K __ 3~----
Approximate depth of each boring (feet): ____ lk£)"-'--
(2) \Veil casing. ls the well(s) cased?
(a) YES If yes, then provide che casing information below.
Type: Galvanized steel ___ Black ~tee-! ___ f'last:.-; __ Other (specify)_~---
Casing depth: From ___ to ___ ft. {reference to lalld surface)
Casing extends above ground~--inches
(b) NO _25_
(3) Grout (grout the vertical length of the borehole to a minimum depth of 20 feet b.l.s.):
NOTE:
(a) Grout type: Cement__ Bentonite .l( Other (specify) ______ _
(b) Grouted surface and grout depth (reference to land surface):
_j(. around <;losed loop piping; from Q to 2{) (feet).
_ around well casing; from __ to_ (feet).
THE WELL DRILUNO CONTRACTOR CAN SCP PLY THE DA TA FOR EITHER EXISTING OR
PROPOSED WELLS [F THIS INFORMATION rs t1"AV l-,[!.A.BLE BY OTHER :VIEAl\'S.
GW-57 CL (May 1998) Page 2 of4
H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering Layout of the injection equipment and exterior pipingltubing
associated with the injection operation. The manufa%.turer's brochure may provide supplementary
(nformation,
LOCATION OF WELL.{S) Attach two maps.
(1) Include a site snap (car, be drawn) showing- buildings. ptoperrn; lines surface eater bodies,
potential sources of groundwater contamination arJ the cr:a: tat;,n of and distances b,.Vieen
the proposed wel1(s) and any existing wells) or waste disposal faciiities such as septic tanks
or drain fields Iocated within ZOQ feet ofth9 groan.d-coupled heat pump well system. Label all
features clearly and include a north arrow.
(2) location map referencing the site to two nearlb) permanem reference points (such as roads,
strearn3 and highway intersections).
PERMIT LIST: Attach a list of all perrnits or constructio;: apP-V, als that are related to t17e site.
Examples incit;de:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of WKter Quality ikon-Dis;harg.e permits
(3) Sewage, Treatment and Disposal Permits
K. CERTIFICATiON
"I hereby certify, under penalty of taw, that I have pzrsrna!ty exam,red and am familiar with the
infortr..ation submitted in this document and all attac"rnsnts thereto and that, bastd on my inquiry of
those individuals immediately responsible for obtaining said information, I be[ieve that the information
is true, accurate and complete. I am aware that :here penalties, including the possibility
of fines and imprisonment, for submitting false informauor., l agree to construct, operate, maintain,
repair, and if applicable, abandon the groLnd-source hear pump system and al related appurtenances in
EWcordar-, a with the approval specirmcations and ,,ondit;cros of the Permit."
�1
(SignatkiTe of Well Owner or Authorized Agent.)
GW-57 CL (May 1998) Page 3 of

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 ogler than the Fpplicant, the property owner hemby consents to
allow the applicant + } construct each injection well as outlined in this application and that it shall be
the responsibility of wte applicant to ensure that the grotinti -source meat pump system's welI(s)
conforms to the Well Construction Standards ( i SA INCAC 2C .020
(Signature O► u� -r If Different From Applicant)
ple,;e rc—%Irn - of the tli iile�alin�
VIC program
Groutndwattr Section
North Carolinas DENR-DWQ
P.U. Box 29578
Raleigh, NC 2 +626-05^18
Telephone [phone]
OW-57 CL (May €998) Page 4 of 4

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NOTES
1. AREA COMPUTED BY D. M. D. METHOD
2. ALL ❑ISTANCES ARE HORIZONTAL
3. FOR REFERENCE SEE AS NOTED
4. IRONS AT ALL CORNERS
FA
01
LOCATION MAP
( NOT TO SCALE j
r'
SITE
s
LOT 22 /
Ir
If
ff
S 49' 29' 19" E 385.30 f
TO THE INTERSECTION OF /
ALLENS LANE AND /
OLEANDER DRIVE /
�f
1639 ALLEN$ LANE.
W I LM 1 NGTON, N. C. 28403
THIS PLAT REPRESENTS AN ACTUAL SURVEY THAT MEETS OR EXCEEDS
THE REOUIREMENTS OF A CLASS 9 SURVEY IN ACCORDANCE WITH THE
STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH CAROLINA.
THIS PRDPERTY 15 LOCATED —IS NOT LOCATED 2 WITHIN A
SPECIAL FLOOD HAZARD AREA ACCORDING TO FLOOD INSURANCE
RATE MAP COMMUNITY PANEL #370188 0085 E EFFECTIVE DATE SEPT. 3, 1992
THIS MAP IS NOT FOR RECORDATION
MAP FOR
IfIIfII/,,
���•�� CARO '''f{,
Q 'A
SEAL _
L-2876
su
rrr� C 'A'.
��1�I1 III111 g�
�7RE A. WR ME X5 L -297'6

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SOIL & GRAVEL
N ss• DRIVE �'qg
4p PUMP
HOUSE
rdp • �M� hod p
0
011,
NOTES
1. AREA COMPUTED BY D. M. D, METHOD
2. ALL DISTANCES ARE HORIZONTAL
3. FOR REFERENCE SEE AS NOTED
4. IRONS AT ALL CORNERS
LOT 22 / I
II
S 49' 29' 1 9" E 385.30 /
TO THE INTERSECTION OF /
ALLENS LANE AND /
OLEANDER DRIVE
1639 ALLENS LANE
W I LM I NGTON, N. C. 20403
THIS PLAT REPRESENTS AN ACTUAL SURVEY THAT MEETS OR EXCEEDS
THE REQUIREMENTS OF A CLASS B SURVEY IN ACCORDANCE WITH THE
STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH CAROLINA.
THIS PROPERTY IS LOCATED —IS NOT LOCATED Z WITHiN A
SPECIAL FLOOD HAZARD AREA ACCORDING TO FLOOD INSURANCE
RATE MAP COMMUNITY PANEL # 370168 0085 E EFFECTIVE DATE SEPT. 3, 1992
THIS MAP IS NOT FOR RECORDATION
MAP FOR
TH OM AS A. MATHESON
LOT 21
TOWNSHIP HARNETT
SECTI❑N N\A COUNTY NEW HANOVER
BLOCK N\A NORTH CAROLINA
REFERENCED.B. 1298 PC. 734 DATE SURVEYED 1-30-98
SUBDIVISION J.S. ALLEN LAND
III of j jj/�
CARQj�'rf'r.
D• 1
SEAL
1. L-2876
A• I+ Vt ti
e A. WAYIVE A L-2876
40 20 ❑ 40
SCALE IN FEET
1" - 40
HANOVER DESIGN SERVICES, P.A.
LAND SURVEYORS ENGINEERS & LAND PLANNERS
319 WALNUT STREET
WILMINGTON, N. C. 2EI401 J
PHONE: [phone]
4724-96KNOI

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