WI0800123_GEO THERMAL_20050318

Mike Hadley
Coastal Geothermal
102 Middle Street
Jacksonville, NC 28546
March 18, 2005
Ref: SQW Notification Submittal
Coastal Carolina Community College
Dear Mr. Hadley:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Thank you for submitting the Notification of Intent to Construct a Closed Loop Water Only Injection Well
System form on behalf of Coastal Carolina Community College, which was received on March 15, 2005. The
Underground Injection Control (UIC) Program received only one copy of the Notification to construct 168
closed loop water only injection wells. Please submit the required second copy along with the injection well
locations map, which we are unable to duplicate. In addition, please provide a more precise date of construction
other than the year 2005; this is too general and is unacceptable. The UIC Program understands that sometimes
a precise construction date can be difficult to identify, especially with this large of a project in development.
However, the UIC Program needs to be notified a sufficient amount of time prior to construction so we can plan
for an inspection or observation. You must notify the UIC Program one week before construction begins unless
a precise construction date is known at this time.
The UIC Program greatly appreciates your cooperation and prompt reply. Please contact me at [phone]
or Evan Kane at [phone] if you have any questions regarding this correspondence, the UIC Program, or
injection well rules and regulations.
cc: David Heatherly, Coastal Carolina Community College
Charlie Stehman, Wilmington Regional Office
CO-UIC Files
Aquifer Protection Section
Internet: http://h2o.enr.state.nc.us
1636 Mail Service Center
2728 Capital Boulevard
Raleigh, NC 27699-1636
Raleigh, NC 27604
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
Best regards,
Thomas Slusser
Hydrogeological Technician IT
UIC Program
Phone [phone] Customer Service
Fax [phone] l-877-623-6748
Fax [phone]
Michael F Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Depart neat of Hnvirortment and Natural Resources
Alan W. Klimek. P.E. Director
Division of Waterguaky
March 18, 2005
David Heatherly
Coastal Carolina Community College
444 Western Boulevard
Jacksonville, NC 28546
Ref: Notification of intent to construct Type 5QW injection wells
Dear Mr. Heatherly:
In accordance with the notification submitted to the UIC Program on March 15, 2005, the Aquifer Protection
Section acknowledges Coastal Carolina Community College's intent to construct 168 closed -loop geothermal
water -only injection wells for the operation of a ground -source heat pump system. The system as described in
the notification is deemed permitted by rule (North Carolina Administrative Code Title 15A: 2C-0211(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 roust contact the Aquifer
Protection Section to verify compliance with applicable rules.
Thank you for submitting this notification. Please contact me at [phone] or Evan Kane at (919) 715-
6182 if you have any questions regarding this correspondence, the UIC Program, or injection well rules and
regulations.
cc, Charlie Stehman, Wil"ngton Regional Office
CO -UM Files
Best regards,
Thomas Slusser
Hydrogeological Technician U
UIC Program
l ltCamI-
,�r12111 r!!7
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
lnternet: httpJlh2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604
An Equal Oppomnity/Afflrmatve Acfm Employer — 50% Recydedf10% Post Consumer Paper
Phone [phone] Customer Service
Fax (919) 7I5-0588 1-877-623-6748
Fax [919) 715-6448

Michael P. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department o£Environmcotand Natural Arsourecs
Alan W. Klimek, P.E. Director
Division of Water Quality
March 18, 2005
David Heatherly
Coastal Carolina Community College
444 Western Boulevard
Jacksonville, NC 28546
Ref: Notification of intent to construct Type 5QW injection wells
Dear Mr. Heatherly:
In accordance with the notification submitted to the LTIC Program on March 15, 2005, the Aquifer Protection
Section acknowledges Coastal Carolina Community College's intent to construct 168 closed -loon geothermal
water -only injection wells for the operation of a ground -source heat pump system. The system as described in
the notification is deemed permitted by rule (Noi#h Carolina Administrative Code Title 15A: 2C.0211(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 Aquifer
Protection Section to verify compliance with applicable rules.
Thank you for submitting this notification. Please contact me at [phone] or Evan Kane at (919) 715-
6182 if you have any questions regarding this correspondence, the UIC Program, or injection well rules and
regulations.
M. Charlie Stehman, Wilmington Regional Office
CO-UIC Files
Best regards,
45�"
Thomas Slusser
Hydrogeological Tecllnician Il
UIC Program
�lot[hcaaolim
)Valurally
Aquifer Protection Section 1636 Mail Service Censer Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: ht1p:#h2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax [phone]
Fax [phone]
An Equal Opportunity/AifirmaWe Action Employer —50% RecydaWl 0% Post Consumer Paper

r
TO:
A.
NORTH CAitOLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP
GEOTHERMAL WATER —ONLY INJECTION WELL SYSTEM
(GROUND COUPLED HEAT PUMP) r
_r
Type 5QW Wells LA
In Accordance with the provisions of NCAC Title 15A: 02C.0240
Complete application and mail to address on the back page. ram:
This is not the proper form to be used for injection wells in an open-lgMgeothermal system
Da not use this form for systems that circulate any substances other than water.
DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: Fe-6 7—t . 20 Or
SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
YES _ C If yes, then continue completing this farm.
NO If no, do not complete this form. Form GW-57 HP, Application For
Perm if To Construct AndlOr Use A Well (s) For Injection With A Heat
Pump System, should be completed.
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.
YES If yes, do not complete this form_ Farm GW-57 HP, Application For
Permit To Construct AndlOr Use A Well(s) For Injection With A Heat
Pump System, should be completed.
NO �X_ If no, then continue completing this form.
C. PROPERTY OWNER
Name&SS
Addre
City: Count
D.
Ver.3/01
STATUS OF PROPERTY OWNER
Private: Federal: Commercial:
State: Municipal: Native American Lands:
OW/l1TC-57 CL
Wy�A jiea�jler/%A , y.P. eyh 7
Page 1 of 4

E, FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial)
Name of Business or anility: �a ' �r �% i►rt�-►'ty I,
� Address: 1 f Mes'i Me-ti 0, .
City: : d.►IV,I I � State: IyU Zip Cade:
Telephone: '?(C — S` - / ili Contact Person:
Standard Industrial Code(s), SIC, which describes commercial facility: _
F- HEAT PUMPCONTRACTOR DATA
-
Name: ■. ef, 4)0-d -*,0.5 6
C/ou/n�ty:sW
Address: " ! NGfili e�-1 r . I)t
City: L i . r nJ State: !, C-Zip Code: '` 0 S Qnnty : t'
Telephone: G - 3 T- ' t cl Contact Person- - f �-4 z" - - -
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 (3) below to the best of your
knowledge. Attach a copy of Form OW-1 (Well Construction Record) if
available.
PROPOSED WELL(S) to be constructed for use as a ground -coupled heat pump
well(s). Provide the information in (1) through (3) below as PROPOSED
construction specifications. Submit Form GW after construction,�,C(1) Well Drilling Contractor's Name: 6kAl6�ec) �,+ ^��'r.� � me- ��''�
NC Contractor Certification number: 2�6e���
Date to be constructed: 2 d d - Number of borings: ■ Q
(2)
(3)
NUIT
Approximate depth of each boring (feet):
Well casing: Is the well(s) cased?
(a) YES
Type: Galvanised steel_
Casing depth: From
;2-0 0 e
If yes, then provide the casing information below.
Black steel
to
Plastic Other (specify)
ft- (reference to land surface)
Casing extends above ground _ inches
(b) NO JK
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)
[h] Grouted surface and grout depth (reference to land surface):
—4 around closed loop piping; from 0 to Zc)?j (feel).
around well casing; from to (feet).
THE wF:t.i.. DRU.LING CONTRACTOR CAN SUPPLY ME DATA FoR FrtHER zYISTING OR
PROPOSED WELLS IF ITUS INFORMAITON IS UNAVAILABLE BY OTHER MEANS.
Ver.3/01 G WCLIIC-57 CL Page 2 of 4

H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the infection operation. The manufacturer's brochure may provide supplementary
information.
L LOCATION OF WELL(S) Attach two neaps,
(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).
1_ 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 permits
(3) Sewage Treatment and Disposal Permits
R. 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 conditions of the Permit."
(Signature of Well Owner or Authorized ent)
ff authorized agent is acting on behalf of tine well owner,
please supply a letter signed by the owner
authorizing the above agent.
Ver.3t01 GWILU -57 CL Mega 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 contrmy agreement in writing.)
Ver.3/01
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)
(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-57 CL Page4of4