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Home My WebLink AboutWI0800126_GEO THERMAL_20051108WA1. ..... j7 f2 ' > ---j o";:=~~' Michael F. Easley, Governor William G. Ross Jr., Secretary North Carolina Department of Environment and Natural Resourc~s Alan W. Klimek, P.E. Director Division of Water Quality November 8, 2005 Ginny and Dennis Minday 13 7 Sound Boulevard Newport, NC 28570 Ref: Notification oflntent to Construct Type SQW Injection Well Dear Mr. and Mrs. Minday: In accordance with the notification submitted to the Underground Injection Control (UIC) Program and received on November 7, 2005 the Aquifer Protection Section acknowledges your intent to construct five closed-loop geothennal water-only injection wells for the operation of a ground-source heat pump. 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. However, you should check with the Carteret 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 919-715-6166 or Evan Kane at 919-715-6182 if you have any questions regarding this transmittal or the UIC Program. cc: Charlie Stehman, Wilmington Regional Office Phil Livermander, Professional Heat & Air CO-UIC Files Aquifor Protection Section lntemct: http ://h2o.enr.statc.nc.us 1636 Mail Service Center 2728 Capital Boulevard Best Regards, Thomas Slusser Hydrogeological Technician II UIC Program l o~1"Oo00/2..6 N~hC.:anilina ;Vnt1m1/ly Raleigh, NC 27699-1636 Raleigh, NC 27604 Phone (919) 733-3221 Customer S~rvice Fax (919) 715 -0588 1-877-62.l-(,74& Fax (9 I 9) 715-60-18 An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper 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 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 open -loop geothermal system. Do not use this form for systems that circulate p2 substances other than water. TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY DATE: If- 4/ . 20 C A, SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous piping that completely isolates the fluid from the environment? YES If yes, then continue completing this form. NO If no, do not complete this form. Form GW-57 HP, Application For Permit To Construct A► dlOr Use A Well(s) For Injection With A Heat Pump ,System, should be completed. B. SYSTEM FLUID Will any additives he introduced to the system's circulating heat transfer fluid? This includes, but is not limited to corrosion inhibitors and/or antifreezes. k•ill4y NO If yes, do not complete this form. Form GW-57 HP, Application For Permit To Construct And/or Use A Well(s) For Injection With A Heat Pump ,Syvtem, should be completed. "lCi FildikG Ali 5E If no. then continue completing this form. Name: N+ f 4i^wN W l: W Address: 6 v City: �.! o,>~fi state: zip Cade: County: /+P e.r� Telephone: D. STATUS OF PROPERTY OWNER Private: Federal: Commercial: State: Municipal: Native American Lands: Ver.3101 C9Y111101161"M �o �►,4b t , a12ofi Page i of 4 TA E. (SITE) DATA (Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial). Name of Business or Facility: A I� r hcr � City: P. J State; IGZip Code: Caunt�: ( � Telephone: .L529 D Contact Person: g nr fijr al, n� Standard Industrial Code(s), SIC, which describes commercial facility- R HEAT PUMP CONTRACTOR DATA // Name: �r�d id,.! �'! t-f'l + Address: Z i - �/i`rtlt� City: or#• State: 2 C-Zip Code: Z County: L r c•r Telephone: 2 2 Z4_ Z 7 Contact .Person: Ne47 L • irrv- 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 GW-1 (Well Construction Record) if available. PROPOSED WELLS) 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-1 after construction. (1) Well Drilling Contractor's Name: Cd A-i _f*) LTA :Srx,�.Aj NC Contractor Certification number. bg'I-- Date to be constructed: —.1 Z r0_!�' Number of borings: S Approximate depth of each boring (feet): (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.I.s.): (a) Grout type: Cement Bentonite -A- Other (specify) - (b) Grouted surface and grout depth (reference to land surface): around closed loop piping-, from to C-06 (feet). around well casing; from to (feet). NOTE: THE WELI, D]ULI-ING CONTRACTOR CAN SUPPLY TIIE DATA FOR MHER EMMNG OR PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OnMR -WANS. Ver.3/01 GW/MC-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 injection operation. The manufacturer's brochure may provide supplementary information. I. 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). J. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site. Examples include: (1) Ha7.ardous Waste Management program permits under RCRA (2) NC Division of Water Quality Non-Discharge permits (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 Permit." /,(Si~Agent) If auth.orized agent is acting on belialf of the well owner, please supply a letter signed by the owner authorizing the above agent. GW/UIC-57 CL Page 3 of4 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.) 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 (919) 715-6165 GW/UIC-57 CL Page4of4 •MSN Maps & Directions - Map Print Page 1 of 1 If'1mPO Maps & Directions Sound Blvd, Newport SIC 28570 li' -Broa C T 71 9 k=Pted"wmR* V -- �, liowpt yyl �'MBpP� 1/ 1�' A'E1Esound 9 Your right to use maps and routes r�e�erated on the MSN service is su��ect at all times to the MSiJ Terms of Use. pia _credits. wD]'�9�it and disclaimer. http:Ilmappoint.msn.coml(dirqup45daligt55a5wf5fyx)lPrintMap.aspx?MPMtd=M&L=US 111412005 s