WI0800130_GEO THERMAL_20060313

David Heatherly
Coastal Carolina Community C~Hege
444 W estem Boulevard
Jacksonville, NC 28546
March 13, 2006
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
Ref: Notification of intent to construct Type SQW injection wells
Dear Mr. Heatherly:
In accordance with the notification submitted to the UIC Program on March 13, 2006, the Aquifer Protection
Section acknowledges Coastal Carolina Community College's intent to construct 91 closed-loo p geothermal
water-onl y injection wells for the operation of a ground-source heat pump system associated with the
Continuing Education Building. The system as described in the notification is deemed permitted by rnle (North
Carolii1a 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 pem1itting 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.
Please contact me at (919) 715-6 I 66 or Evan Kane at [phone] if you have any questions regarding this
correspondence, the UIC Program, or injection well rules and regulations.
cc: Charlie Stehmari, 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/Affinnative Action Employer-50% Recycled/10% Post Consumer Paper
Best regards,
~~
Thomas Slusser
Hydrogeological Technician II
UIC Program
Phone [phone] Customer Service
Fax [phone]
Fax (9 I 9) 715-6048
I
NOR1H 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)
RECEIVED/ DENR/ 0WQ
Type SQW Wells AQUIFER PROTECTION SECTION
In Accordance with the provisions ofNCAC Title 15A: 02C.0200 MAR 1 3 2006
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 substances other than water .
DIREC~ NOR1H CAROLINA DMSION OF WATER QUALITY
DATE:~ l O. 20 01'
SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
YES X If yes, then continue completing this form .
NO __ If no, do not complete this form. Form GW-57 HP, Application For
Permit To Constro.ct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
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.
YES __ 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 System, should be completed.
NO X Ifno, then continue completing this form.
C. PROPERTY OWNER
Name: ___ -------=C=O=A=ST=AL=-=C=AR=O=LIN=A=-C=-O=MMUNI===TY=-=--=C=O=L=LE=G=E=-----------
Address: 444 Western Blvd ___ ,.c-c-~~=~~------------------
C i ty: ______ J~ac~ks~o~n~vt_"l~le~ ____ State: NC Zip Code: ---~2~85~4~6 ___ _
County: Onslow Co. Telephone: [phone]
D. STATUS OF PROPERTY OWNER
Private: Federal: Commercial:
State:___x_ Municipal : __ Native American Lands :
GW-57 CL (Jan, 2000) Page I of4
E. JOB (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal., State, Municipal or Commercial).
Naive of Business or Facility: Coastal_ Carolina Community College
Address: 444 Western Blvd
City: Jacksonville State: NC Zip Code: —28546 County: _Onslow
Telephone: [phone] Contact Person: David Heatherl.
Standard Industrial Code(s), SIC, which describes commercial facility
F. HEAT PUMP CONTRACTOR DATA
Name: Humphrey Mechanical. Inc.
Address: 2421A N. Marine Blvd.
City: Jacksonville State: NC Zip Code: 28546 County: Onslow
Telephone: [phone]I8 Contact Person: Otis Mats burn
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 Constniction 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
construction specifications. Submit Form. GW-I after construction.
(1) Well Drilling Contractor's Name: Sanford L. Sweeting
(2)
(3)
NC Contractor Certification number. NC - 2082
Date to be constructed: Jan - March 2006 Number of borings: �r
Approximate depth of each boring (feet):
Well casing: Is the well(s) cased?
200'
(a) YES If yes. then provide the casing information below.
Type: Galvanized steel Black steel Plastic other [specify)
Casing depth: From
to
Casing extends above ground
(b) NO X
ft. (reference to land surface)
inches
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 piping; from D to 200 (feet).
around well casing; from -- to (feet).
NOTE: TILE WELL DRILLING CONTRACTOR CAN SUPPLY TTIE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS ItiIFORMATION IS LWAVAILABLE BY OTHER MEANS.
G W-57 CL (Jan, 20DO)
Page 2 of 4
w -:]-rgaal 3Q

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)
(2)
(3)
Hazardous Waste Management program permits under RCRA
NC Division of Water Quality Non-Discharge permits
Sewage Treatment and Disposal Permits
K . CERTIFICATION
RECEIVED/ DENR / DWQ
AQUIFER PROTECTION SECTION
MAR 1 3 2006
"I hereby certify, under penalty oflaw, 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."
GW-57 CL (Jan, 2000)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
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.)
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)
GW-57CL
(Signature Of Property Owner If Different From Applicant)
Please return two copies ofthe completed Application package to:
UICProgram
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
(Jan, 2000) Page 4 of 4
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