WI0800142_GEO THERMAL_20070327

Permit Number WI0800142
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
jesse . wise man
Permitted Flow
Facilit
Facility Name
William Schmalz SFR
Location Address
652 Creekway Cir
Bolivia
Owner
Owner Name
William
Dates/Events
NC 28422
Schmalz
Orig Issue
03/27/07
App Received Draft Initiated
03/26/07
Re g ulated Activities
Heat Pump Injection
Outfall . U ~.L
Scheduled
Issuance
Central Files: APS_ SI/VP_
03/27/07
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Wilmington
County
Brunswick
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
William Schmalz
652 Creekway Cir
Bolivia
Public Notice Issue
03/27/07
NC
Effective
03/27/07
28422
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
Michael F. Easley., Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alas} W. Klimek, P.E. Dircctar
Division of Water Quality
March 27, 2007
William Schmalz
652 Creek -way Circle
Bolivia, NC 28422
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Injection Water Only GSUP Well System {5QW}
Permit No. WI0800142
William Schmalz SFR
Brunswick County
Bear Mr. Schmalz:
In accordance with the application submitted to the Underground Injection Control (iIIC) Program which
was received on March 26, 2007, the Aquifer Protection Section (APS) acknowledges your intent to
construct a closed -loop geothermal water -only injection well system for the operation of a ground -source
heat pump. This system is located at 652 Creekway Circle in Bolivia, North Carolina.
This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C,
Section .0211(uj(2}}. However, it is recommended that you contact the Brunswick County Health
Department, as 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 APS to verify compliance with applicable
rules.
Thank you for submitting this notification. Please call Qu Qi at [phone], or email him at
uu.gncmail.net if you have any questions regarding geothermal heating or injection well rules and
regulations.
Sincerely,
Jesse Wiseman
Aquifer Protection Section
Enclosures
cc; Wilmington Regional Offtcc - APS
Al'S Central Files - Permit No. W10800142
Aquifer Protection Section 1636 Mail Service Center
internet: w".ncwaterauaiirK%g Location: 2729 Capital Boulevard
An Equal Opportunity ATimiative Action Empiayer 50% RecycledllD% Post Consumer Paper
N n`hCaroliita
�lw"Allif
Raleigh, NC 27699-1636 Telephone: [phone] l
Raleigh, NC 27604 Fax L M 9] 715-0588
Fax 2: (919) 715-604&
Customer Service: [phone]

From:OBRIEN SERVICE CO. 910 799 5884 03/09/2007 12:37 #045 P.001
0-V a 8lVIF17 14: 31 2015739658 WEsT RIDGE SCHOOL. PAGE a2
FrariT8R I EN SERVICE 00. 910 799 5884 08/09/2007 11: a5 #040 P ,002
NORTH CAROLINA
DEPARTMENT DF ENViRONI►aWr AND NAM AL A3SCURCES
NOTMCAIION OF fNTF.NT TO CONSTRUCT A C>LQ , -LouP
GEUTI M AL A,URB —ONLY INJNCTION WELL SYSTEM
(GROU" COUPLED HEAT PUMP)
Type SQW Weir
In Actaxdance witli lb,e pnviaivne oFNCAC'[ift LM 0=0200 —
Cmpleta applimdan and mail to adaeesa oss the f x4 r4p,
This in W&tht proper farm to bin uird Car Inlecdon w4IN in an eQo �14eo,geotll�r��rl ay�em
VDAZU5 ttlie trYna t� ayatems t3s at etxcaipte wtLv �ubtieenca�jiarfae,
TO: DIMaCMR, NORTH CA QLINA DMOIDN OF WATER s�C.lALr :r
DATE; 31
A. SYSTEM CLABSIFICATION I]cvsa the pNpased syi!k�ar aittvinte p�l�la wetaris, aonts►�Unus
piping that campletelyi0alstea the fluid Exam 1ba envhcrocnt?
YES If yes, then cotiftus enmplaiwthie fQML
NO Farm GW47 HP, 4PP11cattan For
PernxH To Conitruar Ae WOF Usa A. WePW Fbr Iq jacdon MA A Nkat
Pump 3jjtersr, ahaWd ba aamplmd.
15. SYSTEM FLUD Will Bty additives be iairpduaad to tine sysk,-m's aireuladag bmt tmnafir
ff V TX% inoludae, but it nut iimitad to corraeiat irtlsibitut4 w for entifa►xw
YES If yea, do Oat F.OU IONWE urns. Farris QW-57 HP, Appli m0cn For
Permit Tn CmNfmdr,4ndA:)r Ucx t Whh A Rcaf
pamp Smrem, ahvuld be completed.
I�TO If nc, tlsass contit7us ev 7l g :hia than.
C, PROPMTY OVINEP,
Nana:
Addre
City,
Count
D. STATUS OF PROPEKTY OWM
Privitc Fadml:
Btata: MsssctpaL
Comwercinl; _____
Native A:netican lAa6.
RcApad V0 GWfMC-57 CL Page I of

From:OBRIEN SERVICE CO.
910 799 5884 03/09/2007 12:38 4045 P.002
RVEIR/20V 14:31 M673WER
From: 03R IFS! 50I CE M.
WEST RIDrPE SQ-1001 PAGC F�
910 79S 5884 03/08/2007 11:06 C40 P .003
$, FACTUr Y (MR) DATA
dill nut ONLY if the Statue of Owner is ,?edf-M6 State, Munloipal or Commsmial).
Nameaf Bnaincon oriacttity: _
AdcLmvi- _
City. State; _, , Zip Code. County;
Telophoea: C:uutsct Feroon:
Staudmrd lridsratrW CuWd), 510, wbiah dc.Rariha8 aammetcial f4itys
V. HEAT PUMP 1C7NL MCT0it DA'A
Name, r+t r r t� _
Addroas:
City. Zip Coda! Carroty, ��,
xetaplkn�a: - Contact Parade; cn�
G. CONSTAMMON DAU (aheak one)
EXISTING WELL(S) being pmpoaed for us, as A gad-ooupled beat pump
wetl(s). Provide tl* Wermation In (1) through (3) belOW to tho beat of your
lmowledga. Attach a copy of Form QW-1 ('Wetl Cftatruation Recurd) if
Bvallabla.
FROPOSSID WEt.I. R) to bs cntlaw=h!d for uaa f1B a pumd•cvupled hCat P=P
we11(a), Frovids tba lnfo=%lion in (1) through (3) below al FROPOSED
c1nmtrvpripx sge01001ttiolm Submit It= GW-1 aft eauasu4tinn,
(1) ii @4 Deiilia8 CoAtractac1,p Noma: L C'fa��i :' ' f 4`r A -j, v
NC f ontractor 0%tTwien number, 2 0 Z
Data to ba aenetrUckad:Api I -zw0 Nutrbu abosinp,
r
AppmxIMAte depth of eeett botiag (hot)' 2—o6
(2) Wsil oiling: Is the weirs) CU647
(a) YES If yes, edam provide the teeing idlbrm4li n below,
T"; GLvhnived Usat Eta* ateat Ptaeiie Gib= (apedfo
Gaoina depth.: rram . to A. (rafereaae to lead BurN o)
CaBing odmde Above gwund- ._ 1 C119b
N NO
(3) [3-out (grout the vertical les o of the bomhole to a miniMUM $apth of 2D flit b1,s.):
(a) Clrauttype: Cemeat $enmaita- C*ar(ePW4) _
(b) Grouted surface end grout depth. (reference to laud mirihca);
_) arouad closed loop piping; fr mn_L to 2�, *t).
— arm ind well caning; from to _(fat),
NDM TH6 WSLL t]RUU4G =TRAM1K CAN 9MLY VKM vATA FOR Tiii'M 1;Xt5 VQ flF
PRaP055D WELL@ M 11M WC"ATiaN K WAYAMAXI BY PTKLR MEANS.
-3Ravia14 1/05 OWA.l10.57 M Pegs 2 af4

From:OBRIEN SERVICE CO. 910 799 5884 03/09/2007 12:38 #045 P.003
~3/08/2~~7 14:31 2fl1573E!GSl3 \I.JEST RIDGE: SCHOOL PAGE: P.14
From:OBRIEN SERVICE ao. 910 799 5884 08/09/2007 11:06 #040 P.004
H. .lNJ'iC!TION~'SLATBD SQUJl'MENT
Atta,m a dtllfl\m 11bDWit:ld the •@lneoriq layoUl of the lttj.,~on oquipma11t and ex1erior piPUli/tUblna
a1111or;iiattcl with the lqf cctl011 oparat:l.cm, Th, m•nutaetu.-.·, bri:lchurQ wy provide 1u,ppl111mimtazy
, itlformati011.
I, LOCAfflN Of WBLL($) Attach two mGpa.
(1) Iuclu.di, 11 1itll!i m~ (~p,n he drawn) ibllwint, buitdiaga, pro~ lirl11• 1ui£a~ watet ~otliu,
potontlal aour11ea of srowctwat'Br conivnine.tlon and !ha oneutatifll\ of ■ad distanr;ea l,etween
lhe propoff4 w1ll(1) aliQ any OXlMlng -w.U(a) or wastt cli1pa11a\ ~ilitl&la ,.uoh u 11ptic tlU1ka
or dnln fl ,elds locate within 200 feet of th• p,,md-coupled beat pu111p well sysmn. Label all
teawrea clearly Bild lnciludl a north mmw,
lci~a\.ion map refeffl,olng th111 lite to two ~CJl.ffl)' plm!Blltflt ~ i,olnts (sucb u road&i
sttaam, ad ht,hway mt-.r•111:!oDB),
1. P:eB.MlT IJ.,T: AU.oh G: llet of Q)l patmitl or c1mitruoti0t1 lllpprovata that m relatod to the 1lte.
lbtamplcs include:
(1) Heurdous Waite Mauaaelll,l!,Xll pro~.poimit. wder RCRA.
(:Z) NC Di 'Visk1n a£ W11t.or Quality Non-t>llcbup 1'ermit11
(!) Sewage Treatnletlt arid t>lap1;1s ■l Pormita
K. CBR'I'JliICATJON
"I hl!l\'tby certify, \O\dll' paulcy of Jaw, that I h•~ pmonnll)' •11.~ld 1111.d 11m fa.tnnt~r wlth. tha
lafonnatlon submitted Ir.: tbit document and all •bobmant~ thei,!to md tbt, b884ld on my inq_uhy of
l:hoJe lDdhidualll Jmmedli=ly fGA~en,ible fur o1'taill!q ea.lei. ln&tme"-01:l, I boltcvc that the
il'tfonuatii;in it true, acouratt land QaDlploto, l am ,w,ii. tt,1.t then: are li,Jniftout peualtie11, inoludmg
the po111ibi1ity oft.iru1s an4 lmptl•.:irunaul', tor sulnnittl.nS fabi11 iD.ftirm11itioi'1, I ap to r.0natiuot.
opetats, mlllintam, repa.lr, IUld lf appliaable. abandon $e gt'OW:ld-1ounni: heat pump t)'ll:(ltn nm all
nilated. appurt=iu,c1• in-•i;;i;;gi:drmce with tlle appro ed 11pa.1:1lft~on1 c:anditi a at the ~tcllt."
. ;:
~~~~~~~~fr.W-,l
1/ QUthor/zQd agmt Is ar;tJnr on bshalf qfthtt well li'wntr1
p/eQ1f/. 1upply a letter si,ned b)I lh• owner
aulhorb:ing the r;ibovir agent.
GWIUlC■!17 CL
Erom:06RIEN SERVICE CO. 910 799 04 03/09/2007 12:98 4045 R.005
A1VA%A,-U "tia1L.11,, lolly YY 4WAU Lb W4 Al IVLYL UW J]I' "IL, Aval nbiLatfa rvt 0 tue, %.UUSIUL LN%- nomes'... raga 3 OT d
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WhI S AND LOTS
Nfi1lV!i
WN I'At:l' OS
From Wilmington;
Take Highway 17 South
Lo Highway 211 East.
Prom Myrtle Beath=
Take Highway 17 Norlh
to Highway 211 East
RiverSea 111watian is
one milt on right an
Highway Z 11.
RIVERS EA
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a°i. Map date 02007 7eleAtles - TDrns of I
SOUT11PORT NC AREA INFORMATION
Home Ahow Uri Hoinr Desigm Dinectloos, Ncxs Conuici the
Copyright 0 Neighborhood Properties 2006 01MVIRi'vor
RIVERSEA PLANTATION. U$TOM U01MES
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Rivur&n Custom Homes
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http:llwww.rivemeacustDm.comldimetio-ne 3/9/2007

From:OBRIEN SERVICE CO. 910 799 588~
Main floor
ROOm2 Roam3 Rooffl'I
Room1
Roome
Roome
Room7
~
"3 •~
' Room14 /iJ ~ .l ;.
Job#:
Performed by Bryan Donaldson for:
Judy Schmalz
03/09/2007 12:39 #045 P.006
Room5
Roorn10
Room1~ Room12
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Ftoom6
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Scale: 1 : 112
Page 1
Rlght•SUite Resldenllal
6,0.96 RSR20980
2007-Mar-09 07:28:14
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