WI0800145_GEO THERMAL_20070621

Permit Number WI0800145 Program Category Ground Water Permit Type Injection Water Only GSHP Well System (5QW) Primary Reviewer jesse. wiseman Permitted Flow Facilit Facility Name David Gregerson SFR Location Address 1983 Ruddy Turnstone Ln Bolivia NC Owner Owner Name David Dates/Events 28422 Gregerson Central Files: APS_ SWP_ 06/21/07 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation David Gregerson 211 Riverhouse Rd Bolivia Major/Minor Minor NC Region Wilmington County Brunswick Facility Contact Affiliation Owner Type Individual Owner Affiliation David Gregerson 211 Riverhouse Rd Bolivia NC 28422 28422 Orig Issue 06/21/07 App Received 06/15/07 Draft Initiated Scheduled Issuance Public Notice Issue 06/21/07 Effective 06/21/07 Expiration Regulated Activities Heat Pump Injection Private residence, single family Outfall NULL Waterbody Name Stream Index Number Current Class Subbasin
aF W A rE,q � Michael F. Easley, Governor
William G. Ross Jr., Secretary
r North Carolina Department of Environment and Natural Resources
Q Coleen H. Sullins Director
Division of Water QuaIily
June 21, 2007
David Gregerson
211 Riverhouse Road
Bolivia, NC 28422
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Injection Water Only GSHP Well System {5QW}
Permit No. W10800145
David Gregerson SFR
Brunswick County
Dear Mr. Gregerson:
In accordance with the application submitted to the Underground Injection Control (UIC) Program that
was received on June 15, 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 1983 Ruddy Turnstone Lane in Bolivia, North Carolina.
This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C,
Section .0211(u)(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
gu. i a ncmail.net if you have any questions regarding geothermal heating or injection well rules and
regulations.
Sincerely,
"Zr L I) C_��
Jesse Wiseman
Aquifer Protection Section
Enclosures
cc: Wilmington Regional Office - APS
APS Central Files -Permit No. W10800145
Aquifer Protection Section 1636 Mail Service Center
Internet: vgryvy.n�w quality,ora Location: 2728 Capital Boulevard
An Equal OpportunitylAf<irma0ve AcOon Employer- 50% Regcledl10% Post Consumer Paper
N�hCarolina
yarluxa!!il
Raleigh. NC 27699-1636 Telephone; [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

Page I of 5
Main Identity
RECENED l DENR I DWO
From: "DAVID GREGERSON" <[e-mail]> AWJF.1:R'PF10TF"Tl0N SECTION
To: "DAVID GREGERSON" <[e-mail]> JUN 15 2007
Sent: Wednesday, June 13, 2007 11:03 AM
Attach: Gregerson Concept-36 X 24.pdf
Subject: Fw: 5OW well application - cccc.doc
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 SOW Wells
In Accordance with the provisions o€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 o n- oo geothermal system.
Do not use this form for systems that circulate any substances other than water.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: .tune 4, 2007
A. 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 Construct AndlOr 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
Per►nit To Construct An&Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
NO _X� If no, then continue completing this farm.
C_ PROPERTY OWNER
Name: David Gregerson
Address 211 Riverhouse Rd.
City: Bolivia
##40 If*Jill4fl-.4 7F
PAW114 �
State: NC_ Zip Code: 28422_
6/14/2007

Page 1 of 5
Main Identity
From:
To:
Sent:
Attach:
"DAVID GREGERSON" <[e-mail]>
"DAVI D GREGERSON" <[e-mail]>
Wednesday, June 13, 2007 11:03 AM
Gregerson Concept-36 X 24.pdf
Subject: Fw: 5QW well application -cccc.doc
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED~LOQP
GEOTHERMAL WATER-ONLY INJECTION ,vELL SYSTEM
(GROUND COUPLED HEAT PUMP)
Type 5QW Wells
In Accordance with the provisions ofNCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
This is Jmt the proper form to be used for injection wells in an !l_Jlf p-)09.p geothermal system.
Do not use this form for systems that circulate aJ1y s11b~ta_nce$ Qtber than w~ter.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DA TE: June 4, 2007 _
A. 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 __ Ifno, 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 Sy ste
6/14 /2 007
Page 2 of 5
County: Brunswick ___ Telephone: [phone]
D. STATUS OF PROPERTY OWNER
Federal: Commercial: Private: x
State: Municipal: __ Native American Lands:
GW-57 CL (Jan, 2000)
E. JOB (SITE) DATA
Name : _David Gregerson ____ ~
Address: 1983 Ruddy Turnstone Ln.
City: __ Bolivia __ State: _NC Zip Code: _28422 __ County: _Brunswick_
Telephone: [phone] Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: Technical Services
Address: ~ 7213 Ogden Business Lane Suite 212 ___________ _
City: WilrningtQn_ State: NC ___ Zip Code: 28411 County: New
Hanover
Telephone: [phone] Contact Person: Al Moore
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
Page I of 4
knowledge. Attach a copy of Form GW-1 (Well Construction 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-1 after construction.
(1) Well Drilling Contractor's Name: Coastal Geothermal
NC Contractor Certification number: NC -2082 Sanford Sweeting
Date to be constructed: June, 2007_ Number of borings: _6 -----
Approximate depth of each boring (feet):_200 __________ _
(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.l.s.):
(a) Grout type: Cement __ Bentonite _X_ Other (specify) _______ _
6/14/2007
Page 2 of 5
County: Brunswick ___ Telephone: [phone]
D. STATUS OF PROPERTY OWNER
Federal: Commercial: Private: x
State: Municipal: __ Native American Lands:
GW-57 CL (Jan, 2000)
E. JOB (SITE) DATA
Name : _David Gregerson ___ _
Address: 1983 Ruddy Turnstone Ln.
City:_ Bolivia __ State: _1--r_C_ Zip Code: _28422 __ County: _Brunswick_
Telephone: [phone] Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: _Technical_ Sery_i_<;~~--_ _
Address: _721 _3 _Ogden Business Lane _Suite_212 ___________ _
City: ~Wilmington State: NC Zip Code: 28411 County: New
Hanover
Telephone: [phone] Contact Person: Al Moore
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
Page 1 of 4
knowledge. Attach a copy of Form GW-1 (Well Construction 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-1 after construction.
(1) Well Drilling Contractor's Name: CoJ1StJ:l.l Ge_Qtbermal
NC Contractor Certification number: NC -::.208i S11_nfonl Swe~fiQg
Date to be constructed: June, 2007 Number of borings: _6 ____ _
Approximate depth of each boring (feet):_200 __________ _
(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.l.s.):
(a) Grout type: Cement __ Bentonite X__ Other (specify) _______ _
6/14 /2007
Page 3 of 5
(b) Grouted surface and grout depth (reference to land surface):
._X__ around closed loop piping; from __) to 200 (feet),
around well casing; from to (feet).
NOTE: TIIE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
GW-57 CL (Jan, 2000)
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 wel I 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) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
K_ 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, 1 believe that the information
is true, accurate and complete. I arts 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."
,7
6/14/2007

Page 3 of 5
(b) Grouted surface and grout depth (reference to land surface):
X around closed loop piping; from 0. to _200 (feet),
around well casing; from to (feet).
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR FITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION 1S UNAVAILABLE BY OTHER MEANS.
GW-57 CL (Jan, 2000)
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.
]. LOCATION OF WELL(S) Attach two maps.
{] 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) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Nan -discharge permits
(3) Sewage Treatment and Disposal Permits
K. 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 infonnation
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." I
6/14/2007

GW-57 CL (Jan, 2000)
Page 3 of4
Page 4 of 5
(Signature of Well Owner or Authorized Agent)
.lf authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
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)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 2 7 699-1636
Telephone [phone]
6/14 /2007
GW-57 CL (Jan, 2000)
Page 3 of4
Page 4 of 5
(Signature of Well Owner or Authorized Agent)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
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.)
lfthe 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 1 SA NCAC 2C .0200)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
6/14/2007
Page I of 5
Main Identity
From: "DAVID GREGERSON" <[e-mail]>
To: "DAVI❑ GREGERSON" <[e-mail]>
Sent: Wednesday, June 13, 2007 11:03 AM
Attach: Gregerson Concept-36 X 24.pdf
Subject: Fw: 5QW well application - cccc.doc
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 50W Wells
to Accordance with the provisions of NCAC 'fitle 15A: 02C.0240
Complete application and mail to address on the back page.
This is not the proper form to be used for injection wells in an amen -loon geothermal system.
Do not use this form for systems that circulate anti substances other than water.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: June 4, 2007
A. 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 Construct AndlOr Use A Wells) .For Injection With A Heat
Purnp System, should be completed.
B, SYSTEM FLUID WiI] 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 Construcl 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: David Gregerson
Address 211 Riverhouse Rd.. _
City, Bolivia
l
State: NC_ Zip Code: 28422_
6/14/2007

GW-57 CL
Page 4 of 4
Page 5 of 5
(Jan, 2000)
6/14/2007
Page 2 of 5
County: Brunswick Telephone: [phone] ---
D . STATUS OF PROPERTY OWNER
Federal: Commercial: Private: x
State: Municipal: __ Native American Lands:
GW-57 CL (Jan, 2000)
E. JOB (SITE) DATA
Name : _David Gregerson ___ _
Address: 1983 Ruddy Turnstone Ln.
City: __ Bolivia __ State: _NC_ Zip Code: _28422 __ County: _Brunswick_
Telephone: [phone] Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: Technical Services
Address: _ 7213 Ogden Business Lane Suite 21_2 ____ ~-------
City: Wilmin gton State: NC ___ Zip Code: 28411 County:New
Hanover
Telephone: [phone] Contact Person: Al Moore
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
Pagel of 4
knowledge. Attach a copy of Form GW-1 (Well Construction 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-1 after construction.
(1) Well Drilling Contractor's Name: Coastal Geothermal
NC Contractor Certification number: NC-2082 Sanford Sweeting
Date to be constructed: June, 2007_ Number of borings: _6 ____ _
Approximate depth of each boring (feet):_200 ___________ _
(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.l.s.):
(a) Grout type: Cement __ Bentonite _x_ Other (specify) _______ _
6/14 /2007
Page 3 of 5
(b) Grouted surface and grout depth (reference to land surface):
_X_ around closed loop piping; from 0 to 200 _ (feet),
around well casing-, from to (feet).
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR ErrHER EXISTING OR
PROPOSED WELLS IF THIS WORMATION IS UNAVAILABLE BY OTHER MEANS.
GW-57 CL (Ian, 2000)
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.
1. 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).
PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) 1lazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
K. 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 appurtenancip in
46 accordance with the approved specifications and conditions of the Permit."
6/14/2007

GW-57 CL (Jan, 2000)
Page 3 of4
Page 4 of 5
(Signature of Well Owner or Authorized Agent)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
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 ISA NCAC 2C .0200)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
6/14/2007