WI0800157_GEO THERMAL_20080728

Permit Number WI0800157
Program Category
Ground Water
Permit Type
... ..
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Permitted Flow
Facilit
Facility Name
Dave Brese Jr SFR
Location Address
603 Chadwick Shores
Sneads Ferry
Owner
Owner Name
Dave
Dates/Events
NC 28460
Brese
Orig Issue
07/17/08
App Received Draft Initiated
07/15/08
Re g ulated Activities
Heat Pump Injection
Outfall NU 1 L
Scheduled
Issuance
Central Files: APS_ SWP_
07/28/08
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Dave Brese,Jr
3 Virginia Dare Ct
Durham
Major/Minor
Minor
NC
Region
Wilmington
County
Onslow
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Dave Brese, Jr
3 Virginia Dare Ct
Durham
Public Notice Issue
07/17/08
NC
Effective
07/17/08
27705
27705
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
'
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 ofNCAC Title 15A: 0ZC.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 any substances other than water. I Dr~~ I ::w,~
. • ATION
TO: DIRECTOR, NORTH CAROLINA DNISION OF WATER QUALITY
DATE: July 10, 2008 JUL 1 o 2008
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 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,App/ication For
Permit To Construct And/Or 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: Dave Brese, Jr.
Address _l? Q. Bo,c: 2895---~--"4-i-('"~----~-; ~-~("'C.. ~ \
City:_ Durham ______ Srate: _NC_Zip Code: _~7715 ~-i,oS-
County: "b ·-r1'A"'"' Telephone: _919 ~ 14 1388 ----
D. STATUS OF PROPERTY OWNER
Private: _ x ~
State:
GW-57 CL (Jan, 2000)
Federal:
Municipal: __
':3.~~-C..o(Q,
Commercial:
Native American Lands:
Page I of4
E. JOB(SITE)DATA
Name: Dave Brese, Jr. -------
Address: 603 Chadwick Shores -------
City:_Sneads Ferry ___ State:_NC __ Zip Code:_28460__ County: Onslow
Telephone:_919-422-4956__ Contact Person Dave Brese, Jr. _____ _
F. HEAT PUMP CONTRACTOR DATA
Name: Lee Air Conditioners, Inc.
Address: P.O. Box 2895
City:_Durham __ State:NC_ Zip Code: 27715_ County: ____ _
Telephone: [phone]_ Contact Person: Dave Brese __
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 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) belQ}Y as PROPOSED
construction specifications. Submit Form GW-1 a er con&truction.
lll
Well Drilling Contractor's Name: _,,,C=o=as=ta=l'-'G=e=o=th=e=r-r.m'r'-. ='---------
NC Contractor Certification number: .,,_N=C'-------=20.=.,84r--/."--=" ,=~=o=rd=S..,_,w=e=et=in~g:,..._ _________ _
Date to be constructed: Aug. 2008 N/mber of borings: __ 5 ___ _
(1)
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 of20 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 _JL_ 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) Page2 of4
kc..
AQUIF~0
'["JRIDWQ
Fr•10N
H. INJECTION-RELATED EQUIPMENT JUL 1 6 Z008.
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: bui1dings, 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 Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
K. CERTIFICATION
"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)
ell Owner or Authorized Agent)
If authorized ent 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 Pr perty Owner If Different From Applicant)
Please return two copies of the co pleted Application package to:
IDCProgram
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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OW9eo#herma�entherma� Heat
Transfer Systems
Mike Hadley, CGD
Ceffied GeaExetm9e flesigrff
IGSHPAAwredited trainer & joslaller 9i 9-353.092G
m Middle Street Fax: 910,353-1060
Jacksonville, NC 28546 [e-mail]

Print _ Maps Page 1 of 1
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Page 1
Head southeast on Oleander ❑r/US-76 toward Mimosa PI
- g❑ 2.4 m i
Turn left at S College Rd/NC-1321US-117 - g❑ 2.3 mi
Google Earth: Directions 7125/2008

Page 2
J
Take the US-17 N/US-74 E exit toward Jacksom lle - go
0.4 mi
i� Turn right at 171Market St/Market Street Rd (signs for
Jackson\ille) Continue to follow 17 - g❑ 6.5 mi
ISlight right to stay on US-17 - go 22.3 mi
ITurn right at NC-151810Id Folkstone Rd - g❑ 6.0 mi
z.401
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Google Earth: Directions 7/25/2008

cor-SIC
Page 3
Tum right at Chadwick Acres Rd/NC-1553 - go 0.9 mi
ITurn left at Chadwick Shores ❑r - go 0.8 mi
Arrive at: 603 Chadwick Shores Dr, Sneads Ferry, NC
28460 -
Google Earth: Directions 7/25/2008

Michael F. Wiey. Governor
WiIIiarm G. Ross Jr., Seeretary
North Carolina Department of [~'nvironmenI and Natural Resources
Coleen H. Sullins Direcror
Division of Water Quality
July 17, 2008
Dave Brese Jr
3 Virginia Dare Court
Durham, NC 27705
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0800157
603 Chadwick Shores
Sneeds Ferry, NC 28460
Dear Mr. Brese:
In accordance with the application submitted to the Underground Injection Control (UIC) Program that
was received on July 15, 2008, 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 located at 603 Chadwick Shores, Sneeds Ferry, Onslow County, NC 28460. 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 Onslow 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. If you have any questions please tali me at [phone].
Sincerely, ., DAL
(OUJ4 A
Michael Rogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Wilmington Regional Office - APS
APS Central Files - Permit No. W10800157
Onslow County Health Dept.
Lee Air Conditioners, Inc/ PO Box 2895, Durham, NC 27715
W'"ri hCarolina
Xtura!!ty
Aquifer Protection Section 1636 Mail Service Center
Internet: www.ncwgturaualitv.ora Location: 2728 Capital Boulevard
An Equal ❑pportunitylAffirmAe Action Employer— 50% Recycledr10% Post Consumer Paper
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh. NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]