WI0800172_GEO THERMAL_20090909

--Per,:nit Number -WI0800172
------------
Program Category
Ground Water
Permit Type
/
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facili
Facility Name
Ringo Dr5QW
Location-Address
Cando Street Ringo Dr
Wilmin gton
Owner
Owner Name
NC 28405
Cape Fear Public Transportation Authority
Dates/Events
Orig Issue
09/09/09
App Received Draft Initiated
09/03/09
Re g ulated Activities
Heat Pump Inj ection
Outfall NULL
Scheduled
Issuance
Ce ntral Files: APS_ SWP_
09/09/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
James L. Cornette
PG
PO Box 882
Hampstead
Major/Minor
Minor
NC
Region
Wilmington
·County
New Hanover
_____ Facility Contact Affllia~i<>11 _
Owner Type
Unknown
Own-er Affiliation
Albert Eby
PO Box 12630
Wilmington
Public Notice Issue
09/09/09
NC
Effective
09/09/09
28443
28405
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
NA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Albert Eby, Director
Cape Fear Public Transportation Authority
P.O. Box 12630
Wilmington, NC 28405
Coleen H. Sullins
Director
9/9/2009
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0800172
Cando St. and Ringo Dr.
Wilmington, NC 28405
Dear Mr. Eby:
Dee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on
09/03/2009, 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 Cando St. and Ringo Dr.,
Wilmington, New Hanover County, NC 28405. This system is deemed permitted by rule (North Carolina Administrative
Code Title 15A, Subchapter 2C, Section .021l(u)(2)).
However, it is recommended that you contact the New Hanover 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 call me at [phone].
Sincerely, Jai_LtJ-11. ,tfadwc~
for Mich~l Rogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Wilmington Regional Office -APS
APS Central Files -Permit No. WI0800172
New Hanover County Health Dept.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard , Raleigh. North Carolina 27604
Phone: [phone] \ FAX 1: 919-715--0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunity\ Affirmative Action Employer
Ni¥thCarolina
)Vaturall!I
NORTH CAROLINA
wID~Dorrz------
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL
WATER-ONLY INJECTION WELL SYSTEM:
TYPE 5-0W WELL(S)
In Accordance wjth the provisions ofNCAC Title ISA: 02C.0200, please
complete thjs notification and maH to address on the back page {please Print or~ information).
DATE: ~bt.£ I 20ft
Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed-loop)?
Yes _L Continue completing this form.
No ___ Do Not complete this form. Complete other UIC application fonns for installing
either a SA 7 well (open-loop well injecting potable water into the aquifer) or a SQM well (closed-
loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): Ca.pc< {f£l ( 7Jub) IC, Iral!Sp'Xlof-uto · /lollwr-1./y.l
f11r. Al be.rf t?.by., Direohc
(1) Mailing Address: e O . &x 12. {.g ?:JO
City: W,loi r Stale: ,Vl Zip Code: 2/J!t O .S Couoty: A.iw ,&Gr,r1vur
Home/Office eNo.: tpo -~00. -JOSS-CellNo.: q/D -2Cfl-82 90
Email Address:Af; 8 Y@ W/Jr411,5jt,em,Website:
(2) Physical Address of Well Sito Of differemtban above): &ido ,sire,.:/ t ;e;~ or.
ctty, 1M f rn ,1/d/ro Stme: M:.. Zip code: 8,2/./% eouory: {JJ }/4n /JI/ c/
Home/Office le No.: Cell No.:
B. AUTHORIZED AGENT OF OWNER,.JF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC weil)
Company Name: ___________________________ _
Contact Person"-: -------------=EMA=-=IL~A:.::d=dr.::::es:::::s::..: -----~----
Address: ______________________________ _
City: ________ State: __ Zip Code: ______ County: _______ _
Office Tele No.: Cell No.:
Website Address of Company, if any: ______________ _
GPUMC 5QW Notification of Intent Fonn (Revised 8/2008)
,,i::\Jc:.1 v '-'-', ut.r~k, wvvu
AqJifer Protec:~io11 Section
SEP o 1 zooq
Page 1
C.
D.
E.
F.
G.
WELL DRll.LER INFORMATION
CompanyName: App/Jed ~)LCL_ ~I;. /J~ ,
WellDrillerContractor'sName:d-i:~ UJ~J+Z Q'( JI fh1cft a-e / ~
NC Contractor Certification No.: 2'11 t/ rM" 25"3 / Contactl'lar.s<mJ)~ r OCO e,;{,j<__, EMAIL Address: :$ii,_ l1-{IJn t; bd/ciJV'lf,, ,w/---
Address: _'Ps_:.•~0.,;..~~>0u_ X'i.__i..a ;85_.£.c:b==------------=-----,--------
City: l-la rnt1S teA:.d ZipCode: 28'!-'13 County: L..:lt/2!:::::!..L.!=::..!deL~-----~ ' OfficeTeleNo.: t/J0-210-2..'f/9 CellNo.: 9/tJ-5/Z -t/8'QQ
HEAT PUMP CONTRACTOR INFORMATION (If different than driller)
Company Name: {he.dia_,n, i, a..( ~ l,e,s ' ff, rJJ I} rnwz r
Contact Person: Sk»L Jen fins EfuIL Address:
Address: 5 oa s Fu c,L d 7<..oa.d
City: VitJ:J>n i'Gd ~ Zip Code: J 3lf 2 (;, County: ----------
Office T~ No.: 'bl>b-1-t:t--7::k$~e11No.: _______ _
STATUS OF APPLICANT
Private: Federal: Commercial:
State: Municipal: .1_ Native American Lands:
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Cleme.d Lcv p , ltU'.10 OtJ I y I tp UumAI kt: w.e I I
WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: '1/3/of-9/;~lo 7Number of borings: __ , __ _
Approximate depth of each boring (feet):_30~_,0"---' ___ _
(2) Type of tubing to be used (copper, PVC, etc): We / ff-D-P £
(3) Well casing. Is the well(s) cased? (check either (a.) Yes m: (b.) No below)
(a) Yes "'f. if yes, then provide casing information below
Type: ___galvanized steel _black steel_A__plastic_other (specify)
Casing depth: From O to 3o0 feet {reference to land surface)
Casing extends to above ground W inches
(b) No
(4) Grout Info (material surrounding well casing and/or piping):
(a) Grout type: Neat Cement__ Bentonite .:f__ Other (specify) _____ _
(b) Grout placement Pumping X Pressure Other ----,
(c) Grout depth of tubing (reference to land surface): from + (&O II
to ~00 (feet)
If well has casing, indicate grout depth: from O to 360 7
(feet)
GPU/UIC 5QW Notification oflnteot Form (Revised 812008) Page2
FROM Yost t
cFrI 1 y sup a aO" 2- 20/Sm7 _ 2' 1 e /Ne_ 753761'82 0 P a
IL u JECUEO -RELM" EQUI Affi T
A eh a diagr= showing the Wiring layout or proposed modification of the igj n equipment =d exterior
pspinghwbing asso4neted Milt the iojection operation. The asaAufa wrer's brochure may provide supplementary
infnrtaation.
L LOCATION OF Vti►ELL(S)
Attach two copies of maps showb%the following infonnafi=
(1) Include a Site Map (can be drawn) showing: bus iings, Property ftcs� surface ►eater bodes poterstaal
sources ofgrouadwMer cone minawn and the orieutstion of and dismnaes between the proposed well(&) and
any existing wedl(s) or waste disposal facilities such as septic tanks or drain fields located within 200 fees of
the gcot meal heat pump wolf sys'rcrtt_ babel all feat:twn dearly and iadWez nortte maw.
(2) The Site Map must shore the sidpj ct prMay in rdarion to the surrounding area by usixip, at least two fixed
refer> ce poim sirch as roads, stress, andlor highway in#etsectians.
J. CERi9lIriCATION
!Nose: This Permit Appli cgl on meet be Aped by emb paraoa appesriag on the
romrtied legal property deed.
"I hovby certify, un&r penalty of law that I have persomMy exanairied and am familiar with the: iniormatioa
submitted is this document and aft Wwhments thereto and 1W based an, my inquiry of those individuals
immediately respmAblo for obmhft said informaria, I believe tha the infWmadon is true, wcuratc and complete.
I am aware that thew an siguficaut penalties, =Judmg the pwsib isy of tarots and impriwntnent for sabusitting
false infnamalion. I ag= To construct, operate, ruaftm&K repair, and if applicable, abandon the injectiam well and
all related appurtenances in a wordance with th$ approved specffications� .-n and coadilof the Pit"
(.22i V,,,, 1J>tljr4
Signal of Property OwncdApphcaw
p k%'r f 6; * �„ft' -fa r
Friut or Type Full Name and title
Sipa[tre of ftqperty OwnedAppiizwt
Priam or Type Full Neese and fide
Si,gciature of Authorized AgCM if any
Print or Type Full Name and tide
Please retrum two copies of the colrtplWd Applimthm pac�,e tor
North Qum inn 11FNR-DWQ
Aquifer Pratwtias 5ectina-UIC Progr2m
1636 MoR Soviet Center
Raleigh, NC 27699-1634
Telephnne (919) 7154935
rwul lc SOW Nodf flan of lea [ Torte (Rvvjwd InMR)
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Legend:
Approximate Property Lines
Parcel # R04900-001-028-000
0 Approximate Well Installation Location
Note: Adopted from Google Earth, Sept. 2009,
TirLE; 511E VICINITY MAP
SCALE: DATE: IDRAWN BY-
AsShown 09/01 /09 I DNH
or lied Resource Mana .crosnt " C
P.Q. Box 8B2. Hampstead. NC 28443 JOB:
[phone] FAX [phone] WW
FIGURE:
1
V 1
�I

Ro gers, Michael
From:
Sent:
To:
Diana Helias [[e-mail]]
Thursday, September 03, 2009 3:09 PM
[e-mail]
Subject: Type 5-QW Intent Form
Attachments: 5-QW Intent Form .pdf
Mr. Rogers,
Please find attached to this message, a Notification of Intent form (Type 5-QW) for a project we are working on in
Wilmington. Two (2) copies will follow in the mail.
Please let ·me know if you have any questions.
Sincerely,
Diana Helias
Project Coordinator
Applied Resource Management, P.C .
www .ARM-PC.com
ARM's Waterworks
www.WaterWorksWells.com
910.270.2919
910.270 .2988 Fax
P.O. Box 882
Hampstead, North Carolina 28443
1
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0 Approximate well lnvolla"n LO-CoTron
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RINT OF W
Note: P*pedy IS W#hh the C0v hrnft. No krkwvr walla or 59uftc 6yVarrn ore In M3 furfounding ama.
Adapted from MGpprovzedWNopis,KusWlkTunstaN,CzrmgingEr;glrteersCiV2009I
SITE LAYOUT MAP FIGURE: rQ
MMM,V 10fflafft, 1r-
sw=� W-28W SCALE: DaAWNBY; 2
7k 210-2we Fi%w I" = 40' JDADr9101/09 . DNH i

Rogers, Michael
From:
Sent:
To:
Diana Helias [[e-mail]]
Friday, September 04, 2009 12:31 PM
Rogers, Michael
Subject:
Attachments:
Mike,
Re: Type 5-QW Intent Form
WAVE fig2.pdf
The property in within the Wilmington City limits and no known septic systems or wells are in the surrounding area. I am
also including a map with the well location on it provided to us by the engineering firm involved in this project. The
proposed well location is 25' from the foundation as well as from the street. Please let me know if I need to include
anything else.
-----Original Message -----
From: Ro gers . Michael
To: Diana Helias
Sent: Friday, September 04, 2009 11 :23 AM
Subject: RE: Type 5-QW Intent Form
Diana-
We rec'd your NOi form. Thank you. However, we need a site map with the location of the proposed wells in relation
to the proposed structure/buildings (i.e. distance of borings to foundation, and any other wells or septic tanks.
Thanks.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line (919} 715-6166; F.ax 715-0588 (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: Diana Helias [mailto:[e-mail]]
Sent: Thursday, September 03, 2009 3:09 PM
To: [e-mail]
Subject: Type 5-QW Intent Form
Mr. Rogers,
Please find attached to this message, a Notification of Intent form (Type 5-QW) for a project we are working on in
Wilmington. Two (2) copies will follow in the mail.
Please let me know if you have any questions.
Sincerely,
Diana Helias
Project Coordinator
Applied Resource Management, P.C.
www .ARM-PC.com
1
ARM's Waterworks
www.WaterWorksWells .com
910 .270.2919
910.270.2988 Fax
P.O . Box 882
Hampstead, North Carolina 28443
2