WI0800180_GEO THERMAL_20091230

Permit Number WI0800180
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Craig Jorgens SFR
Location Address
8525 Ocean Dr
Emerald Isle
Owner
Owner Name
·craig
Dates/Events
NC 28594
Jorgens
Orig Issue
12/30/09
App Received Draft Initiated
12/17/09
Reg ulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Scheduled
Issuance
Central Files: APS_ SWP_
12/30/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Craig Jorgens
Owner
580 Dalewood Dr
Orinda
Major/Minor
Minor
CA
Region
Wilmington
County
Carteret
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Craig Jorgens
Owner
580 Dalewood Dr
Orinda
Public Notice Issue
12/30/09
CA
Effective
12/30/09
94563
94563
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
6;- L-A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Pardue Coleen H. Sullins
Governor Director
12/30/2009
Craig Jorgenc
580 Dalewood Dr.
Orinda. CA 9456-1
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. W10800180
8525 Ocean Dr.
Emerald Isle. NC 28594
Dear Mr. Jorgens:
Dee Freeman
Secretary
In accordance with the application submitted to the Underground. Injection Control (UIC) Program that was received on
12/17/2009, 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 8525 Ocean Dr., Emerald Isle,
Carteret County, NC 28594. 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 Carteret. 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].
Sinerarm-�
�
1
for Michael ogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Wilmington Regional Office - APS
APS Central Files - Permit No. WI08001 i
Carteret County Health Dept.
Mike Hadley (Climate Control Heating & Cooling Co., Inc., 102 Middle St., Jacksonville, NC 28546)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1635
Location: 2728 Capital Boulevard. Raleigh. North Carolina 2760A
fie
Phone: [phone] FAX 1: 919-715-0588; FAX2:919-715-&AB8 Customer SWce;1.877-623-b748
No TthCarolina
Inteme:: www.ncwatPnualitr.nru
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An Eawl GppartaUy l Atfirmatlue A -Non Frr,ployer

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSEWLOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-OW WELLN
In Accordance with the provisions of NCAC Title 15A: 02CO200, please
complete this notification and mail to address on the back page (please Print or T rye information).
DATE: Dee 15.2009
A.
S.
Well Type Confirmation: Does the proposed system circulate potable water on1 (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed -loop )?
Yes x— Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing
either a 5A7 well (open -loop well injectin potable water into the aquifer) or a 5QM well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
PROPERTY OWNERS)/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 wlauthority for signatures; G'kA 0 66:
(1) Mailing Address:
_ - 5-IRO C/'V ��' ar a/ C//e
City: D I?IN A6 State Zip Code: 2 . 3 County: 6Cy4a0 65�h%
Home/Office Tele No.: ` -92-0 Mv Cell No.:
Email Address: Website:
coe'016-.�irr.xE�rr. NPr-
(2) Physical Address of Well Site (if different than above): _8525 Ocean Dr. —
City: Emerald Isle State: _NC Zip Code: 28594 . --County: Carteret
Home/Office Tole No.: Cell No.:
AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant dot own the subject property,
attach a Ietter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL. Address:
Address:
City: State: Zip Code- _ County:
Office Tole No.. Cell No.:
Website Address of Company, if any:
' EEMEo,rDEP;����I
A4lwf!rpfatwilrt SrL.iLyl
Ili 3 I -- 46?Jiv

C. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal
Well Driller Contractor's Name: Sanford Sweetin g
NC Contractor Certification No.: NC 2082
Contact Person: Mike Hadl ey EMAIL Address: mhadl ey@ bizec.rr.c om
Address: 102 Middle St.
City: Jacksonville Zip Code: 28546 County: Onslow
Office Tele No.: __ 910-353-0926 Cell No.: _910-376-1100 _____ _
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company: Climate Control Heating & Cooling Co., Inc __________ _
Contact Person=-: =Mik=·=ea..:H=a=dl=e'""'v ___ --=E=MAIL=~A=d=dres=s~:=m=h=adl=e"-'v_,.ral"'"'b=izec=·=rr=.co=m,_ __ _
Address: 102 Middl e St.
City: Jacksonville State: NC Zip Code: _28546 ____ County: Onslow __ _
Office Tele No.: _910-353-9040 ____ Cell No.: 910-376-1100 ___ _
E. STATUS OF APPLICANT
Private: _x_
State:
Federal:
Municipal: __
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the iitjection well(s) will be used)
Closed Loo p Geothermal Heat Transfer Systems
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _Feb. 2010 _______ Number of borings: __ 9 __
Approximate depth of each boring (feet): __ 250 ____ _
(2) Type of tubing to be used (copper, PVC, etc): _High Density Polyethylene_X
(3) Well casing. Is the well(s) cased? (check either (a.) Yes m: (b.) No below)
(a) Yes ___ if yes, then provide casing information below
Type: __galvanized steel __ black steel__plastic __ other (specify)
Casing depth: From ___ to ___ feet (reference to land surface)
Casing extends to above ground ---'inches
(b) No _x __
( 4) Grout Info (material surrounding well casing and/or piping):
(a) Grout type: Neat Cement__ Bentonite -~-Other (specify) ______ _
(b) Grout placement: Pumping_X_ Pressure__ Other __
(c) Grout depth of tubing (reference to land surface): from _o __ to _250_ (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
H. INJECTION -RELATED EQUIPMEN
Attach a diagram showing the engineering layout or proposed modification 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 copies of maps showing the following information:
(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 geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, streams, and/or highway intersections.
J. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property need.
"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 ou 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 injection well and
all related appurtenances in accordance with the approved qifications and conditions of the Permit."
Signa of Pf6pffny Owner/Applicant
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Authorized Agent, if any -
Print or Type Full Name and title
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636 RECEIVED 1 DENR j ❑WQ
Telephone [phone] Arlu1w prrofeci'o+l semorl

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Closed Loop Geothermal Heat
Transfer Systems
M~e Hadley, CGD
Certified ~change Designer
IGSHPA Accredited trainer & Installer
102 Middle Street 910-353-0926
Jacksonville, NC 28546 Fax: [phone] mhadley@bizec .rr.com
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL
WATER-ONLY INJECTION WELL SYSTEM:
TYPE 5-0 W WELL (S)
In Accordance with the provisions ofNCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or~ information).
DATE: Dec 15 . 2009
Well Type Confirmation: Does the proposed system circulate potable water onlv (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed-loop)?
Yes _ x_ Continue completing this form.
No __ Do Not complete this form. Complete other UIC application forms for installing
either a 5A7 well (open-loop well injecting potable water into the aquifer) or a 5QM 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 signatures; Cl'i'/J/ I-/'I W/?~11,,_;>
(1) Mailing Address: $' '8:u d 11 IE Woo / r/,e I v IE
City: Ql?INJ4 State:CA ZipCode:Q4'Jl3 County: CGte f A4 C0rJ /A-
Home/OfficeTeleNo.: "f2~2f3 'l ~<f O Cell No.: CfZfJ ~5'S 34".l.5
Email Address: We bsite:
cqAl?,,'J"~1vS {>~lf-Jt, JJ.et
(2) Physical Address of Well Site (if different than above): _8525 Ocean Dr._
City: Emerald Isle State: _NC __ Zip Code: 28594 County: Carteret
Home/Office Tele No.: Cell No.:
B. AUTHORIZED AGENT OF OWNER, IF 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 well)
Company Name: _________________ _
Contact Person: EMAIL Address: ----------~==~=~~---------
Address:------------------
City: ________ State: __ Zip Code: _____ County: _______ _
Office Tele No.: Cell No.:
Website Address of Company, if any: ______________ _
RECEIVED/ DENR / DWQ
Ao1.. fer Pi oter.f1"r Sect on
L~.: l '. 2009
C. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal
Well Driller Contractor's Name: Sanford Sweeting
NC Contractor Certification No.: NC 2082
Contact Person: Mike Hadle y EMAIL Address: mhadley@ bizec.rr.com
Address: 102 Middle St.
City: Jacksonville Zip Code: 28546 County: Onslow
Office Tele No.: __ 910-353-0926 Cell No.: _910-376-1100 _____ _
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company: Climate Control Heating & Cooling Co., Inc __________ _
Contact Person: Mike Hadl ey
Address: 102 Middl e St.
EMAIL Ad dres s: mhadlev@ bizec .rr.com
City: Jacksonville State: NC Zip Code: _28546 ____ Cowity: Onslow __ _
Office Tele No.: _910-353-9040 ____ Cell No.: 910-376-1100 ___ _
E. STATUS OF APPLICANT
Private: _x_
State:
Federal:
Municipal: __
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed Loo p Geothermal Heat Transfer Sys tems
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _Feb. 2010 _______ Number of borings: __ 9 __
Approximate depth of each boring (feet): __ 250 ____ _
(2) Type of tubing to be used (copper, PVC, etc): _High Density Polyethylene_X
(3) Well casing. Is the well(s) cased? (check either (a.) Yes QI (b.) No below)
(a) Yes ___ if yes, then provide casing information below
Type: ___galvanized steel __ black steel__plastic __ other (specify)
Casing depth: From ___ to ---'feet (reference to land surface)
Casing extends to above ground ___ inches
(b) No _x __
( 4) Grout Info (material surrounding well casing and/or piping):
(a) Grout type: Neat Cement__ Bentonite _x_ Other (specify) ______ _
(b) Grout placement: Pumping_X_ Pressure__ Other __
(c) Grout depth of tubing (reference to land surface): from _o __ to _250_ (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
H. INJECTION -RELATED EQUIPMEN
Attach a diagram showing the engineering layout or proposed modification 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 copies of maps showing the following information:
( 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 geothermal beat pump well system- Label all features clearly and include a north arrow,
(2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, streams, and/or highway intersections.
J. CERTMCATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"-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 obtaii ng 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
Use information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approved s cations and conditions of the Permit."
Signal f Proer/Applicant
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Authorized Agent, if any
Print or Type Full Nance and
Please return two copies of the completed Application package to:
North Carolina ❑ENR-DWQ
Aquifer Protection Section-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636 pEC' IVE) t DENR 1 V%14
Telephone [phone] Agt1~ier Pact' ,# W Sx "

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- - - • . Geothermal
Closed Loop Geothermal Heat
Transfer Systems
Mike Hadley, CGD
Certified r. oExLim a Designer
USHPAAccredrted trainer & inslaller
910.353-0926
102 Middle Street Fax: [phone]
Jacksonville, NC 28546 [e-mail]

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