WI0800187_GEO THERMAL_20100331

w&i_Af·. ~~-~ .. ,_-!:_
NCDEMR.
North Carol ina Department of Envi ro nment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Cieorg:c Brady
Pamek Brady
1776 Twisted Oak Lane SW
Ocean Isle Beach, NC 28469
Coleen H. Sullins
Director
3i 31!20l 0
Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System
Permit No. WI080 01 87
1776 Twisted Oak Lane SW
Ocean Isle Beach, NC 28469
Dear Mr. & Mrs. Brady:
Dee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on
3 /29/2010, the Aquifer Protection Section (APS) acknowledges your intent to construct a closed-loop geothennal water-
only injection well system for the operation of a ground-source heat pump located at 1776 T w is1 e d O ak Lan e SW, Ocean
Isle Beach, Brunswick County , NC 28469. This system is deemed permitted by rule (North Carolina Administrative Code
Title 15A, Subchapter 2C, Section .021 l(u)(2)).
However, it is recommended that you contact the Brunswic k 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,
Q~~
. (LG\ , Michael Ro2:ers
cc : V/ilmington Regional Office -APS
APS Central Files -Permit No. \V.IOiW0l 87
Brunswic k County Health Dept.
,--~ Environmental Specialist
GPU-Aquifer Protection Section
Jim Cornette (Applied Resource Mgmt) PO Box 8!C, Hampstead. NC 28443
Justin Fulford (Al Fulford Heating & Air) 3461 Holden Beach Rd SW. Supply NC 28462
AQUIFER PROTECTION SECTION
1636 Mai! Service Center, Raleigh, North Caro:;na 27699-163'.,
Location: 2728 Capital Boulevard, Raleigh. North Carolina 276(),'
Phone: [phone] \ FAX 1: 919-71 5 -0588; FAX 2: 919 -715-6048 Customer Service: 1-877-623-6748
internet: www.ncwaterg uali ty.org
None, 1· . ortn Caro .ma
,,?,)atural!y
Permit Number . WI0800187
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
George and Pamela Brady SFR
Location Address
1776 Twisted Oak Ln Sw
Ocean Isle Beach NC
Owner
Owner Name
George
Dates/Events
28469
Brady
Orig Issue
03/31/10
App Received Draft Initiated
03/29/10
Re g ulated Activities
Heat Pump Inj ection
Outfall i\J! i..
Scheduled
Issuance
Central Files: APS_ SWP_
03/31/10
Permit Tracking SUp
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Jim Cornette
PO Box 882
Hampstead
Major/Minor
Minor
NC
Region
Wilmington
County
Brunswick
Facility Contact Affiliation
Owner Type
Individual
Owner ~ffiliation
George Brady
1776 Twisted Oak Ln Sw
Ocean Isle Beach NC
Public Notice Issue
03/31/10
Effective
03/31/10
28443
28469
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
U-)=.o qq o 0 ($ 1
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-QW WELL(S)
In Accordance with the provisions of NCAC Title 15A: 02C.0200, please
complete this notification and snail to address on the back page (please Print or Type information).
DATE: March 24.2010
A.
B.
Well Type Co►afirmatron: 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 X Continue completing this form.
[pia Do Not complete this form. Complete other UIC application forms for installing
either a SA7 well ❑ en -loop well inject potable water into the aquifer) or a 5¢M well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
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 wlauthority for signature): Georue and Pamela Brad%
(1)
(2)
Mailing Address: 1776 Twisted Oak Lane SW
City: Ocean Isle Beach State: NC Zip Code; 28469 County: Brunswick
Home/Office Tele No.: 910-755-0001 Cell No.:
Email Address: tibra& l;a.�macxom Website:
Physical Address of Well Site (if different than above):
City:
State: Zip Code:
Naive/Office Tele No.: Cell No.:
County:
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 instal and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City:
Office Tele No.:
State: Zip Code:
Website Address of Company, if any:
County:
GPU/UIC 5QW Notification of Inters Form (Revised 812008) Page I

C. WELL DRILLER INFORMATION
Company Name: A pplied Resource Management, P.C.
Well Driller Contractor's Name: _H_. M_ic_h_a_el_S_a~g~e ________________ _
NC Contractor Certification No.: 2531-A
Contact Person-'-: -=-J=im=-=C-=o=m=e=tt=e __________ =E=MA=-=-I=L~A==d=dr=e=ss=-:--"J=im""'-A"-""-RM=®~b=el=ls=o=u=th=.n=e=t __
Address: --~P~.O~. B~o=x-=-=-88=2=-----------------------------
City: Ham pstead Zip Code: 28443 County: ---=P-"e=n=de=r ________ _
Office Tele No.: 910-270-2919 Cell No.: 910-512-4890
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Al Fulford Heating and Air
Contact Person: Justin Fulford EMAIL Address: Justin alfulfordheatingandair.com
Address: ___ 3_46_1_H_o _ld_e_n _B_e_ac_h_R_oa_d~SW _____________________ _
City: Supply Zip Code: 28462 County: ___ B_r_u_ns_w_i_ck _______ _
Office Tele No.: _______ 9-=-10.:...--=-84"""2=6=5-=8.:...9 _____ Cell No.: _________ _
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 sy stem. Water only. Grouted along the loo p 's entirety .
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: __ 3_/3_0_/2_0_1_0 _____ Number of borings: __ 4 __ _
Approximate depth of each boring (feet):. __ --=2=0-=-0' ______ _
(2) Type of tubing to be used (copper, PVC, etc): --=HD=P-=E'--------------
(3) Well casing. Is the well(s) cased? (check either (a.) Yes or (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) Thermex
(b) Grout placement: Pumping __ Pressure Other
(c) Grout depth of tubing (reference to land surface): from 0 to 200 (feet)
If well has casing, indicate grout depth: from to (feet)
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page 2
03/25/10 2:19 PM hello
Page 3
11. tNJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and axterior
pipingltubing associated with the injection operation. The annufat:turer's brochure may provide suppiementary
information. -
I. 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 wcil(s) or waste disposal facilities such as suptic 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 rclation to the surrounding area by using at Ic.ast two fixed
reference points such as roads, streams, and/or highway intersections.
J. CERTWICATION
Mote. This Permit Appiieaition must be signed by each perwen appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law, that T have personally examined and am familiar with the information
sulmtitted in this document and all attachments thereto and that, based on ray inquiry of those individuals
immediately responsible for obtaining said information, I believe that tho 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 appWed specifications and conditions, of the Permit."
tignatU6 of roperty 0"er/Ap carat
7
RSCEIVED i fOR ! QW� y co c J�J - -�e
.R'��i'�lCt1y 5fa~ Print or ype Full Name and title
Signature of Property Owner/Applicant
�LVXELA C'.
Print or Type Fula Name and title
Signature of Authorized Agent, if any
Print or Type Full Name and title
Picric return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section-UIC Program
1636 Mad Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPtJAX 5QW Notin cation of Intent Form (Revised 81 ON) Page 3

ri
lk
Intracoastal Waterway
Approximate Property Lines
Approximate Building Perimeter
Approximate Closed Loop Locations
Notes:
1. Subject property serviced by private septic system and public water.
2. Well locations are approximate and will be a minimum of 20' apart and 25' from the building.
3. Adapted from Google Earth and Brunswick County GIS Map, March 2010.
TITLE; SITE MAP FIGURE:
fled {�e�aurce Mana;:�eme� PC _ 1776 T_W_ISTED OAK LANE SW
o. Box ee , ❑mps ea , JOB: � SCALE: DATE; Df2AWN BY:
At910j 270 29T4 FAX [phone] Brady As Shown 3/25/10 ❑NH

P
11
Intracoastal Waterway '
:• _ � sir,
Approximate Property Lines
Approximate Building Perimeter
Approximate Closed Loop Locations
Notes:
i . Subject property serviced by private septic system and public water.
2. Well locations are approximate and will be a minimum of 24' apart and 25' from the building.
3. Adapted from Google Earth and Brunswick County GIS Map, March 2010,
TITLE: SITE MAP FIGURE:
At
,lied Reeource Mans ement PG - 1776 TWISTED OAK LANE SW
ampsfead, N a JOB: SCALE; DATE: DRAWN BY.
91Q] 270 2919 FAX [phone] Brady As Shown 3125/1 p DNH

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Page 1 of 1
Brunswick County, NC
Parcel Number
244GLO18 Plat Date
61233200 Land Value
107512756949 Building Value
Account Number
$400, 000
PIN
$417,040
Owner
BRADY GEORGE M ET PAMELA C
Other Value
$26,090
Owner Address T
Deferred Value
$0
Owner Address 2
1776 TWISTED OAK LANE Total Taxable Value
OCEAN ISLE BEACH Heated Sq Ft
NC Year Built
28469 Bedrooms
L-18 S-GATE 4 BENT TREE PLAT T1267 Full Baths
$843,130
City
3,742
state
Zip
12997
3 BEDROOMS
Legal Description
Parcel Street Number
1776
Stories
Parcel Street
TWISTED OAK
Ext. Wall I
CEDAR I REDW SIDIN
Street Type
LN
Ext Wall 2
Street Dir
SW
Neighborhood
607C
Subdivision
Munidpality
Deed Book
1090
Fire Tax District
SHALLOTTE POINT
Deed Page
0118
Township
SHALLOTTE
Deed Date
5/22/1996
Acreage
Sale Price
$145,000
Plat Book
Plat Page
Disclaimer.' Map and parcel data are believed to be accurate, but accuracy is not Male
guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch =112 feet
appraisal, survey, or for zoning verification.
http://gis.brunsco.netiprintPreview.aspx?PrintOptData=Brunswick County, NC10101trucIfals... 3/25/2010

Rogers, Michael
From: Diana Hellas [[e-mail]]
Sent: Monday, April 05, 2010 Z09 PM
To: Rogers, Michael /}
Subject: Revised NCI 1775 Twisted Oak Lane b4py
Attachments: NOI Twisted Oak Lane REVISED.pdf V
Michael,
Attached is a revised NOI for the George and Pamela Brady residence, The HVAC system designer decided he needed
four (4) 250' loops instead of four (4) 200' loops, I have revised the application page to reflect this depth change, also the
start date was moved back to this Wednesday, April 7th. No other information was changed.
Please let me know if any further information is needed.
Thank you,
Diana Helias
Project Coordinator
Applied Resource Management, P.C.
www.ARM-PC.com
ARM's Waterworks
www.WaterWorksWells.com
910.270,2919
910.270.2986 Fax
P.O. Box 882
Hampstead, North Carolina 28443

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: April 5. 2010 **REVISED NOi APPLICATION**
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-loo p)?
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 waterinto 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): ---=G=e-=-or:..:e.=e....:a=n=d-=-P-=a=m=e=ia'-'B=r=a=d .... v _______ _
(1) Mailing Address: --~1 .... 77~6~T~w .... is~te~d~O~ak_L .... an_e_S~W _____________ _
City: Ocean Isle Beach State: ____NQ__ Zip Code: 28469 County: Brunswick
Home/Office Tele No.: 910-755-0001 Cell No.:
Email Address: gbrady l @mac.com Website:
(2) Physical Address of Well Site (if different than above): _______________ _
City: ________ _ State: __ Zip Code: ______ County: _____ _
Home/Office Tele No.: -------------=C'-"e=ll""'N"""'o""'."-: __________ _
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~: --------------~E~M=Al~L~A~dd~r~e .... ss~: __________ _
Address:----------------------------------
City: _________ State: __ Zip Code: ______ County:
Office Tele No.: __________________ C_e_ll_N_o_._: __________ _
Website Address of Company, if any: _______________ _
GPU/UIC 5QW Notification oflntent Form (Revised 8/2008) Page 1
C. WELL DRILLER INFORMATION
Company Name: A pplied Resource Management. P.C.
Well Driller Contractor's Name: _H~. =M=i=ch=a=e=l~S=a=g=e _________________ _
NC Contractor Certification No.: --~2=5=3~1~-A~---------------------
Contact Person: Jim Cornette EMAIL Address: Jim ARM@ bellsouth.net
Address: P.O. Box 882
City: Hampstead Zip Code: 28443 County: ---=P--=e=ne:::d=er.__ _______ _
Office Tele No.: 910-270-2919 Cell No.: 910-512-4890
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Al Fulford Heatinl! and Air
Contact Person: Justin Fulford
Address: 3461 Holden Beach Road SW
City: Supply Zip Code: 28462
Office Tele No.: 910-8426589
E. STATUS OF APPLICANT
Private: ____x_
State:
Federal:
Municipal: __
EMAIL Address: Justin@ alfulfordheatingandair.com
County: __ _,B=run"-==sw-'--'---"'ic=k,,__ _______ _
Cell No.: __________ _
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed Loop e eothermal s vstem. Water only. Grouted alone. the loop 's entiretv .
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: __ 4~/7~/2=0~1~0 _______ Number of borings: __ 4-'---
Approximate depth of each boring (feet): __ _..2=5~0~' ______ _
(2) Type of tubing to be used (copper, PVC, etc): __ .;.H=D~P~E=---------------
(3) Well casing . Is the well(s) cased? (check either (a.) Yes 2!: (b.) No below)
(a) Yes ___ if yes, then provide casing information below
Type: __ galvanized steel __ black steel_ylastic __ 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) _Th=e=rm=e-x __
(b) Grout placement: Pumping__ Pressure Other
(c) Grout depth of tubing (reference to land surface): from O to 200 (feet)
If well has casing, indicate grout depth: from ____ to _____ (feet)
GPU/UIC 5QW Notification oflntent Form (Revised 8/2008) Page2
oa12s110 2:19 PM hello
ll. lNJECTION-RELA TED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exlerior
piping/tubing associnted with the injection operntion. The manufacturer's brochure may provide supplementary
infom1ation.
I. LOCATION OFWELl,(S}
Attach two copies ofm11ps showing the following information:
(l) lncludc a Site Map (can be drawn) showing: buildings, property lines, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances bclween the proposed well(s) and
any existing wcll(s) or waste disposal facilitjes such us st--ptic tanks or drain fields located within 200 feet of
!he geothennal !teat 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. CERTIFJCATlON
Note: This Permit Application must be signed by em 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 infonnution
submitted in this document and all attachments thereto and thal, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the infonnation is true, accumte and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonn,ent, for submi11i11g
false information. I agree to construct, operate, maintain, repair, ,ind if applicable, abandon the injection well and
all rem~d -""~ m ""'"'=' w;th d>e "'IF"" ,,,,cifica~mliti""" ofth, Pmnlt." ~:?. :.<::.M c ,· .. -~ji orfro~ey o~mf-
Gc o.lZ.tlc m. ;3/2A.tJ y
Print j-3/pe Full Name and title
P" {J_,1)~'"" a -P(v-____,_ .. -
Signature of Property Owncr/Applicanl
~~CLfi ('. B t2t1..0 ¥
Print or Type Full Name and title
Signatlll'C of A uthorizcd Agent, if any
Print or Type Full Name end title
Please return lw<1 copies oftbe completed Applic11tion package 10:
North Carolina DENR-DWQ
Aquifer Protection Section-UJC Program
1636. Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUllHC SQW"Nulilicnlion 0'1n1cnt l'ann (Revised R/200K)
Page 3
NIV
Area
. 14
Intracoastal Waterway
Approximate Property Lines
Approximate Building Perimeter
Approximate 250' deep Closed Loop Locations
Notes:
1. Subject property serviced by private septic system and public water.
2. Well locations are approximate and will be a minimum of 20' apart and 25' from the building,
3. Adapted from Google Earth and Brunswick County GIS Map, March 2010.
TITLE: SITE MAP FIGURE:
nfied r�e5our�e Mana:�ement F'C ' 1776 TWISTED _OAK LANE SW7
Po. Box 882, Hampstead, NC 28443 JOB: ! SCALE: DATE: DRAWN BY:
[91a] 270.2919 FAX 270-29a8 Brady AS Shown 3J25/10 DNH

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RE'
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r
Brunswick C omty, NC
I l %
3 1
Page 1 of 1
i Parcel Number
244 GL01 B
Plat Hate
- -
iAccouni Number
161233200 - -
' Ladd Value
. $400,000 - —
PIN
107512755949
Building Value
�
$417,040
Owner
'BRADY GEORGE M ET PAMELA C
Other value
$26,090 �.
:OwnerAddress l
Deferred Value
.$0 -
Owner Address 2
1776 TWISTED OAK LANE
Total Taxable Value 11343.130 -
City - �---- —
OCEAN ISLE BEACH
Neater! Sqr Ft
3 742 - -
state
NC
year Buik
1997
;Zip
28469
Bedrooms
;3 BEDROOMS
' Legal Description
L 18 S-GATE 4 BENT TREE PLAT T1267 . Fall Baths r
+, Parcel Street Nvmber
177:6 ��.
Stories _
i Parcel Street
TWISTED OAK
< it t. lWa11 f
CEDAR i REDW SI DIN
i Street Type
LN
i Ext- Wall 2
Street Dil
SW
��NeighWrhood
607C
Subdivision
- - -
'II unicoafity
-
Deed Book
.1090
Fire Tax District
SHALLOTTE POINT
Oeed Pare
0118
Township
SHALLO I I E
Deed Date
5122t1996
Acreage
Plat Book
Sale Price
, $145 ,000
Plat Page
Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Man Scale
guaranteed. This is not a legal document and should not be substituted for a title search, 1 Inch =112 feet
appraisal, sury ey, o r for zoning ve rificatio n.
1.—_ I,- • I ..r - _,err. .r�..,r. . - —rn .I - r . -_ 1T,-l"ln 0..- ..IC a '7 MIC rlt^I^