WI0800189_GEO THERMAL_20100401

Program Category
Ground Water
Permit Type
W I0800189
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Richard Lowdermilk SFR
Location Address
1121 Seashore Dr
Atlantic
Owner
Owner Name
Richard
Dates/Events
NC 28511
Lowdermilk
Central Files: APS_ SWP_
04/01/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Richard Lowdermilk
Owner
206 Mornington Ct
Simpsonville SC
Major/Minor
Minor
Region
Wilmington
County
Carteret
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Richard Lowdermilk
Owner
206 Mornington Ct
Simpsonville SC
29681
29681
Orig Issue
04/01/10
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue
04/01/10
Effective
04/01/10
Expiration
03/30/10
Reauiated Activities
Heat Pump Injection
Private residence, single family
Outfall
Waterbody Name Stream Index Number Current Class Subbasin
+
ALVIFWA
ria
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly caves Perdue Coleen H. Sullins
Governor Director
41112.010
Richard Lowdermilk
206 Mornington Ct.
Simpsonville. SC 29681
Subject: Acknowledgement of intent to Construct Type 5QW Injection Well System
Permit No. W10800189
1121 Seashore Dr.
Atlantic, NC 28511
Dear Mr. Lowdermilk:
Dee Freeman
Secretar.
In accordance with the application submitted to the Underground Injection Control (UiC) Program that was received on
03/30/2010, 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 1121 Seashore Dr., Atlantic, Carteret
County, NC 28511. 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].
Sine ely, {
for MichaWRogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Wilmington Regional Office - APS
APS Central Files - Permit No. 1 10300189
Carteret County Health Dept.
Mike Hadley (Climate Control Heating & Cooling Co.: Inc., 102 Middle St., Jacksonville, NC 28546)
AQU',;:ER PRQTEGTION SE-PON
1W Mail Serme Center, Raleigh, North Carolina 27699-15M
LnCBQVIi 27 2h Capital Boulevard, Raleigh, North Carc:tna 27604 One
Phone- 919?33. M 1 FAY 1: 919.715.0588: FAX 2' Customer Service: 1.877.6 a-6749 NordiCarolina
lntemat: www.ns;wa1l$1ru31itY.4
A: Equal Gpparlun� t n rma; va P:u 01 Emnksyer (J F�Lf• 6 G + �L

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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOUT' GEOTHERMA-L
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 mail to address on the back page (please Print or Type iuforruation).
DATE: March 25. 2010
Well Type Confirmation: Does the proposed system circulate potable water ou]N (no additives) in
continuous piping that completely isolates the fluid from the environment (ix,
closed -loop )?
Yes _x_ Continue completing this form -
No Do Not complete this form. Complctc other LIC application forms for installing
either a 5A7 well (gpen-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).
A. PROPERTY OWNER(S)IAPPLICANT(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; Richard Lowderrnilk
(1) Mailing Adddress: 206 Morningtgn Ct.
City: Simpsonville State: _SC_ Zip Code: 29681 County._.___
Home/Office Tele No.: 864-963-1631 Cell No.:
Email Address: Website:
(2) Physical Address of Well Site (if different than above): _1121 Seashore Dr. . -
City: Atlantic State: NC Zip Code: 28511 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 r DENR i DWO
AQ0FP 'PRnT -r. -nnu W .TIOH
MAR 3 0 2610

C. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal
Well Driller Contractor's Name: Sanford Sweeting
NC Contractor Certification No.: NC 2082
Contact Person: Mike Hadley EMAIL Address: mhadlev@ 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 Hadlev EMAIL Address: mhadley@ bizec.rr.com
Address: 102 Middle 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 injection well(s) will be used)
Closed Loo p Geothermal Heat Transfer Sy stems
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _April. 201 0 _______ Number of borings: __ 7 __
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 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 _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.
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 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 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 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 relan:d app""""""""5 in occonlaru:e with r?,:Vc:l~""" of the Pe,-m;t"
Signature of Property Owner/ Applicant
f.•Ghto-l 5, Lo1vJ~v~,• /{<_
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 Senice Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVED I DENR / DWQ
AQUIFl=R 'PROTFr.r1nN SECT/ON
MAR 3 O 201D
WAA-tr L)t 10
0
4• - . Oeolhermal
Closed Loop Geothermal Heat
Transfer Systems
Mike Hadley, CGD
ItM Acaadk8d trainer & irsWer
910-353-0926
102 Middle Street Fax; 910.353.1060
Jacksonvilk, NC 28W [e-mail]
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1121 Seashore Dr, Atlantic, NC 28511 - Google Maps
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Download Google Maps on yourAPRWA
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http:/hnaps.google.com/maps?f-=d&source=s d&saddr—l121+Seashore+Dr,+Atlantic,+NC... 3/29/2010

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 ISA: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Type information).
DATE: March 25 , 2010
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; Richard Lowdermilk _______ _
(1) Mailing Adddress: 206 Momingt on Ct.
City: Sim psonville State: _SC_ Zip Code:_,2=9-"'6-=81=-___ County: ____ _
Home/Office Tele No.: 864-963-1631 Cell No.:
Email Address: _____ ~W~e~b=si=te-: ____________ _
(2) Physical Address of Well Site (if different than above): _1121 Seashore Dr. __ _
City: Atlantic State: _ NC __ Zip Code: 28511 County: Carteret
Home/Office Tele No.: -----~C=ell~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 me well)
Company Name:-----------~------
Contact Person_: ___________ E_MAIL __ A~dcw~es~s=~---------
Address: _________________ _
City: _________ State: __ ZipCode: _____ County: _______ _
Office Tele No.: Cell No.:
Website Address of Company, if any: _____________ _
RECEIVED/ DENR / owa
AQU\Fi=R'PROT!=r.T1nN Sf:CTION
MAR 3 O 20\0
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: [e-mail]
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 Hadlev
Address: 102 Middle St.
EMAIL Address: mhadley@ bizec.rr.com
City: Jacksonville State: NC Zip Code: _28546 ____ County: Onslow __ _
Office Tele No.: _910-353-9040 ____ Cell No.: 910-376-1100 ___ _
E. STATIJSOF APPLICANT
Private: _X_
State:
Federal:
Municipal: __
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed Loop Geothermal Heat Transfer Systems
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _April. 2010 _______ Number of borings: __ 7 __
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 ___ fe_et (reference to land surface)
Casing extends to above growtd ___ 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.
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 well(s) or waste disposal .facilities such as septic tanks or drain fields located within 200 feet of
the geothermal heat pump well system. babel 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.
CERTIFICATION
!Vote: 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 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. 1 agree to construct, operate, maintain, repair, and if applicable, abandon die injection well and
all related appurtenances in accordance with the pproved specifications and conditions of the Permit."
Signature of Pro er/Applicant
2,-G A,, 4 K. 40 WofQ
Print or Type Full Name and title
Signat= 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-D►dVQ
Aquifer Protection Section-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636 PECEIVEi1 r DENR I DWQ
Telephone [phone] AQOIFpR PRi]TFi`ilm SFr,%%
MAR 3 0 2010

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Closed Loop Geothermal Heat
Transfer Systems
Mike Hadley, CGD
QWMEd GMEXdWW Designer
IGSHPAAmmclitedtraku & lrmtE[
910-353-0926
102 Middle Street Fax: [phone]ON
Jacksonville, NC 28546 [e-mail]
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1121 Seashore Dr, Atlantic, NC 28511 - Csoogle Maps
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Gonole maps
Save trees. Go green!,
thawnload Google Maps on your
phone at google.comlgmm 0�
http:llmaps.google.comlmaps?"&source=s d&saddr=l i21.+Seashore+Dr,+Atlantic,+NC.., 3/29/2010