WI0800192_GEO THERMAL_20100415

Permit Number WI0800192
Program Category
Ground Water
Permit Type
Central Files : APS_ SWP_
04/15/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Injection Water Only GSHP Well System (5QW)
Version
1.00
Permit Classification
Individual
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit ,
Facility Name
Glen Spradling and Wanda Spradling SFR
Location Address
104 Sussex Ct
Jacksonville
Owner
Owner Name
Glen
Dates/Events
NC 28540 -
Spradling
Orig Issue
04/15/10
App Received Draft Initiated
04/15/10
Re o ulated Activities
Heat Pump Injection
Outfall r r i; , .
Waterbody Name
Scheduled
Issuance
Permit Contact Affiliation
Major/Minor
Minor
Region
Wilmington
County
Onslow
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Glen Spradling
104 Sussex Ct
Jacksonville
Public Notice Issue
04/15/10
NC
Effective
04/15/10
28540
Expiration
Stream Index Number Current Class Subbasln
2
NA
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Glen Spradling
Wanda Spradling
104 Sussex Court
Jacksonville, NC 28540
Coieen H. Suliins
Director
4/15/2010
Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System
Permit No. WI0800 ! 92
104 Sussex Court, Jacksonville, NC 28540
Dear M.r. K Mrs. Spradling:
Dee Freeman
Secretary
On April 15, 2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onl v
geothermal injection well system for the operation of a ground-source heat pump located at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection well system as long as the
following conditions are met:
1. The injection well system contains only potable water,
2. The injection well system is constructed in accordance with well.construction standards specified in North
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
3. The required notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Construction Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .02ll(u)(2). Additionally, you should contact the Onslow County Health
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Rogersrdmcdenr.!!ov if you have any questions.
Sincerely,
C)~A-~
Olna A. Boone
Office Assistant
cc: Wilmington Regional Office -APS
APS Central Files -Permit No. Wl0800l 92 :J
Onslow County Health Dept.
Ciimate Control Heating & Cooling Co, lnc (Mike Hadley) I 02 Middle Street, Jacksonville, NC 28546
1-\CU!FER PROTECTIOt; SECTIOtJ
1636 l\'>ail Service Center, Raleigh, North Carolina 276%-1636
Location: 2728 Capital Boulevard, Raleigh. North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-67 48
Internet: www.ncwaterauality.org
A'1 Equ;j Opportunit_/ \ Affirmative Astion Employer
,~Tone, C' ... J..,.. ortn aroJma 1\1 ; ff 11 vurttratq/
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 W_ELLN
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 Tag e information)_
DATE: April 14.2010
Well Type Confirmation: Does the proposed system circulate potable water onIN (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed-lnov )?
Yes x_ Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing
either a SA7 well (open -loop well ink 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)IAPPLICANT(S)
List each Property Owner listed on property deed (if os:med by a business or government agency, state name of
entity and a representative wlauthority for signatures: Glen & Wanda Spradling
(1) Mailing Address: 104 Sussex Court
City: Jacksonville State: NC� Zip Code: 28540 County:_Onsiow
Home/Office Tole No.: 910-347-3091 Cell No.:
Entail Address: Website:
(2) Physical Address of Well Site (if different than above):
City: State: NC Zip Code: County:
Home/Office Tele No.: Cell No.:
B. AUMORIZED 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 UC 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 10ENR 1 ❑y�q
Aquifer Prptctrara S00cn
APR 16 2010

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: [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 Hadley
Address: 102 Middle St.
EMAIL Address: [e-mail]
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 Systems
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _April. 2010 _______ Number of borings: __ 2 __
Approximate depth of each boring (feet): __ 200 ____ _
(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 _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 EQU PNWN
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
(I) 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_no_rth arrp.
(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
iwmediatehy 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 specifications and 4onditions of the Permit."
Signature of Pro v-nerlApplican
Print or Type Ful Nand 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 -[TIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECFJVED / DENa 1 D�
Aqujl� protetr:ttnn Sr
APR 15 201D

JC/
v ss x
• . Geothermal
Closed Loop Geothermal Heat
Transfer Systems
Mike Hadley, CGD
wtified r� Desi-gw
IGSHPAA=eMM trainer & irrUer
910-353.0926
iU2 Middle Street Fax: [phone]
Jacksonville, NC 28546 [e-mail]

yiai$ Lraca}+, Page 1 or 1
http://www.bing.com/maps/default_aspx?FORM= MSNNAV 4/14/2010

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 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or~ information).
DATE: April 14. 2010
Well Type Conftrmanon: 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.
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: Glen & Wanda Spradlin.o-_____ _
(1) Mailing Address: 104 Sussex Court ___________ _
City: Jacksonville State: _NC_Zip Code:...:.2=8=-54=0 ___ County: Onslow
Home/Office Tele No.: 910-347-3091 Cell No.:
Email Address: _____ ~W~e=b=si=te~: ____________ _
(2) Physical Address of Well Site (if different than above):_
City: ____ State: _NC __ Zip Code: __ County: __ _
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
Aquifer Protection Section
APR 15 2010
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: [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 Hadley
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. STATUS OF APPLICANT
Private: _X_ Federal: Commercial:
State: Municipal: __ 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: __ 2 __
Approximate depth of each boring (feet): __ 200 ____ _
(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 gr (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)
A. INJECTION -RELATED EQUIPM EN
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:
(I) 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
ail related appurtenances in accordance with the approved specifications and conditions of the Permit."
r f-
Sign a of Property «rner/Applicant
_A
Print or Type Full Nake 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 RECEIVES] I DENR 1 DM
Raleigh, NC 27699-1636 Aquifer Proter:tion SeG'son
Telephone [phone]
APB 15 2010

Prot 4S,4
,Oe,df
d%RP.M. Geothermal",
Closed Loop Geothermal Neat
Transfer Systems
Mike Ha&ey, CGD
CerVed Geoff Desigm
Q%PAAo3BfiW trainer & irslaler
91 a-353-09Z6
102 huddle Street Fax: [phone]
Jacksonville, NC 2654E [e-mail]

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