WI0800195_GEO THERMAL_20100511

Permit Number WI0800195
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
Peter Carey SFR
Location Address
109 Coquina Dr
Emerald Isle
Owner
Owner Name
Peter
Dates/Events
NC 28594
Carey
Central Files: APS_ SWP_
05/11/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Peter Carey
Owner
109 Coquina Dr
Emerald Isle
Major/Minor
Minor
NC
Region
Wilmington
County
Carteret
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Peter Carey
Owner
109 Coquina Dr
Emerald Isle NC
28594
28594
Orig Issue
05/11/10
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue
05/11/10
Effective
05/11/10
Expiration
05/06/10
Re g ulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin
J
&9A
~~~-""'!""~!'I"
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Peter Carey
Lisa Carey
P.O. Box 4203
Emerald Isle, NC 28594
Coleen H. Sullins
Director
6/1/2010
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0800195
109 Coquina Dr.
Emerald Isle, NC 28594
Dear Mr. and Mrs. Carey:
Dee Freeman
Secretary
On May 6, 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 .021l(u)(2). Additionally, you should contact the Carteret County Health
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county, or
nmnicipal rules and regulations may result in the ~ssessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Ro!!erslai ncdenr. eov if you have any questions.
~· ):;£fu/0
focDe~tts
Supervisor
cc: Wilmington Regional Office -APS
APS Central File~ -Permit No. WI0800195
Carteret County Health Dept.
Jim Cornette (Applied Resource Management, P.C., P.O. Box 882, Hampstead, NC 28443)
Patrick McKee (Airtech Mechanical Services, 153 Two Lakes Trail, New Bern, NC 28560)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
LocaUon: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone : [phone] FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service : 1-STT-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunit; \ Affirmative Action Employer
Ngrth Carolina
;Naturat/11
���
NCDENR
North Carolina Department of Environment and Natural Resources
f'\ 4 Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor %7a��` Director
Peter Carey
Lisa Care
109 Cyzquina Dr.
Erperald Isle, NC 28594
Subject. Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. W14800195
109 Coquina Dr.
Emerald Isle, NC 28594
Dear Mn and Mrs. Carey:
Dee Freeman
Secretary
On May 6, 2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -on].
geothermal injection well system for the operation of a ground -source treat 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
follovving conditions are met;
The injection well system contains only potable water,
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
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 .0211(u)(2 ). Additionally, you should contact the Carteret 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.Ro oers:a ncdenr-gov if you have any questions.
Srel:. ti
for Debra n
Supervisor
cc: Wilmington Regional Office - APS
APS Central Files - Permit No. W10900195
Carteret County Health Dept.
Jim Cornette (Applied Resource Management, P.C., P.O. Box 882, Hampstead, NC 28443)
Patrick McKee (Airtech Mechanical Services, 153 Two Lakes Trail, New Bern, NC 28560)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Ralegh North Carolina 27699.1636
Loca6an: 2 228 Capital Boulevard, Raleigh, North Carolina 27604 O
Phone: [phone] FAX 1: 919-715.0588; FAX [phone] ti Customer Sete ce: 1-877-623-6748 111 rr,,r+k I" a rnl i n
IntemBt: www,ncwatProualiN.om %� � "��� 'r��
An Equ31 ppportuniry t AfirmatEv8 kctian F�np!oyar �Yi161i1 LNy L■

WIF
NCDENR
North Carolina department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdtle Coleen H. Sullins
Governor f?�,- Director
3511112010
1� V
Peter Carey V
Lisa Carew.
109 Coquina Dr.
Emerald Isle, NC 28544
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0800195
109 Coquina Ur.
Emerald Isle, NC 28594
Dear Mr. and Mrs. Carey:
Dee. Freeman
Secretary
On May 6, 2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -on]%
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:
L 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 .021l(u)(2), Additionally, you should contact the Carteret 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.Rocersra nedenngoif you have any questions.
Sin rely,
for Debra tts
Supervisor
cc: Wilmington Regional (Office - APS
APS Central Files - Permit No. W1O8O0195
Carteret County Health Dept.
Jim Comette (Applied Resource Management, P.C., P.O. Box 892, Hampstead, NC 28443)
Patrick McKee (Airtech Mechanical Services, 153 Two Lakes Trail, New Bern, NC 28560)
AQUIFER PROTECTION SECTION
1636 Mail Service Center. Raleigh, North Carolina 27699-1636
Location: 2729 Capital Boulevard, Raleigh, North Carolina 27604 One
Phone: [phone] FAX 1; 9*115-0588; FAX 2; 919-715�60481 Customer Service:1-877-623-6748 NorthCarolina
Vnterrzet: w1Nuv.r>curaterGualitr.arc7 An Equal appwIL ty l AtWa,rve 4^Iion Employer �atL 11}a ■�LIy

A;- �rA
AQ=
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Goleen H. Sullins
Governor director
5/11/2010
Peter Carey
Lisa Carey
109 Coquina Dr.
Emerald We, NC 28594
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. W10800195
109 Coquina Dr.
Emerald Isle, NC 28594
Dear Mr. and Mrs. Carey:
Dee Freeman
Secretary
On May 6, 2010, the Aquifer Protection Section (APS) received notification of your intent: to construct a closed -loop water -only
geothermal injection well system for the operation of a ground -source heat pump located at thq 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 .021l(u)(2). Additionally, you should contact the Carteret 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.Rot+ersia_ncdenr.nov if you have any questions.
Sinwrely,
for Debra W
Supervisor
cc: Wilmington Regional Office - APS
APS Central Files - Permit No. W10800195
Carteret County Health Dept.
Jim Corvette (Applied Resource Management, P.C., P.O. Box 882, Hampstead, NC 28443)
Patrick McKee (Airtech Mechanical Services, 153 Two Lakes Trail, New Bern, NC 28560)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh. Notch Carohna 27699-1636
Location: 2728 Capital Boulevard, Ralelgh. North Carolina 2750
Phone: [phone] FAX 1: 919.715aW FAX[phone] Customer Service- 1-877-623-6748 Alp '-'*L, I-"'7;.. n
Internet: www.ncwatBrouality.org �"�1`1 .. `f�"�+"r"■■"lI�"
An Equal Qppormnity I A9firrtati" Action EmMoyer (/ 1 it �f LL 1 i LL�

1nG��cx�(�S
NDRTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSER -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEb7.
TYPE 5-OW WELL{S
In Accordance with the provisions of WCAC Titic 13A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Type information)_
DATE: Apri128.2010
Well Type Confirmation, Does the proposed system circulate potable water only (na additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed-loov)?
Yes _X— Continue completing this form.
No Do Not complete this farm. Complete other UIC application forms for installing
either a 5A7 well (a en -loop we]I i_niectipotable 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)fAPPLICANT(S)
List each Property Owner listed on property deed (if owncd by a business m government agency, state name of
entity and a representative wlauthority for signature):
(1)
(2)
Peter and Lisa Care,.
Mailing Address: _ 109 Coquina Drive
City: Emerald Isle State: NC Gip Code- 28594 County: Carteret
Home/Office Tele No.: 252-354-1139 Cell No.:
Email Address: Website:
Physical Address of Well Site (if different than above):
City. State: Zip Code: County;
Horne/OffiCe Tele No.: Cell No.:
B. AUTHORIZ]t✓D AGENT OF OWNER, IF ANY (ifthe 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:
Address.
City: _ _ State:
Office Tele No.:
Website Address of Company, if any:
G17UNIC 5QW Notification of fi tent Form (Rrvisrd 812008)
Zip Code:
EMAIL Address:
County -
Cell No..
DM
AquifL4 PD t B� Sedlon
Page t
MAY 66 Zara

C. WELL DRILLER INFORMATION
Company Name: A pp lied Resource Management P.C.
Well Driller Contractor's Name: """H~. M=-=-:.:.ic:.:h=a=e'--'1 S=a,,.g""e'-------------------
NC Contractor Certification No.: -----=2:.::::5,,,_3_.__l--!.A.,,__ ___________________ _
Contact Person ___ : ~J=im"'"""'C~o=m=e=tt=e __________ ~E=M .... A--=IL"""A'-="d=dr~e=ss=:~J=im=--A=R=M-=;;@=b~e~ll~so~u=th=.n=et,__ __
Address: P.O. Box 882
City: Ham pstead Zip Code: 28443 County: --~P-=-e=nd=e=.r ________ _
Office Tele No.: 910-270-2919 Cell No.: 910-512-4890
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: ___ A:....:.:..::irt.:.;e::.=c=h....:.M:..:.e=c=h=a=ni=c=al'--'S=e=rv..,,.i=c~es::........ __________________ _
Contact Person,_: ___ ..._P=at...,ri..,.c=k=M=c=K=e=e'---------"'E'-'--'MA=--"=IL"---A'-=dd.a:.r'""e""'ss::..:.: ___________ _
Address: -----=-1""'53:..-:.T.;.;wca:oc..:L=a=k=es=--=-T=ra=il=---------------------------
City: New Bern Zip Code:
Office Tele No.: 252-636-5841
E. STATUS OF APPLICANT
Private: X
State:
Federal:
Municipal: __
28560 County: __ ___,Ce:.=r..::;av.;.;e=n=----------
Cell No.: _______ _
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed loop geothennal system. Water onl y. 12.routed alon g the loop's entirety.
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _ _.5"-/=12=/-=-to ______ Number of borings: __ 3 __
Approximate depth of each boring (feet):_200' _____ _
(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 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) --'T=h=e=rm=ex"'-----
(b) Grout placement: Pumping__ Pressure_X_ 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/UJC 5QW Notification of Intent Fonn (Revised 8/2008) Puge 2
FROM : DELLRPE PHONE No. : 410 66-?0199 APR. 22 2610 06:05pM P3
a INJECTION -RELATED EQUTPWNT
Attach a diagrams showing the enginming Iayout or proposed modification of thu injections equipment and exterior
pipingitubing mccioted with the injection operation. The xnanufacturer's brochure may provide supplementary
infonnatiori
L L0CATt0N QFW1ELll.(S)
Attach two topics of maps showing the following information!
(1) Include a Site Map (can be drawn) sbowing, buildings, property lines, surl`aee water bodies, potential
souree-s of groundwater contamination and the orientation of and distanEccs between the proposeG well(s) and
any existing well(s) or waste disposal faoiirties such as septic tanks or drain fields located withi t 200 feet of
the geothercn l heat puma well systesrt. label all featL= clearly and include a north wrow.
(2) The Size Map repast slog the subject prop" io retatim w the surrounding area by using at least two fixed
r[fercnoo points such as roads, sheams, and/or highway intorsectiocs.
i, CERTMCATION
Nate: 'This Permit Application must be Agned by tact person stppearing on the
recorded legal property deed.
"I hereby may, such• penalty of law, that. I have personally examined and am familiar with the inforanation
subatitted in this doc,m,cnt and till attachments thereto and that, based on my inquiry of those individuals
i =W- iatcly msponsible -forobtaining stud infonnatIon, I believe that the infg alion is true, accurate and complete.
I am aware that there are significant penalties, including tho possibility of fines and imprtsonment, for siihmitting
false inEcimation- l agree to construct, operate, maintain, repair: and if applicable, abandon the injection well and
all related appuft-nnances in a000rdance with the apprmd specifications and conziatiozs of the Permit."
Signature of'Properry waO er1A te=t
print or Type Full Name and title
Signature of Propeq Osuner/App ant
Font of Ty}y. pull Name and title
Signature of Atathorized. Agent, if my
Pont or Type VU'U lei c and ti k
Please fctttrn M'O copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section-UIC Program
1636 Mail Service Center
]Raleigh, NC 27699-1636
Telephone (919) 7XS-0,15 RECEIVED 1 DENR I DVvQ
OPUMIC 3QW Hmi km6an o£in}cr t Forn Tcviscd S 009) AINl Fr', r Pmfe fjprl Sfttorrv3
MAY 06 2010

ConnectGTS
OWNER:
STREET NAME:
CITY:
MAILING ADDRESS
DIRECTION:
CAREY, PETER A
ETUX LISA
COQUINA
EMERALD ISLE
MAILING ADDRESS
CITY: EMERALD ISLE p:~~:~ ADDRESS PO BOX 4203
DEED BOOK:
BEDROOMS:
YEAR BUILT:
FIRE DISTRICT:
CONDO_:
0745
3
1998
LAND VALUE: 203686
SALE PRICE: 0
ROLL_ TYPE: R
Risk_level:
1:332 feet
Page 1 of 1
Parcels (Updated 04/29/2010)
PIN15: 539420809 7 0 HOUSE NUMBER (7 1 8 OO Digit EX. 00D0812f: 0000109
NEIGHBORHOOD
CODE:
ZIP:
MAILING ADDRESS
STREET:
MAILING ADDRESS
STATE:
TOTAL ACRES:
DEED PAGE:
BATHROOMS:
CITY LIMIT:
RESCUE DISTRICT:
560045
28594
NC
0.258
00626
2
EMERALD ISLE
PDOT: 9178
TAX VALUE: 415204
BLT_CONDO: 0
Noise:
STREET TYPE:
MAILING ADDRESS
HOUSE .NUMBER:
MAILING ADDRESS
STREET TYPE:
MAILING ADDRESS
ZIP:
DEED DATE OLD:
TOWNSHIP:
TOTAL SQUARE
FEET:
DR
28594
0
WHITEOAK
1408
LEGAL DESCRIPTION· L 14 BB SHELL
• COVE
MOTHER: 0
STRUCTURE VALUE: 167544
OTHER VALUE: 43974
PRIO: 15033A0206
aicuz:
http://carteret.connectgis.com/Map/PrintWindow.aspx?Map=http://carteret.connectgis.com/... 5/4/2010
Approximate Property Lines
Approximate Structure Location
Approximate Septic System Area
s.7 Approximate Closed Loop Locations
Notes:
1. Subject property and surrounding area are currently serviced by public water.
2. Geothermal well locations are approximate and will be a minimum of 20' ❑part, 30' away from
the septic area and 25' from the existing structure.
(Adapted from Carteret County G1S Map, April 2010.
TITLE: SITE MAP FIGURE:
rlied Resource Manai ement PC _ 09 Coquina Drive
Q. x arnps JOB: SCALE: LATE: DRAWN BY- I
270 2414 FPJ( 270 24$8
A(910)�I Carey NTS 4/28/ 10 DNH

P.EWAR
Approximate Property Lines
Approximate Structure Location
Approximate Septic System Area
Approximate Closed Loop Locations
Notes;
1. Subject property and surrounding area are currently serviced by public water.
2. Geothermal well locations are approximate and wi11 be a minimum of 20' apart, 30' away from
the septic area and 25' from the existing structure.
(Adapted from Google Earth Map, April 2010.
lied KeSource Mama ;ement PC
P7. Box 882. Hompstead.44
[910) 270.2919 FAX [phone]
TITLE: SITE MAP
109 Coquina Drive
JOB; SCALE: DATE:
Carey As Shown 4/28/10
DRAWN BY:
DNH
FIGURE;
2

Approximate Property Lines
Adapted from Carteret County GlS Map, April 2010.
TITLE; OVERALL SITE MAP FIGURE;
lied Resource Marla:�ement PC _ 109 Coquina Drive
P15. Box 882, amea , 44 JOB: SCALE: !DATE: DRAWN By' 3
1910) 270-29ps19 FAX [phone] Carey NTS 1 4/28/10 ❑NH

Approximate Property Lines
Approximate Structure Location
Approximate Septic System Area
Approximate Closed Loop Locations
Notes:
1. Subject property and surrounding area are currently serviced by pubiic water.
2. Geothermal well locations are approximate and will be ❑ minimum of 20' ❑port, 30' away from
the septic area and 25' from the existing structure.
Adapted from Carteret County GIs Map, April 2010.
TITLE; SITE MAP FIGURE:
Ifect Resource Mana,aement 11C 109 Coquina Drive
P.0. 882, Hampstead, N 44 JOB: SCALE` DATE: DRAWN BY:
[410j 270 2419 FA)C ?70 2488 I Carey NTS 4/28/10 DNH
N{
4

Approximate Propei1y Lines
Approximate Structure Location
Approximate Septic System Area
Approximate Closed Loop Locations
Notes:
1. Subject property and surrounding area are currently serviced by public water,
2, Geothermal well locations are approximate and will be a minimum of 20' apart, 30' away from
the septic area and 25' from the existing structure.
(Adapted from Google Earth Map, April 2010.
TITLE: SITE MAP FIGURE;
:lied Keoource Mann •ement f C 109 Coquina Drive
P.o. Box 882, Hampstead, NU 28443 JOB; SCALE; DATE; DRAWN BY;
[910)270-2919FAX [phone] Carey As shown 4/28/10 DNH 2