WI0800198_GEO THERMAL_20100622

Permit Number WI0800198
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
Chuck Barone SFR
Location Address
9223 Hutton Hts Way
Calabash
Owner
Owner Name
Chuck
Dates/Events
NC 28467
Barone
Central Files: APS_ SWP_
06/22/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Chuck Barone
Owner
306 White Oak St
Jacksonville
Major/Minor
Minor
NC
Region
Wilmington
County
Brunswick
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Chuck Barone
Owner
306 White Oak St
Jacksonville NC
28546
28546
Orig Issue
06/22/10
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue
06/22/10
Effective
06/22/10
Expiration
06/15/10
ReQulated Activities
Heat Pump Injection
Private residence, single family
Outfall r l L
Waterbody Name Stream Index Number Current Class Subbasin
'1
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly i=aves Perdue Coleen H. Sullins
Governor Director
6/22/2010
Chuck Barone
306 White Oak St,
Jacksonville, NC 28546
Subject: Acknowledgement of Intent to Construct Type SQW Injection WeII System
Permit No. W10840199
9223 Hutton Heights Way
Calabash, NC 28467
Dear Mr. Barone:
Dee Freeman
Secretary
On 0611512010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-onh
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 .0211(u)(2). Additionally, you should contact the Brunswick County 1461th
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 Mi_chael.Roge_rsf&ncdenr.1,_ov if you have any questions.
sinply,
far >7ebr 11�stts
Supervisor
cc: Wilmington Regional Office - APS
APS Central Files - Permit -.%o. W10800198
Brunswick County health Dept.
Mike Hadley (Climate Control Heating & Cooling Co., 102 Middle St.,
Jacksonville, NC 28546)
AQUIFER PROTZCTION SECTION
1636 Mail 5enrioe Center. Raleo, North Carolina 27699-1636
Loeatlar:2728 Capital $aulevard, Ra egh. North Carolina 27604
Re
Phone: [phone] FAX t 919-'75 4588; FAY, 2:919-71-5-6a48 I Customer5eN4ca: 1.877-623-6745
intemet: WWW.r10WaterauaIftV'orc
QithCal-olina
Ajatmrally
An Equal OppmSumLy % Affirmative Auwi Employer

JUN 15 lOID
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATUR4L RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-OW WELL_ S)
In Accordance with the provisions of NCAC Title 15A: 02C.0200, please
complete this notification and mail to address ou the back page (please Print or TNpe information).
DATE: June 11, 2010
Well Tppe Confirmation: Does the proposed system circulate potable water ortl-, (no additives) itl
continuous piping that completely isolates the fluid from the environment (►.c.
closed-1oo0?
Yes X_ Continue completing this form,
No Flo Not complete this form. Complete other LAC application farms for installing
either a 5A7 well (peen -loop well in'e� cLing potable water into the aquifer) or a 5QM Nvell (closed -
loop well containing additives such as R-22, ethanol, or other arrtifreeze or corrosion irtt:ibitors).
1. 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.vlauthority for signatures,- Chuck: Barone
R 1) Mailing Address: 306 White Oak St
City: Jacksonville State: _NC_ Zip Code: 28546 County' Onslow
Hone/Office Tele No.: Cell No.: 910-330-5713
Email Address: chuckbarl u earthtink net Website:
(2) Physical Address of Well Silo (if different than above). 9223 Hutton Heights Way
City. Calabash State: NC Zip Code: 28467 _ County: Brunswick
Hone/Office Tole No.: Coil No_:
a. AUTHORIZED A(:ENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the properh, owner authorizing Agent to install and operate iU1C well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: _ State: Zip Code: County' _
Office Tole No.. Cell No_
Website Address or Company, if any:

C. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal
Well Driller Contractor's Name: Sanford Sweeti:qg_
NC Contractor Certification No.: NC 2082
Contact Person: Mike Radle, EMAIL Address: mhadle , a 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 ______ _
Contact Person: Mike Radle, EMAIL Address: mhadle_, ~a'""b=iz=e=c=.rr~.c=o=m=cc...,_ _____ _
Address: _.1_02 Middle S-",.t __________ _
City: Jacksonville
Office Tele No.:
State:NC Zip Code: 28546___ County: Ons~lo~w __ _
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 Loo p Geothermal Heat Transfer S vstems
t.;-. WELL CONSTRUCTION DA TA
(1) Proposed date to be constructed: _July/IO Number of borings: 4
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 _0 ___ to _250_ (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
H. INJECTION -RELATED EQUJPNiEN
Attach a diagram shoving 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
inlormatl on.
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a Site Map (can be drawn) shoming: 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 wetl(s) or waste disposal facilities such as septic tanks or drain fields 3ocatcd within 200 fect 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 relatioo to [be surroundings area by using at least two Imcd
reference points such as roads, streams, and/or highway intcrsections.
J. CERTIFICATION
Nate: This Perin it Application most be signed by each person al)pearing on t he
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 (lie infonnation is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fiches and imprisonment, for submitting
false information- I agree to construct, t. r3nd if applicable; abandon the injection well and
all related appurtenances in accordance: with the approved specilj,:;itioths conditions of (he Permit,"
Signat
Chuck Barone
Print or T,%W Full Name and title
Signature of Property OwnerlApplicarit
Print or Type Full Naive and title
Signature of Authorized Agent, if any
Print or Typc 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
Telephone [phone]

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Bing Maps
Page 1 of 2
Print this page in a mare readable format Click Print next to the lower -left comer of the map.
CO
Driving directions
To: 9223 Hutton Heights Way SW, Calabash
Also available:
Al 02 Middle St, Jacksonville, NC 28546
A-B:108.7 miles, 2 hr 3 min
1. Depart Center St toward Enterprise St
2. Turn left onto Enterprise St
3. Turn right onto Western Blvd
4. Turn right onto SR-24 West 1 Lejeune Blvd
BP on fhe comer
Keep straight onto US-17 South 1 SR-24 West 1 Ronald W Reagan
5. F rwy
6. Road name changes to SR-24 West
7. Bear left onto US-17 South
Pass CIRCLE H in 1.5 mi
Keep straight onto 1-140 West/ US-17 South/ John Jay Burney Jr
S. Fwy
At exit 14, take ramp for US-17 South 1 US-421 toward Clinton 1
9. Carolina Beach f Myrtle Beach
http://www.bing.com/rnaps/default.aspx?FORM=MSNNAV
far
0.1 miles
0.1 miles
0.8 miles
1.9 miles
3.0 miles
0.0 miles
44.3 miles
6.3 miles
0.3 miles
6/ 11 /2010

Bing Maps
Keep straight onto US-17 / US-74 / US-421 / SR-133 / US Highway
11. 421 N / US Hwy 421 N / US-421 N
Page 2 of2
2.7 miles
1.1 miles
Take ramp right for US-17 Bus West/ US-76 South I Andrew 0.6 miles
12. Jackson Hwy toward Beaches/ Brunswick County
Road name changes to US-17 South I US-74 West I US-76 West I SR-2.1 miles
13. 133 South I Andrew Jackson Hwy
Take ramp right for US-17 South I Ocean Hwy E toward Myrtle
14. Beach/ Shallotte
15. Bear left onto Thomasboro Rd SW
16. Turn left onto Clariday Rd SW
17. Road name changes to SR-179 Bus / Beach Dr SW
18. Turn right onto Shady Forest Dr SW
19. Turn right onto Hutton Heights Way SW
Arrive at 9223 Hutton Heights Way SW, Calabash, NC 28467-2747
20. on the left
The last intersection is Horseshoe Lake Rd SW
If you reach Whisper Park Dr SW, you've gone too far
I 89223 Hutton Heights Way SW, Calabash, NC 28467-2747
40.6 miles
2.4 miles
0.5 miles
1.1 miles
0.7 miles
0.1 miles
0.0 miles
These directions are subject to the Microsoft® Service Agreement and for informational purposes only. No guarantee is made
regarding their completeness or accuracy. Construction projects, traffic, or other events may cause actual conditions to differ
from these results. Map and traffic data© 2009 NAVTEQ™, AND™
http://www.bing.com/maps/default.aspx?FORM=MSNNA V 6/11/2010
RECEIVED I DENR I DWQ
AQU/F"J:R :i □,-ION
NORTH CAROLINA JUN 15 2Dta,
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR) '
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL
WATER-ONLY INJECTION WELL SYSTEM:
TYPE 5-0W 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: June 11. 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; Chuck Barone _______ _
(1) Mailing Address :_3_0_6_Whi~·~te~O~ak~S~t ______ _
City: Jacksonville State: _NC_ Zip Code: 28546 County: Onslow
Home/Office Tele No.: --------~C~e=ll~N~o=.,_: .:c-9-=-10~--=-3~30~--=-5-'--71=3'----
Email Address : chuckbar 1 n earthlink.net Website:
(2) Physical Address of Well Site (if different than above): _9223 Hutton Heights Way _____ _
City : Calabash State: NC __ Zip Code: 28467 County: Brunswick
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 Add!.ess:
Address: ___ _
City: _________ State: ___ Zip Code: _____ County: _______ _
Office Tele No.: Cell No.: ----
Website Address of Company, if any· _______________ _
C. WELL DRILLER INFORMATION
Company Name: Coastal Geothermal
Well Driller Contractor's Name: Sanfc,nlSweetim;
NC Contractor Certification No.: NC 2082
Contact Person: Mike Hadlev EMAIL Address: mhadle\ _albizec.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 ____________ _
Contact Person: Mike Radle, EMAIL Address: mhadlev a bizec.rr.com
Address: 102 Middle St
City: Jacksonville
Office Tele No.:
State:NC Zip Code: 28546 _ County: Onslow
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 Svstems
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _July/10 __ Number of borings: 4 __ _
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 EQUIPM- N
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
pipinglhubing associated ivith the injection operation. The manufacturer's brochure rnayr provide supplementary
information.
I. LOCATION OF WELL(S)
Attach two copies of maps showing the falIovring information_
(1) Include a Site Map (can be dra-,vn) 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 v�lthin 200 feet of
the geothermal heat pump well system. Label ail 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, andlor highway intersections.
J. CERTIFICATION
Note: This Permit Application must he signed ky each person appearing on the
recorded legal property deed.
" I hercby certify, under penalty of law, that I have personally examined and am familiar with tho information
submitted in this document and all attachments thereto and that, based on any inquiry of those individuals
immediately responsible for obtaining said infonnation, I believe that the information is tnie, accurate and complete -
I am aware that there arc significant penalties, including the possibility of fines and imprisonment, for submitting
false information- I agree to construct, operate, maintain, repair, and if applicable, abaiidon the injection well and
all relaters appartenances in accordauw with the approved specifications and conditions of the Permit -
Signature Signature of P r Owner/Applicant
JUN 15 2010.
Chuck Barone
Print or Type Full Name and title
Signature of Properh 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
Telephone [phone]

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HORSESHOE LAKE ROAD
WW VARIES - 44' MINIMUM
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-Page l ot' 2
' Print this page in.a mare readable format: CIIckPrint next to the lower4eft comer of the map_ J
Driving directions
To: 9223 Hutton Heights Way SW, Calabash
Also available
A102 Middle St, Jacksonville, NC 28546
A-B:108.7 miles, 2 hr 3 min
1 Depart Center St toward Enterprise St
0.1 miles
2. Turn left onto Enterprise St
0.1 miles
3_ Turn right onto Western Blvd
0.8 miles
4. Turn right onto SR-24 West/ Lejeune Blvd
1.9 miles
8P on the comer
Keep straight onto US-17 South I SR-24 West ! Ronald W Reagan
3.0 miles
5. Frwy
6. Road name changes to SR-24 West
0.0 miles
7. Bear left onto US-17 South
44.3 miles
Pass CIRCLE K in 7.5 mi
Keep straight onto 1-140 West I US-17 South I John Jay Burney Jr
6.3 miles
8. Fwy
At exit 14, take ramp for US-17 South I US-421 toward Clinton 1
0.3 miles
9. Carolina Beach I Myrtle Beach
http-,//u-ww.bing.com/maps/default.aspx?FORM=MSN-N,AV
6/11/2010

mng Maps
Keep straight onto US-17 / US-74 / US-421 / SR-133 / US Highway
11. 421 N / US Hwy 421 N / US-421 N
Page 2 ot 2
2.7 miles
1.1 miles
Take ramp right for US-17 Bus West I US-76 South I Andrew 0.6 miles
12. Jackson Hwy toward Beaches / Brunswick County
Road name changes to US-17 South I US-74 West I US-76 West I SR-2.1 miles
13. 133 South/ Andrew Jackson Hwy
Take ramp right for US-17 South/ Ocean Hwy E toward Myrtle 40.6 miles
14. Beach/ Shallotte
15. Bear left onto Thomasboro Rd SW
16. Turn left onto Clariday Rd SW
17. Road name changes to SR-179 Bus / Beach Dr SW
18. Turn right onto Shady Forest Dr SW
19. Turn right onto Hutton.Heights Way SW
Arrive at 9223 Hutton Heights Way SW, Calabash, NC 28467-2747
20. on the left
The last intersection is Horseshoe Lake Rd SW
If you reach Whisper Park Dr SW, you've gone too tar
189223 Hutton Heights Way SW, Calabash, NC 28467-2747
2.4 miles
0.5 miles
1.1 miles
0.7 miles
0.1 miles
0.0 miles
These directions are subject to the Microsoft® Service Agreement and for informational purposes only . No guarantee is made
regarding their completeness or accuracy. Construction projects, traffic, or other events may cause actual conditions to differ
from these results. Map and traffic data© 2009 NAVTEQ™, AND™
http://www.bing.com/maps/default.aspx?FORM=MSNNA V 6/11/2010