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Home My WebLink AboutWI0800210_GEO THERMAL_20101018Permit Number WI0800210 / 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 115 McDougald Drive Location Address 115 McDougald Dr Castle Hayne Owner Owner Name Suzanne Dates/Events NC 28429 Swanson Central Files: APS_ SWP_ 10/18/10 Permit Tracking Slip Status Active Project Type New Project Version 1.00 Permit Classification Individual Permit Contact Affiliation Jim Cornette PO Box 882 Hampstead NC Major/Minor Minor Region Wilmington County New Hanover Facility Contact Affiliation Owner Type Individual Owner Affiliation Suzanne Swanson 115 McDougald Dr Castle Hayne NC 28443 28429 Orig Issue 10/18/10 App Received Draft Initiated Scheduled Issuance Public Notice Issue 10/18/10 Effective 10/18/10 Expiration 10/07/10 Re g ulated Activities Heat Pump Injection Waterbody Name Stream Index Number Current Class Subbasin Permit Number W10800210 Program Category Ground Water Permit Type Injection Water Only GSHP Well System (5QW) Primary Reviewer michael.rogers Coastal SW Rule Permitted Flow Facii1 Central Files: APS SWP 10/18/10 Permit Tracking Slip Status Project Type Active New Project Version Permit Classification 1,00 individual Permit Contact Affiiiation Jim Cornette PO Box 882 Hampstead NC 28443 Facility fume Major/Minor Region 115 McDougald Drive Minor Wilmington Location Address County 115 McDougald Or New Hanover Castle Hayne NC 28429 Facility Contact Affiliation Gwne- ❑wner Name Owner Type Individual Suzanne Swanson Owner Affiliation Suzanne Swanson 115 McDougald Dr Castle Hayne DateslEvents Scheduled Orig Issue App Deceived draft Initiated Issuance 10/18/10 10/07/10 Reoulated Activities Heat Pump Injection duttall N12L. NC 28429 Public Notice issue Effective Expiration 10/18/10 10118/10 Waterbody Name Stream Index Number Current Class Subbasin Beverly Eaves Perdu e Governo r S uza nn e N. Swanson Rob Zap p le 115 M cDou gald Dr ive Cas tle H ayne, NC 28429 A.VA MC DENR North Carolina Departmen t of Environment an d Natural Resources Division of Water Qual it y Coleen H. Sullins Di rector l 0/18/20 I 0 Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System Permit No. WI0800210 11 5 M cDougald Drive. Castle H ayn e, NC 2 8429 Dear Suzanne & Rob: De e Freeman Secretary On 10/7/2010, 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 constru;ted 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 a_ccurately 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 .021 l(u)(2). Additionally, you should contact the New Hanover 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 (919) 715-6166 or Michael.Rogersr@.ncdenr.gov if you have any questions. cc: Wilmington Reg ional Office -APS APS C entral F il e s -Permit N o. Wl08002 .I 0 New H anover County Health Dep t. Sincerely, O~t'-~ for Debra Watts Sup ervi sor App lied Resour ce Management (Jim Cornette) PO Box 882, Hampstead . NC 28443 A RS (Bryan D onal dson) 20 0 N. Green Meadows Dri ve #A. Wilmi ngt on . NC 28405 AQUIFER PROTECTION SECTION 163G Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 2728 Capital Boulevard. Raleigh, North Carolina 27604 Phone: 919-733-3221 I FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748 In te rnet www.ncwatero ua lify .org An Equ al Opportun:'.; I Affirma'ive Action Employer Nirth Carolina }Vaturall!J 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 ofNCAC Title 15A- 02C.0200, please complete this notification and mail to address on the back page (please Print or Tyne information). DATE: October 5. 2010 4 V CL.ty_� lb Well Type Confirmation. Does the proposed system circulate potable water on1v (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 a en -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)lAPPLICANT(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): Suzanne N. Swanson (1) Mailing Address: _ 115_Mc Dou_iWd Drive _ City: Castle Havne State: NC Zip Code:28429 County: New Hanover Home/Office Tele No.; 910-675-0632 Cell No.: Email Address: Website: (2) Physical Address of Well Site (if different than above): City: State: Zip Code: County: Home/Office Tele No.: Cell No,: B. AUTHORIZED AGENT OF OWNER, W 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: GPU/UIC 5gW Notification of Intent Farm (Revised 912008) Page I C. WELL DRILLER INFORMATION Company Name: A pp lied Resource Management. P.C. Well Driller Contractor's Name: ~H~. M=ic=h=a-=el~S~a=g=e ________________ _ NC Contractor Certification No.: --~2=5=3=1-~A~-------------------- Contact Person~: ~J1~·m~C~o=m~e~tt~e __________ =E=MA=I=L~A~d~d=r~e~ss~: ~J~im-=--A~RM~@ ..... <u~b~el~ls~o~u~th_.n_e_t __ Address: ------"-P..:..;.O=•:....:B=o=x.:....8=8=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: __ ____;A:....::.:..:R=S'----------------------------- Contact Person: Bry an Donaldson EMAIL Address: Address: 200 N. Green Meadows Drive# A City: Wilmin gt on Zip Code: 28405 County: --~N_e~w~H=a=no=v~e~r ______ _ Office Tele No.: 910-799-8810 Cell No.: _~9~10~-~3~67~-~02_2~9 _____ _ 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 s ystem. Water onl y. gr outed alon g the loo p's entire tv . G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: ___ 1~0~/1=8~/~l0 _________ Number of borings: __ 4 ______ _ Approximate depth of each boring (feet): ____ 25_0_'~---- (2) Type of tubing to be used (copper, PVC, etc): _HDPE ____________ _ (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) (b) (c) Grout type: Neat Cement __ Bentonite Other (specify) _Thermex __ _ Grout placement: Pumping Pressure_X_ Other Grout depth of tubing (reference to land surface): from ---"'0_' __ to 250' (feet) If well has casing, indicate grout depth: from ___ to ____ (feet) GPU/UIC 5QW Notification oflntent Form (Revised 8/2008) Page2 Ft. INJECTION -RELATED EQl TIPMENT 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. 11. LOCATION OF WELL(S) Attach two copies of reaps 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 Faced 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 personalty 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 arc 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 specificatiqp,,:nrid conditions of the Permit." Signatur�yt Property Owner/Applicant 5-h2I" n't -`Print or Type Full Name and title S" nature of Property w7I 6ant -- - - Print or Type Fuli Nfte 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 CaroUbia DENR-DWQ ;SCE}VM ► O-Q_riq r rJV%U. Aquifer Protection Section-UIC Program A140er Prnivy.vn 5!Ki;W 1636 Mail Service Center Raleigh, NC 27699-1636 �. f Telephone (919) 715-6935 GPUaRC- 5QW Notification of intent Form (Revised =009) ;3 1'J"ew Hanover County PARID: R01700-001-004-003 SWANSON SUZANNE N Parcel Alt ID Address Unit City Zip Code Neighborhood Class Land Use Code Living Units Acres Zoning Legal Legal Description Tax District Owners Owner City State Country Zip 322114.33.5411.000 115 MCDOUGALD DR CASTLE HAYNE 2760 RES-Residential 10-1 Fam Res 1 1.81 RA-RURAL AG (1.81 ACRES) ADJ BROADWATER BRANCH FD SWANSON SUZANNE N CASTLE HAYNE NC 28429 THE DATA IS FROM 2010 Page 1 of 1 115 MCDOUGALD DR http://etax.nhcgov.com/Forms/PrintDatalet.aspx?pin=ROl 700-001-004-003&gsp=PROFIL... 10/5/2010 New Hanover County Page 1 of 1 New Hanover County Profile Sales Residential Commercial Misc. Improvements Permits Land Values Agricultural Sketch Full Legal Exemptions Sub -parcels) Info original Parcel Info 0. Parcel Map I CONTACT US I HELP XHL •TS), Hnme s ReglBter of oeeav Home Rome property Retards Owner Address Parcel ID Advanced PARID:R01700-001-004-003 SWANSON SUZANNE N Aerials R*711C_!! 1C_T rX! [ro iW 1 r t 1 A _ c 115 MCDOUGALD DR CURRENT RECORD 1011 {' Return to Search Resufts } L Lest OIS Data Update: 4Jan-MG Data Copyright New Hanover County [Disclaimer] [Privacy Palley] Last updated: 27 Sep 2010 Site Design Copyright 1999-2006 Akanda Group U1.C. All rights reserved. http://ctax.nhcgov.com/Forms/MapDatalet.aspx?slndex=0&idx=1 &LMparent=20 10/5/201 a ii gm� au OA3 a V� 13;.3 M1 Rr EE,55�il Mi!s '6 July �aiea Ala6uw ,' •r + °�, w it GE9 `S �f.anlns iealEa;caia,,S n-abevul 14 ik .r err rk - Y it n 6Zt9Z ON 'OuAeH allseD 'J0 ple6noECI o W q l ,v.,a G -,R IL Y SUZANNE SW 115 McDOUGAL CASTLE HAYI �DED EA f 6KN ORAV15L YItlVENGY, / P"POSM29Ta0.Y jlf WOMM WD cAMGMnOM APPRMI 1671 SO. FT, Approximate Geothermal Loop locations, spaced 20' ❑part, Note., Not to Scale z �s 0 z � o a x 0 3 fl � @ (D 0 c>} a a o >0 ° � - Q m mp >� a COOCD �n m o 1 l j V 1� Q SWANSON RESIDENCE 115 McDOUGALD M CASTLE HAYNF NC 2MI REMODELING & NEW CONsTRUCEON Rob Zapple Design & Build, Inc. Custom Home THESE rnQ.AraNa.9 ARV. K70114y'Eo A A Vlewu. OOMF EftW r. GOWYMUC-TfOPI YkP,. G0NT9AG-r0%514ALL VER FY 6ITE GONDITIOHy Al Immax ome ERIpR TC GpNbrY+yGYION ANP R-PCRT ANY MAC;RS OR 0MMIT1CYN5 TO r+P{K lWA.3E oE31Ax9 FMGORReGrfON OR EXPLANATIOK G0N51JVXLoPCA4. !'ROTl9910NAL EN61NG21R FOR SUZANNE SWANSON 115 McDOUGALD DRIVE CASTLE HAYNE, NC 223.6� -- — - — 1 WOODED AREA -- t Approximate Geothermal Loop locations, spaced 20' apart. Note; Not to Scale PARCEL 1D# R01700-001-004-003 ZONED RA 1.81 ACRES 1 WOODED AREA - C oq � Q Q C.) z ' O Q x U w Q REVISIONS NO. DATA. }�1CIIUifCiAL[31]k 04/19/ 10 >7n SHEET C I SUZANNE SWAINSOhJ 115 McDOUGALD DRIVE CASTLE HAYNE, NC WOODED AREA Approximate Geothermal Loop locations, spaced 20' aparf, Note: Not to Scale PARCEL 1D# R01700-001-004-003 ZONED RA 1.81 ACRES � •1 Q I WOODED AREA W 0 ce] "' U A � z REVISIONS NO. DATE hs::onu�;,�n ns DRAWING NO. 04/19/10 DAT ___. DPI, DRAWN SHEET C I