WI0800212_GEO THERMAL_20101028 (2)

. CDE~R
North Carolina Depart men t of Environ ment an d Nat ur al Resou rce s
Divi sio n of Wat er Quali ty
Beveri y Eave s Perdu e
Govern or
Christopher Guilford
1013 Evans St._
-Morehead City, NC 28557
Coi een H. Sulli ns
Directo r
10/2 8/20 10
Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System
Permit i-,;,,. WI0800:1:
1013 Evan s ST.
Morehead Ci.ty , NC 28557
Dear Mr. Guilford:
Dee Freeman
Se cr etary
On 10/21/20 l 0 , 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 condit ions are met:
l . The injection well system contains only potable water,
2 . The injection well system · is constructed in acco~dance with well construction standards specified in No~h
Carolina Administrative Code Title 15A Section 2C Subchapter .0213 , and
3 . The required notification form and associated map s have been COI1J.pletely and accurately submitted.
Failure to compl y 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 Carteret County Health
Department as they ma y have additional requirements for this typ e of system. Noncompliance with applicable state , county , o r
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at (919 ) 7 15-6166 or Michael.Ro!!ers@.ncdenr.izo v if you have _an y questi ons .
cc : Wilmington Regional Offic e -APS
APS Central Files -Permit No. WI0800212
Carteret C ounty Health Dept.
S . l /11 .
mt:ere Y, Lll /\ . r -·
--<J_))!{4_ ~)7_½·0
for Deb~ arts
Supervisor
Jim Cornette (Applied Resource Management, P.C ., P.O . Box 8 82 , Hampstead, NC 28443 )
Phil Livcm1an (Professional Heating and Air, 114 Little 9 Rd., Morcileaa City, NC 2855:J
AOU!FER PROTEGTIO i~ SECTION
1636 Mail Service Center, Raieigt1. Nortl7 Carolina 27699-1636
Locai1on: 2728 Capiial Boulevard. Raieigh. North Carolina 2760!
Phone: 919-733·3221 I FAX 1: 919-715-0588; FAX 2: 919-715-604e \ Customer Service: '1-877-623-6748
internet: www.ncwate ra uali tv .oro
An Eoual Opportunity\ Aff1rrnat\vs .u.cttc:1 Er.1p!oy 1::~
nn~ North Carolina
,/Vatura!!tf
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NC DENA -Division of Water Quality
Aquifer Protection Section
1636 Mail Service Center
Phil Liverman
Professional Heating and Air
114 Little 9 Rd.
Morehead City, NC 28557
00 :!.l/D~/10
RE:TURN ·ro SE':NOF.:R
NO MAIL RECEPTACLE
\.l}iAElt~F.: ·ro F'OR\>.lAF;JO ~Cl ~7~-~~--~~~ *~380-~0~23-02-29
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Permit Number
Program Category
Ground Water
Permit Type
WI0800212 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael .rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Christopher Guilford SFR
Location Address
1013 Evans St
Morehead City
Owner
Owner Name
Christopher
Dates/Events
NC 28557
Guilford
Central Files : APS_ SWP_
10/28/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Christopher Guilford
Owner
1013 Evans St
Morehead City NC
MajorfMinor
Minor
Region
Wilmington
County
Carteret
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Christopher Guilford
Owner
1013 Evans St
Morehead City NC
28557
28557
Orig Issue
10/28/10
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue Effective
10/28/10
Expiration
10/21/10 10/28/10
Re g ulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Waterbody Name Stream Index Number ·current Class Subbasin
AWA
NCDEMR
North Carolina Department of Environment and Naturai Resources
Division of Water Quality
Beveriy Eaves Perdue
Governor
Christopher Guilford
1013 Evans St.
Morehead City, NC 28557
Coleen H. Sullins
Director
10 /28/2010
Subject: Acknowledgement oflntent to Construct Type SQW Injection Well System
Permit No. WI0800212
1013 Evans ST.
Morehead City, NC 28557
Dear Mr. Guilford:
Dee Freeman
Secretary
On 10/21/2010 , 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 iajection 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 .021 l(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!!:ers @ncdenr.2ov if you have any questions .
cc: Wilmington Regional Office -APS
APS Central File~ -Permit No. Wl0800212
Carteret County Health Dept.
Siircerely, , 0 , l. J (A_ JjJ{/(;..)L~
for Deb~~atts
Supervisor
Jim Cornette (Applied Resource Management , P .C., P .O. Box 882 , Hampstead, NC 28443)
Phil Liverman (Professional Heating and Air, 114 Little 9 Rd., Morehead City, NC 28557)
AQUIFER PROTECTION SECTION
1635 Mail Seivice Center , Raleigh , North Carolina 27699-1636
Location: 2728 Capital Boulevard , Raleigh. North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919-715-5048 i Cusiomer Seivice: 1-877-623-6748
Internet: www.ncwaterauali rv .o rc
An Equal Opportunity I /l,filrmat,ve A.ciion Employer
NOne 1 C .. ort1 arouna
/vatu1ully
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 WELUS)
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 Tyne information).
DATE: October 20. 20 10
Well Type Confirmation: 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 ❑ en -loop well iniecting potable water into the aquifer) or a 5QM weii (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 wlauthority for signature): Christopher Guilford & Rebecca Flemtnin
(I) Mailing Address:
1013 Evans Street
City: Morehead Cih State: NC Zip Code: 28557 County: Carteret
Home/Office Tele No.: Cell No.: 252-622-8589
Email Address: crguilford a-onail.com 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, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the properly 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:
CTUIITIC 54W Notification of Intent Form (Revised 8/2008) 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: Jim Cornette EMAIL Address: Jim ARM@.bellsouth.net
Address: --~P""".O"". ___ B=-o=x=-8=8=2'----------------------------
City: Ham pstead Zip Code: 28443 County: ___ P~en=d=e~r ________ _
Office Tele No.: 910-270-2919 Cell No.: 910-512-4890
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: ___ P=--'r ..... o=fe=s=s1=·o=n=al ..... H=e=a=ti=n=g~an=d~A=ir'--------------------
Contact Person: Phil Liverman EMAIL Address:
Address: 114 Little 9 Road
City: Morehead Ci ty Zip Code: 28557 County: ------'C=a=rt=e=re=t ________ _
Office Tele No.: 252-726-2875 Cell No.:
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 e.eothennal s vstem. Water onl v. grouted alon g the loo p 's entirety.
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _ __,'lC..C0"-'/2=8"'-/=10...__ _____ Number of borings: __ 3 ___ _
Approximate depth of each boring (feet):_...:=2=5~0-' ______ _
(2) Type of tubing to be used (copper, PVC, etc): _...:=H=DP~E=------------------
(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)
(b)
(c)
Grout type: Neat Cement __ Bentonite Other (specify) __ T_h_e_rm_ex __ _
Grout placement: Pumping__ Pressure X Other
Grout depth of tubing (reference to land surface): from O to _~2_50 __ (feet)
If well has casing, indicate grout depth: from ____ to ____ (feet)
GPU/UIC 5QW Notification of Int ent Fonn (Revised 8/2008) Page2
it. INHCTIt. N-RELATED EQUIPMENT
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. intorrnation:
(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 weil(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.
(z) 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 l ch 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. l agree to construct, Operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance wit �tir8phr�ved sPecificat}�ns :r 1 nditi8ns of the Permit"
Srgnatc�re of Propertyr��ypEv erlApplicant
Print or Type Full Name and title
5lgnatttregfPraperty :ti rlApplicartt -- -
Pratt or Type Full Name and tife
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]
011UIUIC SQW Norir'icmian afIimni ro m (Rmiser4 812009) C'ngt 3

Approximate Property Lines
Approximate Closed Loop Locations, Spaced 20` apart
Notes; Public water and sewer are utilized in the area.
Adapted from Google Earth and Carteret County GIS Map, October 2010,
TITLE: SITE MAP
r [iect Keoouree Management PC 1013 EVANS STREET
. Box 882, Hampstead, NC 28443JOB: SCALE: DATE; DRAWN BY;
[910)270-2919FAX [phone] Guilford 1" = 30' 10/19/10 i DNH
FIGURE;

Approximate Property Lines
Approximate Closed Loop Locations, Spaced 20' apart
Notes: Public water and sewer are utilized in the area.
Adapted from Google Earth and Carteret County GIS Map, October 201 O.
tdied Reocurce Mana ement f C
Box 882, Hornpstead, NC 28443
9101 270-2919 FAX [phone]
TITLE: SITE MAP
1013 EVANS STREET
1101II& I
N
JOB: SCALE: (DATE: DRAWN BY:
Guilford I" = 30' 1 10/19/10 DNH