HomeMy WebLinkAboutWI0800220_GEO THERMAL_20110106Permit Number
Program Category
Ground Water
Permit Type
WI0800220 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
BEQ Hadnot Pt
Location Address
Beq Hadnot Pt P-1104 P-1193
Camp Lejeune NC
Owner
Owner Name
McB Camp Lejeune
Dates/Events
28547
Orig Issue
01/06/11
App Received Draft Initiated
12/02/10
Re ~ulated Activities
Heat Pu mp Injection
Outfall ' I
Scheduled
Issuance
Central Files : APS_ SWP_
01/06/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Mike Hadley
Driller Well
102 Middle St
Jacksonville NC
Major/Minor
Minor
Region
Wilmington
County
Onslow
Facility Contact Affiliation
Owner Type
Government -Federal
Owner Affiliation
Carl H. Baker
Deputy Officer Public Works
Building 1005
Camp Lejeune
Public Notice Issue
01/06/11
NC
Effective
01/06/11
28546
28547
Expiration
Waterbody Name Stream Index Number Current Class Subbasln
t....R
CDENR
North Carolina Department of Environmem and Natural ResourcAs
Division of Water Quality
Beverly Eaves Perdue Goleen H. Sufiins
Governor Gimctor
11(,' 201 11
Carl Baker — Deputy Public Works Director
Mr,B C.amli Leietlne
BuiIdin_ 1005 Michael Road
MCD Camp Leieune.. NC28547
Subject: Acknowledgement of Intent to Construct Type SQW Infection Well System
Permit No. W10900220
BEQ Hadnot Pt. P• 1 104 P-1 193. N1 1CB Camp Lejeunc. NC29';47
Dear )4;-. bake;
Gee l=reeman
Secretary
On 12117J2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-onl-
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 ❑f this type ❑f geothermal injection well system as long as the
following conditions are met:
I. The injection well system contains onty potable water,
2. The injection well system is constructed in accordance with well construction standaMs 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 Onslnw 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.Roeersiamcdcnr.yov if you have any questions.
Sincerely,
owfl
kir Debra H atts
5wper<�:.n�
cc- N'ilmingion Regional Office- APS
APS Central Files -Permit No. Wlt 9002i20
Onsiriw C'ounta irlealtu ❑cpartnicw
Coastal Gmthemial {Mik;: Hadley - 102 Middle. St_.lacicsonville. NC 283 t6y
A01;IFER FPOTFU1014 SECTION
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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTI17ICATION OF INTENT TO CONSTRUCT A CL0k13-L-Q0P GEOTHERMAL
WATER -ONLY INJECTION WE' 'YSTEM:
TYPE 5-OW WELLt
In Accordance with the provisions of NCAC Title 15A: +. .. '00, please
complete this notification and mail to address on the back page (please Print or Type information).
DATE: Nov.23.2010 Lc<�
Well Type ConfxrnmWon: 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 UTC application forms for installing
either a 5A7 well (open -loop well in�Iecting 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)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 signatures;
MCB Camp Lejeune
ATTN: Carl H. Baker, Deputy Public Works Officer
(1) Mailing Address: Building 1005 Michael Road
City: MCB Camp Lejeune State: NC_ Zip Code: 28547 County: Onslow
Home/Office Tele No.: 9I0-451-2213 Cell No.:
Email Address: cart.h.bake1?44usmc.mil
(2) Physical Address of Well Site (if different than above): BEQ Hadnot Pt. P-1104 P-1193
City: _ MCB Camp Lejeune State: NC Zip Code: 28547 County: Onsiow
Home/Office Tele No.: 910-451-2213
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:
Gt' UIC 5QW Notification of Intent Farm (Revised 7/2008) Page t
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: mhadley@ 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:_N/A _____________________ _
Contact Person=-: -----------=E=MA~=IL~A=d=dr~e=ss==----------
Address: ________________ _
City: ___________ S_ta_te_: __ Zip Code: _____ County: ______ _
Office Tele No.: Cell No.: ___________ _
E. STATUS OF APPLICANT
Private:
State:
Federal: X
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: Dec/2010 thru June 201 l ____ Number of borings: _198
Approximate depth of each boring (feet):_350' _____ _
(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) Grouttype: NeatCement__ Bentonite_x_ Other(specify) ______ _
(b) Grout placement: Pumping_X_ Pressure__ Other
(c) Grout depth of tubing (reference to land surface): from _O ___ to _350_ (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
GPU/UIC 5QW Notification of Intent Form (Revised 7/2008) Page2
H. INJECTION -RELATED EQU PMEN
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.
L LOCATION OF WELL(S)
Attach two copies of maps 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 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
retarded legal property deed.
"1 hereby certify, under penalty of law, that l 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.
t ant aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, i!)r ntain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the mppi oved s cations and conditions of the Permit."
'Sig afore of etty Owner/Applicant
Carl Baker, Deputy Public Works Officer
Print or Type Full Name and title
Signature of Property Owner/Applicant T
Print or Type Fuil Name and title
Signature of Authorized Agent, if any
Print or Type Ful i Name and title
M
Please return two copies of the completed Application package to:
tZ:7
m
North Carolina DENR-DWQ
�
ZI a
Aquifer Protection Section -[)IC Program
c
1636 Mail Service Centerrn
Raleigh, NC 27699-1636
Telephone (919) 715-6935
CZ
GPU/UtC 5QW Notification of Intent Form (Revised 7/2008) Page 3
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