WI0800245_GEO THERMAL_20110714

Permit Number
Program Category
Ground Water
Permit Type
I ..
WI0800245 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Faci" v
Facility Name
Town of Sunset Beach
Location Address
7149 Old Georgetown Rd
Sunset Beach
Owner
Owner Name
Town of Sunset Beach
Date s/Eve!lt s
NC 28468
Scheduled
Orig Issue
07/14/11
App Received Draft Initiated Issuance
06/30/11
Reaulated Activities
He at Pump Injection
Outfall 1~'.JL'_
Central Files: APS_ SWP_
07/14/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
H Michael Sage
Driller Well
PO Box 882
Hampstead NC
Major/Minor
Minor
Region
Wilmington
County
Brunswick
Facility Contact Affiliation
Owner Type
Government -Municipal
Owner Affiliation
Sandy Wood
700 Sunset Blvd N
Sunset Beach NC
Public Notice Issue Effective
07/14/11 07/14/11
28443
28468
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly craves Perdue Coleen H. Sullins
Governor Director
7/ 1412011
Town of Sunset Beach
Sande Wood
700 Sunset Blvd North
Sunset Beach. NC 28468
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. W10800245
7149 Old Georgetown Road, Sunset Beach. NC 28468
Dear Mr. Wood:
Dee Freeman
Secretary
On June 30, 2011, 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 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
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 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.Rogers(Rnedennyov if you have any questions.
Cnctrely,
fnr l7ehra Watts
5upervisar
re: Wilmington Regional Office- APS
APS Central Files - Permit No. W10800245
B"rnswick County Health Dept.
Diana Holia.9 (ARM'.S Waterworks— PO &ix 882, Hampstcad- NC 28,143)
[candy Ramsey (Jacksonville Heating Contractors— 1246 Gurn'Bmnch Rvad..iacksonville, NC 2R540)
AWIFER PROTECTION SECTION
1636 MaB Service Cewer, Raleigh. No4h Caroline 27699163E•
location: 2728 Capital Bouleva4 Ralei h, North GaFains 2761A
Pnone: 914-133-32711,; rx ' 919-71a-MB. FAQ; 2' 915-715.60481 CGslamer Servive: 1-477-623.6748
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NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED -LOOP WATER -ONLY GEOTHERMAL INJECTION WELLS
These weals circuiate potable water only as part of a geothermal heating and cooling system.
These wells are "permitted by rule" and do not require an individual permit when they are constructed in
accordance with the rules of 15A NCAC 02C .0200 and this Notice is submitted prior to construction.
Prima or Type Information and Mail to the Address on the Last Page.
DATE: June 22 20 11 PERMIT NO. L1,' EV
07� to be filled in by DWQ)
A. STATUS OF WELL OWNER (choose one)
Non -Government: Individual Residence Business/Organization
Government: State Municipal x County Federal _
B. WELL OWNER — For individual residences, list each owner on property deed. For all others, state name of
entity and name of person delegated authority to sign on behalf of the business or agency:
Town of Sunset Beach - Mr. Sandy Wood
Mailing Address: 700 Sunset Blvd. N
City: Sunset Beach
Day Tele No.: 910-579-0068
EMAIL Address: srwoad(gatmc.net
State: NC Zip Code: 2848$
910-579-1840
County: Brunswick
C. LOCATION OF WELL SITE — Where the injection wells are physically located:
0) Parcel Identification Number (PIN) of well site: 2270003901 County: Brunswick
(2) Physical Address (if different than mailing address): 7149 Old Georgetown Road
City: Sunset Beach
State: NC Zip Code: 28458
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name: H. Michael Sage
NC Well Drilling Contractor Certification No.: 2531A
Company Name: ARM's Waterworks
Contact Person: Diana Helias EMAIL Address: [e-mail]
Address: PO Box 882
City: Hampstead Zip Code. 28443 State: NC County: Pender
Office Tele No.: 910-270-2919 Cell No.: Fax Na.; 910-270-2988
GPUfUIC SQW Notification (Revised 3/1&2i0H ) Page t

RECEIVED / DENR / OWQ
Aquifer Proter;t 11'JP $ertion
tJUN 3 0 20'1
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Jacksonville Heating Contractors
Contact Person: Randy Ramsey
Address: 1206 Gum Branch Road
EMAIL Address: [e-mail]
City: Jacksonville Zip Code: 28540 State: NC County: _O_n_s_lo_w ______ _
Office Tele No.: 910-347-2843 Cell No.: __________ F_ax_N_o_.: ______ _
F. WELL CONSTRUCTION DATA
(1) Number of borings to be constructed*: 10 Depth of each boring (feet):_28_0_' _____ _
* If existing water supply wells will be used then provide the ieformation in item (4) below.
(2) Type of tubing to be used (steel, PVC, etc): _H_D_P_E _____________ _
(3) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, etc.), diameter, depth,
and extent of casing appearing above ground: N/A -------------------
(4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite** __ Other (specify) _T_h_e_r_m_-e_x ___ _
** By selecting bentonite grout, a variance is hereby requested to ISA NCAC 2C .0213(d)(l)(A), which requires a cement type grout.
(b) Grout depth of tubing (reference to land surface): from O to 280 (feet) ----
If well has casing, indicate grout depth: from ____ to ____ (feet)
G. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearly and include a north arrow.
(I) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or
elevation data.
GPU/UIC 5QW Notification (Revised 3/18/2011) Page2
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Parcel Number
Account Number
PIN
Owner
❑wnerAddress l
Owner Address 2
City
State
zip
Legal Description
Parcel Street Number
Parcel Street
Street Type
Street Dir
Subdivision
Deed Book
Deed Page
Deed Date
Plat Book
Plat Page
QPCFtVFr, i DENR i DM
Brunswick County, NC "'con
vVx Ia. rKTItk;.
I: CCIRP_��;lyr1 4
Nc. ft4
L
2270003901
Plat Date
8/11/2009
60712270
Land Value
$94,720 Y
105619510217
Building Value
$0
TOWN OF SUNSET BEACH Other Value
$0
700 SUNSET BLVD N
SUNSET BEACH
NC
28468
7149
OLO GEORGETOWN
RD
2965
0115
8/14/2009
0061
0018
Defe►red Value
�$o
Total Taxable Value
$94,720
Heated Sq FtYear
Built
Bedrooms
Full Baths
tories
I
Ext. Wall I
Ext. Wall
Neighborhood
6009
Municipality
SUNSET BEACH
J
Fire Tax District
i SUNSET BEACH
- —
Township —
- SHALLOTTE -
Acreage
1.6
Sale Price
$275,000
Disclaimer.- Map and parcel data are believed to be accurate, but accuracy is not Map_ Scale
guaranteed. This is not a legal document and should not be substituted for a title search, 9 inch = 504 feet
appraisal, survey, or for zoning verification.
http://gis.brunsco.net/printPreview.aspx?PrintOptData=Brunswick County, NC10101truelfals... &28I2011

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COUNTY OF BRUNSV
PARCEL ID #: 22700039
VICINITYMAP
Nat to Scale) Sunset Station
#2�I3
TOWN OF SUNSET BEACH TYPE OF WORK,
700 SUNSET BLVD. NORTH
SUNSET BEACH, NC 28468 POTABLE WATER LINE
TEL: [phone] INDEX OF SHEETS
_- C4 WATER SYSTEM PLAN AND DETAILS
C-5 WATER SYSTEM DETAILS
SURVEYOR
EAST COAST ENGINEERING & SURVEYING, P.C.
712 VILLAGE RD. SW, SUITE 105
SNALLOTTE, NC 28459
TEL: [phone]
ARC`_HITECT
GARNER & BROWN ARCHITECTS PA
1718 EAST BLVD.
CHARLOTTE, NC 28203
TEL: [phone]
FAX-- (704)-376-6546
ENGINEER
MR. DONALD M COVIL, P.E.
COMPASS POI.NTE ENGINEERING, PA
5041-3 MAIN SM-EXT
SHALLOTTE, NC 28470
TEL: [phone]
FAX: [phone]
ENGINEERING
"ENG11,MEWS-CERTIFICAMON Qf MELIANCE WUH 13RUNSWICK CO= SPECIE -CATIONS AND DETAILL
I hereby certify that the plans, details, and associated project specifications comply with the latest version, as of this date, of
Brunswick County's Standard Specifications and Standard Details per standard engineering practice. Furthermore, I confirm
my understanding that reviews and approvals by Brunswick County personnel do not imply that Brunswick County personnel
have reviewed and are in agreement with every portion of the plans and specifications that 1 have submitted. I understand that
Brunswick County reviews and approvals are meant to ensure that the overall plans are in general compliance with County
objectives. I understand that it is my full responsibility to ensure that plans and specifications are in full compliance with
applicable County, State, Federal, and other municipal requirements. Additionally, I understand that the County will not
assume operation, maintenance, or ownership of constructed facilities that do nut meet County requirements and the County
may refuse to issue permits at facilities that the County deems are non -compliant with County Specifications. I also confirm
my understanding that County InspeLlions are for the sole use of the County and I certify that I will not use, or direct others
to use, County inspections for State compliance purposes or any other purpose."
DATE:
9/02/2010
SUBMITTAL:
CiVILENGWEEMG I
TWEL My
ems: bmr
nmc
PROJECT NO.
100413
SHEET NO,
l

1 '!
Notes:
1. Subject property and surrounding area are serviced by public sewer and water services.
2. Map adapted from Google Earth and Brunswick County GIS, June 2011.
---now Approximate 1000' radius
------ Approximate Subject Property Lines
Approximate Irrigation Well Locations
Newly Constructed Gas Station
V',
TITLE: SURROUNDING AREA MAP FIGURE:
�� lied I eSaurce Mana:.�ment YC 7149 OLD GEORGET'QWN ROAD -SW
P.Q. sox 882, �tampstead, f�C 284k3 JOB: — — SCALE; .__._._ — DATE: — —_ DRAWN BY:
(gip] 27�-29i4FA}( 27Q-2988 Sunset Beach Eire Station As Shown 6122/1 1 DNH 2