WI0800251_GEO THERMAL_20110815

Permit Number
Program Category
Ground Water
Permit Type
WI0800251 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael .rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Mike Kirkbride SFR
Location Address
510 Hamlet Ave
Carolina Beach
0 ner
Owner Name
Mike
Dates/Events
NC 28428
Kirkbride
Scheduled
Central Files: APS_ SWP_
08/15/11
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
Major/Minor
Minor
NC
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Mike Kirkbride
Owner
510 Hamlet Ave
Carolina Beach NC
28546
28428
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective
08/15/11
Expiration
08/15/11 08/08/11 08/15/11
Reaulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin
NLDENR
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly saves Perdue Coieen H. Sullins
Govemor Director
08/15/2011
Mike Kirkbride
Dolores Kirkbride
510 Hamlet Ave,
Carolina Beach, NC 28428
Subject. Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0800251
510 Harrs et Ave.
Carolina Beach, NC 28428
Dear Mr. Kirkbride:
Resources
Dee Freeman
Secretary
On 08/08/2011, 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:
i , 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 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 [phone] or Michael.Roecrsfa ncdenr.eov if yo ve any questions.
Si cerelly,
for Deb Wa l
Superviso
cc: Wilmington Regional Office - APS
APS Central File; - Permit?4n. WIM0251
New Hanover County Health Dept,
Mike Hadley (Coastal Geothermal. 102 Middle St., Jacksonville, NC 28546)
Dave Maullsby (B & M Heating & Aix, 1222 S. 5"i Ave„ Wilmington, NC 28403)
AQUIFER PROTECTION SECTION
1636 Mai Service Center, Raleigh, North Carolina 27699-1636
Lae wn: 27B Capital Botjlmrd, Raielgh, North GamGna 27604
One
Phnne: 914-7K-3221 ! FAX 1�919-715Z8B, FAX 2:919-715-60481GustumerService; 1-B77-62.3-i748
1,46rtiiC ro-iiTicl
w.ncw Internet wwatemuafitv.ore
An Equal Opprr: v ;� F,firrnalive k,,lwi Employ

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 54QW WELL(S)
In Accordance with the provisions o£NCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the hack page (please Print or Type information).
DATE: Julr 27.2011
A.
B.
Well Type Conjrrmwion: Does the proposed system circulate potable water onF, (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
dosed -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 infecting 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).
PROPERTY OWNER(5)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 wlauthority for signatures: Mike & Dolores Kirkbride
(1)
(2)
Mailing Address: 510 Hamlet Ave.
City: Carolina Beach State: NC _ Zip Code: 29428 County: New Hanover
L ,-�
HomelOffice Tele No.: :'E _. Cell No.:
Email Address:
Physical Address of Well Site. (if different than above):
City: State: NC Zip Code: County:
Home/Office Tele No.: Cell No.:
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 LTIC well)
Company Name: NIA
Contact Person: EMAEL Address:
Address:
City:
Office Tele No.:
State: Zip Code:
Website Address of Company, if any:
Cell No..
County:
RECEIVED I DENR I nvtu
AQUJFr- t'PP0Trr..'n(w sFcT10N
GPUMIC 5QW Notification of Intent Form (Revise 7/2009)
Pale 1

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: mhadle [e-mail]
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: Bt ~~€GI~~
Contact Person: = 'I \ = EMAIL Address: N / A
Address: I 'l.-Z 1 s. 5 fn. l\vt
City: Ni\'M1M"rrm State: ~t, Zip Code: 'Z.~40 3 County: NE)J 1-\o»over
Of:ficeTeleNo.: \J q,o Tu3 'l3¥jel1No.: l\lu -44:':>'l.54~
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 ystems
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _August/Sept-201 l ____ 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)
(b)
(c)
Grout type: Neat Cement __ Bentonite _ x_ Other (specify) ______ _
Grout placement: Pumping_ X_ Pressure Other
Grout depth of tubing (reference to land surface): from_0 ___ to _255_ (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
GPU/UIC 5QW Notification offutent Form (Revised 7/2008) Page2
H. INJECTION -RELATED EQUIPMEN
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 frxed
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,
1 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 tines 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 specifications and c�nditi 'so
s of the Permit."
Signature of Property Owner/Applicant
Print or Type Full Name and title
� r
Signature of Property 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-U IC Program
1636 Mail Service Center
Raleigh, NC 27699-1535
Telephone [phone]
GPU/UIC 5QW Notification of fated Fo= (Ruviscd 7/2008) Page 3

PROVIDE 750 SQUARE FEET
BACK FILE. CLEAN OF 8' DEEP GRASS STORAGE f
SAND ALL AROUND BASIN Tn CONTAIN RUNIIFF-
PIPES AND TO% 1 NON -TRAFFIC
GROUND SURFACE AREA �
EX. ROUND WASHED 5iC
I=-7 � 8�
�C❑NTRACT❑R TO VERIFY
•-: a SOILS WILL ACCEPT I IN/HR
INFILTRATI13N RATE
2' SASS DRY II3I ETRATION BASIN
6' PERFORATED ' . wrs w
PIPE
NOTE -
ALL IMPERVIDIIS RUNOFF SHALL BE
THE TRENCH DRAIN SYSTEM
DOWN SPOUTS SHALL HAW OVERFL
ONTO SPLASH BLOCK AT CROUND L
DISPERSE EXCESSIVE RAINFALL AMC
DESSGN BASED ON 1.5" RUNOFF 571
OVERFLOW SHALL BE DIRECTED TO
AWAY FROM STRUGTURF
Lot Square Fnatage =
Lot Coverage = 6100
5C9°25100"E
100.00`
PERT DRAIN TRENCH
�y r
PIPE
1 TO
W
D
o
Ln
m
Ln
a
N
O
z
PERF. DRAIN
TRENCH
7.8'
ROOF
DOMSPOUT
LAMA STORMWATER
La: x0. i235 Pinfrsll Lana
RIGHT ANGLE
1e ►IQI 4 eEEKIIVQ. P.C.
x1z PRINCESS sTItEE7
WILMINGTON, NC 28401
[phone] FAX [phone]DB
GRASS DRY
INFIL.9TRATION BASIN
PROPOSED RESIDENCE
#51O
i
% Ifir/i,
PORCH
PERT
TRENCH
PATIO
PERE O N TRENCH
0
o a
Ul °
m �
n [\1
0
GARAGE N
Ln
3.71
D m
TRAFFIC RATED
c
GRATE ACROSS
�
D.W. INTO
PERF. DRAIN
TRENCH
100. QG'
ME 0239V a
(ROOF
DOWNSPOUT
u R up.00.m1V _ GRAPMC SCALE 1 -2(Y
f_. — i _ ► T — — — --

Project: Stephanie Covington
Residential Unit
Site: 510 hamlet Dr.
Carolina Beach, NC
Flaw Hanover County L W Area
Lot Dimensions 125 100 12500
Requirements; Control impervious area runoff in Coastal areas
Contain 1.5 in runoff from impervious areas
Calculate Impervious Area
L W Area
Roof Area = 80 57.6 5000 SF
Driveways = 35 20 1100 SF
Total = 6100 SF Impervious Area
Calculate Runoff volume
V 6100 sf 1.5 in. = 763 CF
12 ft. 5704 Gallons
Galtulate Storage in gutter coilection pipes
infiltration Trench Design
Perforated Pike Dia. = 6
in.
Pipe volume Per LF = 0.196
CF
Trench Width = 2
Ft
Trench depth = 2
Ft
Trench Volume Per LF = 4
CF
Washed atone mid ratio = 0.4
far #57 stone
Total Inf1, Trench Storage volurrra per LF =
1.80 CFILF
Trench length used =
160 LF
CF stored in Trench a
207 C F
Calculate Storage In Dry Infiifratlon Basin
Dry Basin Storage Area
L W
Prop Volume Provided Surface Area al Basin
Depth
30 25
Q_88 495 CF 750 Sr -
Total Storage Volume Provided =
782

Print - Maps
Page 1 of 2
Route: 67.6 mi, 1 hr 27 min
Carolina beach 5taie Park
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A: 142 Middle 5t, Jacksonville, NC 28546-6798 B: 510 Hamlet Ave, Carolina Beach, NC 28428...
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Ro gers, Michael
From:
Sent:
To:
Mike Hadley [[e-mail]]
Thursday, August 11, 2011 6:21 AM
Rogers, Michael
Subject: FW: Mike and Dolores Kirkbride phone#
Mike,
Here is the phone#. [phone]
Mike
From: PROXIMITYINVESTMENTS ©YAHOO.COM f mailto:PROXIMITYINVESTMENTS (a)YAHOO.COM J
Sent: Wednesday, August 10, 2011 1:38 PM
To: Mike Hadley
Subject: Re: Mike and Dolores Kirkbride
9106162421 mike kirkbride
Sent from my HTC on the Now Network from Sprint!
-----Reply message -----
From: "Mike Hadley" <mhadle (w,bizec.rr.com>
Date: Wed, Aug 10, 2011 8:26 pm
Subject: Mike and Dolores Kirkbride
To: "adam Covington" <proximitvi nvestments (aJyahoo.com>
Stephanie,
NCDENR would like a phone number for the Kirkbride' s.
Thanks,
Mike
From: Rogers, Michael [mailto:michael.rogers @ncdenr.gov]
Sent: Wednesday, August 10, 2011 12:00 PM
To: mhadley (a)bizec.rr.com
Subject: Mike and Dolores Kirkbride
Mike-
We received the SQW NOi for the above project. However, there was no phone number for the Applicant. Can you
please provide a phone number for the Kirkbrides.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications#geothermApps
E-mail correspondence to and from this address may be subject to the Norlh Carolina Public Records Law and may be disclosed to third parlies
1