WI0800268_GEO THERMAL_20111122

Permit Numbe r
Program Category
Ground Water
Permit Type
WI0800268 I
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
eric.g.smith
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Coastal Carolina Community College -Western
Blvd
Location Address
444 Western Blvd
Jacksonville NC 28546
Owner
Owner Name
Coastal Carolina Community College
Dates/Events
Scheduled
Orig Issue
11/22/11
App Received Draft Initiated Issuance
10/31/11
Regulated Activities
Heat Pump Injection
Outfall NULL
...
Central Files: APS_ SWP_
11/22/11
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
Non-Government
Owner Affiliation
David L. Heatherly
444 Western Blvd
Jacksonville NC
Public• Notice Issue
11/22/11
Effective
11/22/11
28546
28546
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
AWA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coastal Carolina Community College
David Heatherly -Vice President
44 Western Blvd
Jacksonville, NC 28546
Coleen H. Sullins
Director
11/22/2011
Subject: Acknowledgement oflntent to Construct Type SQW Injection Well System
Permit No. WI0800268
444 Western Boulevard, Jacksonville, NC 28546
Dear Mr. Heatherly:
Dee Freeman
Secretary
On October 31, 2011, 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:
l. 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 .021 l(u)(2). Additionally, you should contact the Onslow 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 !!ersuvncdenr.!wv if you have any questions.
cc: Wilmington Regional Office -APS
APS Central Files -Permit No. WI0800268
Onslow County Health Dept.
Mike Hadley (Coastal Geothermal)
AQUIFER PROTECTION SECTION
1636 Mai l Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Sincerely,
fo,Q~ A .fHAt
Supervisor
Phone: [phone] I FAX 1: 919-715-0588: FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwateroualitv.o
/>.n Equal Opportuniiy \ Affiri1ative Action Empioyer
NOneth.,...., .I. ort 1...,aro .rn.a
"Naturall!f
NOR'IH 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 wells circulate 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.
Print or Type lriformation and Mail to the Address on the Last Page.
DATE: Sept. 21 . 2011_ PERMIT NO. ~ 0 2 0 0 :lJ,, S (to be filled in by DWQ)
A. STATUS OF WELL OWNER (choose one)
Non-Government: Individual Residence Business/Organization __
Government: State X Municipal __ 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:
Coastal Carolina Community Colleg e: David Heatherly Vice President
Mailing Address: 444 Western Blvd.
City: Jacksonville State: _NC_Zip Code: 28546 County: Onslow
Day Tele No.: 910-455-1221 Cell No.:
EMAIL Address: --~Fax=N~o-~: ____ _
C. LOCATION OF WELL SITE -Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: 438711561171 County: Onslow
(2) Physical Address (if different than mailing address): 444 Western Blvd.
City: Jacksonville State: NC Zip Code: 28546
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name: .:..Jo=hn==-aS=a=lm=o=n""-----------
NC Well Drilling Contractor Certification No.: -~3~49~7~-----------------
Company Name: Coastal Geothermal
Contact Person . .:..: =Mik=·=e::..:H=ad=l=-ey......_ ___ -=E=MA=ILa=-:.A=d=dr==-e=s=s:'""mh=a=d=lee.,Y-1.:@::cb=iz=e=c=.rr=·=co=m=------
E.
Address: 102 Middle St .. _____________ _
City: Jacksonville Zip Code: 28546 State: NC County: -=O=n=sl~ow~--
Office Tele No.: _910-353-0926_ Cell No.: 910-376-1100 __ Fax No. 910-353-1060
·BEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name:N/A (for testing only)
GPU/UIC 5QW Notification (Revised 3/18/2011)
RECEIVED / DENR / DWQ
AQUIFFRPROTFr.TION SECTION.
OCT 31 2011
Page 1
Contact Person'-: ------=E=MAc=-==IL=-=-A=d=d=re=s~s:
Address:
City: _____ Zip Code: ____ State: _County:
Office Tele No.: Cell No.: Fax.No.:
F. WELL CONSTRUCTION DATA
(1) Number of borings to be constructed*: l ___ Depth of each boring (feet): _ 255' __ _
* ff existing water supply wells will be used then provide the information in item (4) below.
(2) Type of tubing to be used (steel, PVC, etc): _HOPE _____ _
(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: _NIA __________ _
( 4) Grout (material surrounding well casing and/or piping):
(a) Grouttype: Cement__ Bentonite** _X_ Other(specify) _______ _
** 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 _ 255_ (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 clearlv and include a north arrow.
(1) 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
R. CERTIFICATION (to be signed as required below or by that person-s authorized. agent)
15A NCAC 02C .0211(b) requires that all permit applications shall be signed as follows:
I . for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which means all persons listed on the property deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
' 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. 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 conditions of
the Pennit "
Signature of Property OwnerlApplican
David Heatherly, Vice President
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit the complete application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
"RECEIVED I QENR I DWO
A0UI5PR'lxRrt7Ml04 SFCMN
OCT 31 2011
GPU(MC 5QW Notification {Revised 3/18/201 t} Page 3

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