WI0100620_Aqueous Closed Loop Geothermal Well Construction Application_20210510

North Carolina Department of Environmental Quality – Division of Water Resources
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
These wells are “permitted by rule” and do not require an individual permit when constructed in accordance with the rules
of 15A NCAC 02C .0200. This notice must be submitted prior to construction.
GEOTHERMAL AQUEOUS CLOSED-LOOP WELLS
As described in 15A NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water and
performance-enhancing additives as part of a geothermal heating and cooling system.
OR
GEOTHERMAL DIRECT EXPANSION CLOSED-LOOP WELLS
As described in 15A NCAC 02C .0223 these wells circulate a refrigerant gas as part of a geothermal heating and cooling
system.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: May 10 , 2021 PERMIT NO.: _WI0100620_______(to be completed by DWR)
A.TYPE OF GEOTHERMAL CLOSED-LOOP WELL TO BE CONSTRUCTED (select one)
(1)X Aqueous (as per 15A NCAC 02C 0222 Number of wells: 1
(2) Direct Expansion (as per 15A NCAC 02C 0223 Number of wells:
B.STATUS OF WELL OWNER(S) (choose one)
(1)X Single Family Residence Submit this form two (2) business days prior to construction.
(2)Business/Organization Submit this form 30 days prior to construction.
(3)Government: State _____Municipal _____ County ____ Federal* _____
*Submit this form 30 days prior to construction
C.WELL OWNER(S) – For single family residences, list all persons listed on the property deed. For all others,
list the name of the Business/Agency and person and title with delegated signature authority:
James John Walsh; Anne Holly Walsh
Mailing Address: PO Box 246
City: Morganton State: NC Zip Code: 28680 County: Burke
Day Tele No.: 828-390-6024 Cell No.: 828-390-6024
EMAIL Address: jaywalsh@thistle -cottage.com Fax No.:
D.PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) of well site: County: PIN: 2705067978; Burke
(2) Physical Address (if different than mailing address): 1070 Belvidere Lane
City: Morganton County Burke Zip Code: 28655
Closed-Loop Geothermal Well Notification Rev. 3-1-2016 Page 1
E. REQUIRED MAPS, PLANS, AND SPECIFICATIONS

(1) A site maps must be submitted. It must be scaled or otherwise accurately indicate distances (in feet)
and orientations of features located within 250 feet of the injection well(s). Label all features clearly and include a
north arrow. Attach the site-specific map showing the wells in relation to the locations of the following:

 Buildings
 Property boundaries
 Surface water bodies, if any Water supply wells, if any

 Septic systems and associated spray irrigation
sites, drain fields, or repair areas, if any
 Existing or potential sources of groundwater
contamination, if any
(2) Plans and specifications of the surface and subsurface construction details of the well system.

NOTE: In most cases, an aerial photograph and/or plat map 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 and fields, and other wells, etc. can then be drawn in by hand. Also, a ‘layer’ can be selected showing
topographic contours or elevation data.

F. TYPES AND CONCENTRATIONS OF ADDITIVES – List any additives that will be used and their
concentrations. NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at http://deq.nc.gov/about/divisions/water-resources/water-
resources-permits/wastewater-branch/ground-water-protection/ground-water-approved-injectants. All other substances must
be reviewed by the DHHS prior to use.
Propylene glycol as antifreeze in water – not in contact with ground water since this is a closed loop system.

Will use bentonite thermal grout for 500’ length of A Green Ability twister loop.

G. WELL DRILLER INFORMATION Well Drilling Contractor’s Name: Gary Justice
NC Well Drilling Contractor Certification No.: NCWC 2150-A
Company Name: Justice Well Drilli ng Contact Person: Gary Justice
City: Marion State: NC Zip Code: 28752 County: McDowell

Day Tele No.: 828-724-4548 Cell No.:
EMAIL Address: justicewelldrilling @yahoo.com Fax No.:

H. HEAT PUMP CONTRACTOR INFORMATION Company Name: Comfort Zone Heating Air + Refrig.
Contact Person: Javier Guzman EMAIL Address: [e-mail]
Address: 303 New Orleans Blvd
City: Morganton Zip Code: 28655 State: NC County: Burke
Office Tele No.: ____________________ Cell No.: _828-439-9011_________ Fax No.:

Closed-Loop Geothermal Well Notification Rev. 3-1-2016 Page 2
I. PROTECTION – Provide a brief description of how any (a.) water supply wells, (b.) surface water bodies, or
(c.) septic systems and associated spray irrigation sites, drain fields, or repair areas within 250 feet of the proposed
injection wells will be protected during construction of the wells:
Unused 800’ dry well will be used for a closed loop geothermal thermal exchange well. The well lies 44’ from

the house, 51’ from the septic tank, and 75’ from the Western (nearest neighbor) property line as

indicated on the GIS map. Both septic field and repair field extend away from the well as shown. There are

no spray irrigation sites, drain fields, or water wells within 250’ of the well. All adjoining and surrounding

lots are served by City of Morganton water services.

J. VARIANCE – Pursuant to 15A NCAC 02C .0241 the Director of the Division of Water Resources may grant
a variance from applicable well construction or operation standards provided that:
(1) Use of the well(s) will not endanger human health and welfare or the groundwater; and
(2) That construction or operation in accordance with the standards is not technically feasible or the
proposed construction provides equal or better protection of the groundwater.
Any variance request should accompany submittal of this notification to expedite evaluation of the request.
The variance request form can be accessed online at https://ncdenr.s3.amazonaws.com/s3fs-
public/Water%20Quality/Aquifer%20Protection/GPU/GeothermalVarianceRequestFormFillable-
20130805.pdf

K. SIGNATURES – The following section is to be completed as required below or by that person’s authorized
agent. 15A NCAC 02C .0211(e) requires signatures as follows:

(a) for a corporation: by a responsible corporate officer;
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(c) for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official; (d) for all others: by the well owner;
(e) for any other person authorized to act on behalf of the applicant: documentation shall be
submitted with the notification that clearly identifies the person, grants them signature authority, and is signed and
dated by the applicant.

“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 15A NCAC 02C 0200 Rules.”

_________________________________________________
Signature of Property Owner/Applicant

________________James John Walsh_________________
Print or Type Full Name

_________________________________________________
Signature of Authorized Agent, if any

________________Anne Holly Walsh_________________
Print or Type Full Name

Closed-Loop Geothermal Well Notification Rev. 3-1-2016 Page 3
L. SUBMITTAL INSTRUCTIONS – Submit one copy of the completed notification package to the each of the
following:

(1) The Division of Water Resources’ Water Quality Regional Operations Section (WQROS) Regional
Office serving the area in which the injection well facility will be located:

WINSTON-SALEM
RALEIGH
ASHEVILLE WASHINGTON
MOORESVILLE
FAYETTEVILLE
WILMINGTON
Asheville Regional Office
Washington Regional Office
943 Washington Square Mall
2090 U.S. Highway 70 Washington, NC 27889
Swannanoa, NC 28778 Telephone: [phone]
Telephone: [phone] Fax: [phone]
Fax: [phone]
Wilmington Regional Office
Fayetteville Regional Office 127 Cardinal Drive Extension
225 Green Street, Suite 714 Wilmington, NC 28405
Fayetteville, NC 28301-5043 Telephone: [phone]
Telephone: [phone] Fax: [phone]
Fax: [phone]
Winston-Salem Regional Office
Mooresville Regional Office 450 W. Hanes Mill Road
610 East Center Avenue, Suite 301 Suite 300
Mooresville, NC 28115 Winston-Salem, NC 27105
Telephone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone]

Raleigh Regional Office 1628 Mail Service Center
Raleigh, NC 27699-1628
Telephone: [phone] Fax: [phone]

-AND-

(2) The County Environmental Health Department in which the injection wells will be located.

Closed-Loop Geothermal Well Notification Rev. 3-1-2016 Page 4
500’
James J. Walsh, MD - Geothermal Closed Loop Well
Approx. 20-25’ soil
Likely granite rock
of Thermally active
well 500’
Pea gravel base 500’ to
800’ – thermally inactive
but structural support for
closed loop
Total existing well depth 800’
with 500’ used for twister loop
on top of pea gravel base
Twister loop SDR13.8
pressure tested to 100 PSI
1¼” diameter Feed + Return tubes
SDR11 Pressure tested
to 100 PSI
Factory
Installed
1.2 Btu Thermally enhanced grout
pumped from bottom to top via
Tremie tube
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