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Groundwater Protection Unit :: Applications and Forms

ABOVE GROUND STORAGE TANKS

PLEASE NOTICE: The responsibility for above ground storage tanks has been transferred from the Division of Water Quality to the Division of Waste Management. Click here for additional information.

SOIL REMEDIATION

• Soil Remediation Permit Application (Form GW-70)
• Certificate of Approval For Disposal of Soil Containing Petroleum Products (Form GW-71)

GROUNDWATER REMEDIATION (NON-DISCHARGE)

• Groundwater Remediation Permit Application
• Groundwater Quality Monitoring Form For Permitted Facilities (Form GW-59)
• Compliance Report Form (Form GW-59a)
• Permit Name/Ownership Change Form

INJECTION WELL PERMIT APPLICATIONS AND OTHER DOCUMENTS

• IN-SITU GROUNDWATER REMEDIATION
  • For Injection of Remediation Substances and Tracers (Types 5I & 5T)
    This version is form-enabled and can be filled out on your computer.
  • Application For Permit to Construct Electrical Resistance Heating (ERH) Drip Injection Wells (Type 5Z)
  • Injection Event Record (Type 5I)
  • Microbial Risk Assessment Evaluation Form
  • Non-Microbial Risk Assessment Evaluation Form
    
    
• GEOTHERMAL HEATING AND COOLING
  • Notification For Vertical Closed Loop Water Only Injection Wells (Type 5QW)
  • Application For Closed-Loop Geothermal Injection Wells With Additives In The Circulating Fluid (Type 5QM)
  • Application For Open-Loop Geothermal Wells For The Injection of Heating and Cooling Effluent (Type 5A7)
    
    
• OTHER
  • Other Injection Wells Not Mentioned Above (Types 5B22, 5R21, 5S23, 5X25, and 5Z). Use this for Aquifer Storage and Recovery.
  • Guidelines for the Closure of Infiltration Galleries and the Abandonment of Injection Wells at Groundwater Remediation Sites
  • Registration of Pump Installation Contractor
  • Injection Well Permit Name/Ownership Change Form
  • Mechanical Integrity Test Record (Type 5QM closed loop injection wells)

WELL CONSTRUCTION, MONITORING, AND ABANDONMENT

• Groundwater Quality Monitoring Form For Permitted Facilities (Form GW-59)
• Compliance Report Form (Form GW-59a)
• Well Abandonment Record (Form GW-30); form enabled
• NEW Well Construction Records - click here for news of exciting updates
  • Well Construction Record, Residential (Form GW-1a)
  • Well Construction Record, Non-Residential (Form GW-1b)
• Application For Permit to Construct a Monitoring Well System (Form GW-22M)
• Application For Permit to Construct a Recovery Well System (Form GW-22R)
• Application For Permit to Construct a Water Supply Well (Form GW-22W)
  **Note** click here for Regional Office contact information.
• Application For Certification As A Well Contractor
• Continuing Education Approval Form For Certified Well Contractors
• Well Contractor Certification Inspection Report
• Well Construction Variance Application Form

STAFF USE & OTHER FORMS

• Permit Name/Ownership Change Form
• Order the Groundwater Sampling Methodology Video
• Groundwater Contamination Incident Management Site Priority Ranking Form
• Staff Request For Investigation
• Groundwater Investigations Land Use Agreement
• Well and Pump Inspection Report

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Mailing Address: 1636 Mail Service Center, Raleigh, NC 27699-1636
Physical Address: 2728 Capital Boulevard, Raleigh, NC 27604
Telephone: 919-733-3221
Fax: 919-715-0588
DWQ - DENR - NCGOV