WI0100078_GEO THERMAL_20091210

Permit Number WI0100078
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility Name
Kent J. Plemmons SFR
Location Address
225 Triple Creek Dr
Clyde NC 28721
Owner
Central Flies: APS SwP
12/10109
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Eileen L. Plemmons
Co-owner
60 Monte Vista Dr
Waynesville NC 28786
Major/Minor Region
Minor Asheville
County
Haywood
Facility Contact Affiliation
Owner Name Owner Type
Individual
Kent J Plemmons Owner Affiliation
Kent J. Plemmons
Owner
60 Monte Vista Dr
Waynesville NC 28786
Scheduled
Orig Issue App Received Draft Initiated Issuance
12/10/09 12/07/09
eQuiated Activities
Heat Pump Injection
Private residence, single family
Public Notice Issue Effective
12/10/09 12/10/09
Expiration
Outfail
Waterbody Name Stream Index Number Current Class Subbasin

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coieen H. Sullins
Governor director
12/10/2009
Kent J. Plemmons
Eileen L. Plemmons
60 Monte Vista Dr.
Waynesville, NC 28786
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. W10100078
225 Triple Creek Dr.
Clyde, NC 28721
Dear Mr. & Mrs. PIemmons:
(lee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on 12/07/2009,
the Aquifer Protection Section (APS) acknowledges your intent to construct a closed -loop geothermal water-ordy injection well
system for the operation of a ground -source heat pump located at 225 Triple Creek Dr., Clyde, Haywood County, NC 28721. This
system is deemed permitted by rule [North Carolina Administrative Code Title 15A, Subchapter 2C, Section .0211(u)(2)).
However, it is recommended that you contact the Haywood County Health Department. as they may have additional construction or
permitting requirements for this type of system. If you modify your system at any time, including the addition of antifreeze, corrosion
inhibitors, or any other substances to the circulating fluid, you must contact the APS to verify compliance with applicable rules.
Thank you for submitting this notification. If you have any questions please call me at [phone].
Si -.erely,
for Mic Rogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Asheville Regional Office - APS
APS Central Files - Permit No. WI0100079
Haywood Cotmty Health taept.
Randall Cutter (Innovative Environmental Drilling, 6105 Rest Home Rd., Claremont, NC 28610)
Guy Cox (GLC Services, Inc., 2225 Bald Creek Rd., Clyde, NC 28721)
AQUIFER PROTECTION SECTION
1636 M0 Service Center. Ralagh, North Carolina 2 769 9-1636
Location. 2728 Capital Bouksvard, Ratsigh, North Carolina 27604
Phone' 919-733-3221 I FAH 1: 919.715-0588: FAX 2: 919'15-6048 k Cusmmer Service: 1-877.623-674F
Intemet: WWW.ntwateroualay.orq
�oAb Carolina
N^ Equal Op portun" Ath rml Jive ACIivn ErripbyPr

7-OB-199S 12, AWM FROM 82Bar%2d200
P. 2
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RMOURCES £NCDENR)
NOfTDfICATION OF;lt['IM15 T TO C1 NSMUC!' A CLOSED —LOOP GEUTMRMAL
WATERA)MUINdECMN WEEL SYSTEIM
Wa-
In Ao=&ff ce with the prwvbkm ofNCAC Wo ISA: 02C.0200. please
oampleta ibis naMcadan and mad[ to addrm an the back page (per E= m M= h&wmabm).
WeH type Coq*m diwc Days the p grind system ZWYA pce pom5k MW onivoW (no additi► a) m.
eoatimwm pip mS that completely iaoW= the fluid fima the wvkon eat (i.e.
clnaed-taot?>fl
Yer Gowum Qamplatiq6 this form.
No Do Not oomnplft this form. CmWkIa other UIC applieMoe forma for i mshtiling
either a 5A7 well (gM-loop wail sum potable water into the aguf w) or & 5QM well (ckwc&
loop won conafaw" tweh m R: 22, ethanol, or other aniif wm or cmosiaa luldbikn).
A. PROPERTY OWAiLr1 MAPPLICANT(S)
Lin Mb Property Owner Ssted cm property dead (if awned by a bw!rAm or goveramant agmey, ataee name of
eolty wW m reprsae dmflve wJaudwrity far ApNdiae): 1i,4- �m 4- kilmem L 9gI i►s w!->
(li 3V 9Hug Address: Q �
chr. VAV h U! et Stew ZP Codde: Z —Goemty 4. wopw
HomeADffioe Tele No.: (K�� ':�;U,:;
�Adtf :k f Lrt wets;... �r�ic ��YS 600e2
CCWW
(2) Phyaicd Address of Well Site Of Mffurt ttt thaaabm): 5 e-r i`
city;, CLij—e Stame:W.—zip Coft: z--%7 Z - -County:
Homa0ffice Tole No.: k.�) 'ST6 " �" 17 ! Cell My
IL AU THORIT. W AGtW OF OWNM IF ANY (if the PwRit Applicat d2own tie anWM
attach a )NOW ftm the psnpetty awtter aadbariaing Agent to install and operetta UIC well)
C4nqwqr Namc:
Carina, Ptaaon• EMAIL Address:
Address:
City Sta1a zip Cody: Cowley:
boa Tale No.: Cell No •
W obft Addrom of Compm y, if wd:
[aR.MM SQW Nettaartboe of boat F=W M&VW V2W)
RECEIVED 1 DENR 1 DWO
AQU IFFR'pR()iF%T ON SECTION
DEC 0 7 2009
Pap

7--W-1999 12:"M FROM 82Sd524200 P.3
G WELL DRILLER INFORMATION e
Carupre7i�(snte� �•��r ' 11P _ �'�yf �i�,��u� p
Well Driller Co9tra0Ws Nam: aa, NA
NC Ca n&&Mt Ceabftiration No.: cI ❑ 1 '?
Contact Person,' . _! � 1�r-� �+ei- - .SAIL_ Address: PartL a }eb fha CD T
Address: i - —
city: Zip Code: ,Z-_- County' Oa,-J f
ORgce Tele No.: qS Call No.:
a
HEAT PUMP CONTRACTOR WFORMATION (lf dlfi~ time drilkr)
Contact Parson: C04 E I
Address: AaaZ galf—I L
.City: Zip Code: A7 _ c,=*'
Off= TeleNo.( — Call No.: �i4n e
-r -
T_ STATUS OF APPLICANT
Frl►�ame: Federal: Comnicreial:
stems: Mwticpal: Nalive American .iauds:
F. INJZC'TION PROCEDURE (brle$y describe how the ir}mlon well(a) will be used)
G. VVXTIL CONSTSUCTION DATA
(3) Proposed date to be eansmxmd: Number of borings -
le
Apptmximatcdepth ofe h boring -(feet):
(2) Type of tubing to be used (copper, PVC, ewc _ L T L ,• �
(3) Well easing. Is the well(s) cmd7 (check ehhea (a,) Yes 2r (b,) No below)
(a) Yes if M than provide casing h6wmation below
Type: ____gaNwiized steel black steel`plestic other (specify)
ring depth Fratn to feet (mhrmce oo land aWEMCC)
Casing extends to abovq ground iWIM
(b) No }�
&M
n
CON4
(4) Gra1}t Info (mairrifli suairvuatdrng we33 crosrng andkx prprng}: ,
(a)'- Grout type: Ne& Ceneent �_ Seattortibe . Other (s*ify)
(b) Grout p}acatnent: Pmnpin R'easuro� Dtha '
(s) Grout drrpth of tubing (reference w Yand surface): firom
If wetl has casing, indicate grout depth: from to (set)
OPUA TlC 5Qw Nwittarrkm of hwmsene t V2lll18)Per 2.

7-08— T 999 k 2 : ai PM PROM 8284524200 P. 4
S. INJECTION -RELATED EQUIPMENT
Attach a (Sagram showing the engitneeriag layout or proposed modificativu of the injection tquipmem ? *p: exterior
plpiVinbing assacistcd with the injection operatlon. -The rnanu&cttaer's brochure may provide su�'cmer�r�
information. t
L LOCATION OF VVTL4S)
Attach two copies of maps showing the fallowing intbrm tion:
(1) include a Site Map lean be drawn) showing: -buildings, property tiara, surface water bodies• potmtial
saunas of garmdwutff contamination and the orientation -of and distances between the proposed wel)(s) hrtd
any exW ng well(s) or waste dispeGal facilities such as septic tanks or drain Gelds iocatrd within ve fstt of
ft geothermal heat pump well system. Label all fesnmes clearly and;dude a z rya.
(2) T-11e, Site Map mrsst Shaw t>;e SubjeO prWeM is relmdon m the SMT*u ft area by um ng �t Mast two toted
reference pottn. such as roedr, streams, andlar h4bway iiduseatow
J. CI1:fts MCATION
Now Thk ftrmk Appfeatlaa nnaat be slped by SUI person appeatring on the
re owded hWd prrpeytp deed.
"I hmtby certify, under pen&Ity of law, that I have personally examined and aim familiar with the., infamiaaion
submitted in this document and all attachments tltcreto and Chet, based on my inquiry . of those ' individuals
immediately responsible for obtalnirtg said information, I believe that the information is true, accufste arutcomplete.
I am aware that there are significmut penalties, including the possibility of faws and imprisonment for submitting
false Wormatim f agree to com tvct; operane, snairttsirt, repair, and if applicable, abandon the injection well and
all relavd appurtenances in accordance wilt the P' FOT specifications and conditions of the Perak".,
Signature of Property Owner/Appliceni
Print or Type Full Name and tittle
SiigtnMtofftpertyOwar IApplicant
L_ = I&Ainkn an P e4-- '
Print or Type Full Nam and We {
S4=7-0f,rashaa ized Agan, if any
,Prim at Type Fall Name and title
-Pbax return two copies of the empleted Appriirat ion •parkagc to:
• North Caroiiaa.DENR DWG
e A4vilifer Ptrcfmflou Section-US{C'Prr grtxta • - . ±'
' 1636 Mail Service Centex
RsnIeigh, NC Z7699 I636 _ s
telephone (9I9) 7IS-5935 '
(IFLIO IC 9Ow Nad5mmi m of he= Form (Rar➢s 4 VION) P90 3 .
glop pRt1TFf'wl SFf:]i N.
DEC 0 7 ZD09

7.9�q ACMES
.REEK MEADOyyS�
7 f7. ,`` � N F 3.36'35" E k�' ��• j }
C, 41 93) Slide r 13.74' �
3171
w
ti.
}� ti-
a 01d L,ne 'F
33f2 F we I }
� �5 3.4 20 ACRES } I
`5 (PQMC'iy Lafs $7 3dj /• I 4 f
a
� � N �7• `l � f
_S to (A5• R/w)
. RIPLE -- CREEK ❑RiV1E"
} 404.36' a�. 2 r 2.94' T 39J x (►,
` ti
—# 5 4355_02'E 617.30 T^T_ _ — -—
P N a N
o
r
T

1.75
137
Me
, _1-80
i
Map gmmtk-d by (he Maywood CouM Map Server. Feet I inch equals 140-836493 feet
12n)2O09 1:35:18 PM 0 50 100 200 300 400

Aogers, Michael
From: [e-mail]
Sent: Monday, December 07, 2009 2:54 PM
To: Rogers, Michael
Subject: Notice of Intent to Drill Application
Attachments: Plemmons 5OW Geothermal Permit.pdf
Michael,
Attached is the 5-QW form "Notice of Intent to Drill" for the following customer:
Kent J. & Eileen L. Plemmons
Waynesville, NC
I want to thank you for your help and hope you get over the cold.
Thanks,
Randall E. Cutter CWD/PI
IGSHPA Accredited Installer
Geothermal GSHP Loops
Innovative Environmental Drilling
6105 Rest Nome Rd.
Claremont, NC 28510
828-228-1595
Fax: [phone].
randv@iedrillin�.com
www.iedriilinp,.com