WI0100169_GEO THERMAL_20120523

Beverly Eaves Perdue
Governor
AVA-•=~-=-_~-=
NCDEMR --
North Carolina Department otl:nvtronmenfand~Natural Resources
Division of Water Quality
Charles Wakild, P,-E.-
Director
May 23, 2012
Balsam Mountain -Florida, LLC
4270 NW 24th Avenue
Boca Raton, FL 33431
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection ·Well Permit Holders
Permit Number: Wl0100169
To Whom it May Concern:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May I, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells incl:uding geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.org/web/wq/aps.
··-----If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
Eric G. Smith, P.G.
Hydro geologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh , North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: 919-SD7-6464 \ FAX: [phone]
Internet: www.ncwaterguatity.oro
An Equai Opportunity\ Affirmative Action Employer
One North Carolina
/Vaturalf 11
Z00/t00d
AW D SERVICES, INC.
Appalac:hiar) Well Drilling & Water Filtration
P .O. Box 125
Leicester, NC 28748
Phone: [phone] FEB 1 SR£ 'l ~ c) 12._
Fax: [phone]
owner, Larry Wells
To: Aquifer Protection Sectlon-UIC Program
Fax: 919-807-U98
From: AWD Services, Inc.
Date: 2113/12
Number of Pages: (lncludlng cover sheet) 1
Re: Permit No. WI01OO169
Corrected Form with correct name and location.
,H :r..s o0c
10 3$1,tc:I ON! S30IA~3S GM~ €0t6£898Z8 05:st Zt0t/£t/Z0
Z00/Z00d -~. -Ol E0Z6E898ZB -WOHd £v:st Zt ,-~t-Z0 ~3~I3~:ffi suiiman Heating & Air
. , . .._
i "'• ~ >,
Corrected llepore
R.Es1DENTPU WELL coNSTaucr10N RECOM .
North Carolina Department of&vlronment and 'NIQlral llesources• Division orWa=r Qualtey
~~-~ Wtl,l. CONTRACTOllCERTllTICATION # JS.00 ----------
1, WELL CONTRACTOR: 9, WATER ZONES (Glf)th):
Chad Surrett
Well Conttactor (lndMaulll) Name
' Top,_ __ Bottom.____ 'T'op _____ eoux.m,_ __
Top ___ Bottom ___ Top Bottom. __ _
AWD Services, hie . Top. ___ Bottom. __ _ Top ___ Boftl:lm __ _
Well Conlrllctor Comt),lny Narno
2sa North Turkev Creek Rd.
ThlckneNI
WolgM Mltariat T, CASING: Depth Diameter
Street AdGl'HII
Leicester ' : Top_ Bottom_ Ft.. __ _
2874G
City or Town
NC
Zip Code
c 828 > 683·9223
Ar9a oode Phone number
2. WILL INFORMATION:
WELL CONSTRUCTION PeRMll'f . .,,W.......,,fO~1,..,0,...0..,_16=9=------
0THER ASSOCIATED PERMITW(if ap11lie1ble), ______ _
SITI WEI.I. 10 f(rraOPlicable. _________ _
3. WILL UGI (Check Appllcabk! Box): ~dantial Wall}r Supp ly 0
DATE 0RILLEO . ...;9=/""'27 .... / ... 1_..1 _____ _
TIM! COMPl.~D AMO PM rY ------
4. W!!LL LOCATION :
CITY: Svlva couNTY Jackson
'Balsam Mtn Preserve Lot 25
(S111Nt Name, N~mblrl, Commun~. S11bdlviai0n, Lat No., Paial, Zip Cod•I
TOPOGRAPHIC I LANO SE1TING: (clledC 1ppn,pritta bC00
riJSfope ovauay □Flat QRiage □OltlerElev. 4648'
LATITUDE 35 • 23 ' 8.0000 • DMIS OR ____ 00
LONGITUDE~•.!_• 30.0000 • OMS OR ____ DD
LalltudeJlilnoitude souroe; ~ CJropograpnlc map
(Jooation of well must be ahOwn 0t1 a USGS topo m1p endettaohed fl>
111/s form ff IIOt using GPSJ
S. WE.LC. OWNER
Robert & Andy Colton
0wnllfName
4270 NW24TH
Street Addra•
Boca Raton
City or Town
c828 > -=--------Area code Pnone number .
FL 33431
Stat• ZipCcL'le
•• WELL DITAILS: Geothermal Bores
a, TOTALDePTH:14) 300'
b. DOES Wl!U. RiPLACi EXISTING WELL.? ves O NO 0
e. WATl!IU,EV!L PJetow Top of Casing: WA FT.
(Uee ••• if A~ove Top of Casing)
d, TOP OF CMING 18 N/A FT. Abow La11d Su/face•
.,.op af oesing terminated at/o( below 1arid surface may require
:i Vl!ri a:ic,;, in ll<?CO':!"nrr; with , ':.I• 11:CA;. ~('; ,011 a.
.
.
Top_ Boru,111_ FL. __ _
Top_ eiottom_Ft.. __ _
a. GROUT: Depth Mawriel
Top..Q__ eouomlQ'..__ Ft aentonite
Topl!.,__ Botf.Om,lL Ft Pea Gravel
Top_ Bottom_ Ft.. ____ _
9, BCRSEN: Depth Dlamlttr Slot Sia
MethOG
Pour
Pour
lilatarilll
Top_BoltDm_F't-_in. _in. ___ _
Top_eottom_Ft._tn. In. ___ _
top_BottQm_Ft._in. i11, ___ _
10. SAND/GRAVEL PACK:
Depth Btu Malarial T'op. ___ Bottorn_Fl. __________ _
Top. ___ BOUom_Ft.. ___________ _
Top ___ 801tom_Ft., _________ _
11. ORILUNGLOG
Top Bottom s;o,mation DuGriptiOn
I
I ---'.----___ ,. ___ _
---'·.-------'·:--------'.--------'-------'-----/ ---'----/ ---'----' 12. fltl!MAAKS:
, I 00 Me~eev CERTIFY THAT Tl-1IS WELL WAS CONSTRUCTEO IN
• ' ACCORDANCE WITH 1 &A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND TMAT A COPV OF THIS RECORD HAS BEEN
PROVIDE0 TO THE WELL OWNER.
J (,' ti f"' -I
Yll:LU (0ilmf I~/ A METHOD OF 'f'EST N/ A Chad Surrett
f, DISJNfiECTION: Type NIA Amount J:JI A ;;:P;:;:Rt::-:N::::TE::;D::":N:':':AM~E~O:":F-;;P:;::ER::-:S:-::O:-:-:N:-::;C~O:-,-:N,:=:ST==R~U:-::CT=1cccN~G-=T,..,,H!!=-w=eL:-7L __ _
}s~m~·~ti.1,1f30'd~~:or,~mpletlon fo::Oivlalon of'Water Q~allty. (nfoffllltion .~lng, F~rm GW-1a
A~~rr, .. ,tf'S.ervi~.C~nter, Raleigh ; NC :27899 ,161 , Phone : (91~) 807-e3M .. Rev. 2100
"" ,·.. '' ' .. ,'
Z0 39'i1d ONI S30IA~3S CIM~ £0t6£898ZB
2t0 /800d
----Ol 8026889828 -WO&i 00 :tt 2t ,-80-20 ORAI3J38 ~uuman Heating & \.,Ooung
. ·-~~-& ~ ~ ; RESIDENTIAL WELL CONSTRUCTION MCORD
Nortb Carollr.1 Department of Environment end Narutal hso~ Division of Water Qoaley
~-· WELL CONTRACTOR CERTIFICATION No .3421 ----------
1, WELL CONT11ACTOR:
David Stratton
~ell ConlraalDr ~l'ldlvldual) Name
AWQ Services. lnc.
Walt Con1ractorCompany Name
258 bjgrth Turkey Creels Rd .
Street Address
Leicester Ci1Y or Town •
c 828 > 683-9223
AA:I oode PhOf19•numw
NC 28748
Sta1a ZiPCoda
.Z, WELL. INFORMATION:
WE\.L CONSTRUCTION f='.ERMIN'--W_lO_1_0_0_1_6_9_"--_
OTHER ASSOCIATED PERMIT\f(,f app!'!ClbJa,,_ _____ _
81T&W!LLIDf{lf'1ppfll'llbl __________ _
• I. WILL UIE (Chldt Appllelbll Box); Residential Weter Supply □
DA1EORILLE0._.1=2/...,.6~(1...,.1 __ _
TIME COMPLETED ____ ,,___ AM □ PM CY
4. Wl!I.L LOCATION :
~ Svtva oouNTV _lackson
Tote sd C I Preserve Lot 25
(8"et Mame. ~umbers. Cammi , Subcl lllriOn, l,lll No., Parall, ~ Code)
~POGRAPHIC / LAND SetTING: (eheC!c apJll'QPl'iala &lCOO
'181ope □Valley cfllat ORidQe OOlher . ..,,E=le;:;.y..,, • ._ __ _
LATTTU01s ~• ~ 's&.0000 ~OMS OR ____ Dt;>
LONGITUDE~•~• 17Al000 "OMS Olt ____ D0
La1itl.tdallollllltude 1euroa: li!bPs Qropograptllc map
(IOCBtfon of well must be shown on a USGS topo map •ndlttaohed to
this form if not ueing GPS)
I.Wlt.lOWNH
Ken Bowdon
Owner Nemc
Balsam' Mtn Preserve Lot 253 Phase s
Snet.Adnl&
Sylva NC 28773,
City or Town 51D Z-ip Cade
,828 , ~----,..----NM COde Phone number
•· WSLL D1TAU1 ( 5) 3 o o ' C'..eo • s
.. TOTALDEPTM;(1) 3SO' Geo
b. DDl!!B WIIJ. "l!PI.ACl'!XllnNG WEU.? 'VE8 0 NO 0
c.. WATIR t.eVIL Below Top of C.Slftg: N/ A FT,
(use 'II-" if ACIOVe Top of casinal
g. WATER ZONES (oe pth):
Top ___ Bottom. __ _
-
Top ___ eottom. __ _
TOP:-.. __ Botto m._..._~ ToP. Bottom,_ __
~ Top ___ eottom.__ __ Top . Bottom. __ _
1 , CAIING: DepUt Diameter
Thlcllneal
Weight
• iop __ Bottom___:_Ft.. __ _
Too_eouom_r:t.,_ __
' Top_Bottom_Ft. ___ _
'
.
.
.
.
.
. .
8. GROUT: Depth Material
Top.Q.__ eottornlL__ Ft, Bentonite
Topl!._B~Fl PBct Gravel
Toplf._ BottomlQQ:... Ft. Pea Gravel
· Method
Pour
Pour
Pour
Top_eattom_Ft._ln. -II\.----
Top_eottom_Ft._ln. _In. ___ _
Top_SOUOm___Ft _in. _In.. ___ _
10, SANOJG~VEL PACK:
Depth S~ Tcp. ___ Boltom_Ft..__ ________ _
Top ___ BoUom_Ft __________ _
Top ___ ~ttom_Ft. __________ _
11 . DRIU.ING LOG
Top 6tltlom
t
I --':------' _ ___,/,,_ __ _ _ ___,, ___ _ _ ___,/ ___ _
-~'----__ ,. ___ _
_ __,! ___ _
-~'----___ , ____ _
I
, REMARKS:
, Soll:
'
I 00 HIREBY CERTIFY THAT THIS WE1.L WAS CONSTRUCTED IN
ACCORDANCE WITH 1eA NCAC 2C, WEI..L CONSTRUCTION
' STANOAAOS, ANO T\-IAT A COPY OF THIS RECORD HAS BEBN ·
PROVIDED TO Tl-IE WELL O'NNE~-
d. TOP OF CA$1NG IS [WA FT. Above Land ~ulface~. r1
· .,.op of ~ting lefminatad aUor below land t;urfaoe may req uire &a 1 x4.-J/;-h 11 /.b-,__ . • 1/19/12
s \lllrlance in accomance with 15A NCAC 2C .011 8. ~IGNATUR E OF C~R~RACTOR DATE
e. YIELD (gpm); NIA MET~o o OF TE.ST N/A .Davi<:I Stratton
f. DISINFECTION: Typa NIA Amount NIA '-=PRl:.::.NTI:.:.:=..;~o :=NAM=E:_O_F_PE-RS~O-N _CO_N-c-cs=rR--U-C-Tl,..,.NG-=-Tl-fE=:-:-w=et.::-'.L,--
.:;\j~,t wfthl A·30 daye •of,completfon to : DIVlalon of'Water Quality -lnfonnation Prooealng, Fom, GW•1 •
:~~~-~ Matf8tf:Ylca cemei:, bleigh, NC 2ma:.1e1 , 'Ptlon• : [phone] · Rev. 2/09
80 391i'd ONI S30I/\~S QM'1 €0l6€B9Bi s 90 :tt lt0l /80 /l0
Permit Number WI0100169
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael .rogers
Coastal SW Rule
P~rmitted Flow
i itv
Faclllty Name
Balsam Mountain Preserve Lot 25 SFR
Location Address
40 Back Bone Way
Sylva
ne
Owner Name
NC
Balsam Mountain -Florida LLC
Dates/Events
28779
Scheduled
Orig l&1ue
09/23/11
App Received Draft Initiated Issuance
09/02/11
Regulated Activities
Heat Pump Injection
Outfall NULL
Central Flies: APS_ SWP_
09/28/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Indivi dua l
Permit Contact Affiliation
Major/Minor
Minor
Region
Asheville
County
Jackson
Faclllty Contact Affillatlon
Owner Type
Non-Government
Owner Affiliation
Robert Colton
4270 NW 24th Ave
Boca Raton FL
Public Notice Issue
09/23/11
Effective
09/23/11
Reoue,;;ted/Received E ven~
RO staff report requested
RO staff report received
33431
Expiration
08/31/16.
09/13/11
09/16/11
Waterbody Name Stream Index Number Current Class Subbasln
Pe rm it Nu mber W I0100169
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
michael.rogers
Coastal SW Rul~
Permitted Flow
F acility Name
Balsam Mountain Preserve Lot 25 SFR
Location Address
40 Back Bone Way
Sylva
o er
Owner Name
NC
Balsam Mountain -Florid a LLC
28779
Scheduled
Orig Issue App Recei ved Draft I nitiated Issuance
09/02/11
Reo u lated Activiti es
Heat Pump Injection
Outfall NJ:..L
Centra l Flies: APS_ SWP_
09/20/11
Permit Trac king Slip
Status
In review
Project Type
New Project
Version Permit C l assification
Indivi dual
Permit Contact Afflllation
Major/Min or
Minor
Region
Ashev ille
County
Jackson
Facility Contact Afflllatlon
Owner Type
Non-Government
Owner Affiliation
Robert Colton
4270 NW 24th Ave
Boca Raton FL
Public Notice q~/ )I Effective
Begu estP-<l/Receive g ~ve n ts
RO staff report requested
RO staff report received
33431
09/13/11
09/16/1 1
Waterbody Name Stream I n dex Number Current Class Subbas l n
NA
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Directo r
September 23, 2011
Robert Colton
Balsam Mountain-Florida, LLC
4270 NW 24th Ave., Boca Raton, FL 33431
Ref: Issuance of Injection Well Permits WI0100169
Issued to Balsam Mountain-Florida, LLC
Sylva, Jackson County, North Carolina
Dear Mr. Colton:
Dee Freeman
Secreta ry
In accordance with the application received on September 2, 2011, I am forwarding permit number WIO 100169 for
the construction and operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system to
be located at Balsam Mountain Preserve, 40 Back Bone Way (Lot Number 25), Sylva, Jack.son County, NC 28779.
This permit shall be effective from the date of issuance until August 31, 2016, and shall be subject to the conditions
and limitations stated therein1 including the requirement to install well identification tags as specified in Part
11.3 and to submit well construction records as specified in Part .vn.2. Be sure to read the entire permit to
ensure that you are aware of all compliance requirements of the permit.
You will need to notify this office at least 48 hours prior to beginning construction and operation of the injection
well system. In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must
submit an application to renew the permit 120 days prior to its expiration date. This permit is not transferable to
any person without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at [phone] or micbaeLro e:ersiw.ncdem.e:ov if you have any questions about your pennit.
cc: Landon Davidson, Asheville Regional Office
WI0100169 Permit File
Jackson County Environmental Health Department
Larry Wells , AWD, P .O. Box 125, Leicester, NC 28748
AQUIFER PROTECTION SECTlON
1636 Mail Service Center, Ralelgh, Nortfl Carolina 27699-1636
Location : 2728 Capttal Boulevard, Ralelgh, North Carolina 27604
Phone; 919-733-32211 FAX 1: 919-715-0588: FAX 2; 919-715-6048 \Customer Service : 1-BTT-623-6748
lntemet www.ncwaterquallty .org
M~ual Opportunirv I Affirmatt~& Aclio'l Employei
Best Regards,
~ Rt-5=----
..,,Michael Rogers, P.G. (NC & PL)
N$rthCarolina
;Vaturafly
NORTH CAROLINA
ENVIRONMENTALMANAGEMENTCOMMIS~ON
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
P ERMIT FOR THE CON STRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Balsam Mountain-Florida, LLC
FOR THE CONSTRUCTION AND OPERATION OF 4 TYPE SQM INJECTION WELL(S), defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at Balsam Mountain Preserve, 40 Back Bone
Way (Lot Number 205), Sylva, Jackson County, NC 28779, constructed and operated in accordance with the
application received September 2, 2011, and in confonnity with the specifications and supporting data
submitted, all of which are filed with the Department of Environment and Natural Resources and are considered
a part of this permit.
This permit is for Construction and Operation of an injection well and shall be in compliance with Title ISA of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereot:
Permit issued this the 23rd day of September, 2011.
.Jr\coleen H. Sullins, Director l Division of Water Quality
By Authority of the Environmental Manag ement Commission.
Pe r mit #WI0100169 UIC/SQM
ver. 0 3/2010
Page 1 of 5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
I. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87 -94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this pennit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies > depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number 919 715-6166 and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number 828-296-4500.
2. The location of each of the system manifolds shall be recorded by triangulation from three perm.anent
features on the site (e.g., building foundation comers) and shown on an updated Site Map. The Pennittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or 'clu ster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART Ill-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volwne of materials and rate of injection, as
described in the application and other supporting data.
2. This pennit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Pennittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of co mplying with any and
all statutes, rules, regulations, or ordinances, which may b e imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
Permit #WI0100169 UIC/SQM
ver. 03/2010
. Page 2 of 5
PART IV-PERFORMANCE STANDARDS
l. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including_ the creation of nuisance conditions or .failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2 . The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facilit y shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staft: telephone number 919 715-6166. Notification is required so that Division
staff can inspect ·or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI~ INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N .C .G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #WI0100169 UIC/SQM
ver. 03/2010
Page 3 of 5
PART VU -M ONITORING AND REPORTING REQ UIREMENTS
1. All required document ation shall be submitted to:
Aquifer Protection Section -UIC Program
DENR-Division ofWater Quality
1636 Mail Service Center and
Raleigh, NC 27699-1636
Ph# 919-715-3221
Aqu ifer Protection Section
Asheville Regional Office
2090 US Highway 70
Swannanoa, NC 28778
828-296-4500
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Asheville Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3 . A copy of the site map updated with manifold locations requ ired in Pan n.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Asheville Regional Office within 30
days of completion of well construction.
4 , Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection wiU be estab lished and an
acceptable samp ling reporting schedule shall be fo llowed.
5 , The Pennittee shall report by tel ephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, tel ephone number 828-296-4500, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due t o known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) An.y recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect infonnation submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
7. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
In order to continue uninterrupted legal use of the injection facility for the stated purpo se, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Pe rmi t #Wl0100169 UI C/SQ M
ver. 0 3/20 1 0
Page 4 of 5
PAR'TIX-CHANGE OF WELL STATUS
1. The Pennittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose, then that well must be permanently abandoned according to ISA NCAC 2C .0213(h)(l).
Notification shall be submitted to the addresses given in Part VII.I of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in ISA NCAC 2C
.0214, including but not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if the
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that failure
to do so could lead to the contamination of an underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe that extends to the bottom of the well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been removed, the
casing shall be perforated opposite the gravel pack, at intervals not exceeding 10 feet, and grout
injected through the perforations.
(F) In those case~ when, as a result of the injection operations, a subsurface cavity has been created,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit~ copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.1 of this permit.
Permit #WI0100169 UIC/SQM
ver. 03 /2010
P.age 5 of 5
Rogers, Michael
From :
Sent:
To:
Subject:
Agreed . Thanks.
L
Davidson, Landon
Friday, September 16, 2011 8:12 AM
Rogers, Michael
RE: WI0100169 Balsam Mountain-Robert Colton
G: .uinq9-n Da vid son , P..G.
hCE•EI\B c,;..•i:,i:,(1, ot•:::1,·r C:a:s lte,,
,quircr r.r?r -;tton ~ :ctt.m e
.,
"5 'T,fl ""'o:n , ~i.e. 25778
p h .~ !HS 1% '500
b ,; ~.i.S ,cl,! 70-~;; ~
w eb page: http://portal.ocdenr.org/web/wg/aps
Email correspondence to and from tltis address is subject 10
tlte No11h Carolina Public Records Low and may be disclosed
to rltird parties unless the content is e:rnmpt by s1at11te or
other regulation.
From: Stepp, Jonathan
Sent: Thursday, September 15, 201111:27 AM
To: Rogers, Michael
Cc: Davidson, Landon
Subject: RE : WI0100169 Balsam Mountain-Robert Colton
Just spoke with Larry and he said that the minimum distance between any geothermal well and any building perimeter is
28 feet My recommendation is to proceed with permitting.
Jonathan
Jonathan Stepp -Jonathan.Ste pp@ ncdenr.gov
North Carolina Dept. of Environment and Natur al Resources
Asheville Regiona l Office
Division of Water Quality-Aquifer Protection Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to t hird parties.
From: Rogers, Michael
Sent: Tuesday, September 13, 2011 5:12 PM
To: Davidson, Landon
Cc: Stepp, Jonathan
Subject: WI0100169 Balsam Mountain-Robert Colton
1
Please find attached a Sqm residential geothermal permit application. Let me know if you wish to conduct a pre-
permitting inspection or not.
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://oortal.ncdenr.org /web/Wg/aps/gwpro/permlt-applications#geothermApps
E-mail correspondence to and from this address may be subject to ttie North Carolina Pub/le Records Law and may be disclosed ro third parties
2
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This map is prepared tor Inventory of real.property within J ackson County; It is compiled from recorded deeds, plats, and ,public data records.
Users ot· this map-are hereby notifledlhat tho -aforementioneci public information sources s hould be.consultod tor verffication .. Jackson County
or any Countv representative assumes no legal responsi bility for the contents of this map. .Printed :Sep 01, 2011
~~ .. 1:)'. ·;,~_--
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"• RECEIVE9 I OENR / owa
AQUIFFR'PM~ SEeTION
SEP .~J 2011
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· rhis mao·1.,p,wpa,e<1 for lnv•ntory-of raat.property whhm.JaclcSOn County. ltt'I c:omplled.from-.ei:ot11e<1 d~ plltli,:.,,11 ,pubffodala
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· recor<l1'.•Uura of tl\11 map--y notlfiod'tha.t the.1fon11nenlloned plibU<:.-lntormallOn 10Vrc•• ahoulct be consulted forw-.i .
.Jl!cuon-County or any County ·19p,nentaUw mumn no legal rnponlNl>ttlly for the c-or lllf• map. Printed:Sep 01 ,.2011:
Interactive Site Map P age 1 of 1
Ill l·W,HM •@•61¥ E,cplorc &ha r., Mi-W'lhtin Tht Na.tun: r ,enter ·'-ru & !...nation
Homes Available For
Purchase
Featured Homesteads
Completed Amenities
Weekly Activities Calendar
Photo Gallery
"Discover Balsam" Package
Interactive Site Map
E-Newsletter Archive
----
Balsam Mountain .flr~c Intetactiwe M...,
Weituf1''.; t.> our mteractJve communitV Site mat' Clicf; oM the
/~neniM.s Leot<J:! to lo?arn n1ore al;out our Ciub il1TI~n1t1es . ft'
nav,;i.it;i USl! tnc zoom Slide • Gr. tlic fmall mi)fl 10 t ~o bottolT' n~ht
cor-n,?r. o· ,0,1 C.Jn move .tnc r1mt; b y U!11n:J the whit,;, ar((,.v<
ro~3tco on all rour siae; · fo mak e th•~ maf '"'Cle', chci' 0 11 Enu.r
Fu!ls":,·ccn l'X.ltcd In the ~p ri(lht -:ornc;. You caA !.'~t till: s~e-;R
bv ,b~kln:i on tt,e e~rt 1coR or p~ss111(J tne esc~r,.-~c
http://www.ba1 sa.nunountainpres erve.com/interactiv e-site-map.htm1
Amenities t.egen CI
•Jou course
Nature C9ot!ll
f;lub• Voll<>-,
'111\' Stable;
Remote Cabin,
Board1r1g Housi'
H iking Trail I
Cernplng a Fishing D
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9/13/2011
Jar,kson ·County, NC Detailed Tax Parcels Report
7672-90-6352
7682-00-3309
!
7672-90-11189
\
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----/ 7682-00-7152
V
ARNI G: IS IS NOT AS R EY!* Tilts !,.---------~,..-.,,,-:--,..-~---------
.map Is prepared for inventory of real property
!Within Jackson County, It Is compiled from
1recorded deeds, plats, and publlc data
!records, Users of this map are hereby notified
that the aforementioned publ ic lnfonmation
tSources should be consu lted for verification,
!J ackson County or any County representative
!assumes no legal responsibility for the
jco ntents of this map,
Owner 1:
Owner 2:
Physical Address:
Property Description :
Account Number:
PIN:
Mailing Addressl:
Mailing Address2:
City State:
Zip Code:
Deed Reference:
Deed Date:
Sales Price:
Assessed Acreage:
Map Sheet:
Plat Reference:
Appraisal Neighborhood:
Neighborhood Code:
Township:
Township Code:
Total Building Value:
Land Value:
Total Value:
BALSAM MOUNTAIN FLORIDA LLC
LT 205 PH 3 BALSAM MTN PRESERV
LT 205 PH 3 BALSAM MTN PRES ERV
149014
7682-00-7403
4270 NW 24TH AVE
BOCA RATON FL
33431
1901/466
2011-07-20 00:00:00.0
$188,000.00
1.98
7682.00
15/325
BALSAM MTN PRESERVE
25015
SCOTTS CREEK
25
$380,420.00
$600,000.00
$980,420.00
Tuesday, September 20 , 2011
Rogers, Michael
From:
Sent:
To:
Subject:
Larry-
Rogers, Michael
Friday, September 02, 2011 3:48 PM
'LPhi11ips9898@aol .com '
RE: Lot 205 Colton/ Balsam Mtn . Preserve
I will go ahead and give this permit application to our Administration staff to process. However, in the future It is better if
you mail it to the address on the last page of the application, or fax to 919-715-6048. This ensures that the application
will be received and processed. If you send to my e-mail there is the possibility that it could sit in my inbox for days or
w~ks if I am out of the office for training, vacation, sick leave etc.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mall Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
http:/lportal.ncdenr.org/web/wq/aps/gwpro/p ermft-applicat io ns#geothe rmApps
E-mail correspondence to and from this address may be subject to the North C11rol/na Public Records Law and may be disclosed to third parties
From: LPhilli ps9898(6)aol .com (mai1to :LPhilli [e-mail]]
Sent: Thursday, September 01, 2011 5:54 PM
To: Rogers, Michael
Subject: Lot 205 Colton/ Balsam Mtn . Preserve
Michael, Please find attached file for closed loop goe perm it app . Contact me with any questions. Thank s
Larry Phillips [phone]
NA
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Robert Colton
Ba~sam Mountain -Flori~ LLC
4270 N.W. 24TH Ave
Boca Raton, NC 33431
Dear Mr. Colton:
Coleen H. Sullins
Director
September 12, 2011
Dee Freeman
Secretary
Subject: Acknowledgement of
Application No. WI0100169
Balsam Mountain
Injection Mixed Fluid GSHP
Well (SQM) System
Jackson County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on September 2, 2011. Your application package has been assigned the number
listed above, and the primary reviewer is Michael Rogers.
Central and Asheville Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a ~ely and complete response to any additional information requests .
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] [e-mail].
Sincerely,
O~A .~
for Debra J . Watts
Groundwater Protection Unit Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Larry Wells -Appalachian Well Drilling
Joey Bullman -Bullman Beating & Air, Inc.
Permit File WI0100169
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capltal Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX [phone] ; FAX 2: 919-715-604c! I Cus1omar ServJCt;; HITT-623-6748
Internet www.ncwatergua lity.om
An EQual Opportumty \ Affirmative Actioi\ Employer
!forth Carolina
/vatural!lf
RECEIVED/ OENR / OWQ
AOUIFF=R·PROTE"r.TtON SECTION
NORTH CAROLINA DEPARTMENT OF ENVIRONMCNT A:--JD NA fURAL RESO~Ee 2 zou
APPLICATJO~ FOR A PERMlT TO CONSTRUCT OR OPERATE lNJECTJON WELLS
In Accordance With the Provisions of 15 '\. NCAC 02C .0'.!00
CLOSED-LOOP MIXED-FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids other than potable water a" part of a geothennal heating and cooling "-), swm
(check one) ~New Application Renewal* ---__ Modification
* For renewali. C'O\nph:te Pans A-C and the signature page>
I'rint nr T_lp~ Jnt;,rmmmn aud .\fail Jo the AdJress on the La~t Pa.r!I!, flle~ible Applic'utiom Wilt !Je Retui·ned rl.s l11i:omph•fe.
DATE: $ -i S" 20 I/ -------~' --w:J:0 l 00 ((pq
, . S~;f° PERMIT NO , l ::.. (leave blank if ~c\, Applkarioni
A. STATUS OF APPUCANT {choo:::.c one)
Non-Government: Individual Residence (' 13usincss.10rgani7.ation __
(.,ovemment: State Munidpal __ Coun~ __ _ ~ederal
B. PERMIT APPLICAl\"T -For individual residences, list each ov..11~r on propert)' deed. for all others.,
sl'c1tt: name of entity ~d name of person delegated authorrt)' to sign on behalf of the busincs~ or ag1.:ncy:
8RLSAm mou...,tTAi°l''1 -FW>1<l
0
DA t-LC.
Mailing Address: J/-;2 ?lJ N-Ul .;).ytil Bt'F. 7
City: Boca P.BTCN State; El,__ Zip Code: 3 ~ 4/3 / C0umy: Pli/..111 B ett(Ji
Da) f'ele No.: Cell No.: / -S4,/ -7 ~•'J -?¼ '13
EMAIL Address; l?o8 ,;.7l en/Ji... Cb/11 Fax No.: -
C. LOCATION OF WELL SITE-Where the injeL!tion \\ell:-are physicall) located:
( I J Pan:d ldentification Number (PIN> of well situ: ?~B;J -QO-7s/tJ 3 County. ✓IIC.k .So/\/
(2) Physical Address {if different than mailing address): .:/C .Br/9(/3'.oNE' {A}~/l~Y _____ _
City: ..St't../lA State: NC Zip Cnde _;2._9_7_?z~----
n. ' WELL DRILLER lNFORMA'flON
Well Drilling Contracwr·s Name: L../i RR-:r.__· _w_· e-_-u._/~s ______________ _
NC' Well Drilling Comroc1or Certification No.: ~(,tJ=_.., ________________ _
Company Name: l)p;>,9!..2 (ffJR,,Y wet.'-,Ql2/u.,1i.l~--------------
'~onta1..1 Person: L//KR Y WE'-l.>
Addn!ss: Y. &, 3&1( ,f,2.~
EMAIL Addrc_s~,~-_________ _
C.:il~:: Lc/c..F sr&-_ Zip Code: ;2 P 7~& Slate: JI;'.(. County: Bu1v'c:.c II; Be
(1ffict. Tdc '\io,;(£2,S\ w63-922:-~ Cell No.: _____ _t--ac~:.._N~o._: _____ _
E.
F.
HEAT PUMP CONTRACTOR INFORMATION (if different rhan driller)
Company Name:i1lltLll>Arl_ //EI/T/Nv ..J. RJR. ✓~c.
RECEIVED/ DENR / owa
AQU(FJ:'R·PRO~r.TION SECTION
SEP 02 2011
Contad Person: .Joe."/ l3UL.LmAM _______ f _ Llvf'\:(LAd<lress: Wu3J!!j;,"-1J....1':'IQNbeftN, .C,ftl'\
Address: p. tJ • J?!JX -I'-~) (r.-0..., I" • <v
1 !, 'J&P'te'-= ~"\.-t..Jd~ I k) ~
City: Jl~Fl1 u,F. Zip Code: 2.iet}/ State: :N~.County: ltllJNC.. 0171 BE
Office Tele No.: (¥$te>8 -)-"{'1f/ CellNo:: ________ J-ax No.: (62f3)t>.S-9-loPI
WELL CO~STRUCTJON D;,\lfA
(I) Number ofhorings to be constructed•: ·'-/-Depth of.each boring (1eet): -3 o _o ____ _
'" (/'e.Yi,~tit1g wute:r !>U['p~v wl'llt:; witl he used th~z prn11i.de. iht:! i1ifonnali011 in item (./) bl'low.
(2) Chemical a<ld.itives to be used: R-22 ___ Propyknt.:· glylXll ___ Ethanol 1,,-_.-
0ther ______ (-Other aclditives wi II need prior. approva 1. hy NCIJENR bl'fore use)
(3) Type of tubing to be used (copper, PVC. etc): __ -_a,_o_e-_-_1-J_._>-1_'i_1C:. ________ _
( 4) Wel l casmg. ff the well(s) will use: Cabing then provide' tpe ~(steel.PVC. plastic, et,.), diameter. Q\aill!.
and .extent of casing appearing above ground: ____ N __ 1_R~----
(5) Grout (material surrounding well casing and/or piping): /
(a) Groul type: Cement__ Bentonite0 ~ Other tspcdfy) ______ _
u a, .,1:kctm~ bentonit. gmul a variance i;, hereby requested tn IS,\ KCAL'1( ,1l2J 3(d)( 1)1 '\), wbich .rcqui~ 11 cement t)·po gnml.
(h) Grout depth oftuhing (reforcnce to !and surfacer from .::> to ,;Lo . (feet)
If well has casing., ind icate grout depth: from, ____ to ____ (feet)
G. WEL-L bOCATIONS-Maps must be scaled or otherwise accurately·indicate distanc-es and oiicnratioru; of
features located within 1000 teet ofthefojection well(s). Labd all features clear! and inc lude a north arrow.
( I ) Attach a site-specific map show ing the locations of the following:
• Proposed injection v.ells * Buildings * Property boundaries
* Surface water bodies • Water suppl>· wells
* Septic tanks and !l!>~uciat.Ju spray irrigation sites. drain fields. or repair are~
* EXJ-sling or potential sourcci. of groundwat~r contamination
(2) Attach a topographk: m ap of the area extending l:'4 mile from the injectiou well site that indicates the
facility's location and tho map name.
NOTE: In most cases, an aerial plwwpaph of the property parcel shnwing properry lines ,,md structures ca11 be
,1btau1ed and dmvnloaded from the appficable coumy GJS website. Typh:a/(1', the •property •c·an be ·stU1.rch{'d-J1y
owner 1tame or addre!I.-.. The /.ocation of the wcl/$ in re/11tio11 tu property bou:ndarie.t. 1,ous~, septic tank~ other
wells, etc. can then be drawn in by hand. Also, a 'layer.' can he ~·elecled jhOK'ing topograpl,ic co11t0tm, or
elevatio11 data.
GPll/1 IJC :iQt..1 Pcnnt Applic111on f l<c..,-bed lDil/2011 I
"
H. CERTIFICATION (to be ·signed as required belo~ or by that person ·i; authorized age~CENEO/DENR/OWQ
. AOUIFFR·PROTFr.TION SECTION
15-1\"NCAC 02C .021 l(h):requi:res that all permit applications sha11 b~ signed as follows: SEP O .I 2011
1. for a corporation: by a responsible corpor~ llfficcr~
2 . for a partnership ot sole. proprict-OTShip: by a general partner or the proprietor. respectively;
3. for a .municipality or a state. foderal. or other public a~enc;: hy either a principal -executi\'c
offfoer onariki.ng publicly elected official~
4. for aJl ·olhers: by the well owner ( which' means all person~_listed on the ll ropcn \' deed).
Han authorized agent is signing• on bebsif-of.,tbe .a.pplicant, then ·.supply a Jetter signed 'by tht-
applicant: that names and authorizes their agent' to stgn 'this applic.-tion on their hehal£ ·
·•1 hereby certif)'. under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and th~ based ,on my inqniD ._df those fodividuaJ:..
immediate!) responsible fclr obtajning said infnnnation, I 'hcJicvc that the information is true., accurate · and
complete. 1 am aware-that there are si~rnificant penalties. i nduciing Jhe possibility of fines .and imprisonnient,
for submitting false information. I agree-to constn1ct. opcratt:,maintain, repair. and if applicable, aba11don the
Injection weJ!. and all related appurtenan~s in aooordance ,\\ith the.approved specificaliom, and co11ditions 0f
the .Permit.··
Signature of Prope~ Owner/Applicant
/4oEr-;--·W-~,_.;
Print or Type Full Name
SignatUre of Property Owner/Applicant
Print or Type Full Name .
J) ~-Y / ~ r"/W"Lc ~ ---''""'--'w.,:::..---i'---· """"-.,;e,,.::..._ _________ _
Authorized4\.gcn1, if an:
L#£,R.r-P#'1a1p;5 -------------Print or Type Pull Name
Submit two ·copies of. the completed application package to:
DWQ -Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPliiL"(("51)M l'o.:nuit Appliratir,n !Revis.!tl 1/'.!-1/.!0i I Page 3
0 '1'/ _.,,
roio
--;Ji'f--
l(J'l.t,.,
t,l'-
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,,..~(/J
Rogers , Michael
From:
Sent:
To:
Subject:
Attachments:
LPhil [e-mail]
Thursday, September 01 , 2011 5:54 PM
Rogers, Michael
Lot 205 Colton/ Balsam Mt n. Preserve
REC€NEO I OEkR I OWQ
~PRO'rfl'.TV1N ~F.CTION
/SEP O % 1Ull
CCF0901201 1_00000.jpg; CCF09012011_00001 .jpg; CCF09012011_00002.jpg;
CCF09012011_00003.jpg; CCF09012011 _00004.jpg; CCF09012011_00005.jpg
Michael, Please find attached file for closed loop goe permit app. Contact me with any questions. Thanks
Larry Phi llips [phone]
l