WI0100604_Aqueous closed-loop geothermal well application_20201110

-· � ��"��-9�!':�1!!� _!!����.!�_t,:_�_f ��fr�n.m��-�l!Lqi.i�!!tr"-= ���!!i:t!.�-�f_�a�er l!.!!!i!fC�---­NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE rN.JECTION Wl!lLLS rltese wells are '1permtt1ud by rule" mid do nol requlra on fntltvidual fJ(Jl'mft whert comimtted ht tt1JcJ/f1dt111te wlih Iha Yllf(Jf{ of 1M.l'i£..:.&: 02c O]OfJ, 'tltk ffiJlke..111t1;f[b&JltihJffl(f(jdwla.tJ(l,(JOif1Ui.'l{dli6ff-GEOTIIERMAL AOUFAlITII CWllitD•LOQP WEIJ $ As desaribed In. 15A NCAC O2('Jl2ll tl'fes-� We Ifs olr6ltfaW pofab'-10 wafor on'ly or a mfxtur� of potablr§ water ai'l'd.perforMafioo-enhandng addWves as: part of a. geothetmal heatiri]; artd coolfng system,
GElll'HE!tMAL.DIRECT EXI'ANSTQN Gl.QSEl) .. LQOP WELLS A& d�sm-tbed in 15A NCAC 02c Q223 ;h-ese wells cfrc-ufat� tt-re!tig�fit gas: w part ota. goothent1a·I hooth1g @cfcooling system.
Print C/eaJ1t flf 'lyptt l1tjllrmulio1t, 1/lgglbla Siihmllt(llV Wtit J1e kttillirCll As fff(;fJlhfil&it, PERMIT NO., _WI0100604_ (to b,oompletoo by DWl,j A, TYPE OF GEOTHERMAL CLOSEl).LOOI' WELL TO BE CONSTRUCTED (sei"t 1m•) (t) Iii Aqueous (as per lu\.NCAC 02C ,0222) Nmsberofwolls, 3 @, 2.. 'fO(,.j--(2)D Dlrett Bxpans!on (as p•r ISA NCAC 02c ,0 223\ Nmnber ofwoll" .---�-R, STATUS 011 WELL OWNER(S)(choos••n•)
C.,
D,
(!) (21 (3) 8 Single Fam Hy Jtesidenc.e-Subndt tids ram-two (2 -) b_iish'ieSS days ptfoi-ta ttms-trntrtlon, Bt1slftes.40rganlzat!ot1 Submit this-foriif .lll days prlM tt5 MrtMructlllfi, CfovemmMti State _ _ Mun!oipai ~---_ Cotmty =-= Pedernt* �--*Submit iids fofffl iO days prior to construe-tfonWELL OWNER(S}-fior sfo:gle family resideficesf Iist.a:11 persons ffst-e·d on the: vrope:rty de&f. list the name: df the Brndness/ AgeMy Mid pers0n and titlc with delegated. s-!gnature authodty; For all others,
l:ic/iqcd (J. -Dt/noo Ll_rMalling Add"''" ,1508 Gl�fiEden Lanacity, Evansv!Ue l!tiit.: .!!:!_ Day Tele No,: fl I;) -L/ 1/_f -(J -'.t I I EMAIL Addeo": holly,damour@gmalLeom -
l'llYStCAL LOCATION OF WELL SITE (!) Parcel l<l•n«floation Numher(PfNJ of well slto;::_9::__7'2.:,_1:,7�3:,::2:::33::;3,::0:,0c,O::O::O~ _________ _ Cou•ty: ElUhe<>mbe
(2) Physical Address (if diffe1:ent than rnamr1g addrnsg); �3:::0:.:R:,· :::Iv:::•:.:' :.:R::uc:0_---------City: A•hev1lle ___ County B_unoombe Zip Code, 28804
Cfoscrd•t.oop Goo1hemrn[ Well. Nt'itltirntfmi Rmt, 3�1�1-0!6
(1)
Binge MAPS, PLANS, ANIl SPt+` 'IFMCATIONS
A site maps must be submitted. It must be soled or othe.rwfse accurately indicate distances (lit feet)
and orientations of features located within 250 foot of the injection wall(s). Label all featuresrieadv
andkncltale a north arrow. Attach the siteispecfo map allowing the wellstn relation t(s the locations of
the following.
• Buildings
• Property bounder
• Surface water bodies, ifan
• Waler supply wells, ifany
• Septic, systems and associated spray totems sites,
drain fields, or repair areas, if any
• Existing or potential Solift69 of groundwater
contamination, 'fatty
(i) Plans and specifications of the surface and subsurface construction details of the wal sysham,
NOTE, /if mint eater, mm aerial pliormrapk &dlar prat map of the property parcel *bowing property lines sad
.etraelhr& can he abtuleed and dawnlaaded from the applicahle cau,io GIS webs& 7ypfcally, the propery can
& .searched by owner name or address: The Mahon alike welds itt relatiodra property baaadaMMet; lieuses,seplra
leaks and jade, and other feel& ere emit than he drawn In by head ACsa, a %ayes' edit be selected shawhlg
topographic contours or tramline data,
TYPES AND CONCENTRATIONS OF ADDITIVES = List any additives that will be used and their
concentrations, NOTPs Only injectaots approved by the NC Division of P ibtie Health, Department of Health
and Bauman Services can. he injected. Approved fujeorants can be found online at
httot//deq nc gov/about/divislons/water-lesources/waled-resources-oermlts/wastewater-branch/ground wales-
protection/around•water-approved-hfleetants, Ads other rehearing must be reviewed by the ORBS prior to use,
N_jik_
O. WELL DRILLER IYJ':~:ORMATION
Well Drilling Contractors Name: Cult Babbitt
WC Well Drilling Contractor Certification No • NG=3556 A
con an Nam Sweetwater Well Darrel'
P y -.-- Coiled Person.
City; bwannanoa State; NO Zip cede28r Cesety:Seesombe
8 8:291 1117
Day'Pe[o Ito: _ -__ _ Cot[ No.
EMAIL Address; faxN •.. -_
R. HEAT PUMP cONTRACTOlt LNVOItattATiON
company Name Air Excellence
Contact ocean Darrell Toady- B AIL -Address
Address: 244 Hatctsti3dr Cove Rd
car. Caritner Zip Cody 28i15 State; NO Counns Buncombe
Office Tele Isla,: 9 bb'f814'3 CeilNo.r Reath,: -- _
tinged-LaojGcothamra! w+ It M& ficst4m uev, %.1 2fd[6 Pap 2

PROTECTION — Provide a brief description of how any (a.) water supply welts, (b., surface water bodies; or
(c.) septfe systems and associated spray Irrigation attest drain gelds, or repels areas within 2501 feet of the
proposed injection wells wilt be protected during construction of the wells:
We plan on drilling g welts at 240ft each
No drain fieids_pregent French Broad River faceted a flew hundred feet from property
VARIANCE— Pursuant to J SA NCAC 02C .0241 the Oircctor of the Division of Water 1€osonross tttay gran
a variance tfmn applicable well construotk n or operation standards provided that:
(I) Use of the well(s) will riot: endanger human health and welfare or the groundwater, and
(2) That construction or operation in accordance with Me standards is not technically feas€hte or the
proposed construction prividos equal or bettat protection of the groundwater,
Any variance request should accompany Rubinlital oMhis notification to expedite evaluation of the tog War,
The variance request form can bo accessed online at bane://nedwv:s3.ammazonaws;eom/s31s-
psblie/WatelNA20Qnalhv/Actuiferyy26Pratection/CPUKieothermafVgrianetteauesti pnnFiliable-
20130805.odf
SIGNAttii[ES= The following section is €o
agent 15A NCAC 02C,0211(al requires sign&
eounstated as req It rarl holow or by that person's authorizes
res a5 follows!
(a) fora corporation by a responsible corporate -Milan
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(c) far a municipality or a stare, federal. or other public agency; by o€then a principal axe a active
officer or ranking publicly elected of -Ratak
(d) kw all others: by the well owner;
(et foe any othet person authorized to ant on behalf of the applicant; documentation shall be
submitted with the netidcetnti that clearly Identifies the person, grants them suture
authority, and is signed and dated by the applicant.
"I hereby aert(jy, under penalty of that l have personally crammed and amfarnfftar with the fgtarmatlan
submitted In this document and all attachments thereto and that, based on my Inquiry of thane Individuals
immediately reepotrdhle for obtaining said h{jarmatfan I believe that the information is Pines accurate and
complete, tam aware that there are ,signnffcanl penalties., including the porsNhllity opines and imprisonment,
far suhmtttingfalse Won/radon, Iaggree to construed, operate maintainrepair, and /appltcable, abandon the
utpeelton well and all related appletencmcet In accordance with the 154 NCAC 02C 0200 Rules."
Sign setae of prdparf-y 9� ficrlAppliraRt
plo Pitt h_b4rnour , kehard er"YAIM0ci1'
- -- Brinier Tyne pus Name ._
Cory Wax Olelallyslryud ei tarp Wfiti
Sign Yurd of Atifn6rista Agent, it any
Cory Wwc
Print OP Type lien Mauls
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