WI0300163_GEO THERMAL_20101119

Permit Number
Program Category
Ground Water
Permit Type
Wl0300163 /
/ Central Files: APS_ SWP_
11/19/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Injection Water Only GSHP Well System (5QW)
Version
1.00
Permit Classification
Individual
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit ,
Facility Name
Steve Purdy & Beth Purdy SFR
Location Address
3807 Pomfret Lan
Charlotte
Owner
Owner Name
Steve
Dates/Events
NC 28211
Purdy
Orig Issue
11/19/10
App Received Draft Initiated
11/01/10
Re g ulated Activities
Heat Pump Injection
Outfall i ,:~ .F .I
Waterbody Name
Scheduled
Issuance
Permit Contact Affiliation
David J. Brown
1908 Hamptonville
Hamptonville
Major/Minor
Minor
NC
Region
Mooresville
County
Mecklenburg
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Steve Purdy
3932 Beresford Rd
Charlotte
Public Notice Issue
11/19/10
NC
Effective
11/19/10
27020
28211
Expiration
Stream Index Number Current Class Subbasin
Beverly Eaves Perdue
Governor
Sttwe Pmdy
Beth Purdy
3932 Beresford Road
Charlotte, NC 28211
AVA
HCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
11/19/2010
Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System
Permit No. WI0300163
3 807 Pomfret L,tne, Charlotte, NC 28211
Dear Mr. & Mrs. Purdy:
Dee Freeman
Secretary
On 11/1/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-on}\'
geothermal injection well system for the operation of a ground-source heat pump located at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection well system as long as the
following conditions are met:
1. The injection well system contains only potable water,
2. The injection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
3. The required .notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Construction Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .021 l(u)(2). Additionally, you should contact the Mecklenburg County Health
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Ro 0 ers@ncdenr.1wv if you have any questions.
Sincerely,
Jo .. Q~ A.~
cc: REGION Regional Office -APS
APS Central Files -Pennit No. Wl0300163
Mecklenburg County Health Dept.
Yadkin Well Co., Inc. (David Brown)
Ross & Witmer (Geoff Eloge)
AQUIFER PROiECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Supervisor
Phone: [phone] \ FAX 'i: 819-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1 .. 877-623-6748
Internet: www.ncwateraua1 i1v.o ro ·
An Equal Opportunity\ Affirmative Action Employer
..
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Nov. 1. 2010 4:11 PM YA6K•IN WELL No..62,34- P'
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NORTH CAROLINA
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DEPARTMENT OF ENMONMENT AND NATURAL FESOURCES (NCDENR).;•� � , � ^ '
NOTIFICATION OF MENT TO CONSTRUCT A CLOSED -LOOP GEOTIERMAJ4' ,, � :'::-,•.
WATER -ONLY XN.]' cnoN wizu SYSTEM:
TYPE 5-i�' y4'EL�}_
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In Accordance with tlu Prsnrisns of NCAC Tint 15A: 02G4200, please
complete t}us wdficadov and mail to address On tl ,e back page (please Phut or Twee inn# ruxa�::r ;r'_ ■ ,,;
DATE: 26 %C
Well Type Confirmation: Does the proposed system cirei h to potable water only (no additives).
contimwo piping that completely isolates the fluid &tm the =%irCii�d' Qt,o,'
closed-loo =z
52
s CZ Yes Contiaue complatii�g this form. -,
7--% 40 No Do Not complete this farm. Complete other UIC applic etiaai forms far g,
either a 5A7 well [o M-loop well xniectin¢ potable water into the aquifer) or a-SQN waU'(clge
loop well containing additives such as R-22, ethanol, or other antifreeze o.riorrosiqA irhibitoXs)_.:-
A. PROPERTY OWN�61Z(S)1APPLICANT(S) _
List e0_4 Property Owner listed on property deed (if owned by a beisiuess or govern�at ageua��a�#�r�tie`tfii' �'
entity and a representative f wlautha ity or signature):
r' .S4 8 v� ter• � - -
[ 1 Mailing Address: 3 9_T 2
1 •T
City: I•av a State*A Zip Code: 8.211 Cowry.
Home/Office Tele No.. 7 (e- O 7 2 2 Cell No.
Email Address: __Lwe4%,49C4., '--Website:
(2) Physzca.l Address of Well Site (if different tl= above): & 1 R,)," -r
City: CLk /o 44 e _. - Stater ZipCode:-. 2 d 2 1 COUAI�_ 1,40�.. . � w � �I�+.�
Home/Office Tele- No. -- Cell N :=
777
B. AUTHOPUZEDOWNER)
AG�1vT OF O W NER, � ANY (if the Permit Applicant oe. nwa E�e'sitiijaci port3�
attach a letter ort; $ tlsg property owner attthorixiiag Agent to install and op}+erate LIIC we�1j . - •
CprnpanyName: _ �1 _ �he-•1a f 4:�,f'c+G77Dh
Contact Person-TelyW -�/40 n W; K- E L Address: J�Err. ir{ri rrA
Address: _]I 2 3- �. Do pe A � d Sl+ e e
city: r•�.rr1a e stater L ,Zip Code: Z p2 a r} County 1 � . � .
Office TcIe No.- 0 3 7 - 7 S" �� Cell7� ,7C
Website Address of Company, if any:

Nov. 1. 2014 4.11PM YADKIN WELL
No. 6 2.3
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WELL DRILL> R INFORMATION
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Company Na.mG:YnA W S; �_�G ._ -_ _
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Weil Driller Coatractay's Namr. Todymullis Ma ew Brown Milton Cave
NCConttactarGerefastionNa.. 2572-A 3 6- 3548-A
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Contact person: Dav d 1 Brown - 131WIAIT. Address: i
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dr' ler(&=n
Address: 1908 Hamptonvilie Rd.
City: Hjump uville N_C zip Code: 27020 County: Yadkin
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Offloo Tele No.: _326-469-4440 �Cel1 Nc.: 336-374-8736
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Fi tAT FUMY CONTRACTOR INFORMATION [if han driller}
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Company Name: v3� �' ! Y n G .
Cootaot Persan: 0 faw a EMAIL Address Oe t
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Address: 2K20 v
city: �i�v�a%7 _ - - Zip Code: 24, P-M County PCJ[ fes, Div -
DfffceTeleNo.. Y '�'/��' GcliNo.: 7 e'—-S-00i�
STATUS OF APPLICANT
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Private. X Federal; Gammerczal:
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5tate: I► ualcipal: Native AxucrieanLands:
<Y
INJECTION FROMURE (briefly describe bow the Weaboo 1vell(s) will be used)
WELL CONSTRUCTION D ATA S,f-jr,
CI)Proposed data to be coastrueted: AV, Number of borings:
Approximate depth of each boring (Feet):
�+ .
(2) Type of tubing to be vsed (copper, PVC, e10): HOPE Sb -
(3) Weil casing- Ts the well(s) cased? (ehetk either (a.) Yes u (b.) No below)
(a) Yes if Yes, then grov'sde c aiag information below
Type: _gatvenized steel black steel plastic other (Specify)
Casing depth; From to feet (reference to land surface)
Casing mtends to above ground indhes
M
(4) Grout Wo (material surrounding well caslag aad/or piping): - � rk r 4 e.
qr
(a) Grout lypa: Neat Comerrt Bentonke _ Other (speei�Y)
- - - •
(b) Groin placement- Pumping pressure Other
(c) Grout depth Uktubing (reference to land Fur#'gce): From to
.�r „y+cli has casing, indicate grout -depth: from to
(feet)
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m3$mi* is •this locum d wW &U a eats die eto and that, 6s6d .an myinquio tr those iidl*i�s
rmuurrli Wy tgspozible for v said l I be 3�ve t ttbq 1,r is #i A ate and d piece:
I ark a«e ibat #here are signi penal* inClofts the pD ktq Of irripiisanr eid, for sing
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Nov. 1. 2010 4:11PM YADKIN WELL
No. 6230 "•' '
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DATE: - 1 1 1 TIME: REF NO.
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AMPTONVILLE ROAD
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