WI0400122_GEO THERMAL_20120517

Beverly Eaves Perdue
Governor
~
;;;;-;;-;,1.'-.· --~
NCDENR
North Carolina Department of Environment and Natural Resources
Division .of Water Quality
Charles Wakild, P. E.
Director
May 17, 2012
Ken and Robyn Nixon
605 Macon Place
Raleigh, NC 27609
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0400122
Dear Mr. and Mrs. Nixon:
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 1, 2012, the North Carolina Administrative.
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These rev~sions affect all permits issued
for injection wells including 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.or g/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.O.
Hydrogeologist
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: [phone] \ FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity\ Affirmative Action Employer
N°~i..c 1· 01. u..1 aro 1na Jvnturallg
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment end Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 U 3 G 4
-1.INE LL CCWTR� ACTOR:
I /14. -1 "�'i1 W �J r l�t ti wn
Well Contractor (individual) Name
YADK1N WELL COMPANY, INC.
Weil Contractor Company Name
STREET ADDRESS 1908 HAMPTONVILLE ROAD
HAMPTONVILLE NC 27020
City or Town State
( 336 )- 468-4440
Area code- Phone number
2. WELL INFORMATION: �f
SITE WELL ID #7 �`T(tr app!irabis)3
WELL CONSTRUCTION PERMIT#[1 applicable)
OTHER ASSOCIATED PERMIT #(lf apptIcab!e)W 3' Olt 0 tr t 3 2
3. WELL USE (Check Applicable Sox) hton!loring[] Municlpal/Pubticn
industrial/Commerciale Agncu[t relD Recoveryl3 InJectionp
Irr!galloril] Other (!fat use) 6-
DATE DRILLED (2 - J I — Uq
TIME COMPLETED
4. WELL LO C
CITY: 'LCS l�
Cr r Eti "ea r1e.COUNTY
,
1
(Street ma, Nvmber flmmbnry, subdivision, LotNo.. Parcel„Zip Coda)
TOPOGRAPHIC f LAND SETTING:
ASlope ti Valley ❑ Flat 0 Ridge p Olher
(check appropriate box)
LATITUCE 4,.
LONGITUDE ,
Latitude/Iongitude source: PS 0 Topographic map
(rocation otweil must be shown on a USGS top° neap and
attached to this form if not using GPS)
Zip Code
AMLI PMD
May be in degrees,
minutes, seconds or
in a decimal format
.6. FACILITY- t s the name er the buarners what' to s % 11 la toe tad.
FACILITY ID Cif applicable) NAME %]
O W (err\ 1 ! /l e:04i
STREET ADDRESS
City or Town Slate zip Code
CONTACT PEERSON 4,riP��f'P
MAILING ADDRESS
City or Town State Zip Code
Area Bode - Phone number
e. WELL DETAILS:
a. TOTAL DEPTH: 3o 2 r
b. DOES WELL REPLACE EXISTING WELL? YEESI3 NOK
c. WATER LEVEL Betovw Top of Casing: t ,7 FT.
Ps '4. If Above Top of Casing)
st, TOP OF CASING IS )( FT. Above Land Surface'
-fop of casing Ierminatad at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST AIR PUMP
f. DISINFECTION: Type HT Amount / ( i D r
g. WATER ZONES (depth):
From /gQ'To J4r i 2From To
From To Fram_ To
From To From To
C T�"r 5r
7. C kiterti r: Depth Diameter TalckneserWelghl Material
From + f To R I Ft.
From To Ft.
From To Ft.
B. GROUT: {Depth
From 3 To
From To
Matorial Method
Sao Fs.ernr,y,
Ft.d' Ioolf, s.-.
From To Ft.
8. SCREEN: Depth Diameter Slot Sire Materiel
From To Ft. In. In.
From To Ft. In. In.
From To FL In. fn,
10. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
11.DRILLING LOG
From [`_To ` Formation Description
— VQ r JN!1
`r r r`
12. REMARKS:
SIZE OFF
BIT SERIAL NO: ,4') . _012
1 DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE V,MTH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORIy HAS BEEN AROVIDE0 TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
444
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
P.
rd left
12- a1 ()s
DATE
/11054- .1)6
Submit the original to the Division of Water quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center-- Raleigh, NC 27699.1617 Phone No. (919).733.7016 ext 8S8.
lean'-6k,k`.ecr J'l.c�� er(4-/ ,,�.�i16 ---3q`I`r
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r Rev.12f07
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Permit Number WI0400122
Central riles: APS SWP
12/15/09
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Status Project Type
Active New Project
Version Permit Classification
1.00 individual
Primary Reviewer Permit Contact Affiliation
john.mccray
Coastal SW Rule
Permitted Flow
Facif its
Facility Name
Ken Nixon & Robyn Nixon SFR Geothermal
Location Address
500 Galax Cir
Blowing Rock
Owner
Major/Minor Region
Minor Winston-Salem
County
Watauga
NC 28605 Facility Contact Affiliation
Owner Name Owner Type
Individual
Ken Nixon Owner Affiliation
Ken Nixon
Dates/Events
❑rig Issue
12/09/09
App Received
11/19/09
Draft Initiated
Scheduled
Issuance
605 Macon PI
Raleigh
NC 27605
Public Notice Issue Effective Expiration
12/09/09 12/09/09 11/30/14
Re;:ulated Activities Reruested/Received Events
Heat Pump Injection Region comments on draft requested 12/01/09
Region comments on draft received 12/03/09
Outfall N. Li.
Waterbody Name Stream Index Number Current Class Subbasln

North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
Dee Freeman
Secretary
December 9, 2009
Ken and Robyn Nixon
605 Macon Place
Raleigh, NC 27609
Dear Mr. and Ms. Nixon:
Subject: Issuance oflnjection Well Permit
Permit No. WI0400122
Issued to Ken and Robyn Nixon
Watauga County
In accordance with your application received November 19, 2009, I am forwarding Permit No.
WI0400122 for the construction and operation of a vertical closed-loop geothermal mixed-fluid heat
pump injection well system located at 5.00 · Galax Circle, Blowing Rock, NC 28605. This permit shall be
effective from the date of issuance until November 30, 2014, and shall be subject to the conditions and
limitations stated therein.
Please pay special attention to Part 1 .. 7 of the permit and submit copies of the Well Construction
Completion fonn· (GW-1) after construction. Please submit all data within 30 calendar days of receipt of
this letter to the address below:
Aquifer Protection Section (APS)
Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
Additionally, your UIC system is subject to inspection by the APS and at the time of the inspection must
display a permanently affixed identification plate in accordance with requirements ·of 2C .0213(g). Please
insure this is completed in accordance with permit condition Part 1.6 of this permit issued December 8,
2009.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Quality. ff you have any questions regarding your permit or the Underground Injection
Control Program please call me at [phone].
cc: Sherri Knight -Winston-Salem Regional Office
Central Office File-WI0400122
Watauga County Environmental Health Dept.
Winston Petrey -Mountaineer Heating and Cooling, Inc.
Enc: Permit WI0400122
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION 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
Ken and Robyn Nixon
FOR THE CONSTRUCTION AND OPERATION OF 1 TYPE 5QM INJECTION WELL, 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 500 Galax Circle. Blowing Rock. NC
28605. and will be constructed and operated in accordance with the application dated November 19, 2009, and
in conformity 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 only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in compliance
with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until November 30. 2014, and shall
be subject to the specified conditions and limitations set forth in Parts I through IX. hereof.
Permit issued this the ct day off , 2009.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. 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. Tl;iis permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, 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.
6. Each geothermal injection well system shall have permanently affixed an identification plate on a nearby
building or other permanently fixed structure indicating the location and presence of underground UIC
wells according to 2C .0213(g).
7. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
163 6 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
(336 ) 771-5000
GW-ls must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
8. Well construction records must also be submitted for the existing water supply wells on-site as well as a
site map showing any water supply wells on adjacent properties as specified in NCAC .021 l(d)(l)(D).
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 -[phone] and the Winston-Salem Regional Office Aquifer Protection Section Staff,
telephone number (336) 771-500 0.
WI0400122 2
2. · B9rehole0s shall not connect separate aquifers which have differences in water quality (e.g., shallow
surficiat aquifers, saprolite, fractured. bedrock, etc.) as specified in ISA NCAC 2C .0213(d)(8)(C) and
shall be filled with bentonite grout from the lowermost water bearing zone to 3 feet below land surface as
specified in the permit application.
PART III -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit 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 Perni.ittee, 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 respoD:sibility of complying with any and
all statutes, rules, .. regulations, or ordinances, which may be 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.
PART IV -PERFORMANCE STANDARDS
1. 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 abandon.rnc;mt 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
groundwater resulting from the operation of this facility.
PART V -OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility 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 staff, telephone number [phone]. 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.
WI0400122 3
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. Department 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.
PART VII-MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Winston-Salem Regional Office, telephone number (336) 77'1-5000, · any of the
following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information 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.
4. 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
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART IX-CHANGE OF WELL STATUS
1. The Permittee 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 that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
WI0400122 4
' .
2. · When dperations have ceased at the facility and a well will no longer be used for any purpose, the
Pennittee shall abandon that injection well in accordance with the procedures specified in 1 SA 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 which 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 cases when, as a result of the injection operations, a subsurfac~ cavity has been
created, each well shall be abandoned in such a manrier 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 Pennittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
WI0400122
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
Permit Number WI0400122
Central Fifes: APS SWP
12/01/09
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Weil System (5QM)
Primary Reviewer
john.mccray
Coastal SW Rule
Permitted Flow
Facility
Facility Name
Ken Nixon & Robyn Nixon SFR
Location Address
500 Golly Cir
Blowing Rock NC 28605
Owner
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Winston Petrey
PO Box 1905
Boone
NC 28607
Major/Minor Region
Minor Winston-Salem
County
Watauga
Facility Contact Affiliation
Owner Warne
Ken
Dates/Events
Nixon
Owner Type
Individual
Owner Affiliation
Ken Nixon
605 Macon PI
Raleigh
°rig Issue App Received Draft Initiated
11/19/09
Regulated Activities
Outfall NULL.
Scheduled
Issuance
Public Notice ue/o9
019
NC 27605
ErS.1 0+ l n l( q
Waterbody Name Stream index Number Current Class Subbasin

Mccray , John
From: Knight, Sherri
Sent:
To:
Thursday, December 03, 2009 2:18 PM
Mccray, John
Subject: RE: UPDATE FW: Two 5QM Geothermal applications
I'm OK with going ahead and issuing these. l1 m planning a visit to the area within the next week or so to look at a couple
of things I'll try to go by these f I can work the scheduling out. Also the Fox one that we just issued.
Sherri Knight, PE
NC DENR Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection Section
585 Wa ughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Mccray, John
Sent: Tuesday, December 01, 2009 1:39 PM
To: Knight, Sherri
Subject: UPDATE FW: Two SQM Geothermal applications
Importance: High
The two _application numbers are as follows:
WSRO Nixon SQM is WI0400122, and
WSRO Ullman SQM isWI0400121.
Thank you for your prompt response on these applications.
John McCray
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
From: Mccray, John
Sent: Tuesday, December 01; 2009 ·9:55 AM
·to: Knight, Sherri
Subject: Two SQM Geothermal applications
·Importance: High
Dear Ms. Knight,
Attached you will find a copy of two SQM applications. Both of these sites are in Watauga County and should have been
processed the week before Thanksgiving but have been held up because of a mistake. I am reviewing these applications
and as soon as they are entered into SIMS I will send you application numbers for them, but I wanted to get these two
moving as quickly as possible because they have been sitting with no action. Please notify me if you plan on inspecting
the site, otherwise we plan to issue in accordance with our policy to expedite these permits.
1
Best Regards,
John McCray
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
2
Beverly Eaves Perdue
Governor
Jif'A
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
December 1, 2009
Ken Nixon
RobynNix~n
·605 Macon Place
Raleigh, NC 27605
Subject: Acknowledgement of Application No. WI0400122
Ken Nixon & Robyn Nixon SFR
Injection Mixed Fluid GSHP Well System (SQM)
Watauga
Dear Mr. & Mrs. Nixon:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges-receipt of your permit'application and
supporting materials on November 19, 2009. This application package has been assigned the number listed above and will be
reviewed by John McCray.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests. ·
. Please be aware that the Division's Regional Office, copied -below, must provide recommendations prior to final actio1,1 by the
Division. Please also note at this time, processing permit applications can take as long as 60 -90 days after receipt of a complete
application. ·
If you have any questions, please contact John McCray at 919-715-6168, or via e-mail [e-mail]. If the reviewer is
unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To review our
new organizational chart, go to http ://h2o.enr.state.nc.us/documents/dwq or gchart.p df.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON Tms PROJECT.
Sincerely,
0~
for Debra J. Watts ~
Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Winston Petrey (Mountaineer Heating & Cooling -PO Box 1908, Boone, NC 28607)
Permit Application File WI0400122
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \Customer Service: 1-877-623-6748
Internet www.ncwaterguality.org
An Equal Opportunity\ Affirmative Action Employer
Nirth Carolina Jvatural/g
Nov. 19. 2009 7:08RM YADKIN WELL
No. 4044 P.
mia2-0T-TT
Li;1'
INIOR! CAROLINA
DEIPARTM7N7 OP ENVIRONMENT AND NATTJRA SOVRBS (NCOENE.)
APPLICATION FOR PERMIT TO CONSTRUCT ArtifOR USE A WELL(S) FOR
MEMOS wrm A GEOTHERMAL HEAT ThXP SYSTEM FOR:
;
TYPE 5931 WELL(
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DATE: I/ ---42YE.2O
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Company Num:
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WebAddress ofCompany, if any:
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Nov, 19. 2009 7:03PM YADKIN WELL
No, 4044,
P.
D. WELL DIIILLIMINFORMATION
Comp+ Name: YAMt{ 1' L _ ZAAP42t]` k -
Wen:1Mo Qastrsoseig Wont aot7Y ;3..MATKV_ ROWN.M11.
NC Contactor Ceztificatiou No- t (MOWS' rz-1 [BROWN: acrae-Al CA. MOW
Caruso Paso% DAY_i47 MOWN co Mom j v1AIi: Ad t hFerdrmarerrs9npgrt
Address.; loos H,AhRWTONV1LLF RC AO
City; RANIP-rrorrvALLG N t. Zip Codar V020 Covattp; INIEJII9h1
Office Tt a No : MI-483-4445 Cell NO 3147i-
ill
E. EXAT PUMP CONTRACTOR DITOP'T N (if different than
ComPsor a► hi " _ 614
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Contact Para ' � IA4 r� IW► N u • r al .
Address: --Po- 'giro1,3as , till
__53061ci 6,1; Nc Zfp Coder 2g4.07_ Comity-, /1441.4
Ogee Te10 No.: &`' ,X y " egIC Ca Ivo,: a-s- Iv,-feitfgAl�
F. XNMECp0/41 PROCEVORR (hcie2y deecsibe haw the Weal= 0r0(4 ff be seed)
k+ - c,.-, 4- e•t U i /(A.-4 ! e, r e-c f.4 to- .), I- .-i-a C / a i s i
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C. WELL CONSTRUCTION DATA (tgo w_Seettc4tt Ji tlrh pv
(1) Proposed date to be-construc Number 1' Pla"
i�
Approxinnate dew of etch baring (feet): 3." �]
�) C'l:emdesl addltr'ves tabs used in Cloded-loop m (only Chose ,.. indicated hoes been approved):
2..22 _ PT Py glycol erlanel en i vJei {Ilk other (other soft:I.ves ?Ail
Dead prior approvut by P(CDZNa berono n ) Y
(3) Type o€tubing to be used (copper, FYC,.etv): /-� PP
w ell costa the %calico cued.? (deck chba (1.) VIES or (h.
(a) VIZ if yes, then Intrvide oasleg information sub es Opel, PVC, pialtiro etC.), 0=1=6-
•
(b) NO 25
(5') CAVA surittOriatig Tier cesaig sndhst pig*$):
(e) G+ ty'P'c; Cement nite+ ? ' Cotter i.,,t 1 4.p t
(b) OTTOt depth oftub}ng (sefluenoeto land sur ace): from € = m �Af] {fee[) " �;'
Ifweil haveslmB, eadicsgo srcat depab: firom , %
11h11011
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S. Ilg5E oN-flLd►TED li,QUIPMEII ' 1.
iIl
Mach a diagram showing the engineering layout or proposed medi `• 6t the it(jed00u equipment and exterior
pipinettibit g 8soci old w do #tThmxcga ectlon operation. 'nit •. �, , fbatchvro may provide rnpPl'ementarY
information.
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Nov, 19, 2a49g= 7:O8PM YADKIN WELL
lletsd
No, 4044 P. 8,04
bi=SIT sow -et -TT
• CZNITIVICATION
140isc Tliia ramt!! AplwrM..tiala earl.[ be sit.d tlY Wak Pen=
"I hereby catiflo r Prza4 Qf tave. tea NiVe persesiabt
abutillad fa las daaom.ac extmohzesua tbaatirp Aged
respxsibil ebtzliting add irdhatadah 1 bane 'ddd
1 sea rurtare that than are s soetrt belbeet Pa A'
&tie t soat3ac., 1 Ramt opaaldN . xe.rhRaiq.NON
all mime ad appartmxccp accordizroa with rbc sppra 4 .ped.p
is
fie
• OCAT OF WltLLM . "
mod I oOpOiel enlace avowing my
(1) hell& a i± i msp (nabs 4*wn) dairies; buildirss. ga r lies,ado= *sat ba31111. Pima" Karr"
of coarldivglor coalzaztbetkal sad the of imd butw gba p'rvpo.ed wv11(e) end Jry
iodate; •r�.i1(a) ar wane disposal hdibles v sep¢ic ar'rsin tee do tamed Weak z e 1W of �e
rmaI beetptxmas . p won ovum L.bei 1d; ,'? '... juds ■ ism* arrow.
tZ ludtuae ■ lepographia mail oft. area exttedkos or,,lr nos
iadso.te a Soeat = mad tI.Nip
�. PlYTA.SLZ NAM WILL
Lbw ag7 pew wars tags) on the :Wiwi prspaly ar
IfYee, daaa isormazo 1 cols of' atbited trep(s).
ireperty boundegies and
pepartke? YES ,ZNO
• ries es tale recorded pI property deed
red aas ltraMer wltb the ietenzeaks
lisiN booed as mq1 mgcdry of tlrore Whitd b
:111, bElbrflittkElf+ was =creed led
CMOS 4124 tlX1p1410EXCea fic
ll ar'tm deb Weed= *oil ace
ad
SIVsd = at AtillitriateltranY
mit or T b I4'a'm.1
Plume mama two eerie: of the ogeademed Ap plio'Ixioa pomp to: •
North Caxaasta D] )»V
lh.gaI it ?retarti'os: i e a► i
U C Prawn=
1434 Met Service Coo
RA** NC 27634-1 36
Teleologic [919) 715-6'
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11-13-2009 @8:18
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Fb:OT 6002-2T-TT

11 :-1'Nov. 19. 2009 7:09PM YADKIN WELL
~dG <:at•'c ie"....l~
8 l~"1 lt.44.t.: 1,1<. 2K.o<
No. 4044 Pp, 9
Property Card Information http://www.wataugacounty.org/gis/propcard.aspx?pin=2819538515000
Watauga County Property Card Information
PARCEL DATA LAND SEGMENTS
PIN NUMBER ACCOUNT# MAP SHEET ASSESSED SEGMENT TYPE ISIZE !APPRAISED VALUE
ACREAGE PRIMARY RES. SITE I .39 acres ! 24100
2819-53-8515-000 1539365 2819-04 .0000 BlHLDINGSUMMARY
ZONE LAND USE TYPE /DESCRIPTION !APPRAISED VALUE
RESIDENTIAL 1 FAMILY RESIDENTIAL I HOME I 111000
PROPERTY ADDRESS NEIGHBORHOOD
500 GALAX CIR SKI MOUNTAIN EAST
PROPERTY DESCRIPTION
LOT 17 SEC lA SKI MTN
OWNERSHIP AND MAILING ADDRESS
NIXON, KENNETH L
NIXON, ROBYN H
605 MACON PLACE
RALEIGH,NC
TOWNSHIP TAX CODES TAX RATE SALLS DATA
GENERAL COUNTY DATE SALE PRICE
.000 1997-10-15 128000
BLOWING ROCK BLOWING ROCK .000 1996-03-27 24000
FIRE
DEED INFORMATfON
BOOK/PAGE DATE RECORDED DOCUMENT TYPE STAMPS
429/844 10/15/1997 DEED 256
LEGAL DESCRIPTION
L17 SEC IA SKI MOUNTAIN B ROCK
GRANTORS GRANTEES VALUE SlJM.1·1ARY
JONES CHARLES L NIXON KENNETH L LAND !BUILDING ITOTAL
JONES DONNA K NIXON ROBYN H 24100 I 177000 I 201100
BUILDING IN FOR.MA TJON
BUil,DINOl
BUILDING I SUMMARY BUILDING SKETCH
DESCRIPTION USE
HOME RESIDENTIAL
# SECTIONS l#UNITS PHYS ICAL% GOOD
3 I 1 91
AREA HEATEDAREA
1290
MAIN AREA DATA
NUMBER OF STORIES 2.0
EX'IERIOR WALLS ALUM/VJNYL/S1EEL
STYLE CONVENTIONAL
ROOFCOVER ASPH/ASBESTOS SHINGLE
YEARBUILT 1986
YEAR REMODELED
FOUNDATION, C_ONTINUOUS WALL
BASEMENT TYPE CRAWL
HEATRATING CEN'IRAL
HEATING FUEL TYPE ELECTRIC
HEATING SYS1EM TYPE ELECTRIC
NUMBER OF ROOMS 7
NUMBER OF BEDROOMS 4
FULLBA1HS 2
HALFBA1HS 1
ADDIDONAL FIX1URES 2
AffiCTYPE NONE
AREA 900
GRADE FACTOR C+ View Detai]ed Sketch
CDU VERYGOOD
OTl.'IER FEATURES·
FINISHED BASEMENT LIVING
AREA
REC ROOM AREA
MASONRY STACKS 1
MASONRY OPENINGS 1
1 ofl 12/9/2009 12:24 PM