WI0400183_GEO THERMAL_20110405

Permit Number
Program Category
Ground Water
Permit Type
WI0400183 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule-
Permitted Flow
Facmt -~
Facility Name
Neal and Libby Ragan SFR
Location Address
2940 North Pine
Boone
Owner
Owner Name
Neal
Dates/Events
NC 28607
Ragan
Orig Issue
04/05/11
App Received Draft Initiated
04/04/11
Re a ulated Activities
Heat Pump Injection
Scheduled
Issuance
Central Fil~s: APS_ SWP_
04/05/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
David J. Brown
1908 ~amptonville •
Hamptonville NC
Major/Minor
Minor
Region
Winston-Salem
County
Watauga
Facility Contact Affiliation
Owner Type
Individual ·
Owner Affiliation
Neal Ragan
2940 North Pine
Boone
Public Notice Issue
04/05/11
NC
Effective
04/05/11
27020
28607
Expiration
Waterbody Name Stream Index Number Current Class Subbasln
Beverly Eaves Perdue
Governor
Neal Ragan
Libby W. Ragar;
2940 North Run ·
Boon e. N C 28607
J1. . ..-A ii:S:i,1;~-~
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Suliins
Director
4/j/2011
Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System
Permit No. WI0400183
2940 North Ru n. B oo ne. NC 2860 7
Dear kfr. ti:. Mrs. Ragan:
Dee Freeman
Sec retary
On 4/4/2011, the Aquifer Protection Section (APS) received notification of your intent to construct a. closed-loop water-onl \'
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 lSA Sectiori 2C. Subchapter .0213, an~
3. The required notification form and asso~iated 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 .0211(u)(2). Additionally, you should contact the Watauga 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 ri:ersrcv.ncdenr. !:!OV if you have any questions.
cc: Winston-Sal~m Regional Office -APS
APS Central-Files --Pennit No. WI04001 83
Watauga County Health Dept.
Yadkin Well Co., lnc (David J. Brown)
Mountaineer Heating & Co .. Inc (Winston Petrey)
AQUIFER PROTECTION SECTIOM
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard , Raleigh. North Carolina 27604
Sincerely,
OU-1-A A.~
.fbr Debra~~\..; ~
Supervisor
Phone : [phone] \ FAX 1: 919-715-0588 ; FAX 2: 919 -715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwaterquality .org
An Equ2I Oppornmiiy \ Afiirrna!ive Act:on Emo1ov,):
Ni¥th Carolina
J\;llturattu
Apr. 4. 2011 4:53PM YADKIN WELL
FAGS FMLIE TRAHSMl ON FORM
10.7338 P. 1
DATE: TIME: REF NO
LOG NO.
TO: 7-rc- - _ l? 713 �'51Z
COMMMY NWE FAXNM P
ATTENTION OEVE immEWTELY
FROM: n ed C9 . _ ids aCIP - k ;V 01*1
COMPANY NOE FAX NO. PLEASE
RUSK cl n ' t• ❑ RERY
INDIVIDUAL DEn
NUMBER OF PAGES
IYCLUMNG THIS SKEET _
2
PLEASE oRI"Aluws r
REPLY BY SIGNATURE
MESSAGE:
F Y 7 1
FM
r�
EN t DWQ
AQUlr*S'PR0TEr,TPN . .
"FOR ALL YOUR WATER NE6OS"
YADKIN WELL CO., 1NC.
19W HAMPTONVtLLE ROAD
MAMPTONVTLLE. NC 27020
OAVID J. BROWN. VICE PRES.
TOIL. FREE [phone]
OFRIC£ 4
336y 46a-4440
FAX j3.96? 460.4048
RES [phone]
'6065 NEWS AFAEAICA - G00 LAVES YOU'
P1 FASE INF04 M US NUE(uAMY [F WU Op N4T RMME FACSIMILE IN AA.L

.Apr. 4. 2011 4:53PM YADKIN WELL. No. 7338ro P. 2 j
14ORTE CAR©lMik
IDEPARTblWt 0f M4MOIRaMADD X&"iURAL PIMOURM (NCEMM)
NOTMCMION OF INTENT TO COMMUCT A Q GEOTBERbm
as ACCO403ioe w1t h the FMWIM Ott -bW-AC 'l i de 10AA 02 C CM,1
C=Ptem this natKkwd= wd mad to odn *aft ba& peke (pLtme Rft ar Z= iafim=2 ion).
well ,Type Ceqbmatyn: Dom the proposed system dmfiwa P t1wo watarx (Mb O&OVO) i D
continuous pip� that campldely isclates tbA fluid fro= tto %rfiTmmera (l.a.
closad-4
Yes X CM i e camp18t4fts form.
N0 ]']d'iiTctt ��)�s
taznp� t� >�m. Complete � into the fams�
e 5�� (elos�+1-
chbor a 5A7 Kraal MM l waU jWaq , 2g p
loop won c=Wning da'tyw such as R-2Z ae=ot or adw a om oar corrmion b*ibitors)-
PRaPMTY OWN=($)/AM cArrr(s)
l at UMI Property 4wsm toted on pxoperty d" d (if owmd by a bmbnn or govm naoxx icy, Mma of
godly pads:epieMtWV]3wlattthar* for Via): A o-R f AA��r1 er► ieAsAOJ —
Ckr; OR d o XO-N SM.' W ?Jp Codm' -
MonwjCtEce Talc N4.: ,.� _+ llltisyr
Fm dl AtldraW_,_ Websh ?.
�a] Pj*sitc4 Addrass of WQ Sift (if diffneW tbm abq"):
citr C = - --
HOW'doffice Cell -�
$. AEU' TRO=EA AGENT Or GAR., LB ANY (tf ft Peewit Apglia= t AM rtot owx dxO V-Mbot prOpax Y,
gftw,h a Ieiter jor= the pTaperV o wmr anth=n g As*= to ixslaR and apetare UIC wan)
contact PerSva: _.._k ►�' ArL -
Address ; � -
CiTy; Stato• Zip Cod= Counary: -�
gffica Tale No.; Cell b,-
Websita Add ew of COMP V. IfaOr.
01-05-2010 16.35
2 Dim jaauie%unoW Wdbb S 11De, TC Jew

,Apr, 4, 2011 4:54PM YADKIN WELL.
No. 733820 P, 3 u
G
E4
Wx"DRMLzR1KMRMAn0N
RECEIVED I DENR 14WQ
AQUIFFR'PRnTFMN SECTION
COMFUW 1ca= - APR 0 4 2011
weU D&ar Csrome wbar's Nam.- LQdY hUda_ _ _ MAftm &M M Lho dye
Gatrum Persian: ew a-M =A
Add: 1908 Hkn*k ale Rd --•_ -_ _ _ _ _ _
city: _CMyjUL 1I.C. _ 3:Zp Code: 27020 _ _ C4ttaty: Yr.d
Cf9ce Tole No.; 33"8.4.440 Call NO- 336z374-8731
IMA,T 15UMX' CDNIMACTOR wCUMA-EXON (ld#fortat a" iejEsr)
C0n=Crt ptrsDa;�JA.z i i'i �' o` i9p_ f: "t �i � � 4'IM l7a%ti
Ad4css: P- �a � f{ C C G*01 ' C ram►
City: Zip Coda; SCC 0ovmg - �U
offi" role No.: I L F-2-6 V-- 6C2r Call No.. 2X— f0ke _
E. $TATI7S DR A.lPTlJCANT
Private, x Fedeaatt Commercial;
State: uvvigipa1: Nave American Lan&,
F. Il~i'SEMON PROCIAURE (bid* dese i'be ban► the 4�c a wells) WM be used)
G. WELL COMTRUC`I ON DATA
(1) Pcc .d date to be COMOMctrd. 'f' I1-�Q#� _ j'Tv'WbW ofbaacings.
Approximate daptlx of each barWS (fee•!}= 2-14 '
(2) rvo aft to tn uW 0,,,ei, ?ryq eta) - gai} Lx--
(3) wou Is the vmn(s) 7 (eheok -*W= 46) Yas m (b) No Wow)
(a) Yes if yea, the pxovZde csa:bag, i0mmatlraa below
Typo _g3,-makad steel black st�I,�]astic (spodfr)
Casing daptb= F'r= to £eet (reftea n to iaxld &minas)
C=Mg exude to atm grQM4 iacbes
(b) Na _�k
(4) Gizo%Info (mleml summdl% wbll casing e:C,Q er #pOM: vrs. ���• CnG.er ' C�
(a) Groh type: Neat ICO=a�__'•___ Bawnite e_ ❑lone [aped _ --
(b) Grant placome= FM� Od er
tc) arvd dsptb oftzdjag (refinncc to land smAm): iix= Z-
if well bm outM Indicate grunt d%Ah: from T to (fat)
01-05-W10 15:35
6 abed T2V1-*92-B2B 31H Widi�17=5 IT02 IE JUW

Aor, 4, 2011 4:54PO YADKIN WELL
Na, 7338« P. 4
$- XN'JE�TI�N-RLLAT� EQIIN�
AtWh a die, = &Wwivg the wt=a= but or pmpowd m�drficabw of the iwmijan sgtdprsnc and exterior
PxpiWMbwg assocfatded wlth tba zTccdaal opmftD. The ma's bwchwe may provide su+PPl==taiy
.tiara.
I. LOCATION OF VVXLL(S))
A wh two copias ofineps sbxmv ag'tba folUmb4 tax
(1) k el a Site I&p (= bed WM* sbaw3ag: buUdian properly Hems, svrfioe wxa bodiaaa; pawl
somm of Swundwam conUnAnatou snd *c orre Wdon of and di u=m besweea ibe proposed vmU(a) aad
&W aadstft vmU(s) ar viwft db;om,l des gw7a as sepAc tanks or &zlu f Wds iocxlbd witbia 200 feet of
the gwotb 'mal heft pump weH sysUa. LabW all Amfum dearly sad iaalude AAnrk urvmn
(a) Tlte Site Map == gaw the subject p %'V%l tr iu re aooEao tdxs s�wraums�ug arse by at latwo tie
referanca points sttcb os goads, strem% andlor #rwrway h9Mswtiaas.
I CERTMCATION
N44r: Tb* Pamif Appbeatisn must be r4pA by ear�h persona spy on the
recorded lvpLpr9pww*y da mL
"T beroby caridV, nndet ponaV of law, tbat I lave pmrsepkUy eo wdwd and am iamiZfar vvft Ike err EACM
submitted in eu doc+=nt ate PH atiat% * alRw &nd ftt, bised can my iA4abry of those iudividoals
immWkuly mpo=-ble ft *taming said infar=ticn. I'bo iew t'larttt Wftmston is to, a=mato and OMPIO t.
I am awwo that thaw are a3gaticaM pomMes,, incluftg tbo pou%UI y of ft= and map dso=eM for sing
false kftffatlaa. I gam to cawtr opera, Mawmda, Mrk, sadd if s"BMWA amdoil the igectnou well axed
all re$bed a►ppurwmoa8 am sccordau= wa tram apluoved spacifim4cma aid conddihow oftb a Permit"
-* n�4j
S of
Wp-gL fkJwJAO _
l out cr Type Vag Name and tik
REC�iVECf ! i}ENR ! �WQ
A0IRFFR FR0 FP:-il[Ml SECTION V. '
APR 4 4 011 s*mo= /Applimmt
Fft or type Pat Nam- =4 latic
ftwt mOfAsxth i eft,ifny
7 t or Type Fxa Num and tatla
Please t tom two copies oftbe campIftd AppliG404 pecjraga ter_
Nortlh Curollne DINR-DWQ
AgniferPretedie>t Section -MC PmgrAm.
16M f1+I20 $ey C a ur
Ralac jk NC $709-106
Telephone (919) 70-M5
_
35
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is 02ed 3MH Jaaulequnow
Wd**=S T702 Te -+¢W

Apr, 4, 2011 4:54PM YADKIN WELL
pe."( R a j a j+ U`�* �
RECEIVED r DENR I DVVO
AQUIFFR'PRnrFrTfON SgCTf �
APR 0 4 2011
low
No.7338 p, 5

No, m8 F. 6
2011 4.54PM
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YADKIN WELL
Tog
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RECEIVED / DENR r Dw4
1QIJIFR'PRnTFr.TION SECTION
APR 0 4 2011