WI0400195_GEO THERMAL_20110622

Permit Number
Program Category
Ground Water
Permit Type
WI0400195 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Christine Mccuen SFR
Location Address
2501 Durant Pl
Greensboro
Owner
Owner Name
Christine
Dates/Events
NC 27408
Mccuen
Orig Issue
06/22/11
App Received Draft Initiated
06/20/11
Re g ulated Activities
Heat Pump Injection
Outfall N: J~.:.
Scheduled
Issuance
Central Files: APS_ SWP_
06/22/11
Permit Tracking Slip
, Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
David J. Brown
1908 Hamptonville
Hamptonville NC
Major/Minor
Minor
Region
Winston-Salem
County
Guilford
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Christine Mccuen
2501 Durant Pl
Greensboro NC
Public Notice Issue
06/22/11
Effective
06/22/11
27020
27408
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
Beverly Eaves Perdue
Governor
Christine M.cCuen
2501 Durant Place
Greensboro, NC 27408
AVA
MCDEMR
North Carolina Department of ~nvironment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
6/22/2011
Subject: Acknowledgement of Intent to Construct Type SQW Injection Well System
Permit No. WJ0400195
2501 Durant Place, Greensboro, NC 27408
Dear Ms. McCuen:
Dee Freeman
Secretary
On 6/20/2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onlv
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
CarolinaAdministrative Code Title ISA 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 ISA Section 2C Subchapter .021 l(u)(2). Additionally, you should contact the Guilford 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.RoQ:ers1@ncdenr.l!ov if you have any questions.
Sincerely,
forQ~ A .fu:nn~
cc: Winston-Salem Regional Office -APS
APS Central Files -Permit No. WI0400l95
Guilford County Health Dept.
Yadkin Well Company (David Brown)
Green Horizon (Brant Wurster)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh. North Carolina 27604
Supervisor
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwaterauali tv .or
An Equal Opportunity\ Affirmative Action Ernploye;
One North Carolina
JVaturaltu
Jun.20, 2011 8:19AM
k 0487 P, 1
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DATE: I - L _! .TIME; REF NO. LOG NO.
COMPANY N49 FAX NO,
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COMPANY NAME FAX NO. PLEASE
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NUMBER OF PAGES PLEASE QAIGSFLAMfrs
INCLUDING THIS SHEET IMPLY BY — SIGNMRE
MESSAGE:
'cam +tee.
-FOR ALL YOUR WATER NEEDS'
YADKIN WELL CO., INC.
1 SPO HAM12TONVILLE ROAD
HAMPTONViLLE. NC 27020
OAVID J. BROWN, VICE PRE5.
TOLL FRE> (600) 24"Mi5
OFFICE t336) 46a-4440
FAX (330) 4"-40"
RES (3W) 468-AG59
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RECEIVED 1 DENR 1 DV4
Aquifer Prate6on Section
JUN 2 0 2011

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p44h mbicg associated with 1116 J*Cdon opar+riiati. The aWWftdvrWa brads= may pxnvide suppleaneaimy
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Nowth Czralka DICKR DWQ
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Telephone (,919) ?15-6 i.5
RECEIVED 1 DENR 1 p1MQ
Aquifer PmlerAlon Section
JUN 2 0 2011

Jun, 24. 2011 8:19AM
ND. 0487 P. 5
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RECEIVED r DENR i DM
Aquifer Protection Section
JUN 2 4 2011
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