WI0100078_Complete Historic File ARO_20220316

RECEIVED-]
Central Files: APS_ SWP_
1111 12/10/09
Permit Number W10100078 H:C Permit Tracking Slip
Program Category ?glonal Office Status Project Type
Ground Water ( Aouirer Protection Active New Project
Permit Type Version Permit Classification
Injection Water Only GSHP Well System (50W) 1.00 Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers Eileen L. Plemmons
Co-owner
Coastal SW Rule 60 Monte Vista Dr
Waynesville NC 28786
Permitted Flow
Facility
Facility Name Major/Minor Region
Kent J. Plemmons SFR Minor Asheville
Location Address County
225 Triple Creek Dr Haywood
Clyde NC 28721 Facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
Kent J Plemmons Owner Affiliation
Kent J. Plemmons
Owner
60 Monte Vista Dr
Waynesville NC 28786
Dates/Events
Scheduled
Ong Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
12/10/09 12/07/09 12/10/09 12/10/09
Regulated Activities
Heat Pump Injection
Private residence,single family
OuttaF
Waterbody Name Stream Index Number Current Class Subbasin

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
12/10/2009
Kent J.Plemmons
Eileen L.Plemmons
60 Monte Vista Dr.
Waynesville,NC 28786
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No.WI0I00078
225 Triple Creek Dr.
Clyde,NC 28721
Dear Mr.&Mrs.Plemmons:
In accordance with the application submitted to the Underground Injection Control(IJIC)Program that was received on 12/07/2009,
the Aquifer Protection Section(APS)acknowledges your intent to construct a closed-loop geothermal water-only injection well
system for the operation of a ground-source heat pump located at 225 Triple Creek Dr.,Clyde,Haywood County,NC 28721. This
system is deemed permitted by rule(North Carolina Administrative Code Title 15A,Subchapter 2C, Section .0211(u)(2)).
However,it is recommended that you contact the Haywood County Health Department,as they may have additional construction or
permitting requirements for this type of system. If you modify your system at any time,including the addition of antifreeze,corrosion
inhibitors,or any other substances to the circulating fluid,you must contact the APS to verify compliance with applicable rules.
Thank you for submitting this notification. If you have any questions please call me at(919)715-6166.
Sirferely, I j�
for MichW Rogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Asheville Regional Office-APS
APS Central Files-Permit No.WI0I 00078
Haywood County Health Dept.
Randall Cutter(Innovative Environmental Drilling,6105 Rest Home Rd.,Claremont,NC 28610)
Guy Cox(GLC Services,Inc.,2225 Bald Creek Rd.,Clyde,NC 28721)
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636
Location:2728 Capital Boulevard,Raleigh.North Carolina 27604 One
Phone:[phone] t FAX 1:919-715-0588;FAX 2:919-715-60481 Customer Service:1-877-623-6748 NorthCarolina
Internet:www.ncvvaterauahtv.om
An Equai Oppormni y Affirmative Anion EmNover (/'Vah rallb"

7-08-1999 12:40PM FROM 8284.524200 P.2
NORTH CAROLINA
DEPARTWNT OF ENVIRONMENT AND NATURAL RESOURCES(NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL .
WATER-ONLYINJECTION WELL SYSTEM:
TYPE 5-OW WELLS)
In Accordance with the provisions of NCAC Title 15A:02C.0200,please
/1
complete this notification and mail to address on the back page(please Eli t or�information).
DATE: Pe o 7A�
WaU Type Con irraWon: Does the proposed system circulate potable water only(no•additives)in.
continuous piping that completely isolates the fluid from the enviromnent;(Le.
closed-l000l?
Yes Continue gompletingihis form.
No Do Not complete this form. Complete other UIC application forms for installing
either a 5A7 well(_omen-loop well injectine potable water into the aquifer)or a 5QM well(closed-
loop well containing additives such as R;22,ethanol,or other antifreeze or corrosion inhibitors).
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed(if owned by a business or govermnent agency,state name of
entity and a representative w/authority for signal=); K,0.4 z'r <I k'i jeeh L J9heo!71W S
(1) Nailing Address: (o 0 M&Ifr- Udi- pf'
City:WGvr NEVI fl e- . State: Zip Code: Zg 7q L County: &4 W
Home/OfficeTeleNo.: 5A\)' 006 - y79 CellNo.:
EmqU Address:gg4-dD � CIilx Website: 4&1di T CdlrW)
(2) Physical Address of Well Site(if different than-above):QrR5 1 C� A-
City:, G4j.>L j State: {� Zip Code: 7�7 L County: f�r Ww.
Home/Office Te1e No.:l$A)SCF6 - 3'�71 Cell No.:
1�} R. AUTHORIZED AGENT OF OWNER,IF ANY(if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: State:_Zip Code: County:
Office Tole No.: Cell No.:
Website Address of Company,if any:
aP11/01C5QW Notifaanon of lmmt Fmm(Revised a2M) Page l:
RECEIVEDIDENRIDWQ
AQUIFFR'PROTFCTION SECTION
DEC 0 7 2009

7-e8-1999 12:40PM FROM 8284524200 P.3
C. WELL DRILLER
INFORMATION 1
CompaoyName /1/IfNflt>jP �, )i%1(2Y1r2r1�YTfCL� r�l i ((✓10i
Well Driller Contractor's Name: gy-�
NC C0Wmctor CertificationNo.:
Contact Person; ZggpLfi `r, f e EMAIL Address I-Cin .i ld It?jr i tYrti g""
Address: US
City: (� d f F .>trn>y1 Zip Coder L i 0 County:
office TeleNod(� -'� aR4:-) ( r" Coll No.:
D. HEAT PUMP CONTRACTOR INFORMATION(if different than driller)
Company Name: fir! C 2�9IVI C-b'k,
Contact Person: EMAIL dress:
Address: C CCU I
City: > Zip Code: 07 . Comity: p�
Offe!TeleNo.( - U CeliNo.: sme-
E. STATUS OF APPLICANT i
Private: Federal:_ Commercial:_
State:_ Municipal:_ Native American Lands:
F. IN]ECTION YItOCEDURE (briefly describe how the injection well(s)will be used)
G. WELL CONSTRUCTION DATA
. (1)proposed date to be constructed: ASA*D Number of Borings:
Approximate:depth of each horing(feet): [SC1
(2) Type of tubing to be used(copper,PVC,etc) POG f�E9/lS'L F✓E '
(3)Wei!casing. lithe wells)cased?(check either(a)Yes (b.)No below)
- (s) Yes if yes,then provide easing information below - —
Type: aaivaniZed steel Tblack steel_jdastic other(specify) . .
casing depth: From ' ' to feet(reference to land surface)
Casing extends to above ground inches j
(b) No
(4)Grout Info(material suimundmg well rasing aadbr piping):,
...' .
. (aj.'• .('iront;ype:.NahtCemeM '�'•Bentonite� Odier(specify) .
(b) Giouiplacement: Pumpin Pressure_ Other_
(C) " Grout depth of tubiog(reference to land surface): from�_to J t5':0
If well has casing,indicate grout depth: from to (Iaet)
OPUft1IC SQW Natlncanon of lmentXena WkisedWAM) Pij2 .

7-08-1999 12:d1PM FROM 8284524200 P.a
S. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injeetion equipment&*coerior
pipingltubing associated with the injection operation. The manufacturer's brochure may provide sup ementary
information. .
L LOCATION OF WELLS)
Attach two copies of'maps showing the following information:
(1) Include a Site Map (can be drawn) showing: buildings, property lines, surface water bodies; potential
sources of groundwater contamination and the orientation-of and dWences between the proposed:well(s)snd
any existing well(s)or waste disposal facilities such as septic tanks or drain fields located within VO feet of
the geothermal beat primp well system.. Label all features clearly and include a north arrow.
(2) The Site Map must show the subject property in rotation to the surrounding area by using pt least.two fixed
reference points.such as roads,streams,and/or highway Intersections.
J. CERTIFICATION -
Note: This Permit Application mast be signed by each person appearing on the, y
rerorded legal property deed.
"I hereby certify, wider penalty of law, that I have per'somlly examined and am familiar with tfie,infonoation
submitted in this document and all attachments thereto and that, based on my inquiry.of those'individuals
immediately responsible for obtaining said information,1-believe that the information is true,accufm andcomplete.
ere I am aware that th am significant penalties, including the possibility of fines and imprisonment, for'submitting
false information. I agree to construct,operate;maintain,repair,and if applicable,abandon the injection well and
all related appurtenances in accordance with the jar apecificadons and conditions of the Permit";
Signature of Property Owner/Applicant
}�P.rl�- (�.Pa�1rY1 rx�S t�Ct�7•P,r - � , .
Print or Type Full Name and title -
X
Signature ofProperty Owner/Applicant
Print or Type Full Name and title
Signature kythorized Agetn,if any
,PHM or Type Full Name and title
Please return two copies of the completed Application.package to:
1tTorth Carofln&DENR DWQ
a .• A gdifer Protection S.action-UIC Progiam.
0 1636 Mail Service Centuer
Raleigh,NC 276"4636
Telephone[phone]
t3P1f�11C SQW Notifualion of Ia�tFaro(tieviscd a26ot) ' WEIVOIDENRIM py e3
AQ(JIFFR'PRl1TFf.T10N SFCT10N:
DEC 0 7 2009

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REEK MEADOWS
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(x'otmetty Lots 33 R 34) 03
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\\ "TRIPLE CREEK_ DRIVE" \ _
\ < — — — — — — — — —— — — - am—— — z' x (T,
404.36'
E 617.30•
— I —�
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J 4
' 10.1 P 16

,
g 137
96
3504
� 5
+ r �
6fap generated by the Haywood County Mop SmTr. mm Feet 1 inch equals 140.836493 feet
1217/20091:35:18PM 0 50 100 200 300 400

I
Rogers, Michael
From: [e-mail]
Sent: Monday, December 07, 2009 2:54 PM
To: Rogers, Michael
Subject: Notice of Intent to Drill Application
Attachments: Plemmons 5C W Geothermal Permit,pdf
Michael,
Attached is the 5-C W`form "Notice of Intent to Drill'for the following customer:
Kent J. & Eileen L. Plemmons
Waynesville, NC
I want to thank you for your help and hope you get over the cold.
Thanks,
Randall E.Cutter CWD/PI
IGSHPA Accredited Installer
Geothermal GSHP Loops
Innovative Environmental Drilling
6105 Rest Home Rd.
Claremont, NC 28610
828-228-1695
Fax: [phone].
randy@iedrillint .com
www.iedrilling.com
i
1 I ,