WI0100114_Regional Office Physical File Scan Up To 9/14/2022

Central Files: APS SWP
08/25/10
Permit Dumber W10100114.
Permit Tracking Slip
Program Category
Status
Project Type
Ground Water
Active
New Project
Permit Type
Version
Permit Classification
Injection Water Only GSHP Well System (5QW)
1.00
Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers Kevin McRae
Owner
Coastal SW Rule PO Box 698
Enka NC 28728
Permitted Flow
�aciiity
Facility Name Major/Minor Region
Kevin McRae SFR Minor Asheville
Location Address County
68 Glady View Dr Buncombe
Candler NC 28715 Facility Contact Affiliation
Owner Name
Owner Type
Individual
Kevin McRae
Owner Affiliation
Kevin McRae
Owner
PO Box 698
Enka . NC 28728
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective Expiration
08/25/10 08/24/10
08/25/10 08/25/10
Regulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Waterbody Name
Stream Index Number Current Class Subbasin
0

FFV
Beverly Eaves Perdue
Governor
Kevin McRae
P.O. Box 678
Enka, NC 28728
ao.�. m
MCDENR
North Carolina DeDartment of Environment and
Division of Water Quality
Coleen H. Sullins
Director
8/25/2010
Natural Resources
Asheivillw Rc-gibnal ®ffic,a
,nIjifer pr(o~.9cVr_n
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WIO100114
68 Glady View Dr.
Candler, NC 28715
Dear Mr. McRae:
Dee Freeman
Secretary
On 08/24/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -only
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:
The iniection well system contains only potable water,
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
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 .0211(u)(2). Additionally, you should contact the COUNTY 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.Rogers(a)ncdenr.gov if you have any questions.
J
ly,
for Debra tts
Supervisor -
cc:- Asheville Regional_Off Office - Al
APS Central Files - Permit No. WI0100114
Buncombe County Health Dept.
Von Plemmons (Clearwater Well Drilling, Inc., P.O. Box 71, Hot Springs, NC 28743)
Duane Gentry (Gentry Heating, Inc., 100 Buckeye Access Rd., Swannanoa, NC 28778)
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: 919-715-60481 Customer Service: 1-877-623-6748 ®�'et`I1d1€iZI12�
Internet www.ncwatergualiti.org
ti
An Equal Opportunity t Affirmative Action Employer 1p

2010 17:21 FAX
E
Z 001
ClearwaterWell Drilling, Inc.
P.O. Box 71
Hot Springs, N.C. 28743
828-622-7421 828-776-6526
Fax:
August 24, 2010
To:
Mike Rogers, NCDENR Raleigh
From:
Jeff Moore, Clearwater Well Drilling, Inc.
Subject:
Mcrae permit
Pages:
5 Including Cover
Note:
Any further questions, please give me a call.
RECEIVED / DENR / DWO
AQUIFFR; OTFCTION SECTIO�f
AUG 24 2010

/2010 17 : 22 FAX o d Odl l t-i
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
]NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM
TWE SOW WELLM
in Accordance With the Provisions of NCAC Title 15A 02C.0200
Print or type the required information and mail to address on the back page.
DATE'. K — ) , 201
Z 002
Well Type ConJirmalion: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the etiviromnent (i.e.
closed -loon)?
Yes Continue completing this form.
No _ Do Not complete this form. Complete other UIC application forms for installing
either a SA7 well (open -loop well injecting 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)aCbusiness or government agency, state name of
. entity and a representative w/authority for signature): /) (4'j y
rl /. rl C_
(1) Mailing Address: C97 1�
City: State: / /C- Zip Code: 4 O _, County: RUn Of
Home
Email
F
(2) Physical ddress of Well Site if different than above): -J&,'1 .i,tA-410" L
City: State: IX,.Zip Code: County:
Home/Offce'1`efe No.: ZD-9 - (¢« -Q63ko Cell No.:
B.) 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 Tele No.: Cell No.:
Website Address of Company, if any:
dPUNIC 5QW Notification of -hf:TIOt`
AQUIFFR'PR�TF-hunt Form (Rcvised 8/2009) RECEIVED I D TIO 1 SECDEGTION Page t
_..._. _-- - "..Q.J 2010....... ... ....

2010 ,17 : 2.2 FAX
R1003
C.
D.
E.
F.
G.
WELL DRILLER INFORMATION
Company Name:
Well Driller Contractor's Name;
NC Contractor Certification No.: o�
Contact
Address
City: Z
Office 'I
HEAT PUMP
Company
Contact P
INFORM[ TON (if dit erent than driller)
1 7
1.....&s� Zip • 1 r
1 •
STATUS OF APP "ANT,
Private: Federal:
state; Municipal:'
INJECTION PROCII:I)URE. (briefly dgscr
Commercial:
Native American Lands:
e injection well s) will be used)
CONSTRUCTION DATA
(1) Proposed date to be constructed: �� `r�� Number of borings:
Approximate depth of each boring (feet):
(2) Type of tubing to be used (copper,i?'VC, etc): 0
(3) Well casing. is the well(s) cased? (check either (a.) 'Yes or (b.) No below)
(a) Yes if yes, then provide casing information below
Type: galvanized steel black steel plastic other (specify)
Casing depth: From to feet (reference to land surface)
Casing extends to above d -inches
(b) No
.(4),Grout Info (material surrounding well casing and/or piping): �--�
(a) Grout type; Neat Cement Bentonite Gl Other (specify)
(b) Grout placement: PumpingPressure Other
(e) Grout depth of tubing (reference to land surface): from ^ n to (feet)
if well has casing, indicate grout depth: from to (feet)
rnc.•Co
(3PU/u1C SQW Notifieation of Coen Foim (Reviscd 8/2008) i•ag 2

/2010 17:22 FAX
N
QPI,J/UIC5QNI Wcii PermitAPPiicution (Revised 7/200S)
Raleigh, NC 27699-1636
Telephone [phone]
N
16004
Page 5

PV
2010 J7: 22 FAX [a 005
Attach a diagram Showing the engineering layout or proposed modification of the injection a ui 11ne .
pipinb/tuning associated with the injection operation, The manufacturer's brochtue may provide st�pand pletexteri y
il, rormation.
h LOCA!'ION OF WELL(S)
Attach two copies ofmaps showing the following information:
(1) IOf nclude a site map (can be drawn) showing: groundwater buildings, property lilies, surface water bodies, potential sourcgroundwater contamination and the es
orientation of and distances between the; proposed well(s) artd any
existing well(s) Or waste disposal facilities such as septic tames or drai1000 feet of the
n fields Located within
geothermal heat putnp Well system, Label all features clearly and include a north arrow,
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER 3YV1CL),(S)
Are tlhet•e any potable water tivell(s) on the; subject property or adjaccnt properties? yES NO
If Yes, than indicate location on attached niap(s).
K. CERTIFICATION
Note: This Permit Applicatiort must be signed by gaah person appearing on the retarded legal property deed.
submitted in this dc�cunlettt and all athereby certify, under penalty of law, that ! have personally examined and am familiar with the information
stachments thereto and that, based on nay inquiry Of those individuals
immediately responsiblo for obtaining said information, I believe that the infonnation is true, accurate and eonlpldte.
1 ani aware that there are significant penalties, including the possibility of tines and itnpnsazmeut, for submitting
faisr infortation. I agree to construct, operate, maintain, repair, and if applicable, abandon the trajection well u�rl
all related appurtenances in accordance With the approved specifications and conditions of the termite
Sigrtal"re of prop Owner/Applicant
Print or Type IauII Name
Signahue of Property Ow4trr/Applicant
Print or Type Fulf Name
Signature ofAuthorized Agcnt, if any
Print or Type Full Name
Please return two copies or the completed Application package to:
North Carolina DI:NR-DWQ
Aquifer Protection Section
VIC .Program
1636 Mail Service Center
GPU1U1C SQIVI Well PBI•Mit Application (Revised 7/2008)
Rt(,EIVED / DENR / DWQ
AQUIFFR-PR0TFr..Tl0N SECTION
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MCDEHR
North Carolina Department of Environment and Natural Resources
Division[ of Water Quality
B2veriv laves Perdue Coleen H. Sullins Gee Freeman,
Gavemor Dire ;tor Secretary
8/25/2010 U�ir� �a
ECEW E®
Kevin McRae LASheville
T 19 2G 10
P.O. Box 678
Enka, NC 28728
iec�iiL�1!(�fi[ico
es' Orotection
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0100114
68 Glady View Dr.
Candler, NC 29715
Dear Mr. McRae:
On 08/24/2010. the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -only
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 .0211(u)(2). Additionally, you should contact the COUNTY 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.Rogers�.nedenr-gov if you have any questions.
S:t;t
, .�
for Debra
Supervisor
cc: Asheville Regional Office - APS
APS Central Files - Permit No. WI0100114
Buncombe County Health Dept.
Von Plemmons (Clearwater Well Drilling; Inc., P.O. Box 71. Hot Springs, NC 28743)
Duane Gentry (Gentry Heating, Inc., 100 Buckeye Access Rd., Swannanoa, NC 28778)
AQUIFER PROTECTION SECTION
16366 Mail Service Center, Raleigh, worth Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, worth Carolina 27634 One
Phone: [phone] \ FAX 1: 919-715-05R; FAY. 2: 91±;-715-6049 ? Customer Service:1-877-623-FQ N Oit1-i Ca; oliria
iriteme:: ,N uv.n
An Equa+. Opportunuy 1 Affirinafive Avon En. Pmye: