WI0100138_Regional Office Physical File Scan Up To 9/14/2022

Permit Number W10100138
RrFV
a ",�I 1 9 7G �1
Program Category
Ground Water itglal13l o$ICO
A t,9�tg PrOta �O n�
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
i=acilitu
Central Files: APS_ SWP_
01/18/11
ermit Tracking Slip
atus
Project Type
review
ir
New Project
Version
Permit Classification
Individual
Permit Contact Affiliation
Von Plemmons
PO Box 71
Hot Springs
NC 28743
Facility Name Major/Minor Region
John & Alexanne Kreamer SFR Minor Lr- AsheVille
Location Address County
2 Lake Hill Dr Buncombe
Arden NC 28704 Facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
John G R Kreamer Owner Affiliation
John G R Kreamer
2 Lake Hill Dr
Arden NC 28704
Dates/Events
Scheduled
Orig Issue Lapp Received Draft Initiated Issuance Public Notice Issue Effective Expiration
01/05/11
Regulated Activities
Outf"all NUI_L.
Waterbody Name
Stream Index Number Current Class Subbasin

HCDENK
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
1 /18/2011
John. Kreamers
Alexanne Kreamers
2 Lake Hill'Drive
Arden, NC 24704
Subject: Acknowledgement of Intenbto-Construct Type 5QW Injection Well System
Permit No. WI0100138
2 Lake I -lilt Drive, Arden, NC 28704
Dear Mr. & Mrs. Kreamers:
Dee Freeman
Secretary
On 1/5/2011, 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 injection 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 Buncombe 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.Rosers(c6.ncdenr.aov if you have any questions.
_Sincerely, — --
• `�lJ�i/LQ RajFn Debra Watts
r
Supervisor
cc: Asheville Regional Office - APS
APS Central Files - Permit No. WIOI OO138
Buncombe County Health Dept.
Clearvvater Well Drilling (Von Plemmons — PO Box 71, Hot Springs, NC 28743)
Comfort Central (Kevin Schumann — 253 Timberlane Drive, Pisgah Forest, NC 210,768)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh: North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh, North Garolina 27604
Phone: [phone] FAX 1: 919-715-0588: FAX 2: 919-715-60481 Customer Service; 1-877-623-6748
Internet: =m.nmateroualitv.org
One
No1- liCaroiina
An Equal Opportunity', Affirmative Action Ernployer

jan uz -i -i ua-: i -i p Larry uosssu
OGO_OO•t-OJJV
DEPARTA/IIENT OF EAT IRON CAROLINA
MENT AND NATURAL RESOf: RCES
I1TU$�ICATION IDIi' 'A7f n NT TO COI SMUCT A CLOSEI}-LOOP GIE+CiT
IiE-lO1�TILYY �T.:UC7L'IC?N ��I�L rSTEM
'34 i J 9 P
In Accordance With the provisions of NCAC 'Title I SA 02 C,()200
Print or type the regtured information arad mail to address on the back pogo
lJ G
ONE .G l 0(D 13AQ?
Well TyPe C'o1firmailox: Does the proposed system circulate potable water only (no additives) in
continuous piping That compiztely isolates the fluid. from the environment (i.e.
Yes �ntinue completing this form.
No � Do Not complete this either aform. Complete other UIC application forms for installing
.5A7 well en,_loop well jRjgQ in potable water into the aquifer) or a 5(�� v, Gfl {closed-
Ioop well containing ad 'fives such as R-22, cthanal, or other antifreeze or corrosion inhibitors}.
A. PROPERTY OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency,
entity and a representative w/authority for signature):
g cY� state na�l�e of
Mailing Address:
f t Cif}': 7 t r� State: N �ip Code:-5��
County:,' �V�x
Home/Office Tele No.: Cell
Email Address: Vvebsite:
(2) Physical Address of Well Site (if different than above):
City: State: Zip.Code: County:
Home/Office Tele No.: Cell No.:
1i• AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company ?dame:
Contact Person: EMAIL —Address:
Address:
City:
Office Tele No.:
State: Zip Code:
County:
Cel i No.:
Website Address of Company, if any:,
GFUIUIC 5QW.Notiticatinn oflntem Form (km hed S1200$) Page I

C.
0
WELL DRILLER INFORMATION
Company Name:
Well Driller Contractor's Name:
NC Contractor Certification No.:
Contact
Address:
.I
i
City: 7 ') C Zip Coder County: % .�
T
Offrce Tela No.: Cell No.: 61' � j'-� 4
HEAT PUMP CONTRACTOR
Company Name: 1. �n� §ten_ �- Est►"t �c 1
(if different than driller)
Contact Person: _v,. _F' �nn�stiln! EMAIL Address:
Address: i 5 3 1
City: Pi � c�cs i Zip Code:297 bg County:
Gffice TeIe No.: ,-3qc: C, Cell No.: , ) 67q-3)1 ?.-
1- STATUS OF APPLICANT
Private: L� Federal Commercial:
Saute: Municipal: Native American Lands:
F. JLNJECTION PROCEDURE (briefly describe how a ate ells) will he used)
G. WELL CONSTRUCTION DATAs. f } ,.
(7) Proposed date to be constructed: r / / Number of borings:
Approximate depth of each boring (fbet): 3 q
(2) Type of tubing to be used (copper, PVC, etc): - 3 if
(3) Well casing. is the weil(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 ground inches
(b) Noy'-
(4) Groot Info (material surrounding well casing and/or piping):
(a) Grout type. Neat Cement gentonite �Uther (specify)
(b) Grout placement: Pumping 4-� --- Pressure Other
(c) Grout depth of tubing (reference to land surface): from �_ to 3 (feet)
I f well has casing, indicate grout depth: from to (feet)
GPUIUIC 5QW Notifination of Intern Form (Revised $12008)
Page 2

-Ii

Jan U/- r i U,+-. Izp Larry oossen
ti2ts-bb4-bWU p.4
H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection ai ument and
piping/tubing associated with the injection operation. The manufacturer's brochure in G P exterior
information. y provide supplementmy
L LOCATION OF WFLL(S)
Attach two copies of maps showing the following information:
(1) Include a Site Map (can be drawn) snowing: buildings,
sources of groundwater contamination and the orientation ot and distancerty es
ess�betw etheapropter osed well(s) and
s, potential
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of
the geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, streams, and/or highway intersections.
J• CERTFEICATION
Note_ This Permit Ali►"Cation-must be signed by each person appearing on the
recorded legal property deed.
"I hereby certify, under penait3r of Saw, that I h
submitted in this document and aft attachments ave personally examined and am familiar with the information
immediatelyresponsible for obtaining thereto and th based said information, I believe that the inquITY Of those
indivicomplduals
false information. I agree to construct,
I ana aware that there are significant penalties, inncluding the possibility of ffines azmatan iaccurate and and imprisonment, for submitting
operate, maintain, repair, and if applicable, abandon the injection well and
al l related appurtenances in accordance with th ap rowe4l _sveci#icafi ps and corid�tio�s of the Aermit." %I �1' Y
G
Cs CD
ox',s
e�rW�
'rope Dwner/Applicant
or Type FuII Name and title
Signature of Property Owner/Applicant
Print or Type Full T`lame and title
Signature of Authorized Agent, it any
Print or Type Full Name and title
Please return two copies of the completed Application package to.
North Carolina DE( NR-DVWQ
Aquifer Protection Section-1GIC Program
1636 Mail Service Centex•
Raleigh, NC 27699-1636
Telephone [phone]
Cii'UIUIC SQW Ndification of intent Form (lievised 812Q06}
Page 3

eCRP '. GRPmt
DaC ID: O22h1291o001 Tva
pecarded: S2JOB/2009 at 11:41:43 AM
Fee Amt: $14.00 Paae 1 of 1
Workflowg OOOODY7B81-0001
Buncombe :-aunty. NG
Otto W. Dearyhl lReaister of Deeds
'BK+` 746 PG237
poWER.OF AT-FORNEY y2
"NOTICE: TILE P0-VN7ERS GRANTED BY THIS DOCUMEN`r ARE
BROAD AMID S%VEEPYNG. THEY ARE DEFINED IN CI-IA-PTER-32-A. OF rME
NORTIT CAROLINA GENERAL STATUTES WHICH EXPRESSL�r PERIVITTS I-Ir
USE OF AL OTI IER OR DIFFERENT FORM OF POWER OF �9TTOR�iEY
DESIRrLD 13Y THE PARTIES CONCERNED_
State of NORTH C_4ROLINA
County of BUNCOMBE
T, 3OI1N G-R. KREAMER, appoint A-LEXANNE S. KREAMER to be my
atiomey-in-fact', to act in my name in any vMy which I could act for irl�rself, with respect
to the following matters as each of them is defined in Chapter 32A of the North Carolina
General Statutes.
(DIRECTIONS: Initial the line opposite any one or more of the subdivisions. as to -which
the principal desires to give the attorney -in -fact authority.) y�
(1) Real property transactions_.....,-------------------------- -
(2) Personal property transactions........................................... .
(3) Bond, sluu's, stock, securities and commodity transactions...
(4) Banking transactions.- - - - .... _ ....... • ..... • _ I ........ ...
(5) Safe Deposits......................................................................
...._..................
(6) Business operating transactions .......... . . . . . . . .. • • • • - '-�
('7) Insurance transactions_ .... - _ - - ....... _------------....---------
.. _ ......•-_-
(S) Estate transactions .......... .. . . ................................. ...........
(gy Personal re larionslups and affairs _ .... _ .. - - - - - .................... . . . . . . . . . ........ '�
(10) Social security and unemployment......... _
---•...............................•-_ k"
(1 I) Benefits :from military service...................................... .... " ' - ' - -
(12) Tax matters ....................... ..._.........................
(13) EmployrLient of agents .................... _ ........... - - - -
(14) Gifts to charities, and t_o individuals other than the attorney -in -fact. _ .. _ _ _
(15) Gifts to the named attanzey.-In- act ....... _ _ - -
.....................
1 also give to such person full power to appoint another to act as xny attorney-iu�
nunenL_ This power e. attorney shall not be
-fact and foil power to revol,-e such appoi
affected by my subsequent incapacity or mental in rnpeten ,
Dated: December 4, 2009. pi-I*I G.R. KREAMER
STATE OF NORTH CAROLINA; COUNTY OF BUNCOMBE:
On this e day of December, 2009 personally appeared before me, 'the said named
3OHN G.R. I=-AMER to me known and known to me to be the person described in and
who executed the foregoing instrument and he- acknowledged that he executed the salve
and being duly sworn by me, made oath- that the Statements in the --foregoing rinstrinneat
are true. %.6%.,ltii��LJf rf���i_�5!-:cam_ !l
My Commission Ea-piros: I�1ay 6, 2014 s U1�

Beverly Eaves Perdue
Cmernor
John Kreamers
Alexanne Kreamers
2 Lake Hill -Drive
Arden. NC 25704
North Carolina Department of Environment and Natural Resources
Division -of Water_Quality
f"oleen H. Sullins Dee i=reemar
Director Secretai y
1/18(2011
Subject: -Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0100138
2 Lake Hill Drive, Arden, NC 2870,1
Dear Mr. & Mrs. Kreamers:
FEB 09 Nil
Ac eville RJ ogirnalryO,Ofplrice
Prot-ec.
On 1/5/2011, 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 Buncombe County Health -
Department as they may have additional requirementq 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.RoQers(a-mcdenr.vov if you have any questions.
Sincerely, .
_/or Debra Warm
Supervisor
cc: Ashevilic Regional Office - APS
APS Central Files - Permit No. W10100138
Buncombe County Health Dept.
Clearwater Well Drilling (Von PIenimons - PO Box I L liot Sl)rings, NC 28743)
Comfarr Central (Kevin Schumann - 2_53 Titnberlane. Drive, Pisgah forest, NC 28768)
AQU1FEP PROTECTION SECTIOFd
1636 Mail Servira.. Center, Raleigh, Narth Garoliga 2769P 1-36
Lccanon: 2729 G'apital Boulavard. Raleigh. North Garclina 27604
Phone: [phone] FAX 1: 919-715-0588: F, 4Y, 2: 919-715-6048 ? Customer Servidc: 1-877-0023-6748
iniemec vm.nmatereuality.org
No�IiCa.ro na
AP Enuai UPP0A r.:iy ''1 y!iirmaiiVa ACiui: `_MPloper

09/06/2010 06:51 FAX
09MON 88"21 6` 85995664
GORFF
Q 001
PACE .)h,
NoNlS EffnawL AmLcoNsTRummeaRn
Novi) Corolina Doparhnaut of Envirwun4ni and Natural Rarpurces- Diviki, grWatrr quality
WELL CONTRACTOR 'LiMT]WICA` ION # 0
1, WELL CONTRACTOR:
\j Qn P 1 e.M�� n S
well Contaxtor (IndNIdual) Namur
Well Contraetar C61VIIAny Name
STREU ADDRESS
i�0k 5�r ���5 tVc a�143
Oiry or Town State zip coo
tea- (aa--Iaa (
Area code. Phone nurtibar
z. w@4, INFORMATION-
SITE WKI:10#(If,0icahle)
STATE W ELL PERMITR(Barplicable)
DWQ 01 OTHER PERMITV(d eppAoabte) _
WELL USE (Check Appikable Box) Monit"hig © Munioipal/Pubiio ❑
InduslrIQVCommercftzI 3 A9rieuituralI3 Retoueryp lajaotlont7
Ifdgetlanp Ckhar a (!I®t ue&}
DATE VRILI,ED
TIME COMPLETED AM C3 pM p
3, W91.1. LOCATION:.
417Y: RpICtG� 1-�'�Y, GOUN'iY �L-�-4�Gi :t`r�lr
31 cee1.- K-A-Ar-,
(8tr4dt Name, NumbMit, twmmunitY, 6uh4 Ion, Lot No., Psru . zIp Cade)
TOPOGRAPHIC I LAND SFTTIM
ClSlopa pvelley r3FM ❑Ridge ❑ Other
(checkappigNlate box)
LATITUDE 0 3 S� o �il . �33 (y Al+y- W in 9cgrra,
r1'M4c3. smoad+ or
l t)NI31TUt7L' U - to A decimal formal
Lolitude/)Ullgltuelle ammo; rPS O'l op4lSe4p is map
{)u4aNnnafa�allmus! bd sltoWn tx? 8 USGS fops nrsp end
alrechW ra !)rl9 form I not raskri 12PS)
4. FAa1L1't'V. dNe name o! ate bmflnd60 WIIirO AM rro�T 16 NGArBtl.
PACUTY ID #(V applicablo) -
NAME OF FACILITY
eTRE8T A00R@SQ
cltyorToxn SIAIo YlpCade
ae)NTACT PER80N_LOY rt -)r k 11QV1r1e
MAILINOADDRESS c% ` � V_h 11 - Df .
VNT-ck cn ty C a'-6
City or Tcm l Stare Zip Code
Area code- Phone nuM WIr
6. WFLL_DETAILS:
a. TOTAL ptat 14I ��//
b. t 000 WaL,t. REFUGE EXIsTWO W iLk? YES p Nci)l.
c. WATER LEVE4 FWow Top of Casing; � _FT.
(Uqa ^+" if Attova Top of Coxing)
d. TOP OF CASING 4 Fr. Above Land 400ce
'Top of casing terfnirlat4d abor below land audijoe may require
a Va►mft In e000rdance vAth VA NCAC 2C .0118.
e. YIELD (gpm)-. _ - METHOD OF TEST
f. DISINFECTION: Type Amount
g wATIlIt ZONO (depth):
Front Tc _ From To
From T 1'o From To
FTpm(,,,, , , To From To
6. CASING: TIVaknesuf
Depth Dlametar WAlght Material
From _ _. _ To_ Ft
From,_,_,,,,,_ To Ft.
From To Ft
7_ GROUT: bapth Me act Method
Frenj. To Ft.
Fran+__ To Ft.
pram To Ft.
6. SCItEer : peptic Dldmeter alai Size Maleflal
From__,",...,- To Ft. irL irk
From To FL in IR
From To Ft.in. in.
a_ 3ANOMRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft,--
?
10. DRILLING L00 w-
From Tv Formation i]e6aPpt?gt1,_�-
11. REMARKS:
6 h
F�
I OGrreM!bYCePn1FYWATTi4S W6L4 WASCONS- RUCTM iNACOMDANOR Wr1H
fakI, A44MUCiiNVMV0Mt%I9TANPAROIt,nW AGOP�raFnrrs
RECMHASB PROVIDL'Q'MTWWR�LL0ft/wD
M pa - 2D1
S(QNJ TURF OF CERTIFIED WELL CONTRACTOR ATE
Submit the origlllal to the DivisiOn of Wafter Quality within 30 days. Attu; mfomtatioit=tulgt.� � `_' `- Form CAN-ib
lei Mpg Semicet cq(t%r- RFI}algh, NC 276991817 Phone No. (9191733 70ib ext e68. Rev. WOES
��� n 9 2 o1

09/08/2010 08:51 FAX
M1921399 es:z mos664
GQRFF
Q 001
PAGE? �'*&\
NoNJ?ff—siDxmAL wmicommummucolm
Norti) CoroUlla Doparlinenk oM- viro» rnont atsd Nottral ltarourecs- Divitatnt of Wator Qunlih,
WELL CONTRACTOR CM TMICATION # -91 I A
1. WELL CONTRACTOR:
Vora 171 e rnrndn S
Well Gontr4otar (Individual) Name
Well Conimetu Cm mny Nama
STREET ADDRESS nC \QCZ, y-
1
"I-) A- Sp n tic, S N c
City of Town state zip C040
&P 1,7�a- day I
Ares code. Phone number
Z, WNI,r, INFORMATIOM: QQ�� 1 l
B fE►fIW L ID#(Ifapalicablej 'M'fD
STATEUUELL PERMITO(Ifappifcable)
OWIA of OTHER PERMIT OCR appilcaq)a)
WELL USE (Check Applicable Box) Monitaring ® MuniaipaVPubrio!]
IndmirlallCommarcial r3 Agricultural I3 Recovery lr> mAhn 0
Irriggtlonp Other p (iisl use)
DATE DRILLED 1 - 1 �S - 01 11
TIML' COMPLETED AM O PM o
3. WRLL LOCATION.,
omr (2�,\QC�L "tn . CouNTY_t�Ccaf�
NJ(>Y �rkC ZA �GC.L XAJrn,
(9p4ff�is, Gomnlonity, Sowmelon. Lot No., AaraaT p Cadal
TOPOGRAPHIC/LAND SETTING'
13alope pvailey ❑FW ❑Rldge []Other_
(checkapplopte b
LATITUDE 3 V r>pr irl dagrrea:
1*406, 5014ada or
LdNGt1TUt?t: , OLP ' l �i In A decimal format
l.otilukAousitude$Di co: tjGPS O•A'opOSCA&Ctnap
(kcz4nn ad we/1 mrwt bar shown on a USG$ ropy map and
Aftechod W fhls corm ffnot cakia OPS)
4. FAd - lame name of the I1cmlnd6b a1111e tm xW I Is rocetea.
PSCILIT V ID gad appllaablo)
HAMS C F FACILITY
8TREi I ADDRESS
Cliy or Tom _ Stela
Zip Gode
CONTACT PERSON Jl. yy) `- Ark )CO�t(11(Z2 uF'E
MAILING ADDRESS v�2 S'-t�� 1JF]_ I, 1 Q ,
Ch or Taws State Zip Code
Area Code- Phone nuMinr
U. WFt1DETAILSS-
e. TOTAL DEPTN) �iflJ r
b. 00116 WELL REPLACE EXISTING Mi.? YES Q NCB
c. WATER LEV 'u %low Top of Casings FT. !!!///��`
(Use'-0 if Atiave Top of Casing)
d. Top OF CASING IS FT. Ahava LenO f3Wf#ce.
'Top of casing termbmt4d Wor halow land sudiiae may mquira
a varlattee to accordance vAth 13A NCAC 2C ,0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATIR ZONES (depth)=
From - T From To -
From -To, From To
From_ To From To
6_ CASING: 'rhfeknara!
Depth Diameter wolpht Material
FmrD,_,,,,r_ To Ft.
Frotr4­a,,,,, To Ft --
From To Ft
7- GROUT: Depth Matorlat Mathod
Fron LTo L O t=i. �G1 i1G1 Flat }�
From To Ft.
lira To Ft.
6. SGRF.Em 0apgt Diameter 81ol Slae Material
Fram_ To Ft. in. In.._
From To FL tn. Ift
From To Ft. in. In.
B_ 8ANimKAVEL PACK:
Depth Slza Matterkil
From To Fk.
Fr-;rn. ,,,_ _ To
10. DRILLING LOG
From To Formation l3apprii0on
11. REMARKS:
I M HekCbYCN"FY'MAT'T" VAIL WA5CON61R(=M IN ACCORDANCE WITH
fd&N==VYC"CO WMUOPON l)TAN0AR0s,AN0TKATAW"0FTHM
AECO DHAS E ROVICED-M"M WAM CWNM ZU t
S(G ATURE O CERTIFIED WELL CONTRACTOR IATE 1
Summit the original to the Division of Wafter lMuailty within 30 da
loll Mail gmict% Ce(ftr— RAMP, NC 2769s 1897 p)lone No. (919t
E OF PERSON CONSTRUCTING THE WELL
lnfomis _cLn gt i- _ Forn
am sag. Rev.