WI0100209_Regional Office Physical File Scan Up To 9/23/2022

CooltE E K E D
Mike's Heating
North Carolina Department of Environment and Natural Resources- Division
WELL CONTRACTOR CERTIFICATION # 3421
1. WELL CONTRACTOR:
David Stratton
Well Contractor (Individual) Name
AWD Services Inc
Well Contractor Company Name
258 North Turkev Creek Rd.
Street Address
Leicester NC 28748
City or Town State Zip Code .
( 828 ) 683-9223
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WIO1662— 9
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ff applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply Rf
DATE DRILLED 5/29/12
TIME COMPLETED AM ❑ PM W
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
j jl 012012
Q 7voville ,regional office
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
: 7. CASING:
Depth
Diameter Weight Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom .
Ft.
8. GROUT:
Depth
Material Method
Top 0
Bottom 20'
Ft. Bentonite Pour
Top 21'
Bottom 350'
Ft. Pea Gravel Pour
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
4. WELL LOCATION: 10. SAND/GRAVEL PACK:
Depth Size
CITY: Asheville COUNTY Buncombe Top Bottom Ft.
39 Chauncev Circle (Biltmore Forest) Top Bottom Ft.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) Top Bottom Ft.
TOPOGRAPHIC / LAND SETTING:. (check appropriate box) ,
61Slope ❑Valley ❑Flat ❑Ridge ❑OtherEley. 2259.'
LATITUDE 35 ° 30 49.0000 " DMS OR DID
LONGITUDE 82 ° 32 27.0000 " DMS OR DID
LatitudeAongitude source: [tPS Uopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
Phillip Osborn
Owner Name
39 Chauncey Circle
Street Address
Asheville NC 28803
City or Town State Zip Code
8( 28 )
Area code Phone number (2) Geothermal BOreE
6. WELL DETAILS:
a. TOTAL DEPTH: (2) 350'
b. DOES WELL REPLACE EXISTING WELL? . YES ❑ NO E(
c. WATER LEVEL Below Top of Casing: NIA FT.
(Use "+° if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface"
`Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NIA METHOD OF TEST NIA
f. DISINFECTION: Type N/A Amount N/A
11. DRILLING LOG
Top Bottom
Materiar
Formation Description
12. REMARKS:
Variance Request to Rule Attached
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THEWELLOWNER.
/3/i�..i�� 1�i.y►. 5/30/12
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
David Stratton
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30`60 Of completion to:: Division.ofi Watt r Quality - Information Processing, Form GW-1a
4617 Mail Service Center, Raleigh, NG.27699-161, Phone (91;9) 807-6300 Rev. 2/09

NCDENR
North Carolina Department.of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P, E.
Governor Director
May 18, 2012
Mr. Philip Osborn
—7-6 Fsor_est-Rd..—_
Biltmore Forest, NC 28803
RE: Variance Request to Rule 15A NCAC 2C .0222(e)(11)
Notification: W10100209
Geothermal Well System, 39 Chauncey -Circle
PIN# 964660349400000
Biltmore Forest, NC 28803
Dear Mr. Osborn
Dee Freeman
Secretary
On May 15, 2012, the Asheville Regional Office of the Division of Water Quality (DWQ)
received your request for a variance, with additional information received on May 18, 2012, to
the injection well construction rules, specifically Rule 15A NCAC 2C.0222(e)(11). This rule
requires all geothermal aqueous closed -loop wells to be grouted the entire length of the well
boring from the bottom of the boring to land surface or, if completed below land surface, to the
well header or manifold connection. The variance request is for the construction of one (1)
geothermal well system at 39 Chauncey Circle, in Biltmore Forest, Buncombe County, North
Carolina. .
Based upon the signed agreement with your HVAC contractor and the information
provided by your well contractor, It Is my finding that the factors specified are sufficient to
satisfy the.conditions for approval of a variance as defined in 15A NCAC 2C.0241. Please note
the variance conditions, listed below, regarding the construction of this well system. The
variance will be effective for a period of six (6) months beginning from the date of issuance.
Since the well will not meet current regulatory requirements, the following minimum additional
construction requirements will be necessary to mitigate any potential problems that could
affect public health and/or the well's effective operation:
ne
AQUIFER PROTECTION SECTION --Asheville Regional Office (ARO)
2090 U.S. 70 Highway, Swannanaa, NO 2877H211
cci hCarolha
�� flr►i?�Ij/
Phone:[phone] FAX: [phone].
Internet: www.nawateraualitvoro
An Equal Opportunity lAffirmative Action Employer

Mr. Philip Osborn
05/18/2012
Page 2 of 2
This variance shall be subject to the following specified conditions as follows:
1. All wells constructed as part of this system shall be located a minimum of 25 feet from any
existing or proposed structure;
2. All wells constructed as part of this system shall be located a minimum 50 feet from all parts
of existing or proposed septic systems including any repair area;
3—Notification shall be given to Jonathan Stepp at the letterhead address or by- ...
telephone at [phone], at least 24 hours prior to the start of well construction;
4. All wells constructed as part of this system shall be grouted 10 feet into consolidated rock
and extend a minimum of 50 from land surface or, if completed below land surface, to the
well header or manifold connection; and,
5. Attach a copy of this variance'to each GW-1 form submitted for each well constructed as
part of this system.
The granting of this variance is for the grout portion of the well only and in no way
relieves the owner or agent from.other requirements of the applicable North Carolina Well
Construction Standards (NCAC 2T .0200), or any applicable law, rule, or regulation that may be
regulated by other agencies. If you are dissatisfied with this decision, you may commence a
contested case by filing a petition under G.S. 150-23 within sixty (60) days after receipt of the
decision..
4680.
if you have any questions regarding this variance, please contact me directly at 828-296-
Sincerely,
G. Landon Davidson, P.G. .
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
i
.J
I
cc: ARO-APS Files
ec: Ronald Hathcock
j Larry Wells

A�FA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 18, 2012
Mr. Philip Osborn
76 Forest Rd.
Biltmore Forest, NC 28803
RE: Variance Request to Rule 15A NCAC 2C .0222(e)(11)
Notification: W10100209
Geothermal Well System, 39 Chauncey Circle
PIN# 964660349400000
Biltmore Forest, NC 28803
Dear Mr. Osborn
Dee Freeman
Secretary
On May 15, 2012, the Asheville Regional Office of the Division of Water Quality (DWQ)
received your request for a variance, with additional information received on May 18, 2012, to
the injection well construction rules, specifically Rule 15A NCAC 2C.0222(e)(11). This rule
requires all geothermal aqueous closed -loop wells to be grouted the entire length of the well
boring from the bottom of the boring to land surface or, if completed below land surface, to the
well header or manifold connection'. The variance request is for the construction of one (1)
geothermal well system at 39 Chauncey Circle, in Biltmore Forest, Buncombe County, North
Carolina.
Based upon the signed agreement with your HVAC contractor and the information
provided by your well contractor, it is my finding that the factors specified are sufficient to
satisfy the conditions for approval of a variance as defined in 15A NCAC 2C.0241. Please note
the variance conditions, listed below, regarding the construction of this well system. The
variance will be effective for a period of six (6) months beginning from the date of issuance.
Since the well will not meet current regulatory requirements, the following minimum additional
construction requirements, will be necessary to mitigate any potential problems that could
affect public health and/or the well's effective operation:
One
AQUIFER PROTECTION SECTION —Asheville Regional Office (ARO) NorthCarolina
2090 U.S. 70 Highway, Swannanoa, NC 28778-8211 Phone: [phone] FAX: [phone] Natumlim
Internet: www.ncwateroualitv.orq
An Equal Opportunity % Affirmative Action Employer

Mr. Philip Osborn
05/18/2012
Page 2 of 2
This variance shall be subject to the following specified conditions as follows:
1. All wells constructed as part of this system shall be located a minimum of 25 feet from any
existing or proposed structure;
2. All wells constructed as part of this system shall be located a minimum 50 feet from all parts
of existing or proposed septic systems including any repair area;
3. Notification shall be given to Jonathan Stepp at the letterhead address or by
telephone at [phone], at least 24 hours prior to the start of well construction;
4. All wells constructed as part of this system shall be grouted 10 feet into consolidated rock
and extend a minimum of 50 from land surface or, if completed below land surface, to the
well header or manifold connection; and,
5. Attach a copy of this variance to each GW-1 form submitted for each well constructed as
part of this system.
The granting of this variance is for the grout portion of the well only and in no way
relieves the owner or agent from other requirements of the applicable North Carolina Well
Construction Standards (NCAC 2T .0200), or any applicable law, rule, or regulation that may be
regulated by other agencies. If you are dissatisfied with this decision, you may commence a
contested case by filing a petition under G.S. 150-23 within sixty (60) days after receipt of the
decision.
If you have any questions regarding this variance, please contact me directly at 828-296-
H.:I
Sincerely,
G. Landon Davidson, P.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
cc: ARO-APS Files
ec: Ronald Hathcock
Larry Wells

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WEI
These wells are `permitted by rule" and do not require an individual permit when constructed in accordance
the rules of 15A NCAC 02C .0200*. This notice must be submitted prior to construction.
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS
As described in 15A NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water
performance -enhancing additives as part of a geothermal heating and cooling system.
OR
GEOTHERMAL DIRECT EXPANSION CLOSED -LOOP WELLS
As described in 15A NCAC 02C .0223 these wells circulate a refrigerant gas as part of a geothermal heating and
cooling system.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: _! lg , 20_,�7 PERMIT NO. (to be completed by DWQ)
A. TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO BE CONSTRUCTED
(1) Aqueous (as per 15A NCAC 02C .0222): Number of wells:
(2) Direct Expansion.(as per 15A NCAC 02C .0223) Number of wells:
B. STATUS OF WELL OWNER (choose one)
(1) Single Family Residence -2/Submit this form two (2) business days prior to construction.
(2) Business/Organization Submit this form 30 days prior to construction.
(3) Government: State Municipal County Federal Submit this form 30 days
prior to construction.
C. WELL OWNER — For single family residences list the property owner(s). For all others, list name of the
business, organization, or government agency and person delegated signature authority:
? �
Mailing ddress: /
City: State: Zip Code:LtCounty:i/ty,L�
Day Tele No.: _ Cell No.•_ kj<-, L% %LJeg
EMAIL Address: J69L a 41yednLd . n WF Fax No.:
D. PHYSICAL LOCATION OF WELL SITE
C
(1) Parcel Identification Number (PIN) of well site:
County: an A/6m h 641
(2) Physical Address (if different tharynail�g address):
City:
DWQMIC/Closed-Loop Geothermal Notification (Revised 4/30/2012)
State: NC Zip Code: 1Q996?_9
Page 1
2. 3),

E. MAPS, PLANS, AND SPECIFICATIONS
(1) Maps must be scaled or otherwise accurately indicate distances and orientations of features located
within 250 feet of the injection well(s). Label all features clearly and include a north arrow. Attach a
site -specific reap showing the locations of the following:
• Proposed injection well locations • Septic systems and associated spray irrigation
• Buildings sites, drain fields, or repair areas
• Property boundaries
• Surface water bodies • Existing or potential sources of groundwater
• Water supply wells contamination
(2) Plans and specifications of the surface and subsurface construction details of the well system.
F. TYPES AND CONCENTRATIONS OF ADDITIVES — List any additives that will be used. and their
concentrations. Only additives that the Department of Health and Human Services' Division of Public Health
determines do not adversely affect human health shall be used. A list of approved additives can be found
online at htttp://portal.ncdenr.or web/wq/aps/rwpro. All other additives require approval prior to use.
G. WELL DRILLER INFORMATION (if know //
Well Drilling Contractor's Name: �5 G7� l� 2`44
NC Well Drilling Contractor Certification No.:l,3
Company Name: tJG11 ZZ w kh& Y, %1id?6 Contact Person: O. ✓�
City: e re.4 State: Zip Code fecounty: 4f
Day Tele No.: trite �' 2Z Cell No.:
EMAIL Address: Fax No.:
H. HEAT PUMP CONTRAAe
OI
Company Name:
Contact Person:
Address: 3,) 1) �,
City:
Office Tele No.: I,I'11S
Zip Code: 7!�p
Cell No.:
County:
Fax No.:
DWQ/U1C/Closed-Loop Geothennal Notification (Revised 4130/2012) Page 2

I. PROTECTION — Provide a brief description of how (1) water supply wells; (2) surface water bodies; and (3)
septic systems and associated spray irrigation sites, drain fields, or repair areas within 250 feet of the proposed
injection wells will be protected during construction of the wells:
J. 'VARIANCE — Pursuant to 15A NCAC 02C .0241 the Director of the Division of Water Quality may grant a
variance from applicable well construction or operation standards provided that:
(1) use of the well(s) will not endanger human health and welfare or the groundwater; and
(2) that construction or operation in accordance with the standards is not technically feasible or the
proposed construction provides equal or better protection of the groundwater.
Any variance request should accompany submittal of this notification to expedite evaluation of the request.
The variance request form can be accessed online at ham://r)ortal.nedenr.org-1web/wglaps/p-Nvpro/permit-
applications
K. SIGNATURES — The following section is to be completed as required below or by that person's authorized
agent. 15A NCAC 02C .021 I(e) requires signatures as follows:
(a) for a corporation: by a responsible corporate officer;
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively-,
(c) for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
(d) for all others: by the well owner;
(e) for any other person authorized to act on behalf of the applicant: documentation shall be
submitted with the notification that clearly identifies the person, grants them signature
authority, and is signed and dated by the applicant.
"I hereby cert6, under penalty of late, that 1 have personally examined and am familiar with the information
submitted in this docianent and all attachments thereto and that, based on my inquiry of ' those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are 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 reelllated�apppw-lenances in accord/A, � l`�Lr.a�nce with the 115A NCAC 02C 0200 Rides.
�/IIiL��fA"
�",�
Signature of Property Owner/Applicant
23.
Print or Type Full Name
Signature of Authorized Agent, If any
Print or Type Full Name
DWQ/101C/Closed-Loop Geothennal Notification (Revises{ 4/3012(112) Page 3

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NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL, RESOURCES
VARIANCE APPLICATION FOR INJECTION WELL CONSTRUCTION STANDARDS:
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS (15A NCAC 02C .0222) OR
GEOTHERMAL DIRECT EXPANSION CLOSED -LOOP WELLS (15A NCAC 02C .0223)
This form MUST accompany the Closed -Loop Geothermal Notification Form available online at
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: Cr 20_& PERMIT NO. (to be completed by DWQ)
A.
B.
C.
WELL OWNER - For single family residences list the property owner(s). For all others, list name of the
business, organization, or government agency and person delegated signature authority:
Celt No.:/B90 W Z,
PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) of well site: q6(e6,D3il � 461r0400
County:
(2) Physical Add -ess (if different than mailing address):
L'
city: ' r hm t ie af-4
WELL DRILLER INFORMATION. (if known) A ,
Well Drilling Contractor's Name:
State: NC Zip Code: a9se-12
• � v
NC Well Drilling Contractor Certification No.: s
Company Name: AV./-5 Contact Person: .Ct• t�
City: eg State: Zip Cod . �Si�3County: "i®
Day Tele No.: '""q,2n C, ell No.: 6 i) '2
EMAIL Address: AL1,1ffAFax No.: 8
DWQIUIC/Closed-Loop Geothermal Variance Request (Revised 5/212012)
Page I

D. •X ASOX FOR VARIANCE REQUEST — Include type of well(s) to be constructed; rule for which the
variance is being requested; description of how the alternate construction will -not endanger human health and
welfare and the environment; and reason why oonstrumion and/or opoi•ation in accordance with the standards is
notteohnically feasible and/or provides equal or better protection of the groundwarar.
These jobs were priced before this idiotic rule was passed
-nn May 1, 701.9 --
Usin if vs Pea ravel is a cost
of $4.00 per foot more to the HVAC contractor which goes
to the bnrhaowner._
Everyone_ expects this increase to be from the well drillers
pocket. In this economy it can not!
I. SIGNATUM — The following section is to be completed as required below or by that penoWs authorized
agent, 15A WCAC 02C .b21 I(e)requires signatures as follows:
(a). for a corporation: by a responsible corporate officer;
(b) for a partnership or sole propdotorship: by a general partner or the proprietor, respeeti`vely;
(c) for a municipality or a. state, federal, or other public agency: by either a principal executive
•affieer or ranking publicly elected offiolal;
(d) foraU others: by the well owner;
(e) for any other person authorized to act on behalf of the applicant: dnownentation shall be
submitted with the notification that clearly identifies the person, grants theme signature
authority, and io signed and dated by the applicant.
"I hereby certify, mtder penalty of lmv, that Ihave personally ewnined and am familiar wmYlm the inrfomvrsation'
subm Med in this docranent and all auachments rhemvero and that, based on my inquhy of those individuals
i'ntmediately responsible for obtaining safd information" I believe that rho it formateon is true, acew•ate and
complete. -lam aware that there are siVdfmcant penalties, Naluding the possibility of fumes and imp Isomm ent,
for• submIjWng false information. I agree to consruct, operate, mnaintaik repair, and inapplicable, abandon
the injeotton well and all related acppurrenaftees in a+�c'c9ord�}annpce, with the 15A NCAC 02C 0200 Rules "
✓� � VlL'�INr'wvtx.i A.f� '
3ignatnro cfi`t�perty flwaertAppIFennt
PI,1.0 ►e /?_ Osaax..� � h e- ��4aort'l,
Print Or Type Pno NMO
Signature of Authorized migrant, if any
Printer Type RuRName
bV1QlU1GCla5etl-l..odp Grotheem481V3�'iance'lit�ue5t(Rcvised S121:1412)
eta 201i l OMI MIAN2S amti
Page 2
E0g5E898Z8 0L�i3L ZT•OZIbL/96

Submitted to: Tyner Construction Company
P.O. Doc 577
Burnsville, NC 28814
[phone]
Date: Friday, March 2,'2012
"We Deliver Comfort"
MG "i r
(2EOI78D:
Job Location: Osborn Residence
ipeefin.g & Air Conditioning Proposal
39 Chauncey Circle
The Ramble
Biltmore Forest, NG
Thank you for the opportunity to provide you with this Proposal. After a careful inspection & survey of your
home plans, we are pleased to submit the following proposal the subject location in accordance with the
following conditions & specifications. We are confident that the system solutions we have designed will
ensure you client's ultimate comfort & satisfaction!
Description of work to be performed:
We shall install the following Geothermal System in conjunction with the Plans & Specififcations dated
2/15/2012. System Description: We shall install 1- Trane 4-ton 72GY" 2-Stage Geothermal Heat Pump
System w/ Variable Speed Blower & Radiant Floor Hydronic. System shall be located in the Mechanical
Room adjacent to the Encapsualted Crawlspace. Unit shall be set on a 2" Pex Foam Pad for Quiet
Operation, Forced Air Section: System shall include the following: (1) De -Superheater "Hot Water
Generator (connection to the Domestic Water System by others), (1) 10kw Electric Auxiliary Heater, (1)
Trane "Clean Effects" Whole -House Air Cleaner, (1) WaterFurnace Intellizone Zone Control System
consisting of 3-Zones (Great Room Zone, Guest Bedroom Zone, & Master Suite Zone), (3) Honeywell 7-
Day Programmable Thermostats, (1) Honeywell Ventilation Control System to control proper Ventilation
rates (40 cfm/hr.), (1) Honeywell "TrueSteam" Steam Humidifier (12 GPD). Duct System shall consist of
Externally Insulated Metal Trunk Duct w/ Flexible Branch Ductwork (R-8) & shall be located in the
Encapsulated CrawlSpace. Radiant Floor bleat Section: We shall design & install (1) Complete Radiant
Floor System to be installed above the Subfloor utilizing 2x4 Sleepers. Hydronic Radiant Floor Heating
System shall include 3- Zones that shall mirror the 3-Zones of the Forced Air System. Hydronic system
shall include the following: Pex Tubing, Pumps, Valves, Manifolds, (3) 7-Day Programmable Thermostats,
OD Thermostat, (1) Bradford -White 75-gallon Gas Direct -Vent Water Heater m# PDX2-75 & (1) 50 gal.
Geothermal Buffer Tank (required when incorporating Gas Water Heater). We shall install Vertical Boring
& Install all Ground Loop Piping from Mechanical Room to Geo Loop Location (within 50'). Pricing includes
all associated Backhoe work to install Main Lines from house to vertical bore site. Includes Environal
AntiFreeze. The Geothermal System proposed include Internal Hot Water Generator (Connection by
Plumber, not included). We shall install 1- Honeywell Stand -Alone Dehumidifier m# DR65A1000A to serve
the Encapsulated Crawlspace. We shall Install all condensate piping. We shall complete all control wiring.
We shall complete all start-up procedures & checklist, including Leak Test & Flushing/Purging of
Polyethylene Geo Loop Piping & Pex Radiant Floor Tubing.
Page 1

INCLUDES Venting for (3) Bath Exhaust Fans, (1) Clothes Dryer, (1) Range & (2) Water Heaters.
INCLUDES Vertical Geothermal Bore Drilling by Certified Geothermal Well Driller.
All work will be permitted & inspected to conform to local governing codes.
This Proposal INCLUDES All Work Associated with the Installation of the Radiant Floor System as
specified, this work to be performed by ThermaCraft Energy Services at a Subcontract of $11,975.00
Exclusions:
GAS PIPING IS NOT INCLUDED.
VENTING FOR FIREPLACE(S) IS NOT INCLUDED.
Model Type:
Geothermal Heat Pump:
Trane(by Waterfurnace) 4-ton "XL" Series Deluxe 2-Stage Package Geothermal Heat
Pump wl Combination Water -to -Air Ducted & Hydronic Radiant Floor Heat Components.
Includes Variable Speed Blower Motor. Includes Hot Water Generator.
Includes 10kw Electric Supplemental / Emergency Heater.
Includes 75 gal. Gas Water Heater for Supplemental Radiant Floor Heat
Model Number:
Geothermal Heat Pump: T2GY049RLR12C1A
Electric Heater: EALH10
Air Filtration:
TFD245CLFR000C - Trane "Clean Effects" Whole -House Air Cleaner
Cooling Capacity:
Cooling Efficiency:
Heating Capacity:
Heating Efficiency:
1st Stage: 36,100 btu
2nd Stage: 44,600 btu
1st Stage: 21.7 EER
2nd Stage: 16.6 EER
1st Stage: 28,600 btu
2nd Stage: 34,000 btu
Electric Emergency Heat 10kw
1st Stage: 4.2 COP
lead Stage: 3.7 COP
AHRI Certification #:
AHRI # 4660948
Warranty Info:
Compressor:
10 YEARS
Parts:
10 YEARS
Geothermal Loop Piping:
50 YEARS
Radiant Floor Heat Tubing:
25 YEARS
Honeywell Parts:
5 YEARS
All Other Parts:
1 YEAR
Labor Warranty:
10 YEARS
Tow System Price:
$56, 620. 00
Federal Tax Credit:
417,586.00
NC State Tax Credit:
-$8,400.00
Net investment:
$32,634.00
Page 2

Warranties:
All products installed by Mike's Heating & Cooling are warranted to be free from defects in material and
workmanship for a period of one year from the original installation unless otherwise noted. This warranty
includes parts and labor for repair or replacement of defective products or parts. Product manufacturers
limited warranty also applies and in some cases may go beyond a one-year period. (See product warranty
and/or extended warranty agreement).
Total Investment:
Your total Investement for this HVAC System Installation including any taxes will be for the sum of:
(check one)
$ 68,620,00 Trane 72GY" Deluxe 2-Stage Geothermal Heat Pump w/ Combination Water -
to -Air & Water -to -Water to serve both Forced Air Ductwork & Hydronic Radiant
Floor Heat.
Add-Ons
If any of the following add -on accessories are desired please check the appropriate boxes and add the
amount to the system price above.
Add -On Accessory_ Options:
E3 Included Upgrade to 10-Year Extended Parts & Labor Warranty for 1- System
G 450.00 Add "GeoStart" Reduced Load Compressor Starter "Soft Start"
0 Included Upgrade to 1- Trane "Clean Effects" Whole House Air Cleaner (99.98 o Eff.)
El Included Install 1- Honeywell "TrueSteam" Humidifier m# HM512VPIAQ
El IIJL50.00 Install 1- H/W Whole -House Dehumidifier for Optimal Humidity Control m# DR65
® Included Install 1- Honeywell "TrueZone" Zone Control System (3-Zones)
LI Included Install 1- Honeywell Ventilation Control & Fresh Air Vent.
El Included Upgrade to 3- Deluxe 7-Day Programmable Touchscreen Thermostats. Ducted
El Included Upgrade to 3- Deluxe 7-Day Programmable Touchscreen Thermostats. Radiant
® $1,460.00 Upgrade to 1- Trane Energy Recovery Ventilator m# TERVR100.
0 Included Install 1- HAN Stand -Alone Dehumidifier for Optimal Humidity Control m# DR65
(Dehumidifier to Serve the Sealed Crawispacel)
000.00 Install Rigid Black Iron Gas Piping to 3 Appliances including: (1) Range & (2)
Water Heaters. Additional Appliances @ $300.00 / each.
Total System price (Including Accessories): Initials:
Page 3

Terms:
Upon acceptance, signed proposal & 20% Deposit needed to order equipment & schedule installation;
25% due upon completion of Vertical Bore & Pipe; 40% due on completion of Plough -in; & remaining 15%
due upon compietion of Final Set -Out.
Payment:
® Check Check #:
LJ Visa Q MasterCard
Card #:
Name on Card:
0 Cash ® Financing
® Discover 13 AMEX
Exp:
Security Code:
ACCEPTANCE OF PROPOSAL:
The above prices, specifications & conditions are satisfactory and are hereby accepted. My signiture below
authorizes Mike's Heating & Cooling to perform the work as outlined within this proposal. Payment for this
work shall be made as outlined above.
Acceptance Signature: ` M; " ' /,{,� r Date:rt_
Authorized Signature: JZcAaU; athcock, Date:—3/2/2012
* This Proposal is Good for 30-Days!
NC License # 13418
HEATING & COOLING
COMMERCIAL P.ESi[,Erir�ni
Quality. Comfort. Reliability.
Page 4

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
These wells are `permitted by rule" and do not require an individual permit when constructed in accordance with
the rules of 15A NCAC 02C.0200*. This notice must be submitted prior to construction. 1—
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS
$ &I
As described in 15A NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water
and 60
_- -
performance -enhancing additives as part of a geothermal heating and cooling system.
t;-, a,
2?--
RP
OR
®..
GEOTHERMAL DIRECT EXPANSION CLOSED -LOOP WELLS
As described in 15A NCAC 02C these wells circulate a refrigerant gas as part of a geothermal heating Od—
.0223
cooling system.
u
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete. I `°®
DATE: 2, PERMIT NO. (to be completed by D
0_WQ)_
A. TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO BE CONSTRUCTED
(1) Aqueous (as per 15A NCAC 02C .0222): Number of wells:
(2) Direct Expansion. (as per 15A NCAC 02C .0223) Number of wells:
B. STATUS OF WELL OWNER (choose one)
(1) Single Family Residence --,,/—/Submit this form two (2) business days prior to construction.
(2) Business/Organization Submit this form 30 days prior to construction.
(3) Government: State Municipal County Federal Submit this form 30 days
prior to construction.
C. WELL OWNER — For single family residences list the property owner(s). For all others, list name of the
business, organization, or government agency and person delegated signature authority:
,r
Mailing.Address:
City: �T s State: -� Zip Code:a_%63County: &jnz,5,rAZC1
Day Tele No.: p Cell No.: A)
���
EMAIL Address: !J{1 I t X a 4VA.i, ff �_� , rn �� Fax No.:
D. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) of well site: ,I L),
County: _ h eom A .--
(2) Physical Address (if different than�mailipg address):
City:
State: NC , Zip Code: 6299".
DWQ/UIC/Closed-Loop Geothermal Notification (Revised 4/30/2012) Page 1

E. MAPS, PLANS, AND SPECIFICATIONS
P (1) Maps must be scaled or otherwise accurately indicate distances and orientations of features located
within 250 feet of the injection well(s). Label all features clearly and include a north arrow. Attach a
site -specific map showing the locations of the following:
• Proposed injection well locations 0 Septic systems and associated spray irrigation
• Buildings sites, drain fields, or repair areas
• Property boundaries
• Surface water bodies • Existing or potential sources of groundwater
• Water supply wells contamination
(2) Plans and specifications of the surface and subsurface construction details of the well system.
F. TYPES AND CONCENTRATIONS OF ADDITIVES — List any additives that will be used and their
concentrations. Only additives that the Department of Health and Human Services' Division of Public Health
determines do not adversely affect -human-health-shall-be -used.--A-list of -approved additives can- be found- - -
online at http://portal.ncdenr.or web/wq/aps/gwpro. All other additives require approval prior to use.
G. WELL DRILLER INFORMATION (if know
Well Drilling Contractor's Name: ui- ba(r4 !Je I4
NC Well Drilling Contractor Certification No.:�
Company Name: lowlazd ew Nf �� rt6 Contact Person: 16'frLA
City: Z&, State: Zip Code 1jCounty: f4n LM4,
Day Tele No.: 6tol_�g'' q Zz Cell No.:
EMAIL Address: Fax No.:
-H. HEAT PUMP CONTRACTOR-INF ION- --
Company Name: /i-e-
'� � /•.
Contact Person: .1�tr/ a/ 6z° �G EMAIL Address: �� s tP Kf Q Lcr ��
Address:
City:
Office T
Fax No.:
DWQ/UIC/Closed-Loop Geothermal Notification (Revised 4/30/2012) Page 2

I. PROTECTION — Provide a brief description of how (1) water supply wells; (2) surface water bodies; and (3)
septic systems and associated spray irrigation sites, drain fields, or repair areas within 250 feet of,the proposed
injection wells will be protected during construction of the wells:
J. VARIANCE — Pursuant to 15A NCAC 02C .0241 the Director of the Division of Water Quality may grant a
variance'from applicable well construction or operation standards provided that:
(1) use of the well(s) will not endanger human health and welfare or the groundwater; and
(2) that construction or operation in accordance with the standards is not technically feasible or the
proposed construction provides equal or better protection of the groundwater.
Anywariance request should accompany submittal of this notification to expedite evaluation of the request.
The variance request form can be accessed online at http://portal.ncdenr.or web/wq/aps/gwpro/pennit-
analications
K. SIGNATURES — The following section is to be completed as required below or by that person's authorized
agent. 15A NCAC 02C .021 l (e) requires signatures as follows:
(a) for a corporation: by a responsible corporate officer;
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(c) for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
(d) for all others: by the well owner;
(e) for any other person authorized to act on behalf of the applicant: documentation shall be
submitted with the notification that clearly identifies the person, grants them signature
authority, and is signed and dated by the applicant.
"I hereby certify, under penalty of law, that I have personally examined and am, familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are 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 reelllateed, appurtenances in accordance with the 15A NCAC 02C 0200 Rules. "
Signature of Property Owner/Applicant �.
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
DWQ/UIC/Closed-Loop GL6thernlal Notification (Revised 4/3012012) Page 3