WI0100565_Application_20191025

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North Carolina Detmriment of Environmental Otialitv - Division of Water Resources
NOTIFICATION OF INTLN I 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.02 This notice must be submitted prior to construction.
GEOTUIMAL AQUEOUS CLOSED -LOOP WELLS
As described in 15A NCA!L 02C,=2 these wells circulate potable water only or a mixture of potablejai-.,r amd
performance -enhancing additives as part of a geothermal heating and cooling system.
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GEQMRM—AL 12MECT EXPANSION CLOSEDLOOPWELLS
As described in 15A NQ_AC 02C =3 these wells circulate a refrigerant gas as pan of a geothermal heating and
cooling system.
Plint Clearly or ilipe hifornwtion. Illegible Submittals Will Be Returned As Incomplete.
DATE: to I PERMIT NO.: (to be completed by DWR)
A. TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO BE CONSTRUCTED (select one)
M�5 Aqueous (as per 15A M&: 02C-� "?)) Number of wells:
Direct Expansion (as 15AhiCACO2C.0223) Number ofwells:
per
B. STATUS OF WELL OWNER(S) (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(S) - For single family residences, list all persons listed on the property' deed. For all others,
list the name of the Business/Agency and person and title with delegated signature authority:
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Mailing Address:2-5W Eore *
City: 6 Am- (04� State: &( Zip Code: Z?Z//County:
Day"reic No.: Cell No.: A7
EMAIL Address: 1'4-0-p o z-zie-//sj'!9aovtfZ. cgnt Fax No.:
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D. PHYSICAL LOCATION OF WELL SITE
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'T 7 Z 7066 COW"
(1) Parcel Identification Number (PIN) of well site.
County: Pl>Utic-17 *ffloe—
(2) Physical Address (if different than mailing address): 1fk1al
City: Ask - ea County &
e--IPICOWip Code:
Closed -Loop Geothermal Wc11 Notification Rev. 3-1-2016 Page 1

E. REQUIRED MAPS, PLANS, AND SPECIFICATIONS
(1) A site maps must be Ill omitted. it must be scaled or otherwise accurately indicate distances (in feet)
and orientations of features located within 250 feet of the injection well(s). Label all fcjAtg_cs clearly
and include a north ggg* Attach the site -specific map showing the wells in relation to the locations of
the following:
* Buildings z s Septic systems and associated spray irrigation sites,
* Property boundafici drain fields, or repair areas, if any
Surface water bodi4s, if any s Existing or potential sources of groundwater
Water supply wellsif any contamination, if any
(2) Plans and specification$ of the surface and subsurface construction details of the well system.
.N'OTE.- In most cases, an aerial photograph andlor plat map of the property parcel showing property lines and
structures can be obtained and downloaded from the applicable county GIS websile. Typically, the property can
be searched ky owner name or address. The location of the wells in relation to property boundaries, houses, septic
tanks and fields, and other wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing
topographic contours or elevation data.
F. TYPES AND CONCENTRATIONS OF ADDITIVES - List any additives that will be used and their
concentrations. NOTE: Only injectants approved by the NC Division of Public Health, Department of Health
and Human Services can be injected. Approved injectants can be found online at
All other substances must be reviewed by the DHHS prior to use.
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G. WELL DRILLER INFORMATION
K Contractor's Clint Babbitt
Well Drilling
NC Well Drilling Contractor Certification No.:
Company xlnmi-: AAA Sweetwater Well
City: Swannanoa
State: NC
Contact Person: Danielle or Clint
Zip Code: 2877bCounty: Buncombe
Day Tele No.: 828,298.1117 Cell No.:
EMAIL Address: [e-mail] Fax No.: 828 . 3.48.1480
H. HEAT PUMP CONTRACTOR INFORMATION
Company Name: Ric
n^mLmlln ^r ('lint
Contact
[e-mail]
Address:
City: Ele,*,A Zip Code: 'Z1752- State: )_VL-County: #rAkhrho^
Office "fete No.: Cell No. :- -axNoy .:828.348.1480
Closod-l-AxT Geothermal Well Notification Rev. 3-1-2016 Page 2

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profAlsed il�jcclwwt %kcils 'Allfl bc pm3"%wj during, ccmstnK-litvn oftlx- wch'v,
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St(;.NATURJF-S - 'I he folming "t CQTnpj+jl:.4 3S rCqUir'C"d b6OW or by fttl pemm",, ;au thtwcd
(a) for a!:vwIvmation: by a Tcs-pcmmlvle corivnitc oirl"*r,
b) a Aor swilc pnixicit".hip- by a perb=a! parmcror the r.,vnetor- m-siNctivOy-,
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submind with the mitilicat4m, that deart,, idw�cnliithe Pen-A)TL w=ls tbcrn Si'-MxWr;:
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authority, and L-% �ig "- wad 4ated by iht, ap, pEewn,
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13 1 /2 Engle Street, Asheville, NC 28801
828.412.1289
peter@petertart—
www.petertart—
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PETER TART I ARCHITECT
13 1 /2 Engle Street, Asheville, NC 28801
828.412.1289
peter@petertart—
www.petertart—

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