WI0100580_Application_20200413

lNorth Uarolina Department of Environmental duality — Division of Water 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.
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS
As described in 15A NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water and
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: April 13 2020 PERMIT NO.: (to be completed by DWR)
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B.
C.
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TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO BE CONSTRUCTED (select one)
(1) Aqueous (as per 15A NCAC 02C .0222) Number of wells: 3 x 200ft
(2) ❑ Direct Expansion (as per 15A NCAC 02C .0223) Number of wells:
STATUS OF WELL OWNER(S) (choose one)
(1) 0 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
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:
Clayton and Danrae Babbitt
Mailing Address: 101 Sleepy Hollow Lane
City: Swannanoa
State: NC Zip Code: 28778 County: Buncombe
Day Tele No.: 828.298.1115
EMAIL, Address: [e-mail]
PHYSICAL LOCATION OF WELL SITE
Cell No.: 828.779.0093
Fax No.: 828.348.1480
(1) Parcel Identification Number (PIN) of well site: 967867126300000
County: Buncombe
(2)
Physical Address (if different than mailing address): 134 Old Jims Branch Road
City:
Swannanoa
County Buncombe Zip Code: 28778
Closed -Loop Geothermal Well Notification Rev. 3-1-2016 Page I

E. REQUIRED MAPS, PLANS, AND SPECIFICATIONS
(1) A site maps must be submitted. 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 features clearly
and include a north arrow_ Attach the site -specific map showing the wells in relation to the locations of
the following:
• Buildings • Septic systems and associated spray irrigation sites,
• Property boundaries drain fields, or repair areas, if any
• Surface water bodies, if any • Existing or potential sources of groundwater
• Water supply wells, if any contamination, if any
(2) Plans and specifications of the surface and subsurface construction details of the well system.
NOTE. In most cases, an aerial photograph and/or plat map of the property parcel showing property lines and
structures can be obtained and downloaded from the applicable county GIS website. Typically, the property can
be searched by 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
hU://deg.nc.eov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water
protection/mound-water-approved-injectants. All other substances must be reviewed by the DHHS prior to use.
G.
Glycol
WELL DRILLER INFORMATION
Well Drilling Contractor's Name: Clint Babbitt
NC Well Drilling Contractor Certification No.: NC-3556-A
Company Name: AAA Sweetwater Well
city: Swannanoa State: NC
Day Tele No.: 828.298.1117
EMAIL Address: [e-mail]
H. HEAT PUMP CONTRACTOR INFORMATION
Company Name: White & Williams
Contact Person: Ted Lunsford
Zip Code: 2871 �5 county: Buncombe
Cell No.: 828.779,3898
Fax No.: 828.348.1480
Contact Person: Ted Lunsford EMAIL Address: [e-mail]
Address. 514 Swannanoa River Road
City: Asheville
Office Tele No.: 828.296.0267
Zip Code: 28805 State: NC
Cell No.:
County: Buncombe
Fax No.: 828.348.1480
Closed -Loop Geothermal Well Notification Rev. 3-1-2016 Page 2

I. PROTECTION — Provide a brief description of how any (a.) water supply wells, (b.) surface water bodies, or
(c) 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 Resources 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 https://ncdenr.s3.amazonaws.com/s3fs-
public/W ater%20Ouality/Aquifer%o20Protection/GPU/Geotherm al V arianceRequestFormFillable-
20130805.pdf
K. SIGNATURES — The following section is to be completed as required below or by that person's authorized
agent. 15A NCAC 02C .0211(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 certijy, 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 related appprtgnances in ac��ordance with the I5A NCAC 02C 0200 Rules. "
�-' mature gf'Froperty Owner/Applicant
Clayton J Babbitt
Print or Type Full Name
Signature of Authorized Agent, if any
Danrae F Babbitt
Print or Type Full Name
Closed -Loop Geothermal Well Notification Rev. 3-1-2016 Page 3

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