WI0100105_GEO THERMAL_20100719

RESIDENTIAL WELL CONSTRUCTION RECORD
' North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3421
I. -WELL -CONTRACTOR.
David iton
-Well Contractor (Individual) Name
AWD S rvi es. Inc.
Well Contractor Company Name
8 North Turkev Creek R
Street Address
Leicester NC 28748
City or Town State Zip Code
828 5 683-9223
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMrr# WI0100105
OTHER ASSOCIATED PERMIT#(lf applicable)
SITE WELL 1D #Qf applicable)
3. WELL USE (Check Applicable Bore): Reeldential Water Supply Jd'
DATE DRILLED 12/29/08 J
TIME COMPLETED AM ❑ PM i]f
4. WELL LOCATION:
crrr Asheville couNTY Buncombe
One University Hts CP01100
(Street Name, Numbers, Communty, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate boo
FjfSlope'oVatley ❑Flat ❑Ridge ❑ Other Elev. 2136'
LATITUDE 35 ^ 36 - 58.0000 "DMS OR DD
LONGITUDE 82 " 33 ' 58.0000 " DMS OR DID
Latitudellongitude source: yLtPS propographic map
(location of well must be shown on a USGS topo map andatfached to
this form if not using GPS)
5. WELL OWNER
One University Heights. Main Quad
Owner Name
One University Heights
Street Address
Asheville N Q
28804
City or Town State
Zip Code
8c 28 )
Area code Phone number
(2) Geothermal
Bores
B. WELL DETAILS:
a. TOTAL DEPTH: 2-5500r
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO tf
c. WATER LEVEL Below Top of Casing: NIA FT.
(Use "+ if Above Top of Casing)
d. TOP OF CASING IS NIA FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpml: NIA METHOD OF TEST NIA
f. DISINFECTION: Type NIA . _ Amount NIA
g. WATERZONES (depth).
Top
Bottom
Top Bottom
Top -----Bottom
-
-_Top Bottom
Top
Bottom
Top Bottom
Thicknassl
7. CASING:
Depth
Diameter Weight Material
Top
Bottom
Ft.
Top
Bottom
Ft
Top
Bottom
Ft.
8. GROUT:
Depth
Material Method
Top 0
Bottom 500'
Ft Bera Thermal Pour
Top _ _
Bottom. j-___-
Ft.. Grout -&-Hole---- Pour
Top
Bottom
Ft. PlUg
9. SCREEN: Depth —
Diameter Slot She Material
Top
Bottom
Ft in. in.
Top
Bottom
Ft in. in.
Top
Bottom
Ft. in. in.
10. SANDIGRAVEL PACK:
Depth
Size Material.
Top
Bottom
Ft
Top
Bottom
Ft
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
1
1
I
1
I
1
1
1
12. REMARKS:
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 THE WELL OWNER.
12t29/08
: SIGNATURE OF CERTIFIED WELL CONTRACTOR v DATE
David Stratton
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
$ubmiEwithtn 30 day :ctf,complWon:to Division of Water Quality. - .:Infotmaflati Processing, Form GW-1a
fit? Mei1t 5�nric bo RaCeigtr, NC 27699 E.li'1, Moo �����-887-6300 Rev. 21p9

Permit Number WIOIOO105
Program Category
Ground Water
Permit Type
Injection Water Only'GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Central Files: APS— SWP^
07119/10 1
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Chad Cooke
5205 Hovis Rd
Charlotte
NC 28208
Facility Name MajorlMlnor Region
One University Heights, Main Quad Minor Asheville
Location Address County
One University Hts Cpo 1100 Buncombe
Asheville NC 28804 Facility Contact Affiliation
Owner Name Owner Type
Individual
Stephen Baxley Owner Affiliation
Stephen Baxley
& Director Fee Mgmt Plan
One University Hts Cpo 11 aQ
Asheville NC
Scheduled
Orig Issue App Received Draft Initiated Issuance
07/19/10 07/13/10
Recuiated Activities
Heat Pump lnjeatlon
UniversitylCollege
Ouffail '.I.'
Public Notice issue Effective
07/19/10 07/19/10
28804
Expiration
Waterbody Name Stream Index Number Current Class Subbasin

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
7/19/2010
Stephen Baxley, Director of Facilities Mgmt and Planning
UNC Asheville
One University Heights, CPO 1100
Asheville, NC 28804
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. W10100105
One University Heights, Main Quad
Asheville, NC 28804
Dear Mr. Baxley:
Dee Freeman
Secretan,
On 07/15/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-onl,,
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 Notch
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 sbould 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.Rot ers:a ncdenr.Lov if you have any questions.
Sint
for Debra AUtts
Supervisor
cc. Asheville Regional Office - APS
APS Central Files - Permit No. WI0100105
Buncombe County Health Dept.
Chad Cooke (Souther -a Mechanical of the Carolinas, Inc., 5205 Hovis Rd,, Charlorte, NC 28208)
AWVl ER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
f_ocalran: 2728 Capltai 6ouWara, Raleg h• North Carolina 27604 One
Phone: [phone] I FAX [phone]; FAX 2: 919-71"048 I Customer Service; I.877.623-674E NorthCarolina
intemet: www•hcwa�rauaEir�.om_
An Equal Oppxwnlry'� Atirmalivc Anir•n Employer Naturally
���✓t�

yJM.100105
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF IlYTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTICM:
TYPE 5-QW WELLS)
In Accordance with the provisions of NCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or T31 a information).
DATE: July 14 , 2010
WelI7jpe Canfrmation: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the envimnmtmt (i.e.
closed -loop)?
Yes 3C_ Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing
either a $A7 well (QM -loop well inLecting potable water into the aquifer) or a 5QM well (closed -
loop well containing additives such as R-22, ethanol, or other antifireeze 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, state name of
entity and a representative wlauthority for signature): UNC Asheville, Styhen Bwde%-
Director of Facilities Manaeement and Planning
(1) Mailing Address: [JNC Asheville, CPO 1100. One University Heights_ _
City: Asheville State: NC Zip Code: 28804 County- Bunc-ombe
Home/Office Tole No.: 1828i 251-6564 Cell No.:
Email Address: sbaxlcy<run_ca.edu Website:
(2) Physical Address of Well Site (if different than above): One Universit% Heights. Main Quad
City State: Zip Code: County:
HomelOffice Tele No.: C ell No.:
H. 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.
GPU/UIC SQW Notification of Intern Form (Revised HaW8) RECEIVED l DENR 1 OW Page 3
JUL 15 2001

C. WELL DRILLER INFORMATION
Company Name: AWD Services. Inc
Well Driller Contractor's Name: Larry )hlells
NC Contractor Certification No.: 2603
Contact Person: Larry Wells EMAIL Address: we1ls750549+ct+bellsouth.net
Address: PO Boa 125
City: Leicester Zip Code: 28748 County: Btuicombe
Office Tele No.: [phone] Cell No.: [828 i 215-9334
D. IEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Southern Mechanical of the Carolinas. Inc.
Contact Person: Chad Cooke E.NWL Address- claa&Wsouthernmechanical.net
Address: 5205 Hovis Road
City: Charlotte Zip Code: 28208 County: Merklenbert<
Office Tele No.: [phone] Cell No.: 744 361-2341
E. STATUS OF APPLICANT
Pri ►+ate: Federal: Commercial:
State: _X Municipal: Native American Lands:
F. INJECTION PROCE.D[TRE (briefly describe how the injection wells) Kill be used)
Closed loop wellfield and_heat pump system utilixina water for heating and cooling of Rhoades Hall and
Rhoades Totiver at UI,C Ashet7lle.
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constnteted: _ ___ 3uiv 14 - August_1.0. 2010 Number ofborings: 34
Approximate depth of each boring (feet): 500
(2) Type of tubing to be used (copper. PVC. etc): SDR9. 1-1/4 inch pipe
(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: Froun to feet (reference to land surface)
Casing extends to above ground inches
(b) No _X
(4) Grout Info (matetxal surrounding. well casing andior piping):
(a) Grout type: Neat Cement $entonite —X— Other (specify)
(b) Grout placement: Pumping_X Pressure Other
f c j Grout depth of tubing (reference to land surface): from �500 to —0 (feet)
If well has casing, indicate d aut depth: from to (Feet)
GPUIUM 3QV4 Nolificatic n of In tent .Farm (Revised ROM) Page 2

H. INJECTION -RELATED E¢UIIPNMNT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation, The manufacturer's brochure may provide supplementary
information.
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(I) Include a Site Map (can be drawn) showing: buildings, property lines, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of
the geotbermaI 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. CERTIFICATION
Note: This Permft Application must be signed by each person appearing on the
recorded legal property deed.
"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 an 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
Wl related appurtenances in accordance with the approved specifications and conditions of the Permit.."
51,_,44rurr of Prkperrn Owner/App`j=hr
12'C. 0 ,e_J em
Print or Type Fu ! Name
Please return two copies of the completed Application package to:
Nortb Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 MaII Service Center
Raleigh, NC 27699-1-636
Telephone [phone]
RECEIVED / DENR / L°WO
AQwFFR,PRnTFi .`Tffw vc noN
OPU/UIC 3QW NoNScation of W=l Form (Revised WON) JUL 15 Md Page 3

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Rogers, Michael
From:
Alan King [[e-mail]]
Sent:
Thursday, July 15, 2010 9:07 AM
To:
Rogers, Michael
Subject:
Re: UNCA request W 10100105
Attachments:
5QW4gned.pdf; Enlarged Site Plan.pdf
Michael,
The correct application is attached.
I've included all maps again for a complete first submittal.
Regards,
Alan
On Wed, Jul 14, 2010 at 4:48 PM, Rogers, Michael <michael.roL,ersidined enr.�,ov> wrote:
You have submitted the wrong form for this geothermal well system. Since this is a water only system(no additives), you need to complete a
notification of a Gent to construct a 5QW water only form.
These forms are available at our website.
N ichael Rogers. P.G. (NC & FL)
Environmental Specialicf
NC DiN- of Water Qualiry Aqui1-er Protection Section (APS)
I ti t6 Mail Senvice Center
Raleigh, NC ?7699-1636
Direct Line i91')J 715-6166: Fax 7tS-0588 {ryttt to my -9tto on cover letter}
1--mar/ to arm.frolp; dro adtjrr�s 003al.lie luhjerl to Me Nrolm Curajirru hdhlk Pecvr&Y trait and traYhr i ischaed ru third rxr ir.
From: Alan King [mailto:akin r d,unca.edu]
Sent: Wednesday, July 14, 2010 4:03 PM
To: Rogers, Michael
Subject: Re: UNCA request WI0100105

Michael,
No additive will be used - water only.
Regards,
Alan
On Wed, Jul 14, 2010 at 3:14 PM, Rogers, Michael <rnichael.rogersrrr ncdenr.Lov7 wrote:
T am Processing the ��enthernial application. What ti e of additiNe will be actded to flie closed lo+ip �rcutllcnual NV 11 {
elycctl, etba1101 etc.}:'
M i had Rk)L, r. I'-(i- (% C & F L )
Eritir mmentil Spod,ihst
NC 1)1% i) f Water0Lialih- %quiLcr Prot vcriuri Scchrin I,N} ks
1636 N1a i I 3ervlc'L: C enrer
R.11e.rg11. Ir, 1'f+111J-
Direct I ine (9191 71 �d,i 60: Fax 715-05NX tp l ins nn atcn i)ii cnvcr lon-er)
1 m, I?( r"rrr07471 rl 4 Ir+ r117d [rt'm 1h+ , rlr 1d; SIN" ➢ltal• Ili' 110h r.1-0 7rr Ili'' \iwror 1 e f'ohrrtt I'rddir RC.'grl7 11211. aq,1 MCI I,re1l1 i Yrp. d P71h21 e( r 121r?iLI
From: Alan King [mailto:akin4 counca.edu]
Sent: Monday, July 12, 2010 2:52 PM
To: Rogers, Michael
Subject: Re: LiNCA request
Thanks Michael,
The application is attached.
I'll consider this a one-time favor and next time will mail it in per normal protocol.
Thank you again.
Regards,
Alan
2

On Mon, Jul 12, 2010 at 2:17 PM, Rogers, Michael <michael.ro L•ers a)ncdenr. LLov> wrote:
Yes you can e-mail the application. However, you need to check and make sure I'm in the office when you e-mail as
sometimes, I am out of the office for training, conferences, leave etc. In that event, the application would just sit in
my inbox for days or weeks.
Michael RO ECTS. PC,. ('Sc & FL)
EnvironmenLai Sp(ecialisl
NC Div of Water QuaI4- Aquifer Protection Section (AILS}
1636 Mail $ervicc Untc,
Raleigh. NC 2 769 4- 16 36
ofreet Line [phone]: Fa,: 71 i-0588 (put to my niM on weer ietter)
E-mud ion undGoon Ov[ nddres, orm- he Sub>ie(-f hr Me .ynrflr Carohno ftfNI: krr,:urh Lrn+ and piat! 6e discluved ru rhird purl+4s
From: Alan King [mailto:akinr &unca.edul
Sent: Monday, July 12, 201 Q 9.29 AM
To: Rogers, Michael
Subject: i]NCA request
Hi Michael,
Is it possible to email a 5QM application to you in order to get the process started on some well drilling we want
to do?
Without wasting a lot of your time, we are woefully behind schedule on some well drilling that needs to be
done. The Asheville DENR office has indicated to me that I can go ahead and submit this application now that
all items have been addressed on the Pisgah House well field. Jonathan Stepp came out on Friday to inspect
that well -field and has given approval to move forward on other work.
Thanks for your consideration.
Regards,
Alan

Godwin, Tonga
From: Thomas P Vitaz (DOTS) [[e-mail]]
Sent: Monday, July 19, 2010 9:01 AM
To: Godwin, Tonya
Subject: [DOTS] Closed: (HD-85834) Need to have permit # deleted in BIMS
Issue# HD-85834 has been closed.
Issue Details
-------------------------------------
Summary: Need to have permit # deleted in BARS
Issue#: HD-85834
Issue Created: Thursday 03:54 PM
Issue Type: Issue
Reporter: Tonya M Godwin
Assignee: Thomas P Vitaz
Priority: 1
Category: I have another type of issue...
Division: water Quality
Location: 2728 Capital
Location Details: Room 1C 211 Central Files
NCID: tmgodwin2
Number of Users Affected: 1
Phone: [phone]
Queue: Development Queue
Severity: Medium
Sub -category: Other (Please describe)
Subdivision: None
Description:
Detailed Issue Description : Please delete injection permit # WI0100105
was entered incorrectly. Please call if questions 919-733-3221.
Thanks,
Tanya
in BARS. Application
If you require assistance, please contact the DENR ITS Solution Center at:
httn:l/oortal.ncdenr.orp,/grouv/its,
If you have an urgent or critical situation, please call the DENR ITS Solution Center at
[phone] after submitting your help request.
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.

Godwin, Tonya
From: Tonya M Godwin (DOTS) [denr.support@a ncdenr.gov]
Sent: Thursday, July 15, 2010 3:55 FM
To: Godwin, Tonya
Subject: [DOTS] Created: (HD-85834) Need to have permit # deleted in BIMS
This message has been automatically generated in response to a Help Request regarding:
"Ticket Submitted from Portal", a summary of which appears at the bottom of this email.
There is no need to reply to this message sight now. Your Help Request has been lagged at the
DENR ITS Solution Center. Staff are being assigned and you will be contacted if we require
further information or when your request has been completed.
Please include the text: HD-85834
in the subject line of all future email correspondence about this issue. To do so, you may
reply to this message.
NOTE: TICKETS SUBMITTED AFTER 5 PM WILL BE ADDRESSED THE NEXT BUSINESS DAY.
Sincerely,
DENR ITS Solution Center
Issue Details
Summary: Need to have permit # deleted in BIMS
Issue#: HD-8S834
Issue Created: Today 03:54 PM
Issue Type: Issue
Reporter: Tanya M Godwin
Category: I have another type of issue...
Division: Water Quality
Location: 2728 Capital
Location Details: Room 1C 211 Central Files
NCID: tmgodwin2
Number of users Affected: 1
Phone: [phone]
Queue: Solution Center- Queue
Severity: Medium
Sub -category: Other (Please describe)
Subdivision: None
Description:
Detailed Issue Description : Please delete injection permit # WI010010S in
was entered incorrectly. Please call if questions 919-733-3221.
Thanks,
Tonya
--------------------------------------------------------------------------
If you require assistance, please contact the DENR ITS Solution Center at:
httn:,,,.'Dortal.ncdenr.org/2rouc,lits,-'
BIMS. Application

If you have an urgent or critical situation, please call the DENR ITS Solution Center at
[phone] after submitting your help request.
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
z

Central Files: APS SWP
07/14/10
Permit Number W10100105 Permit Tracking Slip
Program Category Status Project Type
Ground Water In review New Project
Permit Type Version Permit Classification
Injection Mixed Fluid GSHP Well System (50m) _ Individual
Primary Reviewer Permit Contact AHIliation
michael.rogers —]Chad Cooke
Coastal SW Rule 'Sti � i 5205 Hovis Rd
Charlotte NC 28208
Permitted Flow !"
Facilit,
Facility Name Major/Minor Region
One University Heights, Main Quad Minor Asheville
Location Address County
One University Hts Cpo 1100 Buncombe
Asheville NC 28804 Facility Contact Affiliation
Owner _
Owner Name
Stephen Baxley
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
07/13/10
Re ulated AC,:, ities
Outfall NULL
Waterbody Name
Owner Type
Individual
Owner Affiliation
Stephen Baxley
& Director Fac Mgmt Plan
One University Hts Cpo 1100
Asheville NC
Public Notice
Stream index Number
tj A*46LO".' A-��
Current Class
28804
Effective Expiration
Subbesln

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELLS) FOR
WJECTIOIK WITH A GEOTETMAA? • HEAT FUMP SYSTEM FOR:
TYPE 50M WELLS)
R New Permit AppGeadon OR Renewal (check one)
DATE: 3uh 8. 2010
PERMIT NO, M� QIM_ (leave blank if NEW permit application)
A. PROPERTY OWNER(S)lAPPUCANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative wlauthority for signature): _ UN Ask-N ille
Stephen Baxley . Director of Facilities Manasernent & Plannine
B.
C.
(1) Mailing Address: One University Heights. CPO 1100
City, Asheville State: NC_ _ Zip Code: 28804 County: Buncombe
HomelOffice Tele No.: f 8281251-6564 Cell No.:
EMAIL Address: sbax_leytu unca.edu _
(2) Physiral Address of Site (if different than above): One Universiyy Heights, Main Quad
City: State: Zip Code: County
Home/Office Tele No.: Cell No.:
EMAIL Address:
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:
Office Tele No.:
State: Zip Code:
Website Address of Company, if any:
STATUS OF APPLICANT
Private: Federal:
State X Municipal:
Commercial:
Native American F ands:
County,
GPUARC 5QM We Permit Application (Remised 712D48) RECEIVED IDENR I DWQ Page 1
A00wFQ oonirrim SEC oO4
JUL 18 Wh

E.
F
G.
WELL DRILLER U FORMATION
Company Name: AWD Services. Inc.
Well Drilling Contractor's Name: Lam, Wells
NC Contractor Certification No.: 2603
Contact Person. Lam' Wells EMAIL Address: we11s750549,abellsauth.net
Address: PC Box 125
City. Leicester Zip Code: 28748 County: Buncombe
Office Tele No.: 18281683-9223 Cell No.: (8281 215-9334
HEAT PIMP CONTRACTOR INFORMATION (if different than driller)
Company Name; Southern Mechanical of the Carolinas. Inc.
Contact Person: Chad Cooke EMAIL Address: c1hada;southemi echanical.net
Address; a20S Hovis Road
City: Charlotte Zip Code: 28208 County: Mecklenbure
Office Tele No,: [phone] Cell No,: [phone]
INJECTION PROCEDURE (briefly describe how the injection well(s) willbe used)
Closed loop heat 12=12 system utilizing* water to be used for heating and cooling Rhoades Hall and Rhoades
Tower at iJNC Asheville.
WELL CONSTRUCTION DATA (Skit) to Section R if this is a Permit RENEWAL}
(1) Proposed date to be constructed: July 8 — .Au -,,List 10. 2010 Number of borings: 34
Approximate depth oFeach boring (feet); 500
(2) Chetnical additives to be used in Closed -loop system (only those chetuicals indicated have been approved):
R-22 propylene glycol ethanol
need prior approval by NCDENR before use)
other (other additives will
(3) Type of tubing to be used (copper, PVC, etc): 500' SDR9 1-114" Loop Pips_
(4) Well Casing. Is the well(s) cased? (check either (a.) YES or (b,) NO below}
(a) VES if yes, then provide casing information such as roc (steel. PVC, plastic. etc. }' diameter,
depth, and extent of casing appearing above ground:
(b) NO X
(5) Grout (marenat surrounding well casing and/or piping). See below
(a) Grout type: Cement Bentonite _xi
❑ther (specify) Thermal)■ enhanced --rout full leneth of bare
(b) Grout depth of tubing (reference to land surface): from to (feet)
If well liar casing, indicate grout depth: From to (feet)
H. INJECTION RELATED EQUIPMENT
GPU/MC 5¢M Well Pem+it Application (Revised 7/2008) Page 2

Attach a diagram showing the engineering layout or pmposed modification of the injection equipment and exterior
pipingltubimg associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
L LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a site map (can be drawn) showing: buildings, property Woes, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
geothermal heat pump 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 WELL(S)
Are there any potable water well(s) on the subject property or adjaceut properties? YES X NO
If Yes, then indicate location on attached tmap(s).
K. CERTIFICATION
Note: This Permit Application must be signed by each per®on Appearing on the recorded legal property deed.
"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 related appurtenances in accordance with the approved specifications and conditions of the Permit"
Siggieure of P arty OwnerlApp i
60 V ems_ 1a,�
Print or Type Fun Name
Please ret un two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVED 1 DENR 10WQ
AQUIR:R-PR(ITF('T1 N SECTION
JUL 19 Z010
GFUMC 50M Wall Permit Applicadon (Revised MODS) Page 3

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Rogers, Michael
From:
Alan King [aking®unca.eduj
Sent:
Monday, July 12, 2010 5:08 PM
To:
Rogers, Michael
Cc:
Stepp, Jonathan
Subject:
new 50M application at UNCA
Attachments:
UNCA-Rhoades-5QM.pdf, Enlarged Site Plan.pdf
Michael,
Attached is the corrected SQM application for work at Rhoades Hall.
A detailed site plan is also attached as a separate file.
Jonathan,
Please review and let me know if you have any questions.
Regards,
Alan
RECEIVED I DENR I DWQ
AOUIFFR'PRi1WION SECTION
JUL 13 2010

Rogers, Michael
From: Alan King [[e-mail]]
Sent: Monday, July 12, 2010 2:52 PM
To: Rogers, Michael
Subject: Re: UNCA request
Attachments: UNCA-Rhoades-5QM.pdf
Thanks Michael,
The application is attached.
I'll consider this a one-time favor and next time will mail it in per normal protocol.
Thank you again.
Regards,
Alan
On Mon, Jul 12, 2010 at 2:17 PM, Rogers, Michael <michael.rogersra ncdenr.gov> wrote:
Yes you can e-mail the application. However, you need to check and make sure Fm in the office when you e-mail as
sometimes, I am out of the office for training, conferences, leave etc. In that event, the application would just sit in
my inbox for days or weeks.
Michel Rogers, P.G. (NC & FL)
EnvironmenW Specialist
NC Div of Water Quality- Aquifcr Protcciion Scction (AP5)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]: Fax 7 € 5-0588 (put to my attn on cover letter)
F rnr+il rorrespuijdence io and frour this address maY be subject to the North Carolina Public Reeorrts lax- and maY 1,2 Af closed to third parries
From: Alan King [mailto:akinga)unca.edu]
Sent: Monday, July 12, 2010 9:29 AM
To: Rogers, Michael
Subject: UNCA request

Hi Michael,
Is it possible to email a 5QM application to you in order to get the process started on some well drilling we want
to do?
Without wasting a lot of your time, we are woefully behind schedule on some well drilling that needs to be
done. The Asheville DENR office has indicated to me that I can go ahead and submit this application now that
all items have been addressed on the Pisgah House well field. Jonathan Stepp came out on Friday to inspect
that well -field and has given approval to move forward on other work.
Thanks for your consideration.
Regards,
Alan

NCDENR
North Carolina Department of Environment and
Division of Water Qua[Ity
Beverly Eaves Perdue Coleen H. Sullins
Govemor Director
July 14, 2010
Stephen Baxley, Dir of Facilities Mgmt and Planning
UNC Asheville
One University Heights, CPO 1100
Asheville, NC 28804
Subject: Acknowledgement of Application No. WI0100105
One University Heights, Main Quad
Injection Mixed Fluid GSHP Well System (5QM)
Buncombe
Dear Mr, Baxley:
Natural Resources
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on July 13, 2010. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as Inng as 60 - 90 days after receipt of a complete
application,
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at michael.rogersC cdenr.gov. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to htii,:llh2o.em•.state.nc.us/documents/dwtjor_•chart.pd>
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
for Debra J. Watts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Southern Mechanical of the Carolinas, Inc (Chad Cooke - 5205 Hovis Road, Charlotte, NC 28208)
Permit Application File WI0100105
AQUIFER PROTECTION SECTION
1636 Mail Service Center, RaIe gti, North Carolina 27699.1636
Location : 2728 Capital Boulevard. Raleigh, North Garoilna 27604 IIe i... Phone: [phone] t FAX [phone]: FAX 2: 919-715-60481 Customer Service- 1.877-623.6748 �[7 ���F011l icl
Infemet; www.ncwatemual�tv.arg ��, f����
An Equal Cppoiunity ; Af TmahyE.Hc.Non Employer ; ii

A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
July 14, 2010
Stephen Baxley, Dir of Facilities Mgmt and Planning
UNC Asheville
One University Heights, CPO 1100
Asheville, NC 28804
Subject: Acknowledgement of Application No. WI0100105
One University Heights, Main Quad
Injection Mixed Fluid GSHP Well System (5QM)
Buncombe
Dear Mr. Baxley:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
evpporting materials on July 13, 2010. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at michael.rogers@ncdenr,gov. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized To
review our new organizational char!, go to htn://h2o."r.state ne.us/documents/dwu or�-,chart.+df.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUrMS ON THIS PROJECT,
Sincerely,
UWn",
for Debra J. Watts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Southern Mechanical of the Carolinas, Inc (Chad Cooke - 5205 Hovis Road, Charlone, NC 28208)
Permit Application File WI0100105
AQUIFER FRQTEC710N SECTION
1636 Moil Service Carver. Raleigh, North Carolina 27599 -16 36
Location, 2728 Capital Boulevard, Raleigh. Noah Carolina 27604 One
Phase: 919.733.3221 l FAX 1' 919.715-0588; FAX [phone] I Customer Service: 1-977-623-674B NoI'thCa�Olina
lniemei: www.ncwatamuapiv.om An EOUBi Gpponunny i AKirmaNe Achort Emck0ir �atmiafly