WI0100132_GEO THERMAL_20110226

_s VOL SiA:F4'�a
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERT MCATTON # 3421
1. WELL CONTRACTOR:
David Strafton
Well Contractor (Individual) Name
WD Serviopra.Inc.
Well Contractor Company Name
258 Uglth Turkey Creek Rd,
Street Address
Leicester Q
28748
City or Town State
Zip Code
828 683-9223"
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#WI0100132
OTHER ASSOCIATED PERMIT#(€rapplicable)
SITE WELL ID #(f applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply fi�
DATE DRILLED 2/2 &11
TIME COMPLETED AM ❑
PM
4. WELL LOCATION:
CITY: Asheville COUNTY Buncombe
One Universi Fits Intramural Bail Field
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC 1 LAND SETTING: (check appropriate I;o4
GTSiooe ❑Valley ❑Rat []Ridge ootherElev. 2068
LATITUDE 35 ^ 39 57,0000 n DMS OR DO
LONGITUDE 82 • 34 10.0000 ^ DMS OR DD
Latitudellongitude source: Rbps Dropographic map
(location of well must be shown on a USGS topo map andettached to
this for if not using GPS)
S. WELL OWNER
One Universitv Heiahts
Owner Name
One University i Intramural Field
Street Address -
Asheville" NC " 28804
City or Town State Zip Code
St 28 y
Area code Phone number
(3) Geothermal Bores
G. WELL DETAILS:
a. TOTAL DEPTH: 3-500r
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO it
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 NIA
9.- WATER ZONES (depth):
Top Bottom
TOP
Bottom -
TOP Bottom
Top Bottom
Top
Top
Bottom
Bottom
Top
Bottom
Thicknestsl
: 7. CASING:
Depth
Iiameter
Weight Material
Top - ' "
Bottom-'
Ft
Top
Bottom
Ft.
Top
Bottom
Ft
8. GROUT:
Depth
Material
Method
Top 0
Bottom 500'
Ft. Thermal
Pour
Top- -- —Bottom
---
Ft. Enhanced
Pour
Top
Bottom
Ft. Grout
9. SCREEN:
Depth
Diameter ' Slot Size Maternal
Top
Bottom'
Ft. in.
in.
Top
Bottom
Ft. In.
in.
Top
Bottom
Ft. in.
in.
10. SANDIGRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
1
1
1
12. REMARKS:
Material
Formation Description
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.
2126111
SIGNATURE OF CERTIFIED VVELL CONTRACTOR DATE
David Stratton
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Subrnitilvithlln`31 ' days of ca#er Quality.- Information Peacessing, Form GW-1a
i;S1T.Mati:$ rvlce:Cedter RaEel h JdC 27699-1r Rhone :"(91-9) 807.6300 Rev. 2/09

Central Files: APS SWP
,1119/10
Permit Number WIOIOO132 Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5OW )
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
3Cilit'.
Faciilty Name
One University Heights - Intramural Ball Field
Location Address
One University Hts - Intramural Ball Field
Asheville NC 28804
Owner
Staters Project Type
Active New Project
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Robert Lary Wells
P O Box 125
Leicester NC 28748
MejorfMinor Region
Minor Asheville
County
Buncombe
Facility Contact Affiliation
Owner Name Owner Type
UNC Asheville Government - State
Owner Affiliation
Stephen Bagley
One University Hts
Asheville NC 28804
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
11/19/10 10/29/10 11/19/10 11/19/10
Regulated Activities
Heat Pump Injection
❑utfall I). , -.-
Waterbody Name Stream Index Number Current Class Subbasln

LTIFAJ
NCDENR
North Carolina Department of Environment and Natural Resources
Bevefly :aver Perdue
Governor
1JNC Asheville
SrephcTi Baxley — Dir. Facilities lvlgrttt & Planning
C'P0 1 1 DO One Universit_Y Hc•iiltts
Asheville, NC 28$04 Y
Division of Water Quality
Ccleen H. Sullins
Director
11;1Q.2010
Subject: Acknowledgement of intent to Construct Type 5QW injection Well System
Permit No. WIO100132
One t]niversity Heialtt5. Intramural Ball 11ield
Dear Mr. Baxley:
Dee Freeman
Secretary
On 10/29/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-onk,
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 geothermaltnjection well system as long as the
following conditions are met:
1. 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 completeiy 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 i SA 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.Rnsers eoncdenr.aov if you have any questions.
Sincerely,
0 cu'a" ic-\ - R'cc"'
f"r• Debra Watts
5upervisar
cc: Asheville Regional Office - APS
APS Central Files -Permit No. WL0100132
Buncombe County Health Dept.
AYI'D Scn7ces. lot(Larn 1V01s)
AQUIF=_P, PROTECTION SECTION
1635 Mail Service Center, Raleigh, North Camllrta 27699-1636
Looation. 2728 Capital Swiavard. Raleigh North Garalrna 27604
Phone: [phone] � FAX - 919 15-}588: FAX 2 919.71,5-60R8I Customer Service. 1-877�i2;-5'�
Inlemel www.nmatemualit. a 7
An E2ua. Qppc:amny r Atrmarr4E� LP,oioyer
One
NorthCuolinL
,A)a&,rally

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5- W WELL(S)
In Accordance with the provisions ofNCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Type information),
DATE: October 26 , 2010 NV-- G i Cc 1'3 2
A-
B.
Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed -loon)?
Yes _X_ Continue completing this form.
No Do Not complete this form. Complete other CTIC application forms for installing
either a 5A7 well ften-loop well in'ectin� potable water into the aquifer) or a 5QM well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors),
PROPERTY OWNERS)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): UNC Asheville. Stephen Baxle.
Director of Facilities Manai•ement and Plannint*
(1) Mailing Address: UNC Asheville. CPO 1100. One University Heiahts
City: Asheville State: NC Zip Code: 28804 County: Buncombe
Horne/Office Tele No.: � 8291 251-6564 Cell No.:
Email Address: sbaxlev-a unca.edu Website:
(2) Physical Address of Well Site (if different than above): One University Heights. Intramural Ball Field
City: State: Zip Code: County:
Home/Office Tele No.: Cell No.:
AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authoHzing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City:
Office Tele No.:
State:
Website Address of Company, if any:
Zip Code:
County,
GPUIWC 5QW Natifira6on of Intent Form (Revised 8/2Do8) Page 3

WELL DRILLER INFORMATION
Company Name: AWD Services. Inc.
Well Driller Contractor's Name: Lam. Wells
NC Contractor Certification No.:
Contact Person: Lam, Wells EMAIL Address: wells750549ra bellsouth.net
Address: PO Box 125
City: Leicester Zip Code: 28748 County: Buncombe
Office Tele No.: [phone] Cell No.: � 828 � 215-9334
C. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name; None — Vertical test wells only' for testinv ourposes for a future construcdon_proiect.
A new i?ermit t or modification of existine permit) will be requested once the proiect is ready to move forward
Contact Person: EMAIL Address:
Address:
City: Zip Code: County.
Office Tele No.: Cell No.:
Private: Federal: Commercial:
State: _X Municipal: Native American Lands:
E. INJECTION PROCEDURE (briefly descnbe how the injection well(s) will be used)
Current/• - Closed loon vertical wells (0) with water to test beat rejection capabilities of the «round.
Future — Closed loon wellfield and heat Pump s.•stem utilizinu water for heatinu and coolinL of a future
G.
WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: November 17. 20 1 0 Number of borings: 3
Approximate depth of eacb boring (feet): 500
(2) Type of tubing to be used (copper, PVC, etc): 5DR9. 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 ❑then (specify)
Casing depth: From to feet (reference to land surface)
Casing extends to above ground inches
(b) No _x
(4) Grout Info (material surrounding well casing and/or piping):
(a) Grout type: Neat Cement Bentonite X_ Other (specify)
(b) Grout placement: Pumping_X Pressure Other
(c) Grout depth of tubing (reference to land surface): from _500 to 0 (feet)
If well has casing, indicate grout depth: from to _ (feet)
GPU/UIC SQw Notification of intent Form (Revised 812008) Page 2

H. INJECTION -RELATED EQUIPMENT
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,
1. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) 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 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. CERTIFICATION
Note. This Permit 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 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, mainmin, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditions of the Permit."
Signs re o£Pr ,erty Owner/A ant
Print or T.1ae Full Name and ti J.aa+-
p104of I
Please return 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]
GPUMIC 5QW Notification of Intent Form (Revised 812009) Page 3

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TFw UNivasirr OF NoRv CaOLiNA
ASHEVILLE
AiAiB 1.... KING, P.E.
Facilities Mechanical Engineer
Office of Design and Construction
CPO #1110
UNC Asheville
One University heights
Asheville, NC 2M-8500
i28J232.2279 6 Fax [phone]
Ceil Phone [phone]
aking9unca.edu

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-OW WELL(S�
In Accordance with the provisions ofNCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Tune information).
DATE: October 26 , 2010
Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed --[goo?
Yes _X_ Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing
either a 5A7 well o(,�en-loop well is et cling potable water into the aquifer) or a 5QM well (closed -
loop well containing additives such as R-22, ethanol, 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, state name of
entity and a representative wlauthority for signature): UNC Asheville. Steoben Baxle%
Director of Facilities Management and Plannim-,
(1) Mailing Address: UNC Asheville. CPO 1100. One Universi1� Neiahts
City. Asheville State: NC Zip Code: 29904 County. Buncombe
RomelOffice Tele No.: r 82S i 251-6564 Cell No.:
Email Address: sbaxlev wuaca.edu Website:
(2) Physical Address of Well Site (if different than above): One University Heights. Intramural Ball Field
City. State: Zip Code. County:
Home/Office Tele No.: Cell No.:
B. 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:
GPUMC 5QW Notification of Intent Form (Revised 812008) Page 1

1','la111111) 0 Pea 1'ItIla 016] :13 FaN 016MII
Company Name: AWD Services_ Inc
Well Driller Contractor's Name: Larry Wells
NC Contractor Certification No.: 2603
Contact Person: Lance Wells EMAIL Address: we11s750549-a bellsouth.net
Address: PO Box 125
City: Leicester Zip Code: 28748 County: Buncombe
Office Tele No.: i 828: 683-9223 CellNo.: � 828) 215-9334
C. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name:None — Vertical test wells onl\ for testing xaumoses for a future construction vroie�t.
A new pertnit for modification of existing permit] will be requested once the project is ready to move forward,
Contact Person: EMAIL Address:
Address:
City:
Zip Code: County:
Office Tele No.: Cell No.:
D. STATUS OF APPLICANT
Private: Federal: Commercial:
State: X Municipal: Native American Lands:
E. INJECTION PROCEDURE (briefly describe bow the injection well(s) will be used)
Currentl% - Closed loop vertical wells + x3) with water to test heat rejection cavabilit es of the around.
Future — Closed loop wellfield and heat pump system utilizing water for beating and cooling, of a Future
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: November I7. 2010 Number of borings: 3
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: From to feet (reference to land surface)
Casing extends to above ground inches
(b) No X
(4) Grout Info (material surrounding well casing and/or piping):
(a) Grout type: Neat Cement Bentonite X_ Other (specify)
(b) Grout placement: Pumping_X, Pressure Other
(c) Grout depth of tubing (reference to land surface): from _500 to _0 (feet)
If well has casing, indicate grout depth: from to (feet)
GMUIC 5QW Notification of lntent Form (Revised 8/2008) Page 2

A. INJECTION -RELATED EQUIPMENT
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.
1, LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) 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 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. CERTIFICATION
Nate: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"I bereby 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 relieve 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."
Lr--
Si,
re of Pr erty Owner/A ant
?�
Print or T_ Tse Full Name and tit e6+rrpa.. 4
Please return 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]
GPUMC SQW Notification of Intent Form (Revised 8/2008) Page 3

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