WI0100165_GEO THERMAL_20110805

Permit Number W10100165N.
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility Name
John & Niki Posten SFR
Location Address
48 Spy Pointe Ln
Fletcher NC 28732
Central Files; APS SWP
08/05/11
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Jeff Moore
PO Box 71
Hot Springs NC 28743
Major/Minor Region
Minor Asheville
County
Buncombe
Facility Contact Affiliation
Owner Name Owner Type
Individual
John P Posten Owner Affiliation
John P. Posten
2000 Old Eastwood Bvld
Asheville NC 28803
DatestEvents
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
08/05/11 07/25/11 08/05/11 08/05/11
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name Stream Index Number Current Class Subbasin

�fimja
NCDENR
Noah Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
815/201 1
John P. Posten
Niki T. Posten
2000 Old Eashvood Blvd Unit C-305
Asheville,'NC 28803
Subject: Acknowledgement of intent to Construct Type 5QW injection Well System
Permit No. W10100165
46 Spy Pointe Lane, Fletctier. NC 28732
Dear Mr. & Mrs. Posten:
Dee Freeman
Secretary
On 712512011. the Aquifer Protection Section (A -PS) received notification of your intent to construct a closed -loop wafer-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:
1. The injection well system contains only potable water,
2. The injection well system is constructed in accordance with well construction standards specified in Nonh
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
The required notification form and associated maps have been completely and accurately subniitted-
Failure to comply with all of these conditions constitutes a violation of the Noah Carolina Well Construction Act and North Carolina
Administrative Code Tttie 15A Section 2C Subchapter .02111(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, nr
municipal ntles and regulations may result in the assessment of civil permities.
Please contact Mike. Rogers at [phone] or Michaei.R02CMa,ncdenr.uo if you have any questions.
cerely,
U ub( oa>v
for Debra 41 arts
Supervisor
cc: Asheville Regional Office - APS
AP5 Central Files - Permit No. M01('01 65
Bunenmhu County Health Dept,
Cleat -water Well DTI-b ng
l3ullrrran 1-leai.inc L. Arr
AQUIFER PROTECTION SECTION
1636 Nlail Service Center, Rakaigir, North Carolina 27699-16H
Locatb n. .272 8 Capital Boulevard, Rale[gh. North Carolina 27614
Pnone 919-733.322, ti FAY 1 919-715-058E. FAX [phone] Custorner SCN c8: 1-8'7-623.6748
vnterrret. www,ncwatemuaitt .oro
An EQ4Lal C;pnorwnn� ,Fri m3hur- F v )' ErnployEr
N AhCarolina
Natun ly

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOT]IFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM
TYPES W_IVEL,LUS
In Accordance With the Provisions of NCAC Title 15A 02C.42DO
Print or type the required information and mail to address on the bath page.
DATE: 2 ! x) ! ., 20 1I (Do I Los
WeA 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.
9lasecAQ0_ )7
Yes L- Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing
either a SA7 well o n-loop well iniectin+ 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 OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed (if owned ky a business or government agency, state name of
entity and a representative wlauthority for signature):_-
(1) Mailing Address: Ibp a b ! A•�T'4�iDat��� `: - r�1 sT t'. �3U�
City: N2i� I LmL� State:�_ Zip Code: :Z��,I< D �_ _ County:&" &P
HomelOffice Tele No.: 9 Z FS 15"p C ] Z $ Cell No.: _
Email. AddreWebs ite:
(2) Physical Address of Well Site (if different than above): $ gY�� FoI'.?rw_L&'w
city: - Ler'ni+ g__ State: A lr Zip Code: County: PaO&V_g ,�g -t
HomelOffice Te1e No.: 5 SJr S 1 la t-'s 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:
Confect Person: EMAIL Address:
Add:
City:
State: Zip Code:
Courrty:
Office Tele No.: jI
Website Address of Company, if any: RECEIVED IDENR 113V4�
quiferS�r.00r,
GPUfUIC 5QW Notification of Intent Form (Revised &7008) JUL 26 Zo fi Pw I

C. WELL DRILLER INFORNIATION
_Company Name: � !
Well Driller Contractor's Name: _ LEA- L"
NC Contractor Certification No.:
Contact Person: ut + '
Address:
EMAIL Address: � �11;; G� ' / �c 10 co;l
City: '�j 0J J _ if ;� Zip Code: ` County: --
Office Tele No,: ` �'' �� Cell No.:
D. HEAT PUW CON CJ'OR INFORMATION (if different than driller)
Company Name:
Contact Person:_�r+r�� -- - EMAIL Address_
Address:
C it y: _ r} C. Zip Code: County:
office Tele No.: U- - o /Cell No.
E.
N
G.
STATUS OF APPLICANT
Private: �`` Federal:
Commercial:
State: Municipal: Native American Lands:
INJELTiON PRQCED RE (biefly describe how
�' the injection well(s) will AAbe used)
L
WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: : 1 Number of borings: _2
Approximate depth of each boring (feel):
( (copper, PVC, etc): �1 / )� 3`4
2) Type of tubing to be used co
(3) Well casing. Is the well(s) cased? (check either (a.) Yea or (b.) No below)
(a) Yes if yes, then provide casing information below
Type: Alvanixed steel black steel plastic other (specify)
Casing depth: From to feet (reference to land surface)
Casing extends to above ground inches
(b) No L�
(4) Grout Info (material surrounding well casing andtor piping):
(a) Grout type. Neat Ceanent Bentonite t'�Odwr (Specify)
(b) Grout placement. Primping, Pressure Other
(c) Grout depth of tubing (reference to land surface): Rom to (feet)
If well leas casing, indicate grout depth: from to (feet)
t_:PUI[1IC 3QW Notification of Intent Form (Revised 8R008) 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.
I. 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 teet 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 roust 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, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the a [ i,,�roved specifications and conditions of the Permit."
Si . azure of Property Owner/Applicant
p6rnt t. r Type Full; Name and title
Sign f Property Owner/Applicant
dos
Print or Type Full Name and title
Signature of Authorized Agent, if any
Print or Type Full Name and title
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section-UIC Program RECEIVED � DENR 1 ❑M
1636 Mail Service Center Aquifer Pra-adw Sn-dion
Raleigh, NC 27699-1636 JUL 25 2011
Telephone [phone]
GPUMC 3QW Notification of Intent Form (Revised W2008) Pop 3

A r
wo�
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RECEIVED I ❑ENR 1 DM
AquiferPmtectson Section