WI0100168_GEO THERMAL_20110825

Permit Number WIOIOO168
Program Category
Ground Water
permit Type
Injection Water Only GSHP Well System (50W)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Central Files: APS SWP
08/25/11
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Bryant Smith
Driller Well
PO Box 204
East Flat Rock
NC 28726
Facility
Facility Name Major/Minor Region
Michael Goebel SFR Minor Asheville
Location Address County
42 Cedar Hill Dr Buncombe
Asheville NC 28803 Facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
Michael Goebel Owner Affiliation
Michael Goebel
Owner
42 Cedar Hill Dr
Asheville NC 28803
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
08/25/11 08/15/11 08/25/11 08/25/11
Regulated Activities
Heat Pump Injection
Private residence, single family
Outfall
Waterbody Name Stream Index Number Current Class Subbasin

A4*wA
WDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H- Sullins
Governor Director
08/25/2011
Michael Goebel
Martha Goebel
42 Cedar Hill Dr.
Asheville, NC 28803
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. Wi0100168
42 Cedar Hi11 Dr.
Asheville, NC 28803
Dear Mr. Goebel:
Dee Freeman
Secretary
On 08/15/2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -on]\
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 North
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
3. 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 A211(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.Rovers a nadenr.gov if you have any questions.
4S' a ly,
or Deb atts
Supervisor
cc. Asheville Regional Office - APS
APS Central Files - Permit No, W 10 100 168
Buncombe County Health Dept.
Bryant Smith (Green River Well & Pump, P.O. Box 204, E. Flat Rock, NC 28726)
Kevin G. Guice (General Heating & A/C Inc,, P.O. Box 843, Hendersonville, NC 28793)
Butch Heatherly (Heatherly Construction Inc., P.O. Box 323, Etowah, NC 28729)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699.1636
Lorailor..728 Capita! Boulevard. Ralai h. North Carolina 27604 ne
Phone: [phone] t FAY 1 919-715-0588; FAY2: 919.715-6048 I Customer &arvice: 1.577-623�748 0 M olina
1ntemet� wma.rtcwalerqualiy.erg i rn (1p00NJ7rl1ly Kfirrrrianv' Y ir.1M Emplove' N * atup ally

NORTH CARt7LI KA DEPARTMENT OF ENVIRCNNMENT AND NAn%AL RESOURCES
NOTMCATION OF HMXT TO CONSTRUCT OR OPERATE JiNMCTION WELLS
EEL Accae kn= VYstb me PrvVis M of 15A NCAC 02C MOO
CL DSED-LOOP LW TICK NLY GEOTIMMAL INJECTION WELLS
Tlmse wells eircaiara p owWo water only es pest of s podmvmd bcafmg wad cooling srtern.
Throe vsweUs aa'�pamilited by sale" eod do acre esquire an iufivid and push when they are consbuded in
accordance with the ndm of 1 SA NCAC 02C AM &W dLU Nodoe b submhftd prior to cvnatsuction.
Print ar Type 14brerotion and Mafl to the Addrerr an the Lost Page
DATE: 20 JPERKM NO. (to be filled in by DwQ)
A. STATUS OF VVFL.L OWN= (choose one) Nc-Gaverruw= Indivit4m l Raideace +ti y
Go► art ant: State
I► unteipat,
BusinesaAX8& za60 t
County Fedrrral
B. WELL OWNER —Jar mdivifdtaal reside mess. list wb owner on pi Terly deed. Far all, timbers, state rlatase of
evdty lam, oasnc of psssno, n delegated mcdwritrl to_sign on behalf of tbae busincas ar eB�Y
Cr�f
C eA&-Q-+ra- .rn.
Mailing Address. T• LL B,�j. -3
City: ` 'fir a % 4 � State: zip Cade: �-� �_ r1 Caity ; k-+MA..1-,Qe �!
Day Telc lro.: ^^r 1 g Z Z cmj N 2 7, I i p
EMAIL Address: ech. � Ci o� G No.: 2 Le iof; 3 L (,
C. LOCA 70K OF WELL SrrZ-- Where the injection wells am pbysic Jly located:
(l] Pried Identiffcadoe ldlseaber(PN) ofwell sde: Gota.)r. A.f
LAI
(2) FhysiircW Addma (if difereta tm mai�addressj: ► � Dr
City: �_ carman --�� _ State: V1�C Lip Code: _ -w L4
D. WELL DRILLER I?QMFaVUT10N
Well Drilft Cboltwrrol 5 Nmm }3�
NC well Dvilliag Contsreetor Catifincadm No..
Company Namc.< -I!!AU—S P s v e r _ 1,
Cacrtacs Person: 1��e arn-t � Wt. l
Address:
2 e f'e 5 +
aty iL zip CoaebQ b--
DfBne Tole 1Jo4 Call No.:
GRYWC 54w Norftludoe (MwLm+d YI&WI1)
Ci
State: Ak—cotufty►:
e
Nsa>�h
►'VQ.T
Papa t
RECE D [ DENR 14WO
A0[t1F;R•va6rFrT10N AECT10N
AUG 16 2011

E.
F.
HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: v n Zy! ij6 G �— ,
Contact Person: EMAIL Address:
Address: P.D. A ac 8 Y 3
City: �,Sa,Hr r��/1: Zip Code: w? State: oW— County: VS
Olf"ice TeIe No.: G 9.2 2JS� Cell No.: cfeJQ2/ V-?Z 77 Fax No.: 22-2
WELL CONSTRUCTION DATA
(1) Number of borings to be constr G *: 6e Depth of each boring (feet): JOO
* If e:rfsting writer supply wells will be used then provide the in in item (4) below.
(2) Type of tubing to be used (steel, PVC, etc); ?e e-
(3) Well casing. If the well(s) will use casing then provide the tie (steel, PVC, etc.), diameter. depth.
and extent of casing appearing above ground:
(4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonite** Other (specify) _
** By selecting b=o mile ®off a variaeoc is hereby requemd to 15A NiCAC 2C A213(d)(1)(Al which inquires a cement type grout.
(b) Grout depth of tubing (reference to land surface): from to (feet)
If well has casin& indicate grout depth: from to (feet)
G. WELL LOCATIONS — Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearly and include a north arrow.
(2)
Attach a site -specific map showing the locations of the following:
* Proposed injection wells
* Surface water bodies
* Buildings
* Water supply wells
* Property boundaries
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater conwminaiion
Attach a topographic map of the area extending 1/4 mile firm the injection well site that indicates the
facility's location and the map name.
NOTE. In mast cases, an aerial photograph of the property parcel sho ingpropefi° lines mid strerweres can be
obtaGted and downloaded from the applkwAk rornty GIS webske- Typkalty, the properry can be searched by
owner moan or addrnL The h adion of the wells in rrefarim to property boundaries, horses, septic tanks, other
wells, eta can then be drawn to by hared Also, a `[ayes' can be selected showing topographic contours or
elevation data.
GPUMC 5QW Natificarion (Revised 3/1&Ml 1) Page 2

IL CIERTMCA77ON (to be 9*W as required bW.ow or by that person's nntborimd agent)
1$A NCAC 02C .021 l(b) requires dat all permit applicatkwu shsll,be signed as follows:
1. For a corpawlen: by a m-spm oble corporme officer;
2. Sw a parmeretitip ar sole proprkomship: by s general Fartreer or the proprielur, respectively
3_ for a municipality or a data, fi+deral, or other public agency. by either a principal owcutive
officer ertsnking publicly alomW official;
4. for all otbars: by the well awaer (whirii means All pi as deeO
H an Authorized agent io ■igabW as behalf of the applicant, dmm aspply ■ letter tdgmed by the
applicant fiat aamesf and smbartma tLeir agent to aim thin application an their behalf.
"I hweby tidy, under pe=11y of law, dM 1 have personally ensr, irmd.st,d am fwni inr with the inft m don
subzOted in this docwnent and all attaehrnestb dwrfta and that, based an ray Inquiry of those indrvid aia
immediately napaasible for obbWag said infaamlon, I believe beta the inrounsdon is tree, accurate and
complete. I am sways that there are zWPL6cwd penalties, iwhxft cite *s+ibility of fures andimprisonment,
for s& m 1amg Moe �. I agree to oo=uct, vp=ktr, mums" m*c, and if applicable, abandon the
icjecoon well and all rr:bu d appuMuu xs in acconiar:ce with the apprwod specifications and conditions of
the PerMA."
Signatum ofPmpaM OwaedAppii t
Pew or Type Full Nance
Signature of Property OwruWApplicaW,
Print or Type Full Name
Sigoanu'e of Authorized Agent, if any
Print or Type FUL. Name
Submit tba complde application padtgge to:
DWQ - Aquifer Protection Section
1636 MaH Sen&c Center
Ral6igh, NC 27699-1.636
Telephone [phone]
GFUAW 5Qw HoWadkm (ti, WbW .VlV 9t l)
RECEIVED IOENR Own
►OlIFFP PRn'rF . ON Sf. CilON
AUG 15 2011
ftc 3

Plug IC 2011 11:2819M General Heating S R-C, In 6266922227 p.2
NORTH C:AROLINA DEPARTMENT OF ENV1R0hMDM AND PiA LM AL RESO]RCES
NOTE"CATION OF 1%7ENT TO G'MSTHUC[' OR OPERAIM EgnC !(ON WIZLL.4
In Acwtdmw WFh the Provisions of 15A NCkC QX AM
CLQML)-LOOP WATER -ONLY GEOTHERMAL WELLS
Tbaaee wells ckcubft pohble wader o0Y as past of a goaeiroamd imiing and mc&* trysMm
Tbesa wc9m we "�ponkt ed by role" and da ant regtaire mm bubviAm! pcmk when dw am eommucted m
woordruce with des salsa of l SA NCAC 02C A90 Red dib Nodes is sussed prior to com Mae rim.
MM or S'Mm 1qk vmWom m dJdaU ao Av Ad&vm an do leer Pie.
DATM 39 PERmo r NO. (w be fined tn by DWQ)
A. STATUS OF WELL OWNI R (dwore Ono)
tend- Inttl*id>tasi iie awme )( Hva'
Go cffaw at suit Municipal County Fidaaatl
B. WELL CPAWM - For individual rea dwmms, list W& ownter on property deed. Fkmr ail others. stfe =w of
sadly Md r na of person deieg mod mdm ft no- sip on bdolf of *v business or agency:
� t
lm r i t tar 1.l ran ❑ +�1.^ ;
`loin a r �'ti� e` J1C
Maa7ingAddeeas: +=
Cry' � L%r . ". �- _ 8dte: [:ode: `�~ . • y-C.outt►ty: �.►a r r�R rti.
n� r� NO-._ `'' �� q iz, cal! ��` -Z L :� i d -
EMALL Addrero: F�u�=l�..vr i••�. ati�G�L:L Fax 3 LLB
T^! � •c/4rt
C. LDCAMOtf OF WELL SM -- VMcm dte IW*moo wdls are pl ocWly latcmd:
(1) Pwmd Mmti ws&n N mttbwMM of veil sips• ` -M - 78 "oCGDG Coumty: BvN ca �K i!E
(2) PhpkW Addrm(R'drdntatlw address):
city Lam. .. 45� r► c�� sum: m z"P ca&: _ ;_`L. f _zBr0 3
D. WILL. DRELLER EWPOKMATMN
well Dr2Hnc csa+truckola NOW H-
NC WcU Daiipeng Cmr§ctgrCertiflcatian Na:
195 ! r._ir_ , i • /
+ M + JL i
� • as � F r
t funks .%Qw Nodf amim (P,-% ed VIMO111 Prtn i

Rut 10 2011 11:28AM General Heating 6 R-c. In 8286922227 p.4
13. Cl?irMI:CATION f to be signed as requb*d below or by that persata I s muft rixedd agt~ )
15A NCAC 02C ,021 l(b) requirrs that all parmit applicafiorts shall be signed as follows:
1. for a corporation. by a respm uible corporates officm;
2. for a partnership or Sole proprietorship_ by a general partner or tfzt: proprietor, rmpCetirely,
3. for a municipality or a staiv, federal, or other public aWey- by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (wWch pNM a,[l pgwjMs listed an the Z MgM dead).
If an authorised agem is oWdeg an beluM at flw appbmut, lkcs empply a tether signed by the
applWant that acmes mad aalkar =% their ag+eat to sign thin apptiiratimm ou their behaIL
"l hereby certify, to der p=Wty of law, thin l have peramrWly examb" and am familiar with the infimnsficn
submitted in this document and all attaehmems fimato trnd that based am my inquiry of those Individuals
immediawly responsible for obtaining said inf6fzu don, T believe that the Wfarmation is true. accurata aQd
complete. 1 am swam that duets are signi5ramt peralfir.% inct fling the pomibigft of fines and imprisonment,
for submitting false ual'onnadom I qpm to consauct, apamtr, nraintsin, repair. and if applicable, abandon the
iejection well and all related apt in acoardw= with the ap"oved spedfiicatioms area caoditions of
the permit"
C .7 7
Sigteature of Property QwnedApyOkApt
P&i or Type Fall Name
Signature of Property Oww/App icaw
Hd'f IhtQ 6 IC Lr
Print or Type mull Name
Sigrnpue of Audwrired Agern, if any
Priem or Type FUU Name
Submit the complete application packcsp to:
DWQ - Aquifer Protection Section
1636 Mail SeMcc Center
Ralrlgb, NC I7699-1636
Telephone [phone]
CrPU/MC 5QWNoriSea<iad [Rniaar] 3IIa17Ai 1) PVC 3

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Smith! Eric
From: Butch Heatherly [heatherlyconst@yahoo,coml
Sent: Wednesday, August 24, 2011 6:39 AM
To: Smith, Eric
Subject: Goebel signature page
Eric
I wrote on the site plan I sent you the grout being used is bin_ anite G wells 300 ft deeQ ea.
I will foward the signature from Goebel. �T
Thanks Butch Heatherly

Smith, Eric
From- Butch Heatherly [[e-mail]]
Sent: Wednesday, August 24, 2011 6:40 AM
To: Smith, Eric
Subject: Fw: Geothermal notification
Attachments: Geothermal notification-Goebel.pdf
--- On Tue, 9/23/11, NIlchael Goebel, NID <MGoebet rrbrbi.com> wrote.
From: Michael Goebel, MD <MGoebely{ b_rbi.cam>
Subject: Geothermal notification
To: "Butch Heatherly" <heatherlvcoast-a v ahoo.com>
Date: Tuesday, August 23, 2011, 11: 08 AM
Attached is the completed document.

Godwin, Tonga
Full Name: Mike and Martha Goebel
Last Name: Goebel
First Name: Mike and Martha
Company: Biltmore Forest client
Home Address: 42 cedar Hill Drive
Biltmore forest 28803
Business: 8282362636
Mobile: [phone]
E-mail: [e-mail]
E-mail Display As: Mike and Martha Goebel jmgoebe!@brbj.comj
E-mail 2: [e-mail]
E-ma112 Display As: Mike and Martha Goebel (mgoebei@bellsouth,net)