WI0100194_GEO THERMAL_20120202

Bullman Heating & Air
Fit RESMENTUL WELL Co sgmucnox RECORD
North Carolina Depmbn6tofEnvironment and Natural Resources- Division of Water Quelity
Wr6L[. CONTRACTOR CFWn1 ICATION * 3421
1. WELL CONTRACTOR: i 9. WATER ZONES (depth):
Ovid Stratton
Top
Bottom
Top
Sott r
Well Corttraotar (lndivMduaq Name
: Top
Bottom
Top
Bottom
Top
Botlam
Top
Bottom
Well Contractor CompM Name-
7hfckt al
258 Ngdh Turkey Creek Rd.
?. CASING:
Depth
Dlanidw
Weight Material
StrestAddreBs
Tap
Bottom,
Ft -- -
Leicester _ _ NC 28748
City or Town State Zip Code
t 828) 683-92�� - -
Area code Phone number
?� nFLL iNTOriia'n� wn:
WELL CONSTRUCTION PERMIT# IO 00'I 94
OTHER ASSOCIATED PERMIT#(if apprirable)
SITE WELL ID #0f apokable)
j
S- WEU- USE (Check Applicable Boob: Residerrtlal WatK Supply ❑
DATE DRILLS} 2128J1 _
TIME COMPLETED AM ❑ PM 0(
4. YYELL. LOCATION:
cITY Fairview couNTY Bunoombe
30 Thousand Oaks Blvd.
(Street Name. Numbers, Community, subdivision, Lot No., Parcel. ZIP Code)
TOPOGRAPHIC I LAND SETTING: (cheek epprop" box)
EXSlope ❑ Valley p Flat []Ridge ❑ Other E16V. 2386'
LATITUDE 35 ° av DMS Oki DO
LONOITUDE S2 ' 21 ' R•Mt " DMS Oft DD
Labidellongibideswrce, i3PS cropograOicmap
potation of well must be shown on a USGS topo map endevached to
this lbrm ff not U aing GPS)
S. WELL OWNER
i3vathia Buff
Owner Name
30 Thqusand Oaks Bivd.
Meet Address
Fairview NC 28730
City or Town �Stixte Zip Code
$(_ 28)
Area code Phone number I
B.VdELLDETAILS, (3) Geothermal. Bores
a. TOTAL DEPTH: 300'
b. DOES WELL REPLACE EXISTING WELL? ; YES ❑ NO ❑
a WATER LEVEL Below Top of Caging: 14i
(Use "�" if Above Top of Casing)
Tap Bottom Ft
Tap Bottom Ft
8. GROUT: Depth Material Method
Top-9-- Bottom 21Y Ft Bentonite Pour
Top 21' Bottom 3DO' Ft Pea Gravel Pour
Top 13pttom Fi.
9. SCREEN: Depth Diameter Slot Sloe 111101terfal
Top Bottom Ft in. In.
Top Bottom Ft in. In.
Top Bottom Ft in. In.
10. 9ANIWGRAVEL PACK:
Depth sus
Top Bottom Ft
Tap Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom
_ 1
1
1
1
. 1
1
1
1
I
• 1
. 1
I
12. REMARKS:
Material
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH t 5A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS NIA FT. At#ove Land Surface"
"Top of casing terminated aYor below land swf= may require /9Q„�,( 10 � _ 212112
a variance In accordance with 15A NCAC 2C .0118. SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD (gpmj. NIA METHOD of TEST N/A. David Stratton
i. DISiNFECTION: Type NIA �mount NI PRINTED NAME OF PERSON CONSTRUCTING THE WELL
{' "-If of.s8ti>Ip 10ila j-16t bivisimi ot.ftfat, Quality Form GW-1a
` i1 Fl :t l igiii Ng ffۤ9-j$j; Ph6f% i (bill j6-7.605 Rev. 2109

9001£00d
S8d HN3a ON -01 E0Z6£898Z8 -WOH9 Z0:TT ZT,-90-£0 aRAI3038
. Hultman. Heating & Air
/. WaLL coNTRACTCR:
wqjQ0NMU0LQN RECENECA)ENOW0
North Carolina Demmm of W mmnem and Natuaal Rmurres. DMaion of Wader ibality 101 Z
WELL CONTRACTOR CERTIVICATION * 3421
Q�
Well CorivacW (IndiNduary Name
g
WIN OoAe&= Company Herne
_258-Nort1 Turks-y Greek R_d.
SOW Addren
Ctty or Town Steve Zip Cede
( 828 S 833'9223- -
"a pads Phone number
7. WELL INFORMATION'
wELL cor+sme- roN PERmn' W iaJ4 00194
OTHER ASSOCIATED PERMITIRN eppmab*
VIX WELL ID V apptsoblel
#. WILL UK {Check AppliWA OW; Raldendel Weser Supply 0
DATE DRILLPD i•2a$I 'I
TIME COMPLETED AM 0 PM I(
L aiM� Vir•=71IrL1
crrr: Fairview o0UNrr,. U Q2mbe_
30 Thausarld go—!% ftd,.
n►% Numbom CommunIV, Subd[ dvn, Lee No., PMW.1p Oode)
TOPOGRAPHIC 1 LAND SI?I'a'ING: "M aawWao MW
61119iope ❑vlaneq ❑Prat aP+dge ❑mwE#ey, 238V
UATrME � y' 30 ' 39-01= "OMSOR DO
LorgWUDE 82 o 211 e2= OMS OR OD
LattgrdeftngNoe sourear: JL6PS a0pographlc map
(►ookbo of weft moatbe a►rawn an a USGS topa maA amdmuched ro
►his I*" ifmat uafsp GPM
6, WELL OWNER
Cvnthia Buff
OrrrA( Name -
30 ThoUland Qeka j3jVd.
Street AWnaee
Fairview _NC_ _28730
Ctlr or T&"" - - - - Slate ZIP Cone
t,
Aran code Proms number
0. WILL DETAILS: (3) Geothermal Hares
a. TOTAL DEPTH.129 -
b. 00 WELL REPLACE dKWITIN G VALL7 YES © ND p
e. WATER LML Below Tap of Ceeing: ," FT.
Pee °+• It Above Top of Cuing)
d. Top op emiNIO IE N/A FT, Above Land Surtaor
`Top of sawing terminaled prier below land auftw may require
a vedenoe in al- o ance with 16A NCAC 2C .0116.
e, YIELD (gpm):1M __ METHOD OF TW N!A
L OWNFiCTION- Type Amount NIA
g. WATER ZOW-9 (depa): Aquifer protecWn SedOn
Tap Bottum
Top Whrn
Top Bottom
Top Bptmm
Top Bftm Top BOUT_
_ r
i71ieinlsaal
7. CASIN 1- Depth
Otantatnr Might Material
Top 9otom
Ft
Top Cotmml
rL
Topes Bottom
Ft
8. GROUT: Degfh
Material McMod
i Tap 0 soawnLV
Ft 9entonb Pour - - -
Tao eo%DmJD0L_
Ft. Pee Gmyel Pour
Top Bottom
Ft_
a SCREEN: depth
04wwWr Stet She MadarW
Tog $aftm
Ft in, in.
Tap a Mff
Pula. In. rt
Topes_ aftm
FL--]n. In.
S0. &WOR AVEL PAWL -
Depth
Blra Molladal
Top�m
Fl��
rep Blattam
FL
Tap I3ot�m
Ft
= 11. DRILLING LOG
Top saftm
Formation DeaWpdon
1
1
1
1
1
1 Z. REMARKS,
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH i5A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO TFIE WELL OWNER,
SIGNATURE OF CERTIFIED��[TFiA�LR DATE
0"Id Stratton
PRIr11T>cD NAME OF PERSON CONSTRUCTING THE WELL
ib.WN1iHaf eer"aloven W. biviskm 6? WNW 6MI a wtl fisaoIbt wlilt,
Fomn OW-1a
Rev. 2100
EB 39vd ONI SBOIA83S QMV MISS69$LB
WIT ztaazl96/sa

CenQ1l21i1t2tral Files.-, APS 9WP
Permit Number W10100194 Permit Tracking Slip
Program Category Status Project Type
Ground Water Active New Project
Permit Type Veralon Permit Classtflcatlon
Injection Water Only GSHP Well System (BOW) 1.00 Individual
Primary Reviewer Permit Contact Affiliation
aric.g.smith Chad Surrett
driller
Coastal SW Rule 258 N Turkey Creek Rd
Leicester NC 28748
Permitted Flow
Facility
Facility Name MajorlMlnor Region
Cynthia Buff SFR Minor Asheville
Location Address County
30 Thousand Oaks Blvd Buncombe
Fairview NC 28730 facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
Cynthia Bull Owner Affiliation
Cynthia Buff
30 Thousand Oaks Blvd
Dates/Events Fairview NC 28730
Scheduled
Orig Issue App Received Draft Initiated tssuarrCe Public Notice Issue EffaCtIva Expiration
01/26/12 11/15M 1 01/26/12 01/28/12
Regulated Activities
Heat Pump Injection
Outfall i•it.1LL
Waterbody Name Stream Index Number Current Class Subbasin

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
1/26/2012
Cynthia Buff
30 'Thousand Oaks Blvd
Fairview, NC 28730
Subject: Acknowledgement of intent to Construct Type SQW Injection Well System
Permit No, W10100194
30 Thousand Oaks Blvd, Fairview, NC 28730
Dear Ms. Buff:
Dee Freeman
Secretary
On 11/15/2011, the Aquifer Protection Section (APS) received notification of year intent to construct a closed -loop water -only
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 ir>,jection well system contains only potable water,
2. The injection well system is constructed in accordance with well constructkm standards specified in North
Carolina Administrative Code Title ISA 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 Noith Carolina
Administrative Code Title 15A Section 2C Subchapter .0211(ux2). 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 Michwl.lingersliyncdenr.goy if you have any questions:
S' cprely,
C
�' 6WP�4
for N)ebra tts
Supervisor
cc: Asheville Regional Office - APS
APS Central Files - Permit No, W10100194
Buncombe County Health Dept
AWD Services, Inc (Chad Surrett)
Bullman Heating & Air (Joey Bullmmn)
AQUIFER PROTECTION SECTION
1636 Mall Serrlce Center, Raleth, North Camlina 27699-1636
Locallm 512 N. Salisbury St, Raleigh, Nodh CaroW 27604
Phone: [phone]iFAX: 919MT-5496
Internet YM-n0rraterouelk9A
An Equal Oppnu l AtAmiaM Mme Empl "
One
N5f Carat' na
aturallry

III
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-QW WELL(S)
In Accordance wit€ the provisions ofNCAC Title 15A: 02C.0200, please
compiete this notification and mail to address on the back page (please Print or'Iy¢e information).
ueifx,jqq
Well Type Confirmation: Does the proposed system circulate potable water a U1 (no additives) is
continuous piping that completely isolates the fluid from the environment (i.e.
closed -too )?
Yes V_ Continue corn pleting this form.
No _ _ Do Not complete this form. Complete other UIC application forms for installing
either a 5 A 7 welt (open -loop well inIectin potable water into the aquifer) or a 5QN[ 4 well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze tar corrosion inhihimrs).
PROPERTY OWNERS}JAPPLICANT(S)
List each Propefty Owner listed on property deed (if owngoy a i>< ijesss or graver new, agency, state name of
entity and a representative wlauthority for signature):_.
(1) MaiIinLx Address: :30 -rAOvSan j G&VS 12(V&
City: �AirJiC0 State: kZT.iF Code: � County:_ �M+ t,
I loine/Oflice Teie Nti.jJ 3-0'77$ Cell No.:
1:1110ii A��dress: Website:
(2) Physical Address of Well Site (if different than above):
City. State: Zip Code: County:
Horne/Office Tele No.:
(f2kNkm
ALIT H0RIZED AGENT OF OWNER, IIF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner Authorizing Agent to install and operate U I C eve€1)
Company Naive:
Contact Person: EMAIL Address:
Address:
City:
orrice 'relr:, No.:
State:
Website Address ot'Company, if «ny:
Zip Code: -_ county:
Cel I No.:
t W 1iIJW iOW No iiii:atiun oI*Inmit Dorm (Itcvis«i S/2008) I"ie-C I

C
WELL DRILLER INFORMATION
Company Name: AWD SERVICES. IN
WeII I)riIIer Contractor's N�ime: s'A 50 rrre: _
NC Contractor Certification No.: 3 00
Contact Person: Larr, Wells EMAIL Address: Wel1050549La7Bellsouth.net
Address: 258 North Turkey Creek Rd.
City: Leicester Zip Code: 28748 County: Buncombe
Office TcleNo.: 828-683-9223 Cell No.: 8M215-9334
1). H I?AT IIUM13 CONTRACTOR INFORMATION (if different than driller)
Company Namc: _ �.Uuk 0.t) '2A cr
Contact Parson �Cr 1i �i� rY �, l 4_ _ EMAIL Address:
Address:-]( r� h+r'�
City: A5Le4�1t= _ Zip Code: �� County: e.&nccrri�,
Office Tele No.:Ceii No.:
E. STATUS OF APPLICANT
Privalc;: x I=ederal: Commercial:
State: Municipol: Native American Lands-
V. INJECTION PROCEDURE (briefly describe how the injection weil(s) will be used)
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: IIAd1T ;� Number of borings: 3
A ppr oxi m ate depth of each boring (feet):_ _ a Q r
(?) Type Oft U bi ng to be used (copper, PVC, etc): _ iH0?6 1;o
(3) Wcll casing. Is the well(s) cased? (check either (a.) Yes or (b.) No below)
(a) Yes ifyes, then provide casing in Formation below
Type: ^galvanized steel black steel plastic other (specify)
Casing depot: From to feet (reference to land surface)
Casing extends to above ground inches
(b) No Vell
(4) G;rout Info {material surrounding well casing and/or piping):
(a) Grout type: Neat Cement______ Sentonite
(h) Grout placement: Pusnping_____ PIUSSUre
(c) t;rnut dcpfh of tubing (reference to land surface): from
If well has casing, indicate grout depth: from
Ci "U"I11C 5QW tdntl6cation of Intent Form (Itcvkod 8I2008)
Other (speci t'y )�-
Other
to (feet)
to (feet)
Page 2

H. IN,IECTION-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.
LOCATION OF WELLS)
Attach two copies of maps showin6) the following information:
(1) Include a Site Map (can be drawn) showing: buildings, property lines, surface water bodies, potential
sources of cytound water contamination and the orientation of and distances between the proposed wells) and
any existing wel[(s) or waste disposal facilities such as septic tanks or drain feids located within 200 feet of
the geothermal heat pump well system. Label all features clearly and include a notch arrow.
(2) The Site Map must show the subject property in relation to the surrounding area by using at least two faced
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 herd?y certify, under penalty of law, that i have personally examined and am familiar with the information
Submitted in this document and all attachimnts thereto and that, based on my inquiry of those individuals
im rnediate Iy responsible for obtaining said information, 1 heIieve that the information is true, accurate and complete.
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 appr Ycd speciii `otit�iis anO conditio s of the Permit."
Signature of -Property Owner�plica
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Fu[1 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
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
61111/1 HC 5OW Notilicalim ot'jmeiv form (Revised 8/2008) Pit-c 3

I
1 I �i� I I ■ � ._ _
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Buncombe County Tax Lookup - Property Card
Page 1 of 2
COUNTY OF BUNCOMBE,
` 7. ' NORTH CAROLINA
� Web Property Record Card
9595-87-8995-00000
Owner Information
CYNTHIA S BUFF
Address:
107 BREVARD RD
ASHEVILLE NC 288o6
Property 3o THOUSAND OAKS
Location: BLVD
Taxing Districts
County: Buncombe County
City:
FAIRVIEW FIRE
Date Printed: 11/15/2011
Parcel Information
Total Property Value: 583,500
Status:
Active
Account:
8156229
Deed Date:
1/6/2005
Deed Book/Page:
3890 / 0028
Plat Book/Page:
0059 / 0170
Legal Reference:
WARRANTY OR SPL/COMP
TRANSFER
Location:
3o THOUSAND OAKS BLVD
Class:
RESIDENTIAL
Neighborhood:
RES/AVG/LINPLAN 20
Subdivision:
GLEN T HIGGINS
Sub Lot:
2
Ownership History
Transfer
Price Legal Deed
Qualified
Vacant
When
Account
Seller
Date
Reference Book/Page
Sold
Names
i MCCARTHY
WARRANTY OR +
IROBERT P
ol/o6/05
$325,000
SPL/COMP 3890 / 0028
No: X
No
8072967
MCCARTHY
TRANSFER
KIMBERLY
ANN
Assessment History
Year Account 11 Acres Land Bldgs Other Assessed Desc Exemptions ! Deferred I Taxable
I iiiliJl
1
2011
lox❑
18156229
8x56a29
1.49
1.49
165,2001502,500
165,20014s2,600lo
' x5,80o 1583,500
1,517,806
0
10
i0
10
1583"500
1517,800
2009
18156229
1.49
165,20oA52,600
0
1517,800
10
10
517,80❑
2008
8156229
1.49
165,200
452,6o0
0 1517,800
10 10
1517,800
2007
18156229
1.49
165,2001452,600
a
517,800
j 0
10
1517,800
2oo6
18156229
1.49
j65,200
452,600
0
517,800
10 10
1517,800
2005
18072967
.1.49
144,2001293,1o❑
0
337,300
10
10
337,300
2004
18o72967
1.49
44,200
366,40o
Eo
41o,600
10
10
410,6o❑
2003
8072967
1.49
144,200
366,40010
41o,600
10 10
410,600
2002
8072967
1.49
144,2-00
366,40v
v
41o,6vv
o
10
41o,600
2001
8072967
1.4g
2a,1o0
24a,5oo
0
260,600
10
10
1260,6001
Land Data Total Acres 1.49 Land Value:
Acres 61-,.200
Other Innpravernents Value: 1 5,8va
Segment# Units
Description
1 11.00 Each IHOME SITE
Improv#
Description Year
Units
Il
�GARAGE 12010
570 Square
I
Feet
http://www.buncombetax,org/PropertyCard.aspx 11/15/2011

Buncombe County Tax Lookup - Property Card
Page 2 of 2
k
11.49 Acres �I,ASS I
Building Structures
Res.
Sq Bsmt
Style
Bsmt
Year
Grade Condition Value
Building ID
Feet SgFt
Finished
Built
1
2.o-STY 4902 2266
CONVENTIONAL
0
1993 C N 502500
Refinement
Description
Built -Ins
Units
Foundation
CONVENTIONAL
Full Bath(s)
jg
Roof TY/MT
GABLE W/ COMP. SHGL.
Half Bath(s)
12
Roof Structure
IWOOD JOIST
Fireplace/Gas Log
11
IIFloor Finish (HARDWOOD Bedrooms(s) �4
(Interior Finish DRYWALL,/SHEETROCK Basement Gr # Cars 11
I Heating I FORCED AIR
r Candition I FORCED AIR/AC SYSTEM
Section
SgFt
# Stories
!BASE AREA
Gil o
�-oo
ASE AREA
16a
Ii.00
BASE AREA
1 o
z.00
BASE AREA
;6
x.00
WOOD DECK
11 o
1.00
OOD DECK
28
ji.00
WOOD DECK
Fab
11.00
PATIO
1228
i.00
(WOOD DECK
1808
'1.00
BASE AREA
118o
1.50
]BASE AREA
16a
11.5o
iBASE AREA
,5?5
Ii.00 I
GARAGE
�576
11.00
(OPEN PORCHp244
U-oo
OP
'1«om
Bps
Total Building Value: 502,500
http:/1►n+ww.buncombetax.or-/PropertyC ard. aspx
zM
11/15/2011