WI0100225_GEO THERMAL_20161028

Ro gers~ Michael
From: Davidson, Landon
Sent:
To:
Friday, October 28, 2016 1:21 PM
Rogers, Michael
Subject: RE: WI0100225
They changed to dosed loop due to yield limitations of the well and issues with grout emplacement by the driller. This
information from 2013 emails.
L
G. Landon Davidson, P.G.
Regional Supervisor-Asheville Regional Office
Water Quality Regional Operations Section
NCDEQ -Division of Water Resources
828 296 4680 office
828 230 4057 mobile
Landon. Davidson @ncdenr.gov
2090 U.S. Hwy. 70
Swannanoa, N.C. 28711
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Rogers, Michael
Sent: Friday, October 28, 2016 1:01 PM
To: Davidson, Landon <[e-mail]>
Subject: WI0100225
Landon-
t amworking on the annual report for EPA inventory. I saw where the above permit was rescinded. What happened to
the proposed open loop well? Never constructed, built but converted to closed loop, p&a? Thanks.
Michael Rogers, P.G. (NC & FL)
Unqerground Injection Control (UIC} Program Manager -Hydrogeotogist
NCDEQ-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6412
http://deq .nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch /ground-water-
prntecti o n/g round-water-a p pl ica tions
1
NOTE: Per Executive Order No. 150, all e -mails sent to and from this account are subject to the North Carolina Public
Records Law and may be disclosed to third parties.
2
Rogers, Michael
From: Davidson , Landon
Sent:
To :
Friday, October 28, 2016 2:20 PM
Rogers, Michael
Subject: RE : WI0100225
Thanks Michael. I do not have access to change the status it appears. Any guidance on that aspect? I have changed
status for other permit types.
L
G. Landon D avidson, P.G.
Regional Supervisor -Asheville Regional Office
Water Quality Regional Operations Section
NCDEQ -Division of Water Resources
828 296 4680 office
828 230 4057 mobile
Landon , Davidson@ ncdenr.g ov
2090 U .S. Hwy. 70
Swannanoa , N.C. 28711
Ema;/ correspondence to and tram this address rs subject to the
North Carolina Pubfic Records Law and may be disclosed to third parties_
From: Rogers, Michael
Sent: Friday, October 28, 2016 2:1S PM
To: Davidson, Landon <landon.davidson@ncden r .gov>
Subject: RE: Wl0100225
OK, thanks. Just a FYI , when rescinding a permit t he well status needs to be updated, i.e. abandoned, never built,
inactive (converted to another use like irrigation or closed -loop}, etc. Thanks.
From: Davidson, Landon
Sent: Friday, October 28, 2016 1:21 PM
To: Rogers, Michael <michael.roge rs@ncdenr.g o v>
Subject: RE: WI0100225
They changed to closed loop due to yield limitations of the well and issues wit h grout emplacement by the driller. This
information from 2013 emails.
L
G. Lctndon Davidson, P.G.
Regional Supervisor -Asheville Regional Office
Water Quality Regional Operations Section
NCDEQ -Division of Water Resources
828 2 96 4680 office
1
828 230 4057 mobile
Landon .Davidson @ ncdenr.gov
2090 U .S. Hwy. 70
Swannanoa, N.C. 28711
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties,
From: Rogers, Michael
Sent: Friday, October 28, 2016 1:01 PM
To: Davidson, Landon <landon.davidson 1@ ncde nr.gov>
Subject: WI0100225
Landon-
'
I am working on the annual report for EPA inventory. l saw where the above p ermit was rescinded. What happened to
the proposed open loop well? Never constructed, built but converted to closed loop, p&a? Thanks.
Michael Rogers, P.G . (NC & Fl)
Underground Injection Control (UIC) Program Manager -Hydrogeologist
NCDEQ -DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6412
http:Ude q.nc.gov(about/divisions/water-resources/water-resources-p ermits/wastewater-branch/ground -water-
p rotection /ground-water-app lications
NOTE : Per Executi ve Order No. 150, all e-mails sen t to and from t h is acco unt are s ubject to the North Ca r olina Pu blic
Records Law and may be disclosed to third parties.
2
Departmeµt of Environment and Natural ·Resources
Dlvlslon of Water Quality
STATUS OF INJECTION WELL SYSTEM
~ennitNumber: WIO/CJO 225
Pennittee Name: fr~ttA ~, eAlc,r-Hz>OG-eS
:Address: Poe, u3 ~ t,PJ?SJJ \ NC 2g7c,'f
JAN -·s 2013
RECEIVED
Please cheok the selection. which most closely descn'b(ls the :qurrent ~-~tus of y9ur jnjec,tion well .sy,~t~i:n:·
1) □ Wel!(s) still used.for injection activities, or may be in the future.
-'
2) □ Well(s) not used for injection but Ware used for w.ater supply or o~er purposes .
.. 3.) □ ·lnjection-discpntinued and: a)□ Well(s) temporarily abandoned
b) _□-Well( s) permaiien~ly abandoned
c) D Well(s) not abandoned
4) ~j~tion well(~) never constructed
Current Use of Well
.If you checked (2), describe the well use (potable water supply, irpgation,monitoring, etc), including pumping rate and ·other
. relevant informatio~. ·
741/t-=
Well Abandonment
if yqu checked (3 )( a) or (3)(b ), describe the method used -to abandon the injection well. (Include a de.Ycription ·of how the well
was sealed and tlie type of material used to fill the we.Ir if permanently a.bandoned): .
Pennit Rescission:
Ifyou ch~ked(2)~ (3), or (4) and will not use a well for injection on this site'in the future, you shouldrequestresdssioil of the
permit Do you~ to. rescind the permit? . . . · . . . . . .
· X, Yes D No
Certification:
•_'thereby certify,_ under penalty oflaw, thatI have personally examined :and am familiar wi~ the information submitted
in this. documen4 and th~no the b_est of my knowledge the information is true, accurate, BJ1d c:Qmplete."
Signature 6
Revlsea 5/05. GW/UIC-68
Date' 7
Asl1nvil f0 Rogionnl OHicm
..r-,..:/~,q~lfQr . .t10J~'lli8!.L.
-
Slusser, Thomas
From: Davidson , La ndon
Sent;
To:
Friday, January 11, 2013 3:41 PM
Slusser, Thomas
Subject: RE: UIC permit rescission
I handled it via email since we 've been communicating_ with t he applicant in that manner . I put a note in the tile and In
SI MS.
Landon
PS -a rogue Regional office met hod I know but it does save pape r and we've had a lot of conversa t ion with t his guy,
G: Land ,on Pavid~on, P.G.
f•,l'.'OE.1·, ~ • OJvili ~,~ W~te r;,~u ~it)·.
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web page: http://portal.ncdenr.org/web/wg/aps
Email co"esponderice to and.from this address is subj ect ro
the North Carolina Public Records Law and may be disclosed
co third parties unless the contenl Is exempt by statute or
9/her regulation.
From: Slusser, Thomas
Sent: Friday, January 11, 2013 3:40 PM
To: Davidson, Landon
Subject: RE: UIC permit rescission
L, we usually do those letters, but if you really want to I won't stop you; just send me a copy if you do. Otherwise, I'll
take care of it.
"'T.
phi/ 919-807~6412 I fax# [phone]
Mailing Address: 1636 Mail Service Center, Raleigh, NC 27699-1636
Physical Address: Room 640M1 Arch dale Buildirtg, 512 N. Salisbury St., Raleigh, NC 27604.
Internet Address: http://portal.ncdenr.org/web/wq/ap s/gwpro
£-moil corresponrlence to anti frnm this address may be subject to the North Caro/ins Public l?ecords Law ond may be disclosed to tlurd parties unless the content is
exempt by statute or other regulation.
From: Davidson, Landon
Sent: Friday, January 11, 2013 2:42 PM
To: Slusser, Thomas
Subject: RE: UIC permit rescission
Thanks, done. We'll send out a letter.
L
1
Slusser, Thomas
From: Davidson , Landon
Sent:
To:
Wednesday, January 09, 2013 8:47 AM
Slusser, Tho mas
Subject:
Attachments:
RE: UIC permit rescission
DOC010913-01092013083249. pdf. pdf
Thomas-
Attached is the r escission request. The only well installed was a single test well (their water supply well which they were
considering using for geothermal). Based on the yield of that well, the builder is going to send us a notification for closed
loop system. Let me know how you mark this in BIMS please which I assume we'll do instead of simply deleting the
permit? Thanks T.
Landon
G. L~ndon Davidson, P .G.
l•,all!J Jt •Dhtblon 1)1 ','.'ate, Ou ;lit(
Aq1;1tle.1 ll101&crklo c:<!<l?llllrt e
~11-i.moi, I ti,~ ~.,.i",,,t.;i,
~l,,;,.;ijle lt(,Jlo11;I Office
203:J IJ ~. Hv,\\ ....
\1•,~M•tl!I-& f,.C , 267711
ph,: allH3 6-PM
b •: R2A-J<:r::. .. 10,1!\ >
web poge: http://portal.ncdenr.org/web/wq/aps
Email correspondence to and.from 1h19 adc/res/J ts subject 10
the North Carolina Public Records law and may be disclosed
10 third parties 1.1nless 1he conte11/ is exempl by slaJUle or
other regulatfo1~
From: Slusser, Thomas
Sent: Wednesday, January 09, 2013 8:32 AM
To: Davidson, Landon
Subject: RE: UIC permit rescission
If you have the request in hand and feel comfortable that the wells were never constructed and no injections were ever
conducted, then we can rescind the permit and send them a letter saying so. Not sure if you want to do a field visit to
verify anything or not. You can email me a copy of th~ letter to get the process going faster if you want to, and, maybe
in the email, include some statement that ARO is okay with the rescission request.
Thought about the new opening! Might be a tough sell with the wife. I guess I could always come back to Ra leigh on
the weekends!
ph# 919-807-6412 I fax# [phone]
Mailing Address; 1636 Mail Service Center, Raleigh, NC 27699-1636
Physical Address: Room 640M, Archdale Building, 512 N . Salisbwy St, Raleigh, NC 27604.
Internet Address: http:/lportalncdenr.org/web/wq/apslgwpro
E-mail correspondence to and from this address may be subject to the North Caro/Jna Public Records Lew a11d may be disclosed to third parties u11/ess the conte11! is
exempt by stalute OF other regulation.
From: Davidson, Landon
Sent: Tuesday, January 08, 2013 5:04 PM
1
To: Slusser, Thomas
Subject: UIC permit rescission
Hey Th o mas
What is the m ethod for completing a permit rescission request for W I01100225? I h ave a request i n-hand, apparently
the wells were never constructed. Thanks.
Landon
PS-ever consider moving out of that rat race? Got a job opening ;)
PSS -doesn't pay as well but hey, close r to g r andparents
G. l.a11don Da vid:s on, P.G.
r•:rnr1 .P:. Di,rni .n,, ~1 ','.';;t~, Oil ;lit;;
l\qLtif~• Ptot~,uon !,ec tkrn e
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2:1 n 1.r .': • H ,., 1', ?:J
~,·.antHoo;. , •. L :..8-778
ph. 6'c6-l%·Ji;_ .,
,.~ l:;l,..1)0). -,1., i
web poge: http:ljportaLnc d enr.org/web/wg/aps
Email correspondence to and from /his address is subject lo
the North Carolina Public Records law and may be disclosed
to third parties unless the content is exempl by statute or
other regulation.
2
Permit Number WI0100225
Program Category
Ground Water
PennltType
Injection Heating/Cooling Weter Return Well
Prrmary Reviewer
michael.rogers
Coastal SW Rul.e
Permitted Flow
Facllit
Faclllty Name
Adam & Erica Hodges SFR
Location Address
359 Walnut Valley Pkwy
Arden NC 28704
Owner
Owner Name
Adam Hodges
Dates/Events
Scheduled
Orig lasue
11/20/12
App Received Draft Initiated l11uance
09/20/12
Regulated Activities
Heat Pump Injection
Outfall NULL
Central Files: APS_ SWP_
11 /26/12
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit ClasslflcaUon
Individual
Permit Contact Afflllatlon
Larry Ferguson
2731 New Leicester Highway
Leicester NC
Major/Minor
Minor
Region
Ashevili_e
County
Buncombe
Faclllty Contact Afflllatloh
Owner Type
Individual
Owner Affllllltlon
Adam Hodges
27848
PO Box638
Arden NC . 28704
Public Noflce Issue
11/20/12
Effective
11/20/12
Requested/Received Events
Additional Information requested
RO staff report requested
Additional Information received
RO staff report received
Expiration
10/31/17
09/24/12
10/01/12
10/01/12
11/19/12
Waterbody Name Stream Index Number Current Claas Subbasln
Permit Number WI0100225
Program Category
Ground Water
PennltType
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facili
Facility Name
Adam & Erica Hodges SFR
Location Address
359 Walnut Valley Pkwy
Arden NC 28704
Owner
Owner Name
Adam
Dates/Events
Orig Iss ue App Received
09/20/12
Reg ulated Activities
Heat Pump Injection
Outfall NULL
Waterbody Name
Hodges
Draft Initiated
Scheduled
Issuance
Central Files: APS_ SWP_
11/20/12
Permit Tracking Slip
Status
.In review
Project Type
New Project
Version Permit Classification
lndlvldual
Permit Contact Affiliation
Larry Ferguson
2731 New Leicester Highway
Leicester NC
Major/Minor
Minor
Region
Asheville
County
Buncombe
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Adam Hodges
PO Box 638
Arden N C
27848
28704
Public Notice u/jul (~ rrr~~')-!Di~'°l 17
Re q uested/Received Events
Additional information requested
RO staff report requested
Additiona l information received
RO staff report received
09/24/12
10/01/12
10/01 /12
11 /19/12
Stream Index Numbe r Current Class Subbasin
&.irA
HCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Adam & Erica Hodges
C/o Skip Brewer
Post Office Box 638
Arden, NC 28704
Re: Issuance of Injection Well Permit
Permit No. WI0100225
Issued to Adam & Erica Hodges
Buncombe County
Dear Mr. and Mrs. Hodges:
Charles Wakild, P.E.
Director
November 20, 20 I 2
Dee Freeman
Secretary
In accordance with your application received September 20, 2012, I am forward ing Permit No.-WIOI00225 for the construction
and operation of geothermal heating/cooling water return well located at 359 Walnut Valley Parkway in Arden, NC. This
permit shall be effective from the date of issuance until October 31, 2017, and shall be subject to the coriditions and limitations
stated therein.
Please Note the Following:
• Per Permit Condition P-art I.9, a copy of the Well Construction Forms (GW-1), which is completed and signed
by the well contractor, must be submitted to this office-and the Asheville Regional Office within 30 days Qf
completion of the injection welJ. Copies of the GW-1 shall be retained on-site and available for inspection.
• Per Permit Condition Part 113, within 30 days of injection well completion, Permittee must provide an 'as~built'
diagram of the injection system to the Asheville Regional Office APS Staff, and to have influent and effluent
samples collected.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submjt an application to rene\.y the
permit UO days prior to its expiration date. As indicated in the permit, this permit is not transferable to any person without
prior notice to, and approval by, the Director of the Division of Water Quality. If you have any questions regarding your pennit
or the Underground Injection Control Program please call me at [phone].
Best Regards,
~ ,,ii~
Eric G. Smith, P.G.
Hydrogeologist
cc: Landon Davidson. Washington Reg ional Office
Central Office Pile, WIO I 00225
Buncombe County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 Mall Service Center, Raleigh, North Carolina 27699--1636
Location: 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone: [phone] \ FAX: 9\9-807-6496
Internet www.ncwaterguality.019
An Equal Oppaminlty I Alfirmalive Action Employer
Nirthcarolina
Natural/[/
NORffl CAROLINA
ENVIRONMENTAL MANAGEMENT CO.MMISSION
DEPARTMENT OF ENVIRONMENT AND NA TJJRAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Adam and Erica Hodges
FOR TI-IE CONSTRUCTION AND OPERATION OF A GEOTHERMAL HEATING/COOLING WATER
RETURN WELL, defined in Title 15A North Carolina Administrative Code 2C .0224, which will be used for
the injection of heat pump effluent. This injection well is located at 359 Walnut Valley Parkway, Arden,
Buncombe County, North Carolina 28704, and will be constructed and operated in accordance with the
application received September 20, 2012, and confoimity with the specifications, all of which are filed with the
Department of Environment and Natural Resources and are considered a part of this permit.
Thls permit is for construction and operation of an iajection well shall be in compliance with Title 15A North
Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to
well construction and use.
Thls permit shall -be effective, unless revoked, from the date ofits issuance until October 31, 2017, and shall be
s ubject to the specified conditions and limitations set forth in Parts I through .QC hereof.
Permit issued this the ;JO ~y of Alovem 6er , 2012
~/j ~
f~charles Wakild, P.E., Director
Division of W~ter Quality
By Authority of the Environmental Management Cpmmission.
Permit #WlOl 00225 UlC/Retum Well -New Construction
ver. 07/2012
Pagel of5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
I. The Pennittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2 . This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be pem1anently labeled with a warning that it is for injection purposes and the entrance to each weU
must be sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.01070),
8 . The Perrnittee shall record the number and location of the well(s) with the regjster of deeds in the county
in which the facility is located.
9. A copy of the completed Well Construction Record (Form GW-1) must be submitted for each injection
well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 27778
828-296-4500
Copies of the GW-1 form(s) shall be retained on-site and available for inspection.
PART Il -WE LL CO N STRUCTION SPECIAL CONDITI ON S
l . Each injection well shall be grouted from land s urface to bottom of casing to reduce risk of commingling
of s eparate aquifers, and effluent being inj ected up the annulus of t_he well ('dayligh ting').
Pennit #WI0 l 00225 UlC/Retum Well -New Constructio n
ver. 07/20 12
Page 2 of5
2. At least forty-eight ( 4&) hours prior to constructing each injection well, the Permittee shall notify the
Aquifer Protection Section-Underground Injection Control (UIC), Central Office staff, telephone number
[phone] and the Asheville Regional Office Aquifer Protection Section (APS) Staff, telephone
number 828-296-4500.
3. Within 30 days of injection well completion, Permittee must provide an 'as-built' diagram of the injection
system to the Asheville Regional Office APS Staff, and to have influent and effluent samples collected.
4. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
5. The injection well system must be constructed with sampling ports so that system influent and effluent
may be sampled.
6. Each injection well must be constructed to a depth such that it is injecting water into the same aquifer that
a source well, if present, is drawing from.
PART ill -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
nam~ change of the Permittee, a formal permit amendment req11est must be submitted to the Director,
including any supporting materials as may be appropriate, at least30 d ays prior to the date of the change.
3. The issuance of this permit shall not reliev.e the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may he imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of ·this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system_ will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater which will render it unsatisfactory fo r normal use. In the event that the
facility fails to petform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Pennittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Pennittee shall be required to comply with the terms and conditions of this pemtit even if compliance
requires a r eduction or elimination of the permitted activity.
Permjt #WIO I 00225 UlC/Retum Well -New Construction
ver. 07/2012
Page 3 of5
3. The issuance of this permit shall oot relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V-OPERATI ON AND MAINTENANCE REQUIREMENTS
1 . The injection facility shall be properly maintained and operated at all times.
2 . The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted fac ility or activity not specifically authorized by
the permit. ·
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Qua1ity may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this pennit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2 . Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII-MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Petmittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number 828-296-4500, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure du(? to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Penuittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Pennittee shall take such
immediate action as may be required by the Director_
Permit #WTO I 00225 UIC/Retu.m Well -New Construction
ver. 07/2012
Page4of 5
PART VIII-PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART IX-CHANGE OF WELL STATUS
I. Toe Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0240,
Abandonment and Chang~of-Status of Wells.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0240, including but not limited to the folloy.ring:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an undergrolllld source of drinking water.
(B) The entire depth of each well shall be sollll.ded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonmeot Record (Form GW-30) as specified in
15A NCAC 2C .0224(£)(4) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to :
Pennit #WIO l 00225
Aquifer Protection Section-UIC Program
DENR-Division.ofWater Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
UIC/Retwn Well -New Construction
ver. 07/2012
Page5 of5
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: October 1. 2012
To: [8J Landon Davidson. ARO -APS
0 Art Barnhardt, FRO -APS
0 Andrew Pitner , MRO-APS
0 Jay Zimmerman, RRO-APS
0 David May. WaRO-APS
D Morella Sanchez King, WiRO-APS
0 Sherri Knight, W-SRO-APS
From: Michael Rogers Groundwater Protection Unit
Telepho11e: 919-807-6406 Fax: [phone]
E-Mail: Michael.Rogers@ncdenr.i?ov
A. Permit Number: WI 0100225
B. Owner: Hodges
c. fad~tOpetation: _
[8J Proposed 0 Existing 0 Facility D Operation
D. Application:
J. f.ermjt_ Ty_pr_: D Animal D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle D I/E Lagoon O GW Remeiliation (ND)
[8J me -Geothermal Heatlrtg/Cnoling WMerReturn Well
For Residuals: □ Land App. D D&M D Surface Disposal
D 503 D 503 Exempt D Animal
2. Pro]eci Typ1: [8J New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Information: 1XI
NOTE: Please return a completed APSARR after completing the site inspection, and collecting water samples if
system operational. At a later date, after the laboratory results are received by your office, send us a copy of the
oover letter & laboratory analytical results, which you send to the Permirtee. ALSO, please record all information on
the well tag, if present, and put on staff report. Thanks.
l8J Return a completed APSARR after the site inspection. At a later date, after sampling & the Jab
results are r~ived, please send us a copy of the letter you send to the Permittee containing
laboratory analytical results.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you rece ive this requ est fonn, please write your name and dates in the spaces bel ow, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: ------------------
FORM: APSARR 07/06 Page 1 of I
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL.Sg
In Accordance With the Provisions ofUA NCAC 02C .0200 f
" . OPEN-LOOP GEOTHERMAL INJECTION WELLS I
These wells discharge groundwater directly into the subsurface as part of a geothermal Jieating and cooling sys1 '
_(check one) LNew Application __ Renewal• Modification ,~ ,• ,. ~
• For renewaJs complete Parts A-C and the signature pag .
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications wm Be Returned As Incomplete.
DATE: 9/t'-f / /2-. . 20_&
PERMIT NO. \J\t1P l 00~~ (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non-Government:· Individual R~idence x_ Business/Organization __
Government: State Municipal_ County_ Federal
B. PERMIT APPLICANT -For individual residences, list ~ pwner on property deed . For alt others,
state name of entity mg name of person delegated authority to sign on behalf of the business or agency:
/'t t>MA ftot)i:-1 ~s
Mailing Address: ?O ~ (;>} B'
City: M eN Sm~;IJL. Zip.,~ode: 287of
Day Tele No.: fU--117-l q (,t; Cell No .: S,t.M.E.
EMAIL Address: SIC:1,,• &ftbJ~ C') ~-.it-ti .(()l"\FaxNo.: ~#Al£
c : LOCATION OF WELL SITE _; Where the injection wells are physically located:
(1) Percelldentiflcation Nwnber. (PIN) of well site: Cfl.2-1 (,Lf oS'z.-z.o OO"&unty: 6v~&E
(2) Physical Address (if different than mailing address): 3 !q W/,,+>JVT fA4f, E.({ i'lt.w-"'41
City: ~W State: NC Zip Code: ~'2-1_7_0_.'f.____ __ _
D. WELL DRll,LER JNFORMATION
Well Drilling Contractor's Name : _L..AR.R ___ ~ __ W_-_F __ -E.R._G_:='\_u_s_o __ Jv _________ _
NC Well Drilling Contractor Certification No.: _N_C._W_C __ 2..o __ 2..J_~_-_A-________ _
Company Name : P~VSoN Wec..L,. ..t, Pc.JM P 1 '-"-C..
Contact Person: ~~ l.v. ~~C1A,) EMAIL Address: ~e:.USol\J w£U..f)f)lc.{\'£. &,~
Address :'l1l ( L.f.\~ t¼lt:ll-WMf
City: L.6l <.5T£R,. -Zip Code: 2.97 ie> State: /JC., County: ~~8~
Office Tele No.: 1')8., 161-cg"t°l4> Cell No.: m -'6'f/ -~"f,1 Fax No .: pJ' (oS~ -2.fo,lO
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: <i:J.£}.J&/rl-(~Ale, ~~ (a:)L.tA/Gi :+:NC·
Contact Person: f:=E \1 1 N Gt • Gi u,CJE, EMAIL Address: g~ '10t-hA.hj Ate(!:, qe(\!0./Tt+ ~
Address: ~e, 'i''f ~
City: f\c,JbruO,vV/u,f:.. Zip Code: 2,8'1 ~) State#(,, County: \+'-,vD£.Al.SO.V
OfficeTeleNo.: Cc.i'-U>ff~-l..'2, .. S2-CellNo.: fl..l-'l.l S-·'h .. 1l.. FaxNo .:i+l -(/f;l.-2.227
F. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES )( NO -~--
(2) Personal consumption? YES ___ NO X ·
G. WELL CONSTRUCTION DATA
(1)
X.. PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
(6) below as PROPOSED construction specifications. Submit Form GW-1 after construction.
____ EXISTING Well(s) being proposed for use as an injection well. Provide the data io (1) through (6)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available.
Well Construction Date: o;f' '2.c)\ 'L Nwnber of borings: _! __
Depth of each boring (feet):._ ... J =o0'-------
(2) Well casing type: Galvanized steel __ Black steel __ Plastic..x__ Other (specify) _____ _
(3)
(4)
(S)
(6)
. thi kn . )~(..\)..$ . (' ) / ,, ,. Casing . c . ess (m. : __ Diameter m. : \I /"t
Casing depth: from: ___ to :. ___ feet below land surface -re O
I"\ ,,
Casing extends above ground --"--inches
Grout material surrounding weII casing:
(a) Grout type: Cement X Bentonite* __ Other (specify) ______ _
•By selecting bcntonite grout, a variance is hereby requested to I SA NCAC 1.C .0213(dXl)(A), which requires a cement type grout.
(b) Depth of grout around well casing (relative to land surface): from ___ to ___ feet T80
Well Screen or Open Borehole depth (relative to land surface}: from ____ to ___ feet l GO
N.C. State Regulations (Title 15A NCAC 2C .0200) require the Pennittee to make provisions for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pwnp) and Effluent
(water being injected back into the well) lines is required. ls there a faucet on:
(a) Influent line? Yes~ No__ (b) Effluent line? Yes_x_No __
Source Well Construction Information. lf the water source well is a different well than the injection
well, attach a copy of the_ weµ construction record (Form GW-1). If Form GW-1 is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will t!ie groundwater be withdrawn? (e.g.
granite, limestone, sand, etc.)
Depth: ______ Formation: Rock/sediment unit: ______ _
NOTE ; THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA lF TIDS
INFORMATION IS OTIIERWISE UNAVAIIABLE. -.
GPU/UIC SA7 Permit Application (Revised 3/18/201 l) Page2
H. OPERATINGDATA
(1) Injection Rate: Average (daily) f gal]ons per minute (gpm).
Average (daily) 2JCo gall~ per day (gpd). (2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
Average (daily) · powds/square inch (psi).
Average(Janu.ary) l.oO °F, Average (July) (fl() ° F.
I. 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.
(1) Attach a site-specific map showing the locations of the following:
• Proposed injection wells • Buildings • Property boundaries
• Surface water bodies • Water supply wells
• Septic tanks and associated spray irrigation sites. drain fields, or repair areas
• Existing or potential sources of groundwater contamination
(2) Attach a topognq,hic DlJlP of the area extending 1/4 mile from the iJtjection well site that Indicates the
facility's location and the map name.
NOTE: In most case,, a,t aqtaJ photograplt of the ptopm, parul sltowlng pmperty lines and atruclllru can be
obtained ll1Ul downloaded from the appUcable county GIS webJlte. Typkally, the property can be searclwl by
owner name or address. Tiu locatum of the wells In relatlon to property boundaries, houses, septk tanks, other
wells, etc. can that be drawn In by ltand. Abo, a 'layer ' can be" selected slwwllfg topographic contoun or
elevatlon data.
rtnT111"nl"' «,..., n-!• •--tJ__.:_ rn-·=--' '1 /t OMl\tt\
J, CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 l(b) requires that all pennit applications shall be signed as follows :
l. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively~
3 . for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the weU owner (which means all persons listed on the pro perty deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
''I hereby certify, under penaJty of law, that I have personally examined and am familiar with the infonnation
submitted in this document and all attachments thereto and that, based on my inquiry of those individua ls
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 infonnatlon. I agree to construct, operate, maintain1 repair, and if applicable, abandon the
inj ection well and al l related appurtenances in C . ce wirl tp proved specifications and conditions of
the Permit" \
RECENEOIOE~RJOWQ
SE P 2 0 2012
~t\\\\fer protectlonStdiOR
Signature of Prope 1 \<\pplicant Ae A~ -C. H~6€~
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ -Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC 5A 7 P~1mit Application (Revised 3/18/20 l 1) Page4
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RECElVED/DENR/DWQ
SEP 2 0 2012
FINISHED PLOORELEVATIONS
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/56
Permit Number WI0100225
Program Category
Ground Water
PennltType
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael. rogers
Coastal SW Rule
Pennltted Flow
Faclll
Facility Name
Adam & Erica Hodges SFR
Location Address
359 Walnut Valley Pkwy
Arden NC 28704
Owner
owner Name
Adam Hodges
Dates/Events
Scheduled
Orig Issue App Received Draft lnitJatad !nuance
09/20/12
Regulated Activities-
Outfall NULL
Central Flies: APS_ SWP_
09/21/12
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classlficatlon
Individual
Permit Contact Affiliation
Larry Ferguson
2731 New Leicester Highway
Leicester NC
Major/Minor
Minor
Region
Asheville
County
Buncombe
Facility Contact Affiliation
owner Type
Individual
owner Affiliation
Adam Hodges
PO Box638
Arden
Publlc Notfea Issue
NC
Effective
27848
28704
Expiration
Waterbody Name Stream Index Number Current Clan Subbaeln
AVA NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Chartes Wakild, P.E. Dee Freeman
Secretary Director
September 21 , 2012
Adam. Hodges
.Erica Hodges
PO Box638
Arden, NC 28704
Dear Mr. and Mrs . Hodges:
Subject: Acknowledgement of
Application No. WI0I0.0225
Adam & Erica Hodges SFR
Injection Heating/Cooling
Water Return Well System
Buncombe County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on September 20, 2012. Your application package has been assigned the number
listed above, and the-primary reviewer is Michael Rogers.
Central and Asheville . Regional Office staff will perform a detailed review of the provided
application, and may contact-you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section, requests your assistance in
providing a timeo/ ~d complete response to any additional information. requee8. · _
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questio~, please contact
Michael Rogers at (919) 807-640q [e-mail].
SO~A.
for DebraJ. Watts ~
cc: Asheville Regional Office, Aquifer Protection Section
Larry Ferguson -Ferguson Well & Pump, LLC
Kevin G. Gqice -General Heating & Cooling, Inc.
Permit File WI0l 00225
AQUIFER PROTECTION SECTION
1636 Mafl Service Center, Rale',lh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \FAX: [phone]
Internet. WWW.ncwaterguaflty,org
Ao Equal Opportunlly I Afflrmadve Action Employer
Groundwater Protection Unit Supervisor
-_ . A:.: .
.....
.. "==!!~--~
State of North 'Carolina
Department or Environment and Natural Resources
Division of Water Quality
Aquifer Protection Section
Regional Staff Report
To: Aquifer Protection Section Centra1 Office
Attn: Eric Smith/ Michael Rogers
ApplicationNo.: WI0100225
Regional Login No.: AB.Q
From: Jonathan Stepp
Choose ao item. Regional Office
L GENERAL SITE VISIT INFORMATION
1. Was a site visit conducted? ~ Yes or O No
a. Date of site visit 11/15/2012
b. Site visit con.ducted by: Jonathan Stepp
c. Inspection report attached? 181 Yes or D No
d. Person contacted: Skip Brewer and their contact information: [phone] ext __
e. Driving directions: Hwy 191 to Rt into The Cliffs At Walnut Cove to Rt on Walnut Valley Parkway
IL PROPOSED FACll.JTIES FOR NEW AND MODIFICATION APPLICATIONS
F:~l'i'lity Clas~ificatbo: _ (PleM-i,e at~ach oompletecl rating she~t t,, be. :;itta~ht!d fo isi-11ed pt<rmlt_)
.\re !h~ new lrr?almem fru;ifitit'S acte<11.mte fr,1· tl"1e t;-11e or M\Soil.' and di~poi;ttl sy:,t.em? D Yes or D No
if no , c:,pfain: --
Are ~i t~ c:ondition:< (soi ls, dt:pth to water tahle, et.:) c~msistent with tl1e submitted rep(.ll'tiS':' 0 Yes D No O l\ifA
If uo. plea~~~ t;-;-(pfo.in: __
4. Do the plans and site map represent the actual site (property lines, we11s, etc.)? f.81 Yes D _No D N/A
lf no, please explain: However, the proposed septic system on an adjacent lot is closer than 50 feet from the
pro posed location the o pen-loo p geothennal injection well.
:'.-i . •~ 1he prop.,xd rr~:sidu~I.~ fl1l)trngemen1 pUm :·lrfoq1.1.i1 ~·: 0 Vt:s [] lvo [J j'\_'A
lfnt\, ph~a)ler.,\r,J.:.,in ; __ _
6. Are rhe propon:etl app!i~~iitinn n ttc:S \e.g ., h,v<.imufa:, nutrie111 l acceptable? r·1 Yts O No[] N i.A,
If no. pka5e-explain : ·-··-·
1. An~ there nny se-tbai::k ,,l)tiflkts for proposed trt~im~~nt-storagt~ and diaJ){i'>al s ites? D Yes or D No
If yes, Mtach ;i 1mi:p slmwiug ,~ont1kt ru:e as.
ij, b rhc pro~Kt~!Xl <l !' ~-,x igti.ng gmu ndwater moniturin~ progn.im ad.eqimte: f.J "'i'\~$ D N\'> D NIA
If nu .. e~plair, anct rt.eom111~11d ,my tilrnngt.-s lo fhe g;rom11iw~1ter monitilring 1-)rogr!lm: --·· _
9. Fo.r rc-sidtn'J.l.:,1, wi.H sc.:-1sot1ul. or other (C,<;fJ_•ictio.us be l\'i:[uircd.? 0 Y1~:s D N(} (] NIA
! f ~eJt. ;1ttm:h I ist of s ite:!. \Vith re.<.:rri:::tionli (Certifieation B)
FORM: APSRSR04-10 Page I of4
ID. EXISTING FACILITIES FOR MODIFICATION AND RENEWAL APPLICATIONS
l. Arc t·lwrc .ippr,:1pl'i11.tcly ccrtHfod Op·-!r/J.10.rs: in Ci;arg ,:: {ORC5!,s foy ruc-fadfoy? [j Yc:s [J No O ':{/A
ORC.
-· ,\re th,: design~ f),lfl.i»tcnnnt-1." r-ind oµernl io;1 ('f the tn::11r1iJcnr foe iiitits :i.c!'.:'quatt:, for !he type N' Wfl.Sfe. and di-:pN,al
sy:,tem'? [] Y-es or O !'Jo
lf 110, please t•.1;p!ai11: ____ _
:3. A,·c th~~ :silc .:vndilfom; (e.g., ~(>ils.. tt~pography. d~plh lo wtil<:'r table. et~.) maiiW1ined appl'i~pl'i,l.ldy :::nd '.kfoquately
!!,,-;si.mil:iting ,he wnste? [] Yes or L I No
.lfno. pteasc-, exp la1n: __ _
4. Has the site changed in any way that may affect the permit ( e.g., drainage added, new we Us inside the compliance
boundary, new development, etc.)? 0 Yes or [81 No
If yes, please explain: __
.5. is thtl rc-sidtml~ nmm1geme11t pl.m tt<lt.'<llllltt!'? Ll Y 1~5 nr O N0
ff no, plcn:;e e;.;pbin: ~
n. /\re the. exi,<;t ing applico,!i~1n rates (e.g., hycl1·:tulic, nutrient; still acceptal-,le-? 0 Ye~or ON,;)
lf n~i. pk.we t'Xplain: __
7. J,; tb.c ex.isl i:H~ groun,'.h-v<1t.cr monitoring :program ad\!911:1rc? 0 Y c)> D Nn O N; A
If no, ~-.xplLtil\ ~nd re.commend any ch;\nges to the grnundw:ik':f mouitoring pmgram :
S. Arc rh<:t(~ MY sdb,tek ~-011flicrs for cxi-;ting trcatnt<'11t. stonig9 ond disposal <:>iti1,? il Y{\s or O No
If yt•,;. attaC'h a map showing w.ntlrct <1re~s.
9 . Is the description of the facilities as written in the existing permit correct? 18] Yes or D No
If no, please explain:
'l:j", -:1: ;,. ... II ' f I ., 1 .. ~J r-1 ,... r-1 N r~~, ~-I\
0 f,1 • ... tOH.""!-nK'>!Htornrg \""~: :..., propt~r,.v c..:OllSd'i.tct,:-c Hnt: ~,,.~;-n~rL '~' l'~:,; .. JI ',.) LJ j "'"' / ~
lt'n,), pleuse explain:_
1 i, ~\re rhc 1nonitorl11~ well c-.:K11dinat.;:s cm,l."~'l 111 BlMS·? 0 Ye.:s-0 N(, 0 N/A
Jf ru J fi H { I 11 ·r ) 1Ju. !)iii;;lSI.:' C1)r□ t;l~ r lC 0 . owmg ,exp.am 1~) C 1 w;ccssary
Mo uttoring Well La.titudc umgitmle
~ ' " ·, t ,, -,,
' " ... ; , .. -
·-I ., .,. I ,, -_ .. , " -,;.. ' ,,
·-I " .. ' "
i ~-Hab a :·cvi~w l1C al! !>-df°:-monitorin g d~11P. been conductt..'l.i (.e.g., NDMR, NDAK UW J'! 0 Ye!-i er O Nii
f'k;aS(~ srnnm:1rii.t: ,my findi11g:,; rc1;i;ulti;1g frum lllt$-review: __ _
I ::.\. Are there uny perm ii r,irn.nges .ueetled in order to ad<lres;, ongoing BlMS vmiati\1m;'1 0 Y~s m i7 No
If y,~s . plt:ti::tt explain:
i 4. Checi-.. all l harnpp!y :
! ·7 ~::-(~ •.:(mJ:.>follll: C isst!eS
i ... i l'-]t,lirt~1i1 t;l'vio!a.ti,,n --...
i"'J C1m\::u.lv u1Hkr j(;(
[j C urrcnil~ ;mdc!r r;;,1r:lh\1·:H:1·1
Pl<.,i::,~ .~:,..phiin ,mJ fll::ich ,my ,foc;11111r.nf~ !!1:il m2.y l1 ~dp dnrdy tm~1,,;:rh.::..\t1Tmamr.; {i c: ... NOV. i'J(1U. ,;-fc f
t 5 il,W'.' ali .::l,1 r,pli.1nc~ Jfo u:s/..:N1ditiow; u1 ll1s~ cx't-;t.ingpcnm[ h1~cn :"Jtis[id'~ 0 Y6 0 i\'.,_; [j i'llc",A
.iCn~1. pkc.18.: ~:-.p!:\in : _____ _
16. Are there any issues related to compliance/enforcement that should be resolved before i ssuing this pennit?
0 Yes O No 181N/A
If yes, please explain:
FORM: APSRSR 04-10 Page2 of 4
IV. REGIONAL OFFICE RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? D Yes or 18J No
Ifycs, please. explain: The location of the proposed,septic system on the ad jacent lot is closer than 50 feet from
the proposed location of the geothermal water return well.
2. List any items that you would like APS Central Office to obtain through an additional information request
Item Reason
3 . List specific permit conditions recommended to be removed .from the permit when issued:
Condition Reason
The property line on the The open-loop geothermal injection well system should be a minimum of 40 feet
south-east side of the lot from the south-east property line so that the proposed septic system on the
should be identified by a adjacent lot will not be any closer than SO feet from proposed injection well
surveyor. system.
4. List specific special conditions or compliance schedules recommended to be included in the pennit when issued:
Condition
5 . Recommendation:
Reason
0 Hold, pending receipt and review of additional information by regiona1 office
0 Hold, pending review of draft permit by regional office
D Issue upon receipt of needed additional information
t8J Issue
D Deny (Please state reasons: ___)
6. Signature of report pn,paror: ..ii.,.,~ ~
Signature of APS regional~o; ~= /;,-c Ls ,./D 0o., DA V 1 O S::OA I
Date: 1(/et,l::i. o/2
FORM: APSRSR 04-10 Page3 of4
V. ADDITIONAL REGIONAL STAFF REVIEW ITEMS
NotT-oScale
FORM: APSRSR 04-10 Page4 of4
•
Not To Scale
Proposed
Septic
7638