WI0500232_GEOTHERMAL_20100104

Permit Number
Program Category
Ground Water
Permit Type
WI0500232 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Kit Lenton SFR
Location Address
2713 Spencer St
Durham
Owner
Owner Name
Kit
Dates/Events
NC 27703
Lenton
Orig Issue
01/04/10
App Received Draft Initiated
12/28/09
Re g ulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Scheduled
Issuance
Central Files: APS_ SWP_
01/04/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Kit Lenton
2713 Spencer St
Durham
Major/Minor
Minor
Region
Raleigh
County
Durham
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Kit Lenton
2713 Spencer St
Durham
NC
NC
Public Notice Issue
01/04/10
Effective
01/04/10
27703
27703
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
1/4/2010
Kit Lenton
2713 Spencer St.
Durham, NC 27703
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0500232
2713 Spencer St.
Durham, NC 27703
Dear Mr. Lenton,
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on
12/2812009, the Aquifer Protection Section (APS) acknowledges your intent to construct a closed -loop geothermal water -
only injection well system for the operation of a ground -source heat pump located at 2713 Spencer St., Durham. Durham
County, NC 27703. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter
2C, Section .0211(u)(2)),
However, it is recommended that you contact the Durham County Health Department, as they may have additional
construction or permitting requirements for this type of system. If you modify your system at any time, including the
addition of antifreeze, corrosion inhibitors, or any other substances to the circulating fluid, you must contact the APS to
verify compliance with applicable rules.
Thank you for submitting this notification. If you have any questions please call me at [phone],
erely,
for Mich'ic1' Rogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Raleigh Regional Office - APS
APS Central Files - Permit No. WI0500232
Durham County Health Dept.
David 3. Brown (Yadkin Well Co., Inc., 1908 Hamptonville Rd., Hamptonville, NC 27020)
Richard Bryant (All Weather Heating & Cooling, Inc., P.O. Box 758, Hillsborough, NC 27278)
AQUIFER DRO1 E TI _ N SECTION
1639 Mail Service Center, Raleigh, North Carolina 2759+9-1o36
i-ocatlkr: 2725 Capital Boulevard, Raleigh. North Carolina 276U4
;'hone 919.733-3221 FAX ;. 919-715-95B8; FAX 2: g455-715.5D481 Cusiotrwr Service: 1-577- 23-"v745
lntemet; www.ncwaterauatiN_oft
A� EAsiaI.Orionr,.urvI Emolnyer
One
NorthCarolira
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Dtc. 28, 2009 5: DOPM YADKIN WELL Vtiot=icoD No. L-295
NORTH CAROL N A
DEPARJ T OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHIERMA.L
WATER -ONLY INJECTION WELL SYSTEM:
TAPE 5-QW WELLS)
In Accordance with the provisions of NCAC Title 15A: 02C.0200. please
complete this notification and mail to address on the back page (please Print or Type information),
DATE: J2 - 2 k 20 e
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 -loop)?
Yes X Continue completing this form_
No _ Do Not complete this form. Complete other TJIC application forms for installing
either a 5A7 well (open -loop well • Lecting potable water into the aquifer) or a SQM well (closed -
loop well containing additives such as R ?2, ethanol, or other antifreeze or corrosion inhibitors).
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, stage name of
entity and a representative wlauthority for signature): }C.' f L eel Jr
B.
(1)
Maiiing�Address: 2 i 13 en c e ✓ ,!'� -
City: 40,x i� ,. , State: Zip Coder a 3 County: tid F fur
Home/Office Tele No.: Cell
Email Address: Website:
(2) Physical Address of Well Site (if differentthan above):
City: State: Zip Code: County:
Home/Office Tele No-: Cell No.:
ATJT,HORIZED 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 N o.: Cell No.:
Website Address of Company, if any:

Dec. 28. 2009 5; DOPM YADKIN WELL No, 4295 P 3
C. WELL DRILLER INFORMATION
Company Nacre:Yadkin Well Co. Inc.
Well Driller Contractor's Name: 3odv Mullis Matthew Brow;. Milton Cave
NC Contractor Certification No.: 25724A 3036 -A 3548- N
Contact Person: David 3- Brown -tR A EMAIL Address: [e-mail]
Address: 1908 Hamptonville Rd
City: Hamptonville N-C. Zip Code: 27020 County: Yadkin
Office Tele. No.: 136-468-4440
Cell No.: 336-374-8736
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: A I tv - "j 4 ti ti.,45 n.c
Contact Person: t is . � Ii.-�. EMAIL Address: iC �+ u.�� c, � Pa-11 4,
Address: Po e o X 7,5- $ ho4c. Cn v
f aea 71► Zip Code: 272.7 County: s..•�.�.,.,
Office Tele No.: (ii. Q - 114 9 _ 7r Celt No.:
E. STATUS OF APPLICANT
Private: X Federal:
State: Municipal:
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly descr
/ibe bow the injection well(s) will be used)
WGt* P I�R C � Gird L ii ryr
G. WELL CONSTRUCTION DATA
-ay
(1) Proposed date to be constructed: ] 2 r- I2- .3, Number of borings: 2
Approximate depth of each boring (feet):_ 3 z
(2) use of tubing to be used (copper, PVC, etc): .4 DPA 5,'? -1
(3) Well casing. Is the well(s)cased? (check either (a.) Yes or (b.)gelow)
(a) Yes if yes, then provide casing information below
Type: _galvanized steel black steel plastid other (specify)
Casing depth: From _ to feet (reference to Iarrd surface)
Casing extends to above ground inches
(b) No
(4) Grout Info (material surrounding well casing and/or piping): T � Enj
(a) Grout type: Neat Cement Bentonite X I•� Other (specify)
(b) Grout placement: Purnping Pressure Other
(c) Grout depth of tubing (reference to land surface): from 3 to .3 2J (feet)
If well has easing, indicate grout depth: from _ to (feet)

Dec, 28. 2009 5 00PM YADKIN WELL No. 4295 P. 4
11. INJECTION-1 ELATED 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-
L LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(I}
(2)
Include a Site Map (can he drawn) showing: buildings, property 1+ sac, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed, well(s) and
iAny ictin.r.; well(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of
the geothermal heat pump well systettl_ Label al] features clearly and include a north arrow -
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, stream, and/or highway intersections.
r. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of Iaw, 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 approved specifications and conditions of the Permit.'
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Property Owner/Applicant
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-0C Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVE' )' Oetiro Digs
A]k)IF-mtvo`4rrr Vl}..7:-.Tow
DEC_ YOU!

Dec.28. 2009 5:01PM YADKIN WELL
No, 4295 P. 5
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No.4295 P, 1
D.ec. 28. 2009 5; OOPM YA KIN WELL
FACSIMILE TRANSMISSION FORM
DATE-12 / ZY! - 9 TIME- _._____REF NO LOG NO
TO: IVC OgA - ( dell .71.. - osi s
COMPANY NAME FAX NO. PLEASE
/Aid% a E, t k.49e') ❑ LETax
ATTENTION DEPT
FROM: KA4 k1e.,. We .kic (336-)YcJ) - Ory2
COMPANY NAME ( FAX NO. PLEASE
Lilr
INDIVIDUAL DEP
NUMBER OF PAGES �'" o PLEASE �i�(AibR'S
INCLUDING THIS SHEET REPLY BY MATURE
MESSAGE: '
spot -tea- 0 wj ,F I-i to 1:.Q1... 'AA,.
17) 3 § 6)AtC I-ge f 106E
-FOR Au...YOUR WATER NEEAS-
YADKIN WELL CO., INC.
19c B HAMPT0NViLL-E ROAD
kAMPTdNVILLE. NC 27020
iAVIO J. BROWN, VICE PRES.
TOLL FREE i500Y 34829355
OFFICE (336) 4v4w r
FAX (336) 4G8-4 4S
RES [3361 40 459
-a .reWS AMERIGI • OCa LOVES YOU'
PLEASE 1NFM US IMMEDIATELY IF1OU DO NOT FIVE FAG$ P.CLE IN RILL