WI0500493_GEO THERMAL_20120307

Permit Number
Program Category
Ground Water
Permit Type
WI0500493
Injection Water Only GSHP Well System {5QW)
Primary Reviewer
eric.g.smith
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
James Brame SFR
Location Address
3311 AvonRd
Durham
Owner
Owner Name
James
Dates/Events
NC 27707
Brame
Scheduled
Orig Issue
03/07/12
App Received Draft Initiated Issuance
03/01/12
Regulated Activities
Heat Pump Injection
Outfall NU LL
Central Files: APS_ SWP_
03/07/12
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
David J. Brown
1908 Hamptonville Rd
Hamptonville
Major/Minor
Minor
Region
Raleigh
County
Durham
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
James Brame
3311 Avon Rd
Durham
NC
NC
Public Notice Issue
03/07/12
Effective
03/07/12
27020
27707
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
Az 1
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
March 7, 2012
James Brame
3311 Avon Road
Durham, NC 27702
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0500493
3311 Avon Road, .Durham, NC 27702
Dear Mr. Brame:
On March 1, 2012, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -ante
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:
I. 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 .021 I (uX2). Additionally, you should contact the Durham 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.Rogers(ncdenr.gov if you have any questions.
Sincerely,
for Debra
Supervisor
cc: Raleigh Regional Olfice - APS
APS Central Files - Permit No. W 10500493
Durham County Health Dept
David Brown - Yadkin Well Company
Olena Vorontsova — Green Horizon
AQUIFER PROTECTION SECTION
1636 Mall Service Canter, Raleigh. North Caroline 27699•1635
Location; 512 N. Salisbury St., Raietgh, North Catalina 27604
Phone: [phone] FAX: [phone]
Internet www.ncwateraualftv.o[ l
An Equal Opporlurdly i Affirmative Action Employer
tiv0A4
acts
One
Carolina
aurally

Mar, 1. 2012 12:32PM
03/01/2012 10:37 4199578965
No. 1937 P. 2
PAGE 01/03
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RECEIVED 83-01-`12 12:10 FROM-
TO- NC DENP P&5 P002/005

Mar. 1, 2012 12:33PM
D3/81/2012 10.37 9199579965
No, 1937 P. 3
PAGE 02/N3
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RECEIVED 03-01-'12 12:10 FROM-
TO- NC DENS P&S P003/005

Mar. 1. 2612 1 2:33PM
03/01/2012 10:V 9199570965
No.1937 P. 4
PAGE g3/93
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O. MiliCTIOMITIMATIMEQUINONT
Aitaclt a disgmui!bowing the eery- iris layout or proposed mvdiftesdasr ot fas letleotioa celvipment and mother
piplapftublag sssaolated with the lalectiop eperstion. ' to arasutfactotrr's brochure may provides aopptsmontaq
Information.
I. LOCATION OF MILD)
Attach two copies dumps shtr++►leg the ikllowing infoonatlem
CI) Include a Site Map (can bs drawn) ehowlag; pvopettp litres, maws wax bodies; potential
mutes orgroundcadie car>tamblatioti gad the orlOON 30lt of on6 distnaceo buivinen 16o proposed ►veli(s) (tad
slap existing well(s) or waste disposal Madden scab as mile lode or drain dale iocurcrf Attila 209 Rep of
the geothermal t pump wall ayatvm. r4,1 all frra10102 c}cadYeoia tllrii5ltilr. tea niu
The 5isa Map arise show t n subject property to :Malign to the l urrcreding tress by coin at loon tyre bad
reforroaco pubic soh cods, sissu n audios hlgbway Wawa
(2)
3. CIICATGON
Nata: This Permit Alrp3iCStiaaubssidIsperson eppei'JngOn iUse
recordsd IcgaZlrCoperty deed.
'1 hereby sett*, under pouchy Of MRe, that I kayo persoustiy atnminoci and sat fatn;iiax with Tso latOrM11004
Omitted in this documeot end all asetchm thereto attd Oat, based on Ivy *dry or tfsase ltadlvidaals
immediately twangb10 far abtstitirg said lt+fortaatta3r, I ballevo tint the latbr:noticm to erne, savage and complete.
. I am amps that hole ate slgullIcaut poohies. rocked vg the pcosibiiiyy or &co sod baprisotta:ent, for so6soltting
ildso agree ro construct, upscale, raektettr, scpair, sad lEspplicable, abandon User 14se lea wall and
all tolattut appurtenances is accords= Wltbtbe approved spe4if#ostiOas and candltbn►s onto Permit.''
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Sigaoiore officpirty atvnrslAppliesat
Print or Typo Nil Name mad Size
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Please return two copies ofilsecompi¢ted Appltcatlott paoi a toy
North Caro Thic Dot DWQ
Aqui*Prott ctlen Sectto *UXC Program
1636 Maii Service Cater
Rataigb, VC 2/6991636
Telegkoge 1j919) 715.933
RECEIVED 03-01-'12 12110 FROM-
TO -
NC DENS P&S
P004/005

Mar. 1, 2012 12:33PM
No. 1937
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RECEIVED 03-01-'12 12:10 FROM-
TO- NC DENR P&S F005/005

Mar. 1, 2012 12 , 32PM Na. 1937 P. 1
FAcSIMLF TRANSMISSION FORM
DATE: 2 / 2- / l L TIME: REF N4, LOG NO.
TO: Va. FgA4 (fig) Yo GYq‘
COMPANY NAME
ATTENTION(
DEPT.
FAX NO. PLEASE
DELVER
❑ IMMEDIATELY
FROM: Kid- &jc. C A Co r r, LTA " 90,T
COMPANY NAME
INDIVIDUAL DEPT
FAX NO. PLEASE
❑ REPLY
NUMBER OF PAGES PLEASE ORIGINATOR'S �
INCLUDING THIS SHEET REPLY OY SIGNATURE _
MESSAGE: �+
S W h.■ �r' �F; rec -1-11bh. 14r .ieJ a r+a a*-e,
^ROR ALL YOUR WATER NEEDS
YADKIN WELL CO., INC,
1908 MAMPTONVILLE RCAG
MAMPT0NVILLC. NC 27020
❑AV}❑ .r. BROWN. VICE PRES,
'TOLL FREE IBQO) #4.0 93'!S
OFFICE 1336) 460.44.4
FAX [phone]
RES 13381 460.4659
-woo NEw'6 AMiPICA • GOO 1.0v1S Yo
`RECEIVED 03-02-'12 12:10 FROM -
PLEASE INFORM US IIRMEI}L4TAY IP YOU DG NDr FIiECE7Va FACCIIMiLE IN FUL
TO- NC DENP P&S P002/005