WI0600083_GEO THERMAL_20111027

Permit Number WI0600083
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
eric.g.smith
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Kevin Hershberger & Susan Keene SFR
Location Address
324 Shagbark Ct
Mount Gilead
Owner
Owner Name
Kevin
Dates/Events
NC 27306
J Hershberger
Scheduled
Orig Issue
10/27/11
App Received Draft Initiated Issuance
10/20/11
Regulated Activities
Heat Pump Injection
Outfall f\u:...:...
Central Files: APS_ SWP_
10/27/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
David J. Brown
1908 Hamptonville
Hamptonville
Major/Minor
Minor
NC
Region
Fayetteville
County
Montgomery
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Kevin J. Hershberger
8709 Wild Magnolia Dr
Raleigh
Public Notice Issue
10/27/11
NC
Effective
10/27/11
27020
27617
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
10/27/2011
ICevin 1. Hershbereer
Susan D. Keene
8709 Wild Magnolia Drive
Raleigh. NC 27617
Subject: Acknowledgement of Intent to Construct Type 5QW injection Weil System
Permit No. W10600083
324 Shagbark Court Mt. Gilead, NC 27306
Dear Kevin & Susan:
On October 20, 2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-oniv
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 recluired,notifcation 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 I5A Section 2C Subchapter .0211(u)(2). Additionally, you should contact the Montgomery 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.Roeers@ncdenr,eov if you have any questions.
Sincerely.
for Debra Warts
Supervisor
cc: Fayetteville Regional Office - APS
APS Central Files - Permit No. W10600083
Montgomery County Health Dept.
Yadkin Weil Co., Inc. (David Brown)
Deeck Mechanical (Gary Deeekl
AQUIFER PROTECTION SECTION
1636 Maii Service Center, Raleigh, North Carolina 2769t-16 6
Locat/or,: 272E Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] FAX 1: 9119.715-058t; FAX 2: 91-7 5-5Ct481 Customer Service: 1-5 7-623-6746
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Oct, 19. 2611 549PM
No. 1217 P. 1
FACSIMILE TRANSMISSION FORM
DATE:A / %q /Gf' TIME: _REF NO. LOG NO.
TO: ire fa_20¢7C-q17(!— - he 4 4,
COMPANY NAME • . FAX NO. PLEASE
SitifEYIESEty
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FROM: Wec�, r.� _ CJ e C� .� � ( )
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MESSAGE:
�e4,:ri•Cej-9.qr J G 4_
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FOR ALL YOUR WATER NEEDS"
YADKIN WELL CO., INC.
1906 HA1. PTONVILLE ROAD
_ S-4A MPTON VILLE. HO 27020
I '[ DAVID J. DROWM. VICE PRES.
TOLL FREE (BCC! 2453355
` I., OFFICE ICY 4684d440
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