WI0100068_Complete File - Historical_20220311

WDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
3/23/2009 `
David Walters
Jean Walters MAR 25 Zuu9
140 Cardigan Circle
Lilbum, GA30047 ^ '? ^ Recianal Office
Protection
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System '
Permit No. WI0100068
4900 Preserve Road
Sylva,NC 28779
Dear Mr. &Mrs.Walton:
In accordance with the application submitted to the Underground Injection Control (UIC)Program that was received on
3/23/2009,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 4900 Preserve Road, Sylva,Jackson
County,NC 28779. 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 Jackson 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(919)715-6166.
Sincerely,
` �A_ Michael Rogers
�i Environmental Specialist
GPU-Aquifer Protection Section
cc: Asheville Regional Office-APS
APS Central Files -Permit No.W10100068
Jackson County Health Dept.
Joey Bullman(Bullman Heating- 10 Red Roof Lane,Asheville, NC 28804)
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 27699-1636
Location:2728 Capital Boulevard,Raleigh.North Carolina 27604 One
Phone:[phone] FAX 1:919-715-0588;FAX 2:919-7154M i Customer Service:1.877-623-6748 OCarolrolina
Internet:v�ww.ncwatemualiN.om [�LFuLN
An Equal Oppomunily l Atfinnarive Action Employer atu all

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1 - f • �
WRTH CAROLINA
DrPAR_MENT OF E;\V[R,-0NN:'ZNT AND NATURAL RESOURCES (NCDENR}
NO1IF'ICATl1.ON OT 3NTGNT TO CONSTRUCT A,CLOSED-COUP G1EOT13rRlv[AL
WATER-ONI,Y IN.1Rf:TIO,N WELLSYSTElh(:
I
' _I<YiPE --!2'4TY 'VVELUS)
LIt,Accordance with the provisions ofNCAC Title ISA:02C.0200.please
coml?I+'tr lhis notif cnyion end mail y:o address oyt Che Gael.page;plc:ctse Pcint ut imL infornletion),
1 C11 •rj-Pe C'anfrrmation: Does the propased system citdtilate potable walg only tno additives)is
contimtom pipit g that completely isolates the fluid fropi the em'irnnnieatt(i.e.
Yes _ Cnntinve cumpleting !his room
Do Not ct>rnplete this form. Complete other UK.application forms for insuiliin<_!
eithera 3A7 well(ngen-loopwell 'n•ectinr potable water into theagoi&il Ora SUM well (closed-
bori tvel! con(ainine1Acjdi}i�ues.uch as R-22,ethanol,or ether anlii'redzc or enrrt).ion inhibltnrs);
:4. 1'li'JF.�A2'1".y" CR>•'�VCR(,g)/AFPt.1f:AN'e'!S)
l.ict epch Proven_,Owner listed on properl` deed(if owned by a business or governmenr agency. ctaW niarne of
cttritp arul a frilt'es;:nliRn'e w/at.nhsirily Ior�ignmure):.._L ler.9.`9� 4 ,y
(?:t Nlai?ing,:\ddrvvs: /:°f 0—�'RRIo } ✓ G2C _ ____. ,_._._.. ----- _—. __._.._.
City _�../6���✓-- ---- _. State.:(�'.�_Tinf.'oda,�oa�j
Httntd(Jty)ce'frb�?lo,:. 77D -56 w-9.77 C'eIl No.:
L:ntaii Addn:ss:
C') Phy:ticulAddressof'We11Site(ifr:ftcrcntthanahevel:!�90O
t..ilpf._ ✓ ._.._._ ,/`G /ip Code:.Z.877`� C:otnuy: CSCiJ
Statr.
Home' ?I'lice T'ele No..
.. ;ell
i . AUTHWRICd51) AGPN_r Of,c• WNTUL W.AkNY(if tilt: Per»itApplicant tl�es not nr.•n site suhje,a propon-tg,
aaaoh a larger rrm: the proFern-owner autl-nrizing Agent io instal(and operate UkC ivell)
Company Natlitr
Contact Per.;orr.
•----Y__.__.__— i;�1Al1.Ad tt;ss:
ZipCodc:
Wabsile Addrem,,pFCol»pam.iu:ny:,—.
tir!ri;:C �t•IA- RECEIVED/DENR/DWQI,.,'sri
Aquifer Protection Section
MAR 2 g 2009 .

------ RwUnCMVII-LbINU PAGE 03
tiY
• Wfl,LL DRILLER(NrORMjk'r(().N
CNIDIC! llcr>nw .10SWs- ---EMA LL
Addresx; _ZS 2_16102y-� ......
Offiwe Tele-NO.. W 1 No,;
D. JilLAT PUMP CONTRACTOR T.INFORMATION(if different than driller)
Comuliny Name:
Address: to F-ast-
Ciry'
017kc-Tele Cell No.:
STATUS OF APPMANY
llrlvm,.-: 4--',`�
=Sco ­." Milmicipal;_ NaziYCAnierican Lzinds:
P. INJrCTION FH04C.EDuR!� (briefly dl'crlbc hOxv 111cifliection well(s)will be used)
.............. ................
Cl. WELL CO3NSj-RjucTjoM DATA
lurnber of borings:
Appv,,xitnait depth of cash borim-,
(2)
j3 dle is cuser'? cililer(a.)Yes or(b.)No bekw)
�al
hlac; mel 13I&WC (juler(srecify)
Zso tl�
611��;oui fill,in .1. .6
tat umoi !.vl7u: Nc:j;ie!ncjj: (Am Nuvcilv)
(1)1 Oroin PILICemeNI: Fampim..—
kO (,told U) land stufac&!); FrOT-1
im 2 b
.
if ;feel)
"ell hz!:!asing.ir-..:1czt13 Prool depth: fromto (reef)
INVIL!C r.Qw N,ww�vn"w

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1d. 1i�;JCC"d'K}y-P,7.1.,A:fBiID EQUIPMENT
Attach a diagr:.m 511oEvitw. the ::nrinecri lavOin or proposed rnudificatiOn of the inje xior.equipment.pad exterior
piuingin,dning associated frith the: igjection Operation. The manufacturer's brochure magi provide suppicrtentary
:lf rornlatlon.
1. [.f)CATIt)IY4?F '.YF.LL{S) .
rVlaclt teva aupits of!naps sht:h'ing the Fallowing information:
(1) Jnclude a. Site 4lap (car be dnwn) showing: buildings, property litres. surface, water bodies. potential Sol:rce:: of bmupolvater contamination nud 1he urientafion of and distnnceS bettvee<l-lbe proposed welt(s)and
any "iNling wetl(A)or-astc disposal faciihies such as septic tanks or drat,field;ioeated within 200 feet Of
the gco0wnnat heat pump well syv=- !_abet all featur=5 clearly tmd i{1t�lude a north arrow.
12% The Siic Ndap must shc", the SuhiC;a property in relation to INSLUTOUnd.jng area by using at icasrl+.vo
rciereno::poinis such a>toads,5rcams. antVor higthway in[ersections.
J. CERTIFICATION
voin 111N,i' omit Applicflti,ln aortae 1:c signed by cacOs person uppens•ing om the
o ernreied Jcgg1 pro{icrtv,d2y d-
"I hereby cerii"V. olldet Pent+l.y of let that I have personally examined and am Fanriiier with il're information
5uhmils.ed in This decument ::qd sill atrmdltnelltc Umrcto and that hasetl tin in,: ingttity of those individuals
i!nrnedintely resnonsihic fur obtniriing said intifrrnation, I believe that the inforrnalimr is Lille. accurate and complete.
I sun alvare tllal there arc siCznifcanl peon, L', including.the pOssibilito or lines and imprisotnnent, for•sub glitung
laisc inttarrnatii:n. 1 agree to,catastn:ct, np rate maintain: repair, and J applicable, abandon the injection wcil and
til related apptnicnanecs in accordance 1c;:h c approv d s crficatious and conditions of the peratlt_-
tii{,maalre.. Yrr./pertyUl9pt�licaril -----_._._.._._._.._._.....
Prinl ur Tyoe Full vamc.and tide
�ignaturnpfPro{n�(lwrrgrlAi '---. -.-
+'yin c Type l'u11 Na Ile and Lille
iiap:aturc.p,AuthoriacdAgenC. ifpny ---- - ..✓.----
runt or 'fypa i'uil Name mid title - -- -----
Please rcr,::n two co;.cs of Life completed Application package te:
motto Carolina DEINIR-d)WQ
k.Ulgafi'es•l rnucYion Section-L19C Prograrn
I6 6 MOIR SCWlftc Center
Raieiglb. NC 27699-1636'
Telephone[phone]
!�I'1.L'L'k'S!114 R,v[ilia:gl�n u'i:rsr.:FtaO an^c,troA Si?.or,,Rt

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RECEIVED I DENR I D
AQu far PrDtedinn S o
MAR 2 3 2009