WI0100094_Complete File - Historical_20220311

MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director RECEIVED 30ecretary
5/1 012 01 0 MAY 12 2G,10
Lawrence Dimmitt Asheville Regional Office
178 Brushy Face Road Highlands.NC 28741 _�Ruifer Protection
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WIO100094
178 Brushy Face Road,Highlands,NC 28741
Dear Mr. Dimmitt:
On 5/3/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-only
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 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 .0211(u)(2). Additionally, you should contact the Macon 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(919)715-6166 or Michael.Ro¢ersrrmcdenr.¢ov if you have any questions.
S`inlc�e�relf &A//
jor Debra Watts
Supervisor
cc: Asheville Regional Office-APS
APS Central Files-Permit No.W10100094
Macon County Health Dept.
George Hair(Geno Air Conditioning&Heating—PO Box 576.Svlva, NC 28779)
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636
Location:2728 Capital Boulevard,Raleigh.North Carolina 276D4 One t...Phone:[phone] FAX 1:919-715-0588,FAX 2:919-715-6MW Customer Service 1-877-623.6748 NO j,CaIOtll1a
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Central Files: APS_ SWP_ • t
05/10/10
Permit Number W10100094 Permit Tracking Slip
Program Category Status Project Type
Ground Water Active New Project
Permit Type Version Permit Classification
Injection Water Only GSHP Well System (50W) 1.00 Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers George Hair
Coastal SW Rule PO Box 576
Sylva NC 28779
Permitted Flow
Facility
Facility Name Major/Minor Region
Lawrence Dimmitt SFR Minor Asheville
Location Address County
178 Brushy Face Rd Macon
Highlands NC 28741 Facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
Lawrence Dimmitt Owner Affiliation
Lawrence Dimmitt
178 Brushy Face Rd
Dates/Events Highlands NC 28741
Scheduled
Ong Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
05/10/10 05/03/10 05/10/10 05/10/10
Regulated Activities
Heat Pump Injection
Outfali NULL
Waterbody Name Stream Index Number Current Class Subbasin

NORTH CAROLINA I
DEPARTMENT OF ENVIRONMENT AND NATURAL'RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP
GEOTHERMAL WATER—ONLY INJECTION WELL SYSTEM
I(GROUND COUPLED HEAT PUMP)
Type'5QW Wells
In Accordance with'the provisions or NCAC Title 15A:02C.0200
Complete application and mail to address on the back page.
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This is not the proper form to be,used for injection wells in an ones-loon geothermall
Do-not use this form for systems that circulate any substan system.
ces other than water.
TO: DIRECTOR,NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: oil 3 (� 20
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A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that compi6tely isolates the fluid from the environment?
YES "' If yes,then continue completing this foray;
NO If no, do not complete this form, Form GW-57 HP,Applicat'i1Pn For
Permit To Construct And/Or Use A Well(s)For Injection Wit A Heat
Pump System, should be completed.
B. SYSTEM FLUID
Will any.additiyes'be introduced tothe system's circulating heat transfer
fluid? This includes,but is not limited fo corrosion inhibitors and/dr antifreezes.
YES If yes, do not complete this form.Form GW-57 I P,Applicatio For
Permit To Construct And/Or Use A Well(s)For Injection Wit Heat
Pump System, should be completed.
NO /If no,then continue completing this form, n V
PROPERTY OWNER -
Name: C M)
Address-
VZ U GO�
City: I�Q�l l fiY�C1 S
Coun State:, Zho Code:
ty: t� Telephone: - 4
D. STATUS OF PROPERTY OWNER
Private: "'� Federal: Commercial:_i
State:_ Municipal:_ Native American Lands: i
RECEIVED'/DENR/DWQ
Aquifer.Protection Section
Revised 5105 GW/UIG57 CL MAY 0 3 2010' Page 1 I f4

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FACILITY(SITE)DATA
(Fill out ONLY it the Status of Owner is Federal,State,Municipal or Commercial). '
Name of Business or Facility:
Address:
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City: State: _ Zip Code: County:
Telephone: Contact Person:
Standard Industrial Code(s), SIC,which describes commercial facility:
HEAT PUMP CONTRACTOR/��� ! DATA
Name: ' 'YlG�^Frt V t'�lC a-))no E NL'citr�.lne.
Address 1� (Ai `ill I 5 WP h r\
State: JL Zi Code: — �
City: I Ni P County:Telephone K 1 �-� (.,_ I ti r - _
Contact Person
G. CONSTRUCTION DATA(check one)
EXISTING WELL p(S) being Proposed for use as a ground-co pled heat pump
well(s). Provide the information in (1) through (3) below to,ihe best of your
knowledge. Attach a copy of Form GWL 1
available. (Well Construction Record) if
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PROPOSED WELL(S) to be constructed for use as a ground-coupled heat pump
we11(s). Provide the information in (1) t1irough (3) below I as PROPOSED
construction specifications. Submit�F/oorrm GW Il after construction.
(1) Well Drilling Contractor's Name: G/eyly.\ r ) Ip( � �MA�-� 7/,
NC Contractor Certification number: 5 9
Date to be constructed: �7 0
Number of borings:
��—
Approximate depth of each boring(feet):_ 3 Ob
(2) Well casing: Is the well(s)cased?
(a) YES If yes,then provide the casing information below.
Type: Galvanized steel_Black steel_Plastic_Other(specify)
Casing depth: From to ft.(reference to land surface)
Casing extends above ground inches
(b) NO
(3) Grout(grout the vertical length of the borehole to a minimum depth of 20 feet b.l.s.):
(a) Grout type; Cement Bentonite_ Odic r(specify) iRA RZV2� �en r
(b) Grouted surface and grout depth(reference to land suiface):
X around closed loop piping; from 0 to 3 1 (feet).
around well casing; from_to_(feet).
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTfiERMEANS.
Revised 5105 GW/LIIC-57 CL
Page 2 Pf4

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H. INJIICTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior pipingltubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
I. LOOATION OF WELL(S) Attach two maps.
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(1) Include a site map (can be drawn) showing: buildings,property lines surface water bodies,
potential sources of groundwater contamination and the,orientation of and distances between
the proposed well(s) and any existing well(s)or waste disposal facilities such as septic tanks
or draih fields located within 200 feet of the ground-coupled heat pump well system. Label all
features clearly and include a north arrow.
(2) location map referencing the site to two nearby permanent reference points(such as roads,
streams and highway intersections).
J. PEll_MIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Exa Ales include:
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(1) j Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
CERTIFICATION
"I he�eby certify,under penalty of law,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
thos'individuals immediately responsible for obtaining said information,I believe that the
information is true,accurate and complete. I am aware that theie are significant penalties,including
the possibility bffines and imprisonment,for submitting false information. I agree to construct,
opersite,maintain,repair,and if applicable,abandon the gtoundjsoorce heatpump system and all
related appurtenances in accordance with the approved specifications and conditions of the Permit"
g
(Signature of V el l Owner or Authorized Agent)
If authorized agent is acting on behalf of the well owner,
please supply alletter signed by the owner
authorizing the above agent.
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RECEIVED/DENRIDWQ
Aquifer?rotertion Section
MAY 0 3 2010
Revised 5105 ; GW/UIG57 CL Page 3 of 4

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CONSENT OF PROPERTY OWNER(Owner means any person who holds the fee or other property
rights in the well being!constructed.A well is real property and its construction on land rests
own rship in the landowner in the absence of contrary agreement in writing)
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If th property is owned by someone other than the applicant,the property owner hereby consents to
alto the applicant to c onstruct each injection well as outlined in this application and that it shall be
the r-sponsibility of the applicant to ensure that the ground-source heat pump systems wells)
conforms to the Well Construction Standards (Title 15A NCAC 2C.020;0)
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� r tore Of Property Owner;If Different From Applicant)
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Please return two copies of the completed Application package to:
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UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh,NC 27699-1636
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Telephone [phone]
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R�CEIVED I DENR I DWQ
Aquifer Protertion Section
MAY 0 3 2010
Revised 5105 GW/UIC-57 CL
Page 4 of

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Directions to 178 Brushy Face Rd, Highlandsa
Goo8fe maps NC28741
43.1 mi—about 55 mins
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