WI0100095_Complete File - Historical_20220311

NCDENR
North Carolina Department of Environment and NaturcA
Division of Water Quality RECEIVED
Beverly Eaves Perdue Coleen H.Sullins DE e Freeman
Governor Director I!IN i l trig Secretary
June 1,2010 y
Asheville Regional Office
Harold and Amanda Demarest Aquifer Protection
P.O.Box 28114
Panama City,F132411
Subject: Issuance of Injection Well Permit
Permit No.WI0100095
Issued to Harold and Amanda
Demarest
Buncombe County
Dear Mr. and Ms. Demarest:
In accordance with your application received May 3, 2010, I am forwarding Permit No.WI0100095 for
the construction and operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well
system located at 720 Peace Lane,Montreat,Buncombe County,NC 28757. This permit shall be
effective from the date of issuance until May 31, 2015,and shall be subject to the conditions and
limitations stated therein.
Please pay special attention to Part I.7 of the permit and submit copies of the Well Construction
Completion form(GW-1)after construction. Please submit all data within 30 calendar days of receipt of
this letter to the address below:
Aquifer Protection Section(APS)
Underground Injection Control(UIC) Staff
1636 Mail Service Center
Raleigh,NC 27699-1636
Additionally,your UIC system is subject to inspection by the APS and at the time of the inspection must
display a permanently affixed identification plate in accordance with requirements of 2C .0213(g). Please
insure this is completed in accordance with permit condition Part I.6 of this permit issued November 16,
2009.
In order to continue uninterrupted legal use of this well for the stated purpose,you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit,this
permit is not transferable to any person without prior notice to, and approval by,the Director of the
Division of Water Quality. If you have any questions regarding your permit or the Underground Injection
Control Program please call me at(919) 715-6168.
Sincerely,
,0��
John McCra;7/
Environmental Specialist

cc: -L-andon-Davidson-=Asheville Regional-Office
Central Office File—WI0100095
Buncombe County Environmental Health Dept.
Duane Gentry—Gentry Heating, Inc.
Enc: Permit WI0100095

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH,NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Harold and Amanda Demarest
FOR THE CONSTRUCTION AND OPERATION OF 4 TYPE 5QM INJECTION WELLS, defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed-loop
geothermal-mixed-fluid heat pump system. This system is located at 720 Peace Lane, Montreat, Buncombe
County,NC 28757, and will be constructed and operated in accordance with the application dated April 30,
2010, and in conformity with the specifications and supporting data submitted, all of which are filed with the
Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in compliance
with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked,.from the date of its issuance until May 31, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 3 day of 2010.
0"6v, _-)
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.

PART I-WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
6. Each geothermal injection well system shall have permanently affixed an identification plate on a nearby
building or other permanently fixed structure indicating the location and presence of underground UIC
wells according to 2C .0213(g).
7. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section—UIC Staff
1636 Mail Service Center
Raleigh,NC 27699-1636
and
Aquifer Protection Section—Asheville Regional Office
2090 U.S. 70 Highway
Swannanoa,NC 28778
[phone]
GW-1s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
8. Well construction records must also be submitted for the existing water supply wells on-site as well as a
site map showing any water supply wells on adjacent properties as specified in NCAC .0211(d)(1)(D).
PART II—WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone] and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number [phone].
WI0100095 2

2. Boreholes shall not connect separate aquifers which have differences in water quality (e.g., shallow
surficial aquifers, saprolite, fractured bedrock, etc.) as specified in 15A NCAC 2C .0213(d)(8)(C) and
shall be filled with bentonite grout from the lowermost water bearing zone to land surface as specified in
the permit application.
PART III—OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate; at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV—PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. • The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V— OPERATIONS AND MAINTENANCE"REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
WIOI00095 3

PART VI-INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII—MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known-or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIR—PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit,request an extension.
PART IX—CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1), Well
Construction Standards.
WI0100095 4

2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) • The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1)within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
W I0100095 5

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue coleen H. Sullins Freeman
Governor Director RECEIVED Secretary
May 10,2010
'UN 02 201g
Hal Demarest '
Amanda Demarest ( Asheville Regional Office
P.O.Box 28114 I—ACLuifer Protection
Panama City,FL 32411-8114
Subject: Acknowledgement of Application No.WI0100095
Hal DemarestSFR
Injection Mixed Fluid GSHP Well System(5QM)
Buncombe
Dear Mr. and Mrs.Demarest:
The Aquifer Protection Section of the Division of Water Quality(Division)acknowledges receipt of your permit application and
supporting materials on May 3,2010.This application package has been assigned the number listed above and will be reviewed by
John McCray.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary.To ensure the
maximum efficiency in processing permit applications,the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office,copied below,must provide recommendations prior to final action by the
Division.Please also note at this time,processing permit applications can take as long as 60-90 days after receipt of a complete
application.
If you have any questions,please contact John McCray at 919-715-6168,or via e-mail at [e-mail]. If the reviewer is
unavailable,you may leave a message,and they will respond promptly.Also note that the Division has reorganized.To review our
new organizational chart,go to htto://h2o.enr.state.nc.us/documents/dwq orgchart.ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sinc y,
for Debra J.Wa is
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Dennis Watts(WNC Management Services,45 Elk Mtn.Ridge,Asheville,NC 28804)
Von Plemmons(Clearwater Well Drilling,Inc.,P.O.Box 71,Hot Springs,NC 28743)
Duane Gentry(Gentry Heating Inc., 100 Buckeye Access Rd.,Swannanoa,NC 28778)
Permit Application File WI0100095
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 276994636
Location:2728 Capital Boulevard,Raleigh.North Carolina 27604 Pe
wa
Phone:[phone]\FAX 1:919-715-0588:FAX 2:919-715-60481 Customer Serum 1-877-62M748 �C Ohlld
Internet w .ncwaferoualiN.oro w.r������l!r�
An Equal OpportunOy�Affirmative ArnimArnimEmpbyer �/{y/

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES(NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A W ELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50M WELLS) ,
_ _New Permit Application OR Renewal (check one)
DATE: A 2IL. 3(7 201a
PERMIT NO. (leave blank if NEW permit application)
t
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on properly deed(if owned by a business or government agency,state name of
entity and a representative w/authority for signature): A M A). M hEea 14RE5 1
(1) Mailing Address: �• d Q X N
City: fQna a. QA �L State:J�L Zip Code: ;2-4 1.1 - RI W County:
Home/Office TeleNn-: 9, - a34 /I ND Cell N_o_.:0,60- Coat - q9I
EMAIL Address: Kal 9119-9 ao I • t1•UYn
(3) Physical Address of Site(if different than above): 72D _PEA•CE I--1aIJE
City: State: L((%Z_ip Code: County:&J21LAIae
Home/Office Te)e No.:,9Zg-_4 1 - 11.05ri Cell No.: � 2 Ss - -312 1 - 6 rlSS
EMAIL.Addresv:L02.+I5 e_nn(S I ra),(a rncu I . LI ufn
B. AUTHORIZED AGENT OF OWNER,IF ANY(if the Permit Applicant does not own the subject properly.
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: I A &)Qg. AKA QACnEME IyT SE 2_;ip.,iE s
Contact Person: 4.t*A-ft-<, EMAIL Address:(t0 Tt S dion ni S T a.i I.C(v1
Address: �5 eLy- wy o a an E
City: W 4 EVIL LE State: Zip Code: County: 9tA'r1C.UtrmA-F_
Office Tele No.:Iq 2q- 25- 1 - I LP 52 Cell No.:
Website Address of Company,ifany: iJooe
C. - STATUS OF APPLICANT
Private: Federal:_ Commercial:
State: Municipal:_ Native American Lands:
KEGENFL)IDENRIDWQ
Aquifer Protection Section
GPU/t1IC SUM Well Permit Application(Revised 7/2008) MAY 0 3 WO -Page I

D. WELL DRILLER INFORMATION
Company Name: U r—PraLL A r f` WEL.,
Well Drilling Contractor's Name: _\[[)IJ �LE 1L�MDIJ S
NC Contractor Certification No.: A11 A
Contact Person:VbN 1�1C-11AMpNS —. FF MQOR.r EMAIL Address: f)10Grz1q50-6VL20( .CDM
Address: -P.C. 6oy r11
City: I& S7Q.(t-)r- S Zip Code: a91743 County: A1,4 IS00
Office Tele NoA—,,q- OF z- 7241 Cell No.: 9 N 70111 -(ySZLP - 5 2W -7`70- 05 24P
E. HEAT PUMP CONTRACTOR INFORMATION(if different than driller)
Company Name: 14opi i X =N
Contact Person: n = EMAIL Address 1 r� t'Cq Inc .
Address: lor, ALA L E XC SS RID Corn
City: SL()Fc014UIDA Zip Code: 1-C County: 9LLI.XJ--•ry1AX7
OIFceTeleNo.: �Zg- 2174-2S7-0 CellNo.: gZq - 5'52-14zt
F. INJECTION PROCEDURE (briefly describe how the injection well(s)will be used)
CLCSED LOD
G. WELL CONSTRUCTION DATA(Skin to Section H if this is a Permit RENEWAL)
(1) Proposed date to be constructed: ]— "I — I D Number of borings:
Approximate depth of each boring(feet): I S
(2) Chemical additives to be used in closed-loop system(only those chemicals indicated have been approved):
11-22 oropyleneglycol -)�—eihanol other(other additives will
need prior approval by NCDENR before use)
(3) Type of tubing to be used(copper, PVC,etc): _ TE - 314D A
(4) Well casing. Is the well(s)cased?(check either(a.)YES or(b.)NO below)
(a) YES if yes,then provide casing information such as type(steel. PVC,plastic.etc.),diameter,
death,and extent of casing appearing above ground:
(b) NO
(5) Grout(material surrounding well casing and/or piping):
(a) Grout type: Cement_ Bentorthe Other(specify)
(b) Grout depth of tubing(reference to land surface): front�L to I S (feel)
If well has casing, indicate grout depth: front__...
H. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
pipinghubing�associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
GP(I/UIC 5QM Well Permit Application(ReAwd 7t20011) Page 2

I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(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 drain fields located within 1000 feet of the
geothermal heat pump well system, Label all features clearly and include a tiorth arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER WELL(S)
Are there any potable water well(s)on the subject property or adjacent properties? _YES_NO
If Yes, than indicate location on attached map(s).
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 law, that I have personally examined and am Funiliar 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 inlonnation is true,accurate and complete.
I am aware that there are significant penalties, including the possibility of tines and imprisonment. for submitting
false information. 1 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
Signature of Property Owner/Applicant
Print or Type Full Name
G-0 IkALA-A
Signature of Authorized Agent. ifanr
"Derwnts (0A-HS
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ RECEIVED/DENR/DWQ
Aquifer Protection Section 9uifer Protection Section
UIC Program MAY 0 3 2p10
1636 Mail Service Center
Raleigh,NC 27699-1636 i
Telephone [phone] i
GPUNIC 5QM Wc111'emilt Application(Revised 7/2008) Page 3

04.30.2010 06:03 M Q002
dv;e
. 3
® r�
!'Ae,

From: [e-mail]
Sent: Thursday, April 29, 2010 5:36 PM
To: [e-mail]
Cc:[e-mail]; [e-mail]
Subject: Re: Demarest Residence
To whom it may concern,
Dennis Watts, WNC Management Services, is serving as my agent pertaining to the building of my house at
548 Peace Lane, Montreat, NC 28711. If you need additional information, please contact me.
Thank you,
Hal Demarest
[phone] (H)
[phone] (M)
1 of 1 5/3/2010 10:20 AM

NORTH CAROLINA
I
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES(NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A W ELL(S)FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50M WELLS)
_New Permit Application OR Renewal(check one)
DATE: 20ja
PERMIT NO. ([cave blank if NEW permit application)
A. PROPERTY OWNERS)/APPLICANT(S)
List each Property Owner listed on property deed(if owned by a business or government agency,slate name of
entity and a representative w/authority for signature): }-SAL ` -AR AUDA -bEM A2ES'7-
(1) Mailing Address: 'P• `• aQ X 2 S I I4
City: riamo. & �l State:.EL Zip Code: ;24 I I - AI N ounty:
Homci0fftceTeleNo.: VD- 934- II SOD Cell No.:4.9)b- wq< - qq J4
EMAIL Address: Kai ?1?9 6D QOI . A.UYvt
(2) Physical Address of Site(if different than above): -PEACE
City: A160-1-R.E.4-f-" State:&C,Zip Code: County: P)Ltirl)MR
Home1011ice Tele No.:-52rd-�S-1 - I lv5r-I Cell No.: q 2 - 3O I -
EMAIL.Address:LLUIlSiHer)niS1(L-./ nictiI rL1U/Y�
B. AUTHORIZED AGENT OF OWNER,IF ANY(if the Permit Applicant does not own the subject properly.
attach a letter from the property owner authorizing Agent to install and operate UIC well)
CompanyNamc: W K)C s AKA NhCnEAkE IUT' SE P—kn e 1E 5 �J
Contact Person'DFNUt� +AAA frS EMAIL Address:11A- 1S dAiriisIP ar�.Cry1
Address: �r] EL-y- MT►-� .. a1nC c
City: QS14EVll L(E� State: )L-ZipCode: ZgrlOq County: 9U.neU1ttk--P—
Office Tele No.:US- 25- 1 - I U 5'7 Cell No.: A 2S- �
Website Address of Company,if any: IJO Q e
C. STATUS OF APPLICANT
Private: -X Federal:_ C•ummerciak•_
State:_ Municipal:_ Native American lands:
RECEIVEU I DENR I DWQ
Aquifer Protection Section
GPU/UIC SQM Well Permit Application(Revised 7211081 i mAy o s zo Page 1

D. WELL DRILLER INFORMATION
Company Name: Ca ra12LAT-er( WEL _ 1712-d(L/ U07 =
Well Drilling Contractor's Name: V00 'PLE►kAt.07J S
NC Contractor Certification No.: A 11 A
Contact Person: EMAIL Address: /hO0(e'450_6VC261 •Czry)
Address: T.D. OY �11
City: LbT S?21)JC4S Zip Code: 09943 County: RADISOr-1
Office Tele No.AA•b 2Z- 7241 Cell No.: 019 -091 -05'7LP - 1 Zq -7-7LP- Grj 2,Cp
E. HEAT PUMP CONTRACTOR INFORMATION(if different than driller)
Company Name: 0,EKXrQQ 14GATiLX, =Q
Contact Person: —// EMAIL Address � 1 « ine .
Address: 10r) t )Ve CE4e AC SS PD COm
City: S,t)FrQ/�XOQA Zip Code: )-r, County: PiC(J CtLrttAP,
OfliceTeleNo.: g2g-2'74-ZS20 CcIINo.: 92q - 652 -IL{ZI
F. INJECTION PROCEDURE (briefly describe how the injection well(s)will be used)
CLOSED L.DO P =,1E0tt oij
G. WELL CONSTRUCTION DATA(Skin to Section H If this is a Permit RENEWAL)
(1) Proposed date to be constructed: rJ- I- 1 D Number of borings:
Approximate depth of each boring(feet):_ 1 S
(2) Chemical additives to be used in closed-loop system(only those chemicals indicated have been approved):
R-22 propylene glycol _X—ethanol other(other additives will
need prior approval by NCDENR before use)
(3) Type of tubing to be used(copper.PVC,etc):
(4) Well casing. Is the well(s)cased?(check either(a.)YES or(b.)NO below)
(a) YES if yes,then provide casing information such as We(steel.PVC,plastic,etc.),diameter,
depth,and extent of casing appearing above ground:
(b) NO X
(5) Grout(material surrounding well casing and/or piping):
(a) Grout type: Cement_ Bentonitc_X_ Other(specify)
(b) Grout depth of tubing(reference to land surface): from_(_- to
If well has casing, indicate grout depth: from . . .__to___ __(feel)
H. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
pip(nghubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
GPU/UIC 5QM Well Permit Application(Revised 7/2008) Page?

I. LOCATION OF WELL(S)
Attach two copies of snaps showing the following information:
(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 drain fields located within 1000 feet of the
geothermal heat pump well system. Label al I features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER WELL(S)
Are there any potable water well(s)on the subject properiy or adjacent properties? _YES NO
If Yes,than indicate location on attached map(s).
K. CERTIFICATION
Note:This Permit Application must be signed by each person appearing on the recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am;ftu»iliar 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 infonnatiotr is true,accurate and complete.
I am aware that there are significant penalties, including the possibility of tines and imprisonment, for submitting
false information. 1 agree to construct, operate, maintain, repair, and if applicable. abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditiniis of(he Permit:'
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Properly Owner/Applicant
Print or Type Full Name
CJ�� /'00d2t
Signaure of Authorized Agent.ifany
"DL'nnts ()JA-t+!5
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ RECEIVED/DENR/DWQ
Aquifer Protection Section Aquifer Protection Section
UIC Program MAY 0 3 2010
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone[phone]
GPt1A11C 5QM well I'moil Application(Revised 7/2008) Page 3

04 J0::010 06:03 F..Al Z002
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file:///C:/Documents%20and%20 Settings/1 ohn_Mecray/Local%20Sett...
^ i
From: [e-mail]
Sent: Thursday, April 29, 2010 5:36 PM
To: [e-mail]
Cc:[e-mail];[e-mail]
Subject: Re: Demarest Residence
To whom it may concern,
Dennis Watts, WNC Management Services, is serving as my agent pertaining to the building of my house at
548 Peace Lane, Montreat, NC 28711. If you need additional information, please contact me.
Thank you,
Hal Demarest
[phone] (H)
[phone] (M)
1 of 1 5/3/2010 10:20 AM

06/02/2010 09:47 8502338292 SAIC PAGE 01/05
To: North Carolina Dept. of Environment and Natural Resources
Asheville Regional office RECEIVED
Division of Water Quality—Aquifer Protection Section
2090 US. 70 Highway UN p 2 21)
Swannanoa,NC 29778
Attn: Jonathan Stepp Asheville Regional Office
Aquifer Protection
From: Harold R. Demarest,Jr.
PO Box 28144
Panama City,FL 32411
[phone](H)
[phone](C)
Subj: Designation as Authorized Agent
This is to certify that Dennis Watts,WNC Management Services, is my Authorized
Agent for the purpose of my application for permit to construct wells for injection with a
geothermal heat pump system for four Type 5QM Wells on my property,Buncombe Co
G1S number 072018692800000 on Peace Lane in Montreat.
Harold R.Demarest,7r.

06/02/2010 09:47 8502338292 SAIC PAGE 02/05
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES(NCDENR)'
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELI:(S')FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5QM WELL(M
X __ New Permit Application OR Renewal(check one)
]DATE:
PERMIT NO. (leave blank if NEW permit application)
A. PROPERTY OWNER(SNAPPLICAIVT(S)
List gch Property Owner listed on property deed(if owned by a business or government agency.state name of
entity and:a representative wAndhorhy for signature):;HAL Am A1.m- lEa amsi:
(1) Mailing Address; 'F•0
City: f10.nt0. State: �LZipCodc: �2�f I I - (L�[County:
Home/officeTeIcNo.: q a 934. l1Nn Cell No..g0'10- UP - 9 q I
EMAIL Address: hal itl2& 401 . t fAtn`
(3) Physical Address of Site(if different than ahove); (�ElkeF-
City: AU&Tt9:9� State:b!C Zip Code: County:j5gj. DME;Y
Home/Offix Tole Na:�2$= `� 1�5� Cell No.:
EMAII.Address:l�l�SrdenQ( ya(�/1;fY1 � � 0/1'1
0. AUTHORIZED AGENT OF OWNER,IF ANY(irthe Permit Applicant dwjiM own the subject property.
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name; LQ&30,. AKA Q&%E& Q:r = 3
.ContactPerwn,]�I=QL)i j JADA-tt`-4;, EMAII Addlf,~n: f s dAlel;-s, 7 &&Cwl
Address; �5 Et iu, I 2tn�,E
City: ASJ4 P f y_l= State: )C .Zip Code: 29 q()q county: Ru.nr piyL-.,.
Office Tele No.:4 Z52- 2-T I - I LP 5+7 Cell No.: Iq
Webslte Address of Company.if any: I3Q Wi=
C. STATUS OF APPLICANT
Private: Federal: Commercial:
Stove: Municipal: __ Native American hands:
kF(;EIvE /0ENR/DWQ
Aquifer PMPLton SeCllon
GRYUK SOM Well Permit Applkaiion tF=bWd 712011111 MAY 0 TWO Pnse I

06/02/2.010 09:47 8502338292 SAIC PAGE 03/05
I .
D. WELL DRILLER INFORMATION
Company Name- (1J GA.y? QA -(?- LQE(-L-- 1QPLIU..WC7
Well Drilling Corltmaoes Namc: V Qil.�'ALOE"oli S
NC Contractor Certification No,: , a I►A
Contact Person;vt?N 0C-MM0N5- Mco r��Isc. ' �� I . rn
-.... _. - Address: �•C. (3Uk '7F — ...... ....
Office Tele Ne.:tb S UU- I2tt I all No.: K Ltd -Cotl1 -1�5 ZGP " x'6 - !'JLO- 05 P
E. HEAT PUMP CONTRACTOR INFORMATION(If different then driller)
Company Name: 4r- =N '
Contact Person:-DL&Ai�EE L'Llitn-k n24 EMAIL AddrossdLiall.1IYIC .
Address; 10D & 'g�@jE Aol SS 2D Cum
City: SI.g&0 A4L4 Zip Code: _, County: gu QJ:rn 15F
OfficeTeleNa: g -27tE�2��0 CallNo.: S2�Z 552^It Z�
F. INJECTION PROCEDURE (briefly describe how the injection well(s)will be used)
�'Jl}SE h L.OD 1� �_t�rL�1 fJFJ
G. WELL CONSTRUCTION DATA(Skin IQ§gAtioa 8 if lbis Is A I? (BjwNE WALI
(1) Proposed date to be constructed:-5^ q I D• Number of borings:._
Approximate depth or each boring(feet): A I S
(2) Chemical additives to be used in closed-loop system(only those chemicals indicated have been approved):
R�2: propylene-glycol ethanol other(other additives will
need prior approval by NCDCNR before use)
(3) Type of tubing to be used(copper,PVC,etc): i * 34?)9
(4) Well casing. Is the well(s)cased?(check either(a.)YES or(bJ No below)
(a) YES if yes,then provide casing information such as ty,Q_e(steel.PVC.plastic,etc.);djumftJ
and 52(ITL of cesing appearing above ground:
(b) NO
(5) Grout(material surrounding well casing and/or piping):
(a) Grout type: Cementer Benlonlle-& Other(specify)
(b) Great depth of tubing{reference to land surface): from�_to A/< Met)
If well has casing,indicate pout depth; tram__-, , .__to__ „(feet)
H. INJECTION-AEI-ATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification ofdte injection equipment and exterior
pipingAubing.associated with the injection operation. The manufacturer's brochure;may provide supplementary
inf6nnatiait.
GPURaC 5QM W ctt Pain ApPt'WIen(Revised 7201111) Page 2

06/02/2010 09: 47 8502338292 SAIC PAGE 04/05
L LOCATION OF WKILL(S)
Attach two copies of traps showing the following information.
(1) Include a site map(can be drawn) showing: buildings. properly lines.surface venter bodies. potential sources
of groundwater contamination and the orientation of and distances between the proposed well(t) and any
existing well(s) or waste disposal,facilities such as septic tanks or drain fields located within 1000 feet of the
geothermal heat pump well system, Label al l features clearly and includ".north arraw.
(Z) Include n topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the snap name.
J. POTABLE WATER WELL(S)
Are there any potable water W011 s) on the subject property or adjacent properties? YES_NU
If Yes,than indicate location on attached map(s).
IC. CERTIFICATION
Note:This Permit Application must he signed by each person appearing on the recorded legal properly deed.
1 hereby certify, under penalty of law. that i have personally examined and am familiar with the inibtmtat'ron
uhnlitted UL this .tlt)cument and all atmehmanN theretn and than. tensed on my inattiry o1' thimc individuals