WI0100652_Aqueous Closed Loop Geothermal Well Construction Application_20220331

NbRTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES NOTII/ICATION OF INTENT TO CONSTRUCT OR OPERA TE INJECTION WELLS
These we(is are ''permi/led by rule" and do not require an i11dividua/ permit when constrncted in Ul'l"Ordance with
i the 111/es qf JJA NCAC 02C .0200 $. TJ,is notice muyt be submitted prior lo cons/rucliolj.
f GEOTHERMAL AQUEOUS CLOSED-LOOP WELLS As desc bed in 15A NCAC 02C .0222 these wells circulate potabk: water only or a mixture of potable water and performance-enhancing additives as part of a geothermal heating and cooling system.
i OR
j GEOTHERMAL DIRECT EXPANSION CLOSED-LOOP WELLS As desc ibed in ISA 'NCAC 02C .0223 these wells ciroulate a refrigerant gas as part ofa geothermal heating and I cooling system.
I Print Clearly or Type lnformntio11. llleg;b/e Submittals Will Be Ret11n1ed A�· /nt:(Jntplete,
DATE: MrCh31 , 20R._ PERMITNO., (tobocomplo<cdbyDWQ)
A.TYP OF GEOTHERMAL CLOSED-LOOP WELL TO BE CONSTRUCTED
(I I
(2)
Aqueous (as per l SA NCAC 02C .0222): ,x'=�Number of wells: (3) Wells @ 350' Depth Each_Dire<Jt Expansion (as per 15A NCAC 02C .0223) Number ofwells: __ _
B.STA US OF WELL OWNER (choose one)(I ) (2)
(3)
Single Family Residence _X_ Submit this form two (2) business days prior to construction. Business/Organization Submit this form 30 days prior to construction. Government: State --Municipal__ Count y__ Federal __ Submit this form 30 days prior to construction. C.WEL OWNER-For single family residences list the property owner(s ). For all others, list name of thebusin s, organization, or government agency and person delegated signatme authority:
K i Ideas, LLC Maili�g Address: _F_i_ve_C_o_n_c_o_u_rs_e_P_a_rk_w_a0y_, _S_u_il_e_2_0_0 ___________ __,_,f0'!,.,,.\:,:0; 0· �-•�I: i,'. ] [ <· ,' , I , ! 1City: I Atlanta State: GA Zip Codc:30328 County:�F�u�lto�n�-...,.�---
h/',I j i '' EMA Address: �kn000y"e "s.@.P.rcocto_n_m_a_il._c0o_m_____ Fax No.:_N_i_A __________ _
I , I' ;/
D.
Day ,jfJe No.: __ 7�7�0_-8_2_8_-4_0_00�------Cell No.:�N�/A�----�[ �\ �--�"/f
·,1\/, ,>n ( 1,1 .. Iii/ I i; 1, '': ,r :;11j,_;11 PHY11CAL LOCATION OF WELL SITE (l)Parcel Identification Number (PIN) of well site:]S""S' 1-County: Ac K.fon i 7-1.S'l b 1\•,l,rvi.lr'i<c,qi,,r1 I'-'''
(2) Physical Address (if different than mailing address): ________________ _J.t 01,} I Jlo/1,w f,f City; C#..fl,;e.,..� State: NC Zip Code: J.. '8'/ 1. 7
DWQ/UICIClosedlLoop Cklothenna! Notification {R�vis�-<l 4,%/2012) Page!
WI0100652