WI0100132_Regional Office Physical File Scan Up To 9/14/2022

�(] ® Central Files: APS_ SWP_
RECE
V 11/19/10
Permit Number W10100132 i• �s Permit Tracking Slip
Program Category Status Project Type
Ground Water Asheville Regional Office Active New Project
Aquifer Protection
Permit Type Version Permit Classification
Injection Water Only GSHP Well System (5QW) 1.00 Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers Robert Larry Wells
Coastal SW Rule P O Box 125
Leicester NC 28748
Permitted Flow
Facility Name
One University Heights - In Ball Field
Location Address
One University Hts - Intramural Ball Field
Asheville NC 28804
Major/Minor Region
Minor Asheville
County
Buncombe
Facility Contact Affiliation
Owner Name
Owner Type
UNC Asheville
Government - State
Owner Affiliation
Stephen Bagley
One University Hts
Asheville NC 28804
Dates/;:vents
Scheduled
Orig Issue App Received Draft Initiated
Issuance Public Notice Issue Effective Expiration
11 /19/10 10/29/10
11 /19/10 11 /19/10
Regulated Activities
Heat Pump Injection
Outfall NULL
Waterbody Name
Stream Index Number Current Class Subbasin

't KAV
MCDENK
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
UNIC Asheville
Stephen Baxley — Dir. Facilities Mgmt & Planning
CPO 1100 One University Heiizhts
Asheville, NC 28804
Division of Water Quality
Coleen H. Sullins
Director
1.1!1.9/2010
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0100132
One University Heights, Intramural Ball Field
Dear Mr. Baxley:
Dee Freeman
Secretary
On 10/29/2010, 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 Buncombe 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.Rouers iicncdenr.aov if you have any questions.
Sincerely,
for for Debra Watts
Supervisor
cc: Asheville Regional Office - APS
APS Central Files - Pen -nit No. W10100132)
Buncombe County Health Dept.
AWD Senices, Inc (Larry NVells)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone; 919-73323221 1 FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwateroualitv.org
One
NofthCaro � in
An Equal Opportunity l Affirmative Action Employer

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-OW WELLS)
In Accordance with the provisions of NCAC Title 15A: 02C.0200 please
complete this notification and mail to address on the back page (please Print or Type information).:..
�(D 1-3z '5
DATE: October 26 20I0 �-- 0 e
Well Type Confirmation: Does the proposed system circulate, potable water only no additives in C
YP .f P P Y P ( )
continuous piping that completely isolates the fluid from the environment (i.e.
closed -loop)?
Yes X_ Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing
either a 5A7 well (open-loop'well injecting potable water into the aquifer) or a 5QM well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Properly Owner listed on property deed (if owned by, a business or government agency, state name of
entity and a representative w/authority for signature): UNC Asheville, Stephen BaxICv
Director of Facilities Management and Planning
(1) Mailing Address: UNC Asheville. CPO I100. One Universitv Heishts
City: Asheville State: NC Zip Code: 28804 County: Buncombe
Home/Office Tele No.: [phone] Cell No.:
Email Address: sbaxley(a.unca.edu Website:
(2) Physical Address of Well Site (if different than above): One Universitv Heights. Intramural Ball Field
City: State: Zip Code: County:
Home/Office Tele No.: Cell No.:
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company, if any:
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page I

WELL DRILLER INFORMATION
Company Name: AWD Services, Inc.
Well Driller Contractor's Name: Larry Wells
NC Contractor Certification No.:
Contact Person: Larry Wells EMAIL Address: wells750549(iDbellsouth.net
Address:
125
City: Leicester Zip Code: 28748 County: Buncombe
Office Tele No.: [phone] Cell No.: [phone]
C. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name:None - Vertical test wells only for testing purposes for a future construction proiect.
A new permit (or modification of existing permit) will be requested once the project is ready to move forward
Contact Person: EMAIL Address:
Address:
City: Zip Code: County:
Office Tele No.: Cell No.:
D. STATUS OF APPLICANT
Private: Federal: Commercial:
State: X_ Municipal: Native American Lands:
E. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Currently - Closed loop vertical wells (x3) with water to test heat rejection capabilities of the around.
Future — Closed loop wellfield and heat pump system utilizing water for heatina and cooling of a future
dormitory.
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: November 17.2010 Number ofborings: 3
Approximate depth of each boring (feet): 500
(2) Type of tubing to be used (copper, PVC, etc): SDR9. 1-1 /4 inch pipe
(3) Well casing. Is the well(s) cased? (check either (a.) Yes or (b.) No below)
(a) Yes if yes, then provide casing information below
Type: galvanized steel black steel plastic other (specify)
Casing depth: From to feet (reference to land surface)
Casing extends to above ground inches
(b) No _X
(4) Grout Info (material surrounding well casing and/or piping):
(a) Grout type: Neat Cement Bentonite X_ Other (specify)
(b) Grout placement: Pumping_X Pressure Other
(c) Grout depth of tubing (reference to land surface): from _500 to _0 (feet)
If well has casing, indicate grout depth: from to (feet)
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page 2

H. INJECTION -RELATER EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
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 200 feet of
the geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, streams, and/or highway intersections.
J. 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 familiar 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 information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I 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."
Signa6fre of Proerty Owner/Aunt
C O IS e
Print or T§pe Full Name and title'µiCts« q
17/0 It h i
Please return two copies of the completed Application package to:
North Carolina DENR-RWQ
Aquifer Protection Section-UIC Program.
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page 3

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