WI0100153_Regional Office Physical File Scan Up To 9/22/2022

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MCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
April 28, 2011
Margaret M. Samano
2012 Spyglass Ln.
New Smyrna Beach, F132169
Ref: - Issuance of Injection Well Permit WI0100153
Issued to Margaret Samano
Sylva, Jackson County, North Carolina.
Dear Ms. Samano:
Natural Resources
Dee Freeman
Secretary
REC�V'5'�_--0 //
d
PPAY 0-9 �i;
Asheville Regional Office
A uifer Protection
In accordance with the application received on April 12, 2011, I am forwarding permit number WI01.00153 for the
construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system. This
permit shall be effective from the date of issuance until March. 31, 2016, and shall be subject to the conditions and
limitations stated therein. Specific attention should be paid tothe the requirement to protect the well during
construction of the site and structures located at the facility as specified in Part I.5, the requirement to install
well identification tags as specified in Part 11.3, and to submit well construction records as specified in Part
VII.2. Be sure to read the entire permit to ensure that you are aware of all compliance requirements of the permit.
You will need to notify this office at least 48 hours prior to beginning construction and operation of the injection
well system. In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must
submit an application to renew the permit 120 days prior to its expiration date. This permit is not transferable to
any person without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at [phone] or [e-mail] if you have any questions about your permit.
Best Regards,
!� John McCrav'
cc:=IndonrDa�'idson;`st�evilte�Re=iona? 4�,ffce:
WI0100153 Permit File
Jackson County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] FAX 1: 919-715-0588: FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
Internet: www.ncwatercuality.org
An Equal Opportunity X Affirmative Action Employer
One
NofthCarol'Ina
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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
Margaret A Samano
FOR THE CONSTRUCTION AND OPERATION OF 2 TYPE 5QM INJECTION WELL(S), 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 Balsam Mtn. Preserve Phase 4 Lot #208,
Cook House Rd, Sylva, Jackson County, and will be constructed and operated in accordance with the
application received April 12, 2011, 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 of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until March 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 27th day of April, 2011.
Cleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #W10100153 UIC/5QM Page 1 of 5
ver. 03/2010

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
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.
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].
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation corners) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
One well identification tag per grouping or `cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III — OPERATION AND USE GENERAL CONDITIONS
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.
Permit #W10100153 UIC/5QM Page 2 of 5
ver. 03/2010

s
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
ground water resulting from the operation of this facility.
PART V — OPERATION 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 (919) 71. 5-6168. 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.
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. Division 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.
Permit #W10100153 UIC/5QM Page 3 of 5
ver. 03/2010

PART VII — MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section — UIC Program Aquifer Protection Section
DENR — Division of Water Quality Asheville Regional Office
1636 Mail Service Center and 2090 U.S. 70 Highway
Raleigh, NC 27699-1636 Swannanoa, NC 28778
Ph# 919-715-3221 Ph4 828-296-4500
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Asheville Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Asheville Regional Office within 30
days of completion of well construction.
4. 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.
5. 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;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. 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.
7. 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 VIII — PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit #W10100153 UIC/5QM Page 4 of 5
ver. 03/2010

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, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
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 that 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 copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.1 of this permit.
Permit #W10100153 UIC/5QM Page 5 of 5
ver. 03/2010

Central Files: APS_ SWP_
04/15/11
Permit: Number W10100153
Permit Tracking Slip
Program Category
Status Project Type
Ground Water
In review New Project
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Version Permit Classification
Individual
Primary Reviewer
Permit Contact Affiliation
john.mccray
Larry Wells
Contact Driller Well
Coastal SW Rule
258 N,Turkey Creek Rtl
Leicester NC 28748
Permitted Plow
Facility
Facility Name
Miajor/Minor Region
Margaret M Samano. SFR
Minor Asheville
Location Address
County
Balsam Mtn Preserve Ph4
Jackson
Sylva NC 28779
Facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
Margaret M Samano Owner Affiliation
Margaret M. Samano
2012 Spyglass Ln
New Smyrna Beach FL 32169
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
04/12/11
Regulated Activities
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

v7
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North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen FI. Sullins
Governor Director
April 15, 2011
Margaret M Samano SFR
2012 Spyglass Lane
New Smyrna Beach. FL 32169•
Subiect: Acknowledgement of Application No. WI0100153
Margaret M Samano SFR
-lujection Mixed Fluid GSHP Well System (5QM)
Jackson
Dear Ms. Samano:
Natural Resources
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on April 12, 2011. 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 john.mceray@ncdenr,gov. If the reviewer is
unavailable, you may leave a message, and they will respond promptly.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
0 x
�A&gym
,for Debra J. Watts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Appalachian Well Drillipng (Larry Wells)
Haywood Heating d_ Air Conditioning, Inc. (David Moody)
Permit Application File WI0100153
AQUIFER PROTEECTION ScCTION
1636 FY 2il Service Center. Raleigh. Norffh Carolina 27699-1636
Location: 2728 Capital Bcdevard, Raleigh, North Caroline 276Cw One
Phone 9 i 9-733-3221 1 FAi,.1: M9-715-0588: FAX 2: 919-71 a-6048 1. Customer Sens ce: 1-8i 1-623-6748
Internet: tm%,.ncwatemuaiitv.orc 1;'gort}. CaC91.I i
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Rogers, Michael
From: [e-mail]
Sent: Tuesday, April 12, 2011 7:02 AM
To: Rogers, Michael
Subject: Fwd: Permit 7 pages
Attachments: Larry_Samano_0_April _11_2011.jpg; Larry_Samano_1_April_11_2011.jpg; Larry_Samano_2
_April_11_2011,jpg; Larry_Samano_3_April_11_2011.jpg; Larry_Samano 4_April _11_
2011.jpg; Larry_Samano_5_April_11_2011.jpg; Larry_Samano_6_April_11_2011.jpg
Hope this one is right. Thanks [phone]
-----Original Message -----
From: Carolyn Parrott <2parrotts(@gmail.com>
To: Larry Phillips <lphillips9898(@aol.com>
Sent: Mon, Apr 11, 2011 4:46 pm
Subject: Permit 7 pages