HomeMy WebLinkAboutWI0100183_Regional Office Physical File Scan Up To 9/22/2022Permit Number WI0100183
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
eric.g.smith
Coastal SW Rule
Permitted Flow
Facilihr
Central Files: APS SWP
10/27/11
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Gail Bredehoeft
3080 Halls Chapel Rd
Burnsville NC 28714
Facility Name Major/Minor Region I
Steve Bredehoeft SFR Minor Asheville
Location Address County
3080 Halls Chapel Rd Yancey
Burnsville NC 28714 Facility Contact Affiliation
IA71 L-
Owner Name
Owner Type
Individual
Steve Bredehoeft
Owner Affiliation
Steve Bredehoeft
Owner
3080 Halls Chapel Rd
Burnsville -NC 28714
Gates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective Expiration
10/27/11 10/25/11
10/27/11 10/27/11
Regulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Waterbody Name
Stream Index Number Current Class Subbasin
f'.JU 01 ?_ul�
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
10/27/2011
Steve Bredehoeft
Gail Bredehoeft
3080 Halls Chapel Rd.
Burnsville, NC 28714
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0100183
3080 Halls Chapel Rd.
Burnsville, NC 28714
Dear Mr. Bredehoeft:
Dee Freeman
Secretary
On 10/25/2011, 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 Yancey 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.Rogers(a,ncdenr.eov if you have any questions.
Si cerely,
for De , ra atts
Supery or
cc: Asheville Regional Office - APS
APS Central Files - Permit No. WI0100183
Yancey County Health Dept.
Larry Wells (AWD Services, Inc., 256 North Turkey Creek Rd., Leicester, NC 28748)
John Smith (Burleson Plumbing & Heating, Inc., 141 Highland Ave., Spruce Pine, NC 28777)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: 919-733-3221 i FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748 One .1CaF®��a .
Internet: wm.nmateraualitv.org
An Equal Opportunity 1 Affirmative Acton Employer P � tr£
1\V'1Jl.l'1�1'1A1V1\ VA' 111%1L'119Y A"ii Vl\lilil LlV1 VAC Vr JVJnt,A L' ALVJ1.�,lAlJl�l WI+iLA��
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED -LOOP WATER -ONLY GEOTHERMAL INJECTION WELLS
These wells circulate potable water only as part of a geothermal heating and cooling system.
These wells are "permitted by rule" and do not require an individual permit when they are constructed in
accordance with the rules of 15A NCAC 02C .0200 and this Notice is submitted prior to construction.
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
. 100 19 'S
Print or Type Information and Mail to the Address on the Last Page.
DATE: (/ C- 20_// PERMIT NO. (to be filled in by DWQ)
A. STATUS OF WELL OWNER (choose one)
Non -Government: Individual Residence Y Business/Organization
Government: State Municipal County Federal
B. WELL OWNER - For individual residences, list each owner on property deed. For all others, state name of
entity and name of person delegated
Mailing Address: 3 O
to sign on behalf of the business or agency:
City: 4 4 rn-s Ville_ State:/1/ G Zip Code! Z d %/ y County: G
Day Tele No.: 4F2-Ij - 4 %25- - q T'Z D Cell No
EMAIL Address: Fax No.:
C. LOCATION OF WELL SITE - Where the injection wells are.physically located:
(1) Parcel Identification Number (PIN) of well site: 0 %,5�'Qo FlQ9�County: C
(2) Physical Address (if different than mailing address):
City: State: NC Zip Code:
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
GPU/MC 5QW Notification (Revised 3/18/2011) RECEIVED / DENR / DVVQ Page 1
Aquifer Protection Section
NC Well Drilling Contractor Certification No.:
Company Name: 11 h/O sc d
Contact Person: Z_a✓ J k1e
Address: ZS'l �., 7 -u-v,
9. ne i
City: lei Gefee:i, Zip Code Z8 % State: �GCounty: gu4 cv.,�
Office Tele No.: ZZ r2-2,3 Cell No.: 94�- -93_3r Fax No.: 17- - - '?L 0 ?
E. HEAT PUMIP CONTRACTOR INFORMATION (if differentthan driller)
Company Name: ��✓!e s aw /044 pc5 , „ �, d- Nam@ 1( j
ContactPerson: EMAIL Address
Address: /f% AlU la n ./ _ wr -� _i'�1111
Ina i` i C,
City:
S .-
A' a
Zip Code: tate:�County: ZVJ
Office
ele No.:
d 2 - 7L5--
4/0 y 2 Cell No,: Z 8_ l 2 L 2- Fax No.: 82. , - 7L.f = Qa1
E. WELL CONSTRUCTION DATA
(1) Number of borings to be constructed*: 2 Depth of each boring
(feet): .300 ! P, g
* If existing water supply wells will be used then provide the information in item (4)
below.
(2) Type of tubing to be used (steel, PVC, etc): t 2
(3) Well casing. If the well(s) will use casing th provide the tyke (steel, PVC, etc.), diameter. depth,
and extent of casing appearing above ground: _ _ �D C-O a ►' h e
(4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonite** Other (specify)
** By selecting bentonite grout, a variance is hereby requested to 1 A NCAC 2C .0213(d)(1)(A), which requires a cement type grout.
(b) Grout depth of tubing (reference to land surface): from �_ to _ 30 L') (feet)
If well has casing, indicate grout depth: from to (feet)
G. WELL LOCATIONS - Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearly and include a north arrow.
(1) Attach a site -specific map showing the locations of the following:
* Proposed injection wells
* Surface water bodies
* Buildings
* Water supply wells
* Property boundaries
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
2 Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE. Inmost cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand Also, a `layer' can be selected showing topographic contours or
elevation data.
GPU/UIC 5QW Notification (Revised 3/18/2011) Page 3
H. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC.02C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. fora partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public, agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which means all persons listed on the prope deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf..
"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."
"Zperty
ignature of Owner/Applicant
Z9
Print or Type Full Name
X4
igof Property Owner/Applic
%nature
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit the complete application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone (919) 733-3221
GPU/UIC 5QW Notification (Revised 3/18/2011)
RECEIVED / DENR / DWC
Aquifer Protection Section
OCT 252011
Page 4
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