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Home My WebLink AboutWI0100191_Regional Office Physical File Scan Up To 9/23/2022A� A Permit Number WI0100191 Program Category Ground Water Permit Type Injection Water Only GSHP Well System (5QW) Primary Reviewer eric.g.smith Coastal SW Rule Permitted Flow Facility Facility Name Michael Bradley SFR Location Address 31 Bleeker Ln Fairview NC 28730 Owner .Owner Name Michael Steven Bradley Dates/Events Scheduled Orig Issue App Received Draft Initiated Issuance 11/07/11 Regulated Activities Outmall NULL Waterbody Name Central Files: APS SWP 11 /23/11 Permit Tracking Slip Status Project Type In review New Project Version Permit Classification Individual Permit Contact Affiliation Larry Wells Contact Driller Well 258 N Turkey Creek Rd Leicester NC 28748 Major/Minor Region Minor Asheville County Buncombe . Facility Contact Affiliation Owner Type Individual Owner Affiliation Michael Steven Bradley 31 BleekerLn Fairview NC 28730 Public Notice Issue Effective Expiration Stream Index Number Current Class EON 2 9 25 11 I _ o , i�.17 Office � 11 f. -A gy A�4 iJ4,,,'fi hPi kJ�P,�lAd�O(Jl Y Subbasin AC _4 NCDEIqR North Carolina Department of Environment and Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Governor Director 11/23/2011 Michael. S. Bradley 31 Bleeker Lane Fairview. NC 28730 Natural Resources Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System Permit No. WI0100191 31 Bleeker Lane, Fairview, NC 28730 Dear Mr. Bradley: Dee Freeman Secretary On November 7, 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 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 (919) 715-6166 or Michael.Rosers(ibncdenr.eov if you have any questions. S'ncerely, A. for Debu's Supervisor cc: Asheville Regional Office - APS APS Central Files - Permit No. WI01001, 91 Buncombe County Health Dept. AWD Services, Inc. (Larn, Wells) Bulhnan Heating & .Air (Joey Bullman) 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 FA:',1: 919-715-0588; FAX 2: 919-715-60481 Customar Service: 1-877-623-6748 Internet: mm.nmateroualihi.oro An Equal Opportunity'', Afirmative Action Employer One ortb Caroilria 412a 6 i NORTH C:AROLINA DEPARTMENT OF ENVIRONMENTAND NATURAL RESOURCES (NCDENR) NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM: TYPE 5-OW WELL(S) In Accordance with the provisions of NCAC Title 15A: 02C.0200, please complete this notification and mail to address on the back page (please Prin. or TvP_e inrormation). �3�eU Ty��e Cnrzfia�!�ation: Does the proposed system cireulate potable water only (no additives) in continuous piping that completely isolates the fluid from the environment (i.e. closed -low)? Yes /Co'ntinue completing this form. No _ _ Do Not complete this form. Complete other UIC application forms for installing either a 5A7 well (gpejn-loop well in'eetLng potable water into the aquifer) or a 5'C)M well (closed - loop well containing, additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors). A. PROPERTY OWNER(S)/APPLIC.ANT(S) List each Property Owner listed on property deed (if owned by a business or government agency, state name of entity and a representative w/authority for signature): —� (1) MailingAddress: � 7`e(fketZ Lb% C:ity:I Al rP,LZ i,e,bWtate:._WC�z-ip Code:Z..V,3 _ _County: )3tAK3CVw\b-e_ I lame/Office Tele No.: - 427 9 �� ----------------- Cell No;— limail Address:----- --- ----- ebslte_ ._... --- — - --- --- --- __ (2) Physical Address or Well Site (if different than above): _ City. State: — Zip Code: County: Home/Office Tele No.: II. AUTHORIZED ACENT 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: Address: City: State: Zip Code: County: Office Tele No.: Cell No.: --- Kt� �iV�L ! L;�fvfi r �ilitr' -- Website Address of Company, if any: ----- -_ Il'C710N NOV a 7 2011 ti('l!illl(' iO�i� Noti(icuion ul'lntan Form (Re•��isexl 8/?(loR) I'agc I C. WELL DRILLER INFORMATION Company Name:_ AWD SERVICES,' INC. —-----------___1 Well Driller Contractors Name: NC Contractor Certification No.: v 5 O 0 Contact Person: Larry Wells EMAIL Address: Wells7_50549(@,13ellsouth.net Address: 2.58 North Turkey Creek Rd. City: Leicester — Zip Code: 28748 County: Buncombe OfFcc 'I'ele No.: 828-683-9223 Cell No.: 828-215-9334 D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller) Company Najme: �(l�{(Y1GLn �-CclC�fl'� `�' �ii �--- Contact Person: �t :' LLL%'Yl-� EMAIL Address: DR Address: I() K@CA (fit Ln . City: - iI �Q; Zip Code: Q County:'_uOCtmr> Office Tele No.: � -�>�� ca ff//17 Cell No.: STATUS OF APPLICANT hrivatc: x Stale: Federal: N-1UIIici1)'A1: ,..._.__.. Commercial: Nativc American Lands: INJECTION t'ION PROCEDURE (briefly describe how the injection well(s) will be used) G. WELL CONSTRUCTION DATA (1) Proposed date to be constructed: Why P:gzkAktA, Number of borings: —_ Approximate depth of each boring (feet):_ au (2) Type of tubing to be used (copper, PVC, etc): i�I� _ 15DM ---- (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: galvanised steel ---black steel plastic —_other (specify) Casing depth: From to feet (reference to land surface) Casing extends to above ground inches (b) No v`"__-- (4) Grout Info (material surrounding well casing and/or piping): (a) Grout type: Neat Cement Bentonite (b) (irou! Placement: I'umpin,. I)rCSSUre (c) Grnu1 (ieptli of tubin1) (reference: to land surface): from If'wefl has casing, indicate grout depth: from U111" !!(_' 5(;'W Notification ol'lment Dorm (Revised 8/2008) Other (specify) t e—ek _al 1 Other `ro F�'; �C/o �,o l; -- to _-_,____ (feet) to Mahe 2 H. INJECTION -RELATED EQUI IMENT 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 t%,o 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. 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." Signature of Property Owner/.Applicant AVC ICKQl 57'eU�C0 3ZM)e- Print or'fype Full Name and title Signature of Property Owner/Applicant Print or Type Full Name and title Signature of Authorized Agent. if any Print or Type Ful l Name and title Please return two copies of the completed Application package to: North Carolina DFNI?-DWQ RECEIVED / DENR / Dl/ Q Aquifer Protection Section-U1C Program AOUIFPk"PRnTP;^,TIo ,%f SFC.T IONJ 163:6 Mail Service Center NOV 0 7 209E Raleigh, NC 27699-1.636 Telephone (91.9) 71.5-6935 GPI IAHC 50W Notification ol'Intenl tronm (Revised 8/2008) Page: ii :a 4�. a nuncomge t-ounry i ax Looxup - rroperty uara Page 1 of 2 COUNTY OF BUNCOMBE, .NORTH CAROLINA Web Property Record Card 9696-83-9488-00000 Date Printed: ll/8/2011 Owner Information Owners: MICHAEL S BRADLE Address: 31 BLEEKER LN FAIRVIEW NC 28730 Property Location:31 BLEEKER LN Taxing Districts County: Buncombe County City: Fire: FAIRVIEW FIRE No Owner History Parcel Information i Date: I Book/Page: Book/Page: I Reference: eighborhood: lbdivision: 1b Lot: Total Property Value: 213,100 Active 8047954 7/1O/1991 1657 / 0280 0000 / 0000 WARRANTY OR SPL/COMP TRANSFE 31 BLEEKEk LN RESIDENTIAL FVW-GARREN CRK AREA Easement:N Ownership History Assessment History Year Account Acres Land Bldgs Oth r er Im Assessed Desc Exemptions Deferred Taxable 2o11 8047954 3.09 68,600 139,900 4,600 213,1oo 0 0 213,100 2010 8047954 3:09 68,600 139,900 4,6o0 213,1o0 0 6 213,100 2oo9 8047954 3.09 68,600 139,900 4,6o0 1213,100 0 0 213,100 2oo8 8047954 3.09 68,600 139,900 4,600 213,1oo 0 0 213,100 2007 8047954 3.09 68,600 139,900 4,6o0 213,100 0 0 213,100 2oo6 8047954 3.09 68,600 139,900 4,6o0 213,100 0 0 213,100 2005 8047954 3.09 41,900 112,900 4,600 159,400 0 0 159,400 2004 ' 8047954 3.09 41,900 112,900 4,600 159,400 0 0 159,400 2003 8047954 3.09 41,900 112,900 4,600 159,400 0 0 159,400 2002 8047954 3•09 41,900 13.12,900 4,600 159,400 0 0 159,400 2001 18047954 3.09 128,500183,300 2,200 114,000 .01 10 1114,000 Lana Data Total Acres: 3.09 Land Value: Other Improvements Acres 68,600 Segment# Units Description 1.00 Each HOMESYFE ValnP• n Ann Improv# Description Year Units 1 POOL,VINYL 1988 648 Square Feet 2 3.o9 Acres CLASS 1 Building Structures Res. Buildin S Bsmt Bsmt Year ID g Style Feet SgFt Finished Built 1 RANCH 1604 1604 0 1964 Grade Condition Value C N 139900 http://,Amm,.buncombetax.org/PropertyCard.aspx 11 /8/2011