WI0100207_Regional Office Physical File Scan Up To 9/23/2022

Mike's Heating & Cooling
.RESIDENTUL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3500
1. WELL CONTRACTOR:
Chad Surrett
Well Contractor (Individual) Name
AWD Services Inc
Well Contractor Company Name
258 North Turkev Creek Rd
Street Address
Leicester NC 28748
City or Town State Zip Code
828 683-9223
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WIO100207 ?
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID *(if applicable) 9586958082
3. WELL USE (Check Applicable Box): Residential Water Supply tr
DATE DRILLED 5/17/12
TIME COMPLETED AM ❑ PM
4. WELL LOCATION:
CITY: Saluda
COUNTY Henderson
894 Whites Lake Blvd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
9Slope ❑Valley ❑Flat ❑Ridge
❑OtherEley. 2176'
LATITUDE 35 - 15 18.0000
" DMS OR DD
LONGITUDE 82 - 23 2.0000
" DMS OR DD
LatitudeAongitude source: @fsps propographic map
(location of well must be shown on a. USGS topo map andaftached to
this form if not using GPS)
5. WELL OWNER
Charles Fisher
Owner Name .
894 Whites Lake Blvd
Street Address
Saluda NC 28773
City or Town State Zip Code
8( 28 )
Area code Phone number
(2) Geothermal Bore
6. WELL DETAILS:
a. TOTAL DEPTH: (2) 300'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9
c. WATER LEVEL Below Top of Casing: NIA FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A . FT. Above Land Surface*
*Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118. .
e. YIELD (gpm): NIA METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount NIA
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top
Top
- Bottom
Bottom
Top
Bottom
Thickness/
7. CASING:
Depth
Diametei
Weight Material
Top_.,__Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material
Method
Top 0
Bottom 20'
Ft. Bentonite
Pour
Top 21'
Bottom 300'
Ft. Pea Gravel
Pour
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in.
in.
Top
Bottom
Ft: in.
in.
Top
Bottom
Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth
Size
Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
I
/
/
/
12. REMARKS:
Variance Request to Rule
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
5/23112
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Chad Surrett
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
S_tiblmitwithin S0 days ofcgm'pletion to: Division`of:.Vltater;Quality -. Information Processing,
fi617 Mail Sernce Center, Raleigh, NC'27699-161, Photie [phone].
Form GW-1a
Rev. 2/09

Ica NR
North Carolina Department of Environment and Natural
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 17, 2012
Mr. Charles Fisher
2244 Old-Kanuga-Rd..--•
Hendersonville, NC 28739
RE: Variance Request to Rule 15A NCAC 2C .0222(e)(11)
Geothermal Well System, 894 White's Lake Blvd.
PIN# 9586958082
Saluda, NC 28773
Dear Mr. Fisher
it A
Asheville Regional Office
Aquifer Prot —
ection
Dee Freeman
Secretary
On May 15, 2012, the Asheville Regional Office of the Division of Water Quality (DWQ)
received your request for a variance to the injection well construction rules, specifically Rule
15A NCAC 2C.0222(e)(11) . This rule requires all geothermal aqueous closed -loop wells to be
grouted the entire length of the well boring from the bottom of the boring to land surface or, if
completed below land surface, to the well header or manifold connection. The variance
request is for the construction of one (1) geothermal well system at 894 White's Lake Blvd., in
Saluda,. Henderson County, North Carolina.
Based upon the signed agreement with your HVAC contractor land the information
provided by your well: contractor, it is my finding that the factors specified are sufficient to
satisfy the conditions for approval of a variance as defined in 15A NCAC 2C.0241. Please note
the variance conditions, listed below, regarding the construction of this well system. The
variance will be effective for a period of six (6) months beginning from the date of issuance.
Since the well will not meet current regulatory requirements,. the following minimum additional
construction requirements will be necessary to mitigate any potential problems that could
affect public health and/or the well's effective operation:
AQUIFER PROTECTION SECTION —Asheville Regional Office (ARO)
2090 U.S.70 Highway, Swannanoa, NC 28778.8211
Phone: [phone] FAX [phone]
Internet: www.nmaternualitv,oxi
An Equal Opportunily 1 Afirmative Action Employer
Nne
orthCarolina

N&. Fisher
05/17/2012
Page 2 of 2
This variance shall be subject to the following specified: conditions as follows:
1. All wells constructed as part of this system shall be located a, minimum of 25 feet from any
'existing or proposed structure;
2. All wells constructed as part of this system shall be located a minimum 50 feet from all parts
of existing or proposed septic systems including any repair area;
3. Notification shall be given to Jonathan Stepp at the letterhead address or by
telephone at [phone], at least 24 hours prior to the start of well construction;
....-..--.4.—All-wells-constructed as part of this system shall be grouted 10 feet into consolidated rock -
and extend a minimum of 50 from land surface or, if completed below land surface, to the
well header or manifold connection; and,
5. Attach a copy of this variance to each GW-1 form submitted for each well constructed as
part of this system.
The granting of this variance is for the grout portion of the well only and In no way
relieves the owner or agent from other requirements of the applicable North Carolina Well
Construction Standards (NCAC 2T .0200), or any applicable law, rule, or regulation that may be
regulated by other agencies. If you are dissatisfied with this decision, you may commence a
contested case by filing a petition under G.S. 150-23 within sixty (60) days after receipt of the
decision.
4680.
If you have any questions regarding this variance, please contact me directly at 828-296-
Sincerely,
G. Landon Davidson, P.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 23, 2012
Mr. Charles Fisher
2244 Old Kanuga Rd.
Hendersonville, NC 28739
RE: Variance Request to Rule 15A NCAC 2C .0222(e)(11)
Geothermal Well System, 894 White's Lake Blvd.
PIN# 9586958082
Saluda, NC 28773
Dear.Mr. Fisher
Dee Freeman
Secretary
On May 23, 2012; the Asheville Regional Office of the Division of Water Quality (DWQ)
received your request for a variance to the injection well construction rules, specifically Rule
15A NCAC 2C.0222(e)(11) . This rule requires all geothermal aqueous closed -loop wells to be
grouted the entire length of the well boringfrom the bottom of the boring to land surface or, if
completed below land surface, to the well header or manifold connection. The variance
request is for.the construction of one (1) geothermal well system at 894 White's Lake Blvd., in
Saluda, Henderson.County, North Carolina.
Based upon the signed agreement with your HVAC contractor and the information
provided by your well contractor, it is my finding that the factors specified are sufficient to
satisfy the conditions -for approval of a variance as defined in 15A NCAC 2C.0241. Please note
the variance conditions, listed below, regarding the construction of this well system. The
variance will be effective for a period of six (6) months beginning from the date of issuance.
Since the well will not meet current regulatory requirements, the following minimum additional
construction requirements will be necessary to mitigate any potential problems that could
affect public health and/or the well's effective operation:
AQUIFER PROTECTION SECTION —Asheville Regional Offtse (ARO)
2090 U.S. 70 Highway, Swannanoa,,NC 28778-8211
Phone; 828-296.45M 1 FAX [phone]
Intemet: www.ncwater�uali .orq
An Equal Opportunity 1 AfffrmativeAcllon Employer
NorthCarolina
NdA(Iha!!11.

Mr. Charles Fisher
05/23/2012 -
Page 2 of 2
This variance shall be subject to the following specified conditions as follows:.
1. All wells constructed as part of this system shall be located a minimum 50 feet from all parts
of existing or proposed septic systems including any repair area;
2. Notification shall be given to Jonathan Stepp at the letterhead address or by
telephone at [phone], at least 24 hours prior to the start of well construction;
3. All wells constructed as part of this system shall be grouted 10 feet Into consolidated rock
and extend a minimum of 50 from land surface or, if completed below land surface, to the
well header or manifold connection; and,
4. Attach a copy of this variance to each GW-1 form submitted for each well constructed as
part of this system.
5. This variance shall replace the variance granted on May,17, 2012.
The granting of this variance is for the grout portion of the well only and in no way
relieves the owner or agent from other requirements of the applicable North Carolina Well
Construction Standards (NCAC 2T .0200), or any applicable law, rule, or regulation that may be
regulated by other agencies. -If you are dissatisfied with this decision, you may commence a
contested case by filing a petition under G.S. 150-23 within sixty (60) days after receipt of the
decision.
If you have any questions regarding this variance; please contact. me directly at 828-296-
4680.
Sincerely,
---------
G. Landon Davidson, P.G.
Aquifer Protection Section. Regional Supervisor
Asheville Regional Office
cc: - ARO-APS Files
ec: Ronald Hathcock
Larry Wells

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 23, 2012
Mr. Charles Fisher
2244 Old Kanuga Rd. .
Hendersonville, NC 28739
RE: Variance Request to Rule 15A NCAC 2C .0222(e)(11)
Geothermal Well System, 894 White's Lake Blvd.
PIN# 9586958082
Saluda, NC 28773
Dear Mr. Fisher
Dee Freeman
Secretary
On May 23, 2012, the Asheville Regional Office of the Division of Water Quality (DWQ)
received your request for a variance to the injection well construction rules, specifically Rule
15A NCAC 2C.0222(e)(11) . This rule requires all geothermal aqueous closed -loop wells to be
grouted the entire length of the well boring from the bottom of the boring to land surface or, if
completed below land surface, to the well header or manifold connection. The variance
request is for the construction of one (1) geothermal well system at 894 White's Lake Blvd., in
Saluda, Henderson County, North Carolina.
Based upon the signed agreement with your HVAC contractor and the information
provided by your well contractor, it is my finding that the factors specified are sufficient to
satisfy the conditions for approval of a variance as defined in 15A NCAC 2C.0241. Please note
the variance conditions, listed below, regarding the construction of this well system. The
variance will be effective for a period of six (6) months beginning from the date of issuance.
Since the well will not meet current regulatory requirements, the following minimum additional
construction requirements will be necessary to mitigate any potential problems that could
affect public health and/or the well's effective operation:
AQUIFER PROTECTION SECTION —Asheville Regional Office (ARO)
2090 U.S. 70 Highway, Swannanoa, NC 28778-8211
Phone: [phone] FAX: [phone]
Internet: www.ntwaterauality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
Naturallb,

Mr. Charles Fisher
05/23/2012
Page 2 of 2
This variance shall be subject to the following specified conditions as follows:
1. All wells constructed as part of this system shall be located a minimum 50 feet from all parts
of existing or proposed septic systems including any repair area;
2. Notification shall be given to Jonathan Stepp at the letterhead address or by
telephone at [phone], at least 24 hours prior to the start of well construction;
3. All wells constructed as part of this system shall be grouted 10 feet into consolidated rock
and extend a minimum of 50 from land surface or, if completed below land surface, to the
well header or manifold connection; and,
4. Attach a copy of this variance to each GW-1 form submitted for each well constructed as
part of this system.
5. This variance shall replace the variance granted on May, 17, 2012.
The granting of this variance is for the grout portion of the well only and in no way
relieves the owner or agent from other requirements of the applicable North Carolina Well
Construction Standards (NCAC 2T .0200), or any applicable law, rule, or regulation that may be
regulated by other agencies. If you are dissatisfied with this decision, you may commence a
contested case by filing a petition under G.S. 150-23 within sixty (60) days after receipt of the
decision.
If you have any questions regarding this variance, please contact me directly at 828-296-
4680.
Sincerely,
G. Landon Davidson, P.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
cc: ARO-APS Files
ec: Ronald Hathcock
Larry Wells

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 17, 2012
Mr. Charles Fisher
-----_22_44-01d_Kanuga_Rd.-
Hendersonville, NC 28739
RE: Variance Request to Rule 15A NCAC 2C .0222(e)(11)
Geothermal Well System, 894 White's Lake Blvd.
PIN# 9586958082
Saluda, NC 28773
Dear Mr. Fisher
Dee Freeman
Secretary
On May 15, 2012, the Asheville Regional Office of the Division of Water Quality (DWQ)
received your request for a variance to the injection well construction rules, specifically Rule
15A NCAC 2C.0222(e)(11) . This rule requires all geothermal aqueous closed -loop wells to be
grouted the entire length of the well boring from the bottom of the boring to land surface or, if
completed below land surface, to the well header or manifold connection. The variance
request is for the construction of one (1) geothermal well system at 894 White's Lake Blvd., in
Saluda, Henderson County, North Carolina.
Based upon the signed agreement with your HVAC contractor and the information .
provided by your well contractor, it is my finding that the factors specified are sufficient to
satisfy the conditions for approval of a variance as defined in 15A NCAC 2C.0241. Please note
the variance conditions, listed below, regarding the construction of this well system. The
variance will be effective for a period of six (6) months beginning from the date of issuance.
Since the well will not meet current regulatory requirements, the following minimum additional
construction requirements will be necessary to mitigate any potential problems that could
affect public health and/or the well's effective operation:
AQUIFER PROTECTION SECTION — Asheville Regional Office (ARO)
2090 U.S. 70 Highway, Swannanoa, NC 28778-8211
Phone: [phone] FAX: [phone]
Internet: www.ncwaterauality.mg
An Equal Opportunity V Affirmative Action Employer
Nne
orthCarolina
Aaturaily

Mr. Fisher
05/17/2012
Page 2 of 2
This variance shall be subject to the following specified conditions as follows:
1. All wells constructed as part of this system shall be located a minimum of 25 feet from any
existing or proposed structure;
2. All wells constructed as part of this system shall be located a minimum 50 feet from all parts
of existing or proposed septic systems including any repair area;
3. Notification shall be given to Jonathan Stepp at the letterhead address -or by
telephone at [phone], at least 24 hours prior to the start of well construction;
4—All-wells-constructed-as-part-of this system shall -be grouted -10 feet -into consolidated - rock----
and extend a minimum of 50 from land surface or, if completed below land surface, to the
well header or manifold connection; and, .
5. Attach a copy of this variance to each GW-1 form submitted for each well constructed as
part of this system.
The granting of this variance is for the grout portion of the well only and in no way
relieves the owner or agent from other requirements of the applicable North Carolina Well
Construction Standards (NCAC 2T .0200), or any applicable law, rule, or regulation that may be
regulated by other agencies. If you are dissatisfied with this decision, you may commence a
contested case by filing a petition under G.S. 150-23 within sixty (60) days after receipt of the
decision.
- If you have any questions regarding this variance, please contact me directly at 828-296-
4680.
Sincerely,
G. Landon Davidson, P.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office

:x
J
Ad �A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
May 17, 2012
Mr. Charles Fisher
__2244-Old-Kanuga-Rd,-------- -
. Hendersonville, NC 28739
RE: Variance Request to Rule 15A NCAC 2C .0222(e)(11)
Geothermal Well System, 894 White's Lake Blvd.
PIN# 9586958082
Saluda, NC 28773
Dear Mr. Fisher
On May 15, 2012, the Asheville Regional Office of the Division of Water Quality (DWQ)
received your request for a variance to the injection well construction rules, specifically Rule
15A NCAC 2C.0222(e)(11) . This rule requires all geothermal aqueous closed -loop wells to be
grouted the entire length of the well boring from the bottom of the boring to land surface or, if
completed below land surface, to the well header or manifold connection. The variance
request'is for the construction of one (1) geothermal well system at 894 White's Lake Blvd., in
Saluda, Henderson County, North Carolina.
Based upon the signed agreement with your HVAC contractor and the information
provided by your well contractor, it is my finding that the factors specified are sufficient to
satisfy the conditions for approval of a variance as defined in 15A NCAC 2C.0241. Please note
the variance conditions, listed below, regarding the construction of this well system. The
variance will be effective for a period of six (6) months beginning from the date of issuance.
Since the well will not meet current regulatory requirements, the following minimum additional
construction requirements will be necessary to mitigate any potential problems that could
affect public health and/or the well's effective operation:
AQUIFER PROTECTION SECTION —Asheville Regional Office (ARO)
2090 U.S. 70 Highway, Swannanoa, NC 28778-8211
Phone: [phone] FAX: [phone]
Internet: www.ncwaterauality.org
An Equal Opportunity %Affirmative Action Employer
One
NorthCarolina
Naturall,ff

Mr. Fisher
05/17/2012
Page 2 of 2
This variance shall be subject to the following specified conditions as follows:
1. All wells constructed as part of this system shall be located a minimum of 25 feet from any
existing or proposed structure;
2. All wells constructed as part of this system shall be located a minimum 50 feet from all parts
of existing or proposed septic systems including any repair area;
3. Notification shall be given to Jonathan Stepp at the letterhead address or by
telephone at [phone], at least 24 hours prior to the start of well construction;
------ -4: -All-wells-constructed as -part- of -this system -shall be -grouted -10 feet -into consolidated -rock -
and extend a minimum of 5Q from land surface or, if completed below land surface, to the
well header or manifold connection; and,
5. Attach a copy of this variance to each GW-1 form submitted for each well constructed as
part of this system.
The granting of this variance is for the grout portion of the well only and in no way
relieves the owner or agent from other requirements of the applicable North Carolina Well
Construction Standards (NCAC 2T .0200), or any applicable law, rule, or regulation that may be
regulated by other agencies. If you are dissatisfied with this decision, you may commence a
contested case by filing a petition under G.S. 150-23 within sixty (60) days after receipt of the
decision.
4680.
If you have any questions regarding this variance, please contact me directly at 828-296-
Sincerely,
G. Landon Davidson, P.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office

_ ,i 10020
Ua-r ; 0ol e, ._�
r
to
>ro
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Ll
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WEL
These wells are "permitted by rule" and do not require an individual permit when constructed in accurdance ivi r% (Q F-S
cst
the r-zrlrcv of LiA NCAC 02C, 0200*. This notice lnust be submitted prior to construction. 5 0CD
t�
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS p' rr"Z
As described in 15A NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water an
performance -enhancing additives as pail of a geothermal hoating and cooling system.
OR
GEOTHERMAL DIRECT EXPANSION CLOSED -LOOP WELLS
As described in 15A NCAC 02C .0223 these wells circulate a refrigerant gas as part of a geothermal heating and
cooling system,
Pratt Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete
DATE: ~ rf 20 %p� PERMIT NO. (to be completed by DWQ)
A. TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO BE CONSTRUCTED
11 (1) Aqueous (as per 15A NCAC 02C .0222): _ Number of wells:
(2) Direct Expansion (as per 15A NCAC 02C .0223) Number of wells:
O
B. STATUS OF WELL OWNER (choose one)
r3 (1) Single Family Residence — 4-ubmit this form two (2) business days prior to construction.
(2) Business/Organization _ Submit this form 30 days prior to construction.
(3) Government: State Municipal_ County , Federal Submit this form 30 days
�1
t prior to construction.
C. WELL OWNER — For single family residences list the property owner(s), For all others, list name of the
business, organization, or government agency and person delegated signature authority:
.Mailing Address: .,L.� � 1d 1��r-'a sh,
y
City:� P`�Ge7 t�/�,�- State: . Zip Code:MVY County:
Day Tele No.: ) 64-7 a � Cell No.
:�
EMAIL Address: Lam` (' J fa/ i n
�i�'" �� � :�,_.,g Fax No,:
D. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (Ply of well site: M1,17,,25�.��1;�;�
County: - ` /-, ;'I
(2) Physical Address (if different than aili�g addre� ):
SI C : 5i Z_ i
City: x lz a — State: NC Zip Code:
DWQ/1J1C/C1cjsed-Loop Geothermal Notification (Revised 4/30/2012) Page I

E. MAPS, PLANS, AND SPECIFICATIONS
(1) Maps must be scaled or otherwise accurately indicate distances and orientations of features located
within 250 feet of the injection well(s). Label all features clearly and include a north arrow. Attach a
site -specific map showing the locations of the following:
Proposed injection well locations a Septic systems and associated spray irrigation
® Buildings sites, drain fields, or repair areas
e Property boundaries
• Surface water bodies a Existing or potential sources of groundwater
b Water supply wells contamination
(2) Plans and specifications of the surface and subsurface construction details of the well system
F. TYPES AND CONCENTRATIONS OF ADDITIVES — List any additives that will be used and their
concentrations. Only additives that the Department of Health and Human Services' Division of Public Health
determines do not adversely affect human health shall be used. A list of approved additives can be found
online at http://portaLncdenr.00rrgg/web/wqlaps/gwpro. All other additives require approval prior to use.
G. WELL DRILLER INFORMATION (if kno
Well Drilling Contractor's Name: Jt CC
NC Well Drilling Contr ctor Certification No.: C�?&D
Company Name: A #_ e.L."n Gj&i/ Drd ode Contact Person: Zarrz, kl, 4
City: �� _. State: Zip CodeM,.'County:
Day Tele Nod Cell No.:
EMAIL Address: Fax No.:
H, HEAT PUMP i
Company Name
Contact Person:
Address
Citv: _
Office Tele No.:
DWQ/U1C/Closed-Loop Geothermal ivotification (Revised 4/30P.012) Page 2

Y
1, PROTECTION — Provide a brief description of how (1) water supply wells; (2) surface water bodies; and (3)
septic systems and associated spray irrigation sites, drain fields, or repair areas within 250 feet of the proposed
injection �wells willbeprotected during construction of the wells:
,i. VARIANCE — Pursuant to 15A NCAC 02C .0241 the Director of the Division of Water Quality may grant a
variance from applicable well construction or operation standards provided that:
(1) use of the well(s) will not endanger human health and welfare or the groundwater; and
(2) that construction or operation in accordance with the standards is not technically feasible or the
proposed construction provides equal or better protection of the groundwater.
Any variance request should accompany submittal of this notification to expedite evaluation of the request.
The variance request form can be accessed online at littp:Hportal.ncdenr.or web/wq/aps/ wpro/permit-
applications
K. SIGNATURES — The following section is to be completed as required below or by that person's authorized
agent. 15A NCAC 02C .0211(e) requires signatures as follows:
(a) for a corporation: by a responsible corporate officer;
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(c) for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
(d) for all others: by the well owner;
(e) for any other person authorized to act on behalf of the applicant: documentation shall he
submitted with the notification that clearly identifies the person, grants them signature
authority, and is signed and dated by the applicant.
"I hereby cert f; under penalty rf, law, that 1 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'ftnes and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon
the injection m nd aev✓ renarrces in accordance with the I Sff NC.aC 02C 0200 Rules.'
Signature of Property ner/Appticant
C S1. L, t rJ S ,. `- fr %.S
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
DWQMIC/Closed-Lonp Geothermal Notification (Revised 4/30/2012) Page 3

L. SUBMITTAL INSTRUCTIONS • Submit one copy of the completed notification package to the each of the
ZP
following:
(1) The Division of Water Quality- Regional Office serving the area in which the injection well facility
will be located:
Asheville Regional Office
2090 U.S. Highway 70
Swannanon, NC 28778
Telephone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
Telephone: [phone]
Fax.- [phone]
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Telephone, [phone]
Fax: [phone]
Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
Telephone: [phone]
Fax: (919) 57I-4718
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Telephone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Telephone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107-2241
Phone: [phone]
Fax: [phone]
(2) County Health Department in which the injection well Facility will be located. A list of county health
departments can be found online at htll)!,/www.ticallid.ordeotiiii),.Iitin.
DWQRAC/Closed-Loop Geothermal Notification (Revised 413012012) Page 4

IV

NORTH CABLO MA DEPARTMENT Or ENVIRONMENT AND NATURAL RESOURCES.
VAI LkNCE APPLICATION POP, 3N MCTXON WELL CONSTRUCTION STANDARDS:
GF,OT]gEliZ1VlAL AQUMOUS CLOSIED-LOOP WELLS (15A NCAC 02C .022A).OR
GrEOTE MAMAL DERECT E"ANSION CLOSED -LOOM WELLS (15A NCAC 02C .0223)
This form MUST accompany the Closed -Loop Geothertnal Notification Form available online at
httm//Aortal.ncdenr.ori/web/w�clabs/gwnro%permit-aoulicatipns aeotherniA„2ps
Pdw Cleariy or Type Information. Il%gible Submittals W11 Be Returned As 1'ncomplere
DATE: r 20 / ]P E)00T NO_ (to be completed by DWQ)
A. WELL OWNER.- For single family residences list the property owner(s). For all others, list name of the
business, organization, or governmenf agency aand'.person delegated signature authority:
Mailing Address: d �°.,� C✓/G` A&gnz! rL &-az,
City: _&4b4z',n n r/ail, State:. L' Zip Code- 'aCounty:
Day Te1e No.-g,)x9 ,y Vo Cell No.:
EMAIL Address: e
P. PHYSICAL LOCt1.TXON OF WELL SITE '
(1) Parcel IdentWoai on Number (PIN) of well site: /,� 'l s-sye)
County: h!_o'l� t e,61.1
(2) Phy_s%cal Addips,(if flifferent than Ipailing ad4ress),:
City:
State:lLC Zip .Code: ! 97 7-7
C. WrX L DRIL1;E12 INFORMATION (if lmown)
.Well Drilling Contractor's blame: P obert Larry Wells
NC Well Drilling Contractor Certification No.: 2603 '
Company Name: A.WD Services, Inc Contact person: Larry Wells
City: Leicester State: NC_ Zip Code: 28748_ County:_ Buncombe
Day Tele No.: 828-683-9223 Cell No.: 828-215-9334
EMAIL Address: ' Welis750549®bellsouth.net • Pax No.: 828-683-920
DWQ/MC/Closed-LLVp Geothermal Vedance Requrst (Revised I/=12)
60 39Vd
ONI S30IA*63s Grid
page 1
E0Z68898Z8 0t�0t i;LO�/tit/90

nASJNd FOR VAMAINCE REQUEST — Include type of wall(s) to b-. constructed; rule for which the
variance is being req=-Eed; description of how the alternate construction will not endanger human health and
welfare and the environment; and reason why construction and/or operation in accordance with the standards is
not teebnically feasible and/or provides equal or better protecilon of the grouadwatcr.
�a �£O �lJ S 4J ire �1� !G c•e 27ra r r� T�i.ie��S.�
7 r�
�a� t u.Qs ��G _
-oe.ao % A+a it
�. = ?e _ T'!w tt/Y.at CwTr Pam- c✓� - 4t somas f d z
�•��- o w Nam- _
k a..
_'tT•� �� �%!/ems /���T , � �✓ %�.'s �eo�o
G'iR•w A/o7r •
X SIG ATUM — The following section is to be completed as required below or by that person's authorized
agent, ISA *NCAC 02C .021 i(e) requires signatures as follows:
(a) for a corporation: by a responsible comoram officer;
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(e) for a municipality or a stale, fedora], or other public agency_ by either a principal exam ive
-officer nr ranking publicly elected official;
(d) for all otners: by the well owner;
(e) for any. other person authorized to act on behalf of the applicant: documentation shall be
submitted with tho notification that clearly IdWiftes the person, grants them -signature;
authority, and is signed and dated by the applicant.
"I hereby certify, under• penalty of Imo, that I have personally exandited w d am fmnIlia- wid? the it formation
sxbtnf(W, In flats doCumerrt and all aaad menr's thereto and that, based on my inquiry of those individuells
immegately.respom ble for obtainbig said Wormatian, I believe that the irforraatiorr is 1",e, adCwate and
complete. Ion aware that there are sigrdfrcant penalties, inahe tag the possibility of final and imprisonment,
for submliring false information. I agree to eomtrtsct, operate, mointain, repair, and if applicable, abandon
the trajection well arrd al lapurtettastcas ir. accordante wil1T tlae •I A NCAC 03C Ct100 R2rles. "
ll _ ti
ftnaturenfPro ty er/Appileant
CHacz s P-SyA64L t. v4 F'r T OL k 15ta il-
Print or Type Fall NA e
Signawre of Authorized Agent, if any
Print or Type Pull INAme
bwQ1MrJCosed-Loop Geothermal Varlante RegoeSt (Revised .50J2012) Page 2

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL, RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WEI
These 147e11s• are "permitted by rule" and do not require an individual permit when constructed in accordance
the rules of hA NCAC 02C.0200*. Tlzis laolice nsust be submitted prior to construction.
GEOTHERMAL AQUEOUS CLOSED -LOOP WELLS
As described in 15A NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water
performance -enhancing additives as part of a geothermal heating and cooling system.
OR
GEOTHERMAL DIRECT EXPANSION CLOSED -LOOP WELLS
As described in 15A NCAC 02C .0223 these wells circulate a refrigerant gas as part of a geothermal heating al id
cooling system.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: i _, 20 PERMIT NO. to be completed by DWQ)
A. TYPE OF GEOTHERMAL CLOSED -LOOP WELL TO BE CONSTRUCTED
(I) Aqueous (as per 15A NCAC 02C .0222): �f Number of wells: J
(2) Direct Expansion (as per 15A NCAC 02C .0223) Number of wells:
B. STATUS OF WELL OWNER (choose one)
(1) Single Family Residence ZSubmit this form two (2) business days prior to construction.
(2) Business/Organization Submit this form 30 days prior to construction.
(3) Government: State Municipal CountyFederal Submit this form 30 days
prior to construction.
C. WELL OWNER — For single family residences list the property owner(s). For all others, list name of the
business, organization, or government agency and person delegated signature authority:
Zip Code:.;iV
D. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number (PIN) of well site:
County: 4, rl
(2) Physical Address (if dif Brent than
City:
State: NC Zip Code:
DWQ/1)IC/Closed-Loop Geothermal Notification (Revised 4/30/2012) Page 1
—Q
M

E. MAPS, PLANS, AND SPECIFICATIONS
(1) Maps must be scaled or otherwise accurately indicate distances and orientations of features located
within 250 feet of the injection well(s). Label all features clearly and include a north arrow. Attach a
site -specific map showing the locations of the following:
© Proposed injection well locations ® Septic systems and associated spray irrigation
Buildings sites, drain fields, or repair areas
a Property boundaries
m Surface water bodies O Existing or potential sources of groundwater
D Water supply wells contamination
(2) Plans and specifications of the surface and subsurface construction details of the well systetn.
F. TYPES AND CONCENTRATIONS OF ADDITIVES - List any additives that will be used and their
- - concentrations. -Only -additives that -the -Department -of -Health and -Human Services' Division of Public Health - — —
deterniines do not adversely affect human health shall be used. A list of approved additives can be found
online at http://poortal.nedenr.org/web/wq/aps/gwpro. All other additives require approval prior to use.
rn
G. WELL DRILLER INFORMATION (if kno )
Well Drilling Contractor's Name: a&_;- l we.
NC Well Drilling Conctor Certification No.: G�d� tr
Company Name: k UJNf �pieContact Person: Ze%fl-lf
City: Pe" r State: Zip Codem- 0scounty:_42M
Day Tole No.:Cell No.:
EMAIL Address: Fax No.:
H. R HEAT PUMP
-- - - "Company Nair
Contact Person
Address•
City: !�
Office Tele No.:
OR
Zip Code; f l"" State:/il__/ County:
Cell No.: Fax No.:
DWQ/UIC/Closed.Loop Geothermal Notification (Revised 4/30/2012) Page 2

1. PROTECTION — Provide a brief description of how (1) water supply wells; (2) surface water bodies; and (3)
septic systems and associated spray irrigation sites, drain fields, or repair areas within 250 feet of, the proposed
injection wells will be protected during construction of the wells:
J. VARIANCE — Pursuant to 15A NCAC 02C .0241 the Director of the Division of Water Quality may grant a
variance from applicable well construction or operation standards provided that:
(1) use of the well(s) will not endanger human health and welfare or the groundwater; and
(2) that construction or operation in accordance with the standards is not technically feasible or the
proposed construction provides equal or better protection of the groundwater. _
Any variance request should accompany submittal of this notification to expedite evaluation of the request.
The variance request form can be accessed online at htip://portal.iicdenr.org/web/wq/aps/gwpro/permit-
applications
K. SIGNATURES — The following section is to be completed as required below or by that person's authorized
agent. 15A NCAC 02C .0211(e) requires signatures as follows:
(a) for a corporation: by a responsible corporate officer;
(b) for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(c) for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
(d) for all others: by the well owner;
(e) for any other person authorized to act on behalf of the applicant: documentation shall be
submitted with the notification that clearly identifies the person, grants them signature
.authority, and is signed and dated by the applicant.
"I hereby certi,�-, wider penalty of law, that I have personally examined and ain familiar with the inforination
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 infonnation. I agree to construct, operate, maintain, repair, and if applicable, abandon
the it jection&W�nd Ja r• ed appta tenances in accordance with the 15A NCAC 02C 0200 Rules. "
Signature of Property ner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
DWQ/UIC/Closed-Loop Geothermal Notification (Revised 4/30/2012) Page 3

L. SUBMITTAL INSTRUCTIONS — Submit one copy of the completed notification package to the each of the
following: t
(1) The Division of Water Quality Regional Office serving the area in which the injection well facility
will be located:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Telephone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
Telephone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Telephone: [phone]
Fax:[phone]
Raleigh Regional Office
- - 1628 Mail -Service Center - - --
Raleigh, NC 27699-1628
Telephone: [phone]
Fax; (919) 57I-4718
Washington Regional Office
943 Washington Square Mall
Washington; NC 27889
Telephone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Telephone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27I07-2241
Phone: [phone]
Fax: [phone]
(2) County Health Department in which the injection well facility will be located. A list of county health
departments can be found online at http://www.ncallid.ora/counly.litm.
DWQMIC/Closed-Loop Geothermal Notification (Revised 4/30/2012) Page 4

Submitted to: Wright Family Custom Homes
P.O. Box 25067
Asheville, INC 28803
[phone]
Date: Monday, February 27, 2012
"We Deliver Comfort"
Job Location: Fisher Residence
Lot #37
Heating &.fir Conditioning Proposal
White's Lake S/D
Saluda, NC13
Thank you for the opportunity to provide you with this Proposal. After a careful inspection & survey of your
home plans, we are pleased to submit the following proposal the subject location in accordance with the
following conditions & specifications. We are confident that the system solutions we have designed will
ensure you client's ultimate comfort & satisfaction!
Description of work to be performed:
We shall install the customer's system choice detailed below. Option 1: We shall install 1- Bosch 4-ton
"CE Series" 2-Stage Geothermal Heat Pump System w/ Variable Speed Blower. Option 2: We shall install
1- Bosch 4-ton "TA Series" 2-Stage Deluxe Geothermal Heat Pump System wl Variable Speed Blower.
Option 3: We shall install 1- Trane 4-ton "XL" Deluxe 2-Stage Geothermal Heat Pump System w/
Variable Speed Blower. Package Geothermal Heat Pump to be located in Basement / Sealed Crawlspace.
Ductwork to be located in Basement / Sealed Crawlspace. We shall install Vertical Boring & Install all
Ground Loop Piping from Mechanical Room to Geo loop Location (within 100'). Contractor to provide
Backhoe for installing Main Lines from house to vertical bore site. Includes Environal Ant!Freeze. All
Geothermal Systems proposed include Internal Hot Water Generator (Connection by Plumber, not
included). We shall install Complete Air Disiibution Systems consisting of Rectangualr Trunk Duct, Round
Flex Branch Ducts, & Multiple Return Air Vents. We shall install 1- Trane Energy Recovery Ventilator to
provide proper Ventilation of home. We shall install 1- Honeywell Stand -Alone Dehumidifier to serve thge
Sealed Crawlspace. We shall install 1- Deluxe 7-Day Programmable Thermostat. We shall Install all
condensate piping. We shall complete all control wiring. We shall complete all start-up procedures &
checklist, including Leak Test & Flushing/Purging of Polyethylene Geo Loop Piping,
INCLUDES Venting for Bath Exhaust Fans, Clothes Dryer, Range & Water Heater.
INCLUDES Vertical Bore Drilling by Certified Geothermal Well Driller.
All work will be permitted & inspected to conform to local governing codes.
Exclusions:
GAS PIPING IS NOT INCLUDED,
VENTING FOR FIREPLACE(S) IS NOT INCLUDED.
Page 1

� �yj� rq.1F74F � �x 1`f,('j.!'1"�-.kl..-f syr�.�/y h/t� ,F/'� 11i hr p... � F S+�}1 Y 6 �+ kN ' f� f{ t13 E r- ,7 `Y f3 t �� f r•si '£ ,. "i y�t G:.... S.fi?az:
:,,.t.. True' XLkSe tes ©eiue
't�i ,.,�'Ew�ti < � ?Ywr �} 1I`r:41 c '�-'++�,-z�•.s
S j T � < �! t"i,ti^ .rr � -r y � � as3 r.,,
4u, r fr; Stage Geoihet`rr�at Hegt> Delu a�2 Ufa e �`y� U
t 5;•r S irFh 4 =>,j'i�,+. ,� nik d " g ''3: S"(-f r 2 Sage taet� her ai eav
•s
F��i',w��6i4�j�„}a��', �.s,±A@.. r�"..?•..;`^';�.v,:�r•,_'�r. ��t,.,± LY ��,.k'nY_: 17���Ars. 7,.'�"s�.?�,Za,t;rg'��t�i�a'��r [il `r6t�t�trt�l���u� r`��n� w�"'�C.��t�a 'L �Y¢,����t����i �1''�:�iY'`�,t�"t"�
Gent
38+,au ,g cf-;_•., ,. ;.zfi3YF xuar. „yz�� .::s t.r.J±��u.. r�.','�r5,. .yt�,�a•,yk�r �:�.;rtm4ii:
ModelType
Geothermal Heat Pump:
Geothermal Heat Pump:
Geothermal Heat Pump:
Bosch 4-ton "CE" Series 2-Stage
Bosch 4-ton "TA" Series Deluxe 2-
Trane 4-ton "XL" Series Deluxe 2-
Package Geothermal Heat Pump
Stage Package Geothermal Heat
Stage Package Geothermal Heat
w/ Variable Speed Blower Motor.
Pump w/ Variable Speed Blower
Pump w/ Variable Speed Blower
Includes Hot Water Generator.
Motor. Includes Hot Water
Motor. Includes Hot Water
Generator.
Generator.
Includes 10kw Electric
Includes 10kw Electric Supplemental
Includes 10kw Electric
Supplemental / Emergency Heater. I Emergency Heater.
Supplemental I Emergency Heater.
Model Number:
Geothermal Heat Pump:
CE049-1VTCFRT
TA049-1VTCFRT
T2GX0498RR11C1A
Electric Heater:
HP100-1XM
HP100-1XM
EAM-10
Air Filtration:
Trane Clean Effects
Trane Clean Effects
Trane Clean Effects
Cooling Capacity:
1st Stage: 36,000 btu
1st Stage: 40,200 btu
1st Stage: 38,700 btu
2nd Stage: 49,000 btu
2nd Stage: 52,000 btu
2nd Stage: 50,000 btu
Cooling Efficiency:
1st Stage: 21.8 EER
1st Stage: 28.0 EER
1st Stage: 25.1 EER
2nd Stage: 15.6 EER
2nd Stage: 19.0 EER
2nd Stage: 18.0 EER
Heating Capacity:
1st Stage: 28,500 btu
1st Stage: 28,000 btu
1st Stage: 31,000 btu
2nd Stags: 38,000 btu
2nd Stage: 38,000 btu
2nd'Stage: 37,400 btu
Electric Emergency Heat 10kw
Electric Emergency Heat 10kw
Electric Emergency Heat 10kw
Heating Efficiency:
ist Stage: 4.0 COP
1st Stage: 4.6 COP
1st Stage: 4.7 COP
2nd Stage: 3.6COP
2nd Stage: 4.1 COP
2nd Stage: 4.1 COP
AHRI Certification #:
AHRI # 4513814
AHRI # 4513938
AHRI # 4660878
Warranty Info:
Compressor:
10 YEARS
10 YEARS
10 YEARS
Parts:
1.0 YEARS
10 YEARS
10 YEARS
Geothermal Loop Piping:
50 YEARS
50 YEARS
SOYEARS
Honeywell Parts:
5 YEARS
5 YEARS
5 YEARS
All Other Parts:
1 YEAR
1 YEAR
1 YEAR
Labor Warranty:
10 YEARS
10 YEARS
10 YEARS
Total System Price: $38, 825.00 $39, 475.00
Federal Tax Credit:-$11,497•64 411,6422.60
NC State Tax Credit. $8,400.00
Net Investment., $18,927.50 $19,232.50
Page 2
$41,210.00
-$12,363.00
$20,447.00

Warranties:
All products installed by Mike's Heating & Cooling are warranted to be free from defects in material and
workmanship for a period of one year from the original installation unless otherwise noted. This warranty
includes parts and labor for repair or replacement of defective products or parts. Product manufacturers
limited warranty also applies and in some cases may go beyond a one-year period. (See product warranty
and/or extended warranty agreement).
Total Investment:
Your total Investement for this HVAC System Installation including any taxes will be for the sum of:
(check one)
❑ $ 38,825.00 Bosch "CE" Series 2-Stage Geothermal Heat Pump System
g $ 39,475.00 Bosch "TA" Series Deluxe 2-Stage Geothermal Heat Pump System
❑ $ 41,210.00 Trane (by WaterFurnace) "XL" Deluxe 2-Stage Geothermal Heat Pump System
Add -Gins
If any of the following add -on accessories are desired please check the appropriate boxes and add the
amount to the system price above.
Add -On Accessory Options:
❑ Included Upgrade to 1Q-Year Extended Parts & Labor Warranty for 1- System
❑ Included Add "GeoStart" Reduced Load Compressor Starter "Soft Start"
❑ Included Upgrade to 1- Trane "Clean Effects" Whole House Air Cleaner (99.98% Eff.)
❑ $600.00 Install 1- Honeywell Large "Bypass" Humidifier m# THUMD300
❑ $1,050.00 Install 1- Honeywell "TrueSteam" Humidifier m# HM512VPIAQ
1 850.00 Install 1- Honeywell "TrueZone" Zone Control System (2-Zones)
❑ Included Upgrade to 1- Deluxe 7-Day Programmable Touchscreen Thermostat
❑ Included Install 1- Trane Energy Recovery Ventilator m# TERVR100
❑ Included Install 1- H/W Stand -Alone Dehumidifier. for Optimal Humidity Control m# DR65
(Dehumidifier to Serve the Sealed Crawlspace!)
❑ 750.00 Install Rigid Black Iron Gas Piping to 2 Appliances including: (1) Range & (1) Gas
Fireplace. Also includes a stub out for future Gas Grill.
Total System Price (Including Accessories): $ 41 3Z S Initials:
Page 3 �l

Terms:
Upon acceptance, signed proposal needed to order equipment & schedule installation; 75% due on
completion of Rough -In, Remaining 25% due upon Completion of Final Set -Out.
Payment:
Check Check #:
E3 Visa C3 MasterCard
Card #:
Name on Card:
C3 Cash F1 Financing
LN lip��11111111111111111111111111111�1111 .7-11 ITJ I WAI
Exp:
Security Code:
ACCEPTANCE OF PROPOSAL:
The above prices, specifications & conditions are satisfactory and are hereby accepted. My signiture
below authorizes Mike's Heating & Cooling to perform the work as outlined within this proposal. Payment
for this work shall be made as outlined above.
Z
Acceptance Signature:
/0 Date.
Authorized Signature: JZanaUffathvck
* This Proposal is Good for 30-Days!
MIKEffs
SVF HEATING & COOLING
COMMERCIAL - RESIDENTIAL
Quality. Comfort. Reliability.
Road I ?A No-n Man rwvJ
Fax [phone]S76 Fw U8-246-9,V
Page 5
Date: 2/2712012
NO License # 13418