WI0100244_Regional Office Physical File Scan Up To 9/23/2022

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AWD SERVICES, INC.
Appalachian Well Drilling & Water Filtration
P.O. Box 125
Leicester, NC 28748
Phone: [phone],
Fax: [phone]
Owner, Larry Wells
To: Division of Water Quality (Asheville Regional Office)
Fax: [phone]
From: AWD Services, Inc.
Date: 2/26113
Number of Pages: (including cover sheet) 6
Re: Notification To Construct Thermal Conductivity
Test Well
Cc: Yancey County Health Department
R CE«ED
FEB 2 6 2013
Asheville Regional Office
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Thermal conductivity test wells are used to determke the amountof hedt that the subsurface may .
transmit Ina given depth irgerval for the purpose of designiiag geddhermul heu ig and coaliYtg syst ins.
pursuant to 15A MAC 02C . 0230, thermal conductivity test wells shall be subject to the. regulatory.
requiremew applicable to geothermal aqueous oe direct expansion closed -loop wells desigired tc'serm
single fmnily residences.
These wells are 'permitted by rule - and -do not require an Indi`riiduad permit when co7i,stru_ cted in
accordance with she. rules of ISA MIC 02C.0200. 4.
nix she itbm'ga at least two (2) business days-Minr k eo>rslrucdvri._
Print Clearly or Type Information: Illegible Submittals Wig Be Rdarned As hicemplele.
DAMFebnaary 21 , 20 "� PERmrr NO: (to be completed by PWQ)
A. TYPE -OF THEW L CONDUCTIVITY Y TEST WELL TO SE CONSTRUCTED
(1) Aqueous (as per 15A NCAC 02C .0222): Number of wins'.—,—
Direet Expansion (as per 15A NCAC 02C .0223) N utriber of Wells: _
IL STATUS OF WELL OWNER.(choose one)
(1) SkAgle Family'Residence
(2) Businms/Uzganiaation
(3) Govenmtent: state Municipal _ : County . Federal
C. WEx,)L, OWNER — For•single family residences list the property om*r(S). Far -all• others, ;list name of the
business, organization; or, government agency. and person delegated"9gnature'aitthor1ty:' '
Mayland Community Colle&ESE7415'.
_ Mr. •Ceraid'Hyde (David Lancor, PBCLArchitecture)_
Mailing Address: 107 Wheeler Hllls Road
City: Burnsville state: NO Zip code-2'8714County: Yancey
Day Tole No.: 828 766-.1220 Cell'No.;.
EMAIL Address: ahyde w _mayland.edu Fax No.: (628)MA 606, -
DavidL c@pbclarchitecture.(;om
1), PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identifi6ation•Nurnber(PIN) of well site"..
County: Ya`ncey _r
(2) Physical Address.(ifdifferent.th'an mailing address):
107Wheeler Hills Road r.
City:. Burnsville State: NC zip code: ;2 714
DWQN1Crfh=d Conductivity Test Notification (Rcvi, cW*6/612012)
EtCEIVED
Asheville Regional Office
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02/26/2013 13:25 8286839203 AWD SERVICES INC PAGE 03
.A,

�•� �xrow: Attach a within 250�feet df the lnject on.well(s). �.abet"all features clearly and.inci dir nnrti� ,
sit&speoifio map showing the locations of the_ fallowing:•
P d ' 111 ropose uz�evtzon we ovations epti
c systems ,an assoe spray unga ion
• ' Buildings. sites, drain -fields, or repairaiees
• Property boundaries
.' Surface water bodies ■ ' Existing or potential . sources 'of groundwater'
a Water supply wells contamination
(2) Plans and specifications ofthe surface and subsurface construction details of -the -well system: Y
F. TYPES A" CONCENTRATIONS OF ADDITIM — 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.bs tbund
online at hteoJJaortal_n'cdenr.or. /wet>Jv_g/cps/ peo. All oTher additives require appYoval''pngr• to 11M,
G. WE,LX, DRMLER UNFORMATION (if known)
Well Drilling Contractor's Narne: Robert Larry 1Ne118
NC Well Drilling Contractor Certification No,; 2603
CCmpanyName: AWD Services, Inc, Contact Person: Larry.ftft
City: Leicester state: NC.- Zip.Code:2$74$Countys';rleombe '
Day Tel. jto.• 828 683-9223 . Cell Nb.: (82$)21:5=9334',
ENMILAddress: [e-mail] bellSbi_lth.net Fax,No.: (828)6834203
U. BEAT PUMP CONTRACTOR INFORMATION _
Company Name:"NIA
Contact Person' �Al
Address:
City: Zip Code: State: Coanty:
Ofl:ice Tele'No.: CeII.No.: Faz
DWQJUlCJii =ial Conductivity Test Notlflmd(m (Revised 6/0012)
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..�_�.. _.. .. _..r ...—,.e �.....,...w.. ..... ,,as wa,.•suuw,v„ va uro woyb, •
Jr. VARIANCE — Pgrsue t to 15A NCAC 02C .0241 the Director of the 13NMou.•of• Water Qim lltymay grant a
variance front'applicable.well -construction or operatoon• standards provided•thaf:
(I) use of the well(s) will not endangerhuman health and welfare or the groundwater;,and
(2) that construction or operation in accordance with the standards_is.no#technically feasible orthe
proposed construction provides equal or bettei•:•protection of the'groutitI*ater,
Any variance request should -accompany, submittal of this notification to expedite. evalvatlon of• the request.
The variance request form can be accessed online at htto:Unortal.nedenr orp(tiveb/w T �f9i f;�
aRplications ' ' ,
X. SIGNATURES — The following•seadon is to be completed as. required below•'or by ihat.person's authorized
agent. 1SA NCAC Q2c•.0211(e)•regtiii'eS signatuies'as;follows: ;
(a) for it corporation: by a responsible corporate officer;
'• (b) for a partnership or sole proprietorship: by a; general partner or the proprietor, Mpegtively;
(c) for a municipality or a state, federal, or other•pablic agency_ by. either a,pririclpal.ea�Actttit�e
oflt. or ranking publicly elected official; ;
(d) for. all others: ..by the well owner;
(e) for ,any other person authorized, to -act on behalf of tt . -Oplicanu , 49c=entation shall be
submitted with the. notification that. clearly 1dontifi .`the `pessotl,-. grants them signature
authority, and is- signed and dated•by'the;applicant
"I hereby +cerO, wader penalty of law, that, I have personally examined and on. fwnilfar with the'bOrmatfon
stibmittmd in*tW docwment and all attuohmerts thereto-iznd.that,. based on my'inquiry'of•those.cfradividuals
'immediately responsible for obtaining said irsformatiow I believe that the Womation- is •,true,; acctgv a and
complete. 14m aware that there 'care:signi scant penalties, :On Iucling the possibility.of fines and imprisomnent
for submiWng false. information. I agree to 'aonstruc4'404te, 'maimzah, repair, etc if applicaTrle; abandon
the fnf ection well and all -related appurtenances in accordance with' the ISA RCAC 0.2C 0200 Rules, "
Signsture of Property O ner/Appiicadi
Gerald Hyde Vice:President Administra#iVe•.Services.
Print or Type Full Naar#,
Sigeeture of Authorind Agen!,' if any
w David Lancor ;PBCL Ardhiteptpre.,
Printer Type fullftik .
PWQ/i11CMemud Conductivity Test Notification (Revised 6/64012)
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(1)
The Dlvtsion of Water Quality Regional Oftica oer0ng the- area in which the' injection vlieil• facility, '
will be located:.
WO
.Y:•NiT�t�:S.iJ� .,
r
T
4hev,'gc Regional.O#fice
Wishiogton Re»ional 0>�lee.
2090 U.S.-Highway 70
943 W Mhington Squaie Na. '
Swannanoa, NC 29778
Washington, NC 27889•
Telephone: [phone]
Telephone: [phone]:-
Fax: (828) 299=7043
Fax: (25Z 975-3716
;
ftyetteville �tegioual•Off ce
WllytliugWwRegioinal Mee
225 Green S reet,'Swte 714
117'Ca'rd,'in81 Drive Extension
Fayetteville, -NC 28301-5043
Wilmiitg &4 NC 28405.:
Telephone: [phone]
Telephone: (910)'796-7215
Fax: [phone]
Fax: (910} 350-2004
;
MearesAlle regional Of lee
Winston-Salem Regional•OPffoe
610 ftt: Center Avenue, Suite 301
585 Waughtown Sheet '
Mooresville, NC 2811.5
Winston-Salem, NC 271072241 .
tilephone! [phone]
Phone. [phone]'
Fax: [phone]
Fax: [phone]
Raleigh Regtomal Ofte
1628 Mid'SeMee Center
Raleigh, NC 27699-1628' .
Telephone: [phone]
Fax: (9I9) 571-4718
(2) Coutdy Health Department in which the injection well facility wilt be located. A list ofcountylidaltfi
=,
departntents' can be found online at httn://www,ncathd.ore/countv.hLm.
�=
DWQ UMMetmel Conductivity Test Notification (Revised 6)6/2012)
page 4
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