WI0100683_Aqueous Closed Loop Geothermal Well Construction Application_20230505

North Carolina Department of Environmental Quality -Division of Water Resources
�OT IFI CATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLSese wells are "perm itted by rule" a11d do 1101 req11ire a11 i11divid11al permit whe11 constructed in accordance withthe rules of 15A NCAC 02C .0200. This 11otice m11st be .rnbmitted prior to co11struction.
GEOTHERMAL AQUEOUS CLOSED-LOOP WELLS As described in \SA NCAC 02C .0222 these wells circulate potable water only or a mixture of potable water and performance-enhancing additives as part of a geothermal heating and cooling system. OR
GEOTHERMAL DIRECT EXPANSION CLOSED-LOOP WELLS A described in lSA NCAC 02C .0223 these wells circulate a refrigerant gas as part of a geothermal beating and cooling system. Print Clearly or Type Information. ll/egible Submittals Will Be Returned As Incomplete.
DATE: May 5th PERMIT NO.: WI0100683__(to be completed by DWR)
A.TYPE OF GEOTHERMAL CLOSED-LOOP WELL TO BE CONSTRUCTED (select one)
ml3oo' (1) Ii] Aqueous (as per ISA NCAC 02C .0222)Numberofwells: _3_'-�----(2)D Direct Expansion (as per !SA NCAC 02C .0223) Number of wells: ____ _B.STATUS OF WELL OWNER(S) (choose one)(!) (2) (3) Ii] Single Family Residence D Business/Organization D Government: State Submit this form two (2) business days prior to construction.
Submit this form 30 days prior to construction. Municipal__ County__ Federal* __ *Submit this form 30 days prior to constructionC.WELL OWNER(S) - For single family residences, list all persons listed on the property deed. For all others,list the name of the Business/ Agency and person and title with delegated signature authority:Stephen LureyAimee LureyMailing Address: 345 Retreat Ridge WayCity: Asheville State: NC Day Tele No.: 615-944-5387EMAIL Address: snlurey4 [e-mail] mD.PHYSICAL LOCATION OF WELL SITE Zip Code: 28804 County:._B _u _n _co _m_be ______ _Cell No.: 615-419-479 6Fax No.: ____________ _ ( I J Parcel Identification Number (PIN) of well Hite:_9_7_4_14_3_7_2_1_4_0_0_0_00 _________ _County: Buncombe (2)Physical Address (if different than mailing address):345 Retreat Ridge Way --------------City: Ashev ille County_B_u_n_co_m_b_e ____ .Zip Code: 28804
Cloaed-Loop Oeollimnal Well Notification Rev. 3-1-2016