WI0100002_Geo Thermal_20160609

Water -Resources
ENWRONMENTAL MRLITY
RECEIVEDINODEMNR
JON_. 212016
Water Quality Regional
%eratons Section
June 20, 2016
Harold E. and Alice M. Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
PAT MCCRORY
GOVBmor
DONALD R. VAN DER VAART
Re: Geothermal Heating/ C ooling Water Return Well Analytical Results
Permit No. WI0100002
Henderson County
Dear Mr. and Mrs. Johnson:
Secretary
S. JAY ZIMMERMAN
Director
On April 20, 2016, I collected geothermal system influent (Sample IDs: AC28451 and
AC28346) and effluent (Sample IDs; AC28452 and AC28347) samples from. your wells located
at 115 Kindy Forest Drive, Hendersonville, North Carolina. The water samples were collected
as part of the permit renewal process for injection well permit WI0100002.
Analytical results for both the influent and effluent samples were all below the Title 15A North
Carolina Administrative Code (NCAC) 02L .0202 groundwater standards. A copy of the
analytical results is attached.
If you have any questions regarding the results please contact me at [phone].
Sincerely,
&L'Atau...-
Andrew Moore
Environmental Specialist
Water Quality Regional Operations Section
Asheville Regional Office
Attachment: Laboratory Analytical Results
cc: ARO File
Michael Rogers, DWR Central Office
State of North Carolina I Environmental Qualify I Water Resources
2090 U.S. Hwy. 70 1 Swannanoa. North Carolina 28778
828 296 4500

AC28346 North Carolina Division of Water Resources Water Sciences Section' Laboratyry Results
Loc. baser.:
1161[1NDY FOREST
DRiYE
County_
Henderson
Collector:
A MOORE
VisitJb
Region:
ARO
Report To
ARO
Location 10: 1904SW10100002iNF
River Basin
E6
Ccaact bate:
M2012016
Priority COMPLIANCE
EmeMency
Collet/ Time:
09_20
Sample Matrix: GROUNDWATER
COC Ye81No
Sample Depth
Lor- Type: Influent
Final Report
SSM* lo_
C28346
PO Nurnberg
45GH04
Date Received:
su�i
Time Received:
Q,;1;20
labworks LogWD
Ma. WtF
Delivery Method
NC Courier
Final Report Date:
film
Report Print date:
WQ1912016
If this report is labeled preliminary neportr the results have not been validated. Do not use for Regulatory purposes.
Result/ Units Method Analysis
CAS # Analrte Name PPL Qualifier Reference Date
LAB
Sampte temperature at receipt by lab 1.1 'C 4121116
►kfldalk br
MSWIFT
Nitrate as N in liquid
0.02
NUT
1A
mg1L as N
EPA 353.2 REV 2
SNJ16
CGREEN
Nitrite as N in liquid
0.01
0.01 U
mg1Las N
EPA 353.2 REV 2
4121116
CGREEN
NO2+Np3 as N in liquid
0.02
1.4
mg/Las N
EPA 353.2 REV 2
412AVIS
CGREEN
Bromide
0.4
WET
OA U
mglL
EPA 300.0 rev2.1
4MI16
CGREEN
Chloride
1.0
3.7
mglL
EPA 300.0 rev2,1
4P21116
CGREEN
Fluoride
0.4
0-4 U
mg/L
EPA 300.a rev2.1
W21116
CGREEN
Sulfate
ZO
2.0 U
ma1L
EPA 300,0 rev2.1
4121116
CGREEN
7429-90-5
AI by lCP
50
MET
60 U
ug1L
EPA 200.7
513116
ESTAFFORDI
7440-38-2
As by ICPMS
2.0
2.0 U
ug/L
EPA200,8
513115
ESTAFFORDI
7440-70-2
Ca by ICP
0,10
28
mglL
EPA20.7
SIX16
ESTAFFOROi
7440-47-3
Cr by ICPMS
5.0
5-0 U
ug1L
EPA 200.6
513116
ESTAFFORDI
7440-50-6
Cu by ICPMS
2.0
7.7
uglL
EPA 200.6
513116
ESTAFFORDI
7439-89'9
Fe by ICP
50
SO U
uglL
EPA 200.7
WWI(]
ESTAFFORDI
7440-09-7
K by lCP
0.10
1.4
mglL
EPA 200.7
513116
ESTAFFORDI
7439-95-4
M9 by ICP
0A0
0.67
M91L
EPA200.7
W 116
ESTAFFORbt
7439mW6
Mn by ICP
10
38
uglL
EPA 200,7
=/t6
ESTAFFORDI
744a23-5
Na by ICP
0.10
4J
mgfL
EPA 200.7
51w16
ESTAFFORo1
744M2-0
Ni by ICPMS
2.0
2.0 U
U911-
EPA 200.8
513116
ESTAFFORD1
743992-1
Pb by ICPMS
FA
2.0 U
UgIL
EPA 200,8
513116
ESTAFFORDI
7440-56m6
Zn by ICPMS
10
IOU
ug1L
EPA 200,8
51WI6
ESTAFFORDI
WSS Chemistry Laborabw rsa 1623 Mail Service Center, Raleigh. NC 27699.1623 J919j 7334908
'Not neleeted' or "U' does not indicate the sample is art yle he but that the analyte is not detected at or above the PQL.
Page 1 of 1

AC20451
North Carolina Division of Water Resources Water Sciences Section Lahoratory Results
Loa Descr.:
Gounry:
Region,
River Basin
Emergency
COC Yes1No
116 KINDY FOREST DRIVE
HENDERSON Collecior. A MOORE
Viskia
ARO Report To ARO
Loraaw ID-
1P040MOl0QM
FREI Called date: 04/2012016
Priority
MPLIANR§
Collect Tlme: 09;20
Sample Matrix;
QRduNOWATER
Sample Depth
Loc. Type;
INFLUENT
Final_ Report
Sample ID:
AC28451
PO Number *
A11$
Date Received;
41a 2012401
Time Received:
11_10
Ladworks Log#00
KJIMISQX2
Delivery Method
Hand delivered
Final Report Date,
616I16
Report Print Date;
061113=16
It this report is labeled preliminary report; the results have not been validated. Do not use for Regulatory purposes.
Result) MethodAnalysis
CAS # Analyte Name PM ualiirer UnitssReference Date^
ARO
Alkallnity4.5 1.0 12 mglL as CaCO3 APHA23208-20th 513f16
yalidatad k?j
ESTAFFOROI
Aikalinity8.3
1.0
1 U
mg1L as CaCO3 APHA23208-20th
513f16
ESTAFFORDI
Bicarbonate
1.0
12
mgfL as CeCO3 APHA2320&20th
5M16
ESTAFFORDi
Carbonate
1.0
1 U
mglL as CaCC3 APHA23208-20Ih
513A6
ESTAFFOROI
pH Alkalinity
6.8
rno-as CeCO3 APHA23208-20th
513116
ESTAFFORD1
Coliform, MF Fecal in liquid
1
1 B2
CFUM00m1 APHA9222D-20th
4120116
ESTAFFORO7
Col'rfOrm, MF Total in liquid
1
1 B2
CFUI700ml APHA92228-20th
V20116
ESTAFFOR01
Sample temperature at receipt by lab
3.6
°C
412a16
RBYRD
Total Dissolved SoSids in liquid
12
46
mgrL APHA2540C-18TH
412611$
ESTAFFORDI
WSS Chemistry Ladoratoryfr 1023 Wit Service Center, Raletyh, NO 27699-1623 [phone]
"Not Oetected" or "U" does not indicate the sample is analyte free but that the Analyte is hat detected at or above the POL.
Page 1 of 1

AC28347
North Carolina Division of Water Resources Water Sciences Section Lgbcrator� Results
Loc. Deacr.:
County:
Region:
River 5"n
Emergency
COC Yea1No
116 KINDY FOREST
DRIVE
}iandenron
Collector.
A MOOftg
VisiO❑
ARO
Report To
Attu
Location ID:
IP049WI0100002EFF
FRB
Collect Date:
04/20/2016
Priority
COMPLIANCE
CcilPi t Tlme:
09w48
Sample Matrix:
GROUNDWATER.
Sample Depth
Lac Type:
Effluen
Sample ID:
AC26347
PO Number #
16GO106
Date Receiived:
414 112016
Time Received:
08:15
tabworks Loginl❑
MSWIFT
Delivery Method
NC Courier
Final Report Date:
SM7116
Report Print Owe:
0t3 W-016
rinal rcepors
If this report is labeled preliminary report the results'have not been validated. Do not use far Regulatory purposes.
Result! Method Analysis
CAS # Analyte Name Pik Qualifier UnitsMethod
Gate
LAB
Sample temperature at receipt by tab 1,1 °c 4121118
Validated by
MSIMFT
Nitrate as N in liquid
0.02
NUT
1.6
nVILas N
EPA 353.2 REV 2
5r2A6
CGREEN
Nitrite as N in liquid
0.01
0.01 U
mg1L a9 N
EPA 353.2 REV 2
4R111t3
CGREEN
NO2+NO3 as N in liquid
0.02
1.5
mWLes N
EPA 353.2 REV 2
4/28JIS
CGREEN
Bromide
0.4
WET
DA U
mgA.
EPA 300.0 rev2.1
4121116
CGREEN
Chloride
1.0
4A
mg/L
EPA 300.0 rev2.1
4121116
CGREEN
Fluoride
0A
OA U
mg1L
EPA 300.0 rev2.1
4/21116
CGREEN
Sulfate
ZO
2.0 LI
mg1L
EPA 300.0 rev2.1
4121116
CGREEN
7428-9M
Al by ICP
50
MET
+50 LI
uglL
EPA200,7
SM116
ESTAFFORDI
7440-38-2
As by ICPMS
2.0
2.0 U
ug&
EPA 200.8
-"/16
ESTAFFORDI
7440-70-2
Ca by ICP
0.10
2.9
mglL
EPA200.7
5/3116
ESTAFFORDI
7440-47-3
Cr by ICPMS
&0
5.0 U
uwL
EPA 200.8
513119
ESTAFFORDI
7440-50-a
Cu by ICPMS
2.0
so
U911-
EPA200.8
513116
ESTAFFORDI
743t1- m
Fe by ICP
50
sou
ug/L
EPA 2001
&3116
ESTAFFORDI
744MD-7
K by ICP
0.10
1,5
MOIL
EPA 2001
51911e
ESTAFFORDI
7439.95-4
Mg by ICP
0A0
0.73
mgA-
EPA200.7
513116
ESTAFFORDI
7439-96-5
Mn by ICP
ill
44
ugn-
EPA200.7
SM16
ESTAFFORW
7440-23-5
Na by ICP
0.10
4.9
mg&
EPA 200.7
51S1ta
ESTAFFORDI
7440.02-0
Ni by ICPMS
2.0
2.5
ug►L
EPA200.8
513116
ESTAFFORDI
7439-92-1
Pb by ICPMS
2.0
3.7
ugAL
EPA2OO.8
513115
ESTAFFORDI
7440-66-6
Zn by ICPMS
10
13
ualL
EPA20O.6
5rXIS
ESTAFFORDI
W88 Chemistry taboratoryna 1623 MWI Service Carder, Raleigh, NC 2709-1623 (919) 733-MB
"Not Detected or IU' does not indicate the aern* is anelyle free but that the analyte is not detected at or above the POL.
Page i of 1

AC20452 North Carolina Division of Water Resources Water Sciences Section Laboraton Results
Loc. Deeer.:
115 KINDX FOREST
DRIVE
County:
HENDERSON
Collector.
A MOORE
Visitlo
Region:
FARO
Report To
AR
Location IU:
1PQ4W0102002E
River Basin
FRB
Collect Date.
041201RO14
Prtoriy
COMPLIANCE
Emergency
Collect Tlme:
09:84
Sample Matrix:
OOUNDIJI IATER
COG Ye9rN0
Sample Depth
Loc. Type:
EFFLUENT
Final Report
Sample ID:
AC2 462
PO Number 0
6Q
Dale Received:
0412tu201a
Time Received:
11_10
Labwoft Loginl0
KJIMISON2
Delivery Method
chant joliyerad
Final Report Dale:
"via
Report Prird Dale:
0611612016
if this report is labeled preliminary report. the results have not been validated. Do not use for Regulatory purposes.
Resul MethodAnalysis
CAS # An to Name � Qualifier Units Reference Date
ARO
Alkaiinity4.5 1.0 11 mg/Las CaCO3 APHA2320B-20th 5016
Valldaw bi
ESTAFFORDI
Alkaiinity8.3
1.0
1 U
mg1L as CaGO3 APHA2320&20rh
513116
ESTAFFORDI
Bicarbonate
1.0
11
mglL as CaCO3 APHA23208-20th
513116
ESTAFFORDI
Carbonate
1,0
1 li
mglLasCaCO3 APHA232DB-20th
513116
ESTAFFORDI
pH_Aikalinity
TA
mglL as CaC43 APHA232dS-201h
513116
ESTAFFORDI
Coliiform, MF Fecal in liquid
1
1 gZ
CFU1100ml APHA92220-20th
4120116
ESTAFFORDI
Coliform, MF Total in liquid
1
1 gZ
CFUf100ml APHA9222B-20th
4120116
ESTAFFORDI
Sample temperature at receipt by lab
3.6
T
4120118
RBYRD
Total Dissoived Solids in liquid
12
42
mg1L APHA2540C-1BTH
4126/16
ESTAFFORDI
WSS Chemistry Lahorstorp> 1623 Mail Service Center, R&WIV , NC 27699.1823 [phone]
"Net Detected' or "U" does not indicate the sample N anoly" free but that the anaiyte is not deWaied at or above the F0L.
Page 1 of 1

..iJ
Ll
-n
ruJ
m
m
Certified Fee
rq Postmark
E,D Return RE LOP[ Fee Here
[_] (Erndomement Required)
C3 Restrioted Do livery Fee
13 IEndersement Raquiredy
O
"' rota, R°' Harold and Alice Johnson
a
trn o - 115 Kindy Forest Dr.
-- Hendersonville, North Carolina 28739
L
- PS Form 3800, Aust)St wu6 ace neera�ac �u� iiie .�
■ Complete items 11 2. ari:] 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front if space permits.
t. Article Addressed to:
Harold acid Alice J01111SOD
115 Kindy Forest ❑:.
Hendersonville, North Carolina 28739
0 AWt
S. Received by (F'rf Name} C. Cate of Delivery E
�b I
D. 1s delivery address dKerent from item i? Oyes
If YES, enter delivery address below: 0 No
3. Service Type
reW�ssm
o
111111111110111111111111
I 111111
Q Asgn
Real lered
n Adult S+pnature RoWated 0194hery
n Reg�tered Mail Restrcted
9590 9403 0730 5196 3155 33
d CerOad Mail Restricted Wivery
a Re+mReceipt for
E] Cailect on Delivery
Mer°hendlae
2. AMcle NuM*. (li'arrsWftb�rrlf+r�38�yv9iCe 1A6eiJ
Q �� on aallvery Restrlc�ed pefivay
❑ S gnature ConFirmati°n'
Q
r
656
7 ©1 R 12 0© 0 n 0 Jl 3432 6 5 61�
M i tiesklcted Dellwry
Restricted Delivery
Rastric0ed Oekivery
�71
PS Form 3811, April 2015 PSN 7W-02-000-9053
Domestic Return Recelpt

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
WaterResources
ENVIRONMENTAL QUAUTV
March 29, 2016
CERTIFIED MAIL # 7014 1200 0001 3432 6561
RETURN RECEIPT REQUESTED
Harald and Alice Johnson
115 Lindy Forest Dr.
Hendersonville, NC 28739
Subject: Notice of Expiration (NOE)
Geothermal Water Retum/Open-Loop Injection Well
Permit No. W10100002
Henderson County
Dear Mr. and Mrs. Johnson:
so—arY
S. JAY ZIMMERMAN
Director
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on May 6, 2011, and expires on April 30, 2016. Per permit conditions and requirements
per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120 calendar days
prior to expiration of the permit if you wish to continue operating the injection well on your
property
If Your Geothermal Water Return Well is Still Currentk' Being Used for lniection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells — Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http:llportal,ncdenr.org/weblwq/aps/gwpro/permit-applications.
If Your Geothermal Water Return Weld is NO LONGER Beim Used for Iniectia_n:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc,). If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section
.0240. When the well is plugged and abandoned, a well abandonment record (Fonn GW-30) must
be submitted to our office to certify that the abandonment was properly conducted.
State of Norfli Cuoinie I Envunnmental Quality I Water Reaomwi;
1611 Mail servi" Center I Ralaigls, North Carona 27699-1611
919 74U7 9000

Page 2 a 2
If There has been a Change of Ownership of the Property-
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change' Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. if you have any questions, please contact me by phone at
[phone] or by email at shristi.shresthaO ncdcar.gov.
Regards,
S hristi •Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Asheville- Regional Office — WQROS w/o enclosures
Central Files - Permit No. W10100002 w/o enclosures

Central Files- APS — 5WP
512J2016
Permit Number W10100002
Permit Tracking Slip
Program Category
Status Project Type
Ground Water
In review Renewal
Permit Type
Version Permit Classification
InjeCion HeatinglCooling Water Return Well
individual
Primary Reviewer
Permit Contact Affiliation
michael.rogers
Coastal SWRule
Permitted Flaw
Facility
Facility Name
MajorlMinor
Region
Harold and Alice Johnson SFR
Minor
Asheville
Location Address
County
115 Klndy Forest Or
Henderson
Facility Contact Affiliation
Hendersonville NC
28739
Owner
Owner Name
Owner Type
Individuai
Harold E
Johnson Owner Affiliation
Harold E. Johnson
1 i 5 Kindy Forest Or
QateslEvents
Hendersonville
NC 28739
Scheduled
❑rig Issue App Recelved
draft Initiated Issuance Public Notice Issue Effective Expiration
10/20/1986 4/6/2016
Regulated Activities
_ _ Requested /Received Events
Heat Pump Iniection
RO staff report requested
4111116
RO staff report received
4128116
❑utfall
Waterbody Name
Strearnindex dumber Current Class
Subbasin

Water Resources
ENVIRONMENTAL QUAUTY
May 6, 20I6
Harold E. and Alice M. Johnson
1 1 S Kindy Forest Drive
Hendersonville, NC 28739
Re: Issuance of Injection Well Permit
Permit No. W10100002
Geothermal Heating/Cooling Water Return Well
Henderson County
Dear Mr, and Mrs. Johnson:
PAT MCCRDRY
Gnvernor
DONALD R. VAN DER VAART
Seery.
S. JAY ZIMMERMAN
2Nreclor
In accordance with your permit renewal application received April 6, 2016, I am forwarding Permit
No. W10100002 for the continued operation of geothermal heatinglcooling water return well
located at the above referenced address. This permit shall be effective front date of issuance until
April 30, 2021. and shall be subject to the conditions and limitations stated therein.
Please Note:
Samples from the influent and effluent sampling ports of your geothermal well system
were collected on April 20, 2016. Laboratory analytical results will be forwarded to you
when it becomes available.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date_ As indicated in the permit, this
permit is not transferable to any person without prior notice to; and approval by, the Director of the
Division of Water Resources. if you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards,
��•*�
Michael Rogers, P.G. (NC R FL)
Underground Injection Control (UIC) Manager - H_ydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Section
Sialc of NuM Carnlim. I Fn 6 rrmn iem a) QJ iry I Waler RESourc ,4
I &I I Mail sem9ce Cenler j Ralergh, Honh Carolina Y ih5i9-1611
919 7117 901k1

Page 2 of 2
cc: Landon Dai idson and Andrew Moore, AsheviIle Regional Office
Central Office File, WIOI00002
Henderson County Environmental Health Department

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OR ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR DUECTION
In accordance with the provisions of Article 7, Chapter 87, Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Harold E. and Alice M. Johnson
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used
for the injection of heat pump effluent. The injection well(s) located at 115 Kindy Forest Drive, Hendersonville,
Henderson County, NC 28739 will be operated in accordance: with the application submitted April 6, 2016- and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental Quality and are considered a part of this permit.
This permit is for continued operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws. Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until April 30, 2021, and shall be
subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 6th day of May 2016.
J`VU#k
-
S. Jay Zimmerman, P.G.
Director_ Division of Water Resources
By Authority of the Environmental Management Commission.
Pennit 4MI10100002 U1C15A7 Pa-c i of 5
ver. 1 1 / 15/2015

PART I — PERIMIT GENERAL CONDITIONS
1. The Permittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance wtiith
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .0211 (a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. In the event there is a desire for the facility
to change ownership, or there is a name change of the Permittee, a forma] permit amendment request must
be submitted; including any supporting materials as may be appropriate, at least 30 days prior to the date of
the change [15A NCAC 0 2 C .0211(q)].
5 The issuance of this permit shall not relieve the Pernaittee of the responsibility of complying with any and
all statutes, rules. regulations. or ordinances_ which may be imposed by other local, state_ and Federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II - WELL CONSTRUCTION GENERAL CONDITIONS
I _ The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with the requirements of rule 15A NCAC 02C _0107 except as required in Item 42 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone_
Fox screened wells_ grout shall be emplaced from the top of the gravel pack to the land surface. For open-
end wells, the casing sha]I be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2).(3)J.
3 Hentonite grout shall not be used to seal any water -hearing zone with a chloride concentration equal to or
greater than 1 ,5 00 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas. chloride levels shall he verified in the field to determine existing conditions.
[ 15A NCAC .0225(g)(8)].
R The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a Functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [ 15A NCAC 02C .0224(d)(4) J.
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S_ 87-85(16).
6. Each well shall have permanently affixed an identification plate [I5A NCAC 02C _0107(j)(2)].
t eFMit zW10100002 t_11C /5 A7 Page ? of 5
ver. I 1 /15/2015

7. A completed well Ccinstruction Record (Form GW-1) shall he submitted as described in Part V.5 of this
permit.
PART III — OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity f 15A NCAC 02C .0211(j}].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damage's to surface water
or groundwater resulting from the operation of this facility. In the event that the facility fails to perform
satisfactorily, including the creation of nuisance conditions or failure of the injection zone to adequately
assimilate the injected fluid, the Pennittee shall take immediate corrective actions that may be required.
such as the repair, modification, or ahandoninent ❑fthe injection facility [15A NCAC 02C .0206].
PART IV — INSPECTIONS [I 5A NCAC 02C _02.11(k)]
Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may;
upon presentation of credentials, enter and inspect any property, premises, or place an or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit_ and may
obtain samples of groundwater, surface water.. or injection fluids.
2. DWR representatives shalt have reasonable access for purposes of inspection. observation- and sampling
associated with injection and any related facilities as provided for in N.C.G.S_ 87-90.
3. Provisions shall he made for collecting any necessary samples of the injection facility's activities.
PART V — MONITORING AND REPORTING REQULREMENTS
Records of well construction, repair; or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on -site and available for inspection [15A NCAC
02C .0224(f)(2), (4)1-
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(1)].
The Permittee shall report any monitoring or other information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violatiori of applicable groundwater quality standards, or
that a malfunction of the injection system may cause the injected fluids to migrate outside the approved
injection zone or area. As specified in rule 15A NCAC 02C .0211(r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence. To the Asheville Regional Office, telephone number 252-946-6481 .
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below
Permi19%V101W002 U105A7 Page 3 of
ver. 1 U] 5/2015

(C) The written notification shall contain a description of the noncompliance and its cause; the period of
noncompliance, including dates and times; if the noncompliance has not been corrected; the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4 The Pennittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. [I5A NCAC 02C .0224(t)(3)1.
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff Water Quality Regional Operations Section
Division of Water Resources and 1) WR AshevilIe Regional Officc
1636 Mail Service Center 2090 U.S. Hwv 70
Raleigh, NC 27699-1636 Swannanoa, NC 28778
PART VI — PERMIT RENEWAL [15A NCAC 02C .0224(c))
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the pen -nit- 'This permit condition does not apply if the Permitter- chooses to discontinue operation
of the well for iniection of effluent from the geothermal heating and cooling system associated with this
permit.
PART 8711 -- CHANGE OF WELL STATUS [15A NCAC 02C .02401
I _ Procedures for temporarily or permanently abandoning a well are the same as those specified in rule I5A
NCAC: 02C .0113. While some of those criteria are given below, the Permittee hears the responsibility of
complying with all applicable regulatory requirements_
2. If a well will no longer be used for arty purpose. then it should be permanently abandoned according to rule
15A NCAC 02C .01 I3(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination. which is prohibited by General Statute 87-89(c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water -tight cap or well
seal that cannot be removed without the use oC hand or power tools.
4. When injection operations have. ceased at the facility and a well will no lodger be used for any purpose, the
Permittee shall permanently abandon that injection well in accordance with the procedures specified in 15A
NCAC 02C .01 13(b). which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
such removal will not be responsible for. or contribute to. the contamination of an
underground source of drinking water.
(B ) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall he thoroughly disinfected prior to sealing in accordance with rule 15A
NCAC 02C .0111 fb)(I )(A),(B): and {C)_
Perrriii='W]0!(1010 l_ Ut05A7 Page 4 of 5
ver 11/15?2Q15 -

(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled-
(E) In those cases when a subsurface cavity has been created as a result of the injection
operations, each well shall be abandoned in such a manner that will prevent the movement
of fluids into or between underground sources of drinking water.
(F) The permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C _0224(0(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VII (4)(F) shall be submitted to the addresses specified in Part
V.5 above.
Perriot 4 W10111C 002 U1C15A7 Page 5 of 5
ver. 1 1 /15/2015

' WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WIOI00002
Date: April 22, 2016 County: Henderson
To: Michael Rogers Permittee/Applicant: Harold E. Johnson
Central Office Reviewer Facility Name: Harold and Alice Johnson SFR
L GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal fl'gCMfiDINCDE0)DWR
❑ Minor Modification ❑ Major Modification
a, Date of Inspection: April 20. 2016 APR S 8 Z616
b. Person contacted and contact information. Harold Johnson; 828-891-8600 i Water r UAV
c, Site visit conducted by: Andrew Moore Reglanal operations Section
d. Inspection Report Printed from BIMS attached: ❑ Yes ®No
e. Physical Address of Site including zip code: 115 KindN Forest Drive. Hendersonville_ NC 28739
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 35.319925 Longitude:-82.5520613
Source of LatfLong & accuracy (i.e„ Google Earth, GPS, etc.): Goo gle Earth
II. DESCRIPTION OF INJECTION WELL rS1 AND FACILITY
1. Type of injection system:
® Geothermal Heating/Cooling Water Return
❑ In situ Groundwater Remediation
❑ Non -Discharge Groundwater Remediation
❑ Other (Specify:_
2. For Geothermal Water Return Weil(s) only
a. For existing geothermal system:
Were samples collected from InfluentlEffluent sampling ports? E] Yes ❑ No.
Provide well construction information from well tag: Well is 30+.ears old. No well _ta-.t+r�sent for
inaction well. Well construction record in file indicates well: drilled 7-15-83: De(ith 405'- Casin, 45';
Grout 20': Drilling, Contractor Caldwell if 'o. 99 �
b. Does existing or proposed system use same well for water source and injection? ❑ Yes ® No
If No, please provide source/supply well construction info (i.e., depth, date drilled. well contractor,
etc.) and attached wrap and sketch location of supply well in relation to injection well and any other
features in Section IYof this Staff Report.
5ur1r,1v Well Drilled 8-8-1983:.Dgpth 2 2 5L Casinu 20': Yield 20 bpm: Driller No. 303.
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)?
What is the distance of the injection well(s) From the pollution source(s)?
4. What is the minimum distance of proposed injection wells from the property boundary?
Rev. 61112015 Page 1

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
5, Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ®Low ❑ Moderate ❑ High
7. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. If No,
attach map of existing monitoring well network if applicable and recommend any changes to the groundwater -
monitoring program.
8. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ❑ Yes ❑ No. If No, or no neap, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9. For Non -Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ NIA.
If no, }Tease explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ NIA_ If no, please explain:
III. EVALVATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
4. Recomuxnendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by regional office
❑ Issue upon receipt of needed additional information
® Issue
5. Sigmature of report preparer(s): An'_
Rev. 6/ l /2d15 Page 2

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Signature of WQROS Regional Supervisor
Date:
1Y ADDITIONAL REGIONAL STAFF REVIEW COMIMIENTSIATTACHAIENTS i I(Needed)
Rev. 61112015 Page 3

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: April 11, 2016
To- Landon Davidson —Andrew Moore
From: Michael Rogers, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WIOI00002
B. Applicant: Harold and Alice Johnson
C. Facilif%, Name:
D_ Application:
Permit Type: Geothermal Reating/Cooling Water Return Well
Project Type: RENEWAL
E. CommentslOtber Information-
❑ 1 would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WUROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above,
RO-WQRGS Reviewer:
101i1009751,1]2Fl &11
NOTES:
Date:
FORM: WQROS-A RR ver. 092614 Page ] of 1

Water Resources
ENVIROMMEarAL QUALfrY
PAT MC CRORY
covemor
DONALD R. VAN DER VAART
seLrrlQy
S. JAY ZIMMERMAN
DhFeclor
April 11, 2016
Harold and Alice Johnson
115 Kind), Forest Dri ve
Hendersonville, NC 28739
RE: Acknowledgement of Application No. W10I00002
Geothermal Heating/Cooling Water Return Well
Henderson County
Dear Mr. and Mrs. Johnson:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application on April 6, 2016. Your application package 17as been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Asheville Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Water Quality Regional Operations Section
(WQROS ) requests your assistance in providing a timely and complete response to any additional
information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact Michael
Rogers at 919-807-6412 or [e-mail].
Sincerely,
6c> Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
cc: Asheville Regional Office, WQROS
Permit File W10100002
Sune ofNn[Yh Carolina j EnvimnmcmW (hurriiy j W tiler Resmyces
1611 Mail service Ccnler j Raiei& Nonh Carolina 27579-1611
919 707 9WO

(14� V 1 o o o L)2-
Harold E. Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
[phone]
�y'4;L,L:Ii a att.nc�
5 April 2016
Mr or Ms Shristi Shrestha
Hydrogeoiogist
Division of Water Resources
Water Quality Regional Operations Section
Dear Mr or Ms Shrestha
RECEIVED/NCdEu1DWR
APR 0 6 2616
Water Quality Regiona�
Operations Section
You folks are worse than when you were DENR and you were no great shakes hack then. I
am the original owner of the injection well permit of some thirty odd years ago, and have gone
through more misery with your predecessors than I cage to discuss. I received your latest (dated 29
March) on the second of April and it certainly should he obvious that 1 will be unable to respond
with a renewal application 120 days before the end of this month._
Typically in 5 year increments over the past 30 years, you have written to advise me that you
would like to come and test the quality of the water going into my heat pump and the water
exhausting into my injection well. A nice young man would come from Asheville and make those
tests and I would receive a renewal in a few weeks from Raleigh. As mentioned above, this has been
ongoing for the past 30 years. I received my first permission to operate this well system on 20
October 1986 from a Mr Davis. After applying on August 25 1986. New approvals have been at
various dates due to variations in water test timing at the state and the response time from DENR I
would like to be excused for not having a calendar reminder to apply 120 days sooner.
R g dsr
G d E.�Johnson PT'

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 42C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S)
-1-hese wells) inject groundwater directly into the suhsurfacc as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application Renewal* Modification Permit Rescission Request*
*For Permit Re"
als or Rescission Request, complete Pages 1 and 4 (signature page) only
Prini ur 7fupe Information and :Mail to lire Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: f 1" L ,20 PF.RNTIT NO.G-1:-01M02 _(leave blank if New Application)
A. CURRENT WELL USE AND OWNERSHIP STATUS (leave Blank if New Application)
1. Current Use of Well
a. Continue to use as
Supply
XGeothermal Well _Drinking Water Supply Other Water
b. Terminate Use: If the well is no longer being used as a geotherma nt ection well and you wish to
rescind the permit, check the box below. If abandoned, attach a ,. �r nment
Record (GW-30). �VvP
❑ Yes, I wish to rescind the permit APR 0 g 2016
VI1afer Quality R )anal
2. Current Ownership Status pP dons Se Reg)"",
Has these been a change of ownership since pern it last issued? ❑ YES NO
If yes, indicate new owner's contact information:
Name(s)
Mailing Address:
City:
State: 'Lip Code: County:
Day Tele No.: Email Address.:
B. STATUS OF APPLICANT (choose one)
Non -Government: individual Residence Business/Organization
Government State Municipal County Federal
C. WELL OWNER(S)IPERMIT APPLICANT — For individual residences, list owner(s) on property deed, For
all other!, name of entity and name of person delegated authority to sign: 1+ n 0 ee
U
Mailing Address: �1�� 1 z.— � _�r{ }
City: d "ell State: !t� lR Zip Code: County N
Day Tele No.: t� �� 4 • - 9 y"�Cel I No.:
EMAIL Address: d 7 C Fax Na.:
Geothermal Water Renfro Well Permit Application (Revi,ed .Tan 201.4) Page 1

J3
E.
F
WELL OPERATOR (if different from well owner) — For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the business
or agency:
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Email Address.:
LOCATION OF WELL SITF, — Where the injection wells are physically located:
(1) Parcel Iden ti fication Number (PIN) of well site: County:
(2) Physical Address (if different than mailing address):
City:
WELL DRILLER INFORMATION
Well Drilling Conlractor's Name:
NC Well Drilling Contractor Certification No.: _
State: NC 7.1p Code:
Company Name:
Contact Person: EMAIL Address:
Address:
City: Zip Code: State: County:
Office Tele No.: Ceti No.:
G. HVAC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name:
NC HVAC Contractor License No.:
Company Name:
Contact Person: EMAIL Address:
Address:
Fax No,:
City: Zip Code: State: County_
Office Tele No.: Cell No.:
Fax No.:
H_ WELL USE Will the iniectisnn well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
I. WTLL CONSTRUCTION REQUIREMENTS — As speciCed in 15A NCAC 02C .0224td1
(1) The water supply we#I shall be constructed in accordance with the water supply we[1 requirements of
i 7A NCAC 02C .0107.
(2) if a separate well is used to inject the heat pump cftluent, then the injection well shall be constructed
in accordance with the water supply well requirements o1' 15A. NCAC 02C .0107, except that:
Geothermal Water Rcrum Well Permit Application (Revised Jan 2015) Page 2

(a) For screen and gravel -packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
`EXISTING WELLS PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include. at a minimum, the following well construction specifications:
Depth of each boring below land surface
Wcil casing and screen type, thickness, and diameter
Casing depth below land surface
Casing height "stickup" above land surface
Grout material(s) surrounding casing and depth below land surface
Nate: bentonite grouts are prohibited far sealing router -bearing zones with 1500
mg1L chloride or greater per 15A NCAC 02C .0107(rii8i
Length of well screen or open borehole and depth below land surface
Length of sand or gravel packing around well screen and depth below land surface
K. OPERATING DA T A
Injection Rate;
Injection Volume:
Injection Pressure:
Injection Temperature:
Average (daily) gallons per minute (gpm).
Average (daily)
Average (daily)
Average (January)
gallons per day (gpd).
pounds/square inch (psi).
° F, Average (July) ° F-
L. SITE MAP — As specified in 15A NCAC 02C QZ24r 51t4 t, attach a site -specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map
shall include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .9107i aii 21 located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Gcothennal Water Rehm Well Permit Application (Revised Jan 2015) Page 3

:4'CJTE: In nio.st cases an aerial photograph of the propery parcel showing property litres aad structures can be
obtained and downloaded from the applicable couaq, GIS website. Tvpicallt,, the property can be searched by
owner name or, address. The location of the wells in relation to propero' boundaries, houses, septic ranks, other
wells, etc. can then he drawn in by hand. Also, a Ygver' can he selected showing topographic contours or elevation
data
N-11. CERTIFICATION (to be signed as required below or by that person's authorized agent)
l ';A NCAC 02C .021 13 ey requires that all pcnru( applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer:
2. for a 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 all the person(s) Iisted on the propert\ dec(l.
If an authorized agent is signing ov behalf of the applicant, then supply a letter signed by the
app!icart that names and authorizes their agent to sign this : ppl:catiou on their behalf.
"F hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attaehment<s thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said infonnation, I believe that the information is true, accurate and
complete. 1 am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false inForniation. I agree to consiruct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
Per mit. "
f ipeT
r1� �-Q�Si ure of y nerlApplicant
p A )5�a)
T- —
Pnnt or Type F=uII Name
Signature of Property OvalerlApplicant
c
r� cleLc /I, * j(VScW
Print or Type Full Name
Signature ❑FAuthorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to_
Division of Water Resources
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Pcn))it Application (Revised Jai) 7015] Page 4

Centrai Flies: APS S W P
05/05/11
Permit Number W10100002 Permit Tracking Slip
Program Category Status Project Type
Ground Water In review Renewal
Permit Type Version Permit Classification
Injection Heating/Cooling Water Retum Well (5A7) individual
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit,
Permit Contact Affiliation
Facility Name Major/Minor Region
Harold and Alice Johnson SFR Minor Asheville
Location Address County
115 Kindy Forest Dr Henderson
Hendersonville NC 28739 Facility Contact Affiliation
Owner Name
Harold
E Johnson
Scheduled
Orig Issue App Received Draft Initiated issuance
10/29/88 03/21111
Re❑elated Activities
Heat Pump Injection
❑utfall NULL
Owner Type
Individual
Owner Affiliation
Harold E. Johnson
115 Kindy Forest Dr
Hendersonville
NC 28739
Public Notice Issue Effective Expiration
05/06/11 05196111 04/39/16
Requested/Received Events
RO staff report requested 03/24/11
RO staff report received 04/21/11
Waterbody Name Stream index Number Current Class Subbasin

MCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Pardue
Governor
Harold and Alice Johnson
115 Kindy Forest Dr.
Hendersonville, NC 29739
Re: Issuance of Injection Well Permit
Permit No. WI0100002
Issued to Harald and Alice Johnson
Henderson County
Dear Mr. and Mrs. Johnson:
Division of Water Quality
Coleen H. Sullins
Director
May 6, 2011
Dee Freeman
Secretary
In accordance with your application received March 21, 2011, I am forwarding Permit No. W10100002 for the
operation of a 5A7 geothermal underground injection control (UIC) well heat pump system located at the above
referenced address. This permit shall be effective from the date of issuance until April 30, 2016, and shall be
subject to the conditions and limitations stated therein.
The Asheville Regional Office collected groundwater samples from your geothermal system on April 19, 2011.
After the laboratory analytical results are received; the results will be forwarded to you by the regional office.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit 120 days prior to its expiration date. As indicated in the permit, this permit is not
transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone].
Best Regards,
i
Michael Rogers, P.G. (NC FL)
Environmental Specialist
cc: Landon Davidson, Asheville Regional Office
Central Office File W10100002
Henderson County Environmental Health Dept,
HOUIFER PROT=CTION c_CTION
1636 Mail Service Center, Raleigh. North Garvlina 276WI- T636
=fan 27 28 Cap kaI 6aufavard. RE eipn Ivor Carohnu 27604
Pharie 915-73 -3221 l FAX [phone] FAY. P -7' 5 -604' i CUS10�er Servic 677-E23.674-.
interns% www.ncwaleraualltv.aro
0nr
NcrffiCarolina
f
Ati mqu2i r'PPLI nL^dy , A"'f^Ia1'V � +'C. CJn - rl i;.d1.v i'

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Harald and Alice .Johnson
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North Carolina
Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump effluent. This
injection well is located at 115 Lindy Forest Dr., Hendersonville, Henderson County, NC 28739, and will be
constructed and operated in accordance with the application received March 21, 2011, and in conformity with
the specifications and supporting data, all of which are filed with the Department of Environment and Natural
Resources and are considered a part of this permit.
This permit is for operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until April 30, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through VIII hereof.
Permit issued this the 6"' day of May, 2011.
r
oleen H. Sullins. Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI« ] 00002

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Eacb well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction, and use.
Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g)•
A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section — UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section — Asheville Regional Office
2090, US Highway 70
Swannanoa, NC 28778
[phone]
GWA s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on -site and available for inspection,
PART II — OPERATION AND USE GENERAL CONDITIONS
This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
?. This permit is not transferable without prior notice to, and approval by. the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change,

3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
PART III — PERFORMANCE STANDARDS
The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART IV — OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2, The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
1M 41kV3 I►l *3 9*0111WI.1
Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must he maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonahle access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
WI I) 1 (1000,

PART VI — MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number [phone], any of the following;
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VII — PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART VIII — CHANGE OF WELL STATUS
The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC ZC .021301}(1), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
,0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall he sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water

(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel -packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Wl()Jf tit n_ 5

A
1N A'r
QG
Y
To: Aquifer_Pmtectioa Section Central Office
Attn: MLchpl Rogers
From: Jonathan STeun
Choose an item. Re Tonal Dffice
L GENERAL SITE VISIT INFORMATION
1. Was a site visit conducted? ® Yes or ❑ No
a. Date of site visit: 04/19/2011
b. Site visit conducted by: ,Jonathan Stems
c. Inspection report attached? ®-Yes or ❑ No
��'10 111117- //P
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Aquifer Protection Section
Regional Staff Report
Application No.: WL0100002
Regional Login No.;
d. Person contacted: Harold Johnson and their contact information, (828) 891 - 8600 ext.
e. Driving directions:
H PROPOSED FACILIIIE,S FOR NEW AND MODIFICATION APPLICATIONS
1. Facility Classification: (Please,attach completed rating sheet to be attached to issued permit)
2. Are the new treatment facilities adequate for the type of waste end disposal system? El -Yes or ❑ No
If no. explain;
1 Are site conditions (soils, depth to water table, etc) consistent with die submitted reports? ❑ Yes ❑ No ❑ N/A.
If no, please explain;
4. Do the plans and site rnap represent the actual site (property lines, wells, etc.)? ® Yes [] No ❑ NIA
If no.. please explain:.
5. Is the proposed residuals management plan adequate? ❑ Yes ❑ No ❑ NIA
If no, please explain:
6. Are the proposed application rates (e.g., hydraulic, nutrient) acceptable? ❑ Yes ❑ No ❑ NIA
If no, please explain;
7. Aare there any setback conflicts for proposed,treetrMent, storage acid disposal sites? ❑ Yes or ❑ No
If yes, attach a map slip -wing conflict areas.
8. Is the proposed or existing groundwater monitoring program adequate? ❑ Yes ❑ No ❑ NIA
If no, explain and recommend any changes to Elie grou»dwater monitoring program:
9. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑Ala ❑ NJA
If yes, attach list of sines with restrictions (Certification B)
FORM: APSRSR 04-10
Page 1 of 3

a
U1 E3MTING FACILITIES FOR MODMCATION AND RENEWAL APPLICATIONS
1. Are there appropriately certified Operators in Charge (ORCs) for the facility El Yes ❑ No ❑ NIA
ORC: Certificate #: Backup ORC: Certificate #:
2. Are the design, maintenance and operation of the treatment facilities adequate for the type of waste and disposal
system? ❑ Yes or ❑ No
If no, please explain:
3. Are the site conditions (e.g., soils, topography, depth to water table, etc) maintained appropriately and adegktawly
assimilating the waste? ❑ Yes or ❑ No
If no, please explain:
4. Has the site changed in any way that may affect the permit (c g., drainage added, new wells inside the compliance
boundary, new development, etc.)? ❑ Yes or ® No
If yes, please explain:
5. Is the residuals management plan adequate? ❑ Yes or ❑trio
If no, please explain:
G. Are the existing application rates (e.g., hydraulic, nutrient) still acceptable? ❑ Yes or ❑ No
If no, please explain:
7. Is the existing groundwater monitoring program adequate? ❑ Yes ❑ No ❑ NIA
If no, explain and recommend any changes to the groundwater monitoring program:
8. Are there any setback oonflicts for existing trmtment, storage and disposal sites? ❑ Yes or ❑ No
If yes, attach a map showing conflict areas.
9, Is the description of the facilities as written in the existing permit correct? ❑ Yes or ❑ No
If no, please explain:
10. Were monitoring wells properly constructed and located? ❑ Yes ❑ No ❑ NIA
If no, please explain:
11, Are the monitoring well coordinates correct in BIMS? ❑ Yes ❑ No ❑ NIA
If no. please complete the following i expand table if necessary t:
Mooito!:i !g Weft
Latitude
Longitude
<• 1 rr
a , 11
if
h r7
X r it
r !7
O 1 rl
r 11
1 N
12. Has a review of all self. -monitoring data been conducted (e.g„ NDMR, NDAR. GW)? ❑ Yes or ❑ No
Please summnarizE any findings resulting from this review:
13. Are there any permit changes needed in order to address ongoing BIMS violations? ❑ Yes or ❑,No
If yes, please explain:
14. Check all that apply:
❑ No compliance issues ❑ Current enforcement action(s) ❑ Currently under IOC.
❑ Notice(s) of violation ❑ Currently under SOC ❑ Currently under'moratoriurit
Please explain and attach any documents that may help clarify answer/comments (i.e., NOV, NOD, etc.)
IS. Halle all compliance dates/conditions in the existing permit been satisfied? ❑ Yes ❑ No ❑ N/A
1f no, please explain:
16. Are there any issues related to comglianeelenforoettment that should be resolved before issuing this pen -nit?
❑ YesEl No ❑ NIA
If yes, please explain:
FORK APSRSR 44-10
Page 2 of 3

W. REGIONAL OFFICE RECOMMNDATIONS
- 1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes or Z No
If yes, please explain, -
I
2. List any items that you would Iike APS Centre,! Office to obtain through an additional information request:
3. List specific permit conditions recommended to be removed from the permit when issued;
Condition Reason
4. List speoi5c special conditions or compliance schedules recommended to be included in the permit when issued:
5. Recommendation: ❑ Bold, pending receipt and review of additional information by regional office
❑ Hold, pending review of draft permit by regional office
❑ Issue upon receipt of needed additional information
® Issue
❑ Derry (Please state reasons: ��
6. Signature of repor
Signature of APS
Date: ` t f i
V. ADDMONAL REGIONAL STAFF REVIEW ITEMS
PIesse note that a signature was not obtained from Alice Johnson on the renewal application as requested. A review
o f previou records md2cares that Ms..iohnson's signature has not been required in the past, In an effort to remain
consistent_ presen•e a positive pubiic perception, and prevent the renewal process from being delayed I am sending
this f icid rGr.ort without the requested signature. I have spoken with Landon Davidson about the matter and he agrees
that in this circum;tancc Ms. Johnson's signature is not essential.
FORM; APSRSR OI-I0 Page 3 of 3

Rogers, Michael
From:
Stepp, ,Jonathan
Sent:
Thursday. April 21, 2011 2:58 PM
To:
Rogers, Michael
Cc:
Davidson, Landon
Subject:
Stan Report W 10100002
Attachments:
v00100002_2011.pdf
Michael,
Please find the staff report attached.
Thanks,
Jonathan
Jonathan Stepp —J__o_�athanStep p{@_n_cdenr.Qov
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Aquifer Protection Section
2090 U.S. 70 Highway
5wannanoa, NC 28778
Tel: [phone]DO
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.

AQLTIFER PROTECTION SECTION
APPLICATION REVIEW REOUEST FORM
Date: March 24. 2011
To: [9 Landon Davidson, ARO-APS ❑ David May, WaRO-APS
❑ Art Barnhardt, FRO-APS ❑ Charlie Stehman, WiRO :4PS
❑ Andrew Pitner, MRO-APS ❑ Sherri Knight, W-SRO-APS
❑ Jay Zimmerman, RRO -AP S
From: Michael R02er5 Groundwater Protection Unit
Telephone: [19 i 715-6166 Fax: + 919) 715-0588
F'-Marl: Michael. Ro Hers, a ncmail,net
A. Permit Number: W l 0100002
B. Owner: Johnson
C. FacilitylOperation:
❑ Proposed ® Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
0 UIC -5A7 Well
For Residuals: ❑ Land App. ❑ D&M El. Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
1. Project Type: ❑ New ❑ Major Mad. ❑ Minor Mad. E Renewal ❑ Renewal wl Mod.
E. Comments/Other Information: ❑
NO 1'11 _ Boih Hat -old and Alic.:: (ahmon aTe r?n the 1-rgperty deed. but Alice Jcr nsnn aid not sign thr
*�71c1�sz! �sppllcrm'r+li. 14'lx:tt tiv�►1 ti�� �:F conslll�t i11G �ltc �r,;t r.cttor+, lilcsse �:a>.�c 1ir...fohiz�on .,rpt3 the
gripte'ii6aPE3k!L%1'4 11 •/ill FLOUIT} to (fit iliP14.1ou.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within, please take the following actions:
Z Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with ether R❑-APS representati'res in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP For additional detail.
When you receive this request form, please write your name and dates in the spaces below, rake a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer:
fate -
FORM. APSARR 07/06 Page 1 of I

AK6;-A`
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quaiity
Severly Eaves Perdue Uleen H. SuPins
Governor Director
March 23, 2011
Harold E . Johnson
115 Kinda Forest Drive
Hendefs-onville.-NC 28739
Subject: Acknowledgement of Application No. WIOI00002
Jbhnson,Hamld E. - SFR
Injection Heating/Cooling, Water Return Well (5A7)
Henderson
Dear Mr. Johnson:
Dee Freemar,
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on March 21, 2011. This application package has been` assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a derailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Duce, copied below, must provide recommendations prior w final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at michael.rogersCncdenngov. If the
reviewer is unavailable, you may leave a message, and they will respond promptly.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
0 U�k 4R-Coru
for Debra 1. Watts
Supervisor
cc- Asheville Regional Office, Aquifer Protection Section
Permit Application File WI0100002
A'XIFER PF❑i=CTQN SE710K
163E Mail Servi;- Certer, Ralenr,. North Caro!,n2 2769,�•1E36
Locsi+on: 2728 Capilal Boulevard. Raielgh, North uarolma 276V
Fhorie: 919-733-322 i 1 FA: 1 919-715-0588. FAX 2: 919-715-60481 Customer Servrce: 1-B77-6'13-674£
Iniemei: www•ncwaterQwa10,or�
k" E�"U 1 1%,�pol Ilin Aill+Tll,-'lye 66i 1- `-,rl �*VL;
C-m---.
N)r-thCarohn�,
4r�F� 14 t�afi7

Harold E. Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
[phone]
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Gentlepersons
Well, you've outdone yourselves in being bureaucratic, I KNOW that in the last 25 years,
I have submitted every bit of this to you before. In the records of the state, you likely know me
better than I know myself.
With respect to request K(1), you're kidding right? You may be able to do this in Raleigh, but
here in the hinterlands, I have neighbors within 1000 feet that don't know where their septic tanks
are and likely are not going to find out just so they can tell me. The regulations here are that the
septic tank and drainSeld and a well drilled for human water consumption only have to be 54 feet
apart and you want information about them out to 1000 feet? Could you please explain the
rational of this?
This well I believe, has the record of being the first or second licensed residential geothermal
injection well in the state_ During the last 25 years, NOTHING has changed, Same owner, same
injection well, same visits every 5 years by DENP, same communications with your results
department. Then to heap insult on injury, you send me ONE copy of the request for information,
and request TWO signed copies of the application package_ I have great difficulty believing that
someone took away all your xerox machines.
r
CE.ohnson"'F&-L--
;E;C;9"c fi£NR 1 iYWO
A"Qd1EFFP PPnTrr''f-oI rFrTIO14
MAR 2 t -m i

NORTH CAROLINA
DEPARTMENT OF ENVIRONM[ENI' AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
WITH A GEOTHERMAL HEAT PUMP SYSTEM
TYPE SA7 "OPEN LOOP" INJECTION WELLS)
(check one) New Permit Application & Renewal Modification
DATE: ih 140k 20 1
1.
PERMIT NO.:,K cited l -Zi (Leave blame if NEW permit application)
AL PROPERTY OWNERMERMIT APPLICANT
Name of each owner fisted on property deed. For a business or government agency, state name of entity and
name o ^pe>� deleted aa. ority atgn X� afton be/h�.alJf of the bus, 1�Ja�augy� -
(1)
Mir
Home/Office Tale No.:
Fax No. Email Address:
(2) Physical Ad&,= of Well Site (if different than above):
City: State Zip Cade Coupty.
HomelOfftce Tale No.. CeII No.:
Fax No.
Email Address:
& PROPERTY ORVNERSHiP DOCUMENTATION
Provide legal docvmentation of property ownership, much as a contract, deed, article of incorporation, etc. and
a PLAT map showing the prornty. Tbis information may be obtained from county Register of Deeds or G1S
website, .4 `0',4 GP
C. AUTHORIZED AGENT, IF ANY
If the property ownarAxmnit applicant want& to authariac someone else to sign the permit an their behalf* then
attach a � letter from the property ownerlpermit applicant specifying and eutbotiving thci agent (well
driller, beat pump ?Cjktraetar, or other type of caatractorlagent) to sign this applieation on their behal£
Company Name;
Contact Person
Address,
City: stale Zip
Office Tele No.; Fabi
Website Address of Company, if any.
-Type5AT hj=ion Ws)1 Perm! Application (Rvr. Aupnei 2009)
RY."19VO DEA I BY.10
AW1PPflPnrP-.T10V nmoH
MAR 21 1611
Page 1 of4

D. WELL DRILLER ]XF'ORMATIOIti
company Nance:_ M P_ 4
Well Drilling Contractor's Nancc:
NC Conti
cufl4 ay
Address:
City.
State Zip Code: County:
Office Telc No.: Fax No.: Cell Na:
E. HEAT PUMP CONTRACTOR INFORMATION (Vdifferdnt than Driller)
CompanyName• Contact Person:
Company Website: WWW, Email
Address: f
City. -- Stare Zip Code Caotmty:
Office Tale No.: Fax No. Cell No.
F. INJECTION PROCEDURE (briefly descrbe how the injection well will be used)
1/t L #ffA.� tr+► i r Y
G. WELL USE Will the injection vmll(s) also be used as the supply well(s) far the following?
(1) The injection operation? YES NO
(2) Personal constunption? YES . NO
H. WELL CONSTItUCMON DATA
PROPOSED Well(a) to be couched fur use as an Wactim we L Provide the data in (1) through
(7) below as PROPOSED c smiction speeificadons. Submit Farm OW-1 afterconstructioa
E39STING Well(s) being proposed for use as an injection well. Provide the data in (1) through (7)
below to -the bcst of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if avail able. )
(1) Well Construction Date: Number of borings:
Depth of each baring (feet):! �J t?, _
(2) We11 casing. is the well(s) rased? y dr
(a) - YES - If yes, then provide the/ casing infaamation below.
Type: Galvanized ateei Black a6ea1'Pleatic Other (specify)
Casing thickness: dyameter (inches): 0 depth: % e to J& fret (rcati,e to land surface)
Casing extends above ground �F inches
(h) NO
(3) Grout material surrounding well casing
(a) Grout type: Cement Bentonites Other (specify)
•sysd=dntoeWoa' gmMavubmegbcrftrcyomudtotSAWAC2CM1s[dXtXAXwtuch-w-lsscemmrtypev m
(b) Depth of grout a wnd weU teeing (relr&e to land surface): from to feet
Tyym SA7 k4ectien Wen Permit Appikatim [Rev. Awns 200% • 14ge 2 04

(4) Well Screen or Open Bombole depth (relative to land surface): liro3m T to feet
(5) N.C. State Regulations (Title 1 SA NCAC 2C .0200) reguue the Permitim to make provisions for
monitoring wellhead promses. A f ineat on both bdkient (groundwater entering heat pomp) and Effluent
(water being injected back into the welt) lim is required. Will these be a 3srsoet on:
(a) in t line? Yes VNo (b) Eglu�nt line? Yes k--"No
(6) Source Well Construetiom information. If the water some weR is a difle m t well than the injection
.cell, attaeb a copy of the well construction zccond (Form GW-1). If Form GW-1 is not available, provide
the following olata:
From what depth, formation, turd type of roc wdiment units will the grumdwater be withdrawn? (e.g.
granite, limestone, and, etc.)
Depth:I %- V� Fotmatiam. L I
NOTE- THE wELL DRu.t.4io oit IiFAT Pump commA=k CAN HELP supply nib DATA Er THis
INFOn"T1t7N IS arRE WLSE UNAVAILABLE.
I. OPERATING DATA
(1)
Injection Rate-
(2)
Injection Volume:
(3)
Injection Pressure:
(4)
Injection Temperature:
J. INJJ&MON RELATED EQIIIP11f1P.n
Average (daily) 4�oms per mintier (gPm)•
Average (dailYjZK glow per day (Spd)•
Average (daily) pounds/.square inch (psi).
.17
Average (Jaguary) If_- F, Average (July) OF.
Attach a scbematie diagram or cross- imt of the well construction that shows the total depth, length of casing,
extent of Smut, stickup. location of influmtlefumt sampling ports, etc. If this is a modification, show the
engineering layout or proposed modification of the injection equipsamt and exieriar piping/tabhsg associated whir
the b*non operation. The mannhewr a brochure may provide suppl=enwy informwon if nce&d.
K. I JDCA77ON OF WELL(S)
(1) Attach s aite map (cart be drawn) showing horses and other structures, property lines, surface water bodies,
potential sow of grow2dwater cantargi=Mm and The orientation of and $4Lq moss between the proposed
injection well(&) and any other existing well(s) or waste disposal facilities such as septic tanks or dmaim fields
looted within 10DO feet of the geothermal heat pump well system. Label all features clearly and include a
north aQogr.
(2) Attach a scaled top:gmbic map of the area trending 314 mile 'Wm The property boundary that indicates
the facility's location, a north arrow, and the map name.
NQTi:: lb Many eases, an affist mph o, f Me prupoV pwcd showing prevery limes and suxetarm can be
obaafted and do"Wbeded from ft appliraeble eowrrey ors %mbsim ryprall, she preopmV can be sewched by ownw
,mate or addkm M laeaakw of d w Free& im relssim to prapraV bow homs#4 aq?dlc ran" od w *do, on,
can dmn be drrrrat in by baud ALL, a 74yer'ran 6e nAwsed abowlggAVwgrMhk contours or elenadon data.
.Z .vw
Type SA7 laiwflan Well Permh Appliurion (Rey. Aug= 2t104) Page 3 of 4

1— CERTIFICATION (to be signed as required below or by that person's authorized agent)
NCAC 15A 2C .4211(b) regttires that all permit applicatioms shall be signed as follows:
1. Far a carparation: by a responsible corpm*c officer,
2. for a partnership or sole props ielorahip. by a general partner or the proprietor, respectively,
3. for a municipality or a state, federal, or other public agency: by either a principal eatecWve
officer or ranking publicly elcoted official;
4. for all others: by the well owner.
If an authorised agent Is aigniug on behalf of the applicant, then submit a letter signed by the
applicant that games and authorises their agent as speciflted sin Part C of this peirmit applfeallon.
" I hereby certify, under penally of law, that t have persanally examtaed and am fatniliat with the information submitted in
this document and all attachments thaeeto and that, based on my inquiry of those individuals immediately reeponarble for
obtsiuir 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 Use information l agree to euns*+ct, opeme,
maintain, repair, and if applicable, abandon the ilgeetion well and all related appurtenances in accordance with the approved
specifications and conditions of the Permit.,,
t^
of Property Owner/Applicant
jW&UA&V
r,ni or Tape Full Name
Signature of Property OwaedApplicant
Print or Type Full Name
Signature of Authorized Agent, if any
Pert or Type Full Name
Submit TWO signed copies of the completed application paclmge and aU attachments to:
[TIC Program
Aquifer Probecdon Section
Forth Carollm DENR DWQ
16M Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Type 5A7 Injection Well Pwmit Applim6on (Ray. Aupm IM)
XCaVU I ftOW ! DWO
PeV 4 of A

HAROLD S JOH)WOR �v
1151ONDY FOREST DR CCC!!!
HENDERSONVILLE, NC 2FM
barn Na 3/6965339
C):OY
CERTWICATE Of SATISFAC!WN
STATE OF NORTH CAAROUNA
COUNTY OF 11ENDERSON
The undersipAd Marp a Gs ty Trust Coupaq. As Trassss cardfj thst we are the owners of the � a mtred
by the bwm ter described Deed of Trust cr Mar4W and Shad the debt or other ob1*d at in the wrAwA of SIAf1 NA9
secured by the Deed of Trust mw=ted by HAROa E. JOEMON AND A1JCE JOEMW (Grent rl NEWELL i SAM
JR (TIUd=j FIRST C1 iCZENS RANK & TRUST Co (Bwwffd=y). and rL'-prde 1 in 'HKNIXRSOR CooatN Soft of
NORTH CAROLINA, an insnwaeat No. — in Book SW Papa WZ and .meoard+pd on Delsober 25,1991, Entry No. --
in Book 507 at Pap 227, CerdSesse ---� was satisfied an 17 -1 rl —0 \ _ . We request drat this Cartif aft of
Sstisfactiion be tecarded MA the above refranced Instrura tt be cannccied of reamd
Motu Guaranty Trust rusteclu
' :`
() ,,,,.� •
(Owner)
STATE OF
OOLNrY OF
I, GLti>t>e 0. SSTti;L:+ a Napery Public for acid county and soft -.(W- fiweby ccthst
.= W= • personally eame befbne me this day and acimawied®od that Wain is !MEE
of MoMm Goaranty Trost CompW, As Tnmtm and acimowtodge, as bahelf of Wargo G=mmf ► T�
Company, As Trodw the due emotion of die forWing btatrurnenL
Witness my hand and official seal, ttfis hfrf19,- 1 JUL 17 A4rl�� AtZl
O6LCWM CLEWELL
V6W& Sigoobv+e tte 01ES11014oMg4
CWWA@b Fftd In Nova cam
STATE OF NORTH CAROLINA
COUNTY OF
The fomego* oeetifkm of ej< . - _� d� , a Notary Public of
is oartifned tie be carte.
Thrs-j -dk9 of
REGISTER OF DEBEGo
RY: LAI
4 _— . Dwatj'
CANCELED BY CERTIFICATE DF SATISFACTION FILED p4usaratt to G.S. 45 37(A)
(6)ON SEE BOOK _ /oo / , PAGE -%
I• /p,, t� ILBY_ Ljg5 .¢,y • '�•L,� ArWLSk k Register of Deeds
ril-CEIVE0 Irij?p i b} . I f
MAR 21 2011

Tw 5
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***WAR-N NG: THIS IS NOT A SURVEY!***
This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby
notified that the aforementioned public primary information sources should be consulted for verification of the in Formation contained on this map. The County and mapping company assume no
legal responsibility for the information contained on this map.
LEGEND
��cas
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Thursday, March 17 201 I
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MAR 21 2Oil

ki7lp�rVRIU�L'�
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(ze �,69m Feet
s

GoMAPS - Henderson County NC Public Access Page 1 of I
Henderson County, NC - GoKaps GIS/Mapping System t;o
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Orrick Sea rh Par cel r r r- 3k - l i r4idHy LF)
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Listed To
Physical Address Parcel Nhimber-
PIN
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Buffer- +N.Aj-iners
Report 1 r.: gill
Fwal-Prc•_. er.
JOHNSON, HAROL D E ; JOHNSarJ, AIJCE
115 W KINRY FORESTDR 0115453
9548999933
62:
41 I
http://gisweb.hendersoncountyne.org/gomaps/map/index.ef n?reid=a115453
3 /24/2011

Property Summary - Henderson County Real Property Data
Page 1 of 1
Home Henderson County Real Property Data
Property Summary
Data last updated on: 3/24/2[111
10\, Ownership current as of; 3 f 18/2011
Parrel Nurnber ❑115453 PIN # 9548999983
OWDR
Location Address Property ❑escription
115 W KINDY FOREST Lot * 21 DAVIS LAND 1LOT ## 21
perty Owner:
HNSQN, HAROLD E ;
HNSQN, ALICE
inistrative Data
Told Map#
VCS
City
Fire District
Township
Land Class
(Spec District
I
Spec District
2
History
Pa rce I
Number 1
History
Parcel
Number 2
Acreage
Permit Date
Permit
Search.Resul_s New Search
zre}]I nllilf,innsl Land Gceds Note= _,ales izu_cs PlI" da
Dwner's Mailing Address
115 W KINDY FOREST DR
HENDERSONVLLE
NC 28739
nsfer Information
9548.08 Deed Date
10011111 Deed Book
Deed Page
VALLEY HILL Revenue Stamps
VALLEY HILL FIRE Package Sale Date
RESIDENTIAL- Package Sale Price
SINGLE FAMILY Land Sale Date
Land Sale Price
103
Go Maps
Tax Bills
Property Search
Property Location Address
115 W KINDY FOREST DR,
perty Value
01/ 12/ 1983 Total Appraised %96, I
000622 Land Value .
00305 Total, Appraised $236,3
29,00 Building Value
provement Summary
otal Units
leated Area
Prints best In landscape mode.
Tnursdai , Morch 24, 20
otal Appraised $332,
slue
Elderly Exclusion
Other Exemptions
3,697 Use Value Deferred
Historic Value Deferred
Total Deferred Value
otal Assessed $3
slue
http://taxinfo.hendersoncountync.org/propertysearch/PropertySummary,aspx?REID=a 115... 3/24/2011

NCDENR
North Carolina department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Goleen N. Sullins
Governor (];rector
March 11, 2011
Harold Johnson
115 Lindy Forest Drive
Hendersonville, NC 28739
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. WIO100002
Henderson Coimty
Dear Mr. Johnson:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. During our records review we have discovered that the above -
referenced operating permit for the underground injection well system, which was issued to you
on October 22, 2002, expired on October 31, 2005. If you wish to keep this permit and operate
the injection well system, the permit must be renewed and issued in your name.
If Your Iniection Well is Currentiv Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http:llifortal-ncdear.vrs /weblwLllapslg►Nprolreporting -forms.
If Your Infection Well is CurrentlN Active:
If the injection well system is still active and you wish to renew your permit, the renewal
application must be submitted within 30 calendar days of the receipt of this letter.
AQUIFER PROTECTION SECTION
1635 Maii Service Cenier, Ralelgh, Nonh Carolina 27699.1636
Locaton: 2728 Capital Ooufevard, Raleigh, North Cadina 27604
Phone. [phone] t FAX 1: 919-715-05M8 FAX [phone] %Customer Service: 1-877-623-6748
Inte met wm.ncwatetgualitv.or9
An Egv4 Opporfuri ry 1 Afirmaffva Arbon Employer
Clue
NorthCarolina

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type 5A7 Wells} if the injection well system on your
property is still active.
-OR-
B, Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate form(s) to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a reuewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
lLttp://b2o.enr.state.ne.us/ap�s/,-ji)t!/forms.htm.
Thank you in advance for your cooperation and timely response. if you have any questions,
please contact me by phone at [phone] or by email at eric.g,.smith:tt:ncdenr.gov.
Sincerely.
Eric G. Smith, P.G_
Hydrogeologist
Enclosures
cc: Asheville Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10100002 w/o enclosures
ra

— —��
RCDENR
North Carolina Department of Environment and (Natural Resources
Division of, Water Quality
Beverly Eaves Perdue Coleeri H. Sullins
Goy'ernGI 5IECtdf
March 11, 2011
Harold Johnson
1 I 5 Kindy Forest Drive
Hendersonville, NC 28739
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. WI0100002
Henderson County
Dear Mr. Johnson:
JH� rreem2ri
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. During our records review we have discovered that the above -
referenced operating permit for the underground injection well system, which was issued to you
on October 22, 2002, expired on October,31, 2005. If you wish to keep this permit and operate
the injection well system, the permit must be renewed and issued in your name.
If Your Infection Well is Currentl\ Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form UW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted, The GW-30 and NarinelOwnership
Change forms can be found at httn:fil,ortal.n.cdenr.oralweblw,ilansl�%' ,LirolrL martin'= -forms.
If Your Infection WeII is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal
application must be submitted within 30 calendar days of the receipt of this letter.
j%J1JFER PP. 07=C7i0PJ ,')ECTlON
61� IJiaiI Sen+ice Germ- Ran, Ivonli Cam line 27699-1633
Lorkor. -72B Capiol 2oulev.ti- Raleigr, I�unh Cams in ^n/
Phono 91973s?721 FAc. ? 9--15CIO 58 :A:,_.0i4-"n-3+748 �ustomercz I, `f+-1'::3-G74?
Interne'- wymnujate .ualltv.oro
Y.i'gJcI '; n6': j Slr. .. A7 rm- r , UI -71[: i-?e!
CJne
Nc, thC� ii (-)III7G-
�'t �i F #rr
w

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A. Subchapter ?C. Section .0211, you must suhmit one of the following
enclosed forms:
A. Application for Permit (Removal) to Construct andlor Use a Well(s) for M1ection with
Geothermal Heat Pump Svstern fbr Tvpe jA7 Well(s) if the injection well system on your
property is still active.
-OR-
B. Statta of Injection ii=ell Svstern if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate form(s) to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope,
The above referenced forms are also available • on-line at the DWQ website at
htr ,-: !/h? o, ennstaw. n c. us/aiis,_­ it 'form s.htm .
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at erie.s_,.smitli(&ncdenr_uov
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - APS w/o enclosures
APS Central Files - Permit No. WI0100002 w/o enclosures

Property Summary - Henderson County Real Property Data
Pagel of 2
Home Henderson County Real Go MaL-S
Property Data Tax Bills
• Property Summary
Data last updated on: 2/25/2011 Property
loop +� Ownership -current as of: 2/22/2011 _ Search
` Parcel Number 01.15453 PIN # 9548999983
Go
A i_ocation Address Property Description
115 W KINDY Lot # 21 DAVIS LAND
FOREST DR ;LOT #21
Search Results New Search
e�x
F arcel 6uildi�i hand Cieeds Nctes Sale Photo f�a
. — Bill .
r'roperty Owner:
JOHNSON, HAROLD E ;
!JOHNSON, ALICE
i
Owner's Mailing Address
115 W KINDY FOREST DR
HENDERSONVLLE
NC 28739
�4dministrative Data Transfer Information
Oid Map# 9548.08 Deed Date 01/ 12/ 1983
VCS 100R Deed Book 000622
!City Deed Page 00305
Fire District VALLEY HILL Revenue Stamps 29.00
Township VALLEY HILL Package Sale Date
FIRE Package Sale Price
Land Class RESIDENTIAL- Land Sale Date
SINGLE FAMILY Land Sale Price
!Spec District
1
Spec District
2
History
Parcel
Number 1
;History
Parcel
Number 2
Acreage 0.66
Permit Date
Permit #
mprovement Summary
Property Location Address
115 W KINDY FOREST DR
roperty Value
otal Appraised Land '
aiue
otal Appraised Building
alue
I Appraised Value
Elderly Exclusion
Other Exemptions
Total Units O
Heated Area 3J697 Use Value Deferred
Historic Value Defer -red
Total Deferred Value
❑tai Assessed Value
Property values will be displayed after the 2011 General Reappraisal Value Notices are mailed in mid March, 2011.
http://ta2 info.bendersoncounryne.org/ProperrySearcbJpropertysummary.aspx?RElD=01 15... 3/10/201 I

Property Summary - Henderson County Real Property Data
Page 2 of 2
Prints best in landscape mode.
€; -day, Ma; & 10, 2-011
http:lltaxinfo.hendersoncountync.org/PropertyScarch/propertysummary.aspx?RPID =0115... 3/10/2011

Q� W A T�9� Michael F. Easley, Governor
William G. Ross fir., Secretary
-Q North Carolina Department of Environment and Natural Resources
rAlan W. Klimek, R E. Director
Division of Water Quality
❑ C Coleen H. Sullins, Deputy Director
Division of Water Qunlity
June 20, 2003
Mr, Haroid Johnson, P.E.
115 Kindy Forest Drive
Hendersonville, NC 28739
Dear Mr. Johnson:
Per your request for a five year Underground Injection Control CU[C) permit, we are forwarding
Permit No. WI0100002 for the operation of a geothermal heat pump injection well at 115 Kindy
Forest Drive, Hendersonville, NC.
This permit shall be effective from the date of issuance until June 30, 2008, and shall be subject
to the conditions and limitations stated therein, In order to continue uninterrupted legal use of
this well for the staled purpose, you should submit an application to renew the pen -nit three
months prior to its expiration date.
If YOU have any questions regarding your permit please contact me at [phone] or Evan
Kane at [phone].
cc: Cd-Ulc Files
Enclosures
Best Regards,
Marl Pritzl
Hydrogeological Technician
LTIC Program
As.
17- E NR
N. C. Division of Water Quality 1 Groundwater Section
1636 titail Service Center kaleigh, X,C, 27699-1636 Customer Service
Phone (919] 733-3271 Far: t919j 715-05$$ Internet, http;//gw.elmr.state.ne.tis 1-877-61 -67�48

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Harold E. Johnson
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL(S), defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This system is located at 115 Kindy Forest Drive, Hendersonville, in Henderson
County, North Carolina, and will be operated in accordance with the application received on July
10, 2002, and in conformity with the specifications and supporting data submitted, all of which
are filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Operation only, and does not waive any provisions of the Water Use Act or any
other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in
compliance with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any
other Laws, Rules, and Regulations pertaining to well construction and use_
This permit supersedes the permit issued on October 22, 2002, and shall he effective unless
revoked from the date of its issuance until June 30, 2008, and shall be subject to the specified
conditions and limitations set forth in Parts I through IX hereof.
4—
Permit issued this the �'- I day of �t , 2003.
l r
Ted L. Hush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Pemut No. W1a100002 Page 1 of 5
ver.3J01 GWIUTC-5

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
The Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N,C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
Each injection well shall have permanently affixed an identification plate.
' .:.1� i �i�=� 7:M 11 ti7±[:� 11i�`j_�IN alil �1:7.•►1[�L]±�M I�C�7�I•y
This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Pennittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
Permit No, W10100002 Page 2 of 5
ver.3101 G WIMC-5

PART III - PERFORMANCE STANDARDS
The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that maybe
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
The issuance of this pen -nit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART IV - OPERATION AND MAINTENANCE REQUIREMENTS
The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
PART V - INSPECTIONS
Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place on
or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G_S. 87-90,
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
Permit No. WI6100002 Page 3 of 5
ver.3141 GWUC-5

PART VI - MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary
by the Division of Water Quality to insure surface and ground water protection, will be
established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Asheville Regional Office, telephone number (828)
251-6208, any of the following:
(A) Any occurrence at the injection facility which results in any unusual
operating circumstances;
(B) Any failure due to known or unknown reasons, that renders the facility
incapable of proper injection operations, such as mechanical or electrical
failures.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4 In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
PART VII - PERMIT RENEWAL
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
PART VIII - CHANGE OF WELL STATUS
The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(b)(1), Well Construction
Standards.
2_ When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
Permit No. WI0100002 Page 4 of 5
ver.3101 G WIUIC-5

(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) The well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Drilled wells shall be completely filled with cement grout, which shall be
introduced into the well through a pipe which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel -packed wells in which the casing and screens have
not been removed, neat -cement shall be injected into the well completely
filling it from the bottom of the casing to the top.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(1) within 30 days of completion of
abandonment.
3_ The written documentation required in Part VH1(1) and (2) (G) shall be submitted to:
Groundwater Section -LTC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX - OPERATION AND USE SPECIAL CONDITIONS
None
Permit No. W10100002 Page 5 of 5
ver.3101 GW"C-5

Harold E. Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
[phone]
February 14, 2003
Mr. Evan 0. Kane
Division of Water Quality
1636 Mail Service Center
Raleigh NC 27699-1636
Dear Mr. Kane
I am in receipt of your letter to me dated 4 February 2003, and would request a further review
of the subject circumstances. I fully understand the Groundwater chemists comments, and her defense
ofcollected data. That same methodology ofcourse, is what caused the repeat visit to my home when
those checks and reviews failed to properly identify the iron "sampling event" of 13 August 2002_
Since you are concerned about the elevated lead concentrations from my source well, you
have certainly noticed that there is a significant reduction in that element in my discharge effluent. I
am hoping at sometime in the near fixture to be able to sell my accumulated lead and intend to enter
negotiations with the lead tire weight folks as one of their suppliers. I would be most appreciative if
you would describe to me, the rationale of your decision to limit my injection well permit to three
years from five, when source well water content has nothing to do with the injection process. I would
think, what with my cleaning of the environment, you would be expending some effort to press
additional permits upon me. I am certain you can see the logic in this.
i would be happy to comply with your recommendation of remedying the lead problem in my
water supply well. Short of drilling another well at some other location, (Mars comes to mind) I have
a bit of trouble deciding how to do that. You might ask your chemist for her suggestions and forward
her answers at your earliest convenience. I am not a Luddite by nature, I have made my living for
most of my life from science and technology, but as a youngster, I grew up in a large city that had
lead water pipes front the cast iron mains to my kitchen faucet and I still managed to grow up. I do
understand that the EPA's MCI_, and MCLG (despite Mr. Davidson-s inversion of the numbers in his
letter) are 15 ppb and 0 as a goal_ Since my discharge well samples fall below the levels the DWQ sets
as mc`i? imunns in ALL measured elements, 1 again request that yoti reconsider and return my sample
periods to the 5 year interval or cite a specific reason for not doing so. Purported elevated lead
content in the source well is not an acceptable reason_
�Cam'/ohnson
• . ry--�r
lNa,dold E.

Betty Wilcox wrote:
Mark,
I have reviewed your comments and Mr. Harold's request letter and file as requested. Following are
the issues, according to my interpretation, and my continents.
1. The validit}J ofDWQ Laborator.v analysis results has been questioned.
The DWQ Laboratory validates its data through a series of checks and reviews that are intended to
assure that reported results are of a verifiable and acceptable quality. The Lab reports results at it's
Practical Quantitation Limit (PQL), which is about 3-5 times the calculated Method Detection Limit
(MDL), and represents a practical and achievable detection limit with relatively good certainty that any
reported value is reli able.
The laboratory data for the influent well, identified as the water supply well, indicate an increase in the
lead content from 14.4 ppb to 54.0 ppb during the August 13, 2043 and September 11, 2003 sampling
periods. Analysis results are based on unfiltered samples. There was no data indicating an increase in
sediment or suspended solids in the well during this time period. Based on the laboratory data, there
does not appear to be justification for invalidating the results.
2. Should UIC issue a S year permit or continue with the current action (3 year permit)?
There is justification for concern and additional follow-up regarding the increase in lead
concentration. Typically, water supply well (drinking water) results exceeding groundwater standards
are sent to Environmental Health (Epidemiology) for an evaluation.
Additional morritoring is recommended.
I can not make a determination as to whether a 3-year or 5-year permit should be issued; however,
cut -rent language in Part III and Part VI (L) of the permit may provide the Groundwater Section with
authority to increase monitoring or take other action as necessary.
Betty r
I'2�i1 a.ov 3

NORTH CAROL INA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87, Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Harold E. Johnson
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL(S), defined in Title 15A North
Carolina Administrative Code 2C .4249(e)(3)(A), which will be used for the injection of heat
pump effluent_ This system is located at 115 Lindy Forest Drive, Hendersonville, in Henderson
County, North Carolina, and will be operated in accordance with the application received on July
10, 2002, and in conformity with the specifications and supporting data submitted, all of which
are filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Operation only, and does not waive any provisions of the Water Use Act or any
other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in
compliance with Title 15A North Carolina Administrative Code 2C .41 04 and .0204, and any
other Laws, Rules, and Regulations pertaining to well construction and use.
This permit supersedes the permit issued on October 22, 2002, and shall be effective unless
revoked from the date of its issuance until June 30, 2008, and shall be subject to the specified
conditions and limitations set forth in Parts I through DC hereof.
4�1
1
Permit issued this the day of 2001
IrTed L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WIO 100002 Page 1 of 5
❑er.3/01 G WIUIC-5

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittec must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to injection Wells (15A NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6, Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
PART II - OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director), In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Pen-nittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
Permit No. W10100002 Page 2 of 5
VCr.3/01 G W IUIC-5

PART III - PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Pernittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittec shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART IV - OPERATION AND MAINTENANCE REQUIREMENTS
1, The injection facility shall be properly maintained and operated at all times.
?. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
PART V - INSPECTIONS
Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place on
or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S, 87-90.
1. Provisions shalt be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
Permit No. W10100002 Page 3 of 5
ver.3101 GWIUIC-5

PART VI - MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary
by the Division of Water Quality to insure surface and ground water protection, will be
established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Asheville Regional Office, telephone number (828)
251-6208, any of the following:
(A) Any occurrence at the injection facility which results in any unusual
operating circumstances;
(B) Any failure due to known or unknown reasons, that renders the facility
incapable of proper injection operations, such as mechanical or electrical
failures.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
PART VIH - CHANGE OF WELL STATUS
The Permittce shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal, If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(1), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
Permit No. W10100002 Page 4 of 5
ver, 3101 GWIUIC-5

(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water-
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) The well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Drilled wells shall be completely filled with cement grout, which shall be
introduced into the well through a pipe which extends to the bottom of the
well and is raised as the well is filled,
(E) In the case of gravel -packed wells in which the casing and screens have
not been removed, neat -cement shall be injected into the well completely
filling it from the bottom of the casing to the top,
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(1) within 30 days of completion of
abandonment.
3. The written documentation required in Part V1II (1) and (2) (G) shall be submitted to:
Groundwater Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX- OPERATION AND USE SPECIAL CONDITIONS
None
Permit No. W10100002 Page 5 of 5
ver.3101 G WfLJIC-5

mailbox:///CllDocurrents%20and%205ettings[WC%2OTech/Applicat...
Subject: Harold Johnson's 5A7 permit
From: "Evan Kane" <[e-mail]>
Date: Thu, 27 Mar 2003 09:57:30 -0500
To: "Mark Pritzl" <Mark.Pritzl [e-mail]>
CC: "Debra Watts" <dehra.wattsCncmail.net>, "Ted Bush" <[e-mail]>
After discussions with Landon and Kay (of ARO) and Debra, we have concluded
that Mr_ Johnson's permit should be issued for the full five years. No
special conditions need to be placed on the permit, because we may inspect
and sample the system at any time under the standard provisions of the
permit and 2C .4211(p).
ARO plans to sample wells in the neighborhood to determine if there is a
broader lead problem. Pending results of that sampling, they may elect to
resample Mr. Johnson's water supply and heat pump effluent, In your
transmittal memo to ARO, please ask them L❑ keep us informed on the results
of their investigation into the lead problem. I have also set myself a
reminder to follow-up on this in 6 months if we have not heard anything.
In a nutshell:
1. Go ahead and re -issue Mr. Johnson's permit for the full five years
2. In your transmittal memo to ARO, ask them to keep us informed on the
results of their investigation into the lead problem.
Evan
Outgoing mail is certified Virus Free.
Checked by AVG anti -virus system (http;//www_irisoft.com).
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I Name I Date I T►•
Mark Pritzl
mit/Comments
Heat r� Remediation
-547
Other
Heat Pump Remediation Other

Harold E. Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739 a
[phone]
February 14, 2003
Ei
L•�l v
Mr. Evan D- Kane -P-
Division of Water Quality `A
1636 Mail Service Center
Raleigh, NC 27699-1636
Dear Mr, Kane
I am in receipt of your letter to me dated 4 February 2003, and would request a further review
ofthe subject circumstances. I fully understand the Groundwater chemists comments, and her defense
of collected data. That same methodology of course, is what caused the repeat visit to my home when
those checks and reviews failed to properly identify the iron "sampling event" of 13 August 2002.
since you are concerned about the elevated lead concentrations from my source well, you
have certainly noticed that there is a significant redrrc#ion in that element in my discharge effluent. I
am hoping at sometime in the near future to be able to sell my accumulated lead and intend to enter
negotiations with the lead tire weight folks as one of their suppliers. I would he most appreciative if
you would describe to me, the rationale of your decision to limit my injection well permit to three
years from five, when source well water content has nothing to do with the injection process. I would
think, what with my clearing of the environment, you would he expending some effort to press
additional permits upon me. I am certain you can see the logic in this.
I would he happy to comply with your recommendation of remedying the lead problem in my
water supply we]1. Short ofdrilling another well at some other location, (Mars comes to mind) I have
a bit of trouble deciding how to do that. You aught ask your chemist for her suggestions and forward
her answers at your earliest convenience. I am not a Luddite by nature, I have made my living for
most of my life from science and technology, but as a youngster, I grew up in a large city that had
lead water pipes from the cast iron mains to my kitchen faucet and I still managed to grow up. I do
understand that the EPA's MCL and MCLG (despite Mr. Davidson's inversion of the numbers in his
letter) are 15 ppb and 0 as a goal. Since my discharge well samples fall below the levels the D WQ sets
as maximums in ALL measured elements, I again request that you reconsider and return my sample
periods to the 5 year interval or cite a specific reason for not doing so_ Purported elevated lead
content in the source well is not an acceptable reason.
a old E. ohnson

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
June 20, 2003
Mr, Harold Johnson, P.E.
115 Kindy Forest Drive
Hendersonville, NC 28739
Dear Mr. Johnson:
Alan W. Klimek, P. E. Dirwor
Division of Water Quality
Coleen H. Sullins, Deputy Direuor
Division of Water Quality
Per your request for a five year Underground Injection Control (LIC) permit, we are forwarding
Permit No, WIOI 00002 for the operation of a geothermal heat pump injection well at 115 Lindy
Forest Drive, Hendersonville, NC.
This permit shall be effective from the date of issuance until June 30, 2008, and shall be subject
to the conditions and limitations stated therein. In order to continue uninterrupted legal use of
this well for the stated purpose, you should submit an application to renew the permit three
months prior to its expiration date.
If you have any questions regarding your permit please contact me at (919) 715-61 b6 or Evan
Dane at [phone].
CC' CO-UIC Files
Enclosures
Best Regards,
Mark Pritzl
Hydrogeological Technician
UIC Program
0M
ZENR
N. C. Division orlVater QuAIity 1 Groundwater Section
1636 Mail Service Center Raleigh. N.C. 27699-1636 Customer Service
Phone: (919] 733-3221 Fax; (919] 715-QS88 Internet_ hnp:I/gwxhm.slate.nc,us 1-877a523�748

Harold E. Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
[phone]
July 5, 2001 "
NCDENR
Mr Mark Prital
Division of Water Quality, Ground water section
1636 Mail Service Center
Raleigh, NC 27699-1636
Dear Mr. Prital
Reference your note of October 212002 with attachments. The variability of the samples
taken August 13' and September 11m, cause me to wonder as to whether the folks in the DENR
laboratory have yet discovered the difference between resolution and accuracy in their measurements.
In turn, I am confused by your comments over the phone with respect to the lead content in
your samples and the results indicated by the samples ofthose two dates. ALL of these measurements
are bordering on the "noise lever'.
I appreciate that from the serial number on my well permit and the seemingly undue attention
that I attract from your department that there may well be a learning curve involved here. I have
reviewed the test results your department has provided me for the years 1995, 1997, September and
October 2002. Test results for prior years on 1986 and 1991 are not available to me, but since the
permit was approved for those years, I feel that they were probably well within limits. These results
indicate a single instance of what in the statistical business would be called an "Outtlier" in the iron
sample. I personally, don't have a problem with this since there is no iron, (Or rather, only two 3 inch
long, 1-1 A inch steel nipples interfacing Monet and copper in the heat exchanger to PVC pipe) in my
system.
Your periodic visits here are pleasant enough, but not without pain. First, aside from the
expenditure of my tax money, (and yours), removing and replacing the thermal covers on both well
heads doesn't do my back a bit of good. While you're welcome at any time, I would like to request
that you review the history of my account with your department and reconsider the three year permit
with a goal of permittir}gfor the normal 5 year cycle and of allowing you to pursue more productive
ends-
*94 E. iohnson PE

daF WA rERpG Michael F. Easley, Governor
William G. Ross Jr., Sacmary
North Carolina L,,artinent of Environment and Natural Resources
t? r Alan W. KJimek, P.E. Director
7 =i Division of Water quality
t7 'C
February 4, 2003
Harold Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
Dear Mr. Johnson:
The Groundwater Section has reviewed your request to extend your geothermal heat pump
injection well permit from a three-year permit interval to a five-year interval. We do agree that
the iron concentration that was reported in the August 13'h, 2002, sampling event is not of any
serious concern. However, we are concerned with the elevated lead concentrations that were
detected from the water supply well in both the August 13t' and September 110' sampling events.
The Groundwater Section's chemist has reviewed the lab results from the last two sampling
events of your geothermal system as well as your request letter received on October 31, 2002. In
her review comments, the chemist stated: "Me DWQ Laboratory validates its data through a
series of checks and reviews that is intended to assure that the reported results are of a verifiable
and acceptable quality. The Lab reports results at its Practical Quantitation Limit (PQL), which
is about 3-5 times the calculated Method Detection Limit (MDL), and represents a practical and
achievable detection limit with a relatively good certainty that any reported value is reliable."
Based on our review, the Groundwater Section believes that the issuance of a three-year permit is
justified and recommends that you remedy the lead problem pertaining to your water supply well
as soon as possible.
If you have any questions regarding your permit, please contact me at [phone] or Mark
Prital at [phone].
Sincerely,
Zff;t,— ajf_�,�
Evan O. Kane, L.G.
Underground Injection Control Program Manager
CC CO-UIC Files
ARd-UIC Files
ARA
NMENR
Customer Service Division of Water quality 1 Groundwater Section
1 800 623-7748 isss (Wail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

Michael F. Easley, Governor
William G. Ross .fr., Secretary
North Carolina arfinent of Environment and Natural Resources
October 31, 2002
Harold E. Johnson
115 Kindly Forest Drive
Hendersonville, NC 28739
Dear Mr. Johnson,
Alan W. Klimek, P.E. Director
Division of Water Duality
The Groundwater Section has received your request letter to reconsider permitting your
geothermal system with a five year injection well permit. The Groundwater Section will review
your tile, consider your request and inform you of our decision as soon as possible.
If you have any questions concerning this letter or injection well rules, please feel fee to contact
me at [phone].
_cc UIC riles
RrA
Customer Service
1 800 623-7748
Sincerely,
Mark Pritzl
Hydrogcological Technician Il
Underground Injection Control Program
Division of Water Duality 1 Groundwater Section
1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Intemet: http:!lgw.ehnr.state.nc.us

DIYISTON OF WATER QUALITY
GROUNDWATER SECTION
October 21, 2002
MEMORANDUM
To: Landon Davidson, L.G., Regional Groundwater Supervisor
Groundwater Section
Asheville Regional Office
From: Mark Pritzl I'ter` [e-mail]
Hydrogeological Technician 11
UIC Group
Groundwater Section
Raleigh Central Office
Re: Issuance of a Open -Loop Geothermal Injection Well System (Type 5A7.):
Permit Number WI0100002 to operate a well for the injection of an open -loop
ground -source heat pump system has been issued to Harold Johnson, in Hendersonville, North
Carolina. This is a renewal permit and the Underground Injection Control Group appreciates your
assistance with the inspection and review tasks. Please retain the application and paper work for
the ARO-TIC files. If you have any questions regarding this permit or the TIC program, please
contact me at [phone].
cc: Ca-UIC Files
Enclosures

F W A �F Michael F. Easley, Governor
_❑�0 �QG William G. Ross Jr., Secretary
North Carolina )artment of Environment and Natural Resources
Alan W. Klimek, P.E. Director
7 Division of Water Quality
o -c
October 21, 2002
Harold Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
Dear Mr, Johnson:
In accordance with your renewal application dated July 26, 2002, we are forwarding Permit No.
WI0100002 for the operation of a geothermal heat pump injection well at 115 Kindy Forest
Drive, Hendersonville, NC, in Henderson County. A copy of the laboratory test results of water
samples collected on August 13 and September 11, 2002 are also enclosed. Please note due to
slightly elevated iron concentrations in the effluent water sample the Groundwater Section is
issuing a three year geothermal heat pump injection well permit instead of the normal five year
interval. This will allow a more frequent monitor schedule to observe iron concentrations.
This permit shall be effective from the date of issuance until October 31, 2005, and shall be
subject to the conditions and limitations stated therein. In order to continue uninterrupted legal
use of this well for the stated purpose, you should submit an application to renew the permit three
months prior to its expiration date.
If you have any questions regarding your permit please contact me at [phone] or Evan
Kane at [phone].
cc- Cd-UIC Files
ARQ-LTIC Files
A--Enrlasures
NL,UM R —
Customer Service
1 800 623-7748
Sincerely,
fia U
Marls Pritzi
Hydrogeological Technician
Underground Injection Control Program
Division of Water Quality 1 Groundwater Section
1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: hktp:/1gw.ehnr.state.nc.us

MEMORANDUM
To: Mr, Harold Johnson
From: #fMark Pritzl tel. [phone]
Re: Groundwater Sampling Results from August 13, 2002
October 21, 2002
Influent Water Sample
Effluent Water Sam 1e
Coliform, total
ns
Coliform, total
ns
Coliform, fecal
us
Coliform, fecal
ns
PH
5.8
pH
5.4
Chloride, Cl
3 mg/L
Chloride, Cl
4 mg/L
Dissolved Solids
42 mg/L
Dissolved Solids
48 mg/L
NO2 + NO3- as N
2.40 mWL
NOz + NO3' as N
3,10 mg/L
NH3 as N
<0.42 mg1L
NH3 as N
ns
TKN as N
ns
TKN as N
ns
Aluminum, Al
<50 ug/L
Aluminum, Al
<50 uglL
Chromium, Cr
<25 ug/L
Chromium, Cr
<25 ugfL
Copper, Cu
7.8 ug/L
Copper, Cu
77 uglL
Iron, Fe
<50 uglL
*Iron, Fe
360 ug/L*
Mercury, Hg
ris
Mercury, Hg
ns
Potassium, K
1.3 mg/L
Potassium, K
1.5 mglL
Magnesium, Mg
0.65 mg/L
Magnesium, Mg
0.78 mg1L
Manganese, Mn
<10 uglL
Manganese, Mn
<10 ug1L
Sodium, Na
4.7 mg1L
Sodium, Na
5.9 mglL
Nickel, Ni
<10 ug/L
Nickel, Ni
<10 uglL
Lead, Pb
14 ug/L
Lead, Pb
<10 ug/L
Selenium, Se
ns
Selenium, Se
us
Zinc, Zn
<10 uryfr
Zinc, Zn
28 ug/L

Groundwater Sampling Results from September 11, 2002;
Effluent Water Samnle
Coliform, total ns
Colifonn, fecal ns
pH ns
Chloride, Cl ns
Dissolved Solids ns
NO2- + NO3- as N ns
NH3 as N ns
TKN as N ns
Aluminum, Al <50 uglL
Chromium, Cr C25 ug/L
Copper, Cu 66 uglL
Iron, Fe <50 uglL
Mercury, Hg ns
Potassium, K 1.3 mg/L
Magnesium, Mg 0,75 mgfL
Manganese, Mn <10 ug/L
Sodium, Na 4.4 mglL
Nickel, Ni <10 uglL
Lead, Pb <10 uglL
Selenium, Se ns
Zinc, Zn <10 uglL

state Groundwater Quality Standard,
Classifications and Water Quality Standards Applicable To The Groundwater's of North Carolina
(North Carolina Administrative Code Title 15A: 02L.200)
Coliform, total
<11100 ml
Coliform, fecal
<11100 ml
Chloride
<250 mglL
Total Dissolved Solids
<500 mglL.
NO2' + NO3- as N
<10 mglL
Cadmium
<5.0 ug/L
Chromium, Cr
-<50 ug/L
Copper, Cu
<1,000 ug/L
Iron, Fe
<300 ug/L
Manganese, Mn
<50 ug/L
Nickel, Ni
<100 ug/L
Lead, Pb
< 15 ug/L
Zinc, Zn
<2,100 ug/L
Arsenic, As
<50 ug/L
Mercury, Hg
<1.1 ug/L
Barium, Ba
c2,000 ug/L
Zinc, Zn
<2.100 ug/L
mglL = milligrams per liter = parts per million
ug/L = micrograms per liter
= parts per billion
1,000 uglL = 1 mglL
ns = not sampled
(1 gram/ 1,000gra ms)I1,000grams
(1 gram11,000,000grams)ll, 000grams

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Harold E. Johnson
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL(S), defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This system is located at 115 Kindy Forest Drive, Hendersonville, in Henderson
County, North Carolina, and will be operated in accordance with the application received on July
10, 2002, and in conformity with the specifications and supporting data submitted, all of which
are filed with the Department of Envirownent and Natural Resources and are considered a part of
this permit.
This permit is for Operation only, and does not waive any provisions of the Water Use Act or any
other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in
compliance with Title 15A North Carolina Administrative Code 2C ,0100 and .0200, and any
other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until October 31,
2005, and shall be subject to the specified conditions and limitations set forth in Parts I through
LK hereof.
.)p
Permit issued this the day of_ 03o&-,r — , 2002.
IrTed L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Manageanent Commission.
Permit No. WI0100002 Page 1 of 5
vex.3I0I GWILUC-5

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
The Pernuttee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (I5A NCAC 2C
,0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers_
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a wai-ning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
PART 111- OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
Permit No. WI0100002 Page 2 of 5
ver.3101 GNMIC-S

PART III - PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART IV - OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
PART V - INSPECTIONS
Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place on
or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids,
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
Permit No. W10100002 Page 3 or 5
ver,3101 GWIUIC-5

PART VI - MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary
by the Division of Water Quality to insure surface and ground water protection, will be
established and an acceptable sampling reporting schedule shall be followed.
2. The Pernttee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Asheville Regional Office, telephone number (828)
251-6208, any of the following:
(A) Any occurrence at the injection facility which results in any unusual
operating circumstances;
(B) Any failure due to known or unknown reasons, that renders the facility
incapable of proper injection operations, such as mechanical or electrical
failures.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Pennittee shall
take such immediate action as may be required by the Director.
PART VII - PERMIT RENEWAL
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
PART VM - CHANGE OF WELL STATUS
I. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection, If a well is taken completely out of service temporarily, the Permittee must
install. a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(1 ), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shalt abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
Permit No. W10100002 Page 4 of 5
ver.3101 GWfUIC-5

(A) All casing and materials may be removed prior to initiation of
abandonment procedures i Fthe Director finds such removal will not he
responsible for, or contribute to, the contamination of an underground
source of drinking water,
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) The well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Drilled wells shall be completely filled with cement grout, which shall he
introduced into the well through a pipe which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel -packed wells in which the casing and screens have
not been removed, neat -cement shall be injected into the well completely
filling it from the bottom of the casing to the tap.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit,
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(1) within 30 days of completion of
abandonment.
3 The written documentation required in Part VII1(1) and (2) (G) shall be submitted to:
Groundwater Section -MC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX - OPERATION AND USE SPECIAL CONDITIONS
None
Pernut No. W10100002 Page 5 of 5
❑er.3101 G WIVIC-5

Re: WId 10002 - ]ohnson resampIing
Subject: Re: WI010002 - Johnson resampling
Date: Mon, 21 Oct 2002 09:07:09 -0400
From: Mark Pritzl <[e-mail]>
Organization: Groundwater Section
To: Landon Davidson Q.andon.Davidsonlwncmai1.ner7
Landon,
Sure, no problem. The UIC will issue a permit but definitely keep us
informed with Mr. Johnson's influent problem. Was that RO lead
investigation or RO lead (Pb) investigation, Ha-ha? It's Monday.
Landon Davidson wrote:
> Mark -
-. I guess I misunderstood our discussion. If the metals of concern are
below 2L for NJEFF (post -system and pre -injection) and Hi.TNF (raster
supply well or influent) is below 2L with exception of lead, then
th e
> permit could be renewed and the RO deal with the lead issue in the
water
• supply well sample? We'll resample cause I don't think the lead is
• really in the water. Copper ramped up also in this last sampling
event
> wherc the Lead was high which makes me teary of the wellhead faucet.
> We'll resample in the guys house spigot and again at the water
supply
> wellhead as part of our RO lead investigation but not related to the
> permit. You'll be copied on all. Thanks.
> Landon
> Landon Davidson - [e-mail]
> North Carolina Dept. of Environment and Natural Resources
> Asheville Regional office
> Division of Water Quality - Groundwater Section
> 59 Woodfin Place
> Asheville, NC 28801
> Tel: [phone]
> Fax: [phone]
Mark Pritzl <Mark.P_ri_ t_z1gyncmail.net>
t11C Pragram
Groundwater See don

O OF Michael F. Easley
- 0,0
ll Governor
� r William G. Ross, Jr., Secretary
7 North Carolina Department of Environment and Natural Resources
p Alan W. K4mek, P.E., Director
Division of Water Quality
Asheville Regional Office
Groundwater Section
October 28, 2002
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville, North Carolina 28739
Re.: Analytical Results of September Sampling
Permit No.: WIa100002
Dear Mr. Johnson,
On September 11, 2002, staff of the Asheville Regional Office collected additional
groundwater samples from your heat pump system including your water supply well. Additional
sampling was necessary due to the presence of elevated levels of some metals in the system
effluent just prior to injection. The laboratory analytical results of the last two sampling events
are attached.
The September analytical results indicate that all metals in the effluent sample (named
HJEFF) were below the 2L groundwater standards. I have forwarded this information to the
Central Office for their review in relation to your permit renewal. It is my understanding that
your permit renewal will be granted. As we discussed on the 18'h, analytical results for your
water supply well (named HJINF) indicate that lead was detected at 56 ppb (parts per billion).
Previous sampling results detected lead at 14 ppb. The EPA drinking water standard for lead is 0
ppb for MCL and 15 ppb for MCLG2. A health risk assessment for these analytical results is
being requested. Someone from our office will resample the well and your kitchen tap for lead
in the near future. You will be contacted to arrange a convenient time to sample.
01619
If you should have any questions, please do not hesitate to call me at 828-251-6208, ext.
Sincer ,
G. Landon Davidson, RG.
Groundwater Section Regional Supervisor
Attached: analytical results for August and September sampling
Cc: ARO file
GW Central Office UIC Group (w/o acts.)
1 Maximum Contaminant Level (MCL) - The highest level of a contaminant that is allowed in drinking water. MCLs are set as close
to MCLGs as feasible using the best available treatment technology and taking cost into consideration. MCLs are enforceable
standards.
Z Maximum Contaminant Level Goal (MCLG) - The level of a contaminant in drinking water below which there is no known or
expected risk to health. MCLGs allow for a margin of safety and are non -enforceable public health goals.
Groundwater Section, 59 Woodfin Place Asheville, N.C. 28801-2414 Telephone: [phone]B Customer Service
Fax: 828Q51-6452 1-800-823-7748

WIOI 0002 - Johnson resampling
Subject: WI010002 - Johnson resampling
Date: Fri, l8 Oct 2002 11:36:41 -0400
From: Landon Davidson <T [e-mail]>
Organization: NC DENR - Asheville Regional Office
To: MARK AR1TZL <MARK.PRITZLgncmail,net>
CC: Landon Davidson <Landon.Davidson a[@nc=il.net>
Mark -
Please refer to the Lab database for the results of the resampling for
the subjet permit. The assigned lab numbers are 2GI431 and 2G1432. AS
you may recall, this was for resampling of metals only. Thanks.
Landon
Landon Davidson - [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Groundwater Section
59 Woodfin Place
Asheville, NC 28801
Tel: [phone]
Fax: [phone]

Re: WI010002 -Johnson resampling
Subject: Re: WIOI0002 -Johnson reswnpling
Date: Fri, 18 Oct 2002 16:17:36 -0400
From: Landon Davidson <[e-mail]1>
Organization: NC DENR - Asheville Regional Office
To: Mark Pritzl [e-mail]
Mark -
I guess z misunderstood our discussion. If the metals of concern are
below 2L for HJEFF (post -system and pre -injection) and HJINF (water
supply well or influent) is below 2L with exception of lead, then the
permit Gould be renewed and the RO deal with the lead issue in the
water
supply well sample? We'll resample cause I don't think the lead is
really in the water. Copper ramped up also in this last sampling event
where the lead was high which makes me leary of the wellhead faucet.
We'll resample in the guys house spigot and again at the water supply
wellhead as part of our RO lead investigation but not related to the
permit. You'll be copied on all. Thanks.
Landon
Landon Davidson - [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Groundwater Section
59 Woodfin Place
Asheville, NC 28801.
Tel: [phone]
Fax: [phone]

Re: UIC WI0100002
Subject: Re: U1C WIOI00002
Date: Fri, 05 Sep 2002 15:17:13 -04GO
From: Landon Davidson <Landon.Davidson@u ncmail.net>
Organization: NC DENR - Asheville Regional Office
To: Mark Pritzl <[e-mail]>
Thanks Mark, we'll do. Had a Zook at the results, I think the lead is
from the piping faucet on the water supply well (only in HJIFF). The
Ni
and Fe are another story perhaps. We'll sample it next week. Thanks
L
Mark Pritzl wrote:
Landon,
Per our phone conversation, please resample Harold Johnson's influent
and
effluent for metals only. You may want to talk to Mr. Johnson and
ask him
>how his geothermal system is connected with the indoor plumbing.
Does he
shave copper piping connected to his geothermal system? Believe it or
not
the state does allow a small percentage of lead in the solder to
connect
> copper piping.
> THANKS and have a good weekend, Landon!
Landon Davidson wrote:
»Hi Mark-
» The analytical results are in for the subject permit renewal. The
lab
»numbers are .2G1.267 and 2G1271. All look ok with a cursory glance.
Let me
»know if you need anything else.
»Landon
» Landon Davidson - [e-mail]
»North Carolina Dept. of Environment and Natural Resources
»Asheville Regional Office
»Division of Water Quality - Groundwater Section
»59 Woodfin Place

Re: UIC W10100002
Subject: Re: UIC WI0100002
Date: Fri, bG Sep 2002 14:43:50 -0400
From: Mario Pritzl <Mark.PriW r�i7ncmail.net>
Organization: Groundwater Section
To: Landon Davidson <[e-mail]>
CC: even kane <evan.kane a1 cmail.net>, debra watts <debra.wattg4,,ncmai1.net>
Landon,
Per our phone conversation, please resample Harold Johnson's influent
and
effluent for metals only. You may want to talk to Mr. Johnson and
ask him
how his geothermal system is connected with the indoor plumbing. Does
he
have copper piping connected to his geothermal system? Believe it or
not
the state does allow a small percentage of lead in the solder to
connect
copper piping.
THANKS and have a good weekend, Landon!
Landon Davidson wrote:
> Hi Mark -
> The analytical results are in for the subject permit renewal. The
lab
> numbers are 2G2267 and 2G1271. All look ok with a cursory glance.
Let me
> know if you need anything else.
> Landon
> Landon Davidson - [e-mail]
> North Carolina Dept. of Environment and Natural Resources
> Asheville Regional Office
> Division of Water Quality - Groundwater Section
> 59 Woodfin Place
> Asheville, NC 28801
a Tel: [phone]
> Fax: 828-25I-6452
Mark Pritzl <Mark.Pritzlram=ail.net>
LUC Program
Groundwater Section

coui\,ft :
QUAD NO:
REPORT TO
COT.T.RCTc1R(s)
DAM
1IMli
PURPOSE:
DIVISION OF WATER QUALM
Chemistry Laboratory Report/ Ground Water Quality
11ENDEPSON SAMPLE PRICArTt•
Fx—lROU TLNli EMERGENCY
ARO Regional OfFiLe CHAIN OP CUSTODY
E r
x DECHANT HJEFF
2my El SAMP[.F:TYPFi �J �� well
LABORATORY ANALYSIS
BOU 310 m L
COD Hi� h 340 m • / L
COD Law 335 m */L
Ccliform: MY Fecal 31616 /100m1
Caliform: NTF Total 31504 /100mt
TC]C m i
Turbitil v N TU
Residu" SusS Lended 530 m / L
ToSakSu5 pendedsolids mg/L
I'll units
Alkiiiniis to +H4.5 m•/L
Allen UWk to 1,118.5 m /L
Carbonate m /L
Bicarbonate m • t
Carbon dioxide m /L
Chloride m • L
Chmmium:Flex1032 u /L
Calor- True 80 C-u.
Ci anide 720 m v / L
COMMENTS: 'METALS PRESERVED W rrH
Lab Number _
2G1431
Date Received
9 lvw
Time Received -
9:DD AM
kUL•cived By
IG
Released By :
AR
Date reportM :
1W10/f12
Owner. H1DHN_SON � L
I.ncation or Site:
Deseriprlon of sampling point
Sampling Medwd:
F.eatarks:
Dim. Salida 70300 my /l.
Fluoride 951 m / L
Hardness. total900 mKIL
Hardness: in on-carbi 902 m / L
Phenols52730 u L
S •ecific Cond. 95 uMhos/rm2
Sulfate m • L
Sulfide 743 m •/ L
M&ks m • L
OU And Grease n+ • L
Siik-A m L
13oron
Formaldeh�de m L
NM asN610 m L
TKN as N 625 TjjL.
NO2 +R O3 as a 630 rn L
P: Total as P 665 rn /L
PCY1 rn • L
A •-$ilver46566
1q, C
X
AI -Aluminum 46557
50U
u i.
As -Arsenic 46551
u / L
Ba-Barlum 465513
u • L
X
Ca -Calcium 46552
3.6
m 1.
Cd—Qidium 46559
u L
X
I Cr-Chromium 46560
25U
u •/l.
X
Cu- Co q •er 1042
66
u ./ L
X
Fe- Iron 1045
56 U
u / L
11 •- Mercun 71900
u 1 L
X
IC -Potassium 46555
1.3
mg/ L
X
idl-Ma•nesium927
0.75
m L
X
Mn-ME u Anese 1055
IOU
u • L
Na-50dium929
4.4
m•/L
X
Ni-Nickel
IOU
u L
X
PLrl ead 46564
IOU
u /L
IX
Se-sewnium
uti: L
X
Zn_linc 46567
IOU
u L.
O anoehlorine Pesticides
Onrano +hoc ,horus Pc5ticides
Nitroeen Pesticides
I I Acid Herbicides I
Gasoline
2G 1431 xis

COUNTY; HENDERSON
QUAD NO:
REPORTTO : ARO
Regional Office
COLLECI'OR(S) : G DAVIDSON
DAT'k: �13Ldt
TIME:
PURPOSF:
Owner.
Location or Site:
Description of sampling point
Sampling Method -
Remarks:
LABORATORY ANALYSIS
DOD310
m• L
COD Hi h 340
m /L
COD Low 335
m L
Colifo= MF Fecal31616
/100m1
Coliform: MF'rota131504
1100ml
TOC
m • 1
Turbititt
NTU
Residue.. Sus +ended 530
m •/ L
Total Sus -en ded solids
m •/L
5.4
units
_1114
Alka[inii% to pH4.5
11
m /L
Alkalinitti to pHS3
1 U
m4jL.
X
Carbonate
I U
m L
x
Bicarbonate
11
m L
Carbon dioxide
m • L
X
Chloride
4
m L
Chromium: Hex 1032
u /L
Color. True 80
C.u.
Ct a-ide 720
m / L
COMMENTS
DIVISION OF WATER QIJALr Y
Chemistry Laboratory Report/Ground Water Quality
SAMP1Y. PRTOR[TY
K]ROl77INEEMERGENCY
CHAIN GF CUSTO➢Y+�j
FIJEFF J 1
W❑ SAMPLE'rYPE (..w 1
IjJDF4NS PQ
Dis8.5olids70300 48 m •/L
Fluoride 951 m •/L
Hardness: to tat 900 MF11.
Hardness: i non-carb 1902 m •/L
Phenols 32730 uLl L
r, +ecif is Cond. 95 u m hos/cm2
Sulfate m • L
Sulfide 745 m L
[WAS m / L
Oil and Grease my,/ L
Silica m /L
Boron
Form a Idehr de mr / L
NH3 as N 610 m L
114N as N 625 m • L
x
NO2 +NO3 as n 6M 3.1 MgZL
P: Total as P 665 m L
PO4 m L
,7 L (�.r —re rift t
300")L_
A $lver 46566
u L
X
AI -Aluminum 46557
5OU
u /L
As -Arsenic 46551
u /1.
lia-8ariuin 46558
u /L
X
Ca -Calcium 46552
3.7
m • L
Cd-Cadium 46559
u / L
X
Cr-Chromium 46560
25U
u /L
X
Cu- Cor per 1042
77
u L
X
Fe- Tron 1043
960 u L
114-Mercur+71900
u /L
X
K-potdssium 46555
1.5
m /L
X
M • Ma nesium 927
0.79
m L
X
Mn-Man anese 1055
IOU
u I.
X
Na-Sodium 929
5.9
m L
X
Ni-Nickel
12
u •/L
X
Pb-Uad 46564
IOU
u L
SeSelenitlm
u /L
7i
Zn_Zinc 46567
IOU
u L
Lab Number :
2GI271
Date Received :
05/02
Time Received _
9:30 AM
Received By
VS
Released By :
AR
Date reported:
W3"2
ON anoddorine Pesticides
❑ ,uno +hos +hares Pesticides
Nitro en Pesticides
Arid Herbicides
Semivolatiles
TPI [-Diesel Range
Volatge Orv, n cs (VOA be KIP.)
KIINFArm

COUNTY
QUAD NO.
HENDERSON
REPORT TO : ARO
COLLECrOR(S) : X 1)ECHA1Vr
RATE 2alV2
TIME:
PURPOSE.
I W.r101(AIN 1101 rNkING1 W&M
Regional Office
OOD310 m• L
COO Hi h 340 m /L
COL} Low 335 m /L
Colifarm; MF Fecal 31616 /IOOmI
Coiifonn: MY Total31304 140ml
DDC m • 1
Turbitiri NTU
Residue, Sus ended 530 m L
fotat Sasrended solids m •/L.
FF units
AikelinfiF to pH 43 m L
Alkalinir, to r H 8.3 mp L
Carbonate sop L
Bicarbonate m L
Carbon dioxide mylL
cmoride MKIL
Chromium: Hex 1932 u • L
Color, True 8o c.n.
Cyanide 720 m , L
COMMPNTS - 'METAIS PRESERVED WTII-I HNO3
Owner.
Location or Site:
Description of sampling point
Sampling Method:
Remarks:
DIVISION OF WATER QUALM
Chemistry Laboratory Report/ Cauund Water Quality
SAMPLE PRR)RrLY
]ROLTTENEEMERGENCY
CHAIN OF CUSTODY
❑ [H�1Nd ���lye I� � {
W SAMPLETYPE
H_jOHN50N dr��.'t
_ t
❑iss. Solids 70300 m •• / L
Fluoride 951 m L
Hardness total 90D m L
Hardness: I non-carbt 902 m /L
Phenols 32730 u L
5 +ecific Cond. 95 umhos/rm2
Sulfate me,/L.
5ulf ide 745 mg/L.
V18A5 int/L
Oil and Grease m L
Silica m L
Boron
Formaldehyde int/L.
Ni13asN610 m L
TKNI as N 625 ru/L
NO2 +NO3 as a 630 m L
P: Tab a6 P 665 m L
PO4 m • L
Ai, -Silver 46566
u L
X
Al -Aluminum 46557
5CU
UOL
As -A rsenic 4 6551
uv L
Ba-Barium 465M
u L
X
C;I 'Alcium 46552
3.5
mg• L
Cd-Cadiurn 46554
U411.
X
Cr-Chromium 46560
25U
u / L
X
Cu-Co-er1042
66
u L
71
Pe- Iron 1045
83 u 1,
ll-Metcar%71900
u /L
X
K-Potassium 46555
1.3
mjj L
](
4f - Ma nrsium 927
0,73
m • L
X
UIn-Matr•atstse1055
ICU
u�,,/L
*
Na-Sodium 929
4.2
m L
X
Ni-NicW
IOU
u • L
X
Pb-Lead 46564
56
us•/L
Se -Selenium
u /L
X
2n_Zinc46567
23
u /i.
LahNumber
2GI432
Dab! Recv!Jved :
9/13/l17
Time Received :
9:00 AM
Received By
jG
Released By : AR
Dale reported : 1wR11/{19.
Or •annrhlorine Pesticides
Or ano •hos •horas Pesticides
Nitro,, an Pestic ides
I I Acid Herbicides I
IVOA
2GI432 XI5

COUNTY - HENDEILSON
QUAD NO:
REPORTTO ; ARO
COLLECTORN : G DAVIDSON
DATE- V13102
ITME.
PURPOSE.
iin IIf] :400r.1:in, n WkiF9
Regional Office
Bpp 310
[lit L
COD Hi h340
m 3.
COD Iow535
m /L
Col i1arm: MFFecal 31616
/200mI
Colif0 m: MF'1'0tal315tY
loom[
TOC
m /]
Turbitav
VT'i1
Residue., Suspended 530
m L
1-otaiSus+endedsolIds
m /L
H
5.8
units
Atka Iinils to -14.5
12
m /L
AlkaIinn % to Ti 8.3
1 U
m r L
X
Carbonate
l U
m r 1.
X
Sirarhonalr
12
m /L
Carbon dioxide
mVIL
X
Chloride:
3
ME/1-
Chromium: Bex 1032
u L
Color. Prue So
c.n•
Cs anide 720
m ./L
COMMENTS
Owner:
Location or Site:
Pe:.crigtion of sampling point
Sam piing Method:
Remarkr.
L MSION OF WATER QUALITY
Chcml5try Laboratory Report/Groundwater Quality
SAMPLE PRI011 Y
EIROLTr E EIPMERGENCY
C1 iATN 0P CUSTODY
fi.l i N F 1C �CGU�C
l SAMPLE 7YPE
� 1a�
IFUCHNSON' 1.ti.1k
X
Diss.Solids 70300 42 rrm /L
Fluoride951 m /L
Hardness: total900 m /L
Hardness: lnon-r•atb! 902 m •/L
Phenols 32730 u L
S I recific cond. 95 u+nhos/cm2
Sulfate m II.
Sulfidc 745 to •/L
MBAS m +/ L
Oil and Greasy m / i.
Silica m /L
Boron
Formaldehsde m /L
N1-13 as N 610 0.02U m L
=gasN625 m /L
C
NO2+ND3asnfi3n 2.4 mr L
P:TalalasP665 :n /L
PL74 m r 1.
A -Silver 46566
a •/ L
h
Al -Aluminum 46557
50U
u L
As -Arsenic 4655I
u I
Ba-Barium 46558
u •/L
X
Ca-Calciune 46552
3.2
m /L
Cd-Cadium 46559
u r L
*
Cr-Chromium 46560
251i
u /L
X
Cu-Capper 1042
7•8
u L
X
re. Iron 1045
50U
a / L
l i •- Mernu rs 71900
u r/L
X
K 1 00 56iu m 46555
1.3
m /L
X
Ni -Magnesium 927
0.65
m L
X
mn-Man •anese 11755
IOU
u L
X
Na- Sodium 929
47
m L
X
Ni-Nickel
IOU
u /i.
X
Pi -Lead 46564
14
u /L
Se -Se le+ulr m
u ' / L
X
7.n 7im-46367
IMJ
nr/l.
Lab NUaltlef
2G1267
Date Received
V15/02
'rime Rcccivcd
9:30 A
Received By
US
R?leasnl By
AR
Date mparted!
kr"2 '
Oryanochtorme re5ticide5
OrKano rhos hums Pesliride.c
NilraNen Pesticides
I I Add HerHride% I
I IVolaWe Ori;,inits iVOA hottlel I
TP7l-Gasoline R,rn�e
TTH-BTFXGasoline Ranee I
2G . 2157 XIS

UIC W10I00()U2
Subject: UIC WI0IO0002
Date: Thu, 05 Sep 2002 16:18:23 -0400
From: Landoll Davidson <Landon,Davidson�w,ncmail.ner7
Organitiation: NC DENR - Asheville Regional Office
To: MARK PRITZL <MAR .PRlTZL@ ncmail.net>
Hi Mark -
The analytical results are in for the subject permit renewal. The lab
numbers are 2G1267 and 2G1271. All look ok with a cursory glance. Let
me
know if you need anything else.
Landon
Landon Davidson - [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional office
Division of Water Quality - Groundwater Section
59 Woodfin Place
Asheville, NC 28801
Tel: [phone]
Fax: [phone]

�F %N A q Michael F. Easley
Governor
U73�L
William G. Ross, Jr., Secretary
]_ Forth Carolina Department of Environment and Natural Resources
Ca `K Alan W. Klimek, P.E., Director
Division of Water Quality
Asheville Reglonal Office
To: Mark Pritzl, UIC Group, Central Office
Date: August 14, 2002
From; G. Landon Davidson, AI(0±�)
Re.- WI0100002 — Harold Johnson, Henderson County
Attached you will find the completed facility inspection report. (form B) for renewal of the
subject permit. I've also attached GW-i forms for the wells associated with the subject
permit. Samples were collected on August 13, zoo2 and submitted to the lab on the morning
of August 14, 2002- IT email you with the assigned lab numbers for the samples upon my
receipt. Digital photos are available for the site and wells upon request. No violations were
noted with inspection of the geothermal injection system, Please call if you have questions.
r
�A
F, L F "
Groundwater Section, 59 Woodfin Place Asheville, N.C. 2a801-2414 Telephone: [phone] Customer Service
Fax: [phone]�452 1-800-623-7748

QUEC710Nt- CaXrY INSPECTION REPORT -FORM - 'CONTMNUED)
WELL CONSTRUCTION
Date constraeted -7 r 93
Drilling contractor: Name
C Pt '�-�•�'• � t- �
Address �
r
7 � L c i C Z� 1—---C et, 1-4-
_
Certification number
Z r LV C]
Total depth of well y`t �
Total depth of source well 27-5-
(f applicable)
Inspection point Measurement Meets minimum standards Comments
Yes Na
Casing
Depth
S '`--
Diameter
Height (A-L.S.)
Grout
Depth
2�
Screens
Depth(s)
Lengths)--
I.D. Plate
Static water level
�►��—
Well yield
ar
Enclosure
Enclosure floor
(concrete)
Sampling port
(labeled)
Water tight pipe entry
Well enclosure entry
Vent
�-
Functioning of heat pump system (Determine from the owner if heat pump functions properly.)
I q o (Ni QOdTqep Pia i, k-z r^S
CNSPECTOR 11 ii C1 �`�` s� Office �1
WITNESS Address
WITNESS Address
Ver.3101 GWIMC-2

North Carol; Department of Environment and N ral Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. DATE OEr • 14 - 0 2-
NAME OF OWNER
��t2-o
J a�4�SocJ
ADDRESS OF OWNERt-t5VT-
rr�-NC) 56NVI�u C. Z 8-+3
(Streetl road or rot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source wells), if applicable)
C2- AooAFs-i A-1oLcZ 9LAg- a-P 4-pT
(Street/ road or lot and subdivision , county, town, if dierent than owner's address, plus description of location on site)
Potential pollution source
Potential pollution source
Potential pollution source
Distance from well
Distance from well
Distance from well
Minimum distance of well from property boundary 2- 2- r ---�
Quality of drainage at site FIooding potential of site
(good adegaate, poor) (high,moderate, low)
GPS Data:
Latitude: r4 Longitude:
O '.
2-2.5Z�03(0 3 L--3
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, a
north arrow.)
,a.
1 zl U
-Tr 6)1Ct) UcZt
DESCRIBE INJECTION SYSTEM (vertical closed loop, encased borehole or cased water well; separate source well and
injection well; combination source and injection well; or other description as applicable)
Ver.3101 GWILHC-2

Name
Dato
lnitiais
Type of permit
Mark Pritzl
o.:
►��'
Evan Kane
❑eE7ra WattsA
a z z ,;
�U

Vo
ot
ki!��Ar -tA
I
l/.
00"

:I., fib ��+lr+! 1f�• • �.��� �', { � � � r• 1� `� � _ ' = � -
■ . „.:' it 'r' tip, �'`� '■, '�.� '� � �}`: *`
pr
•�• ��•, I `� ►/III r � T F�' �'�� � .•I � • N
r Y
rl'. .•'M r S I .�
1p
40
Nv
lip
• ' '' ' •• • + _ t � l�~'-' � ��� y,. • � Ili � '. � � ' ,
.. . 1. �i� '' r � � �. �L�:rt -•1 . ' - • y • ' _� 'r� , ,
'� • a' 4R• 3 '� i � l j ■1Q' �T�ir 11• �. �r.��
.+1
tip► +�Ir• i.'. � � .. •�' '•1 a. 7
t r
•F'

WTt]i00002 - Johnson
Subject: IW10100002-,lohnson
Date. Wed. 31 Jul 2002 08i 19:17 -0400
From: Landon Davidson<L.andon.DavidsonCa•',ncn-iail.net=
Organization: NC DEI%JR - Asheville Regional Office
To: MARK PRITZL <NtARK.PRi'T'[e-mail]>
The subject permit renewal will be late. We'll try for an inspection
next week. Call if questions.
Landon
Landon Davidson - [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of water Quality - Groundwater Section
59 Woodfin Place
Asheville, NC 28801
Tel: [phone]
Fax: [phone]
Landon Davidson <Landon.Davidson.,i iicmail.aet>
NC DENR - Ashe+�ille Regional Office _..�
Division of Water Quality - Groundwater Section

DiviSION OF WATER QUALITY
GROUNDWATER SECTION
July 11, 2002
IT i_���iiZi7►► I
To: Landon Davidson, L.G., Regional Groundwater Supervisor
Groundwater Section
Asheville Regional Office
From: Mark Pritzl M-� • Mark. Pritzl@ncmail, net
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office (CO)
Re: Permit renewal # WIOI00002 under Herold E. Johnson; request for inspection and
routine sampling of Mr. Johnson's geothermal injection well system. This system is
located at 115 Kindy Forest Drive, Hendersonville, NC 28739,
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your LTIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title I SA 2C .0200 standards are being complied
with, using the enclosed Injection Facility Inspection Report (farm B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-u1C.
You are requested to return the completed Injection Facility Inspection Report (form B) to the
CO-LTIC by July 31, 2002. If the inspection can not be accomplished by this date, please
inform the CO-LTIC. The LTIC group greatly appreciates Asheville Regional Office's
assistance with this review. If you have any questions regarding this review or the UIC
program, please contact me at [phone].
cc; CO-UTC Files
Enclosures

F wq]'E Michael F. Easley, Governor
_� 0 �G William G. Rods Jr., Secretary
Q
North Carolina L,epartment of ,Environment and Natural Resources
f Alan W. Klimek, P,E. director
-4 division of Water Quality
July 10, 2002
Mar. Harald Johnson
115 Kindy ?orest Drive
Hendersonville, NC 28739
Dear Mr. Johnson;
Your application for renewal of a permit to use a well for the injection of geothermal
heat pump effluent has been received and is under review. The Groundwater Section
appreciates your timely response to our written inquiry about the status of your geothermal heat
pump system. A member of the Groundwater Section's Asheville Regional Office staff will be
contacting you to arrange an inspection of the injection well and collect water samples as part of
the review.
If you have any questions regarding permit or injection well rules please contact Mark
Pritzl at [phone].
cc: CO-LTIC Files
ARO-UIC Files
QIM
NnEw
Customer Service
1 800 623-7748
Sincerely,
Evan ❑. Kane
LTIC Program Manager
Division of Water quality 1 Groundwater Section
1636 Mail Service Center Raleigh, NC 27689-1636
Phone: [phone] Fax: [phone] Internet: hhp:/fgw.ehnr.state.nc.us

NORTH CAROLINA
,t DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH
A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 15A: 02C.0200
complete application and mail to address on the back page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE:
A. SYSTEM CLASSIFICATION: Does the system re -circulate, only potable water without any additives such as
corrosion inhibitors or antifreezes in continuous piping which isolate-s the Fluid front the environment?
YES _ If yes, do not complete this form. A form GW-57 CL, (Notifrcatio❑ Of Intent To Construct A_
Closed -Loop Geothermal -Water -Only Injection Well System), should be completed.
r•a
NO If no, then continue completing this form.
B. PERMIT APPLICANT
Name: Q G - �,, 4 `�Q•
Address:
F
City: -) J, ,f [-�4��J� ILA State: Zip code: �t "
County: lu'el, Telephone: `~ � � 4967
C. PROPERTY OWNER (if different from applicant)
Name:
Address: , J 2<7
City: ' State: Zip code:
C--="3': Telephone
D. STATUS OF APPLICANT
Private: X Federal: Commercial: State: Public:
Native American Lands:
E. FACILITY (SITE) DATA (Fill out ONLY if the Status of Owner is Federal, State, Public or Commercial).
Name of Business or Facility:
Address:
City: State: Zip code;
County: Telephone: Contact Person:
Standard Industrial Code(s) which describe commercial facility:
ver.310i
GWIUiC-57 HPR
Page I of 3

F. INJECTION PROCEDURE (specify any modifications m the injection procedure since the issuance of the
previous injection permit)
G. WELL USE is(are) the injection well(s) also used as the supply well(s) for either of the following?
(1) The injection operation? YES_,2( NO
(2) Your personal consumption? YES NO X
H. CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
f
(2) NC. State Regulations (15A NCAC, 2C, Section ,0200) require the permittee to make provisions for
monitoring well head processes. A faucet an both influent (groundwater entering heat pump) and
effluent (water being injected into the well) lines is required Is there a faucet on:
(a) the influent line? yes )'c- no
(b) on the effluent line? yes k no
1. CURRENT OPERATING DATA
(1) Injection rate: Average (daily) Jv gallons per minute (gpm)
(2) Injection volume: Average (daily).2 gallons per day (gpd)
(3) Injection pressure: Average (daily) 4 pounds per square inch (psi) --5 �1
(4) Injection temperature: Annual Average degrees Fahrenheit (° F) 0or
I. INJECTION -RELATED EQUIPMENT
Attach r- diagram sowing :s-y modifications to injectinn equipment t since the issuance of the previous �injecuon
perrnit including the engineering layout of the (1) injection equipment, and (2) exterior pipingltubing associated
with the injection operation.. The manufacturer's brochure, if detailed, should satisfy (1). p &X
K. LOCATION OF WELL(S) Attach a map
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
ground -source heat pump well system; include buildings, property lines, surface water bodies, any other potential
sources of groundwater contamination. Label all features clearly and include a north arrow to indicate
orientation. 1
4 trocin-Y
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
ver.3l01 GWIUIC-57 HPR Page 2 of 3

M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment, fluid, operation, etc.) that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere ou this application.
iJ /Z
N. CERTIFICATION
"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 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."
7
(Signatur rf Cval Owner or Authorized Agent)
r
If authorized agent is acting on behalf of the well owner.
please supply a letter signed by the owner
authorizing the above agent.
❑. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the
well(s). A well is real property and its construction on land rests ownership in the land owner in the absence of
contrary agreement in writing.)
If the property is owned by sorneone other than the applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s) as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC
Subchapter 2C .0200)
(Signature of Property Owner if Different From Applicant)
Please return the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
('Telephone: [phone])
ver.3101 GWIUIC-57 HPR Page 3 of 3

a
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I NORTH CAROLINA i
DEPARTMENT OF ENVIRONMENT AND NATURAL ,RESOURCES
DIVISION OF WATER QUALITY, GROUNDWATER SECTION
STATUS OF INJECTION WELL SYSTEM
Date: %J;Iy 672— Permit Number: — 49wy _LVl_ doQ4 i
Name: el
Address: ' ( N t/2"
Please check the selection which most closely describes the current status of your injection well.
In addition, please provide the requested information.
1' C Well is still used for injection activities.
2) Well is used for water supply.
3) _ h-Oction discontinued;
a) _ Well temporarsly abandoned b) ____ Well permanently abandoned
Describe the method used to properly abandon the injection well. (Include a description of how the well
was sealed and the type of material used to trll the well if permanently abandoned): If you checked two
(2), report the pumping rate and what the water is used for.
Certification: (For well abandonment)
"I hereby certify, Under penaIbj of law, that I am personally responsible forthe proper abandonment
of any injection weil as required in Title 15A Nu,;C 2C .Ot14 C, itena and S'Lan dnrds AppIi...able to !njectinn
Wells."
(Signature)
Certification. (For information verification)
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document, and that to the best of my Knowledge the information is true,
accurate, and complete," 7
(Signature)
c�
ver.3101 GWIUIC-68

F yYq TF Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
U7 Alan W. Klimek, P.E. Diredor
-� ❑ivision of Water Quality
❑ `C
July 2, 2002
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
Dear Mr. Johnson:
Our records show that the operating permit for the injection well on your property did expire on June
30, 2002. In addition, our records do not indicate that the well has been abandoned.
In order to comply with the regulatory requirements far permitted injection facilities (15A NCAC 2C
.0211), you must submit either 1) the enclosed Application for permit Renewal to Use a Well(s)for
Injection with a Heat pump System (form GW-57 HPR) if you are still using your injection well or
2) the enclosed Status oflnjection Well System: (form GW-6$) that certifies that the injection well is
no longer in use.
If the well is no longer to be used for any purpose, it must be permanently abandoned according to
the regulatory requirements (15A NCAC 2C .0213), and you must submit the enclosed Well
Abandonment Record (form GW-30). The appropriate form(s) should be forwarded to us by July 31,
2002 to allow adequate time for well water sampling and analysis.
If you have any questions regarding the permit and injection well rules or would like assistance
completing these forms please contact Mark Pritzl at [phone] or Evan Kane at (919) 715-
6165.
CC. CO-LTIC Files
Enclosures
MINK
Customer Service
1 800 623-7748
Sincerely,
D4era Watts
Permits & Compliance Supervisor
Division of Water Quality 1 Groundwater Section
1636 Mail Service Center Raleigh, NC 27699.1636
Phone: [phone] Fax: [phone] Internet: http:#gw.ehnr.state.nc.us

PERMIT APPROVAL REQUEST
Please initial and
return to Marcus
for processing.
Ted Bush Lo
Bob Cheek
Marcus Geist ,�

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality �►
James B. Hunt, Jr., Governor
Jonathan S. Howes, Secretary
A. Preston Howard, Jr., P.E., Director 1:)EHHNF;Z
July 2, 1997
Mr. Harold E. Johnson
115 Kinda Forest Drive
Hendersonville, NC 28739
Dear Mr. Johnson:
In accordance with your renewal application_ dated April 9, 1997,
we are forwarding Permit No. WI0100002 for the operation of a
geothermal heat pump injection well at 115 Kinda Forest Drive, in
Hendersonville, NC, in Henderson County. A copy of the
laboratory test results of water samples collected on April 28,
1997 is also enclosed.
This permit shall be effective from the date of issuance until
June 30, 2002, and shall be subject to the conditions and
limitations stated therein_, including the requirement to notify
this office by telephone 48 hours prior to initiation of
operation of the facility.
In order to continue uninterrupted legal use of this well for the
stated purpose, you should submit an application to renew the
permit three months prior to its expiration date.
If you have any questions regarding your permit please feel free
to contact me at (919) 715 - 6166.
Sincerely,
Marcus A. Geist
Underground Injection Control Program
cc: UIC Files
ARo Files
Enclosures
Groundwater Section��y� Voice 919-733-3221 FAX 919-71&0588
P.O. Box 29578, Raleigh, North Carolina 27526-Q578 An Equcd Gpportunity/AffirmdWe Action EnIplayer
N2728 Capitol Blvd.. Raleigh, North Carolina 27604 5C% recycles110% post -consumer paper

PART I — GENERAL CGNDITI❑NS
1. The Permittee must comply with all conditions of this permit
and with the standards and criteria specified in Criteria and
Standards Applicable to Injection Wells (15A NCAC 2C .O200)'.
Any noncompliance with conditions of this permit constitutes
a violation of the North Carolina Well Construction Act and
is grounds for enforcement action as provided for in N.C-G.S.
67-94.
2. This permit is effective only with respect to the nature,
volume of materials and rate of injection, as described in
the application and other supporting data.
3. This permit is not transferable without prior notice to, and
approval by, the ❑irector of the ❑ivision of Water Quality
(Director). In the event there is a desire for the facility
to change ownership, or there is a name change of the
Permittee, a formal permit amendment request must be
submitted to the ❑irector, including any supporting materials
as may be appropriate, at least 30 days prior to the date of
the change.
4. The issuance of this permit shall not relieve the Permittee
of the responsibility of complying with any and all statutes,
rules, regulations, or ordinances which may be imposed by
other local, state, and federal agencies which have
jurisdiction. Furthermore, the issuance of this permit does
not imply that all regulatory requirements have been met.
1. The injection facility shall be effectively maintained and
operated at all times so that there is no contamination of
groundwaters which will render them unsatisfactory for normal
use. In the event that the facility fails to perform
satisfactorily, including the creation of nuisance conditions
or failure of the injection zone to adequately assimilate the
injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the
Division of Water Quality (Division) such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and
conditions of this permit even if compliance requires a
reduction or elimination of the permitted activity.
Permit No. WIOI00002 PAGE 2 OF 5

(B) The entire depth of each well shall be
sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing
operations.
(C) Each well shall be thoroughly disinfected, prior
to sealing, if the Director determines that
failure to do so could lead to the contamination
of an underground source of drinking water.
(D) Each well shall be completely filled with cement
grout, which shall be introduced into the well
through a pipe which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel --packed wells in which the
casing and screens have not been removed, the
casing shall be perforated opposite the gravel
pack, at intervals not exceeding 10 feet, and
grout injected through the perforations.
(F) in those cases when, as a result of the injection
operations, a subsurface cavity has been created,
each well shall be abandoned in such a manner that
will prevent the movement of fluids into or
between underground sources of drinking water and
in accordance with the terms and conditions of the
permit.
(G) The Permittee shall submit a Well Abandonment
Record (Form GW-30) as specified in 15A NCAC 2C
.0213(h)(1) within 30 days of completion ❑f
abandonment.
3. The written documentation required in Part `III (1) and (2)
(G) shall be submitted to:
Groundwater Section - UIC Staff
DEHNR - Division of Water Quality
P.D. Box 29578
Raleigh, N.C. 27626-0578
'PART VIII - SPECIAL CONDITIONS
NONE
Permit No. WI0100002 PAGE 5 OF 5

NORTH CAROUNA DEPARTWNr OF NATUFaAt. REeO1JRCE3 AND COMMUNITY DEVELOPMEWi FOR OFFICE USE ONLY
OMSION OF ENV1RONPAWTAL MANAGO' - GROUNDWATER SECTION
P.Q. BOX 21587 — RALr-jGKKC. 27. „ PHONE (t;i9) 133-6083 Quad. No. 6 Serial No. 300
Lat. 3 °I I Lang, $2 °�7 pc
Minor Basin
WELL CONSTRUCTION RECORD Basin Cade.'
Header Ent. GW—i Ent.
DRILLING CONTRACTORS -
STATE WELL CONSTRUCTION
DIALLER REGISTRATION NUMBER. _ PERMIT NUMBER:
1. WELL LOCATION- (Show sketch of the 10100on, below)
Nearest Town: �� -v�� _ — County: 4y�&
-
Depth DRILLING LOG
(Road, Community, or Suf division and Lot No.)
From To Formation Descrip tson
2. OWNER -
ADDRESS " ./r cam.: �' �1 C/ P
f1 ��.: �r / •�/[L(KL�
f et orAq..ute No.i
G ,
City or Town State Zip Code,.
1
USE WELL.
3. DATE GRILLED O-
.y
4, TOTAL DEPTH } �-CUTTINGS COLLECTED ❑ Yes C! No A't
5. DOES WELL REPLACE EXISTING WEL ,Yes ❑ No
6. STATIC WATER LEVEL: FT. © above TOP OF CASING,
❑ below ■
TOP OF CASING IS FT. ABOVE. LAND SURFACE.
%
7. YIELD (gpm); METHOD OF TEST
8_ WATER ZONES (depth):
9. CHLORINATION: Type Amount
10, CASING: ` Wall Thickness
If additional space is needed use backof form.
Depth Diameter or WeightlFt. Material
'4'1 d Z12
LOCATION SKETCH
From To Ft
(Show direction and distance from at least twoSlateRoads,
From To Ft,
❑r other map reference points) •'
From To Ft.
11. GROUT:
Depth Material thod
From zl� To 2--' Ft. -
From Te F•.•
Q. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. In.
From To Ft. it in.
t3. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
4. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS.,%zUCT,L-.•D.I CCORDANCE• WITH 15 NCAC 2C, WELL CONSTRtlCTiON
STANDARDS, AND THAT A COPY OF THIS RECOI40 J;i" HEEN'Pf30VI E.D CO THJ, ArEl.t;'OWNER.
F SIGNATURE OF CONTRACTOR OR AGENT ...DATE_
3W-1 Revised 11184 Submit original to Division of Environmental Management and copy to well owner.
W w-Y'nwV'd V•-�d�

NORTH CAROLMA'DEPARTM NT OF NATURALtdsr -CES AND COMMUNITY DEVELOPMENT.
DIVISION OF SAL ~GEMS - GROUNDWATER SECTION, --
P.O. BOX 27497 - RALMGRN.C.27E11, PHONE [phone]e3
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR I Z
DRILLER REGISTRATION NUMBER
1_ WELL' LOCATION: C5 w s�hoftlhe]Mr- below]
Nearest Town.
i
CRoad, Community.; or SuVdlvision and Lot No'.)
2: OWNER • - r �y
.ADDRESS. � r =
C§xe-et..or oye
Clt OVrown State - Zip Code:
3. DATE DRILLED 7 USE OF WELL.
❑ 4• TOTAL DEPTH !--� -- _� CUTTINGS COLLECTED ❑ Yes No
5. DOES WELL REPLACE EXISTING�ELL? ❑ Yes ❑ No
B. STATIC WATER LEVEL: FT, ❑ above- TOP OF CASING,
❑ below
TOP OF CASING IS FT. ABOVE LAND�SUPFA�CE,
7.'YIELD (gpm): METHOC) OF -TEST
8. WATER ,ZONES: (depth): _ ,J
9. CHLORINATION: Type Amount
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. is
{I� •
From "" Tof: Ft. r L<
From —To —Ft.
From To Ft,
11. GROUT:
Depth
Material eThad
From
To
_
From_To_
Ft,
12. SCREEN:
Depth
Diameter Slot Size Material
From
To
Ft.
in. in.
From
To
Ft.
in. in.
From
To
FL
in. in.
13. GRAVEL PACK:
Depth
Size Material
From
To
Ft_
From
To_
Ft.
14. REMARKS.
r
FOR OFFICE: USE ONLY'
1 �6-
Oued. No. t�5 R +J Sedal No. 3QQq
Lat. Pe
Minor Basin
Basin Cods
Header Ent, GW-1 Ent.
STATE WELL. CONSTRUCTION
PERMIT NUMBER: '
County;
Depth DRILLING LOG
From To Formation Description
If additiohal space is needed use back of form.
Lpr,A—np--gKETCi L
[Show direction and distance from at (east two State Roads,
or ❑th®r map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS �CONSTAUGTE ACCORDANCE WITH •I5 NCAC 2C, WELL CONSTRUCTION
STANDARDS, .AND THAT A COPY OF THIS RECORD-yrY� 7� RO IDO THE WEL 4 O�NER.
��'_ED T.a.7:Jc
rSfdi ATURFOF DN CTOR OR AGENT DATE
GW-1 Revised 11184 Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLIIA OEPARTIAW OF 14ATJRAL REEF -CEO AND COLLA1MW CEVELOPWNT
DWIS 1 OF 04VVIO ME WAL MMINAGEMS GROUNDWATER SECTION
P.O. Box 27e07-RALEIGH.N.C. 27011. PrIONE (otE) rss-floes
�G1;@ WAV9
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR L4le� _
DRILLER REGISTRATION NUMBER ?? _
FOR OFFICE 118E ONLY
Quad. No. �224 h rj Serial Nv4_ 30-6
Lat._357012r!-1'" Long. 2e 6 #Pc
Minor Basin
Basin Cede
}leader Ent. OW-1 Ent -
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: - 15�(�y(�1•LJt.[.«_ County:
(Road. �)6mmunity, or Subdivision and Lot No.]
2. OWNER�Z fir! �]ffoUQ_ -
ADDRESS S�
Street or Route No.:
V. e
City or Town State Zip Cod
3. DATE DRILLED 103 USE OF WELL 14 • 4100
4. TOTAL DEPTH _ 40,1— CUTTINGS COLLECTED ❑ Yes [ o
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes R No
B. STATIC WATER LEVEL: FT. ❑ above TOP OF CASING,
❑ below
TOP OF CASING IS FT. ABOVE LAND SURFACE.
7. YIELD (gpml: - IV14 - _- METHOD OF TEST
8, WATER ZONES [depth]:
9. CHLORINATION: Type tj d&_ Amount
10. CASING:
Wall Thickness
Depth
Dlameter or Weight/Ft. Material
From To ��i� Ft_ !o 4
From To
F t.
From To
Ft.
11. GROUT:
Depth
Material Method
From 0 To 2 D
Ft. _ C ZePtz�at
From To
Ft,
12. SCREEN:
Depth
Diameter slot size Material
From AIM- To
Ft. in. in.
From T❑
Ft. in, in.
From To
Ft. in, in.
13. GRAVEL PACES;
Depth
Size Material
From f� i It To
Ft.
From To
Ft.
14. REMARKS:
Depth DRILLING LOG
From To Formation Description
If additional space is needed use back of form.
LOQ ATIQN_9KETCH t
(Show direction and distance from at least two State Roads, Yk
or other map rqeg,0 pqiQt ] li
ti
��i A
V �
0- OfN� t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 Revised 11/84 Submit original to Division of Environmental Management and copy to well owner.

North Carolina Department of Environment, Health, and Natural Resources
Division of %Uivironmental Management - Grou--vater Section
INJECTION FACILITY INSPECTION REPORT -• FORM B
INJECTION WELL PERMIT NO. -Wt_q � -D�D� CC1� � �t DATE 7 q7
NAME OF OWNER4a r Aly7e9k ;i 6�vY,
ADDRESS OF OWNER
(Street/ road or lot and suddivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable]
.-r . _ 1— _ , l i .i r � r I 1 ! J— s-_ )
(Street/ road or lot and suddivision , county, town, if different than owner's address, plus description of location an site)
Potential pollution sourceDistance from well
Potential pollution source Distance from well
Potential pollution source Distance from well
r
Minimum distance of well from property boundary'
Quality of drainage at site q0d c-�-' Flooding potential of site
(good, adequare. Poor) (high, modera te, low)
DRAW SKETCH OF S ITE (Show property boundaries, bui ldings, we I Is,
scale, and north arrow.)
r L
a 7 po 7 lut ion sources, roads, approximate
�C-VC4 k
-('� J a
oA;A:ic�-.
DESCRIBE INJECTION SYSTEM (rertica 7 closed loop, uncased bore+ o 7e or cased water well; separate source well and
injection we77, cnubination source and injection well; or other description as applicable)
1 •A ♦ • l 1 0 ♦ I 1 - A _. 1 _ .J r i .-.... _ lam_ i r r i_ — _ . r . r ...
raj

INJECTION FACILITY INSPECTION REPORT --FORM B (CONTINUED)
WELL CONSTRUCTION
Date constructed il� {]�I
Drilling contractor: Name L'G_-U(AA'(-
Address
Registration number
Total depth of well Total depth of source well
(if app]ir-able)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth
Diameter v
Height (A.L.S.) -1
Grout
Depth O�
Screens
Depth(s)
Length(s) _
I.D. Plate
Static Water level
Well yield NIA
Enclosure
Enclosure floor
(concreted)
Sampling port
(labelled)
Water tight pipe ..entry
Well enclosure entry
Vent 7
Functioning of heat pump system (Determine from the owner ;f neat pump functions p►nperly.)
INSPECTOR z , __ Office_ Y
WITNESS Address
WITNESS Address
JULY, 1994

CUUNTY HENDERSON
QUAD NO
REPORT10 ARO Regional Office
COLLECTOR(S) 7,UKOTr
DAiF �pl12R747
1 ME:
PURPUSE: {lnref
Localion or Sile
D em ipi, an of sampling pu ill
Sampling Alcilmd-
Remarks.
LA BURNFORYANALYSIS
1100 310 mg7L
COD Nigh 140 snSiL
_
COD Low 335 mgR,
CDIfOFM: Alir F-Ccal 31616 11001111
Coll form, LIT 1 otat 3F504 11001n1
TOC OpW1
_
I m bpti ly i4 I U
T
Rcsidue., Suspended 530 mg1L
IutaFSvspcndcd solids mrg+L
pi I uni is
Aik6lioily 1vp114 5 mglL
Alkalloit)- I pl1 3 3 rnVL
Carbonale mg1L
Bicarbonate mgpL
Cutbon dioxide wglL
Chloride rmgiL
Chromium Ncx 1032 ug/l.
Color True80 c.u.�
CFanid[ 720 me7L
COWAIENT5
DIVISION OF WATER QUALI IT
C lr rm ict ry Ln bu rr$or3 Rtpu rl 14r fin a ►VMer Qn n1i 13.
5A41PL t'RtVRiTV
®RO1171NF L1FAMRGENCY
UFAIN OF CUSTODY
J-1
5V 5ANiPLF I /'I'C
N It01,1131111N50N
Diu Solids 70100 111w1_
fluor ide 951 nrp,IL
Ilaidnrsz inl�f a00 apg7l.
f lap dncss. (nan-sorb) 902 uryl.
plrcools 32730 uel F.
T
Specific cond. 95 oKl1wslcrr12
Sull'ale mg1L
Su}firde 745 nI_SA.
M1I1lAS rngl!_
T
Oil and Grease rm¢iL
Silica rugiL
DOfOn
r•onmaldekyde nrglL
N113 as N W mg7L
7HN as N 4-M moll
NO2 +NU3 as n 630 mg1L
P: l otar as P W me7L
I.ab Nvmbrr
7(�4965
0�1r Retsirrd
N30797
rime Rccci,cd -
4 10 AM
Rccckcd By
10"'
R rllTsrd 11v "S
Dare rrpord 51!0.97
/g-SiRcr SUS(+C ugpL
Op ga no Cl plop ine ITESI pe ItteS
01g1unp14415111 kopu5l'C.Ifri41cs
Nirrngru Vc,00dcs
AI-Ati-iill ton-06557 OWL
As -As scn is 4f 551 11WI,
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R'1' 2 71997
j APR
GROUNDWR SECTION 7Gag55

NORTH CAROL NA
ENVIRONMENTAL .MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAI. RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR
INJECTION WITH A HEAT PUMP SYSTEM
In accordance with the provisions of NCAC Title 15A: 02C.0200
complete application and mail to address on the back gage.
Type 5A7/5QM Wells
TLC DIRECTOR, NC RTH CAROLL iA D S N OF WATER QUALITY
DATE: ! Z r ---�- lg
r
1
PIeas . type or print clearly.
A. SYSTEM CLASSIFICATION Does the system re -circulate only potable water without
any additives such as corrosion inhibitors or antifreezes in continuous piping which
isolates the fluid from the environment?
YES _ if yes, do not complete this form. A form GW-57 CL, (Notification
Of Intent To Construct A Closed -Loop Geothermal -Water -Only
Injection Well System), should be completed_
ND Z" if no, then continue completing this form.
PERIviTT APPLICANT -
_ _ Name- 1 ! " ii-
Address: _ 7
Ctty:
County: '�! r
J fG i •� � � l �iK-`�
yZip code: 2-
Telephone: 7 !�, el' 4'91 �?�
C PROPERTY OWNER (if different from applicant)
Name:
Address:
City- —
Coimty: .
D- STATUS OF APPLICANT
Private: f' Federal:
State: Public:
Zip code:
Telephone:
Commercial:
Native American Lands:
GW-57 HPR (April 1997)
Page 1 of 4

J. iN]EC HON-RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the
issuance of the previous injection permit including the engineering layout of
the (1) injection equipment, and (2) exterior piping/tubing associated with the
injection operation. 'The manufacturer's brochure, if detailed, should satisfy (1).
K. LOCATION OF WELL(S) Attach a map
Include a site map (can be drawn) showing: the orientation of and distances
between the injection well(s) and any existing well(s) or waste disposal facilities
such as septic tanks or drain fields located within 1000 feet of the ground -source
heat pump well system; include buildings, property lines, surface water bodies,
any other potential sources of groundwater contamination. Label all features
clearly and include a north arrow to indicate orientation.
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or
applied for by the applicant that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment, fluid, operation, etc,) that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
N. CERTIECATION
"I hereby certify, under penalty of 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
fines and imprisonment, for submitting false information. I agree to operate,
maintain, repair, and if applicable, abandon the injection well and all related
appurtenances in accordance with the approved specifications and conditions of the
Permi t."
(Signature of Owner or Authorized Agent)
Please supply a letter signed by the owner
authorQing the above agent, if authorized agent is signer.
GW-57 HPR (April 1997) Page 3 of 4

I NORTH CPROLINA
ENVIRONMENTAL INLk-M,GEMENT COMMISSIL
DEPARTMENT OF ENVIRONMENT, =a.LTH, - PT3D NATUR,4L RESOURCES
GROUNDWATER SECTION
Date:
Name.
Address:
STATUS OF INJECTION WELL SYSTEM
_ F e riil t Number: WI
Please check the selection which most closely describes the current status
of your injection well. In addition_, please provide the rGcruested �
information.
1) L� well is still, used for injection activities. -
2) Injection discontinued;
a) well temporarily abandoned. b) Well permanently abandoned
Describe the method used to properly abandon the injection well. Include a
-descriotion cf how the Well was sealed and the type or material used to
ill the well if perzmaz en tly ahandone^ :
Certification: (For well abandonment)
"I hereby certify, under penalty of law, that I am personally
responsible for the proper abandonnne_:t of any injection well as requ-i rad. In
'title 15A NCAC 2C .0214 Criteria and Standards Applicable to Injection
Wells. rr
(Signature)
Certification: (For information verification)
"I hereby cWrtifv, under penalty of law, that I have personally
examined and am familiar with the information submitted in this document,
and that to the best of my knowledge the information is t--1e, accurate, and
complete."
(Signature)
GW - 6 8

TO nsort
ARC)
PFSTAT _Ver
3.3
Copyright
(c) Trimble
Navigation,
Ltd, 1991,
1994. All rights reserved
R041316A.COR
Statistics Version 3.3
Recs
Mean
Std Dev
Minimum Maximum
Latitude
187
35�419'11.48503"N
1.34209
35%19111.40210"N 35%19111.57104"N
Longitude
187
82�J31114.8774011W
1.38898
82%31114.97960"W 82%31114.77906"W
Altitude
187
751.46713
8.63970
724.59406 767.61144
No velocity records in file.
No DOP records in file.
Start GPS Week #796 on 04/13/95 at 16:43:26
End GPS Week #796 on 04/13/95 at 16:49:15
Datum : WCS-84
Coordinate System : Latitude/Longitude
Altitude Mode : Height Above Ellipsoid
Altitude/Distance Units : Meters
Velocity Units : Meters/Second
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Beets lain. Standards
Measure Yes No Remarks
Enclosure
Enclosure floor
CasinF, height
Access port
Valved flow
- Water- tight Ripe entry
Well entry
Vent
Hose bib
'fee fret)
jucticn line
Chlorination
Teryora ry Aband .
Date: Well Constructed
Date Pump Installed
Signature
Witness .
Name Address Type
Name Address Type
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II _
State of North Carolina
Department of Environment, Health, and Natural Resources
Qivisiorr of Environmental Management
512 Nnrth Salisbury Street • Roleiph. North Larohoa 27CA
lamas G. Martin, Governor
William W. C:obey, .}r., Secretary
Mr. Harold Johnson
115 kindy Forest Drive
1l1lic'vtll, :ill. , ., Hendersonville, NC'_ 2R739
�,,irlh
I, Dear Mr. Johnson:
_.. 0--
George T. Everett, Pii-D.
�- Di rcctor
�L
in accordance with your application dated December 14,
1991 we are forwarding herewith Permit No. 44-0209-WO-0001 for
I{Itsl,ll the operation and use of a well for the purpose of injecting
1I+t-�32�t-1 heat pump effluent, in Henderson County.
IN I This Permit shall be effective from the date of issuance
until ,lanuars, 28, 1997 and shall be subject to the conditions
"'J1' and limitations stated therein.
In order to continue uninterrupted legal use of this well
for the stated purpose, you should make application for permit
renewal at least 30 days prior to its expiration date.
Sincerely,
Roy Davis
Regional Supervisor
Attachment
cc: UIC Files
AR❑ Files
?`!i?i T6lcigl+ Minh of Iin.l 7?nh ifsgs 1, L•I,h -w 411 77 '17n1� IO1HmHm Ysr�rnli +n i' t.
A,+ I'we� I 1 Ii„11.41 it, AI I•T•i+.„f'.i .V lii'1+}:'?'I&A,-0

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION NSE OF A WELL OR WELL SYSTEM FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87;
Article 21, Chapter 143, and other applicable Laws, Rules and
Regulations
PERMISSION IS HEREBY GRANTED TO
Mr. Harold Johnson
FOR THE OPERATION AND USE OF AN INJECTION WELL/WELL SYSTEM located
at 115 Kindy Forest Drive, Hendersonville, North Carolina in
Henderson County, in accordance with the application dated
December 14, 1991 and in conformity with the specifications and
supporting data submitted, all of which are filed with the
Department of Environment, Health, and Natural Resources and are
considered a part of this Permit.
This Permit is for Operation and Use only, and does not waive
any provisions of the Water Use Act or any other applicable Laws,
Rules or Regulations. Operation and use of a well or well system
shall be in compliance with Title 15 North Carolina Administrative
Code 2C, and any other Laws, Rules and Regulations pertaining to
well construction and use.
This Permit shall be effective, unless revoked, from the date
of its issuance until Ja-nuary 28,- t997 __ and shall be subject to
the specified conditions and limitations set forth in Parts I and
II hereof.
Permit issued this the 28thday of January 1992.
1
Roy Davis
Regional Supervisor
By Authority of the Environmental Management Commission.
PERMIT NO. 44-0209-WO-0001

PERMIT NO. 44- 0209-WO- 0001
PART
A. GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this Permit and with the
standards and criteria specified in 15 NCAC 2C .0200. Any Permit
noncompliance constitutes a violation of the appropriate Act and is grounds for
enforcement action; for Permit termination, revocation and reissuance or
modification; or for denial of a Permit renewal application.
2. It shall not be a defense for a Permittee in an enforcement action that it would
have been necessary to halt or reduce the permitted activity in order to maintain
compliance with the conditions of this Permit.
3. The Permittee shall take all reasonable steps to minimize or correct any adverse
impact on the environment resulting from noncompliance with this Permit,
4. The Permittee shall give advance notice to the Director of any planned changes in
the permitted facility or activity which may result in noncompliance with the
Pennit.
5. The Permittee shall report all instances of noncompliance, not reported under
condition I. of this Part, at the time monitoring reports are submitted.
G. Where the Permittee becomes aware of a failure to submit any relevant facts in a
permit application, or of any incorrect information submitted in said application
or in any report to the. Director, the relevant and correct facts or information shall
be promptly submitted by the Permittee.
7. The Permittee shall give notice to die Director as soon as possible of any planned
physical alterations or additions to the permitted facility_
8. In the event that the pentnitted facilities fail to perform satisfactorily, the
Permittee shall take such immediate action as may be required by the Director.
9. The injection system shall be effectively maintained and operated at all times so
that there is no contamination of groundwaters, or other actions or occurrences
which renders them unsatisfactory for normal use. In the event the facilities fail
to perform satisfactorily, including the creation of nuisance conditions, the
Pertnittec shall take such immediate corrective action as may be required by the
Director.
10. Department representatives shall have reasonable access for purposes of
inspection, observation and sampling associated with injection and related
facility.
t 1, This Pers»it is not transferable without prior notice to, and approval by, the
Director.
12.. An application for modification, renewal or transfer of this Pen -nit shall he filed
with the Department at least 30 days prier to the expiration date of this Permit.

PERMIT NO. 44-0209-WO-0001
PART I (continued)
13. Provisions shall be made for collecting samples of facility effluent, both prior to
its entrance to treatment devices and subsequent to leaving the treatment devices
but before entering the injection well.
PART II
A. SPECIFIC CONDITIONS

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR
INJECTION
CLASS 5 WELLS
TO: DIRECTOR, NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
DATE. / q 1�4 V 919 N
In accordance with the provisions of Article 7, Chapter, 87; Article 21, Chapter 143, and regulations
pursuant thereto, APPLICATION is hereby made for a PERMIT to construct and/or use a well or well system as
described below and in any accompanying data submitted assaa part of APPLICATION.
A. OWNER DATA; Name: —LIZ,� � G _v G' � d 31 A)
Address-, I ; Ie ► ►s oy-
City: /'t -w-_i-e Zipcode:
County: lvt'e' �� -,F Ar'f/ _
_ Telephone: C
B
C.
Ownership: Federal
Public
Other (Specify)
State Private 710c
Commercial
FACILITY DATA (Fill out ONLY if the injection well(s) is (are) for the purpose of serving a business or
industry):
Business/Corporate Name:
Address:
City:
County:
. Zipcode:
Telephone:_
HEATING CONTRACTOR DATA (For heat pump systems only. Please give information for the contractor
that installed or will install your system).
Name:
Address:
City:
ELF
Zipcode: Telephone:
D. Q.VEMON PROCEDURE: Briefly describe how the injection well(s) will be used.
E. WELL USE: Will the injection well(s) also be used as the supply well(s) for either of the following?:
(a) The injection operation? YES NO X
(b) Your personal consumption? YES NO —02C—
E CONSTRUCTION DATA: (check one)
LEXISTING WELL being proposed for use as an injection well. Attach a copy of Form GW•1 (Well
Construction Record) and furnish (7 & 8) below. If Fors GW-1 is not available, furnish the data in (1)
through (8) below to the best of your knowledge.
GW-57B May, 1999, Replaces GW•57A, and GW-57B {2A4)

PROPOSED WELL to be constructed for use as an injection well. Furnish the data in (1) through (8)
below as PROPOSED construction specifications.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR ErMER EXISTING
OR PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
r} �7
(1) Well Drilling Contractor's Name: A, t 4+►S �'��� t'7� _} J I ' : �r t, L,012-
(2) Date (to be) Constructed =Y ,: ^ ; Approximate Depth —YCft-
(3) Well Casing:
(a) Type: Galvanized Steel Black Steel h Plastic Other (Specify)
(b) inside Diameter: _ f� inches; Wall d*kness (inches) 2 ► or schedule #
(c) Casing Depth: From + 3 to 46,E ft. (referenced to land surface)
(4) Cement Grout: j
(a) Around inner or "primary° casing: From to __ ft.
(b) Around outer (pit) casing, if present: From to ft.
(5) Screen(s): (if applicable)
(a) Type:
(b) Depth: From to
(6) Gravel: (if applicable)
Inner Diameter. inches
feet below land surface
From: to feet below land surface
(7) N.C. State Regulations (15, 2, 2C, Section XW) require the permittee to make provisions for
monitoring well head processes, A faucet on both the influent (water from well) and effluent (water
into well) lines is required Is there a faucet on (a) the influent line YES )c NO , or (b)
the effluent line YES NO ?
(8) Attach a diagram showing the details of construction of the existing and/or proposed well(s).
G. PROPOSED OPERATING DATA- (The manufacturer's brochure should include this information.)
(a) Injection Rate: Average (Daily) 1 .Z gallons per minute (gpm)
(b) Injection Volume: Average (Daily) gallons per day (gpd)
(c) Injection Pressure: Average (Daily) ► 1, 7 pounds/square inch (psi)
(d) Injection Temperature: Winter Average (Daily) !q C degrees F
Summer Average (Daily) !,C degrees F
H. INJECTED FLUID DATA:
(1) Fluid Source (From what depth and what type of roWsedirnent unit does the fluid to be injected
derive, i,e, granite, limestone, sand, etc,)
Depth: `'/f/ RD*sediment unit: 6""' 2 6 N J,
(2) Chemical Analysis of Source Water: The following chemical characteristics MUST accompany
this application;
pH ; Total Hardness ppm (parts per million or mg/1); Iron ppm;
Chloride ppm; Nitrate ppm; Coliform bacteria counts/100 ml
dov
P�! 17 as P Y -./ -e -i-.
Gw-57B Mey, 1989, Replaces Gw-57A, and Gw-57B CM4)

NOTE: Assistance in obtaining these values may be facilitated by contacting (a) your local or county health
official, (b) a commercial water -testing laboratory, (c) your well drilling contnxtor, or (d) the Regional
Hydrogeologist, North Carolina Dept, of Natural Resources & Community Development.
NOTE: If injection system is not for a beat pump, then a detailed analysis of both the source water and the
injection florid may be required.
L INJECTION -RELATED EQUIPMENT -
Attach a diagram showing the engineering layout of the (1) injection equipment, and (2) exterior
piping/tubing associated with the injection operation. (J O La- ii,41L)e7
NOTE: The manufacturer's brochure, if detailed, should sapsfy (1) above if the system is a heat pump.
J. LOCATTON OF WELL(S)-
Attach a detailed map showing the orientation of and distances between the proposed well(s), any existing
well(s) that will in any way be involved in the injection opera -lion, and at least two (2) nearby reference
points such as roads, road intersections, streams, etc. The roads should be identified by U.S., N.C. or SR
(county secondary road) numbers, and streams should be named In addition, the diagram should show the
direction and approximate distance to any existing water -supply and/or injection wells within 1,000 feet of
the proposed injection well. 1 } D R
K. CERTIFICATION:
"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 tines and
imprisonment, for submitting false information. I agree to operate and use the injccdon well and all related
appurtenances in accordance with the approved specification? and conditions of the Permit
(Signature of Owner or Authorized Agent)
FOR OFFICE USE ONLY:
1. Initial Applicadon: Complete Incomplete
If INCOMPLETE, Date of Notification _ _ . and Resubmittal
2. Standard Industrial Codes) which best reflect the principal products or services provided by this
facility - if applicable.
(a) (b) (c) (d)
3. APPLICATION NO.
GW-57B May, 1989. Repiacu GW-57A, and GW-57B (2A41

COUNTY � _ter. N.C. PARTMENT OF NATURAL RESOUR
OUA❑ IVO.(�.SERIAL NO. & COMMUNITY DEVELOPMENT
LAT
LONG
Report to: 0 FRO, MRO, PRO. WaRO, WiRO,
WSRO, Kinston FO Other
Shipped by: B+as,�Cour� Other
COLLECTOR[5): ZJDATE
FIELD ANALYSES
pH400 Spec, Cond.94
Temp.10 °C Odor
Appearance Taste
Field Analysis By:
LABORATORY ANALYSES
8005 310 moll
COO High 340 moll
COO Low 135 mall
Coliform:MF Fecal 31616 1100ml
Calilorm:MF Total 31504 1100ml
TOC 6B0 moll
Turbidity 76 NTU
pH 403 units
Alkalinity to PH 4.5 410 moll
Alkalinity to pH 8.3 415 mall
Carbonate 445 mall
9loarbonate 440 mall
Arsanic.Tolal 1002 uglf
Carbon dioxide 405 mg/1
Chloride 940 moll
Chromiunt:Hex 1032 ugll
Color:True 80 Pt -Co
Cyanlde 720 mall
Lab Comments:
DEM
Gr
LAB NUMBER 8
GATE RECE VEE] �� 1"imeILLL�v
Rec'd by: From: Bus- • urle
GROUNDWATER
FIELD/LAB FORM
Other
CA yAPI C
,r LL
❑Oln01TV
,,,y„11 1
nnrw puiI y r�V. !W. i "A
Unn —mint PT•/� r4n.
�F ROUTINE
❑ EMERGENCY
DATE REPORTrO-
�%
r g
TIME
IHAL.ELIIIF,
i;I. I.1F'L 11fiT, +,OMPLlANCE, LUST,
OTHER U 1-
Owner
at 25t1C Locati ❑
❑escrip
Sampling Method
Sample Interval
fR71rm Diller, L c,)
Remarks i 7 Y n EL
f umping ti air temr , etc.]
Dias. Solids 711300 moll
Fluoride 951 moll
Hardness:Tatal 900 moll
Hardness [non-oarb] 002 moll
Phenols 32730 up/i
specific cond. 95 uMhoslcm2
5111fate 94b mall
Sulfide 746 mgll
NH3 as N 610 mall
TKH as N 825 mg/1
i�
NO? EO s N 630.,C a moll
P:Total as P 665 moll
Aq - Silver 1077 40'I
AI - Al urn Inum 1105 uyrl
8a - Barium 1007 Uurl
Cs - Calcium 916 m.4.
Cd - Cadmium 1027 u,;.
Chromium:Totai 103A u 1
Cu - Copper 1042 u.1 1
Fe - Iron 1045 ur•I
H9 - Mercury 71GOO u1+
K - Polassium 937 m,: I
FAq - Magnesium 927 n,u.I
Win - Manganese 1055 ti,
Na - Sodium 929 n ,1
N1 - Nickel 1067 ua �
Pb - Lead 1051 u .
5e - Selenium 1147 u
Zo - Zinc 1097 o-,y I
Orpanocirlorine Pesticidae
OrganOpb"phoryy Peeticidas
Acid Herdicid*s
Baas 1 N*utral Extractable Organics
Acld Extractable Organics
I rr jnahli• i:: u,, i•. . rv'.A O..'rHA,
1,2 - Olbromoerhana (E0O)
• �11J �',ili � i�i; �� I I I
RALEiGi N. L.
GW-54 Revised 7/85 For Dissolved Analysis - submit filtered sample and write '015' In block
White copy - Headquarters Pink copy - Region Yellow copy - Lab

Ir
COUNTY '� ^.�.r, f► - __, sue-
N.C.. DEPARTMENT ; OF NATURAL RESOURCES
LAB NUMBER a r'
dUAD NO. V ? SERIAL-'tvC. '
& -COMMUNITY DEVELOPMENT
DATE RECEIVE❑ -2- ` Time
LAT. 3,-r r1� LONG. !9 4 •31 r1 7Ir
; -DEM
Rec'd by: From: Bus -Courier
'
GROUNDWATER'` FIELD/LAB FORM
Other
Report to: SRO, MRO, FiR0, WaRQ, WiRD,'
17
SAIAPL ICJ- PRIORITY
DATA ENTRY BY: , 6 CK:
WSRO, Kinston FO Other
-ROL7TINE EMERGENCY
DATE FIEPORTE4:
Shipped by: Bus, Courier,. Qther' -, 1
CQLLECTOR(5): ?�llf 1a�ilf/...r.•r:.�;DATE TIME" - PURPOSE: BASE -LINE,
COMPLAINT,
COMPLIANCE, LUST, OTHER
(circle one)
FIELD ANALYSES
Owner =� -
-
pH400 Spec. Cond.gq at 250C
'•:;,.. - •. •ors.-
49c.ati'on-or site e-&-)
��. -'--
TempcC QdOr
De.soription.of sampling -point'
Appearance Taste
Sampling, Method f'
Sample Interval
puR'u, baler, etc.7-.%
Pe=
Fieid Analysis By:
Remarks �1 •
•
'
=F
/(pumping tirr�E,ir temp, etc;]
iI{ t •
LABORATORY ANALYSES
L/
BOD5 310 moll
COD H1911 34D moll.
COD Low 335 mg11
Coil Iorm:NF Fecal a 16,16 1100m1
Coillarrn:Mr Total 31504 1100m1
TOC 680 my/I
Turbidity 76 NTV
pH 40a units
Atkallnily to PH 4.5 410 mgll
Aikalinily to pH.6.3 415 moll
Carbonate 445 moli
elCarbonels 440 mgll
IHsaal e:To tal 1002 ugll -
Carbon dioxide 405 mgll
ILL
Ghlori4a 940 mg11
ChrRmlum:Hex 1032 WO/I
ColocTrus E0 Pi•Ca-
Cya~nids 720 mo/}
Lab. Comments:
Oise. Wide 7030D - mo/1
Fluoride 95 t,, - • mgll
l'
Hardness:Toni 900 moll
+
1lardneaS {rion-.Larb1 902 M9/1
Phenol* 32730' opal'
Specilic Coed; 95 umbo7►dm2
Sullate 94S m911
84111do 745 .nlg/I
-I
"M3 ma-N 81a.moll
T.KWA 4 1152rr
NQ't"NQ3 Ra-N eye - riloll
P;Total-ai P 666 „ariyll
Ag Silver 1077 ugll
Al - Aluminum 1105 ugll
es - Barium 1007 ugll
Ca Calcium 916 m911
Cd - Cadmlurn 1027 uo11
Chromiurm-rcial 1034 ug11
Cu Copper ID42 uo11
Fe - iron 1045 ug/r
Ho - Mercury 71saa ugll
K Potassium 937 mgri
htg - Magnesium 927 mg/I
Mo Manganese 1055 ugli
Na ^. Sodium 929 mg/I
141 - Ntckei $067 ug11
Pb Lead 1051 ugli
Se - Sftlnium 1147 ug/1
In Z [PC 1092 UivM-
OrganoChldfin■ Poslicidas
Organopho5phpruS Pas0Cid$$
I I Acid HerdiCida6 I
Baas 1 Nautrai Exiraetrbl+ Organic►
ACid Extractable Organics
I I PurgsaWe Organics [VQA botlls] I
I I 1,2 - Dibromosiharts [EOBY I
OW-54 Revised 7/85• For Dissolved Analysis - submit fillered sample and write 'UIS' in block
White copy - Headquarter[; Pink copy - Region Yellow copy - Lab

t1NTY
QUAD NO
LAT
North Carolina
• — Department of Environment, Health, and Natural Resources
SERIAL NO. Division of Environmental Management
LONG. Groundwater Field/Lab Form
Report toCO FRO, MRC, RRO, WaRO, WiRO,
WSRO, Kinston FO Other
Shipped by: Bus, a i e oO!!1 r
COLLECTOR(5): r zj �� ATE
FIELD ANALYSES
pH400 Spec. Cond.gq at 250C
SAMPLE PRIORITY
ROUTINE ❑ EMERGENCY 0
LAB NUMBER 11 '
- 99DATE RECEIVED u Time
ReC'd bsi From: Bu Cau
other
DATA EWRY BY; tf_ CK;
DATE REPORTED:-•��
TIME PURPOSE: BASELINE, COMPLAINT, COMPLIANCE, LUST, OTHER
Wrcle on*]
I
owner �_' } : I-' 1? '1
�� �_ f - ? 11 L.
�i�.,� L ,
Location or site
Temp.10 oc Odor Description of sampling point
Appearance Taste
Field Analysis By:
LABORATORY ANALYSES
BOD5 310 mg/1
COO High 340 m911
COD Low 335 mg/:
Colltorm:MF Fecal 31616 ilooml
Colilorm:A1F Total 31504 1100m1
TOC 680 mg/I
Turbidity 76 NTU
PH 403 units
Alkalinity to pH 4.5 410 mg/1
Alkalinity to pH 8.3 415 Mgt]
carbonate 445 rrig►1
81rarbonate 440 moll
Arsenic:TOtal 1002 ugli
carban dioxide 405 mg/i
Chloride 940 mg/1
Chromium: Hex 1032 u9/1
ColanTrue 60 Pt -Co
CyaA1d■ 720 mg/I
Lab Comments:
Sampling Method Sample interval
(pump, bailer, etc:)
Remarks
~ { (pumping V e, air temp, etc.)
ij
666
pits. Salida 70300 mg/t
Fluorlds 951 mall
Nardneaa:Tolal 200 rnpll
Hardness (non•cara) 902 moll
Phenais 32730 ug/I
spaeltic Cana. 95 uMhoalem?
Sulfate 945 inn/l
Sulfide 745 100/1
H3 as N 610 �a malt
T as N 625 mull
.HO2 t No as N 630 mg/I
P:Tofai as P 885 mall
Ag - Silver 1077 ug11
Al Aluminm 1106 up11
as - 6arium'Fp07 ugli
Ca - Calcium 916 milli
Cd • Cadmium 1027 ug►I
chromium, coal 1034 ug/l
Cu - Copper 1042 ug/l
■ - Iran 1045 Wp11
Hg - Mercury 11900 ug11
K - Pblaeaiurn 937 mg/l
Mg Magnesium 927 1"Wi
Mn - hiangan;a; 1055 u911
Na - Sodium 929 m91f
Ni - Nickel 1067 u911
Pb Leed 1051 ugll
S■ Setanium 1147 ugll
2n Line 1092 001!
I � Orp;novAlvrine Peellcld;e
Org;noAht<;Ancrua Paetielda■
I I Acid Mardiclda■ I
Base / Neutral pL7raclebl■ Oleanic■
Aeld FsTracisbl■ Org;nles
I I Purg■ahi■ OrpenlCs (VOA bou14) I
i l 1,2 - O1brom0*1h8r!4 (testa)
GW-54 •.�J. 9/99 For Dissolved Analysis - Submit filtered sampla and-.rae 'DIS" in block
VdhifR C oriv - Groundwater Central Office Yellow Coon - Regional Office Pink Copy -central Files Goldenrod Copy- Lab

COUNTY T _'�� }_`' Nortlh Carolina 3�
r LAB NUMBER a
Department of Environment, Health, and Natural Resources ,
QUAD NO. SERIAL NO, DATE RECEIVEQ� Time �I•�
Division of Environmental Management
LAT. LONG. Groundwater Field/Lab Form Rec'd by: a` F From: Bus -Courier
Other
Report to: ARO, FRO, MRO, RRO, rWaRO, wino, SAMPLE _PRIORITY DATA ENTRY BY: Cwf CK.
WSRO, Kinston FO Other y 4 _ V- 9�
ROUTINE ❑ EMERGENCY0 DA'iE AEPOR7ED:
Shipped by: Bus, C wrier, Other
COLLECTOR(S):ia Y' l DATE Z
FIELD ANALYSES
pH4 flp Spec. Cond, gq at 250C
Temp.,0 oC Odor
Appearance Taste
Field Analysis By:
LABORATORY ANALYSES
BOD5 310 mg/1
CUP High 340 mg11
COD Low 335 MOM
Colliorm:MF Fecal 31616 ■$00ml
Colifarm;MF Total 31604 110omi
TOG 660 mg/l
Turbidity 76 NTLI
pH 403 units
Alkalinity 10 pH 4.5 410 mg/1
Alkalinity to pH 8.3 415 mg/1
Carbonate 445 mg/1
Bicarbonate 440 mg/I
Arsenic:Total 1002 ug/1
Carbon dioxide 405 rng/l
Chloride 940 mg11
Chromium:Hex 1032 dg11
Coior.Tlue 80 P[-Co
Cyanide 720 mgll
Lab Comments:
TIME PURPOSE: BASELINE, COMPLAINT, COMPLIANCE, LUST, OTHER
(circle one)
Owner i r-. I d i�►�
Location or site fr~ T10
Description of sampling point
Sampling Method L4) 9C14
Remarks
�/( C
".14 —P
ump, Caller,
hiss. Solids 703011 3 mg/t
rluoride 951 rng/I
Hardoess:Totai 900 img11
Hardness [non•carb] 902 rna11
Phenols 32730 ug71
5A9CiliC Cond. 95 uMriosjcrO
Sulfate 945 rng/I
Sulflde 745 rng/I
NH3 as N 610 rng11
TKN as N 625 rng/I
NO2 t NO3 as N 630 rng/i
P:Total as P 665 rngll
Sample Interval
Ag - Silvbr 1077 ug/I
Al - Aluminum 1105 ug/i
Bit - Barium 1007 ug/1
Ca - Calcium 916 m911
Cd Cadmium 1027 ug/l
Chromium.Tota.l 1034 ug/l
r,
•Cu - Copper 1042 ugll
Fa - Iran 1045 ug/1
Hg - Mercury 71ODD ug/1
K - Potassium 937 rng/I
Mg - M"nesium 927 mgll
Ma - Manganese 1055 ug/i
Na - Sodium 929 rng/I
Ni - Nickel 1067 u011
Pb - Lead 1051 ugll
Se - Sala niUrn 1 14 7 "/1
Z0 - Zinc 1092 ug11
temp,
Organochlorlos Postrcides
Organophosphorus pesticides
I I Acid Herdicides I
ass@ / Neutral Extractable Organics
Acid Extrectabi■ ❑rganits
I I Purgaabl■ Organics (V0A bottle) I
1,2 - Dibromosthan■ [ED$}
M I
GW•54 REV. 9190 For Dissolved Analysis - submit filtered sample :and write "DIS" In block
White Copy - Groundwater Central Office Yellow Copy • Regional Office Pink Copy - Central Files Goldenrod Copy - Lab

HARM E. JOHN80N
115 IQNDY FOREST DRIVE
UENDED6ONVIUI,E, NC 28739
704-8918600
December 18, 1991
Robert J. Turner
Department of Environment, Health, and Natural Resources
Division of Environmental Management
512 N. Salisbury Street
Raleigh, North Carolina 27604
Dear Mr. Turner
ITM
DR
,3@CgzY?J)
ft a to DI)
GROaifR ��r!
�4 NC
• UN
Thank you I guess, for your letter of 10 December. As Alice probably told you, we
haven't moved, it's just that since enhanced 911 came in, everybody gets a street address. The
friendly postal folks told me that the old box number would work indefinitely since we hadn't
been the ones to instigate the change, but I guess that the postal delivery lady never got the
word.
The folks from Asheville Regional were out in November and took water samples, I had
erroneously concluded that if they found the water to be free of impurities that that would
constitute a permit renewal. They had promised a note as to their results, but I haven't received
it yet. They may have had the same difficulty with the post office that you did.
Anyway, attached is my application for another five year permit. There's been no
changes in the system, and it works great. I did find my drillers registration number, and I guess
if there's something you need that I didn't furnish, tell me who number 303 is and if he's still
alive, I'll go get it for you.
As the season goes, Jingle Bells
' e-' • 'ti'' �---�
Harold E. Johnson
Enclosures
cc:Fred Hankinson - Asheville Regional Office

State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Management
512 North Salisbury Street ■ Raleigh, North Carolina 27604
James G. Martin, Govcrnor George T. Everett, Ph,D,
William W. Cobey, Jr., Secretary December 10, 1991 Director
Mr. Harold Johnson Al,-, -T- ¢
1 1 S Kindy Forest Dr. 0 A 4 �• 4
ReganalDffi�rs Hendersonville, NC 28739
Asheville
XXn51-Q08 Dear Mr. Johnson:
Favetteville
919/48&1541 This is in reference to the well on your property that
MOOMSVille is used for the disposal of water from your heat pump
7W66.1-169 system. As I indicated to Mrs. Johnson over the telephone,
Raleigh your permit to operate this injection well will expire on
9191733.2314 December 31, 1991. Accordingly, you will need to renew your
permit.
Washington
919046-M81 To assist you in renewing your permit, I have enclosed
Wrlmmgton a blank application form, along with a copy of your original
9191395-39LM application. Also enclosed is an informational pamphlet
V/Inston-sdlem entitled "Injection Wells - An Overview of Injection Well
91918967D07 Regulations and the Underground Injection Control Program in
North Carolina." Please complete the application form to
the best of your abilities and forward it to my attention at
the address indicated above by January 10, 1992. If you
have any questions or difficulties completing the
application, please refer to the enclosed pamphlet or
contact me at [phone].
Merry Christmas,
Robert J. Turner
Hydrogeologist
Groundwater Section
Enclosures
cc: Fred Hankinson - Asheville Regional Office
P.O $nt -K615, R.3ICgh, North C.riill n3 77t,7eiti511 rvicphone 914.733 70t5 h4luuc- lies mrr11r Yap,
An Fqr A + )t,ir wti ip, irc AN1r r,r 1ciw 4 r1 w C n, Ph wcr

r 3
State of North Carolina
Department of Environment, Health, and Natural Resources
D€vision of Environmental Management
512 North Salisbury Street ■ Raleigh, North Carolina 27604
James G. Martin, Governor November 6, 1991 George T. Everett, Ph.D.
William W. Cobey, Jr., Secretary Director
Mr, Harold Johnson
Route 4, Box 541-F
Hendersonville, N.C. 28739
*Second Notice*
Dear Mr. Johnson:
Our records show that the operating permit for the water to
air heat pump injection well on your property will expire on
December 31, 1991. In addition, our records d❑ not indicate that
the well has been abandoned. In order to comply with the
regulatory requirements for permitted injection facilities (15
NCAC 2C .0211), it is imperative that you either submit the
enclosed application for permit renewal or submit the enclosed
Status of Injection Well System form that certifies the injection
facility is no longer in operation. Either form should be
forwarded to us by November 15, 1991.
Regional office personnel will make arrangements with you to
,inspect your injection well and sample effluent (injected water)
to assure compliance with existing groundwater quality
regulations. Please note that the regulations now require the
permittee to install, in a readily accessible location, a faucet
or other device suitable for collecting a sample on the effluent
line (water into well) of the injection system.
If you have any questions or need assistance, please do not
hesitate to call me at [phone].
Attachments
cc: Fred Hankinson - ARo
Sincerely,
Robert O. Walton III
Environmental Technician
Permits & Compliance Unit
REGIONAL OFFICES
Aslievsilr Fayetteville MoaresviIle Raleigh Washington Wilmingion Win s[on-Salem
7041251-6208 919/486-1541 704/663 1699 9 191733-23 14 91919h6.6481 919/395-3900 919/896-7007
Pollution Prevention Pays
P.O. Box 29535. Raleigh, North Carolina 27626-0535 Telephone. [phone]
An Equal Opportunity Affirmaiive Action Employer

State of North Carolina
Department of Environment, Health, and Natural Resources
DMsion of EnvitonmentW Management
512 North Salisbury Street 9 hake gh, North C.aroHna 27611
James GL Martin. Governor George T. Everett, Ph.D.
W Warn W_ Cobey, Jr., Secretary August 5, 1991 Director
Mr. Harold Johnson
Route 4, Box 541-F
Hendersor>L, N.C. 28739
P� i;'d
Dear Mr. Johnson:
our records show that the operating permit for the water to
air heat pump injection well on your property will expire on
December 31, 1991. In addition, our records do not indicate that
the well has been abandoned. In order to comply with the
regulatory requirements for permitted injection facilities (15 NCAC
2C .0211), it is imperative that you either submit the enclosed
application for permit renewal or submit the enclosed Status of
Injection Well System form that certifies the injection facility is
no longer in operation. Either form should be forwarded to us by
October 15, 1991. A copy of the original application is also
enclosed for your reference.
Regional office personnel will mace arrangements with you to
inspect your injection well and sample effluent (injected watery to
assure compliance with existing groundwater quality regulations.
Please note that the regulations now require the permittee to
install, in a readily accessible location, a faucet or other device
suitable for collecting a sample on the effluent line (water into
well) of the injection system.
If you have any questions or need assistance, please do not
hesitate to call me at [phone].
Sincerely,
Robert O. Walton III
Environmental Technician
Permits & Compliance Unit
Attachments
cc: Fred Hankinson - ARO
Pokdm Preveofloe Pays
P.a, Sox 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
A- [.....i ArK-r Cmnlrn.ar

nEpAkr?MXT OF MArMAL 'RESOURCES AND COi"IrY DEVEwPmEmr
"ry I S ION OF M rsaPDQ:xrwi. MAJUC Tr
WELL AND 111PI P IHSPEMON REPORT
Well location t [•��'�
.Lr,., Subdivision and Lot No*)
Owner
Address c �� � F
r � �� r�r��r.•-�';�� , del . C. _� t� 7� .
Ili
_Frilling Contractor
Permit
Location
Distance from
Pollution Source
Other location standards
Total Dept
Casin,&
Depth
11 i arve to r
Weight/thickness
Height
Drive shoe
Exception approved by owner
Grou t:
Type
Thickness
Depth
St reens
lure 1 o pmen t
WELL CONSTRUCTION
c
Name
Address
Meets Mir}. St-,vxSard�
Measure No
Abandonment !temporary/permanent
Water level
Well test
Chlorination
Cuttin&s
Reports
11111 amp (Appearance)
Da to 4 17,2 A
Area
County .
Road/Street
Serial No. Pc Soon
Lat . 1 '" Lonk. q 2 031 '� q'
UIC-
Remarks
Reg. 4

Pumr- ins za 1 le r
H air Address Reg.
Meets Min. Standards
Measure Yes No Remarks
Enclosure
Enclosure floor
Casing height
Access 2ort
Valved flow
Water. ti ht pipe entry
Well ently
Vent
Hose bib
Tee -et
-Suction line
Chlorination
Teorary Aband.
Date k 1l Constructed �' 3
Date Pump installed {�
Signature
Witness
Name Address Type
Name Address Type
Jrj'P
1*µ
t�i
-.{ toy jt�
• C�
,4� Irlr
U
P r -k
�ed��FcL jetty dou►npp �'��
�y' rovfjL S�v1•CD�irl40K w CiosS aY L
�J �.3 - -°-'r' i +d. P a-,J Di. w' Da,��� F'1f►t �.dt
r

State of forth Carolina
Department of Natural Resources and Community Development
Division of Errvironmental Management
512 North Salisbury Street a Raleigh, North Carolina 27611
James G. Martin, C-avernor R. Paul Wilms
& Thomas Rhodes, Secretary October 20, 1986 Dicer
Mr. Harold Johnson
Route 4, Box 541-F
Hendersonville, NC
Dear Mr. Johnson:
�r7
OCT 2 2 1986
GROUND
RALOGH, {1.
RE: Permit 44-0209-WI-0001 for a heat pump injection well in
Henderson County
In accordance with your application dated September 25,
1986 we are forwarding herewith Permit No. 44-0209-WI-0001 for
the Operation and Use of a well, for the purpose of injecting
heat pump effluent, in Henderson County.
This Permit shall be effective from the date of issuance
until December 31, 1991 and shall be subject to the conditions
and limitations stated therein.
In order to continue uninterrupted legal use of this well
for the stated purpose, you should make application for permit
renewal at least two (2) months prior to its expiration date.
/Is
Attachment
cc: Bob Cheek
MRO Files
Sincerely,
ny1
vis
Regional Supervisor
Poilu&m F3rmNom Pays
PQ Bar 77w, RA*K North Ca mlm I761I-7697 Tdq*mm 919 793.7M5
An BvW Opwmft Affimwdve Asian &vlcbw

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
-RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION/USE OF A�'WELL OR WELL SYSTEM. FOR INJECTION
In accordance with the provisions of Article 7,'Chapter 87;
Article 21, Chapter 143, and other applicable Laws, Rules and Regula-
tions
PERMISSION IS HEREBY GRANTED TO
Harold E. Johnson
FOR THE OPERATION AND'USE-'OF AN. INJECTION WELL/WELL SYSTEM located on
Circle Drive, Sky Lakes Estate, Hendersonville in Hendersonville
County in accordance with the application dated -August 25, 1986 and
in conformity with the specifications and supporting data submitted,
all of which are filed with the'Department of Natural Resources and
Community Development and -'are considered a part of this Permit.
This Permit is for operation and Use only, and does not waive
any provisions or requirements of the Water Use Act or any other
applicable Laws, Rules or Regulations. Operation and use of a well
or well system shall be in compliance with Title 15 North Carolina
Administrative Code 2C, and any other Laws, Rules and Regulations
pertaining to well construction and use.
This Permit shall be effective, unless revoked, from the date of
its issuance until December 31, 1991 and shall be subject to the
specified conditions and limitations set forth in Parts I and II
hereof.
Permit issued this the2O Tk day of 1986.
Roy . Davis
Regional. Supervisor
By Authority of the Environmental Management Commission.
PERMIT NO. 44-0209--WI-0001

PERMIT NO. 44-0209-WI-0001
PART I
A. GENERAL CONDITIONS
1. The Permittee must comply with all conditions of
this Permit and with the standards and criteria
specified in 15 NCAC 2C .0200. Any Permit
non-compliance constitutes a violation of the
appropriate Act and is grounds for enforcement
action; for Permit termination, revocation and
reissuance or modification; or for denial of a
Permit renewal application.
2. It shall not be a defense for a Permittee in an
enforcement action that it would have been
necessary to halt or reddce the permitted
activity in order to maintain compliance with the
conditions of this -Permit.
3. The Permittee shall take all reasonable steps to
minimize or correct any adverse impact on the
environment resulting from noncompliance with
this Permit.
Q. The Permittee shall give advance notice to the
Director of any planned changes in the permittee
facility or activity which may result in
noncompliance with the Permit.
5. The Permittee shall report all instances of
noncompliance, not reported under condition 1. of
this Part, at the time monitoring reports are
submitted.
6. Where the Permittee becomes aware of.a failure to
submit any relevant facts in a permit
application, or of any incorrect information
submitted in said application or in any report to
the Director, the relevant and correct facts or
information shall be promptly submitted by the
Permittee.
7. The Permittee shall give notice to the Director
as soon as possible of any planned physical
alterations or additions to the permitted
facility.
8. In the event that the permitted facilities fail
to perform satisfactorily, the Permittee shall
take such immediate action as may be required by
the Director.

PART I (continued) PERMIT NO. 44-0209-WI-0001
9. The injection system shall be effectively
maintained and operated at all times so that
there is no contamination of groundwaters, or
other actions or occurrences which renders them
unsatisfactory for normal use. In the event the
facilities fail to perform satisfactorily,
including the creation of nuisance conditions,
the Permittee shall take such immediate
corrective action as may be required by the
Director.
10. Provisions shall be made for collecting samples
of facility effluent, both prior to its entrance
to treatment devices and subsequent to leaving
the treatment devices but before entering the
injection well.
11. Department representatives shall have reasonable
access for purposes of inspection, observation
and sampling associated with injection and
related facility.
12. This -Permit is not transferrable without prior
notice to, and approval by, the Director.
13. An application for modification, renewal or
transfer of this Permit shall be filed with the
Department at least 30 days prior to the
expiration date of this Permit.
PART II
A. SPECIFIC CONDITIONS
- N O N E -

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
RALEIGH, NORTH CAROLINA 27611
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
CLASS/TYPE 5A WELLS
TO: DIRECTOR, NORTH CAROLINA DIVISION OF ENNVIRONMEN`I'AL MANAGEMENT
DATE -
In accordance with the provisions of Article 7, Chapter 87; Article 21,
Chapter 143, and regulations pursuant thereto, APPLICATION is hereby made
for a PERMIT to construct and/or use a well or well system as described
below and in any accompanying data submitted as a part of this APPLICATION.
A. OWNER DATA: Name
Address�^r
ZIP ?-ip
County/- t'C_ fy��,� Telephone S—
U `t" m H 1!:44i"4' C,' 121
1
Ownership Status: Federal State Privateim
Public El Commercial
Other (Specify)
B. FACILITY DATA(Fill out ONLY if the injection well(s) is for the
purpose of serving a business or industry):
Business/Corporate Name:
Address:
ZIP: Telephone:
GW-57B (2/84)

PAGE 2 of 4
L B. Describe briefly:
(I)For what purpose will injection well be used-
(2)Mechanically, how will the injection operation proceed-
C. WELL USE: Will the injection well(s) also serve as the supply
well? Yes[:) NoA
-/ D, CONSTRUCTION DATA: (check one)
EXISTING WELL being proposed for use as an injection well.
Attach copy of Form GW-1 (Well Construction Record) and
furnish (6) below. If GW-1 not available, furnish the
data in (1) thru (6) below to the best of your knowle6Le.
PROPOSED WELL to be constructed for use as an injection well.
Furnish the data in (1) thru (6) below as PROPOSED construction
specifications
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER
EXISTING OR PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE
BY OTHER MEANS.
[/ (1) Date (to be) Constructed j F Approx. Depth yd� ft.
6'.(2) Well Casing:
(a) Type: Galvanized Steel ❑ Black Steel
Thermoplastic ❑ Other(5pecify)
(b) Inside Diameter:inches; Wall thickness(inches) r �J
or Schedule #
(c) Casing Depth: From to 4UO"ft. (referenced to land
surface)
+ (3) Cement Grout:
(a) Around inner or "primary"easing: From to ft.
(b) Around outer(pit) casing, if present: From to ft.
GW-57B(2/84)

PAGE 3 of 4
(4) Screen(s): (if applicable)
(a)
(b)
Type:
Depth:
From
to
Inner Diameter: inches
feet below land surface
(5) Gravel: (if applicable)
From to feet below land surface
(6) Attach a diagram showing details of construction of the
existing and/or proposed well(s).
�E. OPERATING DATA: (Proposed)
(a) Injection Rate: Average(Daily) r 2- gallons per minute(gpm)
(b) Injection Volumn: Average(Daily) gpm
(c) Injection Pressure: Average(Daily) PY. / pounds/square inch(psi)
F. INJECTED FLUID DATA:
t�(l) Fluid 5ource(from what depth and what type of rock/sediment
unit does th fluid to be injected derive)
Z aD ►,,� e,L1 sr v
!— (M Chemical A_nalvsis of Source Water: The fallowing chemical
characteristics must accompany this application;
PH Total Hardness ppm(parts per million)
Iron _____ppm; Chloride ____ppm; Nitrate ppm
Colliform bacteria counts/100
s,�
NOTE: Assistance in obtaining these values may be facilitated
by contacting (a)your local or county health official,
(b) a commercial water --testing laboratory, (c) your well
drilling contractor, or (4)the Regional Hydrologist,
North Carolina Dept. of Natural Resources & Community
Development in the following locations:
Washington,NC [phone] Wilmington,NC [phone]
Fayetteville,NC [phone] Winston-Salem,NC [phone]
Raleigh,NC [phone] Mooresville,NC [phone]
Asheville,NC (704)253--3341
GW-57B (2/84)

PAGE 4 of 4
G. INJECTION -RELATED EQUIPMENT: Provide a diagram showing the type
and engineering layout of the (1)injection equipment
and (2)exterior piping/tubing associated with the
injection operation.
NOTE: The manufacturer's brochure, if detailed, should satisfy
(1) above if the equipment is a heat pump(heat-exchanger)
V H. LOCATION OF WELL(S): Provide a detailed map showing the orientation
and distances of the proposed well(s),and any existing
wells that will in any way be involved in the injection
operation, to at least two(2) nearby reference points
such asroads, intersections, streams, etc. The roads
should be identified by U.S., N.C. or SR(county secondary
road) numbers, and streams should be named. In addition,
the diagram should show any existing water -supply and/or
injection wells within 1,000 feet ❑f the proposed
injection well.
I. CERTIFICATION
"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 operate and use the injection well
and all related appurtances in accordance with the approved
specifications and conditions of the Permit".
(Si- ature �of Owner or Authorized Agent)
J. FOR OFFICE USE ONLY:
1. Initial Application: COMPLETE INCOMPLETE
If INCOMPLETE, Date of Notification and Resubmittal
2. Standard Industrial Code(s) which best reflect the principal
products or services provided by this facility - if applicable
(a) (b) (c) (d)
3. APPLICATION NO.
GW- a7S

industrOnics
211 South Ewing Avenue
Clearwater, MoNde 38616
[phone]
August 25, 1986
North Carolina Environmental Management Commission
Groundwater Section
Division. of Environmental Mgt.
Post Office Box 27687
Raleigh, N. C. 27611
Attn. Mr. Perry Nelson, Chief
Gentlemen
Enclosed is my application for permit to use a well for injection.
Included is Public Health Services inorganic Chemical Analyses
plat map and FHP Water Source Heat Pump sales brochure.
Your prompt attention to this matter will be appreciated.
Very.truiy y rs,.
I ai� FE. 30
he sar�
HE3 /bp
PWram,
s EP 0 2 1986 n�
GROUND bVA. :,}ION
RALEIGFi, ;,_ u.

STATE; LABORATORY OF PUBLIC HEAL`
DIVISION OF HEALTH SERVICES
4 N, C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 - 30-Li N, WI LMINGTON ST.. RALEIGH 27611
L
INORGANIC CHEMICAL_ ANALYSES -PRIVATE WATER SYSTEM
Complete All Items Above Heavy Line
(See -Instructions Qp Reverse Side)_
Y1• -
Name of Harold Johnson -- 692-4945
System
_
211 S . Cwi ng St. , Q ear Water, Fl a.3351
l 5o r of Water:
Address _
F-lVus oR Pavl sus-t. 1'7�
{jce
Ground
Surface
Clear Water, Fla, zlP 33515
Source of Sample:
County Henderson
[ j House Tap
Well Tap
Report To: Daniel S. Jones , R. S. I I I
--
—�
Type of Sample:
Address: enderson Co. Health Dept.
'4
(K ) Raw
1347 Spartanburg Highway
Type of Treatment:
None
Hendersonville, C ZIP 28739
{ A Chlorinated
I j Fluoridated
Collected By--
Filtered.
Alt[m
T, � l ` �
Date Collected�5 L Time:— / d /LJ
M
PM
Type of Analysis Desired:
( 7K,) Regular Parameters
Location of Sampling Point: L� ^_ f
( } Optional Parameters
Remarks:
-- RECEIVED AUG 2 Q 19%
Regular Parameters
Results
pR
_ J7 —units
Arsenio
— �7, Q l
mg/I
Lead
mg/1
Iron
mg/I
Manganese
mg/1
Copper
mg/1
Zinc
�; r}3
m9/1
Calcium
' ,�
mg/l
Magnesium
_v-
mg/i
Hardne7S-CaC(]3 (Ca, Mg}
-
mg/1
Alkalinity-CaCO3
mg/I
rid Chloe
�r
T
mgll
Color
units
Turbidity
NTU
units
Fluoride
n•igll
[ } Both
[ } Purchased
( I Treated
[ j Li me
( ) Soda Ash
[ f Polyphosphate
( 1 Water Softener
[ 1 Other
( } Both
Optional Parameters (List as needed)
Results
Date Received Date Reported Reported B
Date Analyzed
DHS Farm - 1441 Rev, 10/79
Laboratory
Laboratory Number
iu is ; $ ". D r I' P, ;47n,'. t-,y _ Mildred A. Kerbaugh
❑irpctor

State Laboratory of Public Health
Division of Health Services. N.C. Dept. of Human Resoi roan
P.O. Box 2OC47 — 305 N. Wilmington St., Raleigh, N.C. 27611 — 8047
DRINKING WATER DESCRIPTION BLANLLED IN BY SENDER
COLIFORM ANALYSIS —_PRjV0ft SUPPLY
Nam f Owner or Tenant Harold Johson , 692-4945
Ivor house on oavis Ant. —Cour+t
Flit c r,_.a—.. c.& r•1....,. 1.1.4--- ri . Y u..., a..,......,
Type of Sampling Point 1
Cotlected BY Dan .10aes DATE ? ` iZ TIME/9' 1
Source: Well (XX) Spring ( ) Other:
Daniel S. Ones, R.S. III
Signed Henderson Co.Haalth Dept.
By. Name
Indicate; M.D. or Sanitarian
4 BACTERIOLOGIC ANALY515
Media
Positive Tubes
LTB
BG8
1 2
1 2
3 4 5
3 4 `' 5
CdLI�ORM
BACTERIA
Not 'J
1 Found re Psent
MPN
REPORTED -
A U G f
Address 1347 Spartanburg Hi hw {
OHS Farm 1244 City Hendersonville, NC zip 28737
Rev. 7/79 Lib. ALL INFORMATION REQUESTED MUST BE GIVEN. Do not write on this side of form.

14ORTH CARQIJHA DEPARTIMENT OF NATURAL REL .ICES AN0 COMMUNITY DEVELOPMENT
D#V+SIOH OF ENV4ROHIVIENTAL AUWAGEAEN7 - GROUNDWATER SECTION
P.O. BOX 27ee7 - RALEIOH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER' REGISTRATION NUMBER%
FOR OFFICE USE ONLY
a
Ouad. No. �' �t _ Serial into.
`�
Lai.. -55:' 119 Lonla• :" PG
Minor Basin
Basin Code
Header Ent. GW-1 Ent -
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1.- WELL' LOCATION: (S w sket h of the Io n below)
Nearest J County: J 1
Tawn: _ _ /1
t _
Depth DRILLING LOG
,,yy
(Read. Community, orr ',:lulydiviisiion and Lot .]
y}NoFrom Tc Formation Description
2: OWNED _ram L�'1 �_S �` L•Y yC'
*ADDRESS '� �i✓L��
�5 Get -or o e rJ� �* 5
City, or 'y own State . Zip Code
3. DATE DRILLED r USE OF WELL.
4. TOTAL OEPTH -- CUTTINGS COLLECTED ❑ Yes ❑ Nc r�
5. DOES WELL REPLACE EMSTING yfELL7 ❑ Yes. El No
6. STATIC WATER LEVEL: (� FT. ❑:above TOP OF CASING,
❑ below
TOP OF CASING IS I FT. ABOVE LAND S40FACE.---
7.'YIELD Cgpm). METHOD OF TEST - r
B, WATER ZONES (depth):
9: CHLORINATION: Type Amount
to. CASING: if additional space is needed use beck of form.
Watt Thickness
Depth Diem ter or Weight/Ft, la
' LOCATION �I{E71:1i
From To Ft. (Shaw direction and distance from at least two State Roads,
From To Ft. or other map reference points)
From To Ft.
11. GROUT:
/� Depth Material Mx'piod
i Frcm 4 To ZZ) ' Ft:
From To Ft.
12- SCREEN.
Depth Diameter Slat Size Material
From To Ft. In. in.
From To Ft. in. in.
From Tc Ft. in, in.
13. GRAVEL PACK:
Depth Size Material
From -To -Ft.
From Tv Ft._
J4py?I
19(9?
`rFr�, r
14. REMARKS;
I DD HEREBY CERTIFY THAT THIS WELL WAS r+ONSTPU'- ,Eu-tJ ACCORDANCE WITI I -15 NCAC 2C, WELL CONSTnUCTiDN
STANDARDS, . AND THAT A COPY OF THIS RECO1`�1 ++�+<' CENT RDVIDED TO THE WEt C 01x NER.
.410NAT'UR{ OF, Ord-C tA(`TOR t=:R AGCN7 DATE
GW-1 Povised 11164 Sub( -it original to Division of Envlrenmentat Management and copy to well owner.

v....­.... ,,,, ....,,.. .•.,- ,.n,..­ "t 'aM.;LS nnu LUPAMUMFy GEVELOPTTAOTT
DIVISION OF ENVIRONWWAL MAt'IAOEE - GROUNDWATER SECTION
P.O. BOX 27e87 - RAMGH,N,C. 2761 i, PHONE (919) 733-&083
WELL CONSTRUCTION RECORD
-e
DRILLING CONTRACTOR / d/,
DRILLER REGISTRATION NUMBER
1. WELL LOCATION: (Show sketch of the lolcpfian below)
Nearest Town:
I
(Road, Community, or Sub. -division and Lot No.)
ADDRESS . � f
eel or re No,
City o Tawd n State Zip Code
3, DATE DRILLED USE OF WELL.
4. TOTAL DEPTH � CUTTINGS COLLECTED [I Yes ❑ No
S. DOES WELL REPLACE EXISTING W!�—Yes ❑ No
6STATIC WATER LEVEL-. �� FT. ❑ above TOP OF CASING,
❑ below ■
TOP OF CASING IS FT. ABOVE LAND SURFACE.
7. YIELD (gpm): METHOD OF TEST
a. WATER ZONES [depth]:
9. CHLORINATION: Type Amount
10. CASING:
Wall Thickness
Depth Diameter, or Weight/Ft.
From
From To Ft.
From To Ft.
n FOR OFFICE USE ONLY
Duad. No. t�9_&_ _ Serial No.
Lat. - :� �r( r. —Land.` ° �i'r Pc
Minor Basin
Basin Coda
Header Ent. GW-1 Ent,_
STATE WELL CONSTRUCTION
PERMIT NUMBER: -
County:
Depth, DRILLING LOG
From To Formation Description
� 3
_ r
L
If additional space is needed use back of form,
Material
LOCATION SKETCI-t ••-
—51-W (Show direction and distance from at least two State Roads,
or other map reference points)
11. GROUT:
Depth /Material },i�rthad
From To 2 e Fi.
From To Ft.
Q. SCREEN:
Depth Diameter Slot Size Material ;
From To— Ft, in. in.*c,� j'�r
F-am To Ft. ir, in. G-kdr
From To Ft in. in. fr„ 1' u i v,4— 9��
Q. GRAVEL PACK: ALEIGH IV �lc]i%oxj
Depth Size Material
From To Ft.
From To Ft._ s
14. REMARKS.,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS, r',;'CTf,DWACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECORD i2A� 5 BE'-xj P O,V/l:,l-; TO T} W£ OWNER,
'l Fjt NATURE OF CONTRACTOR OR AGENT DATE.
GW-1 Revised 11/84 Submit original to Division of Environmental Mar)agemant and copy to well owner.

North Carolina Department of Human Resources
Division of Health Services
P.Q. Box 2D91 • Raleigh, North Carolina 27602-2d91
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
December 10, 1986
Mr. James A. Bennett
Permits Issuance Group
Groundwater Section
Division of Environmental Management
North Carolina Department of Natural Resources &
Community Development
P. 0. Box 27687
Raleigh, North Carolina 27611-7687
Dear Mr. Bennett:
Ronald H. Levine, M.D., M.P.H.
State Health Director
DEC 1 7 1986
RALE!Gli, 1V, C.
Re: Application for an Injection
Well Permit
Harold E. Johnson
Circle Chive, Sky Lakes Estate
Hendersonville, North Carolina
Henderson County
NCS 44-0209-WI-0001
Reference is made to the above mentioned subject.
Considering the legal matter of endorsing this proposal, we believe we do
not have sufficient information to deny the request due to a threat to the
ground water source or to the public health.
Our recommendation that an assessment be made of the effects these
systems might have on groundwater remains.
If we can be of further assistance, please let us know.
Sincerely,
Lis
James F. Stamey, Chief
Environmental Health Section
JFS/RWC/ar

State of North Carolina
Department of Natural Resourtces and Community Development
Division of Environmental Marogenta t
512 North Salisbury Street ■ Raleigh, North Carolina 77611
James C Martin, C,oM+errfar R. Paul Wilms
Thomas Rhos, $c+cretar}► October 9, 1986 Director
Mr. James 5tamey, Chief
Environmental Health Section
Department of Human Resources
Bath Building
Raleigh, NC
Dear Mr. 5tamey:
This office has received an application(s) for a Permit to Use a
well or well -system for injection, as listed below. In accordance
with Article 7, Chapter 87--88(j), General Statutes of North Carolina,
we submit the following application, in addition to draft copies of
the proposed renewal Permit, to DHR for review and recommendation:
Renewal 2per. Const.
APPLICANT Pe m t Permit Permitrmit INJECTION SOURCE
Heath, James D. - Yes - heat pump+ effluent
Johnson,Harold E. - Yes - heat pump effluent
Sawydr, Quentin R. - Yes - heat pump effluent
Please note that the application complies with the specified
requirements as prescribed by 15 NCAC 2C .0200.
If we have not received any comments or recommendations within
ten (10) working days of the above date, we will assume that DHR has
no objection to the project as proposed. Please do not hesitate to
contact me at 733-5083 if you have any questions.
Attachments
JAB/Ls
Sincerely yours,
Robert B. Cheek, Supervisor
Permits and Compliance Unit
Groundwater Section
Pot/Arho" Nevention Pays