WI0100086_GEO THERMAL_20120517

AE
�D Nit
North Carolina Department of Environment and Natural Resources
Division of Water -Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 17, 2012
Robert and Elizabeth Pyeatt
39 Wild Oaks Drive
Candler, NC 28715
Subject: Notification of Rule Revisions Affecting
Closed -Loop Geothermal Injection Well Permit Holders
Permit Number, WI0 I 00086
Dear Mr. and Mrs. Pyeatt:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed -loop geothermal injection well
system. This letter is to. inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards — Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed -loop geothermal injection well(s) have become
"Permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http:/Ihortal.ncdenr.or;i/web/wq/aps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
Z4. � Ao�
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699.1636 One
location: 512 N. Salisbury St., Raleigh, North Carolina 27604 NO2 h CaY'ohria
Phane: 919-807-64641 FAX: [phone] �WU all
Intemet: W"mcwaterguality,om
An Equal Opportunity lAflirmativeAction Employer

Central files: APS SWP
0005110
Permit Number W10100086
Permit Tracking Slip
Program Category
Status Project Type
Ground Water
Active New Project
Permlt Type
Version Permit Classification
Injection Mixed Fluid GSHP Well System (5QM)
1.00 Individuai
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility Name
Robert and Elizabeth Pyeatt SFR
Location Address
39 Wild Oaks Dr
Candler NC 28715
Owner
Permit Contact Affiliation
Major/Minor Region
Minor Asheville
County
Buncombe
Facility Contact Affiliation
Owner Name Owner Type
Individual
Elizabeth A Pyeatt Owner Affiliation
Elizabeth A. Pyeatt
Owner
39 Wild Oaks Dr
Candler NC 28715
Dates/Events
Scheduled
Orig Issue App Recelved Draft initiated Issuance
04/01 /10 03M 1 /10
Reculated Activities
Heat Pump Injection
Outfail IJ.,'L
Public Notice Issue Effective Expiration
04/01/10 04/01/10 03/31/15
Renuested/Received Events
RO staff report requested 03/24/10
RO staff report received 03/28/10
Waterbody Name Stream Index Number Current Class Subbasin'

Central Files: AP5 SWP
03/30/10
Permit Number WIDIOOO66
Permit Tracking Slip
Program Category
Status Project Type
Ground Water
In review New Project
Permit Type
Version Permit Classification
injection Mixed Fluid GSHP Well System (5QM)
Individual
Primary Reviewer
Permit Contact Affiliation
m ichael. rogers
Coastal SW Rule
Permitted Flow
Facilt -- - —
Facility Name Major/Minor Region
Robert and Elizabeth Pyeatt SFR Minor Asheville
Location Address County
39 Wild Oaks Dr Buncombe
Candler NC 28715 Facility Contact Affiliation
Owner Name Owner Type
Individual
Elizabeth A Pyeatt Owner Affiliation
Elizabeth A. Pyeatt
Owner
39 Wild Oaks Or
Candler NC 28715
r tirc. Fu.�.rr
scheduled
Orig issue App Received draft Initiated issuance Public Nouee issue Effective Expiration
03/11/10
Reaulated Activities RenuestedlReceiver--vents
Heat Pump Injection RO staff report requested 03/24/10
RO staff reRart received 03/28/10
Outtall
Waterbody Name stream Index Number Current Class Subbasln

NCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue coleen H. sul{ins
Governor Director
April 1, 2010
R open and Elizabeth Pycatt
39 Wild Oaks Drive
Candler, NC 2871
Natural Resources
Dee Freeman
Secretary
Subject: Issuance of Injection Well Permit
Permit No. W10100086
Issued to Robert and Elizabeth Pyesv
Buncombe County
Dear Mr. and Mrs, Pyeatt:
In accordance with your application received March 11, 2010,1 am forwarding Permit No. ❑11010t]086
for the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection
well system to be located at the above referenced address. This permit shall be effective from the date of
issuance until March 31, 2015, and shall be subject to the conditions and limitations stated therein,
Please pay special, attention to Part VH.2 of the permit and submit copies of the Well Construction
Completion form (GW-1) after construction. Please submit all data within. 30 Calendar days of
Completion of installation of geothermal well(s) to the following address:
Aquifer Protection Section (APS)
Underground Injection Control (1AC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
Additionally, your UIC system is subject to inspection by the APS. Per special condition Part II,3, in the
event that there will be multiple wells with separate Clusters, one well identification tag per `cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
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. 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 Gall me at (919) 715-615b.

Sincerely,
Michael Rogers, P.G. ( +Ilr C � FL)
Environmental Specialist
cc: Lanaou DaNfidson- Ashevilie Regional Office
Central Office File — WI0100086
Buncombe CounmBealth Dept.
Jeff Moore - Clearwzter Well DriliMa Inc.
Attachment(s)

NORTH LAROLINA
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 HERESY GRANTED TO
Robert and Eixzabetri Pyeatt
FOR THE CONSTRUCTION AND OPERATION OF 2 T-YTE SQM INJECTION WELL(S), defined in Title
1 SA North Carolina Administrative Code 2C .0209(e)(3 )(F), for the purpose of operating a vertidal closed loop
geothermal mixed fluid heat pump system. This. system is located at 39 CVild Oaks Dr., Candler, Buncombe
County IBC 2 7 15. and will be constructed and operated in accordance with the application received March i 1
201 C, and in conformity with the specifications and supporting data submitted, all of which are fled with the
Department of Environment and Natural Resources and are considered a part of this permit,
This permit is for Construction and Operation of an injection well and shall be in compliance with Title 1 5A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until March 31, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IC hereof.
Permit issued this the 1'' day of April 2010.
Coleen H Sullins, Director
� Division of Water Quality
By Authority of the Environmental Management Commission.
Permit Wi0100086 UIC/SQM Page 1 of 5
ver. 03/2010

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 not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope. alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART H — WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number (P) Qi 717-61 nip, and the Ashc%,ille Regional Office Aquifer Protection Section Staff, telephone
number (828) 21)o-z500_
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation corners) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or 'cluster' of wells shall he permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III — 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.
?. 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 W10100086 UIC/SQM Page 2 of 5
ver. 03/2010

PART IV — PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all tunes so that there is no
contamination of groundwater that will render it unsatisfactory far 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
ground water resulting from the operation of this facility.
PART V — 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 ahy
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
IZ"ILIaIalJ3T"000&I
1_ Any duly, authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, eater 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. Division 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 Wi0100085 UiC/5qM Page 3 of 5
per. 03/2010

PART N11 — MONITORING AND REPORTING REQUIREMENTS
1, All required documentation shall be submitted to.
Aquifer Protection Section -- UIC Program Aquifer Protection Section
DENR — Division of Water Quality , _shovel k� Regional Office
I636 Mail Service Center and 2t1Et0 1 J S H)- ghNk-ay 7(i
Raleigh, NC ? 7699-16 36 . wartnatloa-
Ph# 919-715-3?2)1 296-450
2. A completed Well Construction Record (Form GVV-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the :'L•h_.. ilic Regional Office within 30 days of completion
of well construction. Copies of the GVV-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in pan 11.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Asuex ilic Regional Office within 30
days of completion of well construction.
4. Anv 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.
5. 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] anv of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
($) And° failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mecbanicai or electrical failures;
(C ) Any loss of refrigerant in the system, regardless of the origin of the loss:
(B) Any recharging of the refrigerant system.
0. Wliere the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect 'information submitted in said application ar in any report to the Director. the relevant and correct
facts or information shall be promptly submitted to the Director by the Permittee.
7 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.
1 ]1 NI dki 11 S 9 4:713A@11131a MTA
In order to continue uninterrupted legal use of the injection facility for the stated purpose. the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit W10100096 UIC/5QM Page 4 of 5
ver. 03/2010

PART IX — CHANGE OF WELL STATUS
1. 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, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1).
Notification shall be submitted to the addresses given in Part V11.1 of this permit.
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 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 coin 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 that 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 packs 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 copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213 (h)(1) within 30 days of completion of abandonment. Copies shall he
submitted to the addresses given in Part VIM of this permit.
Permit W10100086 U)CISQM Page 5 of 5
per. 0312010

Rogers, Michael
From: Elizabeth Pyeatt [libba,p11 @gmail.com]
Sent. Tuesday, March 30, 2010 9:35 AM
To: Rogers, Mlchael
Subject: Pyeatt
Hello Mr. Rogers,
My husband, Robert Pyeatt, did not sign the permit application because he was out of town and not present at
the meeting.
Thank you.
Elizabeth Pyeatt

Rogers, Michael
From: Davidson, Landon
Sent: Friday, March 26, 2010 11:06 AM
To: Rogers, Michael
Subject: RE: W i0100086 Pyeatt 5QM
Attachments: image003.png
No pre -drilling inspection will be performed. Please add in the permit conditions (I think you da anyway) 24 hours notice
prior to drilling. Thanks.
Landon
G. L-Indoil Davidson, P.G.
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we.b page hCr�'h3e.enrstate,nc,us.'uamtmnl
This e-mail contains o public record which Is subject to disclosure to third
parties and the public pursuont North Carolina's Public Records Law. N.0
Gen. Stat. §I32-I, et seq. This e-mail may contain materials prepared
during or in anticipotion of a legal proceeding as port of preparation for that
legal proceeding, in which case third party or public access to it is subject to
N. C Gen. Stat. §I32-1.9 and may be denied until the conclusion of the legal
proceeding, including the completion of all appeals and past judgment
proceedings, or, in the case where no legal proceeding has been commenced,
upon the expiration of oil applicable statutes of limitatians and periods of
repose.
From: Rogers, Michael
Sent: Wednesday, March 24, 2010 3:07 PM
To: Davidson, Landon
Subject: W10100086 Pyeatt 5QM
Attached is a 5QM application for your review. Let me know if you wish to conduct a pre -permitting inspection or not.
Thanks
Michael Rogers, P.G. (NG & FL)
Environmental Specialist
NC Div of Water Quality- Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone], Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to fhe North Carolina Public Records Law and may be disclosed to third parties

9*j3z-;-Aww
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Doleen H. Sullins
Governor Director
March 23, 2010
Elizabeth Pyeatt
Robert Pyeatt
39 Wild Oaks Dr.
Candler, NC 28715
Subject: Acknowledgement of Application No. W10100086
Elizabeth Pyeatt SFR
Injecdon Mixed Fluid GSHP Well System (5QM)
Buncombe
Dear Mr. and Mrs. Pyeatt:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on March 11, 2010. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional informadon 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 Office, copied below, must provide recommendations prior to 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 a -mail at michael.rogersCncdenr.gov. If the
reviewer is unavailahle, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to http;/lh2o.enr.state.nc.us/documents/dwu orgchart.ndf.
1-99WF.I*J31 11 U 1:eurt►:�1:[Him[III V,fW:U111.IaI1�
Since y,
for Debra J, atts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Van Plemmons (Clearwater Well Drilling, Inc., P.O, Box 71, Hot Springs, NC 28743)
Tracy A, Ponder (Affordable Comfort, Inc., 19 Old Leicester Highway, Asheville, NC 28804)
Permit Application Fiie ❑IT0100096
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location 2728 Capital Boulevard, Raleigh, North Carolina 279A
Phone: [phone] FAX [phone]; FAX 2; 919-71"048 I Customer Service 1-B77-623.6748
Internet: www.rimatergualltY.gM
An E0.uv Cppomniry 1 Afrrrmanva Action Employer
Auvrall#
ngCarolina

„.......�. A%J utiJINO inu�_ !' [NVUK USE A WELL(S) FOR INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
W LLf S ,
FORTH CAROLINA
'ermit Application OR DEPARTKEkWa1DgffibWdRQNMENT AND NATURAL RESOURCES (NCDENR)
th the provisions of NCAC Title 15A: 02C.0200 -
tion and mail to address on the back gage (Please Print or Type Inforn►atign)
CLAA
DATE: r 20&
Eix;�► iiI tT.`Cia
(leave blank if NEW permit application)
A. PROPERTY OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state narne of
entity and a representative wlauthority for signature): • 1{r �� C .�} 7T
(1) MMIingAddress: 1,` ' d a AtS bk
City: cl, aA L't; State: t .Zip Code: aZ' Y I _ _ County:-
HomelOffice Tele No.: �(r,(��? a �h µ� ��_ Cell No.: ) 2A
EMAIL Address, Lh[�
(2) Physical Address of Site (if different than above):
City: State: Zip Code: County:
Home/Office Tele No.: Cell No.:
EMAIL Address:
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: ! tL N
Address; 1 1.. ' . , . I i
C” Li.k-)•
t_'. EMAIL Address: i
City: , �kIL State: Al �- Zip Code: - ► j County: U/7ec fit-
0 ff-i ce Tele No.. Cell No.
Website Address of Company, if
1. STATUS OF APPLICANT
Private: "� Federal: Commercial: REC�VEs7 l DEAR C DM
toles Rotedlon Sec ion
State: Municipal: Native American Lands: MAR I 12010
GPUIUIC 5Qlvt WeII Permit Application (Revised 7/2008) Page 'I

C, WELL DRILLER INFORMATION
f r;,
Company Name:
Well Drilling Contractor's Name: : ► �� i z�� s►' ti
NC Contractor CenificationNo.:-
Contact Person:^ �� �'ir ` l} ty ,!' EMAIL Address: 1C� r� �i�.k %�� • [.�
Address: '
�� --- -
City: � Zip Code: �_ County:
Office Tele No.: YAI--to)) — - Cell No. .4�._ r �J � ` �r�,� ���� �.24;
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: A,t+orda. ble Co"r+,
Contact Person: I r a A.. rr�n r EMAIL Address: 0- r�"d°obl� G°^ +
n ct
Address: I q 0 1 d I C z 1-�;
City: �&Skt36 l I Zip Code: County: B&,LncOrn 6c
Office Tele No.: 818 • .i54. 0404 Cell No.: 13Z6 • 175 .3DQ D
E. INJECTION PROCEDUI (on' fly de�;cnibe how the injection well(s) will be used)
G. WELL CONSTRUCTION DATA (Skip to Section H if this is a Permit RENEL)
(1) Proposed date to be constructed. _ -3- I6' / C Number of borings: rJ}1
Approximate depth of each bo` g�( et): k
(2) Chen additives to be used in clos }}p� iys'[ ie n' only those chemi34 � a s ind � +d have been approved):
R-22 propylene glycol ethanol _ other (other additives will need prior
approval by NCDENR before use) p
(a) Type of tubing to be used (coPe ,PVC, tc};
(4) Well casing. Is the well(s) cased? (check either (a.) YES or (b(j NO belo�,\1-
(a) YES if yes, then provide casing infon-nation such as b2e (steel, PVC, plastic, etc.), diameter,
dWtIi„ and extent of casing appearing above ground:
(b) INO
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonite L---ther (specify)
(b) Grout depth of tubing (reference to land surface): frorn to (feet}
If well has casing, indicate grout depth.- from to (feet)
H. INJECTION -RELATED EQUIPMENT
GPU.'UiC 5QM Well Perniii Application (Revised 712008) Page 3

Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation, The manufacturer's brochure may provide stipple mentary
inforlrtatlon.
LOCATION OF WE LL(S)
Attach two copies of maps showing the following information:
(l ) Include a site reap (can be drawn) showing; buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed weil(s) and any
existing wells) or waste disposal facilities such as septic tanks or drain fields located within tda0 feet of the
geothermal heat primp well system. Label all features clearly and include a north arrow
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER WELL(S)
Are there any potable water well(s) on the subject property or adjacent properties? L00 YES NO
If Yes, than indicate location on attached map(s).
K. CERTIFICATION
Note: This Permit Application must he signed by each person appearing on the recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and ant 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, 1 believe [}rat the information is true, accw-ate and complete.
I an-i aware that there are sign-ficant penalties, inciuding die possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with tthheJ approved specifications aJ conditions of the Permit."
Stgtattire of Property OwnerlAppl 'ant
1izrr4 i. -A,
Print or Type Full Name
Signature of Property Owner/Applicant
Pratt or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to;
RECEIVED 1 DENR r ❑AU
North Carolina DENR-DWQ Aquifer pmlactlon Section
Aquifer Protection Section MAR I 12010
UIC Program
1636 Maul Service Center
GPU/U IC 5QM Wc11 Permir Application (Revised 7/2008) Page 4

Raleigh, NC 27699-1636
Telephone [phone]
1
Ell
GPUIUIC 5 Q M Welt PerauIAppticatiaa (Revised W2008) Page 5

Buncombe County Tax Lookup - Property Card
Page 1 of 2
- COUNTAT OF BUNCOMBE, NORTH C AROLINA
Web Property Record Card
w B695-74-7247-00000
Owner Information
ers: ROBERT E PYEATT II
REVOCABLE TRUST
ELIZABETH A PYEATT
REVOCABLE TRUST
,ddress:
39 WILD OAKS DR
CANDLER NC 28715
Property 547 UPPER GLARY FORK RD
Location:
Taxing Districts
County: Buncombe County
Cit3,:
Fire: UPPER HOMINY
School: ENKA SCHOOL
o Owner History
Parcel Information
Status:
-iccount:
Deed Date:
Deed Book/Page:
Plat Book/Page:
l,eizal Reference:
cation:
Date Printed: 3/30/2010
Total Property Value:
421,800
Active
8199035
4/4/2005
3973 / ❑150
oo98 / a175
OWNER REQUEST
MERGE
547 UPPER GLARY
FORD RD
Mass: SINGLE FAMILY>io AC
ti eighborhood: UPPER HOMINY
SubdiNrision: ROBERT & ELIZABETH
PYEATT
Sub Lot:
z,oning: OU
Co n s ery ation / Ea s ement : N
Flood: N
Ownership History
Assessment History
Year 4 Account
Acres I Land
Bldgs
Imp�r
i Assessed
DescTExemptions
Deferred 'Taxable
200918199035 It95•7511,399,200,227,6o❑
5,50❑
1,632,3001
0
1,210,500 421,8vv
2008 �8199035 1196.75�1,399,200:227,6ov
1 5,500
1,632,300
v
1,210,5001421,800
200718199035 196.751,399,200.227,600!5,500
11,632,3001
10
1,210,5001421,800
Land Data Total Acres: Land Value:
196. Acres 1,`; 200
other Improvements Value: 5,5oo
Improv# !Description Year Units
Segment#
Units
description
Present Use
1
BARN; 2- 1 1536 Square
TORY 11975 Feet
1
I.00 Each
IHOME SITE
FORESTRY
8..)o Acres
ICLASS I
la--
183.8 7 Acres CLASS 2
k4.2,p Acres 'CLASS 3
Building Structures
Res. Building Style Sq Rsmt Bsmt Year
ID Feet SgFt Finished Built
1 RANCH 1934 1934 v 2000
Refinement Description
Foundation CONVENTIONAL
Grade Condition Value
B N 2276vo
http:llwww.buncombetax.org/PropertyCard.aspx 3/30/2010

Buncombe County Tax Lookup - Property Card
Page 2 of 2
Roof TY/MT
GABLE W/ COMP. SHGL.
Roof Structure
WOOD JOIST
Floor Finish
HARDWOOD
Interior Finish
DRYWALL/SHEETROCK
Heating
.HEAT PUMP
Air Condition jCOMBINED SYS/HT PUMP
Section
SgPt
# Stories
BASE AREA
1934
1.00
OPEN PORCH272
i.vv
I
x.vv
IRAGE
EN PORCH190
la.00
Total Building Value: 227,5oo
http://www.buncombetax.org/PropertyCard.aspx 3/30/2010

buncombe county map
N
Feet
0 30 50 120 180 240
The information provided is based on the best available data at the time of currency for all datasets. It is the requestor's responsibility to verify any information derived from the G I S dais
before making any decisions or taking any actions based on the informaion. Buncombe County shall not be held liable for any errors in the GIS data. This includes errors of omission,
commission, errors concerning the content of the data, and relative and positional accuracy of the data.

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North Carolina D T.Aa meni of Eris ,=.manr and U y. Resources
Division of lire'=a)ity
Beverly Eaves Perdue-
Gwerno; DireG _
April 1;D::
Robert and ELizabetli Pveatt
39 Wild Oaks Drive
Candler, NC 28715
Subject: Issuance nf.)Lrt "Dn Well Permit
Permit No..1xc_. k .x
Issued to Tcolie*-. ° Y beta Pvealt
Buncombe
Dear Mr. and Mrs. Pvean:
.In accordance with your application received. March 1 1. 2010, I -am forwarding Pert pri t ; ,=:: `K]ClF6
for the construction and operation of a vertical closed -loop geothermal mixed -fluid h ;='tectiou
well system to be located at the above referenced address: This permit shall he effecti
issuance until March 31, 2015, and shall be -subject to the conditions and limitations stabw trki � :.
Please pay special attention to Part VIL2 ofthe permit and submit copies of the Well ConPi-licti--a-
Completion form (GW-1) after construction.. Please submit all data within 30 calendar days, :;,
completion of installation of geothermal well(s) to the following address:
Aquifer Protection Section (APS)
Underground Injection Control (LiIC) Staff
1636 Mail Service Center
Raleigh, NC?7699-1636
Additionally, your LfIC system is subject to inspection by the APS. Per special condition Part 10, in the
event that there will be multiple wells with separate clusters, one well identification tag per `cluster' of
wells shalt be permanently tly affixed to the heating and coaling unit or other nearby permanently fixed
location in a clearly visible location according to 7C .0213(g).
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 priorto its expiration date_ As indicated in.. l p=14 this
permit is not rransferable 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].
RECEIVED I DENR t DM
Aqulter Protection Section
APR 26 2010

Z SLDENTIAL WEIR., CONMUC 7M RECORD
WELL CONTRACTOR CERTIMCA
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1817 Mal l SerAm eentar - RajWgh, NC 27a9-iSl7 P kmQ N*, (p'i Sy t 3--?oi S ext BBB. Rov. 3Z7

Mechs8iep.1 Integrity 'hest Record
(For 5QM Geothermal Heat Pump lnjection Well System)
Jj
Owner/Permittee Name:__ } h �_ _ ► —11 ; ' Permit Number. WI C I Q
Fadhty Address:
Home Phone: �� - !� t Cell Phone:
Heat Pump Contractor Name: _ --�2 IAA e-
Of6ce Phone: _ f - fJ � l Cell Phone-
Tester Name: i�-i Signature:
Date of Teat:
— !X�_f i_V�s
I Loop
Inidal Pregsure(psi)
F A Pressure(psi)
Duration Minutes
Pass {Yes or No
FIF 2
3
4
i
5
"
1 6
7
8
-
_
9
IO
_
zz
12
13
14
15
Any additional loop terming add to back of this form
CQnuumts: t 1. L 00►G
Other T t Methods and Results:
• ` -
i 1 i ■ }_ r 7 J-11
This fnnm must be Filed out and signed by the tester- The record must be received by Aquifer Protection Section 24 hours
prior to the initiation of the operation of the facility. You can send the form by mail. UIC Program, Mail Service Center 1636,
Raleigh., NC 27699 or by fax: 9I9-7I5-0588"
Mechanical Integriry Teat Form ] 112007

- - ----------------- t- - - ---- - L�-

A
V 0 iI Michael F. Easley, Govenor
�F\N
y
William G. Rosa Jr., Secrctery
r
North Carolina Department of Fnv==ent and Natural Resnanes
❑
Coleco Sullins, Director
��
Division of Water Quality
November 27, 2447
Monte Jefferson
Home Energy, Inc.
PO Box 238
Wendell, NC 27591
Subject: Geothermal Well Installation Data
Dear Mr. Jefferson:
In review of our records concerning closed -loop geothermal mixed -fluid injection well systems,
classified as 5QM type permits, we have found the following records have not been submitted
for permits where your company is listed as the heat pump installers:
• Well Construction Record (GW-1)
• Triangulation Data
■ Well ID plate installation date
• Mechanical Integrity Pressure testing data (if available)
In order to assist your clients (those who hold 5QM permits) in meeting the condition of their
permits, Home Energy, Inc. (specifically Brad Scheel) has agreed to provide the above
information no later than December 27, 2007. For future reference, as we discussed November
14, 2007, we recommend you provide this information to your clients as soon as construction is
complete to assist them in meeting the condition of their permits. Also, please remember their
permits require them to keep this information on -site as well.
To assist you, we have attached a list of permits where you are listed as the heat pump installer.
We have also attached a form to fill out the results of your mechanical integrity tests. Thank you
in advance for your cooperation and timely response. If you have any questions regarding this
letter, please call me at [phone] or Michael Rogers at [phone].
Debra Y. Watts
Environmental Supervisor
Groundwater Protection Unit
Attachment(s)
cc: APS Central Files (copy to each permit file on attached list)
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internet: ww+v.acwateraaelitv.org Lmaticw: 2728 Capital Boulevard Raleigh, NC 276P4
An Equal OpportunitylAfirrnadve Acdon Employer— 50 % Regded110°% Posi Consumer Papar
mewl l;
Talephmie: [phone]
Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

Permit No. Name
WI0400082
WI00800137
W10500145
WI0800140
W10500157
W10100086
W10700105
W10500161
W10500162
W10500163
W10500166
W10500169
W10700107
WI0800150
W10500171
W10500170
W10700094
WI08DO136
W 10500139
W10800135
W10700096
W10500143
W10700093
W10700095
W10500173
W10500174
List of Issued Permits to Home Energy, Inc.
Braden
Panigutti
Claris
Belanger
S. Martin
Combs
Cherrillo
Stein
Lauer
Blach owicz
Manning
Maloney
Latta
Duan
ENT Audiology
Griffin
Harris
Jefferson
Essick
Wilson
Stolar
Kahn
Young
Turner
Bell
Wilson Community College
Heat Pump Contractor
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Date Permit Issued
11/20/2006
11 /22/2006
101912006
2/1312007
3/9/2007
4/18/2007
511712007
6/27/2007
7/6/2007
8/20/2007
8/17/2007
10/12/2007
9/21 /2007
912 D12007
9/20/2007
10/11 /2007
7/30/2006
9/12/2006
1/6/2006
9/12/2006
9/22/2006
8/4/2006
7/3/2006
9/22/2006
not permitted as of 11/20/07
11 /20/2007
November 20, 2007

Mechanical Integrity Test Record
(For 5QM Geothermal Heat Pump Injection Well System)
Ownerr/Permittee Name:
Facility Address:
Home Phone: Cell Phone:
Heat Pump Contractor Name:
Office Phone: Cell Phone:
Tester Name: Signature:
Date of Test:
Number: WI
Loop
Initial Pressure (psi)
Final Pressure (psi)
Duration (minutes)
Pass (Yes or No)
1
2
3
4
5
i
6
7
8
9
10
11
12
13
14
15
Any additional loop testing add to back of this form
Comments:
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24 hours
prior to the initiation of the operation of the facility. You can send the form by mail: [AC Program, Mail Service Center 1636,
Raleigh, NC 27699 or by fax: [phone].
Mechanical integrity Test Form 1112007