WI0400015_GEO THERMAL_20040504

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
May 4, 2004
MEMORANDUM
To: File
From: Thomas Slusser fo
Hydrogeological Technician II
Underground Injection Control Program
Reference: UIC Permit# WI0400015
Issued to Randolph Electric Member Cooperative
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
This permit number for construction and operation of 80 Type 5QW injection wells was originally
issued in July 1996 and due to expire in August 2001. Effective February 1, 1997, this type of
injection well is deemed permitted by rule and no longer requires a permit.
On this date the 'record for this permit was removed from the UICfile database, which keeps track of
injection wells that need permits, and added to the 5QWlist database, which keeps track ofinjection
wells that do not require permits. Likewise, the paper file was moved to a drawer that stores 5QW
injection well files.
N. C. Division of Water Quality / Groundwater Section
1636 Mail Service Center Raleigh, N.C. 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us
Customer Service
1-877-623-6748
f I� � I
y -I- C9
"°ai���
�b 6� Clr �sKn
9/29.

North Carolina Deg- `.meet of Environment, Health,.a* Natural Resources
Division of .vironmental Management - Grourw._ter Section
PRECONSTRUCTION INJECTION FACILITY INSPECTION REPORT - FORM A
INJECTION WELL PERMIT NO. WI D y 0 D DATE
NAME OF OWNER 7—J-0) 1 Fl- c +12- +f - e S Cj "
ADDRESS OF OWNER Q a, 1�J ;( '40 Ar 72 c7
(Street/ road or lot and sudd'iv7sion, county, town)
LOCATION OF
�' 1,ti[_i t5
PROPOSED INJECTION
�• ice.. 7� -� ?rC �^-- ^}� a�
WELL (and source wells ,, if
k..��-� _� .] � S � "_` f �.- . e.c� -f --�
appl.icab y.orsk--
� Q � n
r'i 7L C� 'l rtG
1 . _
✓w `1 .❑ Al. ¢
(Street/ road or Sot and suddivisfor? Ctrunty, town, if d7fferent than wner's address, plus description of location on site)
� ,�rti i � u ew'j�
Potential } I
pollution source Distance from well
Potential pollution source �0.� `�� cQ�^�����µ Distance from well
Potential pollution source
V Distance from well
Minimum distance of proposed well from roperty boundary
Quality of drainage at site air-�.jr ;,� Flooding potential of site 4o�
good, adequate, poor) (high,moderate, low)
DRAW SKETCH OF S ITE (Show property boundaries, bui Id ' s, we I Is, ..patent is I po I lut ion hsources, road , approximate
scale, and north arrow,)
wi re, l
13(---,,rI

PRECONSTRUCTION Ir• 'CTION FACILITY INSPEC' 7N REPORT - FORM A
'k
C014MEWS 1-1�Ie ,mci..� Go�s. s j a 6e._`�— j r_
P II j n? d■ ..A� i ! µ- �P-�{`c f/S �,.,,--j- ' �•.'!� �. S'.. r'!�*/. �ra x `1a .� I Y•�'�-ir r r•� � f� '1�a .- fi r _ �+.,-
_r'. ... �-7' t� , �..�^�•` r, P 1 2 ,9 —'�^• 7� �tJ Ir :� "----C•7v"J f. 7 7' 41 t'-'-£i =C,_
■ n
INSPECTOR C'& nee•r- Office
WITNESSr�-
Address wSP'p rSe-cr,
WITNESS
Address
JULY, 1994

764S433647 P. @1
New, iocuroorvlai
.may .
r n r7Lj F;.I�a-
Septc. mN-i 12, 1996
_jr, 1■ . "rl
I'he 'nu motic of thic letter it to Conrrr+ cur conversation of September 11. 139E 1u A,Iuch vau nave a
vmii t ]K tie a mrmv modi.tmcama. l fie mncnticat,nn �'as requested neCaui2 large fissures were
encountered in the driilinp- of rh4, wells making the original gmiting piocedure immssible. The
mod;ficatirm that we rK: nested and were verbally granted are as fbUoi si
1. Fientonite china may be used in the lower 23; feet of the wells as needed
x Reotnnite chips mixed w)th slum of hentonite grow r6ll be used in the upper 20 feet of the
weii ordv- as mcdcd to control loss of slum.
You indicated that vrna %vould :ont'lrtri this tuodilicatioE inwriting when me o1rices m Ra,1.iegh reopen,
Thank ,6 nn n,r vow mompt as,iIWS"M
11

,i."
e
;:;~·~.-oll, •• ../~~~~~ -~-
ti -• \ ~-•;i. l ...... ~.,-. \~?;~;-/'.a..,• i..1.:..1;.:--.• :..1:'\~1,.:&! j~,,
• r" I
."? ,J •
·-l,., •
7048433647 P.01
~~ ~,;,,t~.::t5-/~.._.;,~
~~4~~~
'"I' -..,
TLJ 41
le
I
704C433j!-:47
i-re eene 0
IN
a,T,Vsis are
A r
P. 02
.., @ FAX (84V 506-6150
'Al
any Ord anti rth

PERMIT APP rAL REQUEST
Please initial and
return to iial!'enfl<t..{~
for processing.
Ted Bush ~'-/,c.
Bob Cheek p;-~L-7/1,l/c,l
Mark Milligan /1/M ?/11,
&aSF 81: ::Ha .A:ts.1.l
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James S, Hunt, Jr., Governor
Jonathan S. Howes, Secretary
A. Preston Howard, Jr., P,E., Director
July 26, 1996
Randolph Electric Membership Corp_
P.O. Box 40
Asheboro, NC 27204
Attn: Alan Holt
Dear Mr, Holt:
FMKMAI
IL 4 0 0
A0_% Kwafti7i
EDEHNR
In accordance with your application dated June 14, 1996 we are forwarding Permit No.
W10400015 for the construction and operation of an injection well system, for the purpose of
operating a vertical closed -loop heat pump system, in Randolph County. We are also forwarding a
copy of the variance granted to A. E. Drilling Services, Inc. (the project's driller) for flush mount
construction of the system.
This permit shall be effective from the date of issuance until August 1, 2001, 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 facilities.
In order to continue uninterrupted legal use of these wells for the stated purpose, you should
submit an application to renew the permit six months prior to its expiration date.
If you have any questions regarding your permit please feel free to contact me at
[phone].
Sincerely,
Mark R. Milligan
Underground Injection Control Program
40: Jerry Myles, Nesco, Inc.
UIC Files
W SRO Files
Enclosures mrrn-c:loTiicelwpdocslpermitsltra=new.rem
Groundwater Section. V�� Voice 919-733-3221 FAX [phone]
P.Q. Box 29578, Raleigh, North Carolina 27626-0578 CAn Equal Cpportunity/ATfrmcative Action Employer
2728 Capital Blvd., Rateigh, North Carolln❑ 27604 �.- = 501/o recycled/10% post -consumer paper

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A 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
Randolph Electric Membership Corporation
FOR THE CONSTRUCTION AND OPERATION OF AN INJECTION WELL SYSTEM for the
purpose of operating a vertical closed -loop heat pump system. This well system, to be comprised of
80 wells, will be located at Hwy. 220 and McDowell Rd., Asheboro, North Carolina, in Randolph
County, and will be constructed and operated in accordance p6th the application dated June 14, 1996,
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 Construction and 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 system 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 August 1,
2001, and shall be subject to the specified conditions and limitations set forth in Parts I through X
hereof.
Permit issued this the 7 day of July, 1996.
Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
PERMIT NO. WI0400015

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. 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 lockable 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.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well, to the Division of Water Quality (Division), within 30 days of completion of well
construction.
PART II-WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall
notify the Groundwater Section -Underground Injection Control (UIC), Central Office
staff, telephone number [phone].
PART ill-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.
PAGE 2 OF 7
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.
PART IV-PERFORMANCE STANDARDS
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 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 groundwaters 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 any 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 Groundwater Section -Underground
Injection Control (UIC), 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.
PAGE3 OF7
PART VI -INSPECTIONS
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 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.
PART VII -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 Winston-Salem Regional Office, telephone number
[phone], 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.
PAGE4OF7
PART VIII -PERMIT RENEWAL
The Permittee shall, at least six ( 6) months prior to the expiration of this permit,
request an extension.
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 that well must be permanently abandoned
according to 15 NCAC 2C .0113, 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 15 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 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.
PAGE 5 OF7
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as
specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion of
abandonment.
3. The written documentation required in Part IX (I) and (2) (G) shall be submitted to:
Groundwater Section -UIC Staff
DEHNR-Division ofWater Quality
P.O. Box 29578
Raleigh, NC 27626-0578
PART X -OPERATION AND USE SPECIAL CONDmONS
1. The fluid to be recirculated in the vertical closed-loop heat pump system shall be
potable water.
2. The material used to make up the heat exchange loop must be composed ofhigh-
density polyethylene or polybutylene pipe.
3. The high-density polyethylene or polybutylene pipe must be thermally fused according
to the manufacturer's specifications and must not leak after assembly.
4. Upon completion of drilling of each well, the closed-loop pipe must be installed and
grouted without delay due to the cave-in potential of the uncased hole.
5. A high-solids bentonite slurry composed of twenty to thirty percent (20-30%) by
weight solids must be used as grout and must be emplaced from bottom to top of the
well in a continuous operation through a pipe lowered to the grouting point.
6. The full length of the hole shall be grouted.
7. The diameter of the hole must be of sufficient size to allow placement of the pipe and
of a pipe to emplace the grout. The grout must fill the hole and surround all pipes.
8. When the closed-loop heat exchanger is removed from service, the pipes must be
filled with a high-solids bentonite slurry.
PERMIT NO. WI0400015
PAGE6OF7
ATTACHMENT 1
PERMIT NO. W10400015
The injection facility design incorporates 80 wells on a 20 by 20 foot grid, each one a closed
loop within a borehole which will extend from a depth of 5 feet below ground level to a depth
of 255 feet (variance) and which will be grouted from bottom to top (full length) with a high -
solids bentonite grout. A trench filled with soil, sand, and/or bentonite will extend from the
top of each borehole to the surface and will contain the lateral lines.
Land surface - _ - _ - - Trench
Header/pipe system -variable design Soil Fill
•` ll -
VERTICAL "CLOSED LOOP
: ► INJECTION WELL, USING
•�: UNCASED BOREHOLE
li II ;•;--`; 11 i 1
I1
'4 High -solids bentonite
Sampling port -
Iinfluent
Housing wall
Sensing ports
HP
Sampling port -
effluent
PAGE 7 OF 7

State of North Carolina
Department of Environment,
Health and Natural Resources 1 •
Division of Water Quality
James B. Hunt, Jr„ Governor
Jonathan S. Howes, Secretary EDE H N iZ
A. Preston Howard, Jr.. RE.. Director
A.E. Drilling Services, Inc.
Two United Way
Greenville, SC 29607
Attn: Mark Lassiter, P.G.
Subjects: Request for Variance - NORTH CAROLINA WELL CONSTRUCTION STANDARDS
Rule 15A NCAC 2C .0213(d)(1)(A)
Randolph Electric Membership Corp.
Hwy. 220 and McDowell Rd.
Asheboro, NC
Permit No. WI0400015
Dear Mr. Lassiter:
This is in response to your letter of June 25, 1996 requesting approval of a variance from the
referenced Rule. Rule 2C .0213(d)(1)(A) requires that injection well casing be installed which extends
at least 12 inches above land surface. Your letter indicates that the subject wells can not be
constructed in accordance with this Rule due to the engineering design of the injection system.
Factors that would act to mitigate any potential problems which could adversely affect human
health and/or the effective operation of this well, because of not meeting this regulatory requirement,
are as follows:
1, Upon completion of drilling of each well, the closed -loop piping will be installed and
grouted without delay_
2. The annular space of each well will be grouted full length from bottom to top with a high -
solids bentonite slurry. The grout will be emplaced in a continuous operation through a pipe
lowered to the grouting point. This construction method will provide an adequate seal and
prevent the vertical migration of contaminants by way of the borehole.
3 The fluid to be circulated in the vertical closed -loop heat pump system will be potable water.
d. The proposed flush mount construction will provide for adequate protection of the well
bead.
Groundwater Section, Syr Voice 919-733-3221 FAX [phone]
t'.7. t3nx 29578, Raleigh, North Carolina 27626-0578 An Equal Opportunity/Affirmative Action Employer
2728 Capital Blvd., Raleigh, North Carolina 27604 50% recycled/10% past -consumer paper

Mr. Mark Lassiter, P.G.
Variance to 15A NCAC 2C .0213
Page2
Based on my review of the available information and recommendations by our staff, it is my
finding that the combination of factors specified above are sufficient to satisfy the conditions for
approval of variance from ISA NCAC 2C .0213 (d)(l)(A) as defined in 15A NCAC 2C .0118. On
that basis, and with the additional requirement that you notify the Winston-Salem Regional Office
at [phone], at least 24 hours before any well construction activities are begun, the requested
variance from Rule 15A NCAC 2C .0213(d)(l)(A) is hereby granted.
The granting of this variance does not affect any of the other requirements of the WELL
CONSTRUCTION STANDARDS or of the requirements of any other applicable laws or rules.
?----DATE: 1/~c,1,,
Ted L. Bush Jr., Assistant Chief
Groundwater Section
Division of Water Quality
cc: Alan Holt, Randolph Electric Membership Corp.
Jerry Myles, Nesco, Inc.
UIC files
WSRO mnn-c:office\wpdocs\Sx25perm\variancc.rcm
GROUNDWATER SECTION
August 13, 1996
MEMORANDUM
To: Sherri Knight
Groundwater Section
Winston-Salem Regional office
From: Mark Milligan
UTC Program
Groundwater Section
Raleigh Central Office
Re- Permit No. W10400015 issued to Randolph Electric Membership Corp. for an injection
well system.
A new permit for construction and operation of an injection facility at Hwy. 220 and
McDowell Rd., Asheboro, NC has been approved by RCO-UIC. A copy of the application,
required variance, and permit is enclosed for your UIC files.
Please inspect the proposed injection facility site to verify the locations and
construction plans specified in the application and to verify compliance with NCAC 15A 02C
.0200 standards, using either the enclosed Preconstruction Injection Facility Inspection Report
(form A) or the enclosed Ii jection Facility Inspection Report (form B) as appropriate at the time
of your visit.
Return the appropriate completed inspection reports by August 30, 1996 (within 2
weeks). The boarings containing the closed -loops and the header pipes will be completed below
grade. Therefore, if inspection cannot be accomplished by this date, please inform RCO-UIC
promptly.
cc: UIC Files
Enclosures
mrm-c: ofi ice�wpdocslpermits4sknmop.rem

Please return the completed Application package to:
GW-57 HP (October 1994)
UIC Program
Groundwater Section
North Carolina DEHNR-DEM
P.O. Box ·29535
Raleigh, NC 27626-0535
(telephone: [phone])
Page 4 of 4
~
!= --..,,
:x -...
U1 w
0
"' ;t
c,::O :JO,.,,
(":,~ C-! 4!<
Or,'l .• .,.c:, ::::::, p,..,
;;::=c
;o2:
::0 (/)
r-r;
fl
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
WITH A HEAT PUMP SYSTEM
Class 5 Wells
TO: DIRECTOR, NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
DATE: (- t , 19 94
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 part of this APPLICATION.
Please type or print clearly.
A. PERMIT APPLICANT Name: W C.Lk Etec4r i e- ers � Car p
Address: ' D a I!Lt 4LIQ I ! 5 c bard
City: Zip code:_ ' '. `T2a-'
County:„s r1 Qm,z: a A
Telephone: 14 3 �i 4Q ba5-�r7� `'
B. STATUS OF APPLICANT
Federal State Private
Public Commercial V Other
Native American Lands
C. PROPERTY OWNER (if different from applicant)
Name:Ti
Address: 'J ,q 14w, =_ .�. Nor�J,
City: L"SI-e �aar a ('J.C. Zip code: ❑
County: -
Telephone: q 10 L 2L` 5 i
D. FACILITY (SITE) DATA (Fill out ONLY if the Status of Owner is Federal, State, Public or Commercial)
Name of Business or Facility: -nc oQ� t r 'i o
Address: i a 4 1.+
City: t.C. Zip code. .97a03
County: cceaL�.• [
Telephone: r ro s e 7
Contact Person: 6 1u.Y, 1 ter, I i-
E.
HEATING CONTRACTOR DATA
Name: Sf-") error ly"e&O, r—._L1_ 1 _
Address:
City:
Counry:
Telephone:
Contact Pers
F. IN]ECTION PROCEDURE (Briefly describe how the injection well(s) will be used..)
W e.l S ic, I7G A xci C� O' r e1. Loop
G. 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
(b) Your personal consumption.? YES NO
GW-57 HP (October 1994) Page 1 of 4

H. CONSTRUCTION DATA . (check one)
(2)
(3)
(4)
(5)
(6)
(7)
NOTE:
EXISTING WELL being proposed for use as an injection well. Provide the data
in (1) through (7) below to the best of your knowledge. Attach a copy of
Form GW-1 (Well Construction Record) if available.
PROPOSED WELL to be constructed for use as an injection well. Provide the ·.
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after construction.
Well Drilling Contractor's Name: Pt. E ' :v; I\\ I 'n q 'S .c2.rv; C. es:
NC Driller Registration number: q 9 3
Date to be constructed: J \.L.li -S ept 9 ~ Approximate depth: ___ t_S-'S'----1
------
Well casing: NA \'' 'fo~e,'\l-e.~ Ge.a p,p.tl.
(a) Type: Galvanized steel __ Black steel __ Plastic __ Other(specify) ______ _
(b) Inside diameter: ___ inches; Wall thickness ___ inches or schedule# ___ _
( c) Casing depth: From el S S to .5 ft. (reference to land surface)
Casing extends above ground r/ A-inches (must be at least 12 inches)
Cement grout: \]0 \e,\o,_'f ;.o 'b So\"J.c; 'B4;1-k ~ c; ro-u¼ F~ bo 'tt•W\.-... ;l~5'
1 -+ o -40 p 5
1 ~
(a) Around inner or "primary" casing: From. ___ to __ ......,;ft.
(b) Around outer (pit) casing, if present: From ___ t.o ___ .ft.
Screens (if applicable): NA
(a) Type: ______ ; Inner diameter: ______ inches
(b) Depth: From ___ to ___ fe.et below land surface
Gravel (if applicable): From (Vft to ___ feet below land surface
N.C. State Regulations (Title ISA NCAC 2C Section .0200) require the pennittee to make
provisions for monitoring well head processes. A faucet on both influent (groundwater entering heat
pump) and effluent (water being injected into the well) lines is required. Will there be a faucet on:
(a) the influent line? yes~no__ (b) the effluent line? yes_r_no __
THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
I. PROPOSED OPERATING DATA
(a) Injection rate: Average (daily) __ ----cg allons per minute (gpm)
(b) Injection volume: Average (daily) gallons per day (gpd)
(c) Injection pressure: Average (daily) p ounds/square inch (psi)
(d) Injection temperature: Annual Average degrees F
J. INJECTION FLUID DATA
(1) Fluid source. If underground, from what depth, formation and type of rock/sediment unit will the
fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth: ______ .Formation: ______ Rock/sediment unit: _____ _
(a) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,
provide the data in part H (1) through (7) of this application form to the best of your
knowledge.
(2) Chemical Analysis of Source Water. The following chemical characteristics MUST accompany this
application:
pH ___ ; Total hardness ____ ppm (parts per million or mg/I); Iron ____ ppm;
Chloride ppm; Nitrate ppm; Coliform bacteria counts/100ml.
NOTE: Assistance in determining these values may be obtained by contacting (a) your local or county
health offical, (b) a commercial water-testing laboratory, (c) your well drilling contractor, or
(d) the regional Hydrogeologist, North Carolina Dept. of Environment, Health, and Natural
Resources.
GW-57 HP (October 1 994) Page 2 of 4
. ,.
K. 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. The manufacturer's brochure, if
detailed, should satisfy (1) above
L. TOPOGRAPHIC MAP
Attach a scaled topographic map which extends one mile beyond the property boundaries of the
facility and indicates the location of the facility.
M. LOCATION OF WELL(S)
Attach a detailed, scaled map of the site of the facility, showing the location of and distances
between the proposed wells(s) (source wells and injection wells) and any waste (including hazardous
waste) treatment, storage or disposal facilities; buildings; property boundaries; surface water bodies;
and any other potential source of groundwater contamination. Additionally, indicate on the map the
direction and distance to existing wells (injection wells, water supply wells, dry wells, abandoned
wells) located within 1,500 feet of the proposed injection well(s). Include with the map a description
of each existing well, incorporating type, construction information, date drilled, and depth. Indicate
on the map at least two nearby reference points such as roads, road intersections, streams, etc., and
identify them by US, NC or SR (county secondary roads) numbers or name. Label all features
clearly. Include a north arrow on the map to indicate orientation.
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 construct, operate, maintain,
repair, and if applicable, abandon the injection well and all related appurt;enances in accordance with the
approved specifications and conditions of the Penn~' f
11 a11N!l> ~f ~ I ec,Y./, .. c /Jf -ew.be,tts/: I' 40
~~~~ l pf!f!.. Ria Ad;/o1f-
< ignature ofOweiorAuthorized Agent)
Please supply a letter signed by the owner
authorizing the above agent, if authorized agent is signer.
0. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights
in the well being constructed. A well is real property and its construction on land rests ownership in the
land owner in the absence of contrary agreement in writing.)
GW-57 HP
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as oulined in this application and that it shall be
the responsibility of the applicant to ensure that each injection well conforms to the Well
Construction Standards (Title 15A NCAC 2C .0200)
Name of Property Owner (Print): Ila ut/4 ?t;: ,£It el, ,c (!f_~,,, J,el' ,,.J: j(f {/, ¢
Mailing Address: fl'~• ~t>l t/-0 _ ._
/1.sA-e b tJr() A/C ~ ~ 2-0 f
(October 1994)
,
;( a µc/4 (A ,E fech: C ,II/ entft'-r$/,,,,-tJ,.~ · aa_ 1. !Wt: /ii-re, //iec fr;J,~J
Page 3 of 4
(Signature of P(operty Owner if Different
From Applicant)
_ E. l O I -C • P • {) • Box .!. 3 4 Mon t 8 ~ , N • C •
(704)843-3 2 ~1 Fax (704)843-j 647
FA. TRANSMITTAL
06/19/96
TO: MARK LASSITER A.E. DRILLING [phone]
FROM: JERRY MYLESt NESCO INC.
,t OF PAGE ' ') r--
MESSAGE: JOB SITE CONTACTS AND MAP
GENERAL CONTRACTOR
PROJECT MGR.
SUPERINTENDENT
MECHANICAL CONTRACTOR
PROJECT MGR.
<'.1r~~
Us
'1.~o
H. C. Rt-, LlAh E
GREG RUSHING
C A L V I: \, ALL\ : E
SUPERIOR MECH
GREG GENTRY
704 289 640 2
910 629 2924
910 498 7217
--~
l-1-li 'i :-(-<.(
, To.k f)\c'b~ fl Ly.·,1 ~
\tllD soc.dl -,-( ll-4HL/ J~~ ·
l L fkR~'i\, + -I (J..P\ ~:,k+ . \
job <5 i"~ is ~r~ W+J
68 — Section Four
Earth Coil Type:
Water Flow:
Pipe Sizes:
Bore Lengths:
Pipe Lengths:
Vertical - Single U-Bend
Parallel
314- or 1-inch loops, 1 1/2-
or 2-inch headers
175 t❑ 225 feet/ton
354 to 450 feet/ton
i I
FlC�lR - ;�araife� Vsr�ica*-�Grv�nd.: ._...._------ .gem`• - : _ -

Grout Placement Methods - 23
RFGURE 40: Grout Pipe Method with Pump

-----·---·--------
FOR MAIN BLDG .
26. POLY SUPPLY
AND RETURN
88 GPM HEADER
I TrP . )
4 EACH
3 #350
AND 1
3-1/2" CONDUITS.
MCM & 1 #350 MCM
#2 GROUND
EACH WITH
NEUTRAL
ENLARGED-..TRANSFORMER/GENERATOR PLAN
1/8' = V -0"
I' PVC CONO, W/CONTROL WIRING
LEADL/LAG CONTROL TO ODC CONTROL PANEL IN BASEMENT
PP2-20,22.24 UMP P-3� LIGHT SWITCH
Pump P-i STARTER Big A.F.F.
STARTER
P2-14.16.i6
SUMP PUMP EQUAL TO ARS PUMPS
MODEL #i20T8. 1/1 HP, 120VAC,
15 GPM AT.15 FEET HEAD, WITH
AUTOMATIC FLOAT SWITCH OPERATION)
1' PVC DRAIN UP
WP -GFI
RECEPT. PS-7
x iB''A.F F.
C3. _ .. LIEF j
_ - z ' - _ i • O■ �(' '4• BACKFILL W/CLEAN
- f fir„„ rC
DRIVEN SRND. RM
RIF=ER
:� : •��.._• ::., �.d-h;-�, .• # � - •6 PVG sItPPLr.
'' POLY
---" 7 TRIPLE DU Y - -w
ALyE P.
B• pv0- RETURN
-l21. POLY
BuTT"FCY -1
�U17ERFLY OFi .BALL YALYE .t T'tP. } CFILINB 11QiRiTEQ LIiNT EQL}A1. T;..TRANSITION
�4- A. WEAL 1!}LTEfl - CIRCUIT SETTER [ TYP . i :.'P%YETHELE
7LPPi�TDN SVA18M. ' iBSY.r
no". C i ]`P:.} MED.-BASE LW
A. �� _ YAi ICE' i 1'F
► .L EWA8 t4 --PIPl'N PLAN = f' _
. - ilHDER-%VAUL
^'�-ter ..t =�. �.. --�• i•••- .7. _ :L�^c', �. yM.�A._ _
'�1y{[-'+y+ ± a-•'7r��'.� - ,. �� S '.i'+•-.'t'� 3 A ■� _ . i 4 • T`S: _.. � '_K_ . •.Y •v - ,i - - N •i^`
=�yy%�': �-'L�:IT= � -k'-'-+L��+�-rL_'�.Y~��'Y� r� •�• s~I �`�.' �� =-4. :� -y34i ..''ti y•T'" _ _ -�..
..ar��.-.�xr���i�':��"�.rl'i.�r.•��a..J"7'7'.F. ?i.►`,`� L-^F: �t'�i�.ti_-..Sw�+'a�'+Yw �s�t,r.:i("i.L•�r�__��"a:Yy •__-�.wtivial:W�'lf'.''C_'.`.i�""•r(r�ai.'� -
Y+;ncr_-1eS 7�. 1 —P.-V :"r �,7fi•.:� {EI' SSA•_``
--�-

PLAN
PUMPS
l20VAC,
: VITH
OPERATION)
LEVIS HANGER ITYP.)
ONCRETE ANCHORS (TYP.)
ALV, HANGER ROD (TYP, )
v
3 #10 IN 3/4' CQNDl ;
CIRCUIT PI-1--
]ENOTES:
POLYETHELENE PIPING FROM VAULT TO WELLS AND
INCLUDING PIPING IN WELLS TO BE INSTALLER BY
I6SHPA CERTIFIED CONTRACTOR.
IGSHPA - INTERNATIONAL GROUND SOURCE HEAT PUMP ASSOCIATION
HEADQUARTERS AT OKLAHOMA STATE UNIVERSITY
TELEPHONE f1-800-626-1741
BUILDING S:
NOT TO SCALE
2' GALV. PIPE
GOOSE NECK
{PAINT SAFETY YELLOW)
12'
LJ w
LT. SW. aix
1`Pc
a
r
1
BUTTERFLY 1.4 t
��• aILVE ( TYP. ] r a
P�VC HEAD ER
VPer�j
CHECK VALVE �
UrRADE
UNION
AS RED
' I l - Y E v PVC
FFM WELLS
1 RAf48ITION.FRDN PVC_ TD '
�•.• 13ACKFILL Y/CLEAN SAND
+" • PIPE -SUPPORT TYP. ] f NO ROCKS)
T]iEL,EiI PIPE IN E
r .YA�lL 't TYPx _ r 21x24X24 DEEP SUMP 'PITS i Ur#P P4lMP .
}tee• f'-'b" •:'�::' �:.. _a;:"_ __ � - =-�• - _
_ VAULT .MECHANICAL -.PIPING SECTION A -A
- �tV.'.. f.. �:F'. ••�: c �•'� _• - � t .[iF:- • .Z:-r• yi t�•S•:AeL •w':Y,,.�Jy'•�.:.��. i- __ - • ��•w.
ti.. �yv.�.�ra-,:.y..�-�+. •,,� _ s.Y����� •S o.;�'F1r �~-`� r"'"'S+ •� _ — _ - T -ti• � i S i'Li'y.C;; '."
yr � "�.�� .a.•= f.: r,:; y �.Z': - - r:-"r _'�i3 � .a._. g_�.-: �`Fy�' _ .��,•.�^- - R'}$�„•:y r.. �'w .Lis"'"•�-'
',��.-4�F :ray . �*�° `'n�+-.-�"• _ .fit ='s� �-� - - - - -'-y.:1-' `-_ham �se'�;,`1.:+ • .-"}s. •r- 4.�-. -_. .4,; �• - ' �' �_' - �-Sr.i.:
• �?�•-•-"�'!'�:.�:•°•��- .i��+i:i:-� ^ - .-{ '� �:� :i �J •s', Yam; x#-' � •., `:• S�'.r'• V . � r't• . r.. =.'t _y .. :'+'
krKFILL P•uD
;;; ROCKS)
5::
2' FOL1 -70 AtLS
IN-LI
BOOST
PUMP -
TRIPLE
Du"Y
VALVE
it
6 OC WATER TEKP
•i 4 yyf SENSOR y�.�/�
y Si 1fy READr,R 'i
ii r1'TEXPERA T
PRESSURE
( TYP. )

f
QiRr`
�18t• kH LSE �W H*rRA/A7
r
U.
th Sound h111 • 2
20
s$
Guth
pojnt4,
X-j . =rna7� . I o tj•4C.,
point
ft a all
rF.v PM
so
Op �.
R }}
art

l�
lI
I 110 GAL. SHOT 6' GATE VALVE (TYP.)
I FEE❑ TANK. SEE On STRAINERS
JOETAIL ON PHIS SHT. DOC SV5
AIR SEPARATOR 1
I I 6x4 REDUCER
2-1/2" C.W. MAIN I 0�---
I REDUCED PRESSOR 6 "
I I BACKFLOW PREVEN fR � -
3"+ 13„WATTS #909-­ p f
I I BUTTERFLY VALVE-'- L'+ GAUGES "
FLEX. CONN. 1" P V
I I I ( TYP. ) _r
._.-__. -7� I I I 12 60
REDUCER
D CE eY-PASS ■ V/
CUN1 I - CIRCUIT SETTER PUMP -PUMP ■
1 T& P GAUGES P-P
I �'I om SENSOR a FLOP 0
3 WAY s I CH SWITCH
BY-PASS ` 6• BOTTOM TRIPLE DUTY
VALVE � 6" Q TEF-- - VALVE ( TYP
& RETURN r
UN HIGH
-1-1/2" S & R
- 220 CFM . __
HP-(;7'
101
x I.
FD
3`-J- CIRCUIT SETTER t�•
12x12 '
72-
.� � D vo
320 CFM
HP-
L
I 1--1�:�20 S & R-
I FD Imo. V TV
{ .4 2�0 �-
X.FD
CFM HP_
3 r • !ti p
+ - Z
0r
6-
DROP
6"
-32x1S SLEEVE THRU WALL
AT 9`0m A.F.F.
— 2-1/2' C.W. RISER
PIPE SLEEVES THAU HALL
CAULK A SEAL. WATER TIGH
6" PVC
TO VAULT & WELLS
SEE SHT. UPE-1
FOR CONTINUATION
6' PVC
- 6 ` GATE VALVE (TYP.)
-- AIRTROL FITTING
-12" CONC. PAD
-COMPRESSION/EXPANSION
TANK C-1, 16" DIA.x42"
HANG AT CEILING
-PIPE SUPPORTS UNDER 6"
LOW PIPES (TYP. FOR 5 )
-DOC SENSOR
TEMPERATURE & PRESSURE
-GAAGES (TYP. )
DOC CONTROL PANEL
-PROVIDE CLEVIS HANGERS
TO SUPPORT 6' HEADERS
FROM CEILING (TYP.) '
DOC CONTROL PANEL
FLEX. CONN . ( TYP. )
— 20x40 PLENUM ON. TO
CONNECTION ON UNIT
(TYP. FOR HP-6.7 & 8 )

• ��I p:r. `
24x24 RA
28X16 SA
x FLOOR ORATE. i-li 2 5& R
12'
ROUTE CONDENSATE DRAINS
. + VD V S & R ; , \ TO FLOOR DRAINS T•i P . 1
16xi
04 RA
�.
v CF H P\2
1 ••.
;
CFM
Yo
VD
-
vo
�-I80 C
_
RUN DUCT
HIGH J
T TYP.?
s
`�
E;. ANINE
510
V[] CFH
n�
i
x
r
HP-3
200
C^
t.
- 200
CFH
�'�
FLOOR DRAIN
■+■,■
V
THRU
;;.`
2" S & R
LOW
F, HIGH
1
Y
14x12 SA
�2-1/2"
S
R
ri-1f2"
S
& R
2.4x24 RA
a
W
w
x
gm
MOTE
MECHANICAL CONTRAi
CONNECTIONS AT PI!
SYSTEM (TYP. )

A.E. DRILLING SER VICES INC.
Two United Way
Greenville, SC 29607
Phone [phone]
FAX [phone]
June 25, 1996
Mr. Bob Cheek, Supervisor
Permits and Compliance Branch
State of North Carolina
Department of Environment, Health & Natural Resources
Division of Environmental Management
Groundwater Section
Post Office Box 29535
Raieigh, North Carolina 27626-0535
Re: VARIANCE TO NORTH CAROLINA WELL
CONSTRUCTION STANDARDS,
Title 15 A NCAC2C.0200,
Criteria and Standards Applicable to
Injection Weils
Site Address: Randolph County EMC Headquarters
Closed Loop Heat Pump System
McDowell Road
Asheboro, North Carolina
Dear Mr. Cheek:
We request a variance to 15A NCAC2C.0213 (d)(1)(A) which requires that a well casing be
installed which extends from at least 12 inches above land surface to the top of the injection
zone. The injection well construction criteria described in Rule 2C.0213 (d)(1)(A) will not be
possible due to the engineering design of the vertical closed -loop heat pump system.
Eighty (80) wells will be drilled to 255 feet deep each via 6-inch diameter downhole hammer.
The grout pipe method recommended by the International Ground Source Heat Pump
Association (IGSHPA) will be followed. The closed -loop ground meat exchanger (GHEX) loop
is immediately inserted into the bore hole. Grout is placed in one continuous operation by
pumping, beginning at the bottom of the zone being sealed and continued until it appears at
the ground surface.

Mr. Bob Cheek,· Supervisor
June·25, 1996
P-age 2
Grouting is· an important aspect of the installation of GHEX when used with a ground-source
heat pump system. Not only will it provide the proper heat transfer between the GHEX and the
ground necessary for the most efficient operation of the ground source heat pump system but
it will also provide groundwater protection.
This method of construction will prevent any fluids from entering the injection well at the surface
because all well heads will feed into a closed loop system · that is underground and out of view
from the system users.
Please contact me at [phone] if you have questions or need additic;,nal information.
MUlhs
Sincerely,
A.E. DRILLING SERVICES, INC.
A subsidi~ry of
ATLANTA TESTING & ENGINEERING
Mark Lassiter, P .G.
President
NC License No. 993