WI0400082_GEO THERMAL_20120523

Beverly Eaves Perdue
Governor
AVA
NCDENR
North Carolina Department of Environment and Natural 'Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 23, 2012
Jeffrey and Gayla Braden
1802 Pierre Park
Apex, NC 27502
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: \VI0400082
Dear Mr. and Mrs. Braden:
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 iri 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://portal.ncdenr.org/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,
£_~
Eric G. Smith, P.G.
Hydro geologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
Internet: www.ncwate rg uality.org
An Equal Opportunity\ Affirmative Action Employer
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September 6, 2011
Michael Rogers , r
NC Dept. of Environment & Natural Resources1 K-
Aquifer Protection Section
1636 Mail Service Center
Raleigh NC 27699-1636
Ref: Injection Well permit WI10400082
Located at 154 Rima Landing
Denton NC 27239
Dear Mr. Rogers,
I am responding to your letter dated August 17, 2011 regarding the information that
should have been remitted when the geothermal system was started up.
The following information is based on my personal observations of the construction and
installation of the systems. I was told that they were following all required protocol and
guidelines for the installation and that all the necessary paperwork was being handled I
did find it odd that I was asked to apply for the permit and the company did not apply,
especially since the permit was included in the description of work to be performed.
The company that installed our systems was HEI (Home Energy incorporated). They are
no longer in business and are unavailable to answer questions or produce records of the
installation. Monte Jefferson supervised the installation of the initial 5 ton unit that now
controls the main floor and basement. That unit utilizes a pit system that extends under
our driveway and under part of the garage floor. I was assured that no permit was
required for a pit system. That unit was started up shortly after the certificate of
occupancy was issued on the house in May 2008. John Webster, now an Engineer with
Earth Link Direct, supervised the installation of the second unit. The second unit was
installed within a couple of months of the start up on the first system. Originally, we were
supposed to have just the one 5 ton system, but because of the way the damper system
worked (only closing 80 percent) and the long run to the second floor from the basement,
It was impossible to cool the upstairs to 78 degrees, with the basement at 66 degrees.
John Webster was hired by HEI to evaluate the problem. It was his determination that the
second system was the only way to correct the cooling deficiency. Since we had not yet
abandoned the permit that was originally applied for in Nov. 2006, HEI determined we
could use that permit for the second system. I will say that John Webster was very
professional and knowledgeable in the operation and installation of the second system.
Looking back on the situation, I should have asked for copies of all the paperwork they
were supposed to be turning in.
The second unit controls heating and cooling to the second floor and the attic areas.
RECEIVED 1 DENR I ❑W7
Aquifer Protarlion Section

It is this 2 ton unit that utilizes the well the permit pertains to. This system uses six (6) 50
foot deep closed loop wells that were drilled in less than a 5 foot diameter in the location
shown on the attached sheet. That sheet shows the house as it is situated on the lot in
relation to the set backs, lake and locations of septic tanks. The wells were drilled on 15
degree angles flaring out from the middle. There is a 6 to 8 inch diameter access that has
a hose bib in it that could be used if the system needed service and had to be cooled
down. The manifold is between 24 and 36 inches under the ground about 2 feet out from
that access ( toward the lake). but is not visible from the surface. The location of the 6
wells is indicated on the sheet
I could not find a Well ID Plate on either of the air handlers or compressors. I have no
official Well Construction Record ( GW-1 ). I have no Mechanical Integrity Pressure
testing data. I do know that a pressure test was done on both the pit system and the well
system. I remember coming back after 24 hours and seeing the same readings on the
gauges.
I hope this letter will satisfy your requirements for continuous operation of the wells.
The systems seem to be very efficient in both heating and cooling and while we do not
live there full time as yet, the utility bills are very reasonable. We also used a spray foam
insulation and solar hot water panels to help lower utility bills and make the house more
efficient.
I can be available to meet with an inspector or representative at the house if any
inspections are necessary. I would need a couple of days notice. Please call me if
you have any further questions.
Sincerely,
Je rey N. raden
1802 Pierre Place
Apex NC 27502
[phone] cell
[phone] home
RECEIVED/ DENR I DWQ
Aquifer Protection Section
SEP 08 2011
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MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Jeffrey and Gayla Braden
1802 Pierre place
Apex, NC 27502
Coleen H. Sullins
Director
August 17, 2011
Ref: Issuance of Injection Well Permit WI0400082
Issued to Jeffrey and Gayla Braden
Denton, Davidson County, NC 27239
Dear Mr. and Ms. Braden:
Dee Freeman
Secretary
In accordance with the application received on June 6, 2011, I am forwarding permit number WI0400082 for the
continued operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system located at
154 Rima Landing, Denton, Davidson County, NC 27239. This permit shall be effective from the date of issuance
until July 31, 2016, and shall be subject to the conditions and limitations stated therein.
NOTE: During the renewal process for this permit, it was noted that the following records were not submitted
when the geothermal wells were originally installed.
• Well Construction Record (GW-1)
• Triangulation Data
• Well ID plate installation date
• Mechanical Integrity Pressure testing data (if available)
After installation, these records were required to be submitted according to requirements of l SA NCAC 2C
.02 l 3(g) 30 days after your permit was originally issued November 17, 2006. Please submit these documents
within 30 days of receipt of this pennit renewal. If you are not able to provide us with the information, please
submit to us a written justification for the missing infonnation.
Please be advised, in the event there are multiple wells with separate clusters, one well identification tag per
'cluster' of wells should be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location.
Also, please pay special attention to Part V.2. The Permittee shall retain all records of repairs, pressure
tests, maintenance, and other activities needed to maintain normal operating .conditions.
In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an
application to renew the permit 120 days prior to its expiration date. This permit is not transferable to any person
without prior notice to and approval by the Director of the Division of Water Quality.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588 ; FAX 2: 919-715-6048 \ Customer Service : 1-877-623-6748
Internet: www.ncwaterguality.org
An Eoua l Opportun ity Affi rmative Act i:::in Employer
RE~EIVED I DENR I DWQ
Aquifer Protection Section
SEP 08 ZOU
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Please contact me at [phone] or michael.ro [e-mail] if you have any questions about yo_ur permit.
cc: Sherri Knight, Winston-Salem Regional Office
WI0400082 Permit File
Davidson County Environmental Health Dept.
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Michael Rogers, P.G. ;C J;;---
w~ rj<f fi </cf BL
When sending a renewal application, send an additional application to an additional address
in case they move: 154 Rima Landing, Denton, NC 27239
Central Files: AP5 SWP
❑8/18111
Permit Number W10400082
Permit Tracking Slip
Program Category
Status Project Type
Ground Water
Active Renewal
Permit Type
Version Permit Classification
Injection Mixed Fluid GSHP Well System (50M)
2.00 Individual
Primary Reviewer
Permit Contact Affiliation
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Jeffrey N. and Gayla S. Braden SFR
Location Address
154 Rima Landing
Denton NC 27239
Owner
Owner Name
Jeffrey
Dates/Events
N Braden
Scheduled
Drig Issue App Received Draft Initiated Issuance
11/17/06 08/06/11
Regulated Activities
Neat Pump Injection
Major/Minor Region
Minor Winston-Salem
County
Davidson
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Jeffrey N. Braden
1802 Pierre PI
Apex NC 27502
Public Notice Issue Effective Expiration
08/17/11 08/ 17/11 07/31 / 16
Re.. uested/Received Events
RO staff report requested 06/17/11
RD staff report received 08/12/11
❑utfall
Waterbody Name Stream Index Number Current Class Subbasin

Permit Number WI0400.082
Pr.ogram Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
m ichael. rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Jeffrey N. and Gayla S. Braden SFR
Location Address
154 Rima Landing
Denton
Owner
Owner Name
Jeffrey
D ate s /C::vents
NC 27239
N Braden
Scheduled
Orig Issue
11/17/06
App Received Draft Initiated Issuance
06/06/11
Re a ulated Activities
Heat Pump Injection
Outfall t,}UL!...
Central Files: APS_ SWP_
08/12/11
Permit Tracking Slip
Status
In review
Project Type
Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Jeffrey N. Braden
230 Joshua Glen Ln
Cary NC
Major/Minor
Minor
Region
Winston-Salem
County
Davidson
Faclllty Contact Afflliation
Owner Type
Individual
Owner Affiliation
Jeffrey N. Braden
1802 Pierre Pl
Apex
Public Notice Issue
NC
Effective
Reg uested/Received Events
RO staff report requested
RO staff report received
27519
27502
Expiration
06/17/11
08/12/11
Waterbody Name Stream Index Number Current Class Subbasin
HDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Jeffrey and Gayla Braden
1802 Pierre place
Apex, NC 27502
Division of Water Quality
Cofeen H. Sullins
Director
August 17, 2011
Ref: Issuance of Injection Well Permit W10400082
Issued to Jeffrey and Gayla Braden
Denton, Davidson County, NC 27239
Dear Mr. and Ms. Braden:
Dee Freeman
Secretary
In accordance with the application received on Tune 6, 2011, 1 am forwarding permit number W10400082 for the
continued operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system located at
154 Rima Landing, Denton, Davidson County, NC 27Z39. This permit shall be effective from the date of issuance
until July 31, 2016, and shall be subject to the conditions and limitations stated therein.
NOTE: During the renewal process for this permit, it was noted that the following records were not submitted
when the geothermal wells were originally installed.
■ Well Construction Record (GW-1)
• Triangulation Data
■ Well ID plate installation elate
Mechanical Integrity Pressure testing data (if available)
After installation, these records were required to be submitted according to requirements of ISA NCAC 2C
.0213(g) 30 days after your permit was originally issued November 17, 2006. Please submit these documents
within 30 dam of receipt of this permit renewal. If you are not able to provide us with the information, please
submit to us a written justification for the missing information.
Please be advised, in the event there are multiple wells with separate clusters, one well identification tag per
'cluster' of wells should be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location.
Also, please pay special attention to Part V.2. The Permittee shall retain all records of repairs, pressure
tests, maintenance, and other activities needed to maintain normal operating conditions.
In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an
application to renew the permit 120 days prior to its expiration date. This permit is not transferable to any person
without prior notice to and approval by the Director of the Division of Water Quality.
AQUIFER PROTECTION SECTION
1636 Mail Service Cerner, Raleigh, North Carolina 27699-1636
Location.; 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] � FAX t 919-715.0588; FAX 2: 919.715-60481 Customer Service: 1-877-623-6-748
Internet: wwwxcwatemualili o-,
Gnu
Ar+ Equal Dpgnnumly ) Affitmaws AL Dn Emplayer

Please contact me at [phone] or michael.ro gers(a),ncdenr.gov if you have any questions about yo_ur permit.
cc: Sherri Knight, Winston-Salem Regional Office
WI0400082 Permit File
Davidson County Environmental Health Dept.
,~~ ...
• Michael Rogers, P.G . (NC &/2L--;-
.,.
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
Jeffrey and Gayla Braden
FOR THE CONTINUED OPERATION OF TYPE SQM INJECTION WELL(S), defined in Title ISA North
Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed-loop
geothermal~mixed-fluid heat pump system. This system is. located at .154 Rima Landing, Denton, Davidson
County, NC 27239~ and will be constructed and operated in accordance with the application received June 6;
2011, 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 of an injection well and shall be in compliance with Title 1 SA 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 July 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through VII hereof.
Permit issued this the 17 th day of August 2011.
10--Coleen H. Sullins, Director tv Division of Water Quality
By Authority of the Environmental Management Commission.
WI04000G2 UIC/5QM-M.F. Renewal
Version 1/2010 ·
Page 1 of 4
PART I-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 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 riot 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. In the event that there are 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).
PART II-PERFORMANCE STANDARDS
1. 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 III-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.
W I0400082 UIC/5QM-M.F. Renewal
Version 1/2010
Page 2 of 4
PART IV -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 V -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 retain all records of repairs, pressure tests, maintenance, and other activities
needed to maintain normal operating conditions.
3. The Pennittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Winston-Salem Regional Office, telephone number 336-771-5000, 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;.
4. 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 relevari.t and
correct facts or information shall be promptly submitted to the Director by the Pennittee.
5. In the event that the pennitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VI -PERMIT RENEW AL
The Pennittee shall, at least 120 days prior to the expiration of this permit, request an extension.
WI~)4(HK)g2 UIC/5QM-M.F. Renewal
Version 1/2010
Page 3 of 4
PART VII-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 15A NCAC 2C .0213(h)(l), 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 l SA 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.
(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 VII (1) and (2) (G) shall be submitted to:
WI0400082
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
UIC/5QM-M.F. Renewal
Version 1/2010
Page 4 of 4
Ro gers, Michael
From:
Sent:
To:.
Cc:
Subject:
Michael,
Mitchell, Patrick
Friday, August 12, 2011 2:12 PM
Rogers, Michael
Knight, Sherri
Braden W 10400082
Review of 2004, 2009, and 2011 aerial photos and the Davidson County permit for the on-site wastewater treatment
system suggests that no site visit is necessary for renewal of Permit WI0400082.
After review of the application it _is my recommendation to issue the permit renewal for WI0400082.
Please let me know if you need anything further.
Patrick
Patrick L. Mitchell, LSS
NC DENR-DWQ
Aquifer Protection Section
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone: (336) 771-:5285
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
Ro gers, Michael
From:
Sent:
To:
Rogers, Michael
Friday, June 17, 2011 4:36 PM
Knight, Sherri
Subject:
Attachments:
WI 0400082 Braden 5QM Renewal
Braden 5QM Renewal.pdf
Sherri-
Attached is a SQM geothermal renewal application. Please let me know if you wish to conduct a pre-permitting inspection
or not.
Thanks
Michael Rogers, P.G. (NC & 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)
http://portal.ncdenr.org/web/wg/aps/gwpro/permit-applications#geothermApps
E-mail correspondence to and from this a·ddress may be subject to the North Carolina Public Records Law and may be disclosed to third parties
1
A.VA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
June 8, 2011
Jeffrey Braden
Gayla Braden
1802 Pierre Place
Apex, NC 27502
Subject: Acknowledgement of Application No. WI0400082
Jeffrey N. and Gayla S. Braden SFR
Injection Mixed Fluid GSHP Well System (SQM)
Davidson
Dear Mr. & Mrs. Braden:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on June 6, 2011. 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 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 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 e-mail at [e-mail]. 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 Tms PROJECT.
Sincerely,
/QI~~
Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Permit Application File WI0400082
AQUIFER PROTECTION SECTION
1636 Mai! Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX·1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Servic€): 1-877-623-6748
Internet: www.ncwaterauali ty .o rg
An Equai Opportur.!l'.' I Affirmative Action Employer
NOnel C 1· ort1 aro..1na
lvatura/f/J
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 02C .0200
CLOSED-LOOP MIXED-FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids other than potable water as part of a geothermal heating and cooling system
(check one) __ New Application ~Renewal* Modification
* For renewals complete Parts_A-C and the signature page.
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: J L(e 6 {o , 20-1.l
PERMIT NO. ~ 0 '-(DO OU~(leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non-Government:
Government:
Individual Residenc~ Business/Organization
State__ Municipal__ County__ Federal
B. PERMIT APPLICANT -For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
"\ & ff a t: Y t= G-.;1--J u-Zl4-i2c .Al
) I
Mailing Address: (8rJ ~ {I 6 {l./Lc /'?4-z;::.c
City: _,4/f,!t6 State:~ip Code: ) ~:l...., County: c.-JAh;;c-
DayTeleNo.: C/19 -:]GJ ,-,?'OO :I= CellNo.: '£]<../-J/7'-l
EMAIL Address: Fax No.: ...
C. LOCATION OF WELL SITE-Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: _________ County: ~t/lDJ \l .A.I
(2) Physical Address (if different than mailing address): J ~'( f2-.; MA LA},-' l)//f,/ <f
City: l)bN'TD ~ State: NC Zip Code: __ ;}~?-_.;>._:f_9 __ _
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name: _______________________ _
NC Well Drilling Contractor Certification No.: ___________________ _
Company Name: _____________________________ _
Contact Person_: ______________ E_MA_I_L_A_d_dr_es_s_: _________ _
Address:--------------------------------
City: _________ Zip Code: ____ State: __ County: ________ _
• Office Tele No.: ________ Cell No.: _Fax~N~o._: _______ _
GPU/UIC SQM Permit Application (Revised 1/24/2011) Page 1
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: __________________________________ _
Contact Person.:....: ---------------=E=M=A=I=L=--A=--=d=dr=e=s=s:'-------------
Address:--------------------------------------
City: _________ Zip Code: ___ _ State: __ County:
Office Tele No.: _________ Cell No.: __________ =--F=ax=----=-N_:_:o=----c. . .c._: _______ _
F. WELL CONSTRUCTION DATA
(1) Number of borings to be constructed*: _____ Depth of each boring (feet): ________ _
* If existing water supply wells will be used then provide the information in item (4) below.
Ethanol (2) Chemical additives to be used: R-22 __ _ Propylene glycol __ _ ---
Other _________ (other additives will need prior approval byNCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): _______________ _
(4) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, plastic, etc.), diameter, depth,
and extent of casing appearing above ground: __________________ _
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite** __ Other (specify) _______ _
** By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C .0213( d)(l )(A), which requires a cement type grout.
(b) Grout depth of tubing (reference to land surface): from ___ to ___ (feet)
If well has casing, indicate grout depth: from ____ to ____ (feet)
G. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearly and include a north arrow.
( 1) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or
elevation data.
GPU/UIC SQM Permit Application (Revised 1/24/2011) Page2
A. CERTUICATION (to be signed as required below or by that person's authorized agent)
1 SA NCAC 02C .0211(b) requires that all permit 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 the well owner (which means all persons listed on the property deeds.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"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 appurtenances in accordance with the approved specifications and conditions of
the Permit."
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUMC 5QM Permit Application (Rv�ised 1/24/2011) Page 3

Michael F. Fasley. Governor
William G- Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W- Kiimck; P.E. Director
Division-of•Water Quality
November 17, 2006
Jeffrey and Gayla Braden]
titer t 5 �e IwIM �9L 011) 3�3 7
_;, N49 { >� 18OZ P/&7Uj5 P C&U, AJuM 0572 (qrq) 430 -1l 7 �
,`9P&7( n!C -Z7soz
Re: Issuance of Injection Well Permit
Permit No. W10400082
Dear Mr. and Mrs. Braden:
61VVr7)L_� 5r
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In accordance with your application dated July 24, 2006, and received August 4, 2006, I am
forwarding Permit No. W10400082 for the operation of a vertical closed -loop geothermal
mixed -fluid heat pump injection well system to be located at 154 Rima Landing, Lot #30 Harbor
Gate, Denton, Davidson County, North Carolina. This permit shall be effective from the date of
issuance until October 31, 2011, and shall be subject to the conditions and limitations stated
therein.
Pay -special- attention to the- well -consffuc#ion'"standards in Parts II and V of your permit.- You
must notify this office (Raleigh Central Office) and the Winston-Salem Regional Office at least
forty-eight (48) hours prior to constructing the system, and forty-eight (48) hours prior to
initiation of the operation of the system.
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.
;0(0 5C e-e-P7- 777 5 z9'5 /�) Y 967�5i 7d I2�
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Carolinaurally
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699.1636
Internet hrWWwww.ncwateroualitv.orz 2728 Capital Boulevard Raleigh, NC 27604
An Equal OpportunitylAi4rmat ve Action Employer- 50% Recycled/10% Post Consumer Paper
Telephone; [phone]
Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

If you have any questions regarding your permit or the Underground Injection Control Program
please call Mr. Qu Qi at [phone] or me at [phone].
Best R~ards,
~~e/
Michael Rogers
Hydrogeological Technician II
cc: Monte Jefferson -Home Energy, Inc.
Sherri Knight -Winston-Salem Regional Office
Central Office File
Attachment(s)
NA
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Jeffrey Braden
Coleen H. Sullins
Director
June 6, 2011
230 Joshua Glen Lane
Cary, NC 27519
Subject: Notice of Expiration (NOE)
SQM Geothermal Injection Well
Permit No. WI0400082
Davidson County
Dear Mr. Braden:
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. Our records indicate that the above-referenced operating permit for
the underground injection well system located on your property at 154 Rima Landing, in Denton,
NC, which was issued to you on November 7, 2006, and expires on October 31, 2011, is soon
due for renewal. 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 Injection Well is Currentl v 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 pr9perty, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at htt ://nortal.ncdenr.orn:/web/wa /apsfa w pro/ren ortin 2.-forms.
If Your In jection Well 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 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by Julv 3 . 2011.
AQUIFER PROTECTION SECTIO~!
1636 Mail S.ervice Center , Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard , Raleigh, North Caroiina 27604
Phone: 919-73J-3221 \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www .ncwaterguality.orq
An Equa1 Opportunili' I Affim1ative Action Empioyer
NOnebC ... art . aro11n2
/Vatural~I/ ·
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 andlor Use a Well(s) ,for Injection with
Geothermal Heat Pump System ,far Type 5QM Well(s) if the injection well system on
your property is still active.
SDI is
B. Status of Irajection Well Svstem if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms 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
htqi://h2o.enr.state.ne.us/aT)s/,znu/fonns.htin.
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.n.smith(w—ncdeur.Qov.
Sincerely,
D is G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Winston-Salem Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10400082 w/o enclosures

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Mechanical Integrity Test Record
(For 5QM Geothermal Heat Pump 16j-eetion Well System)
Owner/Permidee Name: C -E5rcJ-ems _ Permit Number: WIc>4
Facility Address: 154 Rkma Lan&l o c-ot *-3o r:jar6ar
Home Phone., q -311 - taivc Cell Phone: fl0.
Heat Pump Cox twwr Name: - .. &_J& L e- Ein f" t-I
Offlee Phone;
II Ji MIT.
leiW r -
Date of 'Vest or.=, "--2V - � tco,K
Loop
TnWd Pr+essnre siy
Final Pressure
Dmmfion (minutes)
Pass es or No
1
400
1pD psi
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Any additional loop tefing add to back of this form
U
other Test Methods and Results: }
'E ti10 `a I ta.1 I I Da
+ i
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 mad: UIC Program, Mail Service Ober 1636,
Raleigh, NC 27699 or by fax: [phone].
Mechanical Integrity Test Form 1 1/2007

----
---
/'
I
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l
l
09 JAN 26 PM 2= 26
Saving the Planet One Home at a Time™
Mr. Michael Rogers,
Please find the following Mechanical Integrity Test Records and triangulation maps for the following
projects. I will be sending you another packet of the remaining 07 and 08 projects at my soonest
convenience. Thank you for your patience and help on this matter.
• WIO400082
• WIO800140
• WIO100086
• WIO700105
• WOP800150
• WIO500171
• WIO500170
• WIO700094
• WIO500139
Regards,
~~
Anna Jeffreys
Administrative Assistant
Home Energy Inc.
302 E Third Street· Wendell, NC 27591 • 919-366-0261
[e-mail]
List of Issued Permits to Home Energy, Inc.
Permit No. Name
W10400082 Braden
WI00800137 Panigutti
WI0500145 Clark
WI0800140 Belanger
W10500157 s. Martin
WI0100086 Combs
WI0700105 Cherrillo
Wl0500161 Stein
WI0500162 Lauer
WI0500163 Blachowicz
WI0500166 Manning
WI0500169 Maloney
WI0700107 Latta
WI0800150 Duan
WI0500171 ENT Audiology
Wl0500170 Griffin _
WI0700094 Harris
WI0800136 Jefferson
Wl0500139 Essick
WI0800135 Wilson
Wl0700096 Stolar
WI0500143 Kahn
WI0700093 Young
Wl0700095 Turner
WI0500173 Bell
WI0500174 Wilson Community CoHege
November 20, 2007
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
11/22/2.006
10/9/2006
2/1312.007
3/9/2007
4/18/2007
5/17/2007
6/27/2007
7/6/2007
8/20/2007
8/17'2.007
10/12/2007
9/21/2007
9120/2007
9/20/2007
10/11/2007
7/30/2006
9/1212006
1/6/2006
9/1212006
9/22/2006
8/4/2006
7/3/2008
9122/2006
not permitted as of 1112.0/07
1112.0/2007
> 0 c:o
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n
W`1- 0q()()CJY'
Michael F. Easley, Governor
William G. Ross Jr., secretary
North Carolina Department aFEnvironment and Natttrai Resources
Coleen Sullins, Director
Division of Water Quality
November 27, 2007
Monte Jefferson
Home Energy, Inc.
PG Box 238
Wendell, NC 27591
Subject: Geothermal Well Installation Date
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].
Sincerely,
JL7u&
Debra J. Watts
Environmental Supervisor
Groundwater Protection Unit
Attachment(s)
cc: APS Central Files (copy to each permit file on attached list)
Npi Carolina
Aturally
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: [phone]
Intemet: www,rnwateraupli y.ot Location: 2728 Capital Boulevard Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Fqua10pportunitylATirmOve Action Ernployer- 50% Recycle d110°% Past Consumer Paper Customer Service: (87 ) 623-6748

List of Issued Permits to Home Energy, Inc.
Permit No. Name Heat Pump Contractor Date Permit Issued
..-WI0400082 Braden Monte Jefferson 11/20/2006
--WI00800137 Panigutti Monte Jefferson 11/22/2006
-WI0500145 Clark Monte Jefferson 10/9/2006
-WI0800140 Belanger Monte Jefferson 2/13/2007
-WI0500157 S. Martin Monte Jefferson 3/9/2007
--WIO 100086 Combs Monte Jefferson 4/18/2007
_, WI0700105 Cherrillo Monte Jefferson 5/17/2007
-WI0500161 Stein Monte Jefferson 6/27/2007
-WI0500162 Lauer Monte Jefferson 7/6/2007
-WI0500163 Blachowicz Monte Jefferson 8/20/2007
_.-WIOSOO 166 Manning Monte Jefferson 8/17/2007
_ WI0500169 Maloney Monte Jefferson 10/12/2007
_WI0700107 Latta Monte Jefferson 9/21/2007
-. WI0800150 Duan Monte Jefferson 9/20/2007
.. WI0500171 ENT Audiology Monte Jefferson 9/20/2007
.,WI0500170 Griffin Monte Jefferson 10/11/2007
• WI0700094 l~arris Monte Jefferson 7/30/2006
.. WI0800136 Jefferson Monte Jefferson 9/12/2006
~ WI0500139 Essick Monte Jefferson 1/6/2006
.. WI0800135 Wilson Monte Jefferson 9/12/2006
, WI0700096 Stolar Monte Jefferson 9/22/2006
"WI0500143 Kahn Monte Jefferson 8/4/2006
. WI0700093 Young Monte Jefferson 7/3/2006
• WI0700095 Turner Monte Jefferson 9/22/2006
• WI0500173 Bell Monte Jefferson not permitted as of 11/20/07
WI0500174 Wilson Community. College Monte Jefferson 11/20/2007
November 20, 2007
Mechanical Integrity Test Record
(For SQM Geothermal Heat Pump Injection Well System)
Owner/Pennittee Name: Permit Number: WI ----------------------
Fa c il ~ ty Address: ____________________________ _
Honie Phone: Cell Phone: ----------------.=...;;:;.:=--=--==-=-=-=------------
Heat Pump Contractor Name: _________________________ _
Office Phone: Cell Phone: -----------------'--'------'-~-='------------------
Test er Name: ______________ Signature: ______________ _
Date of Test: --------
Loop Initial Pressure (p si) Final Pressure (p si) Duration (minutes)
1
2
3
4
5
6 .
7
8
9
10
11
12
13
14
15
Any additional loop testing add to back of this form
Comments:
Pass (Y es or No)
~
---------------------------------
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: UIC Program, Mail Service Center 1636,
Raleigh, NC 27699 or by fax: [phone].
Mechanical Integrity Test Form 11/2007
Permit Number WI0400082
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
michael. rogers
Permitted Flow
Facilit
Facility Name
Jeffrey N. and Gayla S. Braden SFR
Location Address
154 Rima Landing
Denton
Owner
Owner Name
Jeffrey
Da tes/Events
NC 27239
N Braden
Orig Issue
11/17/06
App Received Draft Initiated
08/04/06
Scheduled
Issuance
Central Files: APS_ SWP_
11/30/06
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Jeffrey Braden
230 Joshua Glen Ln
Cary NC
Major/Minor
Minor
Region
Winston-Salem
County
Davidson
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Jeffrey Braden
230 Joshua Glen Ln
Cary
Public Notice Issue
11/17/06
NC
Effective
11/17/06
27519
27519
Expiration
10/31/11
_R_e_g_u_la_t_ed_A_c_ti_v_it_ie_s _______________ Requested/Received Events
Heat Pump Injection RO staff report requested
Outfall tJ \J U_
Waterbody Name
RO staff report requested
RO staff report received
RO staff report received
Stream Index Number Current Class
08/21/06
10/13/06
11/06/06
11/06/06
Subbasin
Central Files! APS SWP
111151Q5
Permit Number W10400082 Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
sherri.knight
Permitted Flaw
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Jeffrey Braden
230 Joshua Glen Ln
Cary NC 27519
Facility
Facility Name Major/Minor Region
Jeffrey N. and Gayle S. Braden SFR Minor Winston-Salem
Location Address County
154 Rima Landing Davidson
Denton NC 27239 Facility Contact AMilatlon
Owner
Owner Name Owner Type
Individual
Jeffrey N Braden Owner Affiliation
Jeffrey Braden
230 Joshua Glen Ln
Cary NC 27519
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective £xpiratl n
oslo�alos -ell ,11
Regulated Activities ReauestedlReceived Evening _
RO staff report requested 08/21/06
RO staff report requested 10/13/06
RO staff report reoelved 11/06/06
RO staff report received 11/06/06
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

Michael F. Easley, Crovcmnr
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
November 17, 2006
Jeffrey and Gayla Braden
230 Joshua Glen Lane
Cary, NC 27519
Re: Issuance of Injection Well Permit
Permit No. W10400082
Dear Mr. and Mrs. Braden:
In accordance with your application dated July 24, 2006, and received August 4, 2406, I am
forwarding Permit No. W10400082 for the operation of a vertical closed -loop geothermal
mixed -fluid heat pump injection well system to be located at 154 Rima Landing, Lot 430 Harbor
Gate, Denton, Davidson County, North Carolina. This permit shall be effective from the date of
issuance until October 31, 2011, and shall be subject to the conditions and limitations stated
therein.
Pay special attention to the well construction standards in Parts II and V of your permit. You
must notify this office (Raleigh Central Office) and the Winston-Salem Regional Office at least
forty-eight (48) hours prior to constructing the system, and forty-eight (48) hours prior to
initiation of the operation of the system.
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.
N�O,` Caro ma
NaArrallll
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699.1636
Internet: httq�i. www.ncwater1ualit.,prg 2728 Capital Boulevard Raleigh, ?SIC 27604
An Equal OpportunttylAffirrnallwe Action Employer— 5 0 % RecyclW0% Post Consumer Pap or
Telephone:
Fax 1:
Fax 2:
Customer Service:
[phone]
[phone]
[phone]
[phone]

If you have any questions regarding your permit or the Underground Injection Control Program
please call Mr. Qu Qi at [phone] or me at [phone].
Best R~ards,
.~~e/
Michael Rogers
Hydrogeological Technician II
cc: Monte Jefferson-Home Energy, Inc.
Sherri Knight -Winston-Salem Regional Office
Central Office File
Attachment( s)
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
JEFFREY N. AND GAYLA S. BRADEN
FOR THE CONSTRUCTION AND OPERATION OF 15 TYPE 5QM INJECTION WELLS,
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed -loop geothermal -nixed -fluid heat pump
system. This system is located at 154 R.ima Landing, Lot. #30 Harbor Gate, Denton, Davidson
County, North Carolina, and will be constructed and operated in accordance with the application
submitted August 4, 2006, 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 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 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,
2011 and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof:
Permit issued this the _(-�� day of � �� , 2006.
��. ujaL
Alan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Page I

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 unles.s 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 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.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to: DENR-Division of Water Quality, Aquifer Protection Section DIC-Staff, 1636
Mail Service Center, Raleigh, NC 27699-1636, within 30 days of completion of well
construction.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the permittee or his agent shall test the pH of
the soil at a depth of three feet at the planned well location. If the resulting soil pH is less
than 6 standard units or greater than 11 standard units, the well system shall be equipped with
a compatible cathodic protection system. All testing results shall be kept on site available for
inspection.
2. 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 [phone] and the Winston-Salem Regional Office Aquifer
Protection Section Staff, telephone number (336)-771-4600.
3. All underground tubing shall be refrigeration grade copper tubing.
4. Prior to installation, all tubing to be placed in boreholes ("loops") shall be checked for leaks
by pressurizing the loop to a gage pressure of at least 350 pounds per square inch (psig),
Page 2
immersing the loop in water and examining it for leaks. Loops with leaks shall not be
installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents,
and scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop
by the manufacturer before shipping is still present at a pressure of at least 300 psig. The
loqp manufacturer · shall be notified in the event . of damage or pressure loss, and the
manufacturer's instructions shall· then be followed. The nitrogen charge may be released
only when the loop is installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting.
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A
North Carolina Administrative Code 2C .0100) shall be pumped via tremie pipe into the
annular space of each borehole so as to completely fill it from bottom to top.
8 . .All tubing junctions shall be brazed using lead-free brazing material. The brazing material
shall have a galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
10. After installation and prior to operation of the system, a mechanical integrity test shall be
conducted by pressurizing the injection well system to 400 psig with dry nitrogen and
monitoring for leaks using an ultrasonic or other leak detector of equal sensitivity and
monitoring pressure in the system for at least 2 hours. Alternatively, an equivalent vacuum
test is acceptable. Any pressure fluctuation other than that due to thermal expansion and
contraction of the testing medium shall be considered a failed mechanical integrity test. Any
leaks shall be located and repaired prior to · charging the system with refrigerant. A copy of
the post-installation pressure or vacuum test record (initial pressure reading, final pressure
reading, and the duration of the test) shall be submitted to the Aquifer Protection Section.
The test records must be received by the.Aquifer Protection Section at least twenty-four (24)
hours prior to the initiation of the operation of the facility for injection.
11. The lo·cation of each of the system manifolds shall be recorded by triangulation fr.om two
permanent features on the site (e.g., building foundation comers). The permittee shall retain a
copy of the triangulation records. The· permittee shall also submit a copy of the triangulation
records to the Aquifer Protection Section within 30 days of completion of well construction.
12. The written documentation required in Part ll, paragraphs (10) and (11) shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 3
'.
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.
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 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 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 Aquifer Protection Section's
Underground Injection Control (UIC) Program Central Office staff, telephone number
[phone], and the Winston-Salem Regional Office Aquifer Protection Section 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.
Page 4
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 perm.it, and may ~btain sampies 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
lmowledge of the occurrence, to the Winston-Salem 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 lmown or unknown reasons that renders the facility
incapable of proper injection operations, such as mechanical or electrical
failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) ~y recharging of the refrigerant system.
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.
Page 5
't
PART VIII -PERMIT RENEWAL
The Permittee shall, at least 120 days 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 15A NCAC 2C .0213(h)(l), 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 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)(l) within 30 days of completion
of abandonment.
Page 6
3. The written documentation required in'Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-VIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 7
NO. DATE
#59 11/01
11/02
11/02
#60 11/02
11/02
#61 11/02
#62 11/02
11/02
11/03
11/06
11/06
11/06
11/06
11/06
#63 11/07
11/07
#64 11/07
11/07
11/08
il/08
11/08
#65 11/08
#66 11/08
11/08
11/08
11/08
11/08
11/08
11/09
11/09
11/10
#67 11/13
#68 11/13
#69
11/13
U/14
#70 11/14
11/14
11/14
11/14
#71 11/14
#72 11/14
#73 11/15
#74 11/15
11/16
11/16
#77 11/16
#76 11/16
11/17
11/17
#78 11/17
ACTIVITY REPffiT
TIME FAX NO./NAME
15:29 913362993632
10:31 9103502004
11: 54
13:58 919103502004
14:49
15:09 917709213551
15:21 95714718
16:25 9197332496
16:28 2526725477
09:33
11: 16 919 847 8707
14:02 7044621322
14::30 7044621322
15:52
09:39 919103502004
11:05 9104232212
13:43 97163965
20:29
09:16 7047342302
11: 15
13:36 7046636040
13:56 912529753716
14:38 94673872
15:06 561 279 3279
15:13 561 279 3279
15:21 561 279 3279
15:32 561 279 3279
18:24 910 588 4286
09:38
13:37 910 588 4286
14:15 12525682750
09:36 912525231353
10:36 97166767
12:48 252 946 9215
09:52 912529469215
10:43 95714718
11:03
11:23
15: 32 919 508 0831
18:55 918288919511
18:56 918288625603
13:45 917046641778
15:44 95080831
10:10
10:36
9191035020·04 16:56
17: 12 919107967215
09:21 919 508 0831
10:12 2529468961
16:36 913057686280 .
BUSY: BUSY/NO RESPONSE
NG : POOR LINE CONDITION
CV : COVERPAGE CA . : CALL BACK MSG
POL: POLLING
RET: RETRIEVAL
DURATION
49
43
01:32
02:36
18
33
06:52
01: 10
43
0i:15
57
02:03
07:09
01:51
01:18
30
04:39
45
46
18
28
03:37
22
01:05
01:06
01:05
01:06
01:09
43
01:09
01:46
33
45
34
02:18
02:32
18
19
52
47
50
46
28
25
44
02:51
00
32
41
02:42
TIME 11/17/2006 16:44
NAME NCDE&NR/WATER QUAL
FAX [phone]
TEL 919-733-~221
PAGE(S) RESULT COMMENT
02 OK TX ECM
03 OK RX ECM
03 OK RX ECM
03 OK TX ECM
01 OK RX ECM
01 OK TX
08 OK TX'
05 OK RX ECM
03 OK RX ECM
05 OK RX ECM
02 OK RX ECM
03 OK RX
11 OK RX
06 OK RX ECM
04 OK TX ECM
02 OK RX ECM
07 OK TX ECM
01 OK RX ECM
03 OK RX ECM
01 OK RX ECM
01 OK RX ECM
09 OK-TX
01 OK TX ECM
02 OK RX
02 OK RX
02 OK RX
02 OK RX
03 OK RX . ECM
01 OK RX ECM
03 OK RX ECM
·02 OK RX
02 OK TX ECM
03 OK TX ECM
02 OK RX ECM
07 OK TX ECM
02 OK TX
01 OK RX ECM
01 OK RX ECM
03 OK RX ECM
03 OK TX ECM
02 OK TX ECM
03 OK TX ECM
02 OK TX ECM
01 OK RX ECM
02 OK RX ECM
09 OK TX ECM
00 BUSY TX
02 OK RX ECM
02 OK RX ECM
09 DK TX ECM
Permit Number W1O400O82
Central Files: APS SWP
08/18/06
Permit Tracking Slip
Program Category
Status Project Type
Ground Water
In review New Project
P?rnio -rype
Version Permit Classification
Injection Mixed Fluid GSHP Well System (5OM)
Indfviduai
Primary Reviewer
Permit Contact Affiliation
qu.qi
Jeffrey Braden
Permitted Flow
230 Joshua Glen Ln
Cary NC 27519
Facility Name Major/Minor Region
Jeffrey N. Braden Minor Winston-Salem
Location Address County
154 Rim@ Landing Davidson
Denton NC 27239 Facility Contact Affiliation
Owner Name Owner Type
Individual
.Jeffrey N Braden Owner Affiliation
Jeffrey Braden
230 Joshua Glen Ln
Cary N C 27519
r�
Scheduled
❑rig Issue App, Received Draft initiated Issuance Public Notice Issue Effective Expiration
08/04/06
ul,,ted Activities
utfall NULL
Waterhedy Name Stream Index Number Current Class Subhasin
Z_�/ o6

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
August 8, 2006
Jeffrey N. Braden
Home Energy, Inc.
P.Q. Box 238
Wendell, NC 27591
Subject: Acknowledgement of Application No. Wf0500147
Injection Mixed Fluid GSHP Well System (5QM)
Wake
Dear Mr. Braden:
The Aquifer Protection Section of the Division of Watcr Quality (Division) acknowledges receipt of your permit
application and supporting materials on August 4, 2006. This application package has been assigned the number
listed above and will be reviewed by Qu Qi.
The reviewer will perform a detailed 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 Office, copied below, must provide recommendations prior to final
action by the Division. Please also note at this tune, processing permit applications can take as long as 60 - 90 days
after receipt of a complete application.
If you have any questions, please contact Qu Qi at 919-715-6935, or via e-mail at [e-mail]. if the reviewer
is unavailable, 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://h2o.enr.state.nc.us/documents/dwg orgghamV. df.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Sincerely,
for e�J%
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Permit Application File W10500147
Aquifer Protection Section 1635 Mail Service Center
Internet: www.ncwaterguality.org Location: 2728 Capital Boulevard
An Equal ppportunitylAf irmative Action Employer-50%Reeyciedl10% Post Consumer Paper
tI o CaroUna
aWmally
Raleign, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service, {877) 623-6748

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 and SQM Wells
In Accordance with the provisions ofNCAC Title 15A: 02C.0200
Complete application and mail to address on the b~ck page.
TO: DIRECTOR, NORTH CAROLINA DMSION OF WATER QUALITY
DATE: 7..-~'-t . 20 O~
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
B.
C.
D.
( 1) Type 5A 7 wells inject water used to provide heating or cooling for structures.
(2) L Type 5QM wells contain a subsurface system of continuous piping, that is
isolated from the environment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3) Type 5QW wells contain a subsurface system of continuous piping, that is
isolated from the environment and only circulates potable water. If you selected
this well type, then complete form GW-S7 CL, Notification Of Intent To
Construct A Closed-Loop Geothermal-Water Only Injection Well System.
PERMIT APPLICANT
Name: J ~ A/. t/ G&:YtA .S. ~
Address: 2 ~A Gt:..mJ tAfvG
Cify: ~ State:NC:::. ~ cooo.:Z?Sl'f County: ~
Telephone: 'e/lt:, 3g7-6(p(}O L9tqJ ~3-Ztz17
PROPERTY OWNER (if dif.fi:rent from applicant) ~
Name: m tJ. l ~{A .s.
Address ~Af~ lJlfl.l{)//V(s t.PJ--#"3{) 1-MtUJolf.~)
City: Z>ervrlJ,J · Sate: At::. Zip Code: --County: l)#1osoN
Telephone:@!tp ;g7-6bf;o (:il't) 3b~ -?,a:rJ
STATUS OF APPLICANT
Private:~
State:
Federal:
Municipal: _
Mail Permit Care Of:
Home Energy Inc
P.O. Box238
Wendell NC 27591
Email Copy To:
[e-mail]1'}
Revised 5/05 GW/UIC-5
E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial ).
Name of Business or Facility:
Address:
City: Zip Code: _ . _ . _ County:
Telephone: Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: �\Oor sQ
Address:
City: V1f Zip Code: � � County: L3aA,
Telephone: Q 1a) ia Contact Person:
G. InNJJECTION PROCEDURE (Briefly describe how the injection we)ls) will be used.)
WELL USE Will the injection 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. CONSTRUCTION DATA (check one)
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-
d (Well Construction Record) if available.
PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) tluough (7) below as PROPOSED construction specifications. Submit
Form GW-1 after construction.
(1) Well Drilling Contractor's Name:
NC Contractor Certification number: _ a�-{la j
(2) Date to be constructed: Number of barings:
Approximate depth of each boring (feet): 15 t— j150t
(3) Well casing: Is the well(s) cased? �Jtp
(a) Y E S If yes, then provide 0 a casing information ow.
Type; vanized steel Black steed ' astic Other (spec,
l
Casing dept From ft. (refere to land surface)
Casing extends, ove ground ._ L inches
(b) NO
Revised 5105 GWXIC-57 HP Page 2 of

(4) Grout (material surrounding well casing and/or piping): [[LJAL
(a) Grout type: Cement Bentonite V Other(specify)
(b) Grouted surface and grout depth (reference to land surface):
+f around closed loop piping; from to (feet).
around well casing; from to (feet).
(5) Screens (for Type 5A7 wells)
(a) Depth: From to feet below ground surface.
(6) N. State Regular ins (Title "A NC. C 2C A"'O) quire the pc nittee to n ke provisions
far nitaring wellh td processes. A ucet on bath 3 [ uettt (#Iuid itering he Gimp) and
I effluen fluid being in} 'led into the we
»es is require Will there a faucet on.
(a) the is uent line? yes no (b) the effiu� t line? yes no
(7) SOURCE WELL CONSTRUCTION INFORMATION (if different front injection well).
Attach a copy of Form GW-I (Well Construction Record), If Form GWA is not available.
provide the data in part K (1) of this application form to the best of your knowledge.
NOTF- THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERATING DATA (for Type 5A7 wells)
(1) In.3 tion rate: Average (daily) gallons per minute (gpm),
(2) Injects Volume: Average (daily) gallons per day (gpd).
(3) Injection cssure: Average (daily) pounds/square inch (psi).
(4) Injection Te+ crature: Average (January) ° F, Average (July) ° F.
K. INJECTION FLUID DATA
(1) Fluid source (for Type 5A7 wells) if underground, from what depths, formation and type of
ro&/sediment unit will the fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth- _ Formation:.. Rock/sedimew unit: — -
(2) Chemical Analysis of Souree Fluid (for Type 5QM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
L. INTECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation, The manufacturer's brochure may provide supplementary
information.
M. LOCATION OF WELL(S) Attach two maps.
Revised 5105 GW/UIC-57 IMP Page 3 of

I J
(1) Include a site map (can be drawn) showing: buildings, property.lines, surface water bodies,
potential sources of groundwater contamination and the orientation of and distances between
the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet of the geothermal heat pump 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.
N. PERMIT LIST: Attach a list of all permits or construction approvals 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 Pertnits
0. 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 appurtenances in
accordance with the approved specifications and conditions of the Permit."
If authorized agent i.41 acting on behalf of the well owner,
please supply a letter signed by the owner authorizing the above agent
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights m the well being con~cted. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
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 outlined in this application and that it shall be
the responsibility of the applicant to ensure that the injection well(s) conforms to the Well
Construction Standards (Title ISA NCAC 2C .0200)
Revised .5/05
copies of the completed Application package to:
UIC Prog·ram
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GW/UIC-57 HP Page4 of4
a
Davidson -County
f$ Department
L Latytan Long: RA, W& A.
Health Dirbc#or
This scptZc trtolc ayadem * aiptemp. Aronaitiaa aftYb petm%t is that tine
PUMP in tested sand approvWd bW re maY4 kft ft hci %&&a & Yaw eeptic't u*
w l�� �-� piw*p but not wire it lab requhuo a iioweed
dmWidan eW as Impecdou by tbalreifidg r=Wacter. Thin mmW caaeft a. tag time
bmw em the igspriietkm aftho mapda tonic ands the pwap ombe tamed,
= —FM the pump tam (An& vvfh the tasnb W vA&ureter UP to tfid fiti* f WRt on tba
` p=V -t6ia cant be dune *M a sadm.bt m
L-4VO idea drag cord m an tha pnAag
-4MIli do Waahh Depdtrnant whims this is done.
DO No W YOR &RE R&WY M nrr TD no. TERSI
You can riot get i'bA Hembieal Mower or move io wrb7.-4a as dgws•end them am be
pmbtems -or ahentg6e that no= be made--:
DATR
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PYXd$on County Health Dart uj ent
Improvement Permit
If the Information on the Improvement Permit is fahMed, changed or the Fite is altered, tip the
Improvement Permit shall become invalid.
Permit is Valid for Five Years: No Ezoiration date:
Date Pm: Map Code: File No: 2005001030
Applicant Addmae: Daytime Phone: [phone]
NMRiON GRUBB CONSTRUCDON 519 FLAT SWAP" LAKE RD
CD DEMON
NC 27239-
Owner/Uxal Beprenotafive;
Address:
Daytime Phone: [phone]W
BRADEN JEFFREY N & GAYLA S
230 YOSHUA GLEN LANB
CARY
NC X75190000
Subdivision: HARBORGATE
Map
21E Lot 30 Section 2
Township: 09
Road Name: RIMA LANDING
Specific
Directions: to Property HWY S S TIR I]N'1'O HARBORGATE TIR RIMA
Facility Type: H
New x
Repair: Expansiow.
Waaw SupplS , PUBL
No, of Bedrooms: 3 No. of Occupants:
2 Basement YES
Basement Fbaxi es: I
No. of Employees:001e: Pmjectred Dady Flo
/ ra-:
Pump: Yes ✓ rqo — Prppowd War Syaft= Tmx
Permit Cooffidi as: -490;;;(A .
Permit Granted: Pcnmk Denied: _ Authm Siarte A Date 7 IQ B
Owner/Lead Rwreseabafives Siwatare: 4��r ff ��r ��'r► � � .1't'�f - - Date 4"
W M ,RMrt and Nx90flnigge Of an Immran+±emeat Permit RMW
1. In compliunce with I5A NCAC 18A.1937(1), fe durementiaoed paopeny was evaluated pursu=t to this
section aDd the permit was denied due tea:
a) Unsuitable topography and landscape poWiorL I W d) Inadequate soil depth.1943
b) UnmAtable soil. 1941 c) Inadequate seam 1945
c) Soil'Wetuess Condition.1942 t) Other
2. Suggestions, MoMcations, or Alternatives (immutable)
3. Tbis pmW denial may be appealed to the State by the following hods:
A. Request an fuforaud review by the Dept_ of Environment and Natvrai Resources.
B. Rapest an opporinmity to gothm scientific data and syn= design on dw property and submit the data to
the Dept of EaNdranmeot and Natural Resources at P.O. Bax 27687, Raleigh, N.O. 27611-7687.
C. Appeal the decision under G.S. 13OA-24 and have this appeal ?add In Davidson County.
N9W:_!or awl onrtiaao► W Or (c) nleene MWft Hean BMArtmeat ftr tic enntWriorte torsrts,
4. If no informal rtivim, technical review, or appeal to the Offxcc of Admimtatrate Hearings is requested whWn 30
days this property is denied and Improovement Permit by the Davidson County Health Dcpartwnt at this tip
Sae ft Plan I Plat on Attacbe+d Sheet
Z - d *GS* SSB See uo i gonj4suv3 Vgnra uv ijaW

. Pl--kvidsonwCounty Health D^nartment
Improvement Permit
If the informa den an the Lnprovement Permit is falsified, clanged or the site is after ed, then the
Improvement Permit shall become invalid.
Permit is YalW for Five Years: No Exoiratiion date:
Tate Rec. Map Code: File No: 2005001030
Appbcast Address: Daytime Phone: (336) $59 4156
MARION GRUBB CONSTRUCTION 519 FLAT 'SWAMP LAKE RD
Co DBN CK
WC 27239-
Ownerl%e�l Repre5WLStiVC
BRADEN JEFFREY N tit GAYLA S
Subdivision: HARWRGATE
Bold Njunc TUNA LANDING
Lddre sw Daytime Phone: [phone]
230 JOSHUA GLEN LANE
CARY
NC 275190000
Map 21B Lot 30 Section 2 Township: 09
Specific Direatioaw to Property HWY S 9 TAR WTO E ARBORGATE T/R RIMA
Facility Type. H New x Repair: Espamion: Water Supply: PURL
No. of Bedrooms: 3 No. of Occupants: 2 R"ement YES Baaanent Mixture& I
No. of Employees: Other: Projected Daily Flow: YE'' -Z
Pomp: Yes kl/ No � Proposed Wastewater System Type
P'eraait Conditions: ., - • • '�, -.
! . IV
Permit Granted:- ►v' Phrmrt Dlned: _ Aat60r*d *ft Agmt _ . • � � r Date
OwnerlL.esaal Rept�pstiws Shmah, : ,E ��: •' f :�' c' _ Dge ;f r
Autherira irkm. to Consbewet Wastewater System
The Aut1wrixation for Wastewater System Consuwdon is sobjoct to revomtkxa if the site plan or plat changes, the
intended an offt property changes, or if the site is altered or is misrepresented in any way.
Tvve of Wastewater System "��� � � Projected Daily Flow:
Rests UM amen Ropimments
Tame Size: L,-Q2 l' Pump Talc Size: ,� / Squm Footage: A&y_v
Tnwb Length: ,gyp' . 4 Maw Trench Depth: .3o v Trench Width ORO
No. of Trenches: 4 Agpwo Depth: —
Permit Camdiliom
Piave ! t ed Sh[=e
Permit Cxumted: wit DaWed Atrtba Soft Ap ok, omr—
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AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 10/23/06 County: Davidson
To: Aquifer Protection Central Office Permittee:_Braden, Jeffrey & Gayla
Central Office Reviewer: Qu Qi Project Name: Braden Residence
Regional Login No: Application No.: WI0400082
L GENERAL INFORMATION RECElVE13 t1)EN1? r 0WQ
1. This application is (check all that Apply): ® New ❑ Renewal AQlJWFR-GR0TFr:iW)N SK-I]4N
❑ Surface Irrigation ❑ Reuse ❑ RecycIe ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ CIosed-Ioop Groundwater Rernediation Z Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit. 10/20/2006
b. Person contacted and contact information: Jeffrey Braden [phone]: Monte Jefferson [phone]
c, Site visit conducted by: Sherri Knight
d. Inspection Report Attached: ❑ Yes or ® No.
2. Is the following information entered into the RIMS record for this application correct?
❑ Yes or ® No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location: 154 Rima Landing, Lot #30 Harbor Gate, Denton. NC
b. Driving Directions: Take Hny 8 south past Southmont and go across the Brown Loftin Bridge approx. !/A
mile to New Harbor Gate on the right. Follow_ the drive past the security gate, tennis courts and pool. The
road makes a hard right and then bends to the left. Go past the yttch club to the stop sin._ Take a right on
Rima Landine. The site is Lot 30 on the left.
c. USGS Quadrangle Map name and number, Grist Mountain
d. Latitude: Longitude:
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater): Domestic
- Residential
For Disposal and In iection Sites:
(If multiple sites either indicate which sites the information aimlies to_ cony and oaste a new section into the
document for each site. or attach additional pages for each site
a. Locations): same
h. Driving Directions:
e. USGS Quadrangle Map name and number:
d, Latitude: Longitude:
FORM: staff report - braden.doc 1

AQUIFER PROTECTION REGIONAL STAFF REPORT
IL NEW AND MAJOR MODIFICATIONAPPLICATIONS (this section not needed for renewals or minor
modifications. skip to next section)
Description Of Waste{S) And Facilities
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No ~ NI A. If no, please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No~ NIA. Ifno, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)?
~ Yes D No D NIA. Ifno, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No~
NI A. If no, please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No ~ NI A. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes~ No D NIA'. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV:
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or IZI No. If yes, please
attach a map showing conflict areas or attach any new maps .you have received from the applicant to be
incorporated into the permit:
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No ~ NIA. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program:
10. For residuals, will seasonal or other restrictions be required? D Yes D No~ NIA If yes, attach list of sites
with restrictions (Certification B?)
Ill RENEWAL AND MODIFICATIONAPPLICATIONS (use previous section for new or maior modification
systems)
Description OfWaste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate #:
FORM: staff report -braden.doc 2
AQUIFER PROTECTION REGIONAL STAFF REPORT
Backup-Operator in Charge: __ Certificate #:
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: .
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately ~nd adequately
assimilating the waste? D Yes or D No. Ifno, please explain:
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain:
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. If no, please explain:
6. Are the existing application rates (hydraulic or nutrient) still acceptable? D Yes or D No. If no, please
explain:
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Will seasonal or other restrictions be required for added sites? D Yes D No D N/ A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or D No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit:
10. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? D
Yes or D No. Ifno, please explain: __ _
11. Were monitoring wells properly constructed and located? D Yes or D No D N/A. Ifno, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? D Yes or
D No D N/A. Please summarize any findings resulting from this review: _
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; D
Current enforcement action(s) D Currently under SOC; D Currently under JOC; D Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): __ _
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? D Yes
D No D Not Determined D N/A .. Ifno, please explain: .
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? D
Yes or D No D N/A. If yes, please explain:
FORM: staff report -braden.doc 3
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well{S) And Facilities -New, Renewal, And.Modification
1. Type of injection system:
D Heating/cooling water return flow (5A7)
IZ! Closed-loop heat pump system (SQM/SQW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (SL/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes ~ No
3. Are there any potential pollution sources that may affect injection? D Yes ~ No
What is/are the pollution source(s)? . What is the distance of the injection well(s) from the pollution
source(s)? · ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 20 ft.
5. Quality of drainage at site: D Good ~ Adequate D Poor
6. Flooding potential of site: ~Low· D Moderate D 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? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site (property lines, wells, surface drainage)?~ Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Iniection Well Permit Renewal And Modification Only:
L For heat pump systems, are there any abnormalities in heat pump or injection well operation ( e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes D No. If yes. explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes, explain:
3. For renewal or modification of groundwater remediation permits ( of any type), will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? D Yes D No. If yes, explain:
4. Drilling contractor: Name:
FORM: staff report -braden.doc 4
ti , f i l
AQUIFER PROTECTION REGIONAL STAFF REPORT
Address:
Certification number:
5. Complete and attach Well Construction Data Sheet.
FORM: staff report -braden.doc 5
I ,. ff ,t. ,
AQUIFER PROTECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any ~dditional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet -if needed information is available
3. Do.you foresee any problems with issuance/renewal of this permit? D Yes ~ No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information .request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. 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
7. Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information;
1Z! Issue; D Deny. If deny, please state reasons:
8. Signature ofreport preparer(s): .d ~ U,t_" Y ~ ,ij
Signature of APS regional supervisor: '{_//4,1/U Y #
Date: /D/;) 3 Jo'-' r7
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: staff report -braden.doc 6
WcbGIS.net :: QuickSearch :: Davidson Co�utty, North Carolina:: Details
Page 1 of 1
WebGIS. net
quicksearch
Parcels: Record Details
Parcel Number:
Property Street
Name:
Property Street
Type:
Property Direction:
Property Street
Suffix:
Property Mouse #:
Owner game:
Address Line is
Address Line 2:
Address line 3:
City:
State:
Zip:
Legal Description 1:
Legal Description 2:
Land units:
Land Type:
Deed Date:
Deed Book Page:
Account Number:
Township:
Exempt Code:
Building Value:
Other Building
Value:
Land Value:
Market Value:
Assessed Value:
Deferred Value:
Pin Id:
Deed Book:
Deed Page:
09021EO000030
RIMA LANDING
154
BRADEN JEFFREY N &
GAYLA S
230 JOSHUA GLEN LANE
CARY
NC
275190000
L30 P=21-87 BK791-1226
HARBDRGATE
0
LT
10 Dec 1991
07911226
000008988387
Healing Spring
$0
$0
$100,000
$100,000
$100,000
$0
6648-01-37-1338
791
1226
Davidson County, North Carolina
Disclaimer:
The information contained on this site is furnished by
govemment and private industry sources and Is
believed to be accurate but accuracy is not
guaranteed. Mapping information is a representation
of various data sources and Is not a subsitute for
Information that would result from an accurate land
survey. The information contained hereon does not
replace information that may be obtained by
consulting the Information's official source. In no
event shall Davidson County, NC or the consultants
of Rockingham County, NC be liable for any
damages, direct or consequential, from the use of
the information contained on this site.
The WebGIS.net logo Is a Registered Trademark of Anderson & Associates, Inc_.
This site is best viewed in a modern browser that supports web standards.
Questions, comments or problems? Contact WebGIS Technical Support.
http://gWcksearch,webgis.netldetails.php?site=nc_davidson_co&id=81116&lid=parcets&,.. 11 /13/2006

Davidson Co., NC -- Printable Map
Page 1 of 1
Parcel Number: 09021 E0000030
Pin Id: 6648-01-37-1338
Owner:
BRADEN JEFFREY N & GAYLA S
230 JCSHUA GLEN LANE
CARY NC 27519-0000
Property Address:
154 RIMA LANDING
Additional Information
L30 P=21-87 BK791-1226
HARBCRGATE
Davidson Co., IBC
Parcels
Land Units: 0 LT
Deed Book: 791 Pg: 1226
Deed Date: 12/911991
Account Number: 000008988387
Township: Healing Spring
Exempt Code:
Building Value: $0
Other Building Value: $0
Land Value: $100,000
Market Value: $100,000
Assessed Value: $100,000
Deferred Value: $0
DISCLAIMER: The information contained on this page is NOT to be construed or used as a "legal description". Map
information is believed to be accurate but accuracy is not guaranteed.
httpJhvww.webgis.net Anderson & Associates. Inc. http:/Avww,andasscr.com
http:llarcims.webgis.netlncldavidsonlprintable.asp?process=locate3 &x2=164313 8.75 &y2... 11 / 13/2006

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USG5 Grist Mountain (NC) Quadrangle M=_7.687
Projection is UTM Zane 17 NAD83 Datum G=0.465
http:llwww.topoaone.comlprint.asp?lat=35.63278&loner-80.20111 &u=6&layer=DRG&d... 11/14/2006

At�UIEER PROTECTION SECTION
APPLICATION REVIEW REOUEST ]FORM
Date: ku-!ust 21. 2006
y3 ❑ Landon Davidson, ARO-APS ❑ David May, WaRO-APS
❑ Art Barnhardt, FRO-APS ❑ Charlie Stehman. WiRO-APS
❑ Andrew Pitner, MRO-APS ® Sherri Knight. WSRO-APS
❑ Jay Zimmerman, RRO-APS
G
Fr m: QILt2j, Groundwater Protection Unit
Telephone: [phone] Fax: { 9191 715-f15SS
E-Alad: au.,oi.cunctnail.net
A. Permit Number: W10400082
B. Owner: Jeffrev and Gavla Braden
C. Facility/Operation: Braden Residence
® Proposed ❑ Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ Surface Irrigation ❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ YE Lagoon ❑ GW Remediation (ND)
UIC - (5QM) closed loop rnixed fluid geothermal
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
?. Projecr Type: Z New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal wl Mod.
E. Comments/Other Information: ❑ I 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 34 calendar days, please take the following actions:
® Ret= a Completed Form APSSRR. -,.,, %'= -a 0,F6
❑ Attach Well Construction Data Sheet. a f
❑ Attach Attachment B for Certification by the LAPCU. 1 uE rA . E _ I
❑ Issue an Attachment B Certification from the RO'.
* Remember that you will be responsible for coordinating site visits, reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachuwnt 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, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-:BPS Reviewer: �1 r &V� Date: '& I -vi 10l
FORM: APSARR 02/06 Page l of 1

Re: SQM Permit Question
1 of 1
Subject: Re: 5QM Permit Question
From: Dennis Rogers <[e-mail]>
Date: Thu, 02 Nov 2006 08:42:57 -0500
To: [e-mail]
CC: Debra Watts <[e-mail]>
Sherri-
What is the status for the staff report for this project? Are there any issues
which would preclude us permitting this well?
Thanks
Sherri Knight wrote:
I have found this. It is one that I initially assigned to Chris
Greene but due to some scheduling problems was supposed to give to
someone else. That someone was Peter and he ran out of time before
he left, so I guess that leaves me. I'll try to schedule for next
week. Have we permitted this type bef9re?
Sherri Knight, PE
NC DENR Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
On 10/12/2006 11:05 AM, Debra Watts wrote:
Sherri
This is a follow-up on my voice mail. We just need
to know who is assigned this permit at your region
so we can follow up. The permit number is
WI04·00082 and it's a SQM underground injection
permit. I think the permittee may have been trying
to schedule a site visit (yes, I know, it's usually
the other way around), and we need to be able to at
least address his questions. Thanks Sherri! djw
11/2/2006 8:44 AM
[Fwd: Re: SQM Permit Question]
1 of2
Subject: [Fwd: Re: SQM Permit Question]
From: Debra Watts <[e-mail]>
Date: Fri, 20 Oct 2006 18: 17:34 -0400
To: Dennis Rogers <[e-mail]>
Mike
FYI (see below). Looks like we're too late to go out on this one. djw
Debra J. Watts, Supervisor
Groundwater Protection Unit
Aquifer Protection Section
919-715-6699
Subject: Re: SQM Permit Question
From: Sherri Knight <[e-mail]>
Date: Thu, 19 Oct 2006 15:S7:12 -0400
To: Debra Watts <de [e-mail]>
I'm looking at this one tomorrow at 11:00. We should be able to find you a work
space next week. I think I'll be here every day.
Sherri Knight, PE
NC DENR Winston-Salem Reg.ional Off ice
Division of Water Quality, Aquifer Protection Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
On 10/19/2006 1:51 PM, Debra Watts wrote:
Yes --WaRO has gotten several. These are pretty good systems and
they do leak tests on site. I've attached a couple of issued
permits so you can look at the special well construction conditions
that we request. Also, we have some new staff on board who need to
get some field experience concerning SQMs. Can you let me know
when you're going out so he can accompany you?
On a personal basis, I am going to be involved in the Water
Festival for 5th graders at Salisbury (WCCC sponsoring, among
others) Monday through Wednesday, but only until 12:30. Rather
than come back to Raleigh and finish the day, would it be possible
for me to put in a couple of hours at the WSRO instead i.e. access
to BIMS/a computer? If not, that's ok --just let me know.
Thanks! djw
Sherri Knight wrote:
I have found this. It is one that I initially
10/25/2006 4:46 PM
[Fwd: Re: 5QM Permit Question]
2 of2
assigned to Chris Greene but due to some scheduling
problems was supposed to give to someone else.
That someone was Peter and he ran out of time
before he left, so I guess that leaves me. I'll
try to schedule for next week. Have we permitted
this type before?
Sherri Knight, PE
NC DENR Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection
Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771~5280
FAX: [phone]
On 10/12/2006 11:05 AM, Debra Watts wrote:
Sherri
This is a follow-up on my voice mail. We just
need to know who is assigned this permit at your
region so we can follow up. The permit number
is WI0400082 and it's a SQM underground
injection permit. I think the permittee may
have been trying to schedule a site visit (yes,
I know, it's usually the other way around), and
we need to be able to at least address his
questions. Thanks Sherri! djw
Sherri Knight <Sherri.Kni [e-mail]>
WSRO
NCDENR
.----1 Content-Type: message/rfc822
Re: SQM Permit Question C E d". ?b' , I ontent-nco mg: 1t 1
10/25/2006 4:46 PM