WI0400094_GEO THERMAL_20120514

Beverly Eaves Perdue
Governor
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 14, 2012
Bonnie McElveen-Hunter
710 Country Club Drive
Greensboro, NC 27408
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0400094
Dear Ms. McElveen-Hunter:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit -will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://porta.l.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, t:.~
Eric G. Smith, P.O.
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 .ncwaterguality.orq
An Equal Opportunity\ Affinnative Action Employer
No~i..c 1· 01.u1 aro .ma
/Vatural/11
Michael F. Easley, Governor
William G. Ross Ir., Secretary
North Carolina Department of Environment and Natural Resources
Coleen li. Sullins, Director
Division of Water Quality
April 8.2008
CERTIFIED MAIL NUMBER 7006 2150 0003 5466 6489
RETURN RECEIPT REQUESTED
Ryan Brazill
Brazill Drilling, Inc,
72 Westerway
Bunn, NC 27508
Reference: Notice of Violation (NOV-2008-2C-0009)
Ryan Brazill, Well Contractor Certification # 2722
Type 5QM Mixed -Fluid Geothermal Underground Injection Well System
Bonnie McElveen-Hunter property, 710 Country Club Drive, Greensboro
Guilford County, NC 27408
Permit No. WI0400094
Dear Mr. Brazill:
The Aquifer Protection Section (APS) of the Division of Water Quality (DWQ) is responsible for
the protection of the surface and groundwater resources within the State of North Carolina, and
has oversight on underground injection well construction standards.
On January 25, 2008, the APS received a permit application for the installation of a Type 5QM
geothermal mixed -fluid closed -loop underground injection well (UIC) system located at the above
referenced property. Information received by this office subsequent to the application submittal
indicated that all of the UIC wells had already been installed prior to you receiving a valid permit.
A subsequent field inspection by Stephen Berry and Sherri Knight with the Winston-Salem
Regional Office on March 6, 2008, confirmed the installation. This inspection and meeting with
you confirmed this UIC well system was installed without a valid permit issued by the APS. This
is in violation of the following rules and regulations of the state of North Carolina:
VIOLATION 1:
Constructing a well for injection purposes without a permit as specified in rule 15A NCAC
2C.0105(b)(5)
REQUIRED CORRECTIVE ACTION
Obtain an injection well permit before drilling an injection well as specified by the referenced
rule. NOTE- an injection well permit application has been submitted and a permit issued on
March 31, 2008.
Nor hCaroIina
)'aturaIIy
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internet Eitrp://h2o.enr.stitte.nc.us
2728 Capital Boulevard Raleigh, NC 27604
An Equal Opportunity/Affirmative Action Employer — 50%Recycled/10% Post Consumer Paper
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Brazill Drilling, Inc. NOV Page 2 of 2
VIOLATION 2:
Failure to submit to the Division, within 30 days of completion, a record of well construction as
required by rule 15A NCAC 2C.0l 14(b).
REQUIRED CORRECTIVE ACTION:
Please complete and submit the required forms to the APS of the Winston-Salem Regional
Office and the Raleigh Central Office.
Please respond to this Notice in writing within ten (10) days of your receipt of this letter
indicating receipt and the steps you will use in the future to prevent a reoccurrence of the above
violations. If you feel that there were events or circumstances beyond your control that caused
these violations, you should include any such justification along with your response. Failure to
comply with State rules may result in the assessment of penalties and/or the use of other
enforcement mechanisms available to the State. Each day of a continuing violation may be
considered a.separate violation subject to a $1,000.00 per day penalty.
Ifyou have any questions pertaining to this matter, please do not hesitate to contact Michael
Rogers at 919-715-6166 or myself at [phone].
C/JAo-J vJ~
Debra Watts
Groundwater Protection Unit, Supervisor
Aquifer Protection Section
cc: Guildford County Health Department
Bonnie McElveen-Hunter -Property owner
Dwain Strader --Cellusun Heat and Air, Inc.
Sherri Knight -Winston-Salem Regional Office
Drew Morgan, Well Contractors Certification Commission
IT
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U.S. Postal Service
CERTIFIED MAIL-;: RECEIPT
(Domestic Mail Only; No insurance Coverage Provided)
For delivery information visit our website at www.usps.cam„
Poatege
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total POew.. A Fnna
enl o Ryan Brazill
wei Brazill Drilling, Inc.
orP°84' 72 Wester Way
cry. ware Bunn, NC 27508
pS Form
SENDER: COMPLETE THIS SECTION
Poatmerli
Hers
■ Complete items 1, 2, and 3. Also complete
item 41T Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
T. Article Addressed to:
Ryan Brazill
Brazill Drilling, Inc.
72 Wester Way
Bunn, NC 27508
REC
Aqu
COMPLETE THIS SECTION ON OEi.1YERY
A. Sign
x�i
re
❑ Agent
0 Addressee
ived
(PnAted(iVae' q/D t C6ivery
izz1fiC]
D. Ins delivery address different from Item 1? 0 Yes
if YES, enter delivery address below: 0 No
1VED I DENR ! DWa
er Protection Section
A,14,2etAfftt
Certified Maii ❑ Express Mall
❑ Registered Cl Return Receipt for Merchandise
❑ insured Mall 0 C.O.D.
4. Restricted Delivery? (Extra Fee)
2. 7006 2150 00123 5466 6489
❑ Yes
PS Form 3811, August•2001 Domestic Return Receipt
2ACPRi-03-Z-0985 1

Permit Number WI0400094
Central Files: APS SWP
03/31/08
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Status Project Type
In review New Project
Version Permit Classification
Injection Mixed Fluid GSHP Well System (5QM) Individual
Primary Reviewer Permit Contact Affiliation
michael,rogers
Permitted Flow
Parfilh/
Facility Name
Bonnie McElveen-Hunter SFR
Major/Minor Region
Minor Winston-Salem
Location Address County
710 Country Club Dr Guilford
Greensboro NC 27408
Owner
Facility Contact Affiliation
Owner Name
Bonnie
Owner Type
Individual
McElveen-Hunter Owner Affiliation
Bonnie McElveen-Hunter
710 Country Club Dr
Greensboro
NC 27408
Scheduled
Orlg Issue App Received Draft Initiated issuance Public Notice issue
01/25/08
Reafilated Activities RA it eafFrt iar_oiveri E
Effective Expiration,
Heat Pump Injection
Cutfall NULL
RO staff report requested
RO staff report received
01/29/08
0 3/ 17/08
Waterbody Name
Stream index Number Current Class Subbasin

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
March 28, 2008
Bonnie McElveen-Hunter
710 Country Club Drive
Greensboro, NC 27408
Re: Issuance of Injection Well Permit
Permit No. WI0400094
Issued to Bonnie McElveen-Hunter
Dear Ms, McElveen-Hunter:
In accordance with your application dated January 25, 2008, I am forwarding Permit No. W10400094
for the operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system to
be located at the above referenced address. This permit shall be effective from the date of issuance
until February 28, 2013, and shall be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in permit conditions in Part I,
paragraphs 7 and S. Copies of the GW-1 forms shall be retained on -site for inspection.
Also, a well ID plate must be affixed to the geothermal system. Your heat pump and well
contractors should provide this information. Please retain these records so that in the
event your property is sold or transferred, the new Permittee will have this information.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit,
this permit is not transferable to any person without prior notice to, and approval by, the Director of
the Division of Water Quality. If you have any questions regarding your permit or the Underground
Injection Control Program please call Mr. Qu Qi at [phone] or me at [phone].
Best Regards.
/„e
Michael Rogers
Environmental Specialist
cc: Sherri Knight — Winston-Salem Regional Office
Central Office File
Guilford County Health Dept
Attachment(s)
Aquifer Protection Section 1636 Mail Service Center
Internet htt,p //wwwiicwatergi a1jtv.org 2728 Capital Boulevard Raleigh, NC 27604
Raleigh, NC 27699-1636
An Equal Opportunity/Affirmative Action Employer— 50% Recy 1ed110% Post Consumer Paper
N°�; Caroli a
natural
Telephone: [phone]
Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

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
Bonnie McElveen-Hunter
FOR THE CONSTRUCTION AND OPERATION OF A TYPE 5QM INJECTION WELL,
defined in Title 15A 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 710 Country Club Drive, Greensboro, Guilford County, North Carolina 27408, and
will be constructed and operated in accordance with the application dated January 25, 2008, 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 February 28,
2013, and shall be subject to the specified conditions and limitations set forth in Parts I through
X hereof,
Permit issued this the t day of 9kr----... , 2008.
UitL
oleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
WI0400094 Page 2

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 (I SA 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 actio·n as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable·unless the facility-is constructed in accordance with the
conditions .of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be 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 geothermal well injection system shall have permanently afrtx.ed .an
identification plate ac~ording to 2C .0213(g).
8. A copy of completed Weil Construction Record (Form GW-1) must be submitted for each
injection well to: DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff,
1636 Mail Service Center, Raleigh, NC 27699-1636, within 30 days of completion of well
construction. Per the requirements of 2C .0213(h), the original form must be submitted to
the address shown on the form. Copies of the GW-1 forms ·shail be retained on-site and
available for inspection.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall
notify the Aquifer Protection Section-Underground Injection Control (UIC), Central Office
staff, telephone number [phone] and the Winston-Salem Regional Office Aquifer
Protection Section Staff, telephone numb~r [phone].-
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.
WI0400094 Page3
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, which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART 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 Pennittee must notify by telephone the Aquifer Protection Section-
Underground Injection Control (UIC), Central Office staff, telephone number (919) 715-
6166 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.
WI0400094 Page4
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on· or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Winston-Salem Regional Office, telephone number
[phone], any of the following:
(A) Any occurrence at the injection facility, which results in any unusual
operating circumstances;
(B) Any failure due to known or unknown reasons, th_at renders the facility
incapable of proper injection operations, such as mechanical or electrical
failures.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director,.the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4. In the event that_the permitted facility fails to perform.satisfactorily, the Permittee shall
take such immediate action as may be required by the Director. ·
PART VIII -PERMIT RENEW AL
The Permittee shall, at least 90 days prior to the expiration of this permit, request an
extension.
WI0400094 Pages
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.
WI0400094 Page 6
3. The written documentation requiredin Part IX (1) and (2) (G) shall be submitted to:
WI0400094
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page7
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 03117/2008
['tr. ,aci ulfrr Protection Central Office
Central Office Het :levier: Michael Rogers
Regional Login Nu:
County: Guilford
Permit -tee: Biinnie: M.e :Kccn-Hunter
Project Name: :Nft:Ei een-Hunter
Application No,: WI0400094
!. GE.1ER.-1L INFORMATION
1. 14ia.application 1 r,,,"•,,,: ir,.:lpr:y NZV1 ❑ 1t.:ncvfal
❑ Mimi Modification 0 Major -Modification
urfa4.4 Irrigation-0 tz.,:tt.,e (] R4c;vch ;J High Rate tntiltration 0 Evaporaiionintiltration Lagoon
`Lund Application ofResiduals Z Atrsc}smenr 1I irclu4 J 503 reguilate,i ❑ 503 exempt
u DWI ihuticItr of Residuals Surt:k Disposal
j f Closed -loop CrruundwaterR, medi tiOn El Other Injection Wells (including in suu remediation)
Was a site visit conducted in order toprepere this report? Z Yes or 0 No.
a. Date ash* visit: It7 " QQS
b. Pason contacted and contact informal ion: n Putnam (propertq_ msi
itc visa condsictwd b): Stephen Berry
.d. inspection Report Attache D %'e ur Z NO.
L. is t tc .filllowing. information eritaradint0 the BIAS record for this applkatktu comet?
or ❑ No. Ifni?, pleas: coniphte the €olio%ing or indicate that it is corivet on the currant applieati.m.
F4ir Treannent lxacilities:
NIA
For Di.pula1 and Infection Sitea:
;It multiple site .either indicate which sito gisu fy atr t i_applies tc4 copx anAlvste a new scction•into the
Istungptriptea:h site, or attach addition h siti
a. Locatitfnts)i. 110 Comm" Club Drit ..tsLeeni_lwJ! (274081. Guilford County,
h. Driving Diretiorn; From 1-40 talc \ Lliq- Street.. North.ta Country CI1xb • iirc ani3 turn I�fes#. llettse is
ivt silly of 5}reei apprc umatch 1 mile from F i m intr section.
k: [. SGS Quadrangle Map came and`:number: unlcnuvN�i
J. Latitude: 36'6M56 Lonxitudar .79'48.032
IL .NEW AND MAJOR .MODIFICATION .1PPL ICATIO.\S filth ;ectii n not needed for renewals or minor
modification', slipto new :section)
RE.A-EH/ AL AND MODIFICATION .4PPLIC4 TfO_&S fusr drerinus• section for new or mnior modification
TORM7 wlsl40Q114 APRsR

AQUIFER PROTECTION REGIONAL STAFF REPORT
L' 'JEC IOY.'WELL FERMITAPPLIC i TIO\'S (Complete these tw•v sections for all systems that use injection
qsll•. inelading ektsc.:l•t.sop oundaruwrivrn diation effluent injectien wells. in situ r mediation injection :%etis,:lull heat
pump injection t•efIs.)
Tlr+cxintititt' Of Weij(S) And .Facilities —dew, Rcnem al. And NiodH1eatiun
i . 'l ype of injection *stern:
0 I-tcating.cooling water return Clow OAT)
Closed -loop hiatpunip syst+cnt (5QM,3QW)
C f .ti:ti retrtadianon..(51)
❑ Closed -loop groundwater retm:diation :ftiuertt-injection (51;"Non•Diseharge)
L lh'.i. r (Specify: 1
2. Doc• st:m use tiame well for water source and injection? ❑ Yes ®ha
3. Ar. there any potential pollution sources that may affect injection? ❑ Yets Z No
What is. Are the'po1lution.soureeisfi , What is the distance of the in`e..tion wei ,s from it jinn
,Lauer)'? 1t.
4. V4 lust is the minimum dtsttulcoof proposed injedion elL, from the property b.,undan `__' -25 �ft
5 Quality of drainage at she; Ej Good rJ Adequate 0 Poor
u_ 1 l.!oding potential of site:. 0 lauw 0 1Ioderate [] High
foes the,nta presentod ttiipr st~tnt-the aausti sikorniV..rty tines. ► ells. sueraee drairtdge)'' El Yes or S No, if
na or no map, pleasesttae#t`ct l eteb of the site. -Shaw prope boundaries. buildings. wells, potential pollution
outtes. roads. appro'irttat -scale; stud -north afros, jape p and *Composite v.pdrs)
1nirC'tioii V n1t Pe.rntit Renewal And NIoditication [)nl.a
NIA
V f t'4 L I .'4TIi'.iYAND RECOMMENDATIONS.
I Provide any additional narratii4a regarding your [Via, of the application.; See Menlo dated 3/14/8
Arwch Well Construction Data Sheet - If nee&rd information is available
Ihi you.foresee any probl rtni with issuance/renewal Of this permit'? 0 Ye5 No. If yes, please explain
�riet3► .
4 List a:,► =item: that iLitt Wuuld lik AlCentral Utrker ttrobtain::tb otagh=a>a:additional information request.
�1Ulu sure that you -provide ide a rcasou stir va4h 'item:
Item
__ ___
ii ;ii Drilier's Les (submitio WSRO & CO)
Forst ee :hydiOgaology
FoKrl' v.10400094 APRSR

AQUIFER PROTECTION REGIONAL STAFF REPORT
5. L iat sph;i: e Permit conditions that you recomrnend to be removed from the permit u hen issued. Make sure
that i uu. provide a reason for each condition:
r
widition
Reason
None
6. .List si x i#ic special. conditions ur co.mp1 fiance schedules that recommend to be included in the permit when
issued: Make sure that y ou provide a reason for each •peeial condition:
f Condition
None
Reason
7. Recommendation: LI Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of drat permit by regional office: [] l sue upon receipt of needed additional information. d
isue; L : Deny. If dotty, please state reasons:
�.. S ignature of report preparerts): 1I+►.�— � ►,--
Signature ok' APS regional supervisor-:
Date: 5,141 &
fi I1Tf1O- 4L: REG7ONALS7.4I? .REL IEfiE:': ITEMS
Pluje u5c the, thr, e'".pdf Files ise tt to, rl. Rogers-, as snpplernentaI documentation ot'rhe .Ciro visit.
toRm: wpigwa4. a

Molise, F. Easley. Governor
IMrliam G. Ross Jr. et retarr.
North Carvhne Department of Environment and Nature; Resources
Coleen h Sugrms, OireOtor
Divisron of Water Qualay
March 14. 2008
MEMORANDUM:
To: Michael Rogers, Groundwater Protection Unit
From: Stephen Berry
Subject: W10400094
On March 6. 2008, Sherri Knight and myself (Stephen Berry) met with Ryan Brazil (driller), Ren
Putnam (property manager), Tate Russ (heating/cooling specialist), and Dwain Strader (heat
pump contractor) to discuss the proposed and installed closed -loop system.
16 well borings exist (see map *.pdf). There are five clusters with vaned depths. Three
ousters have wells drilled to a depth of 335ft (11 total borings). Another cluster has 4 welts at
a depth of 290ft. The last boring used an existing well (see map) drilled by Billy Yow (several
months ago). The purpose of the well was irrigation though no water was located. The depth
of the well is 600ft though the closed -loop piping goes to a depth of 300ft. This piping is 1' In
diameter while the remaining tubing is 1.25'_
The closest structure is the RV storage at approximately 36ft. The tennis court is
approximately 33ft from a well cluster.
All parties involved claimed ignorance to the need of a permit. The driller now understands
that non -potable water systems require a permit, It is my belief that system design criteria
were not fully explained to all parties involved. That is, the Heat Pump. contractor (Dwain
Strader of Cellusun). Mr. Russ (Singleton Heating & Air), and the well driller. (Mr_ Brazil of
Brazil Drilling) failed to communicate necessary information with one another, in order to
comply with State regulations.
Therefore, it is my recommendation that all involved parties be issued a Notice of Violation
for failure to secure a permit prior to constructing the closed -loop system. Additionally, Mr.
Brazil should be required to submit all relevant well driller Togs to WSRO as well as a copy to
your office.
Please contact me if you need any additional information.
Sincerely,
3 j a Np thCaroimna
StephenwBe aurally
Berry
g %. Dwvisian drWater Gummy 585 Waughtown Street Winston-Salem, NC 27-itf7 1338) 771-5268 Customer Sonora
1300 523-7748

Site Map of
WIO4OOO94
710 Country Club Drive
Greensboro, Guilford County
LE4
'i1QE 7&
ATER Vr•L: L FieHL1E 28,,
LEGEND
New Bore Hales
Existing Well
Scale 1:650
1 inch equals 52.08 feet
Feet
0 20 40 60 80 100 120
r- Meters
0 5 10 20 30 40
•
r41
Scale 1:24,000
Prepared by Stephen Berry of the North Carolina Division of Water Quality,
Aquifer Protection Section, Winston-Salem Regional Office.
Published on March 13, 2005
Note: This map is for reference only and should not be construed as legal survey documentation.

Site Pictures of 71 O Country Club Drive, Greensboro, Guilford .County
Permit#: WI0400094
(March 6, 2008, taken by Stephen Berry DWQ-APS-WSRO )
: ~ ;::~ • .;,;i;,.-, -~·~ ~ ~.. •
'i.w:.,,.
Figures 1, 2, & 3 (clockwise). Three structures
supplied by closed-loop geothermal system; ·
Fig.1 and fig. 3 were taken looking south; Fig.
2 was facing west. System is on north side of
main house and east of tennis court.
Figure 4. Possible water supply well on east
neighbor's property (approx. 100ft from system).
Page 1 of 3
Site Pictures of 71 Q. Country Club Drive, Greensboro, Guilford County
Permit#: WI0400094
.(March 6, 2008, taken by Stephen Berry DWQ-APS-WSRO )
Figures 5 thru 8 illustrate construction
methods; Fig. 5 (looking northwest) shows the
stub up casing of a water supply well (irrigation)/
dry hole converted to house a portion of the
closed-loop system.
Page 2 of 3
Site Pictures .of 71 O Country Club Drive, Greensboro, Guilford County
Permit#: WI0400094
(March 6, 2008, taken by Stephen· Berry DWQ-APS-WSRO )
Figures 9 thru 13 illustrate closed loop piping and bore hole bentonite grouting. Fig. 10 shows
the proximity of the system to the southern structures (pool house), and the location of Fig. 9.
Page 3 of 3
A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: January 29 , 2008
To: D Landon Davidson, ARO-APS
0 Art -Barnhardt, FRO-APS
D Andrew Pitner, MRO-APS
0 Jay Zimmerman, RRO-APS
□ David May, WaRO-APS
□ Charlie Stehman, WiRO-APS
181 Sherri Knight, W-SRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: [phone] Fax: {919) 715-0588
E-Mail: Michael.Ro [e-mail]
A. Permit Number: WI 0400094
B. Owner: Bonnie McElveen.:.Hunter
C. Facility/Operation: __
IZJ Proposed □ Existing D Facility D Operation
D. Application:
1. Permit Type: D Animal D SFR-Surface Irrigation □ Reuse D H-R Infiltration
D Recycle D 1/E Lagoon D GW Remediation (ND)
IZJ UIC -(SQM) closed loop mixed fluid geothermal __
For Residuals: D Land App. D D&M D Surface Disposal
D 5.03 D 503 Exempt D Animal
2. Project Type: IZI New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Information: 181 I would like to accompany you on a site visit.
NOTE: I would like to go on-site during the installation and take some pictures. If vou will be on-
site during this phase, let me know and we will go together.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
181 Return a Completed APSARR Form.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Rem~mber that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: ------------------Date: _____ _
FORM: AP SARR 07 /06 Page 1 of 1
Michael F. Easley, Governor
CO-•,
...1
William G. Ross Jr., Secretary
North Carolina Departrnent of Environment and Natural Resources
Coleen H. Sullins Director
Division of Water Quality
January 29, 2008
BONNIE MCELVEEN-HUNTER
710 COUNTRY CLUB DRIVE
GREENSBORO. NC 27408
Subject: Acknowledgement of Application No. WI0400094
Bonnie McElveen-Hunter
Injection Mixed Fluit GSHP Well System (5QM)
Guilford County
Dear MS MCELVEEN-HUNTER:
The Aquifer Protection Section of the Division of Water Quality (the Division) acknowledges receipt of
your permit application and supporting materials on January 25, 2008. 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 mnax.imtun 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 by phone at [phone] or by email 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:Ilh2o.enr.state.nc.us/documentsldwq oruchart.pdf.
PLEASE REFER TO ILLF ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES
ON THIS PROJECT.
Sincerely,
•
L,
For Debra J. Watts
Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Permit Application File WI0400094
Aquifer Protection Section 1 636 Mail Service Center
Internet: www nncwateroualit4.orp. Location: 2728 Capital Boulevard
An Equal Opportunity/Affirmative Action Employer 50% Recycled/10% Post Consumer Paper
No Carolina
Naturally
Raleigh, NC 27699-1636 Telephone. [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service. [phone]

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5-OM WELL(S )
l."7" New Permit Application OR Renewal (cheek one)
DATE: / tr/Of
PERMIT NO.
Zoo
(leave blank if NEW permit application)
JAN 13(10
A. PROPERTY OWNERS)/APPLICANT(S)
List each Property Owner listed on property deed (if owned liv ,,l business or vovernment agency, state name of
entity and a representative w/authority for signature):
(1)
Mailing Address: '-710 CO u .Jrft 1 C 1.t4 f3 t7-
City: Crri Grsosari to State: /k..Zip Code: a. 7140 $ County: Cm, s. Pi 66
Home/Office Tele No.: 3 3 E ..>' 2$ ES Cell No.:
EMAIL Address:
(2) Physical Address of Site ifdifferent than above): '7J0 5ttorrHj dik b -DAL .
City: m..411 State: KC -Zip Code: 771 1 County: Crio vt. Faga
Home/Office Tele No.: Ce11 No.:
EMAIL Address:
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company, if any:
GPi1MC 5QM Well Permit Application (Revised 9/2007)
Page t

C. WELL DRILLER INFORMATION
Company Name: B M&..&..c.. D &u .. :...~ , Xt«. .
Well Drilling Contractor's Name: ---~....;...+-'1&,,J......:..;;; __ 'B---=R="..,_.a.=---'--'11=-= ... L"--____________ _
NC Contractor Certification No.: --~c:2~2~r-~a...~------------------
Contact Person: f?", ,wJ ~ l,,,.,lq,1 (..-E MAIL Address:
Address: 72,.. d,V&J1ieW '"'1
City: 'B a.&11w ZipCode: ?-1SD~ County: ___________ _
Office Tele No.: 9 19_.;Q:-o 3 9 3 Cell No.: 'r1 1-?,,,_t-'I"~ 3
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
CompanyName: Ce1,1A1 6'fN ~ { ,;J.,i, 1 XN ~
Contact Person: --:D wAIN S TRA1)6'L EMA.ll., Address: <?euw s11N e.. i t>uc.HIJc.. ~e.r
Address: / 115: DR£.._~ f.k L'-~
City: Re., 06V1 a.."" Zip Code: :J.? l"-o County: --~--=-o.;;...;c;;...a.tc---'-,_~ .... h"-'--A-M-'-"-'--' _____ _
Office Tele No.: '3 l ~ -'Jtta.-1 01 ¥ Cell No.: 31<--l-1 3 , Y. 8 a. o
E. STATUS OF APPLICANT
F.
Private: L
State:
Federal:
Municipal: __
Commercial:
Native American Lands:
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
-H~~~#~T~'~~-~-'-~--~~~'-~--o~F-~h,-·_~~---s-~~-·~~H~s--~~-~-&-~~-P_,~a~.
G. WELL CONSTRUCTION DATA (Ski p to Section H if this is a Permit RENEWAL)
(1) Proposed date to be constructed: / /2 I ... 1 / l Number of borings: / (, • I -~---
Approximate depth of each boring (feet): ;Joo
(2) Chemical additives to be used in closed-loop system (only those chemicals indicated have been approved):
___ R-22 --~propylene glycol __ ethanol 6N~l l,dl d L,. othet (other additives will
need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): -~PY~c.... __________ _
(4) Well casing. Is the well(s) cased? (check either (a.) YES m: (b.)~elow)
(a) YES ___ if yes, then provide casing information such as~ (steel, PVC, plastic, etc.), 4iameter,
dCJJth, and extent of casing appearing above ground: ________________ _
(b) NO
(5) Grout (material surrounding well casing and/or piping): /
(a) Grouttype: Cement__ Bentonite_V_ Other(specify) ______ _
(b) Grout depth of tubing (reference to land surface): from Q to ,o e (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
GPU/UIC SQM Well Permit Application (Revised 9/2007) Page2
H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering Iayout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(I) 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 wells) 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.
J. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"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 wi ti . r ved s . • ' + is and conditions of the Permit."
Signan,
Property Owner/Applicant
e-- 6.lLE Linn — t-k.Y1.Ear-'
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
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
IiIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
3PUIUIC 5QM Well Permit Application (Revised 912007)
Page 3

Cabana
RUN PIPING UNDER MED ANUXIR
ASPRAI.T SURFACES
GLIOC sumo,
GU% WNW
OfFIRATMTERICIR WALL —AND EWER
AT CEILING WU OF EASEMENTIN
UNFINISHED CRAWL SPACE; INRAME
PIPING IN CRAWL SPACE WATERTIGHT
SEAL TO ANY EXTERRA Fumy
Asphalt Parking
z
Pool
Walk
Porto Cochork.
E
'Garage •
2 1,2
1-•-r.F • -

•
a
4--
;".
1
RUN Pi PING UNDER FiWED Anti=
ASPHALT SURFACES
ea Gm sPLY
z
2.0
CAW FEWRN
ErFurrreautro A wntrart) EMIR
AT =NG LEve. OF BASENEENT/N
UNFINISHED CRAWL 5PP4E4 INSULATE
PIPING IN CRAWL SPACE WATERTFGHT
SEAL TO ANY EOERXR 9RN
"Nun(
Asphalt Parking
Garage •
Fat! Cochere
C

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While other antifreeze solutions may be toxic, Environol is safe. In fact, the USDA
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Available in two formulas
Environol is the right choice for every application from large office complexes to
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Make Environol your formula for a successful closed loop installation.
Key Environol benefits:
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*He at transfer performance 20% greater than propylene glycol
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Page 1 of 2
Guilford County, NC
Parcel Number
000001210000100004
Plat Book
Owner Name
MCELVEEN-HUNTER BONNIE
Plat Page
Mailing Address 1
710 COUNTRY CLUB DR
Condo Book
Mailing Address 2
Condo Page
Mailing Address 3
Total Assessed Value
$4,124,200
Mailing Address City
GREENSBORO
Total Building Value
$3,092,100
Mailing Address State
NC
Total Out Building Value
$60,100
Mailing Address Zip
274080000
Total Land Value
$972,000
Property Address
710 COUNTRY CLUB ❑R
Total Deferred Value
$0
Legal Desc 1
710 COUNTRY CLUB ❑R
Building Count
3
Legal Desc 2
4504-2009
Building Number
1
Land Units
+1,00
Year Built
1937
Land Type
LT
Heated Area
10175
Deed date
2/6/1997 12:00:00 AM
Bedrooms
7
Deed Document Type
WD
Full Bathrooms
6
Deed Book
4504
Use Code
7
Deed Page
2007
Appraisal Model Code
8
Disclaimer: While every effort is rrrade to keep information provided over the internef
"—I11 f"
http://gcgis. co.guilford.nc. usiguilford_new/printPreview.aspx?PrintOptData=Guilford°%... 101I 8/2007

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http://maps.google.comlmaps/mm?mapprev=1 &ie=UTF8 &11=36.101336,-79.796362&spn... 3/28/2008

AQVIFER PROTECTION REGIONAL STAFF REPORT
Date: 03/1712008
To: Ao offer Protection Central Officer
Central Office =Reviewer: Michael- R ers
Regional Login No:�
County: Guilford
Permitter. . Bonnie. Metiveen-Bunter,
ProjectName: McElveen-H unter
Application No.: W10400094
x GENERAL INFORMATION
1. This application is ict,x:s that apply) j :vt;.w ..0 Renewal
Er Minor: Modification ❑. Mafor-lMdiftcation
l 0 Surface lrrigation.D Reuse 0 Recycle Righ flats hi filtration ❑ Evaporation/infiltration Lagoon
❑'Land Application. of Residuals 0 Attachment-8. included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals 0 Surface Disposal
2 Closed -loop -Groundwater Remediation ❑ Other Injection Wells (including in situ rentediation)
Was a sitoriait.candactsd in order to prepare this report? C31 Yes or ❑:l io.
a. Date of site ►risiv 3l06.17 $
b. Person contactedand contact information: Ren Putnam (property rnla)
Site visit conducted-- Stephen Berry
d. inspection Report Attached: 0 Yes or tg No.
Tithe a failtwing infeimation entered baba. ttte. B MS record for this application correct?
laYcs or raga. if tto,please complete the follow ing or indicate that it is correct on"the current -application.
For Treatment .Facilltieal
N: A
For Di osaIVnd infection_ Slice;
itf multiple sites either indicate which sites the,.infeintatitm applies to. copy and paste a new section into the
document:for cach_ . or attach additional pages for each site)
a. Location{s): 710 Country :CIO f?rive,..Greenshoro (27408). Guilford County.
b. Dri% ing.. Directions: From 1-40 talte.. N.. Elm Street. North to Couriti'x C k b Driveand turn Wait. Honte is
on nurth.side .of street approxitrtatciv 1 mile from 1~Im intersection.
t:, .13425 Quadrangle Map -name and c► Imber: prtkttm+n
d. Latitude: 36'6.i 56 I ongitnclie3 19'48.032
IL NEW AND MAJOR hfMLDJFIATJQY APPiICA:TIONS. (ibis:section iutt needed for renewals or minor
moditicatlon4, sk , to sex; section)
III RENEWAL AND= lD/F,K #TIONAPPLICATIONS fuse previous section for.new or molar modification
W.ems
N/A
FORM: W10400094_APRSR

A.QttlFER
TECTJ.O1 REGIONAL STD REPORT
T f' 1 EC i 1N:WELL.PERMITi ?Jt; x7ONS(Complete these:two:sectiona for ail systerns.that use injection
wells, :ina:Wing:closed-loop groundwater retncdiarian effluent injection wank, in aimternediation injection wass.and heat
pump injection A ells:)
Deletiritim OtWelltSt.And Fealties — New. Renewal, And'tiMadificnt%u
1. Type of injection system:
O. Heating/Goofing water return tow. (A1)
0 Closed -loop heat pump system (5QM 5QW)
❑.In situ remediafiof
Cloud -loop groundwater rcmeidiation effluent injection. (51rNtin-Dist harge").
❑ Other (Spcsafy
2. Does system use same well for water sourceand injection'? 0 Yes
3. Are there any pet 'tfial.pollut an sources t41:rttey ttfil,ct injection? D e: No
What islare:Ihe:.pollution uree(3)? 1 hat. istlle=di re of rite inj a don �vellt from the::ponittion
4. What min3mulm.distanc r uf.propos l injectionwetls fromthe:propeny boundary?—Z,S it.
5. Q y-o drainage: atone: El Good El Adequate . poor
6. Flooding ptential`ofaitse: -Low ❑ Moderate • ❑
7. NIA
Dotes the na i present..d rep nt'ii*-a a4•airtr (property lines, wells, surface dralinage).? ❑ Yes or: 0 No, if
no or no map; please attach a ketch oft e..aite.: Show property boundaries. buildings, welts, potential pollution
•uurces, roads,-approximate.atale, and noteb arrow. (see map and .pieComposite *.pdf'a)
iiiiL•Ction Well Permh. Renewal' And. i !�Eldiflc ti��71..Onh
N/A
V EVAL-114144.4.V.RXC011fiVENDATIONS
1. Provide. any additional narrative regarxlinigyour review of the application.: Ste Memo dated 3/14/8
2. Attach Weil -Construction Data Sheet - ii needed:inionnation is le
3. .Do yore fares any problems —with issmrncchanewal of thialierittlep Yes 0 No. if y es; please es.plain
brie€1y. 4. 1:isr ark- items the you w o itd Iikd :APg Central Ot ceTto:obtain thxough an additional information request.
Matte sure that you -provide a reason for e:h item:
tin Reason.
r
Well Ds flier's Logs (submit to WSRO & CO)
br- ten ce oflocal hydrogeolog
FORM: 1k Io4UO.U94 APRSR

AQUIFER PROTECTION REGIONAL STAFF REPORT
List specific Permit conditions that you recommend to be removed from -the permit when issued. Make sure
that you prnvide.a reason for: ea, i condition:
Condition ' Reason
None
6. Lis€.apceific special conditions or compliance schedules that•you recommend to be included in tit permi€'when
issued. Maize sure that you provide a reason for each special condition:
Condition Reason
Nose
7. Recommendation: [iHvlii,:-pending receipt and review of additional infortnatiern by regkma : ice; 0 Hog;
pending re w-ot. draft-per:nit by regional cAfc;; [ :1ss a .upon receipt of needed:addi I imq,;
Issue;DeLitny. lftleny,.please stare reasons:
Y. '.►
8. *nature et report preparer(s): .
Signature ofieScrogional supervisor 44#.4.4.A.
Dete: 304111
,4DDITIONAL RR`GIONAL-STAFF.R VIEWITEMS
ptease.use-the. three *,pdrf as1 eit10 M; Ragtrs'.as•supp.lemental documentation ofthe site visit.
F'Ok i' WII3400094 APRSR 3

Mictiael F. Easley. Governor
Wi[liern G. Ross Jr., Secretary
North Caroline Deparfrnent cff Envtronmem and Natural Resources
Golsen H. Sullins, Dlectar
bivision of WaterOuallty
March 14, 2008
MEMORANDUM:
To: Michael Rogers, Groundwater Protection Unit
From: Stephen .Berry
Subject W104 0094
On March 6, 2008, Sherri Knight and myPsei (Stephen Berry) rriet.with Ryan Brazil (driller), Ren
Putnam (property manager), Tate Russ (heating/cooling spe iaalist), nd Dwain Strader (heat
pump contractor) to discuss tie. proposed and installed closed —loop system.
16 well borings.exist (see map * t). There aletVeir dusters -with *dui depths: Three
=dusters hakt wells driiled;tt aa:depth of 33501 tam! borings): Mrivther clusterclusterhad 4 wens at
a: depth of 290ft. The last boring used an exist well (see map) drilled by Billy Yew (several
months ago). The purpose Ofthe well was irrigation though ,no water was located. The deplh
of the well is 600ft though the ci1ied6li'lop piping goes.to a depth of 300ft. This piping is V in
diameter while the remaining tubing is 125'..
The closest structure, is the: RV storage sit apProdatately Wit: -Thellinithrdetirtis
approximately 33ft from a well cluster.
.Alt parties involved claimed ignorance to the need of:a permit. The driller now understands
"vat non -potable water systems: require a peer tf. K is my belief that system design criteria
were not fully explained to all parties involved. Thet!1s .the .Heat Pump contractor (Dwain
Strader of Cellusun), Mr. Russ (Singleton 'Heating &-Air), .and the well Miler (Mr. Brazil of
Brazil Drilling) failed to communicate.necessary inn8an with one another, in order to
comply with State regulations.
Therefore,. ftis-my rec iMmendation that all involved parties beti issued a Notice of Volation
for faiture to secure a permit prior to constructing. thewed-ttmp system..Additionally, Mr.
Brazil should be required to submit all relevant well. driller logs to WSRO as well as a copy to
your office.
Please contact me if you need any additional information.
Sincerely,
en Berry
rry
H. C. Dmsion of Water Cluality 885 Waughtovm Street VAinston-Ssiem, NC 27it3T [phone] uStonWM Service
1 800823-7r[8

Site Map of
WI0400094
710 Country Club Drive
Greensboro, Guilford County
41,
GLETp81 IOIF 1 Y�rsr~� ."
'
LE I, Hee
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{ IOLE 1$r'
MIRWELL 4eHOLE284N:p w i • �.
Scale 1:650
1 inch equals 52.08 feet
■ ■ ;f• f• f•
Feet
0 20 40 60 80 100 120
0 5 10 20 30
Meters
40
Scale 1:24,000
Prepared by Stephen Berry of the North Carolina Division of Water quality,
Aquifer Protection Section, Winston-Salem Regional Office.
Published on March 13, 2008
Note: This map is for reference only and should not be construed as legal survey documentation.

Site Pictures of 71 O' Country Club Drive, Greensboro, Guilford County
. Permit#: WI0400094
(March 6, 2008, 'taken by Stephen Berry DWQ-APS-WSR_O )
Figures 1, 2, & 3 (clockwise). Three· structur~s
supplied by closed-loop geothermal system;·
Fig.1 and fig. 3 were taken looking south; Fig.
2 was facing west. System is on north side of
main house and east of tennis court.
Figure 4. Possible water supply well on east
neighbor's property (approx. 1·00ft from system).
Page 1 of 3
Site Pictures of 71 o. Country Club Drive, .Greensboro, Guilford County
Permit#: WI0400094
'(March 6, 2008, taken by Stephen Berry DWQ-APS-WSRO )
Figures 5 thru 8 illustrate construction
methods; Fig. 5 (looking northwest) shows the
stub up casing of a water supply well (irrigation)/
dry hole converted to house a po.rtion of the
closed-loop system.
Page 2 of 3
Site Pictures of 710 Country Club ❑rive, Greensboro, Guilford County
Permit #: W!0400094
(March 6, 2008, taken by Stephen Berry DWO-APS-WSRO )
Figures 9 thru 13 illustrate closed loop piping and bore hole bentonite grouting. Fig. 10 shows
the proximity of the system t❑ the southern structures (pool house), and the location of Fig. 9.
Page 3 of 3

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5.OM WELLLS)
VNew Permit Application OR Renewal (check one)
DATE:
2O Q
PERMIT NO. (leave blank if NEW permit application)
RECEIVED i
JAN252018
A. PROPERTY OWNERS)/APPLICANT(S)
List each Property Owner listed on property deed (if owned 111 • business or zovernrnent agency, state name of
entity and a representative w/authority for signature): L )'JL C --- s
(1)
Mailing Address: '7W µ I.I O r R +F� C L w 13 17 iG
City: 6-R abN ss& go State: /,C.Zip Code: a 1'-1 o $
Horne/Office Tele No.: 3.f 6 ,5 2 $ 6 ei &3" Cell No.:
County: CrI.414. Fs SO
EMAIL Address:
(2) Physical Address of Site (if different than above): 7j0 UgNTH et„ b -Da. .
City: E475&ego State: 14C-Zip Code: �-4 Q I
Home/Office Tele No.: Ce11 No.:
EMAIL Address:
County: Gtfr... Fop?
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company, if any:
GPU/L IC 5QM Well Permit Application (Revised 9/2007) Page 1

C. WELL DRILLER INFORMATION
Company Name: B -.,..'-'-' D &d .. ·y½ 1 I.re.. .
Well Drilling Contractor's Name: --~....:...'1&N""'-= ____ 'B~~ ..... 1r=a.=---• &..,.=-=L ..__ ____________ _
NC Contractor Certification No.: ____ ,;1"'--"?'-"'a..=----a,........__ _________________ _
Contact Person: f?") ,HJ ~ l-,lr-z,, C.-EMAIL Address:
Address: 22:: c.W0r&gw~
City: B k11w Zip Code: ?-1'$06 County: ___________ _
Office Tele No.: '1 r,_;Q:-o ! 9 3 Cell No.: 'fl 1-?.,,_f-'I"~ 3
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Ce1,1A1 ~N /-lf,,,,,,,r-{ A,,i . , '&Ire..
Contact Person: --:/J 1tAJA1N 'S TRA,Qelt EMAIL Address: CS'4ws .,N e. T Ouc141Jc.. a,e.r
Address: /17~ DRE""°~ "'1L'-Pl\
City: R~1oav1a..\.E. ZipCode: 11.?!~o County: __ i?i~o_c_tc_,_..., __ h_AM~-------
OfficeTeleNo.: 3 lt.-'JY2.-10-l 't Cell No.: J'Jt.-t-·1 3 ' ¥-8 &.o
E. STATUS OF APPLICANT
F.
Private: L
State:.
Federal:
Municipal: _. _
Commercial:
Native American Lands:
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
.....H:i ..... ~"""~"'-'~:....,:l..:.;;;ll_,,,.,_,_t.o..:;..;:o:...=~.....:..,"j"-+------'O:...;I'-;..__---'-,., ____ ._~_---'----11, __ s__,,.,,.._. _e ...... & ........... H ...... S=--___.::r! __ ...,_e....;::4-:Cc........_ _____ P ____ 1_au) .
G. WELL CONSTRUCTION DATA (Skip ·to Section H if this is a Permit RENEWAL)
(1) Proposed date·to be constructed: //,., .-1 /t Number of borings: I ~ • 7 -~---
Approximate depth of each boring (feet): Joo
(2) Chemical additives to be used in closed-loop system (only those chemicals indicated have· been approved):
___ R-22 --~propylene glycol __ ethanol 6AJ~l lffl d L-other (other additives will
need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): -~PY~C-__________ _
(4) Well casing. Is the well(s)° cased? (check either (a.) YES m: (b.)~elow)
(a) YES ___ if yes, then provide casing information such as~ (steel, PVC, plastic, etc.), diameter.
skm!h, and~ of casing appearing above ground: _______________ _
(b) NO
(5) Grout (material surrounding well casing anc;i/or piping): / _
(a) Grout type:· Cement __ . Bentonite _V_ Other (specify) ______ _
(b) Grout depth oftubiilg (reference to land surface): from Q to ~o e (feet)
If wen has casing, ~dicate grout depth: from ___ to ____ (feet)
GPU/UIC SQM Well Pennit Application (Revised 9/2007) Page2
R. INJECTION -RELATED EQUW ENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
( 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,
J.
(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.
CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"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 wed s�[ts and conditions of the Permit."
Signature- f Property Owner/Applicant
C V1, \ 1 e ALF - L L1Ss.--V1
Print or Type Pull Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUMC 5QM Well Permit Application (Revised 912007) Page 3

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Environol - WFI Global
Page 1 of 1
Geothermal
Technology
Product
Information
Customer
Resources
Events
Promotional
Items
Investors
Home Sean:* I Sate klap II Secure site I mace] Contac t lie
Environol
High performance freeze protection for closed loop systems
Made from a natural mixture
Environol has been specially formulated for WaterFumace and is the only loop
solution WaterFurnace fully endorses because it is safe, environmentally friendly,
nontoxic and has excellent heat transfer properties. Environol is based on a natural
grain mixture that is inexpensive and mixes easily with water for faster installation.
While other antifreeze solutions may be toxic, Environol is safe. In fact, the USDA
mandates a similar mixture to grade -stamp meat.
Available in two formulas
Environol is the right choice for every application from large office complexes to
schools to single family homes. Formula 2000 is Environol in its. concentrated
form, while Formula 1000 is available in a convenient, ready -to -use form. Whether
in concentrated or pre -mixed formulations, Environol is an inexpensive, safe, high
performance solution for freeze protection in all dosed loop geothermal systems.
Make Environol your formula for a successful closed loop installation.
Key Environol benefits:
•E nvironmentally safe
■I. owest NFPA (National Fire Protection Association) health warning
•He at transfer performance 2O% greater than propylene glycol
•Av ailable in both pure (Environol 2000) and pre -mixed ready -to -use (Environol 1000) formule
•Biode grades more readily than any other antifreeze type
•S pecialiy designed corrosion inhibitor package
Download
Home I Search 1 Site Map I Secure Site I E-Commerce I Contact Us
©2008 WFI Global, Inc. 19000 Conservation Way' Fort Wayne, IN 46809 USA. All Rights Resery
http:llwww.wfiglobal.comlenvironol.asp 1/29/2008

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Page 1 of 2
Guilford County, NC
Parcel Number
000001210000100004
Plat Book
Owner Name
MCELVEEN-HUNTER BONNIE
Plat Page
Mailing Address 1
710 COUNTRY CLUB DR
Condo Book
Mailing Address 2
Condo Page
Mailing Address 3
Total Assessed Value
$4,124,200
Mailing Address City
GREENSBORO
Total Building.Value
$3,092,100
Mailing Address State
NC
Total Out Building Value
$60,100
Mailing Address Zip
274080000
Total Land Value
$972,000
Property Address
710 COUNTRY CLUB DR
Total Deferred Value
$0
Legal Desc 1
710 COUNTRY CLUB DR
Building Count
3
Legal Desc 2
4504-2009
-r
Building Number
1
Land Units
+1.00
Year Built
1937
Land Type
LT
Heated Area
10175
Deed Date
2/6/1997 12:00:00 AM
Bedrooms
7
Deed Document Type
WD
Full Bathrooms
6
Deed Bock
4504
Use Code
7
Deed Page
2007
Appraisal Model Code
8
Disclaimer. While every effort is made to keep information provided over the Internet
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