WI0400121_GEO THERMAL_20120517

Beverly Eaves Perdue
Governor
Tom Ullman
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 17, 2012
203 Edgedale Drive
High Point, NC 27262
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: \VI0400 121
Dear Mr. Ullman:
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 o( 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, t:~
Eric G. Smith, P.G.
Hydrogeologist
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.ncwaterquality.org
An Equal Opportunity\ Affirmative Action Employer
NOnehC 1· o.rt. aro .1.na
,Natural/11
NON RESIDENTIAL WWLL,CON§TRUCTLON RECORD
North Carolina Department of Environment andNalurat Resources- Division of Water Quality
-WELL CONTRACThTt CER.TH ICATION 3 d 3 Y
1. /WELL CONTRACTOR:
/! [ ILI I / Yam, �/C I.A./.1
Well Con racier pndlvldualj Name
YADKIN WELL COMPANY, INC.
Wall Contractor CoRlpanyNamo
STREET ADDRESS 1908 HAMPTONVILLE ROAD
HAMPTONVILLE NO 27020
City or Town slate
{336 1.468.4440
7.1p Coda
j �
"sue
Area code- Phone number
2. WELL INFORMATION;
SITE WELL ID7 fappilcabfe) `�
WELL CONSTRUCTION FERMI et applicable)
OTHER ASSOCIATED PERMIT #(li epplIcable)Wro
3. WELL USE (Check Applicable Box) MonlloringU
InduslriavCommerdalD Agricultureif Recovery°
lrrigaliar l Meg- (listose) GVo e.s.rt.1
4+' 00 f I
MunitipnilPerlrllcl]
injection°
CiroTe
DATE DRILLED j2 • / A 9
Lu.ay,
P
,!' ff
" u-
it.-d
TIME COMPLETEl7�-,ape MAY
4. WELL LOCATIO ;
CITY: COUNTYWci
Le. f V.ze ci !u/b)c?vey
(Street Name, Numbers. Comma . 5ubdMHon, to No., Parcel, Zip Cede)
TOPDGF2APHJC1 LAND SETTING
0 Stops 0 Valley 0 Flat XRIdga la Other
(check appropriate box)
LATITUDE a C 1.2 • 5. e 7
May be In drgrcce,
minuI s, seconds or
in a drelmat format
LONGITUDE $ L. j s 6$ f
Latitude/longitude source: I 11$ El Topographic map
(location of well m ea l b a s o :w on a US G S lope map and
oftener! to Ns form if rrCl using GPS)
b. FACILITY- Ls 'ha p&p!, or aq Wr W_5 s Wriw it the vo Moral rd.
FACILITY ID #(irappllcaOle)
NAME OF FACILITY Torre Ll ( 1 mei.-/ rn 2 V. r.,41.r)
STREET ADDRESS Po ii.4 IC 36,
,, , l 1G i .
/ 1, Po r; U�rl�
ly or Town Slate Zip Cods
CONTACT PERSON (AJ t n 3 4-ati Pe,P$F
ir1A1LING ADDRESS
/41ffl.
city or Town fj C" Stale
f 1-
Zip Cods
VESO NOfk
FT.
Ares coda - Pk ne number
8. WELL DETAILS:
s. TOTAL DEPTH: 3 a a:"
ii. DOES WELL REPLACE EXISTING WELL?
o. WATER LEVEL BetoW Top of Casing; -F--"
{Use W+' 1f Ahova Top of Casing)
0-1141(Al rr — fir ACadr C.v.-ply r4tit'�r.
3 3 (0
713
d. ToP-OF CASING tS.\ FT. Above Land Surface'
'Top of casing terminated atior below land surface may regvlre
a variants in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): ' r METHflD OF TEST AIR PUMP
f. DISINFECTION; Type i 1T1 I Amount
_ -
g. WATER ZONES (depth);
From .2A` TO 2i8 From To
From To From To
To From TO
_�,wFrrom
7. CAS1N0 Depth Olarnater ThrOmeiHANcilghl Malerfal
From' f To4 / rt.‘ " Gaw
-
From To Ft.
From To Ft.
a, GROUT; Depth Melarlal Method
From .0 To 3'2 Fl!7 so — _cam e„.
_
Prom To Fl.° 4.dit '
From To Fl, 300 /6 see...{ /A•E,6
S. SCREEN: Depth Clamelo( SIol SJza Malarial
From_ To Ft. • tn. In.
From To Ft. In. in.
From To FL In, in.
-
10. SAN 0101RAVEL PACK:
Depth Size Material
From To FI,
From_ Tv FI.
From To Ft.
_
11.bRILL1Na LOG
From
m U o �1 Fa/mallet)Description
0— 414
0 2fa) 6r fi�
`fteq,,,4r
21.a'- .3�?' -50o' - G.zr-e_e_
SIZE OFF .S', y; 3 -•
BIT SERIAL NO:
(. TOS %r' 1• ; t
i2, REMARKS:
/01 -`,Fla ,,,A t,.Ak<r dCie 7 in2{LII
I I:9 HEREBY CERTIFY THAT THIS WEIL WAS comsTR[iOTEouraCCOROANce WITH
OAiZt .0 2C,' ,t5LCONSTRLJCTCONSTAHowas, arm T-iArACOPYaF nEs
RECOR a N PRQV+LEATO TIM /I. co lfErr.
c../.? -14-01
SIGNATURE 1. E OF CERTIFIED WELL CONTRACTOR DATE
L4' 'h w ). 43D v'
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
144.' -P Vir.Geu -$ 2k- 20c-?G�a Lift `�i �- — 7 7.
Submit the original to the Division or Wale]. Qualify within au days. Alin; Information Mgt.,
16-17 Mall Service Cantor-- Raleigh, NC 27889.1617 Phone No. (Gig) 733.7016 ext ass.
Lori( 1- MatiA -aIecv (j-\eod-der / 3 .3t)U' ,[fire.)
Pa 6.,N' Ifoa b f}.G 2 Gd7 ` i
IJ,�yry I kopf .2�a /�ou)a
Form GW•th
Ray.1Pnn7
rt-=
4-
so' 745 Ave, it,

1 ? 0,61:
• 0LZ !.W' 6
• f y
v
lAot 14. 114.t.
PO 1L-•
Iv I-
t, N]

1 Y ONRESIDENTIAL 'WELL CONSTRUCTION RECORD
North Carolina Daparhment of Environment and Natural Resources- Division of WelerQuality
... __ ,.- _WELL CONTRACTOR CERTIFICATION if 3O.3 t #
1. WELL CONTRACTOR:
r�+ Est, t 1 3 dwn
Wall Contractor (Indtviduel) Name
YADKIN WELL. COMPANY, INC.
Weft Contractor Company Name
--s'rk>~ —A-66Rtss 18D8 HAMPTONV1L11=RbAD
HAMPTONVILLE NC
27020
Clay or Town Slate
( 336 pl-68-4440
Area coda- Phone number
7. WELSITE INFORMATION:
Ip4 d 5
SITE WELL lO#(lrappecabfey �
WELL CONSTRUCTION PERM (I eppptablej
OTHER ASSOCIATED PERMIT #(II appl}cabte) W .i' 0 SAo
3. WELL USE (CheckAPpifcable Box) Monitoringf MuntdpellPubilc.1]
In dustrtatlCommerc1aI[1 Agrlculluraltl RocovetyLlInJectionD
Irdoet1or0 Otha�- (Eel Use) 94'a 1e•'t't.r+.1 C(e.l
DATE DRILLED I a- 14 -art
TIME COMPLETED t l ►`_30 AMA PIM
4. WELL LOCATIR :
CITY: (/ r cIS
Lo 2.7 Infer, Ett r !C•>S
(Street Hama, Numbers, Communl eubdMLoa, Lot Ka, Pucel, 7p Cade)
TOPOGRAPHIC 1 LAND SETTING:
d Slope 0 Valley 0 Flet,fildoe D Olhar
Cebu): epprnpeeta box)
LATITUDE ,.L C 1.2• �`Rl
LONGITUDE ,, L LS• G $.r
21p Code
Off
COUNTY Viattclett,
Maybe Indeg/co,
minutes, seconds et
In a deolmal fatmat
Latitude/Iongitudesource: 11 'T
opographic opographicmap
(lacellon ofwe',mvstbe oWn on a USSS tope rasp and
attached to fhls form it not uaing GPS)
.5. PAC I LITY• to are %,era or the MMus sotto the wee re Waled.
FACILITY ID tt(lf applicable).
NAME OF FACILITY T n (ei { I s?OQ 7 Cave ( Kt",
t",
STREET ADDRESS Pa f3,,
l g1i rrtk rn... a Yl6 1
tyor-fawn Stalee-� �L ZIp Code
CONTACT PERSON OIL b. g4.34 ey
MAILING ADDRESS
City or Town
Stale Ztp Code
Area coda • Phone number
s, WELL DETAILS:
a. TOTAL DEPTH: 3 D a
b. DOES WELL. REPLACE EXISTING WELL? YEtiSti N0k
o. WATER LEVEL 8elvvr Tap of Casing;
, (Use -+" irAbove Top of Casing)
d. TOIL OP<CASING I9 FT. Above Land Surface
*Top*: wring terminated at/or below lend sunew may raqulre
a valance In esa:War o with 15A NCAC 20 .011S.
e. YIELD Wpm); 0 METHOD OF TEST AIR PUMP
L DISINFECTION: TypeHTH Amount 1.('.c4,10
g. WATER ZONES (depth):
From To Prom To
From To
�syFrr�em _ To
7.4l4.11 Depth 1]larneter
Frcmjj"To (.1 Ft. G r
From To FL
From_ To Ft.
8, GROUT: Depth Materiel Method
Fmm.0—_To3D�Ff'vl'M1AC f C1
From To FIIAe e� rl
Frarrt __ To Ft,
8. SCREEN: Depot
Diameter Slot Size Material
From To FI, in. In.
From To FI. _ 1n. In.
From To Pl. In. in,
10. SAND/GRAVEL PACK:
Depth Size Meiuiel
From To FL
Freak To 'i=t.
FroMTo FI.
11,DR1LLIN0 LOG
From Toe �v Four akin Description
V Gr- 3OD. ' Aft/ — _iQ - & •oAeos,
SIZE OFF
BIT SERIAL NO:
i2.R!'fiAAPtKS: MC "1 deer an[di 93
ju, Mkt w/ N f1 _/-.Pa c r iSta II
SW HEREBY C+ STrFY THAT THIS YYEiL WAS CWUSTAUWTED MACCORPAHC2-{MTH
loll NUM QC, WELL. CONSTRUCTION SrmamanS, m DTHAT A COPY OF THIS
REGOROHAB enatPROVibEOTOTHE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
/44#4j.6 w �• grOWrL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Smouhm t the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
� 1617 Mall Servicce Center — Raalolgh, NC 27/699.16'i7 Phone No. (910) 733-701S,,r}}ext 990.
13.Et f4 tit eon ter., U1ie f1eb./ .- colJ• r[3¢f'G'
t{ hoi 'towc 3o`+ eertovlc
to QYk tier LLtrn.e. ti,c4 Z 44 7
From
From
To
To
ThrraneerrWereta Material
Form GW.1ts
Rev.12!07

NONRESIDENTIAL ONRESIDENTILAL WELL CONSTRUCTION EECORO
North CauuIIns Department oi'Envlr repent andNatural Resources- Division of Water Quality
WPC. COMA:LICA aktitffithifolst 3- . VA--
__._...__.
_
1. WELL CONTRACTOR:
WWI Contractor (Indtsddual) Name
YADKIN WELL COMPANY, INC.
We EICon#aotarcompenyNerne _ . .........................--._, --...-....-
STREET ADDTTEss 1t3Q8 HAMPTONVILLE ROAD
HAMPTONVILLE NC 27020
City of Town Stela Yip Code
f 336 1.488.4440
Area coda- Phone /lumbar
2. WELL INFORMATION:
SITE WELLMIRappllceblel 14 " 6 2 6
WELL CONSTRUCTION PERMI I appllcabre)
OTHER ASSOCIATED PERMIT d(If applicable) W Z - O 1-4O 10. (
3. WELL MR (Check Applltabla Sox) Monlioring° MunlclpallPubticD
TnduatslaVVCommarcla1Ei Agri lluraID Recovelyl3 InjeClin
irrlga0Dr0 Olherg Est ma) (tfn fi-ii a.l+.jJ C1a,S
DATE DRILLED la. — L -2 — 0 ti L..op
TIME COMMETE D . i U,) 00 PMIilii
4. WELL LOCATE° is r
CITY: COUNTY i+tlat/y
Lot27 /inehr.i'I•e4 A4(6 ey /GS
(431realNania,NensbeN.Comrelnli e. BubdMsion, Let Hap Parcel, Tip Code)
TOPOGRAPHIC 1 LAND SETTING:
El Siopa 0 Vawlay U Fiat ,Ridge U Other —
(chtrk appmpdala box) Maybe in degreta,
LATITUDE I. a i.i r Tr 7 mttlutes, seconds or
LONGITUDE 1 J_. N.; G $r s deekdA farmer
Latitude/longitude source; r3PS U Topographicmap
Of:car/on olwellerlrse ba shown on e USGS fops map and
aitarltedfo Mk tom lino! using GPM]
.6, FACILITY.IsEre nameaI OM WOO SS YAM Olt Will Irtouted,
FACILITY ID Rif applicable) NAME OF FACILITY I C.r. CO l r r,ri f efka! Kw".
STREET ADDRESS ,d f3a �{ IC X
Nid PpiA 1, AIL... AI 1'
i' 1torTown Mato
Z.pCode
CONTACT PERSON fAi J n3-i r. Ire.'Y(tP
MAILING ADDRESS_
CltyorTown '? 5rate Tip Coda
Area coda • Phone number
6. WELL DETAILS: �]
a. TOTAL DEPTH: 3 a "
b. DOES WELL REPLACE EXISTING WELL? YESE1 NOt
c. WATER LEVEL EOM Top of Geeing: -:---- FT.
{Use '+' If Above Top of Casing)
d. TOP.OF CAGING IS _ FT Rbova Land Surface'
'Top of casing terminated attar below land surface may require
a varlanca In accordance with 15A NCAC 2C .0118,
o, YIELD (gpm)l 0 METHOD OF TEST AIR PUMP
t. D]SINFt cTTON: Type .iiTH Account et ye
g. WATER ZONES (depth):
Flop► . To From To
From To From To
To From To
.11.-me
pram
7. eAsINGt Depth Diameter T'hianeeehererom Materiel
FrvITr 1 To #6 Ff. fir` G all/
.
Prom_ To Ft.
"_
From_,_, To_ Ff.
9. GROUT; Dap' Material Method
Flom 0 To 3a0'Ft Wr'htill -
From To FL2 4 MAGI
From To I'137{1-4aA4+r
S. SCREEN: Depth biamaler Slot Me Material
Front To Ft. In. In.
From To FL_Jn. In.
From To FI. tn. In.
10. SANDI0RAVEI- PACK:
Doplh 817.e Material
From To FIB___
From To 'FL
Frara To
,Ft,______
11.DRILLINO LCa
From � o .�� � Formation Description
e. 3OQr Tl o,--a� &/.tit r,
300-- Joa1' .S•af4 G.eml,+c.,
SIZE OFF
Br SERIAL NO:
12, REMARKS: `
loaf •TJtLk,/]t( Ivo/LI .Veit,- r.w.ST4/1
I comma'', CERaIFY 1W.T INS LYE&L WAe cuff orRLICrEO In ACDonionf u Nom
tsAMCAC2C,WELLCOMMOTION arANDARCO,MID THATAcop( onnes
IRE 0 etE PR +DFAro,0 EWELLmem[t
SIGNATURE OFCERT1F11EDwell CONTRACTOR DA
At141,, II. grovi.bn
PRINTED NAME OF PERSON CONSTRUCTING 7HE WELL
Submit the original to the Division of Water Quallty within 30 days. Attn; Information Mgf„
1 E17 Mall Sorviao Center -- Ratolgh, NC 27S99-1617 Phone No, [phone] oxt 666.
3lff cep jlvf deitiv .. 3 '
(f4Y r zf UC' .2$CO7
Form GW1 b
fcv 12I01
ill e s r { f kW./9-'1 IC ' Ito�ry c r� 'a u e.

Permit Number WI0400121
Central Files: APS SWP
12/15/09
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Status Project Type
Active New Project
Version Permit Classification
1.00 Individual
Primary Reviewer Permit Contact Affiliation
john.mccray
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Lot 27 Mulberry Place SFR Geothermal
Location Address
Lot 27 Mulberry Dr
Vilas
Owner
Major/Minor Region
Minor Winston-Salem
County
Watauga
NC 28692 Facility Contact Affiliation
Owner Name Owner Type
Individual
Tom Ullman Owner Affiliation
Tom Ullman
Dates/Events
Orig Issue
12/09/09
App Received
11 /19/09
Draft Initiated
PO Box 1636
High Point
NC 27261
Scheduled
Issuance
Public Notice Issue
12/09109
Effective Expiration
12/09/09 11/30/14
Re',julated Activities Requested/Received Events
Heat Pump Injection Region comments on draft requested 12/01 /09
Region comments on draft received 12/03/09
Outfall 4`.'t)t_
Waterbody Name Stream Index Number Current Class Subbasin

Permit Number Wi0400121
Central Files: APS SWP
12/01/09
Permit Tracking Slip
Program Category
Ground Water
Status Project Type
In review New Project
Permit Type Version Permit Classification
Injection Mixed Fluid GSHP Well System (SQM) Individual
Primary Reviewer Permit Contact Affiliation
john.mccray Winston Petrey
Coastal SW Rule
Permitted Flow
Facility
Facility Name
Tom Ullman & Carol Young SFR
Location Address
Mulberry Dr
Vitas
PO Box 1905
Boone
NC 28607
Major/Minor Region
Minor Winston-Salem
County
Watauga
NC 28692 Facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
Tom Ullman Owner Affiliation
Tom Ullman
Dates/Events
PO Box 1636
High Point
prig Issue App Received Draft initiated
11/19/09
Regulated Activities
Outfafi NULL
Waterbody Name
Scheduled
Issuance
NC 27261
Public Notice Issue Effectivari 07 fq
Ex++
�ll
Stream index Number Current Clase Subbasin

Beverly Eaves Perdue
Governor
NA
MCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
December 9, 2009
Thomas Ullman and Carol Young
P.O. Box 1636
High Point, NC 27261
Dee Freeman
Secretary
Subject: Issuance oflnjection Well Permit
Permit No. WI0400121
Dear Mr. Ullman and Ms. Young:
Issued to Thomas Ullman and Carol
Young
Watauga County
In accordance with your application received November 19, 2009, I am forwarding Permit No.
WI0400121 for the construction and operation of a vertical closed-loop geothermal mixed-fluid heat
pump injection well system located at Lot 27 Mulberry Place, Vilas, NC 28692. This permit shall be
effective from the date of issuance until November 30, 2014, and shall be subject to the conditions and
limitations stated therein.
Please pay special attention to Part I. 7 of the permit and submit copies of the Well Construction
Completion form (GW-1) after construction. Please submit all data within 30 calendar days ofreceipt of
this letter to the address below:
Aquifer Protection Section (APS)
Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
Additionally, your IBC system is subject to inspection by the APS and at the time of the inspection must
display a permanently affixed identification plate in accordance with requirements of 2C .0213(g). Please
insure this is completed in accordance with permit condition Part 1.6 of this permit issued December 8,
2009.
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 me at [phone].
Sincerely, . . .
/2-/ .. ,.;/A//' {.'-_.,;-c. ~/([_{.L-~
John McCray, .-/
Environmental Specialist
cc: Sherri Knight -Winston-Salem Regional Office
Central Office File -WI0400121
Watauga County Environmental Health Dept.
Winston Petrey -Mountaineer Heating and Cooling, Inc.
Enc: Permit WI0400121
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
R4LEIGH, NORTH CAROLLNA
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
Tom Unman and Carol Young
FOR THE CONSTRUCTION AND OPERATION OF 3 TYPE 5QM INJECTION WELLS, 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 Lot 27 Mulberry Place, Visas, NC 28692,
and will be constructed and operated in accordance with the application dated November 19, 2009, 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 November 30, 2014, and shall
be subject to the specified conditions and limitations set forth in Parts 1 through IX hereof.
Permit issued this the t day ofL . 2009.
Coleen H. Sullins, Director
Division of Water Quality
By Authonty of the Environmental Management Commission.

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 (ISA NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
6. Each geothermal injection well system shall have permanently affixed an identification plate on a nearby
building or other permanently fixed structure indicating the location and presence of underground UIC
wells according to 2C .0213(g).
7. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Winston-Salem Regional Office
585 Waugh.town. Street
\Vinston.-Salem, NC 27107
[phone]
GW-ls must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
8. Well construction records must also be submitted for the existing water supply wells on-site as well as a
site map showing any water supply wells on adjacent properties as specified in NCAC .0211 ( d)(l )(D).
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone] and the Winston-Salem Regional Office Aquifer Protection Section Staff,
telephone number (3 36) 77 1-5 0 00 .
WI0400121 2
2. Borehole~ shall not connect separate aquifers which have differences in water quality ( e.g., shallow
surficial aquifers, saprol.ite, fractured bedrock, etc.) as specified in 15A NCAC 2C .0213(d)(8)(C) and
shall be filled with bentonite grout from the lowermost water bearing zone to 3 feet below land surface as
specified in the permit application.
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 rendet 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 -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.
3. At least forty-eight ( 48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
WI0400121 3
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 injec.tion facility that results in any unusual operating circumstance~;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
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.
WI0400121 4
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 detennines 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-p_acked 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 IX (1) and (2) (G) shall be submitted to:
WI0400121
Aquifer Protection Section-VIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
Mccray , John
From: Knight, Sherri
Sent:
To:
Thursday, December 03, 2009 2:18 PM
Mccray, John
Subject: RE: UPDATE FW: Two SQM Geothermal applications
I'm OK with going ahead and issuing these. I'm planning a visit to the area within the next week or so to look at a couple
of things I'll try to go by these f I can work the scheduling out. Also the Fox one that we just issued.
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]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parti~s. •
From: Mccray, John
Sent: Tuesday, December 01, 2009 1:39 PM
To: Knight, Sherri
Subject: UPDATE FW: Two SQM Geothermal applications
Importance: High
The two appl_ication numbers are as fo-llows:
WSRO Nixon SQM is WI0400122, and
WSRO Ullman SQM is W10400121.
Thank you for your prompt response on these applications.
John McCray
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from ~his account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
From: Mccray, John
Sent: Tuesday, December 01, 2009 9:SS AM
To: Knight, Sherri
Subject: Two SQM Geothermal applications
Importance: High
Dear Ms. Knight,
Attached you will find a copy of two SQM applications. Both of these sites are in Watauga County and should have been
processed the week before Thanksgiving but have been held up because of a mistake. I am reviewing these applications
and as soon as they are entered into BIMS I will send you application numbers for them,·but I wanted to get these two
moving as quickly as possible because they have been sitting with no action. Please notify me if you plan on inspec~ing
the site, otherwise we plan to issue in accordance with our policy to expedite these permits.
1
Best Regards,
John McCray
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
2
M'A
MCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
December 1, 2009
Tom Ullman.
Carol Young
PO Box 1636
High Point, NC 27261
Subject: Acknowledgement of Application No. WI0400121
Tom Ullman & Carol Young SFR
Injection Mixed Fluid GSHP Well System (SQM)
Watauga
Dear Tom & Carol:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on November 19, 2009. This application package has been assigned the number listed above and Will be
reviewed by John McCray.
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 John McCray at 919-715-6168, or via e-mail [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.ent.state.nc.us/documentsidwg orgchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
() LtiR_ it\.~-
for Debra J. Watts
Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Winston Petrey (Mountaineer Heating & Cooling -PO Box 1905, Boone, NC 28607)
Permit Application File WI0400121
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 Equal Opportunity \ Affirmative Action Employer
N~ith Carolina
Jvatur(!l/11
•Nov. 19 „,2009 7 46PM YADKIN WELL No, 40441 P,
NORTH CAROLINA :3
OP.PARIMENT or ENVIRONMENT AND NATOi AL CES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/O A WELL(S) FOR
INJECTION WITH A GIOTICERM.A.VBEAT Ptfite5YSTEM, FOR;
Renewal (check one)
=x ;[
;'TYPE 3Q.11 WELLI )
New Permit Application OR
DdITE: (1^ 7 2fl
1 .
PERMIT NO. (leave htaak if NEW permit applicn_fit,
A. PROPERTY OWNER(S}IAPPLICAY T(S)
List nsh Property Owaet limed an p roperty deed aa£ ai +d b'y a , nr gavesnmenst agency, y, state as= o'
Godly wad a representative wisaiboority to sigaaduro): Te 1i W( a Fare+/ 1 (ty.•ri^
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ik
(1)
(2)
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City: hl+ 7 Z Po ►i4 State: NC Zip Code: 2bit
/_ _ Cotnaty;
1-toradp9:p"IeleNo.; 33C-ZS - 5E(1 cam: 33C qa,
EMAIL Address: OM "'Mk)u! tr,►,dh.� . rt. a or+
Playa:Leal Address of Site (ifdi.fArant tam shove): 4-.4 241 Ia�4A4Pi' e (M �i ft.
C1 r: V; /11,5 Stet: N- Zip Cade~ Courv: wade.1A
Ko e/OZea Tele go.; .:4111q0.: 334 - fah - LOW
EMAIL Address:., OM•-hZ.s CJ r•F t60( .re. Ce.ri
X. AUTHORED AGENT QF OWN.tR, IP ANY (if the Peraux A
b a letter from the property owner autluirizize Agelit to ;mull
Company Name:
i•if
?waft T. C well)
Corrtactrr c: z2:44a, =
Address:
Jr -County
Of ca Tale No.: d .:inks.:
City: State: Zip Code:
V273
Aggoryx own the sob)acr property,
Websile Address of Coraparly. i"t'anr-
.,.ill
C. smmrr1s 0FPPLicANT
Private: Federal: Commercial;
Stwe.: Municipal: Native American.
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liov• 19. 2009 7:07PM YADKIN WELL No.4O44z 6P, 30t_z�
D. WELL DRILLER INFORMATION
Company Naar YACKD •
WcLrDrilU Cola 'ter'sNudt: aga MLi . MATilEiN eRQWN. M11.TON Cijig
NC C.OultartorCeitificsiinu.No.: (.Wi LIS: 7 A) (MMOWN:3e-k) (CAVE _
COMMPersarg DAVIDi_BROWFZ t'ititE.M MAX. Arldr ++
l i9Cd MANA?TONVSLLE ROAtI
Mtn Gii i�i�'
AMPTONV1l,r, KO- Zp Code:: 27020 , County: Y fl {i i ii !9 1�l
O lee Tele 3�a.:3 C Nc. �4•e7$ 1 ','
$. IIIG,T PUMP CQNTRACTOTO N1'ORMLT ON (tralfferen than drib*
ContPcr u "NSA", t� hddeeSr4.' I4+ ►wcAffil marl eliffal-6'm
Address. g %arc I44S
�sfo' a FIr. Codm gECO7 Coomy:
?C M — 442 g-71V- tle "/
om� xdaM�.: der - ee]11+7ex: 1, . ;�`• ��
R. '[N3TCUON PROCEUY (briefly descar, bow the hijettion well(3) y►1 , �I
WCL - divs .1 it- , r• e u (o O j�I•�' 4 p
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G. WELL CONSTRUCTION DATA ftioicuSeettea, Mr Milli a gVru it ilvAL)
(I) Proposed dale to be`eeeatrextetk Ntalaher of botriod:'lill 1113
Approximate depth of each boring (feet): 3 - I ? ;E
(2) Chemical sddbiVs tabe used inciad(alop xy✓stom (only' Those rheMicaii ` . tame been approved):
Rr22_Foote= g yooI ethanol C by i Yoru ! . 1 other (other °ddaGives will
Hoed prior *pp at by 1.4 CDENit bbtiare aee)
(3) Type oftobing to be mei (copper, PVC, ere); n g D
(4.) Wsil cuSng. is Thew 1L(s) eased (check elfbee (a)YES ax (b) NO be
(a) Yr.S it yes. limo provide casing information such as ' , , PVC, plastic. etc,), dls> ioG
•Itral And Sliagaof oatIag ;,spearing above Pot :
(b) NO _ I :
(I) Omit (material surronorlbse 4.4c1! .casifag sadior piping): 1, '
(e) Oratet typo; Cctnont . : 13c tonne Ogler (Spbdi it LI/m4!7 � L
(b) & n depth of tubtug (re£rrcncic to laud surface): from 1.: i1 OW
If tive ll has•eesiag. fadacatx groom de s: frern , 1 tri i'' r C (feet)
a. DIME CTION-ULATTI3 M NI I
Attach a diegra.ta sbOwIng the etegineetiug Wont or proposed modxficalion • ` i jimam equipinent and =tack;
pfping bing assocIa d with the igjection -cp!radon, The reanufactttne*ar's rave may provide5'vpplementary
information.
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mulberry place, vilas, nc - Google Maps Page 1 of 1
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Address Mulberry PI
Sugar Mountain, NC 28604
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Pleasant View
Get Google Maps on your phone
9 Text the word %MAPS" to466453
©2009 Google - Map data ©2009 Google
http://maps.google.comlmaps?f=q&source=s_q&hl=en&geocode=&q=mulberry+place,+... 11/20/2009

Telli11-17Aov. 19. 2009 7:07PM YADKIN WELL
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Property Card Information
Page 1 of 1
Watauga County Property Card Information
PARCEL DATA
PIN NUMBER
1980-59-7137-
000
ACCOUNT
1639938
PROPERTY ADDRESS
MAL' SI-IFUT
1980
SSLSS.ED
ACREAGE
6.3600
LAND IySE
RESIDENTIAL VACANT
NEIGHBORHOOD
HOMESTEAD
PROPERiV DFS['RIl TION
SR 1113
OW NERSH.lP AND M 1II MG ADORES
ULLMAN, THOMAS L
YOUNG, CAROL M
203 EDGEDALE DR
HIGH POINT, NC
'TOWNSHIP
WATAUGA
TAN CODES
GENERAL
COUNTY
COVE CREEK FIRE
TAN RATE.
.000
.000
AFED ROOM ATION
BOOKIPAGF
1437/787
DATE
RECORDED
DOr1 MENT T 1 t
STAMPS
LEC3AL DESCR1FT:ON
GR1NTOIS
Uf AN7 EL'S
LAND SEGMEk rs
1
S1iOMENf f}'PE
PRIMARY RES.
SITE
RESIDUAL
ACREAGE_ —
9_7E
1.00
acres
5.36
acres
APPRAISED
VALIIrE
90000
53600
DUILDINO SLIMN, ARV
I)L+5CR[PTic)✓ti
ADPRAISLD VALUE
SALAS DATA
DAl'L
SAS L PRJCL
2008-03-20
305000
2001-07-23
127000
1997-11-07
125000
VA Ll!E SUMMA RV
LAND
143600
BUILDING
0
143600
http://www.wataugaaounty.org/gis/propeard.aspx?pin=19$0597137000 11/20/2009