WI0400124_GEO THERMAL_20120517

Beverly Eaves Perdue
Governor
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 17, 2012
Ray and Rhonda Russell
105 Freds Drive
Boone, NC 28607
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0400124
Dear Mr. and Mrs. Russell:
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 wili be valid indefinitely as long as the wells are active and are operated in
acc9rdance 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 ://portal.ncdenr.or g/web/wq/aps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
Eric G. Smith, P.G.
Hydro geologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity\ Affirmative Action Employer
NOnehc· 1· ort . aroma lVatttrntlv
� ►,, GD-THE.RMAL WELL CONSTRUCTION RECORD
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 9 5 7
1. WELL CONTRACTOR:
Well Contractor {S lvldvalj Name
YA❑KIN WELL` COMPANY, INC.
Well Contractor Company Name
STREET ADDRESS 1908 HAMPTCNVILLE ROAD
HAMPTONVILLE NC 27020
City OF Town State Zip Coda
036 y-488-444U
Araa code- Phone number
2. WELL INFORMATION:
SITE WELL ID #[d appflcabie]0
WELL CONSTRUCTION PERMrTu(f eppllcable) LA/ I O' 6O rf a «
OTHER ASSOCIATED PERMIT #(lf eppltcabie)
3. WELL USE (Check Applicable Sox) Nieniloring0 MunlclpaliPublief
lnduslriaitComme,.,rccllai0 Agr1Euyura1D Reroveryf Inleclfon0
irrigattara OlheryC (listuser)(t"-po
DATE DRILLED 3 . r3 - i
TIME COMPLETED •AMt1 PM+
4. WELL LOCATION:
CITY:. F t71� COUNTY C�:jzo,,,_{
_ J a f`,
(Street Name, Numbers, Community. Subdivision. Lot No-, Parcel, zip Code)
TOPOGRAPHIC 1 LAND SETTING:
❑ Slope 0 Valley 0 Flat pcRtdge 0 Dlher
(Check appropriate boxy Maybe in degrees,
LATITUDE j. G� IL 2 z ? minutes seconds or
LONGITUDE 8 3(, 11 'r !n a decimal format
Latitude/longitude source: ,FOPS 0 Topographic map
(location of welt must be shown on a USGS topo map end
attached to this form if no! trstrig GPS)
S. FACILITY -Is the name or the bus4less wire the we Is iace+ed.
FACILITY ID #(1f applicable} NAME GFr I Y RLly RI.f If !f
1
STREET ADDRESS (O. j.-i-t6.f r _
6� o e ..L) L. ziFGo -7
City or Town State
CONTACT PERSON
in NY Teh f• ,t �Ipr�� Code
f-
MAIL VG ADDRESS Po ;4b ejq
Clly or Town Stale Zip Coda
(flLJ 9‘ it . 90 v/
Area ode - Phone number
6. WELL DETAILS: la � ��
e. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES0 NCA-
e, WATER LEVEL aefow Top of Geeing: - FT.
(Use's' If Above Top of Casing)
31-0 ` fir`
3'f;
d. TOP OF CASING IS ` FT. Above Land Surface'
'Top of casIng lerminated et/or below land surface may require
a variance In accordance with 16A NCAC 2C .31113.
e. YIELD (gpm): t METHOD OF TEST AIR PUMP
I. DISINFECTION: Typo HTH Amount
g. WATER ZONES (depth}:1
From t re33TD ltrti From
From To From
From To From
7. CASING D
From
From
From
To
To
To
Depth Diameter Trickness elohr Materra!
To FLIlr aeel
To Ft.
To FL_
e, GROUT: Depth Materiel Method
From To red VC, Ft: h,{I►.+,u Cseit— a] on'S
To Ft -.^'/
To Ft.
From
From
H. SCREEN: Depth
From
From
From
Diameter Stoi Stze Material
To Ft. In. In.
To FI. In. In.
To Ft. In, In
16. SANO/GRAVEL PACK:
Depth
From
From
From
To
To
To
11.DRILLING LOG
Frp} Tq ,
12. REMARKS:
Size Material
Ft.
Ft.
Ft.
F rmalOn Description
rytail pref.
SIZE OFF
BIT SERIAL NO:
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1NACCCRDAHCE WITH
1 SA NCAC 2C, WELL CONSTRUCTION sTAN DARDS. AND 71-W7 A COPY OF THIS
RECORD F:AS SEEN F OVIOEDTo THE WELL OWr!
n _ TIFIED WELL CONRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Qualify within 30 days. Attn: Information Mgt.,
,Ate 617 Mail Service Canter — Raleigh, NC 27699-1617 Phone No. t019) 733.7015 ext 668.
+i,,�,lti 21-0
Z 9divcd 2Sb' ec
1 b1
g;'
Form GW-lb
Rev,12107
•1- +1 u Vi 1'-• 1.' 4
4 •I L7 r-r

CEO-THFRIMMAL WELL .CONSTRUCTION RECORD
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ## S 7 ).
1. WELL CONTRACTOR:
o uJ
Well Coo-actg.(IndivIduaf) Name
YADKIN WELL COMPANY, INC.
We1i Contractor Company Name
STREET ADDRESS 1908 HAMPTONVILLE ROAD
HAMPTONVILLE NC 27020
City or Town State Z1p Code
( 336 ).468-444D
Area Bade- Phone number
2. WELL INFORMATION!
SITE WELL ID tor cabre). % ' — p 5
WELL CONSTRUCTION PERMIT#CI+Aplfceble) 132 X a SL OO1 1.2
OTHER ASSOCIATED PERMIT OM applicable)
3. WELL USE (Check Applicable Box) Monitoringp Munidpal1PubllcD
industrial/Commercial❑ AgrIculluraID Recoveryp lniactionC
Irrigetfortl the list use) 6n--t- 6
DATE DRILLED!! •• ` d
TIME COMPLETED • Qa AM❑ Pt
4. WELL LOC�A1TION:
CETYC : .Cra 0".4. COUNTYS2j2/4g
IQ S
(Street Name, Numbers, Community, SubdMelon, Lot No., Parcel, Zip Cade)
TOPOGRAPHIC lLAND SETTING:
11 Slope 0 Valley 0 Fiat _RIdge ❑ Other
(check appropriate box) fvtay he in degrees,
LATITUDE 1 C /Z, 22-1S minutes, seconds or
'y,� in a decimal format
LONGITUDE g
Latitude/longitude source: GPS 0 Topographic map
(location of well must be a own an a USGS !op❑ map and
arlachod to this form if not using GPS)
G. FACILITY. Is the Hume or the 6uinesa where the well Is loafed.
FACILITY ID Cif applicable)
NAME 6ILPFY�'C.Ul/ Rt•{fJ'
STREET ADDRESS _10 ,: 14-c .t bY•
Rio►-e- ,jc..
City or Town Stale
�y h iOYn Zlp Cade
CONTACT PERSON fru old-1' 1'G• C Infer
,P jtv
MAILING ADDRESS
Cilyor Town State
( ?LY ►• ca4'- 9081
Area code- Phone number
Zip Code
S. WELL DETAILS:
a. TOTAL DEPTH:�
b, DOES WELL REPLACE EXISTING WELL? YES°
G. WATER LEVEL Below Top of Casing: FT,
(Use'+' }t Above Top of Casing)
d, TOP OF CASFNG IS FT. Above Lend Surface
'Top or casing terminated at/or below land surface may require
a variance In accordance wllh 15A NCAC 2C .0118.
a. YIELD (gpm): /0 METHOD OF TEST AIR PUMP
f. DISINFECTION: Type I-'1TH Amount G{.f-
g. WATER ZONES (depth):
From J (2„ To ay From To
From To From To
From To From To
1. CASING: Depth Diameter
From To FI.
From_ To _ Ft.
From To FL
ti, GROUT: Depth Material
C� Zorn [
From 0 , To 34.t,1 t%+'tC+ TYLIIuli,
ThlcknesslWeight lvleledal
Rtovo1, d
From To FI.
From To Ft.
9. SCREEN: Depth Diameter Slot Size
Method
Material
From To Ft. jn. In.
From To Ft.___Fn. In.
From To F4. in, 1n,
ID. SANDIGRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
From To Ft.
11.DRILLING LOG
Fr m do Patti on Cescripiion
Syd hi ec P r{r (rrC#n
12. REMARKS:
SIZE OFF
1317 SERIAL NO:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORQANce WITH
Still NCAC 2C. WELL CONSTRUCTION STANDAR OS, ANC THAT A COPY OF THIS
RECSEEEN `OVIO£t1ToTMEL'I€LLOVrE
TURE 0
tJ77e
STIFFED WELL CONTRACTOR
DATE
J 7 kJ.L\\�
PRINTED NAt E, OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev.12ra7
L tZ rei PI, i9 ,J 24
1K ea._ !'1

2Z{

Permit Number W10400124
Central Files: APS SWP
03/29/10
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Infection Mixed Fluid GSHP Well System (5QM)
Status Project Type
In review New Project
Version Permit Classification
Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers David J. Brown
Coastal SW Rule
Permitted Flow
Facilit
1908 Hamptonvilie
Hamptonville
NC 27020
Facility Name
Ray and Rhonda Russell SFR
Location Address
105 Freds Dr
Boone
Owner
Owner Name
Major/Minor Region
Minor Winston-Salem
County
Watauga
NC 28607 Facility Contact Affiliation
Ray Russeir
Dates/Events
prig Issue
03/31/10
App Received
01 /21 /10
Draft Initiated
Scheduled
Issuance
Owner Type
Individual
Owner Affiliation
Ray Russell
Owner
105 Freds Dr
Boone
NC 28607
Public Notice Issue
03/31/10
Effective Expiration
03/31/10 02/28/15
Reoulated Activities Rea uestedlReceived Events
Heat Pump Injection PO staff report requested 02/03/10
RO staff report received 03/17/10
Outfall IIJLL
Waterbody Name Stream Index Number Current Class Subbasin

Permit Number W10400124
Central Files: APS SWP
03/26/10
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (50M)
Primary Reviewer
michael,rogers
Coastal SW Rule
Permitted Flow
Facii&.
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
David J. Brown
1908 Harnptonville
Hasnptonviile
NC 27020
Facility Narne
Ray and Rhonda Russell SFR
Location Address
105 Freds Dr
Boone NC 28607
Iwn-r
Major/Minor Region
Minor Winston-Salem
County
Watauga
Facility Contact Affiliation
Owner Narne
Ray
ate rEvent
s
Russell
Owner Type
Individual
Owner Affiliation
Ray Russell
Owner
105 Freds Dr
Boone
NC 28607
Orig issue
App Received
01 /21 /10
Draft Initiated
Scheduled
Issuance
Public Notice Issue Effective Expiration
3I��w a�as�is
Regulated Activities - uested1Received Events
Heat Pump Injection RO staff report requested 02/03/10
RO staff report received 03/17/10
Duffel!
Waterbody Name
Stream Index Number Current Class
Sutrbasin

FA
North Carolin-a Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Ray and Rhonda Russell
105 Freds Dr.
Boone, NC 28607
Dear Mr. and Mrs. Russell:
Coleen H. Sullins
Director
March 31.. 2010
Subject: Issuance of Injection Well Permit
Permit No. WI0400124
Issued to Ray and Rhonda Russell
Watauga County
Dee Freeman
Secretary
In accordance with your application received January 21, 2010, I am forwarding Permit No. WI0400124
for the construction and operation of a vertical closed-loop geothermal mixed-fluid he~t 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, 2015, and shall be subject to the conditions and limitations stated therein.
Please pay special attention to Part VII.2 of the .permit and submit ·copies of the Well Construction
Compietionform (GW-1) after construction. Please submit all data within 30 calendar days of
completion.of installation of geothermal well(s) to the following address:
Aquifer Protection Section (APS)
Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
Additionally, your UIC system is-subject to inspection by the APS. Per special condition Part Il.3, in the
event that there will be multiple wells with separate clusters, one well identification tag per 'cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
In ·order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water. Quality. Ifyou·have any questions regarding your permit or the Underground Injection
Control Program please call me at [phone].
cc: Sherri Knight-Winston-Salem Regional Office
Central Office File -WI0400124
Watauga County Environmental Health Dept.
David Brown-Yadkin Well Company, Inc.
Attachment( s)
Sincerelr,
~~
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NO&TH 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 2~, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Ray and Rhonda Russell
FOR THE CONSTRUCTION AND OPERATION.OF 2_.TYPE SQM INJECTION WELL(S), 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 '1:ieat pump system. This system -is located at 105 Freds Drive~ Boone, Watauga County,
NC 28607, and will be constructed and operated in accordance with .the application received January 21. 20 l 0,
and in conformity with the specifications and supporti3:1g data submitted, all· of which are -filed with the
Dep~ent of Environment and Natural Resources and are considered a part of this permit -
This permit is for Construction and Operation of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until February 28, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 31 st day of March 2010.
~oleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit WI0400124 UIC/SQM
ver. 03/2010
Page 1 of 5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and ~pecifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions , and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART 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 (9 19 ) 7 15-6 ] 66, and the vVinston-Salem Regional Office Aquifer Protection Section Staff,
telephone number [phone].
2. The location of each of the system manifolds shall be rec~rded by triangulation from three permanent
features on th~ site (e.g., building foundation comers) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or 'cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
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.
Permit WI0400124 UIC/SQM
ver. 03/2010
Page 2 of 5
PART IV -PERFORMANCE STANDARDS '
-1. The injection facility shall be effectively maintained and operated at all times so that there is no
cont_amination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this ·permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Pennittee 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 iri.jectiori, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Inj,ection Control (UIC)
Program Central Office staff, telephone number (919_) 715-6166. Notification is required so that Division
staff can i~spect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
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 pennit, and may obtain
samples of groundwater, surface water, or injection fluids.
4. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit WI0400124 UIC/SQM
ver. 03/2010
Page 3 of 5
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center and
Raleigh, NC 27699-1636
Ph# 919-715-3221
Aquifer Protection Section
Wi 11ston-Salem Regional Office
585 \X/aughtown Street
Winston-Salem, NC 271 G,...
(~,..,. \ "71 ~())(' .. ,.'.'l b) 1 1·) .l.:
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Wi nston -Salem Regional Office within 30 days of
· completion of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and
retained on site to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Winston-Salem Regional Office within
30 days of completion of well construction.
4. 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.
5. 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 that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6 . 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.
7 . In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit WI0400124 UIC/SQM
ver. 03/2010
Page 4 of 5
PART IX-CHANGE OF WELL STATUS II •
1. The Pennittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be ·used
for any purpose, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to, the following:
(A) All .casing and materials may be removed prior to initiation of abandonment procedures if the
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations .
.. (C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determin~s that failure
to do so could lead to the coµtami:Q.ation of an underground source of drinking water.
(D) Each well-shall be completely filled with cement grout, which shall be introduced into the well
through a pipe that extends to the bottom of the well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been removed, the
casing shall be perforated opposite the gravel pack, at intervals not exceeding 10 feet, and grout
injected through th~ perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been created,
each .well shall he abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water and i:p_ accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C :0213(h)(l) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII. I of this permit. ·
Permit WI0400124 UIC/SQM
ver. 03/2010
Page 5 of 5
Ro gers, Michael
From: Knight, Sherri
Sent:
To:
Wednesday, March 17, 2010 12:18 PM
Rogers, Michael
Subject: RE: WI0400124 WI0400125
I did find these. They had come in when I was out and I filed them in my UIC email folder. So ahead and issue. I don't
have anyone to look at right now and I won't be able to look within the next few weeks. The application indicated that
there are no on-site wells so I assume there is public water available. I can't tell from the tax web site.
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: (336) 771_-4632
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Rogers, Michael
Sent: Tuesday, March 16, 2010 1:01 PM
To: Knight, Sherri
Subject: WI0400124 WI0400125
Sherri-
What is the status of the above 5QM wells? I sent over the Applications 2/3/10. If you do not wish to conduct a pre-permitting
inspection, let me know and I will start permitting process.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
1
Rogers, Michael
From: Knight, Sherri
Sent:
To:
Tuesday, March 16, 2010 3:16 PM
Rogers, Michael
Subject: RE: W 10400124 W 10400125
I am not finding these. They might have come in when I was out and I don't know where they might have ended up.
have WI0400126 and WI0400127 which came in last week. I don't have anyone to look at these right now. I assume we
are only looking to permit .. 127 for the one boring or would we issue for the full 59? I would like to look at this one
during drilling due to the problems with Mid-South at the Watauga County site. If you can resend the info for 124 and "(
125, I'll take a look at them.
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 parties.
From: Rogers, Michael
Sent: Tuesday; March 16, 2010 1:01 PM
To: Knight, Sherri
Subject: WI0400124 WI0400125
Sherri-
What is the status of the above 5QM wells? I sent over the Applications 2/3/10. If you do not wish to conduct a pre-permitting
inspection, let me know and I will start permitting process.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail co"espondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
1
Rogers, Michael
From: Rogers, Michael
Sent:
To:
Wednesday, February 03, 2010 4:09 PM
Knight, Sherri
Subject:
Attachments:
WI0400124 and WI0400125
Russell.pdf; Thompson.pdf
Attached are-two Apps for SQM wells. Please let us know if you wish to conduct pre-permitting inspections or hot. If
you elect not to inspect, we will issue permits.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North carolina Public Records Law and may be disclosed to third parties
1
Ro g ers, Michael
From:
Sent:
To:
David Brown [[e-mail]]
Thursday, January_21, 2010 5:54 PM
Rogers, Michael
Subject: RE: Russell 5QM well
Michael,
Sorry I must have missed that. Yes the thermally enhanced grout will be pumped the entire length of bore
holes, on the Russell job. Do I need to fax in another copy with that filled in, or is the confirmation here
okay?
Thanks,
David Brown
Yadkin Well Co. Inc.
From: [e-mail]
To: [e-mail]
Date: Thu, 21 Jan 2010 16:51:00 -0500
Subject: Russell SQM well
David-
Please confirm that the grouting will be entire length of borings. This was left blank on the form.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699".'1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
Hotmail: Powerful Free email with security by Microsoft. Get it now.
1
Beverly Eaves Perdue
Governor
Ray Russell
Rhonda Russell
105 Freds Dr.
Boone, NC · 28607
,A~A ---~~ ....--;,~----NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
February 3, 2010
Subject: Acknowledgement of Application No. WI0400124
Ray Russell SFR
Injection Mixed Fluid GSHP Well System (5QM)
Watauga
Dear Mr. and Mrs. Russell:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt.of your permit application and
supporting materials on January 21, 2010. This application package has been assigned the number listed above and will be reviewed
by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit app_lications, the Division requests your assistance in providing a timely and complete
response t? 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 thi~ time, processing permit applications can take as long as 60 -90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to htm ://h2o.enr.state.nc.us/documents/dwq or<1 chart.pdt:
PLEASE ~FER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT .
~ dod&iC)
for Debra _;.cttts
Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
David J. Brown (Yadkin Well Company, Inc., (1908 Hamptonville Rd., Hamptonville, NC 27020)
Winston Petrey (Mountaineer Heating & Cooling, P.O. Box 1905, Boone, NC 28607)
Permit Application File WI0400124
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Loci!tion: 2728 Capital Boulevard. Raleigh. North Carolina 27604
Phone: [phone] \ FAX 'i: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www.nC1Naterquality.org
An Equal Opportunity\ Affirmative Action Employer
Ni}thCarolina
lvaturq//!f
Jan. 21. 2010°11:27AMrr" YADKIN WELL'zL-
No. 4413'P, 2 I
NORTH CAROL NA
DEPARTMENT O$ laNTITIRONI4.42ENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTUCT AND/OR USE A WIELL(S)1r'OIt
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FORS
TYPE 50M WELL'S)
New r Permit Application OR Renewal (check one)
DATE: /— Z 1-- zD c o , 24
?EMIT NO. (leave Wasik if NEW permit application)
A. PROPERTY OWNPR(S)/APPLICJ T($)
Last stub Property owner Bored on property deed (if owned by a business or governmamz agency, state paw of
met" and a representative wlauthatity for sib): R AK P 4 : ! , ,,40.A a k
(1) Mailing Address. ' lO rf el S ljt d C.
[2)
City: is6a r.? t Stare: AI< Zip Coda: d 6 02*-7 Couuty VIA b ivi
Homc/Offsce Tele No.: 8 7 E /i T - " a4 Cell No.:. 82E - 773 - 6 2
EMAIL Address: rr ( P.A•owitA4lots Cis �n
Physical Address of Site (if different than above): C, oh. AL -
City: State: Zp Code; County
Aomcfnfncr Tele No.: Cell No.:
EMAIL Address:
B. AUTHOR/ZIP) AGENT OF OWNER, IF ANY alto Permit Applicant SWUM own the s►tbject Props ,
attach a letter from the property owner auLhnrizing Agent to install and operate IT1C wed)
CampanyName: -
Contact. Person, Addrem:
Address:
City: State: Zip Cade: Connq:
Office Tele Na_: Cep luo
Website Adds of Compel}Y, if any:
C. STATUS OF APPLICANT
Ptivsze: Federal: CommeEcial:
State: Municipal: Native American Lands •
01-05-2018 IL:34
metod
RECEIVED 1 DENR I t7
Aquifer Protection SectiOr+
JAN 21 MO
PAGE2
@ge0-x2-T0

Jan, 21, 2410"11:27AV" YADKIN WELLY" No, 4413r'cs
•
D. WALL ZRILLIJEMPORMATION
Company vA to W� C.C3IAPANY. LAIC
welt Drilling G90strRCtorl Narnar: JQDY MVLL13.14l4TlcskM► EIRCAkk M1.LTf}J1 CAW
NC Contractor Certification No.: ( Mt1L IS: 2572 JjHRCWN: Aq) (CAVE : -A)
t'azdett P om: L?Avio 0. BRcWN ft1 ►Ai BAIL Addreig r.=gatatilatCrn n.00m
Addraea; _110 MAMPTON 1 LLE ROAD
City: HAMPTONV1LLE, N.O. Zip Code: 270,20 Camay: YAi'uk
Mere TdleX+Io.: 33e.4eq A9 C No.: ae-3744ja
E. T PUMP CONTRACTOR XNF❑RBIATXO (if different them dr
` �7 Wer)
�-tra = %"Jc7�l,u.�4.+aCF, !c (%4J,,.1i �■"
ContsctPersone ►f/.►+.,7 �'' tups,re.
Address; f 65w icier,: 47.E Ark41 i t4
City: _6qc Q t /I ( Zip Cade: K �� Cwarg: - 4 Aie4., xt
Office TeleNv.: gt cr.:c� ce] Ne.:pa- T49' yckiI -
F. MIECXXOO FROMOOVZ (briefly deacdbi bow ttg %on well®( wW be used)
rattl /Ilpi s f U e ( 1�^� � I C LO.rea S}G :/ S' ' ,1iVL
G. WE .L CONSTRUCTION DATA (S psvk 3vU t b is etclt)t*NFW J
(I) Proposed date to be constructed: Irma a Nether of boxipip; 2
Approxisome depth of each boring (fret): 2 Sd r
(2) amnia.; eddlttras lo be used is closed -loop system (only tboae diemicsls indicated beve baaa fpprcvod):
- It-22 yleaaa S1Ycai E.n v 1 iy sg n a 1other her additives will
need prior approval by NCDENR beta are)
(3) Type etching to be used (capper, PYC,,eta): C /t_.+ I i
(4) Well casing. Is the walla) eased? (check either (a.) YES !Q (b.) .NO below)
(s) ' 'fyes, then pro4ids cubs information such at tog Deal, PVC, plastic, ato.), digirattar,.
dgp$4, andinacil of easing appearing abc ve ground:
(b) NO
(5) Omit (xaa' aril =mounding lea l•cesing and/or piping); �. t • @+►ilan.ce�
(a) Orcut.typs: Cement Bentonite ?� Gtbw tsp )
(b) Grout depth of tubing (,roftrenee to Jaetd ear * from to ) . w-+w
woll hasimam .hmihnte gram depth: from - to (feet)
a. INJECTION -RELATED 114PIPMENT
Atlutlb. a diagram showing the engineering Iayart or proposed moth ficatiaa Hof the infection equipmaj and ertesiar
pipiegirobleg asecOned with the injectiou aporattan. The manufacture a bum -bunt May provide supplementary
inibrrnation.
B1-05-2010 1.6; 35 PAGE3
d a2:F30 0x02-T2-TO

Jan. 227AM. ' YADKIN WELLtLL No, 44131 °P. 4'
L L.00AT[ON OF WELLS)
Attach two copies of {naps showing the following information:
(I)
Include a site map (can be drawn) showing: buildings, property lines, outface wows bodies, potential sources
of groundwater 0000tax atica/u atyd the orientation of and distances between the proposed well(:) end any
existing wells) or waste disposal Mikes mach as septic woos or drain fields loafted within 1000 feet of the
geothermal heat pomp well system. Label all features dearly and laslatutmatuant.
(2) Include a topographic snap of the tires mending ores mile from the property bOuadarie5 and
icidiesth the facility's location and the tip aurae.
3. POTABLE WA TER WELL(5)
Are tine any potable worst wall(4) on the Sabi eci ProPeelY or adjacent ps tip ie 9-;
ifYes, tbao indite location on attached mapp(s).
YES X NO
K. CZ TtJICATION
None: This Permit Appl&oatIon nintr be slimed by eweh person appearing on the recorded legal property deed.
"I hereby certify, under peewit( of law. that I have personally eocaminod and am familiar with the information
submitted in this document and all attachments thereto and that, bared on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the lefprmation is true, act:unite and complete.
I am aware that there are significant penalties, inclmil-n2 the possibility of ares ®d itnprisoasnetn, for submitting
false information. I agree to =amen, operate, Plaints. repair, and if applicable, abandon the injection well and
all related appurtenances m acct dasaom with the approvespacificati s and =lad cgs c1 e Pe .W.
Signature 14r rty O/Applicata
CI KR kti.5'e
Print or Type F6il Name
of 1Z91\044 1/1))4
Signstoro of Froperttiy /Applicant
g?1GtA 1 12 sal/
Print or Type Fall Name
Signature of Ardbcaized Agent, if any
. Print or Type F M Name
Please return two copies of the completed Application package to:
North, Carolina DENRDWQ
Aquifer Protection Sermon
MC Program
1636 Mail Service Canter
weigh, NC Z1699-1636
Telephone [phone]$
01-05-2015 16:35
RECEIVED 1 DENR 1 DV1�
Aquifer Prntection Section
JAN 2 12010
F1=i4
#391dd 32:8@ OTOCiTE-'0

Jan, 21, 2410 11:28AM YADKIN WELL
No.4413 P. 5
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Jan, 21+ 2010 11:26AM YADKIN WELL
FACSIMILE TRANSMISSION FORM
Na. 4413 P. 1
DATE: C / Zf / fa TIME'
TO: t I9SA/ 0w CI
COMANY NAME
REF. NO. LOG NO
F XNO.
MENTION
FROM. -;or frt1e (I (c
COMPANY NAME
4',� 8Y6w
INDIYIB
NUMBER OF PAGES
INCLUDING THIS SHEET
DEPC
❑ IM1 EDIAThIY
Sig' -��
NO. LEASE
�Gf ❑ Tldy
RMASI ORIGINEOFt$_?)
EPLY BY OWE JAQ /fl�Jy■
MESSAGE;
fifrizer;i7.7.i. a 4. 4,,,A,14 zeicei (-10,L0
Za.00 A v 12ay lev ife 1,y,
,dstoL,.l I`a-4- d's,`(ter d mrin. Cam.
-Flan Ir :3dcz.:40
RECEiVbu I U NR TOM!
Aquifer Protection Section
JAN 212ata
-FOR ALL TOUR WATER NEEDS"
YADK1N WELL Co., INC.
1999 l-IAMPTONVILLE ROAD
HAMFTDNVILLE, NO 27020
C1AVID J. BROWN, VICE PRES.
TOLL FR.6 moo) 24.435S
OrricE P336i 466.4■40
r:Ax 3G1 4O -4O46
RE5 (336' a68-4859
•GOOD MEWS M1MrcRIG • GOD LOVES TV
PLEASE INFORM US IMISSUuira.Yniou DO NGST FIECEVE> IGLE rk RA"

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