WI0500165_GEOTHERMAL_20120523

AVA
NC DENR
--~----~~NorthGarolina 0-epartment-ofEnvironment and Natural Resources
Beverly Eaves Perdue
Governor
CP Westgate Road Property, LLC
250 West Court Street, Suite 200E
Cincinnati, OH 45202-1064
Division of Water Quality
Charles Wakild, P. E.
Director
May 23, 2012
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0500165
To Whom it May Concern:
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 htt p://p o11al.ncdenr.or g/web/wq/a ps.
If you have any questions regarding-your current permit or_ the rule revisions, please foe_l fr~~J9--
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 Seivice Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] I FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity\ ALrmative Action Employer
One
North Carolina
/Vatura/l!f
11 4- 4 1
9&00 't ! + 4W001'i/r4
Permit Number W;D500165
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility
Facility Name
CP Westgate Properties, LLC
Location Address
8820 Fast Park ❑r
Raleigh NC 27617
Owner
Owner blame
Cp Westgate Properties LLC
DatesfEvents
Central Files. APS SWP
03/29/12
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Jim Critzer
Local Manager
8820 Fast Park Dr
Raleigh NC 27617
Major/Minor Region
Minor Raleigh
County
Wake
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Melanie Chavez
250 W Ct St
Cincinnati
OH 45202
Scheduled
Brig Issue App Received Draft Initiated Issuance Public Notice issue Effective Expiation
08114/07 03/19/12 03/30/12 03130/12 02/28/17
Regulated Activities Requested/Received Events
Heat Pump Injection Additional information requested 03/23/12
RO staff report received 03/26/12
Additional information received 03/26/12
RO staff report requested 03/26/12
❑utfall NULL
Waterbody Name
Stream index Number Current Class 5ubbasin

Permit Number W10500165
Central Files: AP5 SWP
03/28/12
Permit Tracking Slip
Program Category
Status Project Type
Ground Water
In review Renewal
Permit Type
Version Permit Classification
Injection Mixed Fluid GSHP Well System (5glvl)
Individual
Primary Reviewer
Permit Contact Affiliation
michael.rogers
Jim Crltxer
Local Manager
Coastal 5W Rule
8824 Fast Park Or
Raleigh NC 27617
Permitted Flow
Facilitv
Facility Name
MajorlMinor Region
CP Westgate Properties, LLC
Minor Raleigh
Location Address
County
8820 Fast Park Dr
Wake
Raleigh NC 276-17
Facility Contact Affiliation
Owner
Owner Name
Owner Type
Cp Westgate Properties LLC
Non -Government
Owner Affiliation
Melanie Chavez.
250 W Ct St
Cincinnati OH
45202
❑ateslEvents
Scheduled
Orip Issue App Received Draft Initiated
08114/07 03/19/12
Issuance Public Notice Issue Effective
"rati
jj �
Regulated Activities
Renuested/Received Events ._
!
Heat Pump Injection
Additional information requested
03/23/12
RO staff repast received
03/26/12
Additional information rece{ved
03126/12
RO staff report requested
03/26/12
Outfall IgULL
Waterbody Name
Stream Index Number Current Class Subbasin

. w flow"o • . M! -W _ 4110movmftb
Permlt Number W10500165
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (50M)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flaw
Facllit.
Facility Name
CP Westgate Properties, LLC
Location Address
8820;=ast Paris ter
Raleigh NC 27517
Owner
Central Fifes. APS SWP
03/28/12
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Jim Critzer
Local Manager
8820 Fast park Dr
Raleigh NC 27617
Major/Minor Region
Minor Raleigh
County
Wake
Facility Contact Affiliation
Owner Name
Owner Type
Cp Westgate Properties LLC
Non -Government
Owner Affiliation
Melanie Chavez
250 W Ct St
Cincinnati CH
45202
DateslEvents
Scheduled
❑rig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective
Expiration
08/14/07 03/19112
Regk+lated Activities
ReauestedlReceived Events
Heat Pump Injection
Additional information requested
03/23/12
RO staff report received
03/26/12
Additional information received
03/26/12
RO staff report requested
03126/12
Qutfail l
Waterbody Name
Stream Index Number Current Class Subbasin

ai NCDENR
North Carolina Department of Envircrlment and Natura
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, RE,
Governor Director
March 30, 2012
Brian Prince, Construction Manager
Chavez PropertieslCP Westgate Properties, LLC
250 W, Court St., Suite 200 E
Cincinnati, OH 45202
Ref: Issuance of Injection Well Permit W10500165
Issued to CP Westlake Properties, LLC
Raleigh, Wake County
Dear Mr. Prince:
Resources
Dee Freeman
Secretary
In accordance with the application received on March 19, 2012, and additional information received March 26, 2012, I am
forwarding permit number WI0500165 for the continued operation of a vertical closed -loop geothermal mixed -fluid heat
pump injection well system located at 8820 Fast Park Dr., Raleigh, Wake County, NC 27617. This permit shall be
effective from the date of issuance until February 29, 2017, and shall be subject to the conditions and limitations stated
therein.
NOTE: During the renewal process for this permit, it was noted that the following records were not submitted when the
geothermal wells were originally installed, This was required per the permit issued on August 21, 2007.
Well Construction Record (GW-1)
Triangulation Data
Mechanical Integrity Pressure testing data (if available)
Also, please pay special attention to Part V.2. The Permittee shall retain all records of repairs, pressure tests,
maintenance, and other activities needed to maintain normal operating conditions.
In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an application
to renew the permit 120 days prior to its expiration date. This permit is not transferable to any person without prior notice
to and approval by the Director of the Division of Water Quality.
Please contact me at (9I9) 807-6406 or [e-mail] if you have any questions about your permit.
AQUIFER PROTECTION SECTION
1636 Mall Service Center, Raleigh, North Cadina 2?699-16H
Location, 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Intemet wwrv.n�watemuarltv.or;t
Best Regards,
a
Michael Rogers, P.G. (NC & FL)
I�oAhCarolina
Nationally
An Equal Opportunely 1 AfCnv iveAction Employer

::c: Jay Zimmerman, Raleigh Regional Office
WI0500165 Permit File
Wake County Environmental Health Dept.
NORTH CAROLINA
ENVIRONlVJENTAL ~IANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PER.tvfIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
CP Westgate Properties, LLC
FOR THE OPERATION OF 7 (SEVEN) TYPE SQM INJECTION WELL(S), defined in Title ISA North
Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed-loop
geothermal-mixed-fluid heat pump system. This system is located at 8820 Fast Park Dr., Raleigh, Wake
County 27617, and will be constructed and operated in accordance with the application received March 19,
2012, and in conformity with the specifications and supporting data submitted March 26, 2012, all of which are
filed with the Department ofEnvironm_ent and Natural Resources and are considered a part of this permit.
This permit is for operation of an injection well and shall be in compliance with Title 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, 2017, and shall be
subject to the specified conditions and limitations set forth in Parts I through VII hereof.
Permit issued this the 30th day of March 2012.
¥\-Charles Wakild, P.E.,Director
\ Division of Water Quality
By Authority of the Environmental Management Commission.
Wl0500165 UIC/5QM-M.F. Renewal
Version 1/2010
Page I of 4
PART I-OPER.\TION AND USE GENER<\.L 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.
4. In the event that there are multiple wells with separate clusters, one well identification tag per 'cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
PART II-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART III-OPERATIONS AND MAINTENANCE REQUIREMENTS
l. 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.
WI0500165 UIC/5QM-M.F. Renewal
Version 1/2010
Page 2 of 4
PART IV -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall retain all records of repairs, pressure tests, maintenance, and other activities
needed to maintain .normal operating conditions.
3. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
4. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
5. 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 VI-PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
WI0500165 UIC/5QM-M.F. Renewal
Version 1/2010
Page 3 of4
?ART VII -CHANGE OF WELL STATUS
l.
i
The Permittee shall provide written notification within 1 :5 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 ISA NCAC 2C .0213(h)(l), Well
Construction Standards.
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.
3. The written documentation required in Part VII (1) and (2) (G) shall be submitted to:
WI0500165
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
UIC/5QM-M.F. Renewal
Version 1/2010
Page 4 of4
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED-LOOP MIXED-FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids other than potable water as part of a geothermal heating and cooling system
(check one) __ New Application X Renewal* Modification
* For renewals complete Parts A-C and the signature page.
Print or Type Jriformation and Mail to the Address on the LastPage. Illegible Applications Will Be Returned As Incomplete.
DATE: r1A R,C H °t , 20 /Z
PERMIT NO. W.T ~ S-6 D I 6 ~ (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
RECEIVED/DENR/DWQ
MAR 1 9 2012
Non-Government: Individual Residence Business/Organization 'f.. Aquifer Protection Section
Government: State Municipal __ County__ Federal
B. PERMIT APPLICANT -For individual residences, list each owner on property deed. For all othecs,...
state name of entity and name of person delegated authority to sign on behalf cif the business or agency: ~
,Af6-/ 4 AJI!: C)dAlJf:;i3-i %1/2,1.A!J,,J f;?.1,A)c ·:,. /lcf!Lf(>"bvf"~J1,1%
{ __ P uJ ts r G-A-~ (1/l:)P M-116:!
Mailing ~ddress: CJJ.4 II& c f 1c.,.oee-1Lr/G( ,;}(2 W. ~t,(f'L-1 <:;,r Sf-d}.c)Di!:
r ' J
City: C,,./,Jc../,,JM 4 7 ) State o../i:.Zip Code: t./s;-~o ;)_ County: ____ _
DayTeleNo.: <.1 Z -,}~//-0 L[)'1 CellNo.: ~/J-?/ ?-IVs~
EMAIL Address: /vJ /VJ C -Id di LI l.f--?: e: Fax No.:
C../J,,6-\/~?: j11lcP&l--t/6!. ~,,Al ..) ts P~;,,,Jcc--e CJJ,41/e~J)luf'~J6S.c.'.:JAt.,
C. LOCATION OF WELL SITE-Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: 070539 t.j :f ':ft.[5 County: \A.(1; Kff
(2) Physical Address (if different than mailing address): _______________ _
8 8:J.o F p,.s..-PA A I< D A I V E
City: A: IA l E I G fl State: NC Zip Code: __ :2_7_"_/_7 __ _
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name: ------------------~-----
NC Well Drilling Contractor Certification No.: ___________________ _
Company Name: _____________________________ _
Contact Person"--: ______________ E=MA"'-=-=I=L-=-A=d=d~re=ss==-----------
Address: _______________________________ _
City: _________ Zip Code: ____ State: __ County: ________ _
Office Tele No.: Cell No.: ~Fax~N~o-~: _______ _
GPU/UIC SQM Permit Application (Revised 1/24/2011) Page 1
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: _________________________________ _
Contact Person . .:...: -----------------"'E=MA-'-=-'=IL=--.,..A=d=d=re=s=s~: ___________ _
Address:-------------------------------------
City: __________ Zip Code: _____ State: __ County : _________ _
Office Tele No.: Cell No.: _________ ~F=ax~.N~o~.: ______ _
F. WELL CONSTRUCTION DATA
(1) Number of borings to be constructed*: _____ Depth of each boring (feet): ________ _
* If existing water supply wells will be used then provide the information in item (4) below.
(2) Chemical additives to be used: R-22 Propylene glycol __ _ Ethanol ---
Other _________ (other additives will need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): _______________ _
(4) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, plastic, etc.), diameter, depth,
and extent of casing appearing above ground: __________________ _
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite** Other (specify)
** By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C .0213(d)(l)(A)-, w-h-ic-h-re-q-ui-re-s -a -ce-m-en_t _ty-pe grout.
(b) Grout depth of tubing (reference to land surface): from ___ to ___ (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
G. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearl and include a north arrow.
(I) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites. drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topograpliic contours or
elevation data.
GPU/UIC 5QM Permit Application (Revised 1/24/2011) Page 2
H. CERTIFICATION (to be signed as required below or by that person 2s authorized agent)
15A NCAC 02C .0211(b) requires that at permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others; by the well owner (which means all persons listed on the propertN deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit."
ig sat a of Property Owned/ p licant
I'll A
r
r n or ype Full Name r
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone] RECEIVED/DENRIDWQ
MAR 19 2W
Aquifer Protection Section
GPUfUIC 5QM Permit Application (Revised 1/24/2011) Page 3

Ro g ers, Michael
From:
Sent:
To:
Subject:
I believe this is yours.
Rogers, Mike
Monday, March 26, 2012 1 :38 PM
Rogers, Michael
FW: WI 0500165 CP Westgate Properties
From: Brian Prince (rnailto: BPrince @thefastpark.com ]
Sent: Friday, March 23, 2012 2:16 PM
To: Rogers, Mike
Cc: Jim Critzer
Subject: WI 0500165 CP Westgate Properties
Mr. Rogers,
Melanie Chavez has asked me to respond to your e-mail.
Please use my name, address and phone numbers, which are shown below in my email signature, as the
Applicant.
The address you asked to be confirmed is correct. The local manager's name is Jim Critzer (919-791-
" 0910).
Please let me know if there is anything else that I need to do for you.
Regards,
Brian J. Prince
Construction Manager
Chavez Properties
250 W. Court Street; Suite 200 E
Cincinnati, Ohio 45202
513-241-0429 O; 513-317-1457 C
b p rince @chavez pro perties.com
From: Rogers, Michael [mailto:michael.rog ers@ncdenr.g ov]
Sent: Friday, March 23, 2012 11:39 AM
To: Melanle Chavez
Subject: WI 0500165 CP Westgate Properties
Melanie-
We received the renewal application for the geothermal permit for the above site. However, I need some updated
contact information as this was left blank on the application. Please provide the following:
Applicant name
Mailing address
Daytime telephone number
Cell phone number
Also, I want to confirm the actual address of the geothermal well is 8820 Fast Park Drive, Raleigh, NC 27617.
1
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 919-807-6406
http://portal. ncdenr .orq/web/wq/aps/qwpro/perm it-applications#geothermApps
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
2
Central Files: APS SWP
03/19/12
Permit Number WI0500165 Permit Tracking Slip
Cirou d Water
Permit Type
Injection Mixed Fluid GSHP Well System t5QMj
Primary Reviewer
michael.rogers
r
Coastal SW Rule
Permitted Flow
Faci{it-.,
iET rt'1'ieLlr 'C�[�EW�i
Version Permit Classification
Individual
Permit Contact Affiliation
Melanie Chavez
8820 Fast Park Dr
Raleigh NC 27617
Facility Name Major/Minor Region
CP Westgate Properties, LLC Minor Raleigh
Location Address County
9520 Glenwood Ave Wake
Raleigh NC 27612 Facility Contact Affiliation
Owner
Owner Name Owner Type
Cp Westgate Properties LLC Non -Government
Owner Affiliation
Melanie Chavez
250 Court St
Dates/Events Giricinnab UH 45205
Scheduled
RSrig Issue App Received Draft Initiated Issuance Public Notice Issue Effective expiration
08/14/07 03119/12
Regulated Activities
Heat Pump Injection
Outfall NULL
Waterbody Name Stream Index !Number Current Class Subbasin

fi S tea'+► � .� f � f - �'+�^ � p'�
0 400 600 1600 Feet
I
W�
PIN
0768944445
Real Estate I❑
G020993
Map Name
076804
Owner
CP WESTGATE ROAD PROPERTY LLC
Mailing Address 1
250 W COURT ST STE 200E
Mailing Address 2
CINCINNATI OR 45202-1064
Mailing Address 3
Deed Book
11743
Deed Page
0330
Deed Date
12I2212D05
Deeded Acreage
27.90
Assessed Building
Value
$5,033,426.00
Assessed land Value
$1,546,440.00
Total Assessed Value
$6,579,866.00
BEing Class
CORPORATE LISTING
Property Description
L01 RCMB CP WESTGATE ROAD
PROPERTY EM2007-01934
Heated Area
5162
Site Address
8820 FAST PARK DR
City
Ralelgh
Township
LEESVILLE
Year Built
2007
Total Sale Price
$0.00
Sale Date
Type and Use
Typical Office
Design Styie
Conventional
Land Class
COMMERCIAL
Old Parcel Number
297--
oc
WAKE
COUNTY

Rogers, Michael
From:
Sent:
To:
Subject:
Melanie-
Rogers, Michael
Friday, March 23, 2012 11 :39 AM
'[e-mail]'
WI 0500165 CP Westgate Properties
We received the renewal application for the geothermal permit for the above site. However, I need some updated
contact information as this was left blank on the application. Please provide the following:
Applicant name
Mailing address
Daytime telephone number
Cell phone number
Also, I want to confirm the actual address of the geothermal well is 8820 Fast Park Drive, Raleigh, NC 27617.
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 919-807-6406
http://portal.ncdenr.org/web/wg/aps/gwpro/permit-applications#geothermApps
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
4
R-6— E
North Carolina Department of Environment and Natural Resources
Division of Water Quality
uau vel'i lU!
March 19, 2012
Melanie M Chavez
CP Westgate Properties, LLC
8820 Fast Park Dr.
Raleigh, NC 27617
Dear Ms. Chavez:
Subject: Acknowledgement of
Application No. W10500I65
CP Westgate Properties, LLC
Injection Mixed Fluid GSHP
Well (5QM) System
Wake County
off:;! G lul Y
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 03/19/2012. Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that procc ssurg standard review permit applications may take as Fong as W .W 96 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or michael,[e-mail].
Sincere+,
fvr Dc m 7, Watts
Groundwater Protection Unit Supervisor
cc; Raleigh Regional Office, Aquifer Protection Section
Permit File W10500165
AQUIFER PROTECTION SECTION
1636 Mail Seivlce Center, Raleigh, {North Carolina 27699-1636
Lom ion: 512 N. Salisbury St, Raleigh, Nod) Carolina 27504
Phons:91M07M641FAX: 91W-6h96 1�06Calof a
lntemet: wwsv.ncwatemualllvam �����
An Equal Oppor4�niry 1 Af6rmativa A*n Employer

Ro g ers, Michael
From: Zimmerman, Jay
Sent:
To:
Monday, March 26, 2012 4:42 PM
Rogers, Michael
Subject: RE: WI0500165 CP Westgate Properties
Not at this time. feel free to renew.
-----Original Message-----
From: Rogers, Michael
Sent: Monday, March 26, 2012 3:47 PM
To: Zimmerman, Jay
Cc: Mccartney, Lin
Subject: FW: WI0500165 CP Westgate Properties
Please find attached a SQM RENEWAL application. Please let me know if you wish
to conduct a pre-permitting inspection or n6t.
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 919-807-6406
http://portal.ncdenr.org/web/wg/aps/gwpro/permit-applications#geothermApps
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
-----Original Message-----
From: Heather Jennings [mailto:heather.b.j ennin gs @ncdenr.gov ]
Sent: Monday, March 26, 2012 3:42 PM
To: Rogers, Michael
Subject:
This E-mail was sent from "RNPAC7DD0" (Aficio 2075).
Scan Date: 03.26.2012 14:41:34 (-0500)
Queries to: robin.markha m@ ncdenr.gov
1
I 041*�. • { , My -r
ai"A
WDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakiid, P. E.
Governor Director
March 1, 2012
Melanie M. Chavez
Chavez Properties
250 West Court Street, Suite 200E
Cincinnati, Ohio 45202
Subject: Notice of Expiration (NOE)
5QMGeothermal Injection Well
Permit No. W10500165
Wake County
Dear Ms. Chavez:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for
the underground injection well system located on your property at 9520 Glenwood Avenue in
Raleigh, NC, which was issued to you on August 14, 2007, and expires on July 31, 2012, is soon
due for renewal. If you wish to keep this permit and operate the injection well system, the permit
must be renewed and issued in your name.
If Your InLection Well is Currently Inactive:
If the injection -well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http://portal.nede_nr.or�;(web/wqlaps/ewpro/r�rting-forms.
If Your Fnniection Well is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal
application must be submitted within 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by April 2,20122,2012.
AQUIFER PROTECTION SECTION
1636 M0 Service Center, R*Igh, North Carolina 27699.1636 7 ne
Location; 512 N. Salisbury St., Raleigh, North Carolina 27604 Nc)AhCaro ina
Phone' 819-807-6464 L FAX 91H07-6496
Internet WWW'nN�,�urallff
cwa uafi.a
Ao Equal apportunity I Affirm We Ackti Employer

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 1 SA, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct andlor Use a Well(s) for Injection with
Geothermal heat Pump System for Type SQM Wells) if the injection well system on
your property is still active.
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection. Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms. are also available on -litre at the DWQ website at
htt :11 ortal.nedenr.or weblw la sl ro/Termit-applications#P-eothermAMs.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at eric. .smith a,ncdenr._aQ .
Sincerely,
a
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Raleigh Regional Office - APS w/o enclosures
APS Central Files - Permit No. W`105001 65 Wo enclosures
2

CP Westgate Road
1 of 1
Subject: CP Westgate Road
From: "Melanie Chavez" <[e-mail]>
Date: Wed, 22 Aug 2007 18:07:50 -0400
To: <[e-mail]>
Hi Michael. I just got your voicemail a few minutes ago.
Yes, I am an authorized agent and representative of CP Westgate Road.
Please let me know if you need anything else.
Melanie M. Chavez
Chavez Properties
250 West Court Street
Suite 200 E
Cincinnati, Ohio 45202
513.241.0429 (w)
513.241.0497 (f)
513.720.5475 (m)
8/23/2007 9:04 AM
Permit Number W10500165
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Permitted Flow
Facility
Facility Name
CP Westgate Properties, LLC
Location Address
9520 Glenwood Ave
Raieigh NC 27612
Owner _
Owner Name
Cp Westgate Properties LLC
Dates/Events
Scheduled
Orig Issue App Received Draft initiated issuance
07/19/07
Regulated Activities
Heat Pump Injection
Central Files: AP5 5WP
08/14/07
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classit"ication
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Raleigh
County
Wake
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Melanie Chavez
250 Court St
Cincinnati
OH 45205
Public Notice Issue Effective
0f14Y/o-7
Requested/Received Events
RO staff report requested
R0 staff report received
Expiration
�-)7 �� Z
07/24/07
08/ 10107
Outfall LULL
Waterbody Name Stream Index Number Current Class Subbasin

01 w" rF9
Michael F. Easley. Governor
wJ',Dwa,
7 William G. Ross Jr., Secretary
r North Camlina Depampent of Environment and Natural Resources
Coleen H. suWns, Director
Division of Water Quality
August 14, 2007
Ms. Melanie Chavez
CP Westgate Properties. LLC
250 Court Street
Cincinnati, OH 45205•
Re: Issuance of Injection Well Permit
Permit No. WI0500165
Issued to CP Westgate Properties, LLC
Dear Ms. Chavez:
In accordance with your application received July 19, 2007, 1 am forwarding Permit No,
WIOS00165 for the operation of a vertical closed -loop geothermal mixed -fluid beat pump
injection well system to be located at 9520 Glenwood Avenue, Raleigh, Wake County, forth
Carolina 27612. This permit shall be effective from the date of issuance until July 31, 2012, and
shall be subject to the conditions and limitations stated therein.
Pay special attention to the well construction standards in Parts 11 and V of ,your permit.
You must notify this office (Raleigh Central Office) and the Raleigh Regional Office at least
forty-eight (48) hours prior to constructing the system, and forty-eight (48) hours prior to
initiation of the operation of the system.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application'to renew the permit three months prior to its expiration date. As indicated in the
permit, this permit is not transferable to any person without prior notice to, and approval by, the
Director of the Division of Water Quality. 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,
/17
d�
Michael Rogers
Environmental. Specialist
cc: Jay Zimmerman — Raleigh Regional Office
Central Office File — WI0500165
Witnev Battestilli - Effecta Solutions
Attachment(s)
Nc Carolina
'Viturallb,
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone; [phone]
Internet: ht :,/xvarw.new•aterqua14y.ore 2728 Capital Boulevard Raiaigh. NC 27604 Fax 1: [phone]
Fax 2: [phone]
An EquaI QpporiunitylAifirmative Adon Employer— 50 Re cycle tll10% Post Consumer Paper 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
CP WESTGATE PROPERTIES, LLC
FOR THE CONSTRUCTION AND OPERATION OF 7 TYPE SQM INJECTION WELLS,
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed-loop geothermal-mixed-fluid heat pump
system. This system is located at 9520 Glenwood Avenue, Raleigh, Wake County, North
Carolina, and will be constructed and operated in accordance with the application received July
19, 2007, 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 July 31, 2012
and shall be subject to the specified conditions and limitations set forth in Parts I through IX
hereof.
~
Permit issued this the~_l __ day of __ ~--,"\-~-• 2007.
{)0aj,w~
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500165 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 (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 aecordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate;
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to: DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff, 1636
Mail Service Center, Raleigh, NC 27699-1636, within 30 days of completion of well
construction.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the Permittee or his agent shall test the pH of
the soil at a depth of three feet at the planned well location. If the resulting soil pH is less
than 6 standard units or greater than 11 standard units, the well system shall be equipped with
a compatible cathodic protection system. All testing results shall be kept on site available for
inspection.
2. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the
Aquifer Protection Section's Underground Injection Control (UIC) Program Central Office
staff, telephone number [phone] and the Raleigh Regional Office Aquifer Protection
Section Staff, telephone number [phone].
3. All underground tubing shall be refrigeration grade copper tubing.
PermitNo. WI0500165 Page3
4. Prior to installation, all tubing to be placed in boreholes ("loops") shall be checked for leaks
by pressurizing the loop to a gage pressure of at least 350 pounds per square inch (psig),
immersing the loop in water and examining it for leaks. Loops with leaks shall not be
installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents,
and scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop
by the manufacturer before shipping is still present at a pressure of at least 300 psig. The
loop manufacturer shall be notified in the event of damage or pressure loss, and the
manufacturer's instructions shall then be followed. The nitrogen charge may be released
only when the loop is installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting.
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A
North Carolina Administrative Code 2C .0100) shall be pumped via tremie pipe into the
annular space of each borehole so as to completely fill it from bottom to top.
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material
shall have a galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
10. After installation and prior to operation of the system, a mechanical integrity test shall be
conducted by pressurizing the injection well system to 400 psig with dry nitrogen and
monitoring for leaks using an ultrasonic or other leak detector of equal sensitivity and
monitoring pressure in the system for at least 2 hours. Alternatively, an equivalent vacuum
test is acceptable . Any pressure fluctuation other than that due to thermal expansion and
contraction of the testing medium shall be considered a failed mechanical integrity test. Any
leaks shall be located and repaired prior to charging the system with refrigerant. A copy of
the p ost-installation pressure or vacuum test record (initial pressure readin g, final pressure
readin g, and the duration of the test) shall be submitted to the A quifer Protection Section.
The test records must be received b y the Aquifer Protection Section at least twenty -four {24)
hours prior to the initiation of the op eration of the facili ty for injection.
11. The location of each of the system manifolds shall be recorded by triangulation from two
permanent features on the site (e.g., building foundation comers). The Permittee shall retain a
copy of the triangulation records. The Permittee shall also submit a copy of the triangulation
records to the Aquifer Protection Section within 30 days of completion of well construction.
12. The written documentation required in Part IL para£rraphs (1 0) and (11) shall be submitted to :
PermitNo. WI0500165
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page4
PART III-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3 . The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
imposed by other local, state, and federal agencies, which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater that will render it unsatisfactory for normal use. In the
event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee · must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (24) 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.
Permit No. WI0500165 Page5
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 Raleigh Regional Office, telephone number (919) 791-
4200, any of the following:
(A) Any occurrence at the injection facility that results m 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.
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.
Permit No. WI0500165 Page 6
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.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Pennittee 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 ofdrinking 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.
Permit No. WI0500165 Page 7
(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:
Permit No. WI0500165
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 8
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 08/08/2007 County: Wake
To: Aquifer Protection Section Central Office Permittee: CO Westgate Properties, LLC
Central Office Reviewer: Micheal Rapers Project Name: UIC 5QM
Regional Login No: 05 Application No.: W10500165
1. GENERAL INFORMATION
1. This application is [che,,* an that applY)
Surface Irrigation ❑ Reuse
❑ Land Application of Residuals
❑ New ❑ Renewal
❑ Minor Modification ❑ Major Modification
Recycle ❑ Nigh Rate Infiltration ❑ EvaporationllnMtration Lagoon
❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ❑ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 08/08/2007
b. Person contacted and contact information: Newcomb A, Co. Mr_ Robert '%,rir ht Ph- 0 9 198623000, Larry
Youniz PhA 9194224287 --
c. Site visit conducted by: JGreer. RRO-APS
d. Inspection Report Attached: ® Yes or ❑ No.
2, is the following information entered into the BIMS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities 1 Type of Wastes (e.g„ subdivision, food processing, municipal wastewater): NIA
For Disposal and In Sites:
i If multiple sites either indicate which sites the information applies to. copv andyaste a new section into the
document for each site. or attach additional ies for each site
a. Locations):
b. Driving Directions: See Map Guest ,
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
II. NEW AND MAJOR jVODIFICATTIONAPPLICATIONS flhis section not needed fvr renewals or minar
moth teations Lkk to next section - - - -
Description Of Waste S And Facilities
l . Please attach completed rating sheet. Facility Classification: _

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No D NIA. Ifno, please explain: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No D NIA. Ifno, please explain: __
4. Does the application (inaps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D NIA. Ifno, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NI A. If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No D NIA. Ifno, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No D NIA. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or D No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9 . Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No D NIA. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No D NIA If yes, attach list of sites
with restrictions (Certification B?)
/IL RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or maior modification
systems)
Description OfWaste{S) And Facilities
·l. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate #: __
Backup-Operator in Charge: __ Certificate #: __
2. Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. Ifno, please explain: __
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may. affect pennit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain: __
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. If no, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? D Yes or O No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? 0 Yes O No D N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? 0 Yes O No ON/A If yes, attach list of sites
with restrictions (Certification B?)
9. ·Are there any buffer conflicts (treatment facilities or disposal sites)? 0 Yes or D No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the pennit: __
10. Is the description of the facilities, type and/or volume ofwaste(s) as written in the existing pennit correct? D
Yes or O No. If no, please explain: ____ _
11. Were monitoring wells properly constructed and located? 0 Yes or D No~ N/A. if no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? 0 Yes or
D No ON/A. Please summarize any findings resulting from this review: __ _
13. Check all that apply: 0 No compliance issues; D Notice(s) of violation within the last permit cycle; 0
Current enforcement action(s) D Currently under SOC; D Currently under JOC; D Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ____ _
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? D Yes
0 No D Not Determined ON/A.. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this pennit? 0
Yes or D No ON/A. lfyes, please explain: __
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop growidwater remediation effluent injection wens, in situ remediation injection we1ls, and heat
pump injection wells.)
Description OfWell{S) And Facilities-New, Renewal, And Modification
I. Type of injection system:
0 Heating/cooling water return flow (5A7)
121 Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes C8J No
3. Are there any potential pollution sources that may affect injection? D Yes 121 No
What is/are the pollution source(s)? NIA. What is the distance of the in jection well(s) from the p olluti on
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 1,000' ft.
5. Quality of drainage at site: 121 Good D Adequate D Poor
6. Flooding potential of site: C8J Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: N/ A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? 121 Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
ln iection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
0 Yes C8J No. If y es, explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes 121 No. If y es, explain: Sy stem not yet constructed.
3. For renewal or modification of groundwater remediation pemiits (of any type ), will
continued/additional/modified injections have an adverse impact on migr ation of the plume or management of
the contamination incident? D Yes D No. If yes, explain: NIA
4 . Drilling contractor: Name: Stephen Keener
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: Miller Orig Co .• Inc.
Lawrenceburg. TN.
Certification number: 3468
5. Complete and attach Well Construction Data Sheet.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well. Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. if yes, please explain
briefly.
4_ List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
5_ List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
T. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office, ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
y
8. Signat
Signat
Date:
ADDITIONAL REGIDIM STAFF REVIEW ITEMS
System not vet constructed.

Page 1 of 2
t�5
North Carolina Department of Environment and Natural Resources
Division of Water Quality -Groundwater Section
PRECONSTRUCTION INJECTION FACILITY INSPECTION
REPORT -FORM A
INJECTION WELL PERMIT NO. WI v Srayi
NAME OF OWNER " I-,
DATE '9-Z
�4�+e~5
ADDRESS OF OWNERot-�
I
(Street road or lot and suddNWon, county,
LOCATION OF PROPOSED INJECTION WELL (and source weil(s), if applicable) 75;� rt✓a.r
(Street/ road or lot and suddiuision , county, town, if dierent than owner's address, plus description of location on site)
Potential pollution source �310— _: t=ram Distance from well `a
Potential pollution source _ -: _ _ Distance from well
Potential pollution source C9--- Distance from well I
Minimum distance of proposed well from property boundary A Z ai-y
Quality of drainag t site Flooding potential of site
adequate,porn} j (high,nsoder�w�'
DRAW SKETCH 6F SITE
(Show properly bound buildings, wells, potm lion sources, roads, approximate scale, and north arrow.)
x� s/
Vd
R
. ' V
rCP,"'{ C
. T_-.) ki
March 98

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (cant.)
v 9 A Ni
CO]V WNTS
INSPECTOR -EL -
Office
WITNESS
Address
WITNESS
Address

Pennlt: WI0500165
SOC:
County: Wake
Region: Raleigh
Effective:
Effective:
Contact Person: Melanie Chavez
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 08/08/2007
Primary Inspector: Jimmie W Greer
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration: ·
Expiration:
Title:
Owner: Cp Westgate Properties LLC
Facility: CP Westgate Properties, LLC
9520 Glenwood Ave
Raleigh NC 27612
Phone: [phone]
Certification: Phone:
Entry nme: 09:00 AM Exit Time: 09:30 AM
Phone: [phone]
Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Mixed Fluid GSHP Well System (SQM)
Facility Status: 0 Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Permit: WI0500155 Owner - Facility: Cp Westgate Properties LLC
inspection Dais: 0810KC07 Inspection Type: Compliance Evaluation
Inspection Summary:
System not yet constructed.
Reason for Visit: RoLrdne
Page: 2

WJ~{b
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A QIDFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: July 24, 2007
To: 0 Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
□ Andrew Pitner, MRO-APS
~ Jay Zimmerman, RRO-APS
□ David May, WaRO-APS
□ Charlie Stehman, WiRO-APS
□ Sherri Kmght, WSRO-APS
From: Michael Rogers , Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: [e-mail]
A. Permit Number: WI0500165
B. Owner: CP Westg ate Pro perties, LLC (contact Melanie Chavez)
C. Facility/Operation: __
~ Proposed D Existing D Facility D Operation
D. Application:
I. Permit Type: D Animal D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle D I/E Lagoon D GW Remediation (ND)
~ UIC -(SQM) closed loop mixed fluid geothermal __
For Residuals: D Land App. D D&M D Surface Disposal
D 503 D 503 Exempt D Animal
2. Project Type: ~ New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Information: D I would like to accompany you on a site visit.
NOTE: The requested days for the submittal of the staff re port (SR) has changed. Per the request of
Debra Watts. the requested dates for the submittal of the SR have been changed to 2 weeks for a UIC
report. and 4 weeks for a SFR rep ort.
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 :
~ 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.*
* Remember 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: APSARR 07/06 Page 1 of 1
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins Director
Division of Water Duality
July 20, 2007
Melanie Chavez
CP Westgate Properties, LLC
250 Court Street, Suite 200E
Cincinnati, OH 45205
Subject: Acknowledgement of Application No. W10500165
CP Westgate Properties. L.LC
Injection Mixed Fluid GSHP Well System (5QM)
Wake
Dear Ms. Chavez:
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials on July 19, 2007. 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 maximums 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 lone 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
httpJlh2o.ew.state.ne.us/documents/dwq or ,chart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKJNG INQUIRIES ON THIS
PROJECT.
Sincerely,
A a
far ©ebr� atts - rJ
Supervisor
cc .- Raleigh Regional nice, Aquifer Protection Section
Permit Application File WI0500165
Aqulfer Protection Section 1636 Mail Service Center
Internet: www.ncwataroualitym Location: 2728 Capital. Boulevard
An Equal C3pportunitylATfirmative Action Employer- 50% Recycledl10% Post Consumer Paper
tk7t
Carolina
AndlY
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
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In Accordance with the provisions of NCAC Title I SA: 02C.0200
Complete application and mail to address on thrback page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY RECEIVED i DENR I DWQ
DATE: June 4 , 20 QT
AQUIFER-PRf)TFr,TlnN S TIION
A. SYSTEM CLASSIFICATION Please check column which matches proposed system. JUL 19 2007'
(1) F1Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) Type 5QM wells contain a subsurface system of continuous piping, that is
isolated from the environment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3) E] Type 5QW wells contain a subsurface system of continuous piping, that is
isolated from the environment and only circulates potable water. If you selected
this well type, then complete form CW-57 CL, Notification Of Intent To
Construct A Closed -Loop Geothermal -Water Only Injection Well System.
Name-. CP Westgate Properties, LLC . Melanie Chavez
Address: 250 Court Street, Suite 2OOF
City: Cincinnati State: OH Z, de:4520` County:
Telephone: [phone] — dy;t l M
C. PROPERTY OWNER (if different from applicant)
Name:
Address:
City:
Telephone:
Sate: Zip Code: County:
D. STATUS OF APPLICANT
Private: 0 Federal: 0
State: _[I Municipal:
Commercial: El
Native American Lands: El
Revised 7/06 GW/UIC-57 HP Page l of 4

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility: CP Westgate Properties, LLC -Melanie Chavez
Address: 9520 Glenwood Ave.
City: Raleigh Zip Code: 27612 County: _W_a_k_e ____ _
Telephone: [phone] Contact Person: Melanie Chavez
F . HEAT PUMP CONTRACTOR DATA
Name: Newcomb and Co
Address: 3000 Comfort Court
City: Raleigh Zip Code: 27604 County: _w_a_k_e ____ _
Telephone: [phone] Contact Person: _R_o_b_e_rt _W_ri-=-gh_t _____ _
G. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
Co pp er tubing will be p laced in 4" bores to act a a geothermal heat sink. All bores will be
continuousl y grouted from the bottom of the hole.
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ___ _
YES __ _
NO ---'x"'----
NO _ __,_X.c__ __
I. CONSTRUCTION DATA (check one)
EXISTING WELL being proposed for use as an injection well. Provide the data in
(1) through (7) below to the best of your knowledge. Attach a copy of Form GW-
1 (Well Construction Record) if available.
__ x__ PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after construction.
(1) Well Drilling Contractor's Name: _S_te_p_h_e_n_K_e_en_e_r ______________ _
NC Contractor Certification number: 3468 -----------
( 2) Date to be constructed: 8/1/07 Number of borings: _? ___ _
Approximate depth of each boring (feet):_1_00 _______ _
(3) Well casing: Is the well(s) cased?
(a) YES If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic __ Other (specify) _______ _
Casing depth: From ___ to ___ ft. (reference to land surface)
Casing extends above ground inches
(b) NO x
Revised 7 /06 GW/UIC-57 HP Page 2 of4
. '
(4) Grout (material surrounding well casing and/or piping):
(a)
(b)
Grout type: Cement_ x _ Bentonite x Other (specify) _silica sand ____ _
Grouted surface and grout depth (reference to land surface):
_ x_ around closed loop piping; from _O_ to 100 (feet).
__ around well casing; from __ to __ (feet).
(5) Screens (for Type 5A 7 wells)
(a) Depth: From __ to __ feet below ground surface.
(6) N.C. State Regulations (Title 15A NCAC 2C .0200) require the permittee to make provisions
for monitoring wellhead processes. A faucet on both influent (fluid entering heat pump) and
effluent (fluid being injected into the well) lines is required. Will there be a faucet on:
(a) the influent line? yes __ no__ (b) the effluent line? yes __ no __
(7) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,
provide the data in part K (1) of this application form to the best of your knowledge.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERATING DATA (for Type 5A7 wells)
(1) Injection rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ o F .
K. INJECTION FLUID DATA
(1) Fluid source (for Type 5A7 wells) If underground, from what depth, formation and type of
rock/sediment unit will the fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth: ______ Formation: ______ Rock/sediment unit: _____ _
(2) Chemical Analysis of Source Fluid (for Type SQM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
R-22
L. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
M. LOCATION OF WELL(S) Attach two maps.
Revised 7 /06 GW/UIC-57 HP Page 3 of4
(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies,
potential sources of groundwater contamination and the orientation of and distances between
the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet of the geothermal heat pump well system. Label all
features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
N. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include :
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
0. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document and all attachments thereto and that, based on my inquiry of
those individuals immediately responsible for obtaining said information, I believe that the information
is true, accurate and complete. I am aware that there are significant penalties, including the possibility
of fines and imprisonment, for submitting false information. I agree to construct, operate, maintain,
repair, and if applicable, abandon the injection well and all related appurtenances in accordance with
the approved specifications and conditions of the Permit."
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner authorizing the above agent
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure that the injection well(s) conforms to the Well
Construction Standards (Title 15A NCAC 2C .0200)
Revised 7 /06
Please return two copies of the completed Application package to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GW/UIC-57 HP Page 4 of 4
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Account Summary - 0020993
Page 1 of 2
Wake County Read Estate
Home
Real Estate ID
0020993
WAnLocation Address
couNTY 9952E GLENWOOD
fr01(iII CAR01INA
Data
Account Summary
PIN # 0768943226
Property Description
VAU GHAN LD
Pin/Parcel History Search Results
Acco u nt I B u i Id i ngsl Lana IDeed sl Notes I sales IPhotosl
iMaps
Tax Bills
Account
Search
New Search
Tax
Bill Map
All property values are under review for tax year 2008. Land and building values on properties
existing prior to tax year 2008 are based on 2000 Revaluation Schedules. Newly created
properties for tax year 2008 are valued using 2000 Revaluation Schedules for buildings, and
will not have land values until late 2007. The 2008 Revaluation values of both land and
buildings will be available in late 2007.
Property Owner
Owner's Mailing Address
Property Location Address
CP WESTGATE ROAD
ATTN; TONY KENNETH
9520 GLENWOOD AVE
PROPERTY LLC
250 E COURT-ST STE 200E
RALEIGH NC 27612-7515
ATTN: TONY KENNETH
CINCINNATI OH 45202-1324
Administratve Data
Transfer Information
Assessed Value
Old Map #
297-00000-0011
Map/Scale
076804
Deed Date
12/22/2005
Land Value $1,282,625
VCS
GWRA001
Book & Page
11743 0330
Assessed
City
RALEIGH
Revenue
6000.00
Bldg. Value
Fire District
Stamps
Assessed
Township
LEESVILLE
Pkg Sale Date
Land Class
VACANT
Pkg Sale Price
Tobacco Pounds
ETJ
RA
Land Sale Date
12/22/2005
Tobacco Value
Spec Dist(s)
Land Sale
$3,000,000
Zoning
TD
Price
Land Use Value
History ID 1
Use Value
History ID 2
Improvement Summary
Deferment
Acreage
19.63
Historic
Permit Date
1/23/2007
Total Units
0
Deferment
Permit #
0000052382
'Recycle Units
0
Total Deferred
Apt/SC Sqft
Value
Heated Area
Use/Hist
Assessed
Total Value $1,282,625
Assessed
For questions regarding the information displayed on this site, please contact the
http:llmsweb01 .co.wake.nc.us/realestate/Account.asp?id=0020993&stype=addr&stnum=9... 8/20/2007

Ownership History - 0020993
Page 1 of 1
Wake County Real Estate
Home
Real Estate I D
0020993
WAULocation Address
cou y 952 GLENWOOD
AVE
uuRr11 r.AROHNIA
Data
Ownership History
PIN # 0768943226
Waps
Tax Bills
Account
Search
New Search F--
AccountjSuildingsI Land IDeeds I NatesI Sales IPhotos I Tax
Bill I Map
40
Property Description
VAUGHAN LD
Pin/Parcel History Search Results
All property values are under review for tax year 2008. Land and building values on properties
existing prior to tax year 2008 are based on 2000 Revaluation Schedules. Newly created
properties for tax year 2008 are valued using 2000 Revaluation Schedules for buildings, and
will not have land values until late 2007. The 2008 Revaluation values of both land and
buildings will be available in late 2007.
Owner Name Type
%
Stamps Boole Page
date
Own
Current CP WESTGATE ROAD
ALL
6000.00 11743 0330
12-22-
PROPERTY. LLC
2005
1
ESTES, JOHN THOMAS WILL
112
01040 0-E-
05-09-
Back
1999
ESTES, RINE E
112
2
ESTES, ERVIN M
ALL
0
03-12-
Back
1998
3
ESTES, ERVIN M & NORMA
ALL
01365 0234
01-01-
Back
1959
For questions regarding the information displayed on this site, please contact the
Revenue Department at [e-mail] or call 919-856-5400.
http:llmswebOl.co.wake.nc.uslrealestatelDeeds.asp?id=0020993&stype =addr&strum=952... 8/20/2007

Page 1 of 2
WAKE C0UNi'OANb THr CITY *IF *ALIiC-H
Map created on 8/20/2007 10:56:38 AM.
WAKE
COLIN r V
Parcel Number.
REID.
OWNERi:
ADDR3:
DEED BOOK:
DEED PAGE:
DEED DATE:
DEED ACRES:
BLDG VAL:
LAND VAL:
BILLING CLASEE
DESCRIPTION:
MAP NAME:
PIN NUM:
PIN EXT.-
CITY:
TOWNSHIP:
YEAR BUILT:
SALEPRICE:
SALEDATE:
TYPE USE:
"! DESIGN STYLE
UNITS:
LAND CLASS:
"OLD PARCEL
NUMBER:
RALEIGH SITE
STREET NUM:
STREET SUITE
STREET DIR PI
STREET NAME
STREET TYPE:
STREET DIR St
ADDRESS TYP
ADDRESS
STATUS CODE
DESCR:
http:llimaps.co-wake.nc.uslimapslprintmap- asp?pin=0768943226&pinext--&minX=206870... 8/20/2007

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Real Estate Data
and Revenue
Department
LAYER
CODES:
Fuqua%,-Varina
Zaming
Raleigh Zoning
Wake Forest
Zoning
Soils Legend
Floodplain Data
SURVEY
SELECT A VIEW
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Environmental Features
Aerial Photography
County Zoning
Raleigh Zoning
WHAT'S NEW
Parcel Number: 0768943226
Copyright 2007. City of Raleigh & Wake County
http:lliTnaps.co.wake.ne.uslimapslmap.asp?msize=525&cmd=ZOOMPIN&pin=0768943226 8/20/2007

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14
LIMITED LIABILITY COMPANY
ANNUAL REPORT
NAME GF LMTED LIABILITY COMPANY: CP-Westgate Road Property, LLC
STATE OF INCORPORATION: OH
SECRETARY OF STATE R.L.L.P. ID NUMBER: 0819227
NATURE OF BUSINESS: Ownership of Real Estate
REGISTERED AGENT: CT Corporation System
REGISTERED OFFICE MAILING ADDRESS: 225 Hillsborough Street
Raleigh, ,VC 27603
REGISTERFD OFFICE STREET ADDRESS: 225 Hillsborough Street
Raleigh, NC 27603 Wake County
SIGNATURE OF THE NEW REGISTERED AGENT:
PRINCIPAL OFFICE TELEPHONE NUMBER: 513-241-0429
PRINCIPAL OFFICE MAILING ADDRESS:
PRINCIPAL OFFICE STREET ADDRESS:
MANAGERS/MEMBERS/ORGANIZERS:
Name: Cp-westgate Manager, L,LC
Title: Manager
Address:
250 W, Court Street, Suite 20Of,
Cincinnati, OH 45202
SIGNATLaE CON STTI []TES CONSENT TO THE APPOINTMENT
250 W. Court Street Suite 200 E
Cincinnati, ❑H 45202
250 W. Court Street Suite 200 E
Cincinnati, OH 45202
CERTIFICATION OF ANNUAL REPORT MUST BE COMPLETED BY ALL LIMITED LIABILITY COMPANIES
FORM MUST BE SIGNED BY A MANAGERIMEMBER
DATE
TYPE OR PRINT NAME TYPE OR PRINT TITLE
ANNUAL REPORT FEE: $200 MAIL TO: Secretary of State • Corporations Dinisiou • Post Office Box 29525 • Raleigh, NC 27626-0525