WI0100052_Complete File - Historical_20220308

, 4 RECEIVED
NCDENR VIR 2 3 2512
North Carolina Department of Environment and Natural Resources
Division of Water Quality Asheville Regional Office
Beverly Eaves Perdue Charles Wakild, P.E. Aquifer Protiifiteeman
Governor Director Secretary
April 13,2012
Ron and Linda Thompson
1245 Kentwood Ln.
Pisgah Forest,NC 28768
Ref: Issuance of Injection Well Permit WI0100052
Issued to Ron and Linda Thompson
Pisgah Forest,Transylvania County
Dear Mr. and Mrs. Thompson:
In accordance with the application received on April 5, 2012, I am forwarding permit number WI0100052 for the
continued operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system located at the above
referenced address. This permit shall be effective from the date of issuance until March 31, 2017, and shall be subject to
the conditions and limitations stated therein.
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(919) 807-6406 or [e-mail] if you have any questions about your permit.
Best Regards,
Michael Rogers,P.G.(NC&FL)
cc: Landon Davidson, Asheville Regional Office
WI0100052 Permit File
Transylvania County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636
Location:512 N.Salisbury St.,Raleigh,North Carolina 27604
Phone:[phone] FAX:9107b196 Noe
9-6 Carolina
Internet:www rimatemuality.oro al`lltll!!lf
An Equal Opportunity 1 Alfinnative Action Employer

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH,NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87;Article 21, Chapter 143, and other applicable
Laws,Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Ron and Linda Thompson
FOR THE OPERATION OF 6 (SIX) TYPE 5QM 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 heat pump system. This system is located at 1245 Kentwood Lane, Pisgah Forest, Transylvania County,
NC 28768, and will be constructed and operated in accordance with the application received April 5, 2012, and
in conformity with the specifications and supporting data submitted, all of which are filed with the Department
of Environment and Natural Resources and are considered a part of this permit.
This permit is for operation of an injection well and shall be in compliance with Title 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 March 31, 2017, and shall be
subject to the specified conditions and limitations set forth in Parts I through VII hereof.
Permit issued this the 13a'day of April 2012.
wA
" Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0100052 UIC/5QM-M.F.Renewal Page l of4
Version 1/2010

PART I—OPERATION AND USE GENERAL CONDITIONS
1.' This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Pennittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall 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 Pennittee 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 Pennittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART III—OPERATIONS AND MAINTENANCE REQUIREMENTS
I. 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.
WI0100052 UIC/5QM-M.F.Renewal Page 2 of
Version 1/2010

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.
'r
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 Asheville Regional Office,telephone number 828-296-4500, 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 Permttee 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.
WI0100052 UIC/5QM-M.F.Renewal Page 3 of
Version 1/2010

PART VII—CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised.as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15ANCAC 2C .0213(h)(1)within 30 days of completion of abandonment.
3. The written documentation required in Part VII(1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
WI0100052 UIC/5QM-M.F.Renewal Page 4 of
Version 1/2010

� A
NCDEFIR
North Carolina Department of Environment and Natural Resources
Division of Water Quality R E C E I V E D
UR 1. 0 20;2
April 5,2012
Asheville Regional Office
Aquifer Pro ego
Ron Thompson
Linda Thompson
1245 Kentwood Ln.
Pisgah Forest,NC 28768
Subject: Acknowledgement of
Application No.W10100052
Ron Thompson SFR
Injection Mixed Fluid GSI-IP
WEII(SQM) System
Transylvania County
Dear Mr.Thompson:
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 04/05/2012. Your application package has been assigned the number listed
above,and the primary reviewer is Michael Rogers.
Central and Asheville 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 processing standard review permit applications may take as long as 60 to 90 days
af?P* reeeint of P cmmnlete annliratinn. Tf ynn Dave am, nnestions. nleace enntact
ADebatts
er Protection Unit Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Pennit File WIO100052
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 27699-1636
Location:512 N.Salisbury St.,Ralegh,North Carolina 27604 One
Phone:[phone] FAX:919a7&196 N Carolina
Internet:www.nmaterauality.org turallr�
An Equal Opportunity l Affrmalive Action Employer

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Duality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
March 30, 2012 RECEIVED
[`AR 29 2C2
Ron Thompson Asheville Regional Office
1254 Kentwood Lane Aquifer Pr faction
Pisgah Forest,NC 28768
Subject: Notice of Expiration(NOE)
5QM Geothermal Injection Well
Permit No. WI0100052
Transylvania County
Dear Mr. Thompson:
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 1254 Kentwood Lane in
Pisgah Forest, NC, which was issued to you on September 11, 2007, and expires on August 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 Injection 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 ncdenr ore/web/wq/aps/swpro/reportingJorms.
If Your Iniection 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 May-33, 2012.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636 One
Location;512 N.Salisbury St.,Raleigh,North Carolina 27604 NorthCarolina
Phone:[phone] FAX:[phone] ry{,/��//�
Internet: ncvvatem a'�at l ualitv.om �/ {'
An Equal Opportunity 1 Affirmative Action Employer

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s)for Injection with
Geothermal Heat Pump System for Type SQM Well(s) if the injection well system on
your property is still active.
-OR-
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-line at the DWQ website at
http://portal.ncdenr.or web/wq/aps/gwwpro/permit-applications#PeothermApps.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at(919) 807-6407 or by email at eric.g.smith@,ncdenr.gov.
Sincerely,
Eric G. Smith,P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office -APS w/o enclosures
APS Central Files-Permit No. WI0100052 w/o enclosures
2

f Z
RESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2603
1.WELL CONTRACTOR: g. WATER ZONES(depth):
Larry Wells Top Bottom Top Bottom
Well Contractor(Individual)Name Top Bottom Top Bottom
AWD Services. Inc. : Top Bottom Top Bottom
Well Contractor Company Name Thickness)
258 North Turkey Creek Rd 7. CASING: Depth Diameter Weight Material
Street Address Top Boriom Ft.
Leicester NC 28748 Top Bottom Ft.
City or Town State Zip Code Top Bottom Ft.
8( 28 ) 683-9223 _
Area code Phone number : 8. GROUT: Depth Material Method
2.WELL INFORMATION: Top 0 Bottom 100' Ft.Gee,Thermal Pour
WELL CONSTRUCTION PERMIT# W I0100052 Top Bottom Ft. Grout
OTHER ASSOCIATED PERMIT#(H applicable) Top Bottom Ft.
SITE WELL ID#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply❑ Top Bottom Ft—in. in.
DATEDRILLED 10-1-07 : Top Bottom Ft—in. in.
TIME COMPLETED AM D PM(YJ Top Bottom Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: 1\%
Depth Size Material
CITY: Plsoah Forest COUNTYTransyiyanla Top Bottom Ft.
1245 Kentwood Lane Top Bottom Ft.—
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Top Bottom Ft.
TOPOGRAPHIC/LAND SETTING: (check appmpnate box)
GXSIope DValley ❑Flat ❑Ridge ❑Other Eley. 11. DRILLING LOG
Top Bottom Formation Desrdlption
LATITUDE 35 "DMS OR DD /
LONGITUDE 83 "DIMS OR DD /
Latitude/longitude source: &!�P3 Qropographic map /
(location of well must be shown on a USGS lope,map andattached to /
this form if not using GPS) Lat . & Long. Unknown I
S.WELL OWNER /
Ron Thompson /
Owner Name
1245 Kentwood Lane Ifrw� aoC
Street Address If
Pisaah Forest NC 28768 /
City or Town State Zip Code /
8c 28 ) /
Area code Phone number
6.WELL DETAILS: (6) Geothermal Bores 12. REMARKS:
Soil:
a. TOTAL DEPTH: 100,
It. DOES WELL REPLACE EXISTING WELL? YES D NO❑
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: N/A FT. ACCORDANCE WITH 15A NCAC 2C,WELL CONSTRUCTION
(Use"+•if Above Top of Casing) : STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS N/A FT.Above Land Surface'
"Top of casing terminated atior below land surface may require 2-2-12
a variance in accordance with 15A NCAC 2C.0118. AT TIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): NIA METHOD OF TEST N/A : Larry Wells
f. DISINFECTION:Type N/A Amount N/A PRINTED NAMEOF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality- Information Processing, Form GW-1a
1617 Mail Service Center, Raleigh,NC 27699-161,Phone :[phone] Rev.2/09

\�U, 1yy Michael F.Easley,Governor
O
COYYy William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Coleen H.Sullins,Director
Division of Water Quality
September 11, 2007
Mr. Ron Thompson
524 Three Mile Knob Road RECEIVE D
Apt. #1
Pisgah Forest, NC 28768
SEP 19 2007
Re: Issuance of Injection Well Permit
Permit No.W10100052 Asheville Regional Office
Issued to Ron Thompson A uifer Prot90tinn
Dear Mr. Thompson:
In accordance with your application received August 20, 2007, I am forwarding Permit No.
WI0100052 for the operation of a vertical closed-loop geothermal mixed-fluid heat pump
injection well system to be located at 1245 Kentwood Lane, Pisgah Forest, Transylvania County,
North Carolina 28768. This permit shall be effective from the date of issuance until August 31,
2012, and shall be subject to the conditions and limitations stated therein.
Pay special attention to the well construction standards in Parts II and V of your permit.
You must notify this office (Raleigh Central Office) and the Asheville 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 (90 days) 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 (919) 715-
6935 or me at [phone].
Best Regards,
Michael Rogers
Environmental Specialist
cc: Landon Davidson—Ashville Regional Office
Central Office File—WI0100052
Attachment(s)
Nam`rCarolina
12ftWdly
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:htmI,w newatereualitv.om 2729 Capital Boulevard Raleigh,NC 27604 Fax 1 [phone]
Fax 2: [phone]
An Equal OpportunilylAl8rmelive Action Employer—50%Recycled/10%Post Consumer Paper Customer Service: [phone]

J
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
RON THOMPSON
FOR THE CONSTRUCTION AND OPERATION OF 6 TYPE 5QM INJECTION WELLS,
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed-loop geothermal-mixed-fluid heat pump
system. This system is located at 1245 Kentwood Lane, Pisgah Forest, North Carolina, and will
be constructed and operated in accordance with the application received August 20, 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 August 31,
2012, and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof.
Permit issued this the 0 day of_— ' 2007.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0100052 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 accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are.generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
8. A completed Well Construction Record (Form GW-1)must be submitted for each injection
well to: DENR-Division of Water Quality, Aquifer Protection Section 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 Ashville Regional Office Aquifer Protection
Section Staff,telephone number(828) 296-4500._
3. All underground tubing shall be refrigeration,grade copper tubing.
WI0100052 Page 3

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 post-installation pressure or vacuum test record (initial pressure reading final pressure
reading, and the duration of the test) shall be submitted to the Aquifer Protection Section.
The test records must be received by the Aquifer Protection Section at least twenty-four (24)
hours prior to the initiation of the.operation of the facility for injection.
11. The 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 II, paraeraphs (10) and (11) shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
WI0100052 Page 4

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). hi the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, aformal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
imposed by other local, state, and federal agencies, which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater that will render it unsatisfactory for normal use. In the
event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V- OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (48) hours prior to .the initiation of the operation of the facility for
injection, the Pemiittee must notify by telephone the Aquifer Protection Section's
Underground Injection Control (UIC) Program Central Office staff, telephone number
(919) 715-6166, and the Ashville Regional Office Aquifer Protection Section Staff,
telephone number [phone]. Notification is required so that Division staff can
WI0100052 Page 5

inspect 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 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 Ashville Regional Office, telephone number (828)
296-4500, 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.
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.
WI0100052 Page 6

r
PART VIII- PERMIT RENEWAL
The Permittee shall, at least 90 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)(1), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination_ of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
WI0100052 Page 7

(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(1) within 30 days of completion
of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:,
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
WI0100052 Page 8

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM AUG 27 2007
Date: August 22,2007
To: ® Landon Davidson,ARO-APS ❑ David May,WaRO.APS
❑ Art Barnhardt,FRO-APS ❑ Charlie Stehman,WiRO-APS
❑ Andrew Pitner,MRO-APS ❑ Sherri Knight, WSRO-APS
❑ Jay Zimmerman,RRO-APS
From: Michael Rogers ,AFO Unit '
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Rogers(@,ncmail.net
A. Permit Number: WI 0100052 Oct.07. 07
Iff
AAA t
B. Owner: Ron Thompson ��t-}A2*C-&t74 T
C. Facility/Operation:_
® Proposed Existing �''Dtq�[�ci✓
p ❑ g El El
D. Application:
L Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ UE Lagoon ❑ GW Remediation(ND)
® UIC-(5QM)closed loop mixed fluid geothermal_
For Residuals: ❑ Land App. ❑ D&.M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal w/Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
NOTE: The requested days for The submittal of the staff report (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 report.
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.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ 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 a to Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer. Date: 6 f!`-77- (S-7 —
FORM:APSARR 07/06 - Page I of 1

AQUIFER PROTECTION SECTION 1
APPLICATION REVIEW REQUEST FORM :. AUG .P-7 2007
Date: August 22,2007
To: ® Landon Davidson,ARO-APS ❑ David May,WaRO.•APS'.r;.i`.:(:'`.:i :''-.r ?';?_'.......'`. ._'
❑ Art Barnhardt,FRO-APS ❑ Charlie Stehman,WiRO-APS
❑ Andrew Pitner,MRO-APS ❑ Sherri Knight,WSRO-APS
❑ Jay Zimmerman,RRO-APS
From. Michael Roeers,AFO Unit' '
Telephone: [phone] Fax: [phone]
E-Mail: Micbael.RoP6rsRncmail.nct
A. Permit Number: W10100052
B. Owner: Ron Thompson
C. Facility/Operation:
® Proposed ❑ Existing ❑ Facility ❑ Operation
D. Application;
L Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ UE Lagoon ❑ GW Remediation(ND)
® DIC-(5QM)closed loop mixed fluid geothermal_
For Residuals: ❑ Land App, ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod, ❑ Renewal ❑ Renewal w/Mod.
F. Comments/Outer Information: ❑ I would like to accompany you on a site visit.
NOTE: The requested days for the submittal of the staff report (SR) has changed Per the request of
Debra Watts, the requested dates for the submittal of the SR have been changed;o 2 weeks for a UIC
report, and 4 weeks for a SFR report.
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.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ 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 a to Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer Date:
FORM:APSARR 07106 Page 1 of 1

Ron Thompson UIC Permit Field Inspection
W10100052
Note house footprint differs from sketch on permit.
Contours are 20ft. intervals.
Garage
Edge of House 2780 ft
BREVAR
Kentwood Rd. °
WSW
Feet
0 15 30 60 90 120

Compliance Inspection Report
Permit: W10100052 Effective: Expiration: Owner: Ron Thompson
SOC: Effective: Expiration: Facility: Ron Thompson SFR
County: Transylvania 1245 Kentwood Ln
Region: Asheville
Pisgah Forest NC 28768
Contact Person: Ron Thompson Title: Phone:
Directions to Facility:
take Ecusta Rd.south off of hwy.64, right at light, immediate left on Wilson,proceed then left on Williamson Crk.,proceed to Kentwood
gn left, rocee j o end at Chelsea Circle
yste C lassrficatio ns:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):.
Related Permits:
Inspection Date: 0 910 6120 07 Entry Time: 10:00 AM Exit Time: 12:30 PM
Primary Inspector: Landon Davidson Phone:[phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type:Compliance Evaluation
Permit Inspection Type: Injection Mixed Fluid GSHP Well System(5QM)
Facility Status: ■Compliant ❑ Not Compliant
Question Areas:
Wells
(See attachment summary)
Page: 1

Permit:W10100052 Owner-Facility: Ran Thompson
Inspection Date: 09/06/2007 Inspection Type:Compliance Evaluation Reason for Visit:Routine
Inspection Summary:
Site appears to meet requirements for SQM. No GW-1 for the existing onsite water supply well. Driller was supposed to
submit GW-1 today but has not.Water supply well was constructed properly.Site drainage is very good with no flood
potential. Should probably reiterate 2C requirements in permit if deemed necessary since UIC wells are planned not to be
cased 0.0213(c)(1)(B). Site sketch in application package is no accurate,see attached. Based on new calculations, 6
wells are required instead of 4 as application states.
Page: 2

AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 09-07-07 County:_ Trans.
To: Aquifer Protection Central Office Permittee: Ron Thompson SFR WI0100052
Central Office Reviewer: Project Name: WI0100052
Regional Login No: Application No.:WI0100052
L GENERAL INFORMATION
1. This application is (check all that apply): ®New ❑Renewal
❑ Minor Modification❑Major Modification
❑ Surface Irrigation❑ Reuse❑Recycle ❑High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑Land Application of Residuals ❑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: 09.06.07
b. Person contacted and contact information: Ron Thompson
c. Site visit conducted by: G.Davidson
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/Type of Wastes(e.g., subdivision,food processing, municipal wastewater):
For Disposal and Infection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site,or attach additional pages for each site)
a. Location(s): 1245 Kentwood Ln., Brevard,NC 28768
b. Driving Directions: south on 64 out of Brevard, to Williamson,to Kentwood.
c. USGS Quadrangle Map name and number: Brevard
d. Latitude: 35/13/26.196 Longitude: 82/40/25.60
II NEWAND MAJOR MODIFICATIONAPPLICATIONS(this section not needed for renewals or minor
modifications,skip to next section)
Description Of Waste(S)And Facilities
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal systemT
FORM: WI0100052 1

AQUIFER PROTECTION REGIONAL STAFF REPORT
❑Yes❑No ❑N/A. If no,please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑No ❑N/A. If no,please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? ❑
Yes ❑No ❑N/A. If no,please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑No ❑
N/A. If no,please explain:
6. Are the proposed application rates for new sites(hydraulic or nutrient)acceptable?
❑ Yes❑No ❑N/A. If no,please explain:
7. Are the new treatment facilities or any new disposal sites located in a I00-year floodplain?
El Yes ❑ No ❑,N/A. 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)? ❑ Yes or❑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? ❑ Yes ❑ No ❑ 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:
10. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑No ❑ N/A If yes, attach list of sites
with restrictions(Certification B?)
M. RENEWAL AND MODIFICATIONAPPLICATIONS(use previous section for new or maior modification
systems)
Description Of Waste(S)And Facilities N/A
I. Are there appropriately certified ORCs for the facilities? ❑Yes or❑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? ❑ Yes or ❑No.
If no,please explain:
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? ❑Yes or❑No. If no,please explain:
FORM: WI0100052 2

AQUIFER PROTECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development,etc.)? If yes,please explain:
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
❑ Yes or❑No. If no,please explain:
6. Are the existing application rates (hydraulic or nutrient) still acceptable? ❑ Yes or ❑ No. If no, please
explain:
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ❑ 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?� ❑Yes ❑No ❑N/A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? ❑ Yes or ❑ No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit:
10. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? ❑
Yes or❑No. If no,please explain:
11. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ❑'N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW,NDMR,.and NDAR as applicable)? ❑ Yes or
❑No ❑N/A. Please summarize any findings resulting from this review:
13. Check all that apply: ❑ No compliance issues; ❑ Notice(s) of violation within the last permit cycle; ❑
Current enforcement action(s) ❑ Currently under SOC; ❑ Currently under JOC; ❑ 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? ❑ Yes
❑No ❑Not Determined ❑N/A.. If no,please explain:
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? ❑
Yes or❑No ❑N/A. If yes,please explain:
FORM: WI0100052 3

AQUIFER PROTECTION REGIONAL STAFF REPORT
IV INJECTION WELL PERMITAPPLICATIONS(Complete these two sections for all systems that use injection
wells,including closed-loop groundwater remediation effluent injection wells,in situ remediation injection wells,and heat
pump injection wells.)
Description Of Well(S)And Facilities-New,Renewal,And Modification
1. Type of injection system:
❑ Heating/cooling water return flow(5A7)
® Closed-loop heat pump system(5QM)
❑In situ remediation(5I)
❑ Closed-loop groundwater remediation effluent injection(5LP Non-Discharge")
❑ Other(Specify:
2. Does system use same well for water source and injection? ❑ Yes ®No
3. Are there any potential pollution sources that may affect injection?❑Yes ®No
What is/are the pollution source(s)? What is the distance of the injection well(s)from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary?35 upslope to road ft.
5. Quality of drainage at site: ® Good ❑Adequate ❑Poor
6. Flooding potential of site: ® Low ❑Moderate ❑ 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? ❑Yes❑No. Attach
map of existing monitoring well network if applicable. If No,,explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site(property lines,wells, surface drainage)?❑Yes or®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.
Injection 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)?
❑Yes ❑No. If yes, explain:
2. For closed-loop heat pump systems,has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑No. If yes,ex lain:
3. For renewal or modification of groundwater remediation permits(of any bTel,will
continued/additional/modified iniections have an adverse impact on migration of the plume or management of
the contamination incident? ❑Yes ❑No. If yes,explain:
4. Drilling contractor: Name: —
FORM: WI0100052 4

AQUIFER PROTECTION REGIONAL STAFF REPORT
Address:
Certification number:
5. Complete and attach Well Construction Data Sheet.
FORM: WI0100052 5

AQUIFER PROTECTION 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:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7. Recommendation: ❑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:
8. Signature of report preparer(s):
Signature of APS regional supervisor: _
Date: � ���
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
The six UIC wells will be not be eased so may wish to reiterate requirements of uncased wells in permit.
FORM: WI0100052 6

1
N1
• 1 t r 11 9
' Proposed location of six UIC wells. Four wells were
shown on the UIC permit but new calculations suggest
six wells are necessary.
L r.
View of site facing approximately E, NE. WSW to the right located behind
trailer. Garage shown with gray exterior finish was not shown in original
site sketch with application.

xJ
Approximate location of six UIC wells to be
drilled. Water supply well will be
approximately 33 ft., slightly upslope and to
the right of photo.
z
View of site facing approximately E, NE. WSW to the right located behind
trailer. Edge of house steps shown.

a
Proposed location of 6 UIC wells.
p..
Composite photo facing upslope, toward Kentwood Rd. Note location of water supply well in left of photo behind trailer. Orientation of
photo is opposite previous photos. White line overlay in photo if approximately 33 ft.

AQUIFER PROTECTION SECTION RECEIVED
APPLICATION REVIEW REQUEST FORM AUG 2 7 2007
Date: August 22,2007 Regional Office
To: Z Landon Davidson,ARO-APS El David May, WaRO-APS
❑ Art Barnhardt,FRO-APS ❑ Charlie Stehman, WiRO-APS
❑ Andrew Pitner,MRO-APS ❑ Sherri Knight,WSRO-APS
❑ Jay Zimmerman,RRO-APS
From: Michael Rogers, AFO Unit ,
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Rogers(d>ncmail.net
A. Permit Number: W10100052
B. Owner: Ron Thompson
C. Facility/Operation:
® Proposed ❑ Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation(ND)
® UIC-(5QM) closed loop mixed fluid geothermal
For Residuals: ❑ Land App. ❑ D&.M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal w/Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
NOTE: The requested days for the submittal of the staff report (SR) has changed. Per the request of
Debra Watts the requested dates for the submittal of the SR have been chanced to 2 weeks for a UIC
report,and 4 weeks for a SFR report.
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.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ 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 a ate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer. Date:
g p Aug o or-�
FORM:APSARR 07/06 Page 1 of 1

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070, :inda Thompson $B28-877-2685 p.2
1 NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELLS)FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 an 5Q=Wens
In Accordance with the provisions of NCAC Title 15A: 02C.020D
Complete application and mail to address on the back page.
_ IRECTOR NORTH CAROLINA DIVISION OT WATER QUALITY
)ATE:_ G��_ 20 7_
�YSTEM.CLASSIFICATION Please check cw rip which matches proposed system.
I) Type 5A7 wells inject water used to provide heating or cooling for structures.
x 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..
_ Type 5QW wells contain a subsurface system of continuous piping,that is
isolated from the environment and only circulates potable water.If you selected
this well type,then complete form GW-57 CI Nodf&cation Ojlnierrt To
Constrnd A Ckmd-Loop Geothermal-Water Only lnjedion Weil System.
1' P F•.RMIT APPLICANT
Name: iC,, S ,,/
kddress: /2S<� ye! V;-U1C0b 44-,tjE
s6,+,4( XeZk;' State:6&-' Zip Code427GaCounty:
elephone: _7/7-45/S= 0/
ROPERTY OWNER(if different from plic:,
'dame:
ddress: ti
ity: Sate:_ Zip Code: County: _<;•.
elephone: � -.• ;
TATUS OF APPLICANT V
Private: x Federal:_ +mmerciah 1\3
state:_ Municipal:_ Mtive Amer. Lands:_ U;•
::'06 MUIC-57 HP Page 1 of 4

� s^�
Ya

i
)7 P :4 Linda Thompson _3-877-2685 p.3
ACILITY(SITE)DATA
Fill.our ONLY if the Status of Owner is Feder:; ae,Munk or Commercial).
ame or Business or Facility:
ddress:
City: Zip Code: COW
Telephone: Cont, -rson:
HEAT PUMP CONTRACTOR DATA
Name: Rickey Kitchen
Address: P.O. Box 89
City: _ 9enz69e - Zip Code: _ Cou- - -.-Transylvania-
Telephone: [phone]e85 Comm :'arson: Rio -j kitchen
G. IN.IECT(ON PROCEDURE (Briefly describe 1 he injectic -ell(s)will be used.)
Injection wells (bore holes) will be u, -s a geor_ mal heat sink. Geothermal ground
loons will be placed in the temporary holes. = holes will be continuously g-outed
' from the bottom to the top. -
WELL i iSE Wi11 the injection well(s)also 1, 'sed as the s-. .,.Iy well(s)for the following?
(1) The injection operation? iS NO x
(2) Personal consumption? I-S NO x
CONSTRUCTION DATA(check one)
_ EXISTING WELL being I sed for u:,. . an injection well.Provide the data in
(1)through(7)below to !i ;t of your wledge.Attach a copy of Form GW-
1 (Well Construction Reo: Savailable.
_ PROPOSED WELL to b astrueted t: d as an injection well. Provide the
data in.(I).through (7) be c; PROM ;_.J construction specifications. Submit
s / Form GW--1 after constru,-
(1) ,/Well Drilling Contractor's Name:_` ' "-��''«_ % L E� `' %Z�J 6- 4.7.RYAV/Gf
NC Contractor Certification number: ,'O _-
(2) Date to be constructed: _Numbe: norings:
Approximate depth of each boring.(fc- fbo ft
(3) Well casing: Is the well(s)rased?
(a) YES Ifyes,then provide ;+ ?;ing infom an below.
Type:Galvanized steel_Black steel- Plastic_-- .7ther(specify)
Casing depth: From to reference r td surface)
Casing extends above ground Y. fz SysZt(^
(b) O x ✓ 6 CpFz�ToR- =Yes LkA- L
'.e 7!06 GW/UIC-5*7! Page 2 of 4

'•07 0. :_inda Thompson 28-877-2685 p.4
i
? Grout(material surrounding well casing and/or piping)
Silica Sand &
(a) Grout type: Cement x Bentonite x er(specify) Superplasticieer
(b) Grouted surface and grout depth(reference to 1 surface);
X around closed loop piping;from 0 to 50 (feet).
around well casing;from to
Screens(for Type 5A7 wells)
(a) Depth:From to_feet below ground ce.
N.C. State Regulations (Title 15A NCAC 2C .0200) uire the permittee to make provisions
for monitoring wellhead processes. A faucet on both uem(fluid entering heat pump)and
effluenf(fluid being injected into the well)lines is req Will there be a faucet on:
(a) the influent line? yes_no (b) th effluent line? yes_no
j _SOURCE WELL CONSTRUCTION INFORMATIO if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-I is not available,
provide the data in part K(1)of this application form to the best of your knowledge.
NOTE: TIM WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR 0THEREXLSTING OR
PROPOSED WELLS IF 7MS INFORMATION IS UNAVjA11 OTHER N EAM.
ROPOSED OPERATING DATA(for Type 5A7 wells)
,) Injection rate: Average(daily) Ions per minute(gpm).
Injection Volume., Average(daily) lons per day(gpd).
3) Injection Pressure: Average(daily) unds/square inch(psi).
�A) Injection Temperature: Average(January) rage(July)_ F.
',JECTION FLUID DATA
,I) Fluid source(for Type SA7 wells) If un ;grouhat depth,formation and type of
rock/sediment unitwill the fluid be dray e.g., estone sand,etc.).
Depth: Formation: imentunit.'.) Chemical Analysis of Source Fluid (for oe 5Q
Provide a complete listing ofall chemic. .:tided to the circulating heat transfer fluid:
R-22 Refrigerant
.iJJECTION-RELATED EQUIPMENT
attach a diagram showing the engineering layout of the injection equipment and exterior piping(tubing
.�:sociated with the injection operation. The manufacturees brochure may provide supplementary
,nformation.
i
.00ATiON OF WELL(S) Attach two maps.
06 GW/UIG37 HP Page 3 of 4

Jr C Linda Thompson ..?8-877-2685 p.5
i
(1) Include a site reap (can be drawn) shor+ building property lines, surface water bodies,
potential sources of groundwater cunt w lion and 4te orientation of and distances between
the proposed well(s)and any existing wt• •.) or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet geothermal heat pump well system. Label all
features clearly and include a north arro'-,
(2) Cnclude a topographic map of the area c* mg one mile from the property boundaries and
indicate the facility's location and the nt ame.
PERMIT LIST: Attach a list of all permits }r c uction approvals that are related to the site.,
Examples include:
(1) Hazardous Waste Managementprogran, ;nits under VI",
(2) NC Division of Water Quality Non-Disc permits
(3) Sewage.Treatment and DisposalPermitn
CERTIFICATION —
"I hereby certify, under penalty of law, that ,e persona cicannined and am familiar with the
information submitted in this document and at chments tz to and that, based on my inquiry of
those individuals immediately responsible for tv ing said i t. nation,I believe that the information
is true, accurate and complete. I am aware that are signi it penalties,including the possibility'
of fines and imprisonment, for submitting fal-< -ortnation. Uree to construct, operate, maintain,
epair, and if applicable, abandon the injection 11 and all n _d appurtenances in accordance with
the approved specifications and conditions of t! it"
(' +me of We, ,wner or Authorized Agent)
Jf yr and ageni. ing on behalfaf#w well owner,
pleme sup, leller signe, the owner authorizing the above agent
CONSENT OF PROPERTY OWNER(Owner " :ns any per who holds the fee or other property
rights in the well being constructed. A wee' -eal prop+ and its construction on-land rests
ownership in the landowner in the absence of ..try agreem. in writing.)
If the property is owned by someone other thy,, w applicant property owner hereby consents to
allow the, applicant to construct each injection as outlin, this application and that it shall be
the responsibility of the applicant to ensu; rat the in ;on well(s) conforms to the Well
Construction Standards(Title I SA NCAC 2C r
(Sigt.. Of Prope+ Owner IfDiffenent From Applicant)
Please return two copies of the c, is Led Apph, :on package to:
UIC P+ am
Aquifer Pro• ,n Section
North Carolins, ) NR D!'V,.•
1636 Mail Sc :+:e Center
Raleigh,-N( 'r;99-1636
Telephone(' 715-6935
Rc - '06 GW/UIC-57 IT Page 4 of 4

07 04 ;_inda Thompson 28-877-2685 p.6
\
,NSYMNIA COUNTY HEALTH DEPARTMENT IMPROV ENT PERMIT DIAGRAM
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07 C. Jnda fhompson 828-877-2685 p.7
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0�0�W ATF9pG Michael F.Easley,Governor
William G.Ross Jr.,Secretary
h r North Carolina Department of Environment and Natural Resources
O < Coleen H.Sullins Director
Division of Water Quality
August 22,2007
Ron Thompson
1245 Kentwood Lane
Pisgah Forest,NC 26768
Subject: Acknowledgement of Application No.WI0IGO052
Ron Thompson SFR
Injection Mixed Fluid GSHP Well System(5QM)
Transylvania
Dear Mr.Thompson:
The Aquifer Protection Section of the Division of Water Quality(Division)acknowledges receipt of your permit
application and supporting materials on August 20,2007.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 maximum efficiency in processing permit applications,the Division requests your assistance in
providing a timely and complete response to any additional information requests.
Please be aware that the Division's Regional Office,copied below,must provide recommendations prior to final
action by the Division.Please also note at this time,processing permit applications can take as long as 60-90 days
after receipt of a complete application.
If you have any questions,please contact Michael Rogers at 919-715-6166,or via e-mail at
[e-mail]. If the reviewer is unavailable, you may leave a message,and they will respond
promptly.Also note that the Division has reorganized.To review our new organizational chart,go to
htto://h2o.enr.state.nc.us/documents/dwq_or ca hart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Sincerely, /A )
VV
for eb J. ns
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit Application File WI0100052
NOorthn` Carolina
Naturdly
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:w .ncwatemualitv.oro Location: 2728 Capital Boulevard Raleigh,NC 27604 Fax 1: [phone]
Fax2: [phone]
An Equal Opportunity/Affirmative Action Employer-50%Reeyded/10%Post Consumer Paper Customer Service: [phone]