WI0100048_Complete File - Historical_20220308

kvaA RECEIVED
NCDENR R',R of 2G�2 s
North Carolina Department of Environment and Natural egbdroWle Regional Office
Division of Water Quality . Aquifer Protection
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Govemor Director Secretary
February 28,2012
Timothy Ruemler
Pamela Ruemler
PO Box 752
Marshall,NC 28753
Subject: Acknowledgement of
Application No.WI0100048
Jeff Kaplan SFR
Injection Mixed Fluid GSHP
Well(5QM)System
Madison County
Dear Mr. and Mrs.Ruemler:
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on February 27, 2012. Your application package has been assigned the number
listed above,and the primary reviewer is Eric Smith.
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
after receipt of a complete application. If you have any questions, please contact
Eric Smith at(919) 807-6407 or [e-mail].
Sincerely,
O AA
for Debra J. Watts
Groundwater Protection Unit Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit File WI0100048
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636
Location:512 N.Salisbury St.,Raleigh,North Carolina 27604 One
Phone:[phone]M4 FAX:91H07-6496 N Carolina
Internet:www.no6vatergualb.org OWmna!!y
An Equat Opportunity t Af`rmative Action Empbycr

J
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild,P.E. Dee Freeman
Governor Director Secretary
January 18, 2012
CERTIFIED MAIL#7006 2150 0003 54671322
RETURN RECEIPT REQUESTED
Timothy and Pamela Ruemler
Post Office Box 752
Marshall,NC 28753
Subject: Change of Ownership and Permit Renewal
Permit No. WI0100048
5QM Geothermal Injection Well
Madison County
Dear Mr. and Mrs. Ruemler:
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 permit was issued to
Jeff Kaplan on May 7, 2007, and expires on April 30, 2012.
This permit was issued for the operation of a 5QM (Closed-Loop Mixed-Fluid) Geothermal
Injection Well on your property located at 476 River Run in Marshall, North Carolina. As the
new property owners, you are responsible for maintaining this permit. Therefore, it is important
that you submit a Change of Ownership form within thirty(30) days of receipt of this letter.
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s)for Injection
with Geothermal Heat Pump System for Type 5QM Well(s) if the injection well
system on your property is still active.
-OR-
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
Location:512 N.Salisbury St Raleigh,North Carolina 27604 NorthCarolina,
Phone:919-90ncwate 1 FAX:[phone] �7►'a.Fura//ff
Internet:www.ncwatemual'M.oro � �/�/ ` "
An Equal Opportunity lAfirma6ve Acton Employer

B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the 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 Change of
Ownership form, 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 htto://uortal.ncdenr.org/web/wq/gps/pworo/permit-applications#geothen Apps.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at(919) 715-6196 or by email at [e-mail].
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office-Aquifer Protection Section w/o enclosures
APS Central Files—Permit WI0100048 w/o enclosures

NCDE�iR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
March 2,2012 RECEIVED
Timothy and Pamela Ruemler
Post Office Box 752 MAR 212012
Marshall,NC 28753
Asheville Regional Office
Ref: Issuance of Injection Well Permits WI0100048 Aquifer Protection
Issued to Timothy and Pamela Ruemler
Marshall,Madison County,North Carolina
Dear Mr. and Mrs. Ruemler:
In accordance with the application received on February 27, 2012, I am forwarding permit number WI0100048 for the
construction and operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system to be located
at 476 River Run Road, Marshall, Madison County, NC 28753. This permit shall be effective from the date of issuance
until February 28, 2017, and shall be subject to the conditions and limitations stated therein, including the requirement
to install well identification tags as specified in Part H. Be sure to read the entire permit to ensure that you are aware
of all compliance requirements of the permit.
You will need to notify this office at least 48 hours prior to beginning construction and operation of the injection well
system. 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)807-6407 or eric. .sg mith(a ncdenr. og_v if you have any questions about your permit.
Best Regards,
y�
Eric G.Smith,P.G.
cc: Landon Davidson,Asheville Regional Office
WI0100048 Permit File
Madison County Environmental Health Department
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636
Location:512 N.Salisbury St,Raleigh,North Carolina 27604 one
Phone:[phone] FAX:91M07-6496 NorthCarolina _
In Equal ppotncwatemualtiveAc )Vatllnall#
An Equal Opportunity lAffimgtrce Action Employer K`KL 1`,

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
Timothy and Pamela Ruemler
FOR THE CONSTRUCTION AND OPERATION OF 7 (SEVEN) 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 476 River Run Road,
Marshall, Madison County,NC 28753, and will be constructed and operated in accordance with the application
received February 27, 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 Construction and Operation of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and .
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until February 28, 2017, and shall be
subject to the specified conditions and limitations set forth in Parts I through DX hereof.
Permit issued this the 2"d day of March, 2012.
Charles Wakild, P.E., Director
ivision of Water Quality
By Authority of the Environmental Management Commission.
Permit#W10100048 UIC/5QM Page 1 of 5
ver.03/2010

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 afforded reasonable protection against damage during construction and use.
PART II—WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number 919-807-6406 and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number 828-296-4500.
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation corners) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or `cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III—OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
Permit M10100048 UIC/5QM Page 2 of 5
ver.03/2010

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 perinit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V—OPERATION AND MAINTENANCE REQUIREMENTS
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.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number 919-807-6406. 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.
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. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit#W10100048 UIC/5QM Page 3 of 5
ver.03/2010

:*r.;;,>r- r c a;;�.Mom: : - ._� - y ;• �.i„�..?^. u�g? a..:. e �;�.:s s
PART VII—MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section—UIC Program Aquifer Protection Section
DENR—Division of Water Quality Asheville Regional Office
1636 Mail Service Center and 2090 U.S. Highway 70
Raleigh,NC 27699-1636 Swannanoa,NC 28778
Ph#919-715-3221 828-296-4500
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Asheville Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map -updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office.and the Asheville Regional Office within 30
days of completion of well construction.
4. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed.
5. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the 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;
(C) Any loss of refrigerant in the system,regardless of the origin of the loss;
,(D) Any recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director,the relevant and correct
facts or information shall be promptly submitted to the Director by the Permittee.
7. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII—PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Pennittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit#WI0100048 UIC/5QM Page 4 of 5
ver.03/2010

z
PART LY—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, then that well must be permanently abandoned according to 15A NCAC 2C .02,13(h)(1).
Notification shall be submitted to the addresses given in Part V1I.1 of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to,the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if the
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director 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 that extends to the bottom of the well and is raised as the well is filled.
(E) In the case of gravel-packed-wells in which the casing and screens have not been removed, the
casing shall be perforated opposite the gravel pack, at intervals not exceeding 10 feet, and grout
injected through 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 copy of the Well Abandomnent Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(1) within-30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.1 of this permit.
Permit M10100048 UIC/5QM Page 5 of 5
ver.03/2010

Michael F.Easley,Governor
T William G.Ross Jr.,Secretary
CO r
North Carolina Department of Environment and Natural Resources
t7 < Alan W.Klimek,P.E.Director
Division of Water Quality
May 7, 2007
Mr. Jeff Kaplan
50 Al Faye Farm Wayx
Weaverville,NC 28787
MAY 22 2007
Re: Issuance of Injection Well Permit
Permit No. WI0100048 Ashen:i:_ ;,r, I! r; ;cF
Issued to Jeff Kaplan ?
Dear Mr. Kaplan:
In accordance with your application received March 19, 2007, I am forwarding Permit No.
WI0100048 for the operation of a vertical closed-loop geothermal mixed-fluid heat pump
injection well system to be located at 476 River Run Road, Marshall, Madison County, North
Carolina 28753. This permit shall be effective from the date of issuance until April 30, 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 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,
Michael Rogers
Environmental Specialist II
cc: Landon Davidson—Ashville Regional Office
Central Office File—WI0100048
Andrew Messer—Effecta Solutions
Attachment(s)
N� Carolina
may
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:h"m//www.newatemualiw.org 2728 Capital Boulevard Raleigh,NC 27604 Fax 1: - [phone]
Fax 2: [phone]
An Equal Oppottunity/Afirmative Action Employer-50%Recycled/10%Post Consumer Paper Customer Service: [phone]

e ,.
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
JEFF KAPLAN
FOR THE CONSTRUCTION AND OPERATION OF 7 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 476 River Run Road, Marshall, North Carolina, and will be
constructed and operated in accordance with the application received March 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 April 30, 2012,
and shall be subject to the specified conditions and limitations set forth in Parts I through IX
hereof.
Permit issued this the k�l _day of , 2007.
an W. Klimek,Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0100048 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 wither warning that it is for injection purposes
and the entrance to each well must be secured with a locldng 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 H-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..
WI0100048 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 ara a hs 10 and 01 shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
WI0100048 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). 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 (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section's
Underground Injection Control (UIC) Program Central Office staff, telephone number
(919) 715-6166, and the Ashville Regional Office Aquifer Protection Section Staff,
telephone number [phone]. Notification is required so that Division staff can
WI0100048 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.
WI0100048 Page 6

PART VIII-PERMIT RENEWAL
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)(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.
WI0100048 Page 7

'L
(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
WI0100048 Page 8

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Colleen H, Sullins Dee Freeman
Governor Director Secretary
January 4, 2012
CERTIFIED MAIL # 7006 2150 0003 5467 1254
RETURIN RECEIPT REQUESTED .JAN O 5 ZCiZ
Timothy and Pamela Ruemler
476 River Run
Marshall, NC 28753
Subject: Change of Ownership and Permit Renewal
Permit No. WI0100048
5QMGeothermal Injection Well
Madison County
Dear Mr. and Mrs. Ruemler:
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 permit was issued to
Jeff Kaplan on May 7, 2007, and expires on April 30, 2012.
This permit was issued for the operation of a 5QM (Closed-Loop Mixed-Fluid) Geothermal
Injection Well on your property located at 476 River Run in Marshall, North Carolina. As the
new property owners, you are responsible for maintaining this permit. Therefore, it is important
that you submit a Change of Ownership form within thirty (30) days of receipt of this letter.
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s)for Injection
with Geothermal Heat Pump System for Type 50M Well(s) if the injection well
system on your property is still active.
-OR-
AQUIFER PROTECTION 6E7I0h'
1633E Mail Semml Raietar. Nom Camlina 27e5-1c"3c
=12T.272e, mial bcu dar.,.Rai iq Imr i Caroiin vBOu
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inm www ncwatemualnv om `.'.-

B. Status oflnjection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the 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 Change of
Ownership form, 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 ncd=ore/web/wo/aps/gwoToipermit-applications#geothennApps.
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.g.smithrncderingov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
APS Central Files—Permit WI0100048 w/o enclosures

��y
�� r
ME ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 2, 2011 _
7effKaplan
" 141Gi1
50 Al Faye Farm Way
Weaverville,NC 28787 "1s btti ',; ,.-.;
n�,rCrlfiice
Subject: Notice of Expiration (NOE)
5QM Geothermal Injection Well
Permit No. WI0100048
Madison County
Dear Mr. Kaplan:
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 476 River Run Road in
Marshall, NC, which was issued to you on May 7, 2007, and expires on April 30, 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 Iniection 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 htti)://Portal ncdenr ore/web/wq/ans/gwnro/reporting-forms.
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 January 1, 2012.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegn.North Carolina 276990636
Location:2728 Capital Boulevard,Ralewh.North Carolina 2760= On,
Phone:[phone] FAX [phone]:FAX [phone] ..Customer SeNICE N 6rCh C—'aI•C>11na
Internetw ncwatemualltv.oro
An Eoual OPPorruniiv A4rrm4Ove,Acuor_mDIDYP.:

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 5QM 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 nedenr ore/web/wg/ans/gwproipermit-applications#ReotherrnApns.
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.1z.smithancdenr.eov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office- APS w/o enclosures
APS Central Files - Permit No. WI0100048 w/o enclosures

.NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins I Dee "Freeman
Governor Director Secretary
December 2, 2011 v 255 i 1
LAshev",
pt Jeff Kaplan u l
f'ic6ic:a"'11
476 River Run Road
Marshall,NC 28787
Subject: Notice of Expiration (NOE)
5QM Geothermal Injection Well
Permit No. WI0100048
Madison County
Dear Mr. Kaplan:
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 476 River Run Road in
Marshall, NC, which was issued to you on May 7, 2007, and expires on April 30, 2012, is soon
due for renewal. If you wish to keep this permit and operate the injeetion 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://Dortal.ncdenr.org/web/wq/aps/gwpro/reporting-forms.
If Your Injection 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 January 1, 2012.
AQUI-ER PROTECTION SECTION
1636 Mail Servica Center.Raiegh_North Gamhna 27699-1636
Location 2.2E Caonal Boulevarh.Raieigr North Carciina 2760T Jn:
Phone.919 32211 FAX I.91� 15058E AX_:9157106048'Customer Service 1-877-623-674c N��[p�arUllTl�i
interne w ,ncuatemualltvom „//� g'[ oii 4-�neuz oc �n Afi Frain ,io,cmm�re F;' NL tuilalill
a-

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
htti)://Dortal.ncdenr.org/web/wq/aps�wpro/permit-aDDlications#geothermApps.
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._.smithrncdenr.eov.
Sincerely,
6a 0,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - APS w/o enclosures
APS Central Files - Permit No. WI0100048 w/o enclosures
2

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 2 19 wad FILE COPY County: N-z>
To: Aquifer Protection Section Central Office Permittee: JIFF C.41%(
Central Office Reviewer: Project Name:
Regional Login No: Application No.: Wz" a 1 00048
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 X Other Injection Wells(including in situ remediation)
Was a site visit conducted in order to prepare this report? CWYes or❑No.
a. Date of site visit: 061 W .
b. Person contacted and contact information: 13u,,Ae-4 Os/-S-679
c. Site visit conducted by:
d. Inspection Report Attached: ❑Yes or❑No.
2. Is the following information entered into the BIMS record for this application correct?
Z 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 Injection 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): larlKiW-1 AA4leai Mk14144utA1G 7-y'70
b. Driving Directions: O U'70 14t "(T ad Nc 7-13 )-6 rue MARs/fii![,6 aN ,e'V.x waw' Cc r-. r'aP (1,1000
c. USGS Quadrangle Map name and number:
d. Latitude: 3M'33.1' Longitude: 2'ws-2-I"
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 system?
FORM: Documentl 1

AQUIFER PROTECTION SECTION 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 100-year floodplain?
❑ 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?)
III RENEWAL AND MODIFICATIONAPPLICATIONS(use previous section for new or major modification
systems)
Description Of Waste(S) And Facilities
1. 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: Documentl 2

AQUIFER PROTECTION SECTION 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 wastes) 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: Documentl 3

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 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/5QW)
❑ 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 iniection well(s) from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? ZO ft.
5. Quality of drainage at site: 2 Good ❑ Adequate ❑ Poor
6. Flooding potential of site: X 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)? XYes 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.
Infection 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, explain:
3. For renewal or modification of groundwater remediation permits (of any type), will
continued/additional/modified infections 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: Documentl 4

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

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOMjtiIENDATIONS
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 gNo. 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:
a
8. Signature of report preparer(s):
Signature of APS regional supervisor:
Date: 4/9�',
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Documentl 6

Compliance Inspection Report
Permit: W10100048 Effective: Expiration: Owner: Jeff Kaplan
SOC: Effective: Expiration: Facility: Jeff Kaplan SFR
County: Madison 476 River Run Rd
Region: Asheville Lot 1
Marshall NC 28753
Contact Person: Jeff Kaplan Phone:
Directions to Facility:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 04/17/2007 Entry Time: 09:40 AM Exit Time: 09:55 AM
Primary Inspector: Harold E Minnick Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type:Compliance Assistance
Permit Inspection Type: Injection Mixed Fluid GSHP Well System(5QM)
Facility Status: ■Compliant ❑ Not Compliant
Question Areas:
E Wells
(See attachment summary)
Page: 1

Permit:WI0100048 Owner-Facility:Jeff Kaplan
,Inspection Date: 04/17/2007 Inspection Type:Compliance Assistance Reason for Visit:Routine
Inspection Summary:
Page: 2

BIMS #
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INSPECTED: Y N SAMPLED: Y N
VIOLATIONS: PARAMETERS:
NOV SENT: ARO RESULTS:
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ENF PKG SENT:
ENF PKG RCVD:
LTR TO AG:

AQUIFER PROTECTION SECTION RECEIVED
APPLICATION REVIEW REQUEST FO I I',M' 02 2097
Date: March 27, 2007 Asheville Regional Office/
El David May, ffer Protection
To ® Landon Davidson,ARO-APS
❑ Art Barnhardt,FRO-APS ❑ Charlie Stehman, WiRO-APS
❑ Andrew Pitner, MRO-APS ❑ Sherri Knight, WSRO-APS
❑ Jay Zimmerman,RRO-APS
From: Michael Rogers , Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E Mail: Michael.RogersCailrtcmail.net
A. Permit Number: WI 0100048
B. Owner: Jeff Kaplan
C. Facility/Operation:
® Proposed ❑ Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R hifiltration
❑ 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.
Effecta Solutions will provide corrected forms showing the proposed boring depth as 100 feet.
Attached, you will find all information submitted in support of the above-referenced application for your
review,comment,and/or action. Within 21 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 appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: Date: Or d3
7 7
FORM: APSARR 07/06 Page I of 1

03/02/2007 12:43 FAX [phone] AFFORDABLE COMFORT, INC. Qj003/005
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 trirh the provisions of NCAC Title 15A:02C.02OU
Complete application and mail to address on flw hack page.
TO: DIRECTOR,N RT CAROLINA DIVISION OF WATER QUALITY
DATE: 20
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
(1) _ Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) x Type 5QM wells contain a subsurface system of continuous piping,that is
isolated from the environment and circulates a fluid other then potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
0) _ 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 GT.Mah;walfmr Oflnasnr To
Consbrtcl A Closed--Loop Gwdermd-Waaar Only Injectlan Wel!System.
B. PERMIT APPLICANT
Name: e6LD/QYl
Address: 4'7(o ZVee- kw,, Rd. (Lei-l)
City; state:L Zip Code:aWA County: RECEIVED 1 DENR I DVVQ t
_ (gFFR PPnTFr.'nnN SECTION
Telephone: MAR 19 20071
C. PROPERTY OWNER(if different from applicant)
Name: A I'P 10'A -JAr
Address: _.5'D Al Ado Fap?m }Ja.t
City: Sate:NC. Zip Code: a� County: �Un�srnbC
Telephone:
D. STATUS OF APPLICANT
private: x Federal:_ Commercial:_
State:_ Municipal:_ Native American Lands:
Revised.7106 GW/UIC-57 W page 1 of 4
I

03/02/2001 12:44 FAX 82B 65B 1751 AFFORDABLE COMFORT, INC. IM004/005
1 '
E. FACILITY(SUF)DATA
(Fill out ONLY if the Status of Owner is Federal,State,Municipal or Commercial).
Name of Business or Facility:
Address:
City: Zip Code: County,
Telephone: Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name; Affordable Cemtert
Address: 7 Morgan Branch load
City: 4leaverville Zip Code: 29797 Cody; Buncombe
Telephone: e28-254-0206 Contaotperson: Tracy Ponder
G. INJECTION PROCEDURE (Briefly describe how the injection well(e)will be used.)
injection wells .(bore holes) vill be used as a geothermal heat sink. Geothermal ground
.loops will be placed in the temporary bore holes. Bore holed will he eontinooualy grouted
from the bottom to the top. .
H. WELL USE Will the injection well(s)also be used as the supply well(s)for the following?
(1) The injection operation? YES NO x
(2) Personal consumption? YFS NO x
I. CONSTRUCTION DATA(check one)
EXISTING WFLL being proposed for use as an injection well.Provide the data in
(1)through(7)below to the best ofyourknowledge.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 consumption specifieations. Subunit
Form OW-1 after construction.
(1) Well Drilling Contractor's Name: EEfecia solutions, LLC - Stephen Homer
NC Contractor Certification number: 146e
i
(2) Date tobe constructed: March zoo? , Number of borings: 7
Approximate depth of each boring(feet): lot f t
(3) 'Well casing: Is the welt(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 CTWIMC-57 HP Page 2 of 4
)
a '
0

03/02/2007 12:44 FAX 828 B58 1751 AFFORDABLE COMFORT, INC. @J005/005
I
i
1
I
i
(4) Gsout(rawrialsurreandingwell easing and/orpiping): silica sand s
(a) Gmuttypc:,Ccment x Bentonite X Other(specify) suparplaeticiser
(b) Granted surface and grunt depth(reference to land surface):
x around closed loop piping;from c to Bc (feet).
around well easing,from_to_(feet).
(5), Screens(for Type 5A7 wells)
(a) Depth:From_to_feet below ground surface,
(6) N-C_State Regulations Critic 15A NCAC 2C .02o0)require thepermittee to make provisions
for monitoring wellhead processes. A-fariceton both•idluent(fluid.entering heat pump)and
eflluent(fluid.being injected into the well)lines is required. Will there be a faueci on:
(a) the influent line? yes noL_ (b) the effluent line? yes_no_
(7) SOURCE WELL CONSTRUCTION INFORMATION Cif different from injection wen).
Attach a copy of Form GW-1 (Well Construction Record). If Fort GW-1 is not available,
provide the data in part K(1)of this application form to the best of your knowledge.
NOTE: I'aEWMJ-DRtt.Ln1000NrRACTORCANStIPPLY7MDATAPORL'ITHEREX MOOR
PROPOSED WELLS IF TIES AIFORMA170NIS UNAVAILABLE BY OTHER MANS.
J. PROPOSED OPERATING DATA(for Type SA7 wells)
(1) Injectionrate: Average(daily)__gallons per minute(gpm).
(2) Nection Volume: Average(daily) gallons per day(gpd).
(3) Injection Pressure: Average(daily) pounds/square inch(pai).
(4) Injection Temperature: Average(January) OF,Average(July) °F.
K. INJECTION FLUID DATA
(1) 'Fluid source(for Type SA7 weds) If underground,from what depth,formation and type of
mck(sedimeat unit will the fluid be drawn(e.g.,granite,limestone,sand,etc.).
Depih: Formatiaw Rae§rsediment unit:
(2) Chemical Analysis of Source Fluid(for Type SQU wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
R-22' Refrigerant
L. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment ind exterior pipinghubmg -
associated with the injection operation. The manutbedver's brochure may provide supplementary
information-
M. LOCATION OF WELL(S) Attach two maps. ,
Revised 7106 GW/UIC-57 HP Page 3 of 4

03/02/2007 13: 17 FAX [phone] AFFORDABLE COMFORT, INC. Ia001/001
(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) Iuclude 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 consrruction 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
O. CERTIFICATION
1 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 sigaWcant penalties,including the passibility
of fines and imprisonment, for submitting false information. I agree to consftuct,operate, maimam,
i repair, and if applicable, abandon the injection well and all related appurtenances in accordance with
the approved specifications and conditions of the Permit."
Van a.-,
(Si o era T
Amthorized Agent)
tfauthorized agent fs acting on behalf of dw well owner,
please supply a letter signed by the owner autlwrizing 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)
(Signature Property Owner If Different From Applicant)
Si true Of
Please return two copies of the completed Application package to:
OIC Program
Aquifer Protection Section RECEIVED/DENR/DVIQ
North Carolina DENR-DWQ AQU1FFR'PRt1TPrTjnN RFCTION
16M Mail Service Center MAR 19 2007-
Ralaigh,NC 27699.1636
Telephone [phone]
Revised 7106 GW/11IC-57 HP Page 4 of 4

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�OF N ATFq Michael F.Easley,Governor
6 G William G.Ross Jr.,Secretary
r - North Carolina Department of Environment and Natural Resources
1
O T Alan W.Klimek,P.E. Director
Division of Water Quality
March 20,2007
Jeff Kaplan
50 Al Faye Farm Way
Weaverville.NC 28787
Subject: Acknowledgement of Application No.WI0100048
Jeff Kaplan SFR
Injection Mixed Fluid GSHP Well System(5QM)
Madison
Dear Mr.Kaplan:
The Aquifer Protection Section of the Division of Water Quality(Division)acknowledges receipt of your permit
application and supporting materials on March 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 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
httr)://h2o.enr.state.ne.us/documents/dwq orjzchart.t)
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Since y,
for Deb tts
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit Application File WI0100048
N `
��p7rr�ttth{�C.arohna
✓rrtJ[X4
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:www.ncwaterQuality.org Location: 2728 Capital Boulevard Raleigh,INC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal Opportunity/Affimwtive Action Employer-50%Recycled/1 0%Post Consumer Paper Customer Service: [phone]

AQUIFER PROTECTION SECTION ` „ IVED
APPLICATION REVIEW REQUEST FORM r, �E 02 2007
Date: March 27, 2007 j
t E� :,H9 Regional Office/II
To: ® Landon Davidson,ARO-APS ❑ David May, IaRO-�g!"!r-"Lolft 130 S
❑ Art Barnhardt,FRO-APS ❑ Charlie Stehman,WiRO-APS
❑ Andrew Pitner,MRO-APS ❑ Sherri Knight, WSRO-APS
❑ Jay Zimmerman,RRO-APS
From: Michael Roeers , Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Ro ers(oricmail.net
A. Permit Number: WI 0100048
B. Owner: Jeff Kaplan
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.
Effecta Solutions will provide corrected forms showing the proposed borine depth as 100 feet
Attached, you will find all information submitted in support of the above-referee
review, comment, and/or action. Within 21 calendar days,please take the follows
® Return a Completed APSARR Form. V 1
❑ 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 revier
information requests with other RO-APS representatives in order to prepare a co. tH
J7
certification. Refer to the RPP SOP for additional detail. (��.
When you receive this request form, please write your name and dates in the space_ inaxe a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: Date D! 2cd
FORM: APSARR 07/06 Page 1 of 1

PILL UUVY
AQUIFER PROTECTION SECTION F Pt E C E I
APPLICATION REVIEW REQUEST FORM U i4 02 2007
Date: March 27,2007
As2leFiile P0,0�1re! Office,,,,
To: ® Landon Davidson,ARO-APS ❑ David May,laoz�-- --
❑ Art Barnhardt,FRO-APS ❑ Charlie Stehman,WiRO-APS
❑ Andrew Pitner,MRO-APS ❑ Sherri Knight,WSRO-APS
❑ Jay Zimmerman,RRO-APS
From: Michael Rogers , Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Rogers(a)ncmail.net
A. Permit Number: WI 0100048
B. Owner: Jeff Kaplan
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 accomnanv vn„ nn a eitP
Effecta Solutions will pro-dde corrected forms sh A4/hq-—
Attached, you will fmd all information submitted in LJAJ"'r your
review,continent, and/or action. Within 21 calendar 7
® Return a Completed APSARR Form. IVLA VAOAjy
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the
❑ Issue an Attachment B Certification from the a�
• Remember that you will be responsible for c onal
information requests with other RO-APS repret /CZ l Z56 �� 3 for
certification. Refer to the RPP SOP for additio:
When you receive this request form, please write yo opy
of this sheet, and return it to the appropriate Centr; 1I son
listed above.
RO-APS Reviewer: OfOX247
FORM: APSARR 07/06 Page 1 of 1