WI0100143_Regional Office Physical File Scan Up To 9/14/2022

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North Carolina Department of Environment and Natural Resources
Beverly Ezaves Perdue
Governor
Bo and Pia Nilsson.
_ 268 Ransom Rd.
:Atlanta, GA 3030f+
Division of Water Quality
Coleen H. Sullins
Director-=
Marcli 30, 2011
Ref: Issuance of Injection Well Permit W101001*43
Issued to Bo and Pia Nilsson
Highiands, Macon County, North Carolina
Dear Mr. and Mrs. Nilsson:
�3-,- C . ED
111c, nogiona1®ffice
Dee Freeman
Secretary
In accordance with the application received on March 11., 2011, and additional information received ld%tarcli 17,
2011, I am forwarding permit number WI0100143 for the construction and operation of a vertical closed -loop
geothermal mixed -fluid heat pump injection well system to be located at 984 Bing Crap Rd., highlands, Macon
C ouiity, NC 28741. This permit shall be effective from the date of issuance until Februar}! 28, 2016, and shall be
subject to the conditions and limitations stated therein, including the requirement to install well identification
tags as specified in Part 11.3 and to submit well construction records as specified 'in Part VII.2. 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 anapplication 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 [phone] or michael.ronerstU?ncdenr.cov if you have any questions about your permit.
cc:
anson,_ slieville Regional Office
WI0100143 Permit File
Macon County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh. North Carolina 27604
Phone: [phone] t FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
Internet: wvAv.ncvvatemualitv.org
Best Regards, /
#a.,�C,
, Rjur
Michael. Rogers, P.G. (NC & FL)
Environmental Specialist
ODC
N or tea Cw-oRri
v � �
An Equal 6pportumv � Atiirmative Acuor, Emolove!

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 8.7; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Bo and Pia Nilsson
FOR THE CONSTRUCTION AND OPERATION OF 4 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 984 King Gap Road, Highlands, Macon
County, NC 28741, and will be constructed and operated in accordance with the application received March 11,
2011, and in conformity. with .the specifications and supporting data .°eceived March 17, 2011., 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 28.2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 30th day of March, 2011.
Coleen H. Sullins, Director
ivision of Water Quality
By Authority of the Environmental Management Commission.
Permit #W1010014
UIC/5QM
ver. 03/2010
Page 1 of 5

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and 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 [phone] and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number [phone].
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 #W10100143 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 permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V — OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The 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 (91.9) 71 -5-6166. 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. 87-00.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #W10100143
UIC/5QM
ver. 03/2010
Page 3 of 5

PART VII — MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall, be submitted to: -
Aquifer Protection Section — UIC Program Aquifer Protection Section
DENR — Division of Water Quality Asheville Regional Office
1636 Mail Service Center and 2090 US Highway 70
Raleigh, NC 27699-1636 Swannanoa, NC 28778
Ph# 919-715-3221 [phone]
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 R.eaJonal 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 [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, -such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
7. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as maybe required by the Director.
PART VIII — PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit #W10100143 UIC/5QM Page 4 of 5
ver. 03/20iO

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, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if the
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director 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 Abandonment 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 M1010014' UIC/5QM Page 5 of 5
ver.03/2010

NORTH CAROUNIA
DEPARTMENT OF ENVIRONMENT AND NATURAL. RESOURCES (NCDENR)
I APPLICATION FOR PERMIT TO CONSMICT AN IMOR USE A W ELL(S) FOI2.
INJECTION WITH A GEOTHEILMAL HEAT PUXFP S3'STEIN1 FOR:
TYPE 50M NVELUS) +�
k New Permit Application OR Renewal ("check. one)
DATE: 20
PERMIT NO. (leave blank if NEW permit application)
A. PROPERTY O\VNER(S)IAPPLICANT(S)
List each Properly Owner listed oft property deed (if owned by a business or government agent . state name of
entity and a representative w/authority for signature): �55on f sl�Si
(i) tviai]ing Addr ss: Z4// _
City: Statc: CSf�lip Codc: County; l _
HpmeJOfftce Telc No.: /71� �C>7� . 5� Cell No.: z—` 7?— M
EMAIL_ Address:T�r-,y�« 5 Gotic Ga 3 'i
.(2) Physical Address
ol'S,iirre_ (if different than above): --�?-2w e"". fry er
City: State: C "Lip Code: County: i?f&Chi _
1-1011re!Ofitce TeleNo.: 617 - 9OZ- ?---7D C ., t3.:
EMAIL Address:_ Z 46a e-
B. AUTHORIZED AGENT OF OWNER; I.F ANY (if the Pennit Applicant does not own the subject propen\ .
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL. Address:
Address:
City: State: Zip Code: County:
Office Tele No-: Cell No--
Website Address of Company, if any:
C. STATUS OF APPIACANT
Private:. x_ Federal: Commercial:
State: _ Municipal: Native American Lands:
G11UXIC 50M Well Pcimi[Arplicatien (Rovised 7-2tR181 Pag.• I

D. WELL DRILLER INFORMATIOiti
Company Name.: AWwD ScMces. Inc.
Well Dril;inn Contractor's Name: L.arn Weils
NC Contractor Certification No.: 2603
Contact Person:: Lam,, Wells ErnaiJ Ad<tress:l4_el1:;750549�:13ellsouth.net
Address: PO Box 125
Cin: Leicester. NIC 'Gip Code: 2874E Count; : i3pncotnhe
Qfitce Tele hla: 828-683-9223 Ceit No.: IS-Z -93?4_
E. HEAT PUMP CONTRACTOR INiFORNiATION (if different than driller)
Company Name:
Contact I
Address:
City:
Office TeleTvo.: �2=?�_��(q Cell No
V77-v - 6 f6 - ���, .
F. INJECTION PROCEDURE (briefly describe how the infection wells) will be used)
e L
G. WELL CON-" RUCTION'' DATA (Skip to -Section H If this is a• Kermit RE, NEWa:L)
(1) Proposed date to be constructed: When permitted Number of borings: 4
Approximate depth ol'eaclt i)orimg (feet):_ 400'_
(2) Chemical additiv s to be used in closed -loop srNtem (only thos
r chemicals indicated have been approved):
R-22propylene glycol ethanol other (other additives will
need prior approval by NCC?EMR betbre.use.)
r
(3) 'iype of tubing to be used (copper. PVC, etc): ��
(4) Well casing. Is the well(s) ceased? (check either (a.) YES or (b.) NO below)
(.a) YES i f yes, then provide casing information such a; )e (steel, PVC, plastic, etc.). di, meter.
dentlt, and extent of casing appearing above ground:
(b) too _✓ _
(5) Grout (material surroundine Well casing and/or piping): PjN/L
(a) Cirout type: Cement Rentonite 20°i° Solici5 Other (specify'I sati;l (20')
(b) Grom depth of tubing (reference to land surface): from 400 to "Afeet) to surface Rentonite
If well has casing, indicut. grout depth: from
H. I:NJECTTON-R_CL.kTE D EQUIPi EN'f
Attach a diagram showing the engineering layout or proposed modificatlon of the injection equipment and exterior
pipirghubin, associated with the injection operation. The manufacturer`s brochure o)av provide supplementarn
information.
(il' Nt31C 50M Well P=,:miit Appliestion Mevised ;i_nogi tssc

1. LOCATION OFWELL(a)
Attach ttivo copies of Wraps showing the following information;
(1) Include a sim map (can be drawn) showing: buildings, property lines, surface water bodies, potential sources
or groundwater ewnutmination and the orientation of and distances bC1%%Ten tire proposed well(s) and any
existing wel!(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feel or the
geothermal heat pump well system. Label all feature.-, clearly and include a north arro„.
(2) Include a topographic map of the area extending one mile From the pronertl boundaries arui
indicate the faeilitv's location and the mats name.
J.. POTABLE WATER WE
Are there any potable water well(s) cn the subject propem or adincent properties _YES X NO
1f Yes, than indicate location on attached map(s ).
IC CERTIFICATiON
Note: This Permit Application must he signed by Egh person appearing on the recorded legnl property deed,
"I hereby certify, under penalty of law,'that i have personally examined and am farniliar with tilt: inibrination
submitted in this document and all attachmentstheretoanS/that, based on my intluiry of those individuals
immediateiv responsible for obtaining said inforpihntm.. I believe that tVinfonnation is true, accurate and complete.
f am aware that there are significant penalties; inclitiding tl}e possibivv of fines and imprisonment, for stibmittino
false information. I agree to construct. operate. m�intai Vrepair. aYd if applicable, abandon the injection well and
all related appurtenances in accordance NNIth tl V, '., crv4speciftqZtions and conditions of the Permit."
Signature of Property 0%vnerrApplicam
-1
��) G� �Gr�.• ti.5� C!✓t
Print T�pc "Full Name
Signature of Property OwnerIA pplicant
Print. or- Type Full Name
Signature ofAuthorizcd Agent, if any
Print or Type Fit II Nante
Please return two copies of the completed Application package to:
North Carolina DFNR-DWQ
Aquifer Protection Section
UIC Program
1636 MaD Service Center
Ralei,-h, NC: 27699-1636
Telephone [phone]a
Gf'UIIiC 5QM Well Permit Application (Keviscd-,2003) Pa_'

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984 King Gap Rd, Highlands, NC 28741 - Google Maps Page 1 of 1
� 1 I Save trees. Go green)
Download Google Maps on your
phone at googlexom/gmm d
http://maps.google.com/maps?i=d&source=s_d&saddr=984+King+Gap+Road,+Highlands... 3/ 15/2011

1 a L
Rogers, Michael
From: Kenny Libby (Geosaves) [[e-mail]]
Sent: Monday, March 14, 2011 4:01 PM
To: Rogers, Michael
Cc: [e-mail]; [e-mail]; larry wells
Subject: RE: Geothermal Bore Hole Permit for Nilsson 984 Kings Gap Rd, Highlands NC
Hi Michael. The bores are 400' each and the entire bore is being grouted with bentonite. I think this was determined
after the driller filled out his section on the permit. The additive is going to be propylene glycol, 10% mix.
Thank you,
Kenny Libby
From: Rogers, Michael Imailto:[e-mail]
Sent: Monday, March 14; 2011 3:22 PM
To: Kenny Libby (Geosaves) .
Cc: ,pnilsson(&comcast. net; [e-mail]; larry wells
Subject: RE: Geothermal Bore Hole Permit for Nilsson 984 Kings Gap Rd, Highlands NC
I received, the application for the above. However, I have a few questions.
What is the additive, i.e. R-22, glycol, ethanol, environal?
The grout is from 20-400 feet. What is in the boring from 0 to 20 feet?
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality- Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter
http://portal ncdenr org/web/wq/aps/gwpro/permit-applications#-qeothermApps
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: Kenny. Libby (Geosaves) [mailto:[e-mail]
Sent: Thursday, March 10, 2011 8:11 AM
To: Rogers, Michael
Cc: pniisson(abcomcast.net; benenterprises comcast.net; larry wells
Subject: Geothermal Bore Hole Permit for 984 Kings Gap Rd, Highlands NC
Good morning Michael. My name is Kenny Libby with Geosaves, Inc. and I am filing this application on behalf of my
customers, Bo and Pia Nilsson. We are going to be installing 4 geothermal bore holes at their home in Highlands NC.
Appalachian Well Drilling will be performing the drilling as noted on the permit application. Please see the attached
permit application and let me know if anything is missing or you heed more information. I appreciate your help with
this.
Thank you,

i
Kenny Libby
678-672-5190 - Direct
770-616-7145 - Cell
[e-mail]
www.geosaves.com
2

Rogers. Michael
From: Kenny Libby (Geosaves) [[e-mail]]
Sent: Thursday, March 10, 2011 8:11 AM
To: Rogers, Michael
Cc: [e-mail]; [e-mail]; larry wells
Subject: Geothermal Bore Hole Permit for 984 Kings Gap Rd, Highlands NC
Attachments: GeoSaves Nilsson.pdf
Good morning Michael. My name is Kenny Libby with GeoSaves, Inc. and I am filing this application on behalf of my
customers, Bo and Pia Nilsson. We are going to be installing 4 geothermal bore holes at their home in Highlands NC.
Appalachian Well Drilling will be performing the drilling as noted on the permit application. Please see the attached
permit application and let me know if anything is missing or you need more information. I appreciate your help with
this.
Thank you,
Kenny Libby
3 &� ����LYa✓"�ff
678-672-5190 - Direct
770-616-7145 - Cell
[e-mail]
www.geosaves.com
1