WI0100044_GEO THERMAL_20120523

A' 74 J 5A
irCiDENR
North Carolina Department of Environment and Natural
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 23, 2012
Charles Campbell
151 B Highway 9 #185
Black Mountain, NC 28711
Subject: Notification of Rule Revisions Affecting
Closed -Loop Geothermal Injection Well Permit Holders
Permit Number: WI0100044
Dear Mr. Campbell:
Resources
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed -loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Weld Construction Standards — Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed -loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.or,, /web/wq/aLs.
If you have any questions regarding your current permit or the rule revisions, please feel flee to
contact our underground injection control staff at [phone].
Sincerely,
Gj
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Permit File
AQUTER PROTECTION SECTION
3636 Mail Service Center, Raleigh, North Carolina 27699.1636 One
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604 NofthCarohna
Phone:www.7-64641 FAX: [phone] �r� �
Internet:: www.ncwateraualilv.om yL
An EqualOppor[unity1Af rmativeActtonEmployer

ZL0/800d 5'8d -O,l, EOUE808Z8 -WD3d WTI ZT ,-80-Z0 93AI333H
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- v RESIDE M4L WELL CON31AUCTIQN RECORD
Nod Carolina Depeftmenl• of Environment and Narurat Raaouroea- Division of Wafer Quality
WELL Cpi►rl" R.ACTOR CERTIrICAT101% tt 2603
1. WELL CONTRACWR:
Lan3r_Welis _.
Well CoMmctor [IndivlouaQ Name
.AWD a.I
Well Commewr Company Name
258 Nonh T rkey CLeak Rd, -
Street Aoaress
l,�sester NC 28 4S
City or Town $tste map Code
C- 2$) 90-V23 - -
Area undo Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION FERMIiAI WI❑ 1400"
OTHER ASSOCIATED PERMiTO[davv+fable}
111TE WELL ID ftitappi;cabrel
3. WPi.L USE [Check Applicable BQxl, Residentisi Water Supply rM
DATE DRILLED - _Q- T _.__
TIME COMPLETED AAA p PM IV
4. WELL LOCATION:
CITY: Black Mountain COUNTY Bunrambe
Ca v all Office Buildina Condominium
(EIVW Norm, rNumaets, Community, SuWM&lan, tot No., Panel, L'p Code)
TOPOGfiAPRIC 1 LAND SETTING! lomamr epprnpfte W4
gMlope ©Halley ❑Flat ❑Rld$e ❑011rerEleV, --
LATITuDI: 35 •� � DMS afr DD
LONGITUDE 83 " OM5 OR DO
Labbadellongitude aounn, 9�Ps Qropographie map
ODwfion or well meet be shown on a USGS typo map andanschad to
rhle form rt nor VVhg GPS) L at . & Long. Unknown
A. WELL OWMER
- Camobgll O_ iCe_auildina daminjWm
Owner Name
206 East State Stfeat
Suett Addreaa —
_ Bla awn_ twin^ NC 28711
Crly arTow rt 5t" Zip Code
L8.28
Area oods Phone number
t;.WljLL OlTAIL9: (4) Geothermal Hares
a. TOTAL 05IRTH:600I
RL OOU VKLL A&PLAGE EXISTING WELL? YES ❑ NO ❑
a. WATER LEVEL Below Top of Caging: NIA FT.
(use "+" it Above Top of Ca&g)
d, TOP OF CASING IS NIA FT. Above land Surface
'Top of teeing tsrrninated allar below land surface rnsy require
n vsriancr; in a=Tdanre_ with 15A NCAC 2C .0116
e. YIELD (gpfn); NIA METHOD OF TEST NIA
r. OWNFECTICN: Type hM Amoont NIA
Q. WATER ZONES Cdepth]:
Top
Bottom
Top
8ott rn
T0P
8dttam
Top
Bokt in
Top
Bonn+
Tap
Bdttem
Thivansaw
7. CASING=
Depth
oianl•ter
Weight Materfall
Top
Bottom
Ft.
Top
Bottom Ft
Top
8otlnm
Pt
B. GROUT;
Depth
Material
Method
Top 0
Bauer 40'
FL Bentonke
Pour
Top 0
Botmm AOd'
FL Pea Gravel Pvur
Top
BOnrn
Ft.
a. SCREEN:
Depm
Dlatrteter Slot Sire materiel
Top
Hotter
FL ln.
im
Top
Bottom
Ftr in.
in.
Tap
8ot6o m
Ft. lrt.
m,
1G. SANDIGRAVEL PACK
Depth
arcs
Mmanal
Tap
Bodoni
",
Tog Solmen
AL
Top
Bottom
PL
11. DRILLING LOG
Top Bottom Formation Doeftlion
1
1
r
r
1
r
1
1
1
12. REMARKS:
Suit:
100 HEREBY CERTIFY T+4AT TH113 WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, ANDTHAT A COPY DF THIS RECORD tiAS BEEN
PROVI13£0 TO THE WELL OWNER.
2-2-12
��TRE r'F GFRTIFIED WELL CONTF3ACT1RR GATE
Larry Wells
PRINTED NAME OF PERSON CONSTRUCTING T?1E WELL
;.19�_ li` 30.d am R
4of-�ompletion W: Division of Water Duality - Inton,ot�on Proaessino,
;31f i1iA81 ?Nlac lceiit0jNl9h, PVC t]e88-161, Phone (919) e07.S300
Fenn QW-1a
Rev. 2M
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WIT ZTOZ/80/Z0

Permit Number WIOI 00044
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (50M)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility Name
Campbell Office Building Condominium
Location Address
206 E State St
Black Mountain NC 28711
Owner Name
Charles
C Campbell
Central Files, AP5 SWP
09102/11
Permit Tracking Slip
Status
Project Type
Active
Renewal
Version
Permit Classification
2.00
Individual
Permit Contact Affiliation
MajorlMinor Region
Minor Asheville
County
Buncombe
Facility Contact Affliiation
Owner Type
Individual
Owner Affiliation
Charles C. Campbell
151 B Hwy 9 #185
Black Mountain NC 28711
Scheduled
Orlg Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
01/04/07 08/08/11 08/24/11 08/24/11 07/31/16
Regulated Activities_ _ _ _ Rer uestedlReceived Events
Heat Pump injection Ra staff report requested 08/16/11
Ra staff report received 08/17/11
autfall
Waterbody Name Stream Index Number Current Class Subbasin

Permit Number WIOIOO }44
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (60M)
Primary reviewer
michaei.rogers
Coastal SW Rule
Permitted Flow
Central Files! AP5 5WP
08119/11
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Facilit%
Facility Name Major/Minor Region
Campbell Office Building Condominium Minor Asheville
Location Address County
206 E State St Buncombe
Black Mountain NC 28711 Facility Contact Affiliation
= wn
Owner Name
Owner Type
Individual
Charles C Campbell
Owner Affiliation
Charles C. Campbell
151 B Hwy 94185
Black Mountain NC
28711
Scheduled
069 Issue App Received Draft initleted Issuance
Public Notice
asue Effectivo
Frnimfinn
Q1104107 08/08/11
1 31116
R_ evulated Activities
- -tedlReceived Events
Heat Pump Injerlion
RO staff report requested
08/16/11
RO staff report received
08/17/11
Dutfall h'ia_L
Waterbody Name Stream Index Number Current Class Subbasin

AN"O'Aw)
w -_
NCDEN
North Carolina department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H, Sullins
Govemor Director
August 24, 2011
Charles C. Campbell, President
Campbell Building Condominium Association, Inc.
151B NC Highway 9 #185
Black Mountain, NC 28711
Ref: Issuance of Injection Well Permit WIOI00044
Issued to Campbell Building Condominium Association, Inc.
Black Mountain, Buncombe County, NC 28711
Dear Mr. Campbell:
Dee Freeman
Secretary
In accordance with the application received on August 8, 2011, I am forwarding permit number WI0100044 for the
continued operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system located at
206 E. State St., Black Mountain, Buncombe County, NC 28711. This permit shall be effective from the date of
issuance until July 31, 2016, and shall be subject to the conditions and limitations stated therein.
Please be advised, in the event there are multiple wells with separate clusters, one well identification tag per
`cluster' of wells should be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location,
Also, please pay special attention to Part V,2. The Permittee shall retain all records of repairs, pressure
tests, maintenance, and other activities needed to maintain normal operating conditions.
In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an
application to renew the permit 120 days prior to its expiration date, This permit is not transferable to any person
without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at [phone] or michael.rogersta acdenr.4ov if you have any questions about your permit.
cc: Landon Davidson, Asheville Regional Office
WI0100044 Permit File
Buncombe County Environmental Health Dept.
AWFEF PRD7ECTION SECTION
1636 Nla,! :Ae viw Center, Rale;gh. North Gamlma'7699.1636
Loczbor. 2725 : aplta, baulevarC, Ralelgh, Noah Carolina 276(V
phone- 915-75':-:;221 t FA'� 1' 919-'15-4586': FAX 2' 919-715-6045 1 :,ustome� Service: i•Si7.623.6748
Iruemer. www.nczlemualuv.om
Best Regards,
t
7FIL)
Michael Rogers, P.G. (NC
One
NorthCarob-zia
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NORTH CAROLINA,
ENVIRONMENTAL MANAGEMENT COMAUSSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter S7; Article 21, Chapter 143. and other applicable
Laws, Rules, and Regulations
PERMISSION IS HERESY GRANTED TO
Campbell Building Condominium Association, Inc.
FOR THE CONTINUED OPERATION OF 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 206 E. State St., Slack Mountain,
Buncombe County, NC 28711, and will be constructed and operated in accordance with the application received
August 8, 2011, and in conformity with the specifications and supporting data submitted, all of which are filed
with the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for operation of an injection well and shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until July 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through VII hereof
Permit issued this the 24'' day of August 2011.
�"'3 �
tcoleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI(',!00 144 UIC/5QM-M.F. Renewal Page ] of
Version 1/2010

PART I — OPERATION AND USE GENERAL_ CONDITIONS
This permit is effective only with respect to the nature, volume of materials and rate of iniection, as
described in the application and other supporting data.
1 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 ❑rdamnces, which may be imposed by other local, state. and federal
agencies, which have jurisdiction, Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. In the event that there are multiple wells with separate clusters. one well identification tag per 'cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
PART 11— 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 correcrive
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.
The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART III — OPERATIONS AND MAINTENANCE REQUIREMENTS
The injection facility shall be properly maintained and operated at all times.
?. 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 pennit.
WI0: + — LJ1U5QM-M.F. Renewal Page 2 of
Version 1!2010

P,%RT IV - INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
?. 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.
1 Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART V — MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall retain all records of repairs, pressure tests, maintenance, and other activities
needed to maintain normal operating conditions.
3. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number 828-295-4500, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances,
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures:
4. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
5. 1n the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
Immediate action as may be required by the Director.
PART VI — PERMIT RENEWAL
The Permittee shall, at least 120 days prior to. the expiration of this permit, request an extension.
W1010044 UIC15QM-M.F. Renewal Page 3 of
Version 1/2010

PART VII — CHANGE 4F WELL STATUS
The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213 (h)(1), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel -packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations. a subsurface cavity has been
created. each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part VII (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
❑ENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1536
wt++ + UIC15QM-M.F. Renewal Page 4 of 4
Version 1/2010

Rogers, Michael
From: Davidson, Landon
Sent: Wednesday, August 17, 2011 4:01 PM
To: Stepp, Jonathan; Rogers, Michael
Subject: RE: W 10 100044
Agreed.
G. Landon Davidson, P.G.
CC[IENV iii:iw-in *it':::IC rGEr, lit+
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i
web page: htzp:LlPortai.ncdenr.0rglweblwq&ps
Email tnrrespon detice to ❑nd I om fifis address is subjeer to
the North Cwy?Ihia tir Records I aa, and may be disclosed
re rhirdPare ict Lin 1&, s dw conrenr Cr e_'Cernpr by warfare or
From: Stepp, Jonathan
Sent: Wednesday, August 17, 2011 4:01 PM
To: Rogers, Michael
Cc: Davidson, Landon
Subject: RE: WI0100044
This is a small system, I pulled the file and I don't believe there will be anything to see ... my recommendation is to
proceed with permitting.
Thanks
Jonathan
Jonathan Stepp—Jonathan.Steprj«'ncdenr.cov
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Aquifer Protection Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
From: Rogers, Michael
Sent: Tuesday, August 16, 2011 4:41 PM
To: Davidson, Landon

Cc: Stepp, Jonathan
Subject; WIC100044
Please find attached a 5QM renewal application for your review. Let me know if you wish to conduct a pre -permitting
inspection or not.
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)
h ttp:llportat. n cd en r. oEgiweb/wQ/agstg_wA2ro/p a rm it- a ppiicat io n s#geoth a rmApp s
E-mail correspondence to and from this address may be subjact to the North Carolina Public Records Law and may he disclosed to third parties

Buncombe County Tax Lookup - Property Card
Page 1 of
COUNTY OF BUNCOMBE, NORTH -
�5� E CAROLINA ` ~~
- a Web Property Record Card
o6lL9-35-8793-00000
Owner Information
Owners: CAMPBELL FAMILY
INVESTMENTS LLC
\ddress:
# 185
151 NC HIGHWAY 9 STE B
BLACK MOUNTAIN NC 28711
Property
Location:
2o64 E STATE ST
Taxing Districts
County:
Buncombe County
City:
Black Mountain
Fire:
School:
No Owner History
Parcel Information
katus:
kccount:
)eed Date:
)eed Book/Page:
'lat Book/Page:
,egal Reference:
,ocation:
Date Printed: 8/1g/2011
Total Property Value:
100
Active
8172939
1❑/31/2❑02
2974 / ❑879
0110 / 0175
PLAT
2❑54 E STATE ST
Mass: COMMON AREA
ieighborhood: CAMPBELL
BUILDING
uhdivision: CAMPBELL
BUILDING CONDO
ub Lot:
oning:
onservation/Easement: N
loud:
Ownership History
Assessment History
Year
Account
Acres
Land
Bldgs
12,,,r
Assessed
Dese
Exemptions
Deferred
Taxable
12011 f
8172939 ;0.60
1100
10
10
100
0
0
100
12010 18172939
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10
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100
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Land Data
Total Acres:
0.60 Acres
Land Value: 1o❑
Other
Improvements
Value: o
Segment# Units 1 Description
I o.bo Acres ILOT
Corn. Bldg Sq Bsrnt Bsmt Year
Bldg Class Occupancy Feet SgFt Finished Built Grade Condition Value
ID
1 WOOD OFFICE 8253 0 0 20o6 B N ❑
FRAME BUILDINGS D
http://www.buncombetax.org/PropertyCard.aspx 8/19/2011

Buncombe County Tax Lookup - Property Card
Page 2 of 2
Section SgFt # Stories
OFFICE BUILDINGS D ;2733 11.00
OFFICE BUILDINGS D
1107
12.00
OFFICE BUILDINGS D
1553
12.00
CANOPY �COMM META
502
'I.00
BREEZEWAY
1285
1,1.00
Total Building Value: o
http://www.buncombetax.org/Propert_yCard.aspx 8/19/201 l

AEV-5."'
w,A
w�w■
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coieen H. Sullins
Governor Director
August 16, 2011
Charles Campbell — President
Campbell Building Condominium Association, Inc.
131 B NC Hwy 9 #185
Beach Mountain, NC 28711
Dear Mr. Campbell:
Dee Freeman
Secretary
Subject: Acknowledgement of
Application No. WI0100044
Campbell Office Building
Injection Mixed Fluid GSHP
Well (5QM) System
Buncombe County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on August 8, 2011. Your application package has been assigned the nuaaber
listed above, and the primary reviewer is Michael Rogers.
Central and Asheville Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or michael.rogers alp] cdem.gov.
Sincerely, �Q
V 1
for Debra J. Watts
Groundwater Protection Unit Supervisor
cc; Asheville Regional Office, Aquifer Protection Section
Permit File WIG100044
AQUIFER PROTECTION SECTION
1636 Mail Seryics Confer, Ralagh, North Carolina 27699-1636
Location: 2728 Cepbl Boulevard, Raleigh. North Carolina 27604
Phorla' 919.733-3221 l FAX [phone]: FAX [phone] l Customer Service; 1-877.62M748
Internet' www.flmatemuality=
ont
N'fQI� tb Camli 1a
Nn Eou3, niI-- . Anrrnariu�t R.ir, n ;Elnployer

Pr
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED -LOOP MIMED -FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids other than potable water as part of a geothermal beating and cooling system
(check one) New Application Renewal* Modification
* For
ewals complete Parts A-C and the signature page.
ne Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomj
DATE: f}—, , 20 41
RECEWEU i DENR r 0WQ
PERMIT NO. W t 01 0a ° `f `f (leave blank if New Application) AQUfFFR'PRnTFr>'IRN IFrTION
A. STATUS OF APPLICANT (choose one) AUG-0 8 7A11
Non -Government: Individual Residence Business/Organization P
Government: State Municipal County Federal
B. PERMIT' APPLICANT - For individual residences, list each owner on property deed. For all others,
state name of entity gad name of person delegated authority to sign on behalf of the business or agency.
arm •4c11
Mailing Address:
City: AIX-e-G- A4- w
State: AX—Zip Code: 2IF 7"
Day Tele No.: i }; - G (; Ir 1-6 Cell No_: c.
EMAIL Address: "&rz t Fax No.: Ar `jw C-
County: /�i [l+r4l_
C. LOCATION OF WELL SITE - Where the injection wells are physically located:
-
(1) Parcel Identification Number (PIN) of well sit.e:bq("tf -� L - $-1q3 -L°� un7ty: 4-n CA��
(2) Physical Address (if different than mailing address): Zap (o c! 5� f� 1l
City. Z-�' 1 "-4,/`-/;" • State: NC Zip Code: .2f) 71 r
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.:
Company Name:
Contact Person_ EMAIL Address:
Address:
City:
Office Tele No.:
Zip Code:
Cell No.:
State: County:
GPUMIC 5QM Prnnit Application (Revised 1124f20t t 1 Page I

E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name:
Contact Person: EMAIL, Address:
Address:
City:
Office Tele No.:
Zip Code-
F. WELL CONSTRUCTION DATA
Cell No.:
State: County:
Fax No.:
(l) Number of borings to be constructed*: Depth of each boring (feet):
* If existing Ivater• supply Ivells ivill be used then provide the informarion in item (4) below.
(2) Chemical additives to be used: R-22
Propylene glycol
Ethanol
Other (other additives will need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper.. PVC, etc):
(4) Well casing. if the well(s) will use casing them provide the type (steel. PVC, plastic, etc.), diameter, depth,
and extent of casing appearing above ground:
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonite** Other (specify)
•* By sciccting bentonite groul. a variance is hereby requested to 15A NCAC 2C .0213(d)t ] )(A), which requires a cement type gout
(h) Grout depth of tubing (reference to land surface): from to (feet)
If well has casing, indicate grout depth: from to (feet)
G. WELL LOCATIONS— Maps must be scaled or otherwise accurately indicate distances and orientations of
Features located within 1000 feet of the injection well(s). Label all features clear]v and include a north arrow.
f i } Attach a site -specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
Septic tasks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 114 mile from the injection well site that indicates the
facility's location and the map name.
A10TE: In most cases, an aerial photograph of the property parcel shoring propergo lines and structures can be
obtained and downloaded from the applicable couniD, GIS website- Typically, the property can be searched by
owner name or address. The location of the wells in relation to propert}• boundaries, houses, septic tunks, ,other
wells, etc. can then be drawn in btu hand. Also, a 'layer' can be selected showing topographic contours or
elevation data
GPU[WC 5QM Permit Application (Revised 1/24/201 1 ) Page

H. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (.which means all persons listed on the property deeds.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, -including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances ulaccordance wiflithe approved specifications and conditions of
the Permit"
Signature of Property Ownerhkpplicant
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
D W Q - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVED i OENR 0WQ
A0UM'PRnrrr.1nnl RFCT10N
AUG 4 8 7@11
GPUNIC 5QM Permit Applicapion (Revised 1/24/2011) Page 3

Michas! F. Easley, Govemor
William G. Ross Jr„ Secretary
Borth Carolina Department of Environment and Nautral Resources
Alan W, Klimek, P.E. Director
Division of Water Quality
January 10, 2007
Mr. Charles C. Campbell
15lB Hwy 9 #185
Black Mountain, NC 28711
Re: Issuance of Injection Well Permit
Permit No, WI0100044
Issued to Charles C. Campbell
Dear Mr. Campbell:
In accordance with your application dated November 10, 2006, 1 ari forwarding Permit No.
W10100044 for the operation of a vertical closed -loop geothermal mixed -fluid heat pump injection
well system to be located at 206 East State Street, Black Mountain, Buncombe County, North
Carolina, This permit shall be effective from the date of issuance until December 31, 2011, and shall
be subject to the conditions and limitations stated therein.
NOTE: This permit replaces the previous permit sent to you dated January 4, 2007.
Pay special attention to the well construction standards in Parts 11 and V of your permit. You must
notify this office (Raleigh Central Office) and the Ashville Regional Office at least forty-eight (48)
hours prior to constructing the system, and forty-eight (48) hours prior to initiation of the operations
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
Hydrogeological Technician 11
cc: Ted Minnick — Ashville Regional Office
Central Office File
Attachment(s)
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699.163E
Lmzmet: htto:lfwww.ncwaterguality gi 2729 Capital Boulevard Raleigh, NC 27604
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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
CHARLES C. CAMPBELL
FOR THE CONSTRUCTION AND OPERATION OF A TYPE 5QM INJECTION WELL,
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 206 East State Street, Black Mountain, Buncombe County, North Carolina, and will be
constructed and operated in accordance with the application dated November 10, 2006, and in
conformity with the specifications and supporting data suhmitted, all of which are Fled with the
Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Constriction 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 he 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 he effective, unless revoked, from the date of its issuance until December 31,
2011, and shall he subject to the specified conditions and limitations set forth in Parts I through
X hereof.
Permit issued this the f 1 4-1, day of 'nK.., .. r c , 2007. 71
�
c1q:
G�n�
Alan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Page I

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
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 (15 A 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 collu vial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to, DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff, 1636
Mail Service Center, Raleigh. NC 27699-1636, within 30 days of completion of well
construction.
PART II - WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall
notify the Aquifer Protection Section -Underground Injection Control (UIC), Central Office
staff, telephone number (919) 715- 6166 and the Ashville Regional Office Aquifer
Protection Section Staff, telephone number [phone].
PART Ili - OPERATION AND USE GENERAL CONDITIONS
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,
Page 2

_'. This pen -nit 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 TV - PERFORMANCE STANDARDS
The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater, which 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,
1 The Permittee shall be required to comply with the terms and conditions ofthis permit
even if compliance requires a reduction or elimination of the permitted activity.
The issuance of this permit shall not relieve the Pennittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V - OPERATION AND MAINTENANCE REQUIREMENTS
The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior wntten 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 -
Underground Injection Control (LJIC), Central Office staff, telephone number (919) 715-
61 G6 and the Ashville Regional Office Aquifcr Protection Section Staff telephone number
(82S) 296-4500. Notification is required so that Division staff can inspect or othcrwise
review the injection facility and determine if it is in compliance with permit conditions.
Page 3

LOV 914 &V a 1►f.19 or" I-CO)CK
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. 87-94.
Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VII - MONITORING AND REPORTING REQUIREMENTS
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)
296-4540, any of the following;
(A) Any occurrence at the injection facility, which 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.
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.
Page 4

PART VIII - PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART Ili - CHANGE OF WELL STATUS
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. Wlien 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 I SA 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.
(lr) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, cacti 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.
Page 5

(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.
The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART X - OPERATION AND USE SPECIAL CONDITIONS
None
Page 6

Pei In it Nur low W10100044
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Permitted Flow
Facili
Central Files. AP5 5WP
01 /17/07
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Jeff
Silvis
PO Box 1557
Fla! Rock
NC 28731
Facility Name MajorlMinor Region
Campbell Office Building Minor Asheville
Location Address County
206 E State St Buncombe
Black Mountain NC 28711 Facility Contact Affliation
Owner fume Owner Type
Individual
Charles C Campbell Owner Affiliation
Charles Campbell
151 8 Hwy 9 #185
Black Mountain NC 28711
Scheduled
brig Issue App Received Draft Initiated Issuance public Notice Issue Effective Expiration
01/04/07 11/17/06 01/10/07 01/10/07 12/31/11
ctivitt s RetauestodlRpcelvf-d F
Heat Pump injection RO staff report requested 1 1/29/06
Ro staff report received 12/15/06
utfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

January 4, 2007
Mr. Charles C, Campbell
151B Hwy 9 #185
Black Mountain, NC 28711
Re: Issuance of Injection We11 Permit
Permit No. WI0100044
Issued to Charles C. Campbell
Dear Mr. Campbell:
Michael F. Emley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Naturai Resources
Alan W. iU reek, P.E. Director
Division of Water Qua] iry
/// '1/0 57-
In accordance with your application dated November 10, 2006, I am forwarding Permit No.
WI0100044 for the operation of a vertical closed -loop geothermal mixed -fluid heat pump
injection well system to be located at 206 East State Street, Black Mountain, Buncombe County,
North Carolina. This permit shall be effective from the date of issuance until December 31, 2011
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 Ashville 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
Hydrogeological To0ilician II
cc: Ted Minnick — Ashville Regional Office
Central Office File
Attachment(s)
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
internet: b1WWwww.ncwaterquah1y.org 2728 Capital Boulevard Raleigh, NC 27604
An Equat opportunitylAl1ra aftAction Employer-50%Rwydedl10% Post Consumer Paper
t
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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
CHARLES C. CAMPBELL
FOR THE CONSTRUCTION AND OPERATION OF 4 TYPE aQM 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 206 East State Street, Black Mountain, North Carolina, and
will be constructed and operated in accordance with the application dated November 10, 2006,
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 December 31,
2011, and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof.
Permit issued this the day of � , 2007.
32 6t �,. "*- >
tan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission.

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
The Pennittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C
.0200), Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate,
S. A completed Well Construction Record (Form GWA) 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.
P-ART H - WELL CONSTRUCTION SPECIAL CONDITIONS
I. Prior to constructing the injection welt system., the Per3mittee 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. Ail 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 JAC) Program Central Office
staff, telephone number [phone] and the Ashville Regional Office Aquifer Protection
Section Staff, telephone number [phone].
3. All underground tubing shall be refrigeration grade copper tubing.
Page 2

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
instal led.
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 operation of the_faczlity for insection.
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 corners). 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 11. paragraphs ( 10) and 01 i shall be submitted to:
Aquifer Protection Section-UC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 3

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
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 REQU RE1MIENTS
l . The injection facility shall be properly maintained and operated at all times,
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
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 (CTIC) Program Central Office staff, telephone number
[phone], and the Ashville Regional Office Aquifer Protection Section Staff,
telephone number -[phone]. Notification is required so that Division staff can
Page 4

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.
1 The Permittee shall report by telephone, within 48 hours of the occurrence ❑r 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.
Page 5

PART VHI - PERMIT RENEWAL
The Pennittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART FX - 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 1 SA 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 1 SA 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.
Page 6

(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-L]IC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 7

A
MCDEh�R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H- Sullins
Governor Director
August 1, 2011
Charles Campbell
151 B Highway q
Black Mountain., NC 29711
Subject: Notice of Expiration (NOE)
5QM Geothermal Injection Well
Permit No. WI0100044
Buncombe County
Dear Mr. Campbell:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, -and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for
the underground injection well system located on your property at 206 East State Street, in Black
Mountain, NC, which was issued to you on January 10, 2007, and expires on December 31,
2011, is soon due for renewal. If you wish to keep this permit and operate the injection well
system, the permit must be renewed and issued in your name.
If Your Injection Well is Cun-entIN- 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 Tit]e 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
Narne/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at htir:llnortal.nedenr.orL,/web/wo/ans/,-,ii-nro/rtrortint,-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 September 2. 2011.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh. North Garnlino 27W9 -1636
Lacakr_ 2725 0aoiraI Boulevarb. Ralegh. North Gara[Ina 27504 One
pnone7 sly -733 -3221 I FAX 1: 9 4 9-f 15-0588: FA', 2 919-71-5.6W ', Customer Service.1-877-623-6748 North Carolina
Intemet wmw.nc►vaterauality.o� y7
An Equal ri,:aanunot- Ativrlouoe AOtin Empinver Nahl Qllb

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title I SA, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct andlor Use a Wells) for Jgjection with
Geothermal Heat Pump System for 7:vpe 5QM Well(s) if the injection well system on
your property is still active.
S. Status of Ir!jection Well Svstem 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 276+99-1636
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
littp://h2o.en-r.state.nc.us/ans/L-,pu/fonns.htni.
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,L.sinith(ci)ncdenr.eov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - APS wlo enclosures
AP Central Files - Permit No. WIO100044 w/o enclosures

Permit Number WIOI 00044
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Permitted Flow
Facility name
Campbell Office Building
Location Address
206 E State St
Slack Mountain NC 28711
Central Files; APS SWP
12/21/06
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
Individual
Permit Contact Affiliation
Jeff
Silvis
PO Box 1557
Flat Rock
NC 28731
Major/Minor Region
Minor Asheville
County
Buncombe
Facility Contact Affiliation
Owner Name Owner Type
Individual
Charles C Campbell Owner Affiliation
Charles Campbell
151 BHwy 9#185
Black Mountain NC 28711
Dates/Events
Scheduled
Brig Issue App Received Draft Initiated Issuance
11 /17/06
Requtated Activities
Heat Pump Injection
Ot.ffall NULL
Waterbody Name
Public Notice issue Effective Expiration
OP 12-8
RequestedlReceiyed Events
RO staff report requested 11/29/06
RO staff report received 12/15/06
Stream Index Number Current Class Subbasin

01-03-'07 22:50 FROM-NCDENR ASHEVILLE AO 82824043 T-663 P01/ U-322
• State of North Carolina
Department of Environment
and Natural Resources
A94 A
Asheville Regional once
2090 U. S. Highway is NCDENR
Swannanoa, NC 28778
NoRTn CARwwA DE%wmv4T ofTelephone: (828
)2p-45rt
tWiRONMEW AMo NArUmAL ftkwmA%-_W
FAX Number: [phone]
FAX Transmittal
Date:
To: L)
From:d&
Number of Pages (including cover page):
I) T 14 - 4fm4 A)-T: D `�
" I -

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 1 !f zW6
To: Arluifer Protection Section Central Office
Central Office Reviewer:
Regional Login No:
County: 8P---
Permittee:
Project Name: 6omWw Amtir -^Wi uC
Application No.: Wr of 00044
L GENERAL INFORMATION
1. This application is (check al! 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 PS Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? J&Yes or ❑ No.
a. Date of site visit: ��h _
b. Person contacted and contact information:-rEAfSf Vt-S L�iI+��L (F�) ��- 9��
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`?
® 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:
RECEIVED j DENR ] IMO
AQUM PROTECTION SECTION
DEC 1 5 20OG
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. conv and paste a new section into the
document for each site. or attach additional pages for each site
a. Location(s): Z06 E• S-,*r6 fi,, r3r f4r- ►urn; WC- Z f7//
b. Driving Directions: JS To6 Ts diw-t- M rpi ► S' i W .w` C 4WCX- U-9 717 S''R'l4F�J►F� E.Ir �
c. USGS Quadrangle Map name and number:
d. Latitude: 667r0,0"' Longitude: WI? 76./ '
IL NEW AND MAJOR MODIFICATIONAPPLICATTONS (this section not needed for renewals or minor
modifications, skip to next section)
Descrintion Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: W '
2. Are the new treatment facilities adequate for the type of waste and disposal system
FORM: Documentl

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
❑ Yes ❑ No CKN/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 ❑ NIA. If no, please explain:
4, Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)?
Yes ❑ N❑ ❑ NIA. If no, please explain:
5 Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑ No
NIA. if no, please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptablc?
❑ Yes ❑ No 9 N/A. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a I00-year floodplain?
❑ Yes Z No ❑ N/A_ If yes, please attach a map showing areas of I00-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 EK 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.j adequate? ❑ Yes ❑ No 9 NIA. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program:
10. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No ❑ N/A If _yes, attach list of sites
with restrictions (Certification B?)
III. RENEWAL AND MODIFICA TIONAPPLICA TIONS (use previous section for new or major rnndificatiou
s 'stemrs)- -
Description Of Waste(S) And Facilities
Are there appropriately certified ORCs for the facilities? ❑ Yes or ❑ No.
Operator in Charge:
Backup- Operator in Charge
Certificate 9:
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: Document 1 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:
b. 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 ❑ NIA. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Will seasonal or other restrictions- be required for added sites? ❑ Yes ❑ No ❑ N/A If yes, attach list of sites
with restrictions (Certification IM
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:
14. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? ❑
Yes or ❑ No. If no, please explain:
11. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ❑ NIA. If no, please explain:
12. Has a review of all self -monitoring data been conducted (GW, NDMR, and NDAR as applicable)? ❑ Yes or
❑ No ❑ NIA. 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 ]OC; ❑ 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, 7OC, etc.) been complied with? ❑ Yes
❑ No ❑ Not Determined ❑ NIA.. If no, please explain:
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? ❑
Yes or ❑ No ❑ NIA. If yes, please explain:
FORM: Documentl 3

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
B. I11tJECTIDN JVELL PER311TAPPLICA TIONS (Complete these two sections for all systems that use injection
wells, including closed-ioop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump infection wells.)
Descriyinn df WeII(S) And Facilities — New, Renewal, And Modification
I , Type of injection system:
❑ Heating/cooling water return flow (5A7)
0 Closed -loop heat pump system 5 M SQW)
❑ In situ remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (3L/"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 jK No
What is/are the pollution source(s)? . What is the distance of the injection wells from the pollution
sources ? ft.
4. What is the minimum distance of proposed injection wells from the property boundarv? f ( ' ft.
5. Quality of drainage at site: W Good ❑ Adequate ❑ Poor
5. flooding potential of site: ® Low ❑ Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? ® Yes or ❑ No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale. and north arrow.
Iniection Well Permit Renewal And Modification Oniv
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. lf_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 ves. explain:
3. For renewal or modification of groundwater remediation vetmits of anN t% e). 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: PPi3f�{Ch��Ar9� inl�'KeGw
FORM: Documentl 4

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: pd I Zr
me ZYwf
Certification number: Z403
S. Complete and attach Well Constriction Data Sheet.
FORM: Documentl

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVAL ❑ATIONAND RECOMMENDATIONS
I. 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 [R No. If yes, please explain
briefly.
4. List any items that you would Iike 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
�f ra
1
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
Iy 14
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; B
Issue; ❑ Deny. If deny, please state reasons;
8. Signature of report preparers}:
i
Signature of APS regional supervisor:
Date: a 4 Z/ V
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Docurnentl 6

01-03-' 07 22:50 FROM-NCDENR ASHEVILLE RO =- :w 043 T-663 P022' U-322
I
AQUIVER PROTECTION SECTION • GIONAL STAFF RE T
V EVALUATIO.''AND RECOMAfgi RATIONS
1. Provide any additional narrative regardir. , your review of the; -ilication.:
2. Attach Well Construction Data Sheet - if needed information is ,available
3. Do you foresee any problems with issuancelmnewal of this permit? ❑ Yes [RNo, If yes, p€ease :xp!a;n
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 E Reason
S. List specific Permit conditions that you recommend to be rei d from the permit when issued,
that you provide a reason for each condition:
Condition aso n
b. List specific special conditions or compliance schedules that you recommend to be included in the it when
issued. Make sure that you provide a reason for each special condition: �
Condition s Reason
7. Recommendation- ❑ Hold, pending receipt and review of
pending review of draft permit by regional office; ❑ Issue
Issue; ❑ Deny. If deny, please state reasons:
n e
8. Signature of report preparers): — _ -
Signature ❑fAPS regional supervisor:
Date: Il 1Z 7AVi?
AD.DI TIO.NAL REGIONA L STAFF AE VIE W ITEMS
FORM: Documentl
6
tional information by regional office; ❑ Hold,
receipt of needed additional information; B

RECEIVED
AQUIFER PROTECTION SECTION DEC 01 2006
APPLICATION REVIEW REQUEST FOl
I Aahevllle Fisdanal Otiice
Date: November 29. 2006 A3ullai Protection �/
To: ®
Landon Davidson, ARO-APS
❑
Art Barnhardt, FRO-APS
❑
Andrew Pilner, MRO-APS
❑
Jay Zimmerman, RRO-APS
❑ David May, WaRO-APS
❑ Charlie Stehman, WiRO-APS
❑ Sherri Knight, WSRO-APS
From: Michael Rogers , Groundwater Protection Unit
Telephone: [phone] Fax. [phone]
E-Mail: Michael.Engers(i�ncmail.nct
A. Permit Number: WI 0100044
B. Owner: Campbell Familv Investments LLC Contact: Charles Cam bell
C. FacilitvlOveration:
® 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. Continents/Other Information: ❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, continent, 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 wit/ he 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.
r y
RO-APS Reviewer. = Date: i .f 7-106
FORM: APSARR 07/06 Page 1 of 1

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: November 29.2006
To: ® Landon Davidson, ARO-AP5 ❑ David May, WaRO-APS
❑ Art Barnhardt, FAO-AP5 ❑ Charlie Stehman, WiRO-APS
❑ Andrew Pitner, MRO-APS ❑ Sherri Knight, WSRO-AP5
❑ ray Zimmerman, RRO-APS
From: Michael Rn us , Groundwater Protection Unit
Telephone: ( 919) 715-6166 Fax: (919 ! 715-0588
E Mail: Michael.Rogerswlncmail.net
A. Permit Number: WI 0100044
B. Owner: Campbell F'amlly Investments, LLC (Contact: Charles CamLbell)
C. F'acilit-, /Operation:
® Proposed ❑ Existing ❑ Facility ❑ Operation
D. ApIllicatlpn:
I. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ YE 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 Mad. ❑ Minor Mod. ❑ Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
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-AP5 representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer:
Date:
FORM; APSARR 07/06 Page 1 of 1

�ot W A �F 0. Michael F. Easley, Governor
William G. Ross Jr., Secretary
5;_
1 North Carolina Department of Environment and Natural Resources
❑ 'C Alan W. Klimek, P.E. Director
ow lc=
Division of Water Quality
November 29, 2006
CHARLES CAMPBELL
N ILSSON CONSTRUCTION CO
151 BHWY9#185
BLACK MOUNTAIN NC 28711
Subject: Acknowledgement of Application No. WIOI 00044
Campbell Office Building
Injection Mixed Fluid GSHP Well System (5QM)
Buncombe County
Dear Mr. Campbell:
The Aquifer Protection Section of the Division of Water Quality (the Division) acknowledges receipt of
your permit application and supporting materials on November 17, 2006, 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 it
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 by phone at [phone] or by email at
Michael.Rogers@,ncmail.net. 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 hup:/Wo.enr.state.nc.usldocumentsldwq oruchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION N[TM 3ER WHEN MAKING I1ti QUIRIES
ON THIS PROJECT.
Sincerely,
for Debra J. Watts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Fermit Application Pile WIO10G044
Aquifer Protection Section 1636 Mail Serulce Center
Internet: www.ncwatorcuality.oro Location: 2728 Capital Boulevard
An Equal 4pportunhylAffirm five Action Employer— 50% Rerycledil0% Post Consumer Paper
Oft
N sra ' a
Qlucma �;
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: (919) 71 "04B
Customer Service: (877) 62M74B

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 {�4� 1
In Accordance with the provisions of NCAC Title 15A: 02CM00
Complete application and mail to address on the back page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE. )j1jDgjjf
A. SYSTEM CLASSIFICATION PIease check column which matches proposed system.
(1) _ Type 5A7 wells *ect water used to provide heating or cooling for structures.
(2) A Type 5QM wells contain a subsurface system of continuous piping, that is
isolated from the environment and circulates a fluid other d= potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3) _ 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 CL. Nott cation Of Intent To
Commud A Closed -Loop Geothermal Water Only Injection We11 System.
B. PERMIT APPLICANT
Name: !V �'1 (J c' r ] � e G 2. 2 ,- . 0
_ i
Address: �_ G rZ5-: /
City: X:Ij2&. State: Zip Code-02EW County: �on
Telephone: _ EAE— og-- I&F
C. PROPERTY OWNER (if different from applicant)
Name- 6 -r►f' Br' / '4 - • . I_1 7
Address -.-
City : �� n,� Sate: IL L Zip Code: Ow2ftot ounty: & n C.- .v
Telephone: F 2'— 77;'67--�-2_7y A!T-71I
D. STATUS OF APPLICANT
Private: Federal: Commercial:
State: Municipal: Native American Lands:
Revised 7106 QWILTIC-57 HQ
RECEIVED I DENR I DWD
ADUIFFR-PROTFIrMON SECTION
- NOV 17 2006
Page 1 or 4
U

E, FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Nance of Business or Facility: ?c I _ G'� f
Address: —
City: iblt Av2mw,,� :,Zip Code: 2IL7E1 County: afijc &M2- E
Telephone-,t Contact Person:
F HEAT PUMP CONTRACTOR DATA
Name: ---��AC Il _r�c7_[-t .�31�{ —u�� r7(h'1! W A41/1--
Address: 7 o r7ri
City:
Telephone:
Zip Code: County:
Contact Person: _
G. INJECTION PROCEDURE (Briefly describe how the injection wells) will be used.)
OF
4 �a
�.�� �� G.r �..,i ��. �� .,�,,.��� >r�r �k �� �: nor .., �
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
(2) Personal consurupdon? YES NO
1. CONSTRUCTION DATA (check one)
EXISTING WELL being proposed for use as an injection well, Provide the data in
(1) through (7) below to the hest of your knowledge. Attach a copy of Form GW-
1 (Well Construction Record) if available.
J[ PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after constriction.
(1) Well Drilling Contractor's Name:
NC Contractor Certification number: 2 (0 -7!
(2) Date to be constructed:
Number of borings: --1/i
Approximate depth of each boring (feet): rpo
(3) Well casing: Is the well(s) cased?
(a) YES A If yes, then provide the casing information below.
Type: Galvanized steel Black steel Plastic Other (specify
Casing depth: From aL
0 ft. (reference to land surface)
Casing extends above ground inches
(b) NO
Revised 7/06 GWAAC-57 HP Page 2 of 4

(4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonite __y Other (specify)
(b) Grouted surface and grout depth (referen land ace):
around closed loop piping; from _ 0 to qet}.
around well casing; from e to {fet}
(5) Screens (for Type SAT wells)
(a) Depth: From to feet below ground surface.
(6) N.C. State Regulations (Title 15A NCAC 2C .0200) require die permittee to make provisions
for monitoring wellhead processes. A faucet on both influent (fluid entering hest pump) and
effluent (fluid being injected into the well) lines is required, Will there be a faucet on:
(a) the influent line`? yes no (b) the effluent line? yes no
(7) 'SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-I (Well Construction Record), If Form GW-1 is not available,
provide the data in part K (1) of this application form to the best of your knowledge.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITFIER EXISTING OR
PROPOSED WELLS IFTHIS INFORMATION IS UNAVAILABLE BY OTHER MEANS,
J, PROPOSED OPERATING DATA (for Type 5A7 wells)
(1) Injection rate: Average (daily) gallons per minute (gpm),
K.
i_"
(2) Injection Volume: Average (daily)
(3) Injection Pressure: Average (daily)
(4) Injection Temperature: Average (January)
INJECTION FLUID DATA
gallons -per day (gpd).
pounds/square inch (psi),
° F, Average (July) ° F.
(1) Fluid source (for Type SA7 wells) If underground, from whet depth, formation and type of
rock/sediment unit: will the fluid be drawn (e.g., granite, limestone, sand,
Depth: Formation: Rock/sediment unit:
Chemical Analysis of Source Fluid (for Type SQM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation, The manufacturer's brochure may provide supplementary
information.
M. LOCATION OF WELL(S) Attach two reaps.
Revised 7/06 GWfMC-57 RP
Page 3 of 4

(1) Include a site map (can he 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 goothemial heat pump well system. Label all
features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
N. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits wider RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
O. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document and all attachments thereto and that. based on my inquiry of
those individuals immediately responsible for obtaining said information, I believe that the informAtion
is true, accurate and complete. I am aware that there are significant penalties, including the possibility
of fines and imprisonment, for submitting false information. I agree to construct, operate, maintain,
repair, and if applicable, abandon the injection well and all related appurtenances in accordance with
the approved specifications and conditions of the Permit,"
y
(Signature of Well Owner or Authorized Agent)
IJauthmired agent ra acting on behalfojthe well owner,
please supply a letter signed by the owner authorizing the above agent.
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights in the well being constructed. A well is veal 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)
��- C
(Signature Of Property Owner If Diffewtht From Applicant)
Please return two copies of the completed Application package to:
MC Prograra
Aquifer Protection Section
North Carolina DENR-DWQ RECEIVED 1 DENR 1 DWQ
1636 Mall Service Center AQU1FFFR'PRnTFCTnN SECTION
Raleigh, NC 27599-1636 NOV 17 zm
Telephone [phone]
Revised 7106 GWARC-57 HP Page 4 of 4

Map Output Page 1 of 2
BUNCOMBE COUNTY, NORTH CAROLINA
7849
40
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1IEP
A
i T 8710
ti y-
F8 0655
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This Map Was Created By Bun cambe County t
http://gis.buncombecounty.orglservleticom.esr-i.esrimap.Esrimarp?ServiceName=sid3&Form=True&Encode=True 11/29/2006

Buncombe County Property Report
Page 1 of I
015
Parcel
Record
Report
PIN
MAILING SITUS
k,l l„„Rr.o
IRV1I141 VI\
OWNER
AGGRESS ADDRESS
CAMPBELL
151 NC
0619-10-
FAMiLY
HIGHWAY 9 BLACK NC
36-8710
INVESTMENTS
STE B # MOUNTAIN
LLC
185
CAMPBELL
151 NC
0609-16-
FAMILY
HIGHWAY 9 BLACK NC
72-7854
INVESTMENTS
STE 8 # MOUNTAIN
LLC
185
CAMPBELL
151 NC
0609-16-
FAMILY
HIGHWAY 9 BLACK NC
72-6821
INVESTMENTS
STE B # MOUNTAIN
LLC
185
9751-18-
CAMPBELL
FAMILY
61 GREAT
40-2406
SOMERSET NECK NY
TRUST
DR
ACRE DEED PLAT VALUE
28711 206 4 E STATE
28711 99999 BLUE
RIDGE
28711 99999 BLUE
RIDGE
11020 36 RIDGEVII
http:llgis.buncombecounty.orglreport_process. asp?PINNUM=060916727854, 060916726,.. 11 /29/2006

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ELEMENT DESIGNATION
BUILDING EXHAUST FRESH AIR UNIT
TYPE
AIR TO AIR HEAT RECOVERY
SERVICE
EIGHT OFFICES
CAPACITY
800 CFM AT .5 EXT
EXHAUST CFM
800
OUTSIDE AIR CFM
800
AIR INLET TEMP. WINTER 'F DB- WB
11,0 B.$
AIR OUTLET TEMP., WINTER 'F DB WB
54.5 45.5
AIR INLET TEMP.,, SUMMER 'FKDB/WF]
88.0 75,0 { "
AJR OUTLET TEMtP.• SUMMER •F f] _ WB
78.7 66.E
1- 30% FILTERS
YES
BASE MOUNTING OIPTION
YES
VOLTAGE
12O 1 ii
MCA MOP
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MANUFACTURER
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MODEL
MIN1V-750
NOTES.
1. CONDITIONS; 72 DEGREE 35% RH EXHAUST AIR, WINTER.
2. CONDITIONS; 75 DEGREE 50% RH EXHAUST AIR. SUMMER.
DIFFUSER AND REGISTER SCHEDULE
DESIGNATION
SIZE
NECK SIZE
CFM
COMMENTS
EXH
12x12
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100
METALAIRE CCD -
NOTES:
1. PAINT DUCT INSIDE REGISTER BLACK.,
. PUMP SCHEDULE .
NAME -
TYPE
SERVICE
.. GPM
HEAD (FT.)
MIN, PUMP EFF.
HP
RPM
I VOLTS/PHASE
NOTES
P-1 .
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FIELD
56
53
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1750
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- SEE PLANS
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S.D.
SMOKE DETECTOR
SUPPLY AIR DIFFUSER 0 250 CFM
- SEE SCHED., SHEET M5.01
RU
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- SEE SCHED., SHEET M5.01
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ASHEMtLE, NORTH CAROUNA
Thin drowing and the 6;T3v: gon e the property of Sod As*o6atee, PJL,
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