WI0100045_GEO THERMAL_20120524

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 24, 2012
Jessie & Cheryl Arredondo
17 Thompson Avenue
Canton, NC 28716
Subject: Notification of Rule Revisions Affecting
Closed -Loop Geothermal Injection Well Permit Holders
Permit Number: WIOI 00045
Dear Mr. and Mrs. Arredondo:
Dee Freeman
Secretary
Our records indicate that the previous owners of your property located at 17 Thompson Avenue in
Canton, NC held a permit for a closed -loop geothermal injection well system. Since you are the
new owner, you are now responsible for operating and maintaining the geothermal wells on your
property in accordance with the North Carolina Administrative Code Title 15A Section 2C .0200
entitled "Well Construction Standards — Criteria and Standards Applicable Injection Wells" which
were revised on May 1, 2012.
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 the 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:/lportal.ncdenr.org/web/wqlaps. If you have any questions regarding the permit or the rule
revisions, please feel free to contact our underground injection control staff at [phone].
Sincerely,
14,1�1 - ��
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Perinit File
AQUIFER PROTECTION SECTION
1636 mail Service Center, Raleigh, North Carolina 27699-1636 One .
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604 No h Car6lina
Phone:: Lw. cwa1q 1 FAX: 919�i]7 6496 /�
Internet: www.ncwa ualit .o �[
An Equal Opportunity 1 Affirmative Aellan Employer

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■ Complete items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front If space permits.
1. Article Addressed to
Jessie & Cheryl Arredondo
17 Thompson Avenue
Canton, NC 28716
A
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L. Addmssee
Received by (Printed Name) C. ellvery
45 t2
❑, Is delivery address dlfterent from Item 17 01es
If YES, enter delivery address below: 171rJ
3. Service Type
❑ Certified Mall ❑ Express Melt
❑ Registered ❑ Return Reoelpt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
2. Article Number 7006 2150 0003 5467 15 8 2-
(Tlenslfer from servfas
❑ Yes
P5 Form 3811, February 213114 Domestic Return Receipt tom oe-&t sin

NCDENR
North Carolina Department of Environment and Natural Resources
❑ivision of Water Quality
Beverly Eaves Perdue Chadds Wakild, P. E.
Governor director
March 13, 2012
CERTITUD NL4M # 7006.2150 Q003 5467 1582
RETURN RECEIPT REQUESTED
Jessie & Cheryl Arredondo
17 Thompson Avenue
Canton, NC 28716
Subject: Notice of Violation with Intent to Enforce (NOV-2012-OP-0004)
5QM Geot erm�! r ection Well
Permit No. WI0100045
Haywood County
Dear Mr, and Mrs. Arredondo:
Dee Freeman
Secretary
This permit was issued for the operation of a 5QM (Closed -Loop Mixed -Fluid) Geothermal
Injection Well on your prooperty located at 17 Thompson Avenue in Canton, North Carolina. Our
records indicate that the referenced permit was issued to Haywood Habitat for Humanity on
March 12, 2007, and expired on February 29, 2012. As the new property owners, you are
responsible for maintaining this permit.
On February 7, 2012, the Aquifer Protection Section sent you Change of Ownership forms and
instructions on how to renew the referenced permit. As of the date of this letter, we have not yet
received a response from you,
Therefore, the following violations) exists:
VIOLATION 1:
Operation of your geothermal injection well without a valid permit is a violation of 15A NCAC
02C .0211(a).
REQUIRED CORRECTIVE ACTION FOR TAIS VIOLATION
Please take the following corrective action within 34 days of receipt of this letter:
AQUIFER PROTECTION SECTION
1636 Mail 5arviae Center, Rateligh, North CaroUna 27699.1636 0ne
Location, 512 N. Salisbury St, Raleigh, North Carolina 27604 NorthCarolina
Phone; 91 U07-64 64 1 FAX, 91M07-6496
Intem9t: vyw-naatmoallka.ora Natuh7liff
An Equal Opportuno 1 Affirmative Action Employer

i
Submit a Change of Ownership form (enclosed) and submit one of the following enclosed forms
within thirty (30) days of receipt of this letter:
A_ Application fur Permit (Renewal) to Construct midlbr Use a Wells) for Injection
with Geothermal Heal Pump System for Type 5QPI Well(s) if the injection well
system on your property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to subrnit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a Change of
Ownership, rcnewal application, and a well system status forms are attached along with a self-
addressed envelope, The ahove referenced forms are also available on-line at the DWQ website
at http:llport Lf.ncdent-.org/web/4vqlatzs/gwLiro/t)ennit-applicationsllgeottierin kpps,
Thank you in advance for your cooperation and timely response. if you have any questions,
please contact Eric; G. Smith by phone at [phone] or by email at
eri_c. g. smithCa)ncdenr.,_,o v.
Sincerely,
0A.
a��
atts, Supervisor
Groundwater Protection Unit
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
APS Central Files — Permit WI0I00045 wlo enclosures

Postal
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so that we can return the card to you.
■ Attach this card to the hack of the mallpiece,
or on the front it space permits.
1. Aftle Addressed to:
Jessie & Cheryl ArreJorido
17 Thompson Avenue
Canton, NC 28716
2. Article Number
(Translsr from service labd)
P5 Form 3811, February 20D4
A. Slg ture�
x ❑ Agent
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❑ Addressee
B, Recei d by (Printed Name) C. pate of Dellvery
10 -1ti"i-�-
D. Is del Nary address different from Item f 7 ❑ Yes
If YES, enter delivery address below-. ❑ No
3, Servloe Type
❑ OerUtied Mall ❑ Express Mail
❑ Registered 0 Retum Flecelpt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7006 21SO 0003 5467 1612
Domestic Rsturn Receipt
102595•02-M•1540 :

A64.P.nA
NCDENR
North Carolina Department of Environment -and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, F. E.
Governor Director
1 t1ruw1 ", 'O i
CERTIFIED MAIL 0 7006 2150 0003 5467 1612
RETURN RECEIPT REQUESTED
Jessie & Cheryl Arredondo
17 Thompson Avenue
Canton, NC 28716
Subject: Change of Ownership and Permit Renewal
5QM Geothermal Injection Well
Haywood County
Dear Mr. and Mrs. Arredondo:
{lee Freeman
Secretary
The Underground Injection Control (MC) Prom of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced permit was issued to
Haywood Habitat for Humanity on March 12, 2007, and expires on February 29, 2012.
This permit was issued for the operation of a 5QM {Closed -Loop Mixed -Fluid} Geothermal
Injection Well on your property located at 17 Thompson Avenue in Canton, North Carolina. As
the new property owners, you are responsible for maintaining this permit. Therefore, it is
important that you submit a Chan 7e of Ownershi form within thirty (30) days of receipt of this
letter.
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms:
A. Application for Permit (Renewal) to Construct andlor Use a Well(s) for Injection
with Geothermal }Teat Pump System for Type 5QM Well(s) if the injection well
system on your property is still active.
-OR-
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Camltna 27699.1836 one
Location: 512 N. Salsbury St, Raleigh, North Carolina 27604 1 y U C'aralina
Phone: sls�or�Isa� FAXs1s�0r�ass. !�
Intemet atura!
An Fqual OpWbnit 1 Afrumetive Acton Employer

B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the forms to:
Gromidwater Protection Emit
EUIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely planner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a Change of
Ownership form, a renewal application, and a EUIC Well System Stahis form are attached along
with a self-addressed envelope. The above referenced forms are also available on-line at the
DWQ website at htip:llAortal.ncderr.or,,lwettlwLllapsl wprolpermit-a L)lic_atians#geotherntApt�s.
Tin S, llr,e +' �ri' its.'- rn vt-i- _i, ;1id ;�; �' ;';fii-'I'S rr I!-S n ,�fti �"''. Ti' •iClii�
please contact me by phone at [phone] or by email at eric.g.smilhgncdetu.gov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
APS Central Files — Permit WIOI00045 w/o enclosures

Postal
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Federal Home Loan MTG Corp
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1000 Technology Drive
D Fallon, Missouri 63368
■ Complete items 1, 2, and 3. Also complete
tem 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Ardcle Addressed to:
Federal Home Loan MTG Carp
C/o Citimortgage, Inc.
1000 Technology Drive
C) Falitlll, iviisboUri 65_`66
A. Signature
x 1 £ T ❑ Addrassw
13. Reoglved Wr Prkf tad Name) c. Date of Delivery
1), Is delivery add raw different from Itvtn 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ cerKad Mali ❑ >~xprBse Mall
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❑ Insured Mall ❑ C.d.D.
4. Restrictad DslivW (Extra Fee) ❑ Yes
P. Artcle Number 7008 1300 - 0000 1106 5208
P5 Form 3811, February 2004 Domasto Return Receipt 102595-02-M-1540

NCDENR
Nr�rth r:7rnjjnR nr,,-mrtTPP t of Fnvironm�rt Njfil r l Rev, lIrC
UIVIS100 Of `<UdLel UUdilly'
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
February 7, 2012
CERTIFIIED MAEL N 7006 1300 00001106 5208
RETURN RECEIPT REQUESTED
Federal Home Loan MTG Corp
CID Citimortgage, Inc.
1000 Technology Drive
D Fallon, Missouri 63368
Subject: Notice of Violation (NOV-2011-OP-0021) Retraction
SQM Geothermal Injection Well
Permit No. WI0100045
Haywood County
To Whom it May Concern:
Dee Freeman
Secretary
nll 5crt��r,her 7'R_ 701 1. tht' Caln ins F)Wi�:inn of Winer (7ilalily'c 1�oiiift tr Protection Section
issued a Notice of Violations (NOV-2011-OP-0021) to Federal Dome Loan MTG Corp. Based on a
review of our records, this Notice of Violation was sent in error. Therefore, we herehy retract the
referenced Notice of Violations effective immediately. We apologize for any inconvenience this may
have caused. If you have any questions, please call Eric G, Smith at 919-807-6407, or email him at
ericTsmith, u� on�denr. eov.
Sincerely,
Debra J. Watts, Supervisor
Groundwater Protection Unit
Enclosures
cc: tishGriiie neE,1011al uiiMe - ►quucr 11WWcuo;x 0 tion wto eAclosllres
APS Central Files — Permit WI0100045 w/o enclosures
AQUIFER PROTECTION SECTION
1636 Mail SeMw Center, Raleigh, North Carollna 27699-1636 One
Locatioa:512 N. Salisbury St., Ra"h, North Caroline 27604 NQl ffiCai,Q�xna
phone: 91U07-8 64 FAX:[phone]i496 `/
Internet w.r�cr+raiarrtualilv.o� �vkits�r� ��
An Equal Opportunity 1 AfRrrnau%Action Employer

U
Postal ServiceTIFIED MAIL::., RECEIPT
stic Mail only: No Insurance coverage Provided)
ivery information visit our website at www.usps.com
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C3 1000 Technology Dr.
r� O Fallon, MO 63368
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■ Complete Rams 1, 2, and 3. Also complete
Item 4 if Restricted Oefivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front fr space permits.
1. Article Addressed to:
Federal Home Loan IVITG Corp.
C/O Citimortgage, Inc.
1000 Technology Or.
❑ Fallon, M❑ 63368
A. slgn
13 Agent
13 Addressee
G. Received by (PHnted Nerve]
C. Date of Deilvery
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D. Is delivery address Obrerd from ham i4 Oyes
If YES, enter delivery address below: 17 No
3- Service Type
13 Certffled Malt ❑ Express Mail
❑ Regletered ❑ Return Rscalpt for Merchandise
0 insured Mali ❑ C.O.D.
4 Restricted Delivery'! (Edra Fea} ❑ Yes
2. Article Number 7 010 0780 0001 7057 6140
Moxillar ftr" servits label}
PS Form 3811, February 2004 oameetic Return Receipt 1025954a2-Wt50

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water quality
Beverly laves Perdue goleen H, Sullins
Governor Director
September 28, 2011
CERTIFIED MAIL # 70I0 0780 0001 7057 6140
RETURN RECEIPT REQUESTED
Federal Home Loan MTG Corp
CIO Citimortgage, Inc,
1000 Technology Drive
O Fallon, Missouri 63368
Subject: Change of Ownership
Permit No. WIOI00045
5QM Geothermal Injection Well
Haywood County
To Whom it May Concern:
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 permit was issued to
Haywood Habitat for Humanity on March 1.2, 2007, and expires on February 29, 2012.
This permit was issued for the operation of a 5QM (Closed -Loop Mixed -Fluid) Geothermal
Injection Well on your property located at 17 Thompson Avenue, in Canton, North Carolina, As
the new property owner, you are responsible for maintaining this permit. Therefore,. it is
important that you submit a Change of Ownership farm within thirty (30) days of receipt of this
letter.
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms:
AQUIFER PROTECTION SECTION
IV6 Mail Sorvlcs Center, Raleigh, North Carolina 27699-1636
Lxaton: 2726 Caphal Boulevard Raleigh. North Carolina 27544
Rhone. 919.733-3221 I FAX [phone]: FAX 2: 919-715$fl491 Customer Service. 1-877-623-6749
Internet, ww*,ncwaterguaIItV,orp
An Equal CpDortullih 1 AfirrniMe Ar bn Emdorer
NDrt1Carolina
)Vanzl'l, ll f

A. Application for Permit (Renewal) to Construct andlor Use a Well(s) for Injection
with Geothermal Heat Pump System for Type 5QM Well(s) if the injection well
system on your property is still active.
Ea
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 57-94. For your convenience, a Change of
Ownership form, a renewal application, and a UIC Well System Status form are attached along
with a self-addressed envelope. The above referenced forms are also available on-line at the
DWQ website at hltr:liportal.nedenr,arg/web/wglapsigwpro/permit-applications#geotliermApps.
Thant: you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by entail at eric.s:_smitbiimcdenr,gov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
AP Central Files— Permit WI0100045 w/o enclosures

U.S. Postal Service
CERTIFIED MAIL��,, RECEIPT
(Domestic Mall only; No Insurance coverage Frovided)
For delivery information visit our website at w+eiw.usps.eom..
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ru Federal Home Loan MTG Corp.
7.9nr To- C/O Citimortgage, Inc.
E3ar, 1000 Technology Or.
or PO sox n
ry 0 Fallon, Missouri 63368
■ Complete items 1, 2, and 3. Also complete
ftem 4 If Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front If space permits.
1. Arbole Addressed to:
Federal Home Loan MTG Corp.
C/O Citimortgage, Inc.
1000 Technology tar.
❑ Fallon, Missouri 63368 -
A.
❑ Agent
e.�by( JnG Date of
�ra
0. Is delivery addresa4ilrrarent from sham 1? ❑ Yea
tf YES, enter delivery address below: 0 No
3. Service Type
❑ certified Mall ❑ Express Melt
❑ Registered ❑ Rahrm Receipt for Marchand be
© Insured Mall ❑ C-Q.O.
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{ Ps form 3811, February 2DD4 Dcmeaft Return Receipt 102911542-WISM

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
November 17, 2011
CERTIFIED MAEL # 7006 2150 0003 54671162
RETURN RECEIPT REQUESTED
Federal Home Loan MTG Corp
CIO Citimortgage, Inc.
1000 Technology Drive
O Fallon, Missouri 63368
Subject: Notice of Violation with Latent. to Enforce (NOV-201 1 -OP-002 1)
SQM Geothermal Wection Well
Permit No.1W10100045
Haywood County
To Whom it May Concern:
Dee Freeman
Secretary
The above -referenced permit, which was issued to Haywood Habitat for Humanity on March 12, 2007,
and expires on February 29, 2012, has not been converted to the new owner or renewed. This permit was
issued for the operation of a 5QM geothermal injection system on your property located at 17 Thompson
Avenue, in Canton, North Carolina.
On September 28, 2011, our office sent you a Change of Ownership form and a permit renewal
application package with instructions to submit the necessary paperwork within 30 days of its receipt. To
date, the Groundwater Protection Unit has not received your completed change of ownership or renewal
application package. in addition, our records do not indicate that the well system has been plugged and
abandoned.
Therefore, the following violation(s) exists:
VIOLATION 1:
Failure to obtain a permit prior to construction, operating, or using an injection is a violation of 15A
NCAC 2C .0211(a).
REQUMED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 days of receipt of this letter:
AWIFER PROTECTION SEMON
1636 Mall Service Center, Raleigh, North Carolina 276WI636
Location, 2-r 28 Capital Boulevard, Raie W. North Carolina 27604
Phone: [phone] FAX 1, 919-715-0588; FAX [phone]W I Customer Service.1-977.62W48
Internet: www.nrw0ter4La1JtY.0
An Equal Opponur0y ti AffirrnR Hive Amon Employer
One
NorthCarolina
Naturally

1. CHANGE OF OWNERSHIP. Since you are new property owner, you must first
convert the permit into your name before it can be renewed. Once we receive your
name change request, we can then process the permit renewal in Step 2 below. To
change the name of the permit, you must submit the following information:
a) A completed Permit NamelOwnership Change form (unclosed.).
b) A completed Status of fy�jection Well System form (enclosed)
2. APPLY FOR PERMIT RENEWAL. When you apply for and receive a renewal,
operation of your well system will be permitted to continue. As such, any operation
and maintenance procedures specified in your previous permit will be required. To
renew; you must submit the following information to the address below:
a) A completed Application for Permit (Renewall to Construct andlor Use a Wellls)
for Injection with Geothermal Heat Pump 5vstenz for Type 5QM Well{sl if the
injection well system on your property is still active (enclosed). This form must
be signed by each propertylpermit owner.
All forms must he submitted to the following address within 30 days of the receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a Change of Ownership
form, a renewal application, and a UIC Well System Status form are attached along with a self-addressed
envelope. The above referenced forms are also available on-line at the DWQ website at
httn: // Portal.ncdenr.orit/web/m,g/ans/gu-nro/permit-application.-#L,eothernzAi)ps.
Thank you in advance for your cooperation and timely response. If you have any questions, please call
Eric G. Smith at 919-715-6196, or email him at eric,R.smitisiu ncdenr.2o,.•.
Sincerely,
J6. �_� , L4JA
Debra J. Watts, Supervisor
Groundwater Protection Unit
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section wio enclosures
APS Central Files - Permit W10100045 w/o enclosures

i
Postal
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Craig Justus
C2
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48 Gladstone Rd.
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Asheville, NC Z88D5
orP08ar.
C�ly. SYaie,
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■ Complete items 1, 2, and 3. Also complete
Rem 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front If space permits.
t. Article Addressed to:
Craig Justus
4.8 Gladstone Rd.
Asheville, NC 28805
2. Article Number
MarnwftmaerwOOMW
PS Form 3811, FebRiary 2004
A. Signature
I R Agent
❑ Addressee
]0../7Rt�c. 4ed Lby 1PO M mej 0.`Date
�of Delivery
�r li�•'7f �:L Il .mil '1.1�� _ � �V 4�: �_ �_
D. Is dellvery address dirfe 17 d Yes
If YES, erner dellvsryfiy0 No
I --
IOU — ,. ZO o
V
S. %rvk* Type
Q OWtMW Mall
0 Rewered
© Retum Ipt far Me chwidise
❑ Insured Mail
❑ O.O.D.
4. Restricted Delivery? Aft Feq p yes
7010 0780 0001 7057 6133
Domestic Par um Receipt 102S95A2-W1$40

HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Govemor Director
October 3, 2011
CERTIk7RD MAIL # 7010 0780 0001 7057 6133
RETURN RECEIPT REQUESTED
Craig Justus
48 Gladstone Road
Asheville, NC 28805
Subject: Notice of Expiration (NOE)
5QM Geothermal Injection Well
Permit No. W10100046
Buncombe County
Dear Mr. Justus:
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 33 Walnut Grove Lane, in Asheville, NC, which was issued to you on March
6, 2007, and expires on February 29, 2012, is soon due for renewal. If you wish to keep this permit and
operate the injection well system, the permit must be renewed and issued in your name.
If Your Iniection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section .0214.
When each well is plugged and abandoned, the well abandonment record (Form GW-30) must be
submitted to our office to certify that the abandonment was properly conducted.
If there has been a change of ownership of the property, an Injection Well Permit Name/Ownership
Change Form must also be submitted. The GW-30 and Name/Ownership Change forms can be found at
htt-s:11portal.ncdenr.or2/web/wo/ai)s/gk pro/m,ortinw.-forms.
If Your Injection Well is Current1v 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 November 1. 2011.
AQUIFER PROTECTION SECTION
1636 Mall 5ervica Center, Raleigh. North Carolina 27699-1636
caratlon, 2728 Capital Boulevard. Raleigh, North Carolina 27604
Phone: [phone] FAX [phone]- FAX 2: 919.715-60481 Custorner Service: 1.577-623-6748
lntemel: www.ncwaterguallt ,or -
An Eoual Upoortunirr AMrrnF3hve nenon _mrrioyer
North Carolina
Naturally

In order to comply with the regulatory requirements listed under North Carolina Administrative Code
(NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following enclosed forms:
A. Application for Permit (Renewal) to Construct andlor Use a Well(s) for Injection with
Geothermal Heal Pump ,system for Type 50M Well(s) if the injection well system on your
property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been temporarily or
permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application and
a UIC well system status form are attacbed along with a self-addressed envelope. The above referenced
fortes are also available on-line at the DWQ website at
httn:llmortal.ncdenr.or«/webiwci/ai)s/g«;)roll}ermit-ap_niications#_-eathermALns.
Thant- 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.i�-.stnith(iiraodenr.eo�-.
Sincerely,
6�L "Y Jnu'A
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10100046 w/o enclosures

=nstrument# 2009005058 Soak 761 Page 11:
TUN MA 4k R
DATE � Y
HAYWOOD COUNTY •TAY CERTIFICATION
There ere no del uquenr taxce duc that an a hai,
I .J�288lrtStpflrCEl n1lmhPd0" �•' ,�^ - �D[
David and Caun :t -ollo
Date:
111111111151111111YV11l
2009006058
14AY44000 CC, NC FEE 420.00
STATE OF MC REAL ESTATF F XTK
$380"
W.,Kcv-xr.
05-22-2609 t 1:03:51 AM
AW R. WURRAY
ft rtnao
vy
f SCJNEFEA
BK: R9 761
PG:125-127
Excise Tax: $380.00 (S189,700.00) Parcel Identifier No. 8657-54-0622
Mail after recording to: Brown & Patten, P.A.
This insuwnent was prepared by: Gavin A. Brown, Attorney
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this I8`e day of May, 2009, by and between
GRANTOR
HAYWOOD HABITAT FOR
HUMANITY, INC.
a North Carolina Corporation
GRANTEE
1ESSIE ARREDONDO
and wife,
CHERYL ARREDONDO
17 Thomson Avenue
Cantors, NC 28716
The designation Grantor and Grantee as used herein shalt include said parties, their heirs, succes5ars, and assigns,
and shalt include singular, plural, masculine, feminine or neuter as required by context
WfTNESSES that the Grantor, for a valuable consideration paid by the Grantee, the receipt of
which is hereby ac}snowledged, does grant, bargain, sell and convey unto the Grantee in fee
simple, all that certain lot or parcel of land partially situated in the Town of Cantors, Haywood
County, North Carolina, more particularly described as follows:
SEE EXHIBIT "A" ATTACHED HERETO AND IMiCORPORATED
H EREf N B Y REF ERENC E FOR A COMPLETE
PROPERTY DESCRIPTION

Instrument* _0090050'�r3 acok in! 33+:c 125
The property hereinabove described was acquired by Grantor by instrument recorded in Deed
Hoof 550 at Page 136, Haywood County Registry.
A map showing the above described property is recorded in Plat C;abirlet C at Slut
Haywood County Registry
TO RAVE AND rO ROLD the aforesaid lot or parcel of land and a I I privileges and dppunenences therein
belonging to the Granwe in fee simple.
And the Grantor covenants with line Grantee, that Grantor is seized 01'thr premrscs in tee SiMp[,e. ;has the. right to
ctin vn the same to fee sl tstp Ie, lh at ride is rn arke!ab le and free and Clear of all anc u rn b ran C es. ;in it thl ti Gra vor %Vitt
1Varrani and defend the tithe against the Iawfirl claims of di persons µlromsoever except for the Gttapt rcms hcrcinatter
stated. Title to the property hereinahave described is sobjCi.1 ter 1hi- faltowins exceptions:
IN W ITN CS5 WItEREOF, the Grantor has hereunto u4 his hand and seat, or if corporate, has caused this
instrument to be signed m its ccxporate name by its duly authorized officers and as seal to be hereunto atFKed by
authorsty of its Board of Directors. the day and year first above wrihen -
H.AYNVO0D tI N R I 11 T rnR IIUkIA\,l rY. I,\C.
EAL)
8 MU, 1+•VC&'141-C*'' Kl.tifort\,F T)IRKTsrn
SEAL-ST'ANTP 'Fl C.AROI.FPn A, HAYWOOD C'OUN't l
I, ra,JI. �� , a Nut.try Public fur said eoultry and
state, cenif , that Marnette H. Celborne. peniorkally came betirre me t}sis
day d acknowledged that . e is Fxecutive Director of "in -wood habitat an
ruC9S ,, for humanity, Inc„ a North Caro Iina Corporation. and that by autourit}
O� pAY - duly givon and as the act of the corporation, executed the foregoing
�_ irument on behalf of the 1'wMWt co n. is my hand rind nfli v nstri01
`a Z U seal, this the 2 1 day of 1V y. ?O114
a x
My cc rn'swn Expires: u Nutary Public
The foregoing Certificate (sy of
Ware certified to be correct. This instrument and this certificate are duly registered at the date
and time and in the Hook and Page shown on the first page hereof.
RIEGISTER OF DEEDS FOR
COUNTY- BY _ Deputy/Assistant-Register of Deeds.

:astrw=z t# 2009005058 $our. I2I
ARRE9G3816
EXHIBIT "A"
BEGINNING on a point on the western margin of Thompson Avenue
at the northeastern comer of a tract of land described in a Deed from
Neal C. Bellamy, Jr. and wife, Mary Jean Bellamy to Sam R. Brown,
Jr. and wife, Virginia B. Brown dated May 29, 1959 and recorded in
Deed Book 177 at Page 379, Haywood County Registry; runs thence
with the western margin of Thompson Avenue in a northerly direction
to intersection with Skyland Terrace; thence in a westerly and
southerly direction with the southern and eastern margin of Skyland
Terrace to a point in the eastern margin of Skyland Terrace which is
the northwestern corner of the Sam R. Brown and wife, tract above
referred to; runs thence with the northern boundary of the Brown
tract, North 65 deg. 49' East 128.50 to the place of BEGINNING.
Being all of Fifth Tract described in a Deed to Blue Ridge Paper
Products, Inc. recorded in Book 472 at Page 1073.
BEING the same property conveyed from Blue Ridge Paper
Products, Inc., a Delaware Corporation to Haywood Habitat for
Humanity, Inc. by deed dated November 14, 2005 and recorded in
Book 650, page 136, Haywood County Registry,

t,
Page I c 2
_:Ite - r - : . 1 . , xuyw607 - 2. f F1 .7pe'cy = _ ..
Drscri'�['an Tax tistr_t'S
rlaz�t- 4657-54-9[22 5?-i IAAT Ti'dPf1—� - = C01 TOWN C: AN --VA
❑NNE Ij7 p _4TIO1T
I�:CT: 2G38Fc APaSDONDO, iESSIF
ARnMIRDO, CF]&AYL
THOMSGN AVS
�TON, NC 2016
NS SCa LI.eltiLUiS=NFQi'L'_T IGZd
=ownarsac 01 TOWN OF ANTCN
&adresa SI[Y LaND TSARACE
Land Use
Rb Yhood t UIR029 S➢[YLAND 7EARJR _E
Map 8657.12
Claaa v Al RES10=11-AL I
--- PdOFSR^:Y ?ACTOP
Topear,kchy
I R ROLLING
I
Land Mkt Ara: 9tipLrtB/Rvaa$
- PAVED
_____ ------- SN'r7A:;CE INPCRXATION ------
I Date Type Source Arpraleer
02lL111I icm
I
I
Page: 1
Tax Year : _1012
______— �RL E5 INFCFMF"_'I01
Cate Sales Price V_d 'A6 e,1
USM? 9 169, 7qg Y ro1l:25
i
VJ.Lir 3Ul•',YA4Y
Aaaessed
Current
Land
28,000
20.000
Bldg
154,400
154,400
Tot Avpr
182,400
182,400
Defer
0
0
1 het Taxable :
102,400
182,400
R ema r'cs ;
"GRPIN" nUILT i1Di:5a
--- LAND ➢ATA ---
7SSIT V A I. V E
R MT15 TYPE SIZE PA1CS ;SALE if Ar APPR DEFER TAX
1 A HP Fc�-EsITE PP22+34RY 0.61 44,450 Z9,000 0 25,000
Total Acxea ; 0.63 Laid Totals Z0.{i00 C 29,004
Y&AF EFF YR
hLDGI TYPE YTH CH'SCAIPTION R7.14P FFS tcomp STORIES AREA SR.D SU=LT BUILT COND PHY3 FUNC ECUti !'AX V_O.LUE
f l."+D I OUTHCI;.DING V_4LL_ 0
End of Page 1
=06 FEB 12 - by 0 Haywcod County NC Prope'_y neca_y Celt: Page: 2
CARD 1 OF '_
Parcel 4657-54-0622 SRYLAND TERRACE TR 5
Owner 205866 ARREBOND0, ,1ESSIE
------------- BUILDING DESCRIDITON------------
+Cd+
SCALE IS 1:192
?'A�, ME:ri6^_ . R.
C7 C5
USE CODE 0 DWELLIKG
! ?
OCCUPANCY SF SINGLE FAMI?1
1 I
STYLE : CONVENTIONAL
++-B++
IfB& STOAIE= 1.00
050P S5
WALE HEIGHT
! 4:0 !
FGZINDAT=6N r
-------4201+------
EX'TERIOR WALL LAP SIDING (ROW/ ?INK
1
eA 6�ILT I^F r 200�
1
1
CONDITION A AVERAGE
I
1
GRADE C
I
1
DESIGN FACTOR 20
I
I
BASc'4EN^_ AREA : 1,176 UNFIN:StE,
1
1
ATTIC AREA $0 ATTIC
I
1
F.N UPPER E70RY No
Ate
A25
UNFIN UPPER STORY r NO
I MA
I
A"W'S 15DRSS / 4
1 1176
1
JLL HALF B,ATUS r 2 1 0 ADDL F_X: 2
1
1
SIFZEFIACE TYPEICNT:
I
1
:IA r'yrlCE OPENTNGS: :' r'HI►NCYIS]
-A COND PCT
I
I
SPRINKLER PCT I
!
!
?EATING TYPE 1 E HEAT PUMP
1kRXIT FACTOR I
t_________-DIGA42__-+_____-
3 caXPLET£ i 100
! 1
DESCR=PT IOC] 1.❑/S/$
DB Da
OP !
128 1
http://maps.haywoodnc.net/prc/8657540622_I.txt
2/7/2012

Page 2 of 2
Heated 5q Ft : 1,174;
---------------
8J?WD=NC
3EMON
DETAIL ------
----___
LN TYPE
DESCF_PT70N
AREA
VALUP
If9T P4 F%
l MA
MAIN
Wzh
1176
I49,200
1.00
2 OP
OVrW
POACH
40
1,300
1.00
3 AO
WOOD
DECY,
20
500
l,OG
i ❑P
OPEN
PrJRCK
12B
3,400
1.00
---- ---------- WILDING COMPUTATION
RCN 182,469
PHY9 D--P4 i
I'JNC OnPR
ECON OUR
i COMPUTE 100
HCNLD 154,400
LAST 2ICTURE DATE t
End of Page 2
http://maps.haywoodnc.net/prc/8657540622—l.txt
21712012

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E;
Governor Director
t L1?tLiilS} 1.:.,I�,
CERTTFIED MAIL # 7006 2150 0003 54671612
RETURN RECEIPT REQUESTED
Jessie & Cheryl Arredondo
17 Thompson Avenue
Canton, NC 28716
Subject: Change of Ownership and Permit Renewal
5QM Geothermal Injection Well
Haywood County
Dear Mr. and Mrs. Arredondo:
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. permit was issued to
Haywood Habitat for Humanity on March 12, 2007, and expires on February 29, 2012.
This permit was issued for the operation of a 5QM (Closed -Loop Mixed -Fluid) Geothermal
Injection Well on your property located at 17 Thompson Avenue in Canton, North Carolina. As
the new property owners, you are responsible for maintaining this permit. Therefore, it is
important that you submit a Change of Ownership form within thirty (30) days of receipt of this
letter.
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms:
A. Application for Permit (Renewal) to Construct andlor Use a Wells) for Injection
with Geothermal Heat Pump System for Type SQM Wells) if the injection well
system on your property is still active.
- J P.-
AQUIFER PROTECTION SECTION
1636 Mail Service Conlar, Raleigh, North Carolina 27699-1636
Location: 512 N. Sallshury St., Raleigh, With Canollna 27644 N U C a
Phone: [phone]r4641 FR}C 919-807-i496*�
Internet . nrwaierauallty.nm L �f
An Equal Opportunity 1 Affdmdve Adion Employer FJ

B. Status of Injection Well S))stem if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the forms to:
r
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-163 6
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a Change of
Ownership form, a renewal application, and a UIC Well System Status form are attached along
with a self-addressed envelope. The above referenced forms are also available on-line at the
DWQ website at htt17:I portal.nedenr.or /web/w la s17w rol ermit-a lications# eothei•mA s.
Ty-.,z7t- -�1}t" 'i, - �V-'1'} �Ilj s. r7i:C �•{5f „s*.y y,+i. �i,.r] tiF„YI-r ���,•., V, I'�}�'. '�1}�.� h-.r+••�i it
please contact me by phone at (919) 80.7-o4O / or by emaii at ernc.k.satr1tt3-.t4ncdenr.,-ov.
Sincerely,
7
ICJ
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
AP Central Files — Permit W10100045 w/o enclosures

��
MCDEi�R
North Carolina Department of Environment and Natural Resources
Division of water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 28, 2011
CERTIFIED MAEL # 7010 0780 0001 7057 6140
RETURN RECEIPT REQUESTED
Federal Home Loan MTG Corp
CIO Citimortgage, Inc.
1000 Technology Drive
O Fallon, Missouri 63368
Subject: Change of Ownership
Permit No. WI0100045
5QM Geothermal Injection Well
Haywood County
To Whom it May Concern:
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 permit was issued to
Haywood Habitat, for Humanity on March 12, 2007, and expires on February 29, 2012.
This permit was issued for the operation of a 5QM (Closed -Loop Mixed -Fluid) Geothermal
Injection Well on your property located at 17 Thompson Avenue, in Canton, North Carolina. As
the new property owner, you are responsible for maintaining this permit. Therefore, it is
important that you submit a Change of Qwnershir+ form within thirty (30) days of receipt of this
letter. -
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms;
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Rale+ph, Noi lh Caraiena 27699-1636
Location: 2728 Capaal Boulevard, Raleigh, North Caroira 27604
Phone- 919-733.3221 i FAY 1; 915-715-0588; FAX [phone]Q48 I CustameF Service. l- i -7-6?3-5748
Intemet, www.ncwatsraualo.oM
An Equ4s Gpporwnily , Afrirmstioe Arlon EmVoycu
NortliCarolina

A. Application for Permit (Renewal) to Construct andlor Use a Well(s) for Injection
with Geothermal heat Pump System _for T}pe 5QM Well(s) if the injection well
system on your property is still active.
f
B. Status oflnjection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a Change of
Ownership form, a renewal application, and a UIC Well System Status form are attached along
with a self-addressed envelope. The above referenced forms are also available on-line at the
DWQ website at http://portal.ncdenr.org'web/",qlaps/LwproipL-rmit-applications#geothermApps.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at eric.S-.smith cbncdenr.gov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
APS Central Files — Permit W10100045 w/o enclosures

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakitd, P. E.
Governor Director
March 13, 2012
CERTIFIED MAIL # 7006 2150 0003 54671582
RETURN RECEIPT REQUESTED
Jessie & Cheryl Arredondo
17 Thompson Avenue
Canton, NC 28716
Subject: Notice of Violation with Intent to Enforce (NOV-2012-OP-0004)
SQM Geothermal Injection Well
Permit No. WI0100045
Haywood County
Dear Mr. and Mrs. Arredondo:
Dso Freeman
Secretary
This permit was issued for the operation of ' a SQM (Closed -Loop Mixed -Fluid) Geothermal
Injection Well on your property located at 17 Thompson Avenue in Canton, North Carolina. Our
records indicate that the referenced permit was issued to Haywood Habitat for Humanity on
March 12, 2007, and expired on February .29, 2012. As the new property owners, you are
responsible for mainutining this permit.
On February 7, 2012, the Aquifer Protection Section sent you Change of Ownership forms and
instructions on how to renew the referenced permit. As of the date of this letter, we have not yet
received a response from you,
Therefore, the following violation(s) exists:
VIOLATION 1:
Operation of your geotheimai injection well without a valid permit is a violation of 15A NCAC
02C .0211 (a).
RE TARED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 do),s of receipt of this letter:
AQUIFER PROTECTION SECTION
1636 Mall Serape Center. Raleigh, NoM Carolina 27699.1636 �� e
Location; 512N. Sall$Wry St, Raleigh, North CariAna 27W iVorthCuolina
Phone, 9 19-807 -64 64 1 FAX [phone]
Internet� I .
Naturally
An Equal Nparlundy 1 Affirmative Aebon Employer

Submit a Change of Ownership form (enclosed) and submit one of the following enclosed forms
within thirty (30) days of receipt of this letter:
A. Application for Permit (Renewal) to Construct andlor Use a Well(s)for Injection
with Geothermal Heat Pump System f)r Type SQeV! Weld(s) if the injection well
system on your property is still active.
.OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a tamely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a Change of
Ownership, renewat application, and a well system status forms are attached along with a self-
addressed envelope. The above referenced forms are also available on-line at the DWQ website
at httts:llportal.iicdetir.orglweb/wti/aps/gwpro/permit-gpl)lications#geothermAgus.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact Eric G. Smith by phone at [phone] or by email at
eric.g.smith a.nedenr, kov.
Sincerely,
aA WA,
]. Watts, Supervisor
Groundwater Protection Unit
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
APS Central Files — Permit W 0100045 w/o enclosures

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
Februarti 7. 2012
CERTIFIED MAIL # 7005 1300 0000 11065208
RETURN RECEIPT REOUESTED
Federal Home Loan MTG Cork
C/O Citimortgage. Inc.
1000 Technology Drive
Q Fallon, Missouri 63368
Subject: Notice of Violation (NOV-201 1-OP-0021 ) Retraction
5QM Geothermal injection Well
Permit No. W101000.15
Haywood County
To Whom it May Concern:
Dee Freeman
Secretary
On September 28, 2011, the North Carolina Division of Water Quality's Aquifer Protection Section
issued a Notice of Violations (NQV-2011-QP-0021) to Federal Hone Loam MTG Corp. Based on a
review of our records, this Notice ❑f Violation was sent in error. Therefore, we hereby retract the
referenced Notice of Violations effective immediately. We apologize for any inconvenience this may
have caused. If you have any questions. please call Eric G. Smith at 919-807-6407. or email him at
cricx.smit wticdenE.Zgy.
Sincerely,
���
N-Iffl
Debra J. Watts, Superrisor
Groundwater Protection Unit
Enclosures
cc: Asheville Regional 017ice - Aquifer Protection Section w/o,enclosures
APS Central Files -- Permit W10I 00045 w/o enclosures
M
CA
rY
v
•L,
fi :'.I1FER aRC:TEC 10N ISECT':,.V
`wM We Sri* CeR1Cr Raler,h, MOM Carr.l;na 2ro99� 1 1
0lii I or.?[ -Ft i12 V Sa story 51 . RaOO. Nwh Ca .IPr..i 27604 North Carol Ill a
%^B'c' iq aJ; %44 FAX 9T5 G ; -uRti Al
;!'r5;^e, ++rwi+.ntsratemuality.orr�

C alA
February 27, 2012
North Carolina Department of Environment and Natural Resources
Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699
RE: Property located at; None Provided
Dear Sir/Madam:
CitiMortgage has received the enclosed notice regarding the property and/or owner referenced above.
CitiMortgage was unable to identify the customer, account, or interest in the property. Please provide
additional documentation or information regarding the property or its owner, such as:
Deed of trust
Mortgage
Social Security number of the previous and current owner/mortgagor
Loan number
Title information
Please forward any documents or information to CitiMortgage at the address shown below.
If you have any questions, please contact the CitiMortgage at [phone], Option 1 to discuss this
matter.
Sincerely,
CitiMortgage
Property Preservation/Code Violation
877-2190-3997 Option l
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North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
November 17, 2011
CERTIFIED MAIL # 7006 2150 0003 5467 1162
RETURN RECEIPT REQUESTED
Federal Home Loan MTG Corp
C/O Citimortgage, Inc.
1000 Technology Drive
O Fallon, Missouri 63365
Subject: Notice of Vioiation with Intent to Enforce (NOV -2011-OP-4421)
5QM Geothermal Injection Well
Permit No. WI❑100❑45
Haywood County
To Whom it May Concern:
Dee Freeman
Secretary
The above -referenced permit, which was issued to Haywood Habitat for Humanity on March 12, 2007,
and expires on February 29, 2012, has not been converted to the new owner or renewed. This permit was
issued for the operation of a 5QM geothermal injection system on your property located at 17 Thompson
Avenue, in Canton, North Carolina.
On September 28, 2011, our office sent you a Change of Ownership form and a permit renewal
application package with instructions to submit the necessary paperwork within 30 days of its receipt. To
date, the Groundwater Protection unit has not received your completed change of ownership or renewal
application package. In addition, our records do not indicate that the well system has been plugged and
abandoned.
Therefore, the following violation(s) exists-.
1'1G]".111191MIF
Failure to obtain a permit prior to construction, operating, or using an injection is a violation of 15A
NCAC 2C .0211(a).
RE, OUIRED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 days of receipt of this letter.
ADJIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
I-aeaton' 2728 Capital Boulevard, Ralegh, North Carolina 27604
Phone: [phone] FAX 1; 919-715.0588; FAX [phone]a4g1 Customer 5ervioe. 1-877.623.679
Intemec www,nswateroualitv,ora
hn Equal dpponuniry i AthrmativP Ac»mn Employer
I�"h Carolim
NNaturally

1. CHANGE OF OWNERSHIP. Since you are new property owner, you must first
convert the permit into your name before it can he renewed. Once we receive your
name change request, we can then process the permit renewal in Step ? below. To
change the name of the permit, you must submit the following information:
a) A completed Permit NamelOwnership Change form (enclosed).
b) A completed Stomas afli jection Well System form (enclosed)
2. APPLY FOR PERMIT RENEWAL. When you apply for and receive a renewal,
operation of your well system will he permitted to continue. As such, any operation
and maintenance procedures specified in your previous permit will he required. To
renew, you must submit the following information to the address below:
a) A completed Application.for Permit (Renelval) to Construct andlor Use a Well(s)
for Injection with Geothermal Heat Pump Svstem,for Type 3Q M ff,`ell{s) if the
infection well system on your property is still active (enclosed). This farm mast
be signed by each propertylpermit owner.
All forms must be submitted to the following address within 0 days of the receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit
LTIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 57-94. For your convenience, a Change of Ownership
form, a renewal application. and a UIC Well System Status form are attached along with a self-addressed
envelope. The ahove referenced forms are also available on-line al the DWQ website at
httn:!/liortal.ncdenr.orL/webiwo/ar)s/ n�'nroipermit-au-)lications-4tzenthermAss.
Thank you in advance for your cooperation and timely response. If you have any questions, please call
Eric G. Smith at 919-715-6196, or email him at ericx.smith(-&mcdenr. aoN .
Sincerely,
J4r,3, LAJA
Debra I Watts, Supenrisor
Groundwater Protection Unit
Enclosures
cc: Ashexille Regional Office - Aquifer Protection Section wio enclosures
APS Central Files - Permit W10100045 w/o enclosures

w= o'l 000y S
February 1, 2008
Rickey Kitchen
P.O. Box 99
Penrose, NC 28766
Subject: Geothermal Well Installation Data
Dear Mr. Kitchen:
Michael F. Easley, Cmvemor
William G. moss Jr., Secretary
North Carolina Departmem Qf Environment and Natural Resources
Coleen Sullins, Director
Division of Water Quality
In review of our records concerning closed -loop geothermal mixed -fluid injection well systems,
classified as 5QM type permits, we have found the following records have not been submitted
for permits where your company is listed as the heat pump installers:
Well Construction Record (CW-1)
Triangulation Data
Mechanical Integrity Pressure or Vacuum/Leak testing data
In order to assist your clients (those who hold 5QM permits) in meeting the condition of their
permits, we request your assistance to provide the above information no later than March 15,
2008. For future reference, we recommend you provide this information to your clients as soon
as construction is complete to assist them in meeting the condition of their permits. Also, please
remember their permits require them to keep this information on -site as well.
To assist you, we have attached a list of permits where you are listed as the heat pump installer,
We have also attached a form to fill out the results of your mechanical integrity tests. Thank you
in advance for your cooperation and timely response. If you have any questions regarding this
letter, please call me at [phone] or Michael Rogers at [phone].
Sincerely,
0&,—A
VJA
Debra J. Watts
Environmental Supervisor
Groundwater Protection Unit
Attachment(s)
cc: APS Central Files (copy to each permit file on attached list)
Each Permittee on attached list
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internev WWWJL�w31er�ual'tE�.urg Location: 2728 Capital Boulevard Raleigh, NC 27604
An Equal opportunity/Afinnative Action Employer- 50% Recyded110% Post Consumer Paper
tw
Carolina
allf
Telephone: [phone]
Fax 1: [phone]
Fox Z: [phone]
Cusux=Service: [phone]

Issued Permits with Rickey Kitchen Listed as Heat Pump Contractor
January 11, 2008
Permit No.
Name
Date Permit Issued
WI0100046
Craig Justus
3/6/2007
W10100047
Phil Donehower
3/912007
WI0100045
Habitat for Humanity
3/1212007
WI0100052
I Ron Thompson
9/11/2007

Mechanical Integrity Test Record
(For 5QM Geothermal Heat Pump Injection Well System)
OwnerlPesmittee Name: Permit Number: W1
Facility Address:
Home Phone: Cell Phone:
Heat Pump Contractor Name:
Office Phone: Cell Phone:
Tester Name,
Date of Test:
Signature:
I Lo�op 1 lninai rressure sp rinat rressure sl1 1luranoII (mmutes) rasa yes or ivol
2
3
1
4
f
5
5
7
8
G
9
10
1 11
12
13
14
�I
15
Any additional loop testing add to back of this form
Comments:
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24 hours
prior to the initiation of the operation of the facility. You can send the form by mail: UIC Program, Mail Service Center 1636,
Raleigh, NC 2769� or by fax: [phone].
Mechanical lntegrity Tear Farm 11 R007

p�pF WAG Michael F. Eadey, Governor
William G. Rvas Jr., Secretary
r North Carolina Department of Environment and Natural Resources
7 DAG
QV�e 'C Coleen Sullins, Director
Division of Water Quality
January 11, 2008
Rickey Kitchen
P.O. Box 99
Penrose, NC 28766
Subject: Geothermal Well Installation Data
Dear Mr. Kitchen:
In review of our records concerning closed -loop geothermal mixed -fluid injection well systems,
classified as SQM type permits, we have found the following records have not been submitted
for permits where your company is listed as the heat pump installers:
■ Well Construction Record (GW-1)
■ Triangulation Data
■ Mechanical Integrity Pressure or Vacuum/Leak testing data
In order to assist your clients (those who hold SQM permits) in meeting the condition of their
permits, we request your assistance to provide the above information no later than February 29,
2008. For future reference, we recommend you provide this information to your clients as soon
as construction is complete to assist them in meeting the condition of their permits. Also, please
remember their permits require them to keep this information on -site as well.
To assist you, we have attached a list of permits where you are listed as the heat pump installer.
We have also attached a form to fill out the results of your mechanical integrity tests. Thank you
in advance for your cooperation and timely response. If you have any questions regarding this
letter, please call me at [phone] or Michael Rogers at [phone],
Sincerely,
L&- J. k'4
Debra 1. Watts
Environmental Supervisor
Groundwater Protection Unit
Attachment(s)
cc: APS Central Files (copy to each permit file on attached list)
Each Permittee on attached list
Aquifer Protection Section 1636 Mail service Center
intemei: www.ncwaterqua4(v,om Location: 2728 Capital Bou1everd
An Equal 4pportunllylAffirmative Adlon Employer— 5D% Recydecill0 G Po9t Consumer Paper
20,ato tUra y
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh. NC 27604 Fax l: [phone]
Fax 2: [phone]
Customer Service: [phone]

Issued Permits with Rickey Kitchen Listed as Heat Pump Contractor
January 11, 2008
Permit No.
Name
Date Permit Issued
WI0100046
Craig Justus
3/6/2007
W101OU047
Phil oonehower
3/912007
W10100045
Habitat for HumanitX
3/12/2007
W101Q0052
Ron Thompson
911112007

Mechanical Integrity Test Record
(For 5QM Geothermal Heat Pump Injection Well System)
Owner/Permittee Name: Permit Number: WI
Facility Address:
Home Phone: Cell Phone:
Heat Pump Contractor Name:
Office Phone: Cell Phone:
Tester Name: Signature:
Date of Teat:
Loop Initial Pressure (psi) Final Pressure (psi) Duration (minutes) Pass (Yes or No)
2
3
7
s I
9 a
10
ll I G
12
13
14
15
Any additional loop testing add to back of this form
Comments:
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24 hours
prior to the initiation of the operation of the facility. You can send the form by mail; 1AC Program, Mail Service Center 1636,
Raleigh, NC 27699 or by fax: [phone].
Mecbanical lntegriry Test Fcum I 1/2007

+ Q Michael F_ Easley, Governor
O� William G. Ross Jr., Secretary
> '1 North Carolina Department of Environment and Natural Resources
r Alan W. Klimek, P.E. Director
Division of Water Quality
March 12, 2007
Ms. Marnette Colborne
Executive Director, Haywood Habitat for Humanity
P.O, Box 283
Waynesville, NC 28786
Re: Issuance of Injection Weil Permit
Permit No. WIOI00045
Haywood Habitat for Humanity
Dear Ms. Colborne:
In accordance with your application received January 5, 2007, 1 am forwarding Permit No.
W10100045 for the operation of a vertical closed -loop geothermal mixed -fluid heat pump
injection well system to be located at 17 Thompson Avenue, Canton, Haywood County, North
Carolina 28716. This permit shall be effective from the date of issuance until February 29, 2012,
and shall be subject to the conditions and limitations stated therein.
Pay special attention to the well construction standards in Parts II and V of your permit.
You must notify this office (Raleigh Central Office) and the Asheville Regional Office at least
forty-eight (48) hours prior to constructing the system, and forty-eight (48) hours prior to
initiation of the operation of the system.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit three months prior to its expiration date. As indicated in the
permit, this permit is not transferable to any person without prior notice to, and approval by, the
Director of the Division of Water Quality. If you have any questions regarding your permit or
the Underground Injection Control Program please call Mr. Qu Qi at [phone] or me at
[phone].
Best Regards,
Michael Rogers
Hydrogeological Technician 11
cc: Landon Davidson — Asheville Regional Office
Central Office File — W10100045
Andrew Messer — Effecta Solutions
Attachment(s)
M1�"ehCaralIi'p
Aquifer Proteetion Section 1636 Mail Service Center Raleigh, NC 2 76 99-163 6 Telephone: [phone]
laternec htto:l_hwn w.n y$tsrgyality,,org 2728 Capital Boulevard Raleigh, NC 27604 Fax l; [phone]
Fax 2: [phone]
An Equal opportunitylAfirmativa Action Employer— 50% ReRc5adfl0% Post Consumer Paper Customer Service: [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other
applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
HAYWOOD HABITAT FOR HUMANITY
FOR THE CONSTRUCTION AND OPERATION OF 4 TYPE 5 QM 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 geothemial-mixed-fluid heat pump
system. This system is located at 17 Thompson Avenue, Canton, Haywood County, Nortli
Carolina, and will be constructed and operated in accordance with the application received
January 5, 2007, and in conformity with the specifications and supporting data submitted, all of
which are filed with the Department of Environment and Natural Resources and are considered a
part of this permit.
This permit is for Construction and Operation only and does not waive any provisions of the
Water Use Act or any other applicable Laws, Rules, or Regulations. Operation and use of an
injection well shall be in compliance with Title 15A North Carolina Administrative Code 2C
.0100 and .0200, and any other Laws, Rulers, and Regulations pertaining to well construction and
use.
This permit shall be effective, unless revoked, from the date of its issuance until February 29,
'1012, and shall be subject to the specified conditions and limitations set forth in Parts I through
LAC hereof.
Permit issued this the k' day of VTW� , 2007.
��)22 . �,3�t
an W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission..
Permit No. W10100045 Page 2

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 (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 pubject to flooding_ Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to: DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff, 1636
Mail Service Center, Raleigh, NC 27699-1636, within 30 days of completion of well
construction.
PART II - WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the Permittee or his agent shall test the pH of
the soil at a depth of three feet at the planned well location. If the resulting soil pH is less
than 6 standard units or greater than 11 standard units, the well system shall be equipped with
a compatible cathodic protection system. All testing results shall be kept on site available for
inspection.
2. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the
Aquifer Protection Section's Underground Injection Control (UIC) Program Central Office
staff, telephone number [phone] and the Asheville Regional Office Aquifer
Protection Section Staff, telephone number [phone].
3. All underground tubing shall be refrigeration grade copper tubing.
Pemsit No. W10100043 Page 3

4. Prior to installation, all tubing to be placed in boreholes ("loops") shall be checked for leaks
by pressurizing the loop to a gage pressure of at least 350 pounds per square inch (prig),
immersing the loop in water and examining it for leaks. Loops with leaks shall not be
installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents,
and scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop
by the manufacturer before shipping is still present at a pressure of at least 300 psig. The
loop manufacturer shall be notified in the event of damage or pressure loss, and the
manufacturer's instructions shall then be followed. The nitrogen charge may be released
only when the loop is installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting,
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A
North Carolina Administrative Code 2C ,0100) shall be pumped via tremie pipe into the
annular space of each borehole so as to completely fill it from bottom to top.
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material
shall have a galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
10. After installation and prior to operation of the system, a mechanical integri ry 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_twenh--four (24)
hours prior to the initiation of the o eration of the facility for injection.
11. The location of each of the system manifolds shall he recorded by triangulation from two
permanent features on the site (e.g,, building foundation comers). The Permittee shall retain a
copy of the triangulation records. The Permittee shall also submit a copy of the triangulation
records to the Aquifer Protection Section within 30 days of completion of well construction.
12. The written documentation required in Part II, paragraphs 0 0) and (11) shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Permit No. WTO100045 Page 4

PART III - OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV - PERFORMANCE STANDARDS
I. 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 Perr ittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V - OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section's
Underground Injection Control (MC) Program Central Office staff, telephone number
[phone], and the Asheville Regional Office Aquifer Protection Section Staff,
telephone number [phone]. Notification is required so that Division staff can
Perrot No. WI0100045 Page 5

inspect or otherwise review the injection facility and determine if it is in compliance with
permit conditions.
PART VI - INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
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 sampluig 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 Asheville Regional Office, telephone number (828)
296-4504, any of the fallowitig:
(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.
1 Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to the
Director, the relevant and correct facts or information shall be promptly submitted to the
Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
Permit No. WI0100045 Page 6

PART VM - PERNQT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART IX - CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(1), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the .Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(13) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel -packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
Permit No. WIOI 00045 Page 7

(G) The Permittee steall 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-LUC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Permit No. WIQ100045 Page 8

Michael F. EasiWy, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
ranuary 9, 2007
NIARNETTE COLBORNE
HAYWOOD HABITAT FOR HUMANITY
PO BOX 283
WAYNESVILLE NC 28786
Subject: Acknowledgement of Application No. WI0100045
Haywood Habitat for Humanity
Surface Irrigation - 5FR (Single Family Residence)
Transylvania County
Dear Mr. Colborne:
Alan W. Klimek, P.E. Director
❑Ivlsion of Water Quality
The Aquifer Protection Section of the Division of Water Quality (the Division) acknowledges receipt of
your permit application and supporting materials on January 5, 2007. This application package has been
assigned the number listed above and will be reviewed by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if
necessary. To ensure the maximum effi6iency 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
[e-mail]. If the reviewer is unavailable, you may leave a message, and they will
respond promptly, Also note that the Division has reorganized. To review our new organizational chart,
go to htlp:llh2o.enr.state.nc.us/documents/dwil org-chart.l7df.
PLEASE REFER TO THE ABOVE APPLICATTON NUMBER WHEN MAKING,INQUiRUS
ON THIS PROJECT.
Sincerely,
i
for Debra J. Watts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Permit Application File WI01GO045
Aquifer Protection: Section 1636 Mail Service Center
Intemet: www.ncwateraualiiv.ora Location: 2728 Capital Boulevard
An Equal 4pporunitylAfllrmative Action Employer- 50% Recyclad110% Post Consumer Paper
talCUT411
na
Raleigh, NC 27699-1636 Telephone: (919y 733-3221
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

Central ✓ vies: APS SNIP
03/12/07
Permit Number W10100045 Permit Tracking Slip
Program Category Status Project Type
Ground Water In review New Project
Permit Type Version Permit Classification
Injection Mixed Fluid GSHP Well System (5QM) Individual
Primary Reviewer
michael,rogers
Permitted Flow
Facility Name
Haywood Habitat for Humanity
Location Address
17 Thompson Ave
Canton NC 28716
Owner
Permit Contact Affiliation
Major/Minor
Region
Minor
Asheville
County
Haywood
Facility Contact Affiliation
Marnette
Colborne
PO Box 283
Waynesville NC 28786
Owner Name
Owner Type
Haywood Habitat for Humanity
Non -Government
Owner Affiliation
Marnette Colborne
PO Box 283
Waynesville NC
28786
Dates/Events
Scheduled
Drlg Issue App Received Draft Initiated
Issuance Public Notice Issue Effective
Expiration
01 /05107
Regulated Activities
RequesteWReceived Events
Neat Pump Injection
RO staff report requested
01/10/07
RQ staff report recelved
02/28/07
Outfall NULL
Waterbody Name
Stream Index Number Current Class
5ubbasin

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date:
To: Aquifer Protection Section Central Office
Central Office Reviewer:
Regional Login No:
CountyAOWO
Permittee:4e14V'W4W'ry
Project Name:
Application No.: Wr 01 DDv45-
L GENERAL INFORMA TIGN
1. This application is (check ali that apply): EKNew ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Anachment S included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation [KOther Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ❑ Yes or ❑ No.
a. Date of site visit: Zm i OL 'L [
b. Person contacted and contact information: t 1AA.&rf_rrF &GRO"
c. Site visit conducted by: - /
d. Inspection Report Attached: 9Yes or ❑ No.
2. Is the fallowing information entered into the E1MS record for this application correct?
Z Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b, Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
RECEIVED ► DENR I DWO
JQlllp PAnr 1noN SECTION
FEB S S 2007.
e. Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For Disposal and In*ection Sites:
(If multiple sites either indicate which sites the information avolies to, copy and paste a new section into the
document for each site, or attach additional pages for each site
a. Location(s): I 7 T4t&W , 4 - '�H'rf�'+r • h�L Z '_1/ c
b. Driving Directions: _T'V VJ 31 S'4 t4WfPV g I4- ,%4A-J Ar
c. USGS Quadrangle Map name and number:
d. Latitude: !° V"30•46" Longitude: Z° 57O ' ST O fe
'SIT a'f
Tl. NEWAND MAJOR MGDIFIC4 TIGNAPPLIC4 TIGN,S this section not needed for renewals or minor
modifications, skin to negsecdonl
Description Of Waste 5 And Facilities
I. Please attach completed rating sheet. Facility Classification: 414
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 E NIA. 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? Q Yes ❑ No ❑ NIA, If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? EK
Yes ❑ No ❑ NIA. If no, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑ No X
N/A. If no, please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
❑ Yes.❑ No ® N/A. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
❑ Yes ❑ No El. NIA. 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 [KNo. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit:
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? ❑ Yes ❑ No 0 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 [ NIA If yes, attach list of sites
with restrictions (Certification B?)
III. RENEWAL AND_ &IODIFICATIONAPPLIC4TIONS (ase previous section for new or mrior mmdifcatian
s -stemrs
Description Of Waste(S) Aud Facilities
L Are there appropriately certified ORCs for the facilities? ❑ Yes or ❑ No.
Operator in Charge: Certificate #:
Backup- Operator in Charge; Certificate g:
2. Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? ❑ Yes or ❑ 'No.
If no, please explain:
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? ❑ Yes or ❑ No. If no, please explain:
FORM: Documentl 2

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain:
S. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
❑ Yes or ❑ No. If no, please explain;
6. Are the existing application rates (hydraulic or nutrient) still acceptable? ❑ Yes or ❑ No. If no, please
explain:
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ❑ 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:
S. Will seasonal or other restrictions be required for added sites? ❑ Yes ❑ No ❑ NIA If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? ❑ Yes or ❑ No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit:
10. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct?
Yes or ❑ No. If no, please explain:
11. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ❑ N/A. If no, please explain:
12. Has a review of all self -monitoring data been conducted (GW, NDMR, and NDAR as applicable)? ❑ Yes or
❑ No ❑ 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; 11
Current enforcement action(s) ❑ Currently under SOC; ❑ Currently under JOC; ❑ Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc):
14. Have all compliance dates/conditions in the existing permit, (5OC, JOC, 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 ❑ N/A. If yes, please explain:
FORM: Document? 3

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV, INJECTION WELL PERMIT" APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities — New Renewal And Modification
I. Type of injection system:
❑ Heating/cooling water return flow (5A7)
® Closed -loop heat pump system (5QM15QW)
❑ In situ remediation (51)
❑ Closed -loop groundwater remediation effluent infection (5LP'Non-Discharge")
❑ Other {Specify:
2, Does system use same well for water source and injection? ❑ Yes No
3. Are there any potential pollution sources that may affect injection? ❑ Yes Z N❑
What is/are the pollution source(s)? . What is the distance of the injection well(s) from the pnllution
source(s))_ ft.
4. What is the minimum distance of proposed injection wells from the property boundary? -`:_Q fit.
5. Quality of drainage at site: N Good ❑ Adequate ❑ Poor
fir. Flooding potential ofsite: ® 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:
S. 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.
In'ection Well Permit Renewal And Modification Onlv:
1, For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
❑ Yes ❑ No. If yes, explain:
2. For closed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑ No. If Yes, explain:_
3. For renewal or modification of groundwater remediation permits (of any type), will
coiitinuedladditional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? ❑ Yes ❑ No. It Yes. explain:
4. Drilling contractor- Name;
FORM: Document] 4

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: Pa - A Maw EF-�U* -5acU7-,, ,1r
91 /9) 4SS-- 3 2f-0
Certification number: 3
3. Complete and attach Well Construction Data Sheet.
FORM: Document]

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V EVAL U4TIONAND RECOAINIEND.4 TIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly.
d. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ issue upon receipt of needed additional information: ®,
Issue; ❑ Deny. If deny, please state reasons:
e 6
S. Signature of report preparer{s}:
Signature of APS regional supervisor: ? - Ir
_ -
Date:-k-010Z-7-3
ADDITIONAL. RECIO.IVAL STAFFREVIE FVITEAIS
FORM: Documentl 6

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERNQT TO CONSTRUCT AND/OR USE A
WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In Accordance with the provisions of NCAC Title 15A: 02C.0200
Complete application and mail to address on the hack page.
TO: DIRECTOR. NORTH CAROLINA DIVISION OF WATER QUALITY
DATE; December 21st , 20 06
A. SYSTEM CLASSIFICATION Please ruck column which matches proposed system.
(1) Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) x Type 5QM wells contain a subsur&ce system of continuous piping, that is
isolated from the environment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3)
Type 5QW wells contain a subsurface system of continuous piping, that is
isolated from the environment and only circulates potable water. If you schwted
this well type, then complete farm GW-57 C4 Nodfrcation Of Intent To
ConrtmetA Closed -Loop Geothermal --Water Only injection Well.Syslem.
B. PERMIT APPLICANT
Name:
Haywood Habitat for Humanity
Address:
17 Thompson Ave.
City
Canton State: AC Zip Code: 28716 County: Hayvaod
Telephone:
919-342-2991
C. PROPERTY OWNER (if different frorn applicant)
Name.
Haywood Habitat for Humanity
Address:
P.D. Box 283 --
City
Waynesville Sate KC Zip Code: 28786 County. Haywood
Telephone:
82 8 -24 6- 34 9 8
D. STATUS OF APPLICANT
Private: x Federal:
State: Municipal:
Commercial:
Native American Lands:
Revised 7106 GWIUIC-57 HP Page I of 4

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Feder State, Municipal or Commercial).
Name of Business or Facility:
Address: rw ► l�►l t
City: Zip Code: Z t 71 6County: _ 11 R I wr-
felephone: Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: Rickey Kitchen
Address.. P.O. Box 99
City: Penrose Zip Code: 28766 County: Transylvania
Telephone: [phone]BB5 Contact Person: Rickey Kitchen
G. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
Injection wells (bore holes) will be used as a geothermal heat sink. Geothermal ground
loops will be placed in the temporary bore holes. Bore holes will be continuously grouted
Erom the bottom to the top.
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO x
(2) Personal consumption? YES NO x
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 best of your knowledge. Attach a copy of Form GW-
1 (Well Construction Record) if available.
x PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW- i after construction.
(1) Well Drilling Contractor's Name: Effecta Solutions, LLC - Stephen Keener
NC Contractor Certification number: 3468
(2) Date to be constructed: AsAP Earl,, Jan a7 Number of borings: 4
Approxinmac depth of each boring (feet): 75'Et
(3) Well casing: Is the well(s) cased?
(a) YES if yes, then provide the casing information below.
Type: Galvanized steel Black steel Plastic Other (specify)
Casing depth: From to fL (reference to land surface)
Casing extends above ground inches
(b) NO x
Revised 7/06 GWaAC-57 HP Page 2 of 4

(4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement x Bentonite x Other (specify) _ Silica Sand
(a) Grouted surface and grout depth (reference to land surface):
x around closed loop piping; from o to 75 (feet).
around well casing; from to (feet).
(5) Screens (For Type 5A7 wells)
(a) Depth: From to feet below ground surface.
(6) N.C. State Regulations (Title 15A NCAC 2C .0200) require the permittee to make provisions
for monitoring welihead processes. A faucet on both influent (fluid entering heat pump) and
effluent (fluid being injected into the well) lines is required Will there be a faucet. on:
(a) the influent line? yes x no (b) the effluent line? yes no x
(7) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,
provide the data in part K (1) of this application form to the best of your knowledge.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITITER EMSTTNG OR
PROPOSED WELLS !F TWS INFORMATION IS UNAVAB-ABLE BY OTHER MEANS.
3. PROPOSED OPERATING DATA (for Type 5A7 wells)
(I) Injection rate: Average (daily) ______gallow per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/squam inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) ° F.
K_ INJECTION FLUID DATA
(1) Fluid source (for Type 5A7 wells) If underground, from what depth, formation and type of
rock/sediment unit will the fluid be drawn (e.g., granite, limestone, sand, etc.).
Dcplh: Formation: Rocidsedimeat unit:
(2) Chemical Analysis of Source Fluid (for Type 5QM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
R-ZS Refrigerant
L. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
M. LOCATION OF WELL(S) Attach two maps.
Revised 7106 G W/i]IC-57 HP Page 3 of 4

(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies,
potential sources of groundwater contamination and the orientation of and distances between
the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet of the geothermal heat pump well system. Label all
features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
N. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
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 ray 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."
9
ign ire o Wel [iwner or-�[Authh" Ag
t l �U 1JE ¢ -We a- cured Qgent swing on hQ Qf� 8 ,
pleme Wply a lever signed by the owner authorizing the above agent
P. CONSENT OF PROPERTY OWNER (Owner weans any person who holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of corrtrary 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 .42 0)
fi ,
(Si lire Of Prope r If [Tiffirent From Iicarit}
Please return two copies of the completed Application package to:
F�8 0 .2
TIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Revised 7106 GW/WC-57 HP Page 4 of 4

Jan 05 07 10:25a Marnetta H. Casborne
828-4,%0732 P.1
(1) Jclude a site map (can be drawn) shuMalp buildings, property linen, surface watar bodies,
potentiat sources of groundwater eontarnhod n and the orientation of and distances between
ft proposed vYeU(a) and any existfg well(s) or waste disposal Iseillttes such as sic am" or
drain fields located witNn 1000 feet of the geodurmal 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 f x:ility's locution and fine map name.
N. PFRMiT LIST: Attach a i'tst of all permits or oom3Mmction approvals the are related to the site.
Examples include:
(1) Hazardous Waste h4anagement program pawdta under RCRA
(2) NC Mtsion of Water Qualm+ Nora -Discharge getmifs
(3) Sewgge Tremirnent and Disposal Permits
❑. CERT11FICATION
"I hereby ceeri fy, under penalty of law, that I haws personally examined and am familiar with the
information submitted in this document and all ambraerds thereto sod that, be oa my mgtury of
those individuals immedlamty responsible for obb4ft said inf=aWn, I believe that the information
is true, accurate and complete. I am aware Heat deere are sipenalties, including the possibility
Of fines amend imprison aaent for subomittiog false information. I agree to cuostilA operate, nnai riain,
n*air, and if applicable, ebwx1on the injection well and all related appubmarces in aeoordance with
The approved specifications and conditions of Me Permit"
L 9 AlE, e� �1r Mer ex Ruth A t
PM �=
plem sap* a Garner slg�ed by Nna v aver au$iot:it3ng the eho s ageet
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights in the well being constrwW& A well is real property and its conshuction as lend rests
ownership in the landowner in the absence ofeanomy agreement in writing.)
If the property is owned by someone other than the arpp}icam, the property owner hetue'by eansertts to
allow the appliaa in U conadvct each injection well as outlined in ties application and that it shaell be
the msponniWily of the appEic= to ensure that the injection weU(s) conibuns to the Well
Camnuctian Standards (T hle t5A NCAC 2C . )
(S Of Ov�rWTMKrent Ft+oim3 Applkatt)
C-1c,
Please mum two Copies of the eoseapicted Appl'ecafiion Owks& to: 6'
UIC Program
AgnMr Prob cdon &action
North Car+oUm DENR-DWQ
1636 Mof119ervke Catater
Releiga, MC 276996106
Teieplhow (919) 71S4MS
Rolled 7I06 OWARC-57 HP Pqp 4 uf4

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