WI0100071_GEO THERMAL_20120512

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles=Wakild-P. E,
Governor Director
May 17, 2012
Henry and Deneen Schroyer
7 Sherwood Drive
Mechanicsburg; PA 17055
Subject: Notification of Rule Revisions Affecting
Closed -Loop Geothermal Injection Well Permit Holders
Permit Number: WI0100071
Dear Mr. and Mrs. Schroyer:
Dee -Freeman -
Secretary
Our records indicate that you currently hold a permit for a closed -loop geothermal injection well
system. This letter is to inform you that on May 1 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards — Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed -loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.m /web/wq/aps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636 One
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604 MfthCarolina
Phone: [phone]FAX: [phone] ,�}�t '/
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Internet: www.ncwaterouality.org J �/f�lt�irallff
An Equal Opportunity 1 Affirmative Action Employer v

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JUSTICE WELL DRILLING
3945 HWY US HWY 70 WEST
MARION NC 28752
To: Aquifer Protection Section Fnonx JUSTICE WELL DRILLING
Faux: 919-807-6496
PWFax : $28-724-4648
Phone: onto: 1-30.12
Re: W-�4 0 I ���i`1 j Pages:5 with cover
If you have any questions, please call
Thank you.
Brenda Shipley - }
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JUSTICE WE, LL DRILLING, INC;.
3845 US 70 WEST
MARION, NC 28752
PHONt/FAX [phone]
30 January 2012
To Wixom it may concern,
Re; WI0100071 ,
our records indicate: that this CW-I form was mailed on 10-279.2009 to The Aquifer
Protection in Raleigh and in Swannanoa. I believe that this was mailed to the Division of
watc;r in Raleigh as well. I will make sure that these arc mailed to them again.
Brenda Shipley
Justice Well Drilling, Inc.
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2. WELL INFOWATION:
WELL. CONSTRUCTION PCRMIr* Vd 00� 7
OTHER ASSOCIATED PERMTTK0 app )
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a, WELL USE (ChecicAppliamble 8ox1: Resldenda► Woor Supply O
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4. WELL LOCATIONZ e Lk.: 6,0-
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s. WELL DETAILS:
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b. DOES WELL REPLACE ptIII ING WELL.? Y01 O
C. WATER LEVEL Below Top of Ceara:Fi-
(Use'+• If Above rap of Casing)
d. TOP OF CASING IS ~� FT. Above Lend SuefaWl
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a. WATERZONES(depth):
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12. DEN ' weLL'J
I DO ;eRFXV CG FY HAT T THIs WELL WAS CON3TRLICT ED IN
ACOORDANCE WITIi I SA NCAC 2C, W[LL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECORD HAS BI=EN
PRO ow TO THE WELL OWNER.
SIGNATURE CER IED WEL�;;TR�
DATE:
I+iiINTiD N E OF PCR50NCONSTRUCTING THE WELL -: -
Forth GWAS
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City or Town Staft 2ip Code
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2. WELL INFORMATION: f
WELL CONSTRUCTION PERMrrd W x0 �� • f
OTHER ASSOCIATED PERMITifliiappliob1b) _..
SITE WELL ID*daopimolel
3. WELL USG (Check Applicable 15104: Residential Water Supply ❑
DATE ORILLI=O
TIME COMPLETED AM O PM O
4. WELL LOCATION:
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9r
Street Addmes
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4. WELL DETAILS:
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b. DOES WELL REPLACE EXItSMS WELL? YES O NO 12/
e. WATER LEVIEL Below Top of Casing: A FT.
(Use •+• it Above Top of Casing)
d. TOP OF CASING IS -_ w ce'
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7. CASING: Depth
Diameter
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8. GROUT: Depth
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11. DRILLING LOG
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12. REM
I tZiO FI WEI.I: WAS CONSTRUCTED 1N
ACCORDANCE WITH 15A NCAC 2C. WELL. CONSTRUCTION
: STANDARDS, AND THAT A COPYOF THIS RECORD HAS BEM
' PROvIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIW VVELL CONTRACTOR DATER
PI�INTEO AMEOfPERSONCONSTRUCTING THE WELL
Submit within 30 bays of completion t D: Ohtislon of WaW Quality - Information Processing.
1s17 Mail Service Center, Raleigh. NC 27699401, Phone; (919) 807'4300
Form GW-1a
Rev. V09
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Beverly Edvt;a Perdue
Governor
DEN.,
North Carolina Department of Environment and Natural Resources
Division of water ouality
Char= w0wiid, P. E.
Director
January 24, 2012
JUSTICE WELL DRILLING INC
3845 US HIGHWAY 70 WEST
MARION, NC 28752
Subject: Notice of Deficiencies
Missing -Injection Well Construction Data
Dear Justice Well Drilling, Inc.:
coo Freeman
Sccroznry
A recent review of our records indicates missing injection well construction data (GW.1 forms)
for wells constructed under the following permits:
a
W10100071 Monry and Deneen SchrOyw SFR trajection Mixed Fluid GSHP Well Systa» (50M)
WIOI00073 Mitchell County Historical Foundation Injection Mixed Fluid GSHP Well System (50M)
It was required under the specific permit listed above that a cony of the GW-1 records were to
be submitted to the Aquifer Protection Section at the following address.
Aquifer Protection Section - UIC Program
DENR - Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Within 30 days of the receipt of this letter, you must mail a copy of the completed GW-1
records for each of the referenced permits to the address listed above. You can also choose to
fax a copy to forms to [phone]. If you were not the well contractor for the specified
permits, disregard this letter.
If you have not already done so for all of the above permits, please make sure you have
submitted a copy of the GW-1 records to our Information Processing unit listed at the bottom
of the GW-1 form. Failure to do so is a violation of 15A NCAC 02C .0213(h)(1) and may result
In the assessment of civil penalties in accordance with North Carolina General Statute 87.94.
AQUIFER PROTECTION 10ECt10N
V& U;41 Smim Cenler, RolaIUII, PA 0 Carona 27fi59.1636
LuQLiu ; 512 N.1A*4ty St., Raleigh, North Carolina 27$LA
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Permit Number W10100071
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (50M)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility Name
Henry and Deneen Schroyer SFR
Location Address
348 Haven,Heights Rdg Rd
Marion NC 28752
Central Files: APS SWP
07/30/09
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Gary Justice
3845 US 70 W
Marion NC 28752
Major/Minor Region
Minor Asheville
County
McDowell
Facility Contact Affiliation
Owner Name
Owner Type
Individual
Henry Schroyer
Owner Affiliation
Henry Schroyer
Owner
7 Sherwood Dr
Mechanicsburg PA
17055
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective
Expiration
07/18/09 06/24/09
07/18/09 07/18/09
06/30/14
Reaulated Activities
Reauested/Received Events
Heat Pump Injection
Additional information received
RO staff report received
07/02/09
RO staff report requested
07/02/09
Additional information requested
07/02/09
Additional information received
07/06/09
Additional information requested
07/20/09
RO staff report received
07/23/09
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

North Carolina
Beverly Eaves Perdue
Governor
', f � i
�i M4 wag
MCDENR
Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
July 1.8, 2009
Henry and Deneen Schroyer
7 Sherwood Drive
Mechanicsburg, PA 1.7055
Re: Issuance of Injection Well Permit
Permit No. W10100071
Issued to Henry and Deneen Schroyer
McDowell County
Dear Mr. and Mrs. Schroyer:
Dee Freeman
Secretary
In accordance with your application received June 24, 2009, I am forwarding Permit No. WI0100071 for the
operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system to be located at 348
Haven Heights Ridge Road, Marion., .McDowell. County, NC 28752. This permit shall be effective from the
date of issuance until June 30, 2014, and shall be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. In addition, please submit copies of the
Well Construction Completion form (GW-1) and site map within 30 days after construction as required
in Part I paragraphs -8 and 9.
Please submit the data within 30 calendar days of receipt of this letter to the following address:
Aquifer Protection Section (APS)
Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
Additionally, your UIC system is subject to inspection by the APS and at the time of the inspection must display
a permanently affixed identification plate in accordance with requirements of 2C .0213(g). Please insure this is
completed in accordance with permit condition Part I, paragraph 7 of this permit issued July 18, 2009.

In order to continue uninterrupted legal use of this well foi 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 me at [phone].
Best Regards,
I/ " �4- � _.
Michael Rogers, Environmental Specialist
cc: Landon Davidson — Asheville Regional Office
Central Office File — WI0100071
McDowell County Environmental Health Dept.
Gary Justice — Justice Well Drilling
Attachments)

NORTA CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSI.ON
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
Henry and Deneen Schroyer
FOR THE CONSTRUCTION AND OPERATION OF 2 TYPE 5QM INJECTION WELLS, defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed -loop
geothermal -mixed -fluid heat pump system. This system is located at 348 Haven. Heights Ridge Road, Marion,
McDowell County, NC 28752, and will be constructed and operated in accordance with the application dated
June 24, 2009, and in conformity with the specifications and supporting data submitted, all of which are filed
with the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in compliance
with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until'June 30, 2014, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
-dam
Permit issued this the day of , 2009..
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.

PART I - WELL CONSTRUCTION GENERAL CONDITYONS
l . The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
6. Each geothermal injection well system shall have permanently affixed an identification plate on a nearby
building or other permanently fixed structure indicating the location and presence of underground UIC
wells according to 2C .0213(g).
7. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section — UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
Aquifer Protection Section — Asheville Regional. Office
2090 US Hwy 70
Swannanoa. NC 28778
[phone]
GW-1 s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on -site and available for inspection.
8. Well construction records must also be submitted for the existing water supply wells on -site as well as a
site map showing any water supply wells on adjacent properties as specified in NCAC .0211(d)(1)(D).
PART II — WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone] and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number [phone].
2. Boreholes shall not connect separate aquifers which have differences in water quality (e.g., shallow
surficial aquifers, saprolite, fractured bedrock, etc.) as specified in 15A NCAC 2C .0213(d)(8)(C) and
WI0100071 2

shall be filled with bentonite grout from the lowermost water bearing zone to land surface as specified in
the permit application.
PART III — OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV — PERFORMANCE STANDARDS
The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
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 — OPERATIONS AND MAINTENANCE REQUIREMENTS
The injection facility shall be properly maintained.and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection, Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
WIOI 00071

PART VI - INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII — MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
. injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII — PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART IX — CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1), Well
Construction Standards.
WI0100071 4

2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Penmittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel -packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1.636 Mail Service Center
Raleigh, NC 27699-1636
WI0100071

RECENED I DENR I MNQ
T �{(�UIFFR'PR(1TFf .TIf1N SECTION
NORTH cAROL�NA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCJ&; 3 2009
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50M WELL(S)
,v New Permit Application OR Renewal (check one)
DATE: 7 20 1
PERMIT NO. (leave blank if NEW permit application)
A.
Q
PROPERTY OWNERS)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative Wauthority for signature): lle 2 T Se l 0- U .! f r
(1) Mailing Address: %St4ir990003J
City: MCel- inl r C5 6AO, State: 'PA. Zip Code: 1-10 -County: Cii M irir , A n ()
Home/Office Tele No.: / 7 - &q 7 - to w Cam.- 7/ 7 - 1572
EMAIL Address:
(2) Physical Address of Site (if different than above): o'T' j6 n, I1 e 1 A T.S S4
City: M AR4 014 State:iV_ Zip Code: Z $ -7S Z County: A'
Home/Office Tele No.: A MC— a4 460dC,- Cell No.:
EMAIL Address:
AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person__-_ _--� c.iyt l- Address:
Address:
City: _. State: Zip Code:
Office Tele No.: CCU No.:
Website Address of Company, if
C. STATUS OF APPLICANT
RECEIVED I DENR 100
Private: Federal: Commercial: MCMD / DENR10V& ",IM
State: Municipal: Native American Lands: Aqui* Protection Sqy
L
JUN 24 2009

D. WELL DRILLER INFORMATION
Company Name: - 1.115T i C, t4l i C
Well Drilling Contractor's Name: 6� A tz ti � j us rf cC-
NC Contractor Certification No.o. /VC 2 t S, 0 -A
Contact Person_ acJ++ .y +xS-nCC- EMAIL Address: SCk rA tM VA M A N _OQZ
Address: 3$ us -7C aes' Yq b,c�� • Co rv�
S
City: MAW'64 NQ Zip Code: 7-31S'Z County: /i7 C, 0 s
Office Tele No.: 8- 724- qSr# T Cell No.:
E. HEAT PUMP CONTRACTOR INFORMATION (if differen
Company Name: TDLL1ZIe5 o N P I tuiy..to i Q C� + d e&T
Contact Person: 'To W N gym . EMp
Address:
than driller)
-�uRkeg ori haiv, 4kci 0 &11, ouA-WJ
City: eCpuce 1 i;Jt !V Zip Code: Z 8 7 77 County: '! fy e !1 a,Z
Office Tele No.: `d Z $-76,V Z Cell No.:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
CIo,S�,a �t`o � �• �/� 7` %On4
G. WELL CONSTRUCTION DATA (Skip to Section H if this is a Permit RENEWALI
(1) Proposed date to be constructed: /Y s i P Number of borings: Z
Approximate depth of each boring (feet): .3 80 ter
(2) Chemical additives to be -used in closed -loop system (only those chemicals indicated have been approved):
R-22 propylene glycol ethanol 6Af 1�!&&&00 other (oth additives will
need prior approval by NCDENR before use) (- EThAVB 1 *r rsepxo flANbl3
(3) Type of tubing to be used (copper, PVC, etc): D eA l/ iAt
(4) Well casing. Is the well(s) cased? (cheek either (a.) YES or (b.) NO below)
(a) YES if yes, then provide casing information such as -type (steel, PVC, plastic, etc.), diameter
deAtb, and extent of casing appearing above ground:
N NO
(5) Grout (material surrounding well casing and/or piping): (a) Grout type: Cement Bentonite �/ Other (specify)
(b) Grout depth of tubing (reference to land surface): from .350 to Q (feet)
If well has casing, indicate grout depth from 4 to - - (feet)
H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.

RECEIVED / DENR / DWQ
�iQ�1tFFRPR�7FnT�nA� SpCI'IAN
1. LOCATION OF WELL(S) JUL2 ? ?Ii1iQ
Attach two copies of maps showing the following information:
(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.
J. POTABLE WATER WELL(S)
Are there any potable water well(s) on the subject property or adjacent properties? _ XES NO
If Yes, than indicate location on attached map(s).
K. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of Imes 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 thelapproved s4cilkations and conditions of the Permit."
or TN&Full Name
Signature of Property caner/Applicant
E�y1� 6
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]

Rogers, Michael
From:
Rogers, Michael
Sent:
Monday, July 20, 2009 3:39 PM
To:
'[e-mail]'
Subject:
RE: geothermal well
Attachments:
Schroyer.pdf
Please find attached the App.
Michael Rogers, P.G.
Environmental Specialist
NC Div of Water Quality- Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: [e-mail] [mailto:[e-mail]]
Sent: Monday, July 20, 2009 3:33 PM
To: Rogers, Michael
Subject: Re: geothermal well
Yes we can do that but I do not have a copy of the application if you send a copy via e-mail I will have her sign
and return
Thanks Henry Schroyer
-----Original Message -----
From: Rogers, Michael <[e-mail]>
To: [e-mail] <[e-mail]>
Sent: Mon, Jul 20, 2009 2:08 pm
Subject: RE: geothermal well
Would it be possible for you to have your wife also sign the signature page and send via email attachment?
Thanks
Michael Rogers, P.G
Environmental Specialist
NC Div of Water Quality- Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: hschroyer2gaol.com [mailto:hschroyerN)aol.com]
Sent: Sunday, July 19, 2009 5:52 PM
To: Rogers, Michael
Subject: Re: geothermal well

Just checking the status of the permits
Thanks Henry Schroyer
-----Original Message -----
From: Rogers, Michael <michael.rogers(&ncdenr. ov>
To: hschrover2Ca)aol.com <hschrover2(a)aol.com>
Sent: Thu, Jul 2, 2009 10:01 am
Subject: geothermal well
Mr. Schroyer-
I am processing your geothermal well permit. Would you please confirm that the wells will be at least 50 feet
from the septic field and that you are the only person listed on the property deed (i.e. not married).
Also, do you have a street address on the parcel (or parcel number) where the wells are going in so we can enter
the GIS point for the wells.
Thanks
Michael Rogers
Environmental Specialist
NC Div of Water Quality- Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
Email coaespandencf� so and irorn this sander is subject t:s the lv, ,. Fublk; Records La.+ arts may be. disciosed to ftrd nariie�
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Rogers, Michael
From: [e-mail]
Sent: Monday, July 06, 2009 3:30 PM
To: Rogers, Michael
Subject: Re: geothermal well
Yes the wells are 50 ft from septic and I have recently married but the property is only my name my wifes
name is Deneen you can put it on the permit if you wish
we contacted the 911 center and the address is 348 Haven Heights Ridge Road, Marion,NC any other questions
let me know
Henry Schroyer 717-648-1572
-----Original Message -----
From: Rogers, Michael <[e-mail]>
To: [e-mail] <[e-mail]>.
Sent: Thu, Jul 2, 2009 10:01 am
Subject: geothermal well
Mr. Schroyer-
I am processing your geothermal well permit. Would you please confirm that the wells will be at least 50 feet
from the septic field and that you are the only person listed on the property deed (i.e. not married).
Also, do you have a street address on the parcel (or parcel number) where the wells are going in so we can enter
the GIS point for the wells.
Thanks
Michael Rogers
Environmental Specialist
NC Div of Water Quality- Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line (919) 715=6166; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
Emaii correspondence to and from this sender is subjec' io the N.u. Public Record:. Law and may be disclosed to third parties.
Stay cool with this summer's hottest movies. Moviefone brings you trailers. celebrities movie showtimes and tickets!

Rogers, Michael
From: Davidson, Landon
Sent: Thursday, July 02, 2009 1:22 PM
To: Rogers, Michael
Subject: RE: W 10100071 Schroyer 5QM well
Attachments: image003.png
Michael-
We do not intend on inspecting this prior to permit issuance. Thanks
Landon
G.. t:anduri t7arw�tl t rt::F`:'i .
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Y
a2s E. , ,a.
web page: httto://h2o.enr.state.nc.uslaaw.html
E-mail is a public record and e-mail messages
are subject to public review and may be disclosed
to third parties. E-mail is subject to the Public
Records Low and applicable record retention schedules.
From: Rogers, Michael
Sent: Thursday, July 02, 2009 10:29 AM
To: Davidson, Landon
Cc: Vann, Julie
Subject: WI 0100071 Schroyer 5QM well
Attached is permit application for a 5QM permit for your review. Per our 5QM permitting process, we are allowing the
RO to decide whether to conduct a pre -permitting inspection and submit a Staff Report. Please decide within 5 working
days of receipt to decide if you want to conduct a pre -permitting approval field inspection (the inspection does not have
to be done in 5 days -just the decision whether to schedule an inspection or not). If you elect not to conduct a pre -
permitting inspection, let us know and we will go ahead and issue permit.
Thanks
Michael Rogers
Environmental Specialist
NC Div of Water Quality- Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties

North Carolina
Beverly Eaves Perdue
Governor
NCDENR
Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
June 30, 2009
Henry Schroyer
7 Sherwood Drive
Mechanicsburg, PA 17055
Subject: Acknowledgement of Application No. WI0100071
Haven Heights Subd Lot # 48
Injection Mixed Fluid GSHP Well System (5QM)
McDowell
Dear Mr. Schroyer:
Dee Freeman
Secretary
The Aquifer Protection Section of the ,Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on June 24, 2009. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to hiii-�:Hh2o.enr.state.nc.us/documents/dwcl omc.hart.ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT
Sincer ,
a� l
for Debra J. atts
Supervisor
JO(Q�_;D
cc: Asheville Regional Office, Aquifer Protection Section
Gary Justice (Justice Well Drilling, 3845 U.S. 70 West, Marion, NC 28752)
John Smith (Burleson Plumbing & Heating, 141 Highland Ave., Spruce Pine, NC 28777)
Permit Application File WI0100071
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
Internet: www.ncwaterouality.ora
An Equal Opportunity k Affirmative Action Employer
N rtt-iCarotina
Naturally

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PELT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INFECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50 M WELL S )
;11 _New Permit Application OR _Renewal (check one)
DATE: , 20f
PERMIT NO. (leave blank if NEW permit application)
A. PROPERTY OWNER(S)/APPLICANT(S)
lr11
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature):
(1) Mailing Address: Jr 1a f9V00 r7
City: ►ylee.64i o kL ACl State: ?A. Zip Code: i 10Sir County: Curn -Ie IAny0
Home/Office Tele No.: 7 % ~ - bqI - & 2, to4 Cell No.: 7/7- (p �- /5 % Z
EMAIL Address: k S e-k 20 :I t%R- 2- VA 01 • Conn �
la AAV2�'J
(2) Physical Address of Site (if different than above): LOT 149 d4 ved lre_ir*
TS. sly
City: f�% AEI C _ State:N(�` _Zip Code: ,County: ', ,u. //
Home/Office Tele No.: SA mf- A6 4-belle— Cell No.:
EMAIL Address:
AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: -- —
Office Tele No.:
State:
Website Address of Company, if any:
Zip Code:
C. STATUS OF APPLICANT
Private: / Federal: Commercial:
County:
Cell No.:
State: Municipal: Native American Lands:
RECEIVED I DENR /DQ
RECEVED/MR7DVI -lZ
Aquifer Protection SgctiM,
JUN 24 2009

D. WELL DRILLER INFORMATION
Company Name: _ I l ._ u5T i CL �4e
Well Drilling Contractor's Name: eta us a icL
NC Contractor Certification No.: /\/6 �- O" A
Contact Person: ace t,i ) t 1 r� EMAIL. Address. S��'1 rA LM VA M A N • -002
Address: &94 S- VS 7C, de4 T A,Ve,,' ° CO"V`
City: AP-Jory Svc Zip Code: Z87SZ County: A) (° /.)'s s►c`/_.
Office Tele No.: 8 - 7 Z 4 - S' Cell No.:
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: &LRicS o ra T 1 L.q L o w o,+ FJ eaTI t) G
Contact Person: -To HN/ sm;AEh EMAIL Address:_�I,�Vtesorj huK b t fPC 0 &/A0A4 • WJ
Address: /,nmit ile,
City: sj 6 p o Ce I iA c /V r Zip Code: 7- 8 7 7 7 County: Al,
Office Tele No.: 'KZ 8 - -7& 1- 1/0 Z/ Z Cell No.: S Z S . 3 $ S' - ) Z (e Z
F. INJECTION PROCEDURE (briefly describe how the injection wefl(s) will be used)
0106EP Leo D - Ciec"/,q-& D
G. WELL CONSTRUCTION DATA (SIao to Section H if this is a Permit RENEWAL)
(1) Proposed date to be constructed: �Al S 4 f Number of borings: _ Z
Approximate depth of each boring (feet):_ .3 80 AT ,
(2) Chemical additives to be -used in closed -loop system (only those chemicals indicated have been approved):
R-22 propylene glycol ethanol � '/V �l !& Z06 other (oth additives will
need prior approval by NCDENR before use) L Zi'/11AND I pao pq o/
(3) Type of tubing to be used (copper, PVC, etc): Q0 e�A \/ ENS ^
(4) Well casing. Is the well(s) cased? (check either (a.) YES or (b.) NO below)
(a) YES if yes, then provide casing information such as tpee (steel, PVC, plastic, etc.), diameter.
death, and extent of casing appearing above ground:
(b) NO
(5) Grout (material surrounding well casing and/or piping): /
(a) Grout type: Cement Bentonite �/ Other (specify)
(b) Grout depth of tubing (reference to land surface): from ,-'350 to ---a_ (feet)
If well has casing, indicate grout depth: from - __ — to _ __(feet)
H. INJECTION -RELATED EQUIPNMNT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
pipuig/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.

L LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(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.
J. POTABLE WATER WELL(S)
Are there any potable water well(s) on the subject property or adjacent properties? DYES NO
If Yes, than indicate location on attached map(s).
K. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting)
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and J
all related appurtenances in accordance with tapproved s c' ations and conditions of the Permit."
l A1?tt
or T-.fcTull Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
U-1C Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]

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MCDOWELL COUNTY Parcel Number: 171114436548
PIN Number: 1711-43-6548 Deed Date: 20061025
TAX MAP Owner Name: SHHROYER HENRY Book and Page: 8911195
Address: 7 SHERWOOD DRIVE Legal: LOT 48 HAVEN HEIGHTS
Address 2: Building Value: 0
City: MECHANICSBURG Land Value: 47600
• Disclaimer_
The data provided on this map are prepared for the inventory of real property found WMin State: PA Market Value: 476000 N
McDowell County, NC and are compiled from recorded plats, deeds, and other public records ZIP: 17055 Assessed Value: 476000
and data. This data is for informational purposes only and should not he substituted Land Units: 4.2/AC
for a true title search, property appraisal, survey, or for zoning verification. \ ) One Inch = 2000 Feet