WI0100074_GEO THERMAL_20120517

NCDENI��-
North Carolina Department of Environment and Natural Resources
Division of Water Quality. Dee Freeman
Beverly Eaves Perdue Charles Wakild,-P-.E.- Secretary
Governor
Director
May 17, 2012
Hazel Boyd
2407 Atlantic Avenue
Sullivan's Island, SC 29482
Subject: Notification of Rule Revisions Affecting
Closed -Loop Geothermal Injection Well Permit Holders
Permit Number: WI0100074
Dear Ms. Boyd:
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://2ortal.ncdenr.or 3/web/w /a s.
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,
4 j7n �, -
C ,
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION One1
1636 Mail Service Center, Raleigh, North Carolina 27699 1636 Nol ffiCarolina
Location: 512 N. Salisbury St„ Raleigh, North Carolina 27604 X&Irallpl
'hone: 919-807-6464 \ FAX: [phone]
'emet: www nmaterouality oro
,qual Opportunity 1 Affirmative Action Employer

01-31-2012 15:14 TARHEEL WATER TREATMENT 828-369-0740
PAGE1
RESIDENTIAL WELL CONSTRUCT1Q.N CORD
Nurtb Carolina Department of Envirutuncnt and Naturul Resources- Vivision of Watcr Quality
WELL CONTRACTOR CERTIF IC:ATioN a 3424--A
1. WELL CONTRACTOR:
McClure
Well Contractor (Individual) Ne►ne
Tarheel WaJer Treatment, Inc.
Well Contractor Company Name
34.24 Ceocoia Road - - --
Street Address
Franklin NC Z� Z34
City or Town State Zip Code
c 828 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMITS, �M%l GoGi 0
OTHER ASSOCIATED PERMITS(if appliC IOL
SITE WELL. ID #0 applicable)
3. WELL USE (Cho".#opllcable Box):
DATE DRILLED_
TIME COMPLETED _c % AM 0 PA�
d. WELL L TION: -
CITY: � COUNTY
trbet fine, Numbers, Community, Subdivision, Lot No., Parcel, Zip Cale)
TOPOGRAPHIC i LAND SETTING: (check sppropriate box)
*slope ❑valley llFlat flRidge C101her
LATITUDE M4°Q�,' s " DMS OR 3X.XXXXXXXXX Du
LONGITUDE + ° �'�M -
LONGITUDE OR 7X_XXXXXXXISx DD
Latitudeilongitude source PS L7opographic map
(location of we# must be one USGS topo map anda tached to
this form #not u$a+g GPS)
6. WELL OWNER
Name
P-
OMMMl ..
Street Address , - -t-$
City or Town Slate Zip Cods
U
Area Code Phone number
6, WELL DETAILS: /
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES O N59
Q�
C. WATE 'LEVEL Below Top or Casing: FT.
(Use "+" if Above Top of Casing)
d. �aP OF 18 FT. Above Land Surface'
-Top of C9sing terminated War below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. JRETHOD OF TEST /I
f. DISINFECTION: Type rfr pi 111Amou tf
g. WATER ZONES (deplh):
Top Bottom
op
Bottom -_-_
Top , .. 8Olt
Top,._
Bottom —....—
fop 9ottom
Tap
9ottom_ �
Thlcknosst
CASING; Depth
Diameter
Weight Material
Top
Top
8. GRO Depth Mo Method
To F3oltam Ft.
Bottom.'
Top Bottom Ft. iitl _ 1
9, SCREEN: Depth Diameter Slot Site Material
Top_ Bottom Fl. in. in.
Top Bottom_ . - PI. —in. in.
Top__,,,,,,-. Bottom Ft. in. in.
10. SANDlGRAVEL PACK:
Depth Size Material
Top�BoRom Ft.
Top Bottom Ft._. --
Top Bntlnm_- _ Ft.
11. DRILLING LOG
Top OR
--�---
,'xWMaV9ih Description
. ji11].4W
12. REMARKS:
c�n Lc eve—o-%
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION
STANDARDS, D TH A C PY F THIS RI_CORD HAS BEEN
PROV ED THE R.
IGNATURE OF CERTIFIED WELL L CONTRACT( 'DATE
Micheal S. McClure
PRINTED NAME OF PERSON CONSTRUCTING THE WELT. +
Submit within 30 days of completion to: Division of Water Quality - IntwMatlon Processing, Form GW-1a
1617RECEIVED 01-31-`12 14,40 FROM- 8283690740 TO- NC DENR P&S P001/006

01-31-2012 15:14 TARHEEL WATER TREATMENT 828-369-0740 PAGES
• •4yr
RESIDENTIAL WEL1, CONSTRI)CTI.ON RECORD
1 �i, Nurth ('wvlina rkpariment ul I'mvimnment and Natural Rcsourccs- Division of Winer Quality
.°.." "" �'"" WELL CON1'RAC-fOR C E-11I'1FWATION # 3424-A
vl.Ml-
1. WELL CONTRACTOR:
g, W TER ZONES (depth):
Michael S. MpOure
Top
Well Contractor (Individual) Name
Top
B,� Top Bottom
] grheel Water Treatme t Inc.
T
_ Bottom Top Bottom
Well Conlr2c10r Company Name
Thioknetel
3494 Georaia Road
?. CASING:
Depth Diameter Material
Street Address
Top
t3otlom ____
Franklin NC 2$734
Tq,_
B Ft
City or Town State Zip Code��
Bottom Ft.
828 t 369-0740
Area code Phone number
8• GROUT:
Ifepth Mawal . Method
2. WELL INFORMATION:
Top
Bottom, Ft:
WELL CONSTRUCTION PERMITS- L7
t' .LQ00 �
_
ro( ,!
eonotn, ` - ' rewe
OTHER ASSOCIATED PERMITttt(if evslicaWo)� r, „ _
Top
Bottom Ft,
SITE WELL ID " appiluable) ..,r
3. WELL USE (Check Arolicable Box): Rwa al Water Supp 'l
DATE ORILLED��
TIME COMPLETED 3:M2 AM ❑ P--ftl-
A. WELL LOC 110N:
CITY, A 1e (.Jd I & COUIlITY
(Sbeel Name, Numbem Community, Subdivision, tat No, Pawl Zip Code)
TOPOGRAPHIC I LANO SETTING: (check w3wwriaW bm)
61WIfpe Q Valley ❑ Flal ❑ Ridge IJ Uther
LATITUDE °A i - OMS OR 3%.IcXXXXxxxXt DO
LONGITUDE','_" DMS OR 7x.xxxxxxxxx DO
Latiludellong'dude source PS [lropographic map
(location of well must be ahogrion a USGS tWo map andatfac►Ied to
Ihis form it not uskV GPS)
5. WELL OWNER n
CIA
Owner No
Street Address
Cily or Town Slate Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTALDEPTH:
b. DOES WELL REPLACE E' 1110 WELL? YES GI NPIK
c. WATER LEVEL Below Top of Casing: FT.
(Use •+" If Above Top of Casing)
a-TWO-F-C-AS-1NO IS urfaoe•
'Top of casing terminated atlor below fend surface may require
a variance in accordance. with 1SA NCAC 2C ,0118.
19pm1. METHOD OF TES � i
f. DISINFECTION: Ty Amount d
L SCREEN: Depth Diameter . Slot Size Material
Top Bottom Ft. in. In.
Top Bottom_ Ft._, In, in.
Top Bottom,-- Ft. in. in,
10. 9ANDIGRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top 8ottom-„—..Ft. _ ..._
Top_Bottom Ft.__-____
11. DRILLING LOG
yTop Bottom
Formation es ion
se -Ca
12. REMARKS: j }�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15 CAC 2C, WELL, CONSTRUCTION
STANDARDS. AQID I'M COPY 0 THIS RECORD HAS BEEN
PROV ITT HE
7
SIGNATURE OF CERTIFIED WELL CONTRACTOR U ATE
Michael S; McClure
PfiIN1ED NAME OF PERSON CONSTRUCTING THE WELL
S henif Within 7n rilawit of annnnlallnn in! Division of Water Ousl1tV - Information Processing, Fnrm GW-1a
163ECEIVED 01-31-'12 14;40 FFlOCI- 8283690740 TO- NC DENS P&S P003/006

01-31-2012 15:15 TARHEEL WATER TREATMENT 828-369-0740
PAGE6
RESIDENTIAL WELL CONSTRUCTION`RECOPLD
North Carolina Department ot'tnvironment and Natural Resources- Uivision of Winer iilili
parun 4, ty
A
, ..,... WELL CUN7.'1tAC1Oli C:ER71k'ICATlUN # 3424---, _-- --
1, WELL CONTRACTOR:
Michael S. McClure
Well Contractor (individual) Name
Tarhol 11`1la er Treatment: Inc.
Well Contractor Company Name
3494,Ge®rala Raed
Street Address
Franklin NC 28734
City or Tom, State Zip Code
( 828 369-0740
Area code Phone number
2. WELL INFORMATION: .� }}♦
WELL CONSTRUCTION PERMIT$-jJ- a QQ6
OTHER ASSOCIATED PERMITS(u apptioenla)
SITE WELL ID Ors olit wei
8. WELL USE (Checlt +rrpllcable Box):
DATE DRILLED LL ;; ""Igg
TIME COMPLETED II r L.0 AA( PM [I4. WELL LOCATION: r
�- �t7yi CITY: � � Q couNTY
3H -7UpAgg
(SNoet Name, Numbers, Community, Subdivision, Lot No., Parcel, tip Code)
T POGRAPHIC I LAND SETTING: tenedr appropriate bo q
Slope ovallay UFlat LiRldge OOlher
TITUDE . ` 3" DMS OR 3�t.Xxxxl%-xxx DD
LONGITUDE "12W0-1
" DMS OR 7x xxxxxxxxx nD
LatitudpJWngiwde source: ,QI'cpographic map
(location of well must h- own on tl GS two map andattached to
this loam 91W using GPS)
S. WELL OWNER .�
:5-yr1G5 -wc
OwnQLName
Q kA 7) PxQ Q
Str t Address
City or Town Stale Zip Code
Area code Phone number
6. WELL DETAILS: %
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES n
a. WATER 11 op ar;ing: FT.
(Use -+" li Above Top of Casing)
d. TOP DM
A 1S F . and Surface'
'Top of caning terminated allor below land Surface may require
a variance in accordance wilh 15A NCAC 2C .0119.
a. YIELD. (gpm): METHOD OFT _ 1
If. DISINFECTION: Type I L Amoun
WATER ZONES (depth):
TOp To Bottom
'Top t3ottom Bottom_
Top om Top m
Thiakrrers/
T. Depth Diameter Mararlel
Top . Bottom, _,
Top BOtt
Top Sottom Ft. _
a. GROUT: Depth Mal 'al 'f_ Method
Top �_ sotto 1't. ► e "%� g CC
TO (,� Botto%2 0!j Ft- 411 ,
Top Bottom Ft.
9. SCREEN: Depth Didmeor Slot site Material
Top. Bottom , Fl.,,, �,__in. in.
Top Bottom. Ft. in. in, _
Top Bottom Ft• _ in. In.
10. SANDIGRAVEL PACK:
Depth Size
Top-a.,,._BottorrFL
Top Bottom-_., ",,,,, Ft.
Top Bottom Ft.
11. DRILLING LOG
Material
Top TOM Forms n Description
D l _ !;40 L 1 - .
r
�f
/
irel
_1
12. R KS:
I -DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THATACOPY OF THIS RECORD HAS BEEN
PROVI D'r8 HEW OWNER
y _ arlO
S GNATURE OF CERTIFIED W -L CONTRACTOR ATE
Michael S. McClure
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
$U mit uyiHvtn 1A .Isve of nrn nnlatinn tn' nivialv inn of Wsktar (3iini - l0 rmalton Processino. I~rvrn r.WAa
1s1PECEIVED 01-31_-'.12 14:40 FROM- .8283690740 TO- NC DENB P&S P006/006

01-31-2012 15:15 TARHEEL WATER TREATMENT 828-369-0740
PAGE5
�ESlbE1YTlAL WELL COSTRUCTI<ON-MCORD
t North Ctrrolina Department of linvironmetu and Natural Resources. Vivis%on of Water Quality
+?� .
° N;t WF:1.1: C:0NTRACT0R CF.RTIFTCAT101V # 3424-A
1. WELL CONTRACTOR:
Michael S. McQlgrg
Well Contractor (INivitlual) Name
Tarheel Water Treatment. Inc.
Well ContronMr company Nome
3494 G orcia Road
Sweet Address
Franklin NC 287U
City or Town State Zip Code
8t 28) 369-0740
Area code Phone numoer
2. WELL INFORMATION: '' ''� 11
WELL CONSTRUCTION PERMIT#_ j& ; 0 LC y
OTHER ASSOCIATED PERMIT#Cd applicable)
SITE WELL ID If(ifapplicable)
S. WELL USE (Check n'olicablP Box): R
DATE DRILLEQ"_��tt" " I
TIME COMPLETED ,a C� AM ❑ PQ�
0. WELL L�TION: _ `
CITY: �v COUNTY��
(S1real Nome, Numbera. CommurAy, eubdiviswn, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (ciieck appropriate box)
Pope O Valley ❑ Flat ►_) Ridge.
�'L�A`TITUDE ' Q?. I " DMS OR 3x.x 2Z=._M DD
LONGITUDE��°y^l'_'�•��." DMS OR 7x.XXXXXXXXX DD
Lalitudel"itude source: PS (]Topographic map
(rotation of we# must be Sho^ on a USGS topo map andaffillO ed ro
this fora► rT not using GPS)
S. WELL OWNER
Ow
Der Name
aAn
Street Address
City or Town State Zip Code
L... J
Area code .Phone number
A, WELL DETAILS:
a TOTAL DEPTH:
—4;; — Id
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NJK
e. WATER LEVEL Berow
(Use "*' if Above Top of Casing)
d. TOP OF eAs Surface'
"Top of casing terminated atlor below land surfave ma-yRequire
WATER ZONES (depth):
Top Bottom--- Top Blom
Top To
Top Bottom Bottom
Thi
I ASING: Depth Diameter Ight Materiel
Top SottOrn
Top , — Bottom Ft.
Ft•_
A. GROUT,: Depth Mat iat Method
10
Top /~)/'y Bottom,,l. ' I
Top Bottom Ft. 11 1 _
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Sire Material
Top Bottom Fl. In. in.
Top BotlorrFt, _In. _ in.
Top_.— Bottom Ft. in,
10. SANDIGRAVEL PACK:
Depth Size
Top Bottom- Ft.
Top Bottom.. ,. _,_ Ft.
Top Bottom Ft._,,_.
Msterlsl
11, DRILLING LOG
Top B ttom Foripall Description
�r
12.- REMARK LL
T� rd- ket-6 .
100 HEREFO CERTIFY THAT .THIS WELL WAS CONSTRUCTED IN
ACCORDANCE Wm•11 C 2C, WELL CONSTRUCTION
STANDARDS, D TH OPY OF r IS RECORQ HAS BEEN
PROVI _ HE OWNE
'' Div,
a variance In accordance with I5A NCAC 2C .0110, SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a, YIE i Michael S. McClure
f. DISINFECTION: Typo Amount ' Ie . PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Su rI& ..aw.. lsn afn..e.�f �.n» inlm1l �inn •n• ivieinn of Wnler neimitu - Infort"atton Proci a89N10. PAM PW1A
1IMNECEIVED 01.:31-'12 14:40 FROM- 8283690740 TO- NC DENS P&S P005/006

01-31-2012 15:14 TARHEEL WATER TREATMENT 828-369-0740 PAGE4
�y.
{ , RESIDENTIAL WELL CONSTIttICLION RECORD
North Carelinu Depurimcnt of Hmironmcnt and Natural )tcsour"-s- Division of Water Quality
WELL CONTRACTOR CERTIFICATION s 3414-A
1- WELL CONTRACTOR:
Michael S. McClur
Well Contractor (Individual) Name
Tarheel Water Trea#menf. Inc.
Well Contractor Company Name
3494Czeoraia Road
Street Adorers — — - -
_E-ranklin _ _ NC 28734
City or Town State Zip Code
8c 281.369-0740
Area code Phone number
2. WELL INFORMATION: ' I'
WELL CONSTRUCTION PERMITS W U QI CC-0 744
OTHER ASSOCIATED PFRMIT*(if applicable)
SITE WELL ID #(it applicable)
8. WELL USE (Check licable Box):
DATE DRILLED,_{
TIME COMPLETED a_� 4 AM ❑ PMJ�
g. WATER ZONES (oeptn):
Top In T p_ Bottom
Top Bottom — ea tom
Top So Top . Bottom_
ThlckneoW
7, 0: Depth ohmmeter .---Nlatsrisl
Topes. ea
Ppaertf Ft.
Bottom Ft.
8. GROUT: Depth Ma rial ' ' Method
TOP -- Stmum,:30 F!.
Top _ Bottom L,5 Ft. �I
Top
9. SCREEN. Depth Dlamoter Slot Size Material
Top• Bottom Ft. in. in.
Top Bottom Fl. in. _ in. T-
Top. Bottom Ft. in, in.
4. WELL LOCATION: �,,.... 10. SANDIGRAVEL PACK:
! j ^ Depth size Matarlal
CITY: /��4f I 1_' '�. C LINTY %+ ( Top BoKom_,,,,,�,� Fl.
' -% Top _Bottom FL .... .. _......_
(.Sneat Name. Numbers, Community, Subdivision, Lot No., Pefoel, 2•Ip Cote) Top Bottom FL „
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
X( Iope D Valley I ;Plat i 1 Ridge ❑ Other
LATITUDE '_LA, 5 " DMS OR 3XXX-X—X tXXXX OD
LONGITUDE ' DMS OR 7X.XXIWaXXX DD
LatiludeJlongitude source: Ow.
PS Otopographic map
(location of well mast as s on a USGS ropo map andatteclred to
this form it not using GAS)
6, WELL OWNER -
oud
Owner a
'Q
Street Address
Clty or Town state Di Code
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:_____,
b. OOES WELL REPLACE EXISTING WELL? YES l,) NO F1
c. WATER LEVEL Below Top of Casing: _-FT.
(Use"*'if Above Top of Casing)
d. TOP OF CASINO IS-----: F'r. Above Land Surface*
'Top of casing terminated ttWor below lend surface may require
a variance in accordance with 1 SA NCAC 2C ,0118.
11. DRILLING LOG
Top Itom
ormat) '' n Descr)ption
�. C _.
12. R ARKS: lie
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND A COPY OF �S RECORD HAS BEEN
PR VV D T H L OWNS
rGNATURE OF CE TIMED VVELL CONTRACTOR DATE
0, YIELD (gpm) Michael S. McClure
If. DISINFECTION: Type Amount ' ' PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 dave of comoletion to: Division of Water Qualitv - Information Processing, Form GW-1a
iov1 ECEIVED 01-31-'12 14:40 FROM- 8283690740 TO- NC DENR P&5 P004/006

01-31-2012 15:14 TARHEEL WATER TREATMENT 828-369-0740
i' iWPA b.
3 aESIA.B TIAL WELL C STttCICTtO CORD- .
Nottlt Carolina 1XIm m ant orknvironmcnt and Natural Kcsoutccs bivishm u(Wafer ( liwity
W.E.I,,1, C`ONIVACI'OR C'11aR'I'I@'1CA1'!UN # 342�A. �-
1. WELL CONTRACTOR:
MichaeLS. McClure _
Well Contraelof (Individual) Name
TgEhael Water Treatment_ Inc.
Well Contractor Company Now
3424 raeaEgia Road
Street Address
Franklin NQ 29734
City or Town State Zip Code
828 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION IJERMITVA21 1 1 b[)O" j
OTHER ASSOCIATED PERWTO(if applicable)
SITE WELL 10 Mftf applIcabieL., _— —�
3. WELL USE (Check P• ri0be Box):
DATE DRILLED _
TIME COMPLETED_ AM ❑ PI"'�
4. WELL LOC TION: J sj\
CITY' % s I ouNTY
(Street Name, Numeets, Community, Subdivision, Lot No., Pared, Zip Code)
�T%POGRAPHIC I LAND SETTING: (check appropriate box)
I "rope i iValley ❑Flat ❑Ridge}❑Other .
LAT I rune .�—°A' U9r L " DMS OR 3X.XXXXXXXXX OD
LONGITUDE,2 " OMS OR 7X-.XXXXXXXXX DO
Latitudellongitude source PS Qropographic map
(location of well must be on a USGS "0 map andontached to
this farm Knot using GPS)
L WELL OWNER
OW ar19 ante
Street Address
City or Town State Zip Code
U _
Area code Phone number'
PAGE2
g. WATER ZONES (depth):
Top _ 80"40M.- Topes ��BG1tom
Top Bottom
Bottom
Top BotlCorrt
Top
Thickness!
7. Depth
Dlamoter YYelght Material
Top eortom
Ft. .
Top :::Bottom
T om
{'t
6. GROUT. Depth
Top Bottom
Material Method
Ft. t
Top Bottom
FL
Top &Aom
FI.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in, in. _
Top Bottom _
FL, ,,,,,_—in. In.
Top Sizorn _
Ft. in. in,
10. SANDIORAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft._..,_ _
Top Bollom — Ft.
11. DRILLING LOG
Top
�._
i
(
I
Formati n Description
12. RE ARKS;
6, WELL omits:
is. TOTAL DEPTH:, ,, } '
b. DOES WELL REPLACE EXISTING WELL? YCS r1 N I'DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: FT. ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION
g) STANDARDS, AN THA
(Use '+" if Above Top of CasinOPY OF TH RECORD HAS BEEN
PR
TO W OWNER
d. TOP OF CASING IS _ Above Land Surface'
'Top of rasing terminated allor below land surface may require
a variance In accordance with 15A NCAC 2C .0113.
: SIGNATU E O .CERTIFI D W TRACTOR RATETE
e. YIELD (gpm): METHOD OF TEST__,,, �- Miefteel S. McClure .
I. DISINFECTION: Typ Amount _ i ►5 RINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - InfiorilmOon Processing, Foam GWAa
161RECEIVED 01-31-12 14:40 FROM- 8283690740 TO- NC DENR P&5 P002/006

Permit Number WI0100074
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
john.mccray
Coastal SW Rule
Permitted Flow
Facility Name
James and Hazel Boyd 50M SFR
Location Address
3471 N Norton Rd
Cashiers NC 28717
Owner
Owner Name
Hazel T Boyd
Central Files: APS SWP
11/24/09
Permit Tracking Slip
Status Project Type
Active New Project
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
James G. Boyd
2407 Atlantic Ave
Sullivans Island SC 29482
Major/Minor Region
Minor Asheville
County
Jackson
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Hazel T. Boyd
Owner
2407 Atlantic Ave
Sullivans Island
SC 29482
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
11/16/09 09/10/09 11/16/09 11/16/09 10/31/14
Regulated Activities Requested/Received Events
Heat Pump Injection Region comments on draft requested 10/15/09
Region comments on draft received 10/20/09
Outfall HULL
Waterbody Name Stream Index Number Current Class Subbasin

CDEN
North Carolina Department of Environment and
Division of Water .Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
November 16, 2009
James G. and Hazel T. Boyd
2407 Atlantic Ave.
Sullivan's Island, SC 29482
Natural Resources
Subject: Issuance of Injection Well Permit
Permit No. WI0100074
Issued to James G. and Hazel T.
Boyd
Jackson County
Dear Mr. and Ms. Boyd:
Dee Freeman
Secretary
In accordance with your application received September 10, 2009, I am forwarding Permit No.
WI0100074 for the construction and operation of a vertical closed -loop geothermal mixed -fluid heat
pump injection well system located at 3471 N. Norton Rd, Jackson County, NC 28717. This permit shall
be effective from the date of issuance until October 31, 2014, and shall be subject to the conditions and
limitations stated therein.
Please pay special attention to Part I.7 of the permit and submit copies of the Well Construction
Completion form (GW-1) after construction. Please submit all data within 30 calendar days of receipt of
this letter to the address below:
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.6 of this permit issued November 16,
2009.
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 me at [phone].
Sincerely,
,v
John McCray,
Environmental Specialist

cc: Landon Davidson — Asheville Regional Office
Central Office File — WI0100074
Jackson County Environmental Health Dept.
Bruce Auld —Auld Heating and Cooling, Inc.
Enc: Permit WI0100074

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
James G. and Hazel T. Boyd
FOR THE CONSTRUCTION AND OPERATION OF 5 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 3741 N. Norton. Rd, Cashiers, Jackson
County, NC 28717, and will be constructed and operated in accordance with the application dated September
1.0, 2009, and inconformity 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 October 31, 2014, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
I
Permit issued this the Y day of � r , 2009.
!+ o
toleen H. Sullins, Director
Division of Water.Quality
By Authority of the Environmental Management Commission.

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 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
and
Aquifer Protection Section — Raleigh Regional Office
1.628 Mail Service Center
Raleigh, NC 27669-1628
[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)(1)).
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 ReCrional Office Aquifer Protection Section Staff, telephone
number (8281296-4500.
WIOI 00047

2. Boreholes shall not connect separate aquifRrs'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
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
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V — OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned -physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [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.
WI0100047 3

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.
WI0100047 4

2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel -packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
WI0100047

Central Files: APS SWP— -
09/16/09
Permit Number W10100074
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
Permit Contact Affiliation
john.mccray
James G. Boyd
Coastal SW Rule
2407 Atlantic Ave
Sullivans Island Sc 29482
Permitted Flow
Facility Name
Norton Road 5QM
Location Address
3471 N Norton Rd
Cullowhee
Owner Name
Hazel
Dates/Events
NC 28723
T Boyd
Major/Minor Region
Minor Asheville
County
Jackson
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Hazel T. Boyd
Owner
2407 Atlantic Ave
Sullivans Island Sc 29482
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
09/10/09
Regulated Activities
Outfall NULL
Waterbody Name
Stream Index Number
Current Class
Subbasin

HCDEN
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 16, 2009
Hazel T. Boyd
James G. Boyd
2407 Atlantic Avenue
Sullivan's Island. SC 29482
Subject: Acknowledgement of Application No. WI0100074
Norton Road 5QM
Injection Mixed Fluid GSHP Well System (5QM)
Jackson
Dear Mr. and Mrs. Boyd:
Resources
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on September 10, 2009. This application package has been assigned the number listed above and will be
reviewed by John McCray.
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 John McCray at 919-715-6168, 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 httn://h2o.enr.state.nc.us/docuinents%dwe omichart.ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT
Sincere,/
jl
for Debra J. atts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Bruce Auld (Andrews Auld Heating & Cooling, Inc., 3348 Old Murphy Rd., Franklin NC 28734)
Permit Application File WI0100074
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Locator: 2728 Capital Boulevard, Raleigh. North Carolina 27604 One
Phone: [phone] \ FAX 1: 919-715-0589: FAX 2: 919-715- � � 23 6048 t Customer Service: i-87- -6�0 0748 7`� T 0r h Cal oi.i a
Internet: www.ncwatergual��.om 1 V i E.il
An Epua! Opportunity � A.ffirmative Action Employer (f�

wv��
MCDENP.
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 16, 2009
Hazel T. Boyd
James G. Boyd
2407 Atlantic Avenue
Sullivan's Island, SC 29482
Subject: Acknowledgement of Application No. WI0100074
Norton Road 5QM
Injection Mixed Fluid GSHP Well System (5QM)
Jackson
Dear Mr. and Mrs. Boyd:
Resources
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on September 10, 2009. This application package has been assigned the number listed above and will be
reviewed by John McCray.
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 providerecommendations 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 John McCray at 919-715-6168, or via e-mail [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 httn://h2o.enr.state.nc.us/documents/dwo omrchart,ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT
Sincere ,
for Debra t.arts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Bruce Auld (Andrews Auld Heating & Cooling; Inc., 3348 Old Murphy Rd., Franklin NC 28734)
Permit Application File WIO100074
AQUIFER PROTECTION SECTION
1636 Mail Service Centel, Raleigrt, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604 OneL, 1
Phone: [phone] FAX 1: 919-715-0588; FAX 2: 919-715-6048 l Customer Service:1-877-623-6748 NOS ui dl OL1.Ili3
Internet: www.ncwateraualitv.org /J
An Equal Opportunity 1 Affirmative Actinn Employer F a a`4+

Mccray, John
From: Davidson, Landon
Sent: Tuesday, October 20, 2009 2:36 PM
To: Mccray, John
Subject: RE: 5QM application
John -
I've reviewed the application and know where this.will be located. Based on current RO workload and the fact that this is
residential (high -end) 5QM, we don't plan on doing a site inspection or completing a site visit. Please move forward with
issuing the permit. Just require 48 hour notice to me prior to well installation beginning. Thanks
Landon
O; LandDn Eiutvidsah::.P:O.
NC[lENF [,h'ter tru: tity .::
�`,.iuit.:t F*W:1_:tia115_„tt;jrr �r
ZO-)3 i.. Hv l. 71.
5. nn-n .. N.C. Z9"S
r•`s: S:s : ; S13
web page: http.Vlh2o.enr.stote.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 Caw and applicable record retention schedules,
From: Mccray, John
Sent: Thursday, October 15, 2009 4:57 PM
To: Davidson, Landon
Subject: 5QM application
Dear Landon,
Attached you will find a copy of the application for W10100074. If my name or syntax is unfamiliar it is because I am new
to these permits. If there is anything you prefer changed such as Subject line.or body of the email please let me know.
John McCray
DISCLAIMER: Per Executive Order No. 150, all a -mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTIMURAL TEAT PUMP SYSTEM FOR:
TYPES M MML S
1 _.New Permit Application OR Renew
al wal (check one)
DATE: -7--(- , , 20QC%
PERMIT NO. (leave blank ifNEW permit application)
A. PROPERTY OWNERS)/APPLICANT(S)
List Sch Properly Owner listed on property deed (if ownqd by a business or govern ent agency, stateame
entity and a representative w/outbority for signature):
tl) Mailing Address: ,e-9`f
CRYL:. l/�✓�A/t5 /.9[A?1�0 State:SLZip
Home/Office Tole No.: 3 - ; �7 3 QQ Cell No.:
EMAIL Address• d /4� . D ¢ y1't e IV 7-
(2) Physiccall Address of Site (Ifdifferent tan habove): 3'Y 7 L
City- 5_ State: A tp.Zip Code: :28711 County:.%ACK-21A/
Home/Office Tole No.:
EMAIL Address-,
B. AUTHORIZED AGENT OF OWNER, IF ANY (ifthe Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Cotnpanto Unma-
Contact
Address.
City:
State: Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company, if any:
C. STATUS OF APPLICANT
Private: JZ Federal: Commercial:
State: _ ._ Municipal: — Native American Lands:
GPtiltNC SQM Well Psnait Appli pion (Revised 72008) Pap 1
Aquifer Prntection Section
SEP 10 2009

D.
E.
I.
WELL DRILLER I:NFORIVIA77ON
Company Name: ~k ft e,
Well Drilling Contractor's Name:
NC Contractor Ce�r}ti`fication}�ntNo.: y
Contact Person- i 11 V t -40 f L I!' o 1 t a f p_ MkA h lr A l t_---•
Addre
City:
Office TeteNo.: �,?R= RIA9 D'ZY0Ce11No.:�o7S'�.
r SAS
HEAT PUW CONTRACTOR
Company nD Name- r 4erz
Contact Person:. T2 0 C�
�TION (if different than driller)
1JL
Address• 3 3 oa_ p .v ►e-- ,o -- -
City: _ r kLt .J zip Code: —� County: Ytt
Office Teie No.: G Z-Cell No.: co Z u " 3% / �—
INJECTION PROCEDURE (briefly describe how the injection wells) will be used)
G. WELL CONSTRUCTION DATA LSIdn to Section H if girls is a Permit RENEWAL)
(1) Proposed date to be constructed: 2 2 % -- n ? Number of borings: f _
Approximate depth of each boring (feet):
-e—f—
(2) Chemical additives to be used In closed -loop system (only tho a chemitaiis indicated have been approved):
li propylene glycol ethanol Err i ro0 I other (other additives will
need prior approval by NCDENR before use) }
(3) Type oftubing to be used (copper, PVC, etc): ( e 11
(4) Well cussing. is the well(s) cased? (check either (a.) YES gr_ (b.) NO below)
(a) YES if yes, then provide rasing information such as W.1 (steel, PVC, plastic, etc.), diameter.
401h,and extent of casing appearing above ground:
(b) NO
(5) Grout (material surrounding well casing and/or piping): I 1
(a) Grout type: Cement Bentonitelz Olher(specifv) i f .Ur_
(b) Grout depth oftubing (reference to land surface). from �_ to �Loa ve
1f%rell has casing, indicate grout depth: from to (feet ,37U�Q,r�
H. INJECTION -RELATED EQU1T'1VlENT
Attach a diagram sbowing the engineering layout or proposed modification of the injection equipment and exterior
pipinghubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
GPUMIC 5QM Well Peril Application (Itsrimil 7/2008)
Pogo 2

1. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a site nap (can be drawn) showing: buildings. property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed welI(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 incIsrde 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.
I POTABLE WATER WELLS)
Are there any potable water well(s) on the subject property or adjacent properties? X YES Ti0
If Yes, than indicate location on attached map(s).
lEi:. CERTIFICATION
Note: This Fermat Application must be signed by each person appearing on the recorded tegal 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.
1 am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. 1 agree to construct, operat71�
rain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with thved speeitions nd condi 'ors of the ermit."�lr
St a Property erffipgaht
Print or Type Full Name f
Signature of Properly OwnodAppl4
Print or Type Full Name
Signature of Authorized Agank if any
Print orType Full Name
Please return tmv copies ofthe completed Application package to:
North Carolina DENR DWQ
AquiferProkwAon Section
MC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
G UIUIC stet coal Permit Application (RcvLsed 7n�os) Page 3

14-
r.
Ir
%A4
soil

I
Agpmy,.
�e1
V•� ��V'' 1 1 •,4-
General Notes
L DO NOT SCALE FROM ORAWINB,
I _� '( O.• 2, CONFIRM LOCATON AID ELEVATION OF SURVEYORNLH 5 SEHAAk.
J 5. LAYOUT 517E ELEHE+TS IN THE FIELD PRIOR TO CONSTRUCTION AND
i OBTAIN ARCHITECTS APPROVAL PRIOR TO PROCEEDING.
4. ALL DIMEN910N5 ME TO PALE OF LURE, WALL OR MOB OF
PAVEMENT WL990 OTHERWISE NOTED
5. CONTACT ARLHIECT IMMEDIATELY IF LAYOUT CONFLICTS OR
\ 2 GATGN / AMB16UMES MEVE.
AI R IE. I]B i 6. SPADINS CONTRACTOR SHALL MEET WITH ARCHITECT ON SITE TO
\ RE. USA i REVIEW CLEARING, DEMOUNT AND GRADING PRIOR TO 6TARTIN9 WORK.
NN 12 80ADER DANK _ ^^ - - - TIE M TO EXIST. ROAD ]. ANT EXCESS MATEMA9' REMAMIN6 PROM PROJECT EXCAVAPON
\ _ nic- - - - - -- ^' - TWO 4" PVL SLEEVES HERE / SHALL EE LEGALLY DISPOSED C�"dRF-SITE BY THE CONTRACTOR.
_ T 20' LOCATIONS OF NVAG UNITS, GENERATOR, LIFT STMION AM PROPANE
TTW,24,O p�HA O �.� ` TANKS SHOWN OO 517E PLAN ARE CONCEPTUAL, CONTRACTOR SHALL
"DO
- } �� },-Y�•+FI- T ' COORDINATE FINAL LOCATION OF UNITS WITH ARCHITECT AND OWNER.
y� _ 1• _ FINAL LOCATION SHALL BE M COMPLIANCE WITH ALL APPLICABLE LOOM
'IN.,,[ , 1 ORhI'IILLET ti TH>,71GTYh4TO r _ C - �+ 9. HATCH COOPSED 6RADEB SMOOTHLY WITH EXISTIN& GRADES.
\ 10 BOULDER HALL T.-` y 1 . - _ - THE ONTRACTOR SHALL ENSURE POSITIVE DRAINAGE AWAY FROM
P"ASISTW2S.0TL-'.J y 1 IEI.UTALLN NOWRIZONTALLROOF DR PIPCOHS TO BE 50i 90 PVC. UNLESS
H&A' Nlff B • _ i I R' IIDIOATEO OTHERWISE ON THE ORAWINGS, EXTEND OUTLETS OF ALL ROfR
14 RI�T:R coBELe �.,. J J r . `'+2.. Y
SWAU & ,�..'w �-- -.-I Ty,S/ \POCK Otl�GROP ' �T l . 'I ' 7`-%. / \' POUNDATOk INS AND STORM DRAINS A MINIMUM OF IS PT. FROM THE &IILDIN6
BY OTHERS - ,2y0 } BWyIB'J� 1 / ` ': 'F . nCy . afi4tr I2. COORDINATE DOPSLPO/T LOCATIONS WITH ARCHITECT.
Ti' 1 j fP • &ffi'A� �q 1S. THE CONTRACTOR SHALL BE RESPONSIBLE FOR LOCATING AND
\F$AY�J!' y •• 10 +• V• 1 ' PROEETNG EXISTING UTILITES AND 5TRUCTLRES UNTIL ALL
•,l/ w"�A T mP CONSTRLCTNJN 15 COMPLETG THE CONTRACTOR SMALL REPAIR OR PAT
1 F" �1 ` R 5T0/8 .�yY A' \ f4w yAa ' N� O� / FOR ALL DAMA6E5 MADE TO EX151135 FACILITIES AND STAXTURE5.
14. THE CONTRACTOR SHALL EXTEND ALL REQUIRED UTILITIES (WATER,
/* / •j- PJAATTAfUDDHIE .. � f f SEHOK GAS, ELECTRIC, TELEPHONE. CABLE TV, ETC) IN OOOMPINATION
STONE V OTt.16t¢ -/ 19.4i 'IEC WITH UTILITY COMPANIES AND ARCNIT..
15. CALL ARCHITECT IMHEOIAT&Y IF ANY PROPOSED
OR ExI5TI1d5
,\ \ Ay !J I? ALETI 1� 4i, J05 .�"'•' / CONDITIONS CONFLICT WITH UTILITIES.
\ rI'I a •., yy/'�",T' +'%y` '.� / 16. EROSION CONTROL MEASURES ARE 6ENERAL IN NATURE.
9 WAEC PND CONTRACTOR I$ RESPONSIBLE POR ADDITIONAL MEASURES AS REOJIREO
_ - - -
- \ \ BWI6G j' =b BpiLDER PAVEMENT / / IP'` I N fT+'P TO RNEVENT ON- OR OPP-SITE RIRIOFF AND ER0510N.
- BY OTiFR4 n MI. ALL INLETS TO HAVE TEMPORARY INLET PROTECTION INSTALLED
\ \ Ew101•T 4" G I ` 4 IMMEDIATELY APTCME INLET HAS BEEN CONSTRUCTED, TEES DETAIL.
ER6. CONTRACTOR E VICES,RESPONSI"AND
FOR ONSWEEKLYAN INSPECTION OF ALL
` -1 w EROSION CONTROL DEVICES AND INSPECTIONS ANY TIME PRIOR TO AND
B SILT PENCE (TTPJ AFTER AN EAPECTEO RAIN EVENT. MAKE REPAIRS IMMEDIATELY TO
MAINTAIN CONTROL OF 5EDBIT. MAINTAIN SEDIMENT PENCE BY
REMOYMS ACCULLATED SEONWr BEFORE 11 REACHES HALF FULL.
OO"� -- MAINTAH FENCE M AN UPRIGHT POSITON, CONTRACTOR SHALL INSTALL
" \ AIO BOULDER WALL 5 ADDITIONAL OR MODIFY EXISTING MEASURES AS NECESSARY 10 MAINTAIN
CONTROL OF SEDIMENT AT ALL TIMES, CLEAN UP ANY SEDIMENT WHICH
_ . _ +4! , / LEAVES THE 511E IMMEDIATELY.
w
/ Iq. INSTALL TEMPORARY VEGETATION ON ALL DISTURBED AREAS WITHIN 15
WORKING DAYS OR SO CALENDAR DAYS, WHICHEVER PERIOD 15 SHORTER,
\ \ _ _ a _ IRS . 18 163• I' / / AFTER COMPLETION OF ANY PHASE OF GRADING,
M. REMOVE ALL TEMPORARY EROSION CONTROLS AFTER DISTVRBEO
AREAS NAVE BEEN STABILIZED AND COMPLETED. REPAIR AREAS
1 / / SILT FENCE (TYPJ 5 DI6TURBED BY
REMOVAL OF TEMPORARY EROSION CONTROL OEVIOM
14 RI VBi GOBBLE ^ / / / 21. ALL PROPOSED STORM DRAIN LINES SHALL HAVE A MIN. OF IB'
- RIVER OOf9BlE / COVER UNLESS NOTED OTHERWISE
/ p EPROPOSED RE DENOTE 22. ALL YARD DRAINS SHALL Be ND512 INCH LATCH BASINS WITH
I\ D / \ MAIN FIFE: Iq, 5 / / BLACK PLASTIC ATRIUM 6RATE. ADD RISERS AS NECESSARY TO MEET INLET
\ LOWER PE• 10*7.99 /� HeONs. M. T
25TN! CONTRACTOR SMALL PROVIDE FINISHED GRADES AS SHOWN ON
THE02.5 �. ./ 99D._ I 24. PLAN WITHIN A ER TOLERANCE.
O9rf\ • O �_ _ •L-+ SHALL ALL TREES, CTEP FROM
AND OTTER VEGETATION TO REMAIN
ARIN&
\ \ \ �- _ SHALL BE PROTECTED FROM IN.MY DURING ANY LAND CLEARING AND
%�" / T\1 2$. THE CONTRACTOR SHALL NOT PARK VEHICLES, STORE MATERIALS
\ / 4 S \ I '. ~ "� OR TRENCH WITHIN THE DR Y V9 OF TREES TO EMREMAIN,I.OR WITHIN
\ \ \ \ I { I •\, �� ` BARRIERS PROTECTING ANY NOT CAUSE
TO REMAIN.
26. THE CONTRACTOR SHALL NOT CAUSE OR ALLOW THE INT
EQUIPMENT,
5TLRAM OR DISPOSAL OP MAMMALS SUAS PAINTS,
A°i PAINTS,,
\ wt, \ \ \ A 1 H •\. SOLVENTS, ASPHALT, CONCRETE, OR ANY MATERIAL THAT CAN DAMAGE
♦A \ / !\ \ T j \ �•• THE HEALTH OF VEGETATION WITHIN THEDRIPLINE OF PRD'iKED
SILT PENCE MPJ 5 VEGETATION.
wpO RIVER fTY J E \ \\ /Q \ / \ l - \I / 1 1 •\ D 21. A TEMPORARY TREE PROTECTION BARRIER FENCE SHALL BE
RIVER INSTALLED AS SHOWN ON THE ORAWN6S AND MAY BE MODIFIED BY
BYM RS - �`.` \ \ \ ` O / ~ i - -` I -" • • �. THE ARCHITECT UPON INSPKTIDN. THE BARRIERS SHALL REMAIN
\ \ / / ` .�J .� �• 1F I I _ TMROUSHOJT THE ENTIRE CONSTRUCTION PROCESS. SEE DETAIL.
1N 1 26. SEE ARCHITECTURAL ORANINGS FOR ALL BUILDING DIMENSIONS.
\ \ \A / \ y TEMPORARY GENELONTRKTOR A IS RESPG}.NDSOAPE OONTRACTOIL NJ. FOR COORDINATING LL ITEMS.WORK
CONSTRUCTION 5 SILT PENCE MD B PJ /'
BRIDGE LIST® ARE TO Be PEW'ORMID BY
NDS \
02WRACTOR
/ 02,\ \ ♦ �1 / eANV //1 N�.•_� `. BOULDER PAVEMENT
CRUSHED
CMII rIEIN�TOR�AACONTRACTOR9I ORBCOCOURT.
PEE
\ I \ POND / \ THE DETAIL ON 51EEr A102.
96
ELEY-,0' _ 1 _ \ - RIVER COBBLE IN 9WALES (6@ERAL CONTRACTOR 15
\• / / `\ / RE LE FOR
L BRADINS ACTIVITIES.
STORE
1
\
A ms.
-
BH:190
TH.IgS HVJAC
TH. 0201
3OADER HALL;
\ SILT PRICE MPJ
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9
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HALL b \ \
\\ \\\
\1 I \ \
\ \ \
RIVER cooE wBL\.\ \� 1
1�
11
\
\
\ \ • RIVER CO®LE
\\\ \\ BY OTHERS-
\ \ /
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N.
IN
SYMIBOL6 LEGEND
NOTE, IF A brie L DOES NOT APPEAR ON THE SITE RAN THEN WORK
REPRESENTED BY THAT SYMBOL 15 NOT INCLUDED IN THE PROJECT,
211M.4
EXISTING TREE
•K ------
X----- * SILT FENCE
-
- - -- BARRIER FENCE / LIMITS
>eBNA
TREE TO BE REMOVED
OF CLEARING
870 EXISTING CONTOUR
E64.
PROPOSED CONTOUR
+3
SPOT
�A° oN
HP
HIGH POINT
RAIN CHAIN (RCJ
LP
LOW POINT
YARD DRAIN ITDI
IE.
INVERT ELEVATION
®
CATCH BASIN (CBU
D$
DOHWSPOUT
®
JUNCTION box LBI
TC
TOP OF CURB
DRIP STRIP
BC
IN,
BOTTOM OF CURB
TOP OF WALL
g }( T J,
BOLLDBR BANK
BW.
BOTTOM OF WALL
�y�f�Ay
SWOP
SMOOTH WALLED CCRRV6ATED PIPE
TIP,
TYPICAL
WESTMORE
.VN 1V'
4P.O. 6Cd
P.O.
N84 2
BOX 8426
ASHEVILLE, C 28814
NORTH
828 505 0842
ro50u,�simor�tleaign. co,n
0 10' 20'
40'
SCALE: 1"R10'-0"
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