WI0100084_GEO THERMAL_20120517

A�
rrrwrr.
NDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
May 17, 2012
Susan and Blanton Hamilton
20 Providence Road, Suite 106
Charlotte, NC 28207
Subject: Notification of Rule Revisions Affecting
Closed -Loop Geo*ueim.al IrIjection Well Permit Holders
Permit Number: WI0100084
Dear Mr. and Mrs. Hamilton:
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.oraweb/wglaps.
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 MifthCarolina
Phone: 91."07-64641 FAX: 9IM07-6496
Internet www.ncwaterauality.orat�l
An Equal Opportunity 1 Aflimnative Action Employer

A& —_ A
NCDENR
North Carolina Department of Environment and Natural
Division of Water Quality
Beverty Eaves Perdue Charles Wakild, P: E.
Governor Director
May 24, 2012
Susan and Blanton Hamilton
1704 Brandon Road
Charlotte, NC 28207
Subject: Notification of Rule Revisions Affecting
Closed -Loon Crenthermal Injection Well Permit Holders
Permit Number: W I0100084
-ea"r Mr: and Mrs. Hamilton:
Resources
Gee 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 bLU .// -IortaLncde_nr.ort /web/wt/airs.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at (9I9) 807-6464.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
cc; UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Camlina 27699-1636 One
locatfan: 512 N. Salisbury 5t., Rafeig , North Carolina 27604 NorthCarolina
Phone: [phone] FAX [phone]
tnlemet. www.nwateraualitv.org Q u�'��!
An Equal OpparloMy I Af fniafive Action Enlplay�

01-31-2012 15:06 TARHEElr WATER TREATMENT SES-369-0740
PAGE1
s
a. lLESS$ L4L WEQQ0N9TRUCj!Rt4 1ZC4RD
5 NoM Camilm Lkpe == afEzvW== sod NWaM &=mum,- Division of Wtaer Qua*
W Rid. L:1]MTRA(.-MR t:ILwri rimium
:L WELL a1PORMiTION:
arm VVeLL Io MP app�rla,i
. WELL CONSTRUCTION PEWITS -To L Q �
vr"E" ASSOCIATED PERAIfrqu*P0Mle)
i. WELL 119E (Ch" ArftWo BOW
DATE DRILLED ,,,;g?Q J�
TrIIAE CADMPLETW J'Qf.J ......... AMI PJK,-.
4. WELL M:
cnv. 6aShtpffi comy �� k a�
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1C 1 LI111D 8E�TIIsG:
X=RAPH
i Y14y 1 FIR 4 144 1 09w
[anpk epPORi� �
Qia r - MIN *` 1n ee�raei
LATITUDE fJM
arunat ssi� or
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L.atitudelfv%Itude source- i. )PIw 1 Topographic map
(bMww+ ofoo multIro on a USGS repo nap anti
41aa11ed ioda Amara A ra ualtp GPS)
aWILL CRFM
OVAER'S NAME
STREET ADDRES9
Clip or Town Stile ZIP Code
And code • Phone nunew
4. MLL DBTAILN:
a. 'TOTAL DIPTH
& DOM WILL RSPLACE ESE 1 00 INUP Ys 1 owl
L WA7®1
(UN W ItAbore Too of Cates
IL TOP or CANING Ft. Above LOW Surtoe'
'rop of useft tun howd Aw DOD lend Kvbm M""quire
e woftnoe In aanr 1 mn valid t 8A NCAC 2C .0
YILLD OD OF TEST
f. 015111WECTION:7yp+ An►orrR
a WXM Ef [
From To TO
F=n TO Flom
Fiom o From TO
7. CANING: Thkkvw
i�
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From To
Flan FL
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I& NANDJ[IRAIISL PACK:
DwIll 5120 WINNOW
FrpM-70 R
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Frpr_TO FL
It DRILLNiG LOG
From To Fcrmatbn Dasc*dur
� r l
I1.RKI1lARICS:IJ�AlR.
r��j r1
DATE
Submit the origins) to the Division of Wahn QWf y vftln 30 doL Ann- We.mW&H mgL, Form GVYLU
1647 Veil Service Cartier- Raleigh, NC 27OWGIT Phony No. lHll) 722.7016 alit W. Rev. 3w
RECEIVED 01-31-12 14:33 FROM- 8283690749 TO- PVC DEAR P&S P0011006

01-31-2012 M OG TARHEEL WATER TREATMENT SES-369-0740
PAGE2
&S1MUM WELL LONS'1TILVIC ION JREfLORD
NrxilM i:alolina Qaperl+lwall or Rapoutca! - Divisine o!' Waoer Qualify
WELL CONTRACTOR CERTIFICATION # 3424--A
1. WILL CONTRACTOR:
Michael S. McClure _
Wall Conlracior (Indrvidnaq Kama
Terhtgl 1Nater Treatment. Inc. - - -
V M carted lr Corrrparrp Norm
3424 geQreia_Road-
SOW Address - - -
Pranklin HC- 28734
Cl y or Town sues rip cafe
828 M-0740
Ame coft P1lorre roumber
L WELL INFOR1sAT10141;
WELL CONISTRUQTION PERMITS Y9101 QM84_
OTHER AS=IATED PERMITII(teppftft)
Irrl WELL ID"apifica rly
i. WILL t= (Che& Appkedle SWO:
DATE DRILLED&J-4 10
TIME COMPLETED 1:00 AM ❑ PM c>�
a, t1iIELL LOCAMN:
(she Nam. Nlenbere, Communigr, awbdiri N. lot No.. Pera1, Zip Code)
TOP06PAPHIC r LAND SETTING: (am* eppraprlele too
a(ftw p Vak'y O Ftal p R"e ❑ Olt+er
i1 UDE 35 ' 1 "AN • DMS OR 3XAMMOM DD
LONaiwi E 3 5 40.4m - aMy OR 7x.xxxxx xxu as
I. WATER ZONES (dapl»):
Top $amorr1
Too Bortarrr
Top blallt
Top Ian
Top pAft M �.
Top.«.�...�.. ealtorr+
Thkkfx"
T, t:Aawa.. Boo eft nl" we*N Nobeebal
Tap SWW _i Ft.
Top Baleon FL -
Top euttarrM­ ti.
e. GROU'f: 0"M Material Melfwe
Top g Bmlarn 210 FL 114" gravel poured -
Top 0
Batlanr 20
Ft. nmlonk eami
Top
BORORj__ Ft. ....__
L SCRUN: Depth
DW"W IW sin Nhftdnl
Tap
BOOR1
Ft. in. in.
Top
Boteorrr
Ft in. In,
Tap
Bost am
Fl.__�^ln. In,
MIL OANDIOMVIIL PACK
Depth Skye
Tap BOon1 ­ Ft
Top _ 8otA M_ FL
Top Ft.
11. ORILLAIG LOG
Top eollor<r
A I
Fprrwdun QhAwOdan
LaMA�deAorlpi aeurr�. l]Topagrap Wrap
(ftll n of WIN MO be srrolrn an a USGS lope Map &9d0MKtrd 0
1
Enos brrn IF naf utatp GP�y
_� j
s, tIIIQLL OIAINIR -
1 _
1
Bunton & Susan HamiliQnOwner
Nom
1700 Brandon RQa
SwW Addre4R
1
Charlotte
CAr or Town Shia Zip Coen
704 , 37s- -069
Wes bode Phone m lbse
12, REMARKS:
e. WEU ObTA1LS:
a. TOTAL orm- 2 10
IL DOEi WILL RiPLAC! EotIIT1NL3 tIMELL4 YES r3 NO orI
DO HEREBY CER'TIFIr THAT TH13 WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top o1 Ca ft 2 FT.
ACCORDANCE WITH SA N 2C. WELL CONSTRUCTION
(Use '+" If Above Top of Cn k*
STANDARDS, AND T dF ilal$ �tE Q i IAs il1=tiN
d. TOP OF CASINO M n/8 FT. Abare Land Surhoe'
RRDVil7E 1 TF it r
fi f
'Tap or caskV welninaerd wor below ford ouriaae mat► require
I '� C �--' C Q
a variance In eceardarue with 1SA HCAC 2C .Di if.
_���11@J2Df
SIGNATURE QF CERTIFIED WELL T AGTOR DATE
e, MELD (pprlr): nta METHOD OF TEST
Michael S. McClure
f. DMINFECTON: Type Anmk ;
PRINTED NAMEOF f ERSGN CGNSTRUCTIN WEI-1
Submit vftin 30 days of aomploWn to: Division of Water Quality - Irlforiamion Processing Form OW -la
ti617 AEG' MD 01-31-' 1Z ' !4 �33" FR0"M*- 8283696746-
. - TO- NC DFSIR F&S P002/006

01-31-2012 15:06 TARHEEL WATER TREATMENT 828-369-0740
PAGES
RESIDEMIAL WELL coNsnu irioN
Noft Cwohns Dw m' mt of Eavntsamm gild Natural Rcsoumv* Di►'iaiun of Wittrr 0twilily
WtvI.I. C0N'1•kAC'1'0R C'r;RT)FICATION # 3424 A
1. V MLL CONTRACTOR:
9. WATER ZONES MPIR):
rot? Bottom
Tap — .
Wolf COnWW" (,r ilvidual) WMIG
Top .. 9OQa+K
Top 8ofl0m ,
Tap Bottom
Tap aalhxn
t+Yell Corb►ader Cprtpay Nome
_
Thbkneaal
3494 Georgia Road
T. C"ING. 0"m
ownaw wwMht twfail/I
Sbiet AM
Tcp Bottom
Ft,
Franklin tiC 2$7-34
Top Balm
FL
CRyar Toom 8fee Zipcoae
T Bottom
aP
F1. -
828 SM740
Area coue Phone rulmW
a. GROur Depth
wffidai Met#lod
2. WELL IIiITORMATIdi:
Top Barto 2m 1 O -
Ft.1 /4" gravel poured
wr.LL CONSTRt1CTION PERwye W101 0084
Too 4 9W= 0
Ft, bentanibe poured -
OTHER ASSOCIATED PERMrM * ePPw'Apral.- . �...
Tnp Booam
Ft.
B1TE WELLIQ *[+r sonaaaeMx-
9. 9CRh7M. Depth
DlaWAWf Sw aims Wdr"al
i. VAU 118E (Ch t AppflWtite Boaj:
TOP aaflem
Ft. In. ,.,,,_,-, in.
DATE DRILLED 5118/2010
Top Botnarn
FL ---in. in,
T1ME COMPLETED M AM c aM [�
Tap aottam
F1. JIt, _„�, in.
4. WILL LOMON;
1e. sAMDi'ORAVEL PACK,
CRY: Cmhiers _-- CouNTr
Depth
'rap emtamL_
aw Mmrm
Fe
?BO a0vaaiae Q. Cashers. NC 28717
Tap BWvm
tat,
(B"A Mama. Nuwbn. Commw t. t3r k%ulon. Lot No.. Psi . %p Code)
Top BDtlgm
R• ,..�_ .��
AgPOGWHIC I LAND U-MMO: Wwa1 appraprlaa ow)
Slope DWall" O Fiat DR1dge 0 O9rar
11, DRILLING LOG
Top BOtlam
Foneation Dsaulpiba
LA DE 3i @ 0 Oo.iooG "DM9 OR 3Gp(.3
Soil
LONWMDE e3 • a • aO.apop " DMS OR 7tl.x)LxlMLx Do
�1210
granite .
LiMudeAwqftee sauriOa: WbIRS Qr6MMphlo mop
{Immoor► of 0" mm be m m" an a uSGS ow map wKwo w to
ihlr bntt few 009 GPS)
1
S. MML.L OYgIQR
- - - - - -
Owner Harm
I ZOO Brandon fteg
SnmAMmu
Charlotte
1
City or Town sa zo Cola
(_704 375-0080-
1
Area code Pitons rome r
12. REMARKS:
8' RTLL °U
aeothe►mal heat A air
o. TOTAL Uwm:210
bt OOEB WELL 11I51PLJICE =STING MIMLL9 YES t_l NO W
a. WATM LOU &Ww Top of CaMV: ilia_ � _._ FT.
hiss "t" II Above Top of Cooing)
d, Tw cr CAswo 1e -nra-- _,-- F7. AbM Land .Su fm-
"TOp Of offing torminapad aWr betoW land wfmw may" require
A r9rlono4In aOOordarm V015A NCAC 2C .Q119.
I DO HERESY CERTIFY THAT THU WILL WAS CONSTRUCTED IN
ACCORDANCE WrrH 15A NCAC 2C, WELL CONFilRUCTION
STANDARD&. AND T A C f3r Tli 8 F45ORD HAS BEEN
PROVID 1`ll LL
SIN RE OF CERTIFIED WELL CO R�T -A DATE
a rIELD (Opal): n/a- MUHW OF MT Mkheal 9. McClure
r, MINNRlCTION: TM AmOpn1 PRINTED NAME OF PERSON-eONMUCTING THE WELL
8ubm* within 30 days of comp*_ lion to: DlNlalan of Water Quality - h%%matlan �. Fom+ GVV-1*
1517'3ECfIVED k—k—' �� �1.4; 33---FR6G)- 8283fi30740 TO— NC DENS P&5 P0031006

01-31-2012 15:07 TARHEEL WATER TREATMENT 828-365-0740
PAGER
S EMIAL WELL ONSTR N D Q
NWh Cdivlb a Npts item of L-'mirom mi wxl Ni isrul Remnum%- Olviaion nl' aler QlWity+
W E i.I, CQN't itAC 0R C'ERT11lZCATCON * 3424"A
4. WELL CONTRACTOR:
Michael a.- McClure _
WiA Co►Ktaciw IlydltaidU4 Now
_T-arheeLWaler Tsotment. Inc.
Well Contmcw Co1mmmy Noma
Scher Atltheaa
Franklin _ bC 28734
City or Town &late Op code
828 I paa -
Am atria Phone +tumbet
x WILL INFORMATION:
WELLCONSTRUCTIONPERMa*W101D0084 _- _
OT HER ASSOCIATED PERM17"N ar+aaerarai
one WELL lO ev apphrabiel
S. VV= USE Appiuble Bm*:
DATE GRILL EXI
TIME COMP1.ETED100 .. ,., AM ❑ PM 13(
WATBA mNe (dWM)•
Tbp aodam
TOP Bottom
Top 9mlv
TOP t3oww
TOp aaticrrt
Top 9oltaM_ Ft.
Tap Shcom Ft,
Tap BORan.,,,l, FL
9. GROUT. Depth Matadal melflrw
Tap Zia BOtlom ua t!4"-gmvel - Mould
1 ap 8DR&r 0 Fi. berltOt U pwreC
a. SCRE": Depth
Diamagr Riot Lltn 0110 td
Top Barom
Ft. In. In.
Top Boffiom
Ft. in- in -
Top Bottom
Ft, in. in.
/. WELL LOCATION* 0. 5 MONRAVEL PACK:
CITY., Cashim coum Y Ja — T Depth size MiEarm
op BOttOrlt FL
26�S��� 28717 } Tap _ Fs. ......_..
trait umber. mu", tm ftwk Let uia , Puwa, rip Coo) Top B uffn�­ Ft.
IC 1 LAND SETTING: (door aopad b"
tWe ❑valley ❑Flat ORWVe Dt7llter
ruDE _ 35 .. ` a^: 5iJooc ' DMs ale 3x.00
LONOITUDt= 83 - a' 40•+M • DMs CR 7x.XXXXK M DD
LaduftrionsRude source: 06PS (; Jropoprsoic map
{Redly otwwl arwit be altotln on s uses "map anooaaaw to
Imo bw M rtol uabv OF*
A WNLL CMIMER
Blanton & S
moaner Name
SnSI Address
Charlotte NC 28207
0y or Town Stair Tarr Code
ZG4 I 25- -W-
Wee ON@ Phoraa number
B. WELL PETALS:
eL TOTAL ORPM: 4a
I► DOES ON.L amp"M KrAm"a WELL? YN ❑ N.o of
c, WATER LEVEL Below Top of Guff: FT,
(Use "*' Ir Above Top or CRsarg)
d. TOP OF CAsm iB n 8 FT. Above L ertd SWACa•
'Top of cuing term -OW oft oelOw land Mabcs mom "qu4v
e rarbw= in aawaMnoe with 11A NCAC ZC .0110,
II, ORILLING LOG
Top Bot►wn Formation Desedplion
f�1 sail
amnit0- -
!
1
1
1
!
11. PEMARKS:
_._
I DD HERk CERTIFY THAT THis WEll WAS Cn`a SMuditu IN
ACCORDANGt: tNiTii 1 t3A 20. WELL CONSTRUGrtON
STANDARDS. AN THA F+Y AF Thl RECORQ HAS BEEN
PROM , TOT ER,
I � f I &19)2070
SIGRATURE OF CERTIFIED WELL CONTRACTCIR RATE
s. ► IEiLD ism): Dia METHOD OF Tw MiOtraal B. McClure
L DISINFECTION: Tapp Aanount PRINTED NAME OF PER CQNWrRLiCTING THE L
Molt wKhin 30 days of comploWn to: Mvislon of WaW Quality • IrItw votwI Proaot wM Form G1M-ta
1$11 MAN
01 31-p12 14 339 ROM O8283690740 *�� TO- NC DENR P&S M.
P004/008

01-31-2012 15:07 TAR-IEEL WATER TREATMENT 828-369-0740
PAraES
RESIDENTIAL wELLcoNST'AumoN,REcuRD
north Carolina Dt'rrartment Ui-Rnvlrormcnt and Nffund RC84 olcuS' Dlvisiun of WaWT Quality
WELL CONTRACTOR CERTIFICATION g 3424-A
1. WELL CONTRACTOR:
Ndichael S-McClure
v%1l Co*ocb r tlrrdwuslj Name
Tarheel Water Treatment.-InG,
vftu Contractor Company Name
34945a$flmi Road
Street Addtr
Ermakfin
C+ty or run n state zip Code
(- 821 3612-240
Area node Pitons nunOw
L MLL II F0101ARON:
WFLL CONSTRUCTION PERMITO W19190484
OTHER ASSQCIATE0 PERMITW ppp "bN]
firm WELL Ib PIN *Mow*)
& WELL USE {Check Applicable Bo4-. RdINNEEMBOINWIW
DATE DiiILLED�f�
-nME COMPLET6D.§M., _,_._ AM O PM Iv
4. VWLL LOCATION:
CITY! Cashiers . _ couNrY Jgckson
260 stoYeQlae Qt. CashgI-s, NC 20717_
(3lnwl Nwrnw, Numbers, Cumrawnity, SwWwWort, Los No., Parpl, %p Cooa)
yTOPOGRAPHIC l LAND SETTING: (cnK* @pomOArlstr ball
SMw ❑vallvy ❑Fist ORWP I ID�1ar —_
/ Trruw . 39 ° 8 ; 51•ONO " OMS OR 3x.xloalxun DD
LUNaarrum 83 48 ao,eaoa ' DMS OR 7X.XX-vX (XXXA OD
Lafaudellongh We source: 66ps piopopMONe msp
11 wftn vrnvd muarbe ahem an a USGS mpo ►npp anaarrachaa to
on b.m d ra W" GP51
a. weu. ow"111%
BlaaUn& S Isan Hemiftam_
owner Name
TMSrandon Road
SUeetAddraaa
charigge _ --NQ- 2$2Q7
Cliy or Town St M zip Coco
t7D4 -375-e08e
Area cads Phone r amber
C WELL DETAILS:
& TGTAL OEM: 240
IL DOE 8 WELL REPLACE FJ88TINO WELL7 YES p NO @(
c. WATER LEVEL Below Top of C4aing. nla -Fr
(Uis -+' ff Abow Top of Casing)
d. TOP OF CA61ING IS M a I-T. ADm Larva Surface'
''rep of caairy twninslad atlor below IwW outface may require
a vadorA* In accordance with ISA NCAC 2C .D11S.
e. YIELD tgpnil: n1a_ MiEi;THW OF TEST ,
C 00mrECTIOir: T7 P■ Amount
Q, WATER &ONES ideW.,
Top Bolton
Top 9ottom
Top 9ottom
Top BoRom
Tap Bolionr
Thlskrraesf
r. CASIMri: Depth DMNIer Wftm EI<mm
TcW 63ailom FI.
Top Su tour Ft.
Top Gotorn Fl.
0, GROUT: DeW MA0081 Meow
Top?() - sown, 740 Fi, 1/4` gravel Dou d
Top a eotiem 2C Ft. bentonita p2ured
Top Boliorf� A.
4. SClel#11M: Depth alowater Siot SAM 1111"rial
Tap Bottom Ft, in. Ian
Top SoftR Ft. in. In.....___.v_ _.�.
Top sottwn FL--jr). in,
18. SAMDlf3RAVEL PACK:
080h 31" Mt+terlal
Top—_._.sottorn . Pt
Top Bottom Ft._,,r _—
Top 9atton+ FL
11. DRILLING LOG
Top Bottom formation Description
0 13 sail
3 ! 4� 0 granite
1
1
l
I
1
�1
�1
i
1
1
12. RE:MARKB:
geothGrirlifll.l]Rft &Air
i GO HERE6Y CER- IFY TKAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE Y+ 1 H �5 CAC 2C. WELL CONSTRUCTION
STANDARDS, AN T B COPY OF 198 RECORD ► m 6Er-N
PRUViO TQ E OYVN
SI NA U F CERTIFIE ELL CONTRACTOR DATE
M cnael S. McClure
rRINTE;D NAME OF PEnSON CON T U TING THE WELL
Submit within 30 days of eomplsUon to: alvislorl of Wateir Quality • Infvrmadan P. hm. Form GW-19
1@17 if 009~1-0 f ftPas-r prrwlwi LM q`I�m ■4■ P64.�+ . a^�n� nwy wwnn
ECEIVED 01-31- 12 14:33 .PROM- 8283690740 TO- NC OENR P&5 �PM051006

01-31-2012 15:07 TARHEEL WATER TREATMENT 828-369-0740
WELL MNSTRIAMM MCORD
..r,. I
! ,-1 Nanh Carolina Dmwiment orRnvirnnment and Hetiire! Wmun+es- T]ivi9lnn of waArQtwiily
..,.,.,..' WELLCONTRACTOR CERTIFICATION M 3424-A
well Conlracta () lone
Tarheloil W9ter TreaViwt. Inc. _.
Was Canm for Camww Name
t30eet �raaa
_ Eranklin NC�28M
C „or Tom sun zip coati
f -8 369-0740
Artie coda PhV0 nth PIP
E. WRL.L INFORHAT10sr
wEL.L coNsTRucTIoN PERlaIIT1s w101 OOD84 _
OTHER AWMIATED PERMITM(N a0icahlr)
SFM WELL ID 6Rw0b")
a. WELL USE (Chad[ A00kabie W. III I
DATE DRiLLED 5/20/2010
TIME COMKETED31D AM ❑ PM
CITY: Cashier cowvrr,J.pc a
2S4_Stovepipe Ct, Cashers. MC 28,717
tooNOW Nam6m comff w+lh, mofttw of lei Ne.. Papaw. nP c*00
PWRAPHIC 1 LAND BIEMNG: toe* ape miltlil to)
o VA* 13FM I7RWpe 0011W
LATITUDE X 10 ' 51.1a0a ' 0M8 0lk 3X,=X%X 00
LONGITUDE 83 -1 -4a eoaa * amo OR 7x.xxxxxxxxx au
La4y waft riQlerde ea m i&PS L jTwoww* map
Owidw a1 wed mumbe shown on a L40S NPO map mndata d"a to
NwIbrrrr rriaf &$m OP9)
i. VXLL 01AIIIRR
Blanton & Susan Ha
Charlotte - _ . NQ 28207
city or Town slate zo cafe
1704 3764060
Afee cod■ Phone number
s. WKL oeTAU;
e. TOTAL Died m. 240
b. Doss W&L WL4cr. RxIS m WML? 'TES o Nod
G. WATt:1t LIMM Delft Top of Cesinp: fig FT.
Olm •+' if Above Top of Casvgi
d. TDR OF cAms to n18 FT. Above Land 8vrteoa'
'Top of em" U nfMnetad aft bstow lard nnlraa -ray require
6 varlarioa In accordance vO ILA NCAC 2C ,0118.
aL 'AF 0 *+k.L1/a INETHOD OF TEST
I. DISIMPSOTIOM: Type AAiount
PAGES
0. WATER ZONRS (dem).
Top_—
eclmn, Top 90ftm-
Top
Boom—_ _^ TOP Bolter-
Top
9vnoM� Top 9olbre
7. CASING:
TlitelliiaW
Depth 0-aroaser wogmd mendel
Top
Kamm FL
Top
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8. GROUT: 080 matemw Method
Top 20 Bottom 240 Ft. X amwel poured_
Tip o eclt m 20 Ft b6ntoifte . poured
Too. EWom _ - Fl.
M SCRI N: Depth 01srra-1 r am #Ice Maita�lel
Top Bauafk— FI. in, In.
Top Bottom F7.In. in.
Top Bottom Ft. In. Im
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12, REMARKS:
Ream-sral_how & air
I DO HEREBY CERTIFY THAT THIS WELLWAS CONSTRUCTED IN
ACCORDANCE WITH 1 SA14W 2C, WELL CONSTRUCTION
STANDARDS. AN0 T A OPY OF IS RECORD HAS BEEN
PROVi TO E L WNE
/A'r G � r'L� �. 9Ji9i1D40
S NATURE OF CERTFYE0 V?ELL CONTRACTOR DATE
Michael 8. McClure
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
9ubndt wlthln 30 daiys of ooelpletbn to: Dlvlslon of Wabr Quallly - htlorrnedon pma seft Finn GW-1a
161-r w u 06 ..0.0 N.Mn4.r cmkd..r aM wrma . f84 ahwwA . adat OAT Ewan �....
RECEIVED 01-31- 12 14:33 FROM- 8283fi90740 TO- NC DENB F&5 F®06/006

WIOI00084
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (50M)
Primary Reviewer
michaei.rogers
Coastal SW Rule
Permitted Flow
Facilit,
Central Files: APS SWP
03/29/10
Permit Tracking Slip
Status Project Type
Active New Project
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Christy McClure
Contact Driller Well
3494 Georgia Rd
Franklin NC 28734
Facility Name MajortMlnor Region
Susan and Blanton Hamilton SFR Minor Asheville
Location Address County
260 Stovepipe Ct Jackson
Cashiers NC 28717 Facility Contact Affiliation
Owner Name
Susan
Hamilton
Owner Type
Individual
Owner Affiliation
Susan Hamilton
Owner
1700 Brandon Rd
Charlotte
NC 28207
Scheduled
Orig Issue App Received draft Initiated Issuance Public Notice Issue Effective Expiration
03/24/10 02/23/10 03/24/10 03/24/10 02/28/15
Re❑ulated Activities RenuestedlReceived Events
Heat Pump Injection RO staff report requested 03/05/10
RO staff report received 03/11 /10
OutFali NIA,
Waterbody Name Stream index Number Current Class Subbasin

Central Files: APS SWP
03/17/10
Permit dumber W10100084 Permit Tracking Slip
Program Category Status Project Type
Ground Water In review New Project
Permit Type Verslon Permit Cleselflcation
Injection Mixed Fluid GSHP Well System (50M) Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers Christy McClure
Contact Driller Well
Coastal SW Rule 3494 Georgia Rd
Franklin NC 28734
Permitted Flow
Facile
Facility Flame MajorlMinor Region
Susan and Blanton Hamilton SFR Minor Asheville
Location Address County
260 Stovepipe Ct Jackson
Cashiers NC 28717 Facility Contact Affiiatlon
Ciyynr�r
Owner Flame Owner Type
Individual
Susan Hamilton Owner Affiliation
Susan Hamilton
Owner
1700 Brandon Rd
Charlotte NC 28207
tFS?r crTtC
Scheduled
trig issue App Received Draft Initiated Issuance Public Notice issue Effective Expiratioh
02/23/10
Renulated Activities _ _ ReuuestedlReeeived Events
Heat Pump Injection R4 staff report requested 03105I10
R4 staff report received 03/11/10
Outfall NU!
Waterbody Name stream Index Number Current Class Subbasin

AUA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coieen H. Sullins
Governor Director
March 24, 2010
Susan and Blanton Hamilton
1700 Brandon Rd.
Charlotte, NC 28207
Subject: Issuance of Injection Well Permit
Permit No. WI414U084
Issued to Susan and Blanton
Hamilton
Jackson County
Dear Mr. and Mrs. Hamilton:
Dee Freeman
Secretary
In accordance with your application received February 23, 2010,1 am forwarding Permit No, W 1.0100084
for the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection
well system to be located at 260 Stovepipe: Court, Cashiers, NC 28717. This permit shall be effective
from the date of issuance until Febnzary 28, 2015, and shall be subject to the conditions and limitations
stated therein.
Please pay special attention to Part VU.2 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
completion of installation of geothermal well(s) 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. Per special condition Part 11.4, in the
event that there will be multiple wells with separate clusters, one well identification tag per `cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
Finally, please pay attention to special condition 11.5. The well(s) must at a minimum be grouted
with hentonite grout from land surface to 5 to 10 feet into competent bedrock.
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,
r
Michael Rogers, P.G. (NC FL)
Em ironmental 5pecialtst
cc; L,0itrinp flpvi[icnn — ,AghF-villp -P (7 anal Office
Central Office File - W141000814
Jackson County Environmental Health Dept.
Chrisix McClure - Tar Heel WaterTreatment, Iric.
Attachment(s)

NORTH CAROLINA
I� ►;� Mu E _�f1 �1;1`I 15110 3 I Diet f►►1 pieI% t1i 11"► All Toil) ,, 1@ *i
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
Susan and Blanton Hamilton
FOR THE CONSTRUCTION AND OPERATION OF 6 TYPE 5QM INJECTION WELL(S), defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of -.operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at 260 Stovepipe Court, Cashiers, Jackson
Counry, NC 28717, and will be constructed and operated in accordance with the application received February
23, 2010, 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 of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any, other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until February 28, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 24a' day of March 2010.
�4 C- 1 1 r
�Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit WI0100084 UiC15QM Page 1 of 5
per. 03/2010

PART I - WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART II — WELL CONSTRUCTION SPECIAL CONDITIONS
I. 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 (828) '_'90-4500.
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation comers) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or `cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with l5A NCAC 2C .0213(g).
4. The wells must at a minimum be g7outed with bentonite grout from land surface to 5 to 10 feet into
competent bedrock.
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.
Permit W10100094 UlC/SQM Page 2 of 5
uer, 03/2010

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
ground water resulting from the operation of this facility.
PART V — OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all tunes.
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 (U1C)
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.
PART VI - INSPECTIONS
Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit W10100084 UIC/5am Page 3 of 5
ver. 03j2010

PART V1I — MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section — UIC Program Aquifer Protection Section
DENR — Division of Water Quality AshevI114 Regional Office
1636 Mail Service Center and 2090 US Highway 70
Raleigh, NC 27699-1636 Swarinanoa.�NC 28778
Ph# 919-715-3221 (8281 290-4500
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Ashc� illc Regional ❑ffice within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part 11.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Asheville Regional Office within 30
days of completion of well construction.
4. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed.
5. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number [phone] any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances,
(S) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and correct
facts or informations shall be promptly submitted to the Director by the Permittee.
7, In the event that the permitted facility fails to perfonn satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII — PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the pennit 120 days prior to its expiration date.
Permit W10100084 UIC/SQM Page 4 8f 5
ver. 03/2010

PART IX — CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if the
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected., prior to sealing, if the Director determines that failure
to do so could lead to the contamination of an underground source of drinking water, -
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe that extends to the bottom of the well and is raised as the well is filled.
(E) In the case of gravel -packed wells -in which the casing and screens have not been removed, the
casing shall be perforated opposite the gravel pack, at intervals not exceeding 10 feet, and grout
injected through the perforations.
(F) in those cases when, as a result of the injection operations, a subsurface cavity has been created,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water and in accordance with the terms and conditions
of the permit,
(G) The Permittee shall submit a copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII. l of this permit.
Permit WID100084 UIC/SQM Page 5 of 5
ver. 03/2010

Rogers, Michael
From: Davidson, Landon
Sent: Thursday, March 11, 2010 1.45 PM
To: Rogers, Michael
Subject: geothermal applications
Attachments: image003.png
Michael -
I'm good with both W10100083 and 84. Please process.
Landon
PS — the well schematics were acceptable in regard to grout placement
u. landan Dauid5on, P.G.
A4LO-f i'r-it, 8.m S:_il an C
V;6inrIAH sup--44--Ps
P
1-h--.AIL R==1srvI Otb_
c7=+? IJ c Hv.7. 73
5:,.-nw nJ. _ N.C. 26-76
ph • scs :XG 'SW
i ,Y3
web page: h_[tf :'h2n_enrsrate. c,us. o_�w_html
This e-rnnil Contains a public record which is subject to disclosure to third
parties and the public pursuant North Carolina's Public Records low. N.C.
Gen. 5tot. §132.1, et seq. This e-moil may contain materials prepared
during or in onticipotion of o lea of proceeding as port of preparation for [hat
leg oi proceedin g, in which case third party or public access to It is subject to
N. C. Gen. Slat. §132-.1.9 and may be denied until the conclusion of the legoi
proceeding, including the completion of all appeals and post judgment
proceedings, ar, in the case where no legal proceeding has been corn menced,
upon the expiration of all applicable statures of limitations and periods of
repose,

TRANSMISSION VERIFICATION REPORT
TIME 03/02/2010 01:03
NAME NCDE$NR/WATER QUAL
FAX [phone]BS
TEL [phone]
DATE:TIME 03/02 00:58
FAX NO./NAME 91B2�9 043
DURATION 0 EF: 05 : 2
PAGE(S) 4' 4
MODE TI11PQ6ARD

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RECEIVED 1 DENR 1 DWQ
AQUIFFR'PRn-rFr.nnN RECTO
FEB 2,3 2010
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9ALE: t*-W

OVA
NCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
March 3, 2010
Susan Hamilton
Blanton Hamilton
1700 Brandon Rd.
Charlotte, NC 28207
Subject: Acknowledgement of Application No. WI0I O0084
Susan Hamilton SFR
Injection Mixed Fluid GSHP Well System (5QM)
Jackson
Dear Ms. Hamilton:
Natural 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 February 23, 2010. 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 919-7I 5-6166, or via e-mail at michael.rogers@,ncdenr.gov. 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 httil:llft2o.enr.state.nc.us/documentsldwLL or ,chart.ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQ[UIRMS ON THIS PROJECT.
Since .
for Debra t-tts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Christy McClure (Tarheel Water Treatment, Inc., 3494 Georgia Rd., Franklin, NC 28734)
Bruce Auld (Andrews Auld Heating & Cooling, Inc., 3348 Old Murphy Rd., Franklin, NC 28734)
I'exmit Application File ;A10100084
AOtJIFER PROTECTION SECTION
1636 Mail Service Center, Raiaigh, North Carolina 27599-1636
Locatian 2728 Capiral Eculevard. Raleigh, North Carolina 27804
Pnone. 919-733 32211 FAY V 919-715-0588; FAX [phone] � Cuslorner Servicei 1377-62M748
interneL www.ncwaternuaffiv.em
An Equal OopoftnIly ti A"h OireArlian Fminto yer
NorthCarolina
Aaturallry

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5 M WELL(S)
t. New Permit Application OR Renewal (check one)
DATE: _"�) - D 9 20 / 0
4•I.1IfI kX111
(leave blank if NEW permit application)
A. PROPERTY OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government�agency, state name of
entity and a representative wla► thority for signature): SA tln V"
(1) Mailing Address: _1 {•1_`'+_ L]�+ ,
City: 0'`a k)wl State: QC Zip Coder —County: e �j
Home/Office Tele No.: �'�— 37 S-ca p Cell No.:
L
EMAIL Address: -rv1.+ L ice, S mil'. 11k n
C(,
2 Physical Address of Site if different than above azc�aL-
r
City: _ `�r�I� C? _ State: � Zip Code:Q%"') County: _
+� Home/Office Tele No.:
�r EMAIL Address:
B. 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:
Address:
City: - .-- - -
Office Tele No.:
EMAIL Address:
State: Zip Code: County:
Website Address of Company,- if any:
C. STATUS OF APPLICANT
Private: Z Federal:
Commercial:
State: Municipal: Native American Lands:
RECEIVED i DEAR i DWQ
AQUIFF?'pRnTFnr)N SCCTM
GPUMC 5QM Well Permit Applicadon (Revised 7/2008) Page 1

D. WELL DRILLER INFORMATION
E.
Company Name:
Well Drilling Contractor's Name: —1V11M
NC Contractor Certification No.: 7 L L
} P r, en +
M iO_ 1_IL.ip _
Contact Person: �_i , ��l l r �. C {} EMAIL Ad,
Address: _ Gt? c 41 ion'r c�ci
City: 4� {� Zip cc�dz: county:
Office Tele No.: Cell No.:
HEAT PUMI' CONTRACTOR INFORMATION (if different than driller)
Company Name:
Contact
Address:
city: vccvU-V^Zip /Code
Office Tele No.: oA '3q9 ,�to�4�
County:
Cell No.: r 1j
heQ dnk.�,V\o�-
3aL5
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
G. WELL CONSTRUCTION DATA (Skiri to Section H if this is a Permit RENEWAL)
(1) Proposed date to be constructed: Number of borings:
r
Approximate depth of each boring (feet):_
(2) Chemical additives to be used in closed -loop system (only those chemicals indicated have been approved):
R-22 propylene glycol ethanol other (other additives will
need prior approval by NCDENR before use) i
(3) Type of tubing to he used (copper, PVC, etc). ( C0 lt- i )nc- 1
(4) Well casing. Is the well(s) cased? (check eidier (a.) YES or (b.) NO below)
(a) YES if yes, then provide casing information such as tie (steel, PVC, plastic, etc.), diameter,
depth, and extent of casing appearing above ground:
(b) NO
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonitez Other (specify)
(b) Grout depth of tubing (reference to land surface): from J _ to (feet) (f
If well has casing, indicate grout depth: from 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.
C:PUI TIC SQM Well Permit Application (Revised 7/2008) Page 2

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 WELLS)
Are there any potable water well(s) on the subject property or adjacent: properties? _ 'IES -&Q
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 constrict, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with Iht� approved speeifiic�ations and conditions of the Permit."
Signature of Property Owner/Applicant +
Print or Type Full. Name
'f.
Signafi3re of Property Owner/Applicant
-k_ '" t _ 0(14�
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
1535 Mail Service Center
Raleigh, NC 27699-1635
Telephone [phone]
GPU/MC 5QM Well Permit Application (Revised 7/2008) Page 3

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Wednesday, March 17 2010
***WARNING: THIS IS NO-1 A St'121'1 1'!***
This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded
deeds, plats, and other public records and data. Lasers of this map are hereby notified that the aforementioned public
primary information sources should be consulted for verification of the information contained on this map. The
County and mapping company assume no legal responsibility for the information contained of f this map.

Printed' 25 TAN 7t410 - Lr. 0
CARD 1 OF I
ARs cz:ption
Parcel t 7562-02-7410 LT E.3 'CUM-X:gTOP
OIRIE11 INFOPMA210 Q —_—
ArM 110516 RMIL'r ON FA}SLLY LLC
20 pRGVIOENCE Rn
SJnis 106
C}UFlLOSTE NC 20207
----- ------ 1{ISCELLWE,TJ5 ILiFaptWTIOi7 ---
Township ; HAMBURG
Addzeas LT rl3 MOUNTAINTOP
Zoning
Nbrhodd LS067 M0LrRTM9wP
?fop '562.03
Chao RI RL5IIDCNTIAI. I
Aearark�:
No Randrka on file
-- I.ANb DATA ---
Jackson County NC Property Record Card Page; 1
Tax Year : 2010
Tax Dx3tricta
PROPMTY FACTORS --------- I _ -- EA2.75 INF'ORkhTISK
I I
I Topography utilities I Date 50,1es P:lee v1d Rkag
I I O11I0107 1,625,000 1645157'
I view St-eecelRoada I
I A PRIVATE PAVE13 f
I ----- ENTRANCE INPORMJ.T-TOY _—___—
I __--____
VALVE SiwJu.y
I
1 mate Type %QUECe Appraiaer
I
I
Aaaeaae5
Current
1 07/09/09 27 Eztinate RC
I Lard
1,625,000
1,025,000
1 0111510e 25 Eet:m to BH
I Bldg
0
0
1
Tat Appr
1,625,000
1,625,000
I
I D4fer
0
0
I Net Taxable
c 1.625,000
I,625,000
UNIT
-------- Y A L ❑ E
LAST UPDATED R'� TA on
0'7I1412009
It HIT[ TYPE
SIZE PP.ICS iAD.3
APPR DEFER
TAX L.AZT MIPTTED DY FF un
031141200f-
I L 0110 RESIDENTIAL
7,95
1,625,000
1,625,OOD
Total ACrea : 3.95
Land Totals
1,625,000 0
1,625,000
--- 6U TBUI:,DIFGS --
Mkp EFF YR
BLDGM I'M FTH p£gCRIPTION
RPIWKS
WIDTH LEND H AREA
GRD BUILT BJ.TLT COND MIS FIINC ECON
TAX VALISE
CJIR:�, L DLMT UTLDING VALE
4
Printed: 25 i7XN 2010 - by I,
CA4D 1 o8 1
Parcel 7562-02-1410 LT Ell MDUNTAINTOP
!Amer 140516 RANILTON TAHILY !Li-'
End of page I k
Jackson County NC Property Record Card
-------------- BUILDING DESCRIPTION ---- --
V1�, .2ETAOD
FSZ CODE
STYLE
NOR STOR-ES
!CALL HF.I CHT
sa•.Iti DAr rarr
EYTERIOR ➢aALL
YR BU-7 I M-
C OHPITION
GRAB-
DE5jGti FACTOR.
ROOF :YPE
RCOF cmlfF ,
HA5tMENT ARA NA 5ASiTn T
ATTIC AP -PA NO A:71C
1NI?REOR 2LOOR
IN1'?RIOR WALL
ROCME 1 3DRM5 1
FULL 1 HALF SA78E 0 1 0 AA131. FIX: 0
FIREPLACE TYPWICNT:
FIH621LACE ❑PENitiGS: 0 CFi IFmEY II;; 0
AIR CONL PC1
SPRINGER P:T
SEATING TYP=
XEATINr FUE1
O'.'}iEB. FEAT'iRES
& COMPLETE
DESCRIPTION
RE S
3�ated 9q PC
�_�---__— BUILDING SECTION 17ETA11, ---
LN TYPE DESCRIPTION AREA VALUE MST VA FR
---�--- BUILDING COMP TIATION
aCN
PHYE DEPR
2L.7NC D£PR
ECON DEPR
t COMFLETE
PC17Lr•
LAST PT_CTVRE I
End of Page 2
?R9C: 2

MT �- rTnn- w
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GENERAL NOTES:
1, DO NOT SCALE SITE FEATURES FROM DRAWING
2 SURVEY : TOPOCRAPHIC DATA FROM PEED $HOT POINT DATA, IMSTING
TO PoGRAPHY AL OPA3 THE ROADWAY AND A.ERrAL TGPOGfIAPHY INTERPOLATED
CONTOUR INTERVAL+ TWO FOOT BtiED pN P{RIAL, FfELL SHOTS, AHD r'°LD
TOPO FIELD ADJVSTMENTS MAY FIE NECCESSARY 5FF NOTE @3
* CONTRAC TOR SHALL VERIFY C==RARE$ IN THE FfEf I' AND NOT IFY LA NC13CAti E
ARCHITECT IMMEOIATE.LY IF CGNFL ICT.S AND ANDIGR AMS; GWTIE_ ARISE
C: TJTAL:T LANDS CAP E ARCHIT E CT I MME CIA T E L Y IF LA'IO:IT CONFLICTS OR
AMBIGUITIES ARISE VERIFY LAYOUT INFIELD,
i- GRAD ifJG 42(Ay1 RACTOR SHALL ME CT WITH LANDSCAPE ARCr IiTECT ON 51TE TO
RN1EW CLEARING, OEMOLI I ION ANC) GRADING PRi OR TO STARTING WORK.
e. CONTRACTOR SI fALL BE RESPONSIBLE FOR OCATI I IG AND NZOTECTI NO
EAi5TING LTHLIrIH9 ANtI$TRUCTLIRES CALL U LOCO FOR EaIET1NC LITILRY
LOCATICN PR'OR TOETART ING WORK IF U1ILITY TIE-IN LL'CATIDHS ARE
RE OLI I RED, REVIEW LOCAT IOMQ WI TH LANDSCAPE ARCHITECT, ARCHITE(;T,
ApRLIC.ABI E O TIL I I Y C OMPAN E.S.DAN D MrA N TMRTO P-
7- GONTRAC I DRI�AESPON9IBLE FORM ]NIMAL DISTURBANCE OF Ey,15TING
V E GET ATI ON BURIN O INS TAIL LAT ION OF ANY ANT) ALL t)NDE RGRO UNO V F ILI T IE S.
B CONTRACTOR SHALL EXTEND ALL LIT LI i'ES (WATER, SEWER, GAS, PLECTRK'.
PH04E. ETC.) FROM 13UILCIING5 IO E1[IST I NI) MILITIES UNOFAGROUNO
i REVIEW TI EAN LOCATIONS WITH STRAYS PARK AND COC R DI NATO WITH BUIL DINO
LUILFFY LOCATIONS.
10, LAYOUT SITE ELF.VENTS IN IHE FIELD PRIOR TO CD"TRUGI ION FOR APPROVAL
By LANDSCAPE- ARCHITECT.
TI LAYOU F AND GRADES OF PROPOSED WALKS TO BE VERIFIED wl TH LANDS CAPE
ARCHITECT.
12. ERO81Odr ..04TftDL T✓EASUREB ARE OFFJ$RA.L IN NATFIRF. CONTRACTOR IS
R E9PON616LE FOR A DDFT TONAL MEAB URE 9 AS RECULREO TO PREVENT ON OR
OFF•SITE RUNOTF AND EROSION.
IS. REMOVE ALL TE IIPORARY F. R051ON CONTROLS AFT Fit DISTURBED AREAS I rAVE
BEEN STABILIZED AND GOLfP_FI ER.
14- CONTRACTOR IS RE$PON9IOLE FOR INS PECF ION OF ALL EROSION AN,,
$ERI LI ENTAT ION CONTROL PRAC FACES ON A WEEALY rJAS IS AND AFTER
AF PRECIASLi R",r. EVENT S. NFEOFD REPAJR: A RE Try COUPS ETED
IMMF OIA III-LY. MAIIJTAIN BEEOP IE NT I SR T f FNCE eV CL 011Np OUT w1'F.N , AL
i LA L_
15 NATIVE VEGETA IRON IS NOT TD BE DAMAGED OR DISTIJ ROE D OU IS I DE OF
OLFARI!4U LIMITS.
1e REFER TO ARCM FEC TU RAL PLANE FOR BII IL DV+G LAYORJT AND DIMENSIONS
1T. GUTTER AYC DOWNSPOUT I.00AI IONS ARE NOT SHOWN CONTRAC FOR SMALL
TIE IN oU TTER AND Dr7WNGPOUT RLIN -OF F WITH Any SUBSURFACE DRAINAGE
SYSTEMS. WH1=RE APRLICARLE. ALL OLIWNSPOL ITS $1 +ALL BE ROLJTEO i0
SUB SLIRFA{:E DRAJFIAGE SYSTEMS. RLFN-OFF Di$CHARGE AT PIPE ENu_ SrLALI
SETFEATEOVilr}LSTDMF51EADWALLAWOAP on �7F75ULT ri'IiH LANDSCAPE
ARCHITECT FOR LOCATION OF ❑RIP STRIPE ITN THE ABSENCE OF GUT TE RS)1F
APPLICJts9 E.
ID REFER TO LANDSCAPE PLAN FAR PUV4T MAT FRJAL LOC7A1 rO.49, LANDSCAPE
L IGHT MO, AND OTHE R LAND SCARE P EA TU RE S.
TREE PROTECTION:
ALL PROTECTED TREES, PPSSERVEO IiNCERS FOR',, AND OTT rEA
VEGETATION RF SIRED FOR PROTECTION SHALL BE PRO TECTED=.iGA•
IfIJURY DURING ANY LAND C4 FARING AND BULLING CONSTRL1C T ION IN FHE
FOLLOWING MANNER
I, A TEMPORARY BARRIER S'IALL BE CONS TRLti TED TO RREVFTTT ANY DL5 TURBAN CE
OF 114E SOIL A MI KW IJM OF (0) Slx FFET FROM rHE TRUNK OR HAI F THE ❑i TAN CE
FROM THE TRU'JK TO THE DRIP LINE. mfiCHEVER IS GREATER. THE BARRIER SHALL
RE'dA,N THRO'JGIIQUT 114E ENTIRE CON6TRUCT'ONPROCE99 SEE DETA'L
2, WHEN PREPAR:NG PROPOSEO LANDSCAPE BEOS, 00 NO IILL WIT H IN THE DRIP
LINE OF EXISTING VEO ETA T ION.
], THE PROTEC I ED ARFA SHALL BE MAINTAINED AT ITS ORI G'NAL GRADS, WITH NO
STORAGE OF FILL, COMPAC I ION OF SOrL OR TR ENCHIrfG OR CUTE INO OF TREE
ROOTS 1N NO EVENT SHALL MDI OR IZED VE P4CLC9 BR EW2PMETIT ENTER THE
PROTTEC [ Eli AREA
4. THE CONTPEAQT OR SHALL NOT L-.AUSE ID R.LLLOW THE CLEANING OF EGLI IF ME NT.
S TORAGF OR DISPOSAL OF MATERIAL SUCH AS FAINTS. SOLV ENT$, A5 PHALT_
CONCRE IE, DR ANY MATE MAIL THAT CAN DAMAGE IRE HEALTH �TF VEGETA 110H
WITHIN THE DRIP LINE OF PROTECTED VEOETATLON.
B NO ATTACHMENT OF WIRES Tf%CLU SWE OF PROTECTIVE GUIDE WIR ES), SIGN 9, DR
PERM1,S SHALT. BE FAST FH F'O TO 11C GE TA T I ON WITH if THE PRO TEC TED AREA
e ALL C'_EARI NG AND GRUBBING WI THIN THE PROT E C T Eq AP -EA SHALL OF DONE v+r Tlf
HANG] IOOLS rXILV AHD LINDEN THE D RE CT I(IN G� THE IANDSCAPE AR L' 1K'ECr
LEGEND:
- - —
PARCEL BOUNDARY
-- — —
BUIL DING E".. LOPE
��••ti.�
DRAINAGE SCALE
LP-
LOW PdILT
N A
HIGH POIIFT
F F E
FINISHED FLOOR ELEVATION
O L
ORAIN INLET
Y3.
YAAC, INLET
T-W
Top OF WALL
SWCp
SMOOTH WALLSO C DRRUGATED PIPE
_ -
sT ONE -LINED AFf1ON F CAMINLL
DININAOE DIRECTION AND SLOPE
CONSTRUCRON F9JCE
a A r1
SILT FENCE
SUBSURFACE DRAIN PIPE
COM14 T I[UCTrON ENT AFNCE
TREES TO 6E REMOVE?
EXISTING TREES lip
LOT E-14-
r
}
6% � -r•� �-T1 111 • �P a;a-H rf• 1'r!� , _ - ' �; ''_�. 44
]!L �IMp Y .' 1 r•r}y{y.� y� ..� •A �-_-r �� � �F- T��Y f I•t 4 •�
,'V 1 Y i i� � JL•_�
EOULOER RETAINING WALL, TYP L
--� -_ - —lr .�--r�cla 7• 'l,�-L'
STONE TYPE, SIZE AND COLOR TD 111 - -
BEAPPROVED 8YLANDSCAPE Kk" +
/ ARCHITECT AND OWNER f
8' MA%.HEIOHT � _
WIGENEO OBIYE FOR LAN— -'T'f ,' � '''•. f + qya❑ -
PULLOPF - •J. Ki6•n' .aT?'l•: ry
`
BOULDER AETAINInG WALL. TTP, - - I T r •�.- - _ w [ �,
- 7 we' r rw 1Z }' e� l Ja
STONE TYPE, 91tE ANO COLOR TO ❑ / i -LL-
BE APPROVED BY LANDSCAPE
ARCHITECT AND OWNER �,� • '/f j �{' J i' 1P [a , {'O�7L f} `.• t ..... �sT
2'4' W% nElamT ' �` a fpe9.5.:'Ti'1, a Ie �.;✓ V' j ,�~1_ �� 7`Y�� �__ �°� i'
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! ! I; '� �, y' r +� IN DOUBLE SB" MAPLE
ELEVATION - 4099.50'
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_S �5 .g I i `I 1 i p1- � ► �. •u - -` I'� �BTrHgL'EOETATION�-•, li'
TREE PRO TECT ION F E NCE, TYP � . •'9
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T. I it `Vol
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SILT PENCE, TYP
yrLiFENCEREPRESENTBI j '' --- - - - _ •TA=+ -
LIMIT OF bISTURBJ,NCC
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