WI0400112_GEO THERMAL_20120517

Beverly Eaves Perdue
Governor
A~A-B.,if~~~
NCDEMR ~ -
North Carolina Department-,of Environment ·and Natural Resources
Division of Water Quality
Charles Wakild~-p~-1:~---
. Director
May 17, 2012
Stokes County Schools
Post Office Box 50
Danbury, NC 27016-0050
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0400112
To Whom it May Concern:
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 Ionger __ required to renew your current permit
and the permit will be valid indefmitely 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 r~~o_rd of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.org/web/wg/aps.
If you have ··any ·questions regarding your-current permit or the rule revisions~-pleas·e 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
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity\ Affinnative Action Employer
Nirth Carolina
lVatttraltu
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural. Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contractor (individual) Name
YADKIN WELL COMPANY. INC
Welt Contractor Company Name
1908 HAMPTONVILLE ROAD
Street Address
HAMPTONVILLE NC 27020
City or Town State Zip Code
336_ ) 468-4440
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# J//r2 V.2r' / z `L
OTHER ASSOCIATED PERMIT#{it applicable)
SITE WELL ID Of applicable) ,0 ,[%p J loco rr 41 /
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED
TIME COMPLETED AM ❑ PM ❑
4. WELL LOCATION:
CITY: COUNTY
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING: (crieck appropriate box)
EISlope ❑Valley ©Fiat ❑Ridge ❑Other
LATITUDE "DMS OR
LONGITUDE . " DMS OR
Latitude/longitude source: II PS [Topographic map
(location of weft must be shown on a USGS topo map andaitached to
fhls form if not using GPS)
DD
DD
5. WELL OWNER
,te- Al c'�. r.®I1s G /n.
Owner Nafne
Street Address
City or Town
Area code Phone number
State Zip Code
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES p NO IJ
c. WATER LEVEL Below Top of Casing: FT _
(Use "+^ if Above Top of Casing)
cf. TOP OF CASING IS FT. Above Land Surface'
"Top of casing terminated at/or below land surface may requite
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
t. DISINFECTION: Type HTH _ Amount Cups
g. WATER ZONES (depth):
Top Bottom - Top - Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7, CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft,
Top Bottom Ft_ _
8. GROUT: Depth
Top Bottom Ft,
Top Bottom FL
Top Bottom Ft,
Material
Method
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Tap Bottom Ft. ill. in.
Top Bottom Ft. In. In.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft. -
Top_ Bottom Ft.
Top _ Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
r
1
1
1
1
1
1
1
12. REMARKS:
Formation Description
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NIC 27699-161, Phone : [phone]
Date Site Visited By: Permit: Yes No
Form GW-la
Rev. 2)09
What Is Height of Well caging? Make Sure 12" Above Ground Level.l ! ! !

Rogers, Michael
From: Knight, Sherri
Sent:
To:
Monday, November 15, 2010 4:00 PM
Rogers, Michael
Subject: WI0400112
I have talked with Yadkin Well Company and the building contractors for the Stokes County School system. They did not
install the geothermal system at Nancy Reynolds School due to the cost.
Sherri Knight, PE
NC DENR Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
1
t
Permit Number WI0400112
~· --· ==~=--~: ~rognmrCategory---------------------------·
Ground Water
Perm.it Type
Injection Mixed Fluid GSHP Well System (SQM)
Prtnrary-Reviewer
michael. rogers
Coastal SW Rule
Permitted Flow
·Facility
Facility Name
Stokes County Nancy Reynolds Elementary School
Location Address
1585 NC 66 Hwy N
Westfield -
Owner
Owner Name
Stokes County Schools
Dates/Events
NC 27053
Orig Issue
09/22/09
App Received Draft Initiated
08/05/09
Scheduled
Issuance
Central Files: APS_ SWP_
09/22/09
Permit Tracking Slip
-------status··-···-. · · -:·-·--··-· ·Project:Typ-e· ·--... ·-=-·----·-·---·
Active New Project
Version
1.00
Permit Classification
·Individual
Permit ContacfAffiliation
David J. Brown
1908 Hamptonville
Hamptonville NC
Major/Minor
Minor
Region
Winston-Salem
___ County
Stokes
Facility Contact Affiliation
Owner Type
Government -County
Owner Affiliati on
Ricky D. Goins
Director Maintenance
PO Box 50
Danbury NC
Public Notice Issue
09/22/09
Effective
09/22/09
27020
27016
Expiration
08/31/14
_R_e __ g_u_la_te_d_A_c_ti_v_it_ie_s _______________ Re quested/Received Events
Heat Pump Injection RO staff report requested
RO staff report received
Outfall NULL
Waterbody Name Stream Index Number Current Class
08/14/09
09/04/09
Subbasin
Central Files: APS SWP
09/17/09
Permit Number W10400112 Permit Tracking Slip
Program Category
Ground Water
Status Project Type
In review New Project
Permit Type Version Permit Classification
Injection Mixed Fluid GSHP Well System (50M) Individual
Primary Reviewer Permit Contact Affiliation
rnichaeI.rogers David J. Brown
Coastal SW Rule
Permitted Flow
F:trninty
1908 Hamptonville
Hamptonville
NC 27020
Facility Name Major/Minor Region
Stokes County Nancy Reynolds Elementary Minor Winston-Salem
School
Location Address County
1585 NC 66 Hwy N Stokes
Westfield
•_ Wr,.
NC 27053 Facility Contact Affiliation
Owner Name
Stokes County Schools
Owner Type
Government - County
Owner Affiliation
Ricky D. Goins
Director Maintenance
PO Box 50
Danbury NC 27016
Drig Issue App Received Draft Initiated
08/05/09
Rerulated Activities
Heat Pump Injection
drittall
Scheduled
Issuance
Public Notice
Effective
Ex irati n
3t ���
Recu:';iecI)RGcpiyerj Eyei"s
RO staff report requested 08/14/09
RC staff report received 09/04/09
Waterbody Name
Stream Index Number Current Class Subbasln

AWA ~~l~~ Ncb--EM-R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
September 22, 2009
Mr. Ricky D. Goins, Maintenance Director
Stokes County Schools
P.O. Box 50
Danbury, NC 27016
Re: Issuance of Injection Well Permit
Permit No. WI0400112
Issued to Stokes County Nancy Reynolds Elementary School
Stokes County
Dear Mr. Goins:
Dee Freeman
Secretary
In accordance with your application received August 5. 2009, I am forwarding Permit No. WI0400112 for the
operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system to be located at
1585 NC 66 Hwy North, Westfield~ Stokes County, NC 27053. This permit shall be effective from the date of
issuance until August 31, 2014, and shall be subject to the conditions and limitations .stated therein.
Please pay special attention to the following bolded language in the permit:
Per Part I, paragraph 6, please submit copies of the Well Construction Completion form (GW-1)
after construction.
Per Part II, paragraph 2, the location of each of the system manifold(s), if present, shall be
recorded by triangulation from three permanent features on the site ( e.g., building foundation
corners) and shown on an updated Site Map.
Per Part Il paragraph 4, in the event that there will be multiple wells with separate clusters, one
well identification tag per 'cluster' of wells shall be permanently affix.ed to the heating and cooling
unit or other nearby permanently fixed location in a clearly visible location.
Please submit the data within 30 calendar days of receipt of this letter to the following address:
Aquifer Protection Section (APS)
Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
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].
Best Regards,
~)~--
/ I
Michael Rogers, P .G.
Environmental Specialist
cc: Shen~i Knight -Winston-Salem Regional Office
Central Office File-WI0400112
Stokes County Environmental Health Dept.
David Bro11 1n -Yadkin TVell Co., Inc. (.s'ent via Fax and USPS)
Attachment( s)
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
Stokes County Nancy Reynolds Elementary School
FOR THE CONSTRUCTION AND OPERATION OF TYPE 5QM INJECTION WELL(S). defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed -loop
geothermal -mixed -fluid heat pump system. This system is located at 1585 NC 66 Hwv North, Westfield.
Stokes County, NC 27053, and will be constructed and operated in accordance with the application submitted
August 5, 2009, and in conformity with the specifications and supporting data submitted, all of which are filed
with the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation of an injection well and shall be in compliance with Title 15A
North Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations
pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31, 2014, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the at day of
k,Coleen H S,illinc, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
, 2009.

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.
6. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to
the Aquifer Protection Section Central Office and the Winston-Salem Regional Office within 30
days of completion of well construction at the addresses below in Part II, paragraph 5. Copies of
the GW-1 form( s) shall also be give to the Permittee and retained on-site and available for
inspection.
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 Winston-Salem Regional Office Aquifer Protection Section Staff,
telephone number [phone].
2. The location of each of the system manifold(s), if present, shall be recorded by triangulation from
three permanent features on the site ( e.g., building foundation corners) and shown on an updated
Site Map. The Permittee s-hall retain a copy of this record and submit a copy of the updated map to
the Aquifer Protection Section Central Office and the Winston-Salem Regional Office within 30
days of completion of well construction.
3. Boreholes shall riot connect separate aquifers, which have differences in water quality (e.g., shallow
surficial aquifers, saprolite, fractured bedrock, etc.) as specified in 15A NCAC 2C .0213(d)(8)(C) and
shall be filled with bentonite grout from the lowermost water bearing zone to land surface as specified in
the permit application.
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).
WI0400112 2
l
5. All of the documentation referenced above that is required to be submitted shall be sent to:
Aquifer Protection Section-Central Office UIC Staff
DENR-Division of Water Quality
163 6 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
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 Pennittee 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.
WI0400112 3
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the perrp.itted 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.
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 Winston-Salem 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 RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
WI0400112 4
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 Pennittee must install a sanitary s~al. If a well is not to be used
for any purpose that well must be permanently abandoned according to ISA NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in l SA NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Pennittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) arid (2) (G) shall be submitted to:
·wI04O0112
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
\J.\J\
AQUIFER PROTECTION REGIONAL STAFF REPORT ·t '.} «\ ~
Date: 08/26//09
To: A quifer Protection Central Office
Central Office Reviewer: . Ro gers
County: Stokes \}1'4' /
Permittee: Stokes Countv Schools J~ ~
Project Name: Nancy Reynolds School · ,
Regional Login No: __ _ Application No.: WI0400112
L GENERAL INFORMATION
1. This application is (check all that apply): ~ New D Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land ·Application of Residuals D Attachment B included D 503 regulated D 503 exempt
D Distribution of Residuals D Surface Disposal
D Closed-loop Groundwater Remediation D Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? [gl Yes or D No.
a. Date of site visit: Augu st 24 . 2009
b. Person contacted and contact information: _________________ _
c. Site visit conducted by: Sherri Kni ght
d. Inspection Report Attached: D Ye~ or [gl No.
2. ls the following information entered into the BTh1S record for this application correct?
[gl Yes or D No .. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): None
For Dis posal and Iniection Sites: .
(If multip le sites either indicate which sites the information, applies to , copv and paste a new section into the
document for each site . or attach additional pa ges for each site )
a. .Location(s):
b. Driving Directions: From WSRO , take US 52 north to the Pilot Mountain Hwy 268 exit. Follow hwy
268 east throu gh Pilot Mountain about 8.5 miles to the intersection with Hwy 66. Follow Hwy 66 N to the
school which is located on the left about 1.2 miles from the intersection.
c. USGS Quadrangle Map name and number:
d. Latitude: 36°26.174 Longitude: 80°20.705
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed fo r renewals or minor
modifications. skip to next section )
Description Of Waste{S) And Facilities
I : Please attach completed rating sheet. Facility Clas.sification: __
FORM: staff report-nancy reynolds.doc · l
AQUIFER PROTECTION REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes tJ No ~ N/ A. If no, please explain: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No ~ N/ A. If no, please explain: __ Does the
application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)?~ Yes D No
D N/ A. If no, please explain: __ Is the proposed residuals management plan adequate and/or acceptable to
the Division. D Yes D No ~ N/ A. Ifno, please explain: __
4. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No~ N/A. Ifno, please explain: __
5. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No ~ N/ A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
6. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or D No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
7. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No ~ N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
8. For residuals, will seasonal or other restrictions be required? D Yes D No D N/A If yes, attach list of sites
with restrictions ( Certification B ?)
III. RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or maior modification
systems)
Description Of Waste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate #: __
Backup-Operator in Charge: __ Certificate #: __
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. Ifno, please explain: __
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain: __
FORM: staff report-nancy reynolds.doc 2
AQUIFER PROTECTION REGIONAL STAFF REPORT
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. Ifno, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? D Yes or D No. If no, please
explain: __
7. Is the ·existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any ch~ges to the
groundwater monitoring program: ___ _
8. Will seasonal or other restrictions be required for added sites? D Yes D No D N/A If yes·, attach list of sites
with restrictions ( Certification B ?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or D No. If yes, please attach a
map. showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit: __
10. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? D
Yes or D No. Ifno, please explain: ____ _
11. Were monitoring wells properly constructed and located? D Yes or D No D N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? D Yes or
□·No □-NIA. Please summarize any findings resulting from this review: __ _
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; D
Current enforcement action(s) D Currently under SOC; D Currently under JOC; D Currently under
moratorium. If any items checked, · please explain and attach any documents that may help clarify
.answer/comments (such as NOV, NOD etc):
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? D Yes
D No D Not Determined D N/ A.. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? D
Yes or D No D N/ A. If yes, please explain: __
FORM: staff report -nancy reynolds.doc 3
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description OfWell(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
D Heating/cooling water return flow (5A7)
C8J Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: __________________ _
2. Does system use same well for water source and injection? D Yes C8J No
3. Are there any potential pollution sources that may affect injection? D Yes C8J No
What is/are the pollution source(s)? None known. What is the distance of the injection well(s) from the
pollution source(s)?
4. What is the minimum distance of proposed injection wells from the property boundary? _> 100 ft.
5. Quality of drainage at site: Good X Adequate D Poor
6. Flooding potential of sit~: C8J Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes or D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? C8J Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
In i ection Well Permit Renewal And Modification Only :
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes D No. If yes , ·exp lain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes , explain:
3. For renewal or modification of groundwater remediation p ermits (of any typ e), will
continued/additional/modified injections have an adverse impact on migration ofthe p lume or management of
the contamination incident? D Yes D No. If y es , exp lain:
4. Drilling contractor: Name:
FORM: staff report -nancy reynolds.doc 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
Address:
Certification number:
5. Complete and attach Well Construction Data Sheet.
FORM: staff report-nancy reynolds.doc 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application. This application is for a test bore for
thermal conductivity only. ,
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes ~ No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
-
7. Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information;
8. ~ Issue; D Deny. If deny, please state reasons:
9. Signature ofreport preparer(s): ________________________ _
Signature of APS regional supervisor: _____________________ _
Date: _______ _
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: staff report -nancy reynolds.doc 6
Ro gers, Michael
From: Knight, Sherri
Sent:
To:
Friday, September 04, 2009 4:51 PM
Rogers, Michael
Subject: RE: WI0400112
Attachments: staff report -nancy reynolds.doc; nancy reynolds 001.jpg
Sorry I forgot to send this. I went to _the site early last week. Attached
Sherri Knigtlt, PE
NC DENR Winston-·Salem Regional Office
Division of Water Quality, Aquifer Protection Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
· E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Rogers, Michael
Sent: Friday, September 04, 2009 8:59 AM
To: Knight, Sherri
Subject: FW: WI0400112
Sherri-
Just checking on the status for the below.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail corr.espondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: Berry,'Stephen ..
Sent: Friday, September 04~ 2009 7: 56 AM
To: Rogers, Michael .
Subject: WI0400112
Sherri has taken on the review of Nancy Reynolds .. ~ please contact her to learn of the status.
Stephen Berry
NC DENR
Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection Section
1
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (33.6) 771.-5288
FAX: {336} 771-4631
***************
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
***************
From: Rogers, Michael
Sent: Thursday, September 03, 2009 1:49 PM
To: Berry, Stephen
Subject: RE: Sherertz wi0400008
OK. Also, what is the status for the staff report for:
WI0400112
Stokes Co Nancy
Reynolds Elem
School
This was sent over 8/14/09.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: Berry, Stephen
Sent: Thursday, September 03, 2009 12:25 PM
To:_ Rogers, Michael
Subject: RE: Sherertz wi0400008
Mike,
I have not heard from Mr. Sherertz. You are correct, in that he was to request rescission. I believe a formal letter should
be sent reminding him of his obligations (i.e. NoRR).
Stephen Berry
NC DENR
Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
2
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
August 10, 2009
Ricky D. Goins, Maintenance Director
Stokes County Schools
P.O. Box 50
Danbury, NC 27016
Subject: Acknowledgement of Application No. WI0400112
Nancy Reynolds Elementary School
Injection Mixed Fluid GSHP Well System (5QM)
Stokes
Dear Mr. Goins:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on August 5. 2009. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6 1 66, 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 hup://h2o.enr.state.nc.us/docurnents/dwu or!. chartpdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING ENQUIRIES ON THIS PROJECT.
Sincere5.,
- 4),_irc)
for Debra J. tts
Supervisor
cc: Winston-Salem Regional Office. Aquifer Protection Section
David J. Brown (Yadkin Well Co Inc.. 1908 Hamptonville Rd., Hamptonville, NC 27020)
Permit Application File WI0400112
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1638
Locaton: 2728 Capital Boulevard, Raleigh. North Carolina 27804
Phone' 919-733-3221 I FAX 1: 919-715-0588; FAX 2' 919-715-60481 Customer Service: 1-677.623.6748
Internet: www.nwvatermualitv.orc
Ari Equal OpportunityAffirmative grtion Employer
North Carolina
atu aiyy

Ro gers, Michael
From:
Sent:
To:
David Brown [[e-mail]]
Friday, August 07, 2009 10:29 AM
Rogers, Michael
Subject: RE: Stokes School geothermal
Mr. Rodgers,
It is Ricky D. Goins. He is the Maintenence Director for Stokes County Schools.
Thanks, David
From: [e-mail]
To: [e-mail]
Date: Thu, 6 Aug 2009 14:50:56 -0400
Subject: Stokes School geothermal
David-
What is the title of Mr. Goins w/the school system; and is it Goins or Gains?
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636 •
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the Nc;,rth Carolina Public Records Law and may be disclosed to third parties
Get free photo software from Windows Live Click here.
1
Aug, 5. 2009' 4:09PMe YADKIN WELL
No. 3450
IYU, 344)}
LOTOLICO
DEPrART,N,CENT OF ENVIROINENT AND NATURAL. RESOURCES (NCDER)
NORTH CAROLI A
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A. WELL($) FOR
INJECTION W1TP1 A aarkusziAL SEAT PIThe SYSTEM FOR:
TYPE SQM WELL(S)
New Permit Application OR Renewal (check one)
DATE: $S - 3 C Gi , 20 flit,
PERMIT NO. (leave blank if NEW permit applica is i)
A. PROFF,RTY OWNER(S)h PFLICANT(S)
Listi eac Ptdpesty Owner listed ce prcpeny did Of awrsed by a business or god agency, state mo:te of
ditty and a represeotative wlauthcity for Si re) : SA' gs (49 Cal +y EC b' dkZ.•, _
(1)
Mailing Address: Po 13,2 x a
City_ aim 6A,,n, t'stat : Zip Code; _17 d 1 Cau +:�T� J( .4
Homa(Office Tole No.: , 3G - �. -
ENS Address: M a k ", Cr p 3„ s
Physical A,ddre'ss of Site (xf diffrrera than above): I.I , I�� G G 1��Az2,14
City. Stare:. Zip Code: 2 7 cS-Y C ty: 1 o ke.r
Home/Office Te1eNo.: S'cr-vie — Cell No.:
EMAIL Address:
B. ATITP#4RT F G OF OW11) , rr ANT (aftie Permit Applicant n.at nwit the subject propzrty,
attach a 1ett= from the property maw antiniz ng Agent to install and operate UIC wen)
Company Name: Yea k c, VJ bL G 3 7c..
Contact -Person: cau 7'• �� aE�^-
Address: q 0 rr 14 ❑.rvir #a1'I a i f
may: go tall ❑ die- - Stare: Zip Code: 27 0 2A Coup rq d k h
AaiL Address: Chdt #- d k r r`r eh �a mil
ofee TeINv.: 33_6- r- it V- VO Cell ND.: 3-C- I. C
Website Ad9xess of Company, if any: w ez( I .moo
C. STATUS OF APPLICANT
Pzivete: Federal: Commercial:
Stare: Municipal: Nztive Amezi.ram Lands:
RECEIVED / DEW( DVVu
Aquifer Protection Section
A'O i-2 9IgO -d eLY-1
BEES 16S $E6+ ld3a 33NVH31NIWV 100H3S 03 S31{O1S-110H eVat &OOZ-11V-to

,Aug. 5. 2'O09 4:1OPM ADKIN WELL
Na ] �4) N
D. WtLL ILIMX,Mt INFORNATtoN
COMplmy aatfe:, YA KINWELLCOMPANV_ It c
Well Drilling Contractor's N se .rOIlYMULiJ£_ DROwu. MILrg6a CAVE,
NC COUttaclur Certifl oa Wo.: !MULLI A) t&LOWN: sij3 -A? (CAVE: $S48.A)
C react Pas= DAVID J. !RWWi {21 -A) l L 4i3r+css: dhieforlieriFt mg m
Address: _axe t+P'*ONVIi.E DAD
City HAMPTCt51]Z.h1 a ZpCode; 27020 Comdr. Y2261.x
Oi ce Tele No.: 3.36-4ss.-4440 t NQ.: s 74 573E
E. MAT rtrAir CONTRACT011. INFORMATION Cte afferent nu= dr r)
Campatlt'h'W= (An k 101.0 ��, ►ti o. - 4 + 0
Contael PeTNnO d
Address:
City: Z p Cadet Caata;
O$ce
Cell No.:
F. XtV' C', ioN PRQCFDC E (brledly describe- haw the isfecrianwell(s) will be used
Gi f Ja See- Z r :+ i" try 4 Y' Q.�
G. WELL CONSTlWCflO DAIA fv Scotian f if fhis is a Permit ENE'W,A [.)
(1) Propaseed data to be eenstreeted: y ?--ember'of isof`trip /
Avpraaiza1e depth of auth berg (feet): _TOO"
(2) Chneic21 additives to b e used in eln e4-iccp system (only stew chemicals indicated bsve been approved):
T•,22 wratoy1e gly-col ethanol Ober (041E7 additives will
Deed prior approval by NCMNR before ase)
(3) Type oftasggtcbc Toed (copper, PVC, etc): i4 QP P, .s f 4$ J
(4) 'Well casing, Is the weliKs) cased? (check either (a.yriKS ea' {b.) NO beiaw)
(a) TAS if yes, 'tom provide ca img informaliaasada 28 (tee, PVC, plastic, etc.), diameter.
d 18ad Mal or cesi;og appeeriig above groua&
(b) NO )(
(s) Gnat (=wig yaand gwell casing nimitR, ):
(a) Grout types Cement BelXaah me; (Bp:ci )
(b) Grout ptE o£tvbimg (refeaxnc:a ko find ma/tee): from TOO to _ 3 (feet)
to
If well has easing, vadicate groat de : fron
H. V ECTION AELATED EO
[ I" IJR1'
Attache diagram showio& the evirettring Layout -or proposed modlf cation el' the injection a uiprrtt and exterior
pipinetabitg associa d vvlth the inge is i operation. The manufacrarer's brae bare may provide pp1e y
1br =(ion.
CI LB-4 H01$06'd 811+-1
SE££ t65 9E6+ Lad 3304E101WC 1000$ IN S 310i5-?iCU 9Z:Z1 son-9flY-YC

Aug. 5, 2'000 4: `OP1+I VA)KIN WELL
44 ■TT 1 �
I. LOCATION Off' WELLS)
Attach two copies of reaps showing the fbllarwkEg loft smation:
(1) Include a site map (canbe drawn) Showing: buildings, property liras, surtax water bodies, potential sources
of groundwater contamfriatian and the orientation of and disiances between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic teals ca drain fields located within 1040 feet of the
geothermal beat pump weE system. Label all features clearly and include a_aorth anew.
(2) I.bc ude a topographic map of the trea ectemding one niile from the property boundaries and
indicate the facility's location and the mop acme.
s POTABLE WATER WELL(S)
Ara there Bony potable wain well(e) oil the subject property or adjacent proprrttes? ,XYE6 NO
l'es, darn iudicate location on afta bed )1:lap(s).
K. CERTIFICATION
Note: This Permit Apptioation mast be Big' zed !ur arch person appearing on the recorded legal property deed,
hereby oarel.fy, mar penalty of law, that Z have personally examined and mi i r 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 info ratio, I believe that the it+iarrOat c0 is true, =curare and complete-
r air aware that these are algolficasre p=aIties, including The possibility of foes and imprisonment, for submittimg
fxse information. I agree to construct, operate, maintain_ repair, and if applicable, abandon the injection well and
ail related appurtenances iaq accordance with the approved specificzions and conditions of the Permit"
sigaat eafe'r► + _ owe/ 13r d
prig err 1 pe pull Name
0
t o ofPropr k5CLYo �Applicaau
v, C2L
Print or Type Full Name
Signature ofAuthori2ed Agent, if any
Print or Type Full NUM
Please return two copies of the completed Application package to:
North Cara= D R-DWQ
Aquifer Protection Sections
UZC Frog rim
1636 IVIall Service Center
Raleigh, NC 27699-1636
Telephone [phone]
0i8-d 900/Z00 d Bit-1
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Aug. 5, 2009/ 410PM41 YADKIN WELL1
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Augt 5. 2'004 4.09PM YADKIN WELL
FACSIMILE TRANSMISSION FORM
No.3450 P.
DATE: / .�` / c t TIME. _REF. J EF. NO. WG NO
TO: Pc; ON V1Ig4 7 5'-os
COMPANY NAME
FROM:
AiTFHIIO14
/ram We I C 41, r 7
COMPANY NAME
DEPT.
FAX NO_ PLEASE
MINER
❑ iMMEDLATE1.Y
INDIVIDUAL
DEPT.
FAX NO. PLEASE
❑ REPLY
- REPLY BY SIGNATURE
NUMBER OF PAGES PLEASE ORIGINATOR'S
INCLUDING THIS
MESSAGE:
_It e„, q ;S pJ 57 l Ca tin a-' ..S~-f kP.s (1. S'jadf
nPQn c j cao o / __ fraf P
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_'e(/ 0- rJC- . 74z— ?T3 G
K)r ,-k # 33C- 5 C tD
"FOR ALL TOUR WATER NEET 5-
YADKIN WELL CO., iNC.
1909 HAMPTONVI1.LE ROAO
HAMPTDNVILLE. NC 27020
DAVID J. BROWN, VICE PRES.
TOLL FREE 18O3j 248.9355
OFFICE (3361 41543-4.4-DSO
FAX 1335i 4GG•4e40
RES [3361 459-16Ss
-000C NEWS AIr16RAGA • GQQ LQV YOU -
PLEASE WORM Lis IMMEDUISIEV W YOU DO NC/TRECENE PACStMIS.E IN RAL