WI0500172_GEOTHERMAL_20120514

Beverly Eaves Perdue
Governor
AWA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 14, 2012
Orange County Government
Post Office Box 8181
Hillsborough, NC 27278
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0500172
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 ISA 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 htt p://portal.ncdenr.or g/web/wq/aps.
lf you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at(919) 807-6300.
Sincerely,
t') p ~--·
?i,uL-~(,,..
Eric G. Smith, P.G.
Hydro geologist
cc : UIC Pem1it File
AQUIFER PROTECTION SECTION
1636 Mail Seivice 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\ Affirmative Action Employer
One . . NorthCarohna
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North Carolina Department of Environment and f€ I'RIes6 'rcbs2l.i
Beverly Eaves Pardue
GovernoF
Division of Water O aiity
Charles Wskild. P. E.
Diroctor
January 24, 2012
R. A. SIMMONS WELL DRILLING CO,, INC.
60 DRILL RIG DRIVE
BUCHA NAN, VA 24066
5ubjecL
Notice of Deficiencies
Missing Injection Well Construction Data
Dear R, A. Simmons Well Drilling Company, Inc„
JAN 2 7 2n?i
Dee Freeman
Secretary
A recent review of our records indicates missing injection well construction data 1CW-1 forms)
for wells constructed under the following permits:
0
+� Wr0300048
WI44Oo167
7 W10500172
_Keith and Cathy Pahl SFR
Dalton McMichael Dr SQM
Main Orange County Courthouse
Permit T e
Injection Mixed Fluid GSHP Wall System (5QM)
Injection Mixed Fluid GSHP Well System (5QM)
aiection Mixed Fluid GSHP Well Systern (5QM)
It was required under the specific permit listed above that a co,gy of the GW-1 records were to
be submitted to the Aquifer Protection Section at the following address.
Aquifer Protection Section - UIC Program
DENR - Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1635
Within 313 days of the receipt of this letter, you must mall a copy of the completed GW-1
records for each of the referenced permits to the address listed above. You can also choose to
fax a copy to forms to [phone], If you were not the well contractor for the specified
permits, disregard this letter.
If you have not already done so for all of the above permits, please make sure you have
Submitted a copy of the GW-1 records to our information Processing unit listed at the bottom
of the GW-1 form. Failure to do so is a violation of 15A NCAC 02C ,0213(h)(1) and may result
in the assessment of civil penalties in accordance with North Carolina General Statute 87-94.
AoulFER PPOTeOTION SECTION
1636 ASaii Service Cemar, Rsib'$h, NGsflt Comlina 2 r6i19. 636
Loostion; 512 N. Salsbury S[„ Raleigh, North Carolina 27604
Phone: 919.907•&464 i FAY; 919$07.6496
Inlemei: www,nosater +aalltv,ona
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Page) of I
Stephen Brooks 145 5%14: 114.Jel,J0. $Sr 70o1
From: "Stephen Brooks" <s.brooks@simmonsdrilling,com>
To: crnichaei.rogersencdenr.gov>
Bent; Friday, August 28.2009 12:08 PM
Subject: Injection Well Permit No. W10300048
Mr. Michael f.ogers
Environmental Specialist
NC-DENR
Division of Water Duality
RE: V11030ao4$
O-k area Cf 44-1+y ?chi S R
❑a-14 t r .
Dear Mr. Rogers
Soma time after March 19, 1999, Richard Sknnrone Drilling Co., Inc, of Virginia, or the 5tetasudte, NC. Pike • Hallmark Drilling Co., was
subcontracted by Mr. Tate Rust of Singlelon Heisting & Air (41)0 Valleydale Rd., Charlotte, NC. 28214) to dill ? wells fora residential closed -
loop geothermal inatellation an the Walt side of Lake Normand. An atr•rotary rig wee initiollyv dispatched but found that Conditions dictated mud
drilling to be necessary. That equipment was dispatched and the work aompteted by driller Randy Phillips (NC 12200) from our then
Moresvide, NC. Office. That office was later mowed to Statesville in
2002 and later closed in August of 2007.
To date we have been unable to locate the GW'lfor this address though believe a copy would have been mailed to the contractor and DENR
upon payment for the work. Mrs have been in canted with the oriHer {her, Phillips no longer works tor our company). Although Mr. Phillips
recalls doing the work he does not remember the number of bores. litf,o oily etc. we feel necessary to accurately complete and submit a Gw.-1
for mail work. Wo will however continue to scarce Simmons archives to obtain the Inforrnetton you request.
Ifyou have any questIone about this matter
please call Stephen Brooks at [phone].
Thank you,
Stephen Brooks
Geothermal Manager
RA. Simmons Drilling Co Inc.
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RECEIVED 02-01-`12 12:47 FROM-
TO- NC DENR P&S P0@2I008

Beverly Eaves Perdue
Governor
A7.1.
NCDENR
tt lr i . ; 1
Noah Carolina Department of Environmern ar ff> 1t rat Rtsdur bs
Division of Water Quality
Coleen H. Sullins Dee Freeman
Director Secretary
L"lots tinivertik
(ierald Whittington — Sr. VP of Finance Technt liw
i 00 Carnpu4 Drive
Ion. N.C. 27244 1A)10110D131
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Subject:
5,6!2010
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Acknowledgement of intent to Construct Type 5QW injection Well System
Permit No. W10400134
336 Dalton lMMcMichacl Drive. Cron, !NC 27244
Dear tv.r, 11• hitt'rrinoa,:
On 4127/2010. the Aquifer Protection Section LAPS) received notification of your intent to construct a closed -loop water -only
geothermal infection =11 system for the operation of a ground -source heat pump located at the address referenced above- Ail
individual permit is not required for the construction and operation of this type of geothermal injection well system as long as thr
following conditions are met:
1. The injection well Gystern coutains,only potable wascr,
The injection +gel( system is constructed in accordance with well construction standards specified In North
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
3. The required tigtifiicatiort form and associated maps have been completely and accurately submitted.
Failureto comply ►with, all of those conditions constitutes a violation of the North Carolina Well Construction. Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .0211(u)(2). Additionally; you should contact the Alamance County Health
Department as they may have additional requirements for this type of system- Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties,
Please contact Mike Rogers as (919) 7I 5-6166 or Wehael.Rot;ers(ijpcdenr.l:ov if you have any questions.
TOw $lLF}4.r 414'1 Sincerely.
cr:
Out
iu • [)eh, t, W1 at*^5
SUperviSOI
wrnstap-5alsm Regional Dtfis:a: • F+I'S :;,.. ., rr .
AJ'S Carnal Files - Permit No. W I(1 JO L Z4
AitrniiincC Cowuy Hcaith Dept.
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Beverly Eaves Perdue
uOverrior
p4cDERR
North Carolina Department of Environment and Na aL. Fes .irpe
Division of Water Quality
Coleen H. Sullins Dee Freeman
Director Secretor,;
Elozs University
Atrn: Gerald Whrttin.ttm, VP Financt• & Tech
i 0{l Campus Dri v e "
Clop. NC 27244
Subfecr
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Acknowledgement of Intent to Construct Type 5QW injection Well System
Permit No. W1Q400t 37
33F Dalton McNl[Chnt Drive
Dear Mr- whittingtoo:
On 61 1.!2OJ , the Aquifer Protection Section (APS) received notification of your intent co construct a cloacd-loop wateponly
geothermal injection well system for the operation of a ground -source heat pump located at the address referenced above. Art
individual permit es not required for the construction and operation of this type of geothermal injection well system as long 5E, the
following conditions. are met:
1. The injection well system contains only potable water,
2 The injection well system i5 constructed in accordance with well construction Standards specified in North
Carolina Administrative- Code Title 15A Section. 2C Subchapter .Q213, and
3. The required notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Can$tnjrciion Act and North Caroline
Administrative Code Title 15A Section 2C Subchapter .0211(u1(21, Additionally, ydu should contact the Aiarratnce Counry Heatth
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county. or
municipal rules and regulations may result in the assessment of civil penalties.
Pleas: contact Mike Rogers ec [phone] 4r 1ichaei.Royersfi nedenr.ow if you have any questions.
Sincerely,
OL; IdaCkpir
jor DPbr•ir W att:4
Sul,erviknr
cc' winsiott•Saiert, Regional Office - APS
APS Conma} Fit es - Permit No. Wl114 MI ±7
Ilian�ttr�et' County Hoatltii Dept.
!{..0.. Simmotix trifling (Stephen S. 13rttiaksl All Dt•ilf Rig 1)f'h e, t3uc•hanom. VA 211}06
AUUIFEP. PROTECTION SECTION
153ri Mrail 4ervrce Crier. Raierpt:. North Cantina 27699-163C
Location: 2728 Genira: Souleva'd, Rafaigh North Cola 27804
anflne: 919.733.322t' FAr,1 919.715•058E: FAX 2:9t3-713144A'.Customer Servrce: 1.61762345748
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Beverty Saves Perdue
'ioverr c r
Awi711
NCDENR
North Carolina Department of Environment and Natur4 f i ou ce i
Division of Water Quality
Coleen H, Sullmj Dee Freanlon
Director aec;retary
January 4. 20] 1
Gerald Whittington_ y}. Vp Business Finance & Technology
Elon Universiry
140 Carnpus Drive
Sion. NC 27244
Subject Acknowledgement of Application No, W10400167
Elon University
Injection Mixed Fluid GSHP Weil System (SQM)
Alstmance
Dear Mr. Whittington:
2'5
Cedi i r r kJ
4-11 !�....t
WI I CY e-D
The Aquifer protection Section of'the Division of Water Quality (Division) Acknowledges receipt of your permir application and
supporting materials on October 15. 2010. This application package }tad been assigned tfle number listed above and will be reviewed
by John McCray.
The reviewer will perform a detailed review and contact you,with a request for additional information if necessary, To ensure the
maximum efficiency in processing permit Application , the Tivision requests your assistance in providing a titncly and complete
response io any additional information requests.
Please be aware that the Division's Regional. Office_ copied below. must provide recommendations prior to fsna} action by the
f) vision. please also note at this time. processing permit application. can take - long as 60 • 90 days after receipt of a complete
application.
If you hove Any questions. please conulct 10h111 McCray at 919-7) 5.6168, or via e-mail at,jahn.mccray®cdenr.gov If the reviewci i•
unavailable, you may leave a message. and they will respund promptly,
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING ENQUIRIES ON THIS PROJECT
Sincerely,
fd,- Debra J. Nuns
Supervisor
ce: Winston-Salem Regional Office, Aquifer Protection Section
RA Simrnnns Drilling (Stephen S. Brooks)
Mcch works Mechanical (Andy Swofford)
Pi~rrrrit. Application Fiie W10400157
631; i.101, Stem UentPr; Ralepl k18�h ::8ri+lihA
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Ana !MOTE
�N� FEB 0 $ 2011
North Carolina Department of Environment 10 Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullina
Governor Director
January 28, 2011
Elon University
Attn: Gerald Whittington. Senior VP Business Finance and Technology
l 00 Campus Drive
Eton, NC 27244
Dee Freeman
Secretary
Ref: 111114nce of Injection Well Permit W10400167 -
lssued to Elon University
Elora, Alamance County, North Carolina:
Dear Mx. Whittington:
In accordance with the application received on December 15, 2010, I am forwarding permit number W104D0167 for
the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection walk system,
This permit shall be effective from the date of issuance until December 31, 2015, and shall be subject to the
conditions and limitations ,$rated therein, including the requirement to install well identification tags es
specified in Part 11.3 andtto submit well construction retard' as specified in Part VII.2. Bc sure to read the
entire permit to ensure that you are atatre of all compliance requirements of the permit.
You will need to notify this office at lea9t 48 hours prior to beginning construction and operation of the injection
well system. In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must
submit an application to resew the permit 120 days prior to its expiration date. This permit is not transferable to
any person without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at [phone] or john.mccray>iuncdea,r.gov if you have any questions a ul your permit.
CC:
S}Tcrri Knight. Winston-5WWMM Reeional Office
W10400167 Permit Filc
Alanntice County Envito mental Health X]ep[.
AO hFER PROTECTION SECTION
1636 Mali Servize Center, Raleigh, North Caidlna 27689-1636
Loottorr 2728 CaNN4e1 aaWoverd, Reteigh. Noq Can+ika 2760I
Prrorw 919-13342211 FAX 1; 919-715.4566: FAX [phone] e I Custpne► Servit;r:1.BT1-623-6746
Intend witiMettesiiiiiittxx
Rn64+ OPPOZWIrly 1 AffinTIOEW*auiFiiIpM;
RECEIVED 02-01-'22 12:47 FROM -
Best Regards, ,,!!
c-
1ohn McCr4y
Environmental Specialist
Carolina
aturally
P005/006
TO- NC DENP P&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
Elon University
FOR THE CONSTRUCTION AND OPERATION OF 112 TYPE 5Q14/1 INJECTION WELL(S), defined in
Title 15A North Carolina Administrative Code 2C .0209(c)(3)(F), for the purpose of operating a vertical closed
loop geothermal mixed fluid heat pump system. This system is located at 336 Dalton McMichael Dr., ;Elora,
Alamance County, and will be constructed and operated in accordance with the application received December
15, 2010, and in conformity with the specifications and supporting data submitted, all of which are filed with
the Department of Enviromicat and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation of an injection well and shalt be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 end .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well oonstmetion and use.
This permit shall be effective, unless revoked, from the date of its issuance until December 31. 2015, and shall
be subject to the specified conditions and limitations set forth in Parts I through IX hereof:
Permit issued this the 28th day of January, 2010.
atc,_ (A)*L
tColoen H. Sullins, Director
Division of Water Quality
By Authority of the Envinnuncntal Management Commission.
Permit xw104001&7
RECEIVED 02-01-'12 12:47 FPOM-
UIC15QM
ver. 03/2010
Page 1 Of 5
TO- NC DENR P&S P007/008

..... --8 ' I ... I.'· .. --I . !,. l , ... ,J '
RE: Wl 0500172 Main Orange County Courthouse
R. A. Simmons Drilling Co., Inc. did not do this work .
Possibly • LoopMaster International Inc., Indianapolis, IN.
RECEIVED 0Z°-01-'12 12:47 FROM-TO-NC DENR P&S P008/008
it Nutttner W10500172
Central Files: APS SWP
10/ 12/07
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael,rogers
Permitted Flaw
F Si
Status
Active
Project Type
New Project
Version Permit Classification
1,00 Individual
Permit Contact Affiliation
Pamera Jones
PO Box 8181
Hillsborough
NC 27278
Facility Name
Main Orange County Courthouse
Location Address
105 E Margaret Ln
Hillsborough NC 27278
Major/Minor
Minor
Region
Raleigh
County
Orange
Facility Contact Affiliation
Owner Name
Orange County Government
Owner Type
Government - County
Owner Affi cation
Laura Blackmon
PO Box 8181
Hillsborough
NC 27278
Orig Issue
10/10/07
App Received Draft initiated
10/08/07
:..[liliatl?d Ac_tis•itie
Heat Pump injection
oifal+ NULL
Scheduled
Issuance
Public Notice Issue
10/10/07
Effective Expiration
10/10/07 09/30/12
si I iv - zf
RO staff report requested 09/20/07
RC shaft report received 10/08/07
Waterbody Name
Stream Index Number
Current Class
Subbasin

Michael F. Easley, Governor
William G. Ross Jr.. Secretary
North Carolina Department of-Enviromnent and Natural Resources
Coleco H. Sullins, Director
Division of Water Quality
October 10, 2007
Hillsborough County Government
Attn: Ms. Laura Blackmon, County Manger
P.O. Box 8181
Hillsborough, NC 27278
Re: Issuance of injection Well Permit
Permit No. WI0500172
Issued to Orange County Government
Dear Ms. Blackmon:
In accordance with your application dated October 8, 2007, I am forwarding Permit No. W10500172
for the operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system to
be located at 106 East Margaret Lane, Hillsborough, Orange County, North Carolina 27278. This
permit shall be effective from the date of issuance until September 30, 2012, and shall be subject to
the conditions and limitations stated therein.
Pay special attention to the well construction standards in Parts iT and V of your permit. You must
notify this office (Raleigh Central Office) and the Raleigh Regional Office at least forty-eight (48)
hours prior to constructing the system, and forty-eight (48) hours prior to initiation of the operation
of the system.
In order to continue uninterrupted legal use of this well -for the stated purpose, you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit,
this permit is not transferable to any person without prior notice to, and approval by, the Director of
the Division of Water Quality. If you have any questions regarding your permit or the Underground
Injection Control Program please call Mr. Qu Qi at [phone] or me at [phone].
Best Regards,
t
.4144'eL4
Michael Rogers
Environmental Specialist
cc: Jay Zimmerman — Raleigh Regional Office
Central Office File
Orange County Health Dept
Attachment(s)
Aquifer Protection Section 1636 Mail Service Center
Raleigh, NC 27699-1636
Internet: http://www.newaterqualitv.org 2728 Capital Boulevard Raleigh, NC 27604
An Equal Opportunity/Affirmative Action Employer— 50% Recycledf10% Post Consumer Paper
NorthCarolina
Naturally
Telephone: [phone]
Fax 1: (919) 715-O588
Fax 2: [phone]
Customer Service: [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Orange County Government
FOR THE CONSTRUCTION AND OPERATION OF A TYPE 5QM INJECTION WELL,
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 106 East Margaret Lane, Hillsborough, Orange County, North Carolina, and will be
constructed and operated in accordance with the application dated October 8, 2007, and in
conformity with the specifications and supporting data submitted, all of which are filed with the
Department of Environment and Natural Resources and are considered a part of this .permit.
This permit is for Construction and Operation only, and does not waive any provisions of the
Water Use Act or any other applicable Laws, Rules, or Regulations. Operation and use of an
injection well shall be in compliance with Title 15A North Carolina Administrative Code 2C
.0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well construction and
use.
This permit shall be effective, unless revoked, from the date of its issuance until September 30,
2012, and shall be subject to the specified conditions and limitations set forth in Parts I through
Xhereof.
Permit issued this the~ day of oc.Jv-~<, 2007.
__ c_~~ o ~<<\ __ ~C9£.,.___< -~
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
WI0500172 Page2
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 secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
8. A completed Well Construction Record (Fmin GW-1) must be submitted for each injection
well to, DENR-Division of Water Quality, Aquifer Protection Section DIC-Staff, 1636
Mail Service Center, Raleigh, NC 27699.:.1636, within 30 days· of completion of well
construction.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall
notify the Aquifer Protection Section-Underground Injection Control (UIC), Central Office
staff, telephone number [phone] and the Raleigh Regional Office Aquifer
Protection Section Staff, telephone number [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
WI0500172 Page3
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, which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section-
Underground Injection Control (UIC), Central Office staff, telephone number (919) 715-
6166 and the Raleigh Regional Office Aquifer Protection Section 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
WI0500172 Page4
compliance with this perm.it, 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 Raleigh Regional Office, telephone number (919) 791-
4200, any of the following:
(A) Any occurrence at the injection facility, which results m 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 90 days prior to the expiration of this permit, request an
extension.
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
WI0500172 Page5
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Perrpittee 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 froin obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
WI0500172
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 6
Permit Number WI0500172
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
michael.rogers
Permitted Flow
Facilit
Facility Name
Orange County Courthouse
Location Address
106 E Margaret Ln
Hillsborough
Owner
Owner Name
NC
Orange County Government
Dates/Events
27278
Orig Issue App Received Draft Initiated
10/08/07
Scheduled
Issuance
Central Files : APS_ SWP_
10/10/07
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Pamera Jones
PO Box 8181
Hillsborough
Major/Minor
Minor
Region
Raleigh
County
Orange
Facility Contact Affiliation
Owner Type
Government -County
Owner Affiliation
NC
Laura Blackmon
PO Box 8181
Hillsborough
Public Notice Issue
NC
Effective
27278
27278
Expiration
_R_e-g_u_la_t_ed_A_c_t_iv_it_ie_s _______________ -'--'R=e=g-=u=es=t=e=d,,_,/R~e=c=e=i-=-ve.,._d=--=E'-"v-=e.,_,n=ts~----------
Heat Pump Injection RO staff report requested
RO staff report received
Outfall NULL
Waterbody Name Stream Index Number Current Class
09/20/07
10/08/07
Subbasin
County of Orange
Department of Purchasing & Central Services
Pamela K. Jones, Director
Letter of Transmittal
Subject Justice Facilities Expansion Project Date: October 9, 2007
To: NCDENR-DWO - Underground Injection Control
Attn: Ou Chi, Program Mgr - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Copies Date No.
3 08/0 i/07
Action:
A No Action Required
B. Signature Needed
C. Signed Original
Remarks:
Description
Action
Code
'Application for Permit to Construct and/or use a Weil(s) for Injection with a Hear
1 Pump System
D_ For Your Approval
E. For Your Review
f _ See Remarks Below
G. To Process
Thanks flu. We will be lookirni for the Permit Please let me know if you need additional_
For questions or comments, or if enclosures are not as noted, please contact Tammy Comar ar 919-245-2657
Thank you.
129 E King Street • Hillsborough • NC 27278
Fax [phone] !

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 and SQM We1ls
In Accordance with the provisions ofNCAC I itle 15A: 02C .. 0200
Complete application and mail to address on the back page .
IO: DIRECTOR, NOR1H CAROLINA DIVISION OF WATER QUALITY
DATE: August 1 20.Ql_
A . SYSTEM CLASSIFICATION Please check column which matches prop0$ed system.
(1)
(2) X
Type SA 7 wells inject water used to ptovide heating or cooling foi-structures ..
Type SQM wells contain a subswface system of continuous piping, that is
isolated fiom the envin:mment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or con·osion
inhibitozs ..
(.3) Type SQW wells contain a subswface system of continuous piping, that is
isolated from the environment and only circulates potable water. Hyou selected
thls well type, then com plete for·m GW-57 CL, Notification Of Intent To
Construct A Closed-Loop Geothermal-•Water Only Injection Well Sy5tem.
B . PERMIT' APPLICANT
Name: t>~ Cec.,;1.rey, ..UC.
Address: · /o Box::. i 1E I
City: thtU~ci},,.,trt{ State: ,L.-t:. Zip Code:2:;i-Z.:?3 County: o~
felephone: 't i ';• M'f'--. U.S"Z
C . PROPERTY OWNER (if diffeient from applicant)
Name:-------·-------------------0
-J
Address:
City: ________ Sate: __ Zip Code: ____ Cm.m~:
Telephone: ________ _
D. STATUS OF APPLICANT
Pdvate: F 'ederal: Commercial:
State: Municipal: .,..,-Native Amedcan Lands:
Revised 7 /06 GW/UIC-5"7 HP Page 1 of4
".:)
7
--1
( )
E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of'Ownet· is Fede1al, State, Municipal 01 Commercial).
Name of'Business ot· Facility:
Address: ________ -_______________ _
City: ____ , _____ Zip Code: ·----Com1ty:
lelephone: . _______ , Contact Person: _________ _
F HEAT PUMP CONTRACTOR DAI A
Name: ____ ·-----------------------
Address: _________________________ _
City: _________ Zip Code: _____ County: ______ _
Telephone: Contact Person: _________ _
G INJECTION PROCEDURE (B1iefly describe how the injection well(s) will be used,)
Closed loop geothei:mal wells with additive for
freeze protection.
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the foUowing?
(I) The iajection operation? YES ___ NO _X __
(2) Personal consmnption? YES____ NO _x __ _
I CONSTRUCTION DATA (check one)
IDCTS TING WELL being proposed foi use as an injection well. Provide the data in
(1) through ('7) below to the best of yow· knowledge .. Attach a copy ofForpi GVf-
1 (Well Construction Record) if available,
X PROPOSED WELL to be constructed for use as an injection well, Provide the
data in (1) through (7) below as PROPOSED cons1Juction specifications .. Submit
F'OJm GW-1 after construction. ·
(1) Well Drilling Contractor's Name: R.A. Simmons ])rilling Co., Inc.
NC Coµttactor Ce1tification number~ WC03588 -----------
( 2) Date to be constiucted: August 2007 Number ofb01ings: _6_8 __ _
Approximate depth of each boring (feet):. __ 4,....0 .... 0 _______ _
(3) Well casing: Is the well(s) cased?
(a) YES If yes. then provide the casing infoimatioµ below.,
IYPe: Galvanized steel ___ Black steel ___ Plastic __ Othel' (specify) ______ _
Casing depth: FI'Om ___ to ___ ft. (reference to land SUiface)
Casing extends above ground inches
(b) NO _x_
Revised'7/06 GW/UIC-57 HP Page2of4
(4) Grout (material surrounding well casing and/or piping):
(a)
(b)
Grout type: Cement __ Bentonite __!_ other (specify) ______ _
Grouted swface and giout depth (reference to ]and smface):
_I_ around closed loop piping; from =4.Q..Q_ tosurfacUeet).
__ around well casing; from--· to--· (feet) ..
(5) Screens (for Type SA1 wells)
(a) Depth: From __ to ___ feet below ground smface ..
(6) N..C. State Regulations (Title lSA NCAC 2C .0200) require the pe1mittee to make provisions
for monitoting wellhead processes. A faucet on both influent (fluid enteiing heat pump) and
effluent (fluid being injected into the well) lines is required.. Will there be a faucet on:
(a) thein.fluentline? yes __ no__ (b) theeffiuentline? yes __ no __
(7) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well}.
Attach a copy of Form GW-•l (Well Construction Record) .. If Fo1m GW-1 is not available.,
provide the data in pmt K (1) of this application form to the best of your knowledge ..
NOTE: THE WEI.l, DRilUNG CONIRACJ'OR CAN SUPPLY IHE DA I A FOR EirHER EXIS JING OR
PROPOSED WEI.LS IF IHIS INFORMAIION IS UNAVAILABLE BY OJHER MEANS.
J PROPOSED OPERA TING DATA (for Type SA 7 wells)
(1)
(2)
{3)
(4)
Injection rate:
Injection Volume:
Injection Pressure:
Avetage (daily) gallons pe1 minute (gpm) ..
Average (daily) __ gallons per day (gpd),
Aveiage (daily) __ pounds/square inch {psi}.
Injection Temperature: Average (January) __ ° F, Average (July) __ ° F ..
K INJECTION FLUID DATA
(1) Fluid sow-ce (for Type 5A7 wells) If underground, fiom what depth, f01mation and type of
mck/sediment unit will the fluid be drawn (e .. g., gianite, limestone, sand, etc .. ).
Depth: Fonnation:____ . Rock/sediment unit __ _
(2) Chemical Analysis of Sow·ce Fluid (fo1· Type SQM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
~¼J\
L IN1ECTION-RELA TED EQUIPMENT.
Attach a diagram showing the engineezing layout of the injection equipment and extedo1· piping/tubing
associated with the injection operation. The manufacturei·'s brochure may provide supplementary
information.,
M. LOCATION OF WELL(S) Attach two maps ..
Revised 7 /06 GW/UIC-57 HP Page3 of4
(1) Include a site map (can be dn1wn) showing: buildings, property lines, smface wate1 bodies,
potential sow-ces of groundwater contamination and the J?tientation of and distances between
the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or
dtain fields located within 1000 feet of the geothennal heat pump well system. Label all
features clearly and include a north auqw. :_
(2) Include a topogiaphic map of the ai·ea extending one mile from the propeity boundruies and
indicate the facility's location and the map name ..
N PERl'v!IT LIST: Attach a list of all permits or constmction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program peimits underRCRA
(2) NC Division of Water Quality Non-Discharge pe1mits
(3) Sewage Treatment and Disposal Pe1mits
0. CERTIFICATION
"I hereby ce1tify, under penalty of law, that I have pel'sonally examined and am familiar with the
information submitted in this document and all attachments thereto and that, based on my inquiJy of
those individuals immediately responsible for obtaining said infmmation, I believe that the information
is true, accuiate and complete. I am aware that there are significant penalties, including the possibility
of fines and imprisonment, for submitting false infm:mation, I agree to construct, opernte, maintain,
repair, and if applicable, abandon the injection well and all related appmtenances in accordance with
the approved specifications and conditions ofthe Petmit."
~~
(Signature or'Well Owner 01· Autho1izedAgent)
lfauthorlzed agent ts· acting on behalfofthe well owner,
please sµpply a letter signed by the qwner authorizing the above agent.
P. CONSENT OF PROPERTY OWNER (Owner means any persqn who holds the fee or· other propetty
rights in the well being constructed. A well is i-eal prope1ty and its constmction on land rests
owne1ship in the landowner in the absence of contraiy agreement in wiiting .)
If the prope1ty is owned by someone othez than the applicant, the prope.ity owner hereby consents to
allow the applicant to construct each injection well as outlined in this appJication and that it shall be
the responsibility of the applicant to en.sure that the injection well(s) confonns to the Well
Construction Standards {Title 15A NCAC 2C .. 0200)
Revised 7 /06
(Signature Of Property Owner IfDifferent From Applicant)
Please retum two copies of'the completed Application package to:
IDCProgram
Aquifer Prntection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GW/UIC,57HP Page4of·4
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7611200?

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 10/05/2007 County: Orange Co , 6--et!T.
To: Aquifer Protection Section Central Office
Central Office Reviewer: Micheal Rogers
Regional Login No: 05
Permittee: Ms. Pamera Jones
Project Name: UIC-5QM Closed-Loop
Application No.: W:C t>i'.1)0 t :1:1..
L GENERAL INFORMATION
1. This application is ( check all that apply): 1:8] 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 Distribution of Residuals
0 Attachment B included
D Surface Disposal
0 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation 1:8] Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? (gJ Yes or D No.
a. Date of site visit: 10/05/2007
b. Person contacted and contact information: Ken Smith -Pamera Jones Ph.# 9192452652
c. Site visit conducted by: JGreer, RRO-APS
d. Inspection Report Attached: 1:8] Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
D Yes or 1:8] No. lfno, 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 nrune and number: __
d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): NIA
For Disposal and lniection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): Orange County Courthouse 104 East Margaret Lane,Hillsborough NC 27278
b. Driving Directions: See Map Quest:
c. USGS Quadrangle Map name and number: C22SW Hillsborough
d. Latitude: 36.04.25 Longitude: 79.05.56
II. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification:_
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No D NI 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 D NIA Ifno, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D NI A If no, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NIA. Ifno, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No D NI A. If no, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No D NI A. If yes, please attach a map showing areas of 100-year tloodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? 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: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No D NIA Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No D NIA If yes, attach list of sites
with restrictions (Certification B?)
/IL RENEW AL AND MODIFICATION APPLICATIONS (use previous section fo r new or maior modification
systems)
Description OfWaste(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, eflluent
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. If no, please explain: __
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect pennit ( drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain: __
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. If no, 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 O 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 changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? D Yes D No D N/A Ifyes, 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 pennit: __
10. Is the description of the facilities, type and/or volume ofwaste(s) as written in the existing pennit correct? D
Yes or D No. Ifno, please explain: ____ _
11. Were monitoring wells properly constructed and located? 0 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
0 No D N/A. 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; 0
Current enforcement action(s) D Currently under SOC; 0 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 pennit, (SOC, JOC, etc.) been complied with? D Yes
D No O 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 pennit? D
Yes or D No D N/A. If yes, please explain: __
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -bop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells,)
Description Of Well(S) And Facilities — New, Renewal. And Modification
I, Type of injection system:
❑ Heating/cooling water return flow (5 A7)
® Closed -loop heat pump system (5QM15QW)
❑ In srhi remediation (51)
❑ Closed -loop groundwater remediation effluent injection (5L1"Nan-Discharge")
❑ Other (Specify: _1
2. Does system use same well for water source and injection? ❑ Yes ® No
3_ Are there any potential pollution sources that may affect injection? 7 Yes ® No
What is/are the pollution source(s)? Cirs Sewers. What is the distance of the injection wellisi from the
pollution source(s)? 51' ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 60' ft.
5. Quality of drainage at site: ® Good
6. Flooding potential of site: ❑ Low
❑ Adequate ❑ Poor
Z Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of welts, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: NIA
S. Does the map presented represent the actual site (property lines, wells, surface drainage)? ® Yes or ❑ No. If
no or no map, please attach a sketch of the site, Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal And Modification ()Mr.:
I. 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/cool ing)?
❑ Yes ❑ No, If yes. explain:
For closed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes Pi No. If yes, explain: N/A. New System. Not et Installed.
3 . For renewal or modification of groundwater remediation permits (of an} type), will
continued/additional/modified in jeetions have an adverse impact on migration of the plume or management of
the contamination incident? ❑ Yes ❑ No. If yes. explain:
Drilling contractor: Name: R.A. Simmons Drilling. Cornpanr . Inc. Att: Marty Kim /Steven Brooks

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: Rt. 3 Box 236
Bauchanan Va.24066
Certification number: 2331
5. Complete and attach Well Construction Data Sheet.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly.
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 reconnnend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition
Reason
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information; El
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report preparer(s);
Signature of APS regional supervisor:
Date/O e/LEI?
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
New systen3 not vet installed. CO must enter on Bims after Permit # assiuned.

Page I of 2
North Carolina Department of Environment and Natural Resources
Division of Water Quality -Groundwater Section
PRECONSTRUCTION INJECTION FACILITY INSPECTION
REPORT -FORM A
INJECTION WELL PERMIT NO. WI
NAME OF OWNER
ADDRESS OF OWNER _P-v azaSe..
DATE : L? — 72722-
Oixi) T AI
d
- 7L • A m 174A mod' rA 4=9 )' 34
{Streetlroad or lot and suddivision, cou►rty, town)
LOCATION OF PROPOSED INJECTION WELL (and source well(s), if applicable)
(Street/road or lot and suddrvision cmtnty, town, if different than owner's address, plus description of location on site)
Potential pollution source r L► e
Potential pollution source (-„,1_ I (
Potential pollution source g-o
Distance from well o
Distance from well p ,
Distance from well ) V
Minimum distance of proposed well from property boundary
Quality of drainage at site Flooding potential of site
(Jdeguate,poor) thigh,re_ le w)
fiA •
DRAW SKETCH OF SITE
(Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.)
12-tvfo-e"
r L I I I Cr'-ns

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (conk.)
COMMENTS
C
�- ID ` T I Z' di7I.'
WITNESS
Address
WITNESS
Address

- L-f) (--
LL

1-)12- Cl) GpLt
-
/0/5-10

Map of 104 E Margaret Ln Hillsborough, NC by MapQuest
http://www.rnapquest.com/maps/map.adp?si rchtype— address&count...
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entire map, try clicking the "Printer -Friendly" link at the top of your results page.
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This map Is informational only. No representation is made or warranty given as to its content. User
assumes all risk of use. MapQuest and Its suppliers assume no responsibility for any loss or delay
resulting from such use.
2 of 2 9/27/2007 8:10 AM

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1 of 1 10/5/2007 10:49 AM

DENR Site visit to review Wellfield
lofl
Subject: DENR Site visit to review Wellfield
From: "Kevin Sowter" <[e-mail]>
Date: Fri, 05 Oct 2007 10:24:23 -0500
To: "'Chad Lloyd"' <[e-mail]>, "'ken smith"'
<[e-mail]>, "'Jeffrey Thompson"' <[e-mail]>,
<[e-mail]. us>
CC: "'Jason Moody"' <[e-mail]>, <[e-mail]>,
<[e-mail]>
This am Jim Greer w/DENR 791-4237 stopped by to review the location of the geo-wellfield. I showed
Mr. Greer the comer stakes , the sanitary sewer that was 51' from the N.E. comer well in the South field.
Mr. Greer said the permit process may take approx 15 days.
Thank You, Kevin Sowter
10/5/2007 11 :24 AM
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: September 20. 2007
To: ❑ Landon Davidson, ARO-APS
❑ Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-APS
Jay Zimmerman, RRO-APS
❑ David May, WaRO-APS
❑ Charlie Stehman, WiRO-APS
❑ Sherri Knight, W-SRO-APS
From: Michael Rogers Groundwater Protection Unit AQIfIF�'PM1TH;RECEIVED/DENR IF
il1N RF.CTIDi+I
Telephone: t 9191 715-6166 Fax: t 919j 715-0588 OCT 11 1007
E-Marl: Michacl.RogersLncmail.net
A. Permit Number: No permit number assi„ned vet (w/o letter jvinl; Pamera Jones authorization
to sign application
B. Owner: Orange County Government {contact Pamera Jones
C. Facility/Operation:
® Proposed ❑ Existing
t-1y ris e'64
❑ Facility ❑ Operation
4. y'70-78'
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R Infiltration
[] Recycle ❑ PE Lagoon ❑ GW Remediation (ND)
• UIC - (5QM) closed loop mixed fluid geothermal
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal wl Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
NOTE: QQ asked for you to make arraneements for a site inspection while waitinu for a letter from
Orange County.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
® Return a Completed APSARR Form.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment 13 for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: 1,1 em6#37e"` Date: q/, 1-//-'
FORM: APSARR O7/06 Page 1 of t

Pennit: WI0500172
SOC:
County: Orange
Region: Raleigh
Effective:
Effective:
Contact Person: Pamera Jones
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: Orange County Government
Facility: Orange County Courthouse
106 E Margaret Ln
Hillsborough NC 27278
Phone: [phone]
Directions to Facility: ,.
From Raleigh take 140 West to Hillsborough, NC (R at exit for Churton St/NC Hwy 86 ). Go north to downtown Hillsborough. Court
house is on R ijt comer of Churton and Margaret Lane. System Classificat,ons:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Pennits:
Inspection Date: 10/05/2007
Primary Inspector: Jimmie W Greer
Secondary lnspector(s):
Entry Time: 09:30 AM
Certification: Phone:
Exit Time: 10 :30 AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Assistance
Pennit Inspection Type: Injection Mixed Fluid GSHP Well System (SQM)
Facility Status: 0 Compliant O Not Compliant
Question Areas:
■Other
(See attachment summary)
Page: 1
Permit: Wl0500172
lmspection Date: 10/05/2007
Inspection Summary:
owner -Facility: Orange County Government
lnepectlon Type: Compliance Assistance
This System is yet to be installed ..
Other
Comment:
Reuon for Visit: Routine
Yes No NA NE
Page: 2
A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: Se ptember 20, 2007
To: D Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
□ Andrew Pitner, MRO-APS
IZ! Jay Zimmerman, RRO-APS
□ David May, WaRO-APS
□ Charlie Stehman, WiRO-APS
□ Sherri Knight, W-SRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: [phone] Fax: (919 ) 715-0588
E;.Mail: Michael.Ro [e-mail]
A. Permit Number: No permit number assigned v et {w/o letter givin g Pamera Jones authorization
to sign app lication)
B. Owner: Oran ge Countv Government (contact Pamera Jones)
C. Facility/Operation: __
IZ! Proposed D Existing D Facility D Operation
D. Application:
1. Permit Type: D Animal D SFR-Surface Irrigation □ Reuse D H-R Infiltration
D Recycle D 1/E Lagoon D GW Remediation (ND)
IZ! UIC -(SQM) closed loop mixed fluid geothermal __
For Residuals: D Land App. D D&M D Surface Disposal
D 503 D 503 Exempt D Animal
2. Project Type: !ZI New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Information: D I would like to accompany you on a site visit.
NOTE: 00 asked for you to make arrangements for a site insp ection while waitin g for a letter from
Orange County .
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
IZ! Return a Completed APSARR Form.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet; and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: -------------------Date: _____ _
FORM: APSARR 07/06 Page 1 of 1
B
BORDEAUX
Caiatri c1la■ Company. Inc.
PO DRAWER 2935, 27715-2935
100 E. BR1TAN1A AVENUE
DIJRHAM, NC 27704
[phone]- Tel
[phone] - Fax
LETTER OF TRANSMITTAL
To: North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699
Attn: Qu Qi
Date: 09/17/07
Job Number: #209
RE: Orange County Justice Expansion
RECEIVED 1 t ENR 1 DWQ
AOU FcR PPr1TFr'.TiflN CrTIDN
SEP 18 2007.
. Copies
Date
Number , Description
i
2
09/17/07
1
, Application for Permit to Construct 5QM Wells
2
09/17/07
1 1 Site Map
2
09/17/07
1 1 One Mile Topo Map
Remarks:
Qti,
Please contact me if you have any questions Office [phone] ext. 321 Mobile [phone].
Your contact for site visit will be Project Superintendent Kevin Sowter [phone].
P i o
C.:9
1k C
Signed Chad Llovd

RE: Signature Authority
1 of 1
Subject: RE: Signature Authority
From: "Pam Jones" <[e-mail]>
Date: Tue, 25 Sep 2007 21:03:21 -0400
To: "Qu Qi" <[e-mail]>
Qu (you must tell me how to pronounce your name ... it is fascinating)
I asked that a copy of what you were sent be provided to me by our
project manager. As it turns out, I was not the signator on what you
were sent. They misunderstood the protocol and had our Finance Director
sign it in my absence. I have asked that they produce another signature
sheet and have the County Manager sign it. That will get it underway
for you in a timely manner. In the future, I will send along the letter
of authorization for my signature when I sign so there won't be reason
for pause. Thanks for working with us on getting this moved on through
the process. Have a good day.
FYI, our new County Manager is Laura Blackmon. You may still have on
record John Link, who was our manager who retired in August 2006.
Pam Jones
-----Original Message-----
From: Qu Qi [mailto:[e-mail]]
Sent: Thursday, September 20, 2007 1:16 PM
To: Pam Jones
Subject: Re: Signature Authority
Thanks! I will send a copy to Raleigh Regional Office today, so they can
make arrangement to do site inspection. We cannot enter the application
into our database until we have the authorization letter or proper
signature. Qu Qi
Pam Jones wrote:
I'll get you either a letter of authorization from our new manager or
I'll have her re-sign the permit. My authorization came from our
previous County Manager that retired in August. In the meantime, can
you please continue reviewing the permit? Hopefully, I can get it to
you by the end of the week or first of next. Many thanks .
Pam Jones
-----Original Message-----
From: Qu Qi [mailto:[e-mail]
Sent: Wednesday, September 19, 2007 1:03 PM
To: Pam Jones
Subject: Signature Authority
Ms. Jones,
I cannot find signature authorization letter on file, and I can not
find I your name in our permitting database (DWQ). We have to have this
letter
on file or have a proper person to sign the permit application (see
attached rule). Thanks!
Qu Qi
10/8/2007 10:44 AM
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins Director
Division of Water Quality
October 8, 2007
Laura Blackmon
Orange County
PO Box 8I8I
Hillsborough, NC 27278
Subject: Acknowledgement of Application No. WI0500172
Main Courthouse
Injection Mixed Fluid GSHP Well System ($QM)
Orange
Dear Ms. Blackmon:
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials on October 8, 2007. This application package has been assigned the number
listed above and will be reviewed by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary
To ensure the maximum 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.
!f you have any questions, please contact Michael Rogers at 919-715-6I66, 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
h rtp:Ilh2o. enr.state.nc.usldocum entsfd wq_❑ruchart.pdf
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT
Sincere
Y,
for Debrats
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Permit Application File W10500172
tr Naturally
na
Naturaly
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: [phone]
Internet: www.ncweterauality.oro Location: 2728 Capital Boulevard Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal Opportunity/Affirmative Action Employer-50% Recyrcled110%Post Consumer Paper Customer Service: [phone]