WI0500174_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
Wilson Community College
902 Herring A venue
Wilson, NC 27893
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0500174
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 longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http ://p ortal.ncdenr.or g/web/wq/a ps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
d Jpw K
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Permit Fik
AQUIFER PROTECTION SECTION
~u•-
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] I FAX: [phone]
Internet www.ncwaterguality.org
An Equal Opportunity\ Affi rmative Act ion Employer
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Michael F. Easley, Governor
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Q5-00174
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Ressourves
Coker Sullins, Director
Division of Water Quality
November 27, 2007
Monte Jefferson
Home Energy, Inc.
POBox238
Wendell, NC 27591
Subject: Geothermal Well installation Data
Dear Mx. Jefferson:
In review of our records concerning closed -loop geothermal mixed -fluid injection well systems,
classified as 5QM type permits, we have found the following records have not been submitted
fox permits where your company is listed as the heat pump installers:
• Well Construction Record (GW-1)
• Triangulation Data
• Well ID plate installation date
• Mechanical Integrity Pressure testing data (if available)
In order to assist your clients (those who hold 5QM permits) in meeting the condition of their
permits, Home Energy, Inc. (specifically Bra.d Scheel) has ageed to provide the above
information no later than December 27, 2007. For future reference; as we discussed November
14, 2007, we recommend you provide this information to your clients as soon as construction is
complete to assist them in meeting the condition of their permits. Also, please remember their
permits require there to keep this information on -site as well.
To assist you, we have attached a list of permits where you are listed as the heat pump installer.
We have also attached a form to fill out the results of your mechanical integrity tests. Thank you
in advance for your cooperation and timely response. If you have any questions regarding this
letter, please call me at (919) 71 5-6699 or Michael Rogers at [phone].
Sincerely, L„)}t.
Debra J. Watts
Environmental Supervisor
Groundwater Protection Unit
Attachment(s)
cc: APS Central Files (copy to each permit file on attached list)
Aquifer Pmtection Section 1636 Mail Service Center
Internet: www.ncwaterqualily ortr
location: 2728 Capital Bouievera
An Equal OpporttrnitylAfirmative Action Employer- 50% Recycieal10% Post Consumer Paper
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aturalfi
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: ()19) 715-6048
Customer Service: [phone]

List of Issued Permits to Home Energy, Inc.
Permit No. Name Heat Pump Contractor Date Permit Issued
WI0400082 Braden Monte Jefferson 11/20/2006
WI00800137 Panigutti Monte Jefferson 11/22/2006
WI0500145 Clark Monte Jefferson 10/9/2006
WI0800140 Belanger Monte Jefferson 2/13/2007
WI0500157 S. Martin Monte Jefferson 3/9/2007
WI0100086 Combs Monte Jefferson 4/18/2007
WI0700105 Cherrillo Monte Jefferson 5/17/2007
WI0500161 Stein Monte Jefferson 6/27/2007
WI0500162 Lauer Monte Jefferson 7/6/2007
WI0500163 Blachowicz Monte Jefferson 8/20/2007
WI0500166 Manning Monte Jefferson 8/17/2007
WI0500169 Maloney Monte Jefferson 10/12/2007
WI0700107 Latta Monte Jefferson 9/21/2007
WI0800150 Duan Monte Jefferson 9/20/2007
WI0500171 ENT Audiology Monte Jefferson 9/20/2007
WI0500170 Griffin Monte Jefferson 10/11/2007
Wl0700094 Harris Monte Jefferson 7/30/2006
WI0800136 Jefferson Monte Jefferson 9/12/2006
WI0500139 Essick Monte Jefferson 1/6/2006
WI0800135 Wilson Monte Jefferson 9/12/2006
WI0700096 Stolar Monte Jefferson 9/22/2006
WI0500143 Kahn Monte Jefferson 8/4/2006
WI0700093 Young Monte Jefferson 7/3/2006
WI0700095 Turner Monte Jefferson 9/22/2006
WI0500173 Bell Monte Jefferson not permitted as of 11/20/07
WI0500174 Wilson Community College Monte Jefferson 11/20/2007
November 20, 2007
Mechanical Integrity Test Record
(For SQM Geothermal Heat Pump Injection Well System)
Owner/Pennittee Name: ________________ Pennit Number: --'-W.:....:I:;__ ____ _
Facility Address: ______________________________ _
Home Phone: Cell Phone:
Heat Pump Contractor Name: ___________________________ _
Office Phone: Cell Phone: -----------------=--"'-=-=-=-==-'---------------
Test er Name: _______________ Signature: _______________ _
Date of Test: --------
Loop Initial Pressure (p si) Final Pressure (o si) Duration (minutes) Pass (Yes or No)
1
2
3
4
5
6 -
7
8
9
10
11
12
13
14
15
Any additional loop testing add to back of this form
Comments: ----------------------------------
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24 hours
prior to the initiation of the operation of the facility. You can send the form by mail: UIC Program, Mail Service Center 1636,
Raleigh, NC 27699 or by fax: [phone].
Mechanical Integrity Test Form 11/2007
Permit Number WI0500174
Central Files: APS SWP
11/19/07
Permit Tracking Slip
Program Category
Ground Water
Permit Type
injection Mixed Fluid GSHP Weil System (5QM)
Primary Reviewer
michaef.rogers
Permitted Flow
Facility
Facility Name
Wilson Community College
Location Address
902 Herring Ave
Wilson NC 27893
Owner
Owner Name
Wilson Community College
Dates/Events
Orig Issue
App Received
10/23/07
Regulated Activities
Heat Pump Injection
OutfalI
Waterbody Name
Draft Initiated
Status Project Type
In review New Project
Version Permit Classification
tndividual
Permit Contact Affiliation
Scheduled
Issuance
Major/Minor
Minor
Region
Raleigh
County
Wilson
Facility Contact Affiliation
Owner Type
Government - County
Owner Affiliation
Hadie
902 Herring Ave
Wilson
Horne
Public Notice Issue
Requested/Received Events
RO staff report received
RO staff report requested
Stream Index Number Current Class
NC 27893
Effective Expiration
11/16/07
11/19/07
Subbasin

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
November 19, 2007
Wilson Community College
Attn: Mr. Hadie Horne
P.O. Box 4305
Wilson, NC 27893
Re: Issuance of Injection Well Permit.
Permit No. WI0500174
Issued to Wilson Community College
Dear Mr. Horne:
In accordance with your application received October 23, 2007, I am forwarding Permit No.
WI0500174 for the operation of a vertical closed -loop geothermal mixed -fluid heat pump
injection well system to be located 902 Herring Avenue, Wilson, Wilson County, NC 27893.
This permit shall be effective from the date of issuance until October 31, 2012, and shall be
subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in permit conditions in Part 1,
paragraphs 7 and 8, and Part II, paragraphs I, 10, and 11 concerning your new system.
Copies of the GW-1 forms shall be retained on -site for inspection along with all geothermal
system pressure testing results. Also, a well ID plate must be affixed to the geothermal
system. Your heat pump and well contractors should provide this information. Please
retain these records so that in the event your property is sold or transferred, the new
Permittee will have this information.
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,
Michael Rogers, Enviroma ental Specialist
g P
cc: Jay Zimmerman — Raleigh RO
Central Office File — WI0500174
Monte Jefferson — Horne Energy. Inc.
Attachment(s)
Aquifer Protection Section 1636 Mail Service Center
Raleigh, NC 27699-1636
Internet; httpli/www.ncwaterqg 2728 Capital Boulevard Raleigh, NC 27604
An Equal Opportunity/Affirmative Action Employer— 50% Recycledh0% Post Consumer Paper
N rthCarolino
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Telephone: [phone]
Fax 1: [phone]
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
Wilson Community College
FOR THE CONSTRUCTION AND OPERATION OF $2 TYPE 5QM INJECTION WELLS,
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed -loop geothermal -mixed -fluid heat pump
system. This system is located at 902 Herring Avenue, Wilson, Wilson County, North Carolina,
and will be constructed and operated in accordance with the application received October 23,
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 October 31,
2012 and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof.
Permit issued this the It day of , 2007.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500174 Page 2

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Perrnittee 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 geothermal well injection system shall have permanently affixed an
identification plate according to 2C .0213(g).
8. A copy of completed Well Construction Record (Form GW-1) must be submitted for each
injection well to: DENR-Division of Water Quality, Aquifer Protection Section DIC-Staff,
1636 Mail ~ervice Center, Raleigh, NC 27699-1636, within 30 days of completion of well
construction. Per the requirements of 2C .0213(h), the original form must be submitted to
the address shown on the form. Copies of the GW-1 forms shall be retained on-site and
available for inspection.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the Permittee or his agent shall test the pH of
the soil at a depth of three feet at the planned well location. If the resulting soil pH is less
than 6 standard units or greater than 11 standard units, the well system shall be equipped with
a compatible cathodic protection system. All testing results shall be kept on site available
for inspection.
2. 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 Raleigh Regional Office Aquifer Protection
Section Staff, telephone number [phone].
Permit No. WI0500174 Page3
3. All underground tubing shall be refrigeration grade copper tubing.
4. Prior to installation, all tubing to be placed in boreholes ("loops") shall be checked for leaks
by pressurizing the loop to a gage pressure of at least 350 pounds per square inch (psig),
immersing the loop in water and examining it for leaks. Loops with leaks shall not be
installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents,
and scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop
by the manufacturer before shipping is still present at a pressure of at least 300 psig. The
loop manufacturer shall be notified in the event of damage or pressure loss, and the
manufacturer's instructions shall then be followed. The nitrogen charge may be released
only when the loop is installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting.
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A
North Carolina Administrative Code 2C .0100) shall be pumped via tremie pipe into the
annular space of each borehole so as to completely fill it from bottom to top. ·
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material
shall have a galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
10. After installation and prior to operation of the system, a mechanical integrity test shall be
conducted by pressurizing the injection well system to 400 psig with dry nitrogen and
monitoring for leaks using an ultrasonic or other leak detector of equal sensitivity and
monitoring pressure in the system for at least 2 hours. Alternatively, an equivalent vacuum
test is acceptable. Any pressure fluctuation other than that due to thermal expansion and
contraction of the testing medium shall be considered a failed mechanical integrity test. Any
leaks shall be located and repaired prior to charging the system with refrigerant. This testing
data shall be recorded on the attached Mechanical Integrity Test Record Form and
submitted to the Aquifer Protection Section at least 24 (twenty-four) hours prior to the
initiation of the operation of the facility for injection. A copy of this form shall also be
retained on-site for inspection.
11. The location of each of the system manifolds shall be recorded by triangulation from two
permanent features on the site (e.g., building foundation comers). The Permittee shall retain a
copy of the triangulation records. The Permittee shall also submit a copy of the
triangulation records to the Aquifer Protection Section within 30 days of completion of
well construction.
PermitNo. WI0500174 Page4
12. The written documentation r eq uired in Part II , para gr aphs (l O) and (11) shall be submitted to:
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART ill -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
imposed by other local, state, and federal agencies, which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater that will render it unsatisfactory for normal use. In the
event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
Permit No. WI0500174 Page5
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section's
Underground Injection Control (UIC) Program Central Office staff, telephone number
[phone] . Notification is required so that Division staff can inspect or otherwise
review the injection facility and determine if it is in compliance with permit conditions.
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 Raleigh Regional Office, telephone number (919) 791-
4200 , any of the following :
(A) Any occurrence at the injection facility that 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;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
Permit No. WIOS0Ol 74 Page 6
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 ofthis permit, request an
extension.
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days -of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(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 15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures -if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
PermitNo. WI0500174 Page 7
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion
of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
PermitNo. WI0500174
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 8
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 11/08/2007
To: Aquifer Protection Section Central Office
Central Office Reviewer: Micheal Rogers
Regional Login No: 05
County: Wilson
Permittee: Wilson Community Collage
Project Name: 50M Closed Loop
Application No.: WI500174
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 O Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
~ Closed-loop Groundwater Remediation D Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? 1:8] Yes or D No.
a. Date of site visit: 11/08/2007
b. Person contacted and contact information: Mr. Hadie Horne Ph.# 2522911195
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?
RECEIVED I DENR /OWQ
AQUll:FJ?-PRnn:rnnN ~~CT/ON
NOV 16 2007,
1:8] 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): NIA
For Disposal and Injection Sites:
Of 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): 902 East Herring Avenue, Wilson NC 27893
b. Driving Directions: See Map Quest:
c. USGS Quadrangle Map name and number: E27NW Wilson
d. Latitude: 35.43.48 Longitude: 77.53.48
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description OfWaste(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 O 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? 0 Yes O No O NIA. Ifno, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? 0
Yes D No O NI A. If no, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division.
NI A. If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
0 Yes O No O NI A. If no, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
OYesONoO
0 Yes O No D NIA. 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: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? 0 Yes or O 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 O No O NI 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: __
10. For residuals, will seasonal or other restrictions be required? 0 Yes O No D NIA If yes, attach list of sites
with restrictions (Certification B?)
IIL RENEW AL AND MODIFICATION APPUCATIONS (use previous section for new or maior modification
systems)
Description OfWaste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? 0 Yes or O 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? 0 Yes or O No. Ifno, 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 O No. If no, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? 0 Yes or O No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? 0 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: __
8. Will seasonal or other restrictions be required for added sites? D Yes D No D NIA If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? 0 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 ofwaste(s) as written in the existing permit correct? D
Yes or D No. If no, please explain: ____ _
11. Were monitoring wells properly constructed and located? D Yes or D No D NIA. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR., and NDAR as applicable)? D Yes or
D No D NIA. Please summarize any findings resulting from this review: -~-
13. Check all that apply: 0 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 pennit, (SOC, JOC, etc.) been complied with? D Yes
D No D Not Determined D NI A.. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? 0
Yes or O 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-loop 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
1. Type of injection system:
D Heating/cooling water return flow (5A7)
~ Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5Lf'Noil-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? 0 Yes ~ No
3. Are there any potential pollution sources that may affect injection? D Yes cgj No
What is/are the pollution source( s)? --~· _Wh~a=t ..... i~s ~th=e~di=·=st=an=-c ___ e~o ... f ..... th=e~in_..je ___ ctt ___ ·=o=n ~w"""'e=U"'"(s ... ) ___ fr ___ o ___ m=-=th=e'--'p""'o ___ ll ___ u=ti=on
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary?+-50 ft.
5. Quality of drainage at site: cgj Good D Adequate D Poor
6. Flooding potential of site: cgj 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 D No. Attach
map of •existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: N/ A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? D 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 jection Well Permit Renewal And Modification Onlv:
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 ~ No. If yes, explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes cgj No. If yes, e xplain:
3. For renewal or modification of groundwater remediation p ermits ( of any type ), will
continued/additional/modified injections have an adverse imp act on migration of the plume or manag ement of
the contamination incident? D Yes D No. If yes, explain:
4. Drilling contractor: Name: Pending
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address:
Certification number: --
5. Complete and attach Well Construction Data Sheet.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND 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 recommend 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; Ei
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report
Signature of APS regional supervi
Date: /1 1 ?/o 7
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
System not vet Const.

GO 1S1:70A1 7W'-4_ Cpi1-.- - 1/� 7 Fr,p 4 eye_ C.ari- r m u►L
s��

Permit: WI0500174
SOC:
County: Wilson
Region: Raleigh
Effective:
Effective:
Contact Person: Hadie C Home
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 11/08/2007
Primary Inspector: Jimmie W Greer
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration:
Expiration:
rrt1e:
Owner: Wilson Community College
Facility: Wilson Community College
902 Herring Ave
Wilson NC 27893
Phone: [phone]
Certification: Phone:
Entry Time: 09:30 AM Exit Time: 10:00 AM
Phone: [phone]
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: WI0500174
Inspection Date: 11/08/2007
Inspection Summary:
Owner -Facility: Wilson Community College
Inspection Type: Compliance Assistance
SQM UIC closed Loop system not yet const.
Other
Comment:
Reason for Visit: Routine
Yes No NA NE
Page: 2
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 D c-vt a DATE ,i
NAME OF OWNER /.3 ,.7,4- ! _per r> > f� `_� rl.• r
ADDRESS OF OWNER 92:, 9. a i), 13i ,� ►SIG
iL‘ r . :act �r• �► sr r
�t �5 -cm. 9 P,Wr' &-)) f
(Street/ road or lot and on, county, town)
LOCATION OF PROPOSED INJECTION WELL (and source well(s), if applicable) ry, J yL
tote' 4 a ►�P r / 7� I�w r l�.c.z r� 1 D C
GAF•r•If „r .
(Street/ road or for and saddivision , county, town, if chferent than owner's address, plus description of location on site)
Potential pollution source
Potential pollution source
Potential pollution source
r—f
lel.s
. Distance from wells
Distance from well —
Distance from well
Minimum distance of proposed well from property boundary 5s ' 5 73 - '
Quality of drainage at site Flooding potential of site
goad • dequate,poor) (high,mod
DRAW SKETCH OF SITE
(Show property+ boundaries, buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.)
14"-
`P

Page2of2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (cont.)
COMMENTS
j` eve, g4- .,-k r `5
- P z'2 J 0 1.0
INSPE S R
Office ' /0 S
WITNESS
Address
J
WITNESS
Address

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1 of 1 11/8/2007 3:42 PM

A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: October 26, 2007
To: 0 Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
[8] Jay Zimmerman, RRO-APS
0 David May, WaRO-APS
0 Charlie Stehman, WiRO-APS
0 Sherri . Knight, W-SRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: [e-mail]
A. Permit Number: WI 0500174
B. Owner: Wilson Communi tv Colle ge
C. Facility/Operation: __
[8] 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 I/E Lagoon D GW Remediation (ND)
[8] UIC -(5QM) 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: 1:8] 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:
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:
[8] 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 additi"onal
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: _____ _
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 25, 2007
HADIE HORNE
WILSON COMMUNITY COLLEGE
PO BOX 4305
WILSON, NC 27893
Subject: Acknowledgement of Application No. W10500174
Wilson Community College
Injection Mixed Fluid GSHP Well System (5QM)
Wilson County
Dear MR HORNE:
The Aquifer Protection Section of the Division of Water Quality (the Division) acknowledges receipt of
your permit application and supporting materials on October 23, 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.
If you have any questions, please contact Michael Rogers by phone at [phone] or by email 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 lutp://h2o.enr.state.nc.us/docurnentsidwo orachart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES
ON THIS PROJECT.
For Debra 1. Watts
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Permit Application File WI050O 174
Noe Carolina
,71 aiurally
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: [phone]
Internet: www.ncwaterqualitv.ore Location: 2728 Capital Boulevard Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal Opportunity/Affirmative Acton Employer- 50% Retydedll0% Post Consumer Paper Customer Service: [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 5QM Wells
In Accordance with the provisions of NCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
TO: DIRECTOR NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: pv f4 , 20 '7
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
(1) _ Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) Type 5QM wells contain a subsurface system of continuous piping, that is
isolated from the environment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3)
Type 5QW wells contain a subsurface system of continuous piping, that is
isolated from the environment and only circulates potable water. If you selected
this well type, then complete form GW-57 CL, Notification Of Intent To
Construct A Closed -Loop Geothermal -Water Only Injection Well System.
E. PERMIT APPLICANT
R
Name: 1,C ; \ S'nrI t.^h i s� exte
Address: ?� - 1-i 319r - 4 V � �[lrs " 4
City: In • , 1 r', State: .1-)C.. Zip Code: Z7&3 County: La 15.art
Telephone_ 2 5 A- ,4 t- t) 4 C
C. PROPERTY OWNER (if different from applicant)
Name: Wilson Community Co1le.:4e
Address: P 0 Box 4 05 - 902 Herring Avenue
City: Wilson Sate: _E. Zip Code: 27893 County: Wilson
Telephone: [phone]
D. STATUS OF APPLICANT
Private: Federal: % l: Commercia
State: Municipal: V Native American Lands:
Revised 5/05 GWIUIC-57 HP Page I of 4

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business{or Facility: ; l Qr� 11�rvt fir. f1 { i I
Address: 0 } e c
City: If i 1 Jr1 Zip Code: 7013 County: 1 k ►,r-+
Telephone: 1�i1 ) t ) 4 1 S Contact Person: H a d)
F. HEAT PUMP CONTRACTOR DATA
Name: ] vt... E (1
r
Address: 30,A G l 11, i",4
City: 01 {JI Zip Code: if)e,-7751 ounty: 1.
Telephone: ill Oak L Contact Person: cati co./Are
G. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
hop ri ► 0, (lr) •
H. WELL USE Will the injection wells) also be used as the supply well(s) for the following?
(I) The injection operation?
(2) Personal consumption?
YES NO )(
YES NO X
I. CONSTRUCTION DATA (check one)
EXISTING WELL being proposed for use as an injection well. Provide the data in
(1) through (7) below to the best of your knowledge. Attach a copy of Form GW-
1 (Well Construction Record) if available.
PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after constructiot)k
j
(1) Well Drilling Contractor's Name:
NC Contractor Certification number: , 1 3
(2) Date to be constructed: ) } ; i 5 ;/0 7 Number of borings: 431. -I--
Approximate depth of each boring (feet): 7
(3) Well casing: Is the well(s) cased? IA, 0
(a) YES If yes, then provide the casing information below.
Type: Galvanized steel Black steel Plastic Other (specify)
Casing depth: From to ft. (reference to land surface)
Casing extends above ground inches
(b) NO 1�
Revised 5/05
GWIUIC-57 HP Page 2 of 4

(4) Grout (material surrounding well casing and/or piping),
(a) Grout type: Cement Bentonite ✓` Other (specify)
(b) Grouted surface and grout depth (reference to land surface):
around closed loop piping; from 12__ to 7S (feet). O,.S.�
around well casing from TO (feet).
(5) Screens (for Type 5A7 wells)
(a) Depth: From to feet below ground surface.
(6) N.C. State Regulations (Title 15A NCAC 2C .0200) a ire the persnittee to make provisions
for monitoring wellhead processes. A faucet on uent (fluid entering heat pump) and
effluent (fluid being injected into the well) lines is re . Will there be a faucet on:
(a) the influent Line? yes no (b) the effluent tine? yes no
(7) SOURCE WELL CONSTRUCTION INFO TION (if different from injection well).
Attach a copy of Farm GW-1 (Well C��, on Record). If Form GW-1 is not available,
provide the data in part K (1) of this ap. ] a i n form to the best of your knowledge.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS (UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERATING DATA (for Type 5A7 wells)
(I) Injection rate: Average (dad) gallons per minute (gpn'i).
(2) Injection Volume: Average � ____ gallons per day (gpd).
(3) Injection Pressure: Average (daily) _ pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) ° F.
K. INJECTION FLUID DATA
(1) Fluid source (for Type 5A7 wells) If u
rock/sediment unit will the fluid be drawn
und, from what depth, formation and type of
granite, limestone, sand, etc.).
Depth: Formation: Rock/sediment unit:
(2) Chemical Analysis of Source Fluid (for Type SQM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
%
.0 of t dice 1-7-
L. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering 1r t
associated with the injection operation. o4
�� e
information.
M. LOCATION OF WELL(S) Attach two maps.
the injection equipment and exterior piping/tubing
ufacturer's brochure may provide supplementary
Revised 5/05 GW/UIC-57 HP
Page 3 of 4

(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies,
potential sources of groundwater contamination and the orientation of and distances between
the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet of the geothermal heat pump well system. Label all
features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
N . PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
0. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document and all attachments thereto and that, based on my inquiry of
those individuals immediately responsible for obtaining said information, I believe that the
information is true, accurate and complete. I am aware that there are significant penalties, including
the possibility of fines and imprisonment, for submitting false information. I agree to construct,
operate, maintain, repair, and if applicable, abandon the injection well and all related appurtenances in
accordance with the approved specifications and conditions of the Permit."
~·,\lo" ~rn4..i," i kt C'.ol \ese.
~& (_ ~ v.f. fi~e I~.~~
(Signature of Well Owner or Authorized ~gent) ,
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner authorizing the above agenL
P . CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure that the injection well(s) conforms to the Well
Construction Standards (Title 15A NCAC 2C .0200)
Revised 5/05
., .¥· ... ,. 4. r · ,r . 'l l ,. '~ ·.· 1,·.-{_i r ..-, ~ . f.._, "•1" ► "\ \, £, ) • .. '~ \.· ~. l > ,_~ L \ \': . \.. ..... ~ ....__ : #.
I. f "• { .... {-:u.,. '· ... , ~·_i) , .. ; • .,. ,·'{,,. , .•· ,: . ·· ·( ~·1. , .. , .. · t,Lc ?.!. ,-~, ., i. · 1 r c , ·.,. ~.~. ,. /Tft.L , , . t ...
(Signature Of Property Owner If Different From' Applicant)
Please return two copies of the completed Application package to:
UICProgram
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GW/UIC-57 HP Page4 of4
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