WI0300025_Regional Office Historical File Pre 2018

MEMORANDUM:
To:
From:
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
November 8, 2002
Matt Heller, L.G. Groundwater Supervisor
Groundwater Section
Mooresville Regional Office
Mark Pritzl Of). [e-mail]-
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
REcEivED
NOV 14 2002
Arc DEPT. OF ENMONMENT
ANL) NATURAL RESOURCES
MOORESVI REGIONAL OFFICE
Re: Change of Status of an Injection Well to In -Active or Injection discontinued (Ms.
lle Lee Permit Number I0300025" or "59-0698-WO-00014R" & Ms.
Deborah Turner Permit Number "WI0300016" or "48-0257-WO-0100R1")
Both Ms. Michelle Lee and Ms. Deborah Turner have changed the status of their geothermal
injection well, type 5A7, to In -Active and are located in Charlotte, Mecklenburg County and in
Mooresville, Iredell County respectively. The Underground Injection Control files and database
have been amended to reflect this change of status for each permit. No further UIC action is
warranted at either facility. A copy of the submitted Status of Injection Well System forms are
enclosed for your files. If you have any questions regarding these In -Active permits or the UIC
program, please contact me at [phone] or Evan Kane at [phone].
cc: UIC Files
Enclosures

COUNTY :
QUAD NO:
MECKLENBURG
REPORT TO : MRO
COLLECTOR(S) : CALDWELL
DATE:
TIME:
PURPOSE:
t2/1 BR001
LABORATORY ANALYSIS
Regional Office
BOD 310
mg/L
COD High 340
mg/L
COD Low 335
mg/L
Conform: MF Fecal 31616
/100m1
Conform: MF Total 31504
/ I00m1
TOC
mg/1
Turbitity
NTU
Residue.. Suspended 530
mg/L
Total Suspended solids
mg/L •
PH
units
Alkalinity to pH 4.5
mg/L
Alkalinity to pH 8.3
mg/L
Carbonate
mg/L
Bicarbonate
mg/L
Carbon dioxide
mg/L
X
Chloride
3
mg/L
Chromium: Hex 1032
ug/L
Color. True B0
c.u.
Cyanide 720
mg/L
COMMENTS:
f
Owner.
Location or Site:
Description of sampling paint
Sampling Method:
Remarks:
DIVISION OF WATER QUALITY
Chemistry Laboratory. Report / Ground Water Quality
SAMPLE PRIORITY
El ROUTINE
n CHAIN OF CUSTODY
11 SAMPLE TYPE
MICHELLE I ER
EMERGENCY
RQ-V(5eld
RECEIVED
FEB 0 1 2002
NC DEPT. OF ENVIRONMENT
AND NATURAL RESOURCES
M R SVI
LLE REGIONAL OFFICE
X
Diss. Solids 70300
100,J2
mg/L
Fluoride 951
mg/L
Hardness: total 900
mg/L
Hardness: (non.carb) 902
mg/L
Phenols 32730
ug/L
Specific Cond. 95
umhas/cm2
Sulfate
mg/L
Sulfide 745
mg/L
MBAS
mg/L
Oil and Grease
mg/L
Silica
mg/L
Boron
Formaldehyde
mg/L
NH3 as N 610
mg/L
TKN as N 625
mg/L
X
NO2 +NO3 as n 630
0.24
mg/L
P: Total as P 665
mg/L
PO4
mg/L
Ag-Silver 96566
ug/L
X
AI -Aluminum 96557
SOU
ug/L
As -Arsenic 46551
ug/L
Ba-Barium 4655E
ug/L
X
Ca -Calcium 46552
17
mg/L
Cd-Cadium 46559
ug/L
X
Cr•Chromium46560
25U
ug/1.
X
Cu- Copper 1092
2.1
ug/L
X
Fe- Iron 1045
50U
ug/L
Hg- Mercury 71900
ug/L
X
K-Potassium46555
0.93
mg/L
X
Mg- Magnesium 927
4.6
mg/L
X
Mn-Manganese 1055
10U
ug/L
X
Na- Sodium 929
8.I
mg/L
X
Ni-Nickel
10U
ug/L
X
Pb-Lead 46564
IOU
ug/L
Se -Selenium .
ug/L
X
Zn_Zinc46567
45
ug/L
2.
Date reported : 1/17/2002
Lab Number : 1 G1893
Date Received : 12120I2001
Time Received : 9:00 AM
Received B S
1 aqo
�eleascd
y AR
Organochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
Semivolatiles
TPH-Diesel Range
Volatile Organics (VOA bottle)
TPH-Gasoline Range
TPH-BTEX Gasoline Range
IG1893.eIs

V i
•

GROUNDWATER "FIELD/LAB FORM
County t4 i< I' CNZU2,.0
Quad No 5 b I Serial No.
Lat. 55' I' + .y2'1 r. Long R) ° 446 , 3 "
Report To: ARO, FRO, 0}RRO, WaRO, WiRO,
SAMPLE TYPE SAMPLE PRIORITY
cE 9 WaIEf (�"Routine
DSoit a ] Emergency
}-Other L f L
ZNFL O6/Y 7—
E1 Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Off.,
Shipped by: Sub, ourier; Hand Del., Other•
Colleclor(s): L:Ltt Purpose
FIELD ANALYSES
North Carolina
❑apartment of Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number 41; V 3
Date Reed y eEv�ds 1 a From:
H4nd d b From: Bus, ourier Hand Del.,
Time
Other
Data Entry By: Ck•
Date Reported:
r€//Date / -/.S / Time /L?,U w Baseline, Complaint, om Ian LUST, Pesticide Study, Federal Trust, Other:
pH400 `T. Spec. Cond.9
Ternp.l0 /49 °C Odor
Appearance
Field Analysis By•
LABORATORY ANALYSES
ROD, 310
COD High 340
COD Low 33j_
i
Col' rm: M eca1 115f6 1 /100mi
!dorm: MF Total 31504‘ /l00ml
4
/ at25°C
mg/I
mg/1
mg/1
TOC 660
Turbidity 76
Residue., Suspended 530
mg/I
NTU
mg/I
pH 403
units
Alkalinity to pH 4.5 410
Alkalinily to pH 8.3 416
mgll
mg/I
Carbonate 445
Bicarbonate 440
Carbon dioxide 405
mg/l
moll
mg/I
Chloride 940
Chromium: Hex 1032
Color: True 80
Cyanide 72a
nigh
ugfl
CU
mg/1
Lab Comments:
C y
Owner /1)/e/rtr.0 . /�C' P r 1f C; °��- oei.,\-
Location or site : i.�. �,2 7776--i7sar, Ice C'l�C21- /0 -71 At/C a,r;2
Description of sampling f� point. "1�� f� �? VCy.I f /J y211r1, 4/*e -.(_
Sample Interval
Sampling Mettyyd �f�n✓
�(Pump, 1mllur, OIC.1
Remarks -(— 4. e /n nor,
rpurw"-p Ilmn. p'v amp toll)
M P.,ki.t.5 p trPP-P-4. 1,z' c� >v) 1 s? fJ r� 3 a•LT t E
Diss. Solids 70300
Flouride 951
Hardness: Total 900
Hardness (non-carb) 902
Phenols 32700
Snecifie Concl. 95
Sullale 945
Sulfide 745
OII and Grease
moll
moll
mg/I
moll
ugfl
uMhos/cm'
• mn/I
mq/I
mg/1
NH, as N 610
TIN as N 625
NO, + NO, as N 630
P: Total as P 665
mq/I
mg&
moll
moll
An - Silver 46566
�G Al - Aluminum 46557
As - Arsenic 46551
Ba - Barium 46558
Ca - Calcium 46552
Cd - Cadmium 46559
T
Cr - Chromium 46560
Cu - Copper 46562
Fe - Iron 46563
Hg - Mercury 71900
K - Potassium 46555
Mg - Magnesium 46554
Mn - Manganese 46565
Na - Sodium 46556
Ni- Nickel
Pb - Lead 46564
Se - Selenium
Zn - Zinc 46567
unit
ugfl
uq/l
ug/I
mgli
uq/I
ugfl
ugli
u g/i
ug/l
mg/I
mg/i
ugfl
mg/1
ug/I
uq/1
ugfl
uq/I
i
i
vas
�r
Organoch orine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCB's
Semivolatile Organics
TPH - Diesel Range
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - BTEX Gasoline Range
GW-54 REV. 7/96
For Dissolved Analysis - submit littered sample and write "DIS" in block.

i
4
COUNTY : MECKLENRURG
QUAD NO:
REPORT TO : MR0
COI.LECPO1l(S) : CALItri'ELI.
DATE: 12I1812801
7'IMIE:
PU IU'OSE:
LABORATORY ANALYSIS .
cco3 4-6 fil pit Pr 1'L II r//.)/4-
DIVISION OF WATER QUALIR E C E I \I E D
Chemislry Laboratory Report/Ground Water Quality
SAMPLE PRIORITY
0 ROUTINE
Regional Office n CHAIN OF CUSTODY
i SAMI'I.IE'1'YI'IE
Owner: MIC1111 1 F I FT,
110D 310
mg/L
..
COD lligh 340
mg/L
..
COD Low 335
mg./L
Coliform: MF Fecal316I6
/100m1
Coliform: MF Total 31504
/ 100m1
TOC
mg/I
Turbitity
NTU
Residue,. Suspended 530
mg/L
Total Suspended solids
mg/L
pH
units
Alkalinity to p114.5
mg/L
Alkalinity to p118.3
mg/L
Carbonate
mg/L
Dicatbonate
mg/L
Carbon dioxide
mg/L
X
Chloride
3
mg/L
Chromium: Ilex 1032
ug/L
Color: True 80
e.u.
Cyanide 720
mg/L
COMMENTS :
Location or Site:
Description or sampling point
Sampling Method:
Remark:
EMERGENCY
JAN 2 2 2002
NC DEPT. OF ENVIRONMENT
AND NATURAL RESOURCES
MOORESVILLE REGIONAL OFFICE
X
Diss. Solids 70300
100,J2
mg/L
Fluoride 951
mg/L
I lardness: total 900
mg/L
Hardness: (non-carb) 902
mg/L
Phenols 32730
ug/L
Specific Cond. 95
umisos/cm2
Sulfate
mg/L
Sulfide 745
mg/L
MBAS
mg/L
Oil and Grease
mit/L
Silica
mg/L
Boron
Formaldehyde
mg/L
N113 as N 610
mg/L
TKN as N 625
mg/L
X
NO2 +NO3 as n 630
0.24
mg/L
P: Total as P 665
mg/L
PO4
mg/L
Ag-Silver 46566
ug/L
X
AI-Aluminum46557
50U
ug/L
As -Arsenic 46551
ug/L
Ba43arium 46558
ug/L
X
Ca -Calcium 46552
17
mg/L
Cd•Cadium 46559
ug/L
X
Cr-Chromium 46560
25U
ug/L
X
Cu• Copper 1042
2.1
ug/L
X
Fe- Iron 1045
50U
ug/L
Jig- Mercury 71900
ug/L
X
K•Potassium 46555
0.93
mg/L
X
Mg- Magnesium 927
4.6
mg/L
FX
Mn•Manganese 1055
10U
ug/L
X
Na-Sodium929
8.1
mg/L
X
Ni-Nickel
10U
ug/L
X
1'b-Lead 46564
IOU
ug/L
Se -Selenium
ug/L
X
Zn_Zinc46567
45
ug/L
Lab Number : 1G1893
Date Received : 12/2012001
Time Received : 9:00 AM
Received By : DS
Released By! : A�
Date reported : 1 /17/2002
Organochlorinc Pesticides
Organophosphorus Pesticides
Nitrogen Pcsticidcs
Add Herbicides
Semivalatiles
TPH•Diesel Range
Volatile Organics (VOA bottle)
TPH-Gasoline Range
TP1I-BTEX Gasoline Range
1 G1993.rls

r;r
GROUNDWATER'FIELD/LAB FORM
County iv? C J4 (E14,150 ..6
Quad No R 1,5 b 1 Serial No.
Lat. 35u I `1 '1 a Long IRO ° ��b' �, „
Report To: ARO, FRO, f' O RRO, WaRO, WiRO,
WSRO, ICinston FO, Fed. Trust, Central Off.,
Shipped by: Bu,,
Colleclor(s):
FIELD ANALYSES
PH400 7 V Spec. Cand.94
Ternp.10 /G' °C Odor
Appearance
Hand Del., Other•
//Date
SAMPLE TYPE SAMPLE PRIORITY
Walei' C.-Routine
Soli Emergency
0-Other [ l
3 NFG O/ /YT
❑ Chain of Custody ,
Purpose:
/' -/.S- (r / Time /L't c' 1.2- Baseline, Complaint, om I anger' LUST, Pesticide Study, Federal Trust, Olt16r:
rHrtlo 0
{?— 1 11m, yC
North Carolina
Deportment of Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number ) - Vi 3
Date Recely ci ) aJ ex, J D Time
Rec'd by -5 From: Bus, ourie I-14nd Del.,
Other
Data Entry By' Ck:
Dale Reported:
/bv al 25° C
77.E-r�e-
• Flold Analysis fay A,4.r
4.ABORATORY ANALYSES
I{ mg/I jI
1 I mgli
• BOD,, 310
COD High 340
COD Low 33
mgll
Col rm: MFFeca1gIi�`& /
00' Illorm: MF Total 31504 "TT
/100m1
/100mI
TOC eau
mgll
Turbidity 76
NTU
Residue., Suspended 530 •
mg/I
-.
pH 403
unils
Alkalinity to pH 4.5 410
mgn
Alkalinity to pH 8.3 415
mg,9
Carbonate 445
mgfl
Bicarbonate 440 -
moll
•
Carbon dioxide 405 -
mgll
Chloride 940
mgll
Chromium: Hex 1032
ug/1
Color: True 60
CU
Cyanide 720
argil
Lab Comments:
>.0
Location or site 0» 7'/a �, C ha infke• AI C
Description al sampling point �h/' e Ste' �� •r r�� � j c'm it-a4he
Sampling Mollt�tl - �•n~1
am.)
�� Sample Interval
Remarks {PU"yi, 1WhJO
(purr.,-, IYn�, ail 1orrt�L L
Mrit>is pt,t'44 IL. 11-I)D
Diss. Solids 70300 rnnll An - Sliver 46566
Flourtde 951
Hardness: Total 900
Hardness (non-carb) 902
P11enoI232T30
ethic Cond. 95
Sullale 945
Sulfide 745
011 and Grease
mq/1 >< Al - Aluminum 46557
mn/I
mQWI
un/I
11M11Q61Se1t17
moll
mq/I
mgll
NH, as N 610
Maas N B25
NO, + NO, as N 630
P: Telal as P 665
moll
mall
moll
mg/1
As - Arsenic 46551
Ba - Barium 46558
Ca - Calcium 46552
Cd - Cadmium 46559
ug/1
ug/1
unit
ugll
mqn
ugn
veSar vet.-1 i 1-1- Z•�Cfc
Organochtorine Pesticides
Organophosphorus Pesticides
Nilrogen Pesticides
Acid Herbicides
PCB's
Cr - Chromium 46560
Cu - Copper46562
Fe - Iran 46563
Hg - Mercury 71900
IC - Polasslum 46555
Mg - Magnesium 46554
Mn - Manganese 46565
Na - Sodium 46556
Ni - Nickel
Pb - Lead 46564
Se - Selenium
- Zinc 46567
min
unit
ugn
ugJ1
mg/I
mg/l
ugll
mgll
tig/I
ugll
uqn
Semivolalile Organics
TPH - Diesel Range
Volatile Organics (VOA bailie)
TPH - Gasoline Range
TPH - BTEX Gasoline Range
AIND
GW-54 REV.7/96
l•,
For Dissolved Analysis - submit filtered sample and vwrile "DM" in block.

GROUNDWATER FIELD AB FORM
County
Quad No_R
Lat.
ial No.
Report To: ARO, FRO, M i0;RICO, WaRO, WIRQ,
WSRO, Kinston F=O, Fed. Trust, Central Oil., It_
Shipped by: Buffs,�ir e Hand Del., Other
C©Ilector(s):>J ,r „ .�-rr �� 4. Dale
FIELD ANALYSES
pHiloo a '" � , _Spec. Cond.04 ..y at 25° C
t ernp.10 oc Odor
Appearance
Field Analysis By
LABORATORY ANALYSES
tOD, 310
COL high 340
COL avow 335
mg/I
li cyrrtc: MF Fecal 31616 11 Ci0ml
�li rrrra; MF Total 31504 /l00ml
TOC 680 ° and/I
Turbidity 76 NTU
Residue,, Suspended 530 milli
pH 403 unit
AI'kali nily to pH 4_S �31r3 rng
Alkalini
yroprr
Carbonate 445
415
icarb©nale 440
bon dioxide 405
1or3de 940
Door n. t
tlnr:'True=
;yanide 720
ring/I
Lab Comments:
s4 RITV.7/96
SAMLg PRIQRRTY 1
Routine"
Soli Emergency
tiher
c£ t
]' Chain of Custody
Tirne
Purpose:
:Baseline, Cornplai
Owner _4-
Locafion or site _.z a.2,22'_"
Description of sampling point
Sampling Me11d
Remarks
Liss. Solids 70t60
Flrurid
Hdn ss° Total_ 6Cro
Hardness (Harr-carb_
Phenols 32730
Speciti _end.95
Sulfate 945
Sulfide 745
0I and Grease
Tl
North Carolina
Department cat Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
lc
Lab Number
Date Received
Rec'd by. From: Bus, Courier, Hand Del.,
Other:
Data Entry By: Ck:
Date Reported:
Time
UST, Pesticide Study, Federal Trust, Other:
Sample Interval
r Act - Silver 46566
Al - Aiuminum 4655'7
u
As - Arsenic 46551 uq/I
Ida - t arium 46558 utlil
Ca - Calcium 46552 mq/
Cd - Cadmium 46559 uq/I
Cr - Chromium 46560 ug/I
Cu - Copper 46562 vrg
Fe - lion 46563 Lrg/
Hg Mercury 71900
FC _ Potassium 46555
u
NH, as N 6
NO, °+° NO, as N 630
P: Total as P 665
q - F°7tarn 46554
n - Marroanese 46565 u
Na - Sodium 46556
Pb - Lead 46564
u9.
Se - Selenium ugfl
Zn - Zinc 46567
Organochlorine Pesticides
Organophosphorus Pesticides
n Pesticides
Acid Herbicides
PCB's
Semivolatile Organics
TPH Diesel Rang
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - BTEX Gasollre Range
A Analysis - subrrtit li3dered sample and write "LDS" in block,

4
•
North Carolina Department of Environment and Natural Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WI 5q-06g8-1610 LhATE /02 -/f -c2c�' /
NA1IEOFOWNER t4rdd`ie I(c. Lee_
ADDRESS OF OWNER 34.07,) Theo,)�Icce£ / Ct1,-)(t, 1r �-e r tJC G CS
(Street/road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable)
(Street/ road or lot and subdivision , county, town, if different than owner's address, plus description of location on site)
Potential pollution source
Potential pollution source
Distance from well
Distance from well
Potential pollution source Distance from well
Minimum distance of well from property boundary ii e c,d
Quality of drainage at site t? art5 d Flooding potential of site
(good,adequate,poor) d (high,moderate,low)
GPS Data:
Latitude: 3 5° l 7 ' iLongitude: ° 24. "
DR -VW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, a
north arrow.) - 1 r! t r 1 r r i c k i l t r + r r,•
DESCRIBE INJECTION SYSTEM (vertical closed loop, uncased borehole or cased water well; separate source well and
injection well; combination source and injection well; or other description as applicable)
Ver.3/01 GW/UIC-2

INJECTION FACILITY INSPECTION REPORT -FORM B (CONTINUED)
•
"WELL CONSTRUCTION
Date constructed 6 - - SE)
Drilling contractor: Name M e•Cct (4 c-1-11 e rs
Address P, o, Cliet.r1r-1-1-( ( A S,24,(
Certification number
Total depth of well 3 5-71 Total depth of source well 4.11
(if applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth f o 3
' Diameter
Grout
Height (A.L.S.) ) '
Depth 0.c:
Screens
Depth(s) t\ h-
Length(s)
I.D. Plate
Static water level
Well yield
Enclosure
;/
Enclosure floor �� 1
(concrete)
Sampling port ' t" a
(labeled)
Water tight pipe entry
Well enclosure entry
Vent
PJL
1 Ll2 1 -fi 41 ,/A.��.c_ a —
Lotto( /id
Functioning of heat pump system (Determine from the owner if heat pump functions properly.)
0
v
INSPECTOR` Office ,;EL
WITNESS `al a, 7 )L% c1L L . Address
WITNESS
V er.3/01
Merry-Lfristmasrr!
Address
GW/UIC-?

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION
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 CAROI..INA DIVISION OF WATER QUALITY
DATE: Ad v 9 , 200 (
SYSTEM CLASSIFICATION: Does the system re -circulate only potable water witl out any additives such as
corrosion inhibitors or antifreezes in continuous piping which isolates the fluid from the environment?
YES If yes, do not complete this form. A form GWn57 CL, (Notification Of Intent To Construct A
Closed -Loop Geothermal -Water -Only Injection Well System), should be completed..
NO
Y
If no, then continue completing this form.
PERMIT APPLICANT
Name: M [ C
City: C-ClkiNr to4
County: "aI e Cite hij Telephone:
C. PROPERTY OWNER (if different from applicant)
Name: Same AS eabdv
Address:
City: e
County:
State: Zip code:
Telephone:
STATUS OF A PLICANT
Private: Federal: Commercial: State: Public:
Native American Lands:
E. FACILITY (SITE) DATA (Fill out ONLY if the Status. of Owner is Federal, State, Public or Commercial).
Name of Business or Facility: 9 1'1_
Address: ...
City: State. Zip code:
County: Telephone: _ Contact Person:
Standard Industrial Codes) which describe commercial facility:
ver3/€I1 G1 /U1C-57 HPR

F. INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit)
G. WELL USE Is(are) the injection well(s) also used as the supply well(s) for either of the following?
(1) The injection operation? YES s% NO
(2) Your personal consumption? YES NO
H. CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
nI
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering heat pump) and
effluent (water being injected into the well) lines is required. Is there a faucet on:
(a) the influent line? yes f no
(b) on the effluent line? yes no
I. CURRENT OPERATING DATA
Injection rate:
Injection volume:
Injection pressure:
Injection temperature:
Average (daily) gallons per minute (gpm)
Average (daily) gallons per day (gpd)
Average (daily) pounds per square inch (psi)
Annual Average degrees Fahrenheit (° F)
J. INJECTION -RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the issuance of the previous injection
permit including the engineering layout of the (1) injection equipment, and (2) exterior piping/tubing associated
with the injection operation. The manufacturer's brochure, if detailed, should satisfy (1).
K. LOCATION OF WELL(S) Attach a map
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
ground -source heat pump well system; include buildings, property lines, surface water bodies, any other potential
sources of groundwater contamination. Label all features clearly and include a north arrow to indicate
orientation.
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
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
ver.3101 GW/UIC-57 HPR Page 2 of 3

•
M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment, fluid, operation, etc.) that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
/1'4\
N. 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 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."
(Signature of Well Owner or Authorized Agent)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
O. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the
well(s). A well is real property and its construction on land rests ownership in the land owner 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 operate an injection well(s) as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Well Construction Standards (Title I5A NCAC
Subchapter 2C .0200)
(Signature of Property Owner if Different From Applicant)
Please return the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
(Telephone: [phone])
ver.3/01 GW/UIC-57 HPR Page 3 of 3

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
November 27, 2001
RECEIVED
MEMORANDUM NOV 2 9 2001
To:
From:
Matt Heller, L.G., Regional Groundwater Supervisor
Groundwater Section
Mooresville Regional Office
NC DEPT. OF ENVIRONMENT
AND NATURAL RESOURCES
MOORESVILLE REGIONAL OFFICE
Mark Pritzl Itl,. [e-mail]
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office (CO)
Re: Permit renewal # WI0300025 or 59-0698-WO-0014; request for inspection and routine
sampling of Michelle Lee's geothermal injection well system. This system is located at
3222 Denson Place, Charlotte, NC 28215.
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your UIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title 15A 2C .0200 standards are being complied
with, using the enclosed Injection Facility Inspection Report (form B) as appropriate.
3. ColIect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
You are requested to return the completed Injection Facility Inspection Report (form B) to the
CO-UIC by January 15, 2002: If the inspection can not be accomplished by this date, please
inform the CO-UIC. The UIC group greatly appreciates Mooresville Regional Off ce's
assistance with this review. If you have any questions regarding this review or the UIC
program, please contact me at [phone].
cc: CO-UIC Files
Enclosures

ERSITY
AIDE
an,3 0
b EAST
TOWN
MARKS
AR+ IIAMPJY
a6,(4 HICK
BUS!
Cimmed G'
AZA PARK
HOP CFR
ALBEMARLE
ROAD PARK
Johmson

•<� , rROUNDWATER FIELD/LAB FORM
County_. 4,- -,
Quad No le r. - i Serial No
Sic, 4c. r?
Lat. 5- /y 727 Long.
Report To: ARO, FRO, RRO, RRO, WaRO, WiRO
WSRO, Kinston FO, Fed. Trust, Central Off., ter:
Shipped by: Bus,@oue) Hand Del., Other
Veriy
Colfector(s): f.2,., Date
FIELD ANALYSES
pH400 Spec. Cond.94 /. d at 25° C
Temp.ta 2 °C Odor
Appearance 1
Field Analysis By: —P4.� �..
1:V. :Ir. J+v: " s +,ti.t7lJS2Cr,S
W ` f
SA E PRIORITY' N.C. DEP
M,'' L C,ti t� ar. u�'ry LVi1+fE+
nROLITINE EMERc J ONM g
CHAIN OF CUSTODY
J U L 14
North Carolina
Department of Environment, Health, and Natural Resources
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
Time 1-)-3-• BaselimagurianllHAtnliFGlU
Owner _ i P 0l .1-- 74- ! . ,-...t - -r o
Location or site 3z7 2_
POMO: OF HilIROHMEHTAL. MAHA& FM
reL US oT+ Pesticide Study, Federal Trust. Other t / ( •
Lab Number
Date Received i0 p Time
Rec'd by: From: Bus, our' • , Hand Del.,
Other
Data Entry By:
Date Reported:
Ck•
Description of sampling point sr//� r¢•. f- 4-4
Loll, d)
Sampling Method
Remarks
(Pump. CaiSar, ate.)
Sample Interval
(pumping Limo, air tamp. am.)
LABORATORY ANALYSES
BOD. 310
mg/1
ZC
Diss. Solids 70300 741 mg/I
Aq - Silver 46566
ugll
COD High 340
mg/I
Flouride 951 mg/I
Al - Aluminum 46557
ug/1
COD Low 335
mg/l
X
Hardness: Total 900 1-11-07 mg/1
As - Arsenic 46551
uq/1
.›.--.
Coliform: MF Fecal 31616<*
/100m1
L'
Hardness (non-carb) 9024. / mg/1
Ba - Barium 46558
ug/1
`-
Coliform: MF Total 31504
P /100m1
Phenols 32730 ug/I
Ca - Calcium 46552
mq/l
TOC 680
mg/I
Specific Cond. 95 uMhos/cm2
Cd - Cadmium 46559
ug/I
Turbidity 76
NTU
Sulfate 945 mg/I
Cr - Chromium 46560
0
ug/1
Residue., Suspended 530
mg/I
Sulfide 745 mg/I
"
Cu - Copper 46562 9•,
ug/l
74*,
Fe - Iron 46563 C / 7 i..7
ug/1
Hg - Mercury 71900
ug/I
'
pH 403 7,2„
units
K- Potassium 46555
mgll
7l
Alkalinity to pH 4.5 410 if -co:,
mg/1
Mg - Magnesium 46554
mg/1
>'
Alkalinity to pH 8.3 415 C f
mg/I
Mn - Manganese 46565
ug/I
Carbonate 445 Z' f
mg/I
NH as N 610 le), 0 11- mg/I
Na - Sodium 46556
mg/I
> 'Z
Bicarbonate 440 5 9
mg/I
TKN as N 625 mg/I
7"
Ni - Nickel /er
ug/I
Carbon dioxide 405
mgA
Ze
,N00 + NO3 as N 630 C), 06 mg/I
Pb - Lead 46564
uq/i
Chloride 940 a?,
mg/I
P: Total as P 665 mg/I
Se - Selenium
ug/I
Chromium: Hex 1032
ug/1
Zn - Zinc 46567 r"�
ugll
Color: True 80
Pt -Co
Cyanide 720
mg/I..
`
-
Lab Comments: r - e_ brm ; p-P�tie(rb.
Organochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
Semivolatile Organics
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - BTEX Gasoline Range
GW-54 FIEV.6/93
For Dissolved Analysis - submit filtered sample and write "DIS" in block.

ENUIRONM RESOURCES
& NATURAL
r-t 3 7
GROUNDWATER FIELD/LAB FORM LitIt: fr 7! 1. r.
County c
Quad No R 5 / Serial No
Lat 15— /V Z7 Long 86
Sf(.
c3
Report To: ARO, FRa MR& RRO, WaRO, WiRO
WSRO, Kinston FO, Fed. Trust, Central Off., th
Shipped by: Bus, Courier, Hand Del., Other
Collector(s):.41-. (es-, Date q / 1- `%
FIELD ANAI.Y S
pH400 -5 - Spec. Cond.94 ". G ) at 25° C
Temp.to .Z °C Odor
Appearance C-ca.-err/cLcA,..-
Field Analysis By: -D4I L---
141994 North Carolina
JUL Department of Environment, Health, and Natural Resources
DIVISION OF ENVIRONMENTAL MANAGEMENT- GROUNDWATER SECTION
ti11Y1S10 MOW
SAMPLE PRIORITY
ROUTINE EMERGENCY
CHAIN OF CUSTODY
it?( —
cC,
Time /.'}G
Owner T • P._
Location or site 32— t LQ..,r e„ G'/< c�
Description of sampling point Re k-'h
LE
Sampling Method
Remarks
Lab Number
Date Received
Times'
Rec'd by: I .�T' From: Bus ourier Hand Del.,
Other
Data Entry By:
Date Reported:
Ck•
Purpose: ►
Baseline, Complaint, CompComice
, UST,Pesticide Study, Federal Trust, Other
›e"J r 1. .—j i �7�4- )
�i Sample Interval
(Pump. bailer. etc.)
(pumping rima, au temp. etc.)
LABORATORY ANALYSES
BOD„ 310
mg/l
i
Diss. Solids 70300 '/ will
Aq - Silver 46566
u4+1
COD High 340
mg/I
Flouride 951 mgll
Al - Aluminum 46557
me
COD Low 335
mg/1
2
Hardness; Total 900 11-2 mg/I
As - Arsenic 46551
ug/I
-/
Coliform: MF Fecal 31616 / j
/100m1
Hardness (non-carb) 902 </ mq/I
Ba - Barium 46556
uq/1
Z.-
Colitorm: MF Total 31504 7
/100m1
Phenols 32730 ug/1 _
Ca - Calcium 46552
mq/1
TOC 680
mg/I
Specific Cond. 95 uMhas/cm2
_
Cd - Cadmium 46559
u
uWl
Turbidity 76 .
NTU
Sulfate 945 mq/I
Cr - Chromium 46560< SO
ug/1
Residue., Suspended 530
mg/I
Sulfide 745 mg/I
z -
Cu - Copper 46562 .2 7
ugll
?S
Fe - Iron 46563 ) O
ugil
Hg - Mercury 71900
ug/I
pH 403 7Lp
units,
K - Potassium 46555
mg/I
C
Alkalinity to pH 4.5 410 9-4-,
mg/1
Mg - Magnesium 46554
mg/I
/
Alkalinity to pH 8.3 415 1 /
mg/1
Mn - Manganese 46565
ug/I
Carbonate 445 -f /
mg/I
NH, as N 610 Q, [11-{- mg/I
Na - Sodium 46556
mg/I
Bicarbonate 440 /,
Mg/1
TEN as N 625 mg/I
Ni - Nickel 3(67
ug/1,
Carbon dioxide 405
mg/i
>
NO + NO as N 630 c) . 0 g m /q_I
Pb - Lead 46564
uq/1
Chloride 940 ,�,
mgll
P: Total as P 665 mq/I
_
Se - Selenium
ug/I
Chromium: Hex 1032
ugli
<
Zn - Zinc 46567 1 ?O
uq/l
_
Color: True 80
Pt -Co
Cyanide 720
mg/I
Lab Comments:
Organochlorine Pesticides
Organophosphorus Pesticides
r Nitrogen Pesticides
Acid Herbicides
Semivolatile Organics
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - BTEX Gasoline Range
GW-54 RE'
1.3 For Dissolved Analysis - submit filtered sample and write "DIS" in-'-nk.

GROUNDWATER FIELD/LAB FORM
County .42 - t,.- i
quad No /z L C- 6 / Serial No.
Lat.35' /Y 2:7 Long &G 4,` L �3
•-r" r1,soURC`t,S
i .
fl
North Carolina
Department of Environment, Health, and Natural Resources
DIVISION OF ENVIRONMENTAL MANAGEMENT- GROUNDWATER SECTION
•L,tf nrY r}\1
SA F�1�� PRIORITY OrF10E""
�1:lttilua+1
ROUT1N. EMERGENCY
Report To: ARO, FRO, RRO, WaRO, WIRO CO� CHAIN OF CUSTODY
WSRO, Kinston FO, Fed. rust, Central Off., t er:
Shipped by Bus (9.ourie Hand Del Other*
Lab Number
Date Received _ Time
Rec'd by From: Bus, Courier, Hand Del.,
Other'
Data Entry By Ck•
Date Reported:
Purpose:
Collector(s): . h LA, Date 67ei%r Time J- X4- Baseline, Complaint, ompliaZ ,LUST, Pesticide Study, Federal Trust, Other h r i✓
Owner i et,/ <4,--ri,i5 az-.
/. G at 25° C Location or site 72-2_2-. P/, x.-.
Description of sampling point 5--y'67 (i . <4
FIELD ANALYSES
pH400 ) Spec. Cond.94
Temp.10 2 2- °C. Odor
Appearance
Field Analysis By: -c,d ,t..,_
LABORATORY ANALYSES
Sampling Method
Remarks
{rump, bailor, me.)
Sample Interval
(pumping time, au lamp, etc.)
BOD, 310
mg/I1
Z<
Diss. Solids 70300
mg/I
Ag - Silver 46566
ug/I
COD High 340
mg/1
Flouride 951
mgll
Al - Aluminum 46557
ug/I
COD Low 335
mg/l
Xc
Hardness: Total900
' mg/I
As - Arsenic 46551
ug/I
)'C
Coliform: MF Fecal 31616
/100m1
2<
Hardness (non-carb) 902
mg/I
Ba - Barium 46558
ug/I
- c
Coliform: MF Total 31504
/100m1
Phenols 32730
ug/1
Ca - Calcium 46552
mg/I
TOC 680
mg/l
Specific Cond. 95
uMhos/cm2
Cd - Cadmium 46559
ug/I
Turbidity 76
NTU
Sulfate 945
mg/I
2e
Cr - Chromium 46560
ug/1
Residue., Suspended 530
mg/I
Sulfide 745
mg/I
7'C
Cu - Copper 46562
ug/1
Fe - Iron 46563
ug/1
Hg - Mercury 71900
ug/I
y[
pH 403 •
units
K•- Potassium 46555
MO
7 (
Alkalinity to pH 4.5 410
mg/I
Mg - Magnesium 46554
mg/I
X
Alkalinity to pH 8.3 415
mg/I
Mn - Manganese 46565
ugA
K
Carbonate 445
mg/I
NH, as N 610
mg/I
Na - Sodium 46556
mg/I
>
Bicarbonate 440
mq/1
TKN as N 62C
mg/i
Ni - Nickel
ug/1
dioxide 405
mg/1
`/
C.
NOe + NO3 as N 630
mg/1
Pb - Lead 46564
ug/1
?'C
Chloride 940
mg/I
P: Total as P 665
mg/I
Se - Selenium
uq/I
Chromium: Hex 1032
ug/i
'
x
Zn - Zinc 46567
ug/I
Color: True 80
Pt -Co
Cyanide 720
mg/I
Organochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
Semivolatile Organics
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - STEX Gasoline Range
Lab Comments:
GW-54 REV. 6/93 For Dissolved Analysis - submit filtered sample and write "DIS" in block.

GROUNDWATER FIELD/LAB FORM
North Carolina
Department of Environment, Health, and Natural Resources
DIVISION OF ENVIRONMENTAL MANAGEMENT- GROUNDWATER SECTION
County f cl,6 w4
Quad No r s` 6 / Serial No.
Lat. 3s— iv Z7 Long 80 Sq. D 3
SAMPLE PRIORITY
ROUTINE DEMERGENCY
f�CHAIN OF CUSTODY
Report To: ARO, FR chi', RRO, WaRO,
WSRO, Kinston FO, Fed. Trust, Central Off., h
Shipped by: Bus, Courier, Hand Del., Other
Collector(s): 7G- L. ( Date Vet- (1
FIELD ANAY S
pH400 S - Spec. Cond.94 J.
r � G at 25° C
Temp.10 2. °C Odor
Appearance CL car err/CLt
Field Analysis By:
LABORATORY ANALYSES
C�
ucG
Purpose:
Time /•' J 6 Baseline, Complaint,
Owner I P .1 -
Location or site 32. 7 �-ti.,s a ✓ Ol< c..
Description of sampling point RR-`k4 - , O/u }
Sampling Method
Remarks
(Nrrtp. bailor. etc)
Lab Number
Date Received Time
Rec'd by From: Bus, Courier, Hand Del.,
Other:
Data Entry By• Ck•
Date Reported:
mpliance BUST, Pesticide Study, Federal Trust, Other: eta. -
Sample Interval
(pumping ma, air temp. etc.)
BODR 310
mg/1'
Diss. Solids 70300
mg/1
Ag - Silver 46566
ug/l
COD High 340
mg/1
Flouride 951
mq/1
Al - Aluminum 46557
ug/1
COD Low 335
mg/I
Hardness: Total 900
mg11
As - Arsenic 46551
uc/1
7‹
Coliform: MF Fecal 31616
/100m1
Hardness (non-carb) 902
rngN
Ba - Barium 4655e
ug/1
Z
Coliform: MF Total 31504
/10om1
Phenols 32730
ug/1
Ca - Calcium 46552
mq/1
TOC 680
mg/
Specific Cond. 95
uMhos/cm2
Cd - Cadmium 46559
ug/1
Turbidity 76 .
NTU
Sulfate 945
moil
X
Cr - Chromium 46560
ug/1
Residua., Suspended 530
mg/1
Sulfide 745
mg/1
r
z<
Cu - Copper 46562
ug/1
a
?�
Fe - Iron 46563
ug/I
Hg - Mercury 71900
ug/1
pH 403
units
K - Potassium 46555
mg/I
(
Alkalinity to pH 4.5 410
mg/i
Mg - Magnesium 46554
mg/1
Alkalinity to pH 8.3 415
moll
Mn - Manganese 46565
ug/1
Carbonate 445
rng/1
NH, as N 610
mq/1
Na - Sodium 46556
mg/l
Ki
Bicarbonate 440
mg/1
TKN as N 625
mg/i
Ni - Nickel
ugll
Carbon dioxide 405
rng/I
'
NO; + NOB as N 630
mn/1
Pb - Lead 46564
uq/I
Chloride 940
mg/1
P: Total as P 665
mq/1
Se - Selenium
uq/i
Chromium: Hex 1032
ug/1
Zn - Zino 46567
uq/l
Color: True 80
Pt -Co
Cyanide 720
mg/1
Organochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
Semivolatile Organics
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - BTEX Gasoline Range
Lab Comments:
GW-54 REV.6+g3
For Dissolved Analysis - submit filtered sample and write "DIS" in block.
y

Division of Environmental Management.
GROUNDWATER SECTION
CHAIN OF CUSTODY RECORD
For Investigation of G.�c/lS
[amples collected and GW-54 forms
Lab Only
Lab No.
g5I
Quad
No.
t.1 I
? 3bI
geeep L✓ ell
iNr44-0,-, Ikkizcke-fiRiliu_em 6,11/0
completed by• L)cX/'''v,
Location
Date
N.C. D PT. Off'
E TCNMENT. F1P; ' r m
U�L �.
JtiN 15 MA
incident No. mow
writ
unhZ j1FFknr
No. of
Time Containers
6I `x`L. Cr-Lin 4 `1
c/4 v !`:Op 3
l•Z4_
' Co rto lMy- 8: o5
7
Relinquished by(Signature):•
Rel.
Rel.
Rel.
Method of Shipment:
diy S
Rec. by
nature):
ate/Time
/
Rec. by
Rec. by
Seal by:
Security Type and Condition: Lock by:
Lab No.
From Through
�G gGf5-1
1
P1.66.1
IZ51
No.
Containers
4
LA(3 USE ONLY
Analysis ,Relinquished by
0D o rn ;�t
Al Lyle r\ ,BSI' �' �' ""'(\ '014 Akf4-‘06
Broken b •
Open by:
flies{ice -')10
NDLbara
/(4,r
q/ gs
(o -q -fyl
Date / Time
9 _ /0
iAtvevLAA
rate
.--t-f
i9-149 l
/9,i/o
A \NV ` , i .( [0 / i+f 0
White copy - GW Headquarters , Canary copy - Lab .Pink copy - Region
GW-63 Revised 9/87

North Carolina
Department o1 Environment, Health, and Natural Resources
Divlston of Environmental Management
Groundwater Section
WE' II_ AND PU
P INSPECT* TI N REPORT
Owner:
Address: -34, u_a.
Date
WELL TYPE
County
Road/Street
Quad No.
Serial N_ o,
Lat,� . Lon
Drilling Contractor
perrnit Required ? (YJN)
Location - plstance From ..................
Water Tight Sewage/waste collection„.
Waste disposal (septic tank drain field)
Other Poll. Source (
Other Poll. Source (
Casing
Weightlthickness ...........
Height (A.L.S.) ........�,....,.
Other (
� ruling Fluids/A(3(1W eS
Type....a..., ..„..,.....�...,...,.
Grgut
Type....................F.... ,,..,
Thickness .. a .................
Other ( �._. ..
Screens
Screened interval .............�....,..�
Other
Qeyelopment...............o...,....,o............a.
Total Suspended solids ........................
Settleable Solidsa.=.,.,�,.a.
1._R, plate
Well Contractor ..............................
Abandonment ......................................
Temporary...,...:....................................
ell Construction
c tterras Met t Mn Standards
cured *e No
Permit No.
ar
(Cdre9e one)
Plastic Carbon Galw°. Stain_ St Other
GW-36 Rev, 1 d/92
Applies to wells constructed after Decennber 1, 19 2
(Cont. on Reverse)

Check Items
fteasured
eCs Mn, Standards
Yes No
a
We Test—
Frequency/Accuracy of measurements
Other.
Pislntection ..
Chlorination,rr.....,...F.....r„�..w,,....,,...�,..
Other (,_
ports, m....rfµ�.m�,.,,..,....�....��.��...a.���
Construction (GW-1)_ . ���.�.x.. ,....M_.
Abandonment (GWr30) ...,a.�.,...wn...��... .
r
Access port ..o....„,� . _.,.,..W...�...,...,...
Hose bib
Pitless Adaptor....,....„..w..............a...
Pitlers. Adaptor Unit ,...o....�. a,,.....a�,...,. .
Suction tine .,.....................�...,..........�
Tee(jet) .„,...ot w�,......:„=„a...��............... '
Valvedflow................,......�.a.....,..,.....,.
Vest�.,..,..�.an........o-.....a........�A„�... .
Water tight pipe entry .._.,...�.......,.,,e....
Well
contractor
Name
.fit NTR s..t
Applies to welts constructed afterDecember 1, 1992
Pump tnstatl?tlon
Y'N
Address
Date Pump Installed
�icl tt nss noted attributable to the pump installation contractor are as follows:
INSPECTOR
Witness(es)
(If Available)
Name
Name
Name
Re,, #
of
Address
Address
Type
Type

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.ER. Director
MEMORANDUM
To.
From:
GROUNDWATER SECTION
March 1, 1994
Rob Krebs
Groundwater Section
Mooresville Regional Office
UIC Group
Groundwater Section
Raleigh Central Office
Re: Inspection and sampling of injection well facility
operated/owned by Theodore S. and Patricia M. Arrington,
A copy of the application for the renewal of a permit to
use a well for injection with a heat pump system is enclosed. The
permit has been issued; a copy of the permit is also enclosed.
Please inspect and sample the facility in operation. Complete the
Well and Pump Inspection form B and send the form to RCO-UIC;
also complete the sampling report (Groundwater Field/Lab) form,
collect all necessary samples of both source and effluent waters
and send the samples and sampling report form (pre -addressed to
both RCO-UIC and the regional office) to the DEM laboratory for
analysis.
Your assistance is greatly appreciated. If you have any
questions, please feel free to contact me at (919) 733 - 3221,
ext. 431.
Sincerely,
Karen A. Harmon
Hydrogeological Technician. II
Underground Injection Control Program
cc: UIC Files
MRC Files
Enclosures
P.O, Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Upperunity Affirmative Action Employer 50% recycled/ E O% post -consumer paper

WELL DRILLING --PUMP INSTALLATION LOCATIONS & DIRECTIONS CONTRACT NO- -
1
1 VaC-K 3
Nome -<ot. Q i IY Vl
Address L - t y d.C�..
Location cA.J I u � N �8 o9,0
GIB f
v oft.
xX XX
DevNsov, P1 ac-
T
i Inc Vklcl ` Is l0 2-- r
-c De'1"-•6°v-N 1LC._ ooncis(
e_ ►, IiDa�c� ✓ 3 (4-4k
t_
~] Jam- -Po � �l co.v o �v4-- y).
Salesman

MsO472-A- cat_
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Mr. Theodore S. Arrington
Mrs. Patricia M. Arrington
3222 Denson Place
Charlotte, NC 28215-3111
Dear Mr. and Mrs. Arrington,
ArA
EDE■ `�� T1 a�? OP
U
F;CTS.
4R
1994
L►AMON OF fr1Yl, OIMEOTA
NOORMILLE REG/OP,AL Off10Ef,;fflll
March 1, 1994
In accordance with your application dated February 18, 1994,
we are forwarding Permit No. 59 - 0698 - WO - 0014R1 for the
Operation and Use of a well, for the purpose of injecting heat
pump effluent, in Mecklenburg County.
This Permit shall be effective from the date of issuance
until March 31, 1999, and shall be subject to the conditions and
limitations stated therein.
In order to continue uninterrupted legal use of this well
for the stated purpose, you should submit an application to renew
the permit six months prior to its expiration date.
If you have any questions regarding your Permit please feel
free to contact me at (919) 733 - 3221, ext. 407.
Sincerely,
/AiA. Elizabe h Morey
Manager
Underground Injection Control Program
Groundwater Section
cc: UIC Files
MRO Files
Enclosures
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION/USE 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
Theodore S. and Patricia M. Arrington
FOR THE OPERATION AND USE OF AN INJECTION WELL located at 3222
Denson Place, Charlotte, North Carolina, in Mecklenburg County, in
accordance with the application dated February 18, 1994, and in
conformity with the specifications and supporting data submitted,
all of which are filed with the Department of Environment, Health,
and Natural Resources and are considered a part of this Permit.
This Permit is for the Operation and Use of an injection well
associated with a domestic heat pump system, and does not waive any
provisions of the Water Use Act or any other applicable Laws, Rules
or Regulations. Operation and use of an injecton well shall be in
compliance with Title 15 North Carolina Administrative Code 2C, 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 March 31, 1999, and shall be subject to the
specified conditions and limitations set forth in Parts I through
VIII hereof.
Permit issued this the 1st day of March, d9A-4-.
Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Environmental Management
By Authority of the Environmental Management Commission.
PERMIT NO. 59 - 0698 - WO - 0014R1

PERMIT NO. 59 - 0698 - WO - 0014R1
PART I - 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 (15 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 or Permit termination,
revocation, or modification as provided for in N.C.G.S. 87-94
and 87-95.
2. This permit shall become voidable unless the facilities are
constructed in accordance with the conditions of this permit,
the approved plans and specifications, and other supporting
data.
3. This permit is effective only with respect to the nature,
volume of materials, and rate of injection described in the
application and other supporting data.
4. This Permit is not transferable without prior notice to, and
approval by, the Director of the Division of Environmental
Management (Director). In the event there is a desire for
the facilities 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.
5. The issuance of this permit does not preclude the Permittee
from complying with any and all statutes, rules, regulations,
or ordinances which may be imposed by other local, state, and
federal agencies which have jurisdiction.
PART II - PERFORMANCE STANDARDS
1. The injection facilities shall be effectively maintained and
operated at all times so that there is no contamination of
ground waters which will render then unsatisfactory for
normal use. In the event that the facilities fail 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 Environmental Management
(Division) such as the repair, modification, or abandonment
of the injection facilities.
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 groundwaters
resulting from the operation of this facility.

PART III - OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities 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. The operation of the facility for injection may not commence
until construction is complete, the permittee has submitted
notice of completion of construction to the Division, and the
Division has inspected or otherwise reviewed the injection
well and finds it in compliance with permit conditions. If
the Division cannot complete the review or inspection within
30 days of notification this -condition shall be considered
fulfilled.
PART IV - INSPECTIONS
1. Any duly authorized officer, employee, or representative of
the Division of Environmental Management 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 (see attached diagram).
PART V - MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil
sampling) deemed necessary by the Division of Environmental
Management 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
Mooresville Regional Office, telephone number [phone]
of any of the following:
(A) Any occurrence at the injection well facility
which results in any unusual operating
circumstances;

(B) Any failure due to known or unknown reasons, that
renders the facility incapable of proper injection
operations, such as mechanical or electrical
failures.
3. Where the Permittee becomes aware of an omission of any
relevant facts in a permit application, or of any incorrect
information submitted in said application or in any report to
the Director, the relevant and correct facts or information
shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facilities fail to perform
satisfactorily, the Permittee shall take such immediate
action as may be required by the Director.
PART VI - PERMIT RENEWAL
The Permittee shall, at least six (6) months prior to the
expiration of this permit, request an extension.
PART VII CHANGE OF WELL STATUS
1 The Permittee shall notify the Mooresville Regional Office
within 15 days of any change of status of the injection well
or well field. Such a change would include the discontinued
use of the well or wll field for injection. If the well or
well field is taken completely out of service temporarily,
the Permittee must install a sanitary seal or seals. If the
well or well field is not to be used for any purpose it must
be permanently abandoned according to 15 NCAC 2C .0113, Well
Construction Standards.
2. When operations have ceased at the facility and the well will
no longer be used for any purpose, the Permittee shall
abandon the injection well in accordance with the procedures
specified in 15 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 the well shall be sounded before it
is sealed to insure freedom from obstructions that may
interfere with sealing operations.
(C) The well shall be thoroughly chlorinated, 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) The 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, the
well shall be abandoned in such a matter 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.
PART VIII - SPECIFIC CONDITIONS
NONE

, . AT -MCI -HEM 1
PERMIT NO. 59--0698-WO-0014R1
Sanitary Well Seal
Casing must extend min.
of 12 inches above
land surface
•
•
•
i
1
STATUS : LEGAL
COMBINATION SOURCE
AND INJECTION WELL
•
PERMIT REQUIRED ? : YES

MILD tA�✓
�O
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INSECTIQBI
WITH A HEAT PUMP SYSTEM
P rrl
CO c
Class 5 Wells ;v ;--
t.n 'rn
TO:. DIRECTOR, NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT T,
DATE: IS 'F,i9 r Flr�
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and regulations r•�
pursuant thereto, APPLICATION is hereby made for a PERMIT to construct cndlor use a well or well cl
system as described below and in any accompanying data submitted as part of this APPLICATION.
A. OWNER DATA
Ownership
Please type ar print clearly.
Name: PLO r"- - -' /�� . A.,fWilVG:70-4/
Business:
Address: 3 .2 2-NSAJ AD ,04-
City: ; ,.1 4R �. �" t j� - Zip code: 2 /ii
County: �f tr t1(i-N674
Telephone: -7 0q —fir-- 2-3 Id'
Federal State Private <�
Public Commercial Other (specify)
Native American Lands
B. FACILITY DATA (Fill out ONLY if the injection well(s) is (are) for the purpose of serving a
business or industry.)
Name:
Business:
Address:
City: Zip code:
County:
Telephone-
C. HEATING CONTRACTOR DATA
Name: 1 Ui c, G,A L-ir s i8.1 f 1e
Address: O ,7 EC N V�
City: CA' W oe Or/.-
County: /QFr.:KkF1V �`6•�'r�
Telephone: ?c-3'9- fro
Contact Person:
Zip code: 247
D. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used
GW-57 HP (June 1993) Page 1 of 4
44 .irA^1i)

E. WELL USE Will the injection well(s) also be used as the supply well(s) for either of the
following?
(a) The injection operation? YES —6 NO�
(b) Your personal consumption? YES NO
F. CONS 'RUCTION DATA (CHECK ONE)
f� :ram
>" EXISTING WELL being luapased for use as an injection well. Attach a copy of Form
GW-1 (Well Construction Record) and furnish (7 & 8) below. If Form GW-1 is not
available, furnish the data in (1) through (8) below to the best of your knowledge.
PROPOSED WELL to be constructed for use as an injection well. Furnish
the data in (1) through (8) below as PROPOSED construction
specifications.
(8)
WeII Drilling Contractor's Name:
M C C a(! By-0S
NC Driller Registration number:
Date to be constructed: 3ti • V Approximate depth: 350
Well casing:
(a) Type: Galvanized steel Black steel Plastic X Other(specify)
(b) Inside diameter: inches; Wall thickness inches or schedule # 9 O
(c) Casing depth: From 1 to /b 3 ft. (reference to land surface)
Casing extends above ground / 2__ inches (must be at least 12 inches)
Cement grout:
(a) Around inner or "primary" casing: From 0 to z- a ft.
(b) Around outer (pit) casing, if present From
to ft.
Screens (if applicable):
(a) Type: ; Inner diameter: inches
(b) Depth: From to feet below land surface
Gravel (if applicable): From to feet below land surface
N.C. State Regulations (1SA NCAC, 2C, Section .0200) require the permittee to make
provisions for monitoring well head processes. A faucet on both influent (groundwater
entering heat pump) and effluent (water being injected into the well) lines is required. Will
there be a faucet on:
(a) the influent Iine? yes no (b) the effluent line? yes no
Attach a diagram showing the location of the injection well and sampling faucets relative to
primary building on property.
G. PROPOSED OPERATING DATA
Injection rate:
Injection volume:
Injection pressure:
Injection temperature:
Average (daily) �7
Average (daily) /3 00
Average (daily) 2 /
Winter Average /I -
Summer Average 17
GW-57 HP (June 1993) Page 2 of 4
gallons per minute (gpm)
gallons per day (gpd)
pounds/square inch (psi)
degreesTi C
degrees Ft
jCi nfr
ji
Gu�i t`

ram,
H. INJECTION FLUID DATA
(1) Fluid Source. If underground, from what depth and what typeof rock/sediment does the fluid
to be injected derive (e.g., granite, limestone, sand). Jet cvdll ezri
l.J-1 A, f .DEC f'?l
(2) Chemical Analysis of Source Water. The following chemical characteristics MUST
accompany�this application:
7
pH ! 4 ; Total hardness 'if ppm (parts per million or mg/I);
Iron ' < �0 ppm; Chloride i ppm; Nitrate • a 4 ppm;
Coliform bacteria 4 I counts/100m1
NOTE: Assistance in determining these values may be obtained by contacting (a) your
local or county health offical, (b) a commercial water -testing laboratory, (c) your
well drilling contractor, or (d) the regional Hydrogeologist, North Carolina Dept.
of Environment, Health, and Natural Resources.
I. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering•layout of the (1) injection equipment, and
(2) exterior piping/tubing associated with the injection operation. The manufacturer's brochure,
if detailed, should satisfy (1) above
J. LOCATION OF WELL(S)
Attach a detailed map showing the orientation of and distances between the proposed well(s),
any existing well(s) that will in any way be involved in the injection operation, and at least two
(2) nearby reference points such as roads, road intersections, streams, etc. The roads should be
identified by US, NC or SR (county secondary roads) numbers, and streams should be named.
In addition, the diagram should show the direction and approximate distance to any existing
water -supply and/or injection wells within 1,000 feet of the proposed injection well.
K. 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 operate and use the injection well and all related appurtenances in accordance with the
approved specifications and conditions of the Permit."
f
(Signature of Owner 6r Autho ' : Agent)
Please supply a letter signed by the owner
authorizing the above agent, if authorized agent is signer.
GW-57 HP (June 1993) Page 3 of 4

— -----,.,
Date: J i— Li3 / S
North Carolina
Environmental Management Commission
Department of Environment, Health & Natural Resources
Groundwater Section
STATUS OF INJECTION WELL I
SYSTEM
Permit #: 3 IC -- `•6 �`. -WO- 00 l
Name: !?11;,:• i.1.7/:-: S Q JJu PA -Mg 14 f- 1 FFf & f c3 N
Address: s ,:)F jsc)JJ Q--
Please check the selection which most closely describes the
current status of your injection well. In addition, please
answer the appropriate questions in the space provided.
1) ) Well is still used to inject heat pump return flow.
2) Injection discontinued; well temporarily not being
used.
Why?:
How long out of service?:
Is the well sealed shut?:
Intended use:
Projected date of re -use:
C
3) Injection discontinued; well used as water supply-') '3
well.
Why?:
4) Injection discontinued;'well permanently abandoned.
Why?:
How long out of service?:
Is the well filled or open?:
Who performed abandonment?:
Certification:
"I hereby certify, under penalty of law, that I have
personally examined and am familiar with the information
submitted in this document, and that to the best of my
knowledge the information is true, accurate a9.d complete.
Thie,cvt.,,'
r
(Signature)/J
C.`
GW-68
n

COUNTY eeK.
pH4 00
N.G •)EPARTMENT OF NATURAL RESOU :S
QUAD NO R 5b
SERIAL NO �REC�jvt•�OMMUNITY DEVELOPMENT
LAT.3:5 /L/ 27 DEM
Report iu: Aliu, I Fit.). t�Hu, WaRO, CROUNDWAT I R I•fELO/t All 1 ORM
vim,
i98 .SAMPLE PRIORITY
WSRO, Kiil; toll I 0 ( Mei _
Shipped by: Bus Courie , Other Eri081t ROUTINE ❑ EMERGENC'Y
COLLL•CTOH(S]• JFGCS - 'DATr /�i�/`i/67g TIME O775
Owner s /3?T /`fyeairrikY)
-,.'-3�r a men sot) Pkt ce,
Temp. 10
Appearance
FIELD ANALYSES
!% spec.
oc
LONG 0 4141�a §NOFENVlilo.111E7ft MANAlifilEtii
Field Analysis By• J•
Cond.9J4 /90 at 25°C
Odor NONE
Taste
rcJc /!s
LABORATORY ANALYSES
BOO5 310
mg/I
COO High 340
mg/I
COD Low 335
mg/I
Colilorm:MF Fecal 31616 -)
/IOOml
Colilorm:Mi Total 31504—e1
/100m1
TOC 680
mg/I
Turbidity 76
' NTU
v
PH 403 ' r [
j `
units
•
Alkalinity to pH 4.5 noE( e f
l
mg/I
Alkalinity to pit 6.3 .115-4.. 1
1ng/I
Carbonate 445 ..
mg/I
l/
Bicarbonate 440 54
mg/I
Arsenic:Total 1002
ug/1
Carbon dioxide 405
mg/I
Y
Chloride 940
mg/I
Chromium:Hex 1032
ug/I
Color:True 60
PI -Co
Cyanide 720
mg/1
Lab Comments:
Location or site
Description of sampling point
Sampling Method S�C�•
(pump, bailer,
Remarks Yof)s)-SQ-0 /!7/ecL —fct) 64J6C.L.
Ate-/eJ,/3c,
LAB NUMBER 8
DATE REE1 VED
Rec'd by:
Lyther
-IA 13/TIIY UY:
DATE REPORTED•
opaSCO
PURPOSE: BASELINE, COIAPLAINT, COMPLIANCE, LUST, OTHER U/e,
(circle one)
—Thp well head
Sample Interval 0 TD.
(pumping time, air temp, etc.)
'
Dlss, Solids 70300
mg/I
Fluoride 951 ,
mg/1
Y
Hardness:Total 900 Lf
mg/1
Hardness Cnan-carb) 902 ..ie j
mg/1
Phenols 32730
ug/I
Specific Cond. 95 uhlhos/cm2
Sullale 945
mg/I
Sulfide 745
mg/1
NH3 as .N 610 r ` 1
1
mg/I
TKN as N 625
mg/I
��1�f1111
NO2 i NO3 as N 630iOL{+
mg/1
P;Tolal as P 665 i
mg/1
Ag - Silver 1077
ug/I
Al - Aluminum 1105
5()
ug/I
Be - Barium 1007
u12/1
Ca - Calcium 916
mg/I
Cd - Cadmium 1027
ug/1
I!
Chromium:Total 1034
\ rQ S
ug/l
irr'Cu
- Copper 1042
'(tO
ug/1
Y
Fe - Iron 1045
.-5--r)
ug/l
Fig - Me?cury 71900
uU/1
K - Folasslum 937
mg/1
Mg - Magnesium 927
mg/I
Mn - Manganese 1055
ug/I
Na - Sodium 979
mg/1
Ni - Nickel 1067
l w
ug/I '
Pb - Lead 1051
ug/I ,
Se - Selenium 1147
ug/ll
Zn - Zinc 1092
< 16
ug/+ i
Organochlorine Pesticides
OrganoDhosphorus Pesticides
Acid Herdicides
Base / Neutral Extractable Organics
Acid Extractable Organics
Purgaablv Organics (VOA bottle,
1.7 - Dibromoelhene MOB)
'4-
'' `rZZ-,:r i 3 i i11III
e IV 20 .089 .
UNJWAR
,SFen- ifN
R LJ;Ufi, NC
GW-54 Revised 7/85
For Dissolved Analysis - submit filtered sample and write 'DIS' In block
White copy - Headquarters Pink copy - Region Yellow copy - Lab

State of North Carolina
Department of Natural Resources and Community Development
Mooresville Regional Office
James G. Martin, Governor Albert F. Hilton, Regional Manager
William W. Cobey, Jr., Secretary
DIVISION OF ENVIRONMENTAL MANAGEMENT
January 24, 1989
Mr. Ted Arrington
3222 Denson Place
Charlotte, North Carolina 28205
RE: Well Sampling Results
Arrington Residence
Mecklenburg County, N.C.
Dear Mr. Arrington:
This Office has received the laboratory results on the water samples collected
on December 14, 1988 from your 6.125 inch 'drilled well located at 3222 Denson Place
in Mecklenburg County.
The analysis indicates the water is of good chemical quality.
Should you have any questions, do not hesitate to contact this Office at
[phone].
JWW/bb
Sincerely,
eat
Jesse W. Wells '
Hydrogeological Technician
Approved by,
(Eric,J. Klingel, h.D., C.P.G.
Hydrogeological Regional Supervisor
f
919 North Main Street, P.O. Box 950, Mooresville, N.C. 28115-0950 • Telephone [phone]
An Equal Opportunity Affirmative Action Employer

Report to: ARO. FRO,
WSRO, Kinston FO
Shipped by: Bus
COLLECTOR(S):
COUNTY IYIecK
QUAD NO. Rrc6bf SERIAL NO
N.CLWEPARTMENT OF NATURAL RESOUS
& COMMUNITY DEVELOPMENT
LAT.35 al LONG. C i� DEM
crEENI M TAJ A4 lit[�WATER FIELD/LAB FORM
RRO, WaRO, WiRO,
SkAMPLE PRIORITY
Other ;JAN 24 19 .— ROUTINE ❑ EMERGENCY
Other
DATE
OvitZ.ME Oa
FIELD ANALYSES ,
�] Owner %) E/?47 4/ RiAl6ToAJ
p11400 6. 9 Spec. Cond.94 9?
° at 25°C Locatlon or site >pY7 ��C.cCe
7`-f 7771. cu • W I tI s c
LA13 NUMBER 8 —.p
DATE RECEIVE./ ,L Time C)
Rec'd by•
Other �
ATA ENTRY BY• i7��JJ 1 J
ATE REPORTED• t I
PURPOSE: BASELINE, COMPLAINT, COMPLIANCE, LUST, OTHER
(circle one)
Temp.10 1:3 oC Odor ,J)u6 Description of sampling point 7,5 -JcI—GE'� Ape. j'].. /'r /f
Appearance 604- Taste Sampling Methodal
Sample Interval k,'1.4
Field Analysis 8y ( mp,, b?filer etc.) /�
Remarks PrO/ZQS�C / JcQ..1<fdY1 -c/c l Q -, he -r- /�•crhp
1 iJ (pumping lirfie, air t/mp, etc.)
LABORATORY ANALYSES
BOD5 310
mg/1
COD High 340
mg/I
COD Low 335
m2/1
I,../
Colilorm:MF Fecal 31616L f
/10omt
COIIIorm:MF Total 3 f504- . 1
/tuoml
TOC 650
mg/I
Turbldlly 76
NTU
L.I''''
p11 403 1.0
units
1Alkallnlly
to pll 4.5 410 Lt
mu/I
1�I'Alka1inity
1n nil 11.3 4IS ..
mu/I
✓Carbuncle
445
mg/I
Biearbonale 440
4
mg/1
Arseni c:T ota 1 1002
u9/1
Carbon dioxide 405
mg/I
i/
Chloride 940 a
mg/1
Chromium:Hex 1032
u9/I
Color:True 50
PI -Co
Cyanide 720
mg/I
Lab Comments:
CK:
uIc
-
Disc. Solids 70300
mg/1
Fluoride 951
mg/I
jardnsss:Tolar 900 35
mg/I
;...„Illardnoss
Cnon-carb) 902.
! mg/I
Phenols 32730
u9/I
5pucilic Cond. 95
uMhus/cm2
Sullale 945
mg/I
Sulfide 745
mg/1
NH3 as N 610 aDi
mg/1
TKN as N 625
mg/I
ii......4402
NO3 as N 630 , •
mg/I
P:Total as P 665
mg/I
Ag - Silver 1077
ug/I
Al - Aluminum 1105
4 co
ud/I
Bs - Barium 1007
ug/I
Ca - Calcium 916
mg/I
Cd - Cadmium 1027
ug/t
1lydmiUm:1131a1 1034
4., [gb
ug/I
fr.-----c-e,
- Copper 1042
< 10
ug/t
Fe - Iren 1045
\ 56
ug/I
Hu - Shirru,y 1 1.11111
ng/I
K - Potassium 937
moil
M9 - Magnesium 927
mg/1
Mil - 1.14u J1,'.0 I065
WI
Ipa - Sodium 929
mg/1
�I - Nickel 1067
<)"t)
ug/7
P: - Lead 1051
ug/1
So • Selenium 1147
i._:ug/I
Zn - Zinc 1092
< iQ
! 'ug/I
Orgenochlorine Pesticides
Olga nophospbores Pesticides
Acid Herdicides
Base / Neutral Ealraclable Organics
Acid Extractable Organics
I'w gn•btu Orwielt.a (VOA b011141
1.2 - Dibromoelhane CLUB/
1 '-
D4ifflrl 1 Y 1t SECTi 1
. (v •✓ 1 tili
hL41.LLG , NC
GW-64 Revised 7/85
For Dissolved Analysis - submit Iillered sample and write 'DIS' in block
White copy - Headquarters Pink copy - Region Yellow copy - Lab

i
State_of North Carolina
Department of Natural Resources and Community Development
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 2761!
James G. Martin, Governor
S. Thomas Rhodes, Secretary
Mr. and Mrs. Arrington
3222 Denson Place
Charlotte, NC 28205
January 6, 1989
R. Paul Wilms
Director
Dear Mr. and Mrs. Arrington:
RE: Permit 59-0698-WO-0014 for a heat pump injection well in
Mecklenburg County
In accordance with your application dated October 27,
1988 we are forwarding herewith Permit No. 59-0698-W0-0014 for
the Operation and Use of a well for the purpose of injecting
heat pump effluent, in Mecklenburg County.
This Permit shall be effective from the date of issuance
until January 1, 1994 and shall be subject to the conditions
and limitations stated therein.
In order to continue uninterrupted legal use of this well
for the stated purpose, you should make application for
it
renewal at least two (2) months prior to its expiration date.
Sincerely,
.
D. Rex Gleason, P.E.
Acting Regional Supervisor
/tej
Attachment
Cc:
Files
0 Files
Pollution Prevention Patin
P.O. Sox 27687, Raleigh, North Carolina 27611-7687 'Telephone [phone]
An Equal Opportunity Affirmative Action Employer

State of North Carolina
Deparl.►nent of Natural Resources and Community Development
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor
S. Thomas Rhodes, Secretary
Mr. and Mrs. Arrington
3222 Denson Place
Charlotte, NC 28205
January 6, 1989
R. Paul Wilms
Director
Dear Mr. and Mrs. Arrington:
RE: Permit 59--0698-WO--0014 for a heat pump injection well in
Mecklenburg County
In accordance with your application dated October 27,
1988 we are forwarding herewith Permit No. 59-0698-W0-0014 for
the Operation and Use of a well for the purpose of injecting
heat pump effluent, in Mecklenburg County.
This Permit shall be effective from the date of issuance
until January 1, 1994 and shall be subject to the conditions
and limitations stated therein.
In order to continue uninterrupted legal use of this well
for the stated purpose, you should make application for permit
renewal at least two (2) months prior to its expiration date.
/tej
Sincerely,
f,f.rrzr;-L.
/
D. Rex Gleason, P.E.
Acting Regional Supervisor
Attachment
cc:
UIC Files
MRO Files
Pollulion Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION/USE OF A WELL OR WELL SYSTEM FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87;
Article 21, Chapter 143, and other applicable Laws, Rules and Regula-
tions
PERMISSION IS HEREBY GRANTED TO
Ted and Pat Arrington
FOR THE OPERATION AND USE OF AN INJECTION WELL/WELL SYSTEM located
at 3222 Denson Place, Charlotte, North Carolina in Mecklenburg
County, in accordance with the application dated October 27, 1988 and
in conformity with the specifications and supporting data submitted,
all of which are filed with the Department of Natural Resources and
Community Development and are considered a part of this Permit.
This Permit is for Operation and Use only, and does not waive
any provisions or requirements of the Water Use Act any other
applicable Laws, Rules or Regulations. Operation and use of a well
or well system shall be in compliance with Title 15 North Carolina
Administrative Code 2C, 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 January 1, 1994 and shall be subject to the speci-
fied conditions and limitations set forth in Parts I and II hereof.
Permit issued this the (;f day of tf.rz,y_f. -: , 1989
11 )
/C
D. Rex Gleason, P.E.
Acting Regional Supervisor
By Authority of the Environmental Management Commission.
PERMIT NO. 59-0698-WO-0014

PERMIT NO. 59-0698-WO--0014
PART I
A. GENERAL CONDITIONS
1. The Permittee must comply with all conditions of
this Permit and with the standards and criteria
specified in 15 NCAC 2C .0200. Any Permit
non-compliance constitutes a violation of the
appropriate Act and is grounds for enforcement
action; for Permit termination, revocation and
reissuance or modification; or for denial of a
Permit renewal application.
2. It shall not be a defense for a Permittee in an
enforcement action that it would have been
necessary to halt or reduce the permitted
activity in order to maintain compliance with the
conditions of this Permit.
3. The Permittee shall take all reasonable steps to
minimize or correct any adverse impact on the
environment resulting from noncompliance with
this Permit.
4. The Permittee shall give advance notice to the
Director of any planned changes in the permitted.
facility or activity which may result in
noncompliance with the Permit.
5. The Permittee shall report all instances of
noncompliance, not reported under condition 1. of
this Part, at the time monitoring reports are
submitted.
6. Where the Permittee becomes aware of a failure to
submit 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 by the
Permittee.
7. The Permittee shall give notice to the Director
as soon as possible of any planned physical
alterations or additions to the permitted
facility.
8. In the event that the permitted facilities fail
to perform satisfactorily, the Permittee shall
take such immediate action as may be required by
the Director.

PART I (continued) PERMIT NO. 59-0698-W0-0014
9. The injection system shall be effectively
maintained and operated at all times so that
there is no contamination of groundwaters, or
other actions or occurrences which renders them
unsatisfactory for normal use. In the event the
facilities fail to perform satisfactorily,
including the creation of nuisance conditions,
the Permittee shall take such immediate
corrective action as may be required by the
Director.
10. Department representatives shall have reasonable
access for purposes of inspection, observation
and sampling associated with injection and
related facility.
11. This Permit is not transferable without prior
notice to, and approval by the Director.
12. An application for modification, renewal or
transfer of this Permit shall be filed with the
Department at least 30 days prior to the
expiration date of this Permit.
13. Provisions shall be made for collecting samples of
facility effluent, both prior to its entrance to
treatment devices and subsequent to leaving the
treatment devices but before entering the
injection well.
PART II
A. SPECIFIC CONDITIONS
-- N O N E -

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
RALEIGH, NORTH CAROLINA 27611
CATION FOR PERT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
CLASS/TYPE
A
TO: DIRECTOR, NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANPGENENT
DATE: October 27
19 88
In accordance with the provisions of Article 7, Chapter 87; Article 21,
Chapter 143, and regulations pursuant thereto, APPLICATION is hereby made
for a PERMIT to construct and/or use a well or well system as described
below and in any accompanying data submitted as a part of this APPLICATION.
A. OWNER DATA: Name Ted and Pat Arrington
Address 3222 Denson Place
Charlotte, N.C.
County Mecklenhurg„
zip 28205
Telephone [phone]
Ownership Status: Federa1L Statet_J Private
Public CommercialE
Other(Specify)
B. FACILITY DATA(Fill out ONLY if the injection well(s) is for the
purpose of serving a business or industry)
Business/Corporate Name:
Address:
ZIP:
Telephone:

B. Describe briefly:
(1)For what purpose will injection well be'used- The well is
intended for return from a water source heat pump.
(2)Mechanically, how will the injection operation proceed -
See attachment A
C. WELL USE: Will the injection well(s) also serve as the supply
well? Yes ❑ • No
D. CONSTRUCTION DATA: (check one)
a EXISTING WELL being proposed for use as an injection well.
Attach copy of Form GW-1 (Well Construction Record) and
furnish (6) below. If GW-L not available, furnish the
data in (1) thru (6) below to the best of your knowledge.
PROPOSED WELL to be constructed for use as an injection well.
Furnish the data in (1) thru (6) below as PROPOSED construction
specifications
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER
EXISTING OR PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE
BY OTHER MEANS.
(1) Date (to be) Constructed ng%Rn/RR ; Approx. Depth 350 ft.
(2) Well Casing:
(a) Type: Galvanized Steel n Black Steel
Thermoplastic Other (Specify)
(3)
(b) Inside Diameter: inches; Wall thickness(inches) •
or Schedule ; 40
(c) Casing Depth: From 1 to 103 ft. (referenced to land
surface)
Cement Grout:
(a) Around inner or "primary"casing: From
0
to .20 ft.
(b) Around outer(pit) casing, if present: From to
ft.
GW-578 (2/84)

PAGE 3 of 4
(4) Screen (s) : (if applicable)
' (a) Type: ; Inner Diameter: inches
(b) Depth: From to feet below land surface
(5) Gravel: (if applicable)
From to feet below land surface
(6) Attach a diagram showing details of construction of the
existing and/or proposed well(s). See attachment 8
E. OPERATING DATA: (Proposed)
(a) Injection Rate: Average(Daily) 7 gallons per minute(gpm)
(b) Injection Volumn: Average(Daily) 2.5 gpm
(c) Injection Pressure: Average(Daily) 21 pounds/square inch(psi)
F. INJECTED FLUID DATA:
(1) Fluid Source(from what depth and what type of rock/sediment
unit does the fluid to be injected derive)
See well construction record GW-1
Attached
v//j(2) Chemical Analysis of Source Water: The following chemical
characteristics must accompany this application;
pH 7 D Total Hardness ppm(parts per million)
Iron
ppm; Chloride ppm; Nitrate
ppm
Colliform bacteria counts/100
NOTE: Assistance in obtaining these values may be facilitated
by contacting (a)your local or county health official,
(b)a commercial water -testing laboratory, (c)your well
drilling contractor, or (4)the Regional Hydrologist,
North Carolina Dept. of Natural Resources & Community
Development in the following locations:
Washington,NC [phone] Wilmington,NC [phone]
Fayetteville,NC [phone] Winston-Salem,NC [phone]
Raleigh,NC [phone] Mooresville,NC (704)663--1699
Asheville,NC [phone]
Raw Water and Effluent Sample collected by Jesse W. Wells
12/14/88
GW-57B(2/84)

G. INJECTION -RELATED EQUIPMENT: Provide a diagram showing the type
and engineering layout of the (1)injection equipment
and (2)exterior piping/tubing associated with the
injection operation. See attachment C
NOTE: The manufacturer's brochure, if detailed, should satisfy
(1) above if the equipment is a heat pump(heat-exchanger)
LOCATION OF WELL(S): Provide a detailed map showing the orientation
and distances of the proposed well(s),and any existing
wells that will in any way be involved in the injection
operation, to at least two(2) nearby reference points
such asroads, intersections, streams, etc. The roads
should be identified by U.S., N.C. or SR(county secondary
road) numbers, and streams should be named. In addition,
the diagram should show any existing water -supply and/or
injection wells within 1,000 feet of the proposed
injection well. See attachment D
H.
No wells noted
within 1000 ft. of
proposed injection
well.
I. 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 operate and use the injection well
and all related appurtances -in accordance with the approved
specifications and conditions of the Permit".
(Signature of Owner or uthorized Agent)
J. FOR OFFICE USE ONLY:
1. Initial Application: COMPLETE INCOMPLETE
If INCOMPLETE, Date of Notification and Resubmittal _
2. Standard Industrial Code(s) which best reflect the principal
products or services provided by this facility - if appricable
(a) (b)
3. APPLICATION NO.
(c) (d)

Sanitary Well Seal
Casing must extend min.
of 8 inches above
land surface
ti Z fARC;EA ir7
o.
E
_I- HEAT
1 PUMP
•
COMBINATION SOURCE
• AND INJECTION WELL

DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27067 - RALEIGH,N.C. 27811. PHONE [phone]
Lat.S 1Li .27
Quad. No. R6S b I Serial No.
Long. SO {/t 6.5 Pc f
a-4
County:
Depth DRILLING LOG
From To Formation Description
U /�
3s-
3. DATE DRILLED - USE OF WELL �n /v3
3
4. TOTAL DEPTH Sv — CUTTINGS COLLECTED ❑ Yes No /z 3 -
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes No 62`'h> - 3/7 ' F it 1 ✓-G� �-�
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
Minor Basin
Basin Code
Header Ent GW-I Ent
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER PERMIT NUMBER*
1. WELL LOCATION: (Sho sketch of the location below)
Nearest Town: L.i V.
(Road, Community, or Su divisio and Lot No.)
2. OWNER �-�/f/�L�✓�%)�
ADDRESS
(26741,
32,
reet or Route No.)
)4.2
State
Z. Code
6. STATIC WATER LEVEL• 2 t2 FT. ❑ live TOP OF CASING,
TOP OF CASING IS % FT. ABOVE LANDURFACE.
/
7. YIELD (gpm)• .? METHOD OF TEST��
8, WATER ZONES (depth): ,� ye7 -i/ /.7.
/0/ "rsQ-
9, CHLORINATION: Typefi_ Amount
10, CASING:
Depth Diameter
From �/ To/l'3 Ft
From To Ft
From To FI.
11. GROUT:
Blow
Depth Material Method
From % To �'7 F t .-12'-G'7
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
Fr3m To Ft in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft..
4. REMARKS. 5 Je' 102/Hlgg G kus
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
('_'tM_ 1 Cn.,,w.-.d t 1 r0A
SIGNATURE OF CONTRACTOR OR AGENT DATE
Suhmn nrrninal In IlIvisiOn ni Envirnnmanral hAanancmnnr anri rnnv In well owner.

12" MIN.
CASING SEALED WITH 5U1 I ABLE
FLANGED, THREADED, OR WELDED
CAP OR COMPRESSION SEAL
UPON COMPLETION
7
3000 PSI-
CONCRETE
VaY4
v•.-• p ..1
•
•.• P.
CASING
(SEE NOTE I)
GROUT
(SEE NOTE 2)
IMPERVIOUS
STRATUM
CI:
SUBMERSIBLE --1*,
PUMP
WATER BEARING •
STRATUM
2"
i6644 WWF
r
1'
4"
NOTES:
1. CASING SHALL BE INSTALLED BY
DRIVING TO REFUSAL IN FIRM
ENCOUNT. WHERE BEDROCK20 IS
ENCOUNTERED 5HAL
,t� FEET, A MINIMUM CASING LENGTH OF
20 FEET IS REQUIRED.
2. GROUTING SHALL EXTEND A MINIMUM
OF 20 FEET OR TO FIRM BEDROCK,
WHICHEVER IS GREATER.
3. SEE ATTACHED SPECIFICATIONS FOR
OTHER REQUIREMENTS.

ckc]i mc.r + C
COMMAND/AIRE
•
•
-
......�d=L_y4'•.j•'f3.SY•Y_•�!-iT4Y;;i'C;•' .
•
:..t �,� r__t•_- - •. :i
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�
a artoAireat urps
JOB NAME
ARCMITECI
ENGINEER
LOCATION
SUBMITTED BY
APPROVED SY
CERTIF1CAT'ON
OIMCMSIONS, SPEC11ICAT10MS, AND PERFORMANCE AS
IMDICAT£D OM THIS SUBMITTAL ARE CERTIFIED CORRECT.
Nesco, Inc.
;OUP4rr V44�
P 0 Box 234, Monroe, NC 28110
.nCJrIC n
Ronald D Mahan' '
11-6-86
BY DAT E
ETi TES7:i;
I

WATER TQ AIR HEAT PUMPS
COOLING/HEATING/D,EHUMiDIFICATION
SERIES 060 - 610E-6,700 to 62,000 BTUH COOLING
—9,400 to 78,000BTUH HEATING
The Command -Aire SWP and SWPH Water -To -Air Heat Pumps
are a complete year-round air conditioning system in one sound
insulated package. No separate coils with costly interconnecting piping
and wiring are required.
Command -Aire Water Source Heat Pumps are ETL approved and
ARl certified for indi istrial and commercial installations. The SWP model
(vertical) heat pump is designed for floor level installations (closet or
equipment room). The SWPH model (horizontal) heat pump is
designed for overhead suspension —using bottom mounted isolation
rubber grommets and brackets. The minimum height restrictions of the
Command -Aire units will save ceiling space and reduce building costs;
FEATURES
• Units Are Self -Contained —All
components are located in one compact
cabinet.
• All Connections Located On One
Side —installation is simplified by having
water and electrical connections on one
only=except SWPH 060-130E.
• Convenient Lift -Out Service Doors —
Simplified service access permitted by
easy lift -out doors.
• Easy Filter Access
• Placement of Controls —All controls
conveniently located for easy access.
• Lock -Out Relay Provides Added
Protection—lf overload protectors shut
tff the compressor as a result of
abnormal operation. the system will not
recycle until the thermostat is reset.
• Refrigeration System Factory
Charged —A complete refrigeration
• system —factory charged, tested and
ready to operate.
• Compressor Safeguards —A high
pressure control will shut off the
compressor if unusual operating
conditions develop which could
damage the unit. The rugged
compressor is hermetically sealed
against moisture ana dirt. Internal spring
mounts reduce sound and vibrations for
long. dependable service.
• Freeze Protection—AII Units
• High Pressure Refrigerant --Cut-out
switch
•r:
ter._
SWPH HORIZONTAL MODEL
SWP
VERTICAL
MODEL
.a
1
• •
4,-,..,. ' -41:1;f:Sq:
r14' .:?isT .Lti' ,
• ..
•
H.E.R.S. (Heat Energy Recovery System)
Command -Aye's exclusive
heat exchanger gives ratings
among the highest in the
industry. .
• Permits better balance
between heating and
cooling.
• Gives broader range of
operation conditions.
• Operates at 45° entering
wafer temperature. allowing
increased Iloat in closed
system which gives a higher
system C.O.P.
817r9a0.32aa • P.O. BOX 7916 • wACO. TEXAS 76714-7916
(OMMAND/AIRE

COMMAN D iitE
Cooling Position
(INCREASED AT APPROX. 12°)
WATER OUT
Condenser
Check Valve
Heating Position
WATER IN
REFRIGERANT FLOW DIAGRAM
(DECREASE AT APPROX 6°)
WATER .OUT
Check
Valve
Evaporator
(CHILLER)
Cap Tube
Strainer
Q� Check Valve
Strainer
Cap
Tube
pit
Reversing Valve
(ENERGIZED)
Compressor
RED HIGH PRESSURE GAS
YELLOW ; LOW PRESSURE GAS
BLUE : LIQUID
Reversing Valve
(OE -ENERGIZED)
Condenser
Conditioned
Air (HEATING)
Compressor
RED HIGH PRESSURE GAS
YELLOW I,LOW PRESSURE GAS
BLUE LIQUID •

0
Refrigerant
Copper Finned
Tu De
•:c••r
Liquid Out
Cooling Side
In
\ ", •
• ÷
• • "- '4, •
I .
-I--Liqui d in -
Heatlp,.1
Pressure ReilPf
--- •
NOTE
Mak,
II
1.14
1 A :
• ,
;el•, •
. ) •
Water to Refrigerant Exchanger
Not Gas - Cooling
Suciion Gas - Hearn
Steel Jacket
'A'
Water
Ou
Water

WELL' DRILLING --PUMP INSTALLATION LOCATIONS &
DIRECTIONS CONTRACT NO._
Name 1cl i Peki-kyy lv V1
Address
Location oncxv lv-ke_ c9j(9-0
Dev►5c P1es. C�
T
11.
�L►t Vic 1 t S IO a- - oc-P De 60 Y1 A +.1c,(
7S s c-� -�✓o -' ke_ Y- t ✓oc1ok ✓ K S Cek+ 4 in c_
A.420/ 41 -i-Anc kVv i h ►/DFe-AY)
Salesman

St
?DEMI'. A..
4 730'
.70
LDCAI-to&I
.j 1 t b.EHILS' 1,1 °PUG -
P1/4 CHARLOTTE 15 GUADRA,S4E
.1 47000L FEET 171
,22
BO -tf.
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001)
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1213"
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