WI0500327_GEO THERMAL_20120518

Beverly Eaves Perdlitf
Governor
~4-~--.-.-.1 ,. __ _
NCDENR
North Carolina_DepartrnentotEnvironment and Natural Resources
Division-oLWaterQualitY~--
Charles Wakild;P-.E---~--
Director
May 18, 2012
Robert and Sarah Musser
1001 West Trinity A venue
Durham, NC 27701
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0500327
Dear Mr. and Mrs. Musser:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title ISA Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http ://portal.ncdenr.org/web/wq/aps.
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,
?-Jrr utlk-
Eric G. Smith, P.O.
Hydro geologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] I F/l.X: 919-807-6496
Internet: www.ncwaterquality.o rg
An Equal Opportunity\ Afrmalive Action Employer
One
North Carolina
/vnfttrally
Mar 12 12 03:40p Allison
7045459449
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Reset rccs- Div ibian of Water Qua l lifer Protection Section
WELL CONTRACTOR CERTIFICATION if e 3 g"
WELL CONTRACTOR:
�cii 0-)k l I f
We I Contract/ fin dividual) Name
Contractor orrr
Wet pant Name
STREET AU> ESPPI ; [1'` 1 „5.
A ',RI' 1' - i\.)i
City or Town State
Area coos- FTone number
- F,cjt--1
C"RLo_ 111
Zip l~ode�
2. WELL INFORMATION:
SITE WELL ID d(II applicable) �y
STATE WELL PERMIT apprrctle) (A)1 LJ5 LJC
OWQ as OTHER PERMIT Cif appilcable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED x -- ? ,] ) I
TIME COMPLETED w CAT) AM © PM pit
b. WELL LOCf1T%ONy: CITY: fL it' h o . F V1 COUNTY 1 Jam- r-h ... ev-
-ti
151reet Name, Numbers, Cemmarety. Subdhfav> Lot No.. Parcel, Zip Cade)
TOPOGRAPHIC / LAND ETTING:
°Slope gvalley _ at DRIdge °Other
(check appropriate bar.)
LATITUDE 3
LONGITUDE
May be in dcgres,.
minutes, seconds or
in a do irnal format
Latitudelionglu/de source: oTopographic map
(tocafion of welt must be n on a USGS rope map and
attached to Ihis form ,fnot using GPSJ
d. WELL OWNER
OWNER'S NAMEC'1c C — 4 `S rft.. r' r i L..LN-Sf r�.
STREET ADDRESS i �� + I L/.'' VA -T�,tir t)',
1;�� CA�3 NA NIL.
pity or Town Stale all Code
Area code - Phone number
5. WELL DETAILS: jjo I +y Lk-1i;
a. TOTAL DEPTH: 2 7,7
b. IJOES WELL REPLACE EXISTING WELL? YES [p NO
c. WATER LEVEL Be]aw Top cf Casing: FT.
(L1se'+• if Above Top of Casing)
d. TOP OF CASrNG IS FT. Above+ Larid >3urraac•
"Tap of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0115.
e. YIELD (pm): t--' METHOD OF TEST
p.3
RECE1VEDIDENRIDWQ
MAR I22012
f. DISINFECTION: Type Amount —
g. WATER ZONES (depth):
From - - • Fo From - - -1 o
From ,—.- . To 'From To
...---
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From Q To eJ Ft. v _ 0 0
From To Ft.
From To Ft.
7. GROUT: Depth Material
Fran 0 To .��a tFi. kifQ 6
From To FI. _
From To Ft.
Method
B. SCREEN: Depth Diameter Scot Size PAateria!
From -.To .Ft. ln..--• in. ----
From —To FL Trl, 'FT' -
From To FI. in. irr.-
9. SANDIDRAVEL PACK:
Depth Saxe
From .To Fl.
From To FL
Frem r' To
1a. DRILLING LOG
Frorrl To
5 `- ..„? 70
11. REMARKS:
Fi.
�^=Lariat
Formation Description
I9OHEREBY CERTIFY THATTHIS WEU.wRs cools RUCTEDIN ACCOROA14cE WITH
15A NCAC 2C. WEI.t. CONsinutmon STAN0A00S. aide TernTA COn1. OF nee
RECORD HAS BEEN PROVIOED TO THE WEu.OWNER.
ram- /97. i'�•��
ATUR£ OF CERTIFIED WELL CONTRACT R DATE
j ca�r ri . r1L+ 101:5
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the division of Water Quality within 30 clays. Atttn: Information Mgt-.
1617 Mail Service Center— Raleigh. NC 276994617 Phone No. ( 19) 733-701G oxt 666.
Form GW-a>a
Rev. 7ip5
RECEIVED 03-12-'12 14:36 FROM- 7045459449
TO- NC DENR P&S P003/003

North Carolina Dcpartmt!nt of Environm~nt and Naturnl Resources
Chad Mullis
Mullis Well Drilling
P.O. Box 691446
Charlotte, N.C. 28227
Re: Inspection of geothermal well system
Muster Residence
1001 West Trinity Avenue
Durham, NC-Durham County
Incident # 201101206
Dear Mr. Mullis:
llh is Ion of Water Quality
(.\1lccn 11. Sulli11~
Dirc1.:1ur
June 17, 2011
I kc Fn.:c111a11
S'-·1.:rd~try
The Aquifer Protection Section (APS) of the Division of Water Quality (DWQ) is responsible for the
regulation of well construction activities within the State of North Carolina.
On May 17, 2011, Ms. Sarah Muster (well owner) called in to report that a geothermal well installed
at her residence had started (after several weeks) to discharge water to the surface. The discharge had
caused standing water to accumulate in the yard area. Ms. Muster reported the incident to inquire if this
was a problem in any way with her well system or with regulatory compliance. On June 7, 2011, staff
with the Division of Water Quality, Aquifer Protection Section (APS) inspected the geothermal system
which consists of two wells. The wells have been backfilled (covered over) with fill dirt thus there was no
direct observation of the wells. However, the owner and the Trimech mechanical contractor (responsible
for geothermal loop installation, etc.) indicated that pooling of water on the surface was a result of one of
the geothermal wells. Based on information from the well owner and the phone conversation between
yourself (Chad Mullis) and Aquifer Protection staff on June 3, 2011, it has been established that you were
the well driller who installed the geothermal well system.
In the June 3, 2011, conversation (between you and APS staff) it was stated that a significant volume
of groundwater was encountered approximately two hundred fifty (250) feet below the surface in the
course of constructing the well with the surface discharge violation. The borehole penetrated an artesian
unit that resulted in the discharge of groundwater at approximately forty ( 40) gallons per minute. After
about two hours the borehole yield diminished and installation activities continued. The geothermal loops
were emplaced then the well was grouted. Grouting was completed under pressure utilizing a trernie pipe.
The grout variety was Geothermal Gold mixed with three hundred fifty (350) ·pounds of sand. It was
stated that at the time of well construction there was no groundwater observed discharging from the
completed well.
The Division does not consider the well to be properly constructed due to the surface discharge of
groundwater. The well must be sealed in such a manner that it will preclude any surficial contaminants
\~u11·i.:r :1r1,h.:i,..\I \,, "-\'dliJll
I '·2X '. l.111 '..:n 1cc l ,111~-r ll Jk,~h. '.,•11'1 ( ,r "'"'a ! 7,,.,.,. I,, '.i
I •''-·11 1"11 :~r,1, l!ancll /lr !t,k;~h. '-,>rlh l .11 .. /1n ,i"2U,1 J'I -
'!,, •11 ~· ·-I .,.;,, I .. ,~( 11 1 I· \.\ 1 J !IJ . .:; ... i -➔..,I:,< t 1.1 ... 1( 1111,.;1 \~n 1~c I .. 1-:-:' .,,2 Lt._ -l~
I, ,1.:1 t1 ,·1 •. ,_,~\ 11,•,~,,t~r•Llli!fi!l_•!)'J RECEiVED / DENR I OWQ
AQU ,i::c-ri·c----rlC
JUN 21 2011
Chad Mullis (Mullis Well Drilling)
Page 2
June 17, 2011
from entering the well. The Division suspects that groundwater is migrating through a vertical channel/s
adjacent to the well borehole due to an increase in the internal hydrostatic pressure after the well was
completed. This condition has created a path for surficial contaminants to enter the well.
The following is a summary of the violation:
Specific rule violation(s): ISA NCAC .0213 Additional Criteria And Standards applicable To Class S
Wells
(c) (B) (ii) for Type SQ wells without permanent casing, the well
head must be completed in such a manner so as to
preclude surficial contaminants from entering the well;
Required corrective action for the geothermal well:
• The well must be repaired in such a manner that surficial contaminants can not enter the
well with special attention focused on the containment of the natural conditions
(artesian) that appear to be the root of the issue. If the well cannot be repaired such that
it is in compliance with the rules, it will be required to be abandoned.
If it becomes necessary to abandon a well/s, it shall be abandoned pursuant to lSA NCAC 02C .0113.
The well shall be abandoned by sealing with a cement-grout from the bottom of the well to the top
(tremie). If the cement-grout is to be poured into the well, then the well shall be de-watered prior to
pouring the cement mixture. A certified well contractor must be used for all well repair or abandonment
activities.
Please note that a notice of violation or an assessment of civil penalties is not being issued at this
time. However, if the requirements are not completed and documentation received on or before the
submittal date, then this type of actionls will be forthcoming from the Division.
Please submit the documentation explaining how you brought yourself back into compliance
including the well abandonment records (if applicable) on or before July 18, 2011.
If you have any questions regarding this matter contact Eric Rice or Jay Zimmerman at (919)
791-4200 .
cc: file
Thomas Slusser, CO
Sarah Muster 1001 W . Trinity Avenue, Durham, NC 27701
;.q ""' -, .\-· f ~ I-€ 1,v x 0500 3~ 7
Sincerely,
<;;}7~
S. Jay Zimmerman, L.G .
Environmental Regional Supervisor
RECEIVED / DENR / DWQ
AQUIFl=P PP(\TJ::f'Tlf'\~I ~C:f,T!ON
JUN 21 2011
Permit Numbe r Wl0500327
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
john.mccray
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Robert and Sarah Musser SFR 5QM
Location Address
1001 W Trinity Ave
Durham
Owner
Owner Name
Robert
Dates/Events
NC 27701
Clayto Musser
n
Central Files: APS_ SWP_
01/31/11
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Chad Mullis
Driller Well
9200 Surface Hill Rd
Charlotte
Major/Minor
Minor
Region
Raleigh
County
Durham
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Robert Clayton _ Musser
1001 W Trinity Ave
Durham
NC 28227
NC 27701
Orig Issue
01/21/11
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue
01/21/11
Effective
01/21/11
Expiration
12/31/15 12/08/10
_R_e __ g_u_la_t_ed_A_c_t _iv_it_ie_s _______________ Re a uested/Received Events
Heat Pump Injection RO staff report received
RO staff report requ ested
Outfall NULL
Waterbody Name Stream Index Number Current Class
01/12/11
01/12/11
Subbasin
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Clean H. Sullins Dee Freeman
Governor Director Secretary
January 21, 20; 1
Robert and Sarah Musser
1001 W Trinity Ave
Durham, NC 277U ]
Ref: Issuance of Injection Well Permit WI0500327
Issued to Robert. and Saras! Musser
Durham., Durham C'ounry, North Carolina
Dear Mr. and Ms. Musser:
In accordance with the application received on December 8, 2010, I am forwarding permit number Wei%10500327 for
the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system.
This permit shall be effective from the date of issuance until December 31, 2015, and shall be subject to the
conditions and limitations stated therein, including the requirement to install well identification tags as
specified in Part 11.3 and to submit well construction records as specified in Part VII.2. Be sure to read the
entire permit to ensure thatyou are aware of all compliance requirements of the permit.
You will need to notify the Central and Raleigh Regional office at least 48 hours prior to beginning
construction and operation of the injection well system. In order to continue uninterrupted legal use of the
injection facility for the stated purpose, you must submit an application to renew the permit 120 days prior to its
expiration date. This permit is not transferable to any person without prior notice to and approval by the Director of
the Division of Water, Quality.
Please contact me at [phone] or iohn.ui.ccrayfrvnedenr.gov if you have any questions about your permit.
i.L
Jay Zimmerman. Raleigh Re2ionai Office
W10500327 Permit File
Durham County Environmental Health Dept.
AQUIFER tROTECTION SECTION
1536 Mall Service Center. Raleigh, North Carolina 27699-9636
Ladino: 2728 Capital Boulevard. Rale+gr,_ North Carolina 776O/
Phone. [phone] i FAX w: 919.716-05SE: FAX 2 919.71 a-6M \ Cuslamr Swim. 1-S77-623-6748
inramat; www.rcome aualitv.rr
R• 9a :., ;rnNlru,7. , 4 itf•".1ajwv_ . ;:rr. E...rmye:
Best Regards,
John M1IcCray
Environmental Specialist
N orthCarolina
Naturally

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
Robert and Sarah Musser
FOR THE CONSTRUCTION AND OPERATION OF 2 TYPE SQM INJECTION WELL(S), defined in Title
ISA North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at 100 1 W. Trini ty Ave, Durh am , Durham
County, and will be constructed and operated in accordance with the application received December 8, 2010,
and in conformity with the specifications and supporting data submitted, all of which are filed with the
Department of Environment and Natural Resources and are ·considered a part of this permit.
' This permit is for Construction and Operation of an injection well and shall be in compliance with Title I SA of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked , from the date of its issuance until January 3 L 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 21 st day of January, 2010.
~oleen H. Sullins , Director
\\ ~ivision of Water Quality
By Authority of the Environmental Management Commission.
Permit #WI0500327 UIC/SQM
ver. 03/2010
Page 1 of 5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART II-WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone], and the Raleigh Regional Office Aquifer Protection Section Staff, telephone
number [phone].
2. The location of each of the system manifolds shall be recorded by triangulation from 1hree permanent
features on the site (e.g., building foundation comers) and shown on an updated Site Map·. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or 'cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3 . The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
Permit #WI0500327 UIC/SQM
ver. 03/20~0
Page 2 of 5
PART IV -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, . including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity .
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3 . At least forty-eight ( 48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone n umber (919)715 -6 168 and Raleigh Regional Office Aquifer
Protection Section staff, telephone number (919)79 1-4200. 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. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #WI0S00327 UIC/SQM
ver. 03/201.0
Page 3 of 5
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center and
Raleigh, NC 27699-1636
Ph# 919-715-3221
Aquifer Protection Section
Raieigh Regional Office
l 62S Mail Service Center
Raleigh. NC 27699-1628
Phi'-919-791-4200
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the R alei gh Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the R alei g h Regional Office within 30 days
of completion of well construction.
4. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed.
5. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Ralei gh Regional Office, telephone number /919)791 -4200, any of the following:
(A) Any occurrence at the inj"ection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
7. 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 RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit #WI0500327 UIC/SQM
ver. 03/2010
Page 4 of 5
PART IX -CHANGE OF WELL STATUS
1. The · Pennittee 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 aiiy purpose, then that well must be permanently abandoned according to ISA NCAC 2C .0213(h)(I).
Notification shall be submitted to the addresses given in Part VII.I of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose , the
Permittee shall abandon that injection well in accordance with the procedures specified in ISA NCAC 2C
.0214, including but not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if the
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that failure
to do so could lead to the contamination of an underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe that extends to the bottom of the well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and •screens have not been removed, the ,
casing shall be perforated opposite the gravel pack, at intervals not exceeding IO feet, and grout
injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been created,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.1 of this permit.
Permit #WI0500327 UIC/SQM
ver. 03/2010
Page 5 of 5
Permit Number WI0500327
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
john.mccray
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Robert and Sarah Musser SFR 5QM
Location Address
1001 W Trinity Ave
Durham
Owner
Owner Name
Robert
D ates/ v ents
NC 27701
Clayto Musser
n
Orig Issue App Received Draft Initiated
12/08/10
Rec1 ulated Activities
Heat Pu!Jlp Injection
Outfall NULL
Scheduled
Issuance
Central Files: APS_ SWP_
01/21/11
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Chad Mullis
Driller Well
9200 Surface Hill Rd
Charlotte NC
Major/Minor
Minor
Region
Raleigh
County
Durham
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Robert Clayton Musser
1001 W Trinity Ave
Durham NC
Public Notice Issue Effective
R eauested/R eceived vents
28227
27701
Expiration
RO staff report received 0 1 /12/11
RO staff report requested 01/12/11
Waterbody Name Stream Index Number Current Class Subbasin
Mccray, John
From: Zimmerman, Jay
Sent: Wednesday, January 12, 2011 10:43 AM
To: Mccray, John
Cc: Mccartney, Lin
Subject: RE: 5QM application W10500327
No need for us to review but can you request via the cover letter to contact our office 24 hrs prior to grouting the loop so that we can
inspect if we have time? Several counties have expressed concerns that the loops are not necessarily being grouted the full length as
proposed in the applications. Fil ask Lin McCartney to Visit during the grout job.
Jay
S. Jay Zimmerman, l..G., Regional Supervisor
Raleigh Regional Office, Aquifer Protection Section
1628 Mail Service Center, Raleigh, NC 27699-1528
ATA
NCDE1Ni?l
7 8- -4 c'
E-inai3 correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties.
From: Mccray, John
Sent: Wednesday, January 12, 2011 10:19 AM
To: Zimmerman, Jay
Subject: 5QM application WI0500327
Mr, Zimmerman,
Attached you will find application W10500327 for a 5QM geothermal system in Durham NC. Please let me know how
your office would like us to proceed in the review of this application.
Best Regards,
John McCray
t

/AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
January 4, 2011
Robert C. Musser
Sarah S. Musser
1001 West Trinity Ave
Durham, NC 27701
Subject: Acknowledgement of Application No. WI0500327
Robert and Sarrah Musser
Injection Mixed Flu id GSHP Well System (5QM)
Durham
Dear Mr. & Mrs. Musser:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on December 8, 2010. This application package has been assigned the number listed above and will be reviewed
by John McCray.
The reviewer will perform a detailed review and contact you with a request for additional information 'if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests ypur 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 -96 days after receipt of a complete
application.
If you have any questions, please contact John McCray at 919-715-6168, or via e-mail [e-mail] . If the reviewer is
unavailable, you may leave a message, and they will respond promptly.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
for9ra\~ A~~
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
D.L. Mullis (Chad Mullis)
Trimech, Inc. (Paul Penland)
Permit Application File WI0500327
AQU IFER PROTECTION SECTION
1636 Mail Service Center. Raleigh, North Carolina 27699-1635
Location: 2728 Capital Bouievard, Raieigh . Nort.~.Carolina 27604
Phone: [phone] I FAX 1: 919 -715-0528 ; FAX 2: 918-715-6048 \ Customer Service : 1-877-623-6748
lniemet: www.ncwatergualitv.org
Ar. Ec;.1al Opportun ::1 \ ~4irrn _2;·:ve Ac1;on Employer
NOnel C 1· ort1 aro1na
~7vaturalf!I
NORTH CA ROI..INA
DLPA.RTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5QM WELL(S)
New Permit Application OR Renewal (check one)
DATE: L J IYlj,�.r- I , 20
PERMIT NO. Ma 0 S003 Z 1 (leave blank if NEW permit application)
A. PROPERTY OWNERS)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency. state name a1
11
entity and a representative w/authority for signature): f;rj} �'sr ^ �1 'Art : 1Y1-;,icre
(I 1 Mailing Address: Ll ti ; :Li Mil,. 1)., I VT:-
City: t; (1l,14.trr') State: t'i`-- Zip Code: =i. T -1U1 County: ,,,_ lover...
HomeJOrTice Tele No.: C(i't 441 - l "l,)- :1- Cell No.: `i Ici :?,J 7 i..• = -,
EMAIL Address: 1,:k.:11u's;,L, ' eel.'
(2) Physical Address of Site (if different than above):
City' State: Zip Code: County:
Hom e/O ftice Tele No.:
EMAIL Address:
Cdll No..
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property.
attach a letter from the property owner authorizing Agent to install and operate fiIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: State: Zip Codc: County:
Office Tele No,: Cell No.:
Website Address of Company, if any:
C. STATUS OF APPLICANT
Private: .`1 Federal: Commercial: _ _
State: Municipal: _ Native American Lands:
Gf UIU1C 50M Well Permit Application (Revised 7/2OON
4ge1

' .
D. WELL DRILLER INFORMATION
CompanyName: b,t.. /'11/U.,5
Well Drilling Contractor's Name: ::5 olv,J 1'1/k€ /l{C1t45
NC Contractor Certification No.: _ _../J.-_"'----0_3_~ _________________ ---=---
Conta~ Person: &/ .t{vt.c,:r EMAIL Address: OLM t4f(,. C5 & '/Je{l~ .a-r
'· Address: ½J. ()'() Su, E4t£ th YI e/
City: c:3{t9~ ife. Zip Code: c;2 c;?J '7 County: . jV/e'(!',t'/t:d( bCl./.6
Office Tele No.: 7tJf .S-'f.5= .S-6 93/ Cell No.: 7tJ'f-~('( · 76"/J
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: ""7&·)/}c:,.c..~ '£;Jc, .
Contact Person: &,1 Pr::LJ,/Aa d EMAIL Address;-rom e..c:..( ~": ... ti?v~ c2 , l ·~
Address: 2 /a / ;t); J;u:; z, e...r l~d_
City: ~<.. ii<-Zip Code: 2 7.30 2. Count/: _J_u_...'h.~ii,_q'-'<:"'.="'------' c:;,
Office Tele No.: 'l/'l 8(}~ ff'22 Cell No.: 9/f 9ft d,.r.J~Y
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used) e /osE D (..oo I: g eo IAErM(';(_
G. WELL CONSTRUCTION DATA (Skip to Sectiod H if this is a Permit RENEWAL)
(]) Proposed date to be constructed: /I, 5 /IP Number of borings: 2
Approximate depth of each boring ( feet):_ .3 0 0 F<£e!(
(2) Chemical additives to ~ed in closed-loop system (only those chemicals indic~ted have been approved):
___ R-22 ____L.....propylene glycol __ ethanol ________ other {other additives will
need prior approval by NCDENR before use)
· (3) Type of tubing to be used (copper, PVC, etc): ~a:(~; Po/y:e,-fJ;r/e&cE
(4) Well casing. Is the well(s) cased? (check either (a.) YES ru: (b.) NO below)
(a) YES · if yes, then provide casing information such as~ (steel, PVC, plastic, etc.), diameter,
~ and extent of casing appearing above ground: _______________ _
(b) NO
(5) Grout (material surrounding well casing and/or piping)'. /
(a) Grout type: Cement__ Bentonite ~ Other (specify) ______ _
(b) Grout depth of tubing (reference to land surface): from a to 3 tJO (feet)
~f weU has casing, indicate grout depth: from ___ to ____ (feet)
H. INJECTION-RELATED E'QUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the i~jection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
GPUIUIC 5QM Well Permit Application (Revised 7/2008) Page2
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
( I ) include a site reap (can he drawn) showing: buildings, property tines, 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 or the
geothermal heat pump well system. Label all features clearly and include a north arrow,
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name,
J. POTABLE WATER WELL(S)
Are there any potable water wel(s) on the subject property or adjacent properties? YES ' NO
If Yes, than indicate location on attached maps),
K. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the recorded legal property deed.
"I hereby certify, under penalty of taw, 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, l believe that the information is true, accurate and complete.
I ani aware that there are significant penalties. including the possibility of fines and imprisonment. for submitting
false information. 1 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"
�/
Signature ofroperty Owner/Applicant
,4c:,fir(LAY f"'d /"I6e
Print or Type Full Name
Signature of Property Owner/Applicant
S Nkkisr..r
Print or '1 ype Full Name
Signature of Authorized Agent, if any
Print or Type Full Nante
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
WC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUCIC 5Q11.4 Well Permit Application (Revised 7/2008) Page 3

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