WI0700095_GEO THERMAL_20120523

Beverly Eaves Perdue
Governor
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 23, 2012
Richard Turner
3016 Robin Ridge Court
Fairfax, VA 22031
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0700095
Dear Mr. Turner:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits. issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.or g/web/wq/ap s.
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,
Eric G. Smith, P.G.
Hydrogeologist
cc: UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699 -1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \FAX: [phone]
Internet: www .ncwaterquality.org
An Equal Opporlonily \ Afrirmative Action Employer
NOnel c· 1· ort1 aroma
/Vat11rnll11
Permit Number WI0700095
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Rev iewer
michael. rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name .
Richard & Carolyn Turner SFR
Location Address
128 Providence
Chocowinity
Owner
Owner Name
Richard
Dates/Events
NC 27817
Turner
Orig Issue
09/22/06
App Received Draft Initiated
07/25/11
Scheduled
Issuance
Central Files : APS_ SWP_
08/17/11
Permit Tracking Slip
Status
Active
Version
2.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Washington
County
Beaufort
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Richard Turner
3016 Robin Ridge Ct
Fairfax VA 22031
Public Notice Issue
08/12/11
Effective
08/12/11
Expiration
05/31/16
_R_e~g~u_la_t_e_d_A_c_t_iv_i_ti_e_s ________________ Re a uested/Received Events
Heat Pum p Injection RO staff report received
RO staff report requested
Outfall 1\U!..
Waterbody Name Stream Index Number Current Class
08/09/11
08/09/11
Subbasin
Permit Number W10700095
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michaei.rogers
Coastal SW Rule
Permitted Flow
Facility
Central Files: APS SWP
08/09/11
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
Richard & Carolyn Turner SFR Minor Washington
Location Address County
128 Providence Beaufort
Chocowlnity NC 27817 Facility Contact Affiliation
Gwner
Owner Name Owner Type
Individual
Richard Turner Owner Affiliation
Richard Turner
3016 Ravin Ridge Ct
Fairfax VA 22031
r)ataclFv•�ntc
Scheduled
Cfig Issue App Received Draft initiated Issuance Public Notice Issue Effective Expiration
09/22/06 07/25/11
RAr,ul;ated Activiti.-, Real ested/Recei'ved Fvnntc
Beat Pump In)ection RQ staff report received 08109111
RQ staff report requested 08/0911 1
Outfall P i U'_.!
Waterbody Name
Stream Index Number Current Class Subbasin

NCDEHP
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Richard and Carolyn Turner
3016 Robin Midge Court
Fairfax, VA 22031
Division of Water Quality
Coleen H. Sullins
Director
August 12, 2011
Ref: Issuance of Injection Well Permit W10700095
Issued to Richard and Carolyn Turner
Chocowinity, Beaufort County, North Carolina
Dear Mr. and Ms. Turner:
Dee Freeman
Secretary
In accordance with the application received on July 25, 2011, I am forwarding permit number W10700095 for the
continued operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system located at
128 Providence Pl., Chocowinity, Beaufort County, NC 27817. This permit shall be effective from the date of
issuance until May 31, 2016, and shall be subject to the conditions and limitations stated therein.
Please be advised, in the event there are multiple wells with separate clusters, one well identification tag per
`cluster' of wells should be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location.
Also, please pay special attention to Part V.Z. The Permittee shall retain all records of repairs, pressure
tests, maintenance, and other activities needed to maintain normal operating conditions.
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 michael.rogers,a ncdenr.yov if you have any questions about your permit.
cc: David May, Washington Regional Office
W10700095 Permit File
Beaufort County Environmental Health Dept,
AQUIFER PROTECTION SECTION
1636 mail 5erviee CenLer, Raleigh, North C8rd!nd 2769Q-163a
Locallon: 2728 Cap4al Bwlevard, Raleigh. North Carolina 27W
Pnom: 91573a-322S 1 FAX 1, 919-715-0558: FAX ?' 919-715-13043 i CU31orner CusTVIce' 1-E7"7-62: 674E:
l7temet: www.ncwatt:raualitv,ard
Best Regards, '
14
Michael Rogers, F.G. (NC & FL)
N orth C aruiir z
is 1--17144r

NORTH CAROLINA
ENVIRONMENT AL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE 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
Richard and Carolyn Turner
FOR THE CONTINUED OPERATION OF TYPE SQM INJECTION WELL(S), defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed-loop
geothermal-mixed-fluid heat pump system . This system is located at 128 Providence Pl.,Chocowinity, Beaufort
County, NC 27817, and will be constructed and operated in accordance with the application received July 25,
2011, 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 operation of an injection well and shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws , Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until July 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through VII hereof.
Permit issued this the 12th day of August 2011.
Jr\. Coleen H . Sullins, Director
·~ Division of Water Quality
By Authority of the Environmental Management Commission.
Wl(:700095 UIC/5QM-M.F. Renewal
Version 1/2010
Page 1 of 4
PART I -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.
4. In the event that there are multiple wells with separate clusters, one well identification tag per 'cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
PART II-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART III -OPERATIONS 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.
WW70000: UIC/5QM-M.F. Renewal
Version 1/2010
Page 2 of 4
PART IV -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall retain all records of repairs, pressure tests, maintenance, and other activities
needed to maintain normal operating conditions.
3. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Washington Regional Office, telephone number 252-946-6481, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
4. Where the Pennittee 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.
5. In the event that the permitted facility fails to perform satisfactorily, the Pennittee shall take such
immediate action as may be required by the Director.
PART VI -PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
WIC7o:;'J0:' UIC/5QM-M.F. Renewal
Version 1/2010
Page 3 of 4
PART VII-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 any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director detennines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part VII (1) and (2) (G) shall be submitted to:
WI0700095
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
UIC.!SQM-M.F. Renewal
Version 1/2010
Page 4 of 4
Rogers, Michael
From: May, David
Sent:
To:
Monday, August 08, 2011 11 :56 AM
Rogers, Michael
Cc:
Subject:
Michael,
Hart, William; Clark, Allen
RE: WI0700095 Turner
Thanks for the update. Our office isn't interested in conducting an inspection as part of this renewal. Feel free to
proceed.
David May
David May, Regional Aquifer Protection Supervisor
Division of Water Quality
Aquifer Protection Section
943 Washington Square Mall
Washington, NC 27889
Phone:[phone]
Fax: [phone]
E-mail: david.ma y@)ncdenr.qov
http://portal.ncdenr.org/web/wg/
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Rogers, Michael
Sent: Monday, August 08, 201111:30 AM
To: May, David
Subject: WI0700095 Turner
Attached is a SQM renewal application. Please let me know if you wish to conduct a pre-permitting inspection or not.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
http://portal.ncdenr.org/web/wg/aps/gwpro/permit-aoolications#geothermApos
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
1
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Richard Turner
Carolyn Turner
3016 Robin Ridge Court
Fairfax, VA 22031
Dear Mr. and Mrs. Turner:
Coleen H, Sullins
Director
August 5, 2011
Dee wreeman
Secretary
Subject: Acknowledgement of
Application No. W10700095
Richard & Carolyn Turner SFR
Injection Mixed Fluid GSHP
Well (5QM) System
Beaufort County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 7/25/2011. Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Washington Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please now that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or [e-mail].
Sincerely;
fttlA � A ` bbukk
for Debra J. Wat s
Groundwater Protection Unit Supervisor
cc: Washington Regional Office, Aquifer Protection Section
Pennit File W10700095
AQUIFER PROTECTION SECTION
1636 Melt Service Center. Fralmh. North Carolina 27699-1636
Locator:2728 Capital Boulevard, Relgh, North Carolina 277604
Phoris, 919-733-32214 FAX [phone]; FAX 2: 915-715.60491 Cummer service. 1-877-623-i748
li1'.err t w".nmater0ualih'.Orc
Ar -qu_' -_y7Ap r `; 1 Affirma3lre Acorn Eat*yer
P
N rtb Carolin a
AMUM II

NORTH CAROLINA DEPARTMEN`f OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED -LOOP MIXED -FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids lather than potable water as part of a geotbermal heating and cooling system
(check one) New Application Renewal * Modification
to
DATE: TtA L Y 17 , 24 11
PERMIT NO. {�0D} (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence BusinesslOrganization
Government: State Municipal County Federal
,te.
B. PERMIT APPLICANT - For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
_ GP►AOL--'N 5,_ .T�j_ /L t.1 L t2-- _
Mailing Address: � a 1 CP o a t k3 y '� 0 Gt e co og J7
City: FA i p- r-A x V State: A. Zip Code: 2 ?. 0- —County:
Day Tele No.: -7 d 3 [v JS ~ 1 ! Cell No.: 10 3 L
EMAIL Address: K �, + e 6 d i 2 S @ v earn o O. Geer, Fax No.: NIA
C. LOCATION OF WELL SITE - Where the injection wells are physically located:
(1) Parcel. Identification Number (PIN) of well site: County:
(2) Physical Address (if different than mailing address): 1713 PryVCAL- Vt-ArC-1�— p
City. C 4�0 C 0 V J t 0 1 N State: NC Zip Code: �&i±)��7 131 ' ►
Aquifer Protection 5eetion
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.:
Company Name:
Contact Person: EMAIL Address:
Address:
City:
Office Tele No.:
Zip Code:
Cell No.:
State: County.
Fax No.
JUL 26 2011
GPUfMC 5QM Permit Application (Revised 1/2412011) Page 1

E~ HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: __________________________________ _
Contact Person,_: ----------------=E"-"MAI=-==L=-=-A-""d=dr=es::..::s:.:...: ___________ _
Address:------------------------------------
City: Zip Code: ____ State: __ County:
Office Tele No.: Cell No.: F_~a=x.:...N::....:..:.o:..:...: ______ _ --------------------
F. WELL CONSTRUCTION DATA
(1) Number of borings to be constructed*: _____ Depth of each boring (feet): ________ _
* If existing water supply wells will be used then provide the information in item ( 4) b elow.
(2) Chemical additives to be used: R-22 ___ Propylene glycol ___ Ethanol __ _
Other _________ ( other additives will need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): · _______________ _
(4) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, plastic, etc.), diameter, depth,
and extent of casing appearing above ground: -------------------
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite** __ Other (specify) _______ _
** By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C .0213(dXIXA), which requires a cement type grout.
(b) Grout depth of tubing (reference to land surface): from ____ to ____ (feet)
If well has casing, indicate grout depth: from ____ to ____ (feet)
G. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearlv and include a north arrow.
(1) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or
elevation data.
GPU/UIC SQM Permit Application (Revised 1/24/2011) Page2
H. CERTMCATTON (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation.: by a responsible corporate officer;
2. for a partnership or sale proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency. by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which means all persons listed on the propert•+ deed)_
If an authorized agent is sigdmg on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete, I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit."
Signature of Property Owner/Applicant
VI c4l,lStV,0 R -FuP-Ne�
Print or Type Full Name
Signature ol#roperty OwnerlApplicaut
CA 9 o t.--''�.1 :5. 1� u fit. ►J ER.
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
UESA 1 etio¢
GPUft11C 5QM Permit Appftatiop (Revised 1/2412011) Page 3

State of Nortb Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: 'V` L O -70 d ❑ —9
Permittee Name: 9 1 G",6 . R 0 -B. —rV" G IB-' Cad L y N S "ru R ry is 2 -- 00m E "tJ 9~
Address: } pRD Vt t?�FJG Q Gt: Gtkp�a �1 rN�T�1 . t,1�C, Z? $1-7 -
Please check the selection which most closely describes the current status of your injection well system:
1 } IKWell(s) still used for injection activities, or may be in the future.
2) ❑ Well(s) trot used for injection but is/are used for water supply or other purposes.
3) ❑ Injection discontinued and: a) ❑ Well(s) temporarily abandoned
b) ❑ Well(s) permanently abandoned
c) ❑ Wells) not abandoned
4) ❑ injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
We] I Abandonment
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description of haw the well
was sealed and the type of material used to fill the well if permanently abandoned):
Permit Rescission:
Ifyou checked (2), (3), or (4) and will not use a well for injection on this site in the future, you should request rescission of the
permit. Do you wish to rescind the permit?
❑ Yes ❑ No
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, and complete."
Signature Dite
RECEIVED r DENR 1 DVVQ
Aquifer Protection Section
JUL. 25 2011
Revised 5105 GWIUIC-68

. . ·•~A ~--~~ .-.--."-"--MCD ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Richard Turner
3016 Robin Ridge Court
Fairfax, VA 22031-2133
Coleen H. Sullins
Director
July 13, 2011
Subject: Notice of Expiration (NOE)
5QM Geothermal Injection Well
Permit No. WI0700095
Beaufort County
Dear Mr. Turner:
RE~EIVEO I DENR I DWQ
Aquifer Protection Section
JUL 26 2011
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for
the underground injection well system located on your property at 128 Providence· Place in
Chocowinity, North Carolina, which was issued to you on September 22, 2006, and expires on
September 30, 2011, is soon due for renewal. If you wish to keep this permit and operate the
injection well system, the permit must be renewed and issued in your name.
If Your In jection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title ISA, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http://portal.ncdenr.org/web/wq/aps/gwpro/reporting-forms.
If Your In jection Well is Currentl v Active:
If the injection well_ system is still active and you wish to renew your permit, the renewal
application must be submitted within 120 calendar days of the expiration of your permit.
According to our records, you mustsubmit your permit renewalby June 2, 2011. Since we had
difficulty contacting you, we will extend this deadline until Julv 31 . 2011.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
lniernet: www.ncwaterauality.org
An Equal Opponuri:y I Affirmative Action Employer
OnehC ... Nort aro11na
/vaturtill!f
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subehapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Wells) for Injection with
Geothermal Heat Pump System. for Type 5QM Well(s) if the injection well system on
your property is still active.
-OR-
B. Statics of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forrns to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
btii)://h2o.enr.state.ne.us/aDslou/forras.htiii.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at eric.u.smithfiDncdenr.gov.
Sincerely,
fJA
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Washington Regional Office - APS w/o enclosures
AP Central Files - Permit No. W10700095 w/o enclosures
2

Jr.A --=""-~-~ NCD ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Richard Turner
3016 Robin Ridge Court
Fairfax, VA 22031-2133
Coleen H. Sullins
Director
July 13, 2011
Subject: Notice of Expiration (NOE)
SQM Geothermal Injection Well
Permit No. WI070009S
Beaufort County
Dear Mr. Turner:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for
the underground injection well system located on your property at 128 Providence Place in
Chocowinity, North Carolina, which was issued to you on September 22, 2006, and expires on
September 30, 2011, is soon due for renewal. If you wish to keep this permit and operate the
injection well system, the permit must be renewed and issued in your name.
If Your In jection Well is Currentl y Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title ISA, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http ://portal.ncdenr.org/web/wg/a ps/gwo ro/reportin!!-forms.
If Your In iection Well is Currentl y Active:
If the injection well system is still active and you wish to renew your permit, the renewal
application must be· submitted within 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by June 2, 2011. Since we had
difficulty contacting you, we will extend this deadline until Juh 31. 2011.
AQUIFER PROTECTION SECTION
1636 Me:l Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX i: 919-715-0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet: W\iW/,ncwaterauall ,o n:i
t:: i:oual Oopcrrur :iy \ Affirmative Act!on Employer
OnchC ... Nort ·aronna
/v,1turalfy
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter ?C, Section .021 I, you must submit one of the following
enclosed forms:
A. .4pplication for Permit (Renewal) to Construct andlor Use a Well(s) for Injection with
Geothermal Heat Pump System for Type 5QM Well(s) if the injection well system on
your property is still active.
S. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
TAC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ wehsite at
httz�y:!?h?o.enr.state.ne.us/a slUnulforrns.htm.
Thank you in advance for your cooperation and timely response. if you have any questions,
please contact me by phone at [phone] or by email at eric. ;.smith(&ncdenr.grov.
Sincerely,
f64,r- �J' J7h4"t�6_
Eric G. Smith, P.G.
Hydrogmlogist
Enclosures
cc; Washington Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10700095 w/o enclosures

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Mechanical Integrity Test Record
(For SQM Goothermal Heat Pump Injection Well System)
pwner/Pamittee Name: j Vve C Permit N=ber: WI
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Heat Pump Contractor Name:
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Raleigh, NC 2?699 or by fax, 919 715-05M
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07/12/2D11 14,31 FAX [phone]E NCDEPTENVIRONMENTNATRES f 606/010
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Mechanical Integrity Test Record
{Fvr 5QM Geothermal Heat Pump Injection Well System)
Gwner/Pormittee Name: r[ �n Permit Number: MV_2,
Facility Address:� �Q� �`■ _CaL'1_' .i _L,�bf 'fit, Lnr (..� OU
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�. a
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Raleigh, NC 27699 or by fax; 919-715-0588,
A4edanjcal lategHry Tcst Farm 112007

Smith, Eric
From: Smith, Eric
Sent:
To:
Subject:
Tuesday, July 12, 2011 2:38 PM
'[e-mail]'
Information Regarding Richard Turner
Ms. Kicos:
I am with the North Carolina Division of Water Quality's Aquifer Protection Section. We are looking for a Richard Turner
to send him some information regarding a permit he has with us. The cell phone number he gave us as his contact is
listed as belonging to you. However, when we call this number, we get Mr. Turner's voice mail message. We have tried
sending info to his home address listed in Alexandria, VA, but it keeps coming back to us as unclaimed.
Do you know Mr. Turner and/or do you know where we can reach him? Any information would be helpful.
Thank you very much,
Eric G. Smith, P.G.
Eric G. Smith, P.G.
Hyd rogeologist
NCDENR
Aquifer Protection Section
Groundwater Protection Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
919-715-6196
919-715-6048 Fax
http://portal.ncdenr.org/web/wq/aps
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
1
Smith, Eric
From:
Sent:
To:
Subject:
Your message
To:
Subject:
Sent:
Securence ID:
Securence Mailer
Tuesday, July 12, 2011 2:44 PM
Smith, Eric
Undeliverable: Permit Information from NC DENR
"rcturner164@ hotmail.com" <rcturner164@ hotmail.com>
Permit Information from NC DENR
Tue, 12 Jul 2011 14:42:17 -0400
1310496257456-019-02952647
did not reach the following recipient(s):
rcturnerl64@ hotmail.com
There was a SMTP communication problem with the recipient's email server. Please contact your
system administrator.
Response from destination mail server:
550 Requested action not taken: mailbox unavailable
1
Smith, Eric
From:
Sent:
To:
Smith, Eric
Tuesday, July 12, 2011 2:42 PM
'rcturner164@hotm ail .com'
Subject: Permit Information from NC DENR
Mr. Turner:
We are trying to locate you to send you some information regarding your geothermal well permit with the state of North
Carolina. If this is you, please respond to this email.
Thank you,
Eric G. Smith
Eric G. Smith, P.G.
Hydrogeologist
NCDENR
Aquifer Protection Section
Groundwater Protection Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
919-715-6196
919-715-6048 Fax
http://portal.ncdenr.org/web/wg/aps
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
1
Smith, Eric
From: Hart, William
Sent: Friday, July 08, 2011 12:55 PM
To: Smith, Eric
Subject: W 10700095 - Turner 5QM
I took a little ride across the river this morning to take a look at the Richard Turner property on Providence Pl. 1t did not
appear that anyone was there on a regular basis; the yard was unkempt (forthat area), covers on furniture visible from
the door, etc. There was no "For Sale" sign or anything like that, but no renters either. I'm not sure what else can
reasonably be done; I think I recall you have checked with the county tax office(s) for Contact info. Please keep me
informed, and please let us know if there is anything else we can do from the RO.
Will Hart, Hydrogeologist
❑ivision of Water Qua I ity/Aq u ife r Protection Section
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
william.harff,ncdenr. }ov
Telephone: [phone]
Fax: [phone]
f rrrrff rrre:.p,�ndsn to snd 1rcm tf.'is address mu; 6a su61AGt I the &0 5ralina fWAr I ecurds lax- i rtd maybe drsclvsed to Ard pertres.
1 03z3 fr1%

~A ;-;;;-rYL.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
June 8, 2011
CERTIFIED MAIL # 7010 0780 0001 7057 5549
RETURN RECEIPT REQUESTED
Richard Turner
164 Cameron Station Boulevard
Alexandria, VA 22304
Subject: Notice of Violation with Intent to Enforce (NOV-2011-PC-0348)
SQM Geothermal Injection Well
Permit No. WI070009S
Beaufort County
Dear Mr. Turner:
Dee Freeman
Secretary
The above-referenced permit, which was issued to you on September 22, 2006, and expires on
September 30, 2011, has not been renewed. This permit was issued for the operation of a SQM
geothermal injection system on your property located at 128 Providence Place in Chocowinity,
North Carolina.
On May 12, 2011, our office issued you a Notice of Expiration (NOE) and a permit renewal
application package with instructions to submit the necessary paperwork within 30 days of its receipt.
To date, the Groundwater Protection Unit has not received your completed renewal application
package. In addition, our records do not indicate that the well system has been plugged and
abandoned.
Therefore, the following violation(s) exists:
VIOLATION 1:
Failure to submit a permit renewal request at least 120 days prior to the permit's expiration date is a
violation of Part VIII of the permit and ISA NCAC 2C .021 lG).
REQ UIRED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 days ofreceipt of this letter:
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-5748
Internet: www.ncwaterguality.org
A'1 E(luil Opporl ;;:G/ \ Affirrrc i:ve Action Emrloyer
N~lth Carolina
}vat11rallll
I. APPLY FOR PERMIT RENEWAL. When you apply for and receive a
renewal, operation of your well system will be permitted to continue. As such, all
sampling requirements and any operation and maintenance procedures specified
in your previous permit will be required. To renew, you must submit the
following information to the address below:
a) A completed Application for Permit (Renewal) to Construct andlor Use a
Wells) for Injection with Geothermal Heat Pump System for Type SQM
Wells) if time injection well system on your property is still active. This form
must be signed by each property/permit owner.
b) A completed Statics oflnjection Well System if the injection well system is
inactive or has been temporarily or permanently abandoned.
All forms must be submitted to the following address within 30 days of the receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application
and a UIC well system status form are attached along with a self-addressed envelope. The above
referenced forms are also available on-line at the DWQ website at
httli:1lh2o.enr,state.nc,usla AL,!Vulforrns.htan.
Thank you in advance for your cooperation and timely response. If you have any questions, please
call Eric G. Smith at 919-715-6196, or email him at eric.,,.smith(&pcdenr.,oy.
Sincerely,
Debra J. Watts, Supervisor
Groundwater Protection Unit
Enclosures: I ) GPUIUIC 5QM Well Permit Application
2) Status of Injection Well Forma
cc: Washington Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10700095 w/o enclosures

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED-LOOP MIXED-FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids other than potable water as part of a geothermal heating and cooling system
(check one) __ New Application< Renewal* ---Modification
* For renewals complete Parts A-C and the signature page.
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: _______ ~ 20
PERMIT NO. _________ (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non-Government: Individual Residence Business/Organization __
Government: State Municipal _. _-County__ Federal
B. PERMIT APPLICANT -For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
Mailing Address:--------------------------------
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
C. LOCATION OF WELL SITE -Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: __________ County: _____ _
(2) Physical Address (if different than mailing address): ________________ _
City: _______________ State: NC Zip Code: ________ _
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.: ____________________ _
Company Name: _______________________________ _
Contact Person_: _______________ E_MA __ IL_A~d~dr~e~s~s: ___________ _
Address:----------------------------------
City: _________ Zip Code: ____ State: __ County: _________ _
OfficeTele No.: Cell No.: =-F=ax"'"N"-'-"o"".: ________ _
GPU/UIC SQM Permit Application (Revised 1/24/2011) Page I
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: __________________________________ _
Contact Person~: -------------------'E=MA=-==IL~A=d=d=re=s=s"'": ___________ _
Address: __________________________________ _
City: __________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ----------~~~~-------
F. WELL CONSTRUCTION DATA
(1) Number ofborings to be constructed*: _____ Depth of each boring (feet): ________ _
* If existing water supply wells will be used then provide the information in item (4) below.
(2) Chemical additives to be used: R-22 __ _ Propylene glycol __ _ Ethanol ---
Other _________ ( other additives will need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): _______________ _
(4) Well casing. If the well(s) will use casing then provide the~ (steel, PVC, plastic, etc.), diameter, depth,
and extent of casing appearing above ground:
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite** Other (specify) _______ _
** By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C .0213(d)(l)(A), which requires a cement type grout.
(b) Grout depth of tubing (reference to land surface): from ___ to ____ ( feet)
If well has casing, indicate grout depth: from to (feet) ---------
G. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearly and include a north arrow.
( 1) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or
elevation data.
GPU/UIC SQM Permit Application (Revised 1/24/2011) Page2
H. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 l(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which means all persons listed-on the pro pertv deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and · imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit."
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Property Owner/ Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ -Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC SQM Permit Application (Revi sed 1/24 /2011) Page 3
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: ___________ _
Permittee Name: ___________________ _
Address: ________________________________ _
Please check the selection which most closely describes the current status of your injection well system :
1) □ Well(s) still used for injection activities, or may be in the future.
2) □ Well(s) not used for injection but is/are used for water supply or other purposes.
3) □ Injection discontinued and: a)□ Well(s) temporarily abandoned
.b ) □ Well(s) permanently abandoned
c) □ Well(s) not abandoned
4) □ Injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
Well Abandonment
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description of how the well
was sealed and the type of material used to fill the well if permanently abandoned):
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in the future , you should request rescission of the
permit. Do you wish to rescind the permit?
□ Yes □ No
Certification:
"I hereby certify, under penalty oflaw, 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, and complete."
Signature Date
Revised 5/05 GW/UIC-68
CERTIFIED MAX.
NC CENR - Division of Water Duality
Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
_.,EIVEC I DEINR + NQ
JUN 2011 7010 0780 0001 7057 5549
N T, X 2 E 220 3C i
USPMAZE$ .5J,9p
ziP 27667
ow =90
72 06/15/11
RETURN TO SENDER
ATTEMPTED - NOT KNOWN
UNADL.E TO FORWARD
DO ff: 2 76 991 16:3699 I I *aO1 7- +02100-15 -23
-2769901aae 17i1111111]111111#�ii1l�1+1FI�I1�IYlFli�i111111?J111111111I111

■ Complete Items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1 hO e Addressed to:
Richard Turner
164 Cameron Station Boulevard
Alexandria, VA 22304
A. Somituna
x ❑ Agent
❑ Addressee
8. Reosh►ed by (Afrrted Name) I C. Dee of Delivery
D. Is delivery address d'frent from Item 17 ❑ Yes
if YES, enter delivery address below: E3 No
8. Servloe Type
❑ certified Mail 0 Exposes Mail
0 Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Deliver]? 0&0 Fee) ❑ Yes
2. Article Number
(Ransferf mseryloeIaW 7010 U780 0001 7057 5549
PS Form 3811, February 2004 Darrmstla Return Receipt 10259542-M-1W

Alexandria, VA 1164 CAMERON STATION 13V, ALEXANDRIA, VA I Property Details Page 1 of 2
4
City of Alexandria, Virginia
•.. - : Department of Reaf Estate Assessments
v: tr
Detailed Property Description
164 CAMERON STATION BV.
ALEXANDRIA, VA
Account Number: 5066639U
Primary Property Class: SEMI-DETACHED HOUSE (110)
General Information & Description
Owner Name:
MESSMAN CLIFFORD A OR KITTIE L
Census Tract:
Legal Description-.
LOT 271B PH 1 CAMERON STATION (D-363)
Explore In Parcel Viewer
301 Icing Street, Ciry Hall, Roam 2600
Alexandria, VA 22314
Tat 703.746,4646
Fax!703.706.3979
[e-mail]
Map•Block-Lot Number' 058.02-04-152
Study Group: 0506
Mailing Address:
164 CAMERON STATION BLVD
ALEXANDRIA VA 223047712
Census Block:
See a Quick Street Map
Assessment Information
Tax Status:
TAXABLE
Assessment Date
Land Value
Building Value
Total Value
0112011
$273.290
$309,162
$682,452
01 /2010
$273.290
$309.154
$582,444
0112009
$276,050
$312,026
$588,076
0112008
$311.384
$338,705
$650,089
0112007
$272,448
$353,202
$625,650
0112006
$316,800
$410,700
$727,500
01 /2005
$226,300
$377,000
$603,300
01 /2004
$196, 800
$303,100
$499.900
01 /2003
$145,800
$288,000
$433,800
01 /2002
$97,200
$260,700
$357, 900
01 /2001
$84,500
$223,300
$307, 800
01 /2000
$84.500
$201,100
$285,600
Sales Information
Sale pate
Sale Price
Grantor
Sale Code
Sale Ref. ID
08/30(2006
$648,000
TURNER RICHARD
B OR CAROLYN S
A
060023413
1210312001
$0
TURNER RICHARD
8 OR CAROLYN S
T
020001305
04111/2001
$0
CAMERON ASSOCIATES LLC
T
010009662
06/22/1999
$290,783
.A
1705-1903
Land Description
Lot Size ISq. Ft.): 1.498 Zoning: CDD# R
Building Description
Year Built: 1999
Construction Quality: GOOD PLUS
Building Condition: VERY GOOD
http://reaiestate.alexandriava.gov/detail_ptint.php?accountno=50668390 6/21 /1-O l l

Alexandria, VA I 164 CAMERON STATION BV, ALEXANDRIA, VA I Property Details Page 2 of2
HVAC: CENTRAL AIR TO AIR
Building Type: TOWNHOUSE 3 1/2 STORY
Ext. Wall Construction: FRAME MASONRY VENEER
Above Grade Living Area (Sq. Ft.): 2,200
Total Basement Area (Sq. Ft.): 400
Full Baths: 3
Fireplace Description: DIRECT VENTED GAS -GOOD
Finished Basement Area (Sq. Ft.): 0
Half Baths: 1
FP Units: 1
There may be additional data for this property; contact Department of Real Estate Assessments for more information.
NOTE: Building area is above grade and does not include basement area.
Document generated for printing on 06/21/2011.
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http://realestate.alexandriava.gov/ detail print. php ?accountno=50668 3 90 6/21/2011
a. TV.L-A.
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
June 8, 2011
# 7010 0780 0001 7057 5549 CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Richard Turner
164 Cameron Station Boulevard
Alexandria, VA 22304 fir`' �X
Subject: Notice of Violation with Intent to Enforce (NOV-241 T-PC-0348)
5QM Geothermal Injection Well
Permit No. W10700095
Beaufort County r'
Dear Mr. Turner:
The above -referenced permit, which was issued /0'you on September 22, 2006, and expires on
September 30, 2011. has not been renewed. This permit was issued for the operation of a 5QM
geothennal injection system on your property located at 128 Providence Place in Chocowinity,
North Carolina.
On May 12, 2011, our office issued you a Notice of Expiration (NOE) and a permit renewal
application package with instructions to submit the necessary paperwork within 30 days of its receipt.
To date, the Groundwater Protection L;nit has not received your completed renewal application
package. In addition, our records do not indicate that the well system has been plugged and
abandoned.
Therefore, the following violation(s) exists:
VIOLATION 1:
Failure to submit a permit renewal request at least. 120 days prior to the permit's expiration date is a
violation of Path. VHl of the permit and 15A NCAC 2C .02116).
REQUIRED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 days of receipt of this letter:
AQ10=9 P7,,DTECTION SECTION
1636 Iola:,wrw serCents', Ral%h- North Garokn 27699-1336
LocatOrC 2726 �iaaitaI Bomevard, Rateigr:. North Caro'ina 2760L
Phan' 919-73' 3221 lFAX 1� 919-715.0586; FAY 2: 919-71`,-504? I; uatome?-Seri kre. 1-877-£23-6748
Intemet: www.ri watermuak.or
011e
N( rth Caron 2a
;,Natal"al4l

1. APPLY FOR PERMIT RENEWAL. When you apply for and receive a
renewal, operation of your well system will be pemutted to continue. As such, all
sampling requirements and any operation and maintenance procedures specified
in your previous permit will be required. To renew, you must submit the
following information to the address below:
a) A completed Application , for Permit (Renewal) to Construct andlor Use a
Well(s) for Injection: with Geothermal Feat Pump System for 7:vpe 5QM
WeII(s) if the injection well system on your property is still active. This form
mast be signed by each property/permit owner.
b) A completed Status of Injection Well System if the injection well system is
inactive or has been temporarily or permanently abandoned,
All forms must be submitted to the following address within 30 days of the receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Centex
Raleigh, NC 27699-1636
Failure to submit these farms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application
and a U1C well system status forth are attached along with a self-addressed envelope. The above
referenced forms are also available on-line at the DWQ website at
Mir:!Ih2 o . enr. state .nc. uslaiisl n-nulfonns. htm.
Thank you in advance for your cooperation and timely response. If you have any questions, please
call Eric G. Smith at 919-715-6196, or email him at eric.a.smnithf&ncdenr.vov.
Sincerely,
Debra I Watts. Supervisor
Groundwater Protection Unit
Enclosures: 1} GPUIUIC 5QM Well Permit Application
2) Status of Injection Well Form
cc: Washington Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10700095 w/o enclosures

U.S. Postal ServicerM
CERTIFIED MAIL., RECEIPT
Ir"
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Lt')
(Domestic Mail Only; No Insurance Coverage Provided)
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□ r-
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C]
C]
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Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
I"'-Total Po-
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$
11 ■-·Ji-..""1 ■-· '•''"' . ' . •H •ii
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Postmark
Here
Richard Turner
Cl SentTo
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C] Street, Ap, r-orPOBox
164 Cameron Station Boulevard
Alexandria, VA 22304
City, SIJJ.le
PS Form 3800, August 2006 Se e Reve rs e fo r Instructions
I
CDGN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Govemor Director
May'.), 2011
Richard Turner
128 Providence Place
Chocowinity, NC 27817
Subject: Notice of Expiration (NOE)
5QM Geothermal Injection Well
Permit No. WIO70OO95
Beaufort County
Dear Mr. Turner:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for
the underground injection well system, which was issued to you on September 22, 2006, and
expires on September 30, 2011, is soon due for renewal, If you wish to keep this permit and
operate the injection well system; the permit must be renewed and issued in your name.
If Your Infection Well is Currentl\- Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The OW-30 and Name/Ownership
Change fortes can be found at httr:llnortal.ncdenr.orziweblw /ai-ts/s*%; faro/r or ine-forms.
If Your Injection Well is Currentlt Active:
If the injection well system is still active and you wish to renew your permit, the renewal
application must be submitted within 120 calendar days of the expiration of your permit,
According to our records, you must submit your permit renewal by June 2. 2011.
A01JIFER PROTECTION SECTION
1636 Mall Saulcs Cente:.. Raleigh, North Carotlna 27HP-1636
Lomfton: 2728 GapRaI Boulevard. Raleigh. North Carolina ZW
Phone: [phone] l FAX 1: 919-7415-059. FAX 2: 91S-715-6048 Customer aemm-. 1-917-6,1 w-748
1Memel, wkW.ncwateroualinv.o ,
An Equal Oppo ,wrote- , Airirne:le A:t;on Employe
On --
Novi Caroiiia
F

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type SQM Well(s) if the injection well system on
your property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
http ://h2o.enr.state.nc .us /aps /gp u/forms.htm.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at eric.2.smith@ncdenr.!!OV.
Sincerely, £ Jj ;aar-
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Washington Regional Office -APS w/o enclosures
APS Central Files -Permit No. WI0700095 w/o enclosures
2
NA
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
June 8, 2011
CERTIFIED MAIL # 7010 0780 0001 7057 5549
RETURN RECEIPT REQUESTED
Richard Turner
164 Cameron Station Boulevard
Alexandria, VA 223 04
Subject: Notice of Violation with Intent to Enforce (NOV-2011-PC-0348)
SQM Geothermal Injection Well
Permit No. WI0700095
Beaufort County
Dear Mr. Turner:
Dee Freeman
Secretary
The above-referenced permit, which was issued to you on September 22, 2006, and expires on
September 30, 2011, has not been renewed . This permit was issued for the operation of a SQM
geothermal injection system on your property located at 128 Providence Place in Chocowinity,
North Carolina.
On May 12, 2011, our office issued you · a Notice of Expiration (NOE) and a permit renewal
application package with instructions to submit the necessary paperwork within 30 days of its receipt.
To date, the Groundwater Protection Unit has not received your completed renewal application
package. In addition, our records do not indicate that the well system has been plugged and
abandoned.
Therefore, the following violation(s) exists:
VIOLATION 1:
Failure to submit a permit renewal request at least 120 days prior to the permit's expiration date is a
violation of Part VIII of the permit and 15A NCAC 2C .021 lG).
RE QUIRED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 davs ofreceipt of this letter:
AQUi FE R PROTECT ION SECT ION
1636 Ma il Service Cente r, Raleigh , Nortl ; Caroli na 27699-1 636
Lccaiion: 2728 Capital Bouievard , Raieig iL No rt r1 Caroli na 27604
Ph one: 919-733-3221 \ FAX 1: 919-71 5-0588; FA X 2: 91 9-7 15-6043 Cusiomer Service: 1-877-623 -fi 74 8
Intern et: www .ncwateraualitv.o rc
An EQ ual (Jppo rL ;::'.; \ .A.fflrma::ve hC1::,n E:mr loye:
None, C 1. .. ortn aro 1na
;JVaturall!I
1. APPLY FOR PERMIT RENEWAL. When you apply for and receive a
renewal, operation of your well system will be permitted to continue. As such, all
sampling requirements and any operation and maintenance procedures specified
in your previous permit will be required. To renew, you must submit the
following information to the address below:
a) A completed Application ,for Permit (Renewal) to Construct andlor Use a
Well(s) for Injection with Geothermal Heat Pump System for l vpe SQM
Well(s) if the injection well system on your property is still active. This form
must be signed by each property/permit owner.
b) A completed Status oflnjection Well System if the injection well system is
inactive or has been temporarily or permanently abandoned.
All forms must be submitted to the following address within 30 days of the receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit.
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application
and a UIC well system status form are attached along with a self-addressed envelope. The above
referenced forms are also available on-line at the DWQ website at
httn:llh2o_enr.state_nc.usi s!ginfo s.htm.
Thank you in advance for your cooperation and timely response. If you have any questions.. please
call Eric G. Smith at 919-715-6196, or email him at eric.ry.smith(a_�ncdenr.gov.
Sincerely,
Debra J, Watts, Supmisor
Groundwater Protection Unit
Enclosures: 1 ) GPUIUIC 5QM Well Permit Application
2 j Status of Injection Well Form
cc: Washington Regional Office - APS w/o enclosures
APS Central Files - Permit No.'Ar10700095 w/o enclosures

Page 1 of 1
Site; LOT 370 CYPRESS LANDING
6
_ r
Property Details:
PIN
1115012856
JIGPIN
568440-0499
GPINLONG
5684-40-0499
NAME1
TURNER RIC€1ARD B
NAME2
TURNER CAROLYN 5
ADDR1
164 CAMERON STATION BLVD
ADDR2
ICITY
ALEXANDRIA
STATE
I VA
ZIP
22304
PROP ROAD
PROVIDENCE PLACE
�JJACRES
i o
ACCT NBR
103967
IIfIAP SHEET
F568403
NBR BLDG
2
DATE
6/15/1999
d6 PG
11114010140
LAND—VAL
75000
BLDG VAL
479962
QEFR VAL =10
TOT VAL
554962
NBHD_CDE
JCYPRS
NBHD_DESC
CYPRES LANDIN
5U6_CDE
11788
SUB DESC
CYPRESS LANDING PRASE
I STAMPS
120
SALE PRICE
60000
ZONE
112
LAND USE
I DISTRICT
PROP DESC
LOT 371) CYPRESS LANDING
=IMBL
56740094
EXMPT PROP
EXMPT AMT
0
ROAD TYPE
P
CENSUS BLK
PREVASSESS
0
DISCLAIM ER: These maps and Information either in digital or hardcopy format are provided solely as a public service and they do not meet surveying accuracy Standards- This snap
data is Prepared from the inventory of real property found within this jurisdiction and is compiled from recorded deeds. plats, and other public records and data. Users of any maps
generated on this site are hereby notified that the aforemenfioned public primary information sources should be cwtsulted for verification of the information contained on any maps- Tne
county or Beaufort assumes no Iagal responsibitfy for the information contained on these maps.
http:liwww2 ,undersys. cam/scripts/testadv/usiwebbpd.dlllusi?formis=ptmap&MouseX=32... 5/ 12/2011

AVA
HCDENR
North Caroiina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Richard Turner
164 Cameron Station Boulevard
Alexandria, VA 22304
Coleen H. Sullins
Director
May 12, 2011
Subject: Notice of Expiration (NOE)
SQM Geothermal Injection Well
Permit No. WI0700095
Beaufort County
Dear Mr. Turner:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for
the underground injection well system located on your property at 128 Providence Place in
Chocowinity, North Carolina, which was issued to you on September 22, 2006, and expires on
September 30, 2011, is soon due for renewal. If you wish to keep this permit and operate the
injection well system, the permit must be renewed and issued in your name.
If Your In jection Well is Currentl v Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at htm://portal.ncdenr.org/web/wg/an s/2:\vpro/reoorting-forms.
IfYour In jection Well is Currentl Active:
If the. injection well system is still active and you wish to renew your permit, the renewal
application must be submitted within 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by June 2 . 2011.
AQUIFER PROTECTION SECTION
16361\!ia:t Service Center, Raleigh, l~orth Carolina 27699-1636
Locaiion: 2728 Capital Bouievard. Raieig\ North Carolina 27604
Pnone: 919-733-3221 \ FAX 1: 919-715-0588; FP,X 2: 919-,E;-6048 \ Customer Service: 1-877-623-674G
internet: www.ncwaterauality.org
i,r: Eou2I (Jppo~i :Jr::.✓ \ Af..'. .. na~ive Act:on Empioyf.r
NifrhCarolina
lvatura!z!f
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (ICAC) Title 15A, Subchapter ZC, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct andlor Use a Rrell(s) for Injection with
Geothermal heat Pump System for Type 5QM Wells) if the injection well system on
your property is still active.
-OR-
B. Status of Injection Well .System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-163 6
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
htti�: //li2o. enr.state _nc.usi ar,s/ �� i-iu/forms.htm.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at eric.2.smithrncdenr._ov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
CC. Washington Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10700095 w/o enclosures

-'WA
NCD ENR
North Carolina Department of Env ironment and Natu ral Resources
Divisio n of Wate r Quali ty
Beverly Eaves Perdue
Go vernor
Richard Turner
128 Providence Place
Chocowinity, NC 27817
Coleen H. Sullins
Director
May 2, 2011
Subject: Notice of Expiration (NOE)
SQM Geothermal Injection Well
Permit No. WI0700095
Beaufort County
Dear Mr. Turner:
Dee Freema n
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for
the underground injection well system, which was issued to you on September 22, 2006, and
expires on September 30, 2011, is soon due for renewal. If you wish to keep this permit and
operate the injection well system~ the permit must be renewed and issued in your name.
If Your In jection Well is Currentl Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http ://n ortal.ncdenr.or!!/web/w g/aus /1.!Wpro /ren ortin ~-forms.
IfYour In jection Well is Currentlv Active:
If the injection well system is still active and you wish to renew your .permit, the renewal
application must be submitted within 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by June 2. 2011.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh , North Carolina 27699-1636
Locaiion: 2728 Capital Boulevard. Raleigh. North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Customer Serv:ce: 1-877-623-6748
ln:ernet: www.ncwatero ualin· .oro
An Equal Opporiunit;· \ Affirmative Action Employer
.O ne ., ....... . N ortn carohna 'i\." • ,f, ,/ ,1atura,tt1
'"'
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title I SA, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type 5QM Well(s) if the injection well system on
your property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
http ://h2o.enr.state.nc.us/ap s/grm/forms.htm.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at e1;c.2:.smith@ncdenr.!!OV.
Sincerely,
£ Jj}m~
Eric G. Smith, P.G.
Hydro geologist
Enclosures .
cc: Washington Regional Office -APS w/o enclosures
APS Central Files -Permit No. WI0700095 w/o enclosures
2
:>
Mechanical Integrity Test Record
(For 5QM Geothermal Heat Pump Injection Well System)
-,�Owner/PermitteeName: + 11 Per -it Number. WI
Facility Address: e;,,
Home Phone: 77v - gC_ �, - CC S 1 Cell Phos
Heat Pump Contractor Name:
t]#Tice Phone: Ce_1 Phoi
Tester Name: L r Q . _e�-- Signature: _
Date of "Test• 1�
awrr.
Lao
Ioii W Preasm a !q
FhW Pv=&ure
Dantim mine es
Pan es or Nu
2
3
4
5
6
7
S
9
10
17
11
12
13
14
15
Any additional loth testing add to hack of this form
Comments:
Other Test Methods and Results:
This farm must be Bed out and signed by the fester. The record must be received by Aquifer Pmtection Section 24 fours
prior to the initiation of the operation of the facility. You can send the form by mail: UIC Program, Mail Service Center 1636,
Raleigh, NC 27699 or by fax: [phone],
Kr_t,L LD i DENR I U"U
Mechanical Integrity Test Form i 1/2007 Aquifer Protection SRction
JAN 2 9 2009

... ~ ....
-r • -4 f r '-i ,_, .'( ( r--, .....
0 Ee._.'·,
-..•
-, -
ncorporated
Mr. Michael Rogers,
Please find the following Mechanical Integrity Test Records and triangulation maps for the following
projects. l will be sending you another packet of the remaining 07 and 08 projects at my soonest
convenience. Thank you for your patience and help on this matter.
• WIO0800137
• WIO500157
• WIO500161
• WIO500162
• WO500169
• WIO700107
• WIO700096
• WIO500143
• WIO700093
• WIO700095
• WIO500185 -not included on permit list.
Best Regards,
/;~ /.I/ 1" -· I (,t//C, i.,tA.-/
Anna Jeffreys
Administrative Assistant
Home Energy Inc.
302 E Third Street • Wendell. r ~--
, t -....... , -
RECEIVED / DENR / o~a
Aquifer Protection Section
JAN 2 9 2009
�I�Dw �r �d l-z —
List of Issued Permits to Home Energy, Inc.
Permit No, Name
W10400082 Braden
W100800137 Pantgut6
W10500145 Clark
W10800140 Belanger
W10500157 S. Martin
W10100086 Combs
W10700105 Cherrill[�
W10500161 Stein
W10500162 Lauer
W10500163 Blachowicz
W10500166
W10500169 Maloney
W10700107 Latta
W10800150 Duan
W10500171 ENT Audiology
W10500170 Griffin
W10700094 Harris
W10800136 Jefferson
W10500139 Essick
WIO$00135 Wilson
W10700096 Stolar V
WID500143 Kahn /
W10700093 Young i/ /
W10700095 Turner
W10500173 Bell
W10500174 Wilson Community College
j
November 20, 2007
Heat Pump Contractor
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Monte Jefferson
Date Permit Issued
11/20/2006
11122J2006
10/9/2006
2/13/2007
3/9/2007
411812007
5/17/2007
6/27/2007
7/6/2007
812012007
811712007
10/12/2007
9/2112007
9/20/2007
9/20/2007
10111 /2007
7/30/2006
911212006
11612 006
9/12/2006
9/22/2006
8/412006
7/3/2006
912212006
not permitted as of 11/20107
11 /20/2007
RECEIVED I DENR I DVVQ
Agijifar Protection 5ectior
JAIL 29 2009

F WATFR
Michael F. @alley, Governor
r William G. Ross Jr., Secretary
rNorth Carolisia DLpautnent of Environment and Natural Resources
Coleen Sullins, Director
Division of Water Quality
November 27, 2007
Monte Jefferson
Horne Energy, Inc.
P❑ Sox 238
Wendell, NC 27591
Subject. Geothermal Well Installation Data
Dear Mr. Jefferson:
In review of our records concerning closed -loop geothermal mixed -fluid injection well systems,
classified as 5QM type permits, we have found the following records have not been submitted
for permits where your company is listed as the heat pump installers:
• Well Construction Record (GVLW-1)
• Triangulation Data
• Well ID plate installation date
• Mechanical Integrity Pressure testing data (if available)
In order to assist your clients (those who hold 5QM permits) in meeting the condition of their
permits, Home Energy, Inc. (specifically Brad Scheel) has agreed to provide the above
information no later than December 27, 2007. For future reference, as we discussed November
14, 2007, we recommend you provide this information to your clients as soon as construction is
complete to assist them in meeting the condition of their permits. Also, please remember their
permits require them to keep this information on -site as well.
To assist you, we have attached a list of permits where you are listed as the heat pump installer.
We have also attached a form to fill out the results of your mechanical integrity tests. Thank you
in advance for your cooperation and timely response. If you have any questions regarding this
letter, please call me at [phone] or Michael Rogers at [phone].
Sincerely,
Debra J. Watts
Environmental Supervisor
Groundwater Protection Unit
Attachment(s)
cc: APS Central Files (copy to each permit file on attached list)
AquiferProtecticm Section 1636 Mail Service Center
Internet: www.ncwatergnalily.arg Location: 2728 Capital Boulevard
An Equal OpportunitylAfhrmatwe Aetlon Empboyer— 50% Recycled IO% Post Consumer Paper
Natutrn!! Jg
Raleigh., TIC 27699-1636 'Telephone-- [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

List of Issued Permits to Home Energy, Inc.
Permit No. Name Heat Pump Contractor Date Permit Issued
WI0400082 Braden Monte Jefferson 11/20/2006
WI00800137 Panigutti Monte Jefferson 11/22/2006
WI0500145 Clark Monte Jefferson 10/9/2006
WI0800140 Belanger Monte Jefferson 2/13/2007
Vl/10500157 S. Martin Monte Jefferson 3/9/2007
WI0100086 Combs Monte Jefferson 4/18/2007
WI0700105 Cherrillo Monte Jefferson 5/17/2007
WI0500161 Stein Monte Jefferson 6/27/2007
WI0500162 Lauer Monte Jefferson 7/6/2007
WI0500163 Blachowicz Monte Jefferson 8/20/2007
WI0500166 Manning Monte Jefferson 8/17/2007
WI0500169 Maloney Monte Jefferson 10/12/2007
WI0700107 Latta Monte Jefferson 9/21/2007
WI0800150 Duan Monte Jefferson 9/20/2007
WI0500171 ENT Audiology Monte Jefferson 9/20/2007
WI0500170 Griffin Monte Jefferson 10/11/2007
WI0700094 Harris Monte Jefferson 7/30/2006
WI0800136 Jefferson Monte Jefferson 9/12/2006
WI0500139 Essick Monte Jefferson 1/6/2006
WI0800135 Wilson Monte Jefferson 9/12/2006
WI0700096 Stolar Monte Jefferson 9/22/2006
WI0500143 Kahn Monte Jefferson 8/4/2006
WI0700093 Young Monte Jefferson 7/3/2006
WI0700095 Turner Monte Jefferson 9/22/2006
WI0500173 Bell Monte Jefferson not permitted as of 11/20/07
WI0500174 Wilson Community College Monte Jefferson 11/20/2007
November 20, 2007
Mechanical Integrity Test Record
(For SQM Geothermal Heat Pump Injection Well System)
Owner/Permittee Name: Permit Number: WI ------------------'-'--'a,__ _____ _
Facility Address: ______________________________ _
Home Phone: Cell Phone:
Heat Pump Contractor Name: ___________________________ _
Office Phone: Cell Phone: -----------------==-=--===-'--------------
Tester Name: _______________ Signature: _______________ _
Date of Test: --------
Loop Initial Pressure (p si) Final Pressure (p si) Duration (minutes)
1
2
3
4
5
6 .
7
8
9
10
11
12
13
14
15
Any additional loop testing add to back of this form
Comments:
Pass (Yes or No)
----------------------------------
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24 hours
prior to the initiation of the operation of the facility. You can send the form by mail: me Program, Mail Service Center 1636,
Raleigh, NC 27699 or by fax: [phone].
Mechanical Integrity Test Form 11/2007
September 25, 2006
Carolyn &Richard Turner
c/o Monte Jefferson
Home Energy, Inc.
P.O. Box 238
Wendell, NC 27591
I079uiWOTaluvra Pro, -
Michael F. Easley, Governor
Wifliam G. Ross Jr., secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Ref: Issuance of Injection Well Permit
Permit # W10700095
Carolyn & Richard 'Turner
In accordance with your application submitted on July 6, 2006, 1 am forwarding Permit
#WI0700095 for the operation of a vertical closed -loop geothermal mixed -fluid heat pump
injection well system to be located at 128 Providence Place (Lot 4370) in Chocowinity, Beaufort
County, North Carolina. This permit shall be effective from the date of Issuance until
September 30, 2011 and shall be subject to the conditions and limitations stated therein.
Pay special attention to the well construction standards in Parts I and H of your permit.
You shall notify this office at least 48 hours prior to beginning construction and at least 24 hours
prior to initiating operation of the injection well system.
In order to continue uninterrupted legal use of this well for the stated purpose you should submit
an application to renew the permit three months prior to its expiration date. As indicated in the
permit, this permit is not transferable to any person without prior notice to, and approval by, the
Director of the Division of Water Quality.
If you have any questions regarding your permit or the Underground Injection Control Program
please tali Mr. Qu Qi at [phone] or Mike Rogers at [phone].
Best Regards,
Thomas Slusser, L.G.
Environmental Specialist Ill
cc: David May, Washington Regional Office
WI0700095 permit file
Enclosure
i��hCaro ina
r1YQillra�ltf
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internet: hgpJ/www.ncwatcrqua fty_nrs 2728 Capital Boulevard Raleigh, NC 27604
An Equal OpportunilylASlrrmaGve Action Employer— 50% RecycledhO% fast Consumer Paper
Telephone: [phone]
Fax 1: [phone]
Fax 2: [phone]
Custamer Service: [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other
applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Le�IS�'J�y��I•_�i�l�J�1�7i��►��f�R�
FOR THE CONSTRUCTION AND OPERATION OF 15 TYPE 5QM INJECTION WELLS,
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed -loop geothermal -mixed -fluid heat pump system.
This system is located at 128 Pro�°idence Place (Lot 370) in Chocowinity, Beaufort County, North
Carolina, and will he constructed and operated in accordance with the application submitted July 6,
2006, and in conformity with the specifications and supporting data submitted, all ofwhich are filed
with the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation only and does not waive any provisions of the Water
Use Actor any other applicable Laws, Rules, or Regulations. Operation and use of an injection well
shall be in compliance with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and
any other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until September 30, 2011
and shall be subject to the specified conditions and limitations set forth in Parts I through X hereof.
Permit issued this the :Z2� day of iwkxf' . 2006.
IrAlan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission,
Permit No. W10700095 PAGE 1 4F 7
GWAJIC-5 ver. 9106

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 in jection well shall not be located in an area generally sub ject to floodin g. Areas that are
generally _subject to flooding include those with concave slope, alluvial or colluvial soils,
gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use.
Each well shall be permanently labeled with a warning that it is for injection purposes and the
entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction
and use.
7. Each injection well shall have permanently affixed an identification plate.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to: DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff, 1636 Mail
Service Center, Raleigh, NC 27699-1636, within 30 days of completion of well construction.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the permittee or his agent shall test the pH of the
soil at a depth of three feet at the planned well location. If the resulting soil pH is less than 6
standard units or greater than 11 standard units, the well system shall be equipped with a
compatible cathodic protection system. All testing results shall be kept on site available for
inspection.
2. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff,
telephone number [phone] and the Washington Regional Office Aquifer Protection
Section Staff, telephone number [phone].
3. All underground tubing shall be refrigeration grade copper tubing.
PermitNo. WI0700095
GW/UIC-5 ver. 9/06
PAGE20F7
4. Prior to installation, all tubing to be placed in boreholes ("loops") shall be checked for leaks by
pressurizing the loop to a gage pressure of at least 350 pounds per square inch (psig), immersing
the loop in water and examining it for leaks. Loops with leaks shall not be installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents, and
scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop by the
manufacturer before shipping is still present at a pressure of at least 300 psig. The loop
manufacturer shall be notified in the event of damage or pressure loss, and the manufacturer's
instructions shall then be followed. The nitrogen charge may be released only when the loop is
installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting.
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A North
Carolina Administrative Code 2C .0100) shall be pumped via tremie pipe into the annular space
of each borehole so as to completely fill it from bottom to top.
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material shall
have a galvanic potential as close as practicable to that of the tubing material.
9. Dry-nitrogen shall be circulatea through the tubing during hraiing to prevent oxidation;
10. After installation and prior to operation of the system, a mechanical integrity test shall be
conducted by pressurizing the injection well system to 400 psig with dry nitrogen and monitoring
for leaks using an ultrasonic or other leak detector of equal sensitivity and monitoring pressure in
the system for at least 2 hours. Alternatively, an equivalent vacuum test is acceptable. Any
pressure fluctuation other than that due to thermal expansion and contraction of the testing
medium shall be considered a failed mechanical integrity test. Any leaks shall be located and
repaired prior to charging the system with refrigerant. A co py of the post-installation pressure or
vacuum test record (initial pressure readin g, final pressure readin g, and the duration of the test)
shall be submitted to the A quifer Protection Section. The test records must be received b y the
A quifer Protection Section at least twenty-four (24 ) hours prior to the initiation of the o peration
of the facilit y for injection.
11. The location of each of the system manifolds shall be recorded by triangulation from two
permanent features on the site (e.g., building foundation comers). The permittee shall retain a
copy of the triangulation records. The pem1ittee shall also submit a copy of the triangulation
records to the Aquifer Protection Section within 30 days of completion of well construction.
12. The written documentation re quired in Part II , paragraphs (10) and (11) shall be submitted to:
PermitNo. WI0700095
GW/UIC-5
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
ver. 9/06
PAGE3 OF7
PART III -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to change
ownership, or there is a name change of the Permittee, a formal permit amendment request
must be submitted to the Director, including any supporting materials as may be appropriate, at
least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying
with any and all statutes, rules, regulations, or ordinances which may be imposed by other
local, state, and federal agencies which have jurisdiction. Furthermore, the issuance of this
permit does not imply that all regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is
no contamination of groundwater that will render it unsatisfactory for normal use. In the event
that the facility fails to perform satisfactorily, including the creation of nuisance conditions or
failure of the injection zone to adequately assimilate the injected fluid, the Permittee shall take
immediate corrective actions including those actions that may be required by the Division of
Water Quality such as the repair, modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if
compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to
surface or groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of
any planned physical alterations or additions in the permitted facility or activity not
specifically authorized by the permit.
3. At least forty-eight (24) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section's
Underground Injection Control (UIC) Program Central Office staff, telephone number (919)
715-6935. 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 .
Permit No. WI0700095
GW/UIC-5 ver. 9/06
PAGE40F7
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may,
upon presentation of credentials, enter and inspect any property, premises, or place on or
related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained under
the terms and conditions of this permit, and may obtain samples of groundwater, surface water,
or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided for in
N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with
the injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by
the Division of Water Quality to insure surface and ground water protection, will be
established and an acceptabi~ 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 Washington Regional Office, telephone number [phone], any
of the following:
(A) Any occurrence at the injection facility that results m any unusual operating
circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of
proper injection operations, such as mechanical or electrical failures;
(C) Any loss ofrefrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
3. Where the Pem1ittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to the
Director, the relevant and correct facts or information shall be promptly submitted to the
Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
Permit No. WI0700095
GW/UIC-5 ver. 9/06
PAGES OF7
PART VIII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an
injection well. Such a change would include the discontinued use of a well for injection. If a
well is taken completely out of service temporarily, the Permittee must install a sanitary seal.
If a well is not to be used for any purpose that well must be permanently abandoned according
to 15A NCAC 2C .0213(h)(l), Well Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose,
the Permittee shall abandon that injection well in accordance with the procedures specified in
15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment
procedures if the Director finds such removal will not be responsible for, or
contribute to, the contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have not
been removed, the casing shall be perforated opposite the gravel pack, at
intervals not exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner that
will prevent the movement of fluids into or between underground sources of
drinking water and in accordance with the terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as
specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion of
abandonment.
Permit No. WI0700095
GW/UIC-5 ver. 9/06
PAGE 6 OF 7
.,_
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART X-PERMIT SPECIAL CONDITIONS
1. If the distance between any structural foundations and injection wells is less than 25 feet, then
this distance shall be maximized as much as possible.
2. One well identification plate shall be prepared for each injection well cluster and permanently
affixed in a clearly visible location to the exterior of the heating and cooling system or other
permanent fixture. The identification plate shall include geographic coordinates in order to
provide a permanent record of the locations of the injection wells.
3. The permittee shall submit within 30 days after construction a map showing the as-built locations
of all injection wells plus pertinent system and site information. This information is to be
submitted to the address listed in Part IX, Item #3, above.
Permit No. WI0700095
GW/UIC-5 ver. 9/06
PAGE70F7
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: August 28. 2005 County: Beaufort
To: Aquifer Protection Section Central Office Permittee: Richard and Carolvn Turner
Central Office Reviewer: T. Slusser Project Name: Richard & Carolyn Turner SFR
Regional Login No: Application No.: W10700095
I. GENERAL INFORMATION
1. This application is (check all that apply): ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Rernediation E Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: _qg st IT 2006
b. Person contacted and contact information: NIA
c. Site visit conducted by: Will Hart
d. Inspection Report Attached: ® Yes or ❑ No.
2. Is the following information entered into the RIMS record for this application correct?
N Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For Disposal and Infection Sites:
{If multiple sites either indicate which sites the information_V 1p les to. col and paste a new section into the
document for each site. or attach additional Pat4es for each site
a. Location(s):
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
IL NEWAND MAJOR MODIITCATIONAPPLICATIONS (this section not needed-lor renewals or minor
mndilicutinns, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: NIA
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORMW Richard & Carolyn Turner SFR 1
7.

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
D Yes D No [gl NI A. If no, please explain: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil s.cientist and/or Professional Engineer? [8:1 Yes D No D N/ A. If no, please explain: __
4. Poes the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? i:gj
Yes D No D N/ A. If no, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. D Yes D No i:gj
NIA. Ifno, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No i:gj NI A. If no, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No i:gj NI A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or~ No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No [8:1 NIA. Attach map of existing monitoring well
network if applicable . Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No [gl NIA If yes, attach list of sites
with restrictions (Certification B?)
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells .)
Description Of Well (S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
D Heating/cooling water return flow (5A7)
i:gj Closed-loop heat pump system (5QM/5QW)
□ In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes ~ No
3. Are there any potential pollution sources that may affect injection? D Yes ~ No
FORM: Richard & Carolyn Turner SFR 2
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
What is/are the pollution source( s )? --"""''-Wh"""""=a=t =is~t=h=e~d=is=ta=n=c=e~o=f--"th=e~in=je=c=tt=· o=n~w'""'e=l=l{=s .... ) =fr=o=m~t=h=e_.p=o=ll=u=ti=on=
source(s)? ft.
4 . What is the minimum distance of proposed injection wells from the property boundary? 25 ft.
5 . Quality of drainage at site: D Good [8J Adequate D Poor
6 . Flooding potential of site: · D Low [8J Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: NI A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [8J Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.: The application indicates that there ,
are at this time, two possible l9cations for the injection well system. Upon review of the site, the location
between the residence and Providence Place appears to be more suitable.
2. Attach Well Construction Data Sheet -if needed information is available
3 . Do you foresee any problems with issuance/renewal of this permit? D Yes [8J No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
The applicant should provide the number of The application states the number of borings will
borings prior to issuance of the permit. be "10-15." w?ll JJu~ I 5.-
The location of the injection well system The proposed location to the rear of the residence
should be indicated prior to issuance of the lies in a topographic low; and may be subject to
permit. ponding and/ or conveyance of runoff during a
precipitation event. J{t! 14 .)J -fr,;; .... ~ y~vr-d
b''"-r /'1 u, 1-e
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
FORM: Richard & Carolyn Turner SFR 3
'i/1 ~/,;,,t-., a 'L
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
b. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition
Reason
The distance from the structure foundation and
Wells are to be installed in a circular pattern
"cluster" of wells will be maximized, if less than
based on the manufacturer's design
25 feet.
recommendations. Due to site conditions, it
may not be possible to meet the 25 feet setback
to the building foundation for all wells. The
proposed wells will be grouted the full length of
the boring, which should minimize any
groundwater impacts due to well construction.
One well identification tag per "cluster" of wells
Compliance with 15A NCAC 2C _0213 (g).
shall be permanently affixed to the exterior of
the structure or heating and cooling unit, in a
clearly visible location and in close proximity to
the well "cluster."
The applicant must submit accurate site
Drawings may be required to locate well heads
drawings showing the location of wells, and
in the future.
other pertinent information, pending
installation.
W_ 1 'r
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; N Issue upon receipt of needed additional information; ❑
Issue: n Deny. If deny, please state preaso :
S. Signature of report preparer(s):
Signature of APS regionalssupervison
Date:
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
ss.0"t
FORM: Richard & Carolyn Turner SFR 4

Permit: WI0700095
SOC:
County: Beaufort
Region: Washington
Effective:
Effective:
Contact Person: Richard Turner
Directions to Facility:
Compliance Inspection Report
Expiration:
Expiration:
Owner: Richard Turner
Facility: Richard & Carolyn Turner SFR
128 Providence
Chocowinity NC 27817
Phone: [phone]
Take NC Highway 33 east from Chocowinity, NC . Take left fork onto Old Blounts Creek Road. Continue past first entrance to Cypress
Landing Subdivision (on left}. Turn left onto Potomac Dr. and continue. Turn right onto Providence Place (128)
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
On-site representative
24 hour contact name
Related Permits:
Inspection Date: 08/17/2006
Primary Inspector:
Secondary lnspector(s):
Will T Hart
Richard Turner
Richard Turner
Entry Time: 03:00 PM
Certification:
Exit Time: 04:00 PM
Phone:
Phone: [phone]
Phone: [phone]
Phone:
Phone:
Reason for Inspection: Other Inspection Type: Reconnaissance
Permit Inspection Type: Injection Mixed Fluid GSHP Well System (5QM}
Facility Status: 0 Compliant O Not Compliant
Question Areas:
■Other
(See attachment summary)
Page : 1
Permit: WI0700095
Inspection Date: 08/17/2006
Inspection Summary:
Owner -Facility: Richard Turner
Inspection Type: Reconnaissance Reason for Visit: 0th.er
Site inspection was conducted as part of application review. Area to the rear of the residence lies in a topographic low,
which may be subject to ponding and/or runoff. Location between residenc and Providence Place appears to be more
suitable location for system, though space may be lacking.
Other
Comment:
Yes No NA NE
Page: 2
OFW A7E
y Micliael F. F-asiey, Governor
William 0. Ross Jr„ Secretary
North Carolina Department of Fnviranment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
July 12, 2006
Richard & Carolyn Turner
c/o Home Energy, Inc.
P.O. Box 238
Wendell, NC 27591
Subject; Acknowledgement of Application No. WI0700095
Richard & Carolyn Turner SFR
Injection Mixed Fluid GSI P Well System (5QM)
Beaufort County
Dear Mr. & Mrs. Turner --
The Aquifer Protection Section (APS) of the Division of Water Quality (DWQ) acknowledges the receipt
of your permit application package on July 12, 2006. This application has been assigned the number
listed above and will be reviewed by Thomas Slusser.
The reviewer will perform a detailed review of your application package and, if necessary, may request
additional information relevant to the permitting process. To expedite the processing of your permit
application, the APS requests your prompt and complete response to any additional information requests.
Please be aware that DWQ's Washington Regional Office must provide its approval prior to the issuance
of the proposed permit.
If you have any questions, please call Thomas Slusser at [phone], or email him at
Th o m as. S 1 uss er' n`ricm ai 1. net.
PLEASE REFER TO THE SUBJECT APPLICATION NUMBER WHEN MAKING INQU RIES
ON T M PROJECT.
Sincerely,
for Debra J. Watts, Supervisor
Groundwater Protection Unit
cc: Home Energy, Inc. - Monte Jefferson
Washington Regional Office - APS
APS Central Files
Aqui%r Protection Section 1636 Mail Service Center
lntemet: www.ncwaterquality.ore Location- 2728 Capital Boulevard
An Equal 4pportunilylAtfirmative Action Employer— 50% Recycled(10% Past Consumer Paper
t a Carolina
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1- [phone]
Fax 2: [phone]
Customer Service. [phone]

Permit Number WI0700095
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
thomas.slusser
Permitted Flow
Facilit
Facility Name
Richard & Carolyn Turner SFR
Location Address
128 Providence fllacc.,
Chocowinity NC
Owner
Owner Name
Richard
Dates/Events
27817
Turner
Orig Issue App Received Draft Initiated
or~r1Q'6-
1fb~
Re gulated Activities
Outfall
Scheduled
Issuance
Central Files: APS_ SWP_
07/12/06
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Washington
County
Beaufort
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Richard Turner
128 Providence Plt\C,e...,
Chocowinity NC
Public Notice Issue Effective
27817
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
•W1i31�l� 1 �
Date: July 12,200
To: ❑ Landon Davidson, ARO-APS
❑ Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-APS
❑ Jay Zimmerman, RRO-APS
From: Thomas Slusser, , Groundwater Protection Unit
Telephone:. [phone]
EMail.j thomas.slusse cmail.nef
A. Permit Number:. WI0700095
B. Owner: Richard & Carolyn Turner
C. Facilitr/Orseration: Richard & Carolvn Turner SFR
VEST
® David May, WaRO-APS
❑ Charlie Stehman, WiRO-
❑ Sherri Knight, WSRO-A.
Fax: {919]715-0588
ca
"-
C
M
z
q �
z
t�
®
Proposed
❑ Existing ❑ Facility
❑ Operation--)
D. Application:
1. Permit Type: ❑
Animal
❑. Surface hrigation ❑ Reuse
❑ 11-R Infiliratit n
❑
Recycle
❑ I/E Lagoon ❑ GW Remediation (ND)
®
UIC - (5QM) closed loop mixed fluid geothermal
:y
For Residuals:
❑
Land App. ❑ D&M
❑ Surface Div
❑
503 ❑ 503 Exempt
❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod- ❑ Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 15 calendar days, please take the following actions:
® Return a Completed Form APSSRR.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO*.
* Remember that you will be responsible for coordinating site visits, reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: (A v �• � -- ^ _ Date: —
F&M.- APSARR 0-2/06 Page 1 of 1

TO:
A.
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 and SQM Wells
In Accordance with the provisions ofNCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
DIRECT~R, NORTH.gAROLINA DMSION OF WATER QUALITY
DATE: ~ lo , 20 t>l#
SYSTEM CLASSIFICATION Please check column which matches proposed system.
C) o-..
'-c:
Type SA 7 wells iaject water used to provide heating or cooling for structurer
I
.. ' 1
f 'l
(1)
(2)
,::n
Type SQM wells contain a subsurface system of continuous piping, that is ~.,
isolated from the environment and circulates a fluid other than potable water~ ..., '
(3)
This includes systems that circulate additives such as antifreezes and/or corrw on -
inhibitors. _;;..
.i:-
Type SQW wells contain a subsurface system of continuous piping, that is
isolated from the environment and only circulates potable water. H you selected
this well type, then complete form GW-57 CL, Notification Of Intent To
Construct A Closed-Loop Geothermal-Water Only Injection Well System.
' ' .
B. PERMIT APPLICANT
C.
D.
Name: 'Richo.<fl-f Ca~~~
Address: I a f, ?Ro,,,\ b R., (X/
City: C-noeo lDlo,~ State: ~Zip Code:o\ 1S l~owity: 13-ea.u...~
Telephone:nO~J eo.:e-0051
PROPERTY OWNER (if different from applicant)
Name: Seroe.A-sQr~
Address: _______________ _
City: ________ Sate: __ Zip Code: _
Telephone: ________ _
STATUS OF ~PLICANT
Private: --1L._ Federal: __ Commercial:
Mail Permit Care Of:
Home Energy Inc
P.O. Box238
Wendell NC 27591
Email Copy To:
[e-mail]
State: Municipal: __ Native American Lands:
Revised 5/05 GW/UIC-57 HP Page l of 4
E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State. Municipal or Commercial).
Name of Business or Facility:
Address:
City: -
Telephone:
Zip Code: _ County:
F. HEAT PUMP CONTRACTOR DATA
G
Name:
Contact Person:
Address: _�! -
City: Zip Code: oZ-n I county:
Telephone: &(n- L Contact Person:
MkkdAr, of -a.Sa�
INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
�r.
aWELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
T. CONSTRUCTION DATA (check one)
EXISTING WELL being proposed for use as an injection well. Provide the data in
(1) through (7) below to the best of your knowledge. Attach a copy of Form GW-
1 (Well Construction Record) if available.
PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after construction.
(1) Well Drilling Contractor's Name:
NC Contractor Certification number: WC. 2��
(2) Date to be constructed: Number of borings: Q ^ uC
1
Approximate depth of each boring (feet): r] `
(3) Well casing: Is the well(s) cased? ND
(a) YES Its es, then provide ti casing informathi below.
Type; ;Ivized steel `Slack steel Plastic Oth4 (specify)
Casing dFrom �� to fI (T —1 nce to land surlab�)
Casing extet�+4s above ground inches
.ti
(b) NO --
Revised 5105 GWIUIC-57 HP Page 2 of

(4) Grout (material surrounding well casing andlor piping): [['"
(a) Grout type: Cement Bentonite / Other (specify) L kLl
(b) Grouted surface and grout depth (reference to land surface): WL 6n
t/around closed loop piping; from to (feet).
around well casing; from to (feet).
(5) Screens (for Type 5A7 wells)
(a) Depth: From to feet below ground surface.
(6) N- , State Regulati is (Title 15A N"C 2C .0200�uire the pL �ttee to �Zs;�ke provisions
{] for m litoring wellh rocesses. ANqcet on both ent (fluid a ing hea-wi[np) and
r' effluent id being inject into the well) i�(bl.
red. il�there be a��et one-��
(a) the inilue"m line? yes `,ace l effluent line? yes no
(7) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). if Form OW-1 is not available,
provide the data in part K (1) of this application form to the best of your knowledge -
NOTE: THE WELL DRILLIING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXtSTLVG OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEMNS-
J.
PROPOSED OPERATING DATA (for Type 5A7 wells)
(1)
Inje ,tion rate:
Average (daily)
gallons per minute (gpm).
j
1" 1
(2)
Injecti Volume:
Average (daily)
gallons per day (gpd).
(3)
injection-ssure:
Average (daily)
pounds/square inch (psi).
(4)
Injection Temp , ture:
Average (January)
° F, Average (July) F.
K.
INJECTION FLUID DATA
(1) Fluid source (for Type 5A7 wells) If underground, from what depth, formation and type of
rock/sediment unit will the fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth- _ _ __ Formation: Rock/sediment unit-
(2) Chemical Analysis of Source Fluid (for Type 5QM wells)
Provide a complete listing of a]I chemicals added to the circulating }teat transfer fluid:
L. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
M. LOCATION OF WELL{S) Attach two maps.
Revised 5105 GWIUIC-57 HP Page 3 of4

(1) Include a site map (can be drawls) showing: buildings, property lines, surface water bodies,
potential sources of groundwater contamination and the orientation of and distances between
the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet of the geothermal heat pump well system. Label all
features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
N. PERMIT LIST. Attach a list of all pemuts or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
0. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document and all attachments thereto and that, based on my inquiry of
those individuals immediately responsible for obtaining said information, I believe that the
information is true, accurate and complete. i am aware that there are significant penalties, including
the possibility of fines and imprisonment, for submitting false information. I agree to construct,
operate, maintain, repair, and if applicable, abandon the injection well and all related appurtenances in
accordance with the approved specifications and conditions of the Permit."
(Signature of Well 6Aer or Authorized Agent)
If authorized agent is acting on behalf of the welt owner,
please supply a letter signed ly the owner authorizing the above agent
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure tliat the injection walls) conforms to the Well
Construction Standards (Title 15A NCAC 2C .020(fi —
(tiYgnature Of property ez If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Revised 5/05 GWIMC-57 HP Page 4 of 4

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from: 302 east 3rd street Wendell, nc to: 128 providence chocowinity, ne - Google Maps Page 1 of 2
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Start address: 302 E 3rd St
Wendell, NC 27591
End address- 128 Providence PI
Chocowinity, NC 27817
Distance: 87.0 mi (about 2 hours 15 mins)
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®2DO6 Google - Mep d i
s 1.1 Head west from E 3rd St - go 39 ft
2. Turn right at N Hollybrook Rd -go 0.2 mi
3. Turn right at Wendell Blvd - g❑ 1.9 mi
4.;Continue on Mack Todd Rd -go 1.8 mi
S.:Tum right at W Gannon Ave - go 0.5 mi
6. Continue on E Gannon Ave - go 1.3 mi
7. Turn right into the US-264 E entry ramp - go 55 mi
B. Continue on Stantonsburg Rd - go 2.5 mi
9. Turn left at US-13 - go 0.3 mi
10. Bear right at US-13 N - go 96 ft
11. Turn right at Martin Luther King Jr ❑r[W 5th St - go 0.7 mi
12. Turn right at Albemarle Ave - go 0.4 mi
13. Bear left at W 10th St - go 0.3 mi
14. Continue on E 10th St - g❑ 2.3 mi
15. Continue on NC-33 - go 17 mi
16. Turn left at Old Blounts Creek Rd - go 0.1 mi
17. Continue on Old Blount Creek Rd - go 0.8 mi
18. Continue on Old Blounts Creek Rd - go 0.9 mi
NAVTEQTm - -arms of Use
http://maps.google.com/maps?saddr-=302%20east%203rd%20street%20wendeli°/u2C%2Cnc... 7/6/2006

' . from: 302 east 3rd street wendell, nc to: 128 providence chocowinity, nc -Google Maps
: 19.: Tum left at Potomac Dr -go 0.7 mi
, 20 .. Tum right at Providence Pl -go 0.1 mi
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Page2 of2
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road
conditions to differ from the map results.
Map data ©2006 NAVTEQ™
http://maps.google.com/maps?saddr=302%20east°/o203rd%20street%20wendell%2C%20nc... 7/6/2006
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MAP OF PROPERTY OF:
EDDIE WHITE
PROJECT No. 06126
ENGINEERS
PLANNERS
SURVEYORS
LOT 370 JARVIS CONSULTANTS, INC.
CHOCOWINITY TOWNSHIP
BEAUFORT COUNTY, NORTH CAROLINA
DATE: 06-30-08 SCALE: t" + 50'