WI0700145_GEO THERMAL_20120517

Beverly Eaves Perdue
Governor
N A
NCDENR
Nortti Carolina Departmentof Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 17, 2012
Choanoke Area Development Assoc. of NC, Inc.
Post Office Box 530
Rich Square, NC 27869
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0700145
To Whom it May Concern:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http ://portal.ncdenr.om /web/wq/aps.
If you have any questions regarding your current perniit or the rule revisions, please-feetfte~to ---------
contact our underground injection control staff at [phone] .
Sincerely,
Eric G. Smith, P.G.
Hydro geologist
cc : UIC Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone : [phone] \FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity\ Aff;m1alive Action Employer
One North Carolina
/Vatura/!y
Permit Number WI0700145
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Choanoke Area Dev Assc of North Carolina, Inc.
Location Address
'215 W Modlin Rd
Ahoskie
Owner
Owner Name
NC 27910
Choanoke Area Development Association of North Carolina Inc
Dates/Events
Central Files: APS_ SWP_
09/16/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Anna Jeffreys
PO Box 238
Wendell
Major/Minor
Minor
NC
Region
Washington
County
Hertford
Facility Contact Affiliation
Owner Type
Unknown
Owner Affiliation
Tyrone Williams
PO Box 530
Rich Square NC
27591
27869
Orig Issue
09/02/09
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue Effective
09/02/09
Expiration
08/31/14 08/13/09 09/02/09
_R_e_g~u_la_t_e_d_A_c_t_iv_it_ie_s _______________ Re a uested/Received Events
Heat Pump Injection RO staff report requested
RO staff report received
Outfall NULL
Waterbody Name Stream Index Number Current Class
08/19/09
08/24/09
Subbasin
Permit Number WI0700145
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (5QM)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Choanoke Area Dev Assc of North Carolina, Inc.
Location Address
215 W Modlin Rd
Ahoskie
Owner
Owner Name
NC 27910
Central Files: APS_ SWP_
09/11/09
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Anna Jeffreys
PO Box 238
Wendell
Major/Minor
• Minor
NC
Region
Washington
County
Hertford
Facility Contact Affiliation
27591
Choanoke Area Development Association of North Carolina Inc
Owner Type
Unknown
Date s /Ev ents
Orig Issue App Received Draft Initiated
08/13/09
Reg ulated Activities
Heat Pump Injection
Outfall NUL_
Waterbody Name
Scheduled
Issuance
Owner Affiliation
Tyrone Williams
PO Box 530
Rich Square
Public Notice q\i:\OC\
NC
Effective
Re q uested/Received Events
RO staff report requested
RO staff report received
Stream Index Number Current Class
27869
Expiration
~l~1) 'Y
08/19/09
08/24/09
Subbasin
~•:A · ~C DENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
September 2, 2009
Mr. Tyrone Williams , President
Choanoke A.tea Development Association
of North Carolina, Inc.
P.O . Box 530
Rich Square, NC 27869
Re: Issuance of Injection Well Permit
Permit No. WI0700145
Issued. to Choanoke Area Development Associati.on of North Carolina, Inc.
Hertford County
Dear Mr. Williams:
Dee Freeman
Secretary
In accordance with your application received August 13, 2009, I am forwarding Permit No. WI0700145 for the
operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system to be located at 215
West Modlin Road, Ahoskie, Hertford County, NC 27869. This permit shall be effective from the date of
issuance until August 31, 2014, and shall be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. Per Part II paragraph 13, one well
identification tag per 'cluster,. of wells shall be permanently affixed to the heating and cooling unit in a
clearly visible location. In addition, please submit copies of the Well Construction Completion form
(GW-1) after construction as required in Part I paragraph 6.
Please submit the data within 30 calendar days ofreceipt of this letter to the following address:
Aquifer Protection Section (APS)
Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit three months prior to its expiration date. As indicated in the permit, this permit is not
transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone].
Best Regards,
,/t~IZ -
Miehael Rogers, P.G. (NC ZL)
Environmental Specialist
cc: David May -Washington Regional Office
Central Office File -WI0700145
Hertford County Environmental Health Dept.
Home Energy Inc. -Anna Jeffreys (sent USPS and.faxed)
Attachment(s)
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Choanoke Area Development Association of North Carolina, Inc.
FOR THE CONSTRUCTION AND OPERATION OF 70 TYPE SQM INJECTION WELLS, defined in Title
1 SA 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 215 West Modlin
Road, Ahoskie, Hertford County, NC 27869, and will be constructed and operated in accordance with the
application submitted August 13, 2009, and in conformity with the specifications and supporting data
submitted, all of which are filed with the Department of Environment and Natural Resources and are considered
a part of this permit.
This permit is for Construction and Operation of an injection well and shall be in compliance with Title 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 August 31, 2014, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
I ~ Permit issued this the , lJ day of -~!l.,2009.
. ()fyc _::i v:t/t
½oleen H. Sullins, Director
. ~ ~ivision of Water Quality
By Authority of the Environmental Management Commission.
WI0700145 1
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 (ISA NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
6. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to the
Aquifer Protection Section Central Office and the Washington Regional Office within 30 days of
completion of well construction at the addresses below in Part II, paragraph 14. Copies of the GW-1
form(s) shall also be give to the Permittee and retained on-site and available for inspection.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the Permittee or his agent shall test the pH of the soil at a
depth of three feet at the planned well location. If the resulting soil pH is less than 6 standard units or
greater than 11 standard units, the well system shall be equipped with a compatible cathodic protection
system. All testing results shall be kept on site available for inspection.
2. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the Aquifer Protection
Section's Underground Injection Control (UIC) Program Central Office staff, telephone number (919) 715-
6166 and the Washington Regional Office Aquifer Protection Section Staff, telephone number (252) 946-
6481.
3. All underground tubing shall be refrigeration grade copper tubing.
4. Prior to installation, all tu.bing 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.
WI0700145 2
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A North Carolina
Administrative Code 2C .0100) shall be pumped via tremie pipe into the annular space of each -borehole so
as to completely fill it from bottom to top.
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material shall have ._ a
galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
10. After· installation and prior to operation of the system, a mechanical integrity test shall be conducted by
pressurizing the injection well system to 400 psig with dry nitrogen and monitoring for leaks using an
ultrasonic or other leak detector of equal sensitivity and monitoring pressure in the system for at least 2
hours. Alternatively, an equivalent vacuum test is acceptable. Any pressure fluctuation other than that due to
thermal expansion and contraction of the testing medium shall be considered a failed mechanical integrity
test. Any leaks shall be located and repaired prior to charging the system with refrigerant. This testing data
shall be recorded on the attached Mechanical Integrity Test Record Form and-submitted to the Aquifer
Protection Section Central Office and the Washington Regional Office at least 24 (twenty-four) hours prior
to the initiation of the operation of the facility for injection. A copy of this form shall also be retained on-
site for inspection.
11. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation corners) and shown on an updated Site Map. The Permittee
shall retain a copy of this record and submit a copy of the updated map to the Aquifer Protection Section
Central Office and the Washington Regional Office within 30 days of completion of well construction.
12. Boreholes shall not connect separate aquiferswhich have differences in water quality (e.g., shallow surficial
aquifers, saprolite, fractured bedrock, etc.) as specified in 15A NCAC 2C .0213(d)(8)(C) and shall be filled
with bentonite grout from the lowermost water bearing zone to land surface as specified in the permit
application.
13. One well identification tag per 'cluster' of wells shall be permanently affixed to the heating and
cooling unit in a clearly visible location according to 2C .0213(g).
14. All of the documentation referenced above that is required to be submitted shall be sent to:
WI0700145
Aquifer Protection Section -Central Office UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Washington Regional Office
943 W ashin1:,rton Square Mall
Washington, NC 27889
[phone]
3
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 -OPERA TIO NS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight ( 48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
WI0700145 4
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Washington Regional Office, telephone number [phone], 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;
(C) Any loss pf refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEWAL
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:
WI0700145 5
(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.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
WI0700145
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
6
This Page Left Blank
WI0700145 7
Mechanical Integrity Test Record
(For SQM Geothermal Heat Pump Injection Well System)
Owner/Permittee Name: _________ Permit Number: .a..W"""I _____ _
Facility Address: _______________________________ _
Home Phone: Cell Phone:
Heat Pump Contractor Name:
Office Phone: __________________ ....:::Cc.:e=ll....:.P....:.h.:..::o:..:..n=ec:....: _________ _
Tester Name: ________________ Signature: _____________ _
Date of Test: _______ _
Loop Initial Pressure (psi) Final Pressure (psi) Duration (minutes) Pass (Yes or No)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Any additional loop testing add to back of this form
Comments: ______________________________________ _
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24 hours prior to the
initiation of the operation of the facility . You can send the form by mail: IBC Program, Mail Service Center 1636 , Raleigh, NC
27699 or by fax: [phone] .
Loop Initial Pressure (psi) Final Pressure (psi) Duration (minutes) Pass (Yes or No)
I
I
'
AQUIFER PROTECTION SECTION REGIONAL STAFF Rd i mft ~~~jf~~ION
AUG 25 2009
Date: Au g ust 24, 2009 County: Hertford
To: A quifer Protection Section Central Office Permittee: Choanoke
Central Office Reviewer: Michael Rogers Project Name: Choanoke Area Develo pment Assoc. UIC
Regional Login No:___ Application No.: WI0700145
L GENERAL INFORMATION
1. This application is (check all that apply): 1:8] New O Renewal
D Minor Modification D Major Modification
0 Surface Irrigation D Reuse O Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals D Attachment B included D 503 regulated D 503 exempt
D Distribution of Residuals D Surface Disposal
D Closed-loop Groundwater Remediation 1:8] Other Injection Wells (SQM Closed Loop injection -Geothermal)
Was a site visit conducted in order to prepare this report? 1:8] Yes or D No.
a~ Date of site visit: Au gust 24 , 2009
b . Person contacted and contact information : Mr. Monte Jefferson (919.366.0261 )
c. Site visit conducted by: Allen H . Clark.
d. Inspection Report Attached:~ Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
[8] Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
IL NEW AND MAJOR MODIFICATION APPLICATIONS (t his section not needed (or renewals or minor
modifi cations , skip to next section )
Description Of Waste (S) And Facilities
1. Please attach completed rating sheet. Facility Classification : __
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No !ZI NIA. Ifno, please explain: __
3 . Are the new site conditions (soils , topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? !Z1 Ye s D No D NIA. Ifno, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines , wells, surface drainage)?
Yes 1:8'.l No D NIA. Ifno, please explain: __
5. 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: __
FORM: Choanoke Area Development UIC Staff Report Aug 24 2009
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
6. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No 1:8] 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: __
/IL RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or maior modification
s ystems): NIA
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 (SA 7)
1:8] Closed-loop heat pump system (SQM/SQW)
□ In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (SL/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes
3. Are there any potential pollution sources that may affect injection? 1:8] Yes
1:8] No
□No
4. What is the minimum distance of proposed injection wells from the property boundary? 25 ft.
5. Quality of drainage at site: ~ Good D Adequate D Poor
6. Flooding potential of site: ~ Low D Moderate D High
7. Does the map presented represent the actual site (property lines, wells, surface drainage)?~ 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:
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 1:8] 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: None
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: None
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
FORM: Choanoke Area Development UIC Staff Report Aug 24 2009 2
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Condition Reason
One well identification tag per "cluster" of wells In compliance with 15A NCAC 2C .0213(g).
shall be permanently affixed to the heating and
cooling unit, in a clearly visible location.
Applicant must submit accurate site drawings Drawings may be required to locate well heads
showing the locations of wells, and other in the future.
pertinent site information, pending installation.
7 . Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information;
[81 Issue; D Deny . If deny, please state re~"//;" ~
8. Signature of report preparer(s): ----~-----.:--;----------------
Signature of APS regional supervisor: ---;,W,...{ ......,..<'JA'--""'-Pf?b-'--+----"5--+-------------
Date: --'z;,_r-~=~....__.-&f~-
ADDITIONAL REGIONAL STAFF REVIEW ITEMS:
FORM: Choanoke Area Development UIC Staff Report Aug 24 2009 3
WASHINGTON REGIONAL OFFICE - APS SECTION - PHOTOGRAPHIC RECORD
Site Name: Choanoke Area Develo•ment Assoc. Permit #: WI0700145
Site Location 215 Modlin Road Cit /Count : Ahoskie / Hertford Coun
Photographer:
A. Clark
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L. 1
- • -• ;. ' _ •
A +4R
Photographer:
A. Clark
Date:
8/24/2009
Photo Location:
Rear (south side)
of Building
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-
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��
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•''
Date:
8/24/2009
Photo Location:
Front of Building
Photo Direction:,
West
Comments:
Photo Direction:
NW
Comments:
Photographer:
A. Clark
C F4 ;
'•+i -
Photographer:
A. Clark
Date:
8/1412009
Photo Location:
South & West
Inside corner of
Photo Direction:
NE
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digit
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Date:
8124/2009
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Photo Location:
East Side of
Building
Photo Direction:
SW
Comments:
Location of well
group #7, #8, &•
#9
Comments:
Location of well
group #1 #2, #3,
#4, & #5

State of North Carolina cj. wH r�6)
Department of Environment
and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
Division of Water Quality
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mailing Address: 1636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: [phone]
[phone]
Date:
FAX TO: ^: 12• i . ?4 i
FAX NUMBER:
FROM:
PHONE:
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NO. OF PAGES INCLUDING THIS SHEET:
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If you receive this fax by mistake call: Aquifer Protection Section @ 9 i 9-733-3221

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DATE, TIME
FAX NO./NAME
DURATION
PAGE(S)
RESULT
MODE
..
TRANSMISSION VERIFICATION REPORT
08/20 23:09
912529753716
00:01:14
03 DK
STANDARD
TIME 08/20/2009 23:11
NAME NCDE&NR/WATER QUAL
FAX [phone]
TEL [phone]
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: August 19, 2009
1.0: ❑ Landon Davidson, ARO-APS
❑ Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-APS
❑ Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: t919j 715-6166
E-Mail: MichaetRoaersancmail.net
RECEIVED / 0ENR 1 !MOO
AOU FFR.PPr1TFr,TIi)NI SFITroN
AUG 202009
® David May, WaRO-APS
❑ Charlie Stehman, WiRO-APS
❑ Sherri Knight, W-SRO-APS
Fax: [phone]
A. Permit Number: WI 0700145
B. Owner: Choanoke Area Development Assc.
C. Facility/Operation:
® Proposed ❑ Existing
❑ Facility ❑ Operation
D. Application:
I. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
• U IC — 5QM Geothermal well
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 El 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.
NOTE: Monte w/Home Energy is requesting we expedite this permit as construction is set to begin soon.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within, please take the following actions:
® Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCI] .
❑ Issue an Attachment B Certification from the RO,*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above. ll
RO-APS Reviewer; .' ) t to } 1 (fj
,' Date: WI
FORM: APSARR 07/06 Page I of 1

I
~.I\. _;,,1;_>-_ .. _
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
August 18, 2009
Tyrone Williams
Choanoke Area Development Association of NC, Inc
PO Box 530
Rich Square, NC 27869
Subject: Acknowledgement of Application No. WI0700145
Choanoke Area Development (5QM)
Injection Mixed Fluid GSHP Well System (5QM)
Washington
Dear Mr. Williams:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on August 13, 2009. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you .with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 -90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail] . If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to http://h2o.enr.state.nc.us/documents/dwL1 or!!chart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT_.
Sincerely,
O~A.~~
for Debra J. Watts
Supervisor
cc: Washington Regional Office, Aquifer Protection Section
Anna Jeffreys (Horne Energy Inc -PO Box 238, Wendell, NC 27591)
Permit Application File WI0700,45
AQUIFER PROTECTION SECTION
1636 Mail Service Genier , 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
Internet: www.ncwaterauali tv .o rn
An Equal Oppori.mit:t \ Affirmative Action Employer
N~rthCarolina
Natural/11
Mug, IC Oa 01.,lor
OilrUO„Vf\c rlr cv DcrcIulrumwir COC a000044
04/LI V LU ► i.Yt *(1' Ltd
Aquifer Protection Section
AUG 13 2009
N J(-)lt'i l-1 t:ARO1.1NA
0LP.ARTM7NT OF LWVIRON MINT AND NATURA.E. RE:SOU lkCIzti I NCI)ENRf
APPLICATION 7t PERMIT TO CONSTRUCT AMOR USE A WELL(S) T'OR
INJECTION WITH. A GEO11Ifl MAL. FIF.AT tl iN1Y SYSTEM f OR:
TYPE SOM WPLL(S)
New Permit Application OR Renewal (cheek one)
DATE; `� , 20 01
PERMIT NO. _(leave blank if NEW permit application)
A. 1''ROPERTY O►vNER(S)/A1PPI.MCANT(S)
Lig each Property Owner listed on property deed (if uwned by it business or I;overnrrrent agency, state name or
corky a representative wl:suthority for siJ,tiuIun ): Choanoke Area Dcv& I pmcnt Association
of North Carolina, Inc.
(I) Mailing AkitimxC: P 0 Box 530
City: R3alo Square State: NC.. lip Code: 27869 County:- Nor Cllanrpton
Row/Office Tole 'No.: 252-539-4155 cc!! -No,: 252--578-0224
EMAIL Address: 34urfaC°OnC-Cua:7. org
(2) Pilyr cal Address of'Site (if different than above):
215 West NOd1in Road ( T'
city: Ahoskic times`: NC rip Coda: , 2 "; ? G tS y: lice• t fni
HometOYlice Tele No.: _252 539-4155 C;�l1 j+�y,: 252-578-0224
EMAIL Addrens: asurfaceene—cada.org
t!. AI,i7"RORIJC17 AGENT Olr OWNER, I1N ANY (if the Permit Applicant doe8 n:ol own ibe subject properiy,
clinch a Woe(' from ihu'propeAty owncr nodiorizing Agent to install and operate UC(: wail)
Company Naga::
C7usii,iet Person: FNMA#F_ Aritlracy:
Addfc.v:
Slate: Zip C:ode; County:
O 1ice Tetc No.: Ca No,:
website AsItAress of Company, ifitny:
C. STATUS OF AI'PL1CANT
Private! Federal:
Stale; Municipal;
D. WELT. ',HILLER JNFORM,4'I'ION
Commercial:?(
Native A.mcricun Labels:
Oplinilf f)M Iv Prnuli Applki ticn [ReviLCA 7/2SI ) Ntel

nos lc oa o-r. sae
ci.a.oTiaJne eye eo a�yrsa.r. -•' •'a C0C 000co-to p.a
('iuiipmsy Name: !logic finerey
Weil Drilling C{}irtt'.ee:le)r's Naive: Williism B. 7cffcr1' n
NC Contractor' Cortilie aJon No,: 397 t-A
Contact Petrnon: Anna Jc.il'h ys EMAIL Adelst:xa: anna(rr� het loateE:ncrgyeompany.eorn
Addn .r': PO BOX 23B/ 302 E Third Street
City: Wendel I Zip Cods:: 27591 County: Wako
Office Tole Nil: 919,366.0261 Celt No.: trite
H. HEAT i'XJll1P CQN'I'IUC FOR INFORMATION (if different (iumo driller)
Company Name: lloin,: tisicrgy Inez
Well DriIIlog Cuntr:tctor'v Name; William B. Jefferson
N(:Cani mctorCe7lilinattunNo.: 397I•A
Canluct Pin soli: Ain JeffreyMAIL Atidrexs: anun@ThellarneEnergyC:atnpany.coni
Address: PO 130X 238/ 3O2 (: Third Strcel
City: Wendt:II Zip Code: 27591 County_ Wake
Office Tele No.: 919.366.0261 Cctl No.: nl t
F. INJECTION PROC1 i UR (briefly describe lime the injectionwol1(m) will be used)
Cjettrlwritert I.1VAC". with e<Itr;cd Inns copper...piping
WELL CONSTRUCTION DATA (Skit) to Section II If tliis i9 a I'crrnit R ENEWA! .)
(1) I'rtip cd elate ro kte constroelcd: V 1' Z4 'Q4A Number oftmr#nge: = —] (]
�
Approxirnrtic depth of each burin (feet): 2t (0+.1.
(2) C?unical ndtlitives to be ttsed 'rro elo xl-Wt.ip system (only thoae elJentiealx ineltsulrcl hav4 Won approved):
R-407(_ prupytt nc glycol +ethanol oih r (iIhur udilitivu; will need prior
approval by NC:1)11NR before use)
(3) Type of I'ubi nj; to be used (ccrpper, PVC, cie): C,E;ff
(4) Well casing. is the wall($) tscd7 (ehcck vIthor (tr.) YES or (b.) NO bolow)
(a) YES ;ryes, then provide a;igistg Nfolrmatino Fitch as type. (steel, PVC, plastic, t:/e.), drirnctcr,
depth,, and e I 'n uf'cutiin}t appearing ubovu I ortnd:
(b) 1"i° 7O
(5) {lemur (material surrrruridifg well ensing r:ndk)r pipiist);
(2)
(b)
Grows type. Cctneut UUcntoniti tii Other (spot1Fy)
Grout depth of tubing (rcrfarence to (and surface): from I f to 0 (feet)
IFwell has casing. indicate. grout depth: frsnrt _rstt tp rl a f real)
R. INJECTION -RELATED EQUIPMENT
Attech a tfingr m showing the engineering Layout or propaxat nroditiaitinn or the inji:e:ti+n equipment and exterior
rir,;rrwhrliing a€seeiatert witfs the injection cpeeatinn. The mnnnfheitirer'x b'ochurc may provide %upplelneret:rry
iut./111 Lion.
!. LOCATION OE W LUS)
),at},rri,-- AID -‘171a
CI'Ult.rlt' N OM Wutr t'cyirtie Apptir:errinn IflLviyetl 70Z *) Page

t
rtus se: uu UY. iup..
Ci1.Yciii&Anm air ca tJCww 4r+Craw11 CUA: i1UULUYU M ■ t
(2)
Attach tens espies of cum ye thnweg the following lnfatmolim
{t) Include n aiiv env (centre drawn) Awning: Instldinpr proporry firer, r ,Iic +aarar badire potaraia1 towel
nl pmp+dwatat aeehrreinelirtt Atoll the °tieMilian of Med diatnrxtee, btrlreen f,11Q A4porod wdVl) ape any
existing Wit(a) 41r mete disposal fr[ot'tliea t uch is septic elm ordeals folds locatr.41aaittlin loco free oftbe
roamed Uwt jreteetp welt syetrm Label xu feature; fly teal itteludgxaatraw.
Include a repelpuplt)cipnp ofthc arceette nt ing one sauna Arm tbtpt'ppirty tadonduios oral
lA�1Ca to the ffcilii)r'z location ■ ad tit lump nwara.
.1. PM11tti6ai: WA'•Tl ak WTaiiMS
Arc timer iv/ parable weir veal Ka) on the suhject property or adjer for poirraaes7
If Yee. then indicate Iccalion an dried aep(e).
is crinnive r'i w
Plotr Tide l rr aw Application maiba oipnrd I, gegb its oppurrireg on the (eitainnnd legal property lard.
l herehy certify, tinder penalty of taw, tfrt l have
submitted In thin ducearr40 and an nottutormats
kelrirdisitdy rnaperlibte OW obtaining runts &Orme
I two aw ette bunt deem nag sign i6cent penal
(alto Ilzformetion. I agree ra rmotiuct,
net edited nptnttce ancel in neco beau With tit
ed and ant ! i it u with dm information
Ibinaic eny inquiry of slew itritivittord,
ha infenmeticm ii hate, *emote +Nod enueplese.
its of Ann and ifefpr'iaconnera, for enbmitting
appi!eeble, nbutxian thx injccdl s well etrd
conditions tit the Parole'
r •.
Sig/mum 0 ' ~ a Appriaetyt
Mramok u Area Dfvolo[tont Aoaaciat tna of IIC, ins.
7yroe e W ��.RVreli�ilxld�,d4'A�
Mar at Type Fall Name
Sigcatrlta nelirorpcsr)r Oiamo Applicant
Pore Dr Type Full Nemo
Sigiaomre of Authorized A ru. iCany
1'tiyli gr Typo Hill 14aWw
Ploeatimam ttiwa crspisa of thc complctrli AppTiwtion frndmge to:
North Carolina' DttNR-DWQ
Aquila` Pl lle s�
tit@ PRAMr3
16 l4fltI &m a Cosner
Rakich. NC z7l09-ia.36
Tckp bane OM 7154935
ONitaC5QH Wall hum Arpriiewee ilredare tarns)
RECEIVED 1 DENR I DWQ
Aquifer Protection Sedan
AUG 13 2009