WI0800109_GEO THERMAL_20160120

UNITED STATES MARINE CORPS
MARINE CORPS AIR STATION
PSC BOX 8003 .
CHERRY POINT, NORTH CAROLINA 28533-0003
North Carolina Department of
Environment and Natural Resources
Division of Water Quality
Aquifer Protection.Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Dear Sir or Madam:
5090/26743
LN
January 20, 2006
· Enclosed is a Closed-Loop Geothermal Water-Only Injection Well System Name/Ownership Change Form for Type-QW Wells previously owned by Commanding · General, Marine Corps Air Station (MCAS), Cherry Point, North Carolina.
Effective 1 October 2005, the Department of the Navy conveyed ownership of all improvements and equipment associated with 217 family housioo units aboard MCAS Cherry Point. to Atlantic Marine _Corps Communities (AMCC) LLC. The Government has retained ownership of the underlying land; however, AMCC LCC is responsible under the Real Estate Ground Lease and Conveyance of Facilities for the operation, maintenance, and closure .of the 1,010 geothermal wells associated with these units. The Government retains ownership of the land and responsibility for .all pre-existing environmental conditions.
The geothermal wells are located at the Grants Landing Housing area, which we identified in previous correspondence to the Department of Natural Resourses as the Married Officer Quarters (MOQ). Supporting documentation, including a listing of the affected geothermal wells and diagrams showing their locations, is attached to the enclosure.
. . If you have questions or require additional information, please· contact William Belli of the Environmental Affairs Department at [phone].
Si ce
.w
Envi
By d
Commanding General
Officer
Enclosure: 1. Closed-Loop Geothermal Water-Only Injection Well System Name/Ownership Change
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality -Aquifer Protection Section
CLOSED-LOOP GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM
NAME/OWNERSHIP CHANGE FORM
Any changes made to this form will result in the application being returned.
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
I. RE QUIRED ITEMS
1. Submit one original of the completed and appropriately executed Permit Name/Ownership Change Form. For a
change of ownership, the certification must be signed by both the current permit holder and the new applicant.
For a name change only, the ce1iification must be signed by the applicant.
2. Provide legal documentation of the transfer of ownership (such as a contra.ct, deed, article of incorporation, etc.)
for ownership changes, A copy of the Association Bylaws and Declarations should be submitted for a change of
ownership to a Homeowner's Association. _ RECEIVED/ f'~dR/ DWQ
AQU ,,~EP. Pf:1.,..•''.T('"I';';'.} l~f.'l'TIQ~l I ,' 1-... t .l ~ t-••· i ,,,, J L •• J,11 r
11. cuRRENT PERMIT 1NFORMATION JAN 2 Li LuD6
I. Permit number: ______ ~/V~/_ftc_. ___________________ _
2. System Owner's name: _c_~b~m=· ~'1~1~fl~!i~P_t_" N~G ___ G_-_e_"'N_eRA_~ _·_L _ _,,~m_· _C_·-~--------
3. Name and title of owner or signin~ official:. ____ G...c.,·.,_·"'"". -~-"'_,--'R'-'--4...,,__.P=·· _,_F-=c·='R-tc=:>=---------
(Person legally respo·nsible for system)
l:srvv,,u..~ mb"rvr,tz., Af PA-tllS C, fF1cc11,
B tt ~ ~ .:\,~'-\-to,,{tit1e) o~ tt, -e. l
. <'.:..ctn l'h<h,<-t, 1-~ G,-e.111 -e ro-
4. Mailing address: QS C,. i3 0 'f. 8CC'b
City: C: \;t~t2.Lt Po-,"-'"' State: N~ Zip: ~6.s .3:~ --ero6
Telephone number: (~ 4 &f::.-Lf 5 '7'9 Facsimile number: ( ~ Lf 6~ ...; d--lc (.~
III. NEW OWNER/NAME INFORMATION
1. This request for a permit change is a result of: · · · ·
Va. Change in ownership of property/company
~ __ b. Name change only
___ c. Other (please explain): ____________________ _
Page I of2
ENCLOSURE (.1,.)
Name of new owner: A \4w,; c_ AA VI At- C o rs ; S LL C- . MCC►)
3. Name and title of new owner or signing official:
(Person legally responsible`for systern)
(title)
4- Mailing address: O5O e..5 r, 61k/A 3t4J La f,13 4cct
City: Tc.-cks o.. :1k.- State: _Ft— Zip: 2t 5 L
Telephone number: (GI l a'_) 5 3— 5 7 a Q Facsimile number: (9 l) — o J a i
W. CERTIFICATION
I. Current Permittee's Certification:
r, G. Le.. Q'rA-D n-C)
, on behalf of
lc -5 c 12-1Z4 i , KTr
attest that this application for namelownership change has been reviewed and is accurate and complete to the
best of my knowledge. I understand that if all required parts of this application are not completed and that if all
required supporting information an attach ' - + s are not included, this application package will be returned as
i#j10i 44A Date: c13 rag06
2, Applicant's Certificati • n:
incomplete
Signature:
I, e,-ek- VQer�c
on behalf of A M C- G
attest that this application for name/ownership change has been reviewed and is accurate and complete to the
best of my knowledge. I understand that if all required parts of this application are not completed and that if all
required supporting information and attachments are not included, this application package will be returned as
incomplete. I agree to operate, maintain, repair, and if applicable, abandon the ground -source heat pump system
and all related appurtenances in accordance with 15A NCAC 2C .0200, Criteria and Standards Applicable to
Injection Wells. 1
Signature:
Date: - O(t -Z (0) 0 5
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
UNDERGROUND INJECTION CONTROL PROGRAM
By U.S. Postal Service:
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
RECEIVED/ DENR/ DWQ
AQUIFER PROTECTION SECTION
JAN 2 4 2006
By Courier/Special Delivery:
2728 CAPITAL BOULEVARD
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
Page 2 of 2

EXECUTION COPY
REAL ESTATE GROUND LEASE AND
CONVEYANCE OF FACILITIES
UNITED STATES OF AMERICA,
DEPARTMENT OF THE NA VY -
"Government"
and
AMCC MANAGING MEMBER LLC
"Lessee"
October 1, 2005
TABLE OF CONTENTS
Page
1. LEASE OF LAND AND CONVEYANCE OF EXISTING IMPROVEMENTS .................... 2
2. TERM AND DELIVERY OF POSSESSION .......................................................................... 5
. 3. EASEMENTS AND RIGHTS-OF-WAY ......... ~ .... :. .......... : ...................................................... 6
4. CONDITION OF .PREMISES .................................................................................................. 7--
5. CONSIDERATION ............................................................................................ , ..................... 9
6 ... OPERA TING AGREEMENT .... : .............................................................................................. 9
7. USE OF PREMISES.; ............................................................................................................... 10
8. REPRESENTATIONS, WARRANTIES AND COVENANTS ............................................ 11
9. DEFAULT AND TERMINATION ........................................................................................ 13
10. TAXES .................................................................................................................................. 20·
11. RESTORATION AND SURRENDER ................................................................................ 20 -12 .. ENVIRONMENTAL PROTECTION .................................................................................. 20
13. OPERATION AND MAINTENANCE OF PREMISES .......................... , ........................... 30
14. COMPLIANCE WITH APPLICABLE LAWS .................................................................... 32
15. ACCESS AND INSPECTION .............................................................................................. 32
16. GENERAL INDEMNIFICATION BY THE LESSEE ............................ : ...... , .................... 33
17. INSURANCE/REIMBURSEMENT/CONDEMNATION ................................................... 34
18. CONSTRUCTION OF IMPROVEMENTS, INSTALLATIONS AND
ALTERATIONS ...... : ........................................................................................................ 39
19. UTILITIES, SERVICES AND ROADS ......................... : ..................................... ;, .............. 41
20. NOTICES ...............................................................•............................................................ ;.41
21. ASSIGNMENTS, SUBLEASES AND LICENSES .......... ~ .................................................. 43
· 22; LIENS AND MORTGAGES ...... · .......................... ; ....... : .... ; ....................................... : .......... 44
23. TITLE TO ADDITIONAL IMPROVEMENTS .ON LEASED PREMISES ....... L ............. 49
24 .. DISPUTES .... , ................................................................................... , .................................... 50
25. RENEWAL .OF THIS LEASE; ................................................................... :.· ........................ 50
26. AMENDMENTS ............... : ............. , ..................................................................................... 50.
27. LIMITATION OF LIABILITY ......... : ...................................... : ...... ; ........................ : ......... :. 51 ·
28. HOUSING REFERRALS ................... .: ... : ....................... ~ ....... : ........................ ~ .. : ................ 51
29. MISCELLANEOUS ................................................. : ...... : ........... · ........... :.:.:.~ ...................... '.. 51
EXHIBIT A: LEGAL DESCRIPTIONS
EXHIBIT B: SURVEYS
EXHIBITS
EXHIBIT C: EXCLUDED IMPROVEMENTS
EXHIBIT D: PERSONAL PROPERTY
EXHIBIT E: INDEX OF DEFINED TERMS
EXHIBIT F: RESERVED
EXHIBIT G: EXISTING ENCUMBRANCES
(
EXHIBIT H-1 :MCB CAMP LEJEUNE ENVIRONMENTAL BASELINE SURVEY
EXHIBIT H-2:MCAS CHERRY POINT ENVIRONMENTAL BASELINE SURVEY
EXHIBIT H-3:STEWART TERRACE ENVIRONMENTAL BASELINE SURVEY
EXHIBIT 1-1: MCB CAMP LEJEUNE FINDING OF SUITABILITY TO LEASE
EXHIBIT 1-2: MCAS CHERRY POINT FINDING OF SUITABILITY TO LEASE
EXHIBIT I-3: STEWART TERRACE FINDING OF SUITABILITY TO LEASE ·
EXHIBIT J: PHASE I AND PHASE II ENVIRONMENTAL SITE ASSESSMENTS
EXHIBIT K: ENVIRONMENTAL PLAN
EXHIBIT L: FEDERAL ACQUISITIONS REGULATIONS
EXHIBIT M-1: MCB CAMP LEJEUNE MUNICIPAL SERVICES AGREEMENT
EXHIBIT M-2: MCAS CHERRY POINT MUNICIPAL SERVIeES AGREEMENT
EXHIBIT M:3: STEW ART TERRACE UTILITY PROVIDERS
EXHIBIT N: MAP OF GOVERNMENT MAINTAINED ROADWAYS
EXHIBIT 0: RESERVED
EXHIBIT P: RESERVED
EXHIBIT Q: RESERVED
EXHIBIT R: PARTNER'S PLAN FOR PEST CONTROL
EXHIBITS: RESERVED
EXHIBIT T: TARA WA TERRACE RETENTION POND MAP
REAL ESTATE GROUND LEASE AND CONVEYANCE OF FACILITIES
TIDS REAL ESTATE GROUND LEASE AND ·coNVEYANCE OF FACILITIES
(this "Lease") is entered into to be effective as of October 1, 2005, by and between the UNITED
STATES OF AMERICA, DEPARTMENT OF THE NAVY (the "Government") and AMCC
MANAGING MEMBER LLC, a Delaware limited liability company (the "Lessee");
WITNESSETH
WHEREAS, the Government under the authority contained in 10 U.S.C. _ § 2878 has
determined that the leasing of the real property _ and conveyance of the personal property
identified .in this Lease on the terms set forth herein will be in the public interest and has
otherwise satisfied and complied with all reporting requirements, notification periods, the
applicable award and Jetting procedure and other statutory limitations prescribed in the
solicitation documents and the authorizing legislation, and all required findings and
determinations have beeri made and other conditions satisfied; and
WHEREAS, the Government enters into this Lease for the purpose of providing
sufficient real estate interests to the Lessee in ordei;-to carry out the requirements of a
Department of the Navy Public/Private Venture as desccibed in Invitation for Offerors N62470-
04-RP-00163 and amendments thereto, and the Actus Lend Lease LLC offer in response thereto,
dated October 1, 2005 (including any amendments _ and supplements thereto), including the
construction, demolition, renovation and use, operation, management and maintenance of rental ·
Housing Units and associated . improvements at (ffi)camp L<::jeune Marine · Corps Base,
Jacksonvi~orth Carolina; @..1arine Corps Air Station · New River, JaGksonville, North
Carolina;~arine Corps Air Station Cherry Point, Havelock, North Carolina; and (iv) Marine
Corps Housing Stewart Terrace, Town of New Windsor, New York; and ·
. WHEREAS,· · the Government and Lessee acknowledge . · that the
Development/Management Obligations (as hereinafter defined) will be financed in part by
Lessee's issuance of certain Atlantic Marine Corps Communities Housing Revenue Bonds,
Series 2005 ·(Atlantic Marine Corps Communities Family Housing Project) in the amount of
$285,480,000 and . any modifications, extensions, · renewals and replacements thereof (the
"Obligations") pursuant to that certain Trust Indenture and Security Agreement dated as of even
date herewith (the "Indenture"), between Lessee and U.S. Bank National Association, not
individually but solely as indenture trustee, and its successors in interest (the "Trustee"), for the
registered owners (the "Bondholders") of the Obligations and their Bondholder Representative
from time to time (the Obligations, the Reimbursement Agreement and any subsequent loan, the
proceeds of which . are applied towards refinancing the Obligations or towards the costs of the
Development/Management Obligations, are the · "First Mortgage Loan"; and ~e Obligations,
the Indenture . and all other documents evidencing, · governing or · securing the First Mortgage
Loan are referred to as the "Bond Documents"); and . · ·· · · · · ·
·-. :' ; . . . . . :·. . . •. ·_ · .. -... . . ' :
WHEREAS, prior to cir coricurrentiy with the execution of this Lease, AMCC Managing
Member LLC, as a member (and, in its _ capacity as the manager and a member under the
Operating Agreement referred to below, the "Managing Member") and ~he Government, as a
IN WITNESS WHEREOF, the Government and Lessee have executed this Lease to be effective
as of the date first written above.
WITNESSES:
N&m e: ' i 7 k1 COt)AJ fl-Y A4J
7./c- Z
Name: ke.aazvd f
DISTRICT OF COLUMBIA
)
) as.
GOVERNMENT:
UNITED STATES OF AMERICA
By:
Scott Forrest, Director
Special Venture Acquisition Program
Naval Facilities Engineering Command
Department of the Navy
The foregoing instrument was acknowledged before me on the day of
rrs- K , 2005, by Scott Forrest, Director of the Special Venture Acquisition Program,
Navatl Facilities Engineering Command of the Department of the Navy on behalf of the United
States of America.
f
_ (]}
My Commission Expires
(41 E4&"/
Notary Public in and for
the said county and said state
Dana I. Dor/and
1t'ot3rr grti,? . n="e#r�ckFCeit�s��;
Notary'erypiallvt ted2 Tan 8
[SIGNATURE PAGE TO REAL ESTATE GROUND LEASE AND CONVEYANCE OF FAC11.11'1E5]
Kurak Rack- Firm Liibrary-4838-4099-0976.6

LESSEE:
AMCC Managing Member LLC, a Delaware
limited liability company
By: Actus Lend Lease Holdings LLC, a
Delaware limited liability company,
its sole member
By:
Name: . duechier
Title; ecutive Vice President
3
DISTRICT OF COLUMBIA ) ss.
7
The foregoing instrument was acknowledged before me on the 24t day of
“Abc3 , 2005, by Gary M. Buechler, the Executive Vice President of Actus Lend
Lease Holdings LLC, a Delaware limited liability company, the sole member of AMCC
Managing Member LLC on behalf of such sole member.
My Commission Expires
Cheryl A. Sinsabaugh
Notary Public, District of Columbia
' fiiy runic6icn Expires 08-14-200E1
_ � L
Notary` blic in and for
the said county and said state
C .1_ A-. SIt.1sA „ei sk
Notary's Typed or Printed Name
[SIGNATURE PAGE TO RFALESTATE GROUND LEASE AND CONVEYANCE OF FACruri s]

Exhibit
No.
A-1-1
A-1-2
A-1-3
A-2
A-3-1
A-3-2
A-3-3
A-3-4
A-3-5
A-3-6
A-3-7
A-3-8
A-3-9
A-3-10
A-3-11
A-3-12
A-3-13
A-4
A-5
A-6
EXHIBIT A
. LEGAL DESCRIPTIONS
Property
Cherry Point: Grants Landing Housing
Cherry Point: Slocum Village Community Center
Cherry Point: Slocum. Housing
Stewart Terrace Parcel
Camp Lejeune: Berkley Manor
Camp Lejeune: Boy Scout Road
Camp Lejeune: Courthouse Bay
Camp Lejeune: Knox Mobile Home Park
Camp Lejeune: New River Enlisted Housing
Camp Lejeune: New-River Officer Housing
Camp Lejeune: Old Hospital Point
Camp Lejeune: Paradise Point North I
Camp Lejeune: Paradise Point North 2
Camp Lejeune: Paradise Point South
Camp Lejeune: Tarawa Terrace I
Camp Lejeune: Watkins Village
Camp Lejeune: Scales Creek
Stewart Transfer Parcel
Tarawa Terrace II
Grants Landing Apartments
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
October 16, 2002
MEMORANDUM
TO: Charlie Stehman, Groundwater Regional Supervisor
FROM: Evan Kane, Underground Injection Control Program Manage~
RE: Receipt of Notification for a Closed-Loop Geothermal Water-Only Injection Well System.
Notification of intent to construct and operate a closed-loop, water only injection well system for a
geothermal heat pump (Type 5QW injection well) has been filed by the Marine Corps Base at
Camp Lejeune, North Carolina. A copy of the notification is included with this memo. This
injection well system is deemed permitted by rule (15A NCAC 2C.021 l(u)2) and no further
regulatory action should be necessary. If you have any questions about this notification, please
contact me at [phone].
cc: UIC-CO files
Attachment
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP
GEOTHERMAL WATER -ONLY INJECTION WELL SYSTEM
(GROUND COUPLED HEAT PUMP)
Type 5QW Wells
In Accordance with the provisions of NCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
This is not the proper form to be used for injection wells in an open -loop geothermal system -
Do not use this form for systems that circulate any substance other than water.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: t©/ 9r/d`- ,20
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
YES X If yes, then continue completing this form.
NO If no, do not complete this form. Form GW-57 HP, Application For
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed_
B. SYSTEM FLUID Will any additives be introduced to the system's circulating heat transfer
fluid? This includes, but is not limited to corrosion inhibitors and/ or antifreezes.
YES If yes, do riot complete this form. Form GW-57 HP, Application For. --
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
NO X If no, then continue completing this form.
C. PROPERTY OWNER
Name:
Address:
City: State: Zip Code:
County: Telephone:
D. STATUS OF PROPERTY OWNER
Private: Federal: x Commercial:
State: Municipal: Native American Lands:
GW-57 CL (Jan, 2000) Page 1 of 4

E.
F.
G.
JOB (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility: ~t? fe:rc:vA/'e., IY],1£,Ji'/~ ~0J,'.f'J LfA.rc-j /.
Address: /1111..f ty},c l,A e:-C J'"r. 1
' no~
City:C31tHf le :12-V#'l!f" State:~ Zip Code: Z 1 JY2., County: t(J,./..rt d c...1 ,.}JI'
Telephone: 9lo-¢"/..2J,..f.1 o,,r 2 s,4--Contact Person: !UtwtJ IYJA-£.rtfd'tf /<,.,/ /
Standard Industrial Coqe(s), SIC, which describes commercial facility : rt<-· '
l I
HEAT PUMP CONTRACTOR DATA
Name: Climate Control Heating & Cooling Co., Inc.
Address: 102 Middle Street
~\~ l;\ {(J
~
City: Jacksonville
Telephone: (910 ) 353-9040
State: NC Zip Code: 28546 County: Onslow
Contact Person: =M=ic=h=a=e.;;;;...l =H=a=d=le;.,,..y ______ _
,/
CONSTRUCTION DATA (check one)
____ EXISTING WELL(S) being proposed for use as a ground-coupled heat pump
well(s ). Provide the information in (1) through ( 4) below to the best of your
knowledge. Attach a copy of Form GW-1 (Well Construction Record) if available.
--=X-=----PROPOSED WELL(S) to be constructed for use as a ground-coupled heat pump
(1)
well(s). Provide the information in (1) through (4) below as PROPOSED
construction specifications. Submit Form GW-1 after construction.
Well Drilling Contractor's Name: .;;;;...San=f..;:;..or=d;.;;...L=..;;...;. S:;..;w_;_e=e;..;;;tin=g~---------
NC Contractor Certification number: NC -2082 ;;;..;:..;:;...._==-=c=.------------
Date to be constructed: JiN , fe.b-2.."0 3 Number of borings: _2-_l-_____ _
2 0{), Approximate depth of each boring (feet): _______________ _
(2) Well casing: Is the well(s) cased?
(a) YES __ If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic __ Other (specify) ____ _
Casing depth: From ___ to ___ ft (reference to land surface)
Casing extends above ground ____ inches
(b)NO _X __ _
(3) Grout (grout the vertical length of the borehole to a minimum depth of 20 feet b.l.s.):
(a) Grout type: Cement __ Bentonite _x__ Other (specify) ______ _
(b) Grouted surface and· grout depth (reference to land surface):
_x_ around closed loop piping; from .JL to 200 (feet).
__ around well casing; from __ to __ (feet).
NOTE: 1HE WELL DRILLING CONTRACTOR CAN SUPPLY 1HE DATA FOR EITHER EXISTING OR
PROPOSED WELL.5 IF 1HIS INFORMATION IS UNAVAILABLE BY 01HER MEANS.
GW-57 CL Gan, 2000) Page2of4
G. 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.
H. LOCATION OF WELL(S) Attach two maps.
(1) Include a site map (can be drawn) showing: buildings, property lines surface water
bodies, potential sources of groundwater contamination and the orientation of and
distances between the proposed well(s) and any existing well(s) or waste disposal
facilities such as septic tanks or drain fields located within 200 fe~t of the ground-
coupled heat pump well system. Label all features clearly and include a north arrow.
(2) location map referencing the site to two nearby permanent reference points (such as
roads, streams and highway intersections).
(3)
J. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
K. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with
the information submitted in this document and all attachments thereto and that, based on my
inquiry of those individuals immediately responsible for obtaining said information, I believe
that the information is true, accurate and complete. I am aware that there are significant
penalties, including the possibility of fines and imprisonment, for submitting false information.
I agree to construct, operate, maintain, repair, and if applicable, abandon the ground-source
heat pump system and all related appurtenances in accordance with the approved
specifications and conditions of the PiL rY} ~
' (
GW-57 CL Gan, 2000)
(Signature of Well Owner or Authorized Agent)
~f,nu1Su''1 C,v,C. t"'G:f,r~~
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
Page3of4
L. 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
co~ents to allow the applicant to construct each injection well as outlined in this application
and that it shall be the responsibility of the applicant to ensure that the ground-source heat
pump system's well(s) conforms to the Well Construction Standards (Title 15A NCAC 2C .0200)
GW-57CL
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
IDCProgram
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Gan, 2000) Page 4 of 4
1
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STORAGE IANK
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SEPTIC TANK
PIAI 3O.'0
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UTILITY NOTES
0 PROVIDE PRECAST CONCRETE SEPTIC TANK LAW. STATE OF NC
REGULA.TK)NS, 15A NCAC td* I90D. TANK VGLLIME SHALL MATCH
EXISTING AND 8E RATED FOR H-20 TRAFFIC LOADS. MODIFY EXISTING
PIPING AS NEC-SS.RY TO INSTALL TANK & CONNECT TO EXISTING
SYSTEM. PROVIDE TEMPORARY SN•IITMY SERVICE FOR GUARD HOUSE
LILANG CONSTRUCTION.
0 GROUND LOOP WELL PIPING NOT SHOWN IN ITS ENTIRETY. SEE
SHEET M-603 FOR DETAILS.
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SEP1ic TAMS
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