WI0800110_GEO THERMAL_20060509

Carl Baker, Design Director
Public Works Division
USMC Base Camp Lejeune
PSC Box 20004
Camp Lejeune, NC 28542-0004
Ref: Change in Ownership Form
Closed-Loop Water-Only Injection Wells
Marine Corps Facilities in North Carolina
Dear Mr. Baker:
May 9, 2006
Michael F. Easley, Governor
William G . Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
The Underground Injection Control (UIC) Program received on April 17, 2006 a notice of change in ownership for the
following facilities at Camp Lejeune:
• B .1•.:h,:lnr Enli ·ted Quart~rs (DWQ #'\Vl0S00 I LOJ
• Family Housing (DWQ #WI08001 l 1) .
• General Officer's Quarters (recently assigned DWQ #WI0800134)
Suppo1ting documentation submitted indicates that ownership is being transferred to Atlantic Marine Corps Communities,
LLC. As the new well owner, Atlantic Marine Corps Communities, LLC is responsible for compliance with injection
well rules and regulations specified in the North Carolina A<aministrative Code, Title 15A, Subchapter 2C, Section .0200.,
which can be found at our webs.ite (ht tp ://h2o.enr.state.nc.us/aps/gp u/rules.htm).
Please ensure that Atlantic Marine Corps Communities, LLC knows that if they modify these systems at any time,
including the addition of antifreeze, corrosion inhibitors, or any other substances to the circulating fluid, they must contact
the UIC Program to verify compliance with applicable rules and regulations. Please contact Debra Watts at 919-715-6699
or myself at 919-715-6166 if you have any questions regarding the UIC Program or injection well rules and regulations.
cc: Charlie Stehman, Wilmington Regional Office
Derek Veerkamp, Atlantic Marine Corps Communities, LLC
CO-UIC Files
Best Regards,
Thomas Slusser
Hydrogeological Technician II
UIC Program
None C 1. -W.fth aroma ;vaturall!J
Aquifer Protection Sectio11
Internet: http://h2o.enr.state.nc.us
1636 Mail Service Center
2728 Capita_] Boulevard
Raleigh, NC 27699-1636
Raleigh, NC 27604
Phone [phone] Customer Service
Fax [phone]
An Equal Opportunity/Affirmative Action Employer-50% Recycied/10% Post Consumer Paper
Fax [phone]
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
NAMEIOWNERSHIP CHANGE FORM
Any changes made to this form will result in the application being returned.
(THIS FORM MAYBE PHOTOCOPIED FOR USE AS AN ORIGINAL)
1. REQUIRED ITEMS
l , Submit one original of the completed and appropriately executed Permit Name/Ownership Change Form. For a
change of ownership, the certification must he signed by bath the current permit holder and the new applicant.
For a name change only, the certification must be signed by the applicant.
2. Provide legal documentation of the transfer of ownership (surb as a contract, deed, article of incorporation, etc.)
for ownership changes. A copy of the Association Bylaws and Declarations should he submitted for a change of
ownership to a Homeowner's Association.
U. CURRENT PERMIT INFORMATION
64Cr1Ecco- &NLJSTLTD 4cvhje'freS � wG #1 yV#a8ov 11G}
1. Permit number: (aeMgRA crc-jt5 ❑ v,4 bra pwn owq FApul y a�b�.5�N�4 4wrM W%aSc a i
2. System Owner's name: t,[Nr7L-O STATES MARVE erdeeS + AICB 0 f_AM P t.
3. Name and title of owner or signing official: - _'CArlL MACM P8
(Person legally responsible for system)
d- Mailing address: D.SAA . -�- - S ( +aGJC
City: E State: G Zip: 7,"47 cca4
Telephone number: (1910 ) 4_0 -32,3$ Facsimile nurnher: ( q1 Q ) 467 - &I Z7
Ill. NEW OWNEWNAMI? INFORMATION
rM
1. This request for a permit change is a result of.
a _
a. Change in ownership of property/company
b. Name change only ` -
c. Other (please explain): Zr
Page I oft

2. Name of new owner: 2r • C_ C A/K E t-
3. Name and title of new owner or signing official: pe-"1,'_
(Person legally responnslib f r system)
C.dr�a�i M.c .ti.44
•�Sq�i
' (title) J
4. Mailing address: ,1.1 S to I1,1 �s er.� Rj ,try L a I Q 1 O `1
City: CA& s Q. ".11'r State: !`i L Zip: -2 SS Li L
Telephone number: ( �_ ) 3 53 - 5 7 0 m Facsimile number: ( 91 ca ) -2 15 -_ t. 3 o s\
IV. CERTIFICATION
1. Current Permittee's Certification:
I, - 4 C G SA rely _ , on behalf of 6AA0 f-
�s
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 retuned as
incomplete.
Signature: _
2. Applicant's Certification:
—Date:-
1, � a . on behalf of A M L L_ _
attest that this application for namefownership 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 IBA NCAC 2C .0200, Criteria and Standards Applicable to
Injection Wells.
Signature: Date: 1 , 0 S
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: By Courier/Snecial Deliverv:
1636 MAIL SERVICE CENTER 2728 CAPITAL BOULEVARD
RALEIGH, FORTH CAROLINA 27699-1636 RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
Page 2 of 2

UNITED STATES MARINE CORPS
PUBLIC WORKS DIVISION
1 Marine Corps Base
P5C BOX 20004
Camp Leloune, North Carolina 28542-0004
10111
PW O
11 Apr 06
UIC Program
ri,
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
SUB]: NAME/OWNERSHIP CHANGE
L.l
Mr. Kane:
Lo
Marine Corps Base (MCB), Camp Lejeune recently completed a real estate ground lease and
conveyance of facilities with AMCC Managing Member LLC. The conveyed facilities include
several closed loop geothermal water -only injection well systems. In support of this initiative,
MCB, Camp Lejeune is submitting a Closed Loop Geothermal Water -Only Injection Well
System Name/Ownership Change Form for these systems. Enclosed you will land a completed
name/ownership change form and supporting documentation.
If you have any questions or require additional information pertaining to this project please
contact Mr. Thomas Burton, PE at telephone [phone] or by email at:
thornas.h. bu rton Ca) rimci . usnic. rni 1.
S'ncerely,
Z
Carl H. alter, EE
Director, Design Branch
Enclosure:
Closed -Loop Geothermal Water -Only Injection Well System Name/Ownership Change Form

EXECUTION COPY
REAL ESTATE GROUND LEASE AND
CONVEYANCE OF FACILITIES
UNITED STATES OF AMERICA, 0
DEPARTMENT OF THE NAVY C)
:, -,:, ' ::,:, ~ --.I C'
"Government" -
-0 r
3: < > ---..
+ C-,
0 r
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. OPERATING 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 ....................... 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 :STEW ART 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 1-3: 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 SERVICES 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
EXHIBIT S: RESERVED
EXHIBIT T: TARA WA TERRACE RETENTION POND MAP
REAL ESTATE GROUND LEASE AND CONVEYANCE OF FACILITIES
TIIlS 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 letting procedure and other statutory limitations prescribed in the
solicitation documents and the authorizing legislation, and all required findings and
determinations have been 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 order to carry out the requirements of a
Department of the Navy Public/Private Venture as described 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 (i) Camp Lejeune Marine Corps Base,
Jacksonville, North Carolina; (ii) Marine Corps Air Station New River, Jacksonville, North
Carolina; (iii) Marine 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 the 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 or concurrently 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 the 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;
L �)`G" Ur���
DISTRICT OF COLUMBIA ) ss.
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
2005, by Scott Forrest, Director of the Special Venture Acquisition Program,
Navall Facilities Engineering Command of the Department of the Navy on behalf of the United
States of America.
. of G
My Comnnssion Expires
Notary Public in and for
the said county and said state
�?rt� i_ �eTlatld
NOtSry''�A���fl8
t51D#ATURE PAGE ro REAL ESTATE GROLND LEASE AND CONW.YANCE of FACiLmESl
1Cutak Ruck- Firm Library-483"99-0976.6

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 .l�ueehler
Title: ./R ecutive Vice President
DISTRICT GP COLUMBIA
}
The foregoing instrument was acknowledged before me on the 2`1 day of
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.
L
Notary b� lic in and for
the said county and said state
Cheryl A. 3insabaugh Notary's Typed or Printed Name
Notary Pudic, Distrlctni Colurr,h:a
My Commission Expires My ,-,,...., issl.,., rxpires ns-14-200" S
[SIGNATURE PROF To REAL ESTATE i wum [,EASE AND CONVEYANCE OF FACaLmFS]

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 1
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
Burton CIV Thomas H
From:
Sent:
To:
Evan Kane [[e-mail]]
Tuesday, March 07, 2006 9:24 AM
Burton CIV Thomas H
Cc: Thomas Slusser
Subject: Geothermal heat pump change of ownership
Mr. Burton,
Here are the systems we have on file:
Game Warden's Cabin (no DWQ number assigned)
General Officers' Quarters (no DWQ number assigned)
Marston Pavilion (no DWQ number assigned)
Family Housing (DWQ # WI0800111)
Bachelor Enlisted Quarters (DWQ # WI0800110)
Ammunition Supply PoinVSneads Ferry Road (DWQ # WI0800109)
Page 1 of 1
I have checked the files and we have not already received a change of ownership form for any of these systems.
We will assign "permit" numbers to the Game Warden's Cabin, General Officers' Quarters, and Marston Pavilion
systems after we receive the change of ownership forms. Feel free to call me at the number below or Thomas
Slusser at [phone] if you have any more questions.
Evan 0. Kane, P .G.
Underground Injection Control Program Manager
[e-mail]
Phone: [phone]
Fax: [phone]
http :/ /h2o.enr .state. nc. us/aps/ g u/uic/index. htm
North Carolina Department of Environment and
Natural Resources
Division of Water Quality -Aquifer Protection Section
Mailing Address:
1636 Mail Service Center
Raleigh, NC 27699-1636
Physical Address:
2728 Capital Blvd
Raleigh, NC 27604
35.81532°N, 78.59973°W
3nl2006
1 WA
wr
NCDENR
'- JAMES B. HUNTJR.
GOVERNOR
WAYNE McDEV1TT
SECRETARY
A. PRESTON HOWARD,
JR., P.S.
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
August 13, 1998
Gary R Horne, P-E.
R.O.I.C.C.
1005 Michael Road
Camp LeJeune, NC 28547-2521
Dear Mr. Horne:
DIVISION OF WATER QUALITY
In accordance with the notification submitted on your behalf of Climate Control
Heating and Cooling Co., Inc. and Ramsey Air Conditioning Co. dated December 15,
1997; the Groundwater Section acknowledges your intention to construct closed -loon
geothermal water -only injection wells for the operation of a ground -source heat pump.
The system as described in your notification will not require an injection well permit
and is deemed permitted by rule (North Carolina Administrative Code Title 15A:
2C_0211(u)(2). The Underground Injection Control Group has added your site to our
inventory. If you modify your systern, please contact the Groundwater Section to
verify compliance. Thank you far submitting this notification.
If you have any questions regarding geothermal heat pump wells please feel free to
contact me at [phone] or Amy Axon at [phone]
Sincerely,
/4. il P4
Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Program
cc: UIC Files
WIRO Files
GROUNbWATER SECTION
P.O BOX 2957B, RALEIGH, NC 27628-0S7H - 2728 CAPITAL BLVD., RALEIGH. NC, 27604
PHONE [phone] FA% 91 2-715-058a
AN EQUAL OPPORTUNITY /AFFIRMATIVE ACTION EMPLOYER 50% RtCYCLE17/10% POST -Cori SUOAER PAPER

TELEPHONE: DEPARTMENT OF THE NA VY
OFFICER IN CHARGE OF CONSTRUCTION
RESIDENT OFFICER IN CHARGE OF CONSTRUCTION
NAVAL FACILITIES ENGINEERING COMMAND CONTRACTS
1005 MICHAEL ROAD
910-451-2581
FAX [phone]
IN REPLY REFER TO:
CAMP LEJEUNE, NC 28547-2521
JAX/lOC/grh
04AUG 1998
Mr. Mark Pritzl
Groundwater Section
North Carolina DEHNR-DWQ
P.O. Box 29578
Raleigh, NC 27626-0578
\.0
0,
]:>II
c::
Ci)
l
CJ1
:,t:w =:c: -..
Re: Notification oflntent to Construct a Closed-Loop Geothermal Water-Only
Injection Well System (Ground-Source) Heat Pump, Marine Corps Air Statidr?,
New River, North Carolina
Dear Mr. Pritzl:
Please find enclosed the signed notification of intent as requested. We apologize for any
inconvenience caused by the notification being forwarded without the required signature and will
ensure future notifications are properly completed.
Sincerely,
~~u:.,~
Gary R~ome, P.E.
Supervisory General Engineer
Quality Performance ... Quality Results
p
A�J�
^�.
NCDENR .
JAMEsB. HUNTJR-
GOVERNOR
Mr. Crary Home
R.O.I.C.C.
1005 Michael Road
wAYNE McDEvnrr Camp LeJeune NC 28547-2521
SECRETARV
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
July 30, 1998
DivistoN OF WATER QUALITY
Dear Mr. Horne:
A. PRESTON HOWARD,
JR., RE,
DIRECTOR I have enclosed the original "Notification of Intent to Construct a Closed -Loon Geothermal -
Water -Only Injection Well System (Ground -Source Heat Pump)" form for you to sign and
date. After signing please send to: Mark Pritzl NCDENRIDWQ Groundwater Section, PD
Box 29578, Raleigh, NC 27626-0579. 1 have also enclosed a new revised version of the
same form for your use in the future construction of "Closed Loop Geothermal Water
Only Injection Well Systems".
Thank you for your cooperation and if you have any questions regarding the permit or
injection well rules please contact me at [phone] or Amy Axon at [phone].
Sincerely,
� /_� e
10�;,
Mark Pritzi
Hydrogeological Technician If
Underground Injection Control Program
cc: UIC Files
WIRO Files
Enclosures
GROUNDWATER SECTION
P.O Box 29570, BALE: QH. NC 27626-OS78 - 2728 CAPITAL 0LVD., RALFIGN, NC, 27604
PHONE [phone] FAX S18-7IS-aS88
AN EQUAL OPPORTUMM IAPPIRMATIYE ACTION EMPLOYER • 50% RCCYCL401tO% POST -CONSUMER PAPPR

MEMORANDUM
GROUNDWATER SECTION
July 22, 1998
To: Charles Stehman
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl ft(}
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Receipt ofNotification for a Closed-Loop Geothermal Water-Only Injection Well System.
Notification to construct and operate an injection well system for a geothermal heat pump system
has been filed by Camp LeJeune; a copy of the Notification is enclosed for your files. These
injection well systems are deemed permitted by rule (NCAC TISA: 2C.21 l(u)2) and no
regulatory action is necessary. If you have any questions, please contact me at [phone] or
Amy Axon at {919) 715-6165.
cc: UIC Files
WIROFiles
Enclosures
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESouRGEs
❑IVTSION OF WATER QUALITY
AMr"
June 2S, 1998
KDEN R
Mr. Michael Hadley
Climate Control Heating and Cooling Company
iAMEBB. FILNTaFt, 269 Center Street
�e.OVCRNOF!
Jacksonville, NC, 28546
Dear Mr. Hadley:
WAYNE MCDEVITT
SECRETARY
On June 2, 1998 the Groundwater Section received notifications of intent to Construct
closed -loop water -only geothermal systems for Jeff Sprague, Charles Kay, Regina Lanier,
Larry McRacken, US Government at Camp LeJeune, Jim Bispo, and Sue Souhrada. These
A. PRESTON HOWARD, notices were submitted several months after the systems were installed. The Underground
JR., RE- Injection Control Group has added these sites to their inventory and is in the process of
OFRE(7ma sending fetters to the property owners acknowledging receipt of the notifications.
Please note that NCAC Title 15A Subchapter 2C, Section .0211 requires that the person
responsible for the construction of the injection well system shall submit notification rior
to construction. Therefore, in the future, please submit the enclosed GW-57 CL forms
(Notification of Intent to Construct a Closed -Loop Geothermal Water -Only Injection Well
System) before you begin construction of such systems.
Also, I have enclosed Several GW-1 Forms (WeJI Construction Record). One form for each
well constructed should be submitted to the following address within 30 days of well
completion.
NC DENR
Division of Water Quality, Groundwater Section
P.O. Box 29578
Raleigh, NC 27626-0578
If you have any questions regarding these enclosures or injection wells, please feel free to
contact me at [phone].
Enclosures
Sincerely,
Amy Axon, Prograrn Manager
Underground Injection Control
GROUNDWATER SECTION
P.O BOX 29578, RRLEIGH, NC 27626-OS7e - 2726 CAPITAL BLVD„ RALEIGH, NCp 27SQ4
PHONE [phone] S FAX 919.715-QSSB
AN ERUAL OPPORTUNITY /AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLEOII O°( POST-CONSUMEIR PAPER

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
NOTIF ICATION OF INTENT TO CONSTRUCT A CLDSED-LOOP
GEOTBERMAL-WATER-[ NLY INJECTION WELL SYSTEM
(GROUND -SOURCE HEAT PUMP)
In accordance witl3 the provisions of NCAC Title 15A: 02C.021 l
complete notification and mail to address on the back page.
This is not the promr nj for injection wells to be used in art opera-loo,J2
ground -source (teat pump system. Do not use this form for systenas-that
re-ci►•culaie any substances outer than water below.the ground surface.
Type 5QW Wells
M D1REcrOR, NORTiI CAROLINA DIVISION OF WATER QUALITY
DATE:_—]-z' '� _ , I911
Please type or print clearly.
A. SYSTEM CLASSIFICATION Does the proposed system re -circulate potable
water in continuous piping which isolates the fluid from die environment?
YES X If yes, then continue completing this form GW-57 CL.
ND If no, do not complete this form. A form GW-57 HP
Application For Permit To Construct And/Or Use A WeII
For Injection With A Heat Pump System) must be completed,
Ii. SYSTEM FLUID Will any additives be introduced to [he system"s subsurface
piping, including but not limited to corrosion inhibitors or antifreexes7
YES If yes, do not complete this form. A :orm GW-57 HI'
(Application For Permit To Construct And/Or Use A Well For
Injection Willi A Heat Pump System) must be completed.
NO X If no, then continue completing this form GW-57 CL.
C PROPERTY /ORR
�WNE
Name: (• J • 6d tJ r-4WMe M
Address: It
City: 4 ZU-%�
County:
Zip code: 2Xj 43--
1'e lephone:
GW-57 CL (March 1997) Page I of 4

D. STATUS OF PROPERTY OWNER
Private: Federal:-11._
State: Public: __ _
Commercial: ___ _ Native American Lands: ___ _
E. FACILITY (SITE) DATA (Fill out ONLY if the Status of Prope1ty Owner is
Federal, State, Public or Commercial).
Name of Business or Facility: Blttt!A ID r JFAI /,.,.rtecl ~~ters
Address: hJ,tr ifr~ /4;-/) S" /}.,:,. .S"Td-OtJ
City:~__f_,"" ~ 1
Zip code: '2j:5"''f y County: /JA[s/l[w
Telephone: ______ _ Contact Person: _________ _
Stamhu·d Industrial Code(s) which describes Commercial facility : _____ _
F. HEAT PUMP CONTRACTOR DATA
Name _Rt-,,.,. ,a-!J.'HA.1/-, j, C,;11/J I, ·,>Alt#cjlt,
Address: ~ 7 J ( ~£..<._. /2,/J
City: -:fJ< kso,,/,J,) Le Zip code: W~ffe
County: [}A)s/~~ Telephone:_ q /lJrL/)y l)lfJ'f:
Contact Person: ~ R~s ~
G. WELL USE Will the system well(s) also be used as the supply well(s) for
your personal consumption?
YES__ NO X
H. CONSTRUCl'IONDATA (CHECKONE)
EXISTING WELL(S) being proposed for use as a ground-source heat
pump well(s). Provide tJ1e infomiation in (1) through (4) below to
the best of your knowledge. Attach a copy of Form GW-l (Well
Construction Record) if available.
_)s,_ PROPOSED WELL(S) to be constructed for use as a ground-source
heat pump wcll(s). Provide the i11formalion in (1) through (4) below
a<; PROPOSED construction specifications. Submit Form GW-1 after
construction.
GW-57 CL (March 1997) Page 2 of 4
4f
4
( l) Well llrilling Contractor's Name: lim L� IV
(11
NC Driller Registration number. & 3_7
(2) Date to be constructed: �j� N& J 17 q 7
Approximate depth of eaeli boring:
Number of borings:-gs/
(3) Well casing: Is the well(s) cased?
(a) YES if yes, then provide casing information below.
Casing type. Galvanized steel _ Black steel ____ Plastic
Other (specify)
Casing depth: froin to fL (reference to land surface)
(b) M
(4) Grout (inaterial surrounding well casing and/or piping):
(a) Grout type: -Cement; Bentonitex;
Other (specify)
(b) Grouter/ surface and grout depth (reference to land surface):
E
A around closed -loop piping; from 2� to o f ft-
around well casing; Gomm to ft.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
VROPOSED WELLS IF THIS INFORMATION I5 UNAVAILABLE BY OTHER MEANS.
H. LOCATION OF WELL(5) Attacli two snaps.
(1) a site map (can be drawn) showing 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 feet of the
giound-source treat punnp well system.
(2) a location Wrap referencing the site to a labeled road intersection.
GW-57 CL (March 1997) Page 3 of 4

I. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined
and am familiar with the information submitted in this document and all
attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the
information is true, accurate and complete. I am aware that there are
significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain,
repair, and if applicable, abandon the ground-source heat pump system
well(s) and all related appurtenances in accordance with Title 15A NCAC
Subchapter 2C Section .0200." 11
X '71A "~ Cot.,cee uJ
(Signature of Owner or Authorized A gent)
Please supply a letter signed by the owner
authorizing £he abvve agent,. ff: a:.-!thorized agent is s;gner.
J. 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 land owner in the absence of
contrary agreement in writing.)
If the property is owned by someone-other than the operator, the property
owner hereby consents to allow the operator to construct a ground-source heat
pump system as outlined in this notification and that it shall be the responsibility
of the operator to ensure that the ground-source heat pump system's well(s)
conform to the Well Construction Standards (Title 15A NCAC Subchapter 2C .0200)
GW-57 CL (March 1997)
(Signature of Property Owner if Different From System Operator)
Please return the completed Notification package to:
~JI"" 1") u \.-1: rog:ra1H
Groundwater Section
North Carolina DEHNR-DWQ
P.O. Box 29578
Raleigh, NC 27626-0578
(telephone: [phone])
Page 4 of 4
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N G RTI I CAROLINA,
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTNiENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLQSED--LOOP
GEOTHERMAL-WATER-0NLY INJECTION WELL SYSTEM
(GROUND -SOURCE HEAT PUMP)
In accordance with the provisions of NCAC Title I5A: 02C.021 I
complete notification and (nail to address on the back page.
This is not the 12roper arin for injection wells to be used in an d
gruzmd-source heat pump system. Do not use this forfn for systenis-that
re -circulate any substances to het- harp water- below, the ground surface.
Type 5QW Wells
M DIRECTOR, NORTIT CAROLINA DIVISION OF WATER QUALITY
DATE:A_ reO , 19
Please type or print clearly.
A. SYSTEM CLASSIFICATION Does die proposed system re -circulate potable
water in continuous piping which isolates the fluid from the environment?
YES If yes, then continue completing this form GW-57 CL.
NO if no, do not complete this form. A form GW-57 HP
(Application For Permit To Construct And/Or Use A Well
For Injection With A Heat Pump System) must be completed.
B. SYSTEM FLUID Will any additives be introduced to the systsm's subsurface
piping, 4icluding but not limited to corrosion it hibitors or antifreezes?
YE5 If yes, do not complete this form. A form GW-57 HI'
(Applicadon %or Permit To Construct And/Or Use A Well For
bijection Wilb A Bleat Pump System) must be completed.
NO If no, then continue completing this form GW-57 CL.
C PROPERTY OWNER
Natne; � . �. � O v erg/ iiM e Al�
Address:
City: Ae rr PD in1 t
County: Cr Jev
Zip code_
Telephone: — --
GW-57 CL (March I997) Page I of 4

D. STATUS OF PROPERTY OWNER
Private: Federal: I -
State: Public:
Commercial: , Native Amexicari Lands:
E. FACILITY (SITE) DATA (rill out ONLY if the Status of Property Owner is
Federal, State, Public or Commercial).
Name of Business or Facility: I, Le r 6 r ZT+� 4 e_r3 _ I kw-s
Address:— 00 ' f 80 !1 4 q-7
City: 640/44 �d�N -- zip code: County:- �.4t%CAJ
Telephone: r t r 1 Contact Person: d
p l'7 T��_ �I- � �---
Standard Industrial Codc(s) which describes Commercial facility:
F. HEAT PUMP CONTRACTOR DA.I'A
Name: _ R S �J
7 �J�►'�� ryV r�u
�
Address: 4 13 _ _ �� 1►!!�e� c - -
City: k.YiAIVI C 4J - Zip code: _ -
County: 19A).510 Telephone:
Contact Person:w�rN
G. WELL USE' Will tlae system wells) also be used as the Supply well(s) for
your personal consumption?
YES NO
II. CONSTFiUC CON DATA (CHECK ONE)
EXISTING WELL(S) tieing proposed for use as a ground -source heat
pump wells)_ Provide the information in (1) through (4) below to
the best of your kj)owledc e_ Attach a copy of Form GWA (Well
Construction record) if available.
PROPOSED W ELI.(S) to be constructed for use as a ground -source
lical pump wc11(s). Provide the lnforini3tlon In (1) througll (it) below
as PROPOSED construction specifications. Submit Form GW-1 after
construction.
GW-57 CL Warcli t997y Page 2 of 4

NOTE:
(1) Well D1illing Contractor's Name: (J /; tff.4--/e. {Jµf Ni/ ~ C C/q ·
NC Driller Registration number: ___ /'-/g--"3,::___,,3....__ _______ _
M~
(2) Date to be constructed: Dec,./q7 fliJ I q y'
Approximate depth of each bori~g: /Sr
Number of borings: 1' t
(3) WelJ casing: Is the well(s) cased?
(a) YES If yes, then provide casing information below .
Casing type: Galvanized steel_ Black steel_ Plastic_
Other (specify) ________ _
Casing depth: from. ___ to ___ ft. (reference to land surface)
(b) N) _£_
.( 4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement_; Bentonite,.L;
Other (specify) ______ _
(b) Grouted surlace and grout depth (reference to land surface):
-· I I
_l around closed-loop piping; from Y to fJ ft.
_ around well casing; from ___ to ___ ft.
TI-IE WELL DRILLING CONTRACTOR CAN SUPPLY THE DAT A FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
H. LOCATION OF WELL(S) Attach two maps.
(1) a site map (can be drawn) showing 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 feet of the
ground-source heat pump well system.
(2) a location map referencing the site to a labeled road intersection.
GW-57 CL (March 1997) Page 3 of 4
I. CERTlFICATION
"I hereby certify, under penalty of law, that l l!ave personally examined
aml 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 infomrntion, 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 infonnation. I agree to construct, operate, maintain,
repair, aml if applicable, abandon the ground-source heat pump system
well(s) and all related appurtenances in accordance with Title 15A NCAC
Subchapter 2C Section .0200."
r (Signature of Owner or Authorized Agent)
Please supply a letter signed by the owner
authorizing the above agent, if authorized agent is signer.
J. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or
other prope1ty rights in the well being constructed. A well is real property and its
construction on laml rests ownership in the land owner in the absence of
contrary agreement in writing.)
If the property is owned by someone other than the operator, the property
owner hereby consents to allow the operator to construct a ground-source heat
pump system as outlined in tl1is notification and that it shall be tl1e responsibility
of the operator to ensure that the ground-source heat pump system's well(s)
conform to the Well Construction Standards (Title 15A NCAC Subchapter 2C .0200)
GW-57 CL (March 1997)
(Signature of Property Owner if Different From System Operator)
Please return the completed Notification package to:
UIC Program
Groundwater Section
North Carolina DEHNR-DWQ
P.O. Box 29578
Raleigh, NC 27626-0578
( telephone: [phone])
Page 4of 4
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