WI0100002_Complete File - Historical_20220308

PAT MCCRORY
' IL
cowmor
DONALD R. VAN DER VAART
Secretory
Water Resources
ENVIRONMENTAL QUALITY S. ]AY ZIMMERMAN
Director
June 20, 2016
Harold E. and Alice M. Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
Re: Geothermal Heating/Cooling Water Return Well Analytical Results
Permit No. WI0100002
Henderson County
Dear Mr. and Mrs. Johnson:
On April 20, 2016, I collected geothermal system influent(Sample IDs: AC28451 and
AC28346)and effluent(Sample IDs: AC28452 and AC28347) samples from your wells located
at 115 Kindy Forest Drive, Hendersonville,North Carolina. The water samples were collected
as part of the permit renewal process for injection well permit WI0100002.
Analytical results for both the influent and effluent samples were all below the Title 15A North
Carolina Administrative Code(NCAC) 02L .0202 groundwater standards. A copy of the
analytical results is attached.
If you have any questions regarding the results please contact me at(828) 296-4684.
Sincerely,
AtittL✓
&U"—
Andrew Moore
Environmental Specialist
Water Quality Regional Operations Section
Asheville Regional Office
Attachment: Laboratory Analytical Results
cc: ARO File
Michael Rogers, DWR Central Office
State of North Carolina I Enwon rental Quality I Water Resources
2090 U.S.Hwy.70 I Swannanok North Carolina 28778
828 296 4500

f
AC28346 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loc.Descr: 116 KINDY FOREST DRIVE Sample ID: AC28346
County. Henderson Collector AMOORE Vsi11D PO Number# 16GO104
Region: ARC, Report To ARO Location to: 1904SWI0100002INF Dale Received: 0412112016
River Basin FRB Collect Date: 0 412 012 01 6 Priority COMPLIANCE Time Received: 09_20
Emergency Collect Time: 09_20 Sample Matrix: GROUNDWATER Lebworks LoginlD MSWIFT
CDC Yes1No Sample Depth, Loa Type: Influent Delivery Method NO Courier
Final Report Date: 519116
Report Print Date: 0511912016
Final Report
If this report is labeled preliminary report,the results have not been validated. Do not use for Regulatory purposes.
Result/ Method Analysis
Units
CAS# Analvte Name � POL Qualifier Reference Date validated by
LAB
Sample temperature at receipt by lab 1.1 C 4121/16 MSWIFT
NUT
Nitrate as N in liquid 0.02 1.4 mg/L as N EPA 353.2 REV 2 512116 CGREEN
Nitrite as N in liquid 0.01 0.01 U mg/L as N EPA 353.2 REV 2 4121/16 CGREEN
NO2+NO3 as N in liquid 0.02 1.4 mg/L es N EPA 353.2 REV 2 4128116 CGREEN
WET
Bromide 0.4 0.4 U mg/L EPA 300.0 rev2.1 4/21116 CGREEN
Chloride 1.0 3.7 mg/L EPA 300.0 rev2.1 4/21/16 CGREEN
Fluoride 0.4 0.4 U mg/L EPA 300.0 rev2.1 4121116 CGREEN
Sulfate 2.0 2.0 U mg/L EPA 300.0 rev2.1 4121116 CGREEN
MET
7429-90-5 Al by ICP 50 5011 ug/L EPA200.7 5/3116 ESTAFFORDI
7440-38-2 As by ICPMS 2.0 2.0 U ug/L EPA200.8 513116 ESTAFFORDI
7440-70.2 Ca by ICP 0.10 2.8 mg/L EPA 200.7 513/16 ESTAFFORDI
744D-47-3 Cr by ICPMS 5.0 5.0 U ug/L EPA 200.8 513116 ESTAFFORDI
7440-50-8 Cu by ICPMS 2.0 7.7 ug/L EPA200.8 5/3/16 ESTAFFORDI
7439-89-6 Fe by ICP 50 50 U ug/L EPA 20D.7 513116 ESTAFFORDI
7440-09-7 K by ICP 0.10 1.4 mg/L EPA200.7 513116 ESTAFFORDI
7439-95-4 Mg by ICP 0.10 0.67 mg/L EPA200.7 513/16 ESTAFFORDI
7439-96-5 Mn by ICP 10 38 ug/L EPA200.7 513/16 ESTAFFORDI
7440-23-5 Na by ICP 0.10 4.7 mg/L EPA200.7 513116 ESTAFFORDI
7440-02-0 Ni by ICPMS 2.0 2.0 U .ug/L EPA200.8 5/3/16 ESTAFFORDI
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L EPA 200.8 513116 ESTAFFORDI
7440-66-6 Zn by ICPMS 10 IOU ug/L EPA 200.8 513116 ESTAFFORDI
WSS Chemistry LaboratoM>1623 Mail Service Center,Raleigh,NO 27699-1623 [phone] _
"Not Detected"or"U"does not Indicate the sample is anaVe free but that the analyte is not detected at or above the PQL
Page 1 of 1

AC28451 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loc.Descr.: 116 KINDY FOREST DRIVE Sample ID: AC28451
County: HENDERSON Collector. AMOORE VisitlD PO Number# ARO
Region: ARO Report To ARO Location to: 1P045W101000021 Date Received: 04/20/2016
River Basin FRB Collect Date: 0 412 012 01 6 Priority COMPLIANCE Time Received: 11_10
Emergency Collect Time: 09_20 Sample Matrix: GROUNDWATER Labworks LoginlD KJIMISON2
COC Yes/No Sample Depth Lcc.Type: INFLUENT Delivery Method Hand delivered
Final Report Date: 6/9116
Report Print Date: 06116/2016 -
Final Report
If this report is labeled preliminary report,the results have not been validated. Do not use for Regulatory purposes.
Result/ Units Method Analysis
CAS# Analvte Name PoL Qualifier Reference Date validated by
ARC
Alkalinity4.5 1.0 12 mg/L as CaCO3 APHA2320B-20th 513/16 ESTAFFORDI
AlkalinityB.3 1.0 1 U mg/L as CaCO3 APHA232013-20th 513/16 ESTAFFORDI
Bicarbonate 1.0 12 mg/Las CaCO3 APHA2320B-20th 5/3/16 ESTAFFORD1
Carbonate 1.0 1 U mg/L as CaCO3 APHA2320B-20th 5/3116 ESTAFFORD1
pH_Alkalinity 6.8 mg/L as CaCO3 APHA2320B-20th 513/16 ESTAFFORD1
COIlforrll, MF Fecal in liquid 1 1 B2 CFU/100m1 APHA9222D-20th 4/20116 ESTAFFORD1
COIIform, MF Total in liquid 1 1 B2 CFU/100m1 APHA9222B-20th 4120/16 ESTAFFORDI
Sample temperature at receipt by lab 3.6 C 4120/16 RBYRD
Total Dissolved Solids in liquid 12 48 mg/L APHA2540C-18TH 4/26116 ESTAFFORDI
WSS Chemistry Laboratory>>1623 Mail Service Center,Raleigh,NC 27699.1623 [phone]
"Not Detected"or"U"does not indicate the sample is analyle free but that the analyle is not detected at or above the POL.
Page 1 of 1

i AC28347 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loc.Descr.: 116 KINDY FOREST DRIVE Semple to: AC28347
County: Henderson Collector. A MOORE VisitlD PO Number# 16GO105 '
Region: ARO Report To ARO Location ID: IP045WI0100002EFF Date Received: 04/2112016
River Basin FRB Collect Date: 0 412 0/2 01 6 Prionty COMPLIANCE Time Received: 08_15
Emergency Collect Time: 09_40 Sample Matrix: GROUNDWATER Labworks LoginlD MSWIFT
COC Yes/No Sample Depth Lac.Type: Effluent Delivery Method NO Courier
Final Report Date: 6117116
Report Print Date: O6n 9/2016
Final Report
If this report is labeled preliminary report the results have not been validated. Do not use for Regulatory purposes.
Result/ Units Method Analysis
CAS# Analvte Name P(�L Qualifier Reference Date validated by
LAB
Sample temperature at receipt by lab 1.1 C 4/21/16 MSWIFT
NUT
Nitrate as N in liquid 0.02 1.5 mg/L as N EPA 353.2 REV 2 5/2/16 CGREEN
Nitrite as N in liquid 0.01 0.01 U mg/L as N EPA 353.2 REV 2 4121/16 CGREEN
NO2+NO3 as N in liquid 0.02 1.5 mg/L as N EPA 353.2 REV 2 4128/16 CGREEN
WET _.
Bromide 0.4 0.4 U mg/L EPA 300.0 rev2.1 4121116 CGREEN
Chloride 1.0 4.4 mg/L EPA 300.0 rev2.1 4/21116 CGREEN
Fluoride 0.4 0.4 U mg/L EPA 300.0 rev2.1 4/21/16 CGREEN
Sulfate 2.0 2.0 U mg/L EPA 300.0 rev2.1 4/21/16 CGREEN
MET
7429-90-5 Al by ICP 50 50 U ug/L EPA200.7 - 513/16 ESTAFFORDI
7440-38-2 As by ICPMS 2.0 2.0 U ug/L EPA 200.8 5/3/16 ESTAFFORDI
7440-70-2 Ca by ICP 0.10 2.9 mg/L EPA 200.7 5/3/16 ESTAFFORDI
744047-3 Cr by ICPMS 5.0 5.0 U ug/L EPA 200.8 5/3116 ESTAFFORDI
7440-50-8 Cu by ICPMS 2.0 50 ug/L EPA 200.8 5/3116 ESTAFFORDI
7439-OM Fe by ICP 50 50 U ug/L EPA 200.7 5/3/16 ESTAFFORDI
7440-09-7 K by ICP 0.10 1.5 mg/L EPA 200.7 513/16 ESTAFFORDI
7439-954 Mg by ICP 0.10 0.73 mg/L EPA200.7 5/3/16 ESTAFFORDI
7439-96-5 Mn by ICP 10 44 ug/L EPA200.7 5/3/16 ESTAFFORDI
7440-23-5 Na by ICP 0.10 4.9 mglL EPA200.7 5/3116 ESTAFFORDI
7440-02-0 Ni by ICPMS 2.0 2.5 ug/L EPA 200.8 513116 ESTAFFORDI
7439-92-1 Pb by ICPMS 2.0 3.7 ug/L EPA200.8 5/3116 ESTAFFORDI
7440-66-6 . Zn by ICPMS 10 13 ug/L EPA 200.8 513/16 ESTAFFORDI
WSS Chemistry Laboratory>>1623 Mail Service Center,Raleigh,NC 27699.1623 [phone]
"Not Detected"or"U"does not Indicate the sample is anatyte free but that the analyte is not detected at or above the POL.
Page 1 of 1

AC28452 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
�t
Loc.Descr.: 115 KINDY FOREST DRIVE Sample ID: AC28452
County: HENDERSON Collector: A MOORE VisitlD PO Number# ARO
Region: ARO Report To ARO Location ID: 1P045MO100002E Date Received: 041201201E
River Basin FRB Collect Dale: 04/20/2016 Priority COMPLIANCE Time Received: 11_10
Emergency Collect Time: 09_40 Sample Matrix: GROUNDWATER Labworks LoginlD KJIMISON2
COC Yes/No Sample Depth Loc.Type: EFFLUENT Delivery Method Hand delivered
Final Report Date: 6114/16
Report Print Date: 06/16/2016
Final Report
If this report is labeled preliminary report,the results have not been validated. Do not use for Regulatory purposes. '
Result/ Units Method Analysis
CAS# Analvte Name POL Qualifier Reference Date validated by
ARC
Alkalinity4.5 1.0 11 mg/L as CaCO3 APHA2320B-20th 5/3/16 ESTAFFORDI
Alkalinity8.3 1.0 1 U mg/L as CaCO3 APHA2320B-20th 5/3116 ESTAFFORDI
Bicarbonate 1.0 11 mg/L as CaCO3 APHA2320B-20th 513116 ESTAFFORDI
Carbonate 1.0 1 U mg/L as CaCO3 APHA2320B-20th 513116 ESTAFFORD1
pH—Alkalinity 7.0 mg/L as CaCO3 APHA2320B-20th 513/16 ESTAFFORD1
Coliform, MF Fecal in liquid 1 1 B2, CFU/100ml APHA9222D-20th 4120/16 ESTAFFORDI
C011form, MF Total in liquid 1 1 B2 CFU1100ml APHA922213-20th 4/20116 ESTAFFORD1
Sample temperature at receipt by lab 3.6 C 4/20116 RBYRD
Total Dissolved Solids in liquid 12 42 mg/L APHA254OC-18TH 4126116 ESTAFFORDI
WSS Chemistry LaboratoM>1623 Mail Service Center,Raleigh,NC 27699-1623 [phone]
'Not Detected"or'U"does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 1

PAT MCCRORY
:4.. Gowmor
g
DONALD R. VAN DER VAART
Seas y
Water-Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
Lhr a.r
May 6, 2016
Harold E. and Alice M. Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
Re: Issuance of Injection Well Permit
Permit No. WI0100002
Geothermal Heating/Cooling Water Return Well
Henderson County
Dear Mr. and Mrs. Johnson:
In accordance with your permit renewal application received April 6, 2016, I am forwarding Permit
No. WI0100002 for the continued operation of geothermal heating/cooling water return well(s)
located at the above referenced address. This permit shall be effective from date of issuance until
April 30, 2021, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on April 20,2016. Laboratory analytical results will be forwarded to you
when it becomes available.
In order to continue uninterrupted legal use of this well for the stated purpose,you should submit an
application to renew the permit 120 days 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 Resources. If you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards,
ftd"awe` ED
Michael Rogers, P.G. (NC & FL)
Underground Injection Control (UIC) Manager - Hydrogeologist A(AY 10
Division of Water Resources,NCDEQ
Water Quality Regional Operations Section Water OusAHR
.Asheville Reel Oomvra'y
slate orNonh Cmnllna [ En,.rwmemal O.Al j Wala R.m.¢
1611 Mail seniee Cemer Raleigh,North Carolina 270W-1611
919 707%00

Page 2 of 2
cc: Landon Davidson and Andrew Moore, Asheville Regional Office
Central Office File, W10100002
Henderson County Environmental Health Department
A
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t,x.i

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE 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
Harold E. and Alice M. Johnson
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224(a),which will be used
for the injection of heat pump effluent. The injection well(s)located at 115 Kindy Forest Drive,Hendersonville,
Henderson County,NC 28739 will be operated in accordance with the application submitted April 6, 2016, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental. Quality and are considered a part of this permit.
This permit is for continued operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until April 30, 2021, and shall be
subject to the specified conditions and limitations set forth in this permit:
Permit,issued this the 6th day of May 2016.
S. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit#W10100002 U1C/5A7 = Page 1 of
ver. 1 1/15/2015

PART I—PERAUT GENERAL CONDITIONS '
1. The Permittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). 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 is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [I5A NCAC 02C .0211(a)].
3. 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 [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. 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, including any supporting materials as may be appropriate, at least 30 days prior to the date of
--- — the change-[-15A-NCAC 02C—.021-1(q)]. — —-- —--- - ---
5. The issuance of this permit shall not relieve the Pennittee 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 [15A NCAC 02C .0203].
PART II - WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with the requirements of rule 15A NCAC 02C .0107 except as required in Item 42 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be emplaced from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2),(3)].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or .
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions.
[15A NCAC .0225(g)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director pr6vides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S. 87-85(16).
6. Each well shall have permanently affixed an identification plate [15A NCAC 02C .0l 070)(2)].
Pernut NW 10100002 UIC/5A7 Page 2 of 5
ver. l l/15/2015

7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit.
PART III—OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .02110)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface water
or groundwater resulting from the operation of this facility. 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 that may be required,
such as the repair, modification, or abandonment of the injection facility [15A NCAC 02C .0206].
PART IV—INSPECTIONS[15A NCAC 02C .0211(k)]
l.- Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and may
obtain samples of groundwater, surface water, or injection fluids.
2. DWR 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 samples of the injection facility's activities.
PART V—MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [15A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(1)].
J. The Permittee shall report any monitoring or other information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violation of applicable groundwater quality standards. or
that a malfunction of the injection system may cause the injected fluids to migrate outside the approved
injection zone or area. As specified in rule 15A NCAC 02C .0211(r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number 252-946-6481.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item#5 below.
Permit#W 10100002 U JC/5A 7 Page 3'of 5
ver. 11/15/2015

(C) The written notification shall contain a description of the noncompliance and its cause; the period of
noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. The Permittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. [15A NCAC 02C .0224(f)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff Water Quality Regional Operations Section
Division of Water Resources and DWR Asheville Regional Office
1636 Mail Service Center 2090 U.S. Hwy 70
Raleigh,NC 27699-1636 Swannanoa,NC 28778
PART VI—PERMIT RENEWAL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the permit. This permit condition does not apply if the Permittee chooses to discontinue operation
of the well for injection of effluent from the geothermal heating and cooling system associated with this
permit.
PART VII— CHANGE OF WELL STATUS [15A NCAC 02C .0240]
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to.prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. if a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall permanently abandon that injection well in accordance with the procedures specified in 15A
NCAC 02C .01 13(b), which include, but are not limited to, the following:
(A). All casing and materials may be removed prior to initiation of abandonment procedures if
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 in accordance with rule 15A
NCAC 02C .01I l(b)(1)(A),(B), and (C).
Permit v W 10100002 U 1C/5A7 Page 4 of 5
ver. 1 1/15/2015

f.
(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 those cases when a subsurface cavity has been created,as a result of the injection
operations, each well shall be abandoned in such a manner that will prevent the movement
of fluids into or between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record (Form.GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VII (4)(17) shall be submitted to the addresses specified in Part
V.5 above.
Pemit:M10100002 UIC/5A7 Page 5 of 5
ver. 11/15/2015

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support FILM
Permit No. WI0100002
Date: April 22, 2016 County: Henderson
To: Michael Rogers Permittee/Applicant: Harold E. Johnson
Central Office Reviewer Facility Name: Harold and Alice Johnson SFR
L GENERAL INFORMATION
1. This application is(check all that apply): ❑New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: April 20,2016
b. Person contacted and contact information: Harold Johnson(828-891-8600)
c. Site visit conducted by: Andrew Moore
d. Inspection Report Printed from BIMS attached: ❑Yes ®No.
e. Physical Address of Site including zip code: 115 Kindy Forest Drive, Hendersonville,NC 28739
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 35.319925 Longitude: -82.520613
Source of Lat/Long&accuracy(i.e.,Google Earth, GPS,etc.): Goo leg Earth
IL DESCRIPTION OFINJECTION WELDS)AND FACILITY
1. Type of injection system:
® Geothermal Heating/Cooling Water Return
❑In situ Groundwater Remediation
❑Non-Discharge Groundwater Remediation
❑ Other(Specify:_]
2. For Geothermal Water Return Well(s)only
a. For existin geothermal system:
Were samples collected from InfluentfEffluent sampling ports? ®Yes ❑No.
Provide well construction information from well tag: Well is 30+years old.No well tag present for
iniection well Well construction record in file indicates well: drilled 7-15-83, Death 405'.Casing 45':
Grout 20'• Drilling_Contractor Caldwell(No. 99).
b. Does existing or proposed system use same well for water source and injection? ❑ Yes ®No
If No please provide source/supply well construction info(i.e.,depth, date drilled,well contractor,
etc.)and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
Supply Well Drilled 8-8-1983• Depth 225'• Casing 20'• Yield 20 gom: Driller No. 303.
3. Are there any potential pollution sources that may affect injection? ❑Yes ®No
What is/are the pollution source(s)?
What is the distance of the injection well(s)from the pollution source(s)?
4. What is the minimum distance of p=osed injection wells from the property boundary?
Rev.6/1/2015 Page 1

j WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
5. Quality of drainage at site: ® Good ❑Adequate ❑Poor
6. Flooding potential of site: ®Low ❑Moderate ❑High
7. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring,monitoring parameters,etc.)adequate? ❑ Yes ❑No. If No,
attach map of existing monitoring'well network if applicable and recommend any changes to the groundwater-
monitoring program.
8. Does the map.included in the Application reasonably represent the actual site(property lines,wells, surface
drainage)?❑Yes ❑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.
9. For Non-Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑Yes ❑No ❑N/A.
If no,please explain:
b. Are the site conditions(soils,topography,depth to water table,etc.)consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑Yes ❑No ❑N/A. If no,please explain:
III. EVALUATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑Yes ®No. If yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
c
9
4. Recommendation
❑ Deny. If Deny,please state reasons:
❑Hold pending receipt and review of additional information by regional office
❑Issue upon receipt of needed additional information
® Issue ,J
5. Signature of report preparer(s): /Gti '2a
Rev.6/1/2015 Page 2

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Signature of WQROS Regional Supervisor:
Date: Za /
IV. ADDITIONAL REGIONAL STAFFREVIEW COMMENTSIATTACHMENTS(If Needed)
i
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9
Rev.6/1/2015 Page 3

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WATER QUALITY REGIONAL, OPERATIONS SECTION
APPLICATION REVIEW REQUEST F094
pMsion Gf Y'Zaer Resources
Date: April 11,2016 APR 13 20%
To: Landon Davidson—Andrew Moore
Water 01PM,Rna'onal oneratton9
From: Michael Rogers, WQROS—Animal Feeding Operations and Groundwate Protectkom$iraficb-_„_!"'`_"__.__�
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WI0100002
B. Applicant: Harold and Alice Johnson
C. Facility Name:
D. Application:
Permit Type. Geothermal Heating/Cooling Water Return Well
Project Type: RENEWAL
E. Comments/Other Information:
❑ 1 would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WOROS Staff
Report.
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 Groundwater Protection Branch contact person
listed above.
RO-WOROS Reviewer: Date:
COMMENTS:
NOTES:
A R R ver.092614 Pape I of I
y

y PAT MCCRORY
)'a Gove nor
DONALD R. VAN DER VAART
sec—ly
WaterResources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
Director
April 11,2016
Harold and Alice Johnson
A 5 Kindy Forest Drive
Hendersonville, NC 28739
RE: Acknowledgement of Application No. WI0100002
Geothermal Heating/Cooling Water Return Well
Henderson County
Dear Mr. and Mrs.Johnson:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application on April 6,2016. Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Asheville Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Water Quality ,Regional Operations Section
(WQROS)requests your assistance in providing a timely and complete response to any additional
information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact Michael
Rogers at 919-807-6412 or [e-mail].
Sincerely,
6`6ebra7.'Watts, Supervisor
Animal Feeding Operations&Groundwater
Protection Branch
Division of Water Resources
cc: Asheville Regional Office,WQROS
Permit File WI0100002
State of Moll)Carolina I Environmental Quality I Waler Resources
161I Mail service Center i Raleigh,North Carolina 27699-1611
919 707 9000

Li
Harold E.Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
[phone]
"W4ZCBkatt.net
RECEIVEDINCDEQIDWR
5 April 2016 APR '0 0 2016
Water Quality Regional
Mr or Ms Shristi Shrestha
Operations Section
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Dear Mr or Ms ShresthaYou folks are worse than when you were DENR and you were no great shakes back then. I
am the original owner of the injection well permit of some thirty odd years ago, and have gone
through more misery with your predecessors than I care to discuss.I received your latest(dated 29
March) on the second of April and it certainly should be obvious that I will be unable to respond
with a renewal application 120 days before the end of this month..
Typically in 5 year increments over the past 30 years,you have written to advise me that you
would like to come and test the quality of the water going into my heat pump and the water
exhausting into my injection well. A nice young man would come from Asheville and make those
tests and I would receive a renewal in a few weeks from Raleigh.As mentioned above,this has been
ongoing for the past 30 years. I received my first permission to operate this well system on 20
October 1986 from a Mr Davis. After applying on August 25 1986. New approvals have been at
various dates due to variations.in water test timing at the state and the response time from DENR 1
would like to be excused for not having a calendar reminder to apply 120 days sooner.
R, g ds�?
i
`l8 d E.�Johnson " C t �.-

_y
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C.0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS)
These well(s)inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application Renewal* _Modification _Permit Rescission Request*
'For Permit Ren or Rescission Request,complete Pages 1 and 4(signature page)only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: l L 2o_eo__ PERMIT NO.W yO J JA)02i(leave blank if New Application)
A. CURRENT WELL USE AND OWNERSHIP STATUS(leave Blank if New Application)
1. Current Use of Well
a. Continue to use as XGeothetnal Well Drinldng Water Supply _Other Water
Supply
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit,check the box below. If abandon�� ftWg1 Abandonment
Record(GW-30). KC
❑ Yes,I wish to rescind the permit APR 0 6 2016
Water Quality Rggional
2. Current Ownership Status Operations S on
Has there been a change of ownership since permit last issued? ❑ YES f�NO
If yes,indicate new owner's contact information: t
Name(s)
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Email Address.:
B. STATUS OF APPLICANT(choose one) A
Non-Government: Individual Residence Business/Organization
Government: State_ Municipal_ County_ Federal
C. WELL OWNER(S)/PERMIT APPLICANT—For individual residences,list owner(s)on property,pdeed For
all others, name o entity and name of person delegated authority to sign: �&k oGy g f -1 ee
r
Mailing Address: I 1 S J
City: 9 V State: 1° Zip Code: Coun4JW
Day Tele No.: 0 Z / tP 6 B J� Cell No.:
EMAIL Address: Fax No.: �—
Geothermal Water Return Well Permit Application(Revised Jan 2015) Page 1

_ '.1 a �.
J .. ..._ � '.}' .. . .. ..
_ •r _ _ 1
�- r ti
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.f

r
NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells,etc.can then be drawn in by hand Also,a `layer'can be selected showing topographic contours or elevation
data
M. CERTIFICATION(to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(e)requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state,federal,or other public agency: by either a principal executive officer
or ranking publicly elected official;
4. for all others: by all the person(s) listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate,maintain,repair, and if applicable,abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
Permit."
r
i of Property wner/Applicat t
Print or Type Full Name
Signature of Proper er/Applicant
Print or Type Full Name
Signature of Authorized Agent,if any
Print or Type Full Name
Submit two copies of the completed application package to:
Division of Water Resources
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh,NC 27699-1636
Telephone[phone]
Geothermal Water Return Well Permit Application(Revised Jan 2015) Page 4

PAT MCCRORY
s_; Governor
DONALD R. VAN DER VAART
Secretwi
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
March 29, 2016
RECEIVED
CERTIFIED MAIL# 7014 1200 0001 3432 6561 ONlsmn of W War Resoure"
RETURN RECEIPT REQUESTED
Harold and Alice Johnson APR - 4 2016
115 Kindy Forest Dr.
Hendersonville NC 28739 WateAshjv leRRC-tmalOoeraHona
' Ashev(ile Nc-eionl
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0100002
Henderson County
Dear Mr. and Mrs. Johnson:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on May 6, 2011, and expires on April 30, 2016. Per permit conditions and requirements
per 15A NCAC 2C .0224(c),the renewal application must be submitted at least 120 calendar days
prior to expiration of the permit if you wish to continue operating the injection well on your
property.
If Your Geothermal Water Return Well is Still Currently Beine Used for Iniection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate hijection Wells — Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications.
If Your Geothermal Water Return Well is NO LONGER Bein2 Used for Iniection•
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive,plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section
.0240. When the well is plugged and abandoned, a well abandonment record(Form GW-30)must
be submitted to our office to certify that the abandonment was properly conducted.
State otNorth Carolina I Enviromnental Quality l Water Resources
1611 Mail service Center I Raleigh,North Carolina 27699-1611
919 707 9000

Page 2 of 2
If There has been a Chan¢e of Ownership of the Property:
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
..
UIC Program
w.
1636 Mail Service Center
Raleigh, NC 27699-1636
111Ui p _ R9A
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
e Pen Rrdap6� �Iith North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. If you have any questions, please contact me by phone at
[phone] or by email at shristi.shresthana cn denr.gov.
Regg�ards0
4
Shristi 5hrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Asheville- Regional Office—WQROS w/o enclosures
Central Files - Permit No. WI0100002 w/o enclosures

N (DV Laboratory Section Wesufts
County: HENDERSON Sample ID: AS80397
River Basin �oF wA7Fao PO Number# 12G0028
Report To AROAP O Gy Date Received: 02109/2012
j r Time Received: 12:00
Collector: J STEPP O Labworks LoginlD DLEAVITT
Region: ARO
Sample Matrix: GROUNDWATER Date Reported 2/22/12:
Loc.Type: Report Generated: 03/21/2012
Emergency Yes/No VisitlD
CDC Yes/No
Loc. Descr.: HAROLD JOHNSON -
Location ID: 115 KINDY FOREST DRIVE Collect Date. 0 2107/2 01 2 Collect Tim .: 10:34 Sample Depth
Sample Qualifiers and Comments
�L)
� n
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estimated concentration is<PQL and>MDL
B1-Countable membranes with<20 colonies; Estimated
NE-No established PQL
B2-Counts from all filters were zero.
B3-Countable membranes with more than 60 or 80 colonies;Estimated P-Elevated PQL due matrix interference
B4-Filters have counts of both>60 or 80 and<20; Estimated Qi-Holding time exceaeded priorrtoand/or sample dilution
receipt at lab.
r
Q2-Holding time exceeded following receipt by lab
B5-Too many colonies were present;too numerous to count(TNTC)
J2-Reported value failed to meet QC criteria for either precision or accuracy; Estimated PQL-Practical analyzed
forth Limit-subject to change due to instrument sensitivity
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated U-Samples analyzed for this compound but not detected
Xi-Sample not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
1 AR
Laboratory Section>>1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 1 of 2

C _
l
XC DWQQ Laboratory Section 12esufts ample ID A680397
Location ID: 115 KINDY_FOREST_DRIVE_ Collect Date: 02/0712012
Loc.Descr.: HAROLD JOHNSON Collect Time:: 10:34
Visit ID
CA # Analyte Name PQL Result Qualifier Units Analyst/Date Approved By/Date
LAB
Sample temperature at receipt by lab 2.2 'C MSWIFT DLEAVITT
Method Reference 2/10112 2110/12
MET
7429-90-5 At by ICP 50 50 U ug/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2/14/12 2/20/12
7440-38-2 As by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2/14/12 2/20/12
7440-70-2 Ca by ICP 0.10 2.7 mg/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2113112 2120/12
7440-47-3 Cr by ICPMS 10 10 U ug/L JJURGEVICH ESTAFFORD1
Method Reference EPA 200.8 2114/12 2/20112
7440-50-8 Cu by ICPMS 2.0 3.1 ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200A 2/14112 2/20/12
7439-89-6 Fe by ICP 50 50 U ug/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2/14/12 2120/12
7440-09-7 K by ICP 0.10 1.5 mg/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2/13/12 2120/12
7439-95-4 Mg by ICP 0.10 0.61 mg/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2113/12 2/20/12
7439-96-5 Mn by ICP 10 18 ug/L DSTANLEY ESTAFFORDI
Method Reference EPA 2003 2/14/12 2120/12
7440-23-5 Na by ICP 0.10 4.7 mg/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2/13/12 2/20112
7440-02-0 Ni by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2/14/12 2/20/12
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORDt
Method Reference EPA 200.8 2/14/12 2/20/12
7440-66-6 Zn by ICPMS 10 10 U ug/L JJURGEVICH ESTAFFORDt
Method Reference EPA 200.8 2114/12 2/20/12
Laboratory Section>>1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

N DBV Laborato Section esufts
rReportTo
unty: HENDERSON Sample ID: AB80396
er Basin �OF W A7F9 p PO Number# 12G0027
AROAP O Gy Date Received: 0 2/0 912 01 2
C Time Received: 12:00
Collector: J STEPP p -~c Labworks LoginlD DLEAVITT
Region: ARO
Date Reported: 3/9/12
Sample Matrix: GROUNDWATER
Loc.Type: /b�/o — f L Report Generated: 03I2112012
Emergency Yes/No 62 �j.5 VisitlD
COC Yes/No
Loc.Descr.: HAROLD JOHNSON
Location ID: 115 KINDY FOREST DRIVE O Collect Date: 82I08120" Collect Tim 11:05 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estimated concentration is<PQL and>MDL
B1-Countable membranes with<20 colonies;Estimated
NE-No established PQL
B2-Counts from all filters were zero.
83-Countable membranes with more than 60 or 80 colonies;Estimated P-Elevated PQL due to matrix interference and/or sample dilution
B4-Filters have counts of both>60 or 80 and<20: Estimated Qt-Holding time exceeded prior receipt at lab.
85-Too many colonies were present;too numerous to count(TNTC) Q2-Holding time exceeded following receipt by lab
J2-Reported value failed to meet QC criteria for either precision or accuracy;Estimated PQL-Practical analyQuanzed
forth Limit-subject to change due to instrument sensitivity
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated XI-Sample not analyzed for this compound
Nl-The component has been tentatively identified based on mass spectral library search and has an estimated value
IAR
Laboratory Section>>1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 1 of 2

NC 1DWQ La6oratorySection 1§sufts amps ID AB80396
r,tID
5 KINDY FOREST_DRIVE_0 Collect Date: 0 2/0 812 01 2
ROLDJOHNSON Collect Time:: 11:05
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By/Date
LAB
Sample temperature at receipt by lab 2.2 °C MSWIFT DLEAVITT
Method Reference 2/10/12 2/10112
MET
7429-90-5 At by ICP 50 95 ug/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2J14/12 2/20112
7440-38-2 As by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2//4/12 220112
7440-70-2 Ca by ICP 0.10 2.7 mg/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2113/12 220112
7440.47-3 Cr by ICPMS 10 10 U ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2/14/12 220/12
7440-50-8 Cu by ICPMS 2.0 36 ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2114/12 220112
7439-89-6 Fe by ICP 50 50 U ug/L DSTANLEY ESTAFFORD7
Method Reference EPA 200.7 2/14112 220/12
7440-09-7 K by ICP 0.10 1.5 mg/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2/13112 220/12
7439-954 Mg by ICP 0.10 0.63 mg/L DSTANLEY ESTAFFORD1
Method Reference EPA 200.7 2/13112 220/12
7439-96-6 Mn by ICP 10 19 ug/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2114112 2120/12
7440-23-5 Na by ICP 0.10 4.8 mg/L DSTANLEY ESTAFFORDI
Method Reference EPA 200.7 2/13/12 220/12
7440-02-0 NI by ICPMS 2.0 2.4 ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2114112 220/12
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2/14/12 220/12
7440-66-6 Zn by ICPMS 10 10 U ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 2/14112 220/12
Laboratory Section>>1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

Harold E. Johnson
115 Kindy Forest Drive �/ 4 l J 0�)a Cf
Hendersonville, NC 28739
[phone]
February 7, 2012
Mr Jonathan Stepp EC E I V E D
DENR, Asheville Regional Office
2090 U.S. Highway 70 FLB 09 20112
Swannanoa,NC 28778
Mr Stepp Asheville Regional Off ice
Aquifer Protection
Watching your data collection this morning, and considering the circumstances at the time, a
thought occurred. Does that instrument you used to collect the PH of the water also record the water
temperature? If so, was it moving slowly as well as the PH was?
Shortly before we started the collection, I had reset the thermostat to 80 degrees to keep the heat
pump in operation instead of shutting down during your sampling.
My heat pump is multistage and if the demand from the thermostat is more than 3 degrees from
what the room temperature is, it stages the heat pump to full on. At that point, with 4 GPM flowing, the
water temperature is cooled from the 57 degrees coming from the source well to 40 degrees for discharge.
It would have been running that way for some time and then shifting to a lower stage as the temperature of
the home was nearing the set temperature. At the lower speed, with the same water flow rate, the
temperature rises to about 46 degrees and would be shortly reflected as the exhaust water warmed the
surrounding earth.
If the probe does NOT measure or compensate for temperature as well, I could jumper the solenoid
valve to operate the water flow without operating the compressor. The water would be flowing just as it
would during normal operation, but would not be under any temperature change for another test.
Regards
401,
ri� nson

Driving Directions from 2090 Us 70 Hwy, Swannanoa,North Carolina 28778 to 115 Kindy Fore... Page 1 of 3
Notes
mapquest' ' Harold Johnson 828-891-8600
Trip to:
115 Kindy Forest Dr
Hendersonville, NC 28739-8847
30.55 miles/50 minutes
2090 Us 70 Hwy, Swannanoa, NC 28778-8211
® 1.Start out going west on US-70 toward New Salem Rd. Map 2.4 Mi
2.4 Mi Total
2.Turn left onto Porter Cove Rd.Map 0.1 Mi
�7 Porter Cove Rd is just past Burleson Rd 2.5 Mi Total
If you reach Moffitt Branch Rd you've gone a little too far
3. Merge onto 1-40 W toward 1-261 Asheville.Map 3.7 Mi
' 6.3 Mi Total
4.Take the Sweeten Crk Rd I US-25A exit, EXIT 51,toward Asheville.MaD 0.3 Mi
6.5 Mi Total
r^ 5.Turn left onto US-25-ALT.Map 7.0 Mi
tC251 13.5 Mi Total
6. US-25-ALT becomes NC-280 S. Map 6.8 Mi
40 20.3 Mi Total
4 © 7.Turn left onto Haywood Rd/NC-191.Map _ 6.5 Mi
9 Haywood Rd is 0.1 miles past Goode Or 26.8 Mi Total
Toby is on the corner
If you reach Cross Road Dr you've gone a little too far
8.Turn right onto Blythe St. Map 0.8 Mi
Blythe St is 0.1 miles past Haywood Townes Dr 27.6 Mi Total
If you reach Ewbank Or you've gone a little too far
9.Turn right onto Brevard Rd/US-64.Map 0.8 Mi
64 Brevard Rd is just past Woodmont Dr 28.4 Mi Total
If you reach W Blythe Cir you've gone a little too far
10.Turn left onto Daniel Dr.Map 0.4 Mi
Daniel Or is 0.2 miles past Pisgah Dr 28.8 Mi Total
Hardee's is on the right
If you reach Windsor Dr you've gone a little too far _
11.Turn right onto Davis Mountain Rd.Mao - 0.04 Mi
28.9 Mi Total
12.Take the 1 st right to stay on Davis Mountain Rd.Map 1.3 Mi
If you reach the end of Old Orchard Dr you've gone about 0.1 miles too far 30.2 Mi Total
ro 13.Turn right onto Stone Gate Ln.Map 0.03 Mi
Stone Gate Ln is 0.1 miles past Crescent Point Dr 30.2 Mi Total
If you reach Evenstar Crst you've gone a little too far
` 14.Take the 1 st left onto Kindy Forest Dr.Map - 0.3 Mi
`7 If you reach the end of Stone Gate Ln you've gone about 0.2 miles too far 30.5 Mi Total
■ 15. 115 KINDY FOREST DR is on the left.Map
Your destination is 0.1 miles past Kindy Forest Dr
If you reach the end of Kindy Forest Dr you've gone about 0.1 miles too far
As 115 Kindy Forest Dr, Hendersonville, NC 28739-8847
ir
http://www.mapquest.com/print?a--app.core.abc3fd5e4ebl6a5dfc08f3f2 2/7/2012

" Driving Directions from 2090 Us 70 Hwy, Swannanoa,North Carolina 28778 to 115 Kindy Fore... Page 3 of 3
Total Travel Estimate: 30.55 miles -about 50 minutes
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http://www.mapquest.com/print?a=app.core.abc3fd5e4ebl6a5dfcO8f3f2 2/7/2012

HiJonathan
AB70649 (22ug/L Pb)and AB70650(14ug/L Pb) were analyzed and reported by the ICP-MS on
4/25/11,the quality control for Pb on that run was as follows;
LRB (digested blank) =0.05 acceptance limits are;-1.00-1.00 Passed
LFB (digested spiked blank) 101% recovery—acceptance limits are;—85%-115% Passed
PQL(reporting limit standard) 2.Olug/L—acceptance limits are; 1.5-2.5ug/L Passed
IPC(midrange standard) 101.6% recovery—acceptance limits are; 90%-110% Passed
IPC 2(mi6ange std.at end of run) 102% recovery—acceptance limits are; 85%-115% Passed
QCS (second source QC) 101.7%recovery—acceptance limits are;85%-115% Passed
LFM (spiked sample) 102% recovery—acceptance limits are; 70%-130% Passed
The samples were also confirmed by the ICP AB70649 (25ug/L Pb)AB70650 (16ug/L Pb) On
4/26/11,the quality control for Pb on that run was as follows;
LRB(digested blank) =2.08 acceptance limits are; 5,00-15.00 passed *The ICP has a higher
detection limit of 30ug/L*
LFB(digested spiked blank) 99%recovery—acceptance limits are;—85%-115% Passed
PQL(reporting limit standard)9.81ug/L—acceptance limits are; 5-15ug/L Passed
IPC(midrange standard) 101.%recovery—acceptance limits are; 95%-105% Passed
IPC 2(midrange std. at end of run) 100.4%recovery—acceptance limits are; 90%-110%Passed
QCS ( second source QC) 99.5% recovery—acceptance limits are; 85%-115% Passed
LFM (spiked sample) 100%recovery—acceptance'limits are;70%-130% Passed
The other samples you mentioned AB73911 and AB73912 were both non detects for Pb, let me
know if you want a QC summary for those as well,take care.
Ellen
Hey Jonathan,
AB73911(2.OU Pb) and AB73912 (2.OU Pb)were analyzed and reported by the ICP_MS on
7/25/11,the QC for Pb on that run was as follows;
LRB (digested blank) =0.02 acceptance limits are; -1.00-1.00 Passed
LFB (digested spiked blank) 99% recovery—acceptance limits are;—85%-115% Passed
PQL(reporting limit standard) 2.08ug/L—acceptance limits are; 1.5-2.5ug/L Passed
IPC(midrange standard) 100.4% recovery—acceptance limits are; 90%-110% Passed
IPC 2(midrange std. at end of run) 102% recovery—acceptance limits are; 85%-115% Passed
QCS (second source QC) 107% recovery—acceptance limits are; 85%-115% Passed
LFM (spiked sample) 100%recovery—acceptance limits are; 70%-130% Passed
The same samples were analyzed by ICP with a result of 10U (due to the higher detection limit
on the ICP)on 7/25/11 and the QC for PB on that run was as follows;
LRB(digested blank) =-0.37 acceptance limits are; 5.00-15.00 passed *The ICP has a higher
detection limit of 30ug/L*
LFB (digested spiked blank) 96% recovery—acceptance limits are;—85%-115% Passed
PQL(reporting limit standard) 8.74ug/L—acceptance limits are; 5-15ug/L Passed
IPC(midrange standard) 97% recovery—acceptance limits are; 95%-105% Passed
IPC 2(midrange std. at end of run) 98% recovery—acceptance limits are; 909/o-110% Passed
QCS(second source QC) 98.8% recovery—acceptance limits are; 85%-115% Passed
LFM (spiked sample) 92% recovery—acceptance limits are;70%-130% Passed
Let me know if you have any questions.
Ellen

Harold E. Johnson RECEIVE
115 IGndy Forest Drive
Hendersonville, NC 28739 AUG 31 2G ij
[phone]
August 26, 2011 Asheville Regl anal Office
Any Onr Pratection _
Mr Jonathan Stepp
DENR, Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Mr Stepp
I thank you for the copy of the lab results you had promised. I believe you might forgive me for not having
much in the way of confidence in DENR and their laboratory. They have little in the way of consistency in their
results, first finding excessive 'von in my well water some 20 years ago, and when advised that there was only PVC
and cupro-nickel in my system, changed their mind and decided first that I was removing lead from my source
water, and subsequently, after a challenge to those findings, was adding lead to my water. This latest measurement
is additionally difficult to explain since I have the same old well and the lab results now yield an all clear.
Since lead is the ultimate decomposition of radioactivity, and we are in an area of high Radon
decomposition, I am not surprised that trace amounts have been detected in our mountain water supply. Neither
am I terribly surprised that the EPA has determined that their target for lead content is zero. That likely is not a
realizeable goal. As I have previously mentioned, I grew up in Chicago, IL and when a child, was served my city
water through lead pipes all the way from the main to my faucet. Whilst I may not be the brightest light in the
harbor, I did grow up and eventually made my contributions to society.
One of those contributions was the creation and management of a U.S. Government PMEL. Precision
Measurement Equipment Laboratory, for the years of 1960 through 1963. We were responsible for maintenance
and calibration of standards, both mechanical and electronic for all military stations further West than Hawaii,
including the Far East. To accomplish these requirements, we were visited every 90 days by representatives of the
old NBS, now NIST, to transfer their accuracies to our standards.
Since there has been no explanation for the variability in DENR measured results, despite the stability of
the source, I would offer some several observations. First, how frequently are the laboratory and field
measurement equipments calibrated and who performs these? Were the latest calibrations recently performed? To
the best of my knowledge, all I do is extract 57 degree water from one well, and discharge it at either 91 degrees
during the summer or 39 degrees during the winter into my injection well some 250 feet away. Are the
measurement equipments calibrated against temperature differences?
Quite frankly, the only other explanation of the latest results from DENR I can think of would be a minor
earthquake in the Brevard fault closing off some unknown source of lead, and none have been recently reported.
Since earthquakes are not in the purview of DENR, might we just have an unlimited approval of my injection well
and I'll advise you of any changes made on this end of the equation? You can get on with more important things
and we both can be spared the exertion of removing and replacing that heavy roof over my source well.
Regards /
Ur\J
H d E. Johnson, PE FLand OH.

�D Laboratory Section Resufts
County: HENDERSON Sample ID: A070650
River Basin �pF NlA Te9P PO Number# 11G0314
Report To AROAP �O G Dale Received'. 0412//2011
U
Time Received
Collector. J STEPP = y : DLE
Labworks Lo9inID DLEAVITT
Region: 98Q
Date Reposed: 5/11/11
Sample Matrix: GROUNDWATER
Loc.Type: WATERSUPPLY Report Generated: 05/16/2011
Emergency Yes/No
VisitlD
CDC Yes/No �\J4,r,r
r Loc.Descr.: HAROLD JOHNSON 115 KINDY FOREST DR
Location ID: 1116I9NDY FOREST DWE_OU Collect Date: M19/2011 Collect Time:: 12:10 � Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estimated concentration is<POL and>MDL
Bl-Countable membranes with<20 colonies;Estimated
NE-No established POL
82-Counts from all filters were zero. P-Elevated PQL due to matrix interference and/or sample dilution
B3-Countable membranes with more than 60 or 80 colonies;Estimated
Q1-Holding time exceeded prior to receipt at lab.
84-Filters have counts of both>60 or 80 and<20;Estimated
O2-Holding time exceeded following receipt by lab
U-Too many colonies were present too numerous to count(TNTC)
POL-Practical Quantitation Limit-subject to change due to instrument sensitivity
J2-Reported value failed to meet CIC criteria for either precision or accuracy;Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated
Xi-Sample not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample;Estimated
W-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section>>1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 1 of 3

NC /DWWQ La6oratory Section Results Sample ID A670650
Location ID: 115KINDY FOREST DRIVE_OU Collect Date: 0411912011
Loc.Descr.: HAR0LD JOHNS0N 115 IONDY FOREST DR Collect Time:: 12:10
Visit ID
CAS# Analyte Name PQL Result Qualifier Units AnalystfDate Approved By/Date
LAB
Sample temperature at recelpt by lab 2.9 °C HMORGAN DLEAVITT
Method Reference 421/11 4/26/11
WET
Ion Chromatography _TITLE_ mg/L MAJAYI CGREEN
Method Reference EPA300.0 426111 5/4/17
Chloride 1.0 3.1 m91L MAJAYI CGREEN
Meted Reference EPA 300.0 42a/11 514111
Fluoride 0.4 OA U mg(L MAJAYI CGREEN
Method Reference EPA300.0 426/11 614111
Sulfate 2.0 2.0 U mg/L MAJAYI CGREEN
Method Reference EPA300.0 426/11 514111
NUT
NO2+NO3 as N In liquid 0.02 20 mg/L as BSWANSON CGREEN
Method Reference 1-ac10-107-041-c 426111 5/Vl1
Nitrate as N in liquid 0.02 2.0 mglL as CGREEN CGREEN
Method Reference Laohal1074 14 Sr10111 5/10111
Nitrite as N In liquid 0.01 0.01 U mg/LasN GBELK CGREEN
Method Reference Lacha1107-0 1c 421111 412WIl
MET
7429-905 AI by ICP 50 50 U ug/L SGOSS ESTAFF0RD1
Method Reference EPA 200.7 426/11 513111
744038-2 AS by ICPMS 2.0 2.0 U ug/L DSTANLEY ESTAFF0RD1
Method Reference EPA200.8 425/11 5/3/11
7440-70-2 Ca by ICP 0.10 3.5 mg/L SGOSS ESTAFF0RD1
Method Reference EPA 200.7 425/11 5011
7440-47-3 Crby ICPMS 10 10 U ug/L DSTANLEY ESTAFFORDI
Method Reference EPA200.8 • 4125/11 513/11
7440-50.8 Cu by ICPMS 2.0 11 ug/L DSTANLEY ESTAFF0RDI
Method Reference EPA200.8 V25/11 5/3/11
7439-89-6 Fe by ICP 50 50 U ug/L SGOSS ESTAFF0RD1
Method Reference EPA 200.7 426111 5/3/11
Hardness by Calculation 1.0 12 mg/L SGOSS ESTAFF0RD1
Method Reference SM2340BEPA200.7 425/11 5/3/11
7440-09-7 Kby ICP 0.10 1.6 mg/L SGOSS ESTAFFORDI
Method Reference EPA 2M.7 425/11 SB111
Laboratory Section>>1623 Mail Service Center,Raleigh,NC 27699-1623 (919)7333908 Page 2 of 3
1
�' y

� r
NC CD WQ Laboratory Section Results Sample ID AB7065O
Location ID'. 115KINDY_FOREST DRIVE_OU Collect Date: 04/19/2011
Loc.Descr.: HAROLD JOHNSON 115 KINDY FOREST DR Collect Time:: 12:10
Visit ID
CAS# Analyfe Name PQL Result Qualifier Units Analyst/Date Approved By(Date
7439-95-4 Mg by ICP 0.10 0.77 mi SGOSS ESTAFFORD1
Method Reference EPA 200.7 4 11 5/W11
7439-96-5 Mn by ICP 10 24 uO2 SGOSS ESTAFFORDi
Method Reference EPA 200.7 4/M11 51
7440-23-5 Na by ICP 0.10 5.5 mg/L SGOSS ESTAFFORD1
Method Reference EPA 200.7 41251i1 5 111
7440-02-0 Ni by ICPMS 2.0 2.0 U ug/L DSTANLEY ESTAFFORD1
Method Reference EPA 200.8 4/25r11 5/3/11
7439.92-1 Pb by ICPMS 2.0 14 uWL DSTANLEY ESTAFFORD1
Method Reference EPA200.8 4/25111 513/11
7440-e6-6 Zn by ICPMS 10 10 U ug/L DSTANLEY ESTAFFORD1
Method Reference EPA 200.8 4/25/11 513/11
Laboratory Section>>1623 Mail Service Center,Raleigh,NC 27699-1623 1919)733-3908 Page 3 of 3

r V C
XC D La6gratory Section Wesufts
County: HENDERSON Sample ID: A970649
River Basin of V4A)- PO Number# 11G0316
Report To AROAP i PG Date Received: 041211T011
n g
Collector. J STEPP } r Time Received: DLE
p "� Labworks LoginlD DLEIIWTT
Region: ARO
Data Reported: 5/1 i/11
Sample Matrix: GROUNDWATER
Loc.Type: WATERSUPPLY Report Generated: 0 5/1 612 01 1
Emergency Yes/No VisitlD
CDC Yes/No /
Loc.Descr.: HAROLD JOHNSON 115 KINDV FOREST DR
Location ID: 115KINDY_FOREST—DRIVE_OU Collect Date: 04/19/2011 Collect Time:: 12:32 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
Fora more detailed description of these qualifier codes refer to w .dvvglab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estlmatetl concentration is<POL and>MDL
61-Countable membranes with<20 colonies;Estimated
NE-No established POL
B2-Counts from all filters were zero.
P-Elevated PQL due to matrix interference and/or sample dilution
83-Countable membranes with more than 60 or 80 colonies;Estimated
Cl-Holding time exceeded prior to receipt at lab.
134Fi0ers have counts of both>60 or 80 and<20;Estimated
02-Holding time exceeded following receipt by lab
135-Too many colonies were present;too numerous to count(TNTC)
POL-Practical Quantitation Limit-subject to change due to instrument sensitivity
J2-Reported value failed to meet QC criteria for either precision or accuracy;Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated
Xi-Sample not analyzed for this compound
JGThe lab analysis was from an unpreserved or improperly chemically preserved sample;Estimated
NI-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section>>1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 1 of 3

NC DWWQ La6oratory Section Wgsults Sample ID AB7O649
Location ID: 115KINDY FOREST DRNE OU Collect Date: 0411912011
Loc.Des.,.: 14AROLD JOHNSON 116 KINOY FOREST DR Collect Time:: 12:32
Visit ID
CAS a Anatyte Name PQL Result Qualifier Units Analyst/Dste Approved By/Date
LAB
Semple temperature at receipt by lab 2.9 °C HMORGAN OLEAVITT
Method Reference 421/i 1 4/28/11
WET
Ion Chmmetogrephy _TITLE_ mg/L MAJAYI CGREEN
Method Reference EPA 300.0 4/26/11 514111
Chloride 1.0 3.2 mg/L MAJAYI CGREEN
Method Reference EPA".0 42&11 &at I
Fluoride 0.4 0.4 U mg/L MAJAYI CGREEN
Method Reference EPA 300.0 4 11 &4/11
Sudate 2.0 2.0 U mg/L MAJAYI CGREEN
Method Reference EPA 300.0 M26/11 6/4/11
NUT
NO2+NO3 as N In liquid 0.02 1.9 mg/L as N BSWANSON CGREEN
Method Reference Lac10-107-0 1c 4/2&11 &Nil
Nitrate as N In liquid 0.02 1.9 mg/L as N CGREEN CGREEN
Method Reference L.acntlO7 41c &10/11 &10111
Nitrite as N in liquid 0.01 0.01 U mg/L as N GBELK CGREEN
Method Reference Lachat10740L1c 4/21/11 4/29V11
MET
7429-90-5 Al by ICP 50 50 U ug/L SGOSS ESTAFFORD-1
Method Reference EPA 200.7 4 11 smi1
7440-38-2 As by ICPMS 2.0 2.0 U ug/L DSTANLEY ESTAFFORD1
Method Reference EPA 200.8 4126/ii fWV11
7440-70-2 Ca by ICP 0.10 3.3 mg/L SGOSS ESTAFFOROI
Method Reference EPA200.7 4/25I11 Will
7440-47-3 Cr by ICPMS 10 10 U ug/L DSTANLEY ESTAFFORD1
Method Reference EPA 200.8 4 11 513111
7440-50-8 Cu by ICPMS 2.0 160 ug/L DSTANLEY ESTAFFORD1
Method Reference EPA 200.8 4rW1 5/3/11
7439-89-6 Fe by ICP 50 50 U ug/L SGOSS ESTAFFORD1
Method Reference EPA 200.7 4126/11 5/3/11
Hardness by Calculation 1.0 11 mg/L SGOSS ESTAFFORD1
Method Reference SM23408EPA200.7 4125111 5/3/11
7440-09-7 K by ICP 0.10 1.6 mg/L SGOSS ESTAFFORD1
Method Reference EPA 200.7 4/2&11 5/3/11
Laboratory Section»1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 2 of 3
� 1

NC(DWWQ Laboratory Section Results Sample ID AB7O649
Location ID'. 115KlNDY_FOREST_DRIVE OU Collect Date: O4/1912011
Loc.Descr.: HAROLD JOHNSON 115 KINDY FOREST DR Collect Time:: 12:32
Visit ID
CAS# Ana"Name PQL Result Qualifier Units Analyst/Date Approved By
7439-954 M9 by ICP 0.10 0.76 mg/L SGOSS ESTAFFORD1
Method Reference EPA 200.7 4Q5/11 5/3/11
7439-96-5 Mn by ICP 10 24 ug/L SGOSS ESTAFFORD1
Matinee Reference EPA 200.7 4r26/11 UN'll
7440-23-5 No by ICP 0.10 5.8 mg/L SGOSS ESTAFFORD1
Metic l Reference EPA 3 4/25/11 M3/11
7440-02-0 NI by ICPMS 2.0 3.0 ug/L DSTANLEY ESTAFFORD1
Method Reference EPA200.8 4/2M11 MM11
7439-92-1 Pb by ICPMS 2.0 22 j} ug/L DSTANLEY ESTAFFORD1
McBhoE Reference EPA 200.8 4 11 5IN11
7440-66-6 Zn by ICPMS 10 22 ug/L DSTANLEY ESTAFFORD1
Method Reference EPA 200.8 QM11 swi
Laboratory Section»1623 Mail Service Center,Raleigh,NC 27699-1623 (919)7333908 Page 3 of 3

XC D Laboratcla Section Wesurts
County: HENDERSON Sample ID: AB73912
River Basin OF W ArFFj PO Number# 11G0629
Report To AROAP C) Op Date Received: 0 712 012 011
C Time Received: 08:00
Collector J STEPP Q Labworks LoginlD DLEAVITT
Region: ARO
Date Reported: 8/16/11
Sample Matrix: GROUNDWATER
Loc.Type: TRIP BLANK Report Generated: 08/23/2011
Emergency Yes/No VisitlD
CDC Yes/No
Loc.Descr.: HAROLD JOHNSON _
Location ID: 115tONDY FOREST DRlVE_IN Collect Date: 07/76/2011 Collect Time:: 11:17 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
Fora more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estimated concentration is<POL and>MOL
B7-Countable membranes with<20 colonies;Estimated
NE-No established POL
B2-Counts from all filters were zero.
P-Elevated POL due to matrix interference and/or sample dilution
83-Countable membranes with more than 60 or 80 colonies:Estimated
q1-Holding time exceeded prior to receipt at lab.
B4-Filters have counts of both>60 or 80 and<20;Estimated
O2-Holding time exceeded following receipt by lab
BS-Too many colonies were present;too numerous to count(TNTC)
PQL-Practical Ouentitation Limit-subject to change due to instrument sensitivity
J2-Reported value failed to meet OC criteria for either precision or accuracy;Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated
X7-Sample not analyzed for this compound
J6-The lab analysis was from an unpreservetl or improperly chemically preserved sample;Estimated
N1-The component has been tentatively idenMied based on mass spectral library search and has an estimated value
LAB
Laboratory Section»1623 Mail Service Center,Raleigh,NC 27699-1623 (919)7334908 Page t of 3

NC(D WQ Laboratory Section &suCts Sample ID AB73912
Location ID. 11519NDY FOREST_DRIVE_IN Coiled Data: 0711812011
Loc.Descr.: HAROLDJOHNSON Collect Time:: 11:17
Visit ID
CAS k Anayte'Name PQL Result - Qualifier Units Analyst/Date 'Approved By IDate
LAB
Sample temperature at receipt by lab 1.4 °C HMORGAN DLEAVITT
Method Reference 72W11 722111
WET
Ion Chromatography _TITLE_ mg/L MAJAYI MOVERMAN
Method Reference EPA 300.0 721/11 &Z1111
Chloride 1.0 3.5 mg/L MAJAYI MOVERMAN
Method Reference EPA 300.0 721/11 Mill
Fluoride 0.4 0.4 U mg/L MAJAYI MOVERMAN
Method Reference EPA 300.0 721111 Willi
Sullale 2.0 2.0 U mWL MAJAYI MOVERMAN
Method Reference EPA 300.0 7/21111 811111
NUT
NO2+4O3 as N In liquid 0.02 1.9 mg4 as N BSWANSON CGREEN
Method Reference Lad6107-04-1c 721/11 Willi
Nitrate as N in liquid 0.02 1.9 mg)L.as N MOVERMAN CGREEN
Method Reference Lachat107-0 1-c 7/2611 Willi
Nhdte as N In liquid 0.01 0.01 U mg/L as N GBELK CGREEN
Method Reference Lachat107-04-1-c 7/A411 Will I
MET
7429-90-5 AI by ICP 50 50 U ug/L PGAUTHIER ESTAFFORD1
Method Reference EPA".7 72W11 WIWtt
7440-38-2 As by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORD1
Method Reference EPA200.8 72W11 W1W11
7440-70-2 Ca by ICP 0.10 3.1 mg/L PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 72W1 8/15111
744047-3 Cr by ICPMS 10 10 U ug/L JJURGEVICH ESTAFFORD1
Method Reference EPA200.8 7128111 8/15111
7440-500.8 Cu by ICPMS 2.0 93 ug/L JJURGEVICH ESTAFFORD1
Meted Reference EPA 200.8 7/28111 11
7439-89-6 Fe by ICP 50 50 U ug/L PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 72W11 8I15111
Hardness by Calwlalbn 1.0 11 mg/L PGAUTHIER ESTAFFORD1
Method Reference SM2340BEPA 200.7 72W11 W15/11
7440-09-7 K by ICP 0.10 L5 mg/L PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 712W11 B/15/11
Laboratory Section 1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 2 of 3
jl

NC DWQQ Ga6oratory Section Results Sample ID AB73912
Location ID: 11510NDY FOREST-DRIVE IN Collect Date: 071,1812011
Loc.Descr.: HAROLD JOHNSON Collect Time:: 11:17
Visit ID
CAS# Anayte Name - PQL Result Qualifier Units AnalystfDate Approved By/Date
7439-954 Mg by ICP 0.10 0.70 mgfL PGAUTHIER ESTAFFORD1
Method Reference EPA200.7 726/11 8115111
7439-96-5 Mn by ICP 10 29 ull PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 7/26111 8115111
7440-23-5 No by ICP 0.10 4.8 mg/L PGAUTHIER ESTAFFORD1
-- Method Reference EPA200.7 726/11 8115/11
7440-02-0 NI by ICPMS 2.0 3.8 ug/L JJURGEVICH ESTAFFORD1
Method Reference EPA 200.8 71=11 8115111
7439-92-1 Pb by ICPMS 20 2.0 U ug/L JJURGEVICH ESTAFFORDI
Method Reference EPA 200.8 728111 8116/11
7440-66-6 Zn by ICP 10 10 U ug/L PGAUTHIER ESTAFFORDI
Method Reference EPA 200.7 726111 8/15111
Laboratory Section 1623 Mail Service Center,Raleigh,NC 27699.1623 [phone] Page 3 of 3

� T
DIW La6oratoaSection Wesu ts
County: HENDERSON Sample ID: A873911
River Basin �pF WArei90 PO Number If 11G0628
Report To AROAP Q 7 Date Received: 0 712 012 01 1
[ Time Received: 08:00
Collector. J STEPP ti
p Y Labworks LoginlD DLEAVITT
Region: ARO Date Reported: 8116/11
Sample Matrix: GROUNDWATER
Loc.Type: Report Generated. 08/23/2011
Emergency Yes/No VisitlD
COG Yes/No
�A pi Loc,Descr.: HARLD JOHNSON
Location ID: 11610NDY FOREST_ORIVE_IN Collect Date: 07118=11 Collect Time:: 10:37 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
Fora more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estimated concentra0on is<POL and>MDL
B1-Countable membranes with<20 colonies:Estimated NE-No established POL
B2-Counts from all filters were zero.
P-Elevated PQL due to matrix interference and/or sample dilution
B3-Countable membranes with more than 60 of 80 colonies;Estimated
Qt-Holding time exceeded poor to receipt at lab.
B4-Filters have counts of both>60 or 80 and<20;Estimated G2-Holding time exceeded following receipt by lab
B6-Tco many colonies were present;too numerous to count(TNTC) PQL-Practical Quantitation Limit-subject to change due to instrument sensitivity
J2-Reported value failed to meet QC criteria for either precision or accuracy;Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated
Xi-Sample not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample:Estimated
1,11-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section>>1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 1 of 3

M DWQ Ga6oratory Section Wssults Semple ID A873911
Location ID'. 116KINDY FOREST_DRIVE IN Collect Date: 07/18/2011
Ux.Devi KARLD JOHNSON Collect Time: 10:37
Visit ID
CAS a Analyte Name POL Result - Qualifier Units - Analyst/Date Approves By/Date
LAB
Sample temperature at recalls by lab 1.4 °C HMORGAN DLEAVITI-
Method Reference 72W11 7=11
WET
Ion Chromatography _TITLE_ mg/L MAJAYI MOVERMAN
Method Reference EPA 300.0 721/11 Nwil
Chloride 1.0 3.3 mg/L MAJAYI MOVERMAN
Method Reference EPA300.0 721/11 8/3/11
Fluorine pA 0.4 U mg/L MAJAYI MOVERMAN
Method Refeence EPA300.0 7121111 vxi1
Susate 2.0 2.0 U mg/L MAJAYI MOVERMAN
Method Reference EPA 300.0 721111 WN11
NUT
NO2+NO3 as N In liquid 0.02 1.8 mWL as N BSWANSON CGREEN
Method Reference Iac10-107-041c 721111 811/11
Nitrate as N in Nulty 0.02 1.8 mg/L as N MOVERMAN CGREEN
Method Reference Lacrat107-04-1-c 726/11 8/1/11
Nhrile as N In liquid 0.01 0.01 U mg/L as N GBELK CGREEN
Method Reference Laohat1074W- 720/11 8/l/11
MET
7429-90-5 AI by ICP 50 50 U ug/L PGAUTHIER ESTAFFORD1
Method Reference EPA200.7 7126/11 8I15/11
7440-3&2 As by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORD1
Method Reference EPA200.8 728I11 8 ull
7440-70-2 Ca by IGP 0.10 2.9 og/L PGAUTHIER ESTAFFORD1
Method Reference EPA2D0.7 726I11 8115111
7440-47-3 Cr by ICPMS 10 10 U ug/L JJURGEVICH ESTAFFORDt
Method Reference EPA200.8 72VI1 8115,11
7440-50-8 Cu by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORD7
Method Reference EPA 200.8 728/11 8/15/11
7439-89-6 Fe by ICP 50 50 U u91- PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 726/11 8/15/11
Hardness by Calculetlon 1.0 10 mg/L PGAUTHIER ESTAFFORD1
Method Reference SM2340BEPA200.7 72 11 8/15/11
7440-09-7 Kby ICP 0.10 1.4 mg/L PGAUTHIER ESTAFFORDI
Method Reference EPA 200.7 72MI1 B/1M11
Laboratory SectbN>1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 2 of 3

NC(DWQQ La6oratory Section Results Sample ID AB73911
Location ID: 116VJNDY_FOREST DRlVE_IN Collect Date: 07/18/2011
Loc.Descr.: HARLDJOHNSON Collect Time:: 10:37
Visit ID
CAS# Analyte Name POL Result Qualifier Units Analyst/Date Approved By/Date
7439-95-4 Mg by ICP 0.10 0.66 mglL PGAUTHIER ESTAFFORD11
Method Reference EPA 200.7 726111 8/15/11
7439-9&5 Mn by ICP 10 25 ug/L PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 726111 8/15111
7440-23-5 No by ICP 0.10 4.5 mglL PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 7126111 B115/11
7440-02-0 Ni by ICPMS 2.0 20 U ug/L JJURGEVICH ESTAFFORD7
Method Reference EPA 2W.8 72&11 8115111
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L JJURGEVICH ESTAFFORD1
Method Reference EPA 2W.8 728/11 8115111
7440-66-6 Zn by ICP 10 10 U ug/L PGAUTHIER ESTAFFORD1
Method Reference EPA 200.7 7/26/11 8/15/11
Laboratory Section 1623 Mail Service Center,Raleigh,NC 27699.1623 (919)7333908 Page 3 of 3

NE D LaboratozySection esults
County: HENDERSON Sample to: A1170611
River Basin 1oF warF9 PO Number ill ARO
Report To AROAP p p� Date Received: 04/1912011
>J STEPP Time Received: 14:20
Collector:
Region ARO P Y Labworks LoginlD KJIMISON
Date Reported: 12/30/99
Sample Matrix: GROUNDWATER
Loc.Type; Report Generated: 0 5/1 612 01 1
Emergency Yes/No
visrtlD
CDC Yes/No
Loc.Descr.:
Location ID: 1151GMDY_FOREST_DRIVE_IN Collect Date. 04l19/2011 Collect Time 12:10 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estimated concentration is<POL and>MDL
B7-Countable membranes with<20 colonies;Estimated
NE-No established POL
B2-Counts from all filters were zero. P-Elevated POL due to matrix interference and/or sample dilution
B3-Countable membranes with mom than 60 or 80 colonies;Estimated
O7-Holding time exceeded prior to receipt at lab.
B4-Filters have counts of both>60 or 80 and<20;Estimated
O2-Holding time exceeded following receipt by lab
B5-Too many colonies were present;too numerous to count(TNTC)
POL-Practical Quantitation Limit-subject to change due to instrument sensitivity
J2-Reported value failed to meet OC criteria for either precision or accuracy;Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate deleooination;Estimated
Xt-Sample not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample;Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
ARO
Laboratory Section>>1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 1 of 2

NC D WQ La6orato7y Section ResuCts SamplelD AB70613
LocaOon lD: 116KINDY FOREST DRNE_IN Collect Date: 0411912011
Loc.Descr.: Collect Time:: 12:10
Visit ID
CAS If Analyte Name POL Result Qualifier Units Analyst/Date Approved By/Date
ARO
Sample temperature at recelpt by lab 1.3 'C KJIMISON DLEAVITT
Method Reference 4119111 420/11
Collform,MF Fecal In liquid 1 1 B2 CFU/100ml KAMISON CGREEN
_ Method Reference APHA92Z2D-20N 4/19/11 5/10/11
Colifann,MF Total in liquid 1 1 B2 CFU/1D0mI KJIMISON CGREEN
Method Reference APFW92228-20N V19/11 5/10111
Total Dissolved Solids In liquid 12 52 mg/L KJIMISON
Method Reference APHA2W4 18TH 425/11 12/30/99
l
I
Laboratory Section 1623 Mail Service Center,Raleigh,NC 27699-1623 (919)7333908J Page 2 of 2
1 r
1
_1
_�r

ROM
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H.Sullins Dee Freeman
Governor Director Secretary
August 23, 2011
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
Mr. Johnson,
On April 19, 2011, 1 collected influent and effluent samples from your ground source HVAC
system located at 115 Kindy Forest Drive in Hendersonville, North Carolina. I collected
additional influent and effluent samples on July 18, 2011.
The April analytical results indicate that lead was detected at 14 ppb (parts per billion) in the
influent sample and 22ppb in the effluent sample. Asa result of the elevated lead in the April
sample, a follow up sampling event was scheduled for July. The July analytical results indicate
,that all metals in the influent and effluent samples were below 2L groundwater Standards. Due
to the inconsistencies between these results and prior results, an additional sampling event will
be scheduled in February, 2012; someone from the Asheville Regional office will be contacting
you after the first of the year to schedule this additional follow up.
Please contact Dr. Ken Rudo for health risk information associated with the elevated lead levels
detected in your water supply well. Dr. Rudo can be reached at [phone] or at
[e-mail]. I can be reached at [phone] or [e-mail].
Sincerely,
;x Pell
Jonathan Stepp
Sr. Environmental Technician
Aquifer Protection Section
Attached: analytical results for April and July
C Carolina
turn!/y/y
North Carolina Division of Water Quality—Asheville Regional Office 2090 U.S.Highway 70 Swannanoa,NC28778 Phone[phone]
Aquifer Protection Section FAX [phone]
Customer Service 1.877-623-6748
Internet h2o.enr.state.nc.us
An Equal OpportunitylAffirmativeAction Employer—50%Recycled110%Post Consumer Paper

w
CDENR
North Carolina Department of Environment and Natural Resources
Division of Water Duality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
May 6, 2011
Harold and Alice Johnson RECEIVED
115 Kindly Forest Dr.
Hendersonville,NC 28739 t;AY 0 9 2iiil
Re: Issuance of Injection Well Permit Asheville Regional Office
Permit No. WI0100002 Aquifer Protection
Issued to Harold and Alice Johnson
Henderson County
Dear Mr. and Mrs. Johnson:
In accordance with your application received March 21, 2011, I am forwarding Permit No.WI0100002 for the
operation of a 5A7 geothermal underground injection control (UIC) well heat pump system located at the above
referenced address. This permit shall be effective from the date of issuance until April 30, 2016, and shall be
subject to the conditions and limitations stated therein.
The Asheville Regional Office collected groundwater samples from your geothermal system on April 19, 2011.
After the laboratory analytical results are received, the results will be forwarded to you by the regional office.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit 120 days 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,
i Pit-16
Michael Rogers,P.G. (NC &FL)
Environmental Specialist
cc: Landon Davidson, Asheville Regional Office
Central Office File WI0100002
Henderson County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 Mail Service Center.Raleigh,North Carolina 27699-1636
Locat;om 2728 Capital Boulevard.Raleigh.North Carolina 27604 One
Phone:[phone] FAX 1:919-715-0568:FAY.2:919-715-6048 i Customer Service:1-8Tr-623-674E Noftb Ca.rohna
Intemm:w .ncwateraualitv.om
An EQUal ClrlppfNNtt 1 A(Ilmlaitve Action EmabvB'

r 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
Harold and Alice Johnson
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North Carolina
Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump effluent. This
injection well is located at 115 Kindy Forest Dr., Hendersonville, Henderson County,NC 28739, and will be
constructed and operated in accordance with the application received March 21, 2011, and in conformity with
the specifications and supporting data, all of which are filed with the Department of Environment and Natural
Resources and are considered a part of this permit.
This permit is for operation of an injection well 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 April 30, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through VIII hereof.
Permit issued this the 6t' day of May, 2011.
40-6 x4Ak -
W oleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0100002 1

r
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-I) must be submitted for each injection well to:
Aquifer Protection Section—UIC Staff
1636 Mail Service Center
Raleigh,NC 27699-1636
and
Aquifer Protection Section—Asheville Regional Office
2090, US Highway 70
Swannanoa,NC 28778
[phone]
GW-1 s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
PART II—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.
WI0100002 2

3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will be contingent upon the effluent .not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
PART III—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 IV—OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall, be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
W10100002 3

PART VI—MONITORING AND REPORTING REQUIREMENTS i
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 Asheville Regional Office, telephone number(828) 296-4500, 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;
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 VII—PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit,request an extension.
PART VIII—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)(1), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
WI0100002 4

(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)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
WI0100002 5

OF W ATF9 State of North Carolina
11 OG Department of Environment and Natural Resources
< Division of Water Quality
O C
Aquifer Protection Section
Regional Staff Report
To: Aquifer Protection Section Central Office Application No.: WI0100002
Attn: Michael Rogers Regional Login No.:
From: Jonathan STeoo
Choose an item. Regional Office
L GENERAL SITE VISIT INFORMATION
1. Was a site visit conducted? ®Yes or❑No
a. Date of site visit: 04/19/2011
b. Site visit conducted by: Jonathan Stepn
c. Inspection report attached? ® Yes or❑No
d. Person contacted: Harold Johnson and their contact information: 828 891 - 8600 ext.
e. Driving directions:
H. PROPOSED FACILITIES FOR NEW AND MODIFICATION APPLICATIONS
l. Facility Classification: (Please attach completed rating sheet to be attached to issued permit)
2. Are the new treatment facilities adequate for the type of waste and disposal system? ❑-Yes or❑ No
If no, explain:
3. Are site conditions (soils, depth to water table, etc)consistent with the submitted reports? ❑ Yes ❑ No ❑N/A
If no,please explain:
4. Do the plans and site map represent the actual site (property lines,wells,etc.)? ® Yes ❑No ❑ N/A
If no, please explain:
5. . Is the proposed residuals management plan adequate? ❑ Yes ❑No ❑ N/A
If no,please explain:
6. Are the proposed application rates(e.g., hydraulic,nutrient) acceptable? ❑ Yes ❑No❑ N/A
If no, please explain:
7. Are there any setback conflicts for proposed treatment, storage and disposal sites? ❑ Yes or❑ No
If yes, attach a map showing conflict areas.
8. Is the proposed or existing groundwater monitoring program adequate? ❑ Yes ❑No ❑N/A
If no, explain and recommend any changes to the groundwater monitoring program:
9. For residuals, will seasonal or other restrictions be required? ❑Yes❑No ❑ N/A
If yes, attach list of sites with restrictions(Certification B)
FORM:APSRSR 04-10 Page 1 of 3

qr
III.EXISTING FACILITIES FOR MODIFICATION AND RENEWAL APPLICATIONS
1. Are there appropriately certified Operators in Charge(ORCs) for the facility? ❑Yes ❑No ❑ N/A
ORC: Certificate#: Backup ORC: Certificate#:
2. Are the design, maintenance and operation of the treatment facilities adequate for the type of waste and disposal
system? ❑ Yes or❑No
If no, please explain:
3. Are the site conditions (e.g., soils,topography, depth to water table,etc) maintained appropriately and adequately
assimilating the waste? ❑ Yes or❑No
If no, please explain:
4. Has the site changed in any way that may affect the permit(e.g.,drainage added, new wells inside the compliance
boundary, new development,etc.)? ❑ Yes or®No
If yes,please explain:
5. Is the residuals management plan adequate? ❑ Yes or ❑ No .
If no, please explain:
6. Are the existing application rates (e.g.,hydraulic,nutrient) still acceptable? ❑ Yes or❑No
if no, please explain:
7. Is the existing groundwater monitoring program adequate? ❑-Yes❑No ❑N/A
If no, explain and recommend any changes to the groundwater monitoring program:
8. Are there any setback conflicts for existing treatment, storage and disposal sites? ❑ Yes or❑No
If yes,attach a map showing conflict areas.
9. Is the description of the facilities as written in the existing permit correct? ❑ Yes or❑No
If no, please explain:
10. Were monitoring wells properly constructed and located? ❑ Yes ❑No El N/A
If no, please explain:
11. Are the monitoring well coordinates correct in BIMS? ❑ Yes❑No ❑ N/A
If no, please complete the following ex and table if necessary):
Monitoring Well Latitude Longitude
u r rr r u
12. Has a review of all self-monitoring data been conducted (e.g.,NDMR,NDAR, GW)? ❑ Yes or❑No
Please summarize any findings resulting from this review:
13. Are there any permit changes needed in order to address ongoing BIMS violations? ❑ Yes or❑ No
I1'yes, please explain:
14. Check all that apply:
❑No compliance issues ❑ Current enforcement action(s) ❑ Currently under JOC
❑ Notice(s) of violation ❑ Currently under SOC ❑ Currently under moratorium
Please explain and attach any documents that may help clarify answer/comments (i.e.,NOV,NOD, etc.)
15. Have all compliance dates/conditions in the existing permit been satisfied? ❑Yes ❑No ❑N/A
If no, please explain:
16. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit?
❑ Yes ❑No ❑ N/A
If yes,please explain:
FORM:APSRSR 04-10 Page 2 of 3

IV.REGIONAL OFFICE RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes or®No
If yes, please explain:
2. List any items that you would like APS Central Office to obtain through an additional information request:
Item Reason
3. List specific permit conditions recommended to be removed from the permit when issued:
Condition Reason
4. List specific special conditions or compliance schedules recommended to be included in the permit when issued:
Condition Reason
5. Recommendation: ❑ Hold,pending receipt and review of additional information by regional office
❑Hold, pending review of draft permit by regional office
❑Issue upon receipt of needed additional information
® Issue
❑ Deny(Please state reasons: )
6. Signature of report preparer.
Signature of APS regional unervisor
Date: CH-2 1 t(
V. ADDITIONAL REGIONAL STAFF REVIEW ITEMS
Please note that a signature was not obtained from Alice Johnson on the renewal application as requested. A review
of previous records indicates that Ms. Johnson's signature has not been required in the past. In an effort to remain
consistent, preserve a positive public perception,and prevent the renewal process from being delayed I am sending
this field report without the requested signature. I have spoken with Landon Davidson about the matter and he agrees
that in this circumstance Ms.Johnson's signature is not essential.
FORM: APSRSR 04-10 Page 3 of 3

4 • .
AQUIFER PROTECTION SECTION
APPLICATION REVIEW UEST' CORM
Date: March 24, 2011 F� Cr
To: ® Landon Davidson,ARO-APS N,�R 5L� David ay,WaRO-APS
❑ Art Barnhardt,FRO-APS ❑ Charlie §tehman,WiRO-APS
❑ Andrew Pitner,MRO-APS Asheville _' ❑ Sherri Fight, W-SRO-APS
❑ Jay Zimmerman,RRO-APS p.r.:t
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail. Michael.Rogers[)a,ncmail.net
A. Permit Number: WI 0100002
B. Owner: Johnson
C. Facility/Operation:
❑ Proposed ® Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation[] Reuse ❑ H-R Infiltration
❑ Recycle ' ❑ I/E Lagoon ❑ GW Remediation(ND)
® UIC—5A7 Well
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
Z Project Type: ❑ New ❑ Major Mod. ❑ Minor Mod. ® Renewal ❑ Renewal w/Mod.
E. Comments/Other Information: ❑
NOTE: Both Harold and Alice Johnson are on the property deed,but Alice Johnson did not sign the
renewal application. When you go to conduct the site inspection,please have Mrs. Johnson sign the
attached annlication and return to me. Thank vou.
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 LAPCU.
❑ 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.
RO-APS Reviewer: Date: SZI 01(
FORM:APSARR 07/ Page I of 1

Harold E. Johnson
115 Kindy Forest Drive
Hendersonville, NC 28739
[phone]
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Gentlepersons
Well, you've outdone yourselves in being bureaucratic, I KNOW that in the last 25 years,
I have submitted every bit of this to you before. In the records of the state, you likely know me
better than I know myself.
With respect to request K(1) , you're kidding right? You may be able to do this in Raleigh, but
here in the hinterlands, I have neighbors within 1000 feet that don't know where their septic tanks
are and likely are not going to find out just so they can tell me. The regulations here are that the
septic tank and drainfield and a well drilled for human water consumption only have to be 50 feet
apart and you want information about them out to 1000 feet? Could you please explain the
rational of this?
This well I believe, has the record of being the first or second licensed residential geothermal
injection well in the state. During the last 25 years, NOTHING has changed. Same owner, same
injection well, same visits every 5 years by DENR, same communications with your results
department. Then to heap insult on injury, you send me ONE copy of the request for information,
and request TWO signed copies of the application package. I have great difficulty believing that
someone took away all your xerox machines.
U
H ld ohnson
RECEIVED IDENRIDWQ
AQUIFFR'P;?n7r.TinNi SECTION
MAR 21 2911

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: N 1
Permittee Name: �---�� 7 l�
Address:�k� fi0' / ;"OP , o- ! / f//l�G, �C� `� f7
Please check the selection which most closely describes the current status of your injection well system: ✓
1) PAKe11(s)still used for injection activities,or may be in the future.
2) ❑ Well(s)not used for injection but is/are used for water supply or other purposes.
3) ❑ Injection discontinued and: a)❑Well(s)temporarily abandoned
b)❑Well(s)permanently abandoned
c)❑Well(s)not abandoned
4) ❑ Injection well(s)never constructed
Current Use of Well
If you checked(2),describe the well use(potable water supply,irrigation,monitoring,etc),including pumping rate and other
relevant information. /
N e - 7s
Well Abandonment
If you checked(3)(a)or(3)(b),describe ethod used to abandon the injection well. (Include a description of how the well
was sealed and the type of material used to,f: well ifpermanently abandoned):
Permit Rescission:
If you checked(2),(3),or(4)and will not use a well for injection on this site in the future,you should request rescission of the
permit.Do you wish to rescind the permit?
❑ Yes ❑ No
Certification:
"I hereby certify,under penalty of law,that I have personally examined and am familiar with the information submitted
in this document, and that to the best my knowledge the mformatigy9is true, accurate, and complete."
14zt--, `
Si ature Date
RECS*)IoENR/O
Revised 5/05 GW/UIC-68 AQUIPPPPROTFr,rI(),vs�TION
MAR 21 2011

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
WITH A GEOTHERMAL HEAT PUMP SYSTEM
TYPE 5A7 "OPEN LOOP" INJECTION WELLS)
1
(check one) New Permit Application TIRenewal Modification
DATE: 20
PERMIT NO.:JWf leave blank if NEW permit application)
A. PROPERTY OWNER/PERMIT APPLICANT
Name of each owner listed on property deed. For a business or government agency,state name of entity and
name,of ppersQn delegated authority t sign appl ion behalf of the business/agen y:
(1) Mailin dress: I , / d
City: 444 & fen/vi&State: (V&'pCode: County:
Home/Office Tele No.: 7,e- 99 I - Z 6 LAaell No.:
Fax No. Email Address:
(2) Physical Address of Well Site(if different than above): YA4"-' e
City: State:_Zip Code: County:
Home/Office Tele No.: Cell No.:
Fax No. Email Address:
B. PROPERTY OWNERSHIP DOCUMENTATION
Provide legal documentation of property ownership, such as a contract, deed, article of incorporation, etc. and
a PLAT map showing the pro This information may be obtained from county Register of Deeds or GIS
website. '4 e '/t G j7
C. AUTHORIZED AGENT,IF ANY
If the property owner/permit applicant wants to authorize someone else to sign the permit on their behalf,then
attach a siQrred letter from the property owner/permit applicant specifying and authorizing their agent (well
driller,heat pump tractor,or other type of contractor/agent)to sign this application on their behalf.
Company Name:
Contact Person: Email Address:
Address:
City: State:_Zip Co County:
Office Tele No.: Fax No. Cell No.:
Website Address of Company,if any:
RECEIVED/DENR/DWQ
AQUIPPR RRnrcrT041 SECTION
.Type 5A7 Injection Well Pennit Application(Rev.August 2009) MAR 21 2011 Pagel of4

D. WELL DRILLER INFORMATION] ),j,
Company Name: NY D-r Y el/��j� �pYl��® G'y`;l l�
Well Drilling Contractor's Name: IZZ4 I .�� 12,4`�O/� N G/4 /'� 41 g (' 9
NC Contractor Certification No. nt t son:
Company te: WWW. mailAddess: �y
Address: . C&K F !'M C44 f t°
City: State:_Zip Code: County:
Office Tele No.: Fax No.: Cell No.:
E. HEAT PUMP CONTRACTOR INFORMATION (if different than Driller)
Company Name: Contact Person:
Company Website: WnWW. Email Address::
Address:
City: State:_Zip Code: County:
Office Tele No.: Fax No. Cell No.
F. INJECTION PROCEDURE (briefly describe how the injection well W will be used)
FULL FVLL w 10 biz-: �,t�'� � Pi l �G-r'2�Tip iJ
G. WELL USE Will the injection well(s)also be used as the supply well(s)for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES • NO
H. WELL CONSTRUCTION DATA
PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
(7)below as PROPOSED construction specifications. Submit Form GW-1 after construction.
EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through (7)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1)if available. /
(1) Well Construction Date: Number ofborings:
Depth of each boring(feet): L/ Q'Lg
(2) Well casing. Is the well(s)cased? Y
(a) YES If yes,then provide the casing information below.
Type: Galvanized steel Black steel_,1,41astic Other(specify)
Casing thickness: diameter(inches): ( depth: fromto feet(relative to land surface)
Casing extends above ground J inches
(b) NO
(3) Grout material surrounding well casing:
(a) Grout type: Cement Bentonite*_ Other(specify)-���o"l
*By selecting bentonite grout,a variance is hereby requested to 15A NCAC 2C.0213(d)(1)(A),which req¢ves a cement type grout.
(b) Depth of grout around well casing(relative to land surface): from to feet
Type 5A7 Injection Well Permit Application(Rev:August 2009) • Page 2 of 4

(4) Well Screen or Open Borehole depth(relative to land surface): from to feet
(5) N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well)lines is required. Will there be a faucet on,:
(a) Influent line? Yes 'I-No (b) Effluent line? Yes k-/No
(6) Source Well Construction Information. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-1 is not available,provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn? (e.g.
granite,limestone,sand,etc.) /
Depth: `7i �� Formation: Rock/sediment unit: AAl l
NOTE: THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA IF THIS
INFORMATION IS OTHERWISE UNAVAILABLE. r
I. OPERATING DATA
(1) Injection Rate: Average-(daily) gallons per minute(gpm).
(2) Injection Volume: Average(dailyl K gallons per day(gpd).
(3) Injection Pressure: Average(daily) J pounds/square inch(psi).
(4) Injection Temperature: Average(January) °F,Average(July)L9°F.
J. INJECTION-RELATED EQUIPMENT
Attach a schematic diagram or cross-section of the well construction that shows the total depth, length of casing,
extent of grout, stickup, location of influent/effluent sampling ports, etc. If this is a modification, show the
engineering layout or proposed modification of the injection equipment and exterior piping/tubing associated with
the injection operation. The manufacturer's brochure may provide supplementary information if needed.
K. LOCATION OF WELL(S)
(1) Attach a site map(can be drawn) showing: houses and other structures,property lines,surface water bodies,
potential sources of groundwater contamination, and the orientation of and distances between the proposed
injection well(s) and any other existing well(s) or waste disposal facilities such as septic tanks or drain fields
located within 1000 feet of the geothermal heat pump,well system. Label all features clearly and include a
north arrow:
(2) Attach a scaled topographic map of the area extending 1/4 mile from the property boundary that indicates
the facility's location,a north arrow,and the map name.
NOTE. In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and-downloaded from: the applicable county GIS website. Typically, the property can be searched by owner
nacre or address. The location of the wells in relation-to property boundaries, houses, septic tanks, other wells, etc.
can their be drawn in by(rand Also, a `layer'can be selected showing topographic contours or elevation data.
Type 5A7 Injection Well Permit Application(Rev.August 2009) Page 3 of 4

L. CERTIFICATION(to be signed as required below or by that person's authorized agent)
NCAC 15A 2C .0211(b)requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer,
2. for a partnership or sole proprietorship: by a general partner or the proprietor,respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner.
If an authorized agent is signing on behalf of the applicant,then submit a letter signed by the
applicant that names and authorizes their agent as specified in Part C of this permit application.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted in
this document and all attachments thereto and that, based on my inquiry of those individuals immediately responsible for
obtaining said information, I believe that the information is true,accurate and complete. I am aware that there are significant
penalties, including the possibility of fines and imprisonment, for submitting false information. I agree to construct,operate,
maintain, repair, and if applicable,abandon the injection well and all related appurtenances in accordance with the approved
specifications and conditions of the Permit."
Wg#urenn Jf Property Owner/Applicant
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent,if any
Print or Type Full Name
Submit TWO signed copies of the completed application package and all attachments to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
RECE!VEu i u Raleigh, NC 27699-1636
AQUIFER PROTFCP.1',j CFCTi(y
MAR 21 2011 Telephone [phone]
Type 5A7 Injection Well Permit Application(Rev.August 2009) Page 4 of 4

HAROLD E JOHNSON & // i �v
115 KINDY FOREST DR
VENDERSONVILLE,NC 28739 �`,L✓ Q 1 ���!`Q O��F
Loan No. 306865338 )
CERTIFICATE OF SATISFACTION �G`y
STATE OF NORTH CAROLINA
COUNTY OF HENDERSON
The undersigned Morgan Guaranty Trust Company,As Trustee certify that we are the owners of the indebtedness secured
by the hereafter described Deed of Trust or Mortgage and that the debt or other obligation in the amount of$108,000.00
secured by the Deed of Trust executed by HAROLD E.JOHNSON AND ALICE JOHNSON (Grantor),NEWELL J SALTZ
JR (Trustee), FIRST CITIZENS BANK & TRUST CO (Beneficiary), and recorded in HENDERSON County, State of
NORTH CAROLINA, on Instrument No. — in Book 506 Page 322, and re-recorded on October 25, 1991, Entry No. ---
in Book 507 at Page 227, Certificate —, was satisfied on 17-1 rl`O\.__. We request that this Certificate of
Satisfaction be recorded and the above referenced instrument be canceled of record.
y 4 t2
Morgan Guarant?Trust Com ny s rustee
(Owner)
By: ,
A( RC
STATE OF Nee Yorr
COUNTY OF New York'
1, GLORIA D. ESTELL a Notary Public for said county and state, do-here�b�Yy �ccertit that
JACK RODITI personally came before me this day and acknowledged that he/she is VICE PRESI06N�,
of Morgan Guaranty Trust Company, As Trustee and acknowledge, on behalf of Morgan Guaranty Trust
Company,As Trustee,the due execution of the foregoing instrument.
Witness my hand and official seal,this A4a>`29;3A91 JUL
17 2001
GLORIA D.ESTELL Notary's.Seal
Notary Public,State of Newyork
tary's Signature No.01 ES5049034
Qualified in Kings County
2001.05-24 Certificate Filed in Newyork County
Commission Expires Sept.5,2001
STATE OF NORTH CAROLINA
COUNTY OF 4..�
The foregoing certificate of 6&114.,. 0 i a Notary Public of
is certified to be correct.
This _dateof aeai
2 e cL,_ r/. rn (s,i REGISTER OF DEEDS,
By: /1� !� / /J/ �d , Deputy.
CANCELED BY CERTIFICATE OF SATISFACTION FILED pursuant to G.S.45-37(A)
(6)ON .d V-OI SEE BOOK 1067 , PAGE -4k) /
M.iZ.� , Register of Deeds
d 0 M By: J . ^'`� Aarait./B". Re�star of Deeds
AQUIFER R I D FIrTl R I D CATION
MAR 21 2011

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Colleen H. Sullins Dee Freeman
Governor Director Secretary
March 23,2011
Harold E .Johnson
115 Kinda Forest Drive _
Hendersonville.NC 28739
Subject: Acknowledgement of Application No.WI0I00002
Johnson,Harold E.-SFR
Injection Heating/Cooling Water Return Well(5A7)
Henderson
Dear Mr.Johnson:
The Aquifer Protection Section of the Division of Water Quality(Division)acknowledges receipt of your permit application and
supporting materials on March 21,2011.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.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAICING INQUIRIES ON THIS PROJECT.
Sincerely,
0 wt� (&�
for Debra J.Watts
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit Application File WI0100002
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 27699-1636
Location:2728 Capital Boulevard.Raleigh.North Carolina 27604 One
Phone:[phone] FAX is 919-71M588:FAX 2:919-715-5048 t Customer Service:1-877-623-6748 - �Td�rttjl,�C�1'plll'iu
Internet vrnw.ncwatemualiN.oro ••�"'i-1lrQ��f/
An Equal Qpportumty Athrmanve Acton Employer �/V BILL �/

HOR1e Henderson County Real Property Data Go Maps
Property Summary Tax Bi Is
r. Data last updated on:3/24/2011
Ownership current as of:3/18/2011
Property Search
'4 Parcel Number 0115453 PIN x 9548999983
r F
1 Location Address Property Description
115 W KINDY FOREST Lot # 21 DAVIS LAND ILOT
70i's DR #21
_ Search Results New Search _
Purcell Bulldincis Land Deeds!Not s Sal sf Photos 7a� f1ao
Property Owner: Owner's Mailing Address Property Location Address
JOHNSON, HAROLD E ; 115 W KINDY FOREST DR 115 W KINDY FOREST DR
JOHNSON, ALICE HENDERSONVLLE
NC 28739
Administrative Data Transfer Information Property Value
Old Map# 9548.08 Deed Date 01/12/1983 Total Appraised $g6,100
VCS SOOR Deed Book 000622 Land Value
City Deed Page 00305Total,Appraised $236,300
Fire District VALLEY HILL Revenue Stamps 29.00 Building Value
Township VALLEY HILL FIRE Package Sale Date
Land Class RESIDENTIAL- Package Sale Price Total Appraised $332,400
SINGLE FAMILY Land Sale Date Value
Spec District Land Sale Price
1
Spec District Improvement Summary Elderly Exclusion
2 Other Exemptions
History Total Units 0
Parcel Heated Area 3,697 Use Value Deferred
Number 1 Historic Value Deferred
History Total Deferred Value
Parcel
Number 2
Acreage 0.66 Total Assessed $332,400
Permit Date Value
Permit #
Prints best in landscape mode.
Thursday, March 24, 2011
http://taxinfo.hendersoncountync.org/propertysearch/DropertySummar3,.aspx?REID=0115... 3/24/2011

GoMAPS - Henderson County NC Public Access Page'1 of 1
4 Henderson County, NC GoMSps GIS/Mapping Systein Oo
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Zoom Buffer Adjoi ners Reports Tax Bill Real Property Listed To Physical Address Parcel Number PIN De
Zoom Buffer Adjeiners Report Tax Rill Real Prooertt• JOHNSON,HAROLD E ;JOHNSON,ALICE 115 W KINDY FOREST DR 0115453 9548999983 62:
littp://gisweb.11endersoiicouiityne.org/gomaps/inap/index.efin?reid=O 115453 3/24/2011

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Driving Directions from 2090 Us 70 Hwy, Swannanoa,North Carolina to 115 Kindy Forest Dr, ... Page 1 of 1
pry } Notes
mapques`• Harold E.Johnson A
Trip to: 115 Kindy Forest Drive
115 Kindy Forest Dr
Hendersonville, NC 28739-8847
36.41 miles
49 minutes
2090 Us 70 Hwy i Miles Per
Swannanoa, NC 28778-8211 Section
1. Start out going WEST on US-70I BLACK MOUNTAIN HWY toward NEW SALEM RD. Go 2.4 Mi
` - 2.Turn LEFT onto PORTER COVE RD. ~Go 0.1 Mi
,1 PORTER COVE RD is just past BURLESON RD
rt. 3. Merge onto I-40 W toward 1-261 ASHEVILLE. Go 9.2 Mi
4. Mere onto I-26 E I US-74 E via EXIT 46A on the LEFT toward HENDERSONVILLE I Go 18.4 Mi
SPARTANBURG.
5. Merge onto US-64 W via EXIT 49B toward HENDERSONVILLE. Go 2.4 Mi
LUM
6.Turn LEFT onto BUNCOMBE ST I US-64 W. Go 0.04 Mi
l@4J
7.Take the 1st RIGHT onto 6TH AVE W 1 US-64. Continue to follow US-64. Go 1.7 Mi
ea- If you reach 5TH AVE W you've gone about 0.1 miles too far
6 8. Turn LEFT onto DANIEL DR. Go 0.4 Mi
i DANIEL DR is 0.2 miles past PISGAH DR
- 9.Turn RIGHT onto DAVIS MOUNTAIN RD. Go 0.04 Mi
10.Take the 1st RIGHT to stay on DAVIS MOUNTAIN RD. :Go 1.3 Mi
If you reach the end of OLD ORCHARD DR you've gone about 0.1 miles too far
11.Turn RIGHT onto STONE GATE LN. Go 0.03 Mi
STONE GATE LN is 0.1 miles past CRESCENT POINT DR
` 12.Take the 1st LEFT onto KINDY FOREST DR. Go 0.3 Mi
`1 If you reach the end of STONE GATE LN you've gone about 0.2 miles too far
13. 115 KINDY FOREST DR is on the LEFT. ~
Your destination is 0.1 miles past W KINDY FOREST DR
¢9 116 Kindy Forest Dr LL 36.4 mi
T Hendersonville,.NC 28739-8847
Total Travel Estimate: 36.41 miles -about 49 minutes
All nghts-reser_v_ed.-use Lo_LicenseLcop ri ht
Directions and maps are Informational only.We make no warranties on the accuracy of their content,road conditions or route usability or expeditiousness.You assume
all risk of use.MapQuest and its suppliers shall not be liable to you for any loss or delay resulting from your use of MapQuest.Your use of MapQuest means you agree
to our Terms,of Use
http://www.mapquest.com/print?a--app.core.f16f2a57al9b396aff916116 4/19/2011

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dec Freeman
Governor Director Secretary
March 11, 2011
Harold Johnson RECEIVED
115 Kindy Forest Drive
Hendersonville,NC 28739 MAR 16 Mil �
Subject: Notice of Expiration (NOE) Asheville Regional Office
5A7 Geothermal Injection Well I_ Aquifer Protection
Permit No. WI0100002
Henderson County
Dear Mr. Johnson:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. During our records review we have discovered that the above-
referenced operating permit for the underground injection well system, which was issued to you
on October 22, 2002, expired on October 31, 2005. If you wish to keep this permit and operate
the injection well system, the permit must be renewed and issued in your name.
If Your Injection Well is Currentiv Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http://portal ncdenr ors/web/wa/ys/LNvnro/reporting,-forms.
If Your Iniection Well is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal
application must be submitted within 30 calendar days of the receipt of this letter.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 2769fi-163e
Location:2728 Capital Boulevard,Raleigh,North Carolina 27604 One
Phone:[phone] FAX 1.919-71 Z88,FAX [phone]E\Customer Service.1- r r-c 3-6748 Noptb ea-ohnc
Imeme*www.ncwatemualitv.om 'f /
Ar..Equal Vppntlunily)Afr marve Acwr Pmrii ve' V�

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s)for Injection with
Geothermal Heat Pump Svstem for Tvpe 5A7 Well(s) if the injection well system on your
property is still active.
-OR-
B. Status of Injection Well Svstem if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate form(s) to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available - on-line at the DWQ website at
http://l12o.enr.state.nc.us/al)s/gpu!forrns.htm.
Thank you in advance for your cooperation and timely .response. If you have any questions,
please contact me by phone at(919) 715-6196 or by email at eric.g.smith(a—incderingov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - APS w/o enclosures
APS Central Files - Permit No. WI0100002 w/o enclosures
2

DIVISION OF WATER QUALITY JUL 1 ` 2,J02
�D
GROUNDWATER SECTION
SEN
July 11, 2002 ASHEVILILE REC GROUNDWATER
OIFFICE
MEMORANDUM
To: Landon Davidson, L.G.,Regional Groundwater Supervisor
Groundwater Section
Asheville Regional Office
From: Mark Pritzl /0 • [e-mail]
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office(CO)
Re: Permit renewal#W10100002 under Herold E.Johnson; request for inspection and
routine sampling of Mr. Johnson's geothermal injection well system. This system is
located at 115 Kindy Forest Drive,Hendersonville,NC 28739.
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your UIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title 15A 2C .0200 standards are being complied
with, using the enclosed Injection Facility Inspection Report(form B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
You are requested to return the completed Injection Facility Inspection Report (form B)to the
CO-UIC by July 31,2002. If the inspection can not be accomplished by this date,please
inform the CO-UIC. The UIC group greatly appreciates Asheville Regional Office's
assistance with this review. If you have any questions regarding this review or the UIC
program,please contact me at(919) 715-6166.
p C VE
19fi
Enclosures —
GROUNDINATER SECTIO[-
ASHE,gI lE R-Gi.,i!A- r;ri^E

OF WA Michael F.Easley,Governor
�] q William G.Ross Jr.,Secretary
�O G North Carolina Department of Environment and Natural Resources
r Alan W.Klimek,P.E.Director
> —1 Division of Water Quality
O' Y
July 2, 2002
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
Dear Mr. Johnson:
Our records show that the operating permit for the injection well on your property did expire on June
30,2002. In addition, our records do not indicate that the well has been abandoned.
In order to comply with the regulatory requirements for permitted injection facilities(15A NCAC 2C
.0211),you must submit either 1)the enclosed Application for Permit Renewal to Use a Well(s)for
Injection with a Heat Pump System (form GW-57 HPR)if you are still using your injection well or
2)the enclosed Status oflnjection Well System (form GW-68)that certifies that the injection well is
no longer in use.
If the well is no longer to be used for any purpose,it must be permanently abandoned according to
the regulatory requirements (15A NCAC 2C .0213), and you must submit the enclosed Well
Abandonment Record(form GW-3 0). The appropriate form(s)should be forwarded to us by July 3 1,
2002 to allow adequate time for well water sampling and analysis.
If you have any questions regarding the permit and injection well rules or would like assistance
completing these forms please contact Mark Pritzl at [phone] or Evan Kane at(919) 715-
6165.
Sincerely,
JeraWatts
Permits & Compliance Supervisor
cc: CO-UIC Files
Enclosures
NA
Customer Service Division of Water Quality / Groundwater Section
1 800 623-7748 1636 Mail Service Center Raleigh,NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

OWAIF Michael F.Easley,Governor
\OH ROG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
r Alan W.Klimek,P.E.Director
> � Division of Water Quality
p Y
July 10, 2002
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
Dear Mr. Johnson;
Your application for renewal of a permit to use a well for the injection of geothermal
heat pump effluent has been received and is under review. The Groundwater Section
appreciates your timely response to our written inquiry about the status of your geothermal heat
pump system. A member of the Groundwater Section's Asheville Regional Office staff will be
contacting you to arrange an inspection of the injection well and collect water samples as part of
the review.
If you have any questions regarding permit or injection well rules please contact Mark
Pritzl at [phone].
Sincerely,
Evan 0. Kane
UIC Program Manager
cc: CO-UIC Files
ARO-UIC Files
AV
A
Customer Service Division of Water Quality / Groundwater Section
1 800 623-7748 1636 Mail Service Center Raleigh,NC 27699-1636 -
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT,HEALTH,AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH
A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 15A: 02C.0200
complete application and mail to address on the back page.
TO: DIRECTOR,NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: .S' -fa b / 20 0 'L
A. SYSTEM CLASSIFICATION: Does the system re-circulate only potable water without any additives such as
corrosion inhibitors or antifreezes in continuous piping which isolates the fluid from the environment?
YES _ If yes,do not complete this form. A form GW-57 CL,(Notification Of Intent To Construct A_-
Closed-Loop Geothermal-Water-Only Injection Well System),should be completed. o 0
f1a �'Y
NO If no,then continue completing this form c ?_
r- �m
B. PERMIT APPLICANT
o -�
Name: 6
Address: p i ei o rn
� ' /. -7 p� 7
City: SO / State: � Zip code: Z O 23 o_
County: Telephone: K 2 Vie- tq,�
C. PROPERTY OWNER(if different from applicant)
Name:
Address: i
City: State: Zip code:
Cour-Y. Telephone:
D. STATUS OF APPLICANT
Private: Federal: Commercial: State: Public:
Native American Lands:
E. FACILITY(SITE)DATA(Fill out ONLY if the Status of Owner is Federal,State,Public or Commercial).
Name of Business or Facility:
Address:
City: State: Zip code:
County: Telephone: Contact Person:
Standard Industrial Codes)which descr�e commercial facility:
ver.3/01 GW/UIC-57 HPR Pagel of 3

F. INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit)
/ On��
G. WELL USE Is(are)the injection well(s)also used as the supply well(s)for either of the following?
(1) The injection operation? YES NO
NO
(2) Your personal consumption? YES NOX_
H. CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
nlDN�
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering heat pump) and
effluent(water being injected into the well)lines is required. Is there a faucet on:
(a) the influent line? yes X- no_
(b) on the effluent line? yes_ r no_
I. CURRENT OPERATING DATA
G✓ff�N /.J o�/LFY/<.
(1) Injection rate: Average(daily) -Jr gallons per minute(gpm)
(2) Injection volume: Average(daily),/ gallons per day(gpd)
(3) Injection pressure: Average(daily) 0 pounds per square inch(psi) 144:M''S '&"640 1 1�-
(4) Injection temperature: Annual Average degrees Fahrenheit(°F) �s "J4y
Y Z ;i�.✓ /� GPYi,✓
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing. ny modifications.to injection equipment since the issuance of the previous injection
permit including the engineering layout of the (1) injection equipment, and (2) exterior piping/tubing associated
with the injection operation. The manufacturer's brochure, if detailed,should satisfy(1). YJ 04j sr
K. LOCATION OF WELL(S)Attach a map
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
ground-source heat pump well system; include buildings,property lines,surface water bodies, any other potential
sources of groundwater contamination. Label all features clearly and include a north arrow to indicate
orientation. ,-/I Irliefri,
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
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
ver.3/01 GW/UIC-57 HPR Page 2 of 3

M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment,fluid,operation,etc.)that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
tcl d1✓S
N. 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 operate, maintain, repair, and if applicable, abandon the injection well
and all related appurtenances in accordance with the approved specifications and conditions of the Permit."
(Signatur f e I Owner or Authorized Agent)
If authorized agent is acting on behalyofthe well owner,
please supply a letter signed by the owner
authorizing the above agent.
O. CONSENT OF PROPERTY OWNER(Owner means any person who holds the fee or other property rights in the
well(s). 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 applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s)as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC
Subchapter 2C.0200)
(Signature of Property Owner if Different From Applicant)
a Please return the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
(Telephone: [phone])
ver.3/01 GWIUIC-57 HPR Page 3 of 3

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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY, GROUNDWATER SECTION
STATUS OF INJECTION WELL SYSTEM
Date: Z Permit Number: (/(/— 02el—Gtl1— 000 f
Name: f/ j'
Address: (S n 1n)vy -+'ga2!- gr DA 1,
Please check the selection which most closely describes the current status of your injection well.
In addition, please provide the requested information.
1) k Well is still used for injection activities.
2) _ Well is used for water supply.
3) Injection discontinued;
a) _Well temporarily abandoned b)_ Well permanently abandoned
Describe the method used to properly abandon the injection well. (Include a description of how the well
was sealed and the type of material used to fill the well if permanently abandoned): If you checked two
(2), report the pumping rate and what the water is used for.
Certification: (For well abandonment)
"I hereby certify, under penalty of law, that I am personally responsible for the proper abandonment
of any injection well as required in-Tittle 15A NC,;C 2C.0214 Criteria and Stanftrds Applicable to Injection
Wells."
(Signature)
Certification: (For information verification)
"I hereby certify, under penalty of law, that I have personally examined and am farr�ar with.the
information submitted in this document, and that to the best of my knowledge the informp9onys_true,
accurate, and complete." o
(Signature) o
W n
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ver.3101 GW/UIC-68

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�QF W ATFRO F I Mtcael o
f
O G William G.Ross,Jr.,Secretary
rNorth Carolina Department of Environment and Natural Resources
—I Alan W.Klimek,P.E.,Director
O <
v
Asheville Regional Office
Groundwater Section
July 1, 2003
Ms. Carol Green
113 Kindy Forest Drive
Hendersonville, NC 28739
Dear Ms. Green:
Subject: Results of Water Supply Well Sampling
Green Residence
Henderson County
Enclosed is a copy of analytical data from analysis of a sample collected from your water supply
well on May 13, 2003. The results of the analysis for metals indicate that levels were within the
recommended limits for drinking water.
If you have any comments or questions, please contact me at(828) 251-6208.
Sincerely,
ACl/4b�!1'ez-,-.
Dechant
Hydrogeologist
NMMrNR'
Groundwater Section, 59 Woodfn Place Asheville,NC 28801-2414 Telephone: [phone] Customer Service
Fax: [phone] 1 800 623.7748

North Carolina State Laboratory of Public Health
Department of Health and Human Services
P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27611-8047
INORGANIC CHEMICAL ANALYSIS - PRIVATE WATER SYSTEM
Name of System: Green, Carol Source of Water:
Address: 113 Kindy Forest Drive Source of Sample:
Hendersonville, NC Zip: 28739
Type of Sample:
County: ARO Type of Treatment:
Report To: Asheville Regional Office ATTN: Kay Dechant Type of Analysis Private
[phone]
Asheville, NC 28801
Courier: 12-59-01
Collected By: KAY DECHANT Date: 5/13/03 Time: 12:00:00 AM
Location of sampling point: WS-1
Remarks: [phone]
Parameters Results Units Date Analyzed:
Arsenic <0.001 mg/I 5/15/03
Calcium 2.2 mg/I 5/15/03
Copper 0.05 mg/I 5/15/03
Iron 0.05 mg/I 5/15/03
Magnesium 0.5 mg/I 5/15/03
Manganese <0.03 mg/I 5/15/03
Lead <0.005 mg/I 5/15/03
Zinc <0.05 mg/I 5/15/03
S
dC�
2003D SECTIONNAL OFFICE
Date Received: 5/15/03 Report Date: 5/23/03 Reported By:
Today's Date: 5/27/03 Ref: 6592 Login Batch: 03050042 Sample Number: 94091

Explanations
Coliform Analysis:
If coliform bacteria are Absent, the water is considered safe for drinking purposes. If
coliform bacteria are Present, the water is considered unsafe for drinking purposes.
Presence of E. coli (bacteria) generally indicates that the water has been contaminated
with fecal material. It must be remembered that a water analysis refers only to the
sample received and should not be regarded as a complete report-on the water supply.
Inorganic Analysis:
Recommended limits for drinking water. Sample should not exceed levels listed
below.
Alkalinity No established limits Iron 0.30 mg
Arsenic 0.01 mg/1 Lead 0.015 mg/1
Calcium No established limits Magnesium No established limits
Chloride 250 mg/1 Manganese 0.05 mg'l
Copper 1.3 mg/I Nitrate 10 mg/I (as N)
Fluoride 4 mg/I Nitrite 1.0 mg/I (as N)
Hardness No established limits pH Not less than 6.5 units
Zinc 5.0 mg/1

f �OF WATEgo F IL 44JO.Pasldy
Governor
0 William G.Ross,Jr.,Secretary
CO r North Carolina Department of Environment and Natural Resources
p 'C Alan W.Klimek,P.E.,Director
Asheville Regional Office
Groundwater Section
July 1, 2003
Mr.-Jim Hammond
19 Shelter Cove Lane
Suite 200
Hilton Head, SC 29928
Dear Mr. Hammond:
Subject: Results of Water Supply Well Sampling
Hammond Residence
117 Kindly Forest Drive
Henderson County
Enclosed is a copy of a laboratory report of analysis of a sample collected on May 13, 2003 from
the subject water supply well. Also enclosed is a health risk evaluation performed by Dr. Ken Rudo with
the Occupational and Environmental Epidemiology Branch. Dr. Rudo has recommended that the well be
resampled as indicated to try to determine the source of the copper.
You may contact Ms. Krissie Red with the Henderson County Health Department to set up an
appointment to have the well resampled. Her telephone number is [phone]. 1 am notifing Ms.
Red of these results by copy of this letter. If you have any comments or questions regarding this data,
please call me at [phone].
Siinncceerrely_,
Kay Dechant
Hydrogeologist
cc: Krissie Red, Henderson County Health Department
a_�g
NZ`6 MR
Groundwater Section,59 Woodfin Place Asheville,NC 28801-2414 Telephone: [phone] Customer Service
Fax: [phone] 1 800 623-7748

r�
North Carolina State Laboratory of Public Health
Department of Health and Human Services
P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27611-8047
INORGANIC CHEMICAL ANALYSIS - PRIVATE WATER SYSTEM
Name of System: Hammond, Jim Source of Water:
Address: 117 Kindy Forest Drive Source of Sample:
Hendersonville, INC Zip: 28739
Type of Sample:
County: ARO Type of Treatment:
Report To: Asheville Regional Office ATTN: Kay Dechant Type of Analysis Private
[phone]
Asheville, NC 28801
Courier: 12-59-01
Collected By: KAY DECHANT Date: 5/13/03 Time: 12:00:00 AM
Location of sampling point: WS-2
Remarks:
Parameters Results Units Date Analyzed:
Arsenic <0.001 mg/I 5/15/03
Calcium 6.4 mg/I 5/15/03
Copper 2.92 mg/I 5/15/03
Iron 0.07 mg/I 5/15/03
Magnesium 0.9 mg/I 5/15/03
Manganese <0.03 mg/I 5/15/03
Lead <0.005 mg/I 5/15/03
Zinc 0.06 mg/I 5/15/03
, 10 J U N 2 5 2003 g 20D3 ,!`:�
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
Date Received: 5/15/03 Report Date: 5/23/03 Reported By: C�
Today's Date: 5/27/03 Ref: 6593 Login Batch: 03050042 Sample Number: AA94092

Explanations
Coliform Analysis:
If coliform bacteria are Absent, the water is considered safe for drinking purposes. If
coliform bacteria are Present, the water is considered unsafe for drinking purposes.
Presence of E. coli(bacteria) generally indicates that the water has been contaminated
with fecal material. It must be remembered that a water analysis refers only to the
sample received and should not be regarded as a complete report on the water supply.
Inorganic Analysis:
Recommended limits for drinking water. Sample should not exceed levels listed
below.
Alkalinity No established limits Iron 0.30 mg 1
Arsenic 0.01 mg/I Lead 0.015 m�u l
Calcium No established limits Magnesium No established limits
Chloride 250 mg/1 Manganese 0.05 ma l
Copper 1.3 mg/1 Nitrate 10 mg/I (as N)
Fluoride 4 mg/I Nitrite 1.0 mg/I (as N)
Hardness No established limits pH Not less than 6.5 units
Zinc 5.0 mg/1

North Carolina State Laboratory of Public Health
Department of Health and Human Services
P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27611-8047
INORGANIC CHEMICAL ANALYSIS - PRIVATE WATER SYSTEM
Name of System: Hammond, Jim Source of Water:
Address: 117 Kindy Forest Drive Source of Sample:
Hendersonville, NC Zip: 28739
Type of Sample:
County: ARO Type of Treatment:
Report To: Asheville Regional Office ATTN: Kay Dechant Type of Analysis Private
[phone]
Asheville, NC 28801
Courier: 12-59-01
Collected By: KAY DECHANT Date: 5/13/03 Time: 12:00:00 AM
Location of sampling point: WS_2
Remarks:
Parameters Results Units Date Analyzed:
Arsenic <0.001 mg/I 5/15/03
Calcium 6.4 mg/1 5/15/03
Copper 2.92 mg/I 5/15/03
Iron 0.07 mg/I 5/15/03
Magnesium 0.9 mg/1 5/15/03
Manganese <0.03 mg/1 5/15/03
Lead <0.005 mg/1 5/15/03
Zinc 0.06 mg/I 5/15/03
MAY 2 9 2003
P
GROUNDti' SECTION
ASHEVILLE REGIONAL OFFIC
Date Received: 5/15/03_ Report Date: 5/23/03 Reported By: A470t
Today's Date: 5/27/03 Ref: 6593 — Login Batch: 03050042 Sample Number: AA94092

Explanations
Coliform Analysis:
If coliform bacteria are Absent,the water is considered safe for drinking purposes. If
coliform bacteria are Present, the water is considered unsafe for drinking purposes.
Presence of E. coli(bacteria) generally indicates that the water has been contaminated
with fecal material. It must be remembered that a water analysis refers only to the
sample received and should not be regarded as a complete report on the water supply.
Inorganic Analysis:
Recommended limits for drinking water. Sample should not exceed levels listed
below.
Alkalinity No established limits Iron 0.30 mg l
Arsenic 0.01 mgil Lead 0.015 ma I
Calcium No established limits Magnesium No established limits
Chloride 250 mg/I Manganese 0.05 mg,I
Copper 1.3 mg/1 Nitrate 10 mg/I (as N)
Fluoride 4 mg/I Nitrite 1.0 mg/l (as N)
Hardness No established limits pH Not less than 6.5 units
Zinc 5.0 mg/l

' o
e„.srnao North Carolina Department of Health and Human Services
a�f ll Division of Public Health
t Epidemiology and Communicable Disease Section
�' 1912 Mail Service Center❑Raleigh,North Carolina 27699 1912
•a,�;;;m; 2728 Capital Boulevard❑Courier 56-32-00 ❑�19)733-3421
J. Steven Cline,D.D.S.,M.P.H., Section Chief
DATE i,
MEMORANDUM
TO: KQM �2��aKr
e f,o .nn( //aF �
r3'aJ6jW4� Sz6j6w
FROM: Kenneth Rudo, Ph.D., Toxicologist
Medical Evaluation and Risk Assessment Unit
Occupational and Environmental Epidemiology Branch
SUBJECT: I 4 �I K ( 0-t-
Attached is/are the Occupational and Environmental Epidemiology Branch's drinking
water health risk evaluation(s) for the well water sample(s) listed from the above site(s).
Recommendations for continued water use are also provided.
If you have any questions, please call me at [phone].
KR:lp
Attachment(s)
D E C E WE
JUN 2 5 2003
ID
GROUNDWATER SECTION
ASHEVILLE RE&l;„AL OFFICE
w, �
..�1 ' EveryVAere. EveryDay. EveryBody. An Equal Opportunihy/Affinnative Action Employer

NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
OCCUPATIONAL AND ENVIRONMENTAL EPIDEMIOLOGY BRANCH
DRINKING WATER HEALTH RISK EVALUATION
GENERAL
DATE COUNTY LABORATORY# f117! 7 spy
❑ Based on these analytical results, this water should be considered safe for normal usage.
❑ Chemical analysis did not show any contamination. Water should be resampled if odor
or taste persists.
❑ The water should not be used for drinking or cooking purposes; avoid prolonged
bathing/showering.
❑ Based on these analytical results, this water is highly contaminated and should not be
used for drinking, cooking, or bathing/showering.
l/ The laboratory results are not conclusive,please resample. 1 M1Wj-xje()
PLEASE INDICATE ON LAB SHEET THAT IT IS A RESAMPLE AND PROVIDE
PREVIOUS SAMPLE NUMBER(S).
COMMENTS:
I V-f4l" (Q �a/ //t1,�0'147v1 �ll� �Z(LL Q � f7 Oltz(U s illy
Jere 11,41 �.
1"1� >wd( �II w F �rr,lle �e �MtHc�tM+ o� f6 JOvy'Ct � aI' Q -
�,.�,
G°h�NUPR /pyfowl,V7i�N —
For further information,contact Dr.Ken Rudo,Occupational and Environmental Epidemiology
Branch, [phone].
E WE
DHHS 3S91 (5/99) D
Occupational&Environmental Epidemiology Branch(Revim 2102) JUN 2 5 2003
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

o�oF W a TERQG
Michael F.Easley -
Governor
r- William G- Ross,Jr.,Secretary
North Carolina Department of Environment and Natural Resources
C Alan W. Klimek, P.E., Director
Division of Water Quality
Asheville Regional Office
Groundwater Section
October 28, 2002
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville,North Carolina 28739
Re.: Analytical Results of September Sampling
Permit No.: WI0100002
Dear Mr. Johnson,
On September 11,2002, staff of the Asheville Regional Office collected additional
groundwater samples from your heat pump system including your water supply well. Additional
sampling was necessary due to the presence of elevated levels of some metals in the system
effluent just prior to injection. The laboratory analytical results of the last two sampling events
are attached.
The September analytical results indicate that all metals in the effluent sample (named
HJEFF) were below the 2L groundwater standards. I have forwarded this information to the
Central Office for their review in relation to your permit renewal. It is my understanding that
your permit renewal will be granted. As we discussed on the 18", analytical results for your
water supply well (named HJINF) indicate that lead was detected at 56 ppb (parts per billion).
Previous Sam ling results detected lead at 14 ppb. The EPA drinking water standard for lead is 0
ppb for MCL and 15 ppb for MCLG2. A health risk assessment for these analytical results is
being requested. Someone from our office will resample the well and your kitchen tap for lead
in the near future. You will be contacted to arrange a convenient time to sample.
If you should have any questions, please do not hesitate to call me at 828-251-6208, ext.
301.
Ser��^—
G. Landon Davidson, P.G.
Groundwater Section Regional Supervisor
Attached:analytical results for August and September sampling
Cc: ARO file
GW Central Office UIC Group (w/o atts.)
'Maximum Contaminant Level(MCL)-The highest level of a contaminant that is allowed in drinking water.MCLs are set as close
to MCLGs as feasible using the best available treatment technology and taking cost into consideration.MCLs are enforceable
standards.
'Maximum Contaminant Level Goal(MCLG)-The level of a contaminant in drinking water below which there is no known or
expected risk to health.MCLGs allow for a margin of safety and are non-enforceable public health goals.
ONOR
Groundwater Section,59 Woodfin Place Asheville,N.C. 28801-2414 Telephone: [phone] Customer Service
Fax: [phone] 1-800-623-7748

DIVISION OF WATER QUALITY
Chemistry laboratory,Report Ground Water Quality LF4D.U,ep.fted.
er 2G1271
ed : WIM1002
COUNTY : HENDERSON SAMPLEPRIORITY IORITY ed : 9:30 AM
QUAD NO: %❑ROUTINE EMERGENCY By : D/S�
REPORT TO ARO Regional Office CHAIN OF CUSTODY ? �.P t7—
COLLEC1OR(S) : GDAVIDSON HJEFF y : 0aDATE: 9lU2QOS SAMPLE TYPErted: elJ0l2M2
TIME:
PURPOSE: Ownec HJONN50Y
Location or Site:
Description of sampling point
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD 310 m L ass.Solids 70300 48 en /L A ilver 46566 u /L rrochlorme Pesticides
COD Hi 340 m L Fluoride 951 m L X A4Aluminum 46557 SOU u L Or n lane hoes Pesticides
COD Low 335 m L Hardness:total 900 m /L As-Arsenic 46551 u /L Ni ea Pesticides
CoBfarm:MF Fecal 31616 /100m1 Hardnm: noncarb)902 m L Ba-Barium 46558 u /L
Coliform:MF Total 31504 /IOuml Pherrob 32730 u /L X C.Cakium 46552 3.7 m /L Acid Hetbicidea
TOC m I cifrc Cord.95 umhos/cm2 CdCadium 46559 u /L
Turbid NTU Sulfate m L X Cr-Chromium 46560 25U u L Semivolatiles
Residue.,Suspended 530 m /L Sulfid<745 m L X Cu- r 1042 77 a /L TPH-Diesel Range
Total Suspended solids /L n m /L X Fe-Iron 1045 360 u L
Oil and Grease m L H-Menu 71900 u L Volatile Organia(VOA home)
µ 5.4 units Silin m /L X K-Pmasalnm 46555 1.5 m /L
Alkalinityto H 4.5 11 m /L Boron X Mg.Ma mium 927 0.78 m /L TPH-Gaoline Range
Alkalinityto H 8.3 1 U m /L Formaldeh de m /L x Mn-Man nese 1055 IOU u /L TPH-BTEX Gasoline Range
X Carbonate III m /L NH3 as N610 m /L X Na.Sodium 929 5.9 m /L
X Bicarbonate 11 m L TKN as N 625 m L X Ni-Nickel 12 a /L
Carbon dioxide m /L x NO2+1,103 as n 630 3.1 m /L X Pb-Lead 46564 IOU u L
X Chloride 4 m L P:Total as P 665 m L Se-selenium u L
Chromium:Hex 1032 u L PO4 m /L X Zn_7irc 46567 IOU u L
Color:True 80 C.U.
Cyanide 720 m L
COMMENTS:
U U L SEP - 4 2002
GROUNDWATER SETION
ASHEVILLLE REGIONAL OFFICE
2GI271.rlf

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
SAMPLETYPE SAMPLE PRIORITY
County_ k�-NDEI-Soy" 'Water ® Routine Lab Number
Quad N b Serial No.---- ❑Sod ❑ Emeraencv _ Data Recpy �S TinC\� _
Lat., j0o Long.�2. SI.O�- ❑Other NBC Rec'd'�nn"'t(tLYYJ/11 rom:Bus, ours Hand Del.,
❑Chain of Custody Other.__
Report To:/&P FRO, MRO, RRO,WaRO,WiRO, Data Entry By:__ _ Ck:_
WSRO, Kinston FO, Fed.Trust,Central Off.,Other: Data
� Reported:---
Shipped by:Bus, WI r,Hand Del.,Other: ice«� urAose: SMSccrOnl 6k
Collector(s):__—___(3�_Q�VLQSO.+ Date -13-0� Time��V Baseline,Complaint,Compliance, LUST,Pesticide Study,Federal Trust,Other: WIO OOOIt)Z
FIELDA A Owner_!_�_SDtk^tSv� (� Bpe)
pH Spec.Conde--_—_--at26C Location or Site—_—_ 1 V1140 oltci�
Temp.tp 2L-f• 2 0C Odor_—h(_otc—_ Description of sampling point H SEGG —�s�F�,�� C
Appearance__L_(c_ALL— ------- Sampling Method- Sample Interval_
Field Analysis By: Remarks SYSRM �1'VzFwr
RATORY ANALYSES
(Pumping time,air temp.eta)
BOO 310 mg/L r Diss.Solids 70300 mg/L Ag-Silver 46566 ug/L Organochlonne Pesticides
COD High 340 mg/L Fluoride 951 mg/L AI-Aluminum 46557 ug/L Organophosphorus Pesticides
COD Low 335 mg/L Hartlness'.Total 900 mg/L As-Arsenic 46551 ug/L Nitrogen pesticides
Coliform:MF Fecal 31616 /100ml Hardness(non-taro 902 mg/L Ba-Barium 46558 ug/L Acid Herbicides
Coliform:MF Total 31504 /100ml Phenols 32730 ug8 Ca-Calcium 46552 mg/L PCBs
TOC 680 mg/L Specific Cond.95 uMhos/cm Cd-Cadmium 46559 ug/L
Turbidity 76 NTU Sulfate 945 mg/L 4C Cr-Chromium 46559 ug/L
Residue,Suspended 530 mg/L Sulfide 745 mg/L Cu-Copper 46562 ug/L
dr Fe-Iron 46563 ug/L Semivolatile Organics
Oil and Grease mqa Hg-Mercury 71900 ug/L TPH-Diesel Range
pH 403 units K-Potassium 46555 mg/L
Alkalinity to pH 4.5 410 mg/L or Mg-Magnesium 46554 m /L
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 ug/L Volatile Organics(VOA bottle)
Carbonate 445 mg/L NHr as N 610 mg/L Na Sodium46556 mg/L TPH-Gasoline Range
.X Bicarbonate 440 mg/L TKN as N 625 mg/L Ni-Nickel ug/L TPH-BTEX Gasoline Range
Carbon dioxide 405 mg/L ,'J( NOi-NCb as N 630 mg/L d" Pb Lead46564 ug/L
Chloride 940 mg/L P:Total as P 665 mg/L Se-Selenium ug/L
Chromium:Hex 1032 ug/L 4- Zn-Zinc 46567 ug/L
Color:True 80 cU LAB USE ONLY
Cyanide 720 mg/L Temperature on arrival: 1
Lab Comments
GW-54 REV.12187 For Dissolved Analysis-submit filtered sample and write'DIS'In block.
SEP - q �
OAT* LLE REGIONAL OFF CE

al00(vd�> s kw
G5V`
DIVISION OF WATER QUALITY µot✓ gpaS
Chemistry Laboratory Report/Ground Wafter Quality
to Lab Number 2G1267
�f Date Remved : 8/ISR002
COUNTY : HENDERSON SAMPLE PRIORITY Time Received : 9:30 AM
QUAD NO: X�ROUTINE EMERGENCY Received By DS
REPORTTO ARO Regional Once CHAIN OF CUSTODY 3o I
COLLECTOR(S) : GDAVIDSON HJINF Released By . AR
DATE: WIN2042 W❑ SAMPLE TYPE Damnpon<d: 6131)R902
TIME:
PURPOSE: Owner. HdOxrvSON
Location or Sim:
De mnptlon of sampling point
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD 310 en /L X JDi..Solids 70300 42 m L A Silver 46566 u L Omartachlontre Pesticides
COD High 340 L IlFluorult,951 m /L X AI-Aluminum 46537 5OU u L n hos horns Pesticides
COD Low 335 m L Hardness:tou1900 m L Aa-Anenic46551 USA, Nitrogen Pesticides
Coliform:MF Fed 31616 /100nd Hardncn:(noncarb)902 m L Ra-Rarium 46558 u L
Coliform:MF Total 31504 /IOOMI Phenols 32730 u /L X Ca-Calcium 46552 3.2 m /L Acid Herbicides
TOC m /I S cific Cond.95 umhos/cm2 CdCadium 46559 a /L
Turbid NTU Sulfate m /L X CrCbromium 46560 25U a /L Semivolatiles
Residue.,Suspended 530 m /L Sulfide 745 nn /L X Cu-C r 1042 7.8 u L TPH-Dicael Range
Tout Suspended solids m L MBAS m /L X Fe.[run 1045 50U u /L
Oil and Grease ro /l, H -Mercu 71900 u /L Volatik0 nix(VOA book
H 5.8 units Silica et % K-Poumium46555 1.3 m /L
Alkalinity to pH4.5 12 m /L Enron X I Ms.Ma esium 927 0.65 m L I ITPH-G=Iinc Ran
Alkalinity to pH 9.3 111 m /L Formaldehyde m /L X Mn-Man nese 1055 IOU a /7 TPH-13TEX Gasoline Range
X Carbonate 111 m /L NH3asN610 0.02U m /L X No-Sodium 929 4.7 m /L
X Bicarbonate 12 m L TKN as 625 m L X Ni-Nickel IOU u /L
Carbon dioxide m /L X NO2+NO3 as n 630 2.4 m /L X Pb-Lead 46564 14 a /L
X Chloride 3 m /L P:Total as P 665 m /L Se-Selenium u /L
Chromium:Hex 1032 u L PO4 mg/L X Zn_2inc 46567 IOU u L
Colo.True 80 c.u.
snide 720 m /L
COMMENTS:
GROUNDWATER SECTION
g ` cQ Z) ko 1"g �cz ASHEVILLE REGIONAL OFFICE
�t NarlGy .
3GII67xls

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
SAMPL TYPE SAMPLE PRIORITY r
County NcNoa'2SoV4 _ _ (Water EV Routine Lab Number_
Quad No_ ❑ Soil ❑ Emeraencv I� NF Date Receiv d_
(c _ Serial No._____ _
Lat. =�_ Long._8 2.520 ❑Other Rec'd By: 8 rom:Bu , oune Hand Del.,
❑Chain of Custody Other:_
Report To42ED>FRO,MRO, RRO,WaRO,WiRO, Data Entry By: Ck:
WSRO,Kinston FO,Fed.Trust,Central Off.,Other: ___ Data
Reported:
Shipped by:Bus, rI ,Hand Del.,Other:_____ _ Purpose: f�LgoodOL
Collector(s): G • ppv•o SoN __ Date Mime !Z=�� Baseline,Complaint,Compliance,LUST,Pesticide Study,Federal Trust,Other:
FIELDANALYSES
Owner____ •_JoNNyo / �((circle.)TO-)
pH4ao__ _ Spec.Cond9 Location or Site p � _ _c
• � M
Temp.19 —$�' -
��•� eC Odor_ MaH4? ___ Description of sampling point �•lSr/YF SNF�LAG
Appearance__ a-NSAe_ _Sampling Method-- ma:�T:wT—_____ Sample Interval _
Field Analysis By: 61 L,� Remarks SYfTt/_�i�G ___fr�h7}2 bu°�'-•'� b-f-Il
LABORATORY ANALYSE (Pumping lima.air temp..etc.)
BOD 310 mg/L Dias.Solids 70300 mg/L Ag-Silver 46566 ug/L Organochlorine Pesticides
COD High J40 mg/L Fluoride 951 mg/L AI-Aluminum 46557 ug/L Organophosphoms Pestidtles
COD Low 335 mg/L Hardness:Total 900 mg/L As-Arsenic 46551 ug/L Nitrogen Pesticides
Coliform:MF Fecal 31616 /100ml Hardness(non-cart 902 mg/L Ba-Sarlum 46558 u /L Acid Herbicides
Colifotm:MF Total 31504 Moorni Phenols 32730 ug/I A( Ca-Calcium 46552 mg/L PCBs
TOC 690 mg/L Specific Cond.95 uMhos/cm Cd-Cadmium 46559 ug/L
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 ug/L
Residue,Suspended 530 mg/L Sulfide 745 mg/L 'x Cu-Copper 46562 ug/L
Fe-Iron 46563 ug/L Semivolatile Organics
Oil and Grease mg/L Hg.Mercury 71900 ug/L TPH-Diesel Range
pH 403 units K-Potassium 46555 m /L
Alkalinity to pH 4.5 410 mg/L c"_ Mg-Magnesium 46554 m /L
Alkalinity to pH 8.3 415 mg/L � Mn-Manganese 46565 ug/L Volatile Organics(VOA bottle)
Carbonate 445 mg/L NH3 as N 610 mg/L d' Na-Sodium 46556 mg/L TPH-Gasoline Range
X Bicarbonate 440 mg/Lj
j TKN as N 625 mg/L Ni-Nickel ug/L TPH-BTEX Gasoline Range
Carbon dioxide 405 mg/L NOz-NO,as N 630 mg/L d' Pb-Lead 46564 ug/L
)( Chloride 940 mg/L P:Total as P 665 mg/L Se-Selenium ug/L
Chromium:Hex 1032 ug/L Zn-Zinc 46567 u /L
Color:True 8o CU B U NL
rrival:
Cyanide 720 m9/L mperature on a
Lab Comments - Ill 11 -------------------
GW-54 REV.12/87 For Dissolved Analysis-submit filtered sample and write•DIS•in block.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

f
DIVISION OF WAFER QUALITY
Chemistry[Abors(ory Report Ground Water Quality Lab Number 2C1431
Date Received : 9/13/2002
)UNTY : HENDERSON SAMPLE P 10 ITY Time Received : 9:00 AM
JAI)NO: EJR6UTINE EMERGENCY Received By JG
PORTTO ARO Regional Offew CHAIN OF CUSTODY I // )T1
Dd.PCfOR(S) : K DECUANT HJEFF Released 4 :: //a
k1 F! 9/11/2002 W❑ SAMPLETYPE Date reported: 1 011 012110 2
M Ii:
)HOSE. Owner 11.1011NSON
Liaalian ur tide:
Description of sampling point
Sampling Method:
Remarks:
ABORA'FORY ANALYSIS
BOD 310 m /L Dist.Solids 70300 m /L A -Silver 46566 a /L Or nocishwine Pesticides
COD Ifigh 340 m L Fluoride 951 nn /L X AI-Aluminum46557 50U a /L Organophosphorm Pesticides
COD Low 335 m L Hardness:total 900 m /L lAs Arsenic 46551 u L Nitrogen Pesticides
Coliform:MF Fecal 31616 /100m1 Hardness:(noncarb)902 en /L Ilia Barium 46558 u /L
Coliform:MF Total 31504 /I00m1 Phenols 32730 u /L X Ca-Calcium46552 3.6 m /L Acid Herbicides
TOC m I Specific Cond.95 umbos/cm2 Cd-Cadium 46559 u /L
Tuibitity, NTU Sulfate m /L X Cs-Chro m miu 46560 25U a /L Sem)volatiies
R.sidue.,Suspended 530 on /L Sulfide 745 m /L X C.-Cwm 1042 66 a /L TPH-Diesel Rarove
Total Sutpedcd solids m /L IMBAS m /L X Fe-Iron 1045 5OU a /L
Oil and Grease m /L II -Memo 71900 u L ]Volatile 0 nics(VOA bottle
❑ units Silica m /L X K-Potassium 46555 1.3 m L
Alkalinity to 114.5 m /L Boron X MR-Ma esium 927 0.75 m /L TPH-Gasoline Ran
Alkalinity to pli 8.3 m L Formaldehyde m /L X Mn-Man new 1055 IOU u /L TPH-BTEX Gasoline Range
Caibonale m /L N113 as N 610 m /L X Na-Sodium 929 4.4 m /L
Bicad,onale m /L TKN as N 625 m /L X Ni-Nickel IOU u /L
Carbon dioxide m /L NO2+NO3 as n 630 m /L X PbLead 46564 IOU u /L
Chloride m /L P:Total as P 665 m /L Se-Selenium us/L
Cluomiuns:Hrx 1032 a /L PO4 m /L X Zn_Zinc 46567 IOU u /L
Color-.True 80 e.u.
Cyanide 720 L
JhIMEN'I'S: •M E'I'ALS PR ESE•RVF D WI'f1111-403
OCT 14 Za
LABORATORY SECTION ac1eJ1. .
ASKVILLE REGIONAL OFFICE

i 'ah-
North Carolina
GROUNDWATER FIELD/LAB FORM Department or EnvironmentQUALITY-GROUNDWATER
Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
/ SAMPLET.YPE SAMPLEPRIORI
County__-- eILd�CSJ1L1---------------------- CV3"Waler klullne Lab Number--/--�--- -------�J
__ ❑Soil ❑ Erneraencv �ff Dale Re veen-10'�� Time:=/��
.flllf2lL --- -------
Quad No_ Serial No.__—____________ ❑Other---.-- Rao' By: Fronl:Bu ourier, and Del.,
Lat._ ,S �11___-- Long.—�„ _.'5V�----
❑Chain of Custody Other:__
-----
Report To AR FRO,MRO, RRO,WaRO, WiRO, Data Entry
Data
WSRO, Kinston FO,Fed.Trust,Central Off.,Other:__—__________________
Shipped by: Bus,
Courie and Del.,Other:_____________ _ ________ Put pose:
Collector(s): e:N .42.--...... Date�& ____ Tme �f—
Baseline,Complaint,Compliance, LUST,Pesticide Study,Federal Trust,Other:A=10w,
FIELD ANALYSES Owner-----_/t_�6nf
---- -- ------------
pH 4ae-------------------- Spec.Cond.9+____-_--_____at 250C Location or Site_-&,T _--__ ' �ec'Cs,7_'__ ____ PLsQtltG --
eC Odor---------------------------- Description of sampling point----- ---- '.,.Z 1--- -----LuCI� ---------------
Appearance------------------------------------------ Sampling Method-- ------------l6umu-tan Zercl--------- Sample Interval____-- ---
TVAnalysis ey:--------------------_______-_-___---------_ Remarks
O A O ! A ALYSE (parnptM4me.616c4 p.,etcj
BOD 310 mg1L Dlss.Solids 70300 mglL Ag Sllvcr 46566 ug/L OrOanochlorino PesliciJos
COD High 340 mg/L Fluoride 951 mglL AI-Aluminuen 46557 uglL Or'pna hos ptmms Poslicldes
COD Low 335 rng/L Hardness:Total 900 mg/L As-Arsenic 46551 ug/L Nitrogen Pesticides
Coliform:MF Fecal 31616 /100m1 Hardness(nomcarb 902 mg/L Bs-Barium 46558 ug/L Acid Herbicides
Coliform:MF Total 31504 1100m1 Phenols 32730 ug/I Ca-Calcium 46552 mg/L PCBs
TOG 680 mg/L Specific Cond.95 umhoslcm Cd-Cadmium 46559 uglL
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 ug/L
Residue.Suspended 530 mg/L Sulfide 745 mg1L Cu-Copper 46562 uglL
Fe.lron 46563 ug/L Semivolatile Organics
Oil and Grease mg/L Hg-Mercury 71900 ug/L TPH-Diesel Range
pH 403 units K-Polasslum 46555 mglL
Alkalinity to pH 4.5 410 ra l Mg-Magnesium 46554 mg1L
Alkalinity to pH 8.3 415 mg1L Mn.Mangonese 46565 ug1L Volatile Organics(VOA bottle)
Carbonate 445 mg/L NH,as N 610 mg/L Na Sodium 46556 mglL TPH-Gasoline Range
Bicarbonate 440 mg/L TKN as N 625 mglL NI-Nickel ug/L TPH-BTEX Gasoline Range
Carbon dioxide 405 mg/L NO,- Nor as N 630 mg/L Pb Lead 46564 ug/L
Chloride 940 mg/L P:Total as P 665 mg/L se selenium ug/L
Chromium:Hex 1032 ug1L Zn.Zinc 46567 ug/L
Color:True 60 Cu LAB USE ONLY p
cyanide 72o Temperature on arrival:D
mg/L
Lab Comments-------------------—_ —------ ,JlPSk[y Jv! �-- -
-------------------------
-------------------------Y---------------------------------------------------------------------------
cw.54 For Dissolved Anal sls�submit filtered sample end write"DIS'in block.

DIVISION OF WATER QUALITY
('heaths,Laboratory Report Ground Water Qaallty Lab Number 2G1432
Date Received 9/13I20112
3UNTY HENDERSON SAMPLE PRIORITY Time Received : 9:00 AM
UAD NO: %ROUTINE EMERGENCY Received By JG
EPORT'T'O t ARO Regional Office CHAINOFCUSTODY ❑ L_ 1 /10
ULLEC OR(S) : KDECHAN1' ❑ HJINF 'I x,ted 6y rAK 1 a
A'FE: 91l 1/200 a SAMPLE TYPE Uate reponed: 110II0/2002
IME:
URPOSE: Owner: H JOHNSON
Location or Site:
Desorption of sampling point
Sampling Method: -
Remarks:
,ABORATORY ANALYSIS
BOD 310 m /L Diss.Solids 70300 m /L A -Silver 465M a /L Orgamockdorme,Pesticides
COD High 340 m /L Fluoride 951 m /L X Al-Aluminum 46557 50U a /L Organophosphom Pesticides
COD I.uw 335 m /L I lardneas:I14a19t81 m /L As-Arsenic 46551 u /1. Nitrogen Pestkide,
Culifolm:MF foal 31616 /IOOmI Hardness:(nmrcatb)902 m /L Ba.Berlum46558 u /L
Coliforao:Mt'Total 31504 /IOOml Phenn102730 u /L X Ca-Calcium 46552 3.5 m /L Asid l lcrblcldea
TOC .811 Spex,ific Cond.95 umhos/cm2 Cd-Cadium 46559 a /L
T u,b.tiEy NTU Sulfate m /L X Cr Chromium 465W 25U u L Semivolatiles
Residue.,Suspended 530 m /L Sulfide 745 m /L X Cu-C r 1042 66 a /L TPH-Diesel Range
'total Su%pendedwlids m L IMBAS m /L X I Fe.Iron 1045 83 a /L
Oil and Grease m /L I1 Mercury71900 u /L Volatile Or nice(VOA bottle)
I'll units Silica m /L X K-Pmassium 46555 1.3 m /L
Alk.flinny w d14.5 m /L Boron X I MR.M. ncsium 927 0.73 m /L TPH-Gasoline Range
Alkalinity w PH8.3 m /L Furmaldehyde m /L X Mn-Man new 1035 IOU a /L TPH-BTEX Gasoline Range
Odnmarc m /L NH3*sN610 m /L X Na.Sodium 929 4.2 m /L
Bicarbonate m /L T'KN as N 625 m /L X Ni-Nickel IOU u /L
_Carbon dioxide m /L NO2+NO3 u n 630 en /L X Pb-Lead 46564 56 u /L
Chloride en /L P:Tool as P 665 m /L Se.Selenium u /L
Chromium:Iles 103E u /L PO4 na /L X Zn_Zmc46567 23 a /L
Color.Tmc 80 C.U.
C snide 720 m /L
IOMMENIS: 'METALS PRESERVED WITH HNO3
r
1L OCT 1 4 ZOOZ
LABORATORY SECTION
SHEVILLE REGIONAL OFFICE tat=,,,,

North Carolina
GROUNDWATER FIELD/LAB FORM Department of WATER
QUALITY-GRironment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
SSA.,MC 1 LETYPE SA L PRIORI ��/T(/�7�
Count ua water W Roul no Lab Number _�` _' �_
--------- J�N�
t ❑ Soil ❑ Emeroencv Dale R ed`/ Time:_ -`� _
Quad No--C��GA---- Serial No.---------------- ---------
Lal._, -�L�7�-___ Long �.1 -_—_- ❑Other __ Rec'd� Fro m:B outlet, ad Del.,
❑Chain of Custody Other:__ ____-----__
Report To(0)FRO. MRO, RRO,WaRO, WiRO, Data Entry By:—---------—_ Ck:___-
Data -
WSRO,Kinston FO, Fed.Trust,Central Off.,Other:------------------—__ .f- Reported:—-----------------—_—_—__—__
Shipped by: Bus, ourie Hand Del ,Other:____________________________ Purpose: -4&ecfpq /1e��
9[rf—____-_ Dale D�3�C9JL_ Time_f (Q___ 8asellne,Complaint,Compliance, LUST,Pesticide Study,Federal Trust,Other: 1atee.0_-;
FIELD ANALYSES Owner (alde°ne)
pH erg__—__ Spec. Cond.9+_____________at 25°C Location or Sile_y,�___.�i�y�_�l�.s�__
-------------- - _..L4-f -
Temp.m -------------
Odor-------------------- Description of point—_--Jfr�Jll—___-- - -- ---- ----------
A earance------------------------ ------------------ Sampling Method-------------------------- Sample Interval---------
PP ____ reumo:b—.ir—etc`_—_________
Field Analysis By:------------------------------------- Remarks---�z` &47__�it�lU�q-1- (Pam ng tin o,olrlemc.. Y ✓---�
-AB O A ORY ANALYSES
BOD 310 mgll Diss.Solids 70300 mg/L I Ag-Silver 46566 ug/L Organochlorine Pesticldes
COD High 340 mg/L Meddle 951 inglL AI-Aluminum 46557 ugiL Organophosphorus Pesticides
COD Low 335 mg/L Hardness:Total 900 mglL As-Arsenlc 46551 ug/L Nitrogen Pesticides
Coliform:MF Fecal 31616 /100ml Hardness(nomcarb 902 mg/L Ba-Barlum 46558 ugr- Acid Herbicides
• Coliform:MF Total 31504 1100ml Phenols 32730 ugll Ca-Calcium 46552 mg1L PCBs
r TOC 680 mg/L Specific Cond.95 uMhas/cm Cd-Cadmium 46559 ug/L
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 ugiL
Residue,Suspended 530 mg/L Sulfide 745 mg/L Cu Copper 46562 ugll-
Fedron 46563 ug/L Semlvolatile Organics
OII and Grease mg/L 149-Mercury 71900 ug/L TPH-Diesel Range
pit 403 units K.Potasslum 46555 mg/L
Alkalinity to pH 4.5 410 mg/L Mg-Magneslum 46554 mg/L
Alkalinity to pH 8.3 415 mglL Mn-Manganeso 46565 ug/L Volatile Organics(VOA bottle)
Carbonate 445 mg/L Nit,as N 610 mglL N.Sodium 46556 mg/L TPH-Gasoline Range
Bicmbonale 440 mglL TKN as N 625 mg/L NI-Nickel ug/L TPH-BTE%Gasoline Range
Carbon dioxide 405 mg/L NO,• NO,as N 630 mg/L Pb.Lead 46564 ug/L
Chloride 940 mglL P:Total as P 665 mglL So-selerdum ug/L
Chromium:Hex 1032 ugiL Zn-zinc 46567 ug/L
Color:True 80 Cu LAB USE ONLY DG
arrival:
on arriva
Cyanide 720 mg/L
6 ,
LabCommenls--------------------------------------------'�-LI'�e-7� 'i--�re.sery _--k'%Y1+-- 3--------------
----------------------------------------------------------------------------------------------
GW-54 For Dissolved Analysts-submit 611ored sample and write-DIS'in block.

03/0S/2003 1S: 07 919-715-0588 NODEBNR/WATER QUAL PAGE 01/01
Harold L-_ Johnson
115 Kindy Forest Drive c
I-JendersonvMe, NC 28739 0
[phone] T
rn ��
ca - -
February 14, 2003 post-it- Fax Dote 767'I
u w
rPhone
tl✓a -F C`t Prom Q.1�4 Ir/•i' E5
Mr- Evan O. Kane p2. co. ;� CR
Division ofwater Quality S Phonap �L�161�1636 Mail Service CenterRaleigh, NC 2'7699-163G �
Dear Mr_ Kane
I am in receipt of.your letter to me dated 4 February 2003, and would request a further review
ofthe subject circumstances-I fully understand the Groundwater chemists comments, and her defense
of collected data. 'chat same methodology o£course,is what caused the repeat visit to nay-home when
those checks and reviews failed to properly identify the iron "sampling event" of 13 August 2002-
Since you are concerned about the elevated lead concentrations from my source well, you
have certainly noticed that there is a signific ult reducrion in that element in my discharge effluent. I
am hoping at sometime in the near future to be able to sell my accumulated lead and intend to enter
negotiations with the lead tire weight Folks as one of their suppliers. I would be most appreciative W
you would describe to me, the rationale of your decision to limit my injection well porn-it to three
years from five,when source well water content has nothing to do with the injection process. I would
think, what with my cleaning of the environment, you would be expending some effort to press
additional permits upon me. I am certain you can see the logic in this-
I would be happy to comply with your recommendation of remedying the lead problem in my
water supply well. Short ofdrilling another well at some other location, Q%Iars comes to mind) I have
a bit oftrouble deciding how to do that. 'SCou might ask your chemist for her suggestions and forward
her answers at your earliest convenience. I am not a I-uddite by nature, I have made my living for
most o£my life from science and'technology, but as a youngster, I grew up in a large city that had
lead water pipes from the cast iron mains to my kitchen faucet and I still managed to grow up. I do
understand that the EPA's MCI-and MCI-Cy(despite lvxr. Davidson's inversion of the numbers in his
letter)are 15 ppb and O as a goal- Since my discharge well samples fall below the levels the 17wQ sets
as maximums in AI J- measured elements, I again request that you reconsider and return my sample
periods to the 5 year interval or cite a specific reason for not doing so. Purported elevated lead
content in the source well is not an acceptable reason-
fa old E. Tohnson

WAjF Michael F. Easley,Governor
\0�0 19 William G. Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
uJ 7 Alan W.Klimek,P.E.Director
>_ y Division of Water Quality
O <
February 4,2003
. FEB - 5 2003 UU
GROUNDWATER SECTION
Harold Johnson ASHEVILLE REGIONAL OFFICE
115 Kindy Forest Drive
Hendersonville,NC 28739
Dear Mr. Johnson:
The Groundwater Section has reviewed your request to extend your geothermal heat pump
injection well permit from a three-year permit interval to a five-year interval. We do agree that
the iron concentration that was reported in the August 13ih, 2002, sampling event is not of any
serious concern. However,we are concerned with the elevated lead concentrations that were
detected from the water supply well in both the August 136' and September I lth sampling events.
The Groundwater Section's chemist has reviewed the lab results from the last two sampling
events of your geothermal system as well as your request letter received on October 31, 2002. In
her review comments, the chemist stated: "The DWQ Laboratory validates its data through a
series of checks and reviews that is intended to assure that the reported results are of a verifiable
and acceptable quality. The Lab reports results at its Practical Quantitation Limit (PQL), which
is about 3-5 times the calculated Method Detection Limit(MDL), and represents a practical and
achievable detection limit with a relatively good certainty that any reported value is reliable."
Based on our review, the Groundwater Section believes that the issuance of a three-year permit is
justified and recommends that you remedy the lead problem pertaining to your water supply well
as soon as possible.
If you have any questions regarding your permit, please contact me at [phone] or Mark
Pritzl at [phone].
Sincerely,
Evan O. Kane, L.G.
Underground Injection Control Program Manager
cc: CO-1.11C Files
ARO-UIC Files
Customer Service Division of Water Quality / Groundwater Section
1 800 623-7748 1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

BE C E[ WE
OCT 2 4 2002 D
DIVISION OF WATER QUALITY GROUNDWATER SECTION
GROUNDWATER SECTION ASHEVILLE REGIONAL OFFICE
October 21,2002
MEMORANDUM
To: Landon Davidson,L.G., Regional Groundwater Supervisor
Groundwater Section
Asheville Regional Office
From: Mark Pritzl r/tr [e-mail]
Hydrogeological Technician H
UIC Group
Groundwater Section
Raleigh Central Office
Re: Issuance of a Open-Loop Geothermal Injection Well System(Type 5A7.):
Permit Number WI0100002 to operate a well for the injection of an open-loop
ground-source heat pump system has been issued to Harold Johnson, in Hendersonville,North
Carolina. This is a renewal permit and the Underground Injection Control Group appreciates your
assistance with the inspection and review tasks. Please retain the application and paper work for
the ARO-UIC files. If you have any questions regarding this permit or the UIC program,please
contact me at(919) 715-6166.
cc: CO-UIC Files
Enclosures

VW ATE Michael F.Easley,Governor
`OHOF qoG William G. Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
CO
r Alan W.Klimek,P.E.Director
>_ Division of Water Quality
O Y
October 21, 2002
Harold Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
Dear Mr. Johnson:
In accordance with your renewal application dated July 26, 2002, we are forwarding Permit No.
WI0100002 for the operation of a geothermal heat pump injection well at 115 Kindy Forest
Drive, Hendersonville,NC, in Henderson County. A copy of the laboratory test results of water
samples collected on August 13 and September 11, 2002 are also enclosed. Please note due to
slightly elevated iron concentrations in the effluent water sample the Groundwater Section is
issuing a three year geothermal heat pump injection well permit instead of the normal five year
interval. This will allow a more frequent monitor schedule to observe iron concentrations.
This permit shall be effective from the date of issuance until October 31, 2005, and shall be
subject to the conditions and limitations stated therein. 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.
If you have any questions regarding your permit please contact me at [phone] or Evan
Kane at(919) 715-6165.
Sincerely,
Mark Pritzl
Hydrogeological Technician
Underground Injection Control Program
cc: CO-UIC Files
ARO-UIC Files
� F4closures
N�DEN��R
Customer Service Division of Water Quality / Groundwater Section
1 800 623-7748 1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

MEMORANDUM October 21, 2002
To: Mr. Hai°old Johnson
From: (/!lPMark Pritzl tel. [phone]
Re: Groundwater Sampling Results from August 13, 2002
Influent Water Sample Effluent Water Sample
Coliform, total ns Coliform, total ns
Coliform, fecal ns Coliform, fecal ns
pH 5.8 pH 5.4
Chloride, Cl 3 mg/L Chloride, Cl 4 mg/L
Dissolved Solids 42 mg/L Dissolved Solids 48 mg/L
NOz +NO3 as N z 2.40 mg/L NOZ+NO3 as N 3.10 mg/L
NH3 as N <0.02 mg/L NH3 as N ns
TKN as N ns TKN as N ns
Aluminum,Al <50 ug/L Aluminum, Al <50 ug/L
Chromium, Cr <25 ug/L Chromium, Cr <25 ug/L
Copper, Cu 7.8 ug/L Copper, Cu 77 ug/L
Iron,Fe <50 ug/L *Iron,Fe 360 ug/L*
Mercury, Hg ns Mercury,Hg ns
Potassium, K 1.3 mg/L Potassium, K 1.5 mg/L
Magnesium,Mg 0.65 mg/L Magnesium,Mg 0.78 mg/L
Manganese, Mn <10 ug/L Manganese, Mn <10 ug/L
Sodium,Na 4.7 mg/L Sodium,Na 5.9 mg/L
Nickel,Ni <10 ug/L Nickel,Ni <10 ug/L
Lead, Pb 14 ug/L Lead,Pb <10 ug/L
Selenium, Se ns Selenium, Se, ns
Zinc, Zn <10 ug/L Zinc, Zn 28 ug/L

Groundwater Sampling Results from September 11, 2002;
Effluent Water Sample
Coliform, total ns
Coliform, fecal ns
pH ns
Chloride, Cl ns
Dissolved Solids ns
NOZ+NO3 as N ns
NH3 as N ns
TKN as N ns
Aluminum, Al <50 ug/L
Chromium, Cr <25 ug/L
Copper, Cu 66.ug/L
Iron,Fe <50 ug/L
Mercury,Hg ns
Potassium,K 1.3 mg/L
Magnesium,Mg 0.75 mg/L
Manganese, Mn <10 ug/L
Sodium, Na 4.4 mg/L
Nickel, Ni <10 ug/L
Lead,Pb <10 ug/L
Selenium, Se ns
Zinc, Zn <10 ug/L

State Groundwater Quality Standards:
Classifications and Water Quality Standards Applicable To The Groundwater's of North Carolina
(North Carolina Administrative Code Title 15A: 02L.200)
Coliform, total <1/100 ml
Coliform, fecal <1/100 ml
Chloride <250 mg/L
Total Dissolved Solids <500 mg/L
NOZ+NO3 as N <10 mg/L
Cadmium <5.0 ug/L
Chromium, Cr <50 ug/L
Copper, Cu <1,000 ug/L
Iron,Fc <300 ug/L
Manganese,Mn <50 ug/L
Nickel,Ni <100 ug/L
Lead,Pb <15 ug/L
Zinc, Zn <2,100 ug/L
Arsenic, As <50 ug/L
Mercury,Hg <1.1 ug/L
Barium, Ba <2,000 ug/L
Zinc, Zn <2,100 ug/L
mg/L=milligrams per liter=parts per million (I gram/1,OOOgrams)/1,OOOgrams
ug/L=micrograms per liter=parts per billion (1 gram/1,000,OOOgrams)/1,000grams
1,000 ug/L= 1 mg/L
ns=not sampled

A_
f
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws,Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Harold E. Johnson
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL(S), defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This system is located at 115 Kindy Forest Drive, Hendersonville, in Henderson
County,North Carolina, and will be operated in accordance with the application received on July
10, 2002, and in conformity with the specifications and supporting data submitted, all of which
are filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Operation only, and does not waive any provisions of the Water Use Act or any
other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in
compliance with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any
other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until October 31,
2005, and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof.
'Jo
Permit issued this the day of 2002.
Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No.WI0100002 Page 1 of
ver.3/01 GW/UIC-5

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes;a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
PART II- 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 maybe
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
Permit No.WI0,100002 Page 2 of 5
ver.3/01 GW/UIC-5

PART III-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater which 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.
Z
PART IV- OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
PART V-INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place on
or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
Permit No.WI0100002 Page 3 of 5
ver.3/01 GW/UIC-5

PART VI-,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 Asheville Regional Office, telephone number(828)
251-6208, any of the following:
(A) Any occurrence at the injection facility which 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.
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 VII-PERMIT RENEWAL
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
PART VIII- CHANGE OF WELL STATUS
1. The Pennittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(1), 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:
Permit No.WI0100002 Page 4 of 5
ver.3/01 GW/UIC-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) The 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) Drilled wells 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,neat-cement shall be injected into the well completely
filling it from the bottom of the casing to the top.
(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)(1) within 30 days of completion of
abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Groundwater Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX- OPERATION AND USE SPECIAL CONDITIONS
None
Permit No.WI0100002
ver.3/01 GW/UIC-5 Page 5 of 5

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
SAMPIL�T E AS MPLEPRIORITY e
County— I `� _ ❑ Water ,-Routine Lab Number__
,moll ❑ Ememencv c1 ) �.,
T
Quad No_— Serial No. _ ___— T Date Received11�L2�l�ZTime:�
Lat._— Long.-- El Other V CFF Rec'd By: �,�,r From:BUB,Courier and ,
❑Chain of Custody Other:—Report To:t9,FRO,MRO, RRO,WaRO,WiRO, Data Entry By: Ck:—Z__
WSRO,Kinston FO,Fed.Trust,Central Off.,Other: Data
Reported:—
Shipped by:Bus,Courier,Harjd Del.,Other:_— I Purpose:
Collector(s):__QPqLOS�1 Da�dLkj= Time C2_� — Baseline,Complaint,Compliance,LUST,Pesticide Study,Federal Trust,Other:—___—__
FIELD ANALYSES Owner (ditle ene)
pH 4op----------------- — Spec.Concls at 2ffC Location or Site__-- _—_---
Temp.lp----------_°C Odor-- Description of sampling point_
Appearance_-------------- —Sampling Method_--____ _ _ Sample Interval
Analysis B — —_---- "'°b8�''°�`T— --Field Anal _y y:_ — __ ___ —__Remarks _
LABORAT RYANALYSES (Pumping time,arPomp.,eM)
BOO 310 mg/L Diss.Solids 70300 mg/L Ag-Silver 46566 u /L Organochlonne Pesticides
COD High 340 mg/L Fluoride 951 mg/L AI-Aluminum 46557 ug/L Organoplimphows Pesticides
- mg/L Hardness'.Total 900 mg/L As-Arsenic 46551 ug/L Nitrogen Pesticides
Coliform:MF Fecal 3161 /loom] Hardness(non-wrb 902 mg/L Ba-Barium 46558 ug/L Acid Hemicides
Coliform:MF Total 31504 ,! 1 /100ml Phenols 32730 ug/I Ca-Calcium 46552 mg/L PCBs
TOC 680 mg/L Specific Cord.95 uMhos/cm Cd-Cadmium 46559 ug/L
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 ug/L
Residue,Suspended 530 mg/L Suede 745 mg/L Cu-Copper 46562 ug/L
Fe-Iron 46563 ug/L Semivolable Organics
Oil and Grease mg/L Hg-Mercury 71900 ug/L TPH-Diesel Range
-09 403 units K-Potassium 46555 mg/L
Alkalinity to pH 4.5 410 mg/L Mg-Magnesium 46554 m /L
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 ug/L Volatile Organics(VOA bottle)
Carbonate 445 mg/L NHe as N 610 mg/L Na-Sodium 46556 mg/L TPH-Gasoline Range
Bicarbonate 440 mg/L TKN as N 625 mg/L Ni-Nickel ug/L TPH-BTEX Gasoline Range
Carbon dioxide 405 mg/L NOi i NO,as N 630 mg/L Pb-Lead 46564 ug/L
Chloride 940 mg/L P:Total as P 665 mg/L Se-Selenium ug/L
Chromium:Hex 1032 ug/L ZnZi-ic 46567 ug/L
Color:True 80 cu LAB U
Cyanide 720 mg/L perature on arrival:
Lab Comments —_--_ —__— -----------------
GW54 REV.12/87 For Dissolved Analysis-submit filtered sample and write"DtS'in block. AUG 16 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
SAMPLETYPE AS MPLEPRIORITY
County-- �GNJc iw_ � • RrOater Q-Routine LabNumber__JI V 0 z a.
Quad No_______ Serial No.____ ❑ Soil ❑ Emeraenov Date Received Time: 1 _
❑ ,C �
Lat. Long._ ___ Other - - N� Rec'd By: G w�' From:Bus,Courier and
❑Chain of Custody Other:
Report To: R®FRO, MRO, RRO,WaRO,WiRO, Data Entry By: Ck:_IOy�J/L
WSRO,Kinston FO,Fed.Trust,Central Off.,Other:__ Data
Reported:_Q
Shipped by:Bus,Courier,Hand Del.,Other:_ _ Purpose: n
Collector(s):___()A,4,OS-sJ _ Date O 1 [e'uime_Tj:sy Baseline,Complaint,Compliance,LUST, Pesticide Study,Federal Trust,Other: Y.�^�
FIELD ANALYSES Owner__-- kj"' C-� al -ac*k Sod
pH 4o0_......—_--__ Spec.Condae ___at 29C Location or Site_____ �� �__�evst- i-
Tempao_____ aC Odor Description of sampling point__ c
Appearance_____--_—__ Sampling Method___
Field Analysis By:___ Remarks----
-ABORATORY ANALYSE,5 (PurnD�ng tlme,airterrp..Nc)
Boo 310 mg/L Diss.Solids 70300 mg/L Ag-Silver 46566 ug/L Organochlonne Pesticides
COD High 340 mg/L Fluoride 951 mg/L AI-Aluminum 46557 ug/L Organophosphorus Pesticides
COD Low 335 mg/L Hardness:Total 900 ni As-Arsenic 46551 ug/L Nitrogen Pesticides
Colirorm:MF Fecal 31616 .G /100ml Hardness(non-carb 902 mg/L Ba-Barlum 46558 u /L Acid Herbicides
Coliform:MF Total 31504 < Mooml Phenols 32730 ug/I Ca-Calcium 46552 mg/L PCBs
TOC mg/L Specific Cond.95 uMhos/cm Cd-Cadmium 46559 ug/L
Turbidity 76 NTIJ Sulfate 945 mg/L Cr-Chromium 46559 u /L
Residue,Suspended 530 mg/L Sulfide 745 mg/L CuCopper 46562 ug/L
Fedron 46563 uglL Semivolable Organics
Oil and Grease mg/L Hg-Mercury 71900 ug/L TPH-Diesel Range
pH 403 units K-Potassium 46555 mg/L
Alkalinity to pH 4.5 410 mg/L Mg-Magnesium 46554 m /L
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 ug/L Volatile Organics(VOA bottle)
Carbonate 445 mg/L NHS as N 610 mg/L Na-Sodium 46556 mg/L TPH-Gasoline Range
Bicarbonate 440 mg/L TKN as N 625 mg/L Ni-Nickel ug/L TPH-STEX Gasoline Range
Carbon dioxide 405 mg/L NOi+Nq as N 630 mg/L Pb-Lead 46564 ug/L
Chloride 940 mg/L P-Total as P 665 mg/L Se Selenium ug/L
Chromium:Hex 1032 ug/L Zn-Zinc 46567 ug/L
Color:True 80 CU LAB USE ONLY
Cyanide 720 mglL Temperature on arrival:
Lab Comments _
GW-54 REV.12187 For Dissolved Analysis-submit filtered sample and write'DIS°In black.
AUG 16 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

�0F W A rF90 Michael F.Easley
O G Governor
'Y y William G. Ross,Jr.,Secretary
r North Carolina Department 11,14mriment and Natural Resources
� 1
Y Alan W. Klimek,P.E.,Director
Division of Water Quality
Asheville Regional Office
To: Mark Pritzl, UIC Group, Central Office
Date: August 14, zooz
From: G. Landon Davidson, A Of
Re.: WI0I00002 - Harold Johnson, Henderson County
Attached you will find the completed facility inspection report (form B) for renewal of the
subject permit. I've also attached GW-t forms for the wells associated with the subject
permit. Samples were collected on August 13, zooz and submitted to the lab on the morning
of August 14, 2002. I'll email you with the assigned lab numbers for the samples upon my
receipt. Digital photos are available for the site and wells upon request. No violations were
noted with inspection of the geothermal injection system. Please call if you have questions.
Fri
Groundwater Section,59 Woodfin Place Asheville, N.C. 28801-2414 Telephone: [phone] Customer Service
Fax: 828125"452 1-800-623-7748

INJECTION FACILITY INSPECTION REPORT-FORM B(CONTINUED)
WELL CONSTRUCTION '
Date constructed 7 . t S 3
Drilling contractor:Name G ON I-o �+_L !
Address 3S� _ Leica_C-M2 kwy .
prS",'yiu<' NG Z-bcl o - ZO`14,
Certification number 2 14 0
Total depth of well -44 Total depth of source well .2-ZS
(if applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth
Diameter Co '44 '
Height(A.L.S.) 3 '
Grout
Depth 2y
Screens
Depth(s) _
Length(s) —
I.D. Plate
Static water level
Well yield
Enclosure
Enclosure floor _
(concrete)
Sampling port P-
(labeled)
Water tight pipe entry
Well enclosure entry
Vent c�
Functi
o
ning of heat pump system (Determinefrom the owner ifheat pump functions properly.)
Igo (4POa.:e� PQo��MS
INSPECTOR Cam , t�a�.os Office •Agz>
WITNESS 4 Ai0o 0 Address 5 t Mft.CA ^ )
WITNESS Address
Ver.3/01 GW/UIG2

North Carolina Department of Environment and Natural.Resources
Division of Water Quality- Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. W 1 b DATE 0 2—
NAME OF OWNER HAgcc J 0 4NSo�j
ADDRESS OF OWNER
—,4o�z s6rv'v,�Lc tVc- Zs93�
(Street/road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable)
(Street)road or lot and subdivision, county, town, if different than owner's address,plus description of location on site)
Potential pollution source �J Distance from well
Potential pollution source Distance from well
Potential pollution source Distance from well
Minimum distance of well from property boundary 2 Z yo s
Quality of drainage at site Goon Flooding potential of site
(good,adequate,poor) (high,moderate,low)
GPS Data: 3 S. 3 i `I 46n1 w
Srz.sz ;,3c�3
Latitude: rgs: 3s• 3 zoo Z3 9 N Longitude: ?2 •SZ 0,4�s`l
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells,potential pollution sources, roads, approximate scale, a
north arrow.)
�2
�2-
K,>D't
wc"LL
I 1 E{c ate
0 Sr12�,v �cLl
DESCRIBE INJECTION SYSTEM (vertical closed loop, uncased borehole or cased water well;separate source well and
injection well; combination source and injection well; or other description as applicable)
5cPh¢FTF seuku� r4N� JiN tllOrl [„t�,L t c�a,t - sYSTF'M--•
Ver.3/01 GW/UIC-2

NORTH CAROUNA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT -
DIVISION OF ENVIRONMENTAL MANAGEMENT-GROUNDWATER SECTION FOR OFFICE USE ONLY
P.O.BOX 27987-RALEGHN.C.27e11,PHONE[phone] Quad.NoAQG b! :. -Serial No. 3pp
PC
WELL CONSTRUCTION RECORD Minor Basle
Basin Code
Header Ent. GW-1 Ent.
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER — 9 STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the locatiorr below)
t Nearest•Town: County:
(Road, Community. or Subdivision/and Lot No'.)
Depth DRILLING LOG
2. OWNER zL �r ``�* _. From To Formation Description
ADDRESS mo.
or to No��
City or Town State
Zip Code .,_ . .: _.:..... .
3. DATE DRILLED
USE OF WELL.
4. TOTAL DEPTH /5� CUTTINGS COLLECTED Elyse ❑ No
5. DOES WELL REPLACE EXISTING WEL Yes [I No
6. STATIC WATER LEVEL: FT. ❑ above TOP OF CASING,
TOP OF CASING IS FT. Abelow
BOVE LAND SURFACE. - p.----
,.. .___..
7.'YIELD. (gpm): _/— METHOD OF TEST '
S. WATER ZONES (depth):
9. CHLORINATION: Type Amount
10. CASIN,G- I -..
' Wall Thickness It additional space is needed use back of form.
Depth Diameter or Weight/Ft. Material
From ��To /7ZS Ft,_ L/1-7 j ,y S u, ' ' LOCATION SKEW . ._. _
—T (Shaw direction and distance from at least two State Roads,
From To Ft. or other map reference points) -
From To Ft.
11. GROUT:
Depth Material thod
From To Ft..
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
13..GRAVEL PACK:
Depth Size Material
From To Ft. '
From To Ft.
4. REMARKS: //�� .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS gUCT NNN"•"•"•,,,��,��h���/�rpppe�CCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION,.,.
STANDARDS, AND THAT A COPY OF THIS RECO D �E �����THl OWNER.
.*.
NATURE DOFF CONTRACTOROROR AGENT : DATE.
GW-1 RevisedV 11/84 — _---- Submit original to Division of Environmental Management and copy to well owner.

. _ yam; :,�:L•r:._ ;
NORTH'CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT,; �•
DFOR OFFICE USE ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT-GROUNDWATER SECTION.
H, /
P.O.BOX 27887-RALEIGN.C_27011,PHONE[phone] ; Quad.No. A 5?(a 7 Serial No. 3022
.. - Lat. 3 5 01 4' I 1" •`Lon g•$2o31'19" Pc_
Minor Basin
WELL CONSTRUCTION RECORD Basin code
Header Ent, - GW-1 Ent,
DRILLING CONTRACTOR
STATE WELL CONSTRUCTION '
DRILLER REGISTRATION NUMBER PERMIT NUMBER: '
1. WELL•LOCATION: (S w sket h of the to on'below) -
/CJ/y'
Nearest Town: /�3���-�i/J�/V � .County: i�� �•�/�zJZ� .
Depth DRILLING LOG
(Road, Communjty,or�division and Lot .
h� From. To Formation Description.
2: OWNER ��
ADDRESS'' .
S rest or -
��GGGLf /.
.. - Cit or own State Zip Code _
3. DATE DRILLED USE OF WELL.
4. TOTAL DEPTH CUTTINGS COLLECTED [I Yes ❑ No
5. DOES WELL.REPLACE EXISTING 4yELL1 [I Yes El No
6. STATIC WATER LEVEL: �G (J FT. ❑ above. TOP OF CASING,
❑ below 7 1 i 7 7)
TOP OF CASING IS FT. ABOVE LAND SU FACE.
7.'YIELD (gpm): METHOD OF TEST _ _
8. WATER ZONES (depth): - -
9. CHLORINATION: Type 'n� Amount
10. CASING:
Wall Thickness If additional space' s needed use back of form.
Depth Diameter or Weight/Ft. is
LOCATION SKETCH
From V ToT Ft. l ��- �. (Show direction and distance from at least two State Roads,
From To Ft. ( or other map reference points)
From To Ft.
11. GROUT:
Depth Material /y1 od
! From "` To be-1)
From To - Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. ' in. in.
From To Ft. in. in.
From To Ft. in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS ICONSTRUC E ACCORDANCE WITH 5 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECOR9-f�j4'St�EE/ OVIDED TO THE dWE O ER. . .
fGATURCOFPWAAtTOR"15IR AGENT DATE
GW-1 Revised 11/84 Siginal to Division of Environmental Management and copy to well owner.

NORTH CARO INA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT FOR OFFICE USE ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT-GROUNDWATER SECTION
P.O.BOX 27587-RALEIGH,NC.27611.PHONE[phone] Quad. No. Q8�° 6 7 Serial NO,, 3de
�ow ,^Ory av MinorBa14`fl" Long.. z°31`1 PC_
L,f)It�O7J �•/0�(jl/ Minor Basin
WELL CONSTRUCTION RECO Basin Code
�1 Header Ent. GW-1 Ent
DRILLING CONTRACTOR �r Zd!f't 'A-
DRILLER REGISTRATION NUMBER 99 STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
/-
Nearest Town: County:
% aA , AA" Fla �is fa� Depth DRILLING LOG
(Road, 66mmunity. or Subdivision and Lot No.) From To Formation Description
2. OWNER -���� -/r�o�+'sr g9/—gGdO
ADDRESS SDI—F
1.6treet or Route No.
City or Town State Zip Cod
3. DATE DRILLED 1983 USE OF WELL. I if�j_Pt 44nn _
4. TOTAL DEPTH '40S CUTTINGS COLLECTED ❑Yes C o _
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes 8 No
o STATIC WATER LEVEL: FT. ❑ above TOP OF CASING,
❑ below
TOP OF CASING IS FT. ABOVE LAND SURFACE.
7. YIELD (gpm): NIA METHOD OF TEST
S. WATER ZONES (depth): (Y./K
9. CHLORINATION: Type ij A/K Amount
10. CASING:
Wall Thickness If additional space is needed use back of form.
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From To (1 s Ft. <° " . 14l (Show direction and distance from at least two State Roads, 1
From To Ft. or map rqpppe 1 1 ts) // 1
From To Ft. �7 t0
11. GROUT:
Depth Material Method
From 0 To 20 Ft: C?+'Hz .t
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. Q ��Q� OikUr yq�a
From To Ft. in. in. ,(0IN
From To Ft. in. in.
13. GRAVEL PACK: �\N���y� 'lS•�DDC,O�
Depth Size Material � t9( '.0 I' \
From To Ft. P �n v't06 1..5
From To 'Ft.
14. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 Revised 11/84 Submit original to Division of Environmental Management and copy to well owner.

p E C E
DIVISION OF WATER QUALITY JUL 1 = - -
GROUNDWATER SECTION GROUNDWATER SECTION
July 11, 2002 ASHEVILLE REO:ONAL OFFICE
MEMORANDUM
To: Landon Davidson, L.G., Regional Groundwater Supervisor
Groundwater Section
Asheville Regional Office
From: Mark Pritzl W . Mark.Pritzl&cmail.net
Hydrogeological Technician H
Underground Injection Control Group (UIC)
Central Office (CO)
Re: Permit renewal#WI0100002 under Herold E. Johnson; request for inspection and
routine sampling of Mr. Johnson's geothermal injection well system. This system is
located at 115 Kindy Forest Drive,Hendersonville,NC 28739.
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your UIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title 15A 2C .0200 standards are being complied
with, using the enclosed Injection Facility Inspection Report (form B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
You are requested to return the completed hjection Facility Inspection Report (form B) to the
CO-UIC by July 31, 2002. If the inspection can not be accomplished by this date,please
inform the CO-UIC. The UIC group greatly appreciates Asheville Regional Office's
assistance with this review. If you have any questions regarding this review or the UIC
program,please contact me at [phone].
cc: CO-LJIC Files
Enclosures

• lfiATF Michael F.Easley,Governor
\O�0 RQG D William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
r Alan W.Klimek,P.E.Director
Division of Water Quality
O Y
July 2, 2002
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
Dear Mr. Johnson:
Our records show that the operating permit for the injection well on yourproperty did expire on June
30, 2002. In addition, our records do not indicate that the well has been abandoned.
In order to comply with the regulatory requirements forpermitted injection facilities(15A NCAC 2C
.0211),you must submit either 1)the enclosed Application forPermit Renewal to Use a Wells)for
Injection with a Heat Pump System (form GW-57 HPR) if you are still using your injection well or
2)the enclosed Status oflnjection Well System (form GW-68)that certifies that the injection well is
no longer in use.
If the well is no longer to be used for any purpose, it must be permanently abandoned according to
the regulatory requirements (15A NCAC 2C .0213), and you must submit the enclosed Well
Abandonment Record(form GW-30). The appropriate form(s)should be forwarded to us by July 31,
2002 to allow adequate time for well water sampling and analysis.
If you have any questions regarding the permit and injection well rules or would like assistance
completing these forms please contact Mark Pritzl at [phone] or Evan Kane at (919) 715-
6165.
Sincerely,
De ra Watts
Permits &Compliance Supervisor
cc: CO-UIC Files
Enclosures
Customer Service Division of Water Quality / Groundwater Section
1 800 623-7748 1636 Mail Service Center Raleigh,NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

Michael F.Easley,Governor
\OBOE W ATF9vG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
r Alan W. Klimek,P.E.Director
>_ Division of Water Quality
O Y
July 10, 2002'
Mr. Harold Johnson
115 Kindy Forest Drive
Hendersonville,NC 28739
Dear Mr. Johnson;
Your application for renewal of a permit to use a well for the injection of geothermal
heat pump effluent has been received and is under review. The Groundwater Section
appreciates your timely response to our written inquiry about the status of your geothermal heat
pump system. A member of the Groundwater Section's Asheville Regional Office staff will be
contacting you to arrange an inspection of the injection well and collect water samples as part of
the review.
If you have any questions regarding permit or injection well rules please contact Mark
Pritzl at [phone].
Sincerely, /\
f,
Evan 0. Kane
UIC Program Manager
cc: CO-UIC Files
ARO-UIC Files
N;*ENR
Customer Service Division of Water Quality / Groundwater Section
1 800 623-7748 1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us

A
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT,HEALTH,AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH
A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 15A:02C.0200
complete application and mail to address on the back page.
TO: DIRECTOR,NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: ,C Td(,y _,20_0�
A. SYSTEM CLASSIFICATION: Does the system re-circulate only potable water without any additives such as
corrosion inhibitors or antifreezes in continuous piping which isolates the fluid from the environment?
YES _ If yes,do not complete this form A form GW-57 CL, (Notification Of Intent To Construct A,
Closed-Loop Geothermal-Water-Only Injection Well System),should be completed. p o
N n�
NO If no,then continue completing this form. c
r
B. PERMIT APPLICANT
Name: '�k 6
Address: O i e—' �i /] o a
City: SO State: � Zip code: 2 op % c
County: Telephone: r— ,f to D6�7
C. PROPERTY OWNER(if different from applicant)
Name:
Address:
City: State: Zip code:
County: Telephone:
D. STATUS OF APPLICANT
Private:X Federal: Commercial: State: Public:
Native American Lands:
E. FACILITY(SITE)DATA(Fill out ONLY if the Status of Owner is Federal, State,Public or Commercial).
Name of Business or Facility:
Address:
City: State: Zip code:
County: Telephone: Contact Person:
Standard Industrial Codes)which descn3e commercial facility:
ver.3/01 GWIUIC-57 HPR Page.1 of 3

F. INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection pennit)
G. WELL USE Is(are)the injection well(s)also used as the supply well(s)for either of the following?
(1) The injection operation? YES_— NO
(2) Your personal consumption? YES NOS_
H. CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
r1 DNS
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the petmittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering heat pump) and
effluent(water being injected into the well) lines is required. Is there a faucet on:
(a) the influent line? yes X- no_
(b) on the effluent line? yes no_
I. CURRENT OPERATING DATA
(1) Injection rate: Average(daily) 15� gallons per minute(gpm)
2
Gtf/f�N /.tl O�,epi�
(2) Injection volume: Average(daily) K
/ gallons per day(gpd)
(3) Injection pressure: Average(daily) pounds per square inch(psi)
(4) Injection temperature: Annual Average degrees Fahrenheit(°F) O Y a N ei`' e�epL+rjG
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the issuance of the previous injection
permit including the engineering layout of the (1) injection equipment, and(2) exterior piping/tubing associated
with the injection operation. The manufacturer's brochure, if detailed,should satisfy(1).
K. LOCATION OF WELL(S)Attach a map
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
ground-source heat pump well system; include buildings,property lines,surface water bodies, any other potential
sources of groundwater contamination. Label all features clearly and include a north arrow to indicate
orientation. --A 1ffleNT9
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
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
vec3/01 GW/UIC-57 HPR Page 2 of 3

M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment,fluid,operation,etc.)that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
fJ
N. 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 operate, maintain, repair, and if applicable, abandon the injection well
and all related appurtenances in accordance with the approved specifications and conditions of the Permit."
(Signatur7ff
1 Owner or Authorized Agent)
horized agent is acting on behalfojthe well owner,
please supply a letter signed by the owner
authorizing the above agent.
0. CONSENT OF PROPERTY OWNER(Owner means any person who holds the fee or other property rights in the
well(s). 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 applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s)as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC
Subchapter 2C.0200)
(Signature of Property Owner if Different From Applicant)
Please retum the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
(Telephone: [phone])
ver.3/01 GW/UIC-57 HPR Page 3 of

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' NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY, GROUNDWATER SECTION
STATUS OF INJECTION WELL SYSTEM
Date:
Jdlg d Z Permit Number:
Name: j
Address: ( S �1�yy �fJ/J�'sY `//L ✓�
Please check the selection which most closely describes the current status of your injection well.
In addition, please provide the requested information.
1) �C Well is still used for injection activities.
2) _ Well is used for water supply.
3) _ Injection discontinued;
a) _Well temporarily abandoned b)_ Well permanently abandoned
Describe the method used to properly abandon the injection well. (Include a description of how the well
was sealed and the type of material used to fill the well if permanently abandoned): If you checked two
(2), report the pumping rate and what the water is used for.
Certification: (For well abandonment)
"I hereby certify, under penalty of law,that I am personally responsible for the proper abandonment
of any injection weii as required in Title 15A NCAC 2C.0214 Criteria and Standards Applicable to Injection
Wells."
(Signature)
c
Certification: (For information verification) ,may
"I hereby certify, under penalty of law, that I have personally examined and am farrLar with.the
information submitted in this document, and that to the best of my knowledge the informgon� rue,
accurate, and complete." o _G
(Signature) o �;-
CJ
� G
ver.3101 GW/U I C-68

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ASHEVILLE REGIONAL OFFICE

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