WI0100047_Complete File - Historical_20220308

A
NC©ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
October 24,2011
Phil and Amy Donehower CCT " 1 2U 1
12 Apgar Rd.
Candler,NC 28715
Ref: Issuance of Injection Well Permit W10100047
Issued to Phil and Amy Donehower
Candler,Buncombe County
Dear Mr.and Mrs.Donehower:
In accordance with the application received on October 10, 2011, I am forwarding permit number WI0100047 for
the continued operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system located at
the above referenced address. This permit shall be effective from the date of issuance until September 30, 2016,
and shall be subject to the conditions and limitations stated therein.
Please be advised,in the event there are multiple wells with separate clusters, one well identification tag per
`cluster' of wells should be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location.
Also, please pay special attention to Part V.2. The Permittee shall retain all records of repairs, pressure
tests,maintenance,and other activities needed to maintain normal operating conditions.
hi order to continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an
application to renew the permit 120 days prior to its expiration date. This permit is not transferable to any person
without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at(919) 715-6166 or michael.roeers(a,ncdenr.gov if you have any questions about your permit.
Best Regards,
Michael Rogers,P.G. (NC FL)
cc: Landon Davidson, Asheville Regional Office
WI0100047 Permit File
Buncombe County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636 .
Location:2728 Capital Boulevard,Raleigh.North Carolina 27604 One
Phone:[phone] FAX L 919-715-058B:FAX 2:919-715-6048 t Customer Service:1-877-623-6748 North Carolina
Internet www.nc6vateruualo.org
An Equal Cxponunnv k Afinnat-ve Actwn Empbyer Naturally

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
Phil and Amy Donehower
FOR THE CONTINUED OPERATION OF TYPE 5QM INJECTION WELL(S), defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed-loop
geothermal-mixed-fluid heat pump system. This system is located at 12 Apgar Rd., Candler,Buncombe
County,NC 28715, and will be constructed and operated in accordance with the application received October
10, 2011, and in conformity with the specifications and supporting data submitted, all of which are filed with
the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for operation of an injection well and shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until September 30, 2016, and shall
be subject to the specified conditions and limitations set forth in Parts I through VII hereof.
Permit issued this the 24t'day of October 2011.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0100047 UIC/5QM-M.F.Renewal Page 1 of 4
Version 1/2010

;l
PART I—OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to., and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as 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.
4. In the event that there are multiple wells with separate clusters, one well identification tag per `cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
PART 11—PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART III—OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
WI010004 i U105QM-M.F.Renewal Page 2 of
Version 1/2010

G `
PART,IV-INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N'.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
`'PART V—MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall retain all records of repairs, pressure tests, maintenance, and other activities
needed to maintain normal operating conditions.
3. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the 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;
4. 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.
5. 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 VI—PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit,request an extension.
WI0100047 U105QM-M.F.Renewal Page 3 of 4
Version 1/2010

rf
PART VII—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.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottomof 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 VII (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
WL0100047 UTC/5QM-M.F.Renewal Page 4 of 4
Version 1/2010

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Duality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
October 3, 2011
Phil Donehower
12 Apgar Road
Candler,NC 28715
Subject: Notice of Expiration (NOE)
5QM Geothermal Injection Well
Permit No. WI0100047
Buncombe County
Dear Mr. Donehower:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for
the underground injection well system located on your property at 12 Apgar Road, in Candler,
NC, which was issued to you on March 9, 2007, and expires on February 29, 2012, is soon due
for renewal. If you wish to keep this permit and operate the injection well system, the permit
must be renewed and issued in your name.
If Your Iniection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 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.nodenr.ora/web/wq/aps/g_Epro/reoortine-forms.
If Your Injection 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 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by November 1, 2011.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ra"Ir,North Carolina 27699-1636
Location:2728 Capital Boulevard.Rapgh.North Carolina 27604
Phone:[phone] FAX 1:919-715-0588:FAX 2:919-715-6048 t Customer Service:1-877-62M748 NortYlCarolina
interne.www rimateroualhv.orc
An Equal Gooa'vnm APomanve gCroar cmpoye Naturally

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 Wells)for Injection with
Geothermal Heat Pump System for Type 5QM Well(s) if the injection well system on
your property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
http://Portal.nedenr.ore/web/wq/aps/vwl)ro/permit-applications#geotherinArys.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at eric.e.smith(iuncdenr.eov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - APS w/o enclosures
APS Central Files - Permit No. WI0100047 w/o enclosures

V�\� `1 y Michael F.Easley,Governor o
r C". William G.Ross Jr.,Secretary
7 North Carolina Department of Environment and Natural Resources
ti
Alan W.Klimek,P.E.Director
Division of Water Quality
March 9, 2007
Phil Donehower
12 Apgar Road
Candler,NC 28715 RECEIVE D
Re: Issuance of Injection Well Permit 1 9
Permit No.W10100047 MAR
Issued to Phil Donehower tonal Office
Asheville Reg'
Dear Mr. Donehower: A urfer Protection
In accordance with your application received February 7, 2007, I am forwarding Permit No.
W10100047 for the operation of a vertical closed-loop geothermal mixed-fluid heat pump
injection well system to be located at 12 Apgar Road, Candler, Buncombe County, North
Carolina 28715. This permit shall be effective from the date of issuance until February 29, 2012,
and shall be subject to the conditions and limitations stated therein.
Pay special attention to the well construction standards in Parts 11 and V of your permit.
You must notify this office (Raleigh Central Office) and the Asheville Regional Office at least
forty-eight (48) hours prior to constructing the system, and forty-eight (48) hours prior to
initiation of the operation of the system.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit three months prior to its expiration date. As indicated in the
permit, this permit is not transferable to any person without prior notice to, and approval by, the
Director of the Division of Water Quality. If you have any questions regarding your permit or
the Underground Injection Control Program please call Mr. Qu Qi at [phone] or me at
[phone].
Best�Reeg�ar(d�s,
Michael Rogers
Hydrogeological Technician II
cc: Landon Davidson—Asheville Regional Office
Central Office File—WI0100047
Andrew Messer—Effects Solutions
Attachment(s) p�i ON tthn
NivX rrtlb�
Carolm
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:httn//v .ncwateroualimore 2728 Capital Boulevard Raleigh,NC 27604 Fax 1: [phone]
Fax 2: (919)7t5-6048
An Equal GpportunitylAlPomative Action Employer-50%Recycled110%Post Consumer Paper Customer Service: [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH,NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other
applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
PHIL DONEHOWER
FOR THE CONSTRUCTION AND OPERATION OF 10 TYPE 5QM INJECTION WELLS,
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed-loop geothermal-mixed-fluid heat pump
system. This system is located at 12 Apgar Road, Candler, Buncombe County, North Carolina,
and will be constructed and operated in accordance with the application received February 7,
2007, and in conformity with the specifications and supporting data submitted, all of which are
filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Construction and Operation 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 February 29,
2012, and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof.
d'^
Permit issued this the day of Y'nunsA--� 2007.
Alan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No.WI0100047 Page 2

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'Construetion Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. 'Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to: DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff, 1636
Mail Service Center, Raleigh, NC 27699-1636, within 30 days of completion-of well
construction.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the Permittee or his agent shall test the pH of
the soil at a depth of three feet at the planned well,location. If the resulting soil pH is less
than 6 standard units or greater than 11 standard units,-the well system shall be equipped with
a compatible cathodic protection system. All testing results shall be kept on site available for
inspection.
2. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the
Aquifer Protection Section's Underground Injection Control (UIC) Program Central Office
staff, telephone number (919) 71'5-6166 and the Asheville Regional Office Aquifer
Protection Section Staff, telephone number [phone].
3. All underground tubing shall be refrigeration grade copper tubing.
Permit No.W10100047 Page 3

4. Prior to installation, all tubing to be placed in boreholes ("loops") shall be checked for leaks
by pressurizing the loop to a gage pressure of at least 350 pounds per square inch (psig),
immersing the loop in water and examining it for leaks. Loops with leaks shall not be
installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents,
and scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop
by the manufacturer before shipping is still present at a pressure of at least 300 psig. The
loop manufacturer shall be notified in the event of damage or pressure loss, and the
manufacturer's instructions shall then be followed. The nitrogen charge may be released
only when the loop is installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting.
7. After insertion of the tubing into the boreholes, an approved grout.(as defined in Title 15A
North Carolina Administrative Code 2C .0100) shall be pumped via tremie pipe into the
annular space of each borehole so as to completely fill it from bottom to top.
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material
shall have a galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
10. After installation and prior to operation of the system, a.mechanical integrity test shall be
conducted by pressurizing the injection well system to 400 psig with dry nitrogen and
monitoring for leaks using an ultrasonic or other leak detector of equal sensitivity and
monitoring pressure in the system for at least 2 hours. Alternatively, an equivalent vacuum
test is acceptable. Any pressure fluctuation other than that due to thermal expansion and
contraction of the testing medium shall be considered a failed mechanical integrity test. Any
leaks shall be located and repaired prior to charging the system with refrigerant. A cony of
the post-installation pressure or vacuum test record (initial pressure reading, final pressure
readine, and the duration of the test) shall be submitted to the Aquifer Protection Section.
The test records must be received by the Aquifer Protection Section at least twenty-four (24)
hours prior to the initiation of the operation of the facility for iniection.
11. The location of each of the system manifolds shall be recorded by triangulation from two
permanent features on the site (e.g.,building foundation corners). The Permittee shall retain a
copy of the triangulation records. The Penmittee shall also submit a copy of the triangulation
records to the Aquifer Protection Section within 30 days of completion of well construction.
12. The written documentation required in Part II paragraphs (10) and (11) shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
Permit No.WI0100047 Page

PART III- OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater that will render it unsatisfactory for normal use. In the
event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V- OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section's
Underground Injection Control (UIC) Program Central Office staff, telephone number
(919) 715-6166, and the Asheville Regional Office Aquifer Protection Section Staff,
telephone number [phone]. Notification is required so that Division staff can
Permit No.WI0100047 Page 5

inspect or otherwise review the injection facility and determine if it is in compliance with
permit conditions.
PART VI-INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VII-MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring ' (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the 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;
(C) Any loss of refrigerant in the system,regardless of the origin of the loss.;
(D) Any recharging of the refrigerant system.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to the
Director, the relevant and correct facts or information shall be promptly submitted to the
Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
Permit No.WI0100047 Page 6

PART VIH-PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit,request an
extension.
PART IX- CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the-Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(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.
(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.,
Permit No.WI0100047 Page 7

(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 IX (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
Permit No.WI0100047 Page 8

Compliance Inspection Report
Permit: WI0100047 Effective: Expiration: Owner: Phil Donehower
SOC: IEffective: Expiration: Facility: Phil Donehower SFR
County: Buncombe 12 Apgar Rd
Region: Asheville
Candler NC 28715
Contact Person: Phil Donehower Phone:
Directions to Facility:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits: /
Inspection Date: 0 2121/2 0 0 7 Entry Time: 01:30 PM Exit Time: 02:00 PM
Primary Inspector: Harold E Minnick Phone:828-296A500
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type:Compliance Evaluation
Permit Inspection Type: Injection Mixed Fluid GSHP Well System(5QM)
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
Other
(See attachment summary)
Page: 1

i
Permit:WI0100047 Owner-Facility: Phil Donehower
Inspection Date: 02/21/2007 Inspection Type:Compliance Evaluation Reason for Visit:Routine
Inspection Summary:
Other Yes No NA NE ,
Comment:
Page: 2

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 4'tC';C1 I County: +c
To: Aquifer Protection Section Central Office Permittee: ; +'tNc vex
Central Office Reviewer: Project Name:
Regional Login No: Application No.: Wr C 1 000 47
I. GENERAL INFORMATION
1. This application is(check all that apply): [.New ❑ Renewal
❑ Minor Modification❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed-loop Groundwater Remediation X Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ®Yes or❑No.
a. Date of site visit: Zcc10 Z L/ C 3?d-/dot)
b. Person contacted and contact information: ow,,;V-4
c. Site visit conducted by:._20rr/
d. Inspection Report Attached: (RYes or❑No.
2. Is the following information entered into the BIMS record for this application correct?
XYes or❑No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number: _
d. Latitude: Longitude: _
e. Regulated Activities/Type of Wastes (e.g., subdivision,food processing, municipal wastewater):
For Disposal and Infection Sites:
If multiple sites either indicate which sites the information applies to copy and paste a new section into the
document for each site,or attach additional pages for each site)
a. Location(s): 12 t1PC,A�tZ� u�tEt1 tiG Zb"715
b. Driving Directions: t)S i 4-Z3 ct c.'J "Ic is-1 iNa's "r A,vCAQ
c. USGS Quadrangle Map name and number: ac"?� R- Gc no t�wJ
d. Latitude: 4.462i 2- Longitude: 'L,7W S
H NEW AND MAJOR MODIFICATIONAPPLICATIONS this section not needed for renewals or minor
modiTcations, skin to next section)
Description Of Waste(S)And Facilities
1. Please attach completed rating sheet. Facility Classification: /
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: Documentl I

5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
❑Yes ❑No SN/A. If no,please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? Z Yes ❑No ❑N/A. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? 7j]
Yes❑No❑N/A. If no, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑ No
N/A. If no,please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
❑ Yes ❑No [KN/A. If no, please explain: ,
7. Are the new treatment facilities or any new disposal sites located in a I00-year floodplain?
❑ Yes ❑No ® N/A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV:
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? ❑ Yes or®,No. If yes,please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit:
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? ❑ Yes ❑ No ®.N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program:
10. For 'residuals, will seasonal or other restrictions be required? ❑ Yes ❑No t N/A If yes, attach list of sites
with restrictions (Certification B?)
III RENEWAL AND MODIFICATIONA'PPLICATIONS (use previous section for new or major modification
systems)
Description Of Waste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? ❑Yes or❑No.
Operator in Charge: _ Certificate#:_
Backup-Operator in Charge: _ Certificate
2. Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) 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 (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste?❑Yes or❑No. If no, please explain:
Fr)RM" rincumentl 2

` AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain:
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
❑ Yes or❑No. If no,please explain:
6. Are the existing application rates (hydraulic or nutrient) still acceptable? ❑ Yes or ❑ No. If no, please
explain:
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ❑ N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Will seasonal or other restrictions be required for added sites? ❑ Yes ❑No ❑N/A If yes, attach list of sites
with restrictions (Certification 13?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? ❑ Yes or ❑ No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit:
10. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? ❑
Yes or❑No. If no, please explain:
11. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ❑ N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? ❑ Yes or
❑ No ❑ N/A. Please summarize any findings resulting from this review:
13. Check all that apply: ❑ No compliance issues; ❑ Notice(s) of violation within the last permit cycle; ❑
Current enforcement action(s) ❑ Currently under SOC; ❑ Currently under JOC; ❑ Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV,NOD etc):
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? ❑ Yes
❑No ❑.Not Determined ❑N/A.. If no, please explain:
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? ❑
Yes or❑No ❑ N/A. If yes,please explain:
FORM: Documentl 3

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PE&VITAPPLICATIONS(Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells,and heat
pump injection wells.)
Description Of Well(S) And Facilities—New Renewal And Modification
1. Type of injection system:
❑ Heating/cooling water return flow(5A7)
Closed-loop heat pump system(5QM/5QW)
❑In sitzi remediation(5I)
❑ Closed-loop groundwater remediation effluent injection(5L/"Non-Discharge")
❑ Other(Specify:
2. Does system use same well for water source and injection? ❑ Yes [RNo
3. Are there any potential pollution sources that may affect injection? ❑ Yes - X No
What is/are the pollution source(s)? What is the distance of the injection well(s)from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? Jdb ft.
5. Quality of drainage at site: R Good ❑ Adequate ❑Poor
6. Flooding potential of site: ER 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. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site (property lines,wells,surface drainage)?Q Yes or❑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.
Infection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation(e.g.turbid water,
failure to assimilate injected fluid,poor heating/cooling)?
❑ Yes ❑No. If Yes explain:
2. For closed-loop heat pump systems,has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑No. If yes explain:
3. For renewal or modification of groundwater remediation permits(of any type), will
continued/additional/modified infections have an adverse impact on migration of the plume or management of
the contamination incident? ❑ Yes ❑No. I'ffv—es, explain:
4. Drilling contractor: Name: /' zt

• AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: -Pm- ANaPe=t'I i�IESS��K
Certification number: .3468'
5. Complete and attach Well Construction Data Sheet.
FORM: Documentl 5

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Y. EVALUATIONAND RECOMil'IENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet-if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑Yes ®.No. If yes,please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special.condition:
Condition Reason
7. 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. If deny,please state reasons:
8. Signature of report preparer(s):
C
Signature of APS regional supervisor:
Date: --CZ7 O L Z3
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Documentl 6

COPY
- -�'-
,J AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 'z'26- 2.i
To: Aquifer Protection Section Central Office County: �
Central Office Reviewer:
Permittee: Jt=
611L - NovdEe Regional Login No: Project Name:Application No.: W=o l 00647
I. GENERAL INFORMATION
1. This application is(check all that apply): [RNew [] Renewal
❑Minor Modification❑Major Modification
❑ Surface Irrigation ❑Reuse ❑ Recycle ❑ High Rate hifiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑Attachment B included ❑503 regulated ❑503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed-loop Groundwater Remediation Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ❑ Yes or❑No'.
a. Date of site visit: 2,Xr102-Z1
b. Person contacted and contact information: elwN '
c. Site visit conducted by: r//'
d. Inspection Report Attached: E Yes or❑No.
2. Is the following information entered into the BIMS record for this application correct?
RYes or❑No. If no, please complete the following or indicate that it is correct on.the current application.
For Treatment Facilities:
a. Location:
b. 'Driving Directions: _
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities/Type.of Wastes (e.g.,subdivision, food processing, municipal wastewater):
For Disposal and Injection Sites'
(If multiple sites either indicate which sites the information applies to copv and paste a new section into the
document for each site or attach additional pages for each site
a. Location(s): 1Z ;}AC,fyt �Z� elw-i6y, tiG 74715
b. Driving Directions: USi -23 uc t4pc,v ,fClS/ , i;9. };i,s ege- Cra 2.lY1` ��ny'/�d1r12
c. USGS Quadrangle Map name and number: Bc761- Z- Gc r^o
d. Latitude: 5�'462t2- Longitude: -_8z,r1673 �
II NE}VAND MAJOR MODIFICATIONAPPLICATIONS this section not needed for renewals or minor
modifications, skin to neet section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: Documentl 1
BIZ o I o oo¢q.

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
❑ Yes ❑No aN/A. If no, please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? [SYes ❑No ❑ NIA. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)?
Yes ❑No ❑N/A. If no,please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑No pC
N/A..If no,please explain:
6. Are the proposed application rates for new sites (hydraulic or,nutrient) acceptable? _
❑Yes ❑No [K N/A. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
❑ Yes ❑ No ® N/A. If yes, please attach a map showing areas of 100-ycar floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV:
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? ❑Yes or[KNo. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit:
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? ❑ Yes ❑ No 0 N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program:
10. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑No aN/A If yes, attach list of sites
with restrictions(Certification B?)
III RENEWAL AND MODITICATIONAPPLICATIONS(use previous section for new or major modiTcation
systems)
Description Of Waste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? ❑Yes or❑No.
Operator in Charge: _ Certificate
Backup- Operator in Charge: Certificate#:_
2. Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) 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 (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? ❑Yes or❑No. If no, please explain:
FORM- T)nrnmentl 2 �= Q 1 (�Q¢�

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary,new development, etc.)? If yes, please explain:
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
❑ Yes or❑No. If no,please explain:
6. Are the existing application rates (hydraulic or nutrient) still acceptable? ❑ Yes or ❑ No. If no, please
explain:
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ❑ N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Will seasonal or other restrictions be required for added sites? ❑ Yes ❑No ❑N/A If yes,attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? ❑ Yes or ❑ No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit:
10. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? ❑
Yes or❑No. If no, please explain:
11. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ❑ N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW,NDMR, and NDAR as applicable)? ❑ Yes or
❑ No ❑N/A. Please summarize any findings resulting from this review:
13. Check all that apply: ❑ No compliance issues; ❑ Notice(s) of violation within the last permit cycle; ❑
Current enforcement action(s) ❑ Currently under SOC; ❑ Currently under JOC; ❑ Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments(such as NOV,NOD etc):
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? ❑ Yes
❑ No ❑Not Determined ❑N/A.. If no,please explain:
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? ❑
Yes or❑No ❑N/A. If yes, please explain:
FORM: Documentl 3 �J = OI OOOIyrJ

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS(Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities—New Renewal And Modification
1. Type of injection system:
❑ Heating/cooling water return flow (5A7)
Closed-loop heat pump system(5QM/5QW)
❑In situ remediation(5I)
Closed-loop groundwater remediation effluent injection(K/"Non-Discharge")
❑ Other(Specify:
2. Does system use same well for water source and injection? ❑ Yes [KNo
3. Are there any potential pollution sources that may affect injection? ❑'Yes ' X No
What is/are the pollution source(s)? What is the distance of the injection well(s)from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the propeity boundary? IX) ft.
5. Quality of drainage at site: N Good ❑ Adequate ❑Poor
6. Flooding potential of site: [A'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. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site(property lines,wells,surface drainage)?Q Yes or❑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.
Injection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation(e.g.turbid water,
failure to assimilate injected fluid,poor heating/cooling)?
❑ Yes ❑No. If yes explain:
2. For closed-loop heat pump systems,has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑No. Imes explain:
3. For renewal or modification of groundwater remediation permits (of any type),will
continued/additional/modified iniections have an adverse impact on migration of the plume or management of
the contamination incident? ❑Yes ❑No. Imes explain:
4. Drilling contractor: Name:
rno�x. r, , o ., d WL_ 0 ovo¢7

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address:
CCl/9) 4S�- 3Zj O
Certification number:
5. Complete and attach Well Construction Data Sheet.
FORM: Documentl 5 �� O 100007

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOM;YIENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet- if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes nNo. If yes, please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special.condition:
Condition Reason
7. 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. If deny, please state reasons:
8. Signature of report preparer(s): v �"
G
Signature of APS regional supervisor: y
Date:
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Documentl 6 w,1 OW47

- FILL CUPS
AQUIFER PROTECTION SECTION FEB 16 �Qp7
APPLICATION REVIEW REQUEST FORM
Date: February 15, 2007
To: ® Landon Davidson,ARO-APS ❑ David May, WaRO-APS `
❑ Art Barnhardt, FRO-APS ❑ Charlie Stehman,WiRO-APS
❑ Andrew Pitner, MRO-APS ❑ Sherri Knight,WSRO-APS y
❑ Jay Zimmerman,RRO-APS S
From: Michael Rogers , Groundwater-Protection Unit
i
Telephone: [phone] Fax: f9191715-0588 ;
E-Mail:, Michael.Rogers(a ncmail.net i
i.
k
i
A. Permit Number: N'VI 0100047 t
B. Owner: Phil Donehower
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 (NTD)
M UIC-(5QM) closed loop mixed fluid geothermal
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal w/Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 21 calendar days,please take the following actions:
® Return a Completed APSARR Form.
❑ 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: i ._ ��—� — Date: 456Y 62. )S'
U
FORM: APSARR 07/06 Page 1 of 1

•`h--jdn du u-t u'/:22p nouglae Clark 820-863-8339 p. 1
_
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELL(S)FOR INJECTION WITH A HEAT PUMP SYSTEM
Type SA7 and 5QM Wclb
toAccmdance whh the provisions cfNCAC Title 15A:02CO200
Complete appUcatioa sad mail to addt=on the back page.
TO: DIRECTOR,N RTHCAROLINADIVISIONOFWATERQUALITY
DATE 20b7
A SYSTEM CLASSIFICATION Please check column which imatahes proposed system.
(1) Type 5A7 we113 irgoct water used to provide bating or cooling for s UM1,es.
(2) x Type 5QM wells omm&s Sulmhrfaoe system ofcontinuous plphtg,go is
bowed from the environment and dmpbdm a fluid other then potable water.
This includes syshmm that circulate additives such as antifreezes and/or ce003ion
inhibitors.
(3) Type SQW wells contain a subsiu79ce system of conthtuouv piping,that i3
isolated fmm the environment end only oha later Potable water.If yasi selected
"wen type,then eoetnleh fps UV4Z CL AraMlerdlaa Oflnk&To
Coerhttca A Clmeok,loop G;PWkarP&%&WdW Only Laledmx Well SYswm
IEL PERMITAPPLICANT
Name: OW} hone�,ouier
Address:—LIA R M 121
City Caiis1ar State:A�C 7ipCode:28715 County: &ue+Ca-mL
Telephone: Spl• '717- if 366
C. FROPMTY OWNER Gf different from applicant)
Name:
Address:
City Smote:__ • Zip Cade Caivtty:
Telephone;
REC8VM/VENRr0wa
D. STATUS OF APPLICANT AQUIFER"PROTECTION SECTION
:ptirm x Federal:_ Commercial: FEB U 7 20071
State: ` Municipal: Native American Lands: r
Revised 7/06 OWMIt151 HP Pogo 1 of4
TOOO 011a SSN00 RDalill YVH 80:60 LOOZ/T£/TO

.Tart 30 07 07. 22p 1louglas Clark B2e-sal ^E339 p.2
f .
G. FACILITY(SITE)DATA
(Fill out MLY if the Stams of Owner Is Fedanl,State,Municipal or C nn=rW).
Name of Bombers or Facility:
Address:
City: Zip Code.• County,.
Telepbom: Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: niokey ttitchen
Address; P'O, box 99
City nenroae Zip Code: 207e9 County'Transylvania
Telephoto 028-962-7885 CnjdamperM Rickey xitehea _
0. INIECTION PROCEDURE (Briefly describo how ft ig(ection well(s)will be used.)
tojeotiop walla Ihore holeat will be used as a geothermal heat oink. Geothermal ground
loops will be placed In the temporazy bore holes. rota holes W;LIl he contimwsaly grouted
2.rom the bottom to the top.
H. WELL USE WIII the u&ction well(s)also be used as the supply well(e)for the following?
(1) The injWAion operation? YES NO x
(x} Persorslconsmnption? YES NO, x
1. CONSTRUCMN DATA(check one)
MSTING WELL being proposed for use as an inject(en well.Providethe data in
(1)through(7)below to the best of your knowledge.Attach a copy of Form 6W-
f (Well Construction Record)if available.
x PROPOSTD WELL to be constructed for use as an lyd%don well. Provide the
data in(1)througb(7)below as PROPOSED construction:specificatiotu Submit
FarmGW-1 after construction.
(1) We0 Drilling Coah'aetor's Name.�Eiecea rwlmtloes, tt c - Stephen Keener
NCConlractorCertifleatlodnumber. aaea
(2) Date to be constructed: 3-/ 'D Number of borings: /0 arm
Approximate dopih of eauh baring(feet). 75' ft
(1) Well cashW h the well(s)cased?
(a) YES _ Ifyes,then provide the casing information below.
Type:Galvanlaed stml_Black steel•-, Pia lk Other(specify)
Casing depth: From m�- R(reference to land surface)
Casing extends above ground inches
(b) NO x
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(4) Grout(material surromldhrg well casing mtdJor piping): silica send s
(a) Grout type:Cement x Beptoiute X Other(specify) 'Superplaeticiees
(b) Gwated surface and groat depth(reference to land aurfaoe):
x around closed loop piping;Eton o to n' _(fcat)_
around well casing;from_to._(fed).
(5) Screens(for Type SA7 wells)
(a) Depot:From to_-feet below ground srutice.
(6) - N.C. State Regulationa(Title]$A NCAC 2C.0200)require the'parmitteo to make provisions
for monitoring wellhead pmccrosrs.'A faucet on both Muent(fluid entering heat pump)and
effkmnt(fluid being injected into the well)lines is required. Will them be a faucet on:
(a) the influent line? yes_, no,_,_,., (b) the effluent line? yes_—no
(7) SOURCE WELL CONSTRUCTION INFORbO TIOK(if difremnt from fnjeetion well).
Attach a copy of Porm GW-1 (Well Construction Record). IfFomo GW-1 Is not available,
providc the data in part K(1)of this application form to the bcst,of your knowledge.
r4UM, THEWELLmeal.netcONTRACTORCANVRecYMWVATAFOFMMRsxarmOOR
PROPOM WELLS IF TInS INFORMATION 19 UNAVAILABLE I3Y07MR MEANS,
J. PROPOSED OPERATfNG DATA(for Type SA7 wells)
(1) Injcctionrate: Avamse(daily)_ _gWlmmpermimum(gpm)•
(2) Injection Volume: Average(daily) gallons per daY(SPA
(3) injection Pressure Average(daily).,_poands/squara inch(par).
(4) Injection Temperature: Average(January) °e,Avemge(July)
K. INJECTION FLUID DATA
(1) Fluid source(for Type SA7 walla) If underground,from what depth,fomnationand type of
rocIdsediment unit will the fluid be drawn(e g.,gtanfte,litnestone,send,etc.).
Depth: Fomradan! Rockfoaiioeeat na]R
(2) Chemical Analysis of Source Fluid(for Type SQM wells)
Provide a complete listing of all chemicals added to the chuuMing I=t U=fer fluid:
R-22 Refrigerant
L. IN7i"MON-RELATED,EQUIPMENT
Attach a diagram showlug the engimexring layout of the injection equfpinord and extMior pfpfnghubing
associated with the injection operation. The manufacturer's broaure may provide supplementary
information, .
M. LOCATION OF WELL(S) Attach two maps-,
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(1) ' Include a site map(can be drawn)showiw. bu+ldlop,PWx+ty Keno.surface water bodks;
potarttal morem of gmundws ,e on and the oration of and distances between
the proposed wen(s)Sits any existing wcWs)or waste disposal facilities such es septic tenlm or
drain fields located Within 1000 feat of fha geothermal heat pump Well syrem.. label BE
iestwes clearly end Include a north crow_
(2) Include a topographlp map of dte arm warding one mile from to property beattlarias and
Sndirote the facility's location and the rnmp name.
N. P6RMIT LIST: Much a list of all pamilo or oonsau dOn approvals that are rcldred VD ft Shp-
Examplos include: L
(1) H=mdoasWe=Mengpinwprogtmu pennies under RCRA
(2) NC Division of Water Qatality NoaANSCI+mge permits
(3) Sewage Tsc=e t aud'Disp*W Permits
O. CERTIFICATION
"1 hereby certify, under penalty of IaW,that l hwe petseni ft euwWmd and am familhtr with the
information submitted in this document and all aduc mmuts thmcto and float,based an nW ln4uby of
those Individuals immeduttely xesponside for obtaining avid information,I believathat the information
is lute,amucle and comuplde. I em aware Hwttta=ate significmt penalties cloding inthe possibility
of fhses and irnprisosncmrt,for schoduag MW int'orituntion. 18V=to COROU04 opamte,maintain,
repair,and if applicable,tahandm rho injection well and oil rcWW appnutemaoces in OCCOrdance with
the approved specifications and conditions ofthe Petmit."
•�'
(Sigaasue oP Wetl Owner or Atutboria d Age t}
famdro►isedagma Seale g an 6eb1fQfOm won awmr.
PI&Mm ly a k1mrJowdby dss owner admbftdlo daft aloft
P. CONSENT OF STY OVR4M(Owner morns any parson who holds due fee or other propel'
riglds In the well being constructed, A well is teal property ttnd Its construction on land rests
owmembip is the lasdow=in the absence of contrary aslem tent in writing.)
If the property is owned by sameom other than the%WIWaL the property owner bereby coormts to
allow the applicant to eoastratn each icpactlon well as oa87ned in clots appliedon and that it slstll be
the sespousihirdy of the applicant to emm that pre Medium well(s) confoam to the Well
Conshuction Standmda(Title 19A NCAC 2C.0200)
(tNgmtum OPAoparty owner if Dif&rcat Prom Applicant)
Please wtmn two copies oftht:completed Application padcege to:
UIC Proginsm
Aquifer Pratecliott Section
North Corelloa DENA-DWQ
1636 Mail Service Center
Raleigh,NC 27699-1636
relq&ome(929)715-MS,
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NORTHBUNCOMBE COUNTY, - .
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OF WATF9 Michael F.Easley,Governor
oG
William G.Ross Jr.,Secretary
rNorth Carolina Department of Environment and Natural Resources
1 Alan W.Klimek,P.E.Director
O < Division of Water Duality
February 13,2007
PHIL DONEHOWER
12 APGAR RD
CANDLER NC 28715
Subject: Acknowledgement of Application No. WI0100047
Phil Donehower SFR
Injection Mixed Fluid GSHP Well System(5QM)
Buncombe County
Dear Mr. Donehower:
The Aquifer Protection Section of the Division of Water Quality(the Division) acknowledges receipt of
your permit application and supporting materials on February 7,2007. This application package has been
assigned the number listed above and will be reviewed by Michael Rogers.
1
e
The reviewer will perform a detailed review andcontact yore 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 responsg 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 b phone at(919)715-6166 or by email at
[e-mail]. If the reviewer is unavailable,you may leave a message, and they will
respond promptly. Also note that the Division has reorganized. To review our new organizational chart,
go to http1/h2o enr state nc.us/documents/dwg_orschart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES
ON THIS PROJECT.
Sincerely,
for- Debra . Watts
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit Application File WI0100047
0.
YhCurolina
W"17141
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:www ncwateraualitv.ora Location: 2728 Capital Boulevard Raleigh,NC 27604 Far 2: [phone]
An Equal Opportunty/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper Customer Service: [phone]