WI0100045_Complete File - Historical_20220308

Adja
NCDENR MAR 13 2G,2
North Carolina Department of Environment and Natural esources
Division of Water Quality 19 Regional Office
Beverly Eaves Perdue Charles Wakild,P. E. t�.q lifer Protettl80Ff"man
Governor Director ae ry
March 13, 2012
CERTIFIED MAIL # 7006 2150 0003 54671582
RETURN RECEIPT REQUESTED
Jessie& Cheryl Arredondo
17 Thompson Avenue
Canton,NC 28716
Subject: Notice of Violation with Intent to Enforce (NOV-2012-OP-0004)
5QM Geothermal Injection Well
Permit No. WI0100045
Haywood County
Dear Mr. and Mrs. Arredondo:
This permit was issued for the operation of a 5QM (Closed-Loop Mixed-Fluid) Geothermal
Injection Well on your property located at 17 Thompson Avenue in Canton,North Carolina. Our
records indicate that the referenced permit was issued to Haywood Habitat for Humanity on
March 12, 2007, and expired on February 29, 2012. As the new property owners, you are
responsible for maintaining this permit.
On February 7, 2012, the Aquifer Protection Section sent you Change of Ownership forms and
instructions on how to renew the referenced permit. As of the date of this letter, we have not yet
received a response from you.
Therefore,the following violation(s)exists:
VIOLATION 1:
Operation of your geothermal injection well without a valid permit is a violation of 15A NCAC
02C .0211(a).
REQUIRED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 days of receipt of this letter:
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 27699-1636 One
Location:512 N.Salisbury St,Raleigh,Norm Carolina 27604 NorthCarolina
Phone:[phone] FAX:[phone] Naturally
/
Internet www.ncwateroualiN.oro (/ Y atu`y,Q`l
An Equal Opportunity 1 Affirmative Acton Employer

Submit a Change of Ownership form (enclosed) and submit one of the following enclosed forms
within thirty(30) days of receipt of this letter:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s)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 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 Change of
Ownership, renewal application, and a well system status forms are attached along with a self-
addressed envelope. The above referenced.forms are also available on-line at the DWQ website
at http //portal ncdenr org/web/wq/aps/ayMro/permit-applications#geothermApps.
Thank you in advance.for your cooperation and timely response. If you have any questions,
please contact Eric G. Smith by phone at (919) 807-6407 or by email at
[e-mail].
Sincerely,
Watts, Supervisor
Groundwater Protection Unit
Enclosures
cc: Asheville.Regional Office=Aquifer Protection Section w/o enclosures
APS Central Files—Permit WI0100045 w/o enclosures

17
R7%glonal
NCDENR
Ala+,Iral ,tPA�h A
Beverly Eaves Perdue Charles Wakild, P. E. — Dee Freeman
Governor Director Secretary
February 7,2012
CERTIFIED MAIL#70061300 00001106 5208
RETURN RECEIPT REQUESTED
Federal Home Loan MTG Corp
C/O Citimortgage, Inc.
1000 Technology Drive
O Fallon, Missouri 63368
Subject: Notice of Violation(NOV-2011-OP-0021)Retraction
5QM Geothermal Injection Well
Permit No.WI0100045
Haywood County
To Whom it May Concern:
nn gcpi,,:nK-r IS, 20l1. the North Carolina 17iv;S;nn �f Water Quality's AgliiCer Protection Section
issued a Notice of Violations (NOV-2011-OP-0021) to Federal Home Loan MTG Corp. Based on a
review of our records, this Notice of Violation was sent in error. Therefore, we hereby retract the
referenced Notice of Violations effective immediately. We apologize for any inconvenience this may
have caused. If you have any questions, please call Eric G. Smith at 919-807-6407, or email him at
erie. .sg mithnncdenr.gov.
Sincerely,
n
DebraJ. Watts, Supervisor
Groundwater Protection Unit
Enclosures
cc: Asheville Regional Office-Aquifer Protection Section w/o enclosures
APS Central Files—Permit WI0100045 w/o enclosures
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 27699-1636 One
Location:512 N.Salisbury St.,Raagh,North Carolina 27604 NorthCarohna
Phone:[phone]\FAX:91M07-6496 Naturally
Internet:wwwmwalelnualitv.ora �/Y ! ((
An Equ4 Opportunity\Atfinmfive Action Employer

�� DECEIVED
NCDENR F_rB 09 2012zj
North Carolina Department of Environment and Natu al Resources
Division of Water Quality Asheville Regional Office
Beverly Eaves Perdue Charles Wakild,P. E. A uifer ProteCti019ee Free an
Governor Director tiecreltary
CERTIFIED MAIL # 7006 2150 0003 54671612
RETURN RECEIPT REQUESTED
Jessie& Cheryl Arredondo
17 Thompson Avenue
Canton,NC 28716
Subject: Change of Ownership and Permit Renewal
5QM Geothermal Injection Well
Haywood County
Dear Mr. and Mrs. Arredondo:
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 permit was issued to
Haywood Habitat for Humanity on March 12,2007, and expires on February 29,2012.
This permit was issued for the operation of a 5QM (Closed-Loop Mixed-Fluid) Geothermal
Injection Well on your property located at 17 Thompson Avenue in Canton, North Carolina. As
the new property owners, you are responsible for maintaining this permit. Therefore, it is
important that you submit a Change of Ownership form within thirty (30) days of receipt of this
letter.
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s)for Injection
with Geothermal Heat Pump System for Type 5QM Well(s) if the injection well
system on your property is still active.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 27699-1636 One
Location:512 N.Salisbury St.,Raleigh,North Carolina 27604 NO Carolina
Phone:[phone] FAX:9IM07-6496 _ a�" n al//�
Internet:w"mcwatemualb oro ii
An Equal Opportunity I Affirmative Action Employer

B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the forms to:
Aquifcr Prote�iion Scction
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 Change of
-- Ownership-form;-a-renewal-application, and-a UIC Well System-Status-fomrare-attached-along- -- — _
with a self-addressed envelope. The above referenced forms are also available on-line at the
DWQ website at http://portal.ncdenr.ori4/web/wq/als/g_wpro/ erp mit-gpplicationsggeothennApps.
Thank you in advance for your cn,oherntion and timely i:ecronse. Tf you have any question.,
please contact me by phone at(919) 807-6407 or by email at erie. .smith Qncdenr.�ov.
Sincerely, � 01/
14
Eric G. Smith,P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office-Aquifer Protection Section w/o enclosures
APS Central Files—Permit WI0100045 w/o enclosures

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director - - — Secretary
September 28, 2011 S`P 30 2611
CERTIFIED MAIL# 7010 0780 00017057 61401-.1 CJ 'ice
RETURN RECEIPT REQUESTED -- i
Federal Home Loan MTG Corp
C/O Citimortgage, Inc.
1000 Technology Drive
O Fallon, Missouri 63368
Subject: Change of Ownership
Permit No. WI0100045
5QM Geothermal Injection Well
Haywood County
To Whom it May Concern:
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 permit was issued to
Haywood Habitat for Humanity on March 12, 2007, and expires on February 29, 2012.
This permit was issued for the operation of a 5QM (Closed-Loop Mixed-Fluid) Geothermal
Injection Well on your property located at 17 Thompson Avenue, in Canton, North Carolina. As
the new property owner, you are responsible for maintaining this permit. Therefore, it is
important that you submit a Change of Ownership form within thirty (30) days of receipt of this
letter.
Since the permit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also submit one of the following forms:
AQUIFER PROTECTION SECTION
1636 Mall Service Center,Ralegh,North Carolina 27699-1636
Location:2728 Capital Boulevard,Raleigh.North Carolina 27604 te
t...,Phone:[phone]FAX 1:919-715A588;FAX2:919.715-60461 Customer Service:1-877-623-6748 CarolinInternet:www rimatemualiN.omN An Epual GgPottunm,Affirtnalive Action Employe: ll atb

A. Application for Permit (Renewal) to Construct and/or Use a Well(s)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 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 Change of
Ownership form, 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.ncdenr.or web/wq/ars/awyro/permit-applications#geothermAnns.
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 etic.e.smithamcdenr.aov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Asheville Regional Office - Aquifer Protection Section w/o enclosures
APS Central Files—Permit WI0100045 w/o enclosures

NCDENR
North Carolina Department of Environment and Natural Resource
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins I RECEIVED Dee Freeman
Governor Director ; Secretary
r:OV 23 26i1
November 17, 2011
Asheville Regional Office
Aot)ifer Protection
CERTIFIED MAIL#7006 2150 0003 5467 1162
RETURN RECEIPT REQUESTED
Federal Home Loan MTG Corp
CIO Citimortgage, Inc.
1000 Technology Drive
O Fallon,Missouri 63368
Subject: Notice of Violation with Intent to Enforce(NOV-2011-OP-0021)
5QM Geothermal Injection Well
Permit No. WI0100045
Haywood County
To Whom it May Concern:
The above-referenced permit, which was issued to Haywood Habitat for Humanity on March 12, 2007,
and expires on February 29,2012, has not been converted to the new owner or renewed. This permit was
issued for the operation of a 5QM geothermal injection system on your property located at 17 Thompson
Avenue, in Canton,North Carolina.
On September 28, 2011, our office sent you a Change of Ownership form and a permit renewal
application package with instructions to submit the necessary paperwork within 30 days of its receipt. To
date, the Groundwater Protection Unit has not received your completed change of ownership or renewal
application package. In addition, our records do not indicate that the well system has been plugged and
abandoned.
Therefore,the following violation(s)exists:
VIOLATION 1:
Failure to obtain a permit prior to construction, operating, or using an injection is a violation of 15A
NCAC 2C .0211(a).
REQUIRED CORRECTIVE ACTION FOR THIS VIOLATION
Please take the following corrective action within 30 days of receipt of this letter:
AQUIFER PROTECTION SECTION
1636 Mail Service Center.Raleigh,North Carolina 27699-1636
Location:2728 Capital Boulevard,Raleigh,North Carolina 2760W On-, , 2�..,1
Phone:[phone] FAX 1:919-715-0588:FAX 2:919-715.60481 Customer Service:1.877-623-6748 1 v
Internet www.ncwatemualitv.om wT LLl OlCar01111
An Equal Opponunm�APomanve Hcnon Emplever Naturally .

1. CHANGE OF OWNERSHIP. Since you are new property owner, you must first
convert the permit into your name before it can be renewed. Once we receive your
name change request, we can then process the permit renewal in Step 2 below. To
change the name of the permit, you must submit the following information:
a) A completed Permit Name/Ownership Change form(enclosed).
b) A completed Status oflnjection Well System form(enclosed)
2. APPLY FOR PERMIT RENEWAL. When you apply for and receive a renewal,
operation of your well system will be permitted to continue. As such, any operation
and maintenance procedures specified in your previous permit will be required. To
renew, you must submit the following information to the address below:
a) A completed Application for Permit (Renewal) to Construct and/or Use a Well(s)
for Injection with Geothermal Heat Pump System for Type 5QM Well(s) if the
injection well system on your property is still active(enclosed). This form must
be signed by each property/permit owner.
All forms must be submitted to the following address within 30 days of the receipt of this letter 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 Change of Ownership
form, 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
htto'//Portal ncdenr ore/web/wo/ans/Lwnro/permit-annlications#seothmnApis.
Thank you in advance for your cooperation and timely response. If you have any questions, please call
Eric G. Smith at 919-715-6196, or email him at eric.c.smith(amcdenr.gov.
Sincerely'
\ ' , I
�,�°° �+t�, V�
DebraJ. Watts, Supervisor
Groundwater Protection Unit
Enclosures
cc: Asheville Regional Office-Aquifer Protection Section w/o enclosures
APS Central Files—Permit WI0100045 w/o enclosures

p��� va r+f�9QG
Michael F.Easley.Governor
7 William G.Ross Jr.,Secretary
1_ North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
Division of Water Quality
March 12, 2007
Ms. Mamette Colborne MAR 19 2007
Executive Director, Haywood Habitat for Humanity
P.O. Box 283 ✓
Waynesville,NC 28786
Re: Issuance of Injection Well Permit
Permit No.WI0100045
Haywood Habitat for Humanity
Dear Ms. Colborne:
In accordance with your application received January 5, 2007, I am forwarding Permit No.
WI0100045 for the operation of a vertical closed-loop geothermal mixed-fluid heat pump
injection well system to be located at 17 Thompson Avenue, Canton, Haywood County, North
Carolina 28716. 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 II 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,Regards,
Michael Rogers
Hydrogeological Technician II
cc: Landon Davidson—Asheville Regional Office
Central Office File—WI0100045
Andrew Messer—Effecta Solutions
Attachment(s)
I�Q�`hCarolina
�vatura!!'
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:httr),//www,ncwatercivality.org 2728 Capital Boulevard Raleigh,NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal OpportunitylAffinnative Action Employer-50%Recyciedll0%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
HAYWOOD HABITAT FOR HUMANITY
FOR THE CONSTRUCTION AND OPERATION OF 4 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 17 Thompson Avenue, Canton, Haywood County, North
Carolina, and will be constructed and operated in accordance with the application received
January 5, 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.
Permit issued this the day of 2007.
1Alan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Pernvt No.WI0100045 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 Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be 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 Abe 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) 715-6166 and the Asheville Regional Office Aquifer
Protection Section Staff, telephone number(828) 296-4500.
3. All underground tubing shall be refrigeration grade copper tubing.
Permit No.WI0100045 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 prig. 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 niedium shall be considered a failed mechanical integrity test. Any
leaks shall be located and repaired prior to charging the system with refrigerant. A copy of
the post-installation pressure or vacuum test record (initial pressure reading, final pressure
reading, 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 Permittee 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.WI0100045 Page 4

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 Pernttee, 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 facilityshall 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.WI0100045 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.W10100045 Page 6

PART VIII-PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART IX- CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(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.W10100045 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
Pemut No.WI0100045 Page 8

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: County: JLi
To: Aquifer Protection Section Central Office Permittee: wa, iL;;ti%:,il, ;,y
Central Office Reviewer: Project Name:
Regional Login No: Application No.: Wr of 0004S�
I. .GENERAL INFOR11ATION
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 [K 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: Ze'e 7 eZ '2 1
b. Person contacted and contact information: IVIA IV`Fi7C= 4tcci3e :ya Wy)
C. Site visit conducted by: 7L/
d. Inspection Report Attached: Q-,Yes or❑No.
2. Is the following information entered into the BIMS record for this application correct?
® Yes 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 copy and paste anew section' into the
document for each site or attach additional paces for each site)
a. Location(s):
y r
b. Driving Directions: T 40 Ld ex,r 31 3 c v IBa;tiy �,J r)L ') 'E�Lptr_o"c A'Z %r:4rt J 'Ii�a::t�nvt i s
c. USGS Quadrangle Map name and number: (9
d. Latitude: � 3Z'30.46" Longitude: '' ` SZ'
II. NEWAND MAJOR MODIFICATIONAPPLICATIONS(this section not needed for renewals or minor
modifications, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: �iJf
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: Documentl l

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
❑ Yes ❑No FA N/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? 0 Yes ❑No ❑N/A. 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 Q
N/A.,If no, please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
❑Yes.❑No ®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-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[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 51 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 Q N/A If yes, attach list of sites
with restrictions (Certification B?)
III RENEWAL AND MODIFICATIONAPPLICATIONS(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 9:_
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:
>;nonrt• tlr..• ..nnnrt 2 vuTol 00045'

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 Wy01 pVp*s'

' 1
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 (5L/"Non-Discharge"),
❑ Other(Specify: _1
2. Does system use same well for water source and injection? ❑ Yes Z No
3. Are there any potential pollution sources that may affect injection? ❑ Yes - Q 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?
5. Quality of drainage at site: N Good ❑ Adequate ❑Poor
6. Flooding potential of site: [Z 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:— NIA
8. Does the map presented represent the actual site(property lines,wells, surface drainage)? [Z 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.
Iniection 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 iniections have an adverse impact on migration of the plume or management of
the contamination incident? El Yes ❑No. If yes. explain:
Te i' 7i
4. Drilling contractor: Name: ; /(
�i ee F'i�tW ���'r��`-72� �� -
Ff1R Trt Tlnrmontl 4

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: fa..,. 1;"aae2J Itics-saXi EFr2 C%A Se.tir �a;v"s"
C9/g) 4SS- 32aC�
Certification number: 94&8
5. Complete and attach Well Construction Data Sheet.
FORM: Documentl 5
NSJ=01000¢,,

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet-if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit?❑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):
Signature of APS regional supervisor:
Date: 7colG2L 5
ADDITIONAL REGIONAL STAFFREVIEW ITEMS
inIL01000¢J,

Compliance Inspection Report
Permit: W10100045 Effective: Expiration: Owner: Haywood Habitat for Humanity
SOC: '' //� Effective: Expiration: Facility: Haywood Habitat for Humanity
County�� Fy"-fo PO Box 283
Region: Asheville
Waynesville NC 28786
Contact Person: Marnette Colborne Phone: [phone]
Directions to Facility:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 0212112007 Entry Time: 09:00 AM Exit Time: 09:15 AM
Primary Inspector: Harold E Minnick Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine - Inspection Type:Compliance Assistance
Permit Inspection Type: Injection Mixed Fluid GSHP Well System(5QM)
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
(See attachment summary)
Page: 1

Permit:W10100045 Owner-Facility: Haywood Habitat for Humanity
Inspection Date: 02/21/2007 Inspection Type:Compliance Assistance Reason for Visit:Routine
Inspection Summary:
on inspection date, no wells have been constructed
Page: 2

k 1 LE COPY
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: County:
To: Aquifer Protection Section Central Office Permittee: �'a Aj! .aq.v.,�r
Central Office Reviewer: Project Name:
Regional Login No: Application No.: Wr of 00a4s-
I. GENERAL INFORAIATION
1. This application is (checkallthatapply): [KNew ❑ 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 [KOther Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? Yes or[:1 No.
a. Date of site visit: Z&V/02 Z I I0900- 091r
b. Person contacted and contact information: AIAAo+eti`i tc;,&164 "' (yzy) 746-,301
c. Site visit conducted by:- ip
d. Inspection Report Attached: 9-yes or❑No.
2. Is the following information entered into the BIMS record for this application correct?
® Yes 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 Iniection 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): 17 Tkkxir es x d yi- Zb--Xv
Y +
b. Driving Directions: T40 W, ,Y31, S,:v ,JZ &W; ,,L rk,� %EIS++.., � J-,Eigpr,:J
c. USGS Quadrangle Map name and number:
�
d. Latitude: � V'30-4G" Longitude: 57'Zc ri"P "
II. NEW AND MAJOR MODIFICATIONAPPLICATIONS(this section not needed for renewals or minor
modifications. 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

r! 9
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
❑ Yes ❑No E N/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? 0 Yes ❑No ❑N/A. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? f
Yes ❑No ❑N/A. If no, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division, ❑ Yes ❑No o
N/A. If no,please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
❑Yes.❑No ®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-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV:
S. Are there any buffer conflicts (new treatment facilities or new disposal sites)? ❑ Yes or ZNo. 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 p 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 2 N/A If yes, attach list of sites
with restrictions (Certification B?)
III RENEWAL AND MODIFICATIONAPPLICATIONS(use previous section for flew or major modification
s stems
Description Of Waste(S) And Facilities
I. Are there appropriately certified ORCs for the facilities? ❑ Yes or❑No.
Operator in Charge: _ Certificate 4:_
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:
Fnnnn• n.,ri....nnrl 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 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,NO 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

S
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PEPMIT 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(5U'Non-Discharge")
❑ Other(Specify:
2. Does system use same well for water source and injection? ❑ Yes ID No
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)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? Z5_0 ft.
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. Attach
map of existing monitoring well network if applicable. If No,explain and recommend any changes to the
groundwater monitoring program:_ )t/A
8. Does the map presented represent the actual site(property lines,wells, surface drainage)? ®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. Imes, 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 t=.roundwater 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. If yes explain:
4. Drilling contractor: Name: 4&�`&71, F`it-�/i-Sat., 1rxs(Ui
Fnnnrt n a"rt 4

. i 1
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: Alcsge7Z, EFr G:A �eu�1�evyS
Certification number: 94&?
5. Complete and attach Well Construction Data Sheet.
FORM: Documentl 5

r,
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOMiVENDATIONS
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; ❑X
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report preparer(s): -
Signature of APS regional supervisor:
Date: 2Co10 2-L 5
ADDITIONAL REGIONAL STAFF REVIEW ITEMS

COPS' : { ,
AQUIFER PROTECTION SECTION Jq�
APPLICATION REVIEW REQUEST FORM �Otr;
Date: January 10,2007
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
❑ Jay Zimmerman,RRO-APS
From: Michael Rogers , Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Rogers(cr)ncmail.net
A. Permit Number: WI 0100045
B. Owner: Haywood Habitat for Humanity (Contact: Marnette Colborne)
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 -(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: Date:
FORM: APSARR 07/06 Pagel of 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 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 DMSION OF WATER QUALITY
DATE: December 21st 2006
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
(1) _ Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) x Type 5QM wells contain a subsurface system of continuous piping,that is
isolated from the environment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3) _ Type 5QW wells contain a subsurface system of continuous piping,that is
isolated from the environment and only circulates potable water.If you selected
this well type,then complete form GW-57 CL,Notification Of Intent To
Construct A Closed-Loop Geothermal-Water Only Injection Well System.
B. PERMIT APPLICANT
Name: Haywood Habitat for Humanity
Address: 17 Thompson Ave.
City: canton State: NC Zip Code: 28716 County: Haywood
Telephone: [phone] O F=}'
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C. PROPERTY OWNER(if different from applicant) ' o
Naive: Haywood Habitat for Humanity CJ p�
:.:
Mr"
Address: P.O. Box 283
City: Waynesville Sate: NC Zip Code: 2e786 County: Haywood
L1
Telephone: 82e-246-349e cn
D. STATUS OF APPLICANT
Private: x Federal: Commercial:
State:_ Municipal: Native American Lands:
Revised 7/06 GW/UIC-57 HP Page 1 of

E. FACILITY(SITE)DATA
(Fill out ONLY if the Status of Owner is Federal,State,Municipal or Commercial).
Name of Business or Facility:
Address: (-I 'T(.,d v".1P 5
City: co.. A-l-mow Zip Code: NC Z 9'7(6County: 'I'l wrw
Telephone: Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: Rickey Kitchen
Address: P.O. Box 99
City: Penrose Zip Code: 26766 County: Transylvania
Telephone: 62e-e62-7ee5 Contact Person: Rickey Kitchen
G. INJECTION PROCEDURE (Briefly describe how the injection well(s)will be used.)
Injection wells (bore holes) will be used as a geothermal heat sink. Geothermal ground
loops will be placed in the temporary bore holes. Bore holes will be continuously grouted
from the bottom to the top. '
H. WELL USE Will the injection well(s)also be used as the supply well(s)for the following?
(1) The injection operation? YES NO x
(2) Persopal consumption? YES NO x
I. CONSTRUCTION DATA(check one)
EXISTING WELL 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 Form GW-
1 (Well Construction Record)if available.
x PROPOSED WELL 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.
(1) Well Drilling Contractor's Name: Effects Solutions, LLC - Stephen Keener
NC Contractor Certification number: 346e
(2) Date to be constructed:asaP Early Jan 07 Number of borings: 4
Approximate depth(if each boring(feet): 75ft
(3) Well casing: Is the well(s)cased?
(a) YES If yes,then provide the casing information below.
Type: Galvanized steel_Black steel_Plastic_Other(specify)
Casing depth: From to ft.(reference to land surface)
Casing extends above ground inches
(b) NO x
Revised 7/06 GWIUIC-57 HP Page 2 of 4

(4) Grout(material surrounding well casing and/or piping):
(a) Grout type: Cement X Bentonite x Other(specify) silica sand
(b) Grouted surface and grout depth(reference to land surface):
X around closed loop piping; from c to 75 (feet).
around well casing;from to (feet).
(5) Screens(for Type 5A7 wells)
(a) Depth:From_to feet below ground surface.
(6) N.C. State Regulations (Title 15A NCAC 2C .0200) require the permittee to make provisions
for monitoring wellhead processes. A faucet on both influent (fluid entering heat pump) and
effluent(fluid being injected into the well)lines is required. Will there be a faucet on:
(a) the influent line? yes X no (b) . the effluent line? yes_no x
(7) SOURCE WELL CONSTRUCTION INFORMATION(if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,
provide the data in part K(1)of this application form to the best of your knowledge.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR ErITIER EXISTING OR
PROPOSED WELLS IF TIES INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERATING DATA(for Type 5A7 wells)
(1) Injection rate: Average(daily)gallons per minute(gpm).
(2) Injection Volume: Average(daily) gallons per day(gpd).
(3) Injection Pressure: Average(daily) pounds/square inch(psi).
(4) Injection Temperature: Average(January) °F,Average(July)_°F.
K. INJECTION FLUID DATA
(1) Fluid source(for Type 5A7 wells) If underground, from what depth, formation and type of
rock/sediment unit will the fluid be drawn(e.g.,granite,limestone,sand,etc.).
Depth: Formation: Rock/sediment unit:
(2) Chemical Analysis of Source Fluid(for Type 5QM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
R-22 Refrigerant
L. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
M. LOCATION OF WELL(S) Attach two maps.
Revised 7/06 GW/UI657 UP Page 3 of 4

(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies,
potential sources of groundwater contamination and the orientation,of and distances between
the proposed well(s)and any existing well(s)or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet of the geothermal heat pump well system. Label all
features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
N. PERMIT LIST. Attach a list of all permits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) . NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
O. 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. 1 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."
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wner or Autho ' A t '
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please supply a lelter signed by the owner autlariziog the above aPat
P. CONSENT OF PROPERTY OWNER(Owner means any person wimo.holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant,the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure that the injection well(s) conforms to the Well
Construction Standards(Title ISA NCAC 2C.0 0)
4. 11,9
(Srgna Of Property Owrffr If Different From Applicant
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Please return two.copies of the completed Application package to: a
UIC Program
Aquifer Protection Section C
]Korth Carolina DENR--DWQ
1636 Mail Service Center -= x
Raleigh,NC 27699-1636 r
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http://www2.undersys.com/scripts/testadv/usiwebd.dll/usi?fomiis=newzoom&MouseX=215... 1/5/2007

oaOF W.ATFgOG Michael F. Easley,Governor
William G. Ross Jr.,Secretary
T— North Carolina Department of Environment and Natural Resources
-.
O Y Alan W.Klimek,P.E. Director
Division of Water Quality
January 9,2007
MARNETTE COLBORNE
HAYWOOD HABITAT FOR HUMANITY
PO BOX 283
WAYNESVILLE NC 28786
Subject: Acknowledgement of Application No. WI0100045
Haywood Habitat for Humanity
Surface Irrigation- SFR(Single Family Residence)
Transylvania County
Dear Mr. Colborne:
The Aquifer Protection Section of the Division of Water Quality(the Division)acknowledges receipt of
your permit application and supporting materials on January 5,2007. 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 by 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 hq://h2o.enr.state.ne.us/documents/dwq_or cg hart.Qdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES
ON THIS PROJECT.
Sincerely,, ,
for Debra J. Watts
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit Application File W10I00045
No`rthCamlina
,7Va&ra11j1
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: [phone]
Internet:www.ncwaterguality.org Location: 2728 Capital Boulevard Raleigh,NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal Opportunity/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper Customer Service: [phone]