WI0100023_Complete File - Historical_20220309

Q RECEIVED
NCDENR r,,w 1125112
North Carolina Department of Environment and Natural FeesouMr
Division of Water Quality Asheville Regional Office
Beverly Eaves Perdue Charles Wakild, P. E. �_AQU1fPd 1110.1
ter
'on
Governor Director Secretary
May 10, 2012
Johannes and Martha Penz
667 Keener Road
Murphy, NC 28906
Subject: Rescission of Injection Well Permit W10100023
Dear Mr. and Mrs. Penz:
On May 4, 2012, we received notification that your water supply well is no longer being used for
geothermal heating/cooling purposes. In accordance with this status change and your request for
permit rescission, your permit is rescinded and the well can no longer be used for injection. Our
Asheville Regional Office staff may wish to verify that the well is no longer being used for injection.
If you wish to conduct future injection operations you must first apply for and receive a new injection
well permit. Operating an injection well without a valid permit could result in a civil penalty of up to
$25,000 per day.
If you have any questions please contact me at [e-mail] or 919-807-6412, or our
Asheville Regional Office staff at 828-296-4500.
Best Regards,
Thomas 5lusser, L.G.
Underground Injection Control Program Manager
cc: Landon Davidson—Asheville Regional Office
W10100023 Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Ralegh,North Carolina 27699-1617
Location:512 N.Salisbury St.Ralegh,North Carolina 27604
Phone:[phone] FAX:[phone] One
Internet www.noNatemuality.oralweMvNaos NorthCarollna
An Equal Opportunity t AffmnatQ Action Employer Naturally

• State of North Carolina
Department of Environment and Natural Resources .
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: W 0) C)oo z 3
Permittee Name: -Jo H A N W Es e M A 9TH A PEN Z
Address: 667 K9KJEP, goA3)t MuKPH- NC zBsoG
Please check the selection which most closely describes the current status of your injection well system:
1) ❑ Well(s)still used for injection activities,or may by in the future.
2) Well(s)not used for injection but is/are used for water supply or other purposes.
3) ❑ Injection discontinued and: a)❑Well(s)temporarily abandoned
b)❑Well(s)permanently abandoned
c)❑Well(s)not abandoned
4) ❑ Injection well(s)never constructed
Current Use of Well
If you checked(2),describe the well use(potable water supply,irrigation,monitoring,etc),including pumping rate and other
relevant information.C0N i INLfATioN of Wg-LL USE Fo)Z PP7S'lD (FAMILY( FAMILY OFz) ,
No LONGe2 6IM Fog HVAC - HCATINS1QoLM)6 .
Well Abandonment
If you checked(3)(a)or(3)(b),describe the method used to abandon the injection well. (Include a description ofhow the well
was sealed and the type ofmaterial used tofill the well iifpermanently abandoned):
Permit Rescission:
If you'checked(2),(3),or(4)and will not use a well for injection on this site in the future,you should request rescission of the
permit.Do you wish to rescind the permit?.
Yes ❑ No
Certification:
"I hereby certify,under penalty of law,that I have personally examined and am familiar with the information submitted
in this document, and that to the best of my knowledge the information is true,accurate,and
complete." ^
Signature Date
RECEIVEDIDENRIONQ
Revised 5/05 GW/UIC-66
Aquifer Protection Section

AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 5/1/09 County: Cherokee
To: Aquifer Protection Central Office Permittee: WI0100023
Central Office Reviewer: Project Name:_Penz 5A7 well
Regional Login No: Application No.:
L GENERAL INFORMATION
1. This application is(check all that apply): New X Renewal
X Minor Modification ❑Major Modification
❑ Surface Irrigation ❑ Reuse❑Recycle❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals X 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? X Yes or ❑ No.
,a. Date of site visit: 3/9/09
b. Person contacted and contact information: Johannes and Martha Penz 828-837-6496
c. Site visit conducted by: Julie Vann
d. Inspection Report Attached:_X_Yes _No..
2. Is the following information entered into the BIMS record for this application correct?
X Yes or❑No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities: N/A
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 a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): 667 Keener Road,Murphy,NC
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
II. NEWAND MAJOR MODIFICATIONAPPLICATIONS N/A
Description Of Waste(s)And Facilities
1. Please attach completed rating sheet. Facility Classification: residential
FORM: Penz UIC staff rpt.doc 1

C
AQUIFER PROTECTION REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
❑ Yes❑No X 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? ❑Yes❑No X N/A. If no,please explain:
4. Does the application(maps,plans, etc.)represent the actual site(property lines,wells,surface drainage)?
5. X Yes ❑ No ❑N/A. If no, please explain:
6. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes❑No
X N/A. If no,please explain:
7. Are the proposed application rates for new sites (hydraulic or nutrient)acceptable?
❑ Yes❑No X N/A. If no,please explain:
8. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
❑ Yes X 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:
9. Are there any buffer conflicts (new treatment facilities or new disposal sites)? ❑ Yes or X 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 proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? ❑ Yes ❑ No X 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:
11. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No X N/A. If yes, attach list of
sites with restrictions (Certification B).
III. RENEWAL AND MODIFICATIONAPPLICATIONS(use previous section for new or major modylication
systems) N/A
IV. INJECTION WELL PERMITAPPLICATIONS(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)
X Closed-loop heat pump system (5QM)
FORM: Penz UIC staff rpt.doc 2

dK
AQUIFER PROTECTION REGIONAL STAFF REPORT
❑ In situ remediation(5I)
❑ Closed-loop groundwater remediation effluent injection(5LP Non-Discharge")
❑ Other(Specify:
2. Does system use same well for water source and injection? X Yes ❑No
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)? n/a
4. What is the minimum distance of proposed injection wells from the property boundary? 25 feet
5. Quality of drainage at site: X Good ❑Adequate ❑ Poor
6. Flooding potential of site: X 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. X NA .
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)? X 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:
I 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 X No ❑ Not Applicable. 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 X N/A. If yes, explain:
3. For renewal or modification of groundwater remediation permits(of any type),will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident?_❑Yes ❑No. X NA. If yes, explain:
Drilling contractor:N/A
4. Complete and attach Well Construction Data Sheet. N/A
FORM: Penz UIC staff rpt.doc 3

Job
AQUIFER PROTECTION REGIONAL STAFF REPORT
Y. EYALUATIONANDRECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application: There was a higher concentration of
copper in the effluent than the influent. However,the concentrations in both influent and effluent is below the 2L
threshold.
2. Attach Well Construction Data Sheet- if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit?❑ Yes X 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;
8. X Issue; ❑ Deny. If deny, please state reasons:
9. Signature of report preparer(s): / � Q
Signature of APS regional supervisor S 6 G
Date: COL /�osv D4V1O,5671V
FORM: Penz UIC staff rpt.doc 4

North Carolina Department of Environment and Natural Resources
Division of Water Quality- Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WI Q /000�.. DATE
NAME OF OWNER Benz- I ~
ADDRESS OF OWNER
(Street1 road or lot andsubdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable) ;,elf A ham, <I
(Streef/road or lot and subdivision, county, town, iifdifferent than owner's address,phis description of location on site)
Potential pollution source—�trkte Distance.from well 9J
Potential pollution source v`anc 7 Distance from well
Potential pollution source Distance from well
r
Minimum distance of well from property boundary _ r ,/
Quality of drainage at site Flooding potential of.site �0%g i�Ghts (1+` wI" St
(good,adeguate,poor) (high,moderate,low)
DRAW SKETCH OF SITE (Show property boundaries, buildings,.wells,potential polleaion sources, roads, approximate scale, and
north arrow.) 5`
�oYG
k5<, ao(�. Tro
,v IUO.
' DESCRIBE INJECTION SYSTEM•(verucal closed loop ui'cased borehole o; cased water ivell;;separnte source well and
it jection well;combination source and b jection well;or other description as applicable] rn •-r
.ay � gw rill
d

INJECTION FACILITY INSPECTION REPORT -FORM B (CONTINUED)
WELL CONSTRUCTION
Date constructed 9 Z 16 Drilling contractor: Name u.k �f i I1 lGl 9�
Address
Registration number
Total depth of well 2;L Total depth of source well 37 2
(if applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing 1 ;
Depth
Diameter
Height(A.L.S.) " ✓ —
Grout
DepV1 —
Screens
Depth(s)
Lengths) —
I.D. Plate / —
Static water level ' . 1 W 0_M$4uc— —
WeII yield }.' _ . . �t`"Qop
j
Enclosure —
Enclosure floor
(concrete)
Sampling port .
Water tiglif pipe entry , —
Well enclosure entry~ -
Vent
Functioning of heat pump system (Determine front the owner if heaipublp finlctions properly.)
r
INSPECTOR 7A 11 f R/IVl Office_.
l WITNESS Address
; ,
March 1998
WITNESS J Address,, '

YC D Gaborato ection (Results
County: CHEROKEE Sample ID: AB41611
River Basin aoF WATF9p PO Number# ARO
Report To qARO
ZMAR1
Date Received 03/092009
Collector: > q Time Received: 15:00
l7 Y Labworks LoginlD KJIMISON
Region:Sample Matrix: Data Reported: 3/23/09
Loc.Type: Report Generated: 03232009
Emergency Yes/NceViaitlD3CDC Yes/No
r o.Deacr.: FP.NZ�INF
Location 10: 1PO20WI010002134NF Collect Date: 03/09I2009 Collect Time:: 11:40 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A-Value reported is the average of two or more determinations
1,13-Estimated concentration is<POL and>MDL
Bt-Countable membranes with<20 colonies;Estimated
NE-No established POL
82-Counts from all filters were zero.
P-Elevated POL due to matrix interference and/or sample dilution
83-Countable membranes with more than 60 or 80 colonies;Estimated
GI-Holding
B4-Filters have counts of both>60 or 80 and<20;Estimated dtime exceeded prior to receipt at lab.
n
BS-Too many colonies were present;too numerous to count(TNTC) Q2-Holding 6me exceeded fallowing receipt by lab
PQL-Practical Quandration Limit-subject to change due to Instrument sensitivity
J2-Reported value failed to meet QC criteria for either precision or acourary;Estimated ---
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination:Estimated
X1-Sample not analyzed for this compound D
J6-The lab analysis was from an unpreservetl or improperly chemically preserved sample;Estimated
N1-The component has been tentatively identified bead on mass spectral library search and has an estimated value
MAR 2 6 2M9
ARO WATER QUA
A cl{c I LITY SECTION
Sp
Laboratory Sectlon»1623 Mall Service Center,Raleigh,NC 27699-1623 [phone] Page i of 2

• . NC DWQ Laboratory Section Results sample ID AB41633
Location ID: 1P020W101000213-INF Collect Date: 0310912009
Loc.Descr.: PENZ-INF Collect Time:: 11:40
Visit ID
CAS 0 Analyte Name PQL Result Qualifier Units Analyst/Date Approved By/Date
Sample temperature at recelpt by lab 4.1 'C KJIMISON SMATHIS
Method Reference 319109 3111/09
Collfonn,MF Fecal In liquid 1 1 B2 CFU1100ml KJIMISON CGREEN
Method Relevance APHA9222D-20th 319/09 3112/09
Collform,MF Total In liquid 1 1 -132 CFU/100ml KJIMISON CGREEN
Method Reference APHA922213-20Ih 319/09 3112109
Total Dissohled Solids In liquid 12 23 mg/L KJIMISON CGREEN
Method Reference APHA2640G18TH 3/13m9 3/23N9
Laboratory Section 1623 Mail Service Center,Raleigh,NC 27699-1623 [phone] Page 2 of 2

D aboratoaSection Wesufts
County. CHEROKEE Sample ID: AB41661
River Basin �OF PO Number st 9G0321
Report To AROAp yO Date Received: 01/1'I/2009
Collector J VANN q > Time Received: SMA
THIS
Region: AFRO APR 22 2CUJ O Late Reparks rte: S115/09
Date Reported: 4/15/09
Sample Matrix: GROUNDWATER
Loc.Type: WATER SUPPLY -" Report Generated'. 04/15/2009
Emergency Yes/No VlsitlD
CDC Yes/No
Loc.Deal PINZ 4
Lontfon lD: 1P020WI0700023-INF Collect Date: 03MO120M Cdlect Time:: 11:40 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
Fora more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A-Value reported is the average of two or more determinations
N3-Estimated concentration is<POL and>MDL
E1-Countable membranes with<20 colonies;Estimated
NE-No established POL
82-Counts from all filters were zero.
P-Elevated PQL due to matrix interference and/or sample dilution
83-Countable membranes with more than 60 or 80 colonies;Estimated
01•Holdinp time exceeded prior to receipt at lab.
84-Filters have counts of both>60 or 80 and<20;Estimated
Q2-Holding time exceeded following receipt by lab
BS-Too many colonies were present;too numerous to count(TNTC)
PQL-Practical Quantitation Limit-subject to change due to instrument sensitivity
J2-Reported value failed to meet QC criteria for either precision or accuracy;Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination:Estimated
Xi-Sample not analyzed for this compound
JB-The lab analysis was from an unpreservetl or improperly chemically preserved sample;Estimated
141-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section 1623 Mall Service Center,Raleigh,NC 27699-1623 [phone] Page 1 of 3

NC DWQ La6oratory Section Results Sample ID AB41666
Location ID: 1P020WI0100023-INF Collect Dale: 03109/2009
Loc.Descr.: PENZ Collect Tlme:: 11:40
Visit ID
CAS# - Analyte Name POL Result Qualifier Units AnelysVDate Approved By/Date
Sample temperature at receipt by lab 1.7 C DSAUNDERS SMATHIS
Method Reference 3111/09 Wilms
WET
Ion Chromatography _TITLE_ mg/L AWILLIAMS CGREEN
Method Reference EPA300.0 3117109 3/2OM9
Chloride 1.0 1.0 U M91L AWILLIAMS CGREEN
Method Reference EPA 300.0 _ 3117109 M0109
Fluoride 0.4 OA U m9/L AWILUAIv1S CGREEN
Method Reference EPA300.0 3117109 Moles
Sulfete 2.0 4.1 _mg/L AWILLIAMS CGREEN
Method Reference EPA 300.0 3117/09 3120/09
NUT
NO2+NO3 as N In 0quld 0.02 0.05 m9fL as MAJAYI CGREEN
Method Reference LaOO-107-04.1c 3/1009 3/19M9
Nitrate as N in liquid 0.02 0.05 mglL as MOVERMAN CGREEN
Method Reference LeUat707-04-ic 3/19109 3119/09
Mutts es N in liquid 0.01 0.01 U mgfL as N GBELK CGREEN
Method Reference Lachat107-04.1-c 3111109 3/16109
MET
7429-90-5 AI by ICP 50 50 U ugfL PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 312VO9 4115/09
7440-38-3 Be by ICP 10 10 U uglL. PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 3119109 4115/09
7440-70-2 Caby ICP 0.10 25 mg1L PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 3119/09 4115/09
7440-43-9 Cd by ICPMS 1.0 1.0 U ug1L SGOSS ESTAFFORD
Method Reference EPA200.8 320109 4/15109
744047-3 Cr by ICPMS 10 10 U Ug/L SGOSS ESTAFFORD
Method Reference EPAMOS =0/09 4/15M9
7440-50-8 Cu by ICPMS 2.0 41 ugh. SGOSS ESTAFFORD
Method Reference EPA200.8 T 3QQI09 4/15109
7439-89-6 Fe by ICP 50 50 U ug1L PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 312QI09 4/15/09
7440-09-7 Kby ICP 0.10 0.34 M91L PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 - 3119/09 4/15109
7439-954 M9 by ICP 0.10 2.1 M91L PGAUTHIER 'ESTAFFORD
Method Reference EPA 200.7 3119109 4/15/09 '
Laboratory Section»1623 Mall Service Center,Raleigh,NC 27699.1623 [phone] Page 2 of 3

NC(DWWQ La6oratory Section Nipsults Sample ID AB41666
Location ID: IP020WI0100023-INF Collect Dale: 0310912009
Loc.Descr.: PENZ Collect Time:: 11:40
Visit ID
CAS# Analyte Name PGL Result Qualifier Units Analyst/Date Approved BylDate
7439-96-5 Mn by ICP 10 10 U uglL PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 32N09 4115I09
7440-23-5 Na by ICP 0.10 4.3 M91L .PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 "�`— 3119109 4AS109
7440-02-0 NI by ICPMS 10 10 U uglL SGOSS ESTAFFORD
Method Reference EPA 200.8 320109 41ISM9
7439-92-1 Pb by ICPMS 10 10 "U uglL SGOSS ESTAFFORD
Method Reference EPA 200.8 32009 4/15M9
7782-49-2 Seby1CPMS 5.0 5.0 U uglL SGOSS ESTAFFORD
Method Reference EPA 200.8 320109 4/15M9
7440.66-6 Zn by ICPMS 10 10 U uglL SGOSS ESTAFFORD
Method Reference EPA 200.8 32G(09 4115/09
Laboratory Section»1623 Mall Service Center,Raleigh,NC 27699.1623 [phone] Page 3 of 3

XC(D LaboratoaSection &=Its
County: CHEROKEE Sample ID: AB41611
River Basin \tla OF`ffATF,9OG PO Number# 9G0320
Report To AROAP AIR 2� 1C�J ? ,y Date Received O3I1112009
r Time Received: 09:15
Collector. J VAN 't
G 't' Labworks LoginlD sMATHIS
Region: ARO -.
Date Reported: 4H5/09
Sample Matrix: GROUNDWATER
Loc.Type: WATER SUPPLY Report Generated: 04/15/2009
Emergency Yes/No Visitl0
CDC Yea/Na
Loc.Descc: p Z- F
Locatl nID: 1P020W10100023-EFF Collect Date: 03/09/2009 Collect Time:: 12:05 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to W .dvvglab.org under Staff Access
A-Value reported is me average of two or more determinations
N3-Estimated concentration is<POL and>MDL
B1-Countable membranes with<20 colonies;Estimated
NE-No established POL
B2-Counts from all liters were zero.
P-Elevated PQL due to matrix interference end/or sample dilution
83-Countable membranes with more than 60 or 80 colonies;Estimated
01-Holtlin9 time exceeded prior to receipt at lab.
B l-Fillers have counts of both>60 or 80 and<20:Estimated
02-Holding time exceeded following receipt by lab
BS-Too many colonies were present;too numerous to count(TNTC)
POL-Practice l Ouantimtion Limit-subject M change due to instrument sensitivity
J2-Reported value felled to meet CC criteria for either precision or accuracy:Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated
Xi-Sample not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample;Estimated
NI-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section>>1623 Mall Service Center,Raleigh,NC 27699-1623 [phone] Page 1 of 3

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Sample ID AB41665
NC(D WQ Laboratory Section Results
Location ID: 1P020WI0100023-EFF Collect Date: 03/0912009
Loc.Descr.: PENZ-EFF Collect Time:: 12:05
VISIOD
CAS# Analyte Name POL Result Qualifier Units Analyst/Date Approved By
7439-96-5 Mnby ICP 10 10 U ag/L PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 320109 4/15M9
7440.23-5 Na by ICP 0.10 4.3 m%IL PGAUTHIER ESTAFFORD
Method Reference EPA 200.7 3119109 4115109
7440-02.0 NI by ICPMS 10 10 U aglL SGOSS ESTAFFORD
Method Reference EPA 200.8 =0109 4115I09
7439-92.1 Pb by IGPMS 10 10 U ug/L SGOSS ESTAFFORD
Method Reference EPA 200.8 mum 4115MO
7782-49-2 So by ICPMS 5.0 5.0 U uglL SGOSS ESTAFFORD
Method Reference EPA 200.8 =am9 4115MO
7440-66-6 Zn by ICPMS 10 10 U ug/L SGOSS ESTAFFORD
Method Reference EPA 200.8 320I09 4115109
Laboratory Sectlon>>1623 Mall Service Center,Raleigh,NC 27699.1623 )919)733-3908 Page 3 of 3

(D LaboratooSection Results
County: CHEROKEE Sample ID: AB41634
River Basin RECEIVED sot WArF9 PO Number tl ARID
Report To AROAP Date Received: 0310912009
13 2Gu9 r
Collector. JV NON MAR _ .y Time Received: KJIMI
Region:
ARO P Y Labwarks LoginlD KJIMISON
Sample Matrix: NDWATE Asheville Re®lonal Office Date Reported: 3/27/09
Loc.Type: WATER SUPP A 11�tier Pmtlbiel n Report Generated 0323/2009
Emergency yes/No VisitlD
1 L(
CDC Yes/No
Loc.Descr.: PENZ-EFFLF
Location ID: 1P020W10100023-EFF Coiled Date: 03/09/2000 Collect Time:: 12:05 Sample Depth
Sample Qualifiers and Comments '! t
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A-Value reported is the average of two or more determinations
1,17-Estimated concentration is<PQL and>MDL
B7-Countable membranes with<20 colonies;Estimated
NE-No established POL
B2-Counts from all filters were zero.
P-Elevated PQL due to matrix interference and/or sample dilution
B3-Countable membranes with more than 60 or 80 colonies;Estimated
01-Holding time exceeded prior to receipt at lab.
B4-Filtem have counts of both>60 or 80 and<20;Estimated
D2-Holding time exceeded following receipt by lab
86-Too many colonies were present:too numerous to count(TNTC)
PQL-Practical Ouantifation Limit-subject to change due to instrument sensitivity
J2-Reported value failed to meet OC criteria for either precision or accuracy;Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination;Estimated
Xi-Semple not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample;Estimated
NI-The component has been tentatively identified based on mass spectral library search and has an estimated value ED
C 7 E MAR 2 6 �9
ARID
WATER Q
Laboratory Section>>1623 Mall Service Center,Raleigh,NC 27699.1623 [phone] E REGIONAL OFFfCE

NC(DWQ La6oratory Section Resu(ts Sample ID AB41634
Location lD: 1P020W10100023-EFF Collect Date: 03/09/2009
Loc.Descr.: PENZ-EFF Collect Time:: 12:05
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date - Approved By/Date
Sample temperature at recelpt by lab 4.1 °C KJIMISON SMATHIS
Method Reference M109 3/11/09
Collform,Mile Fecal In liquid 1 1 B2 CFU/100ml KJIMISON CGREEN
Method Reference APHA92220.20th "log 3112109
Colltorm,MF Total In liquid 1 1 92 CFU/100ml KJIMISON CGREEN
Method Reference APHA92228-20th 319109 3/12/09
Total Dissolved Solids In liquid 12 7 mg/L. KJIMISON CGREEN
Method Reference APHA2540G181H 3113109 3/23/09
Laboratory Section 1623 Mail Service Center,Raleigh,NC 27699.1623 (919(733-3908 Page 2 of 2

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWAT R SECTION
LOL'ation code 1 PO20WI0100023-EFF SAMPLE TYPE SAMPLE PRIORITY &9410
County Cherokee EKWater .Routine Lab Number ' 3 7-0
Quad No Serial No. ❑ Soil ❑ Emergency �e L Date Received 3 O l Time:
Lat. Long. ❑ Other GGG###rmltt Redd By: From:Bu , ourier, nd Del.,
❑ Chain ofCustody Other: JD
Report To: FRO, MRO, RRO,WaRO,WiRO, Data Entry By: Ck:
WSRO, Kinston FO, Fed.Trust, Central Off., Other: Date Reported:
Shipped by: Bus, ourier Hand Del.,Other: Purpose:
Collector(s):_Julie Vann Date 9 0 Time 12; Oq Baseline,Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other:
FIELD ANALYSES
Owner Penz (`�°OeB!
pH 400 4 Spec. Cond., n j L at 250C Location or Site_667 Keener Road, Murphy, NC
Temp.to� C Odor V%OVJ— Description of sampling point V.I 1
Appearance CI Sampling Method amD' °1ef'e`' Sample Interval
Field Analysis By: I \ nnn Remarks
LABORATORY ANALYSES (P.pina eina'`Irtmp.•°t)
Boo 310 mg/L' Diss.Solids 70300 mg/L er u !L Organochlorne Pesticides
COD High 340 mg/L Fluoride 951 mg/LtAl-Aluminum 46557 u /L O ano hos horns Pesticides
COD Low 335 mg/L r Hardness:Total 900 mg/L 551 u !L Nitrogen Pesticides
Califonn:MF Fecal 31616 /t00m1 Hardness(non-carb)902 mglLBarium 46558 •u /L Add Herbicides
Califonn:MF Total 31504 /100ml Phenols 32730 ug/I Calcium 46552 m fL PCBs
TOG 680 mg/L S GSc Cond.95 pMhos/cmCadmium 46559 u /L
Turbidity 76 NTU Sulfate 945 mglL ;/ Cr-Chromium 46559 p /L
Residue,Total Suspended 530 mg/L Sulfide 745 mg/L Cu-Copper46562 u /L
Fe-Iron 46563 u /L Semivolalile organics
Oil and Grease mg/L Hg-Mercury 71900 u /L TPH-Diesel Range
pH 403 units mg/L
Alkalinity to pH 4.5 410 mg/L Mg-Magnesium 46554 mg/L
Alkalinity to pH 8.3 415 rn L Mn-Manganese 46565 u /L Volatile Organics(VOA bottle
Carbonate 445 mg/L NH3 as N 610 mglL N -Sodium 46556 m /L TPH-Gasoline Range
Bicarbonate 440 mg/L TKN as N 625 mg/L NJ-Nickel unit. TPH-BTEX Gasoline Range
rbon dioxide 405 mg/L NO2+NO3 as N 630 mg/L Pb-Lead 46564 u /L
Chloride 940 mg/L P:Total as P 665 mg/L Se-Selenium u /L
Chromium:Hex 1032 ug/L Nitrate(NO,as N)620 mg/L n-Zlnc46567 u !L
Color.True 80 Cu itrite(NO,as N)615' ,• -mg/L . . LAB USE ONLY
a9 Temperature on arrival(°C):
Cyanide 720 mg/L
Lab Comments
GW-54 REV.7103 For Dissolved Analysis-submlt filtered sample and write'DIS'in block; ",`.'•.,•
0
r "

North Carolina
-GROUNDWATER FIELD/LAB FORM
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
Location code 1 P020WI0100023-EPr IN F SS— /�AM/LE TYPE SAMPLE PRIORITY
County Cherokee I/�'water Routine Lab Number IGonl
El Soil ❑ Emergency
Quad No Serial No. �G-iyl�Z� Date Received ]1-D 01 Time:
Lat. Long. ❑ Other �t'r Redd By: From:Bus, ouri Hand Del.,
❑ Chain of Custody I N Other: ttk
Report To:® FRO, MRO, RRO,WaRO,WiRO, Data Entry By: Ck:
WSRO, Kinston FO, Fed.Trust, Central Off., Other: Date Reported:
Shipped by: Bus, ourier Hand Del., Other: Purpose:
Collectors)_Julie Vann Date q 0 Time : qQ Baseline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust;Other:
FIELD ANALYSES � Owner Penz (crGeone)
pH 400 lfr 5 2- Spec.Cond.94 = C) Z at 250C Locationnor Site_667 Keener Road, Murpphy, �yC
Temp.lo 14, 3 eC Odor hm Description of sampling point�� �IPllhtacl
Appearance C1e¢(r Sampling Method "1 ,1 � Sample Interval
Field Analysis By: . later. Remarks umo. aiecac.
LABORATORY ANALYSES (Pumping time,eir temp.,etc.)
130D 310 mg/L Diss.Solids 70300 mg/L u /L Or anochlodne Pesticides
COD High 340 mg/L F ucride 951 mg/L AI-Aluminum 46557 u /L O ano hos horns Pesticides
COD Low 335 mg/L Hardness:Total 900 - mg/L u /L Nitrogen Pesticides
Colifonn:MF Fecal 31616 /loom[ Hardness(non-cart)902 mg/L Ba-Barium 46558 •u /L Acid Herbicides
Colifonn:MF Total 31504 Doom[ Phenols 32730 ug/I Ca-Calcium 46552 mg/L PCBs
TOC 680 mg/L Specific Cord.95 pMhos/cm Cd-Cadmium 46559 u /L
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 u /L
Residue,Total Suspended 530 mg/L Sulfide 745 mg/L Z1 Cu-Copper 46562 u /L
Fe-Iron 46563 u /L Semivolafile Organics
Oil and Grease mg/L Hg-Mercury 71900 u /L TPH-Diesel Range
pH 403 units -Potassium 46555 mg/L
Alkalinity to pH 4.5 410 mg/L g-Magnesium 46554 mg/L
Alkalinity to pH 8.3 415 mg/L tl Mn-Manganese 46565 u /L Volatile Organics(VOA bottle
Carbonate 445 mg/L NH3 as N 610 mg/L Na-Sodium 46556 mg/L TPH-Gasoline Range
Bicarbonate 440 mg/L TKN as N 625 mg/L NI-Nickel u /L TPH-BTEX Gasoline Range
rbon dioxide 405 mg/L NO3+NO3 as N 630 mg/L Pb-Lead 46564 u /L
Chloride 940 mg/L P:Total as P 666 mg/L S. elenium u /L
Chromium:Hex 1032 ug/L Nitrate(NO3 as N)620 mg/L Zn-Zinc 46567 u /L
Color.True 80 CLI Abite(NOz as N)615 mg/L LAB USE ONLY
Cyanide 720 mg/L - Temperature on arrival(eC): i
Lab Comments
GW-54 REV.7/03 For Dissolved Analysis-submit filtered sample and write'DIS'in block.

,.
RECEI�IED
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM VAR 0 3 2C09
flan n !I C1 Nj
Date: February 26, 2009
To: ® Landon Davidson,ARO-APS ❑ David May, WaRO-APS
❑ Art Barnhardt,FRO-APS ❑ Charlie Stehman,WiRO-APS
❑ Andrew Pitner,MRO-APS ❑ Sherri Knight, W-SRO-APS
❑ Jay Zimmerman,RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone] Fax. [phone]
E-Mail: Michael.Rogers autcmail.net
A. Permit Number: WI0100023
B. Owner: Johannes and Martha Penz
C. Facility/Operation:
❑ Proposed ® Existing ❑ Facility ❑ Operation
D. Application:
1. Pets ❑ Animal ❑ SFR-Surface Irrigation[] Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation(ND)
® UIC—W Geothermal well
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. AiWiiiW. ❑ New ❑ Major Mod. ❑ Minor Mod. ® Renewal ❑ Renewal w/Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
NOTE: Permittees have requested the site be inspected and permit re-issued by end of March as
they will be unavailable for most of the rest of the year. Please expedite inspection if possible.
THANKS.
Attached, you will find all information submitted in support of the above-referenced application for your
review,comment,and/or action. Within,please take the following actions:
® Return a Completed APSARR Form and attach laboratory analytical results,if applicable.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above. �,
RO-APS Reviewer: 111L�a rl l> Date: 7/ 17
FORM:APSARR 07/06 Page I of t

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES.(NCDENR)
APPLICATION FOR PERNHT TO CONSTRUCT AND/OR USE A WELL(S)FOR a
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
C10
TYPE 5-A7 WELLS)
New Permit Application OR _ Renewal(check one) �o
DATE: 1=E B_ 1 S 20-03
PERMIT NO. (leave blank if NEW permit application)
A. PROPERTY OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed(if owned by a business or government agency,state name of
entity and a representative w/authority for signature): Jo HA N NES a wa!
MgRTHA PENZ
(1) Mailing Address: A 7 k 9-FN E-R. RD .
city: M U R P H Y State: 6LC Zip Code: L 8 90 6 county: N MQK9t
Home/Office Tele No.: RD -83 7- 6 4 4 4 Cell No.:
EMAIL Address: jDGY►2 '0 fYI—LOunry.waiti . hC.. us
(2) Physical Address of Site(if different than above): SQ KA G
City: State:_Zip Code: Coumy:
Home/Office Tele No.: Cell No.:
EMAIL Address:
B. AUTHORIZED AGENT OF OWNER,IF ANY(if the Permit Applicant,does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAII,Address:
Address:
City: State:_Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company,if any:
RECEIVED/DENR/DVVQ
crtrrtnc SA7 Well Permit Applimtice(Revised vnoo7) Aquifer?rntpHinn(section Pap I
FEB 19 2009

C. WELL DRILLER INFORMATION
Company Name.CHL7-',20KF'E 1-JELL 1DiZILLIN& i4AQI _ UMP CO-, INC.
Well Drilling Contractorls-Name: . r . O D Y,+ "i r'M=L/
NC Contractor Certification No.: Z.SS7Z
Contact Person: CNt2/s Y i k' Y 'E16IAIL Address:
Address: _ �oo9 . -H.W Y 6' Y W as T
City: _ 44 U R r-k- ,by Zip Code:-2—J, q 0(a County: 'CH a'12 0 K ET E
OfficeTeleNo. .29)hZ S'008 Ce11Ncm
D. HEAT PUMP CONTRACTORdNFORMATION(if,different than driller)
Company Name: WC)O.DA-93 OLOCTR.IC
Contact Person: (J A RS-2N 1 J 0(SD 9{LD EMAIL Address:
Address: --ti.Q C2EFKS1LR -C12CL-E
City: HAYES MLE F IjC Zip code: Ziff 0W County: CIA Y'
Office Tole No.:692AW?- 8/36 Cell No.:
a
E. STATUS OF APPLICANT
Private: Federal: Commercial:
State:_ Municipal: Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s)will be used)
U 'LL WArM L4 USED F=bfL a-lSAT 1'bCKe Tb HaT-/COOL (-!Ouse.
--PAP.T 0f WAV9 iS rT. -i, NhrD- TD WpLL M19 ikT 1S TAIA10.
G. WELL USE Willtbe injection well(s)also be used as the supply well(s)for the following?
(I) The injection operation? YES ✓ NO
(2) Personal consumption? YES Z NO
H. WELL CONSTRUCTION DATA(Skip to Section I if tliis is a Permit RENEWALI
PROPOSED-VVll(s) to be constructed for'uso as an injection well. Provide the data in (1)
through (7) below as PROPOSED construction specifications. Submit Form GW-1 after
construction.
EXISTING Well(s)being proposed for use as an injection well.Provide the data in(1)through
(7) below to'the best of your knowledge. Attach a copy of Form GW-1 (Well Construction
,:Record)if available.
(I) Date to be constructed: Number of borings:
Approximate depth of each bo ing(feet):
(2) Well casing. Is the wells)cased?(check either(a.)YES or(b.)NO below)
(a) YES If yes,then provide the casing information below.
Type: Galvanized steel_Black steel_Plastic_Other(specify)
Casing thickness:_diameter(inches): depth: from to it.(reference to land surface)
Casing extends above ground inches
GPU/UIC 5A7 Well PennitApplicatim(Revised 9/2007) Page 2

(b) NO
(3) Grout(material surrounding well casing and/or piping):
(a) Grout type: Cement_ Bentonite_ Other(specify)
(b) Grouted surface and grout dejith'(refercuce to land surface):
Around closed-loop piping;from to (feet).
.._ Around w-eII'casing;from' to (feet).
(4) Well(s)Screen Information
Depth of Screen:"From to feehbelow land surface
N.C. State Regulations `(Title l5A NCAC"2C .020 `reu te ? mto make,
-quire ` e .provisions for
monitoring'wellhead water quality and processes. A f tuceC on both-Influent (groundwater entering heat
pump)and Effluent(water being injected back into the well)lines is required. Will there be a faucet on:
(a) Influent line? Yes_No_ (b) Effluent line? Yes_No_
(6) Source Well Constnictioa Information(if the water sourcewell is a different well then the injection well)
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,provide the
following data:
Groundwater Source. From what depth,'formation, and type of roeWsediment units will the groundwater
be withdrawn? (e.g.granite,•limestone,sand,etc.)
Depth: Formation: Rock/sediment unit:
NOTE: THE WELL DRILLING coNTRAcrOR CAN SUPPLY THE DATA FOR EMIER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION IS UNAVAn Aar E BY OTHER MEANS.
L OPERATING DATA Ljpernj Net r PuHP LP
(1) Injection rate: Average(daily)--Lgallons per minute(gpm). U SUM
j•(2) Injection Volume:. Av cup(daily) gallons per day(gpd). ONLY WIN7MA(IMMOR
(3) Injection Pressure: Average(daily)SO pounds/square inch(psi).
(4) Injection Temperature: Average(January) °F,Average(July)_°F.
- i-i e71'r ptaMP 13 u[t:'D Air DUT 4, TO 1 N O KR IPAX IN kV/N78X t,PUr A#drR
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
IL LOCATION OF WELL(S)
Attach two copies of maps showing;the following.information;; r
1 Include a site " ' .. ' `.' i
( ) map(can be drawn)showing:bnldin'gs,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.
GPU/UIC SA7 Well Permit Application(Revised 9/2007) ' ' 'Page 3

I.. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information,I believe that the information is true,accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct,operate,maintain,repair,and if applicable,abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditions of the Permit."
Signature of Property Owner/Applic
JOHANNEJ -PEIVZ
Print or Type Full Name
Signande of Property Owner/Ap2oOt
MAY�!Q �h Z
Print or Type Fall Name
Signature of Authorized Agent,if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
TAC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
Telephone [phone]
GPUAHC 5A7 well Permit AppGwtion(Revised 9/2007) Page 4

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- i
� �.

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 24,2009
Johannes Penz
Martha Penz
667 Keener Rd.
Murphy.NC 28906
Subject: Acknowledgement of Application No.WI0100023
Penz,Johannes&Martha-SFR
Injection Heating/Cooling Water Return Well(5A7)
Cherokee
Dear Mr. and Mrs.Penz:
The Aquifer Protection Section of the Division of Water Quality(Division)acknowledges receipt of your permit application and
supporting materials on February 19,2009.This application package has been assigned the number listed above and will be reviewed
by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications,the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office,copied below,must provide recommendations prior to final action by the
Division. Please also note at this time,processing permit applications can take as long as 60-90 days after receipt of a complete
application.
If you have any questions,please contact Michael Rogers at 919-715-6166,or via e-mail at [e-mail]. If the
reviewer is unavailable,you may leave a message,and they will respond promptly.Also note that the Division has reorganized. To
review our new organizational chart,go to htto://h2o.enr.state.nc.us/documents/dwq_orgchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincer y,
for Debra J.Vatts
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit Application File WI0100023
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636
Location:2728 Capital Boulevard,Raleigh,North Carolina 27604 One
Phone:[phone] FAX 1:919-715-0588;FAX 2:919-715-60481 Customer Service:1-877-623-6748 North Carolina
Internet vrwx.narateraualitv.ora ��I�„����
An Equal opportunity i Alhmm ve Action Empbyer t L

North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
[phone]
17. Feb. 2009
Johannes and Martha Penz
667 Keener Road
Murphy,NC 28906
Dear Mr.Rogers,
This permit application for renewal will be due later this year. Because we are planning a
longer absence from our home with occasional short returns we would like to ask you to
vethis nextinspection done a ore o arc rs possr
Our house is very well insulated and it therefore requires only limited times of heating in
winter and cooling in summer. We heat the house mainly with wood. The only return
water flow is through our geothermal Trane heat pump.
Thank you for your consideration in handling this soon.
Best regards,
Johannes and Martha Penz
RECEIVED/DENRIDWQ
Aquifer Protection Section
FEB 19 2009

AQUIFER PROTECTION SECTION �1 j FEB 2 A 2�'-
APPLICATION REVIEW REOUEST FORM
Date: February 23 2009 sw�c/ DENR R
To: andon Davidson,ARO-APS 4� ❑ David May,WaRO-APS
*Art Barnhardt, FRO-APS ❑ Charlie Stehman,WiRO-APS
❑ Andrew Pitner, MRO-APS ❑ Sherri Knight,W-SRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone] Fax: [phone] MAR 0 4 209
E-Mail: Michael.Rogers(a.nemail.net
A. Permit Number: WI0100023
B. Owner: Johannes and Martha Penz
C. Facility/Operation: __
❑ Proposed ® Existing ❑ Facility El Operation
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface hrigation❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation(ND)
® UIC—5A7 Geothermal well
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.
NOTE: Permittees have requested the site be inspected and permit re-issued by end of March as
they will be unavailable for most of the rest of the year. Please expedite inspection.
THANKS.
Attached, you will find all information submitted in support of the above-referenced application for your
review,comment, and/or action. Within,please take the following actions:
® Return a Completed APSARR Form and attach laboratory analytical results,if applicable.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: Date:
FORM:APSARR 07/06 Page I of I

North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
[phone]
17.Feb.2009
Johannes and Martha Penz
667 Keener Road
Murphy,NC 28906
Dear Mr. Rogers,
This permit application for renewal will be due later this year.Because we are planning a
longer absence from our home with occasional short returns we would like to ask you to
ve this next inspection done a ore o arc s is posse
Our house is very well insulated and it therefore requires only limited times of heating in
winter and cooling in summer. We heat the house mainly with wood. The only return
water flow is through our geothermal Trane heat pump.
Thank you for your consideration in handling this soon.
Best regards,
O
Johannes and Martha Penz
RECEIVED IDENRIDWQ
Aquifer Protection Section
FEB 19 2009

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES;(NCDENR) ..
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S)FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5-A7 WELL(S)
New Permit Application OR _J�Renewal(check one)
DATE: Fe-8- /S 20DI?
PERMIT NO. (leave blank if NEW,permit application)
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed(if owned by a business or government agency,state name of
entity and a representative w/authority for signatuie): JO HA N IVe-S P e N z n wol
(1) Mailing Address: 447 k t;C' N uR }2J7 .
city: A4 UR P H/ State: Zip Code: 2 .� k 6 County: EftrIz0KQ�rF
Home/Office Tale No.: A0 28 -837- 6 4 4 6 Cell No.:
EMAILAddress: ApehZ0 -'Yi^County.Matti nC, US
(2) Physical Address of Site(if different than above): Sa K Le-
City: State:_Zip Code: County:
Home/Office Tele No.: Cell No.:
EMAIL Address:
B. AUTHORIZED AGENT OF OWNER,IF ANY(if the Pennit.Applicant;does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company.Name:
Contact Person: EMAIL Address:
Address: ,v
City: State:_Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company,if any:
RECEIVED/DENR/DWC
GPU/UIC 5A7 Well Permit Application(Revised 9/2007) Aquifer Protontinn S,?cfion Pagel
FEB 19 2009

C. WELL DRILLER INFORMATION
Company Name: C H Erg 0 K e Er WELL IZILL(NG- AAlb PUMP CO3 INC
Well Drilling Contractor's Name: '3 O.D Y, • M LF L.L 1 .9
NC Contractor Certification No.: 2.3-7Z
Contact Person: CY4I5 .DICK 8_Y 'EMAIL Address:
Address: (Fs? H W Y 6 Y b..1 L S T
City: ILl U Ft P(-(y aC Zip Code:-2.? 4 0 G County: CH LY2 0 K E E
Office Tele No. 4, 3 7,T D O 8 Cell No.:
D. HEAT PUMP CONTRACTOR INFORMATION(if different than driller)
Company Name: W0QJ_? 69J aLGsC_TF.IC
Contact Person: W A PURN I J 0 0 AILD EMAIL Address:
Address: V C2G-F_XSI0R C12CL.1=
City: HAYCS V(LLF,AJC Zip Code: A7 8*QO)I County: CLA Y
OfficeTeleNo.:�,92 )35?- SI36 CellNo.:
E. STATUS OF APPLICANT
Private: Federal:_ Commercial:
State:_ Municipal:_ Native American Lands:_
F. INJECTION PROCEDURE (briefly describe how the injection well(s)will be used)
WLfLL WArm L4 we-, Miz J-( _AT PuKP 717 I- e-A-r&OOL HOuSLF.
(PART OP WAIM IS RI=TU2NrD 7V WE!I-L AAID iPi427 IS 2RAIN0.
G. WELL USE Will the injection well(s)also be used as the supply well(s)for the following?
(1) The injection operation? YES ✓ NO
(2) Personal consumption? YES Z NO
H. WELL CONSTRUCTION DATA(Slip to Section I if this is a Permit RENEWAL)
PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1)
through (7) below as PROPOSED construction specifications. Submit Form GW-1 after
constriction.
EXISTING Well(s)being proposed for use as an injection well.Provide the data in(1)through
(7) below to the best of your knowledge. Attach a copy of Form GW-1 (Well Construction
Record)if available.
(1) Date to be constructed: Number of borings:
Approximate depth of each bo ing(feet):
(2) Well casing. Is the well(s)cased?(check either(a.)YES or(b.)NO below)
(a) YES If yes,then provide the casing information below.
Type: Galvanized steel_Black steel_Plastic_Other(specify)
Casing thickness:_diameter(inches): depth: from to ft.(reference to land surface)
Casing extends above ground inches
GPUfMC SA7 Well Pennit.Application(Revised 9/2007) Page 2

(b) NO
(3) Grout(material surrounding well casing and/or piping):
(a) Grout type: Cement_ Bentomte_ Other(specify)
(b) Grouted surface and grout depth"(reference to land surface):
Around closed-loop piping;from to (feet).
Around well casing;from to (feet).
(4) Well(s)Screen Information
Depth of Screen: From to feet below land surface
(5) N.C. State Regulations (Title 15A NCAC 2C .0200)'require the'Pemuttee'to make provisions for
monitoring wellhead water quality and processes. A'faucet on both Influent (groundwater entering heat
pump)and Effluent(water being injected back into the well)lines is required. Will there be a faucet on:
(a) Influent line? Yes_No_ (b) Effluent line? Yes_No_
(6) Source Well Constmction'Information(if the water source well is a different well than the injection well)
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,provide the
following data:
Groundwater Source. From what depth, formation, and type of rock/sediment units will the groundwater
be withdrawn? (e.g.granite,limestone,sand,etc.)
Depth: Formation: Rock/sediment unit:
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
I. OPERATING DATA WHEW K6wr POMP is
(1) Injection rate: Average(daily) 00 gallons per minute(gpm). USED
t(2) Injection Volume: Average(daily) gallons per day(gpd). ONLY W(NI'BR1JaKMgR
(3) Injection Pressure: Average(daily)_5"Q pounds/square inch(psi).
(4) Injection Temperature: Avenge(January) °F,Average(July)_°F.
(- HEAT Pttmia IS t4gn ft m4r Jy To I NoKIt/,PAY IN W/n/TVX ffur''�9R
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
K. LOCATION OF WELL(S)
Attach two copies of maps showing.the following-information:
(1) Include a site map(car&"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:septic4anks 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.
GPU/UIC 5A7 Well Permit Application(Revised 9/2007) Page 3

L. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information,I believe that the information is true,accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and impprisonment, 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."
Signal&of Property Owner/Applic
ZJOHANNE-,S PLNZ
Print or Type Full Name
���� _
Signan re of Property Owner/Ap ' t
Jt?at-lAg- z
Print or Type Full Name
Signature of Authorized Agent,if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/WC 5A7 Well Permit Application(Revised 9/2007) Page 4

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L� 02/26/2009 17:42 919-715-0588 NCDE&NR/WATER QUAL PAGE 01
OWV:c V1 wVitn %-WVIIna V1^1111Zj9
.Department of Environment Vie' pG.
and Natural Resources
Division of Water Quality > 1
0
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
Division of Water Quality -
Aquifer Protection Section RECEIVED
Location: 2728 Capital Blvd.
Raleigh, NC 27604 FE3 2 g 2C09
Mailing Address: 1636 Mail Service Center ✓
Raleigh, N.C. 27699-1636 Asheville Regional Office
FAX: [phone] 1 Aquifer Protection
[phone]
FAX TO: Al FAX NUMBER:
FROM: /1iI- r�1G"�S
PHONE:
NO. OF PAGES INCLUDING THIS SHEET:
If you receive this fax by mistake call: Aquifer Protection Section @ 919-733-3221

r 02/26/2009 17:42 919-715-0568 NCDE&NR/WATER QUAL PAGE 02
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: February 26. 2009
To: ® Landon Davidson,ARO-APS ❑ David May,WaRO-APS
❑ Art Barnhardt,PRO-APS ❑ Charlie Stehman,WiRO-Al
❑ Andrew Pitner,MRO-APS ❑ Sherri Knight,W-SRO-APS D
❑ Jay Zimmerman,PRO-APS c_ °'`
T, ro]
tp r n
From: Michael Rogers Groundwater Protection Unit cfl 0 Telephone: [phone] Fax: [phone]
E-Mail: Michael.Ro ers cmailm a :3
o M
A. Permit Number: WI OI00023 ; co
n
m
B. Owner: Johannes and Martha Penz
!Now�mw,x Tun- S:'tiG A
❑ Proposed M Existing ❑ Facility ❑ Operation
D. Application:
1. :2?'e
T.-.,...., &x..ririt»�: ❑ Animal ❑ SFR-Surface lrrigarion❑ Reuse 0 H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation(ND)
M UIC—Sift Geothermal well
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2 New ❑ Major Mod. ❑ Minor Mod. M Renewal R Renewal w/Mod.
E. Comments/Other lnformation: ❑ I would like to accompany you on a site visit.
NOTE- Permittees have requested the site be inspected and permit re-issued by end of March as
they will be unavailable for most of the rest of the year. Please expedite inspection if possible.
THANKS.
Attached, you will find all information submitted in support of the above-referenced application for your
review,comment,and/or action. Within,please take the following actions:
® Return a Completed APSARR Form and attach laboratory analytical results,if applicable.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the PLO-*
* Remember that you will be respoosible 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 rerun it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer- / Date;
FORM:APSARR 01106 Pap 1 of 1
t,

02/26/2009 17:42 919-715-0588 NCDE$NR/WATER QUAL PAGE 03
f.
NORTH CAROLMA
DEPARTMENT OF ENVIRONMENT AND NATURALS RES0UXCESkNMFNft)
e+PPLICAf ION FOR-PERMT'TO'CONSTRUM AND/OR'USE'A WELL(S)F6k
..INJECnONVirL'I'I3AGLOTHEPIMIALMAT.PUNIP'SYSMMF'OR-. :-.':
T)ZPE S A 7 fSl L
New Permit Application Ok i! Renewal(check one)
HATE: PUB- lS• 20Q
PERNUT NO. (leawblahkif NEW.penniitvoliwtion)
Ac- PROPIERTY•OWNER(S)/APPLICANY`W-'
Lisegt Property Owuer7iatid on piopcM-deed, fuwnedd'by a busineii:or govcmmeDn agency,state name of
eatityund a represeatuti vc wlaWhoritg fw sipAmie): e.J p.f'H/3=1F1 t �S
t.rlc ,E'EN
(>) 1v4ailing Address: 6.7 k P7ps;N E-p— .
city: /t. UR P!f y Stan: NCzip rodc:__4S_90 6 county �tzoKc�F*
5o=/Office Tele No.;
EMAMAddresa: 1�,bz �Yi^Lpunt�,- ytaiYl. riGr us
(2) Physinal'AdthnSSO£Srte'fifdifferevtthan 8liove): I Q'wt C
City.'• State:_Zip-Code: Caumy
Homc/Of$co Telo No.: Cott No.:
PMAILAddtess:
B. ADTIIORiZEbliGENTDFOWNER IF.ANY,(if the PmnitApplicaot,doeanotmxmfae.subjectproperty,
aHach a letter from the pmperty owner authorizing Agent to init ll and operate i 11C well)
Company,Name:
Contact Person: . _ E Ad&Psb:
i .. Ji.
Address:-_ --
City: State:—Zip Code: County:
Office Tole No.:
Websim Address of Company,if any:
RECEIVED I DENR I DWQ
GPU'Ri1C SA7Wc11 PecmitA2Pliraow(kcvieul9l2na7j •AGui18r'Pm4pr:tinnsgdon Page'1
FEB 1.9 2009

02/26/2009 17:42 919-715-0588 NCDE&NR/WATER QUAL PAGE 04
C. WELL DRIL ]pSR 110ORMATION
C°mRanyMine:CH RiUkQ� [JEi L; :(7(LiZLftJG f :f^ltF'lA Cal r I Nr-.
' WaIlDrilliagContractor:'s3Qamt: , •. : ;��:A.�l!+ '++rl�(:f:•{,�..;1.�`�': : •.: . .,.:: ,••
NC ContractorCcrtifimtionNo: ZT7Z
contaet Person; 01413
it u 9ddiess:
Address:.. ES T`. .
City; tit-U•R-P•-(y NC• zip'code:-2 . R D 6 eoantr: HER O ce r,
OffiecTdcNo.�.?R�A37,-, SOB Ceu-Ao-:
D. HEAT PUMC CONTRACTOR+INFOItItSA=ON•(Md18emt1h=drMor)
CompanyNatne: Jn10ba &RJ gf-0 9YZ(c
Contact Person:.. WAM-M l iQUAIZ- 1 BMAHL Addtegg:
Address: tf� C2C6kSl 'G1RC!
City: HAVESVif-LE,1C zipcadc: 2_tf Q01/ COMM _ 'aA�e'
OffrceTeleNcu(s zee! /3(a Cell No.:
E. STATUS OF APPLICANT "
Pdi+ate: � '-Fuleril � . • Comineraal^� --... .
State:T Municipal: Native American Lavds:_
F. EMCTION PROCEDURE (briefly describe bow the injection wells)will be used)
WLTLL WArm 14 trJej MR 14 Al T'ursp Tb, (4F{A7 ZCDOL House.
. . „ .
Akr Or- WATK' tw I�4l�71tt2rtl�D N 1a7pLL AVD PAR7 fS aI�AlN D.
G. WFLL USE Willthc`iojecfion well(s)siso-be used as the supply well(s)'fdr the following?
(1) The injection operation? YES ✓ NO .
(2) Personal consaaiptioa7 YES NO
H. WELL'CONSTRUCTION DATA fSkh)to 6edtlon I if"it' Permit RENEtVAL) '
PROPOSED Well(s)to be constructed foiuse as'an injection well. Provide the data in (1)
throw C7) below as PROPOSED eonstntction specifications. Submit'Fomt GW-1 after
Waslntction.
EXISTING Welf(s)being proposed for=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.
(1) Date to be constructed: Number ofboriags:
Approximate depth of each bo ing(feet):
(2) Well casing. Is the wells)cased?(check eithor(a.)YES of(b.)NO below)
(a) 'YES If yes,then provide the casing information,below,
Type:Galvanized steel__Black steel-Plastic—Other(specify)
Casing thickness:_____diameter(inches): depth:from to R(reference to lend surface)
Casing extends above ground inches
GPUAHC SA7 Wen PeauitAppliastim lmio?A.OaO0✓) Pap 2

02/26/2009 17:42 919-715-0588 NCDE&NR/WATER QUAL PAGE 05
(b) NO
(3) Grout(material surrounding well basing and/or PtPtng):
(a) Grout typo: Ccmauo Bentonite_ Other(specify).
(b) Greukd surface and grout dap`t'G'(tz Terence to land smdacc):
Aro=d closed-loop piping,from to (fret)
Around well'caaing•'from, to
(4) Well(s).Screen,rnformation
Dcpfh of 6ccean '3 men to face below land sarfacc '
(9) N,C.' Stak, Rebtilations '(Titly'lSti TICAC'2C .0200) ia�(ttire the'Petmittee to make„provisouts for
moxi turittg wellhead Waicc qualify twd processes.'`A fffiiibef oit tioth'Iaflttent(gintiadwat4 oftfrag heat
pump)and Effluent(waterbeing injected back into the well)lines is nquired, Will there be a faucet on:
(a) Intluar liue? Yes No— (b) Ef luem line? Yes_No
(6) Source We1PCon9tnicdop in£oiipz tiOri(if the water source well is it diffeat'ut well than the injection well)
Attach a copy of Farm GW-1 (Well Construction Record). IfForm OW-1 is not available,provide the_
following data:
Groundwater Source. From what depth,'formation,and type of TO&Jsedbuent twits will the groundwater
be withdrawn? (e.g•granito,44i stone,sand,
Drrtlr Formation: Rocklsadimenitmit
NOTE: THE WEM DMLLINOCONTRAGTOR CAN,SUPPLY THE DATA FOr EITALRF.7t MNG(aMOPOSED WELLS IF
TIES WWRMATIDN is UNAVAII.h=*J3Y oTHM MEANS,
L OPERATWO DATA W(!Q!J iie& -PUMP u'
(1) Injection rate: Average(daily)— p gallons per minute(gpm). U-T 6P
ik(2) InjcctiouVohuxam Avwage(d0y) gallon sper day(Vd). ON(yLlINTW Ja &tmgK
(3) Injection Pressure: Average(daily) _poumddspara inch(psi).
(4) lujection Temperature: : .Average(Ianuery) °F,Average(Iuly)__-_,°F.
11 i Pw^tP !8 ufBD i9'[3DI.LT 1,F- 7D I koKnIyAX IN W/N7Mtfu�+/wB72
J. INJECT[ON•RELATER EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
Piping/tubing associated'with the injection optration. The manufacn='s brochure may provide supplementary
information.
I{ LOCATION OF VVEWS) `
Attach two copies of maps.showinKthefnllowin&Wmma on:: ,::•:•;
t
(1) hteiude a site map(can)rc dmwd)sliowing: VuildihA prdparty lines,surface water bodies,potential sources
of groumdwatar coptamination and%ft;' i 6iction of and distances between the proposed well(s) and any
mstimg well(s)or waste;d*osai facilities such;as.septietanics or dram fields located within 1000 feet of the
geothorm4 beatpump well system, Labclatl.fcatures.clearly and inchuie 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 iha ivajs name:
OPMUYC SA7 Wdl Peabit Applicafi=akrz Sad 9/2DD71 :P'Ze 5

02/26/2009 17:42 919-715-0588 NCDE&NR/WATER QUAL PACE 06
I . r
I— CEBTMCA.TION
Note: This Ferodt Application must be signed by caclk person appealing on the
worded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this docamcnt and all attachments thereto and chat, based on try inquiry of those iadividuas
immediately responsible for obtaining said information,I believe chat die information is true,accurate and complete.
I am aware that there ate significant penalties, including the possibility of fines and imprisomnavt,for submitting
false information. I agree to construct,operate,mainrain repgjr,and if applicable,abandon the injection well and
AU ielated appurumaaceg in acecrd=.e with.the approved specifications and conditions of the Permit"
Signallie
of Property Owner/ApplicafiO
�JOHA•NNE"S PE/VZ
Print or Type Full Name
�
• Signature ofPropetty Owncr/A&156t
Print or Type Feint Name
Signature of Authorized Agent,if any
Print or Type Fall Name
Please retnm two copies of the completed Application package to:
North Carofta'DENR-DWQ
Aqui€er Protection Section
UIC.Program
1636 Mail Service Center
Raleigh,NC 27699-1636
Telephone [phone]
GPTJAno 5A7 Well Permit Application(Rmmd Mow) Page 4

02/26/2009 17:42 919-715-0588 NCDE&NR/WATER (DUAL PAGE 07
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02/28/2009 17:42 919-715-0588 NCDE&NR/WATER QUAL PAGE 09
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02/26/2009 17:42 919-715-0588 NCDE&NR/WATER (DUAL PAGE 10
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H.Sullins Dee Freeman
Governor Director Secretary
February 24,2009
Johannes Pent
Martha Penz
667 Keener Rd.
Murphy.NC 28906
Subject: Acknowledgamentof Application No.WIOI00023
Penz,Johannes&Martha-SFR
Injection Heating/Cooling Water Return Well(SA7)
Cherokee
Dear Mr.and Mrs.Penz:
The Aquifer Protection Section of the Division of Water Quality(Division)acknowledges receipt of your permit application and
supporting materials on February 19,2009.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 now 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 at919-713-6166,or via e-mail at michael.rogers&cmaiLnet. If the
reviewer is unavailable,you may leave a message,and they will respond promptly-Also note that the Division has reorganized.To
review ournew organizational chart,go to http•/7h'po enr state.nc usLdLcuments/dw or_-chaft. dE
PLEASE REFER TO THE ABOVE APPLICATION NIJhMER WHEN MAMG INQUIRIES ON THIS PROJFCT.
Sincer y,
for Debra J.WVatts
Supervisor
cc: Asheville Regional Office,Aquifer Protection Section
Permit Application File W10100023
AQUIFER PROTECTION SEGTION ,
1636 Mail Service Center,Raleigh,North Carorma 27609.1636
Lowoon:272E Capital Boulevard,Raleigh,North Caroline 17604 One
Phone:[phone]k FAX 1;919715-058a;FAX 2:919.715.0049ICmtomarServioe;1.877$2MI46 Noz'thCarolina
Intemee vrvrx.ncwaterauarm ��. ��//,+
An Egprl Opponunily WfirMWO Aden 6mpoyer Ll[�

02/26/2009 17:42 919-715-0588 NCDE&NR/WATER QUAL PAGE 11
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
[phone]
17.Feb.2009
Johannes and Martha Penz
667 Keener Road
Murphy,NC 28906
Dear Mr.Rogers,
This permit application fbr renewal will be due later this year.Because we are planning a
lon er absence from our home with occasional sh6rt returns we would like to ask you to
ave this next inspection done ore e 1 rs possr
Our house is very well insulated and it therefore requires only limited times of heating in
winter and cooling in summer, We heat the house mainly with wood. The only return
water flow is through our geothermal Tram heat pump.
Thank you for your consideration in handling this soon.
Best regards,
Iohannes and Martha Penz -
RECEIVED IDENR1DWO
Aquifer Protection Section
FEB X 9 2003

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CIT C tx,_1 Ci 0007-3
DIVISION OF WATER QUALITY
Chemistry Laboratory Report/Ground Water Quality Lab Number 5GO242
Dak Received : 2/9/2005
COUNTY : CHEROKEE SAMPI F PRIORITY Time RemivM 9:00AM
QUAD NO: DROUTINEEMERGENCY Received By US
REPORTTO ARO Rcgi..l Office CHAIN OFCUSTODY
COLLECTOR(S) :TMINNICK INF ReleesM By : )C
DATE: Iaam WD SAMPLE TYPE DakrePurtM: N14n(105
TIME: l�
PURPOSE: Owner: 6E KEENER U)AD
Location or Sire:
Description of sampling point
Sampling MethM:
Remarks:
LABORATORY ANALYSIS
BOD310 m Dias.Solids 703W m A -SiNer46566 u emshkmne Pesticides
COD High 340 Fluoride 951 m % AI-Aluminum 46557 S.OU u o hos hams Pesticides
COD Low 335 m9/1. Hind..:total 900 /L As-Arsenic M551 u Nivogen Pesticides - —
Cmilorm:MF Fecal 31616 /IOOmI Hardness:(non-cart,)902 ttrg/L Ba-Bmium 46558 u
Coliform:MF Total 31504 /100mI Phenols 32730 ug/L X Ca-Caldum 46552 3.2 Acid Herbi kks
TOC -801 Spocific Cond.95 umhos/cm2 Cd-Cadium 46559 ug/L 'tom •�j
Tarbitity, NfU Sulfam mg/L X Cr-Chromium 46560 25U u Semivolimles
Rasidue..S.,pdd 530 Sulfide 745 m /L X Cti-Cppa IM2 42 a TPH-Diesel Rats e m 7 . sy �JI
Total SuapaMM solids .911. MBAS mgtL X Fe-Iran 1045 50U u z y 1
Oil ami Go. m H -Mem 71900 a Volatile Organia(VOA bank)
H units Silica /L X K-Potassium 46555 0.41 m p4•; 7 M aPT_
Allmlini(y in PH4.5 m Boom R I Mg-Magnesium 927 2.3 mg(L TPH-Gasoline Ran a IjJw
Alkalinity to PH 8.3 m Formaldehyde t T/L X Mn-Man anew 1055 10U ug/L TPH-BTEX Gasoline Ran e
Carbon.¢ M91L NH3 as N 610 mg/L R Na-$Mlnm 929 5.4 mg/L
Bicarbonate m TKNu N625 mgfL X Ni-Nickd IOU u �-
Cmbmt dioxide m X NO2 aNO3 as n 630 0.03 m X Pb- o d 46564 10U a rv1 —
X Chloride 1U m P:Total as P665 nng ScSalenium a -
Chromium:Hex 1032 u PO4 m /L X ZnyrK 46567 34. --'---'-' -
Color.Ttue 80 Niwte(NO,as N)620 mg/L
Cyanide 720 mg/L Nitrite(NO,as N)615 mg/L
COMMENTS:
aGOIDrx

f ) Q OCR North Carolina
GROUNDWATER FIELD/LAB FORM
"L' �� / �� Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
SAMPLE TYPE SAMPLE PRIORITY _
/r
County. (.'i/c�f-(J cr ®,Water ®. Routine Lab Number 12
Quad No Serial No. ❑ Soil ❑ Emergency f/r,/� Date Receive a Tim
Lat. S��3.3( Long. 74°00,7*7 ❑Other Rec'd By rom:Bu Courier Hand Del.,
❑Chain of Custody Other.
Report Tc: 'RO FRO, MRO,RRO,WaRO,WiRO, Data Entry By: Ck:
WSRO, Kinston FO, Fed.Trust, antral , Other: UT�.-C't+ Date Reported:
Shipped by:Bus ourier�Hand Del.,Other: Purpose:
Collector(s)7 9/nlnfr CA'— Dated d` cs Time
Ow/74 Baseline,Complaii omp�)LUST, Pesticide Study, Fe eral Trust,Other.
FIELD ANALYSES ner �FAfiJCS ���� �
pH 400 Spec.Cond.94 at 25°C Location or Site f,A-7 Eait pieT� ZK d
.ln Temp °C Odor Description of sampling poin Ru0✓r
Appearance Sampling Method 490 Sample Interval
Field Analysis By: Remarks "m° d1QLB4
LABORATORY ANALYSES (Pumping time,air temp.,etc.)
BOD 310 mg/L Diss.Solids 70300 mg/L Ag-Silver46566 u /L Or anochlodne Pesticitles
COD High 340 mg/L Fluoride 951 mg/L AI-Aluminum 46557 u /L Organaphosphows Pesticides
COD Law 335 mg/L Hardness:Total 900 in As-Arsenic 46557 u /L Nitrogen Pesticides
Coliform:MF Fecal 31616 /100m1 Hardness(non-carb) 02 mg/L Ba-Barium 46558 unit. Acid Herbicides
Colifann:MF Total 31604 /100ml Phenols 32730 ug4 Ca-Calcium 46552 m /L PCBs
TOC 680 mg/L Specific Cord.95 uMhos/cm Cd-Cadmium 46559 u 1L
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 u /L
Residue,Suspended 530 mg/L Sulfide 745 mg/L X Cu-Copper 46562 u /L
Fe-Iron 46563 u IL SemNolalile Organics
Oil and Grease mg/L Hg-Mercury 71900 u /L TPH-Dlesel Range
pH 403 units K-Potassium 46555 moll-
Alkalinity to pH 4.5410 mg/L M9-Magneslum 46554 m tL
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 u /L Volatile Organics(VOA battle
Carbonate 445 mg/L NH,as N 610 mg/L Na-Sodium 46556 m /L TPH-Gasoline Range
Bicarbonate 440 mg/L TKN as N 625 mg/L NI-Nickel u /L TPH-BTEX Gasoline Range
Carbon dioxide 405 mg/L NOr+NOr as N 630 mg/L Pb-Lead 46564 u 1L
Chloride 940 mg/L P:Total as P 665 mg/L Se-Selenium g 1L
Chromium:Hex 1032 _ug/L Nitrate(NO3 as N)620 mg/L Zn-Zinc 46567 u /L
Color:True 80 cU XNitrite(NO2 as N)615 mg/L LAB USE ONLY
Cyanide 720 mg/L
Temperature on arrival:
Lab Comments
GW-54 REV.7103 For Dissolved Analysis-submit filtered sample and write'DIS°in block.

NC DENR/DWQ Laboratory
Report to:_ARO Sample Anomaly Report(SAR)
Lab Number: 5G0242 Sample ID: INF ;
Station Location: Johannes Penz County: Cherokee Region: �r
.sample Type: Well Priority: Routine Collector: T.Minnick
Date collected: 2/07/2005 Date received: 2/0 912 0 0 5 Date analyzed: 2/2005
'Affected Parameter(s): NO3,NO2
Analytical Area(check one):
❑WCH ❑METALS ❑VOA ❑SVOA
®NUT ❑MICRO ❑PEST
The following anomalies occurred(check all that apply):
[]Samples ❑Quality Control
❑Improper container used ❑Instrument failure—no reportable results
❑VOA vials with headspace ❑Analyst error—no reportable results
❑Sulfide samples with headspace []Surrogates
❑Samples not received,but listed on fieldsheet ❑None added
❑Samples received,but not listed on fieldsheet ❑Recovery outside acceptance limits
❑Mislabeled as to tests,preservatives,etc. []Spike recovery
❑Holding time expired [—]None added
❑Prior to receipt in lab ❑Recovery outside acceptance limits
❑After receipt in lab ❑Failed to meet criteria for precision
[]Insufficient quantity for analysis ❑Intemal standards
❑Sample exhibits gross non-homogeneity ❑Blank contamination
❑Sample not chemically preserved properly ❑QC data reported outside of controls(e.g.,QCS,LCS)
❑pH out of range(record pH): ❑Incorrect procedure used
❑Improper chemical ❑SOP intentionally modified with QA and Branch Head
❑Residual chlorine present in sample approval
❑Color interference ❑Invalid instrument calibration
❑Heavy emulsion formed during extraction ❑Elevated detection limits due to:
❑Sample bottle broken in lab-no reportable results ❑Insufticient sample volume
®Other(specify):On 2/09/2005,the Nutrients group received one sample bottle for 5G0242.The sample had been preserved
with 25%H2SO4.However,the field sheet indicated that a NO3 result and NO2 analysis had been requested.To determine a
NO3 result,two bottles of a sample must be collected and submitted to Nutrients. One bottle should be preserved with 25%
H2SO4 and chilled to 4 degrees Celsius,and the second bottle should not be acid-preserved(only chilled to 4 degrees Q.The
acid-preserved aliquot of sample is used for NO3+NO2 analysis,and the unpreserved aliquot of sample is used for NO2 analysis.
The results of these analyses are used to calculate the NO3 result.
Comments:The acid-preserved sample that was received will be analyzed for NO3+NO2,and the NO3+NO2 result will be reported.
The field sheet was edited by receiving room personnel to reflect this change.
Corrective Action:
❑Samples were rejected by DWQ Lab. Authorized by: Date:
❑Accepted and analyzed after notifying the collector or contact person and determining that another sample could not be secured.
❑Sample(s)on hold until:
[]Sample reported with qualification.Data qualification code used:
®Other(explain): Sample will be analyzed for NO3+NO2
Notification Required? ❑Yes ❑No
Person Contacted: Date:
Form completed by: ax Oveima M4[ ©ves Date:2/9/2005
Lead Chemist Re (initial):
`r1B1OCHEM OPEIT ❑SVOA
jMETALS } ❑VOA
Branch Head Review(initial): el
QA/QC Review (initial) Logged into database by(initial):
QAVo=N.abomtorysSAR ID/Z)/Dldbs

DIVISION OF WATER QUALITY
Chemistry Labomtory Retort/Ground Water Quality Lab Number 5G0243
Date Received : 2r9/2005
COUNTY : CHEROKEE CAMPI I.PRIORY Time Received : 9:W AM
QUAD NO: OROUTINE EMERGENCY Received By DS
REPORTTO ARO Regional Office CHAINOFCUSTODY
COLLECTOR(S) :T MINNICK Released By : IC EFF /
DATE: VM2005 71 SAMPLE TYPE Date rcpaned: VlArMS ,
TIME: /
PURPOSE: Owner: 667 KEENER ROAD
Location or Site: `J
Description of sampling print
Sampling Methed:
Remarks:
LABORATORY ANALYSIS
ROD 3H) Diss.Solids 70300 en/L A -Silver46566 u Or anachimma,Pesticides
COD High 340 m Fluoride 951 m ti IX .
AI-Aluminum46557 5.0U a Or arm hos hums Pesticides
COD Low 335 Hardness:lend 90() mg/IL As-Asswdc 46551 u Nino en Pesticides
Coliform:ME Fecal 31616 /loom] Hard.:ouaa b)902 m B.Barium 46558 ug/L . ---- - -
Colifam:MF Tend 31504 /loom] Phenols 32730 u Ca-Calcium 46552 3.6m Acid Herbicides --
TDC m Specific Cond.95 umhrsAm2 Cd-C dium 46559 u /L --
Turbitit NTU Sulfate m /L Cr-CTnomium 46560 25U u/L SernwolaUles
i j.U..
Residue,Suspended 530 m Sulfide 745 m/L C.C 1042 52 a TPH-Dicsel Range I
Taal Suspended solids m MBAS m Fe-Iron 1045 SOU u _Z �)i
Oil and G. m/L Hg-Mercury 71900 u Volatile Oranics(VOA bottle) ,
H ..its Silica mg/L X K-Potassium 45555 0.72m �'.Z M y J
-i]
Alkalirmy to H 4.5 mg/L Boron X Mg-Magnesium 927 2.5 m TPHGuoline Range
T
Alkalinity m PH 8.3 mg/L Formaldehyde mg/L X Mn-Manganese 1055 10U ug/L TPH-BTEX Gasoline Rasp
Carbonate mgA NH3 as N 610 mg/L X Na-Sodium 929 5.8 m 1'O S.
Bicarbonate m/L TKN as N 625 m X Ni-Nickel IOU a ! a u
r'J r
Carbon dioxide -91L X NO2 aNO3 as n 630 0.05 m X PbLcad 46564 10U a ti 221 Y u U j
X Chloride 1 U m P:Total as P 665 m Sc-Selenium ugfL
Chromium:Hex 1032 ag1L PO4 mgtL X Zn_23nc 46567 79 a /L
Color:True 80 c.u. Nitrate(NO,as N)620 mg/L -------- --
Cyanide720 m9/1- INibitc(NO,as N)615 mg/L
COMMENTS:
at aNa

GROUNDWATER FIELD/LAB FORM 1 — North Carolina
��� ✓rt,� 0�QQ(�Z 3 Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
/� SAMPLE TYPE _ SAMPLE PRIORITY
County_ (.��!-t:?-�O",L�- IK Water Routine Lab Number
Quad No Serial No. ❑ soil Emergency Date Received m
Lat. f°C3,jJ / Long._rQQ-0 ec) '779' Other Rec'd By: ��From.Buaune Hand Del.,
❑Chain of Custody Other:
Report T .AR O, MRO, RRO,WaRO,WiRO, _ Data Entry By: Ck:
WSRO,Kinston FO, Fed.Trust ntral O Other: ��! Date Reported:
Shipped by: Bus J Hand Del.,Other: PWose:
Collector(s): lIC — Date d Time O
Baseline, Complain omplian e�LUST, Pesticide Study, Federal Trust, Other:
FIELD ANALYSES Owner —iGt�i}Jyn S lie Idr °°"a)
PH 400 Spec.Cond.94 at 25°C Location or Site /mil r/ eNeYL hJdW-W) -2 .
Temp.lp / 2, °C Odor Description of sampling point
Appearance Sampling Method Sample Interval
Field Analysis By: Remarks pm.. 1er.ee,
LABORATORY ANALYSES (Pumping Ume,air temp.,etc.)
BOD 310 mg/L Diss.Solids 70300 mg/L Ag-Silver 46566 u /L Or anochlorine Pesticides
COD High 340 mg/L Fluoride 951 mg/L AI-Aluminum 46557 - u /L Or ano hos horns Pesticides
COD Low 335 mg/L Hardness:Total 900 Tg1L As-Arsenic 46551 u /L Nitrogen Pesticides
Coliform:MF Fecal 31616 /100m1 Hardness(non-cart)902 mg/L Ba-Barium 46558 u A. Acid Herbicides
Collform:MF Total 31504 /100ml Phenols 32730 ug/l Ca-Calcium 46552 mg/L PCes
TOC 680 mg/L Specific Cond.95 uMhos/cm Cd-Cadmium 46559 u /L
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 u /L
Residue,Suspended 530 mg/L Sulfide 745 mg/L }( Cu-Copper46562 u /L
Fe-Iron 46563 u /L Semivolatile,Organics
Oil and Grease mg/L Hg-Mercury 71900 u /L TPH-Diesel Range
pH 403 units X K-Potassium 46555 mg/L
Alkalinity to pH 4.5 410 mg/L Mg-Magneslum 46554 m lL
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 u /L Volatile Organics(VOA bottle
Carbonate 445 mg/L NHa as N 610 mg/L Na-Sodlum 46556 m /L TPH-Gasollne Range
Bicarbonate 440 mg lL TKN as N 625 mg/L FNickel a /L TPH-8TEX Gasoline Range
Carbon dioxide 405 mg/L NOr+NO3 as N 630 mg/L K Pb-Lead 46564 u g_
Chloride 940 mg/L P:Total as P 665 mg/L Se-Selenium u IL
Chromium:Hex 1032 ug/L Nitrate(NO3 as N)620 mg/L Zn-Zinc 46567 u 2
Color:True 80 Cut Nitrite(NO2 as N)615 mg/L LAB USE ONLY
Temperature on arrival:Tem `
Cyanide 720 mg/L P
Lab Comments
GW.54 REV,7103 For Dissolved Analysis-submit filtered sample and write"DIS'in block.

NC DENR/DWQ Laboratory
Report to:_ARO Sample Anomaly Report(SAR)
Lab Number: 5GO243 Sample ID: EFF
Station Location: Johannes Penz County: Cherokee Region:
dample Type: Well Priority: Routine Collector: T.Minnick
Date collected: 2/07/2005 Date received: 2/09/2005 Date analyzed: 2/2005
Affected Parameter(s): NO3,NO2
Analytical Area(check one):
❑WCH []METALS ❑VOA ❑SVOA
NNUT ❑MICRO ❑PEST
The following anomalies occurred(check all that apply):
❑Samples ❑Quality Control
❑Improper container used ❑Instrument failure—no reportable results
[]VOA vials with headspace ❑Analyst error—no reportable results
❑Sulfide samples with headspace []Surrogates
❑Samples not received,but listed on fieldsheet ❑None added
❑Samples received,but not listed on fieldsheet []Recovery outside acceptance limits
❑Mislabeled as to tests,preservatives,etc. ❑Spike recovery
❑Holding time expired ❑None added
❑Prior to receipt in lab []Recovery outside acceptance limits
❑After receipt in lab- ❑Failed to meet criteria for precision
❑Insufficient quantity for analysis ❑Intemal standards
❑Sample exhibits gross non-homogeneity []Blank contamination
❑Sample not chemically preserved properly ❑QC data reported outside of controls(e.g.,QCS,LCS)
❑pH out of range(record pH): ❑Incorrect procedure used
❑Improper chemical ❑SOP intentionally modified with QA and Branch Head
❑Residual chlorine present in sample approval
❑Color interference ❑Invalid instrument calibration
❑Heavy emulsion formed during extraction ❑Elevated detection limits due to:
❑Sample bottle broken in lab-no reportable results ❑Insufficient sample volume
®Other(specify):On 2/09/2005,the Nutrients group received one sample bottle for 5G0243.The sample had been preserved
with 25%H2SO4.However,the field sheet indicated that a NO3 result and NO2 analysis had been requested.To determine a
NO3 result,two bottles of a sample must be collected and submitted to Nutrients.One bottle should be preserved with 25%
H2SO4 and chilled to 4 degrees Celsius,and the second bottle should not be acid-preserved(only chilled to 4 degrees Q.The
acid-preserved aliquot of sample is used for NO3+NO2 analysis,and the unpreserved aliquot of sample is used for NO2 analysis.
The results of these analyses are used to calculate the NO3 result.
Comments:The acid-preserved sample that was received will be analyzed for NO3+NO2, and the NO3+NO2 result will be reported.
The field sheet was edited by receiving room personnel to reflect this change.
Corrective Action:
❑Samples were rejected by DWQ Lab. Authorized by: Date:
❑Accepted and analyzed after notifying the collector or contact person and determining that another sample could not be secured.
❑Sample(s)on hold until:
❑Sample reported with qualification.Data qualification code used:
®Other(explain): Sample will be analyzed for NO3+NO2
Notification Required? ❑Yes ❑No
Person Contacted: Date:
Form completed by: ax Overma� Date: 2/9/2005
Lead Chemist wjinitial):
'1BIOCHEM [-]PEST ❑SVOA
JMETALS ❑VOA
Branch Head Review(initial):
QA/QC Review (initial): Logged into database by(initial):
QA\F..U.bmamr,lSAR 1023alft

•
DIVISION OF WATER QUALITY
Chemim7l.Rbonbry Reptant/Orouud Wasen Quality Lab Numbs 5G0242
Data Received 2N/2ms5
COUNTY : CHEROKEE SAMPI E PRIOR m Time Received : 9:00 AM
QUAD NO: OROUTINE EMERGENCY i B D
REPORTTO : ARO Regional Office El CHAIN OF CUSTODY
COLLECTOR(S) :T MINNICK I F Released By EAS
DATE: 2L7120$ WO SAMPLE TYPE F Date reported: 5/4/2005
TIME:
PURPOSE Owner 661KEENERROAD
Location or Site:
Downpour,of sampling point
Sampling Mahod:
Remi
LABORATORY ANALYSIS
BOD310 on /L Dix,.Solids 70300 m/L A -Silva46566 aSIL orgir.himini,Pesticide
COD High 340 Fluoride 951 m X AI-Aluminum46557 50Uu Orgatnophosphmme Pesticides
COD Low 335 m Hardness:total 900 m (L As-Arsenic 46551 a Nitrogen Pesticides m I r—
Colifmm:MFFatal31616 /loom] Hardness:(ooarxb)902 m/L Ba Barium 46558 a cJ fOlij
Coliforer:MF Total 31504 1100" Phenol.32730 u X Ca-Calcium 46552 3.2 WIL Acid Herbicidea
TOC .91 specific Cord.95 umhoVcm2 Cd-CadWm Ri559 a x}
Tornitity, NTU Sulfate X Cr-Chromium 46560 25U.&IL Sanivolatiles
Residue.,Su¢ Mal 530 Sulfide 745 m 2L Cu-Copper I0Q 42 a TPH-Diesel Range
'rolal Suspended solids MBAS .911. X Fe-Iron 1045 50U us/L1' �!
Oil and Orcue m H -Mac 71900 u Volatile Gr anic&(VOA book) I-� _�
H units Silica m X K-Poinaium46555 0.41 Ji f.
Alkalinity to pH 4.5 Boron X M -Ma rusium 927 2.3 m TPH-Gasoline Range
Alk.Jmitym H8.3 m Formaldehyde ai X I Mn-Man anew 1055 10U u TPH-BTEX Gasoline Rang,
Carbonate m NH3 o N 610 mg/L X Na-Sodium 929 5A
Bicarbonate m TKN.N625 2L Ni-Nickel 1OU aVL -
CrtMn dioxide an X NO2♦NO3 as a 630 0.03 m XL WLead 46561 10U u
X Chloride 1 U m P:Total u P 665 SeSele time u
Chromium:Hex 1032 a g/LPOI m X Zn_Zim 46567 34 u I-
Color:Time 80 c.u. Nitrate(NO,a N)620 mg/L
Cyanide 720 mg/L INiuiw(NO,as N)615 mg/L
COMMENTS: RevisedRevixe!re�514/05 chan�A1 value to 50 U.CHOchan�A]value m 50 U.CHG
aaa2t2

North Carolina
GROUNDWATER FIELD/LAB FORM 23 Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
SAMPLE TYPE SAMPLE PRIORITY
/r ffTlm
Courtly L1t�/E-G7-K�� �,Water ® Routine �—� Lab Number Quad No Serial No. ❑ Soil ❑ EmergencyrDale Receive
Lat. 3S� t�3.3/ ° Long._g o a(�r77H El Other Rao.d By From:Bu CoJiHand Del.,
❑Chain of Custody Other.
Report To: RO FRO, MRO, RRO,WaRO,WiRO,
Data Entry By: Ck:
WSRO,Kinston FO,Fed.Trust, enlral , Other: UZC.-Co Date Reported:
Shipped by:Bus ourier�Han l Del.,Other: Purpose:
Collector(s): C.- Dated d` c Time_/ZC2> Baseline, Complai ompliance LUST,)Pesticjde Study, Federal Trust, Other:
FIELD ANALYSES Owner FMfAIc=S (`vdBen° � _(oej�
pH 400 Spec.Cond.94 at 25°C Location or Site 6 67 '/_7 eo eV7c1 6,
Temp.ln / °C Odor Description of sampling pain '�f2cr'aJ'r—
Appearance Sampling Method 'u7 Sample Interval
Field Analysis By: Remarks
LABORATORY ANALYSES (Pumping fiam,air temp.,etc.)
BOD 310 mg/L Dlss.Solids 70300 mg/L Ag-Silver46566 u /L Orxjanochlodne Pesticides
COD High 340 mg/L Fluoride 951 mg/L AI-Aluminum 46557 u /L Organophosphorus Pesticides
COD Low 335 mg/L Hardness:Total 900 mg/L As-Arsenic 46551 u /L Nitrogen Pesticides
Coliform:MF Fecal 31616 /loom] Hardness(noncarb) 02 mg/L Ba-Barium 46558 u IL Acid Herbicides
Coliform:MF Total 31504 Moral Phenols 32730 ug8 Ca-Calclum 46552 mg/L PCBs
TOO 680 mg& Specific Cord.95 uMhos/cm Cd-Cadmium 46559 u /L
Turbidity 76 NTU Sulfate 945 mg/1. Cr-Chromium 46559 u /L
Residue,Suspended 530 mg/L Sulfide 745 mg/L X 1 Cu-Copper 46562 u /L
Fe-Iron 46563 troll. Sem]volatlle Or anlcs
Oil and Grease mg/L Hg-Mercury 71900 u /L TPH-Diesel Range
pH 403 units K-Potasslum 46555 mg/L
Alkalinity to pH 4.5 410 mg/L Mg-Magneslum 46554 m 2
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 uptil. Volatile Or ants OA bottle
Carbonate 445 mg/L NH3 asN 610 mg/L Na-Sodium 46556 m /L TPH-Gasoline Range
Bicarbonate 440 call TKN as N 625 mg/L NI-Nickel u /L TPH-BTEX Gasoline Range
Carbon dioxide 405 mgA. NO°+NO°as N 630 mg/L Pb-Lead 46564 u /L
Chloride 940 mg/L P: out as P 665 mg IL Se-Selenium u /L
Chromium:Hex 1032 ug/L Nitrate(NO,,as N)620 mg/L Zn-Zinc46567 u /L
Color:True 80 Cu Nildta(ND3 as N)615 mg/L LAB USE ONLY
Cyanide 720 mg/L Temperature on arrival:
Lab Comments
G*54 REV.7103 For Dissolved Analysis-submit filtered sample and write'DIS'In block.

C
NC DENR/DWQ Laboratory
Report to:_ARO Sample Anomaly Report(SAR) 1.
Lab Number: 5G0242 Sample ID: EW
Station Location: Johannes Penz County: Cherokee Region:
,;ample Type: Well Priority: Routine Collector: T.Minnick
Date collected: 2/07/2005 Date received: 2/09/2005 Date analyzed: 2/2005
Affected Parameter(s): NO3 NO2
Analytical Area(check one):
❑INCH ❑METALS []VOA ❑SVGA
®NUT []MICRO []PEST
The following anomalies occurred(check all that apply):
❑samples ❑Quality Control
❑Improper container used ❑Instrument failure—no reportable results
❑VOA vials with headspace []Analyst error—no reportable results
❑Sulfide samples with headspace ❑Surrogates
❑Samples not received,but listed on fieldsheet ❑None added
❑Samples received,but not listed on fieldsheet []Recovery outside acceptance limits
❑Mislabeled as to tests,preservatives,etc. []Spike recovery
❑Holding time expired ❑None added
❑Prior to receipt in lab ❑Recovery outside acceptance limits
❑After receipt in lab []Failed to meet criteria for precision
❑Insufficient quantity for analysis ❑Intemal standards
❑Sample exhibits gross non-homogeneity []Blank contamination
[]Sample not chemically preserved properly ❑QC data reported outside of controls(e.g.,QCS,LCS)
❑pH out of range(record pH): ❑Incorrect procedure used
❑Improper chemical ❑SOP intentionally modified with QA and Branch Head
❑Residual chlorine present in sample approval
❑Color interference ❑Invalid instrument calibration
_ ❑Heavy emulsion formed during extraction ❑Elevated detection limits due to:
[]Sample bottle broken in lab-no reportable results ❑Insufficient sample volume
®Other(specify):On 2/09/2005,the Nutrients group received one sample bottle for 5G0242.The sample had been preserved
with 25%H2SO4.However,the field sheet indicated that a NO3 result and NO2 analysis had been requested.To determine a
NO3 result,two bottles of a sample must be collected and submitted to Nutrients. One bottle should be preserved with 25%
H2SO4 and chilled to 4 degrees Celsius,and the second bottle should not be acid-preserved(only chilled to 4 degrees Q.The
acid-preserved aliquot of sample is used for NO3+NO2 analysis,and the unpreserved aliquot of sample is used for NO2 analysis.
The results of these analyses are used to calculate the NO3 result.
Comments:The acid-preserved sample that was received will be analyzed for NO3+NO2, and the NO3+NO2 result will be reported.
The field sheet was edited by receiving room personnel to reflect this change.
Corrective Action:
❑Samples were rejected by DWQ Lab. Authorized by: Date:
❑Accepted and analyzed after notifying the collector or contact person and determining that another sample could not be secured.
❑Sample(s)on hold until:
❑Sample reported with qualification.Data qualification code used:
®Other(explain): Sample will be analyzed for NO3+NO2
Notification Required? ❑Yes ❑No
Person Contacted: Date:
Form completed by: ax Overma Mt ©,cam Date: 2/9/2005
Lead Chemist Re (initial):
_'rJBIOCHEM ` []PEST ❑SVGA
]METALS } f ❑VOA
Branch Head Review(initial): IVnd/
QA/QC Review (initial) Logged into database by(initial):
QA1Fs.Vv b.=,ylSAR laWffildbs

- `-� DIVISION OF WATER QUALITY
Chemistry Laboratory Report/Ground Water Quality Lah Number 5GO243
Dam Received : 2N2005
COUNTY : CHEROKEE SAMPI F PRIORITY Time Received : 9:00AM
QUAD NO: EIROUTINE DEMERCENCY ived 0y DS
REPORTTO ARO Regional Office CHAIN OF CUSTODY /E
COLLECTOR(S) :TMINNICK EFF Released By : EAS
DATE: 2QQA65 El SAMPLE TYPE Daiereponed: SIV2005
TIME:
PURPOSE: Owner: "7 KEPNFR ROAD
Location or Si.:
Description of sampling Point _
SvnPling Method:
Remarks:
LABORATORY ANALYSIS
BOD 310 Diss.Solids 703M m A .Silver 46566 u Or annchlminc Pesticides
COD High 340 Fluoride 951 X AI-Aluminum 46557 S.OU u hos horns Pesticide
COD Low 335 Hardness:[owl 900 m As-Arsenic 46551 a Ni en Pesticide - CD
Colifaxm:ME Feud 31616 /100m1 Hardness:(ton-cart)902 Ba-Barium46558 u -
CoOform:MP Trial 319A /IUtymi Phenols 32730 ugtL Ca-CAcium 46552 3.6 Arid Herbicides - d
TOC Specific Coed.95 umhos/cm2 Cd-Codium46559 .91LO
ar
Turbitity NPU Sulfate m X Cr-Chromium 46560 25U u Scenivolatile
Residue-S.opcwled 530 SulSde 745 m R C.-Copper 1042 52 a TPH-Diexel Range
Tom]Sus ndcA solids m MBAS m X Fe-Iron INS 5OU u
Oil and Grease m H -Merwry 71900 a Volatile Organics(VOA bottle)
H uniu Silica X K-Pmarsium46555 0.72
Alkalinity MPH 4.5 m/L Boron X Mg.Ma neium 927 2.5 TPH-Gasoline Range
Alkalinity in pH8.3 Fommldeh de X M.-M..Se.1055 IOU u TPH-BTEX Gasoline Range
Carbonate m NH3 as N 610 m X Na.Sodium 929 5.8 m
Bicarbonate m/L TKN as N 625 m X Ni-Nickel IOU u
Carbon dioxide m X NO2+1,103 as n 630 0.05 m X Pb-Lud 465(14 IOU u
X Chloride I U ingA P:Toed U P 665 m Se-Selenium u
Chromium:Hex 1032 u A PO4 m/L X Zv Zinc 46567 79 u
Color:True 80 Nitrate(NO,as N)620 mg/L
Cyanide 720 mgfL I INwite(NOr as N)615 mg/L
COMMENTS: Revised report 5/4/05 changed At value in 50 U.CHO
scam

GROUNDWATER FIELD/LAB FORM North Carolina
U_e I�:L o i 06 0 2 3 Department of Environment and Natural Resources
SAMPLE TYPE SAMPLE RIORITY
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
County. ��/� Y PWater❑ / '�
Routine Lab Number11
q
Quad No Serial No. Soil ❑ Emergency
Lat. 'l Sc C;�,j j / Long.. 0 rip,•7TJ' ❑ Other Dale Received Tim
Rec'd By: From:Bu , Line , Hand Del.,
Report T ,AR O, MRO, RRO, WaRO,WiRO, ❑chain of Custody Other.
WSRO,Kinston FO, Fed.Trust nlral O Other: LZL� Co Data Entry By: Ck:
Shipped by:Bus ourie He d Del.,Other: Date Reported:
Collectors :• P pose: �
�� � Date - Q Time Q Baseline,Complain omplian e; LUST, Pe ticide Study, Federal Trust,Other.
FIELD ANALYSES Owner . /. N€S a (circle one)
pH^n9 A Spec.Cond.94 al250C Location or Sile ' r
Temp.lo 7 eC Odor d fir/ 2 !D
Appearance Description Description of sampling point — :/.
Field Analysis By: Sampling Method Sample Interval
Remarks uno. aier.ec.
LABORATORY ANALYSES
BOD 310 (Pumping sme,air lamp.,etc.)
m9/L Dlss.Solids 70300 mg/L Ag-Silver 46566
COD High 340 mg/L Fluoride 951 u /L O an ichlorine Pesticides
COO Law 335
rngn- AI-Aluminum 46557 u /L O ano has horns Pesticides
mgrL Hardness:Total 900 mg/L As-Arsenic 46551
Coliform:MF Fecal 31616 Moral Hardness non-cart 902 u n- Nitro an Pesticides
( ) mg/L Ba-Barium 46558 u /L Acid Herbicides
Coillorm:MF Total /100m1 Phenols 32730
TOC 680 egn Ca-Calcium 46552 in /L PCBs
ru9/L Specific Cond.95 uMhos/cm L Cd-Cadmium 46559
Turbidity 76 NTU Sulfate 945 u 2
mg/ Cr-Chromium 46559 u
Residue,Suspended 530 mg/L Sulfide 745
mg/L }( Cu-Copper 46562 u 2
Fe-Iron 46563 u /L Semivolatlle O anics
Oil and Grease mg/L Hg-Mercury 71900
pH 403 units u 2 TPH-Diesel Ran e
Alkalinity to pH 4.5 410 mg/L K-Potassium 46555 an /L
Alkalinity to pH 8.3 415 rn9ll. Mg-Magnesium 46554 m /L
Carbonate 445 mg/L Mn-Manganese 46565 NHS as N 6f0 u /L Volatile Or antics CA
battle
rn9/L Bicarbonate 440 m Na-Sodium 46556 gn- TKN as N 625 m /L TPH-Gasoline Ran e
m9/L Ni-Nickel
Carbon dioxide 405 mg/L NO,♦NO,as N 630 u n- TPH-BTEX Gasoline Range
Chloride 940 mg/L }� Pb-Lead 46564 u 2
mgn. P:Total as P 665 mall. Se-Selenium
Chromium:Hex 1032 ug/L Nitrate(NO3 as N 620 u 2
mg/L Zn-Zinc 46567 Color.True 80 Cu Nitrite
/L
te(N07 as N)615 gl �
Cyanide 720 rpgg. 9 LAB USE ONLY
Lab Comments
Temperalure on arrival: `
GW-54 REV.7/03 For Dissolved Analysis-submit filtered sample and write'DIS'In black.

NC DENR/DWQ Laboratory
Report to:_ARO Sample Anomaly Report(SAR)
Lab Number: 5GO243 Sample ID: EFF
Station Location: Johannes Peitz County: Cherokee Region:
Sample Type: Well Priority: Routine Collector: T.Minnick
Date collected: 2/07/2005 Date received: 2/09/2005 Date analyzed: 2/2005
Affected Parameter(s): NO3,NO2
Analytical Area(check one):
❑WCH ❑METALS ❑VOA ❑SVOA
®NUT ❑MICRO ❑PEST
The following anomalies occurred(check all that apply):
❑Samples ❑Quality Control
❑Improper container used ❑Instrument failure-no reportable results
❑VOA vials with headspace ❑Analyst error-no reportable results
❑Sulfide samples with headspace ❑Surrogates
❑Samples not received,but listed on fieldsheet []None added
❑Samples received,but not listed on fieldsheet ❑Recovery outside acceptance limits
❑Mislabeled as to tests,preservatives,etc. ❑Spike recovery
[]Holding time expired ❑None added
❑Prior to receipt in lab ❑Recovery outside acceptance limits
[-]After receipt in lab ❑Failed to meet criteria for precision
❑Insufficient quantity for analysis ❑Internal standards
[]Sample exhibits gross non-homogeneity ❑Blank contamination
❑Sample not chemically preserved properly ❑QC data reported outside of controls(e.g.,QCS,LCS)
❑pH out of range(record pH): ❑Incorrect procedure used
❑Improper chemical ❑SOP intentionally modified with QA and Branch Head
❑Residual chlorine present in sample approval
❑Color interference ❑Invalid instrument calibration
❑Heavy emulsion formed during extraction ❑Elevated detection limits due to:
[]Sample bottle broken in lab-no reportable results ❑Insufficient sample volume
®Other(specify):On 2/09/2005,the Nutrients group received one sample bottle for 5G0243.The sample had been preserved
with 25%H2SO4.However,the field sheet indicated that a NO3 result and NO2 analysis had been requested.To determine a
NO3 result,two bottles of a sample must be collected and submitted to Nutrients. One bottle should be preserved with 25%
H2SO4 and chilled to 4 degrees Celsius,and the second bottle should not be acid-preserved(only chilled to 4 degrees C).The
acid-preserved aliquot of sample is used for NO3+NO2 analysis,and the unpreserved aliquot of sample is used for NO2 analysis.
The results of these analyses are used to calculate the NO3 result.
Comments: The acid-preserved sample that was received will be analyzed for NO3+NO2,and the NO3+NO2 result will be reported.
The field sheet was edited by receiving room personnel to reflect this change.
Corrective Action:
❑Samples were rejected by DWQ Lab. Authorized by: Date:
❑Accepted and analyzed after notifying the collector or contact person and determining that another sample could not be secured.
❑Sample(s)on hold until:
❑Sample reported with qualification.Data qualification code used:
®Other(explain): Sample will be analyzed for NO3+NO2
Notification Required? ❑Yes ❑No
Person Contacted: Date:
Form completed by: ax Overma� Date: 2/9/2005
Lead Chemist A w initial):
�IBIOCHEM []PEST ❑SVGA
JMETALS ❑VOA
Branch Head Review(initial):
QA/QC Review (initial): Logged into database b
BB Y(initial):
QATO=\Ubomory\SA 10MMIdbs

OF W ATF9 Michael F.Easley,Governor
OIL OG William G.Ross Jr.,secretary
0) r North Carolina Department of Environment and Natural Resources
p Alan W.Klimek,P.E.Director
Division of Water Quality
May 9, 2005
Martha and Johannes Penz � I
667 Keener Road N
m� Uua
Murphy, NC 28906 <�
Ile
Ref: Receipt of Corrective Action ro _
Sampling Spigot Installation
7 J
rt
Dear Mr. and Mrs. Penz: --------
On May 4, 2005 the Underground Injection Control Program received your documentation of corrective
action associated with the Notice of Regulatory Requirement issued on March 30, 2005. Thank you very
much for submitting a copy of the invoice for the installation of the required sampling spigots. Your prompt
reply and cooperation with our request are greatly appreciated.
Please contact me at 919-715-6166 or Evan Kane at 919-715-6182 if you have any questions about the
Underground Injection Control Program or injection well rules and regulations.
Best Regards, ,Q Q,' e
Thomas Slusser
Hydrogeological Technician II
UIC Program
Cc: Landon Davidson,Asheville Regional Office
CO-UIC Files
N'o�nCanolina
waturn//Y
Aquifer Protection Section 1636 Mail Service Center Raleigh.NC 27699-1636 Phone[phone] Customer service
Inlemet http://h2o.enr.stale.nc.us 2728 Capital Boulevard Raleigh,NC 27604 Fax [phone] 1-877-623-6748
Fax [phone]
An Equal Opportunity/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper

_ _
v.
w
' r

Johannes and Martha Penz
667 Keener Road
Murphy,NC 28906
May 1,2005
North Carolina Department of
Environment and Natural Resources
Division of Water Quality
Aquifer Protection Section oa
1636 Mail Service Center curlcm,
Raleigh,NC 27600-1636
Dear Mr Kane, — o=
rn
RE:Notice of Regulatory Requirement o o
Martha and Johannes Penz W
667 Keener Road N
Murphy,NC 28906 '
Ref: Notice of Regulatory Requirement
N.C.Well Construction Siandards
NCAC 15A 2C.0213(c)(4)
Dear Mr.and Mrs. Penz:
The Underground Injection Control (UIC) Program of the Division of Water Quality is responsible for the
regulation of injection well construction and operation activities within the state of North Carolina. On
February 7,2005 Mr.Ted Minnick of the Asheville Regional Office conducted an inspection and sampling of
your geothermal heat pump system. A copy of the water quality test results is included for your records.
During Mr. Minnick's inspection he observed that sampling spigots were not present at the well head of the
injection well. These sampling ports are required under Title 15A, Subchapter 2C, Section.0213(c)(4)of the
North Carolina Administrative Code and are necessary to identify the cause or source of any potential ground
water quality violations associated with your heat pump and to accurately characterize the quality of the heat
pump effluent that is being returned to the well.
In order to comply with this rule you must install well head sampling spigots for the influent and effluent lines
and submit sunnorting documentation of the well head repairs within 60 days of receipt of this letter.
Acceptable documentation includes photographs and/or an invoice for the installation of the sampling spigots.
Following receipt of this documentation we may inspect your injection well system to verify compliance. -
Your prompt cooperation with this request will be greatly appreciated. Please contact Thomas Slusser at(919)
715-6166 or me at [phone] if you have any questions regarding this notice, the UIC Program, or
injection well rules and regulations.
Hest regards,
Evan 0.Kane, L.G.
UIC Program Manager
Thank you for informing us of this requirement. A copy4f the invoice for the installation of the sampling
spigots is enclosed.
Sincerely, Martha Penz

CHEROKEE WELL DRILLING QUA. ITEM SELL CUST.COST
AND PUMP CO., INC. —'Ball Valve
_'Check Valve
P.O. Box 1007, Murphy, NC 28906 Pressure Switch
Phone: [phone] • Fax: [phone] , Gauge
Pressure Relief Valve
)ATE: j � S' 1/4'Nipple
::USTOMERNAME. H� �'. Box Connectors
> Sta-Kons
4DDRESS: ���'j/7 /`1 �4 �)� Vulcanized Tape
CITY&STATE Electrical Tape
p _'x-'Galvanized Bushing
TELEPHONE NUMBER: i(,37— sL/�o •x Galvanized Bell Reducer
kit work to be paid for upon completion unless prior arrangements were made. If _'Galvanized Couplings
rayment is not received by then,a1.5%INTERESTAND SERVICE CHARGE will be •Galvanized Adaptor
tdded monthly to past due balances.This charge is equivalent to an interest rate of 18% P
?ER ANNUM. Customer agrees that he shall be responsible for reasonable attorney's •x 'Galvanized Nipple
ees and costs should they be incurred to collect the order,and further agrees that the —
:itus of this contract is Murphy,N.C. 'Galvanized Elbow
QUA. _ ITEM _SELL CUST.COST Well Vent
_H.P.Submersible Pump —'Well Seal
11_Stages GPM Pump Tank Tee
Ft._'SCH 80 PVC Thr.xded Drop ace Silicon Sealer
Ft._'SCH 40 PVC Pipe —'x MBusphlng
Ft.—'SCH PVC Pipe x
Ft. 'Galvanized Pipe x—'
Water Meter&Base Heal Shrink Kits
Ft. Pump Cable All Threads
Ft. U.F.Wire Galvanized Tee
Ft.Safety Rope Galvanized Tee
Torque Arrestor Union
'Clamps Insulation(amount)
•Sla-Lock Stainless Clamps 'Boiler Drain
T'Hose Bibb , / .�L` _'Dresser Couplings
1'Lawn Hydrant Lightning Arrestor
_"PVC Cap Portable Pump Puller Rental
'PVC Coupling Caulking
'PVC Female Adaptor 10.9" 4.!S40 —VrIOPLI y SP' urn
'PVC Male Adaptor r&'LVWI /A!01+ 111_
'go. PVC Elbow Subtotal 0
45' PVC Elbow Subtotal(1)lorwarded
c� i l 'PVC Tree ,2. .5 3 So& Subtotal 0
PVC Bushing 3,6.c NC Stale Tax /33
PVC Glue (size)__;Sal Subtotal 0 0.3y
PVC Cleaner (size) 02. /o Time Out
Teflon Pipe Dope rr - - Time Back
801b.Sand Mix Hours Manual Labor 6 O.CC
Fiberglass Pump House Feet Pump Truck x ¢
_Fiberglass Well Cover Feet Trencher
Concrete Well Tile a Lid 6:.'Drilled Well @$ Ft.
6%. Well Cap Steel Casing Charge @$ Ft.
_H.P.Control Box Subtotal O. y
Tank Men on job: 4_
Black Roll Adaptors
"Gate Valve
SUBTOTAL(1) ✓/rs GRAND TOTAL F G ✓-.1 C�

GROUNDWATER FIELD/LAB FORM C yf Nodh Carolina
C ")L OOo2.J Department or Environment and Natural Resources
7i=
IVISION OF WATER QUALITY-GROUNDWATER SECTION
C,��+�. .� E PRIORITYCounty Kh_Quad No tine Lab Number /�Gsb 0
Serial No. ergencyLat.��"Qj 3i ' Long. °C)Lrt.'I9/7 F Dale Recelved�- 7-OS Time: i_$-?7Rec'd By: J-,w S From:Bus, Courier,waReport T , RO FRO, MRO, RRO,WaRO,WiRO, Other.
WSRO,Kinston FO, Fed.Trust Central Off.,Other: Data Entry By: Ti1nS Ck: TMS
_ Shipped by:.Bus,
Courier(gand De: Other: DateReported:��$-m
Colleclor(s):�/f„V.ryC Purpose:
'FIELD ANALYSES Dal en
, 41 Time i2lD. .Baseline, Complai Compliant LUST,P ticide Stud Federal Trust, Other.
Owner _ 211141 Z7 �y (mcleane) is
pH 4o0_ �i t7� Spec.Cond.94 al 25 C Locallon or Site rc k, /✓;! r 2r!iG
Temp.19 /g °C Odor Appearance T Description of sampling point Sampling Methad r, CNT
Field Analysis By: Sample Interval
LABORATORY ANALYSES Remarks id.
BOD310 m (Pumping ame,elr lemP..elc.J
9 Diss.Solids 70300 O •14,"_ /L,- A Silver 4656fi COD Iligh 340 m g u /L en. Fluoride 951 Or anochlvrine Pesticides
COD Low 335 f°g/L AI-Aluminum 46557 u AL -
m9a- Hardndss:Tvta1900 - Or ano hppP.- horns Pesticides
L Cvlilorm:MF Fecal 31616 n'9/L As-Arsenic 46551 u 0.rj.� /100m1 I fordnoss(non-wrb)902 m /L Nitro en Pesticidva
TOGCollr 580 MF 7olnl 31504 n 9 aa-Berium 46555 u /L Acid Herbicides
£j� J100m1 Phenols 32730
TOG 680 u98 Ca-Calcium 46552 m /L PCBs
mgA- Specific Cord.95 uMhos/cm Cd-Cadmium 46559 ResidTLUblue,
S NTU Sulfate 945 u 1L
Residue,Suspended 530 m 2 R10/L CKChromium 46559 u �
9 Sulfide 745 mg/L Cu-Copper 40562
u 2
Fe-Iron 46563 u /L SemlVvlallle Or anlcs
pi 1403 - Oil and Grease mg/L Hg.Meroury 71900 -
units u 2 TPH-Diesel Ran e
Alkalinity to PI 14.5 410 mg/L K-Potassium 46555 m 2 -
Alkalinity to pi 18.3415 mg/L Mg-Magneslum 46554 m /L -
Carbonate 445 Mn-Manganese 40505
m94- Nl1r as N 610 mg/L Na-Sodium 46556 u IL Volatile Organics(VOA battle
Bicarbonate 440 mg1L 7KN as N 625 - m /L TPH.Gasoline Ran e
Carbon dioxide 405 mg/L NiWckei
mgn- NOx+NO,as N 630 u a- TPH-BTEX Gasoline Ran e
Chloride 940 rnfl/L _
ntHO- P:Total as P 665 Pb-Lead 46564 u IL
Chromium:Hex 1032 mg/L Se-Selenium u 2 -
u9/L Nitrate(NO,as N)620 mg/f- Zn-Zinc 46567 Color:True 80 CU "Iddle(NOr as N)615 man u 2
Cyanide 720 9 _ LAB USE ONLY _m9rl Lab Comments Temperature on arrival:GW-54 REV.1103 For Dissolved Analysis-submit lillared sample and write'DIS-In block. _
! �x� 76 � , �ccJs yl/ 02 (2�20Q,r

North
GROUNDWATER FIELD/LAB FORM UTC olefiCtJL 3 Department of Environment and Natural Resources
_ DIVISION OF WATER QUALITY-GROUNDWATER SECTION
/7 EETYPESAMPLE PRIORITYCounty L /•�:'}?(iKr=� RoutinQuad No Serial No. p Lab Number A 0,5 �Lat. 3SL b3,>; '� Long. ¢ nr7 ' EmergencyTime: /.5 77
77- Date Received J 7-D.Sy Rec'd By: 7i14.5 From:Bus, Courier, and Del.
Report T ARO *FRO, MRO, RRO, WaRO,WiRO, Other.
WSRO,Kinston FO, Fed.T enlral Off., Other. Data Entry By: Haag
Shipped by: Bus, CO urie Ha'nd D .,Other --
Collerlor(s): 'TiL97Nitfit Purpose:
Dale Reported: - -DT-as
FIELD ANALYSES - Dale - es-- Time /2C:1�7 Baseline, Complaint omplianc ' LUST,Pesticide Study, Federal Trust, Other.
PH duo Owner ,�7/,r1n/njFS ,.eiy-_=- (Gale one)
l o Spec. COnd.94 at 250C Location or Sile Temp-16_ i �/ °C Odor -77 !�c7vc�WSJ ti/u E 9L
Appearance -/_" _ Description of sampling pomp E,, « rr��
Field Analysis By: Sampling Method f /y/W
LABORATORY ANALYSES Remarks enema. ,ar.rr Sa a P e Interval
ROD 310 (Pumping time•.tramp,.ru9/L Digs.Solids 70300 � to mg(L All-S.ivar 4656fi COD I ligh 340 mg/L Flu_odde 951 u IL Or anochlorine Pesticides
COD Law 335 - rn9A- Al-Aluminum 46557 u - e
mg/L Hardness:Total 900 Or and ties hems Pesticides
7 Colirorm:MF Fecal 31616 �' /100ml Hardness(non-carb)902 mg/L As-Arsenic 46557 u 2
Nllro en Pesticides
Colilorm:MF Tria131504 s 9 Ba-Barium 46550 u fL. Acid Herbicfdes
/100m1 Phenols 32730
TOC 6B0 u9/I Ca-Calcium 46552 m /L PCBs
rn94 Specific Conti.95 uMhos/cm Cd-Cadmium 46559
Turbldlly 76 NTU Sulfate 945 v 6-
Residue,Suspended 530 m /l me/L Cr-Chromium 46559 u IL
9 Sulfide 745 mg/L Cu-copper 40562
u 2
Fe-Iran 46563
00 and Grease _ u � SemivolaUle Or anlcs
pl1 403 _units - malt, Hg-Mercury 71900 u fL TPH-Diesel Ran e
Alkalinity to pit 4.5 410 K-Potassium 46555 m /L
mg/L
Alkalinity to Pit 0.3 415 -mg/L Mg-Magneslum 46554 m /L - -
Carhnnale 445 Mn-Manganese 46565
mg/L 'NI{�as N 510 mg/L No-Sodium 46556 u /L Volatile so Organics VOA tiollla
Blcarbanale 44U mg/L TKN as N 625 m /L TPI{-Gasoline Ran e
Carbon.dioxide 4U5 rn9n- NI-Nickel u
mg/L P,T t l as as N 630 - mg/L Pb-Lead 46564 IL TPI{-eTEX Gasoline Ran e
Chloride 940 mgiL P:Total as P 665 u I-
Chromium:Ilox IU32 - - m9/L Se-Selenium u IL -
uNitrate(NO,as N)620 mg/L Zn-Zinc 46567 Color.True OU CuU Nitrite(NO,as N)fi15 u �
Cyanide 720 mail mg/L LAB USE ONLY
Lab Comments Temperature on arrival:
GW-54 REV.7/03 For Dissolvad I...... issubmil filtered sample and write•DIS-in block.
FAXD To %, ScUSSew bL/z9 /fir

WELL CONSTRUCTION
Date constructed ?yOZ/oi/t`
Drilling contractor: Name _J—OD y MUG t s, ygg*w 1 u
p
Address /9, D/-t P',�
HNM,°icw'✓iGcc NC Z70ZO
Certification number zr7Z
Total depth of well 322-r Total depth of source well 44mc-_
(ifapplicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth /$b'� _✓
Diameter (o./Zl° _✓ e 2/
Height (A.L.S.)
Grout
Depth �� `� pr R 3'
Screens
Depth(s) /
Length(s)
I.D. Plate ✓ _
Static water level ✓
Well yield 6Pne (°al—/ )
Enclosure t/ a4y Ac t_
Enclosure floor (concrete) i4
Sampling port (labeled) v'
Water tight pipe entry ✓
Well enclosure entry ✓ _
Vent ✓ �Z r.
Functioning off heat pump sy tem, if applicable (Dele,mine from the owner ifheat pump functions properly.)
r;,We leff1w," cXcY
INSPECTOR Office A&
WITNESS t9vtti�tY� Address
WITNESS Address
Ver. 7/04 GW/UIC-2

North Carolina Department of Environment and Natural Resources
Division of Water Quality- Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WI0100023 DATE &t s% cry %d 7
NAME OF OWNER MARTHA & JOHANNES PENZ
ADDRESS OF OWNER 6 7 C: ,g /E5 V
f E/2Gf1 tiiG 2 a
(Street/road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable)
sout2C�r/T�res��e 1 t�.c t`n�� c—l� sub c, 11,V-r A( Td fd�
wi nz CA!nc VIrz r,� — I L! dwc,DJ'-f,:c'i�
(Sheet/road or lot and subdivision, county, town, if different than owner's address,plus description of location on site)
Potential pollution source 5 e is T-+& Distance from well > � 1
Potential pollution source '(0-✓ %% Distance from well >3i'
Potential pollution source Distance from well
Minimum distance of well from property boundary Z3'
Quality of drainage at siteCad) Flooding potential of site 1440
(good,adequate,poot) (lrigh,ntoderate,loiv)
GPS DATA: Latitude: 3}" O3.31S' Longitude: ,FfaC0.779
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells,potential pollution sources, roads, approximate scale, and
north a-row.)
5eppc
���__
I � 115
rFcuC-i✓i 5A1+A,U-) 1N
— C]FFice1✓1 L1wPcL� M-
YniV ES � .JIVt/rit (vc'�I= L;.aR/Vc� ilr- ��7Jsd
tVi'GL
DESCRIBE IN�CTION SYSTEM vertical closed loop, encased borehole or cased water well;separate source well and
injection well; combination source and injection well or other description as applicable)
--------------
INJECTION FACILITY INSPECTION REPORT-FORNI B (CONTINUED)
vP,• '71nA GMT i1C-2

O�O(f WATF9pG Michael F.Easley,Govemor
CO William G.Ross Jr.,Secretary
>
r North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
Division of Water Quality
AQUIFER PROTECTION SECTION
FACSIMILE . .
TELEPHONE NUMBER FAX NUMBER
[phone] [phone]
(828)2964681 Direct
TO: --7-17&-Y ks Sc J5sckl, o 1 Cl, eo
FAX NO: Lq/9) 7/S-
FROM: H.E. (TED) MINNICK,JR.,DWO, AQUIFER PROTECTION SECTION
DATE: 0 Z/0,P��'o r
NUMBER OF PAGES,INCL COVER PAGE: 3
COMMENTS:
1� r�O�cT/�vJ /4��2r �2 Gtf O l OLb Z3
eJVAfTY. TCA0 io
rCarolina
affalltf
North Carolina Division of Water Quality-Asheville Regional Office 2090 U.S.E3ighway70 Swenuanoa,N.C. 28778 Phone[phone]
FAX [phone]
Customer Service 1-877-623.6748
Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Actlon Employer-50%Recycled110°%Post Consumer Paper

North Carolina Department of Environment and Natural Resources
Division of Water Quality- Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WIOI00023 DATE Zoaf/ ez. /eI
NAME OF OWNER MARTHA &JOHANNES PENZ
ADDRESS OF OWNER (j67 eee�fEor— 4,o �se ram)
(StreeUroad or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable)
aP Ale-Ur,- n/c--.,- Td Zeid�-
�CLVrPcc� f.UI TdF Cy',@G7/ �,CE� ,QpCX t�—LC ls7i/Cc CJ;�iPv�
(StreeUroad or lot and subdivision, county, town, ifdiiferent than owner's address,plus description of location on site)
Potential pollution source SgPric T� Distance from well � SO'
Potential pollution source Distance from well �3P
Potential pollution source Distance from well
Minimum distance of well from property boundary Z3'
Quality of drainage at site Gadt Flooding potential of site b4d
(good,adeguate,pooi) (high,nioderatejow)
GPS DATA: Latitude: 3S-° o3,3/S Longitude: F`f°00.779 01
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells,potential pollution sources, roads, approximate scale, and
north arrow.) L
1 �
— ..1.dFctrFiJT SgiU,IE� Ia'
I4S11— c.�tc>nrr' nJdi,Z Pk`,so:,f TRiJ,
— EFFCcc.✓f S1.�f�iE� A
Y,11JES �/-IfIN nIFdL WFHE� J.r I�✓IF
t
Y�—
/1.f /1 /�t�/•/C�2... JCo/1.J
DESCRIBE IN CTION SYSTEM vertical closed loop, uncased borehole or cased water well;separate source well and
injection well; ombination source and injection well or other description as applicable)
INJECTION FACILITY INSPECTION REPORT-FORM B (CONTINUED)
V er. 7/04 GW/UIC-2

WELL CONSTRUCTION
Date constructed : wZ ePi2—
r�
Drilling contractor: Name_ ,J o-)t /WC/4 rs y.4bifld G( cc cLinf�( G
Address /q, /�)�P � L/a1a9;�.vyica Q1
. dnLioi✓t!/GCr NC '2.762O
Certification number 72-
Total depth of well 322-1 Total depth of source well cy4n c
(f applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth /$�` ✓
Diameter ( ,lZf' _ ✓ S2 2r
Height (A.L.S.)
Grout
Depth Zl7` '� Qk 31
Screens
Depth(s) nl�/
Length(s)
I.D. Plate
Static water level _ ✓
Well yield
Enclosure V-- hek-
Enclosure floor (concrete)
Sampling port (labeled) �s
Water tight pipe entry ✓
Well enclosure entry _✓
Vent ✓ �Z J1
Functioning of heat pump sy tem, if applicable (Derertninef om the owner ifheol pump functions properly.)
�,Jc�lonri.✓tr ��uP�xcY
INSPECTOR /GZ Office A s A&
WITNESS l�ysn�e� Address
WITNESS Address
Ver. 7/04 GW/WC-2

Page 1 of 2
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Groundwater Section
PRECONSTRUCTION INJECTION FACILITY INSPECTION
REPORT-FORM A
INJECTION WELL PERMIT NO. WI DATE �/o 2/77
NAME OF OWNER —a° 4-"WOFS AV.7-
ADDRESS OF OWNER (a67 4Ezrr)e- 44,
/v�vR-PffylrJc �906 '
(Street/road or lot and subdivision,county,town)
LOCATION OF PROPOSED INJECTION WELL (and source well(s), if applicable)
R!Pff
(Street/road or lot and subdivision, county,town, ifdifferent than owner's address,plus description oflocation on site)
Potential pollution source -29r tc -f4A(r-11a+wPQ Distance from well 7 rO '
Potential pollution source 7a^g*7-1m1 Distance from well > a f'
Potential pollution source Distance from well
Minimum distance of proposed well from property boundary 7'W
Quality of drainage at site gao Flooding potential of site 4W
(good,adequate,poor) (h igh,m oderate,In w)
DRAW SKETCH OF SITE
(Show property boundaries,buildings,wells,potential pollution sources,roads,approximate scale,and north arrow.)
E]
100A
sQ ss , are72
rwlrrrr_1 9001

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (cont)
GPS Data:
Latitude: 3S° CB. 31P Longitude: F4 0 ua• 779
COMMENTS
INSPECTOR
Office 4fs,, we
WITNESS OWAIf4
Address
WITNESS
Address

North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Groundwater Section
7Welication:_ ti�tf�yw /VC Date 2i 222`
(Town,Communiry,Subdivision and Lot No.) WELL TYPE
Owner:-- -JONyi / :�� evv`8 County C;4499e-jiKe-7,-
�J� Road/Street s;4-/d�J-
Address: �'/ � �`eK /� , Quad No.
/(/UpNy /yC Zb%O� Serial No.
Lat. 35'003-31f' Long..Y40cv
r WelilConstruction
Well Contractor J 4so,v /Lf tlic�s y%J i/ .. ( r'-'
Atltlress �
Contractor Certificaion 9 ZS-7-!Jame
Check Items Meets Min.Standards _Remarks
Measured Yes No
Permit Required � (YIN) (Permit No. ♦ti1L�
Location - Distance From, ...................
Water Tight Sewage/waste collection.. AI J,4
Waste disposal (septic tank drain field) >So`
Other Poll. Source 'A1D,9v7eij
Other Poll. Source ( )
in
(ciicle ono)
Type ..................................................... Plaslic arbon Galy. Stain.St. Other
Depth....................................................
Weightllhickness .................................. S,'.AZI ✓
Height (A.L.S.)..................................
Other( )
Drilling Fluids/Additives
Type .....................................................
Grout
Type .................................::................. G
Thickness ................ w ,,
.............................
Depth......................................
...............
Other ( )
Screens
Screened interval ................................. J
Other( 1
Development.........................................
Total Suspended solids .:....................
Turbidity .......................
Settleable Solids...................................
I.D. Plate
Well Contractor.....................................
Abandonment ....................................... LI
Temporary............................................
Permanent............................................
GW-36 Rev. 1/2000 Applies to wells constructed after December 1, 1992
front nn RAvarcwl

Check Items Meets Min.Standards Remarks
Measured Yes No
Well Test ............................................... rJ h
Duration*....................................
Frequency/Accuracy of measurements
Other( L��i'•y - 'a�ocv ) ✓
Disinfection...........................................
............................
Chlorination ..............
Other( ) . A A
ttn .................................................
Reports..................................................
Construction (GW-1) ............................
Abandonment(GW-30) ........................ I
Well Head Completion
' /L u t✓ '
Accessport...........................................
Hose bib .......
...........I.........I................... ✓
/+
Pilless Adaptor..................:..................
Pilless Adaptor Unit..............................
Suction line...........................................
Tee (jel)................................................
Valvedflow...........................................
Vent........................
Water tight pipe entry ...........................
Wellentry .............................................
Applies to wells constructed after December 1, 1992
Date Well Constructed /p Z GZ
Pump Installation
t
Pump Installation Contractor �fY)�IAI t'�Ct.
Name Address Reg, a
PUMP CONTRACTOR I D. PLATE PRESENT? (Y/N) Date Pump Installed ©y
Violations noted attributable to the pump installation contractor are as follows:
(1)
(2)
(3)
INSPECTOR
Name '` 011ice
Witness(es) �jwidbr- (:Q
(II Available) Name Address Type
Name ddress � Typo

z
o
DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
November 23, 2004
o _
0
MEMORANDUM V
To: Landon Davidson
Asheville Regional Office
From: Thomas Slusser-75'
Central Office
Re: Issuance of a New Water-source Heat Pump Injection Well Permit(Type SA7):
Permit Number WI0100023 has been issued to Johannes and Martha Penz in Murphy,Cherokee
County,to construct and operate a well for a water-source heat pump injection well system. This
permit is valid through November 30, 2009.
Please inspect and sample the injection well once the injection well system is constructed and
operational, and submit the attached post-construction form (Form B) to the UIC Program
Central Office staff.
The Underground Injection Control Program greatly appreciates the assistance of you and your
staff in getting this permit issued. If you have any questions regarding this memo or the UIC
Program, please contact me at [phone] or Evan Kane at(919) 715-6165.
cc: CO-UIC Files
Enclosures

, .
;�.
.•,
{
[l

ueparIment of Environment and Natural Resources
Division of Water Quality
Groundwater Section
77M
�y N�ommunity,Subdivision and Lot No.J Dale _ � 7/2%/2c2`¢WELL TYPE CcJt� OeNS ��376) County/�EEJ 'rx �rRoad/Street 5�Ouad No.
Hy /v'C Zb%e� Serial No.
Lat. 3�i `'Us.�1F' Long..�"'yW.7i!?'
We onstruction
Well Contractor _.J>l}Sed N(cficis �) e„z arce( �JLicci„/�
ame Address
Contractor Cen ) t!ificalor �7�
;mjeed'ardseets Min.Standards
Yes No Remarks
Permit Required
-FromWater Tight Sewage/waste collection.. _Waste disposal (septic tank drain field) ✓Other Poll.Source ✓Other Pall. SourceCasingCircle ono)
Type !� jPIa,u, ,,bo,( Galv. Slain.St. Other
Depth........:........................................... /.Sb e/
Weigh(/thickness .................................. 5�2Z/
Height (A.L.S.)...................................... '�
Other (
Drilling Fluids/Additives
Type ..................................................... .J
Grout
Type .................................:................... G
Thickness .....:....................... �v '.................
Depth.....................• B� is 3 ;
Other
Screens
Screened interval ..............
Other ( 1
Development......................................... _
Total Suspended solids .:..................:... ✓
Turbidity ...............................................
Settleable Solids...............:.
I.D. plate
Well Contractor:.................................... +�
Abandonment ....................................... rf
Temporary............................................
Permanent........
GW-36 Rev. 1/2000 Applies to wells constructed after December 1, 1992
rr:nnl nn Rgvnrcal

Check Items 5minn. ds RemarksMeasuredWell Test ............................................... N &Duration................................................Frequency/Accuracy of measurements
Other ( c _ 94"J ) .
Disinfection...........................................
Chlorination ..........................................
Other( ) • A A
Cuttings.................................................
Reports..................................................
Construction (GW-1) ............................
Abandonment (GW-30) ........................ /
Well Head Completion
Accessport........................................... ✓
Hosebib ................................................
Pilless Adaptor.....................................
Pilless Adaptor Unit..............................
Suction line...........................................
Tee (jet) ................................................
Valvedflow...................................... .....
Vent......................................................
Water light pipe entry ...........................
Wellentry .............................................
Applies to wells constructed after December 1, 1992
Date Well Constructed 4, b 62—
Pump Installation
Pump Installation Contractor
Name Address _- Reg. 9
PUMP CONTRACTOR I D PLATE PRESENT ? (YIN) Date Pump Installed q P�
Violations noted attributable to the pump installation contractor are as follows:
(1)
(2)
(3)
INSPECTOR f
' Name Office
,
Witness(es) WAIC� L
(It Available) Namere Address
Type
Gi`'. ZoJ J,/ //ro
Name Address Type

Q Paget of 2
v North Carolina Department of Environment and Natural Resources
Division of Water Quality
Groundwater Section
PRECONSTRUCTION INJECTION FACILITY INSPECTION
REPORT-FORM A
INJECTION WELL PERMIT NO. WI DATE
NAME OF OWNER_ J W4_"WES PN-7- /�Zr�.8�9- 604
ADDRESS OF OWNER_ 667 rz-emtw- 4f, C�s4 (f'f9)
Mv"'frl rJt= Z3 06
(Street/road or lot and subdivision,county,town)
LOCATION OF PROPOSED INJECTION WELL (and source well(s), if applicable)
Ca!Lf)
(Street/road or lot and subdivision,county,town,ifdierent than owner's address,plus description oflocation on site)
Potential pollution source S-9i rc 7kAf4A),0*,n1Fi6Lb Distance from well T rO
Potential pollution source Ra^e 7-1a^( Distance from well > SC,
Potential pollution source Distance from well
Minimum distance of proposed well from property boundary >'ZO `
Quality of drainage at site qao Flooding potential of site 4(aw
(good,adeguate poor) (high,moderme,low)
DRAW SKETCH OF SITE
(Showproperty boundaries,buildings, wells,potential pollution sources,roads, approximate scale, and north arrow.)
E::�J$e
s¢ iSS
GW/UIC-1 arch 28, 2001

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (eont.)
GPS Data:
Latitude: 3S� 03. 3/9 Longitude: F4 u U • 779
COMMENTS
INSPECTOR ��•vi,^�^r«t�� Iry
Office Aos� p,e0
WITNESS e)vjd£X—
Address
WITNESS
Address
GWIUIC-1 March 28, 2001

1VLLL CONSTRUCTION RECORD
North C:nolina - Ueparinlenl of Envirenulenl and Natural Rmmiceels-Division of Walcl Ouality-Groundwater Section
1 ('IJ • S CF.ICIIFIC,\"f1ONq_ SJL U1:1.1.CON"I RAU]OR(INDIVIDUAL)NAME (prin) I_/ J CPI•_ f/I /_.--_-I -..- __ _
UF.LI.('1IN'l lt.\(`I Olt('OPII',\Nl'N,\PIE- _r tA_KJbO—�hj {.'1 'l�U_1h G PHONE H ��y�V
5I A Ili WE Ll.CNNSIItnC'IION PE IIM Crd ASSOCL\1 ED WO PERM ITN
I if applicable) (iI applicable)
I. \\•EI.I. USE(Check Applicable Box): Residenlial eNflmicipal/I'nblic ❑ 1ndusli iad ❑ Apriculluml ❑
Nlonilming ❑ .Recovery ❑ IZeal Pump Waler Injection ❑ Olher❑ II'Olber, List Use
/,/i� a
2. WELL LOCATION: /-•1 'Topographic/I_alld sellin�gg
Nc;lmsl'fowu: _M UQl�County l�/1C�fLe .rz�._ ❑Ridge ❑Slope ❑Valley ` :1a1
)/,ee/J(.___� Ichcck appl nplialc hull
15ueel Nanm.N...t Elms.Cummmnity,Sub.1hisinn.Lot No.,Zip C•nle) La I ll udc/lollgl little of well locallnll
3. OWNER:—_t�..0`1�_ �—.__. JeE,ecs;wiuulegrt<cauJc)
Address 7c]'�t1,Jr�I L-/J Lalihuldluugiludcsource:❑(ills❑Topographic map
(Sbeelm Rhone Nn.I q Icheck Gast
/L��_,� DRILLING LOG)
15ry nr It 1:u / Sauc p! Zip Code Flnnl ... To I mInalioo I Dcscriplion
Are,r:,de-Phmm JI3=i_f- __ Lop—
4. DAT1i 1)M.I.ED�-off �, �� �,
5. TOTAL DEPTI1: ,?
6. DOES WELL REPLACE EXISTING WELL? ITS ❑ NO ❑
7. STATICWATFRLEVIil.Below Top ofCasing:�•�' _I71'. ---
I ((Ise"I^if Ahnvc fop of Cmiup)
S. TOT' OF CASING IS ! —FT. Above I.;md Sullocc•
"lop of casing lerndualed asior belim land surface rc,p,trcs a
r:u'laore lnuecord:m_ce1,ilh 15A NCAC 2C.I1118. �l ---
9. YIELD(pill): _1,G_KIET110D OF TESf_9 Jf• 7��
10. WA ITR Z_ON177S(depth): _ _ P_ 3�
n ' � �' ��' LOCATION SKI;TC'll '
11. DISINFECTION:Type—CAL � Amounl _[LjO PP-, Show dilection anti tlislance in miles from al least
12. CASINU: Wall'lllickuess Iwo Slate Roads ur County Roads. Include the road
Depth Diameter or leighUFl. Material lllllllbeis;lull common road Inures.
From �/"Io_� � Ira. _ -i��-2( �VL
From 'I'o Fl. _ --
Flom_ ,lo__I-1
13. GROUI': Depth Malcial ,jt lellit } ( 'v J �✓
From "fu_f v ri-Arl MVIA
1.1. SC'RITN: Depth Diameter SlolShe Malcrial
Froul To H.—ill. in.
Prom To
15. SAND/GRAVEL PACK: f
Dcplh Sizc Material
Flom ' o— _IT ---_
From To PI.
16. REMARKS:
I DO HURE1)Y C ERT'IFY TINT"f'DIIS WELL WAS CONSTRUCTED IN ACCORDANCE WI I'll 15A NCAC 2C.WELL
CONS HIM I ION STANDARDS,AND'DIAT A COPY OF TIIIS RECORD HAS BITN PROVIDED TO lllli WELL OWNER
SIGN Ol(E G ERSON CONS]RUCTING 1 Ill: WELL DA I'E
submit the original In (he Divisinu of 1Yaler Quality,Grit mldtr: lei,Scclion, 1636 Mail Service Center-I(alcigh,NC
27699-1636 Plinne Nu.[phone],trilhill 30 Clays. (i W-1 REV,Q7/N)111

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5
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S
5 S S N
N FW s
N
S
_ a
u . H
-S '�:er mal h.ar 5 s
puMp N. l�
CW - community well
PW - Private well
S - Septic System
H - House
I
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WV
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��������� t��'.�,►� /,"i,� '' U: r7
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CAP
y��■�''^^,,�,• .�ulf\�=\ � +\�I�Qpf T� � "�il � - � ��• �1�A \! W WWI-
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D 7 --
DIVISION OF WATER QUALITY JUL 2 0 2004
D
GROUNDWATER SECTION GROUNDSVATER SECION
July 16, 2004 ASHOILLE REGIONAL OFFICE
MEMORANDUM
To: Landon Davidson, Groundwater Supervisor
Asheville Regional Office
From: Thomas Slusser
Central Office
Re: Request for review of an injection well application, type 5A7 injection well (open-loop
beat pump injection well), submitted by Martha and Johannes Penz, for the construction
and operation of a heat pump injection well system in Murphy, North Carolina.
1. Please review the application and submit any comments to CO-UIC group. Retain the
application for your UIC file.
2. Please inspect the injection well site to verify that the location and construction plans
submitted in the application are accurate and that the NCAC Title 15A 2C.0200 standards
are being complied with, using the enclosed Preconstruction Injection Facility Inspection
Report (Form A) as appropriate.
You are requested to return The Review Comments and the completed Preconstruction
Injection Facility Inspection Report(Form A) to the CO-UIC by August 9, 2004. If the
inspection and review can not be accomplished by this date,please let me know.
The UIC group appreciates your assistance with this review. If you have any questions regarding
this review or the UIC program, please contact me at [phone].
cc: CO-UIC Files
Enclosures

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 CAROLINNDIVISION OF WATER QUALITY
DATE: , 20
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
(1) -L/ Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) _ 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 Oflntent To
Construct A Closed-Loop Geothermal-Water Only Injection Well System.
B. PERMIT APPLICANT
Name: JOHANNE-S 4 MARrNR PkNZ
Address: 667 KFENER RD.
City: MURPNY State: NC Zip Code:28 FD6 County: (fNE20KE-49-
Telephone: AUS-837- 61/96
C. PROPERTY OWNER-(if different frdm applicant)
Name:
Address:
City: Sate:_ Zip Code: County:
Telephone:
D. STATUS OF APPLICANT
Private: Federal:_ Commercial:
State:_ Municipal:_ Native American Lands:
GW-57 HP (Jan,2000) Pagel of4

E. FACILITY(SITE)DATA
(Fill out ONLY if the Status of Owner is Federal, State,Municipal or Commercial).
Name of Business or Facility:
Address:
City: Zip Code: County:
Telephone: Contact Person:
F. HEAT PUMP CONTRACTOR DATA
Name: WODDAR.D E-1-ECV-1C SMVICE, INC.
Address: q8 CREEK or CIKeLE
City: t(AYESWLLE Zip Code: g0 County: CLAY
Telephone: 828-3V -8136 Contact Person: WARRM WOODAK"D
G. INJECTION PROCEDURE (Briefly describe how the injection well(s)will be used.)
Re'furfs 01 W Pf- watir 4L" �pas 4,e �4roLtP4
Air (c�cl. iwetc� -- eat- k-xc4a�gg�(Abo,,00% M1elurq,�30J/o ll�o�t-te�crn
, U' ce-
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
(2) Personal consumption? YES ✓ NO
1. CONSTR�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-
I (Well Construction Record)if available.- I :
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:___ /9A �N -: �' 1'^l.C. 7c�ODyMU�fl
NC Contractor Certification number: S oZ
(2) Date to be constructed: a--;L-0 3 Number ofborings:
Approximate depth of each boring(feet): 73:a-a
(3) Well casing: Is the well(s)cased?
(a) YES --Z If yes,then provide the casing informs 'on below.
Type: Galvanized steel_Black steel_Plastic_Other(specify)
Casing depth: From "} tto 15 9 ft. (reference to land surface)
Casing extends above ground inches
(b) NO
GW-57 HP (Jan,2000) Page 2 of 4

(4) Grout(material surrounding well casing and/or piping):
(a) Grouttype: Cement--Z Bentonite_ Other(specify)
(b) Grouted surface and grout depth(reference to land surfacey:.
/around closed loop piping;from to (feet).
'V around well casing; from O to ac) (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✓no (b) the effluent line? yes no
(7) SOURCE WELL CONSTRUCTION'INFORMATION(i£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 CONIRACPOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERATING DATA(for Type 5A7 wells)
(1) Injection rate: Average(daily) L5_ gallons per minute(gpm).
an 2 Injection Volume: 6i l�oftest/ Avera a dail �/2,,,d gallons per d M x
( ) J colt�est' o(v�ys g ( Y) GLV g P Y(gP )• a tw``
(3) Injection Pressure: Average(daily)0 pounds/square inch(psi). Pri
iore.rr�.-e
(4) Injection Temperature:-Avenge(January) YS °F,Average(July) 6S°F.
­; o
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/sedimentunit:
(2) Chemical Analysis of Source Fluid(for Type 5QM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
L. INJECTION-RELATED EQUIPNMNT
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.
GW-57 HP (Jan,2000) Page 3 of

M. LOCATION OF WELL(S) Attach two maps.
(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies,
potential sources of groundwater contamination and the orientation of and distances between
the proposed well(s) and any existing well(s)or waste disposal facilities such as septic tanks or
drain fields located within 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. I am aware that there are significant penalties,including the possibility
of fines and imprisonment, for submitting false information. I agree to construct, operate, maintain,
repair, and if applicable, abandon the injection well and all related appurtenances in accordance with
the approved specifications and conditions of the Permit."
(Signature of Weff Owner Zr Authorized Ag
Ifauthorized agent is acting on behalfofthe well owner,
please supply a letter signed by the owner authorizing the above agent.
P. CONSENT OF PROPERTY OWNER(Owner means any person who holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby 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 15A NCAC 2C.0200)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section-
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh,NC 27699-1636
Telephone [phone]
GW-57 HP (Jan,2000) Page 4 of 4

NJATFROG Michael F.Easley,Governor
William G.Ross Jr.,Secretary
y r North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
Y Division of Water Quality
November 23, 2004
Martha and Johannes Penz
667 Keener Road
Murphy, NC 28906
Dear Mr. and Mrs. Penz:
In accordance with your application submitted July 15, 2004, the Division of Water Quality's Underground
h3jection Control (UIC) Program is forwarding Permit No. WI0100023 for the construction and operation of a
geothern3al heat pump injection system at 667 Keener Road, Murphy, North Carolina, in Cherokee County.
This permit shall be effective from the date of issuance until November 30, 2009, and shall be subject to the
conditions and limitations stated therein. Please read your permit carefully to make sure you thoroughly
understand its requirements your and responsibilities.
Post-construction inspection and sampling of this geothermal heat pump system is necessary to complete the
permitting process. You must contact the Division of Water Quality's Asheville Regional Office at (828) 296-
4500 to schedule the post-construction inspection once the injection well system becomes operational. Please
note, if the sample results exceed groundwater quality standards, it is the well owner's responsibility to take
corrective action as stated in Title 15A Subchapter 2C, Section .0206.
Please contact me at [phone] or Evan Kane at [phone] if you have any questions regarding your
permit, the UIC Program, or injection rules and regulations.
Bregards,
Thomas Slusser
Hydrogeological Technician II
Underground Injection Control Program
Attachment
Cc: Landon Davidson, Asheville Regional Office
CO-UIC Files
,
NanhC:uralina
111'vlura!(y
Aquifer Protection Section 1636 Mail Service Center Raleigh,NC 27699-1636 Plume(919)733-3221 Cuss.mer service
Internet:htipJyh2o.enesmte.oc.us 2728 Capital Boulevard Raleigh,NC 27604 Fax [phone] 1-877-623-6748
Fax [phone]
An Equal Opportunity/Affirmative Action Employer—50%Recycled110%Post Consumer Paper

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
JOHANNES and MARTHA PENZ
FOR THE CONSTRUCTION AND OPERATION OF A TYPE 5A7 INJECTION WELL,defined in
Title 15A North Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the
injection of heat pump effluent.This injection well will be located at 667 Keener Road,Murphy,in
Cherokee County,North Carolina,and will be operated in accordance with the application submitted
July 15,2004 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 November 30,2009
and shall be subject to the specified conditions and limitations set forth in Parts I through X hereof.
RD
Permit issued this the ;13 day of �a?vr`ee(' , 2004.
Ted L. Bush, Jr., Chief
U Aquifer Protection Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No.W10100023 PAGE 1 OF 6
GW/UIC-5 ver. 7/04

PART I- WELL CONSTRUCTION GENERAL CONDITIONS
I. The Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the North
Carolina Well Construction Act and is grounds for enforcement action as provided for in
N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use.
Each well shall be permanently labeled with a warning that it is for injection purposes and the
entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each injection well shall have permanently affixed an identification plate.
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 constriction.
PART II - WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall
notify the Aquifer Protection Section-Underground Injection Control (UIC), Central Office
staff,telephone number(919)715-6166 and the Asheville Regional Office Aquifer Protection
Section Staff, telephone number(828) 296-4500.
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.
Permit No. W10100023 PAGE 2 OF 6
GW/UIC-5 ver. 7/04

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 that may be imposed by other local,
state,and federal agencies that 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-Underground
Injection Control(UIC),Central Office staff,telephone number(919)715-6166. Notification
is required so that Division staff can inspect or otherwise review the injection facility and
determine if it is in compliance with permit conditions.
Permit No. WI0100023 PAGE 3 OF 6
GW/UIC-5 ver.7/04

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.
3. Where the Pennittee 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 Perm ittee.
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. WI0100023 PAGE 4 OF 6
GW/UIC-5 ver.7/04

PART VIII - PERMIT RENEWAL
The Permittee shall, at least three (3) months 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 discontinuation of 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 it 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 that extends to the bottom of the well
and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have not
been removed, the casing shall be perforated opposite the gravel pack, at
intervals not exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner that
will prevent the movement of fluids into or between underground sources of
drinking water and in accordance with the terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as
specified in 15A NCAC 2C .0213(h)(1) within 30 days of completion of
abandonment.
Permit No.WI0100023 PAGE 5 OE 6
GWMIC-5 ver. 7/04

3. The written documentation required in Part D{ (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART X- OPERATION AND USE SPECIAL CONDITIONS
None
Permit No.WI0100023 PAGE 6 OF 6
GW/UIC-5 ver.7/04

NCDENR:
North Carolina Department of Environment and Natural ResourceS
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director RECEIVED Secretary
June 2, 2009
JUN 161C09
Johannes and Martha Penz
667 Keener Road Asheville Regional Office
Murphy,NC 28906 Aquifer Protection
Re: Issuance of Injection Well Permit
Permit No. W10100023
Issued to Johannes and Martha Penz
Cherokee County
Dear Mr. and Mrs. Penz:
In accordance with your application received February 19, 2009, I am forwarding Permit No. WI0100023 for
the operation of a 5A7 geothermal underground injection control (UIC) well heat pump system located at 667
Keener Road, Murphy,NC 28906. This permit shall be effective from the date of issuance until May 31, 2014,
and shall be subject to the conditions and limitations stated therein.
Also attached is a summary of the laboratory sampling results from water samples collected from your
geothermal well on March 9, 2009.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit four 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 me at [phone].
Best Regards,
_.
Mic�ers, E ronmental Specialist
cc: Landon Davidson—Asheville Regional Office
Central Office File—WI0100023
Cherokee County Environmental Health Dept.
Attachment(s)
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh.North Carolina 27699-1636
Locatpn:2128 Capital Boulevard.Raleigh.North Carolina 27604 ne
Phone:[phone] FAX 1w :919-715-0588:FAX 2:919-7156M�.Customer Service:1-877-623-6748 C�..O�lIla
iry
Internet:w riciiatemualiN.orn N1 n
An Equal opoc r Afirrnative Actron Employer Vahmall

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
Johannes and Martha Penz
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North Carolina
Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump effluent. This
injection well is located at 667 Keener Road, Murphy,NC 28906, and will be constructed and operated in
accordance with the application dated February 19, 2009, and in conformity with the specifications and
supporting data submitted, all of which are filed with the Department of Environment and Natural Resources
and are considered a part of this permit.
This permit is for operation only, and does not waive any provisions of the Water Use Act or any other
applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in compliance with
Title 15A North Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations
pertaining to well construction and use.
This permit shall be effective,unless revoked, from the date of its issuance until May 31, 2014, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
ND
Permit issued this the 2 day of 12009.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
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 NGAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record(Form GW-1)must be submitted for each injection well to:
Aquifer Protection Section—UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section—Asheville Regional Office
2090 US Hwy 70
Swannanoa, NC 28778
[phone]
GW-Is must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
9. Well construction records must also be submitted for any existing water supply wells on-site as well as a
site map showing any water supply wells on adjacent properties as specified in NCAC .0211(d)(1)(1)).
PART II—OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This.permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
3

name change of the Permittee, a formal permit amendment request must be submitted to the Director,- q
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.
PART III—PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART IV—OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
. 2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
PART V- INSPECTIONS
I. 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.
4

PART VI—MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VII—PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit,request an extension.
PART VIII—CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the. Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
5

(D) Each well shall be completely filled with cement grout, which shall be introduced into the--
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
PART IX—OPERATION AND USE SPECIAL CONDITIONS
None.
6

r
LABORATORY ANALYTICAL RESULTS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC)WELL
PERMIT NO.: WI 0100023
PERMITTEE: Johannes and Martha Penz
SAMPLE COLLECTED DATE: 319/09
Coliform,total Coliform,fecal pH Total Dissolved Solids Chloride,Cl Sulfate Ammonia,NH3 TKN
1 CFUI100ml 1 CFU/100ml units m /L m IL m IL m IL m /L
MCL=1 MCL=1 MCL=6.5-8.5 MCL=500 MCL=250 MCL=250 MCL=nss MCL=nss
Influent not deceecled not detected na 23 <1 4.1 na na
Effluent not dectected not detected na 7 <1 3.9 na na
NO2+NO3 as N Phosphorus Nitrate Nitrite Silver,Aq Aluminum,AI Arsenic,As Barium,Be
mglL m IL mg/L mg/L /L p IL ti IL IL
MCL=1D MCL=nss MCL=10 MCL=1 MCL=17.5 MCL=nss MCL=50 MCL=2000
Influent 0.05 na 0.05 <.01 na <50 na <10
0.05 na 0.05 <01 na <50 na <10
Effluent
Calcium,Ca Cadmium,Cd Chromium,Cr Copper,Cu Iron,Fe Mercury,Hg Potassium,K Magnesium,Mg
m /L /L p /L pg1L p IL pg/L mg1L mg/L
MCL=nss MCL=1.75 MCL=50 MCL=1000 MCL=300 MCL=1.05 MCL=nss MCL=nss
Influent 2.5 <1 <10 41 <50 na 0.34 2.1
Effluent 2.5 <1 <10 55 <50 na 0.35 2.1
Manganese,Mn Sodium,Na Nickel,Ni Lead,Ph Selenium,Se Zinc,Zn Flouride,F
pg/L mg/L It
pglL p IL N IL mg/L
MCL=50 MO nss MCL=100 MCL=15 MCL=50 MCL=1050 MCL=2
Influent
<10 4.3 <10 <10 <5 <10 <0.4
Effluent <10 4.3 <10 <10 <5 1 <10 <0.4
MCL=Maximum Contamination Level per NCAC 2L.0200(GA Standards)
nss=no stale standard
na=not analyzed
'The laboratory sample matrix interfered with the ability to to make any accumle delemiinatian;Estimated

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
Location code 1P020WI0100023-INF SAMPLE TYPE SAM/PLFrPRIORITY
County Cherokee LK"'Iter Lam' Routine p , Lab Number
Quad Nc Serial No. ❑ Sail ❑ Emergency •��
� �. Date Received $.q -o� Time: I S0
Lat. Long. ❑Other �Y'1 Redd By: ;1LfA'V From:Bus,Courier, Hand Del.,
❑ Chain of Custody Other:
Report To(ARO FRO, MRO,RRO,WaRO,WiRO, Data Entry By: Ck:
WSRO,Kinston FO, Fed.Thief;6@ntral Off.,Other: Date Reported:
-Shipped by:Bus, Courier,i4@Dd De., Other: Purpose:'
Colledor(s):_Julie Vann Date Time—u o Baseline,Complaint,Compliance,LUST, Pesticide Study, Federal Trust, Other:
FIELD ANALYSES Owner Penz 6)
PH 4w Spec.Cond.94 e GG2 at 25cC Location or Site_667 Keener Road, Murphy, NC
Temp.lo L` $'i eC Odor Description of sampling paint
Appearance Q(eay _ Sampling Method Sample Interval
Field Analysis By:
Remarks umo. ai er.e c.
LABORATORY ANALYSES (Pumping time,air temp.,etc.)
J
310 mg/L iss.Solids 70300 ri Ag-Silver 46566 u /L Or anochiorine Pesticides
High 340 mg/L Fluoride 951 mg/L AI-Aluminum 46557 u /L Or ano hos horns Pesticides
Low 335 mg/L Hardness:Total 900 mg/L As-Arsenic 46551 u /L Nitro en Pesticides
oan:MF Fecal 31616 /10om1 rb)902 mg/L Ba-Barium 46558 u /L Acid Herbicides
onn:MF Total 31504 /100ml Phenols 32730 ug/1 Ca-Calcium 46552 m /L PCBs
680 mg/L Specific Cond.95 pmhos/cm Cd-Cadmium 46559 u I
idity 76 NTU Sulfate 945 ri Cr-Chromium 46559 u /L
Residue,Total Suspended 530 mg/L Sulfide 745 mg/L Cu-Copper 46562 um
Fe-Iron 46563 u /L Semivolable Organics
Oil and Grease mg/L Hg-Mercury 71900 u /L TPH-Diesel Range
PH 403 ' units K-Potassium 46555 rn /L
Alkarinityto pH 4.6410 mg/L Mg-Magnesium 46664 mg/L
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 u /L Volatile Organics(VOA bottle
Carbonate 445 mg/L NH,as N 610 mg/L Na-Sodium 46556 mg/L TPH-Gasoline Range
Bicarbonate 440 mg/L TKN as N 625 mg/L NI-Nickel u /L TPH-BTEX Gasoline Range
Carbon dioxide 405 mg/L NO,+NO,as N 630 mg/L Pb-Lead 46564 urill.
Chloride 940 mg/L P:Total as P 665 mg/L Se-Selenium u /L
Chromium:Hex 1032 ug/L Nitrate(NO3 as N)620 mg/L Zn-Zinc 46567 u /L
Color.True 80 Cu Nitrite(NOq as N)615 mg/L LAB USE ONLY
Temperature on arrival(°C):
Cyanide 720 mg/L 1
Lab Comments
GW-54 REV.7103 For Dissolved Analysis-submh filtered sample and write'DIS'in block.

North Carolina
GROUNDWATER FIELD/LAB FORM Department ofRQUAmentand Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
Location code 1 P020W10100023-WIF G ff- ISAMPLE
TYPE SAMP PRIORITYCOuntyCherokee ter Routine Qev77— Lab Number �
Quad No Serial No. l ❑ Emergency I� DateReceived o Time: 1Sb )
Lat. Long. er Reed By: From:Bus, Courier, Hand Del.,
❑ Chain of Custody r� Other.
RepoM1To ARID FRO,MRO, RRO,WaRO,WiRO, Data Entry By: Ck:
WSRO, Kinston FO,Fed.Trust Central Off.,Other: Date Reported:
Shipped by:Bus,Courier, and D ,Other: q Purpose:
Collector(s):_Julie Vann Date 1—Time G3� Baseline,Complaint, Compliance,LUST, Pesticide Study, Federal Trust, Other:
(circle one)
FIELD ANALYSES Owner Penz
Sec.Cond.94 .O Z1 at 25°C. Location or Site_667 Keener Road,Murphy, N
pH4ao p 1. IPAN6 y
Temp.lo °C Odor Description of sampling point
Appearance Sampling Method S o qo Sample Interval_
Field Analysis By: \ n n1+
Remarks umu.
P
LABORATORY ANALYSES mping me,air tamp.,etc.)BOD 310 mg/L Diss.Solids 70300 mg/L Ag-Sihrer 46566 u /L O anochlorine Pesticides
COD High 340 mg/L Fluodde 951 mg/L AI-Auminum 46557 u /L O ano hos horus Pesticides
COD Low 335 mg/L mg/L As-Arsenic 46551 u /L Nitro en Pesticides
Coliform:MF Fecal 31616 /100m1 Hardness(noncarb)902 mg/L Ba-Radom 4fi556 u /L ' Acid Herbiddes
Colifonn:MFTolal 31504 /100ml Phenols 32730 ug/l Ca-Calcium 46552 m /L PCBs
TOC 660 mg/L Specific Cord.95 pMhoslan Cd-Cadmium46559 u /L
Turbidity 76 NTU Sulfate 945 mg/L Cr-Chromium 46559 u /L
Residue,Total Suspended 530 mg/L Sulfide 745 mg/L Cu-Copper46582 u /L
Fe-Imn 46563 u /L Semlvolalile Organim
Og and Grease mg/L Hg-Mercury Moo u /L TPH-Diesel Range
pH 403 - units K-Potassium 46555 mg/L
Alkalinity to pH 4.6 410 mg/L Mg-Magnesium 46554 m /L
Alkallnity to pH 8.3 415 mg/L Mn-Manganese 46565 u /L Volatile Organics OA bottle
Carbonate 445 mg/L NH,as N 610 mg/L Ne-Sodium 46556 m /L TPH-Gasoline Ran e
Bicarbonate 440 moll. T N as N 625 mg/L Ni-Nickel u /L TPH•BTEX Gasoline Ran e
Carbon tlioxide 405 mg/L 3 6 630 'mg/L Pb-Lead 46564 u fL
Chloride 940 mg/L P:Total as P 665 mg/L Se-Selen'urn u /L
Chromium:Hex 1032 ug/L Nitrale 56
(NO. N)620 mg/L Zn-Zinc 467 u /L
AB
Color.True 80 OU as N)615 mg/L L USE ONLY `
Temperature on arrival(°C): �1
Cyanide 720- mg/L
Lab Comments
GW-54 REV.7/03 For Dissolved Analysis-submit Nlered sample and wrile'DIS-In block.