WI0100084_Complete Historic File ARO_20220316

03/02/2010 00:58 919-715-0588 NCDE&NR/WATER QUAL PAGE 02
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES(NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELLS)FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50M WELL(Sl
_New Permit Application OR Renews
REeEIVED
DATE: © � . 20 /0 MAR 05 20
PERMIT NO. (leave blank if NEW permit application)
Asheville Regional Office
A. PROPERTY OWNER(S)/APPLICANT(S) Aclijifer Protection
List each Property Owner listed on property deed(if owned by
a business or ovemment agency, state name of
entity and a representative w/authority for signature): SJ—
(1) Mailing Address; ts; 0 ` a �� �
l ` �ss
City: VIA State:� Zip Code: County: 1 Y\ Y�CD w/�
Home/Office TeleNo.: /DL4- 3 S OL)(oO CellNof7oq— �i l-g h_( Sr4sao
EMAIL.Address: SOU-Ma t 6V% J Cam-LQ l incgr non �C
(2) Physical Address of Site(if different than.above):
City: (1q4\1Q(5 State:Pc_ Zip Code,CQW l ) County:Lt
Home/Office Tele No.: Ce11No.:
EMAIL Address_
B. AUTHORIZED AGENT-OF OWNER,W 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: MAIL Address:
Address:
City: State:_Zip Code: County:
Office Tele No.: Cell No.:
Website Address of Company,if any:
C. STATUS OF APPLICANT
Private: Z Federal:_ Commercial:, RECEIVED/DENRINQ
State: Municipal: Native American Lands: A0UiFFR'pP0TFnT,()N St CT(pry
FEB 2t3 2010
CHU/=IQM Well Permit Application(Revised 7/2008) Pagc 1

03/02/2010 00:5B 919-715-0588 NCDE&NR/WATER QUAL7 PAGE 03
D. WELL DRILLER TNF�0Rf1dATI N
Company Name:
Well Drilling Contractor's Name: , 1 C Q /i} n✓ y v z L l L�F'
NC Contractor Certification No.: 2 q& ft
Contact Person: \N L E- EMAIL Address:
Address: V�L�91� Ge6 .a-
City: V Rax)Ulo Zip Code: County: laf _
Office Tele No.: Cell No.:
E. HEAT kI W CONTRACTOR INFORMATION(if different than driller)
Company Name: &Q•4 A �LW, CQpCA n `
ContactPerso��ntt:�o $(-'ACM EMA.1LAddress: q`1hO-@CtM' -V�k -
Address: o
City: V M� (N _ Zip (Code: 13� r�County, ACL-a
Office Tele No.: ZA`O "�kc(-LWQ Cell Na.: 05
F. INJECTION PROCEDURE (briefly describe how the injection well(s)will be used)
o 1'0 4e,(Oj l 1�- � 121 a- r61 by
G. WELL CONSTRUCTION DATA(Skin to Section H if this is a Permit R ENEWAL)
(1) Proposed date to be constructed: 3 /J -/Q Number of borings:
rl l
Approximate depth of each boring(feet): pt y(
(2) Chemical additives to be used in closed-loop system(only those chemicals indicated have been approved):
R-22 �Propylene glycol ethanol other(other additives will
need prior approval by NCDPNR before use) II nn
(3) Type of tubing to be used-(copper,PVC;etc): 'Y�1l cn.)
(4) Well casing. Is the well(s)cased?(check either e.)'Y) S or(b.)NO below)
(a) YES if yes,then provide casing information such as type(steel,PVC,plastic,etc.),diameter
dendi,and extent of casing appearing above ground:
(b) NO s�
(5) Grout(material surrounding well casing and/or piping):
-
(a) Grout type: Cement Bentonite Z Other(specify) i
(b) Grout depth of tubing(reference to land surface): from to (feet) (Qf
If well has casing,indicate grout depth: from to - (feet)
11. 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.
GPUARC 5QM Well Permit Application(Rcvised 7/2008) Page 2

03/02/2010 00:50 919-715-0580 NCDE&NR/WATER QUAL PAGE 04
L LOCATION OF WELLS)
Attach two copies of maps showing the following information:
(1) Include a site map(canoe drawn)showing: buildings,property lines;surface ryater 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.
X. POTABLE WATER WELL(S)
Are there any potable water well(s)on the subject property or adjacent properties? 1FES g1,10
If Yes,than indicate location on attached map(s).
K. 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 inquiy 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 "pproved spec'i£�/v 7,JC/1cattions and conditions of the.Permit"
JGy--_. (, ,
Signature of Property Owner/Applicant
SVSaV\, 4-r, 14� (IJ
Print or Type Ad Me
Signa are of Property
)Owner/Applicant
Print br 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
Ralelgh,NC 27699-1636
Telephone [phone]
GPU/UIC 5QMWeU11cimil Application(Revised 712008) + Pagn3
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03/02/2010 00:58 919-715-0588 NCDE&NR/WATER QUAL7 PAGE 05
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03/02/2010 00:58 919-715-0588 NCDE&NR/WATER QUAL PAGE 06
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03/02/2010 00:58 919-715-0588 NCDE&NR/WATER QUAL PAGE 07
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HC E N R
North Carolina Department of Environment and NatOral Resources
Division of Water Quality
Beverly Eaves Perdue CQleen H.Sullins Dee Freeman
Governor Director Secretary
March 3,2010
Susan Hamilton
Blanton Hamilton
1700 Brandon Rd.
Charlotte.NC 28207
Subject: Acknowledgement of Application No.WIOI00084
Susan Hamilton SFR
Injection Mixed Fluid GSHP Well System(5QM)
Jackson
Dear Ms.Hamilton:
The Aquifer Protection Section of the Division of Water Quality(Division)acknowledges receipt of your pL itappiication and
supporting materials on February 23,2010.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,pleaac contact Tv rhael Rogers at 919-715-6166,or via e-mail at miohael.rogerMLncdenr.gov. 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 h,":7/lt2aenr.state.nc.us/documents/dwq orechart.pddf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS pROJECT.
I
-
for Debra J. tts
Supervisor
cc; Asheville Regional Office,Aquifer Protection Section
Christy McClure(Tarheel Water Treatment,Inc.,3494 Georgia Rd,Franklin,NC 28734)
Bruce Auld(Andrews Auld,11eating&Cooling,Inc,3348 Old Murphy Rd.,Franklin,NC 28734)
(;;P.erttitApplication File WIOl00b84.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,NOlih Carolina 2769M636
Lwatinnl 2728 Capital aowOvard,R616r9h,Noah Qamlina 27604
Phone:[phone] FAX 1:919-715-0588;FAX 2:919.715.60481 Customer SeMcetl-877-523-67a8 Intemel:%w .ncwalcmuality.om jNf op rC.11ca1,Q1,1If2L O
An Eoual OPP"nityl AtfirmafivEAofion Empoyei [' •� "�

,• PART IX—CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily,the Permittee must install a sanitary seal. If a well is not to be used
for any purpose, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
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 copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.1 of this permit.
Permit W10100084 UIC/5QM Page 5 of 5
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v
C
PART VII—MONITORING AND REPORTING REQUIREMENTS
I
1. All required documentation shall be submitted to:
Aquifer Protection Section—UIC Program Aquifer Protection Section
DENR—Division of Water Quality Asheville Regional Office
1636 Mail Service Center and 2090 US Highway 70 1
Raleigh,NC 27699-1636 Swannanoa,NC 28778!
Ph#919-715-3221 [phone]
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Asheville Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Asheville Regional Office within 30
days of completion of well construction.
4. 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.
5. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number(828) 296-4500 any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. 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.
7. 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 VIH—PERMIT RENEWAL
In order to coniinue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit W10100084 UIC/5QM Page 4 of 5
ver.03/2010
I

•e
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV—PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V—OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. 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.
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. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit WI0100084 UIC/5QM Page 3 of 5
ver.03/2010

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART II —WELL CONSTRUCTION.SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone], and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number [phone].
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation corners) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or `cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
4. The wells must at a minimum be grouted with bentonite grout from land surface to 5 to 10 feet into
competent bedrock.
PART III—OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water.Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
Permit WI0100084 UIC/SQM Page 2 of 5
ver.03/2010

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
Susan and Blanton Hamilton
FOR THE CONSTRUCTION AND OPERATION OF 6 TYPE 5QM INJECTION WELL(S), defined in Title
-15A'North Carolina Administrative Code 2C .0209(e)(3)(F), for the-purpose of operating'a.vertical closed loop
geothermal mixed fluid heat pump system. This system is located at 260 Stovepipe Court, Cashiers, Jackson
County, NC 28717, and will be constructed and operated in accordance with the application received February
231 2010, 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 of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until February 28, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through D{hereof.
Permit issued this the 24"' day of March 2010.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit W10100084 UIC/5QM Page 1 of 5
ver.03/2010

Sincerely,
Michael Rogers,P.G. (NC&FL)
Environmental Specialist
cc: Landon Davidson—Asheville Regional Office
Central Office File—WI0100083
Macon County Environmental Health Dept.
Christy McClure -Tar Heel Water Treatment, Inc.
Attachment(s)

I
CDENR
North Carolina Department or E-nvironment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H.Sullins Dee Freeman
Governor Director Secretary
March 24.2010
Thomas and Sharon Gray
P.O. Box 1447
Franklin,NC 28744
Subject: Issuance of Injection Well Permit
Permit No.W10100083
Issued to Thomas and Sharon Gray
Macon County
Dear Mr. and Mrs. Gray:
In accordance with your application received February 18, 2010,I am forwarding Permit No. WI010008_
for the construction and operation of a vertical closed-loop geothermal mixed-fluid heat pump injection
well system to be located at 84 Soaring Eagle Dr., Franklin, NC 28734. This permit shall be effective
from the date of issuance until February 28,2015,and shall be subject to the conditions and limitations
stated therein.
Please pay special attention to Part VII.2 of the permit and submit.copies of the Well Construction
Completion form(GW-1)after construction. Please submit all data within 30 calendar days of
completion of installation of geothermal well(s)to the following address:
Aquifer Protection Section(APS)
Underground Injection Control(UIC) Staff
1636 Mail Service Center
Raleigh,NC 27699-1636
Additionally, your UIC system is subject to inspection by the APS. Per special condition Part 11.4,in the
event that there will be multiple wells with separate clusters,one well identification tag per`cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
Finally,please pay attention to special condition 11.5. The weH(s)must at a minimum be grouted
with bentonite grout from land surface to 5 to 10 feet into competent bedrock.
In order to continue uninterrupted legal use of this well for the stated purpose,you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit,this
permit is not transferable to any person without prior notice to,and approval by,the Director of the
Division of Water Quality. If you have any questions regarding your permit or the Underground Injection
Control Program please call me at(919) 715-6166.

PART IX—CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
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 copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.1 of this permit.
Permit#W10300083 UIC/SQM Page 5 of 5
ver.03/2010

PART VII—MONITORING AND REPORTING REQUIREMENTS
I
1. All required documentation shall be submitted to:
Aquifer Protection Section—UIC Program Aquifer Protection Section
DENR—Division of Water Quality Asheville Regional Office
1636 Mail Service Center and 2090 US Highway 70
Raleigh,NC 27699-1636 Swannanoa,NC 28778
Ph# 919-715-3221 [phone]
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Asheville Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Asheville Regional Office within 30
days of completion of well construction.
4. 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.
5. 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;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. 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.
7. 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 VIII—PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
I
Permit#WI0100083 UIC/5QM Page 4 of 5
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l
Y 3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV—PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V—OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC)
Program Central Office staff, telephone number [phone]. 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.
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. Division 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.
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PART I-WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
J. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART H—WELL.CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone], and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number [phone].
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation comers) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. Boreholes shall not connect separate aquifers or zones that have differences in water quality (e.g., shallow
surficial aquifers, saprolite, fractured bedrock, etc.) as specified in 15A NCAC 2C .02I3(d)(8)(C).
4. One well identification tag per grouping or `cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
5. The wells must at a minimum be grouted with bentonite grout from land surface to 5 to 10 feet info
competent bedrock.
PART III—OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
i
Permit#W 10100083 UIC/5QM Page 2 of 5
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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
Thomas and Sharon Gray
FOR THE CONSTRUCTION AND OPERATION OF 2 TYPE 5QM INJECTION WELL(S), defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for'th'e'purpose of operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at 84 Soaring Eagle Dr., Franklin, Macon
County, NC 28734, and will be constructed and operated in accordance with the application received February
18, 2010, 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 of an injection well and shall be in compliance with Title 15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until February 28, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 24°i day of March 2010.
u " '
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit#W10100083 UIC/5QM Page 1 of 5
ver.03/2010

NCDENR
North Carolina Department of Environment and I laturaftVME D
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director MAR 3 0 261 ecretary
March 24. 2010 Asheville Regional Office
Aquifer Protection
Susan and Blanton Hamilton
1700 Brandon Rd.
Charlotte,NC 28207
Subject: Issuance of Injection Well Permit
Permit No.W10100084
Issued to Susan and Bianton
Hamilton
Jackson County
Dear Mr. and Mrs. Hamilton:
In accordance with your application received February 23, 2010, I am forwarding Permit No. WI0100084
for the construction and operation of a vertical closed-loop geothermal mixed-fluid heat pump injection
well system to be located at 260 Stovepipe Court, Cashiers,NC 28717. This permit shall be effective
from the date of issuance until February 28,2015, and shall be subject to the conditions and limitations
stated therein.
Please pay special attention to Part VII.2 of the permit and submit copies of the Well Construction
Completion form(GW-1)after construction. Please submit all data within 30 calendar days of
completion of installation of geothermal well(s)to the following address:
Aquifer Protection Section(APS)
Underground Injection Control(UIC) Staff
1636 Mail Service Center
Raleigh,NC 27699-1636
Additionally,your UIC system is subject to inspection by the APS. Per special condition Part 11.4,in the
event that there will be multiple wells with separate clusters, one well identification tag per`cluster' of
wells shall be permanently affixed to the heating and cooling unit or other nearby permanently fixed
location in a clearly visible location according to 2C .0213(g).
Finally,please pay attention to special condition n.5. The well(s)must at a minimum be grouted
with bentonite grout from land surface to 5 to 10 feet into competent bedrock.
In order to continue uninterrupted legal use of this well for the stated purpose,you should submit an
application to renew the permit three months prior to its expiration date. As indicated in the permit,this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Quality. If you have any questions regarding your permit or the Underground Injection
Control Program please call me at [phone].

Sincerely,
i
Michael Rogers, P.G. (NC FL)
Environmental Specialist
cc: Landon Davidson—Asheville Regional Officp,
Central Office File—WI0100084
Jackson County Environmental Health Dept.
Christy McClure-Tar Heel Water Treatment, Inc.
Attachment(s)