WI0100071_Complete File - Historical_20220527

JUSTICE WELL DRILLING, INC.
3845 US 70 WEST
MARION, NC 28752
PHONE/FAX [phone]
30 January 2012 -To Whom it may concern,
Re; WI0100073 ,g W I C 1000-1 1
Our records indicate that this GW-1 form was mailed on 10-29-2009 to The Aquifer
Protection in Raleigh and in Swannanoa. I believe that this was mailed to the Division of
water in Raleigh as well. I will make sure that these are mailed to them again.
Brenda Shipley RE
CEIVE®
Justice Well Drilling, Inc. FEB 0 3 2012
'NFQ WATER
SECTOM IT

MCER
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild,P. E. Dee Freeman
Governor Director Secretary
January 24, 2012
JUSTICE WELL DRILLING INC
3845 US HIGHWAY 70 WEST
MARION, NC 28752
Subject: Notice of Deficiencies
Missing Injection Well Construction Data
Dear Justice Well Drilling, Inc.:
A recent review of our records indicates missing injection well construction data (GW-1 forms)
for wells constructed under the following permits:
I e" 'a`�t' L _ wys;.s ^ems. =3 a'.."^'• v.�*yG9 W10100071 Henry and Deneen Schreyer SFR Injection Mixed Fluid GSHP Well System (5QM)__ ,.
W10100073 Mitchell County Historical Foundation Injection Mixed Fluid GSHP Well System (5QM)
It was required under the specific permit listed above that a copy of the GW-1 records were to
be submitted to the Aquifer Protection Section at the following address.
Aquifer Protection Section —UIC Program
DENR—Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Within 30 days of the receipt of this letter, you must mail a copy of the completed GW-1
records for each of the referenced permits to the address listed above. You can also choose to
fax a copy to forms to [phone]. If you were not the well contractor for the specified
permits, disregard this letter.
If you have not already done so for all of the above permits, please make sure you have
submitted a copy of the GW-1 records to our Information Processing unit listed at the bottom
of the GW-1 form. Failure to do so is a violation of 15A NCAC 02C .0213(h)(1) and may result
in the assessment of civil penalties in accordance with North Carolina General Statute 87-94.
AQUIFER PROTECTION SECTION
1636 Mail Service Center,Raleigh,North Carolina 27699-1636 One
Location:512 N.Salisbury St.,Ralegh,North Carolina 27604 NorthCarohna
Interne:st a i FAX:sts�o7�as6 ;Vaturally
Internet www.nc.nc wateteraualiN.om
An Equal Opportunity�Afimudve Action Employer

RESIDENTIAL WELL CONSTRUCTION RECORD
`• ham- North Csolma Depatrorni ofEnvvmment and Natural Reeomaa-Dimim of Wale Quality
WELL CONTRACTOR CERTIFICATION# NCWC- �2 ISO-Pf 4 V n 3 0 (, .ce;.
e,�
1.WELL CONTRACTOR- 4 WATER ZONES(dop1h):
(� R.0 AIG t�A1 .S US#i t� Top eotom Top Bottom
Web Con ctor(hdividu Q Name Top—Bottom— Top Botom
5'vS-4� cE Ltde LL. DriGQ-N!4 - Top Bobxq Top Boo
Wee Contractor Company Name Thirkoftsl
j,2y 5 L 5 ':p-O CJ.1 7. CASING: Depth Dim W r Weight Material
Street Address Tav_/Z Bottom Z`3 FL
NA A r i b Al A.e Top Bosom Ft
City or Town Stale Zip Code Tap Bottom FL
e( zs� � zy- ti s48
Area code Phone number 8. GRO(IT: Depth Material Method
2.WELL INFORMATION: Tap Bolom Ft WELL CONSTRUCTION PERMIT# LU T Oi OOO Top ..3 Boom J-40 FL e M —W —
OTHER ASSOCIATED PERMRt(raq:a,0e) Top Bolcom Ft �—
SITE WELL ID#rdappicable) 9. SCREEN: Depth Diameter Slot Stm Material
2.WELL USE(Check Applicable BW: ResWerrtial Wafer Supply❑ Top Botorr Ft_m. _ in.
DATE DRILLED I©-Z Top Soaorrr Ft n. _ in.
AM PM p Top Booh= Ft_m. _ in.
TIME COMPLETED
10.SAND/GR
4.WELL LOCLOCATION: ,r,t�� AVEL PACK
rV.C U.%�L L Depth Sine Material
CI
TY'. f rt�13 COUNTY Top BoU m Ft
(�& S P FS 1' t Cd W+.s L C+ 9 t Top Bottom FL
Bred Name.Nwnbers. .Subdwmon.Lot No.,Perod,4p Code) Top 600onn Ft
TOPOGRAPHIC f LAND SETTING: (chain appropriate bwo
❑Share oVeeey ❑Flat pRidge ❑ORrer _ 11_DRILLING LOG
Tap Bottom Formation Description
LATRUDE 40 2(0•12•DMS OR 3XJo0o000=DO
LONGITUDE 6 Ste. iI 'DMS OR 7X.)000O000O( DO /
LatiUWelbrpitudesoruce: [3§PS Oropographicmap /
(bcabon of we/must be shown on a USGS topo map andaaadled to `�_/ 7 9 Di 2
this fare if not using GPS) !
5.WELL OWNER:
�wrrar N'amk / .
S'her.pao� / n
Street Address e /
VIA ec{..1AIIe .SlTufc
City or Town State rip Code / INFDPMj6I 4ae..,.E,..40._-NIT
Area code Phone number
12.
6.WELL DETAILS: I
a. TOTAL DEPTH: A Pul
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO I DO -1F8-=B-yZERnFrTrglY7M WELL WAS CONSTRUCTED IN
G WATER LEVEL Below Top of Casing: �^ Fr. ACCORDANCE WITH 15A NCAC 2C•WELL CONSTRUCTION
(Use'+•if Above Top of Casing) : STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS ' FT.Above Land Surface'
'Top of Casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C.0118. SIGNATURE OF CERTIFIEDWELL CONTRACTOR DATE
e. YIELD(gpm): �' METHOD OF TEST a (4A r b V,
L DISIJIFECTION:Type QtOiCi N e- Amount S6Z PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to:Division of Water Quality- htfortrtation Processing, Form GW-la
1617 Mail Service Center,Raleigh,NC 27699-161,Phone:[phone] Rev.2109

LICSIDENTIAL R'ELL CONSTRUCTION RECORD
North Carolina Department OfFnvaonment and Natural Rcsouroe Nwe"a of Water Quality
WELL CONTRACTOR CERTIFICATION N N C W C a 150-A_ 0 s} 0 ,{
1.WELL CONTRACTOR -r 9. WATER ZONES NOW):
Top—Bottom— TOP 8dbm
Well Contra (Individual)Name Top Bottom TOP Bottom
5US4i t1= L:,Je.LC- �r, 4-0e4 Top Bosom Top Bdbm
Wen Contractor Company Name Thkknmw
3 8 C f 5' U 5 1 O t).S 7. CASING: Depth Diameter wow Nmterial
Sheet Address Top--![; Bosom FL
�+/ct 44fl out,) MN3 C `z $`7 Z-: Top Bosom Ft
City or Town SIaM ZP Cade Top Bottum Ft
U 7z
Area code Phona number S. GROUT: Depth Material Method
2.WELL OIFORWITKIN: Tap-j@4-Botlwn Ft
WELL CONSTRUCTION PERMRt` Top _BotNm-ajjj-FL L'A&& �
OTHER ASSOCIATED PERMIT/(#apptceNe) : Top_Bdfom FL
SITE WELL ID IK#aPpk W) 9. SCREEN: Depth Diameter Slot Sias Material
&WELL USE(Chant Applicable Box): ResiderNal WOW Supply Top_Bottom R—m. — in.
DATE DRILLED IA — Z� t3 : Top_Bolcom FL_m. — in.
Top Bottom Ft—in. _ in.
TIME COMPLETED AM❑ PM❑
4.WELL LOCATION: 10.SAND)GRAVEL PACK
Depth Size Meieriai
CITY: !YI R+ <�µT COUNTY CaOV Tap Bo" FL
L1 g Top Bottom Ft
(Sheol Name.N Canmm#y.Subamalon.1.Na,Paoel,Zip Code) Top Bohan FL
TOpX/OGRAPHIC/LAND SET ING: (d e&awrontt+e umDRILLING: 11.DRILLING LOG
p OVasey OFUd ❑Ridge OOther TOP Bin Fmnation Desaipson
LATITUDE 12 DM.S OR 3x.)00000000(DD
LONGITUDE 81 -5S—5//C-q'] •DillS OR 7x.mW000=DO : /
Latitudellongitude orts w : (BPS ( ropogrsphlc map
(location of well must be shown on a USGS topo map andasarhed to /
this torn If not using GPS)
S.WELL OWNER r /
(a etu r D�_IJ ee l,1
Owner Narn& lY
Sh�twoad 'b r / �CLor
StreetAddress
r14 If C4,4k,'CS urj � A �fDS l
City a Town Scala Zip Code /
e.1' s Co26 / tNFC1RtMhTIBfJ-�'- SECTIGN
Area code Phone number ���NG
12. REMARKS: f 1
6.WELL DETAILS: 9 v_t] 1{ ar YdldK- LAJ L-4
J a. TOTAL DEPTH, so _
b. DOES WELL REPLACE MISTING WELL? YES❑ NO 4ll i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
C. WATER LEVEL Belau Top of Casing: Ff. ACCORDANCE WITH 15A NCAC 2C,WELL CONSTRUCTION
(Use'+•rf Above Top of Casing) PR
AND THAT A COPY OF THIS RECORD HAS BEEN
PR DED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface' 1
`Top of casing terminated arror below land surface may require - 1 o-2la-i?S
a variance inacomdence with 15A NCAC 2C-01Is- SIGNATURE CFR IED WELL CONTRACTOR DATE
e. YIELD(gpm): `— METHOD OF TEST �c3t�'y �r uz%44 C G
f. DISINFECTION:Type G'(d/L/Nt Amount PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to:Division of Water Quality- Information Processing, Form GW-1a
1617 Mail Service Center,Raleigh,NC 27699-161,Phone:[phone] Rev.2/09

a
DRESIDENTUL WELL CONSTRUCTION RECORD
North Cor01ma Deportment of Fnvuonrneat apd Natval Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# NGWC -2 ISO'ft
t.WELL CONTRACTOR: 9. WATER ZONES(depth):
3 ArC... TD It it A) .�a44i C e Top Bottom Top Bolcom
Well Con clor(hdwidual)Name Top Bottom ToP Bottom
5 v s+: c a U9 e,L L, D r-r L , N Top Bottom Top Bottom
Well Contractor Company Name
�g� Thickness/
39,45 L S '*0 t�1E tST : 7. CASING: Depth Diameter Weight Materiel
Street Address ' ` TOp Bottom ZD Ft.
M A r r 60.X N.C 2 : Tap Bottom FL
City or Town Slate zip code Tap Bottom R
t28 7 z14- ti 544
Area code Phone number 8. GROUT: Depth Material Method
2.WELL INFORMATION: : Top Bottom FL - J
WELL CONSTRUCTION PERMITF lJ.l TOf 0067t : Top "33 BottomjBt_ Ft. �x+var:�-e
OTHER ASSOCIATED PERMITts(aappiosbie) : Top Bottom Ft ITT
SITE WELL ID#(H applicable) 8. SCREEN: Depth DWnder Slot Sim Material
3.WELL USE(Check Applicable W: Residential Water Supply❑ Top Bottom Ft_in. _ In_
DATE DRILLED 1026- 011 : Top Bottom Ft in. _ in.
TIME COMPLETED AM D PM D Tol Bottom FLYI. in.
4.WELL LOCATION: 10.SAND)GRAVEL PACK:
,,w�/I C_`- _� � --II Depth SIM Material
CITY: R I6 P) COUiNTY L Top Bottom FL
I�ra S f'1.) - 14- l G L f $ Top Bottom FL
Stred Name,Nwbers, ,Subdivision,Lot No..I'MoK Zip Cods) Top BOltdrrl Ft
TOPOGRAPHIC/LAND SETTING: (check appopiere box)
❑Slope OValley ❑Flat ❑Ridge ❑Other 11.DRILLING LOG
TOP Bottom Formation Description
LATITUDE 40g °HO ' 211iP.it Z'DMS OR 3X.XXXXXXXO(X DD /
LONGITUDE 50,M DMS OR 7X.XXXXXXXXX DO
Latitude/longitude source: 131PS 0170pographic map /
(location of well must be shown on a USGS topo map andattached to 7 5 D' e f
this form if not using GPS) l
5.WELL OWNER;
Lie
r'�I £ leple .LI S L' (n rc,%, e.' )
Ewer aril n — )
'4Sher-LAC,0 )
Street Address
rAecha,NI .Slrurc. TA /7-c65
City or Town GqI -("A' Smte Zip Cade /
CIL 1 y l
Area code Phone number
12. REM
5.WELL DETAILS:
a. TOTAL DEPTH: - 64LAIkk A L
b. DOES WELL REPLACE EXISTING WELL? YES O NO 6Y I DO HE 0 WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: �— FT. ACCORDANCE WITH 15A NCAC 2C,WELL CONSTRUCTION
(Use°+-ff Above Top of Casing) STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface- F' ('1
'Top of casing terminated aflor below land surface may require /`_-eL/ws$,G.1- D
a variance in accordance with 15A NCAC 2C 0118. SIGNATURE OF CERTI WELL CONTRACTOR DATE
e. YIELD(glut). ° METHOD OF TEST G A r y b. 3 US-A i �-
f. DISINFECTION:Type L1 t0iei u e Amour U2. PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit Within 30 days of completion to: Division of Water Quality- Information Processing, Form GW-1a
1617 Mail Service Center, Raleigh,NC 276 9 9-1 61,Phone:[phone] Rev.2109

��Yr e��1r4
Ysra
� RESIDENTIAL WELL CONSTRUCTION RECORD
_ North Camlina Depmt nmt of Environment:and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTMCATION# N C W C a I S0"itr
1.WELL CONTRACTOR: 'r Sog. WATER ZONES(deplh):
�7 'tL �kt�r a ct�-�Jc f Top nora TW Bottom
We" (Individual)Name Top Bottom Top SOlfom
SU$Vt r.G L.Je-LC- lt�ir L,.LTNS : Top Bottom Top Bottom
Wei Contractor Company Name 7hicknessi
a Lf 5' U 3 7 O 7. CARING: Depth Diameter Weight Material
Street Address Top O Bottom Ft
tM 44-j Top Bottom Ft
.—City or Town Sthte Zip Code Top Bottom Ft.
Area node Phone number : 8. GROUT: Depth Materiel Method
2.WELL INFORMATION: Top Bolcom Ft
WELL CONSTRUCTION PERMIT# WSE=1 O o�i�'I Top _Bottom-200�Fty7 CAr *^-
OTHER ASSOCIATED PERMIT#(i el)Pkab )
Top Bottom Ft
SITE WELL ID#(N appfiratle) 9. SCREEN: Depth Diameter slot Site Material
3.WELL USE(Check Applicable Box): Reskkaftl Water Supply 0 Tea Botom Ft_in. _ in.
DATE DRILLED Irk 2b - Top Bottom F4_in. _ in.
Top Bodont Ft_in. in.
TIME COMPLETED AM❑ PM O
IS.SANWGRAVEL PACK:
4.WELL LOCATION: Depth Stsa Material
CITY: Al A7-'-)P4 COUNTY Tap Bottom Ft
/ + 4 8 _ Tap Bottom Ft
(Street Nerve.N .CcrrarrravtY.Su6OiN®on.Act Na..Panxl•LP Cep) : Top Bottom Ft
TOp/OGRAPHIC/LAND SETTING: (check apPmPiaf ta
d
ad 11.DRILLING LOG
tySbpe pValiey ❑Flat ❑.R�i'dge,�OOtlter TOP Bottom Formation Description
LATITUDE OMS OR 3x-IDD0000DDk DO : /
LONGITUDE 81 °A�'5�0. 'DMS OR 7X.XXXXX)o(XX DO / -
Latitudelbngitude source: LyGPS DI'opographic map /
(location of well must be shown on a USGS topo map andanached to
this form if not using GPS) �/ 3 O
S,1l OWNER r /
(1eN - 9 >c— v2✓ )
Owner Na /
ShPrl.r�d 'b rStreet Address
)
A4ec 4y csGv
City or-rown State ZIP Code /
Area code Phone number 12. REMARK,,gqS�:� `1 Y
S.WELL DETAILS: yyr% C3Pi� tYN� ��a4'l. weLL
a. TOTAL DEPTH: 7 PC)
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO e/' : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below TOP of Casing: o� FT. : ACCORDANCE WffH 1SA NCAC 2C,WELL CONSTRUCTION
(Use'+-if Above Top of Casing) : STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
PR04DED TO THE WELL OWNER.
it. TOP OF CASING IS Fr.Above Land Surface° 'D ZfO�C1
"Top of casing terminated atlor below land surface may requite
a variance in accordance with 15A NCAC 2C.01lt3. SIGNATURE VF CE ED WELL CONTRACTOR DATE
e. YIELD(gpm): METHOD OF TEST C�(,��,g ��Z.I-;C r _
f. DISINFECTION:Type C 9mil t+c Amount Q6— PRINTED E OF PERSON CONSTRUCTING I WELL
Submit Within 30 days of completion to: Division of Water Quality- Information Processing, Form GW-1a
1617 Mail Service Center, Raleigh,NC 27699.161,Phone :[phone] Rev.2/09
-.;7 30 2C�3

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H.Sullins Dee Freeman
Governor Director Secretary
July 18, 2009
Henry and Deneen Schroyer DECEIVED
7 Sherwood Drive JUL 312003
Mechanicsburg, PA 17055
Asheville Regional Office ,
Re: Issuance of Injection Well Permit Aquifer Protection �
Permit No. WI0100071
Issued to Henry and Deneen Schroyer
McDowell County
Dear Mr. and Mrs. Schroyer:
In accordance with your application received June 24, 2009, I am forwarding Permit No. WI0100071 for the
operation of a vertical closed-loop geothermal mixed-fluid heat pump injection well system to be located at 348
Haven Heights Ridge Road, Marion, McDowell County, NC 28752. This permit shall be effective from the
date of issuance until June 30, 2014, and shall be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. In addition,please submit copies of the
Well Construction Completion form (GW-1) and site map within 30 days after construction as required
in Part I paragraphs 8 and 9.
Please submit the data within 30 calendar days of receipt of this letter 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 and at the time of the inspection must display
a permanently affixed identification plate in accordance with requirements of 2C .0213(g). Please insure this is
completed in accordance with permit condition Part I,paragraph 7 of this permit issued July 18, 2009.

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].
Best Regards,
Michael Rogers, Environmental Specialist
cc: Landon Davidson—Asheville Reaonal Office
Central Office File—WI0100071
McDowell County Environmental Health Dept.
Gary Justice— Justice Well Drilling
Attachment(s)

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
Henry and Deneen Schroyer
FOR THE CONSTRUCTION AND OPERATION OF 2 TYPE 5QM INJECTION WELLS, 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 348 Haven Heights Ridge Road,Marion,
McDowell County, NC 28752, and will be constructed and operated.in accordance with the application dated
June 24, 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 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"June 30, 2014, and shall be
subject to the specified conditions and limitations set forth.in Parts I through A hereof.
Permit issued this the' :)q- day of , 2009.
� w
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.

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 1s 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.
6. Each geothermal injection well system shall have permanently affixed an identification plate on a nearby
building or other permanently fixed structure indicating the location and presence of underground UIC
wells according to 2C .0213(g).
7. 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-1 s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
8. Well construction records must also be submitted for the 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—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(828) 296-4500.
2. Boreholes shall not connect separate aquifers which have differences in water quality (e.g., shallow
surficial aquifers, saprolite, fractured bedrock, etc.) as specified in 15A NCAC 2C .0213(d)(8)(C) and
WI0100071 2

shall be filled with bentonite grout from the lowermost water bearing zone to land surface as specified in
the permit application.
PART III—OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal .permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility 6f complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV—PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V—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.
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.
WI0100071 3

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 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 VIII—PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit,request an extension.
PART IX—CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1), Well
Construction Standards.
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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 maybe removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing,if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout,which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G):shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,NC 27699-1636
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