WI0100107_Regional Office Physical File Scan Up To 8/16/2022

Parkway Heating & Air
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality 4 a e E
WELL CONTRACTOR CERTIFICATION # 2603
1. WELL CONTRACTOR:
Larry Wells
Well Contractor (Individual) Name
AWD' Services. Inc.
Well Contractor Company Name
258 North Turkev Creek Rd.
Street Address
Leicester . NC 28748
City or Town State Zip Code
( 828 ) 683-9223
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100107
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 9/1 /10
.TIME COMPLETED AM ❑ PM
4. WELL LOCATION:
CITY: Wavnesville COUNTY HayWood
165 Michael Drive
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
VSlope []Valley ❑Flat ❑Ridge ❑OtherElev.
LATITUDE 35 " DMS OR DID
LONGITUDE 83 " DMS OR DID
Latitude/longitude source: R�PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) Lat . Long. Unknown
5. WELL OWNER
Michael & Shervl Lentini
Owner Name
165 Michael Drive
Street Address
Wavnesville NC 28785
City or Town State Zip Code
8�)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: (1 ) 400' Geo
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
'Top of casing terminated allor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NIA METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top
Top
Bottom
Bottom
Top
Bottom
Thickness/
7. CASING:
Depth
Diameter Weight Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material
Method
Top 0
Bottom 400'
Ft.
20% Solids
Pour
Top
Bottom
Ft.
Bentonite
Top
Bottom
Ft.
9
9. SCREEN: Depth
Diameter
Slot
Size Material {
Top
Bottom
Ft.
in.
in. "? )
Top
Bottom
Ft.
in.
iI
in. , -
Top
Bottom
Ft.
in.
i'-'
in. -,
10. SAND/GRAVEL PACK:
l _ I—L
Depth
Size
Material �� ...
Top
Bottom
Ft.
C"
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
12. REMARKS:
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED WELL OWNER.
2-2-12
GNA U O T LCONTRACTOR DATE
Larry Wells
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

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT ANDIOR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50M WELUS)
New Permit Application OR . Renewal (check one)
DATE: t O N J 'Z3 ry0 20
PERMIT INTO. \9T 0 100 1 n71 (leave blank if NEW permit applicabon)
A. PROPERTY OWNERMIAPPLICANT(S)
List each Property Owner listed on propeM-deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): (}��aa� Le- vt `.r
h e r-A 14 • LeniC'nl
(1) Mailing``A''ddresds: c13 l�:'q h0� (�`)Cc� '-r `eL e Llx r►
City: t-t�u e+1 State: Zip Code. ( CountT rri 5
Home/Office Tele No.: '�13 � �Civ � � �� - Cell No -:a$ �
EMAIL Address: Mb{eI+niED 51C�81ok- (, ne� � �l3 - � ICI C)U
(2) Physical Address of Site (if different tban above): .% i G�A� i 17�xc , ,Lf
City: LJO-y r--w't fie State: NL Zip Cale: s-:PtCounty:
Home/OfficeTeleNO.: q 12-1 9 15 CcU No.:
EMAIL Address: +hS rn`�'+ �i S a �Q ` • R� 1
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit AP&cant does not ma the subject property,
attach a letter from the property owner audwrizing Agent to install and. operate UIC well)
Company Name: ���� f Ud
on�A�JC�o.'i
EMAIL. Address:
Contact Pers�� � DrS� c�����/�SJ,r� L� �.M•
Address: �'-��` 6`
tit:1( (3 State: Zip Code: ? � s/ County:
City: - - -�T ~Jfg Office Tele No.: II Cell No_: `O
Website Address of Company, if any. it oil rzS f N W 00-0 -z ✓v+
C. STATUS OF APPLICANT
Private,: Federal
State: Mui�
Z' d 860L-Z9-V-8Z8
Commercial: RECEIVED / DENR / DWQ,
Aquifer Protection Section
Native American Lands:
JUL .19 2010
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flkm UI
jj. WELL DRILLER INFORMATION
Company Name: A WD 5etvices. Inc.
Well Drilling Contractor's Name: L Wells
NC Contractor Certification No.: 2603
Contact Persgn_Larry Wells Emai Addres-.Wells75Q549 Bglt�Lcuth-net_,.
Address: PO _Box 125 --
City: Leicester, NC i Zip Code: 28749 _ County: Bunco be
Office Tele No.: _828-683-9223 ! Cell No.:. W 215.9314
E. HEAT PUMP C+O�NTRACTOR INFORMATIO (if different than driller)
Company Name:-
>` d mow,cOw�u*� 1 iC
Contact PerScm�C1t�lh_ �� _ 6MAIL.Addrsse:
Address' �J� ( �0 'R A —
Ciry: P�� `�� ' �ipCode: at�a County:
Office 'role No.: 8�18- �-5�9 Cell No.- %29- IPA, a, t
V. iNMC-ri r r1tQCED E (bl efl d ribe how the injection well(c) will tie used)
5 ---= -
G. WjLL CONS7MUCTION DAtA (Skip to Sediiva H if this is a Permit RENEWA,�)
(1) Proposed date to be constructed: when ennittW—, Number of borings:
Approximate depth of each boring (feet): "0 r
(2) Chemical additive< to be used in closed -loop systemn (only those chemicals indicat,;d have be cn Hpprovcd):
R-22 propylene glycol ethanol _ ___other (other additives wiI I
need prior approval by NCDENR before use) `/ 1 r
(3) Type of tubing to be used (copper, PVC, etc): (� `P a as
(4) Well casing. Is the well(s) cased? (check either (a.) YES or (b.) NO below)
(a) VES if yes. Bien provide cm sinp. information such as 1W. (steel. PVC;. plastic. etc.). diameter.
d_ a ,and extent of casing appearing above ground:
(b) NO
(5) Grout (material surrounding well casing and/or piping): (a) Grout type: Cement Bentonite � Other (specify) ip � ii Dc-J &rytoylt]
(U) Grout derKh of tut ding (rarereneo to land surfaee): from Je ben ._ (feet) `
If well has using, indicate grout depth: from to
H. INJECTION -RELATED EQUIP5�JENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacwrees brochure may provide supplementary
information. i
(iPllnnC sQM Well Pemulil Appliwtiml (Revised 7/21J0R) J:igo 2

D. WELL DRILLER INFORMATION
Company Name:
Well Drilling Contractor's Name:
'dC Contractor Certification No.: `
E.
F.
City:
Office Tele
HEAT PUMP i
Company Name
Contact Person:
Address: L-� I
City: ft� _ $ A—
Offce Tele No.:
Zip Code: Cow,_
Cell No_:
INFORMATION (if different than dri
�Z�,s-ice
r
Zip Code:
17 Ccll No.:92
INJECTION PROCEDURE, (briefly del how
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constricted:
/� Gr
77 er
well(s) ,mll be used)
of borings:
Apprommate depth of each {feet):
(2) Chemical additives to be usedZ
closed-loop system (only tho p chemicals indicated have been approved):
R-22 wrap eglycol ethanol
other (other additives will
need prior approval by N ENR before use)
(3) Type of tubing to be (copper, PVC, etc):
(4) Well casing. Is the il(s) cased? (check either (a.) YES or (b.) NO below)
(a) YES if _yes, then provide casing information such as � (steel, VC, plastic, etc.), diameter,
de t extent of casing appearing above groan
(b) N
(5) G t (material surrounding well casing and{or piping):
(a) Grout type: Cement Ba tonite Other (specify) � 4
(b) Grout depth of tubing
{reference bo land surface}: from to (feet)
ff wellhas rasing, indicate grout depth fi om 40 {fact) \`
JECTION-RELATED EQUIPMENT \.
Attach a diagram showing the engineering layout or proposed moMcatiou of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
CA 960L-Z9 V-9Z9
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LOCATION OF WEWS)
Attach two copies of maps showing the following iufurruation
(1) Include a site map (can be drawn) showing buildings, properly ham, s�uFaoe water bodies,. potential sources
of groundwater contamination and the oricrnation of and distances .between the proposed well(s) and any
existing well(s) or waste disposal fae7ities such as se c tags or dram fief& located within I(10t} feet of the
geothermal beat primp well systc'rb: Label all feaimes clearly and include a north ai row.
(2) Include a topographic map of the area cxending o= mile froth the propel, boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER WELL(S)
Are there any potable water well(s) on the subject property or adjacent properties? YES NO
If Yes, than indicate location on auarbed map(s)_
Y- CERTIFICATION
Note: This Permit Application must be signed by each person 2PPearing on the recorded
�1� property deed
"I her& may, under penalty of law, that I have
personalty and examined and am familiar with the information
submitted in this document and all attachments thereto and thal5, based on my �q�' of those individuals
inutiediately responsible for obtain' said irrf'OrmadM I believe that the information is true, accurate and complete.
I am aware That there are significant penalties, the P cfb8cs and imprisonment, for submitting
false information. I agree to consuut, oper-ay- min, uPQ, and
A related appurtenances in accordance with the approved the injection well arni
P�'0 r ��'� conditions of the Peernnut."
J��4X
b= of Property Applicant
Print or Type Full Name
Sign 0 Property OwneApplicant
r Le
Print or T Puti Naare
-Z�of Autl=i d Agent, if any
ftrT, �FuU
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]
RECEIVED /DENR/DWQ
Aquifer Protection Section
JUL 19 2010
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MCDENR
North Carolina Department of -Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coieen H. Sullins
Governor Director
July 23, 2010
Michael Lentini
Sheryl, H. Lentini
13527 Grand Masterpiece Lane
Houston, TX 77041
Subject: Acknowledgement of Application No. WI0100107
165 Michael Drive
Injection Mixed Fluid GSHP Well System (5QM)
Haywood
Dear Mr. & Mrs. Lentini:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on July 19, 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, 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 _bttp://h2o.enr.state.nc.us/documents/dwq_orgehartndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
0 WQZk_ A .
for Debra J. Watts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Parkway Heating & Air, Inc (Selwyn Scoggin - 1387 Sulphur Springs Rd, Waynesville, NC 28786)
Permit Application File WI0100107
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 O01"�1�aTOil.Ila
Internet: www.ncwateraualitv.orp
An Equal Opportunity'•. Affirmative fiction Employer 7

Rogers, Michael
From: Mike Lentini [[e-mail]]
Sent: Tuesday, July 27, 2010.10:46 AM
To: Rogers, Michael
Subject: RE: Lentini geothermal well W l 0100107
Thanks Mike.
Mike Lentini
Cobalt International Energy, L.P. , Two Post Oak Central, 1980 Post Oak. Blvd., Suite 1200, Houston, Texas 77056,
U.S.A.
email: [e-mail], Tel [phone], Mobile [phone]
From: Rogers, Michael [mailto:[e-mail]]
Sent: Tuesday, July 27, 2010 9:43 AM
To: Mike Lentini
Subject: FW: Lentini geothermal well WI 0100107
From: Rogers, Michael
Sent: Monday, July 26, 2010 4:05 PM
To:'[e-mail]'
Subject: Lentini geothermal well WI 0100107
Mr. Lentink
I am processing your geothermal well permit and I have a few questions on the some of the items which are left blank
on the application.
What is the certification number of the North Carolina well driller you are proposed to use?
Proposed date of construction?
Number of borings?
Approximate depth?
Type of tubing to be used?
Any surface or protective casing proposed to be used?
Type of grout to be used?
Depth of the grout?
Also, the site map shows 1 proposed geothermal well, near the back (southeast corner) of the house. A small rectangle
is shown in very close proximity of the well. On the legend of the map a rectangle is shown as a septic. Is the small
rectangle/square feature near the geothermal well a septic tank and/or fields? A rectangle is also shown at the front of
the house as a septic tank and/or field? Where is the current septic field with drain lines?
Please complete section D. & G. of the application and provide clarification on the site map in regards to the issues
above. You may scan and send as attachment to e-mail back to me.
Thank you for your cooperation.

� ubdiviropelty seoat ��s a , • �,,.� cs
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Location.
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Sect. No. I F.
No.1:1 a'W%j Ce p �RO�VEbIENT FERNM
YW ODD CO. EEALTE DEPT. WAYMVMLE, NC
PH 452-6682 FAX 452-679i8
• ME EVALUATION
PTTS HAND AUGER15fr L
N / ,1 SYSTEM! DESIGNED FOR., . ANVO • . REPAIR U. ADDITION O
r9 Epllidence UMobileHomeNo. No. Bedrooms m Basement: •Yes a No O
0. ither F4tabUshment -'lope & size
LC) d
gt gatfit Locations Firs Floor C.evel�a t Level Cl
o bf Water supply v Distance from Sewage Sys
tic T � rJ
eP Ga]lonsL igttad Capacity, Nit. SgttateFoamge� Na.L�es�1.
Width 'Max Nit. Field Depth on lower
trainffield type approved for tbfie Q 2�8fa Iteductian L�ei
12' Cltaanber ❑ PS (T & 1 Fanel) 91a"DiameterFabaialVraosod
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ID.AvailableSpaoce: Yes ►' No_ it. Repair Space 12XTA:R .L,6
13, Site Classification - E 5 • SlSuitabie, PSNrovisknally Suitable, UlUnstable
REhL.AfitK . L � T 5 ' STW 1 3 • _A,
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y96it Sot +iorr70„ ✓11 ,+' s-1 _—
NOTICE: This.A.P.WS.C. is subject to all the previsions of Arti k H, G,S. 13t1A— A33 though 399
And Laws and Rules Far Sanitary Sewage Coll_ecdon, Tmtraeot, And Disposal, Section 19W of the
North Camth aAdministradve Code.
TENS TiA^J'K&nh2RQY9M=FERMrF MADE ON
3�3e mlv ANY, ALTER 93
pN OFTH$ Cli°P OR CHANGES MA_ i�1T�I'IaE
DESIGN. O ATIOAF_ ORJZSS OF IBIS RYSTEil.-MADE A 1`B11R'* £CS
•�j,YR'I'A1� WT1.T.�iMRrl,TACr1:Tv VOIDTFiL.S A z?W S �_-
I understand the requirements of this A.F,W.S.C. and di6aformation 1 have provided is acevrate to [hts
best of my kwwWge. , OyYnpr q , Age a
'ThisAP,RrS.C. ez ""yu on ,unless doe described system has been bsWltd.
Lot Approve& Gi" atDisapp'rovcd Q Saujmdaa

08-05-'10 09:04 FROM -Environmental Health 8284526798
T-145 P001/002 F-439
- — - - ayMod County Environmental
-Hea fth Dept
_ 1233 Nort# M41n Street
_ vVayiBE N.C. 28786
Te1itphorie (818) 482-, DMZ
fax
Fax Cover Sheet
No. of pages It�c9aadirta� its §heet
a: u
Asheville Regional Office
N44

North Carolina
Beverly Eaves Perdue
Governor
Michael and Sheryl Lentini
13527 Grand Masterpiece Ln.
Houston, TX 77041
Dear Mr. and Mrs. Lentini:
Department of Environment and Natural
Division of Water Quality
Coleen H. Sullins
Director (=y (( V E
August 18, 2010
Resources
23 2610
,� _I,helvilh, rlcgicnai Off icP,
Subject: Issuance of Injection Well Permit
Permit No. WI0100107
Issued to Michael and Sheryl Lentini
Haywood County
Dee Freeman
Secretary
In accordance with your application received July 19, 2010, I am forwarding Permit No. WI0100107 for
the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well
system to be located at 165 Michael Dr., Waynesville, Haywood County, NC 28785. This permit shall be
effective from the date of issuance until July 31, 2015, and shall be subject to the conditions and
limitations stated therein.
Please pay special attention to the following sections in Part H of the permit:
Part H.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,Jonathan Stepp with the Asheville Regional Office Aquifer
Protection Section Staff, telephone number [phone].
Part VH.2- Submit copies of the Well Construction Completion form (GW-1) within 30 calendar
days of completion of installation of geothermal well(s).
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days 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].
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
Internet: www.ncwateroualit,.org
One Carolina
An Equal Opportunity 1 Affirmative Action Employer

cc: Landon DavidsonshevilleRegional-Office
tentra fi File — WI0100107
Haywood County Environmental Health Dept.
Larry Wells — AWD Services, Inc.
Attachment(s)
Sincerely, _ \
Michael Rogers, P.G. C & FL)
Environmental Specialist
2

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
Michael and Sheryl Lentini .
FOR THE CONSTRUCTION AND OPERATION OF I 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 165 Michael Dr., Waynesville, Haywood
County, NC 28785, and will be constructed and operated in accordance with the application received July 19,
2010, and in conformity with the specifications and supporting data, 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 July 31,' 2015, and•shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 18 b day of August 2010.
Coleen H. Sullins, Director
Division of Water,Quality
By Authority of the Environmental Management Commission.
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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.
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
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.
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).
PART III — OPERATION AND USE- GENERAL CONDITIONS
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.
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.
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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 tl'e pufpose of determining compliance with - this -permit;'may inspectoor
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 VII — MONITORING AND REPORTING REQUIREMENTS
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 OW-1 forms) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site reap 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 krona-rt,i)i 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.
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PART IX — CHANGE OF WELL STATUS
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.I of this permit.
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