WI0100156_Regional Office Physical File Scan Up To 9/22/2022

Beverly Eaves Perdue
Governor
Jimmy Wilson
580 Wilson Rd.
Brasstown, NC 28902
Ai
14,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins Dee Freeman
Director Secretary
April 26, 2011
Reference: NOTICE OF DEFICIANCIES of the NORTH CAROLINA
WELL CONSTRUCTION STANDARDS
Thumping Creek Road, Hayesville
Clay County, NC
Dear Mr. Wilson,
The Aquifer Protection Section of the Division of Water Quality (DWQ) is responsible for the regulation of well
construction activities within the State of North Carolina. On April 4, 2011 you contacted Jonathan Stepp and
voluntarily informed him that you constructed a Closed -Loop Geothermal -Water -Only Injection Well System, on
December 16, 2010, without submitting prior notification to the department.
DEFICIANCY:
Failure to submit notification of construction on forms supplied by the Division to the North Carolina Division of Water
Quality prior to beginning the construction of a Closed -Loop Geothermal -Water -Only Injection Well System in
accordance with 15A NCAC 02C .0211(u)(2)(B).
REQUIRED CORRECTIVE ACTION FOR DEFICIANCY:
Submit notification to the North Carolina Division of Water Quality as required by 15A NCAC 02C
.0211(u)(2)(B). Please note that you should submit notification to the Department prior to any construction
activities when constructing a Closed -Loop Geothermal -Water -Only Injection Well System. These systems are deemed
permitted only after notification has been received by the Department.
Your prompt attention to the items described herein is required. Failure to comply with the State's rules in this manner
may result in the assessment of civil penalties and/or the use of other enforcement mechanisms available to the State.
Each day that a violation continues may be considered a separate violation. If you should have any questions, please do
not hesitate to call Jonathan Stepp at 828-296-4684.
G. Land Davl son, L.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
NorthCarolina
Aquifer Protection Section —Asheville Regional Office �atura!!
2090 U.S. Highway 70, Swannanoa, N.C. 28778 Phone [phone] FAX [phone] ff
Customer Service 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunity lAffirmative Action Employer

MAY 10 2011
Wilson Well Drilling sheville Regional Office
Pump set'' ice A t2ifer Protection
Uc+ensed Water Well Contractor
Trenrhing - Water Systems • Water Anal*s • Water Treatment Systems •
• Pumps Saw & SRrvtoe
* i 1 W r" i i t e
&oaslam NC
Fax (828) 837_298 i
kept. 96 FAJ V, i - 60k ,
DATE_5= jo - it - —
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NORTH CAROLINA
DEPART1tiiENT OF ENVIRONMENT' AND NA'i'URAL RESOURCES (NCI)BNR)
NOTMCAI ION OF INTENT TO CONSTRUCT A CLOSED -LOOP
WATII2-QNLY INJECTION WF'LL S'YST'Elbj;
TYPE 5—QW W CL�L S)
In Accordance with the provisions of NCAC Title 1 jA: 02C.0200, please
complete this notification and mail to address on the back page (please Print or TyRe ii
]DAME: /,A •- / I _20 /()
iV"U T pe C,nnfWmlion: Does the proposed system ciNulale potable water pnjy (no a
continuous piping that completely isolates the fluid from the
clospd-loon)?
Yes V", Continue completing this form.
ad
ci
ca
in
No Do Not complete this form_ Complete outer UIC application forms for installing
either a 5A7 well o en -loop ,well injc�c. •tins potable water into the aquiferyor a SQM' well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
A. PROPERTY 0NMER(S)/AIi'PLICANT(S)
List each Property Owner listed On property deed (if owned by a business or government agency, state name of
entity and a representative wlauthority, for signature): i rn 4 m(X
IL om
(1) Mailing Address: V
City: -k,Ay� Staff NC. Zip Code'
Home/Office Tcle No.: ,$�.,•Q Cell
Email Address•-- Websitc:
(2) Physical Address of Well Site (if different than above);
City; State.'— Zip Code: � �
._ County_
Home/Olfice Tele No.: No.: —
8. AUTHORIZED AGENT O)E' OWNER, TIF ANY (if the Permit Applicant does IIot own the subject property,
attach a letter from the property owner authorizing Agent to install and operate VJC well)
Company Name:
Contact Persun: EMA11�, AddAddress:
Address: "—
City:
-- .�-- State: Zip Code:
Oflice.Tele No_- -- ---Quit No_: —'
Website Address of Company, if any:
GPD/UIC 5QW NotAication of InLmu Donn (Revised &2009)
P�Gc 1
23Jdd 2T:2T 2002-SO-SO

C. ALL DRILLER INFORMATION
Company Name: (�T�1 � ielj
Well Driller Contmetor's Name:
NC Contractor Certification No.: JV,
Contact Person�i_NAPA Q
IT.. Address.
Address: of C O Y4.
City: Zip Code: 2ff2& `__ County:
Ofhce Tele No._ ;&Q&.3 Cell No-,faX�
lU. HE, PUW CONTRACTOR INFORMATION (if different than driller)
Company Name: ov _G't QK .'C.tiZ.�i--'..,
Contact Person: A,ICLt�LYI rMA1L Address:__... i''OR
en Gn�.Iq
Address: �� tv4a«
City: r t% i �� �., - Zip Code: w� County:�A C kn
Office Tele No.: BQA M_ Cell No.-
E. STATUS OF APPLICANT
Private: ✓ Federal_ Commercial: _
State: _ _ Muoioipal• Native American Lands:
F. INJECTION PROCEDURE (briefl describe how the injection well(5) will be used)
Ta t t.L.a a ujcw ,--
h a-
(_. WELL CONSTRUCTION DATA,
(1) Proposed date to be constructed: L;—?- / 9' — J() . Number of borings: 3
Approximate depth of each boring (feet):
(2) Type of tubing to be used (copper, PVC, etc): � �T
(3) Well casing. Is the well(s) cased? (check either (a.) Yes or (b-) No below)
(a) Yes if yes, then provide casing information below
Type: galvanized steel --black. steel— plastic —other (specify)
Casing depth: From to feet (reference to land surface)
Casing extends to above ground ,,,,_inches
(b) No �L:�t=
(4) Grout Info (material s=oundi.ng well casing and/or piping); , (.p t7
(a) Grout type: Neat Cemetrt Rentonite jam' Other (specify),5„ j JAndpq i'As
(b) Grout placement: Pumping_ Pressure_ Other—
(c) Grout depth of tubing (reference to land surface): froz to T (feet) Grtyf p�
If well has casing, indicate Lqout depth; from to $ o D D
(feef)
GPU/IJIC 5QW Notification oflatcat Forts (Revised 8/20U8)
PW 2
2T:2T 2002-SO-SO
€3Jdd

YL INJECd'ION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and mtterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information_
L LOCATION OF WELL(S)
Attach two copies of maps showing the following information..
(1) Include a Site flap (can be drawn) showing- buildings, property lines, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of
the geothermal heat pump well system. Label all features clearly and include a no �rcclw.
(2) Tho Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, stmams, And/or highway, intersections.
J. CERTIFICATION
Note: This Permit Application must be signed by ea — person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law, that 1 have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said infonnation, I believe that the information is true, accurate and complete.
I am aware that there are sigai6eatnt penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the a$proved spocif ions and conditions of the Permit."
t ature of Prop Owner/Applicant
Print Or Type Full Name and title �-
Signature of Property Owner/Applican.t
Print Or Type Pul I Name and title
Signature of Authorized Agent, if any T� .
Print or Type l:ul I Name and title
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Sectiun.UJC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPO/utC 5Qw I3utis�aticm content corm (Revised &,2M) .
Page 3
t?39dd 2T:2T €Ban; -SO-SO

Wilson Well Drilling R E C E oY E D
Pump Service
licensed WeterWell Contractor P2R 10 2l1 '1
Trenching + Water Systems • Water AnaiOs - Water Treatmrrd Sreter"
+ Pumps sales & servim • Asheville Regional Office
' • : protection
&ssSfaNn, NC
_ Fax (828) 837_2991 _
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TOPOGRAPM r LAND SETMpG:
AMM MVWky 13FM UFfte D OEer
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NIAM 0G ADDRESS
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a. TOUL DEPM tm+s
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(lime"a' kTAtaoreTap d Casa�gl
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'TaP of SUM beiun hods S Abm m" mqube
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WATER ZONES (depdkx
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la UVLLMI& LOG
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O18fMGOWN FROMM ODEW91OINIBt
c�F � �wk.TOR ma a - �LD
- iL - _%
Submit the *d9insJ to the Division of Water Quality within 30 days. Ann-
1617 Mail Servios Center — Raleigh, NC 27699.1617 Phonic No. (919)733 7U15
Fan
(ifi8. Rev.'
R in® 2Gil 1
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Asheville regional Office
Aimifed Protection 00:21 2002-ST-b0

Well # 1
239Hd 00:2Z 2002-SZ—tb0

N �
Y`s NONRESIDENTIAL wF.I,LCONSTRUCTION RECORD
' North(;arnlino lkpsutmcnt of Environment and Natural kesourcca- Division of Water Qijalily
•� `"""""�• WELL C:ONTIL4C:TOR CERTIFICATION #
1, WELL CONTRACTOR:
,3tm, 5R-
Well Contractor (individual) Name
t K,�Asf%m WY1l_.._..rl.Si.lnn mete.
Well Contractor Company Name
STREET ADDRESS.. iJl]►� S4>(i41y1_ r
City or Town Stele Zip Code
- IrK'S,`7- 09(AM
Area code- Phone number
I WELL INFORMATION:
SITE WELL ID *(If applicable)
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT "f applicable)___
WELL USE (Check Applicable sox) Monitoring ❑ MunicipallPuNc ❑
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection K
Inigationt7 Other [I (list use) C7 �►E!ftMAI _
DATE FILLED Q 1 & - j a
TIME COMPLETED AM p PM ❑
3. WELL L CATION:
CITY: tt fL11�' COUNTYC % imt
�p
Odo. rM, t
, I5 1
( treat Narila. NumBirs, Community, Subdlvlai&n Nb, parcel, VIP Code)
TOPOGRAPHIC! LAND SET71NO:
Slope ❑Valley ❑Fbi ORIdge a Other_ .............
(chcrk appr*prwe box)
LATITUDE 3 May be in degrees,
- - minute*, smnnds Or
LONGITUDE in a deehnal fbvtrat
Latitude/longitude source: ❑OPS ❑Topographic map
Mcatlon of waif mustbo allpwn Can a USGS topo map and
attached to ibis t = if not using GPS)
4. FACILITY. is the... of fhe busiram wham the wall )g roc*W.
FACILITY 10#(If applicable)
NAME OF FACILITY _
STREET ADDRESS
City or Town Stale Zip Code
CONTACT PER$ON_..
MAILING ADDRESS
City or Town Slate Zip Coda
( Y
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: s3-46 r
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
e. WATER LEVEL Below Top of Casing; —IV FT.
(Use'+- if Above Top of Casing)
d. TOP OF CASING IS . FT. Above Land Surface•
*Top of Casing terminated aVor below land surface may require
a variance In aocardance with i SA NCAC 2C ,0118,
e. YIELD (gpm):._ - _. . METHOD OF TESTk"�,,,�
f, DISINFECTION: Type Amount• 40
g. WATER ZONES (depth):
From 10 From To
From To From 10—
From To From To
G. CASING: Thickness/
Depth Diameter Weight Material
rrom__To Ft,-.___
From To Ft.
From , To , Ft.�—
7. GROUT:. Depth Material Method
t3tli 644
Pram 70 Ft e
From To_ _ Ft.
From To Ft
8, SCREEN; Depth Diameter Slot Size Material
From To Ft in, in.
From _To Ft,- 11. in.
FroM__ TD Fl.,___in, In-
9. SANDfCRAVEL PACK:
Depth 317e Material
From To. Ft -
From �_..To Ft__
From Tc ___ _ . Ft._ _
. • r+ f a .► M�.
100 HEREBY CEHtrFY THAT TFIIS WELL WAS CONSTRUCTED N ACC,ORDANCE WITH
10NcA
AC 2C. WELLCONSTRl1CTiQN bTANDARtx4, ANQTHATA COPY OF THIS
ORD I"BEENPROVIDEQTOTHE WELL OWNERNATURE OF CERTIFIED WELL CONTRACTOR
Submit the original to the Division of Water Quality within 30 days. Aftn: Information Mgt.;
161? Mail Service Center— Raleigh, NC 27699-1617 Phone No. (919) 733-76 5 ext 568.
rT 202U11
i GW-1b
7/05
Rvdionai Office �
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Aouifer Protraction I

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NON&ELDENTM WIKIL .Ugnom &VACORD
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SFA,TEWE LPERMY110taprgery__._ _
kff"� awn FA UM) eM>al
DATE • Its - I�
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S. UrELL LCIrATKft
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� FAR�iTY_airnocaf�I�swlMaorriiitanw.
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ZOMM ADDRESS
CAV or Tarn BUD Zq Code
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6. WAL DETAIL& ��AA
i TDrAL MPM
b. DOM UEU I MACE 8 UNUM TAML? YES ❑ NOX
CL . WATER LEVM 00m Tqp of Carr . O D FF-
(Use'+ iFAb mwTcp d C$a0
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d TOP OF CASING LS _.....
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1, MSPWECnM& T
`
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IL CASH:
�
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15i1'
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id ULLM LOG
Fmm To
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tmt�rc�Y Twt�ns wazwwGOo�®w�
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TURE OF CER - . , wB.L CONnv4-YOR pt7E
Submit the original to the Division of Water (duality within 30 days.
1617 Mail Service Center Raleigh, NC 27699-1617 Phone No. (919)73:
t: information Mgt., F t(W-tb
5 ext 568.
R O 2U I� ft .Troy
i Asheville Regional Office
93Jdd I Aquifer Protection ia:, T 2002-ST-ta

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L3Jdd TO:2T 2002-SI-t7O

04-15-2003 13:01
PAGER
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Y Wilson Well Chilling
Pump service
licensed Water Well Contractor
• Trenctting • Water Systems • Water Analysis • Water Treatment Syaterm
• Pumps Saw & Umke •
Br•aotorm, RC
Fax (828) 837_2981
n a w �A- Qi C Dept- e6 FN V , 4- NJa t • : QcS`..'�
DATE
T3JUd 2T:2T €002-SO-SO

LUT:(q ID O /S-(�'
NORTH CAROLINA
DEPARTMENT. OF F,NViRONUBN-r AND NATURAL IiESOURCFS (NCDFNR)
NOTIFICA'1 ION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTFIERIVIAL
WATER -ONLY INJECTION WF;LL S'YSTEM.� =
TYPE 5-QW W ELKS)
In Accordance with thcr provisions of NCAC Title 15A: 02C.0200, please`
complete this notification and mail to address on die back page (please Print or Tx� information)_
DATE: AA - / $ _20 /y
Well7jrpe C.arrfirnurtion: Does the proposed system cifc:ulate potable water onl rib -additives in
continuous piping t1lat completely isolates the fluid from the envirorunent (i.e.
closed -loop)?
Yes Continue completing this form.
No Do Not complete this forrn_ Complete other U1C application forms for installing
either a 5A7 well(o en -loop well injuc. •tine potable water into the aquiier)(or a 5QM well (closed -
loop well containing additives such as R-22, ethanol, or other antifreeze or -corrosion inhibitors).
A. PROPERTY OWNER(S)/AI'PLICANT(S)
List each Property Owner listed on property deed (if owned by a business or governmetit agency. state name of
entity and a representative wlauthority for signature): ZT, no iN� pc
- -�-_ ►�1, ,ri
(1) Mailing Address: ;L �
City: �. � State: N( lip Coder d
i . Cturtty: �-
Home/Office 'role No.:.
Email Address'-- Websi -._.
(2) Physical Address of Well Site, (if different than above):
City:
State: Zip Code: _. County_
Home/Office Tele No.: _ Cell No.:
�. AU"I'HORUEb ,AGENT OF OWNER, ip ANY (if the Permit Applicant does Tio ovh!n the subject property,
attach a letter from the property owner authorizing Agent to install and operate JJJC well)
Company Name:
Contact Person: E-MA11, Address:
Address: "—
City; State:l.,i
- P Code: • — county:
Office "rele No.: Ccll No_: 1 —
Website Address of Company, if any:
GPiucrlC 5QW Notification of Inicnr Ponn (Revisers g/2008)
Pagc s
239Hd 2Z:2T 2002-SO-SO

YT ,
C. WELL DRILLER INFORMATION 11
Company Name: il �QJI{ t�.>i�-1 1 !YQ • %�j p , _.
Well Driller Contractor's Name: -
NC Contractor Certification No.:
r.1 t --
Contact Personi_1M-- VN--Add
Address: 0 . box 1-7 wr e o rv.
City-1M,SS t.-.11U , Zip Code: 2 %P—A County:
Office Tele No.: 7- b 9��� Cell No.: _q� - Sm 6
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name. .� I C_ S Maw Cam...
Contact Person, L'MA1L Address:. i`OC e n �n�,Q���A
Address: ^�7
City:t�Sy Zip Code: 110-L County:
Office Tele No_ gag ;3 $1— 613 (,�... � Cell No.
E.
F.
�i.
STATUS OIR APPLICANT
Private: ✓ Federal -
State: _ _ Municipal:
INJECTION PROCEDURE (brie]
�c , &u_o, ul&_ 4 -e w s
Commercial:
Native A.uieric in Lands:
describe how the injection welly) will be used)
Ac h av - --
WELL, CONSTRUCTION DATA,
(1) Proppsed date to be constructed: / 1r- JQ Number of borings:
Approximate depth of each boring (feet): 3Z561*
(2) Type of tubing to be used (copper,. PVC, etc). Z
(3) Well casing. Is the well(s) cased? (check either (a.) Yes or (b_) No below)
(a) Yes if yes, then provide easing information h 1
e ow
Type: galvanized steel black. steel plastic_ other (specify)
Casing depth: From to feet (reference to ]anti surface)
Casing extends to above ground „inches
(b) No
(4) Grout Info (material surroundi.iig well casing and/or piping): .6FErq11► ,� f �
(a) (Trout type: Neat Cement Aentonite�, Other (specify), , !MJ
tqq r`/1e
(b) Grout placement: Pumping_ Pressure _ Other _ ,-
(e) Grout depth of tubing (reference to land surtaee): from to ' (feet) C f-0 "&A
If well has casing, indicate grout depth; from to (feet) %6ft*A �D
GPU/U!C SQW Noti&cation oflatmt F" (Revised 8/2008)
Fags 2
�3Jdd 2T :at €00a-SO-SO

IL INJECTION -RELATED FQXTWMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the inje4�tion operation. The manufacturer's brochure may provide supplementary
information. t _.
L LOCATION OF WE, LL(S) '
Attach ijvo copies of maps showing the following information:
(1) Include a Site Map (can be drawn) showing: buildings, property lines, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed wells) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of
the geothermal heat pump well system Label all features clearly and include a north arrow.
(2) The: Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, streams, And/or highway intersections.
J. CERTIFICATION
Note: This Permit Application trust be signed by ea1h person appearing on the
recorded legal property deed. -
"l hereby Certify, under penalty of law, that 1 have personally examined and ant familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and'..,-,
all related appurtenances in accordance with the approved spccif ions and conditions of the Permit"
i
t tature of Prop Owner/Applicant
Print or Type Full Name and title
Signature of Property Owner/Applican.t
Print or 'Type Pull Name and title ,
Signature of Authorized Ageut, if any
Print or Type Pull Name and title
Please retain two Copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer protection Section.U1C Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/U1C: 5QW Notifienticra of latent Form (Rcvi.w4 812008) Page 3
f739W 2T :2T 2002-SO-SO