WI0100161_Regional Office Physical File Scan Up To 9/22/2022

North Carolina
Beverly Eaves Perdue
Governor
Michael and Elizabeth White
123 Browning Road
Black Mountain, NC 28711
,E
HCDENR
Department of Environment
Division of Water Quality
Coleen H. Sullins
Director
July 13, 2011
Ref: Issuance of Injection Well Permits WI0100161
Issued to Michael and Elizabeth White
Black Mountain, Buncombe County, North Carolina
Dear Mr. and Mrs. White:
M, rC-"E�VlI0
Dee freeman
6� r Secretary
J� 11 tut] 1
Asheville Regional Office
Acr,iifer Protection
In accordance with the application received on June 22, 2011, I am forwarding permit number WI0100161 for the
construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system to be
located at 201 Ridge St., Black Mountain, Buncombe County, NC 28711. This permit shall be effective from the
date of issuance until June 30, 2016, and shall be subject to the conditions and limitations stated therein, including
the requirement to install well identification tags as specified in Part 11.5 and to submit well construction
records as specified in Part VII.2. Be sure to read the entire permit to ensure that you are aware of all compliance
requirements of the permit.
Also, please pay special attention to the Well Construction Special Conditions Part IIA and 11.2. During
drilling of the borings and installation of the wells, certain conditions to be met.
You will need to notify this office at least 48 hours prior to beginning construction and operation of the injection
well system. In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must
submit an application to renew the permit 120 days prior to its expiration date. This permit is not transferable to
any person without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at [phone] or michael.rogers ,ncdenrgov if you have any questions about your permit.
Best Regards,
may —
Michael Rogers, P.G. (NC & FL)
cc: (Lan`_don-Davidsbn> -Asheville Regional Office
WI0100161 Permit File
Buncombe County Environmental Health Dept.
Larry Wells, AWD Services Inc:, P.O. Box 125, Leicester, NC 28748
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: 919-71M588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
Internet: www.ncwateraualih,.ora qr�� �j;
An Equal Opportunity l Affirmative Action Employer
�FgF r

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 Elizabeth White
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 the purpose of operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at 201 Ridge St., Black Mountain, Buncombe
County, NC 28711, and will be constructed and operated in accordance with the application received June 22,
2011, 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 June 30, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 13th day of July, 2011.
na
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #W10100161
UIC/5QM
ver. 03/2010
Page 1 of 5

t
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. During installation of the wells, all drilling fluids and/or production water shall be retained on site and not
be allowed to flow off -site onto adjoining properties and any surface water bodies.
2. During installation of the wells, the borings/wells will not be allowed to remain open and unprotected
from contamination of any stormwater.
3. 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].
4. 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. '
5. 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
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 maybe appropriate, at least 30 days prior to the date of the change.
Permit #W10100161 UIC/5QM Page 2 of 5
ver. 03/2010

.� 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 Permitteeshall 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.
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
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 bemaintained 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.
Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #W10100161 UIC/5QM Page 3 of 5
ver. 03/2010

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 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.
J
Permit #W10100161 UIC/5QM Page 4. of 5
ver. 03/2010

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 #W10100161
UIC/5QM
ver. 03/2010
Page 5 of 5 "

RECEIVED, f DEC 100
AQUIFFR'PPOTRi T011 SECTION
NORTH CAROLINA IAN 2 2 2011
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDE
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50M WELLS)
New Permit Application OR Renewal (check one)
DATE: 20
PERMIT NO.' �o (leave blank if NEW permit application)
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
B.
C.
entity and a representative w/authority for signature):
(1)
Mailing Address: Yl t CGvL Gt..e 1 VL 1 " -t-, • I b ✓ 0 l�l L
City: l /_(M'Eyti StateMZ Zip Code: 2 7 County: COV+^
Home/Office Tele No.: $077 3Lq 0'1 *'� Cell No.: SS O' ^ S5 q 1 9 D Z
EMAIL Address: M I G( 142I W In i fie (R) Z Mk vvi
(2) Physical Address of Site (if different than above): 20I '[�: Gt ti 2 5-i-r,1e,t
City: S (-g2 'V In 4-n . State: Al G Zip Code: Z 9-71 1 County: Bt1 oco ate. kae-
Home/Office Tele No.: & 3 32c( © 70� S Cell No.: & 3 5 S L g D
EMAIL Address: ro 1 G h &L e,0 -P—m a,c • CD M
AUTHORIZED AGUNT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person_ ,_ EMAIL Address:
Address:
City:
State: Zip Code: IN County:
Office Tele No.: Cell No.:
Website Address of Company, if any;
STATUS OF APPLICANT
Private: _x:.� Federal:
State: Municipal:
Commercial:
Native American,. -Lands:
GPUMC 5QM well Permit Application (Revised 7/2008)
Page 1

D.
E.
F.
G.
H.
WELL DRILLER INFORMATION
Company Name: AWD Services, Inc.
Well Drilling Contractor's Name: Larry Wells
NC Contractor Certification No.: 2603
Contact Person: Larry Wells Email Address:[e-mail]
Website: www.gppwelldrilliniz.com
Address: PO Box 125
City: Leicester, NC Zip Code: 28748 County: Buncombe
Office Tele No.: 828-683-9223 Cell No.: 828-215-9334
HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: C .i (, S u � e-V LA c.,
Contact Person: 1� r� cc�� \ EMAIL Address:
Address: 6" V L
City: ONE Zip Code: a7 �, 3 o County:
Office Tele No.: � Dq. tZ4 Cell No.: (q �. A
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Gm o,i l ®o is �S o� 4�e�'��✓ r"Ya , �nc�. k n n . n
WELL CONSTRUCTION DATA (Skin to Section H if this is a Permit RENEWAL)
(1) Proposed date to be constructed: when permitted Number of borings: ` w U
Approximate depth of each boring (feet): :�OQ
(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 NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc):
(4) Well casing. Is the well(s) cased? (check either (a.) YES or (b.) NO below)
(a) YES if yes, then provide casing information such as We (steel, PVC, plastic, etc.), diameter,
depth, and extent of casing appearing above ground:
(b) NO _ 'C
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonite Other (specify)
(b) Grout depth of tubing (reference to land surface): from ff to .2 q (feet)
If well has casing, indicate grout depth: from to (feet)
INJECTION -RELATED EQUIPMENT
gpU/LJIC 5QM Well Permit Application (Revised 7/2008)
pzq.
&Aron
Page 2

I.
J.
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,
LOCATION OF WELL(S)
Attach two 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 well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1.000 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.
POTABLE WATER WELL(S)
Are there any potable water well(s) on the subject property or adjacent properties? YES X NO
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 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 approv d specifications and conditions of the Permit."
I
RECEIVED / DENR i DVV'Q Signature of Property Owner/Applicant
AQUIFFR,PR0iE('T IM) SECTION
JUN 2 2 2011 G� a.�-1 � � �1 1� z
Print or Type Full Name
E& ok
S-
Signatutpf Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or TypeFuIl Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
GPU/UIC 5QM Well Permit Application (Revised 7/2008) Page 3

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H:N000NIPYSUFVEvpRSN[T CORPORPTE LICENSE NUM ER C-1Bl4

NIFA
CDEN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
June 23, 2011
Michael White
Elizabeth White
123 Browning Rd.
Black Mountain, NC 28711
Subject: Acknowledgement of Application No. WI0100161
Michael White SFR
Injection Mixed Fluid GSHP Well System (5QM)
Buncombe
Dear Mr. White:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality acknowledges receipt of your permit application and supporting
materials on 06122/2011. 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 http://h2o.enr.state.ne.us/documents/dwq_orlachart.odf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sinc ely, iooj�o
A
for Deb Watts
Supervisor
cc: Asheville Regional Office, Aquifer Protection Section
Larry Wells (AWD Services, Inc., P.O. Box 125, Leicester, NC 28748)
Brad Stickels (Stickels Service Co., 32 Pine Hill Rd., Fairview, NC 28730)
Permit Application File WI0100161
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.nmateroualitv.ong
An Equal opportunity \ Affirmative Action Employer
NorthCarolina

OW A T F'QQG State of North Carolina
Department of Environment and Natural Resources
T.
Division of Water Quality
o �
Aquifer Protection Section
Regional Staff Report
07/06/2011
To: Aquifer Protection Section Central Office Application No.: WI0100161
Attn: Michael Rogers Regional Login No.:
From: Jonathan Stepp
Choose an item. Regional Office
I. GENERAL SITE VISIT INFORMATION
1. Was a site visit conducted? ❑ Yes or ® No
a. Date of site visit:
b. Site visit conducted by:
c. Inspection report attached? ® Yes or ❑ No
d. Person contacted: Larry Wells and their contact information: (828) 215- 9334 ext.
e. Driving directions:
H. PROPOSED FACILITIES FOR NEW AND MODIFICATION APPLICATIONS
I.. Facility Classification: (Please attach completed rating sheet to be attached to issued permit)
2. Are the new treatment facilities adequate for the type of waste and disposal system? ❑ Yes or ❑ No
If no, explain:
3. Are site conditions (soils, depth to water table, etc) consistent with the submitted reports? ❑ Yes ❑ No ❑ N/A
If no; please explain:
4. Do the plans and site map represent the actual site (property lines, wells, etc.)? ❑ Yes ® No ❑ N/A
If no, please explain: The dimensions on the site map are incorrect. I spoke with Larry Wells (certified driller)
and conformed the actual dimensions of the property as well as the location of the aeo wells. These dimensions
are included on an attached map.
5. Is the proposed residuals management plan adequate? ❑ Yes ❑ No ❑ NIA
If no, please explain:
6. Are the proposed application rates (e.g., hydraulic, nutrient) acceptable? ❑ Yes ❑ No ❑ N/A
If no, please explain:
7. Are there any setback conflicts for proposed treatment, storage and disposal sites? ❑ Yes or ❑ No
If yes, attach a map showing, conflict areas.
8. Is the proposed or existing groundwater monitoring program adequate? ❑ Yes ❑ No ❑ N/A
If no, explain and recommend any changes to the groundwater monitoring program:
9. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No ❑ N/A
If yes, attach list of sites with restrictions (Certification. B)
FORM: APSRSR 04-10 Page 1 of 3

III. EXISTING FACILITIES FOR MODIFICATION AND RENEWAL APPLICATIONS
1. Are there appropriately certified Operators in Charge (O.RCs) for the facility? ❑ Yes ❑ No ❑ N/A
ORC: Certificate #: Backup ORC: Certificate #:
2. Are the design, maintenance and operation of the treatment facilities adequate for the type of waste and disposal
system? ❑ Yes or ❑ No
If no, please explain:
3. Are the site conditions (e.g., soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste'? El Yes or ❑ No
If no, please explain:
4. Has the site changed irl any way that may affect the permit (e.g., drainage added, new wells inside the compliance
boundary, new development, etc.)? ❑ Yes or ❑ No
If yes, please explain:
5. Is the residuals management plan adequate? ❑ Yes or ❑ No
If no, please explain:
6. Are the existing application rates (e.g., hydraulic, nutrient) still acceptable? ❑ Yes or ❑ No
If no, please explain:
7. Is the existing groundwater monitoring program adequate? ❑ Yes ❑ No ❑ N/A
If no, explain and. recommend any changes to the groundwater monitoring program:
8. Are there any setback conflicts for existing treatment, storage and disposal sites? ❑ Yes or ❑ No
If yes, attach a map showing conflict areas.
9. Is the description of the facilities as written in the existing permit correct? ❑ Yes or ❑ No
If no, please explain: -
10. Were monitoring wells properly constructed and located? ❑ Yes ❑ No ❑ N/A
If no, please explain:
11. Are the monitoring well coordinates correct in BIMS? ❑ Yes ❑ No ❑ N/A
If no. please complete the following (expand table if necessary):
Monitoring Well
Latitude
Longitude
O r n
o r n
� , n
�• t n
1.2. Has a review of all self=monitoring data been conducted (e.g., NDM.R, .NDAR, GW)? ❑ Yes or ❑ No
Please summarize any findings resulting from this review:
13. Are there any permit changes needed in order to address ongoing BIMS violations? ❑ Yes or ❑ No
If yes, please explain:
14. Check all that apply:
❑ No compliance issues ❑ Current enforcement action(s) ❑ Currently under JOC
❑ Notice(s) of violation ❑ Currently under SOC ❑ Currently under moratorium
Please explain and attach any documents that may help clarify answer/comments (i.e., NOV, NOD, etc.)
15. Have all compliance dates/conditions in the existing permit been satisfied? ❑ Yes ❑ No ❑ N/A
If no, please explain:
16. Are there any issues related to compliance/enforcement that should be resolved. before issuing this permit?
❑ Yes ❑No❑N/A
If yes, please explain:
FORM: APSRSR 04-10 Page 2 of 3

IV. REGIONAL OFFICE RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes or ® No
If yes, please explain:
2. List any items that you would like APS Central Office to obtain through an additional information request:
Item Reason
3. List specific permit conditions recommended to be removed from the permit when issued:
Condition Reason
4. List specific special conditions or compliance schedules recommended to be included in the permit when issued:
Condition
Reason
Retain drilling fluids and water created during the
To ensure that any discharge water from the drilling
drilling process for a sufficient time to allow solids to
process is in compliance with surface water standards.
settle out.
Well head shall be protected throughout the drilling
and construction process. If temporary casing is left
.in the borehole fora portion of the
To ensure protection of the aquifer during the
drilling/construction process it shall be covered with a
drilling/construction phase of the geothermal well
secure water tight cap; the temporary casing shall
field.
terminate no less than 12 inches above grade. Open/
un-grouted bore holes shall be protected throughout
the drilling/construction process.
5. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office
❑ Hold, pending review of draft permit by regional office
❑ Issue upon receipt of needed additional information
® Issue
❑ Deny (Please state reasons: )
Signature of repor
Signature of APS
Date: -7, -)I
V. ADDITIONAL REGIONAL STAFF REVIEW ITEMS
I spoke with Larry Wells about the emplacement of grout and Mr. Wells indicated that the well would be grouted
form 0' to -20' with bentonite and -20' to -300' with pea gravel.
FORM: APSRSR 04-10 Page 3 of 3

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The information provided is based on the best available data at the time of currency for all datasets. It is the requestor's responsibility to verify any information derived from the GIS data
before making any decisions or taking any actions based on the information. Buncombe County shall not be held liable for any errors in the GIS data. This includes errors of omission,
commission, errors concerning the content of the data, and relative and positional accuracy of the data.