WI0100167_Regional Office Physical File Scan Up To 9/22/2022

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North Carolina Department of Environment and Natu
Beverly Eaves Perdue
Governor
Donald and Nancy Lux
62 Willow Rd.
Waynesville, NC 28786
Division of Water Quality
Coleen H. Sullins
Director
August 31, 2011
Ref: Issuance of Injection Well Permits WI0100167
Issued to Donald and Nancy Lux
Waynesville, Haywood County, North Carolina
Dear Mr. and Mrs. Lux:
RE CECY ED
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In accordance with the application received on August 16, 2011,.I am forwarding permit number WI0100167 for
the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system to
be located at the above referenced address. This permit shall be effective from the date of issuance until July 31,
2016, and shall be subject to the conditions and limitations stated therein, including the requirement to install
well identification tags as specified in Part H.3 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.
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.roeersna.ncdenr.aov if you have any questions about your permit.
Best Regards,
Michael Rogers, P.G.
cc: [Land avidson—Asheville Regional -Office - ✓}
WI0100167 Permit File
Haywood County Environmental Health Department
Rick Clemenzi, Asheville Geothermal Inc.-, P.O. Box 18757, Asheville, NC 28814
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carofina 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.ncwatemualitv.orq
(NC & FL)
One,�
NorthCarolll-a
An Equal Opportunity i ASimtative .Action Employer

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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 919 715-6166. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI - INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #W10100167 . UIC/5QM Page 3 of 5
ver. 03/2010

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Donald and Nancy Lux
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 62 Willow Rd., Waynesville, Haywood
County, NC 28786, and will be constructed and operated in accordance with the application received August
16, 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 July 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 31 st day of August, 2011.
J.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #W10100167 UIC/5QM Page 1 of 5
ver. 03/2010

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 919 715-6166. Notification is required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI - INSPECTIONS
1. Any duly authorized officer, employee, or representative of the .Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or _related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records .that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #W10100167 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 828-296-4500
2. . A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Asheville Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(s) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part II.2 of this .permit shall be
submitted to the Aquifer Protection Section Central Office and the Asheville Regional Office within 30 .
days of completion of well construction.
4. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection will be established .and an
acceptable sampling reporting schedule shall be followed.
5. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number 828-296-4500, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
7. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART 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.
Permit #W10100167 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 #W10?00167 U1Q5QM Page 5 of 5
ver. 03/2010

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NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
CLOSED -LOOP MIXED -FLUID GEOTHERMAL INJECTION WELLS
These wells circulate fluids other than potable water as part of a geothermal heating and cooling system
(check one) X New Application Renewal* Modification
int or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Bel Returned As Incomplete.
DATE: August 12 , 20 11
PERMIT NO. (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence X Business/Organization
Government: State Municipal County Federal
B. PERMIT APPLICANT — For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
Donald and Nancy Lux
Mailing Address: 62 Willow Rd.
City: Waynesville State: NC Zip Code: 28786 County: Haywood
Day Tele No.: 828-452-0341 Cell No.:
EMAIL Address: bigpantswheels(&charter net Fax No.:
C. LOCATION OF WELL SITE — Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: 8614-08-9021 County: Haywood
(2) Physical Address (if different than mailing address):
City:
D. WELL DRILLER INFORMATION
State: _ Zip Code:
Well Drilling Contractor's Name: Clearwater Well Drilling
NC Well Drilling Contractor Certification No.: 2491
Company Name: CLEARWATER WELL DRILLING, INC.
Contact Person: Jeff Moore EMAIL Address:
Address: 112 Bluff Mountain Rd
City: Hot Springs Zip Code: 28743 State: NC County: Madison
Office Tele No.: 828-776-6526 Cell No.: Fax No.:
GPU/UIC 5QM Permit Application (Revised 1/24/2011) Page 1

1
8
E.
F.
HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Asheville Geothermal Inc.
Contact Person: Rick Clemenzi EMAIL Address: [e-mail]
Address: PO Box 18757
City: Asheville Zip Code: 28814 State: NC County: Buncombe
Office Tele No.: 828-712-6786 Cell No.: 828-712-6786 Fax No.:
WELL CONSTRUCTION DATA
(1) Number of borings to be constructed*: 2 Depth of each boring (feet): 225'
* If existing water supply wells will be used then provide the information in item (4) below.
(2) Chemical additives to be used: R-22 Propylene glycol Ethanol X
Other (other additives will need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): HDPE
(4) Well casing. If the well(s) will use casing then provide the tie (steel, PVC, plastic, etc.), diameter, depth,
and extent of casing appearing above ground:
(5) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement Bentonite* * Other (specify) See Attached
**By selecting bentonite grout, a variance is hereby requested to 15ANCAC 2C .0213(d)(1)(A), which requires a cement type grout.
(b) Grout depth of tubing (reference to land surface): from to (feet)
If well has casing, indicate grout depth: from to (feet)
G. WELL LOCATIONS — Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearly and include a north arrow.
(1) Attach a site -specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE. In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc can then be drawn in by hand Also, a `layer' can be selected showing topographic contours or
elevation data.
GPU/UIC 5QM Permit Application (Revised 1/24/2011) Page 2

H. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which means all ersons listed on the propejU deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"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 approved specifications and conditions of
the Permit."
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signs a of Authorized Agent, if
Richard A. Clemenzi
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC 5QM Permit Application (Revised 1/24/2011)
Page 3

Lux - Hazelwood
well Locations
>25' e
. sewac
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Asheville
Geothermal
Inc..
Minimum
pipe radius
25x diameter
Bore Depth
Residential Well Specification
Finished Grade
Header depth nominal 4'
(1/2" insulated if <3', 1" insulated if <1')
Trench backfill - no rocks >1/4" in
contact with pipe
Bedrock
Bentonite grout to minimum 20' below bedrock
Well Bore
Geothermal Loop DR11
Pea gravel grout from bottom to static water level
(maximum 20' below bedrock)
Copyright 2010-2011 Asheville Geothermal Inc., All Rights Reserved

A
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Asheville
Geothermal
fne.
To: NC Department of Natural Resources
Re: Geothermal Well Permit
PIN: (�
PIN: � L i q - o q
Dear Department of Natural Resources:
I/We hereby authorize Asheville Geothermal Inc., a licensed NC HVAC contractor, to sign and
otherwise speak for us with regard to obtaining a permit from the NC Department of Natural
Resources (DENR) for ethanol antifreeze protected Closed Loop Geothermal Wells on our
property at the above Property Identification Number (PIN). We ask that Asheville Geothermal
Inc. be allowed to sign and submit the Geothermal Well application, and that a representative
of Asheville Geothermal Inc. be allowed to speak with DENR on our behalf in this regard as
further needed.
Sincerely,
Signature o roperty Owner
Signature of
Signature of Property Owner
A,�4 I / -Z Z, V / N
Printed Name Date
Printed Name Date
Printed Name Date
Signature of Property Owner Printed Name
[e-mail] 828-712-6786
Date
www.ashevillegeothermal.com