WI0300123_Permit (Issuance)_20240207

e,,,STATE aFA'
ROY COOPER
Governor
ELIZABETH S.BISER
Secretary *�`QUAM N°`�'*
RICHAM E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
February 6,2024
James&Regina Lee
900 Club Drive
Monroe,NC 28112
Re: Issuance of Injection Well Permit
Permit No.W10300123
Geothermal Heating/Cooling Water Return Well
Union County
Dear James&Regina Lee,
In accordance with your permit renewal application received December 5, 2023, I am forwarding Permit No.
WI0300123 for the continued operation of geothermal heating/cooling water return well(s) located at the above
referenced address. Please note that this renewed permit shall become effective date of issuance until March 31,
2029, and shall be subject to the conditions and limitations stated therein.
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 Resources. If you
have any questions regarding your permit or the Underground Injection Control Program, please email to
[e-mail].
Best Regards,
F" Fal? =
Blake Butcher
Underground Injection Control(UIC)—Geologist/Hydrogeologist
Division of Water Resources,NCDEQ
Groundwater Management Branch
North Carolina Department of Environmental Quality- Division of Water Resources
Mailing address:1636 MSC,Raleigh NC 27699-1636
NORTH CARCUNAD Physical address:512 North Salisbury Street,Raleigh NC 27604
Department of E,,kon—tal Quay
919.707.9000

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH,NORTH CAROLINA
PERMIT FOR THE USE 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
James Allen & Regina B. Lee
Union County
WI0300123
FOR THE CONTINUED OPERATION OF One (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224, which will be used
for the injection of heat pump effluent. The injection well is located at 900 Club Drive, Monroe,NC 28112, and
will be operated in accordance with the application received December 5, 2023, and conformity with the
specifications and supporting data, all of which are filed with the Department of Environmental Quality.
This permit is for continued operation of an injection well and shall be in compliance with Title 15A North
Carolina Administrative Code 02C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to
well construction and use.
This permit shall be effective,unless revoked,from the date of issuance until March 31, 2029, and shall be subject
to the specified conditions and limitations stated therein.
Permit issued this the 6th day of February, 2024.
/-a/LQ �449�e�
(161
Karen Higgins
Water Planning Section
Division of Water Resources
Permit WI0300123
By Authority of the Environmental Management Commission.
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PART I—PERMIT 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 is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .0224(b)].
3. 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 [I 5A NCAC 02C .0211(e)].
4. This permit is not transferable without prior notice to, and approval. 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, including any supporting materials as may be appropriate, at least 30 days prior to the
date of the change [15A NCAC 02C .0211(o)].
5. 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 [15A NCAC 02C .0203].
PART II—WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with requirements of rule 15A NCAC 02C .0107.
2. Any injection well shall be constructed in accordance with requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be emplaced from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [I 5A NCAC 02C
.0224(d)(2), (3)]•
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions
if bentonite is to be used [15A NCAC 02C .0225(h)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each injection well shall be secured to reasonably insure against unauthorized access and use and shall be
sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each geothermal injection well shall have permanently affixed an identification plate according to [15A
NCAC 02C .01070)(2)].
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7. If not already provided, a copy of the Well Construction Record (Form GW-1) shall be submitted as
described in Part V.5 of this permit within 30 days after completion.
PART III—OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and rules of 15A NCAC 02C .0200, even
if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .0211(i)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface water
or groundwater resulting from the operation of this facility. 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, such as the repair,modification, or abandonment of the injection facility [15A NCAC
02C .0206].
PART IV—INSPECTIONS [15A NCAC 02C .02110)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR)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. DWR 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's activities.
PART V—MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [15A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(1)].
3. The Permittee shall report any report any monitoring or other information that indicates noncompliance
with a specific permit condition, that a contaminant may cause the injected fluids to migrate outside the
approved injection zone or area. As specified in rule 15A NCAC 02C .0211(p),noncompliance notification
shall be as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Mooresville Regional Office, telephone number(704)-663-1699.
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(B) Written notification shall be made within 5 (five) days of the occurrence and submitted to the
addresses in Item#5 below.
(C) The written notification shall contain a description of the noncompliance and its cause; the period
of noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. The Permittee shall record the number and location of the wells with the register of deeds in the county in
the facility is located [15A NCAC 02C .0224(f)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff Water Quality Regional Operations Section
Division of Water Resources And DWR Mooresville Regional Office
1636 Mail Service Center 610 East Center Avenue, Suite 301
Raleigh,NC 27699-1636 Mooresville,NC 28115
PART VI—PERMIT RENEWAL [15A NCAC 02C .0224(c)].
As required by rule, and application for permit renewal shall be made at least 120 days prior to the expiration of
this permit. This permit condition does not apply if the Permittee chooses to discontinue operation of the well
for injection of effluent from the geothermal heating and cooling system associated with this permit.
PART VII—CHANGE OF WELL STATUS [15A NCAC 02C .0240].
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose,then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection 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
.0113(b), which include,but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if any
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 ensure freedom from
obstructions that may interfere with sealing operations.
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(C) Each well shall be thoroughly disinfected,prior to sealing, in accordance with rule 15A NCAC
02C .0111(b)(1)(A), (B), and(Q.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe which extends to the bottom of the well and is raised as the well is filled.
(E) In those cases when a subsurface cavity has been created as a result of the injection operations,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record(Form GW-30) as specified in 15A
NCAC 2C .0224(f)(4)within 30 days of completion of abandonment to the addresses specified
in Part V.5 above.
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WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WI0300123
Date: _01/18/2024 County: Union
To: _WQROS, UIC Permitting Permittee/Applicant: James Allen & Regina B. Lee
Central Office Michael Rogers Facility Name: _James Allen & Regina B. Lee SFR
L GENERAL INFORMATION
1. This application is (check all that apply): ❑New ® Renewal
❑ Minor Modification❑ Major Modification
a. Date of Inspection: 01-17-2024
b. Person contacted and contact information: Mr. James Allen Lee(704)289-2890
c. Site visit conducted by: Edward Watson and Maria Schutte
d. Inspection Report Printed from BIMS attached: ❑ Yes ®No.
e. Physical Address of Site including zip code: 900 Club Drive,Monroe,NC 28112
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 34.969854 Longitude: -80.517618
Source of Lat/Long&accuracy(i.e., Google Earth, GPS, etc.):
IL DESCRIPTION OF INJECTION WELLS)AND FACILITY
1. Type of injection system:
® Geothermal Heating/Cooling Water Return
❑In situ Groundwater Remediation
❑Non-Discharge Groundwater Remediation
❑ Other(Specify:
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
Were samples collected from Influent/Effluent sampling ports? ® Yes ❑No.
Provide well construction information from well tag: Well tag data not collected.
b. Does existing or proposed system use same well for water source and injection? ® Yes ❑No
If No,please provide source/supply well construction info (i.e., depth, date drilled,well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ❑Yes ®No
What is/are the pollution source(s)?
What is the distance of the injection well(s)from the pollution source(s)?
N/A
4. What is the minimum distance of proposed injection wells from the property boundary?
5. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ® Low ❑ Moderate ❑ High
Rev. 6/1/2015 Page 1

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
7. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring,monitoring parameters, etc.) adequate? ❑ Yes ❑No. If No,
attach map of existing monitoring well network if applicable and recommend any changes to the groundwater-
monitoring program.N/A
8. Does the map included in the Application reasonably represent the actual site (property lines,wells, surface
drainage)? ® Yes ❑No. If No, or no map,please attach a sketch of the site. Show property boundaries,
buildings,wells,potential pollution sources,roads, approximate scale,and north arrow.
9. For Non-Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑No ®N/A.
If no,please explain:
b. Are the site conditions(soils,topography, depth to water table, etc.)consistent with what was reported by
the soil scientist and/or Professional Engineer? ® Yes ❑No ❑N/A. If no,please explain:
III. EVALUATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ®No. If yes, explain.
2. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
3. Recommendation
❑ Deny. If Deny,please state reasons:
❑ Hold pending receipt and review of additional information by regional office
❑ Issue upon receipt of needed additional information
® Issue
4. Signature of report preparer(s): Edward Watson 01/18/2024
FDocuftned by:
Signature of WQROS Regional Supervisor:
Date: 1/18/2024
Rev. 6/1/2015 Page 2

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS(If Needed)
The water reported high turbidy at both the Influent and Effluent ports. Collected samples from both ports sent
to DWR lab, sample IDs are AD16573 and AD16574. Sample results will be reported when they are available
to permittee and CO.
Rev. 6/1/2015 Page 3

North Carolina Department of Environmental Quality—Division of Water Resources
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordance With the Provisions of 15A NCAC 02C.022d
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S)
These well(s)inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application_X_Renewal* Modification Permit Rescission Request*
*For Permit Renewals or Rescission Request,complete Sections A thru E,and M(signature page)only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: 11-17-2023 520 PERMIT NO.W10300123 (leave blank if New
Application)
A. CURRENT WELL USE &OWNERSHIP STATUS(Leave Blank if New Well/Permit Application)
1. Current Use of Well
a. I wish to continue to use the well as X❑ Geothermal Well ❑Drinking Water Supply Well
❑Other Water Supply Use-Indicate use(i.e.,irrigation,etc.)
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit,check the box below. If abandoned,attach a copy of the Well Abandonment
Record(GW-30).
❑Yes,I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? ❑YES X❑NO
If yes, indicate New Owner's contact information:
Name(s) James A and Regina Lee
Mailing Address: 900 Club Dr
City: Monroe State:NC Zip Code: 28112 County:Union
Day Tele No.: 704-774-0753 Email Address.:
[e-mail]
B. STATUS OF APPLICANT(choose one)
Non-Government: Individual Residence X Business/Organization
Government: State Municipal County Federal
C. WELL OWNER(S)/PERMIT APPLICANT — For single family residences, list all persons listed on the
property deed. For all others,list name of business/agency and name of person and title with delegated authority
Geothermal Water Return Well Permit Application Rev.4-9-2019 Page 1

to sign: James Allen and Regina Barringer Lee
Mailing Address:900 Club Dr
City: Monroe State: NC Zip Code:28112 County:Union
Day Tele No.: Cell No.:
EMAIL Address: Fax No..
D. WELL OPERATOR(if different from well owner)—For single family residences, list all persons listed on
the property deed. For all others,list name business/agency and name of person and title with delegated authority
to sign: _
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Email Address.:
E. PHYSICAL LOCATION OF WELL(S)SITE
(1) Parcel Identification Number(PIN)of well site: 09159014 County:Union
(2) Physical Address(if different than mailing address):
City: County Zip Code:
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: Derry Honeycutt
NC Well Drilling Contractor Certification No.: 2663
Company Name:Den's Well Drilling
Contact Person: Derry Honeycutt EMAIL Address:
[e-mail]
Address:44283-A NC 29/27
City: Albemarle Zip Code: 28001 State:NC County:
Stanly
Office Tele No.: 704-988-3070 Cell No.: Fax No.:
G. HVAC CONTRACTOR INFORMATION(if different than driller)
Geothermal Water Return Well Permit Application Rev.4-9-2019 Page 2

1 r
HVAC Contractor's Name: Rick Long
NC HVAC Contractor License No.:
Company Name:Carolina Climate Control
Contact Person: Rick Long EMAIL Address:
Address:Box 162
City: MonroeZip Code: 28111 State:NC County: Union
Office Tele No.: Cell No.: 704-164-5637 Fax No.:
H. WELL USE Will the injection well(s)also be used as the supply well(s)for the following?
(1) The injection operation? YES X NO
(2) Personal consumption? YES NO X
I. WELL CONSTRUCTION REQUIREMENTS—As specified in 15A NCAC 02C .0224(d):
(1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent,then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107,except that:
(a) For screen and gravel-packed wells,the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen,the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
X*EXISTING WELLS PROPOSED WELLS
*For existing wells,please attach a copy of the Well Construction Record(Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include,at a minimum,the following well construction specifications:
(a) Depth of each boring below land surface 640'
(b) Well casing and screen type,thickness,and diameterplastic, %2"T,44'D
(c) Casing depth below land surface 44'
(d) Casing height"stickup"above land surface 18"
(e) Grout material(s)surrounding casing and depth below land surface Bentonite
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C.0107(fl(81
Geothermal Water Return Well Permit Application Rev.4-9-2019 Page 3

(f) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
K. OPERATING DATA
(1) Injection Rate: Average(daily)_I8 gallons per minute(gpm).
(2) Injection Volume: Average(daily)_180 gallons per day(gpd).
(3) Injection Pressure: Average(daily)_5_pounds/square inch(psi).
(4) Injection Temperature: Average(January)_40_°F,Average(July) °F.
L. SITE MAP—As specified in 15A NCAC 02C .0224(b)(4),attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map shall
include the following:
(1) All water supply wells,surface water bodies,and septic systems including drainfield,waste
application area,and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107(a)(2)located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s)are
to be located.
(4) An arrow orienting the site to one of the cardinal directions(north,south,west,or east)
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
M. CERTIFICATION(to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(e 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 all the person(s)listed on the property 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 and Title
Geothermal Water Return Well Permit Application Rev.4-9-2019 Page 4

'4703.----- -
0782
FILED
UNION COUNTY
CRYSTAL CRUMP
REGISTER OF DEEDS
FILED Oct 03,2007
AT 02:44 pm
BOOK 04703
START PAGE 0782
END PAGE 0783
INSTRUMENT# 44232
EXCISE TAX (None)
n
ExcisaTwe SNow
i-wc Lot Ivo:09159014 and pottian of 09159013 Parcel ldentiiierNo.
Veri fled by County on the day of 2007 by
Mail after recording to Griffm Smift Catdwe%Helder&Helms,F.A.
This instrument was prepared by Fames Allen Ise a ial)
Brief Desorption for the index Lot 3 end portion of Lot 2 i ileswood Sub.
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED rtrade October t 2007 by and between
GRANTOR GRAAftEE
JAMES ALLEN LEV,11 and spause, REGINA JAMES ALL&N t-F-n and Npoture,REGINA
BARRI!NGBIt i.EE BARRINCdM LIM
9t111 Club Dr.
Monroe,NC 28112
Fsin in aynmprintr Neack rcra+ch prey.eaea0.nCom%s.and-ifT+-�•�•;-.i.¢hmkia ofmti0/e.G.�puselicm or p.rmvahiµ
The designation Grantor and Grantee as used herein shall include said patties,their beim successors,and assigns,and shall
itcludr sipguNar,plural.m&wuli:te.frmiavde err neuter oea reouirerd by context.
WTINESSBTH, that ncc Chimer, fear a valuable consicisr"m pald by the Grantee. the receipt of which is hereby
ackrowledge:d,leas and by these presents does grant,bargain sell and convey unto the Grantee is fee simple,all that cesrain
lot or prival of land situated in Momve Township,Union Cotmty. North Carolina and more particularly described as
follows.
Tract 1—BEGINNING at a point eu the intersection of the Southern r*a.of way of Faller Drive and the western
right of way of Club Drive and nits thence dawn and with the western tight of wary of Club wive,S D0-15 E 145.4
fees to a corner with Lot No.4,thence the division Lime with Lot No.4,N 85 50 W 209,9 feet to a point:,commaa
corner with Lots 2,3,4 and 5;thence with the division line of Lot No.2,N 4-10 E 145 feet to a point is the soutbera
edge of Fuller Drive:tl=cc down and with Fuller Drive,S 85-50 E 1994 feet to the point of the BEGINNING and
being Lot 3 of Lileswood Subdivision(Club Heights)eu mapped and surveyed August 14, 1985 by Walter L_
Gordon,AeCRLS,sad updated on March 16,1987.
Bautg the same property conveyed in 1Cextb a Urif'fin and wife,Polly W.Griffin,by deed dated Jaarasry 18.1982
and recorded in Deed Book 354,page 276,Union County Registry.
Tract 2 BEGINNVG at an iron found on the southem right of way of Fuller Drive(a 60 foot right of way),said
iron being the northeastern corner of Lot 2 of Lileswood Subdivision as shown on a plat thereof recorded in plat
Book 5, Page 221. Onion Crnmty Registry and the northwestern comer of Lot 3 of Lileswood Subdivision and
tuning thence with the common live of Lot 2 and 3,S 04-10A0 W 145.00 Feet to a£Quad imur a common comer of
lots 2,3,4 and 5 of said subdivision thence with due common line of Iota 2 and 5 of said subdivision N 8547-04 W
43.93 feet to a set tron, thence a new live N 10 54-27 E 145.97 feet to a set ups on the sowhem ma Wn of Fuller
Drive.thence with the southern mar&of Fuller Drim S.85-50-00 E 26.72 feet tot the point and place of the
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% Signature of Property Owner/App� (cant
Print or Type Full Name and Title
Signature of Authorized Agent,if any
Print or Type Full Name and Title
Submit two copies of the completed application package to the address below(also attach an electronic
version on CD or USB Flash Drive):
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
Telephone[phone]
Geothermal Water Return Well Permit Application Rev.4-9-2019 Page 5