WI0800178_GEO THERMAL_20200128

Permit Number WI0800178
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Faclllty Name
Timothy and Amy Lougher SFR
Location Address
3100 Scarborough Dr
Wilmington
Owner
Owner Name
Timothy
Dates/Events
NC
Orig Issue
12/18/2009
App Received
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28409
Laugher
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
1/28/2020
Permit Tracking Slip
Status
Active
Version
3.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Wilmington
County
New Hanover
Faclllty Contact Affiliation
Owner Type
Individual
Owner Affiliation
Timothy Laugher
3100 Scarborough Dr
Wilmington
Issue
1/28/2020
Effective
1/28/2020
NC 28409
Expiration
12/31/2025
Requested /Received Events
Administrative amendment request received
RO staff report requested
RO staff report received
Streamlndex Number Current Class
12/20/19
12/30/19
1/21/20
Subbasin
ROY COOPER
Governor
MICHAELS. REGAN
Seaetary
LINDA CULPEPPER
Otrecror
Amy & Timothy Laugher
3100 Scarborough Dr.
Wilmington NC 28409
NORTH CAROLINA
En""'1nlnentDI Quality
January 28, 2020
Re: Issuance of Injection Well Permit
Permit No. WI0800178
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. and Mrs. Laugher:
In accordance with your permit renewal application received December 20; 2019, I am forwarding
Permit No. WI0800178 for the continued operation of geothermal heating/cooling water return well(s)
located at the above referenced address. This permit shall be effective from date of issuance, until
December 31, 2025, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on January 14, 2020. Laboratory analytical results will be forwarded to
you when it becomes available.
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 call me at [phone].
Best Regards,
Shristi Shrestha
Underground Injection Control (UIC)-Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Section
North Carolina Department of Environmental Quality I Division of water Resources
512 North Salisbury Street I 1636 Mall Service Center I Raleigh, North Carolina 27&99-1636
919.707.9000
cc: Morella Sanchez-King-Geoff Kegley, Wilmington Regional Office
Central Office File, WI0800178
New Hanover County Environmental Health Department
108 :Il EVEXT0191 QF1
ENVTRONA ENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
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 1S HEREBY GRANTED TO
Any & Timothy Laugher
New Hanover County
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 2C .0224, which will be used for
the injection of heat pump effluent. This injection well is located at 3100 Scarborough Dr,, New Hanover County,
Wilmington, NC 28409 and will be contracted and operated in accordance with the application December 20,
2019, 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 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from January 28, 2020, until December 31, 2025, and shall be
subject to the specified conditions and limitations stated therein..
Permit issued this the 28'h day of January 2020.
For Linda Culpepper
Director, Division of Water Resources
By Authority of the. Environmental Management Commission.
Permit #W10800178 Geothermal Heating/Cooling Water Return Well Page 1 of 5
ver. 8-8-2018

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 .021 l(a)].
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 [15A NCAC 02C .021 l(k)].
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 .021 l(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 [15A 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
ifbentonite is to be used [15A NCAC 02C .0225(g)(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 .0107(j)(2)].
Permit #WI0800178 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 2 of5
7. A copy of the Well Construction Record (Fonn 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 mid maintain the
injection facility in compliance with the conditions of this permit and rules of 15A NCAC 02C .0200, even
if compliance requires a reducti9n or elimination of the permitted activity [15A NCAC 02C .021 l(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 .021 l(i)]
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)(l )].
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 .021 l(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 Wilmington Regional Office, telephone number 910-350-2004.
Permit #WI0800178 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 3 of5
(B) Written notification shall be made within 5 (five) days of the occurrence and submitted to the
addresses in Item #5 below; and
(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(±)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
And
Water Quality Regional Operations Section
DWR Wilmington Regional Office
127 Cardinal Drive
Wilmington, NC 28405
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
.Ol 13(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 insure freedom from
obstructions that may interfere with sealing operations;
Permit #WI0800178 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 4 of5
(C) Each well shall be thoroughly disinfected, prior to sealing, in accordance with rule ISA
NCAC 02C .011 l(b)(l)(A), (B), and (C);
(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; and
(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.
Permit #WI0800178 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 5 of5
DocuSign Envelope ID: B2D1405E-C04E-49C1-B720-B5686D5B2CA1
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
Date: 1/15/2020 Permittee(s): Timoth v & Am y Lou gher
Permit No.: WI0800178
To: Shristi Shrestha County: New Hanover
Project Name: Geothermal heatin g/coolin g water return well
Regional Login No: Geoff Ke gle y
L GENERAL INFORMATION
1. This application is (check all that apply):0 SFR Waste Irrigation System [8J UIC Well(s)
D New [8J Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation [8J Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? [8J Yes or D No.
a. Date of site visit: 1/14/2020
b. Person contacted and contact information: Tim Lough er: (910} 409-9460 tlougher(w.ec.rr.com
c. Site visit conducted by: Geoff Kegley
d. Inspection Report Attached: D Yes or [8J No.
2. Is the following information entered into the BIMS record for this application correct?
[8J Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For SFR Treatment Facilities:
a. Location:
b. Driving Directions: __
il ,·", 2 1 2020
R W2,.~,Q~,•-c. USGS Quadrangle Map name and number: __ P(Jicm:_,i Ooer&tJ ~-••w
ons:: ectlon Method Used (OPS, Google™, etc.); __ d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For UIC Injection Sites:
(If multip le sites either indicate which sites the information applies to , copy and paste a new section into the
document for each site, or attach additional pa ges for each site)
a. Location(s):
b. Driving Directions:
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: Method Used (OPS, Google™, etc.); OPS
APS-GPU Regional Staff Report (Sept 09) Page 1 of 4 Pages
DocuSign Envelope ID: B2D1405E-C04E-49C 1-B720-B5686D5B2CA 1
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description of Well(s) and Facilities -New, Renewal, and Modification
I. Type of injection system:
IZ! Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: __j
2. Does system use same well for water source and injection? D Yes IZ! No
3. Are there any potential pollution sources that may affect injection? D Yes IZ! No
What is/are the pollution source(s)? . What is the distance of the injection well(s) from the pollution
source (s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 15_.fi,_
5. Quality of drainage at site: D Good IZ! Adequate D Poor
6. Flooding potential of site: IZ!Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? IZ! Yes or D 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.
Injection Well Permit Renewal and Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes IZ! No. If yes, explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If v es . exp lain:
3. For renewal or modification of groundwater remediation permits ( of any typ e ), will
continued/additional/modified injections have an adverse impact on mi gr ation of the plume or management of
the contamination incident? D Yes D No. If yes , explain:
APS-GPU Regional Staff Report (Sept 09) Page 2 of 4 Pages
DocuSign Envelope ID: B2D1405E-C04E-49C1-B720-B5686D5B2CA1
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
4. Drilling Contractor: Name:
Address:
NC Certification number:
Complete and attach NEW Injection Facility Inspection Report, if applicable
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the Application:
This review was conducted for a permit renewal review for a geothermal
heating/cooling water return well at the Lougher residence. Staff visited the home to
inspect the well system. Some iron staining was present surrounding the injection well.
Owner states operation has been normal and the injection well mostly assimilates the
injected water, but can back up and overflow at times. Could be possible fouling of well
from iron bacteria. Re commended rehabilitation of well by a certified driller if this
becomes a problem for operation. Source well water and water prior to injection was
sampled for Metals, total and fecal coliform, Nitrates, Chloride and Total Dissolved
Solids. Sampling results will be forwarded to the Central Office when received. The
WiRO recommends renewal of the permit.
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? D Yes [gl No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
APS-GPU Regional Staff Report (Sept 09) Page 3 of 4 Pages
DocuSign Envelope ID: B2D1405E-C04E-49C1-B720-B5686D5B2CA1
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
6. 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
7. Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information; [gl
Issue; D Deny. If deny, please state reasons: __
Docu81gned by:
8. Signature of report Preparer(s ti"'••./,H'l-~_.,l"~------------------
~
0ocuslgned by:
co11E2S1so39411... 11 , ··-11 . r ...• t. • • b Signature of APS regional supervisor: _________ ,V\.OYU.LA, ....... ......,......,.a .... !8:YM&C) ............. ....,.._ .... ~....,,.--
1/21/2020 E3ABA1-4AC7DC434 .. .
Date:
VI. ADDITIONAL INFORMATION AND SITE MAP (Sketch o f site showing house and waste irrigation
s vstem , spra y or drip fi eld, location o(well(s), and/or other relevant in fo rmation-SHOW NORTH ARROW)
APS-GPU Regional Staff Report (Sept 09) Page 4 of 4 Pages
WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQ UEST FORM
Date: December 30, 2019
To: Morella Sanchez-King -Geoff Kegley
From: Shristi Shrestha, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0S00l 78
A. Applicant: Amy & Timothy Lougher
B. Facility Name:
C. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
__ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days , please return a com pleted W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-WOROSReviewer: __________________ Date: _____ _
COMMENTS:
NOTES:
FORM: WQROS-ARR ver. 092614 Page 1 of 1
ROY COOPER ,
Governor.
MICHAELS. REGAN
Secretary
LINDA CULPEPPER
Olrecf:or
Amy & Timothy Lougher
3100 Scarborough Dr.
Wilmington, NC 28409
NORTH CAROLINA
EnYtronlnffltalQuallly
December 30, 2019
RE: Acknowledgement of Application No. WI0800178
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. & Mrs. Lougher:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt
of your permit application and supporting documentation received on December 20, 2019.
Your application package has been assigned the number listed above, and the primary
reviewer is Shristi Shrestha
Central and Wilmington Regional Office staff will perform a detailed review of the
provided application, and may contact you with a request for additional information. To
ensure maximum efficiency in processing permit applications, the Water Quality Regional
Operations Section (WQROS) requests your assistance in providing a timely and complete
response to any additional information requests.
Please note that processing standard review permit applications may take as long
as 60 to 90 days after receipt of a complete application. If you have any questions, please
contact Shristi Shrestha at 919-707-3662 or email at [e-mail].
cc: Wilmington Regional Office, WQROS
Permit File WI0800178
Sincerely,
For Rick Bolich, Supervisor
Animal Feeding Operations &
Groundwater Protection Branch Division
of Water Resources
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street I 1636 Mall Service Center I Raleigh; North Carolina 27699-1636
919.707.9000
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North Carolina Department of Environmental Quality-Division of Water Resources ·
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTIONlw£If,f2Q/g
In Accordance With the Provisions of ISA NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S)
These well(s) inject gronndwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
__ New Application V Renewal* __ Modification __ Permit Rescission Request*
*For Permit Renewal~cission 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: llic,., I I , 20--13_ PERMIT NO. \JIO<t{)'.)J]& (leave blank ifNew 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 ~Geothermal Well D Drinking Water Supply Well
D 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).
D Yes, I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? D YES ~ NO
If yes, indicate New Owner's contact information:
Name(s) _____________________________ _
Mailing Address: ____________________________ _
City: __________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: ---------------=Em=a=il -=-A=d=dr=e=s=s."-: _
B. STATUS OF APPLICANT (choose one)
Non-Government: Individual Residence 'i_ 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 ofbusiness/agency and name of person and title with delegated authority
to sign: 8-rn" ~~ '.i I 9 h"-fu Mailing Address: '3 ~ lx.Z 'br , .
City: W,~ S1ate:ttc,.·~Pcode: 23L{09 County:New /-ba;,eR-
Day Tele No.: ~·--- ---9Lf3)... Cell No.: e } o) 3{o]-2..Jjg l
EMAIL Address: ±~ ov.q her t2tc ' re I Cb tr) Fax No.:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page I
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.: ________________ E_m_a_il_A_d_d_r_es_s_.: ___________ _
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) Parcel Identification Number (PIN) of well site: __________ County: _____ _
(2) Physical Address (if different than mailing address): ________________ _
City: _____________ County _________ Zip Code: ____ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: __________________________ _
NC Well Drilling Contractor Certification No.: _____________________ _
Company Name: ________________________________ _
Contact Person.~: --------------~EMAIL Address: ___________ _
Address:------------------------------------
City: Zip Code: State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ---------------------------
G. HV AC CONTRACTOR INFORMATION (if different than driller)
H.
I.
HVACContractor'sName: ____________________________ _
NC HV AC Contractor License No.: _________________________ _
Company Name: ________________________________ _
Contact Person ~: _______________ EMAIL Address: ___________ _
Address: ------------------------------------
City: Zip Code: _____ State: __ County:
Office Tele No.: Cell No.: Fax No.: ---------------------------
WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ___ _
YES ___ _
NO .X.
NO =x==
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:
Geothennal Water Return Well Permit Application Rev. 4-15-2016 Page2
(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)
(2)
Specify the number and type of wells to be used for the geothermal heating/cooling system:
,...i,/: *EXISTING WELLS ____ PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Fonn GW-1) if available.
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
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(0(8 )
(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. OPERATINGDATA
(1) Injection Rate: Average ( daily) gallons per minute (gpm).
(2) Injection Volume: Average ( daily) gallons per day (gpd).
(3) Injection Pressure: Average ( daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° 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)
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page3
NOTE. In most cases art aerial photograph of the property parcel showing property limes and structures can be
obtained and downtoaded from the applicable county GIS website. Typica11y, the proper►), 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 lopographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
ISA NCAC 42C .Q21.I (ej requires that all permit applications shall he signed as follows:
l . 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 persons 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 l 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. 1 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 Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources - UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 4

A,46VA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
October 30, 2014
Timothy and Amy Lougher
3100 Scarborough Drive
Wilmington, NC 28409
Subject: Geothermal well sampling results
Permit Number W10800178
New Hanover County
Dear Mr. & Mrs. Lougher-
John E. Skvarla, III
Secretary
On September 17, 2014 staff' from the Division of Water Resources sampled the influent and effluent lines of
your geothermal underground injection well heat pump system. The samples were analyzed by the
Division's laboratory for eoliform, total dissolved solids, metals, nitrates and other inorganic constituents.
No exceedances of the State Groundwater Standards were observed except for Iron (Fe). Iron is a naturally
occurring metal commonly found in groundwater. A copy of the lab results are enclosed for your review.
Should you have any questions concerning this letter, please feel free to contact me at [phone] or by
email at geoff.kegluancdertr.gay.
Sincerely,
Geoff Kegley
Water Quality Regional Operations Section
Wilmington Regional Office
Division of Water Resources, NCDENR
Enclosure: sample results
cc: Michael Rogers, ❑\V l: Central Office
S:1GW51GeafflPermitsl!]10W10840178 sample rrsalf5 4L�E�VEDIDENR1pWR
127 Cardinal Nve Extension, Wilmington, Forth Carolina 2W5
Phone: 910-7W721511nternet: w".nedenr.gov NOV 0 3 ?All
An Equal OppodtoOy 1 Affirmative Achon Employer — Madam part by racyJed paper
Wste* Qkia% R6glonal
Operations Sedron

-~_;>()c' \l c ~ L:~' £:"L-L _-
AC12794 Nc qJ.,,,-1{ Water Sciences Section-Cfiemist:, y La6oratory CJl.#suCts
County: NEW HANOVER Sample ID: AC12794
River Basin DWR PO Number# 14G0377
Report To WIROAP Date Received : 09/18/2014 .
Collector: G KEGLEY
Time Received : 08:00
Region: WIRO Division of Water Resources
Labworks LoginlD MSWIFT
Sample Matrix: GROUNDWATER Final Report Date: 10/10/14
Loe. Type: Water Sueell! Final Re port Report Print Date: 10/10/2014
Emergency Yes/No VisitlD
coc Yes/No
Loe. Descr.: LOUGHER GEOTHERMAL
I Location ID: WIROAPNLC I Collect Date: 09/17/2014 I Collect Time: 13:00 l Sample Depth I
If this report is labeled preliminary report, the re$ults have not been validated. Do not use for Regulatory purposes.
CAS# Anal yt e Name PQL Result/ Units Method Analysis Validated by
Qualifier Reference Date
LAB
Sample temperature at receipt by lab 2.1 ·c 9118114 MOVERMAN
MIC
Coliform, MF Fecal in liquid 1 1 B2, Q1 CFU!100ml APHA9222D-20th 9118114 ESTAFFORD1
Coliform, MF Total in liquid 1 1 B2, Q1 CFU!100ml APHA9222B-20th 9118114 ESTAFFORD1
WET
Ion Chromatography _TITLE_ mglL EPA 300 .0 rev2 .1 9130/14 MOVERMAN
Chloride 1.0 20 mglL EPA 300.0 rev2.1 9130114 MOVERMAN
Fluoride 0.4 0.4U mglL EPA 300.0 rev2 .1 9130114 MOVERMAN
Sulfate 2.0 29 mglL EPA 300 .0 rev2 .1 9130114 MOVERMAN
Total Dissolved Solids in liquid 12 81 mg/L SM 2540 C-1997 9119/14 CGREEN
Bromide 1.0 1.0U rnglL EPA 300.0 rev2.1 9130114 MOVERMAN
NUT
N02+N03 as N in liquid 0.02 0.02U mglLas N EPA 353.2 REV 2 9119114 CGREEN
MET
7440-22-4 Agby ICPMS 1.0 1.0U ug!L EPA200.8 10/6/14 ESTAFFORD1
7429-90-5 Al bylCP 50 550 uglL EPA200.7 10/2114 ESTAFFORD1
7440-38-2 As by ICPMS 2.0 2.0 U uglL EPA200.8 10/6114 ESTAFFORD1
7440-38-3 Ba by ICP 10 61 uglL EPA200.7 10/1/14 ESTAFFORD1
7440-70-2 Ca by ICP 0.10 8.3 mg/L EPA200.7 1011/14 ESTAFFORD1
7440-43-9 Cdby ICPMS 0.50 o.sou uglL EPA200.8 1016114 ESTAFFORD1
7440-47-3 Crby ICPMS 10 10 U ug/L EPA200.8 10/6/14 ESTAFFORD1
7440-50-8 CubylCPMS 2.0 29 uglL EPA200.8 10/6/14 ESTAFFORD1
7439-89-6 Fe by ICP 50 870 ug/L EPA200.7 10/2114 ESTAFFORD1
Hardness by Calculation 1.0 27 mgll SM2340BEPA 200. 7 10/2114 ESTAFFORD1
7440-09-7 Kby ICP 0.10 2.5 mg/L EPA200.7 10/1/14 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 1.5 mg/L EPA200.7 10/1/14 ESTAFFORD1
7439-96-5 Mn by ICP 10 13 ug/L EPA200.7 10/2114 ESTAFFORD1
7440-23-5 Na by ICP 0.10 12 mg/L EPA200.7 10/1114 ESTAFFORD1
7440-02-0 NibylCPMS 2.0 2.0U ug/L EPA200.8 10/6/14 ESTAFFORD1
7439-92-1 Pb by ICPMS 2.0 2.0U ug/L EPA200.8 10/6/14 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service·center, Raleigh, NC 27699-1623 [phone]
For a detailed descri0tlon of the aualifiercodes refer to <htto:/ /oortal.ncdenr.orf!lweb/wa/oos/methods-and-oals>
Page 1of 2
¾C ~ £a6oratory Section 1?.!sufts
Location ID: WIROAPNLC Sample ID: AC12794 Collect Date: 09/17/2014 Collect Time:: 13:00
MET
CAS#
7782-49-2
7440-66-6
Ana lyte Name PQL Result/ Units Method Anal~sis
Qualifier Reference Date
Se by ICPMS 5.0 5.0 U ug/L EPA200.8 10/6/14
Zn by ICPMS 10 52 ug/L EPA200.8 10/6/14
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descrio~on of the aualifier codes refer to <htto :/ /nortal.ncdenr .orfl.!web/wa/ oos/methods-and-nals>
Page2 of 2
Validated by
ESTAFFORD1
ESTAFFORD1
North Carolina
[AQUIFER PROTECTION FIELDSHEET Depautmellt of Environment and INatural Resources
DIVISION OF WATER RESOi1RCES-AQUIFER PROTECTION SECTION
Location code AMPLE TYPE SAMPLE PRIORLTY
County _ j . ��,yt tr,/`G 1,-- 91 Water R) Routine Lab Number �y�r
V4
Quad No Serial No. ©Soli ❑ Emergency Date Received q b
Ttn � Q$"'
Long. ©Other Rec'd By: (VW From:l3us, uri ', Hand Del., -
❑ Chain of Custody Other:
iR0 _
Report To: ARO, FRO, MRO, RRO, WeRO, - Data Cntry By: Cis:
WSRO, Kinston f'0, Fed. Trust; Ceniml Off., Other: Date Reported:
Shipped by: Su Courier, Hand Del.. Other: v,r; pu
Cailectar(s}:7 ,L G ` !]ate Time t9 i� i3alinc. Complaint om j��]cc, LUST, i'cstic'sde Srudy, Federal 'Trust, Other:`
FIELD ANALYSE 5 T� Owner {arse
PH 4M Spec. Cond.,,, _ at 750C Location or S-stir
Temp.lo °C Odor Description of sampling pointy }
Appearance _ Sampling Method
Field Analysis By: Remarks
LABORATORY ANALYSE
SOD 310 mg/L
COD High 340 mglt-
COD Low 335 mglL
Califene. MF Fecal 31616 1100m1
Cotefomr MFToull31504 I100mi
TOC 680 mg/L
Turbidity 16 NT J
Residue. Total Suspended 530 uegir.
pH 403 voila
Alkalinity to pH 4.5 410 mg/L
Alkalinity to pli 83 415 aoa/t.
Carbontme 445 mg/L
81CArb"ajc 440 mal.
Carbon dioxide 405 mg/L
Chlonde 940 MA
Chromium: Hex 1032 uglL
Color Ti ue a0 Cu
Cyanide: 720 rngn-
Lab Cornmew
Sample 1rKerva
(Pump,ng
nrm. or
tamp., ate)
Dtas. Solids 70300 mart.
4-Sdver46566 n fL
Or anxhlorine Pesticides
Fltoonde 951 mr)L
AI -Aluminum 46557 n 1L
Or ro MIMS Pesticides
Mwd,ess. Tonal 9D0 mr)L
As -Arsenic 46131 uL&
Niq Pesvades
Handncss (nrnrc-Irh) 902 MWL
Sa-Bai ium 46558 u
Acid herbicides
Phenols 32730 IJO
Ca -Calcium 46552 111
PCBs
Spec PfrcCond 95 uMhoslcen
Cd-Cadmium 46559 ue/L
Sulfate 945 MA
Cr-Chivrd[urn 46559 u
Sulfide 745 znWL
Cn Copper 46562 uglL
Fe:-irno 46563 IL
Sarni volatile fit gaincs
Oil and Grease: mg/L.
Hg-Mercury 71900 UATPFI-Diesel
Rang
K-PmawvM 46555 mg/L
Mg-Mapiesimn 46554 m L
Mn-Manganese 46565 uriL
Volatile OManics t VOA Uoulr
NH, as N 610 malL
Na-sodsum 46556 MP-1-
i PI ]•Gasoline Range
TKN as N 625 mglL
Ni-Nickel a t,
TPH-$T'EX Gasoline Ran
NO: T NO, as N 630 myJL
r'h-Lead 45564 u L
f Talal as P 665 mg/L
Se -Selenium
Niti ale (NO, as N) 670 mail-
Tar -Zane 46567 u L
Write (NO_ as N) 615 ms1L
LAB
USE ONLY � r
on arrival (C)-
Temperature
GW-54 REV V2013 For Dissolved Analysis-subrreit 5hood sampk and pine"DIS`m block

AC12795
. ) ,·, -t-,, -1.i _ ~ f. .., --re·:, , 1, • -r-r: .... -• ----::-I{'· ,··\. :
\ '-'!!._,· t< \ . . ( '-, --..., --·-e;__ ( / /
:NC qJ,,,, ~ 'Water Sciences Section-Cfiemist-, r La6oratory c.9.§sufts
County: NEW HANOVER Sample ID : AC12795
River Basin DWR PO Number# 14G0378
Report To WIROAP Date Received: 09/18/2014
Collector: GKEGLEY Time Received: 08:00 .
Region: WIBQ Division of Water Resources
Labworks LoginlD MSWIFT
Sample Matrix: GROUNDWATER Final Report Date: 10/10/14
Loe . Type: Water SUQ(!ll! Final Re p ort Report Print Date: 10/10/2014
Emergency Yes/No VisitlD
COC Yes/No
Loe. Descr.: LOUGHER GEOTHERMAL
I Location ID: WIROAPNLC I Collect Date: 09/17/2014 I Collect Time: 13:15 I Sample Depth I
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS# Anal yt e Name PQL ResulU Units Method Anal~sis Validated by Qualifier Reference Date
LAB
Sample temperature at receipt by lab 2.1 ·c 9/18/14 MOVERMAN
MIC
Coliform MF Fecal in liquid 1 1 B2, Q1 CFU/100ml APHA9222D-20th 9/18/14 ESTAFFORD1
Coliform, MF Total in liquid 1 1 B2, Q1 CFU/100ml APHA9222B-20th 9/18/14 ESTAFFORD1
WET
Ion Chromatography _TITLE_ mg/L EPA 300 .0 rev2.1 9/30/14 MOVERMAN
Chloride 1.0 20 mg/L EPA 300.0 rev2.1 9/30/14 MOVERMAN
Fluoride 0.4 0.4U mg/L EPA 300.0 rev2.1 9/30/14 MOVERMAN
Sulfate 2.0 29 mg/L EPA 300.0 rev2 .1 9/30/14 MOVERMAN
Total Dissolved Solids in liquid 12 80 mg/L SM 2540 C-1997 9/19/14 CGREEN
Bromide 1.0 1.0 U mg/L EPA 300.0 rev2. 1 9/30/14 MOVERMAN
NUT
NO2+NO3 as N in liquid 0.02 0.02U mg/Las N EPA 353.2 REV 2 9/19/14 CGREEN
MET
7440-22-4 Ag by ICPMS 1.0 1.0U ug/L EPA200.8 10/6/14 ESTAFFORD1
7429-90-5 Al by ICP 50 590 ug/L EPA200.7 10/2/14 ESTAFFORD1
7440-38-2 As bylCPMS 2.0 3.7 ug/L EPA200.8 10/8/14 ESTAFFORD1
7440-38-3 Ba by ICP 10 62 ug/L EPA200.7 10/1/14 ESTAFFORD1
7440-70-2 Ca by ICP 0.10 8.4 mg/L EPA200.7 10/1/14 ESTAFFORD1
7440-43-9 Cd bylCPMS 0.50 o.sou ug/L EPA200.8 10/6/14 ESTAFFORD1
7440-47-3 Crby ICPMS 10 10 U ug/L EPA200.8 10/6/14 ESTAFFORD1
7440-50-8 Cu by ICPMS 2.0 160 ug/L EPA200.8 10/6/14 ESTAFFORD1
7439-89-6 Fe bylCP 50 990 ug/L EPA200.7 10/2/14 ESTAFFORD1
Hardness by Calculation 1.0 27 mg/L SM23408EPA200 .7 10/2/14 ESTAFFORD1
7440-09-7 Kby ICP 0.10 2.6 mg/L EPA200.7 10/1/14 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 1.5 mg/L EPA200.7 10/1/14 ESTAFFORD1
7439-96-5 Mn bylCP 10 13 ug/L EPA200.7 10/2/14 ESTAFFORD1
7440-23-5 Na by ICP 0.10 14 mg/L EPA200.7 10/1/14 ESTAFFORD1
7440-02-0 NibylCPMS 2.0 2.0 U ug/L EPA200.8 10/6/14 ESTAFFORD1
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L EPA200.8 10/6/14 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descri01ion of the aualifier codes refer to <httn://oortal.ncdenr.onz/web/wa/oos/methods-and-oals>
Page 1 of 2
:NC <D~ La6oratory Section ~sults
Location ID: WIROAPNLC Sample ID : AC12795 Collect Date: 09/17/2014 Collect Time :: 13:15
MET
CAS#
7782-49-2
7440-66-6
Analyte Name POL Result/ Units Method Anall Sis
Qualifier Reference Date
Seby ICPMS 5.0 5.0U ug/L EPA200 .8 10/6/14
Zn by ICPMS 10 10U ug/L EPA200.8 10/6/14
WSS Chemistry laboratory» 1623 Mail Service Center, Raleigh , NC 27699-1623 [phone]
For a detailed description of the Qualifier codes refer to <htto:/ /oortal.ncdenr.onz/web/wa/oos/methods-and-nals>
Page 2 of 2
Validated by
ESTAFFORD1
ESTAFFORD1
Iq&D37Z
AQUIFER PROTECTION FIELDSHEET
Location code
County 4w
Quad No Serial No.
Lai_ Lang.
North Carolina
Department ofEnvimrin l and Nalural Resources
DIVISION! OF WATER RESOURCES -AQUIFER PROT1:CTION SECTION
SAMPLE TYPE SAMPLE PRIOR"
Water ,b kowine Lab Number a" t IZ
❑ soil ❑ Emergency Date Received rp Tine: D
❑ Other Rec-d By: ff,.Q. Fro1n:13us* uri • Hand Del.. _
❑ Chain of Custody Other:
Report To: ARO, FRO, MRO, RRO, WaRO< i tQ
Data Entry By: Ck:
WSRO, Kinston FO, Fed. Trust, Central Of%, then:
Dale Reported:
Shipped by: Bus. ourier, Hand Del., =ether: �'
Collectar(s): L`
Oe tit' Purpo
!]ate ��1 Tune 1 ; l _ Baseline, COmpl in tpiianre,
tJST, Pesticide Study, Federal Trust. Utller:
"r
FIELD ANALYSES
Owner r"-
V i lrt
pH am Spec. Cond.y4
at 250C
Location or Site j
Ternp.,o °C Odor
Description orsampling point
Appearance _ _
Sampling Method u T
Sample lnicrval-
rield
LABORATORY
Analysis By: Remarks
ANALYSES
BM 310 mg1L Bus Solids 70300 inWL
COI] High 340 mglL Fluoride 951 mg1L
COD Lmy 335 mgll Hardness Tonal 900 MER
C0 nn MF 111 31616 110onil Hardness (note-carb)402 mg/L
Colirci MF Tonal 31504 1100ml Phenols 32730 uCA
TOC 680 rnglL SPeciFic Cand 95 pMlurJcm
Tiffbidiiy 76 Yru SLd&ttr945 MWL-
Residue. T6sal Suspended 530 rtiglL St tidy 745 mg&
Oil and rorease mgA
pH 403 _ Win
Alkalinity to pH 4.5 410 rniii
Alkalinity to pH 8 3 415 mglL
tPurnerng
Nw. air
tamp, ate)
A silver 4tr564 rr l_
❑r ranoi:hlonru Prstmdcs
AI-Alumintnn 40537 u IL
0 annrhMitarvs Pesticides
hliufl •ea Pesticides
As -Arsenic 46551 HVIL
82-82ntim 45553 u IL
Acid Herbicides
Ca -Calcium 46551 m L
PCBs
Cd-Cadmium 46559 u. L
Cr Cluomium 46559 u
LL
/'C
Co-CopM 46562 n
Fc-lron 46553 u IL
Semnvolatac Or anics
fig -Mercury 71900 u�IL
TPia-i] es 1 Rori e
K-Potassmm 46555 m r
Mg -Magnesium 46554 ui , L
Ma-M ngartese 46565 u • L
Votwile Oi g 'cs VOA bmlle
Carbonate 445 MBIL
Bieaibonate 440 mE1L
Carbon droaide 405 mpJL
Chlrnrde 940 inglL
NH3 as N 610 mglt
No-Sadmm 4056 m •R
TPH Gasatrne Rama
TKN as N 625 in¢!L—jc
Air -Nickel u•
TPH-BTE.IK Gasoline Range
NO, + NO, as N 630 mWL
Pb-Lead 46564 u /L
P Total as P 05 mglL
jd
Se-Seleatum u aL
Chratmum• Hex 1032 uSA
Ntuate (NOa as N)620 MLrJL
iri-Zane 46567 u
Coker. True 80 C111
Nitrite (Ng as IN) 615 mg?L
LAB
Temperature
USE ONLY
on arrival M)-. 2,1
Cyanide 720 mgR.
Lab
Comments
T
GW-54
REV. IV2013 For Dissolved Awlysis-submit altered ssmnle and write --DIS"in block.

Permit Number
Program Category
Ground Water
Permit Type
WI0800178
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Timothy and Amy Lougher SFR
Location Address
3100 Scarborough Dr
Wilmington
Owner
Owner Name
Timothy
Dates/Events
NC
Orig Issue
12/18/2009
App Received
8/4/2014
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28409
Lougher
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
10/10/2014
Permit Tracking Slip
Status
Active
Version
2.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Timothy Lougher
3100 Scarborough Dr
Wilmington
Issue
10/9/2014
Effective
10/9/2014
NC 28409
Expiration
Requested /Received Events
RO staff report received
RO staff report requested
Streamlndex Number Current Class
9/24/14
8/4/14
Subbasin
Permit Number WI0800178
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Timothy and Amy Lougher SFR
Location Address
3100 Scarborough Dr
Wilmington
Owner
Owner Name
Timothy
Dates/Events
NC
Orig Issue
12/18/2009
App Received
8/4/2014
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28409
Lougher
Draft Initiated
Scheduled
Issuance
Central Files: APS SWP
10/2/2014
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Timothy Lougher
3100 Scarborough Dr
Wilmington
Region
Wilmington
County
New Hanover
NC 28409
Public Notice Issue Effective Expiration
Requested /Received Events
RO staff report received
RO staff report requested
Streamlndex Number Current Class
9/24/14
8/4/14
Subbasin
APA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
October 9, 2014
Timothy and Amy Laugher
3100 Scarborough Drive
Wilmington, NC 28409
Re: Issuance of Injection Well Permit
Permit No. W10800178
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. and Mrs. Lougher:
John E. Skvarla, III
Secretary
In accordance with your permit renewal application received August 4, 2014,1 am forwarding
Permit No. W10800178 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 on December 1, 2014, (i.e., the day after the expiration date of the existing permit), which
may differ from the date of this letter. This permit shall be effective from December 1, 2014, until
November 30, 2019, and shall be subject to the conditions and limitations stated therein.
Please Note: The Wilmington Regional Office (RRO) collected samples from your geothermal
well system on September 17, 2014. Laboratory analytical results will be forwarded to you
when it becomes available.
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 call me at [phone].
Best Regards,
Michael Rogers, P.G. (NC , FL)
Hydrogeologist
Water Quality Regional Operations Section
Division of Water Resources, NCDENR
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: 91 M07-64K Internet: www.nrdenr.gov
An Equal OpportaNty 1 Aflinnailve Action Employer — Made in part by recycled paper

Timothy and Amy Lougher
cc: Jim Gregson/Morella Sanchez-King, Wilmington Regional Office
Central Office File, WI0800178
New Hanover County Environmental Health Department
Page 2 of2
NORTH CAROLINA
OR"? I91113001 DIO 1 fall Ilu r►1z M." 013 Dina dl*031�R•Y•YC�]�1
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
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
Timothy and Amy Lougher
FOR THE CONTINUED OPERATION OF ONE GEOTHERMAL HEATING/COOLING WATER RETURN
WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used for the
injection of heat pump effluent. The injection well(s) located at 3100 Scarborough Drive, Wilmington, New
Hanover County, NC 28409, will be operated in accordance with the application submitted August 4, 2014, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environment and Natural Resources and are considered a part of this permit.
This permit is for continued operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from. December 1, 2014, (i.e., the clay after the expiration elate of
the existing permit) until November 30, 2019, and shall be subject to the specified conditions and limitations set
forth in this permit.
Permit issued this the 9th day of October 2014
Thomas A. Reeder, Director
Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #W10800178 U105A7 Page 1 of 5
►+er. 09/2014

PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall 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). 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 .021 l(a)].
3. This permit sh,all become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice 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 .021 l(q)].
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 m
accordance with the requirements of rule 15A NCAC 02C .0107.
2. If a separate injection well is used then it shall also be constructed in accordance with the requirements of
Rule . 0107 of this Subchapter except that the entire length of the casing shall be grouted from the top of
the gravel pack to the land surface 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 [15A NCAC
02C .0224(d)(2)].
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. [15A NCAC .0225(g)(8)].
4. For open-end wells, the casing shall be grouted from the bottom of the casing to the land surface 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 [15A NCAC 02C .0224(d)(3)].
5 . 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)].
6. Each 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).
Permit #WI0800178 UIC/5A7
ver. 09/2014
Page 2 of5
7. Each well shall have permanently affixed an identification plate [15A NCAC .01070)(2)].
8. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part Vl.5 of this
permit.
PART III-OPERATION AND USE CONDITIONS
1. 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 [15A NCAC 02C .021 lG)].
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 [ISA NCAC 02C .0206].
3. The injection facility shall be properly maintained and operated at all times to achieve compliance with
the conditions of this permit and the rules of 15A NCAC 02C .0200, even if compliance requires a
reduction or elimination of the permitted activity (15A NCAC 02C .02110)].
4. 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 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 .021 l(k)]
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 samples of 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(£)(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(£)(1 )] .
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a
specific permit condition, that a contaminant may cause a violation of applicable groundwater quality
Permit #WI0800178 UIC/5A7
ver. 09/2014
Page 3 of5
standards, or that a malfunction of the injection system may cause the uijected fluids to migrate outside
the approved injection zone or area. As specified in rule 15A NCAC 02C .0211(r), 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 Wilmington Regional Office, telephone number 910-796-7215.
(B) Written notification shall be made within 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. 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 [15A NCAC 02C
.021 l(b)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Water Quality Regional Operations Section
DWR Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
PART VI-PERMIT RENEWAL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the
expiration date of the 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.
Permit #WI0800178 UIC/5A7
ver. 09/2014
Page 4 of5
f
PART VII-CHANGE OF \\-~LL STATUS [15ANCAC 02C .0240]
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 that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
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 which 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 Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to the addresses
specified in Part VII.5 above.
Permit #WI0800178 UIC/5A7
ver. 09/2014
Page 5 of5
Date: 9/17/2014
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
Permittee(s): Timothy & Am Lougher
Permit No.: WI0800178
To: Michael Roger
Project Name: Geothermal Open-Loop Injection Well
Regional Login No: Geoff Kegley
County: New Han0-~~CEIVED/DENR/DWR
SEP 2 4 2014
L GENERAL INFORMATION
1. This application is {check all that apply):0 SFR Waste Irrigation System cgj UIC Well(s) Water Quality Regional D New cgi Renewal Operations Section
D Minor Modification O Major Modification
D Surface Irrigation D Reuse D Recycle O High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed~loop Groundwater Remediation cgj Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? cgj Yes or O No.
a. Date of site visit: September 1 7, 2014
b. Person contacted and contact information: Mr. Louither: tlougher1v ec.rr.com
c. Site visit conducted by: Geoff Keg)ev
d. Inspection Report Attached: D Yes or cgj No.
2. Is the following information entered into the BIMS record for this application correct?
cgj Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For SFR Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number: -. _
d. Latitude: Longitude: __ Method Used (GPS, Google™, etc.); __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For UIC Injection Sites:
(If multiple sites either indicate which sites the information applies to, cop and paste a new section into the
document for each site. or attach additional pages for each site)
a. Location(s):
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: Method Used (GPS, Google™, etc.); GPS
APS-GPU Regional Staff Report (Sept 09) Page I of 4 Pages
Division of Water Resources .
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description of Well(s) and Facilities -New, Renewal, and Modification
I. Type of injection system:
1:8] Heating/cooling water return flow (SA 7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (SL/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes 1:8] No
3. Are there any potential pollution sources that may affect injection? D Yes 1:8] No
What is/are the pollution source(s)? . What is the distance of the iniection well(s) from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 15..ft
5. Quality of drainage at site: D Good 1:8] Adequate D Poor
6. Flooding potential of site: [8'.ILow D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property 1 ines, wells, surface drainage)? 1:8] Yes or D 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.
Injection Well Permit Renewal and Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes 1:8] No. If ves. explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes. explain:
3. For renewal or modification of groundwater remediation permits ( of any type). will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? D Yes D No. If yes, explain:
APS-GPU Regional Staff Report (Sept 09) Page 2 of 4 Pages
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
4. Drilling Contractor: Name:
Address:
NC Certification number:
Complete and attach NEW Injection Facility Inspection Report, if applicable
V. EVALUATION AND RECOMMENDATIONS
I. Provide any additional narrative regarding your review of the Application:
This review was conducted for a permit renewal request for a open loop underground
injection geothermal well heat pump system for the Lougher residence. On September
17, 2014, staff visited the home to inspect the well system. Source well water and
water prior to re-injection was sampled for Metals, total and fecal coliform, Nitrates,
Chloride and Total Dissolved Solids. Sampling results will be forwarded to the Central
Office when received. System operation has been normal.
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? D Yes [8] No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. 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:
APS-GPU Regional Staff Report (Sept 09) Page 3 of 4 Pages
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
Condition Reason
7, 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;
Issuc; ❑ Deny, If deny, please state reasons:
8. Signature of report Preparers):
Signature of APS regional supervisor:
Date: Of4--
V1. ADDITIONAL INFORMATION AND SITE MAP {Sketch of site showinj; house and waste irri�tion
st-stem, Wras- or drip Teld, location at well(n, and/or other relevant informallon- SHOW NORTH ARRO11)
APS-GPU Regional Staff Repon (Sept 09) Page 4 of 4 Pages

WATER 1v t.JALITY REGIONAL OPERA·1fONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: August 4, 2014
To: WiRO-WQROS: Jim Gregson/ Morella Sanchez-King
From: Michael Rogers, WQROS -Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WI0800178
B. Applicant: Lougher
C. Facility Name:
D. Application:
Permit Type: Geothermal Heatingi'Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
D I would like to accompany you on a site visit.
Attached, you will find all information submitted in · support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a com pleted W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above.
RO-WOROSReviewer: __________________ Date: _____ _
COMMENTS:
THANKS!
FORM: WQROSARR-GW Protection Branch 050914 Page I of 1
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Timothy and Amy Lougher
3100 Scarborough Dr.
Wilmington, NC 28409
Dear Mr. and Mrs. Laugher:
August 6, 2014
John E. Skvarla, Ill
Secretary
Subject: Acknowledgement of
Application No. WI0800178
Geothermal Heating and
Cooling Water Return Well
New Hanover County
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your permit
application and supporting documentation received on August 4, 2014. Your application package has
been assigned the number listed above, and the primary reviewer is Michael Rogers.
The Central and WilmingtonRegional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information and/or to arrange a site
inspection. To ensure maximum efficiency in processing permit applications, the Water Quality Regional
Operations Section (WQROS) requests your assistance in providing a timely and complete response to
any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at (9 I 9) 807-6406 or [e-mail].
cc: Wilmington Regional Office, WQROS
Pennit File W10800178
Sincerely.'. /J
~ (;4,7,o
for Debra J. Watts, Supervisor
Division of Water Resources
1636 Mail Service Center, Raleigh , North Carolina 27699-1636
Phone: 919~07-6464 \ Internet: hitp://portal.ncdenr.oro/web/w o
An Eqvai Opporiun;ly I ft.ffirmaiive Action EmplO)'er -Made in pan wi:h recycled paper
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of t 5A NCAC 02C .0224
GEOTHERMAL HEATINGICOOLING WATER RETURN WELLS
These wells inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) New Application _ZRenewal* Modification
* For renewals complete Parts A-C: and the signature page.
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete
DATE: _ 20�
PERMIT NO. , fy 0'0[t f (leave blank if'New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence SusineWOrganization
Government: State Municipal County Federal
B.
C.
WELL OWNERIPERMIT APPLICANT — For individual residences, list owner(s) on property deed. For all
others, list name of entity and name of person delegated authority to sign on behalf of the business or agency:
Mailing Address,_
City.
Day Tele No.:
Stater `Lip Code: �I County:
EMAIL Address: A C1y�,e r�'C r. [fYt'� Fax No.: O/A9 VZT7-wro C.)
WELL OPERATOR (if different from well owner) — For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Mailing Address:
City:
State: Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address:
D. LOCATION OF WELL SITE — Where the injection wells are physically located:
(I)
(2)
Parcel Identification Number (PIN) of well site:
Physical Address (if different than mailing address):
County:
City:
State: NC Lip Code:
GPU/UIC 5A7 Permit Application (Revised 8I8I2013) Page i

E. WELL DRILLER INFORMATION
Well Drilling Contractor's Name: -~-------------------------
NC Well Drilling Contractor Certification No.: _____________________ _
Company Name: ________________________________ _
Contact Person . .o-: _______________ EMAIL Address: ___________ _
Address:------------------------------------
City: Zip Code: _____ State: __ County: _________ _
Office Tele No.: _________ Cell No.: ________ Fax No.: ________ _
F. HVAC CONTRACTOR INFORMATION (if different than driller)
G.
HVAC Contractor's Name: ____________________________ _
NC HVAC Contractor License No.: _________________________ _
Company Name: ________________________________ _
Contact Person~: _______________ .EMAIL Address: ___________ _
Address:------------,-------------------------
City: __________ Zip Code: ___ _ State: __ County:
Office Tele No.: Cell No.: Fax No.: ------------------
WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES __ _ NO ___ _
YES ___ _ NO ___ _
H. WELL CONSTRUCTION REQUIREMENTS -As specified in 15A NCAC 02C .0224(d):
(1)
(2)
(3)
The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
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.
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.
GPU/UIC SA 7 Permit Application (Revised 8/8 /2013) Page 2
I. WELL CONSTRUCTION SPECIFICATIONS
J.
(1) Specify~ number and type of wells to be used for the geothermal heating/cooling system:
__ V ____ *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
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(/)(8 )
(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
OPERATING DATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
K. SITE MAP-As specified in 15A NCAC 02C .0224 (b)f4). 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.
GPU/UIC 5A 7 Permit Application (Revised 8/8/2013) Page 3
I— CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 I (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 the well owner (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." ( �� Z
Ae-nz-,4 .
Print or Ty Full Name �
Signature of operty Ownepr plicant
Print or Type full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWR - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUIUIC 5A7 Permit Applicaiion (Revised 8f8l2013) Page 4

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
STATUS OF INJECTION WELL SYSTEM
Permit Wumber:
Permittee Name: 0a t i r + o l �•L� hs2� .
Address:
Please check the selection which most closely describes the current statiis-6f your injection well system
I) ( Well(s) still used for injection activities.
2) ( Well(s) not used for injection but used for other purposes: a) ( Water Supply
b) ( Recovery
c) ( Monitoring
3) ( Injection discontinued and: a) {Well(s) temporarily abandoned
b) [ Wells) permanently abandoned
c) { Well(s) not abandoned
4) ( Injection well(s) never constructed
Well Abandonment
D(�
If you checked (3)(a) or (3)(b), attach a copy of the GW-30 Well Abandonment Record. If not available, then describe the
method used to abandon the injection well, including a description of how the well was sealed and the type of material
used to fill the well if permanently abandoned:
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in the future, you should request rescission
of the permit. ❑o you wish to rescind the permit?
( Yes { No
Certification:
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted in
this document, and that to the best of my knowledge the infos ation is true, accurate, and complete."
Signature Date
Revised 8I512013 GW/UIC-68

~A
C E R
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
June 30, 2014
CERTIFIED MAIL # 7010 0780 0001 7057 4337
RETURN RECEIPT RE QUESTED
Timothy Lougher
3100 Scarborough Drive
Wilmington, NC 28409
Subject: Notice of Expiration (NOE)
5A 7 Geothermal Open-Loop hijection Well
Permit No. WI0800178
New Hanover County
Dear Mr. Lougher:
John E. Skvarla, Ill
Secretary
RECEIVED!DENRIDWR
AUG O 4 2014
Woater Ql!ality Regional
peratrons Section
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of North
Carolina, and is responsible for the regulation of injection well construction and operation activities
within the state. Our records indicate that the above-referenced operating permit for the geothermal
injection well system located on your property at 3100 Scarborough Drive in Wilmington, NC, which
was issued to you on December 18, 2009, and expires on November 30, 2014, is soon due for
renewal. If you wish to keep this permit and operate the injection well system, the permit must be
renewed and issued in your name.
If Your In jection Well is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal application
must be submitted within 120 calendar days of the expiration of your permit. According to our
records, you must submit your permit ·renewal by August 2, 2014.
If Your Injection Well is Currentl v Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0214. When each well is plugged and abandoned, the well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Change of Ownershi p of the Pro pe rty :
If there has been a change of ownership of the property, an Injection Well Permit Name/Ownership
Change Form must also be submitted. The GW-30 and Name/Ownership Change forms are not
enclosed but can be found at http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications.
1636 Mail Service Center , Raleigh , North Carolina 27699-1636
Phone: [phone] I Internet: www.ncdenr.gov
An Equal Op portun ity I Affirmat ive Action Emp lo yer -Made in part by recycl ed pape r
In order to comply with the regulatory requirements listed under North Carolina Administrative Code
(NCAC) Title ISA, Subchapter 2C, Section .0211, you must submit one of the following enclosed
forms:
A. If the injection well system is active: "Application for a Permit to Construct or
Operate Injection Wells -Open Loop Geothermal Injection Wells"
-OR-
B. If the injection well system is inactive or has been temporarily or permanently
abandoned: "Status of Injection Well System"
Please submit the appropriate forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh , NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application
and a UIC well system status form are enclosed. The above referenced forms are also available on-
line at the DWR website at http://portal.ncdenr.org/web/wg/aps/gwpro/permit-applications.
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at eric.g.smith(Ci ncdenr.gov .
. Sincerely,
tJ_ )J .. krw~
Eric G. Smith, P.G.
Hydro geologist
Enclosures
cc: Wilmington Regional Office -WQROS w/o enclosures
Central Files -Permit No. WI0800178 w/o enclosures
2
•---tea
WATER ()L. LITY REGIONAL UPERATi ,SS SECTION
APPLICATION REVIEW REQUEST FUR ECEiVEWDENR/M
Late: August 4, 2014 'FP
P 0
w 2014
To: WiRO-WQROS: Jim Gregson 1 Moredla Sanchez -King Water Quariiy Regional
F� Michael Rogers, WQRGS -- Groundwater Protection Branch dPeralions See ion
11 �('
_ Telephone. [phone] Fax. [phone] E-Mail: [e-mail]
A. Permit Number W10800178 '
B. Applican#: L.ougher
C. Facility Name:
D. Application -
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
❑ I would like to accompany you on a site visit.
AUK I A ZJp,
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed W[�ROS Staff
R_ _ eparL
When you receive this request farm, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above_
RO-WQROS Reviewer:
10]u.T+►_ !QN_16 1
THANKS!
Date: .I . I ; L
FORM: WQROSARA GW Protection Branch 050914 Page 1 of 1

fig
,A AQ= �
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
June 30, 2014
CERTIFIED MAIL # 7010 0780 0001 7057 4337
RETURN RECEIPT REOUESTED
Timothy Lougher
3100 Scarborough Drive
Wilmington., NC 28409
Subject: Notice of Expiration (NOR)
5A7 Geothermal Open -Loop Injection Well
Permit No. W10800179
New Hanover County
Dear Mr. Lougher;
The Underground Injection. Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of North
Carolina, and is responsible for the regulation of injection well construction and operation activities
within the state. Our records indicate that the above -referenced operating permit for the geothermal
injection well system located on your property at 3100 Scarborough Drive in Wilmington, NC, which
was issued to you on December 18, 2009, and expires on November 30, 2014, is soon due for
renewal. If you wish to keep this permit and operate the injection well system, the permit must be
renewed and issued in your name.
If Your Injection Well is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal application
must be submitted within 120 calendar days of the expiration of your permit. According to our
records, you must submit your permit renewal by August 2, 2014.
If Your Injection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0214. When each well is plugged and abandoned, the well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Change o£ Ownership of the Property
If there has been a change of ownership of the property, an Injection Well Permit Name/Ownership
Change Form must also be submitted. The GW-30 and Name/Ownership Change forms are not
enclosed but can be found at http:l/Portal.ncdenr.org'weblwqlaps/gwpro/permit-aMlications.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone; 919-807-64641 Internet www.ncdenr. av
An Equal Opportunity 1 Atfirmetive Adon Employer — Made In part by mayded paper

In order to comply with the regulatory requirements listed under North Carolina Administrative Code
(NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following enclosed
forms:
A. If the injection well system is active: "Application for a Permit to Construct or
Operate Injection Wells -Open Loop Geothermal Injection Wells"
-OR-
B. If the injection well system is inactive or has been temporarily or permanently
abandoned: "Status of Injection Well System"
Please submit the appropriate forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application
and a UIC well system status form are enclosed.. The above referenced forms are also available on-
line at the DWR website at h ttp ://portal.ncdenr.org/web/wg/ap s/gw pro/permit-applications.
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at eric.g [e-mail] .
. Sincerely,
tJ_)J.h;tt
Eric G. Smith, P.G.
Hydro geologist
Enclosures
cc: Wilmington Regional Office-WQROS w/o enclosures
Central Files -Permit No. WI0800178 w/o enclosures
2
.r..'^ rMw�n.wr.a
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
June 30, 2014
CERTIFIED MAIL # 7010 0780 00017057 4337
RETURN RECEIPT REQUESTED
Timothy Lougher
3100 Scarborough Drive
Wilmington, NC 28409
Subject: Notice of Expiration (NOE)
5A7 Geothermal Open -Loop Injection Well
Permit No. WI0800178
New Hanover County
Dear Mr. Lougher:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of North
Carolina, and is responsible for the regulation of injection well construction and operation activities
within the state. Our records indicate that the above -referenced operating permit for the geothermal
injection well system located on your property at 3100 Scarborough Drive in Wilmington, NC, which
was issued to you on December 18, 2009, and expires on November 30, 2014, is soon due for
renewal. If you wish to keep this permit and operate the injection well system, the permit must be
renewed and issued in your name.
If Your Injection Well is Currently- Active:
If the injection well system is still active and you wish to renew your permit, the renewal application
must be submitted within 120 calendar days of the expiration of your permit. According to our
records, you must submit your permit renewal by August 2 2014.
If Your Ini ection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0214. When each well is plugged and abandoned, the well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Change of Ownership of the Property
If there has been a change of ownership of the property, an Injection Well Permit Name/Ownership
Change Form must also be submitted. The GW-30 and Name/Ownership Change forms are not
enclosed but can be found at htip://aortal.nedenr.orWweb/wq/aps/gwp o/permit-applications.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: 91 M07-64641 Internet: www.ncdenr.,ov
An Equal Opportunity 1 Affirmative Action Ernpbyer - Me& 0 pan by recycled paper

In order to comply with the regulatory requirements listed under North Carolina Administrative Code
(NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following enclosed
forms:
A. If the injection well system is active: "Application for a Permit to Construct or
Operate Injection Wells -Open Loop Geothermal Injection Wells"
-OR-
B. If the injection well system is inactive ·· or has been temporarily or permanently
abandoned: "Status of Injection Well System"
Please submit the appropriate forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these fonns in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application
and a UIC well system status form are enclosed. The above referenced forms are also available on-
line at the DWR website at h ttp ://portal.ncdenr.org/web/wq/aps/gw pro/permit-applications.
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at [e-mail] .
. Sincerely,
tJJJ.JJ-
Eric G. Smith, P.G.
Hydro geologist
Enclosures
cc: Wilmington Regional Office -WQROS w/o enclosures
Central Files -Permit No. WI0800178 w/o enclosures
2
stal
Service
-if,,
FIED
MAIL.
RECEIPT
VFor
Mail
Only;
No Insurance
Coverage
Provided)
Information
visit our
website
at www.usps.corne
O Postage $
r-
Certified Fee
r-a P05tnlark
d Relum Recelpt Fee Hero
r3 (Endorsemenl Required)
L7 Restricted OeUvery Fee
10 (Endorsement Flequired)
ra
r- 7otai Postage a Fees
PS Farm 3900. August 2006 See Revert! iar Inslructiorts
■ Complete items 1, 2, and 3. Also complete t
item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space hermits.
1. Article Addressed to:
j&) S'CCrr�or�u�h �'°l�E
A.
Received py (Pdnfad
❑ Agerrt
❑ Addressee
D. Is deilvery aiddrm$ dfffererit from Item 17 El Yea
If YES, enter deitvary address below: ❑ No
CettiBed Mall ❑ Express Mail
❑ RegIStered ❑ Return Receipt far Merchandise
❑ Insured Mali ❑ C.O.D.
4. Restricted Delivery? F" ❑ Yes
2. Tmneferftom sarviceiatisg 7010 0780 0001 7057 4337
;
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M•1540 ;i

03/58/2012 02:48 9103133152 AQUA WELL PAGE 02
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L WELL USE (Check App6cablee 13wt1: Residential (7 NluniolpsWuhtic o ladusaiej D ARricaFAuu1 O
Moetlwdu © Recovery 0 Heat Pump Water injection 0,.�Odw 0 ffComer. Lik U,*-.62A5,*L-
2. WELL LOCATION: Topogmp dLaltd setting
Neareat Town. r', 1-/,-e Cotmty v e ra N Ar+fa,�-C Midge Tape ovalley
tcbmk mWeprime heal
foi-Citt KM�rwbere.cmmw*.S vi—Mt.eft.ZipCove] Ladtudellongitudeofwelllocation
3. OWNM-
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(Saran ar novae N&I idw* bvsl
Ck v of Tbwn Site Zip Coale Flom! To Formation Dcwdpdou
AM code- P!goe number
4. DATE DRILLED r` 09 -- - - -
s. TOTAL DsqH--3,f
6. DOES WELL REPLACE E]t;I 11NG WELL? YES 13 NO
7. STATIC WATER LSVEL Bdow Top of cam: __Z4 FT.
tree ^+-1rAWvt Top vfCoWel
e. TOA op CASING is , _ LFT. Above Lend Svrface
wTap of wW w raftratd actor beian tand sarfim mgatrm o
rarhM is Wordmte Wtt615A NC4C ]C .0111
9. YIELD lgmk r-0 MMOD QF TEST w -
10. WATER ZOM idyl:
t 1. DiS1NFECJfION: Type At3totrat
12. CASING: Wall Thicmc s
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From T'o ft
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13. GROUT: Depth Material Method
From„ To _ _ _ Ft. ►- ,.r
From 3 To RrJ - Ft. I�
14. SCREEN: Deptd Daaaaat+r Slat 81= 1~6aterial
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16. REMARKS:
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CONMUC;RPN Sr THAT A 00PY OF TM8 RECORD MS AEEN PROVIDED TO THE WELL OWNER p
CON
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RA%isph Nc valL-%17, Patow No. (%9) 733-WM% N►kbto 34 rlayL
GW-i REV. i}91I0N
RECEIVED 03-08-12 13:31 FR01- 9102133102 TO- NC DENR P&5 P002/002

03/08/2012 02:48 9103233102 AQUA WELL PAGE 01
Aqua Well Dr1*11ing
Shallow Wells & Irrigation
Gary Jones 1706 Kennedy Road Wilmington, NC' 28409
910-395-1987
5Y4-k-
tF6? eLf ?4
RECEIVED 03-08-'12 13:31 FROM- 9103133102 TO- NC DENR P&5 P0011002

Permit Number w10$001 78
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well {5A7)
Primary Reviewer
,ziichael.rogers
Coastal SW Rule
P?rmitted Flaw
k
Facilit"
Facility Name
Timothy and Amy Laugher SFR
Location Address
3100 Scarborough Or
Wilmington NC 28409
Owner
Owner Name
Timothy
Central Files' AP5 SWP
12/22/09
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Majorftnor Region
Minor Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Lougher Owner Affiliation
Timothy Lougher
3100 Scarborough Or
Wilmington
NC
Dates/Events _
Scheduled
orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective
12/18/09 11/17/09 12/18/09 12/18/09
Re, ulated Activities ReauestedlReceiyed Events
Heat Pump injection RO staff report requested
RC stair report received
Dutfail NL)L'-
Waterbody Name
28409
Expiration
11/30/14
11/20/09
12/09/09
Stream Index Number Current Class Subbasin

Permit Number W10800178
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Weil (5A7)
Primary Reviewer
michael.rogers
Goastal SW Rule
Permitted Flow
Facility
Facility Name
Timothy and Amy Laugher SFR
Location Address
3100 Scarborough Dr
Wilmington NC 28409
Central Files: APS SWP
12/15/09
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
MajorlMinor Region
Minor Wilmington
county
New Hanover
Facility Contact Affiliation
Owner Name Owner Type
Individual
Timothy Laugher Owner Affiliation
Timothy Laugher
3100 Scarborough ❑r
Wilmington NC 28409
Scheduled
Crig issue App Received ❑raft Initiated Issuance Public Notice I ` Effective Ex ira i
11r17109 p`ll�
F pEmlAtArl ActivltloC Re^!�@gtpd�Rprniy r+ Fvantc
Heat Pump Injection RO staff report requested 1 1 /20/09
RO staff report received 12/09/09
Out -fall NUI L
Waterbody Name Stream Index Number Current Class Subbasin

A�
w�.rrr..s
NCDENR
North Carolina department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleat H. Sullins
Governor Director
December 18, 2009
Timothy and Ari7v Lougher
3100 Scarborou_-h Drive
Wilmington, NC 29409
Re: Issuance of Injection Well Permit
Permit No. W10800178
Issued to ` hnotby and Array Lowi,hcr
New Hanover County
Dear Mr. and Mrs. Lougher:
Dee Freeman
Secretary
In accordance with your application received November 17, 2009,1 am forwarding Permit No. WI0800178 for
the operation of a 5A7 geothermal underground injection control (UlC) well heat pump system located at the
above referenced address. This permit shall be effective from the date of issuance until November 30, 2014,
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 four months prior to its expiration date- As indicated in the permit, this permit is not
transferable to any person without prior notice to, and appro_yaL 13y, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone].
Best Regards,
4'7
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
cc: Charlie Stehman -- Wilmington Regional Office
Central Office File — WI0800178
New Hanover County Environmental Health Dept.
Attachment(s)
AOUIF£R PFOTY— ON SEVION
IC36Mail Sarke Cenlv, Farelgh. Nor CwQna77899.163E
-Acavar;: 7726 Capital Boulsuard kaWah Noon Carolina 77 604
Pnow- 919-733-3221 1 FAX [phone]�562, FAX Z. 914 715-6448 l Uslo"Wr saNMe: 1.677-62a-670-
lntarmel: www.ncvrafe2tu_alitv.ar�
Am Ewa' CipV=UfiY.y � AfilrMallY3 A*+ . E (IIIII•ry+:i
lnt
orth Carn1 ina
i-A�QIE

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
Tim.othv and Amy Lougher
FOR THE CONSTRUCTION AND OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A
North Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump
effluent. This injection well is located at 3100 Scarborough Drive.. Wilmington. New Hanover County. NC
28409, and will be constructed and operated in accordance with the application November 17. 2009, 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 Constriction and Operation of an injection well shall be in compliance with Title 15A North
Carolina Administrative Code 2C .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 its issuance until November 30, 2014. and shall
be subject to the specified conditions and limitations set forth in Parts I through 1X hereof.
Permit issued this the - kCi_ day of 'Ck1---N4 2)009,
oleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
W10800178

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 be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Wilmington Regional Office
12 7 Cardinal D1ive Extension
Wilmins'10U, NC 28405-2845
[phone]
GW-1 s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall notify the
Aquifer Protection Section-Underground Injection Control (UIC), Central Office staff, telephone number
[phone] and the V;,'iimington Regional Office Aquifer Protection Section (APS) Staff, telephone
number(910) 796-7215.
2. Within 30 days of injection well completion, Pennittee must contact the Wilmington Regional Office
APS Staff in order to have samples collected at the source well and injection well.
WI0800178 2
3. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality · of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
4. The injection well system must be constructed with sampling ports so that system influent and effluent
may be sampled.
5. The injection well must be constructed to a depth such that it is injecting water into the same aquifer that
th e source well is drawing from.
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 may be appropriate, at least 30 days prior to the date of the change .
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 which 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
groundwater 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.
WI0800178 3
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-Underground Injection Control (UIC),
Central Office staff, telephone number [phone] Notification is required so that Division staff can
inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for 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. Department 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.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. 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.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Wilmington 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;
3. 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.
4. 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 RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
WI0800178 4
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 that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
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 s_hall 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 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 Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
WI0800178
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 12/8/2009 County: New Hanover
To: Aquifer Protection Section Central Office Permittee: Amyx & Timotbv Lougher
Central Office Reviewer: Michael RoLers. GP TT Project Name: WI0800178
Regional Login No: Rebecca Gerhart Application No.: W 00
L GENERAL INFORMATION
1. This application is (cheek all that apply): ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No,
a. Date of site visit: 12/312009 & 12/7/2009
b. Person contacted and contact information: Am% Laugher 910-367-2886
c, Site visit conducted by: Rebecca Gerhart
d. Inspection Report Attached: ® Yes or ❑ No.
2. Is the following information entered into the RIMS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities 1 Type of Wastes (e.g,, subdivision, food processing, municipal wastewater):
For Disposal and Injection Sites_: -
ff-myl�le sites either indicate which sites the information applies to, copy- and -paste a new section into the
document for each site. or attach additional Daises for each site]
a. Location(s): 3100 Scarborough Drive. Wilmington, NC 28409
b. Driving Directions: From US 17 1 S College), left on Oleander. right on Pine Grove .ri&ht [fin Beasley . right
on Hampshire. right on Scarborough
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
Il. NEW AND MAJOR MODIFICATIONAPPLICATIONS this section not needed Lor renewals or minor
modilleationss_skipto new se_ctran)
Descrintion O€Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: RECEIVED I DENR I DVYQ
Aquff'r Protedlon Sa lian
DEC 4 9 2009
FORM: Staff Report -Laugher Residence �

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No D N/A. Ifno, please explain: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No D N/A. If no, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D N/A. Ifno, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NI A . If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No D N/A. Ifno, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a I 00-year floodplain?
D Yes D No D N/ A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or D No. If yes , please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No D N/A If yes, attach list of sites
with restrictions (Certification B?)
III. RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or maior modification
s pst ems)
Descri ption Of Waste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No .
Operator in Charge : __ Certificate#: __
Backup-Operator in Charge: __ Certificate#: __
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage , etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no , please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. If no , please explain:
FORM : Staff Report-Lougher Residence 2
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain: __
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
0 Yes or D No. Ifno, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? D Yes or D No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? 0 Yes D No D N/A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or D No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit: __
10. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? 0
Yes or D No. Ifno, please explain: ____ _
11. Were monitoring wells properly constructed and located? 0 Yes or D No D N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? D Yes or
D No D N/A. Please summarize any findings resulting from this review:
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; 0
Current enforcement action(s) 0 Currently under SOC; D Currently under JOC; 0 Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ____ _
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? D Yes
D No O Not Determined D N/ A.. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? 0
Yes or O No D N/A. If yes, please explain: __
FORM: Staff Report-Lougher Residence 3
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells , including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Descri ption Of Well(S) And Facilities-New , Renewal , And Modification
1. Type of injection system :
[SJ Heating/cooling water return flow (SA 7)
D Closed-loop heat pump system (5QM/5QW)
0 In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/"Non-Discharge")
0 Other (Specify: )
2. Does system use same well for water source and injection? 0 Yes [SJ No
3. Are there any potential pollution sources that may affect injection? [SJ Yes D No
What is/are the pollution source(s)? Storage Shed, paintin g/fertilizer/automotive/po ol chemicals?. What is the
distance of the in jection we ll(s) from the pollution source(s)? Can easil y be constructed >SOft. from shed ft.
4 . What is the minimum distance of proposed injection wells from the property boundary? __ -=ft=.
5. Quality of drainage at site: 0 Good [SJ Adequate D Poor
6. Flooding potential of site: [SJ Low [SJ Moderate O High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? [SJ Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [SJ Yes or O 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.
Injection Well Permit Renewal And Modification Onl y:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation ( e.g. turbid water,
failure to assimilate injected fluid , poor heating/cooling)?
D Yes D No. If . es . ex plain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If ves, exp lain:
3. For renewal or modification of g roundwater remediation permits (of an y typ e ), will
continued/additional/modified in jections have an adverse im pact on mi gration of the plume or mana gement of
the contamination incident? Yes D No . If yes , ex plain :
4. Drilling contractor: Name: Gary Jones
FORM : Staff Report-Lougher Residence 4
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: Aq ua Well Drillin g
Wilmin gton , NC
Certification number: 2199
5. Complete and attach Well Construction Data Sheet.
FORM: StaffReport-Lougher Residence 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V E'VAL UATION AND RECOMMENDATIONS
l . Provide any additional narrative regarding your review of the application.: A site visit was conducted by
Rebecca Gerhart and Charlie Stehman on 1213I2009. Source well (existing irrigation well) was inspected for
compliance with 2C Well construction Standards. Three items required attention: 1) installation of a hose bib
(sampling poil) 2) installation valved flowlbackflow prevention device 3) grout must be brought up to land
surface, See attached Well Inspection Report. A second site visit was conducted on 12n12009 by Rebecca
Gerhart. The three items have been corrected; the source well is now in compliance with 2C. Only potential
pollution source is shed in backyard (chemical storage? pool chemicals, etc.). Injection well must be
constructed 50' from shed. Lot size enables this to be accomplished.
2. Attach Well Construction Data Sheet - if needed information is available
3. Doyou foresee any problems with issuance/renewal of this permit? ❑ Yes ®No. Ifyes, please explain.
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
may,
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
G. 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
Injection Well Construction
The injection well must be constructed with a
sampling port so that system effluent may be
sampled. The injection well must be constructed
to a depth such that it is injecting water into the
same aquifer that the souce well is drawing
from.
Influent/Effluent Sampling
Within 30 days of injection well completion.
FORM: Staff Report-Lougher Residence 6

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
7.
Aquifer Protection
permittee must contact Wilmington Region
Office APS to have samples collected at the
source well and injection well (system influent
and effluent samples)
I _
Permit shall be contigent upon the results of the
influent/effluent sampling. Injection of effluent
should not be permitted if effluent water
contains constituents present above background
levels (greater than influent) that would degrade
groundwater quality.
Recommendation: ❑ Hold, pending receipt and review of additional information by regional officc; ❑ Hold,
pending review of draft perrnit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please sty reasons} �t
S. Signature of report preparers):
Signature of APS regional supe
Date: 8 /xm
ADDITIONAL REGIONAL STAFFREVIEWITEMS
FORM: Staff Report -Laugher Residence 7

North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Groundwater. Section
n Well C nstru to rat �]
Wadi r..nnfr�Irinr 1?AAa ■ IMDS A;FI; We/ 7rIIl►!fW R10 • �- 1y�A 7+
Name
Contractor Ce iCal
nvv��o jq4l
Permit Required ? (YIN)
Location - Distance From: .................—
Water Tight Sewage/waste collection . .
Waste disposal [septic tank drain field}
Other Pall, Source I }
ore
Check Items
Measured
Meets Min, Standards
Yes No
Remarks
(Permit No.
�.
I .................
Other Poll. Source
�}
Casinl�-
Type
Depth ................. ......... ...............
Weightlthickness ...— ................. . .... ,.
Height (A.L.S.)......................................
Other ( ) ,
Driilina Fluids/Additives
Type,.................................r.................
QEQut
Type...................................................
Thickness ........
Depth....—. ...... ....................................
Other ( } .
Screens
Screened interval ...... ....... --p....... ........,
Other ( .
DevetQpment........................................
Total Suspended solids ... ............. .......
Turbidity..............................................
5et0eabie Solids ...................................
J.D. Plate
Well Contractor ,_ .... ... .. ....... .
Abandonment .......... P..........
`temporary ,........... .......... ............. .,...
Permanent .... .............................. .. , ...
(Circle one)
Pfaslic Carbon Galv. Slain. St. Other -
�'
?9 ►
7Gh�% $ ►
V
V
------ X,,/
�� ►+
.
w
/
v
►
� 3
—
GW-36 Rev. 112000
Applies to wells constructed after December 1, 1992
K'nnl n n RP.vP..rSA0

WellTest ...............................................
Duration................................................
Frequency/Accuracy of measurements
Other { __ .
D is i nfeation............................................
Chlorination ...... ................
Other { .
Cuttings_...............................................I
Reports........................ ........................
Construction (GW-1) ..........................
Ab2ndonment {GW-30) ........................
Weil Head-Comlpleftn
Access part ...........................................
Hosebib ...............................................
Pitless Adaptor .....................................
Pitless Adaptor Unit ..............................
Suction line.
Tee{jet) ...............................................
Valvedflow ...........................................
Vent......................................................
Water tight pipe entry ...........................
Wellentry .............................................
Check items Meets Min- Standards Remarks
Measured Yes I No
mr+ loyme
IVA lye / r
Lt y l
Applies to wells constructed after December 1, 1992
Date- Well Constructed 5- 2-
"fir 1-.
Pump Installation
Pump Installation Contractor
Name Address
PUMP CONTRAC-TQ I.0-PLAT><PRESENT ? (YIN) Date Pum-P-AnwabI�
Violations noted attributable to the pump installation contractor are as follows:
1) --
(2)
(3)
INSPECTOR � -_F t PLY1 F C� ' J]wC
Name Office
Reg. #
Witness(esl
(If Available) Name Address Type
Name Address Type

.. ~::.·:_~~ "::;..~ .. -
I?/-;./ ~nnq
A63 19'� 'c/6
AQUIFER PROTECTION SECTION C�� II/2o
APPLICATION REVIEW REQUEST FORM
Date: November 20. 2009
To: ❑ Landon Davidson, ARO-APS
❑ Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-APS
❑ Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone]
E-Mail: Michael.Roverswmemail.net
A. Permit Number: WI 0800178
B. Owner: Timothv and Amy Loui her
C. Facility/Operation:
® Proposed ❑ Existing
D. Application:
❑ David May, WaRQ-APS
® Charlie Stehman, WiRO-APS
❑ Sherri Knight, W-SRO-APS
Fax: t91917I5-0588
❑ Facility ❑ Operation
I. Pemat Type: ❑
Animal ❑
SFR-Surface Irrigation❑ Reuse
❑ H-R Infiltration
❑
Recycle ❑
IIE Lagoon ❑ GW Remediation (ND)
®
UIC — 5A7 Geothermal well
For Residuals: ❑ Land App.
❑ D&M ❑
Surface Disposal
❑ 503
❑ 503 Exempt ❑
Animal
Z Project Type: ®
New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal
❑ Renewal wl Mod.
E. Comments/Other Information: ® 1 would like to accompany you ou a site visit.
NOTE: If well has not been installed, complete Staff Report and forward w/recommendation for issuance or
not. If approved, we will issue permit wla requirement that they contact you when operational for collection
of samnles, Thanks
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within, please take the following actions:
® Return a Completed APSARR Form and attach laboratory analytical results, it applicable.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCCJ.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SDP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer:
Date:
FORM: APSARR 07/06 Page i of 1

Ar-
MCDENR
North Carolina department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Caleen H, Sullins
Governor Director
November 20, 2009
Timothy Lougher
Amy Lougher
3100 Scarborough Drive
Wilmington, NC 28409
Subject: Acknowledgement of Application No. WI0800178
Timothy and Amy Lougher SFR
Injection Heating/Cooling Water Return Well (5A7)
New Hanover
Dear Mr. & Mrs. Lougher:
Dee Freeman
Secretanr
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on November 17, 2009. 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 a -mail at michael.rogers@nedenngov. 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 httt�h2o.=7-.state.nc.us/documents/dwc or�mhart.ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUMUS ON THIS PROJECT
Sincerely,
for• Debra J. Watts
Supervisor
cc: Wilmington Regional Office, Aquifer Protecdon Section
Nate Carr (D. O'Brien Service Co. Inc, 3308 Enterprise Drive, Wilmington, NC 28405)
Permit Application File WI0800178
AQUIFER PROTECTION SECTION
16-15 A1ail Service Center. Raleigh. Narn Carolina 27699406
L=Ion: ?7 2S C3p'ral Souiward. Raleigh, Nom Carolins 27604
Pherw: t+l9.T33-Mi � FAX 1' 919-715-05M- `A?, 2: 919.7t5.60481 Customer Service: 1-77-623-Ft48
Intemet Www.navatergualrtv.orn
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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR ]INJECTION
WITH A GEOTHERMAL HEAT PUMP SYSTEM
TYPE 5A7 "OPEN LOOP" INJECTION WELLS}
(check one) _New Permit Application Renewal Modification
DATE: l7 zo 0q
PERMIT NO.: WI (leave blank if NEW permit application)
A, PROPERTY OWKER/PERMIT APPLICANT
Name of each owner listed on property deed. For a business or government agency, state name of entity and
name of person delegated authority to sign application on behalf of the businesslagency:
L 'e"If lr.110' id'o 4L �rrlt-. -k.. lc4tcAY D
(1) Mailing Address: _3100 --"i r lv
City: W �\M tna kt�fN --- State:.
(2)
HomelOfftce Tele No.: ' t ld- 3R2. qLk--!i 2-- Cell No.: ( j 10- 3[&3 - 2 EhI42_
Fax No. Email Address: auc.�, cik E; Qj�-' . r e-
�} •
Physical Address of Well Site (if different than above):
City.-
Home/Office Tele No.:
Fax No.
State: Zip Code:
Email Address:
a PROPERTY OWNERSRIP DOCUWNTATION
County:
Provide legal documentation of property ownership, such as a contract, deed, article of incorporation, etc. and
a PLAT map showing the property_ This information may be obtained from the county GIS websitc.
C. AUTHORIZED AGENT, IF ANY
If the property ownerlpermit applicant wants to authorize someone else to sign the permit on their behalf, then
attach a signed letter from the property owner/permit applicant specifying and authorizing their agent (well
driller, heat pump contractor, or other type of contractor/agent) to sign this application on their behalf.
Company Name:
Contact Person: Email Address:
Address:
City: State: Zip Code: County:
Office Tele No.: Fax No. Cell No.:
Website Address of Company, if any:
RED:IVED P DENR I DINO
AA141Ier
Type 5A7 Igjeotion Well Permit Application (Rev. August 2M) N Q V 11 N09 Ew. I of 4

D. WELL DRILLER INFORMATION
E.
F.
G.
H.
Company Name: A G..k,A: W""-Cl P It.a 11,· ...,,
Well Drilling Contractor's Name: G,..,,.,.,_-'--A-..... ':7,~-~---=-ll~,-1'--•-'S''------------------
NC ContFactorCertificationNo.: :)..t 1 "' Contact Person: G/1"7 ~.,~r
C ~n ~"~>.~ite: WWW JI 0.......,.. w,+ I\ B llctf ~ ,.A1-wl-Email Address: .. "-~)) l),b /C-£ .v::J?lfT
Address: ? 0 '-ti.•~ ry llJ. ..
City: C,..,& J" State~ Zip Code: 8 f'ro,. County: fa'......, ,-CA~~
Office Tele No.: ca,11,.3 -,r--, • f-, FaxNo.:_C(2.."-----= ____ CellNo.: ~,,,c..
HEAT PUMP CONTRACTOR INFORMATION (if different than Driller)
CompanyName:]lQ'll&1'e11 _;5eAv/ce Co. kc .. Contact Person: flftde W8.
Company Website: WWW. oba,'e11 .ffgv/ce , Co{)] Email Address: IJat~Db,<,,we,e,11,"ce,ClJt>i
Address: d'.ot>8 [nkfxf{{.15e, ~Wf v
City: h,Jif mJo;io, State:JVL Zip Code: alf?Lflf 5
Office Tele No,q/D-?&ft'/ ~tJ Fax No. q IO-'l"i~ ~sBBL/
County: ///@,( ~Dt/49£
Cell No. qi P.-tft.f 3-?~o'/
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
&· ifljed-/on· JJe n M/l l)M!y /;e eed 72' /zW ntd Cooll!/f~lt ;feS//4ce,
WELL USE WiH the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES ...,,.., NO __ .___
(2) Personal consumption? YES ____ NO v'
WELL CONSTRUCTION DATA
.,,,,,-PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
(7) below as PROPOSED construction specifications. Submit Form GW-1 after construction.
____ EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through (7)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available.
(1) WellConstructionDate: /; '-1-01 Numberofborings: -'~--
Depth of each boring (feet):_~3/_6_' ___ _
(2) Well casing. Is the well(s) cased?
(a) YES ,,,,,--If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic .,,.,,.-Other (specify) ______ _ , ,
Casing thickness: .i.!!_ diameter (inches): 1., depth: from t I to :,.0 feet (relative to land surface)
Casing extends above ground / l
(b) NO
inches
(3) Grout material surrounding well casing:
(a) Grout type: Cement .-Bentonite* .,,,,.--Other (specify) ______ _
*By selecting bentonite grout, a variance is hereby requested to 1 SA NCAC 2C .0213(d)(l )(A), which requires a cement type grout.
(b) Depth of grout around well casing (relative to land surface): from () to ::)...o feet
Type 5A7 Injection Well Permit Application (Rev. August 2009) Page2of4
(4)
(5)
(6)
Well Screen or Open Borehole depth (relative to land surface): from
t I 8-0 to 'f'O feet
N.C. State Regulations (Title ISA NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required. Will there be a faucet on:
(a) lnfluentline? Yes __ No__ (b) Effluentline? Yes __ No
Source Well Construction Information. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-1 is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn?
granite, limestone, sand, etc.)
(e.g.
d , , Depth: O '-' b Formation:_S... __ 1,o~~~--Rock/sediment unit: ______ _
NOTE: THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA IF nns
INFORMATION IS OTHERWISE UNAVAILABLE.
I. OPERATING DATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
J. INJECTION-RELATED EQUIPMENT
Average (daily) G gallons per minute (gpm).
Average (daily) / i./!IO gallons per day (gpd).
Average (daily) __ pounds/square inch (psi). .,
Average (January) 18--5:,j, F, Average (July)~° F.
Attach a schematic diagram or cross-section of the well construction that shows the total depth, length of casing,
extent of grout, stickup, location of influent/effluent sampling ports, etc. If this is a modification, show 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 if needed.
K. LOCATIONOFWELL(S)
(1) Attach a site map (can be drawn) showing: houses and other structures, property lines, surface water bodies,
potential sources of groundwater contamination, and the orientation of and distances between the proposed
injection well(s) and any other existing well(s) or waste disposal facilities such as septic tanks or drain fields
located within 1000 feet of the geothermal heat pump well system. Label all features clearly and include a
north arrow.
(2) Attach a scaled topographic map of the area extending 1/4 mile from the property boundary that indicates
the facility's location, a north arrow, 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 locadon of the wells In reladon to property boundaries, houses, sepdc tanks, other wells, et~
can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or elevation data.
Type 5A7 Injection Well Pennit Application (Rev. August 2009) Page3 of4
L. CERTIFICATION (to be signed as required below or by that person's authorized agent)
NCAC l 5A 2C .0211(b) requires that all permit applications shall be signed as follows:
I . 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.
If an authorized agent is signing on behalf of the applicant, then submit a letter signed by the
applicant that names and authorizes their agent as specified in Part C of this permit application.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted in
this document and ail 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 signtificant
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."
-Q
i atute of Flropc#y Owner/Applicant
Print :ir Type Ptdl Name
Signatwt of Property Owner/Applicant
Print or Xype Ful Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit TWO signed copies of the completed application package and all attachments to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DW[Q+n
1636 Mail Service Center 17 7Du.9
Raleigh, NC 27699-1636
Telephone [phone]
Type 5A7 Injection Well Permit Application (Rcv. August 2009) Plgp4of4

New Hanover County
PARID: R06608-013-009-00O
LOUGHER TIMOTHY AMY
Parcel
Alt ID
Address
Unit
City
Zip Code
Neighborhood
Class
Land Use Code
Living Units
Acres
Zoning
Legal
Legal Description
Tax District
Owners
Owner
City
State
Country
Zip
314617.01 .4355.000
3100 SCARBOROUGH DR
WILMINGTON
5731
RES-Residential
10-1 Fam Res
1
0
R-15-RESIDENTIAL DISTRICT
LT 71 STRATFORD PLACE SEC 5
WM
LOUGHER TIMOTHY AMY
WILMINGTON
NC
28409
THE DATA IS FROM 2009
Page I of 1
3100 SCARBOROUGH DR
http://etax.nhcgov.com/Fonns/PrintDatalet.aspx?pin=R06608-013-009-000&gsp=PROFI... 11/12/2009
New Hanover County
Page 1ofl
New Hanover County
Prorile
Safer
Residerilial
Commercial
Mina. Improvements
Permils
Land
Values
Agricultural
Skelcn
IF Lill Legal
Exempgons
Sut)-parcel{S) Info
❑nginal parcel Info
i parA Map
I CONTACT US I HEj
'i HC T1t HO-R > ReWSter ar Deed6 HOME
Borne Prnperty Records
Owner Address Parcei rb Advanced
PARID. R066CS-013-009-000
LOUGHER TIMOTHY AMY 3100 5CARBOROUGH PR
1011
T.
WIN3�■ s
La as Dafal upkm-. VlAug-2007
Data Copyrght Nm Hanover County [DIsclalmEr] rPrIvaw Policy] Lek updated: 26 Oct 2M
Site Desfgn Copyright 1999-2006 Akanda Group LLC. All rights reserved.
http://etax.nhegov.com/Forms/MapDatalet.aspx?sIndex=0&idx=1&LMparent=20 11 /12/2009

Drapery Address3100 Scarborough Drive _...
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