WI0400011_Staff Report for Injection Well Permit Renewal_20210512

North Carolina Department of Environmental Quality - Division of Water Resources
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WI0400011
Date: 05/12/2021 County: Yadkin
To: Shristi Shresta Permittee/Applicant: _Robert and Linda Risen
Central Office Reviewer Facility Name: 3057 Lori Lane
I. GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 04/22/2021
b. Person contacted and contact information: Robert Risen [phone]
c. Site visit conducted by: Jim Gonsiewski
d. Inspection Report Printed from BIMS attached: ® Yes ❑ No.
e. Physical Address of Site including zip code: 3057 Lori Lane Yadkinville NC 27055
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 36.12016 Longitude: 80.57727
Source of Lat/Long & Accuracy (i.e., Google Earth, GPS, etc.):Google Earth
II. DESCRIPTION OF INJECTION WELL(S) AND FACILITY
1. Type of injection system:
® Geothermal Heating/Cooling Water Return
n In situ Groundwater Remediation
['Non -Discharge Groundwater Remediation
❑ Other (Specify:_)
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? ® Yes ❑ No.
Provide well construction information from well tag: No tags observed on the wells
b. Does existing or proposed system use same well for water source and injection? ❑ Yes ® No
If No, please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)?
What is the distance of the injection well(s) from the pollution source(s)?
4. What is the minimum distance of proposed injection wells from the property boundary?
5. Quality of drainage at site: ❑ Good ® Adequate ❑ Poor
6. Flooding potential of site: ® Low ❑ Moderate ['High
WQROS Staff Report Rev. 4/15/2016 Page 1

7. For Groundwater Remediation Injection Systems only, is the proposed and/or existing groundwater monitoring
program (number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No.
If No, attach map of existing monitoring well network if applicable and recommend any changes to the
groundwater -monitoring program.
8. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ❑ Yes ❑ No. If No, or no map, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9. For Non -Discharge Groundwater Remediation systems only (i.e., permits with WQ prefix):
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ N/A.
If No, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No n N/A. If no, please explain:
HI. EVALUATION AND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If Yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
Reason
3. 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
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by Regional Office
❑ Issue upon receipt of needed additional information
® Issue ('DocuSigned by:
5. Signature of Report Preparer(s):�"°�z'`u'�`
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Signature of WQROS Regional Supervisor:
Date: 5/12/2021
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WQROS Staff Report Rev. 4/15/2016
Page 2

IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional /If Needed)
No well tags visible. Well data not available. The supply well was approximately 20-feet from the injection
well. A photograph of the two wells is below. The injection well is on the left under the green cover.
Laboratory data from the sampling of the influent and effluent will be provided when it becomes available.
WQROS Staff Report Rev. 4/15/2016
Page 3

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County: Yadkin
Region: Winston-Salem
Contact Person: Robert Alan Risen
Compliance Inspection Report
Permit: WI0400011 Effective: 05/09/16 Expiration: 04/30/21 Owner : RobertAlan Risen
SOC: Effective: Expiration: Facility: 3057 Lori Ln (SFR)
3057 Lori Ln
Yadkinville NC 27055
Title: Phone: [phone]
Directions to Facility:
From W-S take US 421N to exit 251 turn R, take Speer Bridge Rd to end turn L, take Old US 421 Hwy E —2.2mi turn L, take Boulder
Rd to end turn L, take Lori Lane —0.7mi the property is on the Lt
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 04/22/2021 Entry Time 10:10AM
Primary Inspector: Jim J Gonsiewski
Secondary Inspector(s):
Exit Time: 11:25AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: Compliant ❑ Not Compliant
Question Areas:
Wells System Operations
(See attachment summary)
Page 1 of 3

Permit: WI0400011 Owner - Facility: Robert Alan Risen
Inspection Date: 04/22/2021 Inspection Type : Compliance Evaluation
Reason for Visit: Routine
Inspection Summary:
The system at the Risen property was inspected on April 22, 2021. The system appeared to be in good working order and,
according to the property owner, has not had any operational problems. The influent and effluent from the wells were
sampled.
Page 2 of 3

Permit: WI0400011 Owner - Facility: Robert Alan Risen
Inspection Date: 04/22/2021 Inspection Type : Compliance Evaluation
Reason for Visit: Routine
System Operation
Is same well used as source well and injection well?
Is injection well capable of assimilating injected fluid?
Injection flow rate at time of inspection (gpm)
Has system owner/operator noticed any abnormalities (turbidity, air in system, poor heating/cooling, etc) in
system operation?
Comment on system operation
Is system operation and construction consistent with that described in application?
Describe inconsistencies between application and observed operation/construction
The system is operating properly.
Comment: No problems with the system were noted.
Yes No NA NE
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