WI0600084_Staff Report_20220125

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
Date: 1/9/21
To: APS Central Office
Central Office Reviewer:
Regional Login No:
M. Ro2ers/S. Shrestha
Permittee(s): Mr. Peter Goolsby
Permit No.: WI0600084
County: Harnett
Project Name: Goolsby
I. GENERAL INFORMATION
1. This application is (check all that apply): ❑ SFR Waste Irrigation System ® UIC Well(s)
❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
n Land Application of Residuals ❑ Attachment B included El 503 regulated El 503 exempt
n 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.
b.
c.
d.
Date of site visit: 10/25/2021
Person contacted and contact information: Peter Goolsby
Site visit conducted by: Kent White
Inspection Report Attached: ❑ Yes or ® No.
2. Is the following information entered into the BIMS record for this application correct?
n Yes or ® 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, GoogleTM, etc.);
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
Geothermal Injection well for HVAC system.
For UIC Injection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): 89 W. Pine St., Lillington, NC 28396
b. Driving Directions: From FRO, take US 401 north to Lillington. Go west on US-421 approximately 11/2
mi. and turn north on Hillcrest Dr., then west onto W. Pine St. Goolsby residence is 2' house on the left..
c. USGS Quadrangle Map name and number:: Lillington, NC
d. Latitude: 35.4057 Longitude: -78.8411 Method Used (GPS, GoogleEarthTM, etc.); (Approx.
Location of injection well.)
e. Latitude: 35.4061 Longitude: -78.8410 (Approx. location of supply well)
APS-GPU Regional Staff Report (Sept 09) Page 1 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
II. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description of Waste System and Facilities
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
❑ Yes ❑ No ❑ N/A. If no, 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? ❑ Yes ❑ No ❑ N/A. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)?
Yes ❑ No ❑ N/A. If no, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. _ Yes _ No
N/A. If no, please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
❑ Yes ❑ No ❑ N/A. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
n Yes ❑ No ❑ 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)? ❑ Yes or ❑ 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? n Yes n No n 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? n Yes ❑ No n N/A If yes, attach list of sites
with restrictions (Certification B?)
IIL RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or major modification
systems)
Description of Waste System and Facilities
1. Are there appropriately certified ORCs for the facilities? ❑ Yes or ❑ No.
Operator in Charge: Certificate #:
APS-GPU Regional Staff Report (Sept 09) Page 2 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
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? ❑ Yes or ❑ No.
If no, please explain:
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? ❑ Yes or ❑ No. If no, please explain:
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?
❑ Yes or ❑ No. If no, please explain:
6. Are the existing application rates (hydraulic or nutrient) still acceptable? ❑ Yes or n No. If no, please
explain:
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ❑ 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? n Yes ❑ No ❑ N/A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? n Yes or n 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? n
Yes or ❑ No. If no, please explain:
11. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ❑ N/A. If no, please explain:
12. Has a review of all self -monitoring data been conducted (GW, NDMR, and NDAR as applicable)? Yes or
❑ No ❑ N/A. Please summarize any findings resulting from this review:
13. Check all that apply: ❑ No compliance issues; ❑ Notice(s) of violation within the last permit cycle; ❑
Current enforcement action(s) ❑ Currently under SOC; ❑ Currently under JOC; ❑ 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? ❑ Yes
n No n Not Determined n N/A.. If no, please explain:
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? n
Yes or ❑ No ® N/A. If yes, please explain:
APS-GPU Regional Staff Report (Sept 09) Page 3 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
V. 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
1.
Type of injection system:
® Heating/cooling water return flow (5A7)
❑ Closed -loop heat pump system (5QM/5QW)
❑ In situ remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (5L/"Non-Discharge")
❑ Other (Specify:
2. Does system use same well for water source and injection? ❑ Yes ® No
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)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 10' ft.
5. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ® Low ❑ Moderate ❑ 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? ❑ Yes ❑ 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)? n Yes or ® 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. See file for the maps prepared by Jim Barber - DWR FRO
engineer during the 7/21/2016 inspection.
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)?
n Yes ® No.
2. For closed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? n Yes n 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? n Yes n No. If yes, explain
APS-GPU Regional Staff Report (Sept 09) Page 4 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. Drilling Contractor: Name:
5. 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: See Section VI for comments.
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® 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:
Condition
Reason
APS-GPU Regional Staff Report (Sept 09)
Page 5 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
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;
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report Preparer(s): Kent White, DWR - FRO
Signature of APS regional supervisor:
1/25/2022
Date:
-DocuSiggnnedd by:
�
'�. _Ak
-5189C2D3DD5C42B...
VI. ADDITIONAL INFORMATION AND SITE MAP (Sketch of site showing house and waste irrigation
system, spray or drip field, location of well(s), and/or other relevant information- SHOWNORTHARROW)
Water samples were obtained from both the supply well and the discharge effluent from the HVAC system
discharging into the injection well. The analytical data is attached. The analytical results are comparable to the
7/21/2016 sampling event.
Modifications to the system were not observed, as compared to the observations made during the 2016
inspection. with both Jim Barber and myself.
APS-GPU Regional Staff Report (Sept 09) Page 6 of 6 Pages

AC91012 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loc. Diner.: GOOLSBY SUPPLY
County: Harnett Collector. K WHITE
Region: Fayetteville Report To FRO
River Basin CPF Collect Date: 1 /25/2021
Emergency Collect Time:
CDC Yes/No Sample Depth
5-heft/
Final Report
VisitiD
Location ID:
Priority
Sample Matrix:
Loc. Type:
6P43W10600084
ROUTINE
GROUNDWATER
Water Supply
Sample ID:
PO Number #
Date Received:
Time Received:
Labworks LoginlD
Delivery Method
Final Report Date:
Report Print Date:
AC91012
10/26/2021
08_40
TASCENZOI
NC Courier
11/23121
11/29/2021
If this report is labeled preliminary report the results have not been validated. Do not use for Regulatory purposes.
CAS # Analyte Name
Sample -temperature at receipt by lab
PQL
Result/
ualifier
LAB
1.1
Units
°C
Method Analysis
Reference Date
Validated by
10/26/21 MSWIFT
E701177
NO2+NO3 as N in liquid
0.02
NUT
0.06
mg/L as N
EPA 353.2 REV 2 10/26/21 ALWILLIAMS
24959-67-9 Bromide
0.4
WET
0.4 U
mg/L
EPA300.0 rev2.1 10/29/21 ALWILLIAMS
16887-00-6 Chloride
1.0
1.5
mg/L
EPA300.0 rev2.1 10/29/21 ALWILLIAMS
16984-48-8 Fluoride
0.4
0.4 U
mg/L
EPA 300.0 rev2.1 10/29/21 ALWILLIAMS
14808-79-8 Sulfate
2.0
3.1
mg/L
EPA 300.0 rev2.1 10/29/21 ALWILLIAMS
Total Dissolved Solids in liquid
12
118
mg/L
SM 2540 C-1997 10/29/21 ALWILLIAMS
7429-90-5 Al by ICP
50
MET
50 U
ug/L
EPA 200.7 Rev4.4 11/18/21 JJURGEVICH
7440-38-2 As by ICPMS
2.0
8.5
ug/L
EPA200.8 Rev5.4 11/10/21 -JJURGEVICH
7440-70-2 Ca by ICP
0.10
18
mg/L
EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7440-47-3 Cr by ICPMS
5.0 5.0 U ug/L
EPA200.8 Rev5.4 11/10/21 JJURGEVICH
7440-50-8 Cu by ICPMS
2.0
2.0 U
ug/L
EPA 200.8 Rev5.4 11/10/21 JJURGEVICH
7439-89-6 Fe by ICP
50
1400
ug/L
EPA 200.7 Rev4.4 11/18/21 . JJURGEVICH
Hardness by Calculation
1.0
70
mg/L
SM 2340B-1997
11/22/21 JJURGEVICH
7440-09-7 K by ICP
0.10
1.8
mg/L
EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7439-95-4 Mg by ICP
0.10
6.1
mg/L
EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7439-96-5 Mn by ICP
10
240
ug/L
EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7440-23-5 Na by ICP
0.10
11
mg/L •
EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7440-02-0 Ni by ICPMS
2.0
2.0 U
ug/L
EPA 200.8 Rev5.4 11/10/21 JJURGEVICH
7439-92-1 Pb by ICPMS
2.0 2.0 U ug/L
EPA200.8 Rev5.4 11/10/21 JJURGEVICH
7440-66-6 Zn by ICPMS
10
10 U
ug/L
EPA200.8 Rev5.4 11/10/21 JJURGEVICH
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 1

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Revision: 6/16/2020
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•

AC91013 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loc. Descr.: GOOLSBY - INJ
County: Harnett Collector.
Region: Fayetteville Report To
River Basin CPF Collect Date:
Emergency Collect Time:
COC Yes/No Sample Depth
K WHITE
FRO
10/25/2021
INitG7/pN
Wet- t-
Final Report
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
Sample ID: AC91013
PO Number#
Date Received: 10/26/2021
Time Received: 08_40
Labworks LoginlD TASCENZOI
Delivery Method NC Courier
Final Report Date: 11/23/21
Report Print Date: 11/29/2021
VisitlD
Location ID: 6P43W10600084
Priority ROUTINE
Sample Matrix: GROUNDWATER
Loc. Type: Water Supply
Result/
CAS # Analyte Name PQL Qualifier
LAB
Sample temperature at receipt by lab 1.1
Units
'C
Method Analysis
Reference Date validated by
10/26/21 MSWIFT
E701177
NO2+NO3 as N in liquid
NUT
0.02 0.06 mg/L as N EPA353.2 REV 2 10/26/21 ALWILLIAMS
24959-67-9 Bromide
WET
0.4 0.4 U mg/L EPA300.0 rev2.1 10/29/21 ALWILLIAMS
16887-00-6 Chloride
1.0 1.7 mg/L EPA300.0rev2.1 10/29/21 ALWILLIAMS
16984-48-8 Fluoride 0.4 -
0.4 U mg/L EPA300.0 rev2.1 10/29/21 ALWILLIAMS
14808-79-8 Sulfate
2.0 2.2 mg/L EPA 300.0 rev2.1 10/29/21 ALWILLIAMS
-- - Total Dissolved Solids in liquid
12 - - . --116 mg/L. SM 2540 C-1997" 10/29/21 ALWILLIAMS...
MET
7429-90-5 Al by ICP • 50 50 U ug/L EPA 200.7-Rev4.4 11/18/21 JJURGEVICH
7440-38-2 As by ICPMS
2.0 8,6 ug/L EPA200.8Rev5.4 11/10/21 JJURGEVICH
7440-70-2 Ca by ICP
0.10 18 mg/L EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7440-47-3 Cr by ICPMS
5.0 5.0 U
ug/L
EPA200.8 Rev5.4 11/10/21 JJURGEVICH
7440-50-8 Cu by ICPMS 2.0
2.0 U ug/L EPA200.8 Rev5.4 11/10/21 JJURGEVICH
7439-89-6 Fe by ICP
50 1100 ug/L EPA200.7 Rev4.4 11/18/21 JJURGEVICH
Hardness by Calculation
1.0 70 mg/L SM 2340B-1997 11/22/21 JJURGEVICH
7440-09-7 K by ICP
0.10 1.8 mg/L EPA200.7Rev4.4 11/18/21 JJURGEVICH
7439-96-4 Mg by ICP
0.10 6.1 mg/L EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7439-96-5 Mn by ICP
10 230 ug/L EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7440-23-5 Na by ICP 0.10 11 mg/L EPA200.7 Rev4.4 11/18/21 JJURGEVICH
7440-02-0 Ni by ICPMS
• 2.0 2.0 U ug/L EPA200.8 Rev5.4 11/10/21 JJURGEVICH
7439-92-1 Pb by ICPMS 2.0
2.0 U ug/L EPA200.8 Rev5.4 11/10/21 JJURGEVICH
7440-66-6 Zn by ICPMS
10 10 U ug/L EPA200.8 Rev5.4 11/10/21 JJURGEVICH
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 1

Lab Use Only:
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Location Code:
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biology Parameters:
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a
Coliform: Total ME
0
V
a
0
a
0
0
G
V
a
Color: Platinum Cobalt
17
a
TOC - Total Organic Carbon
COD: Chemical Oxygen Demand
a
0
0
U
Other Parameters:
0
`0
z
0
a
Hexavalent Chromium (Crg+)
MBAS (surfactants)
0
Nutrients Parameter
Oil and Grease, HEM, Total Recoverable
0
Ammonia as N (NH3-N)
Phenols, Total Recoverable
ra
0
a
a
Nitrate -Nitrite as N (NO3+NO2-N)
Residue: Total (Total Solids)
O.
act
Residue: Volatile/Fixed, Total
Total Kjeldahl Nitrogen as N (TKN)
a
Phosphorus as P (TP)
Residue: Settleable
a
Residue: Suspended (Suspended Solids )
-t-
-0
CU
N.
a
a
a
E
to • I
O
O i
X
C
v
1