WI0300030_Staff Report_20191014

Permit No. WI0300030
Date: 10/14/2019
To: Michael Rogers (Central Office UIC Permitting) _
Permittee/Applicant: (Owner)_Gregory and Elizabeth 011ish
Central Office Reviewer Facility Name: 011ish Residence
L GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 10/14/2019
b. Person contacted and contact information: Greg 011ish [phone]
c. Site visit conducted by: Edward Watson and Maria Schutte
County: Iredell
d. Inspection Report Printed from BIMS attached: ❑ Yes ® No.
e. Physical Address of Site including zip code: 136 Perennial Dr., Mooresville, NC 28117
f. Driving Directions if rural site and/or no physical address:
g. Latitude: Longitude:
Source of Lat./Long & Accuracy (i.e., Google Earth, GPS, etc.): GCS WGS 1984 to nearest 10 seconds.
IL DESCRIPTION OF INJECTION WELL (S) AND FACILITY
1. Type of injection system:
® Geothermal Heating/Cooling Water Return
❑ In situ Groundwater Remediation
❑ Non -Discharge Groundwater Remediation
❑ Other (Specify:
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? ® Yes ❑ No.
Provide well construction information from well tag: Well Depth 300 ft., well dia. 6 inches, casing
depth 119 ft., Static water LVL 40 ft., well construction date 12-06-1996.,, Well Registration # 462.
b. Does existing or proposed system use same well for water source and injection? ® Yes ❑ Nc
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. This is also a Water Supply Well for the residence.
4. Quality of drainage at site: ❑ Good ® Adequate ❑ Poor
5. Flooding potential of site: ® Low ❑ Moderate ❑ High
6. 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.

III. E VAL UA TION 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
5. Signature of Report Preparer(s): Edward Watson 10/15/2019
Docu Signed by:
EF161FB6gA2D84A3
.ikal" H P;4-f. 10.14.19
Signature of WQROS Regional Supervisor: Date:
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional / If Needed)
Well Water samples have been submitted to the Water Quality lab in Raleigh. The samples should arrive at the
lab on 10/15/2019. Results will be reported to the well owner with a copy to CO when the analyses are
completed.