WI0800014_Rescission_20191114

ROY COOPER
Governor
MICHAEL S.REGAN s
Secretary
LINDA CULPEPPER NORTH CAROLINA
Director Environmental Quality
November 14,2019
Graham&Maeomie Mosely
2137 Auburn Lane
Wilmington,NC 28405
Subject: Permit Rescission
UIC Permit No. W10800014
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mrs. and Mrs. Mosely:
Reference is made to your request for rescission of the subject Geothermal Heating/Cooling Water
Return Well Permit located at 2137 Auburn Lane, Wilmington, NC 28405. Staff from the
Wilmington Regional Office has agreed that a permit is no longer required. Therefore, in
accordance with your request, Underground Injection Control (UIC) Permit WI0800014 is
rescinded, effective immediately.
If in the future, you wish to operate a Geothermal Heating/Cooling Water Return Well injection
system, you must first apply for and receive a new permit. Operating a geothermal heat pump
injection system without a valid permit may result in the assessment of civil penalties and/or the
use of other enforcement mechanisms available to the state.
If it would be helpful to discuss this matter further, please do not hesitate to call Shristi Shrestha
at(919) 707-3662.
Sincerely,
4orgLinda Culpepper, Director
Division of Water Resources
Attachment(s)
cc: Wilmington Regional Office-WQROS
Central Files -Permit No. WI0800014
New Hanover County Environmental Health Dept.
North Carolina Department of Environmental Quality I Division of Water Resources
,�-D-E 512 North Salisbury Street 1 1636 Mail Service Center I Raleigh,North Carolina 27699-1636
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919.707.9000

Department of Environmental Quality-Division of Water Resources
STATUS OF INJECTION WELLS)/PERMIT RESCISSION REQUEST FORM
Permit Number: 1
Pennittee Name(s): GLA2—Y11—
Mailing Address: .l�
Physical Address of Well(s)(if different than mailing address): ,,/� j�
City. County IY LAJ & ha Vets Zip Code—Z.D/OS~
Daytime Telephone No.: ell No.:
Email Address: 4�I rfiP�. 1�►''� C O
Please check the selection which most closely describes the current status of your system:
1) ❑ 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)❑Irrigation
d)❑Monitoring
3) [ Injection discontinued and: a)❑Well(s)temporarily abandoned
b)"ell(s)permanently abandoned
c)❑Well(s)not abandoned
4) ❑ Injection well(s)never constructed ❑ N/A injection well(s)never proposed
Well(s) Abandonment/Comments:
If you checked(3)(a)or(b),attach a copy of the GW-30(Well Abandonment Record). If not applicable,then describe
the method used(or to be used)to abandon the well(s),including a description of how the well were seated and material
used. If the work below is proposed a GW-30 will need to be submitted to he UIC Program 30 days after abandonment.
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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. Do you wish to rescind the permit?
Z Yes ❑ No
Certification:
"I hereby certify,under penalty of law,which I have personally examined and am familiar with the information submitted
in this document,and that to the best of m knowledge the information is true,accurate,and complete."
ASignature Date
*xx� rG 5�9Print or �t-pe N#me Title
2s3 A
GW-68 Injection Well Status Fonn Rev.3-1-2016 Page 1 of 1

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Joey Cobarobius 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4055-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Craigs Well Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name HTH
2.Well Construction Permit M
W 10800014 7c.Type of disinfectant used:
List all applicable well construrtion pennits(i.e.UIC,County,State,Ymiance,etc)ifknown 1 lb.
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout 19 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
shTi ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: X For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Hole Plug 7 bags
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Cut well below grade
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
Disinfected Well
a.Date well(s)abandoned: 10/7/19 Filled with Hole Plug
5a.Well location: Capped with Hole Plug
Graham Mosely
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2137 Auburn Lane, Wilmington, NC 28405 f� M e 1017/19
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
New Hanover By signing this forth.I hereby eertfy that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 at-2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat(long is sufficient) 9.Site diagram or additional well details:
34 15 122 N 77 48 155 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same eonstruetlonlabandonment,you can submit one form,
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 54 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 24 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (4a steel) (ft) 10c.For Water Sunnh &Infection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016