WI0300030_GEO THERMAL_20140724

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PS Form 8811, July 2015 PSN 7530-02-000-9053 Domestic Retum Receipt :
Permit Number
Program Cate9ory
Ground Water
Pe rmit Type
WI0300030
Injection Heating/Cooling Water Retum Well
Primary Revl•-r
rnicnael ,rogers
Coastal SWRule
Perrnlttlld Flow
Facility
Facllity Name
Gregory and Elizabeth Ollish SFR
Location AddreH
136 Perennial Dr
Mooresville NC
Owner
Owner Name
Gregory
Dates/Events
Oltish
Orlglsaue
8/611991
Ap p Received
5/20/2014
Draft Initiated
Re gulated Activities
Heat Pump Injection
Outfall
Waterbody Name
Scheduled
Issuance
Central Files: AP$ SWP
7/24/2014
Permit Tracking Slip
Status
Issued
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Afflllatlon
M,Jor/Mlnor
Minor
Region
Mooresville
County
Iredell
Faclllty Contact Affiliation
Public Notice
owner Type
Individual
owner Afflllatlon
Gregory Olllsh
136 Perennial Or
Mooresville
Issue
7/18/2014
Requested /Received Events
RO staff report received
RO staff report requested
Additional information requested
Additional information received
Streamlndex Number Current Class
Effective
10/1/2014
NC 28117
Expiration
9/30/2019
7/3/14
5/28/14
5/22/14
5/27/14
Subbaaln
Permit Number WI0300030
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
mlchael.rogers
Coastal SWRule
Permitted Flow
Faclllty
Faclllty Name
Gregory and Elizabeth Ollish SFR
Location Address
136 Perennial Dr
Mooresville NC
Owner
Owner Name
Gregory
Dates/Events
Orig Issue
8/6/1991
App Received
5/20/2014
Regulated ActMtles
Heat Pump Injection
Outfall
Watarbody Name
28117
Olllsh
Draft Initiated
Scheduled
Issuance
Central Files: APS _ SWP
7/17/2014
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact AfflllatJon
Major/Minor
Minor
Region
Mooresville
County
I redell
Facility Contact Affiliation
Publlc Notice
Owner Type
Individual
Owner Affiliation
Gregory Ollish
136 Perennial Dr
Mooresville
Requested /Received Events
RO staff report received
RO staff report requested
Additional information requested
Additional information received
Streamlndax Number Current Class
Effecti11e
NC 28117
Expiration
CJ/3tJj/JI•
7/3/14
5/28/14
5/22/14
5/27/14
Subbasin
AVA MCDEMR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Gregory and Elizabeth Ollish
136 Perennial Drive ..
Mooresville, NC 28117
Re: Issuance of Injection Well Per.mit
Permit No. WI0300030
July 18, 2014
Geothermal Heating/Cooling Water Return Well
Iredell County
Dear Mr. and Mrs . Ollish:
John E. Skvarla, 111
Secretary
In accordance with your permit renewal application received May 20, 2014, and additional
information received May 27, 2014, I am forwarding Permit No. WI0300030 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 October 1, 2014, (i.e., the
day after the expiration date of the .existing permit), which may differ from the date of this letter.
This pennit shall be effective from October 1, 2014, until September 30, 2019, and shall be subject to the conditions and limitations stated therein.
Toe Mooresville Regional Office will be contacting you soon to make an appointment to inspect
your geothermal system and collect water samples. A copy of the laboratory analytical r~sults will
be sent 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, ~s.~
Michael Rogers, P .G. (NC & FL)
Hydrogeologist
Water Quality Regional Operations Section
Division of Water Resources, NCDENR
1636 Mall Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone]\ Internet: www.ncdenr.gov
M Eqoal Opportunity \ Affirrnati'le Actioo Employer-Made io part by recycled paper
Ollish SFR
Page 2 of2
cc: Michael Parker/Andrew Pitner, Mooresville Regional Office
Central Office File. Wl0300030
Iredell County Environmental Health Department
NORIB CAROLINA
ENVIRONMENTAL MANAGEMENT CO:Ml\fiSSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE 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
PERMJSSION IS HEREBY GRANTED TO
Gregory and Elizabeth Ollish
FOR TIIE 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 136 Perennial Drive, Mooresville, Iredell County, NC 28117,
and will be operated in accordance with the renewal application received May 20, 2014, and in conformity with
the specifications and supporting data received May 27, 2014, 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 operation of an injection well shall be in compliance with Title l SA 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 October 1, 2014, (i.e., the day after the expiration date of
the existing permit) until September 30, 2019, and shall be subject to the specified conditions and limitations.set
forth in Parts I through VIII hereof.
~
Pennit issued this the l 1 day of ~
~~~
\-ti'-Thomas A. Reeder, Director
~ Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0300030 UIC/Retum Well -RENEWAL
ver. ·04/2014
, 2014
Page 1 of5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
I . The Pennittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (ISA 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 condit ions 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 sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
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 p late according to 2C
.01010).
8. Copies of the Well Construction Records shall be retained on-site and available for inspection.
PART II -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 Directo.r of the Divis ion 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 Perrnittee 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.
4 . 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.
P ermit #Wl0300030 UIC/Retum Well -RENE:WAL
ver. 04/2014
Page 2 of 5
PART ID-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 Pennittee 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 IV -OPERATION AND MAINTENANCE REQUIREl\IBNTS
1. The injection facility shall b e 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 o r activity not specifically authorized by
the permit.
PART V -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 VI -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 Mooresville Regional Office, telephone number 704-663-1699, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
Permit #WI030003 0 IBC/Retum WeU -RENEW AL
ver. 04/2014
Page 3 of5
(B) Any failure due to known or unknown reasons that r enders the facility inc apable of prop er
i njection operations, such as mechanical or electrical failures;
3 . Where the P e nnittee becomes aware of an omission of an y relevant facts in a permit application, or of any
incorrect information submitted in said applicatio n or in any report to the Director, the relev ant and
corre ct facts or information shall be promptly submitted to the Director by the Permittee.
4 . In the e vent that the p ermitted facility fails to perform satisfactorily, the Permittee s hall take s uch
immediate action a s may be require d by the Director.
PART VII-PERMIT RENEW AL
The Permittee s hall, at least 120 days prior t o the expiration of this permit, request an extension.
PART VIII -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 wen 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 .0240,
Abandonment and Change-of-Status of Wells.
2. When operations h ave ceased at the facility and a well will no longer be used for any purpose, the
Pennittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0 240, inclu ding but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedw·es 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 e ntire depth of each well shall be sounded before it is sealed to insw-e 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 undergrmmd source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduce d into the
well through a pipe which extends to the b ottom 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 shal l be perforated o pposite tb e gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases whe~ as a result of the injection operations, a subsurface cavity has been
created, each well shall be a bandoned in such a manner that will prevent the movement of
flui ds into or between underground sources of drinking water and in accordance-with the
terms and conditions of the permit.
Pennit #WI0300030 UIC/Retum Well -RENEWAL
ver. 04/2014
Page 4 of S
(G)_ 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.
3. The written documentation required in Part VIll (1) and (2) (G) shall be submitted to:
Permit #WI0300030
Water Quality Regional Operations Section-VIC Program
DENR-Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
UIC/Return Well-RENEWAL
ver. 04/2014
Pages of 5
Rogers, Michael
From:
Sent:
To:
Cc:
Subject:
Pitner, Andrew
Thursday, July 03, 2014 4:27 PM
Rogers, Michael; Parl<er, Michael
Watts, Debra
RE : Permit Update requirement WI0300030
This is another one of those geothermal SFR permits that we have not gotten back out to sample yet. MRO Is ok with
renewa l based on previou s work with this permit. We do plan to get out there at some point to collect the samples. We
are apparently on the verge of a hire for a hydtogeologist that will really help us staffing-wise get to some of these UIC-
SFR facilities like this.
Andrew
From: Rogers, Michael
Sent: Thursday, July 03, 2014 2:41 PM
To: Pitner, Andrew; Parker, Michael
Cc : Watts, Debra
Subject: FW: Permit Update requirement WI0300030
Hi guys. Would you forward to me and Debra an update on the geothermal staff report for Ollish. Thanks.
From: Watts, Debra
Sent: Thursday, July 03, 2014 1:35 PM
To: Rogers, Michael
Cc: Watts, Debra
Subject: Permit Update requirement
Mike
Can you check on or update me on the following permits? Thanks! Djw
WI0500027 Michael and Jackelin
Jefferson
Wl0300030 Gregory Ollish SFR
Debra J. Watts, Supervisor
Groundwater Protection Branch
Water Quality Regional Operations Section
919-807-6338
Geothermal Heating/Cooling
Geothermal Heating/Cooling
Name
Change/ReneVI
Renewal
Email correspondence to and from this_ address is subject to the North Carolina Public Records Law and may be dlsdosed to ttii rd parties unless the
content is exempt by statute or other regulation.
1
WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: May 28, 2014
To: MRO-WQROS: Michael Parker / Andrew Pitner
From: Michael Rogers, WQROS -Groundwater Protection Branch
A.
B.
c.
D.
Telephone: [phone] Fax.: [phone] E-Mail: [e-mail]
Permit Number: WI0300030
A pplicant: Ollish
Facility Name:
A pplication:
Permit Type: Geothennal Heat ing/Cooling Wa ter Return Well
Project Type: Renewal
E. Comments/Other Information:
D I would like to accompany you on a site visit.
Attached, you will find aU information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WOROS 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-WOROS Reviewer: _________________ Date: ____ _
COMMENTS:
FORM: WQROSARR-GW Protectio n Branc h 05 0914 Page 1 of 1
Rogers, Michael
From:
Sent:
To:
Subject:
Attachments :
Mr Rogers:
Greg Ollish [gsollish@yahoo .com]
Tuesday, May 27 , 2014 7:01 PM
Rogers , Michael
Re: WI0300030 Geothermal Renewal App Signature Page
DWR .pdf
Sorry for the mistake and incovienience . If this doesn't please inform me what I can do to correct the situation.
Gregory S. Ollish
On Thursday, May 22, 2014 11 :33 AM , "Rogers , Michael" <michael.rog ers@ncdenr gov> wrote:
Mr. Ollish:
We received the renewal application for the above permitted geothermal system. Thank you.
However, page 4 of the application was missing. Pfease sign and return the attached page 4 Please
also have Elizabeth Ollish sign. You can scan and send back in reply to this email if you wish.
Thanks.
Michael Rogers, Hydrogeologist
NCDWR
919-807-6406
--Original Message-----
From: Michael Rogers [mai lto:[e-mail]]
Sent: Thursday, May 22, 2014 10:58 AM
To: Rogers, Michael
Subject:
This E-mail was sent from "RNPAC7DO0" (Aficio 2075).
Scan Date: 05.22.2014 10:57:59 (-0400)
Queries to: [e-mail]
1
AVA MCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Gregory and Elizabeth Ollish
136 Perennial Drive
Mooresv ille, NC 28117
Dear Mr. and Mrs. Ollish:
May 22, 2014
John E. Skvarta, Ill
Secretary
Subject: Acknowledgement of
Application No. WI0300030
Gregory and Elizabeth Ollish
Heating/Ceeling Geothermal
Water Return Well System
Iredell County
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your permit
appllcation and supporting documentation received on May 20, 2014 Your application package has been
assigned the number listed above, and the primary reviewer is Michael Rogers.
Central and Mooresville Regional Office staff will ~rform 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 infonnation
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 [phone] or [e-mail].
cc: Mooresville Regional Office, WQROS
Permit File WI0300030
Sincerely-,
~~~
for Debra J. Watts, Supervisor
Division of Water Resources
1636 Mail Service Center, Ra\e9h, North Caronna 27699-1636
Phone: [phone] I Internet http://portal.ncdenr.org/web}Ng
AA Equal Oppoltunity \ Affirmative Action Employer -:-Made In part with recycled paper
Exis ting Perm it No.:
Assigned Date: sJ 21 / L <f. !
Date to Processing: ______ AM PM
Owne r: Existing OwnerTyt1e: Non-Government -+ Individual D Organization
D Unknown D Government
Facilit)'.: Weroposed Facilih T v [!e: D Facility
Existing □ Operation
Permit T" pe: Deemed
D Aquifer Test Wells
D Geothermal Aqueous Closed Loop Well s
D Geothermal Direct Expansion Closed Loop Well s
0 In Situ Groundwater Remediation Wells circle one:
( air sparge, passive, small scale, pilot test)
O Stonnwater Drainage Wells
0 Tracer Wells
D Other Wells
► 0 Municipal D Federal D County 0 State
Facilit~• Regul ated Activities:
Individua l _
0 Aquifer Storage and Recovery Wells
[3'°Geothermal Heating & Cooling Water Return Wells
D In Situ Groundwater Remedi ation Wells
0 Experimental Technology Wells
0 Tracer Wells
0 Aquifer Recharge Well s
D Subsidence Control Wells
D Salinity Barrier Wells
Application T ype: D New
0 Ownership Change
0 _)1.ajor Modification D Minor Modification
li2!" Renewal O Renewal w/ Mod (major/minor)
D Name Change
D Resciss ion
Notes:
VIC BIMS Entry Form August 12, 2013
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NA TIJR.AL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS
These wells inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) __ New Application p Renewal* Modification
* £.or renewals complete Parts A-C and the signature page.
Print or Type Infomzation and Mail to the Address on the Last Page. fllegible Applications Will Be Returned As Incomplete;
DATE: .lff/J..r /.1/7°#-, 20 /~ ~1
PERMIT NO. \./EV30DC3D (leave blank if New Application) RECEIVEO/OENR/OWR
A. STATUS OF APPLICANT (choose one) ,1A 2 0 2014
Non-Government: Individual Residence ){2. Business/Organization ___, l '"'11allty Regional
Government: State Municipal __ County__ Federal d ons Secllon
B. WELL OWNER/PERMIT 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: _
b k:~.§0("'~ c)L LTS H-
Mailing Address: l ""3 Lp Pt....--r<S=6...lN,lft\ D~
City: YY'i~ ~, l /..::.-State: IJLZip Code: 28 \ I J
Day Tele No.: 70'-f-t.,p57-SCJB:7 ~:l~
EMAIL Address:b:ZC>\\ ~'?\:.£y~-~ Fax No.:
County: T'(";.:J4--~\ \
,~~<q o,32:5?.,o
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: b~c;: t'\;:-? A~ i=-
Mailing Address: ____________________________ _
City: ___________ State: __ Zip Code: ______ County: _____ _
Day Tele No.: Cell No.:
EMAlL Address: Fax No.:
D. LOCATION OF WELL SITE-Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: _________ County: ____ _
(2) Physical Address (if different than mailing address): _______________ _
City: ______________ State: NC Zip Code: ________ _
OPU/UIC SA 7 Permit Application (Revised 8/8/2013) Page I
E. WELL DRILLE R INFORMATION
Well D1illing Contractor's Name: __________________________ _
NC Well Drilling Contractor Certification No.: _____________________ _
Company Name: ________________________________ _
Contact Person,__: _______________ EMAIL Address: ___________ _
Address:------------------------------------
City: _________ Zip Cod e: _____ State: __ County: _________ _
Office Tele No.: _________ Cell No.: _________ Fax No.: ________ _
F. HV AC CONTRACTOR INFORMA TlON (if different than d ri ller)
G.
HVAC Contractor's Name: ____________________________ _
NC HY 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 th e fo llowing?
(I )
(2)
The injection operation?
Personal consumption?
YES ___ _
YES ___ _
NO ___ _
NO ___ _
H. WELL CONSTRUCTION REQUIREMENTS -As specified in 15A NCAC 02C .0224(dl:
(I) 111e water supply well shall be constructed in accordance with the water sup p ly well requirements of
15A NCAC 02C .0107.
(2) If a separa te well is used to inject the heat pump effluent, then the injecti on well shall be constructed
in accord ance with the wate r supply well requirements of 15A NCAC 02C .0 107, except that:
(a) For screen and gravel-packed wells, the entire length of casing shaU 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 b ottom of the casing
to land s urface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the coll ection of water samples immediately after water emerges from t be
s upply well and immediately prior to injection.
GPU/UJC' SA 7 Permit Application (Revised 818120 13) Page 2
L. CERTIFICATION {to be signed as required below or by that person's authorized agent)
lSANCAC02C.021l(e}req)liresthataUpeim.itapplicationsshallbc.JijgoAd.JauQUC~--------
l . for a corporation : by a mponsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor. tespectively;
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).
lf an authorized agent ls signing on behalf of the applicant, then s11pply a letter siped by the
applicant that names and authorl7.es their agent to sign th.is appllcatio_n on their behalf.
"I hereby certify, under penalty of Jaw, that I have personally examined and am familiar with the inftlrmation
submitted in this do<iument 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 specifi · and condidons of
the Permit."
Signa y Owner/Applicaut
b-~orrnam6 O~llSh.
Print or Typ Full e ..
~i,Rfjvj( ~
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]
OPU/UIC SA 7 Permit Applleation (Rovised 8/8/2013) Page4
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
STATUS OF INJECTION WELL SYSTEM
Permit Number: LJI. C>"3l?t:>Q:3 t:>
Permittee Name: ~:n.s:&7 0\ ~ '!? ~
Address: l-:3k, R-<",_~11-J ti\-\ Dr ~a:ir---::,.1,,(t,,r NL-Z.~\ l"7
Please check the selection which most closely describes the current status of your injection well 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) ( Monitoring
3) ( Injection discontinued and: a) ( Well(s) temporarily abandoned
b) ( Well( s) permanently abandoned
c) ( Well( s) not abandoned
4) ( Injection well(s) never constructed
Well Abandonment
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 t o fill the well if permanently abandoned:
Pennit 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 r~sl~~ the permit?
( Yes ~'lo
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, knowledge the information is true accurate, and complete."
Revised 8/5/2013 GW/UIC-68
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OLLISH
GREGORY 1 -4 '5t Report PRC Deed 4646094556.000 $+ELIZABETH 1055 612 WD 19971231 0 21 l 9-FARMSTEAD
85
FARMSTEAD
SHT2 PB19-17
85-SSA K
©2009-2014 Mobite311, LLC Various icons by: Silk Icons
ATA NCD
North Carolina Department of En vironment and Natural Resources
Pat 'M cCrory
Governor
April 25, 2014
C ERTIFIED MAIL# 7010 0780 0001 7057 4153
RETURN RECEIPT REQUESTED
Gregory Ollish
136 Perennial Drive
Mooresville, NC 281 17
Subject: Notice of Expiration (NOE)
5A7 Geothermal Open-Loop Injection Well
Permit No. WI0300030
Iredell County
Dear Mr. Ollish:
John E. Skva rla, Ill
·secretary
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 regU.lation of injection well construction and operation activities
within the state. Our r ecords indicate that the above-referenced operating permit for the underground
injection well system located on your property at 136 Perennial Drive in Mooresville, NC, which was
issued to you on October 24, 2009, and expires on September 30, 2014, is soon due for renewal. If
you wish to keep this pennit and operate the injection well system, the pennit must be renewed and
issued in your name.
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 (Fonn GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If there bas 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 can be
found at hnp://portal.ncdenr.orQ./web/wq/aps/gwpro/permit-applications.
If Your Injection Well is Currently Active:
If the injection well system is still active and you wish to renew your pemut, 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 June 2 , 2014 .
1636 Mail Service Center, Raleigh , North Carolina 27699-1636
Phone : 919-S07-6464 \ In ternet: www.ncdenr.gov
An Equal Opponunlty I Affirmative Action Employei -Made In part by re(:ytfed paper
In order to comply with the r egulatory requirements listed under North Carolina Administrative Code
(NCAC) Title 15A, S ubchapter 2C. Section .0211 , you must s ubmit one o f the following enclo sed
forms:
A . Application for a Permit to Construct or Operate Injection Wells -Open Loop Geoth ermal
Injection Wells (Renewal) if the injection well system on your p roperty is still a ctive.
B. Status oflnject;on Well System ifme injection well system is inactive or has been temporarily
or pe1manently abandone d.
Please submit the appropriate forms to:
Division of Water Resources
U IC Program
1636 Mail Service Center
Raleigh. NC 27699-1636
Failure to submit these forms in a timel y 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 f01ms are also available on-
line at the DWR website at http://po1tal.ncdenr.org/web/wq/aps/gwpro/permit-applications.
Thank you in advance for your cooperation and timely response. If you have any questions, p lease
contact me b y phone at (9 19) 807-6407 or by email at eric.g,smith{ci/ncdenr.2ov.
Sincerely,
Eric G. Smith, P .G.
Hydrogeologist
E nclosures
cc: Mooresville Regional Office -WQROS w /o enclosures
Centra l Files -Permit No. WI0300030 w/o enclosures
2
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. CERTIFIED MAILhl RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
"··· . . :::J1 L""I • ; ,~~-.
I -' ·~ ~ ~ ~ ~~
Postage $
Certified Fee
Rotum Reoelpt Fee Postmatl(
(Endorsement Required) Hen,
Rastnciad Deflvety Fee
(Endorsement Required)
rota! Pos!aga di Fees $
~ ~:siiii:"'Tiit~>)t,.,.::,-~-----??.-:t..-V.-----l -=-1 __ -!/,,,_1_' ___ -=-___ -J7-··•---,---·n·---_-.--------------·---·-,···
I'-;::s:.-~~~IP.. .. &[e-mail]&~ ..... .
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete Items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery Is desired.
■ Print your name and addl8SS on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallplece,
or on the front If space permits.
3.~'fype
~ Mall
□ Reglsterad
□ Insured Mall
□ Express Mall
□ Return Receipt for Merchandise
□C.O.D.
4. Restricted Dellve,y? (Extra Fee) □ Yes
2. Art!cle Number
(rransfer from service Isbel) 7010 □780 0001 7057 4153
PS Form 3811, February 2004 Domestic Return Receipt 102695-02-M-1640
Perm it Number WI0300030
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facillt •
Facility Name
Gregory and Elizabeth Ollish SFR
Location Address
136 Perennial Dr
Mooresville
Ow er
Owner Name
Gregory
Dates/Events
NC 28117
Ollish
Orig Issue
08/06/91
App Received Draft Initiate.cl
07/14/09
Scheduled
Issuance
Central Flies: APS_ SWP_
10/23/09
Permit Tracking Slip
Status
In review
Project Type
Renewal
Version Permit Classtficatlon
Individual
Permit Contact Affiliation
Gregory Ollish
136 Perennial D r
Mooresville
Major/Minor
Minor
NC
Region
Mooresville
County
Iredell
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Gregory Ollish
136 Perennial Dr
Mooresville
Public Notice Issue
10/24/09
NC
Effective
10/24/09
28117
28117
Expiration
09/30/14
-'-R=e ... ri=u=la=te.a..d;:;;..c..A;;.;;;;c.;;.;ti..;;.v=ltl;.;:e'""s _______________ Requested/Received Events
Heat Pump Injection RO staff report requested
Outfall
Waterbody Name
Additional information requested
RO staff report received
Addllional Information received
Stream Index Number Current Class
07/23/09
07/23/09
09/23/09
09/23/09
Subbasln
Permit Number WI0300030
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well {5A7)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
~acilit v
Facility Name
Gregory and Elizabeth Ollish SFR
Location Address
136 Perennial Dr
Mooresville
Owne
Owner Name
Gregory
Dates/E ye ntc
NC 28117
Ollish
Scheduled
Orig )ssue
08/06/91
App Received Draft Initiated Issuance
07/14/09
Reti ulated Activities
Heat Pump lnjectlon
Outfall NUL_
Central Files: APS_ SWP_
10/19/09
Permit Tracking Slip
Status
In review
Project Type
Renewal
Version Permit Classlflcatlon
Individual
Permit Contact Affiliation
Gregory Ollish
136 Perennial Dr
Mooresville NC
Major/Minor
Minor
Region
Mooresville
County
Iredell
Faclllty Contact Afflllatlon
Owner Type
Individual
Ow11er Afflllation
Gregory Ollish
136 Perennial Dr
Mooresville NC
Public Notice l~r;4foq Effective
Ren• IP ste:1 /Re ceived Events
RO staff report requested
Addiffonal information requested
RO staff report received
Additional informetlon received
28117
28117
07/23/09
07/23/09
09/23/09
09/23/09
Waterbody Name Stream Index Number Current Class Subbasin
NA MCDENR
North Carolina Department of Environmen t and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullln s
Director
October 24, 2009
G r egory and Elizab eth Ollisb
136 P erennial Drive
Mooresville, NC 281 l 7
Re: Issuance of Injection Well Permit
Permit No. WI0300030
Issued to Gregory and Elizabeth Ollisb
lredeU County
Dear Mr. and Mrs. Ollish:
Dee Freeman
Secretary
In accordance with your application recei:ved July 14, 2009, I am forwarding Permit No. WI0300030 for the
operation of a SA7 geothermal underground injection control (UIC) well heat pump system located at the above
referenced address. This pennit sball be effective from the date of issuance until September 30, 2014, and shall
be subject to the conditions and limitations stated therein.
Also attached is a summary of the laboratory sampling results from water samp1es collected from your
geothermal well on August 11, 2009.
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 pennit, this permit is not
transferable to any person without prior notice to, and approval by, 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,
/~~
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
cc: Andrew Pitner -Mooresville Regional Office
Central Office File-WI0300030
Iredell County Environmental Health Dept.
Attachment(s)
AQUIFER PROTECTION SECTION ·
1636 Mail Service Center, Raleigh. North Carolina 27699-1636
Locatlon: :ma Capital Boulevard, Raleigh. North Carolina 27.604
Pllone: 919-733-3221 I FAX 1: 919-715-0588; FAA 2: 919,715-6048 I Customer SelVice: 1-Bn-623-6748
Internet: v,ww,ncwaterguallty.org
AA Equal vpl)O!lunlty I Affirmah,e Action Employe{
N<s1:rth Carolina
/Vaturall!f
LABO RA TORY ANALYTICAL RES UL TS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: WI 0300030
PERMITTEE: Gregory and Elizabeth Ollish
SAMPLE COLLECTED DATE: 8/11/09
Colifonn, total Coliform, fecal pH (field)
1 CFU/100ml 1 CFU/100ml units
MCL=1 MCL= 1 MCL=6.5-8.5
I lnHuent <1 <1 6.85
I Effluent <1 <1 7.06
N02+ N03 as N Phosphorus Nitrate
m gfL mg/L mg/L
MCL=10 MCL=nss MCL=10
I Influent 0.84 na na
I Effluent 0.78 na na
Calcium.Ca Cadmium,Cd Chromium, Cr
mg/L uafl uafL
MCL= nss MCL = 1.75 MCL=50
I Influent 13 <1 <10
I Effluent 13 <1 <10
Manganese, Mn Sodium, Na Nickel, NI
ua/L mg/L ua/L
MCL= 50 MCL=nss MCL= 100
I Influent <10 5.5 <10
I Effluent <10 5.5 <10
MCL = Maximum Contamination Level per NCAC 2L .0200 (GA Standards)
nss = no stale standard
na = not analyzed
·cooler malfunctioned and samp lamp exceeded 60 deg C for appx 8 hrs
Total Dissolved Solids Chloride, Cl
mg{L mg{L
MCL=500 MCL=250
88 <2
82 <2
Nitrite Silver, Ag
mg/L uafl
.MCL=1 MCL= 17.5
na <5
na <5
Conner, Cu Iron, Fe
ua/L uafL
MCL= 1000 MCL=300
38 <50
42 <50
Lead, Pb Sel enium, Se
u a/L u afL
MCL=·15 MCL= 50
<10 <5
<10 <5
Sulfate
mgfL
MCL=250
<4
<4
Aluminum, Al
uafl
MCL= nss
<50
<50
Mercury, Hg
uofl
MCL=1.05
na
na
Zlnc,Zn
uafl
MCL =1050
52
49
Ammonia, NH3 TKN
mg/L m gfL
MCL= nss MCL=nss
na na
na na
Arsenic.As Barium, Ba
ua/L fJQfL
MCL=50 MCL=2000
<2 46
<2 46
Potassium, K Magnesium, Mg
mgfL mafL
MCL=nss MCL= nss
1 5.1
1 5.1
Flourl de, F
mg/L
MCL=2
<.8
<.8
NORTH CAROLINA
ENVIRONMENT AL 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
Gregory and Elizabeth Ollish
FOR THE OPERATION OF A TYPE SA? INJECTION WELL, defined in Title ISA 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 136 Perennial Drive, Mooresville. Iredell County. NC 28117, and will be constructed
and operated in accordance with the application submitted July 14. 2009, and in conformity with the
specifications and supporting data submitted, all of which are fi led with the Department of Environment and
N atural Resources and are considered a part of this permit.
This permit is for 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 ofits issuance until September 30, 2014, and shall
be subject to the specified conditions and limitations s et forth in Parts I through VIII hereof.
Permit issued this the 'd-\~ day of O~&!~< , 2009.
,j,. k oleen H . Sullins, Director t Division of Water Quality
By Authority of the Environmental Management Commission.
WI0300030 1
P ART I -WELL CON ST RUC TI ON GENERAL C ONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Inj ection 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 voi dable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each inj ection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be construct ed 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 reasonab ly i nsure against unaut horized 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 lockin g cap.
6 . Each injection well shall be afforded reason able protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an iden tification p late according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) m u st be submitted for each injection well to:
Aquifer Protection Section -U IC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Mooresville Regional Office
610 East C{,'!lter Avenu e, Suite 301
MooresviIJe, NC 28115
[phone]
GW-1 s must be submitted within 30 d ays of completion of well construction. Copies of the GW-l
form(s) shall be retained on-site and availabl e for inspection.
PART II -OPERATION AND USE GENERAL CONDITIONS
1. This permit i s 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 withou t 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 P ermittee, a formal permit amendment request must be submitted to t h e Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
WI0300030 2
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 ID -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. 1n 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 Pennittee 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 Pennittee 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 thi s facility.
PART IV -OPERATIONS 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 additipns in the permitted facility or activity not specifically authorized by
the pennit.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative o f the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property. premises, or place on or rel ated to the injection
facility at any reasonable time for the pUipOse of determining compliance with this permit, may inspect or
copy any records that must be maintaine-d 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 i nspection, 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 VI-MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, s urface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be establisbP-'
acceptable sampling reporting schedule shall be followed.
WI0300030 3
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Mooresville Regjonal Office, telephone number (704 ) 663 -1699, 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 repo rt to the Director, the relevant and
correct facts or information shall be promptly s ubmitted to the Director b y the Permittee.
4. In the event that the permitted facility fails to perfo rm satisfactoril y, the Permittee shall take su ch
immediate action as may be required by the Director.
PART VIl -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART VIII-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 discont inued 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)(1). Well
Construction Standards.
2. When operations have ceased at the facility and a well will n o longer be u sed for any purpose, the
Pennittee shall abandon that injection well in accordance with the procedures sp ecilied in ISA 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
cont amination of an underground source of drinking wat er.
(B) The entire depth of each well shall be sounded befor e it is sealed to insure freedom from
obstructions that m ay interfer e wi th sealing operations.
(C) Each well shall be tl1 oroughly disinfected, prior t o 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 compl etely 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.
4
(F) In those cases when, as a result of the injection operations, a subsurface cavity bas 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 Pennittee 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 Vll{ (1) and (2) (G) shall be submitted to:
WI0300030
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
Rogers, Michael
From:
Sent:
To:
Cc:
Subject:
Attachments:
Michael,
Schutte, Maria
Wednesday, September 23, 2009 11 :03 AM
Rogers, Michael ·
Pitner, Andrew; [e-mail]
WI0300030
WI0300030 Lab Results for 081109 Sampling.pdf
Attached are the. Ollish UIC sampl e results. I did not see anything to delay permit approval.
Maria
Maria Schutte, Environmental Senior Technician -Maria.Sc hutte@ ncdenr.gov
Division of Water Quality -Aquifer Protection Section
Mooresville Regional Office (MRO)
North Carolina Department of Environment & Natural Resources
610 East Center Avenue, Suite 301, Mooresville, NC 28115
MRO Main Phone: [phone]
Direct Office Phone: [phone]
MRO Fax: [phone]
APS website: http ://h 2o.enr.state.nc.us/agw.htm1
NOTICE: Emails sent to and from this account are subject to the Public Records Law and may be disclosed to third
parties. '
North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DMSION OF WATER QUALITY-GROUNDWATER SECTION
Location code __ WI0300030 --'£~ SAMPLETYPE ~PRIORITY qe,.. (bol kt/tDW @) County_lredell J{wmr tlne Lab Number
Quad No Serial No. 0 Soil D Emergency Date Received f -I a-os Tim~ 0
Lat. Long. D Other
0 Chain of Custody
Rec'd By: HF From:Bus. ourierand Del..
01her.
Re rt To: ARO FRO RO RRO WaRO WiRO Data En : le
~o. K"111ston F~1~st. ee'ntrat Off., Othe;: _______ _
Shipped by: Bus, · Hand Del., Other. _________ -:-. P.u~~e(Ul~System lnspectjOJY
Collector(s): Maria Date: 08/1112009 Time 'J-\\5 \'fl rra"seiine, Complaint, Compliance, !.,UST, Pesticide study. Federal Trust. Other: ____ _
FIEL ANALYS S Owner. Greg and Etlzabeth Ollish (c.-cleo.-J pH..._ __ ..,....,__.,....___ Spec. Cond.94 /f7etJ µj°at 25°C Location or Site: 136 Perennial Dnv·-. -e-, M-oo_resvt __ ill_e _______________ _
Temp.1 ....... _~...c:...~.----°C Odor lfA}~ • Description of sampling point Influent Port ___________________ _
Appearance c.. C.. r SampDng Method: Pump ____ ---.,1Puriii""""""'·tiii"""".•«..,_ e1mc;.,.,-----Sample Interval ______ _ Field Analysis By:· Maria Schutte_____________ Remarks ______________________________ _
LABORATORY ANALYSES ~llma,Utan.,.,m:.)
t,yBy. ______ C
Date Reported: ____________ _
800310 mg/l X Dlsa. Solids 70300 mg/l X Ag-Snver 46566 un/L Oraanochlorine Pea11cides
COOHlgl,340 mg/l X Ruorldei51 mg/l X Al-Aluminum 48557 un/l Oroanoohosohorua Pesticidee
CODl.oW335 mg/L Hardness: Tola! 900 mg/l. X .A&-Pnenlc 46551 ua/L N',tmo,,n Pesticides
X Cdiform: MF Fecal 31616 1100ml Hardness (non-cart>) 902 mg/l X Ba-8alium-48558 •""L Add Hert>icides
X Colibm; MF Tola.I S 1504 1100ml Phenols 32730 ugn X Ca-Caldu-n 46552 mg.IL PCB1 .
TOC880 mg/l Specltlc Cond. 95 pMhos/c:m X C6-CadmiUm 46559 u_Q/L
Turbidity 711 NTU X Sulln,9-45 mg/l X Cr-Chromium 48559 ua/L
Residue, Total Suspended 530 mg,t. SUifide 745 mg/L X Cu-Copper 46562 uoJL
X Fe-lten 46563 • uoJL SerniYolalillfOmAnics
OlandG~ '"l>'l Hg-Mereuiy 71900 uo/L TPH-Oiesel Ranae
pH403 unils X K.Potnsium -46555 ITIQ/l
Alk.alinlly to pH 4.5 410 mg/L X MQ-Magneaium 46554 mail
Alkal1nity 110 pH 8.3 415 mg/L X Mn-M1nganese 46!585 ua/L Volallle Or11anlca NOA bOtllel
Celbonata4◄5 mg/I. NH1 asN810 mg/l X Na-Sodium 46556 ma/I.. TPH-Gasollne Ranae
Blcaltlonale -440 mwL TKNaaN625 mg/l X NI-Kldc81 uQ/L TPH-811:X Gasoline Ranae
C&lbon dioxide 405 mg/l X N0:i + NO. as N 630 mg/l X Pl>-l.ead 48584 unit
X Chloride 940 mg/L P: Total as P 665 mg/L X Se-Selenium ua/l
Chl'omlUm: Hex 1032 UWL-Nitrate (NO.a N) 620 mg/l X Zn-Zinc 41!15&7 Ullll
Color: True 80 cu
Cysnlde720 mi,L
Nitrite (NO.II N) 815 mwl-LAB USE ONLY 't. ~ Temperature on arrival (OC):
lab Comments. __________________________________________________ _
GW<i4 REV. 7/03 For Dissolved Analysis-submit 1llle,ed sample and ~ 'DIS" In bloat.
WC ([YWQ Laboratory Section (J?ssu{ts $:;,mp!e ID AB48080
L ocation ID: WI0300030--<IN Collect Date : 08111/2009
Loe. Oescr.c GREG ANO EUZABE™ OLLISH con&et Time:: 14:15
Vis~ ID
CAS# Analyte Name PQL Rffult Qu-11 fier Unlb Ana yst/Date Ap prolfed By /01111
7439-SM FebylCP 50 so u UG/l BSKINNER EST AFFORD
Mlthod Rot■rence EPA200.7 8117/D9 8/24/09
7440-09-7 KbylCP 0.1 1.0 mG/l WPS EST AF FORD
Melhod Reference EPA21XJ:7 8117109 8/24/D9
7439-95-4 Mgb)'ICP 0.1 5.1 mwt. BSKINNER EST AFFORD
MethOd Reltrenoe EPA200,7 8/17/09 8/24/09
7439-96-5 MnbylCP 10 10 u ug/l. BSKINNER ESTAFFORD
Metl10d Fle!ertnea EPA200.7 8117/DS 8/24/09
7440-23-5 NebylCP 0.1 5.5 mg/I.. WPS ESTAFFORO
Method Reference EPA200.7 8117/09 812.t/09
7440-02-0 NlbylCPMS 10 10 u ug/1.. PGAUTHll:.R ESTAFFORO
Molhod Ro!eN>r><:e EPA200.8 8/17/09 8124109
7439-92-1 PbbylCPMS 10 10 u U(IIL PGAUTHIER ESTAFFORO
Mell\Od Reference EPA 200.8 8117/09 8124109
7782-49-2 S.bylCPMS 5 5.0 u uwL PGAUTHIER EST AFFORD
Method Reference EPA200.8 8117/09 a12.i109
744o..66-6 ZnbylCPMS 10 52 ug/1.. PGAUTHIER EST AFFORD
Mathca Rererena, EPA200,8 8117109 812•109
Laboratory Sktlon» 1623 Ma ll Sorviea Canter, Raleigh, NC 27699-1623 [phone] Page 3 of 3
WC {l)'llttQ_ La6oratory Section <R.,suEts Sample I AB48080
Location ii); WI030C)(l3IHN Collect Date. 01/1112009
L~.Descr.: GREG ANDEUZABElliOLUSH Conect Time:: 14:15,
Vilit ID
CAS# Ana!y1a Name Result Qualifier Units Malyst/Oa1e App«>v.d By /Date
sample temperallll'e Ill NCetol by lab 1.3 'C OSAUNDERS SMATHIS
Melhod Referel\Ce 8112/09 e,,2109
MIC
Colfonn. Uf Feail In llquld 1 8201 CRJl'IOOml NDEO MOVERMAN
MallOd Refemic:a N'HA92220-201h 8/12108 8/18109
Collloon, MFTclal In liquid 1 1 B2Q1 a=u/100ml NOEO MOYERMAN
Met\od RIii.,..,.,. APHA82228-20lh 8112m 8118109
WET
IOll ~8'111Y _TTIUL mg/I.. MIBRAHIM1 MOVERMAN
Melhod Referenct !PA300.0 8/lJA:)9 tlnBIO!I
Total DlslaMd Saids ii llqutd 12 88 mg/I.. JSTALEY MOYERMAN
Melholl Refemlcl APHA25'0C-18™ 811:Mlll 81111108
Chlollde 2.0 U,P ffl0/1.. MIBRAHIM1 MOVERMAN
MetloclReflf9nce EPA300.0 81'13109 8118109
Fluoride tu G..8 U.P mg,\. M!BRAHIM1 MOVERMAN
Melhod Reference EPA300,0 1113109 S/18/09
SUffl'8 2 c.o U.P mglL MIBRAHIMl MOVERMAN
MdlodR-EPA300.0 8113/09 8111/09
NUT
N02+N03 as N In lquld 0.02 0.8-4 mg/1..asN MAJAYI CGREEN
M8'hod Rel8l9ncl u,,;10--107--04-1< 8/12/09 8/1Mlll
MET
7440-22~ AgbylCPUS 5 5 .0 u Ug/L PGAUTHIER ESTAFFORD
~ Refenlnce EPA200.8 8/17109 8124109
7429-9().6 Alby ta> 50 50 u • BSKINNER ESTAFFORO
Mtlhod RefGNncl EPA200.7 8117A:l9 8124/09
7440-38-2 AsbylCPMS 2 2.0 u ug.t. ?GAUTHIER ESTAFFORO
Md10d Reference ~PAa)0.8 8117/09 8124/08
7440-38-3 BaltlylCP 10 46 Ug/L BSKJNNER ESTAFFORD
MllnOd Rl!fl!ffllC$ EPA200.7 8117109 8124/09
7 4 40-70-2 C.byl<J> 0.1 13 mg/L WPS ESTAFFORO
Method Reference EPA200.7 8117108 8124.W
7441>-43-9 CdbylaiMS 1 1.0 u lll>'l-PGAUTHIER ESTAFFORD
IAethod Rwrence EJ>A200.8 8117Al9 8f1Am
744~7-3 Crt,ylCPMS 10 10 u UQ/L PGAIJ'nilER ESTAFFORD
Method Rtletenoe l;PA200.8 Wl7IO!J 8l24/0II
7440-50-& CUbylCPMS 2 38 llll'L PGAUTHIER ESTAFFORD
IAIG!Od R,.,.,_,. EPA200,8 111'17109 8/24109
La.bomory s.ction» 1823 Mall Se,v~ Center, Raleigh, NC 27$99,16Zl (919) 7U.U08 Page 2 ol 3-
% . ©'WO La6oratorv S ection <Results
County: fREOELL Sample ID: A848080
Ri11Cr8asin PO Number# 9G1001
Report To MROAP Oate Received: 08/12/2009
Collector. MSCH!,!TTE
Region : !!aQ
Sample Matrix: GRO!,lNDWA TER
Time Received: 08:40
Labwoiite LoginlO SMATHIS
Cate Reported: 9/15/09
Loe. Type: WATERSU~Ll'. Report Generated: 09/1 5/2009
Eme,gency Yes/No
coc Yes/No VlsitlO
Loe. Dasc:r.: GREG ANO EUZABED1 OLUSH 9C1 9 \ l'l ID9
lr-Loca--tio_n_l_D_: __ W1_0_3_00_0_30-I_N _____________ ,.....l_c_oU_e_ct_D_a_te_: --OS/-11-/200--9----,l-c_ol_ect __ Ti_m_e_::--1,-:-15------,l-s_a_m_p-le_O_e_pth ______ _,I
Sample Qualifiers and Comments
NCOENRMRO
DWQ -AQuifer Protection
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A-Value reported is the aver..ge of two or more determinations
B1-coun1abla membranes with <20 ~onias; Elrtimated
82-Counts from all ffie,. were zero.
83-Countable membranes will1 more than 60 or 80 c;olonies; Estimated
&4-Filters have counts of both >60 or 80 and < 20; Estimated
85-T oo many colonies were presen~ loo numerous to count (TNTC)
J2-Reportied value faied to meet QC criteria ror either precision or ,1ccuracy; Estimated
J3-The sample matrix lnterteted with the ability to make 11ny aCGUnile determinallon; E•timatod
J6• Tl'le lab analysis was rrom an unl)fflerved or improperly c:hemically p~rved $.Bm~e; Estimated
N1-Ttie compo~e,:it t,as Ileen tentatively ldeniified based on ma•~ apedr.ll llbr.iry search :and has an estimated value
LAB
N3-Estimatecl COnC$ntration ls < POL and >t.lOL
NE-No established POL
P-Elevated POL due to mauix lnlelference an<l/or ..ample dilution
01-Holding time exCMdltd prior to receipt at lab.
02· Holding time e><0eeded following receipt by lab
POL-Practical Quantilation Limit-subject to change due to lnstNment cen1l1ivity
U-S.mp\e$ analyzed for this compound but not detected
X.1-Sample not analyted for this compound
Laboratory Section» 1613 Mall Service Center, Raleigh, NC 27899-1823 [phone] Page 1 of 3
North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environmem and Natural Resources
OMSION OF WAlER QUALITY-GROUNDWATER SECTION
Location code __ W10300030,..~f'f-' SAMPLElYPE §AMPLE PRIORITY @) LatJtber100 1.-#2-1/ g oi I County_lredell ~Water ~Routine
Quad No Serial No. □Soll Emergency Date Received i-l.a ... Q9 Time:.-.m40
Lal Long. □ other Rec'd By: From :Bu(Courier)and Del.,
D Chain of Custody Other: Hf RO RRO WaRO WiRO
800310 mg/l X Dias. Solids 70300 mg/l X Ag-S~ver '485611 unit Oraanochlorlne Pestleides
COD~h340 mg/L X Fluolide 951 mgll X AJ-AIUminum 46557 ull/L Omenoohosnhnrus Peeliddes
CODl.ow335 mg/L Hantness: Total 900 mgll X AI-Anlenic 46551 Ull/l Nllrr>o4'n Pestlcidea
X Collfoon: MF Fecal 31816 1100ml Hardness (non-cart>) 1102 mgll X Ba-Barium '48558 Ullll Acid Herbicides
X Colifann: MFTo1al31504 1100ml Phenols 32730 UQ/1 X ca-ca1aum '48552 rrlQ/l PCBs
TOC680 mg/I.. Spedflc: Cond. 95 11Mhoslcm X Cd-Cadmium 46559 uo/1
Turbidity 78 NTU X Sullete945 mgll X Cr-Clvcmium '48559 UQ/l
Residue, TO!al Suspended 530 mg/L Sulllde 7◄5 mg/L X Cu-Copjler 46562 ua/1
X Fe-lroo 46563 UQ/L Semivolalll8 Orru1n1<:s
Oil and Grease mgll Hit-Mercu,y 711100 uQ/L TPH,Dlesel Ral1(1e
pH403 Ullita X K-Potanlum ◄6555 rTlQ/L
Abllnityto pH ◄,5410 mg,1. X Mg-Magnesium "855'4 mall..
Aaallnlty to pH 8.3 '415 mg/l X Mn-Manganese 48585 un/L Volallle Oroanlcs NOA bOllle)
cart>onale ◄45 mg/l. NHJ as N 810 mg/L X Na-SOdlum -46558 mall TPH-Gaaollna Ranae
lflClllbonale '40 mg/l TKNaaN82S mg/I. X Ni~icl<el unlL TPH-BTEX Gasoline Ranae
catbon dioxide '405 mg/l X N()z + NOm as N 630 mg/I. X Pb-Lead48564 ua/L
)C Chloride IMO mg/l P:TolalaP685 mg/I. X Se-Stlenfum uo/L
Chromium: Hex 1032 ug/l Nlvate (NO, as N) 620 mg/l X Zn-Zinc "65117 uo/L
Color: True eo cu
Cyanide720 mgll
Nitrite (NOz as N) 615 mg/I... , ~BUSEQt:lbY
/ C '3 Temperature on artival {"C):
ubComments~------------'----------------------------------------
NC IDWQ La6oratory Section <.8.§su[ts Sample IC AB48081
Location ID: WI0300030·EFF Collect Date· 08111/2009
Loe. Oescr.: GR EG AND ELIZABETH OL USH Collect Tirne:: -14:40
V1&itlD
CA$# Analyte Name PQL Result Quatlfier Units AnalyaVCate Approved By IC.ate
7439-89-6 Fet,ylCP 50 50 u uQIL BSKINNER ESTAFFORC
MethQd RefafQnce EPA20().7 8/17101! 8/24/09
7440-09-7 Kby l CP 0.1 1.0 mg/l. WPS ESTAFFORC
Malhoo Rafarunce EPA200.7 8117/09 11/24/09
7439.95-4 MgbylCP 0.1 5.1 mg,1. BSKINNER ESTAFFORD
Melllo<J Reference EPA200.7 8117/09 812W9
7439-96-6 MnbylCP 10 10 u UOIL BSKINNER !:STAFFORD
Meth0<1 Rofer1noo EPA200.7 8117109 8124109
7440-23-5 NabylCP 0.1 5.5 mg/l WPS ESTAFFORO
M91hod Reference EPA200.7 8/17/09 8124109
7440-02-0 NlbylCPMS 10 10 u ug/L PGAUTHIER ESTAFFORD
MelhOd Raf1ttenc:a EPA200.8 8/17109 8124/09
7439-92-1 PbbylCPMS 10 10 u ug/L PGAUTHIER ESTAFFORO
MW\Od Relerenca EPA200.8 8117/09 8124109
7782-49-2 SebylCPMS 5 5.0 u ug/L PGAIJTHIER ESTAFFORO
M•tho4 Relerence EPA2008 8/17109 8,'24/09
7◄40-66-6 Znt,y l CPMS 10 49 Ug/1. PGAUTHIER EST AFFORD
Methoa Roteref\Ce EPA200.8 3,117109 8124/09
Laboratory s.ctlon» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 3 of 3
NC V'WQ, La6oratory Section <R$sufts Sample 10 AB48081
location 10: WI03000lo.Eff ColedOate: 08/1112009
Loe. O.scr.: GREG ANO EI...IZASEllf OUJSH Col-a limo:: 14:40
VISitlO
CAS I AftllyWName PQL Raull QUlllftar Units Analyst/Dato Appnm1d 8Y /Dale
Sample~ lit ----by lab 1.3 'C OSAUNOERS SMATHIS
Method Rnn,nce 8/lZAl!I 8112/09
MIC
Colffoml, MF Fecal In Dquld 1 1 B2Q1 CFUr100ml NOEO MOVERMAN
Me1110d Ralenlnca APHAi2220-20lh 8112/09 8/1M>!i
CdJml. MFTCltlll In lquld 1 B2Q1 Cl'U/100ml NOEO MOVERMAN
Melhocl Rtfeq-APH-',92228-2.0lh 11112109 8/18/09
WET
Ion~ -~ mo,\. MIBRAHIM1 MOVeAMAN
M-Rellnnc. EPA300.0 8113109 8118/09
TOIIII DlllolvedSolds In~ 12 82 rng,\.. JSTALEY MOVERMAN
Method R-.,,c:. ,_,,HA2540C-18TH 8113/09 8/19/08
Chlortde 2.0 U,P rng,\.. MIBRAHIM1 M0\11:RMAN
Method R-nc. EPA~O 8/13/09 9/18,'0&
RIIDl1de 0 .4 0 .8 U.P mg,\.. MIBRAHIMl MOVERMAN
Melllod Rt-EPA300,0 8113109 8118/0!1
Sutr.19 2 4,0 U.P mg,\. MIBRAHIM1 MO'IIERMAN
Melhod Refenlnce E?A300.0 8113/0G 8/18/09
NUT
N02+N03 as N In Dqlid 0.02 0.78 1J91..asN MAJ.AYI CGREeN
Mt1hod Rele,.,,,.. LK'IG-107-04-H 8/1m9 &1'18/09
MET
74-10.22-4 AQbylCf'MS 5 5.0 u ug,1. PGAllT'HIER ESTAFFORO
Melhod Refela-EPA:200.8 811?109 8/24109
7429-90-6 1,J by lOP 50 50 u u;ll BSKINNER ESTAFFORO
Md'lodR~ EPA:200.7 81171041 8/2.4/09
74-10-38-2 AsbylCPMS 2 2.0 u ug/l. PGAUTHIER ESTA.FFORO
MelhodRn..,,.. EPA:lll0.11 8117/0i 812~109
74A0-3$-3 BabylCP 10 "6 ugA. BSKlNNER ESTAFFORO
Melt-.od Relefenoe EPA200.7 lll7/09 8124109
7440-70-2 C8bylCP 0.1 13 mglL WPS ESTAFFORO
Melhod RefemnCIB EPA200.7 8117109 8124/09
744CM3•9 Cdt,ylCNS 1.0 u ~ PGAUTHIER ESTAFFORO
Mdlodfttftt..u EPA200,8 8117109 812.~
74CCM7-3 Cl"bylCPMS ,o 10 u ug,\. PGAIJTHIER ESTAFFOAO
.... -11.--,, ... EPA200.I 8117109 8/2~
7440-$-8 CubylCPMS 2 42 ug/L PGAUTHIER ESTAFFORO
Moll!oclR....,_ EPA200.I 8117109 8124/09
Labomoty SacUon>:> 1&23 M•U Service Centlr, Rllalgll, NC 27Cllt-112i (81'1 733-3901 Page 2of 3
:M rDWO La6orato rv Section <R esults
County: JREOELL Sample 10: A848081
RiverBuin PO Number-9G1002
Report To MBQ!f Cate Received: 08/12/2009
Col!eclor: M~Cl;!!.!TTE
R~ion: MRO
Sample Matrix: ~RO!,!NDWA TER
Loo. Type: WA!l;B §UPP!. Y <f
Time Received : 08:4D
labworks LoglnlD SMATHIS
Date Repented: 9/15/09
Report Generated: 09/15/2009
Emergency Yes/No
COC Yes/Na
Loe. Descr.: GREG ANO EUZA,BEJH OLLISH ··96 q[{g/09
lr-L-a<a-!ion--,o-:--VVl-0_30_00_3_0--EF-F------------,--,-C-c-Uect--Oa_t_e _: --ol/1_1_12_0_09 ___ -,Tc-c-c-llect_Tl_m_e_::--1.--:-.CO------,I-Sa_m_pl_o_D_o_p_lh _____ __,I
Sample Qualifiers and Comments
NCOE.NRMRO owa . Aauifer Protection
Routine Quali~ers
For a more detailed description or these qua!mer codes refer to www.dwqlab.org under Staff Access
A-Value reported fs lhe average of1WO or more detenninations
B 1 -Countable membranes with <20 colonies; E&tlmated
B2· Counts trom all filters were zero.
83-Counteble membranes witl1 more than 60 or 80 colonies; Estimated
84-Fllters have c:ounls ot both >60 or 80 and < 20: Estimated
85-Too mal'y coloniH were present, too numerous to count (TNTC)
J2-Reporled value fa~ed to meet QC c:ritaria for either precision or accuracy; Estimated
J3-The $ample m alrix Interfered with the abUity to make any accurate detennination: Estimated
J6-The lab analy5 1J wa5 from an unpreserved or Improperly Cllemlcally preserved sample; Estimated
NFThc c;omponent has ~en tentatively Identified bast!!d on mass spectral llbnuy search and has an estimated value
LAB
N3-Estimated concentrati011 is < PQ L and >MDL
NE-No established POL
P-eleY11ted PQL due to matrix interference and/or sample dilution
01-Holtting time exceeded prior 10 reeelptat lab,
02· Holding time e1<ceeded following recaipt by lab
POL-Ptae\ical Ouantitallon limit-subject to change due to inwument 1ensltivity
U-Sample$ analyzed ror Ult$ compound bllt not delected
X1· Semple not analyzed for thb compound
Laboratory Section>> 1623 Mall Servica Center, Raleigh, NC 27699,1623 [phone] Pase 1 of3
Rogers, Michael
From:
Sent:
To:
Greg.Ollish(gollisti@ecrengines .com]
Thursday, July 23, 2009 9:50 PM
Rogers, Michael
Subject:
Attachments :
RE: RE Application No . W10300030
WI0300030.pdf
Mr. Rodgers
Thanks for the tip. Please do not hesitate to contact me if I can be of more service . Sorry
for the mistake
-----Original message-----
From: "Rogers, Michaeltt [e-mail]
Date: Thu, 23 Jul 2009 11:11:55 -0400
To: Greg Ollish [e-mail]
Subject: RE: RE Application No. WI0300030
> Mr. Ollish-
>
> Attached is the signature page. If yo u can sign and scan and send back to me via email, it
would expedite things-and save you some postage.
>
> Thanks
>
> Michael Rogers, P.G. (NC & FL)
> Environmental Specialist
> NC Div of Water Quality-Aquifer Protection Section (APS)
> 1636 Mail Service Center
> Raleigh, NC 27699 -1636
> Direct Line [phone]; Fax [phone] (pllt to my attn on cover letter)
>
> E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties
>
>
> -----Original Message-----
> From: Greg Ollish [mailto:[e-mail]]
> Sent: Wednesday, July 22 , 2009 8:04 PM
> To: Roger~, Michael
> Subject: RE Application No. WI0300030
>
> Mr. Ro dgers
>
> Thanks for the message. unfortunately I did not make a copy of the application. If you
would be so kind to return the form I will promptly have it completed and returned. Sorry for
the inconvienience. And thanks in advance for your help.
>
> Greg Ollish
>
> ECR Engines
> 704-657-5987
> gollish~ecrengines.com
1
>
>
Greg Ollish
ECR Engines
704-657-5987
gollish@ecrengines .com
2.
Rog ers, Michael
F=rom : Pitn er, Andrew
Sent:
To:
Thursday, August 20, 2009 11 :55 AM
Rogers, Michael
Cc: Schutte, Maria
Subject: Ollish geothermal WI0300030
Attachments : APRSR040929-W I0300030-Ollish-5A 7-Aug ust 2009ahpsigned ,pdf
Greetings. Our staff report for the subject should be attached. Let us know if you have any questions & we'll send
results as soon as they're available.
Andrew
Andrew Pitner, [e-mail]
Division of Water Quality -Aquifer Protection Section
Mooresville Regional Office (MRO)
North Carolina Department of Environment & Natural Resources
610 East Center Avenue, Suite 301, Mooresville, NC 28115
MRO Main Phone: [phone]
Dir-ect Office Phone: [phone]
MRO Fax: [phone]
APS website: http://h2o.enr.state.nc.us/agw .html
NOTICE: Emails sent to and from this account are subject to the Publ ic Records Law and may be disclosed to third
parties.
1
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 08/20/09
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __
I . GENERAL INFORMATION
County: Iredell
Permittee: Greg and Elizabeth Ollisb SFR
Project Name:
Application No,: WI0300030
1, This application is (check all that apply): D New [81 Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration O Evaporation/Infiltration Lagoon
D Land Application of Residuals O Attachment B included O 503 regulated O S03 exempt
D Distribution of Residuals O Surface Disposal
D Closed-loop Groundwater Remediation !ZI UIC Injection Wells (5A7) GeoThermal
Was a site visit conducted in order to prepare this report? [81 Yes or O No.
a. Date of site visit: 08/11/2009
b. Person contacted and contact information: Greg & Elizabeth Ollish 704-660-3256
c. Site visit conducted by: Maria Schutte
d. Inspection Report Attached: D Yes or t8J No.
2. Is the following information entered into the BIMS. record for this application correct?
~ Yes or O 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 / Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
ll. NEW AND MAJOR MODIFICATION APPLICA170NS (this section not needed fo,-renewals or minor
modifications, skip to next section)
Description OfWaste{S) And Facilities
1. Please attach completed rating sheeL Facility Classification: n/a
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No 181 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? D Yes O No~ NIA. Ifno, please explain: __
FORM: APRSR040929-WI0300030-Olli&h-5A 7-August 2009 1
AQUIFER PROTECTION REGIONAL STAFF REPORT
4 . Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? rgJ
Yes O No D N/A. If no, please explain: Hand-drawn site maps with written distances are not great (lacks
surface drainage), but get the point across sufficient[)' for this SFR.
5. ls the proposed residuals management plan adequate and/or acceptable to the Division.
NIA. Ifno, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
0 Yes D No ~ N/ A. If no, please ex.plain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
0Yes0NorgJ
D Yes D No rgj NI A. lf ye"5, 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 t8J 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? 0 Yes rgJ No D N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and comp1iance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: No info on the monitoring plan was provided.
10. For residuals, will seasonal or other restrictions be required? D Yes D No [8] N I A If yes, attach list of sites
with restrictions (Certification B?)
HI. RENEWAL AND MODIFICATION APPLICATIONS (use p revious section for new or .nraior 1nodification
systems)
Description Of Waste(S} And Facilities
NIA thisfaci/ity
W. 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:
181 Heating/cooling water return flow (5A 7)
0 Closed-loop beat pump system (5QM/SQW)
D In situ remediation (SD
0 Closed-loop groundwater remediation effluent injection (SU"Non-Discharge")
D Other (Specify: __J
FORM: APRSR.040929-W10300030-Olllsh~5A7-August 2009 2
AQUIFER PROTECTION REGIONAL STAFF REPORT
2. Does system use same well for water source and injection? IZJ Yes O No
3. Are there any potential pollution sources that may affect injection? (8J Yes O No
What is/are the pollution source(s)? Septic svstem (nossible bacterial contamination). What is the distance of
the injection well(sl from the pollution source(s)? Well is approx. 80ft. from septic s11stem. per original hand
drawn map.
4. What is the minimum distance of proposed injection wells from the property boundary? ~25 fL
S. Quality of drainage at site: [8l Good D Adequate O Poor
6. Flooding potential of site: (8J Low D Moderate 'D High
7. P or groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? 0 Yes [8J No. Attach
map of existing monitoring well network if applicable. lf No, explain and recommend any changes to the
groundwater monitoring program: Not a remediation s1 •stem and no monitoring program was established for
this geothermal svstem other than renewal sampling b)• MRO. Prior samvle results do not indicate a problem,
but MRO recommended that resident contact countv DEH for periodic well sampling on their own as this is
also a supplv well.
8 . Does the map presented represent the actual site (property lines, wells, surface drainage)? [8J 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. Map wasn't great. but does an ok iob o(representing the
site. Well is in front vard (acing Perennial Drive approx 25 ft from propern• line. There are no sampling ports
at the well. thev are located inside the garage and are labeled.
Injection Well Permit Renewal And Modification Onlv:
l. For beat 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)?
0 Yes (8JNo. lfyes. explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? 0 Yes O No. If ves. explain:
3. For renewal or modification of groundwater remediation permits (of anv type). will
continued/additional/modified injections have an adverse impact on mi1rration of the plume or. management of
the contamination incident? D Yes D No. If ves. explain:
4. Drilling contractor: Name: Ben Harkev Well Drilling Inc.
Address: Rt 1 Box 175
Mount Hollv, NC.28120
Certification number: 462 (Driller is retired -this is an old # and address)
5. Complete and attach Well Construction Data Sheet.
FORM: APRSR040929-WI0300030-Ollish-5A7-August 2009 l
AQUIFER PROTECTION REGIONAL STAFF REPORT
Permit renewal. well data from original application: Total depth = 300ft: casing den th = 119ft: ,•ield = 15gpm.
Data confirmed b l' well tag. Did not see a pum p installation tag.
FORM: APRSR040929-WI0300030-Ollisb-5A 7-August 2009 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
f EVALUATION A.ND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application: No stated changes to original
permit. New PVC plumbing at sampling location was installed approximately three weeks ago, The system
experiences higher temperatures in summer months; the MRO discussed the option for surface discharge a.s
needed to improve efficiency with owner. The current owner is an ehgineer and has monitored system
temperatures and is knowledgeable about the system though he did not originally design/install it. The MRO
recommends issuing permit upon r eceipt of lab results.
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal of this pennit? D Yes [8J No. If yes, please explain
briefly. As long as lab results do not show a problem.
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 th.e 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; _[8J Issue upon receipt of needed additional information;
D Issue; D Deny. If deny, please state reasons: Reissue provided sample results are oka\',
8. Signature· of report preparer(s): --'M=an=·=-a =S=ch=u=tt=e __________________ _
Andrew Pitner ==-::i ... ~ Signature of APS regional supervisor: --=An=dr,,_,e""'w~P=-'itn""e""'r _________ --_ .... _·_·-_~_-__ _
Date: 08/20/2009
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: APRSR040929-WI0300030-Ollish-5A 7-August 2009 5
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM.
Date: Julv 23. 2009
To: 0 Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
~ Andrew Pitner, MRO-APS
0 Jay Zimmerman, RRO-APS
0 David May, WaRO-APS
0 Charlie Stehman, WiRO-APS
□ Sherri Knight, W-SRO-APS
From: Michael Rot?:ers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: MichaeLRoe:ers{w,ncmail.net
A. Permit Number: WI 0300030
B. Owner: Gre!! and Elizabeth Ollish
C. Facility/Operation; __
D Proposed C8I Existing D Facility D Operation
D. Application:
1. Permit Type: 0 Animal D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle D I/E Lagoon D OW Remediation (ND)
C8I UIC -SA 7 Geothermal well
For Residuals: □ Land App. 0 D&M
D 503 0 503 Exempt
D Surface Disposal
□ Animal
2. Project Type: D New D Major Mod. 0 Minor Mod. C8I Renewal D Renewal w/ Mod.
E. Com.meats/Other Infonnation: D I would like to accompany-you on a site visit. I NOTE: Pear AP, the sire map in your file should suffice a
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:
C8I Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D 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 SOP 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 1 o f 1
Rogers; Michael
From:
Sent:
To:
Subject:
Mr. Rodgers
Greg Ollish [gollish@ecrengines .com]
Wednesday, July 22, 2009 8 :04 PM
Rogers, Michael
RE Application No. WI0300030
Thanks for the message. unfortunately I did not make a copy of the application. If you would
be so kind to return the form I will promptly have it completed and returned. Sorry for the
inconvienience. And thanks in advance for your help.
Greg Ollish
ECR Engines
704-657-5987
[e-mail]
1
AWA
NCDENR
North Carolina Department of Environment and Natura l Res ources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Gregory S. Ollish
136 Perennial Dr.
Mooresville, NC 28117
Subject: Acknowledgement of Application No, WI0300030
Ollish; Gregory & Elizabeth -SFR
Injection Heating/Cooling Water Return Well (5A 7)
Iredell
Dear Mr. Ollish:
Director
July 16. 2009
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your pennit application and
supporting materials on July 14, 2009. This application package has been assigned the number listed above and wilt be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for addittonal information if necessary. To ensure the
maximum efficiency in processing pemtitapplications, the Div:ision requests your assistance in provicling a timel y 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 ·e-mail at [e-mail]. 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 http://h2o.enr.state.nc.us/documents/dwg orgchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
_J~ 'i-~odwfU
for Debrat atts
Supervisor
cc: Mooresville Regional Office, Aquifer Protection Section
Pennit Application File WI0300030
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh , North Carolina 27699-1636
Localion: 2728 Capital Boulevard, Raleigh. North Caronna 27604
Phone: [phone] I FA X 1: 919-716-0588: FAX. 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet www.ncwaterouality .org
Ari Equal Opportunity\ Affinnative Ae1lon Employer
Ni{thCarolina ;vaturally
NORTH CAROLINA
DEP .AR.TMENT OF. ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A ~LL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5-A 7 WELL(S)
____ New Permit Application OR __ ). ___ Renewal (check one)
• 20 c,,
PERMIT NO. WI I) -.000·(1~ (leave blank if NEW permit application)
A. PRQ.PERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): b•,\@:=;:F;.~ '\...,\ 6 D \\ ½ \-,
(1)
(2)
Mailing Address: / :=:; (p /~rL:A..J A..JI~ / Dr
City: /7 ,,r:,r.,L? ;..// //c,-State:~ Zip Code: 2 ~ II 7 County: l r:~~//
Home/Office Tele No .: 7 d:)7'-4.6D -32$G::> p en No.: 7D"t-~::::::Z -S987
~ ' /\1•' EMAIL Address: \ { L L \ I \ ,<~ r , L·\ r \_-
Physical Address of Site (if different than above):'"~~~,,,,.-,-~~~-=-~_At:_~~---~----~-------
City: ________ State: __ Zip Code: ______ County: ____ _
Home/Office Tele No.: ----------~C=e=ll~N .... o=.: _________ _
EMAIL Address: ______________ _
B. AUTHORIZED AGE)'ff OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: /Y / h
Contact Person: EMAIL Address:
Address: _____________________________ _
City: ________ State: __ Zip Code: _____ County: ______ _
Office Tele No.: Cell No.:
Website Address of Company, if any:. _____________ _
GPU/UIC 5A7 Well Permit Application (Revised 9/2007)
RECEIVED I DENR / owa
AQUIFFR PROi'Cr.TION SF.C70N
JUL l 4 2009 Pagel
C. WELL DRILLER INFORMATION
Company Name: T J.t> • o + /4{, .,p~ 3 ~ .< / /4..F-/o '2-!::-
Wen Drilling Contractor's Name: ____ / ____ _./_·"-~--'~=--=-_,.-,._"""'.,::.=---~-~---"-· _# ___ _
NC Contractor Certification No.: _______________________ _
Contact Person,_: ---------------=E=MAfL=-=~A=ddr=es==s"-: _________ _
Address: _______________________________ _
City: _________ Zip Code: ____ County: ____________ _
Office Tele No.: Cell No.: ----------
D. HEAT PUMP CONTRACTOR INFORMATION {If different than drlllel'.')
E.
F.
G.
H.
Company Name: _____________________________ _
Contact Person~: ______________ E=MAIL~=· A~ddre=s=s~: _________ _
Address: _______________________________ _
City: _________ Zip Code: ____ County: ____________ _
Office Tele No.: Cell No.: _________ _
STATUS OF APPLICANT
Private: ,& Federal: Commercial:
State:_._ Municipal: __ Native American Lands:
INJECTION PROCEDURE (briefly des~ow the injection well(s) will be used)
b~,,. 4~~/7">.n-l //4~ ~.,.., ~
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 )L
YES
7 Y
NO ___ _
NO ___ _
WELL CONSTRUCTION DA TA (Skip to Section I lf this is a Permit RENEWAL)
(J)
PROPOSED Well(s) to be constructed for use as an injection welJ. 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 Form GW-1 (Well Construction
Record) if available.
Date to be constructed: _______ Number of borings: ___ _
Approximate depth of eacl1 boring (feet): _______ _
(2) Well casing. Is the well(s) eased? (check either (a.) YESm: (b.) NO below)
(a) YES ___ If yes, then p rovide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic __ Other (specify) ______ _
Casing thickness: __ diameter (inches): ___ depth: from ___ to ___ ft. (reference to land surface)
Casing extends above ground ____ inches
GPU/UIC SA7 We11 Permit Application (Revised 9/2007) Page2
(b) NO
(3)
(4)
(5)
(6)
Grout (material sUITOunding well casing and/or piping}:
(a) Gro ut type: Cement__ Bentonite Other (specify)~------
(b) Grouted surface and grout depth (reference to land surface):
__ Around closed-loop piping; from ___ to ___ (feet).
__ Around well casing; from ___ to ___ (feet).
Well(s) Screen Information
Depth of Screen: From ____ to ___ feet below land surface
N.C . State Regulations (Title I SA NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead water quality and 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) Influentline? 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 Form GW-1 (Well Construction Record). If Form GW-1 is not available. provide the
following data:
Groundwater Source . From what depth, formation , and type of rock/sediment units will the groundwater
be withdrawn? (e.g. granite, limestone, sand, etc.)
Depth: _______ Formation: ______ Rock/sediment unit:,_ __ -'-----
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY TUE DA TA FOR EITHER EXlSTING OR PROPOSED WELLS IF
nus INFORMATION IS UNAVAILABLE BY OTHER ME.ANS.
I. OPERATINGDATA
(1) Injection rate:
(2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
J. INJECTION-RE LATED EQUIPMENT
Average (daily) S gallons per minute (gpm),
Average (daily) __ gallons per day (gpd).
Average (daily) ___ pounds/square inch (psi).
Average (January) __ ° F, Average (July} __ ° F.
Attach a diagram showing the engineering layeut or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
K, LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
{I) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances. between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
geothermal beat pump well system. Label all features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the.facility's location and the map name.
GPU/UJC 5A7 Well Permi t -Application (Revised 9/2007 ) Page 3
L . CERTIFICATION
Note: This Pemut Application must be signed by gm_ person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and e,m familiar with -the information
submitted in this document and 3ll attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is ttue, accurate and complete.
I am aware that th~ are significant penalties, including the poasibility of fines and imprisonment, for submitting
faue information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtcnan~ in accordance with the proved specifications and conditions of the P · t."
Signature e Owner/Applicant
&~~ 6 Ol\ ;6,
Printo,~ hl!N~. K ~
i!:18:tcan• E lrzcJxih · 6//l
· Print or Type Full Name
Signature of Authoriud Agent, if any
Print~ Type Pull Name
Please return two copies _of 1he completed Application package to :
North Carolina DENR-DWQ
Aquifer Protection:Section
UICProgram
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
OPU/UIC SA 7 Well Pennit Application (Revised 9/2007)
RECEIVEO /DENR/DWQ
AQUll=FR'PRnTFCTION AACTION
JUL 14 2009
Page4
L CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of Jaw, 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 filere are significant penalties, including the possibility of fines and imprisonment, for submitting
false infonnation. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with th proved specifications. and conditions of the P
Signature e Owner/Applicant
&~~ ~ Ol\ ;~,
Pri••~~·~· K ~ ld:::2!J:ey1 can,
E/rub:1-tz · 6//l
Print or Type ·Full Name
Signature of Authorized Agent, if any
Print oi: Type Full Name
Please return two copies _of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection:Section
UICProgram
1636 Mall Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC SA 7 Well Permit Application (Revised 9/20/J7)
RECEIVED / OENR I DWQ
AOUIA=R'PRnn:r.nnN ~F.CTION
JUL 14 2009
Page4
L. CER
This Permit Application must be signed by each person appearing on the
corded legal property deed.
"I hereby c tify, under penalty of law, that I have personally examined and am familiar 1th the information
submitted in is document and all attachments thereto and that, based on my inqu· of those individuals
immediately res nsible for obtaining said information, I believe that the information is tru , accurate and complete.
I am aware that re are significant penalties, including the possibility of fines and i · risonment, for submitting
false information. gree to construct, operate, maintain, repair, and if applicable, a ndon the injection well and
all related appurtenan s in accordance with the proved specifications and conditi s of the P
orized Agent, if any
se return two copies .of the completed 'Application p
North Carolina DENR-DWQ
Aquifer Protection$ection
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUllITC SA 7 Well Pennit Application (Revised 9/2007)
RECEIVED I OENR / OWQ
AOUIA=i:? PRlln:r.•r,n~ C'J:CT/ON
JUL l 4 2009
Page4
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Pennit Number: W L b :3 oct::>"3 0
Permittee Name: (s r '--%~7 ~
Address: l ~ {p ?d:1'"'t.....~N· l,/U r
Please check the selection which most closely describes the current status of your injection well system:
1) '/) ( Well(s) still used for injection activities, or may be in the future.
2) ( Well(s) not used for injection but is/are used for water supply or other purposes.
3) ( Injection discontinued and: a) ( Well(s) temporarily abandoned
b) ( Well(s) permanently abandoned
c) ( Well(s) not abandoned
4) ( Injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
Well Abandonment
If you checked (3)(a) or (3)(b ), describe the method used to abandon the injection well . (Include 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. Do 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 ' knowledge the information is tru accurate, and complete."
Revised 5/05 GW/UIC-68
RECEIVED/~ rowo
A0u1~r-R ~mfr; ij ~i:CTIOU
JUL 14 2009
Iredell County, NC Tax Map ~ Pro perty Data Page 1 of3
I redell Count N orth
Carolina
Pro p erty Data
Parcel Number 4646094556 000 (PIN): ..
Inquiry Date: 7/21/2009
Disclaimer: While every effort is made to keep information provided over the
internet accurate and up-to-date, the County does not certify the authenticity or
accuracy of such information. No warranties, express or implied, are provided for
the records and/or mapping data herein, or for their use or interpretation by the
User.
Property M ap
/ \ .
.,,.
=::::--::::-+:::::::~---=-=-
0
ll 11 •~!:Ji
Owner /Property Information
Tax Account 000077390260
Number
Old Parcel Number .1702K19000A021
Owner Name OLLISH GREGORY S & ELIZABETH K
M .1. Add 136 PERENNIAL DR, MOORESVILLE, NC,
a, ,ng ress 281176840
Property Address
http://gis.co.iredell.nc.u s/Iredel1Reporting/report.asp?PIN=4646094556.000 7/2 1/2009
Iredell County1 NC Tax Map - Property D at a
Lot Number
Legal Description #21 FARMSTEAD PB19-85&85A
M unicipal Information
Township Code 17
City Code 00
Neighborhood 17004 Code
Fire Code 0
V alue Information -Click H e re for the Current Year.Ia~ Card
Building Value 150290
Other Building 1350 Features
Land Value 31000
Fair Market Value 182640
Ta x Assessed 182640 Value
Deferred 0
Page 2 o f 3
Land Information -Click Here for Register of Deeds Online__Search
(19~present only J
Date Document Deed Deed
Recorded Type Book Page
19971231 WD 1055 612
Tax Information
Ex emption Ta x Code 1 Tax Code 2
C FR04
For Current Zoning Information Contact:
Jurisdiction
Iredell County
Harmony
Love Val ley
Plat
Book &
Page
I
Tax Code
3
SW
Land Land
Area Type
1 LT
Ta x Code
4
Contact Number
704-878-3118
7 0 4 -878-3118
704-878-3118
http://gi.s.co.iredell.nc .us/lredel1Reporting/report.asp?PIN=4646094556.000
Zoning
RA
Ta x Code
5
7/21/2009
ArcIMS Viewer Page 1 of 1
Iredell County assumes no legal responsibility for inform atlon oontained on this mEJJ.
http://gis.co .iredell.nc.us/website/iredellweb/MapFrame.htm 7/21/2009
Iredell County, NC Tax Map-Property Data Page 1 of 3
I redell Count N orth
Carolina
Parcel Number 4646094556 000
(PIN): .
P rope rty Data Inquiry Date: 7/21/2009
Disclaimer: While every effort is made to keep information provided over the
internet accurate and up-to-date, the County does not certify the authenticity or
accuracy of such information. No warranties, express or implied, are provided for
the records and/or mapping data herein_, or: for their use or interpr,etation by the
User.
Owner /Property Information
Tax Account 000077390260
Number
Old Parcel Number 1702K19000A021
Owner Name OLLISH GREGORY S & ELIZABETH K
M .1. Add 136 PERENNIAL DR, MOORESVILLE, NC,
a, ,ng ress 28 1 176840
Property Address
http://gis.co .iredell.nc.us/Irede11Reporting/report.asp?PIN=4646094556.000
----
7/21 /2009
Ir edell Coun ty, NC Tax Map -Property Data
Lot Number
Legal Description #21 FARMSTEAD PB19-85&85A
Municipal Information
Township Code 17
City Code 00
Neighborhood 17004 Code
Fire Code O
Value Information -Click Here for the Current Year Ti!_x Card
Building Value 150290
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Tax Information
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Iredell County
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Love Valley
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I
Tax Code
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Contact N4mber
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Zoning
RA
Tax Code
5
7/2 1/2009
A7A NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perd ue
Governor
Coleen H. Sullins
Director
March 27, 2009
Gregory and Elizabeth Ollish
136 Perennial Drive
Mooresville, NC 28117
Subject: Notice of Expiration (NOE)
5A7 G~thermallnjection Well
Permit No. W10300030
Iredell Cowity
Dear Mr. and Mrs. Ollish:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division ofWater Quality (DWQ) i s
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 underground injection well system, which was issued on June l 6 1
2004, and expires on June 20, 2009, has not been renewed. If you wish to keep this permit and operate the
injection well system, the permit must be renewed and issued in your name. Our records do not indicate that the
well system has been plugged and abandoned.
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 forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with Geothermal Heat
Pump System for Type 5A 7 Well(s) if the injection well system on your property is still active.
-OR-
B. Status of Injection Well System if the injection well system is in-active or has Qeen temporarily or
permanently abandoned.
If there has been a change of ownership of the property, an Injection Well Permit Name/Ownership Change
Form must also be submitted.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699·1636
Location: 2728 Capital Boulevard, Raleigh , NO'rth Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet; www.ncwaterguality.org
AA Equal Opportunity I Affil'J!lative Action Employer
RECEIVED/ DENR / OWQ
AQUlFF'R'PRl">TFt.nnN ~F._CTION
JUL 14 2009
Nj}rhi Carolina
;vaturill/11
If the injection well system is no longer being used for any purpose, it must be pennanent1y abandoned
according to the regulatory requirements listed under NCAC Title 1 SA, 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 the injection well system is still active and
you wish to renew your pennit, the renewal application must be submitted within 30 calendar days of the
receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit
VIC 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 wel1 system
status form are attached along with a self-addressed envelope. The above referenced forms are also available
on-line at the DWQ website at http :.i/h2o.enr.state.nc.us/ans/gpu/forms.htm.
Thank you in advance for your cooperation and timely response. If you have any questions, please call me at
[phone].
A ttachments
Sincer ely,
;t~ fy.-
Mich ael R o g ers
Environment al Sp ecialist
cc: Mooresville Regional Office -APS w/o enclosures
AP S Central F iles -P ermit No. W10300030 w/o enclosures
2
SA
MCDEHR
North Carolina Department of Environment and Natura l Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
M arch 2 7, 2009
Gregory and Elizabeth Ollisb
136 Perennial Drive
Mooresville, NC 28117
Subject: Notice of Expiration (NOE)
5A 7 Geothermal Injection Well
Permit No. Wl0300030
Iredell County
Dear Mr. and Mrs. Ollish:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Di¥ision of Water Quality (DWQ) is
entrusted to protect the groundwater quality and resources of the State of North Carolina, and is responsibl e for
the regulation of injection well construction and operation activities within the state. Our records indicate that
the above-referenced operating permit for the underground injection well system, which was issued on June 16.
2004, and expires on J une 20, 2009, has not been renewed. If you wish to keep this permit and operate the
injection well system, the permit must be renewed and issued in your name. Our records do not indicate that the
well system has been plugged and abandoned. •
1n or der to comply with the r egulatory requirements listed under North Carolina Administrative Code (NCAC)
Title lSA, Subchapter 2C, Section .0211, you must submit QM of the following forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with Geothermal Heai
Pump System.for Type 5A 7 Well(s) if the injection well system on your property is still active.
-OR-
B. Sta'tus of Inj ection Well System if the injection well system is inactive or has been temporarily or
permanently abandoned.
If there has been a change of ownership-0fthe property, an Injection Well Permit Name/Ownership Change
Form must also be submitted.
AQUIFER PROTECTION SECTION
1636 Mall Service Center, Raleigh, North Carolina 27699-1636
location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone : [phone] I FAX 1 :-919-715-0588; FAX 2: 919-715-6048 I Customer Stiivice: 1-877-623-6748
Internet www .ncwaterguality.org
/vi E.qual Opportunity I Affirmative Action ErnplOyer
~1¥thcarolin a
;JVaturall!f
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 the injection well system is still active and
you wish to renew your permit, the renewal application must be submitted within 30 calendar davs of the
receipt of this letter to :
Aquifer Protection Section
Groundwater Protection Unit
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 attached along wi$ a self-addressed envelope. The above referenced forms are also available
on-line at the DWQ website at http:L/h2o.enr.state.nc.us/aps/gpu/forms.htm.
Thank you in advance for your cooperation and timely response. If you have any questions, please call me at
[phone].
Attachments
Sincerely,
~'~
Michael Rogers
Environmental Specialist
cc : Mooresville Regional Office -APS w /o enclosures
APS Central Files -.Permit No. Wl030003(J w/o enclosures
2
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S} FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR;
TYPE 5-A 7 WELL(S)
____ New Permit Application OR ____ Renewal (check one)
DATE: _______ ~ 20 __
PERMIT NO . ________ (leave blank if NEW permit application)
A. PROPERTY OWNER(S)/APPLICANT{S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative wiauthority for signature): ________________ _
(1) Mailing Address: _________________________ _
City: _________ State: __ Zip Code: ______ County: ____ _
Home/Office Tele No.: -----------=C=e!L-1 N:..:.o='"-: _________ _
EMAD.. Address: _______________ _
(2) Physical Address of Site (if different than. above): _______________ _
City: _________ State: __ Zip Code: ______ County: ____ _
Home/Office Tele No.: -----------~C..,,e...,,ll..,_N=o~.: _________ _
BMAil.. Address: _______________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: ___________________________ _
Contact Person.,_: _____________ _,,E""MAIL==-"A.,,,d~dre=ss .... : _________ _
Address: ______________________________ _
City: ________ State: __ Zi.p Code: ______ County: ______ _
Offi9e Tele No.: Cell No.:
Website Address of Company, if any: ______________ _
QPU/UIC 'SA 7 Well Permit Application (Revised 9/2007 ) Pagel
C. WELL DRILLER INFORMATION
Company Name: _____________________________ _
Well Drilling Contractor's Name: _______________________ _
NC Contractor Certification No.: _______________________ _
Contact Person.:...: ----------------=E=MAIL=-=·=-'A:..:.d=dr=es=s'-: _________ _
Address: _______________________________ _
City: _________ Zip Code: ____ County: ____________ _
Office Tele No.: Cell No.: _________ _
D. HEAT PUMP CONTRACTOR INFORMATION (If different than drllle~)
Company Name: _____________________________ _
Contact Person . .:...: ----------------=E=MAIL~~Ad=d=re=s=s'-: _________ _
Address: _______________________________ _
City: _________ Zip Code: ____ County: ____________ _
Office Tele No.: Cell No.: _________ _
E. STATUS OF APPLICANT
Private: Federal: Commercial:
State: Municipal: __ Native American Lands:
F . INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
G . WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) Theinjection operation? YES____ NO ___ _
(2) Personal consumption? YES ____ NO ___ _
H. WELL CONSTRUCTION DATA (Skip to Section I If this is a·Permlt RENEWAL}
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,
(l)
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 Form GW-1 (Well Construction
Record) 1.f avaiJab\e.
Date-to be constructed: _______ Number of borings: ___ _
Approximate depth of each boring (feet): _______ _
(2) Well casing. Is the well(s) cased? (check either (a.) YES !l!: (b.) NO below)
(a) YES ___ If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic __ Other (specify) ______ _
Casing thickness: __ diameter (inches): ___ depth: from ___ to ___ ft. (reference to lan d surface)
Casing extends above ground ____ inches
GPU/IJIC 5A7 Well Permit Ap-plication (Revised 9/2007) Page 2
I.
(b) NO
(3)
(4)
(5)
(6)
Grout (material sUTTounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite Other (specify) ______ _
(b) Grouted surface and grout depth (reference to land surface):
__ Around closed-loop piping; from ___ to __ (feet).
__ Around well casing; from ___ to ___ (feet).
Well(s) Screen Information
Depth of Screen: From ____ to ____ feet below land surface
N.C. State Regulations (Title lSA NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead water quality and processes. A faucet on both Influent (groundwater entering beat
pump) and Effluent (water being injected back into the well) lines is required, Will there be a faucet on:
(a) Influent line? Yes __ No__ (b) Effluent line? Yes __ No __
Source Well Construction Information (if the water source well is a different well than the injection well)
Attach a copy of Form GW-1 (Well Construction Record). IfForm GW-1 is not available, provide the
following data:
Groundwater Source, From what depth, formation, and type of rock/sediment units will the groundwater
be withdrawn'? (e.g. granite, limestone, sand, etc.)
Depth: _______ Formation: ______ Rock/sediment unit: ______ _
NOTE: THE WELL DRILLtNO CONTRACTOR CAN SUPPLY THE DA TA FOR EITHER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION rs UNAVAILABLE BY OTHER MEANS.
OPERATING DATA
(l) Injection rate:
(2) Injection Volume:
(3) Injection Pressure:
(4) Injection Temperature:
Average (daily} gallons per minute (gpm).
Average (daily) __ gallons per day (gpd).
Average (daily) __ pounds/square inoh (psi).
Average (January) __ ° F, Average (July) __ ° F.
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing 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
infonnation.
K. LOCATION OF WELL(S)
At1ach two copies of maps showing tlte following information:
(1)
(2)
Include a site map (can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and an y
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.
Include a topographic map of the area extending one mile from the property boundaries and
indicate the.facility's location and the map name, ·
GPU/UIC SA7 Well Permit-Application (Revised 912007) Page 3
L. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"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.
1 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."
Signature of Property Owner/ Applicant
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies pf the completed Application package to:
N orth Carolina DENR-DWQ
Aquifer Protection 'Section
· UIC P r ogram
1636 Mail Service Center
Raleigh, N C 27699-1636
Telephone [phone]
GPU/UIC SA 7 Well Permit Application (Revised 9/2007) Pagc4
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Pennit Number: -----------
Permittee Name: __________________ _
Address: _______________________________ _
Please check the selection which most closely describes the current status of your injection well system:
1) ( Well(s) still used for injection activities, or may be in the future.
2) ( Well(s) not used for injection but is/are used for water supply or other purposes.
3) ( Injection discontinued and: a) ( Well(s) temporarily abandoned
b) ( Well(s) permanently abandoned
c) ( Well(s) not abandoned
4) ( Injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation., monitoring, etc), including pumping rate and other
relevant information.
Wen Abandonment
If you checked (3 )( a) or (3)(b ), describe the method used to abandon the injection we ll (Include a description of ho~ 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 Do you wish to rescind the permit?
( Yes ( No
Certification:
"I hereby certify, under penalty oflaw, that I have personally exammed and am familiar with the infonnation submitted
in th.is document, and that to the best of my knowledge the information is true, accurate, and complete."
Signature Date
Revised 5/05 GW/UIC-68
., .. ' ..
Divi;s19; OF W AT~R Qu~i:n/; ·.··.
GROUNDWATE~'SECTION°... .
June ~7, 2qo4
. /.
MEMORANDUM
'J;'o: Andrew Pitne~, Regional doundwater Supervisor
Groqnd~ater Section
Mooresyille Regional Office
From: Thomas Slusser-:zrs ·
Central Office , • ·
Re: Issuance of a Water-source Heat ;£>ump _Inj ectfon W eii P_~rmit (Typ~ SA 7):
i
Permit Number Wl0390030 for the operation of a water-source heat pump ~je~tion well system has
beeIJ. issued· .to Gregory and ·Elizabeth Ollish in Mooresville~ North Carolina~ 'IJris pez:mit was
preVJ.OU~ly issued to No~an Kunz, so please note this name cp.ange in your files.-Attached ~ a copy'
·of this pennit for your f;iles.· 'Please contact me at [phone] if you haye any questions
regarding this 'perinit.
cc: . CO-UIC Files
Enclosures
. ~ .. ' , • I .. . . ·.• . .
Elizab~th and preg~ty"" Olli.sh
136 Perennial Drive . .
Mo~resville; Ne 2·s i 17
.Pear Mr. and Mrs: bllish:'
l r••. •• .., r
;_., • • • ."• •,.:, • • • ... • I , .. ~ • :' :•:••• .-' ~••,•.., •I'• .:•-,• • • •
In accordance with your application dated April 25, 2004, we ·~ foiwarding Permit No .. Yv'J0300030
fot the operation. of a geotl:1#mru.. _heat pump injec~ion _system at 13~ ~~rennial L~e, ~ooresyille, ·: · :: ; : ..
N~rt1:1 . ~arolina,· ili,Iredell _Gounty. · This petmi~ ~~ be' e~ective, unless ~v6k~d, from .the date of·::::·./
issuance.until Jun~ 20, 2009 and shall be subject fo the conditions and.limitations stated ._there.m.· ... ·•.·
Water samples were taken at the mfluent aµd effluent _samplfug ports· of.this geothermal he.at pump· .:.:-·· ..
system as part of the renewal ·process, and these re$uits• are enclosed f,;>i'.yow: reference.· , : ·.\/ .
. · .. . . ' . . ' . . . ·. :·
Plc{ase co~tact m~_'at (9t'9) '.715---0l66 ·or Evan Kane at (919) 7'15-6165 if you have any questions ·. _. .·
, • regar~~g ·your pe.rmit. · · ·
Enclosure
__ Best regards,
Thomas Slusser
Hy<h-ogeological Technician II
Underground Injection Control Program
N. C. Division of Water Quality / Grou.ndwater Section
1636 Mail Service Center Raleigh, N.C. '27699-1636
Phone : (919) 733~3221 Fax: [phone] Internet: http://gw:ehnr.statcJic.us
' :.p.~-.
Customer . Service
1-877-623-6748
GREGORY and ELIZABETH OLLISH
I 4 • .I '' .. -~ ~ ..... •1
• ~ ~ • ,• • • • ,t, •I: ••: ._ :• • ••I • .' • • ( •,..,.•• • ,r!, .•• ,, £ • • I ' ,. • • •' ''
. FOR THE OPERATION OF A TYPE SA7 INJECTION WELL; defined in Title 1SANorth Carolina
Administrati,~e Code :iq .0209( e )(3)(~), which wiiJ be ·useifor_the injection ~fhe.~t p'~p effluent .. :
:This injectio!l _weli, previousJy owµeq ~y Mi-: l'fotman :({wiz, is I!>'cated,'at i36 Pereµnial Drive,_-'.
Mooresville, Iredell County, North Carolina. The injection wen · system wiil be' operated in .·
accordance with the ~pplication submitte4 April 2_5, ioo4 and: in conformity with ~he sp~~cati6ns
filed .with tj'.le Depa.rtmerit of~nvironment and Natural Reso·urces, which are considered a part of this
permit: . · · ·. · · · · · 1 ~ · • · -.-· -~ · : • • "· ·• ·
This permit is for Operation only, .and does nofwaive any provisions of the Water.Use Act or any
other applicabie La~s.· Rules, or Regulations. Operation and use of an injection well shall be. in :
compliance with Title lSA North CarolµiaAdministrative Code 2C .0100 and·.0200, and any other
Laws, Rules, and Regulations· pertaining to well construction and use. ·
This pennit shall be effective, unless revoked, from the date ofits issuance until June 20, 2009, and
shall be subject to the specified conditions ai:id limitations set forth in Parts I through VIII hereof.
~ .J.,....
Permit issued this the / L, day of ~ , 2004 .
~ Ted L: Bush, Jr., Assistant Chief
Groundwater Section
Pivision of Water Quality_ . .
··-
By Authority of.the Environmental Management Commission.
PermitNo. WI0300030
GW/UIC-5 ver. 3/01
PAGE 1 OF 5
r1 r. ir.;,' ~~ •" · •• , • •, .. • • '~ 'l' ,. ' ·,:· , i , .... , · . "• , ·,. -• •· -, ,, • • , • · " · · .. ,.,. ... ~(" ,,f ·:, :r .J,,~. l , ~ 1-,1 ., Lr~-•,~., , __ ....... ,.. ._. -~'• ,,,,. 1," • •; • , -·:.. -=-,_·_..,_ . ., .J ::~.-........... ·.., r· ,:"·~":·· •1~i 4. 1 •• 1 .r.,.;,.&·: ..... ..;,../ .. :c(l.,t ;·.; ... , .. _; .. , •. rc-l· f ..,ir;.;-;·:;/~~-•,,i. •.' ~,· ,• ··.•.t •.,.,~,, ~?1.,; • .. i · :t:i~~i:·~J;:1_,:;:,;~t h if i:f ~1iii~}51t;:ii f :-.ii.~:/i :2-f ~r{:'.\Y·{:::,,: .. : ..
PART I /OPERATION AND USE'GEr,~RAL COJ."C11ITIONS <.,.t ,.·'.' .. ·• . ..-. ·.: · . ., _ _.,_ ,.-.:·.-:. •">-.-.;~1-· _:.
· ........ ,r·~ .. ! , ... _ .. ;·:.:·~-~-'.' . .-':·,··.:,"►, .. !·~· ... f,·,:-:·::,:,.. _,;:i,•:j_.\~,~-~:::•.,;:-.~.:-~~----,~.:-·~.,, ... , -~ .. \-,'? .. }_,_,-:·;• ..... ~.:~· ·
.: i: . tlifi peirpid/effe~ti;e•6~/~tiir~~i e~t to ~e".~;t¥r ~·:-~olciiie ~f~ateri~~ ~a.rate 9{y,~;· _·-
.'injection:as describ;q. in the application .~~ othtj-"suppbrtjng"aata.-' -\~ ·· '1>':. \~ ·-:: · ·
• I . •• •• ,, 'l :, :~/:~./ •\ .~ ... •_ .· • ::., .. >; :_:• '. ·,): '· / "• • ,: -~: ,:• •.;. :•:~:. >, ,-', ·<•.'.' .. ..., : .·. _' \~~• ; • .' ,. . ~.;: \ ·· :.· .
. ~ 2. · TIµ_s p~rrnit t~ nqt--tr~~ferable'1Vhho.~~ p}lot~otic~ to·, and approvai by, the.bire~to~ _qf.the : .. ·· •,.,. ,. ·
. . . ~f ;;i;!i~:~;;~:t:~~~:¼?~:i tt\t~~:t~~:!t~!el~:l:};:!!~Z!~Le~t·:·-·. __ :~:~:~:-·
reque st must b~ submitted to. the Direct9r, ihcludirig ·any .s!}pportii:ig materi~ls as may be · ·
appropriate: at least 3cf days ptjor to the _datcf of the c~g~·;:· · ·· · ·· · · :' ~
' • ; • , ~-J • + I ... _· • •• -• • .., -~. -~ • • ,\,: • I • • • #' •• • i ' ,,
3. The,issuance of.this.permit_ shall not relieve the Pennittee ofth,e':responsibility_o'f_.
complying_ wit:}1 any and al1 s~a~.tes,, rules,. regulations, or _ot~il}.~ces wwch may'be ·. -.
imposed by other lo-cal, state, and fe.deral .agencies which have jurisdiction: Furthermore,
the issuance of this permit does not ~ply_that all regulatory require)J'ients have·been met. . . ,.
PART IT -PERFORMANCE STANDARDS
1_.
2.
3.
The injection facility shall be·effectively;ma~t~ined and operated at all tim~s s~ tha~ tlier_e
is no contamination of gr~undw~ter_ wJiich ·_wjl_l ren~er it unsatisfactory for norinal u~e . In
~e event that the facility fails to perform satisfactorily, including the creation ofnuisap.ce
conditions or failure ?f the injection tone to adequately ~ss1mila~e the injected fluid, the'°·.·
Petmitt~e shall take'imniediat~ correct'ive ac~ions including·ihose ~¢tions that mf.l.y b.e ·,
·reciuired by the Division of Water Quality such as the rep.air: modification, or abancfo~ent
of the injection facility.
The Perrnittee 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.·
The issuance of this permit shall not relieve th~ Permittee of the responsibility for damages
to surface or groundwater resulting from the oper ation of this facility.
PART III-OPERATION AND MAINTENANCE-REQUIREMENTS
1. The injection f'1;cility shall be properly maint ained and operated at .all titµe s.
2. The Peimittee must notify the Division and receive pri_or written' approval _from the
Director of any planned physical alterations, or additions in the permitted facility or· activity
not specifically authorized by the peniut. · " · ·
Permit No. Wl0300030
GW(UIC-5 ver. 3/01
PAGE 2 _\JF 5
-l; -• ._t\t //itit~i\~-:0:~ ;}?: :J;.:.:~::::::;;:r::r;::i}':-;'.-
' .; .. PART IV -iNS.PECTiONS . -'· \ ··· ·.' -i •. :-, \ '/.·· !·.:: .. , ,-, . · · -' '.-... -· -·. : /ii).?-~; :r>: r_;;' :.: . : ..,., . ,_, _-. ._ ·" . ! _ . __ , _.
1. · : Any _dulY, aut4o_qzeg. ~#fcer,' e~ployee,'9'r r"epresent~tive of the •. Diyision· of Viatet' Quality .,,
•• ~• r f" • , , • -.. • I , Jr-, •
·. m~y, ·upo~ pi~sent~tion 9{ ~i::~dentials, enter"~q i~spect aµy properfy,_pren1ises, or place gn >. ·~(r~.l~t~d fo _th~ ~tij~tio~ f~~liity :~f apy feason~bl~.j.ipie for._the p~ose ~f d~te~iniµg
,, c~:mp~i~~~,.t~}hi_~l~~i; fu_a?' ·in~i>fct. -~~-c9py any recoi~~ ~~! 1?~~t -be 1!1~~fa.in¢4 .:.,
u~d,~,the t~rms _and cqnd1tion~ of f41s permit; ~d may obtam s~ples of grou.p.dwafer, -·_.
suiface·w~ter, or inje_ction. fluids.
·2. D~artment rep;esentatives shall have reasonable access for purposes of inspectio~. .
obs~rvation, arid samp~ing associated with injection and any related faciiities a~ provided
(or in N .'C.G.S. 87-90.
3. Provisions shall be made fot collecting any necessary and appropriate samples associated
with the injecti'on facility activities.
PART V -MONITORING AND REPORTING REQUIREMENT~
1. Any monitoring (inclU<;ling groundwate~, .surface water, or soil sampling) deemed necessary
by the Division of.Water Quality to insure surface and gro~d water protection, will be
established ·and an acceptable sampling'.reporting schedule shall he followed.
. . '
2. The Permittee shall report by.telephone, within 48 hours of the occurrence or first
knowledge oTthe ·occurrence, to the Mooresville. Regional Office, telephone number
(704) 663 :-1699, any qfthe 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 faci lity
incapable of proper injection operations, such as mechanical or electrical
failures.
3. Where the P.ermittee 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 fail~ to perfoi:m satisfactorily, the Perynittee s~all
tal<:e s~ch immediate ·action as may be required _by the Director.
Permit No. WI0300030
GW/UIC-5 ver. 3/01
PAGE30F 5
Tht: f ~r~ttei shall, -~t le~st _thr_ee (~) ~onths prior to the expiratiQn of this ·permit,
·request' an extensi9il.. :··.·-· :. ·., .. , . . . :, ; ',•. · . ·; ..
• ,•. • • '-I 4 : •. ~
.:·· • •••· i
.
J.
l. The Pennittee ·shail provide written notification within 15 days of any change of status of
an injection'well. Such a change would include the disco11tinuation qf use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must.
in~taU a saajtary seal. If a well is not to be used for any purpose that well must be ·.
·permanently abandoned according to iSA 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 shail abandon that injection well in accordance with the procedures
specified 'ii) 15A NCAC 2C .02 14, including bu~ not l~ited 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
respons1ble 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 that 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 mann~r
that will prevent the movement of fluids into or hetwe·en underground ,
sources of drinking water and in accordance with the terms and conditions
of the permit.
Permit No. WI0300030
GW/UIC~5 ver. 3/01
PAGE40F 5
'
(G) .Th~ Permittee· shall submit a Vlell Abandonment Record (Fonn GW-30)
as specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion of
·abandonment.
3. The written documentatlon·required in Part VII (1) and (2) (G) shall be submitted to:.
Groundwater -Section-UIC Staff [
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh,_ NC 27699-1636
PART VIII-OPERATION AND VSE SPECIAL CONDITIONS
None
Permit No. Wl03000.30
GW/UIC-5
PAGES OF 5
ver. 3/01
COUNTY: JREDEI.L
QUAD NO:
RRPORT'IO _MR_O _______ Regjooal Office
COLLECT01!.(SJ :_K_B_UB_AK ______ _
DATE: S/6/l004
TIME:
PORPOSB: Owner.
Location or Site:
DMSlON OF WATER QUALITY
CbemllO)' Laboratory 1lepon-/ G r.and Water Q■1Uty
SAMPLE PRlORJJY
(!]ROUTINE □EMERGENCY
□ CHAIN OF CUSTODY
~ SAMPLE 1'YPE
GJUl:G OJ.LISH
I GW-11
.Description of aampling poinl ___ W_-(~~'/~~6.....,'(~0.~d ___________ _
Sampling Method:
Remadt5:
LABORATORY ANALYSIS
BODJI0 mllfL Diss. Solids 70300 mo/1 X Att-Silver 46566
CODHiid,340 rn.tL Fluoridc951 m2'L X Al-Aluminum 46557
CODLow335 mg/L lhrdness: total 900 mlllL X .u-Anlcnic 46551
Colifotm: MF Fccal 31616 1100ml Han!ncss: (non-arb) 902 m•IL X Ba-Barium 46558
X Coliform; MF Total 31504 182, 01 1100ml Phenols 32730 uo/1. X Ca-Calcium 46552
roe mg/I SDCCific Cood. 95 umbos/cm2 X Cd-Cadium 46559
Twbitity NTU Sulliuz, m2'L X Cr-Chromium 46560
Residue~ S u,pc:mtcd 530 me/1 Sulfidc745 mg/L X CU-Com>er I 042
Total Suspended solids m,,/1. MBAS mo/1 X Fo-lnni 104S
Oil and 0-moll. X H2-Mercu,v 71900
oH unita Silica mst/1.. X K-PolaQium 46555
ADcalinitv to oH 4.5 m2/L Boron X Mg-Magoosiwn 927
Alkalinity to pH 8.3 m,z/1 Formaldebwe nwL X Mn-Maq"""°"" 1055
Carbonate IDtl/1 NH3asN610 mi!IL X Na-Sodium 929
Bicarl>onalc m•/1. TKNasN625 mg/L X Ni-Nickel
Camon dioxide me/L N02 +NOJ as n 630 mRll X Pb-Lead 46564
Olloridc m2'l P: Total u P 665 n,v/L So-Scleuium
Chromium: H"" I 032 u<>IL P04 m•/1 Zo Zinc 46S67
Color: Ttue 80 c.u. Nilnlle (NO, IS NJ 620 mglL
Cyanidc720 mg/L Nitrite (NO, u NJ 615 mg/L
COMMENTS:
~~Ce r ~eJ s;-/:J-7-/:z,so t;
Vi<A. e,?-ud ~y"I r.~l,/1. BL,b~t
LabNumbcr : 4G0S81
Date Received : sn/2004
Time Received : 9:20AM
Ri,ceivod By ; OS
Released By : AR
Date repor1,cd : S/24ll004
5.0U u•IL Om,mochJorinc Pe.sticidcs
SOU uo/1. -horus Pesticides
10U ug/L Nitn>K<:n Pcsrieidcs
32 uo/1.
10 muJL Acid Herbicides
2.0U ug/L
25U ul!'/1 Scmivol4tilcs
78 u.tl TPH-Diesel Range
SOU uo/1.
0.2U uo/f. Vollllile o...,..,;ca (VOA bottle)
0.74 ml!/L
4.0 m2/L TPH-Guoline Rlou!e
10U uoll. TPH-BTEX Gasoline Rongc
4.3 nmlL
10U u•lf.
10U uo/L
ug/L
rn,/1_
-1•
COUNTY: DtEDELL
QUAD NO:
DIVISION OF WATER QUALITY
c•em1111y Laboratory Report/ Groaad Water Quallty
SAMPLE PRIORITY
l!)ROlJTINI! 0BMERGHNCY
REPORT TO _MR-=O=-________ Rogional Office
COLLECTOR(S) :_K_B_UBAK~.,.,....-----
□ CHAIN OF CUSTODY
~ SAMPLE 1YPS DATE: 516(2004
TIMI!:
PURPOSE: Owner. GREGOLISH
Location or Site:
DcscriptiOP of ,ampling polnt;__·~_._~__./~V..;:~'-'-'-f _____________ _
Sampling Mtthod:
R,,marb:
LABORATORY ANALYSIS
800310 ll1IIIL Dis.,, Solids 70300 mg/L X Ag-Silver 46566
COD H"lgb 340 mll/L Fluoride 951 mglL X AJ.Afuminam 46SS7
CODLow335 rm,/L Hmlncss: 10111 900 mg/I.. X As-Anenic 46SSI
Coliform: MF Fcc:al 31616 1100ml Huduess: (oon-<:ad>) 902 m)l/1. X Ba-Bariwn 46558
X Coliform! MF Tolll 31504 1 B2. 01 1100ml Phenols 32730 wr/1 X Ca-Caldwn 46552
roe ffl2II Spcci6c Cond. 95 umbos/cm2 X OI-Cadium 46559
Tud>itity N11J Sul6ite mg/L X Cr-Oiromwm 46560
Rcaidue~ Suspend,(! S30 mg/L Sulfide 745 me/L X Cu-Comer I 042
Total SUSDC<ldcd 10l..k ffl<!/L MBAS mglL. X Fo-lron 1045
Oil 8Dd G!cuc rrudI. X Jfg-MttC1m17l900
IPH units Silica moll X K-Powsium 46555
Afblinitv to oH 4.5 man Baron X MK• Mamcsiwn 927
Alblinity 10 oH 8.3 mo/I Fmmaldebvde me/L X Mo-Muuranese JOSS
Camonare m,,/L NJOuN610 mg/L X Na-Sodium 929
Bicamonate mi>/L TKNasN62.5 moll X Ni-Nickel
Caibon dioxide ll1IIIL N02 +NO3 u n 630 man X Pb-Lead46S64
Oiloride ms,/L P: Totol u P 665 msr/L X So-Selenium
Oiromium: Hex 1032 uon 1'04 mon X Zo Zinc 46567
Color: True 80 c.u. Nitntc (NO, as N) 620 m&'l,
Cyauide720 mg/L Nitrite (NO, as N) 61.5 mg/L
COMMENTS:
Lah Number : 4GOS82
Dall: Received : snn004
rune Received : 9:20AM
Rcc;e;vcd By : DS
Released By : ,\R
Date reported : 5/W2004
5.0U ug/L Onzonochlorine Pesticides
50Uutr.lL onl5 Pesticides
10U u)1/L Nitro..,,, Pesticides
32 uy/L
10=!1. Acid licd>icides
2.0U uo/L
25U ue/L Somivolatiles
56 uun TPll-DiCM:l lungc
SOU ug/L
0.2U ue/L Volatile Omarucs (VOA bottle)
0.73 mall
3,9 mo/f. TPB-Guoline lw120
10U uv/L TPB-BTl!X Gasoline RaMe
4.3 =IL
10U UR/L
1ou .... n,
5.0U u!VI,
49 •KIL
North Carolin. ...>epartment of Environment and Na: al Resources
Division of Water Qualit)· -Groundwater Section
INJECTION FACILITY INSPECTION REPORT_-FORl\1: B
INJECTJONWELLPERMITNO. WI 0'3t>oo3'0 DATE ~-6-~c/
NAMEOFO~'NER __ ~_~_l-r..._~C>""'--LL-=---1~_5_/~ __________ _
ADDRESS OF OWNER
(Street/ road or lot and .subdivision , cou11r:-•. rown)
LOCATJON OF INJECTION WF.LL (and source well(s), if applicable) _____ _ ;,.;..,,,'?'--U>
r-ec N i t .i•\"e .. d.
(Street/ road or lot and .subdivision . county, town. (f different than owner's address, plus desc1iptio11 of locarion on .site)
Potential pollution source ~ Y./l It c_, Distance from well //; 0 Fee:r
Potential pollution source Distance from well ---------------
Potential pollution source Distance from well ---------------
Minimum distance of well from property boundary ___ _
Quality of drainage at site h, I) J
(good, adequate.poor)
GPS Data:
Latitude: ----------
Flooding potential of site Li tJ
(high. moderate, low)
Longitude: __________ _
DR...t\. W SKETCH OF SITE (Show propen:y boundaries, buildings, wells , potenrial pollution sources, roads, app@.xima~ scale, a
north arrow.)
DESCRIBE INJECTION SYSTEM (vertical closed loop, uncased borehole or cased water well; separate source well and
injection well; combination source anc1~~el/J A--~ ~cr:J~licabie1
Ver.3/01 GW/UIC-2
INJECTIOl' .iCil.JTY INSPECTION REPORT -FORM :coNTINUED)
WELL CONSTRUCTION
Date co nstructed 17--9tJ
Drillingcontractor:Name __ _.i3c..e~"1_.....;./I._· A-=-c......fLe-=-ac..+-f __________ _
Address --------------------
Certification number
Total depth of well 3oo //
----------
Total depth of source well 5'pJ,ne
(if applicable)
Inspection point
Casing
Measurement Meets minimum standards
Grout
Depth
Diameter
Height (A.LS.)
Depth
Screens
Depth(s)
Length(s)
I.D. Plate
Static water level
Well yield
Enclosure
Enclosure floor
(concrete)
Sampling port
(labeled)
Water tight pipe entry
Well enclosure entry
Vent
Yes No
Functioning of heat pump system (Determine from the owner if heat pump functions p,·operly.)
Comments
INSPECTOR IL~-Office_~M~K~~--------
WITNESS ____________ Address _____________ _
WITNESS ____________ Address _____________ _
Ver.3/01 GW/UIC-2
CXJ(JNTY .: lllBDl!U.
QUAD NO.
DMSION OF WATER QUALfIY
CbnnillrylAbonlorylleport/CroundWaterQuallty
SAMPLS PlUORnY
(K]ROUTINE 0BMERGENCY
RBPORT TO : MRO Regional Office
COLL£CIOR(S) : -K--BUBAK=---------□ CHAINOPCUSTODY
IE) SAMPLll TYPl! DATE: ?'.MK
TlMB:
PURPC6l!; Owner: CllEGPi9§l
Location or Site:
Descriptionofsamplingpoint ___________________ _
Sampling Method!
Remarks:
LABORATORY ANALYSIS
B0D310 mQ/L rn.s. Solids 70300 m l!/L X Aii.-Silver 46566
COD lliRh 340 mvJL Fluorlde951 m1t/L X Al-Alwninum46557
a)0Low33S m v./L fwdnes5: total 900 mR/L X A&-Arsenic 46.551
Coliform: MF Fecal 31616 1100ml Hardness: (J10!Kalb) 902 mv./L " Ba-Barium 46558
X Coliform: MFTolal SlSOi 1B2, 01 1100ml Phmols 32'/30 uv./L X Ca-C.alcwm 46552
roe m9./I s~uic Cond. 95 wnho&/an2 X Cd.C.diwn 46559
Turbitity NTU Sulfate mll/L X Cr-Otromlmn 46560
Residue., SuspenJed 530 ml!/L Sulfide745 ma/L X Cu-Coon,,r10f2
Total Susoentfod oo&h ml!/L MBAS m PJ L X Fe-lronlMS
OilandGtease m v,/L X tu-Men.-urv 71900
,nH tmils Silica m v./L X I<-Pola5oium 46.555
AB:alinitv lo DH '-5 m v./L Boron X MP.-Ma<mP<mm 9'J'J
AB:alinitv 1o r H 8.3 mRIL Formaldehyde DIil.i L X Mn-Man<>,._ 1055
Carbonate m1t/L NH3asN610 m11./L X Na-Sodium 929
Biatbona11, m ~JL TKNasN625 m 2/L X Nl-Nidoel
Carbon dioxide m R/L NOl +N03 as n 630 m K/L X PM.ead.4656'
Oiloride m 2/L P: Total as P 66.5 m1t/L Se&leniwn
Oirominm: Hex 1032 u v./L P04 mv./L 17'n 7'inr46567
Color: True 80 c.u. Nitrate (NO. as N) 620 mR/L
Cyanide120 mg/L Nllrile (NO, as N) 615 mg/L
COMMl!NTS:
u.v./L
u.11:/L
uML
u.11/L
ma /L
u<>IL
uR/L
ua/L
uQ/L
uv./L
mi,/L
mQ/L
u11./L
mv./L
u 2 /L
UR/L
uv./L
u e /L
LabNumber :
Date Received :
Time Received :
Received By :
Released By :
4G0581
Sfl/Ol
9-.211AM
OS
Date reported: PENDING
O r1titnochlorine 'Pesticides
O nlanooh osohorus Pesticides
Nitn>9.en Pesticides
Acid Herbicides
Semivola.tiles
TPH-Diesel Rana•
Volati ~ Orv.anics (VOA bottle)
l'Pl L-Gawll11,, Rnnl{e
TPR-BTEX Gosolino RA1111.e
-400581.lds
COUNO': DUIDHLL
QUAD NO,
DMSION OF WATER QUALITY
Oiemistry Labor•tory R.ep«t/ Gnnmd Water Qu.tllty
SAMPU! PRJORITY
l[]ROlJTINl! □l!Ml!RGENCY
REPORT TO : _Mll! ___ O--________ Regional OffiD!
COLLl!CTOR(S}: _K_B_UB_,\IC ______ _
00IAIN OFCU51'0DY
IR) SAMPLE lYPE I Gw-31 DA TB: 51§11"
11MB:
PURPOSE: Owner: G lti!GOUSH
Location or Sile:
Descriptlonolsamplingpoinl ____________________ _
Sampling Method:
Remarks:
LABORATORY ANALYSIS
800310 m it/L Dis5. Solids 7WOO m i/L X A11.-Sil:ver 46.566
COD lfi~h 340 mgJ L Fluoride 951 m a/L X Al-Aluminum 4h5S7
CODLow 335 m lt/L Hanlnessc -1900 m2/L X As-Amenic 46551
Cclifonn: MF Fecal 31616 1100ml Hardness; {non-catb) 902 m Q/L X Ba-Barium 46558
X Cclifonn: MF Total 31504 182, Ql /lOOml Phenols 32730 u A/L X Ca-Caldum 46552
TOC m m/I Sn,,nfit-Cond. 95 umhos/cm2 X Cd-Cadiwn '6.559
Twbllity NTU Sulfall! m RI L DC Cr-Ouomium46.560
Residue., Suspended 530 m 1t/L Sulfide 745 m 2/L X Cu-Connrr1042
TotalSus.,.,nded solids mR/L MBA5 mR/L X Fe-Irm l MS
Oil and Grease n ui/L X H 2-M=urv 71900
lnH unils Silica mi/L X K-Potassium 46555
Albllnitv to pH 4.5 DlR/L Boron X Mv.-Mai,n<'..sium 917
.Alblinitv to DH 8.3 miu'L FonnaldehvrlP m 2/L X Mn-MllllV.lllll!Se 1055
CarlJonale mR/L NH3asN610 m R/L X Na-Sodium 9'29
Bicarbonate mtuL Tl<NasN625 m tuL X Ni-Nickel
Carbon dioxide mst/L N02 .,.NCG as n 630 m RIL X PM.ead 46564.
Cllloride miuL P: Total illl P 665 m iuL X Se-Sdenium
Cllromrum: He,, 1032 UR/L POI m R/L X ZI\..Zinc46567
Color: True 80 c.u. Nitrall! (NO. as N) 620 mg/L
C yanide720 mg/L Nibile (N0i as N) 615 mg/L
COMMIINTS:
u 2/L
u R/L
u~/L
uR/L
mlt/L
u 2/L
u RIL
u2/L
UR/L
u ir/L
m i,:/L
m •/L
u2/L
m1t/L
u2/L
ult/L
u2/L
uv./L
LabNumber :
Dall!Rec,eived :
TmieRea!ived :
R«.eivec!By :
Releiaoed By :
4GOS82
Sfl/04
9-.20AM
DS
De12 repor12d : PBNDING
Pesticides
OrAAnophosphorus Pesticides
Nitm<ren Pesticides
Add Heriricides
Semivolatiles
Tl'H-Oiesel Ran""
VolAtile Ort>.u= /VOA bottle\
Tl'H-Gasoline Rane.e
TPH-BTl!X Ga<oline Rom,o
North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resollfces
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
§AMel.l:!YPE ~~E PRIORITY ({!]) Ccunly_ ___ :tJ,~ J)~LL_ __________ ---------· Ii! Waler .lf9 Routine Lab Number ________
---••••••• -•,o-• --·-------
Quail No _ .. Serial No. □Soll 0 Etnome11ov Uale Received ___ .. ---·--·-··-... Time: . ..... . .. ... ····--------Oolher ___ ---------····--
Lal. long. _______ -I Rec'd By: From:Bus, Courier, lfand Del., ---~--.. -· ·-· -----------·····------------------_.__
D Chain of Custody Other: _____ ·-----Report To: ARO, FRO, RO RRO, WaRO, WiRO, Data Entry By: -· Ck; ___
Data
Reported:. _____ _
___ __ _ Purpose; -, -1 llme_a_s,::P.-easeline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Olher:_Q.l~_J2.{~_I h.e'('-ft.-\_ b o ,..,., -t,...__ tcltdlono, FIELD ANAL,YSES ·• ~ Owner _____ A~!l -\....ll,,,=~---____ ____ _ __________ _
pH @ __ :_a,,________ Spec. Cond~...L!._.,i_ __ at 25°C location or Sile ___ _ ____ P ·,-6.--,----------·--·---·-·-----
Temp.10 ,2.3_.._J __ "C Odor ____ ». !I! tJ t Description of sampling point ___ J:k·frT .p..,.,.... ~~~----------_________ ... __ _
Appearance ___ ~,.,._~--,--.'T"".-_____ Sampling Method ____________
7
__ ~""'""'"ilcr------Sample Interval •.. -----· ________ _
Ftald Analysis By; ----~~ll.!"' ~ !:) • \( Remarks PUm_c._bm10_,._e •_· ________ _
WSRO, Kinston FO, Fed. Trusl, Central Off., Other: _______ _
Shipped by: Bus~Harw Del., Other;
Collector(s): __ ~h/ P ti l»• ll. __ Oate-5:~L,J...
b.BQRA TOR Y ANALYSES (Pumping ttmo. alt tomp., otc.)
BOO 310 mg/L Diss, Solids 70300 mg/L rt-Ag-Sliver 48566 ug/L Organochlorlna Pastlcldea
COD tflgh 340 mg/L
COD Low 335 mg/L
Fluo!lde 951 mg/L
ltardnau: Total 900 mg/L •
+ Al-Aluminum -48557 ug/L ,-
--I-As-Alllenlc 48551 ug/1.
Organophosohorus Pesllcldes
Nitrogen Pe,tlcldes
Coliform: MF Fecal 31818 1100ml llardnns (non-cerb 902 mg/L -1--Ba-Barium -46558 ug/l Acid llerblcldaa
5( Coliform: MF Total 3150-4 1100ml Phenola 327 30 ug/1 i--Ca-Calcfum 48552 mg/L pee,
TOC 880 mg/L Speclllc Cond. 95 uMhos/cm 'f.. Cd-Clldmlum 48559 ug/L
Turbidity 78 NTU Sullate 9-45 mg/L '/... Cr-Chromium 48559 ug/1.
Resldllll, Suspended 530 mg/L Sulftde 7-45 mg/L "-Cu.CO!lper 48582 ua/L
-J. Fe-Iron 48583 ua/L Semlvolatna Omanlcs
OH and Grease mg/L -{ Ilg-Mercury 71900 ua/L TPH-Dlesal Ranoa
pH403 units )( K-Polasslum -48555 ma/L
Alkallnlly lo pit 4.5 ◄ 10
mg/l '( Mg-Magnesium 48554 mg/L
Alkallnky ID pit 8.3 415 mg/L "J'. Mn-Manganese -48585 ug/l. VolaUla Organics (VOA bolUt)
Carbonate -445 mg/L NH, as N 810 mg/L -A Na-Sodium 46558 mg/L TPH-Gesollne Ranga
Bicarbonate 440 mgll TKN u N 825 .. mg/L ..,__ NI-Nlokal ua/L TPII-BTEX Oaaollne Range
Carbon dloxlde 405 mg/I. NOa + NOJ 11 N 830 -mg/L '{.. Pb-Lead 48584 ug/L
• Chloride 940 mg/I. P: Tola! as P 885 mg/L y:. Se -Selenium ug/L
Chromium: Hex 1032 ~/l I . _. f._ Zn -Zinc 48587 ug/l
Color: True 80 cu '"' 1·1,~c nt..aV
Cyanide 720 mg/L Temperature on amval:
Lah Comments, _________________________ ·---------------~----------
-----~-----·-
OW-54 REV. 12/87 For Dissolved Analysis -submit ftlterad ■ample and write •ors• In hlocl1. ··-··---·-·---·-----·---------···-----·---------··--·····---
GROUNDWATER FIELD/LAB FORM
County Te.12 _Pe_ c.L ________ .. -·······
§AMfb!:!Yff
°'-Water
□Sol
~fBIQBl]Y
M Routine
D Emeraencv Quad No._____________ Serlal No. __ .. _______ D
Lal. __________ Long._____________ Other ________________ _
North Carolina
Deparbnent or Environment and Natural Resources
DNISION OF WATER QUALITY-GROUNDWATER SECTION
Lab Number _______ ---·--··•-----__ .. ________ _
Dale Received ____ -·····-_____ Time: _______ . ··-···-___ _
Rec'd By: From:Bus, Courier, Hand Del.,
other: ________ _ ~ D Chain of Custody
Report To: ARO, FRO,~RRO, WaRO, WIRO, Data Entry By: _______ _
WSRO, Kinston FO, Fed. Trust, Central Off., Other:________ ~:~~led:. ____________ _
Ck: ______ _
I
Shipped by: Bus, ouri Hand Del., Other: _____________ Purpose: -1 Collector(s): -1!~ h ,-.'L. ___ Dale..,S_-(..-o ~1 Time_L..1.s::_ Baseline, Complaint, Compliance, LUST~ Pesticide Study, Federal Trust, Olher: __ \l.! c.. lei[ l\.t"i 11\A-l
fil~D ANALYSES Owner ____ jp_R,~(p CJL ,~~_b,.___ ,r:11c1aone, ______ _
pH 400.__ __ b_______ Spec. Cond~D. 0 at 25°C Location or Site _________ _
Temp.111_ _ _Lfe..A.~ __ "C Odor ____ ~""""" Description of sampling polnL..Wc.i.-Ldc: ~~~,:: _____ _
Appearance_______ t!,J4,_~ . Sampling Method __ w.c.LL.e.~fl\-f~:liiler.ifIT___ Sample Interval __________ _
Field Analysis By: __ .Z:-c.u-J.U.::Jr.il)fl IC. Remarks · r.e c. iALY (Pumping limo, alrtomp., lie.) A~ QIU,TQRYAl\l L '!=:S:!=:
BOD 310 mg/L DIA. Solidi 70300 mg/L ~ Ag•Sllvar 46568 ug/L Organochl01lne PesUcldes
COD lllgh 340 mg/L F1u01lda 951 mg/L -1-. Al-Aluminum 46557 ug/l Org11nopho1phorus Pesticides
COD low 335 mg/L Hardnau: Total 900 mg/L -1-Ae-Arnnlo 4 855 t u11/L Nitrogen Pesticides
Colllorm: MF Fecal 31818 1100ml Hardness (non-carb 902 mg/L -/.. Ba-Barium 46558 ug/L Acid ttarblcldes
){ Colllorm: MF Total 31504 /I00ml Phenols 32730 ug/I .., Ca•Calc(um 48552 mg/l PCB1
TOC 1180 mg/l Specific Corn!. 95 uMhot/cm i-.. Cd-Cadmium 48559 ug/L
Turbldlly 78 NTU Sulfala 945 mg/l " Cr-Chromium 48659 ug/L
Residue, Suapanded 530 mg/L Sulftde 745 mg/l .,.. Cu-Copper 48582 ug/L
i-Fe-Iron 48563 u11/L Samtvolallla Organics
OIi and GreaH mg/L -,.. Hg-Mercury 71900 u11/L TPII-O!uel R1nga
pH 403 units --::L K-Potasstum 48555 mg/L
Alkalinly lo pH 4.5410 mg/L X Mg-Magnesium 46554 mg/l
Alkallnlly to pH 8.3 415 mg/I. Y. Mn-Manganese 48585 ug/L Volallle Organics (VOA botUa)
Carbonale ◄45 mg/L Nil, aa N 810 mg/L -t,. Na-Sodium 48558 mg/L TPH-Oaaollne Range
Bicarbonate 440 mg/L TKN aa N 625 .. mg/l ..,._ Nl•Nlokel ug/L TPH-8TEX Gesollna Range
C&1bon dioxide 405 mg/l NOt + NO, aa N 630 -. mg/L .,_ Pb-Lead 46564 ug/l
I Chlorlda 940 mg/I. P: Total as P 685 mg/L Sa-Salanlum ug/l
Chromium: llex 1032 ug/L 1 '-;i Zn-Zinc 46567 ug/l
Color: True 80 cu I,._, ,,,..,. □NL Y
,--
Cyanide 720 mg/l Temperature on arrival:
Lab Comments ____________________ _
OW-54 REV-:-i21~----Foriii;,oiiedAnalysls-submll flllarad s1mpla and WIiie "DIS " In 't-i~k .
MEMORANDUM
DMSION OF WATER QUALITY
GROUNDWATER SECTION
April 30, 2004
To: Andrew Pitner, Groundwater Supervisor
Groundwater Section
Mooresville Regional Office
From: Thomas Slusser-7.}s
Central Office
Re: Renewal of Permit #WI0300030 and name change to Mr. Greg Ollish. Request for
inspection and routine sampling of Mr. Ollish's injection well in Mooresville, North
Carolina.
1. Please review the application and submit any comments to CO-UIC group. Retain the
application for your UIC file.
2 . Please inspect the injection well site to verify that the location and construction plans
submitted in the application are accurate and that the NCAC Title 15A 2C.0200 standards
are being complied with, using the enclosed Injection Facility Inspection Report (Form
B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results
to the CO-UIC.
You are requested to return the completed Injection Facili'ty Inspection Report (Form B) to the
CO-l)IC by May 20, 2004. If the inspection and review cannot be accomplished by this date,
please let me know.
The UIC group appreciates your assistance with this review. If you have any questions.regarding
this review or the UIC program, please contact me at (919) 715-6 166.
cc: CO-UIC Files
Enclosures
~~-·:~,'. : ... , ..
Greg Ollish
136 Perennial Drive
Mooresville. NC 28117
Dear Mr. Ollish:
Michael F. Easley, Governor
William G. Ross Jr., Sccrctuy
Nonh Carolina Department of Environment and Natural Resoiutes
April 30, 2004
Alan W. Klimek, P. E. Director
Division of Water Quality
C4:>leen H. Sullins. Deputy Director
Division of Water Quality
Your renewal application for a pennit to use a well for the injection of geothermal heat pump
effluent has been received and is under review. A member of the Groundwater Section's
Mooresville Regional Office staff will be contacting you to ·arrange an inspection of the injection
well and collect water samples as part of the review.
Please contact m e at [phone] or Evan Kane at [phone] if you have any questions
regard_ing pennitting or injection well rules.
Sincerely,
Thomas Slusser
Hydrogeological Technician Il
Underground Injection Control Program
N. C. Division of Water Quality / Groundwater Section
1636 Mail Service Center Raleigh. N.C. 27699-1636
Phone: [phone] Fax: (919) 71S-OS88 loternet: http://gw.ehnr.stale.nc.us
Customer Service
1-877~23-6748
PERMIT APPROVAL REQUEST
Please initial and
return to Marcus
for processing.
TedBush &i. (ql~hJ
Bob Cheek /Y~ L (/i,/f:/-1
Marcus Geist~{, 'iyn
SENDER: COMPLETE THIS SECTION
■ Complete items 1, 2, and 3. Also complete
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 mailplece,
or on the front if space permits.
1. Article Addressed to:
G~egory and Elizabeth Ollish
136 Perennial Drive
Mooresville, NC 28117
Item 1? □ Yes
If low: □ No
\
3. Service lt.12!.._•P' _,
~ Certified ~ □ Express Mall
□ Registered O Return Receipt for Merchandise
□ Insured Mail □ C.O.D.
4. Restricted Delivery? (Extra Fee) □ Yes
2 ...... .
70 □3 101 □ 00 □1 2611 0 □27
PS Form 3811 , July 1999 Domestic Return Receipt -.
102595·00•M·OS52
NORTH CAROLINA
DEPAR.1MENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEW AL TO USE A WELL{S) FOR INJECTION WITH
A HEAT PUMP SYSTEM ~ ~
TO:
A.
> ~
Type SA7 and SQM Wells ~
N
,,.
In accordance with the provisions ofNCAC Title 15A: 02C.0200
complete application and mail to address on the back page,
DIRECIUR, NLTH CARQLINA DMSION OF WATER QUALITY
DATE:~ a:jlr ,20~
f
•.D
-0 :x
K N
3-
N
n
(;"
::c
SYSTEM CLASSIFICATION: Does the system re-circulate only potable water without any additives such as
corrosion inln'bitors or antifreezes in·continuous piping which isolates the fluid from the environment?
YES t
NO
If yes, do not complete this form. A form GW-57 CL, (Notification Of Intent To Construct A
Closed-Loop Geothennal-Water-Only Injection Well System), should be completed.
If no, then continue completing this form
B. PERMIT APPLICANT
N ame: Ge-.,;G... Q \ \,·►"" _J
A ddre ss: l=>l_ P~6 ~~~,AA Or.
City: rY\?c<L,.~j lh-
County: T o0e \
State: NL Zip code: __;;;-z..B==c....::\_,_\r _____ _
Telephone: ( t OL\, , l.l..O -.,: ;. $1..,
C. PROPERTY OWNER (if different from applicant)
Name: _______________________________ _
Address: -------------------------------
City: ___________ _ State: ____ Zip code: _________ _
County: ________ _ Telephone: ________________ _
D. STATUS OF ;11PLICANT
Private:_/_ Federal:__ Commercial: ___ _ State: Public: __ _
Native American Lands: ___ _
E . F AGILITY (SITE) DA TA (Fill out ONLY if the Status of Owner is Federal, State, Public or Connnercial).
Name of Business or Facility: ________________________ _
Address: ______________________________ _
City: ______________ State: ___ Zip code: _________ _
County: _______ Telephone: ________ Contact Per son: ______ _
Standard Industrial Code(s) which describe commercial facility: _____________ _
ver.3/01 GW/UIC-57 HPR Page 1 of 3
F . JNJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injec tipn permit)
G.
H.
I
rn.,1 ..
WELL USE ls(are) the injection well{s) also used as tjle supply well(s) for either of the following?
(1) The injectionoperation? YES~ NO __ _
(2) Your personal consumption? YES_ /II"_ NO __ _
CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering heat pump) and
effluent (water being injected in.;9 the well) lines is required. Is there a faucet on:
(a) the influent line? yes_/_n n,o __ _
(b) on the effluent line? yes / no __
J. CURRENT OPERATING DATA
_,.,, (I)
J (2)
J (3)
J (4)
Injection rate:
Injection volume:
Injection pressure;
Injection temperature;
Average (d aily)~ gallons per minute (gpm)
Average ( daily)Z~ gallons per day (gpd)
Average (daily) S~ pounds per square inch (psi)
/ .-l> Annual Average r;::;:; degrees Fahrenheit (0 F)
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the issuance of the previous injection
permit including the engineering layout of the (1) injection equipment, and {2) exterior piping/tubing associated
with the injection operation. The manufacturer's brochure, if detailed, should satisfy (1).
K. LOCATION OF WBLL(S) Attach a map
In~lude a site [!lllP (can be drawn) showing: the ~rientation of and distatices , between the injection well(s) and
any existing well(s) or waste disposal facilities such as septic tarlks or drain fields located within 1000 feet of the
ground-source heat pump well system; include buildings, property lines, surface water bodies, any other potential
sources of groundwater contamination. Label all features clearly and include a north auow to indicate
orienfanon.
L . PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
that are related to the site.
Examples include:
( 1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
ver.3/01 GW/UIC-57 HPR Page 2 of3
M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment, fluid, operation, etc.) that have occuned since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
N. CERTIFICATION
"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 infonnation. I agree to operate, maintain, repair, and if applicable, abandon the injection well
and all related appurtenances in accordance with the approved specifications and condi ·ons of the Permit."
(Signature o
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the ownel'
authorizing the above agen.t.
0. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the
well(s). A well is real property and its construction on land rests ownership in the land owner in the absence of
contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s) as outlined in this application and that it shall be the responsibility of the
applicant to ensure th.at the injection well(s) conform to the Well Construction Standards (Title 15A NCAC
Subchapter 2C .0200)
ver.3/01
(Signature of Property Owner if Different From Applicant)
Please return the completed Application package to:
UICProgram
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
(Telephone: 919-71?-6165)
GW/UIC-57 HPR Page 3 of 3
/
J ·/~ ,-=r c::= .AA'-"iU-
~/~~~/~
4 -:zoe:,J.r e 'l":f'"~-✓ -'t::II
I
l' I
i I
'll ~ I~ ,1 I i ,~ 1-t~ ~ t ~ f
I 1{ ~
~ ' \ ~l
/1-0 1 1~ ~~ ~j
~
~
I;,,,.,~ ~ ~ ~;
Michael F, Easley, Governor
William G. Ross Jr., Secmary
North Caroli na Department of Environment and NaturaJ RcsoWteS
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Gregory and Elizabeth Ollish
136 Perennial Drive
Mooresville, NC 281 17
March 31, 2004
Reference: Notice Of Regulatory Requirement
Permit# WI0300030
Issued to Norman F. Kunz
Dear Mr. and Mrs . Ollish:
Alan W. Klimek, P. E. Diroctor
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
The Underground Injection Control (UIC) Program of the Division of Water Quality is responsible
for the regulation of injection well construction and operation activities within the state of North
Carolina. The purpose of this letter is to inform you as the current propertv owner of your
responsibilities pertaining to injection well rules.
In June of 1997 the UIC Program re-issued Permit Number WI0300030 to Norman F. Kunz to
operate an injection well associated with a geothermal heat pump system located at 136 Perennial
Drive, Mooresville, NC in Iredell County; this permit expired on June 30, 2002.. This office
attempted to bring the expired permit into compliance by sending you a blank application for permit
renewal and injection well status form in June 2003, as the enclosed copy indicates. To date the
Groundwater Section has not received your injection well status form or application for renewal.
In order to comply with the regulatory requirements (North Carolina Administrative Code Title 15.A,
Subchapter 2C, Section 0.0211) you must take one of the following actions:
1. Submit the enclosed form APPLICATION FOR PERMIT RENEWAL To USE A WELL(S) FOR
INJECTION WITH A HEAT PUMP SYSTEM (FORM ow-57 HPR) if you are still using your injection
well for any purpose;
2. Submit the enclosed form STATUS OF INJECTION WELL SYSTEM (FORM ow-68) to certify that
the injection well is no longer in use.
N. C. Division of Water Quality / Groundwater Section
1636 Mail Service Center Ral eigh, N.C. 27699-1636
Phone: [phone] Fax : [phone] Internet: http://gw.ehnr.state .nc.us
Cus10mer Service
l -877-623-6748
Mr. and Mrs. Ollish
March 31 , 2004
Page2 of 2.
If the well is no longer being used for any purpose it must be properly abandoned by a certified well
contractor according to the regulatory requirements (North Carolina Administrative Code Title 15A,
Subchapter 2C, Section 0.0214) and the enclosed form WELLABA ND ONME NT RECORD(FORMGW-30)
must be submitted to our office to certify that the well has been properly abandoned.
Again, we have provided you with the appropriate materials for UIC renewal application. You will
need to respond to this notice b y A pril 30. 2004 or a Notice Of Violation will be issued to vou, which
carries the possibility for assessment of fines or cessation of operation of the injection well system.
If you have any questions about the UIC Program or the enclosed materials, please contact Thomas
Slusser at [phone] or me at [phone].
Enclosures
Sincerely,
~-C) -f:;_____
Evan 0. Kane, L.G.
U1C Program Manager
cc: Andrew Pitner. Groundwater Section Mooresville Regional Office Supervisor
CO-V IC Files
Mr. & Mrs. 01lisb
136 Perennial Drive
Mooresville, NC 28117
Dear Mr. & Mrs. Ollish:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Nonh Carolina Department of Environment and Jlfarural Resources
June 24, 2003
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Direcror
Division ofWarer Quality
The Underground h~ection Control (UIC) Program of the North Carolina Division of Water Quality is
responsible for the regulation of injection well construction and operation activities within the state ofNorth
Carolina. Our re.cords show that a geothermal heat pump system with an associated injection well was
constructed and permitted on your property. At this time the UIC Program's database indicates that this
injection well is operating under the name of Norman F. Kun2. The permit for this injection well has
expired and therefore this well maybe in violation of General Statute §88-87(j) and other state regulations.
The UIC Program would like assistance from you in resolving this situation by completing one of the
procedw-es below.
1 .) If a geotbennal heat pump system is operating on your property and you have an injection
well as part of this system, then please complete and sign the enclosed "APPLICATION FOR
PERMIT RENEW AL To USE A WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM" form. After
the completion of the application please send it to the UIC Program using the address on the
last page of this form.
2.) If an injection well is not operating on your property then please complete and sign the
enclosed "STATUS OF INJECTION WELL SYSTEM" form indicating that an injection well is
not in operation on your property.
The UIC Program is sending this letter in expectation that you respond regardless of whether you currently
have an injection well as part of your heating and cooling system. Please note, if you do not respond to this
letter an inspection of your property may be forthcoming to determine if an injection well is operating on
your property. If you are unsure whether you have an injection well, then please contact us so we can aid in
determining if an injection well is operating on your property.
If you would like assistance in completing this form, or if you have any questions regarding the UIC Program
or injection well rules, please contact me at [phone] or Evan Kane at [phone].
cc: UlC Files
Enclosures
Best Regards,
~Jipj
Mark Pritz!, Hydro geological Technician
UIC Program
N. C , Division of Water Quality / Groundwater Section
1636 Mail Service Center Raleigh, N.C. 27699-1636
Phone : [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc .us
Customer Service
1-877-<>23-6748
Appraisal Card Lookup http://www.co.iredell.nc.us/apprcard/default.a
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136 Perennial Dr
Mooresville, NC 28117
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iii 11_ ~ ........ .....__. .... ~
o~==~~~
Mr. Norman Kunz
136 Perennial Drive
Mooresville, NC 28115
Dear Mr. Kunz:
Michael F. Easley, Governor
William G . Ross Jr., Secretary
North Carolina Dep.artment of Environment and Natural Resources
July 2, 2002
Alan W. Klimek, P.E. !)lrector
Division of Water Quality
Our records show that the operating permit for the injection well on your property did expire on June
30, 2002 . In addition, our records do not indicate that the well has been abandoned.
In order to comply with the regulatory requirements for permitted injection facilities (15ANCAC 2C
. 0211 ), you must submit either 1) the enclosed Application for Permit Renewal to Use a Well(s) for
Injection with a Heat Pump System (form GW-57 HPR) if you are still using your injection weU or
2) the enclosed Status of Injection Well System (form GW-68) that certifies that the injection well is
no longer in use.
If the well is no longer to be used for any purpose, it must be permanently abandoned according to
the regulatory requirements (15A NCAC 2C .0213), and you must submit the enclosed Well
Abandonment Record (form GW-30). The appropriate form(s) should be forwarded to us by July 31,
2002 to allow adequate time for well water sampling and analysis.
If you have any questions; regarding the pennit and injection well rules or would like assistance
completing these forms please contact Mark Pritz1 at [phone] or Evan Kane at (919) 715 -
6 165 . .
cc: UIC Files
Enclosures
6~
Customer Service
1 800 623-7748
Sincerely,
~-J~
Debra Watts
Permits & Compliance Supervisor
Division of Water Quality / Groundwater Section
1636 Mall Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROL I NA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 81;
Article 21, Chapter 143, and other applicable Laws, Rules, and
Regulations
PERMISSION IS HEREBY GRANTED TO
Mr. Norman F. Kunz
FOR THE OPERATION OF AN INJECTION WELL for the purpose of injecting
heat pump effluent. This well is located at 136 Perennial Drive,
Mooresville, North Carolina, in Iredell County, and will be
operated in accordance with the application dated April 9, 1997,
and in conformity with the specifications and supporting data
submitted, all of which are filed with the Department of
Environment, Health, and Natural Resources and are considered a
part of this permit .
This permit is for Operation only, and does not waive any
provisions of the Water Use Act or any other applicable Laws,
Rules, or Regulations. Operation and use 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, No. WI0300030, is a renewal of Permit No.
WI0300030, which was issued on October 19, 1995 1 and shall be
effective, unless revoked, from the date of its issuance until June
30, 2002, and shall be subject to the conditions and limitations
specified in Parts I through VIII herein.
-1-"' Permit issued this the ,;lo day of::::::::::~u=n~e2 ,:::::::=19~9~7 _.__-;---------
&.J1r J ·:::,
Ted L. Bush, Jr ., Assistant
Groundwater Section
Division of Water Quality
Chief
By Authority of the Environmental Management Commission.
C:\OFFICE\WPDOCS\PERMITS\ARCHIVES\1997\KUNZ.WPD
Permit No. WI0300030
PART I -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 .
3. 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.
4. 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 II -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and
operated at all times so that there is no contamination of
groundwaters which will render them 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 (Division) 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.
Permit No. W10300030 PAGE2 OF 5
3. The issuance of this permit shall not relieve the Permitt~e
of the responsibility for damages to surface or groundwaters
resulting from the operation of this facility .
PART III -OPERATION AND MAINTENANCE REQUI~NTS
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.
PART IV -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 (see attached diagram).
PART V -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 Perrnittee shall report by telephone, within 48 hours of
the occurrence or first knowledge of the occurrence, to the
Groundwater Section Staff, Mooresvile Regional Office,
telephone number [phone], any of the following:
Permit No. WI0300030 PAGE 3 OF 5
(A) Any occurrence at the 1nJection facility which
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 VI -PERMIT RENEWAL
The Permittee shall, at least three (3) months prior to the
expiration of this Permit, request an extension.
PART VII -CHANGE OF WELL STATUS
l. The Permittee shall provide written notification within 1 5
days of any change of status of an inj ection well. Such a
change would include the discontinued use of a well for
injection. I£ 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 .0273, 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.
Pcmtit No. WI0300030 PAGE 4 OF 5
State o f North Caronna
Department of En v iro nment,
Health and Natural Resources
Divisio n o f Wat er Quality
Jame s B. Hunt , Jr., G overno r
Jonath a n B. Howes , Se c ret ary
-A. Preston Howard, Jr., P.E., Director
AVA
DEHNR·
GROUNDWATER SECT I ON
June 23, 1997
Mr. Norman F. Kunz
136 Perennial Drive
Mooresville, NC 281 1 5
Dear Mr. Kunz:
In accordance with your application dated April 9, 1997, we a r e
forwarding Permit No . WI0300030 for the operation of a geotpermal
heat pump injection well at 136 Perennial Drive,in Mooresville,
NC in I r edell County. A copy of the laboratory test results of
water samples collected on May 12, 1997 is also enclosed.
This permi t shall be effe ctive from the date of issuance
until June 30, 2002, and shall be subject to the condit i ons and
limitations stated therein, including the requirement to notify
this office by telephone 48 hours prior to initiation of
operation of the facility.
In order to continue uninterrupted legal use of this. well for the
stated purpose, you should submit an application to renew the
permit three months prior to its expiration date.
If you have any questions regarding your permi t please fee l free
to contact me at (919) 715 -6166 .
cc: UIC Files
MRO Files
Enclosures
G ro undwater Section ,
Sincerely, ft~w p,3t.1\
Marcus A. Geist
Underground Injection Control Program
C:\WPDOCS\PERMIT\TRANSA7.WPD
Voice 919-733-3221 FAX [phone]
P .O. Bo x 2 95 78 , Raleigh, North Carolina 27626-0578
2 728 Capitol Blv d .. Rale igh, No rth C arolina 27604 sem1·mee An Equal Opportunity/ Affirmative Adion Emp loyer
50% recycles/10% post-consumer paper
(B) The entire depth of each well shall be
( C)
( D)
( E)
( F)
(G)
sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing
operations.
Each well shall be thoroughly di~infected, prior
to sealing, if the Director determines that
failure to do so could lead to the contamination
of an underground source of drinking water.
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.
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.
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 0£ the
permit.
The Permittee shall submit a Well Abandonment
Record (Form GW-30) as specified in 15A NCAC 2C
.0213(h)(1) within 30 days of completion of
abandonment.
3. The written documentation required in Part VII (1) and (2)
(G) shall be submitted to:
Groundwater Section -UIC Staff
DEHNR -Division of Water Quality
P.O. Box 29578
Raleigh, N.C. 27626-0578
PART VIII -SPECIAL CONDI TIONS
NONE
Permit No. WI0300030 PAGE 5 OF 5
•IJNTY
IADNO:
IREIIEI.L
91 Jmt l '3 PH \ ~ \ S
DIVISION OF WATER QUALITY
Clttmisi~· ubor.1tory R•rort I Grouud Wttrr Qu•llty
SAMPLE l'RIORITY
!!]ROUTINE' □E~IERGENCY
'PORT TO _C_O ________ Rtgional Office ~ CHAIN OF CUSTODY EJ ILLECTOR(S) · _P_IP_P_I N _____ _
ITE:
\IE:
RPOSE:
5/IJ/97
ABORATORY ANALYSIS
BODJI0
COD High )40
CODLowllS
C'olifomr ~IF Fecol J 1616 <1
Coliform , ~lfTot;i!Jlso,t <1
TOC
TU<bi1i1y
Residue. Suspended 530
Total Suspended solids
pH
Alkalinity tu pH 4 S
Alkalinity lo pH 3.3
Carbonate
Bicarbonate
Cnrbon dioe<ide
Chloride 2
Cl1<01nium He., 1032
Color· rru1: 80
C'}anide 7211
mg/L
mg/L
mg/L
1100ml
1100ml
mg/I
ITTU
mg/L
mg/L
units
mg/L
mg/I,
mg/I,
mg/l,
mg/L
mg/I.
ug/1..
c .u.
mg/L
~ SAMPLE TYPE
Ownc:r NORMAN KUNZ.
t..oca1ion Of Sire;
Description ofsampfo'll point _____________________ _
Smnpling ~l<thod:
Remwb:
X Dis, Solids 70300 120 mg/L ,\g-Sil\er 46S66
Fluoride 9S I mg/L Al-Aluminum 46SS7
X lurdn=: total 900 42 mg/L As-Arsenic 46SSI
Hardnett-(non•co,bl 902 m~/L Bo-BBTium 46558
Phenols 32730 ug/L Co-Calcium 46552
Specific Cond. 9S uMhos/cm2 Cd-Cadium 46SS9
Sulr.lle mg/L X C,.0,romium 46560
Sulfide14S mg/L X Cu-Copper 1042
MBAS mg/l, X Fe-Iron 1045
OilondO,_ mg/L Hg• Mercury 71900
Silica ml!fl, K-Potassium ◄6SSS
Boron X Ms-Magne>ium 927
Formaldehyde mg/l-X Mn-Manganese I oss
NHluN610 <0.01· m&'l, Na-Sodium 929
TKNuN62S ms/L X Ni-Nickel
X NOZ +NOJ as n 6J0 0,32• mg/L X Pb-wad 46564
P: Total as P 66S rng/L Se-Selt11ium
P04 mg/I. X Zn_Zinc 46567
lMMENTS: "RECEIVED UNPRESERVED; PRESERVE N01/N03 SAMPLES WITH SULFUfi.JC ACID TO pH<l.O
LcbNumb<r ~ 7GIOS7
Dote Rec:ei,·ec:J · 5/13197
Time Receiu~d 9:~S AM
Reaivcd By : DS
Released By : DS
Da,e rq,or,cd : 6/11197
uwt, Otganochlorine Posticides
uglL O,.gsnophosphorus P...icides
ug/L Nitrogen PniiCtdes
ug/L
ml!fl.. Acid lterbicides
ug/L
<25 ug/L Sanivol111iles
170 ug/L TPH-Ditsd Rar,ge
100 •BIL
ug/L Volatile OTganics (VOA bottle)
mg/L
4.4 mj!/L TPH-Ga.olin• Range
<10 ug/1. TPH-BTEX 011SOlinc Range
mg/I.
<10 ug/l,
58 •BIL
us/L
450 us/L
7G1057.IAAY
. 'ri~'z.j'? •i .• North Carolina
GROUNDWATER FIELD/LA-~ FO~M . ~fffveJ (StX1rce) Department of Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY· GROUNDWATER SECTION
County Jr elf
Quad No'J!. i,(p ~ I l
Lal.½ ,H L/J..
Serial No. ______ _
Long_ &o -5'3
SAMf>,1E TY PE SAMPLE PRIORITY
C!twater ~tine
OOther
0 Soll O Emergency 0
Report To: ARO, FRO, MAO, RAO, WaRO, WiRO, ~-C-h-a-in_o_f_C_u_s-to_d_y ___ _
WSRO, Kinston FO, Fed. Trusl, Central Off~ uu lxf6. j /ff.-e,4 6eilif-
Lab Number -~""t----:&..~?-:::::!.,.......__----,,...,,...._=-::---
Date Receiv
Rec'd by=---~-From: Bus, ouri Hand Del.,
Other: · ·
Data Entry By: ______ Ck: ------
Date Reported: _____________ _
Shipped by: Bus,~ Hand Del., Other~· __________ _ a ~~ ~< Gollector(s): ? fp i;>h. Date S:: -12 --9) Time ll:oC> Baseline, Complaint, Compliance~~• Pesticide Study, Federal Trust, Olher: ______ _
FIELD ANALYs_Es' owner /Vor~-/(:,,, -z..
pH
400
&, Spec. Cond.
94
It 1 at 25° C Location-or_st __ t_e ___ /S&> ____ fu_r,:-,,-,-... -/-b..-,,s-.,,-~----~----------------
Temp.10 /C,.y 0 c Odor #t:}.e Desaiptionofsampli9gpoinl fa,,~6 ~/416 w/,,.e-.1:L~
Appearance tJ/e-Sampling Method q~ f?G,ff(? .S'>.ce s~fr-J 2-1? ~e >--Sample Interval ______ _
Field Analysis By: 0 ?ff?9"'--Remarks --~b~~--.....,~+-a.r-=>--C~_.e~·-1_Pii,.;_.---,.-_-*...,.·1
---,,-___,-,------,--,-----------------
LABORATORY ANALYSES <T~ ~ngliM.airleq).e1e., ---BOD 310 mall ....... Diss. Solids 70300 mnn Ao -Silver 46566 ua/1 Organochlorine Pesticides
COO.High 340 mg/I F IOHrli'IA 951 mo/I Al • Aluminum 46557 ua/I Organophosphorus Pesticides
L--COD Low 335 mg/I v Hardnec;c.: Total 'IO/l mn/1 As-Arsenic 46551 ua/I Nitrogen Pesticides
V Cohlorm: MF Fecal 31616 1100ml Hardness lnon-carbl 902 mall Ba -Barium 46558 uo/I Acid Herbicides
v' Coliform: MF Total 31504 1100ml Phenols 32730 unn Ca• Calcium 46552 ma/I PCB's
TOC 680 ma/I Soecific r.nnrl q,; l •• ·: H ,., Qt{:. Cadmium 46559 ua/I
Turbidity 76 NTU Sultate 945 ma/I y ~hr..omium 46560 uQ/1
Residue., Suspended 530 mg/I Sulfide 745 moll ✓ Ccf".'.' Coooer 46562 uQ/1
I" Fe -Iron 46563 Ug/I Semivolatile Organics
Oil and Grease mQ/1 Hg-Mercury 71900 ug/1 TPH -Diesel Range ·,
pH403 unit~ K~tassium 46555 mg/I
Alkalinity lo pH 4.5 410 mg/I v ~Maonesium 46554 ITlQ/I
Alkalinity lo pH 8.3 415 mg/I V Mn -Manoanese 46565 uQ/I
Carbonate 445 mg/I NH. as N 610 ma/I ~odium 46556 mq/I Volatile Organics (VOA bollle)
Bicarbonate 440 mQ/1 Tl<~ N ,,,,,, rnnll
.,, . ..;..~-~ uo/1 TPH -Gasoline Ranae
Carbon dioxide 405 mg/l /
ma/I / Pb • Lead 46564 ua/I TPH • BTEX Gasollnt Range V NO. + NO. as N 630
i,.-/ Chloride 940 mg/I P: Total as P 665 ma/I S e..--8elenlum uQ/I
Chromium: Hex 1032 ug/1 y Zn -Zinc 46567 ua/1
Color: True 80 cu
Cyanide 720 mg/I
lab Comments:------------------------------------------------------
GW-54 REV. 7,s, For Dissolved Analvsis • submit fillered sample and write "DIS" in blc
91 JU.! \ 3 PH I : \ S DIVISION OF WATER QUA LI T\'
l OUNn
QUAD NO·
IRF:llt::1,1. S.',MPLE PRIORITY
~ROUTINE □EMERGENCY
REPORT TO _c_o ________ Rqional Office ~ C HAIN O F CUSTODY
0 SAMPLETYPE
C OLLECTOR(S) :_P_I P_P_I_N _____ _
DATE· 5112/!17
fl~IE:
l'URrOSE: 0\'•'flc:r. NORJ\IANKUNZ
Localion or Sile:
Oescriphon of sampling puint _____________________ _
Sampling Method:
Rfflurrl<s.
LABORATORY ANALYSIS
BOOJI0 mg/L X D in Solid• 70)00 130 msJL Al!•S ih ·er 46566
COD High340 mgll. Fluoride 9S I mg/L Al-Aluminum 46SS7
COOl.ow)JS msfl, X Hardness. lOW 900 ◄O mg/I. As-Arsenic 46SS t
'( Col;fonn MF f,<al 3 161 6 <1 1100ml Hordness; (non-c-arb) 901 mi;IL Ba-Barium 46558
\'. Coliform Ml'TotolJ1 504 ~1 1100ml f>h,oolsJ27J0 U#L Co-Calcium 46S52
TDC mg/I Specific Cond. 9S uMboslan2 Cd-Cadium 465S9
Tu,-bitity NllJ Sulfate msfl, X CT-Chromium 46560
Residue:., Su.spcndcd SJO msfl, Sulfide 7◄S mg/L X Cu--Coppa-t 042
T ollll Suspended solids msfl, MBAS mg/L X F~lmn 104S
Oil and Groase mg/L Hg• Mercury 71900
pf-I units Silica mg/L K-Polassium 465SS
Alkalinity 10 pH ~.S mg/I. Bo.on X M g• M■Jllle>iurn 927
Alkalinity lo pH &.3 mgll. Formaldehyde mg/L X M n-Manp,ese I0SS
Carbona1e ms/L NHJ asN610 <0.01• m&'L No-Sodium 929
Bicarbonate ms/L TKNasN62S m&'L X Ni-Nickel
Carlooo ,liox ide mg/L X N02 +NOJ an 630 0.32' rng/L X Pb-1.eod 46SM
'( Chloride 2 mg/L P· Total as r 665 mg/L Se-Selenium
Chron1ium: Ho.'< 1032 ug/l. P04 mg/L X Zn_Zinc 46567
Color: True 80 c.u.
Cyanide 7 20 mg/L
COMMENTS : *RE CEIVED UNPRESERVED; PRESERVE N01/NOJ SAMPL ES WITH S ULFUR I C ACID TO pH<1.0
Lab Number 7Gt058
Ontt Recci, cd · !vlJ/'}7
Time Received '1:25 AM
Rtcei\'cd By OS
Released By : OS
DIiie rq,ortcd : 6/11197
usfl, Org.mochlorioc Pes1icidcs
ug/L O<l!Onophosphorus Pesticides
ug/L Nitn,gen PC$1icidcs
ug.'L
111"11. Acid Herbicides
usfl,
<25 ug/L Semi,olalilcs
96 ug/L TPH-Diesd Range
170 us/L
ug/L Volatile Organics (VOA bottle)
mg/L
◄.5 rng/L TPH-Oasoline R.nge
<10 ug/L TPH-BTEX Gasoline Ran~
mg/L
<10 us/L
<10 •sit
ug/L
◄90 ug/L
.
7GI058.IMY
GROUNDWATER FIELD/LAB FORM
County T ,eJelf
Quad No A/f,ft, j -II
Lat. k 31 '12
Serial No. ______ _
Long _ &O 53
SAMPLE TYPE
iB-efater
□soil
~RITV
outlne
D Emergency
North Carolina
Department of Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Lab Number __,~~"..-"":~:>""\'---=---t'lr-:=---
Date Received 1::z!l-"',_,___-1-+-~-
Rec'd by=•--t::,.'--""'--: u ouner, Del., D Other ---------0 ~of Custody
Other: ________________ _
Data Entry By: ______ Ck: -------
Date Reported : _____________ _
/
BOD. 310 ma/I v Diss. Solids 70300 mnn Ao -Silver 46566 · ua/I Organochlorine Pesticides
COD High340 mg/I FJtruride 951 ma/I Al -Aluminum 46557 uall Organophosphorus Pesticides
C0D Low335 mg/I V Hardness: Total 900 m o/I As -Arsenic 46551 unn Nitrogen Pesticides
]I Coliform: MF Fecal 31616 1100ml Hardness /non-carb) 902 mnn Ba -Barium 46558 ua/1 Acid Herbicides
I, v coliform: MF Total 31504 1100ml Phenols 32730 unn Ca -Calcium 46552 mo/I PCB's
TOC680 mQ/1 S o ecific Cond. 95 uMhos/cm2 Cr! -Cadmium 46559 uo/1
Turbidity 76 NTU Sulfate 945 mall ✓ if-Chromium 46560 unn
Residue., Suspended 530 mg/I Sulfide 745 ma/I i/ W-Co ooer 46562 UQ/l
/ Fe ~ Iron 46563 ug/I Semivolatile Organics
011 and Grease mQ/1 Hg -Mercury 71900 ug/1 TPH . Olesel Range
pH 403 units 1< ~ium 46555 mQ/1
Alkalinity to pH 4.5 410 mg/I v Mo--Maonesium 46554 mall
Alkalinity to pH 8.3 415 mg/I ✓ Mn -ManQanese 46565 uQ/1
Carbonate 445 mg/I NH asN 610 ma/I Na.-Sooium 46556 mQ/1 Volatile Organics (VOA bottle)
Bicarbonate 440 mQ/1 I ~~ l\l """' mn/1 V 1\11~ 11n n TPH -Gasoline Ranae
Catbo n dioxide 405 mg/I ✓ NO +Nb as N 630 mall V Pb -Lead 46564 uo/1 TPH -BTEX Gasollre Range
V Chloride 940 mg/I P: Total as P 665 ma/I Se.-»-Selenlum UQ/1
Chromium: Hex 1032 ug/1 V Zn -·Zinc 46567 unn
Color: True ao I cu
Cyanide720 mg/I
Lab Comments:-----------------------------------------------------
GW-54 REV . 7/96 For Dissolved Analysis -submit filtered sample and write "DIS" In bloc1•
North carolina Dep_ .:ment of Environment, Health, a Natural Resources
Division of Environmental Management -Groundwater Section
INJECTION FACILITY INSPECTION REPORT -FORM B
INJECTION WELL PERMIT NO. WI 030003 0 DATE ) -I l -97
NAME OF OWNER-;._ __ Jl/.z....;:;.b _r ~~-Q...-__ ~/~(~v~n~~=-----------------------
ADDRESS OF OWNER_~J3~~~-Pe_r_e_n_!Q~f--_0~1-~~ye_~/~U_a_•~-~_u_:/i_~_-_/i_VC __ 2_~_/I_S-_____ _
(Street/ road or 1ot and sudd1v1s1on, county, town)
LOCATION OF INJECTIOJ' WELL (and sourc~/,well(s), if applicable)
{-<o.r,,f-1/o--rc,/ ➔ I i,,.//vev/ + .G fflc/ e._/ 1'½ ..S 4-e ~ti-
(Street/ road or lot and sudd1v1sion , county, town, 1f different than owner's address, p1us description of location on s1te)
Potential pollution source
Potential pollution source
Potential pollution source
Distance from well
Distance from well
Distance from well
Minimum distance of well from property boundary ..-?::,-'
I
Quality of drainage at site lfc.'"%-C / Flooding potential of site lllo~
(good;.adequats,poor) (htgh,moderate, low)
DRAW SKETCH OF SITE (Show property boundaries, but ldings, we 11s, potent ta 7 po 77utton sources, roads, approx11114te
sca1e, and north arrow.)
&;> ~II
Wf/1 ;5e,lo1t-!, c..s J,..,.;-:ftw,.
t!--
DESCRIBE INJECTION SYSTEM (vertical closed 1oop, uncased borehole or cased water well; separate source we11 and
fn.;Jectjon we17; comb1n8f.ion source and injectio'} we11; or other desc'j~ption as fPP1icab1e);
Wu/tr V #<,-J~,i -/ r~ l-vell lo $• '6/e..,... d'X.,., .,O&dZ >,,i-fo ~c'I I.
INJECTION FACIL-~r INSPECTION REPORT -1RM B (CONTINUED)
iELL CONSTRUCTION
)ate constructed -L-)_-_r_O_______ t{Jo ~( THf9
5
)rilling contractor: Name __ B_e~ __ //_;t_i(_;.t:._1:_l_~-----------------
Address
Registration number
r
rotal depth of well 3CO ------& et/ h/v (rd,.,.__
Inspection point
-Cas ing
Depth
Diameter
Height (A.L.S.)
Grout
Depth
Screens
Depth(s)
Length(s)
I.D. Plate
static water level
Well yield
Enclosure
Enclosure .floor
(concreted)
Sampling port
(labelled)
Water tight pipe entry
Well enclosure entry
Vent
Measurement
/). "
Meets minimum standards Comments
Yes No
✓
✓ I --
v
✓ --
✓
~
/t6 _y,,.11745 r ,ls k--cvkcl
---dil--c. f welt it«-'<-~/.
Functioning of heat pump system (Determine from the owne r if heat pump functions properly .)
/!Ir h I<~ /,II( /
INSPECTOR __ t?_._r_:~?~2_,'v\_ ________ Office ___ ~/n___,;12.~0_-_G_W ________ _
✓ I
WITNESS
WITNESS
;fJ · /tvn 2._ Address --------===---------
Address ---------------
JULY, 1994
NORTii CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVJRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEW AL TO USE A WELL(S) FOR
INJECTION WITH A HEAT PUMP SYSTEM
In accordance with the provisions ofNCAC Title 15A: 02C.0200
complete application and mail to address on the back page.
Type 5A7/5QM Wells
ID Om.ECTOR, NORTii CAROLINA DMSION OF WATER QUALITY
DATE: 4 -q , 19_!!.L
Please type or print clearly.
0 '° "1 _, .:?
:Da . c,:::O -o .;..,m
;:o en
A. SYSTEM CLASSIFlCATION Does the system re-circulate only potable water without-<=; ~
any additives such as corrosion inhibitors or antifreezes in continuous piping which .l:'"' OC!1
isolates the fluid from the environment? ~ =::~
.-~m
r-,::C:
YES .C, If yes, do not complete this form. A form GW-57 CL, (Notification-:: :::: $
Of Intent To Construct A Closed-Loop Geothermal-Water-Only ~ ~
Injection Well System), should be completed. F"l
ID )(_ If no, then continue completing this form.
B. PERWI' APPLICANT
Name: ij \0 Q ,YVl J F. \C,uJ 2
Address: l 3 (p ~ fft. e " & ; q \ "be
City: fYko11. r .... L) ... I l ~ Zip code: ~f / / ~
County: ' J?ri l'.•{d I Telephone: 7 (') 1/ -&;C. Z -IP.0 9 ~
C PROPERTY Oy;NER (if different from applicant)
Name: ________________________ _
Address: _______________________ _
City: __________ _ Zip code: _________ _
County: ______ _
D. STATUS OF APPLICANT
Private:¼_
State:
GW-57 HPR (Apn1 1997)
Federal: __
Public: __
Telephone: __________ _
Commercial: __ _
Native American Lands: __ _
Page 1 of 4
E. FACILITY (SITE) DATA (Fill out ONLY if the Status of Owner is Federal , State, Public
or Commercial).
Name of Business or Facility: _________________ _
Address: _________________________ _
City: .... ____________ _ Zip code: _________ _
County: _________ _ Telephone: __________ _
Contact Person: ______ _
Standard Industrial Code(s) which describe commercial facility: _______ _
F. INJECTION PROCEDURE (specify any modifications to the injection procedure since
the issuance of the previous injection permit)
tJ oN--e
G. WELl., USE Is(are) the injection well(s) also used as the supply well(s) for
either of the following?
(a) The injection operation?
(b) Your personal consumption?
H. CONSTRUCTIONDATA
YES _.,..
YJ;$ ✓
NO __ _
NO __ _
(1) Specify any and all modifications to the well casing, grout or screens since the
issuance of the previous injection permit
. -
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make
provisions for monitoring well head processes. A faucet on both influent
(groundwater entering heat pump) and effluent (water being injected into the
well) lines is required. Is there a faucet on:
(a) the influent line?
1 CURRENT OPERATING DATA
(a) Injection rate:
(b) Injection volume:
(c) Injection pressure:
(d) Injection temperature:
GW-57 HPR (April 1997)
yesLno_ (b) on the effluent line? yes_K_ no __
Average (daily) ' gallons per minute (gpm)
Average (daily)) 5'9 Z gallons per day (gpd)
Average (daily) r pounds per square inch (psi)
I
Annual Average _____ degrees Fahrenheit (0 F)
Selk 7S'0 r:
Page 2 of 4
J. INJECTION-RELATED EQUIPMENT .
Attach a diagram showing any modifications to injection equipment since the
issuance of the previous injection permit including the engineering layout of
fue (1) injection equipment, and (2) exterior piping/tubing associated with the
injection operation. The manufacturers brochure, if detailed, should satjsfy (1).
K. LOCATION OF WELL(S) Attach a map
Include a site map (can.be drawn) showing: the orientation of and distances
between the injection well(s) and any existing well(s) or waste disposal facilities
such as septic tanks or drain fields located within 1000 feet of the ground-source
heat pump well system; include buildings , property lines, surface water bodies,
any other potential sources of groundwater contamination'. .Label all features
clearly and include a north arrow to indicate orientation.
L. PERMIT UST: Attach a list of all permits or construction approvals, received or
applied for by the applicant that· are related to the site.
Examples include:
(1) Hazar~ous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
M. O'I1lER MODIFICATIONS: Indicate any other modifications to the injection wen system
(equipment, fluid, operation, etc.) that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
N. CERTIFICATION
"'I hereby certify, under penalty oflaw, 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 ~e. accurate and
complete, I am a':"~ that the~ are signific?,Dt penalties, ~clu@.tg the,ppssibility of
fines and imprisonment, for submitting false information. I agree fo 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."
t signature of Owner o
Please supply a letter signed by the owner
authorizjng the above agent, if authorized agent is signer.
GW-57 HPR (April 1997 ) Page 3 of 4
orized Agent)
0 . CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other
property rights in the well(s). A well is real property and its construction on land
rests ownership in the land owner in the absence of contrary agreement in
writing .)
If the property is owned by someone other than the applicant, the property owner
hereby consents to allow the applicant to operate an injection well(s) as outlined
in this application and that it shall be the responsibility of the applicant to
ensure that the injection well(s) conform to the Well Construction Standards
(fitle 15A NCAC Subchapter 2C .0200) --
GW-57 HPR (April 1997)
/~~ (Signature of Pr~~erent From Applicant)
Please return the completed Application package to:
Underground Injection Control Program
Groundwater Section
North Carolina DEBNR-DWQ
PO. Box 29578
Raleigh, NC 27626-0578
( telephone: ~19-715-6166)
Page 4of 4
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Latitude
Longitude
Recs
204
204
Mean
3 5½3 4 '3 1 .448 "N
80½52'54 .824 "W
Std Dev
2.457
2.351
~ltitude 204 225.828 4.313
No velocity records in file.
No DOP records in file.
Start GPS Week #795 on 04/06/95 at 17:36 :08
End GPS Week #795 on 04/06/95 at 17:43:12
Datum
Coordinate System
Altitude Mode
Altitude/Distance Units
Velocity Units
WGS-84
Latitude/Longitude
Height Above Ellipsoid
Meters
Meters/Second
. '·
Minimum
Statistics Version 3.3
Maximum
35½34'31.245"N
80½52'55.064"W
208.306
35½34'31.744"N
80½52'54.407 11 W
233.552
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this pin••~ ,s,duJed, at an) time :tCter th• a~µro,d of rh(s ~I
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,EDELL COUNTY HEALTH DEPAR1 . _NT , .
(SEPTIC TANK) IMPROVEMENTS PERMIT AND CERTIFiCATE OF COMPLETlON
(Ground Absorption Sewage Disposal System '..-G. S. Chapter 130-Article 13C)
OWNERORCONTRACTOR J~'Jt. _ti • .'J~ DATE .$ /z.,J➔ l PERMITNo1k-Ji-,4.-
PHONE : Busine . ....._ ________ Home I, 44 -; 1 C-c./
LOCATION ~v.,...-.:)·*..,__·l ,-&?-~1 . ...dJv. ... -{:-r-1.. .;_-/_~4,,--.-d-!-~<1-,-~ 1-:::r-d_._f
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SUBDIVISION NAME
1
-,:: ~~ J. ~• LOT NO. ~-· I SECTION OR BLOCK NO. __
House ( ~ Mobile Home ( ) Business { ) Other ______ _
,
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No. Bedrooms No. Bathrooms Character & Porosi ty of Soil r· :<--
Garbage Disposal Unit Yes ( ) No o-,--· Percolation Rate
Auto. Dishwasher Yes ( ) No (~ Topography 7--<t<:14
Auto. Wash. Machine Yes c·-1~. No ( ) Depth to Water Table
Site Su itable Yr.s (~ No ( ) -Rock or other impervious formations
f}ot Area
Basement w ..
~ Basement without Plumbing No , .. Basemen t
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No . of Unes --==, ___ _
Sq. Ft. ~,., o I inear Ft. -2 oe-
Depth of Stone in Lines I-;...."
Water Suooly: Individu al ( ✓
Pu olic \ )
Installed by .l]Ls._ /4.~)/_
I understand and agree to install septic tank
system as sp eci fi ed on t his Im provements
Permit.
Signed : ___________ _
IMPROV EME~TS PERMIT BY ________________ _
j· COMMENTS:
'-! ---
EXISTING SYSTEM CHECKED BY: _______________________ DATE ___ _
CONSTRUCTION MUST COMPLY WITH ALL OTHER APPLICABLE STATE AND LOCAL REGULATIONS .
Permit is VOID if any unauthorized changes are made in installatio n of system and/or if any false information is supplied in making
Improv emen ts Permit.
' Heal th Dept. Copy: White Inspection Dept. Copy: Yellow.. Sanitarian's-Copy: Pin}t Owner's Copy : Gold
;tie'"
6 Continue on Page 35 7
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State of North Carollna
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathon B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
MEMORANDUM
To: Steve Bograd
Peggy Finley
GROUNDWATER SECTION
October 23, 1995
Groundwater Section
Mooresville Regional Office
From: Karen Harmon ?{arf
UIC Group
Groundwater Section
Raleigh central Office
-BA
DEHNR
Re: Permit No . WI0300030 issued to Mr. Norman Franss Kunz
An amendment of an existing permi t for operation of an
injection well has been approved by RCO-UIC. Mr. Kunz purchased
the property at 136 Perennial Drive, Mooresvi l le, NC from Mr.
Robert Hensel, Jr., to whom the existing permit had been issued.
A copy of the application and the permit are enclosed for
your UIC files.
P.O . Box 29535, Raleigh. North Caollna 2762~5 Telephone [phone] FAX [phone]
An Equa l Opportunity Affirmative Ac tion Employer 50% recycled/ l 0% post-consumer p aper
PERMIT APPROVAL REQUEST
Please initial and
return to Karen
for process~
Ted Bush ~/;i/2~
Bob Cheek
Mark Milligan _-.
Karen Harmon J/~t
State of North Coro11na
Department of Environment,
Health and Natural Resources
Division of Environmental Management .R'A James B. Hunt, Jr ., Governor
Jonathon B. Howes, Secretory DEHNR
A. Preston Howard. Jr ., P.E ., Director
'GROUNDWATER SECTION
OCTOBER 19, 1995
Mr. Norman Franss Kunz
136 Perennial Drive
Mooresville, NC 28115
Dear Mr. Kunz ,
In accordance with your application dated September 5, 1995,
we are amending Permit No. WI0300030 for the operation of a well,
for the purpose of injecting heat pump effluent, in Iredell County.
Please note that the only changes to the referenced permit, issued
August 6, 1991, are as follows:
1) The permi ttee name has been changed from Robert Paul
Hensel to Norman Franss Kunz.
2) The street address has been modified from 18 Perennial
Drive to 136 Perennial Drive.
3) The permit numbering system has been revised so that the
permit, originally numbered 48 -0256 ~ WO -0099, has a
new number.
This permit shall be effective from the date of issuance
until August 6, 1996, 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 six months prior to its expiration date.
If you have any questions regarding your permit please feel
free to contact me at (919) 715 -6166.
cc : urc Files
MRO Files
Enclosures
Sincerely, x~a.~
Karen A. Harmon
Underground Injection Control Program
P.O. Box 29535, Raleigh. North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMM:rSSION
DEPARTMENT OF ENVIRONME NT , HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87;
Article 21, Chapter 143, and other applicable Laws I Rules, and
Regulations
PERMISSION IS HEREBY GRANTED TO
Norman Franss Kunz
FOR THE OPERATION OF AN INJECTION WELL for the purpose of injecting
heat pump effluent. This well is located at 136 Perennial Drive,
Moo r esville, North Carolina, in Iredell County, and will be
operated in accordance with the application dated September 5,
1995, and in conformity with the specifications and supporting data
submitted, all of which are filed with the Department of
Environment, Health, and Natural Resources and are considered a
part of this permit.
This permit is for Operation only, and does not waive any
provisions of the Water Use Act or any other applicable Laws,
Rules, or Regulations. Operation and use 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
Regulat i ons pertaining to well construction and use.
This permit shal l be effective, unless revoked, from the date
of its issuance until August 6, 1996, and shall be subject to the
conditions and limitations specified in Parts I through VIII
her ein.
Permit issued this the /9~day of October, 1995.
Cdf. rc!2=--/id
;;1 L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Environmental Management
By Authority of the Environmental Management Commission.
PERMIT NO. WI0300030
·•~-~.,}~-
• . 1000 ½ ::>l-l-lL t. 1:~'tVVU .. . ,.. ,.. .:.
, -~ l~.7./.J ~~~1,.\1 _ _.. .. , ~ . _ ~ I .~~~ 9 -----~
: ~ ..,._.:,;;;,, ",'-'\\\L.1111>1111~ I • ~ • 'ml,
~ .. w~ \
. '"',,..,=· ... :::.?= ''--'-" ,rr, t . M= .
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EX ft"1-/ ~ wie /U.. ti, I s fl1 /J,i lt?/ci .l' /Jt/Jl, /.,19 ,~4 i /ti A,a l; f
ber~l New .Jo AJ(Jfl.~ Cpu/rq,1
PERMIT NO. WI0300030
PART I
A. GENERAL CONDITIONS
1. The Permittee must comply with all conditions
of this Permit and with the standards and
criteria specified in lSA NCAC 2C .0200. Any
Permit noncompliance constitutes a violation
of the appropriate Act and is grounds for
enforcement action; for Permit termination,
revocation and reissuance or modification; or
for denial of a Permit renewal application .
2. It shall not be a defense for a Permittee in
an enforcement action that it would have been
necessary to halt or reduce the permitted
activity in order to maintain compliance with
the conditions of this Permit.
3. The Permittee shall take all reasonable steps
to minimize or correct any adverse impact on
the environment resulting from noncompliance
with this Permit .
4. The Permittee shall give advance notice to
the Director of any planned changes in the
permitted facility or activity which may
result in noncompliance with the Permit.
5. The Permittee shall report all instances of
noncompliance, not reported under condition
1. of this Part, at the time monitoring
reports are submitted .
6. Where the Permittee becomes aware of a
failure to submit 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 by the Permittee.
7 . The Permittee shall give notice to the
Director as soon as possible of any planned
physical alterations or additions to the
permitted facility .
8. In the event that the permitted facilities
fail to perform satisfactorily, the Permittee
Page 2 of 4
PERMIT NO. WI0300030
PART I (continued)
PART II
shall take such immediate action as may
be required by the Director.
9. The injection system shall be effectively
maintained and operated at all times so that
there is no contamination of groundwaters, or
other actions or occurrences which renders
them unsatisfactory for normal u se . In the
event the facilities fail to perform
satisfactorily, including the creation of
nuisance conditions, the Permittee shall take
such immediate corrective action as may be
required by the Director.
10 . Provisions shall be made for collecting
samples of facility effluent, both prior to
its entrance to treatment devices and
subsequent t o leaving the treatment devices
but before entering the injection well.
11. Department representatives shall have
reasonable access for purposes of inspection,
observation and sampling associated with
injection and related facility.
12. This Permit is not transferable without prior
notice to, and approval by, the Director.
13. An application for modification, renewal or
transfer of this Permit shall be filed with
the Department at least 30 days prior to the
expiration date of this Permit.
A. SPECIFIC CONDITIONS
NONE
Page 3 of 4
Sanitary Well Seal
Casing must extend min.
of 12 inches above
land surface
I
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)\TTACHMENT 1
PERMIT NO. WI0300030
·I
I
Sampling.Tap
(Influent) HEAT
PUMP
COMBINATION SOURCE
AND INJECTION WELL
'
. ;
NORTH CAROLINA
ENVIRONMENTAL MANAGE1\1ENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOu:RCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
WITH A HEAT PUMP SYSTEM
Class 5 Wells
TO : DIRECTOR, NORTH CAROLINA DMSION OF ENVIRONMENT AL MANAGEMENT
DATE: 1 S c•trl ,199S-~ . --
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and regulations pursuant
thereto, APPLICATION is hereby made for a PERMIT to construct and/or use a well or well system as described
below and in any accompanying data submitted as part of this APPLICATION.
Please type or prin.t clearly.
A. -PERMIT APPLICANT
• Name: • k 1.1. tJt.
Address: -~~-~-----=O_tt_,,~e-=-:---:----=~~------
City: ...:..:..L~~i,:.c...~L,Lc..;..:;..__,,...,..__.~.._ ___ Zip code: ..]81 I J
County:
Telephone: zr L f Z .£y J'<-~
B. STATIJS OF APPLICANT
Federal ____ State _____ Private'----''-'--------
Public_____ Commercial Other ________ _
Native American Lands --------
C. PROPERTY OWNER (if different from applicant)
Name:
Address:
City: ____________ Zi.p code: ________ _
County:
Telephone:
D . FACILITY (SITE) DATA (Fill out ONLY if the Status of. Owner is Federal, State, Public or Commercial)
E.
F.
Name of Business or Facility:
Address:
City:
County:
Telephone:
Contact Person: ___________ _
____________ .Zip code: ______ _
HEATING CONTRACTOR DATA t"J /,
Name: IJ.di,e s .)ht'/ //tc ✓i It,. IAI<
'
I v.,.,~1::.:tf\! Address: P,..._,J""J3~4,.,.,,_ .... >"--"-'' S-....,_ ___ -=-r-~--==---:--=--a,--------,,-!2-±-"-• _1 _) _
,:: ('1i,4, /J+',
,;i. F ' ,;L l ..
c1 .;An, l-q
City: 'll_"coRc> ,, 1/r .y'c Zip code:._J._)'.._✓_._(.,.:;O _ __._ __ _
County:
Telephone; 7 Dr (...l ? -.2 0 " )
Contact Person: -u
URE (Briefly describe how the injec;tion well(s):will be used.) 1 , -I . l \ ., > L1«+ Ji..~-., /le..-"' , r, .. , ... t/e~ ... ;({ ~ Cr!t,v--><11 -tt H . PY• ...,, ,. q "it t.({ .... , J:b4t ....,~ll~'~ ,~t:6 .\-9-...,t bp,l ,. ,r t. .... ,,, ~. c:1 0 m1:A.t ,11 ' v-"i d t ,,), "r.., .. k,J1
t./ l , ... ,.,,e..ll h, Cwl
G. WELL USE Will the injection well(s) also be used as the supply well(s) for either of the following:
(a) The injection operation?
(b) Your personal consumption?
GW-57 HP (October 1 994)
YES_){_
YES~
Page 1 of 4
NO __ _
NO __ _
H. CONSTRUCTION DATA (check one)
(1)
(2)
(3)
(5)
X EXISTING WELL 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
Fonn GW-1 (Well Construction Record) if available.
PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED consttuction specification s. Submit
Fonn GW-1 after construction.
Well Drilling Contractor's Name: P/J-/4 ~s ;..,d lb:,, I /4 v 7,~ J"'J Z.. l~s<..J
NC Driller Registration number: ___________ ,
Date to be constructed: '7 D,c:... I ?<it) Approximate depth: .la:J F -1.
Well casing:
(a) Type: Galvanized steel_i__Black steel __ Plastic __ Other(specify) _____ _
(b) Inside diameter: l,, inches; Wf1 rckness--=---~inches or schedule# ___ _
(c) Casing depth: From O to I ft. (reference to land surface)
Casing extends above ground ____ inches (must be at least 12 inches)
Cement grout
(a) Around inner or "primary" casing: From O to 4 ft.
(b) Around outer (pit) casing, if present: From ___ to __ _,ft
Screens (if applicable):
(a) Type: .,,,. Inner diameter. ______ inches
(b) Depth: From to __ --'feet below land surface
(6) Gravel (if applicable): From ___ .to. __ ...,feet below land surface
(7) N.C. State Regulations (Title 15A NCAC 2C Section .0200) require the pennittee to make
provisions for monitoring well head processes. A faucet on both influent (groundwater entering heat
pump) and effluent (water being injected into the well) lines is required. Will there be a faucet on:
(a) the influent line? yes~no__ (b) the effluent line? yes.)t.....no __
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DAT A FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
PROPOSED OPERA TING DATA
(a) Injection rate: Average (daily) B gallons per minute (gpm)
(b) Injection volume: Average (daily)2., en gallons per day (gpd) 8-1sei o,;, !0 %
(c) Injection press-ure: Average (daily) i'o • F pounds/square inch (psi)
(d) Injection temperature: Annua1Average'7S:0 f degreesF ·
I.
J . INJECTION FLUID DATA
(1) Fluid source. If underground, from what depth, fonnation and type of rock/sediment unit will the
fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth: / ]o ' Formalion:, ______ ,Rock/sediment unit: 6'.e@; R
(a) SOURCE WELL CONS1RUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,
provide the data in part H (1) through (7) of this application form to the best of your
knowledge.
(2) Chemical Analysis of Source Water. The following chemical characteristics MUST accompany this
application:
pH --~· Total hardness ____ ppm (parts per million or mg/1); Iron ____ ppm ;
Chloride ppm; Nitrate ppm; Coliform bacteria counts/l00ml.
NOTE: Assistance in determining these values may be obtained by contacting (a) your local or county
health offical, (b) a commercial water-testing laboratory, (c) your well drilling contractor, or
(d) the regional Hydrogeologist, North Carolina Dept. of Environment, Health, and Natural
Resources.
GW-57 HP (October 1994) Page 2 of 4
K. INJECTION-RELATED EQUIPMENT
Attach a diagram snowing the engineering layout of the (1) injection equipment. and
(2) exterior piping/tubing associated wilh the injection operation. The manufacturer's brochw:e, if
detailed, should satisfy (1) above
L TOPOGRAPIIlC MAP
Attach a scaled topographic map which extends one mile beyond the property boundaries of the
facility and indicat~ the location of the facilit:Y;. Ne.~ ~ A~ h.we No :t'cle)f "'I~ a.,~ r.>FTJ.-, PI/Jfl 6C.. to Oltcll~t.,e..
M LOCATION OF WELL(S)
Attach a detailed, scaled, map of the site of the facility, showing the location of and distances
berween the proposed wells(s) (source wells and injection wells) and any waste (including hazardous
waste) treatment, storage or disposal facilities; buildings; property boundaries; surface water bodies;
and any other potential source of groundwater contamination. Additionally, indicate on the map the
direction and distance to existing wells (injection wells, water supply wells, dry wells, abandoned
wells) located within 1,500 feet of the proposed injection well(s). Include with the map a description
of each existing well, incorporating type, construction information, date drilled, and depth. Indicate
on the map at least two nearby reference points such as roads, road intersections, streams, etc., and
identify them by US, NC or SR (county secondary roads) numbers or name. Label all fealUres
clearly. Include a north arrow on the map to indicate orientation.
N. CERTIFICATION
"I hereby certify. wider penalty of law, that I have personally examined and am familiar with the
infonnation submitted in this document and all attachments thereto and that, based on my inqwry of
those individuals immediately responsible for obtaining said information, I believe that the infonnation
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 ~plicable, abandon the injection well and all related appurtenances in accordance with the
approved specifications and conditions of the Permit."
d Agent)
Please supply a letter signed by the owner
authorizing the above agel'II, if au.thorized agenr is signer.
0 . CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property righLS
in the well being constructed A well is real property and its construction on land rests ownership in the
land owner in the absence of contrary agreement in writing.)
GW-57 HP
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as ouiined in this application and that it shall be
the responsibility of the appli cant to ensure that each injection well confonns to the Well
Construction Standards (Title 15A NCAC 2C .0200)
Name of Property Owner {Print): _____________________ _
Mailing Address: __________________________ _
(October 1994) Page 3 of 4
(Signature of Property Owner if Different
From Applicant)
Please return the completed Application package to:
GW-57 HP (October 1994)
UIC Program
Groundwater Section
North Carolina DEHNR-DEM
P.O. Box ·29535
Raleigh, NC 27626-0535
(telephone: [phone])
Page 4 of 4
............ ,
6 Continue on Page 35 7
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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretory
A. Preston Howard, Jr .• P.E .• Director
~~-~ ·-~ a a a
DEHNR.
GROUNDWATER SECTION
August 7, 1995
Mr . Norman F. Kunz
136-Perennial Drive
Moor,esville, NC 28110
Dear Mr. Kunz,
An application for a permit to construct and/or use a well
for injection with a heat pump system is enclosed. The permit
issued to Robert Paul Hensel, Jr., Permit No. WI0300030 (formerly
Permit No .. 48 -0256-WO-0099), is not transferable to you without
approval by the Director of the Division of Environmental
Mamagement. Therefore, you must submit an application to this
office immediately so that the permit can be reissued in your
name. I have enclosed a copy of Mr. Hensel's application and a
copy of the relevant topographic map to assist you in completing
the application.
If you have any questions regarding the permit please feel
free to contact me at (919) 733 -3221, ext. 407.
cc: UIC Files
Enclosures
Sincerely,
Karen A. Harmon
Hydrogeological Technician II
Underground Injection Control Program
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50'l, recycled/ 10% post-coosumar paper
't.EOELL COUNTY JJEALTH DEPART ·.NT ...
(SEPTIC TANK) IMPROVEMENTS PERMIT AND CERTiffJCATE OF COMPLETION
(Ground Absorption Sewage Disposal System :_ G. S. Chapter 130-Article l 3C)
OWNER OR CONTRACTOR ..,J-'Al'-:.JJ,.. .a 'J J__. DATE ..$ / Z1 /'1 I PERMIT NO 2 k-,c; -.4--
House ( ~ Mobile Home ( ) Business ( ) Other ______ _
Ch~racter & Porosity of Soil {--A
/j
No. Bedrooms No. Bathrooms ,,r;..._., ... .__
Garbage Disposal {)nit Yes ( ) No (\1'" Percolation Rate ·-I 1
Auto. Dishwashe·r . Yes ( ) No (~ Topography :k=i'.114
Auto. Wa~h. Machine Yes ('..-f,.... No ( ) Depth to Water Table ~ 'tS ':
Site Suitable Yf!S (t-1 ., No ( ) -Rock or other impervious formations ~;.../~.
t}ot Area
Basemem Whu ;-;_,., Basement without Plumbing No Basement
....
I : )
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Plot of System
.
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,
,
,
'
W' Size of Tank ___ l-'o_c'--O ____ GaJs.
Nitrification Field:
No. of Lines __ 3~---
Sq. Ft. '1'1 ° I iMar Ft. ~ c, ~
Depth ~f Stone in Lines I-:,"
Water Suooly: Individual ( ✓
Puolic ,: )
I understand and agree to install septic fank
system as specified on this Imp1ove.ments
Permit.
IMPROVEMENTS PERMIT BY ________________ _
j COMMENTS~---------------------------------------.;.--,
,1
~
CERTIFICATE OF COMPLETION BY ~ DATE -'---.....a..o..,__.__
EXISTING SYSTEM CHECKED BY: -----------------------DATE ___ _
CONSTRUCTI ON MUST COMPLY WITH ALL OTHER APPLI~ABLE STATE ANO LOCAL REGULATIONS .
Permit is VOID if any unaut horized changes are made in install at ion of sys tem an d/or if any fal se info rm ation is supplied in making
Improvements Permit. , ·
. {
Heal th Dept. Copy: Whi te Inspection Dept. Copy : Yellow ,-. -Saniiarian~i~~py: Pini< Owner's Copy: Gold
,
NORTII CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OFNATIJRAL RESOURCES AND COMMUNITY DEVELOPMENr
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR
INJECTION
CLASS 5 WELLS
TO: DIRECTOR, NORTH CAROLINA DMSION OF ENVIRONMENTAL MANAGE
DATE: /). Jfl/J ~ , 19 il
JUN ?. 1991
In accordance with the provisions of Article 7, Chapter, 87; Article 21, Chapter 143, an~ ~iP:1ations
pursuant therero, APPLICATION is hereby made for a PERMIT ro construct and/or use a well QW'ijy~ ~ ECnOrf
descn'bed below and in any accompanying data submitted as a part of this APPLICATION. LEJ H, {G
A. ~"P ,;-_~r ~ut %,zyset OWNER.DATA: Name:
Address:
City:
County:
Ownership: Federal
Public
State
Commercial
Other(Specify) _____ _
B. FACil.ITY DATA (Fill oui ONLY if the injection well(s) is (are) for the purpose of serving a business or
industry):
.Business/Corporate Name:
Address:
City: ____________ Zipcode: _____ _
County: ___________ Telephone: ______ _
C. HEATING CONTRACTOR DATA (For heat pump systems only. Please give infonnation for the contractor
· that installed or will install your system):
D.
E.
Name:
Address:
City: 1-tftJ(JJ}Es fl/IL~ Zipcode: '() a /I d Telephone: 7 df C fl 3 -~d(f / '
INJECTION PROCEDURE: Briefly descnl>e how th~ injection well(s) will be used.
W IJ'l e/1.. F l,;,, T/l t t. ~e
c ,,~}f t~# tfl~ TO $v U. 'lf?
WELL USE: Will the injection well(s) also be used as the supply well(s) for either of the following?:~,
(a)
(b)
The injection operation?
Yom personal consumption?
YES_L
YES.:.../i-
NO
NO
F. CONSTRUCTION DATA: (checkone)
~ EXISTING WELL being proposed for use as an injection well. Attach a copy of Form GW-1 (Well
Construction Record) and furnish (7 & 8) below. If Fonn GW-1 is not available , furnish the data in (1)
through (8) below to the best of your knowledge.
GW-578 May, 1989,Repllce, GW-S7A.utdGW-S7B (2184)
__ PROPOSED WELL to be constructed for use as an injecti(Jn well. Furnish the data in (1) through (8)
below as PROPOSED construction specifications.
NOTE:
(1)
(2)
(3)
THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR BITTIER EXISTING
OR PROPOSED WELLS IF TIIlS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
' . (7o'l]i1). "l!i:J'I
Well Drilling Contractor's Name: f3A /1e/25 we:./,l V£/LL lf'I/,,
Date (to be) Construcood b oe C, Irr t:J ; Approximate Depth '3 tJQ ft.
Well Casing:
(a) Type: Galvanized Steel~ Black Steel__ Plastic__ Other (Specify) __ _
(b) Inside Diameter: _.Li._ inches; Wall thickness (inches) __ or schedule# __ _
(c) Casing Depth: From (} to 1/'l fl (referenced to land surface)
(4) Cement Grout:
(a) Around inner or "primary" casing: From _(2_ to _J__ ft.
(b) Around outer (pit) casing, if present From __ to __ ft
(5) Screen(s): (if applicable)
(a) Type: ___ -_____ ; Inner Diameter: -inches
(b) Depth: From ___ to ___ feet below land surface
(6) Gravel: (if applicable) From: ___ to ___ feet below land surface
(7) N.C. State Regulations (15, 2, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both the influent (water from well) and effluent (water
into well) lines is required. ls there a faucet on (a) the influent line YES ~ NO __ , or (b)
the effluent line YES _)s__ NO __ ?
(8) Attach a diagram showing the details of construction of the existing and/or proposed well(s).
G. PROPOSED OPERATING DATA: (The manufacturer's brochure should include this infonnation.)
(a) Injection Rate:
(b) Injection Volume:
(c) Injection Pressure:
(d) Injection Temperature:
H. INJECTED FLUID DATA:
Average (Daily) 6 gallons per minute (gprn)
Average(Daily) ~gallonsperday(gpd) -~f!flct( tt ,~&:,• ~~t-/!."N 1•.IYfG
Average (Daily) -,P5 poun'1s/square inch (psi)
Winter Average (Daily) SlJ"F pgrees F
Summer Average (Daily) 7? degreesF
(1) Fluid Source (From what depth and what type of rock/sediment unit does the fluid to be injected
derive, i.e. granite, limestone, sand, etc.)
I --Depth: I '7UJ Rock/sediment unit: ___,:G:::......t.,,£ .... A--'-'lt.L.t .;_1_e __________ _
(2) Chemical Analysis of Source Water: The following chemical characteristics MUST accompany
this application;
pH ___ ; Total Hardness __ ppm (parts per million or mg/1); Iron ppm; __ _
Chloride __ ppm; Nitrate ppm; Coliform bacteria ____ counts/100 ml
GW-57B M.iy, 1989,ReplacesGW-57A. and GW-57B (2/84)
NOTE: Assistance in obtaining these values may be facilitated by contacting (a) your local or county health
official, (b) a commercial water-testing laboratory, (c) your well drilling contractor, or (d) the Regional
Hydrogeologist, North Carolina DepL of Natural Resoorces & Community Development
NOTE: If injection system is not for a heat pump, then a detailed analysis of both the source water and the
injection fluid may be required.
I. INJECTION-RBLA TED EQUIPMENT:
Attach a diagram showing the engineering layout of the (1) injection equipment, and (2) exterior
piping/tub ing associated with the injection operation.
NOTE: The manufactmer's brochure, if detailed. should satisfy (1) above if the system is a heat pump.
J. LOCATIQN OF WBLL(S):
Attach a detailed map showing the orientation of and distances between the proposed well(s), any existing
weD(s) that will in any way be involved in the injection opera-tion, and at least two (2) nearby .reference
points such as roads , (oad intersections, streams, etc. The roads should be identified by U.S., N.C. or SR
(county secondary road) nwnbezs. and streams should be named. In addition. the diagram should show the
direction and approximate distance 10 any existing water-supply and/or injection wells within 1,000 fe.et of
the proposed injection welt
K. CERTIFICATION:
"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 therelO and that. based on my inquiry of those
individuals immediately responsible for obtaining said inf onnation, 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 infoonation. I agree IO operate and use the injection well and all related
appurtenances in accordance with the approved specifications and oonditions~f the Penni "
,R r "I ,CJ, I/ l -✓ , ,fl ,f / ,... , .__ ' '
' (Signature of Owner or Authorized Agent)
FOR OFFICE USE ONLY:
1. Initial Application: Complete__ Incomplete __
If INCOMPLETE , Date of Notification _____ and Resubmittal ____ _
2. Standard Industrial Code(s) which best reflect the principal products or services provided by this
facility-if applicable.
(a) ___ (b) ___ (c) ____ (cl) ___ _
3. APPLICATION NO. ______ _
GW-S7B May, 1989, Rcpll,ceaGW-57A, andGW-57B ('2,184)
8 9
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110.22· _ -.-1 2· ---110.22·-
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INVERNESS LOOP S.R 1228
,29.sa s ~.of 129.51
N65'5\ 09 E \7'42"58 ~!~~
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IREDELL COUNTY 1:iEALTH DEPARTMENT , .
(SEmc TANK) IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
(Ground Absorption Sewage Disposal System :._ G. S. Chapter 130-Article l 3C)
OWNER OR CONTRACTOR ...J~;JA a ... ·, J__,. DATE .s 1 ~1 1~ , PERMIT NO.~ k-,t; -A-·
PHONE : Busines.._ _______ Home b ~:/-l1D'-I
LOCATION r=-~ ,fe-6_L : ~':'~1 _.,J~ •• /J -,-,_ .:.,:L F ~-,+<-4,<i ~ ,~d.__J.
-lo ~lt.u..~ !~ ...._([;), ~ ~ ./U )_,._,ft"'-'-J cl ..... ~ S. R. No
SUBDIVISION NAME ' -,::--~ J.. '; LOT NO . LI SECTION OR BLOCK NO,_. --
House ( ~ Mobile Home ( ) Business ( )
No . Bedrooms ___ No. Bathrooms __ _
Garbage Disposal Unit Yes ( )
Auto. Dishwasher Yes ( )
Auto. Wash. MJchine Yes (',,,,f
(
.JC/ Site Suitable Yr.s - ,
No (\-1'"'
No (~
No ( )
No ( )
Other ______ _
.!:.A fJ Ch~ric~er & Porosity of Soil -------'-'--,--.r=;_.,,;.;..-... ~---;.,--------
Percolation Rate ----------=--•_,_} ___________ _
Topography ___________ 1=.r;;;.....-_'T.._'_:"7o.:,,r._ _______ _
Depth to Water Table __________ ~_4.,_-_..:fi._'_' ______ _
Rock or other impervious formations ____ ....!J:,i..~e •~'-::.!:;J'.kv-<I!:!!...:• ____ _
~, .. ~ p,ra, fi4ot Are:i
Basemen t .. , ... ;-_ Basement without Plumbing No Basement
. ,
: ~
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'
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Plot of System
--
.
.. ·, -.
,
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...... .
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..
(
full Size of Tank _ _./_o;;......;;;.o_D'--____ .Gals.
Nitrification Field:
No. of Lines --=3 ___ _
Sq. Ft. ":70 o I inear Ft. 2 oe-
Depth of Stone in Lines -l-z,..11
Water Suooly: Individual ( ✓
Puohc { )
Installed by LJJ~ j,.....,_'Jt.
I understand and agree to ins t all septic lank
system as specified on this Improvements
flermit.
Signed: ___________ _
IMPROVEMEN TS PERMIT BY ________________ _
*· COMMENTS:---------------------------------------.._-~--~
~ :~
EXISTING SYSTEM CHECKED BY: / DATE ___ _
CONSTRUCTION MUST COMPLY WITH ALL OTHER APPLI CABLE STA TE AND LOCAL REGULATIONS.
Permit is VOID if any unauthorized changes are made in installation of system_and/or if any false info rmation is supplied in making
Improvements Permit. ·
~
Health Dept. Copy: White Inspection Dept . Copy: Yellow , , Saniiarian~i-C~py: Pin):(, Owner's Copy: Gold
State of North Carolina
Department of Environment, Health, and Natural Resources
Mooresville Regional Office
James G. Martin, Governor
William W. Cobey, Jr., Secretary
Mr. Robert Paul Hensel
18 Perennial Drive
Albert F. Hilton , Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
August 6, 1991
Mooresville, North Carolina 28110
Dear Mr. Hensel:
In accordance with your application dated June 12, 1991, we are
forwarding herewith Permit No. 48-0256-WO-0099 for the Operation and
Use of a well, for the purpose of injecting heat pump effluent, in
Iredell County .
This Permit shall be effective from the date of issuance until
August 6, 1996 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 make application for permit renewal
at least 30 days prior to its expiration date.
Attachment
,,.
cc: \...Ure Files
TLM/pl
Sincerely,
~.~-W
Brenda J. Smith, P.G.
Regional Supervisor
919 North Main Street, Mooresville, N.C. 28115 • Telephone 70Hi63-l699 • FAX 704-{i63-6040
An Equal Opportunity Affirmative Action Employer
NORTH CAROLINA
ENVIRONMENTAL -MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
PERMIT FOR THE OPERATION/USE OF A WELL
OR WELL SYSTEM 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
ROBERT PAUL HENSEL
FOR THE OPERATION AND USE OF AN INJECTION WELL/WELL SYSTEM located
at 18 Perennial Drive, Mooresville, North Carolina in Iredell
County, in accordance with the application dated June 12, 1991 and
in conformity with the specifications and supporting data submitted,
all of which are filed with the Department of Environment, Health,
and Natural Resources and are considered a part of this Permit.
This Permit is for Operation and Use only, and does not waive
any provisions of the Water Use Act or any other applicable Laws,
Rules or Regulations. Operation and use of a well or well system
shall be in compliance with Title 15A North Carolina Administrative
Code 2C, 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 August 6, 1996 and shall be subject to the
specified conditions and limitations set forth in Parts I and II
hereof.
Permit issued this the 6th day of August, 1991.
Brenda J. S~egional Supervisor
Division of Environmental Management
By Authority of the Environmental Management Commission
PERMIT NO. 48-0.256-WO-0099
PERMIT NO. 48-0256-WO-0099
PART I
A. GENERAL CONDITIONS
1 . The Permittee must comply with all conditions of this
Permit and with the standards and criteria specified in
15A NCAC 2C .0200. Any Permit noncompliance constitutes a
violation of the appropriate Act and is grounds for
enforcement action; for Permit termination, revocation and
reissuance or modification; or for denial of a Permit
renewal application.
2. It shall not be a defense for a Permittee in an
enforcement action that it would have been necessary to
halt or reduce the permitted activity in order to maintain
compliance with the conditions of this Permit .
3. The Permittee shall take all reasonable steps to minimize
or correct any adverse impact on the environment resulting
from noncompliance with this Permit.
4. The Permittee shall give advance notice to the Director of
any planned changes in the permitted facility or activity
which may result in noncompliance with the Permit.
5, The Permittee shall report all instances of noncompliance,
not reported under condition 1, of this Part, at the time
monitoring reports are submitted.
6. Where the Permittee becomes aware of a failure to submit
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 by the
Permittee.
7. The Permittee shall g i ve notice to the Director as soon as
possible of any planned physical alterati ons or additions
to the permitted facility.
8. In the event that the permitted facilities fail to perform
satisfactorily, the Permittee shall take such immediate
action as may be required by the Director.
9 . The injection system shall be effectively maintained and
operated at all times so that there is no contamination of
groundwaters, or other actions or occurrences which
renders them unsatisfactory for normal use. In the event
the facilities fail to perform satisfactorily, including
the creation of nuisance conditions, the Permittee shall
take such immediate corrective action as may be required
by the Director .
PERMIT NO. 48-0256-WO-0099
PART I (continued)
10 . Department representatives shall have reasonable access
for purposes of inspection, observation and sampling
associated with injection and related facility .
11. This Permit is not transferable without prior notice to,
and approval by, the Director .
12. An application for modification, renewal or transfer of
this Permit shall be filed with the Department at least 30
days prior to the expiration date of this Permit.
13. Provisions shall be made for collecting samples of
facility effluent, both prior to its entrance to treatment
devices and subsequent to leaving the treatment devices
but before entering the injection well.
PART II
A . SPECIFIC CONDITIONS
1. .The fluid used in the heat pump syste~ shall be comprised
of clean water or a mixture of clean water and prophylene
glycol. The use of ethylene glycol, alcohols or other
chemicals not specifically approved by the Director,
Division· of Environmental Management, are expressly
prohibited.
2. The Permittee shall install, in a readily accessible
location, a faucet or other device suitable for collecting
a sample on the effluent {water into well) line of the
injection system.
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Health
James G. Martin, Governor
William W. C.Obey, Jr., Secretary
Public Water Supply Section
P.O. Box 29536 • Raleigh , North Cirolina 27626-0536
Telephone [phone]
September U, 1991
Mr . Robert 0. Walton, III
Pennits and Compliance Group
Goundwater Section
cm\Ki 11!™
SEP.,..,
Division of Environmental Management
North Carolina Department of Environment, Health
and Natural Resources
Post Office Box 29535
Raleigh, North Carolina 27626-0535
, 10
Richard K. Rowe
Director
Re: Application for Injection Well Permit
Robert Paul Hensel
18 Perenneal Drive
Mooresville, North Carolina
Iredell County
Dear Mr. Walton:
We have reviewed the material submitted to this office concerning the above
referenced subject.
Considering the legal matter of endorsing this proposal, we believe we do not
have sufficient information to deny the request due to a threat to the ground water
source or to the public health.
Our recommendation that an assessment be made of the effects these systems
might have on groundwater remains.
If we can be of further assistance please let us know.
Sincerely,
Richard K Rowe
RKR/RWC/mhj
An Equal Opportunity Affinnatlve Action EmplO)"!f
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27604
James C. Martin, Governor
William W. Cobey, Jr., Secretary
George T Everett, Ph.D.
July 18, 1991
Mr. Richard Caspar
Public Water Supply Section
Division of Environmental Health
P.O. Box 27687
Raleigh, NC 27611-7687
Dear Mr. Caspar:
Director
This office has received the applications for Permit to use a
well or well system for injection, as listed below. In accordance
with Article · 7, Chapter 87-88(j), General Statutes of North Carolina,
we submit the following applications, in addition to a draft copy of
each proposed Permit, to OHR for review and recommendation:
Oper. Renewal
APPLICANT Permit Permit Injection Source
Paul S. Madritch Yes No Heat Pump Effluent
Deborah K. Turner Yes Yes Heat Pump Effluent
Billy E. Smith Yes Yes Heat Pump Effluent
Robert Paul Hensel Yes No Heat Pump Effluent
Please note that each application complies with the specified
requirements as prescribed by 15 NCAC 2C .02 00.
If we have not received any comments or recommendations within
ten ( 1 D·) working days of the above date, we will assume that DHR has
no objection to the projects as proposed. Please do not hesitate to
contact me at 733-3221 if you have any questions.
Enclosures
Asheville
704/251-6108
Fayetteville
919/486-154!
Mooresville
704/663-1699
Sincerely yours,
Robert O. Walton III
Permits and Compliance Unit
Groundwater Section
Regional Offices
Raleigh
919/733-2314
Washington
919/946-()481
Pollution Prevention Pays
Wilmington
919/395-3900
Winston-Salem
9191761-1351
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal OpportUnity Affinnative .Action Employer
FIELD ANALYSES
PH ◄OO /, / Spec. Cond.9 4 25"a, 2s0 c
Temp.10_ /9 °c Odor----,-----
pearance ,-/(,,,,,ff-Taste IYPHe:,-
Field Analysis. By : .. , .. T_l-_M _______ _
LABORATOAYI ANALYSES
h Jlt'&t
BOOs 310":1 \.-t "'0"
COO Hlgll 3 ◄0 ffiQ/1
C OD low a3S "1011
,~ ~01110,,,,;MF FtUI 311616 ~, /100m l
Col florm:MF To tal 3 Uo• 1100ml
TOC 680 "!OIi
T11rb ldlt y 76 NTV
pM (03 units
Alkallntty to OM ◄.S 4110 moll
~
Alkallnlly to DH 8.3 415 ffl0/1
Carbonate ◄4$ 111011
Blc:111ion1t• 4 ◄0 "'0"
Allt ftlc:To11I 1002 UOII
C a rb.JWHjlo,l dt •OS moll
'---'" ....-Chlorldt t◄O ::; mg/I
Chromlum:Hu 1032 IIQ II
Color:True 80 Pl•Co
C71nldt 120 moll
Lab Comments:
-~·
LAS NUMBER 8 __.}'---'C ..... :x.____.4 ...... l ....a..\ ____ ~-=
OATE RECEIVE0'5J1fa\C\l Timeq_•_. ~)5~
Rllc'd by:~ f-"rom ; Su~
Other --------..:::--------:r-=:::-•7 --
-.!..-<->---,.-CK: ......,-.....:=:;. __
~OUTINE D f:Ml:RGfNr:Y
OATA
0/\ Tf: lZ.[41_ ______ __:_
Owner
Location or
/ : L/-5 PURPOSE: BASEL:INE. COMPLAINT, COMPLIANCE. LUS~·. OTHER
(ci re l e one) /o~t-P-t-~s c I
Sile /? /Jfl~fzyo;:./ {),., f'\ObfJ.'5 v///e
01·c....
-____,__·I ...,_,F_)_• ~_~_J... _ ____.~._____..'---'~~!.___+-"-· .. _·__,~ _ _,..,_l...,...,-_k_~_1l_£-_~ -,/< Oescription of sampling point '' ""c;-,-~ 6"1~..L.. P..,,.,. 1✓ (;Jt., T"'"'
Sampling Method ·, . ......_ ~ "? oc/ ---:-t'---.,..-,.,-----,-,------------Sample Inter v a I __ ___;:C/:;__ ________ _ ump ai t er, etc·.)
Remarks
(pumping time. air temp. e l c.)
' I •
0\as. Soltd1 10JOO uoll o,oanochforln• P •s llcid•s
Fluotldt 151 mo11 Al • Aluminum 1105 OOII o,oanoohosohor\ls P1s1l cld11
udn1u:To1a1 -too mo/I 8• · 9atium ·,001 ug/1
Hudnau (non·carb) 902 moll C a -Calclum 916 Acid H e :dlcidts
Pllenols 3 2730 uo/1 Cd • Cadmi11m 1021 UQ/1
Sotcltlc Cond. 9 5 uMho s /cm1 Chromlum:To111 103• 11011 Bast / N•11lr1I E ,1t1c11 b lt O r o 1nl cs
$\Ill.alt 945 moll Cu • Coo1ur 1042
Sulfldt HS moll
Ho • Mercury 11900 ,cs (VOA bOIII I)
K • Pota ssium 931
uo/1
P:To11I II P 665
________________________.---.._ --------------GW·~-4 AeviseCI For Oissotved Analysis -sui;mit tillered .pie and write ·01s· in block
Wnile copy • Hn;idquanr.r•: Pi,ik c:np r Rnn i nn Ynll"w r""" • ♦ .....
~ ·1,
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A
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l
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'
,. J
.
;-
;I l ·!
I :Pl
· e 00 i 3 ·, 0',i '"'r '· mo/I·
COO Hlgl\ HO moll
COO ~ow 3l5 moll
.;/ <;01110,m:MF Fecal !I_Hl ,15 N~ /IOOml
:L• ---tolllorm:MF To11l 3 uo, t..'17 1100ml
.
e,...,
.......
Sampling Method
Remarks
4
O(ss. Sollds 70300
l;luorlda 951
VH1tdnon:To1at ,900 4-Z.
.......-Ha,dness· {non•c•rb) 902 ,I
Pl\enols 32730
mol l
mo/I
mo/I
mo/I
uo/1
. .. . . .... •.• ..
0
L,-Et NUMBER 8 / c:;:..&.£/
om REC",l!};JfJB/f Tim• 0 21/0
Rec 'd by: From: Bus-(outie__i..:)
Other
OAT A ENTRY BY: -Q,0<>-11~----CK :.....__ ...... _'---_
DATE REf'OHTEO: __ L0.'-=3"--L-il--'----"-J ____ _
PURPOSE : BASELINE . COMPLAINT, COMPLIANCE. LUS ~·. OTHER
(cirtle ohe)
IAt '--
(pumping time, a i r temp , e1c.)
AO • Sil"or 1077 u q Q O ,oano c'h l orl n .. P ■ s H e ld• s
Al -Atutnl l'HJM 1105 UQ /l ,. q r(Cff!'001'01,of<>-''-'' Pes1lcld,s
81 -81ri u m ,001 11011 I • ' I -
~
c a • Calci u m 916 moll \ . A.C i d H 1 r d l cideJ
Cd • Cadm i um 1027 ~7.tl uoit 1, -"• 1
' . TOC 610 uMl\os/cm 1 ......... ...-Chr0mfurn:To1a1 ~7 r:;, uoll -E.t.tt acta blt O,01nlc.s m0/1 Soeclllc Cond, 95 103• Bas• / Ntu t t>I
! ,
1 ~-. Turbi dlly 76 ,nu Sulla10 945 moll ......... " Cu • Coooo , tO ◄ 2 7 7_ uoll ,,.~,a E11ractabla Oroa~lcs
i.( Sullldt 1'5 ,no/t /• • Iron 10 ◄5 IM \.I . uoll
\ Ho • Mc,curr 11900 uo/1 P uroublt o,,1nl'cs (VOA bolllt)
.;._... I--oH 403 , ... '1 u11l1s K • Po11uium 937 , J>t7 moll
V .,....Alkallnttr io oH •.s 4 10 ~'is' molt-: 1 Mo -· Maonu,um 927 moll 1.2 · Oibromoe11\an o (E08)
..-Alllllnlly lo oH 8.l 41$ <:'. l fflg/1 .... Mn .. Ma1"101r,ese ···'-' .,_,, 1055 uo fl
•, ~, ::-~ --... ~arbon111 ••5 motl · ......... Na • Sod i um 929 mg/I
',";_:,: ~icort,onalo ,co ~ ' mol_l ... _ ! N':43 U N 610 ,\A moll '-"""" ..-NI • Nie-ti 1067 ~V'l ug/1 .. :. ··. ; ,ti ~ Arunlc:Total 1002 uoll -~· TKN as N 62S mo/I Pb • Leacl 1051 UG /I
'· Carbon Cllorld• 405 mg/I .A I,/ ...-,:)02 ♦ N03 as N 630 I lDI moll So .. Selenium 11'7 uQ 1 1
..,.,.. -Chlortd• 140 l m o ll '"';~ '
~--.;l
P :Total u P 865· mo/I Zn · Zi,,c 1097 73:'> uo/1-
. C~romlum:Ho 1 1032 uo/1 _ ~ .. i-. :,
~
Color:Ttut 90 Pl·C p': f:~
! I Cyanide 7 20
., moii ~
#
Comments:~ f'... . .--~~~ -~ /-:=,~
... ,,.r....,....-:_ ~ A ---~~ ~
Lllb -~,_,
'I ' I ........
( I --,-------------------~----------n _____ 0' _________ _
: 1 GW ·S4 R >: ·~cd 7/85
'--------------c----:------------------------r-or Dissolved Analrsis • sui;:ni1 Ii i ... ·..,d samolu and write ·0 1s· in block
Whilo -COOY • 1-lol\dCIUlrlor:; Pink CQf)Y • Acoioo Yollow COPY • Lab