WI0300123_GEO THERMAL_20180302

Permit Number WI0300123
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
James Allen & Regina 8. Lee SFR
Location Address
900 Club Dr
Monroe NC
Owner
Owner Name
James Allen
Dates/Events
Orig Issue
6/13/2008
App Received
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28112
Lee
Draft Initiated
s·cheduled
Issuance
Central Files: APS SWP
3/2/2018
Permit Tracking Slip
Status
Active
Version
3.00
Project Type
Renewal
Permit Classification
Individual
Perm It Contact Affiliation
Major/Minor
Minor
Faclllty Contact Affiliation
Owner Type
Individual
Owner Affiliation
James Allen Lee
900 Club Qr
Monroe
Region
Mooresville
County
Union
NC 281 12510
Public Notice Issue
3/2/2018
Effective
3/2/2018
Expiration
5/31/2023
Requested /Received Events
RO staff report received
RO staff report requested
Administrative amendment request received
Streamlndex Number Current Class
2/23/18
2/1/18
1/30/18
Subbasin
Permit Number WI0300123
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Faclllty
Faclllty Name
James Allen & Regina 8. Lee SFR
Location Addreaa
900Club Dr
Monroe NC
Owner
OWner Name
James Allen
Dates/Events
Orig Issue
6/13/2008
App Received
Reg ulated Activities
Heal Pump Injection
Outfall
Waterbody Name
28112
Lee
Draft Initiated
Scheduled
IHuance Publlc Notice
Central Files: APS SWP
2/26/2018
Permit Tracking Sllp
Status
In review
Version
Proj ect Type
Renewal
Permit Claaslflcatlon
Individual
Permit Contact Afflllatton
Major/Minor
Minor
Fac ility Contact Affiliation
owner Type
Individual
owner Afflllatlon
James Allen Lee
Region
MooresviUe
County
Union
900 Club Dr
Monroe NC 28112510
Issue Effective Expiration
Req uested /Received Events
RO staff report received
RO staff report requested
Administrative amendment request received
Stfeamlndex Number Current Clase
2123/18
2/1/18
1/30/18
Subbaaln
ROY COOPER
Governor
MICHAEL S . REGAN
Secretary
Water Resources
Environmeotal Quality
LINDA CULPEPPER
March 2, 2018
James Allen & Regina B. Lee
900 Club Drive
Monroe, NC 28112
Re: lsl!luance of Injection Well Permit
PermitNo. WI0300123
Geothermal Beating/Cooling Water Return Well
Union County
,Dear Mr. and Mrs. Lee:
Inte rim Director
In accordance with your permit renewal application received January 30, 2018, I am forwarding Permit
No. WI0300123 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 June
1, 2018, (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 date of issuance until May 31, 2023, and shall be
subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on February 19, 2018. Laboratory analytical results will be forwarded 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 pennit, 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,
Shristi Shrestha
Underground Injection Control (UIC)-Hydrogeologist
Division of Water Resources., NCDEQ
Water Quality Regional Operations Section __ ·omt ...
~N ,ng Compa~s.........,
State of North Carolina I Environmental Quality I Division of WaU!t Resources
Water QuUty Regional Operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129
cc: Andrew Pitner-Edward Watson, Mooresville Regional Office
Central Office File, WI0300123
Union County Environmental Health Department
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE 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
James Allen & Regina B. Lee
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 02C :0224(a), which will be used
for the injection of heat pump effluent. The injection well(s) located at 900 Club Drive, Monroe, Union County,
NC 28112 will be operated in accordance with the application January 30, 2018, and in conformity with the
specifications and supporting data, all of which are filed with the Department of Environmental Quality and are
considered a part of this permit.
This pennit is for continued operation of an injection well shall be in compliance with Title I 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 the date of its issuance until May 31, 2023, and shall be
subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 2 nd day of March 2018.
For Linda Culpepper
Interim Director, Division of Water Resources
By Authotjty of the Environmental Management Commission.
Permit #WI0300123 UIC/5A7
vu . 11/15/2015
Page 1 of5
PART I-PERMIT GENERAL CONDITIONS
1. The Pennittee shall comply with all conditions of this pemrit and with the standards an.d criteria specified
in Criteria and Standards Applicable to Injection WeHs (15A NCAC 2C .0200). Noncompliance with
conditions of this pemrit 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 [15A NCAC 02C .021 l(a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this pemrit, the approved plans and specifications, and other supporting data [1 SA NCAC 02C .0211(1)].
4 . This permit is not transferable without prior notice and approval . In the event there is a des ire for the facility
to change ownership, or there is a name change of the Permittee, a formal permit amendment request must
be submitted, including any supporting materials as may be appropriate, at least 30 days prior to the date of
the change [15A NCAC 02C .021 l(q)].
5. The issuance of this permit shall not relieve the Pennittee 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 [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling sys tem shall be constructed in accordance
with the requirements of rule 15A NCAC 02C .0107 except as required in Item #2 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C .0107
except that the entire length of the cas ing shalJ be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be em placed from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2),(3)].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. ln areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions.
[I SA NCAC .0225(g)(8)].
4 . The injection well s ystem shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment s hall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [ISA NCAC 02C .0224( d)( 4)].
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S. 87-85(16).
6 . Each well shall have permanently affixed an identification plate [15A NCAC 02C ,0107(j)(2)).
Pe nnit #Wl03 00I23 UIC/5A7
ver . 1 1/15/20 15
Page 2 of5
7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V .5 of this
permit
PART ID -OPERATION AND USE CONDITIONS
1. The Pennittee shall comply with the conditions of this pennit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .021 l(j)].
2. The issuance of this pennit shall not relieve the Permittee of the responsibility for damages to surface water
or groundwater resulting from the operation of this facility. 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 that may be required,
such as the repair, modification, or abandonment of the injection facility [15A NCAC 02C .0206].
PART IV-INSPECTIONS[l5A NCAC 02C .021l(k)] .
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable tiine 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. DWR 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 samples of the injection facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [ISA NCAC
02C .0224(f)(2), (4)).
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(l)].
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violation of applicable groundwater quality standards, or
that a malfunction of the injection system may cause the injected fluids to migrate outside the approved
injection zone or area. As specified in rule 15A NCAC 02C .021 l(r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Mooresville Regional Office, telephone number 704-663-6040.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below.
Permit#WI030012.3 UIC/5A7
ver. 11/15/20 15
Page3 ofS
(C) The written notification shall contain a description of the noncompliance and its cause; the period of
noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. The Permittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. [15A NCAC 02C .0224(£)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Water Quality Regional Operations Section
DWR Mooresville Regional Office
6 IO East Center Ave.
Mooresville, NC 281 15
PART VI -PERMIT RENEW AL [ 1 SA NCAC 02C .0224( c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the permit. This permit condition does not apply if the Pennittee chooses to discontinue operation
of the well for injection of effluent from the geothermal heating and cooling system associated with this
permit.
PART VIl -CHANGE OF WELL STATUS [15A NCAC 02C .0240]
I . Procedures for temporarily oq,ennanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .Ol 13(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88{c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the u se of hand or power tool s.
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall permanently abandon that injection well in accordance with the procedures specified in 15A
NCAC 02C .0113(b), which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each weU 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 in accordance with rule 15A
NCAC 02C .01 l l(b)(I)(A),(B), and (C).
Pennit#WI0300123 UIC/5A7
ver. 11/15/2015
Page 4 of5
(D) 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.
(E) In those cases when a subsurface cavity has been created as a result of the injection
operations, each well shall be abandoned in such a manner that will prevent the movement
of fluids into or between underground sources of drinking water.
(F) The Pennittee shall submit a Well Abandonment Record (Fonn GW-30) as specified in
15A NCAC 2C .0224(f)( 4) within 30 days of completion of abandonment.
5. The written documentation required in Part VII (4)(F) shall be submitted to the addresses specified in Part
V.5 above.
Pennit#WI0300123 UIC/SA7
ver. 11/15/2015
Page 5 of5
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WI0300123 ------
Date: _02/19/2018 ____ _ County: Union _________ _
To: _ WQROS, UIC Permitting
Lee
Permittee/ Applicant: James Allen and Regina B.
----------Central Office Shristi Shrestha Facility Name: _Lee SFR:_ _______ _
I . GENERAL INFORMATION
I. This application i s (check all that apply): D New [81 Renewal
D Minor Modification D Major Modification
a. Date of Inspection: 02-19-2018
b. Person contacted and contact information: Mr. James Allen Lee
c . Site visit conducted by: Edward Watson and Maria Schutte
d. Inspection Report Printed from BIMS attached: [81 Yes O No.
e. Physical Address of Site including zip code: 900 Club Drive, Monroe. NC 28112
f. Driving Directions if rural site and/or no physical address: __
g. Latitude: 34.969854 Longitude: -80.517618 __
Source of Lat/Long & accuracy (i.e ., Google Earth, GPS, etc.): _____ --Rit--=-----~ ll. DESCRIPTION OF INJECTION WELL(SJ AND FAClLITY
1. Type of injection system:
181 Geothermal Heating/Cooling Water Return
D In situ Groundwater Remediation
D Non-Discharge Groundwater Remediation
0 Other (Specify:__J
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
f:£8 11zo10 '~~,,,, .
i a ;·;n~
~f.ft;Jjt '-tllb lhy
~8 Sectlor,
Were samples collected from Influent/Effluent sampling ports? l8J Yes D No.
Provide well construction information from well tag : Well Tag Data Not collected.
b . Does existing or proposed system use same well for water source and injection? 181 Yes D No
IfN.Q. please provide source/supply well construction info (i .e., depth, date drilled, well contractor,
etc .) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IY of this Staff Report.
3 . Are there any potential pollution sources that may affect injection? D Yes [81 No •
What is/are the pollution source(s)? ________________________ _
What is the distance oftbe injection well(s) from the pollution source(s)?
NIA __________ _
4. What is the minimum distance of proposed injection wells from the property boundary? ______ _
5. Quality of drainage at site: [81 Good D Adequate D Poor
6. Flooding potential of site: [81 Low D Moderate D High
Rev. 6/1/2015 Page 1
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
7. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? 0 Yes D No. If No,
attach map of existing monitoring well network if applicable and recommend any changes to the groundwater-
monitoring program. NIA
8. Does the map included in tbe Application reasonably represent the actual site (property lines, wells, surface
drainage)? [8J Yes O No. IfNo, or no map, please attach a sketch of the site. Show property boundaries,
buildings , wells, potential pollution sources , roads, approximate scale, and north arrow.
9. For Non-Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? 0 Yes O No [8J NIA.
If no, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? [8J Yes O No O NIA. l fno, please explain: __
Ill. EVALUATION AND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? D Yes [8J No. If yes, explain. __
2. List specific special conditions or compliance schedules that you recommend to be included in the pennit when
issued. Make sure that you provide a reason for each special condition:
.Condition Reason
3. Recommendation
D Deny. If Deny, please state reasons: __
D Hold pending receipt and review of additional information by regional office
D Issue upon receipt of needed additional information
[8J Issue
4. Signature of report preparer(s): Edward Watson 02/212018 __ _
Signature ofWQROS Regional Supervisor: Wre-w--H pifn.er
Date: 2/22/18
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (If Needed)
The wate r reported hicll turbidy at botb the Influent and E ffluent ports.
R ev. 6/1/20 15 Page2
Compliance lnapection Report
PHl'llt: Wl0300123
aoc:
lfftctlve: 03/27/13
Effective;
Expiration : 05/31/18 Owner : JJmea Allen Lee
Co1111ty : Un ion
R•IJlon: Mooteavill&
Contad Ptraon: James Allen Lee
Dlrtctlona to Faclllty :
Expll'IIUon:
TIUt:
F•~lllty: James Allen & Regina e. L11e SFR
800 Club Or
Monroe NC 28112
PhoM: 70Hi84-0003
900 Club Dr, Monroe. Residence la located on Ille SE aide of Monroe. Heading Son HWY 601174, al the Junction of HVW 60-1'74
•nd Franklin St, tum R onto Franklin and then an immedtale L onto Mclarty, which Winds Into the nelghbortiood aod Into Club Of.
tyatem CIHalffc1tlona1
Primary ORC: C1rtlflcaUon:
Secondary OR C(e):
On.Site Repn1Hntatflla(1):
Ralatad P■rmlta:
lnapectlon Otta: 02/19/2018 Entry Time: 10:1 8AM Eidt Time: 01 :00PM
Primary lnapactor: Edward Watson Phone:
a1c:ond1ry lnapector(a):
Mana Schutte
Reason for lnapecUon: Routrne IMp1ctlon Typ1: Compliance Sampling
Permit lnapactron. Type: Injection Hea ting/Cooling water Relum Well
Facllity Status: ■ Compliant D Not Compliant
Qualtlon Artas:
■ Wela
(See attachment summary)
Page: 1
Pormlt= WIO3O0123
lntptetlon Det9: 02/19/2018
Owner. F'Kllily! James Alie/\ Lee
ln11pecllo11 TYPil ; Compliance sampllf\11 Reo,on fo r vt11t; Routine
Inspection Summary:
On February 19, 2018, MRO staff collected well samples from both the Influent and Effluent sample ports of the geothermal
well under permit W10300123,
The samples were collected for the purpose of permit renewal. Samples for col iform bacteria , metals, wet
chemistry ,nutrienll> and other water quality analytical parameters were collected and submitted to the DWQ laboratory in
Raleigh NC for anaylsis. Field .parameters were also collected du r1ng the sampling event.
During the samplli,g event, high turbidity was noted in the discnarge of both sampfing ports.
The Sample identification number for the Influent Port 1s AC47510 and the Effluent Port sample identification number is
AC4 7509. Sample results w111 tal<e approximately 30 days to receive due to the high volume samples befng processed by
the laboratory.
Page: 2
Permit: WI0300123
lnepecllon Date: 02/1 ll/2018
<>wn.r • Fa~ity: J■mea Allen Lu
ln ■p■ctlan Type : Compfi1nc1 Sampling Reuon for Vl■lt; Routine
Page: 3
WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
~: February 1, 2018
T o : Corey Basinger-Andrew Pitner
From: Shristi Shrestha, WQROS -Anima l Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: Shristi .shre [e-mail]
PermitNumber:WI0300123
A. Applicant: James Allen & Regina B. Lee
B . Facllity Name:
C. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
-_I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days. please return a com pleted 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-WOROSReviewer: _________________ Date: ____ _
COMMENTS:
NOTES :
F ORM: WQROS-ARR ver. 0926 14 Page 1 ofl
ROY COOPER
Governor
l\.fiCHAEL S. REGAN
Secretary
Water Resources
Environmental Quality
LINDA CULPEPPER
February 1, 2018
James Allen &Regina B. Lee
900 Club Drive
Monroe, NC 28112
RE: Acknowledgement of Application No. W10300123
Geothermal Heating/Coolin,g Water Return Well
Union County
Dear Mr. and Mrs. Lee:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received January 30, 2018. Your application
package bas been assigned the number listed above, and the primary reviewer is Shristi Shrestha
Central and Mooresville Regional Office staff will perform 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 information 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 Shristi
Shrestha at 919-807--6406 or email at [e-mail].
cc: Mooresville Regional Office, WQROS
Permit File WI0300123
Sincerely.
For Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Bratich Division of Water
Resources
--<' l 1... I "l, I
Stete of North Carolina I P.nvironmental Quality I D ivision of Water Resources
Water Quality Reatonal Operatlona Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707•9129
-------
--. -. --
Interim Director
North Car olina Department of Environmental Quality-Division of Water Resources
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEAT ING/CO OLING WATER RETURN WELL{S )
These weU(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOL LOWJNG:
__ New Application --.LRenewal* __ Modification __ Permit ~escission Request*
•For Permit Renewals or Rescission Request, complete Sections A thru E. and M (signature page) only
Print or Type Infom1ation and Mail to the Address on the Last Page. Illegible Applications Will Be Returned A s Incomplete.
DATE: 1/3-0 /2.0tR ,20__ PERMITNO~C> 30012..3 (l eaveblankifNewApplication)
A. CURRENT WELL USE & OWNERSHIP STATUS (Leave Blank if New Well/Permit Application)
1. Current Use of Well
a. I wish to continue to use the well as l5cfl Geothermal Well D Drinking Water Supply Well
D Other Water Supply Use-lnd.icakuse (i.e., irrigation, etc.) ________ _
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record(GW-30). ~ 1 " ,MR
" ' Lnli:..u 1,;1.1u1:wUvv
D Yes, I wish to rescind the permit JAN 8 0 lOIB
2. Curren t Ownership Status
Has there been a change of ownership since permit last issued? D YES 'JlJ NO
If yes, indicate New Owner's contact information:
Narne(s) ____________________________ _
Mailing Address: __________________________ _
City: __________ S tate: __ Zip Code: ______ County: ____ _
Day Tele No.: -----------~=Ema=i=-1-=A=ddr~e=ss=.:'------------
B. STATUS OF APPLICANT (choose one)
Non-Government: Individual Resid ence v'" Business/Organization __
Government: State Municipal__ County__ Federal
C. WELL OWNER(S)/PERMIT APPLICANT -For single family residences, list all pe~ons listed on the
property deed. For all others, list name of busin~gency and name of peL! and title with delegated authority
to sign: J;.IY\.c..S' A-Il e &l-k < K'.e GitJA-~ -e.
Mailing Address: 9 IP C Iv 6 _.r :72te._
City: (!½P e D «..._ State/4C Zip C.OdePI I LL-County: [) ,J ~ c) /J
DayTeleNo.: CellNo.: -'7f)t(--Sf&.4=-OtJ6 ;J
EMAIL Address: fJ..//el,J 2 CJDq ~ rtle... C.0.f'(\. Fax No.: ~·
Geothermal Water Return Well Permit Application Rev. 4-15-20 16 Page l
D. WELL OPERA TOR (if different from well owner) -For single family residences, list all persons listed on
the property deed. For all others, list name business/agency and name of per son and title with delegated authority
to sign: ----------------------------
Mailing Address: ______________________________ _
City: ____________ State: __ Zip Code: ______ County: _____ _
Day Tele No.: --------------~E=m=a=il~A=ddr=e=s=s·~=-----------
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) P arcel Identification Number (P IN) of well site: __________ County: _____ _
(2) Physical Address (if different than mailing address): ________________ _
City: ____________ County _________ Zip Code: _____ ,
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: ________________________ _
NC Well Drilling Contractor Certification No.: ____________________ _
Company Name: ______________________________ _
Contact Person,_: -------------~EMAIL Address: __________ _
Address: ________________________________ _
City: _________ Zip Code: ____ State: __ County: ________ _
Office Tele No.: ________ Cell No.: Fax No.: _______ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name: __________________________ _
NC-HVAC Contractor License No.: ________________________ _
Company Name: ______________________________ _
Contact Person.,_: ______________ EMAJL Address:. __________ _
Address: ________________________________ _
City: _________ Zip Code: ____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ----------------
B. WELL USE Will the injection well(s) also be used as the supply well(s) for the fo11owing?
(1)
(2)
The injection operation?
Personal consumption?
YES ___ _ NO ___ _
YES ___ _ NO ___ _
I. WELL CONSTRUCTION REQUIREMENTS -As specified in 15A NCAC 02C .0224(d):
(I) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements oflSANCAC 02C .0107. except that:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page2
(a) For screen and gravel-packed wells, the entire length of casiJlg shall be grouted from the top
of the gravel pack to land swface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface. ·
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
( 1) Specify the number and type of wells to be us.ed for the geothermal heating/cooling system:
(2)
____ *EXISTING WELLS ___ _,PROPOSED WELLS
*For existing wells. please attach a copy of the . Well Construction _Record (Fonn GW-1) if available.
Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another .
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diam.eter
( c) Casing depth below land surface
(d) Casing height"stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg!L chloride or greater per 15A NC.AC 02C .0107(/)(8 )
(t) Length of well scr~en or open borehole and depth below land surface
(g) Length of sand or gravel pac~g around well-screen-and depth· below land surface
K. OPERATING DATA
(I) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ·° F.
L. SITE MAl'-As specified in lSA NCAC 02C .0224(b)(4), attach a site-specific map that is scaled or otherwise
acc\ll'ately indicates distances and orientations oftlie specified features from the injection well(s). The site map shall
include the following: .
(1) All water supply wells , surface water bodies, and septic systems including drainfield. waste
application area, and repair area .located within 250 feet of the inje'ction·well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107(a)(2) loc;ited within 250
feet of the proposecl injection well(s}.
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
( 4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page3
NOTE: In most cases an aerial photograph of the property parcel showi11g property lines and structures can be
obtained and downloaded from the applicabk county GIS website. Typically, the property can be searched by
ow11er name or address. The location oftlie wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 l(e) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
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 all the person( s) listed on the p roperty deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in thi s document and all attachments thereto and that, based on my inquiry of those inruviduals
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 specifications and conditions of the
Permit."
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources -UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return WellPermitApplicatjon Rev. 4 -15-2016 Page 4
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
W ater Resources
Environmental Quality
LINDA CULPEPPER
January 11, 2018
CERTIFIED MAIL# 7012 1640 0000 9792 3216
RETURN RECEIPT REQUESTED
James Allen & Regina B. Lee
900 Club Drive
Monroe, NC 28112
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Perm.itNo. WT0300123
Union County
Dear Mr. & Mrs. Lee:
Interim Director
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 regulation of injection well construction and operation
activities within the state. Our records indicate that ·the above-referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on March 27, 2013, and expires on May 31, 2018. Per permit conditions and requirements
per ISA NCAC 2C .0224(c). the renewal application must be submitted at least 120 calendar days
prior to expiration of the permit if you wish to continue operating the injection well on your
property.
HYour Geothermal Water Return Well is Still Currently Being Used for Ini ection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .021 I, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells -Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications.
-, ---Noth ing Compare<:.:.-.,,,
State of North Cw:oline I &virorunental Quality I Division ofWetu Resources
Water QuaJlty Regt~11al Oper1tfon1 Section
1636 Meil Service Center I Raleigh, North Carolina 27699-1636
919-707-9129
If You r Geothermal Water Return Well is NO LONGER Being Used for I ni ection~
If the well is no longer being used for inj ection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, p lugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandon ed
according to the regulatory requir ements listed under NCAC Title lSA, Subcbapter 2C, Section
.0240. When the well is plugged and abandoned, a well a bandonment record (Form GW-30) must
be submitted to our office to certify that the abandonment was properly conducted.
If T here has been a Cbanee of Ownership of the Propertv:
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal applicati on.
This fom1 is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1 636
Failure to submit the applicable forms in a timely manner may result in the assessment of civ il
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. If you have any questions, please contact me by phone at
[phone] or by email at [e-mail].
Regards,
Shristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Oper ations Section
Enclosures
cc: Mooresville-Regional Office -WQROS w/o enclosures
Central Files -Permit No. WI0300l 23 w /o enclosures
__ 11, -.
U.S. Posta l Serviceru
CERTIFIED MAILn., RECEIPT
.JJ
.-=t ru
(Domesfc Mall Cnly; No Insurance Coverage Provided)
m
ru ...___ _____ ,--------.--------[J"" r-
[J""
0
Postago $
1---------1
Certllled Fee
CJ Retum Rooelpl Fee
Cl (Endomment Required)
CJ 1---------1
Rastr1cted De!]vely Fee
Cl (Endol8ement Required) :r ,__ ____ __,
Total Postag
Poa1matlt
Here
.JJ
.-:I
1 0 James Allen & Regina B. Lee
~ 900 Club Drive
c ~~;J:!, Monroe, NC 28112 r-
C/ty,51ai.,ZIF
PS Form 3800. Augusl 200& See Rever~e for lnstrucllans
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete Kams 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 retum the card to you.
■ Attach this card to the back of the mallplece,
or on the front If space penntts.
1. Article Addressed to:
James Allen & Regina B. Lee
900 Club Drive
Monroe, NC 28112
A. Signature 1
I / X □Agent
D Addressee
B. Aeoelved by ( Printed Name) I C. Date of D91tve,y
D. Is dellvery address different from Item 1? D Yes 1
If YES , enter delivery address below: 0 No
3. Service lype
D Certified Mal! 0 Express Mall
0 Aeglster9d O Return Receipt for M81Chandlse
D Insured Mall D C.O.D.
4. Restrfctad Delivery? {Bdra Fee) 0 Yes
2. Artlcle Number
(Transfer from service label) 7012 1b4 □ □aoa 9792 321b
: PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540!
I.
Beverly Eaves Perdue
Governor
NA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Waklld, P. E.
Director
December 20, 2 012
James Allen Lee
900 Club Drive
Monroe, NC 28112-5109
Subject:
Dear Mr. Lee:
Notice of Expiration (NOE)
5A7 Geothermal Injection Well
PennitNo. Wl0300123
Union County
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) is 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 located on your property at 900 Club Drive in Monroe,
NC, which was issued·to you on June 13, 2008, and expires on May 31 , 2013, is. soon due for
renewal. If you wish to keep this permit and operate the injection well system, the permit 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 I 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 there has been a change of ownership of the property, an Injection Well Pennit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http://portal.ncdenr.org/web/wq/aps/gwpro/reporting-forms.
If Your Injection Well is Currently Active:
If the injection well system r is still active and you wish to renew your permit, 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 January 31, 2013~
AQUIFER PROTECTION SECTION
1636 Mall Service Center, Raleigh, North Caronna 27699· 1636
Location: 512 N. Sallsbuiy St, Raleigh, North Carolina 27604
Phone: [phone] I FAX: 919-807•6496
Internet: www.ncwaterouality.org
An Equal Opp01tunity I Affinnative Action Employer
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Su~chapter 2C, Section .02 11, you must submit one of the following
enclosed fonns:
A. Application for Permit (Renewal) to Construe/ and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type 5A7 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 inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to :
Aquifer Protection Section
Groundwater Protection Unit
UICProgram
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of c ivi l 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 with a self-addressed envelope.
The above referenced forms are also available o n-line at the DWQ website at
http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications#geothermApps.
Thank you in advance for your cooperation and timely response. If you have any questions,
p lease contact me by phone at [phone] or by email at [e-mail].
Sincerely,
/421)~
Eric G. Smith, P.O.
Hydrogeologist
Enclos ures
cc: Mooresville Regional Office -APS w/o en closures
APS Central Files -Permit No. Wl,0300123 w/o enclosures
2
_;~
C --EN ...... R
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Division of Water Quality
Charles Wakild, P. E.
James and Regina Lee
900 Club Dr.
Monroe, NC 28112
Re: Issuance of Injection Well Permit
Permit No. WI0300U3
Issued to James aud Regina Lee
Union County
Dear Mr. and Mrs. Lee:
Director
March 27, 2013
John E. Skvarla, Ill
Secretary
In accordance with your application received February 7, 2013, and additional information received
March 25, 2013, I am forwarding Pennit No. WI0300123 for the operation of geothermal heating/cooling
water return well(s) located at the above referenced address. This permit shall be effective from the date
of issuance until May 31, 2018, and shall be subject to the conditions and limitations stated therein.
The Mooresville Regional Office inspected your geothermal system on March 18, 2013, and collected
water samples. A copy of the laboratory analytical results will be sent to you when it becomes available.
Also, refer to Part L9 of the permit. During the inspection it was observed that the effluent
sampling port was either missing and/or inoperable. Therefore, samples could not be obtained
from the effluent sampling port during the inspection. The Mooresville Regional Office will be
following np with you to correct this well construction violation in order to be in compliance.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew tile perm it 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 Quality. If you have any questions regarding your pennit or the Underground Injection
Control Program please call me at [phone].
1636 Ma n Service Center, Raleigh, North Caronna 27699-1636
Location: 512 N. Salisbury St Rale1gh, North Carolina 27604
Phone: 919-807~64 I FAX; 919.a07 ~80\FAX: [phone]
Internet: www.ncwaterqual ity.org
An Equal Opportunity I Affirmative Aclion Employer Ninrthcarolina
»t{turall!f
James and Regina Lee
Page2 of2
Best Regards,
' ~~
Michael Rogers, P .G. (NC & FL)
Hydrogeologist
cc: Andrew Pitner, Mooresville Regional Office
Central Office File, Wl0300 I 23
Union County Environmental Health Department
NORm CAROLINA
ENVIRONMENTAL 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
PERMlSSION IS HEREBY GRANTED TO
James and Regina Lee
FOR Tiffi 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 900 Club Dr., Monroe, Union County, NC 28112, and will be
operated in accordance with the application received February 7, 2013, and additional information received
March 25, 2013, and in conformity with the specifications and supporting data, 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 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.June 1, 2013, the date of its issuance until May 31, 2018,
and shall be subject to the specified conditions and limitations set forth in Parts I through VIlI hereof.
...... ~~ ·'"'. , /J. Permit issued this the ot--0 day of ~ , 20 13
,Jf!N,-j ,wJ6
I
U"Charles Wakild, P.E., Director
\) Division of Water Quality
By Authority of the Environmental Management Commission,
Permit #W10300123 UIC/Retum Well -RENEWAL
ver. 01/2013
Page I of5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
J • The Permittee must comply with ail conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection We lls (15A NCAC 2C .0200). Any noncompliance with
conditions ofthis 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. Tb.is permit shall become voidable unless the facility is constructed in accordance with the conditions 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. Eaeh injection well shall be secured to reasonably insure against unauthorized access and u se. 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 u se.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.01070).
8. Copies of the Well Construction Records shall be retained on-site and available for inspection.
9. The injection well system must be constructed with sampling ports so that system influent and effluent
may be sampled.
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 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.
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.
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.
Pennit #WI0300 l 23 DIC/Return Well -RENEWAL
ver. 0 1/2013
Page2 of5
PART ill -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 Permittee 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 Pennittee of the responsibility for damages to surface or
groundwater resulting from the operation oftbis facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintain ed and operated at all times.
2 . The Permittee must notify the Division and receive prior written approval from the Director of any
p lanned physical alterations or additions in the permitted facility or 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, up on
presentation of credentials, enter and inspect any property, premises, or p lace on or related to the injection
facil ity 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 pwposes 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 REQum.EMENTS
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 s chedule shal1 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 fo llowing:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
Permit #WI030012 3 UTC/Retum Well -RENEWAL
ver. 01 /2013
P age 3 of 5
(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 Pennittee.
4. In the event that the permitted facility fails to perfonn satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VII -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
I . 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 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 .0240,
Abandonment and Change-of-Status of Wells.
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
.0240, 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.
(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 thorougWy disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinlang
water.
(D) 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.
(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 l 0 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a s ubsurface 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 of the permit.
Permit #Wl03 00 123 UIC/Retum Well -RENEW AL
ver. 01/2 0 J3
Page4 of5
(G) The Permittee shall submit a Well Abandonment Record (Fonn GW-30) as specified in
15A NCAC 2C .0224(£)( 4) within 30 days of completion of abandonment.
3. The written documentation required in Part VIIl (1) and (2) (G) shall be submitted to:
Pe rm it #Wl0300J23
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Ralei~ N C 27699-1636
UIC/Retum Well -RENEW A L
ver. 01/2013
Page 5 of5
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 03/19/13
To: Aquifer Protection Central Office
Centra.J Office Reviewer: Michael Rogers
County: Union
Permittee: Lee SFR
Project Name:
Regional Login No: __ _ Application No.: WI0300123
/. GENERAL INFORMATION
1. This application is (checkallthatapply): D New 181 Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle O High Rate Infiltration D Evaporation/lnfiltration Lagoon
D Land Application of Residuals O Attachment B included O 503 regulated D 503 exempt
0 Distribution of Residuals D Surface Disposal
D Closed-loop Groundwater Remediation ~ UIC Injection Wells (5A7) GeoThermal
Was a site visit conducted in order to prepare this report? ~ Yes or D No.
a Date of site visit: 03/18/2013
b. Person contacted and contact information: James Lee 704-564-0003 (cell)
c. Site visit conducted by: Maria Schutte
d. Inspection Report Attached: 0 Yes or t8J No.
2. Is the following infonnation entered into the BIMS record for this application correct?
~ Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a Location: BIMS info updated by MRO: sine:le well for extraction and iniection
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); __
IL NEW AND MAJOR MODIFICATION APPUCATIONS (this section not needed for renewals or minor
modl[icatio11s, skip to next section)
Description Of Waste{S} And Facilities
l. Please attach completed rating s heet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes O No [gl NIA. lf 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? [81 Yes D No D N/ A. If no, please explain: __
4. Does the application (maps. plans, etc.) represent the actual si te (property lines, wells, surface drainage)?~
Yes O No O NIA. Ifno, please explain: __
FORM: StaffReport WI0300123 Lee SFR-A.PRSR040929 1
AQUIFER PROTECTION REGIONAL STAFF REPORT
5. Is the proposed residuals management plan adequate and/or acceptable to the D ivision. D Yes D No IZ!
NIA. If no, please explain: __
6. Are the p roposed application rates for new s ites (hydraulic or nutrient) acceptable?
D Yes D No [8] N/A. Ifno, please explain: __
7. Are the new treatment facil ities or any new disposal sites located in a 100-year floodplain?
D Yes D No [8] N/ A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/specia l conditions in Part IV: __
8. Are there any buffer conflicts (new treatment fac ilities or new disposal sites)? D Yes or [8] No. If yes, please
attach a m ap showing conflict areas or attach any new m ap s you have received from the applicant t o be
incorporated into the pennit: __
9. ls proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring.
monitoring parameters, etc.) adequate? D Yes D No [8] N/A-Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and r ecommend any
changes t o the groundwater m onitoring program.: Mr. Lee indicated that he would contact the fvtRO u p on
completion of needed p lum bing work, so the complete s ystem may be sampled.
10. For residuals, will seasonal or other restrictions be required'? D Yes D No IZJ N/A lfyes, attach list of sites
with restrictions (Certification B ?)
Ill. RENEW AL AND JJfODIFICATION APPL/CA TIO NS (use previous sectum fo r new or maior modificatio11
systems)
Description of Waste(S) and FaciJi ties
NIA thisfacility
FORM: Staff Report WT0300 123 Lee SFR-APRSR040929 2
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. 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
I. Type of injection system:
181 Heating/cooling water return flow (SA 7)
D Closed-loop heat pmnp system (5QM/5QW)
0 In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/"Non•Discharge'')
D Other (Sp~ify: __J
2. Does system use same well for water source and injection? 181 Yes D No
3. Are there any potential pollution sources that may affect injection? 0 Yes fgJ No
What is/are the pollution source(s)? • What is the distance of the injection welltsl from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? ~ 1 S ft.
5. Quality of prainage at site: 181 Good D Adequate D Poor
6 . Flooding potential of site: 181 Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc,) adequate? 0 Yes 181 No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program : Mav need to monitor for inorganics & pH and maybe others with permit
renewal -or more freguently depending on lab results.
S. Does the map presented represent the actual site (property l-ines, wells, surface drainage)? 1:81 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. Well is in back yard. which has been re-Jandscaped to a
Japanese garden.
Injection Well Permit Renewal And Modification Onlv:
\
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
181 Yes D No. The MRO was unable to obtain an effluent (return ) sample. (See complete comments
in section V .)
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since peunit issuance
or last inspection? D Yes D No . If yes. explain:
FORM: SraffReport WI0300123 Lee SFR -APRSR040929 3
AQUIFER PROTECTION REGIONAL STAFF REPORT
3. For renewal or modification of eroundwater remediation pennits (of any tvpe ). will
continued/additional/modified in jections have an adverse impact on m igration of the p lume or management of
the contamination incident? 0 Yes O No. Ifv es, explain:
4. Drilling contractor: Name: Derry's Well Drilling
Address: 44283-A NC 29/27
Albemarl e. NC 28001
Certification number: 2663
5. Complete and attach Well Construction Data Sheet.
Per original inse ection: Total depth = 640(l,· casing depth = 44ft: 11ield = 3 gpm. Mr. Lee indicated that lhe welI
had been permitted & inspected b y Union Co Environmental Healt/1 alread1•.
FORM: Staff Report WI0300123 Lee SFR -APRSR040929 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.: The MRO was unable to obtain
an effluent (retnrn) sample. The location of the return line spigot appears to be the problem, as it is after
the "T'' splitter in a 2-Inch line that returns to the weU head. The system was working and water was
returning to the well, but a flow could not be obtained from the spigot The MRO discussed this issue
with Mr. Lee. He said there have been problems sampling at that location in the past and there are no
other ports at the unit (located in the garage). The MRO recommends relocating the spigot in the return
line, either on the opposite side of the "T'' or on the well stick-u p, to ensure successful sampling events in
the future. Mr. Lee is to contact the MRO. upon completion of the plumbing work, to rescbeduJe for
adequate sampling. This well is used for irrigation only, as the area is served bv municipal water and
sewer. The MRO was able to collect a well (influent) sample and will forward those results to the CO
upon receipt
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes ~ No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional infonnation request.
Make sure that you provide a reason for each item:
Item Reason
Note return line repair mentioned above (V.l.) Requirement of permit -unable to adequately
sample system without recommended repair.
S. List s pecific 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. L ist specific special conditions or compliance schedules that you recommend to be included in t he permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
FORM: Staff Report Wl0300123 Lee SFR • APRSR040929 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
7. Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft pennit by regional office; D Issue upon receipt of needed additiona1 information;
[gJ Issue; D Deny. If deny, please state reasons: __
8. Signature of report preparer(s): -~M'-=ar,._,_ia=-=Sc=b=u=tt=e __________________ _
Andrew H . Pit ner =::::.~-----Signature of APS regional supervisor: ______________________ _
Date: -~M=ar=c=h~l=9,~2=0=1~3 __ _
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Staff Report WI0300 123 Lee SFR • AP RSR040929 6
Rogers, Michael
From: Pitner, Andrew
Sent:
To:
Tuesday, March 19, 2013 3:19 PM
Rogers, Michael
Schutte, Maria Cc:
·Subject: MRO staff report for renewal of WI0300123
Attachments: Staff Report WI0300123 Lee SFR-2013renewal-ahpsigned.pdf
HI Mike,
MRO's staff report is attached. We had a problem collecting the effluent sample and had recommended a foe ,
otherwise, no issues with this one. Let Maria or I know of any questions.
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]
Direct Office Phone: [phone]
MRO Fax: [phone]
DWQ website: www.ncwaterguafity .org
NOTICE: Email correspondence to and from this address is subject to the North Carolina P1i1blic Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulation.
1
Rogers, Michael
From :
Sent:
To:
Lee, Allen [[e-mail]]
Monday, March 25, 2013 8 :39 AM
Rogers, Michael
Subject:
Attachments:
RE: WI0300123 Lee Geothermal Permit
well.pdf
Please see attachment
Allen Lee
Siemens Healthcare
Molecular Imaging Sales Executive
704 564-0003
-----Original Message-----
From: Rogers, Michael [mailto:michael [e-mail]]
Sent: Wednesday, March 20, 2013 3:35 PM ·
To ; Lee, Allen
Subject: FW: WI0300123 Lee Geothermal Permit
Mr. Lee -
Please find attached the signature page of the geothermal renewal permit application. Since
both you and your wife, Regina, are the owners and operators of the geothermal well, we need
for her to sign the application also .
Please ha ve her s ign, and you may if you wish, scan in and e-mail back to me.
Thank you for your cooperation.
-----Original Message-----
From : Michael Rogers [mailto:michael.roge rs@ncdenr .gov]
Sent: Wednesday, Ma r ch 20, 2013 3 :24 PM
To: Rogers, Michael
Subject:
This E-mail was sent from "RNPAC7DD0" (Aficio 2075).
Scan Date: 03.20.2013 14:23:45 (-0500)
Queries to: robin.markharr@ncdenr .gov
This message and any attachments are solely for the use of intended recipients. The
information contained herein may include trade secrets, protected health or personal
information, privileged or otherwise confidential information. Unauthorized review,
forwarding} printing, copying, distributing, or using such information is strictly prohibited
and may be unlawful. If you are not an intended recipient, you are hereby notified that you
received this email in error, and t hat any review, diss emination, distribution or copying of
this email and any attachment is strictly prohibited. If you have received this email in
error, please contact the sender and delete the mess age and any attachment from your system.
Thank you for your cooperation
1
Rogers, Michael
From :
Sent:
To:
Subject:
Attachments:
Mr. Lee -
Rogers, Michael
Wednesday, Maret, 20, 2013 3:35 PM
'Allen. Lee@siemens .com'
FW: WI0300123 Lee Geothermal Permit
20130320142345301 .pdf
Please find attached the signature page of the geothermal renewal permit application. Since
both you and your wife, Regina, are the owners and operators of the geothermal well, we need
for her to sign the application also.
Please have her sign, and you may if you wish, scan in and e-mail back to me .
Thank you for your c ooperation .
-----Original Message -----
From: Michael Rogers [mailto:michael.rogers@ncdenr .gov]
Sent: Wednesday, March 20 , 2013 3:24 PM
T9 : Rogers, Michael
Subject:
This E-mail was sent from "RNPAC7DD0" (Aficio 2075).
Scan Date : 03.20 .2013 14:23:45 (-0500)
Queries to : robin.markharr@ ncdenr.gov
1
A QUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: Februa1y 14, 2013
To: 0 Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
t8J Andrew Pitner, MRO -APS
D Jay Zimmerman , RRO-APS
0 David May , WaRO-APS
D Morella Sanchez King, WiRO-APS
□ Sherri Knight, W-SRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Ro~ersr@ncdenr .gov
A. Permit Number: WI 0300123
B. Owner: James and Regina Lee
C. Facility/Operation: __
D Proposed I8J Existing 0 Facility D Operation
D. AppUcation:
1. Permit Type: D Animal D SFR-Surface Irrigation □ Reuse O H-R Infiltration
D Recycle D 1/E Lagoon D OW Remediation (ND)
[gl UIC-Geothermal..Heating/Cooling Water Return Well
For Residuals: □ Land App . D D&M D Surface Disposal
D 503 D 503 Exempt D Animal
2. Project. Type: D New D Major Mod . D Minor Mod. IZI Renewal D Renewal w/ Mod.
E. Comments/Other Information: !YI
NOTE: Please record all information on the well tag, if present, and put on staff report. Thanks.
[gl Return a completed APSARR after the site inspection. At a later date, after sampling & the lab
results are received, please send us a copy of the letter you send to the Permittee containing
laboratory analytical results.
D Attach Well Construction Data Sheet.
0 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 y our 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 I of J
A.~A
MCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory
Governor
James Allen Lee -Owner
Regina B. Lee
900 Club Dr.
Monroe, NC 281 J-2
Dear Mr. Lee:
Charles Wakild, P.E.
Director
February 12, 2013
Subject:
John E. Skvarla, Ill
Secretary
Acknowledgement of
Application No. WI0300123
~egina B. & James Allen Lee
SFR
Injection Heating/Cooling
Water Return Well Sy~tem
Union County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 02/07/2013.-Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Mooresville Regional Office staff will perfonn a detailed review of the provided
:appHe1ition;·,and ···tnaf contact··you, ·with :•a ·tequest for a<iditional 'mforµ,.ation'. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely .and complete response to any additional information 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] ..
Pnce'(e}y, , 0 I
--..;;Jo~~~
for Debra . . · arts
Groun water Protection Unit Supervisor
cc: Mooresville Regional Office, Aquifer Protection Section
Permit File WI0300123
AQUIFER PROTECTION SECTION
1636 Mall Servk:e Center, Raleigh, North CsroUna 27699-1636
Location: 512 N. Salisbtlry St, Raleigh, North Carolina 27604
PhOf\8: 919-607--6464 \ FAX: 919-807 .:s496
Internet www.ncwatemualltY.om
An Equal ~nlly \ Affimlalive Aclion Em~yer
NORTII CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
OPEN-LOOP GEOTHERMAL INJECTION WELLS
These wells discharge groundwater clirectly into the subsurface as part of a geothermal heating and cooling system
(check one) __ New Application n_Renewal* Modification
* Fo/r':newals complete Parts A-C and the signature page.
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: o<. -✓ . 20 / '3.
PERMIT No.W / a ~ VO l t ~ (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non-Government: Individual Residence ~ Business/Organization __
Govertunent: State Municipal __ County __ Federal
B. PERMIT APPLICANT -For individual residences. list each owner on property deed. For al l others,
state name of entity~ name of person delegated authority to sign on behalf of the business or agency:
:fiat'Ns-' H-C~ l.JLJl...
C LOCATION OF WELL SITE -Where the injection weUs are physically located:
(J) Parcel!dentificationNumber (PIN)ofwellsite:4',...../51 -611 County: VtV,'tJ.,,/
(2) Physical Address (if different than mailing address): ______________ _
City; ______________ State~ NC Zip Code __ :~-------
RECEfVED/DENR/DWQ
D. WELL DRILLER INFORMATION FEB O 7 2013
W~ll Drilling Contractor's Name: ----------------t.-Atnn:iffl',rl"t::=c::T"'"-.---:-:---AQU ife r Protection Section NC Well Drilling Contractor Certification No.: __________________ _
Company Name: ____________________________ _
Contact Person~: --------------=E=MA=-=IL=-=-A=d=dr=e=ss==----------
Address : ______________________________ _
City: _________ Zip Code: ____ State: __ County: ________ _
Office Tele No.: Cell No.: ~Fax~N~o~.=~-------
GPU/UIC 5A7 Permit Application (Revised 3/18/201 I ) Page I
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: _______________________________ _
Contact Person.:...: ______________ ____,E=M="-'A=lL=->-A=d=dr=e=s=s.,__: __________ _
Address: __________________________________ _
City: __________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: __________ =-F=ax"'-N"-=o.,_,_.: ______ _
F. 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 ___ _ NO ___ _
YES ___ _ NO ___ _
G. WELL CONSTRUCTION DATA
(1)
____ PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
(6) 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 (t ) through (6)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Fonn
GW-1) if available.
Well Construction Date: _______ Number of borings: ___ _
Depth of each boring (feet): _______ _
(2) Well casing type: Galvanized steel __ B lack steel __ Plastic __ Other (specify) _____ _
Casing thickness (in.): __ Diameter (in.): __ _
WeJl depth: from: ___ to: ___ feet below land surface
Casing extends above ground ____ inches
(3) Grout material surrounding well casing:
(4)
(5)
(6)
(a) Grout type: Cement__ Benton ite* Other (specify) _______ _
*By selecting bentonite grou!, a variance is hereby requested lo I 5A NCAC 2C .0213(d)(l )(A), which requires a cement type gro1.1l.
(b) Depth of grout around we ll casing (relative to land surface): from ___ to ___ feet
WelJ Screen or Open Borehole depth (relative to land sruface): from ____ to ____ feet
N.C. State Regulations (Title 15A NCAC 2C .0200) require the Pennittee to make prov1s1ons for
mon itoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required. Is ther e a faucet on:
(a) rnfluent line? Yes No (b) Effluentline? Yes No
Source Well Construction Information. If the water s ource well is a different well than the injection
well, attach a copy of the weU construction record (Form GW-1). ff Form GW-1 is not available, provide
the following data:
From what dep th, formation, and type of rock/sediment units will the groundwater be withdrawn? (e.g.
granite, Jimcslone, sand, etc.)
D epth: _______ Formation: ______ Rock/sediment unit: _______ _
NOTE: THE WELL DRlLLlNG OR HEAT PUMP CONTRACTOR CAN HEU• SUPPLY HlE DATA LF l'LIJ S
INFORMATION TS OTHERWISE UNA VA ILABLIZ.
GPU/UlC 5A7 PermitApplicatioa (.Revised 3/18/2011) Page 2
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: W / {) 3 0[) l L ~
PermitteeName:~S Jl v'1.e .,., ~
Address: tltv d I 7Y:
Please check the selection which most closely describes the current status of your injection well system:
I) ~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) D 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 infonnation.
Well Abandonment
If you checked (3)( a) or (3)(b ), describe the method used to abandon the injection well. (Include a descriptioh of how the well
was sealed and the type of material used to fill the well if pennanently 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 pennit?
□ Yes □ No
Certification:
"l 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 n now ledge the information is true, accurate, and complete."
~~
Revised 5/05 GW/UIC-68
Date
RECEIVEO/DENR/DWQ
FE B O 7 2Ui3
AqutferPmtection Section
. ... ~-~· :~:~-. -·.•: .
aR'J'IFICAUON ~~ be signed as ieqmmd beknv arbythat person's authmimlagent} . .. -~
:~·, ·:-.. :.
tSA.NCAC01C:ozn(b)~·._~~applica1ions.U~'~as~
·: l.: fon corponrtion: by a re:spousib1e conJt¥ate ~ · ,. . ,,
.2.· fora partDmhip or sole :popiittmsbip: by a~ par1D« or the pro¢eb ... iespe.ct:ively;: .
. \l. · ~ a monicipality or a stain, fedeml. QI' !ltbor public ~· by either a }li:incipal ~c,
· · · officer or'Bnkiog publico-cloc::k:d official; ·· . • ...... · •.•. / ? ·
4.. :fur .all odain: by-the~ owoer<w}lidt Plffl'II all~ listeclontho P•~ deed).
if~ adN>~ -,ent b -•~ oa behlf of ·._~~-•~ ~ • 9-r-::~. by the
. .,ap~t:tbatlWllCI. aacl audJ.o .. their agent to lip tJm ap~ .~ their .behalf;'.. '
~-~~.undet~Qf~~lbave;personalfy~anit·IIJ&·~.~-~oa
submitted in ~ doeument and :all ~ 1hereto and 1bat,, based OQ m_y inquiry of lbose iodmduak ,.
hmuediately ~1,11, ~ obfainmg saia infQIIDation. l betimi ·tbat fl.le-lil.tbrmaifon ls 1"Je, ~~ and · ·
campl• I am awam.1hat there are signffJcw,t ~es. inc11;1dµJg~. possibility of ,fines and~
" fur submitting false-iDfannation. ) ~ to COllS1nlcf, opc,ate. rnainf.ah\ lq,air, 1Uld ifappqcab}e. aband<il)-th.e
iajection we[ aod' all nibm,d ~ in accon1anc:c with tho approved ~.ifiaitioM and conditions of
.. · ~Pennih~ . . .e._ . -
. '.Applicant
(b,. '~
. ; : , ::::;L., ;: . ' ·• :•: ·,•,
~tw.o copies .of.the completed appli~on package f9,:'
. ~-. ~-· . J
D:WQ-t\qoifer'Protecti()D SediQU .=
, ,. J,~6M!U1Seni~Ceuter .· ".
,.,.····>·,,~ ~~NC21699-1636\ . ••,.
•·. ~ : ',;
· f£B,-IJ 7 20'f3 . , ❖
. ~~~~·~ ,·,
' .
..
J. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 l(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
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 (which means all persons listed on the property deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their bebal£.
"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 infonnation, 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 applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Pennit."
Owner/ Applicant
.e, f~ ~
Signature of Property Owner/Applicant
Print or Type Full N ame
•
Signature o f Authorized Agent, if any
Print or Type F ull Name
Submit two copies o f the completed application package to:
DWQ -Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
T elephone [phone]
GPU/UIC 5A7 Permit Application (Revised 3/18/20 11)
RECEIVEDlDENR/DWQ
FEB O 7 2013
Aqutfer Protection Section
Page4
H. OPERATINGDATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
lnjection Pressure:
Cnjection Temperature:
I
Average (daily) __ ~gallons per minute (gpm).
Average (daily) gallons per day (gpd).
Average (daily) pounds{square inch (psi).
Average (January) ° F , Average (July) __ ° F.
J. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection welJ(s). Label all features clearl y and include a north arrow.
(1) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the inj ection well site that indicates the
facility's location and the map name.
NOTE: ln most cases, an aerial photograph of the property parcel showing property lines a11d structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, l1ouses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a ;layer' can be selected showing topographic contours or
elevation data.
GPU/UIC 5A 7 Perm it Applilla tion (Revised 3/l 8/2011) r•ag.e 3
June 13, 2008
Jam.es Allen and Regina B. Lee
900 Club Drive
Monroe,-NC 28112
Re: Issuance of Injection Well Permit
PermitNo.WI0300123
Issued to James Allen and Regina B. Lee
Dear Mr. and Mrs. Lee~
Michael F. Easloy, Governor
William G. Ross Jr .. Secretaiy
North Carolina Department of Environment 1111d Natural Resources
Colew H. Sullins, Director
Division of Water Quality
In accordance with your signed_ and completed application received May 13, 2008, I am
forwarding Perm.it No. WI0300123 for the operation of a SA7 geothermal underground injection
well (UIC) heat pump system located at 900 Club Drive, Monroe, Union County, North
Carolina. This permit shall be effective from the date of issuance until May 31, 2013, and shall
be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. Additionally, please
notify the Mooresville Regional Office at 704-663-1699 when the geothermal system is
operational in order for groundwater samples to b e collected from the influent and effluent
sampling spigots.
In o_rder to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit four ( 4) months 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 Quality.
If you have any questions regarding your permit or the Underground Injection Control (UIC)
Program please call Mr. Qu Qi at [phone] orme at [phone].
Best Regards,
' ~~
Michael Rogers
Environmental Specialist
GPU -UIC Control P rogram
cc: Andrew Pitner-Mooresville Regional_Of:fice
Central Office File-WI0300123
Union County H ealth D epartment
Attachment( s)
Aquifer Protection-Section 1636 Mail Serviee Center
Internet: h ttp://www.ncwatemualin•.org 2728 Capital Boulevard
Raleigh, NC 27699-1636
Raleigh. NC 27604
An Equal Opportunity/Affirmative Action Employer-50% Recydled/10% Post Consumer Paper
Telephone:
Fax 1:
Fax 2:
Customer Service:
N.?JlhCaroJµia
/Vtllllfa//!f
(9 19) 733-3221
(9 19) 71S-OS88
(9 19) 715-6048
(877) 623-674 8
NORTH CAROLIN A
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
C
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
JAMES ALLEN AND REGINA B. LEE
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A 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 900 Club Drive, M o nroe, Union County, North
Carolina, and will be operated in accordance with the application receiv ed May 13 , 2008, and in
conformity with the specifications and supporting data submitted, 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 only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rul es, 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 shall be effective, unl ess revoked, from the date of its issuance until May 31, 2 013,
and shall be subject to the specified conditions and limitations set forth in Parts I through VIII
hereof.
~
Permit issued this the P day of ~~ , 2008.
k1Y"-Coleen H. Sullins, Director
\)-Division of Water Quality
By Authority of the Environmental Management Commi ssion.
WI0300123 Page2
I
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this perm.it 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 WeU Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-9:4.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions 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 pUiposes
and the entrance to·each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each geothermal well injection system shall have permanently affixed an
identification plate according to 2C .0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -MRO
610 East Center A venue
Mooresville, NC 28115
GW-1 s must be submitted within 3 0 days of completion of well construction. Copies of
the GW-1 form(s) shall be retained on-site and available for inspection.
9. Well construction records must also be submitted for any existing water supply wells on-
site as well as a site map showing any water supply wells on adjacent properties as
specified in NCAC .021 l(d)(l)(D).
WI0300123 Page 3
PART II -WELL CONSTRUCTION SPECIAi:. CONDITIONS
At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall
notify the Aquifer Protection Section-Underground Injection Control (UI C), Central Office
staff, telephone number [phone] and the Mooresville Regional Office, telephone
number [phone].
PART ill-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, vohnne 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 Director of the
Division of Water Quality (Director). 1n 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 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 m.et.
PART IV-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 iajected fluid, the
Permittee 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 r esulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1 . The injection facility shall be properly maintained and operated at all times.
WI0300123 Page4
2 . The Permittee must notify the Itivision 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.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section-
Underground Injection Control (UIC), Central Office staff: telephone number (919) 71 5-
6166. Notification is required so that Division staff can inspect or otherwise review the
injection facility and determine if it is in compliance with permit conditions.
PART VI • 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 VII-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 O:fficei telephone number (704)
663-1699, any of the following:
(A) Any occurrence at the injection 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
WI030012 3 Page 5
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 VIII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART IX-CHANGE OF WELL STATUS
1. The Pennittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinuation of use of a well for
injection. If a well is taken compl etely 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)(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 shall abandon that injection well in accordance with the procedures
specified 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 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, whic~ 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) 1n 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.
WI0300123 Page 6
(F) In those cases '\\'hen, 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
of the permit.
(G) The Permittee 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 VIlI (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART X -OPERATION AND USE SPECIAL CONDITIONS
None.
WI0300123 Page7
AQUIFER :rROTECTION REGIONAL STAFF REPORT
Date: 05/23/08 County: Union
Permittee: Lee SFR
Project Name:
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __ Application No.: Wl0300123
L GENERAL INFORMATION
1. This application is (Cl>eclt &Jl lhat apply): [8J New O Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse O Recycle O High Rate Infiltration O Evaporation/Intihration L agoon
0 Land Application of Residuals 0Anachment B iitcluded O 503 regulated O 503 exempt
D Distribution of Residuals D Surface Disposal
0 Closed-loop Groundwater Remediation 181 VIC lnjection Wells (5A7) GeoThennal
Was a site visit conducted in order to prepare this report? 181 Yes or D No.
a. Date of site visit 05/22/2008
b . Person contacted and contact information: James Lee 704-564-0003
c. Site visit conducted by: Andrew Pitner
d. Inspection Report Attached: D Yes or l8J No.
2. Is the following information 121tered into the BIMS record fo r this application con-ect?
181 Yes or D No. Ifno, please complete the followmg or indicate !hat it is correct on the cWTCllt application.
For Treabnent FacillUes:
a. Location: BIMS info updated by MRO; single well for ex1raction and injection
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): __
II. NEW AND MAJOR MODIFICATION APPLICATIONS (t/1is section not needed for renewals or minor
modi(ications, skip to nexJ section)
Description OfWaste(S} And Facilities
I. Please attach completed rating sheet Facility Classification: ??
2 . Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No l8J NIA . lfno, 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 Engineet'? 181 Yes D No D N/ A. If no, please explain: __... ............ _,. .--(_Fo_rm_a_tted _______ -
4, Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? 181
Yes D No ON/A. Ifno, please explain:-······························----·----···-----------·-·· .. ·· .. ··--···-.. -·~··--·· ~Fo_rm_ill_tted _______ _
FORM : APRSR040929-wi0300 l 23Lee5A 7 .doc
AQUIFER PROTECTION REGIONAL STAFF REPORT
5. Is the proposed residuals managemoot plan adequate and/or acceptable to the Division .
NIA . Ifno,please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptab1e'l
D Yes O No fZI N/A. Ifno, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a I 00-year floodplain?
0 Yes 0No [81
0 Yes O No l2sl N/A . If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities ornew disposal sites)? 0 Yes or [81 No. lfyes, 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, freq11cncy of monitoring,
monitoring parameters, etc.) adequate? 0 Yes fZI No O NIA. Attach map of existing monitoring well
network if applicable. lndicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: No info on the monitoring plan was provided. Mr Lee
indicated that he would be sampling the well to make sure that the pH and other p arameters were acceptable
and would not result in foulin tt of the svstem u pon use.
10. Forresiduals, will seasonal or other restrictions be required? 0 Yes D No [81 NIA If yes, attach list of s{tes
with restrictions (Certification B?)
Ill. RENEW AL AND MODIFICATION APPLICA'll.ONS (use previous section for new or maior modification
svstems)
Description Of Waste(S) And Facilldes
Nia tl1isfaeility
FORM: APRSR040929-wi0300123LccSA7 .doc 2
AQUIFER PROTECTION REGIONAL STAFF REPORT
W. JNJECTJON WELL PERl,OT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effiuent injection wells, in situ remediation injection wells, and heat
pump injection wells .)
Descrlpdon OfWelllS) And Facilldes -New, Renewal, And Modification
1. Type of injection system:
181 Heating/cooling water return flow (SA 7)
0 Closed-loop heat pump system (5QM/5QW)
0 In situ remediation (51)
0 Closed-loop groundwater remediation effluent inJection (5LJ"Noo -Discharge")
0 Other (Specify: _)
2 . Does system use same well for water source and injcotion? IZJ Yes O No
3. Are there any potential pollution sources that may affect injection? 0 Yes 181 No
What is/are the pollution source{s )? __ -=.· _Wb'--'-"',.,at~i=s =lh=e'-"d=is"-'tan=ce=-=o~f=th=e~in"""'jec=n=· o=n_,_w=el=l{.,,,s,._) =fro=m~t=he.=po=l=h=111=· o=n
source(s}? ft.
4. What is the minimum dislance of proposed injection wells from the property boundary? ~JSJt
S . Quality of drainage at site: IZJ Good O Adequate O Poor
6. Flooding potential of site; l8J Low O Moderate O High
7. for groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? 0 Yes 1:8] No. Attach
lllllp of existing monitoring well network if applicable. If No , explain and recommend any changes to the
groundwater monitoring program: No monitoring program proposed in application materials: need to monitor
for inorl!llnics & pH and maybe others.
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? 18) 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 gre-.it. but does an ok job of renresentin!! the
site. Well is in back yard, which is being re-landscaped to a Japanese garden.
In jection Well Permit Renewal And Modification Only:
1. For beat pump systems, are lhere any abnormalities in heat pump or injection well operation (e.g. turl>id water,
failure to assimilate injected fluid, poor beating/cooling)?
0 Yes 181 No. If yes, explain: but could not really evaluate: well has been dnlled, but no pump or system
in place yet: well owner reports low yield (3 11pm) and is evaluatiru! the possibilitv of using some of the
wastewater from the system for irrigation.
2. For closed-loop he.at pump systems, has system lost pressure or required malc:o-up fluid since permit issuance
or last inspection'! DY es O No. lf yes. explain:
FORM: APRSR040929-wi0300l23Lee5A7.doc 3
AQUIFER PROTECTION REGIONAL STAFF REPORT
3. Fot renewal or modification of groundwater remediation p ermits ( of any type t, will
continued/additional/modified injections have an advene impact on migration of the p lume or management of
the contamination incident? D Yes D No. If yes, explain:
4. Drilling contractor: Name: D mv's Well Drilling
Address: 44283-ANC 29/27
Albemarle. NC 28001
Certification number: 2663
5. Complete and attach Well Construction Pata Sheet.
GW-1 was not available 1•et Total deptlt = 640Oi casing devth = '40; l'ield = 3 gpm. Mr Lee indicated that the
well Juul been perm/Jted & inspected b v Union Co Environemtnal Health alreadl'•
FORM: APRSR040929•wi0300123LeeSA7.doo 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
V. EVALUATION AND .RECOMMENDATIONS
I . Provide any additional narrative regarding your review of the application.: System is wider construction -the
well has been completed, but it does not have a pump and plumbing to the system in the house has not been
completed. Based on the site visit, the entire area is served by murucipal water and sewer-no other
groundwater USSJiS apparent in the vicinity. Need to establish the standard monitoring schedule, which should
be completed by the owner and submitted to the CO & RO.
2. Attach Well Construction Data Sheet-if needed infonnation is available
3. Do you foresee any problems with issuance/renewal of this permit? 0 Yes ~ No. lfyes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
Info from Union Co HD / GW 1 Union Co HD _inspection of well installation
should confirm proper construction of the well
and may include the GWl
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 reconnnend to be included in the pennit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7. Recommendation: 0 Hold, pending receipt and review of additional information by regional office; 0 Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information;
~ Issue; 0 Deny. If deny, please state reasons : __
8 . Signature of report preparer(s): _ _,An=drew=.,_P,._nn,.,,· =er,_ ________________ _
FORM: APRSR040929-wi0300123Lee5A7.doc 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
Signature of APS regional supervisor: _ __...,And=r=ew-'--'P..._.i=tn=er _____________ _
Date: _____ _
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM : APRSR040929-wi0300123LeeSA7.doc 6
AOUIFER·PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: May 15 , 2008
To: 0 Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
181 Andrew Pitner, 1v1RO-APS
0 Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone]
E-Mail: [e-mail]
A. Permit Number: WI 0300123
B. Ow.ner: James and Regina Allen
C. Facility/Operation: __
(8] Proposed D Existing
D. Application:
0 David May, WaRO-APS
0 Charlie Stehman, WiRO-APS
0 Sherri Knight, W-SRO-APS
Fax: [phone]
D Facility D Operation
1. Per,nit Type: D Animal D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle D VE Lagoon D GW Remediation (ND)
181 UIC -(SA 7) open loop geothermal __
For Residuals: □ Land App. 0 D&M
0 503 D 503 Exempt
D Surface Disposal
0 Animal
2. Project Type: 181 New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Inf ormatton: D I would like to accompany you on a site visit.
NOTE:
Attached, you will find all information submitted in support of the above-referenced application for yo\J.r
review, comment, and/or action. Within 14 calendar days, please take the fo11owing actions:
~ Return a Completed APSARR Form.
0 Attach Well Construction Data Sheet.
0 Attach AttachmentB 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 fonn, 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: ------------------
FORM: APSARR 07/06 Page 1 of I
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Caronna Department of Environment and Natural Resources
Coleen H. Sullins Director
Division of Water Quality
May 14, 2008
Regina B. & James Allen Lee
900 Club Drive
Momoe, NC 28112
Subject: Acknowledgement of Application No. WQ0000123
Regina B. & James Allen Lee SFR
Injection Heating/Cooling Water Return Well (SA 7)
Uni.on
Dear Mr. & Mrs. Lee:
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials on May 13, 2008 . This application package has been assigned the number listed
above and will be reviewed by Michael Rogers,
The reviewer will perform a detailed review and cont.act you with a request for additional information if necessary.
To ensure the maximum efficiency in processing permit applications, the Division requests your assist.ance in
providing a timely 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 applica~on.
If you have any questions, please contact Michael Rogers at 919-715-6 166, 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 bas reorganized. To review our new organizational chart, go to
http://h2o.em.state.nc.us/documents/dwg or2chart.pdf.
PLEASE REFER TO THE ABOVE APPUCATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Sincerely,
for Debra J. Watts
Supervisor
cc: Mooresville Regional Office, Aquifer Protection Section
Permit Application File WQ0 000123
Aquifer Protection Section
Internet: www.ncwaterquallty.org
1636 Mall Service Center
Location: 2728 Capital Boulevard
An Equal Opportunity/Affirmative Action Employer-50% Recycied/10% Post Consumer Paper
Raleigh , NC 27699-1636
R~lelgh, NC 27604
~Carolina ;vat11rall11
Telephone: [phone]
Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]
NOR1H CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL BEAT PUMP SYSTEM FOR:
TYPE 5-A7 WELL{S)
_X,~ __ New Permit Application OR ____ Renewal (check one)
DATE: 5 -/ '4
PERMIT NO. _______ (leave blank ifNEW permit application)
/l. PROPERTY OWNER(S)/APPUCANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
~lily ..... --w/-.irity ""' signature), '.A "-'?:s: rJ l'I i:;:i . 5 J0-m e :;-,
ttl\P}:U l>e.-e...
(1) Mailing Address: 9 cc C~I t L h Dr .
(2)
City: 0 l:N CG € State: AJ:..;z.ip Code: a.8 (Id\ County: LJ r) i D tt.)
Home/O~eTeleNo.: 7ulf ;J.89-di.8 90 Cell No.: 'ltJ1/-5f.D </-CJC0::3
EMAIL Address : ,q lie rn • L e.e @~ ',em ~os . co rY)
Physical Address of Site (if different than above): _____________ _
City: ________ State: _Zip Code: _____ County: ____ _
Home/Office Tele No.: __________ C=e=ll ..... N=o=·=---------
EMAIL Address:. _____________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (J.fthe 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~mm~:· ___________ __.:EMAIL=-=~A=ddres==s:'---------
Address: ___________________________ _
City: ________ State:_Zip Code: _____ County: ______ _
Office Tele No.: Cell No.:
Website Address of Company, if any: ______________ _
I
GPU/UIC 5A7 Well PennitApplication (Revised 9/2007) Page 1
C. WELL DRU,LER INFORMATION
Company Name: Tie✓ I 1-U 's Lt)E· 1 l "'D 1 • ~ I \ \ n CL
Well Drilling Contractor's Name: be r-C¼ Ho n € bf <?-ti ~t J
NC Contractor Certification No.: ...... ~::.-Cti__., l .... c .... -5...__ ________________ _
Contact Person:Dr:t:14 J-lon Q(,J () J+ EMAIL Address:ct.) r r~ ~ LvtiZ H d ti ll i r 1t:i@> ~
Address: J./</-J &'3-A N(~ 8.9 /~ 1
City: t9 lbe mo.rl e Zip Code: km' County: ..St a_ V) \ ~
Office Tele No.: 7of '782-;$0 70 Cell No.: 7cx/· 985-/QI 35 ;::.s
D. BEA]' PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: C,o r:::ol I ,)o c, 1'1 !'.Y)G,.;ff: Co n±t:o\
E.
F.
G.
H.
Contact Perso~\ C K,, L >DO 'tf EMAIL Address:
Address:.:?,,:y IL, a
City: manta€., /1..X_ ZipCode: d'61l ( County: -'-'•-l-10_n ______ _
Office Tele No.: 70'/-11J,¥-...J/aJ7 Cell No.: ______ _
S~ATUS OF ~PLICANT
Pnvate: L Federal:_ Commercial:
State: Municipal:_ Native American Lands:
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
L~ ,µ 1a:i:vu Lta li I, 9 >iULmzpi{) ~ {,.fi(lbm 4 tel~~
#tm'f':/1 s;µet/M;n;cO'/k I .P' ·n. n -i1-bv,1-~ bcu.!Jc t.4o
boK.JJio I~ ed. o..-~ au ~ ~ alw..wfro.~~.lu,.e().
WELL USE Will the injection well(s) also be used as the supply weU(s) for the following?
(1) The injection operation? YES ✓-NO -----.---
(2) Personal consumption? YES___ NO Z
WELL CONSTRUCTION DATA (Skip to Section I if this is a Permit RENEW AL)
(1)
v
PROPOSED WeU(s) ~ 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.
EXISTING Well(s) being proposed for use~ 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 cnndn1r.t,"-O.:~ui-.---=-~~b,I--Number ofborings: __ _
Approximate depth of each boring (feet): __ t,'--'~ ..... D~--
(2) Well casing. Is the well(s) cased? (check either(a.) YES.!!!: (b.) NO below)
(a) YES / If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic / Other (specify)_~----
Casing thickness: ..ia_ diameter (inches): Co depth: from O to4 ft. (reference to land surface)
Casing extends above ground / 8 inches
G,PU/UIC SA 7 Well Permit Application (Revised 9/2007) Page2
L
(b) NO
(3)
(4)
(S)
(6)
NOTE:
Grout (material surrounding well casing and/or pi~:
(a) Grout type: Cement__ Bentonite Other (specify) ______ _
(b) Grouted surfuce and grout depth (reference to land su.rfuce ):
__ Around closed-loop piping; from ___ to __ (feet).
✓ Around well casing; from Q
Well(s) Screen Information
to J.JL/ (feet).
Depth of Screen: From ____ to ___ feet below land surface
N.C. State Regulations (Title 15A 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 fJucet on:
(a) lnfluentline? Yes__}.L_No__ (b) Efflueptline? Yes_LNo __ _
Source Well Construction Information (if the water sonn:e well is a different well than the injection well)
Attach a copy of Foan GW-1 (Well Construction Reoard). If Form GW-1 is not available. provide the
following da.t.a:
Groundwater Source. From what depth. formation, and type of rock/sediment. units will the groundwater
be withdrawn? (e.g. gnl,!lite. limestone, sand, etc.)
Depth: lra.O .g . Formation:&roli QQ, Rock/sediment unit ' 'lSJ4e. ~IQ..¾ -----
llmWELL DRil..UNG CON'IRACTORCAN SUPPLY THE DATA FOR.EITHER EXISTING ORPROPOSED WELLS IF
nns INFORMATION IS UNA V AIi.ABLE BY OTHER MEANS.
OPERATING DATA
Average(daily) / 8 gallons per minute {gpm).
Ave.rage ( daily) /.8[1_ gallons per day (gpd).
Average(daily) 5 pounds/square inch (psi).
{l) Injection rate:
(2) lnjection Volume:
(3) Injection Pressure:
(4) Injection Temperature: Average(January) 1./!) °F,Average(July~~
J. INJECIION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection ,rnmon. The .manufacturer's brochnre may provide supplementary
information, Se. e o1:Ja .. cPre.4.I
K. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) 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 weU(s) and any
existing well(s) or waste disposal facilities such as septic tanks o.r drain fields located within 1000 feet of the
geothermal heat pmnp well system. Label all features clearly and in.erode a north arrow.
(2) lnc]ude a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
OPU/UIC SA 7 Well Perm.it Application (Revised 9/1.007) Page3
L. CERTIFICATION
RECEIVED/ OENR / DWQ
Aquifer Protedlon Sectton
MAY 1 2008
Note: This Permit Appllcattoo must be liped by am person appearing on the
recorded legal property deed.
''I hereby certify, under peoalty of Jaw, that I have peaooally examined and am familiar with the infonnation
submitted in this document and all attacbmcnts 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 construct. o~. maintain. repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditions of the Permit."
k •Pro:!:~,!:~
::J >m,J .4 ({ e ✓ hA: :L
Print or Type FuU Name 11/4~ Si ~f Property Owner/Appti~nf"
I 14G / lfl[l A /2,,&.t:.
Print or Type Full Namo
Signature of Authorized Agent, if aJJY
Print or Type Full Name
PJease return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UICProgram
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC SA7 Well Permit Application (Revised 912007)
__ AZQ3.,. __ _
0782
. ' .
Excise Tax: $None
FILED
UNION COUNTY
CRYSTAL CRUMP
REGISTER OF DEEDS
FILED Oct 03, 2007
AT 02:44.pm
BOOK 04703
START PAGE 0782
END PAGE 0783
INSTRUMENT# 44232
EXCISE TAX (None)
JT
Tax Lot No: 091S9014 and portion of09l59015 Parcel h!cntifi.er No. -----,----,---------
Verified by County on the day of , 2007 by
Mail after recording to Griffin, Smith, Caldwell, Helder & Helms , P. A.
This instrument was prq,ared by James..-"-'Allc:n=-'=.ccLcecc..c...(""jal""),_ _______ ~
Brief Description for the index I, Lot 3 and portion of lot 2 Lileswood Sub.
NORTH CAROLINA GENERAL WARRANT¥ DEED
TIUS DEED made October • 2007 bv and berween
GRANTOR
JAMES ALLEN LEE, II and spolllle, REGINA
BARRINGER LEE
GRANTEE
JAMES ALLEN LEE, U and tpome, REGINA
BARRINGER LEE
900 C lub l>r.
Monroe, NC 281U
Enlc, in~.., block forCM:11 rlffY: name, odAlrcs,, and. if iq,pnrprialc, characla or""lilY, •·C·, corponnion or P"ffll<nhip.
The designatioo Granto, and Grantee as used herein shall include said parties, their heus, successors, and assigns, and shall
include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, thal (he G11111tor. for a valuable consideration. paid by the Gnmtee, the receipt of which is haeby
acknowledged, has and by these presents does grant, batgain, sell and convey llllto the GranJee, in fee simple, all that cCltllin
lot or parcel of 11111d sitWtted in Monroe Township, Union Couruy, North Carolina and more particularly described as
follows:
Tract I -BEGINNlNG at a point at th.c intersection of the Southern tight_ of way of Fuller Drive and the western
right of way of Club Drive and runs th= down and with tile western righl ofwu:y of Club Drive, S 00-15 E 145.4
fl:et to a comer with Lot No. 4; thence the division line with Lot No. 4, N 85-50 W 209.9 feet to a point, common
comer with Lots 2,314 and 5; thence with the division lim, of Lot No. 2, N 4-10 E l 4S feet tO a point in the southern
edge of Fu.lier Drive; thence down and with Fuller Drive, S BS-SOE 198.9 feet 'to the point of the BF.GlNNING and
being Lot 3 of Lileswood Subdivision (Club Heights) as mapped and surveyed A11gllSt 14, 1985 by Walter L.
Gordon, NCRLS, and updated on March 16, 1987.
Being the same property conveyed to Keith H. Griffin and wife, Polly W. Griffin, by deed dated J3Jluaty 18, 1982
and teeorded in Deed Book 354, page 276, Union County Registry,
Tl'8'll 2-BEGINNING at an iron found on the southern right of way of Fuller Drive (a 60 foot right of way), said
iron being the northeastern comer of Lot 2 of Lileswood Subdivision as ebown on a plat thereof recorded in Plat
Book S, Page 221, Union County Registry and the ®11hwestern comer of Lot J of Lileswood Subdivision and
running thence with the collllllon line of Lot 2 and 3, S 04-10-00 W 145.00 Feet to a found iron a common comer of
lots 2,3,4 and S of said subdivision thence With the common line of lots 2 and 5 of said IIUbdivision N 85-47-04 W
43.85 feet to a se1 iron; thence a new line N 10-54-27 E I 45.97 feet to a set iron 011 the southern margin of Fuller
Drive; thence with the southern margin of Fuller Drive S. 8.S-50,-00 E 26.72 f=t lot the point and place of the
N. C. S.r A>1oc. from No . J Q I 977
Printed by A!lf(OITlcnl with lhc N,C, Bar......,.
II003
:...
--
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dlll11flJ) factDls I
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conduf;fion + convecthHr
at borehole wall
r SUbmersible pumpeledrica1 r~
, ~{;:i~;,i·i":;;~t}i~::;r
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brmation
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low in formation
water
discharge
1mm
formation
i
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900 Club drive 28112-Google Maps
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http://maps.google.com/maps?f=q&hla:en&geocode=&q=90o+Club+drive+ 281 l 2&sll=3 7.. .. 5/12/2008
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
James Allen and Regina B. Lee
900 Club Drive
Monroe, NC 28112
Dear Mr. and Mrs. Lee:
Coleen H. Sullins
Director, Division of Water Quality
RE: UIC Effluent Sampling Results
WI0300123 Lee 5A7 UIC
Union County
Dee Freeman
Secretary
March 24, 2009
On December 9, 2008, staff from the Mooresville Regional Office of the Aquifer Protection Section sampled the
effluent and influent lines of your geothermal underground injection well heat pump system. The samples were
analyzed by, the Division of Water Quality lab for metals, nitrates and other inorganic constituents. A copy of
the results is enclosed for your review.
Should you have any questions, please feel free to contact me by email at Andrew. [e-mail] or by
phone at [phone].
s;rL t\~~~
Andrew H. Pitner
APS Regional Supervisor
Enclosure: 12-9-08 effluent sample results
Cc: Michael Rogers, APS-GPU-UIC, Raleigh (by email)
Division of Waler Qujillty I Aquifer Protection Section I Mooresville Regfonal Office
610 East Center Avenue, Suite 301, Mooresville, North Caronna 28115
Phone: [phone] \ FAX: 704-663-e040 \ Cuslomer Service 1-877-623-67 48 \ Internet: w.vw.ncwaterguality .org
An Equal Oppcnlnlty \AfflrmativeAelon Empioy8(-50% ~ I 10% Post Consumer Paper
~ftb:Caroli a
/\llllllrll/4!
County:
RlllerBuin
Report To
.lllOOH
MROAP
Colec:tar: ~
Region: !!B2
Sample Matrtx: GltOUNDWAJIR
Loe. Type: a:~ :t"'jl)~ I ~i:;/J \'.
&,e,gency VMINo I
COC Ves/No I I
I
I.Deallan lO: Wl0300123 !
-
wrqn,1/n La6oratorv Section <Resu[ts
SamplelO:
PONumbert
Data R-lved:
Tma~ivecl:
labwc>IIQI I.OglnlO
Oa1aRopor1-d:
Rapc,11 GenataOt<f:
Vls1111D
Loe. 0-::r.: ~
_, I C~Tlme:: 111:li1 1$an"'90eplh
Routine Qualifiers
For a tnore detailed descr~n "! the:;ie qualifier codes refer to www.ctwqlab.org under Staff Ar:a!:ss
A-Vltue ~porwd Is Illa ""8f-sle of two or me 1w cfe111minlllona
81-CO\fflllbla membranes with <20 cdoniea; Ealll!IUld
82· Counts l'l'om •• 1ltet'l-aro.
BS-Coumabl• membtanes will moi. lh1111 6< or 80-mlQnies; Esllmalad
84-Flwra llaw c:ounla d boU1 ~o or 80 and c 20; £s1lmated
N~ ooncematkln ls< POL and >MOL
NE-Ho establ"IShecl POL
P.Elevabf PQL due 10 ma~ lnlfJlfeml~ and/Of Mffll)le diutloll
01-l-lolding lime eia:ieodlld p/101" ID re°"" at lab.
Q2• Holdlfl9 time uceeded.~ rwmlpt by lab
Am8701
1101SU
12/10/2008
Ol:00
HPAIU<ER
,l'D/r/9
02/V/2009
85-Too lll&IIY CIOlc,nle$'Wel't pl'll$Ollt lillO nun OfOln to CXJUnt(TN'TC)
J2-Reporlad value fded ta meet QC critlelia or eltler predllon or accwacy; Estima1llld
JS-The sample mavtx !Melfered Wllll Ille atill IY to make aw, a0CUfallt delelminallon: Eatimai.al
PQL-Ptadical Quanttatian lJmit.tubject IO ctwioe dlle ID inatNment aensitvily
V-Samples analyzed for tllll compound but not detBcled
JS. Th• lab analysis wu trom .,, unp1Nervec or ~y cl!omlcally preaarwc1 sampw, Es11maled X1· S.iiiil• noc anafned for this~
N1-llle ~nent has Ileen ttneatlvely ldenbfied based on mus specnl llbrary tea/Ch ai,d hu an esUrrmllld value
\AB
NC ©WQ £a6orat:.ory Section <J{,esults
Sample ID AB38701
l.Ocllllon ID! WI030012a ~Oate: 12/lll/200I
Loc.q.cr.: ~LEE COlleel Time:: 10:58
V131t it)
CAS• AM~._.,,.
I
PQL Reeult Qlllilfllr Unllll Analyst/On, Appraved By /0allt
~~•l!"C81P'bJllb 1.9 -c OSNJNDERS HPAAKER
Metlo<I Rft!WIOI 12111WB 1211DIOS
WET
tanCll!omllog.ajJiy _TITIJL mglL A'MLUAMS CGREEN
MdlodR.r-EPA300.0 12/JOIQI 1/IIIOSI
TdllDIMcllvldSOl49 1 ~ ,2 151 .. AWILUAMS COREEN
lolellOdRallnnce APHA2540Ct llTH 12'12Alll 12122.()e
Ollol1dl 1,0 81 .. A'MWAMS COREEN
~R..,,_ EPA:IOO.O 1213Q101 1191119
FIIIOltde O.A 2.0 U,P .. AWIUJAMS COREEN
MttlOd fl.,.,._ EPA300.0 1:v31l.'011 1/Rm
SIiia 2.0 10 U,P mg/\. AWILUAMS COREEN
Mol'odR.r--EPA300.0 12/30,QI 1NO!I
NUT
NQ2tN03es N In lqr.ll:I 0.02 ,., "9\-UN MA.JAY! CGREEN
MfflOCIRllflrlncl9 l.ai::10-107,04, 1-c 11/10/08 12122A:le
MET
7440-22-4 ~l,rlc:PMS 5.0 5.D u lo\. JJURGEVICH ESTN'FORO
Mllllod R......,._ EPA 12D0.8 12'17Al8 1/8/llt
7~ AlbJICP 50 95 lo\. OSTANLEY ESTN'FORD
MethodR ......... EPA:Dl.7 1211GIOS 11Ml9
7440-M-2 AsbJICPMS 2.0 2.5 uo'L JJURGEVICH ESTAFFORD
t,1-~ EPA20D.8 12'17101 ,_
7~ Bl llJfCP 10 10 u uo'L DSTANLEY ESTAFFORD
M4IIIOCIR.,.,_ EPA:ll)0.7 ,..,,_ 11911)11
7441H~2 CII IIJICP 0.10 45 .. OSTANI..EY ESTAFFORD
Md,od~-EPA200.7 12118/08 1ISIO&
7440-43-9 CdllflCPMS 1.0 1.0 u IO'L J.PJRGEVICH ESTAFFORO
MtG10d Ref'lnnl>e f!PA2110.8 12'17ftll 1/Ml8
74CM74 Cl'bJICl'f"5 10 10 u IO'L JJURGEVICii ESTAffORD .......,R ___ EPA210.1 12117,QII 1111,W
7-440-60-8 01bJICPMS 2.0 45 IOI-JJURGEVICH ESTAFFORD
Mtthod Rtlelwa EPA2D0.S 12117101 ;iam
7'39-IM ... !lrlCP 50 50 u IO'L OSTANLEY £STAFFORD
Mtlho<I R8'elfflC9 EPA200.7 1:V,6/08 11$10!J
7~7 KbJICP 0.10 G,53 mg/\. OSTANLEY ESTAFFORO
MelllOORel-ePA200.7 12116/08 1111/0e
Laborn,ry S Oft» t!ID Mall Sfflrlce Centllr, lta .. fgh, NC fflff.111fl (.,9) ~901 Page2of3
'
!NC ©'WQ La6oratory Section <J{f!sults SamplelD AB38701
I.OClliOnlD: WI03001D Coled Date: 12/0tl200I
Loc.O..cr.: MRLE£ CoVectTrne~ 10:M
Visit ID
I CAS• Anaiyt,IN -PQL RHul Qualltler Unlls Analy$t/Oala Apprcl¥9d By /Date
7439-95-4 "Vrlf ..... 0.10 13 • OSTANLEY ESTAFFORO
MIIIOdRlf-EPAZl0.7 121111/118 1111109
7439-86-6 Mi\llYICP 10 15 ug/L OSTANLEY ESTAFFORO
-...SR_.,... EPA200,7 1211Mlll 111111)8
7~ NllllylCP 0.10 2' ~ OSTANLEY ESTAFFORD
M~R--EPAa».7 1711Mlll 1J6jQ9
744~ NlbJICPMS 10 15 IO'L .u.JRGEVICH ESTAFFORD
Mll,od"-I-EPA2X>,8 12t1711Jf 1Jlll09
74~9-62-1 PbbylCPMS ,o 10 u uglL JJURGE:VICH ESTAFFORD
PMIOCIIW!r'll'A EPA200.8 12117.QI 1lMl8
77l2-49-l Sa bJICS'MS 5 .0 5.0 u 19'1-JJURGEVICH ESTAFFORO
lilelhodR«an:e S"A200-8 12117AJ8 1,1!/08
1~ 2'll ti,ICPMS 10 24 ~ JJURGEVICH ESTAFFORO
Macl,od-EPAZlOJI 1ar17.0, 118/09
Location coc1o du ~mf ~ PR!ORQY ( 11,n,. 3 ~
County \,\Nl orv l!!JWat. 3" RoutN @) D Im nrJ O 101 .
Quad No. ____ Serial No . I D Seil □ Emefvency 1-TrJ DateReceivedJ.2.-/0{IE TimeJ;tdt) Lal______ Long. ____ 4 ____ □ Other Rec'd By: _f3 From :B~er, Hand Del .,
~ ~ D Ctim <A C ustody Other. Report To: ARO, FRO.~RRO, Wa , WiRO , ~;;;;;;;;;;;..1!5iiiiiiiiioi1....,;=2'!iiii.i ... iii1!!1oiiiiiiiiiiiiiiiiE51iii~ Data EntJy By:. ______ Ck:. ___ _
WSRO, Kinston FO, Fed... Trust. Central ff., Other:________ Date Reported:
Shi pped by: Bus~-~--"} ald Del., ··----------P!!J)OSe: "~c. S 't'.S-te-Y""-ff?/Zrnx.T U)c.,('(.,-,fA;)---C-6....--------
Collector(s); ~· • 'I ~ ,~~\ /,s,;,. ~ Date '2.M/J; Time {P ~ s ~ Base1lne. compl"nlc:P§[e-mail], Pesticide Study, Federal Trust, other.. ___ _
FIE• nANALYSES ' .S ~~~ 1 =--t OWner.--iC.i~r;t.~~~·l=-£~Gc:..........,,..-...-----<-.-a._-_1-:,---.-.------------
pH --,.,_< Spec.dond M £5 u:> at259C LocatlonorSite 1$ Cl~ t>~.~~:=iiJL
Temp.10 "'· !-. •c Oder ]r?t?riff O
Oescriptionafsamplingpoint~Xt .... AJc,,w-P._ti..:!::!~'...i.:f..:.'~ ...... __...:::;jg.E..,jr~----~--------
Appeatance ,.. , c .A->.P Smnpling Method. _ _.Y,..,,u."'"~<-=e;::..._-.......,=-.---.-----Smnple frierval, _____ _ Field Analysis By: A.. • ..J.M>t~ p .~~ Remartts, __________ ,P!iii_o._bll_il'_._11C._r _______________ _
LAJl r">RATnRy ANALYSES
800~10 rrvL
COOHlgh:MO rnglL I
COD Low3S5 rnglL
Colllonn: MF FIICll 31111 t100n •
Coliform: MF Tami 31561 1100n
TOC8a0 mg/I..
Tlllllldilr 71 NTV
Relldue. Tai.II Suipended 5!0 mg/I..
pf.1403 1111111
Alblinlly to pH 4.5410 mglL
Albilili!ylD pH U 415 mg/L
c.tiona11 445 mg11.j
Bic:aution"9 440 mg/L
CalbDn dlo)clda 405 mglL
>< Chloride940 mg/I.
ci-t,h,n:: Hex 1032 ug/1.
Cdot: True IIO cu
C)ianide720 ml>'l
lab Comments
(l'umfq.,,., ..... ,
17' ..-...------------.
1,.1-.;;...i-_________ mgll.-=------4 µl .,.C'--!-~::...:..:.;_:_46_;,.;;.;Slle.:,__ ____ __;•::x.::...,,--1 n.n.nocJiortne Pn1lddllt Dill. Solldl 70300
I...C A-'deff1 mgll.. )C, A!-.Alumnm41567
•• Hlrdnes&:Tolll 900 mg/L ,c. ~ 46551
Hardnas& (non-atll) 902 rnglL ,C a.a.llffl 48558
Phenol• 32730 • ><-~46552
Specific Cond. 95
I~ Si,jfllllt1145
1,11otios1cm X C6-Calmlum 41m ,-....~'---------__;'-----f
1+-a:.+----------m_gll..-----1 ::,C Cr~um-46559
SUl!ide745 1-.,.._ _________ m_gn.-----1 X Cu-Copper-~582
)<,, Fe-lrffl 4SSIIS
01 •nd Greaae 1-_.,_ _________ m...;glL~ Hg,Mercwy71800
)C ~lum 46565
JC ~ 41554
)CM~46565
NH,as Nt110
TIOl a Nt125
,<.;. N02 •~•N630
P: Total• P 885
Nilmll (NO,• N) 620
1-_.,_ _________ mg11.--'------4 I~ Na-Sodlum46558
_ _.,_ _________ mgll.-=------4 )<.. NJ.Nlclclt
l'---+--=---::.......;.._ _____ rnglL-=----1· JC Pl>-I.Nd ◄65M
mg/L X. Se-Selenium
1----1----------mg11.......:a..---1 IX: ZIN!lnc:'4e5417
Nltr11D (NOz n N) 815 mg/L
"""
'""'
ua/l
m nlt
,.,,.
In/I
mall
mall ,...,.
-n
u...,,
I n/I
""" ,.,n
0 ·-~Pel1icldel
N_,,_l'MticidN
Ar:ldHertlic:ld11
PCBs
n,H-8'Tl:)(GacJlneD•,._
LAB USE ONLY ' Ll Tempera1ure ~ arrival ("C): l -I .
~REV.7/fJS For DiNohlld Ml)yele-1Ub!Nttl1BAICI -pie and vlt9 't>IS" lnllloct.
County. yt!J2!
RlwitB .. 111
Report To MftOAP
Cclledor: M!IHm
Region: .M!!Q
Sample Matrix! GRQ!,!N!2W!Il;R
Loe.. "Type: EFfWEMT
Eme,gency Yea/No
COC Y111/No
I l.oca1!on ID: Wl03001D
I
I ~I I
I \oz\ l
I I' o,
I ~o\ ir-·l.i\ ~~Al
!.:?~. ,_;_;-A
F;Oi gi
1
.
}!j;i;}
31:: ~ ©
I ifiii1
(0 = I ~
tiiil1
[c -iJ
Nr. <D<WO £a6oratorv. <;ecti.on <Results
Date: I OolKtllmll:: 10-.c:
Sample Q1,13llflers and ~ments
Routine Quaftfiers
Samplll 10:
PO Number I
Dalll R...,.,Ned:
rimeRace!Wd:
Labwolb l.csiinlO
Data Reported:
Report Generaled:
I s.mple 0eptll
for a more detailed description of these quaHfier QOdes refer to www.dwqlab.org under Staff At:cess
A-Value repo,1ed • lie .-age at two or m re ddfflftirlatlons
B1.CO.,nlllblamambtar1awilh <20 oclonie1 Esllma1ld
82-Counts rrvm d fillers--zn
114,Rtera have C0U11tl o1 bOlh >eo or eo < 20: Estima19II
N:9-Eallmawd oonc:erintlon Is < PQI. and >MDL
N&No h1atllislled PQL
P.El9Vllled POL 4uo 1D matrix lnlerf---and/or Ml'llple d1utian
Q1-Hclding tlm• eiaceeded l)IIOI' to ,-1pt at lab.
Q2-HoldlflQ 1ilN U0Nded foflawinO receipt by lab
I
AB38700
tG1591
12!'10/2008
ot:00
HPARKER
'Jm/09
02/'012009
83-Countable lllll1lln.Tl9$ with more thallf80 colonles; &11mated
85-Too many c:donles -present; tDo nu s 1D count (™TC)
n-Reported value fded lo meet QC c:rflef llitl\er pl9dtlon « IICICUra<:y; Eat!maled
J3. The S8111ple rnatrilc W'llelfllnld with 1fte • 10 make any accurate dll1Mminnon; Et11mated
POL-Pradic8I av.rtitallon Llmlkubject 1D diange duo IO instrument $llllsitivily
U• Samples anafrz8d torll1it compound but not delec:ti9d
J!.-The W> analysis -f«lffl an unprasarv or improperly chemically ,,__i nmpw. ewtllalold x1-samp1e not 1111el)'zed ror1111a oompound
NHlle axnponent has been ten1111Yely ide tified ballld on mass !lpedral llblwy search and hn an fftimalMI value
LAB
Page 1 of3
1'/C <D'WQ La6oratory Section f.R,§sufrs Sample ID AB38700
Locaaon ID: Wl030Dt23 Collect Date: 12J0912001
Loc.DNct.: MRLEE Collect Tune:: 10:U
VlsltlO
I CASt Analyla Mame PQL Result Qualifier Units Analyst/Date Approved By IDN
sen.-111mp11anatrbylab 1.ll ~ OSAIJNOERS HPARKER
Mllllodltetnnca 1:i,,o,,oa 12110/08
WET
I Ion OwaN!ogr9'1hY _Til\.£... ~ AWII..UAMS CGREEN
MellP!RfflllWIOI I ePA300.0 1:nolOII t/WO!I
TOlalOlacMdSolla ,lqml 12 Z3I ~ AWIWAMS CGRE!:N
-R..... Al'tlA2540C-1srtl 12112/0I 12/22.GI
Qllortde 1.0 60 IIO'l-AWIU.IAMS CGREEN
MlllrlDclR-EPA300.D 1213()U! 1,'9/08
Ruande o., 2J) U.P IIO'l-AWILLIAMS COREEN
MetlOCIR"818r101 EPA300.0 '1:2f.lOI08 1/111111
SUIWe 2.0 10 U.P IIO'l-AWIWAMS COREEN
MeChCIG R-EPA300.Q 12/30'08 1191011
NUT
N02+N03 • N In~ 0.02 1.2 ffll>'.NN MAJAVI CGREEN
MtilllDd~ l.aC10-107-<M-1-c 112/10,IQI 12/22JIJI
MET
74-41).22-l >(JbylCPMS 5.0 5.0 u ..,,_ JJURGEVICH ESTAFFOfm
M9':1,oc1Referr,ce EPA21X>.I 12117/09 1/IIQl
7429-$G-S NbylCP 50 s, ui,L DSTANLEY ESTAFFORD
~Rtlferm EPA3l0.7 12116,08 11M18
74<4o-38-2 Ml¥~ 2.0 2.8 LVL J.AJROEVICH ESTAFFORO
Mlt,od~ EPA3l0.8 1'117/08 11MJD
74<4G-3&-3 BlbJICP 10 10 u IO'L OSTANl..£V ESTAFFORO
Meh>dReflnnc,e EPA200.7 ~9/08 f,'Mlt
7"'40-70-2 CllbylCP 0.10 48 • DSTANU:V ESTAFfORD
MdlOIIR...,_ EPA21)1).7 12f1M)8 1/IM09
74-40-43-9 OdbylCPMS 1.0 1.0 u UO'\, JJURGEVICH ESTAFFOR0
lolilltllldR..,.. l!PA2IXIJI 12/17101 11Ml9
7«0-41-3 CrbflCNS 10 10 u ui,1. JJURGEVICH ESTAFFORD
MillllodR-EPA200.8 12.'171011 llMlll
7440-50-8 CUbylCPMS 2.0 Q UQt'L JJIJRGEVICH ESTAFFORO
M11111oc1R"-'<:e EPA:200.I 12'1711111 1A!«l9
7~9-8U FebflCP 50 l'iO u UWl-0STANLEY ~AFFORD
Mdlod Rll'ertne1 EPA200.7 \211Mlll 1!!1109
7-440-09-7 KbylCP 0 .10 U1 ~ OSTANLEY ESTAFfORD
~Rlf-,ce EPA'EIJ.7 1211Ml8 116109
Labo,atory S,CUon>> 182) Mall Str1lca Cerar, Ralelgh, NC 27899-1623 (9191 ~901 Page 2of3
!NC ©WQ. La6oratory Section <R§sults SamplelD AB38700
Location ID: Wl030012J Collect Dale: 12J091200I
Loe. Descr.: MRLEE -Collect ,nne:: 10:AZ
VbitlO
CAS• ~ ,ma PQL Rault au.utter Analyet/Oa1e Approvad 8V 101111
743"5-4 lllgllylCP 0.10 13 DST ESTAF
Moll,od~-EPA200,7 1211111011 1111,W
70M6-S MnllylCP 10 15 IO'L OSTANLEY ESTAFFORD
Mllhod!Wam l!PA:200.7 t2/18,C)8 1All09
744G-23-S Nlb)'ICP 0.10 2C mc,L OSTANLEV ESTAFFORO
llo\lllbod~ EPA200.7 12'11108 11111119
7440-02-0 Nb)'ICPMS 10 1!f IJl>1. JJURGEVICH ESTAFFORD -~ EPA2l0.I 12'17/0a 1Alo'OO
7439-92·1 Pblly lCPUS 10 10 u • JJIJRGEVICH ESTAFFORO
MllladRlfwwncla EPA200.B 12117/D8 1181011
n&2-c~2 S.ti,ICPMS 5.0 5.0 u IO'L JJURGEVICH ESTAFFOR0
MICIIOdRNwa EPAZI0.1 12t,7Alll ,_
7440-66-8 Znb)'ICPMS 10 24 Uljl. JJURGEVICH E.STAFFORD
MelhadRtftnnce EPA200,8 l2117Alll 1....all
LabontD!y Sectlotl» 1822 Man S8'Vlce C.lllaf', Ralalgh, NC znN-1123 {911} 73)-3908 Page 3of3
.
GROUNDWATER FIELD LAB FORM
LocaUoncode'-Jl~::::....:'--'--=--:;:_Ji..=-1"'------SAMf!.E~
county <.{ w l e ,-J
Quad No. ____ _
Lal'-------
Diss. Solids 70300
CODHlg!\S40 ~
C00l.ow335 Hlldnesa: Tollll 800
Cdlfonn: MF Fecal 31616 ~ ,_.,,) 902
Collfocm: MF Tolill 31504 PIMlnda327S0
TOC&aO SplClfic Cond.. 85
T...tlkllty 711 SullnlMS
&Mlde7<4S
OIJand~
pH403
~ ID pH 4.5410
CarllclMta 446 NH:,MN810
Tl<NMN625
N0.z + NO, a N 630
CNorldelMO P: Total as P li65
Cluomil.ln: He>t1CD2 Niimi (NO,• N) 62!1
Cdot: True eo cu Nl1rla (N0:t D N) 815
C,-nlde 721) mg
mg/I.
mg/I.
mg/I..
ing/1.. ...
~
mg/I..
ms.tL
mgll.
mg/I.
mgll.
fflGll
fflQll
mgll
~
Cr-Chnlmlum '46559
Ci,,,Coppe,46582
F..wn46563
HQ-Men:wy 71000
Mrt-Mangianne 46585
Nit-Sodium 465M
PM.Nd46S64
Zn-Zinc 46667
North Cwollna
Depar1mert of Enlllronment and Natlnl Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
PCB&
LABUSEQNLY
Tempera11.n on IUTMII ("C):
~bCommenls~------+----------------------------------------
GW-54 RE.V. 7/113 For OiuaMld Anatys bmt lllered sample and write '015" In lllock.
James Allen and Regina 8. Lee
900 Club Drive
Monroe, NC 28112
Dear Mr. and Mrs . lee:
Michael F. Easley, Governor
WIiiiam G. Ross Jr., Secretary
North Carolina Department of Environment and Natural ~esources
Coleen H, Sullins, Director
Dlvlslon of Water Quality
AQUIFER PROTECTION SECTION
RE: UIC Effluent Sampling Results
WI0300123 Lee 5A7 UIC
Union County
July 31, 2008
On July 1, 20081 staff from the Mooresville Regional Office of the Aquifer Protection Section sampled the
effluent llne of your geothermal underground injection well heat pump system. The samples were
analyzed by the Division of Water Quality lab for nitrate and nitrite as nitrogen and a variety of metals. A
copy of the results Is enclosed for your review.
Staff indicated at the time that the influent sample could not be collected due to improper installation of
the sampling port on the influent side. Unfortunately, this does not allow us to truly evaluate the
operation of the system using the effluent results , which showed elevated levels of manganese (76 µg/L).
As such, when the repair has been made to the influent sampling port, please contact this office
at [phone] to arrange for re..aampllng of the system.
Should you have any questions, please feel free to contact me by email at [e-mail] or
by phone at {704) 663-1699 .
Andrew H. Pitner
APS Regional Supervisor
Enclosure: 7-1-08 effluent sample results
Cc: Michael Rogers, APS-GPU-UIC, Raleigh (by email)
Division of Water Quality/ Aquifer Protectlon Section I Mooresville Regional Office Phone: [phone] Fax: (704) 66~040 N~,Carota
610 East Center Avenue, Suite 301, Moo,eavllfe, NC 28115 Customer Servloe 1-877-623-67◄8 Internet: WNW ncwaterguallty.ora /WUIIIYl/1!1
County: UNION
Rive<Basin
Rej)ortTo ~
Collecior: !;;UINOMAN
Region: .MBQ
Sample Malrix: GROUNDWATER
Loe. Type: }!A;!sB:i!.!PebY
Eme,yency Yes/No
COC Yes/No
:I t.oca1ion 10: WI0300123EFFWEMT
Wt. <lYWq_ £a6orato,:y . <:ection <Results
VisillO
Loe. Descr.: LEE-Wl030Q12l
I Collect Date: 07/01/2008 I Collect rime:: 10:40
Sample Qualifiers and Comments
Sample ID: AB32111
PO Nu111ber# 8G0812
Date Received: 07/02/2008
Time Received: 08:10
Labwotl<s LoginlD MMATHIS
Date Reported: 7/21/08
Report Generale<I: 07/21/2008
C-)C ,lz.2..Joa
I Sample Depth I
NC0ENRMRO owa -Aouifer Protection
Routine Qualifie~
For a mure detailed description of these qualifier codes refer to www.dwqlab.org under Staff Ao::ess
A-Value reported ii the average of two or more ctetenninations
81-Ccuitable membmnes with <2> colonies; Estimated
82-Counts from all filters were zero.
83-Counlable membranes with more than 60 or 80 COionies; Estimated
84.filters have oounts of boll\ >60 or 80 at\d < 20; Estimated
BS-Too matly colonles were present l0o nun'lel'CIIS 1o C:OUlnt (ll,ITC)
J2-Reporled value failed ID meet QC c:ritena for either p11!osi0n or accuracy, Estimated
J3-The sample matriK lnterfefed with lt1e ability to make any aQ:l.lrate determination; Estlrnated
J6-The lab analysis w.l$ flOm an Ll'lpraserved or Improperly c:hemicatly pre$Grved sample; Estimated
N1-Theoomponert has beel'I tel'l(alively identified based 1:,n mass spectraf lfbtary seardl and has 81\ estimated value
LAB
NHMal911 oonceatratlon is< POL al'ld >MOL
NE-No 8$labli$hed PQL
P~Elevat.d PQL due io matrix interfenmoe and/or sample dllution
Of-Holding time~ prior to raceiPt at lab.
02· HOldir,g time eiaeded followiog 111a1ipt by lab
PQL-Practlc:at Cluanlffalion LlmiHUbjlld lo change Clue lo lnstMnent sen1ltMty
U-Samples analyzed for this compound but not deleded
X1-Sample not analyzed for this a:nnpound
Laboratory SKtioo» 1623 Mail Service Center, Raleigh, NC 276'9•1623 (919) 73~908 Page 1 of3
..,
'NC <1YWQ La6oratory Section <.Rgsu{ts Sample ID AB32111
Location 10: Wl0300123EFFLUENT CoUect Date: 07/0112008
Loe. Oe5Cr.: LEE• W10300123 CoUect Time:: 10:40
V~ID
CAS# Analyte Name PQL Result QuaUfier Units Analyst/Date Approved By /Date
Sample tempe,ra1IJle et l9Celpt by lab 2.0 "C HPARKER MMATHIS
Matllod Ref-.ce · 71Z108 712JOa
NUT
N02+N03 as N In nquld 0 .02 0.93 mg/1.esN MOVERMAN CGREEN
MethodR-Lac10.107~l-c 7/2108 7/9/08
MET
7440-22-4 Ao by ICPMS 5.0 5.0 u ug/L DSTANLEY ESTAFFORO
Melllod Reference EPA200.8 718,1)4 7/18108
7429-90-5 AJbylCP · SO 64 lql SGOSS ESTAfFORD
Mathocl Relerlnce EPA200.7 718,<)1 7118/08
7 44o-36-2 A3 by ICPMS 5.0 5.0 u ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.8 7/Ml8 71111/08
7440-38-3 BabylCP 10 10 u Ul>'L SGOSS ESTAFFORO
Machod RefertnQ8 EPA200.7 ?n/04 7/18108
7440-70-2 C3bylCP 0.10 43 mgl.. SGOSS ESTAFFORD
Mef'lod Reference EPA200.7 7nf()8 7118108
7440--\3-9 CdbylCPMS 1.0 1 .0 u ug/L OSTANLEY ESTAFFORD
Meflocl R.,,,,.;,, EPA200.8 718,118 7/18108
7440-47-3 Crbyta>MS 10 10 u lql DSTANLEY ESTAFFORO
Metllod Refwenca EPA200.8 7/811)8 7/18108
7440-50-3 Q.ibylCPMS 2.0 10 ug/L OSTANLEY ESTAFFORO
Me!llcdR.,,.._ EPA200.8 7/8/08 7/18/08
7440-43-4 febylCP 50 50 u ug.'l SGOSS ESTAFFORO
MethodR.r.renca E?A200.7 7/811111 7/18108
7439-S7-6 Hg245..1 0.2 0.20 u uwL ESTAFFORD ESTAFFORD
Method R.i.nnc. EPA24S.1 713108 7/111108
744~7 KbylCP 0 .10 Q.83 mgl.. SGOSS ESTAFFORO
~Retarenca EPA200.7 7nl04 711BID8
743S-9H Mgt,ylCP 0 .10 12 mgA. SGOSS ESTAFFORO
Melhocl Referw1ca EPA200.7 7nt08 7/1Ml8
7439-96-5 fmbylCP 10 78 1¢ SGOSS ESTAFFORD
Me1hod RelwJm<:e EPA.200.7 7/8/08 7118I08
7440-23-4 Nal'flCP 0 .10 22 mgll SGOSS ESTAFFORD
MetllodR"'--EPA200.7 1moa 7/18,1)8
7440-02-0 fllbylCPMS l0 10 u ug/l. OSTANLEV ESTAFFORO
Method Rer.nnce EPA200.8 7/8/08 7/18108
l.abomo,y Seellon» 1623 Mall Service Center, Raleig h, NC 275"-1623 [phone] Page,2of3
:NC ©'WQ, £a6oratory Section r.R..,esu[ts SamplelD AB32111
Location 10: WI0300123EFFUJENT Coiled Date: 0"7/0112008
Loe. Desc:r.: L~ -W1D30012J Coiled nme:: 10:40
VisJ:tlD
CAS# Analyte Name PQL Resu lt Qualffier Units Analyst/Date Approved Sy /Date
7'39-92-1 PbbylCPMS 10 10 ug/L OSTANLEY ES AFFORO
Ml!lhodR.,,__ EPA200.8 718J08 7118108
n82-49-2 SebylCPMS 5.0 5.0 u ug/1. DSTANLEY ESTAFFORO
Method R--.na. EPA200.8 718108 7118108
7440-66-6 ZnbylCPMS 10 14 ug/L OSTANLEY ESTAFFORD
Method Reference EPA200.8 7/8/08 ·7118108
Labor.tory Section-» 1W Man Servlee C1111t.r, Ralelgh, NC 27699-1623 (919) 7~908 Page3of3
GROUNDWATER FIELD/LAB FORM
LOCATION CODE _ W10300123effluent
COUNTY : Union
QUAD NO: Serial No.
Lal Long.
REPORT TO Mooresville R!!:Slonal Office
SHIPPED BY: COURIER
COLLECTOR(S) : DATE: 711/08 Ellen Hindman/Broclc Freyer
TIME. Io. ':(o
Spec. Cond. .. 'S 45"5 at 25°C
Odor ~
FIELD ANALYSES
pH-400 7 ,(,'-{
Temp. '},-Li . <'., }:
SAMPLfi TYPE SAMP!,,!; PRIORITY
IK]wa1er [K}R~ttine
0So0 QEmergency
0 Other (ROCKS end Ceramic r~es)
0 Chain of CUstody
Purpose: Baseline. Complalnt, Come!::tanoe, LU.) I
Owner.
Location or Site:
North \,;arou na
Department ot Environment end Natural Resources
DIVISION OF WATER QUAU1Y • GROUNDWATER SECTION
~·=.\¼~.1 1il Ml" 1 II W \ o1c;o \ ~:;.
a..~kl~T I I Rec'd By: ¥:f From: Bus, 8 Hand Del.,
Other:
Data Entry By: Cit:
Data
Reportlr<I:
, Pes1icide Study, Other
Lee · Wl0300123
900 Club Drive, Monroe
f;.,. fl;;,...., spigot at -u head. EFFLUENT
Appearance <..tc....r
Descriptjon of sampling point
Sampmg Method: pumped well I g eothermal system Sample Interval:
Aeld Analysis By: E Hindman I B Freyer
LABORATORY ANALYSIS
Rema,tcs: """'-.eoQ UIC GEOTMERNALEFFLUNENT
80DJIO ,.,rJL Diss. Solids 'IOlOO ...n.. X Aa-Sil,.46S66 u..A. ~...,.,_
CODHi.i.)40 Mail. l'1oorido 931 mRll X AI-Alununn 46557 uo/L hodddoi
CODLowm ...n.. ~-900 _,. X /IS·Arlnc "6Sll ... n N".-Pmiciib
Q,ljfom,: W f,col ]1616 /IOO!rl llrias:l-.cubl902 .....,, X S.llariwo463SI ua/1-
Califon,,: MFTalll 31~ 1100ml l'IMnolo 32730 -A X c.c.lmm-16ln m!llt Acid~
TDC """' s....ill<COlld.9S unt.,,/crn1 X Ccl-Cdunl46SS9 ut/1-
Twbi1ily HIV SIIIIID ...,, X ~-46360 ...n.. S-Ndotilco
lesiduo._S_.tod3JO _,, 5..i&clo743 _,. X C,,. C:-1042 _,_ rTPH-DiDKI K...,._
ma/I.. X Fo-lraol~3 uAI\.
l'aed310 OilnlGt-moll X Ha-.,_71900 _,. Volarilo o...-;.. !VOA bonlc)
plf uMI X X-Pmaiun>46.5SS tnWI-
Allmf..,.__,,,1u_s ... o/1. SIIJCA _,. X .. 9:11 ...it. -ii......
Alblinitvto pfl I.] '"!II\. X 'Ml>-M-IOSS w,/L Tftl-8TEX Ooloin' llane<
~ .....it NH3 ■N610 ""Ill, X No-Sodium929 qi!.
~ ..... TKN ■NW malL X l'li-Nid!d •""-
C-.cliclcldo nwt. ~ N01+NOJ ■a630 nail.. X l'l,-Lad46S6' u,n_
O.larido ,.,4. P: Toal • P 665 moll X Se,Sclmi,,m uvlf.
°"""1iunl:lbl0)2 """ X. Z.. Zioc4M67 _,_
Color: TND IO <.IL
C...lde720 ffllllL
LAB VSE ONLY .:J
iTEMPDAruJlEON MJIIVAl.: .n
U.B COMIIRIO'S :
GHaREV,12187 POR Dt.\:WLf/1::D AJIAL1SIS • SVBMlT FIJ.TF.RED SAMJ>LJ; AND mun· "1)IS' fJI BLIX/C
Ln" "4NrC'
-·