WI0500186_GEO THERMAL_20130618

Permit Number WI0500186
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Margaret Laroe SRF
Location Address
384 Potluck Farm Rd
Rougemont
Owner
Owner Name
Margaret
Dates/Events
NC 27572
Laroe
Scheduled
Orig Issue
09/29/08
App Received Draft Initiated Issuance
04/08/13
Re gulated Activities
Heat Pump Injection
Outfall l\!ULL.
Central Files: APS_ SWP_
06/18/13
Permit Tracking Slip
Status
Active
Project Type
Renewal
Version
2.00
Permit Classification
Individual
Permit Contact Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont
Major/Minor
Minor
Region
Raleigh
County
Person
Facillty Contact Affiliation
Owner Type
Individual
Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont
NC
NC
Public Notice Issue
06/14/13
Effective
06/14/13
Re quested/Received Events
RO staff report requested
RO staff report received
27572
27572
Expiration
08/30/18
04/26/13
06/03/13
Waterbody Name Stream Index Number Current ·class Subbasin
Permit Number W10500186
Program Category
Ground Water
Permit type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michaei.rvgers
Coastal SW Rule
Permitted Flow
3cility
Facility Name
Margaret Laroe SRF
Location Address
384 Potluck Farm Rd
Rougemont
NC 27572
Central Files: APS SWP
06/13/13
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont
MajorlMinor Region
Minor Raleigh
County
Person
Facility Contact Affiliation
NC 27572
Owner Name
Owner Type
Individual
Margaret Laroe
Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Dates/Events
Rougemont NIC
27572
Scheduled
Orig Issue App Recelved Draft Initiated Issuance
09/29/08 04/08/13
public Notice su Effective
lq 113
lrati np
� I Q
q
Regulated Activities
Re uestedlReceived Events
Fleas Pump 11'Fpct10r1
RC staff report requested
04/26/13
RD staff report received
06/03/13
Outfall NULL
Waterbody Name
Stream Index Number Current Class 5ubbasln

NA
NCDEMR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Division of Water Quality
Thomas A. Reeder
Acting Director
June 14, 2013-
Margaret LaRoe
384 Potluck Farm Rd.
Rougemont, NC 27572
Re: Issuance of Injection Well Permit
Permit No. WI0500186
Geothermal Heating/C~oling Water· Return Well
Person County
Dear Ms. LaRoe:
John E. Skvarla, Ill
Secretary
In accordance with your application received April 8, 2013, I am forwarding Pennit No. WI0500186 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 August 30, 2018, and shall be subject to the
conditions and limitations stated therein.
The Raleigh Regional Office inspected your geothermal system on May 23, 2013, and collected water
samples. A copy of the laboratory analytical results will be sent to you when it becomes available.
In order to .continue uninterrupted-legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Quality. If you have any questions regarding your permit or the Underground fujection
Control Program please call me at [phone].
~ /d,--
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
cc: Rick Bolich, Raleigh Regional Office
Central Office File, WI0500186
Person County Environmental Health
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: 919~07-6300 \ FAX: 919~07-6492
Internet: www.ncwaterguality.org
An Equal Opportunity\ Affirmative Action Employer NgrthCarolina
/vatural/g
NORTH 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
PERMISSION IS HEREBY GRANTED TO
Margaret LaRoe
FOR THE 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 384 Potluck Farm Rd., Rougemont, Person County, NC27572,
and will be operated in accordance with.the application received April 8, 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 the date of its issuance until August 30, 2018, and shall be
subject to the specified conditions and limitations set forth in Parts I through VIII hereof.
Permit issued this the \4'~Y of ~ , 2013
' ~ ~ ; "'-J~
Tom Reeder, Acting Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Pennit #WI05001.86 DIC/Return Well .: RENEWAL
ver. 01/2013
Page-I of5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit 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 purposes and the entrance to each well
must be sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.01070).
8. Copies of the Well Construction Records shall be retained on-site and available for inspection.
PART II-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the 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.
Permit #WI0500186 UIC/Return Well -RENEWAL
ver. 01/2013
Page 2 of 5
PA.RT ID-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater which will render it unsatisfactory for normal use. In the event that. the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the 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 resulting from·the operation of this facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1.-The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or 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, 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 repre~entatives shall have reasonable access for purposes q/' inspection, observation, and
sampling associated with inj~ction and any related facilities as provided fof in N.C.G.S. 87-90.
3. Provisions shall be :r;nade for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VI-,MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed. ·
2. The Permittee shall report by telephone, within 48 hours of.the occurrence or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
Permit #WI0500 l 86 VIC/Return Well -RENEWAL
ver. 01/2013
Page 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 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 VII -PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART VIII-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the 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 thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a 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.
Pennit #WI0500186 UIC/Retum We11 -RENEWAL
ver. 01/2013
Page 4 of 5
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Permit#WI0500186
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
DIC/Return Well -RENEWAL
ver. 01/2013
Page 5 of 5
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P. E John E. Skvarla, III
Govemor Director Secretary
May 24, 2013
MEMORANDUM
RECElVED1DENRIDWO
To: Michael Rogers, The Central Office, APS SUN 4 3 2013
Through: Rick Solich ' Aver Pro c iorl SecWn
From: Lin McCartney
Subject: Staff Report- WI 0500186, Margaret LaRoe, Geothermal
Heating/Cooling Water Return Well Renewal Application
Person County
Aquifer Protection section
1628 Mai Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barret[ Dr., Raleigh, North Carolina 27609
Phone: [phone] FAX: [phone]
Internet: www.ncwaterquality.org
NoithCarolina
Naturally
An Equa] Opportunity 1 Affimative Action Employer

AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: May 24, 2013
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __ _
County: Person
Permittee: Margaret LaRoe ·
Project Name: Open-Loop Geothermal
Injection Well
~pplication No.: WI0500186
L GENERAL INFORMATION
1. This application is (check all that apply): D New IZ! Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 re gulated D 503 exempt
D Closed-loop Groundwater Remediation IZ! Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? 1Z1 Yes or D No.
a. Date of site visit: 05-23-2013
b. Person contacted and contact information: Margaret LaRoe, 336-364-1353
c. Site visit conducted by: Lin McCartney
d. Inspection Report Attached: IZ! Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
RECEIVEDIDENRIDWQ
JUN O 3 20 13
AquiferProtection Section
IZI 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:
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): __
For Disposal and Injection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): 384 Potluck Farm Rd., Rougemont, nc 27572
b. Driving Directions: Take US-70 W, take US-501 N, turn right onto US-501, tum right onto Red Mountain
Rd., turn left onto Moriah, turn left onto Potluck Farm Rd.
c. USGS Quadrangle Map name and number:
d. Latitude: 36-14-56 Longitude: 78-50-55
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications. skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: __
FORM: Laroe-staff report 1
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 OfWell(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
~ Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation ( 51)
D Closed-loop groundwater remediation effluent injection (5L/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? ~ Yes D No
3. Are there any potential pollution sources that may affect injection?~ Yes D No
What is/are the pollution source(s)? The septic tank. The septic tank is approximately 150 feet distance from
the well.
4. What is the minimum distance of proposed injection wells from the property boundary? 80 ft.
5. Quality of drainage at site: ~ Good D Adequate D Poor
6. Flooding potential of site: ~ Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number ofwells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: N/ A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)?~ Yes or D 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.
Iniection Well Permit Renewal And Modification Only:
1. For he~t 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)?
D Yes ~ No. If yes, explain:
2. For closed-loop beat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes, explain:
3. For renewal or modification of groundwater remediation permits ( of any type t will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? D Yes D No. If yes, explain:
FORM: Laroe-staff report 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
4. Drilling contractor: Name: ACME Well Co. Inc.
Address:
7990 NC Hwy . 75 L Durham. NC 27703
Certification number: 2949
5. Complete and attach Well Construction Data Sheet.
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
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 information request.
Make sure that you provide a teason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
FORM: Laroe-staff report 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 permit by regional office; D Issue upon receipt of needed additional information; IZJ
Issue; D Deny. If deny, please state reasons: __
8. Signature of report preparer(s): _d __ i r" __ ~_t_[~t;....,......,_~-------~---1-------
Signature of APS regional supervisor: --__,--=-.;,.......,._...,.,f_ i)_· .,_ h~ ___ fl ___ ,__i;z....,.__,,,_,_/ _ _,_;...,.J'-------
1/ ~ /~'
Date: ______ _
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
Well construction inspection and well water sampling were conducted on May 23, 2013.
Based on the description of the well by visual inspection and a review of the well construction data,
the subject geothermal injection well has been constructed in accordance with N.C. State
Regulations (Title 15A NCAC 2C), Well Construction Standards.
The following comments are highlighted as a result of the inspection.
A review of the construction data indicates that the subject geothermal injection well has been
constructed in accordance with N.C. State Regulations (Title 15A NCAC 2C), Well Construction
Standards.
The following items were checked:
1 . Well Casing
• Casing :Diameter: 6.25 inches
• Casing depth: from ground to 43 feet. Casing extends above ground 16 inches
• Type: Galvanized Steel.
2. Grout
• Grout type-unknown
• Grout surface and grout depth-Around well casing from O to 40 feet.
3. Identification plate
• The well has an identification plate.
• The plate contains the following information: Contractor: ACME Well; Registration
No. 2949; Date Well Completed 05-01-2007; Total Depth of Well: 405 ft; Casing
Depth: 43 ft; Diameter: 6 ¼ inches; Static Water Level: 25 ft; Yield: 12 GPM.
4. The location of the well
• The septic tank (potential pollution source) is approximately 150 feet distance from
the well.
• The minimum distance of the well from the property boundary is about 80 feet.
• The minimum distance of the well from the building is 36 feet.
FORM: Laroe-staff report 6
AQUIFER PROTECTION REGIONAL STAFF REPORT
Over all, this geothermal injection well is still in compliance with well construction standards.
However, we are awaiting the lab results of the well water to complete this permit renewal
application process.
FORM: Laroe-staff report 7
Permit: WI0500186
SOC:
County: Person
Region: Raleigh
Compliance Inspection Report
Effective: 09/29/08 Expiration: 08/31/13 Owner: Margaret Laroe
Effective: Expiration: Facility: Margaret Laroe SRF
384 Potluck Farm Rd
Rougemont NC 27572
Contact Person: Margaret Laroe Title: Phone: [phone]
Directions to Facility:
From Rougemont, NC take Red Mtn Rd/NC1471 E appx 5 miles. Road forks to left on Berea Rd and go appx 1 mile. Turn Lon Potluck
Farm Rd. Go a,opx .~5 mi and property is off road on R.
System Cfassiflcat1ons:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 05/23/2013
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Certification:
Entry Time: 10:00 AM Exit Time: 11 :30 AM
Phone:
Phone: [phone]
Ext.4243
Reason for Inspection: Routine Inspection Type: Compliance Sampling
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
• I Permit: WI0500186
Inspection Date: 05/23/2013
Owner -Facility: Margaret Laroe
Inspection Type: Compliance Sampling Reason for Visit: Routine
Inspection Summary:
Well construction inspection and well water sampling were conducted on May 23, 2013.
The following comments are highlighted as a result of the inspection.
A review of the construction data indicates that the subject geothermal injection well has been constructed in accordance
with N.C. State Regulations (Title 15A NCAC 2C), Well Construction Standards.
The following items were checked:
1. Well Casing
Casing· :Diameter: 6.25 inches
Casing depth: from ground to 43 feet. Casing extends above ground 16 inches
Type: Galvanized Steel.
2. Grout
Grout type-unknown
Grout surface and grout depth-Around well casing from Oto 40 feet.
3. Identification plate
The well has an identification plate.
· The plate contains the following information: Contractor: ACME Well; Registration No. 2949; Date Well Completed
05-01-2007; Total Depth of Well: 405 ft; Casing Depth: 43 ft; Diameter: 6 ¼ inches; Static Water Level: 25 ft; Yield: 12
GPM.
4. The location of the well
The septic tank (potential pollution source) is approximately 150 feet distance from the well.
· The minimum distance of the well from the property boundary is about 80 feet.
· The minimum distance of the well from the building is 36 feet.
Over all, this geothermal injection well is still in compliance with well construction standards.
However, we are awaiting the lab results of the well water to complete this permit renewal application process.
Page: 2
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: April 26, 2013
To: ❑ Landon Davidson, ARO-APS
❑ ,Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-AP5
® Rick Bolich, RRO-APS
From: Michael Roizers Groundwater Protection Unit
Telephone: [phone]
E Mail: Michael.RogersAnedenr.gov
A. Per;nit Number: WI 0500186
B. Owner: LaRoe
C. FacWWOperatio4:
❑ Proposed ® Existing
D. Application:
❑ David May, WaRO-APS
❑ Morelia Sanchez King, WiRO-APS
❑ Sherri Knight, W-SRO-APS
Fmc: 919-907-6496
❑ Facility ❑ Operation
1. Fermrt 2, pe: ❑ Animal ❑ SFR Surface Irrigation[] Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
® UIC — Geothermal HeatinglCooling Water Return Well
For Residuals., ❑ Land App. ❑ ❑&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ❑ New ❑ Major Mod. ❑ Minor Mod. ® Renewal ❑ Renewal wl Mod.
E. Comments/Other Information: M
NOTE: Please record all information on the well in. if Mesot and Dtrt on staff report. Thanks.
® 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.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer:
Date:
FORM: APSARR 07106 Page 1 of 1

NA
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory
Governor
Margaret LaRoe
3 84 Potluck Fann Rd.
Rougemont, NC 27572
Dear Ms. LaRoe:
Charles Wakild, P.E. John E. Skvarla, Ill
Secretary Director
April 23, 2013
Subject: Acknowledgement of
Application No. WI0500186
Margaret LaRoe SFR
Injection Heating/Cooling
Water Return Well System
Person County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 04/08/2013. Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Raleigh 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 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 michael.rogers@ncdenr.g]cerely, . n .
~~
for Debra J.~tts
cc: Raleigh Regional Office, Aquifer Protection Section
Permit File WI0500186
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
lntemet: www.ncwaterguality.org
An Equal Opportunity \ Affirmative Action Employer
Groundwater Protection Unit Supervisor
.. One . . .
N_~fili._Ca_·_ ro_-lma ;vatlitalllf
NORTH CAROLINA DEPARTl\.1ENT OF ENVIRONl\.1ENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of ISA NCAC 02C .0200
OPEN-LOOP GEOTHERMAL INJECTION WELLS
These wells discharge groundwater directly into the subsurface as part of a geothermal heating and cooling system
( check one) __ New Application ✓ Renewal* Modification
* For renewals 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: ?r}(lA.,.~ ;2,] , 20 13
PERMIT NO. WIOS oa,alo (l~ave blankifNew Application)
A. STATUS OF APPLICANT (choose one)
Non-Government: Individual Residence 'I.. Business/Organization __
Government: State ·Municipal__ County __ Federal
B. PERMIT APPLICANT -For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
·")tJ~GA /lIT L:9Rf>s-. 7 (('I' L
City: R_ ou3 e 0J.0 0L State:.JVC Zip Code: ~ J S 7.:;i
Day Tele No.: 33 (e -.3 l, ~ -\ 3 ,S-3 Cell No.:
County: PF: RS ON
EMAIL Address: /vJ J...J~ (s 0€ @ e s r N'C' 1 Fax No.:
C. LOCATION OF WELL SITE-Where the injection wells are physically located:
,..-l') (1) Parcel Identification Number (PIN) of well site: .fi Cf q ~ ~[ '7 County: f £ R ~ 0 Al
(2) Physical Address (if different than mailing address): -=_s=-·-----'-~~/vf--'---'r;:-;;,__ __________ _
City: _______________ State: NC Zip Code: ----=:-:r==-n___,_..,_,.......
RECEIVEDIDENRJDWQ
D. WELL DRILLER INFORMATION APR O 8 2013
Well Drilling Contractor's Name: ________________ __,...~"'=-=-.--f"b.,...,___._,,~~ .... Aquifer Protection Section
NC Well Drilling Contractor Certification No.: ___________________ _
Company Name: _____________________________ _
Contact Person~: ----------------=E=-=-MA'-=-=-IL=--.,A'---=dd=v'-=-'es=s-=-: __________ _
Address: _______________________________ _
City: _________ Zip Code: ____ State: __ County: ________ _
OfficeTele No.: Cell No.: ~Fax_N_o_._: _______ _
GPU/UIC 5A 7 Permit Application (Revised 3/18/2011) Page 1
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name:
Contact Person: EMAIL Address:
Address:
City:
Office Tele No.:
Zip Code: State: County:
Cell No.:
Fax No.
F. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
G. WELL CONSTRUCTION DATA
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 (1) through (6)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available.
(1) Well Construction Date: Number of borings. -
Depth of each boring (feet):
(2) Well casing type: Galvanized steel Black steel Plastic Other (specify)
Casing thickness (in.): Diameter (in.):
Well depth: from: to: feet below land surface
Casing extends above ground inches
(3) Grout material surrounding well casing:
(a) Grout type: Cement Bentonite* Other (specify)
*By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C M13(d)(()(A), which requires a cement type grout.
(b) Depth of grout around well casing (relative to land surface): from to feet
(4) Well Screen or Open Borehole depth (relative to land surface): from to feet
(5) N.C. State Regulations (Title I5A NCAC 2C .0200) require the Perinittee to make provisions for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected hack into the well) lines is required. Is there a faucet on:
.(a). . Influent line? Yes No (b) Effluent line? Yes No
(6) Source Well Construction Information_ if the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1), If Form GW-I is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn? (e.g.
granite, limestone, sand, etc.)
Depth:
Formation-
Rock/sediment unit:
NOTE: THE WELL ❑RILLfNG OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THF. DATA IF TFUS
INFORMATION IS OTIIERWISE UNAVAILAf3t_H,
GPU/UIC 5A7 Permit Application (Revised 3/18/201 1) Page 2

I CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(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 applications on their behalf.
"1 hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false 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. roperty Owner/Applicant
,41i1 tkCof1l,E i 1T C.A14a
Print or Type Full Name
Signature of Property Owner/Applicant
Print or TWe Ful l Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECENEDIDENEWa
APR 4 8 2013
Aquit r prote*ri Section
GPUUC 5A7 Permit Application (Revised 3/1812011) Page 4

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Acting Director Secretary
July 16, 2013
MEMORANDUM
To: Michael Rogers, The Central Office, APS
Through: Rick Boiich 9
From: Lin McCartney
Subject: Analytical Results Report- W10500186, Margaret LaRoe
Geothermal Heating/Cooling Return Water Well Renewal
Application
Person County
JUL 10 Z013
Aquifer Protection Section
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Loeation: 3800 Barrett Dr., Raleigh, North Carolina 27609
Phone: [phone] FAX: [phone]
Internet: w►yyy_nCwatCrr�ualil4,grg
An Equal Opportunity 1 Affirmative Action Employer
to
Carolina
urllr�

ANIM
M. -. aw,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvaria, III
Governor Acting Director Secretary
July 16, 2013
Margaret LaRoe
384 Potluck )Farm Rd.
Rougemont, NC 27572
Subject: Analytical Results of Well Water
Permit No. WI0500186
Geothermal Heating/Cooling Water
Well
Person County
Dear Ms. LaRoe,
Enclosed please find the analytical results of the subject well water which was sampled on May 23,
2013. Your geothermal well was sampled as part of the permit renewal application process. The influent
(groundwater entering the heat pump) and the effluent (groundwater being injected into the well) of the
geothermal well system were sampled.
The analytical data indicate that all the parameters are in compliance with Groundwater Quality
Standards and the construction of the subject well is in compliance with the permit conditions. if you
have any questions, please contact me at [phone].
Sincerely,
Lin McCartney
t
Environmental Senior Tech.
Cc: RRO-APS Files
The Central Office-APS Files
Aquiter Protection Section
1628 Mail Service Center, Raleigh. North Carolina 2 7699-162 8
Location: 3800 Barrett Dr., Raleigh, North Carolina 27609
Yhoac 919-791.42001 FAX: [phone]
Internet: www,newatenquaiii�-.ay;
An Equal ❑pportuntry 1 Athrmative Aeuon Employer
One
NorthCarolina
,V171U,ra!!11

��A
NCQENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, Ill
Govemor Acting Director Secretary
July 16, 2013
Margaret LaRoe
384 Potluck Farm Rd.
Rougemont, NC 27572
Subject: Analytical Results of Well Water
Permit No. W10500186
Geothermal Heating/Cooling Water
Well
Person County
Dear Ms. LaRoe,
Enclosed please find the analytical results of the subject well water which was sampled on May 23,
2013. Your geothermal well was sampled as part of the permit renewal application process. The influent
(groundwater entering the heat pump) and the effluent (groundwater being injected into the well) of the
geothermal well system were sampled.
The analytical data indicate that all the parameters are in compliance with Groundwater Quality
Standards and the construction of the subject well is in compliance with the permit conditions. if you
have any questions, please contact me at [phone],
Sincerely,
Lin McCartney
Environmental Senior Tech
Cc: RRO-APS Files
The Central Office-APS Files
Aquifer Protection Section
1628 Mail Service Center, Raleigh. North Carolina 27699-1628
Location; 3$00 Barrett Dr., Raleigh, North Carolina 27609
Phony: 919-791-42001 FAX: [phone]
Internet. www,n�wgtgrgualgi<,pnl
An Equal Opportunity) Affirmative Action Employer
NorthCarohna
Naturally

r_ on
r cpjLo L afiomLary Section C
-ff
esufts
County: PERSON
wAr�q
Sample ID:
A895892
River Basin
OF
%
Pa Number #
13GO433
Report To RROAP
04
4 I �1 V
Date Received:
06123/2013
Collector: L MCCARTNEY
flY
Time Received:
13:30
Labworks LoginlD
MSWIFT
Region: RRO
Final Report Date:
6121/13
Sample Matrix: GROUNDWATER
Final Report
Report Print Date:
07115/2013
Loc. Type: WATER SUPPLY
Emergency Yes/No
VisitlD
COG Yes/No
Loc. Descr.: MARGARET LARGE 384 POTLUCK FARM RD. ROUGEMONT. NC 27572
Location ID: SP073WI0500186 IN
Collect Date: 05123/2013
Collect Time: 10.00
Sample Depth
If this report is labeled preliminary report, the results have not been validated.
Do not use for Regulatory purposes.
^.-- A__E. II
n'-,E Result/ „-;,-
Method
Analysis
t/I"{1fJ- !"1EEQy {qualifier """" Reference Date ----
LAB
Sample temperature at receipt by lab 2.3 °C 5/23/13 HMpRGAN
MIC
Coliform, MF Fecal in liquid 1 1 82 UU1100ml APHA92220-20th 5/23113 ESTAFFORDI
Coliform, MF Total In liquid 1 4 CFU1100ml APHA92228-20th 5/23/13 ESTAFFORD1
WET
Ion Chrorrtatography
_TITLE_
mg/L
EPA 300.0
5130/13
CGREEN
Chloride
1.0
6.1
mg1L
EPA 300.0
5/30113
CGREEN
Fluoride
0.4
0.4 U
mglL
EPA 300.0
5/30113
CGREEN
Sulfate
2.0
8.4
mglL
EPA 300.0
5130113
CGREEN
Total Dissolved Solids in liquid
12
222
mg/L
AFIHA254OC-18TH
5129/13
CGREEN
NUT
NO2+NO3 as N in liquid
0.02
0.02 U
mgILas N
LacID-107-04-1-c
5129113
CGREEN
Phosphorus total as P in liquid
D 02
0.02
mglL as P
LaclC-115-01-1 EF
5/30/13
CGREEN
MET
7440-22-4
Ag by ICPMS
1.0
1.0 U
UgIL
EPA 200.8
6113/13
ESTAFFORDI
7429-90-5
Al by ICP
50
87
uglL
EPA 2003
U7113
ESTAFFORDI
7440-38-2
As by ICPMS
2.0
2.0 U
ug/L
EPA 200.8
&/13113
ESTAFFORDI
7440-38-3
$8 by 1CP
10
120
ug/L
EPA 200.7
6r7113
ESTAFFORDI
7440-70-2
Ca by iCP
0.10
37
mglL
EPA 200.7
&7113
ESTAFFORDI
7440-43-9
Cd by ICPMS
0.50
0.50 U
uglL
EPA 200.8
6113113
ESTAFFORDI
7440-47-3
Cr by ICPMS
10
IOU
ug/L
EPA 2008.
6113/13
ESTAFFORDI
7440-50-a
Cu by ICPMS
2.0
4.5
uglL
EPA 200.8
6/13113
ESTAFFORD1
'439-89-6
Fe by ICP
50
50 U
uglL
EPA 200.7
6r7113
ESTAFFORDI
Hardness by Calculation
1.0
110
mglL
SM2340SEPA 200.7
fi17113
ESTAFFORDI
7439-97.6
Hg 245.1
0 2
0.20 IJ
uglL
EPA 245.1
615113
ESTAFFORDI
7440-09-7
K by lC P
0,10
0.45
mg/L
EPA 200.7
617113
ESTAFFORD1
1439.95-4
Mg by JCP
0.10
4.9
mg1L
EPA 200.7
6/7113
ESTAFFORDI
1439.96-5
Mn by ICP
10
250
ug)L
EPA 200.7
617113
ESTAFFORDI
1440-23-5
Na by ICP
0.10
37
mg/L
EPA 200.7
617/13
ESTAFFORD1
7440-02-0
Ni by ICPMS
2.0
2,0 U
uglL
EPA 200.8
6/13/13
ESTAFFORDI
'439-92-1
Pb by ICPMS
2.0
2.0 U
ugll-
EPA 200.8
6113/13
ESTAFFORDI
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Far a detailed desaiption of the quaiitiar codas refer to httv.Il�rta�-�sds_n_ry;�wrOlwaliahJs[affinfcltesh�ss�s[�Pi=z_Q<-a�rHe. Coas� <nn�:ypQrs�,R�da�r or p�Wp�{xbLti �±clL�rhs»ini>
Page 1 of 2

--·~\ I :NC ©'WQ, £a6oratory Section <R§su[ts
Location ID: 5P073Wl0500186_IN Sample 10:· AB95892 Collect Date: 05/23/2013 Collect Time:: 10:00
MET
CAS# Anal yte Name PQL Result/ Units Method Anal~sis Validated by Qualifier Reference Date
7782-49-2 Se by ICPMS 5.0 5.0 U ug/L EPA200.8 6/13/13 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 30 ug/L EPA200.8 6/13/13 ESTAFFORD1
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description of the qualifier codes refer to http://portal.ncde nr.o (l/web/wg/lab/mffl nfu/techass ist#Da ta Quali fier Code s <htt p:llportal.ncdenr.o rg/web/wg/lab/stafftnfo/techas.sist>
Page 2 of 2
Norlh Carolina
GROUNDWATER F1ELDIAB FORM 0"I h I Re' I of ErmiIcm9, ent and Natnrat Resnuroes
l7MSt0N OF WATER OUALMY-GR0UNDWATER SECTION
Location code ' "V -t D 5 L 1 I ;6WLE TYPE AMEL-E In fry 33
cols sty Pe irS D r'1 ._ - -- Yvater �i Rmrtirre tab Number RIB 'A S$ q L
Ound No serial No. ❑ Sad ❑ Emergemy Hate Recce S- �� 1'3 Timer
Las. Lang. 0 Reed By: Frpm:aus, C*urier. De .
❑ Chak+ nt Cuslady Other
Report To: ARO, FRO. MRO, rRia waRO, t1lWRO,
- - - -
Data Entry By: Ck:
WSRO, Km"m FO. Fed. Trust. Cer" Off.. Other.
rL
bate R eparted_
Shipped by: B s Cau+ter� Outer,
Cof4ectar(s): - ]- of h t [Date
1rne012 Bilwi,te. Cnrnptairt! Ti
LUST. Pest6de S", Federal Tnat, Other
R
FIELD ANALYSES
Owner Pi &n5 c. r-e
pR ,m & D spec. Cond.9. :�5d at WC Location or Site U C
Y 1v+ L1 Y err.
Temp -en 'C Odo►_ y-► one
Desraiption of sampling t�
Appearance I G Per'
Strmplil Method
Stsmpfe Inform!
Field Anat0s Bar. L u r r+'r -
Remarks
LA130RAT0RY ANALYSES
M-I*m %m. so wmxx wet
BaD 310 NWL um. 30a mw
trrglt Ag-8itrer44566
u2i or Pp0k*ks
COD HNIh 340 crook FhxMft 951 '
w#L AtA*K*m n 46557
VaLk mophoa�,orus prstrc�Ees
cm tow 335 nrq& HWnrss: TOM OW
rrgFL ?( hw um t 46551
Nvag—
CEnAmr. tMF Fleas 37676 /fOOn4 tdarpmsa lrrx►rardq on
wall !t aadrlrn 46536
Aela Herbk*ee>t
CORlbwrr: IMF ?do sis" ROD" "ends 37?m
ply -
Im 66O rngR Sp c t ce". 05
oAe ft" C6C9&Mk rn 4N%
Tvaft" "Tu Sntlate 945
W40L Cr-Chea+irrn 45SH
IRrsi4rre, TeRal SmnvR+rded 570 ngrL Shclde i45
rrgtL f CwCalipa►1E'A2
.nn
pH ads
wft
Att6Fnit f Ef pH 4.5 410
nylL
Alkl0 ttr to pH 6.3 415
"VOL
cvftm* as$
rrylt
Bkxrboww 440 •
ffgoL
Carbon dkfflkm 405
"wL
x t we
m9k
Cnrvellrnrr Hart 1Q32
UOL
Cetar. Tme on
cu
Card* 120
--w
Lab Cnnwnents
r'
D4 and Grease
W40L
r+t+t, as K 61v
nglL
Wm n M exs
n,olL
vKh+ No, as N s30
nrgR
�[ F Taw m A 665
rql
fllhlle tflOy 4d „f Bis
rn9R
i
GW-54 REV, 4rD5 For Dissotwrd Ana"is-submit 1tkMd sarrrpte *W wwrta'DTS" in MCC
F*4m" 46563
ft-- q*" 719M
K-14ft"km 4a555
mRm&w"kp" 4B5U .
!Nmamaenese 46565
Na-Sodkrrr46556 -
ta.rAeret
t�terd 46564
nrr.&t 4650
rAq

t tt
3 ,
County:
PERSON
WA7'�o
Sample ID:
A895893
River Basin
D�
`�G
PO Number #
13GO434
Report To
RROAP
O�
Date Received:
0512312013
Collector.
L MOCARTNEY
'�
Time Received;
13:30
Labwarks LoginlD
MSWIFT
Region:
RRO
Sample Matrix:
GROUNDWATER
Final Report RataReport
fi12f113
Loc. Type:
WATER SUPPLY
Final Report
Print Date:
0711512013
Emergency Yes/No
Visitlo
COC Yes/No
Loc. Desor.: MARGARET LARGE 384 POTLUCK FARM RD, ROUGEMONT. NO 27572
Location 11):
5P073WI0500186_OUT
Collect Date: 05/2312013 Collect Time: 11:00
Sample Depth
ii this report is labeled preliminary report, the results have not been validated.
Do not use for Regulatory purposes.
CAS #
LAB
Analyte Name
Sample temperature at receipt by lab
PQL
Result/
Qualifier
2.3
Units
°C
Method
Reference
Analysis
Date
5123/13
Validated by
HMORGAN
MIC
Coiiform, MF Fecal in liquid
1
1 B2
CFU110am1
APHA92220-20th
5/23/13
ESTAFFDRDI
Coiiform, MF Total in liquid
1
3
CFU/100mi
APHA92228-20th
5123/13
ESTAFFDRDI
WET
Ion Chromatography
_TITLE_
mg/L
EPA 300.0
film 3
CGREEN
Chloride
1 0
5.8
mgJL
EPA300,0
616113
CGREEN
Fluoride
0.4
0.4 U
mglL
EPA 30G.0
5013
CGREEN
Sulfate
2.0
9.0 J3
mg1L
EPA 300-0
616113
CGREEN
Total Dissolved Solids in liquid
12
244
mgIL
APHA2540C-18TH
5/29/13
CGREEN
NUT
NO2+NC3 as N in liquid
0.02
0.02 U
mg/L as N
Lac9R-107-04-1-c
5129113
CGREEN
Phosphorus total as P in liquid
0.02.
0.03
mg/Las P
Lacf4-115-01-1EF
5130/13
CGREEN
MET
7440-22-4
Ag by ICPMS
1.0
1.0 U
ug/L
EPA200.8
6113/13
ESTAFFDRDI
7429.90-5
Al by ICP
50
5d U
u91L
EPA 200.7
6/7113
ESTAFFOR01
7440-38-2
As by ICPMS
2.0
2.0 U
ugIL
EPA 200.8
6/13113
ESTAFFDRD1
7440-38-3
Ba by ICP
10
IOU
ugIL
EPA 200.7
617/13
ESTAFFDRDI
17440-70•2
Ca by iCP
0.10
13.10 U
mg1L
EPA 200.7
617113
ESTAFFDRDI
7440-43-9
Cd by ICPMS
0.50
0.50 U
ug/L
EPA2W8
6113/13
ESTAFFDRDI
7440-47-3
Cr by ICPMS
10
IOU
ug/L
EPA 200.8
6/13113
ESTAFFDRD1
7440.50-8
Cu by ICPMS
2.0
3.9
ug/L
EPA 200.8
&13/13
ESTAFFDRDI
-1439-89-6
Fe by 1CP
50
50 U
ug/L
EPA200.7
617173
ESTAFFDRDI
Hardness by Calculation
1.0
0.66
mg/L
SM2340BEPA 200.7
6R113
ESTAFFDRDI
7439-97-6
Fig 245.1
0.2
0.20 U
ug/L
EPA 245.1
615113
ESTAFFORDI
7440-09-7
K by ICP
0.10
0.10 U
mg/L
EPA 200.7
617113
ESTAFFDRDI
7439-95-4
Mg by ICP
0.10
0.10 U
mg1L
EPA 2003
617113
ESTAFFDRDI
7439-96-5
Mn by ICP
10
IOU
ug/L
EPA 200.7
617113
ESTAFFDRDI
7440-23-5
Na by ICP
0.10
93
mg/L
EPA 200.7
617113
ESTAFFDRD1
7440-02.0
Ni by ICPMS
2.0
2.0 U
ugiL
EPA200.8
6/13113
ESTAFFDRDI
7439-92-1
Pb by ICPMS
2.0
2.0 U
ug/L
EPA 200.8
5113113
ESTAFFORDI
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a Clete IIed desmp[ion of the qualifier codas War to hna'!/oorca1.noianr.aable tywol:ahlstaMAnfchachanlstM an g,@Ilff*r Codas <hi%pj/mrtil,nb/ata4h
gjs ,jchasiNp
Page 1 of 2

:NC cDWQ La6oratory :Section ~su{ts
Location.ID: 5P073WI0500186_ OUT Sample ID: AB95893 Collect Date: 05/23/2013 Collect Time:: 11 :00
MET
CAS # Analyte Name PQL ResulU Units Method Analysis Validated by
Qualifier Reference Date
7782-49-2 Se by ICPMS 5.0 5.0U ug/L EPA200.8 6/13/13 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 10 U ug/L EPA200.8 6/13/13 ESTAFFORD1
Sample Comments
WET:-SO4-J3-ESTIMATED-MATRIX INTERFERENCE IN MS/MSD
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description of the qualifier codes refer to http:/Jport1!,ncdenr.org/web/wg/lab/st1ffinfo/techassist#Q1ta Qualifier Codes <http·J/portal.ncdenr.org/web/wg/l1b/st1fflnfo/techapist>
Page 2 of 2
North Carolina 1
GROUNDWATER FIELD/LAB FORM Department Of En Nk"amnent and Natural Resources
DIVISION OF WATER QUALITY-GRMNOWATER SECTION
Location code. 3 �-/! vs(---0r U_©u
Quad fft
Water
❑ SON
❑ Other
❑ Chain of cmwv
Repot! To- ARO, FRO, MRO. 90IWaRO. WiRO, ill
WSRO, ICmston FO. Fed. Trust, Central M. Other:
PRIORrrr )3 C704 31-
RD�' Lab Number A licl 'W 3
❑ Ente'9ency pate Rene' • Z3�3 Time- 3
Reed $y; . From:t3r►s, Courier, nd l..
Other._
— Data Entry By: Ck:
o u t pate Reported:
SNOW by: BUS COINW.1 a e . Other: Purpose:
trollecior(s)_ L m c.r ►-� r y Date —,;> -$ 7 (0 2 9asek*. Complaint, C li LLUUSTT,, Pese+eide stuay, Federal Truss, Other
FIELD ANALYSES ;� Owner c�fr��r e f L c,ru e-
pH 4M 6. 0 Speg. Condm att 25aC Location a Site Pc4jucZ Ttxr-rn jeou- a r-err
Temp:,a - aC Odor _ n-v ka-f Description of samplirV point
Appearance CA V'A r Sampxng Method Sample Inter4 of
Field Analos By; -e Remarks
Serial No.
Lang.,
LABORATORY ANALYSES
COO Wqh 340
COD tow 335
RwL
"wL
Fluoride 951
ttsr�: 'IN
IFIpIL
WWL
Cd fry m fMF focal 31616
IIo"
"rdness (nw-c+ W2
Mot
?(
Caft m: VF Tdtel31SM
fie"
PAe32730
u04
TOC 6"
TurEldiry 76
ReWtw- T*W SuwwWed 530
wqk
M
IeT{1
Spw k Card- Is
StIfatr 945
SuMe 745
omhm m
WWL
Me&
PH 403
ands
AfkaKnilr to pH 4.3 ■t9
reglL
Alkafinrtr to pH 6-3 415
RWL
Cardonalte 445
ff%YL
9iCarbonate 40
HWL
Carbon dlor�- 14os
myL
Chlofte 940
sylL
ChMnft m: Hex IM
ugIL
Cdldr` Tare VD
Cu
Cyanide 720
.R+9R
r Cornmef is
t'+U" 6Frw, Aw rev.. w' I
kwow Pewoftii ' M6. - i
Atli trerbfelpoS j
x
fe fron 4ll763
Senraeglle niece
ON and Gram
W49L
X
HO-UMM TIM LILLTP144%
----A R
i� K-POUSslum46555
x
MVAvWM0M 46554 Mak
M"Aiw rwse 43555 ujVL
Vde%k amm (VOA ba"ej�
mo% as H ato
ffayL
](
N64%M int 495S6
TPH.G&Wme Range
TKN as ►t 625
m9k
y
1G40dfel '�UYLTPH41'E]R
Gaseaae Rnr,
Wh * f% as N we
RgfL
7%
PbLtsd 455M
P. •Tdtal as P 665
" 1
A
I Sean
xiMft IM(has fM) 9W
W4&
7(
ZR IMC 46567
rliMite {NO, ss IrJ 6t5
mpll
LAB USF ONLY
I
Temperature on arrival I"C]-
GW-54 REV- 4fa6 For Dissohed Aray3is.svbmn fRered WrVe 0nd write 'QIS' in NuCk.

. J Nurn W10500186
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Permitted Flow
Facility Name
Margaret Larce SRF
Location Address
384 Potluck Farm Rd
Rougemont
NIC 27572
t!�� gA,(l � 7
Central Files: APS SWP
1010V08
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
MajorlMirtor Region
Minor Raleigh
County
Person
Facility Contact Affrllation
Owner Name
Owner Type
Individual
Margaret Larce
Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont NC
27572
vent_
Scheduled
arlg Issue App Received Draft Initiated Issuance
Public Notice Issue Effective
Expiration
09/29/08 06/16/08
09/29/08 09/29/08
08/31/13
Rectulated Activit' s
keoue Ted Received Fv_nts
Heat Pump injection
RQ staff report requested
06/25/08
Additionai information requested
07/10/08
RQ staff report received
07/15/08
Additional information received
09/19/08
utfall NULL
Waterbody Name Stream index Number Current Class Subbasln

Permit Number WI0500186
Program Category
Ground Water
Permit Type _
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael .rogers
Permitted Flow
Facilit
Facility Name
Margaret Laroe SRF
Location Address
384 Potluck Farm Rd
Rougemont
Owner Name
Margaret
Dates/Events
Orig Issue App Received
06/16/08
Re g ulated Activities
Heat Pump Injection
Outfall t·lih.: ..
NC 27572
Laroe
Draft Initiated
Scheduled
Issuance
Central Files: APS_ SWP_
09/24/08
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Raleigh
County
Person
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont
•
NC
Public Notice Issue Effective
q~q\oi
Re q uested/Received Events
RO staff report requested
Additional information requested
RO staff report received
Additional information received
27572
Expiration
~1 31 11-3
06/25/08
07/10/08
07/15/08
09/19/08
Waterbody Name Stream Index Number Current Class Subbasin
CF E9
_off DWG)L
����
Q■r®me :
September 29, 2008
Margaret Laroe
384 Potluck Farm Road
Rougemont, NC 27572
Re: Issuance of Injection Well Permit
Permit No. W10500186
Issued to Margaret Laroe
Dear Ms. Laroe:
Michael F. Easley, Governor
William G. Ross Jr.. Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. SulIins. Director
Division of W ater Quality
In accordance with your signed and completed application received June 16, 2008, I am
forwarding Permit No. WI0500186 for the operation of a 5A7 geothermal underground injection
well (UIC) heat pump system located at 384 Potluck Farm Road, Rougemont. Person County,
North Carolina 27572. This permit shall be effective from the date of issuance until August 31,
2013, and shall be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. In order 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.
Also. please find attached the laboratory analytical results from samples collected from the UIC
geothermal well system, If you have any questions regarding your permit or the Underground
Injection Control (UIC) Program please call Mr. Qu Qi at [phone] or me at (919) 715-
6166.
Best Regards,
f�Michael Rogers
Environmental Specialist
GPU — UIC Control Program
cc: Jay Zimmerman — Raleigh Regional Office
Central Office File — W10500186
Person County Environmental Health Department
Attachment(s)
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internet: ham://www.newapMuahtv.ar_ 2729 Capital Boulevard Raleigh, NC 27604
An Equal OpportunttyfAffirr We Adon Employer— 50% Recycle l0% Post Consumer Paper
Noon hCarolina
Naturally
Telephone.. [phone]
Fax 1: [phone]
Fax 2: [phone]
Customer Service- [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
FO935TV6Eel'7�fir to A �iT�1����►1amixeimb- �ki
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
MARGARET LARGE
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 384 Potluck Farin Road, Rougemont. Person
County, North Carolina, and will be operated in accordance with the application received June
16, 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, Rules, or Regulations. Operation and use of an injection well shall
be in compliance with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and
any other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31,
2013, and shall be subject to the specified conditions and limitations set forth in Parts I through
VIII hereof.
-kV—
Permit issued this the 30 day of 2008.
�Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
W10500186 Page 2

PART l-WELL CONSTRUCTION GENERAL CONDITIONS
1. The Pennittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (ISA NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds. for enforcement action as provided
for in N.C.G.S. 87-94. •
2. This permit shall become voidable unless the facility is constructed in accordance with the
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 purposes
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).
PART II -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and tate of
injection, as described in the application and other supporting data.
2. Thi~-p~it is not transferable without prior notice to, and approval by~ the Director of the
. Division_ofWater Quality (Director).-In the event there i~ a desire for the facility.to .
·change 'owiiers~ip·,. or there is a 'naine .change of.the P~ittee, a fonnalpermit 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 perm.it does not imply that all regulatory requirements have been met.
WI0500186 Page 3
PART III -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 Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be-properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or 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) 715-
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 V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
WI0500186 Page4
PART VI -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be-established and an acceptable sampling reporting schedule shall be followed.
2. The P~ittee shall report by.telephone, within 48 hours of the occurrence or first • knowledge of the occurrence, to the Raleigh Regiona] Office, telephone number (919) 791-
4200, 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
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 Pennittee shall
take such immediate action as may be required by the Director.
PART VII -PERMIT RENEWAL
The Perm.ittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART VIII-_CHANGE OF WELL STATUS
1. The Permittee shall provide-written notification· within 15 days of any change of status of
an injection well. Such a change would irj.clude the discontinuation of use of a well for
injection. Ifa well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is· not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(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
WI0500186 Page 5
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 couldJead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bLaroeom of
the well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a 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 Abandpnment Record (Form GW-30)
as specified in l SA NCAC 2C .02 l 3(h)(l) within 30 days of completion
of abandonment.
3. The written documentation required in Part VIII (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 IX -OPERATION AND USE SPECIAL CONDITIONS
None.
WI0500186 Page 6
·LABORATORY ANALYTICAL RESULTS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: WI 0500186
PERMITTEE: Margaret Laroe
SAMPLE COLLECTED DATE: 7/10/2008
Coliform, total Coliform, fecal pH
1 CFU/100ml 1 CFU/100ml units
MCL=1 MCL=1 MCL = 6.5-8.5
Influent 1 1 -7.94
Effluent 1 1 8:07
NO2-+ NO3-as N Phosphorus Nitrate
m g/L mg/L mg/L
MCL = 10 MCL= nss MCL = 10
Influent <.02 <.02 <.02
Effluent <.02 0.02 <.02
Calcium, Ca Cadmium.Cd Chromium, Cr
mg/L µg/L µg/L
MCL=nss MCL= 1.75 MCL=50
Influent 6.3 <1 <10
Effluent <.1 <1 <10
Manganese, Mn Sodium, Na Nickel, Ni
ua/L m g/L ua/L
MCL=50 MCL=nss MCL= 100
Influent 45 89 <W
Effluent <10 98 <10
MCL = Maximum Contamination Level per NCAC 2L .0200 (GA Standards)
nss = no state standard
na = not analyzed
Total Dissolved Solids
m g /L
MCL=500
237
250
Nitrite
mg/L
MCL=1
<.01
<.01
Copper, Cu
µg/l
MCL= 1000
3.1
4.7
Lead,Pb
µg/L
MCL= 15
<10
<10
"parameter not dectected but higher PQL used due to matrix Interference and/or sample dilution
Chloride, Cl
mg/L
MCL=.250
4.2
4.2
Silver, Ag
IJQ/L
MCL= 17.5
na
na
Iron, Fe
ua/L
MCL=300
<50
<50
Selenium, Se
ua/L
MCL=50
na
na
Flouride
m g/L
MCL=2
0.5
0.5
Aluminum, Al
ua/L
MCL=nss
na
na
Mercury, Hg
ua/L
MCL= 1.05
na
na
Zinc,Zn
1,.1 9/L
MCL=1050
72
<10
Sulfate Ammonia, NH3* TKN
mg/L m g/L mg/L
MCL=250 MCL= nss MCL=nss
na <.1* <.2
na <.1* <.2
•
Arsenic,As Barium, Ba
ua/L . pg/L
MCL=50 MCL=2000
<5 na
<5 na
•·
Potassium, K Magnesium, Mg
m g/L mg/L
MCL=nss MCL=nss
na 0.68
na <.1
County:
PERSQN
Sample ID:
A932434
River Basin
ad ��b
w
RROAP
at WA r�4
PO Number 9
9G0673
07/10/2008
Buporl To
/11 Zt'1t L �V
Date Received:
11:10
Collector,
3_ GREBR
Time Received.-
Labworks Login1D
WIMATHIS
Region:
BUD
date Reported:
7/30108
Sample Matrix
GROUNDWATER
Loc. Type:
WATER SUPPLY
Report Generated:
07/30/2008
Emergency Yes1No
COC YeslNo
VfsitlD
�] J p�7 �j
Lac. Oescr.: MA8GARET LAROE
Location iD: RROAPNLC
Collect Date: 07NO12008 Collect Time:: 10:00 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab-org under Staff Access
A -Value reported is the average of two or more determinations
N3-Estimated concentration is < PqL and >MDL
B1-Countable membranes with <0 oolonies: Estimated
NE-Na established POL
B2- Counts frrxn all filters were xero-
P-Elevated PQL due to matrix interlerence and/or sample dilution
83- Countable membranes with more than SO or 80 colonies; Estimated
B417iltens have counts of both >60 or80 and a 20; Estimated 01-Molding time exceeded prior to receipt at lab.
BSToo many cDlpnie5 were present; too numerous to count {TNTC} 02- Holding time exceeded following receipt by lab
J2- Reported value failed to meal ❑C criteria for either precision or accuracy; Estimated PQL- Practical Cluantdation Limit -subject to change due to instrument, sensitivity
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated U- Samples analyzed for this compound but not detected
JrrThe lab analysis was from art un reserved or im XI- Sample not analyzed for this compound
y p property chemical preserved sample; Estimated
N1-The component has been tentatively identified based an mass spectral library search and has an estimated value
LAB
Agtu(et i meaii� l w�� t3Un
SEP It 2008
Laboratory Sectivn>> 1623 Kali service Center, Raleigh, NC 276W1623 (919) 7333908` Page 1 of 3

WC ©'WQ, £a6oratory Section ·<R.#sults SamplelD AB32434 Location ID: RROAPNLC Collect Date: 07/10/2008
Loe. Descr.: MARGARET LAROE Collect Time:: 10:00
VISitlO
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date . Approved By /Date
samp1e tempera11n at~ b'f lab 9.9 -c HPARKER MMATHIS
Melhod Reference 7110/08 7/10I08
MIC
Cdlfarm. MF Fecal In lqljd 82 CFUl100ml PCOTTEN MOVERMAN
Method Reference APHA92220-20lh 7110108 7115108
Colbm.MFTotallnlqljd 1 82 CFUl100ml PCOTTEN MOVERMAN
Method Reference APHA92228-20lh 7/10/08 7/15108
AllcallnlytD pH 4.5 d lquld _TITIJ:.... mgll. as CaC03 NDEO MOVERMAN
Method Reference APHA23208--20lh 7/14'08 7/18108
Mcatily4.5 160 mgll. as CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20lh 7/14108 7/18I08 -
Allcallnlly8.3 1 u mgll.asC8C03 NDEO MOVERMAN
Method Reference APHA2320B-20lh 7/14"08 7N8108
Bicarbonate 160 mgll.asCaC03 NDEO MOVERMAN
Method Reference APHA2320B-20lh 7/1-WS 7/18'08
Carbonale u mgll as CaC03 NDEO MOVERMAN
Method Reference APHA2320B--201h 7/141D8 7/18108
pt-LAlcallnlly 7.94 mgll as CBC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14"08 7/18108
WET
Ion Qaomatography _11TlE_ mgll MIBRAHIM1 MOVERMAN '
Method Reference EPA300.0 7/18108 7/30IOB
Total Dlssalvad Sollds In lquld 12 237 mglL AWIWAMS MOVERMAN
Method Reference APHA2540C-18TH 7/161D8 7/23/08
01lollde 1.0 4.2 mglL MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7118108 7/30/08
Aloltde 0.4 0.5 mgll MIBRAHIM1 MOVERMAN
Melhod Reference EPA300.0 7/18/08 7/30/08
SIJlrale 2.0 X1 mglL MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
NUT
NH3 as N In lquld 0.02. 0.1 0 U,P nvL.asN MOVERMAN CGREEN
Method Reference Lac10.107-06-1-J 7/10108 7/15/08
Tdall(jeldahlNasN lnlkpd 0.2 0.2 u nvL.asN GBELK CGREEN
Melhod Reference Lac:hat107..Q6.2-H 7/16.'08 7/17/08
N02+NOO as N In llquld 0.02 0.D2 u mgll.asN MOVERMAN CGREEN
· Method Reference Lac10.107-04-1-c 7/10/08 7/15/08
..
Laboratory Section» 1623 Mail Service Center. Raleigh. NC 27699-1623 [phone] Page2of3
NC <DWQ, La6oratory Section <J{esults Sample ID AB32434
Location ID: RROAPNLC Collect Date: 07/10/2008
Loc.Descr.: MARGARET LAROE Collect Time:: 10:00
Visit ID
-CAS# AnalyteName PQL Result Qualifier Units Analyst/Date Approved By /Date
Phosphorus~total as p In llquld 0.02 0.02 mgll..asP MA.JAY! CGREEN
Method Reference Lac10-11S-01-1EF 7/15108 7/17/08
Nitrate as N In liquid 0.02 0.02 u rngl.asN MOVERMAN CGREEN
Method Reference Lachat107-04-1-c 7/15/08 7/15/08
Nltrfle as N In liquid 0.01 0.01 u mgll.asN MAJAYI CGREEN
Method Reference Lachat107..Q4: 1-c 7/11/08 7/15/08
MET
7440-38-2 AsbylCPMS 5.0 5.0 u uglL DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-70-2 CabylCP 0.10 6.3 mg/L SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 7/18108
7440-43-9 CdbylCPMS 1.0 1.0 u ug/1.. DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-47-3 Q-bylCPMS 10 10 u uglL DSTANLEY ESTAFFORD
Method Reference EPA200.8 7/15/08 7/18/08
7440-50-8 CUbylCPMS 2.0 3.1 ugll. DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-48-4 FebylCP 50 50 u uglL SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 7/18108
7439-95-4 MgbylCP 0.10 · 0.68 mglL SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 · 7/18/08
7439-96-5 MnbylCP 10 45 uglL SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-23-4 NabylCP 0.10. 89 mgll SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-02-0 NlbylCPMS 10 10 u uglL DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7439,-92-1 PbbylCPMS 10 10 u ugll. DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-66-6 ZnbylCPMS 10 72 ugll. DSTANLEY ESTAFFORD
Method Reference EPA200.8 7/14/08 7/18/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page3of3
North Carolina
G RQ U N DWATE R FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER PECTION
County - ? SAMPLE TYPE SAMPLE PRIORITY Lab Number 11
Quad No Serial No. 0 Water C1 Routine ❑ Saki ❑Emergency Date Received 1 r✓ l pl.S2 5 Time O
Lat. Lang. ❑ ether � Rec'd by: Sy From: Bus, Courier, Hand Del.,
Other.
Report To: ARO, FRO, MRO, F�IVaRO, WIRO, ❑Chain of Custody _I(Data Entry By: CIC
WSRO, Kinston FO, Fed. T_ al Off., Other: Date Reported:
Shipped by: Bus, Courier, and Del ther Purpose:
Collectorts). Date A' TTlme APE' _fBaseline, Complaint, Compliance,, UsST. Pesticide Study. Federal Tru je" A00V4
FIELD ANALYSES ` Owner r'--r' •�A--�
pH4W [r f 4l Spec. Cond..4 ,� 4 �. � at 25° C Location or site � � � � � � �
.t!7 1
Temp.1,) oC Odor _,&Jx_Y,2e Description of sampling point
Appearance C' Sampling Method Sample Interval
Field Analysis By: �' f- Remarks tSr
LABQFBMOB.Y ANALYSER " -
BOD 310 m Dis& Solids TWOO A -Silver 4%w u l Or anochiorina Pesticides
COD High 340 mgl{
Flouride 951
AI - Aluminum 48567 UqA
Organophosphorus Pesticides
COD Low 335 mgA
Hardness: Total 9W m
k
As - Arsenic 46551 u /1
Nitrogen Pesticides
Coliforrm MF Fecal 31616 11 t)fiml
Hardness non-car6 90p m_qA
Ba - Barium 465N UqA
Acid Herbicides
Co iform: MF Total 31504 1100mI
Phenols 32730 UCLA
Ca -Calcium 4WW m
PCB's
TOC 680
if M
Cd - Cadmium 46559 uaA
Turbidity 7e NTU
X I
Sulfate 945
Cr - Chromium 4WW u
Residue., Suspended 530 mgA
Sulfide 745
Cu - Copper 4&%2 UgA
Fe- Iron 46563 ugA
Semivolaiile Organics
Oil and Grease mgn
H - Mercury 71900 UgA
TPH - Diesel Range
pH 403 unit
K- Potassium 46555
Alkalinity to pH 4.5 410 mgA
M - Magnesium 46554 i
Alkalinity to pH 8.3 415 m9A
X
mn _ manganese 46565 u A
Carbonate 445 rttgll
NH as N 610 MCV1
Na - Sodium 46566 m II
Volatile Organics (VOA bottle)
Bicarbonate 44n m
TPH - Gasoline Range
Carbon dioxide 405
HO + rip as N 630
Pb -Lead 4B564 UCjA
TPH - STEX Gasollre Range
Chloride 940 mgA
P: Tatal as P W5
Se - Selentum ugA
Chromium: Hex 1032 u
Zn - Zinc 4e5e7 u
,
Color. True so CU
. a j s. (, r� s •s
Cyanide 720 mgli
Lab Comments:
r,'
h"
-41 W03 All -r /_k Al ;�� I/ -'A 5;11/ r 4 __
tyl -54 REV. IM For Dissolved Analysis - submlt filtered sample and write "DIS" in bl,

'N-
C
!D Laboratory Section gesufts
County: PERSON
Sample ID:
A832435
w'4r�'N
River Basin
0�
PO Number#
8GO874
Report To RROAP
�d
Efate Received:
07110/2008
Collector J GREER
f
w,
i
r
Time Rece ved:
17 :10
Labworks LoginlD
MMATHIS
Region: RR❑
Date Reported:
7130108
Sample Matnx: GROUNDWATER
Lae. Type: WATER SUPPLY
Emergency YesfNo
COC YesfNc
Location iO: RROAPNLC
visitlo
Lot. Descr.: MARGARET LAROE
Collect Date: 0711=008 I Collet! Time:: 10:30
Sample Qualifiers and Comments
Routine Qualifiers
Report Generated:
Sample Depth
For a more detailed description of these qualifier codes refer to www.dwgiab.org under Staff Access
A -Value reported is the average of two or more determinations
81-Countable membranes with <20 colonies; Estimated
32- Counts from all filters were zero.
B3- Countable membranes with more than 60 or 80 colonies, Estimated
B4-Flters have counts of both >60 or 80 and a 20; Estimated
B5-Too many colonies were present; too numerous to count (TNTC)
J2- Reported value Failed to meet QC criteria for either precision or accuracy; Estimated
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
Nt-The component has been tentative]y identified based on mass spectral library search and has an estimated value
LAB
07130f2008
� ) :3 tl to
N3-Estimated concentration is < POL and aMDL
NE -No established PQL
P-Eievated PQL due to matrix interference and/or sample dilution
Qt-Holding time exceeded prior to receipt at lab,
02- Holding time exceeded following receipt by lab
PQL- Practical Quantitation Lim it-subled W change due to instmment sensitivity
U- Samples analyzed for this eompaun6 but not detected
X 1 - Sample not analyzed for this compound
+MG Ei VE❑ / DENR
SEP 1 2Df}8
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699.1623 [phone] Page i of 3

:NC ©'WQ, La6oratory Section ~sults Sample ID AB32435
Location 'io: RROAPNLC Collect Date: 07/10/2008
Loe. Descr.: MARGARET LAROE Collect Time:: 10:30
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample tempera111ra at receipt by lab 5.6 ·c HPARKER MMATHIS
Method Reference 7110/08 7/10/08
MIC
Collfonn, MF Fecal In llquld 82 CFU/100ml PCOTTEN MOVERMAN
Method Reference APHA9222D-20th 7/10/08 7115/08
Collfonn, MF Total In liquid 1 B2 CFU/100ml PCOTTEN MOVERMAN
Method Reference APHA9222B-20th 7/10/08 7/15108
Alkalinity 10 pH 4.5 of Bquld _TITLE_ mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
Alkallnlty4.5 160 mgll as cacoo NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
Alkallnlty8.3 u mg/LasCaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
Bicarbonate 160 mg/Las caco3 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
Carbona1e 1 u mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
pH_Alkallnlty 8.07 mg/Las cacoo NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
WET
Ion Chromatagraphy _TITLE_ mg/L MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7118/08 7/30/08
Tolal Dlssolved Sollds In llquld 12 2 50 mg/L AWILLIAMS MOVERMAN
Method Reference APHA2540C-18TH 7/16/08 7/23/08
Chloride 1.0 4.2 mg/L MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
Fluortde 0.4 0.5 mg.IL MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
SUifate 2.0 X1 mg/L MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
NUT
NH3 as N In llquld 0.02 0.10 U,P mg/LasN MOVERMAN CGREEN
Method Reference Lac10-107~1.J 7/10108 7/15/08
Total Kjeldahl N as N In liquid 0.2 0.2 u mgllasN GBELK CGREEN
Method Reference Lacha\107-06-2-H 7/16/08 7/17/08
N02+N03 as N In liquid 0.02 0.02 u mgllasN MOVERMAN CGREEN
Method Reference Lac10-107-04-1-c 7/10/08 7/15/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page2of3
:NC <lJ'WQ £a6oratory Section <JJ&sults Sample ID AB32435
• Location,10: RROAPNLC Collect Date: 07/10/2008
Loe. Desi;r.: MARGARET LAROE Collect Time:: 10:30
~Visit ID
CAS# Analyte Name PQL Result Qualifier Units AnalysUDate Approved By /Date
Phosphorus_total as p In liquid 0.02 0.02 mg/1..asP MAJAYI CGREEN
Method Reference Lac10-115-01-1EF 7115/08 7/17/08
Nitrate as N In llquld 0.02 0.02 u mg/LasN MOVERMAN CGREEN
Method Reference Lachat107-04-1-c 7/15/08 7/15/08
Nitrite as N In liquid 0.01 0.0 1 u mg/LasN MA.JAY! CGREEN
Method Reference Lachat107-04-1-c 7111/08 7/15/08
MET
7440-38-2 AsbylCPMS 5.0 5.0 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-70-2 CabylCP 0.10 0.10 u mg/L SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-43-9 CdbylCPMS 1.0 1.0 u ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-47-3 CrbylCPMS 10 10 u ugll DSTANLEY ESTAFFORD
Method Reference EPA200.8 7/15/08 7/18/08
7440-50-8 CubylCPMS 2.0 4.7 ugll DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-484 FebylCP 50 50 u uglL SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7439-95-4 MgbylCP 0.10 0.1 0 u mg/L SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7439-96-5 MnbylCP 10 10 u uglL SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-23-4 NabylCP 0.10 98 mg/I.. SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-02-0 NlbylCPMS 10 10 u uglL DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7439-92-1 PbbylCPMS 10 10 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-66-6 ZnbylCPMS 10 10 u uglL DSTANLEY ESTAFFORD
Method Reference EPA200.8 7/14/08 7/18/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 {919) 733-3908 Page3of3
GROUNDWATER FIELD/LAB FORM
County fir O ryS 4224
Quad No Serial No.
Lat.
Long.
AMPLE TYPE SAMPLE PR1413iD[
Dff Water [aRoutlne
❑ Soll ❑ Emergency
❑ Other
Report To: ARO, FRO, MR , R O WaRO, WIRO, ❑ Chain of Custody
WSRO, Kinston FO, Fed. Trust Central Off., Other:
Shipped by: Bus, Couriers Ha do Del ,`Other
Purpose:
Collector(s): - '- Date ,' -P-5-Time Baseline,
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
61
Lab Numbery (00
Date Received 'It 1 oI v 9 - Time by 1 "
Rec'd by- l+ - From: Bus, Courier, Hand Del_,
Other.
Data Entry By: Ck:
Date Reported:
Pesticide Study, Federal Tru he ,
FIELD ANALYSES Owner
pH4on - (�% 1 Spec. Cand-� �,�'at 250 C Location or site 9`i !�_ �; •^y%r- a ��ca � 4
Temp.1e �oC Odor �h'►�• 5ze Description of same ing point -
Appearance Sampling Method _ �. Sample Interval
Field Analysis By:
1 Remarks
W m ong &m. ex Seem. etc.}
LABORATORY AID LYSES
BOD, 31Q m9A
Diss. Solids 70300 m ll
A - Silver 465W u 11
Or anochlorine Pesticides
COD High 340 mgA
Flouride 951 MW
Al -Aluminum 46567 u II
Organophosphorus Pesticides
COD Low 335 mil
Hardness: Total 9DO MC0
As - Arsenic 46551 u j
Nitrogen Pesticides
Coliform: MF Fecal 31616 1100ml
Hardness non-cart3 9W m Il
Ba - Barium 46&% UqA.
Acid Herbicides
Conform: MF Total 31504 1100ml
Phenots 32730 uaA
Ca - Calcium 46552 MOA
PCS's
TOC 680 m
n Mh t-O
Cd - Cadmium 46559 u ll
Turbidity 76 NTU
Sulfate 945
Cr - Chromium 46560 u 11
Residue., Suspended 530 mo
Sulfide 745
Cu - Co er 46562 u II
Fe - Iron 4fi563 u9A
Semivolatiie Organics
Oil and Grease m II
H - Mercury 71900 ugA
TPH - Diesel Range
pH 4U3 unit
K - Potassium 45555
Alkalinity to pH 4.5 410 mgA
M - Magnesium 46554 m
Alkalinity to pH 8.3 415 mgll
Mn - Manganese 46665 A
Carbonate 445 m9A
NH as N 610 m A
Na - Sodium 46556
Volatile Organics (VOA bottle)
Bicarbonate 440 m
k
TPH - Gasoline Range
Carbon dioxide 405 mgll
.�
NO + NO as N 630 m A
Pb - Lead 46564
TPH - BTEX Casolire Range
Chloride a40 mgll
P: Total as P 865 m
Se -Selenium
ju
Chromium: Hex 1032 u
Zn - Zinc 46567
War. True go CU
M.f
Cyanide 720 rngA
Lab Comments:
GW-54 REV.1219. — For Dissolved Analysis - submit filtered sample and write "DIS" in bl, 1

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 07/10/2008 County: Person
To: Aquifer Protection Section Central Office Permittee: Mrs. Mar et Laroe c
Central Office Reviewer: Micheal Rozers Project Name: [TIC-5A7 OPEN LOOP �-•
Regional Login No: 05 -- Application No.: W10500196 rrs
Q
I GENERAL INFORMATION o
1. This application is (cbmz zu that sppiyy ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle [] High Rate Infiltration ❑ Evaporafion/Gnfiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 07/10/2008
b. Person contacted and contact information: Mr. Steven Bulard Ph. # 919451 9943
c. Site visit conducted by: JGreer, RRO-APS
d. inspection Report Attached: ® Yes or ❑ No.
I Is the following information entered into the g1MS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude
Longitude:
e. Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater): NIA
For Disp9sal and infection Sites -
(if multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): 384 Potluck Farm Road Rougemortt NC 27572
b, Driving Directions: See Map Quest:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
II NEWAND MAJORMODIFIC4 TIONAPPLICATIONS (this section not needed for renewals or mhtor
►nod1fWatians, skill io fext sectinn)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: _

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
2. Are the new trea1ment facilities adequate for the type of waste and disposal system?
D Yes O No D NIA. Ifno, please explain: _
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes O No D NIA. Ifno, please explain: __
4. Does the application (maps, plans, et:c.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D NIA. Ifno, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NI A. If no, please explain: __
6. Are the proposed application rates for new sites {hydraulic or nutrient) acceptable?
D Yes O No D NIA. Ifno, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No D N/ A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? 0 Yes or O No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No O NIA. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: _
10. For residuals, will seasonal or other restrictions be required? 0 Yes D No D NIA If yes, attach list of sites
with restrictions (Certification B?)
III. RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or maior modification
systems}
Descrip don Of Was te(S ) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate#:_·_
Backup-Operator in Charge: __ Certificate #: __
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage,· effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. Ifno, please explain: __
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If y~s, please explain: ___ _
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or O No. If no, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? D Yes or D No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? D Yes D No D NIA. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? D Yes D No D NIA Ifyes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or D No. If yes, please attach a
map showing conflict areas or attach any new maps ·you have received from the applicant to be incorporated
into the permit: __
10. Is the description of the facilities, type and/or volume -of waste(s) as written in the existing permit correct? D
Yes or D No. Ifno, please explain: ___ _
11. Were monitoring wells properly-constructed and located? D Yes or D No D NIA. If no, please explain:
12. Has a review of all self-monitoring data been conducted (OW, NDMR, and NDAR as applicable)? D Yes or
D No D N/ A.· Please summarize any findings resulting from this review: __
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; D
Current enforcement action(s) D Currently under SOC; D Currently under JOC; D Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ___ _
14. Have all compliance dates/conditions in .the existing permit, (SOC, JOC, etc.) been complied with? D Yes
0 No D Not Determined O NI A.. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? D
Yes or D No D NIA. If yes, please explain: __
AQUIFER PROTECTION SECTION 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.)
Descri ption Of Well{S} And Facilities -New , Renewal , And Modification
1. Type of injection system:
-~ Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (SQM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: }
2. Does system use same well for water source and injection? ~ Yes D No
3. Are there any potential pollution sources that may affect injection? D Yes ~ No
What is/are the pollution source(s)? . What is the distance of the in jection well (s) from the pollution
sourc e(s)? ft.
4. What. is the minimwn distance of proposed injection wells from the property boundary? 100 ft.
5. Quality of drainage at site: ~ Good D Adequate D Poor
6. Flooding potential of site: ~ Low D Moderate D High
7. For groundwater remediation system~ is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: NI A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)?~ Yes or D 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.
ln iection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes ~ No. Ifyes , exp lain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up. fluid since permit issuance
or last inspection? D Yes D No. If yes, explain: NIA
3. For renewal or modification of groundwater remediation permits ( of any type), will
continued/additional/modified in jecti on s have an adver se impact on mi gr ation of the plume or manag ement of
the contamination incident? D Yes D No. If yes , exp lain: NIA
4. Drilling contractor: Name: ACME Well Co. Inc.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: 7990 NC Hwy . 751, Durham NC 27703
Att: Mr. Charles Carter
Certification number: 2949
5. Complete and attach Well Construction Data Sheet.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
1 Attach Well Construction Data Sheet - if needed information is available
1 Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explains
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:
Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition
Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you proNride a reason for each special condition:
Condition _ _ _ Reason
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information,
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report preparer(s�: I
�.
Signature of APS regional supefvis6r:
Date:
DITIONAL REGIONAL STAFF REVIEW IT EMS
New System. Ok

Pennlt: WI0500186
SOC:
County: Person
Region: Raleigh
Effective:
Effective:
Contact Person: Margaret Laroe
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Pennits:
Inspection Date: 07/10/2008
Primary Inspector: Jimmie W Greer
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: Margaret Laroe
Facility: Margaret Laroe SRF
384 Potluck Farm Rd
Rougemont NC 27572
Phone: [phone]
Certification: Phone:
Entry nme: 09:30 AM Exit Time: 10:30 AM
Phone: [phone]
Inspection Type: Compliance Sampling
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
J--::I >I-P-1 "-,::..J.l + ,J-L:'FFI IA T!.~ "
? ;,'°; ,a-y.,,£.4
Page: 1
Permit: WI0500186
Inspection Date: 07/10/2008
Inspection Summary:
owner -Facility: Margaret Laroe
Inspection Type: Compliance Sampling
New System no problems as of this date ...
Reason for Visit: Routine
Page: 2
Page 2 of .3
INJECTION FACILITY INSPECTION REPORT -FORM B(CONTINUED)
WELL CONSTRUCTION
Date constructed
Drilling contractor: Name _
Address 1-7
NA A.
Certification number
Total depth of well _ '-2>4�y Total depth of source well -e-
(f applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth
Diameter
Height (A.L.S.)
Grout
Depth
Screens
Depth(s)
Length(s)
I.D. Plate
Static water level
Well yield
Enclosure
Enclosure floor
(concrete)
Sampling port
(labeled)
Water tight pipe entry
Well enclosure entry
Vent
s�
a�
y
J &
4`
s�
y
Functioning of•heat pump system (Determine from the owner if hea`ipump fug=coons proper2v)
414 L— — 6 3 . �r1 e .
i1
GW/UIC-2
March 28, 2001

Page 1 of 3
North Carolina Department of Environment and Natural Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
f
INJECTION WELL PERMIT NO. W171- Q c,,
lm-11-i6_I_ BKQZIIIV9I011�
ry
DATE -:7 f ;
rj
ADDRESS OF OWNER,.s�r� �L�- �a.r�.,.-, ►� - - -
(Street/ road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable) 1� aS
f/ %+14-/' 1 1 _ii!" 1, /P, / IAl /.ilk-n/-- - �-j
(Street/ road or Pot and subdi�sion , county, town, if different than owner's address, plus description gflocahon an sire)
Potential pollution source �jyL4 c Distance from well S—i? /
Potential pollution source 5 C=. Distance from well �,� '
Potential pollution source t^ Distance from weltF�!
Minimum distance of well from property boundary
Quality o inaae at site
(;oo dequate•pow)
GPS Data:
Latitude:
_ Flooding potential of site
{higkmoderar ow
Longitude:
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources. roads. e ppro hnare scale. and
north arrow) �e-d)
V
�D r---RIBE INJECTION SYSTEM (vertical closed soap, uncased borehole or cased writer well: separate source well and
ze t well; combination source and injection well; or other description 0 applicable)
C-2
March 28, 2001

; INS FECTO ~ d----/2 ~1 Office __ -------'-f2.------=-12 ........ 2._/'---, ------'--<-A----'-·0-~~----
· ~ Page 3 of 3
7
WITNESS ___________ Address ___________ _
WITNESS Address ------------------------
GW/UIC-2 March 28, 2001
Map of 384 Pot Luck Farm Rd Rougemant, NC by MapQuest
http://Www. map quest. conVmaps?city=Rougemont&state=NC&addres..
384 Pat luck Farm Rd
Rougemant, NO 27672-9247
t�4htt�Rltl
!e
3
�.
V
12p ei
MA{ YUI SY.
acme lMQ—A kmap 'Ar 6MOVIl"TlA a TOW"
Rr rt�l�. r..atr.d. tl.. wbJad fa Lloen.aA'kpy�ld Map Lft+d
Ck.cuon..rd mra..te idotmtdfonm any. w. rtrka ray wavnrrWm on Im acwrwW d 1tr.k ac.raK mad Gm dklom
w Fwft a bft or.I*.drtoisn.0- Yov.aalun. d risk u M.p0pied wd 14.upplf.ra "t
netm Q.hts 107w
for anY 10M ar dO* r.s tg fn7m Y'oW "Of Mippwat YOW LM d Maw m..n. you api.. fo wr y
1 0£ 1 7I112408 8:57 AM

A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: June 25, 2008
To: D Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
~ Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone]
E-Mail: [e-mail]
A. Permit Number: WI 0500186
B. Owner: Margaret Laroe
C. Facility/Operation: __
D Proposed ~ 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. Permit Type: D Animal D SFR-Surface Irrigation □ Reuse D H-R Infiltration
D Recycle D I/E Lagoon D GW Remediation (ND)
~ UIC-5A7 Open Loop
For Residuals: D Land App.
0 503
0 D&M
D 503 Exempt
D Surface Disposal
D Animal
2. Project Type: ~ New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Information: 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 your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
~ Return a Completed APSARR Form.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: ------------------Date: ____ _
FORM: APSARR 07/06 Page 1 of 1
Michael F. Easley. Governor
William G. Ross Jr„ Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins Director
Division of Water Quality
June 23, 2008
Margazret Laroe
384 Potluck Farm Road
Rougemont, NC 27572
Subject: Acknowledgement of Application No. W10500186
Margaret Laroe SFR
Injection Heating/Cooling Water Return Well (5A7)
Person
Dear Ms. Faroe;
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials on June 16, 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 contact you with a request for additional information if necessary.
To ensure the maximum efficiency in processing permit applications, the Division requests your assistance 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 application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via a -mail at
[e-mail]. If the reviewer is unavailable, you may leave a message, and they will respond
promptly. Also note that the Division has reorganized. To review our new organizational chart, go to
http://h2o.enr.state.nc.us/document:sldwq orgehampdf
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Sincerely,
0 a 00"Am
jar Debra J. Watts
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Permit Application File W10500186
Aquifer Protection Section 1636 Mail Service Center Raleign, INC 27699-1636
Internet: wyv+�.ncwatertiu8lity.arst Location: 2728 Capital Boulevard Raleigh. NC 27604
An Equal Opporlunity/Aflinnetive Action Employer 50% Recyctedll0% Post Can sumer Paper
!V M Caro i
rtura}
Teiepnone: [phone]
Fax1. [phone]
Fax 2' (919) 71"048
Customer Service: [phone]

RECEIVED/ DENR / DWQ
AQUlF~R·PRnTFr.TION SECTION
JUN 16 2008
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE S-A7 WELU S} ✓ New Permit Application OR ____ Renewal (check one)
DATE: \..;\\r, .20~
PERMIT NO. _______ (leave blank if NEW permit application)
A. PROPERTY OWNER(S)/APP~~CANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): _______________ _
M\\3,.,4. :St KY Ld\R\'\~
(1) Mailing Address: ~:"et~ "? SlTL~ S..,."-,,, E "'¼-="" '5,, 5?
City: )p'1k..;.. ~Se,;~· State:J.iS...._ZipCode: L ] 5] "l..... County: ·p~,N
Home/OfficeTeleNo.: 33'9 3'9 4 1.353 Cell No.: 9:41 Bl3 5 1:33
EMAIL Address: _____________ _
(2) Physical Address of Site (if different than above): ______________ _
City: ________ State: _Zip Code: _____ County: ____ _
Home/Office Tele No.:_•_· _________ .....;::C'-=,,;ell=-N--=o·-=-= ________ _
EMAIL Address: _____________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: _________________________ _
ContactPerson,__: -------------=E ...... M ___ Al __ L........._A.....,dd=re"""""s __ s: _________ _
Address: ____________________________ _
City: ________ State: _ZipCode: _____ CoWlty: ______ _
Office Tele No.: Ceil No .:
Website Address of Company, if any: _____________ _
GPU/UIC 5A7 Well Permit Application (Revised 9/2007) Page 1
C. WELL DRILLER INFORMATION
D ..
E.
Company Name: -/4.C.. W\'£ W T;"~\... C ~ i }\ <-
Well Drilling Contractor's Name: _____ c;'""""· ..... \:1 ...... ~ ..... ~......._'-.:=,C..,,=,.S=--_(!_a.;_:\.. ......... T:__,~=----:'s.....:...=-_________ _
NC Contractor Certification No.: ____ 1,:_5':.............ii!'--<\.;:...._ _________________ _
Contact Person~ C:~~i.,,,~ S C: :,.·i,:::n::::k EMA IL Address:
Address: 1. ~ ~ S) J\\_, H\t') ._, S l
City: P'-:l1'-'¼ :,-,.,+ Zip Code: N _c_ County: ~\.\ li.-,.~ ll.M
OfficeTeleNo.: ._..,q S 44 \~4S)Cel1No.: ~\~ 2-)£ ~$"1
HEAT PUMP CONTRACTOR INFORMATION (if di~ent than driller)
Company Name: E Vl'I N' €LI $'T"' S' F,(.Vf ,ca.
Contact Person: Sit<. cul4/lrlto t~, •~T""' EMAIL Address:
Address: 111 7 84-rcH~6.C. tecM-o
C
City: A{Je ~ ZipCode: iz 7 .fZ~ County: _C_H_#rfl __ i:a _"" _______ _
Office Tele No.: 'fl'f-362-'7Q/o Cell No.:
STATUS OF APPLICANT
Private::!.._
State:
Federal:
Municipal: __
---------
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
fff:4.'TtNfl t Cct.,~ fo I A:> l"fEI~ (..
G. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(l) The injection operation? YES >< NO ___ _
(2) Personal consumption? YES X' NO ___ _
B. WELL CONSTRUCTION DATA {Skjp to Section I i(thil it I Permtt RENEWAL}
PROPOSED WelJ(s) to be constructed for use as an injection well. Provide the data in (1)
through (7) below as PROPOSED construction specifications. Submit Form GW-1 after
construction.
X EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through
(7) below to the best o.fyour knowledge. Attach a copy ofFonn GW-1 (Well Construction
Record) if available.
(1) Date to be constructed: ______ Number of borings: __ _
Approximate depth of each boring (feet): ______ _
(2) Well casing. Is the well(s) cased? (check either (a.) YES m: (b.) NO below)
(a} YES ✓ ff yes, then provide the casing infonnation below.
Type: Galvanized steel__!L_ Black steel __ Plastic __ Other (specify) _____ _
Casing thickness:~ diameter (inches): ~depth: :from O to 4--:3 ft. (reference to land surface)
i ~ ii Casing extends above ground ----~--inches
GPU/UIC SA7 Well Permit Application (Revised 9/2007) Pagel
(b) NO
(3) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite Other (specify) CXm.:CNlcS;> S, ~-CS)
(b) Grouted surface and grout depth (reference to land surface):
__ Around closed-loop piping; from ___ to __ (feet).
~ Around well casing; :from O to 4S> (feet).
(4) Well(s) Screen Information
Depth of Screen: From Nb).) C-to ___ feet below land surface
(5) N.C. State Regulations (Title 15A NCAC 2C .0200) require the Pennittee to make provisions for
monitoring wellhead water quality and processes. A faucet on both Influent (groundwater entering heat
pump) and Effluent (water being injected back into the well) lines is required. Will there be a faucet on:
(a) Influent line? Yes_}L_ No__ (b) Effluent line? Yes-A,_ No __
(6) Source Well Construction Information (if the water source well is a different well th.an the injection well)
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available, provide the
following data:
Groundwater Source. From what depth, formation, and type of rock/sediment units will the groundwater
be withdrawn? ( e.g. granite, limestone, sand, etc.)
Depth: '3 4·<,\ Formation: CR:,,tJ ,z&:._ Rock/sediment unit: t..~l\S~\_\ ~ ~~~O
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION IS UNAVAILABLE BY OTHER :MEANS.
L OPERATING DATA
(1) Injection rate:
(2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
J. INJECTION-RELATED EQUIPMENT
Average (daily) 6 gallo~s per minute (gpm).
Average ( daily) / 7 ~ gallons per day (gpd).
Average (daily)~ pounds/square inch (psi).
Average (Januaiy) S'r" ° F, Average (July) 6S-° F.
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
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 well{s) and any
existing well(s) or waste disposal facilities such as septic tanks-or drain fields located within 1000 feet of the
geothermal heat pump well system. Label all features clearly and includ e a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
OPU/UIC SA 7 Well Permit Application (Revised 9/2007) Page3
I- CERTIFICATION
Note; This Permit Application must be signed by each person Appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my ipquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditions the Permit."
PU
Signature of Prdperty Owncr/AliplI&M
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Foil Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-D WQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone (9I9) 715-6935
GPU/LJIC SA7 Well Permit Application (Revised 912007) Page 4

RECENED I BENR 1 DWU
A010-Fa oan�t".�tnN �1=C�l�N
1 A zn[l� ENVISION RESIDENTIAL INSTALLATION MANUAL
Closed Loop Ground Source Systems
Note: For closed loop systems with antifreeze protection, set SW-2 to the "loop" position (see table on page 28).
Once piping is completed between the unit, pumps and the ground loop (see figure below), final purging and charging
of the loop is required. A flush cart for a 1.5 HP pump minimum) is needed to achieve adequate flow velocity in the loop
to purge air and dirt particles from the loop itself. Antifreeze solution is used in most areas to prevent freezing. Flush the
system adequately to remove as much air as possible then pressurize the loop to a static pressure of 40-50 PSI (summer)
or 50-75 PSI (winter). This is normally adequate for good system operation. Loop static pressure will fluctuate with the
seasons, Pressures will be higher in the winter months than during the cooling season. This fluctuation is normal and should
be considered when initially charging the system.
After pressurization, be sure to open the plug 1 turn in the end of the loop pump motor(s) (if applicable) to allow trapped
air to be discharged and to ensure that the motor housing has been flooded. Ensure that the loop pumps provide adequate
flow through the unit(s) by checking the pressure drop across the heat exchanger and comparing it to the unit capacity data
in the specification catalog. 2.5 to 3 GPM of flow per ton of cooling capacity is recommended in earth loop applications.
Figure 7: Closed Loop Ground Source Application
Multiple Units on
One Flow Center
When two units are connected to
one loop pumping system, pump control is
automatically achieved by connecting the
SL terminals on connector P2 in both units
with 2-wire thermostat wire. These terminals
are polarity dependant (see Figure 8). The
loop pump(s) may be powered from either
unit, whichever is more convenient. If either
unit calls, the loop pump(s) will automati-
cally start. The use of two units on one flow
center is generally limited to a total of 20
GPM capacity.
To
_Oop
Note: Additional information can be found
in Flow Center installation manual (IM1961)
and Flush Cart manual (WFS302).
Figure 8: Primary/Secondary Book -up
Envision to Envision
Envision to Envision
Envision to
Microprocessor Units
Microprocessor Units
Eleciramechanii al Units
Dual Capadty
Sfple Speed
Envision Link 81
Emrision Unit #t
E rftkn Lknit Irk
C C et t sr s
ti
awe 4 c gat ttt
ICI
w C C rAk 811
�
1_� �
o�
AWVXM—
—
W"P—P
,w W IDUM 1
WRd k, MR,
with A•m
WK7
ua2
{
C
C
+ ss+
C
C S
w+
i to crt
Envision Unit 02
Envision Unit 02
To Efec ernechank a Unit
Dual capacity
54np3a Speed
9

ENVISION RESIDENTIAL INSTALLATION MANUAL
Desuperheater Connections
To maximize the benefits of the desuperheater a minimum 50-gallon water heater is recommended. For higher
demand applications, use an 80-gallon water Beater or two 50-gallon water heaters connected in a series as shown
below. Electric water heaters are recommended. Make sure all local electrical and plumbing codes are met for installing
a desuperheater. Residential units with desuperheaters contain an intemal circulator and fittings.
Note: Under certain conditions. Envision dual capacity units operate with very low refrigerant discharge temperatures,
producing little or no water heating capability_ This scenario occurs when the unit is operating with cold entering sou rce
water (loop orwelI)_ Allowing the desuperheater pump to operate during these conditions actually removes beat from the
DHW circulating through the unit. To overcome this, Envision unit microprocessors have been programmed to disengage
the desuperheater pump during such conditions. (During low capacity cooling operation, the pump will operate only if
the DHW temperature entering the unit is less than the liquid line temperature plus 360 F During high capacity cooling
operation, the pump will operate only it the DHW temperature is less than the liquid line temperature plus 600 F.) Using
a preheat tank, as shown in Figure 12, will maximize desuperheater capabilities.
Water rank Preparation
To install a unit with desuperheater, Ballow these installation guidelines.
1. Turn off the power to the water heater.
2. Attach a water hose to the water tank drain connection and run the other end of trte hose to an apen drain or
outdoors.
3. Close the void water "inlet valve to the water heater tank.
4. Drain the tank by opening the valve on the bottom of the tank, then open the pressure relief valve or hat water
faucet
5. Flush the tank by opening the cold water inlet valve to the water heater to free the tank of sediments. Close when
draining water is clear.
6. Disconnect the garden hose and remove the drain valve from the water heater.
7. Refer to Plumbing Installation and Desuperheater Startup on page 12_
/ j \ CAUTION: Elements will burin out if energized dry.
Figure ft Typical Desuperheater Installation
314 X a14 l< 112 tee
Cold
V1 'Twlr�rf Oraln Vahm
lioi
Aer but
Figure 12: desuperheater installation In Preheat Tank
venting waste Valve 314, x 3/4, x 112, Cold
nr Vent Coupling _ pap ` Water In
Hot
Water Rul
D"w 4raln YaWe praln Vawe
Water In
Note: This configurabon maximizes desuperheater capability.
11

ConnectGIS
PIN: 0940-00-49-
6516. 000
Record
Number:
Billing 1709 AUTUMN City and
Address: RIDGE RD State:
Parcels
21645
DURHAM NC
D. . . POTLUCK AC OR LOT A escnpt10n: COM/FRM/1/L7/H8:L --:
OBJECTID: 774 ACRE_ 1 : 3. 17
Page 1 of 1
Owner's LAROE
Name: MARGARETE
TRUSTEE
Tax Map: A99 97
SUBN0_1: 0
PAC: 3
OBJECTID_ 1: 3223868 SHAPE_AREA: 137473.572695 SHAPE_LENG: 2020.33708672
FTR_CODE: PARCEL RECN_1: 21645 Sale Year: 107
ZIP: 27712 Townships: 107 Acreage: 3.17
Building 0 Value:
Property 22050 Other 0 Value: Buildings:
Current 156679 Value: Deed Page: 818 Deed Book: 640
Plat: 9/85/1 Sale value: 0 Calculated 3.15595915342 Acres:
Subno: 7183
r s.o n county GIS
http://gis.personcounty.net/ConnectGISWeb/Map/PrintWindow.aspx?Map=http://gis.perso... 6/25/2008